Pampered artificial life of dogs as predisposition. Eating carrion.
Chills especially when heated and exhausted. Infection from bowels.
Obstruction of gall duct by inflammation, calculi, neoplasms.
Catarrhal exudate as a protector of microbes. Toxins from intestines,
food or water. Youth, lack of acclimation, mental shock, blocking of
bowel, blood effusion in gall bladder, incubation. Symptoms: signs of
gastro-enteritis, prostration with invasion of the liver and
especially of the kidney. Icteric urine without jaundiced mucosa.
Gravity of icterus with suppression of urine. Hypochondriac
tenderness, arched back, dullness, irregular bowels, excited
circulation and breathing, preliminary fever tends to subside,
tympany, colic, trembling. Death in one or two days or more. Lesions:
congestion, degeneration, ecchymosis, ulceration of gastro-duodenal
mucosa, extending into liver ducts and acini, bile inspissated, liver
enlarged, yellowish brown, softened, fatty, shrunken, distorted
hepatic cells. Kidneys congested, ecchymosed, cortical part with
necrotic foci; lymph glands congested. Diagnosis: by icterus of
tissues and urine tests. Prognosis: grave in acute cases, more hopeful
in tardy ones. Treatment: antiseptics, cholagogues, salol,
salicylates, alkalies, carbonates, tartrates, iodides, laxatives, cold
enemata, aloes, electricity, water freely, pilocarpin, strychnia, aqua
regia, digitalis, bitters, muriatic acid, convalescent diet.
_Causes._ The dog is much more subject to jaundice than the horse, and
the affection is liable to be much more severe, than in solipeds. He
leads a more artificial life, especially in cities, where the lack of
open air exercise, and of the facility for attending to nature’s wants,
together with an excessive, varied, stimulating diet predisposes him to
constipation, indigestion, and disorders of the stomach, bowels and
liver. In other cases the devouring of decomposing food and foul water
proves a cause of direct microbian infection, and of poisoning by
ptomaines and toxins generated out of the body. Exposure manifestly has
something to do with the prevalence of canine icterus, which is more
common in spring and especially in autumn than at other seasons. In
hunting dogs, out of condition, the suddenly induced over-exertion and
fatigue, and the succeeding chill in cold air or water, become accessory
factors.
It appears to be most commonly the result of the transference of germs
from the intestine, either by way of the bile ducts, or with the blood
through the portal vein. The first form is usually the sequel of
muco-enteritis affecting the duodenum, with swelling of the walls of the
common bile and pancreatic duct at its orifice, or from obstruction by
gall-stones, concretions, impacted bowels or neoplasms. With the arrest
of the biliary flow the intestinal ferments gain an entrance into the
common duct and the sac of Vater, finding protection from the antiseptic
bile in the resulting catarrhal exudate, and in this way they reach the
gall-bladder, the biliary radicles and the acini. With the entrance of
bacteria or toxins by the portal vein on the other hand, there is first
a troubled condition of the acini and hepatic cells, an over-secretion
of thick bile, and blocking of the passages so that little is passed
into the intestine, the greater part being absorbed into the hepatic
veins. Fermentation microbes in the stomach and intestines, the germs of
suppuration and septicæmia, and saprophytic germs from outside the body
are held to be causative of icterus. Cadeac lays much stress on the
putrefactive germs in water, and traces different attacks to marshes and
foul ponds.
As in other infecting diseases, early age has a predisposing influence.
The older subject has presumably been already exposed to the microbe and
acquired some measure of immunity. Animals coming new to the locality
and poison, are equally susceptible with the young. Trasbot found that
14 out of 17 dogs thus attacked were between three and eighteen months.
Leblanc and Trasbot claim mental shock as a cause of icterus in the dog.
The disappointment and weariness caused by the master’s absence, the
excitement of a fiercely contested fight, and brutal punishment are
adduced as cases in point. Abuse of emetics and purgatives, in
connection with a pre-existing hepatic or duodenal disorder or as a
supposed prophylactic of canine distemper has induced jaundice.
Obstruction of the small intestine has proved a factor, partly by the
reflex irritation through the splanchnic nerves, and partly through
obstruction to the common bile and pancreatic duct.
Walley records a case of obstruction of the cystic duct by extravasation
of blood in the gall bladder.
Icterus not infrequently supervenes during canine distemper in which the
early gastric and duodenal irritation becomes an occasion of the
extension of the catarrhal infection to the common bile duct. Even apart
from this Trasbot has seen the majority of cases ushered in by a
gastro-duodenitis. In this connection it is interesting to quote the
remark of Pfuhl that 26 out of 27 persons using the foul baths of a
given establishment contracted icterus, while the soldiers bathing in
another branch of the Elbe entirely escaped.
The fact that icterus usually sets in several days after such an
exposure, whether in man or dog, indicates a period of incubation, and
thereby sustains the theory of infection.
_Symptoms._ In the majority of cases, gastro-enteritis constitutes the
first step of this affection and the early symptoms are characteristic
of that disease. Frequent vomiting, at first of food, and later of a
glairy fluid which may be discolored by bile, redness of the tongue,
especially along its margins, bloodshot, watery eyes, lying down with
the nose on the right side of the abdomen, or standing with the abdomen
tucked up and the back arched, halting movements of the limbs, wincing
if manipulation is made of the spine or the epigastrium, elevated
temperature, accelerated pulse and breathing, anorexia and perhaps
purging, mark the onset. So long as the liver is unaffected prostration
is not a marked feature.
Even when the liver is invaded, a fair measure of life and activity may
often be retained so long as the kidneys remain sound and active. The
bile pigments and salts, and the toxins generated by the invading
microbes are alike eliminated in large part in the urine, and the
profound poisoning and prostration of the nervous system are in a
measure prevented. In many cases therefore the urine is strongly
jaundiced without much or any discoloration of the mucosæ and in such
cases the prospects are usually good for an early and complete recovery.
It must not, however, be inferred that such a happy issue will always
follow, as the pigments are by no means as toxic as are other hepatic
products and fatal results may ensue with very slight jaundice of the
tissues.
As a rule, however, the jaundice of the tissues (eyes, nose, mouth,
white portions of the skin) is to be accepted as a grave manifestation,
indicating either an excessive production and absorption of bile, or a
suppressed secretion through the kidneys, or both. Then the poisoning by
biliary salts and bacterial toxins is shown in profound dullness,
prostration, muscular weakness, indisposition to rise, moving stiffly
and only when dragged by the collar, the limbs trembling and the back
arched. The tender back is arched, the right hypochondrium sensitive,
the expression dull, stupid and listless, and constipation or a fœtid
diarrhœa is liable to set in. The heart beats may be strong and
irregular, the breathing is easily disturbed and hurried. The
temperature at first 104° to 107° may descend to the normal as the
system becomes charged with the toxic products, and does not usually
exceed 99.5° after two or three days of jaundice of the tissues.
The icterus is shown in the eye or mouth, or on any white portion of the
skin, and in the urine it will be detected by the eye or by the tests
above given.
In the worst cases the urine is very scanty and of a deep yellowish
brown color, prostration is extreme, tympany, colic, obstinate
constipation or bloody diarrhœa may set in, the breathing, hurried or
not, is trembling, the pulse small, and the temperature at first high
may descend to 95° or even much lower before death.
The _course_ of the disease varies according to its gravity. If there is
complete retention of bile, and abundant production of toxins, the
animal dies in one or two days in a state of collapse. If there is
general progressive degeneration and destruction of the hepatic tissue
without at first absolute suppression of the discharge of bile into the
duodenum, the patient may last till the fourth or fifth day, or later.
_Lesions._ There are usually congestion, tumefaction, friability,
ecchymosis and even ulceration of the gastric and duodenal mucosa. The
organs are empty, but show a reddish brown exudate of a glairy
consistency, and containing red blood globules and pus corpuscles. The
same inflammatory lesions are to be traced into the common bile duct,
the cystic duct and bladder, the biliary ducts, and the acini. The mouth
of the common duct is usually blocked with a plug of tenacious mucus,
the gall bladder having been unable to expel this and the inspissated
bile into the intestine. The liver is slightly enlarged, yellowish, with
patches of brownish yellow more or less deep, and the acini contain an
abundance of oily globules, and yellowish brown granules. The acini have
no clear line of delimitation, and the contained hepatic cells are
shrunken and distorted, standing apart from each other in a dropsical or
watery medium.
The kidneys are congested and ecchymosed; the cortical substance brown,
friable, and with numerous areas of necrosis of a bluish white color,
and even abscesses. The medullary substance is yellow and the
uriniferous tubes contain an abundance of yellowish brown granules.
The lungs have a yellowish red color, with patches of ecchymosis.
The lymph glands generally are congested and many of them gorged with
blood, of a dark red color, and lacking in consistency and cohesion.
_Diagnosis._ The characteristic icterus is lacking in the early stages,
and active treatment gives good hope of success. When indigestion,
persistent vomiting and tenderness of the epigastrium, and right
hypochondrium, are associated with diarrhœa, it is highly important to
examine the urine for even slight traces of bile. When the jaundice is
due to impaction of a biliary calculus, the symptoms may increase
slowly, and yet reach a sudden climax with acute colicy pains and
tenderness of the right hypochondrium.
_Prognosis._ In acute rapidly developing cases a fatal issue is to be
expected. In those which develop more slowly, recovery may be hoped for
if early treatment is instituted.
_Treatment._ Cases due to biliary calculus must be treated for that
lesion.
In purely infective icterus attempts must be made to arrest the
intestinal and hepatic fermentation. As intestinal antiseptics,
naphthol, benzo-naphthol, naphthaline, 5 grains four to six times a day.
As hepatic antiseptics, salol 5 grains, salicylate of soda 8 grains, or
calomel 1 grain four times a day. The salol and salicylate tend to
increase biliary secretion and to render it more fluid. The same end is
attained by alkalies (carbonates of potassa, or soda or lithia,
bitartrate of soda, iodide of potassium). These are further valuable in
hastening the elimination of toxic matters by the kidneys. The expulsion
of bile, and of intestinal microbes and toxins may be sought by laxative
doses of Glauber salts, or by cold enemas of the same. Verheyen
recommends aloes in laxative doses for six days. Siedamgrotzky had good
results from induction currents of electricity, sent through the region
of the liver twice a day for ten minutes on each occasion. To assist in
elimination abundance of pure water or of watery fluids may be used. The
most effective eliminating agent is pilocarpin in ⅙ gr. dose
hypodermically, repeated daily. In weak conditions frequent small doses
of strychnia, ether, aqua regia, or digitalis may prove valuable.
In case of improvement a course of bitters is usually demanded, and
these may be combined with hydrochloric acid or small doses of sodium
bicarbonate.
Throughout the disease, gruels, beef tea, buttermilk, whey or any simple
nutritive aliment which the animal relishes may be given, but both then
and during convalescence fatty matters and indigestible materials should
be carefully withheld.