Disease etiology in horses refers to the study of the causes and development of diseases within equine populations. It encompasses various factors, including genetic predisposition, environmental influences, infectious agents, and nutritional imbalances, that contribute to the onset and progression of diseases in horses. Understanding disease etiology is essential for identifying risk factors and implementing preventative measures in equine health management. This topic includes research on pathogen-host interactions, the impact of management practices on disease incidence, and the role of genetic and environmental factors in disease susceptibility. This page compiles peer-reviewed research studies and scholarly articles that explore the mechanisms, contributing factors, and implications of disease etiology in horses.
Matthews AG, Waitkins SA, Palmer MF.The prevalence of antibody titres to a range of 20 leptospira antigens in the serum of horses and ponies with no ophthalmic abnormalities and with ophthalmoscopic evidence of endogenous uveal inflammatory disease was determined using a microscopic agglutination technique. Titres against leptospira antigens were observed in 13 out of 138 (9.1 per cent) animals with no ophthalmic abnormalities, and in three out of 27 (11.1 per cent) animals with anterior uveitis. Serovar sejroe was common to all seropositive animals with anterior uveitis. The results show that leptospira infection is not a major...
Szymanski CM.Enlargement of the left eye, corneal opacification, and blindness were clinical signs of a teratoid medulloepithelioma in a 5-year-old Standardbred mare. Diagnosis was made on histologic examination of the enucleated eye. Medulloepitheliomas are congenital intraocular tumors arising from primitive ciliary body epithelium. Their development is rare in domestic animals.
De Cock AW, Mendoza L, Padhye AA, Ajello L, Kaufman L.Pythium insidiosum sp. nov., the etiologic agent of pythiosis, a cosmopolitan disease of horses, cattle, and dogs, is described and illustrated.
Ziemer EL, Parker HR, Carlson GP, Smith BP, Ishizaki G.An 11-year-old Quarter Horse mare and a 2-year-old Quarter Horse colt with clinical diagnoses of renal tubular acidosis (RTA) were donated to the University of California Veterinary Medical Teaching Hospital. A series of diagnostic tests was performed in an attempt to characterize the type and cause of RTA in these horses. Endogenous creatinine clearance and sodium sulfanilate clearance were within reference ranges; thus, no abnormality of glomerular function was detected. To assess renal tubular function in response to acid loading, each horse was given 0.1 g of NH4Cl/kg of body weight via na...
Tolliver SC, Lyons ET, Drudge JH.The prevalence and number of naturally acquired gastrointestinal parasites were compiled for horses used in critical tests of activity of parasiticides over a 28-year period (1956-1983). Data are presented as follows: n = number of horses examined; % = mean prevalence; number in parentheses after % = aggregate mean number of parasites in infected horses. Parasites found were: bots (n = 513) - Gasterophilus intestinalis, 2nd instar, 61%(58); 3rd instar, 94%(168); G. nasalis, 2nd instar, 36%(28); 3rd instar, 81%(51); stomach worms (n = 200) - Habronema muscae, 65%(179); Draschia megastoma, 29%(9...
White NA, Tyler DE, Blackwell RB, Allen D.Records of 20 horses with small intestinal disease causing acute colic and affecting the proximal portion of the small intestine were examined retrospectively. The disease was characterized by severe to moderate pain, which was replaced by depression, fever, gastric reflux, slight distention of the affected small intestine, leukocytosis, and high concentrations of total protein in the peritoneal fluid. Grossly, the affected intestines were hemorrhagic and had yellow discoloration. Histopathologic findings included submucosal edema, neutrophilic infiltration of the submucosal and laminal propri...
Adams SB, Fessler JF.Infection of the umbilical cord remnants was diagnosed in 16 foals. The infection was found in the urachus alone in 3 foals, the umbilical arteries in 2 foals, the urachus and umbilical arteries in 3 foals, the urachus and umbilical vein in 2 foals, and the urachus, umbilical vein, and umbilical arteries in 2 foals. The specific location of the infection was not determined in 4 foals. Eleven foals developed an acquired patent urachus between 4 and 16 days of age. Seven foals had one or more joints infected. All foals with umbilical cord remnant infections were treated with orally, intramuscula...
Brownie CF, Cullen J.An isolate of Fusarium moniliforme (M-1225 Cairo #1) was cultured on autoclaved corn and fed daily to 5 ponies at a rate of 2.5 g corn/kg body wt. One pony developed clinical signs of toxicity after 28 days and was sacrificed. The remaining 4 ponies developed no clinical sign of toxicity even after extended exposure. Hematology, serum chemistry, cerebrospinal fluid (CSF), and liver and brain pathology were evaluated as possible diagnostic and prognostic indicators. Hematology was not informative. Aspartate aminotransferase and gamma-glutamyltranspeptidase activities were elevated only in the c...
Mayhew IG, Brown CM, Stowe HD, Trapp AL, Derksen FJ, Clement SF.Two horse farms, on which there was a high incidence of proven and suspected equine degenerative myeloencephalopathy (EDM), were studied. Symmetric ataxia and paresis, along with laryngeal adductor, cervicofacial, local cervical, and cutaneous trunci hyporeflexia, characterized the syndrome. Serum vitamin E concentration reflected a deficient state in affected and unaffected horses on both farms when compared with selected reference groups and with published values. A high incidence of the disease was evident in offspring of two particular sires on one farm. Vitamin E supplementation resulted ...
Scott DW.Pemphigoid (from the Greek “resembling pemphigus”) has been recognized in humans for many years. The occurence of pemphigoid in domestic animals is a much more recent observation. In the dog, bullous pemphigoid was first documented in 1978.1 Equine bullous pemphigoid was originally reported in 1981.2 The purpose of this article is to review pemphigoid in domestic animals, compare the disease with its human counterpart, and alert the physician to an exciting area for comparative dermatologic research.
Petzoldt K, Merkt H, Müller E, Kirpal G.Over the last years the percentage of foals lost by EHV at term or close to term seems to be higher than in former years. Furthermore, the pathological findings seem to shift from liver to lung. So far there has been no explanation for this phenomenon.
Kiryu K, Nakamura T, Kaneko M, Oikawa M, Yoshihara T.Twenty thoroughbred race horses were selected for postmortem cardiopathological study of sudden cardiac death; ten of the twenty horses died suddenly. In order to define accurately the morphological changes observed in these ten hearts, ten other thoroughbred race horses considered to have normal hearts were selected as a control group and studied by postmortem coronary angiography. Of the ten horses that died suddenly, eight were witnessed to have died either during or shortly after training or racing. The death was instantaneous except in one horse, which showed ventricular tachycardia and d...
Kaspar B, Kähn W, Laging C, Leidl W.During macroscopic post-mortem examinations of the genital tract in 104 mares endometrial cysts occurred in 14 (13%) cases. Whereas in mares up to the age of 10 years cystic changes were absent, endometrial cysts occurred in 19% of the animals above the age of 10 years. In 6 mares only 1-2 cysts per uterus were found, and in 8 animals there were between 5 and 18 cystic changes per organ. The cysts were equally distributed in the uterus body and horns. Sporadically occurring cysts were about 11 mm in diameter with a decreasing size to a mean value of 5 mm in multiple cysts. Predominantly in the...
Kraft W.Neurological examination in equine practice, physiological findings and pathological disturbances are described. Because of the sizes of the horse the neurological examination is more difficult than in small animals. The examination of cerebrospinal fluid is a worthful completion and is able to refer to the etiology of a certain disease. The technique of the puncture of cerebrospinal fluid is described.
Eysker M, Wemmenhove R.The epidemiology and control of helminth infections in the horse were studied in four small grazing experiments between 1981 and 1984 at the University of Utrecht. At autopsy in November or December negligible Strongylus vulgaris burdens were found in the cranial mesenteric artery of four groups of ponies, which had been treated with an anthelmintic in July and subsequently transferred to a clean pasture. Considerable arterial S. vulgaris burdens were seen in three groups of ponies which were treated with an anthelmintic in July without a move to clean pasture, and in another group of ponies i...
von Fellenberg R.The importance of proteases and protease inhibitors for the pathogenesis of pulmonary emphysema and chronic bronchitis of the horse is described. Endogenous elastases from neutrophil granulocytes and macrophages, which probably provoke emphysema in the human being, are not relevant in horse emphysema. Exogenous elastases from different species of streptomyces may be responsible for emphysema generation in this species. Part of the exogenous elastases are poorly or not inhibited at all by the equine blood protease inhibitors especially by alpha 1-protease inhibitors. A disorder similar to genet...
Cohen ND, Honnas CM.To determine the incidence of the risk factors for developing diarrhea in horses after celiotomy for colic. Methods: Retrospective cohort study. Methods: 357 adult horses that had celiotomy for colic at the teaching hospital between Jan 1, 1990 and Sep 1, 1994. Methods: Medical records of horses that had celiotomy for colic were reviewed to abstract information regarding development of diarrhea, signalment, history, and treatment. Results: In horses that had celiotomy for colic, the incidence of diarrhea was 53.2% (190/357). Using multiple logistic regression, horses with a disorder of the lar...
Jeffcott LB, Kold SE, Melsen F.The gross and histological appearance of subchondral bone cysts in six Thoroughbred or partbred horses is described. The lesions were all situated in the centre of the medial femoral condyle and were not associated with any other damage to the articular surface of the femorotibial or femoropatellar joints. In three cases the cysts were unilateral but had an early non-cystic lesion present in the opposite stifle. All the cysts had a narrow channel at their distal extremity which communicated with the femorotibial joint. The more recently developed ones were fluid filled and contained fibrous st...
Wester RJ, Baillie LL, McCarthy GC, Keever CC, Jeffery LE, Adams PJ.Free Fecal Liquid (FFL), also termed Fecal Water Syndrome (FWS), is an ailment in horses characterized by variable solid and liquid (water) phases at defecation. The liquid phase can be excreted before, during, or after the solid defecation phase. While the underlying causes of FFL are unknown, hindgut dysbiosis is suggested to be associated with FFL. Three European studies investigated dysbiosis in horses with FFL using 16S rRNA sequencing and reported results that conflicted between each other. In the present study, we also used 16S rRNA sequencing to study the fecal microbial composition in...
Yu YT, Olarte Castillo X, Reboul G, Zehr J, Sun Y, Anderson R, Wang M, Sun Q, Tallmadge R, Sams K, Brown J, Marra N, Stanhope B, Grenier J.... is a parvovirus that was identified in the blood of four horses in the United States. Here, we report one genome from a horse in New York State. This genome may represent a new species within the genus .
Thornton JJ, Roberts JF, AuCoin DP, Tuanyok A.We report a presumptive case of melioidosis caused by an atypical Burkholderia pseudomallei serotype in an American quarter horse in north-central Florida, USA, through archived formalin-fixed paraffin-embedded specimens dating back to 2006. This case underscores the potential pathologic impact of emergent B. pseudomallei in the Gulf region of the United States.
Pablo LS, Purohit RC, Teer PA, Newton JC, Hammond LS.Total strangulation obstruction of the caudal part of the jejunum was induced in 3 groups (each of 3 ponies) for 2, 4, and 6 hours. Coagulation tests which included blood platelet counts, prothrombin time, activated partial thromboplastin time, activated coagulation time, plasma fibrinogen level, and fibrin/fibrinogen degradation products assay were performed at specified time intervals for 1 week or until death of the experimental ponies. Another 3 ponies (sham-operated) were similarly treated, except that intestinal strangulation obstruction (ISO) was not induced. Necropsy was done on ponies...
Norton E, McCue ME.A role for a genetic contribution to equine metabolic syndrome (EMS) and pars pituitary intermedia dysfunction (PPID) has been hypothesized. Heritability estimates of EMS biochemical measurements were consistent with moderately to highly heritable traits. Further, genome-wide association analyses have identified hundreds of regions of the genome contributing to EMS and candidate variants have been identified. The genetics of PPID has not yet been proven. Continued research for the specific genetic risk factors for both EMS and PPID is crucial for gaining a better understanding of the pathophys...
Hoegaerts M, Pille F, De Clercq T, Fulton IC, Saunders JH.A 10-year-old show jumper was evaluated for an acute severe lameness (grade 4 of 5) of the right foreleg. During weight bearing, the toe of the affected limb rotated dorsally suggesting rupture of the deep digital flexor tendon (DDFT). Upon radiographic examination of the hoof, a severe erosion at the flexor surface and a parasagittal fracture of the distal sesamoid bone were found. Ultrasonographic examination confirmed rupture of the DDFT. These findings were confirmed on post-mortem examination. Prior to the acute lameness, the horse was treated with corticosteroid injections into the podot...
Henry M, Amaral D, Tavares FF, Santos NR.The aim of the present study was to analyse the effect of hydrocoele of the vaginal cavity of stallions on semen characteristics, libido and fertility, and to contribute to the understanding of the aetiopathology of this condition in stallions. Hydrocoele did not substantially affect either the libido or semen characteristics of affected stallions compared with a control group, and had no effect on fertility. However, the protein content of hydrocoelic fluid was significantly higher than that of peritoneal fluid and was lower than the protein content of blood serum. Electrophoretic profiles of...
Cordes V, Lüpke M, Gardemin M, Seifert H, Staszyk C.In equine dentistry periodontal diseases, especially periapical inflammation, are frequently occurring problems. Anachoresis is believed to be the most common cause for the development of such disorders. Nevertheless, there is still no substantiated explanation why settlement of pathogen microorganisms occurs in equine periodontal tissues. It is expected that excessive strains and stresses occurring in the periodontal ligament (PDL) during the horse's chewing cycle might be a predisposing factor. In this study this assumption was examined by finite element (FE) analyses on virtual 3-D models o...
Stoughton WB, Begin S, Outman S, Stryhn H, Yu J, Conboy G, Nielsen MK.Widespread overuse of anthelmintics has produced a growing population of intestinal parasites resistant to control measures. A paradigm shift in equine parasite control is warranted to prevent continued resistance development and maintain equine health. Small strongyles, which are ubiquitous in horses, are currently the most important intestinal parasites of adult horses. Sustainable management programs consider the variation in egg shedding by individual horses, and varied risks associated with age, use, density, climate, and environment. To develop regional recommendations for Prince Edward ...
Liu IK, Cheung AT, Walsh EM, Miller ME, Lindenberg PM.The functional competence of peripheral blood and uterine-derived polymorphonuclear leukocytes (PMN) from 12 mares were analyzed for chemotactic responsiveness using a chemotactic chamber (filter) assay and for deformability by cell elastimetry analysis. Peripheral blood PMN obtained from control mares and from 8 mares experimentally inoculated via the uterus with 1 x 10(9) Streptococcus zooepidemicus had similar normal chemotactic responsiveness and were highly deformable before and at 12 hours after inoculation. Uterine PMN obtained 12 hours after uterine inoculation with S zooepidemicus fro...
Wattle OS.To determine whether there is a change in the expression of cytokeratins in the epidermal cells of the non-weight-bearing parts of the limb in horses with acute laminitis and thus determine whether the morphologic changes that develop in the periople and chestnut (torus carpeus) of horses early in acute laminitis are caused by inhibition of keratinocyte differentiation. Methods: 8 horses with acute laminitis. Methods: Tissue specimens were obtained from the chestnuts of all 8 horses and from the stratum externum of the hoof wall of 3 horses. Tissue specimens were obtained within 48 hours of th...
Moore EN, Spear JF.We tested the multiple-wavelet hypothesis by studying the initiation and maintenance of atrial fibrillation in normal mules, horses, cows, calves, and goats. Persistence of atrial fibrillation in animals with a large atrial mass was compared with results in adult goats and calves having a smaller atrial mass. Atrial stimulation in clinically normal cows, mules, calves, and goats was accomplished using an intra-atrial stimulating catheter with rapid atrial pacing (30/s). Once initiated, atrial fibrillation persisted for 95,120,125 min, 3 days, and 8 weeks in five adult cows, respectively. In co...
Bertone AL.With large colon resection and anastomosis, up to 95 per cent of the length of the large colon has been successfully removed. A hand-sewn end-to-end anastomosis is effective for lesions in the left dorsal colon and pelvic flexure. Transection and a side-to-side anastomosis with stapling equipment is most effective for extensive resections (greater than 50 per cent). Horses with extensive colon resection (95 per cent) have permanent deficiencies of water absorption and digestion of cellulose and protein. Fermentative capacity is reduced, owing to decreased particulate matter retention time in t...
Chavatte P, Brown G, Ousey JC, Silver M, Cottrill C, Fowden AL, McGladdery AJ, Rossdale PD.Clinical and pathological records of 124 foals were studied. The foals were assigned to six groups; normal, premature, dysmature, bacterially infected, neonatal maladjustment syndrome and Equid herpesvirus type 1 (EHV-1) infected. Also, 6 pony fetuses were sampled via catheters in the umbilical vein and artery between 280 and 310 days gestation. Bone marrow aspiration was performed on a further 14 foals. Premature foals had significantly lower neutrophil counts than normal foals up to 5 h. Foals with bacterial infections had significantly lower neutrophil counts up to age 12 h. EHV-1 infected ...
Lu G, Huang J, Li S.Theiler's disease-associated virus (TDAV) could be the aetiological agent of Theiler's disease. Horses experimentally inoculated with equine plasma containing TDAV develop acute and chronic infections with viraemia. Since its first identification in 2013, TDAV has not been detected in equines in the epidemiological studies that have been conducted. Until now, only one genome sequence of TDAV (HorseA1_serum) had been obtained. In this study, we sequenced the genome of four TDAV strains (A/China, F/China, H/USA and I/USA) in commercial equine sera used for cell culture propagation in China using...
Weiss DJ, Monreal L, Angles AM, Monasterio J.Carbohydrate-induced laminitis has been associated with decreased platelet survival, decreased blood flow to the hoof wall and with the deposition of platelets and microthrombi within venules in the dermal laminae. To evaluate further the systemic prothrombotic events occurring in the prodromal stages of laminitis, plasma samples from control and laminitis-affected ponies and horses were tested for the presence of thrombin-antithrombin (TAT) complexes and fibrin fragment D (D-dimer). No statistically significant differences between the control and laminitis-affected animals were observed for e...
Waelchli RO, Winder NC.Endometrial sections from mares with varying degrees of mononuclear cell infiltration were examined for immunoglobulin (Ig)A-, IgM-, IgG(T)- and IgG(Fc)-containing cells, luminal and glandular epithelial cell Ig-staining and free interstitial Ig-staining, using a peroxidase anti-peroxidase technique. Mares with mild to moderate (Group 2) and mares with severe diffuse mononuclear cell infiltration, superimposed by acute endometritis (Group 3), had significantly higher numbers of Ig-containing cells than genitally-normal mares (Group 1). The differences between Groups 1 and 3 were significant fo...
Tschetter JR, Blikslager AT, Little D, Howard RD, Woody SL, Beex LM, Crisman MV.Colic is a serious disease syndrome in horses. Much of the mortality is associated with ischaemic-injured intestine during strangulating obstruction, yet there is limited understanding of the associated molecular events. Identification of differentially expressed genes during ischaemic injury should expand our understanding of colic and may lead to novel targeted therapeutic approaches in the future. Objective: To isolate and identify differentially expressed genes in equine jejunum following a 2 h ischaemic event compared to normally perfused jejunum. Methods: Suppressive subtractive hybridis...
Kingsley NB, Sandmeyer L, Parker SE, Dwyer A, Heden S, Reilly C, Hallendar-Edman A, Archer S, Bellone RR.Equine recurrent uveitis (ERU) is the leading cause of blindness for horses; previous research implicated the leopard complex spotting allele (LP) as a genetic risk factor for insidious uveitis in the Appaloosa. There is limited information about risk in the Knabstrupper. Objective: To evaluate clinical manifestations, disease frequency and potential risk factors for ERU in Knabstrupper horses. Methods: Cross-sectional study. Methods: Ocular examinations were performed on 116 horses, and based on identified anomalies, horses were classified as suspect, ERU-affected or having no clinical signs....
Gołyński M, Metyk M, Ciszewska J, Szczepanik MP, Fitch G, Bęczkowski PM.Homocysteine is an endogenous, non-protein sulfuric amino acid, an intermediate metabolite formed by the methionine transmethylation reaction. Its elevated serum concentration in humans, hyperhomocysteinemia, is a sensitive indicator and a risk factor for coagulation disorders, cardiovascular diseases and dementia. However, the role of homocysteine in veterinary species has not been unequivocally established. Although some research has been conducted in dogs, cats, cattle and pigs, relatively few studies on homocysteine have been conducted in horses. So far, it has been established in this spe...
Chiba A, Ujiie Y, Aoki T.While intrauterine fluid (IUF) is observed as mucous in healthy mares during estrus, the presence of IUF during diestrus is an indicator of endometritis. Mating induces endometrial inflammation in healthy mares, called mating-induced endometritis, that disappears within 1-2 days after mating. On the other hand, it is also known that IUF remaining beyond 12 hr after mating can cause persistent inflammation, bacterial growth, and decreased fertility. This study aimed to investigate the relationship between the presence of IUF and cervical bacteria before and after mating. Mares were classified i...
Johnson CM, Cullen JM, Roberts MC.Ten ponies (160-250 kg, ages 17 months to 20 years) developed severe diarrhea within 24 hours of castor oil administration (2.5 ml/kg orally). The diarrhea was most severe between 24 and 48 hours post-dosing and subsided by 72 hours. Ponies were euthanatized at 24, 48, and 72 hours post-dosing and intestine was evaluated histologically and ultrastructurally. Twenty-four hours after dosing, the mucosa of the cecum and ventral colon had extensive superficial epithelial erosion and neutrophil infiltration. In the ileum, the epithelium of villous tips was separated from the lamina propria. Scannin...
van der Vekens N, Decloedt A, de Clercq D, Ven S, Sys S, van Loon G.Studies on the use of atrial natriuretic peptide (ANP) as a biomarker for left atrial dilatation in horses have produced variable results. Few have been performed, and the results may have been influenced by ANP instability, differences in sampling protocol and changes in the assay over time. N-Terminal proANP (NT-proANP) is a more stable molecule and might be a good alternative for clinical use. Objective: To compare ANP and NT-proANP in terms of the detection of left atrial dilatation and to determine the influence of sample storage at temperatures of -80 and -20°C. Methods: Prospective cli...
Malone ED, Les CM, Turner TA.To report a severe form of carpometacarpal osteoarthritis (CMC-OA) affecting primarily older Arabian horses. Methods: Retrospective study. Methods: Thirty-one horses with CMC-OA. Methods: Carpal radiographs (405 sets) from 3 hospitals were evaluated to identify horses with marked osteoproliferative reaction across the medial aspect of the CMC joint. Owners were contacted to obtain detailed histories and status updates. Necropsy specimens of the CMC joint were evaluated at 2 hospitals to determine the prevalence of 2 variations in the articulation between the proximal second and third metacarpa...
Furuoka H, Mizushima M, Miyazawa K, Matsui T.We report the pathological findings of the skeletal muscle and peripheral nerves from a male 14-months-old thoroughbred horse showing idiopathic knuckling. The affected animal, when in staining position, presented knuckling at the fetlock joint of both forelegs, and dragged both fore- and hindlegs when attempting forward movement. The skeletal muscles demonstrated neurogenic atrophy characterized by the scattering of single angular fibers, groups consisting of five to ten angular fibers, and multiple fascicles of atrophic and hypertrophic fibers. The severity of changes tended to be a distal g...
Gutzmer C, Nijdam P.Dentigerous cysts are characterised by the formation of cysts containing dental material with a variable level of development. They are the result of a distinct embryological phenomenon. Usually, they are of significant clinical relevance in horses, especially in tandem with ectopic tooth. Contrarily, supernumerary teeth or typical polyodontias usually have limited impact. In this case report, we describe the occurrence of a supernumerary first premolar (Triadan 105). Dissimilar to known scientific literature however was the formation of a cystic structure around the supernumerary tooth. Surgi...
Reimer JM, Reef VB, Sommer M.Pulmonic valve rupture was determined to be the cause of severe right-sided heart failure in a 20-year-old Thoroughbred gelding. A flail in the intermediate pulmonic valve cusp was detected by 2-dimensional echocardiography. Significant pulmonic and tricuspid valvular regurgitation were confirmed by Doppler echocardiography. Despite treatment, the horse's condition deteriorated, and euthanasia was performed. At necropsy, a tear in the pulmonary artery extending into the right valve cusp and a tear at the base of the intermediate valve cusp were identified at the junction of the right and inter...
Draper AC, Trumble TN, Firshman AM, Baird JD, Reed S, Mayhew IG, MacKay R, Valberg SJ.To investigate and further characterise posture and movement characteristics during forward and backward walking in horses with shivering and acquired, bilateral stringhalt. Objective: To characterise the movement of horses with shivering (also known as shivers) in comparison with control horses and horses with acquired bilateral stringhalt. Methods: Qualitative video analysis of gait in horses. Methods: Owners' and authors' videos of horses with shivering or stringhalt and control horses walking forwards and backwards and manually lifting their limbs were examined subjectively to characterise...
