CHAPTER V.. Rheumatism.

RHEUMATISM.

In bovine pathology the term “Rheumatism” is applied to a number of different morbid conditions, the sole connection between which is that they seriously affect the organs of locomotion. This reason may perhaps be accepted as sufficient for including the study of rheumatism amongst diseases affecting locomotion.

The disease is of considerable importance, and for this reason the study of rheumatism itself necessarily precedes the description of pseudo-rheumatism, secondary rheumatism, or infectious rheumatism in young and adult animals.

ARTICULAR RHEUMATISM.

Acute rheumatism has a clearly marked predilection for the articulations. Sometimes the great serous membranes are simultaneously affected (pleura, pericardium, endocardium), but only in very exceptional circumstances are they primarily attacked. That form of rheumatism known as visceral is as a general rule secondary in comparison with articular rheumatism. Several joints and tendon sheaths may be attacked at the same time. Under such circumstances rheumatism may be defined as a febrile disease, probably of an infectious nature, revealing itself by simple or multiple inflammation of joints and the tissues surrounding them, and capable of becoming complicated with inflammation of the pleura, pericardium, endocardium, meninges of the brain, etc.

=Causation.= All authors agree in recognising the influence of heredity, of wet and cold, of sudden changes in temperature, draughts in the stable, prolonged exposure to low temperatures, or the chilling of animals saturated with perspiration. These are and cannot be otherwise than occasional causes; but the determining cause remains at present unknown.

In human pathology it has been proved beyond dispute that a certain relationship exists between arthritism, or the “uric acid diathesis,” and rheumatism. This fact is so well recognised that doctors have said that rheumatism was to arthritism what scrofula is to tuberculosis. That, however, does not advance our knowledge of the question in the smallest degree, and it may simply be that arthritism represents one of the principal favouring conditions in the development of rheumatism.

In domestic animals the uric acid diathesis is little known, renal lithiasis is no more a rarity than gravel; but at the present time no one appears clearly to have established the relationship between these diseases and the development of rheumatism. What, however, we must all admit is that rheumatism exhibits all the phases of development of a rapidly progressive infectious disease.

Numerous attempts have been made by doctors during the last few years to discover the presence of a microscopic agent and to demonstrate its pathological characteristics. Several microbes have been described, but one is forced to confess that the results have until now been very contradictory and uncertain; and yet there is little room to doubt that the disease is of an infectious character.

=Symptoms.= The symptoms are generally well defined and well developed. The onset is sudden; an animal which one day before appeared perfectly well is attacked in one or several joints. Usually the upper joints of the limb are involved—the shoulder, elbow, knee, haunch, stifle, hock.

Nevertheless, invasion is probably not as sudden as it appears to be, and, as in the human species, the subject begins by feeling erratic pains, which, however, pass unnoticed. The animal moves with difficulty, as though it were suffering from laminitis, and has pain when placing weight on the limb, while the joint attacked soon shows a swelling which extends to the tendon sheaths and the neighbouring serous bursæ. The local temperature is higher than that of surrounding parts, sensibility becomes very marked, and pain attends the slightest pressure on, or even movement of, the affected joint. Intense lameness follows, which may even at first give rise to the suspicion of fracture. The animals remain lying for long periods, groan from time to time, and suffer great pain when rising.

In some cases the local manifestations appear to be transferred from one joint to another.

These local symptoms are accompanied by high fever. The temperature rises to 105° or 106° Fahr., the pulse to 80 or 90, and the breathing is enormously accelerated if the patients are forced to move.

Loss of appetite is very marked. Rumination may be suspended, and these grave symptoms are accompanied by constipation, rapid wasting, cessation or marked diminution of the milk supply, decrease in the quantity of urine passed, etc.

A few days after the onset, visceral complications may occur, though fortunately such complications are far from being constant. Auscultation and percussion sometimes reveal the lesions of pleurisy, endocarditis, pericarditis, etc.

The development of articular rheumatism varies greatly, and may occasionally continue for weeks or months, the condition of one joint improving only to be followed by inflammation of another.

The visceral lesions rarely disappear completely, and it is not uncommon to note symptoms of chronic valvular endocarditis. Relapses are somewhat frequent, and the disease may continue in a chronic form after the acute symptoms have disappeared.

=Lesions.= The joint itself is not alone affected. All the tissues surrounding it are congested, swollen and painful, particularly the sheaths and insertions of the tendons. Within the inflamed synovial capsules of the joints an increased quantity of turbid synovia accumulates, distending the joint and producing a condition of hydrarthrosis.

In animals slaughtered during the course of the disease one finds congestive infiltration of the limbs.

The temperature of the parts near the affected joints is higher than that of neighbouring regions. Sensibility is much more acute, and the slightest external pressure gives rise to pain.

In favourable cases the joint may appear scarcely injured. The principal symptoms are those of pain. In old-standing cases certain permanent changes may occur, such as thickening and hardening of the wall of the synovial capsule, fibrous infiltration of the tissues around the joint, or even diffuse and irregular calcareous infiltration.

Cases of false or true anchylosis are rare, the animals usually being slaughtered before such conditions can develop.

=Complications.= The commonest complications are endocarditis and pericarditis. Valvular endocarditis localised in the auriculo-ventricular valves is revealed by a systolic sound, and by tumultuous or irregular beating of the heart when the animals are forced to move. Pericarditis, which seems rare in bovine animals, is much commoner in sheep. This pericarditis, however, produces none of the external signs of pericarditis due to a foreign body. Like tuberculous pericarditis, it is only accompanied by a trifling amount of exudate, and is recognised by increased cardiac dulness and diminution in the cardiac sounds on auscultation.

Simple pleurisy associated with pericarditis is frequent in sheep, but unknown or little known in the ox.

If in animals other visceral complications occur, affecting the peritoneum, meninges of the brain or intestines, they are at present little recognised.

=Diagnosis.= Articular rheumatism can only be confused with osseous cachexia or laminitis. Osseous cachexia, however, possesses symptoms peculiar to itself, and generally extends to an entire district, whilst rheumatism appears in an isolated form. Again, the arthritis peculiar to osseous cachexia most commonly affects the joints of the extremities (fetlock and phalanges). The disease may be differentiated from laminitis by simply manipulating the joints, which are painful in rheumatism but not in laminitis, and by percussing the claws, which are painful in laminitis but not in rheumatism, and by noting the character of the gait.

=Prognosis.= The prognosis is grave, as in all acute diseases which are capable of assuming a protracted chronic form. It is also necessary to take into account the loss of condition, the possibility of relapse, and the complications due to prolonged decubitus.

=Treatment.= The first indication is to place the patients in a nearly constant temperature, to supply bedding generously, and to arrange for the animal being undisturbed. Among drugs salicylate of soda gives the best results if administered in sufficient doses—6 to 7 drams per day for oxen or cows of medium size, 45 to 75 grains for sheep.

Diuretics, like bicarbonate of soda, nitrate of potash and hay tea or infusion of couch grass, pellitory, etc., also give good results.

The joints attacked may be blistered, but it is often preferable to use mild ointments, containing camphor or belladonna, because, as soon as pain diminishes, moderate massage of the affected parts, which favours rapid absorption of the effusions, can then at once be resorted to. The diet should consist of easily digested food and of lukewarm hay tea, etc. When the animals are suffering from kidney disease in any form salicylate of soda is contra-indicated.

Antipyrin may also be of service in doses of 45 to 75 grains for bovines and 15 grains for sheep. Preparations of methyl salicylate can only be used for animals of value.

MUSCULAR RHEUMATISM.

Muscular rheumatism is due to causes similar to those of articular rheumatism. The symptoms, moreover, often occur simultaneously, or may alternate with the articular manifestations, with which they are seldom entirely unconnected.

Moist cold seems to be the predetermining cause, whether it acts indirectly on the nerve trunks or affects the capillary circulation in the muscles, through the medium of the vaso-motor supply. The results are revealed by the development of neuralgia, neuritis or interstitial myositis; and these diseases, by producing more or less intense pain, cause difficulty in movement or distinct lameness. Attempts have been made to explain the development of these lesions by ascribing a certain action to the uric acid (which is said to be in excess in the body), and to the lactic acid, which accumulates in the muscular tissue after fatigue or over-exertion, and may occasionally produce temporary myositis. Up to the present time, no satisfactory proof has been furnished enabling us to identify the myositis of rheumatism with the myositis of over-exertion, which, moreover, appears to differ from it in essential particulars.

=Symptoms.= Muscular rheumatism is often ill-recognised in veterinary medicine, and closer observation would appear to suggest that it is much less frequent than has been stated. Generalised muscular rheumatism is rare; patients stand stiffly as though incapable of moving; the limbs and the back appear rigid, and the animal seems only capable of changing its position by a single movement of its whole body. One might readily believe at first sight that the case was one of generalised laminitis or slight generalised tetanus. The animal has difficulty in rising; when moving the limbs are dragged, and the patient is cautious in lying down.

Most frequently the disease is localised in one region, such as the shoulder, the loins, or the quarters. The affected part is stiff, tense, painful, hard, and as though in a state of cramp. Palpation and pressure reveal the presence of very exaggerated sensibility, which varies within wide limits, according to circumstances, changes in atmospheric conditions, etc. These local signs are accompanied by a general reaction of varying severity, somewhat resembling that seen in articular rheumatism. Appetite is diminished or suppressed, as is rumination; the muzzle is dry and hot; the temperature may rise as high as 103° or 104° Fahr.

=Lesions.= The lesions are imperfectly recognised, because those who might most easily observe and study them have often neither the means nor the leisure for the purpose. Possibly one would at times discover lesions of neuritis; but in any case it is not so very rare to discover lesions of interstitial sclerosing myositis in the depths of the muscles of the quarter, loins, shoulders, etc., a condition rarely found in any other disease. Naturally these are only the ultimate lesions of muscular rheumatism; for slight attacks leave no traces visible to external examination.

=Diagnosis.= The commonest error is that of mistaking the condition for laminitis of all four limbs. The history often suffices to eliminate this disease from consideration, while palpation and percussion of the claws remove any remaining doubt.

=The prognosis= is not usually grave, and recovery sometimes follows the adoption of good hygienic conditions. On the other hand, certain patients lose flesh rapidly.

=Treatment.= Salicylate of soda and antipyrin still form the two most efficacious drugs, particularly the first, which may almost be regarded as a veritable specific in rheumatism. The doses vary with the size of the patients, from 2½ to 7 drams per day. These doses are continued for six to eight days consecutively. Some authors prefer salicylic acid, which, however, is more irritant, in doses of 15 to 75 grains. Tartar emetic, in doses of 2½ to 4 drams per day until purgation is established, is also said to have proved of great value in the hands of the older practitioners. Local treatment comprises stimulating frictions with camphorated alcohol, ammonia, and oil of turpentine. Such applications are usually of great service, particularly when associated with methodical massage of the affected parts. These modes of treatment should be supplemented with a proper dietary and the administration of tepid, diuretic fluids as required.

INFECTIOUS FORMS OF RHEUMATISM OR PSEUDO-RHEUMATISM.

Under the head of infectious rheumatism or pseudo-rheumatism may be grouped joint diseases of a rheumatic type accompanying various general or local diseases in young animals and adults: diseases of the umbilicus, rachitis, peripneumonia, retention of the fœtus, dysentery, etc. These diseases are characterised by articular symptoms, which sometimes appear early, sometimes only when the disease itself is declining, and develop suddenly or gradually, the joint cavities themselves either being directly invaded by the agents of the primary disease or remaining exempt. These pseudo-rheumatic attacks are due to the localised action of microbic toxins on the articular synovial membranes. Sometimes the serous membranes of the large body cavities are also implicated.

This theory explains the development of acute arthritis without the presence of gonococci during the course of an attack of blenorrhagia in man, and may be applied in respect of certain forms of arthritis or synovitis without the presence of microbes in domestic animals.

INFECTIOUS RHEUMATISM IN YOUNG ANIMALS.

=Causation.= To explain the occurrence of infectious rheumatism in young animals a variety of causes has been invoked, such as bad feeding, the absence of that purgation which usually follows the action of the mother’s first milk (i.e., colostrum), and clears the bowel of meconium, the effect of heredity, of chills, of insufficient food, and of unduly abundant or very rich food, which has been said to produce indigestion and its various complications.

All these causes may play a certain part in favouring the development of infectious rheumatism, but none constitutes the direct cause.

Lecoq and Loiset in their investigations regarding this disease in colts mentioned the almost invariable existence of lesions in the umbilical region. Bollinger in 1869 recognised the possibility of infection by way of the umbilical vein. Röll and Guillebeau are of the same opinion, and Morot’s excellent study shows that here must be sought the most frequent point of origin of the articular symptoms. In animals born in dirty stables the umbilical cord becomes infected at the time of birth, or its cicatrix a few days later. The result is the development of rapidly fatal septicæmia, suppuration in the wound, omphalitis, omphalo-phlebitis, or umbilical arteritis; and to this infection are due the various complications, which may appear almost immediately, as in the case of septicæmia of calves, or may be deferred for a shorter or longer interval, for so long indeed that the umbilicus may appear to have healed externally (infectious pneumonia and endocarditis, infectious arthritis, etc.). The umbilical cord and the tissues surrounding the cicatrix form excellent culture grounds for those microorganisms which always exist in such abundance in litter and manure; and there is, therefore, no difficulty in understanding why in dirty stables infection so readily occurs. The infective agents may be of very varying kinds, a fact which explains the difference in the symptoms which follow umbilical infection; although ovoid bacteria, streptococcus pyogenes, and the bacilli of necrosis seem most common.

Omphalitis and omphalo-phlebitis are not the only diseases capable of producing infectious rheumatism in young animals. Certain infections resembling dysentery and diarrhœic enteritis are also its frequent forerunners. In young animals even rachitis, which is accompanied by various digestive disorders, may serve as the point of origin for infectious rheumatism and all its complications.

In older animals—i.e., in animals from five to six months, or even twelve to fifteen months—infectious rheumatism may occur without a clearly defined cause. It then develops with the symptoms and lesions of that condition known as “osteomyelitis of adolescence” in human pathology. These forms of osteomyelitis are due to infection with streptococci and staphylococci. In veterinary medicine the pathogeny has not yet been accurately ascertained.

=Symptoms.= Infectious rheumatism in young animals assumes one of two clinical appearances, possibly due to different causes, viz.—plastic or suppurative arthritis following umbilical infection, and simple exudative arthritis. In the former variety symptoms appear soon after birth, rarely after the age of two months, and as an exception in animals of six to eight months affected with rachitis. The onset is sometimes sudden; the patient, though healthy on the previous evening, is unable next morning to rise or move. Hence in France this disease has received the titles, amongst others, of laminitis and paralysis of the newly born.

Certain joints, often a pair, appear swollen, hot and painful. The synovial sacs are distended, and in the upper joints of the limb appear much more prominent than in the lower. When the patients are still able to move they walk on three legs, but usually they remain lying permanently, and if aroused show great difficulty in rising and very acute pain in moving.

General disturbance is also very marked; the temperature varies between 103° and 105° Fahr. The animals are dull, have no appetite, and exhibit intense thirst. The pulse rate and respirations are increased, and not uncommonly symptoms of grave visceral complications, such as endocarditis, pleurisy, pneumonia, etc., can be detected. Diarrhœic enteritis sometimes appears as a secondary development.

The animals remain permanently lying down. They can only be induced to rise with difficulty, and, when moved, exhibit very acute pain.

In many cases the disease then takes a rapid course and ends fatally. Death is the usual termination whenever any of the above-mentioned visceral complications exist. Recovery is exceptional. In certain lucky cases, sometimes without any treatment whatever, the symptoms become less acute, the appetite persists or improves, fever diminishes, the condition of the joints remains stationary, and after the lapse of several weeks there is ground for anticipating recovery. In all cases, however, the convalescents remain thin and sickly, exhibit pain and capricious appetite, and in very few cases indeed is there any economic reason for keeping them alive.

More frequently infectious rheumatism terminates by abscess formation in the joints. The articular cavity becomes filled with pus, the tissues covering one of the synovial sacs soften, and the abscess opens, discharging fibrinous clots, thin watery pus mixed with synovia, and débris of articular cartilages or ligaments. Pyæmia is the final complication when the patients are not slaughtered.

In the cases comprised under the second heading the symptoms appear more slowly and develop insidiously, the chief, viz., a tendency to remain lying and difficulty in movement, long preceding the appearance of exudative arthritis. The course depends chiefly on the nature of the infective agent. In calves suffering from peripneumonia, calves from stables in which epizootic abortion rages, rachitic calves or calves suffering from severe diarrhœic enteritis, the joints do not become the seat of suppuration.

In such cases the arthritis is of a simple exudative character, but without microbic infection of the joint cavity. This form is less dangerous, and is often curable provided the original cause be kept in mind.

=Lesions.= The lesions are always very marked, and are quite different from those of simple rheumatism. The synovial membranes and the periarticular tissues are always thickened, injected, inflamed, and infiltrated.

In more benign cases the synovial exudate from the joint cavities is simply cloudy, contains no infectious germs, and proves sterile on attempts at cultivation. In such cases there is no abscess formation. But most frequently this stage of serous exudation is only temporary, and the articular fluid, which at first seems sterile, may, when tested some days later by means of cultures, reveal the presence of organisms. The synovia accumulated within the joint sometimes contains fibrinous flocculi, which are at first small, but later form veritable coagula, filling up and thickly coating all the prominences of the joint and moulding themselves on the extremities of the bones constituting the articulation. Sometimes the cartilages undergo very rapid ulceration, the subjacent layers of bone become inflamed, and the osteoarthritis which develops is so severe and painful that the patients are forced to remain absolutely still, and are quite incapable of rising. The lesions may remain stationary at this point. In other cases suppuration occurs in the articulation itself, the wall of the synovial cavity, the periarticular tissues, and the skin soften; then the abscess breaks, giving rise to open suppurating arthritis. Animals are rarely kept long enough to become so gravely affected; many die before this stage, and the others are usually slaughtered. Moreover, they rapidly perish from exhaustion and from visceral complications of a pyæmic character.

In many cases post-mortem examination reveals nothing whatever in the region of the umbilical cord (through which infection has occurred), but the germs of infection may be found in the blood or general circulation; or again, careful investigation may show ulceration of the umbilicus, lesions of omphalitis, of ascending umbilical arteritis in consequence of infection of the thrombus, of umbilical phlebitis, or of infective peritonitis, etc. The infectious agent reaches the liver through the blood-vessels, then attains the posterior vena cava, after which the infection assumes the gravest possible character, producing complications like arthritis and purulent infection, with the formation of multiple abscesses in the depths of the viscera.

The Staphylococcus aureus and various streptococci are the most frequent but not the only causes of these infections.

=The diagnosis= is not difficult, provided the disease be not mistaken for true rheumatism. As true rheumatism is very rare in young animals, and as, on the other hand, attention is aroused by the presence of lesions of the umbilicus and by the existence of diarrhœic enteritis, rachitis, etc., there is seldom room for doubt.

=Prognosis.= The prognosis is extremely grave whenever the case results from infection of the umbilicus. French statistics place the mortality at 90 per cent. and German at 75 per cent.

Curative =treatment= can only be attempted with any chance of success in the simple exudative form. Even then it is necessary to simultaneously treat the primary disease, such as rachitis or diarrhœic enteritis.

The recommendations of former practitioners as to the use of saline purgatives, cream of tartar, etc., were probably due to their having recognised that diarrhœa is sometimes the primary cause.

Moussu has seen simple exudative arthritis in rachitic subjects disappear, together with the rachitis, under proper treatment.

The indications therefore are, firstly, to take measures against the primary disease, treating the local lesions separately with blisters, douches, or simply cold applications and massage. Provided the general condition can be improved, recovery may follow.

Unfortunately, this treatment is useless against infectious rheumatism with suppurative arthritis resulting from infection of the umbilicus. In such cases treatment, if undertaken, should be directed towards perfectly disinfecting the umbilical wound or any existing sinuses.

Injections of strong carbolic solution, the application of antiseptic ointments or of antiseptic pencils containing iodoform, salol, etc., into the sinuses, followed by a surgical dressing covering the umbilicus, form the basis of this primary treatment, which, it need scarcely be said, has little chance of checking the course of already existing arthritis. The use of internal antiseptics and of antipyretics like camphor, salicylate of soda, etc., is worthy of trial. On the other hand, prophylactic treatment in an infected area has every chance of succeeding. The use of dry, clean litter under the mother and the new-born calf, thorough cleansing of the umbilical cord or umbilical cicatrix, and the application to the umbilicus of a small surgical dressing or even a smear of tar, almost always suffice to prevent the occurrence of these forms of arthritis.

INFECTIOUS PSEUDO-RHEUMATISM IN ADULTS.

The infectious pseudo-rheumatism of adults differs from infectious rheumatism in young animals in that it never becomes complicated with suppurative arthritis, and rarely affects more than one joint at a time. The hind limbs are the parts usually attacked, and the joints seem predisposed to disease in the following order of frequency: the femoro-tibial, coxo-femoral, and hock joints.

On account of its greater frequency in cows, it has been termed “arthritis of milch cows” and “infectious arthritis of milch cows,” etc. In reality it may also attack bulls and oxen, but such cases are exceptional.

=Causation.= First mentioned by Coulbeaux in 1824, and by Pauleau in 1832, this disease has been well studied by Ph. Heu. Old works mention it as attacking good milkers in the best dairies around Paris, and Heu declares it to be the most deadly disease after peripneumonia and tuberculosis.

This form of arthritis usually appears in an insidious form after abortion, retention of the fœtus, or post-partum metritis. In cases of epizootic abortion infectious rheumatism sometimes assumes an epizootic form, and completes the devastation begun by abortion. Under other and much rarer circumstances it may follow enteritis of adults or attacks of mammitis, etc. The pathogeny of these forms of arthritis is not difficult to understand, for in the greater number of instances they form delayed consequences of local uterine infection.

The soluble products secreted by infectious organisms multiplying within the uterus are absorbed by the uterine mucous membrane, causing slow intoxication; and in consequence of the special elective affinity which the toxins show for the articular serous membranes, and in many cases also for the visceral serous membranes, the special characteristics are developed. Under certain circumstances the joint cavity may even become the seat of true microbic infection.

=Symptoms.= The appearance of the first symptoms is difficult to identify, for many cows abort, fail to “cleanse,” or become affected with metritis without infectious rheumatism supervening. It is a long-delayed condition, which may be postponed for weeks or even for several months after an abnormal parturition, and to a time when the symptoms of metritis have almost entirely disappeared. The onset is characterised by difficulty in rising, and soon afterwards by lameness, or by the animal failing to place weight on one of the hind limbs. The affected joint, usually one of the articulations of the stifle, appears markedly enlarged, is not appreciably hot to the touch, but reveals a certain amount of painful sensibility on pressure. The periarticular tissues are infiltrated and the synovial sacs slightly distended.

After a few days, a week or two at most, the periarticular swelling diminishes, and the condition appears to remain stationary.

Appetite is normal or only diminished. The pain continues, and causes progressive wasting and diminution in the yield of milk.

If at this time the practitioner makes a careful digital examination of the diseased region, he may find one of two conditions. In the first, the synovial sacs appear distended, fluctuating and in exactly the same condition as in ordinary bog spavin. This is what has been termed the exudative form of infectious arthritis. In the second, the enlarged joint remains very sensitive, the walls of the synovial sac are thickened, fluctuation is either absent or only slightly marked, but induration is very manifest. This constitutes the plastic form.

Exudative arthritis is the form usually seen at first. It may preserve its primary characteristics, but only too often proves to be the forerunner of the plastic form, which develops with the lapse of time. If nothing is done wasting becomes more marked, and is accompanied by cachexia. The animals are unable to rise, the complications inseparable from decubitus occur, and wasting or secondary purulent infection sets in.

=Lesions.= In the exudative form the changes are confined to inflammation and thickening of the synovial membranes, intra-articular exudation, and sometimes grooving of the cartilages without ulceration of the articular surfaces and without disorganisation of the joint.

The plastic form, on the other hand, leads to destruction of the cartilages, ligaments, and sub-cartilaginous bony layers, induration and calcification of the walls of the synovial cavity, and even periostitis of the ends of the bones, with the formation of false joints. The internal surface of the inflamed synovial membranes begins to granulate, the fibrous clots distending the articular dilatations are perforated by these extending granulations, and fibrous tracts soon develop even in the articulation itself, undergo calcification, and produce complete anchylosis.

=Diagnosis.= The diagnosis is easy. The animal’s history and symptoms, and the stationary character of the pain in the earlier stages are sufficient to prevent any error.

=Prognosis.= The prognosis is grave, but not fatal. In the exudative form recovery may follow early treatment. In the plastic form, however, the chances of success are extremely meagre.

=Treatment.= It is easier to prevent than cure, particularly in these forms of arthritis. The means are simple, and consist in always treating the post-partum infection as soon as it is recognised. The animals can be effectively safeguarded against later articular complications by the free use of intra-uterine antiseptic injections, until the uterine injuries have wholly healed, and by the administration of saline purgatives and diuretics.

When infectious arthritis is diagnosed, it is still necessary to resort to the same methods if the uterine symptoms persist, and to complete the treatment by local applications.

The best method of local treatment seems to consist in puncturing the articulation aseptically, removing almost all of the liquid exudate, and immediately thereafter firing the skin covering the joint in points or lines.

If treatment has been invoked too late, if plastic arthritis with the formation of fibrous bands within the joint and destruction of the cartilages and calcification of ligaments, etc., already exists, there is no economic object in undertaking treatment. Fattening may be attempted, or the animals may be handed over to the butcher, if wasting is not too far advanced.

The use of cold douches, plaster bandages, blisters containing nitrate of mercury, painting with sulphuric acid, etc., are too inconvenient and too inefficient to be recommended in actual practice. Similarly, the salicylate of soda, which is so useful in simple rheumatism, has no real superiority over diuretics in this condition.

SCURVY-SCORBUTUS.

=Definition.= “Scurvy is a subacute or chronic trophic disorder characterised by debility, inanition, anæmia, swelling and bleeding of the gums, gingival ulceration, dropping of the teeth, and petechial or more extensive hæmorrhages and exudations in the skin, serosa, and solid tissues.”

=Causes.= “Among the lower animals, pigs especially suffer, when kept in close, foul quarters and fed on a monotonous and insufficient ration. Formerly scurvy ... was attributed to an exclusive diet of salt food; to excess of sodium and deficiency of potassium salts; to the absence of fresh vegetables; to tainted food, etc. In pigs the food and environment are usually chiefly at fault, the subjects have been kept ... in foul buildings, in a hot, moist atmosphere, and with an uniform diet of maize or other unvarying and insufficient ration. Röll attaches great importance to putrid food. Benion has found the affection mainly in obese swine, the forced feeding and intestinal fermentations manifestly operating as factors. Hess and others attribute the disease in pigs to the germ of erysipelas. Stengel has produced purpuric disease in animals by inoculation of the extravasated blood from human scurvy patients. Muller and Babès found a slender bacillus and streptococci in the tissues of scorbutic gums.... There is considerable presumption of the existence of a microbian cause, the efficiency of which is dependent on the unhygienic conditions above stated, while these unwholesome conditions are equally non-pathogenic in the absence of the microbe.”

=Lesions.= “The blood is black and incoagulable or clots loosely, rigor mortis is slight, changes may be found in the number and character of the white and red blood globules, but are not constant; there is usually an excess of sodium salts and deficiency of potassium ones, and there is marked petechiation of the skin, mucosæ and serosæ. The bone marrow may be abnormally red and the bones fractured at the epiphyses, or carious.... The gums are softened, swollen, red and uneven, with hæmorrhagic discoloration, erosions, necrotic areas and ulcers.”

=Symptoms.= “Anorexia or fastidious appetite, prostration, debility and sluggish, indifferent movements, are followed by the local lesions on the skin and gums. On the skin appear petechiæ and extravasations, which often implicate the bristles, so that they may be shed or pulled out with ease, the bulbs appearing dark and blood-stained (bristle rot). These may be followed by necrotic sloughs, and deep ulcers that are slow to heal. The gums are red and swollen, with hæmorrhagic spots, and bleed on the slightest touch. Erosions, sores, and ulcers are not uncommon; the tongue is dry and furred, and the mouth exhales a fœtid odour. The teeth may become loose in their sockets. Swelling of the joints ... may be noticed, and lameness or stiffness from muscular or intermuscular extravasation. Blood effusions into ... the eye have been noticed, and paralytic or comatose symptoms from similar effusions on the brain. In the absence of improvement the patient becomes more and more debilitated and exhausted, and death may be preceded by profuse exhausting diarrhœa.”

“=Prognosis= is unfavourable in advanced cases, and when the faulty regimen cannot be corrected.”

=Treatment.= “The first consideration is to correct the unwholesome conditions of life, purify the building and its surroundings, and allow a free range on pasture. Subject each patient to a thorough soapy wash, and if possible allow clean running water in which a bath may be taken at will. Access to green food and invertebrates (slugs, larvæ, etc.) is important, or a varied diet of grain, middlings, bran, roots, fruits, tubers, cabbage, silage, etc., must be furnished. Iron and bitters (gentian, nux vomica) are useful, and sometimes small doses of arsenite of soda solution or cream of tartar are useful. Acorns or horse-chestnuts are recommended. For the mouth a wash of potassium chlorate, soda biborate, or potassium permanganate may be resorted to.... In the case of fat pigs it is more profitable to butcher at once, as soon as early symptoms appear.” From Law’s “Veterinary Medicine,” p. 558, Vol. III.