At the beginning of these attacks of snorting, which are produced by the

reflux of pus from the sinus towards the nasal cavities, the respiration

becomes snoring and rapid, and the animal makes sniffing movements as

though the nasal cavities were partially obstructed. After these crises,

the respiration again becomes silent.

Contrary to what has been observed in purulent collections in the

frontal sinus, the discharge is unilateral, reddish yellow in colour,

viscous in consistence, and is accompanied by clots of a gelatinous

material or even of blood.

During the attacks of snorting, the discharge resembles that of croupal

or pseudo-membranous bronchitis, but the material discharged is not

moulded on the internal shape of the bronchi. The masses of discharge

are irregular in form, and appear as though made up of fibrous tissue

matted together. Attention having been attracted by the discharge,

exploration of the trachea and chest reveals nothing; on an examination

of the sinuses, however, palpation and percussion betray a certain

amount of sensitiveness, together with partial or complete dulness, and

the lesion is discovered.

=Diagnosis.= Confusion between pus formation in the maxillary and

frontal sinuses can be avoided by careful examination.

=Prognosis.= The prognosis is not very grave; the animals maintain their

appetite, but become thinner, and the condition shows no tendency to

spontaneous cure.

=Treatment.= The only rational treatment consists in trephining, an

operation practised immediately above the maxillary tuberosity and over

the lowest part of the sinus (Fig. 164). This opening allows the cavity

to be washed out and the sinus drained.

Antiseptic treatment exactly resembles that of purulent collections in

the frontal sinus. Injections of astringents, dilute carbolic acid and

iodine solutions, etc., are recommended.

ŒSTRUS LARVÆ IN THE FACIAL SINUSES OF SHEEP.

(FALSE STURDY.)

=Causation.= This disease of sheep, which sometimes produces vertigo

resembling that shown in gid or sturdy, is produced by the growth of

larvæ of _Œstrus ovis_ in the frontal sinuses. The œstrus of the sheep

assumes perfect insect form during the fine days of summer from July to

September. The females swarm around the flocks and attempt to alight on

the animal’s head close to the nostrils, where they deposit their eggs

or larvæ. The larvæ crawl into the nostrils, thence into the nasal

cavities, the meatus, and finally the sinuses, where they become fixed.

In these sinuses they undergo complete development, increasing from a

length of about ⅒ inch to from ¾ to 1 inch before their transformation

into the nymph and perfect insect. They remain in the sinus for eight to

ten months. When numerous and well developed they may fill the whole of

the cavity.

=Symptoms.= It is easy for a careful observer to note the time at which

the larvæ penetrate the sinus. During the hottest hours of the day the

adult insects are continually hovering over the flocks, and on watching

carefully one sees sheep suddenly become excited, tap with their feet,

rub their faces against any hard, resisting object in the neighbourhood,

plunge their nostrils into the dust, and snort violently.

When the larvæ have penetrated the nasal cavities they produce frequent

attacks of sneezing by irritating the mucous membrane, and cause an

intense sero-mucous and afterwards a moderate muco-purulent coryza. As

long as the larvæ remain of small size, the apparent results they

produce are insignificant, as during the first months of winter; but

when they are numerous, and have become of considerable size, they cause

symptoms which might suggest an attack of gid or sturdy.

Thus the bodily movements become spasmodic, the gait irregular, and the

animals show attacks of vertigo. They stagger and fall, making

convulsing movements, grinding their teeth and rolling their eyes, while

frothy saliva escapes from the mouth, etc.

Death may occur during such attacks, which, however, are happily very

rare. Most commonly the animals are simply dull and somnolent. They feed

badly, carry their heads low, and sometimes hide themselves under the

mangers or in corners.

In exceptional circumstances they bury their heads in the wool or carry

them high in the air in walking, while they lift their front legs high,

with a stepping movement.

[Illustration: $1]

=Diagnosis.= The diagnosis of parasitic invasion of the sinus in the

sheep is rather difficult, because certain of the symptoms suggest gid.

One never finds the signs of true gid, however, and, on the other hand,

a certain amount of discharge and attacks of snorting always exist.

Finally, gid (cœnurosis) only attacks young animals, whilst the larvæ of

œstridæ are commonest in adults.

To confound the disease with verminous bronchitis is still less likely,

for although a discharge exists in both cases, this is accompanied by

cough in bronchitis, and only by sneezing attacks in infection of the

sinuses.

Finally, in bronchitis, histological examination leads to the discovery

of eggs or embryos of the strongyles. The diagnosis becomes very easy on

post-mortem examination, the identification of the larvæ of œstridæ

being extremely simple.

=Prognosis.= The prognosis is only grave when infestation is very

pronounced. Most commonly the parasites complete their development

without producing disquieting symptoms; as summer approaches they are

expelled and recovery occurs.

=Lesions.= The only lesions consist in very active inflammation of the

mucous membrane of the sinus, which appears excessively hypertrophied,

and in the existence of larvæ. These develop in the midst of a magma of

purulent, fœtid discharge. The number of parasites usually ranges from

two to twenty, although Zürn declares that he has found as many as

eighty in one subject.

=Treatment.= Many precautions have been suggested for preventing

infestation. Many are impossible or difficult to carry out in current

practice, even the soaking of the nostrils in empyreumatic oil, and the

majority are useless. The only suggestion to which we attribute any

importance consists in trying to prevent the perfect insects from

obtaining a lodgment in cavities in the walls or roofs of sheep-sheds.

The really efficacious modes of treatment are also few in number, for

the larvæ are so firmly lodged in the mucous membrane of the sinuses

that they can only be detached after these have been trephined. The use

of nasal injections, embrocations and powders, with the object of making

the animal sneeze, are ineffectual.

Trepanation should not be performed until it is quite clear that the

flock is badly infested, and when serious symptoms appear to threaten

the lives of some of the animals.

The operation, although very simple, requires care on account of the

thinness of the bones.

The anatomical directions are the middle line of the head, and a

transverse line uniting the upper margin of the two orbits. The orifices

are made in the two lower angles produced by the intersection of these

lines (Fig. 169).

It is then easy to remove with the fingers or forceps the larvæ situated

immediately below the point of trepanation, and afterwards to wash out

thoroughly the cavities of the sinuses. If some lie at points which

cannot be directly reached, they can be killed by injecting a little

benzine and water. This proceeding is quite safe.

CHAPTER III.

LARYNX, TRACHEA AND BRONCHI.

LARYNGITIS.

Laryngeal diseases are common, but are usually only the local expression

of some grave general infection, such as foot-and-mouth disease,

gangrenous coryza, or tuberculosis. Pathological conditions such as

these can be disregarded for the moment, as they will receive attention

under special heads.

The two current forms of laryngeal disease are acute laryngitis and

stridulous laryngitis.

ACUTE LARYNGITIS.

Acute laryngitis, like simple coryza, of which it is often only an

accompaniment, is caused by chill, by irritant vapours, by smoke, etc.,

or by external traumatic causes.

The cough is dry and painful at first; afterwards it is accompanied by a

discharge or by the swallowing of mucus or muco-purulent products. The

respiration sometimes appears accelerated and difficult, but roaring or

whistling and marked fever are rare. The slightest pressure over the

laryngeal region causes pain and attacks of coughing. The respiration is

normal while the animal is at rest, provided that the laryngitis remains

localised; frequently, however, it is complicated with bronchitis.

The appetite is somewhat diminished, but all these symptoms very rapidly

improve.

=The diagnosis= is based on the frequency of the cough and the

sensitiveness of the throat region.

=The prognosis= is favourable in cases of simple laryngitis.

=Treatment= consists in the administration of steam inhalations, warm

drinks, the application of mustard plasters or blisters around the

laryngeal region, and the administration of expectorants to facilitate

mucous discharge.

PSEUDO-MEMBRANOUS LARYNGITIS.

Pseudo-membranous laryngitis, also termed by German authors croupal or

diphtheritic laryngitis, because it bears a certain resemblance to human

croup, is characterised by the formation of false membranes on the vocal

cords, arytenoid cartilages, and subglottal region, etc.

In France it has been described under the name of stridulous laryngitis,

because its dominant symptom consists in attacks of intense dyspnœa,

during which the respiration is accompanied by whistling. Without making

any attempt to prejudge the nature of the disease, which resembles the

pseudo-diphtheritic forms of laryngitis in man, we prefer the term

pseudo-membranous laryngitis. Moreover, this pseudo-membranous

laryngitis very frequently accompanies pseudo-membranous sore throat,

tracheitis and bronchitis, with formation of false membranes.

=Causation.= The causes suggested are similar to those of simple sore

throat: they include chills, the ingestion of ice-cold water, or the

inhalation of irritant gases, during outbreaks of fire, etc., etc.; but

it is quite certain that here, as in many similar cases, a primarily

simple laryngitis is complicated by a well-marked infection.

=Symptoms.= The general symptoms seen during the early stages consist in

loss of appetite, general depression, rigors, and a rise in temperature

of 1° to 2° Fahr.

Then, after twenty-four or forty-eight hours, the respiration becomes

more rapid, difficult, whistling and dyspnœic, with intermittent attacks

of suffocation.

Examination of the chest gives negative results, but, on the throat

being manipulated, the slightest pressure exercised over the larynx

produces attacks of coughing. During the first few days these attacks

are loud, spasmodic, and difficult, but on succeeding days they lead to

the discharge, from the nostrils or mouth, of masses of false membrane

accompanied by whitish and sometimes blood-stained fluid. Secondarily

the mucous membrane of the nasal fossæ appears inflamed to a varying

degree. The conjunctiva is also affected, the eyes are watering. An

important symptom consists in the fact that this watering is accompanied

by internal ophthalmia, as in gangrenous coryza.

In consequence of the respiratory difficulty, the animal takes up a

characteristic attitude, holding its neck stiffly in a horizontal

position and its head completely extended; the nostrils are widely

dilated. When the disease is fully-developed rumination is suppressed,

the bowels are constipated and the fæces are coated as in grave cases of

enteritis, the yield of milk diminishes, the heart beats feebly, the

pulse remains small; death may occur from asphyxia, and probably also

from intoxication.

The disease usually lasts from eight to ten days, but death may occur

earlier. In the majority of cases, however, the animal can be saved. All

the symptoms diminish, the temperature falls, rumination again appears

and with it appetite, and the whole condition becomes normal. Many

animals, however, remain thin and recover slowly; these are principally

cases which have suffered from pseudo-membranous bronchitis.

=Lesions.= The lesions may be confined to the larynx, but may also

invade neighbouring cavities. They consist in the formation of

mucoalbuminous and fibrinous exudates, covering the mucous membrane in

superposed layers, penetrating the epithelial stratum, and adhering so

strongly to the corium that attempts to loosen them cause the deeper

seated structures to bleed.

=Diagnosis.= The symptoms are sufficiently well marked to prevent any

confusion arising except with gangrenous coryza, but in this case there

is no ophthalmia lesion of the nasal cavities, cutaneous eruption, or

eruption over the claws.

=The prognosis= is grave when the disease attacks debilitated or

exhausted animals.

=The treatment= is confined entirely to treating symptoms. As in all

acute inflammatory affections, moderate bleeding, sinapisms over the

region of the larynx, repeated as often as necessary, or applications of

antimonial ointment have been recommended. Applications of moxas or

setons in the neighbourhood of the dewlap might possibly prove of value.

Internally tartar emetic, in doses proportioned to the size of the

animal (2½ to 3 drachms in adults), has been recommended; also iodide of

potassium.

General stimulants, like alcohol, coffee, tea, acetate of ammonia, and

suitable hygienic conditions suggest themselves. Tepid drinks can be

given freely. Nourishing and easily digested food, and a ration of milk

complete the treatment.

Emollient and antiseptic fumigations are also of value, as in ordinary

sore throat or laryngitis, for they favour the separation and discharge

of the false membranes.

TUMOURS OF THE LARYNX.

Acute forms of pseudo-membranous laryngitis, or even tuberculous

laryngitis, are not the only diseases which affect the larynx. It is by

no means exceptional to discover intra-laryngeal tumours, mucous polypi,

tuberculomes, and growths due to actinomyces, etc.

The presence of these tumours is indicated by difficulty in respiration,

fits of coughing, and threatened suffocation, accompanied by discharges

of varying character.

When the tumour is largely sessile, the respiration may simply be

snoring or whistling, without any suggestion of suffocation; but if, on

the other hand, it is pedunculated, displacement of the polypus produced

by the currents of air during inspiration and expiration causes spasm of

the glottis, fits of coughing and threatened suffocation.

=The diagnosis= is not always easy, though examination of the nasal

cavities, the sinuses, trachea and chest gives negative results.

Auscultation of the larynx may suggest the existence of the lesion, but

an exact diagnosis can only be attained by digital examination of the

larynx through the pharynx.

[Illustration: $1]

=The prognosis= of these tumours is grave, because death from asphyxia

may occur during an attack of coughing or as a consequence of the fits

of suffocation.

=Treatment.= As it is usually extremely difficult, if not impossible, to

discover the exact nature of the tumour, medical treatment, except for

instance in the case of actinomycosis, is of very uncertain value.

Surgical treatment alone suggests itself. Before attempting an operation

tracheotomy should be performed and a metal canula inserted. The animal

having been cast, and the upper laryngeal region anæsthetised by means

of cocaine, a vertical incision is made in the median line below the

larynx, passing through the skin, the vertical junction between the neck

muscles and the three first circles of the trachea, and access is thus

obtained to the larynx and subglottal region. The operation should only

be performed in exceptional cases, such as that of a valuable stud

animal.

Provided that the new growth has a well-developed pedicle it can be

removed through the mouth by the use of an _écraseur_ or simply by

tearing out.

BRONCHITIS.

Diseases of the bronchi in bovine animals reveal very different

characters, according to the nature of the primary cause, for which

reason cases occur of simple acute bronchitis, verminous bronchitis,

simple chronic bronchitis, pseudo-membranous bronchitis, tuberculous

bronchitis, etc.

SIMPLE ACUTE BRONCHITIS.

Simple acute bronchitis co-exists with, or is often only the logical and

inevitable complication of, coryza and acute laryngitis. It is commonly

associated with inflammation of the mucous membrane of the trachea.

It accompanies cold and wet seasons, and usually appears with the autumn

frosts, in animals still at grass. In animals under shelter it occurs

after undue exertion followed by chills, and after sudden rain storms.

It also attacks working oxen, which are much exposed to the weather.

=The symptoms= follow very rapidly on the determining cause. They are

ushered in by rigors, trembling attacks, diminution or loss of appetite,

arrest of rumination, acceleration of breathing, and the appearance of a

rough and spasmodic cough.

In ordinary cases these symptoms rapidly diminish, even without

treatment. The appetite again becomes moderate, rumination returns, but

the cough remains more or less rough and spasmodic, ending in the

discharge, or more often in the swallowing, of abundant bronchial mucus.

This is the condition at the period of crisis. Percussion of the thorax

reveals normal resonance. On auscultation of the sides during the period

of onset, rough _râles_ are heard, which at the period of crisis are

replaced by mucous _râles_. The cough diminishes in frequency, and after

a fortnight everything again becomes normal.

=The diagnosis= is very easy, the important point being not to confuse

common bronchitis with tuberculous bronchitis, which very often assumes

a chronic form.

=Prognosis.= The prognosis is not grave, even though the disease may

assume a chronic condition.

=Treatment= does not differ from that of acute bronchitis in the horse.

It consists in antiseptic and steam fumigations, tepid drinks, the

administration of doses of 2 to 3 drachms Kerme’s mineral in adult

animals, and of 1 to 1½ drachms of iodide of potassium, given in a mash

or in honey electuary. During convalescence tar water should be

administered.

CHRONIC BRONCHITIS.

Chronic inflammation of the mucous membrane of the large bronchi and

trachea may follow acute bronchitis, but it is also a frequent

termination of verminous bronchitis. It is found in fully developed

animals, adult or old, and particularly in those inhabiting wet, cold

valleys.

It is characterised by frequent paroxysms of coughing, which appear on

the slightest provocation, such as the action of cold air on leaving the

stable or of the air of a confined space on animals returning from the

open; concussion of the chest by the pleximeter, squeezing of the loins,

rapid movement, etc.

This coughing is accompanied by the discharge of mucus, which rarely

arrives at the nostrils, but is swallowed in passing through the

pharynx. Such mucus is always thick, greenish yellow in colour, and

without smell.

The respiration, although regular whilst the animal is at rest, becomes

accelerated on moving, and after attacks of coughing. It is sometimes

rapid and whistling.

Percussion discloses neither partial nor complete dulness, but

everywhere irregularly distributed mucous rattling and sibilant _râles_

are revealed by auscultation.

There is no fever, the appetite is maintained, and, what is an even more

important point, animals in good condition preserve their flesh.

Interlobular pulmonary emphysema and emphysema resulting from dilatation

are inseparable accompaniments of chronic bronchitis, for which reason

the flank respiratory movement is frequently very marked.

=The diagnosis= is of only moderate difficulty, because although in

certain conditions the disease may be mistaken for tuberculosis or

emphysema, it can be distinguished by bacteriological examination of the

discharge, by an injection of tuberculin, by careful auscultation, and

by consideration of the general condition.

=Lesions.= The walls of the bronchi are thickened, the submucous

connective tissue is sclerosed, the muscular fibres are modified in

structure, and have become fibrous, while the epithelial layer is

desquamated and suppurating. The peribronchial tissue also undergoes

sclerosis, and in certain cases the smaller bronchi present marked

dilatations resembling small caverns (bronchi-ecstasis).

=Treatment= can never be more than palliative; the aim should be to

prevent the lesions becoming aggravated, and to check the pathological

secretion from the bronchi, but the lesions already existent can never

be removed. Tar water should be perseveringly administered. Essence of

turpentine in doses of 2 to 2½ drachms per day in electuary (adults),

creosote in doses of 1¼ to 1½ drachms, and terpine in doses of ¾ to 1

drachm give the best results, and produce a marked improvement.

PSEUDO-MEMBRANOUS BRONCHITIS.

The pseudo-membranous forms of bronchitis, formerly termed “croupal or

diphtheritic bronchitis,” are rare. They develop suddenly or follow

pseudo-membranous laryngitis. Like the latter, they are due to a

specific infection, possibly aided by accidental causes.

Their =causation= is imperfectly understood, and they cannot be

compared, still less homologated, with diphtheritic disorders in man.

They are characterised by the formation of false membranes, which

develop on the mucous surface, mould themselves over the internal

surface of the large bronchi, and ramify throughout the bronchial

channels like branches of trees. They are of greyish-yellow colour, and

appear to be formed of fibrin, coagulated albumen, and epithelial

_débris_ cemented together with mucus.

=Symptoms.= At the outset these pseudo-membranous forms of bronchitis

have the same characters as acute bronchitis, which at the crisis would

be marked by the expulsion of fragments of false membrane by coughing.

Most frequently it seems that the bronchitis follows its regular course,

and in such case it is only during convalescence or a considerable time

afterwards that the membranes begin to be discharged during paroxysms of

coughing.

The patients are subject to intense dyspnœa, appear about to suffocate,

and during the efforts then made the false membranes are discharged in

the form of half-organised layers, or, on the other hand, in branched

masses, resembling twigs.

The dyspnœa at once ceases. Despite the development of these false

membranes in the bronchi, no alarming symptoms are produced, which is

explained by the fact of the false membranes being adherent only to the

inner surface of the principal conduits, without closing or even

markedly obstructing them or the smaller passages leading to the

pulmonary alveoli. When, however, they are displaced, violent reflex

spasms are produced as soon as the fragments approach the larynx.

=Diagnosis.= The diagnosis rests entirely on examination of the

expectorated material.

So far as the =prognosis= is concerned, it is less grave than might be

supposed from the symptoms. The gravity arises from the fact that this

disease has a certain tendency to become chronic.

=Treatment= scarcely differs from that of ordinary bronchitis. Tar,

creosote in doses of 2½ to 5 drachms given in oil; terpine in doses of ½

to ¾ drachms per day can be recommended. Iodide of potassium also has

certain advantages.

VERMINOUS BRONCHITIS IN SHEEP AND CATTLE (HUSK, HOOSE, ETC.).

Lambs, young sheep, and calves sometimes suffer severely from

infestation with lung worms, which set up great irritation in the

bronchial passages, leading to chronic bronchitis. The animals show

frequent attacks of paroxysmal coughing, during which some of the

parasites may be expelled. The irritation produced causes serious loss

of condition, and if not alleviated may lead to death. The parasite of

the sheep is known as _Strongylus filaria_ (sheep lungworm), that of the

calf _Strongylus micrurus_. The worms are from 2 to 4 inches long,

whitish in colour, and of the diameter of a hat-pin.

=Treatment.= According to generally accepted views among veterinarians

and zoologists, it is a comparatively simple matter to kill worms in the

bronchial tubes, and a number of cases of the disease are reported in

literature which are alleged to have been cured. These views, however,

are open to very serious doubt.

Neumann (1892b, pp. 590, 591, 593, 594) summarises the subject of

treatment as follows:—

Two different procedures in treatment are pursued. In one, substances

are passed into the digestive canal, which, being diffused in the blood,

are believed to be capable of attacking the worms in the bronchial

tubes. With this view, the picrate of potash (0·20 to 0·40 gram per

head) is given, dissolved in thin gruel or mucilage; creosote; oil of

turpentine; a mixture of equal parts of oil of turpentine and tincture

of camphor—a teaspoonful every day to each lamb in a mucilaginous fluid;

a mixture of creosote 120 grams, spirits of wine 500 grams, and water

700 grams—an ordinary spoonful every day to each animal; or creosote 60

grams, benzine 300 grams, water 2 litres—an ordinary spoonful given

every day for eight days to each sheep. Hall states he has successfully

employed prussic acid in ten-drop doses, morning and evening.

But experience has shown that, while such treatment is troublesome to

carry out, its efficacy cannot be relied upon.

Success is more certain with fumigations, as they penetrate directly to

the worms, stupefy them, and induce fits of coughing that cause

expulsion. They are practised in buildings from which all forage is

previously removed, and which are well closed. Into these the diseased

[animals] are introduced, and on a red-hot shovel are placed rags,

horns, feathers, hair, old pieces of leather, empyreumatic oil, tar,

juniper berries, asafetida, etc. The intensity, duration, and number of

these fumigations are graduated as the sheep become accustomed to them.

At first once a day may suffice, and then the intensity should be

moderate and the duration about ten minutes; afterwards two, and finally

three, may be given during the day, each lasting for twenty minutes.

Kowalewsky says he has obtained very good results from similar

fumigations. Fumigations with chlorine, sulphur, and sulphuret of

mercury or cinnabar have been recommended, but they are dangerous.

(Stephen recommends as follows: Put about forty lambs at a time into an

air-tight house, and place tar, sulphur, and turpentine in a pot of

burning coals, suspended by a chain from the ceiling and brought as near

to the heads of the animals as possible; the fumes are to be allowed to

fill the house, and more ingredients are added as required, the lambs

being kept in the place for twenty-five minutes each time, and the

process to be repeated on three occasions.)

Tracheal injections in the verminous bronchitis of calves are of great

utility; but for a flock of sheep they would be troublesome and

difficult to administer. However, Nieman, has successfully employed them

on 384 sheep belonging to several small owners. He used a solution of 2

parts iodine and 10 parts iodide of potassium in 100 parts of distilled

water. This fluid was mixed, in equal parts, with oil of turpentine, and

made into an emulsion with olive oil; each sheep received 5 to 8 grams

of the mixture, and the number of the injections varied according to the

gravity of the disease—from two to three at two days’ interval. The

worms were killed and expelled during the paroxysms of coughing, and the

bronchitis was modified.

The medical treatment should be assisted by very nourishing food, and by

bitter, stimulating, and ferruginous tonics, which arouse the digestive

functions and allow those animals which are least exhausted to reach the

period of elimination of the parasites.

At the commencement of any kind of treatment it is well to have an

examination of the flock, with the object of sending the worst cases to

the butcher.

The same medicaments have been employed in treating this malady in

calves as in that of sheep, and no better results have been obtained.

Neumann and Janné have, however, been successful with asafetida (30

grams), Chabert’s empyreumatic oil (60 grams), and a mucilaginous

decoction (500 grams)—a spoonful of this mixture being given in a half

litre of milk, and the treatment continued for about a month.

The results are less uncertain if the worms lodged in the bronchial

tubes are directly acted upon, either by means of injections of the same

kind as those employed for sheep, or fluid medicaments introduced

directly into the bronchi.

Read says he has cured calves worn down almost to skeletons by verminous

bronchitis by the following procedure: The head of the calf is slightly

elevated, and about 2 drachms of ether, chloroform, oil of turpentine,

or rectified oil of amber—single or combined—are poured into each

nostril and allowed to vaporize there; it will then, by the respiration,

be carried into the air passages, and thus destroy the filariæ. In some

cases it must be repeated two or three times, but once has frequently

the desired effect.

The method of treatment by intra-tracheal injection, introduced by Levi,

of Pisa, has yielded very satisfactory results. Levi has been completely

successful with a sheep. Éloire has employed it in sixteen calves

affected with the disease, and all were cured. He used the following

mixture: Black poppy oil, 100 parts; oil of turpentine, 100 parts;

carbolic acid, 2 parts; purified cade oil, 2 parts. Each calf received

10 grams of this mixture daily for three days.

The injection, which should be given slowly, is followed by a fit of

coughing, and the expired air has the odour of turpentine. This

treatment has also been successful at Milan. Similar favourable results

have followed Hutton’s treatment of eight calves, some of which were in

the last stage of verminous bronchitis. He employed a mixture of oil of

turpentine, tincture of opium, pure carbolic acid, and water—the oil of

turpentine forming one-half of the mixture. The dose was ½ an ounce, and

in the serious cases this was given every day for three days, and in

other cases every second or third day. Kriwonogow has likewise cured

twenty-two calves by giving each of them two tracheal injections of 8

grams of the following mixture: Essence of cloves and oil of turpentine,

360 parts of each; carbolic acid and olive oil, 30 parts of each.

(Williams speaks highly of the administration of prussic acid. Penhale

gives—by intra-tracheal injection, and slowly—oil of turpentine 2 drams,

carbolic acid 20 minims, and chloroform ½ a dram.)

CHAPTER IV.

LUNGS AND PLEURÆ.

PULMONARY CONGESTION.

Besides passive congestions of the lung, which it is unnecessary to

describe here, and which result from cardiac or pericardiac affections

or the compression of important vessels, there sometimes occur,

particularly among young animals, cases of active congestion of the

lung. Such cases are produced by over-exertion on the part of animals

which have escaped from control or have been chased by dogs.

They are most common in animals usually kept in stables, but which have

accidentally escaped, or in very fat animals.

Dyspnœa and cough are the chief =symptoms=. The animals stop as though

exhausted, extend their neck and head, dilate their nostrils and thrust

their limbs out on either side of the body, while at the same time they

appear in a condition of terrible distress.

The respiration is rapid and short, the patient can scarcely breathe,

and asphyxia seems imminent. On auscultation it seems that the

respiratory murmur has disappeared over almost the entire extent of the

lung.

Death may occur very quickly.

=The diagnosis= is extremely easy, provided that the history is known.

=The prognosis= is grave.

One of the most successful methods of =treatment= consists in free

bleeding. In a great majority of cases this causes the symptoms to abate

as though by enchantment. Cutaneous stimulation by mustard and similar

irritants, as well as ablutions of cold water, are useful. The animal

should be placed in a very airy spot.

SIMPLE PNEUMONIA.

=History.= Veterinary surgeons have long been divided in opinion on the

question whether simple pneumonia occurs in animals of the bovine

species. Whilst some affirm it, others think that all lesions of the

lung in the ox, apart from pneumonia due to foreign bodies, should be

regarded as of the nature of peripneumonia.

Some ten years ago two veterinary surgeons of the department of the

Aisne, Coulon and Ollivier, practising in a district where peripneumonia

rages, made some extremely interesting observations on pneumonia in the

ox. Their object was to distinguish between contagious peripneumonia and

simple pneumonia during life, simple pneumonia having formerly been

regarded as a non-contagious peripneumonia. Despite the rather

unfavourable conditions in which ordinary practitioners are frequently

placed, these gentlemen performed a work of great value. The facts which

point to the occurrence of simple pneumonia are as follows:—

=The disease= is not contagious. One may allow affected animals to mix

with normal subjects without the disease being communicated. Pulmonary

exudate from cases of simple pneumonia can be injected into the dewlap

and hind quarters of young and adult animals, without pathological

results.

=The lesions= and =course= of simple pneumonia entirely differ from

those of peripneumonia.

=Causation.= Simple pneumonia is not common, and only occurs quite

exceptionally in fat stock, or in milch cows kept in stables at a

regular temperature, as in the north of France and near Paris.

It occurs most commonly in working animals, which are exposed to

variations in temperature and to chills. By causing vascular

disturbance, chill favours microbic infection and visceral inflammation.

Trasbot has described the case of an ox which, after having worked hard,

and whilst freely sweating, was left exposed to the wind under a shed

for about three hours. This animal contracted unilateral pneumonia the

following day.

Coulon and Ollivier have seen the disease in animals living in damp,

low-lying valleys, or valleys exposed to the north wind, which are

exposed in consequence to great variations in temperature.

=The symptoms= follow almost the same course as in the horse, and one

may distinguish three periods:—

=I. Period of onset.= The symptoms which mark the onset of the disease

are moderate fever, which progressively increases, and acceleration of

respiration and of circulation. The number of the respiratory movements

rises to twenty or twenty-five per minute, those of the pulse to fifty,

sixty, or eighty. The conjunctiva becomes injected, and then of a yellow

tint. At this period the appetite never disappears completely,

rumination is regular, and there is neither tympanites nor colic.

These general symptoms, which are not of special significance, are

supplemented by more precise local symptoms—an abortive, difficult and

painful, cough which is easily induced, and a whitish discharge. The

rusty expectoration which is characteristic of simple pneumonia in the

horse and in man has never been observed.

Percussion discloses partial dulness, usually on one side, in the lower

region of the chest: the respiratory murmur in this region is

ascertained by auscultation to have diminished, whilst in the upper part

and also on the opposite side the respiratory murmur is increased.

=II. Period of exacerbation.= This period is characterised by

accentuation of all the symptoms: the temperature rises, and may attain

104° Fahr.; the submaxillary artery is tense; the dulness becomes more

marked, whilst crepitant and mucous _râles_ are heard. In the portions

still unattacked the function of the lung is exaggerated in order to

make up for the defect of the diseased parts, and the respiration

becomes juvenile.

The appetite, which previously had been maintained, diminishes

considerably, without, however, entirely disappearing, and intense

thirst sets in, as a consequence of the fever.

=III. Period of crisis.= The general symptoms remain stationary for four

or five days; the respiration, which is always affected, sometimes

becomes as rapid as thirty to forty per minute; the tubal souffle which

invariably occurs in pneumonia of the horse is not always clearly

audible.

=Terminations.= (1.) Resolution.—This is indicated by the attenuation of

all the symptoms and the disappearance of fever, which gradually sinks

from 105° to 101° Fahr. The respiratory movements become fuller and

fewer in number, the pulse slower, and the artery softer and more

compressible. The cough changes its character, is stronger, more

sonorous and prolonged, and is accompanied by the free discharge of

muco-pus. The dulness descends, and the tubal souffle, if previously

existing, is replaced by the returning crepitant _râle._ In general the

disease runs its course in eight to ten days in young and in fourteen to

fifteen days in aged subjects.

(2.) Death by asphyxia is almost the only fatal termination of pneumonia

in the ox. It occurs in one-third to one-fourth of the subjects

attacked. Its approach is announced by a deep mahogany-red coloration of

the conjunctiva. The pulse becomes very rapid, 100 to 110 per minute,

thready, small, and almost imperceptible, whilst the beating of the

heart is strong and tumultuous. Respiration is rapid and very laboured

(50 to 70 per minute). The animal’s attitude is typical; it stands with

its limbs thrust out, its head extended, its nostrils dilated, and its

mouth half open, discharging foamy and viscous saliva. Throughout the

greater portion of the lung gurgling sounds and crepitant mucous _râles_

can then be detected.

(3.) Cases ending in gangrene and suppuration are excessively rare, and

others resulting in chronic pneumonia have not been authoritatively

described.

Pneumonia is distinguished from broncho-pneumonia by the existence of

dulness at the period of crisis, whilst in the case of broncho-pneumonia

this period is only marked by partial dulness, which is even then

sometimes slight. Moreover, broncho-pneumonia usually develops much more

slowly.

The disease, then, is distinguished from peripneumonia by the following

points:—

(_a_) By the character of the temperature curve, which is regular in

pneumonia, only attaining its highest point at the period of crisis,

whilst in peripneumonia it ascends suddenly, and presents sudden

oscillations.

(_b_) The appetite remains, although diminished.

(_c_) Sensitiveness in the region of the ribs is but feebly marked, or

is entirely absent, simple pneumonia not being accompanied by pleurisy.

(_d_) The dewlap never shows œdema, a symptom which usually accompanies

the period of crisis in peripneumonia, when the jugular veins and the

anterior vena cava are compressed.

(_e_) These signs alone are almost sufficient on which to base the

=diagnosis=, but they are often supplemented by two others, of some what

less importance (for in exceptional cases they may also be observed in

simple pneumonia), viz.—the absence in most instances of a membranous

sound, and of a well-marked souffle.

=Prognosis.= Two-thirds of the cases recover. This proportion might be

increased if the veterinary surgeon were called in at the beginning.

=Lesions.= Post-mortem examination reveals neither pleural exudate nor

pleural lesions. The lung is large and of increased weight, hepatised

along its lower borders, and congested in its upper part.

The sero-hæmorrhagic infiltration of the interlobular spaces varies,

according to the region examined: the upper regions are engorged and

black, owing to capillary hæmorrhages and blood clots, which completely

surround the pulmonary lobule, the latter being violet or brownish-red

in colour. In the hepatised portions the lobules are of a washed-out

reddish tint, and the interspaces of a whitish colour.

The bronchi are filled with frothy, whitish mucus; the small bronchi

sometimes contain fibrous concretions and the mucous membrane is

injected, and may be destroyed in places. The bronchial lymphatic glands

are enlarged, congested, and contain small hæmorrhages.

It is important in making a post-mortem examination to be able to

distinguish pneumonia from peripneumonia. This is comparatively easy if

one bears in mind that in the latter pleurisy always exists, that the

interlobular connective tissue spaces are always greatly distended with

a citrine-coloured serosity, that on section the peripneumonic lung

resembles a mosaic; and that, finally, the course of hepatisation is

centripetal, the inflammation commencing at the periphery of the lobule,

and progressively extending towards the centre. In pneumonia, on the

contrary, pleurisy is always absent; the interlobular connective spaces

are only distended slightly, if at all, and always contain a

brownish-red serosity: the course of hepatisation is centrifugal; it

commences in the pulmonary alveoli, and extends towards the periphery

and the interlobular divisions. The following table gives a _résumé_ of

the other differences between the two diseases:—

_Peripneumonia._ │ _Pneumonia._

│

Œdema of the dewlap. │No œdema of the dewlap.

Pleural exudate. │No pleural exudate.

Centripetal lobular hepatisation. │Ascending centrifugal lobar

│ hepatisation.

Extreme infiltration of the │Moderate infiltration of the

interlobular connective tissue │ interlobular connective tissue

spaces (primary yellow │ spaces (secondary reddish-brown

infiltration). │ infiltration).

=Treatment.= Good hygiene, regular ventilation, moderate warmth, and the

administration of tepid drinks facilitate recovery.

Certain German authors recommend cold compresses to the thorax, douches,

and cold enemata in pneumonia. We do not think that such treatment has

proved very successful, although it has been well tried.

The classic treatment commences with moderate bleeding, the free

application of mustard to the sides, the application of moxas, frictions

with antimonial or blister ointment, and the administration of draughts

containing 2 to 2½ drachms of tartar emetic per day, or considerable

doses of alcohol; and this treatment seems to have given the best

results. Antithermic agents, like acetanilide, phenacetin and quinine

sulphate, are too costly to be greatly used in bovine medicine.

Salicylate of soda is preferable.

In order to assist circulation, support the tone of the heart and avoid

engorgement of the lung and asphyxia; digitalis should be given in doses

of ¾ to 1 drachm per day, or digitalin in subcutaneous injections of 5

to 6 milligrammes, continued for five or six days. Finally, iodide of

potassium may be given in doses of 1 to 1½ drachms, to reduce

inflammation and as an expectorant.

PNEUMONIA DUE TO FOREIGN BODIES—MECHANICAL PNEUMONIA.

It may happen that in examining a patient pneumonia is diagnosed under

circumstances which seem to forbid its being regarded as simple or

primary. This may be explained by the fact that ruminants are very apt

to suffer from pneumonia produced by foreign bodies. The lung may be

penetrated either by some sharp object making its way forwards from the

rumen or reticulum or by liquid or solid material passing into the

trachea. These are two common methods by which this form of pneumonia is

produced.

PNEUMONIA DUE TO THE MIGRATION OF FOREIGN BODIES FROM THE RETICULUM.

=Causation.= The conditions under which food is swallowed by ruminants

after preliminary mastication permit indigestible objects, such as

stones, fragments of wood, nails, needles, bits of iron wire, etc., to

enter the rumen, whence they reach the reticulum in consequence of

peristaltic movements. Sharp, perforating objects, like needles or

fragments of iron wire, penetrate the walls of the gastric compartments,

and, impelled by the movements of these organs, pass through the

intervening tissues, usually in the direction of the heart. Under

conditions which cannot precisely be defined, these foreign bodies make

their way towards the pleural cavity (usually the right, in consequence

of the situation of the reticulum), traverse the diaphragm, and directly

penetrate the base of the lung.

As the migrating object is usually infected, its passage through the

diaphragm always produces a localised patch of diaphragmatic pleurisy.

Although possible, it is only rarely that the pleural sac becomes

generally infected, or that rapidly fatal septic pleurisy is set up.

Usually the localised pleurisy causes the base of the lung to become

adherent to the anterior surface of the diaphragm. The foreign body

continuing its movements, passes into the lung, and there sets up

pneumonia.

=Symptoms.= When the practitioner is first consulted he often finds only

indications of the crisis period of a localised pneumonia at the base of

the affected lung. The symptoms include fever, accelerated breathing,

moaning, loss of appetite, cough without discharge, dulness over the

base of the lung on percussion, disappearance of the respiratory murmur

in the dull area, souffle opposite the inferior bronchi, and normal or

juvenile respiration towards the front, _i.e._, in the anterior lobe,

and sometimes in the cardiac lobe.

The temptation under such circumstances is to deliver a diagnosis of

simple pneumonia with prognosis of probable recovery. It should be

remembered, however, that in all cases of basilar pneumonia without

affection of the anterior lobes there is a considerable chance of the

condition being due to the presence of a foreign body. On more careful

examination it is found that the intercostal spaces opposite the

affected region are very sensitive, and that the circle of the

hypochondrium is correspondingly sensitive. The owner, moreover, almost

always informs the practitioner that for several weeks his animal has

coughed, shown tympanites, diminished appetite, etc.

Compression of the roots of the corresponding diaphragmatic nerve at the

base of the neck always produces coughing.

These symptoms rarely accompany the development of simple pneumonia.

Furthermore, the =course= of this accidental pneumonia is entirely

different. Instead of developing regularly according to the

above-described cycle, pneumonia due to foreign bodies develops slowly,

and only becomes well defined after several weeks, whilst its tendency

is to grow more and more aggravated. The zone of dulness extends both in

a forward and upward direction. The souffle extends forwards.

Auscultation and palpation sometimes reveal the formation of an abscess

or local gangrene; while there is slight œdema of the wall of the chest,

as well as a gurgling sound at the moment when the lung is displaced,

high fever, intensely coloured urine, and very marked leucocytosis, etc.

Death is inevitable, and when gangrene exists it sometimes occurs

suddenly.

=Diagnosis.= The diagnosis is based on the information furnished with

regard to the course of the disease, the localisation of the hepatised

zone, and the progressive character of the affection.

The diagnosis, nevertheless, is always a little doubtful, but may be so

far assured as to attain the position of a quasi-certainty.

=Prognosis.= The prognosis is unequivocal.

=Treatment.= No practical treatment, either to extract the foreign body

or to combat the special pneumonia which it has produced, can be

attempted. All the interlobular connective layers and the lobules

themselves are invaded by various microorganisms carried by the foreign

body. Numerous fragments of tissue serve as centres of suppuration and

gangrene, and the only chance would lie in attempting resection of the

lung. Such intervention has no practical interest in veterinary surgery.

It is true that when the existence of an abscess is suspected, an

aseptic exploratory puncture may be made, and, in the event of the

diagnosis being so far confirmed, the abscess might be opened through an

intercostal space. Under such circumstances, however deep the point of

penetration of the foreign body, the development of the resulting

abscess causes local pleurisy and adherence between the pleura and lung,

so that there is no immediate danger of producing purulent pleurisy and

pneumo-thorax. If small the foreign body might possibly be discharged

through the passage thus afforded.

In practice the best plan is to recommend slaughter as soon as the

diagnosis becomes certain, provided that the meat can still be utilised.

PNEUMO-MYCOSIS DUE TO ASPERGILLI.

The term pneumo-mycosis, or pulmonary aspergillosis, is used to denote a

condition due to the growth in the respiratory apparatus of a fungus of

the order aspergillus (family, _Perisporiæ_; sub-order, _Perisporiaceæ_;

order, _Ascomycetes_).

In ruminants, as in all other animals, pulmonary aspergillosis occurs

accidentally, and may often pass unperceived, in spite of the

indications given by Lucet and Bournay regarding its development and

symptoms.

It seems most frequently to be caused by _Aspergillus niger_ and

_Aspergillus fumigatus_, particularly by the latter, which, according to

Rénon’s work, also appears to be the most pathogenic. It only develops

in animals whose respiratory apparatus is injured and is the seat of

such lesions as those of chronic bronchitis, bronchi-ectasis, and of

parasitic lesions or those containing cavernous spaces resulting from

abscess formation, etc., etc.

The fungi, or more properly the spores, which have accidentally

penetrated into the respiratory channels germinate and develop in the

pathological dilatations, causing disseminated areas of pneumonia and

some mechanical disturbance, but not producing intoxication by

liberating toxins.

=Causation.= Infection occurs through the air passages, in consequence

of the inspiratory current carrying spores of the fungi into the

ramifications of the bronchi, where they develop if the soil is

favourable. Development is favoured if the animals exposed to

contamination are in bad condition, or if, as sometimes happens, the

walls of the stables are not kept clean, and are covered with various

forms of fungi.

Prolonged feeding on musty fodder may also favour respiratory infection;

but it seems highly improbable that under ordinary conditions infection

can occur through the digestive tract. Infection of the lung must also

be regarded as exceptional, if one bears in mind the frequency with

which oxen are fed on musty or mildewed fodder and the small number of

accidents recorded.

=Symptoms.= The symptoms are obscure, and pulmonary aspergillosis is

often only discovered on post-mortem examination. A cough is the chief

symptom. It is dry at first. Afterwards it becomes spasmodic and

frequent.

Respiration is difficult, dyspnœic, effected only with effort, and

sometimes even discordant. Expiration is sighing.

Percussion reveals zones of partial or complete dulness when the lesions

are near the surface of the lung, which, however, is rare. Bournay has

noted the occurrence of a musical sound resembling that obtained by

tapping a small crystal or glass bell.

Auscultation is said to reveal rough or sibilant _râles_, but as the

lesions occur only in animals whose respiratory apparatus has already

been impaired, it is difficult to offer an opinion on the subject.

These signs are invariably accompanied by a certain amount of general

ill-health, wasting, and irregularity of appetite and of rumination.

On post-mortem examination the lung of the affected animal appears

strewn with nodules, varying in size between a hazel-nut and a walnut.

On section, Bournay claims to have found a wall or fibrous shell

covering a greenish cryptogamic growth, in the centre of which was a

yellowish, sharply defined kernel formed of masses of fungi (_Mycelium_,

_sterigmata_ and spores). In cases of rapid development, the pulmonary

tissue around the parasitic lesion is completely hepatised.

=Diagnosis.= Diagnosis is impossible without recourse to microscopic

examination of the discharge. This examination, which, however, is

somewhat difficult, may, after staining, result in the detection of

_débris_ of the mycelial filaments and of spores, with or without

bacilli of tuberculosis. The diagnosis as regards fungi can only be

assured by preparing cultures.

=Prognosis.= The prognosis is grave, because the disease is always

superadded to lesions, which of themselves would justify a sombre view.

=Treatment.= In consequence of the small number of observations

published and the difficulty in diagnosis, no rational treatment has

hitherto been laid down. From a purely theoretical standpoint,

fumigations with tar and essence of turpentine and the inhalation of

carbolic spray have been recommended. Life in the open air would,

without doubt, be equally or more efficacious. Preventive treatment

consists in withholding musty fodder and keeping the stables clean.

GANGRENOUS BRONCHO-PNEUMONIA DUE TO FOREIGN BODIES.

Foreign bodies which find their way into the trachea instead of the

œsophagus provoke in most cases broncho-pneumonia, which very rapidly

terminates in gangrene and death.

=Causation.= Forced feeding of sick animals which have lost their

appetite is one of the principal causes of this grave condition. In

order to administer food such as mashes, gruel, hay tea, etc., the

oxherds have a bad habit of lifting the entire head and drawing forward

the tongue whilst they pour the concoctions into the animal’s mouth. The

liquid cannot then be divided into portions, deglutition in the pharynx

is badly effected, and the substances administered find their way partly

into the larynx and partly into the œsophagus. In the case of

astringent, bitter, or highly stimulating drugs, a similar accident may

be caused by spasm of the pharynx or œsophagus, where the tongue has not

been left free and excessive quantities have been given.

Again, during the course of diseases complicated with paralysis of the

pharynx (cow-pox, parturient apoplexy), obstruction of the pharynx and

œsophagus (tympanitic indigestion), intense pharyngeal dysphagia

(foot-and-mouth disease), etc., the risk of broncho-pneumonia due to

foreign bodies is much greater still. It may even occur spontaneously in

animals in the enjoyment of complete freedom (foot-and-mouth disease).

Lastly, cases of broncho-pneumonia have been described as a consequence

of inhaling foreign bodies, when the animals are fed, for example, with

meal made from undecorticated cotton-seed. Under such circumstances the

lesions produced are similar to those of pneumoconiosis in man (the

chronic forms of pneumonia of miners, charcoal-burners, quarrymen,

stonemasons, etc.).

=Symptoms.= The symptoms of gangrenous broncho-pneumonia become apparent

immediately after the foreign body has entered the trachea. They

commence with a violent, spasmodic cough, produced by reflex action,

which in its turn is due to the laryngeal mucous membrane having been

touched. But this cough is now too late to be of use, for the food, drug

or liquid has passed into the depths of the trachea, and cannot be

ejected. The cough soon ceases, and the animals may even return to their

food. These appearances, however, are deceptive, for twelve, twenty-four

or forty-eight hours later the cough reappears, whilst appetite

diminishes. The attacks of coughing are succeeded by the discharge of a

greyish or reddish-grey offensively smelling material; respiration

becomes more rapid, the heart’s action violent, and the temperature

rises to 103° or even 105° Fahr. (39·5 to 40·5° C.).

The patients soon refuse all solid food, and if the chest is then

examined by percussion one finds partial dulness, rarely simple dulness,

over the cardiac lobes opposite the point where the girth passes. The

partial dulness may rise to a varying height on both sides; sometimes it

is confined to one side.

On auscultation the respiratory murmur in the upper two-thirds of the

lung appears exaggerated on both sides, and is found to have greatly

diminished, or disappeared altogether in the inferior zone.

Auscultation through the scapula almost always shows that the anterior

lobes are affected; but, at all events, in the examinations we have

made, checked by post-mortem examination, the cardiac lobes have always

proved to be most affected, a fact attributable to the direction of the

principal bronchi. The lower portion of the posterior lobes may also be

affected, but this is rarer. All the lower zone is irregularly

hepatised, and on auscultation one hears large moist _râles_, whilst

respiration sometimes appears of a blowing character, and divided by a

pause, but there is no tubal souffle. If the patient survive for a

certain time, the sounds heard on auscultation undergo change; gurgling

noises and sometimes true cavernous souffles are heard, as a result of

suppuration in the bronchi and gangrene of one or more areas in the

lung. Diffuse gangrene is rare, and the inferior zone is usually the

only portion affected.

During this phase the expired air has an absolutely characteristic

gangrenous odour.

Death occurs by asphyxia and intoxication, but some animals hold out for

a fortnight and more.

=Lesions.= Post-mortem examination reveals a suppurative but secondary

inflammation of the mucous membrane of the nasal cavities, pharynx,

larynx, and trachea.

In the bronchi, sometimes very deeply placed, remains of foreign bodies

are found in cases where some solid material has been inhaled. The

mucous membrane of the bronchi is violet in colour, in places appears to

be sloughing, and is covered by gangrenous patches immersed in a

reddish-grey putrid fluid of offensive odour. In places the pulmonary

tissue has undergone gangrene; and incision of the diseased centres

discovers irregular cavities, filled with a pultaceous, greyish

material, which often makes its way into the bronchi. These are the

irregular cavities which give rise to the gurgling sounds. The walls of

these cavities are formed of disintegrating pulmonary tissue, which

again is surrounded by a zone of grey hepatisation. The gangrenous areas

may unite, forming vast caverns. If near the surface they cause adhesive

or septic pleurisy.

=Diagnosis.= The diagnosis is not very difficult, provided that an exact

account can be obtained of the circumstances which preceded the

appearance of the disease. The signs furnished by the discharge, the

expired air, percussion and auscultation are sufficiently significant to

remove any doubt.

=Prognosis.= The prognosis is extremely grave, and in the great majority

of cases fatal.

=Treatment.= There is very little chance of recovery, no matter what

treatment may be employed. The most favourable termination consists in

the gangrene remaining limited to the bronchi and to a small fragment of

the lung, so that the damaged tissues, being gradually delimited and

sloughed off, may finally be discharged by coughing.

This is an exceptional termination, but attempts may be made to assist

its evolution by giving alcohol in doses of 8 to 10 ounces per day, and

salicylate of soda in doses of 4 to 5 drachms. When the condition can be

early diagnosed before intense and continued fever has set in, and when

the animal’s condition is good, it is often preferable to slaughter the

patient.

INFECTIOUS BRONCHO-PNEUMONIA.

The ox’s lung is liable to so many and such extremely varied diseases

that it seems desirable to add to the above descriptions some remarks on

infectious broncho-pneumonia of external or internal origin.

Anatomically these forms of broncho-pneumonia are characterised by the

occurrence of “islands” of pulmonary hepatisation, more rarely by

extensive (massive) hepatisation; in all cases the hepatisation is

irregular, and in no way resembles that of simple pneumonia.

=Causation.= The internal causes are numerous and varied. They are due

to primary infection of an organ whence arises a general infection,

sometimes even true septicæmia. Some form of broncho-pneumonia, such as

simple broncho-pneumonia, purulent broncho-pneumonia, gangrenous

broncho-pneumonia, etc., then follows as a complication. These

broncho-pneumonias are therefore only manifestations of purulent

infection or septicæmia. They frequently follow post-partum infections,

vaginitis, metritis, and suppurative mammitis.

=Symptoms.= The general symptoms first attract attention, and are

extremely acute. They comprise high fever, loss of appetite, cessation

of rumination and of milk secretion, breathlessness, blowing, etc.—all

signs of grave and rapidly progressive infection.

Sometimes at this period nothing more than the primary lesion, such as

metritis or mammitis, can be detected. It may even happen that the

uterus seems little affected, and, despite the accelerated respiration,

neither partial nor complete dulness of the lung is discovered.

Hepatisation only occurs some days afterwards, and with it irregular

partial dulness localised in the lower zones, disappearance of the

respiratory murmur in the corresponding regions, exaggeration in the

infected regions, an expiratory sound which is barely perceptible or may

be of a blowing character, or, again, after several days may be

transformed into a tubal souffle.

The cough then becomes frequent, generally difficult, paroxysmal,

feeble, and easily provoked. The appetite suffers, the patients seem to

prefer fluid nourishment and lose flesh very rapidly.

If the broncho-pneumonia is about to terminate in suppuration or

gangrene, the respiration becomes sighing, the breath fœtid, and the

cough is accompanied by a greyish muco-purulent or gangrenous discharge.

When the abscesses are deep-seated, the alarming symptoms retain their

primary degree of intensity for weeks, until the animals are completely

exhausted. Abscesses, originating in deep-seated parts, may even extend

towards the surface of the lung, and produce either adhesive pleurisy

that can be detected by palpation, or exudative pleurisy, easily

recognised on percussion.

When the infective microbes are not pyogenic the general condition

appears less grave, the animals exhibit only moderate fever, appetite is

diminished but not lost, wasting is slower, and may continue for months,

but the affected portions of lung become converted into fibrous masses

or a material resembling spleen pulp.

The duration of infectious broncho-pneumonia, therefore, varies with the

nature of the infecting organism. In cases which terminate in gangrene,

the animals may survive for three or four weeks; in those where

suppuration occurs, for several months. In short, recovery is the rule

in simple broncho-pneumonia; but from an economic standpoint there is

little reason for keeping the animals alive.

=Diagnosis.= The diagnosis is not generally very difficult; for if at

first the case may be mistaken for one of simple pneumonia, the

persistence or prolonged aggravation of the symptoms and the

irregularity in position of the lesions revealed by percussion and

auscultation enable the condition to be distinguished at an early period

from simple pneumonia.

Confusion with acute or chronic pleuro-pneumonia may easily be avoided

by noting the absence of pleural effusion, and of the soft pleuritic

souffle of peripneumonia, etc.

Where auscultation is chiefly relied upon it is more difficult to

differentiate between this disease and acute tuberculosis, and between

it and broncho-pneumonia produced by foreign bodies, although the latter

disease develops differently.

=Prognosis.= The prognosis is always extremely grave and, in cases where

there is gangrene or abscess formation, fatal. From the economic

standpoint the chronic form is also very grave.

=Treatment.= As broncho-pneumonia is frequently of a secondary

character, treatment should at first be particularly directed against

the primary condition, whether in the mammary gland, uterus or

elsewhere. Early treatment of suppurative mammitis, metritis, etc., is

therefore necessary.

Broncho-pneumonia is treated by free vesication of the walls of the

chest, the administration of tonics and antiseptics, alcohol in small

doses, acetate of ammonia in doses of 1 to 2 drachms, salicylate of soda

in doses of 5 to 8 drachms per day, salicylic acid in doses of 1 drachm,

and creosote in doses of 1½ to 5 drachms, given in electuary, etc.

Diuretics, farinaceous gruels, etc., may be used freely, and are of

value.

If the symptoms persist or become aggravated, and suggest the

development of an abscess or gangrene, it is better to slaughter the

animal.

BRONCHO-PNEUMONIA OF SUCKING CALVES.

Young animals still with the mother, particularly calves during the

first few weeks of life, are liable to broncho-pneumonia of a

specialised character, as regards not only its causes, but its

development and duration.

=Causation.= The causes may be grouped under two principal heads:—

(_a_) In slow or difficult cases of parturition, the fœtus may be

injured whilst being delivered, as a consequence of direct compression

of the great blood-vessels, etc. (particularly of compression of the

umbilical cord, compression of the thorax in the cardiac region, or

partial premature separation of the envelopes), and may thus by reflex

action make automatic inspiratory movements.

Respiration being impossible, inasmuch as the thorax has not yet passed

the posterior passages, such inspiratory efforts made during the passage

through the pelvis may cause amniotic liquid to pass into the bronchi.

This accident is particularly liable to occur during deliveries with

breech presentation. If, as happens frequently, the amniotic liquid has

become infected either prior to or as a consequence of obstetrical

manipulation, the result is fatal; for the passage of infected amniotic

fluid into the bronchi develops a broncho-pneumonia of a degree of

gravity depending on the character of infection.

(_b_) By an entirely different mechanism broncho-pneumonia may occur in

sucking calves during the first few weeks of life, even in the case of

animals born in a vigorous condition, and kept in warm and well-arranged

stables. This form follows diarrhœa, and constitutes a final

complication which is always of very marked gravity, and in most cases

fatal.

Such secondary broncho-pneumonia only occurs when the diarrhœa has

resisted treatment, and it is important to note that the pectoral

lesions appear at a time when the intestinal mischief seems to have

diminished, the diarrhœa having lessened or disappeared. This variety of

broncho-pneumonia of young animals is by far the most frequent. It has

been termed broncho-pneumonia of intestinal origin, and exactly

resembles, so far as its development and gravity are concerned, the

broncho-pneumonia in young infants described by Sevestre and Lesage.

The term broncho-pneumonia, moreover, is not strictly correct, or at

least is not exclusive; for the rapid forms often exhibit lesions other

than those of broncho-pneumonia. Post-mortem examination reveals

pleurisy and pericarditis.

=Pathogeny.= At the outset of these attacks of broncho-pulmonary

disease, a careful bacteriological examination of the organisms to be

found in the discharge of bronchial mucus leads to the discovery of

bacilli which do not stain with Gram, and which resemble varieties of

the colon bacillus; in other cases of streptococci. At a later stage,

when the animal has become weak, microorganisms are present in much

greater variety. Nocard found in lung abscesses the bacillus of

epizootic lymphangitis. It seems that the development of various lesions

in the thoracic cavity may be due to auto-infection, _i.e._, to the

penetration from the intestine of germs which, after passing through the

circulation, establish themselves at some point in the lung. The pleura

is attacked at a later period as a consequence of continuity and

contiguity of tissue.

In a similar way pericarditis and even valvular endocarditis may be

produced.

=Symptoms.= The symptoms are similar to those of all forms of

broncho-pneumonia. Where diarrhœa has been neglected, the conditions may

apparently improve without evident cause, whilst the respiration becomes

more frequent. The patient soon suffers from cough, and in a few hours

the existence of broncho-pneumonia is clearly apparent. Acceleration of

breathing is the dominant symptom. The respirations may rise to fifty to

sixty per minute, at which they continue, while fever sets in. On

percussion the thorax may appear of normal resonance throughout; but

when pleural lesions and exudates exist, resonance gives place to

partial or complete dulness. Should pericarditis or small

cardio-pericardial adhesions exist, they may escape observation, but if

the exudate is abundant or the adhesions multiple or of large size the

usual symptoms of pericarditis develop progressively.

On auscultation the respiratory murmur is always found to be greatly

exaggerated in the healthy parts, usually the upper portions of the

lung. On the contrary, it is attenuated or suppressed in the affected

regions. The other signs vary greatly, according to the extent,

intensity, and more or less advanced condition of the lesions. Crepitant

and bronchial _râles_, blowing respiration and tubal souffles, etc., are

among the symptoms.

The duration of the disease varies; some patients may be carried off in

five or six days, while others survive for one or two months, or even

longer. A few recover, but they remain thin, puny, and atrophied, and

are not worth keeping alive.

=Lesions.= The lesions extend to the bronchi, the pulmonary tissue, and

sometimes the pleura and pericardium. They consist in lesions of diffuse

broncho-pneumonia, pleurisy with false membranes and parietopulmonary

adherences, and pericarditis with partial cardio-pericardial adhesions.

In rare cases abscesses caused by pyogenic streptococci may be found.

The anterior lobes, cardiac lobes, and lower part of the posterior lobes

are those singled out for attack.

=Diagnosis.= The diagnosis is not difficult, provided that the

circumstances preceding the appearance of the pulmonary lesions are

known.

=Prognosis.= The prognosis is very grave.

=Treatment.= Treatment very often proves useless, because the patients

have little resisting power and are exhausted, and also because they are

suffering from a slowly progressive septicæmia. It may, however, be

worth while in the early stages to apply blisters to the chest and

administer general stimulants: alcohol in doses of 8 to 12 drachms per

day, divided into two parts and mixed with milk; acetate of ammonia in

doses of ½ to 1 ounce; and tinctura digitalis 5 to 6 drops.

The primary disease of the intestine is masked by the pulmonary

symptoms, but should not be overlooked. Rice water, subnitrate or

salicylate of bismuth may be added to the milk or albuminous solutions

constituting the diet. When an epizootic of broncho-pneumonia

complicates the diarrhœa it is necessary to take all the preventive

measures which have been suggested in connection with white scour and

umbilical diseases in calves. These comprise disinfection of the

premises and local disinfection of the animals affected.

SCLERO-CASEOUS BRONCHO-PNEUMONIA OF SHEEP.

The sheep suffers from a special form of broncho-pneumonia, which is

seldom seen except in isolated cases, but which, under exceptional

circumstances, may nevertheless attack a certain number of animals in a

particular flock. It was first noticed and described by Liénaux in 1896,

and has more recently been studied by Sivori (1899). Moussu has only

seen it in flocks in the north of France.

=Causation.= The causes of this disease are still imperfectly

understood.

Sivori’s researches show that the disease may be referred to a

microorganism, but we do not yet know exactly by what path infection

occurs.

The agent of sclero-caseous broncho-pneumonia in the sheep appears

similar to that described by Preisz and Guinard in 1891, and identical

with the microbe of ulcerative lymphangitis of the horse (Nocard, 1897).

It is probable that infection occurs through the respiratory apparatus.

=Symptoms.= The clinical development of the disease is difficult to

describe, because its course is slow and unaccompanied by well-marked

external signs.

The animals lose flesh, pant for breath when moved, drop to the rear of

the flock, cough frequently, feed badly and end by becoming cachectic.

Many suffer from the disease and yet remain in fair bodily condition.

On post-mortem examination the lungs are found not to collapse, having

lost their elasticity, and are of a yellowish-white colour, which is

only seen in this disease. On section the pulmonary tissue appears

dense, hard, and of a fibrous and lardaceous character. At various

points nodules with fibrous envelopes and caseous, yellowish or greenish

contents are found.

When the caseous nodules are near the surface the pleura may be

chronically inflamed and thickened. The liver and kidney frequently

contain caseous lesions.

=Diagnosis.= The diagnosis becomes easy after the first post-mortem

examination, for the lesions discovered cannot be mistaken for those of

parasitic broncho-pneumonia, degenerated pulmonary echinococcosis or

tuberculosis. In the living animal, on the contrary, the diagnosis is

extremely difficult.

=Prognosis.= The prognosis is grave. No special method of treatment is

known.

PULMONARY EMPHYSEMA.

Pulmonary emphysema, _i.e._, exaggerated dilatation of the pulmonary

tissue by air, is not uncommon in the bovine species, and occurs under

the two classical forms—(1) alveolar or intra-lobular emphysema limited

to dilatation of the alveoli; and (2) interlobular emphysema, produced

by the entrance and diffusion of air in the interlobular spaces in

consequence of rupture of the lobules.

These two forms are very frequently associated:—

(1.) Emphysema by dilatation usually begins in the right pretracheal

lobe; also in the cardiac and even in the posterior lobes.

(2.) Interlobular emphysema begins in the same regions, but it spreads

readily in a backward direction, remaining interstitial; or, on the

other hand, becoming subpleural at the periphery of the lung.

In both cases the pulmonary tissue is pale, the blood-vessels are

partially obliterated by compression; circulation and aeration of the

blood are impeded—hence the appearance of the disturbance noted.

=Causation.= Emphysema is seen in adult working oxen; also, and to an

even greater degree, in aged cows. It is produced by excessive strains

in draught, or more often by the paroxysms of coughing so common during

simple or parasitic bronchitis, broncho-pneumonia, pneumonia, chronic

broncho-pneumonia, etc. Successive gestations also produce it.

All these pathological conditions also interfere with the nutrition of

the bronchial mucous membrane, particularly of its deep-seated muscular

layer, which is then incapable of regulating the distribution of air in

the bronchial channels. The distribution being no longer regulated by

reflex action, air accumulates at certain points as a result of the

expiratory efforts made during coughing, and dilatation of the vesicles

or lobules occurs.

Diseases of the digestive apparatus, acute or chronic tympanites in

particular, may play a certain part by compressing the diaphragm,

causing expiratory efforts and fits of coughing.

Furthermore, swelling of the lymphatic glands at the entrance to the

chest, by compressing the pneumo-gastrics, provokes reflex cough and

finally emphysema.

=Symptoms.= Pulmonary emphysema is marked by accelerated respiration due

to diminution in the respiratory capacity, which is often very seriously

affected; to insufficient absorption of oxygen in consequence of

diminution in the space available for exchange of gases in the lung, and

to insufficiency of expiration. This acceleration in breathing, though

little marked during repose, becomes very pronounced after exercise, or

during hot weather; and under these circumstances is accompanied by a

paroxysmal, feeble but shrill cough, without discharge. This cough

without discharge is frequently followed by swallowing.

Percussion reveals an important point, viz., increase in the normal

resonance of the thorax.

On auscultation the vesicular murmur is found to be diminished, the

respiration assumes a rough and rasping character, inspiration is

difficult, expiration painful, and often divided into two periods, as

indicated by a slight double movement of the flank. Expiration is

clearly audible. Its duration is generally less than that of

inspiration, although in some cases it is equal or even longer. It is

accompanied by sibilant and snoring _râles_, sometimes even mucous

_râles_, of an intermittent character. In rare cases there may be

difficulty of respiration, as in broken-winded horses.

=Diagnosis.= The diagnosis may suggest a doubt as to whether emphysema

or tuberculosis is present, but in the latter there is fever, the

general condition is poor; on percussion the thorax reveals areas of

partial dulness; and expiration is rough and prolonged, sometimes of a

blowing character, a peculiarity which is exceptional in emphysema.

=Prognosis.= The prognosis is not very grave, except where emphysema is

only an accompanying symptom of another disease, such as chronic

bronchitis, tuberculosis, etc.

=Treatment.= Little can be done to check the development of the above

described pulmonary lesions; but the cough may be relieved, and the

pulmonary circulation improved by assisting the heart.

The most prompt and efficacious assistance is given by digitalis in

doses of ½ to 1 drachm per day for adults, iodide of potassium in doses

of 1 to 1½ drachms, and bromide of potassium in doses of 1 drachm to

guard against reflex excitability of the pneumo-gastric. This treatment,

however, should not be followed for more than five or six days, and

should then be replaced by the administration of arsenious acid in doses

of 15 grains per day, ground horse-chestnuts in doses of 3 ounces per

day, etc., etc.

DISEASES OF THE PLEURA.

Primary inflammation of the pleura is very rare in animals of the bovine

species, but secondary diseases of this membrane, on the other hand, are

frequent.

ACUTE PLEURISY.

Cruzel, Fabry, and a number of practitioners have described the

occurrence in working animals of acute pleurisy _à frigore_ or

serofibrinous pleurisy in consequence of severe, sudden variations in

temperature, or prolonged chills. At the present day it seems fairly

well established that pneumonia, and not pleurisy, is commonest under

such conditions, and Moussu disclaims ever having seen primary pleurisy.

On the other hand, pleuritic effusions are very common in contagious

pleuro-pneumonia, secondary pleurisy due to pericarditis produced by

foreign bodies, septic broncho-pneumonia or broncho-pneumonia due to

foreign bodies, and the pleurisy which accompanies septicæmia consequent

on parturition, etc. These forms of disease, however, are not simple

serofibrinous pleurisy, but septic or suppurative pleurisy, still little

understood in veterinary surgery.

Tuberculosis of the pleura, although very frequent, is rarely

accompanied by marked exudation. Like secondary disseminated pleural

carcinoma, it usually assumes the vegetative and adhesive form, with

adhesions of greater or less extent between the lung and wall of the

chest.

=Symptoms.= In all these morbid conditions the symptoms vary greatly,

and it would be difficult to give an accurate general description of

them.

In acute pleurisy _à frigore_ shivering attacks, moderate fever,

dulness, loss of appetite, interference with rumination, dryness of the

skin, rapid wasting and intercostal pain, first indicated by dull colic,

constitute the usual symptoms.

The respiration is short and irregular, interrupted when the exudation

is abundant. Pressure over the intercostal spaces produces pain, as does

strong percussion. Percussion reveals an area of dulness bounded above

by a horizontal line.

Auscultation shows the respiratory murmur to have disappeared throughout

the zone of dulness, and reveals the presence of a soft pleuritic

souffle (a soft tubal souffle quite different from that of contagious

pleuro-pneumonia) when pleural exudation is abundant. In septic or

suppurative pleurisy fever is higher, loss of appetite more marked,

wasting more rapid, and depression extreme, with, however, identical

local symptoms.

=Diagnosis.= The diagnosis of pleural exudation presents little

difficulty, because of the peculiar characters of the dulness and the

pathognomonic indications obtained by auscultation. The exudation is

usually unilateral, the mediastinum being very resistant and not

perforated in the ox.

By passing the needle of a Pravaz’s syringe with antiseptic precautions

through the intercostal space a little fluid may be drawn off and the

diagnosis formed, the form and nature of the pleurisy being

simultaneously established. The liquid extracted can be examined

bacteriologically, and can be grown on nutritive media, or inoculated

into experimental animals.

=The prognosis= is grave, because in the ox pleurisy is very often of a

secondary character. The outlook varies, however, with the form of the

pleurisy and the nature and virulence of the infecting organism.

=Treatment.= Treatment consists firstly in applying an energetic

vesicant like antimonial ointment or liquid cantharides blister;

internally diuretics such as soda bicarbonate, nitrate of potash, resin,

and decoctions of pellitory, dogs’ grass, etc., may be given. If thought

desirable the chest may be tapped and the pleural cavity washed out with

an antiseptic solution.

CHRONIC PLEURISY.

Chronic pleurisy is frequent in aged animals, but usually assumes the

form of local adhesive pleurisy. The adhesions between the lung and

pleura are more or less extensive; they result from verminous

broncho-pneumonia, echinococcosis, external injuries, etc. Clinically

this form is of no importance, and is almost impossible to diagnose.

During the development of pleural tuberculosis, on the contrary,

adhesive dry pleurisy is frequent, and sometimes becomes so well marked

that almost the whole of the opposing pleural surfaces may become

united.

PNEUMO-THORAX.

The name pneumo-thorax is given to the condition produced by the

entrance of air or gas into one of the pleural cavities.

The accident is usually produced by rupture of the parenchyma of the

lung and of the pleura, a rupture which produces a communication between

the alveoli or a bronchus and the corresponding pleural cavity. As soon

as the rupture occurs air passes from the lung into the pleural cavity,

and the lung collapses in consequence of the resilience of its elastic

constituents.

Under other, much rarer, circumstances pneumo-thorax occurs in

consequence of gas generated in the digestive tract passing into the

pleural spaces. The condition then makes rapid progress, and death

occurs in a few days.

[Illustration: $1]

=Symptoms.= The symptoms are well defined. As soon as the accident

occurs the animal exhibits extremely marked and sudden dyspnœa,

accompanied by heaving at the flank or general agitation of all the

muscles of the body. One of the lungs, in fact, has suddenly been called

on to perform the functions of both, and at first it naturally has great

difficulty in meeting this demand.

The heaving at the flank and the general agitation of the body muscles

is due to the fact that the regularity and rhythm of contraction of the

diaphragm are disturbed, and the mechanical conditions have become

different on the two sides. From the first, respiration is moaning and

expiration becomes rapid, stertorous and deep, while the face is

anxious-looking, and the nostrils are dilated as though the animal was

on the point of suffocation. On examining the animal from in front or

behind, the thorax is easily seen to be wanting in symmetry, the side on

which the pneumo-thorax has occurred being immobile as compared with the

sound side. The latter, moreover, is dilated in order to compensate for

the loss of function of the collapsed lung.

Percussion reveals greatly increased resonance on the side of the

pneumo-thorax. On the other hand, the opposite side yields a normal

sound.

Auscultation reveals an increase of the respiratory murmur on the side

which is still acting and, on the contrary, complete and total

suppression of the respiratory murmur on the affected side. On applying

the ear to the chest wall, a large soft, amphoric souffle of well-marked

metallic character is heard. This is particularly clear on respiration,

giving the impression of the existence of a large cavity beneath the

ear. The sighing sound heard on auscultation of the chest wall is louder

than that heard externally or over the region of the nostrils or larynx;

and it seems to be reinforced, as though by the resonance of a large

cavity with thin metallic walls. Once or twice per minute, moreover, a

sound may be heard like that of dropping water. It is of a very special

character, resembling that produced by drops falling to the bottom of a

hollow metallic vase, and setting up prolonged vibration.

As secondary symptoms the heart’s action is accelerated, the number of

beats rising to 80 or even 120 or 130 beats per minute; appetite is

lost; slight tympanites develops as a result of rumination and

eructation being suspended; the peristaltic movements of the rumen are

interrupted, and constipation develops.

=Diagnosis.= The diagnosis of pneumo-thorax is easy, and the condition

can scarcely be mistaken for any other except diaphragmatic hernia; but

the indications derived from percussion and auscultation are so

different in the two cases that they need not be further emphasised.

The task becomes more difficult, however, when an attempt is made to

identify the exact form of pneumo-thorax, for three principal varieties

are recognised.

In open pneumo-thorax, the first and most frequent form, air passes from

the lung into the pleura at each inspiration, and flows back from the

pleural cavity towards the bronchus at each expiration. The

intra-pleural pressure is then approximately equal to the

intra-bronchial pressure, and undergoes similar oscillations. (It should

be noted that the aperture in the lung is seldom sufficiently large to

establish an absolute equality of pressure between the bronchus and the

pleural cavity. Respiration, therefore, though very seriously impeded,

generally continues in a modified form.)

In a second variety, termed “valvular pneumo-thorax,” air passes freely

from the lung into the pleural cavity, but is unable to return from that

cavity towards the lung, because a flap of tissue acts as a valve and

closes the orifice at the commencement of expiration. As soon as

intra-pleural pressure rises above that of the inspiratory effort, the

valve remains permanently closed.

In the third variety, called “closed pneumo-thorax,” the orifice of

communication is obstructed by some mechanism, and the pleural sac only

contains a film of air.

In practice, valvular pneumo-thorax is recognised by the movement of the

thoracic wall (which in open and closed pneumo-thorax remains

depressed), as well as by extreme intensity of the dyspnœa and attacks

of threatened suffocation. Closed pneumo-thorax, which is only a

termination and a stage in the cure of open pneumo-thorax and of

valvular pneumo-thorax, is suggested by progressive improvement in the

symptoms. Scientifically it is very easy to make this diagnosis by

putting a manometric apparatus in communication with the pleural cavity

by means of a simple hollow needle provided with a thick-walled rubber

tube.

In open pneumo-thorax the liquid column in the manometer undergoes

rhythmic oscillations corresponding to the respiratory movements; in

valvular pneumo-thorax the intra-pleural pressure increases

progressively until it becomes higher than the external pressure; and

finally, in closed pneumo-thorax, the column of the manometer assumes a

certain level at which it rests.

=Prognosis.= The prognosis is very variable, according to the primary

cause of the accident. Animals might recover, but economically there is

little advantage in preserving them when the diagnosis is assured,

except in cases of animals of great value, and when the primary disease

admits of it.

=Causation.= Pneumo-thorax may be produced by various causes. The most

frequent cause in large animals is pulmonary echinococcosis, during the

course of which a peripulmonary vesicle, after having injured several

lobules, one of the air passages or even a bronchiole, may break through

the pleura, thereby setting up direct communication between the bronchi

and the pleural cavity.

To pulmonary tuberculosis, with peripheral softened tubercles,

perforating simultaneously into an alveolus or a small bronchus and into

the pleura, must be assigned the second place.

Vesicular and interstitial subpleural pulmonary emphysema is also a

frequent cause of pneumo-thorax, the pleura being ruptured over the

emphysematous points.

Finally, and exceptionally, an abscess of the lung may open into the

pleura and form sinuses, which may establish a communication between the

digestive reservoirs and pleural sacs; but such accidents produce

pyo-pneumo-thorax and septic pleurisy of a rapidly fatal character.

=The diagnosis= of pneumo-thorax, and even of its varieties, does not,

however, enable one to form a prognosis; the important point is to

ascertain the original cause.

=Treatment.= It may be said of pneumo-thorax that no treatment exists,

and that the position is one of expectancy. In fact, we possess no means

of directly dealing with such diseases as echinococcosis, tuberculosis,

or emphysema. For this reason it is best as a rule to advise slaughter.

Nevertheless, when the condition is due simply to pulmonary

echinococcosis of a discrete character, there is some chance that after

several months the animal may recover spontaneously. The communicating

orifice becomes closed by reparative processes (cicatricial contraction,

the formation of a false membrane, limited adhesion between the two

walls of pleura, etc.); the layer of air imprisoned within the pleural

cavity is progressively absorbed, provided that it has not been

accidentally infected; the collapsed and partially splenised lung

progressively regains its function under the inspiratory efforts, and

after some months complete recovery may occur. This termination cannot

always be confidently predicted, because complications may arise at any

moment; under no circumstances can complete recovery be anticipated when

the primary disease is tuberculous.

[Illustration: $1]

In cases of valvular pneumo-thorax with extreme oppression, attacks of

suffocation threatening death as a consequence of excessive

intra-pleural pressure, displacement of the mediastinum towards the

opposite side, compression of the heart, and functional disturbance of

the sound lung, it may be worth considering whether the attacks of

suffocation and threatened asphyxia can be modified or removed by

preventing the excess of intra-pleural pressure. By simply passing a

stout hollow needle through one of the intercostal spaces, the

intra-pleural pressure may be reduced to that of the external

atmosphere, and the effects of compression removed. This, however, is a

last resort, and has no permanent effect.

HYDRO-PNEUMO-THORAX AND PYO-PNEUMO-THORAX.

When pneumo-thorax is set up, it rarely remains simple. In the great

majority of cases the pleura becomes infected, either directly, by the

lesion which has determined the pneumo-thorax (tubercle, superficial

abscess, actinomycotic lesion, etc.), or secondarily, by the penetration

of germs from the air or from the bronchus (echinococcosis, emphysema).

Simple pneumo-thorax then becomes converted into hydro-pneumo-thorax or

pyo-pneumo-thorax, according to circumstances—that is to say, whether

the exudation into the pleural cavity is of a simple character or is of

the nature of pus.

=Symptoms.= Hydro-pneumo-thorax is characterised by the signs common to

true pneumo-thorax, which constitutes the primary lesion, viz., sudden

difficulty in breathing, exaggerated unilateral resonance, amphoric

souffle accompanied by a sound like that of drops of water falling into

a metallic vessel, and by the signs of secondary exudative pleurisy,

viz., moderate fever, dulness over the lower zones of the chest, limited

above by a horizontal line, slight splashing sound, and a soft distant

pleuritic souffle.

All the secondary symptoms—loss of appetite, suppressed rumination,

sighing, accelerated pulse, etc.—are found in a more or less accentuated

form.

In pyo-pneumo-thorax fever is more marked, while the signs noted on

auscultation and percussion are identical, and are accompanied by

digestive disturbance and marked œdema of the wall of the chest, which

can be seen or detected by palpation.

=Diagnosis.= The diagnosis is relatively easy when the lesion is

secondary; but the difficulty (as in simple pneumo-thorax) is to

identify the exact character of the primary affection.

On the other hand, pyo-pneumo-thorax and hydro-pneumo-thorax are not

always complete; adhesions of very varying character may exist between

the lung and the chest wall; hence it is impossible to group together

all the possible symptoms.

Diagnosis is facilitated by aseptically puncturing the chest with a

Pravaz’s syringe.

=Prognosis.= The prognosis is extremely grave even in cases of

hydro-pneumo-thorax. Treatment is useless, for even allowing that the

primary disease might be cured, this process of cure, after reabsorption

of the transudate, would be extremely tedious, and the animals would

long remain in poor condition.

=Treatment.= In hydro-pneumo-thorax no treatment is advisable. Nothing

is gained by thoracentesis, at least at an early stage, or before the

lesion causing the pneumo-thorax has closed.

In pyo-pneumo-thorax, on the contrary, the theoretical course is to

evacuate the pus and completely wash out the pleural sac with lukewarm

non-irritant solutions of antiseptics.

CHAPTER V.

DISEASES OF STRUCTURES ENCLOSED WITHIN THE MEDIASTINUM.

The mediastinum is a space enclosed in the median plane of the thorax by

the approach of the two opposite layers of pleura. Needless to say, at

those points where the layers are in apposition, the space is

theoretical only. It extends from the suprasternal region to the dorsal

subvertebral region, and encloses all the vessels which pass from or to

the base of the heart, the trachea, the œsophagus, the pneumo-gastric,

diaphragmatic and cardiac nerves, etc., as well as the pericardial sac

and the heart. The organs most frequently affected are the lymphatic

glands lodged in the thickness of the mediastinum, the glands placed at

the entrance to the chest, the bronchial glands, and the glands situated

in the posterior mediastinum.

Inflammation of the mediastinum may coincide with inflammation of the

mediastinal layers of the pleura; but this can only be detected on

post-mortem examination. The lesions which can be recognised during life

are simple inflammation of glands, resulting from pulmonary or pleural

diseases, tuberculous inflammation of glands, and the presence of

cancerous tumours of the mediastinum and hypertrophy of glands due to

lymphadenitis.

Simple inflammation of the lymphatic glands is secondary and consecutive

to broncho-pneumonia, verminous bronchitis, infectious bronchitis, etc.

It produces reflex irritation by compressing the pneumo-gastric and

laryngeal nerves, and is indicated by loud, spasmodic coughing.

=Treatment= consists in administering iodide and bromide of potassium,

terpine, in doses of 1 drachm per day for adults, essence of turpentine

and tar water.

Tuberculous inflammation of glands, inseparable from pulmonary

tuberculosis, has very special characteristics peculiar to tuberculosis.

Inflammation due to lymphadenitis is also very easy to diagnose as a

rule, in consequence of the symmetrical enlargement of lymphatic glands

elsewhere.

TUMOURS OF THE MEDIASTINUM.

Sarcomata, carcinomata, lymphomata, and lympho-sarcomata all occur in

the mediastinum. They attack young healthy animals, and sometimes

develop with such rapidity that in a few weeks they become generalised

and invade the heart, lungs, and principal viscera. Their cause is as

yet unknown.

=Symptoms.= At first sight the symptoms are much like those of

pericarditis caused by foreign bodies. They consist in deformity of the

presternal region, swelling of the jugulars, submaxillary œdema,

irregular pretracheal tumefaction, etc.

The tumour, whatever its nature, commences in the mediastinum, develops

towards the entrance to the chest, where it projects, and before long

produces in the pretracheal region clearly marked œdematous swelling.

Between the two first ribs the tumour compresses the carotids, the

jugulars, the nerve trunks, and also the trachea and œsophagus,

producing difficulty in the return circulation, especially in the

jugulars, swelling in the submaxillary space, loss of appetite and

dyspnœa.

Palpation affords indication of a tumour of soft consistence,

bosselated, more or less adherent to the skin, usually painless on

pressure, and of irregular development. Compression of the œsophagus

interferes with the deglutition of rough forage, impedes rumination,

prevents eructation, and thus produces trifling but permanent

tympanites.

The heart is affected reflexly or directly as a result of generalisation

of the tumour, and the pulse may rise to 70 or even 120 per minute.

During the first stages neither auscultation nor percussion points to

any pulmonary lesion. At a later stage the lung itself may be affected.

The other important functions are normal.

Animals suffering from sarcoma, carcinoma, or lympho-sarcoma of the

mediastinum waste very rapidly, lose appetite, become feverish, and soon

develop cachexia.

=Diagnosis.= The diagnosis of tumour of the mediastinum is easy, because

of the well-marked character of the apparent symptoms.

=Prognosis.= The prognosis must be regarded as extremely grave, and in

most cases fatal, for there is no active method of intervention,

extirpation being impossible.

There is no =treatment=. The animal should at once be slaughtered.

SECTION IV.

THE ORGANS OF CIRCULATION.

SEMIOLOGY OF THE ORGANS OF CIRCULATION.

The semiology of the circulatory apparatus comprises the clinical

examination of the heart, arteries and veins, and the examination of the

pulse and blood.

=Heart.= In animals of the bovine species, the heart is situated in the

thoracic cavity opposite the third, fourth, fifth and sixth ribs, nearly

in the median plane of the thorax, and inclined from front to back at an

angle of 70 degrees.

The pericardial sac touches the extremity of the sternum where it is in

immediate contact with the lower insertion of the diaphragm. This

peculiar arrangement favours the development of pericarditis due to

foreign bodies.

On the left side the pericardial sac may come in direct contact with the

internal surface of the thoracic cavity opposite the lower extremity of

the third, fourth, and sometimes fifth ribs. At all other points the

pulmonary lobes, as expanded during inspiration, separate it from the

thoracic wall.

Although the pericardium and heart are situated in the median plane,

percussion and auscultation should be performed on the left side, since

the anterior and cardiac lobes of the left lung are less developed than

those of the right; but the heart can be auscultated on the right side,

as is advisable at times.

In the healthy ox there exists an area of the left thoracic wall which

may be called the cardiac zone, on a level with which are heard the

normal heart sounds. In diseased conditions this zone or area may vary

in size, and the sounds may be modified.

The heart can be examined by inspection, palpation, percussion, and

auscultation.

Under ordinary conditions inspection reveals nothing in well-nourished

animals; but in very thin subjects and in those suffering from recent

cardiac lesions or pseudo-pericarditis, a rhythmic movement of the chest

wall is sometimes detected.

Palpation is performed by placing the open hand on the cardiac zone. In

this way the cardiac shock can be felt, its degree of intensity judged,

and, in an imperfect manner, its rhythm.

Percussion by means of the fingers or a pleximeter discloses the extent

of the physiological area of partial dulness, due to the presence of the

heart, as well as its variations in pathological conditions,

particularly in pericarditis with marked exudation.

[Illustration: $1]

In such cases there may even be complete dulness when the distended

pericardium thrusts upwards the corresponding pulmonary lobe, and comes

in contact with the internal surface of the thoracic wall, or, in cases

of pericardial pneumatosis, exaggerated resonance, and a tympanitic

sound.

Auscultation is carried out either directly or by the stethoscope or the

phonendoscope. The normal or pathological sounds of the heart are thus

ascertained, as well as the intensity of the cardiac beats and sounds,

the frequency of the rhythm, etc.

When injuries have occurred which cause murmurs, it is best to use the

stethoscope and to apply it at the points where murmurs are heard at

their maximum intensity, _i.e._, exactly at the spot where the cardiac

shock is noted, and towards the base, in the region where the great

arterial trunks begin.

In the latter case it is often useful to draw the left fore leg forward.

=Arteries.= The arteries are rarely the seat of lesions that can be

detected by examination, and therefore such examination is usually

limited to noting the state of the pulse.

Arteritis and thrombosis of arteries are rare, and although lesions of

atheroma have been discovered in certain chronic diseases, such as

tuberculosis, chronic diarrhœa, etc., they are difficult to detect, even

on examination per rectum of the bifurcation of the aorta.

=Pulse.= The examination of the pulse, on the contrary, is of great

importance. In animals of the bovine species the pulse may be taken at a

number of different points, such as the submaxillary artery, on the side

of the lower jaw: in the case of very thin animals at the radial within

and in front of the elbow joint; at the internal saphenous artery, at

the height of the mamma or scrotum; or at the coccygeal artery, at the

base of the tail.

This examination reveals the frequency (50 to 60 per minute), the

quality, whether strong, feeble, imperceptible, etc., the regularity,

etc., etc.

=Veins.= The veins are more easily examined than the arteries, on

account of their superficial position in most cases.

Inspection and palpation are the only means of examination.

Inspection shows the degree of fulness or collapse, and also the

existence or absence of what has been termed venous pulse.

Venous pulse occurs only at the lower extremity of the jugulars. It is

very frequent in animals of the bovine species, and in thin animals is

not necessarily a pathological symptom. It is due to reflux of blood in

the anterior vena cava, under the influence of the expiratory effort;

sometimes to emphysema, tuberculosis, etc.; in other cases to the return

of blood towards the vena cava and jugulars at the moment of auricular

systole, as a result of lesions of the tricuspid or auriculo-ventricular

orifices.

By palpation of the veins their permeability can be estimated, also the

degree of distension or obstruction, and the condition of their

contents.

=Capillary system.= Among methods of arriving at the state of the

circulatory system must be included an examination of the vascular

condition of the accessible mucous membranes, such as those of the eye,

mouth, nostril, vulva, etc. This examination is easy to carry out, and

is of value in diagnosing congestive states, pneumonia, and local

inflammation.

=Blood.= Examination of the blood is sometimes necessary for the exact

diagnosis of certain diseases, and therefore should be carried out

whenever occasion requires. The physical state, coloration, and rapidity

of coagulation afford valuable data in certain diseased conditions, and

indicate the approximate richness in hæmoglobin, the normal or abnormal

composition of the plasma, and the richness of the blood in white

corpuscles.

Microscopic examination is still more valuable, whether carried out by

the moist method, in which a drop of blood is compressed under a cover

glass, or the dry method with or without staining. In the latter case

the specimen is fixed with a mixture of equal parts of alcohol and ether

or by immersing it in a 1 per cent. solution of osmic acid.

By this means it is possible to detect the condition of the red and

white blood corpuscles and hæmatoblasts; the existence or non-existence

of leucocytosis and its degree, as well as the existence, for instance,

of leucocythæmia.

The blood corpuscles may also be counted.

Histological examination, supplemented by suitable staining, reveals the

presence of normal or abnormal blood corpuscles, parasites such as

piroplasma, or microbes such as bacteria.

Such examination necessarily presupposes a knowledge of what should be

looked for in the normal state.

In normal blood the red blood corpuscles predominate. They are all

similar in form and, with few exceptions, of the same size. They stain

strongly with acid solutions such as eosine. In pathological conditions,

large or giant corpuscles may be found (macrocytes), as well as those of

medium size (normal) and small size (microcytes). Some are vigorous and

stain deeply; others, on the contrary, are degenerating or dead, and

have no greater affinity for one constituent than for another of the

double or triple stains commonly employed.

In pathological conditions the hæmatoblasts occur in very varying

numbers.

The white blood corpuscles found in health may be classified as

follows:—

Large and small lymphocytes, each of which has a round voluminous

nucleus and a narrow border, and contains a non-granular protoplasm;

their proportion varies between 22 per cent. and 25 per cent.:

Polynuclear leucocytes or polymorphous leucocytes with a single nucleus,

which originate in bone marrow, stain best with neutral colours, and are

present in the proportion of 70 per cent. to 72 per cent.:

Mononuclear leucocytes with an ovoid eccentric nucleus stain best with

basic colours, and form about 1 per cent.:

Polynuclear leucocytes stain best with eosine or acid colours, and form

about 1 per cent. to 2 per cent.

When these white blood corpuscles are in larger number the condition is

known as leucocytosis, and when one or other variety is in very great

excess the condition is known as leucæmia.

CHAPTER I.

CARDIAC ANOMALIES.

ECTOPIA OF THE HEART.

Ectopia of the heart, _i.e._, congenital malformation in which the heart

is displaced from its normal position and thrust sometimes completely

beyond the thoracic cavity, is not very rare. The heart may be well

developed, but it is not enclosed by the thoracic walls when the

thoracic cavity closes during the first stages of embryonic life. The

sternum, which is cartilaginous and becomes ossified only at a later

period, remains fissured along the median line, and the fissure, usually

of oval form and with rounded margins, surrounds the auricles and the

vessels at the base of the heart. The ventricles form a hernia

projecting beyond the thorax, which then only contains the two pleural

sacs and a complete mediastinal partition. The pericardium remains

undeveloped.

Despite this malformation, the embryo develops. The fœtus may in due

season be brought forth living, but as a rule death occurs in a few

hours.

=The diagnosis= is easy, but this malformation cannot be treated. All

that can be done is to protect the ectopiated organ against external

violence in cases where the young creature is born alive.

CHAPTER II.

PERICARDITIS.

Pericarditis consists in inflammation of the pericardial sac. It is

attributable to different causes, varying in importance and in

causation.

=Specific pericarditis= may be produced by the tubercle bacillus, or it

may develop during an attack of contagious peripneumonia. Tuberculous or

peripneumonic forms of pericarditis as a rule form only complications of

chronic pulmonary tuberculosis or peripneumonia. They are very rarely

primary in character, and, like the allied forms of pleurisy, assume a

vegetative and adhesive form in tuberculous cases.

Moussu has never seen the true exudative form either in acute or chronic

tuberculosis, but only vegetative and caseous forms.

=Simple acute pericarditis.= Cases of simple acute exudative

pericarditis have been described, and have been referred to chills,

wounds, or injuries in the region of the heart, and in a few cases to

the rheumatic diathesis.

Such forms of pericarditis may occur, but probably are very rare, for

Moussu has seen but two cases. As the symptoms correspond exactly to

those of exudative pericarditis produced by a foreign body, it is

unnecessary to describe them specially.

The only important detail to bear in mind with this disease is the

possibility of cure by suitable treatment, such as the application of

stimulants or vesicants to the cardiac zone, the administration of

salicylate of soda or diuretics, and complete rest.

=The diagnosis=, moreover, should be confirmed by making an aseptic

exploratory puncture with the capillary trocar. The nature of the liquid

withdrawn will indicate whether the case is one of simple acute

pericarditis or pericarditis due to a foreign body.

=Cancerous pericarditis= is generally secondary, and is caused by

development of tumours on the pericardial serous membrane, and in the

myocardium. Moussu, however, has seen one case of primary cancerous

pericarditis, the tumours being found only on the periphery of the

myocardium. The growth assumes a vegetative form with moderate

exudation. The symptoms, however, so closely approach to those of

exudative pericarditis due to foreign bodies that only the latter

variety, which is by far the most frequent in animals of the bovine

species, need be described.

EXUDATIVE PERICARDITIS DUE TO FOREIGN BODIES.

[Illustration: $1]

This condition has been erroneously described as traumatic pericarditis,

but the latter term would suggest that the disease was due to an injury

acting from without. It may be defined as a disease produced by the

discharge into the pericardial cavity of some foreign body from the

gastric compartments.

Boizy in 1858 described several cases of this kind of pericarditis.

Hamon in 1866 gave an excellent table of symptoms. Roy in 1875

supplemented this with numerous observations showing clearly the

possibility of recognising the disease by clinical examination.

Pericarditis due to foreign bodies is to-day one of the best

characterised diseases of the ox, and it is easy to diagnose.

Before approaching the etiological side of the question, it is necessary

to recall in a few words the anatomical arrangement of the pericardium

and its relations to neighbouring organs.

In the ox the diaphragm presents a marked concavity directed towards the

abdomen. The pericardium, situated exactly in the median plane, is fixed

by its point to the sternum. A fold of adipose tissue directly connects

it with the anterior surface of the diaphragm. On the abdominal side the

conical right compartment of the rumen is in free communication with the

reticulum, which is closely applied to the posterior surface of the

diaphragm on the median line opposite the spot occupied by the

pericardium on the anterior surface (Fig. 176). As a result of this

arrangement any object passing through the reticulum and diaphragm in

the median plane would enter the pericardial cavity. These particulars

indicate clearly how this form of pericarditis is produced.

=Causation.= One of the chief causes of pericarditis by a foreign body

is connected with the way in which oxen feed. They rapidly swallow their

food and any foreign bodies that may be concealed in it, submitting it

later on to a second mastication in the course of rumination. This

method of feeding results in bolting the food almost without

mastication, hence the possibility of swallowing foreign bodies.

The proximity of the reticulum to the pericardium is also an important

factor, because the foreign bodies fall into the reticulum as soon as

the bolus of food begins to break up. It is important to notice,

moreover, that pericarditis is commonest on farms where the oxen are

attended by women, or in regions where sharp objects are to be found on

roads or pastures frequented by the animals, such as the vicinity of

needle, nail, and rivet factories.

The sole cause is the penetration of a foreign body into the pericardial

sac.

=Pathogeny.= All kinds of foreign bodies are swallowed by oxen, as is

abundantly shown by post-mortem examinations. These indigestible bodies

pass with the food into the rumen, and accumulate in the deepest

portions of that receptacle. Owing to physiological contractions the

lower wall of the rumen rises to the level of the orifice of

communication with the reticulum, and so passes much of the material

accumulated within it into this organ.

Soft foreign bodies fall towards the lower parts of the reticulum, but

sharp objects may lodge in its walls. Very often the bodies penetrate in

this way without causing reticulitis or grave inflammation. The

functions of the reticulum are not impeded. The commonest of such

objects are needles, pins, nails, or fragments of iron wire. On account

of their form, needles are the most dangerous. The sharpness of one

extremity ensures its passing readily through the tissues, and as the

point is the part that offers least resistance, the needle continues

gradually to penetrate.

If the foreign body becomes implanted vertically in the lower wall of

the rumen or reticulum it may be expelled directly through the medium of

an abscess. This is a favourable termination, though it usually results

in permanent gastric fistula.

More often the objects penetrate the anterior wall of the reticulum and

gradually work their way towards the diaphragm, impelled by the

movements of the reticulum and the other digestive compartments. They

perforate the muscle and pass into the thoracic cavity, either in the

direction of the pericardium or of the pleural sacs.

First as to the penetration of the pericardium. The foreign body,

whatever it may be, produces by its presence alone very marked

irritation, and as in addition it is always infected in consequence of

its having passed through the digestive compartments, inflammation is

set up to a degree proportionate to the pathogenic qualities of the

infective agent.

=Symptoms.= The early symptoms are those of indigestion, and not of

pericardial disease, a fact which is easy to understand, because at

first the whole mischief is in the abdominal cavity. The patients are

dull, restless, and seem to be suffering from an obscure ailment. They

remain standing more than usual, show more than ordinary deliberation in

lying down, lose appetite, cease to ruminate regularly, and exhibit

intermittent tympanites.

The cause of these symptoms is as follows: At first the reticulum is

partly immobilised by the local inflammation, and at a later stage

movement of the diaphragm is checked by reflex action when the sharp

body has progressed far enough to touch it. The rhythmic movements of

the reticulum and the diaphragm are interfered with, rumination is

disturbed, eructation ceases, and tympanites appears.

The patient often utters slight groans, particularly when forced to

move; but as this is a sign common to all grave diseases it can only

give rise to a suspicion as to what has occurred. In ten to fifteen days

this primary phase may have terminated; but it is impossible to say how

long it lasts, for it varies with each animal as with each variety of

foreign body, and it may be prolonged for months.

From the moment it reaches the thoracic cavity the foreign object makes

its way towards the channel formed on either side by the ribs and below

by the sternum, and therefore towards the point of the heart. This is

the second phase of development.

The passage of the foreign body through the diaphragm occupies a more or

less considerable time, depending on its length; the beginning of this

second phase is characterised by relative immobility of the circle of

the hypochondrium during respiration. The abnormal sensibility and pain

impede contraction of the diaphragm.

Palpation of the region of the xiphoid cartilage then reveals abnormal

sensibility, and sometimes causes the animal to resent being handled.