Interesting cases

Interesting cases

CLlNIC.\L ARTICLES. CLINICAL - ARTICLES. - 1) - - INTERESTING CASES. By THOMAS 'W ALLEY, M. R.C. V.S., Principal of the Royal Veterinary College,...

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CLlNIC.\L ARTICLES.

CLINICAL -

ARTICLES. -

1) - -

INTERESTING CASES.

By THOMAS 'W ALLEY, M. R.C. V.S., Principal of the Royal Veterinary College, Edinburgh. PARALYSIS AND iliDEMA OF THE EYELIDS IN A PONY, WITH OPACITY AND ULCERATION OF THE CORN EA . THIS case was brought under my notice by Mr J. E . Tudor, M.R.C.V.S., South Shields. Subject.-An entire pony, 31 years old, in gross condition, h ad been in possession of last owner for a p eriod of 5 years, doing light work in a governess's cart. HistoY)I.-Up to 4 months prior t o death the animal had not suffered from any form of illness, nor had it given any evidence of ocular derangement. Mr Tudor's advice was soug ht owing to the absence of the regular veterinary attendant, and he found the following symptoms presented. Profuse lachrymation and considerable thickening of the eye lids, with congestion and ectopia of the palpebral conjunctiva:. As time went on these conditions gradually became aggravated, the lids became more ten se and m ore swoll en, the swelling extending to the roots of the ears ; ultimately the cornea became opaque, and, partial paralysis setting in, the pony was destroyed. Throughout the whole course of the case there was no apparent alteration in the eyeballs beyond the corneal opacity. TYt'atJlt f!1lt.- The application of warm fomentation s to the eyes with boracic ac id lotion, follmyed by liqu or plumbi and opium lotio n, and subsequently by weak collyrium of nitrate of si lver and an occasional application of this agent in the stick form to the corne
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movements of the muscles to which it is distributed; when paralysed or divided the following effects ensue : (r) Ptosis. (2) Abduction of eyeball. (3) Inability to move the eyeball in any other direction . (4) Mydriasis with photophobia. Division of the fifth nerve" produces such a series o f morbid effects in the organs of special sense as to make it probable th a t in the normal st ate this nerve exercises some trophic influence on these organs, although in part the effect of section of the nerve is only indirectly d estructive by abolishing sensation and therefore the natural safeguard which leads to the protection of parts from external injury. Thus, after a period varying from 24 hours to a week opacity of the cornea set s in; then it becomes co mpletely white, and ultim ately a low d estructive form of inflammation ensues, which in tim e may lead to entire disorganisation of th e e ye. Again, in speaking of the special senses Kirke says, "It is not unreasonable to believe that in paralysis of the fifth nerve, the tissues may be the seat of such changes as are seen in the laxity, the vascular co ngestion, cedema and other affections of the skin of the face and other tegumentary parts which also accompany the paralysis; and th at these changes, which may appear unimportant when they affect external parts, are sufficient to destroy that refinement of structure by which the organs of special sense are adapted to their functi ons." In view of the abo\Oe quoted statement, I addressed a series of questions to Mr Tud or, and received from him the followin g : "At first I thought the le sion might be oL the nature of granular conjunctivitis, but as the sy mptoms progressed and sig ns of paralysis developed, I was forced to the conclusion that there was brain mischief. The head was continually depressed but h eld in a straight line with the body; the animal showed a tendency to turn to the left side, and any attempt to turn him to the right caused him to stagger. These symptoms were progressive, but up to the time of his death the pony was able to elevate his head and attempted to open his eyelids when spoken to by his groom; the attempt, however, was only momentary. " Latterly there was slight cedema of the connective tissue of the throat and of the interm axi llary space, with slight coughing. I did not at any time observe the phenomena embodied in queries 2, 3, and 4, but I may observe that the head \vas depressed equally -as much in the darkened box as in sunlight." It is quite clear from the description given by Mr Tudor that the symptoms observed in thi s case were due to some g ross cerebral lesion, and that the case was a hopeless one. It is a great pity that Mr Tudor was not enabled to obtain the head of the animal for examination. T( lNIC SPASM OF THE SUPERFICIAL ANTERIOR PECTORAL MUSCLES J N THE HORSE.

Tonic spasm of groups of the muscles of locomotion or of individual muscles is frequently m et with in veterinary practice, but such conditi on is only occasionally seen in the pectorals. As in other similar

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cases, it is not always possible to trace the cause, but it may be assumed that in most instances tonic spasm is due to nerve irritation. I have sometimes thought, however. ,,·hen I have met with such cases in hunters, that the cramp was rather the result of muscular exhaustion than of nerve excitation, and more especially so since the cramp does not persist here for a longer period than from 12 to 48 hours. In several cases which have come under my observation the cramp has been so persistent and so little influenced by treatment that I have found it necessary to advise slaughter. In one case, in a heavy cart - horse, the cramp of the pectoral muscles was associated with, and in my opinion was due to, the pain accompanying large sidebones; at anyrate, the spasm passed off after the adoption of treatment for the relief of the pain. ' In one or two other cases in which I had reason to believe that the cramp was of rheumatic origin I administered anti - rheumatic medicines with favourable results. In a case which recently came under my observation treatment was of no avail. The indications of cramp of the anterior pectorals may be arranged in two groups-1st, those observed when the animal is quiescent; 2nd, those observed in motion. In the former, the fore legs are crossed-one in front of the other; the involved muscles are apparently swollen, but in reality their fibres are only shortened; they are intensely hani and rigid, and although in some cases tenderness on pressure is evinced in most they are non-sensitive. In the latter the animal \\"alks with an extremely stiff gait. as though the shoulders were bound down to the chest, and the legs are alternately crossed one in front of the other. The slightest obstacle to progression causes the animal to trip and fall. In treating such cases endeavours must be made to get rid of the cause, if it can be recognised; if it cannot, local fomentations and the application of belladonna liniment, with friction and the internal administration of anti-spasmodics, must be had recourse to, and if these fail in affording relief strychnine may be administered in tolerably large doses with good results. DOES PREGNANCY INFLUENCE THE AHSORPTION OF OSSIFIC FORMA1IONS?

This question originated in my mind on the observation of a case of dissolution of splints in a pregnant mare which came under my notice during the past summer. The subject was a well-bred aged mare, about 14 hands 3 inches high. During the months of April and May 1892 I treated the animal on two occasions for splint lameness by the repeated application of biniodide of mercury ointment, with the result that on each occasion the lameness passed off but the splints did not diminish in size. Late on in the season the owner of the mare determined upon putting her to the horse. This was done and she became pregnant. In the early part of the summer of this year J had occasion to visit

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the establishment in which the mare was kept for the purpose of treating another patient, and curiosity led me to examine her fore legs, when I was gratified to find that there was not the slightest vestige of the pre-existing splints. I am quite aware that splints sometimes disappear under ordinary circumstances, but I think I am warranted in concluding that in this case the demand for bone salts consequent upon pregnancy had much to do with the spontaneous removal of the exostoses; at any rate, it would be interesting if those of my professional brethren who have the medical charge of breeding studs would follow out this line of observation and record the results. That pregnancy is not always associated with such favourable results as in this instance I have had proof-also during the past summer-in the case of another brood mare; but here the splints had been in existence for several years. SCIRRHUS CORD WITH URETHRAL OBSTRUCTION IN THE HORSE.

Subject-an aged chestnut Clydesdale gelding. On the I7th March of the present year I was requested to examine 'the above-mentioned animal, the statement of his attendant being to the effect" that there was something wrong with his water." On examination I found that the animal made repeated attempts (even when in motion) to micturate, but succeeded only in passing small quantities of urine, and after each attempt the urine continued to flow from the urethra for several minutes. On manipulating the penis, sheath, and scrotum I found that the animal was the subject of scirrhus cord on the left side, and that, continuous with the scirrhus anteriorly, there was a considerable amount of dense tissue which embraced the lower and lateral aspect of the penis at a point about 6 inches from its free extremity. Conceiving that this had some connection with the urinary trouble, I attempted to pass the catheter, but failed to insert it beyond the point indicated. Rectal exploration showed that the bladder was distended, so much so, in fact, as to p~eclude the possibility of making a thorough examination of the VISCUS.

The horse was cast on the following day and the scirrhus exposed by dissection, and after placing a compound ligature round its pedicle it was detached, high up, from its connection with the cord. Continuing the dissection in an anterior direction, I found that the enlargement immediately in front of it consisted of hypertrophy of the suspensory ligament of the sheath, the hypertrophied tissue passing qp on either side of the penis and embracing its inferior and lateral aspects. This mass was removed by the knife without any trouble save that arising from the seyerance of an unsuspected artery of large dimensions. After the operation catheterisation was practised, when it was found that all obstruction to the passage of the catheter had been removed. After the urine had been drained off I again examined the bladder PCI' rectu III , and found that with the exception of its coats being much thickened, as the result of the prolonged retention of urine, the viscus was normal. The incision in the sheath was closed with sutures, the wound being dressed antiseptically.

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Beyond a considerable amount of subcutaneous cedema with suppuration no untoward result followed the operation. In due course, the ligature, with the slough produced by its 'compression, was removed; the wound healed and the eneuresis gradually ceased. The animal made a very satisfactory recovery. ULCERATION AND NECROSIS OF THE MUCOSA OF THE SMALL BOWEL IN THE HORSE, 'WITH ROUND-CELLED SARCOMA OF THE MESENTERIC GLANDS.

On the r6th of the present month I received from Mr F. "V. Taylor, M.R.eV.S., New Ross, Wexford, several sections of the small bowel of a horse, along with several groups (massed together by new connective tissue) of mesenteric glands. The following particulars of the case were furnished by Mr Taylor. The subject-a bay cob about r5 years old, was submitted to ::\1:r Taylor for examination about a month before the r6th inst. The cob had shown no evidence of illness until the month of April, when it was noticed that it was off its appetite and out of spirits. On examination, Mr Taylor found that the animal showed symptoms of pneumonia, for which disease he treated it with beneficial results, but after the lapse of a fortnight the owner informed him that the cob was again failing. The animal was removed to Mr Taylor's own premises, when it was found that all evidence of lung mischief had disappeared but that the appetite was bad; after eating small quantities of fresh grass the cob would move a few steps in a backward direction, stretch out its body, and remain in that position for the space of one or two minutes. It evinced a desire for cold water, but only partook sparingly of mashes and gruel, and on each occasion after partaking of water the pain returned. In addition to small quantities of mash and gruel, milk and eggs were administered, but notwithstanding this diet it was observed that the fceces were somewhat hard, and after defcecation the animal groaned. On the 9th inst. a small dose of linseed oil was administered; this produced catharsis which continued up to the night of the I rth, when, although the animal appeared to be very weak, he partook of a mash of bran and flour with relish, and at r r o'clock appeared to be brighter than usual. On the morning of the 12th inst. he was found dead. During the period the cob was under Mr Taylor's care the pulse varied between 60 and 67, and the temperature between !O3' and !O5° F. A lItopsy.-The lower portions of the lungs were collapsed and the upper portions emphysematous, with a few circumscribed centres of inflammation present throughout their structure. All the other organs, with the exception of the bowels and mesenteric glands, were healthy. Portions of the latter were removed and forwarded to me. Examination revealed a most extraordinary condition of matters; the walls of the bowel, in circumscribed patches of several inches in extent, were enormously thickened, so much so as to nearly occlude r

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the lumen; externally, no structural changes were observable, but on laying the bowel open the whole of the mucosa corresponding to the tumefied area was either in a state of ulceration or necrosed. The necrosed tissue was shreddy and of a dark colour, and along with the retained ingesta (which was of a yellow colour) evolved a most abominable odour-an odour comparable only to the decomposing fcecal matter of the human subject. The walls of the bowels \,"ere thickened, in places, to the extent of an inch or more. The mesenteric glands were greatly enlarged and softened, pulpy in consistence, and creamy in colour. As Mr Taylor truly remarks in his letter describing the case"One could only marvel how an animal could exist for such a prolonged period of time with its bowels in such a state." Examination (microscopically) of the mesenteric glands by Mr Stockman showed that they were the subject of round-celled sarcoma. TORSION OF THE SINGLE COLON IN A lIIARE-SARCOMA AND DEATH FROM H.K\IORRHAGE.

On the 12th of May last I received from Mr P. Beattie, M.R.C.V.S., Bogfern, a portion of a tumour which had been removed, post-mortem, from the abdomen of a mare, with the following particulars of the case. Subjcct.-A heavy cart mare 12 years of age. HistOl]'.- The mare had been in the possession of her late owner for a period of I I months, during which time it was observed by her driver that she was incapable of performing severe exertion, and that her team companion, although 22 years of age and of a much smaller size, was more than a match for her in work. The mare had given birth to a foal some 4 years p~ior to her death, and had been again put to the horse during the season of 1892, but was not impregnated. Inquiry elicited the fact that as a 3-years-old the mare, having shown some temper, was put to plough on stiff land, the plough being set deeper than usual in order to bring her into subjection. The result, or assigned result, was that before she reached her 4th year she became roach-backed, the arch rising to the height of 4 or 5 inches. The animal had not evinced any marked sign of illness while in her last owner's possession, but it was noticed that she \vas a shy feeder. During the night preceding the morning on which she was seized with her fatal illness the mare had passed fceces, and at 6 A.M. she started on a journey of 7 miles with a load of grain, and at the stables of the inn where she was baited she refused her corn. When within a mile or two from home on the return journey the mare showed signs of pain, which continued until she reached her stable. Mr Beattie was summoned to attend the mare, and he saw her within an hour after her arrival at home; he found her showing symptoms of acute abdominal pain, pawing persistently and rapidly perambulating her box while on her feet, but never attempting to roll; she would occasionally lie down for a period of a quarter of an hour at a time. The treatment consisted in the administration of large doses of oplUm, belladonna, and chloroform, \'lith the hypodermic injection of morphia, but although these agents produced symptoms of stupor and intoxication they did not give any

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relief from the pain; observing this, Mr Beattie came to the conclusion that the mare \vas the subject of some form of mechanical occlusion of the bowel, and on rectal exploration he found that it was impossible to explore to a greater distance than an easy length of his hand and arm on account of the existence of an unyielding obstruction. From the nature of the obstruction Mr Beattie thought he had to deal with torsion of the colon. The rectum did not contain a vestige of f~cal matter. During the cou-rse of the case symptoms of tympany made their appearance, and Mr Beattie performed the operation of paracentesis intestinalis, but without giving relief; neither did he succeed in removing any of the imprisoned gas. The mare died in about 19 hours after the first symptoms of illness were noticed, and a post-mortem examination was made under very unfavourable conditions. Autopsy.-The abdomen contained a large quantity of blood; there was double torsion of the single colon, the walls of which were in a gangrenous condition; and on removing the intestines an enormous mass of a globular shape was found attached to the structures of the sub-lumbar region; the mass when detached weighed 35 lbs., and in cutting into it a cavity was discovered in its centre which contained about a quart of softened matter mixed with blood. Macroscopically, the portion of tumour forwarded to me had all the appearance of a spindle-celled sarcoma, and a microscopical examination made by my colleague, Mr Stockman, showed that such was its character. From Mr Beattie's statement that the tumour was attached to the muscles only, one is forced to the conclusion that it had originated in the sub-lumbar group of lymphatic glands. VERMINOUS OCCLUSION OF SMALL BOWEL IN A FOAL WITH RUPTURE AND PERITOKITIS.

The particulars of this case have been communicated to me by Mr T. G. Heatley, M.R.CV.S., Hollesley Bay. SubJcct.-Foal of the Suffolk breed, one week weaned. History.-Mr Heatley's attendance was requested on the morning of the 6th of October, the owner of the foal being of the opinion that it was suffering from a chill, as it had not previously shown any signs of illness and had eaten its early morning feed with a relish. ~ylllPtoJ1ls.-Depression of the head, dulness, temperature I04" F., pulse imperceptible, respiration hurried, mucous membranes of a bright scarlet colour. Mr Heatley's first impression on visiting his patient was that it was the subject of acute pulmonary congestion, but the condition of the mucous membranes precluded this supposition. The foal was removed to a loose-box, and in the space of two minutes it fell and, after a hard struggle, died. Autopsy.-Revealed intense peritonitis, distribution of small quantities of ingesta and a large number of parasites (ascaris megalocephala) throughout the abdominal cavity. The peritoneum was, in places, coated with recently exuded and coagulated lymph. In the small intestine there existed a rupture through the serous

Plate XIV.

Fig.

I.-PARALYSIS AND (EDEMA OF THE EYELIDS OF A PONY.

(Mr. Tudor's Case)

dI

Fig.

r

2.-VERMINOUS OCCLUSION AND RUPTURE OF BOWEL OF FOAL.

(Mr. Heatley's Case)

a, a, Rupture; b, Portions of two Ascarides protruding through aperture in mucous membrane c, Free Ascaris; d, Mesentery.

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and muscular coats to the extent of about 18 inches, with perforation of the mucous membrane at one extremity. Through the perforation a quantity of ingesta, as also the ascarides found in the abdominal cavity, had escaped. As will be observed in the accompanying sketch (Plate XIV.) made by Mr Hodder, a student in the college, the ruptured edges of the muscular wall had retracted to the extent of an inch at the widest part; they were inverted, h~morrhagic, smooth, and coated with lymph, showing that the rupture had existed for some hours prior to death; the peritoneum showed evidence of recent and acute inflammation. The points of interest in this case are the cause of rupture and the absence of any symptoms during life of the occurrence of such an important accident. That the rupture was caused by the eccentric pressure exerted on the walls of the intestine by the congregation of the parasites in a limited an~a there can, I think, be little doubt, and it is equally without doubt that the subsequent perforation of the mucous membrane was due to the active movements of the parasites themselves, as several of them were, as shown in the sketch, partly extruded through the aperture which existed in that structure. Careful inquiry failed to elicit any proof of the infliction of injury or violence on the colt, nor can it be imagined that such a lesion as that described could be produced by external violence without at the same time severe injury to the abdominal walls. CARCINOl\L\TOUS INTRA-ORBITAL GROWTH WITH DESTRUCTION OF THE EYE IN A COW.

~IALIGNANT

Sztbject.-A well-bred shorthorn cow. History.- The attention of Mr A. Breakell, M.R.CV.S., Garstang, was first directed to the cow on the 20th of March, the owner informing him that two years previously she had suffered from" chaff in the eye," followed by a cold, and, thinking recovery would ensue, he delayed seeking for advice. On examination Mr Breakell found that the right eye was totally destroyed, its place being occupied by a fungoid mass which protruded beyond the palpebral fissure to the extent of two inches. The surface of this mass was encrusted with a scab, and on removal of this it was seen that the tumour was composed of broken down tissue and new capillary vessels. Mr Breakell, considering that he had to deal with a malignant growth, advised slaughter; but, in view of the fact that the animal was pregnant, that she fed well and did not appear to suffer much pain, her owner declined to follow the advice so given. Antiseptic and astringent applications were prescribed, with strict cleanliness, and in May the cow calved and was apparently doing well, but as the tumour had in June attained enormous proportions she was cast, and the whole of the diseased mass was removed, the resulting wound being dressed with a saturated solution of sulphate of zinc. The treatment was beneficial for a time, but in the course of a few weeks the eyelids and the surrounding subcutaneous tissue became involved. Between the month of June and the date of the

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death of the cow Mr Breakell time and again removed masses of new growth which had an abominably fcetid odour. Up to a fortnight before death the cow appeared to be in good health, ate heartily, and gave a large quantity of milk; at this time, however, the quantity of milk decreased, and seeing that the disease had spread to an alarming extent Mr Breakell persuaded the owner of the animal to kill her. The head was sent on to the college, and on examination the following conditions presented themselves. The orbit was occupied by a foul stinking mass of broken-up tissue of a dirty brown colour, the eyelids were enormously thickened, and in place of the eyelashes there was a border of cicatricial tissue. The diameter of the extruding mass was about st inches, and the surrounding swelling attained a diameter of about 9 inches. On making a section through the tumefied tissues I found that underlying the skin to the extent of several inches there was a mass of necrosed new growth, having an abominable odour and presenting the characteristics of carcinoma. The bones of the cranium were absolutely healthy, and the disease appeared to have originated either in the eyeball itself or from the peri-orbitale. A microscopical examination of the new growth made by Mr S. Stockman showed that it was carcinomatous in character. Thinking that the sudden change in the health of the cow was due either to visceral metastasis or to septic infection, I wrote to Mr Breakell asking if he saw any evidence of either complication when making the post-mortem examination. He informs me that he failed to detect any evidence of visceral metastasis or of septic infection, but that fearing the advent of the latter for some time prior to death he had frequently made inquiries as to the animal's general health and more particularly as to the existence of diarrhcea. The cow, however, appeared perfectly healthy up to a fortnight before her death. -

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By Vet.-Captain F. SMITH, A.V.D. EPILEPSY. CASE L--A mare four years old was suddenly taken with a fit at 6 P.M. on 23rd September r882. I found that without any warning she had suddenly fallen down in her box, and exhibited every appearance of a fit: when I saw her she was still down, partly conscious and in a state of extreme nervousness, head rocking to and fro, eyeballs rolling, cars constantly on the move, but no salivation such as is seen in human epilepsy. After a deal of trouble she was got up and walked to the infirmary about three hundred yards away; she had to be supported by several men, being partly paralysed behind and leaning all over to the left side. She was placed in slings, a purgative exhibited, and mustard applied to the spine. On the second da)' she was better, the eyeballs had left off rolling, there was not so much I These crt..'>es have never been recorded Jll any En~li~h .1olU'nal ; tIley ,\.ppeared at, intel vall'! in the Quarterly Juurnal of Veterimuy Science In lnelm, and .tIe nuw colleete(l aUIl btunght togethel owmg to their interest.