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Hand-raising Orphan Asian Elephants

Chapter 2: Physical Examination and Preventative Healthcare Practices


By Susan Mikota

Reviewed by Bhaskar Choudhary and Willem Schaftenaar


Dr. Susan Mikota listening to Baby Gold's heart.jpg

Sections in this chapter include the following: 

  • Introduction

  • Initial examination of new orphan

  • Physical examination (comprehensive)

  • Daily/weekly monitoring

  • Training for veterinary procedures 

  • Blood collection

  • Vaccinations



Preventive health care is of the utmost importance when hand-raising orphan elephants. Preventive health care encompasses procedures aimed at averting health problems. Physical examination, daily checks, routine fecal examinations, vaccinations, training for blood draws and other veterinary procedures, and prompt attention when problems arise comprise preventive health care practices. 

Initial Exam of New Orphan

Please read Chapter 1: First Encounter.


The newly orphaned Asian elephant calf is under tremendous stress and may be injured. The initial exam should therefore be as brief as possible, aimed at identifying any injuries or life-threatening problems with a goal of initiating treatment to stabilize the patient. Important initial steps are summarized here and described in detail in sections throughout this chapter.


Initial steps include: 


1. Assess the general body condition. Is the calf, bright, alert, responsive and well-nourished or weak, thin, and dull? 

2. Assess the vital signs (temperature, pulse, and respiration). See Tables 2.1 and 2.2 (below).

3. Is the breathing slow and regular or labored? 

4. Assess hydration (see below).

5. Note any wounds, bleeding, or areas that appear infected. 

6. Check the suckling reflex by placing a clean or gloved finger in the calf’s mouth.

7. Estimate the age. See Table 2.3 (below).


Light sedation during transport and/or to conduct the initial exam and treatment can minimize stress. A combination of xylazine (0.08 mg/kg) and ketamine (0.05 mg/kg) given intramuscularly is recommended (Bhaskar Choudhary, personal communication March 2022). The decision to administer sedation should be made by a veterinarian. 


A comprehensive physical exam as described below can be performed at a later time after the elephant has been stabilized.


Table 2.1.jpg
Table 2.2.jpg
Table 2.3.jpg

Physical Examination (Comprehensive)  


Step 1. Begin by observing the general body condition.


Healthy orphans are alert, active, bright-eyed, are able to move well, and may vocalize. Sick or malnourished calves may be thin, and listless with dull eyes. See Figures 2.1 and 2.2.

Step 2. Assess Hydration.

If the skin is dry and dull, the calf may be dehydrated. 

A simple test for dehydration in calves (personal observation, Khyne U Mar):

  • Gently pinch the skin on the shoulder blade, loin, or brisket with two fingers so that it makes a “tent” shape.

  • Release the skin

  • Calf is normal if the skin springs back to its normal position in one to three seconds.

  • If the skin is slow to return to normal, the calf may be dehydrated.


Pinching the skin in adult elephants may not be as reliable to assess hydration as the skin is more taut. 


Mucous membranes (e.g. inside the mouth) that are dry to the touch, scanty urine output, dark concentrated urine, and hard feces are other indicators of dehydration.

If dehydration is suspected and the calf can be bled, the hematocrit and total protein values can be used to evaluate hydration status. Both of these values will be elevated with dehydration.

Figure 2.1 Healthy orphan.jpg

Figure 2.1 Healthy orphan calf.

Figure 2.2 Thin orphan elephant calf.JPG

Figure 2.2  Malnourished orphan calf.

The hematocrit is the percentage of red blood cells in the blood. A hematocrit value of 50 or greater and a total protein value of 10 or greater should raise concern. 


An elevated urine specific gravity (a measure of urine concentration) can also help to evaluate hydration status. Specific gravity (measured using a refractometer) averaged 1.017 +/- 0.007 in one study of 8 healthy newborn elephants ((Wiedner et al., 2017). 

Step 3. Inspect the head and trunk.

Observe the eyes for abnormal discharges or scars on the surface of the cornea.  A clear discharge from the eyes that spills over onto the face is normal. Check the color of the conjunctiva (the mucous membrane lining the eyelids) for anemia (pale), icterus (yellow), or cyanosis (blue). Observe the color of the mucous membranes just inside the trunk and check for air flow from each of the nares (nostrils). Check the suckling reflex by inserting a clean or gloved finger into the mouth.  

Step 4. Inspect the tusks (males) or tushes (females) if present for any asymmetry, discolorations, or fractures.

Examine the tusk sulcus (where the tusks join the body) on each side and note any discharge or bad odor. Gently lift the flap of skin at the sulcus to observe the tusk/tush base. Parasite eggs (e.g. Cobboldia; bots) can occur here. 


Note the two small temporal gland openings on either side of the face caudal to the eye and above the zygomatic arch. There should be no swelling or discharge.


Step 5. Observe the tongue and mucous membranes inside the mouth, which should be a rosy pink.


Check the capillary refill time (1-2 seconds is normal) by applying light finger pressure to the mucous membranes. Note if teeth are present. Newborn elephants may or may not have teeth (Wiedner et al., 2017). Calves that are older then one year should be checked for the presence of small hemorrhages on the tongue, especially on its lateral side. These small bleedings can be a sign of EEHV-HD.


Step 6. Examine the ears.

If the calf is very calm and not moving too much it may be possible to palpate the auricular artery on the caudal (back) aspect of the ear to measure the pulse rate. Count the beats for 15 seconds and multiply by 4 to determine the beats per minute (bpm). Small white lice nits can occur behind the ears. 


Step 7. Observe the forelimbs and feet for wounds, asymmetry, swelling, heat, or tenderness.


The carpus (wrist joint) on the front legs is a common site for a snare injury. Check the nails and also the pad of each foot (if the calf will allow the foot to be picked up or wait until the calf is sleeping and then examine the pads). Look for foreign bodies or signs of infection.  


Step 8. Note the character, depth and frequency of respiration by observing movements of the chest. 


Veterinarians can listen to the heart and lungs using a stethoscope. They can also apply the stethoscope to the abdomen to evaluate the gut sounds. 


If a pulsoximeter is available, oxygen saturation can be measured (normal is 96.2 ± 1.55 %) Although this is not a necessary component of a routine exam, measuring the oxygen saturation in critical patients can be informative. 


Step 9. Observe the hind limbs and hind feet, looking for the same problems listed above for the forelimbs.  


Step 10. Observe the mammary glands located in the pectoral (chest) area on the ventral (bottom) thorax just medial (inside) to the elbow.


Step 11. Note the shape of the abdomen to detect any distention or ventral edema (swelling).  


Step 12. Check the umbilical area in newborns or very young calves. Look for redness, swelling, or discharge that can be signs of infection.


If any of the above signs are present, clean the area gently and apply dilute povidone iodine. Continue this 2-3 times daily until signs resolve. Umbilical infections can be serious and can spread to other areas of the body. 


Elephants that have umbilical infections may be septic. Sepsis is a serious bacterial infection in the blood or body tissues. Signs may include fever or very low body temperature, rapid breathing, diarrhea, weakness, and shivering. The veterinarian may elect to culture the blood. 


Note that the umbilical cord generally dries up within 7 days of birth. Newborn or young calves may have a “hernial ring” which should not be confused with an umbilical hernia. The hernial ring resolves automatically with age. 


Step 13. Observe the genitalia for wounds or evidence of discharge.  


The vulva (the exterior opening in females) is located ventral to the pelvic symphysis, rather than near the anal opening as in other mammals. Check for wounds or swelling. 


Step 14. Take the temperature (may be taken rectally or by inserting a thermometer deep into a freshly voided bolus). 


The average temperature is 97-99˚F; 36-37˚C (Brattstrom et al., 1963; Buss and Wallner, 1965). The temperature of a freshly defecated fecal bolus will accurately reflect the rectal temperature (Buss and Wallner, 1965). Temperatures in excess of 100˚F (37.8˚C) should be considered elevated.


Forehead or ear thermometers have not been adequately tested in elephants but may be easier to use for daily routine monitoring. In humans, an ear temperature is usually 0.5-1°F (0.3-0.6°C) higher than an oral temperature, whereas a forehead temperature is usually 0.5-1°F (0.3-0.6°C) lower than an oral temperature. Therefore, it is typical to get 1-2°F (0.6-1.2°C) difference between an ear measurement versus a forehead measurement. Develop a consistent procedure if using this type of thermometer. If there is variation from the baseline established for the calf, check a rectal temperature which will always be more accurate.


Note that some forehead and ear thermometers will not function properly if the ambient temperature is higher than 40.0°C (104.0°F) or lower than 10.0°C (50.0°F). Follow the manufacturer’s instructions. 

Step 15. Observe the urine and feces.

The urine may appear clear, straw-colored, or cloudy. Feces should be well-formed but moist. Dark colored or scant urine or hard feces may indicate dehydration. A urinalysis can be performed and results compared to published values. See the Appendix for Reference Values. Examine a fecal sample for parasites. See Chapter 9 (Medical Procedures, urine and feces collection and analysis). Figures 2.3, 2.4, and 2.5 show abnormal feces.

Figure 2.3: Calf with diarrhea

Figure 2.3 Calf with diarrhea.

Figure 2.4_diarrhea may be yellow.

Figure 2.4 Diarrhea may be yellow.

Figure 2.5 Abnormal feces may be gray and pasty.jpeg

Figure 2.5 Abnormal feces may be gray and pasty.

Step 16. Weigh the elephant if equipment is available​.

Digital scales are ideal but if not available, platform scales available locally at agricultural supply stores may work. Methods to estimate body weight work well for adults but not for calves (Hile et al., 1997). Monitoring the weight over time is an important indicator of health. Weigh calves daily for the first few months to insure adequate nutrition and growth. The average daily weight gain should be about 1 kg (~ 2 pounds).  Sudden weight loss can indicate a health problem. 


Figures 2.8, 2.9, 2.10 and 2.11 below show weighing methods. Table 2.3 above lists average birth weights and heights.

Step 17. Take measurements.

Measurements (shoulder height, total body length, and chest girth) are useful but don’t have to be done during initial exam which should be quick to minimize stress. Performed on a regular basis, these parameters can be useful to monitor growth. Detailed standard measurements for adults have been developed (Wemmer and Krishnamurthy, 1992). 

Figure 2.6 - Measurement points (Olsen 2004):


A. Health girth

B. Shoulder height

C. Body length from point of shoulder to point of hip

D. Pad circumference

Figure 2.7 - Measuring the shoulder height in an orphan calf in Vietnam. 

Weighing the Elephant Calf

Weighing is the most important method to monitor growth and development. Very young calves should be weighed daily if possible; older healthy calves can be weighed weekly. 

Figure 2.8 - Weighing using a digital scale. The digital scale has four load cells that connect to a central that then connects to the digital viewer.  


Figure 2.9 - The platform is made with wheels for easy mobility but are off the ground when the platform is placed on the load cells.

Figure 2.10 - Very young calves can be picked up to weigh.

Figure 2.11 - Older calves can be weighed by placing a board on the scale.

Body Condition Score


A body condition score is a subjective assessment of an animal’s overall condition based on evaluating muscle, fat, and skeletal features. It is a general indicator of health that is most useful when comparisons are made over time.


A number of body condition scoring systems have been developed for elephants  (Wemmer et al., 2006; Fernando et al., 2009; Morfeld et al., 2014; Wijeyamohan et al., 2015; Morfeld et al., 2016). A body score for young elephants has been developed for young calves and is presented in Chapter 7 ( Growth and Behavioral Development).


Estimate the age (see Table 2.3 above).

Daily/Weekly Monitoring

The younger the calf the more important it is to observe them closely and frequently. Caregivers/mahouts should record daily health and behavior observations. These observations can be recorded on the feeding record (see Table 2 in Chapter 4). Comprehensive physical exams should be conducted periodically by the attending veterinarian. Weighing and taking measurements are advised to monitor growth. 

Training for Veterinary Procedures


Calves that will remain in captivity can be trained to voluntarily cooperate with veterinary procedures. Training to allow blood to be collected is particularly important and may be life-saving. Training is discussed in Chapter 10.

Blood Collection

Collect blood for a CBC and chemistry panel from the orphan as soon as this can be done with a minimum of stress. The initial blood sample provides baseline values for comparison to future samples and is an important way to monitor health. While adult elephants are usually bled from the ear, it may be easier to obtain blood from a neonate or calf using the medial saphenous vein (located inside the hind leg). See Chapter 9 (Medical Procedures) for blood collection techniques. Blood values for calves and adults are presented in the Appendix.


There are several diseases that can be prevented by vaccination. Vaccination should be considered for elephants that are to remain in captivity. Vaccination practices may vary by geographic area. Below are the diseases for which vaccines are available; the recommended vaccination times are those used for government-owned elephants in Myanmar (Dr. Khyne U Mar, personal communication).


  • Anthrax vaccine is given after six months and then yearly. 

  • Hemorrhagic septicemia is given every six months.

  • Note: In pregnant females, anthrax and HS boosters are given only after eight months of gestation. 

  • Foot and Mouth Disease is given when an outbreak has occurred in nearby livestock.

  • Rabies vaccine is given after a bite has occurred from a suspect animal. However, it would be prudent to vaccinate annually in rabies endemic areas. (see Isaza et al., 2006).

  • Tetanus toxoid vaccine is given at three and four months of age and again at one year then annually. (See Lindsay et al., 2010).

Figure 2.6 Measurement diagram.jpeg

Figure 2.6 Measurement diagram.

Figure 2.7 Measuring the height.JPG

Figure 2.7 Measuring height.

Figure 2.8 Weighing using Digital scale.jpg

Figure 2.8  Weighing using a digital scale.

Figure 2.9 Scale platform on wheels.jpg

Figure 2.9  Scale platform on wheels.

Figure 2.10 Weighing a very young elephant calf.jpg

Figure 2.10  Weighing a very young elephant calf.

Figure 2.11 Weighing small elephant calf.jpg

Figure 2.11 Weighing a small elephant calf by placing a board on the scale.

Note: Tetanus toxoid vaccine and tetanus anti-toxin are not the same. Tetanus toxoid is given as a vaccine to prevent tetanus; tetanus anti-toxin is given as a treatment to elephants that have sustained an injury. 


Elephants at the Elephant Transit Home in Sri Lanka are not vaccinated.  

Record Keeping


It is important to document the initial history of the orphan including where he or she was found, the circumstances, and any foods or medications that may have been given by villagers. In addition to the initial physical examination, keep on-going notes (ideally daily) describing the orphan’s health status, any tests and test results, etc. Daily medical observations can be kept simply using chronological entries in a Word document. The record of milk intake should be separate but should have a place where caregivers can make comments that pertain to health. 


See the Appendix for sample forms for physical examination, daily care, and milk intake.




Thank you to Dr. Willem Schaftenaar and Dr. Bhaskar Choudhary for reviewing this chapter. 

Literature Cited

Brattstrom, B.H., Stabile, A.J., Williams, F.R., Des Lauiers, J., Pope, D., 1963. Body temperature of Indian elephants. J. Mammal 44, 282-283.


Buss, I.O., Wallner, A., 1965. Body temperature of the African elephant. J. Mammal 46, 104-107.


Choudhary, B. 2022. Basics of neonatal care and nursing orphan Asian elephant calves in Nigam, P., Habib, B., and Pandey, R. (Eds.) Caring for Elephants: Managing Health & Welfare in Captivity. Project Elephant Division, MoEF&CC, GoI- Wildlife Institute of India. Pp. 220.


Fernando, P., Janaka, H.K., Ekanayake, D.K., Nishantha, H.G., Pastorini, J., 2009. A Simple Method for Assessing Elephant Body Condition. Gajah 31, 29-31.


Hile, E.M., Hintz, H.F., Hollis, N., 1997. Predicting body weight from body measurements in Asian elephants (Elephas maximus). J. Zoo Wildl. Med 28, 424-427.

Isaza, R., Davis, R.D., Moore, S.M., Briggs, D.J., 2006. Results of vaccination of Asian elephants (Elephas maximus) with monovalent inactivated rabies vaccine. Am. J. Vet. Res 67, 1934-1936.


Lindsay, W.A., Wiedner, E., Isaza, R., Townsend, H.G., Boleslawski, M., Lunn, D.P., 2010. Immune responses of Asian elephants (Elephas maximus) to commercial tetanus toxoid vaccine. Vet. Immunol. Immunopathol 133, 287-289.


Morfeld, K.A., Lehnhardt, J., Alligood, C., Bolling, J., Brown, J.L., 2014. Development of a body condition scoring index for female African elephants validated by ultrasound measurements of subcutaneous fat. PLoS ONE 9.


Morfeld, K.A., Meehan, C.L., Hogan, J.N., Brown, J.L., 2016. Assessment of body condition in African (Loxodonta africana) and Asian (Elephas maximus) elephants in North American zoos and management practices associated with high body condition scores. PLoS ONE 11.


Wemmer, C., Krishnamurthy, V., 1992. Methods for taking standard measurements of live domestic elephants. In: Silas, E.G., Nair, M.K., Nirmalan, G. (Eds.), The Asian Elephant: Ecology, Biology, Diseases, Conservation and Management (Proceedings of the National Symposium on the Asian Elephant held at the Kerala Agricultural University, Trichur, India, January 1989). Kerala Agricultural University, Trichur, India, 34-37.


Wemmer, C., Krishnamurthy, V., Shrestha, S., Hayek, L.A., Thant, M., 2006. Assessment of Body Condition in Asian Elephants (Elephas maximus). Zoo Biology 25, 187-200.


Wiedner, E., Kiso, W.K., Aria, J., Isaza, R., Lindsay, W., Jacobson, G., Jacobson, K., Schmitt, D., 2017. Vital signs and first occurrences in normal and abnormal newborn Asian elephant ( Elephas maximus) calves. J Zoo Wildl Med 48, 997-1015.


Wijeyamohan, S., Treiber, K., Schmitt, D., Santiapillai, C., 2015. A Visual System for Scoring Body Condition of Asian Elephants (Elephas maximus). Zoo Biology 34, 53-59.

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