Chapter VIII: Part 8

The =sonorous râle= has been variously exemplified by the humming of a gnat, the cooing of a wood pigeon or the bass notes of a violin. It commonly bespeaks the onset of bronchitis and testifies to the thickened, dry and rigid character of the tubes, but may give place in as short a time as three hours to a mucous râle from the occurrence of a free secretion. It rarely extends over two or three days. Sometimes when caused by a piece of tenacious mucus obstructing a tube, it is very transient disappearing at once when the mucus is expelled by coughing. Sometimes it is modified by an occasional clicking sound from the flapping of a shred of semi-solid mucus attached to the walls of a bronchial tube. This disappears when breathing becomes more hurried.

The =sibilant= (whistling) =râle= often acknowledges the same causes as the sonorous, but indicates a narrower closure of the tubes. More frequently it is heard further back on the chest and results from pulmonary emphysema and dilatation of the smaller bronchial tubes (broken wind, heaves). It is then heard chiefly in expiration and coincidently with the second quick lifting of the flank. It is further associated with the double lifting of the flank in expiration with the short, weak, paroxysmal cough and the indigestion characteristic of broken wind. If the whistling noise is so loud as to be heard without applying the ear to the chest it is called wheezing.

A =mucous râle= is caused by air passing through any liquid contained in the bronchial tubes, such as mucus, pus, or blood. It may be imitated by blowing a large number of soap bubbles in a thick lather and noticing them burst simultaneously or successively. It is chiefly observed in bronchitis after the preliminary dry stage of the mucous membrane has passed off and an abundance of mucus has been secreted. The nature of the sound will vary according as it comes from the larger or the smaller tubes or in other words as to whether the bubbles are large or small. That from the smaller tubes is sometimes called a =submucous râle=. Either of these râles may be temporary or permanent as the mucus may be momentarily cleared away by coughing.

The =crepitant râle= is a sound of very fine crackling which has been variously compared to the crackling of salt when put on red hot coals, the noise of a sponge expanding in water and the rubbing of a small lock of hair between the finger and thumb close to the ear. The existence of the _crepitant râle_ usually denotes the existence of the early stage of inflammation of the lungs, and the progress of hepatization in such cases may be traced by the advance of the line of crepitation which precedes it. So the progressive absorption of exuded matter in recover may be equally followed by a line of crepitation gradually decreasing in area until it meets in a point. The observations will be corroborated by the dull sound elicited on percussing the parts. The production of the sound has been attributed to the passage of air through the thick mucus in the smallest bronchial tubes or more plausibly to the separation of the walls of the air sacs and cells during inspiration, they having been previously adherent by reason of the secretions.

_Crepitation_ is not heard in all pulmonary inflammations. In weak animals with a low type of inflammation tending to gangrene, and in those cases of broncho-pneumonia in which a viscid mucus blocks up the bronchial tubes passing to the affected lobes, it may be altogether absent.

_Crepitation_ may further occur without inflammation. Thus in pulmonary œdema (dropsy of the lung) and capillary hemorrhage in which liquids are effused in the smaller bronchial tubes and air sacs a crepitation is sometimes heard.

A =modified crepitation= (=dry crepitant râle= of Delafond) is usually heard over an emphysematous lung. The noise in this case has been compared to that induced by handling a sheet of paper.

The =subcrepitant râle= is another modification holding a place intermediate between the crepitant and the mucous râles. It has been likened to the sound of a moderate effervescence in beer or other liquid. It is referable to the presence of mucus in the smaller bronchial tubes and indicates bronchitis or broncho-pneumonia.

Still other sounds are heard in diseased conditions of the pleuræ. These are =friction sound=, =creaking=, =metallic tinkling=, and =gurgling= or =splashing=.

A =friction sound= is heard in the early stages of pleurisy and is caused by the dryness of the pleural surfaces from the absence of the halitus or vapor which normally moistens them and the deposition of layers of lymph by which the surfaces are rendered rough and uneven. An approximate sound may be observed by placing the palm of the left hand on the right ear and drawing a finger of the right softly over its back. The sound is quick and jerking, one or a few jerks only being heard with each inspiration as the act is cut short on account of the pain attending the friction. It is rarely heard in expiration. It is chiefly heard at the lowest part of the chest where the lungs have the greatest freedom of movement. The thinness of the walls of the chest above the breast bone in cattle and dogs permits the friction sound to be heard more distinctly than in the horse. After the lapse of twelve, twenty-four or forty-eight hours the friction sound disappears, the surfaces of the pleuræ being separated by the liquid effusion, but it may reappear when the fluid is absorbed in the process of recovery. Sometimes the friction is further manifested by vibration of the walls of the chest perceptible to the touch.

The =creaking sound=, as from the bending of a piece of strong leather is caused by the movement of a thick and solid false membrane binding the lungs to the side of the chest. This is often confounded with crepitation.

=Metallic tinkling= is only heard when liquid and gas both exist in the pleural sac and is due to the falling of a drop from the shreds of false membrane above into the fluid contents below. The sound is somewhat like the falling of drops in a closed cask half full of water, or it may be fairly exemplified by placing the palm of the left hand flat on the right ear and striking the back of the hand smartly with the middle finger of the right. The sound is chiefly heard after the patient has changed its position and especially after rising. The explanation of this is that in the recumbent position the liquid changes its place and bathes parts which in standing are surrounded by gaseous products only. Drops accordingly fall into the liquid for some time with diminishing rapidity until they cease altogether. Other explanations of the sound but which less frequently exist are: the ascent of a bubble through the liquid and its bursting on the surface; and the sudden recoil of air from one wall of the plueral cavity to the other as the result of movement or sound generated in the deeper seated solid structures.

A =gurgling= or =splashing= sound is equally indicative of the presence of fluid and gas in the pleural sac. It is almost never heard unless after a sudden movement on the part of the patient causing considerable commotion in the contained liquid. Gurgling sounds transmitted from the abdomen are too often mistaken for this. In small animals with hydro-pneumothorax a quick shaking of the patient will develop it.

=Auscultation of the Cough= is sometimes valuable, though more difficult and less satisfactory in the lower animals than in man, chiefly because of the extensive movement of the ribs in the former. As conveyed through a healthy lung to the ear applied on the side of the chest, the sound is short, dull and indistinct. When the lung is more solid from hepatisation, pleural exudation or other cause, or when the bronchi are dilated the sound is loud and strong. The extent over which it may be heard thus forcibly agrees with the area of lung in a state of consolidation. When a considerable cavity or canal communicates with a bronchial tube and extends to near the surface of the lung the sound is loud and ringing. The note is specially clear and metallic when such a cavity opens into the bronchus by a narrow orifice; an apt illustration of this noise may be obtained by coughing into a narrow necked vessel.

The results obtained by auscultation should be confirmed by percussion before arriving at any definite conclusion as to the state of the chest. Consolidated lung tissue is a much better conductor of sound than the healthy, and sounds conveyed through this may be heard at a considerable distance from their point of origin. Thus the heart sounds are frequently heard over any part of the right side of the chest, and crepitation and other sounds may be heard in the centre of a hepatized portion. On all such occasions the dull sound elicited on percussion will not fail to correct the fallacy.

PALPATION. TOUCH.

This is chiefly useful in cases of pleurisy. As already noticed the vibration of the chest walls which accompanies the early friction sound is sometimes perceptible by the hand applied on the side of the chest. Pressing firmly in the intercostal spaces at the affected part invariably causes wincing and in cattle grunting. Pinching the back in inflammatory chest diseases in cattle but especially in pleurisy has a similar effect.

MENSURATION.

Measurement of the chest gives less reliable results in the lower animals than in man. A cord four feet long should have one end placed on a definite point on the withers and not removed until both sides have been examined. It should be first carried down to a point in the middle of the breast bone and the distance marked by a knot; a comparison may be made by carrying to the same point over the opposite side. It should next be carried successively to the lower end of the 8th rib on the two sides and the difference marked, and lastly from the lower end of the third rib to the lower end of the eighth. These measurements should be made at one stage of the respiratory act, say when the chest is fully dilated, and similar measurements when the chest is collapsed to ascertain any difference in the expansion of the two sides of the chest. In the smaller animals any difference in the expansion of the two sides may be observed by inspection only, the practitioner standing directly behind the animal and watching the movements of the two sides from this standpoint.

A permanent dilatation of one side may be seen in water in the chest confined to one side, and particularly if of some standing. Complete hepatisation of one lung gives a similar result. The intercostal spaces are observed to be wider than usual in such cases, and the movements of the opposite side of the chest are much more extensive than of the affected one.

A collapse with limited movement of one side is an accompaniment of chronic disease of the lung, with wasting of its substance as in cases of tubercular deposit.

DISEASES OF THE LUNGS.

Divisions of lung diseases. Bronchitis, pneumonia, pleurisy, their
results, nervous disorders, asthma, hiccough. Œdema. Emphysema. Morbid
growths, neoplasms. Infectious and parasitic diseases.

Inflammatory diseases of the respiratory organs situated within the chest may be divided into: inflammation of the air tubes within the substance of the lungs—_bronchitis_:—inflammation of the spongy tissue of the lung—_pneumonia_:—inflammation of the covering of the lungs and lining serous membrane of the chest—_pleurisy_:—and complicated cases in which two or more of these conditions coexist. Beside inflammatory diseases there are the various permanent morbid results of these affections, such as consolidation of lung from exuded products becoming organized; collapse (compression) of lung from organization and contraction of false membranes, thickening or dilatation of bronchial tubes as a result of bronchitis; also nervous affections, such as asthma and hiccough; morbid alterations in the lung tissue independently of inflammation, as pulmonary or pleural œdema and emphysema; specific morbid deposits, as tubercles, glander nodes, cancer, melanosis, etc., and morbid states, due to parasites, as in the verminous affections of cattle, sheep, etc.

BRONCHITIS.

Relation to other maladies of the air passages. Horse. Causes,
susceptibility, heat, cold, sudden changes, thick coat, rebreathed
air, on shipboard, in zoological gardens, in close stables, in navies,
organic matter in expired air, water vapor in expired air, effect on
the air and bacteria. Ingesta in bronchia. Medicinal liquids in
bronchia in horses and cattle. Exposed locations. Clipping. Smoke and
gaseous irritants. Symptoms, in mild cases, in severe: fever, cough in
dry stage, after secretion, auscultatory sounds, percussion,
discharge, watery, glairy, frothy, later milky, flocculent, purulent.
Convalescence. Capillary and pseudo-membranous form. Intensity of
symptoms, labored breathing, dyspnœa, violent cough, pinched
countenance, dark mucosæ, perspirations, palpitations, asphyxia.
Course, duration. Termination, difficult expectoration, blocking of
bronchia, pneumonia, bowel susceptibility, skin congestion, laminitis.
Chronic condition. Lesions, congestion and contents of bronchia, soft,
thick, friable mucosa, absence of vascular ramification, tenacious
mucus, false membranes. Collapse, atelectasis, splenisation,
emphysema, bronchiectasis. Treatment, in mild cases, in severe,
hygienic, steaming, sulphur dioxide, derivatives, guarded laxative,
neutral salts, calmatives, expectorants, alkalies, stimulant, oxygen,
peroxide of hydrogen, iodide of potassium. Diet. In advanced stages
tonics.

_Definition._ Inflammation of the mucous membrane which lines the bronchia. It is the counterpart of _coryza_ and _laryngitis_, being but the inflammation of another portion of the same mucous membrane which lines the whole respiratory track. That portion of this mucous membrane which lines the trachea is rarely or never the exclusive seat of inflammation, so that in case of its being implicated we do not speak of the case as one of _tracheitis_ but as _laryngitis_ or _bronchitis_, according as the throat or bronchia form the seat of active inflammatory action.

The bronchial mucous membrane is often inflamed in influenza, strangles, contagious pleuro-pneumonia of cattle, distemper in dogs, and parasitic diseases of the lungs, but the following remarks will be confined to the simple inflammatory affection. It appears as an _acute_ and a _chronic_ affection.

HORSE. ACUTE BRONCHITIS.

This is more frequent in the horse than in other animals, and especially so in young animals when newly stabled or put in training.

_Causes._ These are the same as those of _catarrh_ and _sore throat_. It is but the continuation of the same mucous membrane which is affected in all alike, and the same atmospheric changes, hot stables, noxious inhalations and exposures to cold and wet will induce this disease rather than the others when the bronchial mucous membrane is more predisposed. Bronchitis often supervenes upon sore throat, by the extension of the inflammation downward into the chest. Chilling of the surface by exposure to cold, drenching rains, is a frequent cause, by reason of the intimate sympathy existing between the skin and the mucous membrane. For the same reason certain conditions of the skin will predispose, thus a long, thick coat which keeps the animal constantly drenched with sweat and the skin relaxed and sensitive. Williams draws attention to the frequency and severity of bronchitis in both horses and cattle conveyed by sea during stormy weather, and especially when the hatches had to be fastened down. Such an experience combines in one the evils of an overheated stall, a sudden transition often to extreme cold, a lowering of the vitality of the whole system by the circulation of non-ærated blood, a systemic poisoning by the retention of the waste organic products that would otherwise have been eliminated, and the special weakening of the lung tissue by congestion of the whole pulmonic circulation.

But the development of bronchitis and broncho-pneumonia is the least fatal result. The statistics of our European cattle traffic are rich in the examples of absolute suffocation of cargoes in transit to Europe. The following from Report of U. S. Treasury Cattle Commission is illustrative:

“Dr. Thayer reports the case of a steamer from Boston to Liverpool, with 400 cattle on board, which encountered a storm and came through it with only one animal surviving. Mr. Toffey, of Jersey City, lost 30 head out of a cargo of 300 by suffocation in 1880. This happened, he informs us, on a calm sea on a southern route with a temperature about 90° F., and the wind astern and light so as just to keep pace with the ship. The air on board the ship became perfectly stagnant, and there was no means of establishing an artificial current. A still more disastrous experience befell the steamer Thanemore, Captain Sibthorp, of the William Johnson & Co. line. This vessel left Baltimore with 565 cattle on board, of which 228 perished by suffocation before she reached Cape Henry.”

Among animals that survive such treatment the susceptibility to lung disease including even the contagious forms like tuberculosis is enormously enhanced.

EFFECTS OF MODERATELY VITIATED AIR.

“When air only moderately vitiated is breathed continuously for a greater length of time the results are still very injurious, and in the front rank of diseases so caused stand pulmonary consumption, and other destructive affections of the lungs. Perhaps no better example of this can be given than that of the monkey houses of the Zoological Gardens of London and Paris. While these houses were small and ill-ventilated the monkeys died in large numbers from pulmonary consumption, but after they had been enlarged and better ventilated the mortality from this cause nearly ceased. (Arnott.)”

“Town dairy cows which are packed in close ill-ventilated buildings and never allowed to go out are very subject to consumption, while horses kept in no better conditions, but spending nearly half their time in the open air, rarely have phthisis. (With lung plague it will be remembered that the out-door exercise and mingling of herds leads to an increase of the mortality.) Horses newly stabled suffer severely from diseases of the lungs. The same holds true of human beings. A long list of careful observers have noticed the essential connection of lack of ventilation and pulmonary consumption. Baudelacque, Carmichael, Arnott, Lepelletier, Allison, Sir James Clark, Toyubee, Guy, Greenhow, Sir Alexander Armstrong, Parkes, and Aitken have especially insisted upon consumption being a sequence of lack of ventilation. Dr. Cormac indeed insists with great force that consumption is originated by rebreathed air.”

“The notorious prevalence of consumption in sailors has been directly traced to the impure air in which they sleep, and an extensive outbreak of lung disease (not tubercular), leading to destruction of lung tissue, in the English Mediteranean squadron in 1860 was clearly traced by Dr. Bryson to the contamination of the air. In a nursery hospital at Dublin with entire neglect of ventilation, 2,944 children died in four years, whereas after the ventilation had been improved only 279 died in the same length of time.”

“Parkes (Practical Hygiene) says:

“‘But not only phthisis may be reasonably considered to have one of its modes of origin in the breathing of an atmosphere contaminated by respiration, but other lung diseases, bronchitis and pneumonia, appear also to be more common in such circumstances. Both among seamen and civilians working in confined, close rooms, who are otherwise so differently circumstanced, we find an excess of the acute lung affections.’

“In this connection, the statement of the air breathed by an ox per hour and that supplied him on board a ship with insufficient ventilation or none may be instructive. The ox takes in with each breath about 5 liters of air. This is at the rate of 50 liters per minute, or 3,000 per hour = 105.9 cubic feet. This amount of air is therefore rendered all but irrespirable by each animal in the course of an hour. And this, be it noted, is by breathing alone, and makes no account of the contamination by perspiration in the overheated hold, and by the emanations from the accumulating excrement.”

“On board the steamers we have found the space allotted to each bullock to vary from 150 to 240 cubic feet. On the steamship “Holland,” loaded at New York, August 21, 1881, we found the stalls amidships allowed the full space of 240 cubic feet per head. In the bow where there was less height between the decks the space was considerably less. On the lower deck, where 129 cattle were accommodated, the space allowed each was 217.4 cubic feet. The port-holes in the upper deck were nine inches in diameter and there was one for each pair of stalls—central and lateral—or for eight oxen. These being well above the water line would be available for ventilation in ordinary weather. The port-holes in the lower deck, similarly arranged, were about two feet above the water line, and consequently not available for ventilation, save in exceptionally calm weather. The temperature on the main deck of this ship (between the outer and main deck), when only half the cattle had been loaded, was in the neighborhood of 90° although she was lying in the center of the North River with port-holes and hatches open, and a fresh breeze blowing from the north.”

“On the ‘Assyrian Monarch’ the space per head was only 192 cubic feet, but this ship was supplied with a ventilating fan or blower capable of delivering over 50,000 cubic feet of fresh air per hour, so that her ventilation was abundantly provided for. In some smaller ships we found the space per head to exceed little, if at all, 150 cubic feet. In these, accordingly, a single hour without any change of air would threaten the life of every animal on board, and two hours would endanger those for which even the larger space is provided. It is true that such absolute seclusion is rarely required, and that a certain amount of ærial diffusion is always going on through imperfectly closed hatches, companion ways, and ventilators, yet that these are often insufficient has been amply shown by such losses as are reported above, as well as by the bronchitis and tuberculosis which Drs. Whitney, Lyman, and Williams have found in the lungs of American animals arriving in England.”

“ORGANIC MATTER IN EXPIRED AIR.”

“The decomposing organic matter given off by the lungs and skin is probably the most injurious of the animal excreta, when allowed to act on the system for a length of time. This exhaled organic matter is easily recognized in the air by chemical tests, or by the putrid odor evolved when cotton wool, that has been breathed through, is left to soak in otherwise pure water at a temperature of 70° to 80° Fahrenheit. The experiments of Gavarret and Hammond, in which expired air had its carbonic acid and water vapor removed, leaving only the organic matter, showed that the latter was highly deleterious. Hammond found that a mouse died in forty-five minutes in such an atmosphere. It has also been again and again demonstrated that air containing a given amount of carbonic acid as the result of respiration is far more poisonous than air which contains the same amount of carbonic acid as a product of combustion.”

“WATER VAPOR IN EXPIRED AIR.”

“The amount of water vapor given off by the lungs varies greatly according as the air is already more or less saturated with water. As the air in the stalls between decks is always saturated with water vapor, we may take the very lowest estimate for each animal, namely, 60 ounces in 24 hours, which for a cargo of 200 head would amount to over 93 gallons. And this is in addition to the exhalations from the skin and the bowel and kidney excretions. The air between decks is therefore constantly saturated with moisture which condenses and runs down in streams on every solid object. Among the ill effects of this saturation may be noted:”

“First. The saturation of the air with water vapor increases the exhalation of carbon dioxide from the lungs. This effect on the excretion of carbonic acid is usually so great as to counterbalance the tendency of warm air to reduce the production of this acid. This saturation, therefore, with water increases the danger of suffocation by the accumulation of the irrespirable carbon dioxide in the ship, unless the air is being constantly removed.”

“Second. The excess of moisture in the warm atmosphere hastens the decomposition of the organic matter derived from the lungs, skin, and manure. Sir Alexander Armstrong, head of the medical department of the British Navy, says: “There can be no more fertile source of disease among seamen, or, indeed, other persons, than the constant inhalation of a moist atmosphere, whether sleeping or waking; but particularly is this influence injurious when the moisture exists between a ship’s decks, where it may be at the same time more or less impure, and hot or cold, according to circumstances.” It has become an aphorism with sanitarians that “a damp ship is an unhealthy ship,” and many instances are adduced in which a sufficient renewal of the air between decks, with or without stoves to dry it, has transformed a naval pest-house into a salubrious vessel.”

“All such considerations must emphasize the demand for such a constant renewal of air between decks on steamers carrying cattle as shall serve to obviate all those conditions of ill-health, with congestion and inflammation of the lungs, as have proved in the past a serious drawback to our foreign cattle-trade. To accomplish this and at once remove from between decks the excess of carbon dioxide, of decomposing organic matter, and of humidity, and to furnish air approaching in purity and dryness that of the atmosphere outside, we can conceive of nothing more simple and effective than thorough ventilation by fan or heat extraction, as referred to below.” Report of the U. S. Treasury Cattle Commission, 1882.

The above quotations were written with special reference to cattle but the author reproduces them here as in principle applicable to horses as well.

In both horses and cattle treated as above it is common to find ingesta in the bronchia drawn in during the violent paroxysms of coughing. Here we have a direct mechanical irritant and a means of septic infection, highly calculated to induce unhealthy broncho-pneumonia. Williams quotes the case of a horse in which vomition was caused by an over dose of aconite, and a portion of the food entered the bronchi.

In this connection must be named the introduction into the bronchia of liquids forcibly administered to horses and cattle. In the horse the length of the soft palate enables him to hold liquids in the mouth during his pleasure, and among the expedients adopted to coerce him are the very dangerous ones of holding the nostrils and of pouring the liquid through the nose. When the nostrils are held the urgent demand for air leads to attempts to breathe through the mouth, and, whether he succeeds in this or not, the usual result is the drawing of a portion of the liquid into the lungs. When it is poured through the nose the animal cannot protect himself except by rapid gulping, and as he must breathe, a portion of the liquid is usually drawn into the lungs. Any irritant taken in this way will develop bronchitis, and some bland agents like melted lard are almost equally injurious. Cattle having a short palate can scarcely resist swallowing liquids that are poured into the mouth, but a cough with the succeeding quick inspiration will almost certainly draw a portion into the bronchia. To return to the influence of cold, exposed situations which receive the full force of cold winds, those from the north and west on the Atlantic slope are specially conducive to bronchitis. Exposure of newly clipped animals to stand without protection in winter or early spring, has the same tendency. Finally the inhalation of smoke or of heated and irritant gases and vapors, as in a burning building, is an effective factor.

_Symptoms_: In its _mildest form_ bronchitis is a transient illness with some dullness, impaired appetite, hot, dry mouth, redness of the visible mucous membranes, a moderately strong, resonant cough, attended with slight pain, slight rise of temperature, accelerated breathing and pulse, and mucous discharge from the nose. Such an attack passes over in a few days and without any medicinal treatment if ordinary precautions are taken to avoid a repetition of its causes.

In _severe cases_ the symptoms are more intense from the first. Besides the dullness and inappetence, hot, dry mouth, generally increased temperature of the body (102° to 104° F.), accelerated and labored breathing, and other manifestations of fever, there are more specific symptoms. The cough is dry, hard, painful, often paroxysmal, and appears as if it came from the very depth of the chest. A strong, harsh, bronchial sound is heard over the lower end of the trachea and the upper border of the middle third of the chest just behind the shoulder. Percussion detects no change from the natural resonance of the chest, nor auscultation any crepitating sound. Pressure in the intercostal spaces causes no suffering. The expired air feels hot. The pulse though accelerated is moderately soft and sometimes even weak, a condition which marks inflammations of mucous membranes as contrasted with those of the serous. The mucous membrane of the nose has a dark red hue, especially when the inflammation extends to the smaller ramifications of the bronchial tubes so as to impair the æration of the blood. In the same state there is excessive dullness and prostration because of the supply of partially venous blood to the brain. The head is held low, the nose often supported upon the manger, and the eyelids are semi-closed and injected.

From the second to the fourth day a free exudation takes place from the surface of the mucous membrane, and the symptoms are materially changed. The cough becomes more frequent but softer, looser, and attended with a rattle from the air passing through the abundant mucous secretion. The cooing or tubal sound heard at the lower end of the windpipe and behind the shoulder has now given place to a _mucous râle_. A nasal discharge appears at first watery, thin, of a whitish, glairy froth, but soon becoming more opaque, white, milky and flocculent and having little tendency to stick to the nostrils. This is often expelled with sneezing and accompanied by movement of the jaws. With the access of free secretion there is a great mitigation of the fever and the other distressing symptoms, and, if no relapse nor complication supervenes, recovery may be complete in a fortnight or three weeks from the onset.

From this time all the febrile symptoms decline and disappear, appetite and liveliness return, the discharge rapidly diminishes and finally disappears, when the patient may be said to have completely recovered.

=Capillary and pseudo-membranous bronchitis= are described by Reynal as occurring in young horses recently brought into the army and subjected to the hot and close stables in some of the French barracks. It began as ordinary bronchitis, which in place of tending to recovery, propagated itself to the most minute bronchial ramifications, and was frequently complicated by the formation of false membranes. The signs of its accession are an extreme intensity of the general symptoms, the rapid, labored, difficult breathing, accompanied by convulsive action of the pectoral and abdominal muscles; the frequent, painful, suffocating and abortive cough, which violently shakes the whole body; the extended head, open mouth, distorted nostrils, reddish brown protruding eyes; the pinched, haggard features, and the frothy mucous, nasal discharge striated with blood, and later interspersed with shreds of false membrane similar to those existing in croup. In connection with these are the symptoms of extreme oppression, partial sweats, tumultuous action of the heart and small, weak, rapid pulse. Death resulted from suffocation during a paroxysm of coughing.

_Course._ _Duration._ _Termination._ Bronchitis is not usually fatal, except in very young or old or worn out animals, or unless it assumes the _capillary_ form or is complicated by pneumonia, pulmonary abscess or by metastasis to the bowels or feet. In the mildest cases health is re-established in three or four days, and in the severe, about the twelfth, fifteenth or twentieth day. In old and debilitated animals in which pure bronchitis proves fatal, the abundant effusion into the bronchial tubes, the influence of gravitation retaining this in the smaller tubes, the palsy of the cilia which normally carry it outward, and the want of power to expectorate by coughing, usually bring about suffocation. This is favored by the non-ærated state of the blood, which rapidly prostrates the already weakened nervous centres. The supervention of pneumonia will be marked by a new class of symptoms, especially labored breathing, dullness on percussion and crepitation on auscultation. The susceptibility of the bowels is so great in some cases of bronchitis, particularly in those associated with a low fever, that superpurgation, enteritis and death may result from the smallest dose of laxative medicine,—the author has seen a fatal result from the administration of two drachms of aloes in a case of this kind. In such circumstances the skin usually participates in an equal degree, and though the superpurgation be checked an extension of the disease to the feet may still prove fatal or induce such changes of structure as to leave the animal practically worthless. In old animals or after repeated severe attacks of bronchitis it may merge into the _chronic_ form. _Thick wind_ is a frequent sequel of severe cases from thickening or dilatation of the bronchial tubes, from collapse of the lung or from emphysema.

_Postmortem appearances._ In the bodies of animals that have died of bronchitis the air passages within the lungs are filled with a white or greenish yellow mucus. If this is washed from the tubes by a stream of water, the mucous membrane is often found to be injected, studded more or less profusely with red points or with branching red lines, and with petechia, and the mucous membrane is softened, sometimes thickened and friable. When, however, the bronchitis has been attended by a free purulent expectoration the mucous membrane may, when washed, show no perceptible alteration from the healthy standard as examined by the naked eye.

In the _capillary form_ the blocking up of the smaller tubes by a tenacious frothy mucus, and by the false membranes which form complete casts of many of the tubes and the partial consolidation (collapse) of circumscribed pyriform masses of lung tissue with which such tubes communicate form the chief features on examination after death.

This state of _consolidation_ or _collapse_ of lung is frequently seen in simple bronchitis as well. It is then due to the blocking up of one or more bronchia by plugs of tenacious mucus which act as valves, preventing the entrance of air, though it may permit of its easy passage outward. This state of lung differs materially from the consolidation due to inflamed lung tissue (hepatisation). When cut it does not present the granular appearance of the latter, caused by the exudation into the minute air cells, but the cut surface has an uniform homogeneous aspect aptly likened by Lænnec to _muscular flesh_ (splenisation). Mendelson, Traube and Gairdner have induced artificial collapse of the lung by introducing foreign bodies into the bronchia of animals.

_Emphysema_ of the margins of the lung is a frequent concomitant of _collapse_. The cause is plain. The portion of lung, the subject of collapse, emptied of its air, does not occupy a tithe of the space it would normally fill. The rest of the lung tissue expands unduly to fill out the vacated portion of chest and the cells become overdistended and ruptured. The emphysematous lung is known by its lighter color, by its irregular bulging surface, by the subsidence of these elevations when pricked with a needle, and by a more marked crepitation when pressed. When the cells have burst and the air escaped into the areolar tissue between the lobes, it appears as dark lines circumscribing small portions of pulmonary tissue and collapsing when pricked.

_Treatment._ The mildest cases will recover of themselves, especially if care is taken to protect the patients against cold, wet, draughts of cold air, over-exertion, and other injurious causes, and to give a part of the food warm and sloppy. In severe cases treatment must be more active, but it will be borne in mind that severe depletive measures are badly endured. Bleeding dangerously increases the already existing weakness and prostration without affording any corresponding advantage. It is only admissible when from the severity of the symptoms in the early stages suffocation is threatened or when the brain becomes involved in disease.

Causing the patient to inhale water vapor from scalded bran or hay is to be assiduously carried on for half an hour to an hour twice or thrice daily until expectoration has been freely established and the cough and fever alike moderated. The density of the vapor must of course be apportioned to the particular case so as to avoid any approach to suffocation. The addition of the fumes of burning sulphur will often by their astringent and antiphlogistic action on the mucous membrane, render the vaporous application more effective. A pinch put into a small piece of paper twisted at one end to prevent burning of the fingers may be set fire to and the fumes allowed to pervade the apartment so that they can be breathed freely without inducing cough. A mustard poultice to the neck and sides of the chest should also be applied and kept on an hour or until effusion into the skin is well marked by thickening of its substance. Injections of warm water should be given alike to check or obviate shivering and to equalize the general temperature and to solicit the action of the bowels. In sporadic cases with active fever and full strong pulse a laxative dose of aloes (3 to 4 drachms) may be given, but if with a low fever and during the prevalence of influenza not more than half the dose should be given or enemata alone may be relied upon. As soon as the medicine has set or at once if it is withheld, neutral salts may be given (Liquor Ammoniæ Acetatis 2 oz. or Sweet Spirits of Nitre 1 oz. or nitrate of potass ½ oz. combined with 10 drops tincture of aconite repeated twice or thrice daily). If the cough is troublesome and secretion long in being established, expectorants may be used (oxymel of squill 3 oz., powdered squill ½ oz. or liquorice 1 drachm) with half the doses of the neutral salts.

In the early stages to hasten expectoration such preparations as the following may be given:

Recipe: Potas. Bicarb. 2 ounces; Ammon. Carb. 2 ounces; Digitalis Pulv. 2 drams. Mix. Divide into eight powders: give one every four hours.

Recipe: Ammon. Murias. 2 ounces; Choral. Hydrat. 1 ounce; Tinct. Hyoscam. 2 fluid ounces; Aqua 8 fluid ounces. Mix. Give two tablespoonfuls every four hours.

Apomorphia, tartar emetic, turpentine or benzoin may be employed or even pilocarpin, care being taken not to increase prostration unduly. Compressed air, oxygen and peroxide of hydrogen will sometimes relieve.

With the advent of expectoration, or earlier, iodide of potassium in one drachm dose, thrice a day will do much to obviate glandular and other enlargement which would tend to develop _roaring_.

The diet should be laxative, non-stimulating and somewhat spare. Mashes of wheat bran, boiled linseed or boiled barley; roots such as turnips, carrots, beets; in summer a limited supply of fresh grass, with little hay at any time and that scalded, may indicate the nature of the aliments to be used. As a beverage chilled fresh water or linseed tea may be supplied _ad libitum_.

Should the nasal discharge manifest no disposition to cease at the end of 15 or 20 days, as will sometimes happen in young horses, stimulants and tonics must be employed. Gentian (4 drachms), Sulphate of iron (2 drachms), Arsenious acid (5 to 10 grains) or nux vomica (1 scruple) may be given daily as ball, electuary or powder. A full and nutritive diet should at the same time be allowed, and open air exercise enjoined.

CHRONIC BRONCHITIS IN THE HORSE. BRONCHIAL CATARRH.

As Sequel of Acute: as result of unhygienic environment, diet and
usage. Symptoms, breathing accelerated, double expiratory act, short
breath, cough husky, or paroxysmal, excited by cold air, water,
discharge white flocculent. Percussion, drum-like patches;
Auscultation mucous and sibilant râles. Lesions, thick mucus, pale
membranes, bronchiectasis, emphysema, ulceration. Thick wind.
Treatment, stimulating, tonic, derivative, medicated vapors, careful
diet. Tar water.

This may be a sequel of the acute form, or it may appear at once as a catarrhal discharge from the bronchial tubes and without any very marked febrile affection, in animals debilitated by damp stables, overwork and a faulty regimen and diet.

_Symptoms._ Respiration accelerated, and expiration effected with a double lifting of the flank; the horse is easily blown when moderately exercised; the cough is frequent, soft or rattling and paroxysmal—sometimes hard and deep—is excited when brought from the warm stable into the cold air, and is followed by a whitish, flocculent, purulent discharge from the nostrils, consistent but not sticky (like buttermilk). The pulse is rapid and small in volume.

Percussion manifests a healthy resonance over the greater part or all of the chest, a drum-like sound over given areas, and auscultation over its median part detects a bronchial rattle and in most cases a dry sibilant râle.

_After death_ the bronchial tubes are found to contain an abundance of thick mucus, though abnormal redness of the mucous membrane is by no means a necessary condition. There is always more or less dilatation of the bronchial tubes especially at their points of subdivision where they are often twice their healthy calibre, and an emphysematous state of the lungs is equally constant. Delafond and Rodet have noted minute ulcers on the bronchial mucous membrane and Reynal miliary abscesses and grayish and white indurations of the lung tissue and bronchial glands which may have been glanderous.

It will be observed that the symptoms and lesions closely resemble those of broken wind (heaves), and unless early and successfully treated, into this it gradually merges. The chief distinguishing symptoms are the abundance and nature of the discharge, the fetor of the breath, and the presence of the mucous râle in the chest. It is one of the conditions known by the horseman’s expression “_thick wind_.”

_Treatment._ Like its type (dilatation of the bronchia, bronchiectasis) in man this disease obstinately resists treatment. In our efforts to cure it the same general principles must be followed as in acute bronchitis, with this grand qualification that the general aim must be to stimulate and support. Stimulating liniments may be repeatedly applied along the course of the trachea and on the sides of the chest. An equable temperature is desirable and a dry building. Water vapor medicated with various astringents and antiseptics (creosote, carbolic acid, turpentine, tar, or tar vapor) is to be commended. A course of tonic and expectorant medicine is desirable and a highly nutritious and laxative diet is imperatively demanded.

As tonics Gentian may be given daily in 4 drachm doses combined with quaiacum in doses of 2 scruples. In most cases it will be advisable to add to the above or employ separately arsenious acid in doses of 5 to 10 grains combined with three times the amount of bicarbonate of soda, and given daily for a month or longer.

The diet should be as for broken wind, nutritious, in small bulk, of a laxative nature and given at least an hour before work. A moderate supply of grass, roots, bran, oats or barley may be given, but hay must be sparingly supplied and, if exclusively clover hay, dry and dusty, is better withheld. In the north of France horses with chronic bronchitis are maintained in a serviceable condition by a diet of cut straw and cut hay, well sifted to remove all dust mixed with oats and molasses and set aside in a large cask to ferment before being given to the animals. Tar water may be the exclusive drink.

A pint of linseed, well boiled, and given daily for a length of time in succession is often of great value.

BRONCHITIS IN THE OX.

Working oxen most susceptible. Causes, damp buildings, wet, cold,
exposed localities. Debility, overwork, poor feeding, close, foul
stables, sudden changes of temperature. Previous attacks. Symptoms,
mild form, and severe, fever, sneezing, cough, dry, later soft,
prostration, retraction of nostrils, labored breathing, hot breath,
discharge, watery, milky, purulent. Duration, Complications and
sequelæ. Chronic form. Respiratory disturbance, paroxysmal cough,
purulent discharge, mucous and sibilant râles, emaciation. Lesions.
Treatment, laxative safer, expectorant, derivative stimulant, etc., as
in horse. Bronchitis in pigs and sheep.

This is less common than the same disease in the horse, though in working oxen, in which many of the same causes operate, it is frequently seen. It is not infrequent in other cattle in damp buildings or in wet cold exposed situations. Debility from overwork and poor feeding, often brings on the chronic form of this disease. Living out in damp nights after a hard day’s work is another frequent cause. The enervating influence of the hot foul air of many cow houses conduces to it and is specially injurious if alternated with a chilling atmosphere out of doors. Previous attacks strongly predispose to future ones.

_Symptoms._ Some cases are so slight as to escape a cursory observation and subsiding in a few days leave the animal perfectly well. Others are severe and may prove dangerous.

The earlier symptoms are dullness, staring coat or shivering, and sneezing, followed by reaction with hot clammy mouth, general increase of temperature, rapid pulse, reddened nose and eyes, and suspended rumination. The more characteristic symptoms are a hard, dry, hacking cough, not so resonant as in the horse, and soon a mucous discharge from the nose usually cleared away by the tongue almost as rapidly as formed.

If the case increases in severity, and in many cases almost from the first there is great depression, hanging head, semi-closed watery eyes, extreme movement of the nostrils, hot expired air, labored action of the flank, complete loss of appetite, constipation, fæces covered by mucus, cough very hard, painful, occurring in paroxysms and easily excited by touching the larynx or trachea. This is followed by a loose cough, a free discharge from the nose and a mucous râle on auscultation. Percussion gives healthy resonance. The disease reaches its height on the fifth day and recovery may be almost perfect on the eighth. Its chief danger is from a complication with pneumonia or pleurisy, or from its merging into the _chronic form_.

=Chronic bronchitis in the ox= is characterized by a persistent disturbance of the respiration, paroxysms of coughing, a white flocculent discharge from the nose, increasing emaciation, pallor of the mucous membranes, a mucous râle over the windpipe and median part of the chest and a cooing sound over other points. If left to itself emaciation becomes extreme, the skin is harsh, inelastic, attached to the ribs and covered by vermin, and death usually ensues from diarrhœa or consumption.

_After death_ the lesions are like those seen in the horse, unless there is the complication of tuberculous or other disease of the substance of the lungs.

_Treatment._ Neither the general care nor the remedial treatment differs materially from that for the horse. The principle difference is in the lesser liability to superpurgation and in the preference to be given to Epsom or glauber salts over aloes as a laxative. Either saline may be given in dose of one pound combined with an ounce of ginger or other stimulants, and followed up by similar diuretics, expectorants and tonics, as in the horse. The _chronic form_ is to be treated as in the horse.

=Pigs and sheep= affected with =bronchitis= must be treated on the same general principles as the ox, only giving one-fifth the amount of the different medicaments, and in the case of the pig oleaginous purgatives and emetics as advised for the dog.

BRONCHITIS IN THE DOG.

Causes, damp kennels, cold and damp after hunting, pampering and
exposure, distemper. Symptoms, fever, cough hard, later soft,
discharge watery, glairy, purulent. In capillary bronchitis cough more
paroxysmal, painful and attended with vomiting. Disturbance of
breathing, pulse, temperature. Fatality in different breeds.
Treatment, laxative, expectorants, diuretics, heart tonic, calmative,
water vapor, chest jacket, stimulant expectorants, stimulants, tonics.
Diet.

This is common and severe. Hounds kept in damp kennels, much exposed to cold and damp after being heated in hunting, or subjected to frequent and sudden alternations of temperature are specially liable. Pampered pets kept in warm rooms, overfed and having little open air exercise, are equally subject to its attacks. It is an usual form in which distemper is manifested.

_Symptoms._ There is roughness of the coat or shivering and a small, hard cough often repeated. If confined to the bronchi the cough soon becomes loose, a free discharge sets in, and with care recovery may be secured in five or six days.

If the smaller bronchial tubes are involved the symptoms are more intense and persistent. The temperature may reach 104° or 105°. To the same early symptoms succeed, a painful cough occurring in paroxysms and sometimes followed by vomiting of a glairy mucus. There is running from the eyes and nose, and reddening of thin membranes. The creature stands with his elbows turned out, his flanks heaving and his heart beating rapidly and tumultuously. In the worst cases when the inflammation has been propagated to the smallest bronchial tubes constituting _capillary bronchitis_, these symptoms are seen in their most aggravated type and the subject often dies of suffocation, or by implication of the lung tissue. Percussion and auscultation are even more applicable than in the larger animals, showing the clear resonance, of the lung tissue, the tubal murmur in the early stages and the mucous rattle in the later ones. In the _capillary form_ a distinct crepitation is heard like that of pneumonia. Bronchitis proves most fatal to the higher bred dogs, such as King Charles spaniels, Italian greyhounds, and English terriers, and according to St. Cyr small dogs suffer more severely than large ones.

_Treatment._ If the bowels are costive a tablespoonful of castor oil should be given, followed up by nauseating expectorants and diuretics (tartar emetic two grains, nitrate of potass one drachm, and sugar one drachm, mix thoroughly, divide into twelve powders and shake one on the tongue thrice daily). If the cough is very troublesome two grains of powdered digitalis may be added to each dose, or after the nasal discharge has been freely established two to four grains of opium among the tartar. The opiates are of great value in controlling the paroxysms of coughing and the propagation of the disease to the smallest ramifications of the air passages, but as they check secretion they must be used with caution until a free discharge has been established. In the early stages bromides, hyoscyannes or digitalis may be preferred. Muriate or carbonate of ammonia, syrup of Tolu, senega, or gnaiac may follow.

Inhalations of water vapor, the maintenance of an equable temperature, and the moist chest jacket, followed by mustard poultices to the throat and chest are not to be neglected. The diet should be simple, oatmeal or Indian corn pudding with milk, soups and the like may be allowed, but as a rule butcher meat is to be withheld. If the patient has previously fed entirely on the latter it should now be given in very limited amount only, and qualified by an admixture of farinaceous diet.

In some cases the prostration becomes so great that the patient must be supported by tonics and stimulants (a teaspoonful each of sweet spirits of nitre and tincture of gentian, or a teaspoonful of port wine repeated twice daily).

In case of persistent discharge, iron, liquor arsenicalis, the same strength as Fowler’s solution, or cod-liver oil may be used.

CROUPOUS BRONCHITIS IN CATTLE AND SHEEP.

Causes, smoke, hot air or gas, irritant inhalations, concomitant of
infectious diseases. Lesions, intense congestion covered by fibrinous
exudates. Symptoms, slowly or suddenly developed, fever, loud,
wheezing, stertorous, panting breathing, dyspnœa, dry râles and
blowing. Course. Treatment, moist jacket, soothing, expectorant,
stimulant inhalations, expectorants, derivatives.

This affection has been found in cattle and sheep from exposure to smoke, hot air or gas, and other irritants, and even from exposure to cold, and without any suspicion of a contagious element. Again it has been seen as a complication in Rinderpest, lung plague and malignant catarrh. The lesions are those of tumefaction and extreme arborescent redness of the mucosa, and the formation of patches of a dense fibrinous exudate of a yellowish color, in some cases completely obstructing some of the smaller tubes.

_Symptoms._ The attack may come on slowly as in ordinary bronchitis, while in other cases it is sudden. The respiration being loud, wheezing, stertorous and panting and general dyspnœa supervening. Auscultation furnishes loud, blowing sounds, dry râles and rouchi, while percussion may show no abnormal change. A strong tremor is felt by the hand on the trachea, and after a paroxysm of coughing false membranes may be expelled. If there is no improvement by the second or third day death is liable to supervene by asphyxia.