SYMPTOMATOLOGY. SEMEIOLOGY.
Definition. Symptom. Sign. Constitutional symptoms—local, objective, subjective, direct—idiopathic, indirect—symptomatic, premonitory. Anamnesis. Position. Movements. Decubitus. Acute. Chronic. Fever. Sthenic. Asthenic. State of limbs, muzzle, nose, snout, palmar-pad, hoof, bill, digits, mouth. Thermometry. Normal temperature, in doors, in field, at work, in hot season, in nervous subject, in thirst, in youth—age, starvation, plethora, cold, sleep, rest, stimulants, suppressed perspiration, eliminants, antipyretics. Fever temperature, morning, evening, transient elevation, persistent rise, sudden fall—collapse, crisis. Fatal elevation. Rise during defervescence. Pulse. Respiration. Skin, staring coat, pallor, coldness, dryness, harshness, mellowness, pliancy, hidebound, yolk, clapped wool, scurfy, lesions, itchiness, tenderness, loss of hair, emphysema, anasarca, sweat, sebum. Expression, life, dullness, paralysis, dropsy, jaundiced, eye, discolorations, photophobia, amaurosis, pinched face. Nasal mucosa, red, violet, etc., nodules, polypi, osseous disease, pentastoma, œstrus, discharge from teeth—sinuses—actinomycosis—tumors. State of the bowels, kidneys, nervous system.
The usual basis of diagnosis must be a clear and intelligent observation of the symptoms of disease. A symptom is an appreciable evidence of disease. A symptom however may indicate illness, without affording the means of diagnosis, while the term sign is often used for a pathognomonic symptom—one by which the disease can be identified. Used in this sense a sign may be said to be a diagnostic symptom.
1. Constitutional Symptoms are such as affect the entire system, like a rise of body temperature, or a shivering fit.
2. Local Symptoms are confined to a definite area as redness, tenderness, swelling, ulceration.
3. Objective Symptoms include all that can be recognized by the senses of the observer. These alone are available in dealing with the lower animals.
4. Subjective Symptoms can only be felt by the patient himself, as pain, giddiness, cold, heat, blindness, numbness. Such symptoms are therefore only obtainable from the human patient who can tell how he feels. In the lower animals they can only be matter of inference, thus pain may be inferred from lameness or wincing on pressure, and giddiness from unsteady gait. The fact that the veterinarian is restricted to objective symptoms renders his task a specially difficult one, yet this has its compensation, as this very restriction tends to train the observant practitioner to greater skill.
5. Direct Symptoms (idiopathic) are those which are connected with the seat of disease, as the redness, exudation, and swelling of inflammation.
6. Indirect (sympathetic, dependent) Symptoms are observable at a distance from the actual disease:—as when headache attends on dyspepsia, or lameness in the right shoulder upon disease of the liver.
7. Premonitory or precursory symptoms precede the diagnostic symptoms of some diseases, thus dullness and languor often heralds an approaching fever, and the strangles of young horses is often preceded by a general unthrifty appearance, poor appetite and indisposition to exertion.
In observing symptoms as in other things, some have far greater natural ability than others, but in all a careful training will do much to develop and improve the power and habit. A most important thing in such habits is the strict maintenance of a system, not to be followed as a cast iron rule but to be constantly kept in mind and strictly carried out except when sound judgement and experience show it to be unnecessary.
Anamnesis. As a rule the first thing to be learned about a patient is his history, and personal and hereditary characteristics. What are his general health, temperament, previous attacks, hereditary predisposition, environment? Is the site of the building, its condition as regards soil, springs, drainage, structure, ventilation, light, cleanliness such as would favor any particular disorder or class of disorder? Is the patient in high, low, or moderate condition, robust or debilitated, alert and lively or dull and stupid? Have other animals suffered recently, or at a corresponding season, or under similar conditions in apparently the same manner? How long has the patient suffered, were there any premonitory indications of illness, what were the first symptoms, and what symptoms have followed up to the present? Has there been any change of food, water or management that might throw light on the cause? Has there been any change of weather or unwonted exposure to cold, storm, overwork, compulsory abstinence or enforced retention of some secretion? If a female is she pregnant?
Having exhausted this method, using such lines of inquiry as promise good results in the particular case, the veterinarian is prepared to bring his own powers of observation to bear more directly.
Position and movements will often furnish valuable data. The horse which lies on his ribs, stands obstinately in chest diseases, or whenever there is much interference with breathing. The ruminants and carnivora on the other hand which lie on their smooth or padded sternum, can breath with comfort in this position and only stand up persistently in the worst cases. The habit of standing day and night is also characteristic of anchylosed back or loins in the solipede. Roached back may be natural, or the result of overwork and slight sprains or injuries of the loins, of anchylosis, of intestinal or renal inflammation, or of certain injuries to the limbs. The extension of the head on the neck may suggest sore throat, chest disease, tumors around the throat, abscess (fistula) of the pole, sprain or spasm of the extensors of the neck, disease of the axoido-atloid joint, tetanus, or cervical rheumatism. Dropping of head and neck might suggest paresis, mechanical injury to the levator muscles or cervical ligament, extreme debility, or prostration from a profoundly depressing fever or poisoning. Inability or indisposition to back, might indicate sprain or fracture of the back, anchylosis, laceration of the sublumbar muscles, paresis, cerebral or spinal inflammation, softening or other lesion, tetanus, laminitis, dislocated patella and certain other affections. Swaying or unsteadiness in walking or turning would similarly suggest sprain or fracture of the back, paresis and other nervous and locomotor injuries. The solipede with peritonitis arches the back and draws the hind feet forward under the belly, with impacted colon or obstruction to urination he will often stretch with fore limbs advanced and hind limbs retracted. The mode of decubitus may be significant. With peritonitis, enteritis, metritis or acute nephritis or hepatitis the solipede lies down slowly and with caution: with spasmodic colic he throws himself down as if reckless of possible injury. Lying well up on the costal cartilages and side of the breast bone suggests a slight affection of the air passages; lying on the side, disease of other parts. Rolling on the back may indicate simple intestinal spasm, but also blocking by intussusception, impaction, volvulus or otherwise. Sitting on the haunches may suggest a similar trouble or it may imply ruptured stomach or diaphragm. The dog may sit on his haunches in health, or with dyspnœa in acute affections of the respiratory organs, asthma and heart affections. Decubitus on the belly with hind legs extended backward, may imply paraplegia, or acute inflammation of the abdominal organs. Lying with the nose in the flank or turning the head toward the flank, though a normal position of rest, often indicates abdominal suffering. Turning of the head to one side may, however, suggest injury, spasm or rheumatism of the cervical muscles, or disease on the corresponding side of the brain. Animals, at liberty, lie more frequently on the side on which the heaviest internal organs are lodged, thus ruminants, pigs, and dogs rest on the right (the side of the liver) though in cattle with a heavily loaded rumen the condition may be reversed. Decubitus on the abdomen, with the limbs extended and abducted implies profound nervous disorder or shock.
Habitual decubitus often indicates severe suffering in legs or feet. Resting one limb more than another implies injury to that limb. Standing with the pastern of one limb more upright than the others has the same meaning. Extension of one fore foot in advance of its fellow with flexion of the pastern and fetlock denotes suffering in the posterior part of the foot or in the flexors. Flexion of carpus and fetlock without advance of the foot probably bespeaks injury to shoulder or elbow. Inability to bear weight on the fore limb, without knuckling at the knee, should call for examination of the olecranon and joints especially the elbow. Inability to extend the carpus should lead to investigation of the flexor muscles and tendons, the joints and the heel. Movement of the hind limb without flexure of the tarsus would suggest injury to that joint, the stifle or the flexor metatarsi tendon. Inability to extend stifle and hock, should demand examination of the tendo-Achillus and olecranon, of the triceps extensor cruris and of its nerves.
Atrophy of a muscle or group would require scrutiny of its tendons and its nerve and blood supply.
More precise indications of injury of the locomotor system must be found under surgery.
After posture, the general or constitutional disorder may claim attention. Is the illness acute or chronic? Is fever present? Has the animal had a rigor? Does the coat stare in patches (along the spine) or generally? Is there perspiration? Is there full, clear, somewhat congested eye (sthenic) or drooping lids over a dull brownish sclerotic (asthenic). Are the lower parts of the limbs and other extremities cold, and the roots of the horns or ears hot? Is there significant heat and dryness of the muzzle (ox), nose (dog), snout (pig), palmar-pad (carnivora), hoof (solidungala, bisulcates), bill and digits (birds)? Has the mouth the hot burning feeling of fever? Finally is the temperature as indicated by the thermometer abnormally high? To estimate this with any degree of certainty one must be well acquainted with the normal temperature.
Normal temperature. As taken indoors under ordinary conditions, the normal temperature taken in the rectum may be: fowl, 107°–110°F.; swine, 103°–106°F.; goat and sheep, 103°–104°F.; ox, 100°–102°F.; dog, 99°–100°F.; horse, 99°–99.6°F. Ranging in the fields, at work, or on forcing or stimulating feeding, it may be 1° higher than when at rest indoors. A whole herd may be raised 2° by a three miles drive in warm weather. In our summer heats a rise of 1° is common. In nervous animals any change in management may raise the temperature, for example, 1° to 2° after failure to water at the usual time, or from retaining the milk in the udder when the milker had been changed. Young animals are normally .5° to 1° warmer than old ones though more sensitive to the action of cold. Half starved animals, when put on abundant and nutritious food may have a rise of 1° or more. Females in heat, in advanced pregnancy and at the time of parturition are usually 1° to 3° above the natural temperature. Among the agencies lowering temperature are: cold, (1° to 2°); sleep, (1° to 2°); rest; starvation; alcoholic and other circulatory stimulants which fill the cutaneous capillaries and thereby cool the whole mass of blood; suppression of insensible perspiration (retention of waste matters) as by varnishing the skin which lowers the temperature to 25°; purgatives and diuretics (1°); certain drugs like antipyrin, acetanilid, etc., which act on the heat producing centres and retard metabolic changes.
Temperature in disease. Comparative temperatures should be taken at the same hours on successive days, bearing in mind that the morning temperature is usually slightly lower and the evening one slightly higher. Where possible both morning and evening temperature should be taken. With elevated temperature, repeat sooner to see that it is not transient. A transient rise of 1° to 2° is unimportant. A permanent rise of 2° or 3° indicates fever. A sudden additional rise of several degrees in the progress of fever is grave. A persistence of the high evening temperature to morning shows aggravation. A persistence of the low morning temperature to the evening bespeaks improvement. A sudden extreme fall to much below the normal (4° or 5°) indicates collapse. This is usually attended with other symptoms of extreme prostration and sinking. A sudden considerable fall to near the normal, without untoward attendant symptoms, may indicate a crisis and a more or less speedy improvement may be hoped for. This sudden fall often attends the period of eruption of certain exanthemata, as cowpox, horsepox, sheeppox, aphthous epizootic, etc. A sudden extensive fall of temperature may result from some transient accidental cause, as a prolonged deep sleep, a hemorrhage, the relief of constipation, or of enuresis. A sudden rise may supervene on such suppressed function or other cause of nervous irritation or on toxin poisoning, but it does not persist more than twelve or twenty-four hours after the cessation of the morbific cause.
A rise of 10° or 12° above the normal standard is usually promptly fatal.
A continued high temperature indicates persistent disease, and a considerable rise during defervescence implies a relapse and in the absence of any error in diet or nursing is grave.
Pulse. Before the introduction of the clinical thermometer, the indications furnished by the pulse were held to be of the highest value. Though largely superseded by the usually more reliable thermometer, yet they should not be discarded, but employed as symptoms corroborative of the thermometric indications. In many cases the pulse will furnish criteria, when in the absence of fever, the heat of the body will tell of nothing amiss. This is especially true of diseases of the heart, the large blood vessels, and of the nervous system, and in cases of poisoning. For special indications furnished by the pulse, see diseases of the heart.
Respirations. The morbid activity or inactivity of the respiration, its modified rythm, the pathological significance of the altered breathing sounds and of the superadded sounds, the indications furnished by percussion, palpation, mensuration, succussion, sneezing, snorting, yawning, cough, moan, grunt, stertor, discharge, etc., afford material of inestimable value to the diagnostician. See under diseases of the chest.
Skin Symptoms. The erection of the hair of carnivora in rage or fear implies a profound nervous disturbance, and a similar erection (staring coat) in the larger herbivora especially, implies a corresponding nervous disorder, due however to a different cause. The pallor and coldness of (white) skin and extremities the retrocession of blood toward the internal organs, the contraction of the involuntary muscles of the hair bulbs, the sense of cold, and the actual shivering all come from the fundamental nervous disorder. The loss of lustre and gloss in the hair and the dryness, rigidity and mobility (mellowness) of the skin imply lack of nutrition. The mellow feeling of the skin under the pressure of the finger, soft and yielding by reason of the lax connection tissue and fatty layer in the thrifty animal, is in marked contrast with the dry, hard, tough, unyielding hide firmly adherent to the parts beneath (hidebound), which denotes the unhealthy or unthrifty animal, or from the thin, attenuated, mobile, bloodless skin of the debilitated subject, the victim of lung, liver, or intestinal worms. In sheep in parallel conditions there is a lack of yolk in the wool, which is dry, lustreless and brittle and often flattened (clapped) on the skin. In fowls ruffling of the plumage indicates the nervous disorder and chill. The skin may be scurfy in conditions of low health or in connection with the presence of vegetable or animal parasites. Ringworm has excessive scurf, and tends usually to a circular form, and to complete shedding of the hair from the spots. The hairs split up before dropping. In acariasis there may be scurf, scab, abrasion and sore of many kinds, but the outline is not necessarily circular, nor strictly limited, isolated hairs remain even on the bare patches, and itching is extreme as shown by the movement of the body and especially of the lips or foot when the part is scratched.
The hair may be freely shed during convalescence from debilitating diseases, a condition that must not be confounded with the yearly shedding of the winter coat and the moulting of birds, which is a perfectly normal process. Yet even the spring shedding and the growth of the new coat makes a great drain on the system, and must always be taken into account as a probable cause of derangement of health.
The lesions of the skin in the different cutaneous affections must be remanded to the special chapter on skin diseases. The following however may be named as having a general bearing.
Emphysema may be due to a local wound, (elbow, trachea, rib); it may indicate black quarter, or it may occur subcutaneously in cattle without marked impairment of health.
Anasarca, from diseased blood, heart, liver or kidneys is denoted by swellings, often painless, or a general infiltration which pits on pressure. It often shows primarily in the lower parts of the hind limbs. Warty looking elevations must be carefully discriminated, having in mind primarily papilloma, tubercle (grapes), actinomycosis, condyloma (in dogs), cancer, melanosis. The secretions of the skin (sweat, sebum) may be suppressed, or in excess, producing at times a special odor, as in thrush and canker of the horse, cowpox and sheeppox, and rheumatism. Before death the cadaveric odor may be marked, and attracts crowds of flies to the victim.
Facies. The countenance may be expressive. Between the bright, full, clear, prominent eye of health, and the dull, sunken, lifeless, semi-closed eye of serious disease the contrast is extreme. The drooping lids (ptosis) may be paralytic and even unilateral, in which case drooping ear, and flaccid lips and alæ nasi complete the picture. With paralyzed lips there is usually drivelling of saliva, and dropping of half chewed morsels in the manger and stall. The eye may show dropsical lids in kidney or liver disease and in anæmic conditions like distomatosis in sheep. It may show the upper lid bent at an angle in recurrent ophthalmia of solipedes. The mucosa may be red in ophthalmia, yellow in jaundice, dusky brown in Southern cattle fever, anthrax, cerebral meningitis, and other fevers attended with destruction of red globules and liberation of their hæmatin. The pupils may be all but closed in internal ophthalmias, or widely dilated and irresponsive to light in amaurosis. The iris may lack its normal lustre or may be distorted or torn in various ways from adhesions. Opacities of the cornea, lens, or vitreous may be recognized.
The facial muscles may be flaccid and devoid of expression in palsy, and prostrating diseases; they may be firm, giving the bright, intelligent look of health; or they may be painfully drawn in the agonized expression of spasmodic colic or enteritis.
Nasal Mucosa. The pituita is bright red in sthenic fevers, simple acute coryza, strangles, laryngitis and inflammation of the larger bronchia. It assumes a violet hue in capillary bronchitis, pulmonary congestion, glanders, and petechial fever. Petechiæ appear in the last named affection, and in a number of bacteridian diseases, such as anthrax, swine plague, hog cholera, the red fever of swine etc.; a yellow tinge in shown in jaundice. Millet-like or pea-like nodules, or elevated patches, and ulcers show in glanders and may be felt by the fingers. In cattle hard millet-like nodules appear in a chronic coryza with hypertrophy of the mucosa. The orifice of the lachrymo-nasal duct, seen in the horse on the floor of the chamber at the friction of the mucosa with the skin of the false nostril and in ass and mule on the outer ala near the upper commissure, is sometimes plugged with inspissated mucus. Among other lesions of the nasal chamber may be named polypi—soft and calcareous,—thickening and obstruction in purpura hemorrhagica, osteoporosis and hypertrophy of bone, and parasites—pentastoma denticulata (in the horse and dog), and the larva of the œstrus (in sheep and buffalo). Disease of the upper molars and abscess of the fronto-maxillary sinus may be manifested by swelling beneath and on the inner side of the eye, fœtid discharge from the nose, and obstruction of the air current. Dullness on percussion will show the filling of the sinuses. These conditions must be carefully differentiated from actinomycosis, sarcoma and other morbid growths in the same situation.
Costiveness with fœtor and lack of the normal color in the stools may suggest liver torpor or inflammation, while fatty stools may suggest pancreatic disease. The uneasy movements of colic, should lead to a careful investigation of the chylo-poietic organs (see digestive organs). Weakness of the hind parts, tenderness of the loins, and altered condition of the urinary discharge should demand a close enquiry into the state of the kidneys and bladder. Satyriasis or nymphomania would suggest disease of the generative organs or the nerve centres that preside over them. The same is true of impotence, sterility and abortion.
In eruptions on the skin (erythema, eczema, pustule, squama) a cause may be found in the local action of heat, friction, or other direct irritant, but in the absence of any such manifest cause, an enquiry should be made into the functions of sanguification, digestion, urination and the action of the liver. It may further suggest parasitism (ring worm, phthiriasis, fleas, acariasis, verminous disease, etc.)
Symptoms of nervous disorder are too numerous to be here traced to local lesions. Motor paralysis of one limb may, however, suggest injury to its motor nerves, to the same side of the spinal cord, or of the opposite half of the cerebrum. Paraplegia almost always indicates injury to the cord. Sensory paralysis of one side may depend on disease of the opposite corpus striatum. The animal moves in a circle when a tumor (coenurus in sheep) exists in the roof of the lateral ventricle presumably pressing on the ganglia on its floor. An animal rolls on its axis when there is a lesion of the median cerebral peduncles, of the supero-external portion of these peduncles, of the posterior part of the encephalon, or of different parts of the hemisphere. Amaurosis suggests disease of the corpora quadrigeminia. Loss of coördination of muscular movement usually implies some lesion of the cerebellum. Vertigo may imply disease of the encephalon (congestion, anæmia, inflammation, dropsy, hæmorrhage, tumor, abscess); it may be disease of the internal ear; it may be digestive disorder connected often with cryptogamic poisoning; it may be heart disease with obstruction of the jugular veins; it may be parasites in the nasal sinuses; or it may be disease of the eye. Coma occurs in most congestions and pressures on the encephalon, and like vertigo in poisoning by alcohol, solanine, monoxide of carbon, etc. In acting on any ganglionic centre the agent may, according to its degree, operate positively or negatively, producing spasms, or paralysis as the case may be. As in the case of other visceral affections the specific diseases must be referred to for particular symptoms.
For the more precise points in diagnosis, including chemical, physical, electrical and instrumental methods, etc., the reader is referred to the special diseases.