28 RURAL VETERINARY SECRETS 



(1) First stage (congestion) : The onset is sudden. The patient 

 stops eating, seems stupid, and may show pains simulating mild 

 colic. There is often a marked chill during which the temperature 

 rises rapidly to 104 to 106 degrees F. The muscles of the thorax 

 tremble. The pulse is frequent (70 to 80), small and hard. The 

 respirations are accelerated (25 to 40) and of the abdominal type. 

 If the pain is great, and the diaphragm not involved, the ribs may 

 be rolled forward and held, breathing being performed by the flanks. 

 The patient may not show cough or nasal discharge. 



Sounding the thorax in this stage pains the patient and causes 

 coughing. Sensitiveness is sometimes shown on palpating the inter- 

 costal spaces, especially in the region of the elbow. If the exam- 

 iner's hand be laid against the thorax, marked vibrations may be 

 felt. Unless the lung is involved in this stage, there is no change 

 in the percussion sound. 



The respirations seem shorter than normal and of interrupted, 

 catching character. On listening, a rubbing, grating, frictional 

 sound is heard with the respirations. The animal is usually stiff 

 and when turned "moves as one piece" in a rigid, wooden fashion. 



(2) Second stage (effusion) : In this stage the clinical picture 

 is a good deal modified. The patient finds more difficulty in breath- 

 ing and the character of the breathing is changed, depending upon 

 the quantity of exudate in the chest. If a considerable amount of 

 fluid forms rather rapidly in the thorax (25 to 40 quarts) at inspira- 

 tion the ribs are rolled forward at a maximum and at expiration, 

 which is accomplished by a double-pumping movement of the flanks, 

 the lumbar region is elevated and the anus protruded, the manner 

 of performing the respirations much resembling that noted in pul- 

 monary emphysema. A groove is formed along the costal cartilages 

 at each expiration. The nostrils are dilated and often flapping. 

 Percussion : As high as the fluid in the chest extends, a marked 

 flatness with resistance under the hammer is noted. The flat area 

 extends across the ribs in a straight horizontal line. Above this 

 line subdued resonance is heard. Changing the position of the body- 

 will shift the horizontal line. (Only feasible in small animals.) 

 When effusion occurs the frictional sound disappears (in some 

 instances it may still be heard above the area of flatness), and, as 

 a rule, no respiratory sounds can be determined below the horizontal 

 line. Above it the vesicular murmur is harsh ; tubular breathing 

 is frequently present. 



The heart beat is weakened in this stage and may often be 

 heard more distinctly on the right than on the left side of the chest. 



