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 PRAISE FOR
LET’S TALK ABOUT IT
AND DR. PAUL L. MARCIANO

“The new standard for conflict resolution, Let’s Talk About It equips
you to build and deepen relationships one conversation at a time.”
—KEVIN KRUSE, CEO of LEADx and author of
Great Leaders Have No Rules

“Dr. Marciano has created a brilliant and thorough playbook on how

we can all improve our relationships, both within and outside the
workplace. This extremely useful set of recommendations, exercises,
and reference scripts will prove invaluable to anyone who needs a
strategy and proven tools on how to be deliberate and effective with
everyday conversations. In my more than 25 years of advising and
investing in companies, I wish I’d had a manual like this to
recommend to entrepreneurs and management teams.”
—KRISHNAN RAMASWAMI, Director at Fallbrook
Private Equity, LLC

“Dr. Paul Marciano has delivered a truly insightful and

comprehensive guide to building collaborative relationships by
changing the only thing within our power—our own behavior! It is a
must-read for high-potential leaders to gain the vital skills of self-
awareness and conflict resolution required in C-suite roles.”
—SHARON M. WERNER, Senior Vice President of
Human Resources at Marsh & McLennan
Agency LLC

“This book provides crystal clear advice on how to turn difficult

conversations into productive ones. In Let’s Talk About It, Dr.
Marciano has distilled his 30 years of transforming workplace
relationships into universal, easy-to-implement strategies that we
can all use to improve important relationships in our professional and
personal lives.”
—ELIOT BRENNER, PhD, Executive Director of
Klingenstein Philanthropies

“Let’s Talk About It should be required reading, regardless of what

position or industry you are in. This is an easy read with effective tips
to make anyone, at any level, a better communicator. Successful
leaders communicate authentically and honestly. This book will help
you become that leader.”
—SHARON NOBLE, Vice President of Human
Resources at Huber Engineered Materials

“Having healthy conversations is the key to effective leadership and,

ultimately, to organizational success. In Let’s Talk About It, Dr.
Marciano provides the communication strategy and tactics to
achieve those twin goals.”
—CHRISTOPHER J. PHELAN, President and CEO of
Hunterdon County Chamber of Commerce

“Marciano reminds us that creating inclusive and welcoming

workplaces requires intentional and meaningful work—work that
starts with the ‘I’ in inclusion. This work is not so much a destination
as it is a journey of self-reflection, soul-searching, and commitment
that will inevitably have communal impact. Let’s Talk About It
cultivates the common good by focusing on the we.”
—CAROL E. HENDERSON, PhD, Vice Provost for
Diversity and Inclusion, Chief Diversity Officer,
and Adviser to the President of Emory
University

“Let’s Talk About It is an essential handbook that enables us to

recognize how our biases, blind spots, and body language inform the
manner in which we communicate. In today’s fast-paced digital
world, the book’s scripts, scenarios, and best practices—especially
in videoconferencing—will empower you to handle any
communication conflict with confidence. Packed with solutions, it will
equip you to foster and maintain healthy, respectful relationships.”
—DIANE PIRAINO-KOURY, McDonald’s franchise
owner and operator

“Relationships deepen because of, not in spite of, conflict. Dr.

Marciano helps us transform conflict into opportunity, providing the
tools (and courage) to convert negative emotion into successful
conversations that produce positive outcomes.”
—MELANIE KATZMAN, PhD, business psychologist
and #1 Wall Street Journal bestselling author
of Connect First

“Now more than ever, the skills we need to bridge divides, find
common ground, and come together in joint purpose are even more
critical to our success. If relationships are the foundation of that
success, conversations are the glue. Let’s Talk About It equips us
with the necessary tools to build that strong foundation.”
—JEREMEY DONOVAN, Senior Vice President of
Sales Strategy at SalesLoft and bestselling
author of How to Deliver a TED Talk
Copyright © 2021 by Paul L. Marciano. All rights reserved. Except as
permitted under the United States Copyright Act of 1976, no part of
this publication may be reproduced or distributed in any form or by
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prior written permission of the publisher.

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 Jack, my best friend, I miss you every day

and

Kristen, my puzzle piece, I love you more each day

 CONTENTS

ACKNOWLEDGMENTS
INTRODUCTION

CHAPTER 1 ROOT CAUSES

CHAPTER 2 I THINK I’LL PASS
CHAPTER 3 AVOIDANCE COSTS
CHAPTER 4 UNCONSCIOUS BIASES
CHAPTER 5 PERSONALITY TRAITS
CHAPTER 6 NONVERBAL COMMUNICATION
CHAPTER 7 LOADED LANGUAGE
CHAPTER 8 PUSH-BUTTON MANAGEMENT
CHAPTER 9 ENGAGING MINDSET
CHAPTER 10 COMMUNICATION SKILLS AND STRATEGIES
CHAPTER 11 CONVERSATION ROAD MAP
CHAPTER 12 BUILDING, RESTORING, AND MAINTAINING
HEALTHY RELATIONSHIPS
CHAPTER 13 LAST WORD
APPENDIX A QUESTION AND ANSWER
APPENDIX B SCENARIOS AND SCRIPTS
APPENDIX C BEST PRACTICES FOR VIDEOCONFERENCES

INDEX
 ACKNOWLEDGMENTS

T
hroughout this project, my godchild, Amanda Eliades Zalla,
has been a godsend. Her tangible and intangible contributions
have been indispensable in bringing this book to life.
I am deeply grateful to the many organizations and leaders with
whom I have worked, but none more so than Rob, TJ, and Michael
Earle. Remaining faithful to their father’s core values of quality,
efficiency, and integrity, they have built Earle into an extraordinary
company. It has been a privilege and an honor to be part of their
journey.
I would like to acknowledge the following individuals for whom I
have great respect and appreciation: Dr. Eliot Brenner at
Klingenstein Philanthropies; Doug “Film Doc” Clayton at SES; Dr.
Jim Dlugos at Saint Joseph’s College of Maine; John Emmons at
Mannington Mills; Dr. Carol Henderson at Emory University; Bill Hills
at Navy Federal Credit Union; Dr. Alan Kazdin at Yale University;
Kevin Kruse at LeadX; Chris Phelan at the Hunterdon Chamber of
Commerce; Leah Pontani at Goodwill; Lily Prost, Daniel Krawczyk,
and Sharon Noble at Huber; Dan Rehal at Vision2Voice Healthcare
Communications; Sharon Werner at Marsh & McLennan Agency;
and Dawn Wilno at Core Association Partners.
My thanks to those who shared their insights and stories from
their “playing field,” including Kristen Avery, Josh Budde, Michael
Caldwell, Dr. David Desteno, Giles Garrison, Nancee Gelineau, John
Hellier, Diane Koury, Robin Lapidus, Jean Larkin, Axel Larsson, Jack
Licata, Sharon Mahn, Jeff Masters, Crista McNish, Erica Moffett,
John Parks, Krishnan Ramaswami, Laura Reilly, John Rice, Amanda
Seirup, Kriste Jordan Smith, Warren Spitzer, Robert Stanisch,
Timothy Theiss, and Joe Wingert.
I am so very grateful for the unconditional support of Jeanne
Murphy and Colleen Kelly of Mariah Media, who, next to my mother,
have been my greatest cheerleaders. Writing a book can be stressful
at times (or all the time), and everyone needs a friend who can talk
him off the ledge. My thanks to John Bradshaw for always being
there and letting me talk about it. With love to Maddie, Taylor, Brady,
and Katie whose lives give mine meaning. Finally, a nod to my
friends at Beehive Poker League, who have proven over and over
again that I am terrible at reading body language.
With gratitude.
—PLM
 INTRODUCTION

I
hate conflict; I really do. However, I have come to realize that
avoiding it does not serve me or anyone else well. When I choose
to bite my tongue and stop myself from discussing an issue that
concerns or upsets me, I invariably become frustrated and then
resentful not just toward the other person, but also toward myself for
being too much of a wimp to initiate a conversation. Instead, I usually
end up complaining to others in hopes of gaining sympathy under
the guise of garnering advice. Sometimes I let my anger build to the
point of losing my cool, and I speak sharply to the other person,
which, frankly, is terribly unfair, as she may have had no idea that I
was even upset. After losing my temper, I end up feeling worse
about the situation because I have now demonstrated to myself and
others that I cannot control my emotions, let alone deal with the
problem effectively. Ironically, when we have problems in our
relationships, we often avoid talking about them, and in the process
make things worse.
Over my 30-plus year career, I have seen a lot of conflict in the
workplace and the damage it does to relationships, morale, and
productivity when it goes unaddressed. Among the more egregious
examples that still make me shake my head include the manager
who refused to speak to his direct report for two years, an employee
who was fired over text because his manager wanted to avoid
conflict, and two colleagues who did not speak for four months
because one failed to copy the other on an email. Obviously, most
situations are more mundane and subtle; I bet that a few examples
have already come to your mind. Can you imagine the total number
of interpersonal conflict situations that exist in the workplace at any
one time and the adverse impact they have on individuals and
organizations? Just think about how distracting these conflicts are
and how much time and energy they take to both address and avoid.
I have come to believe that much conflict in the workplace (and
the world) could be resolved or prevented altogether if people were
skilled at straightforward conversations. Have you ever avoided
having a difficult conversation, the simple thought of which caused
your blood pressure to rise and heart to race? Have you ever
regretted not having a critical conversation sooner because, in the
end, not doing so made the situation worse? Have you gotten
frustrated with yourself for not having the courage to address a
person or situation head-on? Can you imagine how your life might
change for the better if you could deal directly and effectively with
any conflict in your life? If you answered “Yes” to any of these
questions, then you did yourself a favor by picking up this book.

Difficult Conversations
A difficult conversation is one we believe will evoke strong negative
emotions and likely involve conflict. In our minds, the conversation
may become unpredictable and unsafe as tensions rise. Or, we
might find the topic of the discussion embarrassing, making us
vulnerable in some way. We might have to deliver bad or
disappointing news. Or we may simply want to ask a question to
which we fear the answer will be “No.” In general, difficult
conversations are those we anticipate will make us feel
uncomfortable and may lead to a poor outcome. Examples of such
situations include:

Confronting a colleague who has taken credit for your work

Discussing with a boss why you have been passed over for a
promotion
Furloughing or firing an employee
Quitting
 Telling a coworker that he has bad breath or body odor
Informing your supervisor about a costly mistake
Notifying a customer that you cannot deliver what was
promised

It is critical to realize that difficult conversations are difficult

because we think they are. Conversations are not inherently good or
bad, easy or difficult. They are so because we label them as such. If
we say that something is “hard,” then it is hard. Our thoughts and
words shape our reality; moreover, we believe that we are never
wrong. The assignment you were given is unfair because you say it
was unfair. Your boss is a jerk because you say she is a jerk. Your
colleague is conniving because you say he is conniving. How we
choose to label people and situations makes them that way.
The extent to which we view situations as potentially easy or
difficult depends largely on how competent we feel in taking them on.
For example, I will not drive in New York City because I believe it to
be far too difficult and stressful. I do not feel competent in my driving
skills to navigate the stop-and-go traffic. (I am also embarrassed to
say that I never learned to parallel park.) On the other hand, I do not
find public speaking hard, which some people fear more than death.
In general, we experience stress whenever perceived environmental
demands exceed our perceived internal resources. Thus, most
people avoid engaging in what they believe would be a difficult
conversation because the thought of doing so causes anxiety. But
what if we changed our mindset from telling ourselves we must face
a difficult conversation to believing we have the skills to engage in a
healthy conversation?

Healthy Conversations
I find that highly successful people are very good at dealing with
conflict. They address interpersonal problems quickly in a
straightforward, calm, and respectful manner. There is no finger-
pointing or drama, and the goal is not to make the other person feel
bad or guilt him into apologizing. A productive conversation takes
place in which both people speak and listen to one another. The
issue often gets resolved promptly, and importantly, both people
leave the interaction feeling complete and move on without
resentment. In short, they have learned how to have healthy
conversations.
You will read a whole chapter on helpful mindsets, but for now I
would like you to reframe difficult conversations into healthy
conversations. Just as people who are good at giving corrective
feedback think in terms of “constructive” rather than “critical,” people
who are good at dealing with conflict situations think of
conversations in terms of “healthy” rather than “difficult.”
Approaching conversations in this way can help decrease the
likelihood of defensiveness (on either side) and emotional escalation.
Such conversations are more effective and efficient, which is
advantageous for the relationship and for workplace productivity.
What makes for such a conversation? Healthy conversations are
characterized by the following:
A two-way flow of communication in which both people have
the opportunity to fully express their views, opinions,
concerns, and feelings in a safe environment without fear of
retribution or other negative impact.
Both people feel heard and understood.
Communication is transparent and straightforward; there is no
distortion or withholding of information.
The conversation remains respectful and professional.
Each person remains calm and composed.

A healthy conversation does not mean that everyone gets exactly

what they want. Being happy or even satisfied with the outcome is
not part of the deal. For example, imagine your boss asks you to
take on work unfinished by a colleague. You are not happy and ask
to discuss it. The conversation might have all the elements of a
healthy one, but, in the end, you still have to take on the
responsibilities. It was a healthy conversation—it just did not go the
way you wanted.

What to Expect
The goal of this book is to make you comfortable, confident, and
competent in addressing and resolving conflict through healthy
conversations. As with my previous title, Carrots and Sticks Don’t
Work, this book provides tangible and actionable strategies that will
empower you to deal effectively with any workplace conflict. In this
book you will learn about the unconscious cognitive biases that lead
to systematic distortions in our thinking and how to deal with different
personality types. You will discover the minefields and gold mines of
language and learn specific communication strategies and
techniques. Perhaps most importantly, you will find many anecdotes
throughout the book and an entire appendix devoted to real-world
scenarios and scripts to guide you through healthy conversations on
your playing field. And while I certainly hope that you find this book
an enjoyable and interesting read, my greatest hope is that it will
make a difference in your life—both professionally and personally.

UP NEXT
In order to figure out how to address potentially difficult
conversations, it is helpful to understand what triggers them in the
first place. Let’s find out.

ON YOUR PLAYING FIELD

1. Whom do you consider highly skilled in holding difficult
conversations and resolving conflict? What does that
person say and do that makes her so effective?
2. How would you evaluate yourself in terms of your
willingness and ability to address and successfully resolve
contentious issues?
3. Do you believe you can learn the skills necessary to have
healthy conversations?
 CHAPTER 1

ROOT CAUSES

W
hen it comes to figuring out how best to deal with conflict, a
good place to start is understanding the underlying issues
and events that drive it. In fact, doing so may help us
prevent problem situations from arising in the first place, rendering
contentious conversations unnecessary. As you read over the
following list of common causes of conflict in the workplace, think
about how these situations were handled in your own experience
and how they might have been dealt with differently:

Perception of inequality in workload distribution; employees

not pulling their weight and having their tasks consequently
pushed onto other team members
Perception of unfair or unequal pay; discord created by
employees who perceive they are doing the same work as
colleagues with equivalent credentials but for less pay
Unfulfilled expectations: perceived broken promises, such as
being led to expect a promotion or raise with no follow-
through
Poor communication: ambiguous, inaccurate, delayed, or a
total lack of communication
Another random document with
no related content on Scribd:
 Fig. 210.—Deep-seated lymphatic glands of the head and neck. The posterior
portion of the lower jaw removed. P, pharynx; GRp, retro-pharyngeal gland;
GC, deep cervical glands (cervical chain); NS, spinal nerve; NP, pneumo-
gastric nerve; GCs, superior cervical nerve ganglion; NMi, inferior maxillary
nerve.

Beginning with the head and fore quarters, the lymphatic

apparatus comprises a subglossal, a preparotid, a subatloid, a
prescapular and several prepectoral glands (Fig. 209).
None of these glands are very deeply placed, and all are easily
accessible to palpation, provided their exact position is known and
the animals are not too fat.
The subatloid is a little more difficult to detect, but in thin animals
the tips of the fingers can easily be passed under the wing of the atlas
so that the condition of the gland can be examined.
In a normal condition, any gland on being examined conveys a
sensation of softness and elasticity of a special character which never
varies. Palpation is painless.
When, however, the gland is diseased, palpation causes pain in the
case of all acute affections. It may, indeed, be impossible to reach the
glands, as they are buried sometimes in œdematous swellings of
varying size. On the other hand, they may be painless on being
touched, but swollen, hypertrophied, indurated, hardened or
caseous.
The deep-seated glands of the fore portion of the body comprise
the retro-pharyngeal and the cervical chain running along the
posterior border of the trachea. Normally these glands cannot be
examined (Fig. 210); but when the seat of certain morbid processes,
they may be so enlarged as even to be readily visible. The larynx and
pharynx are then displaced downwards, the depression between the
head and upper extremity of the neck disappears, together with the
depression known as the jugular furrow. Such deformities may be
either perfectly symmetrical, as in lymphadenia, or (as is more
commonly the case) asymmetrical, as in tuberculosis; and if
inspection leaves any doubt, the glands may be further examined by
palpation.
 Fig. 211.—Lymphatic glands of the hind quarter. GG, Precrural
lymphatic gland; GF, lumbar lymphatic; GP, popliteal lymphatic
(deep-seated); GI, ischiatic lymphatic (deep-seated); GA, anal
lymphatic (deep-seated).

To obtain the fullest information both hands should be used, one

arm being passed over the neck and the fingers engaged behind the
trachea. The operator may also stand in front of the animal, whose
head should be lifted so that the points of the fingers can be thrust
deeply inwards on either side of the trachea in the direction of the
vertebral column.
In the posterior portion of the body the number of glands that can
be examined is much smaller. The gland of the stifle, also called
“gland of the flank,” is, so to speak, the only one which can readily be
detected by examination or palpation. Nevertheless, in cases of
lymphadenitis, tuberculosis of the glands, etc., it becomes easy to
detect lymphatic glands in the loose fold of skin known as the flank.
These glands are very small, and three in number. They are arranged
in a triangle, one being much more prominent than the two others.
In exceptional cases, little nodular glands, indistinguishable at
ordinary times, may become hypertrophied. This is particularly true
of the small glands in the neighbourhood of the last rib.

Fig. 212.—Lymphatic glands of the thoracic and abdominal cavities. T, Trachea; C,

heart and pericardium; Bd, right bronchi; O, œsophagus; A, posterior aorta; VCp,
posterior vena cava; R, rectum; VIe, external iliac vein; AIe, external iliac artery;
GA, aortic lymphatic gland (anterior mediastinum); GM, mediastinal lymphatic
glands (posterior mediastinum); GSL, sublumbar lymphatic glands (part of lumbar
chain); GSS, subsacral lymphatic glands; GI, iliac lymphatic glands.

The retro-mammary glands need only be mentioned, but it is

important to know that a deep-seated popliteal gland also exists
above the semi-tendinosus and semi-membranosus muscle in the
thickness of the muscles of the thigh; as also an ischiatic gland
opposite the ischiatic notch, which can only be examined by internal
palpation from the pelvis, and an anal gland situated deeply on the
sides and in front of the sphincter ani.
 With the exception of those of the pelvis and of the sublumbar
region, the glands of the thoracic and abdominal cavity cannot be
examined, but change in them is indicated under certain
circumstances by clearly defined clinical symptoms, and moreover it
is necessary to be able to detect changes in these glands on post-
mortem examination.
In the thoracic cavity the lymphatic apparatus comprises the mass
of the prepectoral glands, which extends into the anterior
mediastinum between the first ribs (glands of the entry to the chest),
the aortic lymphatic gland situated beneath the dorsal portion of the
spine opposite the bifurcation of the aorta, and the lymphatic glands
of the posterior mediastinum, one of which is relatively small and is
lodged in the concavity of the posterior aorta, the other large,
elongated and situated immediately above the œsophagus in front of
its passage through the diaphragm.
In the abdominal cavity a sublumbar chain is found situated on the
sides of the lumbo-sacral portion of the vertebral column, the mass
of the subsacral lymphatic glands, and, at the entrance to the pelvis,
extending on either side along the course of the external iliac arteries
and veins and resting on the shafts of the iliac bones, the iliac glands.
All these glands are partly accessible to examination by the
rectum.
Last of all, we may mention the gland situated on the hilum of the
liver, the mesenteric glands, and the little lymphatic glands above the
sternum.
In the front limb the only glands of importance from a clinical
standpoint are those of the internal surface of the shoulder, close to
the divisions of the brachial plexus.
When enlarged or invaded by any specific organism, they may, by
compressing the nerve trunks, cause lameness.

THE LYMPHOGENIC DIATHESIS.

(LYMPHADENITIS, LYMPHO-CYTHÆMIA, MYELO-

CYTHÆMIA.)
 It has been questioned whether the term “lymphogenic diathesis,”
which was employed in human medicine by Jaccoud to describe
certain morbid conditions also found in animals of the bovine
species, should continue in use. At the present moment it is difficult
to determine the question. Under any circumstances it has the
advantage of including diseases of the lymphatic system, indicated by
hypertrophy of the lymphatic glands (adenitis) or by an exaggerated
production of white blood corpuscles (leucæmia), and the passage
into the general circulation of products derived from the lymphatic
apparatus. For these reasons it may be employed here.
Clinical investigation long ago demonstrated that in man certain
pathological conditions were characterised by a peculiar colour of the
blood, due to the presence of white blood corpuscles in excessive
quantities, whence the names “leucæmia” (Virchow) and
“leucocythæmia” (Bennett). In the same way it has been shown that
the change in the blood characterised by a superabundance of white
blood corpuscles generally coincides with engorgement or more or
less marked hypertrophy of the lymphatic system and of the adenoid
tissue of the body (lymphatic glands, spleen, bone marrow, and, in
exceptional cases, liver, kidneys, etc.)—leuco-cythæmic
lymphadenitis; but that many cases also occur in which this
hypertrophy of the adenoid tissue or of the lymphatic gland tissue
may exist, without any excessive number of white blood corpuscles in
the blood, whence the name “aleucæmic lymphadenitis or pseudo-
leucæmia.” Cases of true leucæmia without adenitis are much rarer,
the lesions therein being confined to the adenoid tissue of the bone
marrow.
These three morbid conditions—leucæmic lymphadenitis, or
leucocythæmia; aleucæmic or pseudo-leucæmic lymphadenitis, or
more simply adenitis; and true or simple leucæmia—are frequently
found in the bovine species. Whilst stating that these diseases are
frequent, we must, however, be understood to except the numerous
cases of tuberculous lesions formerly included under the same head.
Jaccoud has shown that in reality the causes of these three morbid
conditions are very similar, and that a case which at first appears to
be of the nature of aleucæmic lymphadenitis may later become
transformed into leucæmic lymphadenitis; or, inversely, that a case
which at first appeared to be a simple leucæmia might often become
complicated with lymphadenitis: hence the grouping of these
different morbid conditions under the heading of lymphogenic
diathesis.
Investigations have now thrown more light on the subject because
of the more perfect recognition of the varieties of white blood
corpuscles, and the above-mentioned morbid conditions may be
defined as follows:—
(1.) The first variety consists of a more or less marked adenitis or
lymphadenitis without leucæmia (aleucæmic lymphadenitis).
(2.) The second variety, consisting of leucæmic lymphadenitis, or
leucocythæmia, is a lymphatic lucæmia or lympho-cythæmia, the
anatomical characteristic of which is enlargement of lymphatic
glands, and the histological characteristic increase in number of the
large and small lymphocytes.
(3.) A third variety, formerly regarded as simple leucæmia without
lymphadenitis, is myelogenic leucæmia or myelo-cythæmia, the
anatomico-pathological characteristic of which is to be found in
myeloid hypertrophy of the bone marrow, giving to the bone marrow
on post-mortem examination a puriform appearance, and in the
myeloid condition of the spleen.
Histologically this variety is characterised by an absolute increase
in numbers of the large mono- and poly-nuclear eosinophile
leucocytes.
Symptoms. Simple lymphadenitis begins in an insidious manner,
and is characterised by weakness, anæmia, paleness of the mucous
membranes, and wasting without apparent reason, although the
appetite is preserved. It is only at a later stage that the glandular
enlargements are discovered (adenitis), and often this discovery is
not made until the veterinary surgeon is called in.
The existence of the disease is indicated by enlargement of the
superficial glands, and this enlargement, which may commence at
any point, extends along the course of the lymphatic vessels to the
neighbouring glands, until in a shorter or longer time it involves all
the lymphatic glands in the body.
The enlargement of the glands is usually symmetrical, and on
clinical examination it is sometimes easy to detect at the outset an
increase in size of the retro-pharyngeal glands, the glands of the
neck, the prescapular glands, the glands of the flank, etc.
Rectal exploration reveals hypertrophy of the glands of the pelvis
and of the sublumbar region, etc. The animals waste very rapidly,
and sometimes in a few months become incapable of standing. They
develop cachexia, and die in a state of exhaustion, with no other
lesions than those of lymphatic hypertrophy. Neither do they exhibit
any marked increase in the number of white corpuscles in the blood.
In lympho-cythæmia the beginning of the disease is often identical
with that of simple lymphadenitis, the increase in the number of
white blood corpuscles not occurring until later. In other cases, on
the contrary, leucæmia appears first, and the enlargement of the
lymphatic gland follows; but what characterises this form and allows
of it being distinguished from myelo-cythæmia is the great increase
in the number of large or small lymphocytes. The development is
identical with, and sometimes much more rapid than, that of the
preceding form. The animals waste away and become anæmic and
cachectic, dying at last in a state of absolute exhaustion.
Post-mortem examination reveals, as in the previous condition,
symmetrical hypertrophy of all the lymphatic glands; the spleen is
very often enormous, and the liver is sometimes affected, as are also,
in exceptional cases, the kidneys.
It may happen that the spleen alone appears affected, or at least
that it has been first attacked, a fact which explains the existence of
leucæmia before any enlargement of the lymphatic glands.
Causation. The causes of lymphadenitis and of lympho-cythæmia
are unknown in veterinary as in human medicine. Apparently these
diseases are more common in adults than in young animals. Some
regard them as infectious in character, but this can hardly be the
case, as all experimental attempts to transmit the diseases have
failed. It is more plausible to compare the development of these
morbid conditions with that of malignant tumours, and although
some doubt still exists, simple lymphadenitis may be described as an
aleucæmic lymphoma or lympho-cytoma, which has gradually
become generalised, spreading by way of the lymphatic channels
from the gland first affected through the surrounding glandular
system. Lympho-cythæmia, on the other hand, may be said to be a
leucæmic lympho-cytoma, which spreads both by the blood
circulation and by the lymphatic paths (spleen, hæmatopoietic
glands and organs).
This view of the development of the lesions enables us to class
lympho-sarcomata with lymphomata and lympho-cytomata. The
malignant character and extremely rapid development of lympho-
sarcomata appear due to its extending by contiguity of tissue, and
simultaneously by the lymphatic paths.
This new grouping would consequently place on one side
myelogenic leucæmia, also called myelo-cythæmia, which is perhaps
a different morbid species. This would destroy the unity implied in
Jaccoud’s theory of the lymphogenic diathesis; but for all that this
method of grouping might be justified by reference to specific
cellular characteristics. In myelo-cythæmia the disease appears to
commence as a lympho-cythæmia, i.e., it is unaccompanied by
enlargement of lymphatic glands or hypertrophy of the spleen or
liver, though the blood appears leucæmic. The condition is not a
leucæmia due to lymphocytes, but rather a leucæmia produced by
mono- and poly-nuclear eosinophile leucocytes, i.e., leucocytes
derived from the bone marrow.
The patients are carried off rapidly after persistent wasting,
decline and cachexia, whilst on post-mortem examination the
puriform aspect of the bone marrow is an extremely striking
characteristic.
Diagnosis. There is rarely much difficulty as regards the
diagnosis. The enlargement of the lymphatic glands, for instance, can
readily be detected, and the only disease with which this can possibly
be confounded is tubercular enlargement.
With the means at present available for diagnosing tuberculosis,
such as microscopic examination of the discharge, inoculation with
discharge, examination of material from the glands, injection of
tuberculin, etc., the nature of the disease can always be placed
beyond doubt.
In lympho-cythæmia and in myelo-cythæmia, the whitish-violet
lactescent appearance of the blood is of unmistakable significance,
particularly when the manifest progressive wasting of the whole
system is taken into account.
 Histological examination of the blood after fixation and staining
will in the former cases reveal the presence of very large numbers of
lymphocytes, and in the latter an absolute increase in the number of
the mono- and poly-nuclear lymphocytes. It should be easy,
therefore, to distinguish the two diseases, especially as other
symptoms vary.
In the early stages leucæmia may be mistaken for the leucocytosis
seen in infectious diseases. These forms of leucocytosis are very
common in animals of the bovine species. They occur in certain
forms of tuberculosis, in uterine infections, in cases of internal
suppuration, in tumour of the heart, the rumen, etc., and vary in so
far as one style or another of white blood corpuscle predominates.
The diagnosis, therefore, necessitates that the white blood corpuscles
should be counted, and whenever it is found that their variations in
number are no more than between 5,000 and 15,000 per cubic
millimètre, the case may be regarded as one of temporary
leucocytosis.
If, on the other hand, those corpuscles number more than from
15,000 to 20,000, or, as may sometimes happen, they attain to from
200,000 to 300,000 per cubic millimètre (one white to two or three
red blood corpuscles), the case is one of leucæmia, and, according to
the predominance of the particular type of cell, it is a lympho-
cythæmia or a myelo-cythæmia.
In leucæmic conditions the red blood corpuscles are also present
in fewer than the normal numbers. They are more irregular, assume
giant and dwarf forms (macrocytes and microcytes), sometimes
exhibit lacunæ, and are always polychromatophile, i.e., without
special affinity for any particular constituent of double or triple
stains.
Prognosis. The prognosis of diseases included in the
lymphogenic diathesis is extremely grave, and in the present state of
our knowledge it may be assumed that sooner or later death is
inevitable.
Treatment. Treatment can scarcely be considered to exist, for at
the best it can only delay the development of the disease.
Nevertheless, and with this reservation, it is certain that preparations
of iron, iodine and arsenic have a certain effect, probably by acting
on the hæmatopoiesis.
 CASEOUS LYMPHADENITIS OF THE SHEEP.

In the sheep the lymphatic glands are sometimes the seat of

peculiar changes, which do not appear to have any marked effect on
the general condition. Thus a post-mortem examination or an
examination of animals in the slaughter-house sometimes shows a
certain number of isolated or symmetrical glands, such as the
mediastinal, tracheal, inguinal, pelvic or sublumbar glands, to be
greatly enlarged and completely degenerated. The precrural,
prescapular, and popliteal glands are said to be most frequently
affected. Their contents are caseous and yellowish, enveloped in a
fibrous sheath, and show no signs of peripheral inflammation. The
other organs and viscera may either be healthy or exhibit caseous
lesions identical with those found in caseous broncho-pneumonia.
The causes of this disease are imperfectly understood, although
Cherry and Bull (1899, the Veterinarian, Vol. LXXII., No. 860, p.
523) have isolated from the lesions an organism identical with
Preisz’s bacillus and with the microbe of ulcerative lymphangitis in
the horse.
Norgaard and Mohler (Annual Report, United States Bureau of
Agriculture, 1899, p. 638) have studied the disease. In June, 1897,
Turski, at Danzig, found about 150 breeding ewes, from eight to
twelve years old, suffering from nodules or abscesses the size of a
child’s fist in the inguinal and prescapular regions. They had been
sold for slaughter, and many were in very poor condition. The
disease occurs in Europe, Western America, South America, and
Australia. Several thousand cases are annually seen in the slaughter-
houses of the United States.
The symptoms generally escape notice, and it is only by accident
that one sometimes detects marked enlargement of the lymphatic
glands of the neck or of the superficial inguinal glands. The patients,
moreover, may remain in very good bodily condition, so that the
lesions are only discovered on the meat being inspected.
Having regard to our imperfect knowledge of this disease, it is
impossible to express an opinion as to its importance or treatment.

GOITRE IN CALVES AND LAMBS.

 Although not strictly relevant to the foregoing matter, a few
remarks may here be made on the subject of goitre.
True goitre consists in hyperplasia of the follicles of the thyroid
gland, with colloid change of their contents, which are chiefly
albuminous. The swelling is mainly due to enlargement of the
follicles, and is termed struma follicularis. It may attack the entire
organ or only one-half; less frequently it is confined to certain
sections. Other varieties of goitre are recognised, such as fibrous,
varicose and cystic goitre. (For fuller details see Möller and Dollar’s
“Regional Surgery,” p. 149.)

Fig. 213.—Calf showing swelling due to goitre.

Treatment by injection of thyroid juice or by feeding on thyroid

extract has given better results than drugs.
The following account of an outbreak in New Zealand is
summarised from the Annual Report of the Chief Veterinarian of
New Zealand, 1901:—
The calves affected were born with enlarged thyroids. The farm is
of rich alluvial deposit, and rather below the level of the river, which
it borders. The land has been in occupation, however, for many
years, and no similar condition had been previously noted. At first,
as calves only were affected, it was thought possibly to be due to the
bull, a two-year-old animal, but when a foal was born suffering from
a similar malformation this theory naturally fell to the ground.
The land had been ploughed with a special plough 20 inches deep,
but this is no uncommon practice in the island.
About the same time, a similar disease was discovered affecting
lambs at a farm near Outram. From 450 ewes, 150 lambs had been
lost, the glands being enlarged to the size of a cricket ball. A few had
been born dead, many only lived a few hours, others lived several
days, and a considerable number recovered. There was no
connection, directly or indirectly, between the two farms, they being
at least fifty miles apart. A few of the calves died or were killed, the
remainder recovered, and the foal grew rapidly better. The land on
both farms is very similar in composition.
Mr. Wilkie states, from observation of previous cases in lambs,
that “it appears to be always associated with malnutrition and a
condition of anæmia in the parent, induced in most cases by feeding
with watery, innutritious foods.”
Specimens were forwarded, from a calf and from a lamb, of
enlarged glands. The gland of the calf was enormously enlarged,
being at least twice the size of an orange, dark in colour, flabby in
consistency, and on section a mucous material exuded copiously
from the cut surface. Micro-examination showed the acini to be
larger than normal, filled with the usual mucous material, and lined
with cubical epithelium. The connective tissue surrounding the
alveoli was, however, crowded with round-cells, so much so that the
whole parenchyma seemed to be practically composed of these cells.
A specimen of an enlarged thyroid from the lamb was about the
size of a sheep’s kidney, and very much the same shape and colour.
Sections microscopically examined showed a different condition to
that of the calf’s thyroid. Here the acini were filled with epithelial
cells loosely arranged as if the lining epithelium had been
proliferating rapidly, while the connective tissue surrounding the
acini was fairly normal. The section had a somewhat adenomatous
appearance.
 SECTION V.
NERVOUS SYSTEM.

CEREBRAL CONGESTION.
According to Cruzel, cerebral congestion is somewhat frequent in
working oxen subject to continued concussion from the yoke,
especially among animals working on a rocky soil. The condition may
also be produced by prolonged exposure to the sun, as well as by
sudden and intense cold.
Passive cerebral congestion by stasis may be produced by any
cause markedly interfering with the return circulation (pericarditis
due to foreign bodies). Clinically it is of no importance.
The animals, previously in good health, suddenly appear
comatose. They are insensible to stimulation of any kind, the head is
rested on any convenient object or is held stationary, the animal
looks drowsy, the gait is hesitating or vacillating, the respiration slow
or irregular. Left at liberty, the animal does not seem to know where
it is going; indeed, sometimes it is absolutely blind and strikes
against any obstacle in its path, or falls and suffers from epileptiform
convulsions. The cranial region is abnormally warm. The course of
the attack is rapid, and the animal either dies in a state of coma or
convulsions or else recovers rapidly.
Diagnosis. The diagnosis is decidedly difficult; and the
prognosis should be reserved.
Treatment commences with free bleeding, the amount of blood
drawn being proportioned to the animal’s size. The sides of the body
may then be stimulated and a purgative administered.
 MENINGITIS.
The generic term “meningitis” includes all inflammations of the
arachnoid, pia mater and internal surface of the dura mater.
These forms of inflammation occur in diseases such as
tuberculosis and in parasitic diseases of the brain. Under other
circumstances, they are rare, and may be produced by very varying
causes.
An epizootic cerebro-spinal meningitis of the bovine species has
also been described, principally in Germany. It seems almost
unknown in France, and French literature contains no well-
authenticated case.
Furthermore, an epizootic cerebro-spinal meningitis of sheep, or
rather of lambs, has been described in Germany, in Italy, and in
France. These descriptions are all open to many objections. It seems
that under the term “cerebro-spinal meningitis” have been grouped
cases of enzootic tetanus, doubtful cases of poisoning, and
particularly cases of cœnurosis in the first stage of development. We
therefore discard these descriptions, which differ too much among
themselves to be of any value.
Causation. Meningitis occurs in the ox and sheep as a
complication of wounds in the cranial region, accompanied by
fissuring of the bone, periostitis, abscess formation, etc.
It is also seen as a complication of fractures of the horns, and old-
standing catarrh of the facial sinuses. In the sheep it follows parasitic
catarrh due to the larvæ of œstridæ.
The meningitis appears, according to circumstances, in the forms
of local meningitis, anterior frontal meningitis, basilar meningitis,
etc. Finally, it may develop as a complication of different diseases,
such as gangrenous coryza, purulent infection, subparotid abscess,
suppurative phlebitis, suppuration of the eye or of the orbit, etc.
Symptoms. It is difficult to detect and interpret the first
symptoms shown, because these chiefly consist in dulness, want of
appetite and constipation, without any particular fever. At a later
stage, excessive excitability is produced by noises, by changes of
light, or by handling. Careful examination of the patients shows a
change in their expression, rapidly followed by contraction and
inequality of the pupils or deviation of the visual axis (strabismus,
squinting). The pulse becomes irregular, as also the respiration. The
appetite is entirely lost, and it is not uncommon to note a contraction
of the muscles of the neck and jaws, as well as inability to move
about and symptoms similar to those of dropsy of the cerebral
ventricles.
The chronic form is rare.
Lesions. The lesions comprise local or general hyperæmia and
exudative inflammation of the pia mater and arachnoid, together
with the formation of false membranes or of pus in the subdural
space. The meninges are partially adherent, and the superficial layers
of the brain are also inflamed by contiguity of tissue.
Diagnosis. The diagnosis must be based on the disturbance of
vision, movement, and appetite, and on the course of the symptoms,
as well as on the external signs in the case of such diseases as are
prone to become complicated with meningitis.
Prognosis. Sooner or later the case is likely to end fatally, and
there is no practical use in treating the patient.
Treatment. If in exceptional cases slaughter is objected to, setons
and blisters may be applied to the poll or the parotid region, or the
parts may be enveloped in ice bags or compresses of iced water
frequently renewed.
 ENCEPHALITIS.
Encephalitis, i.e., inflammation of the cerebral substance, is very
closely allied to meningitis; in a great number of cases meningitis
and encephalitis co-exist. In other cases encephalitis may be found
apart from meningitis, and vice versâ. Moreover, many of the
symptoms of meningitis are to be found in cases of encephalitis.
Encephalitis may develop as a complication of meningitis.
Encephalitis may also follow abundant parasitic infestation, as in
cœnurosis (which will be particularly studied as it affects sheep), or
microbic infection, the commonest form of which in the ox is
tuberculosis. The encephalitis may be diffuse or circumscribed,
according to the cause, while the symptoms are varied and
numerous. Very frequently, particularly in cases of tuberculosis,
encephalitis assumes a chronic form.
Symptoms. The earliest symptoms are extremely difficult to
detect, because they are scarcely characteristic and because it is
impossible to ascertain the sensations of the animal.
It is only when the disturbances in walking, in the eyesight, in
swallowing, etc., are noted that suspicion is aroused.
The symptoms may appear suddenly. Nevertheless it is beyond
doubt that there are certain slightly marked prodromata, indicated
by diminution of appetite, wasting, and changes in vision. Soon
afterwards occur other forms of disturbance, which may be classified
under the heading of “motor, visual, nervous, and impulsive.” The
patients appear stunned, their movements are slow and hesitating,
they partially lose control over their limbs and display lameness,
with spasmodic movements of one or two limbs. Examination of the
joints shows no injury. The lameness may simultaneously affect two
diagonal limbs or two fore and two hind limbs, or even three limbs.
This lameness is of central origin.
The ocular disturbance is marked by diminution or loss of vision,
by strabismus, or by frequent unconscious movements of the eyes
and eyelids, and also more particularly by inequality, contraction or
dilatation of the pupils.
 Nervous, impulsive disturbance is most readily noted when the
animals are at liberty. Even when the sight remains, they seem quite
incapable of avoiding obstacles or as though absolutely forced to
move to the right or left, etc.
Attacks of giddiness, moreover, are not unusual under the
influence of the slightest excitement. During such attacks the
animals thrust the head against a wall, or they involuntarily recoil or
make lateral movements. In many cases these vertiginous attacks
end by the animal falling and showing epileptiform convulsions,
during which it may die.
The symptoms are never the same in two different animals, but
they may easily be classed according to the above indications. The
indications furnished by the condition of the eyes and by the peculiar
impulsive movements are particularly significant.
On the other hand, there are modifications in breathing without
apparent local cause, and difficulty or even impossibility of
swallowing, etc., although there exists no material obstacle.
Diagnosis. The condition is often confused with meningitis, and
the mistake is not serious, because meningitis and encephalitis
frequently accompany one another.
Prognosis. The prognosis must be regarded as fatal. The patients
very seldom recover, and there is no reason for keeping them alive.
Treatment. Here, again, blisters may be applied to the upper
extremity of the neck, or setons may be passed. Cooling applications
to the cranial region have also been suggested. None of these
methods produces more than a temporary palliative effect.
 CEREBRAL TUMOURS.
The brain may be injured and compressed by various tumours of
other than parasitic origin. Such tumours may originate in the bones,
the meninges or the choroid plexus, or they may simply be due to
generalisation of a previously existing tumour. Whilst of very varied
origin and nature, all tumours of the cranial cavity have one common
effect, viz., to compress the brain. This continuous compression
causes progressive atrophy of the brain, but its existence is not
always suspected, because the lesions may not give rise to any
marked symptoms.
The hind portions of the hemispheres and the white substance are
generally very tolerant. The front portions, on the other hand—the
frontal lobes and the grey substance—resent compression, which
provokes various symptoms in consequence.
The symptoms of compression and atrophy of the brain differ
greatly, a fact which is easily understood, inasmuch as the seat of the
change may vary, and therefore it is possible only to trace the chief
manifestations, which suggest the existence of a cerebral tumour.
The general changes are indicated by signs precisely similar to
those so common in horses with dropsy of the ventricles (general
depression, inability to back, long intervals between the prehension
of successive mouthfuls of food, sudden cessation of mastication,
etc.), by an impulsive or automatic gait, and by the assumption of
strange attitudes (kneeling down in front, etc.). When at rest the
animals appear to be in a state of continual torpor.
Special symptoms sometimes occur, which enable the seat of the
injury to be localised in more or less exact fashion. These symptoms
affect the vision (amblyopia, amaurosis, strabismus, nystagmus),
general sensibility (hyperæsthesia, anæsthesia, etc.), and the power
of movement (total, partial or crossed hemiplegia, want of co-
ordination of movements, etc.).
Trifling stimuli almost always lead to marked and even
epileptiform attacks.
 The diagnosis of cerebral tumours is very difficult, particularly
when attempts are made to indicate their exact seat, but that of other
cerebral lesions is somewhat easier.
The prognosis is very grave, and in the case of domestic animals
nothing can be done. In the ox intra-cranial operations are difficult,
by reason of the presence of the sinuses which obstruct the approach
to the brain cavity; economically surgical treatment is seldom
advisable.