Part 4

=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.

PROGNOSIS.

Definition. Demands on the veterinarian, the question of economy. Basis of Prognosis. Cause of the illness, internal or external, vital or nonvital organ, enzootic, fatigue, infection, in one or two symmetrical vital organs, regular or irregular in its course, persistence, relapse, complications, effect of treatment, appetite, temperature, pulse, breathing, youth, age, debility, previous disease, breeding, climate, season.

Prognosis is a more complicated question for the veterinarian than for the physician. The latter must pronounce on the malady, whether it is likely to follow a regular or irregular course, whether it will last short or long, whether it will be curable or incurable, and if curable whether recovery would be complete or partial. For the veterinarian there is in addition the question of economy. The veterinary patient is, as a rule, of value, only if he can be rendered sound, and a partial recovery may be even worse than a fatal result, since the subject remains as a ruinous charge on his owner. The veterinarian must pronounce on the prompt and perfect curability of the case, on the outlay that will be requisite for treatment, on the depreciation which will be entailed on the patient, and whether, in certain lesions that do not harm the carcass, it would not be more judicious to butcher the subject. The physician is expected to do the best he can for life and health, and even a very imperfect recovery brings him a mead of gratitude. The veterinarian on the other hand must be an expert not only on disease, but on animal values, and if his treatment, however skillful it may be, results only in the prolonging of the life of an useless animal, the owner may charge him with imposing upon him an unnecessary outlay. The soundest judgment and highest skill are often necessary to secure the interests of an employer in such circumstances. In certain cases the recommendation to destroy is of much more value to the employer than the most skillful, and partially effective, curative treatment. On this basis, the reputation of a skillful man may be securely built. He can deceive no one if his prediction of recovery is not justified, while if he advises destruction and the patient recovers, he is at once discredited.

To give a sound prognosis the practitioner must have a thorough knowledge of pathology, he must have acute powers of observation, and he must be quick to appreciate every point that makes for or against the patient in the particular case.

The causes of the trouble must be carefully considered. Are they transient or permanent? Are they removable or irremovable? Are they external or internal? As a rule an internal cause is the more redoubtable. Some lesions are necessarily fatal, as a needle penetrating the heart or an attack of rabies or milk sickness. Is the cause an enzootic one? If so can the patient be removed from the locality? Is it a fatigue fever or an infectious one? Is it a simple inflammation or an infecting one? The latter are usually much more grave. In case of contagious disease, can its propogation be prevented? Is it of a fatal or non-fatal type? Is it situated in a tissue favorable to a fatal extension, (anthrax in lung) or in one unfavorable (anthrax in the tip of the tail)? Disease in a single vital organ like the heart is necessarily much more grave than in one of a symmetrical pair (kidneys, lungs) one of which can carry on the functions. The regular progress of the disease and especially an uninterrupted improvement, following on a critical perspiration or urination, is a good prognostic sign, whereas unevenness of temperature, pulse and respiration, with temporary aggravations of the general symptoms, should demand a less hopeful prognosis. The persistence of the malady is also an unfavorable indication. A relapse after partial recovery is a serious indication unless due to some obvious and easily removable cause, and unless the former convalescent condition is speedily restored on its removal. A complication is a serious indication whether it consists in an embolism, or new centre of the same disease, or the supervention of a second disease upon the first. The system has just so much more to contend with and the very supervention of the second focus or malady argues a special susceptibility, debility, or lessened power of resistance.

The prompt success or entire insuccess of treatment proves valuable.

The preservation of appetite, the slow, uniform descent of the temperature, and the improvement of pulse and breathing are among the most valuable indications.

Something may be deduced from the condition of the patient. If very young or old, debilitated by overwork, bad or insufficient food, previous disease, or any other cause, the prognosis is less hopeful, as it is also as a rule, during gestation, in the parturient state, or if abortion ensues. A hereditary predisposition to the malady in question is equally unfortunate.

Climate may be an important factor. Thus liver diseases are far more to be dreaded in a damp tropical or semi-tropical region, and rheumatism and catarrhal affections in winter and in cold northern localities. Acclimatization should also be considered. The bovine animal, raised on the Gulf Coast is likely to make a good recovery from Southern Cattle Fever while the northern beast would almost certainly die.

All in all the question of prognosis cannot always be judiciously decided at a first visit, and for the sake of his own reputation, it is well that the practitioner should give only a qualified opinion at first until he can certify himself as to the probable outcome of the disease.

PROPHYLAXIS. PROPHYLACTICS. PREVENTION.

A test of public sentiment. Soil. Water. Exposure. Buildings. Local hygiene. Breeding. Diet. Work. Harness. Ventilation.

With advancing knowledge of veterinary medicine the subject of prophylaxis is steadily assuming a more important place, and especially in the classes of enzootic and epizootic diseases. Indeed for the fatal infectious diseases of animals one can fairly estimate the medical intelligence of the people by the extent to which therapeutic treatment is still allowed. With economy as the great central object of veterinary medicine, the problematical recovery of the few can never balance the assured preservation of the many. But this subject belongs to contagious diseases to which the reader is referred.

In enzootic affections, improvements in soil, water, exposure, buildings, and other local unhygienic conditions, are the final ends to be sought, according to the particular nature of the prevailing disease.

So in sporadic diseases the correction of faults in breeding, hygiene, diet, water, work, harness, exposure, buildings, ventilation, etc., are called for in different cases as will be noted under the individual diseases.