DISEASES OF THE URINARY APPARATUS.
Symptomatology. The urinary apparatus comprises the organs of secretion (the kidneys) and those of excretion (the ureters, the bladder, the urethra).
A thorough examination of the urinary apparatus should include, firstly, that of the external organs (the sheath, glans penis and urethra) in the male, and, in the female, the vulva, meatus and urethra; secondly, that of the internal organs (the bladder, ureters and kidneys) in both sexes.
To carry out the external examination, the head must first be fixed and the hind limbs hobbled. If necessary, the animal can be attached to the side of a wall.
External examination comprises inspection and palpation, which is only possible in males. Inspection will reveal at once the existence of malformation, deformity, traumatic lesions, or tumours of the organs.
By palpation the sheath and glans penis can be examined, and cellulitis, abscess formation, calculi in the urethra, obstruction of the extremity of the canal by very fine gravel, as in the case of sheep, etc., can be detected.
The inner margin of the right kidney may also be examined by external palpation, though only in very thin animals. The examination is made from the flank region, behind the last rib, in an upward direction and towards the right (Fig. 227). The kidney, attached under the lumbar region, sometimes extends back beyond the last rib, under the transverse processes of the lumbar vertebræ. On the left the presence of the rumen prevents any examination.
In sheep this examination requires special care.
Examination of the internal urinary organs must be made through the rectum. It should be undertaken slowly and gently. In the male the hand detects the condition of the organs contained within the pelvic cavity, the fulness or emptiness of the bladder, or the existence of calculi within it. More deeply seated can be felt the entire length of the right ureter; its state of dilatation can be felt, and the existence of diverticula of inflammation, if any, can be ascertained. The left ureter cannot readily be examined, on account of the position of the rectum, except as regards the posterior part, close to the bladder and the rumen.
Fig. 226.—Genito-urinary organs in the male (pelvic cavity exposed). Cp, Peritoneal cavity (posterior cul-de-sac); Vs, vesicula seminalis; R, rectum; U, ureter; Ip, line of insertion of the peritoneum; Cd, vas deferens; V, bladder; Agt, testicular artery; Ci, inguinal canal; P, penis; Cv, neck of the bladder; Ic, accelerator urinæ muscle; Gc, prostate gland.
In the abdominal cavity the rectum, or rather the floating colon, turns to the right, in such a way that, in spite of the shortness of the meso-rectum and meso-colon, the hand can be passed as far as the right kidney. It is, then, easy to discover whether this organ is sensitive to pressure, hypertrophied, atrophied, cystic, etc. The paunch interferes with examination on the left side.
Fig. 227.—Relations of the abdominal organs in the female. RR, rectum; D, duodenum; P, pancreas; Rd, right kidney; FF′F″, liver; Di, diaphragm (showing the extent to which the diaphragm projects upwards); Fe, omasum; Id, line of insertion of the diaphragm; C, abomasum; Vb, gall bladder; U, gravid uterus; I, small intestine.
In females the ureters and kidneys can be examined in the same way, but the bladder and the canal of the urethra must be reached through the vagina. About 2 or 2¼ inches from the vulva on the floor of the vagina is the entrance to the urethra, covered with a special valve. The meatus becomes visible by separating the lips of the vulva and the vaginal walls. For this purpose a speculum ad hoc can advantageously be used. It is clear that if it is thought desirable to examine the bladder through the rectum, which is not absolutely impossible, the vagina will be interposed between the arm and the urinary organs, and the sensations experienced will, therefore, be much less clearly defined (Fig. 226).
In passing a catheter for the purpose of emptying the bladder the end of the sound should be introduced under the valve of the meatus. By slightly lowering the back end of the sound, the front end is lifted above the cul-de-sac, and the operator at the same time pushes gently forwards. It is then only necessary to lift the hand, and the sound passes readily into the urethra and the bladder.
Examination of the urine and even chemical analysis are of great importance in diagnosing diseases of the urinary tract.
From the clinical point of view very complete analyses are not necessary, but the tests for albumen, sugar, bile pigments and indican are absolutely indispensable; and the same is true of microscopic examination for ascertaining the presence or absence of epithelial cylinders, blood corpuscles, pus corpuscles, etc. It is important also to note the colour and odour and the quantity passed.
These examinations are by no means difficult. Albumen is detected by adding a few drops of acetic acid to the urine, and heating, or by adding nitric acid and Esbach’s liquid. Esbach’s albumenimeter is sufficiently exact to discover the approximate amount of albumen present. Sugar is detected by the use of Fehling’s solution, bile pigments by nitric acid, and indican by adding a few drops of 10 per cent. chloride of calcium solution and hydrochloric acid. Should indican be present a more or less deeply tinted indigo blue circle appears, resulting from its oxidation.
Hippuric acid is precipitated by pure hydrochloric acid.
CHAPTER I.
POLYPI OF THE GLANS PENIS AND SHEATH.
In young animals the extremity of the glans penis and the margins of the sheath are not infrequently studded with polypi, soft swellings of papillomatous or verrucous appearance, sometimes of considerable size, which interfere with micturition, and deform the glans. The existence of these growths is shown by very well marked signs—viz., difficulty in micturition, deformity of the sheath, deviation of the jet of urine, obstruction in the passage of the penis, and more or less marked deformity of the penis itself.
These polypi are of the same nature as those so common in dogs, viz., papillomata.
The diagnosis is very easy. On digital examination the growths are almost always found at the base of the sheath.
At an early stage the prognosis is benign, provided intervention is promptly undertaken. If the disease is of old standing, or is not treated, the animals may become somewhat thin. They suffer pain, caused by retention of urine and inflammation of the sheath; urethritis may even be set up.
The treatment is fairly easy, and is exclusively surgical; but as it necessitates casting the animals the bladder should first be examined per rectum, and operation should never be attempted until the bladder has been emptied so as to avoid possible rupture. The animal being fixed on its back, the penis is withdrawn from the sheath, and the polypi can then be snipped off with scissors, the wounds being slightly cauterised to arrest hæmorrhage: in the case of the sheath, rather extensive wounds must sometimes be produced; these may be sutured.
To prevent the wounds afterwards becoming infected and suppurating, the sheath should be regularly washed out with an antiseptic solution and the animal kept on a very clean bed.
INFLAMMATION OF THE SHEATH.
This condition is much more common in the ox than in the horse on account of the different anatomical structure of the parts, and the methods of keeping and using oxen.
Causation. Several predisposing causes undoubtedly exist. The sheath is prolonged beneath the abdomen to a considerable distance beyond the glans. It is narrow, deeply seated, and, during micturition, not even the point of the penis passes beyond it. The urine, therefore, soils the interior, or a certain quantity may be retained, according to whether the orifice is more or less obstructed by urinary sediment, sebaceous material, manure, or other material. Moreover, experience shows that of all the large ruminants, those used for outdoor work are the most affected.
Of the occasional causes, if we except sebaceous and urinary products, the most important is mechanical violence, such as the lacerations or wounds produced by the bed-piece of the trevis when the animal is being shod. The working ox throws its whole weight on this bed-piece, on which it lies on one side or the other, according to the foot which is being lifted. The sheath is compressed, and if the animal is heavy and struggles, the parts may be abraded and torn, or the sheath and even the glans may be crushed. In less dangerous cases the connective tissue may be lacerated by the edge of the bed-piece. Any injury so inflicted is aggravated by dirt in the neighbourhood.
Symptoms. The first signs which attract attention are of a general character, and seldom very strongly marked. The animal shows slight fever, dryness of the muzzle, is restless and continually moves about, as though to get rid of the pain it feels. The hind limbs are frequently lifted. In this attitude it makes efforts to urinate, but urine is passed very slowly, and the act seems painful; then, later on, the appetite diminishes, rumination is suspended, and, as in all intense forms of cellulitis, complications may occur.
The local symptoms are more suggestive. The slowness and difficulty with which urine is passed at once attracts attention to the diseased parts. Examination immediately reveals extreme sensitiveness of the sheath, although as yet there is only slight engorgement. At a later stage a large swelling develops and extends along the abdominal wall on either side, sometimes upwards into the groin. In certain cases the sheath may be totally obstructed by sebaceous and inflammatory material, and in the absence of surgical assistance the bladder may become ruptured.
Inflammation most frequently ends in the tardy formation of an abscess, which shows little tendency to open spontaneously. It is usually accompanied by gangrene and by mortification of a mass of skin and subcutaneous tissue, sometimes of portions of the abdominal tunic. Such grave complications may even lead to the opening of an artery, and to fatal hæmorrhage.
All these symptoms develop comparatively slowly. Abscesses scarcely ever appear before the twelfth or fifteenth day, but when the disease is not treated it may continue as long as five or six months. On the other hand, resolution is the ordinary termination under suitable treatment.
Diagnosis. The diagnosis is easy when the exact facts can be ascertained. The difficulty in micturition is the chief indication. At a later stage, local swelling and acute sensitiveness are characteristic.
Prognosis. The prognosis is grave, having regard to possible complications and the chronic character which the inflammation tends to assume.
Treatment. When the sheath is filled with sebaceous material or foreign substances it may be necessary to cleanse it daily with mild antiseptic injections. Some practitioners recommend laying open the external orifice, an operation which may be performed in the standing position. This, however, is not without danger, and infection may easily occur.
When the subcutaneous connective tissue surrounding the sheath and the glans penis is infiltrated and inflamed, the inflammatory swelling must be examined every day, so as to detect the abscesses as early as possible, and open them without delay. Under some circumstances deep firing in points produces very favourable results.
When an abscess has caused partial necrosis of the sheath, it is well to pass a drain and wash out the parts frequently with antiseptic solutions. For this purpose a counter-opening is made through the skin opposite the fluctuating point. The mucous membrane of the sheath is then cautiously punctured, and a seton or strip of gauze is passed by means of a seton needle, so as to allow of constant drainage.
PERSISTENCE OF THE URACHUS.
This condition is an infirmity or congenital anomaly, rather than a morbid condition. Persistence of the urachus after birth and after separation of the cord is due to the fact that the canal which communicates with the bladder fails to close up. The urine, instead of escaping through the urethra, passes along the urachus, and the animal urinates through its umbilicus.
Causation. The causes are simple. Certain practitioners have suggested that sex has some influence, this being an anomaly occurring more frequently in males than in females. From investigations which have been carried out, it would appear that, in some cases, persistence of the urachus is due to an imperforate condition of the urethra; in other cases, to its obstruction by accumulations of mucus of a caseous appearance, which enter the urethra and completely block the passage. Finally, in other cases the urachus simply persists while no lesion exists on the side of the urethra.
Whatever the original cause, escape of urine by the umbilicus produces irritation, which may end in complications, infection of the unhealed umbilical wound, infection of the canal of the urachus itself and the bladder, or even infection of the peritoneum.
Symptoms. At first, persistence of the urachus is shown by permanent or intermittent discharge of urine through the umbilicus. Usually this discharge is only seen from five to eight days after birth, when the necrosed cord is detached; in most cases it is continuous, for the opening is abnormal and has no sphincter.
Contact with the air and the wound causes the urine to undergo a kind of ammoniacal fermentation and to irritate neighbouring tissues, such as the stumps of the umbilical vessels, the interstitial connective tissue, and even the skin. The wound constitutes an excellent culture medium for microbes. The umbilicus becomes swollen and œdematous, and soon exhibits a saccular swelling, 2 to 4 inches in diameter, which, on palpation, proves to be hot and painful; its centre is occupied by the opening of the urinary fistula. A probe passed into this fistula travels upwards and backwards (see Fig. 183).
At a later stage other complications, including omphalitis and omphalo-phlebitis, may set in. The most frequent of the delayed complications is purulent cystitis, with the formation of purulent concretions in the bladder, which may occur even after the fistula of the urachus has healed. In other cases the canal of the urachus contracts and becomes obliterated towards the bladder. A blind fistula then persists, with an opening at the umbilicus, or, the parts having healed externally, all that remains is a phlegmonous swelling with the characteristic symptoms.
Diagnosis. A thorough examination will invariably allow of urinary fistulæ being distinguished from other diseases of the umbilicus, the escape of urine at this point being so suggestive.
Prognosis. The prognosis is rather grave, on account of the complications, which are possible, and, in fact, usual, unless the disease is promptly diagnosed.
Treatment. Formerly as a preventive measure a ligature was applied to the whole mass of the cord at birth, but this ligature in no way prevents the canal of the urachus persisting after the atrophied portion separates. Cauterisation of the urinary fistula with Rabel’s fluid or tincture of iodine can have no good result, unless the urethra is permeable.
If the urethra is obstructed it is evidently from that side that treatment should be attempted, either by displacing the mucoalbuminous plugs with a catheter or in some other way. Such intervention is very delicate and difficult in the case of young animals. Sometimes it is better to allow the discharge of urine from the umbilicus to continue, and to recommend that the animal should be rapidly fattened for the butcher.
In practice, pervious urachus may be treated by suturing, by firing across the fistula, and sometimes by blistering. The first step in all cases is to see that the urethral passage is free. English veterinary surgeons claim to have had a fair measure of success from these methods.
If a radical cure were thought desirable, the abdomen would have to be opened, and the operator would proceed to isolate the urachus, resect it, and suture the base of the bladder by bringing together its external surfaces. The operation, though not perhaps impossible, is of no practical value.
CHAPTER II.
DISEASES OF THE BLADDER.
ACUTE CYSTITIS.
Cystitis, or inflammation of the bladder, may be divided into two varieties: simple (acute or chronic) cystitis, and chronic cystitis due to the presence of calculi.
Simple acute cystitis occurs most commonly in the cow, less frequently in the ox, and rarely in the pig or sheep. Female animals are more subject to it than males.
It consists of more or less acute inflammation of the vesical mucous membrane. The inflammation sometimes extends to the muscular coat and the peri-vesical tissues, setting up local or general peritonitis.
Causation. The internal causes to which Cruzel attributes the disease are rather open to question. Retention of urine in particular is common in working oxen, which only pass urine when resting, and this would be more likely to produce distention, paralysis, or rupture of the bladder than true inflammation; it is doubtful whether inflammation would even follow the chronic irritation resulting from frequently repeated over-distention.
The ingestion of irritant plants certainly has a more marked action. Irritant principles eliminated by the kidneys might not injure them, although they would bring about changes in the vesical mucous membrane, with which they would remain in contact for some time.
More frequently cystitis is the result of inflammation due to continuity of tissue, and forms a complication of urethritis, vaginitis, and the conditions set up by retention of the after-birth. It may also result from ascending infection causing pyelo-nephritis, or ascending infection of any kind which eventually attacks the bladder. It is a very common consequence of the use of unclean catheters, but only in equines and females, as the catheter is not passed in the ox or bull until after urethrotomy.
In by far the majority of cases it is of infectious, and not of toxic, origin.
Symptoms. At first the symptoms are obscure. They commence with slight colic, and are afterwards characterised by frequent, difficult and painful micturition and by the small quantity of urine passed on each occasion.
The urine, moreover, is modified in appearance. At first it contains a small quantity of blood, and is reddish, or at least of a darker tint than is usual. Later it becomes thick and whitish, and contains greyish films of epithelium, and the débris of fibrinous coagula. The microscope reveals in it the presence of pus corpuscles, flat polygonal cells with large nuclei, and sometimes red blood corpuscles.
Locally almost all that can be detected in male animals is a little tenderness of the neck of the bladder on rectal examination, and in females on examination of the meatus urinarius by means of a speculum.
The vaginal mucous membrane then appears inflamed around the meatus, which itself is exceedingly sensitive.
In cases of very marked inflammation, accompanied by partial necrosis of the mucous membrane or the production of false membranes, the temperature rises as high as 104° Fahr. (40° C.), appetite disappears, colic is extremely acute, and violent efforts to pass urine are continually made until the animal is completely exhausted. The patient then refuses to walk about, but frequently lies down, arches its back, and constantly makes efforts to urinate, which are abortive or end only in the passage of little jets of fluid.
The urine passed contains little greyish necrotic fragments or débris of false membranes, suggestive of diphtheria. In female animals the canal of the urethra may also become obstructed, and rupture of the bladder, though rare, occasionally occurs.
In the ordinary forms inflammation persists for two to three weeks, then diminishes in intensity, and either ends in recovery or becomes chronic.
In the grave forms, where inflammation and infection extend to the peri-vesical tissues and the peritoneum, death by peritonitis is the rule.
On post-mortem examination, the mucous membrane is seen to be of a greyish colour, and sloughing or gangrenous over surfaces of varying size, whilst the surroundings are infiltrated, blackish and greatly thickened. The whole of the connective tissue layer which supports the peritoneum near the base of the bladder, and also the adipose tissue around the bladder, are markedly inflamed. At this stage pelvi-peritonitis or generalised peritonitis may occur as complications.
In the simple forms the mucous membrane is desquamating, infiltrated, and covered with granulations of apparent healthy appearance.
Diagnosis. The diagnosis is comparatively easy, the external symptoms being so clearly defined. There is a difficulty, however, in distinguishing this disease from cystitis caused by a calculus. In male animals this latter form of cystitis is characterised by frequent spasmodic contractions of the accelerator urinæ. In acute cystitis, on the contrary, the contractions are temporary only and of no importance. Lastly, in female animals cystitis due to calculus formation is quite exceptional, owing to the large diameter and shortness of the urethra.
When nephritis and cystitis co-exist certain signs indicate the fact.
Prognosis. The prognosis varies, according to the acuteness of the disease and the character of the urine and epithelial débris, which afford valuable information.
Treatment. The treatment should be directed towards relieving the vesical and pelvic pain and modifying the local conditions.
Hot fomentations to the loins and flanks relieve pain. The administration of bicarbonate of soda and of cold drinks, such as barley-water, decoctions of couch grass and pellitory, mucilage, etc., are of service. These materials are readily taken by the patients, and have a soothing effect. Camphor also produces good results, but benzoate of soda is most useful on account of the disinfectant action produced within the bladder, as a consequence of the benzoic acid being separately eliminated by the kidney. Repeated washing out of the bladder with antiseptic solutions has been recommended, but is open to criticism. Such treatment is difficult in male animals, owing to the special formation of the glans penis and urethra, and in female animals it is by no means easy. In all cases of acute cystitis, in fact, the passage of the catheter is painful, and as a metal, gutta-percha or hard rubber sound is used, the mere contact of the tip of the instrument injures the diseased mucous membrane, makes it bleed, and gives rise to danger of autoinoculation, with the possibility of serious results.
Those who recommend this method of treatment can never have followed closely the development of a grave case of acute cystitis, and if the practice is at all permissible, only a soft catheter should be used.
In chronic cystitis, on the other hand, washing out the bladder might be useful.
CHRONIC CYSTITIS.
Chronic inflammation of the bladder is still rarer than acute cystitis. It usually attacks females as a consequence of acute inflammation, though the condition may be chronic from the first, in which case the early stages are commonly overlooked.
Symptoms. The chief functions of the body do not appear to be disturbed, although the urine seems abnormal. Micturition is difficult, slow, and somewhat painful, and is followed by long-continued tenesmus.
The urine appears whitish, purulent, slimy, or of a deeper tint, rapidly becoming blackish. It is of ammoniacal or fœtid odour, and decomposes quickly.
The period of development may be prolonged, and recovery rarely occurs spontaneously. The condition often leads to ascending infection, inflammation of the ureters, pyelitis, and nephritis.
On post-mortem examination of animals slaughtered before complete wasting has occurred the vesical mucous membrane is found to be thickened, granulating, or suppurating. The muscular tissue shows infiltration and localised sclerosis, and is very irregularly thickened, inelastic, and wanting in contractile power. The peri-vesical tissues may be chronically inflamed.
Diagnosis. The diagnosis is easy, provided the peculiar characteristics of the urine are noted, and an examination is made through the vagina of the condition of the walls of the bladder, of the ureters and of the kidneys.
Prognosis. The prognosis is grave, because treatment would occupy too much of the practitioner’s time to allow it to be rigorously carried out, and therefore animals are usually slaughtered.
Treatment. Treatment comprises the use of many of the drugs used in acute cystitis, particularly benzoate of soda, benzoic acid, and bicarbonate of soda. The medicines comprised in the balsamic group are also valuable, viz., turpentine, tar, and terpine.
In this chronic form the bladder should be irrigated, but this must be done with strict aseptic precautions, the fluids used being cooled boiled water, boric acid or borax solution of 3 per cent, strength, or solution of fluoride of soda of a strength of 15 grains to the quart.
We need not point out the difficulties of pursuing this treatment in ordinary practice. As a rule, treatment is confined to internal medication whilst the animals are fattened.
URINARY LITHIASIS. CALCULUS FORMATION.
Normally the urine contains in solution certain salts, such as urates, hippurates and phosphates of lime, magnesia or ammonia. Under certain circumstances, in animals predisposed to the condition, these salts are precipitated in the kidneys, ureters or bladder, and form powdery or sandy deposits known as sediments; or, on the other hand, calculi, produced by the adhesion of the powdery masses. This constitutes urinary lithiasis.
The sediments are of a greyish-yellow colour.
The calculi are generally rose-coloured, white or somewhat grey. They contain oxalates and carbonates of lime and magnesia, earthy phosphates, etc. In appearance and shape they vary greatly. They may resemble coral or may form growths of a rounded, polyhedric or raspberry appearance. Some are hard and resistant; others friable. They vary in size between that of a grain of sand and a hen’s egg or more. A large calculus is usually solitary; the smaller sizes are often multiple.
Calculi occur in oxen and sheep, but more particularly in the latter species. They develop slowly without producing any marked external signs, and often it is only when the urethra becomes obstructed and urine is retained that the diagnosis is established. Calculi are rare in females in consequence of the dilatability of the urethra.
CALCULI IN BOVINE ANIMALS.
Causation. The older writers believed that calculi developed through winter feeding and a stinted supply of water. Nowadays this would not apply to well-managed establishments, water being provided regularly, and winter feeding comprising roots, etc., rich in water. Experience and observation have shown that the chief cause is excessive feeding, calculus formation occurring most frequently in animals which are most richly fed.
Nevertheless, it would be a mistake to overlook the effects of temperament and constitution. In human medicine the importance of hereditary predisposition and of the special diathesis is undeniable (uric or gouty diathesis). In veterinary medicine the same thing applies, for, apart from rich feeding, it is not uncommon to meet with cases of gravel in animals living under the most diverse conditions, although the issue of the same parents.
Certain infections of the urinary passages, though trifling at first, or at least of slow development, are also capable of causing mineral deposits in the urinary passages, a fact which Moussu considers to be proved by his success in experimentally reproducing given forms of pyelo-nephritis.
Symptoms. The symptoms are often overlooked, as long as the calculus deposits affect only the kidneys, their increase in that part not giving rise to alarming symptoms. It is certain that the eventual passage of the calculus through the ureter towards the bladder causes nephritic colic, but this form of colic is little understood, and has never been well described. Writers have simply mentioned cases of colic accompanied by great tenderness in the lumbar region, temporary suspension of the secretion of urine, and more or less marked dysuria.
Nothing resembling the extremely grave symptoms of nephritic colic in mankind has been described, though probably there is little difference in the complaint as it affects the bovine species.
When the sediment or the calculus reaches the bladder there is a tendency for it to be passed during micturition. The signs then become more strongly marked, because they point to obstruction of the urethra. If the deposit is simply of the nature of sediment, there is merely a little difficulty in urination, accompanied by some moderate amount of pain, and sediment is afterwards found within the sheath or adhering to the groups of hair at its extremity.
If, however, the deposit is in the form of small calculi, these are pushed towards the neck of the bladder and the urethra, which then appears to be obstructed.
The obstruction may occur at the origin, at the ischial curve, or at the S-shaped curve of the penis (Fig. 226). Henceforth strongly marked and unmistakable symptoms rapidly develop. Vesical colic appears, owing to retention of urine, and rapidly acquires extreme intensity, though it instantly ceases with rupture of the bladder in cases where no treatment is attempted. This form of vesical colic is accompanied by continual but unsuccessful efforts to urinate and by spasmodic contractions of the accelerator urinæ.
Appetite and rumination cease, and the animal shows extreme anxiety. Palpation along the course of the penis reveals unusual tenderness, and the calculus can sometimes be felt near the S curve, though more frequently in the ischial arch. The litter is not soiled with urine.
Cautious rectal examination proves the bladder to be extremely distended, or, in the case of rupture having occurred, entirely collapsed. In the latter case the spasmodic contraction of the accelerator urinæ completely ceases soon after rupture, and the animal appears to be recovering. This deceptive calm is due to the disappearance of the vesical colic, but the animal’s condition is still graver in consequence, and it must of necessity die. Rupture of the bladder is followed by inundation of the peritoneal cavity with urine, which is partly reabsorbed by the peritoneum, producing a kind of urinary intoxication, so that despite the elimination of certain volatile principles through the lungs (the breath has an odour suggestive of urine), the animal very soon dies.
In many cases, also, the urine is not aseptic, and after rupture of the bladder acute peritonitis supervenes and carries off the patient in from six to ten days.
Even when the urine appears to be aseptic, chronic exudative peritonitis is produced by the irritant action of the urine on the peritoneal endothelium. The exuded liquid mixes with the urine, and the animal soon shows marked ascites. Despite this condition, some animals have been known to survive as long as from three to six weeks without showing very marked disturbance.
Death is the inevitable sequel after a longer or shorter time. When large calculi have been arrested, or rather developed, in the bladder the same symptoms occur should the calculus be thrust towards the neck of the bladder so as completely to obliterate the passage. This, however, is a very rare accident. As a rule the obstruction is merely temporary, and the resulting vesical colic and retention last but a short time. The displaced calculus falls back again into the lower part of the bladder, where it is retained, and the urinary passages again become free.
Diagnosis. The diagnosis is sometimes extremely easy, but it may present serious difficulty.
When the urethra is obstructed, the symptoms are so striking that there can scarcely be any doubt; but the diagnosis of renal calculus, nephritic colic, calculus in the bladder, and rupture of the bladder demands more attention. Examination of the urinary organs through the rectum then proves of great service.
Prognosis. The prognosis is grave in all cases, because of the possibility of the urinary passages being obstructed, so that surgical interference is necessary.
Lesions. The lesions caused by urinary calculi may vary greatly. Though insignificant and scarcely apparent in certain cases, they are often very marked, and comprise simple or suppurative pyelitis, inflammation of the ureters, hydro-nephrosis, cystitis of varying intensity, urethritis, and inflammation of the sheath.
Treatment. All farmers who fatten their animals know that the use of alkaline drugs, such as bicarbonate of soda, together with diuretics, linseed, barley and pellitory diminish the danger of urinary calculus formation. Bicarbonate of soda is often given with this object, and is excellent in cases where lithiasis does not extend beyond the production of sandy or muddy deposits. By rendering the urine more alkaline it prevents the growth of sabulous deposits, and may even cause slow but progressive solution of concretions already formed. When, on the other hand, the urethra is obstructed, and urine is retained, early surgical treatment (urethrotomy) alone offers any chance of preventing rupture of the bladder.
Certainly it is possible, as recommended by the older practitioners, to try massage of the glans penis and urethra opposite the obstruction, and, after withdrawing the penis, to attempt to loosen and eject the obstructing matter. But such attempts very frequently fail, because the material is too firmly fixed, and no time must be lost.
Urethrotomy is usually practised at one of two points, according to circumstances—firstly, opposite the ischial arch; and, secondly, opposite the S-shaped curve.
Ischial urethrotomy is the promptest method of affording relief, and should always be preferred whenever there is danger of rupture of the bladder.
It is performed in the standing position, but is only possible when the animal is not too fat.
In other cases urethrotomy is performed opposite the point where the calculus is fixed, and aims at removing the obstruction. It can only be practised after casting the animal; but, in this case also, it is indispensable that the animal should not be excessively fat, as in such cases a secondary urinary abscess is almost certain to form.
Should the animal be so fat as to render treatment difficult, it is best to slaughter it at once.
URINARY CALCULI IN SHEEP.
Urinary calculi are commoner in sheep than in oxen, and seem to depend more on the breed and on conditions of feeding. They are almost exclusively confined to animals which are richly fed, to show animals, and to males. In exceptional cases they are seen, under ordinary conditions of feeding, in aged subjects.
Calculus formation can moreover be induced experimentally, and in a relatively short time, by giving certain rations—e.g., 7 lbs. per day of maize, lentils and beans for adults, and 3 lbs. for lambs. The other favouring circumstances, viz., hereditary gouty diathesis and infection, are less well established than they are in the case of the ox.
In sheep the symptoms are still less characteristic than in oxen, for which reason gravel in sheep merits special description.
It shows itself in the passage of turbid urine, forming a deposit at the extremity of the sheath, which becomes somewhat inflamed. The colic resulting from retention of urine is shown by depression, want of appetite, dysuria, and generalised convulsive shivering fits.
The patients lie down in the sterno-abdominal or sterno-lateral position. They constantly suffer from attacks of general violent shivering, and die after twelve, twenty-four, or forty-eight hours.
On post-mortem examination the bladder is found to be ruptured, or the urethra obstructed.
Diagnosis. The diagnosis involves no difficulty, provided the method of feeding is understood. In many cases the shepherds themselves perfectly recognise the cause of the symptoms.
Prognosis. The prognosis is very grave, it being impossible to pass the catheter on account of the perineal valve in the urethra, while it is difficult to operate, the urethra being very small and deeply embedded in a thick layer of fat.
Treatment. The only resource is massage along the urethra, which may sometimes break up the mass of sediment or move the obstructing calculus. One remark may, however, be made, viz., that in the majority of cases the urethra is obstructed at its extremity by local accumulations of sediment behind the spiral filiform prolongation of the penis.
It is then sufficient, and experienced shepherds have no hesitation in performing the operation, to remove the spiral filament, thus facilitating the expulsion of the sediment and affording relief. If both methods, viz., massage and section of the filament, fail, the animal should be slaughtered, so as to avoid rupture of the bladder, which would render the flesh useless as food.
From a preventive standpoint, all sheep which are richly fed should receive an allowance of some slightly alkaline drink.
PARALYSIS OF THE BLADDER.
Paralysis of the bladder is somewhat frequent in female, but very rare in male, animals. In the majority of cases it is the consequence of difficult parturition, or is a post-partum complication.
It is characterised by incontinence of urine or retention with overflow. The continuous discharge soils the hind quarters, hocks, shanks, pasterns, etc., and the urine decomposes and causes irritation; it soon sets up urinary eczema in all the parts with which it comes in contact, a condition which can only be successfully treated by removing the cause.
The prognosis is grave, for methods of treatment are few, and of doubtful efficacy.
Treatment. If the condition results from post-partum infection, this must naturally first receive attention. Should the infection have disappeared whilst incontinence of urine still continues, the administration of tonics, e.g., tincture of nux vomica in daily doses of ¾ to 1 drachm for ten days or so in the case of a bovine animal, and a stimulating application to the lumbo-sacral region, may bring about recovery.
But if, in spite of such treatment, the incontinence persists, it is better, from an economic standpoint, to treat the urinary eczema with astringents, etc., and quickly to fatten the animal.
EVERSION OF THE BLADDER.
Eversion of the bladder only occurs in female animals after difficult parturition. The viscus is turned completely inside out, as occurs in eversion of the uterus, the base of the bladder becoming invaginated in the cavity of the bladder itself, and afterwards passing into the urethra and vagina. The bladder thus becomes totally displaced, and appears between the lips of the vulva, resting on the inferior commissure, and forming a mass the size of an orange.
Eversion cannot occur unless the ligaments of the bladder have become relaxed, stretched or ruptured. Expulsive efforts and the pressure of the intestinal mass complete the process, the peritoneum and peri-vasicular layers of connective tissue being torn.
Diagnosis. The diagnosis of eversion of the bladder presents no difficulty. The everted mass appears to have a narrow neck opposite the meatus, and is seen to form a reddish, unctuous mass. The mucous membrane now forms the external coat and appears covered with mucus so long as inflammation does not occur.
The urine continually escapes from the ureters (which open on the surface of the mucous membrane) as it is formed, and flows away by the lower commissure of the vulva. The vulva is half open, and the prominence formed by the bladder projects beyond it.
Prognosis. The prognosis is grave, because reduction is difficult, and may be accompanied by rupture of the organ; also because even in favourable cases it is invariably followed by acute cystitis.
Treatment. Treatment is confined to reduction. Before attempting this, measures must be adopted to prevent straining, either by passing a rope round the animal’s body, thus causing it to flex the vertebral column, or by puncturing the rumen or performing tracheotomy. The open hand is then applied to the surface of the swelling, which is gently compressed and thrust in turn through the meatus and urethra. The portions nearest to the urethra should first be returned. It is sometimes necessary to use both hands, and even to employ a catheter with a large round head, to reduce the eversion effectually. After reduction a truss or vulval clamp should be applied. Subsequent treatment consists in the administration of sedatives—e.g., laudanum, mucilaginous drinks, barley-water, pellitory, etc.
HÆMATURIA.
Hæmaturia, i.e., the passage of blood-stained urine, is in itself only a symptom, which may accompany very varying conditions, such as the congestion peculiar to the early stages of nephritis, traumatic lesions of the kidneys, ulceration of the uriniferous tubules, or of the pelvis of the kidney, lesions of the ureters, bladder, etc., etc. The term, therefore, does not indicate a disease, but nevertheless in bovine practice the term hæmaturia has acquired a special significance.
This hæmaturia of bovine animals is clinically indicated by the presence of blood in the urine; anatomically by lesions of the bladder, sometimes also of the ureters. It is probable that some forms at least of the condition will ultimately be proved to be due to the piroplasmata, but in the present state of our knowledge the disease can only be described from the clinical standpoint. The reader is recommended to refer to the article on “Bovine Piroplasmosis,” ante.
Pichon in 1863 and Sinoir in 1864 introduced the name “hæmaturia” in the course of their remarkable investigations concerning the disease. Vigney in 1845 and Gillet in 1862 had previously described it, and it has since formed the subject of constant researches.
Detroye in 1891 termed it “essential hæmaturia,” and Galtier in 1892 gave it the name of “hæmorrhagic cystitis.” Boudeaud in 1894 also used the term “hæmaturia of bovine animals.” In Germany the disease is known as “stallroth” (stable-red).
Geographical distribution. Hæmaturia is a perfect scourge in certain countries. It seems to have made its appearance in the departments of the West of France, the Mayenne and the Sarthe, afterwards spreading into the Maine-et-Loire and the Indre. At the present day, it inflicts great ravages in the Creuze, the Corrèze, Haut-Vienne, Cantal and Haute-Loire districts. It has been described in Germany, Belgium, and Italy. These forms are probably due to Piroplasma bigeminum.
Causation. The most varying opinions have been advanced regarding its cause. Pichon believed its appearance was due to changes in cultivation, which between 1830 and 1860 completely altered the general appearance of the country and the conditions of breeding in the old province of Maine. Land reclamations and the use of lime dressings have been mentioned, as well as the introduction of the Durham breed of cattle. Sinoir practically adopts the latter view, for he considers that the crossing with the Durham breed, while increasing the precocity, has diminished the powers of resistance of the indigenous cattle.
But in course of time these ideas have become modified, and investigation has taken a new direction. Detroye regarded the disease as a microbic and easily transmissible disorder, while Galtier in the following year described it as merely a chronic hæmorrhagic cystitis, produced by the consumption of irritant plants in animals previously suffering from distomatosis. In Germany, Arnold attributed “stallroth” to coccidia developing in the epithelium of the vesical mucous membrane.
Cruzel considered the disease to be due entirely to poor feeding. Boudeaud thought the same. He says that hæmaturia affected one-tenth of the whole of the oxen in the south of the Indre and the north of the Creuze, in parts where the arable soil is thin and poor in phosphoric acid. Furthermore, he suggests that dressings with lime and phosphates would result in the disappearance of hæmaturia.
We cannot admit that poor forage and feeding alone are sufficient to produce hæmaturia, for one frequently sees poorly nourished animals pass through all the stages of wasting and most profound cachexia without ever showing signs of this particular ailment. Besides, hæmaturia may attack animals in good condition.
Detroye’s early opinion as to the infectious or microbic nature of the disease seems scarcely more acceptable, for it now appears certain that the organism originally described is incapable of producing the disease.
Galtier’s theory is still less admissible. According to the Lyons professor, hæmaturia occurs only in animals suffering from distomatosis. The liver, he says, being affected by the growth of liver flukes, no longer performs its proper work of destroying toxins, and if under these conditions the animals eat improper food containing ranunculaceæ, sedges, rushes, etc., the toxic principles of these plants are absorbed. Then, he adds, these principles being no longer destroyed, are eliminated by the kidneys, their stay in the bladder causes irritation, and hæmorrhagic cystitis is set up, this being afterwards maintained by microbic agents in the bladder.
This very specious theory, all the points in which may readily be refuted, in our opinion falls to the ground before the simple fact that hæmaturia occurs in animals which present no trace of distomatosis on post-mortem examination, and that, furthermore, it is not seen in the lower regions of the departments of the Nord, the Pas-de-Calais and the Somme, where ranunculaceæ and other irritant plants are common and distomatosis rages.
Moussu states that he has proved that hæmaturia is very rare in young animals and is exceptional before the age of two and a half years or three years; that it attacks oxen as often as cows; that it is particularly common in low regions; and that it is scarcely ever seen above a height of 800 yards. Careful investigation, moreover, shows that the passage of blood occurs just as frequently in winter, when the animals are housed, as in spring, when at pasture.
Lesions. The lesions of hæmaturia are to be found in the bladder, though in exceptional cases they may also affect the ureters and kidneys. They have been described by Pichon and Sinoir, but as these observers regarded the condition as a disease of the blood due to poor feeding, etc., they did not attach much importance to them. Detroye has described the different appearances very well, though Moussu states that he has never met with the “blisters” which he mentions.
The first period is accompanied simply by abnormal vascularity of the bladder, which appears in the form of true varicosities of the submucous vessels and intra-mucous capillaries. But if this lesion is primary, it does not correspond to the period during which blood-stained urine is passed, and is not sufficient to explain it. It always appears in the form of a more or less abundant hæmorrhagic intra-mucous, sub-epithelial spotting.
Over the hæmorrhagic area, which may be of very varied dimensions, ranging from those of a small pin’s head to those of a lentil, the epithelium is swollen and loosened, and so separated from the surrounding parts as to have lost its vitality. This patch of separated epithelium soon falls away, leaving an epithelial ulceration of the mucous membrane. The subjacent clot rapidly breaks up in contact with the liquid in the bladder, and is replaced by a small ulceration which becomes the seat of continual capillary hæmorrhage. Nevertheless, the neighbouring tissues react, and the process of repair may end either in true cicatrisation, which appears to be rare, or more frequently in the formation of exuberant granulations, which are also of the nature of a soft, bleeding vegetation. This vegetation is either sessile or pedunculated, and is of very varying size.
The wall of the bladder also reacts, becoming sclerosed and thickened beneath the granulations, so that, in animals which have long suffered from hæmaturia, it may entirely have lost its dilatability.
When the disease has existed for a certain time, sub-epithelial hæmorrhages, ulcerations, vegetations and points of sclerosis may all co-exist, a fact which shows that the disease does not develop all at once, but that, on the contrary, every little lesion develops separately and continuously. This fact also explains the length of time for which blood may be passed, despite the presence of old or healed lesions.
Finally, in very old standing cases dating from several years back (Moussu saw an animal aged twenty-eight years which had suffered from this disease for more than twenty years, but in a very intermittent fashion), it is not exceptional to find numerous papilliform vegetations 1 or 2 inches in length, either with a fine pedicle or largely sessile, invading one-half or two-thirds of the internal surface of the bladder.
These vegetations sometimes, though rarely, invade the ureters. When they occur towards the point where these conduits enter the bladder, they obstruct the passage of urine, and lead to the development of hydro-nephrosis or pyelo-nephritis.
Symptoms. The early symptoms often escape notice, because general disturbance is rare. The first appreciable signs are cystitis and frequent urination.
The urine passed is turbid, particularly towards the end of the act of urination; then it is of a pink or red colour, and all intermediate shades between a pale pink and a bright arterial red colour may be observed.
The patients sometimes seem to pass unaltered blood in the urine, but on microscopic examination this blood is found to be extremely diluted. Provided the bladder is not gravely infected by the (secondary) penetration of germs into its cavity the blood corpuscles remain normal, or are scarcely changed. As soon as the bladder, however, becomes secondarily infected an almost immediate change takes place; the red blood corpuscles become crenated, broken up and dissociated; the hæmoglobin is also partly dissolved and modified, and at this stage the urine is red-brown or coffee-coloured, according to the length of time it has been retained in the bladder.
In other cases, chiefly when hæmaturia has existed for some time, the extravasated blood coagulates in the bladder, and the urine passed contains filamentous clots the size of a man’s thumb, a pigeon’s egg, or more. If the clots formed are too large to be passed, which is often the case in the ox, they may obstruct the urethra, causing retention of urine and all the accidents which accompany this condition, even including rupture of the bladder. This, in the ox, is a frequent termination. In the cow the dilatability and shortness of the urethra render retention of urine much rarer. It is certainly possible, however, and it is not exceptional, to find from 4 to 6 lbs. of clotted matter in the distended bladder. All these conditions can be detected by rectal exploration, and by attention to the symptoms of obstruction of the urethra.
Whenever there is retention of clots dysuria is extremely marked and, so to speak, permanent, the animals having continual tenesmus.
Hæmaturia observes a slow, progressive course, which, in time, ends in death by exhaustion, though this is not invariably the case. Hæmaturia is frequently intermittent, and, after having been very marked for weeks or months, may suddenly or gradually cease, and only reappear a long time afterwards. This fact is explained by a study of the development of the lesions. When ulceration occurs the sub-epithelial vessels of the mucous membrane, which have contributed to the formation of the hæmorrhagic spot, are widely open, and a capillary hæmorrhage results; but as soon as a small clot forms in this position, or local capillary thrombosis occurs, the hæmorrhage ceases, with the result that the hæmaturia disappears. Unfortunately, however, the obliterating clots are not permanent, any more than the local thrombosis—or, in the event of their proving permanent, another small lesion develops at a different point, and this lesion may at any time cause the reappearance of the hæmaturia; the process goes on until the animal succumbs. Should the lesions heal successively, spontaneous recovery may take place, but such recovery is exceptional.
The animals may not appear to suffer from the passage of blood for weeks or even months, but after a time they become less capable of replacing the loss. They become anæmic, the number of corpuscles falls from the normal figure of from six to seven millions of red corpuscles per cubic millimètre to three millions, two millions, one million, and even to five hundred or eight hundred thousand.
The richness in hæmoglobin simultaneously diminishes; wasting progresses to the point of cachexia, and the appetite diminishes while diarrhœa appears; swellings are noticeable about certain parts of the body; and the animals, continuing to pass blood, die in a state of absolute exhaustion, without apparent suffering.
This termination is the most common, unless slaughter is determined on, and is very different from the premature end which follows the formation of clots and obstruction of the urethra.
Externally the patients only show feebleness, pallor of the visible mucous membranes, and difficulty in urination. The bunch of hair at the lower commissure of the vulva is always soiled with blood-stained urine or little clots.
Hæmaturia may cause death by exhaustion in from six weeks to two months, but not infrequently it lasts for months or even years.
Diagnosis. The diagnosis presents no difficulty when the urine can be examined; but in the periods of intermittence no opinion can be advanced. These intermittences are so frequent that in parts of the country ravaged by this disease it is a usual custom, when selling, to grant or refuse guarantees for a longer or shorter term.
The condition can be distinguished from parasitic hæmoglobinuria (piroplasmosis) or from Brou’s disease (a febrile disease of rapid development) by simply examining the urine or blood.
Prognosis. The prognosis is extremely grave, for, up to the present, no really efficacious treatment has been discovered, and although some animals may live for years without their lives being in any way endangered, this cannot possibly be foreseen, and there is no economic advantage in keeping them.
Treatment. No curative treatment is known.
It is true that iron salts, tonics, Rabel’s liquid, decoctions of certain plants, such as plantain, have been recommended, but apart from the fact that they are of doubtful efficacy, they cannot be used over long periods. All these preparations also tend to increase the coagulability of the blood; but considering that the disease is beyond question of a parasitic character, good results cannot always be expected of them.
Preventive treatment appears more hopeful, although even in this connection, the best informed appear to have considerable doubts. All those who have studied the question agree in recommending drainage of the pasturages, and their improvement by the use of various manures, particularly superphosphates and lime. These improvements alter the character of the pasture, render the soil healthier, and may perhaps prove sufficient to diminish or prevent the local growth of the germs. Under such conditions, Boudeaud declares that he has seen hæmaturia disappear from farms where it had previously been in permanent possession. It has also been recommended that the affected cattle should be sent elsewhere to places where the disease does not exist, and experience shows that spontaneous recovery is more frequent under such conditions.
It is probable that, during attacks of hæmaturia in a contaminated country, successive parasitic infestations occur, which would explain the persistence with which blood is passed, a symptom which does not occur in a healthy country. This view, however, is still only an hypothesis.
CHAPTER III.
DISEASES OF THE KIDNEYS.
CONGESTION OF THE KIDNEYS.
Congestion of the kidneys is not a morbid condition in the strict sense of the term, for it is merely the forerunner of nephritis caused by infectious diseases or intoxications (primary active congestions) or the final consequence of other diseases, such as diseases of the heart or liver, mechanical compression of the vena cava or renal veins (secondary passive congestion, cardiac kidney).
Nevertheless, under certain circumstances the development of nephritis may be arrested at the primary congestive stage, and it is only then that an opportunity occurs of studying it as a definite complaint.
Causation. All infections accompanied by lesions of the kidneys, and these are numerous (gangrenous coryza, anthrax, parasitic hæmoglobinuria), produce congestion of the kidneys.
Cold also acts directly under certain conditions, as do large doses of diuretics, irritant foods the principles of which are eliminated through the urine (fermenting or putrid sugar-pulp, for example), and foods rich in resins, essential oils, various glucosides, tannin, etc. (young shoots of trees during the spring-time).
Symptoms. The symptoms are difficult to define accurately, and the diagnosis can only be arrived at with the aid of the history.
Renal congestion produces pain, indicated by dull colic and repeated and ineffectual attempts to urinate, suggesting acute cystitis. The patients lose appetite, and present all the general symptoms of marked visceral inflammation, viz., fever, acceleration of breathing, somewhat tumultuous action of the heart, etc.
External or internal examination of the kidneys reveals abnormal sensitiveness. The urine is of a dark or bright-red tint, owing to the presence of red blood corpuscles. These blood corpuscles are precipitated on placing the fluid in a tall glass, and can be detected, together with renal epithelium, by microscopic examination.
The diagnosis is somewhat difficult, and it requires very careful attention to distinguish between congestion of the kidney and true nephritis.
The prognosis should always be reserved until it is certain that acute nephritis will not ultimately develop.
The treatment consists in removing the cause of the congestion; rich foods, or foods containing irritant principles, should, therefore, be avoided, as also the administration of diuretics, etc.
Otherwise, the treatment is similar to that employed in all visceral inflammations: bleeding to the extent of two to four quarts, according to the size of the animals, warm poultices to the loins and flanks, dry friction, mucilaginous drinks and emollient decoctions of barley or pellitory. The animals should be kept in a warm place.
In cases of passive and secondary congestion, treatment must be directed towards improving the condition of the organ primarily affected, whether it be the heart, liver, or lymphatic glands.
ACUTE NEPHRITIS.
The term nephritis applies to inflammation of the renal tissues. Clinically, two forms only can be distinguished, the acute and the chronic.
As regards its pathological anatomy, the inflammation may principally affect either the interstitial tissue or the epithelial parenchyma, a fact which has suggested the division of the condition into epithelial nephritis, interstitial nephritis, and mixed nephritis. Clinically, such distinctions are impossible; and in reality all forms of nephritis are to a varying degree mixed, the lesions predominating in one or other of the constituent tissues. These lesions depend on the extent, intensity, and duration of the inflammatory attack, whatever the primary causes. All the constituent tissues of the kidney may be affected, simultaneously or individually: the Malpighian corpuscles, the convoluted tubules, the collecting tubules, or the interstitial connective tissue.
Causation. Cold seems to be an important factor. All acute or chronic intoxications in which the toxic principles are eliminated by the kidneys, such as poisoning by cantharides, fermented beet pulp, young shoots of trees or toxic plants, may cause acute nephritis.
Infectious diseases, such as gangrenous coryza, hæmoglobinuria, tuberculosis and post-partum infections, also play an important part, whether the nephritis be direct, that is to say, the result of the infecting agent itself, or indirect, i.e., produced by toxins generated in the body. In female animals gestation is an often unsuspected cause. Moussu believes that albuminuria is frequent during gestation, and although in most cases it is only of moderate degree, he thinks it is often associated with subacute nephritis, which might be aggravated by an accidental cause.
Many forms of nephritis are overlooked in consequence of their slight character.
Symptoms. The early symptoms are similar to those of congestion of the kidney, viz., dull colic, excessive sensitiveness over the region of the loins, passage of pink urine, loss of appetite, and fever. At a later stage, in cases of acute nephritis due to cold, the animal stands with the limbs close together and remains stationary, arching the loins and back, which are held stiffly. The animal obstinately refuses to move in consequence of the pain produced by so doing.
The general condition becomes grave, respiration is rapid, the pulse frequent, the artery tense, the muzzle dry, the accessible mucous membranes are injected, and appetite is almost entirely lost.
Urine is frequently passed, but the act causes pain, and the quantity is small. Absolute anuria is rare, and does not last long.
The urine is generally sanguinolent, at least at first, but to a very varying extent. It is always albuminous, the quantity of albumen varying enormously, and on microscopic examination, is usually found to contain red and white blood corpuscles, epithelium from the kidney hyaline or epithelial cylinders, and, towards the end, pus corpuscles.
Œdema or anasarca, though common in mankind, does not occur in a very marked form, except in intense acute nephritis. Epistaxis is also rare.
Diagnosis. The diagnosis requires some care, because unless the urine be examined the symptoms might lead to error. Nevertheless, it is always possible to distinguish between this condition and hæmaturia or accidental renal hæmorrhage.
Prognosis. The prognosis is grave, because absolute recovery is rare, and because the condition is very apt to become chronic.
The degree of anuria and the respiratory difficulty are of great service in confirming the prognosis. As soon as urine is freely passed the prognosis becomes more favourable.
Treatment. Among the most effective methods of treatment must be included bleeding, which always produces some improvement. Dry friction over the kidneys and flanks, hot moist applications, and the application of a sheep-skin to the loins are also of service. Internally, mucilaginous drinks, diuretic decoctions and milk give the best results. The proportion of albumen rapidly diminishes, dysuria becomes less marked, urine is passed in greater quantities, and in from eight to ten days all the alarming symptoms disappear. Bicarbonate of soda may then be given for a fortnight.
In very grave cases camphor, bromide of camphor, injections of camphorated oil (1 to 2½ drachms internally, or 1 to 1¼ drachms in subcutaneous injections) give excellent results in modifying the pain and moderating the inflammation.
From ½ to 1 drachm of digitalis in powder, or better still an injection of from 5 milligrammes to 1 centigramme of digitalin may also be given when dyspnœa is very great and is accompanied by anasarca. Medicines such as oil of turpentine and considerable doses of nitrate of potash, however, are contra-indicated.
CHRONIC NEPHRITIS
True chronic nephritis, i.e., a condition strictly limited to the renal tissue, and unaccompanied by pyelitis, is still little known among our domestic animals. The symptoms characterising it have not always been carefully noted, and the diagnosis is very often uncertain. Nevertheless, one of the most common forms has been carefully studied by Seuffert, viz., chronic hypertrophic nephritis.
Causation. Chronic nephritis is the common sequel to the acute forms, whatever their origin, but it may also occur primarily from repeated chills produced by such conditions as exposure to heavy continued rain when at grass, chills contracted during cold nights and the great variations in temperature in spring and autumn. The conditions, however, thus produced are rather of the nature of subacute nephritis than of chronic nephritis, properly so called.
These forms of chronic nephritis may also occur primarily in consequence of chronic hepatic lesions with pressure on the posterior vena cava, producing blood stasis in the kidneys. Finally, they may represent the delayed effects of slight lesions which have escaped notice and have developed during grave diseases or as a consequence of repeated gestation.
From the anatomico-pathological standpoint, the only conditions hitherto recognised are the chronic hypertrophic forms of nephritis (large, white sclerotic kidney with lardaceous degeneration and sometimes marbling). This is probably because the animals are slaughtered as soon as they suffer in condition, but if they were kept long enough they would undoubtedly suffer also from the atrophic chronic forms of nephritis found in man and in the dog. In the case of man observation has shown that these two forms only represent different stages in the development of one disease, the large, hypertrophied kidney of the early stages afterwards undergoing marked progressive atrophy.
The symptoms are at first so vague that diagnosis would be impossible on a single examination. Seuffert states that the condition develops as follows:—
The first sign, loss of appetite, is soon followed by constipation and dull colic, due to congestion of the kidney; the pain is often so great as to cause intermittent groaning.
The urine passed is always turbid, and sometimes blood-stained, but this staining rarely lasts longer than a week. The urine then gradually resumes its normal appearance, is passed in small quantities, and contains more or less albumen. The yield of milk markedly and progressively diminishes.
If treatment is resorted to at this stage laxatives and diuretics appear to effect a real improvement. Unfortunately, however, the apparent improvement is but temporary; the kidneys become hypertrophied, and the right soon occupies the whole of the sublumbar space, its margin extending as far as the extremity of the transverse processes near the anterior angle of the hollow of the flank.
This hypertrophy and the extreme sensitiveness can be detected by external palpation. Internal examination confirms the facts so observed as regards both the kidneys.
The patients eat little and become thin, whatever treatment be adopted. They progressively waste, and die after some months in a state of marasmus, exhausted and intoxicated.
It is very probable that the digestive disturbances are complicated by respiratory and cardiac trouble, as in man and the dog; but neither cardiac nor uræmic disease of the kidney has been recorded.
Diagnosis. When the urine is analysed the diagnosis becomes comparatively easy. Persistent albuminuria and hypertrophy of the kidneys during the early stages are significant indications. There can be little hesitation except in so far as pyelo-nephritis and hydro-nephrosis are concerned, but the conditions are distinguished by the character of the urine in the two latter cases, together with the condition of the pelvis of the kidney, and of the ureters.
Prognosis. The prognosis is grave, and Seuffert believes that recovery never occurs. This is also true, generally speaking, as regards all forms of chronic nephritis.
Treatment. As the disease must be regarded as incurable there is really no justification for treatment. Nevertheless, if for special reasons the owner wishes to keep the animals for a certain time, as in the case of a cow near its time of calving, recourse may be had to the internal treatment suggested in acute nephritis, viz., mucilaginous drinks, diuretic infusions, milk, bicarbonate of soda, stimulating applications to the loins, etc.
HYDRO-NEPHROSIS.
Hydro-nephrosis, i.e., retention of urine in the pelvis of the kidney and in the collecting and secreting tubules, is a somewhat common malady of the bovine species. It is usually confined to one kidney.
Fig. 228.—Hydro-nephrosis of the kidney.
Causation. Anything which obstructs the discharge of urine through the ureters may cause hydro-nephrosis. Thus, vesical tumours pressing on the orifices of the ureters, calculi which have become fixed in them, torsion or “kinking” of the ureters, may bring about hydro-nephrosis. The urine secreted by the kidney being unable to escape, accumulates in the pelvis of the kidney, in the ureter, and uriniferous tubules, producing dull colic, which escapes observation, or the exact cause of which is not discovered, because the second kidney vicariously acts for the one affected, and urination continues regularly. Secretion continuing in spite of the obstruction, that portion of the ureter above the obstructed point, together with the pelvis and the uriniferous tubules, gradually becomes dilated, until the whole mass of the kidney is hypertrophied.
The ureter sometimes becomes enlarged to the size of a man’s arm, the kidney double, treble, or quadruple its normal side: the interlobular divisions are lost, and each circumscribed lobule soon forms a cystic cavity varying in size. The pressure due to the accumulated urine causes the renal tissue, first the medullary substance and afterwards the peripheral zone, to undergo atrophy.
The kidney is represented by a vast cystic cavity, and the lobules by culs-de-sac; the cortical layer may become atrophied to such a degree as to form merely a fibrous sheath, the primary constituent elements of which are difficult to discover. From 20 to 40 pints of liquid may sometimes be found in the cystic kidney.
Diagnosis. The condition is rarely diagnosed, because, as one of the kidneys continues to act, no acute disturbance follows. Only in cases where the cystic kidney projects into the flank are suspicions aroused. Examination per rectum will then permit of the diagnosis being made.
Prognosis. Hydro-nephrosis being, as a rule, unilateral, the prognosis is not very grave as regards immediate danger. As the condition is hopeless, however, the lesions being irreparable, the animal should be prepared for slaughter.
Treatment. Practically there is no treatment. Puncture of the cystic cavity or even the removal of the hydro-nephrotic kidney certainly suggests itself, but, as such operations are usually opposed to the interests of the owner, they are rarely or never practised.
INFECTIOUS PYELO-NEPHRITIS.
Fig. 229.—Section of a kidney affected with hydro-nephrosis. The gland substance is almost entirely atrophied, and each lobule shows marked dilatation.
The term “infectious pyelo-nephritis” describes an inflammation which may involve any portion of the mucous membrane of the urinary tract, and which is produced by a special bacillus. As a rule, this inflammation commences in the mucous membrane of the calices and pelvis (pyelitis). It afterwards extends into the depths of the uriniferous canaliculi (nephritis), but in grave and old-standing cases the mucous membrane of the ureters and the bladder may also be affected. The disease had long been known in France (Rossignol, 1848). It was afterwards described in Germany (Siedamgrotsky, 1875; Pflug, 1876), in Switzerland (Hess, 1888), and also in France (Lucet, 1892; Masselin and Porcher, 1895).
Causation. Female animals are more frequently affected than males, because the lesions are produced by an ascending infection, originating very frequently in genital infection after delivery. Nevertheless, calculus formation is also an important factor in producing the disease.
Many different agents are capable of producing pyelo-nephritis. Hofflich in 1891 described a bacillus about 2 to 8 micromillimètres in length, which stained readily with aniline colours and with Gram solution. Lucet in 1892 found a short bacillus which did not stain with Gram, and later another thin bacillus which did. Kitt has described cocci, but no other organisms. Masselin and Porcher discovered a cocco-bacillus which stained with Gram and reproduced the disease in an animal lent by Moussu, after a single intra-vesical injection of the culture. Cadéac has met with staphylococci, and Moussu has discovered various bacilli, some resembling the colon bacillus, and pyogenic streptococci.
There is no doubt that many different organisms may produce pyelo-nephritis by ascending infection. The most common seem to be forms of paracoli, such as the Bacillus ureæ. Moussu nevertheless believes that Hofflich’s bacillus, which was rediscovered by Porcher, is that which produces typical pyelo-nephritis. It grows in the bladder without producing cystitis, and is succeeded by an ascending infection of the ureters without causing primary ureteritis, the local inflammation occurring chiefly, it would seem, in the pelvis and the kidney. All the other organisms which Moussu has tested have caused lesions of cystitis and of ureteritis, together with those of pyelo-nephritis.
In these latter cases the pyelo-nephritis assumes the acute form, and is accompanied not infrequently by cellulitis and abscess formation in the tissue around the kidney.
Symptoms. Pyelo-nephritis develops in one of two principal forms, the slow chronic form, which is the most frequent, or an acute or subacute form, much more rapid in its development.
The chronic form for a time escapes notice. There is no doubt that at first some general disturbance occurs, such as diminution of appetite, disturbed nutrition, unhealthy general appearance, staring of the coat, tightness of the hide, wasting, etc., but such symptoms are in no wise characteristic, being found in all grave diseases.
The signs only become really significant from the clinical standpoint when the urine appears modified in character, and such modification does not occur until the pelvis of the kidney and the kidneys themselves are already gravely diseased.
The urine is then turbid, of a brownish colour, and charged with sediment, filaments of mucin, pus corpuscles, and earthy phosphates. On analysis it is found to contain more or less albumen.
At a late stage it may even become glairy, blood-stained, or of the colour of blood, and when the pelvis or the calices of the kidney are ulcerated may, on standing, deposit considerable quantities of red blood corpuscles.
Fig. 230.—Pyelo-nephritis with hæmorrhagic pyo-nephrosis of one side. One ureter is dilated and blocked with a blood clot.
Exposed to the air, the urine rapidly assumes a brown tint and smells strongly of ammonia.
Percussion of the loins in the region of the kidneys causes pain, as does external palpation by the flank. On rectal examination at this period the ureters are found to be distended and hard, and they give the impression of rigid or bosselated fibrous cords, sometimes as large as a child’s arm. The corresponding kidney, often both kidneys, are enlarged, sometimes to double or treble their normal volume, and are painful on pressure and fluctuating, at least in the region of the pelvis. On vaginal examination the meatus urinarius is usually found to be inflamed, rough and turgid.
In this condition the animals rapidly lose flesh, the appetite becomes irregular, the general condition gradually gets worse, and they die as a result of continued uro-septic fever or uræmic troubles.
The acute form takes a much more rapid course, with fever, more marked general disturbance, acceleration of pulse and breathing, the passage of turbid and sometimes purulent urine with a strong ammoniacal smell. Pyo-nephrosis is the most frequent and characteristic end. Ordinary chronic pyelo-nephritis may also occur in these cases, and the acute course may be determined simply by accidental ascending infections.
Diagnosis. During the early stages diagnosis is extremely difficult, unless a careful examination of the urine be made. Afterwards it becomes easy, the appearance of the urine and the indications furnished by rectal exploration being perfectly characteristic. In very exceptional cases there may be some doubt, as where the urine remains normal, in spite of hydro-nephrosis, or where there is old-standing hæmaturia or renal tuberculosis. In simple hæmaturia the lesions are confined to the bladder and ureters, the kidneys not being affected, and in renal tuberculosis the diagnosis can always be confirmed by the use of tuberculin.
Prognosis. The prognosis is extremely grave, for the lesions produced are irreparable, and, moreover, local intervention is impossible.
Treatment. There is no curative treatment. All that is possible is palliative treatment with the object of facilitating the function of the kidney and of disinfecting the urinary passages by administering antiseptic substances which are excreted by the kidney. It is not possible, however, to administer active drugs of this kind (e.g., combinations of carbolic acid). As the kidney acts badly it soon ceases to eliminate such substances, and the condition would not be improved, but aggravated.
Benzoate of soda in doses of 2 to 2½ drachms per day dissolved in diuretic liquids is the most useful drug, and sometimes holds the disease in check for a sufficient time to allow of the animals being fattened.
Treatment also comprises certain prophylactic precautions. As the infection which produces pyelo-nephritis originates in the genital tract, it is desirable to protect all animals in a receptive condition (those about to calve or having recently calved) from infection; hence, when the disease is detected in a cow-shed, the patients should be isolated, and the shed thoroughly disinfected.
SUPPURATIVE NEPHRITIS AND PERINEPHRITIS.
Suppuration of the kidney may occur under two conditions. In the majority of cases such suppuration occurs as a complication of pyelo-nephritis; less frequently it is the consequence of infection from within or infection of adjacent parts, leading to the formation of an abscess.
When it results from an ascending infection the kidney becomes swollen, congested and inflamed, and soon displays localised minute hæmorrhages. Pus then forms within the calices, in the large straight tubes, and diffuse suppuration invades all the uriniferous tubules. The enlarged kidney is yellowish, firm under the knife, and when sections are compressed pus exudes from the openings of the tubular canaliculi.
When suppurative nephritis has resulted from accidental infection of internal origin, an abscess is found to have produced more or less extensive atrophy of a portion of the kidney while not affecting the rest of the organ.
It is only in those favourable cases where the renal abscess opens into the pelvis that suppuration may invade the whole of the kidney, producing diffuse suppurative nephritis by secondary infection of the uriniferous tubules. Such complications are rare. Usually the abscess empties through the pelvis, and recovery may occur.
More frequently suppurative pyelo-nephritis develops, together with ureteritis, cystitis, dilatation of the ureters, dilatation of the pelvis of the kidney, and dilatation of the collecting tubules of the pyramids, the final stage resembling the lesions of pyo-nephrosis.
Perinephritis and perinephritic cellulitis, i.e., inflammation with or without abscess formation in the connective tissue and adipose layer surrounding the kidney, always occur in cases of suppurative nephritis or pyelo-nephritis. Such inflammations may also, in exceptional cases, follow direct mechanical injury, but they almost invariably represent complications, the organisms infecting the kidney passing through the tissues and the layer of fibrous tissue, or extending by the lymphatic paths, finally attaining the fatty tissue surrounding the kidney and there undergoing multiplication. The fatty tissue is infiltrated with reddish serosity, is inflamed, and may become the seat of large abscesses communicating with or separate from the abscesses of the kidney itself.
Symptoms. Suppurative nephritis is characterised by fever, loss of appetite, arrest of rumination, and frequent attempts to urinate. These attempts are painful, are accompanied by groaning, and end in the passage of an insignificant quantity of blood-stained and purulent urine.
Palpation, more especially palpation of the right flank, percussion over the region of the loins, and examination of the kidneys through the rectum are painful. Wasting is rapid.
If the suppurative nephritis develops rapidly, and particularly if it be accompanied by perinephritis, the patients refuse to rise and appear to be suffering from paraplegia, although not really so, both sensation and motor power persisting in a greater or less degree. Probably the condition is accompanied by reflex pain and irritation of the nerve trunks of the lumbo-pubic plexus.
On the other hand, when suppurative nephritis tends to develop slowly and assume a chronic form, lesions of pyo-nephrosis gradually develop, and are identical in appearance with those of hydro-nephrosis, except that the ureters, the pelvis and the dilatations corresponding to the lobules, are filled with pus.
Fig. 231.—Leaf lard around kidney of pig.
Diagnosis. The diagnosis is not very difficult. The urinary trouble and the composition of the urine itself always arouse suspicion. The diagnosis is confirmed by careful and methodical examination per rectum; the inflammation of the fatty tissue surrounding the kidney can usually be detected.
Prognosis. The prognosis is extremely grave, and almost always fatal, particularly in cases of diffuse nephritis.
Treatment. No curative treatment can be absolutely relied on. Treatment, if attempted, is limited to the methods suggested for pyelo-nephritis. Mucilaginous, emollient, and diuretic drinks, and daily doses of 2 to 3 drachms of benzoate of soda given in the drinking water, cause some improvement.
Fig. 232.—Sclerostoma pinguicola. External view of female. a, Male, natural size; b, female, natural size; c, mouth; d, buccal cavity; e, œsophagus; f, intestine; g, anus; h, genital opening; i, genital tract; k, cephalic gland. (Louise Taylor, Annual Report, Bureau of Animal Industry, 1899, p. 614.)
Stimulation of the region of the loins also undoubtedly has a favourable effect, and should always be practised, particularly where perinephritis is developing. It may check the course of the disease and prevent the formation of abscesses. On slaughtering animals suffering as above described the layer of tissue surrounding the kidney is found to be lardaceous and fibro-fatty.
Any treatment through the bladder is contra-indicated, for even the passage of a catheter may cause severe injury of the urethra or the vesical mucous membrane and produce a fatal aggravation.
If these conditions are diagnosed early, while the function of the kidney is more or less preserved, and if the animal is still in good condition, it should be slaughtered.
THE KIDNEY WORM (SCLEROSTOMA PINGUICOLA) OF SWINE.[[7]]
[7]. From Report of the U.S.A. Bureau of Animal Industry, 1899, p. 612. (Louise Taylor.)
In the United States of America a worm is frequently found in the fat surrounding the kidneys of pigs, and is supposed by farmers to be the cause of paralysis of the hind limbs.
This so-called kidney worm of hogs (Sclerostoma pinguicola) should not be confounded with the kidney worm (Dioctophyme viscerale) of dogs and man. Both of these parasites belong to the same zoological family (Strongylidæ), but to different subfamilies and genera. The kidney worm of dogs grows to a length of 1 to 3 feet. The kidney worm of hogs is much smaller, attaining at most something less than 2 inches in length.
Fig. 233.—Embryos of Sclerostoma pinguicola. (Louise Taylor, Annual Report, U.S.A. Bureau of Animal Industry, 1899, p. 634.)
The body of the worm is plump, mottled in color—red, yellow, white, black—according to the organs visible beneath. The average female is about 37 mm. and the average male 32 mm. in length. The worms seem to occur in pairs, usually in cysts or canals; thus, upon the examination of two kidneys with their surrounding fat, fifteen specimens were found, seven males and eight females. The connective tissue layers between the fat were found to be the most general seat of infection, and the cysts were numerous and closely packed together. Although a cyst usually contained two worms, a male and a female, sometimes three were found together, two females and one male, or just as often one female and two males. The cysts contained pus, which bathed the parasites, and in which were thousands of eggs in the segmentation stage. Still, other cysts, upon being cut into, were found without parasites and in a necrotic condition.
It will be noticed that Sclerostoma pinguicola is colloquially known as the kidney worm. In no case, however, has Miss Taylor found it in the kidney substance, but only in the tissue surrounding this organ; the lard appears to be its normal habitat, at least.
Just how the eggs leave the kidney fat or enter the bodies of fresh hogs has not been demonstrated, but it does not seem unreasonable to suppose that they eventually find their way out with the urine. Indeed, Dean reports eggs found in the urine. From analogy one is led to believe that no intermediate host is required, but that in all probability the embryos develop for a short time in water, casting several skins, and they eventually gain access to the hogs either through contaminated drinking water or food.
Because of the hog’s habits, it is difficult to see any practical measures which can be adopted to prevent infection. Feeding from troughs and supplying plenty of pure drinking water will decrease but not exclude the disease. Leuckart’s advice to the Germans, “Swine should be kept in a less swine-like manner,” holds good in all countries and in connection with all diseases. It is equally impossible to suggest practical methods of treatment. This is all the more true because it seems probable that a number of distinct complaints are popularly grouped together by the farmer as kidney-worm disease.
CHAPTER IV
GENITAL APPARATUS.
Semiology. The examination of the genital apparatus properly so called is easy in animals of large size, whether male or female, but is more delicate and difficult, and is sometimes partially impossible, in small creatures.
In male animals it comprises the examination of the testicles by inspection and palpation, of the vas deferens, and of the intra-pelvic genital organs (vesiculæ seminales, prostate, etc.).
Inspection and palpation of the scrotum reveals hypertrophy, atrophy, œdematous or sanguineous infiltrations, inflammation of the tunica vaginalis, and tumours of the testicle. Intra-pelvic examination partly covers the same ground as examination of the pelvic portion of the urethra, and, provided the anatomical relationships of the different organs encountered are known, there is no difficulty in detecting the position of possible lesions (Fig. 226).
In small male animals, such as he-goats and rams, rectal exploration is confined to the use of one or two fingers.
In female animals examination comprises inspection, intra-vaginal examination, and rectal examination.
Inspection reveals lesions of the vulva and clitoris.
Vaginal examination with the hand establishes the condition of the walls of the vagina, the neck of the uterus, and the vaginal culs-de-sac.
If a lesion is detected, its character can easily be ascertained by means of a speculum, which exposes the base of the vagina, the prominence formed by the uterus, or any particular part of the vagina itself. Examination with the speculum is the only useful method in young female animals, heifers in particular, on account of the narrowness of the genital tract.
In small female animals, such as she-goats, ewes and sows, the fingers alone can be employed.
As regards examination of the uterus, the direct method gives little exact information, and examination by the rectum is to be preferred. By passing the arm into the rectum and gently pressing downwards towards the base of the pelvis, the hand can be brought in contact with the body of the uterus, which can be moved and displaced from right to left; the horns of the uterus can be felt and followed from the body of the uterus as far as the Fallopian tubes and the ovaries. By this means the state of the uterus, its degree of sensitiveness and mobility, as well as the state of the Fallopian tubes and of the ovaries, can all be ascertained. The examination also reveals the existence or non-existence of gestation, during which the uterus becomes hypertrophied and is displaced in a forward direction towards the right flank, at the same time descending in front from the base of the pelvis over the abdominal wall and under the mass of the intestinal convolutions.
Fig. 234.—Genital organs in a cow, showing the anatomical relations. R, Rectum; Gr, meso-rectal lymphatic glands; U, ureter; LL, broad ligament; Va, vagina; V, bladder; Cu, uterine cornu; O, ovary; F, Fallopian tube.
VAGINITIS.
Inflammation of the vaginal conduit may be primary or secondary. It usually follows difficult parturition, but may occur under various circumstances. From the clinical standpoint three varieties are distinguished: simple or contagious acute vaginitis; croupal vaginitis; and chronic vaginitis.
ACUTE VAGINITIS.
Causation. Deep-seated genital injuries leading to metritis, excessive and prolonged strains due to painful labours, accidental injuries caused by obstetrical operations, etc., are followed by more or less acute vaginitis.
Suppurative inflammation of Gartner’s canals, irritant and caustic injections, and foreign bodies likewise cause local irritation, which may become complicated by infection and eventually produce vaginitis. The infective organisms may be numerous and varied.
Symptoms. The vagina being closed to external inspection, the symptoms are not very apparent. At first, acute vaginitis is suggested by swelling of the vulva, pruritus, and dysuria. The lips of the vulva are œdematous, injected, sensitive and of a brownish-red or violet-red colour on the internal surface. Sometimes they are excoriated and torn.
The period of full development is accompanied by the escape from the vulva of a serous, mucous, muco-purulent or purulent discharge of varying odour. Urination is painful and defæcation difficult. Examination of the vagina by means of a speculum shows the mucous membrane to be excoriated, ultra-sensitive, ulcerating or suppurating at certain points. The parts are hot.
The general symptoms are little marked, and without importance. The usual termination consists either in recovery, which may be spontaneous, or in passage to the chronic form.
The diagnosis is easy, and the prognosis favourable, provided the vaginitis has not been caused by severe mechanical injuries, capable of setting up cellulitis or the formation of deep abscesses of the pelvis.
Treatment. One of the principal reasons why vaginitis persists is the retention of morbid products in the vaginal culs-de-sac. Treatment ought therefore to aim chiefly at removing these by soothing, astringent, and antiseptic injections. Soothing injections should first be tried. They consist of lukewarm water at body temperature, decoctions of black-cherry bark, poppy-heads, linseed, etc. After a few days, when the excessive sensibility has disappeared, antiseptic and astringent solutions may be used, such as crystallised alum, 150 grains to the pint; sulphate of zinc, 75 grains to the pint; carbolic acid, lysol, cresyl, etc., 150 grains to the pint.
Injections of permanganate of potash of the strength of 150 grains to the pint and of solutions of iodine at a strength of 1 in 2,000 are more active, but require more careful handling. Hydroxyl diluted with from 3 to 5 parts of water is also of great efficacy. Strong solutions should never be used, because they cause irritation and expulsive efforts.
All these injections may be made without difficulty by passing a simple perforated drainage tube to the end of the vagina, and connecting it with a syringe, or, better, with a small cistern hung from the wall, which allows the required pressure to be obtained.
When there are deep and severe wounds, the parts should be washed out once or twice daily and the vagina should be packed with surgical wool and iodoform gauze. The septic liquids are absorbed by the dressing, which acts continuously. This dressing is renewed until recovery takes place.
CONTAGIOUS VAGINITIS.
During the past few years certain observers have described a disease which has been termed “contagious vaginitis,” in consequence of the facility with which it is transmitted.
This vaginitis may be transmitted by copulation, the bulls then serving as propagators of the disease. The bulls themselves are usually affected with balanitis.
The causative agent of the disease is unknown.
This contagious vaginitis is characterised by all the symptoms of acute vaginitis, and it is only from the fact of its appearing in all the animals served by one bull that its contagious character is established. A short time after service the vulva appears swollen and extremely sensitive; at the same time general disturbance appears, viz., diminution of appetite and of milk secretion, slackening of rumination, etc.
Vaginal exploration, which is somewhat difficult, reveals a papulovesicular eruption, accompanied by a muco-purulent discharge.
This vaginitis is easy to diagnose. It may disappear spontaneously, and the treatment differs in no respect from that of ordinary acute vaginitis.
CROUPAL VAGINITIS.
Croupal vaginitis is a form of acute vaginitis, from which it is distinguished by the formation of false membranes resembling those of diphtheria over the whole of the vaginal mucous membrane.
It was described by Baumeister. Moussu has only seen one case, and that at a period which rendered recovery out of the question.
Symptoms. The external symptoms are those of acute vaginitis, with greyish, fœtid, purulent or sanguinolent discharge. On examination, the mucous membrane is found to be covered with yellowish, greyish false membranes, and with vegetations of a greyish, dirty, verrucous appearance. The entire extent of the vaginal mucous membrane may be attacked, together with the neck of the uterus. In Moussu’s case the uterus itself was entirely invaded.
These false membranes and vegetations are very adherent, and bleed freely at the slightest touch. They are apt to extend by degrees.
The cause of this infection has not yet been determined. It appears to obtain access to the parts during parturition, and develops insidiously for a week or two, when widespread lesions have already formed.
The diagnosis is extremely easy.
The prognosis is grave, for the lesions have a tendency to extend towards neighbouring organs. Moreover, the general health is severely affected; there is rapid wasting, loss of appetite, and continued fever and death occurs from exhaustion, intoxication, and possibly infection.
Treatment. The treatment suggested for the ordinary acute forms appears to be useless in this condition. The new membranes show too many folds, depressions, and accidental culs-de-sac for simple injections to have any real effect. Better results might be expected from packing with antiseptic gauze or from the use of antiseptic ointments applied after washing out the cavity with permanganate of potash solution or hydroxyl.
Curettage, followed by the use of gauze dressings, might also be tried; considerable difficulty must necessarily be anticipated in operating in a cavity which has become inextensible and partly filled with vegetations and false membranes.
CHRONIC VAGINITIS.
Chronic vaginitis usually represents the last stage of some form of acute vaginitis, though it occasionally develops in a slow and progressive fashion as a primary condition in consequence of some deep-seated genital lesion. There is usually a constant discharge of irritant material.
The symptoms are not very striking, and are purely local.
Externally all that can be detected is a continuous or, much more frequently, an intermittent muco-purulent discharge from the vulva, which occurs only on urination, defæcation, coughing, etc.
Locally, examination with a speculum discloses the fact that the mucous membrane is of a greyish colour, thickened, less yielding than usual, and in places sclerosed. The entire thickness of the mucous membrane is affected, as also at times the muscular tissue, chronic irritation having caused sclerosis.
The diagnosis is very simple, and the prognosis of no particular gravity, because the animals can always be fattened. The condition is only grave as regards animals intended for breeding.
Treatment is often very successful, but, as in all chronic diseases, it extends over a considerable time. Practically it is not often attempted. It does not differ greatly from that of ordinary acute vaginitis, but the best results seem to follow the use of astringents.
METRITIS.
Infectious or traumatic diseases of the uterus are of the greatest importance in bovine pathology, both on account of their frequency and gravity. They comprise septic metritis, acute metritis, and chronic metritis.
SEPTIC METRITIS.
Septic metritis is also termed “metro-peritonitis” and “parturient septicæmia.” It may be compared with puerperal fever in woman.
These terms are sufficiently explicit to indicate that if at first the metritis is typical it frequently becomes complicated with peritonitis, and too often also with true septicæmia.
Causation. The disease only appears after parturition or abortion, and during the few days immediately succeeding delivery. Parturition may occur spontaneously in a perfectly regular and easy manner, and nevertheless be followed by fatal metritis as a consequence of infection. Usually the labour has been difficult, and the after-birth, or portions of the fœtal membranes, have been retained. Septic metritis then develops in consequence of their putrefaction.
Infection with microorganisms is therefore the essential cause, and the only one of importance. None of the conditions formerly invoked can do more than favour or check the course of this infection.
Moreover, the subsequent complications are entirely due to the special character of the infective agent.
These infective agents may be of various descriptions. They have been the subject of numerous investigations, on account of the gravity of puerperal fever in woman. Pasteur, Colin, Chauveau and Doléris were the first to take up this question. In veterinary medicine several inquiries have been instituted, but a great deal remains to be done. The most frequent agents are varieties of streptococci, of the colon bacillus, and of putrefactive bacteria.
Septic metritis may occasionally be purely accidental and only affect one animal, but infection of stables by a primary case is an obvious cause of propagation. Moussu has seen six animals successively die of septic metritis in one year, and in a stable which had not been disinfected after each death.
Symptoms. The first symptoms occur between the first and fourth days after parturition, when the uterine mucous membrane is still tender, discharging and bleeding, and the lochial discharge is abundant. The disease rarely appears after the first week. The earliest symptoms are dulness, depression, loss of appetite, and general weakness. The animals appear exhausted, the secretion of milk is diminished or altogether suspended, and all the chief functions of the body are interfered with.
The temperature varies in a peculiar and significant way. In some forms, due to infection with streptococci or to mixed infection, it rises to 104° or 105° Fahr.; in others it remains stationary or falls below normal. It might be thought that in these latter cases, which are usually due to infection with the colon bacillus, the general condition was not grave. This, however, would be a very serious error, for in such cases death follows as rapidly as in the others.
The patients, or some of them at least, have slight colic and peritonism when the infection extends to the peritoneal pockets at the entrance to the pelvis. At a later stage they appear prostrate, remain lying, and seem to be suffering from paralysis of the hind quarters.
None of these general symptoms are in themselves significant, and to appreciate them at their true value the local signs must be taken into account.
The external genital organs are moderately swollen, the vagina is infiltrated and sensitive, and is soiled by exudate of varied character.
The neck of the uterus is sometimes prematurely contracted after the first or second day, constituting a troublesome complication both in examining the parts and in treatment. When, however, it is dilated and the hand can be passed, it is found that the uterus itself is not contracted or is only half-contracted, and that it is filled with a reddish-grey liquid of putrid appearance, sometimes without smell, at others fœtid or even putrid.
The uterine mucous membrane is infiltrated, thickened, and extremely fragile, partially destroyed, and breaks at the slightest touch. The cotyledons may become loosened by necrosis, and accumulate in the depression formed by the gravid horn of the uterus; otherwise they may be detached without difficulty.
When the neck of the uterus is prematurely contracted direct exploration gives no result, but rectal examination reveals a much enlarged uterus, filled with liquid or distended with putrid gas.
If, however, the after-birth has not come away, fragments of fœtal membranes may be removed from the deeper portions of the uterus or the surface of the cotyledons.
Death is inevitable unless treatment is early initiated. The animals succumb to infection produced by germs entering the vascular apparatus. When the infection extends by contiguity of tissue to the peritoneal cavity the immediate causes of death are infection and intoxication. In cases where the infection remains localised within the uterus the animal is poisoned by the absorption of toxins through the uterine mucous membrane.
The condition may prove fatal in from four to six days in the cow, but in a shorter period in the goat, ewe, and bitch.
Lesions. The uterus is excessively fragile, and can be torn at will. The mucous membrane in which the microorganisms more particularly develop appears necrosed in places. Large areas are sloughing or ulcerated.
The vessels are thrombosed, and extensive portions of the organ may be affected by true capillary phlebitis.
The lymphatics are dilated and distended with pus in animals which have resisted for some days.
If there is peritonitis, the entire floor of the abdominal cavity is affected, and sometimes the peritonitis is generalised.
The lesions in the other tissues and viscera are similar to those found in septicæmia and in general intoxication, such as injection of the capillary system, and interstitial extravasations of blood in the pleura, pericardium and other tissues.
Diagnosis. The diagnosis of septic metritis is not very difficult, though something more is required than simple observation of external signs. From the clinical standpoint it is of no great importance to distinguish between the various forms or to determine the responsibility of microorganisms for the infection. In every case the practitioner must utilise all the means at his disposal.
Prognosis. The prognosis is extremely grave, and death almost invariably occurs when treatment is not early undertaken.
Treatment. Treatment should be prompt and energetic. Infection of the genital organs being the cause of the symptoms, it is against this that remedies should be directed. The parts should first be thoroughly washed out with boiled water at the body temperature. A stiff drainage tube about 6 feet in length is passed to the base of the uterus and connected at its free end with a reservoir of liquid, which can be raised so as to obtain sufficient pressure. During this operation the animals should be placed with the front limbs higher than the hind.
When the liquid injected returns perfectly clear, antiseptics may be employed. Strong solutions containing mercury, carbolic acid, lysol or creolin should be avoided, partly because of their toxic action, but principally because they cause irritation and violent expulsive efforts.
A 25 per cent. hydroxyl solution gives surprisingly good results. A 1 in 2,000 iodine solution (iodine 15 grains, potassium iodide 1 drachm, warm water 4 pints) is also of very great service.
As the first irrigations are difficult to carry out thoroughly, it is often advisable to cleanse the parts directly by means of a large disinfected sponge, which should be passed over the whole surface of the mucous membrane and into the depressions of the uterus, thus directly removing septic liquids. Thereafter irrigation will be easier and more efficacious.
This method, however, of cleansing the parts is dangerous for the operator unless he takes the antiseptic precautions necessary in every case of delivery.
When the neck of the uterus is prematurely contracted, the difficulties become much greater, and are sometimes insurmountable on account of the impossibility of dilating it. It then becomes necessary to use metallic canulæ or uterine sounds made of aluminium in order to pass through the neck of the uterus. Liquids can be evacuated by compressing the uterus through the wall of the rectum, but the method is very troublesome.
This local treatment should be practised twice a day at least until all danger is over, and may be completed by the administration of diffusible stimulants, such as alcohol in doses of 6 to 10 ounces, acetate of ammonia in doses of 2 drachms, wine, coffee, and diuretic decoctions. These may be given with food or drink to whatever amount is considered necessary if the animals still retain their appetite. The food should be light and easily digested.
From 8 to 12 pints of physiological salt solution may be injected intravenously every day, the temperature at which this fluid is injected being varied according to the degree of fever. (Physiological salt solution consists of chloride of sodium 9 parts, sterilised water 1,000 parts.)
Prophylaxis. Should a case of septic metritis occur in a byre containing other cows about to calve the building should be disinfected.
ACUTE METRITIS.
The term “acute metritis” is used to indicate a variety of inflammation of the uterus of a sufficiently grave character, which, however, does not prove fatal in twenty-four or forty-eight hours.
Causation. In domestic animals acute metritis develops exclusively after difficult parturition and as a consequence of the tearing of tissues or accidental post-partum infection.
At one time it was the rule to recognise a traumatic form consequent on wounds by embryotomy hooks, crutches, cords, etc., etc. There is no reason for maintaining this distinction, because the essential condition for the development of metritis is the infection of the injuries.
Acute metritis follows non-delivery, incomplete delivery, or accidental infection.
Symptoms. The external signs are very few, and must be carefully studied, in order that wrong conclusions may be avoided.
Certain of these external signs suggest general disturbance such as one finds in all acute visceral inflammations, viz., loss of appetite, progressive wasting, irregular slight fever, diminution or cessation of the secretion of milk, dulness, etc.
The others are purely local. The discharge from the vagina is mucoid, muco-purulent, sanguinolent or fœtid, according to circumstances. It is small in quantity, and occurs only when the animal lies down or makes expulsive efforts. Examination with the speculum reveals the existence of slight secondary vaginitis and more intense inflammation of the neck of the uterus, which remains half open. Rectal examination shows that the uterus is abnormally large and more difficult than usual to displace. If acute metritis has existed for some weeks, the uterus is painful to the touch, and sometimes fixed in position in consequence of the development of parametritis and of slight pelvi-peritonitis, the occurrence of which is always indicated by temporary tympanites.
Cases of acute metritis may recover spontaneously, but they rarely do so. The condition usually tends to become chronic or to be complicated with peri-uterine diseases which may prove fatal.
Diagnosis. The diagnosis can be established without difficulty by rectal examination and direct examination with a speculum.
Prognosis. The prognosis is grave, because the patients are temporarily or permanently incapable of becoming pregnant, and because acute metritis may be complicated with pelvi-peritonitis, phlebitis of the intra-pelvic veins, etc.
Treatment. The uterus, and particularly the uterine mucous membrane, being affected, all our efforts should be concentrated on that organ. A careful study of the lesions shows that the glandular follicles are infected, and with them the entire thickness of the mucous membrane. The object to be attained, therefore, is the perfect disinfection of this tissue. The parts should repeatedly be washed out with warm water at blood-heat, followed by antiseptic injections containing 4 drachms of chloral per pint; a 1 in 2,000 iodine solution or 20 per cent. to 25 per cent. hydroxyl solution, etc. Despite such injections, the inflammation disappears slowly and with difficulty, and when the neck is sufficiently open it might perhaps be possible, as in human medicine, slightly to curette the mucous membrane of the uterus and plug the cavity with iodoform gauze.
Where, however, the neck of the uterus is so far contracted as no longer to admit a sound or canula for irrigation, the difficulties are very great. Nothing effectual can be done until the neck of the uterus is dilated, an exceedingly troublesome operation.
In the forms termed “post-partum traumatic metritis” antiseptic injections must not be made with any considerable pressure, because of the danger of rupture; plugging the cavity with antiseptic gauze is preferable.
CHRONIC METRITIS.
Chronic metritis is often the termination of acute metritis, though inflammation of the uterine mucous membrane may assume the chronic form from the first. All post-partum infections with pathogenic microbes may give rise to chronic metritis, as may the various forms of cystitis, vaginitis, rupture of the vulva, etc. Tuberculosis also leads to chronic metritis, which is easily diagnosed by a simple bacteriogical examination of the discharge.
Symptoms. Chronic metritis is accompanied by bad general health and persistent local disturbance. The animals show a permanent muco-purulent discharge varying in amount, or simply an intermittent discharge, which is then more abundant and only lasts some hours or some days, but reappears after irregular intervals. On examination the neck of the uterus is found to be half open, slightly hypertrophied, sometimes sensitive, and covered with vegetations.
Examination through the rectum may show the organ to be considerably hypertrophied, sensitive, and comparatively immobile. Cases are numerous, however, in which the examination reveals nothing very striking.
In other cases, vaginal examination by means of the speculum reveals nothing, except that the neck of the uterus is completely closed, and yet on rectal examination the uterus is found to be of large size, tense, uniformly fluctuating, and in exactly the position to be expected were the animal pregnant. This clinical form was formerly termed “hydrometritis,” but it would be better named “pyo-metritis,” inasmuch as it depends on chronic metritis. The neck of the uterus remains contracted, and the morbid products accumulate in the body and uterine horns, which are gradually dilated. Then suddenly the uterus is seized with reflex contractions overcoming the resistance of the neck and expelling the contents in one jet. The discharge may continue for some days, after which the neck again closes and the disease enters on a new phase.
Lesions. The lesions affect the mucous membrane, more particularly the glandular tissue and the interstitial tissue. From the anatomical and pathological point of view different forms are recognised, some with glandular and mucous atrophy, others with marked hypertrophy, the mucous membrane being covered in some cases with vegetations and fungus-like growths.
Diagnosis. From a clinical standpoint, it is only necessary to distinguish the ordinary forms from tuberculous metritis, which latter is of no clinical importance on account of the impossibility of treatment.
Prognosis. The prognosis is grave, as in all chronic diseases. Furthermore the animals are, for the time being, sterile and difficult to fatten.
Treatment. One of the fundamental conditions of treatment is to attack the disease locally, and it is necessary, therefore, that the uterine neck should be dilated.
If the neck of the uterus is pervious, the parts must be washed out daily with antiseptic solutions, after having lightly curetted the mucous membrane with a blunt curette. Boiled water is first used, and is followed by solutions of chloral, iodine, hydroxyl, or permanganate of potash.
When the neck of the uterus is contracted, it must first of all be dilated. In practice such treatment is sometimes considered too costly, so that the animals are slaughtered or recovery is left to chance.
Moussu has seen several animals suffering from metritis, and even from salpingitis, recover spontaneously after six to eight months at grass.
EPIZOOTIC ABORTION IN COWS.
This disease, which was carefully investigated, first by Professor Nocard of Alfort, and afterwards by Professor Bang of Copenhagen, may be regarded as a specific uterine catarrh, determined by a definite species of bacterium.
It often affects large numbers of animals in one district or on one farm, and causes very serious loss. It is conveyed from cow to cow either by the bull or by litter or utensils used in the byre which have been soiled by the uterine discharges of an infected cow. As in many other infectious disorders, one attack of the disease seems to confer a certain immunity, and although some cows become sterile after an attack and others continue to abort, a certain proportion after aborting two or three times acquire relative immunity, so that they conceive and carry their calves the full time. This is probably why epizootic abortion usually ceases after some years in herds which are kept isolated and do not receive fresh recruits.
The microbe of epizootic abortion is a very small bacterium which stains well with Löffler’s methylene blue. When massed together these bacteria resemble cocci, but isolated specimens are seen to be true bacteria containing one, two, or occasionally three roundish, elongated deeply-stained granules. They do not stain with Gram, and are non-motile.
These bacteria exhibit remarkable vitality. Bang relates cases which seem to prove that they may exist within the uterus for at least fourteen months, and in the uterine exudate outside the body for at least seven months, even at comparatively low temperatures.
On post-mortem examination one finds between the mucous membrane of the uterus and the fœtal envelopes an abundant odourless exudate, dirty-yellow in colour, somewhat thin, pultaceous, slimy, or lumpy in character. Under the chorion is found a thin, clear, gelatinous substance contained within the fine connective tissue lying between the chorion and allantois. The umbilical cord is often œdematous. All these exudates contain the specific minute bacterium.
The above exudate forms the peculiar dirty, reddish yellow, slimy, flocculent, pus-like odourless fluid which escapes from the vagina during or immediately after the act of abortion.
The results of infection of the uterus with Bang’s bacterium may be delayed for a considerable time. In two cases where he injected pure cultures into the vaginæ of pregnant cows no apparent local results had been produced at the end of thirty-three and thirty-five days respectively when the cows were slaughtered; but in the case of two other pregnant cows, inoculated three months after conception, signs of abortion became apparent, and one cow in fact aborted in about ten weeks; post-mortem examination revealed the characteristic local changes, and microscopical and cultural preparations clearly established the presence of the specific organism.
Although the sexual organs form the usual channel of infection, it seems possible that the organism may in some cases enter the body through the respiratory or digestive tract.
The treatment in this condition is chiefly of a prophylactic character. Bulls which have served cows belonging to herds known to be infected should not be allowed to cover healthy cows. They should undergo careful local disinfection, and for a time be withdrawn from the stud.
Cows which show signs of impending abortion should at once be removed to a separate shed. The fœtus and its envelopes should be buried or burnt, and the person who attends the diseased cow should be prohibited from entering the common cow-shed.
Where space does not admit of this the affected cows should be removed as far as possible from those still healthy and placed in a separate row. When they abort the after-birth should be removed by hand, and the uterus daily washed out with some non-irritant but effectual disinfectant. Even after apparent recovery a period of probation should elapse before the cow is again put to the bull.
The genital organs and vaginæ of the still healthy animals may also be irrigated with a disinfectant solution, in order, if possible, to ward off infection. For disinfecting the channels and floor of the stable quick-lime will be found clean, non-odorous, cheap and effective.
In dealing with this disease one must always bear in mind the great vitality of the bacterium, the relatively long time it may persist either in the animal’s body or in the infected sheds, and the considerable period which may elapse before its effects become evident.
The same or a similar organism seems capable of producing abortion in sheep and mares.
SALPINGITIS SALPINGO-OVARITIS.
This section will be brief, because the condition is very far from having been thoroughly elucidated. Moussu himself has only studied a single case of simple suppurative salpingo-ovaritis.
Salpingitis and salpingo-ovaritis, i.e., inflammation of the Fallopian tubes and of the ovaries, can only develop as a consequence of ascending infection, as a complication of acute or chronic metritis, by auto-infection during the course of tuberculosis, or as an accident during what is known as tubal gestation.
Tuberculous salpingitis is frequent, and exists in a very large majority of cases of genital tuberculosis. Accidental salpingitis as a consequence of tubal gestation is extremely rare, and is usually overlooked or mistaken for some other condition.
From the clinical standpoint, therefore, we recognise two varieties of salpingitis—the one suppurative, the other tuberculous.
Symptoms. The external symptoms are similar to those of metritis, because salpingitis develops as a complication of metritis after parturition, abortion, or retention of the after-birth. The only external symptom is a discharge of varying quantity from the vulva. This may be intermittent or permanent, and it is accompanied by frequent expulsive efforts in no respect characteristic.
The nature of the lesions is ascertained by rectal examination, and as lesions of the uterus, of the Fallopian tube, and sometimes of the ovary often co-exist, the examination must be carried out methodically and gently in order to distinguish between the parts touched. The normal relationships may be modified by uterine lesions, inflammatory adhesions, local peritonitis, etc.
Diagnosis. The diagnosis requires care.
Prognosis. The prognosis is grave. The lesions are too deep-seated to be directly attacked, and, moreover, salpingitis may terminate in pyo-salpynx, i.e., in encysted abscess of the Fallopian tube.
Treatment. The treatment is similar to that of metritis. The natural opening of the Fallopian tube into the uterus allows pus and morbid products to escape, and when the metritis disappears the salpingitis may diminish and recovery may take place.
Treatment therefore is quite indirect, for in veterinary surgery it is useless to attempt to repeat on large domestic animals the brilliant operations of human surgery. The relations between uterine diseases and those of the Fallopian tubes are so close that this method of treatment gives excellent results. Moussu has seen a case of chronic metritis complicated with salpingitis recover after simple uterine treatment.
TORSION OF THE UTERUS.
Although torsion of the uterus is a condition more particularly pertaining to the domain of obstetrics, a few remarks on the subject may not be altogether out of place at this point.
The accident is commonest in the cow, but it has also been described in the mare, ewe, bitch and cat, and it probably occurs, though less frequently, in the other domestic animals. In the cow it is commonest during the last month of pregnancy.
Very little is known as to its cause, though the consensus of opinion—if any consensus can be said to exist in face of the existing divergent views—appears rather to indicate that it follows falls in awkward positions, sudden efforts, severe prolonged exertion, or tympanites.
In pregnant cows the uterus assumes the appearance of a pendulous organ the body and horns of which constitute the bob of the pendulum, whilst the ligaments represent the cords by which it is suspended. The fixed points are formed by the insertions of the two ligaments in the neighbourhood of the two external iliac angles.
The uterus, however, is also steadied in position by the vagina and by the cellular tissue surrounding it; in fact, in non-pregnant animals it can scarcely be regarded as pendulous, but rather as freely floating and readily yielding to the movements of the surrounding organs.
As soon as the uterus is occupied by a fœtus, however, the conditions become changed. In consequence of the increased weight of its contents the uterus exerts a pull on the broad ligaments and sinks lower in the abdominal cavity. The vagina and the surrounding connective tissue are rendered tense to a degree depending on the increasing weight of the calf. The uterus then more closely resembles a pendulum, the bob being represented by the fœtus and its envelopes. The suspensory apparatus can be divided into three parts, viz., the two broad ligaments and the tissue connecting the uterus to the vagina.
The pull on the vagina increases greatly as soon as the gravid uterus is twisted either to the right or left, for, torsion being attended with more or less extensive displacement towards the lower abdominal wall, the tension on the vagina must become more marked.
Considering now how the spiral folds and the constrictions which are of such importance in diagnosis are formed, we find that both structures, viz., the wall of the uterus and the ligaments, are implicated, though to different degrees. Whilst the spiral folds are more particularly formed by the wall of the uterus, the broad ligaments are chiefly responsible for the constrictions, though to some extent the spiral folds also contribute to their production. The spiral folds of the body of the uterus are formed solely by twisting of its own walls. This can easily be shown by taking any tubular organ whose walls are not too rigid, and twisting it round its horizontal axis.
The broad ligaments contribute less to the formation of the spiral folds, though they play a more important part in producing constrictions and thus in compressing the wall of the uterus.
The symptoms are ill-defined. Sometimes there is difficulty in micturition, but as a rule little evidence exists of any abnormal condition until the advent of labour pains. The first pains, which are usually feeble and separated by rather long intervals, are succeeded by colic. The succeeding efforts steadily become more violent and frequent, but the “water-bag” fails to appear, and in a period varying between twelve and forty-eight hours the pains subside. Rumination is at first suspended, the pulse and respiration are accelerated, and the surface temperature is irregular.
If treatment is not undertaken similar symptoms, but of exaggerated intensity, may again appear in from one to six days. Failing relief death always follows after a varying interval.
The diagnosis is not difficult, provided the maternal passages be examined. On passing a carefully lubricated hand into the vagina the operator discovers, at a varying distance from the os uteri, signs of collapse and twisting of the canal. In cases of quarter twist it is often possible, by rotating the hand so as to follow the spiral folding of the vagina, to introduce the fingers as far as the os uteri; but in half or complete rotation only one or two fingers can be passed so far, or it may be altogether impossible to reach the os.
In the Berliner Archiv for 1902 Lempen gave a summary of the extensive literature dealing with this disease and of the varying views held regarding its origin and treatment, particularly as to the direction in which the animal should be rolled in order to reduce the torsion.
In common with the majority of authors, Lempen rightly concluded that the rolling should be in the same direction as the torsion. He also proposed to describe the torsion as being to right or left, according to the direction of the spiral folds to be found on the upper wall of the dilated cervix uteri when the examiner stands behind the animal. This mode of describing the changes seems least likely to cause misunderstanding.
In describing the degree of torsion Haase takes as his index the upper wall of the uterus. Where this has moved through an angle of 90 degrees he speaks of quarter torsion; when through an angle of 180 degrees (in which case the upper wall will have become the lower) of half or semi-complete torsion; when through an angle of 270 degrees as three-quarter, and when through 360 degrees (the upper wall having then described an entire circle and returned to its former position) as complete torsion.
In forming a diagnosis, the extent to which the maternal passages seem fixed in position, the amount of resistance they offer to the hand, and the degree of tension in the spiral folds to some extent indicate how far torsion has proceeded. Where the spiral folds are very tense and the passages completely immovable, so that the operator cannot reach the fœtus, torsion is usually complete; in cases of less complete torsion (one-quarter to three-quarters) the cervix uteri is closed and displaced to a proportionate extent, and the resistance to the passage of the hand is in keeping.
The prognosis is very grave.
Treatment is difficult, and of the numerous methods suggested (laparotomy and direct abdominal taxis, vaginal hysterotomy followed by abdominal taxis, vaginal taxis, etc.) most have fallen into desuetude or are looked on as of so desperate a character as only to be justified in extreme cases. That which most merits attention and has been attended by most uniformly favourable results consists in the rotation of the animal’s whole body. The best results are said to be obtained by casting the animal, or causing it to lie down, on a sloping surface with the hind quarters higher than the fore and then to roll it down hill, in the same direction as the spiral twists discovered in the vagina. It is possible to follow the course of the manipulation by retaining the hand in the vagina, but failing this the vagina should be examined after each attempt. Even, though the first attempts fail hope should not be abandoned, for Haase has succeeded in effecting delivery after rolling the animal twenty times. The operation should be performed smartly and the animal’s body be rolled as a whole, the fore limbs turning along with the hind.
TUMOURS OF THE UTERUS.
The study of tumours of the uterus is still so incomplete that it would be impossible to give a precise description of them. This is to a great extent due to the fact that as treatment is difficult the animals are usually slaughtered as soon as an assured diagnosis can be given.
The general symptoms of tumours of the neck, body, or horns of the uterus resemble those of chronic metritis, viz., permanent or intermittent discharge from the vulva, wasting, expulsive efforts, dysuria and sterility. The position of the tumour, its form, point of insertion, size, consistency, mode of attachment, etc., can be detected by vaginal or rectal examination.
The diagnosis having been made, the only question is as to treatment. Should the tumour prove mobile, clearly delimited, and with a well-marked pedicle, it can be removed either by tearing away or by breaking into fragments, or again simply by dividing the pedicle and applying antiseptic pads to check bleeding. But if the tumour proves largely sessile and ill-defined and it extends into neighbouring tissues the animal should be slaughtered, as such patients can neither be fattened nor used for reproductive purposes.
TUMOURS OF THE OVARY.
We might repeat in regard to tumours of the ovary what has just been said as regards those of the uterus, though the former are much commoner than the latter.
Clinically, ovarian tumours may be grouped under two heads, solid tumours and cystic tumours—the first represented by the fibromata, fibro-sarcomata and epitheliomata, the second by uni- or multi-locular cysts.
All these tumours are dangerous; they may develop rapidly, and they rarely fail to produce disturbance, the animals presenting various genital troubles, among which may be mentioned sterility and nympho-mania.
The cystic tumours, which develop at the expense of epithelial invaginations of the peritoneal covering or at the expense of Pflüger’s tubes, and not, as was formerly believed, by the morbid development of the Graafian vesicles, constitute dangerous growths, true cysto-epitheliomata or cystic epitheliomata, capable of producing fatal complications (vascular disturbance, local or general peritonitis, compression of the ureters, etc.).
The diagnosis must be arrived at by vaginal and rectal examination. It is usually possible to distinguish the condition from disease of the kidney, bladder, or pelvic lymphatic glands.
Treatment. The only possible treatment is removal of the diseased ovary and of the ovarian tumour, but much depends on circumstances. If a large tumour has formed extensive adhesions, ablation may be impracticable or so dangerous that under the circumstances in which veterinary practitioners are forced to operate it cannot be undertaken. If, on the contrary, the ovarian growth is free and pedunculated, even though of large size, extirpation is possible.
The method is exactly similar to that of castration of the cow, and follows the same rules, but the vaginal incision has to be much longer, so as to allow the entire hand to be passed as far as the tumour. The pedicle is divided by means of the écraseur, which should be worked very slowly. In removing very large tumours, however, it is possible to operate from the flank.
GENITAL MALFORMATIONS.
IMPERFORATE VAGINA.
Many forms of genital malformation occur, but only those which produce sterility are pathologically important.
One alone causes very marked disturbance, viz., imperforate vagina. This condition may be accidental or acquired, and may follow either difficult parturition, with circular lesions of the vagina, or burns or cauterisation of the vagina, followed by adhesion of its walls.
It is generally of congenital origin, and the obstruction as a rule is in the region of the hymen, as a consequence of some anomaly in development, and not of abnormal development of the hymen itself.
This imperforate condition of the vagina is not attended by grave consequences during early life; but later, when the generative functions become active, all the products of secretion of the uterine and vaginal mucous membranes accumulate in the closed cavity, giving rise first to muco-metritis, then to muco-kolpitis, similar in its development to the hæmato-kolpitis of young girls. The uterus gradually becomes distended with liquid, the neck is dilated, and a portion of the vagina may attain enormous dimensions, so much so as to suggest pregnancy.
Symptoms. The symptoms become appreciable only after a time—about one year or fifteen months in heifers—and they seem to be associated with the appearance of œstrum. The animals make continued expulsive efforts, which when the genital canal is much distended may become extremely violent. There is also dysuria as a consequence of compression, together with uterine and vesical colic, loss of appetite and wasting.
Diagnosis. The diagnosis requires care, and can only be arrived at after examination of the vagina and examination per rectum. In young females this examination is extremely difficult, because of the narrowness of the genital tract and of the rectum. For vaginal examination we prefer to use a small speculum, which exposes the depths of the vagina or the transverse septum without necessitating other manipulation. On rectal examination the uterus and vagina are sometimes found to be enormously enlarged, and to contain a quantity of fluid, but no fœtus.
Fig. 235.—Imperforate vagina: position and appearance of the genital organs. Cu Distended uterine horns (muco-metritis); Va, dilated extremity of the vagina; Ve, bladder, distended with urine, owing to compression of the urethra. The hymen was situated about 1¼ to 1½ inches in front of the meatus urinarius.
Prognosis. The prognosis is grave. Unless treatment is undertaken the animals die in consequence of exhaustion or secondary peritonitis.
The treatment is simple, and consists in aseptic puncture of the septum and evacuation of the contents. The operation is carried out with a long, large-sized trocar, which is passed through the centre of the most prominent portion of the transverse septum where it projects towards the vulva. Five, ten, or fifteen quarts of mucous fluid escape, and the constitutional disturbance disappears almost instantly.
Antiseptic precautions are necessary in order to avoid the development of secondary pyo-metritis. The artificial orifice can afterwards be gradually dilated to allow free exit to the discharges, but in practice, as the animals cannot be used for breeding purposes, they are usually fattened for slaughter.
NYMPHO-MANIA.
The term “nympho-mania” is employed to describe a special condition in female animals which is manifested by continual sexual excitement. The animals are almost always sterile. The disease is most frequent in cows.
Causation. This general condition may depend on one of many causes, but is rarely due to a true neurosis, as was once believed. Some morbid influence of genital origin is always responsible for the appearance of the symptoms.
Nympho-mania, therefore, often co-exists with lesions of the ovaries (simple ovaritis, cystic ovaritis, tumours of the ovary), with lesions of the Fallopian tubes and of the uterus (salpingitis, chronic metritis and tumours of the uterus), with chronic vaginitis and lesions of the clitoris (hypertrophy and tumour formation), and even with peri-vaginal or peri-uterine lesions (cysts or tumours).
In exceptional cases it may be found occurring as a simple nervous disturbance without genital lesion, and it would then appear to be due to some temporary genital affection having produced nervous irritation.
In short, nympho-mania may be considered as almost invariably the result of a genital lesion.
Symptoms. The symptoms are very clearly marked. They consist in persistence of the sexual appetite, which is quite abnormal in female domestic animals. The patients lose flesh, feed badly and irregularly, annoy their fellows, cause accidents, and sometimes become dangerous.
Diagnosis. The diagnosis of nympho-mania is so simple that the condition is generally recognised by the owners or cow-herds. The only difficult point lies in discovering the exact cause. Complete examination of the genital organs per rectum and per vaginam is absolutely necessary to settle this question.
Prognosis. From an economic standpoint the prognosis is generally grave.
Treatment. The treatment varies considerably, according to the nature of the lesion.
In mild cases where nympho-mania is due to some lesion of the clitoris (balanitis, hypertrophy, or tumour formation), the radical treatment consists in clitoridectomy. The operation is comparatively slight, the organ being removed with forceps and scissors, or with a bistoury after the animal has been hobbled or placed in a trevis. The hæmorrhage which follows removal of the clitoris is of little importance, and after-treatment simply consists in keeping the parts clean.
Animals so treated can sometimes be preserved for breeding.
Fig. 236.—Specimen of lesions found in nympho-mania. V, Vagina laid open; Cu, neck of the uterus; O, O, ovaries; Cd, right horn of the uterus; Cg, left horn of the uterus; K, K, K, peri-uterine cysts.
When nympho-mania co-exists with, and is a delayed consequence of, either chronic vaginitis or metritis localised in the neck of the uterus, or, again, chronic metritis of the cavity of the uterus, etc., the treatment must be directed against these diseases, and the nervous condition may be sufficiently modified to render the animals useful for breeding, or at least for slaughter, while fattening is easy.
Similarly, when the nervous condition results from a lesion of the ovary, improvement will only follow removal of the diseased part. The operation is similar to that of castration of the female. It presents, however, certain added difficulties, in consequence of the size of the organs and of the abnormal adhesions which often occur. Nevertheless, these difficulties are seldom insurmountable.
In the case of peri-uterine disease operation is difficult, and it is better to slaughter the animal.
Finally, as may occasionally happen, should there be no congenital lesion capable of explaining the appearance of nympho-mania, the disease may be regarded as a neurosis, and may then be treated by such sedatives as the bromides of potassium, sodium and strontium, in doses of 2 to 3 drachms per day, divided into two or three portions. Bromide of camphor also gives excellent results by acting simultaneously on the nervous system and calming excessive genital irritation.
The above method of treatment is much preferable to performing clitoridectomy, or ovariotomy as a kind of panacea, although certain writers have suggested these operations without taking into account the special local conditions.
CHAPTER V.
DISEASES OF THE MAMMARY GLANDS.
In animals used for the purpose of providing milk, viz., cows, goats, and milch ewes, diseases of the mammary glands are of daily occurrence, but are rare in those in which the mammary function is limited to the nourishment of the young, such as the mare, female ass, sow, etc.
In order clearly to understand the development of these diseases, it is necessary to bear in mind the anatomical construction of the organs, for which purpose we may take as a type the mammary gland of the cow, which is the most complicated.
The udder of the cow is of hemispherical shape. It is situated in the inguinal region, and is composed of two parts, the right and left, which are absolutely independent and can easily be isolated from each other along the median plane throughout their extent. The mass of parenchyma is enveloped in a fibrous envelope, which is covered with a very loose layer of subcutaneous connective tissue. Each half is subdivided into two quarters, an anterior and a posterior quarter. Each quarter again represents a distinct gland, although anatomical separation between the anterior and the corresponding posterior quarter would be almost impossible, the separating fibro-connective partition being common to both glands.
In very good milkers it sometimes happens that two small supplementary glands may be found behind the posterior quarters, bringing up the total number to six.
Parenchyma.—Each of these glands is provided with a teat containing a large sinus. Anatomically the mamma consists of glandular tissue arranged like a bunch of grapes, in which the active tissues of the acini deliver their secretion into little excretory canals, which unite, forming a large collecting plexus. The collecting canals, or galactophorous canals, open into the galactophorous sinus, which occupies the entire depth of the teat and communicates with the exterior by a small pore provided with a sphincter. The interacinous connective tissue of the udder and the subcutaneous tissue of the teat, which envelops the galactophorous sinus, is extremely rich in elastic fibres, enabling the organ to undergo great changes in volume without injury.
Vessels.—The mammæ are supplied by two great arteries, the mammary arteries, which are given off from the prepubic arteries, pass into the inguinal canal, and penetrate the gland by its upper, deep face. Each principal lateral artery divides into two trunks, one for the anterior, the other for the posterior quarter.
Fig. 237.—Schema showing the structure and organisation of the udder. Antero-posterior section showing the arrangement of the anterior and posterior quarters and the teats, skin, transverse partition, etc. GRM, Retro-mammary lymph gland; Lp. lymphatics of the posterior quarter; La, lymphatics of the anterior quarter; LE, efferent lymphatics; AM, mammary artery; VM, mammary vein; VMa, anterior mammary vein (subcutaneous abdominal vein); C, transverse intermammary septum.
The veins which collect the blood from the mammæ form two systems, the first accompanying the mammary arteries, the second, more superficial, giving rise to the anterior subabdominal mammary veins. The arterio-venous plexus of the udder, which represents the vascular pedicle of the organ, penetrates the gland, near a line dividing the posterior and middle thirds of the upper surface, an inch or so in front of the mammary lymphatic gland.
Lymphatics.—On either side of the middle line lies an extremely rich lymphatic plexus, the origin of which is to be found near the ends of the teats and in the peri-acinous spaces.
The superficial collecting vessels are dispersed under the skin, perforate the fibrous sheath towards the base of the teat, and anastomose with one another on the surface of the gland, the anastomosis being most intimate between those of the same quarter, finally emptying separately by two large trunks into the retro-mammary lymphatic gland of the same side.
The vessels of the anterior quarter enter the lymphatic gland at its most anterior point; those of the posterior quarter join it a little below.
The retro-mammary lymphatic glands are two in number, and are situated very high and towards the back, above the posterior quarters and close to the perineum, outside the fibrous envelope of the gland. They are sheltered in a recess excavated within the depths of the gland itself. The main collecting lymphatics from the anterior and posterior quarters enter it separately.
The lateral efferent vessels are divided into two groups, one of which ascends vertically in the perineal region, towards the lymphatic glands round the anus; the other passes through the inguinal canal towards the sublumbar region, together with the blood-vessels.
The mammary nerves are two in number. The anterior has a downward course outside the fibrous envelope and supplies the teat; the posterior nerve is similarly distributed. In other domestic female animals which have only two mammæ the general arrangement is precisely the same.
PHYSIOLOGICAL ANOMALIES.
Imperforate condition of the Teat.—It sometimes happens that although the udder is otherwise well formed, the teats, or more frequently a single teat, proves to be imperforate. Between the galactophorous sinus and the exterior, opposite the sphincter, a little membrane may be found which closes the teat and entirely prevents the contents of the udder from escaping. Its existence is only discovered when the animal first calves and lactation commences. Not a drop of milk can be withdrawn, although the udder is swollen. Local examination readily reveals the defect.
Treatment is very simple and effective, the membrane being perforated with the end of a milk catheter.
Contraction of the Sphincter (Atresia of the Extremity of the Teat).—Under other circumstances the teat may present a distinct perforation, and yet milking may be impossible, or at all events may be extremely difficult. This is sometimes due to contraction of the sphincter, or possibly to atresia of the orifice.
The diagnosis of this condition is easy, but the outlook is not promising.
Treatment is rather difficult. Some operators recommend dividing the terminal sphincter with a small, specially formed bistouri caché, provided with two cutting points. The operation has very satisfactory immediate results, but after the little wounds so produced have healed, cicatricial contraction takes place around the orifice.
Forcible dilatation is far preferable. It is carried out in the same way as in human medicine, where the sphincter ani or the orifice of the uterus has to be dilated. No superficial lesion and no incision is produced; the result is therefore more permanent (see “Operative Technique”).
WOUNDS OR TRAUMATIC LESIONS.
CHAPS AND CRACKS.
These injuries consist in little transverse or oblique wounds of the teat.
Causation. In free milkers the udder appears completely relaxed after milking. In the intervals between the different milkings, however, the quarters become swollen, and are sometimes so distended as to overcome the resistance of the sphincter at the base of the teat. The teats are then greatly elongated, and, despite the richness of the tissues in elastic fibres, this distension leads to little superficial epidermic fissures.
These small lesions are unimportant, but if they become infected by contact with the litter they granulate and suppurate, so that grave complications may eventually follow.
The wounds caused by the calves’ teeth when sucking, or simply by the rough way in which the little animal seizes the teat, may produce similar accidents.
Symptoms. The teat shows one or more little transverse fissures, a few millimètres to a centimètre or more in length. The base of the fissure appears of a reddish or brownish-red colour, and has thickened, indurated, painful, discharging or suppurating margins. Local sensitiveness may be either slight or very pronounced. In the latter case, the patients resist being milked, and even refuse to let the calf suck.
Diagnosis. The diagnosis is extremely simple.
In a general sense the prognosis is favourable, but nevertheless the local infection may extend and become generalised, thus giving rise to interstitial mammitis, sometimes of a very grave character. On the other hand, the sensitiveness may of itself render milking difficult or impossible, and thus cause serious distension of the gland with milk.
Treatment. As both sucking and milking aggravate the lesions, they should be prevented by the insertion of a milk catheter.
The surface of the udder and the wounds should be cleansed with an antiseptic solution and be dressed with a 20 per cent. camphorated vaseline or with carbolic or iodoform ointment, to favour healing. If the cracks produce excessive sensitiveness a small quantity of orthoform may be added to the camphor ointment. Before the milk catheter is inserted, the teat should be very carefully cleansed with boiled water and the catheter sterilised by boiling. Neglect of these precautions may result in infection of the galactophorous sinus and mammitis.
MILK FISTULÆ.
Causation. Any accidental injury to the udder which establishes connection between the galactophorous canals or the galactophorous sinus and the exterior may give rise to milk fistulæ, if the injury occur during lactation.
Apart from lactation these wounds may be grave, though if carefully treated they heal without complication. During lactation, on the contrary, the milk escapes permanently from the injured spot, cicatrisation cannot occur, and a fistula forms.
Fig. 238.—Milk fistulæ. 1, Deep suture—schema showing the course of the suture; FL, base of the fistula; S, suture; 2, superficial interrupted suture.
Symptoms. The principal symptom is the permanent discharge of milk. The fistula may be large or small, according to circumstances. In rare instances it is situated on the udder itself, but it is commonest on the teat. Milk may escape in mere drops or, on the other hand, in considerable quantities.
Diagnosis. The diagnosis presents no difficulty.
Prognosis. The prognosis is grave so far as the loss of milk is concerned, although the lesion has no effect on the general health. It is particularly serious, however, because it may cause the interior to become infected, and an acute parenchymatous mammitis may thus be set up. It must also be borne in mind that old fistulæ are much more difficult to obliterate than recent ones.
Treatment is much more troublesome than might at first be thought, the great obstacle to repair being the continual secretion and discharge of milk.
At first, attempts should be made to re-establish and render permanent the natural method of discharge. This can be effected by inserting an aseptic milk catheter and fixing it in position with a little pitch bandage.
The course of the fistula is then cleansed, curetted, and rendered aseptic in some way, as for example by washing with boiled salt solution and dilute hydroxyl.
As there is little hope of obliterating the fistula by merely suturing the skin, its course should first be closed by passing one or two deep sutures without touching the external orifice and without passing over it (Fig. 238). The discharge of fluid being then entirely stopped, the external portion of the fistula is thoroughly cleansed, powdered with iodoform, and finally closed with external, closely-applied sutures. These sutures are protected with a little cotton wool or collodion dressing, and healing then almost invariably occurs.
The animal should be given a very clean bed, and closely watched to prevent it tearing out the milk catheter. On the fourth or fifth day the catheter is removed, and is afterwards only used at intervals.
As all the sutures can be of aseptic catgut or silk, there is no necessity to trouble about their removal. The dressing can be left until it falls away of itself.
INFLAMMATORY DISEASES.
CONGESTION OF THE UDDER.
Congestion—i.e., distension of the vascular plexus as a consequence of momentary stasis, vaso-motor disturbance, or paralysis of the little vessels in the udder—can only be regarded as pathological in cases when it precedes mammitis or when it results from prolonged neglect to milk the animal, external irritation, etc. It was studied long ago by H. d’Arboval, Gellé, Delafond, Trasbot, Lucet, etc.
It also occurs, but in a form which might almost be termed physiological, after the first parturition in the large milch breeds, where the rush of blood which precedes secretion is very great.
Symptoms. The udder is swollen, tense, doughy, shining, and œdematous, not very painful on pressure, but sufficiently so to interfere with movement. The general condition is little altered, but the temperature of the udder is abnormally high.
Manipulation reveals the existence of more or less œdema, the parts preserving the imprint of the finger. Sometimes this œdema extends along the abdominal wall in front of the udder. The milk may be grumous or even sanguinolent. The congestive state continues for some days, eight to ten at the most, and may gradually disappear by resolution. Not infrequently it terminates in acute mammitis after forty-eight hours.
Lesions. In simple mammary congestion the lesions are confined to excessive dilatation of the peri-acinous capillary vessels, and extravasation into the connective tissue. On section the tissue has a dark-red appearance.
Diagnosis. The diagnosis is simple.
Prognosis. The prognosis is less alarming than might at first sight be supposed.
The treatment consists simply in hygienic precautions, frequent milking, emollient, sedative applications to the udder, and frequent washing. As far as possible the use of milk catheters should be avoided.
Boric vaseline and belladonna ointment may be recommended. In very serious cases blood can be withdrawn from the jugular. This is better than bleeding from the mammary vein, which always entails the risk of thrombus formation.
MAMMITIS.
Under the heading “mammitis” are included different forms of inflammation of the mammary tissue, whether such inflammation attack the parenchyma of the gland or the interstitial tissue. Generally the whole gland is invaded at the end of a few days, whatever the point of origin, and the inflammation is therefore of a mixed character.
Mammitis has been recognised from very early times. In his researches on “contagious mammitis” Nocard in 1884 showed that infection was the principal factor in its evolution.
Numerous classifications, based on the causes or on the pathological anatomy of the condition, have been suggested; but most appear too rigid, and therefore, without discussing them, we confine ourselves to giving the following résumé:—
| Rainard (1845) | Lacteal engorgement. | ||
| Cellulitis of the udder. | |||
| Mammitis | Acute. | ||
| Chronic. | |||
| Lafosse (1856) Trasbot (1883) | Mammitis | Acute. | |
| Chronic. | |||
| Saint Cyr (1874) Violet (1888) | Mammitis | Catarrhal. | |
| Phlegmonous or interstitial. | |||
| Parenchymatous. | |||
| Lucet (1891) | Primary mammitis (properly so-called) | Acute | Galactogenous. |
| Lymphogenous. | |||
| Chronic | Galactogenous. | ||
| Lymphogenous. | |||
| Symptomatic mammitis | Acute | Hæmatogenous. | |
| Lymphogenous. | |||
| Chronic | Hæmatogenous. | ||
| Lymphogenous. | |||
All these classifications are justified by the guiding ideas of the writers, yet, as in every case of attempted systematisation, they have the disadvantage of not being in entire agreement with clinical experience.
For instance, the differences between catarrhal and parenchymatous forms of mammitis are only of degree, and it is difficult, therefore, to see why they should be divided into two distinct varieties. The difference is in regard to the prognosis.
Similarly in practice it is difficult and sometimes impossible to distinguish between an interstitial and a parenchymatous mammitis, because all the tissues of the gland may be involved at a given moment. The only factor which allows of differentiation is the discovery of the point from which infection took place. Finally, it is sometimes so difficult to distinguish between galactogenous and lymphogenous mammitis that the attempt has had to be abandoned. In gangrenous mammitis of milch ewes, for example, the infective organism is found not only in the sinus and the galactophorous canals, but also in the serosity of the interstitial tissue and of the perimammary œdema.
Without doubt the causative agent of mammitis may enter the gland by three principal channels—the galactophorous sinus, the lymphatic plexus (after some injury), and the blood circulation. But from the clinical standpoint it is not at all necessary to identify all the causes in order to establish the classification.
The symptoms allow of a division only into acute and chronic mammitis. Careful examination of the general condition of the patients will afterwards allow cases of primary mammitis to be distinguished from secondary or symptomatic mammitis such as occurs in tuberculosis. Finally, consideration of the conditions under which a particular case of mammitis has appeared, and study of the symptoms in detail (peculiarities of the milk, local temperature, hardness of the tissues, œdematous infiltration, etc.) will in most cases indicate whether the mammitis be parenchymatous or interstitial.
This system really differs little from that adopted by Lucet in his work on Mammitis.
The classification adopted in the following pages is as follows:—
| Mammitis | Acute | Primary | Parenchymatous or galactogenous. |
| Interstitial or lymphogenous. | |||
| Secondary or symptomatic. | Hæmatogenous. | ||
| Galactogenous. | |||
| Chronic | Primary | Simple. | |
| Parenchymatous. | |||
| Interstitial. | |||
| Secondary | Parenchymatous. | ||
| Interstitial. |
We shall leave on one side everything concerning secondary symptomatic mammitis, the study of which merges into that of the general diseases from which it arises.
ACUTE MAMMITIS.
Causation. The general cause of acute mammitis, like that of chronic mammitis, is infection by pathogenic organisms, whether such organisms enter by the usual natural path, viz., the galactophorous sinus and excretory apparatus, by the lymphatic path, owing to some accidental injury, or, again, by the blood circulation.
Infection of the lymphatics undoubtedly plays a part in superficial and interstitial inflammations, and it is proved that certain microorganisms may pass into the milk, as it has been proved that they pass through the kidney.
But if infection is the determining cause, certain secondary favouring influences must not be overlooked.
Thus lactation is an almost indispensable condition. It is true that some cases of mammary inflammation apart from lactation have been described, but they have been the result of violence, accidental or mechanical.
Accumulation of milk in the udder (overstocking) has unquestionably a certain influence in the large milk-yielding animals, not because it directly produces inflammation, but because milk then escapes spontaneously; and as the udder cannot be entirely evacuated without external assistance, the entrance is kept permanently open for the passage of germs, which are freely transferred to the teat from the litter and surrounding objects.
Cold, or rather chills, also act in a complex manner, particularly by disturbing vaso-motor control. Different forms of mechanical violence, such as blows, crushing strains, wounds, etc., may immediately and directly set up local or general inflammation.
Bacteriological investigation has proved that numerous and varied microorganisms can be found in the milk or interstitial exudates in cases of mammitis, but only a few special forms have been proved to be specific: streptococcus of contagious mammitis of milch cows, and micrococcus of contagious gangrenous mammitis of ewes (Nocard).
Pathology. The pathogenic results produced by infective organisms depend on their number and power of reproduction, and on the activity of their life products.
The most immediate and regular result of acute mammary infection is coagulation of the milk within the udder by decomposition of the lactose, and the formation of lactic or even of butyric acid. The acini and excretory canals are dilated by coagula, and can no longer expel their products of secretion, so that the colonies of microorganisms develop there in full security. The active epithelial cells undergo granular degeneration and disappear, whilst the walls of the glands become infiltrated and large numbers of leucocytes are poured forth around the glandular culs-de-sac.
The tissues being thus affected, the virulent organisms penetrate from the acini into the interstitial tissue, and from this time onwards the lesions become mixed.
Inversely, should infection originate in the lymphatic spaces, a time arrives when the organisms make their way from the interstitial tissue into the acini, with a similar result in the end.
The development of the lesions may be arrested or may pass on to suppuration, or even gangrene, of the parenchymatous lobules. Cases happen in which infection is so rapid and severe that the successive stages cannot even be identified, and gangrene appears without any preliminary stages at all. Luckily the commonest forms are less serious.
Symptoms. Acute mammitis is characterised by its sudden appearance, more or less acute general symptoms (dulness, fever, and loss of appetite), and variable local symptoms. When the practitioner is able to follow the development of the disease throughout, he may sometimes distinguish well-marked signs, which permit the two clinical varieties to be distinguished.
A. Interstitial Mammitis.—This form, which might perhaps also be termed peri-mammitis when it primarily affects the subcutaneous lymphatic spaces, has also received the names of phlegmonous and lymphogenous mammitis.
It is characterised by alarming general symptoms, and particularly by a rise in temperature of 2°, 4°, or even 5° Fahr., with all its consequences, such as loss of appetite, stoppage of rumination, acceleration of breathing and circulation, slight tympanites, constipation, and by the thrusting of the hind limb on the affected side away from the centre line. The animals groan when forced to move.
These symptoms sometimes precede by a considerable interval the appearance of the local changes, which consist in painful swelling of one or two quarters, rarely of more.
The perimammary subcutaneous tissue is infiltrated, œdematous, painful on palpation and preserves the imprint of the finger. The teat is tense, swollen, very tender, and of reddish colour. In the grave forms the swelling extends forwards under the abdomen in the direction of the umbilicus, and backwards towards the perineum. The local temperature is abnormally high, the secretion of milk in the diseased gland is modified or checked, and sometimes this phenomenon extends by reflex action to the neighbouring quarters, although the latter may not themselves be affected. The inflammation rarely extends from one quarter to another, because the lymphatic plexuses do not anastomose (Fig. 237).
The animals lose appetite and fall away rapidly.
Resolution may occur after from five to eight days. By degrees all the symptoms then become less marked. The appetite returns, pain diminishes, the fever drops, and the lesions gradually disappear, but the yield of milk rarely regains its former amount.
Suppuration may occur; sometimes a superficial subcutaneous abscess forms, more rarely, a deep-seated, interstitial abscess, originating in the connective tissue or lymphatic spaces. With a superficial abscess, the local symptoms again revive to a slight extent; these are present in a more marked degree where the abscess is deep-seated. An extremely sensitive œdematous swelling forms, the skin covering which is at some point of a deep-red tint, whilst fluctuation gradually appears.
In cases of deep-seated abscess formation the general condition becomes alarming; the affected quarter is tense throughout, hard and very sensitive.
Deep-seated suppuration is difficult to detect, and exploratory punctures with a fine needle may be necessary before the diagnosis can be made.
Local or diffuse gangrene forms a rare complication. It is due to the vessels of one or several glandular lobules becoming obliterated or thrombosed.
Such a termination is indicated by extreme aggravation of the general symptoms, feebleness of the heart and great weakness of the patients, who fall into a condition of coma. Locally the udder remains œdematous, the skin becomes of a blackish-violet colour, whilst the local temperature falls and the animals die from exhaustion and intoxication.
Parenchymatous Mammitis.—Parenchymatous mammitis when mild is also termed catarrhal mammitis. It is in reality true primary mammitis; interstitial being primarily and practically perimammary lymphangitis.
In this case infection occurs through the teat, and may be localised in the sinus or excretory apparatus, giving rise to galactophoritis, but it usually extends to the acini. Inflammation of the mammary tissue is therefore direct and primary. It rapidly extends, however, through the glandular wall into the interstitial tissue, thus setting up (from the anatomo-pathological standpoint) a mixed mammitis. Clinical distinction between this form and interstitial mammitis is at first easy.
The symptoms usually occur in the following order:—Swelling of the affected quarter or quarters; appreciable increase in size and sensitiveness; the presence at first of curdled milk in the galactophorous sinus, then of clots mixed with slightly red tinged serosity; complete cessation of the yield of milk, and suppuration in the secreting portions of the gland.
The general symptoms appear only after the objective signs, and vary greatly in intensity, according to the case. As in the interstitial form, there may be marked fever, loss of appetite, cessation of rumination, groaning, and difficulty in walking.
In some grave forms, where development is peracute, infection spreads rapidly from the glandular to the interstitial tissue, and subcutaneous, subabdominal, or perineal interstitial œdema occurs secondarily.
The udder is turgid, tense, shining, and of reddish-violet colour in places, as if a deep-seated abscess were developing.
Pressure on the galactophorous sinus causes the flow of reddish-grey milk, sometimes fœtid or of gangrenous odour. The animals seem exhausted, show signs of profound intoxication, are unable to rise, and appear paralysed.
But besides these grave forms are others, in which the patients seem scarcely to suffer: appetite is preserved and all the vital functions are in full activity. Only the local signs are of importance.
This variability in the clinical symptoms of acute forms of mammitis is entirely due to differences in the pathogenic infecting organisms.
Parenchymatous mammitis may end in resolution in three to four days, with progressive but slow return to the physiological condition. This termination is announced by the gradual disappearance of all the symptoms and the return of milk secretion. It is, however, quite exceptional for the former condition to be fully restored, and in many cases the affected quarter must be regarded as lost from the physiological standpoint.
It gradually becomes hardened, sclerotic and atrophied.
Suppuration is very common. It attacks the galactophorous sinus, the excretory canals, and even the acini. If obstructions occur in the course of the collecting vessels, or if evacuation is not artificially stimulated by milking, the pus collects in the depths of the gland, and enormous diffuse abscesses may form at the expense of the mammary tissue.
Circumscribed or diffuse gangrene, as a primary condition, is rarer. Infective organisms rapidly invade even the depths of the gland, the interstitial and subcutaneous tissue, and thrombosis due to infection or intoxication occurs, followed by gangrene. Death results from infection or intoxication.
Complications such as necrosis of the abdominal tunic, of the fibrous tissue enveloping the mamma, and of the muscular layers on the inner surface of the thighs, may occur in the suppurative forms.
Diagnosis. The diagnosis of acute mammitis is easy, and the interstitial forms (mammary lymphangitis) can be distinguished from the parenchymatous forms very early in the attack.
Careful examination suffices to differentiate between this condition and mammary congestion or primary chronic mammitis. The examination, however, must be much more thorough and searching when a specific disease (such as tuberculous mammitis) is in question.
Prognosis. The prognosis of acute mammitis is always grave, whatever form the disease may assume, for, if the animal’s life is not invariably endangered, its economic value is always affected. Moreover, should superficial or deep-seated abscesses form, prolonged suppuration may follow, resulting in loss of condition and enormous depreciation.
Lesions. The lesions of interstitial mammitis are similar to those of ordinary lymphangitis, the condition originating near the teat and gradually extending to the layers of connective tissue between the acini, mammæ, etc.
In the parenchymatous form the inflammation may remain partial, and be localised in particular tracts of glandular tissue. The secreting epithelium, when infected, exhibits cloudy swelling, becomes loosened, and disappears; the margin of the gland and the interstitial divisions become infiltrated with enormous numbers of white blood corpuscles, and are the seat of suppurative processes which end in the production of small acinous abscesses. By the union of neighbouring abscesses large branching collections of pus are produced, and lead to partial or total destruction of tracts of the parenchyma, of the connective tissue divisions, vessels and aponeuroses.
The abscess tends to break through the skin, which becomes inflamed and ulcerated, or, when the microorganisms are of slight virulence, the tissues may react, so that the abscess becomes surrounded with a thick indurated wall, and finally encysted.
Treatment. Very numerous methods of treatment have been proposed, an admission which, in itself, suggests that no perfect one has been discovered. No infallible system, in fact, exists of arresting the disease and restoring the parts to their normal condition.
From a prophylactic standpoint, mammitis can be avoided by placing the animals under proper hygienic conditions, paying special attention to cleanliness, avoiding overstocking, and treating excoriations or injuries to the teat or udder as soon as they appear.
Once acute mammitis has developed, general and local treatment must both be attempted.
The older practitioners were in the habit of bleeding from the mammary or jugular vein. Since their time, however, objections have been made to bleeding because acute mammitis has been proved to be of an infectious character, and, therefore, it is undesirable to lower the patients’ resisting power.
This reasoning, however, appears to be erroneous. Little by little the advantages of bleeding, both in intoxications and infections, have been recognised, and one thing at least is beyond dispute, namely, its action on fever. Undoubtedly, it must not be resorted to without judgment, nor should it be freely employed in debilitated animals; but in well-nourished patients its effect on fever and on the accompanying respiratory and circulatory disturbance is immediate.
We, therefore, recommend moderate bleeding from the jugular.
Bleeding from the mammary vein entails too great a risk of infection to be commendable.
Purgatives and diuretics diminish or prevent accidents such as intoxication and the complications resulting from temporary suspension of the digestive function.
Local treatment is more or less efficacious in mammary infection. To relieve pain and check infection it should be of an emollient and antiseptic character. Ointments containing 10 per cent. of carbolic acid, boric acid or iodine, or 12½ per cent. of camphor, opium or belladonna, are of real service during the first stages, particularly of mammary lymphangitis and interstitial mammitis.
Repeated applications of 10 per cent. carbolic glycerine have similar advantages.
In the less acute forms originating in the parenchymatous tissue, mild ointments of plumbic iodide, Goulard’s extract, or mercury may also be used if precautions are taken to prevent the animals from licking, and so poisoning themselves.
When the tendency to suppuration is marked, vesicants hasten the development of the abscess and facilitate puncture. The most commonly used are the 33 per cent. tartar emetic ointment or the 10 per cent. biniodide of mercury ointment.
If, on the other hand, the mammitis is of the interstitial type, with severe subcutaneous œdema, extending over the belly and towards the perineum, good results often follow deep firing in points over the swollen region. The points should be widely spaced, venous branches being avoided. In this way numerous ducts are formed by which the toxic and septic liquid which causes the œdema is enabled to escape.
This method of treatment can be supplemented by the simultaneous use of antiseptic ointments.
Finally, in mammitis of the parenchymatous type, where there is no marked tendency to invade the interstitial tissue, the most important point is to wash out the interior of the gland, and even the acini as far as possible, with antiseptic fluids. Practically this is difficult to effect, because such irrigation must be performed aseptically, and cannot properly be left to the cowmen.
In current practice, therefore, one often has to be content with stripping the udder every hour. Milk clots which accumulate in the sinuses and galactophorous canals are broken down by soft pressure, and withdrawn with more or less difficulty. By repeated milking they are prevented from accumulating in the galactophorous sinus and canals, a very important point. Neglect of this precaution enables the colonies of microorganisms to develop uninterruptedly in the culs-de-sac, whereupon the coagula formed of casein obstruct the excretory channels and complications develop despite all external treatment.
By repeated friction of the udder as in milking the advantages that would be produced by washing out the gland from the direction of the acini are secured, and thus the ascending infection is checked.
The diseased udder must always be emptied before making antiseptic injections, which would otherwise be useless.
Should the practitioner decide to face the practical difficulties of injections, he must take care that his instruments are aseptic; that the solutions employed are always at or about bodily temperature; that these solutions are incapable of irritating even tissues so tender as the epithelium of the acini or of the galactophorous canals; and, finally, that the drugs employed will not coagulate the milk within the gland.
Bearing in mind these points, the practitioner will do well to restrict himself to the use either of boiled water, physiological salt solution (·9 per cent.); alkaline 3 per cent. solution of borate of soda; or ·05 per cent. of fluoride of sodium. Every precaution having been taken, from 12 to 20 ounces of liquid can be injected into each quarter, according to its size. The solutions should be made to penetrate as far as possible into all portions of the gland by gently manipulating the parts, and should again be withdrawn in about a quarter of an hour.
It must always be remembered that failure to observe the above precautions may make matters worse instead of better, and therefore that intra-mammary injections can only be of value when carried out by a skilled person.
In otherwise hopeless cases there remains as a last resort total or partial ablation of the mamma. This operation is advisable in cases of diffuse gangrene, or of intense massive suppuration, where there is imminent danger of death from infection.
Directions for its performance will be found in Möller and Dollar’s “Regional Surgery” (uniform with the present volume), p. 454.
CONTAGIOUS MAMMITIS IN MILCH COWS.
Although its cause was unknown before the investigations of Nocard and Mollereau in 1884, this disease is of very common occurrence in England, in large dairies in the environs of Paris, and is also seen, though more rarely, in Normandy, in Brie and the Soissonnais, causing serious losses on account of its transmissibility.
It had been described in Germany by Gerlach as early as 1854, and Kitt in 1885 recognised it as common, and proposed for it the title of “contagious catarrhal agalaxia.” It also occurs in Denmark, Italy, and England.
Contagious streptococcic mammitis of cows always assumes a chronic form, during the course of which indurated centres appear, varying in size between that of a hazel-nut and a walnut.
Causation. The cause is always to be found in contagion, the disease being due to a streptococcus, which has been carefully studied by Nocard. Its transmission from a diseased to a healthy udder is explained by the fact that the milkers are careless as to cleanliness, and thus directly convey the germs to healthy teats and facilitate infection.
Symptoms. As in chronic mammitis, general symptoms are not well marked, though some cases are ushered in with cough, slight nasal discharge, and offensive diarrhœa. The first appreciable indication is a change in the milk, which diminishes in quantity, and, although normal to all appearance, coagulates rapidly if left undisturbed. Infection has already taken place, although nothing can be detected on examining the udder.
Next appears a nodule of hardened tissue above the teat. This nodule is of rounded or ovoid shape, ill-defined towards its periphery, and it becomes progressively enlarged without any sign of acute inflammation. The milk becomes watery and of a bluish colour. Microscopical examination reveals numerous streptococci. The hardening process proceeds slowly. At the end of several months the sclerosis may only have extended to one-third of the height of the infected quarter. With the appearance of these lesions the character of the milk again changes. It becomes yellowish in colour and fœtid, and contains a fibrous reticulum, whilst its reaction is distinctly acid. The lesions, which at first had been confined to one quarter, successively extend to the others unless precautions are taken.
Lesions. The lesions consist in mammary sclerosis, with nodules which progressively increase in size. This sclerosis originates in the galactophorous canals, and extends first to the periphery, then to the interstitial connective tissue; the latter undergoes hyperplasia and confines within its tracts the true glandular elements, destroying their secretory power. Locally, catarrhal mammitis exists.
The lesions can easily be recognised on microscopic examination, and, when the section is suitably stained, numerous streptococci can be detected in the acini, which are blocked with proliferating epithelial cells. These lesions are due to the invasion of colonies of microorganisms, which spread from below upwards.
The streptococcus causing this mammitis colours readily with thionin and methylene blue. It can be cultivated in liquid and solid media containing sugar or glycerine, but growth is impeded by the presence of peptone or common salt. Under ordinary circumstances the culture dies after some weeks, but if the acidity of the medium is neutralised by the addition of powdered carbonate of lime, it preserves its vitality for six or eight months. The culture when injected into the udder of a healthy cow or she-goat reproduces the disease. The microorganism is not pathogenic for any of the smaller animals used for purposes of experiment.
Diagnosis and prognosis. The diagnosis is easy, the presence of the sclerotic nodules being characteristic, whilst in doubtful cases a microscopical examination can always be made.
The treatment should be prophylactic and curative.
Prophylactic treatment comprises disinfection of the milkers’ hands, which are the ordinary vehicles of contagion, and disinfection of the cow’s udder. Diseased animals in a byre should be milked last of all, and the milk should be destroyed.
Curative treatment is confined to local antiseptic injections. Warm concentrated boric solution gives good results. The injections may be repeated three or four times a day after milking, the liquid being left for a certain time within the udder. In this way animals suffering only from a slight attack may be cured, but when the disease is already somewhat advanced injections lose their effect.
Injections of fluoride of sodium (·1 to ·5 per cent. strength) appear to be much more effectual. Moussu claims to have cured by this means several old-standing cases where all four quarters of the gland were diseased.
These injections necessitate the same precautions as those above indicated for securing perfect asepsis. In grave cases it is very difficult to prevent the disease from extending in infected stables, because the necessary precautions cannot be observed.
CHRONIC MAMMITIS.
Chronic inflammation of the udder may form a termination of ordinary acute mammitis, or it may result from infection with organisms of a less virulent type.
In cases of acute mammitis, where severe injury of the interstitial tissue or mammary parenchyma has occurred, its physiological function is partially destroyed. The circulation is disturbed, the vessels undergo change, the layers of connective tissue are indurated and sclerotic, the epithelial tissue is not fully restored, and chronic inflammation of the udder persists.
Clinically, it is impossible to distinguish all the variations that may occur, because the constituent tissues are all injured, and the disease is of a mixed type, with very numerous variations.
Symptoms. When chronic mammitis follows the acute form its onset is only indicated by gradual diminution in the signs of acute inflammation. The appetite is regained, and all the important vital functions are properly performed.
Nevertheless, it is possible to distinguish two different clinical forms. In one, the secretion of milk is almost entirely suspended, the udder becomes atrophied, shrivelled and sclerotic; the hardening gradually continues, and the patients, being useless as milch cows, can only be fattened for slaughter. The induration may be partial, nodular, or diffused.
In the other form the udder is large, but the milk is replaced by a purulent secretion which permeates the acini and galactophorous canals. Although they eat well, the patients remain thin, and are with difficulty fattened for slaughter.
The suppuration may be diffuse or local. In rarer cases it is localised in the form of “cold abscess.”
Treatment. No treatment can perfectly restore the udder after chronic mammitis with sclerosis and atrophy.
In the suppurating forms of chronic mammitis the morbid secretion may be checked by internal irrigation of the udder and antiseptic injections, but, as this treatment necessitates careful and continued attention, it is usually out of the question.
If only one quarter is diseased the animal may be kept for milking purposes, but where two or three quarters are attacked it should be prepared for the butcher.
In cows suffering from chronic purulent mammitis of all four quarters, Kroon suggests removing the teats in order to facilitate fattening. The teats are removed with the bistouri or scissors, by which means a large opening into the galactophorous sinus is produced, through which the purulent secretion escapes freely and continuously; the retention of pus and intoxication in consequence of resorption are prevented and the animal can be fattened, which would be difficult without the operation.
GANGRENOUS MAMMITIS OF MILCH EWES.
This disease occurs in different parts of France, and has also been seen in Germany.
Causation. Lafosse in 1856 attributed it to the dark and dirty condition of the sheep-folds, a cause which certainly contributes to its propagation, though it is not the determining cause of the disease itself. The latter is a specific micrococcus discovered in 1875 by Rivolta, and thoroughly studied by Nocard in 1886 and 1887.
Symptoms. The course of the symptoms offers a certain analogy to that of septic engorgements and interstitial mammitis or mammary lymphangitis. As a rule only one gland is infected, but generally symptoms at once appear, indicating an extremely dangerous condition, viz., peracute mammitis. The patient suddenly becomes dull and entirely loses appetite, rumination ceases and respiration is short and jerky, although the bodily temperature does not always rise to any marked extent.
Local symptoms soon develop. The udder assumes a violet-red tint and becomes the seat of an erysipelatous swelling; the local temperature rises, but as the disease progresses it gradually falls again. Milk secretion ceases.
All these appearances rapidly become aggravated. The patient lies down; the œdematous swelling extends to the belly and even to the chest and thighs; the local temperature falls, indicating the imminence of gangrene; the teat becomes contracted, and the pulse is very frequent and almost imperceptible. From time to time the animal grinds its teeth.
The bodily temperature next falls to 98° or even 96° Fahr. (37° or 36° C.), and the animal shows extreme prostration. The subcutaneous swelling extends as far as the sternum in one direction and the quarters and perineum in the other. The udder crackles under the finger. Death occurs without a struggle.
All these symptoms follow as a rule in barely more than twenty-four hours. Nevertheless, in certain cases, the disease lasts for three, four or five days. Cases of spontaneous recovery are exceptional. The gangrenous part may become delimited and slough away, leaving an enormous suppurating wound, which slowly cicatrises. Even though the animals survive, they never recover condition, but remain weakly, so that, from a monetary standpoint, death would have been preferable. Moreover, the lambs are starved and require a foster-mother.
Lesions. Post-mortem examination reveals œdematous infiltration of the udder and surrounding connective tissue, and often extensive, diffuse gangrene. The serosity is of a reddish colour, and sections of the diseased udder of a violet tint. The tissues of the udder and the serous liquid contain the specific micrococcus.
It is very small, and stains readily by the Gram-Nicolle method. It grows rapidly in liquid and solid media, liquefies gelatine, and quickly renders neutral media alkaline.
The injection of a few drops of culture into the udder of a milch ewe reproduces the typical disease. In any other species it is without effect. Infection occurs through the open extremity of the teat, or the medium of a wound, and the microorganism is so virulent that it rapidly invades all the tissues.
Treatment. No antiseptic treatment appears capable of checking the course of the disease.
Surgical treatment alone is of any value, and consists in ablation of the udder, followed by antiseptic dressing. Only a portion of the gland is removed: an elliptical incision is made, including the diseased teat, the skin is then dissected free so as to form a flap; the diseased tissue is isolated; last of all, the vessels are ligatured. The consequences of operation are less grave than might be expected, considering the size of the wound, which heals with fair rapidity.
Moussu has frequently practised this radical method of treatment without losing a single case. The remaining portion of the udder becomes hypertrophied, and is often quite capable of secreting sufficient milk for the nourishment of one lamb.
GANGRENOUS MAMMITIS IN GOATS.
Goats suffer from a form of mammitis which presents symptoms precisely similar as regards development and termination to that of ewes. The disease occurs in a sporadic form in animals giving milk, whatever their breed or the conditions under which they are kept. It has been seen at Alfort, as well as at Lyons.
Moussu has seen it in an enzootic form in herds of milch goats near Bizerta (Tunis), and considers that contagion results from kids sucking healthy animals after having been suckled by diseased ones. Fifty milch goats out of a total of three hundred were affected at the time of Moussu’s visit, and two had already succumbed.
The diagnosis presents no difficulty.
The prognosis is very grave.
The treatment is precisely similar to that of gangrenous mammitis of milch ewes, viz., ablation of the diseased udder.
Of the above-mentioned herd, twenty animals were operated on, and all recovered without accident. Among the others treated by less radical methods, such as scarifications, incisions, antiseptic injections, etc., eight died. The only justifiable treatment, therefore, is ablation.
CYSTS OF THE UDDER.
Cysts of the udder may assume one of two forms, milk or galactocelous cysts and serous cysts; possibly the latter are only hydatid cysts.
Both varieties are of the nature of retention cysts, and result from accidental obliteration of a milk conduit, which has been obstructed by coagulated casein, or from atresia due to contraction of inflamed connective tissue. The acini are isolated and become dilated, the milk undergoes changes in composition, the secretory epithelium degenerates, and the cyst is produced.
The serous or milk cysts may vary considerably in size, and always show a rapid tendency to suppuration.
The diagnosis is based on the detection of uniform fluctuation without excessive sensibility, and can be confirmed by an exploratory capillary puncture.
The prognosis is grave, for recovery can only occur after the lining membrane of the cyst has been destroyed.
Treatment. Puncture followed by irrigation is insufficient, whatever the nature of the cyst.
Free incision, or simple puncture with a bistoury, produces suppuration within the cystic cavity, which continues until the lining membrane is completely destroyed; but this takes a very long time.
Removal of the entire cyst, either with the bistoury or by tearing through the surrounding connective tissue, is the best method of treatment. The wound thus produced heals regularly and rapidly under an antiseptic surgical dressing.
TUMOURS OF THE UDDER.
Tumours of the udder have been little studied in the larger domestic animals, the reason being that immediately animals cease to yield milk they are fattened and despatched to the butcher. Clinically, therefore, these tumours are not of great practical importance.
Without entering into general considerations of a pathological anatomical character, by which different varieties of these tumours are differentiated, we may say that they assume one of three different forms. The first is sharply circumscribed, of clearly defined shape, and easily separated from neighbouring tissues, to which it adheres but slightly. Such tumours are benign, and have no tendency to return after removal.
The second is ill-defined, very adherent, and appears to infiltrate the surrounding tissue. It is malignant in character, is often impossible to completely remove, returns after extirpation, and infects neighbouring lymphatic glands.
Between these two varieties may be placed a third, occupying an intermediate position as regards both its characteristics and gravity.
Practically a knowledge of the above facts is a sufficient guide in dealing with lesions of this character.
Canalicular Papillomata.—There exists another variety of tumours which is of much more frequent occurrence, and which is apt to cause mistakes. This variety consists of inter-canalicular papillomata.
These show no sign of their existence on external examination of the diseased udder, and can be diagnosed only by reasoning based on the signs observed.
They are of very small size, and grow from the internal wall of the galactophorous sinus or excretory canal. They increase in length, finally extending for some distance along the sinus, where they remain unrecognised until some external manifestation arouses suspicion as to their existence.
Under the mechanical contraction due to milking they easily become excoriated, and their existence is then suggested almost solely by the fact that the milk is tinted with blood, for palpation of the udder very seldom gives more than negative results.
The diagnosis is always doubtful. The prognosis is grave, because it is impossible to remove the tumour, which is often deeply placed within the udder. There is no curative treatment.
VERRUCOUS PAPILLOMATA OF THE UDDER.
In cows suffering from cutaneous papillomata the udder is often covered with a varying number of little sessile warts, which are spread over a considerable surface, are very sensitive, and bleed at the lightest touch. Milking is thus rendered extremely painful and difficult; the animals struggle, kick, and become dangerous.
The condition is extremely troublesome, and in spite of every precaution the milk is always soiled.
The best method of treatment consists in removing the warts individually with fine, sharp-bladed curved scissors.
The animals must be firmly secured, if necessary cast, and the operator should avoid removing more of the skin covering the udder than is absolutely necessary. The bleeding which follows is trifling, and stops of itself. After washing the parts with an antiseptic solution, the little wounds may be powered with a mixture in equal proportions of tannin and boric acid.
CHAPTER VI.
DISTURBANCE IN THE MILK SECRETION AND CHANGES IN THE MILK.
Changes in the milk are so common and play so important a part in the milk industry that it is absolutely necessary to mention the more important, the country veterinary surgeon being frequently consulted on this point.
The udder acts as a natural emunctory, just like the kidney, by which are eliminated, in consequence of special selective properties, certain natural principles (the active principles contained in the forage and other food, vegetable alkaloids, etc.), drugs (alcohol), and poisons (nicotine). This physiological peculiarity explains the influence of changes of diet on the composition of the milk in mothers and on the condition of their offspring. In the human species it also explains congenital alcoholism in children, and a number of diseases whose cause was formerly unknown.
Agalaxia.—This term implies a temporary or definite arrest of the milk secretion. In many instances it represents nothing more than a disturbance in the physiological function of the gland, but in others it forms a true diseased condition.
Thus it is beyond dispute that psychical influences may produce disturbance in this respect. Temporary suspension in the secretion as a consequence of removal of the offspring from its mother, especially when the young animal has been sucking for several days or weeks, is a fact very well known to all breeders.
Under ordinary circumstances, however, the reasons are quite different, and when the secretion of milk is diminished or suppressed it is due to the ingestion of plants, substances, or drugs which check the secretion of milk. All the solanaceæ (belladonna, hyoscyamus, stramonium, woody nightshade, etc.), certain umbelliferæ (hemlock), colchicum, etc., have this effect.
As to agalaxia of a true pathological character, it occurs in debilitating and grave diseases, and sometimes follows certain contagious forms of mammitis complicated with sclerosis of the udder (infectious agalaxia of goats).
Diagnosis. The diagnosis of agalaxia presents no difficulty.
Prognosis. The prognosis varies, according to the determining cause. In cases of accident and in temporary agalaxia, it is sufficient to change the food in order to restore the secretion. Cooked food and warm drinks, with an allowance of roots such as turnips or mangolds, have excellent results. Where restoration of the secretion is delayed the use of what are called galactogogues has been recommended, comprising fennel, carraway, cummin, aniseed, juniper, sulphur, etc., mixed in equal parts and given in doses of 6 to 8 drachms per day for a cow.
They act principally through the stimulating effects of their aromatic principles.
MICROBIC CHANGES IN MILK.
LACTIC FERMENTS.
Microbic changes in milk are much commoner than changes of a chemical nature. Milch animals differ very markedly one from another, and, according to circumstances, give milk of ordinary composition, milk of a very rich character, or watery milk; but the most important changes in composition are those due to microbic agents.
During the milking, and according to whether this is performed in a low, dirty byre, in a clean, roomy byre, or in the open air, various numbers of germs obtain entrance to the milking vessels, and develop there with extraordinary rapidity. The milk may even become infected by non-pathogenic germs while still within the udder, in the sinus and galactophorous canals. The cleanliness of the milking vessels also has a considerable influence on the number and variety of the microbes which may eventually germinate in the liquid.
Among the microorganisms usually found in milk there are some, however, which always preponderate and play the part of organised ferments, viz., the lactic ferments and the organisms which cause coagulation of the casein; these may be regarded as normal constituents. The others are more or less foreign, and may cause important changes in the milk or cream.
The lactic ferments are numerous, comprising the lactic bacilli of Hueppe and Grotenfeld, the micrococci of Hueppe and Marpmann, and the bacilli and micrococci of Freudenreich. These different agents act on the lactose of the milk, decomposing it into carbonic and lactic acids, which coagulate the milk.
Another group of microorganisms which were well studied by Duclaux comprises those acting on the casein, among others Tyrothrix tenuis, filiformis, turgidus, scaber, virgula, etc.
These organisms secrete principles having similar effects to those of rennet, and are capable of coagulating enormous quantities of milk. After a certain time, they also secrete a second diastase, viz., casease, which acts in the ripening of cheese.
Clotted Milk.—This term is used in dairies to indicate milk which coagulates in lumps immediately after being withdrawn from the udder, or which coagulates spontaneously a few hours later.
The change may be of a chemical nature, depending on conditions of keep or feeding. More frequently, however, it is related to a latent non-pathogenic infection of the udder, or to immediate infection of the milk after removal by lactic ferments contained in the milk vessels or the atmosphere.
It is necessary, according to circumstances, either to modify the diet or disinfect the milk vessels, and immediately pasteurise the milk.
Milk without Butter.—Less commonly the diseased condition is indicated by marked diminution in the quantity of cream.
Churning only produces a poor kind of butter, particles of which do not readily cohere. This peculiarity is due to the presence of microorganisms, which have not yet been fully identified. It can be prevented by disinfection of the milking vessels, as well as of the dairy itself, and by the use of centrifugal separators.
Putrid Milk.—This milk is characterised by its odour. It cannot be used for making butter. In fact, as soon as the cream separates, little bubbles of gas form at various points and break, leaving small cavities. These little separate cavities reunite very rapidly, and the cream becomes reabsorbed as fast as it is formed. Afterwards oily drops formed of butyric, capric, and caprylic acids appear in the depressions and give the milk a repulsive odour (rancidity).
This change is seen during mammitis, but most commonly results from uncleanliness in byres and dairies. In the latter case putrefaction occurs about twenty-four hours after milking, and is due to the growth in the milk of Bacterium termo, lineola, etc. These organisms are present in the dust which falls into the milking pails in the byre; when milk so contaminated is stored in the dairy the changes occur.
Putrid odour may also be due to the presence of ammoniacal gas in the byre, or to special toxins liberated by microbes which have found their way into the milk. It is most marked during the warm seasons of the year.
The occurrence of putrid milk can be prevented by disinfecting the dairy and the milking pails daily for a certain time.
Mucous, viscous, or thready Milk.—These terms are applied to a condition which usually appears twenty-four or thirty-six hours after the milk has been withdrawn. The milk seems thick and viscous, and can be drawn out into threads like mucus. It sticks to neighbouring objects, and adheres to milk vessels like molasses. It coagulates imperfectly on standing, gives little cream, and even this cream only furnishes a mawkish, ill-flavoured butter.
In certain parts of Switzerland the production of mucous milk is favoured, because it is employed in making cheeses.
The change is due to the presence of various microorganisms. Those which have been best studied are Schmidt-Mülheim’s micrococci, the Actinobacter polymorphus of Duclaux, the Bacillus lactis pituitosi of Löffler, the Bacillus lactis of Adametz, the Streptococcus hollandicus, and, finally, three others which are much commoner, Guillebeau’s bacillus, the Micrococcus Freudenreichii, and the Bacterium Hessii. These microorganisms act on the lactose, decomposing it and causing the formation of a kind of filamentous mucilage, which can be isolated by the addition of alcohol.
The mucilaginous change in milk can be prevented by ordinary methods of disinfection.
Red Milk.—Milk which becomes red some hours after withdrawal, or within forty-eight hours after milking, should be distinguished from milk which on withdrawal from the udder is tinted red in consequence of hæmorrhage within the udder itself. When the milk is of a hæmorrhagic tint the blood corpuscles are soon deposited on the bottom of the vessel if the milk is allowed to remain undisturbed.
The tint which the milk assumes is due to the growth of chromogenic organisms, the best known of which are as follows:—1. B. prodigiosus, which produces large red patches on the surface. It grows readily on potato and gelatine, which it liquefies. 2. The Sarcina rosea, which develops first of all in the cream and afterwards invades the milk. It grows in sterilised milk, on alkaline potato, and on gelatine. 3. The Bacterium lactis erythrogenes, which liquefies gelatine and produces a reddish coloration. Casein can be precipitated and peptonised by means of its cultures. It develops in the milk below the cream, the serum alone becoming red, and only when shaded from the light.
Blue Milk.—In this case the milk appears normal when withdrawn, but some days afterwards shows blue patches, which gradually increase in size, and by uniting produce a distinct blue tint at the surface.
This change is connected with the presence of the B. cyanogenus. The organism grows in sterilised milk, but in this case merely produces greyish patches, the blue tint only occurring when a certain quantity of lactic acid is added or when the ordinary lactic ferments are present.
Yellow Milk.—A yellow tint occurs in ordinary milk and cream, particularly in certain breeding districts—in Normandy, for example, where the butter produced is greatly valued on account of this appearance. Pathological yellow milk is the result of the growth of B. synxanthus Schröter, which secretes a substance resembling rennet, curdles the milk, and finally dissolves the clot, at the same time producing the yellow colour.
Bitter Milk.—Milk which is of a normal character on being withdrawn from the udder may acquire a bitter taste some hours later. At rest, this milk produces a small quantity of yellowish, frothy cream. The organisms which produce the change have been studied in Germany, Switzerland, and Auvergne. We may mention Weizmann’s bacillus of bitter milk, Conn’s micrococcus of bitter milk, and Duclaux’s Tyrothrix geniculatus.
Medicated Milk.—Medicated milk may be divided into two kinds: Firstly, medicated milk proper, which differs from normal milk inasmuch as it contains a certain proportion of drugs, which, when swallowed by milch cows are partly eliminated through the udder. When taken by a young animal or child such milk has a distinct therapeutic effect, depending on the principles employed.
It does not appear, however, that up to the present any very great success has followed this system. It is possible to increase the richness of the milk in phosphates, but as regards mercurial or iodine preparations the failure has been complete.
Secondly, fermented milks, which in addition to their nutritive action are made more digestible.
Fermented milk is easily digested, and is better borne by the weakest stomachs.
In human practice the fermented forms of milk are two, viz., kephyr and koumiss.
Kephyr is prepared in Afghanistan and Persia from camel’s milk, but for some years past it has been made in England with cow’s milk. A certain quantity of cow’s milk is placed in a bottle and the ferment, consisting of kephyr grains, is added. The lactose is converted into carbonic acid and alcohol in consequence of the action of certain lactic microbes.
This milk after ingestion does not require to be coagulated and then digested before absorption, a fact which considerably diminishes peptic digestion.
Koumiss is a milk preparation resembling kephyr; it is made by the Kirghizes with mare’s milk according to the same principles, but the ferment employed gives more alcohol.
Preservation of Milk.—On account of the importance of preserving milk for use in large towns, in hospitals, and in the army during war, the question of its preservation has long been studied.
Chemical Processes.—The principle of preserving milk by chemical action consists in preventing, or at least retarding, the changes which inevitably follow exposure to the air. For this purpose, chemical substitutes are added which in themselves have no injurious action. Those most commonly employed are:—
| Carbonate of soda | 45 grs. | per quart. |
| Bicarbonate of soda | 45 grs. | „ |
| Boric acid | 15 to 30 grs. | „ |
| Salicylic acid | 12 grs. | „ |
| Borax | 60 grs. | „ |
| Lime | 20 grs. | „ |
The results obtained are of comparatively little value; the milk only keeps for a few hours, or at the most for three or four days.
Cold.—Refrigeration, which is so valuable in preserving all kinds of animal products for long periods, has also been used for preserving milk. Unfortunately, although cold impedes the development of bacteria, it also has the grave inconvenience of causing the cream to separate from the milk, and it being impossible to mix them again satisfactorily, milk preserved in this way is more or less unfit for consumption.
Heat.—The principle of preserving milk by heat is based on the destruction of the microorganisms at a high temperature. In this respect again, one meets with obstacles, for, if the heat be applied direct, some of the principles of the milk are converted into caramel, and if the temperature rises beyond 157° Fahr. (70° C.) the composition of the milk is changed.
Preservation by Oxygen.—Within the last few years the use of oxygen at a pressure of about two atmospheres has been recommended. When the milk is to be used it is only necessary slightly to relieve the pressure and allow the oxygen to escape, the liquor which remains having all the characters and qualities of fresh milk. The method appears excellent, but is too costly for every-day use.
Pasteurisation.—The pasteurisation of milk aims at destroying the greater proportion of the ferments above mentioned. The milk is heated at atmospheric pressure, and is kept for a time at a temperature of between 150° and 157° Fahr. (65° and 70° C.). It preserves its properties and composition, but sterilisation is not complete, and the milk cannot be kept indefinitely.
Concentrated Milk.—Concentrated milk is obtained by prolonged heating to 157° Fahr. (70° C.) in a vacuum, when it becomes syrupy by evaporation and its composition is not greatly modified. It is then drawn off into bottles, which are hermetically sealed and subjected to a higher temperature to complete the destruction of all the germs. Condensed milk keeps for a very long time. To prepare it for use it is mixed with a certain quantity of water, and then yields a liquid similar to normal milk.
Sterilisation.—Sterilisation necessitates the use of special apparatus in which the milk is heated in a water or steam bath sheltered from the action of the air, the temperature rising to 212° to 240° Fahr. (100° to 115° C.); all the ferments are destroyed, and the milk will keep indefinitely, but its composition is slightly modified.
Diseases Transmissible to Man through the Medium of Milk.—Tuberculosis.—The history of tuberculosis contains numerous facts proving the possibility of contagion by milk from cows suffering from tuberculous mammitis, though it seems necessary that the milk should be taken for a certain time to produce these effects.
Foot-and-Mouth Disease.—Observations recorded by veterinary surgeons prove that this disease affects the teats. It may be transmitted to man. The milker may be directly inoculated, but the milk is the ordinary vehicle of contagion. Chauveau saw an epidemic in a school at Lyons where milk was obtained from cows suffering from foot-and-mouth disease. In a similar way 205 persons were inoculated at Dover in 1884, and suffered from vesicles about the mouth.
Although foot-and-mouth disease is extremely benign in men, it is well to take every precaution against it.
Gastro-Intestinal Infections.—Cases have been recorded of gastro-intestinal infection in young animals and children in consequence of consuming milk which had undergone abnormal changes. Milk containing various kinds of microorganisms may at first produce lactic indigestion and afterwards diarrhœic enteritis.
CHAPTER VII.
MALE GENITAL ORGANS.
The scrotum, the vaginal sheath, the testicles, the vas deferens, the vesiculæ seminales, the prostate, and Cowper’s glands may all become the seat of disease.
The scrotum and testicles seldom reveal more than mechanical injuries of external origin, producing wounds and cuts and, in the case of severe contusions, hæmatoma of the scrotum, of the vaginal sheath, and of the testicles. Inflammation of the testicle, that is to say, traumatic orchitis, is rare; on the other hand, Moussu has several times seen tuberculous orchitis, for which he has operated. This, however, was in the boar. These different lesions, the last named excepted, usually heal with rest and the application of antiseptic dressings, anodyne and resolvent lotions.
Breeders seldom retain more entire animals than are strictly necessary for reproduction. The others are castrated, and this alone explains why the treatment of genital diseases in male animals of any species is rare.
TUMOURS OF THE TESTICLE.
Of the genital diseases which possess real clinical interest the most important are tumours of the testicle. These occur not only in male animals, but also in those which have undergone the operation of bistournage.
It might à priori be believed that in an animal of the latter class the testicle had been completely destroyed, not only from the physical, but from the pathological point of view. This, however, is by no means the case, and Cruzel has described, under the erroneous designation of sarcocele, tumours of the testicle which develop in oxen of various ages.
Moussu has had a similar experience with animals of from four to six years of age which had been carefully operated on.
These tumours, the origin of which is unknown, develop at the expense of the rudiments of the atrophied testicle. They vary in character, and Moussu has only observed tumours of a type different from that of the testicle itself, containing tracts of carcinomatous, sarcomatous, and fibrous tissue. They also appear to vary greatly in gravity, for, although the cases seen by Moussu had become generalised in a few months, Cruzel states that these tumours may remain stationary for several years.
Fig. 239.—Upper surface of the neck of the bladder and origin of the urethra in the ox. 1, Bladder; 2, vesiculæ seminales; 3, vas deferens; 4, principal portion of the prostate gland extending beneath the sphincter; 5, sphincter; 6, aponeurosis of the sphincter, clothing the upper portion of the urethra and the flattened portion of the prostate. (After Barrier.)
The symptoms consist in progressive enlargement of the scrotal region and the appearance of a tumour surrounded by œdematous or lardaceous tissue.
The tumour, which is confined to one side, increases in size, is bosselated and adherent at points to the surface of the skin, while it is insensitive or only slightly painful to the touch.
In a few months it may increase to the size of a child’s head. The animals have difficulty in moving or lying down, the hind limb on the affected side is abducted, and the animal usually lies on its chest and abdomen. The patient rapidly loses flesh, although the appetite remains good.
When the growth is removed, it is easy to prove that the tumour has developed in the atrophied mass of testicular tissue, and that it remains suspended from the end of the cord.
The diagnosis of tumour of the testicle is extremely easy, for the condition cannot be mistaken for a hæmatoma or for a scrotal abscess.
The prognosis necessarily depends on the nature of the tumour, but as it is impossible to determine this point before extirpation, the prognosis should always be regarded as very grave.
Treatment. Whatever the nature of the tumour, ablation is advisable. If it is of a benign character, recovery may be complete and permanent, but if it is malignant, generalisation will rapidly ensue. Before interfering surgically, however, it is essential to examine the inguinal, pelvic, and sublumbar lymphatic glands, to make sure that they are not affected. If they prove to be already invaded, an operation should be avoided.
Fig. 240.—Roof of the neck of the bladder and first part of the urethra (internal surface). 1, Orifice of the ureter; 2, urethra at a point beyond the urethral valve; 3, submucous erectile tissue; 4, urethral sphincter; 5, vesiculæ seminales; 6, veru montanum; 7, orifices of the vesiculæ seminales; 8, orifice of the vas deferens; 9, orifices of the prostate; 10, urethral valve, showing on its free margin the point-like openings of the ducts of Cowper’s gland. (After Barrier.)
Even despite such precautions and the apparent absence of any glandular infection, operation may be followed by generalisation in a few months, although for a short time the condition may seem to have greatly improved. No special indications need be given beyond those suggested as necessary in dealing with all kinds of tumours, whatever their nature.
The skin should be freely divided, that the tumour may be thoroughly dissected out and no fragments be overlooked. The mass of the tumour having been dissected free, the écraseur is applied to the pedicle or the cord. Enucleation of the tumour may be very difficult on account of the presence of numerous ramifications or attachments, but the closest attention must be given to removing every fragment if a fresh local growth is to be avoided. In the event of fragments being left, a fresh growth is certain to occur.
Generalisation, which may extend to all the viscera (lymphatic glands, liver, spleen, lungs, pleura, peritoneum, heart, etc.), is indicated by rapid wasting, fever, acceleration of breathing, digestive disturbance, and sometimes coughing, etc.
Local new growths assume the form of ulcerating swellings. In practice, if the general condition can be improved for a short time, it is advisable to slaughter the animal.
ACCESSORY GLANDS OF THE GENITAL APPARATUS.
(PROSTATE, VESICULAR SEMINALES, COWPER’S GLANDS.)
Inflammatory or other diseases of the above glands are most frequent in entire animals. As a group they are uncommon, and are still ill-recognised and ill-described, being seldom identified except on post-mortem examination.
Fig. 241.—View of Cowper’s gland and of its compressing muscles. (After Cocu.) 1, Cowper’s gland; 2, compressing muscle; 3, accelerator urinæ muscle turned back to expose the gland; 4, sphincter of the urethra.
The cause of inflammation of the prostate, of the vesiculæ seminales, and of Cowper’s glands is probably an ascending infection of the urethra and neighbouring channels, a fact which explains the comparative rarity of such conditions in castrated animals.
The pathogenic germs penetrate from the urethra into the excretory ducts of the glands, obtain a lodgment in the culs-de-sac of the glands themselves, and thus produce simple or suppurative inflammation.
The symptoms may easily be mistaken, to some extent at least, for those of acute cystitis or cystitis due to the presence of a calculus, and it is only by rectal examination that the diagnosis can be made.
The first symptom is defective micturition, which occurs in jets, is intermittent and painful, and sometimes causes slight groaning. It is accompanied by vesical colic, spasmodic lifting of the hind legs, and more or less unsuccessful expulsive efforts.
These symptoms are of reflex or mechanical origin, and are due either to direct compression of the urethra by an hypertrophied and inflamed gland, or to spasm of the vesical sphincter. The urine passed, unlike that in cases of acute cystitis or in cystitis due to calculus, is of a normal character. Rectal examination usually reveals distention of the bladder, and hypertrophy and exceptional sensitiveness at certain points.
If the painful and hypertrophied area is over the neck of the bladder, this indicates that the lobes of the prostate are affected. If, however, the affected parts are situated on the sides of the neck and along the posterior pointed end of the bladder (Fig. 239), the vesiculæ seminales are affected; finally, if the painful points are directly above the ischial arch and below the sphincter ani, Cowper’s glands are the seat of disease (Fig. 240).
To diagnose these conditions requires very close and careful examination. They may easily be mistaken for acute cystitis, though the character of the urine should suggest doubts and lead to rectal examination.
Although they do not endanger the animal’s life, these conditions give rise to such serious inconvenience as often to render entire animals useless for stud purposes.
Local treatment is impossible, and the practitioner is restricted to the use of anodynes, balsamic preparations and diuretics. The treatment, in fact, differs little from that of cystitis. In cases of suppuration of Cowper’s glands, the abscess usually forms just below the anus and close to the median line. Thus the diagnosis may be confirmed by capillary puncture, the part being laid open if necessary.
SECTION VIII.
DISEASES OF THE SKIN AND SUBCUTANEOUS CONNECTIVE TISSUE.
CHAPTER I.
ECZEMA.
Under the name of eczema may be grouped a series of cutaneous diseases characterised by pruritus, by a discharge from the skin, or simply by epidermic proliferation, without any apparent parasitic or accidental cause.
These diseases have been referred to a special constitutional condition termed a diathesis, although during the last few years we have come to recognise certain microbic and toxic influences in their production. In the ox eczema assumes different appearances. Accordingly, the disease has been divided into the acute, chronic, sebaceous, and toxic forms.
ACUTE ECZEMA.
Causation. In the ox, as in all other species, the determining cause is to be found in bad hygienic conditions, improper feeding, and in a special individual condition of the animal affected, that is to say, a diathesis.
Symptoms. During a preliminary period, which might be termed a prodromic period, only general symptoms can be detected, such as fever, loss of appetite, digestive disturbance, constipation, etc. Local signs are still absent, or at least are not noticeable, and are only represented by congestion of the skin.
The second phase is characterised by a papulous eruption which is difficult to detect, inasmuch as it occurs in the depths of the coat. Nevertheless, the skin is distinctly sensitive, and at numerous small points the hairs appear to stand upright.
The third phase consists in the development of more or less confluent vesicles, with exudation and discharge. The disease is not really visible externally until after the hair has become agglutinated by the discharge. This discharge is seldom as abundant as in eczema in the dog or horse. It is produced slowly and dries rapidly.
As the crusts fall, carrying with them a portion of the hair, the general symptoms disappear, but the sites of these vesicular patches now show cracks extending as deep as the dermis and often complicated by secondary infection involving suppuration, adenitis, abscess formation, or diffuse subcutaneous suppuration.
Acute eczema is generally confined to the limbs. It may develop fully in from twenty-four to forty-eight hours. The acute stage is attained in a few days, and the condition disappears in two to three weeks provided it does not assume the chronic form as the result of complications.
Diagnosis. The absence of parasites enables the condition to be distinguished from phthiriasis and acariasis, whilst the history prevents its being confounded with toxic eczema.
Prognosis. The condition is troublesome rather than grave. Suppuration is often persistent, and despite careful attention the discharge may only diminish slowly, while the disease is always liable to return.
The treatment is local and general. Local treatment consists in emollient and antiseptic washes and the application of drying powders. The former comprise glycerole of starch, bran water, boric ointments, camphorated vaseline, iodine and glycerine. At a later stage the skin can be washed with decoction of oak bark or a weak iodine solution, followed by the application of talc or starch powder. As far as possible this external treatment should be supplemented by the frequent use of mild purgatives and various diuretics, which seem to have a special action on the arthritic diathesis.
CHRONIC ECZEMA.
Comparatively few cases of chronic eczema have hitherto been described in oxen, and the details given are extremely meagre. Chronic eczema may assume that form from the first or may succeed acute eczema. The causes are probably the same in both conditions.
The symptoms appear to be those of the acute form, but are much less severe. They consist in papulation, a miliary vesicular eruption, pruritus, and the formation of crusts and epidermic scales.
In a case seen by Mégnin the crusts separated and fell away, leaving bare spots. The disease re-appeared for several years in succession. The spots finally remained bare, but showed no thickening of the skin and no microscopic changes.
Diagnosis. Microscopical examination is necessary to distinguish this disease from scabies or ringworm.
The prognosis is grave, because large areas of the skin may be invaded in succession.
Treatment. As in acute eczema, the condition is improved by the prolonged administration of small doses of salines and diuretics. Arsenical preparations are also valuable, but should only be employed for two or three weeks together, with intervals of equal duration. The dangerous complications which sometimes result from accumulations of this drug in the system are thus avoided.
SEBACEOUS OR SEBORRHŒIC ECZEMA.
Whilst the two preceding forms of eczema result from vascular disturbance of the skin or dermis that now under consideration seems due to vascular and secretory troubles in the accessory structures of the skin, and more particularly in the sebaceous glands.
Fig. 242.—Sebaceous eczema, first stage. Depilation of the extremities.
Symptoms. The disease develops slowly. At first circular or elliptical patches of skin, distributed regularly over the body, more especially round the natural orifices, become deprived of hair. The surface of these patches is covered either with thick crusts of a peculiar greyish-brown tint which display numerous superficial cracks, or parts normally free from hair exhibit shining epidermic crusts arranged in layers, which are shed on the slightest touch.
This depilation has a strong tendency to spread, and so at first it often resembles ringworm. It results from changes in the hair follicles, with atrophy of the papillæ and complete loss of hair. The changes in the skin, however, are little marked. The skin itself is but slightly thickened and preserves its usual suppleness, while the subcutaneous tissue is not œdematous.
Fig. 243.—Sebaceous eczema, second stage. Partial alopecia.
Fig. 244.—Sebaceous eczema, third stage. Total alopecia.
The hairs, however, when examined microscopically are found to be thickened at their roots, though otherwise throughout their whole length they remain normal. The condition is a consequence of disturbance in the circulation and nutrition of the papilla and the root of the hair.
Finally, the congestive process extends to the sebaceous glands, the secretion of which it modifies, and sets up seborrhœa, which is responsible for the formation of the crusts and epidermic scales above-mentioned.
The pathogeny of the disease is difficult to explain, but the stages in the clinical development are as follows: the skin undergoes repeated attacks of congestion, followed by seborrhœic folliculitis, epidermitis and loss of hair.
The diagnosis is easy, the absence of ringworm being proved by the absence of the spores of trichophyton and by the non-contagious character of the discharge.
The prognosis is not grave from the point of view of general health, the chief functions being perfectly regular, but it is otherwise as regards possible terminations, viz., partial or total loss of the coat, which may be irremediable.
Treatment. It is difficult to lay down a really satisfactory method of treatment, because the exact cause of seborrhœa is still unknown. As it is probably to be sought in some individual constitutional peculiarity, the feeding and method of life should be changed and the skin stimulated by washing with lukewarm water and soap and by dry friction. Locally, if the alopecia threatens to be permanent stimulating applications may be tried. These comprise lotions containing alcohol, solutions of chloral, salicylate of soda, etc., and they should be applied with smart friction.
The sufferers should not be used for breeding purposes.
ECZEMA DUE TO FEEDING WITH POTATO PULP.
Among the forms of eczema due to toxins, several varieties may be recognised. Some result from the administration of drugs such as iodine, others from special forms of food. The only one of clinical importance is that following the consumption of excessive quantities of potato pulp.
Causation. The disease is seen in all districts in which potatoes are employed for the manufacture of alcohol and starch, more especially in Germany. The disease seems to be a direct consequence of feeding with residual products of distilleries and starch manufactories.
Spinola states that 160 lbs. of potato refuse per day to 1,000 lbs. of body weight would certainly produce eczema: 60 to 80 lbs. only produce it in rare cases and 20 to 40 lbs. are harmless.
There is a further point to consider as regards the variation of potato pulp in toxicity. Potatoes yield a more or less active residue, according to the year in which they are grown, their state of germination, and the variety to which they belong. Raw or cooked potatoes may produce eczema if given in large quantities or for long periods.
Numerous theories have been advanced as to the nature of the morbid disturbance producing eczema. Some authorities declare the appearance of the disease to be due to the presence of a toxic principle contained in potatoes, viz., solanin. It might be objected that this chemical principle only exists during germination while potatoes that have not undergone germination produce the disease. Further, the symptoms of poisoning by solanin differ from those of this form of eczema, among which loss of appetite, for instance, or stupefaction, or narcosis is never observable.
According to other writers eczema is due to the action of the lower alcohols contained in the refuse pulp, but again these properties exist in brewers’ and distillers’ grains, the consumption of which produces no bad results. Similar objections might be made regarding the suggested action of the acids of fermentation (lactic, butyric, and acetic acids, etc.).
Johne blames the salts of potassium, which, however, can only act as digestive irritants, and Zürn suggests mycosic inflammation.
Whatever the toxic principle, its effects are most marked in animals undergoing fattening, and are rarely found in working oxen, still more rarely in milch cows. In the last named the injurious principle appears to be eliminated in the milk, and this theory is supported by the fact that the liquid has purgative properties; the calves which consume it suffer from diarrhœa, which ceases when the feeding is altered.
Finally, it has been proved that different animals show different degrees of susceptibility to the action of potato pulp.
The symptoms do not appear until after two or three weeks’ feeding on the potato pulp. Then the animals walk stiffly, rise with difficulty, and display redness, swelling and sensitiveness of the limbs. When the œdematous infiltration and reddening have become distinctly marked there appear, not only between the claws, as in foot-and-mouth disease, but over the entire limb and principally near the folds of skin about the joints, numerous closely-packed small papules, which in one or two days become transformed into vesicles through exudation below the epidermis.
This marks the eczematous phase properly so called. The vesicles then become ruptured, the exuded matter glues the hairs together, dries, and forms crusts, which have a peculiar and distinctive odour.
The disease may extend towards the hocks, the knees, the stifle, the armpit, etc. In the folds of skin surrounding the joints deep cracks form, and sometimes become secondarily infected, thus leading to the development of lymphangitis.
General symptoms, such as fever, loss of appetite and constipation, always follow; they are afterwards succeeded by diarrhœa and progressive weakness, ending in death.
The disease is easily curable if seen in its earlier stages, but after all signs of the first attack have disappeared, the condition may return five or six times in a year if potato pulp is again given. Recovery is always very difficult in aged or enfeebled patients.
The mortality varies greatly; formerly it was as high as 20 per cent., but at the present time it is much lower.
Diagnosis. Provided the history of the case is borne in mind, the diagnosis is always easy.
The prognosis is not grave if the disease is treated early.
Treatment. This consists first of all in altering the diet and reducing the quantity of potato pulp, or, better still, in discontinuing it entirely. The food should consist of good hay, bran, oatmeal gruel, pollard, etc. Internally, diuretics are given to assist in the elimination of the toxic products.
This treatment arrests the course of the disease. Suitable local treatment will remove the existing lesions. It is precisely similar in character to that of acute eczema, but it must be borne in mind that it can only prove effective if the primary cause be removed.
IMPETIGO IN THE PIG.
The term impetigo is used to describe a disease characterised by an eruption of papules, the discharge from which forms yellowish crusts, which when dry are of a grey or brown colour. The point of origin of the eruption is unknown, but the crusts rapidly become infected on contact with the air, and the bodily lesions may end in suppuration. The disease is not frequent nowadays except in sucking pigs and in large or badly-kept piggeries.
Symptoms. The eruption usually appears between the ages of two and three months, and is accompanied from the first by moderate pruritus. The papules rupture after two or three days and discharge a lemon-coloured liquid, which is distributed over the surface, dries rapidly, and causes the bristles to stick together at the roots. The crusts formed in this way remain adherent to the skin, though their surface becomes cracked. They increase in thickness, cover the head and part of the body, particularly the belly and the inner surface of the thighs, and if removed, an operation of some difficulty, leave exposed a bleeding, sanious, or purulent wound. The animals lose condition and appetite, cease to grow, seem as though attacked with rachitis, and may die if the general conditions of their maintenance are not improved.
The diagnosis is not difficult, but the prognosis depends on how long the disease has existed and the bodily condition of the patients.
The treatment consists entirely in improving the hygienic conditions and the feeding. The patients must be repeatedly washed or bathed and carefully disinfected, and they must have better food.
The crusts should be softened before the animals are washed, so that bleeding may be avoided and the affected areas not be transformed into suppurating wounds. By applying oil or some fatty matter to the crusts it is possible to cleanse the parts with bran water. If considered necessary, this cleansing can be followed by dressing with boric or weak creolin solution. Open-air life and good food soon relieve the principal symptoms.
ACNE IN SHEEP.
Acne, that is to say, localised inflammation of the sebaceous glands and hair follicles, sometimes occurs in sheep apart from any parasitic invasion. The eruption is particularly seen after shearing, and it is probable that, as in the horse, irritation produced by the machine, and possibly by accidental infection, constitute the principal determining causes.
Symptoms. The disease is indicated by the appearance of cutaneous pustules, which are only slightly painful on pressure and which involve the entire thickness of the skin. The dermis is hardly congested, and no constitutional disturbance occurs.
Acne lesions may be more or less confluent, and may attain the size of a small hazel-nut.
The diagnosis presents no difficulty. Puncture or incision reveals the fact that the abscesses are filled with white sebaceous material and are quite free from parasites.
The prognosis is not grave. Recovery occurs spontaneously in a few weeks.
Treatment. Liquid emollient applications and the opening of the small follicular abscesses appear to represent the only means of hastening recovery.
FAGOPYRISM (BUCKWHEAT POISONING).
Fagopyrism is a disease of toxic origin in sheep, and is due to eating buckwheat (Polygonum fagopyrum).
The disease has also been entitled erysipelatous or gangrenous dermatitis, according to its form and gravity.
Causation. The cause is extremely simple, viz., the consumption of buckwheat and other food pertaining to a like species, such as Polygonum persicaria. The green plant and the straw give the same results, but the action of light and air are also necessary for the production of the disease, a fact which is somewhat difficult to explain.
According to German writers the disease occurs more frequently in white sheep and lambs than in those in which the skin is of a very dark colour.
Symptoms. When the sheep are fed in folds, with the green plant in summer or with the straw in winter, nothing unusual is seen, the herds being, to all appearance, in perfect health. On their being set at liberty, however, the first symptoms appear, perhaps in less than an hour. Some animals become restless, make peculiar movements of the head, and soon display intense congestion of the parts free of wool, together with redness and swelling of the ears, eyelids, face, throat, etc. The condition develops with extreme rapidity, the animals being immediately afflicted with pruritus over the affected regions. If they are not removed to the quiet and warmth of the fold the symptoms increase and papules appear, which may be transformed into vesicles and bullæ. In the fold, on the other hand, all the symptoms rapidly disappear.
The disease rarely assumes an erysipelatous form, but respiratory and cerebral symptoms, together with fever and vertigo, are not exceptional.
Treatment. The feeding on buckwheat should at once be discontinued, and the patients should be kept in the fold until the toxic principles have been eliminated, that is, for a month or more.
Bicarbonate of soda may be added to the drinking water. The local lesions about the head must be kept clean and dressed with antiseptic astringent lotions.
CHAPTER II.
PHTHIRIASIS.
The term phthiriasis is applied to infestation of the skin with lice.
Causation. These diseases are due to the presence of various parasites which live by destroying the epidermic scales, or by piercing the superficial layers of the skin. They are of a greyish-yellow colour, and belong to the genera Hæmatopinus and Trichodectes.
The Hæmatopinus forms have pointed heads, and are equipped for penetrating the skin by suction. The Trichodectes have a large flat head constructed for masticating.
Fig. 245.—Hæmatopinus eurysternus of the ox, magnified 20 diameters. (After Neumann.)
Fig. 246.—Hæmatopinus of the calf, magnified 20 diameters. (After Neumann.)
The ox harbours two forms of Hæmatopinus and one of Trichodectes, the Hæmatopinus eurysternus and tenuirostrus, and the Trichodectes scalaris.
The sheep suffers from Trichodectes sphærocephalus and a Melophagus, the goat from the Hæmatopinus stenops and the Trichodectes climax, and the pig from the Hæmatopinus urius.
The symptoms are, with trifling variations, the same in all domestic animals, the principal being rubbing and itching. The animals scratch, bite and attempt to rub against hard objects, even abrading the skin when this is thin and the irritation is severe.
The parasites may, however, remain localised, and it rarely happens that they are present in any considerable number in all parts of the body.
Fig. 247.—Sheep louse (Trichocephalus sphærocephalus). a, Female; b, antenna; c, d, dorsal and side view of leg. Enlarged. (After Osborn, 1896; Bul. No. 5, Div. Entomology, Dept. Agr.)
In the ox they are principally found in the depression at the back of the base of the horns, and in the upper margin of the neck and the back. In the absence of treatment phthiriasis may become generalised over the entire surface of the body.
The trichodectes and the melophagus of the sheep choose similar points, but when the wool is long they may be found nearly all over the body.
In the pig the hæmatopinus is found on the neck, in the region of the poll, about the armpits, and round the eyes and ears.
These parasites, whose powers of increase are astonishing, keep the patients in a continual state of irritation, causing them to lose condition and, in the absence of treatment, to die of exhaustion.
The diagnosis is very easy, the parasites being visible to the naked eye.
The prognosis is not grave unless the condition affects a large number of animals in herds. In young animals the prognosis is much graver, for the little creatures rapidly become anæmic and die in a state of exhaustion.
Treatment. When the byre, fold, or piggery is infested the first point is to remove the animals and thoroughly disinfect and cleanse all parts.
Fig. 248.—Sheep foot louse (Hæmatopinus pedalis). a, Adult female; b, ventral view of terminal segment of same, showing brushes; c, terminal segments of male; d, egg. Enlarged. (After Osborn, 1896; Bul. No. 5, Div. Entomology, Dept. Agr.)
After the manure has been cleared out, the walls, mangers, racks, etc., are washed with boiling water, or, better still, potash solution, and disinfected first with vaporised sulphurous acid, then, if necessary, with a washing of caustic lime.
The patients are afterwards clipped, washed with soft soap and dressed with anti-parasitic solutions, such as 1 per cent. tobacco juice, or a mixture of equal parts of benzine and oil or benzine and petroleum, etc., which give excellent results.
A 3 per cent. creolin solution is also a very active anti-parasitic and very easy to use.
All these solutions, however, are more or less poisonous and need to be used with caution, weak solutions only being used at first, particularly in the case of animals, such as oxen, which are given to licking themselves.
Fig. 249.—Adult sheep tick (Melophagus ovinus). (a) Tick; (b) puparium. Magnified. (Salmon and Stiles, Annual Report, U.S.A. Dept. of Agriculture, 1897, p. 103.)
Fig. 250.—Trichodectes scalaris of the ox. Magnified 20 diameters. (After Railliet.)
SCABIES—SCAB—MANGE.
The term scabies is given to a group of diseases affecting man and all domestic animals. These diseases are produced by two classes of parasites, viz., sarcoptinæ, which live within the epidermis or on the surface of the skin, and demodectes (sing. demodex), which penetrate into the sebaceous glands and hair follicles.
Scabies, though known from the earliest times, has long been confounded with constitutional diseases characterised by cutaneous eruptions. The symptoms shown were formerly regarded as due to the elimination of “humours” which the organism was casting off, for which reason scabies was even treated with internal medicines.
At the present time the cause of the disease is perfectly well understood, as well as the mode of development of the different parasites. The rate at which these parasites develop is almost incredible, a fact which explains the highly contagious character of the disease.
Each species of animal may present several varieties of scabies, caused by different parasites, such as sarcoptes, psoroptes, chorioptes, demodectes, etc.
SCABIES IN SHEEP.
Scabies in sheep usually assumes one of three forms—sarcoptic, psoroptic, or chorioptic scabies. Follicular, or demodectic, mange affects the eyelids, and is very rare. It is produced by the Demodex folliculorum var. ovis.
SARCOPTIC SCABIES
This scabies has long been recognised as affecting more especially the head, muzzle, etc. It was mentioned as long ago as the fourteenth century by Jehan de Brie, but, until Delafond’s time, no one recognised that it was caused by an acarus. In 1858 Delafond discovered the parasite in Piedmont sheep.
Fig. 251.—Sarcoptis, magnified 100 diameters. (After Railliet.)
Causation. Formerly, writers on the subject and shepherds attributed this disease to the wounds and excoriations which sheep receive in passing through brambles, holly, etc., or in rubbing against their racks. The true cause of the disease is the presence under the skin of the Sarcoptes scabiei var. ovis, which passes from sheep to sheep by direct contact. The animals attempt to rub against everything about them, even against their neighbours. These parasites can be transferred from the goat to the sheep, and vice versâ.
Walraff, Roloff, Delafond, Gerlach and Railliet have described cases of infection in man, but the disease is rarely more than of a temporary character.
Symptoms. This form of scabies affects the head and the parts free from wool.
At first the parasites invade the upper lip and the tissues about the nostrils, sometimes, but more rarely, the eyes and ears. They cause the formation of vesicular papules, accompanied by violent itching. The animal, in rubbing itself, excoriates these papules, which discharge a fluid and soon become covered with yellowish-brown crusts.
The disease afterwards invades the face, forehead, jaws, and entire head. The skin becomes wrinkled and the brownish crusts thicker and more abundant. These are fissured and bleeding, and they give the face the appearance of one vast sore.
The parasite rarely attacks the region of the elbow, the belly, or the inside of the thigh. The disease never advances in parts covered by wool, although in breeds of sheep with thick wool, such as are found in Algeria and Tunis, the sarcoptic form of scabies may become generalised and attack the entire body. The extremities of the limbs, however, are usually attacked after all the head has become involved.
Throughout the course of the disease the patients scratch and rub themselves, thus tearing off the crusts and causing bleeding and the formation of new crusts of a blackish hue. This form of scabies about the head may become complicated with conjunctivitis, the inflammation extending from the extremity of the eyelids to the conjunctiva. This arises from the fact that the membrane is frequently injured by the animal rubbing the parts. Conjunctivitis may be so intense as to lead to purulent ophthalmia and the loss of the eye.
Fig. 252.—Sarcoptic mange of the sheep, showing the appearance of the head.
Diagnosis. Sarcoptic mange in sheep cannot be mistaken for any other disease on account of its localisation.
Prognosis. The disease is not very dangerous, for it is easy to treat, though if left to itself it might in time become fatal.
Treatment. Preventive treatment consists in isolating diseased animals, cleansing and disinfecting the folds, and preventing the introduction of diseased animals into healthy flocks.
Curative treatment. When the disease is detected at an early stage anti-psoroptic remedies may be directly employed.
If, however, it is of old standing, the crusts must first be softened and removed by the use of fatty substances, such as vaseline or oil, before any curative treatment can be undertaken.
The crusts can be removed in from twenty-four to forty-eight hours by vigorous washing with soft soap and the application of anti-parasitic solutions. The omission to wash the parts causes drugs to lose much of their efficacy.
Helmerich’s ointment, oil of cade, mixtures of oil, benzine and petroleum, and 3 per cent. to 4 per cent. of tobacco juice, are the commonest and most efficacious applications.
A non-poisonous ointment may be made by taking 4 ounces of oil of turpentine, 6 ounces of flowers of sulphur, and 1 lb. of lard. Mix the ingredients at a gentle heat, and rub in well with the hands or with a brush, at the same time breaking the crusts. The simple sulphur ointment may be made of one part of sulphur and four parts of lard; one fourth part of mercurial ointment may be added. Few remedies are so useful as sulphur iodide, and it may well be given a trial on head scab.
In most countries this disease has been made the subject of special legislation.
PSOROPTIC MANGE—SHEEP SCAB.
This is probably the gravest form of mange. It was described by Cato the Censor in 160 B.C., by Virgil, Juvenal, Celsius, Columella, Pliny, Vegetius, etc. In 1787 Abildgaard first showed that psoroptic mange in sheep could be cured by simple external remedies, without internal medications. In 1809 Walz described the causes, nature, seat, and treatment of the disease.
Since then, the parasitic, contagious nature of mange or scabies has been more and more clearly recognised.
Causation. Experience and observation have long shown that the only cause is the presence of the Psoroptes communis (ovis). This disease is much more contagious than that just described. Psoroptic mange or scabies exclusively affects those portions of the body covered by the wool, and may for a long time remain unrecognised.
The parasite is visible to the naked eye, though most inspectors employ the microscope. The adult female is about ¹⁄₄₀ of an inch long and ¹⁄₆₀ of an inch broad; the male is ¹⁄₅₀ of an inch long and ¹⁄₈₀ of an inch broad. The mites are discovered more easily on a dark background, and if a portion of the wool and crusts is placed on black paper and exposed to the sun for a few minutes the parasites will generally be seen crawling about on the paper.
The disease is transmitted directly or indirectly by contact from diseased to healthy animals in the folds, fields, or sheep runs. One diseased sheep may contaminate an entire flock. The disease is extremely contagious, and may appear even within a week after exposure.
The parasites have exceptional vitality. It is generally stated that, kept at a moderate temperature on portions of scab, the adults may live from four to twenty days, but they will occasionally live much longer; cases are on record where they have lived three, four, or even six weeks when separated from sheep; if the atmosphere is dry they will generally die in about fifteen days; but death is often only apparent, for the mites may sometimes be revived by warmth and moisture even after six or eight weeks; the fecundated females are especially tenacious of life.
Fig. 253.—Left-hand figure shows adult male parasite of common sheep scab, dorsal view; right-hand figure, ventral view of same; top figure shows head of female; bottom figure, leg of female. All greatly enlarged. (Salmon and Styles, Annual Report, U.S.A. Bureau of Animal Industry, 1897.)
Experience has shown that in some cases apparently healthy sheep have become infected in places where no sheep have been kept for four, eight, twelve, or even twenty-four months. The conditions underlying this infection are not thoroughly understood. Possibly some of the eggs have retained their vitality a long time and then hatched out; possibly the vitality of the fecundated female has also played a rôle; while it is not at all improbable that an entirely new infection has accidentally been introduced by birds or other animals. Certain authors of high standing scout the idea that birds can introduce an infection of scab, but there is no reason why birds should not do this, and there are some reasons for believing that they do. It has been noticed on the Experiment Station of the United States Bureau of Agriculture, for instance, that crows delight in perching on the backs of scabby sheep and picking at the scab; while so doing it is only natural that small tags of wool would adhere to their feet, and thus scatter scab.
Delafond’s experiments show that psoroptic mange is most troublesome amongst thin, ill-nourished, weakly animals, whilst robust sheep in good condition may be cured simply by attention to cleanliness and abundant feeding.
In America this disease causes extremely heavy pecuniary loss, second only in importance to that produced by hog cholera. It has also interfered very seriously with the export of American sheep.
The course of the disease is affected by the time of year and surrounding conditions. In autumn and winter, when sheep are in continual contact in a moist, warm atmosphere within the folds, the disease makes rapid progress. Young, weak, closely-inbred animals, and those with long, coarse wool, most quickly succumb. Unhealthy surroundings, damp, and bad ventilation favour the disease. Pure or mixed bred merino sheep suffer severely. In summer the animals are generally shorn and live in the open, and the disease then usually diminishes or may even be arrested.
A study of the life history of the scab parasite is necessary in order to determine several important points of practical value, such as the proper time for the second dipping, etc.
The female mite lays about fifteen to twenty-four eggs on the skin, or fastened to the wool near the skin; a six-legged larva is hatched; these larvæ cast their skin and become mature; the mites pair and the females lay their eggs, after which they die. The exact number of days required for each stage varies somewhat, according to the writings of different authors, a fact which is probably to be explained by individual variation, and by the conditions under which the observations and experiments were made. Thus Gerlach, in his well-known work (1857) estimates about fourteen to fifteen days as the period required for a generation of mites from the time of pairing to the maturity of the next generation. He divides this time as follows: Under ordinary conditions the eggs hatch in three to four days, although two authors allow ten to eleven days for the egg stage; three or four days after birth the six-legged larvæ moult and the fourth pair of legs appears; this fourth pair is always present when the mites are two-thirds the size of the adults; when seven to eight days old the mites are mature and ready to pair; several (three or four) days are allowed for pairing; another generation of eggs may be laid fourteen to fifteen days after the laying of the first generation of eggs. Without going into all of the other observations on these points, it may be remarked that the eggs may not hatch for six or seven days; the six-legged larvæ may moult when three to four days old, and become mature; after pairing, a second moult takes place, lasting four to five days; a third moult follows immediately, then eggs are laid and the adults die; in some cases there is a fourth moult, but apparently without any further production of eggs. Accepting Gerlach’s estimate of fifteen days as an average for each generation of ten females and five males, in three months time the sixth generation would appear and consist of about 1,000,000 females and 500,000 males.
Fig. 254.—Adult female parasite of common sheep scab. (Both greatly enlarged.) (Salmon and Stiles, loc. cit.)
Several practical lessons are to be drawn from these figures: Firstly, it is seen that the parasites increase very rapidly, so that if scab is discovered in a flock, the diseased sheep should immediately be isolated; secondly, if new sheep are placed in a flock, they should either first be dipped, as a precautionary measure, or they should at least be kept separate for several weeks to see whether scab develops; thirdly, since the chances for infection are very great, the entire flock should be treated, even in case scab is found only in one or two animals; fourthly, as dipping is not certain to kill the eggs, the sheep should be dipped a second time, the time being selected between the moment of the hatching of eggs and the moment the next generation of eggs is laid. As eggs may hatch between three and seven, possibly ten or eleven days, and as fourteen to fifteen days are required for the entire cycle, the second dipping should take place after the seventh day, but before the fourteenth day; allowing for individual variation and variation of conditions, the tenth, eleventh, or twelfth day will be the best time to repeat the dipping.
Symptoms. Psoroptic mange attacks the parts covered with wool, so that attention is only drawn to the disease by some slight injury to the fleece, which becomes rough, matted, brittle, and liable to fall.
Scabies commences with intense pruritus. The animals scratch and bite themselves, and tear away the fleece. These symptoms become aggravated when the animals are hot, as, for instance, when travelling. If the sheep have travelled through mud, the fleece becomes matted on the neck, behind the shoulders, and at all points where they are able to scratch themselves with the hind limbs.
When a scabby sheep is touched at a diseased point, the animal shows pleasure by nibbling and moving the head up and down.
At an early stage, if the fleece is divided and the skin examined, little papules may be discovered somewhat less in size than a lentil. They are of a yellowish colour, and are distinctly visible against the reddish colour of the skin. These papules are due to the attacks of the psoroptes.
Fig. 255.—Left top figure, egg of mite which causes common sheep scab; middle top figure, six-legged stage of sheep scab mite; right top figure, young female before moulting for the last time, dorsal view; middle figure, adult male parasite of sarcoptic scabies of man (the corresponding parasite of sheep is very similar), ventral view, × 250 (after Blanchard); left bottom figure, adult female parasite of sarcoptic scabies, dorsal view, × 250 (after Blanchard); right bottom figure, same, ventral view (after Blanchard). All greatly enlarged.
They soon become more numerous and even confluent, break and discharge, become converted into pustules, and cause the formation of crusts. In a few days the diseased points are covered with a squamous, yellowish, sticky covering, under which the psoroptes lie hidden and which affords them nourishment.
The crusts steadily grow thicker and lift the individual fibres of wool, tearing them from their follicles, so that patches of skin become bare. The patches thus formed increase in diameter, for the acari leave the centre, where crust-formation is replaced by abundant desquamation of the epidermis. The skin is thickened, assumes the character of parchment, and in old-standing cases becomes wrinkled.
The disease always commences along the back, withers, loins, and the upper part of the quarters. Thence it spreads to the flanks and sides of the chest. The psoroptes are almost exclusively confined to recently affected points on the edges of the scabby patches. They are visible to the naked eye, and appear as little whitish-brown points.
Scab is specially liable to attack a flock containing lambs and yearling sheep, whose skin is thin, fine and supple, and therefore more susceptible to their attacks. If a portion of a scabby flock be shorn, the shorn animals will probably recover on account of the psoroptes transferring themselves to the animals with long fleeces.
The diagnosis is easy. Psoroptic mange cannot be mistaken for sarcoptic mange, on account of the different points affected.
Psoroptic mange only attacks regions covered by wool, and sarcoptic mange those free of wool. A microscopical examination of acari removed from the diseased animals will, however, immediately remove all doubt.
Nor can the disease be confounded with phthiriasis, the trichodectes being immediately distinguished from the psoroptes by their greater size and the shape of their head. Moreover, they are usually to be found on the front portions of the shoulders.
It is more likely to be mistaken for another disease, termed by some writers seborrhœa and studied and described by Delafond under the name of sebaceous folliculitis. This disease appears mostly in autumn, and attacks animals much exposed to the weather and on moist, cold soils. It begins with very violent pruritus, followed by biting and loss of portions of the fleece. The skin is red, inflamed and painful, and the wounds are covered with large quantities of yellowish acid discharge of a sticky and offensive nature. The treatment of this disease consists in placing the sheep in clean, dry, well-ventilated sheds. Recovery is assisted by clipping and the application of some emollient dressing to the diseased parts.
The ease with which the disease can be cured and the absence of parasites enable one to readily distinguish it from psoroptic mange (scab).
Prognosis. The disease is not specially grave, so long as only a few animals are affected, for it is not difficult to cure by isolation, good feeding, and proper external treatment; but if scab appears in a flock, the freedom with which the animals intermingle is such that all are rapidly attacked, and the irritation produced at once checks their growth and causes loss in condition. Many ewes give birth to small, feeble lambs, which are almost certain to die, and in any case the wool is considerably diminished in value.
Delafond estimated that psoroptic mange formerly attacked one thirty-fifth of all the sheep in France every year, causing damage to the extent of five francs per head. At the present time, and since proper sanitary laws have been instituted, it has become much less common.
During the bad season of the year the mortality is greater, and may reach as much as from 40 to 50 per cent. In cases where scab is accompanied by some other disease, such as distomatosis, it may even rise to 80 per cent.
The treatment is preventive and curative. Preventive treatment consists in separating the healthy from the diseased animals and in disinfecting the folds, sheds, etc.
Curative treatment. The first point in this treatment consists in improving the diseased animal’s food both as to quality and quantity.
It is to be observed that the parasite has more difficulty in living on robust and well-nourished animals. Moreover, observation shows that transference from poor land to rich pastures is sometimes in itself sufficient to bring about a spontaneous cure. Such, at least, is the belief of the Spanish sheep farmers in Estramadura and of the French shepherds.
The shepherd can do a great deal to arrest the course of the disease. If he is careful, zealous, intelligent and observant he will quickly note the first indications of the disease and, by isolating the animals, check its spread.
The second point consists in shearing the diseased animals, and this must be carried out at any season of the year. The money loss is sometimes important, but must be met, for otherwise treatment is impossible. In cases of localised scab, empyreumatic oil, oil of cade, solutions of sulphuret of potassium, decoctions of black hellebore (water 1 quart, fresh rhizome 4 ounces or dry rhizome 2 ounces), decoction of tobacco and diluted tobacco juice (6 ounces in 1 quart of water) have been recommended. Such local treatment, however, is often useless, because incomplete.
When scab is generalised and it is impossible to define the parts attacked, general treatment is indispensable and the diseased sheep should be dipped.
As a preliminary, however, and in order to make sure that the application will produce its effect, the animals after shearing should be passed, twenty-four hours before the medicinal bath, through a warm bath containing soap in order to soften and remove the scabs. Applications of oil or some fatty substance will also soften the scabs, which may afterwards be removed with a scraper without producing bleeding. One pound of soft soap may be dissolved in fifty quarts of water and each sheep plunged into this and scrubbed with a brush for a few minutes. Washing alone removes a large number of the parasites.
Whatever bath be used it should not be given until four or five hours after the last feeding. The dips most popular in France are as follows:—
Tessier’s Bath (1810).
| For 100 sheep | Arsenious acid | 1½ | parts or lbs. |
| Sulphate of iron | 10 | „ | |
| Water | 100 | „ |
The above materials should be boiled for ten minutes, and, as a consequence of the chemical fusion which occurs in the process, the proportion of arsenious acid dissolved amounts to about 2 drachms per quart instead of 3¾ drachms.
In this bath the arsenious acid acts as a parasiticide and the sulphate of iron as an astringent, the latter checking the absorption of toxic principles by the skin and sores, and preventing the sheep from licking themselves.
Absorption by the skin is not so dangerous as has been believed. Rossignol has shown that poisoning need not be feared in chemical baths unless the proportion of dissolved arsenic is above 150 grains per quart, especially if the period of immersion does not exceed five minutes. Even pure solutions of arsenic, free from any astringent, may be used, provided the quantity in the bath does not exceed 120 grains per quart.
The bath should, if possible, be kept warm—85° to 95° Fahr. (30° to 35° C.).
Four men are generally employed for the operation. One drives in the sheep, two others hold and brush them in the bath, and the fourth holds the head of the animal above the liquid. Tessier recommended gloves for the use of the operators, but experience has shown that such a precaution is unnecessary. The udder, and particularly the teats, of ewes with young may, if necessary, be smeared with some fatty substance, such as vaseline or oil, in order to guard against the astringent action of the liquid.
Each sheep is plunged in the bath for one or two minutes, or five minutes at the most. All the diseased spots must be brushed, rubbed and cleansed; but care must be taken not to make them bleed.
Tessier suggested leaving the animals for twenty-four hours in some disinfected place, without straw or food, to prevent these materials from being wetted by the liquid which runs from the fleece, and which, if afterwards eaten, might have a poisonous effect. Here, again, the danger has been exaggerated. Delafond has shown that sheep may be given a fluid ounce of Tessier’s bath for eight days running without producing the slightest unfavourable symptom.
Tessier’s bath is excellent from the therapeutic standpoint, but it imparts a yellow tint to the fleece, which is thus rendered less valuable. The mixture has therefore been modified in various ways.
Clément’s Bath (1846).
| For 100 sheep | Arsenious acid | 1·5 | parts or lbs. |
| Sulphate of zinc | 5 | „ | |
| Water | 100 | „ |
In this bath every quart contains about 2½ drachms of arsenious acid. Its toxic power, therefore, is considerably greater than that of Tessier’s bath.
Clément’s formula has one drawback. The sulphate of zinc may be mistaken for a non-astringent alkaline sulphate (sulphate of soda), and as a consequence poisoning may occur, as experience has shown.
Mathieu of Sèvres replaced the sulphate of iron by an equal quantity of alum. In this case, each quart of the bath contains 2½ drachms of arsenious acid.
Clément’s and Mathieu’s formulæ have given just as good results as Tessier’s.
A last formula is that of Professor Trasbot. The aloes is of very little use, however, because it is almost insoluble.
| For 100 sheep | Arsenious acid | 2 | lbs. |
| Sulphate of zinc | 10 | „ | |
| Aloes | 1 | „ | |
| Water | 25 | gallons. |
Condition of the animals after the bath.—On leaving the bath the abraded parts are slightly cauterised. During the five or six following days the skin is stiff, and covered with adherent crusts over the points attacked by the parasites. The animals no longer scratch or bite themselves.
Towards the eighth day the crusts fall, the skin appears supple and of a pink colour, and the wounds cicatrise. In animals which have suffered for a long time recovery is much slower, and may extend over from thirty to fifty days. The wool again grows soft and bright, while the sheep rapidly regain their spirits and condition. The cicatrisation of the wounds is often accompanied by intense itching, which must not be taken as a sign of the persistence of the disease. It is well, however, to keep the animals under observation at this period.
Under any circumstances, six weeks or two months should always be allowed to elapse before giving a second bath. Should a few spots appear to be attacked secondarily, they may be moistened with a little of one of the bath liquids.
In Germany the creolin bath is generally employed:
| For 100 sheep | { Water | 250 | gallons or parts. |
| { Creolin | 6·5 | „ |
Each sheep is bathed a second time after an interval of one week, the animal being immersed for three minutes in the bath and thoroughly scrubbed with a brush. The efficacy of this method, however, is less certain.
In America, where the flocks are large and scabies is frequent, sulphur baths are employed, the baths themselves being of great size. The animals are forced to pass through them and remain there for some minutes.
The size and value of American, Australian, and New Zealand flocks demand that the modes of treatment practised and the experience gained in these countries should receive something more than passing notice. We therefore purpose giving a short résumé of some parts of the very valuable monograph on sheep scab issued in 1897 by Dr. Salmon and Mr. Stiles, for the American Bureau of Animal Industry.
In selecting a dip the question of expense will naturally arise; next, the question as to whether or not scab actually exists in the flock to be dipped. The facilities at hand, the set-back to the sheep, and the length of the wool are also matters for consideration, as well as the pastures into which the dipped sheep are to be placed.
Expense.—In estimating the expense one should consider not only the actual outlay for the ingredients of the ooze, but the cost of fuel and labour, the injury, if any, to the sheep, and the liability of not curing the disease. It is much more economical to use an expensive dip and cure scab, than it is to use a cheap dip and fail to cure it.
Does scab exist in the flock?—If scab does not actually exist and the wool is long, the dipping in this case simply being a matter of precaution, it is best not to select a dip containing lime.
The facilities at hand for preparing dip.—If fuel is very scarce, so that it is impracticable to boil the mixture for at least two hours, the lime-and-sulphur dips should not be selected.
Fig. 256.—A comparatively early case of common scab, showing a bare spot and tagging of the wool.
The pastures.—In case it is necessary to place the dipped sheep on the same pastures they occupied before being dipped, it is always best to use a dip containing sulphur. If a proprietary dip is selected under those circumstances, it is suggested that sulphur be added, about 1 lb. of flowers of sulphur to every 6 gallons of dip. The object in using sulphur is to place in the wool a material which will not evaporate quickly, but will remain there for a longer period of time than the scab parasites ordinarily remain alive away from their hosts. By doing this the sheep are protected against reinfection.
Sulphur is one of the oldest known remedies for scab; its use is best known in the tobacco-and-sulphur dip and in the lime-and-sulphur dip. These home-made mixtures are the two dips which have played the most important rôles in the eradication of scab from certain English colonies, and their use is extensive in America.
The Tobacco-and-Sulphur Dip.
Fig. 257.—A slightly advanced case of common scab.
The formula as given here, and as adopted by the New South Wales sanitary authorities, appears to have first been proposed in 1854 by Mr. John Rutherford. “On the Hopkins Hill Station Mr. Rutherford, with two dressings of these ingredients, then cured over 52,000 sheep which had been infected for eighteen months. Since then millions of scabby sheep have been permanently cured in Victoria in the same way, and in South Australia and New South Wales hundreds of thousands of scabby sheep have also been cleansed with tobacco and sulphur. Judging, therefore, from the experience of the three colonies, there is no medicament or specific yet known that can be compared with tobacco and sulphur as a thorough and lasting cure for scab in sheep.” (Dr. Bruce, Chief Inspector of Sheep for New South Wales.)
The proportions adopted by Rutherford, and afterwards made official by the scab sanitary authorities, are—
| Tobacco leaves | 1 | lb. |
| Flowers of sulphur | 1 | „ |
| Water | 5 | gallons. |
The advantage of this dip lies in the fact that two of the best scab remedies, namely, tobacco (nicotine) and sulphur, are used together, each of which kills the parasites, while the sulphur remains in the wool and protects for some time against reinfection. As no caustic is used to soften the scab, heat must be relied on to penetrate the crusts.
Directions for preparing the dip.—Infusing the tobacco:—Place 1 lb. of gold-leaf or manufactured tobacco for every 6 gallons of dip desired in a covered boiler of cold or lukewarm water, and allow to stand for about twenty-four hours; on the evening before dipping bring the water to near the boiling point (212° Fahr.) for an instant, then remove the fire and allow the infusion to stand overnight.
Thoroughly mix the sulphur (1 lb. to every 6 gallons of dip desired) with the hand in a bucket of water to the consistency of gruel.
When ready to dip, thoroughly strain the tobacco infusion from the leaves by pressure, mix the liquid with the sulphur gruel, add enough water to make the required amount of dip, and thoroughly stir the entire mixture.
Lime-and-Sulphur Dips.
Under the term “lime-and-sulphur dips” is included a large number, of different formulæ requiring lime and sulphur in different proportions.
To give an idea of the variety of the lime-and-sulphur dips, the following list is quoted, the ingredients being reduced in all cases to avoirdupois pounds and United States gallons:
(1.) The original “Victorian lime-and-sulphur dip,” proposed by Dr. Rowe, adopted as official in Australia:
| Flowers of sulphur | 20⅚ | lbs. |
| Fresh slaked lime | 10⁵⁄₁₂ | „ |
| Water | 100 | gallons. |
(2.) South African (Cape Town) official lime-and-sulphur dip, February 4th, 1897:
| Flowers of sulphur | 20⅚ | lbs. |
| Unslaked lime | 16⅔ | „ |
| Water | 100 | gallons. |
(3.) Fort Collins lime-and-sulphur dip:
| Flowers of sulphur | 33 | lbs. |
| Unslaked lime | 11 | „ |
| Water | 100 | gallons. |
(4.) A mixture which, used to some extent by the Bureau of Animal Industry, contains the same proportions of lime and sulphur (namely, 1 to 3) as the Fort Collins dip, but the quantities are reduced to—
| Flowers of sulphur | 24 | lbs. |
| Unslaked lime | 8 | „ |
| Water | 100 | gallons. |
In case of fresh scab Formula No. 4 will act as efficaciously as the dips with a greater amount of lime, but in cases of very hard scab a stronger dip, as the Fort Collins dip, should be preferred; or, in unusually severe cases, an ooze with more lime in proportion to the amount of sulphur, such as the Victorian (No. 1) or the South African (No. 2) dip might be used.
Prejudice against Lime-and-Sulphur Dips.
There is at present great prejudice (a certain amount of it justified, no doubt) against the use of lime and sulphur, emanating chiefly from the agents of patent or proprietary dips and from the wool manufacturers.
In the first place, it is frequently asserted that lime and sulphur does not cure scab. Experience in Australia and South Africa, as well as in America, has shown beyond any doubt that a lime-and-sulphur dip, when properly proportioned, properly prepared, and properly used, is one of the best scab eradicators known.
It is claimed by some that it produces “blood poisoning.” But the cases of death following the use of lime-and-sulphur dips have been infinitesimally few when compared with the number of sheep dipped in these solutions, and when compared with the deaths which have been known to follow the use of certain proprietary dips. The details of such accidents, so far as they have been reported, have not shown that death was due to any property prepared and properly used lime-and-sulphur dip. It is highly probable that the cases of so-called “blood poisoning” of shear-cut sheep are generally due to an infection with bacteria in stale dip containing putrefying material.
The greatest objection raised against the use of lime-and-sulphur dip is that it injures the wool. This objection is raised by many wool manufacturers and echoed with ever-increasing emphasis by the manufacturers of prepared dips; while, after years of extensive experience with properly prepared dip, its injury to the wool is strongly and steadfastly denied by the Agricultural Department of Cape Colony.
It is believed that a certain amount of justice is attached to this objection to lime and sulphur as generally used; unless, therefore, lime and sulphur can be used in a way which will not injure the wool to an appreciable extent, we should advise against its use in certain cases; in certain other cases the good accomplished far outweighs the injury it does. Let us, therefore, examine into this damage and its causes.
Fig. 258.—A more advanced case of common scab.
The usual time for dipping sheep is shortly after shearing, when the wool is very short; whatever the damage at this time, then, it can be only slight, and the small amount of lime left in the wool will surely do but little harm.
In full fleece lime and sulphur will cause more injury. In Australia the deterioration was computed by wool buyers at 17 per cent., although in Cape Colony the Department of Agriculture maintains that if properly prepared, and if only the clear liquid is used, the sediment being thrown away, the official lime-and-sulphur formula will not injure the long wool. The United States Bureau of Agriculture have found some samples of wool injured by dipping, while on other samples no appreciable effect was noticeable.
If a lime-and-sulphur dip is used, care must be taken to give the solution ample time to settle; then only the clear liquid should be used, while the sediment should be discarded. In some of the above tests on samples of wool it was found that the dip with sediment had produced very serious effects, even when no appreciable effects were noticed on samples dipped in the corresponding clear liquid.
Experience has amply demonstrated that a properly made and properly used lime-and-sulphur dip is one of the cheapest and most efficient scab eradicators known, but its use should be confined to flocks in which scab is known to exist, and to shorn sheep, with the exception of very severe cases of scab in unshorn sheep. It should only be used when it can be properly boiled and settled. The use of lime-and-sulphur dips in flocks not known to have scab, especially if the sheep are full fleeced, cannot be recommended; in such cases tobacco, or sulphur and tobacco, is safer and equally good.
All things considered, where it is a choice between sacrificing the weight of sheep and to some extent the colour of the wool by using tobacco and sulphur, and sacrificing the staple of the wool by using lime and sulphur, the owner should not hesitate an instant in selecting tobacco in preference to lime. The loss in weight by using tobacco and sulphur is not much greater than the loss in using lime and sulphur, while the loss in staple is of more importance than a slight discoloration.
Preparation of the mixture.—Take 8 to 11 lbs. of unslaked lime, place it in a mortar-box or a kettle or pail of some kind, and add enough water to slake the lime and form a “lime paste” or “lime putty.”[[8]]
[8]. Many persons prefer to slake the lime to a powder, which is to be sifted and mixed with sifted sulphur. One pint of water will slake 3 lbs. of lime if the slaking is performed slowly and carefully. As a rule, however, it is necessary to use more water. This method takes more time and requires more work than the one given above, and does not give any better results. If the boiled solution is allowed to settle the ooze will be equally safe.
Sift into this lime paste three times as many pounds of flowers of sulphur as of lime, and stir the mixture well.
Be sure to weigh both the lime and the sulphur. Do not trust to measuring them in a bucket or to guessing at the weight.
Place the sulphur-lime paste in a kettle or boiler with about twenty-five to thirty gallons of boiling water, and boil the mixture for two hours at least, stirring the liquid and sediment. The boiling should be continued until the sulphur disappears, or almost disappears, from the surface; the solution is then of a chocolate or liver colour. The longer the solution boils the more the sulphur is dissolved and the less caustic the ooze becomes.
Pour the mixture and sediment into a tub or barrel placed near the dipping vat and provided with a bung-hole about 4 inches from the bottom, and allow ample time (two to three hours, or more if necessary) to settle.
When fully settled draw off the clear liquid into the dipping vat, and add enough water to make a hundred gallons. Under no circumstances should the sediment be used for dipping purposes.
Fig. 259.—A shorn sheep with large bare area due to scab.
To summarise the position of the United States Department of Agriculture on the lime-and-sulphur dips:—When properly made and properly used these dips are second to none and equalled by few as scab eradicators. There is always some injury to the wool resulting from the use of these dips, but when properly made and properly used upon shorn sheep, it is believed that this injury is so slight that it need not be considered; on long wool the injury is greater and seems to vary with different wools, being greater on a fine than on a coarse wool. This injury consists chiefly in a change in the microscopic structure of the fibre, caused by the caustic action of the ooze. When improperly made and improperly used the lime and sulphur dips are both injurious and dangerous, and in these cases the cheapness of the ingredients does not justify their use. In case scab exists in a flock and the farmer wishes to eradicate it, he cannot choose a dip which will bring about a more thorough cure than will lime and sulphur (properly made and properly used), although it will be perfectly possible for the farmer to find several other dips which will, when properly used, be nearly or equally as effectual as any lime-and-sulphur dip. There is no dip to which objections cannot be raised.
Arsenical Dips.
There are both home-made arsenical dips and secret proprietary arsenical dips. It is well to use special precautions with both, because of the danger connected with them. One of the prominent manufacturers of dips, a firm which places on the market both a powder arsenical dip and a liquid non-poisonous dip, recently summarised the evils of arsenical dips in the following remarkable manner:
“The drawbacks to the use of arsenic may be summed up somewhat as follows: (a) Its danger as a deadly poison. (b) Its drying effect on the wool. (c) Its weakening of the fibre of the wool in one particular part near the skin, where it comes in contact with the tender wool roots at the time of dipping. (d) Its not feeding the wool or stimulating the growth, or increasing the weight of the fleece, as good oleaginous dips do. (e) The danger arising from the sheep pasturing, after coming out of the bath, where the wash may possibly have dripped from the fleece, or where showers of rain, after the dipping, have washed the dip out of the fleece upon the pasture. (f) Its occasionally throwing sheep off their feed for a few days after dipping, and so prejudicing the condition of the sheep. (g) Its frequent effect upon the skin of the sheep, causing excoriation, blistering, and hardness, which stiffen and injure the animal, sometimes resulting in death.”
Although this manufacturer has gone further in his attack upon arsenic than the United States Bureau of Agriculture would have been inclined to do, it must be remarked that when a manufacturer of such a dip cannot speak more highly of the chief ingredient of his compound than this one has done in the above quotations, his remarks tend to discredit dips based upon that ingredient. Bruce, the Chief Inspector of Live Stock for New South Wales, speaking of arsenical dips, says: “Arsenic and arsenic and tobacco (with fresh runs) cured 9,284 and failed with 9,271.”
It may be said, on the other hand, that arsenic really has excellent scab-curing qualities; it enters into the composition of a number of the secret dipping powders, and forms the chief ingredient in one of the oldest secret dips used. This particular dip has been given second place (with some qualifications) among the officially recognised dips in South Africa.
Formulæ for arsenical dips.—Finlay Dun recommends the following:—Take 3 lbs. each of arsenic, soda ash (impure sodium carbonate) or pearl ash (impure potassium carbonate), soft soap, and sulphur. A pint or two of naphtha may be added if desired. The ingredients are best dissolved in 10 to 20 gallons of boiling water, and cold water is added to make up 100 gallons. The head of the sheep must, of course, be kept out of the bath.
A mixture highly endorsed by certain parties consists of the following ingredients:
| Commercially pure arsenite of soda | 14 | lbs. |
| Ground roll sulphur | 34½ | „ |
| Water | 432 | gallons (U.S.) |
The arsenite of soda is thoroughly mixed with the sulphur before being added to the water.
Precautions in use of arsenical mixtures.—Any person using an arsenical dip should bear in mind that he is dealing with a deadly poison. The following precautions should be observed:
(1) Yards into which newly-dipped sheep are to be turned should first be cleared of all green food, hay, and even fresh litter; if perfectly empty they are still safer. (2) When the dipping is finished, the yard should be cleaned, washed, and swept, and any unused ooze should at once be poured down a drain which will not contaminate food or premises used by any animals. (3) Dipped sheep should remain in an open, exposed place, as on dry ground. (4) Overcrowding should be avoided, and every facility given for rapid drying, which is greatly facilitated by selecting fine, clear, dry weather for dipping. (5) On no account should sheep be returned to their grazings until they are dry and all risk of dripping is passed.
The feeling of the United States Bureau of Agriculture towards arsenical dips is shown by the following:
Suggestion as to danger.—The formulæ given above are copied from the writings of men who have had wide experience in dipping, but this Bureau assumes no responsibility for the efficacy of the dips given, or for their correct proportions. Furthermore, as long as efficacious non-poisonous dips are to be had, we see no necessity for running the risks attendant upon the use of poisonous dips.
Carbolic Dips.
This class of dips kills the scab mites very quickly, but unfortunately the wash soon leaves the sheep, which is consequently not protected from reinfection in the pastures. If, therefore, a carbolic dip is selected, it is well to add flowers of sulphur (1 lb. to every 6 gallons) as a protection against reinfection.
The advantages of carbolic dips are that they act more rapidly than the tobacco or sulphur dips, and that the prepared carbolic dips are very easily mixed in the bath. They also seem, according to Gillette, to have a greater effect on the eggs of the parasites than either the sulphur or the tobacco dips. The great disadvantages of this class of dips are—first, in some of the proprietary dips, that the farmer is uncertain regarding the strength of material he is using; second, the sheep receive a greater set-back than they do with either lime and sulphur or tobacco.
Fig. 260.—An advanced case of common scab.
The United States Bureau of Agriculture is inclined to be extremely conservative in regard to them, and to advise their manufacturers to prepare them in a guaranteed strength with more explicit directions for use than are to be found in the present circulars.
One of the prominent proprietary carbolic dips was formerly recognised as one of the three official dips in New South Wales, but it has now been erased from the list. In Cape Town carbolic dips are not much used, and in the official reports little is said concerning them.
The United States Bureau of Animal Industry gives the following advice as regards dipping:
(1.) Select a dip containing sulphur. If a prepared “dip” is used which does not contain sulphur, it is always safer to add about 16½ lbs. of sifted flowers of sulphur to every 100 gallons of water, especially if, after dipping, the sheep have to be returned to the old pastures.
Fig. 261.—An American sheep-dipping plant in operation.
(2.) Shear all the sheep at one time, and immediately after shearing confine them to one-half the farm for two to four weeks. Many persons prefer to dip immediately after shearing.
(3.) At the end of this time dip every sheep (and every goat also, if there are any on the farm).
(4.) Ten days later dip the entire flock a second time.
(5.) After the second dipping, place the flock on the portion of the farm from which they have been excluded during the previous four or five weeks.
(6.) Use the dip at a temperature of 100° to 110° Fahr.
(7.) Keep each sheep in the dip for two minutes by the watch—do not guess at the time—and duck its head at least once.
(8.) Be careful in dipping rams, as they are more likely to be overcome in the dip than are the ewes.
(9.) Injury may, however, result to pregnant ewes, which must on this account be carefully handled. Some farmers arrange a stage, with sides, to hold the pregnant ewes, which is lowered carefully into the vat, and raised after the proper time.
(10.) In case a patent or proprietary dip, especially an arsenical dip, is used, the directions given on the package should be carried out to the letter.
CHORIOPTIC MANGE, SYMBIOTIC MANGE, FOOT SCAB.
This disease was studied in Germany by Zürn in 1874, and by Schleg in 1877. It has not yet been seen in France.
Causation. The sole cause is the presence of Chorioptes scabiei (v. ovis). Contagion is favoured by the animals being in poor condition. The disease extends very slowly. Only 2 to 3 per cent. of the animals are affected, and the sufferers are usually those with fine skins.
German shepherds consider this disease to be due to an excessive allowance of salt, because it is most common during the winter, when the sheep are housed. Needless to say, this theory is incorrect.
Symptoms. Sometimes this form of mange attacks the limbs and develops very slowly. It commences about the pasterns, and gradually extends upwards towards the knee or hock. It really advances beyond these points. The parasites are much smaller than those of common scab, and are often overlooked. The sheep stamp their feet and scratch and bite the infected parts, sometimes transferring the disease to the lips and face, where it may persist for a time.
Fig. 262.—The left-hand figure shows the adult male parasite of chorioptic scabies of the horse (the corresponding parasite of sheep is almost identical), ventral view. The central figure shows the young female parasite of chorioptic scabies, ventral view. The right-hand figure shows the adult female parasite of chorioptic scabies with egg, ventral view. All × 100. (After Neumann.)
In very old standing cases which have been entirely neglected, it may be met with in the region of the armpit and thigh, the limbs becoming swollen so as to suggest lymphangitis. In the folds of the hock and pastern the thickening of the skin may lead to the formation of yellowish or brownish crusts, according to whether the exudation is merely of a serous character or accompanied by bleeding.
The diagnosis is easy. The parasites are found in the thickness of the crusts, and are readily recognised under the microscope.
The prognosis is not grave, because of the comparative rarity of the disease and its mildly contagious character. This disease, moreover, never attacks the head or body, but remains localised in the lower portions of the limbs.
Treatment. The crusts should be removed by washing or by standing the animals for a time in warm water. Simple cleanliness often suffices, but, to save time, some anti-parasitic may be used. The condition is easily cured even without disinfecting the folds.
MANGE IN THE OX.
Bovine animals may be attacked by three varieties of mange, all of which have long been known.
SARCOPTIC MANGE.
This is not of any great clinical importance, as it is purely accidental, and only results from the conveyance of sarcoptes from other animals, such as the horse, sheep, dog, goat or cat, to an animal of the bovine species. That the disease does occur, however, is shown by the following excerpt from a report by Professor McFadyean: The animal showed no symptom of skin disease at the time of purchase, but soon after it was brought home it was noticed to be rubbing, and the skin began to assume an unhealthy appearance. When seen in January (four months after purchase) it was rather poor, although it had been in very good condition when sold. Almost the entire skin had become affected, including that of the legs down to the top of the hoofs. There had been extensive loss of hair, and the skin was thick, grey, wrinkled, and dry. At some places it had become thrown into thick folds. Only a few scabs or crusts had formed where the animal had recently rubbed itself. In some scurf scraped from what seemed to be the parts most recently invaded, numbers of acari were without much difficulty found with the microscope.
A good many cases of mange of undetermined character have been reported as occurring among cattle in various parts of England during the last year or two, and in a number of instances the disease was believed to have been contracted during exhibition at a show. It is not improbable that some or all of these were cases of this sarcoptic mange, and in view of its very contagious character it is desirable that care should be taken to exclude from shows animals exhibiting any symptom of the disease.
PSOROPTIC MANGE.
This condition has also been termed dermatodectic mange. This is very rare, and, like the former, of trifling clinical importance.
Causation. It is due to infection with Psoroptes communis (v. bovis). Poor condition, want of grooming, bad hygienic surroundings and general neglect, facilitate its spread.
Symptoms. It commences at the base of the neck, in rarer cases at the sides of the neck, along the withers, and at the root of the tail; thence it gradually attacks the croup, loins, back, shoulders, sides of the chest, and finally all the body with the exception of the limbs.
It produces violent itching, the animal continually scratching itself, even causing raw sores. At first the epidermis is elevated in little miliary points, which may be isolated or confluent, and are filled with serosity. This fluid discharges, gluing together the hairs; it then hardens and produces adherent crusts, which increase in number and size. The skin exhibits large numbers of bare, mangy points; these have irregular margins, and are covered with thick, grey, scaly crusts. The psoroptes are found under these crusts.
The skin becomes hard, dry, fissured and cracked, and sometimes forms large folds on the sides of the neck, shoulders and chest.
The influence of the seasons on the development of this disease has been well shown by Gerlach and Muller. The disease commences about the end of autumn, when the animals are stabled. It continues to extend until February, but diminishes as soon as the animals return to the fields in spring. The crusts fall, the hair again grows, and the animal appears to be cured, but the disease again revives during the autumn. The psoroptes lie hidden during the summer round the poll and the horns. The disease seldom attacks animals at grass and in good condition, or those over three years old. Calves, yearlings, and two-year-olds in poor condition suffer most.
When the disease is very extensive, the animals lose condition and may even die.
Diagnosis. Psoroptic mange in the ox may be mistaken for several cutaneous diseases, to which it has a certain resemblance, as for instance phthiriasis and the first stage of ringworm.
These different diseases, however, show their own distinctive symptoms on a careful examination.
The prognosis only becomes grave when the disease has been neglected and the animals are greatly reduced in condition. When recent, this form of mange can readily be cured by the application of parasiticides.
Treatment. As in dealing with all transmissible diseases, the animals must be isolated and washed with soap, and the diseased parts must be dressed with some parasiticide, such as sulphur ointment. The best preparations are: Benzine and petroleum in equal quantities; concentrated solution of sulphuret of potassium (8 ounces to the quart); Helmerich’s ointment; diluted creolin solution; decoctions of tobacco; ointment of pentasulphuret of potassium, and oil of cevadilla.
One or two applications are generally sufficient to effect a cure, and relapses are not likely to take place if the stable is disinfected. In America the disease is common in the West and North-West, where it is treated by the lime-and-sulphur bath recommended for sheep scab (which see). Large vats are constructed, and the oxen are lowered into these by means of a wooden cage controlled by machinery, which is operated either by a small engine or more frequently by a horse.
The food should be of good quality, for good general health plays a great part in resisting parasitic invasions.
CHORIOPTIC MANGE.
This disease has also been termed dermatophagic and symbiotic mange.
It was first described in 1835 by Kégélaar, and has been the subject of investigation by Hering, Gerlach, Delafond, and Mégnin.
Causation. It is produced by the Chorioptes bovis, and is transferred with difficulty, even by cohabitation.
Symptoms. This form of mange in the ox does not affect the same parts as in other animals. In the horse, etc., it attacks the limbs, whilst in the bovine species it is usually found at the base of the tail. It causes slight itching. The diseased region becomes covered with numerous little pellicles, the hairs gradually fall, crusts form, and the skin shows deep cracks. When the disease is completely neglected, it may extend to the loins, back, sides of the body and shoulders. It may also affect the perineal region, the inner surface of the thighs, and in fact the whole of the body if the animals are young and in poor condition.
Diagnosis. At the outset it is difficult to distinguish between chorioptic and psoroptic mange, and the use of the microscope is necessary. On a superficial examination chorioptic mange may be mistaken for phthiriasis when the latter attacks the posterior portions of the body, particularly the base of the tail, and when it is accompanied by eruptions, loss of hair, and intense itching.
The distinction between the two conditions, however, is extremely easy after an examination of the two parasites.
Prognosis. The disease is of slight gravity, and does not threaten the animal’s health unless neglected for so long a time that the parasites invade all parts of the body. In that case the disease may cause anæmia and loss of condition.
The treatment of this form of mange comprises nothing special, it being sufficient to proceed as directed in the previous article.
The stables ought always to be thoroughly disinfected.
MANGE IN THE GOAT.
The goat suffers from the attacks of sarcoptes, psoroptes, and chorioptes, but up to the present time only two forms of mange have been described, sarcoptic and chorioptic mange.
Psoroptes have only been found about the eye, where the disturbance they produce is comparatively trifling.
SARCOPTIC MANGE.
This disease was noticed in 1818 in goats imported into France from Thibet.
Henderson published the history of a Persian goat which conveyed sarcoptic mange to men and horses. In 1851 Walraff noticed an epizootic mange which attacked the goats in the Prattigau valley of Switzerland, which was transmitted to men and sheep and which exhibited the clinical characters of sarcoptic mange.
Causation. This disease is due to the presence of Sarcoptes scabiei (v. capræ).
It sometimes occurs in an epizootic form, as Walraff’s observations show, but it seems specially to attack goats in Asia and Africa.
This mange may be transmitted by the goat to sheep, in which animals it attacks the head and muzzle; it is particularly contagious in sheep having coarse, dry fleeces.
Similarly sarcoptic mange of sheep may be conveyed to the goat, in which animal it extends all over the body.
Symptoms. This mange causes intense itching. It first attacks the head and ears, then the trunk, belly, udder, and limbs. If the disease is neglected it becomes generalised very rapidly, and the animals waste away and die in a very short time.
At the commencement little crusts, which discharge a viscous liquid, are found about the head. The goats rub themselves raw, and, as in facial mange of sheep, there appear dry, scaly, branlike patches. After a time the diseased area extends, the wool falls, and the skin becomes dry, thick and wrinkled. The appearance is exactly like that of sarcoptic mange in sheep, the lower part of the head being seldom invaded. The animals lose condition, waste and die of exhaustion.
Diagnosis. The parasite is readily recognised, and the practitioner, moreover, is often put on his guard by the epizootic character assumed by the disease.
The prognosis is grave. Walraff declared the mortality in Grisons (Switzerland) to be as high as 20 per cent.
The treatment is identical with that of psoroptic mange in sheep. After the animals have been sheared and washed with soap, they should be completely immersed in a bath of the character mentioned in connection with sheep scab. If only one animal is infected, it may be sufficient to dress it repeatedly with an ointment containing some parasiticide.
CHORIOPTIC MANGE.
This form of mange was noted by Delafond in 1854 at the Jardin des Plantes (Paris) in some angora goats, and by Mollereau in 1889. The disease studied by Delafond had invaded both sides of the neck, the eyes, withers, back, loins, and base of the tail. It was characterised by partial loss of hair, the finer hair falling and the coarser remaining in position.
In Mollereau’s case the disease was located in one of the hind pasterns, and assumed the form of a thickened band, which produced an œdematous swelling. The chorioptes were discovered in a thick crust formed by the drying on the hair of the discharge due to their punctures.
Diagnosis. The parasites can easily be found under the crusts, and, once recognised, distinguish the disease from any other infection.
Treatment. Ointments containing some parasiticide and solutions of sulphuret of potassium generally suffice, the disease having little tendency to become generalised.
MANGE IN THE PIG.
The pig suffers from one variety only of mange. It was described by Viborg, Gürlt and Spinola, who found a sarcopt in the mange of wild boars in 1847. Hertwig and Gerlach made a similar observation some years later. Delafond in 1857 discovered the sarcopt of mange in the pig.
Causation. Sarcoptic mange in the pig is due to the presence of Sarcoptes scabiei (v. suis), although the pig may contract (temporarily) the sarcoptic mange of goats.
Contagion is favoured by poor condition, over-crowding, dirt and bad hygienic surroundings.
The primitive races of pigs resist the disease better than the improved races. This mange can be conveyed to man and to other animals.
Symptoms. It usually commences about the head, ears, and eyes, and extends to the quarters, internal surface of the thighs, etc. In the early phases it is impossible to discover the little galleries under the epidermis, but closely placed reddish papules may be seen. The active proliferation of the epidermis, together with discharge, causes the formation of dry crusts of a greyish-white, silvery tint, adherent while still thin, easy to detach at a later stage, and sometimes ⅜ of an inch in thickness. The skin becomes wrinkled, the bristles are shed or loosened in their follicles, and are glued together in little bunches before falling. As these patches extend over the whole surface of the body, the animal appears to be bespattered with dry guano (Muller).
Under the crusts the skin is rough, excoriated, and, about the thorax and abdomen, is indurated, and sometimes measures 1 to 1½ inches in thickness. In other parts, particularly at the base of the ears, the papillæ are hypertrophied; they become as large as a pea, or even a bean, and, lifting the crusts which cover them, assume the appearance of the warts sometimes found on the cheeks of dogs or the teats of cows. Sarcoptes may be found under these epidermic growths, though in order to obtain them the skin must be scraped until it almost bleeds.
The dimensions of these parasites render them visible to the naked eye. They are the largest variety of the sarcoptinæ, the egg-bearing female being half a millimètre in length. Guzzoni has found in the ears specimens of smaller size.
Mange in pigs develops slowly. When it affects the whole body, it prevents fattening and causes loss of condition.
Diagnosis. This is the only parasitic disease which affects the entire surface of the body and presents these peculiar powdery crusts.
Treatment. All the styes should first be carefully disinfected. Treatment is commenced by vigorously scrubbing the animal with a brush dipped in soap and water, and thus getting rid of the crusts as far as possible.
The animals are afterwards dressed with decoctions of tobacco, with Helmerich’s ointment, or the other mixtures above mentioned.
DEMODECIC MANGE.
This mange is produced by parasites of the family Demodecidæ (Demodex folliculorum), which live in the hair follicles and sebaceous glands of several species of mammals.
DEMODECIC MANGE IN THE OX.
This was described in 1845 by Gros, and in 1878 was found by Faxon in Illinois in the skins of cows prepared for tanning. It has not been met with in France. The skins examined by Faxon showed numerous rounded enlargements, resulting from dilatation of the hair follicles in the regions of the neck and shoulders.
By pressing on these enlargements a whitish, greasy, sebaceous material was ejected, very rich in demodectes.
DEMODECIC MANGE IN THE GOAT.
Fig. 263.—Demodex of the pig, magnified 250 diameters. (After Railliet.)
This was first noticed by Niederhaüsern, at the Bern Veterinary College, in a goat which showed little nodosities over different parts of the trunk, varying in size between that of a pea and that of a hazel-nut. By forcibly compressing these enlargements a yellowish-grey semi-solid material, containing a considerable number of demodectes, was caused to exude.
In 1885 Nocard and Railliet found the same parasite in a young he-goat; the pustules were spread over the sides and flank. Treatment consists in opening the pustules and dressing them a few times with an anti-parasitic lotion.
DEMODECIC MANGE IN THE PIG.
This was well described for the first time by Csokor. It was afterwards seen by Neumann and Lindqvist.
The isolated pustules are of the size of a grain of sand, but when confluent may reach the size of a hazel-nut. They are sometimes dark in colour, often deep-seated, are surrounded by a zone of inflammation, and appear in places where the skin is fine (the groin, neck, belly, etc.). The demodex becomes lodged and multiplies, not in the hair follicles, but in the sebaceous glands. Csokor regarded this disease as contagious; in a herd of one hundred he found twenty-two pigs affected with it. Lindqvist, however, found but one case in a herd of two hundred.
NON-PSOROPTIC FORMS OF ACARIASIS.
These are produced in farm animals by arachnide belonging to the families of Trombidiidæ and Ixodidæ.
(1.) The Leptus autumnalis is considered to be the larva of the Trombidium Holoscriceum, or silky trombidion. It lives in late summer and autumn, in the grass.
Symptoms. The animals show intense itching, and cannot sleep owing to burning sensations. They continually rub themselves, and thus, secondarily, produce excoriated papules and patches resembling those of eczema. When the papules are very numerous, particularly if the animals are thin-skinned, more or less extensive erythema may be produced.
At the points attacked the skin swells, becomes red, and sometimes even violet, and exhibits irregular, isolated or confluent swellings, ¼ to ⅜ of an inch in diameter.
The parasite most commonly becomes fixed round the lips, the forehead, the cheeks, the sides of the neck, and the extremities.
The diagnosis is easy, the discovery of the parasite removing all doubt.
The condition is of slight importance. The parasites do not live for more than a few days on the animal’s skin, so that they only produce temporary disturbance.
Treatment consists in bathing the parts with some lotion, such as 2 to 3 per cent. creolin or 2 per cent. chloral, or in applying mixtures of oil and petroleum, etc.
(2.) Ixodes hexagonus, I. ricinus, and other species of the tick family (Ixodidæ) attack sheep, goats, and oxen in France.
Symptoms. In sheep the ixodidæ usually affix themselves at points where the skin is tender and unprotected by wool, as for instance the thighs, armpit, and upper part of the neck. Their bites produce irritation, followed by an intense burning sensation, and the formation of a red blush round the point bitten.
In the ox the ticks fasten on the neck, behind and within the ears, and also wherever the skin is tender. Until the last few years little importance was attached to their development, but since it has been proved that Rhipicephalus annulatus is the active factor in desseminating Texas fever, ticks have attracted much attention.
It seems, moreover, to be proved by the researches of Lignières that a form of piroplasmosis exists in France, and it seems possible that the Ixodes ricinus may be a means of propagation.
The diagnosis of acariasis produced by ticks is easy, for the parasites attain large dimensions.
Prognosis. It is difficult at present to say what importance should be attached to this form of acariasis, but its existence and possible consequences should be noted.
Treatment. Some authors have recommended killing the ticks by touching them with benzine, petroleum, essence of turpentine, etc., but these methods do not always succeed. Applications of concentrated solution of chloral are more effective. When the parasites are so large as to render this possible it is better to remove them by hand, taking care at the same time to remove the rostrum, which, if left in place, might cause more or less suppuration. In countries where ticks are numerous and large numbers of cattle are infested, the parasites are destroyed by smearing and dipping.
Fig. 264.—Ixodes ricinus. (After Railliet.) A, Natural size; B, ventral surface; C, dorsal surface.
(The cattle ticks of America are of especial importance in relation to the disease known as Texas fever. Those who wish to study the entomology of this subject are referred to the masterly account and fine coloured illustrations of Salmon and Stiles, “Cattle Ticks of the United States,” Ann. Rep. U.S.A. Bureau of Agriculture, 1900, p. 380.)
HYPODERMOSIS IN THE OX (WARBLES).
Causation. This is a parasitic disease characterised by subcutaneous swellings due to the presence of larvæ of the Hypoderma bovis. The larva is met with throughout Europe. It attains the perfect stage during the summer, from the middle of June to the commencement of September.
The female deposits her eggs on animals with fine skins. These eggs are elliptical, and provided with a kind of tail of a brownish colour. They soon become converted into larvæ, provided with rows of little spines.
The manner in which the eggs are laid is not exactly understood, nor are we better informed regarding the hatching of the young larvæ. Until recently it was believed that the larva perforated the skin as soon as it quitted the egg, and then penetrated as far as the subcutaneous connective tissue. Recent observations, however, have upset this view. It is probable that this larva, like other gastrophili, is swallowed by animals of the bovine species, and passes through the intestine into the surrounding tissues by a path which is yet unknown, possibly by the blood-vessels, whence it makes its way after a longer or shorter interval into the subcutaneous connective tissue.
Fig. 265.—A, Hypoderma bovis, natural size. B, larva of the hypoderma escaping from a “warble.” (After Railliet.)
Certain recent observations seem to support the latter view, which is also corroborated by known facts regarding hypodermic myiosis in man. The eggs are laid in summer, and the swellings indicating the presence of the larvæ only appear during the winter. Henrichsen found young larvæ in the fatty tissue situated between the periosteum and spinal dura mater, between the period from December to March.
Symptoms. Whatever the mode of development of the larvæ, cutaneous swellings appear between the months of February and March on the back, lumbar region, quarters, shoulders and ribs, and, less frequently, over the chest, belly and thighs.
They vary in number. Commonly there are from ten to twenty, and it is only in rare cases that less than four or five are found. As soon as they attain the subcutaneous connective tissue they act as foreign bodies, causing a circumscribed inflammation, and finally suppuration. In this way the so-called “warbles” are produced.
Each larva is surrounded by a thick wall, forming a cavity, which communicates with the outer air by a minute aperture.
When the swelling is sufficiently advanced the larva may be extricated by pressing with the fingers around the base of the warble. A few days before it leaves its shelter the larva enlarges the little opening by thrusting its last rings into it. Soon after the larva has escaped the discharge of pus ceases, and the skin wound heals.
Diagnosis. The times at which the swellings appear and the larvæ are present render the diagnosis easy.
Prognosis. This is seldom grave, for the larvæ rarely cause death. In cases where they are present in very large numbers, however, they may set up purulent infection.
Treatment. No really effective treatment against warbles is known. Curative treatment consists in squeezing out or killing the larvæ when in the subcutaneous tissue, but this is practically useless, as the dead larvæ then set up prolonged suppuration.
CHAPTER III.
RINGWORM.
The old term “ringworm” is still used to indicate a well-marked skin disease due to parasitic fungi which grow at the expense of the epidermis. Other names, such as dermatophytis and epidermophytis, have been suggested, to indicate the mode in which the parasite grows. The term dermatomycosis suggests a cutaneous vegetable parasite.
The dermatomycoses of the domestic animals are caused by fungi belonging to six distinct genera:—
Trichophyton (horse, ass, ox, dog, pig); Eidamella (dog); Microsporum (horse, dog); Achorion (dog); Lophophyton (fowl); Oospora (dog).
Ringworm is common in animals of the bovine species, but very rare in other domesticated animals, except, perhaps, the horse. It is caused by the growth of a parasite, Trichophyton mentagrophytes (Robin), of the genus Trichophyton, family Gymnoascea, order Ascomycetes.
The ascosporaceous form of reproduction is still unknown, but the mode of reproduction by conidia is characteristic. In cultures the mycelium is represented by growing filaments branching off at right angles, and by separate superficial aerial reproductive filaments of the conidian form. There is some reason for believing that these fungi may lead a saprophytic as well as a parasitic existence, i.e., that they can exist and multiply apart from the animal body.
Their vitality is marked. Various experimenters have transmitted the disease with crusts kept for eighteen months. Thin declares that in two and a half years the spores had lost all power of germination. They resisted immersion in water for two days, but were dead after eight days. Soft soap and 1 per cent. acetic acid kill them in an hour.
Symptoms. The disease most frequently attacks young animals and milch cows—very rarely adults or old animals. This peculiarity is very difficult to explain.
In calves, ringworm seems specially to attack the head, the neighbourhood of the lips, the nostrils and submaxillary region, as well as the throat and neck. It assumes the form of circular patches, over which the hair stands erect.
Gruby in 1842 discovered the parasite of tinea tonsurans, or herpes, and thus proved that the cutaneous lesions were not due to any constitutional condition, as was long thought, although dirt, bad hygienic conditions, and crowded stables favoured the spread of ringworm.
Fig. 266.—Calf suffering from ringworm.
Direct contact between healthy and diseased animals and the transport of spores, by combs, brushes, etc., favour contagion. The disease may not only be conveyed from one animal to another of the same species, but from the ox to man, and, with somewhat greater difficulty, from the ox to the horse. Cases of transmission from the ox to the sheep, pig, and dog have also been recorded.
Mégnin in 1890 attempted to prove that all the trichophytons producing ringworm in animals do not belong to the same species, and gave the name of Trichophyton epilans to that usually found in the ox, because it causes absolute loss of the hair by growing in the follicle, whilst he named the parasite found in the horse Trichophyton tonsurans, because it only grows on the surface of the skin and in the thickness of the hair, without causing inflammation of the hair follicle and without invading it.
The epidermis soon undergoes proliferation, and becomes covered with crusts, which adhere to the hairs, gluing them together, and finally causing them to be shed, leaving bare patches the size of a shilling or a florin. The lesion extends in an ever-widening circle, until it attains, perhaps, the dimensions of a five-shilling piece or more.
The affected hairs break off level with the free surface of the skin, rendering the patches more apparent. White hairs are less affected, and some always remain projecting above the crusts, causing the patches, when on a white skin, to retain a certain amount of covering.
At first the crust is closely adherent to the skin, and, if forcibly detached, exposes the dermis, which is swollen and bleeding. Gradually the centre becomes detached, whilst the periphery, representing a more recent lesion, continues to adhere. The crusts then rest on a thin layer of pus, and the dermis, whilst still inflamed, is punctuated with numerous minute apertures, representing the roots of the detached hairs. The pus lifts the crust; gradually it dries up and forms superposed layers, which may or may not prove adherent to the parasitic products, and which form a new crust. The latter is purely inflammatory in character, and is left after the fall of the first. It no longer contains any parasites, at least within its deeper layers.
This second crust dries up in its turn, falls away or breaks up, leaving a smooth spot, over which the hairs again appear, either at once, or at least after a short period of desquamation.
The disease is accompanied by well-marked pruritus, more marked at the commencement and towards the end than during the intermediate period, but, nevertheless, much less acute than in scabies.
Ringworm may undergo spontaneous cure in from six weeks to three months. It is more obstinate in calves than in adults, and the want of grooming tends to increase its duration. If it extends over a large part of the body the disease may seriously affect the animal’s health, and the cases described by Macorps prove that where pruritus is violent it seriously affects the animal’s general condition.
The patches may finally become confluent and the disease extend over the whole of the neck, shoulder and back, or it may attack the entire body, leaving it practically hairless.
When the hair has been shed, the crusts and discharge seen at the outset disappear, and the bare spots are covered with a scaly coating, due to excessive production of epidermic cells.
According to Gerlach, such crusts are thicker where the skin is black, and often exhibit a greyish-white, fibrous, starchy appearance. On unpigmented portions of the skin, which are usually thinner, the crust is less dense, and is slightly yellowish. Gerlach failed to reinoculate the bare patches of skin left after a primary eruption of ringworm. Where the hair had again grown an eruption could again be produced, though it was usually of a feeble character.
In a second form of the disease, the spots may be of very small dimensions. The hair falls away, but there is no exudative inflammation, and no formation of crusts. In this second form the animals simply show characteristic circular bare spots about the head, neck, or shoulders.
Causation. The disease is due to the growth of germs on the skin of animals which are in a receptive condition. The parasite thereafter develops in the hairs, the hair follicles and the epidermis, causing lesions which vary according to the species.
At the present time three groups of ringworm are recognised as occurring on animals, Trichophytic, Microsporous, and Favus.
Clinically the trichophytons are divided into the T. ectothrix, which lives outside the hair, and both outside and inside the hair follicles; T. endothrix, which penetrates the thickness of the hair itself, rendering it brittle and easily destroyed; and T. endo-ectothrix, which both surrounds and invades the hair.
The study of artificial growths of these fungi will probably afford valuable information on the above points. In the ox the particular parasite is invariably the Trichophyton mentagrophytes, whatever may be the characteristics of the clinical lesion.
In France ringworm is particularly common in Auvergne and Normandy, where hygienic precautions are neglected, but cases may also be found throughout the country.
After affecting cows throughout the winter, the disease often disappears in the spring. Throughout the winter cows are kept in dark and often filthy sheds, where the parasite propagates rapidly, whilst in spring they are sent to grass, where the conditions are inimical to contagion.
Diagnosis. The diagnosis of ringworm seldom presents any difficulty. The appearance of the lesions (Fig. 266), their particular tendency to spread and contagious character, facilitate the diagnosis. They entirely differ from those of eczema or mange, and should any doubt exist, the slightest microscopic examination is sufficient to dissipate it. In ringworm in the ox the base of the hairs is covered with enormous numbers of spore chains, which do not extend into the depths.
To detect the parasites it is best to shave off a thin fragment of skin from the periphery of the patch, place it on a slide with a drop or two of 30 per cent. caustic potash solution, and heat it for a few seconds almost to boiling point. By applying a cover glass with firm pressure the epidermal cells are spread out and the parasites can be seen, especially around the roots of the hairs. Sometimes they form little dirty-yellow masses, consisting almost exclusively of spores.
When ringworm has attacked the entire surface of the body, it is much more difficult to distinguish from sebaceous eczema, and a microscopic examination or experimental inoculation may become necessary. Inoculation with ringworm material always succeeds with calves.
Prognosis. Ringworm is not dangerous in itself. In time it may disappear spontaneously, but when it extends over the whole body it may be dangerous. Owing to their bare condition the animals easily catch cold, while the epidermic proliferation is very great, and makes great demands on the animal’s bodily powers. Under such circumstances it is better to slaughter early.
Spontaneous recovery from small lesions may occur in two or three months.
Treatment. The patients should be isolated, and any brushes, combs, etc., with which they have been in contact must be disinfected.
The diseased areas should then be dressed with some fatty substance, to soften the crusts and enable them to be removed without injury.
Dressings are useless unless these crusts have been removed, for the spores are always in the deepest recesses and in the follicles, so that the drugs employed never come in contact with them.
Once the skin is cleansed, numerous chemical substances may be utilised, the solutions being applied for several days in succession. Amongst them may be mentioned tincture of iodine, oil of cade, 10 per cent. solution of sulphate of iron, and solution of perchloride of iron. Such drugs, however, must not be used for a long time, as they all attack the skin to some extent.
When the patches are small and well defined the following mixture proves very efficacious:—
| Crystallised carbolic acid | } | Equal parts. |
| Tincture of iodine | } | |
| Chloral hydrate | } |
Two or three applications generally prove successful.
Despite the natural activity of the spores, which are capable of germination after three months’ desiccation, some medicines are useful, although it is necessary, in order to judge of their effects, to wait for the renewal of the skin, hair follicles, and hair.
Where the disease is generalised this form of treatment is scarcely practicable, or at least it becomes more difficult.
Nevertheless, by dressing with soft soap the disease may be cured in a few months. The soap should remain on the skin for some hours and then be washed off, after which dressings of creolin, lysol, or chloral solution, etc., should be employed.
RINGWORM IN THE SHEEP, GOAT, AND PIG.
Little information regarding the dermatomycoses of the sheep, goat, and pig is available. Allowing for modifications due to the nature of the coat, the symptoms of recorded cases seem to indicate a close relationship with ringworm in the horse and ox.
In sheep suffering from ringworm, the wool is at first matted into small irregular tufts, which grow larger and more numerous. The coat appears felted together at various points. The neck, chest, shoulders and back exhibit crustaceous patches covered with branlike epidermal scales, and the animals suffer from marked pruritus, which causes them to rub and injure the coat.
Ringworm is very obstinate in the goat.
Two pigs described by Siedamgrotsky showed irregular, rounded patches, due to trichophyton, from 1 inch to 2 inches in diameter, reddish in tint, without exudation, but covered with abundant scales.
In the pig ringworm attacks the croup, sides of the chest, flanks and sides of the abdomen, but is commonest on the back and outside of the quarters. It forms red isolated patches, from 1 to 2 inches in diameter, covered with miliary vesicles, which in turn are replaced by brown crusts. The bristles remain unchanged, and are not shed or broken. There is no pruritus. Contagion from pig to pig occurs readily. The disease may be conveyed from oxen to pigs through the medium of litter removed from the cowsheds to the piggery.
Gerlach was unable to inoculate sheep or pigs with ringworm from the ox. Perroncito mentions a case of contagion from the ox to a lamb. Schindelka has seen sheep contract ringworm as a result of confinement to sheds previously occupied by oxen suffering from the disease.
Siedamgrotsky successfully inoculated two pigs and two sheep with ringworm from the horse and a goat with the bovine form of the disease. The two pigs inoculated two others by contact. Contagion from the goat to the ox was noted in the canton of Zürich in 1852.
Fuller particulars on these heads will be found in a series of articles by Neumann in the Revue Vétérinaire, January to June, 1905.
In 1876 Laillier communicated to a French medical society a letter written by Lespiau describing an endemic of trichophyton disease in the cantons of Céret and Arles-sur-Tech. Thirty-four persons, including twenty-eight children, were affected. A dog was first attacked and seems to have inoculated a pig, which in these districts often lives with the human family. The pig inoculated the human beings. A moist season appears to have favoured the development of the disease. The parts principally attacked were the head, eyebrows, cheeks, and neighbourhood of the genital organs. The subjects showed considerable pruritus.
CHAPTER IV.
WARTS IN OXEN.
Warts are cutaneous tumours, real papillomata, which most commonly attack young animals such as heifers. As a rule they are pedunculated, smooth, wrinkled or deeply cracked on the surface, but in some cases they are sessile.
Causation. The cause is difficult to ascertain. It has been referred to the growth of bacteria (Bacterium porri) in the superficial layers of the skin. It is at least certain that warts can be transmitted by inoculation or through the medium of cutaneous injuries.
Symptoms. On their first appearance warts consist in hypertrophy of the cutaneous papillæ, which become covered with layers of actively growing epidermis and end by projecting above the general surface. The lesions may remain isolated, or they may become confluent or unite at their base. This form is fairly common, the warts attaining the size of a man’s fist or more.
The disease attacks the most tender portions of the skin, such as that covering the udder, internal surface of the thighs, lower abdominal wall, region of the elbow, posterior surface of the ears, etc. In rarer cases warts may be seen on the limbs.
When they extend over a considerable surface they become infected, suppurate and give rise to various complications, the most serious being pyæmia. The patients lose condition and value.
Diagnosis. The diagnosis is easy. It has been proved that warts are contagious, not only as between animal and animal, but as between animal and man.
Prognosis. Warts are not dangerous to life, but they diminish the value of the animals, particularly that of milch cows when the teats are affected.
Treatment. Leaving out of account internal medication with calcined magnesia, many medicines that are still recommended are of comparatively little value.
Peuch and Cruzel recommend friction with oil of cade. Repeated cauterisation with nitric acid is declared to give good results by destroying the new tissue.
These modes of treatment, however, are impracticable in dealing with large multiple lesions, nor does the elastic ligature give much better results.
Total removal with the scissors or bistoury, or simply tearing out by hand, is preferable to any other course. Troublesome bleeding may follow, but is rarely of great importance. It usually stops in a few minutes, even where small arteries of the size of several millimètres in diameter have been divided. As a measure of precaution, however, the little wounds may be touched with the red-hot blade of the thermo-cautery.
The écraseur is rarely required. The smaller warts are generally sessile, and can be removed with a bistoury or a sharp curette. The removal of those about the udder requires considerable precaution to avoid injuring the teats.
Fig. 267.
All the growths are usually removed at one operation; Moussu has thus taken away 30 lbs. weight without the slightest ill effect. After the wounds have been washed with an antiseptic, the raw surfaces are powdered with a mixture of equal parts of boric acid, tannin, and calcined alum; cicatrisation occurs in a few days.
URTICARIA IN THE PIG.
This disease usually attacks pigs during the spring or summer, producing characteristic cutaneous lesions, which, however, are of a benign character. It seems to arise from some form of alimentary intoxication.
Symptoms. At first the dominant symptoms point to disturbance of digestion. The appetite is lost, and the bowels may be confined or there may be diarrhœa. This is sometimes accompanied by vomiting, and by fever.
The symptoms may develop fully in from six to twelve hours; sometimes the skin is covered with slightly prominent reddish patches, varying in size from ⅓ of an inch to 1¼ inches in diameter.
The patches may also become confluent and form large, irregular red or violet flattened swellings, sensitive to the touch and spread over the upper and lateral portions of the body. Only in exceptional cases is there any oozing of blood.
In favourable cases recovery takes place in forty-eight hours, and even in grave cases in from five to six days.
Diagnosis. It is sometimes very difficult to distinguish this condition from swine erysipelas, particularly in the first few cases, although the congested or hæmorrhagic patches occupy different positions.
The prognosis is usually favourable.
Treatment. The disease being unquestionably of digestive origin, the animals should be kept without food and receive repeated doses of mild purgatives according to their age and condition, sulphate of soda, 4 to 12 drachms, or calomel, 1½ to ·8 grains. Recovery is rapid.
SCLERODERMA.
This term is applied to a disease characterised by thickening and hardening of the skin. Up to now it has been described only in the pig, and principally in male animals or old animals of either sex.
The symptoms are difficult to detect, and in many cases are only discovered after slaughter. Without any change in external appearance, the skin becomes thick, hard and sclerosed over limited or extensive areas, and is thus transformed into hard, rigid, inextensible and inelastic plates, sometimes as much as 1 to 2 inches in thickness. The change usually commences about the dorsal region, and extends irregularly towards the chest and sometimes towards the limbs.
The patient thus becomes imprisoned in a kind of cuirass, which interferes with its movements and causes unaccountable stiffness. Palpation of the skin gives the impression of a piece of wood, for it is hard and resistant over the affected regions, whilst over the belly, inner surface of the thighs, and region of the elbow, it retains its usual pliability.
The patient exhibits no other symptoms, the principal functions of the body appearing to be properly performed. There is no fever, but in time the animals lose condition and waste away.
Causation. This disease is also well known in man, but no general agreement exists regarding its nature. Some refer it to disturbance of the thyroideal function, though scleroderma is quite different to myxœdema. Others attribute it to changes in the cutaneous blood-vessels, others, again, to peripheral neuritis accompanied by atrophic disturbance. Nothing, however, is proved.
The apparent lesions are limited to hypertrophic sclerosis of the dermis, with progressive atrophy of the layers of subcutaneous adipose tissue.
The diagnosis is comparatively easy.
The prognosis is grave, because it is never known how rapidly the disease may develop.
No method of treatment being known, the animals should at once be slaughtered.
CHAPTER V.
SUBCUTANEOUS EMPHYSEMA.
By subcutaneous emphysema is meant the condition produced by the entrance of air or gas into the subcutaneous and interstitial connective tissue. Emphysema may remain localised or it may become generalised, according to the nature and extent of the lesion which causes it, and the points where emphysema is developed. Subcutaneous emphysema is common in the sheep and ox.
Symptoms. Sometimes the symptoms of subcutaneous emphysema are extremely well defined. They consist in the presence of diffuse or limited crepitant swellings which may appear at various points—in the flank or the entrance to the chest; more rarely in the region of the elbow, etc.
The limits of crepitation may be ascertained by palpation, while percussion produces a peculiar abnormal sound. The subcutaneous tissue and very often the interstitial tissue appear as though blown out.
Emphysema may be generalised. Such an accident is rare, but may occur in the ox as well as in the sheep and goat.
Provided the emphysema remains confined to the subcutaneous tissue, the animals are not necessarily in danger. Where, however, it also extends to the interstitial tissue, and particularly if the cause to which it is due continues, death may result in a very short time. This occurs, for example, when the emphysema extends into the mediastinum, and thus gains the pleura and lung.
The symptoms of emphysema are then complicated with respiratory and circulatory disturbance and with signs of asphyxia.
Causation. Subcutaneous emphysema may be produced in many different ways.
If, for example, in puncturing the rumen the canula be carelessly withdrawn so that the skin is slightly separated from the subjacent tissues, gas may pass from the rumen into the channel produced by the instrument. It then becomes distributed throughout the subcutaneous tissue, and if the cutaneous opening is displaced its escape is confined to the connective and interstitial tissues in the region of the flank. Diffuse suppuration may then be set up in these parts, and may extend far beyond them.
In the ox emphysema rarely becomes generalised, but in the sheep and goat extension is more common; the patients perish of intoxication, caused by reabsorption of septic gases.
Under other circumstances emphysema may be due to an injury in some region where the connective tissue is loose and pliable, as for instance the region of the elbow, the internal surface of the shoulder, or the fold of the flank. Every time the animals move the tissues are displaced, and air being drawn in, it is imprisoned by the valve-like action of the injured part and gradually finds its way into the subcutaneous tissue.
Accidental injuries to the trachea, particularly injuries produced by dogs biting sheep or goats, are always accompanied by local emphysema, unless the wounds in the skin and trachea correspond, which rarely happens. At every respiration a portion of the air expelled passes into the peritracheal tissue, from which it gradually invades neighbouring parts, and may attain the mediastinum, etc. The injured animal thus inflates its own tissues and dies from asphyxia.
The open lesions due to pulmonary echinococcosis, and the accidents associated with pneumo-thorax, tuberculous caverns and abscesses, or pulmonary emphysema may become points of departure for local, general, interstitial or subcutaneous emphysema.
The diagnosis of accidental emphysema presents no difficulty, for the local swellings can only be mistaken for those of black-quarter. In the latter disease, however, fever is a constant accompaniment, whilst in simple emphysema it is absent.
Nevertheless, it is well to remember the possibility of complications due to compression, asphyxia, and even intoxication.
The prognosis may be very hopeful or very grave. Everything depends on the primary lesion, and it is therefore important that the practitioner should know how to interpret the course of affairs.
Treatment. In slight cases the best method is to immobilise the parts and await developments, but in grave cases, for instance where the trachea is much injured, the animal should at once be slaughtered.
Scarification, cutaneous incisions, and massage were formerly recommended as a means of aiding the escape of gas accumulated in the tissues. Such methods, however, are useless, and have the disadvantage of causing numerous suppurating wounds.
Provided the initial wounds are not seriously infected and the animals are kept quiet, in a well-ventilated place, the gas gradually becomes reabsorbed, and healing may take place in a fortnight or three weeks.
SECTION IX.
DISEASES OF THE EYES.
In domesticated animals, apart from parasitic diseases, the diseases of the eye which particularly deserve description and offer a special clinical interest are very few. These are the diseases that affect the globe of the eye or the organs annexed to it.