Navicular disease

“ Some hyperthermia is to be recognized in acute inflammation, by comparing the extremities. In the fore legs, navicular disease is differentiated by noting absence of contraction at the heel. By use of the hoof testers one may recognize evidence of inflammation of the navicular apparatus. In inflammation of the posterior ligaments of the pastern joint, there is also absence of the characteristic stumbling which is seen in navicular disease. ”

“ Hunters are frequently found to be affected by navicular disease, although their work is for the most part over soft, yielding ground. These animals suffer most when made to jump from high banks into roads, especially when the muscles are tired and have lost much of their power. In these circumstances the full weight of the body falls upon the feet, with the result that the navicular bone may suffer by impact with the ground and become the seat of disease. ”

“ When with this we take the facts that the fore-limbs have to carry the head and neck, and that they have to bear this added weight, plus a propelling force from behind, we see why it is that they should be so subject to the disease, and the hind-limbs so exempt.
As pointing out the part that concussion plays in its causation, we may mention that navicular disease is a disease of the middle-aged and the worked animal. It is interesting to note, too, that it occurs in animals with well developed frogs—in feet in which frog-pressure with the ground is most marked. ”

“ A disease of the horse, consisting in strain of the strong flexor tendon of the foot, at the point within the hollow of the fetlock where it passes over the navicular bone. It is most common among the lighter breeds of horses, and especially where the pasterns are upright, toes outturned, and work is early and severe on hard roads. ”

“ Extreme congestion of the kidneys may be produced by exposure to cold, owing to some intimate relationship existing between the cutaneous and the renal vessels, the constriction of the one being accompanied by the dilatation of the other. Infective diseases, such as typhoid fever, pneumonia, scarlet fever, in fact, most acute specific diseases, produce during their height a temporary nephritis, not usually followed by permanent alteration in the kidney; but some acute diseases cause a nephritis which may lay the foundation of permanent renal disease. ”

“ Some ships, particularly the Montague and Royal Oak, had no increase of fevers or other complaints, though the one lay in port for seven, and the other for eleven weeks, and were more or less exposed to the causes of sickness which affected the rest of the fleet. This is a proof, among many others, that a particular combination of 127 causes is necessary to produce a disease: no single one, however powerful, being sufficient, without the concurrence of others. What seemed to be wanting here was the predisposition requisite for the admission of disease into the constitution ”

“ Exceptional cases of epidemics breaking out on ships can not be regarded as arising from contagion from person to person, but always from previous communication of the ship or its crew or passengers with some place infected with the disease. ”

“ The ships that had been the longest from England, were still among the most healthy. But of all the fleet, none was so free from sickness and mortality as the Formidable. No man belonging to this ship died of disease for the first four months after sailing from Plymouth, though there were at times 900 men on board, and never less than the established complement, which is 750; and so few were taken sick in that time, that only thirteen were sent to hospitals, and their complaints were small-pox and ulcers. ”

“ That the health of a ship’s company depends in a great measure upon means within our power, is strongly evinced by this, that different ships in the same situation of service enjoy very different degrees of health. Every one who has served in a great fleet must have remarked, that out of ships with the same complement of men, who have been the same length of time at sea, and have been victualled and watered in the same manner, some are extremely sickly, while others are free from disease. ”

“ Some time before a man's arrival a health sheet is sent to me on which is indicated any disease which he may have had during his period of service, together with information as to whether or not he may have been exposed to anything infectious in the interval immediately before he is sent to us. Any treatment for minor chronic ailments which may be in progress is continued in the ship. A general disinfection of kit and a daily reporting for twenty-one days for examination makes it practically impossible for a new rating to bring disease to the Ship's Company. ”

“ The stroma of the kidney is infiltrated with serum, pus-cells, and blood.
ETIOLOGY.—Most of the cases of acute diffuse nephritis occur after exposure to cold or as a complication of scarlatina.
SYMPTOMS.— (1) The Idiopathic Cases.—Of these we may distinguish two sets of cases. In the first set of cases the invasion of the disease is acute. A person who has previously been usually in good health, after exposure to cold and wet will be suddenly attacked with rigors, a febrile movement, and pain in the back. ”

“ Hyaline casts are the least significant of all the casts, [p. 115] and occur in many slight and transitory conditions. Small numbers are common following ether anesthesia, in fevers, after excessive exercise, and in congestions and irritations of the kidney. They are always present, and are usually stained yellow when the urine contains much bile. While they are found in all organic diseases of the kidney, they [p. 116] are most important in chronic interstitial nephritis. Here they are seldom abundant, but their constant presence is the most reliable urinary sign of the disease. ”

“ It is low in chronic interstitial nephritis, diabetes insipidus, and many functional nervous disorders. It is high in fevers and in parenchymatous forms of nephritis. In any form of nephritis a sudden fall without a corresponding increase in quantity of urine may foretell approaching uremia. It is highest in diabetes mellitus. A high specific gravity when the urine is not highly colored should lead one to suspect this disease. A normal specific gravity does not, however, exclude it. ”

“ NEPHRITIS.—Congestion and inflammation of the kidneys commonly occur in mixed and specific infectious diseases, such as septicaemia, pyaemia and influenza. The toxic effect of spoiled feeds, impure drinking water, and irritating drugs like cantharides and turpentine may so irritate the kidneys as to cause them to become inflamed. Chilling of the skin and nervousness or extreme fear may sometimes cause a congestion of these organs. Inflammation of the kidneys is a common complication of azoturia. Irritation from parasites should be included among the causes of this disease. ”

“ The Primary Cases.—The cases characterized by both dropsy and cerebral symptoms usually end fatally. The cases characterized by cerebral symptoms alone are also very apt to die. The cases characterized by dropsy and anæmia often get well, but the albumen and casts may persist for a long time, and the patient may have several attacks of such a nephritis.
(2) The Secondary Cases.—Here the prognosis varies with the intensity of the nephritis. The more severe forms of the inflammation may add very much to the danger of the primary disease or may persist for a long time afterward. ”

“ DISEASES OF THE KIDNEYS.—As has been abundantly proved by careful autopsies, inflammation of the retina may be developed during any form of Bright's disease, either with the enlarged mottled kidney of acute parenchymatous nephritis, the large white kidney, the amyloid kidney, or the cirrhotic kidney of chronic disease. In the vast majority of cases the retinal inflammation appears during the later stages of the last-named form of disease, and seems to be in some way dependent upon blood-poisoning, which has been caused by the degenerating kidney. ”

“ And, happily, since one attack confers an immunity, the patient who recovers from eclampsia need not fear a recurrence of the disease.
Nephritic Toxemia is a serious toxemia, sometimes complicating pregnancy, and though it may occur at any time during the period of gestation, it usually develops during the latter months. As a rule, it is simply an exacerbation and accentuation of a previously existing, chronic nephritis, of which the patient may, or may not, have been aware; though in some instances the disability of the kidneys may arise during pregnancy. ”

“ Besides this, renal phthisis sometimes succeeds, as a more local invasion, to tubercle or cheesy inflammation of the urinary passages, and in this case the symptoms appear simply as aggravations of those already present and depending upon ureteritis and pyelitis. Renal phthisis is seldom if ever an independent disease. It is often associated, besides the affections already named as standing in etiological relationship with it, with cheesy inflammation of the testicle, vesiculæ seminales, and much less frequently of the ovaries and Fallopian tubes. ”

“ Recovery.—The prognosis is favorable in uncomplicated cases. It also depends upon the character of the epidemic type of the disease. In England it varies from thirteen to fourteen per cent. In this country it is sometimes as low as two to four per cent. The kidney trouble is always feared for it may result in uremia and death, or the acute may be followed by chronic nephritis or Bright's disease, which will ultimately prove fatal.
Sanitary Care of Room and Patient.—If you are exposed to this disease what can you do? If a child, it must be put in a room by itself. ”

“ On the 11th July, Captain Marryat wrote to the Commodore as follows:
“I must now call your attention to the condition of H.M.S. Larne, whose crew I am sorry to say have been rendered quite inefficient by disease. Since we have been on this expedition, we have had 170 cases of cholera and dysentery. We have had thirteen deaths – we have now thirty patients at the hospital on shore, and twenty in the sick list on board; our convalescents are as ineffective as if they were in their hammocks ”

“ If the patient is a female, and deranged or suppressed menstruation has not marked the accession of pulmonary symptoms, the flow now becomes profuse and clotted, or is scanty and colorless, sometimes ceasing altogether. In the male, the sexual powers diminish, and copulation is followed by excessive and long-continued prostration. From this time onward, the progress of the disease is more rapid. The liver and kidneys are implicated. In addition to the pallor, the complexion becomes jaundiced, giving the patient, who is now wasting to a mere skeleton, a ghastly look. ”

“ The educated physician will explain to her what symptoms are normal and what are pathologic, and often he will be able to entirely cure the latter. It is now a well-established fact that the most serious complications of the pregnancy, and of the labor itself are caused by severe congestion or disease of the kidneys. The condition of the kidneys can only be determined by frequent examinations of the urine; during the early months of pregnancy these examinations are made once a month, and during the last month they are made every week. ”

“ Infectious diseases are sometimes caused by the foul air arising from a ship's hold, owing to the decomposition of vegetable substances in a hot climate, or to an accumulation of filth, without ventilation, when crowded with passengers. The malignant, pestilential disease, caused by inhaling this noxious atmosphere, often sweeps off portions of the crew and passengers; and those who visit a ship under such circumstances, and breathe the poisonous gases, even in a northern latitude, are liable to be attacked by this fatal disease. ”

“ Infectious disease has to be provided against, especially in the case of ships carrying emigrants. Dispensaries and hospitals are carried, with their proper equipment, and it is not so long since the world was thrilled by the announcement that on one of the swiftest mail liners a case of appendicitis manifested itself, and had to be attended to without delay. When the moment arrived the engines of the great ship were stopped in mid-Atlantic while, with great courage and admirable nerve, the surgeon performed successfully the delicate operation on the unfortunate man. ”

“ After separating the true cases of chronic parenchymatous nephritis—cases in which only the epithelium of the tubes and of the Malpighian capsules is changed—all the other kidneys of chronic Bright's disease present essentially the same lesions and give rise to the same symptoms.
We can indeed often tell during the life of the patient whether he has large white or atrophied or waxy kidneys, but in many cases such a diagnosis is impossible. ”

“ Anaesthetics, that is, chloroform and ether, are not well tolerated when nephritis exists, and this adds to the danger of operation in such patients. No matter how simple or short the operation that is to be performed on a person suffering from kidney disease, if an anaesthetic is to be administered it would be well to prepare the patient for an untoward event that may occur.
Kidney disease is often extremely insidious. It may develop absolutely without the patient's knowledge, even though he might be deemed to be in a position to have at least some suspicion of its existence. ”