CHAPTER V.

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.

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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.

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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.

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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.

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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.

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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.

SECTION II. DISEASES OF THE DIGESTIVE APPARATUS.

SEMIOLOGY OF THE DIGESTIVE APPARATUS.

The group of diseases which affect the digestive apparatus is one of the most important in bovine pathology, because almost all animals of the bovine species are bred with the object of utilising to the full their powers of digestion and assimilation.

Whether we consider adult fat animals, calves intended for slaughter or milch cows, the object sought is always the same—_i.e._, to secure the greatest possible economic return through the medium of the digestive functions.

Even although in working oxen there is no tendency to overfeeding, the animals remain none the less predisposed to diseases of the digestive apparatus; the meal times are often too short, and rumination has to be performed under the yoke or during work—in a word, under unfavourable physiological conditions.

=Semiology.= To ensure correct diagnosis it is necessary here, perhaps more than in any other department of pathology, to be capable of grasping the symptoms or syndromes and signs afforded by the different parts of the digestive apparatus; to know how to co-ordinate and group them so as logically to deduce the final synthesis, the diagnosis. The diagnosis proving correct, the prognosis becomes easy, and this is the chief object from the economic standpoint. The practitioner who undertakes treatment knows how to deal with the case, and the owner likewise knows what he undertakes to do.

Although this classification may appear arbitrary, we shall consider successively diseases of the mouth, of the pharynx, œsophagus, stomach, intestines, etc., firstly describing the symptoms characterising these diseases. At the same time we should state that many symptoms are common to a large number of diseases and in themselves have absolutely nothing characteristic. They are simply sign-posts capable of showing the way.

=Mouth.= External examination reveals the condition of the muzzle, the lips and their commissures, and the surroundings of the buccal opening, and detects the existence of any desquamation, rents, eruptions, ulcerations, etc., which may be present.

In quiet animals the practitioner can examine the cavity of the mouth single-handed, but in troublesome animals it becomes necessary to have an assistant, who seizes the muzzle with one hand and the tongue with the other, or who simply fixes the animal’s head. In exceptional cases it will be necessary to secure the patient to a post, tree, or wall. The mere attempt at examination will show whether there is trismus or absolute freedom of movement in the jaws.

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By introducing the fingers between the commissures and applying them to the bars or to the free portion of the tongue, the practitioner will be able approximately to estimate the local and general temperature. The sensations experienced will also inform him of the degree of moisture or dryness of the mouth and of its sensibility.

On separating the jaws, he will note the odour exhaled and its possible abnormalities—its acid, sourish, fœtid, or putrid character. He will directly observe any anæmia or hyperæmia of the mucous membrane, from the inner surface of the lips and cheeks up to the soft palate, although owing to the thickness of the buccal epithelium it is not always easy to estimate anæmia or hyperæmia in the ox. The surface of the tongue should also be examined, and a note made whether it appear dry, pasty, dusty, sooty, etc., though these appearances are occasionally apt to lead one astray. The observer should also inquire regarding want of appetite, depraved or exaggerated appetite, etc.

Even the manner in which the animal picks up its food will serve to direct his attention to the development, or possible existence, of some disease of the mouth, although want of appetite is not always characteristic of a lesion in the pharynx or œsophagus, but sometimes of a lesion in its neighbourhood, like hypertrophy of the retro-pharyngeal or bronchial lymphatic glands.

This examination will also detect the existence on the lips of wounds, cuts, injuries or specific eruptions (aphtha, tuberculous ulcerations, the ulcerations of gangrenous coryza, etc.) on the gums indications of gingivitis, periostitis, mercurial poisoning, actinomycosis of the maxilla, and ulcerations of all kinds; on the tongue, of wounds, of simple or specific inflammatory eruptions (aphtha, the ulcerations of actinomycosis, tuberculosis, gangrenous coryza, etc.), as well as the swellings due to superficial or deep-seated glossitis. By the same method of examination, though with somewhat more difficulty, one can detect abnormal mobility, irregularity of development, caries, etc., of the teeth, the condition of the excretory ducts of the salivary glands, the state of the hard and soft palate, and the existence of fissures, vegetations, polypi and tumours.

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=Salivary glands.= The salivary glands, particularly the parotid and submaxillary, should be examined by direct inspection and palpation.

Direct inspection reveals the existence of swellings, deformity of parts, increase in salivation, or ptyalism, which sometimes occur in conjunction with foot-and-mouth disease, actinomycosis, acute stomatitis and mercurial poisoning, as well as increase in size of the salivary ducts.

Palpation reveals the degree of sensibility of the parts, the existence of œdema, induration, cysts, and, more frequently, distension of the salivary ducts as well as the presence of calculi, tumours, the direction of fistulæ, etc.

Difficulties may occur, particularly when the submaxillary and parotid glands are affected; but methodical and complete examination will usually enable one to differentiate the conditions.

=Pharynx.= The pharynx may be examined externally by inspection and palpation, and internally by direct digital palpation. Inspection reveals possible deformities of the region of the gullet, palpation the condition of the tissues as well as abnormal sensibility and infiltration. Internally, digital examination must be cautiously conducted, and after a strong gag has been securely inserted in the mouth. Under such conditions it is without danger. The hand being inserted exactly in the median line will detect obstructions which may already have been partly identified by external palpation, as well as the existence of inflammation with or without the formation of false membranes, and of ulcerations, polypi, etc.

=Œsophagus.= In consequence of its anatomical formation, situation and course, the œsophagus may be divided into two distinct parts—viz., the cervical, which can be examined from the outside, and the thoracic, which cannot so be examined.

The cervical part may be examined by inspection, by palpation from one side, or by palpation with both hands and from both sides.

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Inspection leads to the detection of changes in the shape of the œsophagus and of the jugular furrow. In fat subjects, however, it is of little value. As the position and the course of the œsophagus are known, unilateral palpation, or, better still, bilateral palpation, employing both hands, is of very much greater service. These methods reveal the presence of swellings, infiltrations, changes in shape and sensibility, the presence of foreign bodies, the existence of dilatations or contractions of the tube, etc.

Auscultation and percussion, though recommended by some practitioners, are not of much service.

Inability to swallow, due to change in the œsophagus, is also detected by inspection. Its existence suggests a number of possible conditions, such as fissure or ulceration of the œsophagus, compression in the mediastinal region as a result of tuberculous or other disease, contraction or dilatation of the œsophagus, etc. Furthermore, inspection will betray the existence of dilatation of the tube, to which vomiting and regurgitation of food are sometimes due.

Internal exploration is the only method of detecting changes in the thoracic portion, and may also be utilised to locate lesions in the cervical region. It is practised by passing a sound of small calibre or any flexible cylindrical object, such as a cart rope, etc. The patient must be fixed with the head extended on the neck and a proper gag or speculum introduced into the mouth. Exploration assists us in recognising the existence of inflammation of the œsophagus, true or false contraction, dilatation and the presence of obstructions.

In animals of the bovine species all these lesions—viz., inflammation of the œsophagus, fissuring and ulceration, obstructions, compressions, dilatations and contractions of the tube—although not very frequent, are nevertheless from time to time encountered.

=Stomach.= Exploration of the stomach or of the different gastric compartments presupposes an exact knowledge of the respective positions of the different reservoirs. Topographical anatomy shows that the rumen is situated in the left flank, and that it occupies the whole of the left abdominal region from the diaphragm to the pelvic cavity. As a consequence, it may be explored from the region of the twelfth rib; it is inclined slightly from above downwards, and from left to right, its extreme right border extending as far as, or a little beyond, the white line.

The reticulum, the smallest of the four reservoirs, is situated in the sub-ensiform region at right angles to the median plane of the body. On the left it touches the rumen and the diaphragm; on the right side it is in contact in front with the diaphragm, above with the omasum, and to the right and towards the rear with the abomasum. The omasum is situated above the reticulum and conical right portion of the rumen; in front it touches the liver, and towards the back and left the rumen. The abomasum is situated obliquely in the right hypochondriac region, its anterior surface resting on the lower wall of the abdomen towards the middle and right side of the body, its pyloric portion extending upwards, behind the right hypochondriac region.

=Rumen.= The rumen can be examined by inspection, palpation, percussion, and auscultation. The use of the œsophageal sound and of the trocar and canula is also of value in diagnosis.

Inspection affords information of a varying character, according to the moment when it is practised, even in a condition of health. It only extends to the condition of the flank before or after a meal, etc., emptiness of the rumen being accompanied by hollowness of the flank, and distension, following an abundant meal, by fulness in this region.

When digestion is not proceeding normally, the flank may be distended unduly by gaseous accumulations or by the presence of solid food. In abdominal and mediastinal tuberculosis and in gastro-enteritis there may be simple tension or slight dilatation. When indigestion or enteritis is entering on a favourable stage, the flank may appear hollow, and in cases of chronic diarrhœa it may appear retracted.

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Digital examination or palpation may be practised over the entire region of the flank. It shows whether the rumen is full or empty, reveals the consistence of the contained food in cases of chronic indigestion, the sensibility of the walls, and the rate and order of the muscular contractions. Direct or indirect percussion may be carried out on a horizontal line from the twelfth rib as far back as the flank, and vertically from the lumbar vertebræ to the white line. In health one discovers in young animals an upper zone of normal resonance due to gas, a zone of semi-dulness and an inferior zone of absolute dulness, due to the liquids in the rumen. The spleen, which is attached to the supero-anterior surface of the left side of the rumen, does not seriously restrict the area open to percussion.

In pathological conditions percussion from above downwards may produce a tympanitic sound, due to gaseous indigestion or a clear sound throughout the greater portion of the vertical diameter suggestive of acute gastro-enteritis with the formation of gas in the rumen, or of adhesive peritonitis preventing the rumen from collapsing. Indigestion due to excess of solid food, on the contrary, is characterised by a dull sound throughout the entire region from above downwards. Percussion along a horizontal line permits of the delimitation of certain zones which vary a great deal in area, according to the case.

Auscultation is more instructive than percussion. Like percussion, it may be practised throughout the entire depth of the abdomen, from the transverse processes of the lumbar vertebræ as far as the white line, and in a horizontal direction from the eleventh rib to the region of the flank.

Auscultation of the upper zone enables one to detect sounds of deglutition, gurgling sounds (glou-glou), and a sound resembling falling water, due to the movement of solids or liquids in the rumen and reticulum. The sounds heard vary in different cases, and depend on the state of repletion or of emptiness of the rumen.

Auscultation of the middle zone reveals:

Firstly, a very special crepitation sound, which may be compared to the deflagration of a handful of salt thrown on burning coal. It is believed to result from the bursting of bubbles in the contents of the rumen under the action of normal digestion.

Secondly, a churning sound produced by the rhythmic peristaltic contractions of the rumen, by which the substances ingested are very intimately mixed. By applying the ear over the flank region or by palpation the rhythmic contractions of the rumen, two per minute in most cases, can readily be perceived.

In practice examination of the rumen is confined to these four methods.

=Puncture.= From an exclusively scientific point of view, exploration of the rumen also comprises analysis of the gas collected through puncture and analysis of the liquids removed by aspiration (first stages of gastric digestion). Normally, these gases, in the order of their abundance in the mixture, consist of the following: Carbonic acid, carburetted hydrogen and nitrogen.

In disease, and in most cases of abnormal fermentation, the carburetted hydrogen is greatly in excess of the carbonic acid. In chronic gastro-enteritis, ammonium sulphide and other offensive gases are found in addition.

=Chemical analysis.= In the rumen the ingested food is macerated in an alkaline liquid at a temperature of 100° to 101° Fahr. (the alkalinity is due to the saliva). This process markedly modifies the composition of the ingested matter. Nevertheless, the upper portion in contact with the gas sometimes presents a slightly acid reaction, probably due to carbonic acid. The sugary and fatty materials contained in the food respectively undergo lactic and butyric fermentation. Only a small quantity of the starch, however, is transferred into sugar. In the calf, and in very young animals, the reaction of the rumen is acid throughout the entire period of sucking. In disease, when rumination has long been suspended and chronic loss of appetite or gastro-enteritis exists, the reaction is generally acid. The sugars, gums, and soluble salts of forage, roots, etc., are dissolved in the rumen, but fatty materials undergo no modification.

The reticulum, which is the smallest of the gastric compartments, is situated in the sub-ensiform and retrodiaphragmatic regions, extending right and left of the middle line to a nearly equal distance. Above and to the left it communicates freely with the rumen, to the right with the omasum.

In practice it can only be examined in two ways: inspection and palpation.

By inspection changes in the configuration of the ensiform region may sometimes be detected. Such changes are rare, and must be distinguished from congenital deformity. They sometimes accompany inflammation of the reticulum produced by a foreign body, when the lower abdominal wall is directly perforated by such body.

In cases of inflammation of the reticulum due to foreign bodies, abscess formation, perforation, etc., it is possible to detect œdematous infiltration, abnormal sensibility, fluctuation and increased heat, etc., by manipulating the parts with the fingers or the clenched fist.

If the evidence pointing to the presence of a foreign body in the reticulum is considered sufficient, gastrotomy may be performed and the interior of the viscus examined with the hand, but although the operation is possible it is very rarely practised.

=Omasum.= The omasum occupies, so to speak, a position inverse to that of the reticulum, lying deep down on the right side, behind the diaphragm, under the hypochondrium, and above the abomasum and reticulum.

It is the only gastric compartment which cannot be examined, although when impacted it may be felt on the right side.

=Abomasum.= The abomasum is lodged in the lower part of the right flank under the circle of the hypochondrium. It extends obliquely from below, upwards from the sub-ensiform to the sublumbar region. The smaller curvature is turned towards the rumen on the left side; the larger curvature is in contact with the abdominal wall. In spite of what has so often been stated by those who have never seen it, the abomasum can be examined and is accessible along the circle of the hypochondrium.

In adults useful information can rarely be obtained by inspection; but in sucking calves the abomasum, if distended by indigestion, gastro-enteritis, etc., sometimes appears prominently in the right abdominal region. Palpation with the fingers or with the fist will detect exaggerated sensibility, irritation, inflammation, or distension.

Percussion and auscultation furnish no very precise information. The information obtained by the above-described examination of the stomach is in practice amplified by a search for certain symptoms which are usually easy to detect. They comprise:

(_a_) Suppression or irregularity of rumination. This very important symptom suggests the degree of gravity of the digestive disturbance, and to some extent the gravity of the general condition. Suppressed rumination is a common symptom in many diseases, some of which are purely digestive, though all are not. It is, however, a grave sign in most cases.

(_b_) Eructation, which is usually frequent, may be regarded as normal provided the exhaled gas preserves the fresh odour of grass or of the food swallowed, like brewers’ grains, turnips, etc. Sometimes the gas is sour, acid, fœtid, or putrid, all of which conditions indicate disease.

(_c_) Yawning is not common. It becomes frequent and attracts attention in certain abnormal conditions; in others, again, it may be completely suppressed.

(_d_) Nausea and vomiting are rare. Vomiting is commoner in calves, and results from inability to digest the milk, or simply to over-distension of the abomasum. The matter vomited by adults usually consists of partly masticated food, and is derived from the rumen; while the contents of the abomasum are occasionally rejected, in which case the material is of pulpy consistence and has an acid smell.

(_e_) Digestive disturbance is sometimes accompanied by various modifications in the breathing, such as immobilisation of the hypochondriac region and of the diaphragm; abnormal sensibility and reflex coughing on palpation, and, in inflammation of the reticulum due to foreign bodies, costal respiration.

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It is by methodically observing, grouping, and classifying the symptoms presented that one is enabled to detect the links connecting them.

=Intestine.= The intestinal mass is contained in the right half of the abdomen above the compartment of the stomach. The large intestine occupies the upper zone, corresponding externally with the hollow of the flank from the thirteenth rib to the haunch. The small intestine occupies the middle zone from the thirteenth rib to the entrance to the pelvis and the stifle region; the inferior zone is occupied by the rumen and abomasum, and in pregnant females by the gravid uterus.

Notwithstanding these indications it is somewhat difficult to examine the mass of the large intestine, separated as it is from the abdominal wall by the =U=-shaped inflection of the duodenal loop, of which the deep retrograde branch is in contact with the terminal portion of the floating colon.

Inspection of the right flank furnishes no information of value in diseases of the intestine, nor is auscultation of much service beyond enabling one to detect the frequency, diminution, or absence of borborygmus. Palpation alone is really of service. Practised gently and superficially with the tips of the fingers it detects abnormal sensibility in acute cases of enteritis; when with more energy, palpation reveals whether the bowel be full or empty, provided that the muscular resistance be not too marked.

=Colic.= In colic the clinical signs, their varieties, and the lesions which give rise to them are of much more importance. When it results from intestinal congestion _à frigore_ (due, for example, to the ingestion of cold water), colic is usually violent, sudden, and of relatively short duration. In other cases it is violent and prolonged for several hours, a whole day, or even two days, and may be followed by coma and suppressed peristalsis; it then indicates invagination, volvulus, or strangulation. Sometimes, on the contrary, it remains dull and is slow and continued (acute gastro-enteritis, hæmorrhagic gastro-enteritis, etc.).

Finally, colic of the latter character may, in addition, be accompanied by icterus, in cases of retention of bile, biliary calculi, hepatitis, etc.

=Anus.= Examination of the anus is easy. Simple inspection reveals its presence or absence, and consequently the existence of congenital rectal atresia, which is somewhat common in calves and colts. Digital exploration is, however, sometimes useful, for in occasional cases an anus may exist, which externally appears normal, but terminates in a sac, the rectum being closed by a membranous partition.

Nothing is easier to recognise than tenesmus; it occurs in cases of profuse diarrhœa, diarrhœa of calves, and dysentery in newly-born animals.

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=Rectal exploration.= Exploration of the rectum is a last and most valuable means of confirming the diagnosis in all visceral diseases of the pelvis and abdomen. To utilise this method to the full, the rectal pouch should first be thoroughly emptied by the free use of enemata, the subsequent examination being made with great care. The animal’s hind legs being secured, the operator smears his hand and forearm with some fatty substance, and, forming the fingers into a cone, introduces them with gentle pressure through the anus, the palm of the hand being turned downwards. Passing the hand gently along the rectum, the operator will be able to distinguish the conical posterior pouches of the rumen, the loop of the duodenum, the mass of convolutions of the small intestines and of the colon, etc. Next, he will examine the vagina, uterus, bladder, ureters, kidneys, aorta, and the pelvic and sublumbar lymphatic glands. He may be able to recognise distension of the rumen with food, twists of the intestine, herniæ, mesenteric or diaphragmatic invagination or volvulus of the bowel, etc.

In other cases he may be able to discover lesions of the kidney, of the uterus, of the broad uterine ligaments, of the ovaries, or of vessels.

In all cases it is desirable to make a methodical and complete examination, whatever the primary object may have been. Such an examination may be carried out as follows: The operator having introduced his hand into the rectum, begins by examining the state of the pelvic organs, the rectum, base of the vagina, the body and horns of the uterus, the bladder and the lymphatic glands and ligaments of the pelvis.

By laying the hand flat in the rectum and pressing gently downwards the anterior border of the pubis may be felt, somewhat more deeply placed. The rectum is then thrust slightly to the right, and the ascending branch of the right ilium, as high as the sacro-iliac articulation, and the lower surface of the sacrum, are directly examined; lastly, the hand is directed towards the left, gliding down the left ilium, and returning to the point of departure. In this way the state of the pelvic floor, of the arteries, veins, and lymphatic glands, etc., the degree of mobility, tension, or fulness of the uterus, as well as the condition of the broad ligaments, are all ascertained.

Still more deeply placed, and at the extreme limit to which the arm can be introduced, will be found some or all of the above-mentioned organs—viz., the small intestine, large intestine, kidney, etc.

=Defæcation: Examination of the fæcal material.= The character of the fæces is very important in certain diseases; _e.g._, diarrhœa assumes a varying importance, according as the discharges are of an alimentary, serous, mucous, or sanguinolent type, and are slight, temporary, intense, profuse, or continued. In other cases defæcation is slow, becomes difficult, and various degrees of constipation exist. Defæcation may be completely suppressed, as in invagination or strangulation of the intestines; on the other hand, one may observe diarrhœa, dysentery (microbic or sporozoic diarrhœa), and intestinal hæmorrhage. The last named may be of varying degrees of acuteness, from the passage of simple drops or streaks of blood, distributed over almost normal excreta, to the passage of unchanged blood in liquid jets or in clots.

=Macroscopic examination.= Macroscopic examination takes cognisance, firstly, of the quantity (40 to 80 lbs.), consistence (firmness or softness), colour (olive green, blackish green, greyish black, sooty, or tarry) and odour (normal, fœtid, putrid, etc.) of the fæces.

Sometimes the excreta are moulded and covered with glairy mucus, or contain such abnormal products as undigested food (a sign of chronic diarrhœa), false membranes, false membranes due to pseudo-membranous enteritis, fibrinous clots, or parasites like liver flukes, tæniæ and strongyles.

=Microscopic examination.= Microscopic and bacteriological examination is sometimes useful; and even when macroscopic examination has revealed nothing, it is possible to detect the presence of the eggs of parasites like flukes, strongyles, hooked worms, etc., the presence of sporozoa (as in intestinal coccidiosis) and of specific microbes, as in the diarrhœa of calves, etc.

It is only by the synthesis of methodically collected signs that one finally succeeds in exactly diagnosing the numerous diseases which may affect the intestine: intestinal congestion, invagination, volvulus, intestinal strangulation (mesenteric or diaphragmatic herniæ, etc.), atresia of the anus, acute or hæmorrhagic enteritis, or intestinal helminthiasis.

=Liver.= The liver is situated in the right sublumbar region. It is fixed behind the diaphragm and under the hypochondriac region, and extends from the ninth to the thirteenth rib. It can be examined by palpation through the last intercostal spaces and behind the thirteenth rib. In health it is difficult to pass the fingers sufficiently under the hypochondriac circle to reach the liver; but in case of morbid hypertrophy it extends more or less beyond the last rib, and palpation between the last ribs sometimes reveals abnormal sensibility.

Percussion better than palpation enables one to delimit the space occupied by the liver, particularly towards the back, where there is no interposed layer of lung. Percussion is especially useful in detecting hypertrophy due to cancer, tuberculosis, echinococcosis of the liver, etc., or hepatic atrophy. In isolated cases icterus may exist, confirming the conclusions otherwise arrived at.

=Pancreas.= The pancreas is situated rather deeply in the right sublumbar region, below the kidney, behind the liver, above the floating colon, and within the duodenal loop. It is therefore very difficult to examine; moreover, the diseases which affect it are still little understood.

The point most prominently brought forward by this demonstration of the topographical anatomy and semiology of the digestive apparatus is the difficulty of accurately diagnosing digestive diseases in the ox when one confines oneself to a superficial examination. To have any chance of arriving at an exact diagnosis, methodical and thorough examination is indispensable. Given this condition, accurate diagnosis becomes possible, despite all difficulties.