/\'i.:^'X >°',-^''3?\/ %^^. ■^ ^^..^^ ,^ Vo V <^ *V «0 ^ *o«o' •l5^^ * O N O ' '%o^ %-^^^^V^ %"-:f.^>,o^^ -X^^^S.^ "^^o.^^^^^v \'^^'\v^^^ V'*^^*'/ \'^ Vo V cV' * ,0^ 0^ I N <\>(\ NOTE. While lecturing on the diseases o£ the dog the writer recognized the fact that there was not in existence a work that could really be called a text-book for the student and the practitioner; there were then, and have been issued since, a number of ^^ popular" works that endeavored to fill the dual role of text-book for the vet- erinarian and a '^ Dog Book" for the layman; these, as a rule, have been inadequate for the former and confusing to the latter. With the purpose of supplying this want the writer, several years ago, began to write a book on the subject, but two years ago read this work by Professor Miiller, and instantly recognized its value as a text-book: every detail in the diseases of the dog being carefully considered, and the whole so admirably arranged that the student can readily find and study any subject in a clear and condensed form. He secured from the author the right of translation, and has made it as exact as possible, perhaps in some jiarts too literal, but has done so in the endeavor to closely follow the original. He has also added, in the proper places, the results of his own obser- vations, and also everything of value that has been added to veterinary science since the appearance of Dr. Midler's work, thus making a second and much enlarged edition. The metric system, as in the German work, has been followed, with the hope that its use may be a slight aid to the general adop- tion of what may be the future international system of measure- ment. ALEXANDER GLASS. Philadelphia, April 11, 1897. (iii) PREFACE. In writing these pages the author has endeavored to give a short, accurate, and clear definition of the modern knowledge of diseases of the dog, and to adapt his treatise to the requirements of the profession. Speculations and hypotheses have been studiously avoided, while, on the other hand, plain facts have received careful consideration. Diagnosis has been given the most prominent place, as it deserves in a work of this kind, and the author has endeavored to establish the symptoms with their relation to the disease and to confine their therapeutic treatment to a knowledge of normal and pathological anatomy and physiology, for he believes that it is on a clear and accurate knowledge of the normal and pathological structure of life the fundamental base of all clinical science lies. The writer has also included some selected formulae which he considers of practical value to the reader. Due consideration has been given to modern literature whenever it appeared consistent, and a glance at the contents will also show that the author has added the results of his own researches and observations. These have been derived from his experience as director of the clinic of small animals in this locality. His space has been somewhat restricted, and he has had to dis- pense with the details of the bibliography of our literature, but this is not of much consequence when we have such works as Friedberger and Frohner's, Hoffmann's, VogeFs, and others at our disposal. (V) vi PREFACE. The illustrations in this work are nearly all original. Some, however, have been obtained from other works, principally from Ellenberg and Baum's Anatomy of the Dog, edited by Paul Pa^ey, and the author expresses his thanks for their use. The author would feel gratified if his work be favorably received by those who are interested in the diseases of the dog. G. MULLER. Dresden, October, 1891. CONTENTS. General examination .... the physical condition . the skeleton the constitution .... the mucous membranes and the skin oedema emphysema .... the temperature .... increased temperature subnormal temperature . local temperature peritoneum Diseases of the digestive apparatus . the examination of the digestive apparatus the condition of the throat and mouth examination of the oesophagus examination of the stomach . digestion of the stomach on a meat-diet , physical examination of the bowels and the feces ...... physical examination of the liver . examination of the spleen diseases of the mouth, tongue, and salivary glands inflammation of the mucous membrane of the mouth aphtha ....... parenchymatous inflammation of the tongue ulcerous inflammation of the mouth diseases of the teeth .... dentition ..... malformations of the cavity of the mouth ranula inflammation of the salivary glands parotitis ..... idiopathic parotitis abscess of the glands . inflammation of the mucous membranes of the throat PAGE 17 17 18 , 19 19 , 22 22 , 23 23 . 25 . 26 . 27 . 27 , 27 . 30 . 31 , 34 , 37 . 38 , 41 , 42 . 43 , 43 , 43 . 43 . 44 , 45 . 47 . 47 . 48 . 49 . 49 . 49 . 49 , 51 vii ) vm CONTENTS. Diseases of the digestive apparatus— (7on aa 500.0 Spts. menth. ) S. — Several dessertspoonfuls daily. GATABBHAL INFLAMMATION OF THE LUNGS. 125 DISEASES OF THE LUNGS. Catarrhal Inflammation of the Lungs ; Pneumonia. {Catarrhal Pneumonia; Lobular Pneumonia; Broncho-pneumonia.) Etiology Catarrhal inflammation of the kmgs generally orio-inates as a secondary disease following bronchitis, by an exten- sion of the inflammation of the small bronchia into the alveola or from the obstruction of the bronchial tubes. The causes of lobular pneumonia are from accumulations of mucus ni the trachea, which may be only imperfectly coughed up, or in very weak cases, lying in the tubes, become decomposed and putrid, and act as an irritant. These, on inspiration, are carried into the deep portions of the lungs directly on the alveoli, and from a capillary bronchitis it may become converted into a catarrhal pneumonia. In some cases particles of food, medicines, especially thick mixtures, get into the larynx, when the animal is unconscious or where there is partial paralysis of the throat. These substances penetrate into the lungs, and are very difficult to dislodge from the bronchia. This form of the disease is generally termed traumatic or aspirmg pneumonia Pathological Anatomy. In a lung affected with catarrha pneumonia we always find all the characters of bronchitis, and as the disease advances the groups of alveoli that belong to the affected bronchia are rapidly filled with the catarrhal deposit, preventing the air from penetrating into them. Soon we see an intense hyperemia of the walls of the alveoli and the exudation of a thin, non-curdling fluid and numerous white blood-corpuscles which soon become pus-corpuscles, and the commencement of a fatty degeneration and detachment of the alveolar cells. The alveoli and the small bronchia become entirely filled with pus- corpuscles and a certain number of blood-corpuscles and broken- down epithelial cells, and the inflamed portion of the lung can easily be distinguished from its healthy surroundings. They form hard touo-h, roundish or lobulated lumps which vary in size and number, projecting slightly above the surface of the lung, and on making a cross-section of the diseased portions in the earlier stages of the disease they are seen to be dark bluish-red and later on become gray while the surrounding tissue that is not diseased is normal, or what is more frequent, is slightly congested with blood. The 126 DISEASES OF THE RESPIRATORY ORGANS. detached centres which show plainly in the early part of the disease soon become confluent, so that finally we have large sections of the lung involved. In rare cases we find fibrinous (croupal) cen- tres in connection with the catarrhal pneumonic centres, and extended vesicular emphysema in the neighborhood of the affected centres, and at the borders of the lungs, is often seen. We may also have subpleural and interstitial emphysema and sero-fibrinous or pussy pleuritis about the broncho-pneumonic centres. Clinical Symptoms, It is very difficult to make a sharp distinction between capillary bronchitis and lobular pneumonia on account of the close relation between these two diseases. If the disease has affected the alveoli, there is a marked acceleration of the respirations, in some cases as high as 60 per minute, and also inflation of the cheeks with each expiration; the cough is short, frequent, and apparently very painful; the pulse running from 150 to 170. On making a physical examination by percus- sion there are a number of dull centres through the lungs; in some instances the whole of the lung gives dull sounds. According to the stage of the disease, strong vesicular breathing, snoriog, fine or loud bruit, and where there is extended infiltration we hear bronchial respiration. The temperature often goes up to 40° or 41°; this high temper- ature usually commences early in the disease, or it often makes a rise when the disease has become converted into catarrhal pneu- monia. If this complication does not occur, the temperature will not make any marked change, but follow a regular course, which is to rise quickly at the onset, and gradually fall as the disease decreases and the animal goes on to convalescence. Course and Prognosis. The course of catarrhal inflamma- tion of the lungs is rarely less than three weeks, and often pro- longed over several months, with varying degrees of intensity. Traumatic pneumonia is the only form of the disease that runs its course quickly. The terminations of the disease are : Recovery by resolution, in which the inflammatory products which fill the smallest bronchia and the alveoli are changed into a kind of emulsion and are either re- absorbed or coughed up. Or in the secondary disease, for instance; chronic interstitial inflammation of the lung, or in rare cases the formation of purulent gangrenous centres. Third, death, which CHRONIC INTERSTITIAL PNEUMONIA. 127 may occur at any stage of the disease, in the early stages as a con- sequence of great extension of lobular pneumonia, or at any time as a result of oedema of the lungs. Chronic Interstitial Pneumonia. {Chronic Induration of the Lungs; Cirrhosis of the Lungs; Phthisis.) When the disease terminates in this pathological condition we find an inflammatory deposit in the interlobular and interstitial connective tissue; this deposit compresses the alveoli and small bronchia, and they lose their functions and are finally absorbed, and on section of the affected portion of the lung it is found to be coarse, rough, and irregular on its surface, the tissue varying from yellow to yellowish-red in color. The bronchia surrounding the affected portion are distended and pocket- shaped, and there are also a certain number of spots of localized emphysema. The clinical course of the disease shows very little fever, but the animal is never entirely restored to health ; the respirations are short, labored, and with a quick, weak cough. They finally become emaciated, complicated with dropsical effusions, and finally die from exhaustion. In some cases of lobular inflammation of the lungs the inflamed portions form abscesses, or we may find gangrenous portions. These terminations depend on the nature of the irritant, and generally occur after traumatic pneumonia (foreign bodies). When an abscess is formed a pear-shaped body is found in the centre of the infiltrated lobule, and surrounding it is a thin, delicate layer of yellowish tissue, and over that a tough red layer of inflamed pulmonary material; large abscesses may be formed by the fusion of all the infiltrated pulmonary tissue. When gangrene is formed the inflamed catarrhal centre becomes dirty greenish-brown in color, or in severe cases almost black. In the early stages the diseased portion is hard and fibrous, but it soon becomes soft and pulpy and filled with a turbid, fetid, green- ish serum. When the disease is slow and chronic the gangrenous spots are limited in size, but generally when the disease assumes the gangrenous form it becomes diffuse, and the animals die rapidly from exhaustion . We recognize the 2:ang;renous form when the breath becomes 128 DISEASES OF THE RESPIRATORY ORGANS. putrid, for in the clog it is almost impossible to get any of the discharge that is coughed up, the animal generally swallowing the mucus. When the animal has a putrid breath we always find a course of alarming symptoms accompanying it — septic fever, chills, and a high temperature. If the sputa were examined, we would probably find numerous micrococci, bacteria, and portions of broken-down lung and elastic tissue. CEdema of the Lungs. This is apt to follow all debilitating diseases that weaken the left side of the heart, and that organ is unable to force the venous blood through the lungs. There is a regurgitation of the blood, and the alveoli and bronchia become filled by a serous fluid which exudes from the bloodvessels. The oedematous lung is distended and much larger than normal; on pressure with the finger the indentation remains some time. On section of the lung a large quantity of reddish foamy fluid exudes from the tissues and the bronchial tubes. When oedema of the lungs follows catarrhal pneumonia it gen- erally begins with great difficulty in respiration, labored or ster- torous in character, a short, faint cough, and in rare instances a quantity of thin reddish fluid comes from the nose or mouth. On making a jjhysical examination, percussion gives no results but those found in catarrhal pneumonia. On auscultation we hear rattling bruits all over the chest, especially in the anterior part, and also in the trachea; the blowing sounds may be very loud in some cases and can be heard some distance from the animal. Death occurs in a short time. Some time before the actual symp- toms of oedema appear the exhausted condition of the heart is in- dicated by the pulse being irregular — that is, weaker at inspiration than at expiration. Therapeutics. In treating lobular pneumonia we use the same general course as we do in bronchitis. The author obtained the best results with Priessnitz's compress, and by the remedies recommended under the treatment for bronchitis. The good effects of moist, warm compresses can be much increased by sharp friction with a small quantity of mustard-oil to the sides; but it must only . be applied in young, strong, healthy animals. The best method of application is to make a liniment of 3 parts of oleum sinapis jethe- reum in 45 parts of olive oil, and divide it into two parts, and apply one-half to each side of the chest, then wind a dry bandage CHRONIC INTERSTITIAL PNEUMONIA. 129 around the chest-walls, and ten to twelve hours later apply Priess- nitz's compress. In cases where there is great accumulations of mucus it is advisable to give the animal an emetic (apomorphia is the best). Narcotics are to be given when the cough is constant and distressing. Where there is much debility stimulants are indicated, such as wine, ether, and give the animal small, often-repeated quantities of chopped meat, broth, milk, and the peptone preparations. Very little good is to be derived from inhalations in this disease. When the breath is offensive we advise inhalations of turpentine or a 1 to 50 solution of creolin. Inhalations of carbolic acid are recommended, but on account of the danger of poisoning by that drug they are to be used with extreme caution. In septic fever, after the appearance of gangrene of the lungs, give subcutaneous injections of ether or camphor. When oedema of the lung is recognized, it must be regarded as a grave symptom and generally fatal. We must, therefore, take very energetic measures — active stimulants, such as mustard oil, to the sides, and also injections of ether or camphor subcutaneously. Bleeding and the use of cardiac stimulants, such as digitalis or caffeine, are useless. Catarrhal pneumonia is the only grave important disease of the lungs in the dog; the others are of small importance. Croupal inflammation of the lungs, as we understand it, is a firm, hemorrhagic exudation in the alveoli of the lungs and small bronchia. This is very rare in the dog. The author has never seen a case of true lobar pneumonia, but has seen a few cases of croupal lobular pneumonia, the course of which is very similar to catarrhal pneumonia in all its symptoms, the difference only being detected on post-mortem. Roll makes the statement that croupous inflammation of the lungs is common in the dog, but he probably meant croupal lobular pneumonia. Anthrakosis pulmonum (blackening of the lungs) is quite common in the dog, but it has no pathological significance. Emphysema of the lungs is not such an important disease in the dog as it is in man and the horse. That form of emphysema which "appears in bronchitis and pneumonia, characterized by an extreme distention of the alveoli, has been mentioned under these diseases. If the irritation is constant, the disease becomes 9 130 BISEASES OF THE RESPIRATORY ORGANS. chronic, and a progressive atrophy of the alveolar walls takes place until they are entirely closed up, the neighboring alveoli become absorbed or altered, and finally cavities are formed, and the blood- vessels become atrophied. On section of the lung the edges of the cavities are pale, soft, and the bloodvessels are stained with pig- ment. Sometimes laceration of the alveolar walls allows air to penetrate into the interlobular, interstitial, or subpleural connective tissue; this is generally caused as a result of severe and continual coughing spells, and where animals have died from some form of suffocation. Siedamgrotzky describes a case where an old emphy- sematous dog had a severe fit of coughing and the lung was lacer- ated, causing pneumothorax. DISEASES OF THE PLEURA. Injaammation of the Pleura ; Pleurisy. {Pleuritis.) Etiology. The disease is divided into two forms — primary and secondary pleuritis. The primary form may be caused by cold, from traumatism, etc. ; the secondary from the extension of inflammations from the surrounding organs, as in pneumonia, gan- grenous pericarditis, peritonitis extending through the diaphragm, fractured ribs, injuries to the walls of the thorax, or perforation of the throat by foreign bodies. We also see it in all forms of pyaemia and tuberculosis. Pathological Anatoimy. The i3leura is dull and swollen and very much injected, rough on the surface, due to it being cov- ered with fibrinous accumulations (small button-like elevations), and in the advanced stages large masses of fibrinous substances. When there is no accumulation of fluids it is called pleuritis fibrinosa. But generally we find a more or less copious secretion of fluid from the capillaries. This fluid (pleuritic exudation) accumulates between the pleural folds in copious fibrinous masses; it is usually serous or sero-fibrinous, appearing as a slightly yel- lowish turbid fluid, with more or less fibrinous coagula swimming in it. Chemically it is almost like blood-serum. This liquid contains red blood-corpuscles and round cells; if the former is in large numbers, the hemorrhagic exudation is found; but if the cells INFLAMMATION OF THE PLEURA: PLEURISY. 131 are present in quantities, the purulent or suppurating form is seen. True purulent exudation is always caused by the presence of a specific purulent poison, and becomes fetid as soon as decaved or gangrenous agents find their way into the pleural cavity, as in gan- grene of the lungs, perforation of the throat by foreign bodies, in deep wounds of the chest, and in perforation of the oesophagus in the thoracic cavity. The excretion which collects rapidly crowds the lung of the affected side and finally presses it against the spinal column and mediastinum, pressing the lung into an inert mass. The opposite lung is the seat of considerable collateral hypersemia, which may lead to cedema, according to the severity of the condition. When compression of a lung is continued for any length of time the alveoli lose entirely their functional activity, their walls collapse and become adherent if the fluid exudated finally becomes absorbed. After this has occurred it can readily be recognized by the depressed appearance of the ribs. In cases of primary pleuritis which were seen by the author the inflammatory process was always restricted to one side, and that, as a rule, was the left side. The cases of secondary pleuritis were generally double-sided, but the inflamma- tory conditions are never of equal intensity on both sides, one side being always a little worse than the other. Besides having the results of pressure shown on the lungs, we also have the heart pushed toward the healthy side of the mediastinum or the dia- phragm. The conclusion of pleuritic inflammation depends on the inten- sity and duration of the disease and the character of the exudate. In favorable cases the latter is reabsorbed and good results follow. In serious cases only part of the liquid portion of the exudate is absorbed, while a fibrinous exudate covers the pleura; this becomes converted into a granular tissue, containing numerous vessels, and later into a stringy cicatricial tissue, called a pleuritic sward, and more or less adhesions of the pleura between the lungs and inner wall of the thorax and between the lungs and diaphragm. Although the sward formations may be very extensive, it is pos- sible for the lung to regain its normal extension, but it takes a long time. Thin adhesions sometimes tear; extended adhesions offer a constant hindrance to the unrestricted use of the affected part of the lung. Purulent exudates are sometimes reabsorbed; but, as 132 DISEASES OF THE BESPIRATOBY ORGANS. a rule, if the pus is not removed at the proper time by surgical interference, it breaks out, either through the pleura into the lungs and then through the bronchia, or it forms abscess somewhere in the cavity of the chest, generally in the region of the sternum, by undermining the pleura and muscles of the walls of the chest. Clinical Sympto.ms. In the primary form of pleuritis, when its origin is from cold, etc., it is ushered in with more or less fever and increase of temperature, the pulse increases in frequency, and at the onset the animal generally has a chill; the temperature remains high, and the pulse small, weak, and thready. Primary pleuritis with purulent or putrid effusions is rare, and when it does occur it is always accompanied with a high intermittent fever. The general health is very much disturbed. They are stiff and sore in moving about; little or no appetite, but intense thirst. The visible mucous membranes are reddened and congested, and in cases where there is much exudation the membranes are dark bluish-red. The feces are dry and hard. The urine presents some symptoms that are diagnostic : While the exudate is forming and collecting the urine is scanty and thick, and albuminous in reaction. When the exudate is commencing to be reabsorbed the urine increases very much in quantity, and is very clear and white (see chapter on Examination of the Urine). There is also a marked dyspnoea. In dry pleuritis the respira- tion is superficial and rapid, and where there is great exudation the respirations are short and painful and the animal has all the symp- toms of smothering. A characteristic symptom is the way the animal endeavors to assist respiration by assuming a sitting posi- tion, with the front legs spread out as far apart as possible, and using the abdominal muscles, and shows pain on pressure of the abdominal muscles of the affected side. The animal has a dull, dry, weak cough; this may, however, be absent. The physical symptoms are characteristic. On percussion at the onset of the disease there is little change of sound, but when the exudate has reached a certain height the lower parts of the chest give a dull sound which seems to be limited in a straight line, according to the position of the animal. Above the excretion the sound is tympanitic on account of the retraction of the lung. Aus- cultation gives a friction bruit in the onset, and when the fluid begins to be reabsorbed and the pressure of the exudate against the DISEASES OF THE PLEURA: PLEURISY. 133 lungs is lessened the respiratory bruit is altered. In the earliest stages of the disease the sounds are vesicular, but as the exudate collects the sounds become indistinct or blowing and finally only bronchial, and when the bronchial tubes are affected sound is lost entirely. In the healthier parts of the lungs we have increased vesicular breathing. Course and Prognosis. Primary pleuritis is generally slow in its course; the time taken by the exudate to become reabsorbed is very long, unless it is removed in an operative way. When the exudate commences to be reabsorbed the percussion-sound becomes less dull and the respiration bruit more distinct, and if the exudate becomes quickly reabsorbed the diseased side is less in circumference, or it can be better described as being flatter. Death may occur during the critical period of the disease by collateral hyperaeraia and oedema of the non-affected sections of the lungs, by carbon-dioxide-poisoning from defective function of the lungs, by total stagnation of the circulation of the blood from pressure of the exudate on the large bloodvessels and the heart ; later on by exhaustion and by secondary diseases. To this class belong dropsy caused by stagnation of the blood circulation from weakness of the heart, and amyloid degeneration of the kidneys, liver, and spleen. Death may also occur from complicating diseases, such as bronchitis and lobular pneumonia. The prognosis is generally favorable; as a rule, very severe cases of primary pleuritis make good recoveries. In secondary pleuritis the prognosis depends on the original disease. Therapeutics. The treatment of secondary pleuritis is the same as the primary; but in the former we must take into consid- eration the treatment of the original disease. In the early stages of the disease, when the exudate is collecting, we must apply counter- irritants, such as liniments or plasters of mustard. When a copious exudate has been formed we try to get its reabsorption by stimulating the kidneys by means of acetate of potassium, acetate of sodium, and juniper berries. When the heart is weak we use digitalis and squills. Small doses of calomel are also useful. R. — Hydrarg. chlor. mite 0.03 Digitalis pulv. 0.05 Saccliarum lactis . . . . . . .0.5 Fiat pulv. No. vi. S. — One powder three times daily. 134 DISEASES OF THE RESPIRATORY ORGANS. Diuretics and cardiac stimulants have only an indirect influence on the accumulations, and when the exudate is gradually absorbed we can hardly credit these drugs with accomplishing the results, as the exudate is usually re-absorbed when the acute inflammatory stage of the diseases has passed. The best method of treatment is the removal of the secretion by surgical means — that is, to punc- ture the chest-wall. This operation is not at all dangerous in the dog, and is generally successful unless the adhesions are too thick. The operation must be performed where there is a very large exudate and the dull sound can be heard over the entire lung; where there is oedema of the lung; in intense dyspnoea caused by the pressure of the exudate; and where there is deficient reab- sorption, as is seen when the fever has entirely disappeared and the fluid does not show any signs of becoming reabsorbed. Puncture of the cavity of the chest : The trocar used in this operation is an ordinary sized trocar, seen in Fig. 38, or, if we wish to make first an exploring puncture, we use the needle of the ordinary hypodermatic syringe. The needle, after having been disinfected, is introduced into the lower third of the wall of the chest, between the fifth and ninth rib, the patient being in a stand- ing position. The entrance of air into the thoracic cavity must be avoided, and to prevent this we must use a trocar that has a faucet, or else when the flow of fluid becomes stopped at any time from some obstruction at the end of the trocar it is well to put the finger over the end of the opening to prevent the air from being sucked into the cavity. It is well to empty the cavity slowly and never entirely, as the affected pleurae come in contact with each other and rub, often causing acute hemorrhage. After withdrawing the trocar it is well to paint the opening with some iodoform collodion. Fig. 38. Trocars for puncture ot the thorax. When the fluid obtained is purulent, it generally requires several punctures to empty the cavity. The animal should have a nutritive but easily digested diet — soup, beef -tea, lean meat; and when the fever is high, anti- pyrine in doses of 0.5 to 2.0, according to the size of the dog. PNEUMOTHORAX. 135 Dropsy of the Chest. {Hydrothorax.) Any accumulation of serous fluid that is not dependent on an inflammation of the pleura (that is, of a transudate) in the cavity of the thorax is called hydrothorax. This is often a symptom of general dropsy, or it may arise from chronic disease of any of the organs (see ascites). In such cases the effasion first shows itself in the chest when dropsy of the skin (anasarca) exists. Pathological, Anatomy. Hydrothorax, as a rule, affects both sides of the chest. Frohner records a case where one side only was affected. We find in the cavity of the chest a clear yellow fluid, sometimes mixed with blood; the pleura is cedematous, swollen, and in long-continued cases it has a flaccid or macerated look. The lungs do not present any change, except the signs of partial compression. The other organs of the body are anaemic. Clinical Symptoms. The physical examination of this dis- ease presents symptoms very similar to pleuritic exudates, but in dropsical transudates both sides of the thoracic cavity are filled, and on changing the position of the animal the fluid moves about much more quickly than a pleuritic exudate would, and the sensi- tiveness of the animal to pressure on the walls of the chest and the rubbing or crepitating bruit of pleuritis are absent. Therapeutics. The treatment, as a rule, is of a palliative character, as it is only in very rare instances we succeed in remov- ing the original disease; we use the same agents as in ascites. The operation of tapping the chest-wall (see Puncture of the Cavity of the Chest, page 134) is only to be resorted to when the fluid has collected in large quantities and the animal is threatened with suffocation; but this only affords temporary relief. Pneumothorax. Etiology. The cause of pneumothorax — that is to say, the accumulation of air in the thorax — is produced in several ways. By perforating wounds of the chest, by the breaking into the pleural cavity of a collection of pus from the lung, tearing of the lung-tissue from great exertion, and from perforation of the oesophagus. 136 DISEASES OF THE RESPIRATORY ORGANS. Pathological Anatomy. On making an opening into the chest with trocar and canula the air escapes with a hissing sound; if the collection of air is great, the lungs are pushed out of position, interfering greatly with respiration. If this condition exists for any length of time, a purulent, and, in rare cases, a sero-purulent, pleuritis is developed, caused by the presence of some irritant agents that have gained admittance into the cavity with the air. Clinical Symptoms and Course. There is great difficulty in respiration, and the affected side of the chest -wall is visibly dis- tended, and during respiration it remains almost stationary. When the heart is pushed out of position there is a peculiar tympanitic sound, the pulsations have a metallic echo, and the respiratory bruit is absent. In some rare cases we hear a metallic bruit, which is caused by the entrance of air directly into the pleural cavity with each inspiration. Animals in this condition generally die rapidly, although we may find rare cases where recovery takes place by an absorption of the air or by the accumulation of a fluid, which in turn becomes rapidly absorbed itself. The treatment consists in tapping the chest-wall. Haematothorax. In consequence of the destruction of some large vessel or vessels in the lungs or the pleural cavity, from the presence of growths, we have extensive hemorrhage into the thoracic cavity. The physical symptoms are similar to those of other pleural exudates; but this condition comes on very rapidly, and also in this condition the mucous membranes become very pale. When the symptoms are not pronounced the operation of puncture will determine the condition positively. Normal hemorrhages are easily and quickly absorbed, but often there is more or less pleuritis connected with them. Where there is great dyspnoea puncture is always advis- able. DISEASES OP THE CIRCULATORY APPARATUS. EXAMINATION OP THE CIRCULATORY APPARATUS. Examination of the Heart. Anatomy of the Heart. The normal position of the heart may be seen in Fig. 39. It lies.oa the left side, but not so far as is seen in other domestic animals. The direction of its axis is not vertical, but extends slightly ia a posterior direction, with a slight curve toward the left side. The base of the heart extends from the third to the seventh rib; the apex extends backward toward the diaphragm. Superiorly the heart lies close to the large Fig. 39. The heart in position : a, right ventricle ; b, left ventricle ; c, left auricle ; d, right auricle /, pulmonary artery ; g, aorta ; k, oesophagus ; I, diaphragm. vessels — the trachea and the oesophagus — and lies close on all sides to the lobes of the lungs. In its inferior portion it lies close to the chest-wall, extending from the third to the seventh rib. In the heart-sections we find the following arrangement : the right section lies in a right anterior direction from its axis and the left lies in a left posterior direction. The size of the heart varies greatly in different animals, even when in a normal condition, and it is, therefore, impossible to lay (137) 138 DISEASES OF THE CIRCULATORY APPARATUS. down any relative rule as to its size or dimensions. According to Colan, the weight of the heart compared with that of the body is 1 to 90; and according to Rabe, it varies from 1 to 4 to 100, and taking relatively all the breeds of dogs, and also sex and age, the relative size is 0.6 and 2,2 to 100. It is difficult to make an examination of the heart on account of its position, lying as it does hidden between the lobes of the lungs, and only a small portion of its surface exposed where it can be heard, and from the fact that it varies in size not only in the various breeds, but also in individuals. We find that in animals affected with the various heart-affections and also in perfect health the pulmonary bruit may be so increased that it is impossible to detect when there are weak heart-sounds, as the largest portion of the heart is covered by portions of the lungs, and these parts making sounds the ears cannot detect the sound, as the restlessness of the animal during examination and the movements of the cuta- neous muscles and the coat of the animal are all factors that assist in preventing a proper examination of the heart. The following details must, therefore, be looked upon as theo- retical in character to a certain extent. In making an examination of the heart we must consider the position and size of that organ, its palpitation sounds, and char- acter of the pulsations. Position and Size of the Heart. Both are to be detected by percussion, but for the reasons above explained it rarely answers our expectations. In percussion over where the heart lies we find in normal conditions a dull sound, which lessens in deep respiration, and also the ^position, either standing or recumbent, may make a decided difference. Animals having a small heart the sound is often entirely absent. The sound of that section of the lung that lies between the heart and the chest-wall is also a factor that makes the dull sound, and it is only by strong percussion that any sound can be detected at all, so that it may hardly be said to be of much diagnostic value. There may be an abnormal dulness in the heart' s action in hyper- trophy, in dilatation, in exudates and transudates around the heart, in retraction or contraction of the lobules of the lung surrounding the heart; but we may often be deceived by abnormal processes CHARACTER OF THE HEART-SOUNDS AND BRUITS. 139 that surround that organ, such as thickening of the lung-sections or swards on the pleura. The dull sound is absent in enlargement of the lungs by emphy- sema, when air has entered the pericardium, after injuries, in one- sided pleuritis, in pneumothorax, and the sound is anteriorly situated in the chest when there is intense meteorization of the stomach or intestines, and in ascites. Character of the Heart-pulsations. The pulsations of the heart can be distinguished by putting the hand on the inferior portion of the chest near the sternum, about the fifth rib (on the right side the pulsation is a little more ante- riorly situated). The pulsation makes a distinct vibration of all the adjacent parts, and in emaciated animals there can be noticed with each pulsation a distinct swelling or motion of the lower por- tions of the ribs; this vibration may be greatly lessened by the presence of layers of fat on the sides of the chest. After great exertion or excitement the strength of the pulsation against the chest- wall is greatly increased. The pulsations of the heart are increased by disease in the fol- lowing manner : After considerable loss of blood, in any case of fever, in palpitation of the heart, in some forms of heart-disease, in hypertrophy of the heart, by the influence of some poisons, like digitalis or aconite. It is almost imperceptible in degen- eration of the muscle of the heart, in the later stages of acute diseases, in cases of poisoning, in fatty degeneration of the heart and when the heart has become compressed by the effects of hydro- thorax, pneumo-pericarditis, or emphysema of the lungs. It is distinguished only on the healthy side in lateral pleuritis. Character of the Heart-sounds and Bruits. In order to distinguish the heart-sounds we must put the ear closG to the side directly over the heart where the beats are loud- est; it is better to cover the place with a handkerchief or cloth, or we may use a stethoscope. We should hear two sounds in each heart-beat — a systolic, which corresponds to the ventricular contrac- tion, and a diastolic, which corresponds with the beginning of the diastole. Both these sounds follow each other with short intervals between. The pause between the first and second sound is short, 140 DISEASES OF THE CIRCULATORY APPARATUS. but between the second and the next first the sound is much greater. The first sound is a mixed muscular and valvular sound of the mitrals and tricuspids, and the second is a semilunar valvular sound. Unfortunately these sounds are indistinct and incomplete in the dog, even in perfect health. In very fat dogs we may not hear any heart-sound, or we may only hear the first one. In well-fed dogs it is not rare to hear the first sound, which is a great deal louder than the second, only on the left side. In thin animals we can hear the sound distinctly on both sides. With the respira- tory bruit we lose to a certain extent the full strength of the sounds, and often only the first sound is heard. After great activity the heart's action is increased so much that the sounds follow each other so rapidly that it is impossible to distinguish one from another. In pathological conditions the heart-sounds may be increased by a number of causes, as in the beginning of certain fevers; but generally it is an indication of hypertrophy. A lessened heart- sound is found in any heart-weakness, as in degeneration of the heart-muscle, in accumulations of exudates around the heart in the pericardium, or in emphysema of the lung-sections, etc. In such cases, as a rule, the heart-sound is imperceptible. As can be readily seen, it is by no means easy to hear the heart beat in its normal condition, and the condition becomes more com- plicated when we have to distinguish pathological sounds — " heart- bruits." We distinguish between endocardial heart-bruits, which originate in the heart direct, and pericardial heart-bruits, which come from the arterial part of the heart and its envelope. The former are divided into organic and inorganic bruits. The organic heart-bruits are produced by stenosis (contraction) of the ring and by insufficient or imperfect closing of the valves, which may occur either in systole or diastole, making the heart-sound indistinct, or it may be entirely absent, and the bruit takes the place of the heart-sound. The systolic bruit is buzzing or blowing in charac- ter, and indicates an imperfect closing of an arterio-ventricular valve (in most cases of disease of the mitrals). The diastolic bruit is rushing or wheezing in character, and indicates a stenosis of the arterio-ventricular ostia, or the imperfect closure of an arterial valve. The inorganic heart-bruit is seen in man in all CHARACTER OF THE PULSE. 141 forms of ansemia, and occasionally iu fevers. The pericardial bruits are very similar to pleuritic friction-sounds — that is, a scratching or scraping sound. They are located in a sharply defined locality and do not occur in direct rhythm with the heart-sounds, but seem to occur between them. They are noticed in pericarditis as soon as there is any fibrinous deposits present and there is not sufficient pericardial fluid present to keep the folds free from contact with the heart. A change in the position of the animal makes quite a difference in the character of the bruit, and they may easily be distinguished from endocardial sounds. The pericardial friction-sound is dis- tinguished from the pleural friction-sounds from the fact that it is entirely independent of the movements of respiration. Character of the Pulse. The pulse is best examined in the femoral artery inside of the thigh, and it may also be felt inside of the forearm. In the exam- ination of the pulse we must take into consideration its frequency, its cadence, and its quality. The normal pulse varies greatly, according to the breed, age, and size of the animal, and is rapidly increased from such causes as physical efforts, fear, fright, pleasure, etc. The general pulse is from 70 to 120 — large animals being less, and very small animals having a correspondingly frequent pulse-rate. The rhythm (cadence) should be regular in a healthy animal, and physical causes make it irregular; but an irregular pulse in perfect health is very common in the dog; in fact, perfect rhythm is rare, as can be easily demonstrated by taking the pulsations frequently, the irregu- larity being well marked in very young or old animals. In normal conditions the pulse must be similar in both thighs. We find a lessening in the pulse in some forms of poisoning, following hemorrhages, in affections of the muscle of the heart, in starvation, diseases of the brain, meningitis and hydrocephalus, in hepatogenous icterus, also in collapse and in diseases charac- terized by a continued high temperature. An increase of the pulse is found in all fevers, in cases of valvular defects, in heart-weakness and paralysis or collapse of that organ from continued high fever. When the temperature increases the pulse rises. The pulse is irregular (arhythmic) in 142 DISEASES OF THE CIRCULATORY APPARATUS. some diseases of the heart (incompensated valvular defects, myo- carditis), after large doses of digitalis, aud in heart- weakness. It is only intermittent (as a forerunner of entire irregularity) in slight cases of valvular defects, in some diseases of the brain, and in gastrocism. The pulse is full and distended where great f)hysical exertion is used ; small and collapsed after severe hem- orrhage and in enteritis. In intense heart-weakness and collapse it becomes thread-like and imperceptible. The venous pulse — that is, the apparent increase in the amount of blood in the jugular at its entrance into the chest — is often seen in the dog. It is generally a symptom of some chronic heart- affection, such as imperfect closing of the tricuspid valves, and of heart-weakness. DISEASES OF THE HEART. Valvular Defects. General Notes on Valvular Defects. By valvular defects we understand such anatomical alterations in the valves and openings as lead to an irregularity in the circulation of the blood, becoming apparent by visible symptoms in the pulse or general condition; but those slight valvular defects so often seen in post- mortems and never noticed during life, are not to be considered. Valvular defects appear in two forms: first, when the valves close imperfectly ; or, secondly, when the openings become con- tracted, causing stenosis. Imperfect closure of one valve causes a certain amount of blood to flow back into the portion of the heart from whch it has just come; for instance, when we have imper- fect action of the mitrals or of the tricuspids in systole, part of the contents of the ventricles run back into the auricle, and when there is insufficient action of the semilunar valve in the diastole a part of the blood that has been thrown into the artery returns into the chamber again. Stenosis of one opening retards the passage of blood, when we have a contraction of an arterio-ventricular opening. At the time of diastole the blood is kept back at the entrance of the affected ventricle, and it is imperfectly filled; while in the aortic opening in pulmonic stenosis the exit of the blood out of the ventricles (Fig. 40) in systole is retarded. In any of these conditions there VALVULAR DEFECTS. 143 is imperfect heart-action; every defect of an arterial opening in- terferes with perfect ventricular action and every defect in a venous opening causes a corresponding lessening of power in the auricle. Fig. 40. Diagram of the blood-circulation. An abnormal pumping of the blood in this manner is sure to cause more or less disturbance of the entire organism, but there are certain compensatory processes in the heart itself that tend to overcome this. As a consequence of the impaired flow the heart- muscle is worked much harder and becomes hypertrophied (com- pensating heart hypertrophy). We often see cases where defects of the aorta become equalized by a hypertrophy of the left ven- tricle. In valvular defects of the mitrals the stagnation of the blood occurs in the veins, capillaries, and arteries of the lungs, and as far back as the right ventricle, which becomes dilated and hypertrophied while trying to take up the extra work thrown on it. In course of time we also see hypertrophy and dilatation of the left ventricle, and during diastole the stagnated blood runs in great quantities into it out of the dilated auricle. These compensating processes of the heart are apt to prevent for a long time any great functional disturbance, provided the heart receives its proportional nutrition. If this is not the case, for instance, in ansemic and cachectic, feverish animals, the com- pensating heart hypertrophy is not present or is only developed to a slight degree, and also in cases of insufficient nutrition, due to some alteration in the coronary artery, the heart is no longer able to satisfy the demands claimed from it and tires out, and all the effects of blood- stagnation rapidly show themselves. 144 DISEASES OF THE CIRCULATORY APPARATUS. Etiology of Deficient Valvular Action of the Heart. The most common causes of valvular defects are endocarditic pro- cesses, which are developed on the valves and take an acute course, according to the amount of the irritation, and cause a fibrinous, rigid thickening of the valves. Sooner or later we have an im- perfect closing of the valvular opening through cicatricial retrac- tions ; also adherences to the lobula of the valves or in their neighborhood. We may also see deposits of lime salts, and a contraction of the opening belonging to the affected valve. In rare cases there are heart-weakness and imperfect valvular action ; it may be caused by a dilatation of the opening, and, becoming abnormally distended, the valves cannot meet and make a com- plete closure. Atheromatous processes may also produce this con- dition. General Symptoms of Deficient Valvular Action of THE Heart. The symptoms which appear at a certain time in all valvular troubles are: Increase of heart- and pulse-action (after slight exertion it is abnormally increased); palpitation of the heart; difficulty in respiration; cyanosis of the visible mucous membranes, especially of the head; venous pulse; dropsical effusions, such as oedema of the legs, abdomen, or testicles; hydrothorax; ascites; albuminuria, with lessening of the amount of urine; complica- tions of the digestive organs of various kinds; and, finally, gen- eral nutritive disturbances, anfemia, emaciation, etc. Symptoms of Valvular Deficiency in One Opening. Deficiency of the Mitrah. The imperfect closing of two of the valves occurs very frequently in the dog. Besides the alterations of the valves we find hypertrophy and dilatation of the left aur- icle of the right heart, and in the later stages the right ventricle also. The clinical symptoms are: Increase of the pulse and disten- tion of the artery, systolic bruit of the left wall of the chest, in- crease of the second (pulmonic) sound, weak, frequent pulse, shortness of breath, and later dropsy, etc. Stenosis of the Left Venous Opening. This is generally accom- panied by mitral insufficiency. It leads also to dilatation and hypertrophy of the left auricle and the right ventricle, and the left ventricle is generally small, narrow, and contains little blood. The clinical symptoms are : Slight increase in the pulse^ dias- VALVULAR DEFECTS. 145 tolic bruit (this is absent in some cases) ; considerable increase of the second (pulmonic) bruit; very small, irregular pulse; great difficulty in respiration; and dropsy makes its appearance early in the disease. Disease of the Aortic Valves. This condition of the semilunar valves causes a dilatation and hypertrophy of the left ventricle and flattening of the papillary muscles. The clinical symptoms are as follows : A very strong heart-beat; increase of the heart-dulness on the left side; a full, bounding pulse is very frequently noticed. This character of the pulse is also noticed in small arteries that in normal conditions have no distinct j)ulse. Shortness of breath, oedema, and dropsy of the dependent parts. Stenosis of the Aortic Opening. Rare in the dog. The clinical symptoms are a systolic bruit, a very slight sound of the aorta, small, weak pulse, general anaemia, etc. Imperfect action and disease of the tricuspid valves cause dis- tention of the right auricle, and it also has a systolic murmur on the right side and a strong, venous pulse. Stenosis of the right venous opening and defects of the pulmonary valves are extremely rare. We very frequently have a combination of a contraction of an opening and also a deposit on or retraction of the valve at that opening and also a single valvular defect, and the two make a combination of symptoms that are rather hard to separate. Prognosis axd Therapeutics of Valvular Defects of THE Heart. A diseased valve must be considered incurable, but it may exist for a long time without causing any decided dis- turbance of the general circulation. It is impossible to predict how long a ''compensating" state will continue. Mitral defects seem to last the longest. This conclusion is arrived at from the fact that it is quite common to hold post-mortems on dogs that have been apparently healthy during life and find serious heart-defects. Compensating heart-defects do not require any treatment. We try to aid the heart in its efforts by giving nutritive diet and re- moving all exciting causes, such as great or prolonged exertion. As soon as the heart begins to weaken and the difficulty in res- piration increases, accompanied by oedema, palpitation, etc., we must use heart-tonics — ^digitalis, strophanthus, caffeine, etc. 10 146 DISEASES OF THE CIRCULATORY APPARATUS. R, — Tinct. strophanthus sem 15.0 S. — Ten to twenty drops morning and evening. R. — Caffeine citrate 0.05 Fiat M. No. x. S. — One powder morning and evening. R.— Tinct. digitalis 4.0 Aquse 64.0 S. — One teaspoonful twice daily. If we succeed in re-establishing a compensating action, the symptoms gradually disappear, and we need not use diuretics; if, however, we do not get the desired result and there should be any oedema, we must treat it symptomatically. (See Dropsy of the Abdomen.) The symptoms above described are sometimes found in dogs that do not present any marked alterations in the valves or open- ings either during life or on post-mortem. These are due either to simple idiopathic hypertrophy and dilatation or to alteration of the heart-muscle. Idiopathic Hypertrophy and Dilatation of the Heart: On post- mortem we find, as a rule, a hypertrophy of the left ventricle; but occasionally it is in both ventricles. At the same time we do not find any alteration of the lungs or kidneys which might pro- duce secondary hypertrophy of the heart-muscle. The causes are extreme and constant exertion, cold, abnormal excitability of the heart (in closely bred animals), overfeeding, and too much rich blood (as in pet animals). A condition called Callous Indurative Degeneration of the Heart is often mistaken for valvular defects. In this condition the heart is greatly enlarged and dilated and the walls are hypertrophied. The body of the heart-muscle is filled with a number of whitish, hard bodies, which on examination are found to be cicatricial con- nective tissue. The left ventricle is the favorite seat of these bodies. The cause of these bodies has not been fully determined, but they are due either to Myocarditis or to defective nutrition of the heart-muscle as a consequence of contraction or closing of the cor- onary artery. The clinical symptoms presented are as follows: The heart becomes weak, palpitation, increase in the number of pulse, dropsical effusions. PERICARDITIS, 147 Auscultation gives nothing but pure heart-sounds, and with the above symptoms you may have a callous degeneration of heart or a pure idiopathic hypertrophy; during life it is impossible to de- termine which; as the treatment in both cases is the same, it is of no practical value. This consists of protection against excitement or great bodily exertion ; give nutritive, easily digested food ; and, if the heart is irregular, heart-tonics. DISEASES OP THE PERICARDIUM. Pericarditis. (Inflammation of the Heart-envelope.) Etiology. Inflammation of the pericardium may originate in a primary way by traumatisms or cold, or, secondarily, in connec- tion with infectious or inflammatory diseases of the neighboring organs, especially pleuritis or pleuro-pneumonia. Pathological Anatomy. It either occurs in the acute or chronic form. The anatomical alterations that it produces on both surfaces of the pericardium correspond to those on the pleura caused by pleuritis. The most common form is sero-fibrinous pericarditis, with copious liquid exudates in the pericardium and masses of fibrinous lymph attached to the surface of the pericar- dium; in very rare instances the folds are attached to each other. When this condition has been present some time the pouch becomes dilated and relaxed and the heart-muscle shows more or less atrophy. Clinical Symptoms. Slight pericarditis rarely shows itself to any marked degree; but in severe cases there is decided palpita- tion, the pulse becoming weak and indistinct, with marked irregu- larity in the rhythm. On auscultation there is great dulness all over the region of the heart; finally, the heart-sound is entirely lost or simply a pericardial rubbing bruit is heard. When the pericardial folds are attacked or when they are separated this sound disappears. There may be an increase of temperature, caused by the com- pression of the lungs, and the slightest exertions cause marked increase in the respiration (Siedamgrotzky and others). As soon as the disease becomes advanced the same symptoms that are seen in any case of defective heart-action are noticed; the lessened 148 DISEASES OF THE CIRCULATORY APPARATUS. arterial pressure causes irregularity in the action of the urinary- apparatus, and from venous stagnation dropsy shows itself in different parts of the body, especially in the extremities. Therapeutics. Keep the animal as quiet as possible; give nutritive, easily digested food (meat-diet), and such agents that will lessen the fever and tone up the heart. The Priessnitz com- press and cold-water compresses might produce better effects, but they excite the animal and produce more harm than the good they do. Laxatives (sulphate of magnesium or sodium, calomel). As heart-tonics give strophanthus, digitalis, etc. When the exudate accumulates to an alarming extent we must resort to surgical means and empty the pericardium by means of the trocar, as in pleuritic effusions (see Fig. 38), using as long and as thin a trocar as possible; an aspirating syringe-needle is the best. Select a space over the dullest part of the heart and insert the trocar low down in the left chest wall, taking care not to put the point in too deep and injure tiie heart itself. The treatment of pericarditis is generally symptomatic. Dropsy of the pericardium (hydro-pericardium) is a collection of serous fluid in the pericardium without any direct infiam- raation of the pericardium. In health the pericardium always contains a small amount of fluid, and it is only when we recognize by physical means a very much increased amount of fluid in the sac that it can be called Hydro-pericarditis. Dropsy of the pericardium may appear as a symptom of various diseases (defects of the valves, inflammation of the heart-muscle, diseased conditions of the coronary arteries, disease of the kidneys, and acute anaemia) as well as in connec- tion with inflammation of the pericardium, and is generally accom- panied with all the symptoms of general dropsy. The clinical symptoms are those of pericarditis ; the friction- bruit and the increase of temperature are absent, however. The treatment consists in removing the original causes, and, if this cannot be cured, to puncture; diuretics (digitalis) are to be admin- istered; but these, as a rule, produce only a temporary effect. Hemorrhage into the pericardium (hsemopericardium) is rarely seen. It may be caused by gunshot-wounds, by a bursting aneu- rism, or by laceration of one of the coronary arteries. Death gen- erally occurs in a short time by cotnpression of the heart. Where FILARIA IN THE BLOOD. 149 fatal results do not occur for a short time — that is, where the blood oozes out slowly and fills the sac gradually — it is impossible to make a certain diagnosis. This is also the case when air or blood (pneuraocarditis) penetrates into the cavity from the lungs in cases of some traumatism of those organs. Pilaria in the Blood. Three kinds of parasites have been found in the blood, namely^ filaria immitis, spiroptera sanguinolenta, and strongylus vasorum. Pilarise Immitis (males 130 mm. and females 250 mm. long; both 1.5 mm. thick). Tliey generally lie in the right side of the heart ; very rarely in the left. Its embryos, which are 0.25 mm. long and 0.05 thick, inhabit the blood directly in the circulation (Delafond, Nocard, Gruby, Ruether, Johne, Rieck, Deflfe, and others). This parasite is generally found in Indian, Chinese, and American dogs, especially in the Southern States. Wheeler rarely made a post-mortem that he did not find it, often with- out presenting any observable symptoms during life. It is rarely found in Europe. The characteristic symptoms are emaciation, epileptiform convulsions, unconsciousness, dyspnoea, and rabiform symptoms. How the parasites find their way into the blood is rather interesting. The embryo is passed in the urine and carried by air or water into rice-fields or swampy places, and the parasite finds its way into the system by the dog drinking the water. Some authors contend that the larvse get into the blood like the larva? of the filaria sanguinis, by being first absorl^ed by the mosquito and then developed and passed again to the dog. The only case observed by the author was a dog which had been imported from India and brought to the hos- pital to be treated for a large Avound. The subject was emaciated and anfemic, but seemed to be very healthy otherwise ; he had a good appetite, so that we did not consider it necessary to make an examination of the circulatory apparatus. One morning the patient died in his box. On post-mortem there were all the symptoms of imperfect circulation of all the veins of the poste- rior extremities, distention of the base of the heart, and disten- tion of the right ventricle, the wall being thickened about 1 or 2 cm. ; the chamber was filled with dark red blood-clots, and in 150 DISEASES OF THE CIRCULATORY APPARATUS. this clot was found five fully developed filarise — three females and two males. The number of embryo filarise found in the blood was enormous ; Reicke estimated them to be aboui one million. The affected heart is shown in Fio;. 41. Fig. 41. Heart, with filaria immitis in the ventricle (photograph). The clinical symptoms of this disease were very plainly seen in a case described by Deffe. This was a five-year-old Japanese dog. On post-mortem the right heart showed several dark red blood- clots and thrombus and nearly fifty examples of the filaria immitis, ranging from 12 to 30 cm. in length and gathered in balls. He found also enormous quantities of the embryos in the blood ; as many as fifty could be counted under one microscopic glass-slide. The following changes were found in the right heart : Hyper- trophy, thrombus, endocarditis, and thrombus in the arteries of the lungs ; chronic interstitial nephritis in the kidneys, and a number of embryos in Bowman's capsule and the canals hollowed and distended in different portions. The most important clinical symptoms were great emaciation, notwithstanding plenty of good food and a good appetite (the appetite afterward disappeared) ; cough, weakness of the heart' s action (small, irregular pulse, varying in force) ; polyuria (the urine was light and contained epithelium of the kidneys and blad- der) ; hyaline and granular cylinders ; albumin; triple phosphate crystals; pain in the posterior portion of the body, especially in the region of the kidneys, and slight paralysis. FILARIA IN THE BLOOD. 151 Spiroptera Sanguinolenta (Filaria Sanguinolenta) (male 30 to 40 mm., female 60 to 70 mm., and about 0.5 mm. in width). These have been found by Megnin, Raillet, and others in aneurism of the aorta and (very rarely) in the blood. This parasite is occa- sionally found in the walls of the stomach and the mucous mem- brane of the oesophagus, and in the bronchial lymphatic glands. Eggs and embryo are found in great numbers in the blood. The intermediate host of the spiroptera, according to Grassi, is the kitchen moth (blatta orientialis). When the spiroptera locates itself in the walls of the oesophagus it causes more or less dis- turbance of the system and rapid emaciation (Driessen, Little- wood, and others). Strong-ylus Vasorum {Hcematozoon Subulatuni) (male about 1.5 mm., female 1.5 to 2 mm., and 0.080 thick). According to Laulanie, they are located in the right ventricle and the pulmo- nary artery. The eggs reach the capillaries of the lungs through the circulation, and from these the liberated embryos enter the alveoli and bronchioles and form transparent nodules which look like tuberculous masses. Leisering found sexually ripe parasites in these nodules in the alveoli and also in the prostate and spongy portion of the penis. Both observers found numerous embryos in the blood. DISEASES OF THE URINARY AND SEXUAL APPARATUS. EXAMINATION OP THE URINARY APPARATUS. This comprises the examination of the prepuce, urethra, prostate, bladder, and especially the urine. Examination of the Prepuce and Urethra. I£ a glossy or purulent discharge comes from the prepuce, it in- dicates a catarrhal condition of the part (catarrh of the foreskin or gonorrhoea of the prepuce). If the discharge is purulent, bloody, and has a fetid odor, we will find wounds or ulceration on the prepuce or the glans. Catarrhal affections (urethral, gonorrhoeal) of the urethra are very rare in the dog. They are recognized by a discharge of purulent mucus from the urethra, by difficulty in urination, and the animal shows great pain on catheterization. In cases where there is great difficulty in passing urine, or where it is retained entirely, it becomes necessary to pass the catheter or sound. When this retention of urine occurs it is generally due to the presence of a stone in the bladder, a collection of stones in the urethra, or swelling of the prostate. Passing the catheter in the dog : It is best to use an ordinary rubber catheter in the male dog (about 2 to 5 mm. in diameter and the ordinary length). The subject is laid on the left side or back and held in that position by an assistant. The lirej^uce is shoved back behind the swelling of the glans and held firmly with the left hand (see Fig. 43). Now grasp the cath- eter with the right, and, of course, first see that it has been well lubricated with some oil or cosmoline and that it contains the wire-stylet, and introduce it into the urethra ; if it is jjushed forward up the canal and meets with an obstruction at the posterior end of the bone of the penis, it is due to a flexure of the canal and also to the fact that (152) Catheters : a, male catheter ; 6, female catheter. EXAMINATION OF THE PREPUCE AND URETHRA. 153 the diameter of the urethra is less and the part at that portion has slight contractile properties. By a gradual pressure the stricture is overcome and the catheter passes upward to the arch of the perineum ; here the Fig. 43. Passing the catheter. wire-stylet must be withdrawn from the catheter at least one -third, so as to allow the catheter to make the curve ; a gradual pressure soon brings it into the bladder, when the wire can be removed entirely. Fig. 44. Median section through the pelvic cavity; o, rectum ; 6, vagina ; V , vulva ; d, bladder; e, urethra; I, pubic symphysis. In the bitch we generally use a metallic catheter, either silver or Ger- man silver (Fig. 42, B). The instrument is passed up on the floor of the vagina until it comes in contact with the urethral opening (see Fig. 44) ; this is closed with a slight sphincter (the so-called urethral valve) ; this is 154 DISEASES OF THE UBINABY AND SEXUAL APPARATUS. soon overcome and the catheter passes into the bladder without difficulty, except in cases where the urethral opening is extremely small. It is only in exceptionally large animals that we have an oppor- tunity to make an examination of the urethra. In the bitch cer- tain discharges from the vagina are of diagnostic value. During the period of ''heat" (menstruation) we have a copious, bloody discharge, and during the preparatory stages of labor we see a thick, clammy discharge, and the lochia commences with a non- fetid, serous, slimy discharge, which soon changes to a thick, yel- lowish fluid. Purulent, putrid, and bad-smelling discharges are generally found in inflammatory or ulcerative discharges from the vagina or uterus. It may also be observed when a carcinoma is present. In such cases it is best to introduce a mirror-speculum into the vagina and make a specular examination. Examination of the Prostate. This body varies in size, but in the dog it is large in comparison to the relative size in other animals. It is a round, ball-like body Fig. 45. Section through the pelvis of the male : 1, bladder ; 2, opening of the ureters into the bladder ; 3, spermatic ducts ; 4, prostate gland ; 5, urethra, showing Wilson's muscle ; 6, arch of the urethra ; c, pelvis. cut into two portions, lying on the neck of the bladder where the urethra commences. It lies about the anterior portion of the pubic EXAMINATION OF THE UBINE. 155 bone, and being free to a certain extent it can be pushed into the abdominal cavity by the finger. When we have hypertrophy of that organ we distinguish it by a hard enlargement extending in all directions in the pelvic cavity. Examination of the Bladder. The bladder is almost entirely covered by peritoneum and lies just anterior to the brim of the pelvis, or in some cases it lies en- tirely in the abdominal cavity. When the bladder is very much distended it extends as far as the umbilicus and fills up the lower portion of the abdomen ; it can be distinguished by manipulation. It is a round, distended, tumor-like body, with a dull sound on per- cussion. On examination per rectum we not only feel the neck of the bladder and the prostate, but the bladder itself can be easily distinguished. Tumor or stones in the bladder can be felt by pressing down toward the wall of the abdomen, and the animal evinces more or less pain when the bladder is distended and any pressure put on it. It is very hard to make any examination of the kidneys that is of any practical value, as will be seen from the plates on Figs. 32 and 33, as they lie high up toward the spine and are well pro- tected and covered by the intestines and also by large collections of fat. In some animals with loose, flabby abdominal walls, or when a large collection of fluid has been removed from the abdom- inal cavity, we can examine the kidneys. We can, however, dis- tinguish any specially large body, such as tumors of the kidneys or perinephritic abscesses, by manipulation. Examination of the Urine. The urine has to be examined as to its amount, color, transpar- ency, reaction, weight, odor, and the presence of certain foreign or chemical substances. The properties of normal urine are described in all works on physiology, and concerning pathological urine the author would refer you to such works as the Treatise on Microseopy and Chem- ical Diagnosis of Diseases of Domestic Animals, by Siedamgrotzky and Hofmeister; the Comparative Physiology of Domestic Animals, by Ellenberger; and also a Text-book of Clinical Methods of Exami- nation, by Friedberger and Frohner. The author will confine 156 DISEASES OF THE URINARY AND SEX UAL APPARATUS. himself to a slight summaiy of the distinguishing characters of urine, both normal and pathological. Amount of Urine. The amount of urine passed in one day depends largely, of course, on the size of the animal, the quantity of fluids it drinks, and the temperature of the atmosphere. The average amount of urine passed by a dog is from 0.5 to 1.5 kilo- grammes daily. A decrease in the amount of urine passed indicates that the water of the body is being taken up through some other channel, as in violent diarrhoea, great salivation, daring the for- mation of pleuritic or peritoneal exudates, or in dropsy, in fevers, in decrease of the pressure of the heart, as in valvular defects, myocarditis, etc. An entire stoppage of the urine may occur in inflammation of the kidneys, in obstruction of the urethra, paral- ysis or rupture of the bladder, from calculi in the bladder or urethra, from stricture of the urethra, or from swelling and pressure of the prostate. An increase of the amount of urine (polyuria) may be due to the presence of a large amount of water in the blood (anaemia, hydrse- mia), in atrophy of the kidney, where there is great reabsorption of exudates; in diabetes mellitus (a condition that corresponds to diabetes iusipidus in man). This, however is extremely rare in doffs. We niav see it after the administration of the different diu- retics. It is frequently seen in convalescence from acute diseases. Constant dribbling of urine indicates paralysis or weakness of the bladder. The Color of the Urine. This varies in the healthy dog from pale yellow when it is thin, to dark yellow when it is concen- trated. Food also has a certain influence on the color. After eating fat it is reddish -yellow, and after meat it is light yellow; after eating sugar and bread it is dark yellow, and when the ani- mal is starved it is deep yellow. Disease has also a great effect on the color. It is a deep yellow color in fevers, and pale or colorless in diabetes, general anaemia, and atrophy of the kidneys; a green or light brown in diseases of the liver and catarrh of the duodenum; a greenish-black color after the absorption of tar preparations or carbolic acid ; a red color from santonin, rhubarb, and senna (in these cases there is always an alkaline reaction). The appearance of blood in the urine indicates grave conditions. In hsematuria we may see the color vary from bluish-red to almost EXAMINATION OF THE URINE. 157 Fig. 46. black, the color corresponding to the number of blood-corpuscles present, and in hsemoglobinuria the coloring-matter is granular or dissolved blood-coloring matter, actual blood-corpuscles rarely being present. Both the above conditions may exist simultane- ously in some cases. (The test for coloring from blood is to be be found under hsemoglobinuria). Transparency and Reaction of the Urine. When the urine has been recently passed it is clear and transpareut, and has an acid reaction. After feeding with bread for some time it is turbid and alkaline. After feeding with fat it is alkaline. In patholog- ical conditions when the urine is recently passed it is turbid and filled by mucus and epithelium, pus-cells, triple phosphates. An alkaline reaction generally indicates catarrh of the bladder, or we may see it in haematuria, in reabsorption of large exudates, and in hemorrhage into the abdomen or thorax. Odor of the Urine. There is a slight penetrating odor in normal urine. In cases of catarrh of the bladder the urine has a strong ammoniacal odor, and when there is any amount of turpentine absorbed the urine has a faint smell of violets. The Specific Gravity of the Urine. This varies in the dog between 1016 and 1060. It can be tested either by means of Vogel's uri- nometer or if we have only a small quantity we can test it readily by the areapikometer. This instrument the author has found to be very use- ful. It is shown in Fig. 46. Place the urine to be tested into the receptacle C. Fill it full, taking care that there are no air-bubbles in it. Close it and then sink it in water at 15° R. The specific weight of the urine will then be marked on the scale. As a rule, it will be found that dark urine has a high specific gravity and light-colored urine has a low specific gravity. But there are ex- ceptions to this, for in diabetes mellitus the urine is clear and high in specific gravity, while in nephritis it is dark in color and has a low specific gravity. Dark urine seen during starvation has a low specific gravity. Areapikometer. 158 DISEASES OF THE URINAB Y AND SEX UA L APPARA TUS. Foreign Substances in the Urine. The following substances appear in the urine under pathological circumstances : Mucus. This is found in the urine under all conditions, both in health and disease, and when any of the urinary passages are inflamed it appears in larger quantities, especially in catarrh of the bladder. Blood-corpuscles. If the blood is mixed in the urine evenly and the corpuscles are reduced in size and cylinders are present, it indicates hemorrhage from the kidneys. This condition is always present in acute nephritis, in the early stages of the disease. If the urine is bloody at irregular intervals, it indicates hemorrhage from the pelvis of the kidney, generally as a result of calculi. When the blood is not mixed with the urine, but comes down in a mass, the diseased condition must be in the bladder. This indi- cation is not always certain, as we may see the blood evenly mixed with the urine in diseased conditions of the bladder, such as cystitis. When the blood is passed just before the urine or follows after the last of the urine has passed, it indicates hemorrhage from the prostate or urethra. Pus or White Blood-corpuscles . When there is a considerable quantity of pus passed it indicates the opening of an abscess in the prostate. When a smaller quantity is present it indicates the presence of some inflammation on the mucous membranes of the urethra, and it is also seen in some inflammations of the kidneys. We can obtain definite information as to this condition by making a microscopical examination of the epithelium, and see whether any cylinders are present or not. Fat may be seen in drops on the surface of the urine or shortly after it has been passed. In very fat animals this may be seen as a normal condition, and where animals have had large quantities of fat given to them it also indicates the fatty degeneration of the epithelium of the kidneys. It is also present in the various dis- eases of the kidneys. Do not make a mistake when you have passed a well-lubricated catheter and see oil floating on the urine to think it is a pathological condition. Epithelium. In health there are always a few epithelial cells passed, but when they are present in large quantities it indicates some active inflammation going on in some jjart of the urinary tract, and a microscopical examination of the cells to ascertain EXAMINATION OF THE URINE. 159 their size and shape will indicate the section of the track that they come from. Large quantities of squamous epithelium indicate an irritable condition of the bladder. (Fig. 47.) Where we find Fig. 47. EpitheUum found in the urine: a, from the bladder ; 5, from the ureters ; c, from the pelvis of the kidney. hyaline cylinders, granular cylinders, epithelial cylinders, or casts of blood, then we can feel assured that there is some disease of the kidneys. Blood-cylinders indicate hemorrhage of the kidneys. Epithelial cells in large numbers indicate great desquamation of the epithelium, as in acute parenchymatous nephritis. Hyaline or epithelial cells when mixed with pus-cells indicate nephritis. Hyaline and granular cells are present in all diseases of the kid- neys and always in albuminuria. (Fig. 48.) Uric cylinders : a, hyaline cylinders ; b, epithelial cylinders ; d, granular cylinders ; c, blood-cylinders. Orystals and Bacteria. When we find collections of precipitates in the urine and indications of alkaline fermentation, the urine being alkaline in reaction, and containing crystals of triple phos- phate and in rare instances crystals of uric acid, it indicates a severe irritation of the bladder. Elongated strings of bullet-like bacteria and numerous pus-cells indicate a purulent condition of 160 DISEASES OF THE UBINAB Y AND SEXUAL APPABATUS. the prostate (see Fig. 49). There are a number of abnormal sub- stances found in the urine. The principal ones are albumin, sugar, and the coloring substances of the bile. Urine of cystitis in the dog, containing cystic epithelium, hlood-eorpuscles, triple phosphate crystals, and bacteria. Albumin. The presence of albumin in the urine is always an indication of disease. The best method to indicate its presence is by Koch's test. The urine is boiled in a test-tube, having been previously rendered acid in reaction by a small quantity of acetic acid. It may become opaque from two causes : from the presence of albumin or from phosphates. We pour a small quantity of nitromuriatic acid down the side of the tube, and if there is any albumin present there will be a pronounced opaque line where the acid meets the urine. Albumin occurs in the urine from two causes : first, in false or accidental albuminuria, and true or renal albuminuria. The first occurs when there is free albumin in the urine from accidental causes, where the albumin is added to the urine in its passage from hemorrhage, inflammatory conditions in the passages, or from purulent inflammations. In such cases the microscope will easily make the differential diagnosis. True albuminuria is of much greater importance, as this condi- tion is always a symptom of pathological alterations in the epithe- lium covering the walls of the gland. Healthy epithelium will always retain the albumin in the blood. We see true albuminuria in all forms of acute and chronic inflammation of the kidneys, in fatty degeneration of the kidneys, in amyloid kidneys, and in any altered condition of the circula- tion, such as stagnating hypersemias as a consequence of heart- disease, chronic inflammatory conditions of the lungs, pleuritis, EXAMINATION OF THE URINE. 161 hydrothorax. The horizontal position of the dog does not, how- ever, cause such a great disturbance in the posterior extremities when the smaller bloodvessels are congested as it does in man (Dieckerhoff). Albumin will sometimes be found in the blood from ansemia, leukaemia, in acute poisoning, and from high fevers, but in the latter condition we generally find that there is more or less nephritis or a slight parenchymatous degeneration of the kidneys present. Sugar. The grape-sugar test is generally made when an animal has loss of appetite and polyuria and becomes generally emaciated. The test is Trommer's. Trommer's test for sugar : Put a few cc. of urine in a reagent glass, taking care to first see that there is no albumin in it, and if so coagulate it and filter it out. Take the urine and dilute it with an equal bulk of water, and render it alkaline with a small quan- tity of sodium hydrate, then add drop by drop a 4 per cent, solution of cupri sulphas until the liquid is clear and the sediment dissolved, then heat it until it boils, and if sugar is present we see a reddish- yellow vapor appear at the surface of the fluid. In diabetes mellitus a large quantity of sugar is found. This disease, however, is extremely rare in the dog. It is also found when the animal has been fed on a pure sugar diet. Sinety observed it in bitches that were nursing, especially when the pups were prevented from nursing for some time. The author cannot say whether it is found in the dog as in man, in certain cases of poisoning, and from some neurotic causes. Coloring Substances of the Bile. The coloring substances of the bile are found quite frequently in the urine of the dog. The presence of the coloring substances in the bile indicates an obstruction in the excretion of bile. It may often be seen in catarrh of the intestines and in the gastric form of distemper. Icterus is the most common cause of this condition. (For further information, see Icterus.) Frohner found this also in neurosis and bronchial forms of distemper, in some diseases of the kidneys, in pleuritis, and in great heart-weakness. Voigt also found it in animals that were starved. Bile acids in the urine are of no diag- nostic value in the dog. 11 162 DISEASES OF THE URINAB Y AlSD SEXUAL APPARATUS. DISEASES OP THE KIDNEYS. Inflammation of the Kidneys ; Nephritis. It is impossible to accurately separate the different inflammatory conditions of the kidneys, and as a rule it is only on post-mortem that the conditioa can be properly diagnosed. Consequently, the practitioner has to be satisfied if he can recognize with certainty that the animal has some affection of the kidneys, and whether it is acute or chronic. In the dog it is only in chronic nephritis that we have a general atrophy of the kidney. The diseases of the kidneys in the dog do not possess that impor- tance that they do in man. Acute Inflammation of the Kidneys. {Acute Nephritis; Nephritis Acuta.) Etiology. The most common causes of this condition are infec- tious diseases and poisons. By this is meant the effect produced by the absorption of infectious noxious agents, such as the various septic diseases, or certain irritants that have originated in the body and are passed by the kidneys and cause great irritation while they are passing through these organs, and also certain micro-organisms that reach the blood and become located in the capillaries of the kidneys. Certain chemical substances that are absorbed or taken into the stomach pass through the kidneys and cause great irrita- tion, such as phosphorus, arsenic, mercury, copper, cantharides, turpentine, carbolic and tar acids, naphthol, pyrogallic acid, and chrysarobin. Some of these preparations are absorbed by the skin from various ointments that are applied in mange, such as carbolic acid, mercury, cantharides, etc. Acute nephritis may also originate from an extension of inflam- mation from neighboring organs, and also from traumatic influences, such as blows, shocks, etc. , in the regions of the kidneys. There is a condition called rheumatic inflammation of the kidneys that is supposed to originate from cold, but this disease has not been observed in the dog. Pathological Anatomy. The alterations in the structure of the kidney depend on the intensity of the irritation, and the alter- ACUTE INFLAMMATION OF THE KIDNEYS. 163 ations are more or less distinctly marked. In slight cases the epithelium seems to be the only part affected, the connective tissue and the bloodvessels show no other pathological alteration than a reddish-gray coloration of the covering (parenchymatous degenera- tion). When the irritation is great there is true parenchymatous inflammation of the kidneys. The epithelium and the interme- diate tissue become affected, and also the bloodvessels and all the exudation processes follow which accompany acute inflammation. The anatomical alterations that are found are as follows : The epithelium has undergone the same alteration as in parenchymatous degeneration, but more acute in its type. The capsules of the glomeruli and the small urinary canals are altered, and the con- nective tissue is filled with a liquid infiltration, forming numerous coagulated masses containing large numbers of leucocytes. The vessels are enlarged (hypersemic) and partially compressed by the surrounding exudates. In the interstitial tissue and in Miiller's capsule we find small circumscribed hemorrhages. There are a number of circular-shaped inflammatory centres sur- rounded by liquid exudates. The inflamed kidney may present a variety of different appearances. It may be enlarged or normal in size, soft or hard, reddened or very pale, yellowish-white, and on the surface of the kidney there may be found a number of hemorrhagic spots that are slightly elevated from the surface of the gland. The capsule can easily be stripped from the body of the kidney. There are certain forms of acute nephritis and glomerulo-nephritis that present so little visible changes that they may escape the eye of the non-experienced practitioner. Concern- ing more accurate details the author would refer you to the various text-books on pathological anatomy. Clinical Symptoms and Course. Slight inflammatory con- ditions of the kidneys are rarely recognized in the dog, as the only diagnostic points are to be found on examination of the urine. This contains a small amount of albumin, some hyaline cylinders, and a few epithelial cells and leucocytes. In acute inflammatory conditions the animal has a peculiar stiff gait in walking, and in some cases staggering, with the hindlegs carried straight. Tenderness on pressure in the regions of the loins; a quick, full pulse; great lessening in the amount of urine secreted, and what is passed is dark in color and contains small 164 DISEASES OF THE URINARY AND SEXUAL APPARATUS. portions of coagulated blood ; the feces are dry and hard. In toxic nephritis in dogs the author has had special opportunities to make observations. The amount of urine passed in such condi- tions is small and contains a large amount of albumin. The urine is turbid, containing numerous tube-cylinders, epithelium, discol- ored blood-corpuscles, and also red blood-corpuscles, which give the urine a variable color, according to the number of corpuscles present. There is generally more or less pain in urination, which is probably due to the acrid condition of the urine. There are also more or less symptoms of ursemia present; great weakness, fatigue; temperature is generally subnormal; the pulse weak and thready; vomiting, convulsions, coma, and death. "When the symptoms were milder the animal recovered, or this condition was followed by chronic nephritis. Therapeutics. Medicine, as a rule, has little or no effect on these cases. Tannin, 0. 1 gm. several times daily ; tinct. fol. uva ursi, 1.0, or fuschin. Iron preparations may all be used to try to eliminate the irritating substances from the kidneys. Fig. 50. Bath-tub. The dietetic treatment is the most successful, and consists prin- cipally of rest and food that is non-irritating to the kidneys. Milk and broth are especially useful. Meat may be given, but only lean meat, and in spare quantities, avoiding anything that is spiced. Small quantities of salt, however, are beneficial. The symptomatic CHRONIC INFLAMMATION OF THE KIDNEYS. 165 treatmeat is to try to lessen the strain thrown on the kidneys by trying to carry the fluids out of the body by some other channel than the kidneys. (Fig. 50.) This can be accomplished to a certain extent by giving the animal hot baths or by warm bandages around the body, and by active purgatives, like senna or cascara segrada, also jalap and calomel. B. — Res. jalapse 0.1 Hydrarg. chlor. mite 0.05 Sacchar. alba 0.6 M. F. pulv. No. vi. S. — One three times daily. We can also try pilocarpine, which produces great salivary secre- tion in the dog. Diuretics must not be used in nephritis, as they increase the secretion of salts, especially the alkalies. Heart-weak- ness must be counteracted by means of heart-tonics. General debility should be treated by general stimulants, such as brandy, whiskey, or sherry, in very small animals. Use clysters of chloral hydrate to counteract convulsions. Chronic Inflammation of the Kidneys. {Chronic Nephritis ; Nephritis Chronica.) Etiology. Chronic nephritis originates, as a rule, from acute nephritis, or starts in a mild form and gradually becomes chronic. Pathological Anatomy. There are two forms of chronic inflammation of the kidneys : first the large white kidney (Chronic Parenchymatous Nephritis), and the atrophic or hard kidney (Chronic Interstitial Nephritis). The first condition is generally the forerunner of the second, but, as the hard kidney is most frequently found in post-mortems, it is possible that it may develop as a pri- mary condition. The white kidney is enlarged from the normal size, and has a smooth yellow or irregular yellow-colored surface. The cortical portion is yellowish in color, while the pyramids are red. In some cases we find the kidney large and red, or alternated red and yellow, or covered with hemorrhagic spots. The atrophic kid- ney (shrunken or contracted kidney) results from an increase of the interstitial substance and atrophy of the parenchymatous substance. It is hard and tough on its surface. It has small, watery-like irregularities and granulations. The capsule is thickened, and it is hard to strip from the body of the kidney. The cortical sub- 166 DISEASES OF THE UBINAR Y AND SEX UAL APPABA TUS. stance is lessened in diameter and striped with layers of dark colored tissue. The pyramids are smaller and deep red in color. Clinical Symptoms and Course. As a rule, there is very little that can be recognized in the dog during life, and the author has held posts on animals that have had chronic nephritis of both kidneys that did not present the slightest symptoms of the disease during life ; and even the urine may not contain any albumin, the only symptom being the amount of urine secreted. This is greatly increased in amount, the specific gravity being much lessened. In such cases there is generally hypertrophy of the left ventricle, which can be recognized by palpitation of the heart (loud pulsa- tions and a hard, full pulse). It is presumed that this high arte- rial pressure tends to keep up the action on the impaired kidney and prevent any serious disturbance in the secretion of the kidney. As the disease advances we soon recognize a change : The heart becomes weaker in its action, the pulse is small and frequent, the urine is scant, dark, and very albuminous. This is followed by chronic inflammatory processes in various organs, especially the bronchia, and in the intestinal canal, and finally we have symp- toms of uraemia. In the majority of cases the parenchymatous form can be recognized by the urine. This is very similar to acute nephritis. It contains much albumin, and the urine is scant in quantity, and there are certain dropsical symptoms in the depend- ent region. There are also loss of appetite, great fatigue on taking any exercise, hypertrophy of the heart, which finally becomes weak, and then symptoms of uraemia follow as stated above. Therapeutics. The treatment of chronic nephritis is the same as in acute, but the dropsical conditions can be treated by digitalis and strophanthus, and when there is great anaemia give iron salts. Amyloid Kidney. Amyloid kidney generally occurs in connection with amyloid degeneration of some other organs of the body. The kidney is contracted, and in the parenchymatous form the condition can gen- erally be recognized by the character of the urine. This generally presents the same symptoms as acute nephritis. The urine is loaded with albumin and much lessened in quantity. The amyloid condition is not only seen in the kidneys, but also ABSCESS OF THE KIDNEYS. 167 ia the liver, pancreas, and intestines. Kabe only saw one case where the kidney was the only organ affected. He observed, as a rule, the liver was also affected. Pathological Anatomy. A kidney thoroughly affected with amyloid disease is slightly enlarged, hard, smooth, and shows at the intersections a deep yellowish-white coloration, easily distin- guished on section. The glomeruli are dull, glairy in color. On staining with Lugol's solution the affected parts are colored a mahogany brown, and with methyl are colored purple. Clinical Symptoms. Rabe made the following observations : Where the kidney was the only portion affected the animal was emaciated, the temperature 35.9°, the pulse 72. The extrem- ities were dropsical, complete loss of appetite, coma, and death. Where the liver was affected the animal was unsteady and weak, paleness of the mucous membrane, temperature 38°, ascites, appetite good. Where the kidney aud liver were affected there was great weakness, indifference, unsteady gait, temperature 39. 6, pulse 96, respirations 50, appetite good, and the urine was acid and free from albumin. With the above symptoms, which are rather meagre and liable to be very difficult to distinguish from other diseases, it still might be a guide in making a diagnosis. (In man in this disease there is always more or less albuminuria.) Therapeutics. The treatment consists in foUovdng what is described in nephritis. Abscess of the Kidneys. (Suppurative Nephritis; Pyelonephritis.) " Etiology. The direct cause of the formation of abscess of the kidney is from direct injury of the kidneys or in the region of them, causing the formation of purulent abscess in the urinary passages, the bladder, the urethra, or the pelvis of the kidney. In certain conditions it is associated with ulcerous endocarditis. Pathological Anatomy. Purulent nephritis occurs in various forms, according to its origin. When they are caused by an em- bolus they appear in the shape of small spots, which are easily distinguished by the naked eye. When a section is made through the kidney they are grayish-yellow in color, round or oblong in 168 DISEASES OF THE URINAB Y AND SEXUAL APPABA TUS. shape. They are generally surrounded by a red circle. When the spot is examined under the microscope there are swarms of micrococci in the centre of the mass, and it is reasonable to believe that these are the cause of the abscess. Only in rare cases do the abscesses become confluent, and when they do they form large pus- centres that, as a rule, cause death. When the abscess forms in the pelvis of the kidney the pus extends into the straight urinary canals — in some cases as far as the surface of the kidney — and is indicated by a protrusion or elevation of the external surface, which is yellowish in the centre and surrounded by a circle of yellowish points. When large abscesses are formed from these, becoming confluent, the whole kidney may become altered into one large abscess. The covering capsule of the kidney becomes thickened and holds the abscess with its contents (pyonephrosis). In the early stages, where the micrococci have just collected in the urinary canals, and have started to form abscess-centres, it makes a very interesting study. Where there is a formation of a perinephritic al)scess in the region of the kidney caused by traumatic causes, from purulent abscess, from purulent pyelitis, or abscess in the neighboring organs, it may lead to the formation of considerable pus. Clinical Symptoms and Therapeutics. The symptoms of abscess of the kidneys may not differ to any great extent from chronic nephritis. The abscess of the kidney occurring in pyaemia is only seen on post-mortem. The symptoms of pyelonephritis are also completely disguised by the preceding symptoms of purulent cystitis. Treatment is, therefore, useless. Perinephritic abscesses may become so large that they form a tumor-like body in the lumbar region, and the pus can be detected under the skin, in some cases so large that it fluctuates. When such is the case, and we have confirmed our diagnosis by means of an exploring needle, the sac should be emptied by an aspirator, or make a fairly large opening and empty the abscess of its con- tents and fill it with an antiseptic dressing. If the kidney itself is not directly affected by the abscess, we may expect a quick recovery under good antiseptic conditions. (See treatment of wounds.) CYSTS OF THE KIDNEYS. 169 Inflammation of the Pelvis of the Kidney. (^Pyelitis. ) Etiology. This is caused by the irritation or extension of certain inflammations from the body of the kidney, from poisonous irritants passed from the blood through the kidneys, from foreign bodies that lie in the pelvis, nephritic stones, strongylus gigas; and it is also seen in diseases that are acute in character and in hydronephrosis. Pathological Anatomy. Pyelitis occurs in a number of forms according to the intensity of the irritants. From catarrh, where it forms purulent or diphtheritic pyelitis. Clinical Symptoms and Therapeutics. This disease is only recognized by means of the microscope, when we detect cer- tain forms of epithelium in the urine. There are also some symp- toms of inflammation of the kidney or catarrh of the bladder. Cysts of the Kidneys. (^Hydronephrosis ; Enlargement of the Pelvis of the Kidney.) Etiology and Pathological Anatomy. Whenever there is a stenosis or stricture of the urinary passages and obstruction of the urine it is dammed back and presses on all the canals back of it, and as a consequence the canals are distended and become finally enlarged. If the obstruction is in the urinary tube, the bladder, ureters, and the pelvis of the kidney become enlarged ; but if one ureter only is affected, the corresponding kidney becomes enlarged ; and where the pelvis is much distended the body of the kidney becomes absorbed after the condition has lasted some time. The whole kidney becomes inverted into a pouch-like mass of con- nective tissue, filled with liquid. This fluid at first is urine, but from the alteration soon becomes converted into mucous secretion. In one case described by Siedamgrotzky, he observed, instead of*a kidney, a big bladder or cyst with walls formed of connective tissue, and filled with a slimy, brownish fluid, containing numer- ous cholesterin crystals. Clinical Symptoms and Therapeutics. The cystic kidney is generally recognized only when it is indicated by a fluctuat- 1 70 DISEASES OF THE URINAB Y AND SEXUAL APPABA TUS. ing mass in the region of the kidney. When there is double hydronephrosis the urine is suppressed and symptoms of uraemia show very quickly. The only condition where the disease can be treated is when it is caused by obstruction of the urethra. Nephritic Stones. (Nephrolithiasis. ) Nephritic stones are formed in the pelvis of the kidney and range from the size of a mustard-seed to that of a pea. (Meguin found two stones weighing six and seven grammes each in the pelvis of a dog.) They are irregular^ watery, yellowish or yel- lowish-brown in color. In rare cases they become very large and fill up the pelvis or greatly distend it. They are the shape of the pelvis, and on section they are found to be in layers, and consist of phosphoric acid, carbonic acid, triple phosphate, and uric acid. The formation of these collections is not thoroughly understood, but they are probably formed by a small piece of epithelium or mass of cells becoming fastened together, and the salts are deposited on this medium in successive layers, and finally a large mass is formed. DISEASES OP THE BLADDER. Catarrh of the Bladder. ( Cystitis.) Etiology. Catarrh of the bladder is generally caused by cer- tain mechanical or chemical influences or by microbes which find their way into it as a result of certain infectious diseases, and are eliminated by the kidneys or by certain chemical irritants, such as oil of turpentine, cantharides, carbolic acid, and also foreign bodies. These irritate the mucous membrane. Septic instruments, such as catheters, when introduced into tbe bladder, may set up an irrita- tion, and also by the extension of an irritation from the urinary ducts, the pelvis of the kidney, from the uterus, and from reten- tion of the urine, caused by stones in the urethra, from hypertrophy of the prostate. The last two are the most frequent causes of cystitis. Where the urine becomes very alkaline from the excess CATABBH OF THE BLADDER. 171 of ammonia it produces an irritating effect on the kidney ; continued retention of urine, especially when it is heavily charged with salts, acts as an irritant. It has been said that cold will produce cystitis, but it is not positively known. Pathological Anatomy. There are quite a number of varie- ties of cystitis — mucous, muscular, serous, croupal, ulcerous, diph- theritic, and gangrenous — but, as a rule, it is very seldom that we can distinguish the various forms, and it is best from a practical standpoint to distinguish the disease in its different forms by acute and chronic catarrh of the bladder. In the acute form the mucous membrane of the bladder is colored in an irregular way by dark- red spots. It is also more or less swollen and covered with mucus and detached epithelium. In the later stages of the disease the mucous membrane may be covered with detached epithelium and covered with small hemorrhagic spots. In very severe cases we find a croupous membrane covering the bladder, and it may be so acute as to cause gangrene, and mucous membrane is sloughed off and extensive abscesses are formed. In such cases the muscular and serous coats of the bladder are also greatly inflamed, and if the irritation is extensive enough we may also find evidences of peri- tonitis. In the chronic form the mucous membrane becomes very much thickened and covered with enlarged mucous glands. The surface presents a peculiar greenish or slate-gray color. This is due to the hemorrhages that occur in the tissues from time to time. On the surface we often find raised papilla-like formations, and the sub- mucous tissues and muscles are hypertrophied. Clinical Symptoms and Course. The first symptom noticed in this disease is the passage of an increased amount of urine, the animal emptying the bladder frequently, but passes only a small quantity of urine each time, at the same time showing symptoms of pain. On making an examination of the bladder through the abdominal wall the animal shows pain on pressure of that region. An examination of the urine by the microscope will assist us in making a positive diagnosis. If there should be some disease of the kidneys present, the .specific gravity of the urine is not much changed, but in the early stages of the disease it is somewhat increased in salts and contains only a normal amount of mucus, a few colorless blood-corpuscles, and epithelium of the bladder. This 172 DISEASES OF THE URINARY AND SEXUAL APPARATUS. condition may continue for a long time. Mild cases of cystitis are not diagnosed, but as the disease continues the urine be- comes thicker and turbid, and on examination of the urine micro- scopically we find numerous pus-cells and epithelium of the blad- der ; the urine rapidly loses its acid reaction, and soon becomes neutral or alkaline, and has a strong ammoniacal odor. Urine from an animal in this condition ferments very rapidly. It contains numerous crystals of triple phosphate, and in rare instances uric- acid crystals and also numerous bacteria. (Fig. 51.) Fig. 51. , '"^ ^ }" '^'. ^^® '-&/ :-^ ^'•" Mil •-- \ *i ■'»v. • t Urine of a dog with cystitis, triple phosphate crystals, red and white blood-corpuscles, and cystic epithelium. Bacteria. Fever, as a rule, is present in this disease, but is never intense, but rather shows an intermittent character. There are also severe depression and loss of appetite. The course of the disease, gene- rally, is rapid, and in slight cases the animal recovers in a few days, but in acute cases the case may last for a month or more, and death may finally be caused by perforation of the bladder and the animal dies of peritonitis, gangrene, or ursemia. The most frequent termination of the acute form is into the mild chronic form. In the chronic form the symptoms are much milder, and for a long time the urine is the only guide to a diagnosis, as it is only in advanced cases that the animal will show any pain on pressure of the abdomen. The contractile power of the bladder is gradually lost, and the animal may present symptoms of incontinence of urine, passing small quantities of urine without any effort ; or this is seen in well-trained house animals that pass small quantities of urine while making every effort to retain it until they are out- side, or it may pass away drop by drop when they are moving about or asleep. DEBILITATED CONDITIONS OF THE BLADDER. 173 Therapeutics. The treatment of cystitis may be dietetic, medicinal, or local, according to the symptoms presented. In slight cases it is only necessary to administer such non-irritating agents, such as tartaric acid, nitric acid, liquor potassii acetatis, infusions of juniper, and a liquid diet, such as milk or soups. This assists in increasing the urine and also in lessening its specific gravity, and by that means cleans out the bladder. In the more acute con- ditions we try to correct the urine by means of disinfectants, such as salicylic acid, boric acid, naphthalin, chloride of potassium, or a decoction of fol. uva ursi. The author has always obtained good results from the administration of the last two agents. R. — Potassii chloras 12.0 Aqua destil 300.0 M. S. — One teaspoonful three times a day. B.—Decoc. fol. uva ursi 15.0:180,0 S. Several teaspoonfuls or tablespoonfuls daily. In the treatment of this chronic form, besides the various alkaline salts, we should use the resinous diuretics, such as oil of juniper, oil of turpentine, or juniper water. The local treatment of the bladder is very effectual. This con- sists in introducing the medicinal agents directly into the bladder by means of the catheter. The catheter is introduced into the bladder, and by means of a small hose is connected with a small funnel (see Fig. 52), and a liquid emptied into the bladder, and then the hose is placed in a dependent position and the liquid allowed to trickle out. This can be repeated several times without removing the catheter. The author first cleans out the bladder with clean water, then allows a solution of boric acid, 2 per cent., to flow in. Creolin, 1 per cent., is also used, but is not as preferable as the former. The liquids must be tepid. In the dog, of course, it is a little harder to do than in the bitch, but with a little practice it is very easily performed and produces very satisfactory results. In the bitch a short metallic catheter can be used. Debilitated Conditions of the Bladder. Etiology, Clinical Symptoms, and Prognosis. Weak bladders, due to paralysis or paresis, are generally seen in old dogs, 174 DISEASES OF THE URINARY AND SEXUAL APPARATUS. and are produced from a number of reasons. One frequent cause of this condition is seen in house dogs that cannot get outside, and retain the urine for a long time, producing extreme distention of the bladder. It is also caused by obstructions of various kinds, which prevent the passage of the urine, such as hypertrophy of the prostate, strictures of the urethra, and by weakness of the muscular coat of the bladder, caused by chronic catarrh of that organ. Certain diseases of the nervous system also produce this condition. Fig. 52. Apparatus aud method of irrigating the bladder in the dog. There are two forms of this disease : Paralysis of the Detrusor and Paralysis of the Sphincter Vesicae. It is quite common to find both conditions present in one animal. In the first con- dition the bladder becomes so distended that its elasticity is lost, and the muscular coat loses its power of contraction, and, finally, when the bladder is so distended that the connective tissue alone holds it and presses on the sphincter vesicae and overcomes it, the urine trickles out in small quantities. This is termed over- flowing of the bladder (urination by incontinence). When the CYSTIC CRAMP. 175 sphincter is paralyzed the urine flows constantly or at very short intervals, the slightest contraction of the depressor being sufficient to expel it. In this condition the bladder is nearly always empty. In making an examination of the bladder through the abdomen, when paralysis of the detrusor is present, the bladder will be found distended, even when the animal has passed some urine a short time before that, whereas in paralysis of the sphincter the bladder will be found to be iempty. When cystitis accompanies this condition the animal shows more or less pain when he urinates. This, however, is only seen in rare instances. The prognosis is unfavorable in the majority of cases. The only case in which the author has seen a favorable termina- tion was one of simple distention of the bladder. Therapeutics. The treatment best adapted to relieve this condition is to regulate the passage of arine, as in catarrh of the bladder, by cold injections into the bladder of tine, nucis vomicse, 5 to 10 drops once or twice daily; strychnia muriate, 0.001 to 0.003 subcutaneously ; and fluid ext. ergotse 0.50. We can also try faradization of the abdomen in the region of the bladder. Cystic Cl-amp. {Cramp of the Bladder.) There can be no doubt that cramp or spasm of the bladder (cystospasmus) may occur in the dog, although we have no literature on the subject. By this condition we mean an extreme irritability of the bladder, causing an extreme contraction of the muscular coat of the bladder, and small quantities of urine, in some cases only a drop at a time, are passed with great difficulty. In some cases all the symptoms of uraemia are observed. On passing the catheter, which is extremely painful, we easily recognize it by the bladder being empty, or, if the contraction is at the neck, the urine is passed in a quick stream as soon as the catheter overcomes the contraction. Morphia hypodermatically is the best drug to insure relief ; tine, valerian is also very useful. 176 -disi:ases of the ubinab y and sexual appabatus. stone in the Bladder. (Lithiasis.) Etiology and Pathological Anatomy. The various lithic formations that are found in the bladder may be subdivided into urates, oxalates, phosphates, and cystates. Urates. These consist of uric acid, or uric acid salts, or both in combination. They are small, hard, yellowish or reddish-brown bodies, having a smooth surface, and on cutting through the centre are found to be in concentric layers or strata. Oxalates are chiefly composed of oxalic acid and lime salts, and also more or less mixed with uric and phosphoric acids. They are hard, brown in color, and have an irregular mulberry surface. Phosphates. These are composed of phosphoric acid, lime, and triple phosphate. They are gray-white in color, and, as a rule, are soft and friable. Cystic Stones. These are soft, wax-like bodies, having a shiny, crystalline, irregular surface. All these lithic deposits contain besides their inorganic ele- ments numerous organic elements, such as epithelium, blood- cells, mucus, etc. The size to which these calculi may grow is considerable. In Dresden there is a calculus taken from a German boar-hound that is 11 cm. long and 7.5 cm. wide, 6 cm. thick, and weighed 490 grammes when fresh. They are generally started in their forma- tion in the pelvis -of the kidney, and, generally, from some for- eign body, such as a blood-clot, a piece of mucus, epithelium, etc., around which the sediment in the urine forms and gradu- ally the crystalline elements accumulate. This deposit is especially favored in cases of cystitis, where the urine is undergoing alkaline fermentation and produces a copious sediment in the urine. Paul Bert and Studensky found by experiments that the food aud fluids that the animal takes may have a certain influence on the formation of stone in the bladder. The former mentions two cases in which one was fed exclusively on meat and the other on vegetables. On post-mortem of the animal fed on meat there was found a phosphatic calculus, but no trace of inflammation of the urinary organs. STONE IN THE BLADDER. 177 Studensky placed foreign bodies in the bladder and found that when the animal was allowed to drink only water that was thor- oughly impregnated with lime salts that there M^as soon formed over the body a thick, heavy deposit of lime salts, and differed greatly in animals fed in the usual way, with pure water and meat. In this case the calcretion was much smaller and deposited much more slowly. Clinical Symptoms and Course. When the uric calculus lies in the bladder and has not attained any size it may stay there a long time and not produce any severe symptoms, with the excep- tion of a slight catarrh, and that is only noticed when the animal has had a long ran, the urine being voided with great difficulty, perhaps mixed with blood or mucus, and has a penetrating odor. As soon, however, as the stone gets into the neck of the bladder or passes into the urethra and lodges at the posterior end of the bone of the penis there is a series of severe symptoms. The urine is retained, which is indicated by an entire suppression, or it is passed in a thin stream or only by a drop at a time. A partial obstruction of urine is soon followed by a complete obstruction. The symptoms presented in the dog are very striking. The animals are very restless, looking frequently towards the region of the kidney and whining. They place themselves in the position to urinate and strain violently without any result, or it may be a few drops are passed; this may be mixed with blood. The appe- tite is lost and the pulse is rapid and thready ; they stand with an arched back or walk with a staggering gait and extended legs. The abdomen becomes distended, and we can finally feel the bladder through the abdominal walls like a hard, distended body that is very painful on examination. When the catheter is passed it goes in easily enough until the neck of the bladder is reached, when it stops and cannot be passed any further, and no urine escapes from the catheter. Uric calculi lie on the floor of the bladder and can be felt through the abdominal walls by manipulation — that is, of course, when they have reached a good size ; the small ones escape detec- tion, but they may be suspected when the urine has a gravel or sand-like sediment. The urine, when it is retained in the bladder, gradually accu- mulates, and if it is not drawn off in three days the bladder is 12 178 DISEASES OF THE UBINAB Y AND SEXUAL APPABA TUS. ruptured and it may even burst in two days; when this occurs it causes death in a few hours, with the following symptoms: the animal becomes dull or comatose, with shaking or trembling of the muscles ; the restlessness and pain seem to have disappeared. Pressure on the abdomen may produce slight evidence of pain, but in the majority of cases this is absent. After the first two hours the abdominal wall is covered with a cold sweat ; the blad- der cannot be felt on manipulation. Soon a deep coma sets in, from which the animal cannot be roused, and dies in a short time. In rare instances the animal may have convulsions, which occur with short intervals between them. Death may also occur before the bladder has ruptured, as a coasequence of extensive gangrenous cystitis. Therapeutics. It has been thoroughly established that it is impossible to produce any good results from the injection into the bladder of any of the various agents that are supposed to have the property of dissolving calculi; for instance, acids for dissolving phosphatic calculi, alkalines for breaking up uric calculi, or the drinking of mineral-waters, such as Vichy, Wildung, Carlsbad. There is nothing left then but to remove the stone by means of an operation, called urethrotomy, if it is lodged in the urethra, which consists in opening the urethra in the dog at the posterior end of the bone of the penis, or cystotomy if the stone is in the bladder ; this is performed by opening the urethra at the ischial arch, and by means of a small pair of forceps introduced into the bladder through the urethra the stone is grasped and crushed and afterward washed out of the bladder. In the bitch an in- cision is made into the short urethra and the stone is seized and crushed in a like manner. When ischuria or stoppage of urine is present the treatment depends to a large extent on the location of the calculus — that is, whether it is in the neck of the bladder or whether it has gone into the urethra some distance and lodged there. In the first in- stance we can sometimes introduce the catheter, and by a gradual pressure we can push the stone into the bladder ; or, if it is fur- ther in the urethra, we can push a well-lubricated catheter past the stone and allow the escape of urine and prepare for the opera- tion, for if the stone is in the urethra this must be performed immediately. STONE IN THE BLADDER. 179 Urethrotomy is usually performed from the posterior end of the bone of the penis, as the great majority of uric calculi pass down the urethra and lodge at the posterior end of the bone of the penis, and can be detected by the cath- eter ; when this is passed there is a certain rough sound that resembles crepitation. Lay the animal on the side, and after having injected the skin with cocaine or administered ether — if the animal be very hard to handle, although the latter procedure is rarely necessary — make an incision about 3 cm. in length, cutting down on the urethra. The calculus can then be pushed back toward the opening in the majority of cases, and by means of a pair of small forceps the stone can be grasped and pulled out. In some cases it is necessary to enlarge the opening in the urethra ; as a rule, how- ever, do not make the opening any larger than is absolutely necessary. It is well to leave the wound open except it is a very large animal or if the stone should be exceptionally large ; in that instance do not put more than one stitch in it. For two days the urine escapes out of the external open- ing, but soon closes up, and in about eight to ten days it has closed up com- pletely and the urine is passed in the natural way. Cystotomy : when the stone is located in the bladder the catheter is passed directly into it, and an incision is made into the urethra down on the catheter at the arch of the urethra, and then a well-oiled pair of for- ceps is introduced into the bladder and the stone grasped and crushed, if possible, and the bladder and urethra washed out with tepid water. In some cases the entire tract of the urethra is packed with small uric cal- culi, starting from a fairly large stone at the posterior end of the bone of the penis, and it is only necessary to remove the larger stone, when the others will be passed out by the force of the urine Friedberger mentions one case where there were forty packed in the urethra ; these varied in size from a small seed to a pea, and the whole mass weighed about 28 grammes. The operator cut down on the urethra on the ischial arch and washed the stones from the end of the penis, and then by injections filled the bladder with warm water and washed out that part, assisting the emptying of the bladder by pressure on the abdominal walls. The animal made a complete recovery. [The translator finds that quite frequently calculi accumulate in the con- stricture of the urethra at the posterior end of the bone, and operates in the following manner : Introduce a catheter into the penis until it reaches the obstruction, and by means of a tape looped around the free end of the penis it is drawn away from the prepuce, which is held back by an assistant, and then cut down on the end of the catheter ; the catheter is pulled back a short distance, but not entirely, and the penis bent over, and by means of a small pair of blunt forceps the stone can be removed ; when this is accomplished pass the catheter into the bladder, and wash out any calculi that may still .remain in the bladder or urethra ; by means of a small hose attach the catheter to a syringe and inject the bladder full of tepid water. In the bitch the operation is much more simple. The urethra is opened by means of a thin tenotome introduced on a grooved director and the opening enlarged, and then the forceps passed into the opening, the stone 180 I>ISEASES OF THE URINARY AND SEXUAL APPARATUS. crushed, and the bladder washed out. It is necessary to introduce one finger into the rectum to guide the stone into the forceps before it can be grasped. Great care must be taken in such an operation to avoid crushing the tissues. In the bitch there is no after-treatment necessary.] When the bladder is so distended that it is deemed dangerous to operate before emptying the bladder of its contents, we may empty the bladder by means of a fine trocar and canula. In the bitch the trocar should be introduced on the median line at the brim of the pelvis, and in the dog either on the right or left side of the flank, low down and as near as possible to the brim of the pelvis. Sometimes ruptures of the bladder are caused by accidents, such as being run over by wagons when the bladder is full. The ani- mal dies, as a rule, in forty-eight hours from collapse before peri- tonitis has developed. On post-mortem the bladder is found to be infiltrated with blood and very much swollen at the lacerated region only. In injuries to the lumbar region where the animal is dull and comatose it is always well to consider the prognosis doubtful, and Siedamgrotzky deems it advisable to consider the prognosis doubtful in injuries to that region, even where there are no acute symptoms presented. Indications of painful retention of urine are often presented when there is a stricture of the urethra caused by injuries to the urethra from calculi or by cicatricial contraction following the oper- ator's knife, from intense nephritis, or by torsion following coitus. An examination with the catheter generally gives some informa- tion as to the character of the stricture; the practitioner must, however, remember that there is always more or less normal stric- ture at the posterior end of the bone of the penis. The sound must be passed each day and allowed to remain about twenty minutes; if the stricture will admit of it, the size of the catheters must be gradually increased; great care must be taken to thor- oughly disinfect the catheters. This method has been used with success in a number of cases when it has continued for several weeks. Hoffmann cured a case of stricture of the posterior end of the bone of the penis by opening the urethra at the spot of stricture and amputating about 2 cm. of the bone of the penis with a pair of bone forceps. INFLAMMATION OF THE PROSTATE. 181 DISEASES OP THE PROSTATE. Inflammation of the Prostate. {Prostatitis.) This disease appears in both acute and chronic forms; the causes have not been sufficiently investigated up to the present date to state positively what is the exciting cause of the disease. The acute form is rare and causes the animal to show evidence of great pain when either urine or feces are passed. In cases where there is great enlargement of the prostate the animal may hold the feces back by not putting any pressure on the abdominal muscles or may retain the urine. On making an examination of the gland, by introducing the finger, well lubricated, into the rec- tum, we find it very much enlarged and hot and painful to the touch. The animal shows great pain during catheterization when the instrument passes the prostate. The terminations of this acute condition are as follows: The prostate may break down completely and cause death, or it may assume the chronic form and ultimately form abscesses which break through into the bladder, the urethra, or the intestines, and in very rare cases into the connective tissue of the pelvis. Therapeutics. This consists in giving the animal small quan- tities of non-irritating food, cold clysters, and cold applications to the perineum; also the frequent passage of the catheter to prevent the stagnation of the urine in the bladder ; and also the adminis- tration of saline purgatives, such as sulphate of magnesium, Carls- bad salt, etc. When pus has formed, which can be determined by a digital examination per rectum, introduce a speculum into the rectum and cut down on the fluctuation by means of a sharp- pointed bistoury. The hemorrhage which follows is very slight, and no attention should be paid to it. Where the swelling ex- tends to the perineum and distends it the author has cut down from there and evacuated the sac. Chronic prostatitis (Hypertrophy) is the form of the disease most frequently seen, and develops from the acute form, or in the majority of cases starts in the onset as the chronic form. It is a common disease in old dogs, and is indicated by a hypertrophy of the whole organ ; as a rule, one side of the gland is larger than the 182 DISEASES OF THE URINARY AND SEXUAL APPARATUS. other. It varies in consistency; in some cases it is very hard, in others it is soft; in the former case it is due to a hyperplasma of the fibro-muscular tissue; in the latter it is due to an infiltration of the gland with a purulent fluid as a consequence of a chronic purulent inflammation. The symptoms of a hypertrophy of the prostate are irregular; in some cases there is difficulty in urination (dysuria, stranguria), and also cystitis, pyelitis, etc., or constipation due to the animal making no effort to evacuate feces. The best means of diagnosis is to make a digital examination per rectum of the prostate. It is distinguished from the acute form by the absence of heat and sensitiveness, but is very much larger than the normal gland. Therapeutics are not productive of much good results. Saline laxatives, ergot, and iodide of potassium have been tried by the author. The remedy that has given the best results has been to inject into the gland a solution of iodine (iodide of potassium, 2 parts ; tincture of iodine, 2 parts; and water, 60 parts) at in- tervals of fourteen days. The solution is injected through the rectum directly into the gland by means of a small hypodermatic syringe. [The translator has recently tried castration, but has not had enough experience to say whether it is to be recommended. In a number of cases it has produced very good results and the animal was greatly relieved from active symptoms; but, on the other hand, in several cases the animal has steadily gone down, lost flesh, and in three or four weeks become a skeleton and died apparently from inanition.] Cancer of the Prostate. Cancer of the prostate is generally carcinomatous in character, causing an irregular enlargement of the gland. It is difficult to make a diagnosis, and conclusions can only be drawn from the general health of the animal, which shows a gradual want of nutrition. It is impossible to remove the prostate, and therefore treatment is useless. GONORBHCEA—GONORRHCEA OF THE PREPUCE. 183 DISEASES OP THE PENIS AND PREPUCE. Phimosis and Paraphimosis. By phimosis we mean a contraction of the prepuce over the free end of the penis. It is often of congenital origin, and is fre- quently caused by injuries and consequent inflammatory swell- ings; but as the foreskin is rarely withdrawn in the dog it is of little importance, for as soon as the penis passes through the nar- row opening of the prepuce during coitus or from erection the prepuce becomes tightened behind the glans penis and causes what is termed paraphimosis; the narrow ring of the prepuce causes venous stagnation and a swelling and purple coloration of the glans, and, if this is allowed to remain some time, causes partial gangrene. The therapeutics of paraphimosis consists in reducing the glans as soon as possible with friction and careful manipulation; this is accomplished by careful lubricating of the parts with some bland oil and putting a steady pressure on the glans, at the same time pressing forward the prepuce over the enlarged part; with a little patience it is reduced. If this is not successful, bathe the glans with cold water or alum applications. If we do not reduce it by this means, then cut the ring with a probe-pointed bistoury or a pair of scissors. The last means will reduce it immediately. It is well, however, not to resort to this until you have tried every other method. Gonorrhoea — Gonorrhosa of the Prepuce. By this term we mean the catarrhal inflammation of the skin of the prepuce, which is similar to mucous membrane. It is prob- ably caused by retention of urine, dirt, uncleanliness, or mastur- bation; it is frequently observed in old dogs, with stagnation of the veins of the prostate (Siedamgrotzky). The symptoms con- sist in slight redness, swelling of the prepuce and glans, and the secretion of a thin, purulent mucus, which is generally licked off by the animal. The lymph-follicles are generally swollen, and can be felt by manipulation with the finger as small bodies about the size of a seed or pea. The treatment consists in the injection 184 DISEASES OF THE UBINAR Y AND SEXUAL APPARATUS. of acetate of lead water or 1 per cent, solution of zinci sulphas or argenti nitras. In rare cases we may have an animal affected with specific gon- orrhoea which has extended from the foreskin into the urethra and an enlargement of the inguinal lymphatics, forming a bubo (Sie- damgrotzky and author). In one of the cases observed by Siedam- grotzky the gonorrhoea was accompanied by intense inflammation of the eyes (gonorrhoeal ophthalmia). Neoformations of the Glans and Prepuce. Neoformations are sometimes found on the dog and bitch, and are either condyloma, carcinoma, or sarcoma. The former can be removed by the scissors or a small pair of pincers and tlie blood stopped by compression or a solution of alum, or, what is much better, the thermo-cautery. Carcinoma and sarcoma gen- erally require the removal of a portion of the glans. (See chapter on Neoformations.) DISEASES OP THE TESTICLE AND ITS COVERINGS. We frequently see inflammatory conditions of the scrotal cov- ering as a result of contusions; they may, however, be caused by eczema, which sometimes causes great swelling and sensitiveness. (See Diseases of the Skin.) MoUer has also seen serpentine vari- cosis with ulceration and accompanied with profuse hemorrhage. Inflammations of the Testicle — Orchitis. Orchitis without any other injury is very rarely seen in the dog ; it may be caused by a kick, or a blow, or from crushing. The testicle is swollen and smooth on its surface and very sensitive to the touch. In one case that the author observed the epididymis was also greatly swollen (epididymitis). The therapeutics consists of cooling applications and rest. Injuries to the Testicles and Scrotum. As a rule, the wounds of these parts are caused by fighting with other dogs, and are either lacerations or perforated wounds. In INFLAMMATION OF THE VAGINA. 185 the majority of cases try to get drainage and keep the wound clean by antiseptics ; this is best accomplished by putting a piece of absorbent cotton on the testicle, and by means of a long-tailed bandage tied around the body the cotton can be kept in place. If the testicle is injured, the gland had better be removed by cas- tration, as it is only in favorable cases that the animal makes a good recovery and the seminal power is retained. (For further details on the subject, consult the chapter on Hernia of the Testicles and Castration.) [Cuterebro Emasculator. {Emasculating Bot Fly.) This parasite, which is common in rabbits and squirrels, was described by French as occurring in the scrotum of the dog, and since then the translator has observed two cases in setters where the grub has been present in the scrotum. The scrotum swells slowly, beginning at the dependent portion, until a round, firm mass, resembling in size and shape the ordi- nary '^ warble" seen in cattle's backs, but not quite as large; it apparently gives the animal no discomfort, unless the parasite should act as an irritant and form an abscess, which is followed by great irritation of the parts, and subsequently sloughing of a portion of the scrotum and destruction of the testicle. The treatment consists in finding the opening or vent in the skin and carefully enlarging it, taking care not to penetrate the larva, when it can be pushed out and the wound cleaned with a solution of peroxide of hydrogen. If the grub is punctured and it collapses, the remaining portion of the parasite must be carefully removed, as it causes great irritation if allowed to remain.] DISEASES OP THE VAGINA AND THE UTERUS. Inflammation of the Vagina. ( Vaginitis. ) Inflammation of the vagina (catarrh of the vagina) results, as a rule, from difficult labor, and in rare cases as a result of im- proper copulation. The condition is indicated by a whitish, 186 DISEASES OF THE UBINABY AND SEXUAL APPABATUS. Fig. 53. purulent discharge, in some cases being fetid, which is generally licked off by the animal. The examina- tion can be made by means of a speculum in the larger animals (Fig. 53). On examination of the vagina we find it intensely red and inflamed and covered with a grayish, mucous discharge; the mucus is also grayish in color; carcinoma is often present. (See chapter on Tumors for further details.) The therapeutic treatment consists of the daily injec- vaginai tious of astringent and disinfectant washes: Nitrate sPGCUlum, of silver (1 per cent, solution), sulphate of zinc (1 per cent.), alum, permanganate of potassium solution, boric acid, and creolin. Prolapsus of the Vagina and Uterus. {Pi'olapsus Vagince ; Prolapsus Uteri.) Prolapsus of the vagina is more common than prolapsus of the uterus. In some instances it is accompanied by serious alterations of the vagina, especially hypertrophic alterations, and also, in rare cases, polypus formations. These alterations are generally caused by difficult whelping. As a rule, there is more or less pro- trusion of the vagina through the vulva, appearing in the form of pear- or flap-shaped, red, inflamed tissue covered with mucus. In very rare instances the prolapsus is so great that the os of the vagina can be seen through the external opening. When the uterus is prolapsed the protruded portion is forced out of the vulva, and we see a pear-shaped body, intensely red, with salient borders. One horn of the uterus is protruded only; the author has never heard of a case where both horns were protruded. The prolapse of the uterus in the dog is practically impossi- ble, for the reason that the uterus itself is merely a body in name, and really the uterus consists in the horns, the true body of the uterus being a small body from which the horns bifurcate almost at the OS. (Fig. 54.) The therapeutics of prolapsus of the vagina is practically that used in prolapsus of the anus and rectum. The retention of the vagina is much more difficult than returning it to its normal position. Hertwig advises that the vagina be returned, and for several hours it is held in position by the fingers, and if that is PROLAPSUS OF THE VAGINA AND UTERUS. 187 not sufficient, to introduce a sponge into the vagina or pack the vagina with gauze or cotton and stitch the lips of the pudenda. The author generally uses the following method: After returning the vagina to the normal position he puts two stitches in the pudenda and leaves them for three days. Fig. 54. The genito-urinary organs of the bitch : a, ovary covered with capsule ; 6, capsule of ovary; c, ovary ; d, horns of the uterus ; e, body of the uterus ; /, os uteri ; g, vagina ; g', opening of the urethra ; h, clitoris ; i, i, vulva ; I, bladder ; m, urethra. In one case where there was great thickening of the walls of the vagina and reduction of the prolapse was impossible, and another where the vagina prolapsed immediately after the stitches were removed after being there for several days, the author per- 188 DISEASES OF THE UBINABY AND SEXUAL APPABATUS. formed a partial amputation, taking out an elongated piece of mucous membrane and sewing it up by a continuous stitch of cat- gut, which was followed by good results. Reduction of the uterus is much more difficult, and in the ma- jority of cases it is impossible. The prolapsed portion should be lubricated and gradually worked back, and after the fingers can- not reach any further a tallow-candle must be inserted and the horn pushed back as far as possible. If this method is not suc- cessful, laparotomy should be performed, in the manner spoken of in hernia. An incision is made into the abdominal wall and the finger inserted until the ovary is felt, and then the animal is held up by the posterior extremities, and by gradual tension the horn of the uterus is pulled back into position and the opening in the abdomen closed up. The rules named for retaining the vagina are then to be followed. An English veterinary journal says that the uterus can be retained in position by making an opening in the median line of the abdomen and pulling the horn into posi- tion and then stitching the horn to the upper part of the abdom- inal wall. It is needless to say that the stitch must be of catgut. Amputation of the uterus by ligating or crushing the pro- lapsed portion is done in the following manner : Ligate tightly the base of the protruded portion and amputate the free portion of the uterus — not too close to the ligated portion, as the ligature might slip and push the stump back into the pelvic cavity. An- other method is to remove the ligated portion by means of an ^craseur ; this latter operation is by far the best. Inflammation of the Uterus. (Metritis.) It is a common occurrence to have inflammation of the uterus after protracted labor, and the disease can be subdivided into the following varieties, according to the exciting causes: Catarrhal Metritis. In this condition the disease is limited to the mucous membrane, and presents the same symptoms as are seen in all catarrhal inflammations of mucous membranes ; the causes are mechanical injuries which the uterus may be subjected to during labor or immediately after. The clinical symptoms are as follows : The vulva is slightly INFLAMMATION OF THE UTERUS. 189 Fig. 55. reddened and swollen, and there is a copious discharge from the vulv^a, which is ]3urulent, sometimes bloody or slightly putrid, and is much increased in quantity after the passage of feces or urine; but the animal licks it off so soon that the observer must look immediately after each evacua- tion or it may escape his notice. Some bitches carry their tails in a curved position when suffering from this condition ; some animals have complete loss of appetite, and in some cases slight fever is present. The therapeutics consist in tepid injections of non- poisonous antiseptic fluids, such as permanganate of potassium (1 per cent, solution), boric acid (2 per cent.), and creolin (1 per cent.). In using these solutions it is best to use the irrigator with the two catheters that have been already mentioned (Fig. 55). In the chronic form (dysmenorrhcea) we should use injections of ergot. R.— Ext. ergotae 2.0 Spts. vini dil. | _ ^ ^ .. g^ Glycerinum | • • • • M. S. — Inject a small portion several times daily. Septic Metritis (Puerperal Fever). Septic in- flammation of the uterus should be considered a disease of wound-infection in which we find intense irritation of the uterus and vagina, accompanied by violent constitutional disturbances. During and after labor septic materials find their way into the uterus, and, owing to the condition of the uterus at that time when it is practically in the same condition as an open wound, the septic materials are taken up very quickly and every condition is favora- ble for their propagation. Collections of blood, decidual tissue, etc., exposed to the air decay very quickly, and where there is any erosion of the vagina or the cervix, or even the uterus at the points of pla- cental attachment, the poison is taken up. The eroded portion that has taken up any of the septic material soon presents an ulcerated surface which is covered by a necrotic or diphtheritic coating, and in some cases the vagina becomes intensely swollen, dark brown or reddish-brown in color, and covered with spots of diphtheritic ulcerations. The inflammatory process rapidly extends from the mucous membrane into the deeper tissues, affecting the muscular and the Double cathe- ter for washing out the uterus. 190 DISEASES OF THE UBINABY AND SEXUAL APPABATUS. pelvic cellular tissues and the lips of the pudenda, and from the internal surface of the uterus it extends to the uterine muscles and the broad ligament, and in acute cases to the serous covering of the uterus and the peritoneum. When the acute symptoms are present ptomaines and septic substances enter the circulation and cause acute septic fever. (For further information, see chapter on Wound Infection.) The prognosis is generally unfavorable. Clinical Symptoms. The vulva and the mucous membrane of the vagina are swollen and livid red, and discharges copious masses of discolored, fetid pus. In the earlier stages the animal shows great j)ain on pressure to the abdomen ; the pulse is thready and finally becomes imperceptible and very fast. The respirations increase in number. The temperature in the early stages is in- creased, but soon falls to normal and frequently becomes subnor- mal toward the end. The mucous membranes of the mouth and conjunctiva are livid. When the animal presents the acute symptoms early and does not eat or drink from the onset, it soon becomes comatose and dies in from twelve to twenty-four hours. Therapeutics. In such cases treatment must be prompt and energetic to get any favorable results. The uterus and the vagina must be thoroughly irrigated with antiseptic fluids, and also the general treatment indicated in septicaemia. For antiseptic irri- gating fluids we use creolin, 2 per cent, solution ; corrosive sub- limate, 1 to 2000 solution. First irrigate the uterus with warm water, and clean it thoroughly until there is no discoloration in the escaping fluids ; then inject the medicated solution into the uterus several times; repeat this several times daily. As a stimulant use camphor, either internally or hypodermatically; the latter is the best, as you are apt to get quicker results and you also avoid the danger of the animal vomiting it, which it is very apt to do. Ergot and salicylic acid are also used with some suc- cess (Letzerich). R. — Camphor i^ulv. 0.2 Gummi acacia 0.6 F. chart. No. xii. S. — One powder every two hours. OBSTETRICS AND CASTRATION OF THE BITCH. 191 Obstetrics and Castration of the Bitch. As a rule, the bitch has her pups without any difficulty. The period after conception varies from fifty-eight to sixty-two days [Dun kept a record of 1^9 bitches and found the average period was 63.28 clays, the maximum being 71 days, and the minimum being 53 days], when she generally seeks a quiet place and drops from one to eight blind pups, the period of whelping being from one to six hours (quite frequently lasts ten or twelve hours). The labor-pains generally come on from three to ten hours before birth, and are indicated by the bitch being very restless and going into dark corners or scratching as if to make a bed, and on putting the hand on the abdominal walls the foetuses are found to be very lively. Immediately after the birth of each pup the placenta is passed out and is eaten by the bitch. The retention of the whole or a portion of the placenta is very rare in the bitch, and must not be mistaken for a dead foetus. Violet has seen three such cases, and describes them as follows : Great depression ; no milk in the mammre; the bitch pays no at- tention to the pups ; frequent contraction of the uterus similar to labor-pains ; entire loss of appetite ; pain on pressure of the abdo- men. The temperature was normal at first, but gradually in- creased; the pulse was quick and hard; and a fetid discharge from the vulva. The treatment consists in constant irrigations of antiseptic solu- tions, ergot, warm poultices around the abdomen, and stimulants. After the birth of the pups there is slight lochial discharge, bloody in the onset and finally purulent. The short but strong umbilical cord is torn during labor or bitten off by the bitch immediately after birth, and the entire mass of placenta and amnion is eaten by the mother. The normal course of birth may be changed in some instances by certain circumstances. 1. The labor-pains may not be strong enough ; there may be a narrow, contracted pelvis; the vagina may be lessened in diameter by cicatricial contractions, tumors, etc. The foetus may be very large or may be presented in an irregular position. Extract of ergot is the best preparation to increase the contractions of the uterus. [Several writers have recently spoken 192 DISEASES OF THE URINARY AND SEXUAL APPARATUS. very highly of glycerine as an agent to encourage the contrac- tion of the uterus. In cases of difficult ]Darturition it is injected directly into the uterus; in 1 to 10 solution with warm water the translator has had very good results from it.] If the animal is depressed and weak, administer stimulants, such as whiskey, wine, or alcohol; and if these fail to produce the birth of the foetus, it may have to be removed by forceps, hooks, or the foetus may be noosed by means of a copper wire held in a tube (see Fig. 56). Fig. 56. Apparatus for the extraction of the foetus and method of extraction : a, Brulet's apparatus ; h, method of application. ; c, Defay's apparatus. Fluid extract of ergot 1.0 to 2.0 every half-hour ; or if the animal vomits, give 0.50 to 0.75 of ergot hypodermatically every half -hour. When the foetus is in an irregular position, and after failing to remove it by meaus of forceps, etc., or if the foetus is so very large that it is impossible to get it through the pelvic opening, or if it cannot be reached so that it can be cut into sections, or if the pelvis is contracted or a tumor present, we must perform the Ceesarean operation (gastro-hysterotomy). This is not a very dan- gerous operation, provided it is performed before the animal is in a state of collapse or the foetus is not dead and commencing to OBSTETRICS AND CASTRATION OF THE BITCH. I93 decay. Empty the bladder and the lower bowel, and having washed out the genital passages with an antiseptic solution, the bitch is laid on her back, the legs are held by an assistant, the forelegs together and the hindlegs wide apart. The region wh^re the incision is to be made should be thoroughly washed and the hair removed from the part. Make an incision on the median line of the linea alba from the umbilicus with a sharp-pointed bistoury, and cut into the abdominal cavity, taking care not to injure the intestines or uterus; then insert a probe-pointed bistoury and make the opening larger, cutting toward the pubis; then cut through the omentum; the uterus is now visible and can be lifted out and the foetuses can be felt in the uterus, separated by a constriction in the body of the horn. Pull the uterus out of the opening as far as possible and have an assistant keep the opening of the ab- dominal wall closed, so as not to allow the intestines to escape, and also to avoid any of the fluids from the uterus falling into the cavity ; and by means of a bistoury open the uterus by making an incision through its wall; the opening should not be any larger than is necessary to get the foetus and the membranes out. It is not necessary to make an incision in the horn over each foetus, but after one foetus is removed the others can be pushed toward tlie openino- and removed through it, taking care to take the membranes also. The uterus is now thoroughly disinfected with corrosive subli- mate solution (1 to 5000) or boric acid, 2 per cent., and by means of a continuous suture, (using the stitch illustrated in Fig. 19, page 70), using catgut ligature, then sew up the abdominal muscles by an interrupted suture, using silk. The abdomen is covered with a piece of absorbent cotton soaked in a mild solution of corrosive sublimate, and held in position by an eight-tailed bandage of muslin tied over the back. This has to be dressed daily. The animal must have absolute rest, and be fed on food that is easily digested and not apt to constipate or ferment. Meat-juice or ex- tract is the best, but not vegetables. Castration of the 'Bitoh. (^Ovariotomy). This operation is gen- erally performed to avoid the trouble that owners have when a bitch is in ''heat." and also that they make good housedogs. The operation is a very simple one and not attended by any great danger if the proper antiseptic rules are followed and the animal is not too fat or in ''heat." The bitch is given a narcotic or 13 194 DISEASES OF THE UBINAB Y AND SEXUAL APPABATUS. ether and placed on a table on her back and an incision made in the linea alba at the umbilicus with a sharp-pointed bistoury, and then the opening is made larger by means of a probe-pointed bis- toury, cutting toward the diaphragm. The operator can find the uterus easier by putting a sound into the uterus previous to the operation. The finger is introduced into the abdomen close against the wall and the horn of the uterus is felt and drawn toward the opening, and by careful traction the ovary is drawn toward the opening and cut off with the scissors ; the same procedure is fol- lowed in the other ovary and the wound closed with an inter- rupted silk stitch. The ovaries of the dog are small, round, elongated bodies located at the posterior edge of the kidneys and are imbedded in a deep fatty covering or pocket (see Fig. 54). Hoffmann cuts through the broad ligament and ligates the ovary both above and below and cuts off the ovary with a blunt pair of scissors. The abdominal wound should be stitched with a double row of stitches. We first sew the muscular coat with a continuous catgut suture, and then sew the skin with an interrupted suture of silk; an antiseptic dressing is useful, but not absolutely necessary. The animals should be muzzled. Many operators perform castration in very young and old dogs by opening the abdominal cavity at the linea alba and ligating the uterus by two catgut ligatures about an inch apart on the body of the uterus, and cut through between the ligatures. This method has the advantage of being very simple, and there is little or no danger connected with it, but the author has tried a number of cases for experiment and found in a short time a great collection of cream-like matter gathered at the ligated end of the uterus, and distended that portion very much, which was noticeable in. the animal. Many operators advise castration through the flank, and proceed in the following manner: Make an incision in the flank about 4 cm. long, midway between the last false rib and the thigh, in an anterior direction, cutting through the skin and muscular layer; then tear the peritoneum by means of the finger and pull the ovaries through the opening and cut them off wdth the scissors, and sew up the wound as described in the other operation. Fried- OBSTETRICS AND CASTRATION OF THE BITCH. 195 berger has operated on hundreds of bitches in the above-described manner; he removes both ovaries through the one opening in the left flank. Gunther makes an opening in both flanks, taking the ovary out of each. The subsequent treatment consists of feeding the animal on small quantities of easily digested food, treating the wound in the regular antiseptic way. DISEASES OP THE NERVOUS SYSTEM. EXAMINATION OP THE NERVOUS SYSTEM. Disturbances of the nervous system are marked by impair- ment of consciousness, sensitiveness, and motility. Besides these there are complications in the functions of the eyes, ears, and the digestive system. 1. The Disturbances of Consciousness are variously defined according to their intensity. Dulness (indifference to any exter- nal influences), somaolence (drowsiness, sleepiness, the patient may be awakened easily), stupor (deep sleep, difficult to arouse the patient), coma (entire uaconscioiisness, the animal is not dis- turbed by external influences). In extreme cases of unconscious- ness all sphincters of the body become relapsed. Such cases are found in the various diseases of the brain and its coverings and in cases of injury and concussions of the brain ; it is also seen in poisoning by narcotics, iu uraemia, in acute anaemia, and in all diseases accompanied by intense fever and pain. Short attacks of unconsciousness may occur in the form of dizziness, and are seen occasionally as the result of great excitement or pain (in oper- ations); and also idiotism, which occurs in rare instances as a result of distemper, when it assumes the nervous form. 2. Disturbance of Sensitiveness. This is not easily recog- nized in the doff. In all instances it is advisable to cover the patient's eyes, and compare the sensitiveness of the affected side with that of the healthy one. In cases of hsemaphraic diseases we test the sensitiveness of the skin by pricking it slightly with a needle or letting cold water drop upon it so as to produce some irritation or symptom of pain. A test may also be made by means of a battery; still this method has failed to be as reliable and practical as the needle and cold-water test have been to the author. Total ancesthesia occurs, as a rule, from poisoning, and must not be mistaken for a want of reaction when in a comatose condition. Local ancesthesia — that is to say, a more or less circumscribed or disturbed zone of sensibility — may be found in any part of the (196) EXAMINATION OF THE NERVOUS SYSTEM. 197 body. la such a case, if anaesthesia corresponds with a region of a special nerve or a mixed nerve, or if it is extended upon several nervous regions, or if it is even double-sided, we can distinguish peripheric anaesthesia. Peripheric anaesthesia indicates an injury of the end organs of the sensitive nerves and originates through local influences — intense cold, acids (especially carbolic), also alcohol and certain narcotics (especially cocaine). Peripheric anaesthesia may be caused by some traumatism, compression, malformation, or inflammatory exudates; also through inflammations, such as degenerating processes, etc., of the peripheric nerves. Special anaesthesia is seen and, as a rule, is double-sided; due to compres- sion of the nerve or the spinal cord. Cases of cerebral anaesthesia are caused by hemorrhages, tumors, inflammations, etc., in the zone of the sensitive nerves. It may also be caused by the effects of various poisons — chloroform, ether, alcohol, morphia, and bromine. Hypercesthesia. This is an increased sensitiveness of the cuta- neous nerves, and is, as a rule, found in the early stages of certain diseases of the spinal cord. It is very rarely seen in the later stages of such diseases. Siedamgrotzky observed in one dog with lameness in the hind-quarters such intense hyperaesthesia in the paralyzed centres that the animal gnawed his hindlegs to the bone, notwithstanding all the precautions that were taken to prevent him. 3. Disturbances of Motility appear in paralysis and convul- sions of the affected muscular system. Paralysis. We generally make a distinction between paral- ysis and lameness — that is to say, an entire loss of movement — and paresis or weakness, which is simply due to debility. In the first case there is not the slightest movement performed in a muscle or a whole group of muscles. In some cases there are slight muscular movements, but they are weak, without strength, and do not last very long. In order to determine the origin of paralysis it is necessary to have some knowledge of the psychomotor centres. These centres are located in the cerebrum, and are called the cor- tico-muscular leading tracks. Up to the present time they have definitely located the following motor centres in the external sur- face of the cerebrum, the position of which is indicated in Fig. 57 : 1 is the centre for the movements of the muscles of the neck ; 2 is that of the extensors and adductors of the anterior limb; 3 is 198 DISEASES OF THE NERVOUS SYSTEM. Fig. 57. Fig. 57, 1., shows superior portion of the cerebrum; II., the lateral surface ; and I., II., III., IV. are the four convolutions. ; S, is the sulcus cruciatus; F, the fissure of Sylvius; 0, the bulbus olfactorius ; p, is the optic nerve. The motor centres are : 1, for the muscles of the neck ; 2, for the extensors and adductors of the anterior limbs ; 3, for the flexors and rotators of the anterior limbs; 4, for the muscles of the posterior limbs ; 5, for the facial muscles ; 6, for the lateral movements of the tail ; 7, for the retraction aiad adduction of the anterior limbs ; 8, for the lifting of the shoulder and extension of the front limb (walking) ; 9,9, for the orbicularis palpebrarum, zygomaticus, and closing of the eyelid ; I., t, the heat- centre of Eulenberg and Landois. (Landois.) Fig. 57, II., a, a, retraction and elevation of the corners of the mouth ; 6, opening of the mouth and movements of the tongue ; d, the opening of the eyelids. EXAMINATION OF THE NERVOUS SYSTEM. 199 for extending and turning the anterior limbs ; 4 controls the move- ment of the posterior limbs; 5 the facial muscles ; and 6 the lateral movement of the tail; 7 for retraction and adduction of the anterior limbs; 8 for elevating the shoulders and stretching the front legs (walking); 9 for dilating and contracting the orbic- ularis palpebrarum and zygomaticus muscles. In the front of 9 we also find the centre for the movements of the tongue. Between the anterior and middle portion of 9 is for closing the jaw. On irritating 9 we have a retraction and elevation of the corners of the mouth. By irritating 6 the mouth is opened and the tongue is moved. c,c, causes a retraction of the corners of the mouth; c' lifts the corners of the mouth and half of the facial muscles as far as the closing point of the eyelids. The middle e (on irritation) opens the eye and dilates the pupil. Any disease which becomes located in any portion of this cortico- muscular brain centre and inflames or stops the power of these cen- tres must lead to paralysis of the centre which it controls. We therefore can locate any disturbance in the motor centres of the brain by the paralysis which occurs in certain parts of the body. A diseased condition of the covering of the brain, if not very extensive, generally causes the paralysis of one part of the body, as the single motor centres are separated and very distinct from one another. Diseases of the brain, when they occur in the inner surface between the capsules and the pyramids, where all the motor fibres are close together, cause a more or less complete paralysis of one side of the body. That is to say, a hemiplegia (affecting one side of the brain) causes the paralysis of the muscles of the other side of the body. For instance, if the disease is located on the left side of the brain, the muscles of the right side become paralyzed. In diseases of the spinal cord the muscles affected are on the same side, except in the case of diseases of the cervical portion of the spine, when, as a rule, paralysis is seen in all the extremities, and in disease of the lumbar region paralysis of the posterior extremities is seen. We therefore summarize in a general way that hemiplegia is usually a form of cerebral paralysis (of the controlling centres); paraplegia indicates a diseased condition of the spine; and monoplegia is due to a paralysis of the brain as well as the spine. This description gives only the fundamental theories on this subject. Concerning more precise details we 200 DISEASES OF THE NERVOUS SYSTE3f. would direct our readers to some one of the various physiological text-books. The most important peripheric paralyses which have been observed in the dog (by traumatism, compression, or exudation, inflammatory or degenerating processes of the affected nerves) are as follows: 1. Motor Trigeminal Paralysis. (Paralysis of the lower jaw.) The lower jaw hangs down; mastication is impossible; saliva runs out of the mouth. This condition occurs very frequently as a symptom of rabies. In rare instances it has been observed as a result of some other disease. 2. Paralysis of the Anterior Limbs. The front legs hang inert and all the joints flex very easily. 3. Paralysis of the Posterior Limbs. The hindlegs are dragged along the ground, the paws being flexed and drawn backward. If the paws are drawn forward and this flexion overcome, the animal is able to stand on its legs if the body is held. 4. Paralysis of the Cruralis. In this condition the animal does not use the posterior limb. All the joints become flexed abnor- mally, and the thigh bends backward. This condition may also be due to some disease of the spine. The most important test of paralyzed muscles is their size. In all cases of prolonged paralysis the muscles atrophy quickly. The muscle gradually becomes smaller and smaller until it resembles a cord or tendon. In cerebral paralysis this does not occur, while in spinal paralysis it is always present. Of course, in some in- stances an inactive muscle will atrophy without any actual disease being present. The amount of atrophy which may occur in cer- tain cases is indicated by a communication given to the author by Goubaux. In this instance the paralyzed anterior limb of a dog weighed 103 grammes, while the perfect limb weighed 148 grammes. Convulsions. Convulsion of the controlling muscles is the very opposite of paralysis. Convulsions are diseased contractions of the muscles which are independent of the will. There are several varieties of them. Clonic convulsions are short muscular contractions that occur at intervals, and between the intervals the affected portion of the body quivers constantly. Tonic convul- sions are muscular contractions in which the muscle remains con- EXAMINATION OF THE NERVOUS SYSTEM. 201 stantly contracted. It may occur for a minute or two, or may last several days. Tonic clonic convulsions are the medium form of the two conditions before described. A mild form of clonic con- tractions is noticed in the original muscular twitchings. Trem- bling and shaking convulsions seen in chills, fear, or sudden cooling after heat. Epileptiform convulsions, or eclamptic con- vulsions, are seen and extend over the whole body. In very rare instances they may be restricted to one portion, such as the head or neck. These generally come on suddenly and disappear in a few minutes. They are generally seen in the early stages of distemper, in teething, in irritated conditions of the bowels, or from noxious and poisonous food and from parasites; in cases of pentastomum in the nasal cavities, in encephalitis, meningitis, uraemia, and occasionally in acute ansmia; they may also occur from some injury or irritation of the peripheric centres, and are very prominent in epilepsy. Rhythmic twitchings are seen in some muscular regions where the affected part of the body makes regular motions; for instance, in the muscles of mastication, in the muscles of the chest during sleep, and also in the twitching of certain limbs. They are very often mistaken for chorea, and appear as a result of distemper or some disease of the brain. They may also occur from disorder of the spine. These so-called cataleptic attacks consist of a rigid and contracted condition of all the muscles of the body, but are subject to passive movements. Nothing is known concerning their etiology. Tetanic convulsions are tonic convulsions of the whole muscular system of the body. They appear in tetanus and in some cases of poisoning (strychnine, brucine, caffeine, etc.). A variety of these tetanic convulsions is observed in the so-called cases of eclampsia in bitches who are nursing a litter. Forced irregular actions of the body, such as walking backward or in a circle, or the animal rotating on its own axis, are seen as a rule in diseases of the cerebellum and in some cases of poisoning (cocaine). In rare instances we see, in the above-mentioned, symptoms of ^^ epileptiform attacks," which we will refer to further on. Ataxia is due to disturbance of motility or an interference in the coordination of muscular action. Animals are unsteady on their legs, stagger from one side to another, and their action in walking is irregular. Ataxia is undoubtedly found in some dis- 202 DISEASES OF THE NERVOUS SYSTEM. eases of the cerebellum, and may also be seen in disease of the pons and the fore ventricles, and, in very rare instances, of the spinal cord. Ataxia occurs very often as a result of distemper, and it occurs without any previous brain or spinal symptoms. Concerning disturbances of vision, hearing, and the action of the sphincters, they will be described under their special chapters. DISEASES OP THE BRAIN AND ITS COVERINGS. Hypersemia of the Brain. Etiology. An active congestion of the brain is caused by an increase of the circulation as the result of increased heart-action. This occurs in hypertrophy of the left ventricle, from excitement, from heat (sunstroke), in great bodily exertion, in teething, and high temperature. Passive hypersemia (stagnation) occurs in compression of the jugular veins by tumors, such as large goitres, by obstructed respiration in acute broQchitis, and in compressed conditions of the lungs, extended indurations of the lungs, defects in the venous openings of the heart. Hypersemia of the brain accompanies various acute internal diseases, and as a secondary symptom of a number of disorders; it is also seen as a result of various poisons, such as alcohol, certain narcotics, etc. Pathological Anatomy. As a rule, hypersemia of the brain occurs in connection with congestion of the coverings of the brain, especially the pia mater. When hypersemia is very intense, or where it has existed for a long time, we cannot definitely sepa- rate the conditions. We find the dura mater distended, but very little changed. The vessels of the pia mater are much injected, the torsions of the vessel are flattened, and the sulci are perfectly flat as if pressed out of shape. We find the gray matter is darker red than usual, while the white brain-substance is dull gray or yellowish-red, and presents numerous bloody spots which may be easily removed. In chronic conditions of this disease we find venous hypersemia. The brain appears in such cases pale and ansemic, very moist and soft, and on section has a brilliant, mirror-like lustre. It is lessened in size, and the subarachnoidal fluid is increased. HYPEBJEMIA OF THE BRAIN. 203 In a dog which had died suddenly from sunstroke Siedamgrotzky found all through the entire muscular system a number of small hemorrhages. Inside the skull was hypersemic. Between the dura mater and the arachnoid he found considerable accumulations of bloody serous liquid. The surface of the brain was greatly injected and covered with hemorrhages, and here and there small hemor- rhages in the brain and medulla. The chambers were normally filled with fluid. The lungs were congested and oedematous. The heart was collapsed, flabby, and filled with dark, clotted blood. Clinical Symptoms. The symptoms of hypersemia of the brain are characterized by a sudden development of excitable symptoms. These consist in restlessness, running around, frequent changes of position, irritability, a tendency to biting and attacks of delirium, partial or general convulsions, and an increased activity of the action of the heart. The pulse is quick and irregular; the respiration is short. There is congestion of the mucous membrane of the head, and the upper section of the head is warm to the touch. There is contraction of the pupils and occasional vomiting. These symptoms of excitement rarely last long; they generally disappear quickly, although in rare instances they may last some time without leaving any trace on the general system. They may, however, alternate with periods of apparent rest to recur again in a short time. We have observed this in cases of apoplexy of the brain. In this condition we have dulness, unsteady gait, and if there is entire stupor we have stertorous respiration with this last symptom. It is doubtful in such cases if we have to deal with actual hypersemia; more likely a more or less serious alteration in the brain. Therapeutics. Bleeding, as a rule, is contraindicated on account of the debilitated condition of most dogs. We would, however, recommend enemas (soap and Avater) and purgatives with quick action, such as sulphate of magnesium in large doses, senna- leaves, or castor oil . Cold compresses around the head are also useful, while violent purgatives such as croton oil, are not advis- able, as they excite the animal and do more harm than good. The animal should be put in a cool room and kept as quiet as possible, avoiding excitement, heat, and also feed the animal very little. In cases where marked symptoms of excitement show themselves an injection of morphine is generally indicated. 204 DISEASES OF THE NERVOUS SYSTEM. Anaemia of the Brain. Etiology. The most common cause of anaemia of the brain is from impoverished blood, acute hemorrhage, prolonged and debilitating disease, or from some obstruction of the arterial sys- tem, such as tumors, hemorrhages, or inflammatory exudations within the skull ; compression of the carotid arteries by emphy- sema, and in some instances from contraction of the small arteries of the brain caused by excitement. Pathological Anatomy. The white substance in rare in- stances has a few bloody points. As a rule, the brain appears on section dull white, the gray matter being unusually bright, without any trace of coloration. The meninges and coverings of the brain may possess their normal quantity of blood even in intense anaemia. Clinical Symptoms. Acute anaemia, especially when it has been caused by hemorrhages, is indicated by a small, weak pulse, distention of the pupils and a coldness of the extremities, attacks of dizziness, and loss of consciousness. Convulsions are rarely present in chronic anaemia of the brain, and very often stupidity, quivering of the muscles, great fatigue on the slightest exertion, loss of appetite, and a tendency to vomiting are noticed. Therapeutics. The therapeutic treatment consists in stimu- lants, such as wine, ether, camphor, etc. In the chronic form nutritive diet, blood-producing food, tonics. Cerebral Hemorrhage. (Apoplexia Sanguince ; Hcemorrhagia Cerebri.) Etiology. The chief cause of cerebral hemorrhage is an increased pressure on the vessels containing the blood, and where the walls of these vessels present some abnormal condition by which they are debilitated or weakened. This condition of the walls of the vessels may be caused by atheromatous degeneration, or by some disturbances in the nutritive process of those parts, as in serious diseases, except specific diseases, such as distemper, leu- kaemia, and in certain forms of poisoning. Pathological Anatomy. Hemorrhages appear, as a rule, on the cerebrum, and occur from a capillary hemorrhage, and CEREBRAL HEMORRHAGE. 205 are indicated by a slight red coloration which cannot be wiped off; but ill the most serious forms you may find a distinct number of spots which become confluent. In some cases there is a consider- able bloody discharge, indicating the breaking down of some large bloodvessel. If the bloodvessel is located in the hemisphere near the surface, the dura mater appears distended at the affected loca- tion; the convolutions of the brain are flattened and the furrows depressed. The substance of the brain is always more or less destroyed, and, if the animal does not die quickly, the discharged blood forms clots very rapidly. Its fluid parts become absorbed, fibrinous substances are formed, and the blood-corpuscles de- stroyed. The blood-substance is altered into a chocolate-colored emulsion and finally becomes absorbed. The coloring matter of the blood remains on the brain as a rose-colored pigmentation. The centre becomes smaller and smaller until we see the develop- ment of numerous connective-tissue adhesions uniting it to the wall, or an apoplectic cyst is formed which has a smooth inner wall filled with serum. This cyst takes the shape of the surround- ing parts. Clinical Symptoms. Without any premonitory symptoms we suddenly see serious cerebral symptoms — that is to say, apo- plexy. The animals drop, and immediately, or in a short time afterward, walk unsteadily for a distance, and then lose entire con- sciousness. The pulse becomes weak or irregular, or rapid and very small. The respirations are deep, stertorous, and irregular. The mucous membranes of the head are intensely reddened, and in the early stages of the attack convulsions are very frequently noticed. This is followed by partial or complete paralysis which is due to a direct destruction of the brain-substance, by the blood pressing on the brain. This paralysis may affect the extrem- ities, both anterior and posterior, that half of the body which is opposite to the extravasation in the brain being the one affected. The animal may also become blind. This disease may result: 1, in death, which occurs either in a few moments or may take days; 2, in complete recovery — this, however, only occurs where there is a small hemorrhage, and in the centre of the hemisphere; 3, in complete recovery with partial or complete paralysis, according to the amount of hemorrhage. The treatment of hemorrhage of the brain is connected closely with congestion of the brain, and it 206 HIS EASES OF THE NERVOUS SYSTEM. consists of applications of cold compresses around the head, of enemas, and, when there is a weak, irregular pulse present, of cardiac stimulants. Great hemorrhages of the cerebral membranes are marked by the same symptoms as apoplexy of the brain. Apoplexia men- ingia occurs generally in connection with violent traumatisms of the skull, such as shocks, concussions, fractures, etc. The blood is generally found in the cerebral membrane between the dura mater and the skull. It may also be observed in the subarachnoidal chamber and in the brain-cavities. The symptoms are similar to those of apoplexy of the brain, but, as a rule, convulsions appear earlier, and the animal, while he may present symptoms of coma, makes a much quicker recovery. The treatment is similar to that of cerebral apoplexy Inflamraation of the Brain. From a pathological standpoint we have to make a distinction between inflammation of the hard cerebral substance (pachymenin- gitis) and that of the soft cerebral membrane (leptomeningitis). However, this classification need not be used in a clinical way, because in the dog the described forms run their course with the same symptoms. Etiology. Inflammation of the brain is primarily a result of traumatism, such as sunstroke, great psychical excitement, over- exertion, etc. This occurs secondarily from disease, such as dis- temper and pyaemia, also with suppuration in the skull, in inflam- mation of the frontal cavities from parasites, and purulent in- flammation of the ear (in connection with external otitis). 1. Inflammation of the Dura Mater. Pachymeningitis. The dura mater is covered with a number of small hemorrhages. It is loose and easy to tear, and over the surface is a collection of bloody purulent masses of exudation. In the later stages of the disease we see a circumscribed or extended thickening and adhe- sion of the covering to the base of the skull or to the soft cerebro- membrane. 2. Inflammation of the Cerebral Membrane. Leptomeningitis. The arachnoid is loosened and dull. The subarachnoid chambers are filled with more or less torpid fluid. The pia mater is hyper- INFLAMMATION OF THE BRAIN. ■ 207 semic, loosened, and covered by fibrinous exudation. The cover- ings of the brain are almost always infiltrated and detached from the pia mater with difficulty and according to the amount of inflammation and purulent fluid that may be found in the ven- tricle. In a chronic case we have a circumscribed thickening of the cerebral membranes and adhesions uniting the coverings with the brain, etc. 3. Inflammation of the Brain Mass. Encephalitis. This dis- ease, as a rule, involves single centres and causes a general irrita- tion of the healthy tissue without any distinctly marked limit. In the affected regions the substance of the brain is swollen, hyperaemic, and frequently filled with small hemorrhagic centres. In the course of time the inflamed cerebral substance becomes softened and pulpy. This condition may be present without any hemorrhage, but as a rule the brain matter becomes red and finally yellowish. This latter color is due to metamorphosis of the color- ing substance of the blood or to fatty degeneration. These con- ditions are divided into white, red, or yellow — softening of the brain. Finally cicatrices and cysts are formed, as in apoplexy, or an abscess may be developed which is filled with thick yellow or greenish pus, and becomes encysted and sometimes solidified (calcareous). In some cases small encephalitic centres may heal without leaving any trace. In some cases we see the development of a (non-inflammatory) softening of the brain with thrombosis and embolus of the arteries; and, as a general rule, we find symptoms which resemble apoplexy very much. Clinical Symptoms. The symptoms of inflammation of the brain in its early stages resemble those of hyperemia. The ani- mals are excited; they run aimlessly from one side to the other, and are fretful and irritable. They whine and howl constantly. The head is hot; the conjunctiva is more or less reddened, the pupils are contracted, and the reflex action is very slight. The appetite is lost; constipation is generally present, and more or less vomiting. The patient is indifferent to the impressions of exter- nal objects, being sleepy and apathetic. Soon the disease changes in its character. We see acute convulsions, especially those of the jaw, or eclamptic convulsions. The animals cry and howl. At the same time the sphincters are relapsed, the animal apparently having no control of them. Then there is an interval of quiet- 208 DISEASES OF THE NERVOUS SYSTEM. ness, in which the animal falls back into a deep semicomatose con- dition, and between these periods of quietness we very often see automatic movements, such as quivering or twitching of one or two of the legs ; also the corners of the mouth may be retracted. Many cases either howl constantly, and at the same time seem to be semicomatose, or they may bark hoarsely (delirium). As a rule, the temperature is a little above normal. Within a short time the animal becomes gradually paralyzed, losing all power of the muscles. The patient is dull and unconscious of external influ- ences. The breathing is rattling and stertorous. The pulse is increased a number of beats, but is almost imperceptible to the touch. The temperature now begins to rise. In some cases the temperature may remain normal, and in rare instances has fallen below. As a rule, the animals die shortly after the convulsions make their appearance. Complete recovery is very rare, and slight attacks terminate as a rule either with paralysis (partial or complete), idiotism, or blindness. Very similar symptoms to those already described appear in cases of cysticercus cellulosse in the brain or its membranes. Sie- damgrotzky found in the dura mater of both hemispheres of a dog, which had suddenly developed symptoms of encephalitis and which died in twenty-four hours, twenty-three sacs the size of a pea. This is peculiar from the fact that the animal had been per- fectly healthy up to twenty-four hours before its death, and had not shown the slightest loss of intelligence or in muscular move- ment. Therapeutics. The treatment of inflammation of the brain corresponds with that of hyperemia of the brain. Rest, cold applications to the head, clysters, laxatives, especially calomel. In cases of great excitement sedatives (morphine, sulphate 0.02 subcutaneously, chloral hydrate 2.0 to 4.0 by the mouth or per rectum in the form of clysters). The violent irritants which were formerly used on the skin, such as croton oil rubbed on the inner fascia of the thighs and along the spine, or cantharidal ointments, are of no particular benefit. The course of this disease varies greatly in affections of the cerebellum. If the hemispheres are affected, we may have exten- sive alterations of the brain, which may run their course without any decided symptoms being shown ; but as soon as the cerebellum CEREBROSPINAL MENINGITIS. 209 and one or both hemispheres become affected we then see the various symptoms peculiar to this disease, and a diagnosis can be made with ahnost absolute certainty. In diagnosing disease of the cere- bellum there is generally an unsteadiness of the gait in walking. There are peculiar movements, such as walking around in a circle and rolling on the ground, when both hemispheres are involved. We may have paralysis of the posterior extremities. In rare instances, however, these symptoms may be presented in cases of poisoning (by cocaine or apomorphia). The therapeutic treatment of this disease is not very definite. In cases of simple unsteadiness of the gait the author has been able to secure good results by means of laxatives and collodium of cantharides applied to the neck. Where the animal turns in a ring constantly, or rolls on the ground, such agents as morphia, chloral, and bromide are often used. DISEASES OP THE SPINAL CORD AND ITS MEMBRANES. Cerebro-spinal Mening-itis. (^3Ieningitis Cerebro-spinalis. ) Etiology. Nothing is definitely known of the causes of this disease. It is extremely rare in the dog. Renner and Kempen have made several observations on the subject, and the author had one case of his own. In this the disease seemed to be related, in some way, with a wound on the anterior extremity. Pathological Anatomy. The anatomical foundation of the disease seems to be an acute suppurating inflammation of the brain and spinal membranes, for Renner, as well as the author, found purulent exudation in the arachnoid, especially on the hemi- spheres and the base of the brain, which was infiltrated by a quan- tity of serous fluid. The same condition was also found in the spine. Clinical Symptoms and Therapeutics. The symptoms which were observed by Renner and the author were disturbances of the sensitory nerves, in some cases the animal becoming uncon- scious. There were loss of appetite, fever, and on the fifth day a marked unsteadiness of the gait, beginning with a slow, dragging 14 210 DISEASES OF THE NERVOUS SYSTEM. walk, and becoming complicated with tonic convulsions which become finally epileptic, and, lastly, stupor, coma, and death. Renner treated two cases with calomel, opium, and purgatives. The author did not have good results, although he treated a case in the same way. Inflammation of the Spinal Cord and its Membranes. {Myelitis and Spinal Meningitis.) Etiology. A common cause of myelitis and spinal meningitis is traumatisms of some kind causing direct injuries to the spine. It may also be caused by simple contusions, violent blows, shocks, falling out of a window, etc., and further by concussions of the spinal cord. Violent muscular exertions frequently bring it on. In very rare instances the disease may follow the presence of an abscess on the outside of the spinal canal (for instance, in one case which was observed by the author, in the long muscle of the back), by extension of the suppurating process through the orifice of the vertebra, and occasionally you see it originate in connection with some infectious disease (distemper, rabies, pysemia). It may also be caused by cold. Pathological Anatomy. The inflamed pia mater appears thickened, infiltrated, and injected in some places, and, as a rule, adherent by means of the exudation to the spine itself. It is covered on its upper surface by a serous, fibrinous, or purulent exudation. The arachnoid exudation is covered by a milky, false membrane and greatly thickened. The dura mater is rarely involved, but when such is the case it becomes thickened and loosened, and covered with a thin serum. The spine itself shows the inflammatory process either extended over large surfaces or else confined to small centres. In the early part of the disease the spine is slightly swollen ; the gray substance is somewhat red- dened, dark, and soft. Later the spine becomes a yellowish-red, breaks down and undergoes white, yellow, or red degeneration. In the chronic course we see atrophy of the nerves as a conse- quence of malformations of the connective tissue. Clinical Symptoms. The symptoms of alteration of the spinal cord appear gradually, and become more intense as the dis- INFLAMMATION OF SPINAL CORD AND MEMBRANES. 211 ease progresses, where the disease is due to violent traumatisms, producing a direct destruction or laceration of the nervous centres, or pressure, which is caused by the blood being discharged and pressing upon the spine. In all diseases of the spinal cord it is very important to recognize the fact that consciousness is present. As a rule, the symptoms appear either slowly or quickly, accord- ing to the amount of irritation present on the spine itself, and in cases where the spinal cord is very much involved and compressed by masses of exudated serum we find complete paralysis. We will take up all these symptoms in the following description, which may be observed in affections of the spinal cord : 1. Motor Symptoms of Paralysis. These are, as a rule, the first symptoms presented. The patients have a heavy, dull look ; stag- gering gait, but not irregular (in this it differs from disease of the cerebellum). Finally, they drag their hindlegs ; as a rule, these extremities are the parts paralyzed. When they are placed on their legs they stand with tliem spread apart, or they may simply drop sideways on their hind-quarters. In rarer cases, not only the posterior extremities but also the anterior are paralyzed, and it is evident that in cases of paralysis of all the members the spinal substance of the neck must be affected, while paralysis of the posterior extremities must occur no matter what part of the spine becomes affected; it may be in any part of the spinal column. In these cases we ah\'ays have the double-sided paralysis; and in very rare cases paralysis is marked more intensely on one side than the other; but, as a rule, it is very rarely present, and we can only suppose that in one-half of the spinal cord the disease is more advanced than in the other. 2. Motor Symptoms of Irritation. These appear in the shape of slight, irregular twitchings, rarely of any great consequence, and seldom leading to convulsions. They are generally noticed in the early stages of the disease upon the extremities. 3. Disturbances of Sensitiveness, We observe more rarely dis- turbances of sensitiveness in the shape of hyperaesthesia than in the form of anaesthesia. In the former it may invariably be observed in the early stages of the disease that patients show intense pain, especially when touched, lifted, or pressed upon the spinal cord. (This they indicate by biting, howling, etc.) In the latter case they do not show the slightest reaction in the 212 DISEASES OF THE NERVOUS SYSTEM. affected regions even when subjected to serious irritations of the skin. 4. Disturbances of the. Sphincters. In mild stages of this disease the sphincters, such as the bladder, appear sUghtly affected. In the serious stage we observe complete paralysis, loss of control of the sphincters, and complete paralysis of the sphincter vesicae. More details will be introduced on this subject under Diseases of the Bladder. Such paralytic conditions of the bladder may occur in all diseases of the spine. There is difficulty in the passage of fecal matter, as a consequence, producing constipation and paralysis of the intestines, caused to a certain extent by the loss of abdom- inal pressure. This is evinced by a gaping rectum and escape of fecal matter which accumulates in the lower bowel. 5. Nutritive Disorders. Through want of active exercise the muscular system of paralyzed animals, especially the extremities, becomes flabby, soft, and atrophied. The temperature is reduced in the paralyzed portion, the extremities being cold and ansemic. In cases where there is paralysis of the spinal cord caused by compression, and in cases of atrophy due to hemorrhage on the spinal cord, and also in certain luxations or fractures of the verte- brae, we see the same symptoms. (a) Paralysis of the spinal cord caused by compression may result from thickening of the membranes and pressure on the spine itself. It may also occur in some diseases of the vertebra, for instance, in exostosis, but both of these are very rare. In such cases the symptoms come on very slowly and gradually increase in intensity. (6) Apoplexy may occur, due to the presence of some blood escaping on the spine and causing pressure. In these cases the paralysis appears very suddenly, but may gradually disappear after some time. (c) Luxations of the spinal cord only happen in the vertebra of the neck, and cause a peculiar oblique position of the head, as if it were twisted to one side. This is due to displacement of the ligaments. At the same time there is present a series of what might be called '^ special symptoms," which are not very pro- nounced in any of their characters. (d) Fractures of the spine : These are generally recognized by some change in the position of the region in which they are located INFLAMMATION OF SPINAL CORD AND MEMBRANES. 213 (bending inward, flattened depressions, and in rare instances slight distortions of the spinal cord), and also by the extensive sensitive- ness to pressure in this location. In certain instances there may be an abnormal mobility of the part. Crepitation, as a rule, is absent. In fractures of the cervical vertebrae we generally notice an oblique position of the head. If the symptoms just described are absent, when an animal has had a severe fall on the spine, unless paralyzed or remains so without loss of consciousness, it is always doubtful if there is a fracture of the vertebrse or a hemor- rhage within the vertical canal. In such cases we simply have to await developments, or if paralysis does not immediately follow the injury, but comes some time afterward, it is due to compres- sion of the spine from a gradually increasing hemorrhage. We must remember, however, that a fall, shock, or blow upon the back, or ordinary irritations of the spinal substance may occur, like a concussion of the brain, in which there is not the slightest alteration to be found in the spinal substance, or its membranes. In many cases we may expect a recovery as long as there is no myelitic complications. Therapeutic Treatment of the Diseases of the Spinal Cord. In the early stages of the disease when fever, hypersemia, and accompanying convulsions give pronounced evidence of the disease, it is advisable to give antiphlogistic treatment, consisting of compresses upon the spinal cord, and vigorous purgatives (calo- mel), and lastly enemas. In cases where the paralytic symptoms predominate we use irritants along the spinal cord, such as can- tharides, croton oil, or biniodide of mercury. Sometimes in mild cases mustard oil. If we succeed in lessening the convulsions, or if the paralytic symptoms predominate, we must use stimulants, such as strychnia and electricity. The first should be used internally in the form of tincture of nux vomica, from five to twelve drops, or subcutaneously in a strychnia solution; the latter method is the better. We must remember that one daily injection is sufficient, and that a medical pause of from thirty-six to thirty-eight hours ought to be made every four or five days, in order to prevent the cumulative influ- ence of this drug. R. — Strychnia muriate 0.005 Aqua 5.0 214 DISEASES OF THE NERVOUS SYSTEM. Electricity is applied in the following method: One pole of the battery is placed on the spine and the other at the termination of the paralyzed limb. For instance, one is put on the foot and the other in the middle or side of the spine, gradually increasing the current after having previously dampened the region with a con- centrated saline solution. In such cases, besides administering a purgative and cleansing the bowels, we must also see that the bladder is emptied by means of a catheter. Electricity is also a useful agent in peripheral paralysis, which has been mentioned. The faradic current is preferable. Place one of the poles as close as possible to the point of the central location of the affected nerves and rub the paralyzed muscles with the other pole. This treatment should be renewed every day for ten or fifteen minutes. Alcoholic frictions, which are so popular among the general public, are of slight value and only to be recommended when connected with true massage (pinching, friction, and massage of the paralyzed muscle in its proper direction). Epilepsy, Epilepsy is a disease which is rare in the dog. Its chief symp- toms are irregular attacks of unconsciousness accompanied by acute convulsions in older cases. Etiology and Pathological Anatomy. The causes of epi- lepsy are unknown, but at the same time there is no doubt that certain diseases of the brain and its membranes, especially chronic diseases, very frequently cause epileptiform seizures which are similar to true epilepsy, and we may also observe in some cases a reflex epilepsy, which does not resemble true epilepsy in any way except in some general symptoms. These will happen after trau- matic legions of the peripheral nerves, in intestinal parasites, in poisonous substances in the intestines (for further particulars, see page 201). We may also observe epileptiform convulsions in dis- temper. In true epilepsy there are no anatomical alterations to be found in the brain. Wherever they are found they cause epileptiform convulsions. It is, therefore, certain that in a case of epilepsy it is only due to some temporary irritating condition, and that the membranes of the brain are the starting-point of the irritation. EPILEPSY. 215 The experiments which have been made lipon dogs in connection with this disease by Ferrier, Eulenberg, Landois, and others are interesting. They found that with great irritation of the motor regions of the large brain (the cerebrum) a complete attack could be produced. This begins with twitching of the muscles which belong: to that centre. It then becomes extended over the corre- sponding group of muscles on the other side, producing shocks and twitching of the whole muscular system of the body from tonic and, later, clonic convulsions. The convulsions extend from centre to centre, and they never miss any region, but run consecutively from one to the other. If the chief centre is cut out, the convulsions will not be present in that region during the epileptiform attacks. Irritation of the subcortical white substance of the brain also causes epilepsy. This begins, however, in the muscles of the same side. Bromide of sodium administered for some time has been found very valuable in preventing epilepsy caused by membranous irritation. From the above experiments it can be readily understood that the membranes of the cerebrum are the original centres of epileptic attacks. It is hard to explain, however, the actual cause of this irritation. Epilepsy can hardly be caused by over-stimulation or feeding, for, as a rule, the largest number of true epileptic subjects are weak, delicate, and ansemic; but at the same time we often see vigorous, well-fed dogs of all ages suffering from this disease. There are many cases in anaemic animals which, under treatment, gradually improve, at the same time the epileptiform attacks be- coming less and less as the animal improves. It is doubtful if these cases can be called true epilepsy. [The translator is inclined to think that quite a number of these cases should be classed under the head of hysteria; in two cases in particular where he advised to have them castrated (ovariotomy), he found in one case a large cyst attached to the ovary, and in the other intense hyperseraia of the ovary (the left). After the oper- ation both animals made good recoveries ; one, however, had slight attacks for three months afterward, A third was operated on that had been affected for two years, and the ovaries were found to be hypertrophied and congested. In this case the attacks were lessened, but not entirely cured.] Clinical Symptoms and Course of the Disease. In acute attacks of epilepsy the symptoms begin suddenly, or they may start 216 DISEASES OF THE NERVOUS SYSTEM. with slight premonitory symptoms. In the later stages the ani- mals run in a circle, are restless, have a staring look out of their eyes, or remain standing with outstretched legs, and shake their heads from side to side. We soon see clonic convulsions followed by loss of consciousness, and in some cases a rapid change into clonic tonic convulsions. The muscles of mastication are especially affected. Single muscle-contractions follow one another with aston- ishing rapidity, so that the saliva which lies in the mouth is turned into foam. The convulsions, which are now tonic, extend over the whole muscular system. The body and neck are drawn backward or sideways; the legs are stretched; the respirations seem to cease. This tonic form of convulsion lasts but a short time. A few seconds after its appearance it has altered into clonic cramps of the muscles, especially noticed in the legs, which are frequently twitched. After a few minutes these twitchings stop ; the animal lies on the ground for some time; it finally rises and recovers very quickly. The pulse and temperature during an attack of this kind present no alteration of any consequence. The mucous membranes of the head are reddened and congested. This is noticed at the termination of an attack, and is probably due to the interruption of perspiration and the slight respiratory move- ments. In very rare instances an involuntary passing of feces and urine is noted during these convulsions. There are also certain forms in which the animal is restless, running from side to side, or having fainting spells (dropping on one side), slight muscular twitchings of the head or extremities, and occasionally, in mild attacks, a very slight twitching of the jaw. The duration of these attacks varies, as a rule, not lasting very long, generally only a few minutes, although severe attacks have been knoAvn to last for five or six hours. Their frequency is very uncertain; some animals have had several attacks daily, while in others they have appeared at intervals of months. A peculiar feature of some cases of true epilepsy was the frequent attacks on the slightest excitement. Therapeutics. No agent seems to have any decided effect upon epilepsy. The author has tried a number of remedies, one after another, without result. Bromide of sodium seems to be the best (this is preferable to bromide of potassium, as it has no detri- mental effect upon the appetite), provided it is given in substantial CHOREA. 217 doses. With this drug it is always possible to prolong the inter- vals between attacks; they are also shortened, and relatively less serious. Other agents, such as oxide of zinc, arsenic, nitrate ot silver, belladonna, hyoscyamus, valerian, bromo-hydrate, cold water, and electricity. R, — Bromide of sodium 15.0 Aqua 150.0 S. — One tablespoonful three times daily. In connection with this disease we must devote a few words to convulsions of young animals. We very often see weak, debili- tated animals which are backward or poorly fed, but which have rickets as a consequence of reflex irritability during the course of catarrhal diseases of the digestive tract or of the nasal cavities. We also notice them after the absorption of large quantities of fermenting, indigestible food, in constipation, and in cases of intestinal parasites, at the time of teething, and also as a conse- quence of great psychical excitement. We often see spontaneous convulsions; these are very similar to epilepsy, and are probably of reflex origin. In some of these cases we may have to deal with true epilepsy, but, as a rule, they may be ascribed to an undeveloped form of distemper. In some cases it may be due to some brain affection, such as congestion of the membranes. It cannot be denied, however, that there are a great number of convulsive attacks for which the cause remains obscure. We may, therefore, conclude that we can only obtain an approx- imative insight into these convulsions by the symptoms which are presented. Frequent occurrence of eclamptic attacks with a short interval between must be considered as a very serious symptom. The therapeutic treatment of convulsions consists in the use of applications of cold water to the head; large doses of bromide of sodium, morphia, and similar sedative agents. We must also take into consideration the causes of the disease and keep the animals as quiet as possible. Chorea. {St. Vitus' s Dance.) We define this disease as a persistent clonic convulsion of some muscular group in certain parts of the body. For instance, shak- 218 DISEASES OF THE NERVOUS SYSTEM. ing of the head, twitching movemeuts with one or two legs, reg- ular, rhythmic contractions of the mouth, and also an automatic opening and closing of that part; regidar movements of the tongue, and an undulating action or movement of the whole body. If the patients are left to themselves, the twitching action is gener- ally less marked, and under physical excitement becomes much more aggravated. For instance, when eating, if any pain is present, and during catarrhal conditions of the air- passages, or the intestines, stomach, etc. The choreic movements lessen during sleep and under the influence of ether, chloroform, and bromo-ether, but morphia and chloral have little or no influence upon them. Sensitiveness and consciousness are not disturbed in any way whatever, but are perfectly normal. The course of this disease is slow, and may extend for months and years ; but, as a rule, the symptoms lessen, and in rare instances may disappear entirely. A fatal termination is only to be feared when compli- cations arise. Etiology. Under the name of chorea there are a great many complications of the dog which should really be classed under another head; for instance, nervous distemper, or obscure cerebral diseases, also myelitis, and some cases of symptomatic chorea. In true chorea of man we do not see any pathological alterations of the brain, and in the few cases which the author had to con- sider as true chorea on account of the aneemia, absence of any symptoms of distemper, or other diseases of the brain and spine, the convulsions were restricted to certain special muscular groups, and not, as in human chorea, to irregular regions — that is to say, in the various muscular centres of the body. In some of these cases the animals were destroyed, and their post-mortems gave an entirely negative result, there being no apparent pathological change in the central nervous system. As a rule, the affected animals are in an ansemic condition and show all the effects of bad nutrition, and, after some observation, we are convinced that with improvement in the general system the choreic symptoms become very much lessened. Therapeutics. The author has tried all the various agents recommended in this disease, but without any decided results. Arsenic, either in the form of Donovan's or Fowler's solution, or alternated with some preparation of iron, has given the best TETANUS. 219 results, but these drugs must be given for some time, and it is only after prolonged administration that any favorable result is observed. The author thinks that more benefit is derived from a nutritive diet than anything else. Antipyrine, which is used in man, is of not much service in the dog. Bromide of potassium, chloral hydrate, oxide of zinc, nitrate of silver, electricity, and hydropathy can all be used. Catalepsy. Catalepsy, or ^' cataleptic rigidity," is understood to be a pecu- liar rigidity of the muscles in which the animals may be placed in certain positions and will remain so. Consciousness and sensitive- ness seem to be suppressed entirely. Such an attack lasts for hours and days, and (according to Hertwig) for weeks. In many cases they finally relapse and die in a short time. If this is really a disease, or merely a symptom of some brain complication, the author has not been able to positively determine. Hertwig mentions as causes of catalepsy cold, fright, overload- ing the stomach with indigestible food, and metastases in various diseases, while Fr5hner considers this disease as a purely func- tional neurosis of the brain and spine. He found it impossible to recognize any definite alterations in the central organs, either in catalepsy, eclampsia, or tetanus, but he found occasionally certain secondary alterations in the muscles, namely, hemorrhages, dark venous swellings, and fatty degeneration of the muscles, also waxy degeneration of the fibres of the heart. No practical therapeutic treatment is known. Frohner advises electricity and cold douches as a means of restoring the disturbed reflex irritability of the nervous system. Tetanus. {Lockjaw. ) This very rarely occurs in the dog. The symptoms consist (according to Hertwig and Siedamgrotzky) in a stiff, stilt-like gait, the head and neck being distended and drawn, the eyes fixed, the ears more or less retracted and stiffened; prolapsus of the nictitating membrane ; wrinkling of the skin of the forehead ; con- 220 DISEASES OF THE NERVOUS SYSTEM. vulsive closing of the mouth, making the animal utterly unable to eat, bark or drink; great fretfulness, and hardness of the mus- cles, which when touched no symptoms of pain are shown by the animal. Consciousness is not affected, and the temperature is generally normal. [The translator has observed two cases in which the temperature rose to 43°.] The therapeutic treatment consists in lessening the irritation by narcotics, especially morphia, clysters, chloral; and if there is any wound present, it must be treated with poultices or anything to lessen the irritation. It is almost certain that a great majority of cases are due to diseased wound-infection and the presence of microbes (tetanus bacilli). These bacilli remain in the wound or in the neighborhood of it. It is generally advisable, therefore, to cauterize, or, better still, to excise the wound with its entire sur- roundings. The author does not consider it impossible for the bacillus of tetanus to enter the organism in other ways than directly through the skin. Eclampsia. Eclampsia, which is not a very good definition, is a tonic-clonic convulsive spasm which is observed iu bitches, and, as a rule, during the attacks the animal is perfectly conscious. Etiology. The causes of this disease are very little known. According to Hertwig, it may be caused by cold, stagnation of the milk in the udder, taking away the young, and sometimes by worry. In one-third of the cases of true eclampsia which were observed by the author, all the young were still with the mother, [The translator has observed a large number of cases of this disease, and invariably found the animal weak, inclined to be delicate, light in bone, but to be excellent mothers, and the litters were generally strong, healthy pups. They laid on flesh very quickly while the mother lost it. The onset of the disease was generally at the end of the second or third week.] In the rest of the cases, either one or more had been taken away from the mother. In the onset of the disease the mammary glands contain very much milk. The animals are generally small, delicate (house dogs and pet animals), and, as a rule, have a light coat. Friedberger and Frohner are of the opinion that the disease may originate from anaemia of the spinal cord, or in a reflex way from ECLAMPSIA. 221 the lacteal glands. With this last theory the author is inclined to agree. According to the statements of authors, deep anatomical disturbances of the brain may be caused directly from the mam- mary glands. Friedberger has observed two bitches that had eclampsia without having puppies. Clinical Symptoms. The disease may appear in from forty- eight hours to thirty days after whelping ; very rarely later than this time; in the majority of cases appearing at or about four weeks. In one case of Friedberger's fifty days elapsed. It comes on suddenly without any marked symptoms. The animals become restless and anxious; they have a staring expression of the eye, short, rapid respiration, reddened mucous membranes; they show no pain from pressure on the walls of the chest, neck, or abdomen. After a short time (about a quarter of an hour after the appear- ance of increased respiration) they become paralyzed, are no longer able to stand on their feet, and remain for some time with their legs stretched from them. A slight increase of temperature has been observed in several instances at the onset of the disease. The dog lies on her side with her legs firm and tense; the muscles of the body hard and quivering to the touch; the joints are stiff and hard to bend; and at intervals we see clonic convulsions of all the muscles, especially those of the extremities, and the respiratory muscles are especially involved. The respirations become more rapid as a consequence of this, and finally the mouth is opened and the tongue protrudes, while the animal breathes with great difficulty. The pulse is small, hard, and sometimes irregular, and always quick; the eyes are staring and protruded, and there is an anxious look in the face. All the visible mucous membranes are cyanosed. The saliva which accumulates in the mouth is either swallowed convulsively at certain intervals, or, as is generally the case, it dribbles out of the corners of the mouth. As a rule, con- sciousness is not disturbed. The pupilla are normal in size; reflex action is present. The animal seems to notice external objects or impressions, such as calling the patient, or noticing one it knows coming into the room. The appetite is lost; the normal discharges are entirely suppressed; the urine, after such an attack, gives an albuminous reaction. The attack may last for twenty-four hours, but generally varies a little in intensity. If the attack is very acute, the animal falls into a deep comatose condition and dies in 222 DISEASES OF THE NERVOUS SYSTEM. about forty-eight hours after the onset of the disease from apoplexy and paralysis. Therapeutics. Any of the narcotics can be used, and, as a rule, produce good results. Here they use injections of morphia, which were first recommended by Siedamgrotzky; the quantity is 0.002 to 0.005 gm. of muriate of morphia diluted with water. As a rule, a few minutes after the hypodermatic is administered, the animal becomes quiet and rests easily. Inhalations of chloro- form, chloral hydrate, bromide of potassium, etc., are also recom- mended. Warm baths and friction produce relaxation of the tense muscles. Valerianate of zinc in 0.5 gm. dose every two hours. DISEASES OP TRUE INFECTION. Distemper and Contagious Catarrhal Fever. The definition of the word " distemper " means a disease which is peculiar to the canine race, and it is caused by specific poison which finds its way into the system, as a rule, through the lungs and air-passages. It generally attacks young animals and runs its course as a catarrhal fever, affecting all the mucous membranes of the body, and almost invariably accompanied with certain nervous symptoms, also skin eruptions. Etiology. Distemper is a disease which is contagious in the highest degree, and is only communicated by infection. An animal affected with distemper can remain but a short time in any locality and affect every animal there. As a rule, few young animals escape distemper, generally contracting it before they are a year old, and dogs over that age very rarely take the disease. That, however, may be accounted for from the fact that dogs having arrived at that age have either come in contact with the disease previous to that and they have had it in a mild form, or the system was in such a condition that they did not contract it. The disease affects animals but once during life, although a few exceptions are presented where animals have contracted it the second time. As a rule, delicate, weak, poorly-fed animals (vegetable diet), or ani- mals which have been affected by some catarrhal disorder of the respiratory mucous membranes, contract the disease in its acutest form ; while, on the other hand, dogs which have lots of exercise, especially animals in the country or small cities, are mildly affected with the disease. Distemper exists in all countries of the world. In the large cities it is found at any season of the year, while in the country it is generally present during the warm weather. The specific poison of distemper is not definitely known. It is undoubtedly a fixed and volatile poison which enters the system by the mouth and nose, and it exerts its first influence on the respiratory passages. Vaccination of young animals by means of the secretory fluid (223) 224 DISEASES OF TRUE INFECTION. from animals affected with this disease has been tried, and often, as a rule, produces the disease artificially. Semmer believes that he has definitely defined the contagious germ in the blood, and also found it in the lungs, liver, and spleen, in the form of small, dagger-shaped microbes, which he calls the ^' bacilli of distemper." Rabe has found in the secretion of the nose and connective tissue, also in the blood, small cocci which accumulate in heaps, or are generally together in small groups of three or four in a superficial sac-like manner, or they may hang together like a string of beads. In some cases they take the form of a light, thin membrane, which is easily colored by methyl-violet. He considers these as the specific infecting agent of distemper, but this theory is one that Friedberger does not agree with. Matins found in the mucus contained in a pustule a diplococcus which could be colored with fuchsine. He used bouillon cultures of this for the inoculation of dogs. These were affected by symptoms which resembled very closely those of distemper. Marcone and Meloni found a micrococcus in the dog which was affected by distemper, and considered that this agent was the true pathogenic fluid, as it produced the skin eruptions, broncho-pneumonia, and gastro-enteritis in dogs which had been inoculated with pure cultures. Legrain and Jaquot obtained pure cultures of micrococci, when held in certain medi- ums, from fluid obtained from the bladder in the exanthematic form of distemper. These were gathered together and in the form of diplococci and short chains. In dogs vaccinated with these cultures the skin eruption, with the development of pustules, was seen only, but the subjects so treated seemed to enjoy immunity from the disease. Millais made cultures from the nasal excretion of the dogs affected by distemper upon gelatinous cocci of two various bacilli, which, on inoculation, produced distemper. [Galli- Yalerio has isolated ovoid bacilli two micro-millimetres in length which grow freely in gelatin. These he found in abundance in the lungs and central nervous system, but did not find them in the blood. The inoculation of the cultivations produces charac- teristic distemper in puppies, but did not give the same results in adult dogs. This he accounts for in that they may have had pre- vious attacks of the disease, and were thus protected.] Direct vaccinating methods have been practised by various prac- DISTEMPER AND CONTAGIOUS CATARRHAL FEVER. 225 titioners. For instance, Trasbot placed secretions from the nose and bladder of animals affected with the disease in the abdominal wall of healthy young animals. The disease appeared after eight days. Krajewski vaccinated numerous young animals with secretions of the nose and pustule, these inoculations being on the mucous mem- brane and under the skin, and arrived at the following conclusions : 1. The contagious germ of distemper sticks to the secretion of the nose and eyes, and the blood is also contagious. 2. The germ does not lose its virulent properties in any degree when dried at a normal temperature, or frozen at 18° to 20° of cold. However, its virulence becomes attenua;ted when kept for any length of time in a dry place. 3. The disease, which is produced by vaccinating, runs a very mild course, and kills, as a rule, from 10 to 15 per cent., while the ordinary disease kills from 32 to 70 per cent. Laossou has obtained the same results after vaccinating ninety-eight animals, and found also that the contents of these pustules are generally inactive, and that the nasal secretion loses its virulence after eight days. Fried- berger's observations are diametrically opposite, for he contends that he has caused infection by means of the contents of the pus- tules. He also recognized in one case that the disease originated from vaccination passed through a short intervening stage, and, as a rule, was much less in intensity, ran a very rapid course, and that the group of pustules was confined to the region of vaccina- tion. Schantyr has lately published certain observations concerning the microbes of distemper. He agrees with Plitz that distemper of the dog resembles distemper in horses to a remarkable degree, and his theory of the subject is that distemper may be classified into three diseases, according to the presence of three micro- organisms of different characters. These diseases are : Abdominal typhus, true distemper of the dog, and canine typhoid. Their clinical as well as their pathological symptoms have a great sim- ilarity with one another, and it is only with a careful microscopical examination that the specific micro-organisms can be separated. The bacilli of typhoid (small, short bacilli, which are almost ex- actly like man's bacilli) are generally found separate in the blood, while the bacilli of distemper (small, somewhat bead-shaped) and 15 226 BISEASES OF TB UE INFECTION. the bacilli of typhoid (typhoid are very small and thin) are gen- erally arranged in groups. The bacilli are hard to color with fuchsiue, and become colorless with Graham's test. This is not the case with the bacillus of typhoid. Typhus and typhoid bacilli give characteristic cultures upon gelatin and potato, while the bacillus of distemper is extremely hard to culture under any cir- cumstances. Clinical Symptoms and Course. The stage of incubation of distemper is generally from four to seven days. In rare cases it may linger, after contact with the diseased animal, until eight or twelve days, and Krajewski states that cases of infection through cohabitation may sometimes take from two to two and a half weeks to develop. The first actual symptom is an increase of temper- ature. In the initial stage it rises to 40°, and some cases 41° and over. An increase in temperature has been observed by the author in all cases of distemper, when the examination was made early in the disease. Later on the temperature falls slightly, but in some cases very rapidly, and it may even go to the normal point, accord- ing to the condition of the animal. In cases developed by inocu- lation we occasionally find a marked increase in temperature. The next symptom is the disturbance of the general condition. The animal is depressed, restless, has little or no appetite, seeks heat, becomes easily fatigued, is chilly aud shivering, the nose is hot and dry, the skin is hard, and the hair becomes harsh and dry. In some instances vomiting occurs, but that caa hardly be called a characteristic, initial symptom of the disease. This stage of the disease is short; the symptoms increase rapidly, and have many characteristic points, which are as follows: 1. Symptoms on the External Membranes. These appear in the majority of cases and are of great importance. We see a number of small red spots upon the inner fascia of the thighs, the abdo- men, and in rare instances the mouth and eyes, and still more rarely covering the entire body. They are generally scattered, very rarely confluent. They rapidly form small bladder-like blis- ters filled with serum, and later on this serum changes to pus. They are about the size of a lentil or small bean, and soon dry up, forming yellowish scabs and crusts. After these scabs fall off (generally in about one week), they leave on the skin a red, cir- DISTEMPER AND CONTAGIOUS CATARRHAL FEVER. 227 cular spot which disappears slowly. In other cases we find more or less depth to the cicatrix, leaving pit-like ulcerations. They are probably due to the animal scratching or gnawing the sore. This is the only skin eruption that characterizes this disease, and it dries up very quickly, so that in from eight to fourteen days we see no other marks except those light, granulating spots (exan- thema of distemper, distemper-pox). Hertwig and Friedberger have observed some cases in which this eruption made its appear- ance without any other symptom of distemper. 2. Symptoms Indicated by the Eyes. There is generally more or less purulent catarrhal conjunctivitis. The animal avoids the light. There are redness and swelling of the conjunctiva. In the early stages the secretion is serous and very fluid. Later on it becomes a muco-purulent secretion, either light gray or yellowish in color. This sometimes occurs in large masses (blennorrhoea of the eyes). This fluid collects in the corner of the lower eyelid or trickles down over the face, drying in yellowish crusts in the edges and borders of the eyelids, frequently gluing them together. The corrosive action of these secretions and also the inflammation of the surrounding membranes may cause lesions of the cornea, sometimes from the animal scratching and rubbing the eye, especially in animals with prominent eyes (such as pugs and king diaries spaniels). In some cases it may be due to deficient nutrition of the cornea. This ulceration starts with a slight swelling on the external surface of the cornea and subsequent formation of an ulceration. (Other details will be found in the chapter on Diseases of the Eye.) We see in rare cases keratitis parenchymatosa by extension of the inflammation of the cornea. This may be complicated with a permanent opacity of the sclerotic membrane, and in rare cases the whole eye becomes acutely inflamed and breaks down (see Diseases of the Eye). 3. Symptoms of the Respiratory Apparatus. These are generally a catarrhal inflammation of the mucous membranes of the upper air-passages, and, if the disease is acute, the finer sections of the bronchi become inflamed. The first symptom is a catarrh of the nose, which is marked by sneezing and the animal rubbing or wiping his nose with his front paws. This discharge increases. In the early stages it is simply serous ; later it becomes mucous, 228 DISEASES OF TRUE INFECTION. grayish-white or grayish -yellow, sometimes bloody, and in some cases even purulent, with more or less odor. We also see a '^sniffling" respiration. This is particularly noticeable in short- headed dogs (such as pugs or bulldogs). In all cases there is catarrh of the larynx, bronchi, and bronchioles. Catarrh of the larynx is generally marked by a loud, hoarse, dry cough, which is particularly distressing to the animal, especially at night. As the diseases advances it becomes moist and looser, and is easily produced by a slight pressure on the larynx. Where there is simple laryngitis, we do not generally see any visible increase or difficulty in respiration. This is changed, however, as soon as the large bronchial tubes become involved. In such cases we see a marked increase in respiration, which gradually becomes more intense as the inflammatory process goes downward into the finer bronchi. Any pressure on the sides or tapping upon the walls of the chest causes a very distinct, painful, distressing cough. On auscultation we hear an increased vesicular breathing, as well as dry and moist rattling bruits, which are of various forms and intensity. If the inflammatory process has extended to the fine bronchi, it is not rare to see the formation of lobular pneumonic centres — that is to say, catarrhal pneumonia. Difficulty in respiration now appears more pronounced; respiration is superficial but laborious, as is proved by the inflation of the cheeks. The number of respi- rations may increase from 60 to 80, and even more. The cough is very painful, dull, and weak ; the pulse is greatly increased, and the temperature may increase to a marked degree, but it is remit- tent. On auscultating we hear in the lungs snoring, groaning, and wheezing sounds and rattling bruits (these last are moist and numerous), also more or less blowing sounds in different regions. We notice an increased vesicular respiration with sharp, prolonged, expiratory bruits, and alternating bruits of a mixed character. In the same region we may notice bronchial respiration. Percussion, as a rule, is not very instructive. 4. Symptoms of the Digestive Trad. The chief of these is catarrh of the stomach, which may vary in intensity. There is entire loss of appetite, vomiting of a thin turbid liquid, shiny or muco-puru- lent, which is frothy. There are frequent discharges from the bowels of a thin, muco-purulent fluid, occasionally streaked with DISTEMPER AND CONTAGIOUS CATARRHAL FEVER. 229 blood, and always accompanied by a painful tenesmus. We may also find the abdomen very painful on pressure, and, as a rule, contracted and tense. 5. Symptoms of the Nervous System. The animal is very dull, especially its senses. There is a marked apathy and depression, and in some cases deep coma. In a great many cases this con- dition may be accompanied by periods of excitement, nervous- ness, great restlessness, and even true delirium. These periods, however, are not of any great length, as a rule, the animal sooner or later showing signs of marked depression. Motor disturbances, such as twitching of various groups of muscles, mostly the head and extremities, are noticed, and, in some cases, convulsions or true eclamptic attacks. These follow one another at long inter- vals, or keep the animal irritated for days. Clonic convulsions of the maxillary muscles are very frequently seen. They consist of a rapid and regular twitching of the muscles of the lower jaw, sometimes confined only to chattering of the teeth, and occasion- ally sufficiently strong to make a foam of the saliva. Beside this, we may see symptoms of motor paralysis. The patients are unsteady and irregular in their actions. In some instances they drag their legs, or occasionally their posterior extremities lose their power, and the animal is unable to stand ; in rare instances, due to paralysis of the sympathetic, the bladder and the lower bowel lose their nervous control, and urine and feces are evacuated involuntarily. The anatomical alterations produced by this disease of the ner- vous system, which are shown in the section of the brain, are sometimes very slight, and it is rather remarkable to find such acute nervous symptoms with so little pathological alterations. The microscopical examination showed little change, or what alter- ations you might expect from many of the infectious diseases of other animals. We must, therefore, admit that the microbes of distemper are not as yet well known. Like all other pathogenic micro-organisms, they produce " ptomaines." It has been proven that the severity of the nervous symptoms depends to a certain extent upon the natural disposition of the animals, and also on their bodily health. When they take the disease, as weak, anae- mic, poorly-fed animals, they are very apt to be severely attacked with a nervous form of the disease. Occasional symptoms appear 230 DISEASES OF TRUE INFECTION. in this disease which should be mentioned, such as serious weakness of the heart. This may be due to a parenchymatous degenera- tion of the heart-muscle. It is generally fatal, as it produces oedema of the lungs. Albuminuria is produced by parenchymatous degeneration of the kidneys, and in rare instances from true nephritis; decubitus is seen occasionally in severe cases in the elbow- and knee-joints, also at the femoro-tibial articulation. This sometimes causes septicaemia and produces death in this way. The large number of the above-described symptoms shows how completely the whole body may be affected with this disease. We also observe in some instances pecCiliarities and symptoms which may to a large extent come from a general want of nutrition, or want of resistance in some cases, while in others, and especially in the terrier classes, they seem to be able to throw off the disease and stand more acute attacks than other animals. There are some forms of the disease which may be said to deviate from the reg- ular course. These are as follows : 1. Distemper with a Mild Termination. In such cases we have a mild exanthema which may be difficult to recognize. A slight respiratory or intestinal catarrh. The duration of this mild form of the disease may be from half to one week. 2. Distemper with Severe Termination. In these cases we have for a long time separated the disease under the following divisions: '^pulmonal," '^nervous," ^ Agastric," according to the acuteness with which the symptoms may appear in the respiratory tract, the nervous system, or the digestive apparatus. 3. Acute Distemper with a Protracted Course. Distemper lasts generally for two to three weeks, although we occasionally see cases where the disease is prolonged for a much longer period. In such case this prolongation is not due to the influence of the disease directly, but rather with secondary complications. We may count among these certain nervous diseases which frequently remain or appear after the disease has run its course. For instance, paral- ysis of some of the muscles, of the hind-quarters, or of all the ex- tremities, and rhythmic movements resembling St. Vitus's dance; in some of the muscular groups, especially the muscles of the face or of the legs, and indicated by constant twitching, clonic in charac- ter, sometimes severer at one time than another, but more especially after excitement. Amaurosis (deafness) may occur in some cases. DISTEMPER AND CONTAGIOUS CATARRHAL FEVER. 231 Prognosis. The prognosis of distemper, as a rule, should be re- garded as unfavorable even in those cases which are apparently mild. Of course, the danger of the disease increases with the intensity of the symptoms, and especially if the symptoms are prolonged and with them a persistent high temperature, and even in cases where we have a subnormal temperature. Another series of cases which must be regarded as unfavorable are those which are in their course com- plicated by serious nervous symptoms, or by symptoms of catarrhal pneumonia. Young dogs which are delicate (especially when not fed on meat), anaemic, or rhachitic, will succumb to the disease sooner, and, as a rule, present severer symptoms than those which have been fed with meat and have had plenty of open-air exercise. A marked decrease of the temperature, without a similar improve- ment in the general condition, is always to be looked upon as an extremely serious symptom. Death may occur in two ways: through paralysis of the brain or oedema of the lungs, and occa- sionally from septicaemia or from general exhaustion. From the experience of the author, the death-rate is from 20 to 30 per cent. [The translator's experience does not admit of such a favorable percentage; he would say about 50 to 60 per cent.] It depends to a great extent whether there are a number of cases together or solitary cases — in the former the percentage is much higher; but at the same time it is impossible to give any positive statistics, because in cities the death-rate is much higher, and in small towns and in the country, where distemper runs a comparatively mild course, the death-rate is much smaller. The author finds that in a large city the death-rate amounts to 60 to 70 per cent. Pathological Anatomy. The most prominent and constant anatomical alterations found on the post-mortem are those in the respiratory and digestive organs. The lesions of the respiratory tract are as follows : The pituitary membrane is injected, infiltiated, and covered with a muco-puruleut exudate; numerous ecchymosed spots are found on the membrane. The mucous membrane of the larynx, trachea, and bronchi shows various degrees of inflammatory alterations — the large bronchi are filled with bloody mucus, the smaller bronchi are filled with a thick, tenacious exudate ; with this condition we frequently have evidence of lobular pneumonia; the tissue is firm, and gangrenous masses are found in the centre of the lobules. The pleura is covered with a rose or citron-colored 232 DISEASES OF TR UE INFECTION. exudate. The bronchial lymphatics are infiltrated and tumefied, and in rare cases purulent. The lesions of the digestive tract are principally confined to the small intestine ; the mucous membranes are red, and numerous ecchymosed spots are found, and decided hemorrhages in the sub- mucous tissue. The follicles of the patches and solitary glands of Payer are tumefied, sunken in the inflamed mucous membrane, and superficial ulcerated spots are found over the entire length of the intestine (Nocard and Leclainche). We find also more or less pathological alteration in the central nervous system, such as hyperemia and small hemorrhages in the coverings of the brain; oedema of the brain is sometimes present, and serous infiltration into the subarachnoids. In the ventricles and base of the skull we have more or less marked venous hyper- semia, and in rare cases purulent meningitis. As a rule, the spinal cord shows nothing abnormal except that it is pale and seems soft and bloody in consistence. Under the microscope decided changes have been noticed in the brain. KolesnikofE detected an infiltration of brain-matter and walls of the brain-vessels with lymphoid cells, as well as a dis- tention of the capillaries and arteries. These were filled with red and white blood-corpuscles. In the infiltrated walls of the vessels of the brain were found dark-colored, brittle, homogeneous gran- ulations and accumulations. Krajewski found also the perivas- cular spaces and the ganglionic cells filled with lymphoid corpuscles, and he mentions particularly that those cases had died without showing any prominent nervous symptoms. Another observer found inflammation of the spinal cord in acute nervous distemper, in which there was marked hypersemia. He also found alterations in the walls of the vessels, and an albuminous exudation in the upper third part of the spinal cord along the bloodvessels, as well as in the interstitial tissue of the gray substance. In " chronic" distemper we have found an interstitial myelitis with partial atrophy of the spinal cord. [The translator questions very much whether there is a condition that can truly be termed ''chronic" distemper; if so, he has failed to observe it. The conditions that the author speaks of should more properly be called sequences of the disease.] Other abnormal conditions are found in distemper, such as DISTEMPER AND CONTAGIOUS CATARRHAL FEVER. 233 anaemia, parenchymatous or fatty degeneration of the heart, liver, kidneys, and an abnormal swelling of the lymphatic glands Therapeutics. No special therapeutic treatment can be given for distemper — that is, -no agent has been found up to this time which has the property of destroying or rendering harmless the specific micro-organisms present in this disease. Certain antiseptic and antibacterial remedies, like quinine, salicylic acid, antipyrine, etc., may generally reduce the fever, but they produce no influence on the general course of the disease. The use of agents for reducing the temperature is objectionable, as they deprive us of the symp- tom of temperature, which is of greatest importance during the course of the disease. According to Frohner's experiments, calo- mel is supposed to have a slight claim as a universal agent, on the same order as black coffee, which was formerly advocated by Tras- bot. Common salt has been recommended by Zippelius, and ergotin was highly recommended and frequently used a few years ago. All of these remedies, while they prove beneficial in some cases, are not to be laid down as a specific for the treatment of the disease, therefore we must continue to treat it in a purely symp- tomatic manner until it is possible to discover some specific which may be ultimately found in the altered products of the bacilli. Antipyrine, which has lately been advocated as an absolute specific, does not in the least deserve this recommendation. The diet must be easily digested food, but at the same time as nutritious as pos- sible. Milk, bouillon, soup, and scraped raw meat (which is gen- erally taken with a relish) have much to commend them. In grave cases where there is entire loss of appetite, we must use concen- trated food, such as peptonized meat, extract of beef, and clear broth. This may be given with some mild alcoholic stimulant, wdne, etc. There are some forms of extract of beef which are not to be recommended on account of their slight nutritive value, and containing a large proportion of sodium salts. When the temperature rises above 40° we must try to reduce it by means of cold compresses and mild antiseptics. It is best, however, not to try to reduce a normal increase of temperature, as this is necessary, as a rule, to restrict the growth of bacilli, or even impair their vitality, and in this way lessen or destroy their virulence. The nutritive medium upon which the bacteria have developed may 234 DISEASES OF TB UE INFECTION. possibly undergo some alteration, so that they can no longer multiply. The ' ' antipyretic ' ' treatment can only be used in rare instances in the dog. The chief medicinal agents are quinine, salicylate of sodium, antifebrine, and antipyrine. The older remedies (digitalis, veratrum) have been abandoned for some time on account of their direct action on the heart. This is also the case with kairin, thallin, and phenacetin. The author, as a rule, does not advise the use of quinine on account of its action upon the heart. [The translator cannot agree with this.] R, — Antipyrine 1.0 F. chart. No. v. S. — One powder in a little water twice daily. R. — Antifebrine 0.5 Saccliar. alb 1.0 F. pulv. No. V. S. — One powder twice daily. R . — Ferri. et quininse citratis ..... 15.0 Elixir simplex. ....... 96.0 S. — One teaspoonful three times daily. Good, nutritive food and slight alcoholic stimulants, as a rule, produce good results. These assist in stimulating the digestive powers, preventing loss of tissue, and assist in reducing the tem- perature. Other therapeutic measures will have to be treated as the symptoms arise, and we would refer you to the Diseases of the Nose, Larynx, Bronchia, and Air-passages, also to those of the Stomach and Intestine, and lastly Diseases of Brain, Spinal Cord, and Eyes. As a rule, no treatment should be used for the skin eruption in distemper. If any irregularity arise, however, this may be treated according to the methods recommended under Dis- eases of the Skin. Conjunctivitis is generally treated by a solution of sulphate of zinc (1 to 100), or painting the diseased membranes with a solu- tion of nitrate of silver (1 to 70). This must be followed after- ward by a 1 per cent, solution of chloride of sodium. " Blen- norrhoeaof the eyes" should be treated by bathing the parts with some antiseptic solution, such as creolin (1 to 100); corrosive sub- limate (1 to 2000), or boric acid (1 to 40), or by painting the mucous membrane by means of a camel' s-hair pencil with a 2 per cent, solu- tion of sulphate of copper. Ulceration of the cornea should be treated with a 3 or 4 per cent, solution of boric acid. Parenchy- INFECTIOUS BRONCHIAL CATARRH. 235 matous keratitis may be treated with a few drops of a 1 to 100 solu- tion of atropine. After the inflammatory symptoms of the eye have subsided blowing calomel directly on the cornea produces good results. [The translator finds it also useful in the early stages, when the ulcer is acutely inflamed.] In catarrh of the upper air- passages make the animal inhale vaporized solutions of creolin, carbolic acid, or infusions of calomel and tar-water. In catarrh of the lungs and lobular pneumonia we use expectorants, such as have been described under Diseases of the Lungs. Catarrh of the stomach is to be treated with opium, tannic acid, and creosote. In the acute nervous form of the disease we may produce good results with bromide of potassium, chloral hydrate, or subcutaneous injections of morphia, while motor paralytic symptoms should be treated with strychnia and electricity. In severe depression stim- ulants, such as ether and hypodermatic injections of camphor, may be used. [Infectious Bronchial Catarrh. {False or Bench-show Distemper.) Within the last ten years bench shows have become a regular institution, and also where large kennels have increased in number the translator has frequently observed a disease that resembled canine distemper in a great many of its characters, but the general symptoms and course were such as to lead the observer to think that it is not the true contagious distemper, although it is decidedly infectious, and for a better name has called it " bench-show dis- temper" or " kennel distemper." Since making the translation he has noticed that the author has also felt that there may possibly be such a condition, and has intimated that fact under the head of Catarrh of the Bronchia (page 120). Etiology. It is generally seen in large kennels, attacking one after another or several at once. It may also be observed where several dogs have been sent to a bench show, developing shortly after they return. The period of incubation is three to five days. Another peculiarity is that one attack does not insure immunity from another. The writer has observed several dogs that have developed this disease, and the next year repeat the attack after returning from a show. Pathological Anatomy. The lesions found are very similar 236 DISEASES OF TRUE INFECTION. to those of true distemper, but milder in character. The alterations in the lungs are those of catarrhal pneumonia. The most frequent condition observed is great irritation of the mucous membrane of the intestines, with more or less swelling of the whole intestinal tract. The follicles and glands of the intestines may be swollen or enlarged, and in rare instances ulcerated, but not to the marked degree seen in distemper. Clinical Symptoms. The animal is dull and listless for two days, when the temperature will be found to be 39° or 40°; slight running from the eyes; and invariably diarrhoea. This last symp- tom is generally observed from the first, the stools being liquid the first few days, and later filled with gelatinous mucus. At the end of a week there may be some blood passed in the stools, but this is not commonly seen. The appetite may be very poor or even lost, but generally in three or four days the animal will commence to eat, but stop again if the diarrhoea should be severe or eat very small quantities. Vomiting is rarely seen except at the onset. The discharge from the nose and eyes is difficult to distinguish from distemper, except that it is thinner and muco-purulent. The cough is stronger, and not the soft, shallow cough observed in distemper. There is no rash on the skin, but the hair is dry and harsh, and frequently the hair falls out very rapidly in the long- coated dogs, especially collies. The mouth very frequently becomes sore and the gums may ulcerate. In rare cases a series of aphthous ulcers are seen on the lips and around the free end of the tongue. This condition rarely causes death unless the diarrhoea is persistent and the animal will not eat; and any attempt at forced feeding is followed by vomiting. In some cases shortly after the acute symptoms commence there may be evidences of congestion of the brain, accompanied by severe and continued convulsions, which frequently cause death. The treatment is practically the same as in distemper. Keep the animals warm and dry, give easily digested food, lean meat, carefully removing all fat, and quinine, iron, and some of the pepsin preparations, and allow them to run if they are not too weak. Penning them up closely does harm. RABIES. 237 R. — Ferri et quininae citras 12.0 Elixir simplex 96.0 S. — One teaspoonful three times daily. If the diarrhoea is severe, give Be . — Bismuth subgallate 0.75 F. charta No. xii. S. — One powder three times daily.] Rabies. [Hydrophobia.) This is an acute disease of the entire nervous system caused by a specific poison, and distinguished by a variable period of incu- bation, as well as by an absence of any marked anatomical alter- ation. Etiology. Rabies is a true infectious disease, and never occurs spontaneously, but is only transmitted by direct infection through the bite of affected animals. This disease, as a rule, is confined to the canine race (dog, wolf, fox, hyena, and prairie dog). It is seen in rare instances in the cat, horse, cattle, sheep, goat, deer, guinea-pig, rabbit, rat, mouse, chicken, pigeon, and in man. The dog is the animal that contracts the disease quicker than any other. Country, climate, care, nursing, age, and sex do not seem to have any influence upon it. The disease is more frequently seen in central Europe and the New England and Middle States than anywhere else. This may be accounted for by the fact that dogs in larger numbers run at large, and also to the fact that the owners do not conform to the rules of the sanitary police. Rabies seems to be influenced, to a certain extent, by the seasons of the year, as cases are more frequently seen in the spring and summer than in the fall and winter. The poison of rabies is as yet unknown, or at least it has not been definitely described. It is reproduced in the body of the animal only; never outside of it. It is mixed with blood, saliva in the salivary glands, and in the secretions of the lachrymal glands. It is also said to occur in the mammary glands. From direct inoculations, this disease appears in its most concentrated form in the brain and spine. This poison is virulent in the spine and brain during the incu- bative period, and retains its full streugth for several days after the death of the affected animal. Pasteur has demonstrated that a 238 DISEASES OF TRUE INFECTION. rabid brain loses its infectious virulence only when that part has become partially decomposed — that is to say, after four or five days; while it remains virulent in air-tight tubes or in moistened carbolic gauze. Neustube found that the brain of a rabid dog retained its virulent properties when kept under a slightly elevated temperature for ten or twelve days. Mergel found the virulence as strong as ever in the putrid brain of a rabid wolf fourteen days after the animal had been killed. Galtier noticed the same condi- tions in the decayed brain-substance of a rabid dog, when kept under a low temperature (12° Celsius). An affected brain was not rendered harmless even when exposed for three weeks at a time, but its virulence was attenuated when kept some time at 61° Celsius. Blum berg found that an affected brain is rendered harm- less when it has undergone a freezing process at 20° or 30°. Galtier was able to destroy the virulence of affected cerebral matter in four to twenty days by placing it upon plates and allowing it to become dry. Saliva and blood are much less resistant than brain- matter. Both substances, as a rule, lose their harmful property twenty-four hours after leaving the animal. As a rule, it is necessary to make a natural or artificial inocula- tion in order to obtain any successful transmission of the rabid poison, as no infection will take place if the inoculation is simply rubbed on the cutaneous or mucous membranes. The most com- mon method, of course, is the bite of the rabid animals; more rarely, licking of a wound. In many cases the bite may not be severe enough to cause its development in dogs or in man. Deep bites, however, are certainly the most dangerous, especially when made on the unprotected parts of the body (hands and face in man). Wounds which bleed much are less dangerous, as the poison may be washed out of the wound by the flowing blood. Bites of dogs which have bitten numerous others are less dangerous than the first or second bite made by a rabid animal. Infectious wounds which were made by biting or inoculation, according to Hertwig's observations, showed only 37 per cent, of positive results, and Renault's 67 per cent. Of 137 animals which were bitten by rabid dogs under observation for the last five years at the Veterinary College of Berlin, six only ultimately developed the disease. Zundel finds that about 25 per cent, of inoculated animals become affected, while Haubner found 40 per BABIES. 239 cent. At Alfort they have found the proportion to be about 33 per cent., and at Lyons 26 per cent. In man 50 per cent, of the bitten subjects develop the disease, but if we sum together the cases of true rabid and ' ' suspected ' ' dogs, the proportion is re- duced to about 8 per cent. It has not up to the present time been definitely determined that the disease can be transmitted through the medium of milk and meat, or by any other intermediate agents. The period of incubation between the time of the actual bite and the appearance of the disease is not as yet definitely fixed. This peculiar fact may be explained in different ways. Some have contended that there is a form of encysting of the poison in the inoculated region which takes place. This is supported by the following facts: 1. That by a rapid destruction of the inoculated region, and even when this is per- formed some time after the bite, the disease may be prevented. 2. In animals and man there are a peculiar itching and swelling of the bitten cicatrix before the appearance of the true disease. This "■ encysting theory," however, is opposed by the observations of Galtier upon rabbits. These he inoculated in the ear with a rabic virus, and they afterward became affected with the disease, notwithstanding the fact that the ear was amputated three or four hours after inoculation. Another explanation of the various lengths of the period of inoculation is the theory that a small amount of poison enters the body, and that this has to be reproduced according to the quantity inoculated until there is sufficient virus in the body to develop the disease. Pasteur has positively demonstrated that the period of inoculation is much longer when the amount inoculated is in very small quantities, and also in cases where the poison is very much weakened. The disease may not be developed at all. This theory, however, does not thoroughly explain the varying length of the period of incubation, and some observer may yet be able to give us a more thorough and reliable explanation. The character of the rabic poison is as yet unknown. We have to accept the theory that it is a micro-organism, for Paul Bert was able to render the infectious material innocuous by filtering it through tablets of gypsum. Hallier claims to have found a micro- coccus in the blood of rabid dogs and horses. Ziirn, Frank, and 240 • DISEASES OF TRUE INFECTION. Bollinger obtained negative results. Pasteur has found fine gran- ulations in the brains of rabid animals, which could be colored with aniline, and he is inclined to consider this as a specific organism of rabies, but he was not able to make any cultures from them. Chamberland and E.oux noticed micro-organisms in the blood of rabid animals, which were shaped like fine network. Rabbits which had been inoculated with such cultures became very sick, but did not show any symptoms of rabies. Babes noticed in the brain and spinal cord of rabid subjects microbes which were crowded together, forming shiny granulations. These were colonies of diplococci or egg-shaped corpuscles which could be cultivated in blood-serum at 37°. Dodeswell found in the spine and medulla a coccus, and Rivolta noticed a '^ coccobacterium lyssse." Aurep produced a very poisonous alkaloid with the brains of 100 rabbits (affected by furious rabies). Notes on Pasteur's Methods of Vaccination. (Preventive Inoculation.) Within the last ten years Pasteur has made a series of very remarkable observations which have led him to recommend a special method of prophylactic inoculation of rabid virus. The observations which he made were as follows: 1. The rabid poison is most concentrated and purest in the brain and spine. 2. If the brain is the particular seat of the rabid poisoning, the affected animal has furious rabies. If the spine is affected the most, we see the quiet (or dumb) form of rabies, 3. After direct inoculation of rabic poison on the brain-surface, under the dura mater (intracranial inoculation), the disease appears much more rapidly than it does from cutaneous or subcutaneous inoculations. With direct brain inoculation the disease may appear in from six to ten days. 4. After cutaneous or subcutaneous inoculation of the poison the rabid symptoms appear after a much longer time, and seem to depend on the fact that the further the inoculated region is from the brain the longer it takes to develop the disease. 5. The disease appears more rapidly if the virus has been intro- duced directly into the circulation than cutaneously or subcuta- neously. In the latter case it generally takes the form of quiet or dumb rabies. 6. A spontaneous cure of rabid inoculation may occur after the BABIES. 241 appearance of the first symptoms of the disease, provided the first symptoms are extremely mild. We can never expect any good termination when the symptoms are very violent in the early stages of the disease. An injection of blood or saliva of a rabid animal into the veins does not, as a rule, terminate fatally, but at the same time it does not appear to protect an animal, in the future especially, if it is inoculated again under the dura mater with rabid virus. 7. The intensity of the poison may become very much modified by inoculation through the medium of other animals. The rabid poison loses its intensity if it is inoculated into monkeys. After a series of generations of inoculation through different monkeys, it is much weakened and does not produce rabies in dogs, either by subcutaneous or intracranial inoculation, but this ' ' weakened " virus, if injecterl into the dog, renders the animal proof against further inoculations of the most active virus. On the other hand, rabid virus increases in intensity if it is inoculated from one rabbit to another, and the period of incubation is lessened until the dis- ease shows itself positively in seven days. By experimental trans- mission over forty to fifty generations, Pasteur has obtained a fixed virus which has a constant and regular virulence. This he obtained from the rabbit's spine, and is even more intense than the rabic poisoning of a furious dog, and he was able to produce the disease from eight to ten days after inoculation. 8. If the brain and spinal cord are cut into small portions and mixed with fixed virus, and subjected to a careful and slow drying process under 20° Celsius, the infectious substance gradually loses its activity and becomes perfectly harmless at the end of fourteen days. We may thus obtain an inoculating substance which possesses varying degrees of intensity, and it is possible to inoculate ani- mals with weakened virus, rendering them proof against direct inoculation from a rabid dog. This inoculation is made by means of a hypodermatic syringe directly under the abdominal muscles. After twelve or thirteen mild inoculations, each inoculation beins: increased in intensity, the subjects become proof against the inoc- ulation of the disease in any form whatever. When Pasteur first made these inoculations, using the material in varying degrees of strength, and at periods which took at least ten days, he was able later on to make all the inoculations within twenty-four hours, making each inoculation two hours apart. 16 242 DISEASES OF TRUE INFECTION. These observations within the last year or two have been proved correct by scientists in different parts of the world. Pasteur con- cludes from his observations that man may be protected against rabies by inoculation, and this is even possible when infection has already taken place. As is well known, Pasteur, before his death, applied this theory for some years upon inoculated people, and he stated that he reduced the mortality, which varied from 16 to 60 per cent., down to | to 1 per cent. Similar results have been obtained in other institutions established in different parts of the world by following the same methods ordinarily practised by Pasteur. In the year 1888 they had 454 cases of patients inoculated by rabid animals, which were afterward treated with weakened virus, only 1 to 1| per cent, of which died. Pasteur's system has been opposed by several authors. For instance, Frisch claims that it is impossible to prevent the devel- opment of rabies after infection by means of Pasteur's preventive inoculation, as the poison has reached the cranium, and it is too late to do anything. This opinion is indorsed by Amoroso and de Renzi; and Babes, after numerous experiments, arrived at the conclusion that it is very difficult to protect dogs from intracranial infection, even after following Pasteur's method. Nevertheless, we cannot but admit that there is great value in the experimental observations made by Pasteur; but, on the other hand, they still require a great deal of improvement to make them perfect. The method of obtaining the lymph is yet very primitive, and it has not been accepted by other countries as a method for general adoption. Pasteur's observations, however, have shown the way, and there is no doubt that in the future, with improved appliances and close observation, the disease may be prevented or cured with success, as we know that vaccination of splenic fever and tuberculosis belong to the same class, and they are still very incomplete. Other vaccinating methods, like, for instance, Hogyes's, who uses a virus which was weakened with 1 per cent, of a saturated solution of chloride of sodium, have been very little used. Pathological Anatomy. The post-mortem results are gen- erally negative and vary in different animals, but, as rule, specific alterations are noticed. These are as follows: Great emaciation with very distinct muscular rigidity and a rapid tendency to decay; collections of mucus upon all the natural BABIES. 243 orifices, such as the moutli, nose, and the prepuce; prominence of the cutaneous veins, which are found to be filled with thick, imperfectly clotted blood; redness and swelling of the mouth and mucous membranes. The throat is covered with a whitish-gray mucous exudation; intense inflammation of the glands of the pharynx; in some cases slight swelling and hypersemia of the salivary glands. In the cavity of the throat and mouth we find foreign bodies, such as hair, straw, coal, wood, etc. ; they may also be found in the oesophagus, which is frequently very red and covered with clammy, gray mucus. This condition is seen in the stomach which contains little or no food, but, as a rule, numerous indigest- ible objects of various kinds and sizes — straw, hair, wood, stones, or pieces of leather or rags. The mucous membrane is reddened and swollen, especially on the surface of its folds, and marked with hemorrhagic erosions. The intestine may be empty, or it may contain some of the foreign bodies. The mucous membrane of the pharynx is always very red, swollen, and covered with mucus in its anterior portions. These alterations are also seen in the trachea and the large bronchia. The lungs are, as a rule, filled with blood, but otherwise normal. In rare instances we find circumscribed centres or irritation due to foreign bodies being inhaled through the bronchial tubes. The heart and its envelope are generally normal. The inner surface of the pericardium may show hemorrhagic spots. The chambers of the heart, as well as the large bloodvessels, are filled with dark, imperfectly clotted blood. The liver and kidneys are hypersemic. The spleen is always filled with blood, swollen, and occasionally streaked with hemorrhagic spots. The condition of the brain and spine was formerly supposed to present some reliable indications of the disease, but, according to the investigations of the last few years, it cannot be said that they present any constant pathological alterations. They vary greatly, and in some cases may present nothing at all. We frequently find hypersemia of the covering of the brain and spinal cord, accom- panied by slight hemorrhages, and the brain and spinal matter itself contains more blood than usual and is in a more or less oedematous condition. Kolesnikoff found on microscopic examination of the walls and neighboring vessels of the brain (of dogs which have died with 244 DISEASES OF TRUE INFECTION. rabies) an accumulation of lymphoid cells and extravasated red blood-corpuscles, Wassilieff observed also dull masses which were considered by Weller as peculiar fatty bodies present in rabies, while Czokor and others have demonstrated that these corpuscles are products of involution which are found in other animals in the normal state. He also found that these were entirely absent in the early stages of rabies. The accumulation of discolored cells and red corpuscles in the walls and perivascular chambers of the small bloodvessels indicates to a certain extent a condition which in rabies is of pathological importance. They are undoubtedly symptoms of inflammation. These changes vary in different cases. According to Czokor, it was noticed to a very slight degree in dogs affected with the furious form of rabies, but it was noticed to a marked degree as soon as the disease developed the dumb form (the perivascular spaces and their neighborhood were filled with leucocytes). Similar alterations have been noticed in other diseased conditions, such as chorea, tetanus, and menin- gitis. Clinical Symptoms and Course. The period of incubation lasts in the majority of cases from three to five weeks. In very rare instances the disease may appear in one week. According to Haubner's observations upon nearly 200 dogs, in 83 per cent, of the cases the disease developed in two months; in 16 per cent, of the cases within three months; and in 1 percent, four months, or even later. Ziindel has calculated that in 264 dogs 1 per cent, became affected within twenty-four hours after being bitten; 11 per cent, between the second and third day; 33 per cent, between the fifteenth and thirtieth day; 19 per cent, between the thirtieth and forty-fifth day; 10 per cent, between the forty-fifth and six- tieth day; 16, 18, and 10 per cent, over three months. The longest period of incubation was observed by Leblanc; this case developed in 364 days. In the human race it is generally admitted that the average period of incubation is seventy-two days (this average covers over 510 cases). During the period of incubation nothing abnormal may be observed in the affected animal, but Hogyes, Babes, Ferr6, and others have observed in rabbits which were inoculated with virus a slight increase of temperature on the fourth or fifth day, and Babes has noted that the time this fever is observed there are no BABIES. 245 nervous symptoms presented, the animals remaining healthy for weeks until finally the disease appears. There are two forms of rabies — a furious and quiet (or dumb) form. Both forms are fatal. Furious Rabies. This comprises three distinct stages, namely, the melancholic, the irritating, and the paralytic stage. In the melancholic stage the dogs seem to change in their dispo- sition. They are capricious, and at other times irritable or de- pressed. They show symptoms of anger, are easily excited, fretful, and rarely very affectionate. They soon show a tendency to gnaw or swallow indig-estible substances. Tliev refuse their usual food, or they may take such food as they have a special taste for. They will lick and gnaw in a greedy manner various objects, such as wood, coal, furniture, and eat straw, earth, stones, wood, blankets, and even their own feces. The sexual excitement is very much increased, and we see in the first stage an uncertainty in the gait and a weak- ness in the hind-quarters. After a short space of time, generally from one to three days, the second stage appears. This is the irritable or maniacal stage. This is characterized: 1. By a ten- dency to escape and run away; 2. By a great irritation and an inclination to bite animals, objects, or man; 3. By a strange alter- ation in the voice, or bark. The inclination to run off is very marked. As soon as they get their liberty they wall run about aimlessly, covering very much ground in a short space of time, and return in one or two days, showing every indication of great excitement or of having travelled long distances. During this condition they bite any object that comes in their way. Soon the delirium increases and they run around in an insane way, attacking and biting anything that is within their reach, snarling or biting all the time. As a rule, these cases do not tear or mutilate their own bodies, and, if they do, they generally bite the region of the wound where they were formerly bitten. In the first stage of the disease we have often noticed that they will lick and bite places where they have had wounds before. The patients snap frequently, as if they were catching flies, and, as a rule, will bite any animal or man that will come within their reach. The biting and delirium are not constant, but appear after alternate periods of rest, followed by uncontrollable delirious 246 DISEASES OF TRUE INFECTION. attacks, especially if another dog should come near. These attacks may occur at intervals varying from one to four hours. The peculiar change in the voice is due to a paralysis of the vocal cords, and the sound of the bark is prolonged into a higher vocal sound, so that it makes a combination between a howl and a bark, which has been described by different authors as a '^ howling" bark. This is harsh and raw. Repugnance to water does not exist in the dog as in man, but toward the end of the second stage, from paralysis of the muscles of deglutition, we see great difficulty in swallowing, and very often see an animal pick up some indigestible object, attempt to swallow it, and, not succeeding, drop it from its mouth. Vomiting sometimes occurs. There is great difficulty in defecation, which seems to produce evident pain. There is very little alteration in respiration, but it may be slightly increased. The pulse is increased; the tempera- ture also rises, but falls toward the end of the disease. The duration of the second stage, which does not always present all of the characteristic symptoms, may last from two to four days. After the paroxysms have increased in intensity and the intervals between them grow shorter the paralytic, or last, stage begins. The animals rapidly become emaciated; the eyes are staring, dull, and the eyeball is retracted into the skull. The conjunctiva is generally hypersemic; the hair is erect; and we begin to see symp- toms of paralysis. As a rule, the first sign of this is a paralysis of the muscles that close or raise the lower jaw. This allows the saliva to run out of the corners of the mouth and form threads which hang down, and we easily recognize the fact that the tongue and lower jaw have lost their power. The tongue becomes lead- colored and hangs out of the mouth. Soon we see paralysis of the posterior extremities. This begins with a staggering, unsteady gait, and finally total inability to use the posterior half of the body. Then the animals stretch themselves out and become completely paralyzed, or in the last stage we may see convulsions, but that is very rare. Death, as a rule, occurs in the fifth to the seventh day after the onset of the disease. In rare instances it may last ten days. The quiet or dumb form of rabies, according to Bollinger, comprises about 15 to 20 per cent, of all cases. [The translator thinks that the average given of this form of rabies is entirely too f BABIES. 247 small, and should be at least 60 per cent., the great majority of cases observed being the dumb form.] This is distinguished from furious rabies by the fact that the irritating or nervous symp- toms are less marked, and in very rare cases entirely absent, also that the paralytic symptoms appear rarely in the disease. First we see paralysis of the muscles of the lower jaw. The mucus or saliva runs out of the opened mouth, and an inclination to bite is entirely absent, although under certain conditions when the mouth is forcibly opened the animal will be able to bite. The voice is also changed, but it is very rarely heard. We see a loss of appe- tite, the animal being unable to seize or swallow foreign bodies. In this quiet form the three stages follow very closely on each other, the course of the disease being very rapid, and death, as a rule, appears in two or three days, never over five. The diagnosis of rabies may be complicated by certain condi- tions present, due to other diseases. This is especially noticed in the mild form and in well-trained, affectionate animals which obey their masters to the last. [The translator knows of two in- stances in which the English setter was under complete control ; hunted in the field, obeying whistle and call instantly, and at the same time had every symptom of dumb rabies.] Often we see cases where the history is either insufficient or the owner can give none at all. On the other hand, in the furious form, a history, as a rule, is not required, as the disease can be constantly recognized from the appearance of the animal. Great excitement and rest- lessness, a tendency to escape, biting and delirious actions, rapid emaciation, and debility are characteristics of the furious form of this disease, while great depression and paralysis of the lower jaw are characteristic of the dumb form. In both forms there is a great inclination to gnaw objects. Sexual desire, in the early stage, is prominent. A depraved appetite and altered bark; more or less rapid symptoms of paralysis, and the cases being invariably fatal. The post-mortem confirms the disease when we find acute hyper- semia of the throat, pharynx, and mucous membrane, hemorrhagic erosions, and foreign bodies, etc., in the stomach. In doubtful cases the disease can only be accurately diagnosed by vaccina- tion — ^that is to say, by the injection of small quantities of brain or spinal substance which have been diluted with distilled water. This should be injected into the dura mater of a dog or rabbit 248 DISEASES OF TR UE INFECTION. after it has been trephined. The operation is easily performed, and is especially valuable when the suspected animal may have bitten not only other dogs, but man. As this inoculation from the spinal matter of a suspected dog takes at least two or three weeks, the persons bitten should not delay, while waiting for development, but all measures should be taken as soon as possi- ble. Another method of vaccination for diagnostic purposes is recom- mended by Nocard and others, and is used at Alfort at the present time. This consists of making a solution of the spinal matter of the suspected animal in distilled water. The emulsion which is thus obtained is filtered through a piece of linen and brought in contact with the anterior chamber of the eye of the animal which is to be inoculated. They do this by means of a small hypodermatic syringe, having first placed cocaine on the cornea, and then inject the solution directly into the anterior chamber. If the suspected animal was rabid, we will see the development of the disease in from fourteen to seventeen days, even if the chamber should sup- purate from the irritation of the injected solution. Gal opposes this procedure by pointing out the fact that the stage of incuba- tion may be greatly delayed. According to Di Vestse and Zagari, the inoculation of the rabbit is more reliable than dogs or guinea- pigs, and it is much more certain when a direct inoculation is made on the dura mater. He also proposes that a small cutaneous wound can be made, exposing a nerve-trunk, and the rabic poison placed in contact with the cut end of the nerve. The following diseases are sometimes mistaken for rabies : Cer- tain affections of the brain, teething, distemper, angina, intestinal parasites, inflammation of the intestines, peutastoma in the nose and frontal cavities, foreign bodies in the mouth (between the teeth) or in the throat, paralysis of the lower jaw, luxation of the lower jaw, intense excitement in bitches that have had their young taken from them, and poisoning. The course of the disease, how- ever, and the after-symptoms always enable one to make a differ- ential diagnosis. Concerning the prophylactic measures, which are of great importance, relating to the prevention of the spread of this disease (that is, muzzling, taxing, etc.), we must limit our- selves to the publication of the German law on the subject, as follows : BABIES. 249 Dogs or any domestic animals which are suspected of rabies must be killed immediately by their owners or keepers, or kept safely locked up until the arrival of the police. No attempts at medication of suspected animals may be made before obtaining the consent of the police officials. It is forbidden to sell or use any portion of a suspected animal, or, if it is a cow, to consume its milk. If the existence of rabies is established in a dog, the animal must be destroyed at once, as well as all dogs, cats, or other ani- mals which are suspected of being bitten. If any other domestic animals are suspected, they must immediately be placed under police observation. If they show any symptoms of rabies, they have to be destroyed at once. In exceptional cases suspected dogs may remain under obser- vation and confinement for a period of three mouths. This, how- ever, is left to the judgment of the police officials, provided the owner of the animal is willing to bear the expense. If a rabid animal has been running loose, the police authorities of that district must see that all dogs therein shall be muzzled, or held by a leash, for at least three months. If any dogs are allowed to run about loose during that period, the police have instructions to kill them at sight. The cadavers of dead, or killed rabid subjects, must immediately be burned, and no animal suspected of this disease shall be skinned, or any portion of its hide retained. Instructions of the Veterinary Congress of February 24, 1881. The stables and other premises in which rabid animals have been kept, as well as the utensils and other objects with which the ani- mals may have come in contact, must be disinfected according to rules and regulations. Vehicles and other means of transporta- tion which have been used for the removal of dead animals must undergo the same cleansing. Straw and the kennels of dogs must be burnt. Disinfection must be made according to the direction of the official veterinarian and under police supervision. The owner or keeper of the premises must satisfy the author- ities that these orders are obeyed without delay. The official veterinarian must send his report to the police 250 DISEASES OF TRUE INFECTION. department certifying that the above orders were executed to the letter. Tuberculosis. Under this name we class all affections which owe their origin to a peculiar specific bacteria known as ^' tubercle bacilli." These are found in all tubercular deposits in man or in animals, whether they occur spontaneously or are inoculated. Under the microscope they appear in the shape of very thin tube-like casts, showing a certain activity of movement. They multiply by means of transverse sections, and under certain conditions oval-shaped spores form in the body, which ultimately develop new bacilli. The tuber- cle bacilli should be considered as true parasites which multiply and live in the body only, but they also seem to possess the prop- erty of living outside of the body for a certain length of time, as the excretions of consumptives can be used successfully in inocu- lating animals, after having been dried for several weeks. We therefore conclude that tuberculosis is only produced by infection, or a better term would be transmission of tubercle bacilli from one subject to another. While it is well known that tuberculosis of man aud of certain domestic animals, such as cattle, is very common, it is rather rare in dogs. They seem to possess more power of resistance and are able to throw off the disease. [In the last three years the translator has seen a great number of cases of tuberculosis, and has been surprised to find such a large number, especially in fine-bred animals, and in a number of instances could trace the cause of the disease directly to women that were affected with tu- berculosis, and had the animals as pets; in one instance a woman had three dogs; one after the other died with symptoms of the disease, which was confirmed on the post-mortem of two of them.] Certain experiments by inoculation and inhalation have demon- strated the fact that one-third of the cases develop the disease, and the feeding of tubercular matter in the food invariably produced negative results. Considering the rarity of this disease in the dog, we will not give any detailed explanation of any length con- cerning its etiology, pathological anatomy, etc. Etiology and Pathological Anatomy. A number of observers agree in the fact that, as a rule, an animal affected with TUBERCULOSIS. 251 tuberculosis has been at some time near or in the vicinity of some person who was in an advanced stage of consumption. In one case, particularly, which was observed by the author, the affected dog had been an inseparable companion of a woman who had died of phthisis. In another, the dog had frequently licked the expectorations of a man in the last stages of consumption. In such cases the bacilli may be introduced in the form of fine dust and be respired into the lungs, or they may be taken up by the intestines, finding their way into the bowels mixed with food. In one case which the author observed there were tuberculous ulcers in the parotid region, and also tubercular deposits in the lymphatic glands of the neck. It is demonstrated that it is pos- sible to absorb the poison through the skin. The disease appears in the dog in the form of an acute or local tuberculosis. The disease may be found in the lungs, the mesenteric glands, the intes- tines, liver, kidneys, and peritoneum, and in rare instances affect- ing the entire body. This has been shown by post-mortems made by a number of observers, and especially by Jensen. He has made post-mortems of twenty-eight tuberculous dogs, and in nine cases he found the lungs involved. In the same cases he found accumulations of miliary tubercles. These masses were scattered and were of a cheesy character. The tubercular mass varied in size between that of a millet-seed and a bean. In two cases he found collections as big as an ^gg which had undergone slight de- generation in their centres. In some cases tuberculosis has taken the form of lobular pneumonia, separating certain sections in the lungs. In these cases cheesy masses of tubercular matter were generally found. The hepatized tissue of the lungs often breaks down, and large sections of the lungs remain, while the broken- down portion is coughed up, leaving a series of irregular, cavern- ous spaces, frequently hollow and at other times filled with pus-like masses. In one case they were directly against the large bronchia, although this condition, as a rule, is rare. In nearly 50 per cent, of all cases the lymphatic glands of the thorax, especially the bronchial glands and the glands which are located above and behind the mediastinum, are invariably infected to a marked degree with tubercular deposits, and are found to be very often enlarged, forming large tumor-like masses. These consist of a lar- daceous tissue and generally contain a centre cavity filled with a 252 DISEASES OF TR UE INFECTION. cheese-like mass. True cheesy tuberculosis is rather rare in the dog, but, on the other hand, we have a peculiar process of absorp- tion of the tissues, forming white masses, which on examination are found to be tuberculous deposits, or have undergone fatty degeneration. When the process of breaking down, or disintegration, has gone on to any marked degree, the tuberculous mass forms a tumor-like body containing in its centre a whitish fluid held in fibrinous tissue. This was noticed in 50 per cent, of the cases observed in the dog where the lymphatic glands had undergone this degeneration. In the other half of the cases the serous membranes of the abdominal cavities were covered with tubercular masses, the pleura being the most common seat of the disease. In the majority of cases of pleural tuberculosis it takes the form of what is known as the ' ' pearl ' ' tubercular masses. These are known to be deposits of soft connective tissue, of numerous conglomerating granulations, or in largre round tumors. In some cases there is extensive exuda- tive inflammation present (sero-fibrinous and purulent pleuritis). Two cases of tubercular inflammation were found in the pericar- dium, and a very peculiar alteration of the mediastinum has been observed in several cases. This part was changed into a large, thick, partially folded, or twisted leaf -like body. This consisted of tubercular tissue with tubercular masses in enormous quantities lying on its surface. The heart, as a rule, rarely presents any tubercular formations. In the digestive organs the lymphatic glands of the head and neck are rarely invaded ; also the submax- illary and retro-pharyngeal were only noticed to be affected in one case. On the other hand, the mesenteric glands were particularly affected, some cases presenting large tumor-like masses containing broken-down centres. Tuberculosis of the Intestines. Tuberculosis of the intestines is rare, and is restricted to slight ulcerations or abscesses. The liver, as a rule, is generally involved to a marked degree, its sub- stance being filled with small knots, also large granular masses which are milky white in color. In the centre of these is found a broken-down opaque fluid, the result of fatty degeneration. The spleen was only noticed to be tubercular in two cases, and that only to a slight degree. The kidneys are frequently the seat of more or less tubercular deposits, and in twelve cases scattered TUBERCULOSIS. 253 granulations were found in the spinal and membranous substance, but cheesy abscesses and centres were also found. These were accompanied by chronic indurative nephritis. Ulceration of the pelvis of the kidney was observed in one case. One dog showed but a slightly tubercular ureter and bladder. The sexual organs are, as a rule, found healthy and very rarely attacked by the dis- ease. In rare instances a tubercular testicle is noticed. Tuberculosis of the prostate has been observed in two cases by Cramer. The same author observed a tubercular ovary in one case. Clinical Symptoms and Course. On account of the various ways in which tuberculosis appears, no positive line of symptoms can be made. Tuberculosis of the lungs only will show marked symptoms, especially if it has made considerable progress, and is very similar to chronic catarrh of the lungs or chronic lobular pneumonia (see this disease). There are rapid emaciation, notwith- standing a good appetite, and a quick loss of strength, to suspicion tuberculosis of the lungs. We can only be positive of our diag- nosis by recognizing tubercle bacilli within the secretions, although it is very difficult to obtain such. Ehrlich advises that the observer place the secreted matter in a very thin layer upon a covered plate, and allow it to dry in the open air. When this is done pass the glass three times slowly over the flame of a gas- or alcohol-lamp. Then place it in a watch- glass which contains a colored solution of sputa. This can be prepared previously in a small reagent-glass, in which we mix six parts of water and one part of aniline, then filter. The filtered liquid is placed in the watch-glass and diluted with six or eight drops of concentrated alcoholic solution of fuchsine. The covered glass with the dried sputa must be left as long as possible, say twenty-four hours, in this coloring solution, or it may be heated, but not to the boiling-point. Then it has to be left standing ten or fifteen minutes, and after that the covering should be removed. This is then quickly washed in water and placed for a short time (six or seven seconds) in a solution of one part of nitrate of sodium to three parts of water, and the agent again thoroughly washed. This preparation is now ready for examination. The tubercle bacilli will be found to be colored intensely red, and the rest of the material is either colorless or a very dull red. Another method is to place, for a short time (one or two minutes), 254 DISEASES OF TRUE INFECTION. some sputum in a watery solution of Bismarck brown. This ren- ders the bacilli still more distinct. Other coloring methods are known, but the reader is advised to follow the above method, as it is the best. M. Tempel, of Dresden, injected Koch's tuberculin into two apparently healthy dogs, and in one dog which was affected with the pulmonal form of distemper, doses from 0.006 to 0.1, without observing any rise of temperature. The post-mortem of the dogs, which were killed some time later, showed no tuberculosis present. [There have been a number of suspected animals inoculated at the University of Pennsylvania, and in all the cases that after- ward proved to be affected with the disease the reaction was most pronounced, rising to 40° and 41°.] Tuberculosis of any of the abdominal organs is very difficult to recognize. The only way we might succeed is by pressure, or manipulation, of the abdominal cavity, recognizing swollen lym- phatic glands or some external manifestation of this in this region. We find, however, great emaciation and symptoms of chronic catarrh of the intestinal tract. These last two symptoms would be sufficient to make us suspect intestinal tuberculosis. In one case of tubercular ulceration of the intestines which was observed by the author, the dog was very thin and had shown this for some time. There were also present symptoms of catarrh of the lungs upon the upper portion of the neck and a deep abscess was formed. This was quite large and contained numerous masses of thin pus. In the region of the neck near the abscess we observed a granular mass, the size of a chestnut. This could be pushed under the cutane- ous membrane and moved about freely. There were also present a few enlarged lymphatic glands in the upper portion of the neck. Therapeutic Treatment. When you have once established the fact that the animal is affected with the disease, it is the duty of the veterinarian to warn the owner of a tubercular or suspected dog of the danger of infection, and advise him to destroy the animal. The successful treatment of this disease is as yet unknown. It may be that Koch's inoculating method will pro- duce favorable results, but up to the present date nothing positive has been done. Koch's lymph or tuberculin has been tried thor- oughly, and while it has no apparent value in curing the disease, it has fairly established itself as a reliable diagnostic agent. ANTHRAX. 255 Anthrax. Anthrax is quite rare in the dog, and when it occurs it is gen- erally caused by the animal eating portions of cadavers of animals that have had this affection. All forms of anthrax have been observed in the dog, but generally the seat of the disease is in the mouth and throat and in the intestines. Therapeutic treatment is useless on account of the rapid progress of the disease. Con- cerning sanitary laws, the following apply to this disease : Animals which suffer from or are suspected of anthrax cannot be slaughtered for consumption. Any operation that will cause bleeding in an animal suspected of anthrax can only be performed under the supervision of the official veterinarian. All cadavers of animals which are affected or suspected of having anthrax must be rendered harmless by burning the ca- davers. Skinning the animal is strictly forbidden. CONSTITUTIONAL DISEASES. Ansemia ; Chlorosis. By ansemia we mean a lessening or thinning of the blood. This is especially noticeable after great hemorrhages. At the same time much greater importance must be placed on that condition of the blood where it contains a very small quantity of albumin, and where the number of red blood-corpuscles is very much decreased." This is the most important form of ansemia. Etiology. The disease occurs frequently in young, delicate animals of the improved or closely bred classes. It seems to be hereditary in some of these animals, and may depend to a certain extent on the defective development of the arterial system and an abnormally small heart. Ansemia occurs most frequently from the lessening in quantity of the vital fluids, such as the albuminous, or after a large or long-continued slight hemorrhage; from pro- longed suppuration in chronic, persistent diarrhoea; chronic inflam- mation of the kidneys; and lastly a want of proper nutrition — for instance, young animals in a poor condition should be fed on meat. Very often impaired digestion prevents an absorption of certain nutritive substances in chronic disease, in fever, etc. Clinical Symptoms. The symptoms of the disease consist in a reduction of the coloring elements of the blood and a general condition of debility, showing every indication of loss of blood. The skin and visible mucous membranes are very pale in color. The animals are easily fatigued and have a draggy way of walk- ing; the pulse is often small and generally rapid. The tempera- ture in many cases is below normal, in other cases it may be normal or even higher. The respiration is increased with the pulse, and especially after very slight physical exercise. Reflex excitability of the brain in ansemic subjects is increased to such an extent that the animal will go into convulsions at the slightest provocation. Impaired digestion is a frequent symptom and naturally assists in complicating the disease. It is generally chronic, but proper treatment will often produce very good results. ( 256 ) LEUKEMIA. 257 Therapeutic Treatment. The treatment must all tend to one object — that is, the formation of more blood. This may be obtained by proper hygienic measures, feeding with light, easily digested substances, especially meat (not milk, which does not agree with the animals for any length of time), as well as medicinal substances — that is to say, ferruginous preparations. Among the latter, carbonate of iron, saccharated oxide of iron, and lactate of iron. These should be given in 0.4 to 0.5 gramme three times daily. Tincture chloride of iron, 10 to 20 drops daily. In many cases these iron preparations do not agree well with the patients, as the drug irritates the stomach and their appetite becomes im- paired. These preparations should have some vegetable tonic added to them, the bitter principle stimulating digestion and counteracting the irritant effect of the iron. A very useful prepa- ration in this disease is citrate of quinine and iron. This prepa- ration is valuable not only for the iron it contains, but the tonic properties of the quinine, and also the very slight tendency it has to disorder the stomach. Frequently arsenic is useful as a general tonic. Leukaemia. This disease is one that is characterized by an alteration of the blood, due to the presence of an increased quantity of white blood- corpuscles which must be due to some disorder of the lymphatic organs. The pathological anatomist distinguishes two conditions in the affected lymphatic — a lienal and myelogenic form — accord- ing to the origin of the disease: the spleen or the marrow of the bones. This, however, is of no special value to the practitioner, as both of these forms, as a rule, are combined in the dog, as in other domestic animals. The myelogenic form has never been observed alone (Siedamgrotzky and others). Etiology. The causes of this disease are not definitely known at present. In the human race we find that middle-aged men are mostly affected with this disease; in the dog, the middle or ad- vanced period of age seems to show the greatest tendency, but young animals frequently show very acute cases. This disease was observed in 1878 by Siedamgrotzky. From his own sta- tistics with those of many physicians he was inclined to consider leukaemia an infectious disease. Attempts to produce the disease 17 258 CONSTITUTIONAL DISEASES. by transfusion of leuksemic blood in healthy animals always gave negative results. The same observer saw two cases of secondary leukaemia. In both there was a virulent catarrh of the prepuce. This soon produced a swelling of the glans and of the lymphatic glands in its immediate neighborhood. This is accompanied by a marked increase in the white blood-corpuscles. Pathological Anatomy. The most important alteration always observed in this disease is an increase of white blood- corpuscles in the blood. This may become so great (in the dog) that we find the projDortion of white to red blood-corpuscles is 1 to 5 (Bollinger). We find in this ' Meucocy thsemia " the blood possesses a much lighter color than it does normally. We also notice a great tendency to emaciation and a characteristic altera- tion of the spleen, lymphatic glands, and the marrow. This alteration is especially found in the spleen, whicli is very much enlarged in all directions, and is also increased proportionately in weight. It is not rare to find it weighing at least 1000 grammes, and in among the sections marks of true hyperplasia. We also see at times circumscribed hyperplasia of the spleen in dogs. As a rule, the lymphatic glands are enlarged, and in other cases very slightly. This is caused by a hyperplasia of the glandular tissues. The marrow of the bones is occasionally involved and appears dark red. In serious cases the color is yellowish -gray, becoming soft and plastic. In very rare cases hyperplasia is seen in other organs, such as the tonsils, liver, and lungs. Clinical Symptoms and Course. The symptoms of the disease are similar to those of intense anaemia. First, there is a characteristic alteration of the blood, and, second, the symptoms presented by the spleen and lymphatic glands. In mild cases a microscopic examination and counting the number of blood-cor- puscles will insure a diagnosis. The best way to obtain a small quantity of blood for the purpose of making an examination is to make a slight slit in the upper surface of the outside of the ear. Place it under the microscope without adding any other substance to it, and we will recognize not only an enormous increase in the number of white blood-corpuscles, but a difference in their normal size. While we may be able to correctly diagnose the disease from the condition of the blood during life, we may also notice certain DIABETES MELLITUS. 259 alterations in the size of the spleen and lymphatic glands. In the glands of the head and neck we may find considerable enlarge- ment, as is also the case with the testicles. It is somewhat hard to really detect an abnormal enlargement of the mesenteric lym- phatic glands; while tumors of the spleen may occasionally be detected by manipulation, it is only when they have reached a very much enlarged ^^'^'^'^ condition (Fig. 58). Various observers ,s>>^ ^'^ have mentioned other symptoms, such as increase of the pulse (130 to 140 per min- ute); loss of appetite; the buccal mucous membrane is red and inflamed, and the tongue is coated. In rare instances, diar- rhoea and dropsical symptoms may be The bio^ in'^ucocythaemia. present. The disease is generally chronic, and death may occur after several months as the result of total exhaustion. Therapeutic Treatment. The agents generally used by physicians in the treatment of this affection are iron, quinine, iodine, and bromine, but, as a rule, none of these produce favor- able results. Arsenic seems to have answered better than any of the others, and is, therefore, to be recommended for dogs. Besides the disease just described, we have a condition which is very rarely seen in a dog — " pseudo-leuktemia." In this condi- tion we see exactly the same hyperplasia of the lymphatic glands as in true leukiemia, but there is no increase in the white blood- corpuscles (Frohner). One case which was observed by the author was that of an old setter dog which showed considerable hyperplasia of the lymphatic glands of the neck and trunk; also acute anaemia. There was not any enlargement of the spleen or the lymphatic glands of the abdominal cavity. Diabetes Mellitus. Etiology. By diabetes mellitus we understand a peculiar abnormal condition of the urine which contains a large quantity of sugar. The true cause of this peculiar disease is not exactly known, but from observations which have been made on dogs and other animals it is supposed to be due to a partial paralysis of the vaso- 260 CONSTITUTIONAL DISEASES. motor nerves going to the liver — " glycosuria." The same results may be produced by certain poisons — coal-gas, amyl nitrite, prussic acid, and in some cases it is produced by morphia and chloral hydrate. Another peculiar condition is also seen in cases of con- cussion of the brain, fracture of the skull, and epilepsy, in which sugar may be found in large quantities in the urine as a result of this disease. Some observers have noticed it in true infectious diseases, such as distemper. Clinical Symptoms and Course. The author has not been able to find any sugar (grape-sugar) in the urine of dogs, notwith- standing the fact that he has made a large numb(;r of tests. According to our text-books, the symptoms of diabetes are as fol- lows: Depression, dulness, great emaciation, in spite of the fact that the animal has an enormous appetite; there is increased thirst, and the animal passes an ordinary amount of urine with a high specific gravity, containing from 7 to 12 per cent, of sugar. (The method used for the detection of sugar in urine will be found under Examination of Urine.) In many cases cataract may develop in both eyes, causing total blindness. In other cases the hair falls out ; chronic bronchial catarrh, phthisis of the lungs, persistent diarrhoea, and some have noticed an ulceration of the skin and cornea. The course of the disease is gradual; emaciation and debility increase until finally the animal sinks into a deep coma, accom- panied, as a rule, with convulsions, and finally death. The prog- nosis in all cases should be unfavorable. Therapeutics. The treatment of diabetes consists of feeding the animal on food which does not contain any carbon, or as little as possible. This may be accomplished to a certain extent by a meat-diet, and even this diet cannot be followed up for any great length of time. Diabetes Insipidus, This form of diabetes is extremely rare in the dog [the trans- lator has been fortunate enough to have observ^ed six cases in the last ten years], as we find but one case of this disease de- scribed in veterinary literature (Holzmann). In this disease we have an abnormal increase of the urine without the presence of any sugar. It is more frequently found in young than in old DIABETES INSIPIDUS. 261 animals, and may be ascribed to be due to some disease of the nervous system. Claude Bernard has demonstrated that simple polyuria (without sugar) may be produced on a certain location on the left side of the brain, immediately in front of the diabetic centre. Peyrani was able to obtain the same effect by intersection of the splanchnic nerve, and by an irritation of the sympathetic nerve of the neck. Kahler produced polyuria in rabbits by inject- ing a solution of nitrate of silver into the medulla oblongata. In man this disease occurs very frequently in those cases where brain-tumors, meningitis, encephalitis, and concussion or injury of the brain is present. This disease is frequently seen in man without any apparent cause, and may be frequently fonnd in the dog, and should be observed, as was proved in Holzmann's case. The dog shown to him was three years old, having a pale mucous membrane and rectal temperature of 38°. This animal drank 12.76 c.c. of water daily, and passed about 12.760 c.c. of urine. The urine was yellowish, had a weak acid reaction, its specific gravity was 1.006, and contained nothing abnormal. On post-mortem nothing of any great consequence was found, except a myxoma hyalinum, which appeared in the shape of a yellowish, transparent, coagulated mass between the periosteum and the dura mater, entirely surrounding the spine with the exception of a small por- tion of the neck. There was also some hypersemia and slight bleeding in the gray substance of the lumbar region. Five elon- gated osteoid sarcoma masses were found pressing on the dura mater. Holzmann could not decide which of these conditions was the true cause of the disease. [Of the translator's cases the disease followed recovery from distemper in three of them, two had no definite history, and one had an enormously enlarged thyroid gland. All the cases passed large quantities of urine so pale that it could only be said to be tinted with yellow; the reaction was not taken; the mucous membranes were pale and blanched, especially the in- side of the lips and tongue, which was yellowish-white. The ap- petite was good, and it was noticed that bread and rice aggravated the condition, whereas meat seemed to lessen the amount. They drank large quantities of water, and gradually became thin, with the exception of one which kept in fairly good condition. One recovered and two died; three were lost sight of. On holding a post-mortem in two there was nothing particular found, except the 262 CONSTITUTIONAL DISEASES. mucous membranes of the body were very pale and ansemic ; the liver was enlarged in both cases, and in one there was a greatly enlarged thyroid gland, which was a sarcoma. The treatment consisted of belladonna and iodide of potassium.] The therapeutic treatment of diabetes in man consists of a meat- diet, open-air exercise, suppression of all physical or nervous excite- ment, small doses of opium, belladonna, valerian, and ergotin. Obesity. Etiology. This disease is due to the absorption of large quan- tities of hydrate of carbon, and also to a lack of proper exercise, and in some cases as a consequence of improper oxidizing processes in the body. It may also be hereditary in some cases. This dis- ease is especially seen in lap-dogs or pet animals, and is also noticed in bitches after ovariotomy and in dogs that have been castrated. Clinical Symptoms. The common location of fatty deposits is in the panniculus adiposus, around the region of the abdomen, and surrouadiog the internal organs — for instance, in the medias- tinum, the pericardium, and the capsule of the kidneys. The circumference and weight of the body increase very much, and round prominences form in different parts of the body, especially the neck, shoulders, back, and hips. The abdomen is round and distended. The animals are lazy, dull, awkward, and tired on the slightest physical exertion. When this condition becomes very marked, and there is a large deposit of fat in different parts of the body, especially when it has accumulated in the thorax and neighborhood of the heart, we have a lessened heart-action and more or less difficulty in respiration, sometimes from the pressure of quantities of fat on certain bloodvessels, decreasing their size and thus requiring greater effort of the heart's action, until finally the heart becomes overtaxed, and we have symptoms of heart-failure, bronchitis, chronic catarrh of the stomach, and cedema. Therapeutic Treatment, The following causes which pro- duce fat in the body must be understood, so that we may be able to properly treat the animal: 1. The source of fatty deposits may be due to albuminous or carbonaceous substances, or to fat itself. The nutritive fat, if not taken up, is deposited in the fat-cells of the body. OBESITY. 263 2. Albumin is a factor iu the formation of fat in the animal, while carbonaceous substances are very easily digested, and pre- vent a disintegration of reabsorbed fat which comes directly out of the food and favors its accumulation. 3. Hydrate of carbon and fat may act as substitutes, so that an animal eating albumin and fat, or albumin and carbon hydrate, may become fat. 4. A purely fat or hydrate of carbon diet cannot sustain the body for any length of time. In the first case it gains fat but loses flesh; in the latter it loses flesh and also fat. A pure lime-diet is also insufficient, although it has been demonstrated that lime may replace to a certain extent albuminous substances in the food. 5. A dog can be kept in this abnormal fat condition when fed on lean meat or when he is given large quantities of fat (one- twentieth to one-twenty-fifth of his own weight daily) ; but if a fat dog receives less meat than the quantity mentioned above, he will lose flesh. From the above indications it will be seen that, besides medical treatment, we have two ways of reducing obesity: 1. By reducing the quantity of fat. 2. By feeding with lean meat. The choice of the method employed is left to the practi- tioner. The author's experience has been that both are practica- ble, and must be applied according to circumstances. As a rule, the first method should be tried, as it generally corresponds with the owner's ideas. The animal should be weighed from time to time, as this is the only way in which we may ascertain whether the treatment is producing the desired effect. The animal must also be exercised regularly, as muscular exer- cise increases the destruction and use of fat in the body. It also increases the heart-action, the heart-muscles thus becoming strengthened and the circulation improved. A method employed by a number of practitioners is similar to that followed in man, viz., suppressing as much as possible the use of all fluids. This, however, is hardly practicable in dogs, as the only fluid they drink, as a rule, is water, and, if this treat- ment is carried to any extent, it is actual cruelty. The pilocar- pine treatment might be useful. According to experiments made by various authors, subcutaneous injections of pilocarpine were found to produce good effects (0.006 of pilocarpine daily); but 264 CONSTITUTIONAL DISEASES. this must be used very carefully, as in old, fat dogs we frequently find a chronic bronchitis, and from the increased respiration and amount of fluids thrown out by the lungs it may produce death by suffocation. Sulphate of magnesium and sulphate of sodium are useful to increase the action of the intestines and to carry away a certain quantity of fluid out of the body. They should be given on an empty stomach, a teaspoonful at a dose, diluted in a small quantity of warm water. Hsemog-lobinaemia and Haemoglobinuria. When there is any decomposition of red blood-corpuscles in the body (hoemoglobinsemia) the coloring substance is eliminated through the kidneys, staining the urine and producing hsemoglo- binuria. These conditions occur as the result of the action of certain chemical poisons, such as large doses of naphthol, chloride of potassium, carbolic acid, and by certain infectious, poisonous substances, transfusion of blood, and sterilized water. Influences of extremes in temperature also produce it. In this condition the urine is characterized by a dark red, brownish, or brick-red color- ation, and when examined through the spectroscope shows streaks, a and /9, of the haemoglobin in yellow and green (Fig. 59), and Fig. 60. ^ A aB C J) E b gpectrum of urine in htemoglobinuria. Hsematin crystals. close to it is a narrow methsemoglobin streak in orange. If we cannot examine it by means of a spectroscope, we may use the following tests : First, by means of the guaiac treatment or Teich- mann's hseminprobe. The first method consists in placing a small portion of a mixture composed of equal parts of tincture of guaiac and oil of turpentine in a reagent-glass and covering it with the urine which is to be tested. If any coloring substance of the blood is present, we immediately notice the formation of a dirty white UREMIA. 265 segment surrounded by an indigo-blue ring ; and if the test-tube is agitated, the whole solution becomes a light blue opaque fluid (Fig. 60). The hsemin-test consists of drying a large drop of urine in a small saucer, and with the dry mass we mix a small quantity of finely pulverized chloride of sodium, placing it on a plate. Then add two drops of cold glacial acetic acid. Now slowly heat the cup over an alcohol-lamp and allow it to cool. As it does so, you will see a quantity of dark-brown crystals. If these are not easily distinguished by the eye, they are with a magnifying glass. While we cannot distinguish the presence of the coloring matter of the blood in the urine with the aid of the microscope, we may detect the presence of blood-corpuscles in the fluid. We may also find by this means uric casts and epithelium of the kidneys, and small red granulations. These may be considered haemoglobin. The therapeutic treatment of hsemoglobinuria consists of the use of various diuretics, and an attempt must be made, as soon as pos- sible, to remove the coloring matter from the blood and the kidneys. Uraemia. As a consequence of disease and impaired activity of the kid- neys certain substances that should be thrown out in the urine remain in the blood, also the watery excretions of the body, pro- ducing a condition known as "uraemia." Certain experiments have been made on the dog to produce these ursemic symptoms artifi- cially — for instance, when both kidneys are removed or the ureters ligated. Voit observed that when healthy animals were fed on food containing uric acid, and at the same time deprived of water, these conditions produced the disease. Grehant and Quinquaud produced death in dogs when urea was injected into them subcu- taneously to the amount of 1 per cent, of the whole weight of the body. This produces convulsions, apparently from suppression of respiration. Feltz and Ritter produced uraemic symptoms in the dog with injections of salts of ammonium. It is of practical interest to know that uraemia may also occur in acute nephritis, in cases of enlargement of the prostate and obstruction of the pas- sage of urine, or from uric stones filling up the urethra or the neck of the bladder. 266 CONSTITUTIONAL DISEASES. The clinical symptoms have been described by Roll and others as high temperature alternating with chills, constant vomiting, convulsions, paralysis, coma, decrease in the temperature, and death within a few days, Roll also states that dogs which have suffered with hypertrophy of the prostate showed the same symp- toms of this disease, but they were produced gradually and the symptoms were not so acute. In snch cases we find dulness, dis- turbance of the intestinal canal, and convulsions. Scurvy. It is doubtful if true scurvy occurs in the dog — that is to say, a hemorrhagic diathesis marked by a spontaneous bleeding of the cutaneous and mucous membranes,and also from the muscles, joints, etc. Siedamgrotzky described a case of a two-year-old dog which died suddenly with symptoms of hemorrhage of the brain after being under treatment for four days. Numerous hemorrhagic centres were found in the skin and cellular tissues. The buccal mucous membrane was somewhat swollen and filled with hemor- rhagic spots. The gums were also in the same condition. The intestinal canal was filled with spots of hemorrhage from one end to the other, the mucous membrane of the pylorus being espe- cially affected. It was much swollen by a bloody infiltration. The mesenteric glands were filled with blood; the spleen was very much enlarged and weighed 107 grammes. On section it con- tained apparently a normal amount of blood. The liver and kidneys were healthy and normal. The lungs showed small hem- orrhagic spots under the serous membrane and were slightly oede- matous. The heart was flabby, light in color, and contained a quantity of non-coagulated blood. The frontal cavities were filled with blood-clots. The dura and arachnoid upon the left side also contained small hemorrhages. On the brain itself there were numerous flea-like spots, especially on the base of the brain. The blood on chemical examination was very deficient in salts of potassium. Friedberger and Frohner observed a case of scurvy in which there was bleeding of the gums and nasal mucous membrane, also in the retina of the eye. Friedberger found numerous hemor- rhages in the cutaneous membrane of the hunting dog, in the PRIESSNITZ'S COMPRESS. 267 neighborhood of the joints, in the serous membrane, and in the mucous membranes of the various organs, and an enlargement of the spleen to twice its normal size. He was of the opinion that this condition very much resembled the morbus maculosus Werl- hofii of man (a variety of scurvy). The treatment consists in nutritive feeding, stimulants, and in following out the treatment given under the head of Ulcerative Stomatitis. [Priessnitz's Compress. This compress is mentioned a number of times in the work, and as it has special advantages in the treatment of dogs, the translator will attempt to describe it, as the author has not done so, probably due to the fact that it is so very w^ell known in German therapeu- tics that it needed no explanation, but to English-speaking veter- inarians this is the reverse. The object of the compress or bandage is to keep up a continual heat, either dry or moist, to certain parts of the animal's body. Wo first apply against the part affected a piece of absorbent cotton, thick wool, or dry felt; or if moist heat is required, it is soaked in warm water or a medicated solution and waning out to remove the excess of fluid ; this is then held in position by a covering of some light material — a wide bandage of cheese-cloth is the best — and next a layer of oiled silk or rubber cloth (the object of this is to retain the heat and, in case of a wet compress, the moisture), and finally over this is placed a compress or bandage of flannel. This last is to prevent loss of heat by radiation. Sometimes the inner layer of cheese-cloth is omitted, or else it is put on the out- side of all. The above procedure may seem to the hurried practitioner a rather long and unnecessary method, but after one has tried it and found the great advantages it has in the retention of heat, espe- cially in diseases of the lungs, in hastening the maturing of an abscess, or in the lessening of a tumefaction by the constant and direct application of heat and moisture, he will realize its benefits.] DISEASES OP THE BONES AND ARTICULATIONS. Rhachitis. {Rickets.) Etiology. The different theories which have been advanced concerning the origin of rhachitis do not seem to answer in some cases (a deficiency of lime-salts as a consequence of disturbances of digestion ; excessive formation of carbonic or lactic acid, which would dissolve the lime-salts; an alteration of the general nutritive condition on account of abnormal influences in young, animals; inflammatory hypersemia and an increase in the number and size of bloodvessels in the osteogenic tissues, so that the lime-salts con- tinue to circulate in the blood instead of being deposited in the bones). We therefore do not know positively anything relating to the character and origin of rhachitis. It is, perhaps, better to admit that it is a specific disorder (which has not as yet become positively known). We know positively, however, that rickets can be developed in the dog by deficient, improper food, by want of meat, and especially bones, as it has been demonstrated that animals with this disease if given these articles of diet seem to improve immediately. A proper amount of exercise is specially important for puppies kept in a small place. Rickets generally appears in young animals in the first few months of their life. It is often hereditary. The symptoms appear relatively in proportion to their growth. If the animal grows quickly, rickets appears quickly; if it grows slowly, the disease comes on gradually. Pathological Anatomy. Rickets consists of a peculiar dis- turbance of the bones of the whole system. It seems to be due to a deficiency of lime-salts in the bones, making them soft and flex- ible. At the same time the nutritive process in the perios- teum seems to be changed. The bones are light and soft enough to cut with a knife, and the epiphyses of the long bones are very much thickened ; the marrow and periosteum are reddened. When (268) RHACHITIS. 269 the latter is removed from the bones of an animal in this condi- tion certain portions of the bony tissue come away and remain attached to the membrane. This is especially noticeable between the epiphyses of the vertebrae. The inner layer of the periosteum is thickened and the diseased tissue seems to have undergone a spongy degeneration. Inside of the bone we find it soft and cavernous. Clinical Symptoms and Course. The first appearance of rickets is gradual, and generally the veterinarian is not consulted in the early stages, but only when the skeleton shows marked alterations of form, especially in the bones of the extremities. We find periosteal inflations in the frontal bone and bones of the temple, so that the head shows a peculiar marked alteration. Schiitz has found that in rhachitic animals the bones of the skull are extremely thin and the sutures separated. In the thorax there is a weakening of the walls of the chest, and the animals present that one-sided or " chicken-chest" condition. There is a peculiar knot-like spelling of the ribs both at their upper extremities where they unite with the vertebrae, and in their inferior extremities where they unite with the sternum and false ribs. In this latter condition there forms a series of small, round nodules known as '' rhachitic bead-string." In acute forms of this disease the spinal cord is twisted or bent in different directions. The most striking alterations are observed in the extremities. The long bones are thickened at both ends and bent on account of the softness of the bone and pressure of the weight of the body when standing. The upper portion of the front legs bends inward, rarely outward, and the animals have a peculiar, unsteady, awk- ward gait. Tliey stand on the hind legs with the leg twisted under them, and in aggravated cases the bones are bent in a circle, the bend of the astragalus coming down on the ground. As a consequence of the altered position of the bones the ligaments become distended and stretched, causing an inflammation of the joints, consequently more or less enlargement of them. At the same time we observe emaciation, loss of appetite, and in some cases catarrh of the stomach and air-passages. The disease, as a rule, is chronic and the prognosis is unfavorable. If the dis- ease is taken early, it may be checked by means of proper feeding; but when the deformity is once formed, it is only in extremely rare 270 DISEASES OF THE BONES AND ARTICULATIONS cases that it does not show as the animal grows to an adult age; either in the form of a peculiar bending or bow-legged appearance of the front legs, or a twisting, or show halt-shape in the hind legs. Theeapeutic Treatment. The treatment of rhachitis con- sists of improving all the nutritive conditions and encouraging digestion as much as possible. Give the animal plenty of meat and bones, adding to them a certain amount of phosphate of cal- cium, egg-shells, and lime-water to drink. Improve the digestion as much as possible by tonics. Canine literature does not show that osteomalacia exists in dogs, and it is not likely that they are affected by this disease, which affects the middle-aged or old animals. It is a progressive disin- tegration of the phosphates and softening of the bones. Kitt described, in 1890, a peculiar diseased condition of a German bull- dog, and compared it with myositis ossificans progressiva. The head of the affected dog was disfigured by enormous osteophytes on the lower jaw and by prominences of the frontal bones. The bones of the forearm and thigh were covered with large osteophytes which had accumulated, particularly aroimd the muscular centres, while, on the other hand, around the joints there was very slight indication of the disease. The whole spinal vertebrae, as far as the last one in the tail, as well as the ribs, chest, and shoulder- blades, were normal and well formed, abnormalities being confined entirely to the bones before mentioned. During life the animal seemed lively and free from any fever, had a good appetite, but walked in a j)eculiar, undulating way, giving it a very awkward and unsteady appearance. Multiple periostitis has been observed by Siedamgrotzky in a dog. This was very different from the case described above. The animal during life showed marked symptoms of general muscular rheumatism, the disease affecting the periosteum of the entire body, especially the joints. DISEASES OF THE JOINTS. Inflammation of the Joints, General Pathological Anatomy of Inflammation of the Joints. The most common affection of the joints is syn- ovitis. In a simple case of inflammation of the joints we see an INFLAMMATION OF THE JOINTS. 271 increase of blood, au infiltration of the small cells, and even disin- tegration of the endothelial cartilage, the tissue under it becoming granular. We find quite frequently an accumulation of fibrinous or ''croup-like" membranes, followed by a cicatrization of the synovial membrane. In all acute forms of synovitis we see hem- orrhages in the form of small, tick-like bodies. Inflammation of the joints, when it takes a chronic form, makes the synovial mem- brane thick, tougher, with marked indentations which present a tree-like form. The synovia appears in large quantities, is yel- lowish, clear, or slightly turbid, and dulled by cells or fibrinous flakes. It is very rarely thick. If this synovia is gathered in a large quantity, we see a distention of the capsule, producing a hernia-like protrusion in the parts of the joint where there is the least resistance. Occasionally we find the synovial membrane covered with thick masses of clotted fibres. These occur from the excessive formation of secretion of synovia in the joints. Some- times small bodies appear in the joints due to some parts of the hard cartilage becoming loose, and in rare instances by a breaking off of small pieces of bone, and, finally, we may see the develop- ment of a peculiar cicatricial contraction of the synovial mem- brane. This is due to an acute or chronic inflammation of the joints, or when for any cause (for instance, dressing of fractures) a healthy joint is rendered immovable for some time. This con- dition may produce a temporary stiffening of the joint, but this, as a rule, is overcome in a short time. The fibrous capsule of the joint is occasionally inflamed, but, as a rule, in acute and chronic inflammation of the joint it remains unaffected. Where there is suppuration present it may become detached from the periosteum with the bone, and also perforated by the pus. The ligaments are also impregnated with the pus from a purulent inflammation, but they are rarely destroyed. Occasionally, however, we may see in chronic inflammation of the joints a cicatricial contraction where the joints become firm and united, immobility being lost. Sometimes from traumatisms we find only the soft parts which surround the joint, such as the exter- nal ligaments, and the neighboring tendons become involved in the inflammatory process, while the inner joint seems to be very little affected. The cartilage of the end of the joints is very little affected in 272 DISEASES OF THE BONES AND ARTICULATIONS. all conditions. In acute cases of suppuration of the joints the cartilage may be softened, perforated, or partially destroyed, so that the bone is bare in some places. In many chronic cases of inflammation of the joints the cartilage becomes macerated and dissolved into fibres, or it may be overgrown with abnormal syn- ovial extensions. As soon as the bone proper becomes involved in the inflammatory process extensive granulations form, causing a peculiar spongy growth. These crowd and perforate the bone here and there, and also affect a cartilage of the opposing bone, leading to a cicatricial growth on the end of the joint. In some cases we also see the fibres and cells of the cartilage becoming soft and finally growing up with numerous raised cartilaginous cells, and an acute inflammation of the ends of the joints. From these periodical conditions we may have a marked alteration in the form of the joint. Edges of the joint protrude, the inner surface being hollowed and grooved. A peculiarity of deforming inflammation of the joints is an inflammation of the synovial mem- brane, with a normal excretion of synovia and a great enlargement of the free or loose portion of the membrane which may develop into pa]3illa-shaped masses. The bone, as a rule, does not become affected in acute inflam- mation of the joint; but if it should become uncovered from suppu- ration of the cartilage, the inflammation extends to the spongiosa, and we see occasionally the formation of purulent or granular centres on the surface. In rare cases the periosteum becomes covered with osteophytes. In tubercular diseases the joints of the dog may become diseased, but as yet such cases have not been demonstrated in veterinary literature. Acute Synovial Inflammation of the Joints. (Synovitis Acuta Serosa.) The joint is swollen and hot, and the animal shows pain on pressure or movement of it. These symptoms indicate an inflam- mation of the synovial membrane and a lessening of the secretion of synovial fluid into the joint. It is very rare that we see intense fibrinous excretions (synovitis sero-fibrinosa), and still more rare are those cases of colorless blood-cells mixed with detached epi- purule:nt inflammation of the joints. 273 thelia. The patients are lame whea tlie joint is moved, especially at the beginning and toward the end of any movement of the joint. Very frequently small dogs will only walk on three feet, carrying the inflamed member. Etiology. The following may cause synovitis : Crushing or concussion of the joint, blows, sprains (such as falling from a height). In cases of injuries of the joints Ave may expect only a simple synovitis when the injuring object is clean and the wound is cleansed immediately after the injury (by blood-clots or an anti- septic dressing). According to the observations of the author, acute synovitis occurs most frequently in the carpal joint, joints of the toes, in the knees, and hip-joints. Its course is, as a rule, rapid. If the patient receives proper treatment, in a short time we see an improvement (especially if the animal gets complete rest). In other cases the disease takes a chronic form — that is, it may form one of the following condi- tions: Chronic Serous Inflammation of the Joints. [Synovitis Chronica Serosa.) In this the joint is slightly swollen and painful, also very fever- ish. In some cases we may see a fluctuating swelling as a result of enlargement of the capsule by serous secretion. If the disease is still more acute, we may have a thickening of the fibrous cap- sules, and very frequently quite an enlargement starting from the edge of the joint. This chronic synovitis may appear in the onset of the disease, but, as a rule, it results as a consequence of the acute form. The author has seen these cases in the carpus and knee-joint. The lameness is not especially marked, but any active movements increase it very much. Purulent Inflammation of the Joints ; Suppuration of the Joints. [Pyarthrosis.) While the two forms which have before been described are rarely accompanied by fever, it is quite different in suppuration of the joint. In this there is great fever from the beginning, which is 18 274 DISEASES OF THE BONES AND ARTICULATIONS. ushered in by a chill. We may see a more or less rapid develop- ment of a swelling of the joint, which is extremely painful. The joint is kept in a bent or flexed position, and the patient walks on three feet. We may also see an oedematous swelling extending both above and below in tne neighborhood of the joint. The temperature is considerably increased in some cases; the skin ap- pears normal or reddened, sometimes even bluish-red. The pus may eventually break through the skin in the neighborhood of the johit, or it may lie in the joints, become absorbed, and cause pyaemia. This termination will perhaps occur even when the pus has broken out externally, and in some cases where the inflammation has been very acute we may have a subsequent adhesion of the joint (ankylosis). Etiology. Suppuration of the joints is frequently produced by infected wounds at or near the joint. In rare instances it may be the result of a phlegmonous inflammation in the neighborhood of the joint; concussion or crushing may also cause it, or it may occur in a metastatic way. Such inflammations of the joints may also occur as a purely suppurating inflammation; but, as a rule, they are sero-fibrinous or sero-purulent, and with it we may see purulent centres of abscesses, or pyiTemia, abscesses forming in the glands, or the development of the disease in several joints at the same time, or at short intervals. The author saw metastatic sup- puration of the joints of the knee, carpus, and toes. Rheumatic Inflammation of the Joints. [Bheumatic Arthritis.) This form of disease of the joints seems to be caused by cold, especially in shooting dogs, if used in cold weather or during winter, when they become very wet and lie around in a draught. It has also been ascribed to be due to a specific infectious substance, and this is brought out in animals that take cold. There are two forms of this disease : an acute and chronic form. The former aj)pears in a serous, but more rarely sero-purulent synovitis, accom- panied by great pain and high fever. The lameness is much greater than in any other form of joint-irritation. Very often several joints become diseased at one time, or the disease may go from one DISEASE PRODUCING MALFORMATION OF JOINTS. 275 part to another. As a rule, if the animal is kept in a warm place, the disease abates in severity in a few days. When the disease takes a chronic form, either from the onset, or merges into the chronic from the acute stage, it resembles very much chronic sero- synovitis. There is great thickening of the capsule, a formation of adhesions between the surface of the joints and the connective tissue, and in rare instances we may have ankylosis of the joint. The most common seat of this disease is in the knee-joint, and still more rarely in the ankle and hip. While the diagnosis is rather difficult where the disease in confined to one joint, it is easily dis- tinguished when you see it appear in several joints at once, and also from the fact that it may move from one joint to another. Disease Producing Malformation of the Joints. {Arthritis Deformans.) The cause of this disease is very little known. It is very prob- ably due to a chronic rheumatism, or to some inflammation of the joint. It may also be due to great exertion, and is especially seen in Holland, where animals are used to pull carts and vehicles. The first symptom of this disease is a slight lameness in the dis- eased joint. This lameness may be overlooked, as it is generally very slight, and after the animal has taken a little exercise it grad- ually disappears, although in some rare cases the lameness may continue, or even with exercise become aggravated. In the early stages of the disease there is no indication of pain on movement or pressure of the joint, but later on pain on pressure and motion begins to show itself. At the same time there are a gradual swelling and thickening of the capsule of the joint, with apparently a loss of the normal amount of svnovia. Sometimes we notice slight heat. A peculiar symptom of this disease, which is noticed from the very onset, is a peculiar creaking or crepitating sound when the joint is moved. After a time stiffness of the joints becomes more marked. There are hard swellings on the cartilaginous borders, also a ten- dency of the ends of the joint to enlarge, and finally marked alter- ation in the form of the joint. By these changes we are enabled to distinguish between arthritis deformans and chronic serous inflammation of the joints. The anatomical alterations have already been mentioned. Arth- 276 DISEASES OF THE BONES AND ARTICULATIONS. ritis deformans, as a rule, occurs in the knee-joint, the elbow, and shoulder. The prognosis of this disease is always to be unfavor- able, because it seems to defy medical treatment, going on until finally the joint becomes a large unsightly mass. Theeapeutic Treatment of Inflammation of the Joints. In all cases, except those of slight synovitis, the joint must be kept as quiet as possible. In simple cases the animal should be kept in a kennel or in a room for several days. In serious cases where no operation seems to be required, and there is no danger of poison breaking through the joints, and where the inflammatory swelling is not very great, it is best to apply the bandage of cotton and dress over that with a plaster or silicate of sodium bandage, treating it the same as a fracture. The author has obtained very good results with this method in the carpal, tarsal, and toe-joints. Albrecht advises that the joints should be rubbed with a thick layer of citrine ointment before applying the dressing. (For further details, see under head of Dressings, etc.) It is well, however, to take into consideration one point: that the dressing must be in such a position as not to interfere with the use of the leg. With the above treatment we generally obtain good results in a short time. In the serious forms of the disease, and where the dressing cannot be used on account of the position of the joint, we must apply such local applications as will abate the inflammation. As a rule, the best treatment is cold-water applica- tions containing lead or arnica. In cases where there are great pain and acute rheumatic inflammation of the joint, it is better not to apply too much cold water, but use instead Priessnitz's compress. Wrap the joint in a piece of linen which has been folded several times, similar to a handkerchief, and then cover it with some imper- vious object, such as oil-cloth, silk, rubber, or a woollen cover. If, for some reason, neither the cold nor the moist treatment is prac- ticable, we must paint the part with tincture of iodine once or twice daily, and the fluid must be rubbed into the skin by means of a rag. The author has never had very good results from this method of treatment, but painting with iodine produces better results than any of the liniments, such as camphor or soap liniment. Massage has been found to produce good results in many diseases of the joints in dogs, although it has not been used very extensively among canine practitioners. In chronic cases where there are great DISEASE PBODUGINQ MALFORMATION OF JOINTS. 277 thickening and a large quantity of secretion of the capsule, as in cases of acute inflammation of the joint, or in purulent arthritis, massage with cocoanut oil is particularly adapted. In cases of rheumatic inflammation of the joint, which have been recognized as such, we must use internal remedies, such as recommended in muscular rheumatism. In many traumatic and purulent inflammations of the joint we can only get good results by an operation which varies according to the condition. The general procedure is as follows: Puncturing. This method of treatment is indicated in all chronic serous secretions of the joint. As soon as we find that the measures which encourage reabsorption, such as tight dressing and massage, do not produce good results, and where the secretion causes great distention of the capsule, and where there are great lameness and indications of suppuration, we proceed in the following manner: fig ei a. The part to be punctured must be rendered strictly aseptic ; b, the part must have a particu- larly tight dressing over it for a few days after the operation. If this latter method is not practicable on account of the position of the joint or some other circum- stance, puncturing the joint will not give favorable results and may even lead to very serious conditions (suppuration, etc.). The method of operation is very simple. After having removed the hair from the region of the joint and washing with sublimated soap, disin- fecting it with a \ per cent, solution of carbolic acid and 2 per cent, of creolin or 1 per cent, of corrosive sublimate, we then puncture the part with a good- sized hypodermatic needle and slowly evacuate the sac by drawing it into the syringe. If the syringe be- comes filled and the joint is not entirely emptied, the syringe must be detached from the needle and the opening closed at once by means of the finger, as any air that may find its way into the joint will produce bad results. .Empty the syringe and pro- ceed as before. This method, as a rule, is absolutely harmless, evacuating the sac in cases of serous secretions. If, however, we find in the fluid withdrawn from the joint many cellular elements — that is to say, if it possesses a marked puru- lent character — we must use at the same time an injection of antiseptic A large hypodermatic syringe for puncturing enlarged joints. 278 DISEASES OF THE BONES AND ARTICULATIONS. fluid directly into the joint, so as to make it asei^tic. For that purpose we use a slightly warm solution of 1 to 1000 solution of corrosive sublimate or a 2 per cent, solution of carbolic acid and a Lugol solution of iodine (1 per cent, tincture of iodine, 2 per cent, of iodide of potassium, and 50 per cent, of water). Either of these solutions may be injected through the needle into the joint ; then, by manipulation, try to work this solution inside of the capsule by means of careful pressure, allowing it to flow out through the needle in one or two minutes. The needle is then withdrawn and the perforated ojiening is closed at once by means of an iodoform- tampon, and over that an antiseptic dressing is placed. This should be allowed to remain on the wound for a few days. (For further particulars, see the chapter on Treatment of Wounds.) In chronic inflammations or great secretions we may also use simple injections of disinfecting solutions, such as iodide of potassium, as a means of reducing the inflammation or destroying its products. We perforate directly into the cavity of the joint by means of a hypodermatic needle and with a syringe inject a quantity of fluid in proportion to the size of the joint. This operation has to be repeated every three or four days, fol- lowing the same procedure before and after the operation as has been already described. The Joint may be opened by means of a puncture with a lancet. This is advisable where there is extensive suppuration going on in the joint and where the diseased part shows every indication of a septic condition. The joint to be opened should be punctured by means of a lancet or bis- toury, making a wound just sufficient to empty it freely. It must then be cleansed with an antiseptic solution and any clots or detached portions of tissue washed out ; then close the wound by means of sutures. In some cases it is well to leave one corner open for drainage, that, of course, being the lower one. We then place an antiseptic dressing over the whole part. Injuries of the Joints. These may be divided into several groups — true wounds of the joints, contusions, distortions, and luxations. "Wounds of the Joints. Wounds of the joints — that is to say, injuries which expose the joint proper to the atmosphere — are divided into perforating or cutting wounds, being produced by laceration, contusion, and shot. Clinical Symptoms and Course. The first symptom of injury to the joint, as a rule, is a discharge of synovia from the wound. This, however, may be absent in cases where the wound is very fine, or where the puncture runs in an oblique direction; INJURIES OF THE JOINTS. 279 the amount of discharged synovia, as a rule, is very slight at the beginning and of normal consistency. If the wound is not closed immediately, it increases in amount and becomes thinner. In some cases it is difficult to tell positively whether the synovia comes from the joint or from the sheath of a tendon. In the latter case, however, the amount of synovia is generally very slight. Blood may accumulate in the cavity of the joint and develop a htemarthros. In some cases where there is hemorrhage, the wound may be very small and close up quickly, or it may lie in an oblique direction and prevent the escape of blood. This flows into the joint and fills it up. Hsemarthros is distinguished from serous or purulent secretions by appearing shortly after the injury, and the absence of all inflammatory symptoms — that is, at the onset of the disease. The other symptoms of wounds of the joints are acute sensitive- ness, the animal limping and showing great pain, holding its leg in a flexed condition. Generally the external opening of the wound can also be distinguished. The course of this disease differs greatly according to the char- acter of the wound and whether the object that caused it was clean or not. Small perforating wounds heal rapidly, and the animals limp only for a few days. In serious wounds where the joint has been exposed, and dirt or other foreign bodies have obtained entrance into the joint, the prognosis is less favorable. In such cases we notice a great discharge of synovia. This is clear in the early stage of the disease, but soon becomes turbid by the addition of pus-corpuscles and fibrinous clots. It then becomes flaky and finally purulent. At the same time there is great fever around the joint, which is swollen very much, and the neighboring tissues become oedematous, extending in all directions. We may see numerous abscesses forming all around the joint or in the inter- muscular connective tissue, and finally the animal dies from gen- eral exhaustion or pynemia. According to the circumstances and condition of the wound, the course may be much more rapid. The synovia becomes purulent in a short time; septic fever shows itself quickly; there is a rapid pulse ; the animal sinks into a coma, and dies from septicaemia. This may even occur in slight wounds, if they have not been treated properly, and where thorough disinfection has not been followed. ■280 DISEASES OF THE BONES AND ARTICULATIONS. Therapeutic Treatment. The first thing to do after an injury has occurred is to thoroughly disinfect the wound and its immediate neighborhood. Clip the hair from all around the part, then wash it with a solution of corrosive sublimate, and, in cases where the puncture is very narrow, clean it out by means of a syringe with a 2 per cent, solution of creolin and 5 per cent, solution of carbolic acid, or a 1 per cent, of corrosiv^e sublimate. If you find the object which caused the puncture was very dirty, the wound must be enlarged and thoroughly washed with any of the above-named solutions. The wound should then be closed by means of sutures, taking care when stitching it up not to include the synovial membrane or any part of the joint in the sutures. It is well, however, in some cases, to place a small piece of catgut or silk in the lower surface of the wound in order to assist in emptying the joint. We then place the joint in an antiseptic dressing and cover it up. If we have to deal with a wound that has been neglected and where suppuration has been going on for some time, and the owner does not wish to destroy the animal, we must enlarge the wound at once, and all pockets, or sacs, in the joint must be emptied and washed with a solution of corrosive sublimate. Any clots, masses, or pieces of tissue must be removed, and the operation finished as before described. In all these cases the animal must have absolute rest, and the dressing be renewed frequently. Contusions of the Joints. Under this head we class injuries to the joints which have been caused by compression of the soft parts against the bones or from shocks, such as jumping or leap- ing from a height, kicks, and where the extremities have been run over by vehicles. In this we may have a series of results, such as crushing or laceration of the capsule of the joint, with forma- tion of hremarthros, or a concussion or crushing of the bone with little escape of blood. In rare instances we may see a laceration of the cartilage. Clinical Symptoms. The animal shows great sensitiveness and pain on manipulation of the joint, and, as a rule, carries it in the air. There is a rapid swelling of the joint and oedema of the surrounding parts, also a high temjjerature. Therapeutic Treatment. The treatment consists in cold- water applications, if the position of the joint admits, renewed INJURIES OF THE JOINTS. 281 constantly. The best method is to soak a piece of absorbent cotton iu water, lay it on the joint and bandage it up lightly, moistenine; it in cold water from time to time. In old cases use friction (massage) of the joint in a circular direction (twice daily for ten or fifteen minutes), or use a tight bandage. Any stimu- lating liniments, such as camphor, soap, or arnica, may be used, bat it is questionable whether the good effects are not due more to the massage than to the drugs themselves. Distortions of the Joint {Sprains). By this is meant a twist- ing or temporary displacement of the joint, as a rule, in a lateral direction. The capsule and the ligaments may be partially torn and in some cases entirely ruptured on one side. The round ligament of the hip-joint is sometimes torn, as are also the tendons of the knee-joint. Clinical, Symptoms. When the sprain occurs there is violent pain. The animals use the joint irregularly, or may carry the member. The lameness increases, and in the region of the joint swelling soon appears. Any manipulation of the joint produces great pain, and we may be able to recognize a laceration of some of the ligaments, and the joint shows greater mobility on one side than the other. Where there is tearing of the broad ligaments of the hip-joint there is nothing indicated beyond the lameness and symptoms of pain when the joint is turned or twisted. Therapeutics. The treatment of distortions, or sprains, is the same as that for contusions. It is well, however, to be careful to put the joint, by means of the bandage, as near as possible to its original lines. Luxations of the Joint (Dislocations). While distortions of the joints disappear in a short time in cases of luxation, if it is not reduced it is lasting. If both surfaces of the joint are no longer in contact, it is called an entire dislocation. If they are partially in contact, it is called an incomplete luxation (subluxa- tion). The causes of dislocation are, as a rule, mechanical, falling out of windows, jumping from high objects, getting the foot caught, and hanging, as iu jumping over a fence; concussions and blows by being run over by vehicles, etc. In all dislocations there is invari- ably laceration of the capsular ligament. This membrane only remains intact in dislocations of the lower jaw. As a rule, the 282 DISEASES OF THE BONES AND ARTICULATIONS. accessory ligaments are seldom torn except in such cases where a portion of the bone is torn with them. The cartilage of the joint may be torn or detached in some cases by the subsequent inflam- mation. The ends of the bones may be unaffected and in some cases broken. Other alterations are seen in the muscles and ten- dons in the neighborhood of the joint. They are abnormally extended on one side and flabby on the other side. They may be torn, lacerated, or even crushed. It is only in rare instances that the large bloodvessels and nerves are lacerated. The joints which are dislocated are surrounded by a large quantity of blood which infiltrates the tissues and is gradually reabsorbed. When reduction is not performed quickly — that is to say, the displaced end of the joint remains in its abnormal position — we have what is called nearthrosis as a consequence of the irritation which it produces in the immediate neighborhood of the joint. In such a case there is slight immobility due to partial adhesions of the affected part, and also due to a certain extent to atrophy of the muscles surrounding it. In some cases motion of the joint is entirely lost. Clinical Symptoms and Prognosis. "When a dislocation has just occurred, and when it has been there for some time, the symp- toms are more marked than they are in the intermediate stage, for the reason that the hemorrhage produces so much swelling as to render obscure, to a certain extent, the position and character of the luxation. In some cases the condition can be very easily recog- nized by comparing it with the perfect joint on the other side; at other times, it is only by careful manipulation in the region of the joint that the alteration can be felt. AYe may find a projection of bone at one place and depression in another, where they do not occur in the healthy side. We may even feel the luxated end of the joint. In some cases where the deformity has been concealed by the rapid swelling of the surrounding tissues, the leg may be shorter, or it may be on a longitudinal axis with the other leg. Another characteristic symptom is the loss of movement in the luxated joint, especially when the case is seen early, although in some cases where the ligaments have been so lacerated or torn, or where a piece of bone has broken, there is abnormal flexion in that part. This is especially important, as it enables us to locate a fracture of the bone that is in the neighborhood of the joint. INJURIES OF THE JOINTS. 283 There is also a slight crepitation. This, however, is soft, and not the hard, rough crepitation that we find in fractures. Luxations are not dangerous to life except those of the vertebree, but they are very troublesome, and, as a rule, make slow recov- eries. Dislocations can be reduced quickly where the animal is seen a short time after the injury; but in rare cases, on account of the lacerated condition of the capsule and ligament, it is rather difficult to hold the injured joint in position after it has been reduced. Therapeutic Treatment. The treatment consists of: 1. Reduction of the dislocation. 2. In holding the joint in position after the reduction has been made. It is rather hard to lay down any rule to be followed in all cases, but try if possible to return the joint in the same position as it was before, comparing it with the joint of the opposite leg, follow- ing, as a rule, tlie same procedure as that followed in fractures of the bone. As soon as the reduction is made the joint must be dressed and allowed to remain if possible for a period of three weeks (further particulars will be found in the chapter relating to fractures of the bones and wounds), so that the soft parts which are lacerated — the capsule and the ligaments — may have an opportunity to grow together and return the joint to its normal position. If the dressing cannot be applied in cases of dislocation of the hip, the animal must be kej)t in a cage or in a small room, in order to keep it as quiet as possible. We may find more or less stiffness of the joint when the dressing is removed. This can be assisted to a certain extent by means of massage. The following dislocations appear more frequently in tlie dog and require especial mention: Dislocation of the Lcwer Jaw. This is extremely rare, and may occur in some instances where a setter or retriever endeavors to carry a very large bird, opens his mouth, and distends it in such a way that it is dislocated. In some cases this luxation is confined to one side, and in others both articulations are out of joint. The lower jaw projects forward, the incisors project beyond the upper incisors, giving the animal an '' undershot" position, while in a lateral direction the jaw is pushed to one side, the mouth remains wide open, and cannot be closed except with great exer- tion. In many cases, on account of the pressure which is caused 284 DISEASES OF THE BONES AND ARTICULATIONS. by the coronoid process pressing on the posterior portion of the eye, it is bulged, causing what might be termed an incomplete prolapsus of that organ. Other symptoms are salivation, great pain, rest- lessness, blue coloration of the tongue. (For differential diagnosis of paralysis of the lower jaw, see Diseases of the Mouth.) Therapeutic Treatment. According to Stockfleth, the ani- mal must be held by an assistant. The best method is to hold him between the legs and steady his head while the operator by means of a lever-like action upon the lower jaw endeavors to reduce the dislocation. To accomplish this, wrap a cloth around the hand, place the thumbs on both teeth of the lower jaw, and by means of external pressure attempt to reduce the bone into its normal condition. Another method which the author finds is not as reliable consists in placing a strong stick between the jaws, as far back as possible, then by pressure on the anterior portion of the jaws, allowing the stick to act as a fulcrum, the jaw will very often fly into position. In order to prevent a recurrence of this, the dog for some time should wear a par- ^'°-^"- ticularly (Fig. 62) tight-fitting muzzle and should receive nothing but soft food. Dislocation of the Elbow. In the dog; the bone of the forearm forms with the elbow a pivot joint. Each of these joints has a capsular ligament. The Muzzle. • n 1 • 1 • Ti 1 1 upper IS fitted with a ring-like band, and in the lower portion the radius is kept in position by means of transverse ■ ligaments. A slight rotation of the radius may occur independent of the elbow-joint itself. A dislocation of this articulation may occur from jumping from tables, chairs, fall- ino' from some heiffht. In the former case the bone of the forearm is dislocated backward and outward. In dislocation of the lower pivot joint the bone of the forearm may project forward as well as backward. If dislocation of the upper joint occurs in the dog, the forearm is kept flexed; it becomes immobile in the elbow-joint, the animal using three legs and carrying one in the air. The joint is wider, and the dislocated portion of the forearm may be felt distinctly, also may see more or less marked sensitiveness or swell- ing. If, on the other hand, we have a certain amount of move- ment on extension of the elbow-joint and great elasticity in the INJURIES OF THE JOINTS. 285 joint, too much for the normal conditiou, the animal evinces great pain on movement. This dislocation is easily corrected. The joint may be moved freely, but as soon as the animal stands upon its feet agaiu the displacement recurs. This is due to the annu- lar ligament, which holds the joint to the forearm in place, being torn. If this dislocation is not reduced and left for some time,ihe leg will be held constantly in a flexed position, and the animal will not use it. In cases of lower dislocation of the joint the animal walks upon three legs, and on examination we find that the lower end of the bone of the forearm is displaced in a posterior direction, and more rarely in an anterior direction. This dislocation is easily reduced, but on the slightest movement reappears again. The prognosis is not favorable, as it is a rather difficult condition to treat. The weak ligaments (the annular ligament and transverse ligaments) do not heal quickly, and the dislocation has a tendency to become chronic, especially in the upper joint. TuEATMENT. In the treatment of the upper joint the forearm becomes extended and the legs should be crossed and an attempt made to push the forearm backward and outward into its normal position. It must then be held there by means of a tight bandage. This bandage must be changed once a day, as it is apt to produce tenderness of the skin from being so tight. If the dislocation affects the lower joint, the bone of the forearm will have to be pushed into its normal condition with more or less force and a sili- cate of sodium bandage applied. Dislocation of the Patella. Stockfleth states that the patella may become dislocated on both sides, but not upward, and that the dislocation is generally on the inner side, on account of the forced extension of a very much flexed tarsus and a tendency of the muscles to turn inward. This is seen occasionally in circus dogs (grayhounds) making high jumps. In cases of inside dislo- cation the patella lies on the inner side of the joint where it moves on the tibia, and in external dislocation it lies on the outside of the external condyle. Inner Dislocation of the Patella. In the early stages, shortly after the dislocation occurs, the animal holds its leg in a very flexed position. The hock is flexed and the heel turned outward. At the joint the patella may be found lying sideways, and is easily 286 DISEASES OF THE BONES AND ARTICULATIONS. moved laterally. If we take hold of the knee and flex or extend it, the animal evinces great pain. The leg must be bent backward and straightened as much as possible, then by means of manipula- tion of the fingers the patella can be made to slip into position This is very easily performed, and the animal walks away as if nothing has occurred. This dislocation, however, may recur when the animal jumps any distance. When the disease becomes chronic and dislocation occurs often, the animal runs on three legs, or walks lame on the affected leg. The stifle-joint is uneven, thick, and the patella can be dislocated, or put into position simply by pressure of tlie fingers. If the dislocation affects both legs, these are kept in a flexed position, the animal making peculiar jumping move- ments, using both legs at the same time when he attempts to walk. If he lies down, the hind legs are extended backward and crossed. The prognosis is favorable in new cases, but unfavorable in old ones. Teeatment. The tarsus must be extended in order to overcome the tension in the straight ligaments and extensors, and the patella may be easily shov^ed into position. If the animal is then kept quiet for several days, as a rule, no after-treatment is required. If the dislocation of the patella is old, treatment is useless. Stockfleth has used a dressing in this disease which he describes as follows : He attached a broad linen bandage around the tibia, and fastened a wide girth around the abdomen, and a breast-piece to prevent it from slipping backward. The bandage was then fastened to the tibia, close to the girth around the abdomen. The affected leg was then pulled up close to the abdomen, so that the animal must stand on three legs. The dressing remained on for twenty days, and when it was removed the animal was eutirely cured. In another case he had a double-sized dislocation of the knee. After returning the patellse to their position, the knee- and ankle-joint were covered with thick wadding, and a capsule of gutta-percha, which had pre- viously been soaked in hot water, was applied to each leg, sur- rounding the leg from the knee to the toes. In order to prevent bending of the gutta-percha before it was sufficiently hardened, a wooden support was fastened to the outside. The dog, which had formerly crept upon its hind legs, walked ujDright as if on stilts. The dressing was left on the animal for two weeks, and on removal of the dressing the dislocation did not recur. DISEASE OF THE BURSA MUCOSA. 287 External Dislocaiion of the Patella. This accident is very rare. Stockfleth saw but one chronic case in both legs in a small dog. The subject was lively, walked rapidly, but had very flexed ankle- joints, giving him very much the appearance of a weasel. The tarsus appeared thick and uneven ; the patella, which was located in the muscles of the outside, could easily be pushed back into its normal position; but if left, it immediately slipped out of position, and became dislocated again. This was due to the fact that the crest of the joint had disappeared, offering no resistance to dislo- cation. Moller states he has seen external dislocation of the patella quite often, especially in Skye-terriers, while Hoffmann believes that an external luxation of the patella in dogs is impossible for anatomical reasons, because of the straight ligaments. The middle one is the only one of any consequence, and for another reason the patella is extremely small. Other luxations occur in the dog — for instance, in the hip-joint. In this the head of the femur becomes pushed upward after laceration of the capsular ligament, and the joints of the phalanges sometimes become dislocated. These do not possess any special symptoms that may not be easily recognized by the indications stated under Clinical Symptoms of Luxations. DISEASE OP THE BURSA MUCOSA. Diseases of the mucous capsules which lie under the skin — for instance, in the acromion, olecranon, and at the ankle. These are not of any special importance in the dog, although we occasion- ally see them affected. These diseases are developed in the form of circumscribed, fluc- tuating swellings, either caused by hemorrhage, sero-fibrinous or purulent inflammation of the mucous surfaces. These may be caused by blows, jars, or by some other traumatism. The purulent form is generally caused by some injury produced externally. It is easy to recognize these enlarged bursse. We find a large fluctuating swelling, accompanied by acute inflammatory symptoms. There is much pain on pressure, and the fever, when it has been caused by active inflammation and not through hemorrhage, is very acute. Purulent secretions, as a rule, perforate the skin and escape. 288 DISEASES OF THE BONES AND ARTICULATIONS. Serous or sero-fibrinous secretions are rarely entirely absorbed, but leave a slight, fluctuating tumor with thickened walls, which is to be termed a " cystic abscess." When the condition comes on gradually, continuing to swell and increase, taking a chronic form from the first, the walls of the pouch become very much thickened. There is a gradual accumu- lation of a mucus-like fluid. As a rule, true inflammatory symp- toms are not present ; but if they are, only very slightly. Treatment. In cases of large fluid secretions (blood or serum) it is best to puncture, following the antiseptic rules. Purulent secretions may be removed by opening the pouch, making a par- ticularly large opening, and using a draining-tube. Cystic abscesses may be removed by means of tincture of iodine injected in them, or by cutting them open, but best of all by excising them. The author has found good results from first opening them, using the drainage-tube, and applying such stimulating agents as tincture of cantharides, creosote, solution of nitrate of silver 1 to 10. Diseases of the tendons or sheaths are of no importance in the dog, and need not be discussed. MUSCULAR RHEUMATISM. Muscular rheumatism is a primary infection with more or less complication of the muscular system. In some cases there is little or no inflammation present, no fever, and the only indication of rheumatism being present is stiffness of gait and pain on pressure. Etiology. The cause of rheumatism, which has been described as a certain poisonous substance, may also be due to cold, atmos- pheric influences, etc. , or dampness, animals lying in kennels that . do not get the sun, or being kept in the cellar. We have, undoubt- edly, a number of diseases of the muscular system which do not develop from rheumatism, for instance, abnormal muscular exer- tion and consequent laceration of some of the muscular fibres; also from disturbances of the circulation, from chronic toxic in- fluences, etc. It would be much better to discard the name ''muscular rheumatism" and simply call it ''muscular pain." Experience has taught the author that muscular rheumatism is seen frequently in old, delicate, or fat dogs, and is oftener ob- served in winter than in summer. MUSCULAR RHEUMATISM. 289 Pathological Anatomy. It is very difficult to make any definite statement as to the cause of rheumatism. We speak of rheumatic muscular inflammation, but at the same time we do not, as a rule, find any different muscular alterations on post-mortem from animals which have suffered from muscular rheumatism. We may find slight alterations which have occurred from other causes, such as hyperemia, slight exudation in the muscles, tendons, and fascia. It is well known that slight inflammations of the mucous membrane are not generally recognized during life. On the other hand, we find cases in veterinary literature where very distinct alterations have been observed in the affected muscles. Deposits occur in the connective tissue (rheumatic callosities). These occur in a man who has suffered for a long time from muscular rheuma- tism, and in old rheumatic dogs we may also observe characteristic alterations in acute or chronic inflammations. Clinical Symptoms and Couese. Muscular pain is a most marked symptom. This is observed in slight cases by the animal having a contracted appearance of the muscles, or when by pres- sure upon them they are foupd hard and tense. We also observe that dogs affected with this disease move with fear, showing great disinclination for any movement, and occasionally they cry out with pain when touched or lifted in certain parts of the body, or if any portion of a particular muscle is touched. If compelled to rise, they do so in a slow, fatigued way. Their movements are stiff and strained, and when feces are passed the animals do so with pain, frequently crying or howling, or it may be they make no effort, producing obstinate constipation. As rheumatism is generally located in the joint regions, these symptoms become modified in certain parts of the body and inten- sified in others. We very often see rheumatism of the back and loins. Rising and stretching of the extremities and all movements of the trunk are very painful. The region of the back and loins is very sensitive, so that the animals cry at the slightest move- ment. The muscles in the neck are also subject to this disease. Animals show great pain while eating on account of being com- pelled to bend their neck in stooping down to reach their food. The muscles are distended and painful to the touch. If the head is bent, the animal shows great pain. In rare cases we see rheuma- 19 290 DISEASES OF THE BONES AND ARTICULATIONS. tism in the masseters (a great difficulty in mastication). Only in very severe cases is any fever noticed. The course of the disease is sometimes acute and occasionally chronic. In the former case the disease runs its course very quickly, and may disappear without any special treatment, but there is always a tendency to relapse. In the latter form the disease may be prolonged for months, varying in degrees of intensity, also showing a tendency for the pain to move from one part of the body to another. This peculiarity is noticeable in chronic rheumatic conditions. Therapeutics. The agents recommended for the dog are sali- cylic acid, antipyrine, tincture of colchici, morphia, friction, mas- sage, and electricity. The first three drugs produce the most favorable results: R. — Salicylic acid 5.0 Aqua destillata 50.0 S. — One tablespoonful three times daily. R. — Antipyrine 5.0 Syrup, simplex 25.0 Aqua destillata 50.0 S. — One teaspoonful three times daily. R. — Tincture of colchici, 10 to 20 drops several times daily. R.— Salicin 2.0 Potassii iodidi ....... 1.0 Fiat divid. charta No. viii. S. — One powder twice daily. In the chronic form of the disease various cutaneous stimulants have been used, such as spirit of camphor, opodeldoc, spirit of mustard, but we must remember that their influence is more due to the massage than to anything else. It is advisable to rub the stimulating embrocation into the skin, either by the hand or with a woollen rag. Albrecht has found that this therapeutic treatment may be greatly improved by putting the patient into a bath of 28°, rubbing it dry and wrapping it in hot blankets. (Fig. 63.) The opinion concerning electricity is much divided. The author has never been able to obtain any very marked results by using this form of treatment. Muscular rheumatism in some cases may be confounded with those of cysticercus cellulosus. In the latter case parasites should FRACTURES OF THE BONES. 291 appear in very large numbers, Pauli found, for instance, in one dog a peculiar, stiff, flexed condition of the head, a surface one inch square in the psoas muscles which \vas filled with cysticercus cellulosus the size of a pea; and Trasbot found, at the post-mortem Fig. 63. Bath-tub. of a dog which had shown great pain during life, especially when touched or moved, all the muscles filled with cysticercus of taenia solium. (For further details concerning cysticercus, see Internal Para- sites.) / FRACTURES OF THE BONES. Etiology. By a '' fracture of the bone" we mean a breaking or disunion of a bone or a bony cartilage. Most fractures are caused by external forces, and the bone fractured is at the region where the force or shock has expended most of its force — for instance, from blows or being run over; or in some instances a fracture may be some distance from the region where the greatest amount of force has been made, such as falling for some distance, or concussions. We also see fractures of small projections of bones caused by great muscular exertion. The author saw a fracture of the olecranon in a hunting dog, which could not have originated in any way than by enormous muscular strain. Very old and 292 DISEASES OF THE BONES AND ARTICULATIONS. youDg dogs have a predisposition to fractures and rickets, or a tendency that way may also produce fractures from a weakened or softened condition of the bone. General Classification of Fractures. We separate fractures under different names according to their position, severity, and the compKcations accompanying them. General Classification of Complete and Incomplete Frac- tures. In the first class belong infractions, splits or cracks, impressions or depressions. In the second class belong oblique, transverse, longitudinal, and fissure fractures; in pups where the epiphysis and diaphysis would sometimes have fractured through the symphysis due to traumatic influences. This fracture, which is rather common, especially in the humerus and radius, is always confined to the immediate neigh- borhood of the symphysis. The general course of these fractures is the same as ordinary fractures, and no special mention is neces- sary regarding fractures of the soft parts. The condition of the soft tissues in the neighborhood of the frac- tures and the amount of injury that they have had are of great importance in the prognosis. All fractures in which the soft tissues are not very much injured, and where the skin has not been torn, heal very much quicker than those where there is an open wound extending into the fractured end of the bone. The first are termed simple fractures, and the latter compound fractures. Where the fracture has involved a joint, it is called an intra-articular fracture. They are very slow and difficult to treat, and present such symptoms as synovitis, either with or without serous or puru- lent inflammations. In such fractures, even when we have union of the broken ends of the bone, Ave may have either a stiff joint or ankylosis from complications in the joint. Clinical Symptoms, The symptoms of fracture are generally indicated by partial or complete loss of the use of the whole or part of a limb. There is pain on pressure, deformity in the sym- metry of the broken bones of that part of the body, and on moving the fractured ends there is a rubbing sound (crepitation) similar to rubbing two hard, rough surfaces against each other. The amount of loss of power in a broken bone depends to a great extent on the amount and severity of the fracture. This is very marked in frac- tures of the extremities; great pain on pressure, especially on the FRACTURES OF THE BONES. 293 line of the fractured bones. This may also be of especial diag- nostic importance in case of cracks or fissures of the bone. In such a case, while the symptoms are all present, the ends of the bones are not displaced. This is generally seen in the longitudinal form and in very young animals where the bone pivots on the fractured epiphysis. Crepitation and an abnormal movement are easily recognized by taking hold of the part above and below the fracture and moving it in different directions. Both of these symp- toms are absent in incomplete fractures and in such fractures where the bones will close together with very little displacement. This is especially seen in longitudinal fractures of the short compact bones. We occasionally find a mild, rubbing bruit or sound produced by dry blood-extravasations or fibrinous coagulations between the surfaces of joints. In cases of fracture where the periosteum has not been torn, we will have a certain amount of swelling in the fractured region, pain on pressure, loss of appetite, and a certain amount of fever. This last symptom, however, is rarely noticed. Where there is an external wound which becomes rapidly closed by the blood and the purulent agents cannot penetrate between the fractured ends of the bone, we have a form of fracture that is not so difficult to treat; but if any septic materials should have pene- trated into the wound and found their way between the ends of the bones, the condition is generally indicated in the following manner : There is a marked inflammatory swelling in the neigh- borhood of the wound. At first the discharo;e from the wound is blood-colored, then rapidly becomes pus-like, and finally purulent in character. If the discharge becomes obstructed in any way, we quickly notice a purulent, oedematous swelling all around the part, which is always a very grave symptom. If the course is favor- able, the injured part becomes rapidly filled with red, granulating tissue, which finally dries, becomes hard, and forms a scab. By means of strict antiseptic treatment this is possible, and we can reduce the danger and time of an open fracture by strictly follow- ing the usual antiseptic forms of treatment. In the dog, however, this is always rather difficult to accomplish, as the animals are hard to confine, moving about constantly and pulling or tearing the bandages. The Phenomena of Union in Fractures. The healing and 294 DISEASES OF THE BONES AND ARTICULATIONS. Fig union of the fractured ends of a bone are very similar to those of wounds, either by first intention (primum intentionem) or by sec- ond intention (secundum intentionem). In simple fractures we generally get union by first intention, and in compound fractures, unless the union be extremely small, we get union by second in- tention. (Fig. 64.) In both cases the union is accomplished by means of a callus growing around the ends of the bone — that is to say, a soft cellular tissue which forms an envelope surrounding the bone and gradually becoming hard through the ossific action of the periosteum and the marrow of the bones. The ring- shaped or external callus surrounds the fractured parts. This cellular tissue is formed of osteoblasts. The inner callus is formed by the marrow, forming a peculiar plug-shaped body and filling up the open ends. The periosteum is the true factor in mak- ing union between broken ends of bones. This is especially noticed in fractures where the periosteum is ex- posed, and where that envelope is torn or injured union is almost twice as long as where the periosteum is preserved. The extravasation of blood found in the early stages of a fracture which lies in the surrounding parts does not in any way assist in the actual union, but helps to a certain extent in holding the bones together until the callus is formed. The callus beginning is a spongy mass, especially in bones containing a large quantity of marrow. This gradually changes into a bony cicatrix or callosity. This becomes thinner and denser, lessening in diameter, and finally becomes smooth on its surface, forming what is known as " final callus." Reabsorption commences at the same time until the bony masses, which are use- less after the bone is united, finally disappear, but there is always a certain amount of enlargement around the fractured ends of a bone at the point of union. Cracks and fissures undergo the same process. Diagram of union of fracture in the tibia of the dog : a, outer callus ; b, periosteum ; c, inner callus ; d, in- flammatory deposit. FRACTURES OF THE BONES. 295 Period of the Process of Union in Fractured Bones. The time required to obtain complete union of a fracture — that is to say, until the animal can use the part without any pain or diffi- culty — depends largely on the size and position of the bone, the age of the auimal, and the amount of use the patient makes of it. According to the observations of the author and others, in fractures in which the periosteum is not torn, or simple fractures of the large bones containing marrow, the time is from eighteen to twenty- four days in adult healthy animals. Fractures of the ribs unite in from ten to fifteen days; in metacarpal and metatarsal bones, ten to eighteen days. In young animals the process is a few days shorter; in very old animals it is much longer. After the union of the fracture, as a rule, the affected leg is not used with as great freedom as it was before. This is especially noticeable in young animals that are growing. Very often there is a subsequent atrophy and impaired development of the muscles of that part. While this may be due to a certain extent to the inactivity of the muscles when tied up ia the splint, and also to pressure of the dressing, it is often noticed after the dressing is removed, and sometimes for weeks afterward the animal walks stiff or is even lame. Therapeutic Treatment. In simple fractures the treatment consists of returning the broken ends of the bone to their proper anatomical position, and holding them in position. The bringing together of the fractured ends of the bones must be done as soon as possible, and it is accomplished by pulling or extending them in a longitudinal direction until the fractured ends fit together. In some instances where the tissue is loose they have to be pressed back in their normal position. The animal should be held by an assistant while the operator manipulates the ends into position. In cases where there is extreme pain and in order to keep the animal from struggling, it is advisable to etherize. In such cases as fractures of the metacarpal bones, bones of the face, etc., a reduction can be made without an assistant. When the bones have been placed in position as near as possible to their normal shape, we must then apply a dressing which will keep the fractured ends in their proper position until they have united. The best dressing for fractures in dogs are those which dry rapidly, such as plaster and silicate of sodium solution. In some 296 DISEASES OF THE BONES AND ARTICULATIONS. Fig. 65. cases it becomes necessary to apply a temporary splint apparatus for a few days. This splint apparatus must be used where there is great swelling or where the condition of the wound or part would lead you to expect much swelling. The author finds the best thing for these dressings is a broad pasteboard splint. This should be dipped in water and kneaded by the hand until flexible. There are various other materials for making splints — gutta-percha, wire gauze, etc. In some cases where there is an open wound wire gauze may be used, fastened above and below the fractured ends, leaving the wound exposed. This gives it sufficient support, and proper antiseptic methods can be followed. A plaster-of -Paris or silicate of sodium dressing may be applied immediately after the fracture, provided there are no wounds. Where there are wounds or swellings we must wait until the swelling is absorbed. We apply a permanent dressing, or a temporary dressing may be put on in the following manner: Cover it thoroughly with cotton wadding and apply the ordinary bandage, taking care not to make it too tight. In plaster-of-Paris dressings the ordinary gauze, crinoline, or cheesecloth may be used, and the plaster, in powder form, rubbed into the part. Then oil the point of the fracture to prevent the bandage sticking. At the same time place the plaster bandage in water for a few minutes and then wrap it care- fully around the part, following the methods adopted in ordinary bandage rolling, being careful not to place it too tight. Smooth the water out of the part, making the bandage as level as possible. In some cases where you want a very stiff bandage, it is ad- visable to put a certain amount of plaster between the folds of the ban- dage and finally give a good coating over the entire bandage. After the dressing has been applied the animal must be kept perfectly quiet for at least ten to twenty minutes to allow the dressing to become hard, A plaster dressing will dry and harden a little o. Bandage-cutting scissors. b. Bone forceps. FRACTURES OF THE BONES. 297 quicker by the addition of a small quantity of alum or common salt. The scissors shown in Fig. 65 (a) are the most practicable for the removal of this dressing. Tripolith dressing (a mix- ture of plaster-of-Paris and soot) can be applied in the same manner as the plaster. Its composition is said to be much lighter and it dries much more rapidly. Silicate of sodium dressing has the advantage of lightness, durability, and of being removed easily, but it has one disadvantage, and that is it dries slowly, sometimes taking a couple of hours. The author likes this form of dressing best, and to overcome the drawback of slow hardening has placed thin layers of wire gauze between the dressings. Flan- nel may be used as an under layer. Another dressing is a mixture of benzoate of sodium and silicate of sodium. The dressing may be left in place until we feel sure that union has taken place. In cases where the dressing has been too tight, or if the patient shows restlessness, whining, crying, loss of appetite, or fever, indicating that something is wrong ^ig 66 in the fractured region, the dressing must be removed at once. (Fig. QQ.) In complete fractures we follow the same rules as in the subcutaneous forms — that is to say, we endeavor in one w^ay or another to hold the broken ends of the bone together while the wound is healing, and at the same time to dry up the wound antiseptically. This is rather difficult to do in the dog, but it may be accomplished by making a '' win- Eflects of tight bandaging dow" or hole in the dressing. The wound ofaspUnt. must first be made thoroughly clean, dressed antiseptically, and then we apply a plaster dressing according to the usual method, and place a piece of wadding upon the wound , AVhen the dressing becomes hardened we cut a hole over the wound by means of a probe-pointed bistoury, coating the edges of the opening wath a small quantity of plaster-of-Paris or collodion in order to prevent the discharge of pus, etc., from running under the dressing. The rest of the operation is performed according to the general rules followed in the treatment of wounds. In cases where the fracture is fresh and the wound is very small we cover it with an antiseptic dressing (for instance, tincture of iodine and several 298 DISEASES OF THE BONES AND ARTICULATIONS. layers of corrosive sublimate gauze). Then apply the closed dress- ing of plaster- of -Paris entirely over it. If the wound is slight, as a rule, you do not require to remove the bandage. Care must be taken, however, to take the temperature and watch the leg to see if it swells, and if the animal is restless and uneasy. In cases where there is a wound and several broken bones, making a com- pound comminuted fracture, the patients can only be saved by amputating the leg. Amputation of the leg, as well as exarticu- lation, has been performed a number of times in the dog, and gen- erally successfully, the animals soon becoming accustomed to the loss of the leg, using the other three with almost as much ease as they did with four. Amputation. Before the operation clean the aflfected leg with soap and a brush ; then disinfect with powerful antiseptics (5 per cent, solution of carbolic acid, 1 to 1000 solution of corrosive sublimate, and 2 per cent, solution of creolin). In operating do so with as little loss of blood as pos- sible. To accomplish this use Esmarch's rubber bandage. All of the rules Fig. 67. Different methods of amputation : o, straight section ; b, flap operation ; c, method of sewing the wound. of antisepsis must be strictly adhered to, and at short intervals during the operation the wound must be irrigated with some antiseptic. Avoid any serious manipulation or compression of the soft parts. The skin must FRACTURES OF THE BONES. 299 always be cut in such a manner as to cover the stump when the two ends or flaps are united. All the vessels, arteries as well as veins, which have been cut must be taken up separately with the forceps and ligated with cat- gut or silk. All stumps of nerves which lie loose upon the wound are to be drawn out with the forceps and cut ofi" as close as possible. The ban- dage must not be removed until all the bloodvessels have been ligated (Fig, 67). The wound and its neighborhood are then thoroughly irrigated with an antiseptic solution and closed with stitches ; the skin is also stitched at the same time. The different forms of stitching are illustrated on page 314. The whole wound is to be covered with a permanent antiseptic dressing. (For further details, see Treatment of Wounds.) Amputation by means of a Circular Section. Cut through the skin of the affected extremity to the fascia, making a complete circle around the mem- ber. Pull this back and have it held by an assistant, he pulling the skin toward the body as far as possible. It may be necessary to dissect the skin and the cellular tissue from the under layer of the skin. After that make a sharp, clean cut, entirely circular, close to the edge of the skin which is pulled back, amputating all the muscles, and finally cut with bone forceps (Fig. 65, b, page 296), or saw through the bone. "While cutting through the bone it is necessary for the assistant to pull back the soft tissues as far as he possibly can toward the body, either with his hands or by means of a linen compress which has been dipjjed into an antiseptic solution. In cases where amputation of the extremities has to be performed, where there are two bones, as in the forearm, it is necessary to cut the soft tissues which are located between the bones. Flap Amputation. We cut two half-moon-shaped flaps of the skin and separate them from the fasciae in which they are located as far as their base, turning them upward and backward. The muscles are cut close to the flaps, the tissues pulled back, and the bones sawed through. Amputation of the tail. Exarticulation. Separate the soft parts exactly as in amputation by means of a circular or flap cut. We then open the affected joint by bending it, 300 DISEASES OF THE BONES AND ARTICULATIONS. producing a tension of the ligaments which are located in front of it ; then cut through them with a bistoury. Exarticulation is finished by separating the other ligaments and the capsule of the joint; then proceed exactly as we do in ordinary amputation. Amputation of the tail is one form of exarticulation : This operation, which is comparatively harmless, is sometimes required in cases of necrosis of the bones of the tail after serious injuries to the soft parts or from frac- ture of the caudal appendage. An amputation between two of the vertebrae is much better than cutting through the bones. The operator must distin- guish the slightly enlarged point (Fig. 68) where the articulation lies ; then proceed by means of the " flap " or " round" operation, whichever is pre- ferred. As the vessels are slight they can easily be stopped by means of a thermo-cautery. The author generally uses the circular operation, cutting posterior to the bony protuberances of the articulation. Pull the skin back, cutting through the muscles and tendons just below the articulation ; then, with the help of an assistant, pull up the tissues and cut between the carti- laginous disk. In cases where there is much hemorrhage the artery may be taken up by means of a catgut ligature. The edges of the skin are united by an interrupted suture and an antiseptic dressing is applied, taking care not to make it too tight. When the average period of union of fracture has passed remove the dressing carefully and see that the fragments are united. If we recognize any mobility in the fractured region, we then under- stand that we have a slow, callous formation, and nothing else is to be done but to renew the dressing as soon as possible, having first rendered the parts antiseptic by means of sublimate soap and water. Put on the bandage again and let it remain for two or three weeks more. If we do not obtain a cure at the end of that time we may conclude that we have a false joint (pseudoarthrosis). The methods pursued in man of introducing ivory pins into the bone or screwing it together by means of clamps or resecting the ends with a saw are hardly practicable in the dog. If, however, we discover that there is any danger of the formation of a false joint, we may irritate the ends of the wound by rubbing the broken ends together and applying a dressing, giving the animal phosphate of lime or phosphoric acid. Other diseases of the bones in the dog are of so slight importance that the author has omitted them. WOUNDS AND THEIR TREATMENT. By a wound we mean any injury which lacerates or punctures the skin, no matter what is the depth. Wounds are classified according to various authors in the following manner: 1. Their location, whether they are in the head, neck, chest, or extremities. 2. .According to their depth into the muscles or bones, they are called penetrating or non-penetrating. Those that injure the skin slightly are called lacerations or excoriations. 3. They are also termed longitudinal, transverse, or oblique, according to their direction or length. Regular or irregular — that is, indented or flap wounds. 4. Their cause is also considered, whether produced by cuts, blows, lacerations, concussions, bites, or gunshot. These causes, however, are of no special importance. Clinical Symptoms. All wounds are accompanied by three symptoms: the open, gaping condition of the edges of the wound, hemorrhage, and pain. As a rule, the wider the wound the deeper it is. If the wound is long but does not gape, it corresponds with the direction of the muscle or the tissues beneath it. On the other hand, wounds across muscles are much wider and gape more, this being due to the retraction of the muscles. The bleeding is either arterial, venous, or capillary. The former may be recognized by the fact of blood being mixed with more or less light-colored arterial blood. The danger of such arterial bleed- ing depends on the size of the arteries and how severely they have been injured. In small arteries the bleeding generally stops of its own accord, due to contraction of the severed bloodvessels; but in large arteries the animal will frequently bleed to death unless surgical interference stops it. In cases where the artery is cut in a transverse wound the hemorrhage is more severe than when it is in a longitudinal wound. There is more bleeding in cleanly cut wounds than there is in those produced by laceration or concussion, but the latter present more complications than the former, due to consecutive hemorrhages. In venous bleeding dark-red, even col- (301) 302 WOUNDS AND THEIR TREATMENT. ored, blood flows out of the wound. Hemorrhages in small and medium-sized veins generally stop without any surgical interfer- ence, but the large veins, especially those in the neighborhood of the heart, are dangerous and should be taken up quickly. Capillary bleeding consists in a slow trickling of blood, which, as a rule, lasts for a very short time and is of no great importance. A serious hemorrhage endangers the animal's life, and the more rapid it is the greater the danger. The following symptoms are presented: general coldness of the skin and extremities; paleness of the mucous membranes, especially the mouth and eye ; great prostration ; staggering gait ; and often from weakness inability to rise. In some cases we have unconsciousness, dyspnoea, enlarge- ment of the pupils, uncontrollable evacuation of urine and feces, finally slight convulsions, and death. This conclusion is to be expected if about half the blood contained in the body is lost in a very short time. Many experiments have been made upon the dog in order to find what are the consequences of slight hemorrhages. One-fourth of a dog's blood may be withdrawn without causing any appreciable les- sening of the blood-pressure in the arteries. The pulse may become very indistinct while the blood is withdrawn, but it is soon restored to its ordinary pressure if the hemorrhage is stopped, from the fact that the arteries contract in proportion to the smaller quantity of blood. The rapidity of the current and the number of contrac- tions of the heart remain the same as before the hemorrhage. Any loss of blood amounting to more than one-third of the blood-mass reduces the blood-pressure very much. The current becomes slow and contractions of the heart are much less. At the same time the composition of the blood is changed. At first we observe a compensation of the water of the blood, and the salts which are thereby being reabsorbed from the tissues when this is exhausted; then albumin is drawn into the blood. It requires a much longer time to form new blood-cells after the animal has been bled of one-fourth of the weight of the body. The red blood-corpuscles become normal and return to their original number in from seven to thirty-four days. The hemorrhage is stopped by the closing of the bloodvessel by a clot or thrombus. The blood within the walls of the bloodvessels is only kept in a liquid condition as a result of its contact with WOUNDS AND THEIR TREATMENT. 303 the endothelium, aud if from any diseased condition the endothe- lium is changed, or if the blood runs off through another opening, or if the circulation is obstructed by a ligature, the blood becomes coagulated, aud we quickly have the formation of a thrombus. This not only closes the bloodvessel externally, but it is more or less extended into the bloodvessel until it reaches the first branch where there is an active current of the blood. These useless ves- sels soon become converted into solid cellular connective tissue. We shall refer later to the puriform, pussy, and purulent degen- eration of the thrombus. It is readily understood that the formation of a thrombus may occur rapidly when the ends of bloodvessels which have been detached have their opening reduced by contraction or twisting of the coats (media and intima), as in the case of crushing or lacer- ating, especially in the capillaries or small veins. In partial injuries of the bloodvessels the bleeding may be stopped without com- plete obstruction of the bloodvessel. In favorable conditions the lacerated wall of the bloodvessel becomes coated M^ith a solid coagula. This becomes organic, so that the only result is a slight thickening of the wall. The pain of a wound is indicated in the dog by howling and crying when the injury occurs, or later when the wound is exam- ined. The pain evinced by the patient also depends upon the individuality of the animal. Some dogs are great cowards and show great sensitiveness to the slightest pain, while others will stand any amount of it; and we must, therefore, always carefully examine a wound, seeing its depth, situation, and character, and not in any way be guided in making a diagnosis by the symptom of pain indicated by an affected animal. Wounds of the lips, lower extremities, external genitals, and of the bones are the most painful. In the dog we see occasionally a series of symptoms which are identical with what is known in man as " shock." This, as a rule, occurs immediately after any painful injury, such as extensive crushing of tissues or bone, and during or after operations. The visible mucous membranes in the skin become pale, then cold; the eyes are fixed, the pupils dilated; the pulse becomes irregular, reduced in volume; and the respiration weak and irregular. The animal appears indifferent or unconscious. These symptoms may disappear very rapidly or in some cases go on until the animal 304 WOUNDS AND THEIB TREATMENT. dies without rallying in spite of any form of treatment that may be tried. Symptoms of a very similar character, as a result of extensive hemorrhage, are sometimes presented, and must not be mistaken for '^ shock." The same may be said to occur occasionally in the dog when under the influence of chloroform. It is believed that the symptoms of '^ shock" presented are due to an irritation or concussion of the sensitive nerves, producing reflex paralysis of the vasomotor or centre of the medulla oblongata. In connection with the above symptoms we occasionally see dis- turbance of a function — that is, when certain muscles are injured and their nerves are separated, or when any of the joints or cavities of the body are opened. The symptom which appears when the muscles are divided or cut is a loss of power in that region covered by the affected muscle. The symptoms after the separation of peripheric nerves consist in the loss of movement and a partial loss of sensation. The latter is extremely hard to recognize in the dog on account of the numerous anastomoses which occur between the branches of the fine nerves of the skin and also of the injured nerves in the immediate vicinity. We also observe a marked decrease in temperature in the paralyzed or partially paralyzed part. The Course of the Healing- Process in a "Wound. The healing of a wound depends to such a large extent on its form, condition, location, and treatment, that from a practical standpoint we may generally separate the processes into, first, healing by tem- porary union; second, healing by second intention or suppuration ; third, healing under a dry scab; fourth, healing under a moist scab. Healing by First Intention. This may only be expected when the edges of the wound are smooth and sharp, due to cuts with sharp objects that are clean or surgical wounds which can be easily closed with stitches and covered by dressings. The microscopical examination shows that the healing of such wounds often occurs within twenty-four hours, and the adhesions form so quickly that the edges of the wound can only be separated by exerting a certain amount of strength. The wound is covered by a narrow, thin blood-scab; its edges appear normal or only slightly swollen or inflamed. The scab drops off after a period of five or six days, leaving a somewhat depressed, pale-red cicatrix. This gradually COURSE OF HEALING PROCESS IN A WOUND. 305 loses its color, and in a short time it is difficult to distinguish it from the surrounding tissues. Healing by Suppuration or Second Intention. This appears when the wound Is left to itself, and, if the animal does not lick it, it becomes quickly covered with dry blood and lymph, also a thick crust, which varies in color between red and dark-brown, covering over the edges of the wound. If the wound is licked from time to time, we have a discharge of bloody, watery fluid. After this the wound becomes covered with a veil-like gray covering, the secretion becoming more and more copious and thicker, then yel- lowish-gray, and finally pure yellow (pus). The edges of the wound become swollen and red, the gray covering of the edges drops off in pieces, carried away by the pus or licked off by the animal. From the second to the fourth day we see the appearance of small red granulations from the wound. These increase in number and finally fill up the spaces in the surface of the skin. Now the active secretion of pus begins to stop. The skin grad- ually contracts around the wound, the neighboring epithelial border rises above the edges, and eventually forms a cicatrix. The granulating surfaces, as a rule, shrink, contracting and draw- ing together the cutaneous borders from all directions, finally leaving a whitish somewhat depressed cicatrix. This is more irregular, broader, and thicker than the cicatrix formed in wounds healing by first intention. Healing under a dry scab occurs, as a rule, in small wounds which are not exposed to infection or have not been licked. Under this head we may class excoriations, cauterizations, various small incised or superficial wounds which have been covered in their early stages by antiseptic powders, such as boric acid, iodo- form, or antiseptic collodion. The same effect is seen after the use of the thermo-cautery. Dried blood, tissue fluid, etc., form a scab which becomes adherent, and only when this scab is removed by force does it produce bleeding. If it is not interfered with, it drops off in from eight to fifteen days, according to the size of the wound, aud as a result we see a reddened, non-resistant cicatrix which soon becomes pale and hard. If the scab drops off at an early period from some other cause, we generally see distended, red, irritable granulations, surrounded by a cicatricial wall. Healing under a Moist Scab. This may be produced by follow- 20 306 WOUNDS AND THEIR TREATMENT. ing the antiseptic method of healing wounds. In closing an entirely clean wound with a strictly antiseptic dressing, the wound having been produced as a result of an operation, and which is no longer bleeding, after having been closed it becomes filled with blood which coagulates. This coagulation, if perfectly antiseptic, fills in the cavity for a short time, when it is soon crowded out by the quick formation of granulations, And soon undergoes a change, becoming yellowish, due to an alteration of the coloring matter in the blood. This healing process is distinguished from that which occurs with the formation of pus by the fact that the constant loss of cells used in building up the tissues is not required, and that the cellular elements which are destroyed as a consequence of the injury are not detached to any great extent by the cleansing process of the wound, but they undergo a quick molecular destruction, and are then as quickly reabsorbed. Notwithstanding the fact that under the microscope the healing processes of wounds seem to differ greatly, still the histological pro- cess is the same in all. The formation of a deficient vascular cicatrix is the main point in all forms of wound treatment. This is accomplished by neoforraation of bloodvessels, by the appearance of numerous wandering cells, and by alteration of these cells into fixed bodies of connective tissue with a rigid interlaying sub- stance. The various modes of healing already described depend on the degree of irritation that the wound has been exposed to. The most marked symptom of acute irritation under the usual conditions is granulation with suppuration, and we must also point out that it may be well, from a practical standpoint, to con- sider suppuration as an abnormal condition due to infection. We must also state that the regenerative power of the disconnected tissue varies. The skin and mucous membrane are always closed by a cicatrix, and it usually heals by first intention because the epithelium unites quickly. Compensation tissues which fill up wounds that have been accompanied with a loss of a certain amount of tissue, it either being cut out or destroyed, especially when they contain few or no bloodvessels, seem to fill up very rapidly. Diseases Resulting- from Septic Infection of Wounds. There are a number of conditions which appear in wounds that are due to microbes and germs, producing certain irritations of DISEASES FROM SEPTIC INFECTION OF WOUNDS. 307 the tissues surrounding the wounds, especially the bloodvessels and the lymphatics. Phlegmons. By this we mean the inflammation of the soft tissues which has a tendency to formation of pus, especially in the loose subcutaneous connective tissue between the muscles and under the fasciae. There are two forms of this condition — a circum- scribed and a diffused phlegmone. Circumscribed phlegmone. The symptoms are very prominent, especially when it is near the skin. We find in a certain circum- scribed region a hot, painful, very red swelling, firm and tense in the early stages, but soon becoming soft, doughy, and finally fluc- tuating, due to the tissue breaking up and forming a purulent liquid. From the pressure of the pus the skin becomes gradually thinner and thinner, until it finally makes its exit through the skin and escapes. If, for some reason, the skin is too tough, or if the pus has not been allowed to escape by means of an incision, it may cause a purulent infiltration of the surrounding tissues, which is very serious and ends with necrosis of the parts, espe- cially of the fasciee, tendons, muscles, bones, and it may be taken up in the blood, and portions of the diseased tissues are carried in the circulation to different parts of the body. Diffused phlegmone is generally a very serious condition. The local symptoms are the same as the circumscribed, but the fever is much higher, and the purulent pus rapidly extends in all direc- tions in the loose connective tissue, undermining and frequently causing extensive necrosis of the skin, fascise, muscles, tendons, etc. Death occurs, as a rule, from septicaemia or pyaemia. The treatment of diffused phlegmone consists of scarification and incisions. Numerous slight incisions are made to reduce the inflammatory tension of the tissues and to encourage the pus to escape, also to prevent it from burrowing in different directions, and to make an opening into the parts so that they can be disin- fected by means of injections or irrigations of 1 to 1000 solution of corrosive sublimate, 3 to 5 per cent, of carbolic acid, or 2 per cent, of creolin. In circumscribed phlegmone it is better, as a rule, to wait until the abscess is in that condition known as "ripe," or '^ points." This can be distinguished from the fact that the swelling fluctuates or is soft in the centre. In a light skin it may be even yellow. As soon as the incision is made it 308 WOUNDS AND THEIR TREATMENT. should be emptied and irrigated and injected with an antiseptic solution, afterward treated as an ordinary wound. Inflammation of the Lymphatics [Lymphangitis). This is caused by poison absorbed from an unclean, unhealthy wound, although in some instances it may be caused by a high nitrogenous condition of the blood due to over-feeding. The author has observed several cases in dogs where one or more of the legs was hot, painful, and swollen, and there were also lameness and an increase of temperature. On examining the subcutaneous lym- phatics they were found to be enlarged, presenting a peculiar corded appearance and running in the direction of certain of the lymphatics. These were enlarged and very tender to the touch. In cases of this kind we may see two terminations : first, a rapid recovery; second, the formation of an abscess contain- ing a large amount of purulent pus in the swollen lymphatic glands, producing extensive inflammation, blood-poisoning, and the animal eventually dying from septicaemia. The therapeutic treatment consists first in the irrigation of the parts with cooling applications, and, if the glands show indications of forming abscesses, apply hot poultices and open as soon as possible. Inflammation of the "Walls of the Bloodvessels (Phlebitis). This is especially interesting to the veterinarian, as it is quite fre- quently seen in the dog. Purulent inflammations of the blood- vessels are seen in connection with infectious purulent wounds, and originate as a secondary symptom by extension of the suppurating process from the surrounding tissues. This is especially noticeable where the wall of the vessel is crushed, forming a thrombus, and this thrombus, lying in the bloodvessel, becoming infected from the wound, produces suppuration and breaks down, and is carried into the general circulation and deposited in some part or organ of the body, setting up an irritation, and a consequent formation of an abscess. This condition is termed " metastatic abscess." The therapeutics are the same as those of lymphangitis. Open the wound as soon as possible and thoroughly disinfect the abscess. Fever. Concerning the clinical symptoms of fever, we have given all necessary details on page 23. The fever which accom- panies wounds varies greatly in intensity according to the cause. The following are the different varieties of wound fever : DISEASES FROM SEPTIC INFECTION OF WOUNDS. 309 1. Aseptic Wound Fever. This is produced by entrance into the circulation of the blood of harmless substances (water, irrigating fluids, non-decomposed wound secretions, and fibrinous ferments). This occurs in the majority of cases shortly after the animal receives the wound, and causes very slight disorder in the general condition. The rise of temperature is generally the only visible symptom in the dog. There is no alteration in the appetite, and the tempera- ture is reduced within a few hours; in very rare cases it may be slightly increased for two or even three days. 2. Septic Wound Fever and Septiccemia. As soon as putrid or decayed substances find their way into the system by means of a wound the symptoms of fever appear rapidly. If they are mild in character, it is called ^' septic wound fever;" if they are acute, presenting symptoms which may endanger the life of the animal, it is called " septicaemia." Septic wound fever and septicaemia are only separated by their degree of intensity, otherwise they are similar. They are both produced by ptomaines which are devel- oped in putrid wounds finding their way into the circulation. There is one difference that we will point out between septic poisoning and septic infection, and that is, in the first form, the micro-organisms which produce putrefaction are to be found only in the centre of infection and not in the blood, while in the second form the centre of infection is in the blood and in the tissues. Septicaemia appears, as a rule, thirty-six to forty-eight hours after the injury with an increase of temperature as high as 40.5°, rarely above, and showing a remittent character marked by de- pression, fatigue, and loss of appetite, the last being very rare. If the wound is treated quickly and rendered thoroughly anti- septic, the symptoms rapidly disappear. The most dangerous forms of septicaemia which occur most frequently in the dog appear two to four days after the injury, showing a general disturb- ance of the system, and frequently without presenting any unusual symptoms in the wound itself. In many cases, however, we may then distinguish symptoms of putrefaction. The animal suddenly refuses food, becomes weak, somnolent, the mucous membranes become livid, and death occurs in a few hours, or more rarely after some days. The temperature is rarely increased to any extent. More often it is normal or subnormal. We are not able, there- fore, to place any dependence on the temperature as far as prog- 310 WOUNDS AND THEIR TREATMENT. nosis is concerned, the ouly value being when the normal temper- ature is presented and the acute symptoms already described begin to abate. We sometimes see very peculiar cases — for instance, the author has observed a case of septicaemia with normal temperature the first day accompanied by weakness, depression, loss of appetite, etc. In the next few days the temperature gradually increases; sleepiness, fatigue, and rapid emaciation; the symptoms increase in intensity; the pulse becomes weak, rapid, and much slower, until it falls below the normal rate, and finally ends in the death of the animal. In many cases diarrhoea is present, and in rare cases convulsions. Therapeutics. Antiseptic solutions must be used vigorously and the wound irrigated frequently. If there is any dead tissue that is hard to loosen, the thermo-cautery should be used to render it aseptic. The animal must be stimulated by means of ether, alco- hol, and camphor. The author finds subcutaneous injections (4,0 to 6.0 doses) of spirit of camphor or camphorated ether, 1 to 10, of great value in such cases. This drug he is inclined to call a specific agent in septicaemia. It must be injected every two or three hours under the skin until the alarming symptoms have disap- peared. Slight muscular contractions which sometimes follow the use of camphor are not to be regarded as anything especially serious. 3. Purulent Fever and Pycemia. When a suppurating wound becomes very much inflamed and infects the surrounding tissues, it is generally followed by the entrance into the blood of some micro-organisms. If the symptoms of fever are slight, the patients may recover, with only a chill and a slight increase of tempera- ture. If the fever is very serious and the temperature rises high, it is called pysemia. In this disease you will find that the majority of cases are followed by metastatic suppuration in various organs of the body. This is due to the fact that the thrombus undergoes purulent destruction in the bloodvessels, breaks down, and the infectious matter is carried into the circulation, and from there it finds its way to different organs or locations in the body. The symptoms of pyaemia in the dog are not very easily distinguished from those of septicaemia, and it is very hard in the majority of cases to make a positive diagnosis. Very frequently we see symp- toms of septicaemia and pyjjemia combined, forming what is known DISEASES FROM SEPTIC INFECTION OF WOUNDS. 311 as septico-pysemia. In this case the animal dies before any deposit of the suppurating poison has produced abscesses. In pyaemia the symptoms are marked by chills in the early stages, and by inter- mittent fever. The appetite is often good, and, as a rule, rarely entirely absent, as in septicsemia. Later the disease presents much more serious symptoms: the fever loses its intermittent character, the temperature remaining high; the appetite disappears; fatigue and weakness may occur ; the patients become rapidly emaciated and finally die. With these symptoms we see metastatic suppura- tion in the internal organs. The therapeutic treatment of pyaemia is similar to that of septi- csemia. Treatment of "Wounds. In the treatment of wounds we must pursue the following directions to obtain good results : 1 . That the edges of the wound must be brought together as soon as possible to encourage union. 2. That in the treatment of wounds we must protect them from all kinds of irritation, and especially from the invasion of micro-organisms. A wound may be infected with microbes through the hair, or by direct infection from unclean hands, instruments, dressing ma- terials, or septic fluids. It is also possible to infect a wound from the blood. The main point in the treatment of wounds should be to prevent the direct entrance of microbes into it, or to destroy the infectious substances which have entered the wound, and finally to put it in such a condition as to prevent the further development of any microbes that may still remain there. The first is rather difficult in the dog even under ordinary circumstances; the last can be followed out to a certain extent, as the treatment of wounds is greatly influenced in the dog by two facts : first, many dogs will not allow a dressing to remain in place; and, second, a wound is interfered with to a certain extent by the tendency that all dogs have to lick the injured part. For this reason we frequently have to modify the treatment of wounds in the dog. We must, however, apply a dressing in all cases where we can keep the patient quiet and prevent him from removing it. The veterina- rian has two powerful agents at his disposal for the treatment of wounds: the first is, primary disinfection of the wound and its neighborhood; second, keeping the wound as dry as possible. 1 . The First Disinjedion of Wounds. This is of special impor- 312 WOUNDS AND THEIR TREATMENT. Fig. 69. tance, and especially during and after operations where there is much blood lost. The wound and everything coming in contact with it, also the tissues surrounding it, should be carefully rendered antiseptic. The hair has to be shaved or cut very close, the skin washed with ether and benzoin in order to remove all the fatty matter lying in the skin. Follow this by washing with antiseptic fluids (1 per cent, solution of sublimate, 3 per cent, carbolic acid, 2 per cent, creolin). Any existing wound has to be treated in the same manner. If there is a wound the shape of which forms a cavity, an antiseptic solution must be injected into it and come in contact with all parts. The irrigator shown in Fig. 69 is especially adapted to tbat purpose. For cleansing wounds do not use sponges un- less they are thoroughly aseptic, also disinfect the gauze and dressings (tampons). Instru- ments aud the operator's hands must also be carefully attended to. The former should be placed in an antiseptic solution of carbolic acid, 5 per cent., or a 2 per cent, solution of creolin. Do not use corrosive sublimate solution for in- struments, as it leaves an insoluble coating of mercury on the steel. The hands and nails have to be brushed and washed with carbolic solution, or sublimate soap. During the oper- ation the wound should be disinfected from time to time — that is to say, it should be washed or wiped with the solutions referred to above. 2. Future Treatment of the Wound. This consists of various measures, according to whether there is hemorrhage and the con- dition of the wound. Stopping all Hemorrhage. If the blood which runs into a wound is left there, it has a bad effect, preventing an adhesion of the surfaces of the wound, and also being a favorable ground for the development of microbes. Drainage of the Wound. By this we mean the removal of wound secretions, especially pus, by means of drainage-tubes. The regular drainage-tubes are made of rubber, having numerous Apparatus for the antisep tic irrigation of wounds, DISEASES FROM SEPTIC INFECTION OF WOUNDS. 313 holes cut in them. These are placed iu the deepest part of the wound, and fastened by means of a stitch in the skin, or the wound closed around it. In small wounds we use instead of this small pieces of silk thread or catgut, which have been twisted together in the shape of a cord. Wounds which are not deep, but cavernous, and where it is difficult to get quick adhesion in order to Insure proper drainage, it is best to leave the wound open, cov- ered with antiseptic powder, such as iodoform, sulphonal, boric acid, naphthalin, salicylic acid, etc. The first- named agents pos- sess special properties for the treatment of surgical wounds, drying them rapidly and depriving the microbes of a proper medium to develop in, and thus rendering it impossible for them to extend. It is advisable to use some material that will take up the secre- tions of the wound quickly, and assist in drying them. For this purpose, we use iodoform, salicylic-, or carbolic-acid gauze. Cover the wound with the gauze, and in wounds with cavities fill them with a tampon of the same material. In a wound where there is a deep cavity it may be well to fill it in with a tampon of iodoform for twenty-four to forty-eight hours after the operation, then, having cleaned it, by means of sutures bring it together and cover it with iodoform -gauze. The following is the ordinary treatment of wounds : (1) Controlling the Hemorrhage. This may be accomplished in various ways. The best method is by means of a ligature. As a rule, this is performed by carefully ligating the bleeding blood- vessel, either directly on the vein or artery, or taking up a certain portion of the tissue with a pair of forceps, including the blood- vessels, and tying it behind the point of the instrument with catgut or silk. When the bleeding end of a bloodvessel is located in very firm tissue, out of which it cannot be drawn far enough to ligate, we pick up the bloodvessel with the end of the forceps, draw it out as far as possible, and twist it in a spiral direction; by this means we usually succeed in controlling the hemorrhage. If, however, the above does not answer, we pass a thread through the tissue underneath the bloodvessel and tie it tightly, and by this means close the opening. Compression is sometimes used as a means of stopping hemor- rhage. This we can accomplish by pressure of the finger above the bleeding region, or, if it is an extremity, ligate the member 314 WOUNDS AND THEIR TREATMENT. above the part by means of a rubber band or tube, or even a hand- kerchief. Esmarch's rubber bandage is the best. If there is a cavity, we may also fill the wound with a tampon of aseptic wad- ding of gauze or oakum. Another means of stopping a hemor- rhage is by using a cauterizing iron (thermo-cautery), a solution of chloride of iron, vinegar, alum, and tannin. These, however, should only be used in wounds where you do not expect healing by first intention. All agents which have the property of stopping hem- orrhages, as a rule, coagulate or draw the tissues in such a way as to prevent healing by first intention. Oil of turpentine is some- times used, and is a particularly reliable styptic. Capillary or slight subcutaneous hemorrhages can be stopped by pressure or irrigation with cold water. Hot water is also used to control hemorrhage. Different forms of stitches used in the dog and method of tying : a, head-stitch ; &, con- tinuous oblique stitch with cross-stitch ; c, deep continuous cross stitch ; d, mattress-stitch ; e, button and interrupted stitch. Wounds which can heal hy first intention, such as all operative wounds which have been thoroughly disinfected according to the method described above, and where the hemorrhage has been DISEASES FROM SEPTIC INFECTION OF WOUNDS. 315 stopped, we bring the wound together by stitches or ligatures (Fig. 70). As a rule, the ordinary knot-stitch with antiseptic silk is used, although we may connect it with other forms, such as the extension-stitch (Fig. 70). Small wounds do not, as a rule, require drains. The wound should be compressed for several minutes by means of an antiseptic sponge, and after that covered with iodoform-collodion. If the pusition of the wound allows, we must apply a firm, compact dressing over every wound that is stitched ; if it is a simple one, the dressing may remain until it is entirely healed — that is, for about one week. If we have a large wound, however, with flaps, caverns, etc., it is advisable to place drains in the wound and change the dressing after three or four days. Instead of collodion dressing in such wounds, use antiseptic powders, such as sulphonal, iodoform, and boric acid. These should be dusted on the wound itself, directly on the line of the severed skin. Lister's dressing in its original form is very rarely used at the present time. The author has been in the habit of covering ordi- nary sewed wounds with a thin layer of salicylic or carbolic gauze, and over it a dry, aseptic muslin bandage, and over this a damp starched gauze bandage. The latter has the advantage of forming a stiff envelope, becoming dry on account of its starchy contents, and exerting a certain hold on the injured member. If a serious rise of temperature takes place, the dressing must be immediately removed and the directions followed which are given under the head of " Wound Fever." When the bandage has been displaced, and when it has been moistened by the wound secretiou, it must also be changed. Wounds lohich heal under a dry scab are generally superficial. These do not require to be closed by means of stitches, and they seldom are licked or irritated by animals. We use in these cases the following method of treatment : After thoroughly disinfecting the wound and its neighborhood, by means of caustic agents (nitrate of silver, chloride of iron, burnt alum, or with a thermo-cautery), we produce an artificial scab, or we cover the wound surface with collodion. The latter is recommended in common lacerations. As a rule, no dressing is used. The scab loosens after some time and falls off. When we are obliged under certain circumstances to leave a wound open 316 WOUNDS AND THEIR TREATMENT. it is advisable to muzzle the animal (Fig. 71), not only to prevent the patient from licking the wound, but in order to properly apply the sprinkling powder, which is less dan- ^*^' ■ gerous than iodoform. The best powder to use is boric-creolin (1 part of creolin to 40 or 50 parts of boric acid), naphthalin or sulphonal (1 part to 5 parts of starch). An open wound generally requires antiseptic washings daily. It frequently happens that granulating wounds, espe- cially when they have been subjected to exposure to air, may at some period lose their power of healing and become converted into ulcers. Ulcers or Ulcerations. By this we understand a granulating surface which does not heal on account of the purulent destruction of the granular tissue. Wounds are changed into ulcers when they are continually irritated by some mechanical or chemical irri- tant, or as a consequence of the skin becoming inflamed or necrosed from pressure (muzzling, etc.). Callous ulcers and fistulous ulcers are the most difficult to treat. The former are superficial ulcers with hard callus, having raised edges, and a whitish, hard, bacon- like surface. This is covered with a thin unhealthy secretion. They may form sinuses or canals, which very often contain at the bottom a foreign body or ulcerated tissue. They may also lead to some of the glands. These pipes are called fistulse or fistular canals. The treatment of ulcers is, to a certain extent, the same as that of wounds — that is, to follow all the antiseptic rules. The use of iodoform, salicylic acid, naphthalin, powdered camphor, or boric- acid ointment is advisable. We may also remove callous ulcers by surgical means and convert them into fresh wounds by taking a knife, paring the tissue at the bottom of the ulcers, and treat them as indicated in cases of fresh wounds. Caustic agents, such as nitrate of silver, tincture of iodine, etc., as a rule, produce little or no good effects. If the tissue surrounding the ulcers is hard and rigid, preventing contraction of the ulcerated area and the healing process, we must perform circumcision of the part, as trans- plantation is not practicable in the dog. We cut about 1 cm. from the border of the ulcer over its entire thickness, keeping the wound DISEASES FROM SEPTIC INFECTION OF WOUNDS. 317 open by means of vaseline. When the location of the fistulous sinus admits of it we split open the fistulous passage and convert it into an open wound. When the fistulous canal is not very deep we may also try to produce healthy granulations by means of actual cautery, or the injection of caustic fluids and introduction of cray- ons of caustic (nitrate of silver or caustic potash). Always try to slit open the canal, if possible, as it produces the best effects. Ni- trate of silver or any of the mineral acids, and in obstinate cases a small piece of corrosive sublimate, is pushed down into the bottom of the wound; these caustics produce more or less irritation and consequent sloughing of the wall of the canal and allow the growth of healthy granulations. Contusions. In subcutaneous wounds of the soft tissues (bruises and contusions) we find a different condition of the tissues. These injuries are generally caused by some blunt object — for in- stance, a blow, kick, shock, or fall. The soft parts are bruised and injured according to the intensity of traumatism; very slight resistance is offered by the loose connective tissue; small blood- vessels are ruptured from crushing or bruising of the soft parts, and the hemorrhage that follows percolates all through the torn tissues. The greatest amount of resistance is found in the skin, face, sinews, and large bloodvessels. Clinical Symptoms of Contusions. One of the first symp- toms of a subcutaneous bruise is a swelling in the region of the injury. This appears, as a rule, immediately after the injury, and is due to the blood running out of the torn vessels. The fluids in the enlargement always contain lymphatic substances on account of the laceration of certain lymphatic glands. In rare cases we see a lymphatic secretion only, which is distinguished from the blood secretion by being very slowly absorbed. The fluid which appears lies either in the loose connective tissue under the skin or between the muscles, and, as a rule, is irregularly divided, or we may find the condition presented in a number of ways, so that we may have a ^' doughy " swelling in one case, or it is accumulated in centres in another, and we see a fluctuating swelling or a " blood- boil' ' (hsematin), or it may run into a cavity, and we have a bloody secretion of the joint (hsemarthrosis), or we find a bloody secretion in the cavity of the chest (hsemato thorax). The swellings, as a rule, occur shortly after a contusion, and in the early stages rarely show 318 WOUNDS AND THEIR TREATMENT. any inflammatory symptoms. Later the inflammatory symptoms may appear. Beside the swollen condition, the animal may present symptoms of pain, especially at the time of the injury, and later on we find the injured region very tender to the touch. We may also find a crushed muscle which will no longer contract, or a torn nerve that does not convey sensation or motion. The further course of the wound depends to a great extent on the amount of the injury. If the skin is crushed in such a man- ner that all the vessels are torn, it will become necrosed from deficient nutrition, and, as a result, we see a putrid process going on as indicated in the discharge, which contains septic blood and broken-down tissue. The same is to be expected if the skin is deprived of nutrition, caused by the destruction of the bloodvessel supplying it. This condition is materially different from a contusion where the skin has been removed; but if the integrity of the skin is maintained, the subcutaneous secretions under it are generally absorbed very rapidly. The soft parts which are lacking in vitality are absorbed, and are gradually replaced by a new con- nective tissue in exactly the same way as healing under a moist scab. Exceptions to this termination occur occasionally, and we may sometimes find a cyst, which is a hollow cavity filled with a yellowish-red liquid and enclosed in a capsule of connective tissue. In very rare instances this may be filled with calcareous concretions. This, however, is only seen in rare instances and is the result of a chronic irritation of the tissues at that particular locality. In the treatment of contusions, to get good results we must have one object in mind — that is, the rapid reabsorption of the secretion. For that purpose we use cooling compresses soaked in lead-water (Goulard's extract), or arnica-water, or we may try to get absorp- tion by means of massage — that is to say, make a centrifugal fric- tion with the thumbs, fingers, or hand for fifteen or twenty minutes at a time. We may also squeeze the excreted blood into the tissues and lymphatic passages, and apply a tight bandage immediately afterward to prevent any recurrence of subcutaneous bleeding. This latter treatment is not to be practised unless the swelling is very small and there is very little fluid in it. DISEASES FROM SEPTIC INFECTION OF WOUNDS. 31 9 The therapeutic treatment is not simple in all contusions. In large ''fluid-boils" we rarely can wait for an absorption of the secretion, but are compelled to open the swelling at the point where it is soft, and where the skin is thinnest. In animals we must always try to make an opening in the dependent part of the enlargement, so as to get perfect drainage. After having opened the tumor clean it out, removing all clots, etc., and treat the inner surface of the wound according to the usual method applied in such cases. If the location of the wound prevents such a proced- ure, the fluid may be emptied by means of a hypodermatic syringe, and an antiseptic solution injected in its place, and, if possible, this should be followed up afterward by a compress-dressing. In all cases where the skin is very much injured, or where extensiv^e destruction of the soft parts has taken place, or even fracture of the bone has occurred, we cannot use massage, but instead compressing antiseptic dressings must be applied. As a rule, treat the slightest injuries of the skin according to the best antiseptic methods. Inflammatory symptoms are observed as soon as fever appears. The skin becomes hot and painful ; finally fluctuation is found in some parts. Then we must immediately remove the secretion, clean out the wound, and by drainage keep the cavity empty, at the same time inject into it a 1 to 1000 solution of corrosive sub- limate or a 5 per cent, solution of carbolic acid, and use an anti- septic bandage. ABDOMINAL HERNIA. Hernial Rupture. By the word " hernia" we understand a protrusion of a certain portion of the abdominal contents through a normal or abnormal opening in its wall, and where the displaced portion is covered, or partially covered, by the peritoneum. In the majority of cases hernia appears under the external skin, although we may find it in other parts, such as hernia of the diaphragm. There are several different forms of hernia. We distinguish the following parts in a hernia: first, the in- testines or contents which protrude from the abdominal cavity; second, the hernial pouch ; third, the envelope, or covering of the rupture ; and, fourth, the entrance or constricted portion of the rup- ture, or where the intestine passes through the abdominal wall. By '^ hernial pouch " we mean that part of the peritoneum which is around the part protruding from the abdominal cavity, and we distinguish it where it is near the constricted portion by forming at the neck. The portion which lies in the hernial sac is the body and lower portion. The hernial pouch is absent in some cases — for instance, in a hernia which has occurred in a traumatic way, as a result of some injury, and the injury has been severe enough to tear the peritoneum; or where the hernial pouch collapses or draws together. Hernial coverings of the pouch are the names given to that portion of the skin and subcutaneous cellular tissues which coyer that part; in some instances we also include the mus- cles and aponeuroses. The contents of the hernia consist of some portion of the abdominal organs enclosed in the hernial pouch. As a rule, it is the intestines, in most cases the duodenum, and in some cases the jejunum. Very frequently the duodenum may be found lying in the hernia with some portion of the large intestine or uterus, and more rarely the bladder or stomach. Under certain conditions we find a certain quantity of fluid lying in the sac. This is generally serum, and originates from venous stagnation. According to the location of the hernial orifice we distinguish umbilical, ventral, inguinal, scrotal, and hernia of the diaphragm. (320) HERNIAL RUPTURE. 321 The causes of hernia are generally described as direct and indi- rect. In the former we have a certain number of abnormalities which are due to diseased conditions — for instance, an umbilical hernia is due to an imperfect closure of the opening of the umbili- cal ring. The latter may occur from the abdominal walls being flaccid from cicatricial contractions after operations, and occa- sionally from great abdominal pressure in prolonged straining, vomiting, etc., the muscular wall is ruptured, or from kicks or blows on the abdomen. In traumatic hernia which has been caused by blows the hernial pouch is sometimes absent, and its contents are surrounded by a hernial envelope; in most cases by the skin ; and in rare instances certain muscles are included in the sac. Clinical, Symptoms and Course. The symptoms as well as the course show a marked difference, according to the character of the hernia, and it depends to a large extent on the " possibili- ties " — that is to say, if the hernia can be reduced and replaced in the abdominal cavity or not. Reducible Hernia. This is generally seen in the region of the wall of the abdomen. We find a swelling which does not present any inflammatory symptoms, and is especially prominent when the animal is walking or standing. It is also seen during abdominal pressure, especially after the dog has eaten a hearty meal. If the animal is turned in such a way that the hernia occupies a superior position, as a rule, it immediately disappears, as the contents fall back into the abdominal cavity, or they may do so on a slight pres- sure of the hand. If we examine the abdominal walls the orifice of the hernia can be distinctly felt, and we may even be able to penetrate the abdominal cavity with the finger. Further symptoms depend upon the nature of the prolapsed intestine ; this intestine will be recognized as a soft, elastic swell- ing, having to a certain extent the round or tubular form of an ordinary intestine. It may also be further distinguished by a slight distention which is generally due to gas or air. The omen- tum is soft and doughy to the touch, having an uneven surface and dull on percussion. Ruptures of the bladder may be distinguished by the acute symptoms of hernia and also by the entire absence of urination. Hernias of the horns of the uterus are only distinguished from a loop of intestine after conception and during whelping. 21 322 ABDOMINAL HERNIA. Mechanical influences, such as bites, blows, contusions, etc., may cause an inflammation of the hernia with a thickening of the pouch, and an adhesion between it and the contents of the hernia. If the injury is severe enough, we may have suppuration in the pouch. In such cases we may have a subsequent mechanical con- traction and reduction of the hernia, especially when the pouches are small, or in some cases the hernia has only been large enough to admit a fold of the omentum. Irreducible Hernia. 1. This may be due to an adhesion of the intestinal contents with the hernial pouch. 2. The union of the intestinal contents with each other (for in- stance, adhesion of the intestines). 3. From thickening of the omentum, which lies in the hernial pouch. 4. From strangulation of the hernia. This is especially impor- tant, as it may occur in all cases of abdominal hernia and at any time. Concerning the causes of strangulation there are three important groups : 1. Strangulation by extreme distention of an intestinal tube by fecal matter. 2. A distention of the opening of the hernia, which subse- quently closes on the intestine and strangulates it. 3. By the intestines becoming twisted in the sac. Invagination is very frequently seen in young animals. In many cases we distinguish three stages of hernia, according to the anatomical alterations produced as a consequence of strangu- lation in the prolapsed parts. First, we have a venous hypersemla, then inflammation, and lastly suppuration. In the first stage the veins and capillaries are gorged with blood, and serum is exuded in different directions. In the second stage we observe inflamma- tion of a septic character, which extends from the mucous mem- brane to the serous membrane, as a consequence of the noxious or poisonous contents of the intestines. In the third stage the pro- lapsed parts become necrosed, due to the stricture of blood-circu- lation. The intestinal portion becomes black, easily torn, dull in color, and covered with gray or greenish spots on its surface, the hernial fluid becomes purulent, and the inflammatory processes in the intestine above the strangulation cause septic peritonitis. HERNIAL RUPTURE. 323 The clinical symptoms of strangulated hernia are very marked in most cases. The hernia can no longer be reduced or pushed back into the cavity, or a swelling suddenly appears after any trau- matism, or after great abdominal pressure, and cannot be reduced even with careful manipulation. The hernia is distended, harder and fuller than usual, becoming very sensitive to pressure, and especially so as the inflammation becomes more intense. The skin covering: the hernia is normal in the begrinnincr, but later becomes red, swollen, and warm to the touch. Another symptom which is generally present is vomiting. This may be so constant and vio- lent toward the later stages that the animal will vomit feces. At that period symptoms of severe intestinal obstruction present them- selves. The hernial swelling becomes cold, insensible to pressure, and symptoms of collapse appear, and death occurs from twenty- four to forty-eight hours after strangulation first appears. The temperature can hardly be said to have any diagnostic value, as we very often find it normal or even subnormal up to the time of death. In rare instances we have the formation of a fecal abscess; this is caused by the sloughing of a certain portion of the intestine, allowing the contents of the intestine to escape into the sac ; this is due to the circulation being cut off and subsequent mortification of the part; this is quickly followed by purulent inflammation of the hernial covering. If an incision is made in the hernial swelling, fecal matter and pus flow off externally without being followed by any grave symptoms, except that it may subsequently form a false anus in the cavity. Fecal fistule, intestinal fistule, or preternatural rectum is seen in very rare instances. The expression " fecal fistule " or '' intes- tinal fistule" is used where there is an external intestinal orifice, but the greater mass of fecal matter is passed through the rectum. The term '^ preternatural rectum" (anus praeternaturalis) is used when all the fecal matter passes through this opening. Such an opening may also be produced by penetrating wounds or the entrance of foreign bodies. In strangulation of the omentum the symptoms are less marked, but there is great pain on pressure. We frequently find adhesions between the omentum and the orifice of the hernia. This inflam- mation produces a complete immobility of the hernia and gan- 324 ABDOMINAL HERNIA. grene, followed by the formation of an abscess, and finally the escape of pus externally. Death is rare in such conditions, and if it should occur it is caused by septicsemia. The prognosis of irreducible hernia depends greatly on the length of time that the strangulation has been present, and also on the character of the contents of the hernia. In cases where a loop of intestine is strangulated and is gorged with fecal matter the results are generally serious; but, on the other hand, strangula- tion of the omentum is not serious. Therapeutics of Hernia. In cases of reducible hernia we cannot use a truss, which is the favorite mode of treatment in man, it being impossible to keep a hernial bandage steady in any posi- tion for any length of time on the dog. When hernia has been caused in a traumatic way, and followed by a subcutaneous rupture of the abdominal wall, or in umbilical hernia of very young ani- mals, we may close the orifice in such cases by means of a dress- ing, and the hernia may be entirely removed by the following method : Place the animal on its back or in such a position that the hernia is placed as high as possible. Then reduce the sac by working the contents back into the abdomen. In some cases this is accom- plished very easily, but in others it requires a certain amount of careful and patient manipulation. Then place a tampon of wad- ding or a small piece of cardboard upon the hernial orifice. This will have to extend over the borders of the hernia far enough to entirely cover the opening. Now fix small pieces of adhesive plaster across the cardboard and attach them in a circle around the piece of cardboard. These Avill adhere easily if the skin has been cleansed and any fat or other material has been removed by means of ether or benzine. [The translator finds that the plaster adheres a great deal better than the ordinary adhesive plas- ters sold, if, after the hair has been shaved off, ordinary shoe- makers' wax made liquid is put on the end of the plaster strips.] We now place a gauze bandage around the adhesive-plaster dress- ing and the whole posterior part of the body, in order to protect the dressing from being torn or shifted by the animal. The dog should be fed on light, easily digested food, avoiding any that has a tendency to flatulency or constipation, at the same time assisting defecation by means of laxatives. The safest and most certain HERNIAL RUPTURE. 325 method, however, of removing hernia is the operation of herniot- omy, or hernial section, which will be discussed later. Where we have a strangulated hernia we must attempt to reduce it by pushing the contents of the hernia back into the abdominal cavity. This may be accomplished either by means of taxis or by hernial section. The former method is only to be used when the strangulated intestines have not yet undergone any serious alterations, namely, when they are not affected by gangrene, and when there are no serious symptoms of a local or general character. In the operation of taxis the patient must be placed in such a position that the hernia occupies the highest region in the abdo- men and assists the relaxation of the abdominal covering and the orifice of the hernia as much as possible. We first try by manip- ulation upon the orifice of the hernia with one hand, and by pres- sure of the flat of the other upon the periphery of the swelling to push the contents of the hernia back into the abdominal cavity. When the animals are under the influence of ether or a narcotic, the reduction is easier. Taxis must be considered successful when the swelling of the hernia has disappeared and when the aperture of the hernia can be felt, and also when the symptoms of distention have gone. If the latter still continue, notwithstanding the fact that the contents of the hernia seem to have disappeared, we have a false reduction — that is to say, the hernial contents and pouch have been shoved entirely through the orifice into the abdominal cavity, or we have to deal with a volvulus or invagination of the intestinal portion in the cavity; or it may be that the hernial contents are crowded between layers of the abdominal muscles. In the first instance the orifice of the hernia seems free, aud in the latter instance it is closed. If the attempts at taxis to produce reduction fail, or if the above-mentioned contraindications are present — that is, where the hernia has been left too long — we must proceed at once to perform herniotomy, which must be done under the strictest antiseptic rules. Herniotomy is, as a rule, a rather easy operation in the dog. It may be performed in two ways : with or without opening the hernial pouch. The former is especially used iu fresh cases of hernia with wide orifices and in old cases of hernia wath extended adherences of the hernial contents, where the whole mass is firmly fastened together. The latter method of operation is used in cases of hernia which are not complicated with a hernial pouch, in strangulated hernia with considerable alteration of the contents, or with 326 ABDOMINAL HERNIA. a very narrow hernial opening. These conditions, however, are only dis- tinguished during the course of the operation, and we are then forced to change from the first to the second method of operation. In both methods the skin of the operated region must be shaved and carefully disinfected. We then lift up a fold of the skin corresponding with the axis and the length of the hernia and split it open with a longitudinal incision. This must be made very carefully until we reach the hernial pouch. This is recognized by its irregular surface, which is of a grayish-yellow color ; also by the fact that it is impossible to get an ordinary sound directly into the abdominal cavity. Having opened the sac, taking care not to injure the contents, we follow one of the two methods before spoken of — that is, not opening or opening the hernial pouch. In the former case we introduce by means of the index-finger a probe- pointed bistoury, or herniotome, between the neck of the hernia and its ori- fice, turning the cutting edge of the knife toward the neck or restricted portion, the dull side of the knife being toward the strangulated portion of the intestine. By means of a small incision the tension becomes greatly relaxed, and reduction is very easily accomplished. If the opening of the hernial pouch is required, we hold up one of its folds with a hooked-shape forceps and split it by means of a knife held flat or a pair of scissors. After the discharge of the fluids in the hernial sac a notch is cut in the hernial pouch by means of th^ herniotome. The exposed loop of intestines, which is intensely red and inflamed, must be cleaned by means of warm boric-acid water (4 per cent.) or creolin (2 per cent.), taking care not to allow the cleansing fluid to get into the abdominal cavity. This exposed piece of intestine is reduced by the method just described by cutting through the constricted portion and working the intestine back in such a way that the portion of the intestine which was prolasped last must be reduced first. If the intestine is much distended by gas, it may be emptied by means of a puncture of a very fine trocar (or the canula of a large hypodermatic syringe). Any degenerated portions of the epiploon must be amputated after being ligated. If the intestine is intensely inflamed or gangrenous, we must either resect it or make an artificial anu«. Such operations, however, are ex- tremely rare in the dog. We therefore will not enter into minute details on the subject. After reducing the hernia we must close the hernial orifice. For that purpose we place a tight catgut ligature around the entire hernial pouch, which, if necessary, must be isolated, or, better still, we close the pouch and orifice by means of a continuous stitch after having amputated the super- fluous portions of the hernial sac. In cases where no hernial pouch is presented or it has been shoved back into the abdominal cavity it is advis- able to freshen the borders of the orifice by means of a blunt knife or curette ; then stitch it up by a continuous suture of catgut. After thoroughly disin- fecting it for the second time the external wound is to be stitched and cov- ered with an antiseptic dressing, held in position by means of a bandage (eight-tailed) around the body. INGUINAL AND SCROTAL HERNIA. 327 Inguinal and Scrotal Hernia. (Hernia Inguinalis and Sorotalis). The inguinal canal of the dog is located in the abdominal mus- cles with the seminal cord, and runs from the testicles into the abdominal cavity. In the bitch we find a round ligament from the end of Fallopian tube toward the subcutis. Inguinal hernia may be produced by a portion of the intestine passing from the abdom- inal cavity into the inguinal canal. If this is the case in the dog, and the loop of the intestine goes as far as the scrotum, we call it scrotal hernia. If it simply lies in the canal, it is called inguinal hernia. Clinical Symptoms of Inguinal and Scrotal Hernia in THE Dog. According to Hertwig, from the external abdominal ring as far as the scrotum the canal is almost cylindrical, and we find this filling up with an abnormally warm swelling, which has a peculiar elastic softness and " doughy " feel under the skin. In large hernias we may reduce this partially or altogether by placing the animal on its back, holding up the hind-quarters, and gently pressing or rubbing with the finger upon the hernial swelling. If the intestine has entered the scrotum, the affected side appears full and large, and may be reduced by the manipulations indicated above. In cases of strangulation the symptoms which have been described before become apparent, and, if the symptoms are very acute and all attempts at reduction are futile, we must perform the operation of castration. Castration. In normal conditions — that is to say, when no hernia is present — castration of the dog must be performed by laying the animal on his side, rendering all the parts aseptic, and holding the skin tightly over the testicle, compressing it between the finger and thumb. Then make an incision the entire length of the scrotum, cutting through the scrotum, the tunica dartos, and tunica vaginalis, so that the testicle, which is covered by the tunica vaginalis, is exposed (compare with Fig. 72). This must be removed, and after that the common intersecting membrane is opened up as far as possible by means of a pair of scissors ; then place a strong silk suture around the seminal cord, close up to the inguinal ring and ligate it. When this is done, the seminal cord, with all the superfluous portions of the interstitial membrane, is amputated about 1 cm. below the ligature. The other testicle must be removed in the same manner. After carefully closing the wound with a strong non-irritating disinfectant, the 328 ABDOMINAL HERNIA. wound of the testicle has to be closed with an ordinary head-stitch, and it is advisable to place a small drain, like a silk thread, into one of the cor- ners of the wound. No dressing is required, provided the animal is muz- zled. Healing occurs generally within a few days. If, however, we have Fig. 72. Genital organs of the dog : 1, scrotum opened ; 2, right testicle ; 3, body of the epididy- mis ; 3', globus major and, 3", globus minor ; 4, spermatic cord ; 5, vas deferens ; 6, prepuce (partially dissected) ; 7, free portion of the penis ; 7', posterior attachment of the penis ; 8, erectile masses (bulbous bodies) ; 8', size of erectile masses \vhen distended by blood. a case in which we wish to operate for inguinal or scrotal hernia, we deviate from the above described method of castration by ligating the intersecting membrane externally and as close as possible to the external inguinal ring. In valuable breeding animals the testicle of the affected side only is removed. Sarcocele. This is a collective name for all kinds of tumors of the testicles, especially for sarcoma, carcinoma, enchondroma, and cysts. The testicles are swollen, the swelling, as a rule, being hard, tough, and sometimes fluctuating; never warm or very pain- ful. The condition can only be remedied by castration. INGUINAL AND SCROTAL HERNIA. 329 Hydrocele. By this we define an accumulation of serum in the scrotum. The affection is often associated with oedema of the lower extremities and of the scrotum. It is frequently seen with ascites, hydrothorax, etc., appearing in the shape of a fluctuating swelling of the testicular pouch, which disappears when the animals lie on their back. Therapeutic Treatment. This consists of puncture and emptying of the sac, also injection with any of the following stim- ulating fluids: alcohol, Lugol's solution, carbolic acid (1 to 40), €tc. Of course, these are only to be used when castration is not performed. A variety of hydrocele is seen where we have oedema of the spermatic cord. This appears as a fluctuating swelling which may be easily moved from one side to the other. It occupies the whole length of the spermatic cord, and, as a rule, is never interfered with. When the fluid of the hydrocele, which is discharged by puncture, consists of bloody serum, we call it hemorrhagic hernia, or hsematocele. Any other complications of the testicles and their membranes may be found on page 184. Fig. 73. Middle section through the pelvis, showing the organs : a, pelvis ; b, coccygeal vertebra; c, broad pelvic ligament ; d, anterior and, d', posterior portions of the rectum ; e, bladder ; /,/, seminal vesicles ; g, fold of the peritoneum. Clincal Symptoms op Inguinal Hernia in the Bitch. The contents of the hernial pouch are generally the uterus, and it 330 ABDOMINAL HERNIA. may either be one or both horns; in some cases the gravid uterus may form the hernia. Cadeac saw a srreat accumulation in a bitch which was affected by double-sided inguinal hernia. Each pouch had attained the size of a child's head; the right side contained the whole intestinal tube ; the left side contained the epiploon, spleen, uterus, and blad- der. The hernial covering was formed by one-half of the mam- mary glands and the external membrane. This condition is easily distinguished. In the posterior sections of the mammary glands we find an elastic, painless swelling which disappears generally after manipulation, when the animal is placed on its back ; provided, of course, that we find the uterus which is located in tlie hernia is not gravid. In that case the progeny may be distinguished by manipulation externally. It is hardly possible to confound this form of hernia with hypertrophic conditions of the round ligaments, or the so-called false inguinal hernia. A radical operation of double-sided hernia is to be performed accord- ing to the general rules already described. Umbilical Hernia. ( Hernia Umbilicalis. ) The hernial ring is formed by the umbilical ring. The contents may consist of the omentum, duodenum, and in rare cases part of the large intestine. In the hereditary form the intestines are located in the umbilical cord, and are not covered by the abdominal membrane (hernia of the umbilical cord). In accidental hernia of the umbilicus we always have a hernial pouch, originating from the peritoneum. As a rule, umbilical hernia occurs a few days after birth. It may increase gradually and become eventu- ally strangulated, but it often disappears without any surgical inter- ference. Hernia of the omentum we see occasionally, but, gener- ally, it cures itself by an adhesion between the hernial pouch and the hernial ring. Umbilical hernia is easily recognized. We find a swelling under the umbilical ring, which may vary in size from a hazelnut to a walnut. Treatment consists, as a rule, in replacing the contents of the umbilicus into the abdominal cavity and ligat- ing the umbilical cord. ■ PERINEAL HERNIA. 331 Femoral Hernia. (^Hernia Cruralis.) Femoral hernia is extremely rare in the dog. The ring is formed by the upper end of the so-called femoral canal, and is formed of the crural fascia, the external membrane forming the hernial covering. The femoral canal of the dog is a long, three- cornered cavity in the median surface of the upper part of the leg, which is surrounded front and back by the inverted muscles of the upper thigh — that is to say, in the front by the sartorius muscle, and back by the long adductor, the large and short adductor, and on its upper surface by the ileo-psoas, while the floor of the cavity is formed by a portion of the muscles of the thighs and by the crural fascia. Below the borders of the sartorius the adductors run together at an acute angle. This canal, as a rule, is filled with masses of fat, nerves, and bloodvessels. In cases of fracture of the pelvis the intestines which leave the abdominal cavity, after having followed the direction of the large bloodvessels, locate them- selves in this cavity and are covered by the peritoneum, the crural fascia, and external membrane; but they may also under certain conditions penetrate directly under the skin through an opening of the crural fascia. In the inner fascia of the thigh we find a soft swelling which has more or less pain when the condition is examined before the disease has been of recent origin, and in cases of strangulation. In the latter cases, however, we see also a peculiar dragging motion of the thighs, with lameness and symptoms of intestinal obstruc- tion, such as vomiting, etc. Herniotomy has to be performed according to the rules mentioned before, but must only be done in extreme cases. In making incisions into this region great care must be taken to avoid the large bloodvessels which pass into and through the femoral canal. Perineal Hernia. Perineal hernia occurs in both dogs and bitches. In the former it is recognized by a peculiar bulging or lifting of the recto- vesi- calis, and in the latter by a bulging of the vesico-uteriua. In both 332 ABDOMINAL HERNIA. cases we observe a prolapse of the duodenum or lower bowel, and sometimes in the dog we observe a prolapse of the bladder. In the dog we recognize perineal hernia by a soft swelling the size of an egg or the size of a hand. This appears in the side and above the anus, between the root of the tail and the tuber ischii. In the bitch this hernial swelling is seen under the vulva and on the peritoneum. This hernia can only be removed by means of an operation. TUMORS. A THOROUGH description of tumors with the different varieties and forms cannot be discussed here as explicitly as the author would like, and he therefore will confine himself to such tumors as are met with in general practice, and for further details would direct the reader to books on general pathology and morbid anat- omy. The following tumors have been found in the dog: Tumors of the Connective Tissue. Soft and Hard Fibroma. A soft fibroma consists of connective tissue containing bloodvessels and cavities. These are filled with a serous or mucous fluid. They are generally found lying in the skin, and form round, soft, inelastic bodies, not especially circum- scribed, flabby in consistency, and generally with a broad base. A hard fibroma consists of a very firm body made up of closely united fibrinous tissue, and forms rounded or oblong, distinctly circum- scribed hard tumors, which originate, as a rule, in the skin or subcutis. Fibromas belong to the class called '^ mild tumors," and are easily removed. Lipoma {Fatty Tumor). A lipoma is formed exactly like nor- mal fatty tissue, but possesses larger fat cells. It is also flabby and soft, but no fluctuation is present. As a rule, it is very distinctly circumscribed, being separated from the neighboring tissues by a layer of connective tissue. Very rarely do we find it diffused in different directions. As a rule, it is found in the dog around the synovial folds of the joints, in tendons and their sheaths, as well as in the internal organs. Lipomas occur in the lower cellular cutaneous tissue, and, as a rule, can be easily removed by an operation. After the removal of fatty tumors which had not been distinctly circumscribed the author saw several recurrences of the tumors; also septic inflam- mation in the neighboring tissues as a result of the wound. Enchondroma {^Cartilaginous Tumor). Enchondroma consists ( 333 ) 334 TUMORS. of cartilaginous tissue, either hyaline or mucous, "We find it in a normal condition in the bony system and quite frequently in the lacteal glands. True enchondroma is considered as a very mild form of tumor, and may be recognized by its round or nodulated body, distinctly circumscribed, hard and cartilaginous character. Osteoma {Tumor of the Bones). Osteoma is a compact or spongy bony tissue, consisting of a tumor generally developed on the body of a bone. As a rule, it occurs on the periosteum; more rarely in the muscles, fasciae, tendons, and still more rarely in the thyroid glands. (This last condition was described by Siedamgrotzky, and may be generally recognized by its location and bony consistency.) The author has seen an old dog in which he found osteomata nearly as large as a hen's egg. These were remarkable for their extremely irregular surface, and were attached by distended tendinous tissue to the left of the transverse prolon- gation of the fifth cervical vertebra, but were removed without any bad results. As a rule, osteomas are removed only when they are closely connected with the bone, and when they are likely to cause a great deal of trouble. Sarcoma. By sarcoma we mean a tumor which originates in the connective tissue, which is developed from a certain type of embryonal connective tissue, and formed with numerous cells. It originates in various parts of the body, such as cartilages, bones, periosteum, connective tissue, fatty tissue, etc. We may also ©bserve it in the form of mild tumors. Their histological formation and their different varieties are better described in text- books of pathological anatomy. Sarcomas are generally considered as malignant tumors: 1, be- cause they possess a great tendency to become large; 2, because they are apt to reappear after removal; and, 3, because under cer- tain conditions they are apt to form in other parts of the body. Their malignant character is generally much greater in proportion to tlie size of their cells and the softer their Intercellular substance. The external anatomical appearance of a sarcoma does not always present characteristic symptoms. In most cases these tumors are round, distinctly circumscribed, and sometimes they form encysted knots, which are of different consistency and color. We may recognize fibrin and even bone in sarcomas, and some that are soft EPITHELIAL TUMORS. 335 as gelatine or mucus. Their color depends, as a rule, on their vascular condition, and any blood extravasations which may have occurred also produce certain alterations, so that on section a sar- coma may appear white, yellow, brown, gray, dark red, and even entirely black (melanotic sarcoma). The metamorphoses which occur in the sarcoma are of some diag- nostic value, especially the mucous softening, which leads to the formation of cysts, and sometimes to bony deposits. This is fre- quently noticed in sarcoma, and the ulceration in sarcoma of the skin and mucous membranes occurs without producing any active disintegration of the tumor. There are very rare forms of osteosarcoma, or myeloid tumors, which occur in the marrow cavity of bones. They have been noticed in the forearm, also in the shoulder-blade, the bone of the arm, and femur (Siedamgrotzky and others). Circumscribed nodules are developed in the medullary cavity which gradually crowd out the bone by their growth, and, when new bone is formed from the periosteum, filling up the entire cavity. In this manner we find enormous lumps, or masses, possessing the hardness and firmness of bone, and in the centre is found a soft tumor sur- rounded by a bony cyst. Sooner or later the soft parts penetrate the bony envelope and certain of the fluid escapes. The treatment of sarcoma consists in removing it as soon as possible, and always endeavor to remove the entire tumor, as a small portion allowed to remain may form a nidus for the com- mencement of a new growth. There is a group of tumors of the connective tissue which we see occasionally, called angioma. These are mostly in the form of fibro-angioma, small, ball-like, tough, cutaneous tumors, which on section are generally colored bluish-black. Epithelial Tumors. Papilloma. Papilloma originates by hyperplasia of the cover- ing epithelioma of the cutaneous and mucous membrane, with a proportionate formation of connective tissue. These are sepaz'ated as follows : (a) Warts. A wart is a neoformation of the papillae of the skin and of the epidermis. Warts vary very much in size, from a lentil to the size of a pea. The external covering of a wart is very 336 TUMORS. often hard and firmer than that of the connective tissue, so that the surface is surrounded by a firm, hard, horny covering (horny warts). The reverse is found in the case of soft, fleshy warts. These little formations are found on the skin of dogs of all ages, as a rule, on the head and back, but also in other regions, and they often disappear without any treatment. Now and then these horny warts grow to a very large size and form what are called ''cutaneous horns." Such are found on the forehead, the ear, and flanks; they are generally seen in old dogs. Enormous num- bers of warts are sometimes seen in the mouth on the buccal membrane. (6) Flat Condyloma. By this we mean certain marked malfor- mations which have the shape of a papilla, but, as a rule, are ramified and divided, forming coxcomb-like collections. They also appear in some cases as true papilloma, particularly as a sarcoma- tous formation. As a rule, they appear upon other regions than the skin, such as the lips, cheeks, and prepuce, also upon the mu- cous membranes in the buccal cavity. They are generally salient and easily made to bleed. This is due to the large number of bloodvessels they contain, their softness, and very thin epithelial covering. The author has noticed that dogs affected with con- dyloma of the vulva or penis also show these formations quite frequently on the edges of the lips. Gratin has often seen the obscure transmission of condyloma from one dog to another. This would tend to establish the fact that this disease is con- tagious. All varieties of papilloma may be removed by a curette or a pair of scissors. The use of caustics, ligatures, or amputations is also recommended. Palm recommends the following: R . — Acid, salicylicum 1 part Acid, lactic. . . . . aa 2 parts Collodion-ether S. — Apply twice daily. Adenomata. These are malformations of the true glandular tissue, which always originate in some gland and can be distin- guished from simple glandular hypertrophy by the fact that they stand out from their surroundings, are knotty, tough, or sometimes soft tissue. Their growth is slow; their metamorphoses consist, EPITHELIAL TUMORS. 337 as a rule, in the formation of cysts; and in those cases that are superficial we may have ulcerations externally somewhat resem- bling carcinoma. While adenoma is not malignant, it may become so in certain cases and change into a carcinoma. We have observed adenoma in most of the various glandular organs, upon the skin, in the mucous membranes, in the mammary glands, in the salivary glands, and thyroid gland. Tumors of the anus and stomach deserve special mention. (a) Tumors of the Anal Glands. The rectum of the dog has beside the ordinary cutaneous glands: 1. Glands of the anal pouches. These are glands having a branch tube-shaped form, located in the walls of the anus. 2. Acinous glands, which are formed in the so-called anal protuberance. 3. Anal glands, which are small, grape-like bodies located between the lower bowel and the anal mucous membrane. All these glands may become the seat of adenoma, but the latter is mostly developed in the circum-anal glands. Sarcoma and carcinoma occur quite frequently in the rectum of the dog. Tumors of the circum-anal glands, which are generally found in old dogs, have been carefully studied by Siedamgrotzky. They appear as round or irregular, firm tumors which are connected closely with the skin, and produce more or less enlargement of that part ; otherwise they are connected with their neighborhood by a loose connective tissue. In the transverse section they appear to be formed of yellowish-white or yellowish-red tissue, which is similar to the circum-anal glands. As a rule, they are easily removed. In some cases we have acute inflammation of the circum-anal glands with a formation of abscess. The tumors may be easily distinguished by the presence of pain, heat, and later fluctuation. We also see on these occasions an inflammation of the anal pouches. The anal pouches represent the csecal pouches, which vary in size from a hazelnut to a walnut, and lie between the mucous membrane and the muscular membrane. They contain within their walls the above-mentioned glands and have only an external exit by means of a very narrow canal. Inside we have a yellowish- brown, thick fluid, which, as a rule is fetid. Various influences, generally of a traumatic character, may cause inflammation of these pouches and a retention of their contents. The anus be- 22 338 TUMORS. comes swollen considerably on one or both sides. The membrane over the swelling is red, feverish, and painful to pressure. The animal makes frequent attempts to defecate without any result. A local examination shows the presence of a discharge of purulent matter from the orifice. This condition is soon relieved by means of cooliog applications and frequent emptying of the pouch. (6) Goitre; Struma. Goitre is a non-inflammatory swelling of the thyroid gland, and is frequently seen in the dog as a simple hypersemia and enlargement. In some cases we find an adenoma of the thyroid gland (true goitre). In very rare cases we find a sarcomatous or carcinomatous deposit of the thyroid gland (false, malignant goitre). It has been observed that in 30 or 40 per cent, of tumors in old dogs the disease is a cancerous degeneration of the thyroid gland. The thyroid gland in the dog consists of two portions, lying on each side of the trachea, separated by the median line, a short dis- tance below the larynx, and connected in the larger animals by a narrow isthmus. In small dogs this connection may be absent. We generally speak of two thyroid glands in the dog, and more so because we occasionally find only one side diseased, and very frequently find one portion more affected than the other. "VVe divide goitre into three varieties: the hard, soft, and cystic forms. A tumor of the neck is the symptom of all three varieties, which may sink downward as far as the entrance of the chest. As soon as goitres reach any development they may cause alarm- ing symptoms, such as difficulty in respiration by pressure on the trachea, and, in rare cases, dysphagia. Leisering saw a goitre in a poodle dog which extended from the larynx to the sternum, and covered almost the whole lower surface. It was about 16 cm. long, 10 cm. wide, and 3 cm. thick. The hard goitre (struma fibrosa) is a fibrous hypertrophy of the gland and a disappearance of the glandular substance. The swell- ing is hard and firm. In the soft form of goitre (struma mollis) there is more or less hyperplasia of the glandular tissue. In the cystic goitre (struma cystica) the gland is altered into one or more fluctuating cavities, which, as a rule, are filled with a colloid fluid. There are other varieties of this tumor, but the writer refers you to the text-books on pathological anatomy. Carcinoma and sarcoma of the thyroid gland are distinguished EPITHELIAL TUMORS. 339 from true goitre hj the fact that the swelling does not possess the smooth surface seen in the ordinary form, but is uneven and irreg- ular, becoming developed into a goitrous degeneration of the gland. The etiology of the mild form of goitre is very obscure, notwith- standing numerous researches. In man, as well as in horses and cattle, the appearance of goitre has been found to be due to their existence in certain districts, especially in mountainous ranges, and on that account its cause has been looked for in local conditions of the soil and Avater, especially where they contain large quanti- ties of lime. In the dog no such reason can possibly be ascribed, as in the regions where man, horses, etc., are rarely affected, many affected dogs of various ages and different nutritive conditions are found. The observation made by Maumeni of feeding fluor cal- cium to dogs was of no especial value. The fact has been pointed out by Schrauz that goitre is due to or may accompany certain affections of the heart; this is a much more important cause, according to the author's opinion. Schrauz has found that in a goitre district of the Tyrol in Q>Q per cent, of cases of heart-disease the people were affected with goitre. It is advisable therefore to make an examination of dogs affected with this trouble, following the same procedure as is described under Diseases of the Heart. We do not know if this affection is hereditary, but we question it, although some authors claim that it is. Therapeutic Treatment. The treatment of goitre may be medicinal or operative. As soon as the enlargement occurs, or signs of development appear, we obtain satisfactory results with preparations of iodine. Use iodine internally in the form of iodide of potassium in small doses, and externally in the shape of oint- ment of iodide of potassium, tincture of iodine, or ointment of iodoform (Siedamgrotzky). Also injections into the gland of tinc- ture of iodine, or alcohol and iodine, equal parts, are very success- ful, but are sometimes dangerous from subsequent fever in cases of parenchymatous goitres. These injections must be strictly aseptic in order to avoid suppuration. After thoroughly disinfect- ing the cutaneous region, we thrust a hypodermatic needle into the goitre, and first see if any bloodvessel has been injured. With this syringe inject into the gland equal parts of tincture of iodine and pure alcohol. In large goitres the injections must be repeated at intervals of several days. In all cystic and fibrinous goitres 340 TUMORS. the parenchymatous injections are generally useless, as is also the internal treatment with iodine. We must treat these forms like any other cystic tumor — that is to say, by puncture, opening it freely, tamponing with iodoform-gauze or wadding, and encourag- ing the formation of true granulations to fill up the cavity. The removal of a thyroid gland which is affected by goitrous degeneration is performed in the same manner in the dog as the removal of any other tumor. We must, however, consider three very important things during the operation: 1. The large number of bloodvessels in the immediate vicinity requiring careful incision and subsequent ligation. 2. The fact that after removal of both parts of the thyroid gland we often have the appearance of serious constitutional symp- toms and death. 3. Any uncleanliness during or after the operation always pro- duces severe septic irritation in the remaining portion of the gland and its surroundings. We have found from the observations made on a number of these cases that removal of one part of the gland does not affect the animal materially ; but if both are removed, or the whole gland, we might say, the dog dies within three or four days, with symp- toms resembling those of acute poisoning, or it becomes affected by marasmus, becoming depressed, will not eat, emaciation follows, the number of white blood-corpuscles in the blood increases to an enormous extent, the animal becomes unsteady and uncertain in walking, there are muscular twitchings and convulsions, and finally general paralysis, and death occurs in three or four days after the acute symptoms make their appearance. It is only in rare cases that the dog survives removal of the whole gland. We can, therefore, conclude that if the dog is affected on both sides we should remove the one that is affected the most. In rare cases we see a goitrous degeneration and enlarge- ment of the thyroid gland. The symptoms of this inflammation invariably occur in young animals, and may be due to traumatic influences. In these cases we find a traumatic swelling over the region of the gland, sensitiveness to pressure, increased tempera- ture, slight fever, generally followed by the formation of an ab- scess. The treatment is to be that advised under the treatment of abscesses. EPITHELIAL TU3I0BS. 341 Cysts (Cutaneous Tumors). A cutaneous tumor generally con- sists o£ a closed sac or pouch, which is lined with epithelial cells, and contains more or less liquid. Cysts are divided into several varieties : Dermoid Cysts. These consist of cutaneous tissue, sebaceous glands, sweat-glands, and hair-follicles forming in the centre a pulpy-like sebaceous mass. Esser found dermoid cysts in the ovaries. Retention Cysts. These are described as accumulations of sweat in the glandular passages or follicles, as a consequence of an obstruction of the canal at its exit. Atheroma originates as a result of these accumulations in the sebaceous glands. They are generally small, round cysts, lying in the skin, and filled with a grayish-white, fatty, or pasty mass. Secretory accumulations in the salivary glands cause mucous cysts or mucous polypi. These are small formations having a soft, elastic feel externally, and filled with watery or mucous secretions. In the large secretory glands, when the canals of exit have become plugged up, we have the formation of true retention cysts. There are two forms, called the ^^ honey-pouch" cyst and " glandular." These have already been described (page 51). Extravasation Cysts. These cysts are developed in all loose tissue, especially the cellular tissue under the skin; and in cases where the inflammation is acute and the secretion becomes encysted we generally find an accumulation of bloody, lymphatic fluid. The therapeutic treatment of cysts varies greatly, and depends to a certain extent on their formation and location. Entire removal is, of course, the best method, and this is generally adopted in cases where the pouch or sac has been uninjured, while in cases where the fluid has been allowed to escape it is almost impossible to remove the follicle entirely. There are some cases where a sim- ple puncture with a scalpel is effective. The puncture must be followed by an injection of tincture of iodine for the destruction of the cyst wall, \yhere we simply make an incision and evacu- ate the sac, we clean it out and follow it up by applications of creosote solution, oil of turpentine, tincture of cantharides, or nitrate of silver solution (1 to 10), or we may 'Houch it up'' with the thermo-cautery. This, however, as a rule, takes a long time to heal. \ 342 TUMORS. Carcinoma, or Cancerous Tumor. We call '' carcinoma" a neoformation which has originated by an accumulation of epithelial cells. These cells possess the peculiar property of forming meta- stases through the various lymphatic glands, and producing a gene- ral cancerous infection of the body, and are, therefore, considered malignant. Almost all the cancerous forms are distinguished by their tendency to regressive metamorphoses. These are mucous, colloid, and fatty degeneration with cystic formation, calcification, cicatricial contraction, and in superficial carcinoma of the skin and mucous membranes ulcerous disintegrations with formation of a purulent centre are called " phagedenic " tumors. We recognize the following forms of carcinoma : Squamous Cancer, or Cellular Epithelioma. This occurs in the cutaneous membrane and in all the mucous membranes containing squamous epithelium, as the mouth, throat, larynx, external gen- itals, bladder, and urethra. This affection in the cutaneous membrane, cutaneous cancer or cancroid, is very often seen in old animals, and occurs in any part of the body. It originates as diifused, thickened, or warty growth of the skin, becoming rapidly extended over its surface, and finally altered into cancerous tumor (ulcus rodens). It is a peculiar fact that this cancerous growth may accumulate rapidly for a short time, and then remain stationary without increasing any more. Squamous cancer or cellular epithelioma, which appears in the mucous membranes, especially in the vagina, which deserves spe- cial mention, has a great tendency to extend superficially, followed by a cancerous disintegration, also by a constant, bloody, purulent discharge. Cylindrical-cell Cancer. We observe this in the mucous mem- brane of the digestive tract and the uterus. Cancer of the stomach is of some importance, as it has been recognized in a number of post-mortems. Its existence during life can only be guessed at by frequent vomiting of more or less blood. Cancer of the Glandular Tissue. This is found in all glandular organs and especially in the mammaries of old bitches. This cancer of the mammaries is marked by the following character- istics : It is of slow growth, is particularly hard and firm, and has a EPITHELIAL TUMORS. 343 tendency to remain stationary for a long time. In some regions of the glands we may see a small, hard knot developed, which is not sensitive to pressure, and shows no signs of inflammatory action. This enlargement gains slowly and may be accompanied by other knots in the immediate neighborhood, which finally unite and form one mass. The carcinoma at this stage is found to be a hard, irregular, circumscribed tumor, and united, as a rule, with smaller masses by a thin, cord-like enlargement that lies in the integu- ment. When this enlargement is located very near the skin it shows a peculiar cicatricial contraction, and especially if it is near the teat this may be drawn entirely into the skin. This is quite common. AVe also observe great distention of the cutaneous veins, which may even be varicosed. As a rule, the enlargement is rarely confined to one, but we may find scattered through the gland numerous lumps or knots of various sizes. The author has counted twenty scattered through a gland. We also see in the mammaries of the dog fibromas, chondromas, adenomas, sar- comas, and cysts, but these are much rarer than carcinoma. It is hardly possible to confound these tumors of the mammaries with inflammation of the lacteal gland. True acute mammitis occurs very rarely in the bitch, and is indicated by a circumscribed, painful, very sensitive reddened swelling of a definite glandular section. The section may undergo complete disintegration, forming an abscess and sloughing, or we see chronic inflammation with a formation of knotty lumps, and a peculiar cicatricial contraction. A rapid improvement generally results from the use of acetate of lead solution. True mammitis must not be confounded with inflam- mation ^f the lacteal glands, which may appear in bitches that are nursing and deprived of their young. The swelling disappears in a few days by itself, but it may be hastened by a light diet and saline purgatives. In very rare instances there is a peculiar condition of the lacteal glands that is seen in bitches that have had several litters of pups; about forty-five days after they have been in ^' heat" we may find a general enlargement and filling up of the entire glands, also the appearance of a thin milk or colostrum in the glands, and every appearance of active lactation. This might lead the practitioner to believe that the bitch was in whelp. The tendency of carcinoma to become malignant and cause a general infection of the whole body is especially marked in the 344 TUMORS. soft forms of cancer, particularly those having a tendency to ulcerative degeneration, while the hard forms, such as above described in cancer of the mammaries, may remain months and even years after producing no other effect than a gradual enlarge- ment. The process is generally developed in the lymphatic glands, but we may see the appearance of secondary tumor centres which swell up without being accompanied by any pain or inflammation. A large part of the body may become affected in this manner — that is to say, the gradual development of the process through the entire body, these various tumors being supplied from the primary tumors, or carried into the circulation and scattered in all direc- tions, forming new centres of development. We may see this occur in cancerous masses in the liver, kidneys, and lungs, producing very little irritation of the surrounding tissues beyond the centre tumor, but we find the animal falling away quickly, becomes emaciated, has weak heart-action, and presents all the symptoms of what is known as cancerous cachexia. The prognosis is always unfavorable. Removal of a cancerous tumor may only be made when the neighboring lymphatic glands have not become affected, and where the animal is in good nutri- tive condition. Cases of ulcerated carcinoma must always be con- sidered unfavorable, except in the form of cancroid, which has been already described. The treatment of cancer consists of speedy removal and keeping the animal in as healthy condition as possible. General Therapeutics of Tumors. The internal medicinal treatment by preparations of iodine may be used in cases of goitre. In carcinoma and sarcoma we may give arsenic in the form of a solution of mercury, iodine, and arsenic (Donovan's solution), and the treatment advised under Chorea (page 218). Surgical Treatment. This is generally palliative in cases where the tumor is difficult to reach, being restricted to the prevention of hemorrhage, suppuration, and a fetid odor. The therapeutic measures used by Fricker and Hertwig are as follows: Tampons of tow which have been saturated in a solution of . chloride of iron and injections (where there is an opening) of sub- sulphate of iron, 1 to 90. This palliative method is only indicated where a radical opera- tion cannot be performed from some cause or location of the tumor and where the owner wishes to keep the animal alive as long as EPITHELIAL TUMORS. 345 possible without surgical interfereuce. The methods of radical removal of tumor are as follows (these do not include torsion or twisting) : Ligation. This method may be applied in all cases where the base of the tumor is not too broad, and if it has not penetrated deeply into the tissues. It is useful in many forms of warts, fibromas, and sarcomas; but, as a rule, it is objectionable because it acts slowly, is extremely painful, produces great inflammation with suppuration, and the tumor has a tendency to return. Ligate the base of the tumor with a strong silk thread or a rubber band. Another method which is more rapid is the use of the ecraseur, either by chain or wire. The chain of the 6craseur is put around the base of the tumor, and greatly tightened by means of the instrument, when the tissues are gradually crushed. The author Fig. 74. Wire ecraseur. has used the wire-loop, shown in its simplest form in Fig. 74, for the removal of epulides. The bleeding, as a rule, is very slight if the crushing is done slowly, but there is always a danger of recurrence of this condition. We must, therefore, touch the open space left after the removal of the tumor with a thermo- cautery. Cauterization. We may destroy tumors of the cutaneous or mucous membrane, flat warts, etc., by means of Paquelin's thermo- -cautery, or we may use some of the various cauterizing substances. The best form of using this treatment is by the instrument illus- trated in Fig. 75 (page 346). This instrument is based on the fact that platinum, under certain conditions, very readily takes a red-heat at a low temperature. The instrument is made in the form of a pipe or cylinder, with different forms of platinum fitted on the end. By means of an ordinary blowpipe or hand-bulb a fine spray of benzine or rhigolene is thrown on the heated plati- num end, causing constant combustion, and if the flame is kept steady it reaches a white heat. Tliis instrument has the advantage of being kept at an even heat for a long time, and on account of this steadiness is especially valuable in controlling hemorrhages. The caustic chemical substances, such as burnt alum, caustic 346 TUMORS. potash, blue-stone, chromic acid, chloride of zinc, and nitric acid, are not especially valuable in the therapeutic treatment of tumors. Fig. 75. Paquelin's thermo-cautery. Removal — Extirpation. This method is the best one to follow in all large tumors which are easily reached. Various modifica- tions are possible, according to the form and location of the tumor, but the following is the general mode of procedure: 1. The incision: The cut should be made by an ordinary scalpel between the tumor and soft parts; making the incision, if possible, in the direction of the hair and of the large bloodvessels. 2. After the extirpation of the tumor the cavity should be cleared of all loose tissue by means of a pair of scissors or scraped with a curette. 3. Ligate all the bloodvessels. 4. Tie up, or bring together by means of sutures, the edges of the wound. 5. Place over the wound an antiseptic dressing. Anaesthesia. We have already given information as regards the last three points of the operation. We must confine the animal, in all operations, in such a way as to prevent him from biting or from moving that part of the body which is operated upon. It is best to place a leather strap or bandage around the mouth (see Fig. 76), and have an assistant hold it. This method is preferable to strapping with cord, etc. Berdez, Arnold, and others have con- structed special operating-tables which are to be used in hospitals. In very serious operations, accompanied by great pain, it is advisable to place the animal under the influence of some anses- EPITHELIAL TUMORS. 347 thetic (except in slight operations o£ the eye, in which *'• local" anaesthesia with cocaine is sufficient). We generally use chloral, ether, chloroform, or bromo-ether. It is advisable to give chloral Fig. 76. Fig. 77. Manner of tying the mouth. in the form of a clyster. We inject the following solution in the rectum of a medium-sized dog, fifteen minutes before the operation: Chloral hydrate 8.0 Aqua 100.0 Mucilage 25.0 The other agents are inhaled by means of an anaesthetic cover- ing — a flannel mask. The mask is made of wire netting shaped like a muzzle, covered with flannel, and held under the ani- mal's nose (Fig. 77, a). We must take care that a certain amount of air is inhaled with the vapor of the anaesthetic. The pulse, respi- ration, and reaction of the eyelids must be watched at the same time. After a few inhalations we notice a period of excitement which is marked by great restlessness, howl- ing, groaning, and, in rare cases, delirium. This is followed in a short time by a period of depress- ion, and after that the narcotic con- dition is completely established. The cornea has now become insen- sible — that is to say, there is no reflex action or closing of the eye- lid when touched. The muscles are now entirely relaxed, feces and a, inhalation mask; &, inhalation bottle. 348 TUMOBS. urine are discharged involuntarily. This result is not always even or regular, but depends to a large extent on which of the above- mentioned remedies is used. For instance, in using ether the stage of excitement is usually prolonged (twenty to forty minutes) [this is not the translator' s experience with a good assistant — ten minutes at the most], and in the stage of depression reflex excitement does not disappear immediately. Chloroform produces much quicker results, and, as a rule, answers fairly well, but it has one disadvantage: the attendant or administrator must be very careful not to push it too far, or it is apt to produce paralysis of the lungs or stop the action of the heart, or perhaps act on both parts at the same time, causing death. We prefer to use a combined narcotic in the form of an injection about ten minutes before the operation. This injection consists of 0.03 to 0.06 of morphia muriate dissolved in water. Afterward administer a mixture of equal parts of ether and chlo- roform. The narcotic stage is mild, the period of excitement short, and death is very rare. But even by this method, if there is any acute disease of the heart, it is apt to be dangerous. For this reason the author has lately used bromo-ether after having repeatedly tested its reliability. The author uses an inhalation of bromo-ether by means of an apparatus shown in Fig. 77 (6), which, of course, may be used to administer any anaesthetic. The funnel is placed under the ani- mal's nose so that he is compelled to breathe through the bottle. The sponge in the bottle is impregnated with bromo-ether; a double curved tube serves to supply the requisite amount of atmospheric air. The amount of bromo-ether necessary varies from 10 to 40; the stage of excitement is short but very marked; the narcotic effect is deep but lasts a few moments only, so that it is not advis- able to discontinue the inhalation at any time during the operation. The stage of excitement may be reduced to a minimum by means of morphia injections. As a rule, the temperature of the rectum drops from 1 ° to 3° after this narcosis. The lowest the author ever observed was 35.5°. [The translator has recently used an inhaler suggested by Professor Hobday, of the London school, that has a number of advantages over the methods suggested by the author, but at the same time it must be admitted that it is really an improved modification of the apparatus suggested in the author's work, the EPITHELIAL TUMORS. 349 mask and the bottle being greatly improved in '^Hobday's" apparatus. It consists of a mask that has the form of an elongated blunt cone, having a stopcock at one end where the tube enters that carries the ansesthetic into the apparatus. This is fixed on the head by means of a collar, and a circular continuation of the cone made of soft cloth, which is adjustable, is fitted over the face. A container with a broad base to prevent any chance of it being over- turned contains the ansesthetic. This container has two openings — one to connect the tube and the other to allow the admission of air to mix with the vapor of the ansesthetic. Connecting the container and the mask is a bulb apparatus usually seen on the thermo-cautery. The muzzle apparatus is fixed on the animal's head, and by means of the bulb the mixed vapor is blown into the muzzle and directly on the animal's nose, thus preventing the irritation of the direct contact of the ether or chloroform. By means of the stop- cock the supply of vapor can be stopped instantly, or, if need be, the whole apparatus can be slipped over the animal's head or the rubber tube can be pulled from the container and a supply of pure air blown directly on the animal's nostrils.] The most important requirement, after the use of the anaesthetic, is controlling the hemorrhage in large operations. In operations on the extremities we may use for that purpose the bandage recom- mended by Es march. The member must be held high and the blood removed by frictions made by the hand from the periphery toward the proximal end, then place a rubber bandage around the limb above the part that has to be operated upon. This method not only gives us a clean field for operation, but it enables us to find numerous little arteries which may have been overlooked, and which begin to bleed as soon as the bandage is removed. We find, as a consequence, fewer consecutive hemorrhages than were for- merly noticed. This method must not be practised under any circumstances where there is any risk of introducing pus or puru- lent matter into the blood. For instance, in purulent cellular inflammation of the tissues, gangrene, etc. In such cases we avoid any manipulation of the part. Place a simple compressing bandage above the operating region in order to prevent hemorrhage during operation. We must not use friction in order to carry or empty the blood from the affected member. DISEASES OF THE EYES. AFFECTIONS OF THE EYELIDS. Closure of the Eyelids. It is a well-known fact that puppies are born blind — that is to say, the palpebral fissure is closed at birth. This is not a simple agglutination of the eyelids, but a true adhesion of membranes. This has been proven from the fact that if they are forcibly sepa- rated after birth the cornea has an opaque look and the edges of the eyelids bleed. As a rule, the fissure opens itself in from seven to twelve days. It is very rare that we have an obstinate closure of the eyelids. If this should be the case, we try to produce sep- aration by means of emollients, tepid water, and normal tension upon the eyelids. If these are not successful, the eyelids must be separated by means of a pair of scissors; then we rub the edges of the wound with vaseline, or, if they persist in uniting, with caus- tics in order to prevent an adhesion. Entropion — Turning in of the Eyelid. By this term we understand a turning or wrinkling of the eyelid in such a manner that the edge of the lid is directed toward the eyeball, and the eyelashes come in contact with the conjunctival tissues and cornea. Entropion occurs quite frequently, especially in bulldogs, Newfoundlands, and setters, although it may be present in all breeds. In some cases it is present at birth, or it may be developed by constant convulsive closing of the fissure of the eye, due to some irritating conditions of the cornea or conjunc- tiva. It is occasionally caused by cicatricial contraction of the conjunctiva of the lid, after injuries, caustic substances in the eyes, burns, or some chronic inflammatory condition. The looser the cutaneous tissue may be in the neighborhood of the eyelid, the more obstinate the diseased condition is to treatment. Haltanhoff considers that the tendency to entropion is hereditary. (350) ENTROPION— TURNING IN OF THE EYELID. 351 Clinical Symptoms. As a rule, the inversion of the lid occurs more frequently in the upper than the lower eyelid, but we may also see both affected at the same time. Sometimes we see a lateral inversion of the eyelid. This is extremely rare, however. A symp- tom observed is constant irritation, which is caused by the hair of the lashes being directed toward the cornea. We also see a marked lachrymal secretion, a twitching and convulsive compressing of the eyelids, and a thick, gray mucus accumulates in the corners of the eyes. The hairs of the eyelashes become adherent, and the eyelids may become completely glued together. Besides this we see an intense inflammatory condition of. the connective tissue, and in some cases inflammation of the cornea, and in extremely bad cases suppuration. Prognosis and Therapeutics. The prognosis may be favor- able when we operate at the proper time, but relapses are not rare, especially in dogs which show a peculiar wrinkled condition of the facial membrane. We may expect a relapse in such cases where we do not entirely remove the conjunctivitis (primary or secondary) at the same time as the entropion. It is only in fresh and very mild forms of the disease that we obtain any favorable results by means of medicinal treatment, and this must be directed toward removing the conjunctivitis which exists in conjunction with entropion, otherwise an operation alone will answer. The following methods of operation are suggested: 1. Simple removal of the turned-up eyelid by means of scissors. This is undoubtedly the simplest method, but it is very evident that the appear- ance of the animal is very much impaired by it, and that the eyeball may t)e, affected in some manner on account of the insufficient closure of the lid. 2. Incision of the eyelid in the neighborhood of the internal corner of the eye. This method, which was formerly described by Stellway and recently by Zirin, is not thought by the author to be advisable. This operation con- sists in taking a wedge-shaped piece from the lid through its whole thick- ness. We cannot advise this, however, as we doubt if the lid will become thoroughly united. 3. Ligation of small portions of cutaneous membrane in different parts of the lid. Stockfleth describes this method in the following manner : We in- troduce a number of needles through the fold of the skin in the eyelid, drawing the portion of skin together by means of a thread in the form of a figure-of-eight. This will act as a ligature. The points of the needle must be cut short, and a small piece of wax put on the ends to prevent 352 DISEASES OF THE EYES. either slipping or puncturing the skin. After the ligated portion of the skin has become inflamed and detached we see a series of round, cutaneous wounds near the eyelid, which heal by granulation. The eyelids turn out of their normal position by means of a contraction of the cicatricial tissue. 4. Excision of a portion of the cutaneoiis membrane from the eyelid. This is the best and most common mode of operation. It may be performed in two different ways : a. Take up a horizontal fold of about 0.5 to 1.0 cm. by means of a strong pair of pincers (Fig. 78, a), or what are known as entropion forceps, about Fig. 78. Operation for entropion by means of excision : a, elliptical incision ; 6, triangular incision. 5 to 8 mm. from the edge of the eyelid, cutting it off closely by means of a pair of scissors (Fig. 78, a) ; and b. Take up and cut out a triangular or heart-shaped jjiece, instead of an elliptical one (Fig. 78, b). We then close the wound by a united or con- tinuous suture, and paint over this suture with collodium. While we do not, as a rule, obtain union by first intention, the wound closes very quickly and gives satisfactory results. Ectropion — Turning Out of the Eyelid. This condition is, as a rule, in the lower lid, the free edge of the lid being turned out from the eyeball toward the external side of the eyelid. This is generally noticed in bulldogs, St. Bernards, and setters, especially so in the animals that have sunken eyeballs. It may be due to an alteration or partial paralysis of the palpebral muscles. Sometimes it may occur from the shape of the cartilage, which does not consist of a firm disk, but of bunches of connective tissue mixed with elastic fibres. In some cases it may be caused by a contraction of the membranes of the face, especially cicatricial contraction, such as results from wounds or burns. It may also be INFLAMMATION OF THE CONJUNCTIVA. 353 due to a loosening or softening of the tarsal cartilage as a result of prolonged conjunctivitis. Clinical Symptoms. The affected eyelid is turned up and out, so as to show the conjunctiva. The latter is inflamed from the action of the air and is more or less reddened, and at the same time there is considerable secretion of mucus and tears along the cheeks (lachrymal eyes). Therapeutic Treatment. We must first endeavor to reduce by " touching" the connective tissue of the eyelid with a pencil of nitrate of silver or sulphate of copper, or by removing a portion of the eyelid. This, however, is extremely hard to do, and, as a rule, it is not advisable. If these measures are useless, or if they seem doubtful from the onset, Moller recommends to excise from the external half of the affected lid an arch-shaped piece of skin, 0.5 to 1 cm. broad, the arched edge standing from the edge of the lid. Placing a few stitches is advisable, but is really not necessary. Concerning other diseases of the eyelids, we would refer you to text-books on ophthalmology. DISEASES OP THE CONJUNCTIVA. Inflammation of the Conjunctiva — Conjunctivitis. {Conjunctivitis ; Syndesmitis.) Inflammatory conditions of the conjunctiva are the most frequent affections of the eye in the dog, and appear in various ways accord- ing to their cause. Under ordinary circumstances we see the development of a simple catarrh of the conjunctiva, which, like all catarrhs of the mucous membrane, causes swelling, great red- ness, and formation of loose folds of tissue. The redness may vary from a slight injection to a dark or bluish-red coloration. This is, as a rule, regular and rarely spotted with blood extrava- sations. The secretion of the mucous membrane is sero-mucous in the beginning, but later on becomes muco-purulent, and in some cases there is a peculiar grayish secretion. This secretion becomes agglutinated to the interstices and corners of the eyelids, producing a gluing together of the lashes, and during the night, when the animal is asleep, it dries up, forming a grayish-yellow adhe- sive mass. The inflammation is usually restricted to the conjunc- 23 354 DISEASES OF THE EYES. tiva of the lid, the transition fold and the bulb of the conjunctiva being very rarely affected. The follicles of the connective tissue are generally swollen in all prolonged forms of catarrh of the eyes. Sometimes they protrude here and there from the reddened con- nective tissue in the shape of a millet-seed or a sago granule. In cases where the irritation is due to the influence of some infectious substance we notice a marked cellular infiltration of the tissues of the mucous membrane, with proportional swelling of the connective tissue, and the production of a copious, thick, yellowish- green secretion. Under the influence of chemical irritants we have the formation of grayish-white or transparent membranous accu- mulations upon the surface of the mucous membranes, and some- times we have ulcers which may lead to trichiasis (turning in of the hair of the lashes toward the bulbs; the mildest form of entropion). In some cases it may cause a natural entropion or symblepharon adherence between the lid and bulbs of the conjunctiva). The following forms of conjunctivitis are noticed in the dog : Catarrhal Ophthalmia (Conjunctivitis). By this we mean an acute catarrh with intense redness and loosening of the con- junctiva, also copious mucous or muco-purulent secretion. The local disturbances do not seem to be very marked, but we see in rare cases irritation and itching, the patients attempting to rub their eyes with their paws. The course may be acute or chronic. Conjunctivitis follicularis is a variety of this disease (catarrh of the eyes). Frohner says that this is indicated by the appearance of large quantities of lymphatic follicles upon the internal surface of the membrana nictitans. These stand out distinctly in the form of rounded millet-seed bodies upon the surface of the mucous membranes. They are dark-red and transparent, consisting of ball-shaped accumulations of lymphoid cells. Soon they appear in numerous masses, giving the membrane the appearance of a granulating wound surface, and in such cases the membrana nicti- tans is detached from the bulbus and extended over the cornea. The question, is follicular conjunctivitis to be accepted as a dis- ease sui generis or not, we have not been able to determine fully, but we know that the presence of numerous lymphatic follicles prolongs indefinitely the course of conjunctivitis. We ought, there- fore, to always expose the membrana nictitans by means of a pair of forceps, especially in catarrh of the connective tissue. Accord- INFLAMMATION OF THE CONJUNCTIVA. 355 ing to Frohner, 40 per cent, of all dogs are affected more or less by conjunctivitis follicularis. Etiology. Catarrh of the eyes may occur at any period of the animal' s life, and, as a rule, affects both eyes ; in very rare in- stances only one. It is generally the result of exposure to cold or the influence of sharp, cold winds. It is, therefore, apparent why it appears at certain seasons of the year more than at others — that is, in the spring and fall. Mechanical and chemical influences also produce a certain effect, such as foreign bodies (dust, hair, etc.), eyelashes turned in, smoke of soft coal, etc. Catarrh of the conjunctiva is intimately connected with catarrh of the respiratory organs, especially cold in the head, distemper, and all serious internal diseases which have a prolonged course. Purulent Ophthalmia (Purulent Conjunctivitis; Blennor- rhoea). This form of conjunctivitis is marked by considerable swelling of the membrane. This is sometimes spotted red by hemorrhages, sensitiveness to light, and photophobia, the animal constantly winking or convulsively closing the eye. The secretion of the eye is changed into a muco-purulent mass, becoming filled with a thick, yellowish-green fluid with pus, and in this condition complications of the cornea are generally present. The latter be- comes dull in the centre, showing erosions in some cases. This opacity of the cornea gradually increases, becoming darker, more opaque, and then taking a yellowish-gray coloration. We may see in some cases ulceration of the cornea. This blennorrhoea of the conjunctiva is a rare and dangerous disease, causing extensive inflammation and ulceration of the cor- nea, the condition being prolonged in some cases from four to eight weeks, and in extremely bad cases the eye is lost. Etiology. It is admitted that this disease is due to a specific infectious substance in the course of some epizootic disease. This may or may not be present. It is possible to produce the same form of the affection by inoculating the conjunctiva of a healthy dog with this purulent material. Guilmot observed that by placing dogs in a kennel which had been previously used by a dog affected with this disease that they soon became similarly affected. In many cases we see no ulceration, simply the development of the conjunc- tivitis. Frohner states that he has observed purulent conjunc- tivitis, which he found to be due to the transmission of gonorrhoeal 356 DISEASES OF THE EYES. secretion from the affected person placed on the conjunctiva of the dog. Guilmot says that gonorrhoeal secretion of the dog itself is the cause of this disease, but this assertion is combated by Moller, whose experiments with secretions of preputial gonorrhoea in the dog have always given negative results. Therapeutic Treatment of Inflammation. If the disease is produced by foreign bodies, an eruption, etc., we have to remove the cause first. If we have to deal with dirt, coal-dust, or small bodies, it is sufficient to wash out the eye with a little syringe, such as a hypodermatic without a needle. If the bodies are adherent, such as iron fragments, sand, etc., accompanied by convulsive movements of the lids and intense secretion of tears, we must apply a certain amount of cocaine to the eye, remove the foreign bodies, or wipe them off by means of a blunt probe or sound, cov- ered by a handkerchief. Then keep the animal away from strong light, smoke, etc. In ophthalmic catarrh we must use astringents, such as sulphate of zinc, sulphate of copper, and nitrate of silver. These must be used in mild solutions, such as 0.2 to 0.75 per cent. These solu- tions may be applied by means of a camel' shair pencil put between the lids and washed off in a short time with clean water; or we may apply nitrate of silver, following it up a few minutes after- ward with a 2 per cent, solution of chloride of sodium. Alum solutions are also useful for washing or painting the inflamed membrane. In pronounced photophobia we may paint the con- junctiva with a solution of cocaine or tincture of opium and gum arabic. In chronic cases apply ointments of calomel, 10 to 20 per cent. ; oxide of mercury, 3 to 5 per cent. ; or iodoform, 20 per cent. In chronic catarrh of the eyes a very effective method of reduc- ing the irritation is to blow small quantities of calomel directly on the membrane. Follicular conjunctivitis may be removed by astringents, but in the acute forms which occur on the surface of the membrana nictitans we can only remove them by surgically removing the membrane. This is cut out in the following manner: Removal of the Membrana Nictitans. We first place the eye under the influence of a few drops of a 4 per cent, solution of cocaine, then by means of a light suture needle we run a thread through the membrane and lift it uj) as far as possible from the eye. By means of a pair of scissors we then cut the enlarged INFLAMMATION OF THE CONJUNCTIVA. 357 membrane from the eye. The incision does not require any further treatment except to bathe it with cold water. The author has never seen any bad results from this operation, which has been especially recommended by Frohner, Moller, and others. The influence of cocaine upon the conjunctiva and cornea renders these parts insensitive and permits a number of small operations without producing any feeling of pain or convulsive irritation of the eyelid. We pour a little 5 per cent, solution of cocaine into the eye and obtain in this manner, from two to three minutes, an absolute insensibility to pain, both in the cornea and conjunctiva. This does not, as a rule, last more than ten minutes, and must therefore be renewed every five minutes if necessary. In order to reduce blepharospasm, as a consequence of violent conjunctivitis, we should apply solutions of cocaine every two or three hours. Therapeutics. In ophthalmic blennorrhoea we must endeavor to prevent it before it goes too far. We must treat it with anti- septic agents, and it is especially important to keep the conjunctiva clean with water or some non-irritating antiseptic fluid, such as boric acid, 3 per cent. ; corrosive sublimate, 0. 02 per cent. ; per- manganate of potassium, 0.05 per cent.; creolin, 1 per cent.; salicylic acid, 1 per cent. These must be introduced into the pouch of the lid by means of a syringe, brush, or sponge. When it is necessary we must irrigate the eye with strong solutions of nitrate of silver (1 to 3 per cent.), taking care to observe the rules mentioned on page 356, We may also use diluted alcohol (equal parts), covering the conjunctiva with calomel ointments or oxide of mercury, or blowing on it powder of iodoform or calomel. Aniline (pyoktanin) is also advised by some authors. The treatment may also be materially altered by complications of the cornea, for which we would refer to page 359 for further details. Besides the inflammatory condition which has just been de- scribed, we may have tumors of the conjunctiva, but, as a rule, these occur on the membrana nictitans. Their treatment depends on general rules which have been already described. It may be advisable to remove them in the manner described. 358 DISEASES OF THE EYES. DISEASES OP THE SCLEROTIC COAT OP THE EYE. Inflammation of the Sclerotic Coat. (Keratitis.) Notwithstanding the fact that the sclerotic coat does not contain any bloodvessels, it is frequently the seat of inflammatory pro- cesses which become present through a pericorneal injection due to intense irritation of the bloodvessels which surround the border of the sclerotic coat, and further by an opacity of the cornea form- ing an obstruction that prevents the admission of rays of light into the eye itself. This clouding or opacity may extend over the entire sclerotic coat, or it may only involve a small portion. It varies in color from a grayish-blue to a pure gray. It is yellowish- gray in some cases, but never pure white in coloration (cicatricial dulness). On careful examination it seems to be diffuse, forming spots or stripes. The lustre of the membrane is dull on its surface and a partial loss of the epithelium is noticed. The other symp- toms are avoidance of light, convulsive movements of the eyelids, and discharge of thin water from the corner of the eyelids, visual deficiencies, and in some cases the animal may be partially or even totally blind. This is especially seen when the opacity of the sclerotic membrane is in the region of the visual line that is opposite the pupil. Pathological Anatomy. We have in other cases of keratitis the appearance of large quantities of round cells in the sclerotic membrane. These come from the bloodvessels of the neighboring membranes and conjunctiva. These are wandering cells which find their way into the sclerotic coat. As long as the round cells in the sclerotic membrane are not crowded together it remains unaltered in its true structure (infiltration of the sclerotic mem- brane), and complete recovery follows after the cells have disap- peared. But as soon as the cells are packed too closely together the sclerotic tissue is partially destroyed by maceration and necrosis, followed by a loss of actual substance. If this is sur- rounded by intact tissue of the sclerotic membrane, it forms an abscess; if it is open externally, it is an ulcer. We consider as ulcers small superficial openings in the cornea which are always round in the early stages, and are caused by infiltrations located INFLAMMATION OF THE SCLEROTIC COAT. 359 closely under the epithelium, forming little bags or sacs, and finally bursting through the epithelial covering. In the dog, as a rule, they heal without leaving any cicatrix. Still, many cases are seen where they finally close up, leaving a white cicatrix, or else they lead to perforation of the cornea or to a total destruction of the eye by extending into the anterior chamber. "VVe find the following forms of inflammation of the sclerotic membrane: (1) Keratitis Superflcialis. The cornea is clouded and opaque, being of a diffuse grayish-blue or grayish-white coloration, appear- ing with a slightly irregular surface, but under certain circum- stances it may also be covered with small epithelial masses. In this affection the eyes are watery, and this may disappear in a few days or last for weeks. In the latter case we observe the forma- tion of bloodvessels at the borders. These bloodvessels increase in size and the edges become very vascular. Moller found that during vascularization of the cornea it is not rare to see hemor- rhages in that organ followed by a number of brownish-black pigment-spots. Etiology. Superficial inflammation of the sclerotic membrane is caused by slight irritations of various kinds (superficial injuries, inversion of the eyeballs or entropium). It may also originate, secondarily, with acute conjunctivitis, the inflammation extending from the conjunctiva to the cornea. Therapeutics. The treatment is the same as in inflammation of the conjunctiv^a — that is, washing and painting with a solution of sulphate of zinc, corrosive sublimate, alum, or sulphate of copper. Avoid all use of lead solutions in such cases where there is any loss of substance of the cornea, as the lead is deposited in the cornea and produces black-colored spots. If there is any ulceration, we must apply the therapeutic treatment as indicated on page 362, and in cases where the spots on the sclerotic mem- brane remain use the treatment given on page 363. (2) Keratitis Profunda or Parenchymatosa. The surface of the cornea has an opaque, dull, slightly grooved condition, the color bluish-gray or gray, rarely grayish-white, accompanied by watery eyes, sensitiveness to light (but only to a slight degree), and also the formation of new vessels, which extend from the borders of the cornea toward the centre. Abscesses and ulcerations, as a 360 DISEASES OF THE EYES. rule, are rare. This form, however, must not be mistaken for ulcerative keratitis. The course of this disease is generally favorable. After several weeks the dulness disappears and the new vessels become thinner, disappearing entirely in a short time. Therapeutics. We remove the irritation to a certain extent by applications of compresses. Also irrigate with warm water or boric acid, and drop atropia into the eyes. If the inflammatory symptoms are reduced, we then follow it up by stimulant irritants, such as calomel powder or ointments of red oxide of mercury. (3) Abscesses of the Sclerotic Membrane. When there is intense dread of light and great increase of tears, and when we see a pericorneal injection and the cornea colored a gray, yellow, or straw yellow, and a certain spot on that part which is sharply defined from the tissue of the normal sclerotic membrane, or may be sur- rounded by a more or less dull zone, we then can safely conclude that it is the formation of an abscess. Its location varies; some- times it is on the edge of the cornea, at other times in the centre; then, again, we may find it close to the surface of the membrane or deep in the centre of it. It may be very small in dimension, such as the size of a pin-head, or it may even include the whole sclerotic membrane. The course varies also. In small abscesses it may disappear by simple absorption, while in large ones the acute inflammation sub- sides, frequently leaving an intensely white spot, or it may break out externally, forming an open ulcer. This latter conclusion, or termination, is the most common, and in rare instances it may break in a posterior direction toward the anterior chamber of the eye, causing an accumulation of pus in it, and producing further inflammatory processes in the internal part of the eyeball. Etiology. Abscesses of the sclerotic membrane appear after some traumatism, especially contusions or bruises of the mem- brane, also after non-aseptic operations, in connection with blennor- rhoea or conjunctivitis, or during distemper, and very frequently appear without any appreciable cause. Therapeutics. This is closely related to that of ulcerations of the sclerotic membrane — that is, to incise the abscess after using cocaine in the cornea, make a broad cut and turn up the borders of the wound. This has to be done to expose the bottom of the INFLAMMATION OF THE SCLEROTIC COAT. 361 abscess. It is then dried with corrosive sublimate or iodoform- gauze and washed out with a solution of corrosive sublimate and dusted with iodoform or calomel until it dries up. (4) Ulceration of the Sclerotic Membrane. In this condition we find a loss of substance in the cornea which varies in size and depth, showing a grayish-white or grayish-yellow ground, and, as a rule, has short, abrupt borders with a bluish-gray, gray, or grayish-yellow opacity in the immediate neighborhood of the ulcer- ation. When the ulceration of the sclerotic membrane begins to heal it is indicated by a lessening of the infiltration in the imme- diate neighborhood of the ulcer, the dull circle surrounding it becomes clearer, the color shiny, and the pericorneal injection less. The dread of light begins to disappear. In rare instances the bloodvessel will shoot from the edge of the cornea toward the ulcer, and an epithelial covering is now formed over the pit-like ulcer, which resembles very much the normal tissue of the sclerotic membrane, but it is not as transparent in color as it was before. If the ulceration has not been very deep, we see the dulness grad- ually disappearing, leaving only a very thin white veil ; or, if the ulceration is deep, we have as a result a distinct white spot which remains permanent (cicatrix of the sclerotic membrane, macular cornea). This cicatrix of the membrane may become clearer in the course of time, but, as a rule, it never disappears entirely. "When the ulcer does not take a favorable termination we find the inflammation increases, the ulceration becomes deeper, and we have a perforation of the membrane in a few days. The contents of the anterior chamber escape through the opening, and in rare instances the iris and the lens push forward and may also escape if the opening is large enough. After perforation occurs the ulcer begins to heal, and we have an adhesion of the iris and lens to the posterior wall of the sclerotic membrane. In other cases where the opening of the ulcer is very narrow the anterior chamber fills up again, is forced forward, forming a clear bladder-like body, forming dropsy of the sclerotic membrane, or keratocele. If the ulceration is large, the whole ground of the ulcer becomes embossed — that is, it stands out from the surrounding membrane in a pecu- liarly distended manner. As a consequence of rupture we may have a series of ulcers of the membrane. The opening may close up quickly, the fluid of the anterior chamber may collect, and the 362 DISEASES OF THE EYES. lens and iris may be pushed back into their normal position. In large ulcers the iris is generally forced into the orifice, filling up the opening and causing adhesions. When the fluid of the ante- rior chamber collects again the lens and iris may be pushed back from the cornea into their old position, but the section of the iris which has united at the orifice remains adherent, so that the pupil is pulled forward to the cicatrix of the sclerotic membrane, and the power of vision of the eye is greatly impaired. Externally the iris, which is drawn into the orifice, becomes covered with cicatri- cial tissue, and by its contraction it forms a lobule of the iris. This finally contracts into a peculiar club-shaped body over the anterior surface of the membrane (iris staphyloma). We must not confound this condition with staphyloma pellucidum. By it we mean a change of form in the sclerotic membrane, where it becomes more or less opaque, and is forced outward in the shape of a grape-like body by the dropsical condition of the anterior chamber. When there is great irritation of the sclerotic membrane in some cases we may have a prolapsus of the lens, and the eyeball subsequently collapses, forming an opening in the centre of the eye which finally becomes closed up by a whitish-gray cicatrix. Etiology. Besides the causes already mentioned in the forma- tion of abscesses, the following also produce them : cauterization, foreign bodies which adhere to the membrane, wounds in some cases, etc. This disease may appear in the epizootic form with or without distemper, and generally in connection with blennorrhoea of the connective tissue. Prognosis and Therapeutic Treatment. The prognosis depends to a large extent on the irritation of the ulcer and the rapidity of its progress. Ulcers which are small and located on the borders are easier to treat than those which are larger and located in the centre of the sclerotic membrane. In weak, badly fed young animals and in pugs the prognosis is more unfavorable than in healthy old animals. The treatment requires cleanliness and strict antiseptic remedies. The use of a dressing is of great advantage, but few dogs can be made to submit to one. In canine hospitals, as a rule, they use a specially constructed leather cap (seen in Fig. 79). The various antiseptic agents which are used are corrosive sublimate, 0.1, or chlorine water (either pure or mixed with two or three INFLAMMATION OF THE SCLEROTIC COAT. 363 parts of water), to be applied with a brush, and iodoform as a powder blown from a quill directly on the eye. The author has obtained very satisfactory results with hot fomentations of boric acid (3 parts to 100). These should be applied three times daily, ten minutes at a time. They are far better than cauterizations with nitrate of ^^^- '^^• silver or painting with aniline. y^""^ f n. Besides the antiseptic treatment we ^ J ^Sj^K can use atropine or eserine solution, of \ „^^ J^ f i^ which a few drops are put in the eye. ^"^^tu-^-- y^ The first-named agent should be applied (,^ when the ulcer is located centrally, as w^„oT^ it dilates the iris, and consequently the pupil is enlarged, and the latter when the ulceration is located on the borders, as it contracts the pupil and draws it away from the seat of irritation. The iris is dilated or contracted by these drugs and removed from the neighborhood of the ulcer, so that if the perforation does occur the iris will be drawn far enough out of the road to prevent any adhesion. Good results have been obtained with cocaine, alternating with atropine : R. — Atropine sulphate . . . . . . .0.1 Aqua destil 10.0 M. S. — In order to produce a dilatation of the pupil we must intro- duce five drops of this remedy into the conjunctiva, drop by drop, by means of a brush or a dropper. R . — Eserine salicylate 0.05 Aqua destil. 10.0 M. S. — To be used like the atropine solution. When a keratocele is developed we may prevent rupture by puncturing the membrane with a needle and allowing the water in the chamber to escape. In prolapsus and adhesion of the iris we can do very little, as it is impossible to push back the iris into place. We must dust it with iodoform; at the same time we may reduce the enlargement by means of nitrate of silver, sulphate of copper solutions, or a powder of oxide of mercury blown on the eyeball. If we have an iris staphyloma, it is best to remove it carefully by means of the scissors. We must try to remove any spots on the sclerotic membrane by 364 DISEASES OF THE EYES. means of irritants, such as the mild chloride or oxide of mercury or massage. According to Bayer, massage of the cornea has to be performed in the following manner : The points of the fingers are placed on the closed-up eyelids and by a constant circular or cen- trifugal friction move the eyelid for some time. In some cases we may also apply the above-mentioned ointments and powders. The author has obtained far the best results from calomel than anything else. He placed daily a small amount of powder com- posed of equal parts of calomel and sugar (grape sugar) on the cornea, and applied it by massage for some time. The following; other alterations have been observed in the sole- rotic membrane of the dog : Dermoid of the Cornea. We occasionally find a peculiar abnormal collection of true membranous tissue on the cornea which is covered with hair and interferes with the direct action of light, and also produces irritation in the cornea and conjunctiva. The hair should be cut off by means of scissors. Thierry observed the same abnormality on the sclerotic membrane of both eyes in a three- months-old dog. There was a slight swelling and enlargement above the surface of the membrane, which was covered with fine hair. This trichiasis bulbus was removed with the scissors. Pterygium. By this we mean a malformation of the connective tissues containing bloodvessels and branching over the cornea toward the centre. This growth can be removed by means of caustics or by an operation. Injuries to the Cornea. It is not uncommon to observe injuries to the sclerotic membrane of dogs where the epithelium is removed slightly, or where they may have a deep penetration of the mem- brane, and in such cases, such as injuries from cats' claws, it is entirely perforated. Immediately after the injury we observe a great fear of light, closing of the eye, and copious tears. Wounds which have not entirely perforated the sclerotic membrane are rapidly followed by an opacity and swelling in the neighborhood of the injury. When the membrane is perforated the symptoms and results are very similar to ulceration. Superficial and very small wounds which penetrate deeply heal very quickly after a few days, leaving scarcely any opacity. This, of course, must be expected in wounds that have been caused by some object that was clean, while septic large wounds, caused by some unclean object, CATARACT. 365 frequently produce great irritation, and penetrating ulceration results, ending in panophthalmia and destruction of the eye. The therapeutic treatment of wounds of the sclerotic membrane is identical with that of ulcers. DISEASES OP THE CRYSTALLINE LENS. Cataract. All diseases of the lens, either of its substance or of its capsule, as a rule, cause a certain amount of opacity, and may form one or more star-like gray bodies in the centre of the lens itself (cata- ract). It is not possible to enter into a description of the various forms of cataract and its pathological alterations, but we will only take up one form (gray) of cataract that can be subdivided into two forms — soft, which may be congenital; or traumatic and hard or contracted cataract, which is senile. The softening process generally begins in the equator of the lens, and becoming diffused soon causes a total opacity of light gray color. This may be streaked with darker lines or it may have a mother-of-pearl discoloration, with enlargement or distortion of the lens and a contraction of the anterior chamber. This is very often seen in young animals. The contracting process, on the contrary, begins in the shape of a num- ber of small whitish striae, or dull opacities, in the peripheric layers of the lenticular nucleus, and extend gradually over the cortical, giving the lens a yellowish- white or yellow aspect after some time. This is generally observed in old dogs (hard nuclear cataract, senile cataract). The so-called capsular cataract does not, as a rule, de- pend on true opacity of the capsule, but on an accumulation of products of the same, which have been developed from disease- processes which have gone on in its immediate neighborhood. For instance, in inflammation of the iris. In some cases they appear in small, star-like or streaked pigmented dull spots, which are distinctly marked. Etiology. Gray cataract, as a rule, is a senile or old-age affection, but it appears quite frequently in young dogs, and now and then it is congenital. The author saw one case of hereditary star cataract in connection with microphthalmus. The develop- ment of cataract which occurs in advanced age — that is to say, 366 DISEASES OF THE EYES. after ten or twelve years — is what is known as senile cataract; this is slow in its development, while cases of opacity of the lens, which are observed in young animals, appear frequently without any marked cause. Haltenhoff was able to recognize traces of sugar in the urine of a dog which became very thin and anaemic in a short time, and developed cataract. The author has tested the urine of many dogs affected by blindness caused by cataract, but has never been able to find any sugar. Inflammatory Process of the Eye. There is no doubt that cataract is also caused by inflammatory processes of the eye, and the nutritive supply of the lens becomes disturbed and its normal condition impaired, such as ulcerations of the cornea with central perforation, inflammation of the membrane of the veins and iris, and also bleeding into the anterior chamber. Injuries of the lens and concussions of the eye also cause a number of cases of cataract. Certain conditions are developed as the result of concussion of the eye and appear quite frequently; they may be thus briefly described : The lens either sinks downward with the capsule or becomes laterally displaced. It may lean against the iris or it may drop forward into the anterior chamber of the eye, and it may finally crowd into the vitreous humor. If the lens has undergone but slight displacement (subluxation), it may remain clear for some time, but the vision is much impaired. If it has fallea into the anterior chamber or has been forced into the vitreous humor, we see a rapid development of the cataract, and in the later stages considerable inflammation of the choroid membrane, of the iris, or of the whole eyeball. Clinical Symptoms. In cases where the disease is somewhat advanced, and the cataract is fully developed into one of the fol- lowing forms : punctiform, streaked, spotted, or complete opacity of a whitish-blue, brownish-blue, or mother-of-pearl color, it is easily recognized ; but, on the other hand, where there is a mere cloudy dimness and small spots of cataract, we must use candle- light or some illuminating power such as an ophthalmoscope and a strong light to see the action of the lens in the eye itself. Before doing so, however, we must dilate the pupil with atropia. The prognosis is rather difficult to make, and, as a rule, it CATARACT. 367 should be an unfavorable one. Hereditary cataract shows little inclination to enlargement, as is also the case in senile cataract. In soft cortical cataracts we may see a rapid opacity of the lens in a few days or weeks. The sight is entirely lost and medical treat- ment is of little use. Therapeutic Treatment. A cataract may be removed by an operation, and this is much more advisable in the dog because it is, as a rule, attended without any great danger, and its results are generally beneficial, producing a partial restoration of the vision. It is advisable to perform the operation of cataract after having first dilated the pupil by means of atropia, and then performing the operation under ether. The author has tried cocaine alone, but he finds it unsatisfactory. The animal must be tied up, placed on a table, and ether or chloroform administered. The operation is performed by one of the following methods : Opening- of the Capsule. The anterior capsule of the lens has to be opened in a transverse way with what is known as a dis- cission needle. (Fig. 80, a.) The fluid in the anterior chamber causes a gradual breaking up and reabsorption of the lens. An assistant holds the eyelids open and the operator seizes a fold of the conjunc- tiva with a small tenaculum, holding the eye firmly with the left hand, while hold- ing the needle in the right hand placed on the animal's head to steady it. The needle is then introduced into the cornea, in the middle of the lower external quad- rant, in such a direction as to meet the ciliary insertion of the iris and as far as the upper internal quadrant. Before the point of the needle has reached this latter point, however, it is placed firmly on the capsule of the lens, and this is cut through in a transverse direction with a lever-like movement of the needle (Fig. 81). The instrument must then be removed in the same way that it was introduced in perforating the cornea. After the operation the animal must be placed for some time in a dark place and o, stop discission needle ; b, Graefe's cataract knife ; c, Daviel's cataract spoon. 368 DISEASES OF THE EYES. the eye treated twice a day with atropine. We must treat all irri- tating symptoms of the eye by means of cold compresses, and some- times we use purgatives. After six or eight weeks the reabsorption of the lens is complete. We generally perform discission in young Fig. 81. , Discission of the lens ; a, form and size of the cross-incisions ; 6, method of insertion of the needle. animals affected with soft cataract. The result of this operation, however, is not always satisfactory, as reabsorption is slow and in many cases requires a second operation. Several months may also elapse before the cataract is absorbed. Schlampp advises in such cases puncturing the cornea, and by this means allowing the fluid of the anterior chamber to escape, leaving the lens untouched. Anterior displacement of the lens enlarges or ruptures the opening which has been made in the capsule. Reabsorption follows, as a rule, more quickly when this is performed, probably due to the fact that the fluid which contains the elements of the lens has been discharged and replaced by fresh fluid. The process is not danger- ous, and may be repeated oftener than discission itself. Linear Extraction. After having prepared the dog for this operation (indicated on page 367), we fix the membrana nictitans by means of a pair of forceps. AVith another forceps we seize the conjunctiva of the eyeball in the neighborhood of the median line of the eyeball, at the same time everting the upper eyelid. We then make an incision by means of Graefe's cataract knife (Fig. 80, b), about 5 mm. broad, through the cornea, about 2 or 3 mm. from the border of the sclerotic membrane. We then pass a dis- cission needle through the wound, split the anterior capsule, as CATARACT. 369 in discission, and empty the soft parts of the cataract by means of Daviel's spoon (Fig. 80, c). Any remnants of the cut capsule which may not be removed at the time are left to be reabsorbed. If during the operation we observe prolapsus of the iris, we must try to restore it to its position by means of Daviel's spoon (Fig. 80, c). If this is not possible, we may cut it off close to the wound of the cornea. It is very evident that linear extraction is only to be performed in cases of complete softening of the lens. This may be recog- nized by total opacity of the lens and alteration of the iris, and also when the anterior capsule is pushed toward the cornea. Lobular Extraction. Lobular extraction is indicated in shrunken cataract, which is generally senile, where the lens has prolapsed into the anterior chamber and where discission will only produce an imperfect result — that is to say, where reabsorption of the lens does not progress properly. It is performed in the fol- lowing; manner : Make an incision into the cornea exactly as in linear extraction, by means of Graefe's cataract knife, but it must be enlarged tO' 8 or 10 mm. After that the capsule of the lens is split by the discission needle, the fluid of the anterior chamber is allowed to escape, and at the same time the lens must be detached by means of an even, but not too energetic, pressure upon the other side of the eye from the wound, and by means of the spoon the lens is scooped out of the opening. The consecutive treatment is the same as in linear extraction. Dislocation of the Cataract. This operation, which has been abandoned lately on account of the impairment of the choroid membrane and retina, was performed in the following manner: By means of a bent or straight needle pushed through the scle- rotic membrane, and at other times through the cornea, steady pressure was made on the upper part of the lens, and it was pushed down into the lower posterior part of the vitreous chamber of the eye. 24 370 DISEASES OF THE EYES. DISEASES OP THE SCLEROTIC MEMBRANE, OP THE NERVOUS PORTION OP THE EYE, AND ALSO THE VITREOUS HUMOR OP THE POSTERIOR CHAMBER. These diseases are generally not of any great importance com- pared with the diseases before described, and therefore we will not go into minute details. (1) Inflammation of the Iris (Iritis). This affection is very rare in the dog (Moller). It may be recognized by contraction and difficulty of movement of the iris, change in the color of the iris, fibrous accumulations in the shape of a gray veil-like coating, and dulness of the fluid of the anterior chamber, and slight dimness of the cornea. The cure for this disease consists in complete rest, keeping the animal in a dark place, and solutions of cocaine and atropine. (2) Purulent Inflammation of the Eye (Panophthalmitis). This is produced by serious concussion of the eye itself. It may also be due to septic wounds of the cornea and sclerotic mem- brane, as well as to the large perforating ulcers of the cornea. We recognize the following acute symptoms: The eyelids are constantly closed ; great redness of the con- junctiva; total opacity of the cornea; purulent accumulations in the anterior chamber of the eye; myosis; great hardness and enlarge- ment of the bulbus. After a short time we may have perforation through the cornea, and, in rare cases, through the sclerotic mem- brane. The lens and vitreous humor are ejected through the opening with the purulent mass; the eyeball collapses, becomes contracted, and forms a knob-shaped mass in the eye; the lids com- pletely collapse and form a hollow in the face. The only, thing to do in such a case is to perform enucleation, or removal of the eye. Enucleation. Removal of the eyeball should be performed under a narcotic or ether. We pull out the eyeball by means of a tenaculum, cut through the conjunctiva with a pair of small, pointed scissors closely behind the cornea, snipping the scissors around the eye, keeping as close to the bulb of the eye as possible, and by this means separate the muscles and cut through the optic nerve. The author thinks it is advisable to remove the membrana nictitans at the same time (Fig. 82). DISEASES OF OPTIC NERVE AND RETINA. 371 After enucleation, the cavity of the eye is washed out with an anti- septic fluid and the bleeding stopped by means of a tampon ; it should be powdered with iodoform or sulphonal. Moller advises to pack the orbit Fig. 82. Muscles of the left eye : a, superior ; b, external ; c, inferior straight muscles of the eye ; 1, eyeball ; 2, orbital arch cut through. with absorbent cotton and stitch the eyelids. Dogs are not badly dis- figured by the loss of one eye, as the orbit becomes contracted and partially filled with granulations. It is not advisable to use artificial eyes, as the animal generally rubs them out. (3) Dropsy of the Anterior Chamber [Glaucoma). Moller has observed this a uiimber of times in the dog. The anterior cham- ber is very much enlarged, hard, and tense, so much so that the eyelids cannot be closed. The bloodvessels of the conjunctiva and the sclerotic membrane are injected, the cornea more or less opaque, the pupil much contracted and greenish in color. The animal cannot see. On post-mortem of one case Moller found total cataract and a partial luxation of the lens, liquefaction of the vitreous humor of the eye, swelling of the papilla, and injec- tion of the vessels of the retina. He was inclined to consider this condition as identical with glaucoma in man. A number of authors have seen similar conditions in dogs. (4) Diseases of the Optic Nerve and the Retina. These occur very frequently in the dog, and may be recognized at first by symptoms of what is known as " black cataract " — that is, impair- ment of visual power (amblyopia), or complete blindness (amau- rosis). Total blindness in the dog may be recognized by anyone, 372 DISEASES OF THE EYES. although it is difficult to detect blindness in one eye. The veter- inarian may recognize blindness by the unaltered condition of the pupil when in contact with or close to light. It is necessary to cover up one eye of the animal in order to test the other, as the influence of light may act in a reflex way from the healthy organ. We must especially point out that in very rare cases we may see a certain amount of reaction in the pupil under the influence of light, notwithstanding the fact that complete blindness exists. The author has observed this in a dog which had become blind from nervous distemper. Later symptoms, however, are not known; the author was unable to make any further observations. The brain of the animal had, however, probably undergone cer- tain alterations in its hemispheres, although the patient did not seem to be affected with any cerebral complications. This is one of the so-called cases of '^ spiritual blindness." Moller and Eversbusch have recognized pathological alterations in the visual nerve and retina in the form of small red spots and opacity of the retina (symptoms of retinitis), also a lifting or enlargement of the papilla. The author had two cases in which he observed papillo-retinitis from its beginning till it entirely dis- appeared. All these processes may be recognized by means of the ophthalmoscope. For therapeutic treatment of inflammation of the eye, which is not given in this chapter, we refer you to the text-books on oph- thalmology. It consists, as a rule, in rest, keeping the animal in the dark, the use of atropine or eserine, and an occasional laxative. Prolapse of the Eyeball. (^Exophthalmus ; Prolapsus Bulbi OculL) There are a number of causes that produce prolapse of the eye- ball; it may be crowded out of the cavity of the eye, or exposed in its external circumference by the swollen and distended eyelids which are closely adherent to its posterior surface. This condi- tion occurs especially in bulldogs, although it may occur in any breed. The dog does not possess any bony arch of the eye (zygomaticus), the space being filled up by a ligament, and the muscles are also very weak. Occasionally, from any mechanical force, such as blows in the region of the eye, or bites in its PROLAPSE OF THE EYEBALL. 373 neighborhood causing hemorrhage and a large amount of blood to collect in the posterior part of the orbit, it is pushed out of posi- tion; frequently the entire eyeball is crowded out, standing out on the face clear of the orbit (Hertwig). This condition has also been noticed in very rare instances to be due to inflammatory pro- cesses inside the eye, and by the formation of tumors in the orbits. The prognosis of a prolapsed eyeball depends largely upon the circumstances and condition of the organ. If the prolapse is of recent origin, if the muscles of the eye and optic nerve are not torn, and if the eye itself has not been very much injured, we may expect complete recovery in a short time without any disturb- ance of sight. If the prolapse is recent and the muscles are not torn, or only partially so, but abnormally distended, we must expect there is some irritation of the optic nerve, and while the eye may be restored the animal may remain blind. If the muscles of the eye and optic nerve are lacerated and the eye proper is injured, or if any of the chambers of the eye are filled with blood, or if the prolapse has been sufficiently long that the irritating influence of the air is marked by an opacity and a dry look of the cornea, which has a horny appearance, the eye must be considered as lost. The therapeutic treatment consists in returning the eyeball as soon as possible, especially when the organ appears to be in such a condition as would encourage you to think it can be saved; but if otherwise, it must be removed as soon as possible. We try to return the eye to its position in the following manner : First clean it thoroughly by means of an antiseptic that is not irritating, such as a 2 per cent, solution of boric acid or a 1 to 2000 solution of corrosive sublimate. Place the flat of the hand or the points of the fingers on the eyeball, at the same time an assistant distending the eyelids as much as possible, and by gentle pressure endeavor to push the eye back into the orbital cavity. If it is impossible to return it by this means, the fissure of the eye must be distended by making a small incision in the external corner, or the anterior chamber of the eye may be perforated by means of a cataract-needle or pointed bistoury, so as to empty the eye to a certain extent and thus allow it to return to the chamber. After returning the eye we must try to prevent another prolapse by placing a bandage over the eye, taking care not to compress it too much. If the animal will not allow it to remain, we must 374 DISEASES OF THE EYES. join the fissure of the eye by one or two stitches. Hertwig says that after stitching the eye we generally see great inflammation of the lids and the eye itself, but the author has found that these bad effects may be easily prevented by taking care not to carry the stitch through the entire lid, but only through the external mem- brane. At the same time it is advisable to keep the animal with- out food for at least twenty-four hours, as the use of the jaw, and especially the pressure of the prolongation of the crown of the inferior maxillary, may push the injured eye out of position. Cold applications are useful if the eyeball cannot be saved, or if reduc- tion is impracticable for some reason or other, on account of tumors in the orbit, etc., there is nothing left to do but enucleate the eyeball. (See page 37.) DISEASES OP THE EAR. Serous Cyst. [Oihcematoma ; Hcematoma.) By this term we mean a blood or lymphatic excretion lying between the skin and cartilage of the ear, and forming a tumor in the external or internal part of the lobe. It generally occurs on the inside. This swelling is fluctuating, and when the skin of the animal is white it may have a bluish coloration. Etiology. This condition is probably due to some irritation or traumatic cause — for instance, by striking the ear against the collar or muzzle, pulling the ear, concussions, and injuries through biting. It is always seen in the lobe of the ear. If the sac is not emptied, after a few weeks the secretion is reabsorbed and it may leave quite a thickening and even malformation of the exter- nal ear. In some cases when the fluid suppurates it makes a perforation of the skin internally; this, however, is very rare. Clinical Symptoms and Prognosis. The swelling, as a rule, is on the internal part of the ear. The lobe, which generally hangs downward, is pushed upward in a peculiar manner. The swelling is hard, and in white animals it has a blue color. It is very sensitive to pressure and shows distinct fluctuation. The animal carries its head in an oblique manner, the affected ear being held downward, and the fact that it gives the dog more or less pain is indicated by the careful way that the animal shakes its head or scratches its ear. The prognosis is favorable provided proper treatment is applied, although it may take some time before they are entirely cured. In many cases where no dressing is applied, we may have as a sequence a slight thickening of the lobe of the ear. This, how- ever, is of very little importance. Therapeutic Treatment. The methods of treatment which the author considers advisable are as follows: 1 . We perforate the swelling with a large-sized hypodermatic (375) 376 DISEASES OF THE EAR. Fig. 83. syringe or aspirator. The secretion is then removed and a soUition of iodoform and ether (10 to 20 per cent, of iodoform) is injected. The needle must remain in the cavity for some time in order to allow the vapor of ether to escape. We then apply a compressing dressing in the following manner : The ear is turned up and laid on the top of the head and cov- ered with antiseptic wadding on both surfaces. It is then held in position by means of an ear-cap (Fig. 83). This dressing must not be displaced, but allowed to remain for eight days. [Hobday has recently intro- duced a very practical method of treatment for this condition. He carefully removes the hair from the ear anid renders it aseptic, and either paints the ear with cocaine or administers chloroform (the translator prefers ether). A longitudinal incision is made into the sac and it is completely emptied ; sutures are then inserted, about one-third of an inch apart, directly through the ear and tied on the outer or hairy side, thus producing a firm pressure between the two surfaces of the sac and by that means get prompt union; the ear must then be irrigated with an antiseptic solution, carefully removing all blood, etc., and dressed with antiseptic wadding, and further covered with an ear- cap. It should be dressed every second day.] 2. The second method is to be resorted to if the first does not answer the requirements, or if we find pus in the swelling. The swelling is opened at both ends — that is to say, at the base and inferior line of the lobe — and a drainage-tube placed in it, which must be kept in place by means of a tape or rubber fasten- ing. The irritation caused by this seton is generally sufficient, and it is not necessary to inject any stimulating liquid like tinc- ture of cantharides or nitrate of silver, but simply remove the seton twice daily, cleaning out the cavity and disinfecting it by means of antiseptic irrigations. After a certain time we replace the drainage-tube by a smaller one, and finally we remove it altogether. EXTERNAL CANKER. 377 3. The third method, which is generally the most successful, provided it is performed uuder antiseptic rules, is as follows : Shave and thoroughly disinfect the lobe. A long incision in a louofitudinal direction of the ear must be made, aud the clots and remains of tissue removed. The cartilage must be scraped carefully, so that we see a fresh wound surface. Sew it up with catgut ligatures, keeping as close as possible to the cartilaginous surface. Place the drainage-tube in the ear, turn the ear up on the top of the head and dress it with antiseptic cotton. Examine the dressing every day to be certain that it is in its proper place. This, as a rale, cures the wound entirely in from three to six days, provided that the antiseptic rules are followed very carefully; but it is generally advisable to leave the dressing stay on from eight to ten days, as the union between the two surfaces is not strong enough to stand the energetic shaking of the head which every dog does for some time after the removal of an ear bandage which has been on for several days. External Canker. By this we mean a purulent or ulcerative process on the edge of the external ear. This, however, is not confined to the edge, but may spread over different parts of the lobe. Etiology. The chief causes of this trouble are injuries and lacerations of the skin. Dogs are liable to scratch or shake the ears violently against the muzzle or collar, producing an inflam- mation. It may also be developed from the ear itself, as in cuta- neous inflammations of the external auditory passages. We may also see this as a result of wounds or lacerations of the ear caused by bites of other dogs, which from neglect or improper treatment become ulcerated, and do not heal readily on account of constant shaking of the ear. This affection is almost entirely confined to animals with long ears. Clinical Symptoms. The animals hold their heads to one side, shaking the ear frequently, sometimes keeping it up so long that the ulcerated surface bleeds and the blood is thrown iu all di- rections. They attempt to scratch the affected ear with their paws, and are very sensitive about having them touched. On making an examination we find at the edge of the external ear, generally its extreme end, an ulcer or a number of them which are covered 378 DISEASES OF THE EAR. with a blackish loose scab with turned-up edges, and the tissues of the immediate neighborhood are cedematous. Therapeutic Treatment. There is no doubt that the quickest results may be obtained by cutting off a portion of the diseased lobe of the ear; this, however, disfigures the animal very much. This is the easiest method of cure, and the operation is generally performed on animals under the influence of ether. First remove the hair and thoroughly disinfect the parts, and cut off a circular piece from the ear that will include the torn portion, being careful not to remove any more of the lobe than is actually necessary. Another method is to cutout of the edges of the slit ear a thin section about one-eighth of an inch in thickness, so as to insure two raw fresh surfaces; the two edges of the wound must then be drawn together by means of sutures; these should not be inserted too close to the edge of the wound, as they are apt to tear through. The stitched line is then powdered with iodo- form or sulphonal. The external ear is covered with wadding, turned over the top of the head, and held in position by means of a bandage, as indicated on page 376 (Fig. 83). If the animal is one that you cannot see and dress the part every day, instead of sewing the wound after the lobe has been cut, touch it up by means of the thermo-cautery, and by means of the consequent cicatricial contraction draw the edges together. Hoffmann deviates from the above-described method, which was practised by Siedamgrotzky, by using cocaine and cutting a three- cornered piece out of the external integument, then stitching it together without any attempt to control the hemorrhage. The author has been able to obtain satisfactory results in slight cases of external ear-canker by covering the ulcer with oxide of mer- cury and tying the ear up. On the other hand, he was much dis-' appointed by caustics, such as acids, nitrate of silver, and corrosive sublimate, as they gave only negative results. Inflammation of the External Ear — Internal Canker. (^Otitis Externa.) This consists of an iuflammatory irritation of the external canal of the ear. It is generally of an eczematous nature and appears in a diffuse form, extending over a larger part of the lining of the ear. It is accompanied by redness, swelling of the membrane. INFLAMMATION OF THE EXTERNAL EAR. 379 Fig. 84. and an exudation of a serous and, later, a purulent secretion, in the chronic course. We may also have the formation of abscesses and contraction of the meatus (caused by thickening of the cutis, by granulations, and by polypous malformations). Although we may have acute inflammation of the canal extending deep into the lining, it is very rare that the tympanic membrane becomes ulcer- ated and perforated. Etiology. The causes are similar to those mentioned under eczema. It is due to an accumulation of cerumen, dirt, and cuta- neous scabs. It is also recognized that otitis is produced by acari. (See Parasitic Otitis, page 381.) Hoffmann states that he has observed serious suppuration in cases where dogs' ears have been clipped too close to the head. Clixical Symptoms and Prognosis. The animals shake their head, and, as the disease is almost invariably located in one ear only, they hold their head in an oblique position, trying to scratch the head against the base of the ear or to rub it against some object. They avoid carefully any attempt which is made to touch the ear, and show great pain when the tube of a concha is touched. In examining the external ear we use a forceps- shaped speculum or ear-mirror (Fig. 84). If we distend the canal, we generally find it filled with a fetid, grayish-green, or reddish liquid consist- ing of glandular secretions, fungi, cutaneous scabs, pus, acari, etc. After the organ is cleaned out we find an intensely red, swollen, sometimes ulcerating surface of the skin. In advanced cases the meatus is almost entirely closed by thickening of the cutis. Numerous granulations appear quickly, and in some cases where both ears are affected we may have symptoms of impaired hearing or deafness. According to Hoff- mann, in deep suppurating conditions we hear a characteristic smacking or sucking liquid sound, which is produced by side pressure or rapid compression on the base of the ear. The general condition is very seldom affected. Vomiting is only observed in exceptional cases. Vertigo, spasms, and epilep- tiform symptoms sometimes follow where acari are present in enormous numbers. Kramer's ear speculum. 380 DISEASES OF THE EAR. Fig. 85. Therapeutic Treatment. The treatment which corre- sponds with that of eczema is generally followed. We must thoroughly clean the external ear. This is best performed by a syringe fitted Math an acorn-shaped point so as to prevent injuring the ear (Fig. 85) [the translator finds the best ear syringe is one made entirely of soft rubber with a long flexible point that can be pushed into the meatus without any great danger of injuring the canal; the flexible point adapts itself to the turns of the canal], and by using applications of warm water injected into the meatus. The duct is then dried with absorbent cotton introduced into the ear on the end of a small jmir of forceps. As the meatus is elongated, narrow, and slightly curved, there is not much danger of injuring the tympanic membrane. In very slight affections of this character, which may be recognized by a slight redness of the membrane, itch- ing, and the presence of a certain amount of fluid, it is only necessary to clean the meatus several times, using solutions of lead-water, phosphate of lime, acetate of zinc, etc. The author has found that simply powder- ing with lycopodium, amylum or talcum, filling up the ear, is much preferable to any of the above-mentioned liquids. [The translator generally avoids syringing in mild cases. It causes a great deal of irritation, exciting the animal un- duly. He generally cleans the ear with wood alcohol, filling in the cavity and working the alcohol into the canal by manipulation of the base of the ear. It is then to be dried thoroughly with absorbent cotton until all trace of browai coloration, characteristic of this condition, is removed. He then fills up the ear with powdered boric acid, working it thoroughly into the canal, and covering all the inflamed portions. This should be repeated every third day until the irritation is lessened, and then once a week. With this treatment he also prescribes a laxative, such as cascara sagrada. If there is eczema present, he adds to the treatment two dro])s of Donovan's solution, morning and evening.] In serious diseased conditions where there is much ulceration, we may treat them in two different ways: By syringing the ear with solutions of disinfecting and astrin- Ear syringe. PARASITIC CANKER OF THE EAR. 381 gent agents, such as salol in alcohol (1 to 40), tannin in glycerin (1 to 30), nitrate of silver (1 to 100), carbolic acid in glycerin (1 to 10). This must be' repeated several times, and we may also dry up the secretion by means of oxide of zinc or boric acid. Hoff- mann advises us to use subnitrate of bismuth or sulphate of cop- per in starch. Immiuger uses a 3 per cent, aqueous solution of chromic acid in auricular catarrh, cleans the ear with tepid water, and drops ten to twenty drops of the solution into the ear, and then massages the base for several minutes; this he repeats every second day. As a rule, the general treatment with powders is preferable to that Avith liquids, but the latter must be used when the meatus is much contracted and the ulcers located deeply. An ear-cap is only necessary when the animal is constantly shaking its head and the organ is very sensitive. We remove the numer- ous granular accumulations by means of nitrate of silver. If there are polypous enlargements, they may be touched with a thermo-cautery. Hoffmann states that in a very obstinate case he excised the entire lower region of the meatus, introduced a drainage-tube, and treated the wound with disinfecting powder. External otitis may sometimes produce either partial or entire deafness. Both of these conditions are due to the entire closure of the external auditory canal, either by swelling and filling up with granulations or by polypous formations, etc., and more rarely by extension of the inflammatory process in the middle ear, destroy- ing the tympanic membrane. Of course, any disturbance of the sense of hearing or entire deafness which comes from old age or is hereditary will not show any of the symptoms already described. When a dog is getting deaf he changes his manner very much: he seems strange, does not answer to the call of his master. As a general rule, there is very little result from treatment. We have a contraction of the external meatus, and may try to dilate it by means of the introduction into the canal of cylindrical compressed tampon sponges. [Parasitic Canker of the Ear. {Parasiiie Otitis.) The symbiotes auricularis (canis) is a parasite that inhabits the ear of the dog, causing an aggravated form of canker (Nocard and 382 DISEASES OF THE EAR. Sewell). The parasite which is common to the dog and cat is said to produce a peculiar form of vertigo. The parasite differs from the common symbiot by the absence of abdominal lobes in the male, which are represented by a notch which has three bristles; the pubescent female has four pairs of legs which are simple knobs. The male is 30 mm. long and 23 mm. wide, and the female is 42 mm. long and 29 mm. wide (Neu- mann). Hering found this parasite in an ulcer of the ear which was accompanied by a deep-seated otitis. Nocard describes minutely cer- tain epile]3tiform fits in which the dog has a peculiar husky cry and rushes about violently, running into various obstacles, and finally falls insensible, and after a number of such attacks becomes totally deaf. Sewell describes the condition as finding a collection of brown or sooty-colored cerumen in the ear, or as looking dirty. If the inside of the ear is examined closely a number of tiny white specks, the size of the eye of a needle, are seen to be rapidly moving about the ear, and he believes that the tickling sensation caused by these movements and the biting of the parasite are what produce the irritation of the lining membranes of the ear. Symptoms. The ear is hot and slightly swollen, and on exam- ination it is hardly distinguishable from ordinary otitis ; there is, however, less discharge in this condition; the head is carried to one side, and the animal will scratch the base of the ear very gently with its paw and whine in a plaintive way. The translator has observed a number of animals infected with the parasite, and is inclined to think that the carrying of the head on one side and the gentle scratching of the ear are characteristic of the disease, although it is quite frequently seen in non-parasitic otitis. He has never observed the epileptiform symptoms described by Nocard, although he has made numerous examinations of animals that have presented similar symptoms. Treatment. Nocard recommends naphthol 1 part, ether sulph. 3 parts, and olive oil 10 parts. This should be injected into the external auditory canal once daily, and the ear plugged up with cotton to prevent the escape of the ether. The translator does not think the latter procedure advisable, for if the ether is confined in the ear it causes great irritation, and has found from experience where he has followed this procedure that while he may PARASITIC CANKER OF THE EAR. 383 not have observed epileptiform fits before the treatment, he has had symptoms simulating them very much after the ear was in- jected with ether and the cotton plug put into it. Sewell advises the application of the following liniment: H. — Ung. hydrarg. nit. ...... 4.0 Oleum amygd 32.0 M. S. — Apply a small amount to the inner surface of the ear with a camel's-hair pencil. The translator thinks it advisable to first clean the ear out with wood alcohol, and then inject the above.] DISEASES OP THE SKIN. INFLAMMATORY CONDITIONS OP THE CUTANEOUS MEMBRANE. Inflammatory symptoms of the skin vary according to their intensity, character, or location. Tiie slightest irritation may pro- duce redness, either with or without swelling — this is defined as erythematous inflammati9n; or we may have a formation of circum- scribed, solid, firm protuberances, papillse, fistules, boils, or gran- ulations. These are ascribed to exudations originating partially in the papillary body, in the Malpighian membrane, and also in the neighborhood of the follicles. The inflammatory exudation may become reabsorbed in certain cases, so that after the acute period of the disease has passed the epidermis, which has become loosened, is gradually desquamated in the form of scabs or crusts. We also occasionally see a dark pig- mentation after the disease has run its course. This originates from the haemoglobin of the extravasated red blood-corpuscles. If the inflammatory processes and exudations increase gradually in the cutaneous tissue, we may observe two different results. The inflamed location may become covered with a moist, liquid exudation, or the horny layer of the epidermis is raised up by the fluid, and we may have vesicles which raise the granular layer of the mucous strata, and also the deeper layer of the membrane becomes destroyed in the affected region. In the first case it is covered by the deep layers of the membrane; in the latter case the upper surface of the corium is exposed, having lost its vesicu- lar covering. The liquid which fills the small or large vesicles is deficient in cells in the early stages of its formation, and the liquid is clear or slightly yellow. Later it becomes turbid by the addition of leucocytes, and a number of whitish-yellow cells fill the fluid. In some cases it has this appearance from the very onset. When the liquid contained in the vesicle is yellow and filled with cells it is called a pustule. Sooner or later the covering of the pustules (384) IXFLA3IMAT0BY CONDITIONS OF THE SKIN. 385 becomes ruptured, aud the fluid dries up in a yellow, gray, or brown crust, under which the regeneration of the lost epidermic layer goes on rapidly. Now and then the inflammatory process shows it is in the neigh- borhood of a follicle and its sebaceous glands, and we have the formation of a dark -red, very sensitiv^e nodule, and finally suppu- ration of the same membrane and its adjacent tissues. As a con- sequence of that we find that the glands and canal of exit are filled with purulent or bloody matter. Soon the internal follicles become involved; the masses of matter can be easily pressed out of the orifice of the follicle, and we may have an elasticity of the purulent cavity surrounded by infiltrated cutis in which we find the hair has become entirely detached from the follicle and falls out. This condition is generally a rather serious affection in the dog, as in this animal there are always several follicles which are accumulated into one group with a common orifice, and in every case of cutaneous disease we find a group of affected sebaceous glands. In very bad cases peri-glandular and peri-follicular inflamma- tion may become so acute that we see the formation of an extended, nodule-shaped, dark-red swelling, forming a so-called " boil.'^ This is marked after a certain period by a yellowish-green, necrotic thrombus, which becomes detached by purulent disintegration of the surrounding tissue, and is sloughed after the pus has been dis- charged. In such cases we find that not only is the external sur- face of the skin impaired, but the corium is affected, and as the follicles are destroyed the hair does not return. The formation of abscesses and ulcerations, also inflammations of the skin, will be discussed further on. In chronic cutaneous inflammation we may see the formation of hypertrophic as well as atrophic conditions. In the former case we find as a consequence of the constant increase and congestion of blood to the part the formation of superfluous connective tis- sue, whereby the skin may be thickened several times its normal size, and may form large folds or callosities, and in rare cases club-shaped or warty elevations; in the latter case the corium becomes thinner. This is also the case with the epidermis. Its tissue is either greatly reduced or greatly increased in size, and in the latter case the epidermic cells which proceed from the deep 25 386 DISEASES OF THE SKIN. part of the tissues do not undergo any horny degeneration, but rather a drying, mummifying process, covering the membrane in the shape of numerous whitish, or white-gray scabs. We recognize the following inflammatory conditions : Erythema. Erythema is the mildest form of inflammation of the cutaneous membrane, and consists either of normal hyperemia of the corium in its upper layers (erythema simplex), or it may be due to a slight sero-cellular infiltration of the membrane of Malpighi (dermatitis erythematosa). Etiology. Erythema originates as the result of various cuta- neous irritations which may be mechanical, chemical, or thermic — for instance, by friction of the collar upon the skin, by rubbing together two cutaneous surfaces, by ether, oils, chloroform, tar preparations applied to the skin, bites of insects, by ammoniacal urine (in catarrh of the bladder), and by slight burning or freezing. Erythema may also appear in connection with various cutaneous diseases, such as eczema, scab, and canine varioloid. Clinical, Symptoms and Course. The symptoms consist of a bright arterial redness of the cutaneous membrane, which disap- pears under pressure of the finger, but reappears immediately after, and may be complicated by slight swelling in a few cases. As a rule, the affected portion is reddened, but not irritable. The course is usually short, depending to a large extent on the cause. When this is suppressed erythema disappears, especially after the itching and rubbing have discontinued, and in certain conditions by con- secutive desquamation of the upper membrane. There is, how- ever, a more or less dark-red spot left after the acute symptoms of the disease have lessened. These finally disappear, but very slowly. Therapeutic Treatment. There is not, as a rule, any great irritation. It will be sufficient to remove the cause in order to remove the erythema. If there is a certain amount of irritation, we must lessen it by bathing the animal with cold water and sponging the parts with any of the following solutions: lead- water, ichthyol, or salicylic acid, soap, rubbing with salicylic oil (1 part of salicylic oil dissolved in 35 to 40 parts of olive oil and ECZEMA. 387 heated slightly), or a mixture of 1 part of glycerin and 5 of water; 1 part of carbolic acid, 10 of alcohol, 10 of water; 4 parts of creolin, 100 of water; 1 part of ichthyol, 10 of glycerin, 30 of water ; 10 parts of nitrate of silver, 100 of water (Friedberger). In very obstinate cases we may also use laxatives or purgatives (aloe, jalaj), salines, etc.), also the internal administration of arsenic in the form of Fowler's or Donovan's solution. Urticaria. (Nettlerash.) Nettlerash was only seen in three cases by the author. The subjects were all small, well-fed, middle-aged dogs, which were covered over the entire body with circumspect, flat, beet-like eleva- tions, about one and one-half inch in diameter, only slightly red, and which had originated spontaneously. They were rapidly lessened by the administration of purgatives. Eczema. (Red Ilange.) By this we mean an inflammatory condition of the cutaneous membrane indicated by redness, swelling, nodules, pustules, vesi- cles, scabs, and crusts, which are generally accompanied with more or less itching. In the first stages development of a hyper- semia is seen, thus reddening the skin superficially, and accom- panied by a serous exudation. If the inflammatory irritation stops, or if proper therapeutic measures are taken, recovery may occur at once, and we have a more or less prolonged desqua- mation of the epidermis. In the majority of cases, however, the irritation increases and we may have the formation of numerous pale red, tough, itching nodules, accompanied by serous swellings and slight cellular infiltration of the papillae, but generally it is con- nected with the cutaneous follicles. This condition may become retrogressive; the nodules become depressed, forming scabs. In other cases the serous exudation increases constantly inside the papule, and, as a consequence, we have a rising of the horny layer in these locations ; or, in other words, numerous vesicles are formed (eczema vesiculosum). If the horny covering is strong enough 388 DISEASES OF THE SKIN. to resist the accumulated exudation for some time, the contents of the vesicles gradually become milky and pus-like, on account of the entrance of colorless blood-cells into the tissues (eczema pustulosum). In other cases the vesicles burst or are scratched open; the skin is dark red in large blotches, and is marked by fine furrows which correspond with the location of the ruptured vesicles; the eczematous exudation oozes freely out of the upper surface (eczema rubrum). It is a common occurrence to see the detachment of small portions of tissue which are located between the numerous furrows in the epidermis. Thus the whole surface of the eczema is stripped of its horny layer and may become filled with pus. The oozing liquid dries rapidly and becomes a scab or crust (eczema impetiginosum), which is pushed away gradually by the consecu- tive exudation, and finally becomes hard, dry, and firm. Inflam- mation and swelling become gradually lessened under the crust, and we have the formation of a firm epidermic cover, from which the crusts gradually become detached. The diseased membrane, which is now exposed, is not swollen to any great extent, but very red (sometimes marked with dark, livid pigmentations), and covered with numerous loose scabs, which constantly fall off and are re- newed from time to time (eczema squamosum). Etiology. The etiology of eczema is of great importance for establishing the correct prognosis, as no cure can be obtained until after the cause of the trouble is removed. The first thing we must do is to lessen the mechanical irritations, such as appear under the collar and on the testicles. But the lesions which the patient inflicts upon himself are of very much more importance, for we see it in all forms of itching eruptions of the skin, in erythema, in cases of parasites of the cutaneous membrane — flies, lice, acari — in great accumulations of dirt, scabs, and falling out of the hair. We also have the appearance of eczema which extends very fast, and in some cases may go all over the body. As regards the second group of agents which cause eczema, they are chemical irritants, especially those which have an influence upon the tissues, such as acids, alkalies, mixtures of mercury, also tar and carbolic salves, combinations of ether and oil of turpen- tine, of mustard, and also tar-soap. The third group is formed by a number of thermic irritations, ECZEMA. 389 namely, excessively high temperature, but not high enough to produce vesicles. Eczema appears more frequently in summer than in winter, and we have a great deal more difficulty in healing it during the sum- mer weather. We also have a number of eczematous formations for which we can find no cause. In such cases the disease has been ascribed to acids in the blood or diseases of the nervous apparatus, and also to vegetable parasites. Clinical Symptoms and Course. Eczema may appear in any breed of dogs, and in any region of the body without regard to age, sex, etc., but, as a rule, it affects old, well-fed dogs, such as terriers. Great Danes, and setters. It is usually seen on certain regions of the body (back, head, neck, and external surface of the extremities). There are three general forms of eczema without taking into consideration the changes which may be produced by irritation, scratching, or rubbing. The first type is restricted to small, irregularly circumscribed regions, but has a tendency to extend to the neighboring tissues. The eruption begins as eczema papulosum with close nodules. It is rapidly altered into the vesicular layer by change of the nodule, and finally we see the appearance of the median stage. This has a more or less extended surface without skin or hair, and shows a bright red, serous, sero-fibrinous, or purulent exudate, very painful to the touch, and having a great tendency to extend to the adjacent tissues. The stage of crustion follows very slowly. The second type shows from the beginning an inclination to extend. In the early stages we see it as eczema erythematosum with formation of scattered papules. These are scratched open on account of the great itching they cause, or they become altered into pustules. Later we see the appearance of small scabs under which regeneration of the epidermis occurs. In the other regions desquamation of the epidermis follows. The great tendency to scratching in dogs, notwithstanding the very slight alterations of the cutaneous tissue, may lead to what is classified under another form of skin affection called '^ prurigo." We must admit, however, with Friedberger and Frohner, that true prurigo does not exist in the dog, and that all the cases 390 DISEASES OF THE SKIN. mentioned in canine literature were simply modifications of papu- lar eczema. The third stage has a great tendency to become chronic. The skin is quite hot, a symptom which is not generally observed during the first stage of the disease; it is also much thickened and thickly covered with whitish-gray epidermic scabs. If these are removed, the affected region seems very red and shiny; the skin becomes tougher and more inflamed ; the hair becomes erect, breaks off, or falls out to some extent. We see the formation of cracks and fissures, also certain dark pigmentations. A charac- teristic state of this chronic eczema in the dog which may also be developed from the other two forms is that of acute vesicular — that is to say, the moistened scab which forms later may be caused by the slightest irritation, rubbing, tar or carbolic soap, and this disease may reappear each summer, finally becoming chronic, reappearing each spring to dry up the following winter. Theeapeutic Treatment. In the treatment of eczema we must consider the following facts : 1. That we have no specific drug that cures this disease; conse- quently it is very erroneous to treat all its forms with one agent only. 2. That in many cases the tar preparations which have been used almost exclusively are very harmful, as is also the method of systematically washing the animal with strong alkaline or carbolic soaps. The first thing to do is to give attention to the causes and find out from what cause the itching really occurs, as many cases of eczema disappear as soon as the irritation has been suppressed. The following treatment has given good results : (a) We must first remove any cause of itching or irritation in the early stages of eczema erythematosum or eczema madidans. We dust the affected parts with a powder of oxide of zinc, cerussa, sulphur, or thiol mixed with cornstarch. If the affected parts are very moist, they may be dusted with lycopodium or smeared with vaseline. R.— Zinc, oxydat 20.0 Lycopodium 80.0 S. — Dust on the parts several times daily. R. — Plumbi carbonas 10.0 Amylum pulv. .20.0 Talc, venet. pulv . 40.0 S. — Dust on the parts once daily. ECZEMA. 391 In cases of extensive redness of the skin we must apply com- presses of lead-water or thymol (1 per cent.), creolin (1 to 2 per cent.), carbolic-acid water, thiol water (20 per cent, thiol, liquid, 50 per cent, glycerin, and 50 per cent, water) ; but powdering is preferable, as every skin is not benefited by liquid applications. As soon as the marked symptoms of the disease have decreased we may replace the use of powder by ointments of zinc or lead, white precipitate ointment, or by mild ichthyol soaps. (6) In very moist eczema with a prolonged course the use of powder is not always successful. In those cases we must apply drying fluids, such as corrosive sublimate solution (1 to 1000), nitrate of silver solution (2 per cent.), twice daily by means of a brush or a cotton tampon. Sublimate ointments (1 per cent.) or subiodide of mercury (2 per cent.) are beneficial, but strong solu- tions of blue-stone or crude sulphate of iron and tormentilla root are not to be recommended. R. — Hydrarg, bichlorid 1.0 Glycerinum ........ 10.0 Alcohol 90.0 To apply upon eczematous surfaces. R. — Hydrarg. bichlorid 1.0 ^Ico^ol I -- 50 Glycerinum j Adeps 90.0 Ointment for chronic moist eczema. (c) In cases of pustula we may use the same treatment as is indicated in 6, after having pressed out and emptied the pustules. The author has also obtained good results with ichthyol liniment and salicylic ointment (see Acne). (d) In eczema when it has reached the scaly stage we must first clean the skin thoroughly with some mild, non-irritating soap, but not carbolic or tar soap. The best kind to use is Castile, ivory, or a pure potash soap of the Pharmacopoeia. The author has had good results from '^Hebra's" alcoholic potash soap : R. — Saponis kalin. venal 200.0 Alcohol 100.0 Hebra's soap is poured or rubbed upon the surface which is thickly covered with crusts, and on the following day they are removed easily without subjecting the animal to much pain. After 392 DISEASES OF THE SKIN. careful cleansing we use the same agents as are used in the moist forms of eczema — zinc powder, corrosive sublimate, or nitrate of silver. (e) We use tar and ichthyol preparations with good results in the chronic forms of eczema where there is considerable cutaneous thickening with cracks, fissures, etc. Ichthyol is especially use- ful, and when used in concentrated form in ointments or lini- ments it is much more valuable than tar preparations, because it relieves the itching or irritation in a very short time. Oil of tar in the treatment of eczema (Leistikow) : R, — Oleum picis 3.0 Spts. viui rect. 2.0 ^ther sulphirrlc 1.0 F. M. S. — Eub into the parts every third day. B. — Picis liquidse \ Saponis kalin. venal. I aa 100.0 Spirit, dilut. J Apply once daily. R. — Amnion, sulfo-ichtliyolic 15.0 Aqua calcarise ] .. _^ „ r,} T aa 75.0 Oleum ohvarum J Apply upon the thickened membrane once daily. (/) If there is considerable thickening of the skin, and if the latter is covered at the same time with scabs, we can obtain good results by rubbing salicylic oil (1 part salicylic acid in 35 parts of warm olive oil) over it daily for a week. If this does not succeed, which, however, is very rare, we must first use tar or ichthyol preparations and follow it up by the other. Some authors advise friction with soft soap, chrysarobin ointment, iodoform, or naphthalin, and washing with potash. Internal treatment, as a rule, has been abandoned. Formerly all used purgatives or laxatives, and administered arsenic, but this has lately fallen into disuse, and it is only in very obstinate or chronic cases that anyone uses them. [The translator can not entirely agree to this, as it is very evident that this disease is frequently caused by some disorder of the stomach or liver, and would advise slight laxatives, especially the salines, and small doses of arsenic in chronic cases, and also certain restrictions in the diet.] BUENINO AND FREEZING. . 393 Burning and Freezing". In cases where a high degree of temperature acts upon the skin it causes hypersemia, accompanied by a slight exudation, or an erythematous inflammation. This is called the first degree, or mild form of burning, and generally follows the same course as that described on page 384. When the skin is subjected to the action of a very high temperature we see violent serous exuda- tion in the stratum mucosum. This lifts up the epidermis, form- ing large vesicles. The covering of the vesicles bursts, and heal- ing proceeds very rapidly, also complete regeneration of the epi- dermis, provided there is no septic influence acting on the wound surface. If the burn is still more severe, the tissue of the skin becomes charred or burnt entirely, the whole skin being softened and healing by the formation of a cicatricial tissue underneath. In cases of burning in the first and second degrees the hair is only lost temporarily; in the third and fourth degrees of burn it is permanently lost. Therapeutic Treatment. The treatment of burns consists in mild cases of cooling agents, sugar of lead, lead ointments (1 part of lead plaster to 9 parts of olive oil); in burns accompanied by vesicles we use a powder of oxide of zinc and apply potash liniments (equal parts of linseed oil and lime-water), or boric-acid solution (20 per cent.). In cases where the burn is sufficiently deep to char and make the skin black we must wait for softening and detachment of the burnt portion and then proceed according to the ordinary antiseptic treatment of wounds. Freezing has exactly the same effect as heat. In the first degree we find bluish-red, but not distinct, flat swellings. In more serious freezing we find serous vesicles somewhat bloody. This, however, is very rare in the dog. Complete loss of the skin after the freezing of a member has never been observed by the author in the dog. In such cases it is advisable to use the same treatment as is followed in human medicine — that is, friction with petroleum, spirit of camphor, injections of tincture of iodine, and in the severe forms strict antiseptic methods. 394 DISEASES OF THE SKIN. Gangrene of the Skin. We may see necrotic withering of the skin from the effects of extremely high or low temperature, or it may be caused by trau- matic influences, by disease-alterations of the mucous membrane or subcutaneous tissue — for instance, in phlegmoue, acne, and in some cases from internal causes. Spontaneous gangrene belongs to this latter class. It is developed in some cases, according to Moller, on the cheeks, and corresponds with noma in the human species. The disease is recognized by salivation, poor appetite, fever, and necrosis of the corners of the mouth, which may extend gradually over the entire cheek. The treatment is to follow strict antiseptic methods; to apply dressings of iodoform, sulphonal, or boric creolin (1 part of creo- lin to 50 of boric acid), and improve the general condition by means of tonics. Acne. Under the name of ''acne" we mean an inflammation of the hair-follicles and sebaceous glands resulting in suppuration. This is not produced, however, by follicular acari. The anatomical processes which we recognize in this serious eruptive form have been already mentioned on page 385. This condition generally appears on the nose, cheek, side of the face, and external faseise of the extremities, between the toes, and in some cases over the entire body. Etiology. Very little is known of the actual cause of this disease. Local irritations have been thought to be the cause, such as constant pressure of the muzzle, rubbing the affected parts, and in certain cases to some hereditary predisposition in the character of the sebaceous glands. Vegetable irritants have also been said to cause this disease when the skin was in a certain irritable con- dition. It is not infectious. Clinical Symptoms and Peognosis. This disease develops very slowly, beginning with redness and loss of the skin and hair. These red spots are painful, irregular, swollen, and extend over the surface the size of a large dollar. They are caused by the formation of a large number of pea-like nodules which are hard and firm. In some cases we find the whole surface of the skin ACNE. 395 red, hard, and very painful to the touch. After a short time the nodules become soft, discharge spontaneously a more or less amount of bloody pus, and contain in some cases cores of necrotic tissue. Occasionally we see the union of a number of these acne nod- ules, so that the skin presents a bluish-red discoloration and dies or becomes purulent, as if the skin was undermined by purulent collections ; this may appear all over the body. This " non-acarian " acne very often produces bad results. It has a great tendency to extend in almost all directions, and the cicatrices which appear after healing of the disease leave bare spots all over tlie body, pink in color, streaked with lines of black pigment deposits. Therapeutic Treatment. The treatment consists in the ener- getic local application of various preparations externally. If the aeneous nodules are in the early part of their development, we must puncture them, or open the follicles by some strong antiseptic, such as salicylic or naphthalin ointment. In cases where puru- lent disintegration has gone on it is advisable to open the pustules. This is best performed by means of a small bistoury, and then fill in the opening with boric creolin, or paint it with disinfecting solutions, such as pyoktanin solution (1 to 10 of alcohol), or a 1 to 1000 solution of corrosive sublimate. This should be used once a day when the acne is developing. R. — Acid, salicylic 20.0 Oleum olivse 40.0 Lanolin 80.0 S. — Put a small portion on the parts once daily. The following should be used when the pustules have been emptied : R.— Creolin 1-0 Acid, boraci 40.0 Frohner advises curetting the cavities and the use of the creolin ointment just mentioned, and in some cases cauterization with nitrate of silver, or powdering with iodoform and tannic acid. In cases of circumscribed acne it is advisable sometimes to cut out the diseased portion of the skin. 396 DISEASES OF THE SKIN. CUTANEOUS AFFECTIONS WHICH ARE CAUSED BY ANIMAL -PARASITES. The changes produced on the skin from disease caused by animal parasites are divided into two conditions — primary and secondary. The primary appears as a superficial inflammatory process, pro- duced directly by irritations of the parasites upon the skin, and this condition depends to a large extent upon the amount of irri- tation and the depth that the parasites have penetrated in the skin. The secondary symptoms are the results of this penetration into the cutis, causing more or less itching and irritation, and, as a rule, scratching and rubbing on the part of the animal, producing heat, redness, papules, vesicles, pustules, hemorrhages, or excoriations. These irritated spots may not be restricted entirely to the affected region in which the parasites are located, but may spread to other localities. This form, which is nothing more or less than eczema, possesses two peculiarities which may distinguish it at once from the common form of eczema which is not produced by a parasite : . 1. It invariably appears in single, isolated eruptive spots, and it is only after the disease has been present for some time, or where there is extensive irritation, that we may find the surface connected together; and, 2. We see the appearance of these eczematous eruptions in cer- tain locations which are especially preferred by the parasites, and showing their greatest development of the eruption in those regions, even when the whole body is affected. A microscopical examination of the scales of the skin will furnish definite information as to the character of the cause of the erup- tion. We distinguish two groups of cutaneous parasites: First, those which live upon the external surface of the skin, and, second, those which enter the tissues of the membranes, puncturing deeply into the tissues. In the first group we have the following : Ceratopsyllus (Pulex) Canis, the Dog Flea. The true dog flea as well as the human flea (pulex irritans) is found in the dog. The former is distinguished from the latter by its size, by the different length of its tentacles, and by the presence of a number of sharp hairs arranged in a comb-like layer along HJEMA TOPINUS PILIFEB US. 397 the side of the head (Fig. 86). Coarse breeds of dogs are not par- ticularly affected by the bites of fleas, but pet dogs and delicately bred animals scratch and rub to such an extent as to cause irri- , ^ fig. 86. tated splotches and redness over the entire body, and lead the owner to believe that the animal is affected with mange. If the fleas are removed from the skin by a bath or in some other manner, we may relieve the itching and irritation by the application of „ ^ ^*u . ^^ •' i £^ Head of the ceratopsyllus cams. some soothing solution. (Megnin.) Therapeutic Treatment. Fleas are best removed by means of Persian insect powder (Flores pyrethri). This must be moistened with alcohol and rubbed into the hair. Zuru recommends the placing of pine shavings in dogs' kennels. Hseniatopinus Piliferus {Dog Lice) and Trichodectes Latus Canis {Dog Parasites). Description of Hcematopinus Piliferus. This parasite is distin- guished by an egg-shaped head fitted with fine, short hairs and fleshy sheath-trunk with hooks at the edge. This when lifted shows a sucking tube and two movable knife-shaped stilettos. The thorax is wrinkled and possesses three pairs of scissor-like claws. The posterior portion of the body is large and possesses nine rudimentary legs. The length of the body is about 2 mm. (see Fig. 87). Description of the Trichodectes. In this parasite the head is broad, quarter-shaped, with three manacle feelers and a tooth- shaped mouth. The thorax is contracted, the posterior part of the body has nine distinct members, and the length of the body is from 1 to 2 mm. (see Fig. 88). The former parasites are the most disagreeable, as they suck the blood from the body, live particularly on those parts of the skin where the hair is thick and which are not exposed to the cold, such as the neck, flanks, and at the tail. The trichodectes feed, as a 398 DISEASES OF THE SKIN. rule, upon the hair and epidermis, and are particularly found on the head and neck. Both skin parasites produce intense irritation Fig. 87. Fig. 88. Hsematopinus piliferus. Trichodectes latus. The accompanying small lines give the natural size of the parasite. and rubbing, causing inflammatory efflorescences which look very much like squamous eczema, with partial loss of hair and forma- tion of scabs. The diagnosis is usually easy, as we can see the parasites and their eggs by separating the hair. Therapeutic Treatment. This consists of destroying the parasites and their eggs. For that purpose it is often requisite to clip the animals. The safest and least harmful agents are decoctions of tobacco (5 to 10 per cent.), solutions of creolin (3 to 6 per cent.), petroleum (pure, or mixed with olive oil), and in small dogs anise-seed oil (1 to 10 per cent, of olive oil). Mer- curial ointment may be rubbed in the neck around the collar, but we must not apply more than a piece the size of a bean. Washing with corrosive sub- limate solution has been tried, but it must be very carefully done, and the animal not allowed to lick the body, as it is very apt to produce mercurial symptoms and salivation. Ixodes Ricinus. Ixodes ricinus. The ac- companying line is the na- tural size of the parasite. (KUCHENMEISTEE-ZURN. ) This parasite, which is about 2 mm. in length, and sometimes when full grown al- most 3 mm., looks very much like an acari (Fig. 89). It penetrates into the skin SABCOPTES SCABIEI COMMUNIS. 399 and sucks the blood, and is generally seen in setters or pointers, and dogs when working through the woods and underbrush be- come filled with them. Turpentine and petroleum will destroy them instantly. Leptus Autumnalis. This is what is known as a '' harvest bug," or acari. It is about 4 mm. in length, and is the red larva of thrombidium holoseri- ceum. While human beings are quite frequently affected with this parasite, it is only rarely found in the dog. Defrance and Friedberger have seen pustular inflammations of the skin of the dog produced by this parasite. The rash was very prominent on the abdomen and the inner fascia of the legs, and was healed quickly by an application of carbolic acid and glycerin, or carbolated cosmoline. Dermatophagus Canis. This is very rarely found in the dog, and is a parasite which affects the ear, producing otitis externa. For further details refer to Parasitic Otitis (page 381). The following parasites belong to the second group : Sarcoptes Scabiei Communis. [Sarcoptic Mange ; Scabies Sarcoptica. ) Description of the Sarcoptes. This para- fig, oo. site is about 0.25 to 0.30 mm. broad and from 0.20 to 0.50 mm. long. It has a rounded, turtle-like shape and a horseshoe- shaped head, with well-developed club- shaped scissor-like jaws. It has short rudimentary feet, and tulip-shaped suction cups which are attached to the first, second, and fourth pairs of feet in the male, while in the female they are found in the first female sarcoptes of the dog, and second pairs only. In the back we magnified 75 times, giving the , „ 111 abdominal view. (Siedam- see a number or acorn-shaped scales or grotzky.) thorns, and four rows of lance-shaped scales on the upper surface of the back. The skin shows trans- verse folds and we find four elongated hairs on the posterior end of the body. (Fig. 90.) 400 DISEASES OF THE SKIN. The male acari and the young parasites generally inhabit cavi- ties in the skin which they have made for themselves. These cavities are connected externally by short ducts, the entrances of which may be marked by small vesicles or pustules, while the females may move to different parts of the body when sexually ripe, burrowing ducts through the upper layers of the epidermis down as far as the membrana Malpighii, which contains a great deal of fluid. At the end of the duct — that is, the place of entrance of the acari — we see the development of a small, somewhat moist nodule — or a vesicle, which dries up ultimately, leaving a scar. This digging of the parasite may produce more or less detachment of the epidermis. We generally find that the parasite has a prefer- ence for certain parts of the body, such as the head, neck, abdomen, and chest, at the root of the tail, and the paws. It is very hard to detect it with the microscope. The best way is to remove some of the membrane with the scissors or scrape the upper portion of the skin to the corium. If parasites have been present for some time a secondary eczema is soon developed, which is produced by scratching and rubbing, also by itching of the scabs and scales. This " mange eczema" appears in various forms, according to the sensitiveness of the skin, and is either papular, vesicular, or pus- tular, and sooner or later produces decided thickness of the skin and leads to the formation of a number of folds, wrinkles, and ulcerated points between the clefts of the wrinkles. There is always a certain characteristic appearance about these affected localities which makes it easy to distinguish between the para- sitic and simple eczema. The surfaces finally become confluent, forming large eczematous areas. It is very improbable that a mistake will be made in diagnosis, except in the early stages, when there is only a very small spot affected, because the para- sitic eczema produces rapid characteristic changes, accompanied by scratching, twitching, rubbing, and licking, which are very much aggravated as soon as the animal is placed near any warm object — for instance, in the neighborhood of a stove or if covered up with a blanket, and also the evident pleasure which the animal gets if the affected part is rubbed or scratched; and finally, if the animal is kept with other dogs, the disease is carried to them and developed very quickly. The disease can also be produced in man by taking a mangy scab and applying it to the SABCOPTES SCAB IE I COMMUNIS. 401 arm, holding it there by a bandage. As a rule, however, the parasite does not propagate rapidly in man. Therapeutic Treatment. In order to produce good results in mange we must kill or remove the parasites, as the itching and scratching cease as soon as they are destroyed, and on that account the artificial eczema disappears rapidly. A large number of anti- parasitic agents are used — creosote, wood-tar, creolin, lysol, sali- cylic acid, and Peruvian balsam. They are all useful, and may be applied according to the following directions : It is always necessary to make a general application of the agent, even in such cases where the disease seems to be restricted to one region of the body. The dog must be covered all over with a layer of soft soap or with Hebra' s alcoholic potash soap (see page 391), which is to be shampooed into the skin with the hands or a stifE brush, and cleansed thoroughly in clear tepid water. The agent which is to be used is then applied with the hand or with a brush, covering only one-third of the body at a time [the trans- lator thinks that the body can be covered entirely with the medi- cinal agent at each application, except in the creosote and carbolic acid combination], repeatiog tliis operation in two or three days. At the end of that period the application may be removed by soft soap and water. The best ointments for mange are: 1. Picis liquid., sapo potassii viridis, spiritus vini rect., aii q.s. Ft. liuimentum. 2. Creolini, sapo potassii viridis, aa 1 part; spiritus vini rect., 10 parts. 3. Creosoti, 1 part; picis liquid., sapo viridis, spirit, vini rect., aqua, aa 7 parts. 4. Creolini (lysol), 1; petrolatum, 12. 5. Two to 5 per cent, oily solution of creosote or carbolic acid. 6. Peruvian balsam, pure or with a little alcohol, ether, glycerin, or oil. The four agents which are mentioned first are very energetic, but more or less dangerous, so it is advisable to use them in healthy or not too young or delicate animals, and at the same time to administer small quantities of sulphate of sodium in their drink- ing-water in order to prevent carbolic poisoning. Peruvian balsam is harmless and very useful, but, unfortunately, it is expensive, and is only adapted to very fine pet dogs, 26 402 DISEASES OF THE SKIN. Prevention Methods. The owner of the dog must have his attention called to the fact that the sarcoptes are highly conta- gious, and may produce similar complications in other dogs and in man, and while this may be of a very mild character, it has been observed in the acute form in several cases (Siedamgrotzky, Fried- berger, and others). The contact of mangy dogs with healthy animals must be prevented, and covers, blankets, bedding, etc., which have been used by the affected animals must be sub- jected to a thorough cleansing by washing with hot solutions of soda and a high degree of heat. The straw, of course, must be burned. Fig. 91. ACARUS DEMODEX POLLICULORUM. {Follicular Mange. ) Deseripiion of the Acarus This parasite is about 0.3 mm. in length and about 0.045 mm. in breadth. It has a broad, scissor- like masticatory apparatus, a mobile anterior trunk, and three jointed maxillary feet. It has a worm-shaped, wrinkled abdo- men, with three jointed, clawy, thick, short feet attached to the thorax. The elongated oval larvse have only six legs. (Fig. 91.) These parasites are found in the hair-follicles and sebaceous glands, and by their presence show a purulent disintegration of the peri-glandular and peri-follicular tissues. The sebaceous glands are also destroyed, causing aeneous pustules (see pages 835 and 394). The demodex acne shows itself in cer- tain preferred parts of the body, especially the head, throat, neck, and paws, but it may extend over the entire body. It is not very easily transmitted, as has been proven by the attempt made by Weiss, Martemucci, and others, who were unsuccessful. Clinical Symptoms and Course. These are distinguished by a pustular and squamous form of eruption. The pustular form is the most common and may be recognized by the hair falling out, by hyperffimic and swollen skin, which becomes thickened and folded, forming nodules often the size of a millet- seed, which change from bluish-red to yellow pustules, and finally Acarus follicu- lorum, magnified 250 diameters. (Friedberger. ) A CAB US DEMODEX FOLLIC UL OB UM. 403 the purulent bloody contents escape, and in it and under the membrane we find hundreds of acari. The itching, as a rule, is never very great, as in sarcoptes mange, and in some cases not even present. When the affected cutaneous regions are scratched or rubbed, the patients, as a rule, resent it and do not derive the pleasure that scratching gives in sarcoptes mange. The disease spreads very slowly, and only in very rare instances does it cover the whole body. The parts that are affected finally heal, but the skin remains thick, denuded of hair, marked in some places by scars or cicatrices, and also by cracks and wrinkles. In some cases we may have a dark pigmentation marked with warty projections. When there is any itching pres- ent the appearance of the cutis may be changed materially by secondary eczema. The appetite is very rarely affected, the animal eating well, although some cases, in spite of good food, have shown the animal to have an impoverished, unhealthy look. The squamous form is seen in the neighborhood of the eyes, but it may show itself in other places of the body. It is a normal cutaneous inflammation accompanied by falling out of the hair and great accumulation of scabs. The hair drops from the affected places; the skin is only slightly reddened, but covered with thick scabs. If these places are squeezed, the parasites can be pushed out of the skin very rapidly. The easiest way to obtain the para- site is to rub the blunt end of a knife over the affected parts, and the microscope will aid you in distinguishing this disease from simple scaly eczema. The prognosis is generally unfavorable, and it is almost impos- sible to reach the parasites. This is especially the case with the squamous form, which is always considered the worst form of parasitic mange. Therapeutics, (a) Treatment of the Pustular Form. When pustules are present they must be squeezed and emptied every day, and at the same time apply the antiparasitic agents already men- tioned with a brush. The animals, as a rule, show great pain and object to it, but to obtain any good results this must be followed up patiently. Any of the solutions may be used, as one is as good as another, but we must remember that where we have an openiug directly into the deep portions of the skin that reabsorption of poisons through the membrane is much easier, consequently it is 404 DISEASES OF THE SKIN. better to select a nou-poisonous remedy, such as Peruvian balsam or warm ^^reparations of salicylic acid (1 part of salicylic acid to 40 parts of olive oil). Both agents may be replaced by styrax (in oil solution). Another form of treatment which is advised by Friedberger is also recommended by Bruasco. In following this treatment we clip the dog carefully and put him in a bath of sulphate of potas- sium on the first day (100 grammes to 70 litres of water), and on the second, third, and fourth days rub the body with a thin oint- ment of cantharides (1 to 6 of lard). Then on the fifth or sixth day wash the animal thoroughly with soft potash soap. Allow a few days to intervene, then renew the treatment, going through the same course again. Megnin has obtained very good results from a sulphur bath. For this purpose he uses the bath-tub shown in Fig. 92. Fifi. 92. Bath-tub. (6) Treatment of the Squamous Form. In this we must first try to reach the parasites, and this we do by systematic rubbing with acid ointments or strong concentrated salicylic ointments (1 to 5), and also with soft soap or lye. When we have removed the scabs and scales with this form of treatment we must apply the same treatment as prescribed in the pustular form. The prophylactic measures must be the .same as in sarcoptic mange. No transmission of this disease has ever been observed in man. CUTANEOUS AFFECTIONS OF PARASITIC ORIGIN. 405 Filaria. Siedamgrotzky, Rivolta, and Griffith have seen pus- tular eruptions of the skin which were caused by thread-worms. The former saw upon the external surface of the legs red-bordered pustules which contained one or two round worms, which were 0.04 to 0.7 mm. long, and had awl-shaped tails. The parasites had probably entered the skin through the hair-follicles, and some were found measuring 1 mm. in length in the straw of the dog's kennel. The treatment is simply cleanliness. Cutaneous Affections -w^hich are Caused by Vegetable Parasites. We know at present of but two skin diseases in the dog which are ascribed to the presence of vegetable parasites; these are favus and herpes, which belong to the fungi class, and may be simple or ramified, membranous or non-membranous, double contourated, cellular threads (hyphen), which become mixed in their growth and form a real fungous bed or fungous turf (mycelium). These fungous growths produce at their ends and at the point of their short side branches bead- or string-like spores, uniting and ligating each other, which are considered as sexual or multiplying organs (Fig. Fig. 03. Favus spores, magnified 450 times, (von DCben.) 93). We cannot make a strong distinction between the fungi of favus and those of herpes, but there is a difference, as is seen in the disease in its local form, and we have given a description of both. 1. Favus. This fungus is called achorion Schonleinii, and is developed upon the skin, between the epidermic layers in the hair-follicles, and also in the hair itself. It may be transmitted to the cat, horse, rabbit, mouse, and human beings, causing a characteristic skin affection. 406 DISEASES OF THE SKIN, Clinical Symptoms, Favus is found in special regions of the body, namely, upon the forehead, back of the nose, abdomen, and external surface of the hindlegs, as gray, gray-yellow or even saffron-yellow, dry, brittle crusts or eschars. These are about the size of the head of a needle in the beginning, but gradually by their growth cover the entire surface, and may finally become from 2 to 5 mm. in tliickness. They appear in the shape of round or ellip- tical scutula, depressed in a saucer-like manner, generally per- forated with a dull, lustreless hair, which drops out later on. If the escharious mass is removed we find a corresponding depression with exposed, very red epidermis. As a rule, this is followed by bleeding, and, according to St. Cyr, there is always great itching. This last, however, has not been the author's experience. Therapeutic Treatment. The treatment of this disease is easy, consisting of removal of the scutula and a daily application of antiparasitic agents, especially tincture of iodine, carbolic acid and creosote solution, sublimate solutions of red, white, or gray mercurial ointment, solution of salicylic acid (10 per cent, solution with alcohol), and tar soap. Chloride of sodium (common salt) has recently been advocated in the treatment of ringworm. It is either to be applied in saturated solution or else made into an oint- ment with vaseline. Concerning the prophylaxis, we refer you to the indications which are given later in herpes. 2. Herpes Tonsurans. Depilating herpes, herpetic ring, herpetic eshcar, bare herpes. This fungus which is said to be the cause of herpes, is called trichophyton tonsurans, and is found in large masses lying on the upper portion of the epidermis, and espe- cially in the hair and its covering. Trichophyton has a much more rapid growth than achorion. It not only grows from one centre, as in the other form, but it may make its appearance in a number of new centres scattered all over the body, until finally the whole is strewn with numerous, isolated, round-shaped bare spots. The parasite may be transmitted to dogs, man, cattle, goats, cats, pigs, and rabbits. Clinical Symptoms. The eruption is marked by small, round, or elongated herpes, which vary in shape and size between a lentil and a large bean. The spots are hairless and distinctly circum- scribed ; the blotches are arranged at intervals, and are generally ALOPECIA. 407 very regular. They become confluent in some cases, and extend over the entire body. Affected regions show a peculiar grayish- white or' dirty gray scab, and in old cases yellowish-brown crusts about 2 mm. in thickness. These crusts may have some hair adhering to them. The skin under the crust is copper-red in color and covered with numerous millet-like nodules (swollen hair-folli- cles). After a certain time, if the disease ceases to spread, the scab drops off gradually, and we see a bare, scaly herpes upon which the hair slowly returns. The animals are often affected with sec- ondary eczema. This, however, is produced by constant scratch- ing^, due to the irritation of the disease. Therapeutic Treatment. The treatment of herpes depends on the removal of the favus. We must, therefore, clean the affected part, lift and remove all scabs and eschars by means of a thin knife, or shampoo with soft soap, following it up by a dress- ing of some of the agents mentioned under the head of mange. Prophylaxis. The animals must be separated, as the danger of infection to both dog and man is very great. The kennels are to be cleaned and all straw, etc., burned, and the animals kept away from children. ATROPHIC CONDITIONS OP THE CUTANEOUS MEMBRANE. Alopecia. (Falling out of the Hair.) By this term we mean a falling out of the hair which is not caused by actual disease. We make a distinction, however, between general alopecia and alopecia areata. The former is an extensive falling out of the hair, often recognized after serious disease and during the period of convalescence. The latter is a symptom of bad nutritive condition (alopecia symptomatica), and is character- ized in some cases by a circumscribed or rounded herpes; this may become confluent and is especially developed on the back, tail, and external fasciae of the thighs. In both forms it is not rare to find the skin pigmented. Siedamgrotzky has proved that alopecia of the dog, if circumscribed or diffuse, depends on the atrophic condition of the hair and infiltration of the upper cutaneous layers, and it is especially seen in dogs with silky, white or grayish hair. 408 DISEASES OF THE SKIN. In some cases where the dog has black-tipped hair it is also notice- able. Therapeutic Treatment. The treatment consists of wash- ing with alcoholic soap, and a diluted tincture of cantharides is also useful. It is advisable in alopecia areata to use antiparasitic agents, such as diluted tincture of iodine (Friedberger and Froh- ner), or an alcoholic salicylic acid (10 per cent.). The principal therapeutic agents, however, are rubbing with a strong brush, increasing the nutrition of the skin, plenty of exercise, and, above all — patience. INDEX. ABDOMEN, fatty deposits in, 88 puncture of, 90 Abdominal cavity, tumors of, 89 dropsy, 86 Abscess of the kidneys, 167 of the liver, 96 of the sclerotic membrane, 360 Abscesses, perinephritic, 168 Acarus demodex folliculorum, 402 mystax, 74 Acids, bile, 93 Acne, 394 Acute and chronic peritonitis, 88 catarrh of the bowels, 59 of the bronchia, 121 of the stomach, 55 diffuse peritonitis, 84 inflammation of the kidneys, 162 intestinal catarrh, 59 laryngeal catarrh, 116 laryngitis, 116 nephritis, 162 parenchymatous hepatitis, 95 peritonitis, 8 synovial inflammation of the joints, 272 Adenoma, 336 Affection of the eyelids, 350 Air-passages, diseases of, 120 Albumin, digestion of, 36 in urine, 160 Alopecia, 407 Amaurosis, 371 Amblyopia, 371 Amount of urine, 156 Amputation, 298 of the tail, 300 Amyloid kidney, 166 liver, 97 Anaemia, 256 of the brain, 204 Anaesthesia, 346 Anal glands, tumors of, 337 Anchylostomum, 81 Angina catarrhalis, 51 Angioma, 335 Animal parasites, affections caused by, 396 Anterior chamber, dropsy of, 371 limbs, paralysis of, 200 Anthracosis pulmonum, 129 Anus, imperforate, 74 prolapsus of, 71 stitching of, 73 Aphthae, 43 Apoplexia, 204 Areca nut, 80 Arsenical poisoning, 98 Arthritis deformans, 275 rheumatic, 274 Articulations, diseases of, 268 Ascites, 86 Aseptic wound fever, 309 Asthma, 122 Ataxia, 201 Atresia ani, 74 Atrophic conditions of cutaneous membrane, 407 Auscultation of the thorax, 110 "D ACTERIA in the urine, 159, 172 ■■-' Bench-show distemper, 235 Bile acids, 93 color in urine, 161 Bitch, castration of, 191,193 inguinal hernia in, 329 menstruation of, 154 passing the catheter in, 153 Black cataract, 371 Blackening of the lungs, 129 Bladder, catarrh of, 170 cramp of, 175 debility of, 173 diseases of, 170 examination of, 155 stone in, 176 urine in, 88 worms, 76 Bleeding at the nose, 114 Blennorrhoea of the eyelids, 355 (409) 410 INDEX. Blood-boils, 317 -corpuscles in urine, 158 filaria in, 149 Bloodvessels, inflammation of, 308 Boils, 385 . Bones, diseases of, 268 fractures of, 291 tumors of, 334 union of fractured, 295 Bothriocephalus, 82 bubius, 82 cordatus, 82 fuscus, 82 latus, 82 reticulatus, 82 Bowels and peritoneum, physical ex- amination of, 37 acute catarrh of, 59 chronic catarrh of, 62 distention of, with gas, 88 Brain, ansemia of, 204 ■ diseases of, 202 hypertemia of, 202 inflammation of, 206 Brom-ether, 348 Bronchia, acute catarrh of, 121 catarrh of, 120 chronic catarrh of, 121, 122 Bronchial breathing. 111 catarrh, infectious, 235 tubes, diseases of, 120 Bronchitis, 120 Broncho-pneumonia, 124 Bruises, 317 Buccal fungi, 43 Burning, 393 Bursa mucosa, diseases of, 287 piESAREAN operation, 192 ^ Calculi, uric, 177 Cancerous tumor, 342 Cancer of glandular tissue, 342 of the prostate, 182 squamous, 342 Canker, external, 377 internal, 378 of the ear, parasitic, 381 Carbolic-acid poisoning, 98 Carcinoma, 342 Cartilaginous tumor, 333 Castration, 182, 191, 327 in the bitch, 191 Catarrh, acute, of bronchia, 121 laryngeal, 116 chronic, of bowels, 62 of bronchia. 122 of larynx, 118 Catarrh, infectious bronchial, 235 nasal, 113 of the bladder, 170 of the duodenum, 91 of the nose, 113 of the windpipe and bronchia, 120 Catarrhal fever, contagious, 223 inflammation of the lungs, 124 jaundice, 90 metritis, 188 ophthalmia, 354 pneumonia, 124 Catalepsy, 219 Cataract, 365 black, 371 Catheter, passing of, 152 Cauterization of tumors, 845 Cavity of the mouth, malformations of, 47 Ceratopsyllus canis, 396 Cerebral hemorrhage, 204 Cerebro-spinalis, 209 -spinal meningitis, 209 Cerebrum, inflammation of, 207 Cestodes, 75 Chest, dimensions of, 106 Chloroform, 348 Chlorosis, 256 Chorea, 217 Crystalline lens, diseases of, 365 extraction of, 368 Chronic catarrh of the bowels, 62 of the bronchia, 121, 122 of the larynx, 118 of the stomach, 67 dyspepsia, 57 induration of the lungs, 126 inflammation of the kidneys, 165 interstitial hepatitis, 95 nephritis, 165 irritable cough, 118 laryngitis, 118 nephritis, 165 parenchymatous nephritis, 165 peritonitis, 84, 85, 88 prostatitis, 182 serous inflammation of the joints, 273 Circumscribed peritonitis, 85 phlegmone, 307 Cirrhosis of the liver, 95 of the lungs, 126 Closure of the eyelids, 350 Coccidium, 82 perforans, 82 Coenurus cerebralis, 78 Cold in the head, 113 INDEX. 411 Collections of urine in the bladder, 88 Color of urine, 156 Compression, 313 Condyloma, 336 Congestive hypersemia of the liver, 94 Conjunctivitis, 234, 353, 354 in distemper, 234 purulent, 355 Conjunctiva, diseases of, 353 inflammation of, 353 Connective tissue, tumors of, 333 Consciousness, disturbance of, 196 Constipation, 39 Constitutional diseases, 256 Contagious catarrhal fever, 223 Contraction of the intestines, 66 Controlling hemorrhage, 302, 313 Contusions, 317 of the joints, 280 Convulsions, 200 Convulsive cough, 118 Cornea, dermoid of, 364 injuries of, 364 Coryza, 113 Costiveness, 39 Cough, 102 chronic irritable, 118 convulsive, 118 Coverings of the brain, diseases of,' 202 Cramp, cystic, 175 of the bladder, 175 Croupal membranes, 52 pneumonia, 129 Cruralis, hernia, 331 paralysis of, 200 Cutaneous affections caused by ani- mal parasites, 396 caused by vegetable para- sites, 405 membrane, inflammatory condi- tions of, 384 membranes, atrophic conditions of, 407 tumors, 341 Cuterebro emasculator, 185 Cylindrical cell-tumor, 342 Cystic cramp, 175 Cysticercus pisiformis, 77 tenuicollis, 78 Cystitis, 170 Cystotomy, 179 Cysts, 341 dermoid, 341 extravasation, 341 glandular, 341 honey, 51 " honey-pouch," 341 Cysts of the kidneys, 169 retention, 341 serous, of the ear, 375 rvEBILITY of the bladder, 173 -^ Deformans, arthritis, 275 Dentition, 47 Deposits in the abdomen, fatty, 88 Dermatitis, 386 Dermoid cysts, 341 of the cornea, 364 Detrusor, paralysis of, 174 Diabetes insipidus, 260 mellitus, 259 Diagnosis of the larynx and wind- pipe, 102 Diffuse peritonitis, 84 phlegmone, 307 Digestive apparatus, diseases of, 27 examination of, 27 Digestion of albumin, 36 of hydrocarbonaceous food, '35 of meat, 34 of milk, 35 Dimensions of the thorax, 106 Discission, 367 Diseased malformations of the joints, 275 Diseases, constitutional, 256 of the air-passages and bronchial tubes, 1 20 of the articulations and the bones, 268 of the bladder, 170 of the brain and its coverings, 202 of the bursa mucosa, 287 of the conjunctiva, 353 of the crystalline lens, 365 of the digestive apparatus, 27 of the ear, 375 of the eyes, 350 of the intestines, 59 of the joints, 270 of the kidneys, 162 of the larynx, 116 of the lens, 365 of the liver, 90 of the lungs, 124 of the mouth, tongue, and sali- vary glands, 42 of the nasal cavities, 113 of the nervous portion of the eye, 370 of the nervous system, 196 of the oesophagus, 53 of the optic nerve, 371 of the penis and prepuce, 183 412 INDEX. Diseases of the peritoneum, 83 of the pleura, 130 of the prostate, 181 of the respiratory organs, 101 of the retina, 371 of the salivary glands, 49 of the sclerotic coat of the eye, 358 of the sclerotic membrane, 370 of the sexual apparatus, 152 of the skin, 384 of the spinal cord and its cover- ings, 209 of the stomach, 55 of the teeth, 45 of the testicle and its covering, 184 of the urinary apparatus, 152 of the vagina and the uterus, 185 of the vitreous humor, 370 of true infection, 223 Disinfection of wounds, 311 Dislocation of the elbow, 284 of the lower jaw, 283 of the patella, 285 Dislocations, 281 Distemper, 223 bench-show, 235 conjunctivitis in, 236 false, 235 Distention of bowels with gas, 88 Distortions of the joints, 281 Disturbance of consciousness, 196 of digestion, effect of, on gastric secretion, 35 of motility, 197 of sensitiveness, 196 Diuretics in dropsy, 89 Dochmius, 81 duodenalis, 82 stenocephalus, 82 trigonocephalus, 82 Dog flea, 396 lice, 397 passing the catheter in the, 152 parasites, 397 Dropsy, abdominal, 86 of the anterior chamber, 371 Duodenum, catarrh of, 91 Dura mater, inflammation of, 206 Dyspepsia, 55 chronic, 57 Dyspnoea, 107 ■pAE, diseases of, 375 ^ inflammation of external, 378 parasitic canker, 381 Echinococcus polymorphus, 79 Eclampsia, 220 Ectropion, 352 Eczema, 387 moist, 391 parasitic, 396, 400, 402 Elbow, dislocation of, 284 Emasculating bot-fly, 185 Emphysema, 22 of the lungs, 121, 129 Enchondroma, 333 Enteritis catarrhalis, 59 Enterotomy, 70 Entropion, 350 operation for, 351 Enucleation, 370 Epilepsy, 214 Epistaxis, 214 Epithelial tumors, 335 Epithelium in the urine, 158 Erythema, 386 Ether, 348 Examination of the bladder, 155 of the digestive apparatus, 27 of the mouth and throat, 27 of the nervous system, 196 of the nose, 101 of the oesophagus, 30 of the prepuce and urethra, 152 of the prostate, 154 of the stomach, 31 of the urinary apparatus, 152 of the urine, 155 physical, of the lungs, 103 Exarticulation, 300 Exophthalmus, 372 External canker, 377 Extravasation cysts, 341 Eyeball, prolapse of, 372 Eyes, diseases of the, 350 Eyelids, 350 affections of, 350 blennorrhcea of, 355 closure of, 350 inversion of, 350 turning in of, 350 turning out of, 352 Eye, dropsy of the anterior chamber, 371 enucleation of, 369 inflammatory processes of, 366 opening the capsule of, 367 purulent inflammation of, 370 FALLING out of the hair, 407 False distemper, 235 Fat in urine, 158 Fatty deposits in the abdomen, 88 INDEX. 413 Fatty liver, 97 tumors, 333 Favus, 405 Feces, 38 Femoral hernia, 331 Fever, 308 aseptic wound, 309 puerperal, 189 purulent, 310 septic wound, 309 Fibroma, hard, 333 soft, 333 Filaria, 405 immittis, 149 in the blood, 149 Filix mas, 80 First intention, healing by, 304 Fistula, intestinal, 323 Flat condyloma, 336 Flea, dog, 396 Follicular mange, 402 ophthalmia, 354 Forceps, 46 Foreign bodies in the oesophagus, 53 substances in the urine, 158 Fractures, general classification of, 292 of the bones, 291 union of, 293 Freezing, 393 GALLSTONES, 97 Gangrene of the skin, 394 Gas in bowels, 88 Gastricismus, 55 Gastric secretion, disturbance of, 35 Gastritis catarrhalis, 55 Gastro-hvsterotomy, 192 General ' classification of fractures, 292 examination, 17 Gestation, 88 Glandular cysts, 341 Glands, cancer of, 342 Lieberkiihn's, 79 Glaucoma, 371 Goitre, 338 Gonorrhoea, 183 of the prepuce, 183 specific, 184 Harvest bug, 399 Head, cold in, 113 Healing by first intention, 304 by suppuration, 305 process of a wound, 304 under a moist scab, 305 Hebra's potash-soap, 391 Hsematoma, 375 Hsematopinus piliferus, 397 Hsemoglobinsemia, 264 Hsemoglobinuria, 264 Helminthiasis, 74 Hemorrhage, 302 cerebral, 204 controlling of, 313 Hemorrhoids, 63 Hepar adiposum, 97 Hepatitis^ 95 acute parenchymatous, 95 interstitial, 95 Hepatogenous icterus, 91 Hernia, 320 cruralis, 331 femoral, 331 inguinal. 327 in tiie bitch, 329 irreducible, 322 perineal, 331 reducible, 321 scrotal, 327 umbilical, 330 Herniotomy, 325 Herpes tonsurans, 406 Hobday apparatus, 348 Honey cysts, 51 " Honey-pouch" cyst, 341 Hydrobilirubin, 93 Hydrocarbonaceous food, digestion of, 35 Hydrocele, 329 Hydrocyanic-acid poisoning, 98 Hydronephrosis, 169 Hydrophobia, 237 Hydrops abdominalis, 86 ascites, 86 peritonii, 86 Hypersemia of the brain, 202 of the liver, 94 Hyperaesthesia, 197 H.FMATOZOON subulatum, 151 Hair-follicles, inflammation of, 394 Hair, falling out of, 407 Hard fibroma, 333 I CTERUS catarrhalis, 90 gastro-duodenalis, 90 hepatogenous, 91 of reabsorption, 91 stagnating, 91 Imperforate anus, 74 Induration, chronic, of the lungs, 126 414 INDEX. Infectious bronchial catarrli, 235 Inflammatory conditions of tlie cuta- neous membrane, 384 Inguinal hernia, 327 in the bitch, 329 Inflammation, mycotic, of the stom- ach and intestines, 64 of the brain, 206, 207 of the brain-mass, 207 of the cerebral matter, 206 of the cerebral membranes, 206 of the conjunctiva, 353 of the dura mater, 206 of the external ear, 378 of the hair-follicles, 394 of the iris, 370 of the joints, 270 purulent, 273 rheumatic, 274 of the kidneys, 162 of the liver, 95 of the lungs, 124 of the lymphatics, 308 of the mammary gland, 343 of the mucous membranes of the mouth, 42 of the mucous membranes of the throat, 51 of the pelvis of the kidney, 169 of the peritoneum, 83 of the pleura, 130 of the prostate, 181 of the salivary glands, 49 of the sclerotic coat, 358 of the spinal cord, 210 of the testicle, 184 of the uterus, 188 of the vagina, 185 of the walls of the bloodvessels, 308 purulent, of the liver, 96 toxic, of the stomach and intes- tines, 64 Inflammatory processes of the eye, 366 Injuries of the cornea, 364 of the joints, 278 to the testicles and scrotum, 184 Inoculation, Pasteur's method, 240 Internal canker, 378 parasites, 74 Interstitial hepatitis, 95 nephritis, chronic, 165 Intestinal fistula, 323 catarrh, 59 Intestines, contraction of, 66 diseases of, 59 mycotic inflammation of, 64 Intestines, obstruction of, 68 stenosis of, 66 toxic inflammation of, 64 Inversion of the eyelid, 350 lodoform-poisoning, 99 Iris, inflammation of, 370 Iritis, 370 Irreducible hernia, 322 Irritable cough, chronic, 118 Ixodes ricinus, 398 JAUNDICE, catarrhal 90 ^ _ Jaw, dislocation of, 283 Joints, acute synovial inflammation of, 272 chronic serous inflammation, 273 contusions of, 280 distortions of, 281 diseases of, 270 inflammation of, 270 injuries of, 278 luxations of, 281 malformation of, 275 puncturing of, 277 purulent inflammation of, 273 rheumatic inflammation of, 274 suppuration of, 273 wounds of, 278 T/- AM ALA, 80 ^*- Kennel distemper, 235 Keratitis, 358 parenchymatosa, 859 profunda, 359 superficialis, 359 Kidneys, abscess of, 167 acute inflammation of, 162 amyloid, 166 chronic inflammation of, 165 cysts of, 169 diseases of, 162 inflammation of, 162 of the pelvis, 169 Kusso, 80 T ARDACEOUS liver, 97 -^ Laryngeal catarrh, acute, 116 Laryngitis, acute, 116 chronic, 118 Laryngoscope, 28 Larynx, chronic catarrh of, 118 diseases of, 116 physical examination of, 102 Leptomeningitis, 216 Leptus autumnalis, 399 INDEX. 415 Leuksemia, 257 Lice, dog, 397 Lieberkuhn's glands, 79 Ligation of tumors, 345 Linear extraction of the crystalline lens, 368 Linguatula ttenoides, 114 Lipoma, 333 Lithiasis, 176 Liver, abscess of, 96 amyloid, 97 cirrhosis of, 95 . „ o^ congestive hypersemia ot, 94 diseases of, 90 fatty, 97 hypersemia of, 94 inflammation of, 95 lardaceous, 97 neoformations of, 97 physical examination of, 41 purulent inflammation of, 96 stagnating hypersemia of, 94 Lobular extraction of the crystalline lens, 369 pneumonia, 124 Local temperature, 26 Lockjaw, 219 Lower jaw, dislocation of, 283 paralysis of, 200 Lungs, blackening of the, 129 catarrhal inflammation of, l2o chronic induration of, 126 cirrhosis of, 126 diseases of, 124 emphysema of, 121, 129 oedema of, HO, 127 physical examination of, 103 Lunguatula denticulata, 115 Luxations of the joints, 281 Lymphangitis, 308 Lymphatics, inflammation of, 308 MALE fern, 80 Malformation of the ]oints, 2/5 Malformations of the cavity of the mouth, 47 Mammary gland, inflammation ot, 343 Mammitis, 343 Mange, follicular, 402 red, 387 sarcoptic, 399 Meat-diet, 34 -digestion, 34 Melanotic sarcoma, 335 Membrana nictitans, removal of, 3 )6 Meningitis, 209 Menstruation of bitch, 154 Mercury-poisoning, 100 Metritis, 188 catarrhal, 188 septic, 189 Milk-digestion, 35 Moist eczema, 391 scab, healing under, 305 Motor symptoms of irritation, 211 of paralysis, 211 Mouth and throat, examination of, 27 diseases of, 42 diseases of the mucous mem- brane of, 42 malformations of, 47 ulcerous inflammation of, 44 Mouth-gag, 28 Mucous membrane of the mouth, dis- eases of, 42 membranes of the throat, in- flammation of, 51 Mucus in urine, 158 Mumps, 50 Muscular rheumatism, 288 Mycotic inflammation of the stom- ach and intestines, 64 Myelitis, 210 XTASAL catarrh, 113 ^ cavities, diseases of, 113 Neoformations of the glans penis and prepuce, 184 of the liver, 97 Nephritic stones, 170 Nephritis, 162 acute, 162 chronic, 165 interstitial, 165 parenchymatous, 165 suppurative, 167 Nephrolithiasis, 170 ' Nervous portion of the eye, diseases of, 370 system, diseases of, 196 examination of, 196 Nettlerash, 387 Nose, catarrh of, 113 examination of, 101 Number and character of the respi- ratory movements, 106 Nux-vomica poisoning, 100 fvBESITY, 262 yj Obstetrics, 191 Obstruction of the intestines. 68 Odor of urine, 157 416 INDEX. (Edema, 22 of the lungs, 110, 127 CEsophagotomy, 54 Oesophagus, diseases of, 53 examination of, 30 foreign bodies in, 53 Opening of the capsule of the eve, 367 Operation for entropion, 351 Ophthalmia, catarrhal, 354 follicular, 354 purulent, 355 Optic nerve, diseases of, 371 Orchitis, 184 Osteoma, 334 Othsematoma, 375 Otitis externa, 378 parasitic, 381 Ovariotomy, 193 Oxyuris vermicularis, 81 PACHYMENINGITIS, 206 Panophthalmitis, 370 Papilloma, 335 Paralysis, 197, 211 of the anterior limbs, 200 of the crural is, 200 of the detrusor, 174 of the lower jaw, 200 of the posterior limbs, 200 of the sphincters, 212 of the sphincter vesicae, 174 Paraphimosis, 183 Parasites, 74 Parasitic canker of the ear, 381 eczema, 396, 400, 402 otitis, 381 Parasite, dog, 397 Parasites, internal, 74 tapeworm, 75 Parenchymatous hepatitis, 95 inflammation of the tongue, 43 nephritis, chronic, 165 Parotitis, 50 Passing the catheter, 152 Pasteur's methods of inoculation, 240 Patella, dislocation of, 285 Pelvis of the kidney, inflammation of, 169 Penis, diseases of, 183 Pentastoma denticulatum, 115 tsenioides, 114 Percussion of the thorax, 109 Perineal hernia, 331 Perinephritic abscesses, 168 Peritoneum, physical examination of, 37 Peritonitis, 83, 88 acute diffuse, 84 chronic, 84 circumscribed, 85 Peritoneum, diseases of, 83 inflammation of, 83 Pharyngitis, 51 Phimosis, 183 Phlebitis, 308 Phlegmone, 307 Phosphorus-poisoning 99 Phthisis, 126 Physical diagnosis of the larynx and windpipe, 102 examination, 17 of the bowel and perito- neum, 37 of the liver, 41 of the lungs, 103 of the respiratory apparatus, Pilocarpine in dropsy, 89 Pleura, diseases of, 130 inflammation of, 130 Pleurisy, 130 Pleuritis, 130 Pneumonia, 124 broncho-, 124 catarrhal, 124 croupal, 129 lobular, 124 traumatic, 127 Poisoning by arsenic, 98 by carbolic acid, 98 by hydrocyanic acid, 98 by iodoform, 99 by mercury, 100 by nux vomica, 100 by phosphorus, 99 by strychnine, 100 Poisons, 98 Pomegranate, 80 Posterior chamber of the eye, diseases of, 370 limbs, paralysis of, 200 Potash-soap, Hebra's, 391 Prepuce, diseases of, 183 examination of, 152 gonorrhoea of, 183 neoformations of, 184 Preventive inoculation, 240 Priessnitz's compress, 267 Probang, 30 Proglottides, 76 Prolapse of the eyeball, 372 of the rectum, 71 of the uterus, 186 of the vagina, 186 INDEX. 417 98 Prolapsus bulbi, 372 of rectum, reduction of, 73 uteri, 186 vagiufe, 186 Prostate, cancer of, 182 diseases of, 181 examination of, 154 inflammation of, 181 Prostatitis, 181 chronic, 182 Prurigo, 389 Prussic-acid poisoning, Pseudo-leukaemia, 259 Puerperal fever, 189 Pulex, 396 Puncturing the abdomen, 90 the joints, 277 Purgatives in dropsy, 89 Purulent conjunctivitis, 355 fever, 310 inflammation of the eye, 370 of the joints, 273 of the liver, 96 ophthalmia, 355 Pyaemia, 310 Pyarthrosis, 273 Pyelitis, 169 Pyelonephritis, 167 RABIES, 237 Rabific symptoms, 82 Ranula, 48 Reabsorption, icterus of, 91 Reaction of urine, 157 Rectum, preternatural, 323 prolapsus of, 71 stitching of, 73 Red mange, 387 Reducible hernia, 321 Removal of the membrana nictitans, 356 of tumors, 346 Respiratory apparatus, physical ex- amination of, 101 organs, diseases of, 101 movements, number and charac- ter of, 106 Retention cysts, 341 Retina, diseases of, 371 Rhachitis, 268 Rheumatic arthritis, 274 inflammation of the joints, 274 Rheumatism, 288 Rhinitis, 113 Round worms, 74 Rupture, 320 of the bladder, 88 SALIVARY glands, inflammation of, 49 Sarcocele, 328 Sarcoma, 334 melanotic, 335 Sarcoptes scabiei communis, 399 Sarcoptic mange, 399 Sclerotic coat, diseases of, 358 inflammation of, 358 membrane, abscess of, 360 diseases of, 370 ulceration of, 361 I Scrotum, injuries of, 184 Scurvy, 266 I Sensitiveness, 211 disturbance of, 196, 211 Septicaemia, 309 Septic infection of wounds, 305 metritis, 189 -wound fever, 309 Serous cyst, 375 inflammation of the joints, chronic, 273 Sexual apparatus, diseases of, 152 Skin affections caused by animal par- asites, 396 caused by vegetable para- sites, 405 atrophic conditions of, 407 diseases of, 384 gangrene of, 394 inflammatory conditions of, 384 Soft fibroma, 333 Sore-throat, 51 Specific gravity of urine, 157 gonorrhoea, 184 Speculum, 38 Sphincter vesicae, paralysis of, 174 Sphincters, paralysis of, 212 Spinal cord, inflammation of, 209 membranes, inflammation of, 209 myelitis, 210 Spine, nutritive disorders of, 212 Spiritual blindness, 372 Spiroptera sanguinolenta, 151 Spleen, 42 Sprains, 281 Squamous cancer, 342 Stagnating hyperemia of the liver, 94 icterus, 91 Staphyloma, 362 Stenosis of the intestines, 66 Stitches, 314 Stomacace, 44 Stomach, acute catarrh of, 55 chronic catarrh of the, 57 diseases of, 55 examination of, 31 27 418 INDEX. Stomach, mycotic inflammation of, 64 -pump, 33 toxic inflammation of, 64 ulceratioQ of, 68 Stomatitis, 42 Stone in the bladder, 176 Stones, nephritic, 170 Strongylus vasorum, 151 Struma, 338 Strychnine-poisoning, 100 St. Vitus' s dance, 217 Sugar in urine, 161 Suppuration, healing by, 305 of the joints, 273 Suppurative nephritis, 167 Syndesmitis, 353 Synovitis acuta serosa, 272 chronica serosa, 273 Synovial inflammation of the joints, 272 TAENIA, 74 coenurus, 78 cucumerina, 78, 79 echinococcus, 79, 80, 81 marginata, 77 serrata, 77, 80 Tseniafuge, preparation for, 81 Tfeniafuges, 80 Tail, amputation of, 300 Tapeworms, 75 natural history, 75 Tapping the abdomen, 90 Taxis, 325 Teeth, diseases of, 45 Temperature, 23 -chart, 24 increased, 23 subnormal, 25 Testicles, diseases of, 184 inflammation of, 184 injuries of, 184 Tetanus, 219 Therapeutics of tumors, 344 Thermometer, 23 Thorax, auscultation of, 110 dimensions of, 106 percussion of, 109 Throat, inflammation of the mucous membranes, 51 Tobacco-bag stitch, 73 Tongue, diseases of, 43 parenchymatous inflammation of, 43 Tooth-forceps, 46 Toxic inflammation of the stomach and intestines, 64 Trachea, physical examination of, 102 Transparency of urine, 157 Traumatic pneumonia, 127 Treatment of wounds, 301, 311 Trichocephalus, 82 Trichodectes latus canis, 397 True infection, diseases of, 223 Tumors, 333 cancerous, 342 cartilaginous, 333 cauterization of, 345 cutaneous, 341 cylindrical cell, 342 epithelial, 335 fatty, 333 ligation of, 345 of the abdominal cavity, 89 of the anal glands, 337 of the bones, 334 of the connective tissue, 333 removal of, 346 therapeutics of, 344 Turning in of the eyelid, 350 out of the eyelid, 352 UMBILICAL hernia, 330 Ulceration, 31 6 of the sclerotic membrane, 361 of the stomach, 58 Ulcers and ulceration, 316 Ulcerous inflammation of the mouth, 44 Ulcus ventriculi, 58 Union of fractured bones, 295 of fractures, 293 Uraemia, 265 Urethra, examination of, 152 Uric calculi, 177 Urinary apparatus, examination of, 152 diseases of, 152 Urine, albumin in, 160 amount of, 156 bacteria in, 159 bile-coloring in, 161 blood-corpuscles in, 158 color of, 156 epithelium in, 158 examination of, 155 fat in, 158 foreign substances in, 158 in the abdominal cavity, 88 in the bladder, 88 mucus in, 158 odor of, 157 reaction of, 157 specific gravity of, 157 INDEX. 419 Urine, sugar in, 161 transparency of, 157 Urethrotomy, 179 Urticaria, 387 Uterus, diseases of, 185 inflammation of, 188 prolapse of, 186 TTAGINA, diseases of, 185 ^ inflammation of, 1 85 Vagina, prolapse of, 186 Vaginitis, 185 Vegetable parasites, cutaneous affec- tions caused by, 405 Vermicularis, oxyuris, 81 Vitreous humor, diseases of, 370 Vomiting, 34, 36, 85 VELLOW mucous membranes, 92 H 247 84 M a. < > <" > ^O. ^'•, ^O ^-c,^' 0^ ^. 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