Special Report on Diseases of the Horse.
by United States Department of Agriculture and Leonard Pearson and Rush Shippen Huidekoper and Ch. B. Michener and W. H. Harbaugh.
THE EXAMINATION OF A SICK HORSE.
By Leonard Pearson, B. S., V. M. D.
In the examination of a sick horse it is important to have a method or system. If a definite plan of examination is followed one may feel reasonably sure, when the examination is finished, that no important point has been overlooked and that the examiner is in a position to arrive at an opinion that is as accurate as is possible for him. Of course, an experienced eye can see, and a trained hand can feel, slight alterations or variations from the normal that are not perceptible to the unskilled observer. A thorough knowledge of the conditions that exist in health is of the highest importance, because it is only by a knowledge of what is right that one can surely detect a wrong condition.
A knowledge of anatomy, or of the structure of the body, and of physiology, or the functions and activities of the body, lie at the bottom of accuracy of diagnosis. It is important to remember that animals of different races or families deport themselves differently under the influence of the same disease or pathological process. The sensitive and highly organized thoroughbred resists cerebral depression more than does the lymphatic draft horse. Hence a degree of fever that does not produce marked dullness in a thoroughbred may cause the most abject dejection in a coa.r.s.ely bred, heavy draft horse. This and similar facts are of vast importance in the diagnosis of disease and in the recognition of its significance.
The order of examination, as given hereafter, is one that has proved to be comparatively easy of application and sufficiently thorough for the purpose of the readers of this work, and is recommended by several writers.
HISTORY.
It is important to know, first of all, something of the origin and development of the disease; therefore the cause should be looked for.
The cause of a disease is important, not only in connection with diagnosis, but also in connection with treatment. The character of feed that the horse has had, the use to which he has been put, and the kind of care he has received should all be closely inquired into. It may be found by this investigation that the horse has been fed on damaged feed, such as brewers" grains or moldy silage, and this may be sufficient to explain the profound depression and weakness that are characteristic of forage poisoning. If it is learned that the horse has been kept in the stable without exercise for several days and upon full rations, and that he became suddenly lame in his back and hind legs, and finally fell to the ground from what appeared to be partial paralysis, this knowledge, taken in connection with a few evident symptoms, will be enough to establish a diagnosis of azoturia (excess of nitrogen in the urine). If it is learned that the horse has been recently shipped in the cars or has been through a dealer"s stable, we have knowledge of significance in connection with the causation of a possible febrile disease, which is, under these conditions, likely to prove to be influenza, or edematous pneumonia.
It is also important to know whether the particular horse under examination is the only one in the stable, or on the premises, that is similarly afflicted. If it is found that several horses are afflicted much in the same way, we have evidence of a common cause of disease which may prove to be of an infectious nature.
Another item of importance in connection with the history of the case relates to the treatment that the horse may have had before he is examined. It sometimes happens that medicine given in excessive quant.i.ties produces symptoms resembling those of disease, so it is important that the examiner be fully informed as to the medication that has been employed.
ATt.i.tUDE AND GENERAL CONDITION.
Before beginning the special examination, attention should be paid to the att.i.tude and general condition of the animal. Sometimes horses a.s.sume positions that are characteristic of a certain disease. For example, in teta.n.u.s (lockjaw) the muscles of the face, neck, and shoulders are stiff and rigid, as well as the muscles of the jaw. This condition produces a peculiar att.i.tude, that once seen is subsequently recognized as rather characteristic of the disease. A horse with teta.n.u.s stands with his muscles tense and his legs in a somewhat bracing position, as though he were gathered to repel a shock. The neck is stiff and hard, the head is slightly extended upon it, and the face is drawn, and the nostrils are dilated. The tail is usually held up a little, and when pressed down against the thighs it springs back to its previous position. In inflammation of the throat, as in pharyngolaryngitis, the head is extended upon the neck and the angle between the jaw and the lower border of the neck is opened as far as possible to relieve the pressure that otherwise would fall upon the throat. In dumminess, or immobility, the hanging position of the head and the stupid expression are rather characteristic. In pleurisy, peritonitis, and some other painful diseases of the internal organs, the rigid position of the body denotes an effort of the animal to avoid pressure upon and to protect the inflamed sensitive region.
The horse may be down in the stall and unable to rise. This condition may result from paraplegia (paralysis), from azoturia, from forage poisoning, from teta.n.u.s, or from painful conditions of the bones or feet, such as osteoporosis or founder. Lying down at unusual times or in unusual positions may indicate disease. The first symptom of colic may be a desire on the part of the horse to lie down at an unusual or inappropriate time or place. Sometimes disinclination to lie down is an indication of disease. When there is difficulty in breathing, the horse knows that he can manage himself better upon his feet than upon his breast or his side. It happens, therefore, that in nearly all serious diseases of the respiratory tract he stands persistently, day and night, until recovery has commenced and breathing is easier, or until the animal falls from sheer exhaustion. If there is stiffness and soreness of the muscles, as in rheumatism, inflammation of the muscles from overwork, or of the bones in osteoporosis, or of the feet in founder, or if the muscles are stiff and beyond control of the animal, as in teta.n.u.s, a standing position is maintained, because the horse seems to realize that when he lies down he will be unable to rise.
Abnormal att.i.tudes are a.s.sumed in painful diseases of the digestive organs (colic). A horse with colic may sit upon his haunches, like a dog, or may stand upon his hind feet and rest upon his knees in front, or he may endeavor to balance himself upon his back, with all four feet in the air. These positions are a.s.sumed because they give relief from pain by lessening pressure or tension upon the sensitive structures.
Under the general condition of the animal it is necessary to observe the condition or state of nutrition, the conformation, so far as it may indicate the const.i.tution, and the temperament. By observing the condition of nutrition one may be able to determine to a certain extent the effect that the disease has already had upon the animal and to estimate the amount of strength that remains and that will be available for the repair of the diseased tissues. A good condition of nutrition is shown by the rotundity of the body, the pliability and softness of the skin, and the tone of the hair. If the subcutaneous fat has disappeared and the muscles are wasted, allowing the bony prominences to stand out; if the skin is tight and inelastic and the coat dry and harsh, we have evidence of a low state of nutrition. This may have resulted from a severe and long-continued disease or from lack of proper feed and care.
When an animal is emaciated--that is, becomes thin--there is first a loss of fat and later the muscles shrink. By observing the amount of shrinkage in the muscles one has some indication as to the duration of the unfavorable conditions under which the animal has lived.
By const.i.tution we understand the innate ability of the animal to withstand disease or unfavorable conditions of life. The const.i.tution depends largely upon the conformation. The type of construction that usually accompanies the best const.i.tution is deep, broad chest, allowing plenty of room for the lungs and heart, indicating that these vital organs are well developed; capacious abdomen, allowing sufficient s.p.a.ce for well-developed organs of digestion; the loins should be short--that is, the s.p.a.ce should be short between the last rib and the point of the hip; the head and neck should be well molded, without superfluous or useless tissue; this gives a clear-cut throat. The ears, eyes, and face should have an expression of alertness and good breeding. The muscular development should be good; the shoulders, forearms, croup, and thighs must have the appearance of strength. The withers are sharp, which means that they are not loaded with useless, superfluous tissue; the legs are straight and their axes are parallel; the knees and hocks are low, which means that the forearms and thighs are long and the cannons relatively short. The cannons are broad from in front to behind and relatively thin from side to side. This means that the bony and tendinous structures of the legs are well developed and well placed. The hoofs are compact, tense, firm structures, and their soles are concave and frogs large.
Such a horse is likely to have a good const.i.tution and to be able to resist hard work, fatigue, and disease to a maximum degree. On the other hand, a poor const.i.tution is indicated by a shallow, narrow chest, small bones, long loins, coa.r.s.e neck and head, with thick throat, small, bony, and muscular development, short thighs and forearms, small joints, long, round cannons, and hoofs of open texture with flat soles.
The temperament is indicated by the manner in which the horse responds to external stimuli. When the horse is spoken to, or when he sees or feels anything that stimulates or gives alarm, if he responds actively, quickly, and intelligently, he is said to be of lively, or nervous, temperament. On the other hand, if he responds in a slow, sluggish manner, he is said to have a sluggish, or lymphatic, temperament. The temperament is indicated by the gait, by the expression of the face, and by the carriage of the head and ears. The nature of the temperament should be taken into consideration in an endeavor to ascertain the severity of a given case of illness, because the general expression of an animal in disease as well as in health depends to a large extent on the temperament.
THE SKIN AND THE VISIBLE MUCOUS MEMBRANES.
The condition of the skin is a fair index to the condition of the animal. The effect of disease and emaciation upon the pliability of the skin have been referred to above. There is no part of the body that loses its elasticity and tone as a result of disease sooner than the skin. The practical herdsman or flockmaster can gain a great deal of information as to the condition, of an animal merely by grasping the coat and looking at and feeling the skin. Similarly, the condition of the animal is shown to a certain extent by the appearance of the mucous membranes. For example, when the horse is anemic as a result of disease or of inappropriate feed the mucous membranes become pale. This change in the mucous membranes can be seen most readily in the lining of the eyelids and in the lining of the nostril. For convenience of examination the eyelids can readily be everted. Paleness means weak circulation or poor blood. Increased redness occurs physiologically in painful conditions, excitement, and following severe exertion. Under such conditions the increase of circulation is transitory. In fevers there is an increased redness in the mucous membrane, and this continues so long as the fever lasts. In some diseases red spots or streaks form in the mucous membrane. This usually indicates an infectious disease of considerable severity, and occurs in blood poisoning, purpura hemorrhagica, hemorrhagic septicemia, and in urticaria. When the liver is deranged and does not operate, or when the red-blood corpuscles are broken down, as in serious cases of influenza, there is a yellowish discoloration of the mucous membrane. The mucous membranes become bluish or blue when the blood is imperfectly oxidized and contains an excess of carbon dioxid. This condition exists in any serious disease of the respiratory tract, as pneumonia, and in heart failure.
The temperature of the skin varies with the temperature of the body. If there is fever the temperature of the skin is likely to be increased.
Sometimes, however, as a result of poor circulation and irregular distribution of the blood, the body may be warmer than normal, while the extremities (the legs and ears) may be cold. Where the general surface of the body becomes cold it is evident that the small blood vessels in the skin have contracted and are keeping the blood away, as during a chill, or that the heart is weak and is unable to pump the blood to the surface, and that the animal is on the verge of collapse.
The skin is moist, to a certain degree, at all times in a healthy horse.
This moisture is not in the form of a perceptible sweat, but it is enough to keep the skin pliable and to cause the hair to have a soft, healthy feel. In some chronic diseased conditions and in fever, the skin becomes dry. In this case the hair has a harsh feel that is quite different from the condition observed in health, and from the fact of its being so dry the individual hairs do not adhere to one another, they stand apart, and the animal has what is known as "a staring coat." When, during a fever, sweating occurs, it is usually an indication that the crisis is pa.s.sed. Sometimes sweating is an indication of pain. A horse with teta.n.u.s or azoturia sweats profusely. Horses sweat freely when there is a serious impediment to respiration; they sweat under excitement, and, of course, from the well-known physiological causes of heat and work. Local sweating, or sweating of a restricted area of the body, denotes some kind of nerve interference.
Swellings of the skin usually come from wounds or other external causes and have no special connection with the diagnosis of internal diseases.
There are, however, a number of conditions in which the swelling of the skin is a symptom of a derangement of some other part of the body. For example, there is the well-known "stocking," or swelling of the legs about the fetlock joints, in influenza. There is the soft swelling of the hind legs that occurs so often in draft horses when standing still and that comes from previous inflammation (lymphangitis) or from insufficient heart power. Dropsy, or edema of the skin, may occur beneath the chest or abdomen from heart insufficiency or from chronic collection of fluid in the chest or abdomen (hydrothorax, ascites, or anemia). In anasarca or purpura hemorrhagica large soft swellings appear on any part of the skin, but usually on the legs, side of the body, and about the head.
Gas collects under the skin in some instances. This comes from a local inoculation with an organism which produces a fermentation beneath the skin and causes the liberation of gas which inflates the skin, or the gas may be air that enters through a wound penetrating some air-containing organ, as the lungs. The condition here described is known as emphysema. Emphysema may follow the fracture of a rib when the end of a bone is forced inward and caused to penetrate the lung, or it may occur when, as a result of an ulcerating process, an organ containing air is perforated. This accident is more common in cattle than it is in horses. Emphysema is recognized by the fact that the swelling that it causes is not hot or sensitive on pressure. It emits a peculiar crackling sound when it is stroked or pressed upon.
Wounds of the skin may be of importance in the diagnosis of internal disease. Wounds over the bony prominence, as the point of the hip, the point of the shoulder, and the greatest convexity of the ribs, occur when a horse is unable to stand for a long time and, through continually lying upon his side, has shut off the circulation to the portion of the skin that covers parts of the body that carry the greatest weight, and in this way has caused them to mortify. Little, round, soft, doughlike swellings occur on the skin and may be scattered freely over the surface of the body when the horse is afflicted with urticaria. Similar eruptions, but distributed less generally, about the size of a silver dollar, may occur as a symptom of dourine, or colt distemper. Hard lumps, from which radiate welt-like swellings of the lymphatics, occur in glanders, and blisterlike eruptions occur around the mouth and pasterns in horsepox.
THE ORGANS OF CIRCULATION.
The first item in this portion of the examination consists in taking the pulse. The pulse may be counted and its character may be determined at any point where a large artery occupies a situation close to the skin and above a hard tissue, such as a bone, cartilage, or tendon. The most convenient place for taking the pulse of the horse is at the jaw. The external maxillary artery runs from between the jaws, around the lower border of the jawbone, and up on the outside of the jawbone to the face.
It is located immediately in front of the heavy muscles of the cheek.
Its throb can be felt most distinctly just before it turns around the lower border of the jawbone. The b.a.l.l.s of the first and second or of the second and third fingers should be pressed lightly on the skin over this artery when its pulsations are to be studied.
The normal pulse of the healthy horse varies in frequency as follows:
Stallion 28 to 32 beats per minute.
Gelding 33 to 38 beats per minute.
Mare 34 to 40 beats per minute.
Foal 2 to 3 years old 40 to 50 beats per minute.
Foal 6 to 12 months old 45 to 60 beats per minute.
Foal 2 to 4 weeks old 70 to 90 beats per minute.
The pulse is accelerated by the digestion of rich food, by hot weather, exercise, excitement, and alarm. It is slightly more rapid in the evening than it is in the morning. Well-bred horses have a slightly more rapid pulse than sluggish, cold-blooded horses. The pulse should be regular; that is, the separate beats should follow each other after intervals of equal length, and the beats should be of equal fullness, or volume.
In disease, the pulse may become slower or more rapid than in health.
Slowing of the pulse may be caused by old age, great exhaustion, or excessive cold. It may be due to depression of the central nervous system, as in dumminess, or be the result of the administration of drugs, such as digitalis or strophantus. A rapid pulse is almost always found in fever, and the more severe the infection and the weaker the heart the more rapid is the pulse. Under these conditions, the beats may rise to 80, 90, or even 120 per minute. When the pulse is above 100 per minute the outlook for recovery is not promising, and especially if this symptom accompanies high temperature or occurs late in an infectious disease. In nearly all of the diseases of the heart and in anemia the pulse becomes rapid.
The pulse is irregular in diseases of the heart, and especially where the valves are affected. The irregularity may consist in varying intervals between the beats or the dropping of one or more beats at regular or irregular intervals. The latter condition sometimes occurs in chronic diseases of the brain. The pulse is said to be weak, or soft, when the beats are indistinct, because little blood is forced through the artery by each contraction of the heart. This condition occurs when there is a constriction of the vessels leading from the heart and it occurs in certain infectious and febrile diseases, and is an indication of heart weakness.
In examining the heart itself it is necessary to recall that it lies in the anterior portion of the chest slightly to the left of the median line and that it extends from the third to the sixth rib. It extends almost to the breastbone, and a little more than half of the distance between the breastbone and the backbone. In contracting, it rotates slightly on its axis, so that the point of the heart, which lies below, is pressed against the left chest wall at a place immediately above the point of the elbow. The heart has in it four chambers--two in the left and two in the right side. The upper chamber of the left side (left auricle) receives the blood as it comes from the lungs, pa.s.ses it to the lower chamber of the left side (left ventricle), and from here it is sent with great force (for this chamber has very strong, thick walls) through the aorta and its branches (the arteries) to all parts of the body. The blood returns through the veins to the upper chamber of the right side (right auricle), pa.s.ses then to the lower chamber of the right side (right ventricle), and from this chamber is forced into the lungs to be oxidized. The openings between the chambers of each side and into the aorta are guarded by valves.
If the horse is not too fat, one may feel the impact of the apex of the heart against the chest wall with each contraction of the heart by placing the hand on the left side back of the fifth rib and above the point of the elbow. The thinner and the better bred the horse is the more distinctly this impact is felt. If the animal is excited, or if he has just been exercised, the impact is stronger than when the horse is at rest. If the horse is weak, the impact is reduced in force.
The examination of the heart with the ear is an important matter in this connection. Certain sounds are produced by each contraction of the normal heart. It is customary to divide these into two, and to call them the first and second sounds. These two sounds are heard during each pulsation, and any deviation of the normal indicates some alteration in the structure or the functions of the heart. In making this examination, one may apply the left ear over the heavy muscles of the shoulder back of the shoulder joint, and just above the point of the elbow, or, if the sounds are not heard distinctly, the left fore leg may be drawn forward by an a.s.sistant and the right ear placed against the lower portion of the chest wall that is exposed in this manner.
The first sound of the heart occurs while the heart muscle is contracting and while the blood is being forced from the heart and the valves are rendered taut to prevent the return of the blood from the lower to the upper chambers. The second sound follows quickly after the first and occurs during rebound of blood in the arteries, causing pressure in the aorta and tensions of the valves guarding its opening into the left ventricle. The first sound is of a high pitch and is longer and more distinct than the second. Under the influence of disease these sounds may be altered in various ways. It is not profitable, in a work such as this, to describe the details of these alterations. Those who are interested will find this subject fully discussed in the veterinary textbooks.
TEMPERATURE.