Part 96

Chronic rheumatism may be a sequel of the acute, or it may occur from the same causes acting with lessened force, or on a less susceptible animal. It tends to attack the larger joints especially, though it may implicate the muscles as well. Coincident affection of the heart is less common than in the acute, and when it does arise seems to advance slowly. It is liable to cause permanent distensions of the affected joint capsules, as well as false membranes, articular abrasions, degenerations and ulcerations and less frequently bony enlargements and calcifications, the latter implicating the soft tissues in the vicinity.

The attendant lameness is liable to be remittent or intermittent, subsiding in warm buildings and during genial, clear sunny weather, and relapsing in connection with cold, raw nights and mornings, exposure in the dew or rain, and before and during great changes of weather. Cold, damp beds, chilling draughts between open doors or windows, washing with iced water, sudden intense cooling of the body after perspiration, clipping during cold weather, any cause of sudden rigor, when followed by stiffness, lameness and articular swelling, serves to identify the latter as rheumatic. Even the warmth induced by judicious exercise, may cause improvement, so that a horse, starting out stiff or lame, may drive out of it after going a mile or two. The formation of subcutaneous nodules, though rare, appears to be more frequent than in acute rheumatism.

Diagnosis is to be based largely on the variability of the lameness at different times, its propensity to shift from place to place, its manifest association with exposure to cold, and with the immanence of electric storms or change in the barometric pressure, and its improvement under genial weather, warmth and comfort.

SYMPTOMS OF MUSCULAR RHEUMATISM IN HORSES.

Under usual causes, muscles tender, stiffness, groaning, loins, quarter, shoulder, neck, chest.

Developed under conditions similar to those causing rheumatism of the joints, rheumatism of the muscles tends to attack those of a particular region, and to continue in these throughout the attack rather than change to others. The affected muscles are very tender to the touch, but usually show no swelling nor heat. The muscles are relaxed and tend to atrophy, fever is little marked, there is comparatively little tendency to the implication of the heart, and the suffering and stiffness vary with the variation of the weather, or with electric or barometric changes. When generalized, however, fever may supervene, and the joints may be implicated (Thompson).

When the loins are affected they become extremely tender to the touch, and the horse shows great stiffness, and groans when made to walk and above all when turned or backed. He does not, however, show the unsteadiness in gait and tendency to stagger that is shown in sprain of the loins, and there is no history of a slip, fall or injury, but an unmistakable connection with cold, exposure, change of weather, or overfeeding on grain.

When the gluteal muscles are attacked there is intense lameness, and dragging of the hind limb, with an acute sensitiveness of the skin of the region, which characterizes neither disease of the hip nor of the trochanterean bursa.

When the scapulo-humeral muscles are the seat of disease, there is a marked stiffness, shortness of step, drooping of the head, and great tenderness of the skin and muscles to manipulation or the use of the currycomb. Like the other cases named it occurs suddenly, without evidence of accident, but bearing a relation to cold or other change of the weather, and is better or worse as the weather is more or less genial.

When the cervical muscles are affected (torticolis), the same features are noted, the absence of traumatic cause, the presence of a meteorological one, or at least of cold or wet, the responsiveness of the disease to the state of the weather, and to revulsive agents applied to the part. The neck may be held rigidly in one position, to one side or elevated so that there is great difficulty in getting the nose to the ground.

The costal muscles are less frequently attacked (pleurodynia), but the same general principles guide in diagnosis.

Seidamgrotzky alleges the constant existence of acidity of the urine in muscular rheumatism. This may be attributed to the active trophic changes going on in the muscles.

SYMPTOMS OF ACUTE ARTICULAR RHEUMATISM IN CATTLE.

Sudden onset, hyperthermia, chill, fever, acid saliva, decubitus, does not stretch on rising, lameness, joints involved, metastasis, variability, morning and noon, suppuration, walking on toe, secondary articular rheumatism. Course: muscular symptoms, cardiac, pleuritic, digestive. Chronic. Muscular rheumatism: of back, loins, shoulder, quarter, neck. Changes in blood and nutrition.

There is a sudden attack with constitutional disorder, chill, staring coat, cold horns and ears, dry muzzle, impaired appetite and rumination, acid saliva, constipation, thirst, hurried breathing, hard accelerated pulse and more or less hyperthermia. Then there may come reaction with surface heat and glow. The patient inclines to lie and when raised fails to stretch the back or the hind limbs, stands with arched back, and walks stiffly and with more or less lameness. The joints attacked may be determined by local strain, compression on concussion, hence the frequency of lesions of the knees and fetlocks. Yet any of the great joints of the limbs may suffer,—hip, stifle, hock, shoulder or elbow—or several may be affected at once. The disease may extend from one joint to another, may improve in one or more, only to suffer a relapse, and may oscillate better and worse according to the state of the weather or the exposure to cold or warmth. Often almost helpless in the early morning, the patient improves greatly in the heat of the sun.

The affected joint is swollen, distended with liquid, hot and tender with considerable infiltration of the surrounding tissues, including the tendons and their synovial sheaths. Suppuration is much more common than in the same affection of the horse appearing to be due to a complex infection with pus microbes. In walking in severe cases the foot of the affected limb is planted with great care and caution mainly on the toe and there appears to be exquisite suffering when weight is thrown on it, so that the fetlock and knee may knuckle over and the patient comes to the ground. Great infiltrations, fibroid, and other hyperplasias and even calcifications are not uncommon.

Cadeac describes as secondary articular rheumatism, those infective inflammations of the joints that follow on parturition, abortion, omphalitis, enteritis, etc., but it is manifest that these are special disorders due to the presence of the microbes of specific diseases or their toxins and should be described with these rather than with rheumatism.

The course of acute rheumatism in the ox is very uncertain. Mild cases may recover in a few days. In others the lesions become extensive, great hyperplasia and induration occur around the joint and permanent stiffness and even anchylosis may supervene. The occurrence of temporary improvements and relapses is a common feature. The extension of the disease to other joints, tendinous sheaths, muscles and even internal organs is to be dreaded. Extreme tenderness of the back and loins when handled or pinched, with groaning is a marked feature especially in cold and damp times or in early morning. Cardiac complications show themselves by shortness of breath, palpitations, hard intermittent, irregular or unequal pulse, blowing murmur with the first heart sound, and other signs of circulatory trouble. Pleuritic, pulmonic and abdominal complications are also to be looked for. The costiveness by which acute rheumatism is ushered in, becomes complicated by congestion of stomach and intestine, and impaction of the first and third stomachs, great dullness, anorexia and even nervous disorder. Colic and even diarrhœa are occasional consequences.

Many cases subside into a chronic form which shows a variable condition, better and worse, according to the condition of the weather, the exposure to cold and damp, and even the changes of diet. This may last throughout life.

SYMPTOMS OF MUSCULAR RHEUMATISM IN CATTLE.

This may set in with the same abruptness as articular rheumatism, the animal in the morning after a wet, dewy or frigid night showing general stiffness and lameness with extreme sensitiveness of the skin and muscles along the back and loins. The animal moves slowly and stiffly, grunting perhaps at each step and shows inappetence, fever, dry muzzle and costiveness. This is essentially rachialgia or lumbago. Pandiculation on rising is entirely omitted.

Not infrequently the muscles of the shoulder are mainly affected and become exceedingly tender to manipulation. The patient seeks to remain recumbent and when raised will get up on his hind parts and remain thus for some time resting on the knees before he can be made to get up in front.

When the muscles of the croup are attacked the mode of getting up is reversed, the animal rising first on its fore feet and remaining for a time sitting on its haunches or resting on the hocks before it gets on the hind.

If the muscles of the neck are involved there is the same stiffness, soreness, tenderness and twisting to one side or rigid elevation of the neck as seen in the horse in similar circumstances.

In any case there is a tendency to extension or shifting from one part to another, and notably to the implication of the tendons, synovial sheaths and joints. This is especially the case in the acute type, while chronic rheumatism may remain long confined to the groups of muscles which are first attacked. In the acute forms too there is the greatest liability to internal complications not only cardiac, but according to Cruzel abdominal and thoracic as well.

A fatal result is rare, but the impairment of appetite and digestion, the constant and often severe suffering, the destruction of the red globules, and the malnutrition, and increased and perverted metabolism as shown in the pallor of the visible mucous membranes, the steady loss of condition and advancing emaciation, the rigid, dry, scurfy, hidebound skin, tends to wear out the subject or render it unprofitable. In the chronic form it may last for months.

SYMPTOMS OF RHEUMATISM IN SHEEP.

Articular rheumatism seems to be very rare in mature sheep, while it has been recorded in lambs. Muscular rheumatism on the other hand has been seen in connection with untimely shearing, exposure to cold storms and cold, damp folds. The back and loins, are tender to the touch, or in other cases the neck or hind quarter, the limbs are carried straight and rigid, the animal moves slowly and stiffly, falls behind the flock, and is found alone, unthrifty and emaciated. It usually terminates in recovery though it may cause chronic disease and distortion of the affected joints or it may even prove fatal. The usual tendency of the morbid process to shift from joint to joint or to muscles, is here again characteristic.