Chapter XXIII: Part 23

In acute cases and especially in fat pampered dogs, and in all cases associated with torpid or disordered liver, a preliminary laxative will be of great service, and others should be given later as demanded. The horse may have aloes or salines, and saline enemata may be given to all animals when called for throughout the progress of the disease. Pigs may take 1 or 2 drops croton oil, or like dogs they may be given castor oil or jalap. Torpid liver and constipation must always be carefully guarded against.

To cut short the attack much reliance was formerly placed on colchicum which increases the elimination of solids in the urine, and on alkalies, which beside the theoretic antagonism to acidity are at once chologogne and diuretic. The action was somewhat slow but on the whole satisfactory, usually abating the suffering very materially in the course of a few days. To the horse or ox ½ dram doses of colchicum were given daily in combination with 4 to 6 drams of bicarbonate of soda; pigs of 100 lbs. may take 1 grain of the former to 10 grains of the latter; a shepherd’s dog may take half the amount just named. Trimethylamine proved even more effective than colchicum, and acetate or citrate of ammonia, soda, or potassium was often substituted for the carbonate.

But the modern treatment of rheumatism dates from 1876, when the introduction of salicylic acid and later sodium salicylate, salicine and ol. gaultheriæ gave to such treatment an efficacy previously unknown. Salicylic acid acts very harshly on the gastric mucosa, and with sensitive stomachs is advantageously replaced by sodium salicylate, into which it is transformed in any case in the blood. Salicine which is held to be transformed into salicylic acid in the system, is specially recommended for its bitter and tonic action exercised in the stomach and prior to such transformation. In debilitated subjects, therefore, and in those that suffer from the characteristic rheumatic reduction of the red blood globules it would be somewhat preferable. As a prompt and effective anti-rheumatic agent however it appears to be somewhat less reliable than sodium salicylate or ammonium salicylate. Ol. gaultheriæ may be better borne by the stomach of the dog and pig than the salicylates, the dose being 10 to 15 drops thrice a day.

The secret of success with all of these salicylate compounds, lies in the speedy saturation of the system with the drug, rather than in its moderate and continuous administration. The horse or ox may take ½ oz. repeated every two hours for ten hours if relief is not obtained earlier. The pig may take 20 grains, and the dog 5 to 10 grains at similar intervals. It is not desirable, however, to continue this indefinitely, and therefore when immediate relief has been secured it is well to give the agent but twice or thrice a day, and resort in part to the alkaline treatment. If the salicylates fail to relieve when pushed energetically for ten hours, there is reason to fear that the case is not one of genuine rheumatism.

The salicylates are less applicable to chronic cases and may be even dangerous when the heart is affected, as they tend to render the heart’s action slower and weaker, and thus add to the dangers of hypo-hæmoglobin, and heart failure. A similar caution applies to an excessive use of alkalies and especially of compounds of potassium which depress the heart action.

As substitutes for the salicylates, salol, salophen, phenocoll, antipyrin and acetanilid have been largely resorted to. The first is safe and trustworthy and does not irritate the stomach nor interfere with digestion. It may be given to horse or ox in a dose of 3 drams, thrice a day, to the pig in 10 grain, and to the dog in 5 grain doses.

Hübner had good success with pilocarpine hydrochlorate hypodermically (4 grains for a 7 months colt,) but this was not equally successful in the hands of Siedamgrotzky. Other sudorifics like tartar emetic, Dover’s powder, ammonium acetate, hot or spiced drinks (chamomile, boneset,) hot baths, hot air baths, and wet packs have been used successfully and may still be employed in suitable cases. The opium is often very helpful in relieving intense suffering, and beside or in place of the Dover’s powder internally, morphia may be injected subcutem over the affected region. The main objection to its use is its tendency to lock up the liver and bowels. Liquor of the acetate of ammonia fills at once the rôle of a potent diaphoretic, an antacid, and an eliminant.

In the use of baths and packs it is well to consider the condition of the patient. If the surface is cold with little reaction, and if the attack has supervened on exposure, or chill, persistent hot applications are indicated. Dogs and other small animals should have full hot baths lasting for 15 or 20 minutes, and while in full glow may be quickly sponged with cold water and rubbed dry in blankets, great care being taken to avoid exposure or chill when damp. Or for these and the larger animals as well, a hot air or steam bath may be applied under similar precautions. A cold wet wrapping on the cranium will tend to relieve cerebral congestion during the administration of the hot bath. In horses and cattle surface heat and sudation may be secured by active rubbing with wisps of straw, of both body and limbs, or by covering the neck and trunk with large bags containing a small amount of chaff, sand or grain hot from an oven. Hot carminative or alcoholic drinks are excellent adjuvants, and even sedatives or nauseants (opium, veratrum, aconite, tobacco). Another resort is to pass a hot smoothing iron an indefinite number of times over the affected region. The part may be finally wrapped in cotton.

In cases where the temperature runs high, on the other hand, and when the surface glows, this dread of chill and reaction may be dismissed. For the small animal a bath starting at 70° F. may be gradually lowered to 60° or 50° F. Or a full pack may be employed, a sheet wrung out of cold water being closely wrapped around the body, and covered at all points with two or more dry woolen blankets, care being taken to avoid the entrance of air and the occurrence of evaporation from the inner, damp layer. This cools the surface and the blood returning inwards, and in fifteen or twenty minutes it should induce free perspiration. It may be kept up twenty to thirty minutes and may be repeated as often as there is a serious rise of temperature. A less energetic method is the mere sponging of the surface with cold water. In all such cases friction is a valuable accessory.

Anodynes and revulsives are often applied to the affected parts with good results. In very acute cases (especially articular), lotions and liniments of salicylic acid or salicylate of soda with laudanum, aconite, or chloral hydrate may be used. In the less violent cases camphorated spirit, soap liniment, or a combination of essential oils (gaultherium, turpentine, cajeput, origanum, peppermint) with aqua ammonia and sweet oil may secure great relief. Mustard or essential oil of mustard in vaseline is an excellent alternate. Finally active cantharidine blisters are usually most effective. These are applied over the affected joints or muscles and if the inflammation shifts to other parts it is followed up until it finally disappears. A concurrent alkaline treatment, and more important still, absolute rest, will serve to protect the heart to some extent, against a metastasis from the exterior. It has been supposed that the beneficial action of the blister is in ratio with the amount of exudate, and hence cantharides has been highly esteemed in this connection. Friedberger and Fröhner have used tincture of iodine and biniodide of mercury.

The local application of anti-rheumatic agents would embrace all the salicylates, oil of wintergreen and guaiacol, the latter mixed with an equal amount of glycerine. Methyl salicylate has been strongly recommended for external use.

Stengel covers the surface with lint smeared with salicylate of methyl ointment, and then applies a plaster bandage over all. This removes muscular spasm, pain and swelling and is rarely required for longer than a few days.

In cases in which salicylates fail, other agents have been resorted to in man and to a lesser extent in the lower animals. Greenhow strongly advocates a combination of quinine and potassium iodide internally, while Russell Reynolds has successfully employed tincture of muriate of iron in large doses repeated every three hours.

In _chronic_ cases these would especially commend themselves as calculated to repair the general health and overcome the loss of hæmoglobin. In _chronic rheumatism_ a course of tonics is often the best resort, and in dogs especially cod liver oil has benefited when all else had failed. Arsenic too (3 to 8 drops Fowler’s solution thrice daily) has been beneficial in both dogs and pigs. In other cases iodide of iron has been helpful. So also with gum guaiacum given in combination with potassium iodide. In such cases too, treatment by alkalies and salicylates may be called for, and close attention should always be given to secure a free action of the liver, bowels and kidneys. The local treatment recommended for acute rheumatism, (hot baths, frictions with essential oils and above all blisters of mustard or cantharides) is even more applicable to the chronic. A firm bandage over a covering of cotton wool, and a systematic application of electricity will often help. Warmth, a run at grass in a sheltered sunny paddock, moderate exercise and a nutritious and easily digestible diet are important conditions.

GOUT. PODAGRA. ARTHRITIS URICA.

Definition. Affects birds, dogs, perhaps pigs. Causes: excess of
nitrogenous food, imperfect oxidation, impaired metabolism and
elimination. Susceptibility of birds in confinement. Xanthin bases.
Nuclein. Hepatic torpor. Contracted kidney. Affects tissues of little
vascularity. Lesions: chalky deposits around joints, and in internal
organs. Solubility of biurate of soda in synovia, serum, etc.
Symptoms: arthritis, joint tenderness, resting on breast, hard or
fluctuating swellings, desquamation, ulceration, chalky urates.
Diagnosis: test for biurate. Treatment: less albuminoid diet,
eliminating salts, colchicum, piperazin, surgical and antiseptic
dressing.

_Definition._ An arthritis characterized by periodical exacerbations, by the deposit of sodium biurate in and around the joints and at times in other parts of the body, and by more or less constitutional febrile disturbance during the paroxysms.

_Animals susceptible._ Among the lower animals the disease has been noticed almost exclusively in birds, which even normally excrete so much uric acid that the liquid may be semi-solid as found in the cloaca or in the droppings. While this is a constitutional peculiarity in the bird yet it is enhanced in connection with an abundant diet of rich nitrogenous materials, as in forced feeding, and in old animals in which the eliminating action of the kidneys is more or less impaired. Ebstein has shown that gout can be produced in birds by tying the ureters. All domesticated birds, chickens, turkeys, pigeons, ostriches, geese, ducks, Guinea fowl, have been found to suffer. A case of gout has been reported in a =dog=, and Pradal has described it as existing in swine, but the symptoms given are more in accord with articular rheumatism.

_Causes._ The causes of gout are overfeeding especially on highly concentrated nitrogenous food, acid sweets, and in turn sweet and acid alcoholic drinks, an excess of uric acid in the blood and tissues, imperfect oxidation of albuminoids, impaired metabolism, imperfect elimination of uric acid, and impaired innervation. Probably no single morbid condition is in itself sufficient to induce the disease but a combination of several, unquestionably operate in many cases.

The uric acid theory is favored by the constant presence of this acid in considerable amount in the blood of birds, and by Ebstein’s experiment in tying the ureters, but it has to face the fact that young and active birds living in the open air, and hunting for their food do not suffer, that it is usually scanty in the blood of man just before an attack, that Gilman Thompson failed to produce any symptoms of gout by injecting into the blood of animals more uric acid than the amount which they normally excrete in twenty-four hours, that the familiar symptoms of uric acid poisoning are not at all those of gout, and that the excess of uric acid in leucæmia, anæmia and pneumonia produces no such symptoms. In addition to excess of uric acid some other factor is required.

_Xanthin bases_ (Xanthin, hypoxanthin, etc.) found in the blood by various observers, are derived from albuminoids, especially nuclein and nuclein bases, including in man caffein and theine, and being closely allied to uric acid are believed to have a nearly similar action.

Various forms of abnormal metabolism are invoked as the cause of uric acid and gout, and Haig and Vaughan hazard the theory that the breaking down of the nuclein is an important factor. This and other metabolisms are attributed to the local action of the uric acid and urates, and again to a fault in innervation. The imperfect action of the liver where the uric acid should be largely resolved into the more soluble urea, and of the kidneys through which it should be promptly excreted must be attributed to a nervous source. Levison incriminates the granular, contracted, inactive kidneys.

Ebstein attaches great importance to impaired nutrition in the affected tissues which undergo necrotic changes that pave the way for the deposition of urates in their substance. This is somewhat sustained by the occurrence of the local deposits in tissues in which circulation and nutritive changes are slow, and in older animals in which not only are the osseous tissues more calcic and less vascular, but the articular lamella has been formed by cretefaction of the bone and cartilage. Haig suggests that in the old, the joints are less vascular and less alkaline, and more sensitive to cold. On the other hand those in the greatest vigor of life are more ravenous, digest more actively and are in this sense more subject to injury from excess of uric acid and allied products. Birds at this age, confined and in process of fattening are thereby exposed. Overfed, obese, lazy, old house dogs are under similar causative conditions.

_Lesions._ The most prominent lesions in birds are chalky concretions of urates on the articular ends of the bones and in the structures around the joints including even the tendons, with more or less inflammatory exudate and even necrosis, invading the bony tissue and articular cartilage. Abscesses may be present usually outside the bursa. Birds suffer especially in the tarsal, metatarsal and phlangeal joints, but often also in the corresponding joints of the wing, and less frequently in the joints of the trunk, and in the internal organs,—kidneys, liver, lungs, serosæ,—and skin. In these last, miliary chalky concretions and encrustations are found. In Brückmüller’s case in the dog the chalky deposits of urates were found mainly on the epiphyses of the ribs, but also on the joints of the limbs.

Uric acid is always abundant in the blood of birds, and Roberts has shown that biurate of soda (the usual form of precipitate) is insoluble in blood serum, synovia and other body fluids when in excess of 1:10,000.

_Symptoms._ In birds the febrile and constitutional symptoms have not been carefully observed so that the objective symptoms in the affected joints have been mainly relied on. There is extreme tenderness marked by standing on one limb, or resting on the breast, and hence moping apart from the flock. When made to rise, the affected limb may be used to steady the body, or even to walk, with a limp, though in bad cases the sound limb only may be used. The affected joints are swollen, soft, hot, extremely tender, pitting on pressure, and later the seat of nodular yellow masses, usually hard, but sometimes fluctuating and in size from a pea to a hazel nut. The superimposed epidermis is thick, dry and scaly, falling off in flakes. At a more advanced stage the concretions may burst through the skin, discharging a buffy, granular, debris containing crystals of urates of ammonium or calcium, or of uric acid. Later still are ulcerous sores, involving the disintegrating urate nodules and the necrotic bones and cartilages. The deposits deflect the bones from their normal direction, causing not only nodular swellings on the toes but much crookedness and distortion. As in man the disease is essentially chronic and advances slowly, with anæmia, emaciation, debility and at times diarrhœa.

_Diagnosis_ depends largely on the recognition of the excess of urates in the deposits. These appear under the microscope as fine acicular crystals, which in the harder portions have a concentric arrangement. A portion of the concretion may be moistened with a few drops of nitric acid and evaporated to dryness. To one part of the residue is added, by means of a pipette, a drop of aqua ammonia, and to another caustic soda. The ammonia develops a beautiful purple red color, and the soda a blue or purplish blue ring (Murexide test). In tubercular joints, which are common in birds, the caseated nodule is made up of cells and granular debris, with tubercle bacilli, and though cretaceous particles may be present they fail to give the microscopic and color appearances of uric acid.

_Treatment._ This must be largely preventive. The rich albuminoid feeding and close confinement must be modified especially in the older birds, and eliminating agents must be given in the drinking water. The Carlsbad combination (sodium sulphate 22; potassium sulphate 1; sodium chloride 9; sodium bicarbonate 18) may be used. Powdered colchicum ¼ gr. once or twice daily during an attack, or piperazin ½ gr. twice a day. Locally, abscesses should be opened, and like any sores or ulcers, treated with antiseptics (Salicylate of sodium 75 grs., glycerine 2 ozs.; or piperazin solution 2:100).

SCURVY: SCORBUTUS.

Definition. Susceptible animals: pigs, dogs. Causes: unwholesome salt
meat, lack of fresh food, vegetables, potassium, bad environment,
unvarying diet, lack of free range, putrescent food, foul water,
infection; non-recurrence. Lesions: blood black, diffluent, little
rigor mortis, excess of sodium, petechiæ and extravasations, red
marrow, softened, swollen, bleeding, ulcerating gums. Symptoms:
Anorexia, prostration, debility, tardy movements, petechiæ, loss of
bristles, ulcers, gum lesions, joint swellings, blood extravasations.
Diarrhœa. Prognosis unfavorable. Treatment: correct unwholesome
environment and food, wash, rich food partly green or animal, iron,
bitters, arsenic, mouth wash (potassium chlorate), for suckling milk.
Butcher.

_Definition._ Scurvy is a subacute or chronic trophic disorder characterized by debility, inanition, anæmia, swelling and bleeding of the gums, gingival ulceration, dropping of the teeth, and petechial or more extensive hæmorrhages and exudations in the skin, serosa, and solid tissues.

_Animals susceptible._ In past times _man_ has suffered extensively in connection with unwholesome food and environment, on long sea voyages, on uninhabited islands, in military campaigns, in besieged cities, in famines, when restricted to one article of food, etc. Among the lower animals, =pigs= especially suffer, when kept in close, foul quarters and fed a monotonous and insufficient ration. =Dogs= suffer under similar conditions, and probably other animals would if equally badly used.

_Causes._ Formerly it was attributed to an exclusive diet of salt meat and bread; to excess of sodium, and deficiency of potassium salts; to the absence of fresh vegetables; to tainted food, etc. A broader generalization shows the Eskimo living on a pure meat diet, the Mongolian on rice alone, the Congoese on plantains, and without scurvy. Yet it cannot be denied that these various conditions undermine the general health, and prepare the system for those faulty states of nutrition which are seen in scurvy. In pigs the food and environment are usually chiefly at fault, the subjects have been kept closely confined in foul buildings, in a hot, moist atmosphere, and with an uniform diet of maize or other unvarying and insufficient ration. It does not appear when there is a free access to a spacious yard or open field, and when the monotonous diet can be varied by a variety of slugs and other invertebrates. Röll attaches great importance to a putrid condition of the aliments (putrescent swill). Benion has found it mainly in obese swine, the forced feeding and intestinal fermentations manifestly operating as factors. Corrupt drinking water has proved a manifest factor among men living in camps, and pigs above all other animals are subjected to this cause. Benion says it occurs in the advanced stages of measles (cysticercus cellulosa).

It is evident that unwholesome conditions of life such as the above, contribute strongly to the affection, yet probably no one of these is by itself an effective factor. Its rapid extension among men and animals, that are huddled together in close, filthy quarters suggests an epizootic or infective element, and Cornevin, Hess and others attribute the disease in pigs to the germ of erysipelas. Stengel has produced purpuric disease in animals by inoculation of the extravasated blood from human scurvy patients. Müller and Babes found a slender bacillus and streptococci in the tissues of scorbutic gums. The bacillus was present in the mouth of non-scurvy persons. Boruträger found cocci in the spleen. Berthensen alleges that after complete recovery the disease does not attack the same person a second time, which, if confirmed, will go far to establish a bacteridian origin. There is considerable presumption of the existence of a microbian cause, the efficiency of which is dependent on the unhygienic conditions above stated, while these unwholesome conditions are equally nonpathogenic in the absence of the microbe.

_Lesions._ The blood is black and incoagulable or clots loosely, rigor mortis is slight, changes may be found in the number and character of the white and red blood globules, but are not constant, there is usually an excess of sodium salts and deficiency of potassium ones, and there is marked petechiation of the skin, mucosæ and serosæ. The bone marrow may be abnormally red and the bones fractured at the epiphyses, or carious. The addition of the gum lesions makes the case characteristic. The gums are softened, swollen, red and uneven, with hæmorrhagic discoloration, erosions, necrotic areas and ulcers.

_Symptoms._ Anorexia or fastidious appetite, prostration, debility and sluggish indifferent movements, are followed by the local lesions on the skin and gums. On the skin appear petechiæ, and extravasations, which often implicate the bristles, so that they may be shed or pulled out with ease, the bulbs appearing dark and bloodstained (bristle rot). These may be followed by necrotic sloughs, and deep ulcers that are slow to heal. The gums are red and swollen, with hæmorrhagic spots, and bleed on the slightest touch. Erosions, sores and ulcers are not uncommon, the tongue is dry and furred, and the mouth exhales a fœtid odor. The teeth may become loose in their sockets. Swelling of the joints, from hæmorrhage or effusion, may be noticed, and lameness or stiffness from muscular or intermuscular extravasation. Blood effusions into the anterior or posterior chamber of the eye have been noticed and paralytic or comatose symptoms from similar effusions on the brain. In the absence of improvement the patient becomes more and more debilitated and exhausted, and death may be preceded by profuse exhausting diarrhœa.

_Prognosis_ is unfavorable in advanced cases, and when the faulty regimen cannot be corrected.

_Treatment._ The first consideration is to correct the unwholesome conditions of life, purify the building and its surroundings, and allow a free range on a pasture. Subject each patient to a thorough soapy wash, and if possible allow clean running water in which a bath may be taken at will. Access to green food and invertebrates (slugs, larvæ, etc.) is important, or a varied diet of grain, middlings, bran, roots, fruits, tubers, cabbage, silage, etc., must be furnished. Iron and bitters (mix vomica, gentian,) are useful and sometimes small doses of arsenite of soda solution, or cream of tartar are useful. Acorns or horsechestnuts are recommended. For the mouth a wash of potassium chlorate, soda biborate, or potassium permanganate may be resorted to. Friedberger and Fröhner advise for the dog extract of meat in wine.

In the case of fat pigs it is more profitable to butcher at once, as soon as early symptoms appear.

In pigs or puppies brought up by hand, as in babies, the true course, is to discard milk substitutes and give sweet new milk, preferably of the genus to which the patient belongs. The important elements of cleanliness and outdoor life must not be forgotten.

GOITRE. BRONCHOCELE. ENLARGEMENT OF THE THYROID.

_Definition._ A non-inflammatory enlargement of the thyroid gland, independent of known microbes or parasitism.

_Causes._ Goitre is an endemic disorder in man and beast, though it may occur sporadically during or after a _debilitating disease_, or in animals that are overworked or out of condition. As occurring endemically all accessory factors that undermine the general health must be admitted as potent factors, though insufficient of themselves to develop the malady in the absence of the specific cause. Thus in Europe women suffer more than man, being more _confined indoors_ and being less muscular and vigorous. In New York the new born offspring of ewes, kept in close confinement during winter, may be all goitrous, while those of flocks, having a free run through the whole season, escape. Gurlt has seen the same in goats. Apart from debilitating diseases New York horses and cattle develop the greater number of cases in winter, the period of confinement and idleness. House dogs suffer more than hounds.

_Poor diet_ has a similar effect. In Europe where the disease is very prevalent in the underfed peasant population, it is rare among the highly fed domestic animals. Bouley says it is excessively rare in animals even in the localities in which it prevails in man, and though mentioned by Lydtin, Johné, Haubner and others it is not as a common affection. In New York and Pennsylvania on the other hand it is rare in the well-fed human population, and very common in horses, mules, cattle, sheep, swine and dogs. I have known congenital goitre to prove fatal to a new born dromedary in Central Park, New York. The long, severe winter, close confinement, and impure air, doubtless as much as the spare diet contribute to this prevalence among the animals in New York.

_Intestinal worms_ and other parasitisms must be accepted as secondary factors, the development of goitre often going on simultaneously with the increase of the parasites.

_Heredity_ is claimed as a cause by Möller and others, and doubtless a weak constitution transmitted from parent to offspring, is more susceptible. Apart from this the exposure of both to a common specific cause is the main factor in its production.

_Locality._ This must be accorded a first position in the causation of goitre, so far at least as it occurs endemically and enzootically. In England it has prevailed, in man, on the limestone hills of Derbyshire, and Gloucester (Cotswold); in Europe it is common in the Alps, Pyrenees, Savoy, Styria, Silesia, in the Black Forest and in the Rhone valley; in Asia it prevails in the Himalayas, the Altai Mountains, the hills of China, and in the Punjaub; in South America it is seen in the valley of the Oronoco; in North America in Saskatchewan, Ontario, Michigan, Ohio, Pennsylvania, New York, Vermont, Virginia and Alabama. A large number of these localities lie on magnesian limestone or are supplied with water that has percolated through this, so that at one time the excess of magnesia and the lack of iodine were held to be the main causative factors. This contention cannot be sustained in all cases, so that the disposition is, at present, to attribute the disease to some unknown poison. This unknown poison may be present in districts apart from the magnesian limestone, yet the disease is so frequently seen upon this formation that its presence must always be looked upon with suspicion as a probable bearer of the poison, and waters bearing its products are unsuited to the victims of goitre.

_Pathological Anatomy._ Sometimes the swelling of the gland which appears during catarrh or pharyngitis will subside on recovery. In other cases it remains as a distinct hypertrophy. This is usually an increase of the parenchyma and dilatation of its follicles with an albuminous fluid (_hypertrophic goitre_). This may affect one lateral lobe or both. In other cases the fibrous tissue mainly increases and the gland becomes hard and resistant (_fibrous goitre_). In other cases the individual follicles become distended, and may even break into each other forming a large cavity or several with liquid contents (_cystic goitre_). In other cases there is a great increase of the vascular network of the gland so that blood alone is obtained on puncture (_varicose goitre_). Tumors of all kinds may be found in the gland, thus encysted adenoma, sarcoma and melanoma in horses, carcinoma in old dogs.

_Symptoms._ In _horses_ there may be swelling of one lateral lobe of the gland or of both, reaching individually the size of a hen’s egg or the fist, or larger. Cadeac cites cases that weighed 4 lbs. In _dogs_, _cattle_, _sheep_ and especially in _swine_, the two lobes are much more closely connected, and the disease affecting both, together with the commissure, the whole may be resolved into one uniform swelling, much larger than in the horse relatively to the size of the animal, often covering the whole front of the neck, and extending into the chest. Cadeac mentions cases in the dog in which the mass weighed 4 lbs.

The smaller swellings appear in the solipeds on the two sides of the larynx, and in other animals more in front. They are mobile, but rise somewhat with the larynx in swallowing, and are usually covered by loose, movable skin. The consistency of the swelling varies; some are soft, elastic or pitting on pressure, others fluctuate and still others are firm and resistant. Old cases that have become calcified may even feel bony. In dogs it will sometimes pulsate like an aneurism.

Functional secondary troubles are rare in solipeds. In the other animals the goitre may compress the pharynx or gullet causing dysphagia, or the larynx, trachea or recurrent nerves causing more or less wheezing or dyspnœa. Asphyxia is not uncommon in new born sheep, and goats, and Johné and the present writer have seen cases in dromedaries. The soft embryonic tracheal rings had been so compressed from side to side that respiration became impossible. Honert records a case of asphyxia in an adult horse. Cases of _roaring_ in adult horses and mules and of asphyxia in adult dogs are also on record. Warz records the obliteration of the jugular in a dog, and Cadeac œdema of the lips and face.

The _course_ of goitre is usually slow, extending over years, yet in young dogs it may make a very rapid progress. It will often stand still for a time, and later start a new growth under a fresh access of the cause. Spontaneous disappearance is rare.

_Prevention._ This is especially important in localities in which goitre is enzootic, and embraces careful attention to the general health, the avoidance of overwork, exhaustion, indoor life, lack of exercise, impure air, faulty feeding, starvation, and water from the goitrous soils. Rain water is preferable.

_Treatment._ First remove the various causes, and secure the best hygiene. If a change to a non-goitrous district can be had, avail of it.

Among medicinal agents iodine holds the foremost place. It may be given internally as potassium iodide, alone, or along with tincture of iodine, and applied locally as iodine ointment rubbed into the skin, or tincture of iodine painted on the surface.

Of surgical measures the simplest and best is the injection of iodine into the diseased thyroid. The nozzle of a hypodermic syringe is inserted into the gland, preferably into the largest cyst or follicular mass, and the liquid drawn off as fully as possible. It is then injected with the following mixture: compound solution of iodine one part, distilled water two parts. The amount may vary with the size of the goitre. In cases of moderate size ½ dr. to 1 dr. is suitable. There is usually some resulting inflammation, which may be met by a wet compress around the throat. A second and third injection may be made if necessary, when the effects of the preceding one have passed off. In simple forms it is very successful. For dogs Möller recommends from 5 to 15 drops of undiluted tincture of iodine at an injection. In other cases he used a watery solution of papain (1:10) to be left in for 48 hours. The thyroid was then soft and, on incision, discharged its digested parenchyma as a milky fluid, and favorable healing followed.

The removal of the diseased lobe has been successfully accomplished in horses, the reservation of the other lobe, or even of the connecting commissure, being sufficient to prevent the occurrence of tetany. From the extreme vascularity of the organ it is important to ligature the arteries before attempting the removal.

In the other domestic animals in which the commissure is practically obliterated and the two lobes confluent in goitre, the excision of the mass is liable to be followed by tetany, dropsy (myxoedema), stunted development, anæmia or marasmus. If a portion of the gland is left these results do not follow. Grafting of a portion of healthy gland may correct the tetany. The hypertrophy of the gland may sometimes be arrested by ligature of its nutrient arteries, and without the dangers above named. This may be combined with the internal and external use of iodine.

EXOPHTHALMIC GOITRE.

_Definition._ A complex disorder manifested by hypertrophy of the thyroid, excessive bulging of the eye balls out of the orbits, cardiac palpitations or tardy heart action and other nervous or trophic disorders.

Cadiot records a case in a horse, in low condition, with painful œdematous swelling of one fore foot, and swellings in other parts of the body, great enlargement of the left lobe of the thyroid, tumultuous heart action with beats 70 to 80 per minute, and strong visible pulsations in the superficial arteries. There was no leukæmia and no exophthalmia. The patient died on the third day.

Jeswejenko records that of a four year old English thoroughbred which after a race showed anorexia, weakness, thirst, rapid pulse, palpitations, conjunctivitis, enlarged thyroid and after fourteen days exophthalmia with thyroid pulsations. It died in the fourth week, anæmic and exhausted. A second case in a 7 year old bitch recovered in three months under treatment with iodine.

Röder gives the case of a cow with palpitations, abnormally strong pulsations, thyroid hypertrophy and double intense exophthalmia. This persisted for four years.

RACHITIS. RICKETS.

Definition. Lesions and pathology; gastro-intestinal disorder,
hepatic, splenic and renal congestion and hypertrophy, lessened blood
salts, dilated arteries, hyperæmia of bone, deep red marrow, blue
articular cartilage, softening of epiphyseal cartilage and under the
periosteum, with hyperplasia, decrease of lime salts, bending of bone,
loose periosteum; sclerosis in repaired cases. Causes: appears as if
infection, lack of lime salts in food, inconstant, free phosphorus,
glycero-phosphoric acid, lactic acid, oxalic, acetic and formic acids,
heredity, bad air, crowding, damp soils, cold, confinement, darkness,
infection, toxic matters. Symptoms: unthrift, thin neck, arched or
hollow back, drooping pelvis, weariness, stiffness, recumbency, limbs
not plumb, tender, swollen puffed joints, enlarged epiphyses, bent
shafts, or spine, brittleness. Swine fed on potatoes or corn,
“snuffles”, breaking teeth, diarrhœa, bronchitis, skin eruptions,
arthritis. Cattle, epiphyseal swellings, bow legs, crooked back. Dogs,
bow legs. Goats. Birds, knotted thickening of bones, flexibility.
Fever, colics, indigestion. Lameness shifting, intermittent,
relapsing. Paraplegia. Treatment, hygienic, vigorous breeding animals,
nutritious rations, rich in earthy salts, well balanced, from sound
land, rich abundant milk without excess of fat, avoid spoiled food,
adapt cow’s milk to foal or puppy, fresh air, sunshine, damp soils,
antacids, lime water, laxatives, bitters, phosphates, bone dust,
phosphorus.

_Definition._ A constitutional disease of young animals, associated with disorders of digestion, nutrition, assimilation, and sanguification, and especially characterized by softening and distortion of the bones.

_Lesions and Pathology._ Apart from the bones there does not seem to be an absolute constancy in the lesions. There is usually, however, a period of ill-health and faulty nutrition before the lesions in the bones can be recognized. Thus, there may be gastric or intestinal congestion, or catarrh, indigestions, constipation alternating with diarrhœa, enlargement of the liver, spleen and kidney with hyperæmia, and according to V. Jaksch, a diminution of the salts of the blood. Beneke found that the arteries are dilated throughout the entire body, but the heart does not always participate in this distension. The arterial dilatation is very marked in the pulmonary artery, yet the lungs are relatively small. In the bones there is a well marked hyperæmia, most prominent beneath the periosteum, in the cancellated tissue, the line of junction of the epiphysis and diaphysis, and near the articulating surface. The contents of the cancelli are of a deep red, and the color shines through the articular cartilage giving it a bluish tinge. The shaft of the bone does not escape, but like the epiphysis and epiphyseal cartilage may be soft and yielding to pressure, and cut readily with the knife.

At both points the process of growth is increased and its area extended, but it is not completed by the full deposition of earthy salts, and the softening is not confined to the new tissues, but extends into the subjacent bone as well.

The chemical composition of the bone is profoundly altered, the organic basis, at times amounting to 65 per cent., as compared to 33.30 per cent in the normal bone. The softened bone, yielding under the weight of the body, bends out of shape at the epiphyseal cartilage, or even elsewhere, giving rise to bow legs, deviation of the joints inward, or other distortion. The periosteum is red, thickened, the seat of exudate and easily torn from the bone.

The bones are often thickened by new deposit under the periosteum and especially at the junction with the epiphyses. Old cases of distortion, the result of rickets, do not necessarily show a deficiency of earthy salts, as these are restored in case of repair and they may even be found in excess of the normal, increasing the hardness of the bone.

_Causes._ This disease does not seem to have been recognized in Great Britain until the beginning of the 17th century, the period of England’s early activity on the sea, and the beginning of extensive commerce and manufactures. From that time it has been increasingly and extensively prevalent. Yet it has not been shown to be propagated by any specific germ, nor to have extended in line with the introduction and use of new food products like the potato. It appears to be traceable rather to unwholesome conditions of life and a reduction of the general tone and nutritive vigor.

_A deficiency of earthy salts in the food_ has been a natural and favorite explanation, and the ill-health that is thereby brought about is often an important factor. Yet rachitis occurs independently of such a condition.

In Roloff’s experiments, pigs fed on aliment deficient in lime salts, suffered from bone softening, while the control animals on food rich in lime salts remained well. The diseased animals further recovered on a diet rich in lime. Voight, Chossat, Milne-Edwards, Lehmann, Bousaingault, Heitzmann, etc., had similar experimental results, and the effects were shown in goats, sheep and dogs, in curvature, shortening, swelling of the costal cartilages and joints and contracted pelvis. Growing pigs have often been found to suffer in this way when placed on an exclusive diet of maize. The great improvement often secured in feeding an excess of calcareous phosphates tends to corroborate the hypothesis. Wagner found that food rich in lime salts, and the administration of small doses of phosphorus, rendered the epiphyses of the growing bones more compact. Kassowitz, on the other hand, found that an excess of phosphorus caused absorption from the bone substance and an irritable inflammation of the osseous tissue. Schneidemühl has seen the disease in calves raised on milk, poor in lime, the product of emaciated cows; in pigs getting only potatoes and swill, and in puppies that were denied bones. It is common in pigs on an exclusive diet of maize. Yet it is most destructive in many breeding studs where the alimentation is rich and generous. It must be admitted that as a concurrent cause, the paucity of lime salts and phosphates is a powerful factor, and that in supplying the bone ash, and improving the nutrition, these often prove of great value. Their privation is, however, not an essential condition of rachitis.

_Free phosphorus._ Ziegler and Kassowitz emphasize the hyperæmia of the cancellated tissue, and Wagner shows that this condition can be induced by excess of phosphorus, but this excess of phosphorus has not been found in the blood in ordinary cases, and is not likely to occur in a great number of young, at the same place and time, irrespective of food, as has been shown in breeding studs in New Jersey, in the South and West. In particular cases excess of phosphorus may operate, but it cannot be looked on as universal or essential.

The presence of _glycero-phosphoric acid_ is alleged by Trasbot, but there is no proof of its constancy in rachitis, nor would its presence explain the real cause of the disease.

_Lactic acid in the system._ Lactic acid, in vitro, dissolves the calcareous salts of the bones. Trasbot alleges that it opposes the precipitation of lime in the form of tribasic phosphate, as found in bone. Siedamgrotzky and Hofmeister found that the salts of the bone were lessened under the administration of lactic acid. Heitzmann and Baginsky showed that by restricting the lime in food and giving lactic acid, by the mouth or subcutem, the lime salts in the bone were lessened relatively to the organic basis. It should be noted that an exclusive diet of buttermilk is liable to cause an attack of arthritic rheumatism. Lactic acid is undoubtedly a coöperative factor in certain cases, but though often found in the diseased bone and urine of rachitic children (Ragsky, Morehead, Simon, Lehmann), it is not shown to be constant.

_Oxalic acid. Acetic acid. Formic acid._ Beneke found oxalic acid in the urine in many cases of rachitis and attributed to it the removal of the lime salts. Others have made the same charges on acetic and formic acids which are sometimes found in the diseased bone.

It is quite plain that the process of normal ossification is easily disturbed, and that the same agent (lime, phosphorus) will assist or hinder according as it is present in small or large amount, and that certain chemical agents like organic acids may act injuriously even in the presence of an abundance of bone salts.

_Heredity._ Rickety parents have often rickety offspring, the weak somatic cells, failing in both cases to build healthy, strong tissues, but as a rule also, both have been condemned to live in similar unwholesome surroundings.

_Unhygienic Conditions._ Schneidemühl notes that in animals as in man, bad ventilation, close impure air, crowding, damp impervious soils, and cold, are found more or less in places where rachitis prevails. By lowering the general health and tone, these debilitate the tissue cells and impair nutrition and growth.

_Confinement_ has a manifest influence. Rickets prevails in children in the great manufacturing cities, where the exclusion of sunlight and the breathing of impure air rob the system of its vigor. The children of soldiers in India kept in close barracks are largely rickety, while the more poorly fed native children outside escape. Wild beasts in confinement are often rachitic, unlike their fellows of the forest. Colts in confined stables suffer while those in the fields and yards remain healthy. Swine in Sweden in close pens and fed on potatoes alone suffer (Stockfleth).

_Darkness_ usually coincides with confinement and it is noteworthy that deep sea fishes, living in comparative darkness, have usually cartilaginous skeletons.

_Infection._ Certain facts seem to point to a direct infection, as coöperating with the debilitating conditions above named. The advent of the disease in England about 1700: its frequency in English swine on the European continent (Schneidemühl); and its enzootic prevalence in different parts of America, give seeming support to the doctrine.

Dr. W. L. Williams has seen it appear on an Illinois farm twenty years after reclamation from virgin prairie, prevail for ten years and then disappear. There was a remarkable coincidence of recurrent ophthalmia, and disease of the bones and joints (navicular disease, spavin, splints, ring bones, etc.).

In most of these cases the trouble occurred on low, damp or impervious soils, agreeing with rickets in children, which avoids the Alps or hilly districts, and abounds in valleys or bottom lands.

_Symptoms._ The colts show a lack of thrift and though there may be no lack of growth or size, they have a rough coat, a poor development of the neck, arching of the back and drooping pelvis. The chest may seem to sink between the scapulæ. They move stiffly with swaying of the limbs, or even staggering and are easily wearied or lacking in endurance. They lie a great portion of their time or even persistently, refusing to rise. When up they do not hold the limbs plumb, but allow them to deviate one way or another in an unsightly way. There is liable to be swelling of important joints of the limb, (knee, hock, stifle, fetlock), which are tender to pressure and kept partly flexed. The ends of the ribs are often enlarged. Bending of the long bones (tibia or radius), and deviations of the back or sternum from the straight line are significant. Thickening of the ends of the bones, or in the region of the epiphyseal cartilages are largely diagnostic. The bones are easily fractured. In _swine_ fed on potatoes, corn, etc., besides the affections of the limbs, the thickening of the bones and swelling of the joints, especially the hock and pastern, there is enlargement of the nasal and maxillary bones so as to seriously obstruct breathing (“Snuffles”). The teeth suffer and break readily and in the general break down diarrhœa, bronchitis or skin eruption appears and the subject falls into marasmus and perishes. In the necropsy arthritis is commonly found. In _cattle_ beside the epiphyseal swellings, the bow legs and joint enlargements, the back becomes crooked, vertically or laterally. The same general symptoms appear in _dogs_ in which bow legs are a very prominent feature. Goats suffer badly and mostly remain recumbent.

_Birds_ suffer most, showing knotty thickening of the bones of the legs and wings, and flexibility of the bones generally but above all of the keel of the sternum, which is usually badly distorted from sitting on the perch.

In all alike there are usually a few days of fever, followed by indigestion, colics, anorexia, and a general air of illness. Then appear the lameness, stiffness and swelling of bones and joints. Any joint may suffer, shoulder, elbow, knee, hips, stifle, hock, or fetlock. The lameness may shift as in rheumatism, it may intermit, occurring periodically, or it may advance uninterruptedly to a fatal issue. Paraplegia is common and appears to be due at times to pressure on the spinal nerves by the diseased vertebræ. Before this becomes complete, the animal may walk with the whole digits and metatarsi in contact with the ground, and the softened crumbling calcis may project through the skin forming an unsightly sore which soon becomes septic. The same happens at times to the point of the elbow.

_Treatment._ The most important, are the hygienic considerations. Reject weak or cachectic animals from breeding, and those that have been rachitic to a marked degree, as their progeny are likely to show the same weakness. Change the ration giving one that is well balanced and rich in nutritive matters and earthy salts. Clover, alfalfa, and a generous grain diet may serve as an example for herbivora, and a fair allowance of meat and bones for dogs. Food from land that has apparently contributed to the disease in other cases is best avoided. If the land is poor, sandy, or destitute of earthy salts and phosphates, so much the more is it to be suspected and set aside. In the case of sucking animals it should be seen that the milk is rich and abundant, and that it is not too rich in fat, nor otherwise calculated to disagree and induce indigestion. Above all soured or otherwise fermented milk should be withheld, and any buckets or troughs used in feeding should be regularly washed, scalded and disinfected. In case colts, or dogs are being raised on cow’s milk it may be requisite to dilute it with one-third its volume of barley water, or solution of gum arabic, and to sweeten with sugar. Lime water with each meal is valuable in counteracting acidity, and fermentation, and in furnishing lime which may be absorbed in part.

In prevention and treatment alike, fresh air and sunshine must never be neglected and in warm weather, an outdoor life, night and day is of the greatest value. At the same time cold storms, damp beds, or any condition which may induce chill must be excluded. Close stalls, pens, or kennels must be absolutely forbidden.

Among medicinal agents antacids are often essential on account of the acid condition of the ingesta, lime water will often suffice, but if there is manifest constipation calcined magnesia three times a day on an empty stomach so as to counteract costiveness will often serve a good end. The atony of the bowel may be further met by small doses of strychnia. Other bitters may be used if this has little effect. Small doses of phosphate of soda, or bone dust have been long lauded in the affection, and probably act beneficially as a tonic as well as a food material. Phosphorus in minute doses tends to increase the deposit of earthy salts and consolidate the bones. Large doses induce hyperæmia of the epiphyseal ligament and even favor fracture. A grain of phosphorus daily may be given in olive oil or better in cod liver oil which acts as a valuable tonic. Dieckerhoff recommends the intratracheal injection of the solution of phosphorus in olive oil.

BRAN DISEASE: SHORTS DISEASE: BRAN RACHITIS.

Miller’s horses. Bran and middlings as fodder. Torpid bowels,
impaction, indigestion, colic, early fatigue and perspiration,
stiffness, lameness, epiphyseal swelling, facial bones swell and
soften symmetrically, teeth drop, dyspnœa. Ash of bran. Treatment.

A curious form of rickets has been observed, especially in miller’s horses as a result of an excessive consumption of bran or middlings. It is characterized by torpor of the bowels, impaction, indigestions, slight colics, early fatigue and profuse perspiration under slight exertion followed by stiffness, lameness, enlargement of the bones in the region of the epiphyseal cartilage (near knee or hock), or of the bones of the face. The superior and inferior maxillary bones are symmetrically enlarged, the teeth are shed, mastication becomes difficult and there may be some dyspnœa and snuffling. This resembles the “snuffles” in pigs on an exclusive diet of Indian corn or potato and Friedberger and Fröhner seek to explain both, by the lack of lime and phosphorus in the food. But wheat bran has 5.1 per cent. of ash, and middlings 2.3 per cent. as compared with wheat flour 1.7 per cent. or oats 2.7 per cent. Putz on the contrary attributes the disease to the excess of phosphorus in the bran acting as the free phosphorus in lucifer match factories in causing necrosis of the jaw. But the phosphorus in bran occurs as phosphate of lime which has no such action on the bone and one must infer that the phosphoric acid is set free by some acid developed perhaps in the intestinal fermentations. This is, however, as yet unproved.

The _treatment_ of this affection consists in the suspension of the bran and the expulsion of offensive accumulations and products from the bowels, followed by a course of tonics and the general treatment for rickets.

OSTEO-MALACIA (MALAXOS SOFT): CACHEXIA OSSIFRAGA; FRAGILITAS OSSIUM:
“THE CRIPPLE:” “THE STIFFNESS.”

Definition. Disease of the mature. Decalcifying in cancelli and Canals
of Havers. Dairy cows. Heavy milkers. Perverted appetite. Limed soils,
sandy or limestone. Low, damp, soils rich in organic matter.
Cultivation. Watery food. Plethoric. Debilitated. Cold. Change of
locality improves. Microbes. Toxins. Lesions: vary with stage,
congestion of marrow, excess of cells and fat, osteoclasts, exudates,
friability of bone, distortions and fractures in pelvis and elsewhere.
Symptoms: low condition, projecting bones, rough coat, perverted
appetite, stiffness, decubitus, swaying limbs, inappetence, drying of
milk, fever, bed sores, sloughs, sepsis, pus infection, fractures.
Duration, 2 to 3 months and upward. Enzootic. Prognosis, varies with
enzootic, and stage; best in recent cases, occurring, sporadically.
Treatment: according to cause, rich, generous diet, grain, salt
bitters, cod liver oil, apomorphia, wholesome pasturage, intensive
culture change water, dry up milk, dry stables, pure air, sunshine.
Slaughter. Local derivatives.

_Definition._ A softening and fragility of the bones of adult animals, in connection with solution and removal of the earthy salts.

This is essentially a disease of mature animals and is thus easily distinguished from rachitis, in which the lesions are due to a faulty development of young, growing bone. In osteo-malacia, too, the decalcifying proceeds most actively in the walls of the Haversian canals and cancelli, while in rachitis it progresses especially under the periosteum and in and around the epiphyseal cartilage.