Definition. Symptom. Sign. Constitutional symptoms—local, objective,
subjective, direct—idiopathic, indirect—symptomatic, premonitory.
Anamnesis. Position. Movements. Decubitus. Acute. Chronic. Fever.
Sthenic. Asthenic. State of limbs, muzzle, nose, snout, palmar-pad,
hoof, bill, digits, mouth. Thermometry. Normal temperature, in doors,
in field, at work, in hot season, in nervous subject, in thirst, in
youth—age, starvation, plethora, cold, sleep, rest, stimulants,
suppressed perspiration, eliminants, antipyretics. Fever temperature,
morning, evening, transient elevation, persistent rise, sudden
fall—collapse, crisis. Fatal elevation. Rise during defervescence.
Pulse. Respiration. Skin, staring coat, pallor, coldness, dryness,
harshness, mellowness, pliancy, hidebound, yolk, clapped wool, scurfy,
lesions, itchiness, tenderness, loss of hair, emphysema, anasarca,
sweat, sebum. Expression, life, dullness, paralysis, dropsy,
jaundiced, eye, discolorations, photophobia, amaurosis, pinched face.
Nasal mucosa, red, violet, etc., nodules, polypi, osseous disease,
pentastoma, œstrus, discharge from teeth—sinuses—actinomycosis—tumors.
State of the bowels, kidneys, nervous system.
The usual basis of diagnosis must be a clear and intelligent observation
of the symptoms of disease. A _symptom_ is an appreciable evidence of
disease. A _symptom_ however may indicate illness, without affording the
means of diagnosis, while the term sign is often used for a
pathognomonic symptom—one by which the disease can be identified. Used
in this sense a _sign_ may be said to be a diagnostic symptom.
1. =Constitutional Symptoms= are such as affect the entire system, like
a rise of body temperature, or a shivering fit.
2. =Local Symptoms= are confined to a definite area as redness,
tenderness, swelling, ulceration.
3. =Objective Symptoms= include all that can be recognized by the senses
of the observer. These alone are available in dealing with the lower
animals.
4. =Subjective Symptoms= can only be felt by the patient himself, as
pain, giddiness, cold, heat, blindness, numbness. Such symptoms are
therefore only obtainable from the human patient who can tell how he
feels. In the lower animals they can only be matter of inference, thus
pain may be inferred from lameness or wincing on pressure, and giddiness
from unsteady gait. The fact that the veterinarian is restricted to
objective symptoms renders his task a specially difficult one, yet this
has its compensation, as this very restriction tends to train the
observant practitioner to greater skill.
5. =Direct Symptoms= (=idiopathic=) are those which are connected with
the seat of disease, as the redness, exudation, and swelling of
inflammation.
6. =Indirect= (=sympathetic=, =dependent=) =Symptoms= are observable at
a distance from the actual disease:—as when headache attends on
dyspepsia, or lameness in the right shoulder upon disease of the liver.
7. =Premonitory= or =precursory symptoms= precede the diagnostic
symptoms of some diseases, thus dullness and languor often heralds an
approaching fever, and the strangles of young horses is often preceded
by a general unthrifty appearance, poor appetite and indisposition to
exertion.
In observing symptoms as in other things, some have far greater natural
ability than others, but in all a careful training will do much to
develop and improve the power and habit. A most important thing in such
habits is the strict maintenance of a system, not to be followed as a
cast iron rule but to be constantly kept in mind and strictly carried
out except when sound judgement and experience show it to be
unnecessary.
=Anamnesis.= As a rule the first thing to be learned about a patient is
his history, and personal and hereditary characteristics. What are his
general health, temperament, previous attacks, hereditary
predisposition, environment? Is the site of the building, its condition
as regards soil, springs, drainage, structure, ventilation, light,
cleanliness such as would favor any particular disorder or class of
disorder? Is the patient in high, low, or moderate condition, robust or
debilitated, alert and lively or dull and stupid? Have other animals
suffered recently, or at a corresponding season, or under similar
conditions in apparently the same manner? How long has the patient
suffered, were there any premonitory indications of illness, what were
the first symptoms, and what symptoms have followed up to the present?
Has there been any change of food, water or management that might throw
light on the cause? Has there been any change of weather or unwonted
exposure to cold, storm, overwork, compulsory abstinence or enforced
retention of some secretion? If a female is she pregnant?
Having exhausted this method, using such lines of inquiry as promise
good results in the particular case, the veterinarian is prepared to
bring his own powers of observation to bear more directly.
=Position= and =movements= will often furnish valuable data. The _horse_
which lies on his ribs, stands obstinately in chest diseases, or
whenever there is much interference with breathing. The ruminants and
carnivora on the other hand which lie on their smooth or padded sternum,
can breath with comfort in this position and only stand up persistently
in the worst cases. The habit of standing day and night is also
characteristic of anchylosed back or loins in the solipede. Roached back
may be natural, or the result of overwork and slight sprains or injuries
of the loins, of anchylosis, of intestinal or renal inflammation, or of
certain injuries to the limbs. The extension of the head on the neck may
suggest sore throat, chest disease, tumors around the throat, abscess
(fistula) of the pole, sprain or spasm of the extensors of the neck,
disease of the axoido-atloid joint, tetanus, or cervical rheumatism.
Dropping of head and neck might suggest paresis, mechanical injury to
the levator muscles or cervical ligament, extreme debility, or
prostration from a profoundly depressing fever or poisoning. Inability
or indisposition to back, might indicate sprain or fracture of the back,
anchylosis, laceration of the sublumbar muscles, paresis, cerebral or
spinal inflammation, softening or other lesion, tetanus, laminitis,
dislocated patella and certain other affections. Swaying or unsteadiness
in walking or turning would similarly suggest sprain or fracture of the
back, paresis and other nervous and locomotor injuries. The solipede
with peritonitis arches the back and draws the hind feet forward under
the belly, with impacted colon or obstruction to urination he will often
stretch with fore limbs advanced and hind limbs retracted. The mode of
decubitus may be significant. With peritonitis, enteritis, metritis or
acute nephritis or hepatitis the solipede lies down slowly and with
caution: with spasmodic colic he throws himself down as if reckless of
possible injury. Lying well up on the costal cartilages and side of the
breast bone suggests a slight affection of the air passages; lying on
the side, disease of other parts. Rolling on the back may indicate
simple intestinal spasm, but also blocking by intussusception,
impaction, volvulus or otherwise. Sitting on the haunches may suggest a
similar trouble or it may imply ruptured stomach or diaphragm. The dog
may sit on his haunches in health, or with dyspnœa in acute affections
of the respiratory organs, asthma and heart affections. Decubitus on the
belly with hind legs extended backward, may imply paraplegia, or acute
inflammation of the abdominal organs. Lying with the nose in the flank
or turning the head toward the flank, though a normal position of rest,
often indicates abdominal suffering. Turning of the head to one side
may, however, suggest injury, spasm or rheumatism of the cervical
muscles, or disease on the corresponding side of the brain. Animals, at
liberty, lie more frequently on the side on which the heaviest internal
organs are lodged, thus ruminants, pigs, and dogs rest on the right (the
side of the liver) though in cattle with a heavily loaded rumen the
condition may be reversed. Decubitus on the abdomen, with the limbs
extended and abducted implies profound nervous disorder or shock.
Habitual decubitus often indicates severe suffering in legs or feet.
Resting one limb more than another implies injury to that limb. Standing
with the pastern of one limb more upright than the others has the same
meaning. Extension of one fore foot in advance of its fellow with
flexion of the pastern and fetlock denotes suffering in the posterior
part of the foot or in the flexors. Flexion of carpus and fetlock
without advance of the foot probably bespeaks injury to shoulder or
elbow. Inability to bear weight on the fore limb, without knuckling at
the knee, should call for examination of the olecranon and joints
especially the elbow. Inability to extend the carpus should lead to
investigation of the flexor muscles and tendons, the joints and the
heel. Movement of the hind limb without flexure of the tarsus would
suggest injury to that joint, the stifle or the flexor metatarsi tendon.
Inability to extend stifle and hock, should demand examination of the
tendo-Achillus and olecranon, of the triceps extensor cruris and of its
nerves.
Atrophy of a muscle or group would require scrutiny of its tendons and
its nerve and blood supply.
More precise indications of injury of the locomotor system must be found
under surgery.
After posture, the general or constitutional disorder may claim
attention. Is the illness acute or chronic? Is fever present? Has the
animal had a rigor? Does the coat stare in patches (along the spine) or
generally? Is there perspiration? Is there full, clear, somewhat
congested eye (=sthenic=) or drooping lids over a dull brownish
sclerotic (=asthenic=). Are the lower parts of the limbs and other
extremities cold, and the roots of the horns or ears hot? Is there
significant heat and dryness of the muzzle (ox), nose (dog), snout
(pig), palmar-pad (carnivora), hoof (solidungala, bisulcates), bill and
digits (birds)? Has the mouth the hot burning feeling of fever? Finally
is the temperature as indicated by the thermometer abnormally high? To
estimate this with any degree of certainty one must be well acquainted
with the normal temperature.
=Normal temperature.= As taken indoors under ordinary conditions, the
normal temperature taken in the rectum may be: fowl, 107°–110°F.; swine,
103°–106°F.; goat and sheep, 103°–104°F.; ox, 100°–102°F.; dog,
99°–100°F.; horse, 99°–99.6°F. Ranging in the fields, at work, or on
forcing or stimulating feeding, it may be 1° higher than when at rest
indoors. A whole herd may be raised 2° by a three miles drive in warm
weather. In our summer heats a rise of 1° is common. In nervous animals
any change in management may raise the temperature, for example, 1° to
2° after failure to water at the usual time, or from retaining the milk
in the udder when the milker had been changed. Young animals are
normally .5° to 1° warmer than old ones though more sensitive to the
action of cold. Half starved animals, when put on abundant and
nutritious food may have a rise of 1° or more. Females in heat, in
advanced pregnancy and at the time of parturition are usually 1° to 3°
above the natural temperature. Among the agencies lowering temperature
are: cold, (1° to 2°); sleep, (1° to 2°); rest; starvation; alcoholic
and other circulatory stimulants which fill the cutaneous capillaries
and thereby cool the whole mass of blood; suppression of insensible
perspiration (retention of waste matters) as by varnishing the skin
which lowers the temperature to 25°; purgatives and diuretics (1°);
certain drugs like antipyrin, acetanilid, etc., which act on the heat
producing centres and retard metabolic changes.
=Temperature in disease.= Comparative temperatures should be taken at
the same hours on successive days, bearing in mind that the morning
temperature is usually slightly lower and the evening one slightly
higher. Where possible both morning and evening temperature should be
taken. With elevated temperature, repeat sooner to see that it is not
transient. A transient rise of 1° to 2° is unimportant. A permanent rise
of 2° or 3° indicates fever. A sudden additional rise of several degrees
in the progress of fever is grave. A persistence of the high evening
temperature to morning shows aggravation. A persistence of the low
morning temperature to the evening bespeaks improvement. A sudden
extreme fall to much below the normal (4° or 5°) indicates collapse.
This is usually attended with other symptoms of extreme prostration and
sinking. A sudden considerable fall to near the normal, without untoward
attendant symptoms, may indicate a _crisis_ and a more or less speedy
improvement may be hoped for. This sudden fall often attends the period
of eruption of certain exanthemata, as cowpox, horsepox, sheeppox,
aphthous epizootic, etc. A sudden extensive fall of temperature may
result from some transient accidental cause, as a prolonged deep sleep,
a hemorrhage, the relief of constipation, or of enuresis. A sudden rise
may supervene on such suppressed function or other cause of nervous
irritation or on toxin poisoning, but it does not persist more than
twelve or twenty-four hours after the cessation of the morbific cause.
A rise of 10° or 12° above the normal standard is usually promptly
fatal.
A continued high temperature indicates persistent disease, and a
considerable rise during defervescence implies a relapse and in the
absence of any error in diet or nursing is grave.
=Pulse.= Before the introduction of the clinical thermometer, the
indications furnished by the pulse were held to be of the highest value.
Though largely superseded by the usually more reliable thermometer, yet
they should not be discarded, but employed as symptoms corroborative of
the thermometric indications. In many cases the pulse will furnish
criteria, when in the absence of fever, the heat of the body will tell
of nothing amiss. This is especially true of diseases of the heart, the
large blood vessels, and of the nervous system, and in cases of
poisoning. For special indications furnished by the pulse, see diseases
of the heart.
=Respirations.= The morbid activity or inactivity of the respiration,
its modified rythm, the pathological significance of the altered
breathing sounds and of the superadded sounds, the indications furnished
by percussion, palpation, mensuration, succussion, sneezing, snorting,
yawning, cough, moan, grunt, stertor, discharge, etc., afford material
of inestimable value to the diagnostician. See under diseases of the
chest.
=Skin Symptoms.= The erection of the hair of carnivora in rage or fear
implies a profound nervous disturbance, and a similar erection (staring
coat) in the larger herbivora especially, implies a corresponding
nervous disorder, due however to a different cause. The pallor and
coldness of (white) skin and extremities the retrocession of blood
toward the internal organs, the contraction of the involuntary muscles
of the hair bulbs, the sense of cold, and the actual shivering all come
from the fundamental nervous disorder. The loss of lustre and gloss in
the hair and the dryness, rigidity and mobility (mellowness) of the skin
imply lack of nutrition. The mellow feeling of the skin under the
pressure of the finger, soft and yielding by reason of the lax
connection tissue and fatty layer in the thrifty animal, is in marked
contrast with the dry, hard, tough, unyielding hide firmly adherent to
the parts beneath (hidebound), which denotes the unhealthy or unthrifty
animal, or from the thin, attenuated, mobile, bloodless skin of the
debilitated subject, the victim of lung, liver, or intestinal worms. In
sheep in parallel conditions there is a lack of _yolk_ in the wool,
which is dry, lustreless and brittle and often flattened (clapped) on
the skin. In fowls ruffling of the plumage indicates the nervous
disorder and chill. The skin may be scurfy in conditions of low health
or in connection with the presence of vegetable or animal parasites.
Ringworm has excessive scurf, and tends usually to a circular form, and
to complete shedding of the hair from the spots. The hairs split up
before dropping. In acariasis there may be scurf, scab, abrasion and
sore of many kinds, but the outline is not necessarily circular, nor
strictly limited, isolated hairs remain even on the bare patches, and
itching is extreme as shown by the movement of the body and especially
of the lips or foot when the part is scratched.
The hair may be freely shed during convalescence from debilitating
diseases, a condition that must not be confounded with the yearly
shedding of the winter coat and the moulting of birds, which is a
perfectly normal process. Yet even the spring shedding and the growth of
the new coat makes a great drain on the system, and must always be taken
into account as a probable cause of derangement of health.
The lesions of the skin in the different cutaneous affections must be
remanded to the special chapter on skin diseases. The following however
may be named as having a general bearing.
Emphysema may be due to a local wound, (elbow, trachea, rib); it may
indicate black quarter, or it may occur subcutaneously in cattle without
marked impairment of health.
Anasarca, from diseased blood, heart, liver or kidneys is denoted by
swellings, often painless, or a general infiltration which pits on
pressure. It often shows primarily in the lower parts of the hind limbs.
Warty looking elevations must be carefully discriminated, having in mind
primarily papilloma, tubercle (grapes), actinomycosis, condyloma (in
dogs), cancer, melanosis. The secretions of the skin (sweat, sebum) may
be suppressed, or in excess, producing at times a special odor, as in
thrush and canker of the horse, cowpox and sheeppox, and rheumatism.
Before death the cadaveric odor may be marked, and attracts crowds of
flies to the victim.
=Facies.= The countenance may be expressive. Between the bright, full,
clear, prominent eye of health, and the dull, sunken, lifeless,
semi-closed eye of serious disease the contrast is extreme. The drooping
lids (ptosis) may be paralytic and even unilateral, in which case
drooping ear, and flaccid lips and alæ nasi complete the picture. With
paralyzed lips there is usually drivelling of saliva, and dropping of
half chewed morsels in the manger and stall. The eye may show dropsical
lids in kidney or liver disease and in anæmic conditions like
distomatosis in sheep. It may show the upper lid bent at an angle in
recurrent ophthalmia of solipedes. The mucosa may be red in ophthalmia,
yellow in jaundice, dusky brown in Southern cattle fever, anthrax,
cerebral meningitis, and other fevers attended with destruction of red
globules and liberation of their hæmatin. The pupils may be all but
closed in internal ophthalmias, or widely dilated and irresponsive to
light in amaurosis. The iris may lack its normal lustre or may be
distorted or torn in various ways from adhesions. Opacities of the
cornea, lens, or vitreous may be recognized.
The facial muscles may be flaccid and devoid of expression in palsy, and
prostrating diseases; they may be firm, giving the bright, intelligent
look of health; or they may be painfully drawn in the agonized
expression of spasmodic colic or enteritis.
=Nasal Mucosa.= The pituita is bright red in sthenic fevers, simple
acute coryza, strangles, laryngitis and inflammation of the larger
bronchia. It assumes a violet hue in capillary bronchitis, pulmonary
congestion, glanders, and petechial fever. Petechiæ appear in the last
named affection, and in a number of bacteridian diseases, such as
anthrax, swine plague, hog cholera, the red fever of swine etc.; a
yellow tinge in shown in jaundice. Millet-like or pea-like nodules, or
elevated patches, and ulcers show in glanders and may be felt by the
fingers. In cattle hard millet-like nodules appear in a chronic coryza
with hypertrophy of the mucosa. The orifice of the lachrymo-nasal duct,
seen in the horse on the floor of the chamber at the friction of the
mucosa with the skin of the false nostril and in ass and mule on the
outer ala near the upper commissure, is sometimes plugged with
inspissated mucus. Among other lesions of the nasal chamber may be named
polypi—soft and calcareous,—thickening and obstruction in purpura
hemorrhagica, osteoporosis and hypertrophy of bone, and
parasites—pentastoma denticulata (in the horse and dog), and the larva
of the œstrus (in sheep and buffalo). Disease of the upper molars and
abscess of the fronto-maxillary sinus may be manifested by swelling
beneath and on the inner side of the eye, fœtid discharge from the nose,
and obstruction of the air current. Dullness on percussion will show the
filling of the sinuses. These conditions must be carefully
differentiated from actinomycosis, sarcoma and other morbid growths in
the same situation.
Costiveness with fœtor and lack of the normal color in the stools may
suggest _liver torpor_ or inflammation, while fatty stools may suggest
pancreatic disease. The uneasy movements of colic, should lead to a
careful investigation of the chylo-poietic organs (see digestive
organs). Weakness of the hind parts, tenderness of the loins, and
altered condition of the urinary discharge should demand a close enquiry
into the state of the _kidneys_ and _bladder_. Satyriasis or nymphomania
would suggest disease of the _generative organs_ or the nerve centres
that preside over them. The same is true of impotence, sterility and
abortion.
In eruptions on the skin (erythema, eczema, pustule, squama) a cause may
be found in the local action of heat, friction, or other direct
irritant, but in the absence of any such manifest cause, an enquiry
should be made into the functions of sanguification, digestion,
urination and the action of the liver. It may further suggest parasitism
(ring worm, phthiriasis, fleas, acariasis, verminous disease, etc.)
Symptoms of _nervous disorder_ are too numerous to be here traced to
local lesions. Motor paralysis of one limb may, however, suggest injury
to its motor nerves, to the same side of the spinal cord, or of the
opposite half of the cerebrum. Paraplegia almost always indicates injury
to the cord. Sensory paralysis of one side may depend on disease of the
opposite corpus striatum. The animal moves in a circle when a tumor
(coenurus in sheep) exists in the roof of the lateral ventricle
presumably pressing on the ganglia on its floor. An animal rolls on its
axis when there is a lesion of the median cerebral peduncles, of the
supero-external portion of these peduncles, of the posterior part of the
encephalon, or of different parts of the hemisphere. Amaurosis suggests
disease of the corpora quadrigeminia. Loss of coördination of muscular
movement usually implies some lesion of the cerebellum. Vertigo may
imply disease of the encephalon (congestion, anæmia, inflammation,
dropsy, hæmorrhage, tumor, abscess); it may be disease of the internal
ear; it may be digestive disorder connected often with cryptogamic
poisoning; it may be heart disease with obstruction of the jugular
veins; it may be parasites in the nasal sinuses; or it may be disease of
the eye. Coma occurs in most congestions and pressures on the
encephalon, and like vertigo in poisoning by alcohol, solanine, monoxide
of carbon, etc. In acting on any ganglionic centre the agent may,
according to its degree, operate positively or negatively, producing
spasms, or paralysis as the case may be. As in the case of other
visceral affections the specific diseases must be referred to for
particular symptoms.
For the more precise points in diagnosis, including chemical, physical,
electrical and instrumental methods, etc., the reader is referred to the
special diseases.