SPECIAL PATHOLOGY AND
THERAPEUTICS

OF THE

DISEASES OF DOMESTIC ANIMALS

 

BY

DR. FRANZ HUTYRA

Professor of Infectious Diseases,
AND

DR. JOSEF MAREK
Professor ot Special Pathology and Therapy; both of the
Royal Veterinary College at Budapest

2 Authorized American Edition
From the Third Revised and Enlarged German Edition

‘ JOHN R. MOHLER, V. M. D.

Chief of Pathological Division, U. §. Bureau of Animal Industry,
AND

ADOLPH EICHHORN, D. V. S.

Senior Bacteriologist, Pathological Division, U. S. Bureau of Animal
Industry, Washington, D. C.

»- EDITORS.

he

 

VOLUME I.

Infectious Diseases; Diseases of the Blood and of the Hematopoietic
Organs; Diseases of Metabolism, of the Spleen, Urinary
and Circulatory Organs.

With 198 illustrations in the text and 10 plates.

 

 

LONDON
BAILLIERE, TINDALL AND COX
8 Henrietta Street, Covent Garden
1913
(ALL RIGHTS RESERVED)

 

he.

 
CopyricuTepD at WasuincTon, D. Cc.
BY
ALEXANDER EGER
1912

 
TRANSLATORS OF THE FIRST VOLUME

JOHN R. MOHLUER, V. M. D.
Chief of the Pathological Division, U. S. Bureau of Animal Industry
Washington, D. C.

ADOLPH EICHHORN, D. V. 8.

Senior Bacteriologist, Pathological Division, U. 8. Bureau of Animal Industry
Washington, D. C.

DR. PAUL FISCHER

State Veterinarian, Columbus, Ohio

DR. H. J. ACHARD
of the Editorial Staff, American Journal of Clinical Medicine
Chicago, Illinois
Editors’ Preface

 

Hutyra & Marek’s Sypezielle Pathologie und Therapie der
Haustiere is generally recognized as the most comprehensive
and authoritative treatise on the theory and practice of veter-
inary medicine in Germany, Austria and Hungary, and has been
adopted as a textbook by all the veterinary colleges in these °
countries, as well as in Switzerland.

The favorable reception of previous editions in foreign lan-
guages has convinced us that the work has found favor with the
professions abroad, and the present edition, which has been
prepared in response to a frequently expressed desire for such
a translation, should prove equally valuable to the English-
speaking veterinarian. The chapter on infectious diseases will
also appeal to physicians and sanitarians who have to deal with
the diseases communicable from animals to man, and it may
reasonably be anticipated that the work as-a whole will serve
as an authoritative guide, and also as an admirable textbook
and a standard of reference for students and practitioners,
especially those who graduated before modern science had
thrown its light upon the etiology of disease. .

We wish to express sincere thanks to our eminent collabora-
tors for their able assistance in translating portions of this
work, and to Drs. Henry J. Washburn and Jacob Traum, of
Washington, D. C., for their aid in proofreading and in the.
preparation of the index. Acknowledgment is also due the pub-
lisher, Mr. Alexander Eger, for his uniform courtesy and assist-.
ance in many -ways.

Washington, D. C., Aug. 16, 1912.
MOHLER & EICHHORN.
Table of Contents

Infectious Diseases.

GROUP I.

Acute General Infectious Diseases.

en AMDT AR: ssi osc vas eh ee HE Ee taiciste chu aad odie a eds ce aalee deems
Anthrax in Man............ iia itd Ag aera aie waning, lene Sanne ased sees uve

2. Malignant Edema .......... 0. ccc cece cece ence eceneueeeuees
De. Dldeklep® sit ac iste Gis Sha aie dan albu ayard Ma cuel eaala tes Sapa wag eaeieds
Bradsot of Sheep................005 Ren arse te ees Cet con
Reindéer Pest) ic 42 wus she Bane ae a eh we eee ered ate ent els Te

4, -Switle Mrysipelas i cvek ya cinis aa bar cere ede wae Da ehadeomes Boos
The: Disease it Maite. ich wars aed dead aes e sae dace tee cei dea ce tek

5. Hemorrhagic Septicemia ............ cece cece cee ce cee teen tenes
(a): Wow Choletar..i/csesebos ncaa ennai ae tated Gat Os i chad as
Other Diseases of Fowl of a Septicemic Character.........

Septicemic and Pyemic Affections of Rabbits..............

(b) Hemorrhagic Septicemia of Cattle...................02e eee
Septie Pleuro-pneumonia of Calves.............-.-0.0 000

MGC GUS esas wee asa okt w Win ean ewe Ma AG ow a doe aceler heen ee wTRaa obs

(ce) Buffalo. Diseasé: onasccaes pac caa case cio vae ese ove ees as ya

(d) Hemorrhagic Septicemia of Sheep............ 0. cece eee ane
Infectious Pneumonia of Goats........ 0.0 cece cee eee

Takosis of Angora Goats... ...cce ccc c eee eee nett ee ee eens

(e) Swine: Plague: «05. osa ines esis us enacts eee ea eh aoe ee ee
Enzootic Pneumonia of Pigs............. 2.0 cece eee eee
Pyobacillosis of Hogs......... sees cece eee ences eee eens

6. Septicemic Affections of Newborn Animals ............--++-+++++-
(a) White Secours of Sucklings............- see eee eee ee ees
Various Colonbacilloses of Cattle........ 0... eee cece aee

(b) Pyo-septicemia of Sucklings...........-..eee eee eee eens

7. Influenza of Horses .......200sceccee cece cere eee eeeeene eee nees
© Tn fluéngay in). Matis 2 sestnas cas vdg ord ACS S ee Rese
Dengue Fever ....... 0. ccc ccc cece cee renee een enon nancies
Three-days’ Sickness ..... 606. c cece eect eee eee e ene eneeee -
Malta. R6Ve?. sis foc oa Ss CARER DESI SG ONS ew CoN ARI TIRE ENS
x Contents.

PAGE
8. Distemper of Dogse cis civces sevens seus aw ineasw ewes aes aed ea wae es 197
Distemper ‘of -CatSess.acotoase geeweagenderar ieee anns crane cq LO
Ty phus: 01 Dogsi seccadwarascceagucw ence teat nto tan abe Oees 211
9. Purpura Hemorrhagica ......... 0c cece cece cette eens . 216
Purpura Hemorrhagica of Cattle....... rath esky otarntede = Goma nual meena 232
Purpura Hemorrhagica of Dogs............ cece eee eee eee eee 233
Purpura Hemorrhagica of Man.......... 6. . cece eee eee ners 233
Scarlatinoid of HorseSs cas csscacssevseesciweeseeigaeme eens geen 233
Scarlatinoid of Cattle. ....... 6 cece ect e eee te ene nee 234
10. Rinderpest) oiiscau cea eit eee eee wile ae ewe kak hele ae Oa See sae 234
Rinderpest of Sheep and Goats........ 0... cece cece eee eeee 256
Heartwater ...0.cescasew ese renee accora es I Sia 5 poe aacsara ss aes ek 257
Ts. Hop Cholera: 5 vss anckhe a:igiditgie dod Gandy peewee ween at awa aaa ele Bie 257
12... African Horse=Sickness ccc case cae as ee etidis de eee rea a ase Bae 285
13. Fowl Pest, sstsictatevcie  acisaetehneeaawee pri dnewe sak da esenae 290
GROUP II.
Acute Exanthematous Infectious Diseases.

iy Pox “Varidla«teswiabiagun ae aaike rendtanteeewes ou Soe eens 295
(8) Sheep POX: xc a Sc da were ae Pee bw ee ee ae eae oes 302
(0) COW ROX ae a he wh eect ia adnate tian aaeva ulene thnaudey c eauen easel ates, lanier aun 318
(G) Horse Pox. icc dace dazs Gara) cordpia dele ae ebale WAS Ae asus 324
(d)i Swine Pox ws vsecdavs casas ie nes oes Gee wed wee derek wee es 325
(e): Goat Pox’ <snway srecansitiabaw sean ssn scene and cdasaoant 327
2. Foot-and-Mouth Disease ........... 02. cee eee eect e eee eee enees 328

Foot-and-Mouth Disease in Horses, Carnivorous Animals and in
Fow1s: oaisds cass cates aes caries eh Vs eee Re ees oe ee Hee eee 354
Foot-and-Mouth Disease in Man........-...-. cee cece ee ee eee ee - 855
3. Cottal: Wxanthemia, ack Ga ceed eledatwals tans dod ae 34 eule tue shee teks 356
Infectious Sexual Disease in Rabbits and Hares................. 360
4. Infectious Pustular Stomatitis of Horses............. ccc eee eeees 360

GROUP III.

Acute Infectious Diseases with Localization in Certain Organs.

Ag Strang les esis alaceieteccetsisue wait ance Basi scnene Give ghele aa aale aathnal ane Sadat 366
Strangles of Cattle. <i cc eo saevaw vow deere seme Hd FMine dace ee Since 388
Stranglés of Swine): cits ce nede dg ese ksese cae as eeeaveaees aie 388
Stranclés Of. Dots iw ieasarsins wa eseea eee eeekageoaeeea nee 388

2. Contagious Pleuro-pneumonia of Cattle.............. 0.0 c eee eee 389
Infectious Pleuro-pneumonia of Goats.............. Tojnibsepesia bs: aelinas 406
Chronic Pneumonia of Sheep.......... ee cece cece eee eens 407

3. Malignant Catarrh of Cattle........ 0c. ccc eee eee 408
Croup OF Cattle sic. ce aie econece Move Siw) ROWS SIRS Hoe ah Oe pale Ang 417
Catarrhal Fever of Sheep........... 0. eee cece eee e eee eee nns 418

4, Diphtheria of Calves......... 06 ccc cece eee eee ae pai Cour mudee aes 419
Diphtheria of Other Mammalia............... 0 cee eee eee eee 423

5. Avian Diphtheria and Chicken Pox...........0 cece eset cece ee eeee 424
Diphtheritic Inflammation of the Eyes in Ducks................. 436

Diphtheria in Man..............4.. S ALD HARD RSIS Gneregctna de aodoms Gada s 437
Contents. XI
GROUP IV.

Infectious Diseases with Special Involvement of the Nervous System.

PAGE
Dy TQtANUS®. tacos. salle aaa te cade e luis dabei edets bere ate Glens 439
Dire SRB LOS 3 rcs oss Sots ergce adc Sy yeerai bor setgaancc nue sa ayes = sk Budniactova cl sete tend desooaned riences 463
Reales: in Manis. secede ages joie 6 meena s ee Ge MOST IA tne om wale 494
Infectious Bulbar Paralysis............. 0.0 c cc eecee cece ce eeeas 495
Epizootic of Cats with Nervous Manifestations................65 497
GROUP V.
Chronic Infectious Diseases.
Ls Tuberculosis: 5.2.4) ho patie seo ee awe eerie aba Yee aude deeb: 498
(a) Tubereulosis in Mammals............ 00. c cece cee eee ence 498
Tuberculosis: in Man iscsccnae georeaye sare eas Bod Ase ohha HOE OG Mas 606
(b) Tuberculosis in Fowls.......... 0. ccc cece cece cence eee eeees 608
Tuberculosis of Parrots..............005 Shes ternee edaete oaater- OLD
(c) Etiological Relation between Human and Animal Tuberculcsis 616
Tuberculosis of Cold-Blooded Animals............0000000 630
2. Pseudotuberculosis is .ucccissececsass cise ieedimveubenveeseneees 630
(a) Pseudotuberculosis of Sheep.......... 0. eee eee eee ce eee 633
Mal Rouge of Sheep.......... cc cece cece eee eee ences 637
(b) Pseudotuberculosis of Calves........ ee eee asses 638
3. Specific Paratuberculosis of Cattle.......... 0. cece eee cere ee eee 639
A, ACtMOMYCOSIS! bc ics ciscels wise wpe odd aed bind weve a dedlolnLe a end 4S A sastatnani aves 642
Actnomycosis of “Mantes cos. ee0e (esses Ge sie ieesoreesc es aae# 665
Actinobacillosis: © dss sui ced de geen aig og ute sand aes Seay Sie ona 665
Bg WS ETS PLOLHTICOSIS, ics sess sede sie she's opsiacniara dio. asenece enero ane avdeaie mace aetlgaa e's tote de 667
(a). Farey Of Cattles. ccc. sasce von imide wnesouscecsiuaesdace  OOT
Other Streptothricoses of Ruminaste and Horses.......... 669
(b) Streptothricosis of Dogs.......... 00... cece eee eee ene cea 670
6. Botryomycosis. c.cccswevs: cece on cect aes eee ends eiav ee ease eae 672
Tre “Glanders jain va edged kesh Vee sk dere ears Heak we See aaa 678
Glanders in Carnivora......... 0... cece ee ee cece cette eee eee 730
Glanders in Sheep and Goats........... ccc cece eee eee eee eens 730
Glanders: in: Mans. cesience sae e a me oe eed ohare s ee ae 731
-8. Ulcerative Lymphangifis of Horses ........... cc eee e eee eee eee eee 731
gPseudofarey: icavs%-03e voc dev de gee ep ene es cee eee S Risto 734
9. Epizootie Lymphangitis ........ 0. se eee c cece eee teen eens 734
Malignant Fungus Disease of Horses.............--00-eeeeeeee 739
10. Infections Abortion ........... 2. cece cece eee e ee ee tet eee neeneees 740
11. Infectious Vaginal Catarrh of Cattle.......... cece cece eee eee nee 750
GROUP VI.
Infectious Diseases Produced by Protozoa.
EL, Piroplasmoses: 3.4 cgesewsae sade peed 2 whoa oat naw gh 4 Sighs wid ae wees 760
(a) Piroplasmosis of Cattle. ......... cece cece e eee eee eee ee 764
(b) Hast African Coast Fever...........000 ese e een eee neta 778
‘Tropical Piroplasmosis of Cattle............2-..-e eee eee 782
Pseudo-Coast Fever ....... cece cece cect eee eenee 782

Gall Sickness . 1.0.2... ese cece cece eect tees teen teens 783
XII Contents.

PAGE

(c) Piroplasmosis of Horses........... 20.20 c cece eee eee eeees 784

(d) Piroplasmosis of Sheep............ 0000s cence rece eee eeees 789

(e) Piroplasmosis of Dogs............0 00 ccc cece ence eeeeeeee 791
Piroplasma: tn Mainy..ceccyeacie caw os eee toe ae a tek aie 8 on ace 796

Malaria: Gi, Wat 3. ses ciock athe ied Adie quannunied dear eted Seta tue Sets aa 797

2. Trypanosome Diseases ........ 20. ccc cece ee ee tenes een eee ncnes 797
(a) NAB AME. | aiere see ode elna Ge ovanee wheebad s Pade a iain Ge eae eel ae: 805

(bo) (Sura: is case ee ng kates Be eutes ae PGT we Aaa eee ee 811

CO) DOWLING: aay gig sage wate wis nn cae he tem bo SE an ae nca a alin nade Gaderer 815

(d) Mal-de-Caderas ....... 0 cece eee eect eee teen eeeneetaaes 835
Other Trypanosome Diseases........... 0. cee ee eee eee ees 837

Other Trypanosomes ....... 0.0.0 cece cnet ee eee eens 838
Trypanosome Affections in Man............0eee cece cease 839

3. Spirochaetosis of Birds........... 000: e cece eee cence eee eee 839
Spirochaetes in Mammals .......... 0. cece ccc teen eee e eee naee 843
Spirochaetosis of Man ....... 00: cece cece eee e eet e eens 844

Diseases of the Blood and Blood-Producing Organs.

I oAviemian ci tcknd bcvea wera uate vile a eee SOAP wee 845
2. Infectious Anemia of Horses .......... 0.0.0 cece eee cee eee ees 851
3. Progressive Pernicions Anemia........ cee cece e eee een eens 863
Progressive Pernicious Anemia in Cattle. dak EERE MEER EERE A ET eS 868
Anemia of Sheep and Goats in Punjab...............-.e sees 868

Ao LOURCMIE, (thi ea tee eae VaR Oak Bh eee eon ee cemented nae 869
(a) Leukemia of Mammals........... 0000: ccc cece een eens 869

(b) Leukemia of Chickens.......... 0.00.00. e eee cece ee 877

DP sendolenkemia:: weit cic tigs-n ca Gudece casas sy otecede wee ae ener 881
6, Hemoglobinemias ie cays: ne sare ek uik a woe ens eee RLY ae ee wee She 884
7. Paralytic Hemoglobinemia .......... 0. 0c cece cee ee tee teenie ees 886
Paralytic Hemoglobinemia of Cattle.....................0..080, 900

8.2 ELOMOP NIA: os vere do ae ee we sie Sa ae eae Le eae ea eee 900
9. Animal Parasites in the Blood ............ 0.00. c eee cee eee eeee 902
(a). Filaria. Immitis: 2. vase saa dae ts ee ete s saree 8 Ee doe stan 902
Filaria Sanguinis equi............. WOU Sets Seated alretachbara wera che 905

(b) Other Animal Parasites in the Blood................0000eee 906

Diseases of the Spleen.

Diseases of the Spleens: sie acest saab ie pig eke uae made s BeBe OES 909

Vis OOS Y  aieis owes si lake aa ev aes asi acsta cg Sys apr e Ra HLS Hated hada 915
2:.: Diabetes LMS iPIOUS” aicivég sisrd oust saves anes 0iosd. eave! dead Ware MES Hla dais Sale een a 918
Bi. Diabetes: Mellitus, isc sis i aisie cists isles ecciadleicras sch acaig sua etal Ga 4 bla Meee 1. 922
4, Diseases of Metabolism Which Particularly Affect the Osseous System. 930

(a) Rachitis: :.02en0 stibtee tds vad dbo ae Paaihs BER PIE acer ees o 930

(bi): Barlow's DISCaS6: oi. 3.0js eds oe Se tne bee eae aacnerama nuns aa pans ta 949
Dis PICA ten ae Sea dae. wegen atin eden cree Mosegeab ibid aed SPAS CREE ete 963
6. Wool Eating .................. Seosy IRS She Tae Ya Paards bas 966
4 Gouk: saalexaaw orendaes dees rinesscaad een A i 5 icp a sates an oan aera shez nad Oro 968
8; ‘Seorbutus) asvassekpaevovewewien Wise ree eee cay HA drat Wiese RSS asad a 973
Contents. XIII

Diseases of the Urinary Organs.

SECTION I.
Diseases of the Kidneys.

PAGE
Te Albominuriay cise caceaw yet a ged jedepiesu bv van vow egnly ee aga deus weed 977
2) RQMATUNIR, sie sia wistiace vabate ai are gwen eae scree eae shawe pata narteteewele t 979
Haematuria Vesicalis 1.0.0.2... cee cece ccc ee ence eee ee nen 981
Ses WLCMNIA ices die od aid arenes dude anes d ea Ohad avn ad Warsuseduora due bed abate 982
4. Hyperemia of the Kidneys............0 ccc cece cece cece eee ees 984
Hemorrhagie Infarct of the Kidneys.................0.0..0005 986
«Amyloid “Kidney: iatsesane cae eaug a ba ois Denes eaveegaaciee-dimeWe cine A 987
6... Aeute: INGPHTIS) six iain sade aun ele nS Seca ete noande a ob oe: anes smniwane Caley 988
7. Chronie Non-indurative Nephritis...........00 00000 ccc ccce eee eee 996
White Spotted Kidney ......... 0.0 ccc ccc cece cece eens 1000
8. Chronic Indurative Nephritis.................. Se iuiceetndgine ded Sees Madan a 1001
9. Purulent Nephritis 1.0.0... 0.00. eee iene en 1007
0. Bacterial Pyelonephritis ..........0 00000. cece eee 1010
Die PYCHUS 2 iene asin ad eae ce RNS. awed Ri eed Ay oe ha eae die we 1019
2, N@phroluthiasis' a. 2i-5 de cites Mowery ng awe as cpe ers owe aan eer eter 1021
3 ELydronephnosis  ocwecevecace dey Onne ceree shed RAs eye Bee ee hace ale 1025
Ae. Eueniall PUMOws: 4.20 seas sient Secaics hs aceencts Gesenye eats beanie a. esas 1028
5. Animal Parasites in the Kidneys .......... 00... eee e eee eee eee 1028
(a) Eustrongylus Gigas ....... 0... eee eects -1028
(b) Other Parasites of the Kidneys............. 0.02. esses eee 1029

SECTION II.

Diseases of the Bladder.
1. Catarrh. of the Bladdeérs iss ascnsiagiaosseiveuntercsraesieecarecds 1031
Twisting of the Bladder................ aid, ie Biden ean Gace ies 1635
2. Paralysia of the Bladderic oi. ce ais ese ecco eee edie omie gomuee aun en ele ew 1036
Spasm of the Bladder: :css00 secs eceeveease dace sees oe eae exaes 1038
Diseases of the Circulatory Organs.
SECTION I.
Diseases of the Pericardium.
L-

Ly; Pericarditis js scsngwia vn wade Wis Sac ee eae Se eee See oa as 2s 1039
Compression of the Heart...... 2.0... ccc eee ences 1051
2% ‘Wy dropericardium Mitel MA hEMe Ee ea ea eeEE Cee eTA Rea ees ae 1052
, Hemopericardium ........0. eee e eee ee eee ee Orcs Meee aMuihehi oe Sta 1053
3 /Pneumopericardium eadiiid Gard igi ete has ena Bae ee re annes TO ere eT 1053

SECTION II.

Diseases of the Heart.

LL -Palpitatio: (Cordis \ssac ne via Cuntae ned eeeedieqssatwaee se swundauens 1055
2. Bradycardia ......cccccec cece seat cee eee eee tenet ene n enna 1056
3., Intermittent Action of the Heart........... cece eee cece n ete ees 1057
4. Hypertrophy of the Heart.........-.. 0 cee eee cette tenet eee 1061
5., Dilatation of the Heart........0...ccce eect e eee tenet ee eens 1063

G. Myocarditis 0.0.0... cece ccc nen tee ene enna 1069
XIV Contents.

(CE ae 1 | ern nm

UD) OTE Sea esa ie 255 ea cov alae So ce ed ae Lactauatacaitrh Ole ae opieaa ey oeacs %
Ossification of the Heart Muscle ...............00- ee ere

eg AGEY LOA 55 ec 3a os Grso 8 Set oat ire Diitsca cated ge when guia oaey wage Ain
8.; Rupture of the Heart.... 0.6... cece ee eee
9. New-formation in the Heart .............. 0.0 ccc eee eee ete eens
10. Animal Parasites in the Heart................ 0... c eee eee eee ees
11. Acute Endocarditis ....... 0. cc ccc cect cee te eee eee ta een anaes
12. Valvular. Diseases: 24 .20dee0-aeue eee si hese vee ya wie peso een ner ees
(a) Insufficiency of the Aortic Valves................ cece eee

(b) Stenosis of the Aortic Opening............... 0.020. 00e eee

(ec) Insufficiency of the Bicuspid or Mitral Valve ..............

(d) Stenosis of the Left Auriculo-Ventricular Opening..........

(e) Insufficiency of the Pulmonary Valves.............-++ 20000

(£) Stenosis of the Opening of the Pulmonary Artery...........

(g) Insufficiency of the Tricuspid Valve...............00e eens

(h) Stenosis of the Right Auriculo-Ventricular Opening.........

(i) Congenital Heart Lesions..........:ce cee cee ce ete e eee eeeas

(k) Combined Valvular Lesions...........eeeeeceeeeceeeeeeree

SECTION III.
Diseases of the Blood Vessels.

1. Chronic Inflammation of the Arterial Wall ................--02-4-
2... Dilatation, of thé: AGP taj. a. dye ieceteske ee ee nie eet qos eee wale edin a Sede
Aneurysms of Other Blood Vessels............ 0.00. c eee e eee eee
General Diminution in the Tonus of the Small Arteries... ......

3. Obstruction of the Larger Arteries ......--- 5-60 - eee eee eee eee -
Thrombosis of the Pulmonary Artery.......... cee cece e eee

4. Obstruction of. the Large Venous Trunks ............0. cece ee eee
5. Rupture of the Large Blood Vessels ..............-- hte ie nade cane

APPENDIX.

Lymphorrhagia ............... Siig Sena massa TS YS a asada

1095
1096
Explanation to the Abbreviations in the

A. L. =

Amer. V. Rev. =

An. (Anim,) Ind. =

Ann, =

A. P.

Arb. d. G: A.

A. d’Alf.

Arch, f. exp. Path.
u. Phmk.=

Hid

A. f. Tk.

ll

Arch. f, Vet.-Wiss.
A. vet.

Beitr. z. path. An.
B. kl. W.

B. t. W.

B. Mt.

Bull. P

Chl. f£. B. (Bakt.)

Chl. £. med. Wiss.
C. RB.
Comp. Path.

Int edd

g
g
a
ll

Ht

Diss. (Inaug.-Diss. )
Dresdn. B.
Ergebn. d. Path.

F. d. M.
F, d. Vhyg.
Hb. d. p. M.

H. (Hann.) Jhb.
Holl. Z.

Hyg. de viande

J. du Midi

J. of comp. Path.

Hil

Il tt a

J. vét.
Kongr.

tI tl

Kézl.

Leipz. B.
Maanedsskr.
Mag.

M. Orv. Arch.
Med. vet.
Mitt. d. G.-A.
M. (Miinch.) Jhb.

Podge

Reference to Literature.

Allatorvosi Lapox (Budapest).

American Veterinary Review (New York).

Annual Report of the Bureau of Animal Industry (Washington).
Annales de médecine vétérinaire (Bruxelles).

Annales de 1’Institut Pasteur (Paris).

Arbeiten aus dem Kaiserlichen Gesundheits-Amte (Berlin).
Archives vétérinaires d’Alfort.

Archiy fiir experiment. Pathologie und Pharmakologie (Leipzig).
Archiv fiir wissenschaftliche und praktische Tierheilkunde
. (Berlin).

Archiv fiir Veterinirwissenschaften (St. Petersburg).
Arhiva veterinara (Bucarest).

Beitrige zur pathol. Anatomie u. allgem. Pathologie (Jena).

Berliner klinische Wochenschrift.

Berliner tierarztliche Wochenschrift.

Badische tieriirztliche Mitteilungen (Karlsruhe).

Bulletin de la Société centr. de médecine vétérinaire (Paris).

Centralblatt fiir Bakteriologie, Parasitenkunde und Infektions-
krankheiten. Originale (Berlin).
. Centralblatt fiir medizinische Wissenschaften (Berlin).
Comptes rendus des séances de 1’Académie des Sciences (Paris).
The Journal of comparative Pathology and Therapeutics
(London).

Dictionnaire pratique de médecine et de chirurgie vétérinaire
(Paris).

Deutsches Archiv fiir klinische Medizin (Leipzig).

Deutsche medizinische Wochenschrift (Berlin).

Deutsche tierirztliche Wochenschrift (Hannover).

Deutsche Zeitschrift fiir Tiermedizin und vergleichende Patho-
logie (Leipzig).

Inaugural-Dissertation.

Jahresbericht der tierarztlichen Hochschule in Dresden.

Ergebnisse der allgemeinen Pathologie und pathol. Anatomie
(Wiesbaden). ‘

Fortschritte der Medizin (Berlin).

Fortschritte der Veterinarhygiene (Berlin).

Handbuch der pathogenen Mikroorganismen; redigiert von
Ko.iie & WASSERMANN (Jena).

Jahresbericht der Kén. Tierarzneischule zu Hannover.

Tijdschrift voor Veeartsenijkunde.

L’hygiéne de la viande et du lait (Paris).

Journal des vétérinaires du Midi.

The Journal of comparative Pathology and Therapeutics
(London).

Journal de médecine vétérinaire et de zootéchnie (Lyon).

Internationaler tierarztlicher Kongress (Bern, Baden-Baden,
Budapest, Haag).

Kézlemények az ésszehasonlité élet-és kértan kéréb6l (Budapest).

Bericht des Veterinir-Institutes zu Leipzig.

Maanedsskrift for Dyrlaeger (K¢benhavn).

Magazin fiir die gesamte Tierheilkunde (Berlin).

Magyar Orvosi Archivum (Budapest).

Il medico veterinario (Torino).

Mitteilungen des Kaiserlichen Gesundheitsamtes (Berlin).

Miinchener Jahresbericht (Jahresbericht der kénigl. Zentral-
tierarzneischule in Miinchen).
XVI Explanation to the Abbreviations in the References to Literature.

M. m. W.
M. t. W.
Mod. Zooiatro
Monh.
Neur. Cbl.
N. Ere.
Orv. H.

oO. M.

O. R.,

O. Vj.

O. Z. £. Vk.

Pr. Mt.
Pr. Mil. Vb.
Pr. Vb.

Pr. vét.

Ree.

Rep.

Revista

Rey. f. Tk.
Rev. gén.

Rev. vét.
Schw. A.

Schw. A. f. Tz.
Ss. B.

Soe. biol.
The Vet.
Tidsskr.
Tm. R.

T. R.

T. Z.
Trop. Vet.
Ung. Vb.
Vet.

V. A.

V. J. (V. Journ.)

Vet. Jhb.
Vet. Ree.

V. f. T. (Vortr. f.

Fido e add

I ll

Il

Hd ted

ddd tad

II tl

Tzte.) —

bh

Tk.
Biol.

. Flhyg.
Hyg.
Imm.
Infkr.

. kl. Med.
Vet.-Wiss.

N NN NNNNNG
th bhhe pepere the,

Tm.

Z. £. Vk.
Z. f. Phys,
. méd,

Hid el

I i

Miinchener medizinisecne Wochenschrift.

Miinchener tierarztliche Wochenschrift.

Il moderno Zooiatro (Torino)

Monatshefte fiir praktische Tierheilkunde (Stuttgart).

Neurologisches Centralblatt (Leipzig).

Il nuovo Ercolani (Pisa). ‘

Orvosi Hetilap (Budapest). .

Osterreichische Monatsschrift fiir Tierheilkunde (Wien).

Revue fiir Tierheilkunde und Tierzucht (Wien). ;

Osterreichische Vierteljahrsschrift fiir Veterindrkunde (Wien).

Osterreichische Zeitschrift fiir wissenschaftliche Veterinarkunde
Wien).

intial aus der tierirztlichen Praxis im preussischen
Staate (Berlin).

Statistischer V eterindrsanititsbericht tiber die preussische Armee
(Berlin).

Verdffentlichungen aus den Jahresveterinarberichten der be-
amteten Tierairzte Preussens (Berlin).

Le progrés vétérinaire (Alfort).

Recueil de médecine vétérinaire (Alfort).

Repertorium der Tierheilkunde (Stuttgart).

Revista di medecina veterinaria (Bucarest).

Revue fiir Tierheilkunde und Tierzucht (Wien).

Revue générale de médecine vétérinaire (Toulouse).

Revue vétérinaire (Toulouse).

Schweizer Archiv fir Tierheilkunde (Ziirich).

Schweizer Archiv fiir Tierheilkunde und Tierzucht (Bern).

Sdchsischer Bericht (Bericht tiber das Veterina’rwesen im
K6nigreich Sachsen).

Comptes rendus de la Société de biologie (Paris).

The Veterinarian (London).

Tidsskrift for Veterenaerer (Kgbenhavn).

Tiermedizinische Rundschau, mit besonderer Beriicksichtigung
der vergleichenden Pathologie (Halle).

Tierarztliche Rundschau (Friedenau-Berlin).

Tierarzthches Zentralblatt (Wien). ;

The Journal of Tropical Veterinary Science (Caleutta).

Jahresbericht tiber das Veterinirwesen in Ungarn (Budapest).

Veterinarius (Budapest). :

VircHow’s Archiv fiir pathol. Anatomie u. Physiologie und
fiir klin. Medizin (Berlin).

The Veterinary Journal (London).

Jahresbericht tiber die Leistungen auf dem Gebiete der Veteri-
narmedizin (Berlin).

The Veterinary Record (London).

Vortrige fiir Tierarzte (Leipzig).

Wochensehrift fiir Tierheilkkunde und Viehzucht (Miinchen).

Zeitschrift fiir Biologie (Miinchen).

Zeitschrift ftir fleisch- und Milchhygiene (Berlin).

Zeitschrift fiir Hygiene und Infektionskrankheiten (Leipzig).

Zeitschrift f. Immunitaitsforschung und exper. Therapie (Jena).

Zeitschrift fiir Infektionskrankheiten, parasitiire Krankheiten
und Hygiene der Haustiere (Berlin).

Zeitschrift fiir kliniseche Medizin (Berlin).

sae ee fiir praktische Veterinir-Wissenschaften von Pitz

ern).

Zeitschrift fiir Tiermedizin. Neue Folge der Deutschen Zeit-
schrift fiir Tiermedizin und der Osterreichischen Zeitschrift
fiir wissenschafthche Veterinirkunde (Jena).

Zeitschrift fiir Veterinirkunde (Berlin).

Zentralblatt fiir Physiologie (Leipzig u. Wien),

Traité de zoologie médicale et agricole (Paris),
Infectious Diseases

I. Group

ACUTE GENERAL INFECTIOUS DISEASES

1. Anthrax. Febris carbunculosa

(Splenic Fever; Milzbrandfieber, Milefieber, Karbunkelkrank-
hett [German]; Fiévre charbonneuse, Charbon bactéridien
[French]; Antrace, Febbre carbonchiosa [Italian].)

Anthrax is an acute, febrile, infectious disease of domestic
animals, particularly of ruminants and horses, caused by the
bacillus anthracis, and characterized anatomically by an acute
swelling of the spleen and by serous hemorrhagic infiltrations of
the subcutaneous and subserous connective tissue.

History. The disease was known by its present name in the oldest
times (éy3oat—coal, on account of the black color of the blood), but-it
was confused with other diseases disclosing similar symptoms until the
middle of the last century. Its contagiousness was first established by
Eilert in 1836 by successful inoculations as well as by the feeding of
anthrax blood, and by Gerlach in a similar manner a few years later
(1845). In the year 1850 Davaine, and Rayer, in 1855 Pollender and
soon after Brauell found in the blood of animals which died of anthrax
peculiar rod-shaped bodies, which Brauell also demonstrated in the blood
of living animals, attributing a diagnostic value to his findings. After
Delafond (1860) had already recognized the vegetable nature of these
bodies and named them bacteria, Davaine (1865) established their etio-
logical importance, as in his experiments blood containing these bodies
produced the disease even in high dilutions, while inoculations with blood
without such rods gave negative results.

The fungous nature of anthrax bacilli was definitely established by
Cohn. However, they were first artificially cultivated by R. Koch (1876)
and by Pasteur (1877), whose fundamental investigations opened a new
path for the theory of the infectious diseases in general through the study
of the biological characteristics of the anthrax virus, as well as the
etiology of the disease. At the same time Pasteur’s classical experiments
in attenuation and protective inoculation established the foundation for
the modern theory of immunity, the development of which has already.

1 1
2 Anthrax.

produced highly important and valuable results, and for which the an-
thrax bacterium furnishes very satisfactory material.

Occurrence. As a disease of the soil prevalent in progres-
sive agricultural countries, anthrax is usually confined to certain
localities (so-called anthrax districts) where the moist, marshy
or periodically inundated soil is suitable for the growth of the
infective agent. In such localities the disease appears enzo-
otically almost annually with a variable virulence, principally
among animals at pasture in the summer time. On the other
hand, and particularly in stable-fed animals, it is observed more
rarely and mostly sporadically.

In Germany anthrax formerly existed very extensively, and the losses in Prussia
alone amounted in the years from 1878 to 1883 to over one and a half million
marks ($375,000). During the period from 1886 to 1905 the number of cases
occurring quarterly rose from 0.22 to 0.62 for 10,000 cattle, in which the highest
numbers occurred mostly in the second quarter of the year. In the period of 10
years (1899-1908) the average cases were 172 horses, 4,489 cattle, 3,194 sheep, 10
goats and 100 hogs; and in the year 1908 the disease occurred on 4,536 farms of
3,832 townships, affecting 125 horses, 4,865 cattle, 369 sheep, 13 goats and 216 hogs,
that is of each 10,000 animals, 0.29 horses, 2.36 cattle, 0.48 sheep, 0.04 goats, 0.10
hogs; in all 9.5 per cent less than in the previous year. In the last year the disease
showed the largest extension in the government districts—Schleswig, Posen, Breslau
and Liegnitz; in 86 per cent of the infected farms only one animal each was found
to be affected.

In France the disease at one time existed to such an extent that Delafond
estimated in 1842 the annual loss at seven million francs ($1,400,000); in 1908
the number of infected stables fluctuated between 23 and 47 monthly, and the
largest extension occurred in the northern districts.

In Great Britain the annual average during the period of 1899-1908 showed
835 outbreaks, that is 43 cases in horses, 893 in cattle, 58 in sheep and 223 in

“hogs. In the year 1908, 80 counties were infected.

In Austria the average annual loss from anthrax during the years 1891-1900
amounted to 195 horses, 1,334 cattle, 128 sheep, 40 goats and 60 hogs; in the last
years the affection existed per 10,000 animals in 1.3 horses, 1.7 cattle, 0.3 sheep,
0.06 goats, 0.05 hogs. In 1908 the number of affected townships fluctuated during
the summer months between 6 and 27, and of farms between 6 and 123.

In Hungary there were affected during the years 1899-1908 an average of
273 horses, 2,542 cattle, 1,008 sheep and about 28 hogs, which involved from 821
townships in 1899 to 2,491 in 1908; the number of affected animals in 1899 were
2,962, and 7,540 in 1908. In 1908 the disease occurred in 2,491 townships, that is
on 5,090 farms, with 358 cases in horses, 6,411 in cattle, 729 in sheep and 42
in hogs. The greatest number of cases occurred in the low, flat lands of southern
Hungary along the Tisza and Maros rivers, as well as along the lower Danube.

In Russia the disease formerly existed to such an extent that in some periods
(1864-1866) numerous persons fell victims, and in the District of Novgorod alone,
during the years 1867 to 1870, 56,000 horses, cattle and sheep as well as 526 human
beings succumbed to the infection. At the present time the disease is still exten-
sively prevalent, particularly in southern Russia, where the official reports for 1908
show 8,555 infected townships with 34,650 cases.

In Switzerland the disease appeared in 1908 in 160 townships, affecting 9
horses and 192 cattle.

Anthrax also exists in the other European countries in the north but not as
frequently as in the south. Thus, in 1908, there were 3,853 cases in Italy, 466 in
Holland, 395 in Norway, 878 in Roumania, while in Denmark 143, and in Sweden
214 premises showed new outbreaks.

The disease is prevalent in all parts of Asia; in Asiatic Russia, the ‘‘ Siberian
pest’’ (there known as Jaswa) which is identical with anthrax, causes great losses
annually, 95,316 cases being reported in 1899. The disease has likewise been well
known from the earliest times in Africa and America, (In Brazil it is known as
‘‘gorrotilho’’ of cattle and sheep.) In Australia it was not supposed to have
been introduced until the year 1847, but at present it causes an annual loss of
300,000 sheep.
Etiology. 3

Etiology. The bacillus anthracis is 1.5 to 4.0 long, and
1.0 to 1.54 broad. It is a nonmotile bacterium which multiplies
by fission and spore formation, and forms in the body fluids,
and still more on artificial media, long chains.

Staining. The bacilli stain well, while living, with diluted
aqueous fuchsin or methylene blue solution; on dried cover glass slides
with the usual solutions of aniline stains, as well as by Gram’s and
Weigert’s methods. Bacilli just stained with fuchsin disclose in their
bodies one or more intensely stained granules adherent to the wall
(Fig. 1). In stained dry specimens the ends of the bacilli appear
sharply cut, sometimes even slightly thicker (resembling the form of
I) ; in the chains they are separated by straight lined or double convex
light spaces (bamboo-rod forms). The light parts are formed by the |
mucin capsule (Serafini, Johne) which surrounds the plasma of each

  

Fig. 1. Bacillus anthracis. Fresh sheep Fig. 2. Bacillus anthracis, with capsules.

blood stained with diluted Spleen juice from a horse.
fuchsin solution. | Gram-eosin staining.

individual bacillus and holds them together in chains (Fig. 2). The
capsule is well developed in fully virulent bacilli taken from the blood
of animals, particularly of ruminants, as well as in those cultivated in —
fluid blood serum, while on other media the capsule formation is incom-
plete (see also page 11).

Cultivation. Anthrax bacilli grow on alkaline media in the
presence of oxygen at body as well as room temperatures. The highest
limit which is suitable for their growth is 43°C., while the lowest tem-
perature is 12-15°C. In gelatin of not too strong concentration a
white streak develops after 1 to 2 days along the stab from which hori-
zontal radiations branch off in all directions (test-tube brush forms,
Fig. 3). After 3 to 4 days the gelatin commences to liquefy under the
influence of a peptonizing ferment (Fermi) along the streak from the
surface downwards, while the bacterial masses later form a layer of
flaky sediment. onthe bottom of the stocking-shaped liquefied part.
The liquefied gelatin above this, however, remains entirely clear. On
gelatin or agar plates the surface growth appears in the form of white
points which consist of braid-like interwoven chains. The streak eul-
ture on agar and on potato forms a grayish white, reticulated, viscous
4 Anthrax.

growth of dull luster, with wavy borders, while in bouillon it forms a
flaky, slimy sediment over which the liquid remains clear or only
slightly cloudy. The bacilli may also multiply and form spores in
greatly diluted albuminous solutions and in. ordinary
water.

In the animal body anthrax bacilli multiply ex-
clusively by direct division, and in this way short chains
of 8, 4 or 8 links result in the tissue fluids (Fig. 2).
On artificial media very long chains develop by similar
division, and the bacilli, which on these media are
usually more slender, grow even to form long, homog-
enous threads, which subsequently become divided by
cross sections into chains of bacilli (Figs. 5 and 6).

In the presence of a sufficient quantity of oxygen
and at a temperature of 438°C. maximum or 12°C. mini-
mum spores develop in the bacilli (I'igs. 5 and 6). One
pole of the bacillus separates by a cross section from its
body and incloses one or a half of a chromatin granule ;
after the disappearance of the granule the fertile pole
segment separates from the wall whereupon its central
part forms the body, and the peripheral part forms the
covering of the spore (Preisz). Under favorable condi-
tions the oval spore swells, its covering becomes extended
and soon forms one of the poles. The young germ then
makes its appearance and grows, developing into a
bacillus, which later again propagates either by fission
or spore formation. (Spores never develop in the tissue
fluids of the living animal, in the unopened carcass, or
inside of the meat of slaughtered animals.)

According to Brotzu bacilli produce spores in the intestinal
tract of the dog which is only slightly susceptible to anthrax.
According to Oppermann spores form in the caecum of the rabbit
and according to Piana in the intestinal tract of birds.

At 42-43°C., as well as on media containing substances
which retard their growth (for instance, 0.1% carbolic acid), and
by limiting the air supply, anthrax bacilli may temporarily, or
forever, lose the faculty of spore formation, (so-called asporo-

enic modification [Behring, Roux, Pfersdorf]). On artificial
media various irregular forms develop occasionally after 2 to 3
days (elub-, pear-, and screw-forms), although the culture may
Fig. 3. Six-day retain its original virulence (Ligniéres & Durrien).

old gelatin cul-
ture of the an-
thrax bacillus.

 

Tenacity. There is a marked difference in the tenacity of
the bacilli and spores. While the bacilli are less resistant, the
spores are only destroyed by substances which have a very ener-
getic action.

The bacilli are destroyed by drying in thin layers in the sunlight in from 644
to 15 hours, in thick layers and in the dark in from 2 to 3 weeks, and by heating
to 55-58°C. in 10-15 minutes. In dried blood, however, they may remain virulent
for one month or longer, and may then form spores on addition of water and
under proper temperature conditions (Bongert). .They are only destroyed in dried
tiood when heated to 92°C. for 244 hours (Momont). On the other hand, they
die in putrid blood, particularly in anerobie putrefaction inside the unopened
carcass, in warm weather in 2 to 3.days. The bacilli manifest a great resistance
against low temperatures, as for instance, at —10°C. they are destroyed in 24, and at
—24°C. in 15 days (Klepyzof). In the gastric juice they die in 15-20 minutes; in
pure or putrid water in 1 to 2 days. chor destroys them if mixed with anthrax
hlood in 2-4 hours (Schipp). The ordinary disinfectants destroy the bacilli even
in high dilutions (Koch).

Simple drying does not destroy the spores at all, so that in such condition,
for instance, when dried on silk threads, they may remain germinative for 181%4
Tenacity. Pathogenicity. 5

years (Székely). They also remain virulent for a long time in pure or putrid
water, in putrid blood and in the ground (according to Sirena & Scagliosi, they
live in the ground for 3 years, in water for 17 and in ichor for 15 months). They
resist the direct sunlight for 100 hours (Momont). Dry heat (120-140°C.) destroys
them in 3 hours, while blowing steam of 100°C. kills them in 5 minutes (Koch).
They may still germinate after 5 minutes boiling (Geppert). On the other hand,
the action of a falling temperature from 76.5 to 72°C., inside of a manure pile is
sufficient to destroy the spores (Pfeiler).

_ Of the disinfectants, corrosive sublimate is the most effective, since a solu-
tion of 1:1000 destroys the spores in 20 minutes (the addition of 0.5% hydro-
chloric acid or 2% earbolic acid increases the action of the solution). The follow-
ing are also effective: fresh chlorine and iodine water (2%), formaldehyde (34%),
permanganate of potash (5%), lysol (5%), ecarbolic acid (5%), fresh chlorate of
lime (5%), chlorine gas (5%), fluorhydrogen (0.1%), and the vapors of formalde-
hyde, which will positively disinfect hair containing spores in 48 hours (Gruber).

Pickling destroys the bacilli in meat after 1144 months (Peuch), but it does
not affect the spores (Abel). The drying and salting of hides does not destroy
the attached spores which may remain virulent for 125 days on hides that have been

 

, Fig. 4. (a) deep, (b) superficial colonies of the anthrax bacillus on
gelatin plates. Enlarged 80. (After Fltigge.)

treated with fresh milk of lime (Griglio). In sunlight hides containing the bacilli
are sterilized in 614 to 7 hours, while those containing spores are not sterilized even
after exposure for 13 hours (Esmarch). Quick lime solution and lime kill the spores
in the tanning process in 12-17 days. Infusion of quebracho bark does not affect
them in 12 days (Keszler), the lime pits (0.5-0.8% lime contents) are not effective
against the spores (Gartner & Dammann. See also p. 23).

Pathogenicity. Rabbits, guinea pigs and mice are usually
killed by subcutaneous or intravenous injections of anthrax
blood or cultures, in 1 to 3 days, while infection is less certain
when the spores are fed. By the first method horses and sheep
may easily be infected, while in cattle a local infection only re-
sults sometimes, even after the injection of larger quantities of
virus. The infection of herbivora is also quite easily accom-
plished by feeding spores, even when the mucous membrane of
the digestive organs is in a healthy condition. Although hogs
6 Anthrax.

may sometimes be infected by subcutaneous injections and by
feeding (Perroncito, Crookshank, Garth), yet in most instances
they resist artificial infection (Ratz, Tschernogoroff). Dogs oc-
casionally become ill from intravenous injections with pure cul-
tures (Bardach, Martel), and exceptionally from the feeding of
anthrax meat. However, as a rule they manifest considerable
resistance to artificial infections. Young pigeons and small
birds in general may be quite easily infected artificially, while
in large birds as well as in chickens infection is difficult.

The high virulence of the blood of animals dead of anthrax
has been established by experiments, according to which a mil-
lionth part of a drop of blood injected subcutaneously kills a
guinea pig in 23-24 hours (Davaine). By repeated passage
of the virus through the body of susceptible animals (mice,
guinea pigs) as well as through resistant animals (chickens,

  

Fig. 5. Spore formation in anthrax Fig. 6. Anthrax threads with spores.

bacilli. Eight-hours old agar Cover glass preparation from an
culture stained with diluted . ,eight-hours old agar culture.
fuchsin solution. Fuchsin staining.

‘

dogs) its virulence is increased, and in this manner a virus
which is fatal in 24-30 hours may be obtained (Martel). On
the other hand, influences which check the development (high
temperature, disinfectants as well as the continuous action
of the oxygen of the air), have attenuating effects on both the
bacilli and the spores. (See protective immunization. )

In the presence of certain other bacteria the multiplication of the
‘anthrax bacillus is hindered or entirely checked. As such antagonists
the following are known: Bac. pyocyaneus, prodigiosus, fluorescens,
phosphorescens, Gartner’s bacillus, JF riedlander’s pneumococcus,
streptococci and staphylococci, and the anerobie putrefactive bacteria.
The antagonism manifests itself in such a way that virulent anthrax.
bacilli when mixed with such antagonists have little or no pathogenic
action.

The natural infection in herbivorous animals occurs usually
through the ingestion of food and water which contain anthrax
Natural Infeetion. 7

spores. When taken into the digestive tract with the food or
water some survive the action of the gastric juice and pass
through the stomach unimpaired, germinating in the alkaline
contents of the intestines where they multiply by fission. The
bacilli enter the lymph spaces of the intestines and finally reach
the blood through the lymph stream.

The contamination of the food with bacilli and spores
usually takes place from the infected soil on which it was grown.
Anthrax bacilli which in some way, especially by means of
blood or intestinal contents of affected animals, are deposited
in the superficial layers of the soil may there remain alive for
some time, and under favorable moisture and temperatures
multiply or form spores. The spores are for a long time capa-
ble of propagation, resisting dryness and moisture, cold and
heat, as well as putrefaction, until favorable germinating con-
ditions arise, whereupon the bacilli continue to multiply and
produce new spores. Under unfavorable conditions, such as
excessive dryness or cold, the bacilli are destroyed, but the
spores resist such influences. In this manner the soil of a
certain locality which has once become infected may remain a
source of infection for a very long time.

The elevation as well as the moisture and temperature of
the soil are naturally of great importance. The infective agent
thrives best in moist soil rich in organic matter, generally in
swampy, marshy soil, or in localities subject to periodical inun-
dations. In such places anthrax usually appears when by a
rapid recession of the ground-water the superficial layers of
the soil become exposed, and then, in the presence of proper
moisture and temperature, germination of the spores and mul-
tiplication of the bacilli results. Consequently the disease is
observed most frequently during the summer time, particularly
in warm days following a period of rainy weather.

Forage plants are very apt to transmit the disease since
the animals always ingest with their food a certain quantity of
dirt which adheres to the dried and stored feed. Further, in
the infected localities the water contained in pools as well as
that from springs may become contaminated. As a matter of
fact various outbreaks in pastures may be due to the use of
certain springs, particularly if they are shallow.

The infectious material contaminates the soil in many ways.
The running surface water may carry along the spores and
deposit them elsewhere. Likewise, the wind may carry them
to previously uninfected localities from places where the water
has receded and the surface layer of the soil has become dried.
Most frequently, however, the soil becomes infected by carcasses
or parts of carcasses as well as by the excrements of affected
animals. While the bacilli do not produce spores in the carcass,
yet they pass to the outside, either through the body orifices
or through decomposition of the carcass, when they form
8 Anthrax.

spores; from previously opened carcasses spore-containing
material may be disseminated at once. When carcasses are
not buried sufficiently deep or are left unburied the soil be-
comes heavily infected; even burying opened carcasses rather
deeply does not offer a sufficient protection in this respect.
The spores retain their germinating power for a very long
time even in the deeper layers of the soil, and from here they
may be conveyed to the superficial layers by the rising ground-
water. They may also be brought to the surface by earth-
worms and deposited in their excrement (Pasteur, Bollinger).
According to Karlinski the contagium may also be spread
through certain snails (Arion subfuseus). Investigations of
local outbreaks have frequently proved shallow burying of an
anthrax carcass on a pasture or meadow to be the cause; be-
-sides this, the disease frequently occurs in pastures in the im-
mediate vicinity of a decomposing anthrax carcass.

Wholesome food grown on uninfected soil is sometimes
subsequently infected by the excrements or the blood of af-
fected animals which have been bled. The bacilli which con-
taminate the food may continue to multiply and form spores
if the conditions of moisture and temperature are favorable,
and in this way they may cause stable infections.

The intestinal contents of affected animals is particularly danger-
ous as it may not only contain bacilli but also spores. Horse or cattle
manure or its mixture with dirt represents an excellent medium for
the propagation of the virus, and particularly for sporulation (accord-
ing to Oppermann, spores which are formed on such soil are particu-
larly resistant).

In anthrax districts the intestinal contents of healthy animals may
not infrequently also contain spores which have been ingested along
with the food or drinking water and passed out through the intestinal
canal without molesting the host. It is therefore possible for such
spore-carriers to spread the contagion into uninfected territories with-
out becoming affected themselves.

According to Marchoux & Salimbeni the disease is spread in Brazil by the
Urubus, a species of vulture, as they consume the anthrax carcass and then pass
masses of spores from the intestinal tract with their feces.

The food may also occasionally become infected by the
hides of animals dead of anthrax. Hides are frequently dried
in the hay-loft where the blood drops on the hay or other food
stored there, or with the accumulated dust, into the mangers
below. Sheep stables are particularly liable to become infected
in this manner, as it is a frequent practice secretly to skin
carcasses which died of anthrax and to dry the pelts in the
stable. It has also been demonstrated that hides which have
been thoroughly dried or even salted or treated with milk of
lime (Griglio) may contain virulent spores. They may also be
present in bone meal made from anthrax carcasses due to
incomplete decalcification and the consequent retention of more
Natural Infection. 9

or less fat in the prepared product (Lehnert). Lastly, the soil,
as well as the food and drinking water may occasionally become
infected by drainage water and waste from tanneries, -wool-
works and horse-hair mills (Grebe, Uhlich; Gartner & Dam-
mann found that while keeping the skins in the lime pit during
the process of tanning the anthrax spores are not destroyed).

The introduction of a large quantity of spores is necessary for an
active infection, and accordingly anthrax infections usually appear
only after the ingestion of a considerable quantity of infected food or
drinking water. The necessary quantity of spores varies with the indi-
vidual susceptibility or resistance which may be influenced by internal
and external conditions. Animals which are affected with the so-called
“Vatent infection’’ (or the above mentioned ‘‘spore carriers’’) not
infrequently develop the disease as a result of external weakening influ-
ences through colds, physical exertion, starvation, ete. Furthermore,
by repeated though slight intercurrent attacks the resistance of the
animals is reduced, and under such conditions the anthrax bacilli
begin to multiply, and thus produce the specific affection. (According
to Oppermann healthy sheep may be infected by the feeding of 200,000
spores, while sheep which were previously starved were infected by
feeding 51,000 spores). A reduction in the natural resistance is also
claimed to be caused by protective inoculation, according to Leclainche
& Vallée, and some of the losses from inoculation may be explainable
in this way.

Carnivorous animals usually become infected after ingest-
ing meat or blood of anthrax animals. If the meat is fresh it
contains only bacilli which are usually destroyed in the stomach.
On the other hand, if the meat has stood for a sufficient length
of time for the spores to develop on its surface and a large
amount is ingested at one time the spores may pass through
the stomach and germinate in the intestinal tract. In some
instances, indeed, it may be assumed that even fresh anthrax
meat may cause infection, provided the animals have eaten at
one time such a large quantity as to cause a portion of it to
leave the stomach undigested. In all cases there exists the
possibility of the infection occurring through the mucous mem-
brane of the mouth and pharynx, particularly in the presence
of bone splinters; from the clinical appearance of the affection
in hogs which is usually manifested as a pharyngitis and ulcer-
ative stomatitis, it seems evident that the entrance of anthrax
bacteria into the tissues occurs through the pharynx.

The milk of affected animals does not transmit the infec-
tion as the bacilli do not pass into the milk from the blood
unless during the last hours of life. Moreover, the milk secre-
tion ceases almost completely very early in the disease.

Anthrax very rarely develops through skin abrasions, and
only in those instances in which the injury to the skin extends
through the epithelial layer. In this way bacilli as well as
spores may enter the tissue fluids, and in such cases the in-
fection is transmitted through the blood, the excretions and
10 Anthrax.

secretions of the affected or dead animals. The disease may
also be transmitted through infected food, straw, stable utensils,
surgical instruments, hariess, hands and cloths of attendants,
the stable floors and water. The injuries may be of the most
varied origin (bites, phlebotomy, shearing of sheep, surgical
wounds, spinous plants, wounds caused by sharp pointed ob-
jects, etc.), whereas the transmission by flies and insects is
considered doubtful according to recent investigations (Nuttal,
Mihling).

According to Dalrymple the carbuncular form of anthrax predominates in
Louisiana, the infection being transmitted to healthy animals by horse flies known
there as charbon flies.

Inasmuch as an artificial infection through inhalation of
air containing spores is possible even when the respiratory
mucous membrane is uninjured (Feser, Buchner, Enderlen)
such infection may occur under natural conditions when
the animals are fed very dirty infected feed. However, in-
halation anthrax has never yet been positively established in
domestic animals (in man a primary affection of the lungs
does actually occur. See page 31).

Anthrax is not frequently transmitted directly from animal
to animal. This kind of infection occurs only when the blood
or infectious excrement of affected animals comes in direct
contact with injuries on the skin or mucous membrane. Never-
theless the diseased animal is a source of danger for its
neighbors as its excrement contaminates the straw, food and
the ground by contact with which other animals are indirectly
infected in the manner above mentioned.

Susceptibility. Of the domestic animals the herbivorous
mammals are the most susceptible, among which may be first
mentioned sheep, horses and cattle, and the goat to a less
extent. Considerably less susceptible are hogs, dogs, cats, and
carnivorous mammals in general. Buffalo appear to become
affected but rarely. Wild ruminants may be classed with the
domestic ruminants as regards their susceptibility to anthrax.
Domestic fowls are very resistant to artificial infection with
the exception of the somewhat more susceptible pigeon (the
occurrence of anthrax in fowls through natural infection has
not yet been established with certainty).

The susceptibility is probably influenced to some extent
by the breed, since certain breeds are more susceptible than
others. Thus, according to the experiments of Chauveau,
Algerian sheep manifest a remarkable resistance to artificial
infection which was only overcome by large doses of the virus.
Age has an influence, inasmuch as young animals are more
susceptible than older ones. Fatigue, starvation and chilling
increases the susceptibility; it also appears that well nourished
and carefully stabled animals are more easily affected than
Susceptibility. Pathogenesis. 11

those which are more used to hardship. Shedding of teeth
as well as pre-existing catarrh and digestive disturbances
render the animal particularly susceptible to anthrax.

Susceptible animals acquire a long lasting immunity against
ee infections after a recovery from the disease (see immuniza-
tion).

Pathogenesis. The spores taken into the digestive tract
germinate there and grow into bacilli. They then pass through
the mucous glands and lymph follicles into the lymph spaces
of the mucous membrane and submucosa, while spores which
directly enter the connective tissue through injuries in the
skin or mucous membrane germinate at the point of entrance.
In the lymph spaces of the tissues the bacilli multiply by fission,
although they are more or less inhibited and even partly de-
stroyed by the hostile anthracocide. substances which are pres-
ent in the tissue fluids. The final result of the infection de-
‘pends then on the one hand upon the resisting power of the
infected organism, and on the other hand, upon the virulence
of the anthrax bacilli. This again depends principally upon
their capability of forming capsules. According to the investi-
gations of Preisz, which correspond with the results obtained
by Gruber & Futaki and also by Weil, the virulence of the
anthrax bacilli depends first of all upon the character of their
capsules, that is, the virulence of the different strains of bacilli
is more or less dependent upon the density and solubility of
the capsules, inasmuch as dense capsules protect the bacilli
against the destructive action of the dissolved hostile substances
and the engulfing action of the phagocytes.

In immune animals even bacilli capable of producing dense
capsules are quickly destroyed by the numerous anthrax de-
stroying substances which are present in the tissue fluids, be-
fore they have time to form protecting capsules. Consequently
an infection in such animals remains ineffective. On the other
hand, in susceptible animals which possess a smaller quantity
of anthrax destroying substances a greater or lesser number
of the bacilli remain active, form capsules and become more
resistant, producing also capsuled progeny. In this manner
the capsule forming bacilli multiply at the point of infection,
but in the meantime their destruction is also in progress, part
of them being taken up and digested by the migrated leucocytes.
A part of the destroyed extracellular bacilli are dissolved, and
in this way the capsule substance, which has been named
anthracomucin by Preisz, on account of its mucin-like action
against reagents, reaches the circulation of the body fluids.
Hereby the anthracocide substances are gradually weakened.
They are further affected by the capsule substance which results
from the bacilli entering the blood circulation in the earliest
stages there to be destroyed and dissolved. Finally, the bac-
tericidal substances of the body fluids are completely or almost
12- Anthrax.

completely neutralized, and therefore the bacilli gaining en-
trance into the blood circulation multiply therein very rapidly
with little or no hindrance. The blood becomes heavily charged
with the bacilli and in a short time the animal dies, showing
manifestations of a severe disease—frequently in a few hours
or even less.

At points where large numbers of bacilli accumulate as at
the point of infection, the great amount of capsule substance
which is present swells from the gradual absorption of fluid.
These body fluids are absorbed by the capsule substance which
becomes gelatinous, and consequently the fluids are prevented
from re-entering the circulation, causing in these parts edema-
tous swellings. The bacilli also accumulate in great masses in the
capillaries, and because of the resulting interference with the
blood circulation, principally on account of the injury to the
walls of the vessels, more or less extensive hemorrhages de-
velop. These occur very frequently in the center of the
edematous swellings as well as in the organs with slow circula-
tion (spleen, liver, brain).

The importance of the capsules as a protection against injurious
action of the phagocytes and bactericidal substances in the body fluids
is recognized by the majority of authors, among them being Babes,
Metschnikoff, Gruber & Futaki, Preisz and others. There are others, how-
ever, such as Bail, Fischoeder, Toyosumi and Menokawa, who are even
at the present time inclined to consider the capsule formation as an
abnormal swelling.

Regarding the origin of the bactericidal substances in the body
fluids, Preisz accepts the opinion of Metschnikoff that they originate
from leucocytes. Gruber and Futaki also attribute a certain amount
of importance to the leucanthracocidin which is given up by the
leucocytes on certain stimulation, but they believe that the destruction
of the extracellular anthrax bacilli is due to the action of the
placqanthracocidin which is secreted by the blood plates into the blood
plasma under the stimulation of the anthrax substances, and which
also confers upon the serum its germicidal action after the coagulation
of the extravascular blood.

Some of the symptoms of the disease (fever, severe general dis-
turbances) as well as analogy to other diseases point to the fact that
anthrax bacilli produce toxic substances similar to those of other path-
ogenic bacteria. When these are absorbed into the circulation their
action, on the one hand, is injurious to the central nervous system,
particularly the respiratory center, and on the other hand, at the
places where great numbers of bacteria are accumulated, on the blood
vessels. However, the filtrates of the cultures are not toxic, and as a
matter of fact, the existence of an anthrax toxin has not been satis-
factorily proved (Conradi, Levy & Beckmann). Nevertheless, through
the process of autolysis a rennet ferment, a fatty acid splitting and a
peptonizing ferment, may be extracted from the bacilli (Pfersdorff),
while Boidin produced from them fatty substances which, when inocu-
lated subcutaneously, caused inflammatory edema and progressive
emaciation. Lastly, the observations of Johne show a production of
hemolysins whereby in a hanging drop of blood charged with anthrax
Anatomical Changes. 13

bacilli the red blood corpuscles dissolve in a few hours. This explains
the destruction of erythrocytes, the pronounced dyspnoea in the later
stages of the disease and the laked condition of anthrax blood. Recently
Casagrandi, Wunschheim, Heyrovsky & Landheimer, as well as Krogh
proved the presence of hemolysins also in cultures.

Anatomical changes. The carcasses of animals dead of
anthrax decompose rapidly on account of the blood remaining
in a liquid condition, and therefore they become, as a rule,
greatly bloated. Rigor mortis is also incomplete. Dark red
blood escapes from the body openings, the visible mucous mem-
branes are cyanotic and frequently hemorrhagic, especially on
the prolapsed rectum. The autopsy shows, in addition to the
general manifestations of asphyxiation, extensive serous in-
filtrations and blood extravasations in the connective tissue at
different parts of the body. The subcutaneous and intermus-
cular connective tissue is infiltrated in places, having a jelly-like
consistency, and being permeated with small circumscribed or
large flat, dark red hemorrhages. Similar changes such as
gelatinous infiltrations and hemorrhages also occur in the loose
subserous connective tissue, principally in the mediastinum of
the pleura, mesentery and that surrounding the kidneys; also
under the mucous membrane of the pharynx, in the epiglottis
and tissue surrounding the frenum of the tongue. Hemorrhages
may be present in places without serous infiltrations, principally
under the serous membranes, in the catarrhal mucous mem-
branes, under the endocardium, and in the subcutaneous con-
nective tissue. In rare cases a circumscribed swelling consist-
ing of fixed, infiltrated cordaceous tissue may be present in
any part, over which the dirty brown skin may be broken, form-
ing a deep sinuous ulcer covered with necrotic shreds of tissue.
The superficial lymph glands appear greatly swollen, partic-
ularly near areas of gelatinous infiltration. The cut surface is
reddened, moist and frequently studded with small hemorrhages.

The spleen with rare exceptions shows the characteristic
picture of an acute swelling. In most cases the entire organ
is greatly swollen, the capsule distended, the pulp blackish red,
softened and even fluid, and the swelling may be so large as
to burst the spleen capsule. In rare cases the knobbed surface
of the spleen shows only a few blackish red, softened areas of
various sizes, and fresh hemorrhages. ;

The parenchymatous organs, principally the liver and
kidneys, are also congested, swollen, and as a result of
parenchymatous degeneration they are brittle and soft. Fre-
quently the muscles and heart muscle have a grayish-red, flabby
appearance. The mucous membrane and submucosa of the in-
testinal canal, especially in the duodenum and small intestine,
but rarely in the stomach and large intestine, are uniformly
swollen in considerable portions, intensely red, and permeated
with small blackish-red hemorrhages. The swellings may be
14 Anthrax.

very marked and confined to smaller areas, particularly those
corresponding to the Peyer’s patches and solitary follicles, thus
causing the mucous membrane to project into the lumen of the
intestine in the form of spherical protuberances (carbuncles),
or as elongated, thick pads. On the protuberances or pads the
mucous membrane appears necrotic, which sometimes affects
only the superficial layers, although its entire thicknéss may be
involved, giving it the appearance of a pale yellow pulpy de-
posit. The inner surface of the abdominal wall may also show
various sized ulcers with greatly swollen blackish-red borders,
their bases being covered with necrotic tissue shreds. Around
the nodules and ulcers the mucous membrane and subserous
connective tissue usually manifests a marked gelatinous infiltra-
tion and permeation with hemorrhages.

The lungs are highly congested, and edematously infiltrated.
The respiratory mucous membrane is hyperemic, catarrhal and
swollen, particularly at the opening of the larynx, and contains
numerous ecchymoses. The brain and meninges are also
hyperemic, and between the latter sometimes extensive flat
blood coagula are present (apoplexia intermeningialis).
Hemorrhages may also occur exceptionally in the brain sub-
stance. The body cavities of the carcass frequently, especially
in warm weather, contain a reddish fluid. The internal lymph
glands show a condition similar to that seen in the external
glands except that the condition is more marked, particularly
in the mesenteric glands.

The blood is dark to blackish-red in color, contains only
a few loose fibrin coagula, and clears up only slowly in the air.
On microscopic examination the leucocytes appear greatly in-
creased (hyperleucocytosis).

Anthrax bacilli are usually present in great numbers in
the blood, spleen, lymph glands and parenchymatous organs.
Occasionally, however, but few are present, especially in the
rapid, apoplectic form of the disease.

The pathological changes described are the more distinctly developed, the
more slowly the disease had progressed. Their distribution depends in the first
place upon the nature of the infection as the edema and hemorrhages are most
pronounced at the point of infection. However, superficial edemas may also develop
after infections through the intestines, whereas the described intensive changes in
the intestinal mucous membrane develop almost exclusively in this mode-of infee-
tion, although they are not invariably present in such a conspicuous form in all
cases.

The manifestations of the changes in hogs differ inasmuch
as in most cases the lesions are principally confined to the
pharyngeal region. In addition to a marked gelatinous-hemor-
rhagic infiltration of the pharyngeal connective tissue and the
retropharyngeal lymph glands, the tonsils are covered by
strongly adherent pale-yellow, pseudomembranes, and are sur-
rounded by the greatly swollen mucous membrane. The tissue
of the tonsils under the pseudomembranes appears yellowish-

gray, lusterless and several millimeters in thickness. The in-
Anatomical Changes. Symptoms. 15

flammatory swelling extends also to the perilaryngeal connec-
tive tissue and superior cervical lymph glands. x

Intestinal anthrax occurs more rarely in hogs. When pres-
ent the mucous membrane of the small intestine shows severe
inflammatory changes and developing ulceration in patches or
over more extended areas (Carl).

_ The spleen usually presents a normal appearance, but may
at times be greatly swollen and softened. Zimmerman, Carl
and Bongert describe as rare occurrence sharply circumscribed
nodules in the moderately swollen pulp, from a hemp to a millet-
seed in size, in which the cut surface appears brownish-red to
grayish-red in color, dry and lusterless.

In one case of Wyssmann the lesions corresponded to a serofibrinous
pneumonia (inhalation anthrax?).

» Anthrax bacilli are found in great numbers in the gelatinous-hemorrhagie con-
nective tissue as well as in the swollen lymph glands. On the other hand, they are
only sparingly present in the blood, and in the spleen nodules mentioned they are
mostly found in a degenerated form.

Symptoms. -The time of incubation of anthrax after arti-
ficial infection varies from 1 to 14 days, depending to a great
extent on the place and intensity of the infection. After sub-
cutaneous or intravenous
inoculation the manifesta-__|1,/p.\p,
tions of the disease ap-
pear in 24 to 48 hours.
Sheep usually succumb in
2 to 3 days to the feeding
of large quantities of
spores. However, the
time of incubation under
natural conditions, when
the animals take up a con-
siderably smaller quan-
tity of spores, is undoubt-
edly longer. Thus in the
experiments of Pasteur,
Roux ‘& Chamberland
sheep, which were infected
with food grown on in-
fected pastures, devel-
oped the disease only
after 10 days. In horses
and cattle the time of in-
cubation seems to be hard-
ly less than 3 days.

In horses, ‘cattle and
sheep anthrax when de- Fig. 7. Fever curve in anthrax of a horse.
veloping as a result of an
intestinal infection usually manifests itself in the form of a
general, acute infectious disease in which the individual

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is
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16 Anthrax.

symptoms are only rarely characteristic of the specific
affection. ,

In the peracute cases the course of the disease simulates
cerebral apoplexy (anthrax acutissimus s. apoplecticus). Well
nourished and apparently healthy animals, which, however, were
probably feverish, suddenly go down in the stable or in the
pasture and remain lying on the ground in convulsions; the
respiration is rattling; bloody foam oozes from the mouth and
nose, the mucous membrane of which shows a dark bluish-red
discoloration, and from the anus pure blood even may escape,
until finally in a few minutes, or at most within an hour, the
animal dies. This form of anthrax is observed most frequently
at the beginning of an outbreak, and particularly among sheep.

In the acute and subacute cases which represent by far
the largest percentage of cases the disease commences with:a
quick rise in the temperature to 40-42°C., at which height it
remains for a time, dropping quickly just before death.
(Fig. 7.) Some animals, especially cattle, manifest quite a
lively disposition at the onset of the disease and take their
food in the usual manner.

In some cases the disease commences with restlessness and
excitement which soon pass into depression. In most cases,
however, the malady is preceded by symptoms of general de-
pression, the animal refusing to eat and standing in one place
with head hanging, staring look and dilated pupils. In the
pasture the affected animals trail behind the others, remain
for a long time in one place or lie down; when urged to move
they stagger and sway. At the same time they have chills and
their temperature is unevenly distributed over the surface of
the body. The pulse is accelerated and small while the heart
beats are metallic in sound.

The respiration is very labored and accelerated, and the
dark bluish-red cyanotic mucous membranes, which are fre-
quently studded with petechial hemorrhages, are indicative of
insufficient oxidation of the blood. A mechanical cause for the
difficult respiration cannot be established except in those cases
in which edema of the glottis is suspected, because of pharyn-:
gitis, swelling of the neck and whistling inspiration. Examina-
tion of the lungs reveals nothing abnormal except a harsh
vesicular breathing.

Very frequently disturbances in the digestion are observed.
Apart from affected appetite horses manifest severe colicky
pains but without any indication of meteorism or bloating.
Ruminants are less restless and frequently show moderate
bloating (in one case, a cow observed by Schmidt, the course
of the disease manifested the symptoms of an acute paralysis
of the rumen with left-sided pleurisy). At first there is con-
stipation, but diarrhea soon sets in, during which the feces,
particularly in cattle, are fluid and frequently intermixed with
Symptoms. 17

blood, or occasionally large masses of blood may be passed
by the affected animals. In horses it is sometimes possible
to demonstrate a marked enlargement of the spleen by rectal
exploration or by percussion. The urine is dark red and some-
times even bloody. (This is a particularly frequent symptom
in sheep, in which animals the compression of the nasal openings
causes immediate urination.)

The milk secretion usually ceases shortly after the onset
of the disease ; if there is a slight secretion of milk it is yellowish
or bloody in appearance, slimy, and possibly bitter. Pregnant
animals frequently abort. After the difficulty in respiration
has reached a high degree, death finally results with signs of
asphyxiation. .

Besides these symptoms, which clearly indicate the pres-
ence of an acute infectious disease, in some cases, particularly
in horses, more rarely in cattle and very exceptionally in sheep,
acute edematous swellings develop on the surface of the body,
which make a more accurate orientation of the nature of the
affection possible. In any region of the body, but especially
on the neck, breast, flanks, or lumbar region, a more or less
extensive, rapidly growing swelling develops. The swellings
are hot, and of a doughy or dense consistence, but the skin
covering them usually shows no changes. Exceptionally on a
circumscribed area of the skin proper a warm, painful and dense
swelling develops surrounding which the subcutaneous tissue
also appears greatly swollen as a result of the inflammatory
edema. With the swelling of the neck there is usually associated
a severe pharyngitis or edema of the glottis which considerably
increases the pre-existing dyspnoea. On the rectal mucous
membrane carbuncular growths develop occasionally as a result
of infection introduced by a rectal examination or by manual
removal of the feces. In such cases the feces are usually
evacuated under severe straining, and contain dark, tar-colored
blood or exfoliated tissue shreds. The rectum is prolapsed;
the perineal region is edematously swollen, while the hand in-
troduced into the rectum may detect flat or nodular swellings
in the hot mucous membrane.

A primary affection of the skin only rarely occurs in
animals, and consists in the appearance of circumscribed, warm,
painful and hard swellings which later become gangrenous,
commencing in the center, and change into ulcers (carbuncles)
which have ragged borders and are covered with necrotic tissue.

‘ According to some authors anthrax may occur in sheep in the
form of an erysipelas-like dermatitis accompanied by a subcutaneous
edema which starts at one extremity and soon extends to the body,
whereby the patients show high fever and die inside of 14 to 2 days.
The anthrax nature of the affection has not yet been positively estab-
lished.

The occurrence of the so-called gloss anthrax is also doubtful, as
most case¢ in cattle designated under this name belong to hemorrhagic

2
18 Anthrax.

septicemia. The presence of gloss anthrax can only be accepted as prob-
able when the tongue is greatly swollen, cyanotically discolored, or
when the buccal mucous membrane contains hard nodules and cysts
filled with bloody fluid.

In hogs anthrax usually runs its course with manifestations
of febrile pharyngitis with marked swelling of the subparotidal
and laryngeal regions. The swelling may extend from the neck
to the head and cause considerable difficulty in deglutition and
respiration. At the same time the mucous membranes are
-eyanotic, bluish-red spots develop on the skin, diarrhea sets
in, and the difficulty in respiration and swallowing reach such
a state that the animals finally die from asphyxiation. In
experimental cases cysts filled with bloody fluid develop on the
mucous membrane of the tongue, cheeks and lips.

In those cases where there is no swelling of the neck the
symptoms observed are only debility, suppressed appetite and
hiding under the straw.

In dogs and in other carnivorous animals the disease is
of rare occurrence and is usually manifested by severe gastro-
enteritis as well as pharyngitis. Sometimes after eating an-
thrax blood an inflammation develops on the lips and tongue,
or general infection may follow the development of a ear-
bunculous ulcer upon the toe pads.

Course. The development of the disease and the succes-
sively appearing symptoms as well as the general picture of
the affection show great variations from case to case. While
sometimes only half an hour passes from the onset of the dis-
ease until death, in other cases the duration extends to two
and more, exceptionally to 7 days. In slow cases the intensity
of the symptoms may decrease temporarily so that the patients
are somewhat brighter, and take some food, but the improve-
ment is followed after a shorter or longer period by new at-
tacks, and the disease may even assume an intermittent charac-
ter (anthrax intermittens) in which the animal becomes greatly
emaciated under periodical febrile symptoms.

The species of the animal affected, influences considerably
the manifestation of the clinical picture. Anthrax in horses .
is usually marked by symptoms of a severe spasmodic colic
in which quite frequently edematous swellings develop on the
neck and chest. In cattle only symptoms of a general febrile
affection are usually observed, but hemorrhages from the in-
testines as well as edematous swellings are not very rare.
Anthrax in sheep usually runs a rapid course without localiza-
tion to certain regions, acting like a pure septicemia, and the
apoplectic form occurs most frequently in these animals. *An-
thrax in goats is less acute. Hogs usually die in 1 to 2 days
with symptoms of asphyxiation due to the extension of pharyn-
gitis. ”
Diagnosis. 19

Diagnosis. It is hardly possible to diagnose with certainty
the peracute case of anthrax on the living animal, as acute
hyperemia and acute edema of the lungs as well as edema of
the glottis, further congestion of the brain (sunstroke) and
hemorrhages into the brain substance resulting from other
causes may kill the animal under very similar manifestations.
In the less acute cases anthrax is indicated principally by the
appearance of the rapidly extending edematous swellings as
well as by the bloody. feces and urine, but even in this respect
hemorrhagic septicemia very closely resembles anthrax (on
post mortem the acute swelling of the spleen is always absent
in the former).

Likewise anthrax may be also suspected in severe gastro-
intestinal inflammations, especially when associated with in-
testinal hemorrhages, while in horses, on account of the severe
abdominal pain, colicky affections, invagination and volvulus
of the intestine, may be chiefly confounded with it, and particu-
‘larly so when, as sometimes happens, there are no characteristic
symptoms present other than those of colic. In cattle blackleg
and malignant edema are differentiated by the cold and crepitat-
ing consistence of the swelling in the latter diseases, as well as
by the peculiar sour, disagreeable odor of the fluid which is
contained in the swellings of anthrax edemas. In hogs,
especially when suffering with pharyngitis as a result of an
infection with the virus of buffalo disease, the resemblance
to anthrax is so pronounced that a differentiation is only pos-
sible by additional circumstances (prior cases in_ buffaloes).
Finally, poisonings occasionally come into consideration, in
which, however, a rise in the body temperature occurs only in
the later stages.

The diagnosis is certainly established by the demonstration
of bacilli in the blood of the living animal which in size and
form resemble anthrax bacilli, as there is no other disease
known in which bacteria in any way resembling these would
circulate in the blood; unfortunately, they can be demonstrated
in the blood only a short time—not earlier than 16 to 18 hours
—before death.

Characteristic indications on post mortem are the dark-red
color of the uncoagulated blood, the acute swelling of the spleen
and the lymph glands, bloody edema in the subserous and sub-
cutaneous connective tissue and also hemorrhagic enteritis.
These findings retain their importance even in case of negative
bacteriological examination. However, in exceptional cases the
enumerated changes and also swelling of the spleen may be
absent. In such cases the bacteriological examination alone
will give enlightenment. If the careass is fresh, not older
than 24 hours, then the presence of large, non- motile rods and
short chains in the blood. which has been taken from vessels
distantly located from the intestines, such as a superficial vein,
20 Anthrax.

is certain proof of anthrax, particularly when by staining the
presence of a capsule can be demonstrated. If, however, a
longer time has elapsed after death, especially in summer time,
other bacilli, first in importance bacilli of malignant edema,
may have migrated from the intestines into the blood, and
these in many instances can only be differentiated from anthrax
bacilli by cultural methods and animal inoculations.

Bacteriological diagnosis. Relative to distinguishing anthrax
bacilli from other bacteria more or less closely resembling them the
following is to be noted:

1. Anthrax bacilli are present in the blood of fresh carcasses;
they are thick, rounded at the ends or squarely cut. They usually have
a distinctly recognizable capsule and form chains of 2 to 4, rarely
more, segments, in which the individual segments are separated from
one another by light cross lines; they are aerobic and never produce
spores inside the animal tissues and body fluids. Subcutaneous or
intravenous injections kill mice, guinea pigs and rabbits, in which
after death the blood usually contains the bacilli in great numbers. ;

2. The bacilli of malignant edema are more slender, motile, rounded
at the ends, and besides, the edematous swelling, fluid of the abdominal
cavity and blood of the portal vein contain curved thread-like forms
of various lengths, some homogenous, others beaded. In older car-
casses many of the bacilli contain in the center one oval spore each;
they are strictly anrobic, liquefy gelatin, and form gases even in
coagulated blood serum. Intravenous inoculations are harmless; sub-
cutaneous inoculations into test animals produce a rapidly extending
edematous inflammation with gas formation.

3. Blackleg bacilli are present only in the serous fluid of the
crepitating swelling in a fresh carcass; they are comparatively short
and thick, motile, never grow in form of threads, and produce in the
animal body shortly after death, oval spores located either at the end
or in the center of the bacillus. They may be grown anaerobically but
also aerobically; liquefy gelatin slightly ; and in coagulated blood serum
they do not produce gas. Intravenous inoculations are harmless; sub-
cutaneous or intramuscular inoculations kill the guinea pig and mouse,
but rabbits only as an exception.

In the examination of material which is no longer fresh, various
putrefactive bacilli (Bac. subtilis, Bac. termo) come into consideration,
particularly those resembling saprophytes, the Bac. pseudoanthracis
described by Burri & Baas, as well as the Bac. anthracoides found by
Hueppe & Wood. They are found frequently in blood or parts of
organs that have been stored, and they have some characteristics in
common with the anthrax bacillus, but may be distinguished by the
absence of other characteristics of the true anthrax bacillus (Hoppe).
Further, they coagulate milk after a short time and do not form cap-
sules in inactivated horse blood serum.

The anthrax bacillus may be demonstrated in most instances in sufficiently
fresh material by a microscopical examination for which the various capsule stain-
ing methods are especially adapted (according to Johne, staining with heated 2%
gentian violet solution followed by a quick discoloration with 2% acetie acid;
according to Olt with 3% safranin solution also with heating; according to Raebiger
staining of the air-dried smears with formol-gentian violet (100-150:10-15);
further, Gram’s stain with subsequent eosin treatment). The material for exam-
ination should be taken from the blood or spleen of very fresh carcasses; later
Bacteriological Diagnosis. Prognosis. 21

from a peripheral vein (ear or jugular) as putrefaction sets in later in these parts
than in the internal organs. As a result of putrefaction the bacilli change their
form after a time; they become morg slender; their plasma does not stain well, and
later not at all; at the same time other bacteria and especially anaerobic putre-
factive bacteria multiply very rapidly. The capsule of the anthrax bacillus is
preserved somewhat longer so that after a time only empty capsules or the remains
of plasma envelopes can -be seen (See fig. 2 on page 3). They finally become
unrecognizable (according to Olt, in the summer time in about 48 hours). Its
diagnostic importance, however, should not be overestimated as a capsule may occa-
sionally occur on some putrefactive bacteria resembling the anthrax bacillus
(Noetzl), and on the other hand sometimes they cannot be demonstrated even on
true anthrax bacilli, especially in the blood of horses and carnivorous animals.

According to Cinca & Fenea the feces of affected animals (sheep and hogs)
invariably contain anthrax spores which can be isolated through cultural methods
by a previous heating to 65°C. This is possible even in cases in which the carcass
is already putrid and the examination of the blood gives negative results.

In the examination of stale blood or material from organs good results may
sometimes be obtained by the mucin reaction which was first described by. Weichsel-
baum (1892), later by Heim and recently recommended by MacFadyean. This
reaction is manifested in smears stained with 1% methylene blue solution by the
appearance of violet or purplish-red granules which are seen near the bacilli and
originate from their capsules.

Positive results are obtained in doubtful cases by the isolation of the anthrax
kacillus by the plating method. According to Bongert the bacilli remain active in
dried blood for 36 to 50 days, in putrefied dried blood or tissue fluids for a shorter
period. However, they retain their virulence on an average of from 8 to 20 days.
In carcasses which have lain unopened the results from the examination of smear
preparations are uncertain even after 24 hours, while by the plating method they
may be demonstrated for 2 or 3 days after death.

Finally, the diagnosis may be proved by animal inoculations, for which the
usual Jaboratory animals, with the exception of the rat, may be utilized (to prevent
an intoxication only small quantities of the material should be used for inocula-
tions; the scarified shaven skin is best adapted for the inoculation of putrid
material).

Suspicious material forwarded for an accurate bacteriological examination is
best prepared by spreading the softened pulp of the spleen from 3 to 4 mm. tnick
on a slide, across each end of the slide a strip of thick cardboard is placed, and
another slide is then placed on these pieces of cardkoard.. They are then securely
tied and forwarded in a box for examination (Kitt, Bongert). Another method
consists in breaking a boiled potato in two; the blood or spleen tissue having been
smeared on one of the broken surfaces, the pieces are placed together again and
the whole forwarded to its destination (Olt). Further, the blood or spleen pulp
may be dried on the inner surface of a test tube, or on woolen threads or cotton
pads (Heim, Mazzini). :

Jakobsthal & Pfersdorff, as well as Marxer and Eberle, recommend for the
above purpose quadrangular pieces of gypsum rods saturated in Loeffler’s bouillon
and placed in strong test tubes. Before use they are dipped in pure water, then
covered with a thin layer of blood or splenic pulp, placed in the tube, which is
packed in a wooden case and forwarded to the laboratory. Inasmuch as the bacilli
form spores on the rods in a proper temperature the diagnosis is possible even after
14 months. Instead of gypsum rods small pieces of burned bricks are also adapted
(Reinecke), or even better filterpaper rolls about the thickness of the small finger
and moistened in water (Schiller, Grabert).

Prognosis. Obviously anthrax terminates not infrequently
in recovery, although it is hardly possible to estimate the per-
centage of recoveries with any degree of certainty. In the
course of various outbreaks it is a quite frequent occurrence
that some of the animals which were exposed to the infection
show an indisposition and fever, but recover completely in 1
to 2 days. Such passing affections are probably the result
of an anthrax infection, which, however, is overcome by the
energetic resistance of the animal. Toward the end of some
epizootics the disease often assumes a subacute form and then

‘
22 Anthrax.

cases of recovery are more frequent. The prognosis is most
unfavorable in the peracute cases, and most favorable in the
primary local skin affections as long as there are no intensive
general disturbances to indicate the entrance of the bacteria
into the blood circulation. The development of edematous
swellings in the course of the febrile affection is almost in-
variably of unfavorable significance, while the appearance of
bacilli in the blood is indicative of approaching death.

Treatment. In primary local affection of the skin, sub-
cutaneous tissue or the visible mucous membranes, surgical
treatment is first indicated. This consists in deep incisions of
the swellings, and after thorough squeezing and scraping, the
wound is repeatedly washed and cauterized. Cross incisions
-are advisable, while large swellings may be incised in several
places. As disinfectants the following are recommended:
Corrosive sublimate (1-1000), carbolic acid (3%), creolin (5%),
ete. Good results are also obtained from subcutaneous injec-
tions at various places in the periphery of the swelling with
2-3% carbolie acid or 5% creolin solution, and covering with a
carbolic dressing.

In cases of generalized disease which are not yet far ad-
vanced the treatment with immune serum (see page 28) gives
remarkably good results. After the intravenous injection of
40-80 g. of sufficiently active serum the temperature falls
rapidly, frequently within as short a period as 6 hours, and this
is followed by a complete recovery after 12 hours (Jaeger,
Detre, Raebiger, Gal and others). In cases in which no im-
provement is observed after a few hours, or in which the tem-
perature rises, it is advisable to repeat the serum injection.
Serum of high potency proves effective even in small doses and
in subcutaneous applications.

Sometimes favorable results may be obtained from symp-
tomatic treatment, viz., repeated bathing with cold water, rub-
bing with camphor, turpentine or pure alcohol. Internally
wine, alcohol or camphor may be given; also subcutaneous in-
jections of ether or camphor, etc. In the presence of an in-
testinal infection the administration of disinfectants in large
doses is indicated, such as creolin or lysol (larger animals.
20-50 gm., smaller animals 5-10 gm. or even larger doses) ; creo-
sote (5-10 and 1-2 gm., respectively), carbolic acid (according
to Hess 40-50 ec. of a 14% solution daily), calomel in small
and frequent doses (for horses, with 14. gm. opium) and oil of
turpentine (for larger animals 200-300 gm. mixed with sweet
oil). Enemas with disinfecting fluids may also be tried, es-
pecially in cases in which the symptoms indicate a severe af-
fection of the rectum. Intravenous injections of collargol (1
gm. dissolved in 50-100 gm. of water) are also recommended.

The sick animals should be provided with well-ventilated,
shady and cool quarters. They should receive an abundant
Treatment. Prevention. 93

supply of fresh water, preferably water which has been
slightly acidified with hydrochloric acid.

Bleeding, which is still practiced, produces only temporary beneficial action in
the presence of pulmonary congestion, but should be performed cautiously on account
of the danger of spreading the infection.

Prevention. In order to protect healthy animals from in-
fection care should be taken that the food, drinking water,
utensils, ete., which are accessible to them, and also the ground,
should not become contaminated by the excrement, blood, ete.,
of animals affected with anthrax. In cases, however, where this
has occurred the infectious substances should be destroyed or
at least propagation of the infection should be prevented.

This can be accomplished by the destruction of, or by
rendering harmless all products and excretions of the affectéd
animals and carcasses. The safest method for the destruction
of the infectious material is by burning or rendering (steaming
the carcasses under high atmospheric pressure should be em-
ployed to the greatest extent possible owing to the advantages
afforded by this method). When this is impossible the carcasses
should be buried at least. 2 meters deep in out-of-the-way,
fenced-off places. They should also be covered with disin-
feetants, preferably powdered unslaked lime. The stalls oc-
cupied by the affected animals should be thoroughly disinfected.
All food and straw that has come in contact with affected ani-
mals or their carcasses, or which has been contaminated by
their excrement or blood should also be burned.

In common practice the best disinfectants are boiling water and steam, 0.1%
corrosive sublimate, 5% carbolic acid, creolin or lysol solutions; also formalin
vapors. However, it is necessary for these substances to remain in prolonged con-
tact with the material to be disinfected owing to the great and variable tenacity of
the anthrax spores. :

According to Grossenthaler peat possesses disinfecting qualities on account of
the ulnic acid it contains, and this action may be increased by the addition of 3%
sulphuric acid. Hides may be disinfected with 5% creolin or lysol, but this
method is only absolutely successful when employed within two hours after the
death of the animal (Ligniéres & Zabala), otherwise it frequently fails. As a
matter of fact at the present time there is no method known for an effective dis-
infection of hides without injuring them for their technical utilization (Xylander).
Brekle believes that the question may be solved by subjecting the spore-containing
hides in a moist condition to a temperature of 43-44°C., by which all spores would
germinate and the hides accordingly would contain only sporeless bacilli which
could be destroyed with milk of lime. Horse hair is effectively disinfected by dry
heat at 110°C. followed by steam at 100°C. (deRossi; see also page 5). :

The officially required disinfection of railroad stock cars in Germany with
5% ‘‘Kresulfol’’ (cresol-sulfonie acid) was found by Schnitirer to be absolutely
ineffective against anthrax spores, and he recommended instead the disinfection
with 144% formaldehyde solution.

When the disease appears careful search should be made
for the source of the infection (origin of food, drying of hides
in the hay loft, or in the stable, etc.). If suspicion is directed
to the forage from certain fields or meadows this supply should
not be fed, at least not while the animals are susceptible to
the disease. Should the disease occur in a pasture the healthy
24 Anthrax.

animals should be removed to another higher and dryer place.
When necessary they should be stabled. Not infrequently a
careful investigation of the’ pasture will disclose dangerous
places from which the animals should be kept. In other cases
it is possible to suppress an outbreak by the exclusion of pol-
luted, muddy watering places. In suspected places the danger-
ous character of the soil may be eliminated by draining and
cultivation.

If under existing circumstances the danger of infection
cannot be excluded, and the presence of a threatening infec-
tion exists, it is advisable to reduce the natural susceptibility
of the animals by protective inoculations thereby protecting
them from the danger of infection.

Immunization. Domestic animals may be immunized in
practice by attenuated living cultures of the bacilli, by spore-
containing cultures, by immune serum, and finally by immune
serum and living cultures.

I. Immunization with attenuated cultures (Pasteur’s
method). In 1881 Pasteur established by conclusive experi-
ments that anthrax bacilli, when subjected to a temperature
of 42-43°C., will continue for a time to multiply actively and
no longer form spores. He further found that in such cultures
the bacilli die in about a month, but that in the meantime their
virulence decreases gradually, and finally he proved that the .
bacilli, when attenuated to a certain degree, will retain this
degree of virulence if their cultivation is continued at body
or room temperature. On this experimental observation is
based the practical method of protective inoculation worked out
by Pasteur with the co-operation of Roux and Chamberland.

' The vaccine is prepared by growing the anthrax bacilli in bouillon
at a temperature of 42.5°C. The cultures which are at first fatal for
rabbits, guinea pigs and mice are, after 12 days’ growth:at the above
temperature, attenuated to such degree that they are only exception-
ally fatal to rabbits. After an additional 12 days the culture kills
only young guinea pigs and mice.” After the virulence of the culture
has been attenuated to these degrees their cultivation is continued at
35-37°C. With such stock cultures fresh bouillon cultures are inocu-
lated, and in this manner the vaccine is prepared in any desired quantity.

The more attenuated culture represents Pasteur’s first,
the weaker vaccine, while the less attenuated is the second or
stronger vaccine (premier et deuxiéme vaccin). The protective
inoculation is carried out by first injecting subcutaneously the
weaker, followed in 10 to 12 days by an injection of the stronger
vaccine. The immunization is based on the principle that the
first inoculation reduces the natural susceptibility of the animal
to such an extent, without endangering life, that it withstands
Immunization. Pasteur’s Method. 45)

without injury the second inoculation with the stronger vaccine.
Without the first injection the second inoculation would prob-
ably prove fatal, while the two inoculations confer the neces-
sary immunity upon the animals.

The results of the vaccination are in general satisfactory
in view of the experience obtained from a large number of
cases. Some of the immunized animals do not resist an artificial -
infection by feeding repeated large quantities of spores (in
Koch’s experiments 2 out of 10 sheep died after feeding them
for days with virulent spores in quantities of the size of a’
hazelnut). These are exceptions which have no influence on
the practical value of vaccination, inasmuch as under natural
conditions the intensity of the infection is far below the amount
given in these artificial infections. Where vaccination is prac-
ticed in large herds the losses from anthrax in the year follow-
ing are in general greatly reduced compared with periods in
which the animals were not vaccinated. In numerous localities
where the disease raged regularly year after year it has almost
entirely vanished as a result of vaccination of the animals.
Not infrequently vaccination immediately checks the spread of
the disease in a herd.

The immunity reaches the necessary degree in about 10
to 12 days after the second inoculation, and lasts about one
year. (In the experiments of Azary vaccinated sheep resisted
the artificial infection even after 8 months.) A longer duration
of the artificially produced immunity is doubtful, and there-
fore a repetition of the vaccination is indicated annually in
pronounced anthrax districts. The breed, age and sex of the
animals do not appear to influence the results of the vaccination,
and young animals which were only shortly weaned may also
be vaccinated without danger and with promising results.

Pasteur’s protective vaccination is therefore indicated in
all places where the annual losses from anthrax exceed the
cost of the vaccination.

The effectiveness of the vaccination has been proved by Pasteur
beyond a doubt through control experiments which he carried out be-
fore a commission appointed for this purpose in 1881 at Pouilly-le-
Fort. Of 50 sheep 25 were regularly vaccinated with his two vaccines
and 14 days after the second vaccination they were inoculated with
anthrax material, together with the 25 control animals. The results
showed that inside of 2 days all of the 25 control animals died of anthrax,
while all of the 25 vaccinated sheep remained alive.

Up to the end of the year 1899, 708,980 cattle and 4,971,494 sheep had been
vaecinated successfully in France, as a result of which the entire annual loss over a
period of 12 years dropped to an average of 0.34% in cattle and to 0.94% in sheep.

In Hungary the first vaccinations were carried out in 1881 on Azary’s initia-
tive.. Thuillier, Pasteur’s assistant, applied them first at the Veterinary Institute
at Budapest with very favorable results, while the later ones in Kapuvar were less

favorable. As vaccination gave very good results in practice, this protective treat-
* ment was soon taken up very extensively. During the period of 15 years between
1886 and 1900, 53,843 horses, 1,015,700 cattle and 2,279,221 sheep were vaccinated.
26 Anthrax.

The official report contains the results on 39,506 horses, 718,266 cattle and 1,247,331
sheep, and according to its statements the percentage of vaccinated animals given
below died of anthrax:

 

 

 

Horses. Cattle. Sheep.

After the first vaccination................. 0.10% 0.02% 0.26%
In the course of following years............ 0.09 % 0.02% 0.33%
Dotal,» ccc csankatc si ninenvaccacas sinew ts. “OMO% 0.04% 0.59%

In Germany the results were at first less favorable (in Packish during the
period 1882 to 1888 the entire loss of vaccinated cattle amounted to 3.1% and of
vaccinated sheep 2.8%). Later, particularly in Wiirttemberg and Alsace-Lorraine,
the results were more satisfactory. Since 1900 in the vicinity of Magdeburg over
2,000 cattle, mostly draft oxen, have been vaccinated annually with uniformly good
results, and since that time the previously frequent intestinal catarrhs (slight anthrax
infections?) are no longer observed (Jungklaus).

In Austria vaccination was carried out on 9,456 fattening cattle with complete
success during the period between 1894 and 1898. It was observed, however, that
the vaccination of such animals during the summer months caused a severe reaction.

In Russia vaccination has also been followed by uniformly good results, with
the exception of the fatal vaccination in the Crimea (1888), which was supposed to
be due to an error in the vaccines, in which instance 4,564 sheep were vaccinated
and 3,478 died in the course of a few days. The total loss in the district of Cherson,
in which 20,000 sheep were vaccinated during the years 1885-1888, amounted to
0.87% compared with previous losses of 10% to 33% in former years (Wysokowicz).

Similar good results followed vaccinations in Holland (Wirtz), in Switzer-
land (Hess), as well as in America (Dalrymple), and Australia.

Direct results from the vaccination. In the vaccinated animals a slight
elevation of temperature is observed as a rule in 2 to 5 days, which, however, is
rarely accompanied by perceptible disturbances in the general health. Not infre-
quently in cattle an extensive subcutaneous edema develops in the vicinity of the
point of inoculation, which, however, disappears in 1 to 3 days, especially if cold
applications are made. Exceptionally, pregnant animals abort or give premature
birth. In milk cows a diminished quantity of milk may be observed. Anthrax
bacilli, however, do not pass into the milk as a result of the vaccination (Nekljudow).

Fatal results may sometimes follow even when the vaccination is earried out
correctly, with faultless vaccine, probably as a result of the low individual resist-
ance of the animal. In several instances of this kind numerous losses were observed.
Thus, excepting the case mentioned in the Crimea after the first vaccination in 1889
of 1,383 sheep in the Hungarian township of Lukacs, 77 sheep and 44 lambs died
of anthrax, and in Guta in 1893 out of 1,564 vaccinated horses 72 died within 2
weeks after the first vaccination. The autopsies in this case revealed a septicemic
complication in the form of a suppurative inflammation of the serous membranes,
and a necrosis of the muscles at the point of inoculation, which was caused by a
rod-shaped bacterium (Preisz). In Fokté, of 680 horses 38 died in 1896 of anthrax
in two weeks following vaccination. In this case the post mortem revealed a severe
intoxication and anthrax bacili in association with other bacilli were found exclu-
sively in the edematous swellings at the point of inoculation (Preisz). In the
vicinity of Debreczen, of 30 horses vaccinated in 1902 with vaccine prepared for
cattle, 9 became severely affected, 6 of which died of anthrax. In Austria, 316
cattle were vaccinated in the township of Storozynetz (Bukowina) in 1893, and
among these 265 were fattening cattle. On the day following all animals mani-
fested fever, dyspnea, bloody, foamy discharge from the nose and rectum, and 24
died inside of a few hours from peracute anthrax.

In cases in which the vaccine acted too severely the indication appears inside
of a week following the first, or more frequently the second vaccination in which
a marked edema develops from the point of inoculation followed by a general infec-
tion and the usual post mortem lesions of anthrax. In some cases the animals do
not become visibly affected until after three weeks of incubation, in the meantime
manifesting a disturbed appetite, finally succumbing to cachexia, which points to a
chronic intoxication. After the vaccination of already infected herds the occur-
rence of deaths may be the result of latent infection (see page 8) as in these
bacilli carriers the resistance may possibly be reduced by the vaccination.

The attenuated bacilli contained in the vaccine retain their cultural charac- .
teristics in the body of the vaccinated animal (according to Preisz they form soft,
Immunization with Spore-containing Vaccines. 27

rapidly liquefying capsules) as well as their reduced virulence, which cannot readily
be increased even if passed through guinea pigs (Ascoli).

Technic of vaccination. The vaccine prepared by the ‘‘Institut Pasteur’’ or
by the ‘‘Laboratoires Pasteur-Chamberland’’ which are established in the various
countries, is marketed in small bottles closed with rubber stoppers. The vaccine is
drawn up into a sterilized syringe of about 1 cc. capacity, the plunger of which is
graduated into 8 parts, and sheep, calves and foals are injected subcutaneously with
1 of the contained vaccine, while mature cattle and horses receive %4 (about 0.12
and 0.25 ec.). The injections are made in sheep on the inner surface of the thigh;
in cattle posteriorly to the shoulder; in horses on the side of the neck. Prior to
the injection the site should be clipped and carefully disinfected. Twelve days fol-
lowing the first vaccination the second injection is made at the corresponding place
on the opposite side of the body.

The vaccine retains its potency for several days when kept in a dark and
moderately cool place. Its effectiveness, however, is changed in time. It should
therefore be fresh, and the contents of an opened tute should be used up by all
means on the same day. Good vaccine when shaken is only very slightly cloudy,
rather opalescent; more pronounced cloudiness is an indication of deterioration
(contamination with foreign bacteria), and such vaccine should not be used under
any circumstances. The vaccine is prepared in a somewhat different way for the
various species of animals, and therefore vaccine for a specified species should be
used. This is particularly applicable in the vaccination of horses (in horses, a mix-
ture of the first and second vaccine of cattle is used for the second vaccine, and is
therefore Jess severe than the second vaccine for cattle and sheep). The best time
for vaccination is the spring, as anthrax usually occurs during the summer months,
and an attempt should therefore be made to establish an immunity of the susceptible
animals shortly before the period of danger. ;

Results obtained from the use of contaminated and ineffective vaccines pre-
pared by the various laboratories indicate that official control is urgently desirable.

Bad results from vaccination cannot be excluded with certainty. On the one
hand they may be due to the uncertainty of the degree of virulence and purity of
the vaccine, while on the other hand the variance in the individual resistance and ~
susceptibility of the animals must be taken into consideration; and the veterinarian
making the vaccinations is unable to judge these factors. Therefore owners of
animals should be informed beforehand of the possible dangers. Errors com-
mitted during vaccination, especially neglect in the required cleanliness, may nat-
urally endanger the results, as in such procedures other pathogenic bacteria may
enter the body and produce a passing or fatal disease. During the days immedi-
ately following vaccination the animals should be fed :regularly and should not be
exposed to cold or heat, or overtaxed by hard work. As they are particularly sus-
ceptible to the infection during this time (negative phase) they should be kept
from suspected pastures.

II. Immunization with Spore-containing Vaccines. Cien-
kowsky (1884) in Charkow produced two vaccines by attenua-
tion of living cultures at higher temperatures, the weaker of
which kills the mouse and the earless marmot, but not the rabbit
and sheep, while the stronger kills 30 to 50% of rabbits, and
10 to 20% of sheep. The cultivation of the attenuated cultures
is then continued in bouillon at body temperatures until an-
abundance of spores are formed, when it is mixed with two
parts of glycerin and placed in stock. Before the vaccination
fresh cultures are made from the spore-containing fluid, and
with these the animals are injected (Gordzialkowsky) or ‘the
spore-containing fluid itself is employed for the vaccination.

According to Rajewsky the fluid containing the bacilli and spores remains
effective for a longer time in a cool, dark place. Otherwise both in the technique
as well as the valuation of this form of vaccination the same rules are followed as in
Pasteur’s method. The dose of the vaccine consists of 0.1 cc. for sheep, and 0.2 ec.
for larger animals. The animals usually stand the vaccination well, but disagree-
able accidents are not totally excluded. Thus, 100 cattle were vaccinated in 1902
28 Anthrax.

in one estate and in three weeks’ time 44 became affected with anthrax, 35 dying
of the disease.

‘ Satisfactory results are obtained in many places with spore-containing vaccine.
This method was also employed several years ago in Hungary (according to Detre,
with vaccines which he prepared by washing old agar cultures with a salt-glycerin-
water mixture). -In 1901 to 1902 the losses amounted, according to Detre’s esti-
mate, to 0.26% in horses, 0.03% in cattle and 0.12% in sheep.

According to a report of the Veterinary Institute at Charkow, Russia, 5,584
horses, 19,572 cattle and 174,172 sheep were vaccinated in 1897 in the southwestern
part of Russia with losses of 0.25, 0.09 and 0.35% respectively. In Russia a method
of vaccination originated by Lange is also used. The preparation of this vaccine,
however, is unknown.

According to Beinarowitsch the direct loss in reindeer from vaccination
amounts to 1%. -

III. Immunization with Immune Serum. If animals sus-
ceptible to anthrax are injected with increasing doses first of
attenuated and later of fully virulent anthrax cultures, they
will after a certain time produce a serum, which, while possess-
ing no direct bactericidal action, protects rabbits, guinea pigs
and sheep against a fatal infection. If injected shortly after
the infection such serum even prevents the development of
the disease. Such immune serum also renders good service in
practice, especially in cases in which infection threatens, or
where anthrax has already appeared in a herd. The action of
the injected serum becomes effective in the course of a few

-hours. However, the established passive immunity is only of a
short duration, lasting only from 1 to 2 weeks. It is therefore
advisable in cases of continued danger of infection to render
the animals actively immune. This may be accomplished by
a subsequent regular vaccination with attenuated cultures by
one of the above described methods.

Potent anthrax serum was first prepared from sheep by Marchoux, and also
by Sclavo almost at the same time, in 1895. Later: Sobernheim, Mendez, Detre,
‘Carini and Ascoli carried on investigations along this line, but they employed large
animals, especially horses, for this purpose. This method was also followed by
Sclavo. The horses withstand after a certain time an intravenous injection of
500 ce., and even more of a virulent culture; and they produce a very potent serum.
Of Sclavo’s serum 0.5 ce. protects a rabbit and from 5 to 10 ce. protect a sheep
against a fatal infection. Detre’s serum has a similar effect on rabbits, while from
3 to 5 ec. will protect a guinea pig against an intraperitoneal infection, which is
ordinarily fatal in from 1 to 1% days. In the experiments of Sobernheim, of whose
serum 2 cc. protects rabbits against 1/1000 of a loopful of a virulent culture, the
serum proved a protective agent even against the feeding of anthrax spores. San-
felice prepared a serum by immunizing dogs, and 3.5 ee. of this serum per kilo
weight had a protective effect, while 7 cc. had a curative effect on rabbits even when
administered 40 hours after the infection.

In practice the dose for large animals consists of 10 to 20 ec., while for small
animals it is 5 ec. Sobernheim uses a mixed serum which is obtained from cattle,
horses and sheep; Sclavo obtained it from asses. Even when exposed to the harm-
ful influences of light and air the serum retains its potency for 2%4 years (Sobern-
heim).

In already infected herds the spread of the outbreak may be checked by treat-
ing only those animals with serum in which a rise in temperature is observed; the
temperature of all animals being taken twice daily (Keleti). Of course, if fever
is present the serum should be used in correspondingly higher doses, and the injec-
tions should be repeated until a drop in the temperature is noticed.

In some cases after the administration of the serum, anaphylactic symptoms
appear. These occur in from 5 to 20 minutes, and are manifested by edematous
Immunization with Immune Serum. 29

swellings of the head, at the point of inoculation and other parts of the body.
Nodular eruptions resembling urticaria, frothy discharge from the mouth, snorting,
reddening and swelling of the mucous membranes, uneasiness, and in cattle bloat-
ing, may also be observed. Kovarzik observed these symptoms in two herds in about
20% of the inoculated cattle, among which the two showing the strongest reactions
died from asphyxiation. Inasmuch as the reaction appears well pronounced in
animals that were especially exposed to the danger of infection, Kovarzik and also
Zimmer, from his experience in horses, are inclined to believe that such an affection
is a reaction, indicating an already existing latent infection (anaphylaxis due to
proteids of the bacilli which circulate in the blood of the latent infected animals,
against the analagous proteid contained in the immune serum).

IV. Immunization with Immune Serum and Cultures
(Sobernheim’s method). Sobernheim (1902) recommends for
a lasting, combined, passive and active immunization of do-
mestic animals a simultaneous vaccination with serum and
anthrax cultures (cattle and horses are injected on one side
of the body with 5.0 cc.; calves with 3.0 to 5.0 cc. and sheep
with 4.0 ec. of an immune serum; and five minutes later, they
are injected on the opposite side with 0.5 or 0.25 ec of an
attenuated culture, washed in salt solution, the degree of viru-
lence of which corresponds with Pasteur’s second vaccine).
This method has the great advantage of requiring only a single
treatment of the animals, and the results obtained from it are,
with the exception of a few failures, quite satisfactory. Svarde
(1906) however, claims that the superiority of this method
over Pasteur’s has not been established.

After vaccination there is usually a moderate elevation in tem-
perature of 0.5 to 1.0°C., slightly diminished appetite and milk secre-
tion. A swelling often occurs at the place of inoculation. The nasal
mucous membrane may be swollen, and an exanthema resembling urti-
caria may be observed. Occasionally the vaccination results in the death
of the animal (most often observed in work oxen).

In Argentine and Uruguay this method of vaccination was employed from the
spring of 1904 to September, 1905, on 140,000 cattle, 30,000 sheep and 2,000 horses.
According to Sobernheim no fatalities resulted from the vaccination, and almost
everywhere a complete eradication, or at least a marked restriction of anthrax
was noted.

In Germany, according to Sobernheim’s statistics, up to the year of 1906 about
4,500 cattle and sheep were successfully vaccinated. Raebiger & Johnk reported
very satisfactory results, although some failures were also observed by them. Accord-
ing to other reports, however, the results appeared unfavorable. Thus, according
to Burow, of 5,000 cattle vaccinated by this method in Pommern, 8 (0.15%) died
as a result of the vaccination; besides, from 4 to 7 weeks later 3 (0.08%) additional
deaths resulted from anthrax. In one instance, of 39 vaccinated cattle, 3 died; in
another case, of 137 cattle, 37 showed indications of anthrax inside of 5 days of
which 8 died (Heine). Unsatisfactory results are further reported by Hummel
(losses from vaccination, 139 sheep) and Lothes (of 78 cattle, 2 deaths, 17 severe
affections, marked diminution in milk secretion in cows).

V. Other Methods of Vaccination. Previous to the experi-
ments of Pasteur, Toussaint (1880) vaccinated with anthrax blood
heated for 10 minutes at 55°C., or mixed with 1% carbolic acid.

Chauveau (1883) prepared a vaccine by heating bouillon cultures
which were grown at 42.5 to 47°C., then kept at 37°C. until spore-
formation, and finally heated to 80-84°C. Other vaccines were made
30 Anthrax.

by subjecting the spores to a pressure of approximately 8 atmospheres,
also by growing the virus in pure oxygen and under pressure of 214
atmospheres.

According to Sobernheim, Chauveau’s method of immunization is used in
Chile, where 80,000 to 85,000 animals are vaccinated annually by that method; the
results are indicated as being favorable in cattle, but only fairly good among sheep.

According to Chamberland & Roux, the action of a mild solution
of carbolic acid (1:600) on anthrax bacilli for 24 days will attenuate
them to such an extent that they represent protective vaccines. The
same result is obtained by the action of bichromate of potassium
(1:2000-5000) for 10 days, and according to Gibier by cooling to —45°C.,
whereas Murillo prepares a vaccine which is also supposed to be satis-
factory in practice by growing the culture alternately in diphtheria
toxin and in bouillon.

Arloing, and also Hankins succeeded in immunizing test animals
with bacteria-free filtrates of culture. Similar results were obtained
by Ogata & Jasuhara with a ferment from the blood serum of anthrax
animals. Aujeszky also succeeded with a mixture of anthrax bacilli
and spleen tissue, and also with the spleen pulp alone. According to
Emmerich, Pawlowsky, Bouchard, Gilruth and others, an immuniza-
tion is possible by the treatment with organisms which are antagonistic
to the anthrax bacillus (see page 6).

Finally, Bail (1904) used for the immunization the sterilized
edema fluid of anthrax animals. He presumed that the aggressins
(lysins in the sense of Kruse) of the anthrax baillus, which are present
in the edematous fiuid, favor the development of the pathogenicity of
the bacillus, and.if injected into an animal they would stimulate the
production of antiaggressins which would protect the animal against
a bacillary infection. Sheep which received 2.5-10 ec. of such edema
fluid subcutaneously developed an immunity even against severe sub-
cutaneous infection with bacilli in from 8 to 10 days. If, however, a
certain quantity of the edema fluid is exceeded the body is unable to
use it up, and because of the increased aggressins present a hypersensi-
tiveness to infection develops. This method has not yet been tried in
praetice.

Veterinary Police. The veterinary police regulations refer
in the first place to the harmless disposition and destruction
of all excrements of anthrax animals, and to the cremation,
rendering or deep burying of their carcasses. Diseased animals
should be kept separated from healthy ones, and their stalls
should be disinfected. The food and straw which have come
in direct contact with affected animals should be rendered
harmless; meat, milk and raw products in general (also hides)
of affected animals should not be permitted to enter the trade.
On the other hand, quarantine restrictions for healthy animals
with the exception of severe outbreaks do not appear justified
as the disease is not directly contagious.

Literature. Gerlach, Mag., 1845, XI, 113; 1846, XII, 321—Heusinger, D. Milz-
brandkrkh. d. Tiere u. d. Menschen, Erlangen, 1850 (Old Lit.).—Pollender, Viertel-
jschr. f. ger. Med., 1855, 102.—Brauell, V. A., 1857, XI, 131. Davaine, C. R., 1863,
LVII, 320; 1864, LIX, 393.—Bollinger, Beitr. z. vergl. Path., 1872, 122; D. Z. £.
Anthrax in Man. 31

Tm., 1885, XI, 160.—Koch, Beitr. z. Biol. d. Pflanzen, 1876, II; Mitt. d. G.-A., 1881,
I, 49.—Pasteur, C R., 1877, LXXXIV u. LXXXV.—Pasteur, Chamberland & Roux,
C. B., 1880, XC u. XCI; 1881, XCII.—Oemler, A. f. Tk., 1800, VI, 401.—Koch, Mitt.
d. G.-A. 1881, I, 184; 1884,° II, 161.—Léffler, Ibid., p. 49.—Roux & Chamberland,
A. P. 1887, I, 513; 1888, II, 405 —Kitt, Monh., 1894, V, 215 (Review on diagnosis).
—Sclavo, Chl. f. B., 1895, XVIII, 744.—Sobernheim, Z. f. Hyg., 1897, XXIV, 301;
Hb. f. p. M., 1904, ITI; 1904, IV, 793 (Lit. on etiol. and vaccination).—Conradi,
Z. f. Hyg., 1899, XXXI, 323 (Lit. on toxins).—Bongert, Chl. f. B., 1903, XXXIV,
497.—Preisz, Cbl. f. B., 1904, XXXV, 280; 1907, XLIV, 209; 1909, XLIX, 341.—
Ernst, Monh., 1905, XVII, 172 (Lit. on diag. meth.).—Oppermann, A. f. Tk., 1905,
XXXII, 41 (Lit.).—Gruber & Futaki, M. m. W., 1907, 249; D. m. W., 1907, 1558.—
Wyssmann, Schw. A., 1907, XLIX, 287 (Lit. on anthrax in hogs).—Xylander, Arb.
d. G.-A., 1907, XXV, 457._Fischoeder, Chl. f. B., 1909, LI, 320 (Lit. on capsule
formation).—Hoppe, Diss., Leipsic, 1909 (Lit. on pseudo-anthrax bacilli).

Anthrax in Man. Anthrax in man usually oceurs as a local
affection of the skin and subcutaneous tissue (carbuncle, pustula
maligna, carbunculus malignus) as a result of skin infections. There-
fore it is chiefly persons who come in contact with diseased or dead
animals who become affected. The persons who most commonly receive
accidental infections are veterinarians, herders, butchers and laborers
who work on hides, hair, bristles and wool. In these forms of employ-
ment there is also a possibility of infection through the inhalation of
spores, and it appears that the so-called ‘‘rag disease’’ or ‘‘wool-
sorters’ disease’? in many cases develops in this manner. Infection
takes place very rarely through the intestinal canal, as the meat of
anthrax animals as a rule only contains bacilli and not spores, and they
are digested by the gastric juice; furthermore the virus is usually
destroyed in the cooking of the meat. Therefore this method of infec-
tion only occurs after the ingestion of putrefactive and improperly
kept meat, or from sausage prepared from infected meat which was not
fresh. It is also possible that infection is transmitted by flies.

The development of the carbuncle usually commences with a
lancinating pain at the point of infection and is soon followed by the
appearance of a bright red nodule, from which a blackish-red vesicle
forms, containing a reddish serous fluid. After the rupture of the
vesicle the breaking down of the tissue commences, whereupon in the
surrounding parts new nodules and vesicles form and the affected area
shows marked edematous infiltration. The subcutaneous connective
tissue, and the skin appear reddened as in erysipelas. In the mean-
while general febrile manifestations develop until the infection becomes
general and the patient succumbs from septicemia. The intestinal infec-
tion manifests itself in a severe (frequently hemorrhagic) inflamma-
tion of the intestines which is accompanied by severe abdominal pain,
vomiting and chills, until collapse and symptoms of asphyxiation ter-
minate the disease. Both forms may occur combined, and especially
may an intestinal infection be followed by the appearance of edematous
swellings in various parts of the body. Inhalation anthrax is mani-
fested by an acute pleuritis or broncho-pneumonia.

The carbuncle developing after a local infection can be cured by
early surgical treatment; and frequently in such cases, as well as in
intestinal infections, the administration of immune serum is followed
by good results.

Literature. S. Kordnyi, Nothnagel’s Handbuch, 1909, V, Bd., 1. T.
382 Malignant Edema.

2. Malignant Edema. Oedema malignum

(Septicaemia gangracnosa, Septicémie gangréneuse [French];
Malignes Odem [German] ; Setticemia gangrenosa [Italian].)

Malignant edema is an

 

Tig. 8. Edema bacilli with flagella.
Agar culture; flagella staining.

 

Vg. 9. Bacillus of malignant edema.
Spore formation three-day old
agar culture, stained with
diluted fuchsin solution.

 

Fig.10. Bacillus of malignant edema.
Peritoneal exudate from guinea
pig; dried cover glass prep-
aration ; fuchsin staining.

acute, febrile, infectious wound
disease of domestic animals,
which is characterized princi-
pally by edematous, later crepi-
tating swellings at the place of
infection. Its cause is the anae-
robice bacillus oedematis maligni.

History. The development of crep-
itating swellings following injuries,
seatons, castrations, ete., has. been
known since earliest times, and Girard
(1880) proved that crepitating swell-
ings in sheep may be produced by

putrid animal substances. Chauveau

(1873) showed by experiments carried
out on male goats that the living or-
ganisms contained in injected putrid
blood were closely associated with the
development of the disease. Pasteur
(1877) studied more closely the hac-
terium, named by him as ‘‘Vibrion
septique,’’ and also succeeded in grow-
ing it in pure culture. Later Koch
& Gaffky (1881) extensively investi-
gated the disease produced by the in-
oculation of dirt, and which they
termed malignant edema. Since that
time Kitt, Jensen & Sand, and Le-
clainche, have contributed to the bac-
teriology, while new observations re-
garding its occurrence in domestic
animals have been published by Jen-
sen & Sand, Ratz, Fréhner, Carl and
others.

Occurrence. Malignant edema
occurs everywhere since its caus-
ative agent is ever present in the
superficial layers of the soil.
Nevertheless it is not a very fre-
quent disease, but may occur in
horses and cattle, in cows partic-
ularly after parturition. Occa-
sionally in sheep it causes great
losses, and may in veterinary
hospitals among horses assume
an enzootic character as a sequel
of operations (L. A. Merillat).
Etiology. Pathogenicity. 33

; Etiology. The bacillus oedematis maligni, Koch, (Vibrion
septique, Pasteur) is an anaerobic bacterium resembling the
anthrax bacillus, but appearing somewhat more slender, rod-
shaped, peritrically flagellated, motile and multiplying by fission
and spore formation. (Figs. 8 to 10.) Several rods unite to
form longer chains in which the ends in contact with each other,
as well as the free ends, appear rounded. In artificial media,
as well as inside the animal body after death, the bacilli grow
to long, curved unsegmented threads. In the bacilli, oval spores
develop either in the middle or ends (exceptionally even the
edematous fluid taken from the living animal contains spore-
bearing bacilli [Jensen & Sand]).

Staining. With aqueous aniline dyes the bacilli stain readily, and
they also take the Gram stain after being carefully
treated with alcohol.

Cultivation. The cultivation of this organism is
only possible under oxygen-free conditions. Stab
cultures in agar or gelatin show along the stab cloudy
or lentil-shaped colonies which usually develop at the
bottom of the medium and close to which the gelatin
is later liquefied. In coagulated blood serum and also
in dextrose bouillon (not in saccharose and lactose,
Smith) gas having a characteristic sweetish putrid
odor is formed, which later causes disruption of the
media. (Fig. 11.) Kerry found inthe gases hydro-
gen, hydrogen sulphide, carbon dioxide and methane.
Milk is changed in a few days into a watery fluid with
gas formation and the collection of a layer of fat on
the surface (Smith). In bouillon cultures the bac-
teria produce toxins in small quantities (Roux and
Chamberland).

The spores show great vitality. Dry muscle substance
and. spore-containing edema fluid enclosed in glass tubes prove
virulent even after years. In fluid media spores are destroyea |
after heating to 100°C. for fifteen minutes (Sanfelice), while
in the dry state they are killed in ten minutes at 120°C.
(Arloing). Direct sunlight kills them only slowly. Disin-
fectants are only effective in strong solutions and after pro-
longed contact. Sporeless bacilli are quickly destroyed in the
presence of air and sunlight as well as by putrefaction.

 

Pathogenicity. After the inoculation of a Fig. 11. Stab eul-
pure culture in the depth of the connective tis- tui? 4 edema ba
sue, a rapidly extending swelling develops at agar.
the point of injection. It becomes crepitating as
a result of gas formation within, and the animal soon dies of a
form of septicemia. Guinea pigs and mice succumb in from
24 to 28 hours. Cattle can be infected only with great difficulty,
and feeding of spore-containing material will not produce the
disease even in susceptible animals. Edema bacilli injected
into the blood produce the disease only when they find a suita-
ble soil for their development somewhere in necrotic tissue (for
instance, in previously ligated testicles [Chauveau] ).
34 Malignant Edema.

Probably there are also other bacteria capable of producing a dis-
ease resembling malignant edema. Thus, Novy observed the appear-
ance of a similar disease in guinea pigs following subcutaneous injec-
tions of milk nuclein, and he proved that an organism closely resembling
the above-described bacillus was the cause. However, it was somewhat
more slender and provided with strikingly long and thick flagella. It
is also an anaerobic but sporeless bacillus (Bac. ed. maligni II).
Klein isolated from garden soil (Bac. ed. sporogenes) and Sanfelice
from guinea pigs inoculated with dirt containing putrid organic sub-
stances, a similar, although only facultative anaerobic, bacillus (Bac. ced.
srogenes). According to Fraenkel the Bac. phlegmones emphysema-
tose produces in man a similar disease (gangréne foudroyante). On
the other hand, according to Kirsten the edema bacilli, like most of the
species of bacteria, form groups of varieties which may be distinguished
from éach other by their morphological and biological characteristics.
However, in their clinical relation the most important characteristic is
the absence of pathogenicity in most of the varieties.

For natural infection of domestic animals solipeds are
most susceptible, while cattle, sheep and goats are less sus-
ceptible. Hogs, dogs and cats are rarely affected.

The infection results in most instances from the entrance
of the edema bacillus into the deeper parts of the subcutaneous:
or submucous tissue through breaks in the continuity of the
skin or the mucous membrane of the mouth and esophagus.
There are many opportunities for such infections as the bacilli
are widely disseminated in the dirt, especially in dust of hay,
in garden or field soil, in street dust, in household drainage,
in putrid organic material, and in excrement of healthy animals.
These substances are very prone to come in contact with wounds
on the body, and yet the rare occurrence of the disease can be
explained by the fact that successful infection occurs only when
large masses of bacilli enter the lymph spaces of the connective
tissue which contain but little oxygen. On the other hand, where
the infectious material enters superficial wounds on the skin,
granulating ulcerations, or even directly into the blood stream,
the bacilli cannot propagate on account of the presence of
oxygen. Hence the infection occurs either through contused or
lacerated wounds or during parturition by means of contami-
nated hands or instruments. In other cases the infection may
also follow vaccination, castration, shearing, bleeding, intro-
duction of seatons, subcutaneous injections with unsterilized
medicines (eserine, morphine, creolin, arecoline), unclean
syringes, bites, penetration of straws into the canthus of the
eye, etc. The disease has also developed in association with
necrotic processes.

Lembeken observed 50 out of 600 and Gilruth 300 out of 4,000 sheep dying
from malignant edema during or after shearing.

Infection may also occur through injuries or necrotic ulcer-
ations on the mucous membrane, whereas the healthy mucous
Pathogenesis. Anatomical Changes. 35

membrane affords an effectual protection. Feeding and in-
halation have failed to successfully transmit the infection to
experiment animals.

Pathogenesis. After the germination of the spores in the
lymph spaces the bacilli continue to multiply by fission at the
point of infection until large bacterial colonies develop. In the
meantime gases are formed by the dissociation of the tissue
fluids, and toxins are produced under the influence of which the
blood vessels are dilated, allowing the blood plasma to transude
into the connective tissue spaces through the relaxed walls of the
vessels. With the penetration of the bacilli the swelling en-
larges, and in case the point of infection is near the abdominal
cavity, the bacilli multiply rapidly on the surface of the
_ peritoneum where they grow into long threads. At the same

time the absorbed toxins act also on the central nervous system,
particularly on the respiratory and heat centers, as a result of
which respiration becomes difficult and the temperature elevated.

The edema bacilli are capable of multiplying in the tissues
only under special conditions. The spores will germinate only
in- the presence of toxins (from older cultures) in the tissues,
because otherwise they would soon be taken up by the phago-
’ eytes and rendered harmless. Their propagation is also facili-
tated by the simultaneous entrance into the tissues of other
micro-organisms (Bac. prodigiosus, staphlyeocci, diplococcus
pyogenes and others). In addition propagation is aided by
the presence of particles of dirt or sand which protect the
spores mechanically against the phagocytes, while toxins and
substances like lactic acid, keep away the cells through negative
chemotaxis (Besson, Leclainche & Vallée). At the same time
the presence of other bacteria has an influence on the develop-
ment of the pathological changes and gives rise to numerous
cases of mixed infection.

Anatomical changes. During the formation of a swelling
in any part of the body the connective tissue becomes distended
and infiltrated with a yellow or reddish fluid which contains
gas bubbles and liberates a peculiar disagreeable odor. The
gelatinous infiltration of the connective tissue may also extend
between the deeper layers of the muscles, while the muscle
substance proper turns pale yellow or dark red in color, be-
comes brittle and tears readily. The connective tissue appears
in places permeated with smaller or larger hemorrhages. The
abdominal cavity contains a small quantity of reddish serous
fluid; the peritoneum is markedly injected, lustreless, but is not
covered with an exudate. ,

If the malignant edema has developed after parturition, the
uterus is found insufficiently contracted, and the subserous con-
nective tissue of the small pelvis shows edematous infiltration.
The wall of the uterus is also edematous, the mucous membrane
36 Malignant Edema.

swollen and covered with a dirty, pasty, ill smelling mass which
also covers the cotyledons that are in the process of breaking
down (Carl).

The spleen as a rule appears normal in size or slightly
swollen. Exceptionally, however, an acute swelling of this
organ with gas formation in the pulp has been observed
(Frohner). The liver shows cloudy swelling and the intestinal
mucous membrane shows indications of an acute catarrh. The
lymph glands are acutely swollen, while the lungs manifest well
marked active hyperemia and also edema (which, according to
Kitt, are occasionally the only lesions found in sheep) ; the heart
muscle usually shows marked parenchymatous degeneration.
The blood is slightly coagulated, and the carcass decomposes
rapidly.

In the fluid squeezed out from the crepitating swellings or
taken from the cut surface, or frequently in the abdominal
fluid, edema bacilli may be found in large numbers even in the
unstained miscroscopical preparations. The bacilli, which not
infrequently contain spores, occur singly, in chains or as curved
threads, and are often found in association with other bacteria.
Several hours after death the bacilli are found in the blood,
particularly the blood of the lungs where they often oceur in
long threads similar to those seen on the peritoneum.

The presence of the bacilli of malignant edema is not in itself
proof that the particular animal died from this disease. These bacilli
occur frequently in association with other bacilli in the intestinal con-
tents of herbivorous animals, and from there they may spread after the
death of the animal throughout the body even to its most distant parts.
This is particularly the case when the blood remains fluid, as for in-
stance, in a suddenly appearing asphyxiation, and thus promotes their
multiplication and dissemination. From the intestines the organisms
first enter the peritoneum, next the blood vessels of the intestines and
mesenteries, and then the portal vein from whence they may be dis-
seminated throughout the blood.

Symptoms. After infection an edematous swelling, which
is not sharply circumscribed, may develop in 12 to 24 hours in
any part of the body. The swelling is at first tense, warm,
very painful, later cooler, soft, doughy and less sensitive, and
may even become entirely insensitive in the center, so that
the animal does not manifest pain when incisions are made
into the swelling (at the borders, however, it shows the charac-
teristics mentioned). At the same time the swelling reveals
erepitation on palpation. The swelling usually develops at
places where considerable loose connective tissue occurs under
the skin; by spreading over the surface it may occasionally
involve the entire side of the body, anteriorly to the neck,
posteriorly to the upper parts of the extremities, resulting in
difficult and painful movements of the body. Upon incision a
reddish-yellow, reddish-brown, or a colorless serous fluid is
Symptoms. 37

discharged which contains gas bubbles. In some cases the skin
over the swelling acquires a dark color, and may finally become
extensively necrotic.

In cases where the swelling develops in association with
an evident injury the wound takes on a bright color and a
peculiar lustre, and a dirty red, fetid, serous fluid oozes from
its surface. Later the margins of the wound become necrotic
in portions.

If the infection occurs through the genital passage during
or shortly after parturition the first manifestation of the disease
appears after 2 to 5 days. The vulva swells in the form of
a cushion, and a dirty, brownish-red, very fetid, thick secretion
is discharged from the vagina. Soon a crepitating swelling de-
velops in the surrounding parts of the external genitals which
is at first warm and painful but later cool and painless, and.
gradually extends over the perineal region and the lower abdo-
men. Besides high fever, bloating and diarrhea are observed.

Malignant edema developing in association with parturition in cat-
tle is frequently mistaken for blackleg. Recently Alrert & Carl estab-
lished with a certain degree of probability that the cases described as
parturition blackleg are actually malignant edema, and that blackleg
never develops in this form.

Following castration the first symptoms appear after a
few days or sometimes after several weeks; aside from high
fever, an extensive edema develops under the skin of the abdo-
men, emanating from the castration wound, and later shows
crepitation on palpation. In addition the animal manifests
colicky pains, sensitiveness over the abdominal wall and bloat-
ing; in other words, there are indications of peritonitis, and
finally signs of a general infection and exhaustion.

Of the other symptoms of the disease the markedly diffi-
cult respiration, the cyanotic mucous membranes, the accelerated
and weak heart action, and the corresponding small, wavy pulse
are conspicuous. The body temperature reaches a high degree
even at the onset of the disease, remains at a uniform height,
but as death approaches it drops to normal or subnormal. In
later stages of the disease diarrhea is very frequently observed
in which fetid and watery feces are discharged.

The symptoms follow each other rapidly; the crepitating
‘swelling increases in size from hour to hour, and death usually
occurs in twelve hours to three days after the appearance of
the first symptom. In some of the cases, however, the disease
terminates in recovery, especially after appropriate treatment.

Livesey observed the disease in a dog. On the left side of the head
an emphysematous swelling developed and progressed to the neck and
shoulders. At the same time the lips and cheeks became necrotic.
Pankul demonstrated the disease in hogs; a crepitating swelling devel-
oped in this instance from a wound in the skin.
38 Malignant Edema.

Diagnosis. In cattle malignant edema may be mistaken for
blackleg. Malignant edema is indicated by the appearance of
the disease in localities where blackleg is not prevalent, further
by the advanced age of the patient, the occasional localization
of the swelling in parts which are poor in muscle tissue, and by
the relatively severe affection of the connective tissue com-
pared with the slight involvement of the muscles. Parturient
apoplexy is differentiated from malignant edema by the absence
of the crepitating swelling, and the different bacteriological
findings.

In horses and sheep the development of a crepitating swell-
ing under febrile manifestations indicates malignant edema.
The crepitation distinguishes the disease from edema, which
often resembles it very closely, as well as from the inflammatory
edema which is caused frequently by a streptococcus infection
following injuries; whereas in the simple subcutaneous emphy-
sema there is in addition to the pre-existing skin or lung injury
an entire absence of febrile symptoms. On post mortem care
should be taken not to mistake the emphysema caused by putre-
faction with the crepitating swelling which develops during
life. (For differential diagnosis regarding the bacilli, see p. 20.)

Treatment. The only possible method of treating the
patients consists in incising the swellings as they are forming
in one or several places. This is to be followed by squeezing
out the serous fluid and by thorough disinfection of the wounds;
at the same time it is advisable to inject disinfecting substances
subcutaneously into the tissue immediately surrounding the
swelling.

While the disinfectant treatment is practically without
effect upon the spores of the edema bacilli, it indirectly prevents
the germination of the spores by destroying the foreign bacteria
which entered the wound and also prevents the multiplication
of the bacilli.

Prevention. In order to prevent the occurrence of the
disease, wounds of the skin and mucous membranes should: be
guarded against contamination with dirt. Those wounds which
have already become contaminated should be disinfected,
whereas, after difficult parturitions in which the genital pas-
sages have been injured a thorough irrigation of the vagina
and uterus will prevent the disease.

Immunization. Experimental animals may be immunized against
virulent infections by injections of spore-containing tissue fluids which
have been heated for 7 hours to 92°C. (Leclainche & Vallée) ; by bouil-
lon cultures heated for 10 minutes to 105-110°C., also by filtrates of
the edematous fiuid, or through the toxins contained therein (Roux &
Chamberland) ; further by blood serum of immunized animals which
have received repeated injections of virulent material (Duenschmann,
Leclainche & Morel). These inoculations protect only against malignant
Malignant Edema. Blackleg. 39

edema but not against anthrax also, as was proven by Leclainche &
Vallée, and which is contrary to the former views of Roux & Duensch-
mann.

Literature. Chauveau, Rec., 1873, 263.—Pasteur & Joubert, C. R., 1877, LXXXV,
101.—Koch, Mitt. d. G.-A., 1881, I, 49.—Affky, Ibid., S. 83.—Chauveau & Arloing,
Acad. de Méd., 1884, XIII, 604.—Kitt, Miinchn. Jhb., 1883-84 u. 1884-85; Monh.,
1897, VIII, 206 (Review) ; 1900, XI, 49.—Jensen & Sand, D. Z. f. Tm., 1887, XIII,
31—Roux & Chamberland, A. P., 1887, I, 561—Leclainche & Vallée, Ibid., 1900,
XIV, 590.—Frohner, Monh., 1901 to 1903, XII-XIV; Allg. Chir., Wien, 1905 (Lit.).—
Carl, A. f. Tk., 1903, XXIX, 225.—Jensen, Hb. f. p. M., 1903, II, 619 (Lit.).—
Livesey, Vet. Rec., 1906, 356.—Hohneker, B. t. W., 1907, 267.

3. Blackleg. Gangraena emphysematosa.

(Black Quarter, Quarter Ill [English]; Rauschbrand, Kalter
Brand, Rauschender Milzbrand [German]; Emphysema
gangraenosum, Sarkophysema haemorrhagicum; Char-
bon symptomatique, Charbon bactérien, Mal de
cuisse, Mal de montagne [French]; Car-
bonchio enfisematosa o sintomatico,

Acetone, Quarté nero [Italian].)

Blackleg is an acute, infectious, but not contagious,
epizootic disease of cattle, and exceptionally of other ruminants
and of swine, in the course of which crepitant swellings develop
in the musculature of certain regions of the body, accompanied
by febrile symptoms. It is caused by the anaerobe, bacillus
gangraenae emphysematosae.

Historical. Until the seventies of the last century, the disease was
considered as identical with anthrax or as a particular form of that dis-
ease. As early as 1782, Chabert had differentiated the disease from
anthrax under the name of charbon symptomatique, while Bollinger
(1875) and Feser (1876) showed that blackleg was to be separated from
anthrax from an etiological point of view. Both investigators observed
the bacilli contained in the crepitant swellings, and produced the dis-
ease in ruminants through injection of the serous fluid; Bollinger also
caused it by introducing subcutaneously mud from places in which
blackleg was frequent. Later the etiology of the disease and properties
of the bacteria were investigated thoroughly by Arloing, Cornevin &
Thomas (1879-1884), and through these studies not only the etiology
of the disease was determined upon, but they also introduced a prac-
tical method of protective vaccination. The bacteria which the French
call bacterium Chauveaui were developed in cultures by Roux (1887)
and later by Kitasato (1889), while still later Kitt, Leclainche & Vallée,
as well as Grassberger and Schattenfroh, completed our knowledge in
that direction.

Occurrence. Blackleg appears mostly in mountain regions
and in valleys with swampy pastures, but is also observed on
low lands exposed to inundation. In such regions it appears
chiefly during the hot season and causes nearly every year con-
40 Blackleg.

siderable losses among the young cattle, while older animals
are attacked only exceptionally. During the winter, and when
the cattle are fed in the stable, the disease appears very rarely.

In Germany, blackleg was observed during the years 1888 to 1905 most fre-
quently in the Prussian provinces, Schleswig-Holstein, Rhineland and Westphalia,
and on the mountain pastures of the Rhine provinces; before the: introduction of
the protective vaccination, 4 to 8%, at some places even 12 to 15%, of the young
cattle were destroyed by the disease. During the 10 years 1899 to 1908, in about
188 districts 7 (?) horses, 1,193 cattle, 36 sheep and 2 goats were infected with
the disease; the number of districts varied between 157 (1897) and 214 (1908),
while the number of cases varied between 928 (1902) and 1973 (1906). More than
two-thirds of the communities and cases were in Prussia, where the government dis-
trict Schleswig was particularly attacked; then follow Bavaria, Hesse, and Wirttem-
ae According to Scheibel, blackleg is often observed in Upper Hesse in sheep
and goats. ;

In Austria the disease appears chiefly in Lower Austria and Tyrol, while the
coast regions, Silesia and Dalmatia, are nearly free from it. During the years 1891
to 1900, the average loss amounted to 552 head of cattle or 0.006% of the total stock
in the involved regions. The number of infected localities varied between 142 (1892)
and 227 (1898). ‘

In Hungary, the disease appears on the mountain pastures of Siebenbirgen
and in the Northeastern part of the country, and also in the former inundation dis-
trict of the Tisza River. Although the disease is not subject to obligatory notifi-
cation, 1,460 cases were reported from 30 communities in 1907.

In Switzerland the average annual loss during the years 1897 to 1902 amounted
to 687 head of cattle, two-thirds of which must be charged to the cantons of Berne,
Friebourg and Waadt. During the year 1908, in 272 communities, 779 animals were
attacked.

In the other European countries blackleg is also in evidence, and in 1908
Belgium had 274 cases of the disease, mostly in the provinces Liége and West
Flanders; Italy had 407, and Norway 67 cases, while in Sweden there were 56
infected farms. In France the northerly and southeasterly mountain districts are
severely infected, while in Great Britain it is Scotland, and in Denmark, Jutland.
In Holland the disease causes greater losses than anthrax.

In Africa, blackleg has been observed in Algeria and the southern part of the
continent (there known as Spons-Ziekte and Swamm-Ziekte), and it is said that in
many regions of the Transvaal 10 to 25%, sometimes even 50%, of the young cat-
tle are destroyed annually by the disease. In America the disease has been observed
in most of the northern states and seems to be very common. During the year 1906,
from the Federal Bureau of Animal Industry alone, there were shipped 1,250,000
doses of protective vaccine to 40 states and territories. Most exposed to attacks are
the vast regions between the Mississippi Valley in the east and the Rocky Moun-
tains in the west. In South America (Chile) the disease has also been observed.

Etiology. The blackleg bacillus, bacillus gangraenae em-
physematosae (Clostrydium sarcophysematos bovis Kitt, bac-
terium chauveaui) is on an average 2 to 6 long, 0.5# thick,
slender and straight, rounded at the ends, and motile by means
of flagella. At a certain stage of its development, the bacillus
assumes a whetstone or lemon-like shape (clostrydium form),

while in the interior a spore develops at the center or at the
end. (Figs. 13 and 14.)

Staining. For this the common watery solutions of aniline dyes as
well as Gram’s method are suitable.

Culture. Cultures develop in the presence of hydrogen
and illuminating gas, with the exclusion of oxygen, as well as
in vacuum, particularly in Martin’s pepton-bouillon (Leclainche
& Vallée); also in chicken bouillon (Arloing), and on gelatin
and agar containing blood-serum, pepton, glycerin or a re-
ducing substance (Kitasato). The bacillus thrives best at 36
Etiology. 41

to 38°C., poorly at 14°C. The gelatin becomes liquefied; in
the depth of the agar culture medium along the needle punc-
ture radiating white growth devel-
ops (Fig. 15). The bouillon at
first becomes uniformly turbid,
small gas bubbles appearing on the
surface and later a white sediment
is formed, above which the solution
isclear. From dextrose and lactose
(not from saccharose) the bacillus
develops a gas which is either odor-
less or resembles rancid butter
(Preisz, Smith). Milk is curdled
only imperfectly.

  

Fig. 12. Blackleg bacilli from an

Tenacity. Fresh blackleg meat is ster- agar culture. Flagella staining.
ilized in 2 hours at a temperature of 80°C. or
in 20 minutes at 100°C.; fresh virus inclosed in
glass tubes is made inactive in 2 minutes when
kept in hot water. On the other hand, in
dried meat, the spores are made inactive only
by heating to 110°C. for 6 hours, or boiling
in water for 2 hours, while at room tempera-
ture the spores in dried muscular tissue
are kept virulent at least 2 years (according
to Mattei even 10 years); in salted meats they
are kept virulent for more than 2 years, and
in decaying flesh 6 months. Temperature hbe-
tween 85 and 100°C. decreases the virulence
of the spores through the destruction of the
toxins. Extreme cold has hardly any effect
In the summer, exposed to direct sunlight, the
dried virus loses its activity in 24 hours, and Fig. 18. Blackleg bacilli with
the fresh virus in 18 hours. The spores show spores. Muscle juice from
also considerably more resistance to chemical a guinea pig; unstained.
disinfectants than the bacilli. The most ef-
fective are carbolic acid (2%), salicylic acid
(1:100), nitrate of silver (1:1000), and bi-
chloride of mereury (1:5000); vapors of thy-
mol and eucalyptus weaken fresh virus, as’ it
is destroyed by the action of these media
in 100 hours (Arloing, Cornevin & Thomas).
Virus contained in blackleg meat possesses
a greater resistance than do cultures (A.
Schmidt). ~

 

Pathogenicity. After subcu-
_ taneous or intramuscular injection
of larger e capeletaae of meat juice AY
containing spores there appear in ,,. ae oe

the inoculated cattle, marked fever- ee : weede ei pa
ish symptoms, and, at the place of guinea pig; dried cover glass

injection, a painful, warm, edema- preparation; fuchsin staining.

tous, and later crepitant swelling, which, after the death of the
animal produces a black color of the musculature of the in-
volved region. These muscles together with the serous
infiltrated subcutaneous and intramuscular tissue are found in-
terspersed with gas bubbles. If an animal is inoculated
subcutaneously, with only a small amount of the infectious sub-

 
42 Blackleg.

stance, no edema will, as a rule, appear at the place of injec-
tion itself, but at some distance a small swelling appears, which
disappears in a few days. If the inoculated amount has been
very small, the injection will only cause a small indisposition
and a moderate i increase in temperature for a few days.

The intravenous injection of a larger amount of virus
produces typical blackleg, but a smaller amount causes only
2 or 3 days of indisposition, indicated by trembling and an in-
considerable increase of temperature. A similar effect follows
the intratracheal injection of the virus. In animals which have
gone through the short indisposition, the disease cannot be-
produced by a second injection of even a larger amount. In-
oculation in the tail of the animal only causes a crepitant swell-
ing and fever, if the tail is covered up, since its temperature,
which is normally 29.8°C., is thus artificially raised to 38.6°C.

In calves less than six months old, the subcutaneous or in-
travenous injection of an amount of fresh and virulent virus
which in 90% of cases would be fatal to a grown animal (1 to 6
drops) only produces a slight indisposition. Larger amounts
of virus, 7 to 10 drops for 1 to 14 days old and 10 to 20 drops
for 3 to 10 weeks old calves, produce typical blackleg (Arloing,
Cornevin & Thomas).

Small amounts of virus inoculated intramuscularly kill
guinea pigs, goats and sheep within 12 to 36 hours; mice are
also very susceptible, while rabbits, rats and pigeons are in-
fected only in exceptional cases. In horses and asses only an
inconsequential swelling appears after the injection; hogs are
slightly and other animals are not at all susceptible to the
infection.

In artificial culture media both toxins and gases are: produced, but
most abundantly in Martin’s bouillon. Intravenous injection of 10 to
12 ec. of an old culture kills horses in 5 minutes, evidently through
the action of the toxin. The toxin is mostly confined to the bodies
of the bacteria, culture filtrates being much less effective. The toxin
very soon becomes inactive in the air, while heating for 10 min-
utes at 115°C. only weakens without destroying it (Roux); its nega-
tive chemotaxis turns positive at 75°C. (Leclainche & Vallée).

According to Grassberger and Schattenfroh, the toxin is a product
of the bacilli and is particularly in evidence in the presence of car-
bonate of calcium. In calves 40 cc. of the filtrate of a culture cause
edematous swelling, fever, perspiration, diarrhea, prostration and, after
5 to 6 days, death. Contrary to other bacterial toxins, these show their
poisonous effect on the injected animal at once, without any distinct
period of incubation (Leclainche & Valleé, Hisenberg).

In many cases natural infection results from the fact that
mud from the swampy and rough soil of certain regions pene-
trates under the skin of the cattle, particularly through wounds
on the tail and the extremities (Liipke observed the disease
after castration).

More frequently the infection results from the consumption
Etiology. Susceptibility. 43

of infected feed or drinking water. Artificially it is successful
in this way only in exceptional cases (Bollinger, Arloing), but
the fact that in blackleg regions the intestinal canal as a rule
contains blackleg bacilli (Leclainche & Vallée), while lesions
on the surface of the body are observed only in exceptional
cases, and furthermore, that crepitant areas are present in the
internal organs, speaks in favor of the frequency of infection
through the intestines. In the rare cases when such swellings
originate in the region of the throat or in the wall of the
esophagus, the infection is evidently brought about through the
mucous membrane of the throat or the mouth.

Attacks of the disease in swine have so far only been ob-
served in fattening establishments, where the symptoms. also
have indicated infection of the tonsils (Marek).

Blackleg is a disease connected with infected soil, and trans-
mission from animal to animal, as in contagious diseases, or
through intermediary objects, evidently occurs very seldom.
The blackleg bacilli seem to be capable of multiplying in the
soil, and through their resisting ‘spores, to preserve their
capacity of development and infectiveness even under unfavor-
able conditions. This, as well as the fact that bacteria from
carcasses of dead animals again infect the soil, explains the
stationary occurrence of blackleg in certain regions. In fact, it
appears most frequently in swampy, low pastures, and. in
regions subjected to occasional inundations; also in pastures
where carcasses of cattle infected with blackleg had previously
been buried, and sometimes after feeding hay or other feed
in the neighborhood of which carcasses had been skinned, or
after drinking from creeks in which parts of blackleg carcasses
had been thrown.

Sauer suggests the possibility that flies which have been feeding on blackleg
carcasses, and in whose bodies the bacilli have increased in number, may be capable
of transmitting the infection.

Susceptibility. In blackleg regions the cattle contract the
disease with few exceptions only at the age of from 1% to 4
years; sucking calves are only attacked in. exceptional cases
(Strebel observed the disease in a 3 days old calf), and animals
over 4 years as a rule only when they are transferred at an
advanced age from disease-free places to an infected. place.
Whether or not the breed has any influence on the suscepti-
bility is not yet determined with certainty; it is a fact that
eattle of the native breed contract the disease, but not as
often as the improved breed; the same also is true of the
Algerian cattle (Brémond). As to the susceptibility of the
buitalo, no satisfactory data are so far available (Cronevin ob-
served in 2 buffaloes inoculated with virulent material only
intermittent changes of temperature, while, according to
Makoldy. these animals contract blackleg). In sheep Vogdt and
Monseur. and in swine Marek, Battistini and Born have found
44. Blackleg.

isolated cases of the disease, but it is still a matter of con-
tention whether the disease appears in horses or not.

According to a compilation by Tillmann, out of 614 animals suffering from

blackleg, 7 were from 1 to 4 weeks old, 23 from 2 to 3 months, 94 from 3 to 6.

months, 449 from 14 to 4 years, and, finally, 41 were above 4 years old.

Symptoms similar to those of blackleg, and analogous anatomical
changes may also be produced by other bacteria (the so-called pseudo-
blackleg bacilli). Thus Kerry has isolated a bacillus from a guinea
pig which had been inoculated with blood from a cow supposed to
have died from blackleg. This bacillus grows at a higher tem-
perature than the blackleg bacillus, produces no spores, and is patho-
genic not only for guinea pigs, but also for rabbits (bac. edematis
thermophilus). Preisz found in one case, which otherwise was similar
to blackleg in every way, a considerably longer and thicker bacillus
than in common blackleg.

Ligniéres and Bidart in their clinical reports on diseases similar
to blackleg in Argentine refer to an affection which is known under
the name of Mancha (=spot, owing to the dark color of the skin over
the edema). Calves from 6 to 10 months old contract the
disease exclusively and succumb within 24 to 28 hours. The
disease is caused by a bacillus similar to the blackleg bacillus,
but it is pathogenic for young rabbits, horses, and ‘pigeons.
Protective vaccination with blackleg virus is without effect.

Pathogenesis. Toxin-free spores which have
penetrated into normal healthy tissues are soon taken
up by phagocytes and digested; if, however, at the
same time, other bacteria or grains of dust have
gathered, and the tissue, particularly the muscula-
ture, is not quite sound, or if, at the involved place
an extravasation of blood exists, then the spores,
protected against the phagocytes, begin to germinate,
and the bacilli thus created continue to multiply
through fission. Under natural conditions a small
disturbance in the tissue, a strain of the muscles or a
hemorrhage (blow by a stick or a horn), may cause
the bacteria which have reached the blood from. the
intestines, and’otherwise are soon destroyed, to locate
at these points, to increase in number, and excite the
pathological process.

 

eas inflammation and sometimes also small hemorrhages
ig.

Stab cul. Will be observed. Under the influence of the toxins,

ture of the the musculature degenerates, and, through the de-
es ea struction of the nitrogenous matter, gases are
impeaben formed. The toxins are also absorbed by the body
agar. fluids and cause the general symptoms accompanying
the local process; they also reduce the power of resistance of the

tissues against the pathogenic effect of the virus (Roger).

According to the investigations of Leclainche & Vallée, cultures
containing spores and heated from 80 to 85°C. are inactive, as the

Where the bacilli appear in abundance, a serous.
Pathogenesis. Anatomical Changes. 45

spores in the tissues are digested by the phagocytes within 48 hours.
These spore-containing cultures cause the disease, however, if active
toxin is added or if they are injected mixed with sand or saprophytic
bacteria (bac. prodigiosus, proteus vulgaris, staphylococcus albus).
The spores will also show a greater pathogenic activity by the addi-
tion of a small amount of 20% lactic acid, salt solution or diluted
alcohol, and alsu through a traumatic injury immediately before or
after the infection. These saprophytic bacteria, the sand and the dead
tissue protect the spores mechanically against the phagocytes and make
their development possible. The same result is produced by the chem-
ical substances as well as by the inoculation of toxins contained in
unheated cultures, through negative chemotaxis.

Anatomical Changes. Characteristic of blackleg is the
crepitant swelling occurring anywhere on the rump or extremi-
ties, more or less distinctly circumscribed, above which the skin
appears sound, or in rare cases, partly necrotic, and therefore,
stiff, parchment-like, and dark colored. The subcutaneous tissue
is red or infiltrated with a yellowish, gelatinous exudate, at
places intermixed with hemorrhages and gas vesicles, and in the
deeper parts similarly changed connective tissue separates the
single muscle fibres from each other. The musculature of the

‘swollen part is dirty brown or dark red; at the periphery it
is darker red or dull yellow with black stripes, and either in-
tersected with bloody serous liquid or is spongy and dry (the
latter with great development of gas). The dirty red, or claret
colored liquid squeezed from the swellings contains gas bubbles
in abundance which give off an odor suggesting rancid butter.
In the tissue surrounding the swelling the lymph vessels are
sometimes distended, filled with lymph and gas, while the
lymphatic glands are acutely swollen, edematously infiltrated,
and sometimes intermixed with hemorrhages.

Crepitant swellings appear in rare cases in the musculature
of the tongue, throat, and diaphragm, from which points they
may also involve the muscles of the shoulder and arm (Hen-
ninger). They may likewise be found in the loin or in the
muscles between the ribs.

The internal organs show few conspicuous lesions and no
constant changes. Relatively often a reddish serous liquid is
found in varying amounts in the thoracic cavity. Further, there
may be present on the pleura, as well as on the epicardium, a
reddish gray fibrinous exudate sometimes mixed with dirty red,

.jelly-like substances, or the parietal pleura may be covered
with soft, jelly-like, wine-colored deposits (Foth, Katona, Till-
mann). In the lungs, the interlobular septa may be infiltrated,
and the lobules themselves edematous. In very rare cases the
heart muscle at localized points is dark red and edematous
(Tillmann) or necrotic (Blome), and the epicardium is covered
with. strips or tufts of exudate. ;

In the abdominal cavity lesions are frequently found which
are similar to those in the thoracic cavity. The spleen is gen-
46 Blackleg.

erally unchanged or only moderately swollen, but sometimes
a well developed tumefied spleen is found where the capsule is
distended by gas bubbles, but without hemorrhages.

The liver frequently appears mottled on section, owing to
ochre-yellow foci from a pea to a walnut in size, which increase
after death, and owing to the development of gas, assume a
porous, friable consistency (Kasselmann, Foth, Warringholz,
Tillmann). According to Warringholz, there exist in the cortex
of the kidneys, light gray foci of the size of a millet grain.
The mucous membrane of the intestines is catarrhal, reddened
and loosened; sometimes it is dark red, swollen, intersected
with hemorrhages, and covered with bloody mucus. Finally,
the blood is dark red and forms a coagulum in the heart and
the large vessels.

In rare cases with rapid course the characteristic external
swelling is lacking, but by thorough examination dark red dis-
colored portions of muscles may be found in hidden places, as
under the shoulder blade, in the sexual organs, masseter
muscles, psoas muscles or in the pillars of the diaphragm.

Rebiger found vesicles under the endocardium varying in size
from a pea to a pigeon egg, which were filled with a dark red, turbid ,
liquid containing numerous blackleg bacilli. Scheibel sometimes found
a crepitant swelling of the spleen and a gray-brown, porous, and
spongy appearance of the kidneys. According to Schmitt, an intes-
tinal infection is especially indicated by numerous small hemorrhages
in the omentum and in the serosa, particularly in the neighborhood
of the spleen which is swollen on account of hemorrhagic infiltration.
There is also a serous infiltration of the reticulum and a bloody dis-
coloration of its mucous membrane.

In swine a swelling of the region of the throat is mostly observed
where the subcutaneous, intermuscular, and peripharyngeal tissues
show a serous gelatinous fluid containing gas vesicles. The adjoining
muscles appear striped with dark red streaks, the lymphatic glands
are acutely swollen, and the mucous membrane of the throat shows a
eatarrhal condition with small hemorrhages (Marek). In other cases
the crepitant swelling has been found on one of the posterior extremities
(Battistini).

In horses the occurrence of blackleg has not been definitely deter-
mined. The literature contains reports by Ganter, Hafner, Schmidt,
Velmelage, Fischer, and others, but, in these cases, a confusion with
pseudo-blackleg or malignant edema is not only not excluded, but even
probable. Hasenkamp, for instance, found in a horse a serous-hemor-
rhagic fluid in the thoracic cavity and pericardial sac, hemorrhages in
the serous membranes, and black, crepitant, softened muscles of the
shoulder region, the neck, and the hind leg which were also infiltrated
with a sero-sanguinolent fluid. Quadekker observed in a similar case
a sweetish odor in the diseased parts which was neither pleasant nor
foul.

Blackleg bacilli are generally present in large numbers in the serous liquid
of the crepitant swellings as well as in the yellow foci of the liver (frequently in
company with various other bacteria, as staphylococci, micrococcus prodigiosus,
proteus vulgaris, bacillus coli and others, particularly at the edges of the swell-
ing), and a certain time after death they are also found in the transudate of the
serous cavities, in the bile, in the lymphatic glands, and in the blood. In the juices
Symptoms, 47

of the diseased muscles numerous clostrydian forms are seen, and if the course of the
disease is not acute the bacilli will be found to contain spores at the time of death
and still more 24 to 48 hours later.

Miiller recommends to submit for bacteriological examination pieces of. muscles
covered with salt, because the decaying process is arrested by the salt and the black-
leg bacilli are stimulated to a rapid formation of clostrydian forms and spores.

The gases formed in the crepitant swellings have not always the same com-
position; according to Roux, they consist of carbonic acid and hydrogen in equal
proportions, while Tappeiner’s chemical analysis shows 13.15% of carbonic acid,
76.51% of hydrogen, and 10.34% of nitrogen.

Symptoms. The period of incubation of the disease is
generally 3 days, although in exceptional cases it may be more,
but does not, however, exceed 5 days.

In cattle the disease starts with sudden febrile symptoms;
the animals stop eating, grazing and ruminating, the tempera-
ture rising in a few hours to 41-42°C. (Fig. 16.) In mary
cases, however, the disease seems to progress with a moderate
temperature or without
fever (Schiitt & Warring-
holz, Steinbriick). In graz-
ing animals lameness or
stiff dragging of an extrem-
ity is also frequently ob-
served.

Shortly thereafter may
be seen the characteristic
blackleg swelling, particu-
larly in portions of the body 395
with thick layers of muscle.
Most frequently they appear 390
on the upper leg, on the
buttocks, in the region of 385
the loin, on the shoulder, ; :
chest or neck (in exceptional 36, Fever curve in Meckleg. The
cases also in the submaxil- previous evening.
lary space [Fig. 17], on the
tongue or on the throat), while they never appear below
the carpal or tarsal joints or on the tail. At one of
the above named places a distinctly bordered or diffuse
swelling of irregular shape develops rapidly, which, from the
beginning, is hot and painful, later becoming cold and torpid
in the center, so that the animal finally does not feel pain on
touch or when an incision is made. The skin over the swelling
is dry, stiff, dark colored, incidentally black and parchment-like,
and in exceptional cases also necrotic. On palpating or pressing
the tumor a peculiar crepitation is observed, while percussion
brings forth a pronounced tympanitic sound. If the swelling
is cut at the beginning of the disease, dark red blood, later a
dirty red, foamy and singularly sweet smelling liquid will be
discharged from the wound. The tissues surrounding the tumor
are edematously infiltrated. The lymph glands are swollen
‘and may be felt under the skin as firm knots the size of apples.

 
48 Blackleg.

In the meantime, pronounced respiratory disturbances de-
velop, while the activity of the heart is accelerated (90 to 100
contractions a minute) and becomes weak. Sometimes attacks
of colic are observed. At last the animal lies on the ground
stretched out motionless, the temperature is lowered to
37-35°C. or rises once more, and then death follows immediately.

The disease generally lasts from 14 to 2 days; in rare cases,
however, it may last from 4 to 10 days.

The crepitant swelling mostly develops at one place, but
in some cases tumors appear at several parts of the body, grow
rapidly and coalesce to
form a single large
swelling,

If the swelling is de-
veloped in the deep
layers of the hip. or
shoulder muscles, its
other properties can-
not be exactly deter-
mined, aside from the
increase in volume of
the involved part of the
body. The skin appears
relatively healthy, and
no crepitation is ob-
served on touch; how-
ever, by a stronger per
cussion, a hollow sound
may be observed in the
periphery of the swell
ing even in these cases

If the cavity of the
mouth or the throat is
the seat of the disease

: Phssnthe lta as a symptoms of a severe
ee te teat Gate inflammation of the

lary space. throat are usually ob-

served whose specific

nature is indicated by the crepitation of the swollen parotid

region. Infection of the tongue is indicated by considerable

swelling, while the tip of the organ crepitates on touch and

projects from the mouth. In the extremely rare cases of

primary infection of the diaphragm, the cause of the fever as

well as of the difficult respiration can only be determined by
autopsy.

According to Arloing, Cornevin & Thomas, and also Feser, black-
leg, especially in older animals, sometimes appears in a much milder
form. In such eases there may or may not appear a moderate, indis-
tinct swelling on any part of the body, the animals show moderate fever

 

 
Symptoms. Diagnosis. 49

for 1 to 3 days, stop eating and ruminating, and also develop symptoms
of colic or tympany, after which recovery takes place. After intravenous
injection of blackleg virus a similar mild infection sometimes appears.

Very severe’ cases of infection occur sometimes in which the
animals suffer from general indisposition, tympany, and diarrhea and
succumb in 8 to 12 hours, without the appearance of a distinct swelling.

The existence of a genuine parturient blackleg, according to the
latest investigations, seems doubtful (see page 37) and could at best
be ascertained by autopsy, and then only in cases where the muscles
in the neighborhood of the genital organs show the characteristic
necrotic changes (such a case was observed by Kosselmann).

In sheep the disease has a sudden onset, and is indicated
by a stiff walk, weakness of the back, moderate tympany,
champing of foam, and high fever. On the surface of the
front portion of the body, particularly on the neck and lower
chest, the wool is raised at one place, and here a swelling may
be found the size of the palm of the hand (Scheibel).

In swine blackleg mostly appears with a severe acute inflammation
of the throat and heavy phlegmonous swelling of the surrounding parts
(Marek, Born). The development of the tumor which’ may extend
backwards and to the shoulder is also accompanied with feverish. symp-
toms, by vomiting and diarrhea, and the latter symptoms are also ob-
served when the crepitant swelling has developed on a posterior ex-
tremity (Battistini). mF are

Diagnosis. The rapid course and the development of a
crepitant, edematous swelling, in cases where the latter appears
on the surface of the body, make the diagnosis fairly easy. Tf,
however, the swellings are in the interior. of the body, the nature
of the acute feverish attack can only be surmised through other
factors, particularly by the fact that blackleg frequently ap-
pears in the particular region. The disease may be mistaken,
especially for malignant edema, in the course of which crepitant
swellings appear on the surface of the body also. The
appearance of the swellings, which are restricted to certain re-
gions and to young animals, in those parts of the body with
abundant musculature is suggestive of blackleg. Besides, the
swelling is here more emphysematous, the contained fluid dark
red and foamy, and the muscles are black colored, while in
malignant edema the swelling is more edematous, the fluid
gray-red or colorless, and the muscles diffusely reddened or
only red-gray (Gutzeit). The development of an edematous
crepitant swelling in the neighborhood of the external genital
organs at the time of birth will in itself be an indication of the
presence of malignant edema.

Blackleg is differentiated from anthrax more readily, for
in the latter edematous swellings are rare and, if present, al-
ways hot and painful without crepitation. In phlegmonous
inflammations of the subcutaneous tissue, from pyogenic wound
infection the local character of the disease is distinctly indicated
50 Blackleg.

and the course, as a rule, is slower. In subcutaneous emphy-
sema, leaving out of consideration the etiological factors, the.
total absence of acute symptoms of inflammation and the normal
condition of the skin are characteristic.

At the autopsy, aside from the microscopic results and
the serous-emphysematous infiltration in the region of the
swelling, blackleg is indicated especially by the odor of rancid
butter, the black discoloration of the musculature, and the
absence of a strictly acute tumefaction of the spleen.

In doubtful cases the diagnosis is verified through microscopic examination
of the diseased muscles or the yellow foci in the liver and the kidneys, and through
injection of such material into test animals. For this purpose Wulff recommends
drying the piece of muscle in an air current at 30-32°C. and, after pulverization, to
heat the material 5 minutes in distilled water at 65°C. From a mixture made of
0.1 gm. of dried muscle substance and 10 ec. water, 0.002 ec. is sufficient to kill
guinea pigs by intermuscular inoculation. At the autopsy of such guinea pigs
numerous bacilli are found in the liver, which, however, never form chains (Foth;
forming of chains characterizes the bacilli as edema bacilli). On the other hand,
pigeons, rats and rabbits are never, or at least only exceptionally, killed by 0.01 cc.
of the emulsion.

Owing to the extreme rarity of blackleg in other kinds of animals, the diag-
nosis should always rest upon an exact bacteriological examination, because, other-
wise, confusion with pseudo-blackleg and malignant edema is liable to occur.

Treatment. The treatment of blackleg is hardly ever suc-
cessful and only consists in a local antiseptic treatment of the
swellings. For this purpose, it is advisable to incise the tumor
at several places and then press it out and wash the exposed dis-
eased tissue carefully and repeatedly with disinfecting liquids.
The most suitable for this are: 3% carbolic acid, 5% lysoformic
acid, 0.1% salicylic acid, 0.1% formalin solution, and tincture
of iodine, of which liquids the first ones should also be sub-
cutaneously injected at several places in the immediate sur-
rounding tissue.

If the swelling has developed in the middle of an extremity,
a bandage or other ligature may be applied above the tumor,
and the latter may then be scarified (Wallraff). Tolstouchow
obtained good results from applications of ice and snow, and by
rubbing with oil of turpentine.

Leclainche & Vallée recommend the treatment with immune
serum, of which first 60 to 100 ce. are injected into the jugular
vein, and thereafter this amount is injected every 2d to 4th
hour under the skin in the region of the shoulder. In the be-
ginning of the infection and in cases of a protracted course,
the results are said to be favorable.

Prevention. As the disease seems to be limited to certain
regions, and to certain places within those regions, especially
damp, swampy pastures, the cattle should be kept away
from such places. Through rational amelioration of the soil
(draining away the water, regulating the rivers, planting trees
and plowing) places which have been considered dangerous
may be made harmless. In Denmark, according to Jensen, the
Prevention. Immunization. BL

disease has decreased considerably in the course of the last
30 to 50 years, owing to such improvements of the ground.
When this is not practicable, and the danger of infection re-

mains, the appearance of the disease can be prevented by means
of protective vaccination; otherwise, the immediate change of
pee or stable often results in the disappearance of the
isease.

Immunization. Arloing, Cornevin & Thomas have stated
that cattle raised in blackleg districts mostly contract the disease
at a young age, while animals brought there from disease-free
regions are liable to be infected at an older age. This is ex-

lained by the supposition that the young animals, during their
stay in blackleg districts, become immunized early by repeated
absorption of smaller amounts of virus. When these authors
produced a mild attack of the disease by means of injection
of small amounts of virus, they also found that the inoculated
animals later resisted otherwise fatal infections. Based on this
experience they have devised.a very valuable and practicable
method of protective vaccination, which has since been modified
in many ways by other authors.

I. Two inoculations with attenuated virus. (Method of
Arloing, Cornevin & Thomas.). A vaccine is prepared from
diseased, powdered muscles by attenuating the virus through
heating to a high degree of temperature. For this purpose,
the diseased part of the muscle is ground in a mortar with some
water, and dried in a thin layer at 37°C.; then the dry mass
is mixed with 2 parts of water, and the one half heated at
100-104°C., the other at 90-94°C. for 7 hours. The former
makes the first weaker vaccine, the latter the second stronger
one.

The high temperature attenuates the virulence of the
virus, and the longer and stronger it has been heated the more
attenuated it becomes. The spores, however, in spite of the
influence of the heat, remain capable of germinating, but the
toxin having been weakened through heat, the spores are not
capable of exerting their pathogenic influence. Being to a cer-
tain degree protected against the phagocytes by the coagulated
albumin, the spores begin to germinate and to multiply slowly,
and thus little by little, the newly produced toxin immunizes
the tissues. The immunity reaches the necessary degree in 8
to 10 days after the second vaccination. Until then, however,
the animals have a lower resistance aganst an artificial or
natural infection (negative phase).

The practical value of the protective vaccination is already
definitely established. The first experiments proved that ani-
mals, vaccinated at the end of the tail, subsequently withstand
the intramuscular inoculation of a very virulent culture without
harm, and that the immunity obtained lasts at least 17 or 18
52 Blackleg. s

months. Later vaccinations on thousands of animals performed
in many sections have shown that the artificial immunity also
protects against natural infection. The vaccinations have re-
sulted in a large decrease in cases among vaccinated animals
(11 to 12 times fewer cases than among non-vaccinated animals) ;
besides in the infected localities the percentage of mortality has
decreased during recent years, which evidently is owing to the
fact that there have been fewer diseased carcasses and less
contaminated material to infect the ground. The protective
vaccination is now practiced with good results in those districts
where the disease usually appears as an epizootic.

The method was modified by Preisz so that the powdered muscle
substance is heated for 6 hours in live steam, and 0.05 gm. is used
for the first, and 0.10 gm. for the second vaccination.

In 1880, Arloing, Cornevin & Thomas subjected 13 head of cattle to protec-
tive vaccination at Chaumont before a commission; when these cattle were later inocu-
lated with virulent material they all remained healthy, while out of 12 non-vac-
cinated animals 11 acquired blackleg as a result of a similar artificial inoculation,
and 9 of them died.

According to Strebel, out of 82,550 cattle vaccinated during the years 1884
to 1898, in Switzerland, 0.75% contracted blackleg, while out of 35,400 non-vac-
cinated animals, kept under the same conditions, 2.6% succumbed. According to
another compilation by Strebel, during the years 1885 to 1894, out of 325,892 vac-
cinated cattle in various countries, 0.056% died from vaccination blackleg, and later
0.38% died from spontaneous blackleg. There were 129,705 vaccinated animals kept
during the summer on the same pasture with 240,560 unvaccinated animals; out of
the former 0.42% and out of the latter 1.76% were the victims of blackleg. Strebel
considers vaccination in the tail as less dangerous than in the shoulder, since with
the former, 23 out of 107,080 vaccinated animals (0.021%) and with the latter 181
animals out of 26,816 (0.67% or 31 times more) -died as a result of the vaccina-
tion. On the other hand, Suchanka at Salzburg was. satisfied with the vaccination
in the shoulder. In the canton of Berne in the years 1885 to 1908, out of 463,613
vaccinated animals 580 (0.125%) died after vaccination, and 1,915 (0.41%) in the
following 14 months (Belavoine). In the Austrian alpine regions, during the year
1909, 33,056 head of cattle were vaccinated, out of which, during the pasture sea-
son, 114 (0.345%) died, against 1.094% among the unvaccinated herd-mates.

In Hungary the protective vaccinations have had good effect both on the improved
breeds and on the native cattle. First the Lyons vaccine, and later Preisz’ vaccine
were used. According to Hutyra’s compilations, during the years 1893 to 1900, out
of 16,679 vaccinated animals 22 (0.13%) were lost. In the year 1907, out of 14,029
animals vaccinated in infected herds, 30 died after the first vaccination, and sub-
sequently by the end of the year 36 had died; on the other hand, in previously unin-
fected herds, the loss amounted to only 1 and 15 respectively out of 14,148 vaccinated
animals.

Technique of Vaccination. The 10 doses (1.0 g.) of vaccine contained in folded
paper-wrappers (yellow-red powder) are ground carefully with 5.0 cc. of sterilized
water in a small mortar, and the mixture is filtered through sterilized, moistened
linen cloth. The filtrate is drawn into a syringe 5 ec. capacity made for the pur-
pose, and the fluid kept agitated in order to avoid sedimentation. The piston of the
syringe is divided into 10 divisions; after filling the syringe the indicator is placed
at the 1st division.

According to the original French method (Lyons), the place of injection is on
the lower part of the tail; the first injection is made 3, and the second 2 hand-
breadths from the end of the tail. While the animal is secured at the head and
at the hind part, the tail is taken up with the left hand, the hair is shaved from
the site of injection and the skin disinfected; then the trocar going with the syringe
is pushed under the skin to the handle, thereby making a canal about 5em. long.
The trocar is then carefully withdrawn and in its place the dull hollow needle is
inserted, and one dose is injected into the canal. Then the needle is pulled out, the
place of injection pressed together with the left thumb, the syringe delivered to the
assistant, and the injected vaccine pressed upward by means of the right thumb;
finally, the tail is bandaged with a narrow linen bandage over the place of injection.
Immunization. 53

The bandage is removed after four hours, although it may safely be left on in cattle
kept in the pasture. After 10 to 12 days the animals are again vaccinated in the
same manner but with the stronger vaccine.

Many firms ship emulsions of the vaccine powder in sealed glass tubes for
immediate use. Such vaceine is easily contaminated and should be used as soon
as possible, but the powder vaccine keeps unchanged for months.

According to recent experiences, the vaccination, at least on the hardy range
cattle, may be performed behind the shoulder with the same results and more
conveniently (see, however, Strebel’s statistics). Here it is also advisable to per-
forate the skin by means of a trocar, while the bandage after the injection of
course is dispensed with. The second vaccination likewise follows 10 to 12 days
later, but on the opposite side of the chest.

It is advisable to apply the vaccination at the end of winter or in the
spring, if possible, before the cattle are sent to pasture. Otherwise the animals
are liable to be infected before vaccination, and the summer heat may cause
unpleasant complications after tail vaccination, according to the Lyons method,
because the animals do not keep the vaccinated part of the body quiet. Calves less
than six months old and cattle over 4 years old raised in blackleg districts, as well
as pregnant heifers in the last four weeks of pregnancy, should not be vaccinated.
Sucking calves are not immunized by the vaccination, and old animals as a rule do
not contract the disease.

Immediate results of the vaccination. Vaccinations if properly per-
formed only cause a slight local swelling at the place of injection, which rarely
is accompanied by general indisposition and only by a slight rise in the tem-
perature. Unpleasant complications are seldom observed and, as a rule, occur only
when the vaccination has not been performed with the necessary care and cleanli-
ness. Such complications, which usually appear 3 to 6 days after thc vaccination,
consist in necrosis of the 3 or 4 last vertebra of the tail, bending of the iail, forma-
tion of abscesses, inflammation, ete.

Protective vaccination of sheep. Scheibel vaccinated sheep successfully
with vaccine prepared from diseased muscles of sheep. The meat is dried at 30° C.

‘and ground; one half is heated at 100° C. and the other half at 85° C. for 6
hours; of this 1.0 gm. is used for every 20 sheep. The vaccination is performed, as
with cattle, near the end of the tail, and in docked sheep on the inside of the
leg. Such vaccinated animals prove immune against the infection with fresh diseased
muscle or blackleg virus.

II. One inoculation with attenuated virus. According to
experiments by Kitt, a powder prepared from diseased muscles,
after having been heated for 6 hours in dry air at 85 to 90°C.,
or still better, in live steam at 97°C., gives a suitable vaccine.
One injection of such vaccine into cattle immunizes them suffi-
ciently and lastingly, without causing conspicuous symptoms
of disease (the vaccine kills sheep in doses from 0.2 to 0.6 gm.;
smaller doses produce only slight fever).

This method which is conducted in the same way as vac-
cination with Lyons vaccine, except that the operation is per-
formed in one act, is especially to be recommended for vaccina-
tion of the more hardy native cattle, but it also gives satis-
factory results in the improved breeds which have less power of
resistance.

In Bavaria, during the years 1898 to 1906, out of 62,178 vaccinated head
of cattle 8 died shortly after the vaccination and 134 later, in all 0.22%, while in the
first 5 years, on the same pastures out of 23,324 non-vaccinated animals 398 or
1.70% died from blackleg (Kitt). In the years 1903 to 1905, out of 25,609 vac-
cinated animals 68 or 0.26% died later from natural infection. In Austria, accord-
ing to the official reports, in the years 1891 to 1894, 28,855 head of cattle were
vaccinated by one inoculation with the Kitt vaccine; out of those 47 or 0.16% died
from vaccination blackleg and 86 or 0.29% from spontaneous blackleg.

In Hungary, in the year 1892, Makoldy vaccinated 230 head of cattle from
1 to 4 years old by Kitt’s method, one-half belonging to the Hungarian-Sieben-
biirgen breed, and the other half to the Pinzgau breed. The vaccination itself
54 Blackleg.

caused no loss, and no case o. blackleg appeared among the vaccinated animais
during the following year. :

In the United States this method has been much in use since 1897, with the
modification however that Norgaard heats the dried ground muscle intended for vacci-
nation only to 93-94°C. The Bureau of Animal Industry sends out 114 millions of
doses of vaccine every year, and the resuits of the vaccinations have been favorable.
Thus, in the years 1907-08, out of 690,828 vaccinated animals 227 died within 48
hours after vaccination, 507 from 2 to 7 days after, and 2,734 later within a
year (total loss 0.50%). ;

In India, Holmes obtained the best results from one injection of a mixture
of the first and second Lyons vaccine, which by means of a particularly con-
structed syringe was placed under the skin in the shape of a pill.

III. Immunization with serum and attenuated cultures.
Kitt (1893-1899) obtained from sheep which had been treated
repeatedly with intravenous and later with subcutaneous in-
jections of muscle juice from blackleg tumors, a blood serum
which in 5 to 10 ce. doses protected sheep against an injection
of the virus made 3 to 8 days later, and 15 cc. injected into a
goat cured the already developing disease. According to later
investigations (1899), goats, cattle and horses also produce
similar active blood sera, and the last named animal partic-
ularly seems to be suitable for the purpose.

These results were later confirmed by Arloing, and still
later by Leclainche & Vallée; besides, the latter authors have
ascertained that blood serum and virus mixed together, or each
for itself when injected at the same time, do not immunize,
but that the successive application of blood serum and virus
affords a mode of immunizing, which may be used for practical
purposes.

The method which has so far peen tested only in France is as
follows: For vaccination two different vaccines are used. The one
is blood serum from horses, which, through repeated intravenous injec-
tions with bouillon cultures of the blackleg bacillus containing toxins,
have been highly immunized; the other is a bouillon culture of ‘the
same bacillus attenuated by being heated to 70°C. for 3 hours. First
the animals are injected with 10 to 20 cc. of blood serum, according to
their weight, in the region of the shoulder, and 5 to 6 days later a
second injection is given subcutaneously with 0.5 to 1.0 ce. of attenu-
ated pure culture at the same place or in the neck, ear or tail. This
form of protective vaccination may also be applied without hesitation
in already infected herds.

Leclainche & Vallée vaccinated in the year 1902, 447 head of cattle without
any direct loss, but subsequently one animal died from blackleg; later statistics
indicate 8 deaths among 7,987 vaccinated animals (0.1002%).

According to Leclainche & Vallée some of the animals on blackleg pastures
harbor the virus in the intestinal canal (latent infection), but they are protected
against its pathogenic action by the intestinal juices and phagocytosis; if, however,
such animals are inoculated with live, even attenuated, virus, the body thus attacked
from two sides, can no longer combat the infection. Through the preceding vaccina-
tion with serum, the resistance of the animal is increased to such a degree through
the production of passive immunity as to make it efficient even against the double
danger. This conception can hardly be recognized as correct in its present form,
because after vaccination of already diseased herds with live virus direct losses from
the vaccination are seldom observed. To the occurrence of such losses other factors
are contributory, particularly the relative susceptibility of the animal in comparison
with the degree of virulence of the vaccine.
Immunization. 55

IV. Protective vaccination with thread covered with spores.
(Method of Thomas.) Thomas, a veterinary surgeon at
Verdun, recommends a spore-containing vaccine, the prepara-
tion of which is not given (supposedly through growth in frog’s
bodies); with this vaccine silk threads (fils virulents, black-
legine) are impregnated which he introduces into the sub-
cutaneous tissue of the tail. In his opinion, this method is
more effective than the original Lyons method, because a
blackleg culture develops around the threads left under the
skin which exerts a continued immunizing action on the
organism (in an experiment with sheep, he found virulent
spores and bacilli between the silk threads 328 days after the
vaccination).

The vaccination instrument consists in a trocar fastened to a handle of wood
behind the tip of which is a eut for placing the silk threads. One dose of the
vaccine consists of 7 to 8 short threads which are fastened together at the ends
by means of a metal nipper. At the vaccination, after the threads have been placed
in the notch and the nipper is cut away, the needle is stuck deep into the sub-
cutaneous tissue near the end of the tail (in calves behind the shoulder) as nearly
as possible parallel with the surface of the skin, and immediately pulled out again,
whereby the threads slip off from the needle and remain in the depth of the vac-
cination canal. The vaccination is either performed twice with a weaker and a
stronger vaccine, or only once with the latter.

In America 135,000 head of cattle were vaccinated in the years 1899 and 1900
according to this method (one single vaccination). According to the reports of
the results, the vaccination itself caused no losses, while later, as a result of natural
infection, 0.4 to 0.7% of the vaccinated animals died.

Lately this method has also been used in Germany, and Warringholz obtained
good results in 406 and Witt in 700 animals; on the other hand, in Alsace-Loraine
(1901) 22 vaccinated animals out of 260 died, while in Hungary, Viasz lost 16 out of
70 vaccinated animals within 3 weeks.

According to investigations by Régn, the vaccine is very impure and con-
tains particularly a large number of staphylococci; in connection herewith, Guillebeau
frequently observed vaccination abscesses among cattle in the canton of Berne.

V. Other methods of immunization. It is also possible to
immunize cattle by means of other methods, which, however, are
little used in practice, and only deserve attention from a scien-
tific point of view.

1, Protective vaccination with non-attenuated virus. Cattle
may be immunized by subcutaneous injection of a small amount of
the juice from the swellings into parts of the body with low tem-
perature and dense subcutaneous tissue. The subcutaneous injection of
1 to 6 drops into the end of the tail causes neither local nor general
symptoms; 10 to 15 drops will cause an increase in temperature of
1.5°C., while 20 drops will cause a local swelling. The further away
from the trunk the injection is made the milder the symptoms appear ;
injections in the vicinity of the root of the tail, however, often cause
severe disease.

According to Arloing, the direct intravenous injection, although
it requires more manual skill, is the most favorable. It consists in
injecting 3 to 4 drops of the serous fluid of a swelling into a vein of
the animal, care being taken that none of the liquid gets into the peri-
vascular connective tissue. After a regularly performed vaccination,
general symptoms, such as a slight elevation of temperature and loss of
appetite, will appear, after the disappearance of which tie animal
56 Blackleg.

will resist a subsequent artificial or natural infection. The results of
these experiments are very favorable, but the operation requires great
care and skill, because, if some of the vaccine should locate in the
porous tissue of the neck, fatal blackleg will almost surely result
(Eloire). Intratracheal injection with fluid from the: swellings is
subject to the same consideration as to the immunizing effect and the
danger.

Poels used virulent cultures of blackleg bacilli for protective vac-
cination. As soon as the formation of spores has begun in the culture
small cotton pads are immersed and afterwards dried; at the time of
vaccination they are pushed under the skin of the tail where they
cause a violent, but harmless, inflammation. During the years 1904 to
1906, 21,329 calves from 2 to 10 months old were vaccinated in Hol-
land according to this method with an annual total loss of from 1.0
to 14% (Balavoine).

2. Protective vaccination with attenuated pure culture.
Kitasato found that fresh bouillon cultures more than 2 weeks old
or heated to 80°C. for half an hour did not kill guinea pigs, but im-
munized them effectively. Kitt had a similar experience (1894) with
subcutaneous injections of 1 to 5 ec. of bouillon culture in sheep and
cattle, which, 6 weeks later, resisted a virulent infection. Owing to these
favorable experimental results the method was used in practice for a
time. (In Austria, out of 7,434 cattle vaccinated during the years 1894
to 1895, 8, or 0.11% died as a result of the vaccination and 93 or 1.25%
from spontaneous blackleg.)

Leclainche & Vallée injected cattle subcutaneously with a 5 to 8
days old bouillon culture which had been heated at 70°C. for 2 hours,
whereafter the animals thus treated were subjected one week later to
a subcutaneous injection of 2.0 ec. of a very virulent culture without
any harmful effect. This single vaccination, however, has not been
kept up in practice, because out of 39 animals 4 died as a result of
the vaccination. Later the vaccination was performed in 2 acts, the
first with a culture heated for 3 hours to 75°C. and the second with
one heated to 68-70°C. The result this time was also unsatisfactory,
one animal dying after the first vaccination and six after the second.

Of the vaccine prepared by the sero-therapeutic institute at Toulouse 0.5 ce.
is injected into calves less than 6 months old, and 1.0 ec. into older animals, under
the skin of the ear or the end of the tail.

Detre recommends a liquid vaccine which he prepares by separating the
muscle fibers and albumin coagula from the spores and toxins in the Lyons vac-
cine, obtaining a liquid which contains the same active substances as the Lyons
vaceine. The spores and toxins attenuated through higher temperature at two
different degrees of exposure in a hypertonic solution of salt, are offered for sale in
the market, and the vaccine is said to prove its efficiency in practical experiments.

3. Immunizing with toxins. Roux succeeded in immunizing
guinea pigs against blackleg by repeated injections of 15-day old bouillon
culture heated to 115° C. or a filtrate of such culture, into the ab-
dominal cavity, and also by subcutaneous injection of a bacteria-free
filtrate of the juice of the swellings. Duenschmann obtained similar
results with only the filtrate of the juiee of the swellings from animals
that had died from spontaneous blackleg. Finally, Schattenfroh used
pure solutions of toxins from which the bacteria had been removed by
means of clearing powder, but with very unfavorable results, as 23
out of 306 vaccinated animals died from the effeet of the poison, and
40 to 50 more became very sick.
Immunization. Veterinary Police. Bradsot. 57

4. Protective inoculation with immune serum. In 1905 Grass-
berger & Schattenfroh injected about 800 head of cattle in Tyrol and
Lower Austria with serum from an animal which had been immunized
by means of toxin and afterwards with virulent material. The results
were unsatisfactory, inasmuch as 8 animals later succumbed to blackleg
when placed on infected pastures.

’

5. Immunization with toxins and immune serum. Grassberger
& Schattenfroh prepared a very effective antitoxic serum (0.0025 cc.
of serum neutralized 1.0 cc. of toxin) by treating cattle with their
toxin (page 43), 40.0 ec. of which killed young cattle, and used this for
vaccination after having mixed it with toxin. According to their ex-
perience immunity may be attained by means of such a mixture as
well as with toxin alone, the former, however, having the advantage
that it does not cause edema nor interfere with the general health of
the animal. The vaccination consists in one single subcutaneous injec-
tion with 5 to 10 cc. of the neutralized mixture of toxin-serum.
In the Austrian mountain districts, more than 4,500 head of cattle were
vaccinated in 1904 without direct loss, but later 78 died from natural
blackleg while at pasture.

Veterinary Police. Owing to the enzootic appearance of
blackleg in many regions, as well as to the considerable losses
caused by it, the disease has recently been made subject of
obligatory notification in several countries, among others Ger-
many and Austria. The legal methods of prevention are similar
to those employed for anthrax, special attention being paid to
the destruction of the carcass, and also to the indemnification
of the owner and the application of vaccination.

According to the results of the investigations of Sauer, hides from animais
having died from blackleg may be thoroughly disinfected by being placed for 10
days in a 1:1.000 solution of bichloride of mercury, 5% creolin or carbolie acid
solution, and also in freshly prepared whitewash.

Literature. Bollinger, D. Z. f. Tm., 1875, I, 297.—Feser, Z. f. pr. Vet. Wiss.,
1876, IV, 18; D. Z. f. Tm., 1880, IV, 371.—Arloing, Cornevin & Thomas, Le Charbon
sympt. du. boeuf, Paris, 1887.—Roux, A. P., 1887, I, 62.—Kitt, Chl. f. Bakt., 1887
I, 684, and 1888, III, 572; Monh. 1893, IV; 1896, VIII, and 1901, XIII (Review) ;
Hb, d. p. M., 1903, II, 600 (Etiology), and 1904, IV, 1001 (Immunization; with
literature).—Kitasato, Z. f. Hyg., 1889, VI, 105.—Leclainche & Vallée, A. P.,
1900, XIV, 202 and 590 (Lit.).—Thomas, Rép. de. pol. san., 1900, 31—Kerry, O. Z
f. wiss, Vk., 1894, V, 228.—Marek, Monh., 1896, VII, 489; 1897, VIII, 174.—Grass-
berger & Schattenfroh, Uber d. Rauschbrandgift, 1904.—Smith, Z. f. Infkrkh., 1906,
T, 26.—Scheibel, D. t. W., 1907, 61.—Balovoine, Diss., Bern, 1909 (Literature and
vaccination statistics).—Tillman, Diss., Bern, 1909.—Foth, Z. f. Infkrkh., 1909, VI,
201.— Wulff, Z. f. Tm., 1909, XIII, 241.

“Bradsot’’ of sheep (Gastromycosis ovis). This destructive dis-
ease of sheep occurs on the western coast of Norway, in Iceland, and
on the Faroe Islands of Denmark, in Scotland where it is known as
Braxy, also in Mecklenburg and Prussia (Peters, Dammann & Opper-
mann, Hilbrand). Ivar Nielsen established the fact that the disease
is caused by a specific bacterium which causes severe inflammation
especially of the abomasum and duodenum.

The disease (Bradsot, Braasot or Brosot—quick plague) is chiefly
observed late in the fall or winter when the sheep are driven from

!
58 Bradsot.

the mountain pastures to the farms and are pastured on lower lands
which have been infected by unburied carcasses. The disease also
oceurs frequently during ‘stable feeding in the winter, and exception-
ally in summer during pasturing. Yearlings are most susceptible, while
lambs and animals over 3 years old rarely become affected. Well nour-
ished animals appear more predisposed.

Frequently the course of the disease is very rapid, and the animals
die within a few hours. In the slower form a marked weakness is
observed. Later the animals pass into a comatose stage, grind their
teeth, respiration is difficult, and soon death results. In some cases
frothy saliva drips from the mouth, and frequently tympanitis develops
in association with colicky symptoms. R. Fréhner also observed swell-
ing of the head, throat and tongue, bleeding from the mouth, nose and
vulva, swelling and bluish-red discoloration of the vaginal mucous
membrane.

On post mortem the most conspicuous change is a severe acute
inflammation of the abomasum and duodenum, the mucous membrane

 

Fig. 18. Bacilli of Bradsot with Fig. 19. Bacili of Bradsot with
spores. Kidney fluid from sheep; flagella. (After Tokishige.)
staining by Gram. (After Jensen.)

and submucous connective tissue of which appear edematously swollen
and permeated with extensive hemorrhages which may sometimes be
necrotic. Similar changes are occasionally found in the small intestine,
whereas in some of the cases the autopsy reveals a general infection
with parenchymatous degeneration of all organs and a considerable
enlargement of the spleen, which may crepitate. A sero-hemorrhagic
exudate is present in the abdominal cavity, and gelatinous infiltration
of the subcutaneous connective tissue may be observed while the serous
fluid may also contain gases.

_ Bacilli 2.64 long, 1# thick which stain by Gram, may be demonstrated
in the affected mucous membrane and in the subjacent gelatinous con-
nective tissue, while in a general infection they are also present in the
blood. They frequently form chains, and mostly contain centrally located
oval spores, and may grow into long threads. The bacillus is supplied
with numerous long screw-like flagella (Fig. 18 and 19). It ig an anae-
robe and multiplies in the depth of the media, forming gas, and therefore
resembling the bacillus of blackleg. From this, however, it may be
distinguished by the formation of threads and chains. It is also patho-
genic for pigeons, chickens and mice (Jensen, Tokishige).
Bradsot. 59

_ -Subecutaneous injections of pure cultures produce only excep-
tionally a generalized affection in sheep when the clinical picture re-
sembles blackleg (hemorrhagic-gelatinous infiltrations and gas forma-
tion in the subcutaneous connective tissue and muscles). In most
instances only a local swelling develops which later disappears. Ani-
mals thus affected which recover later resist natural infection. Guinea
pigs, rabbits and pigeons are also susceptible. The natural mode of
infection is at present not known with certainty, but it is possible that
the infection occurs through slight injuries along the upper digestive
tract. After the appearance of the disease a change of pasture and
stable as well as a thorough disinfection of the premises is indicated.

Immunization. Nielsen used a heated powder made from kidney
tissue, containing numerous bacilli and spores obtained from sheep
which had died spontaneously. This method was principally employed
in Iceland, but with uncertain results. Tokishige, on the other hand,
proved that horses and goats treated intravenously with the virus
yielded a potent serum. Jensen worked up the three following methods:

1. Eight-day old spore-containing bouillon-serum cultures of the
bradsot bacillus are rapidly evaporated at 50°C., finely pulverized
and mixed with a small quantity of gum tragacanth. The dose
(0.005-0.03 gm.) must be established by test inoculations, as the suscepti-
bility of sheep varies in different breeds and ages. The immunity is
satisfactory, and no losses were observed from the vaccinations in the
Faroe Islands, while in Iceland they amounted to 1.5%.

2. Blood serum of horses immunized by intravenous injections of
virulent cultures (0.02 gm. serum protect guinea pigs against fatal
infection) is dried, pulverized and mixed with the vaccine described
under 1. For practical purposes a mixture of 0.005 gm. each of culture
and immune serum is used. :

3. Threads are placed in 3-4 weeks old dextrose bouillon cultures
and then dried at 40-50°C. These threads are inserted with a suitable
needle under the skin on the inside of the thigh and left there. The
practical results appear uniformly satisfactory. In some cases, how-
ever the acquired immunity was insufficient.

In Iceland and the Faroe’s about three quarters of a million sheep were vac-
cinated by these three methods previous to 1906. The losses in the first group
which included 208,805 animals amounted to 1.45% as a result of the vaccination,
and 0.32% later on. In the second group of 52,327 the losses were 0.03% and 1.93%
respectively. In the third group of 15,934 animals 0.03 and 4.65% succumbed, while
in the unvaccinated sheep it reached 4.21, 5.04 and 5.80% respectively (Jensen).

In opposition to the above conception of the etiology of the dis-
ease, Miessner believes it is questionable whether bradsot represents a
uniform disease, being rather a clinical-anatomical name for any dis-
ease in sheep which causes death within a few hours, and which
manifests on autopsy an extensive hemorrhagic inflammation of the
abomasum in addition to an injection of the subcutis. He also con-
cluded from his numerous bacteriological examinations of cases con-
‘sidered as representative of the disease, that the etiological significance
of the bradsot bacillus is very questionable, principally on the ground
that it has not been possible to produce the anatomical picture of the
disease with bradsot bacilli. He also failed as a rule in demonstrating
the mentioned micro-organism in fresh carcasses of animals dead of
the disease or which were killed shortly before the fatal termination.
He, however, failed to ascertain the true causative agent.
60 Bradsot. Reindeer Pest. Swine Hrysipelas.

Literature. Krabbe, D. Z. f. Tm., 1875, I, 34.—Nielsen, Monh., 1896, VIII, 55.
—Jensen, D. Z. f. Tm., 1896, XXII, 249 (Lit.); Hb. f. p. M., 1903, I], 680 (Lit.).—
Hamilton, The Vet. J., 1901, 286.—Peters, A. f. Tk., 1897, XXIII, 73.—Tokishige,
Monh., 1901, XII, 1—Hilbrand, Z. f. Infkrkh., 1907, III, 325 (Lit.).—R. Froehner,
Dz t. W., 1906, 359.—Miessner, Mitt. d. Inst. f. Landw. in Bromberg, 1909, I, 217
(Lit.).

Reindeer Pest. This devastating disease occurs periodically (the
last time in 1895 and 1896) among the reindeer herds of the Lap-
landers in northern Sweden and probably also in Norway. In such
outbreaks many thousands of animals, mostly calves, but also yearlings
and two year olds become victims of the disease. It usually rages dur-
ing the summer time when the animals drift during the warm weather
from the cool high pastures into the valleys. The etiology of the dis-
ease was established by Lundgreen (1897), and the virus has been
more extensively examined by Bergmann (1901).

The symptoms of the disease, which is usually fatal in from-6 to
12 hours, are excitement, inappetence, cessation of rumination, in-
creased thirst, staggering and uncertain gait, difficult and accelerated
respiration, cough, and particularly the appearance of edematous-
emphysematous swellings at various points of the body. The tem-
perature which is at first high, drops at the approach of death. There
is bleeding from the nose, and a very repulsive odor is apparent.

The post mortem examination reveals fluid containing considerable
gas in the subcutaneous connective tissue, as well as collection of gas
in the internal organs. In addition to a reddish transudate in ‘the
body cavities a yellowish discoloration of the liver and a moderately
acute swelling of the spleen may be observed.

From the subcutaneous serous fluid, the transudates of the body
cavities and the blood the reindeer pest bacillus, which resembles the
blackleg organism, may be obtained in pure culture. It is Gram-posi-
tive, motile, forms oval spores in the animal, and in artificial media
at a temperature of 30-38°C. It may be cultivated on the ordinary
media aerobically as well as anaerobically, and the growth is especially
luxuriant at body temperature, when a great amount of fetid gas and’
acid is formed; gelatin becomes liquefied.

By subcutaneous and intramuscular inoculation of pure cultures
the disease may be reproduced in reindeer. Sheep and guinea pigs
as well as mice and cattle are also susceptible to artificial infections,
whereas rabbits, hogs, dogs and chickens are tmmune. Natural infec-
tion probably results through wounds in the skin and intestinal mucous
membrane.

Inoculations of sheep into the tail produce only passive elevation
of temperature, and result in an increased resistance against an other-
wise fatal subeutaneous infection into the rump. Animals immunized
against reindeer pest are not immune to blackleg or bradsot.

Literature. Lundgreen, Z. f. Tm., 1898, II, 301.—Bergmann, Ibid., 1901, V,
241.

4, Swine Erysipelas. Erysipelas suis.
(Stabchenrotlauf, Rotlaufseuche [German]; Rhusiopathia suis,

Rouget du pore [French]; Red fever [English]; Antrace
eresipelatoso, Mal rosso [Italian].)

Swine erysipelas is an acute, septicemic infectious disease
of young hogs caused by a very fine, rod-shaped bacterium,
Occurrence. Etiology. 61

Bacillus erysipelatis suis, which is found in the blood of the
affected animals.

History. The disease which until the eighties was vot distin-
guished from anthrax was first studied by Pasteur & Thuillie: (1882).
These investigators did not establish the etiology of the diseas2, since
they accepted as its cause the eight-shaped bacterium which was first
recognized by Detmers. Nevertheless their investigations resulted in
the preparation of a satisfactory serum for practical immunizations.
The bacillus of erysipelas was discovered by Liffler in 1885, who
together with Schiitz differentiated the disease from hog cholera. The
differentiation had, however, also previously been made by Eggeling
from his clinical observations. Later the etiological knowledge was
advanced by the work of Lydtin & Schottelius, Bang, Jensen, Preisz,
Lorenz, Voges and Schiitz, while Lorenz, Leclainche and Schiitz worked
extensively on the problem of serum immunization.

Occurrence. Swine erysipelas occurs everywhere on the
European continent, and is usually prevalent in the infected
territory in summer, with varied severity in an enzootic
form, and not infrequently epizootically. During the last dec-
ades the disease has become more widespread as a result of
the propagation of pure-bred animals. The disease usually
appears during the warmer periods, increases in intensity
during the course of the summer, and abates at the approach
of autumn; whereas, during the winter only sporadic cases
are observed. .

In Germany erysipelas is very extensive. Since the inauguration of com-
pulsory reporting, the number of infected townships increased. from 8,491 in 1897 to
21,522 in 1907; and the number of individual infections in hogs from 33,950 to
75,619, of which 80% died or were killed. During the last years the disease raged
in the Prussian government districts, particularly in Posen, Oppeln, Bromberg,
Marienwerder, Liegnitz, and Breslau. :

In France the disease also occurs extensively. Optimistic figures show that
the annual losses amount to at least 100,000 hogs valued at over $1,000,000 (Nocard
& Leclainche).

In Austria the disease is more prevalent in Bohemia, Galicia; also in Moravia
and Southern Austria; while in the Alpine countries the erysipelas invasions
are very slight. During the period from 1891 to 1900 the number of infected
districts increased from 953 to 2,368; that of the affected animals from 9,286, to
14,891 (0.25 and 0.32% of all the hogs).

In Hungary the disease was hardly known three decades ago in the flut lands
around the river Tisza, but since that time it has become quite prevalent. In
the years between 1899-1908 the average number affected amounted to 30,757
hogs, but fluctuated between 7,624 in 254 townships (1899) and 56,455 in 1878
townships (1906). :

The disease is also widely spread in Belgium (annually about 2,000 cases),
in Holland 1,514 cases in 1908, in Denmark 330 new herds, in Russia 55,996 cases in
3,929 townships; further it prevails in the southern European countries, whereas
in Sweden and Norway it occurs more rarely, while in Great Britain only sporadi-
cally, and in a chronic form. The disease also occurs in the United States of North
America, but in the benign form mentioned. [Urticaria but not infectious swine
erysipelas occurs in the United States].

Etiology.. The causative agent, Bacillus erysipelatis suis
(Bac. rhusiopathiae suis, Kitt) is a very slender, straight or
slightly curved, non-motile organism which multiplies by
fission, and is from 1 to 1.5 long (1-4 to 1-5 the diameter of
62 Swine Erysipelas.

a red blood corpuscle, Fig. 20). In bacilli grown in cultures
fine Gram-positive granules may be demonstrated which are
considered by Fedorowitsch and by Rosenbach to be lasting
forms (protospores).

Staining. They stain readily with aqueous aniline dyes as well as
by Gram’s method.

Cultivation. The bacilli grow well on the ordinary
artificial media with the exception of potato. It is
aerobic as well as anaerobic and grows in cultures some-
times as long rods or curved threads. On gelatin plates
the cultures form whitish, cloudy, very fine flakes with
coarse granular centers, which spread out towards the
periphery, into a delicate thready meshwork. More
-rarely they form bright shiny, branching small colonies,
whereas in stabs pinhead sized, white points develop in
2 to 3 days which later fuse into grayish-white, cloudy
colonies, from which fine horizontal radiating branches
run in all directions of the gelatin (test tube-brush
shape, Fig. 21). On agar and on blood serum the
bacillus forms very fine
punctiform, dew-drop-
like colonies. Bouillon
is made slightly cloudy,
while later a fine, flaky
sediment forms on the
bottom of the tube. .

Smee aces mae

|
a

Tenacity. The ery-
sipelas bacilli manifest con-
siderable resistance towards
harmful influences, which

: mer probably owe to a wax- a
ae ASS like capsule (Schiitz & .

Voges). Drying kills them Fig. 21. Gela-
only gradually as they re- tin stab culture.
main alive when subjected Of Swine ery-
to a temperature of 37°C, SiPelas bacilli.
; . ; for 31, and to direct sun-
light for 12 days (Sirena & Alessi). Heating to 70°C. destroys them in about 5
minutes. Pieces of meat not over 15 cm. thick require 24% hours boiling for a
complete sterilization (Stadie). Putrefaction does not destroy the bacilli in meat in .
4 months (Stadie). Salting and pickling destroys them very slowly; pieces of meat
and bacon may contain the virulent bacilli after lying in pickle for 170 days, and in
a mixture of salt and saltpeter for 30 days, while in smoked ham virulent bacilli were
found even after 3 months (Petri). On the other hand, continued smoking for 2
weeks or shorter periods of smoking once repeated destroys the virus of erysipelas
in pieces of pickled meat not over 214 kg. in weight (Stadie).

Of the disinfectants the following are effective: Chlorate of lime (1%), hot
lye (1%), soda (5%), iron sulphate (83%), copper sulphate (44%), corrosive
sublimate (.1%), carbolic acid, creolin and lysol (Petri).

  

Fig. 20. Bacilli of swine erysipelas.
Smear prepared from blood of a
hog.. Gram-eosin staining.

Pathogenicity. Pure cultures inoculated subcutaneously
kill white and gray mice as well as pigeons in 2 to 4 days. In
rabbits the inoculation produces erysipelas-like reddening and
swelling at the point of inoculation, which is occasionally fol-
lowed in 5 to 6 days by a fatal general affection. In hogs an
inunction of virulent bouillon cultures into superficial wounds
Pathogenicity. Natural Infection. 63

of the skin as well as subcutaneous injection produces a typical
affection of erysipelas which terminates fatally in 6 to 9 days
(Preisz). The feeding of cultures also makes hogs ill (Corne-
vin, Kitt), but this mode of infection is not always successful.
Other animals cannot be infected. Repeated passage of the
bacilli through the body of hogs increases their virulence for
hogs (Schiitz), and passage through pigeons results similarly
for mice (Stickdorn), while the virulence is gradually dimin-
ished by continued cultivation.

Natural infection usually occurs through the intestinal
canal, more rarely through injuries to the skin. The greater
frequency of the infection per os is proven by the presence of
the bacilli in the intestinal contents of affected hogs, also by the
numerous affections which occur in a herd. The infection may
also occur through the uninjured intestinal mucous membrane.
Injuries such as those from the echinorhynchus, however, facili-
tate infection. ;

_Food and drinking water are usually the carriers of the
infective agent, and become readily contaminated through feces
or excrement, urine and other offal of affected. animals. The
infection may also occur through the ingestion of blood and
meat of dead or slaughtered hogs.

The disease is introduced into territories which have been
free from the infection, and is thus spread mostly by animals
sick or dead of the disease, or by their products. The bacilli
are present both in the blood and the excrement of the affected
animals, of which the infectivity has been established by the
experimental work of Cornevin and Kitt. The infection is
present in the excrement even when the hogs are infected
through the skin. Therefore the bacilli reach the lumen of
the intestines through the blood. The urine of affected animals
may also contain erysipelas bacilli. Therefore pastures in
which affected animals have been kept or fields which have been
fertilized with the manure of such hogs are particularly dan-
gerous. The annual occurrence of erysipelas in herds which
have been exposed to such pastures or fields is thus readily
explained. On the other hand, pastures are frequently con-
taminated by improperly buried carcasses, especially since the
carcasses of such animals are frequently dug up by dogs and
hogs which scatter the infection over the pastures. If dead ani-
mals are thrown into flowing water the infection is transmitted
to herds of hogs which are pastured along the banks of the
stream.

Peddling of hogs and hog markets greatly aid in the dis-
semination of the disease, inasmuch as affected animals driven
over the roads contaminate the roads and the halting places -
with their manure.

The infection is further spread through the meat of hogs
slaughtered in emergency, particularly when healthy animals
64 Swine Erysipelas.

are given water in which contaminated meat has been washed.

The spread of the disease is also frequently brought about
by wandering gypsies who carry the carcasses given to them, or
which they dig up, from one town to another, at the same time
scattering the viscera in the pastures. Furthermore, butchers,
hog herders and castrators may spread the infection, particu-
larly through utensils and containers in which meat and meat
offal have been kept and which have afterwards been used in
feeding or watering.

By the findings of Olt, Jensen, Bauermeister and Pitt it has
been proven that true erysipelas bacilli may be present in the
intestinal canal, particularly in the secretion of the tonsils as
well as in the mucous plugs of the ileo-cecal valve of healthy
animals. .It is therefore possible that on the one hand the
contagion may be spread through healthy hogs, while on the
other the disease may break out in healthy herds without a
direct introduction of affected animals or products originating
from them. Healthy carriers of bacilli may thus become
affected, if through weakening influences such as cold, heat,
starvation, etc., their normal resistance is reduced, and the
bacilli which were present in the intestinal canal may then set
up the disease process.

In examining the intestines of 66 animals Pitt found the true erysipelas
bacilli in 26 cases, and 28 times in 50 tonsil examinations. He believes that through
their presence the hog becomes gradually immunized which explains why animals
strictly guarded from exposure have been found to possess a lower resistance,
such animals becoming severely affected if exposed to infection in spite of all pre-
cautions.

In territories once infected, erysipelas usually recurs
almost annually, although with varying intensity, provided that
in the meantime no measures have been undertaken for its
suppression. This fact also proves that the infection may
remain virulent in the soil and in stable floors for a considerable
length of time. It will multiply in the summer time and infect
young hogs which will then reinfect the soil with their excre-
ment and carcasses.

The bacillus of mouse septicemia (Bac. murisepticus) which cor-
responds morphologically and in its cultural characteristics with the
erysipelas bacillus, and which has been formerly distinguished from
the latter by its very slight virulence for hogs must at the present
time be considered identical with the erysipelas bacillus or as an at-
tenuated variety of it. These conclusions were reached by Jensen,
Lorenz, Loffler and Prettner, who proved that animals immunized
against erysipelas are also immune against the virus of mouse septi-
cemia and vice versa. As the virulence of the mouse septicemia bacillus
may increase under natural conditions, and as it has been repeatedly
found in stagnant, polluted water (Koch), in putrefactive meat
(Johne), and in blood of cattle (Preisz), it is possible that the mice
affected with septicemia contribute to the dissemination of erysipelas.

Rohrbach has recently (1909) been inclined to consider the bacillus of swine
erysipelas and mouse septicemia as two different micro-organisms, and to group
Susceptibility. Pathogenesis. 65

them with the erysipeloids of man in a special class (Erysipelotriches: Erysipelothrix
porci, EK. erysipeloides and E. muriseptica). This conception, however, appears to have
insufficient foundation as the morphological differences are only slight and since
the variance in the rapidity of their growth in artificial media is pronounced. (The
quickest growth is obtained with the mouse bacillus; less rapid is the Bac. erysipe-
loides, while the slowest is the erysipelas bacillus). Stickdorn observed similar dif-
ferences in the erysipelas bacillus after passage through mice and pigeons in
spite of the fact that serum examination showed no differences in the strains or
species; and Overreck also found that the erysipelas bacillus and the mouse bacil-
lus agglutinate practically uniformly (1:2000 to 4000) when the organism of the one -
is applied to the immune serum of the other.

Schipp found a bacillus in the blood of a chicken which was identical with
the erysipelas bacillus. On that particular farm many animals died in a short
time and the autopsies revealed principally an enteritis and a parenchymatous de-
generation of the heart muscle. The same author also isolated a bacillus from the
spleen of a cow which died with symptoms of anthrax and which on autopsy re-
vealed only petechiae on the serous membranes and on the heart. This organism
corresponded morphologically and culturally with the erysipelas bacillus. It was,
however, pathogenic for field mice and was not influenced by erysipelas sera. As
a secondary finding erysipelas bacilli were also obtained from a cow which died
from vaginal diphteria and septic metritis, and by Hiuser in diphtheritic mem-
branes of chickens. .

Susceptibility. Hogs are particularly susceptible to nat-
ural infection between the ages of three months and one year.
Sucking pigs manifest a higher resistance while animals over
one year old become only exceptionally affected as they have
probably acquired immunity during their earlier life.

According to Lydtin the English breeds are more suscep-
tible, particularly the Suffolk and Poland China breeds, while
Yorkshires are less susceptible. The German hogs are highly
resistant, while the Hungarian breeds (Mangalicza) occupy a
middle position in the order of susceptibility. The disease usu-
ally rages more severely among imported hogs than in the
hogs which have been raised in the infected locality. The
disease has not yet been established in wild hogs.

Pathogenesis. The entrance of highly virulent erysipelas
bacilli in large quantities into the intestinal canal of healthy
hogs will reduce the normal resistance of the animals, and on
the other hand the entrance of such bacilli will promote the
pathogenic action of such bacilli as were already present in
the intestinal canal, by their weakening influences upon the
system. ‘Their penetration into the depth of the intestinal
mucous membrane is facilitated by injuries through intestinal
parasites (strongylids, echinorhynchus gigas), whereupon they
multiply in the lymph spaces of the tissues, enter the lymph
glands and finally the blood circulation. The bacilli which enter
the blood in this manner or through injuries in the skin will
continue to multiply there, and then they accumulate in large
masses in certain blood vessels, producing weakening of the
vessel walls, serous transudations and small hemorrhages
probably by the action of the metabolic products. The
reddening of the thinner parts of the skin may be
traced to this cause, whereas the necrosis of the skin which
occasionally occurs is the result of the obstruction of the blood

5
66 Swine Erysipelas.

vessels. The accumulation of the bacilli in certain parts is
probably favored by their being engulfed by leucocytes which
then adhere to the intima of the vessel. In chronic cases when
they become attached to the valves of the heart they produce an
affection of the valvular tissue (endocarditis verrucosa s. bacil-
losa) or a bacillary thrombosis develops in some of the vessels
of the corresponding valves.

In some cases especially those in which the bacilli are not
very virulent, their multiplication occurs only in the lymph
spaces of the skin whereby reddening of the skin with circum-
seribed edema develops (urticaria, diamond-skin disease) which
symptoms disappear after the death of the bacilli.

These changes prove that the erysipelas bacilli produce toxins in
the body tissues, and in cases of general infection the fever, depres-
sion, paralysis and finally death may also be traced to the action of
the toxins. This is substantiated by the experience that hogs some-
times die as a result of a cutaneous infection with the symptoms of
the disease, yet bacilli are only found at the point of inoculation and
in the immediately surrounding tissue (Preisz). Until the present
time, however, it has been impossible to demonstrate toxic substances
either in artificial cultures of erysipelas bacilli or in the carcasses of
animals succumbing to the disease. (According to Petri & Maassen,
erysipelas bacilli produce toxin in media containing hydrogen sulphide.)

Anatomical changes. In the acute form of hog erysipelas
the post mortem on animals which have succumbed to the
disease shows in most instances only slight changes in the inter-
nal organs. The mucous membrane of the stomach, particularly
at the pylorus, shows an infammatory swelling, reddening, and
numerous small hemorrhages. The surface is covered with a
sticky, glassy mucus. The mucous membrane of the small intes-
tine, especially in the duodenum and ileum, appears catarrhal
and congested. The solitary follicles and Peyer’s patches are
also swollen, the superficial layer of the mucous membrane may
sometimes show desquamation and even ulceration (Schotte-
lius). Small ulcers also occur on Bauhin’s valve as well as
in the large intestine.

The spleen is usually only slightly swollen and congested.
The liver and kidneys show indications of cloudy swelling; the
cortical substance of the latter is mostly darker and often
mottled by dark red points (glomerulonephritis). The lungs
are hyperemic and edematously infiltrated; sometimes they are
atelectatic at their borders as a result of catarrhal inflamma-
tion. All the lymph glands are markedly swollen, rich in blood
and fluids. The serous membranes may be covered with fine
fibrin membranes. Small hemorrhages also occur with relative
frequency on the serous and mucous membranes, under the epi-
and endocardium as well as in the subcutaneous connective
tissue. :
Anatomical Changes. Symptoms. 67

Haase found, 2 to 4 weeks after the disappearance of the disease, small dark
red areas in the kidneys and in the later stages, purulent nodules, sometimes accom-
panied by extensive inflammation of the kidney tissue.

_ The blood vessels, corresponding to the red spots of the
skin, appear dilated, filled with blood, while the skin and sub-
cutaneous connective tissue is edematously infiltrated and
studded with small hemorrhages. The muscles either appear
healthy or they are grayish red and lustreless, while the inter-
muscular connective tissue may be edematous. In rare cases
certain parts of the body (ears, tail, nostrils, etc.) or larger
areas of the skin may be necrotic (e. g., on the back).

In the chronic form the disease manifests an endocarditis
(verrucosa or ulcerosa) in the majority of eases. In one or
more orifices of the heart, particularly in the left arterial ori-
fice, the convex surface of the valves is covered with a cauli-
flower-like fibrin coagulum which sometimes reduces the orifice
to such an extent that it is hardly possible to insert the quill
of a pigeon feather. After the removal of the fibrin deposit
small wart-like vegetations or ulcerations appear on the thick-
ened valve. Such carcasses also manifest the secondary changes
which are usually produced by affections of the heart, such as
hydrothorax, passive hyperemia of the lungs, liver and spleen,
infarcts of the kidneys, ete.

In some cases the autopsy also reveals chronic enteritis,
hypertrophy of the lymph glands (without necrotic areas),
small necrotic foci in the liver and chronic inflammation of the
serous membranes as well as of some of the joints.

The bacilli may be demonstrated easily in acute eases in the blood in the
capillary vessels of the internal organs (especially spleen, liver and kidneys), in
the lymph spaces of the skin, and the subcutaneous connective tissue, in thé red
areas of the skin and plaques, as well as in the regional lymph glands, In the
blood they are present either free in the plasma-or inclosed in the leucocytes. In
chronic cases the bacilli are usually only present in the affected tissues, particularly
in the valves of the heart and in the fibrin coagulum as well as in the bile where
they remain for a longer time even after the acute affection has subsided (Kitt).
With Gram’s stain they may be demonstrated even in putrefactive tissues (Opalka,
Rosso). However, it is advisable to cover the parts of organs with salt in order to
prevent putrefaction when shipped for laboratory examination.

Symptoms. The time of incubation of erysipelas after arti-
ficial inoculation is 3 to 5 days (Preisz, Kitt). After natural
infection from the ingestion of infectious meat or of contami-
nated water the first indications of the disease appear as early
as 24 hours, otherwise the time of incubation is usually 3 to
5, and exceptionally probably as long as 7 days.

The clinical symptoms show a considerable variance in
different cases; in general the following three readily distin-
guishable forms of the disease may be observed which may also
differ from each other in their course.

1, Urticaria (Diamond-skin disease) represents the mild-
est form of erysipelas. In its course the animals show after
1 to 2 days a disturbance of their general health, and sharp
68 Swine Erysipelas.

circumscribed, round or more frequently quadrangular or rhom-
boidal spots develop in various parts of the body, especially on
the chest and back, outside of the thighs and on the neck, but
sometimes over the entire body, which are warm to the touch
and dark red or violet in color. Later they appear elevated
above the surface of the surrounding skin as much as 2 to 3
mm. The center usually becomes pale while the border retains
the bright color. In other cases the raised parts remain red
and even become darker, while on their surface a serous fluid
exudes, which raises the epithelium in the form of small vesi-
cles which later dry to crusts. As a rule the plaques are of
dollar size, but by their confluence swellings may be formed as
large as the palm of the hand.

The development of the eruptions is usually associated
with fever (up to 42.8° C.), dullness, loss of appetite, thirst,

 

 

 

 

 

Fig. 22. Swine erysipelas. Gangrene of the skin of the back.
(After Schwarzbart.)

constipation, conjunctivitis, sometimes symptoms of paralysis
and nausea. After the development of the eruptions the symp-
toms diminish. Soon afterwards the eruptions also disappear,
and after 2 to 3 days, sometimes however only after 8 to 12
days, the animal recovers.

In some of the cases the changes in the skin take on a
malignant character. On the parts of the body mentioned,
more frequently, however, on the ears, head and tail, the skin
swells considerably in certain spots, becomes dark red and
warmer; soon these places become insensitive, cooler and
dry, and finally become separated from the surrounding and ,
underlying tissues, or the animal loses one or both ears, its
tail or distal digits. Sometimes the inflamed skin over the back
dies off in its entire extension so that it covers the upper part
of the body in the form of a shield (Fig. 22), and gradually
loosens from the borders and is east off. The resulting raw
surfaces heal later should the animal remain alive, causing dis-
Symptoms. 69

figurement in the form of thick, sometimes cartilage-like
cicatrices.

In some cases an erysipelatous endocarditis develops after
the disappearance of the eruptions which terminates fatally,
or a paralytic condition results which may remain for a longer
time.

Jensen (1891), Lorenz, Liipke and others found in urticaria the
erysipelas bacillus in the lymph spaces of the affected parts; on the
other hand, Markus succeeded in producing a verrucose endocarditis
as well as kidney infarcts in a pig by intravenous injection of 2 ce.
of a bouillon culture which was derived from a dermatitis, while
Schiitz observed urticaria in ordinary country hogs and erysipelas in
English, breeds after the injection of the same culture. Jensen and
Lorenz proved the presence of the erysipelas bacillus in the lymph spaces
of the chorion to be a cause of dry gangrene.

2. Erysipelas septicemia. In this, the most frequent form
of the disease, the animals suddenly cease to root and to run.
They lie exhausted and dull upon the ground, they crawl under
the straw in the stall and when caught they do not squeal or
show the usual resistance. They show inappetence, nausea and
vomiting. The body temperature rises even at the onset very
high (up to 41° to 42° C.) and remains practically constant.
The eyelids are frequently edematously swollen, the conjunctiva
is injected, the canthus of the eye is filled with a slimy: secre-
tion. At first there is constipation, later, however, diarrhea
appears, when the animals pass frequently soft, mushy, later
entirely fluid stools, which are light gray or dark brown from
the admixture of blood.

On the second day, rarely earlier, or only immediately
before death the characteristic reddening of the skin appears
on various parts of the body. On the abdomen, the inner sur-
face of the thighs, in the axillary region, sometimes also on
the neck and ears, various sized, irregular, pale red spots
appear, which later take up a darker and brighter color, and
confluate.. The skin over the affected areas is only slightly
swollen if at all, and not painful. The redness disappears when
pressure is applied but returns when it is removed. In a few
cases hempseed sized vesicles containing a serous fluid de-
velop on the surface of the spots which later dry and form
brownish crusts. Exceptionally gangrene of the skin is ob-
served in some parts, especially on the ears, nose and the point
of the tail.

In severe cases in addition to the described symptoms there
are weakness of the hind quarters, cyanosis of the mucous
membranes as well as manifestations of pulmonary edema. As
the symptoms become more progressive, a sudden drop of tem-
perature follows, and finally the animals die in 3 to 4 days.
Exceptionally death results at the end of the first day or then
only after 8 to 9 days. In milder cases the intensity of the
70 Swine Erysipelas.

symptoms diminishes from the second to the third day on,
whereupon the animals recover in a short time, or, on the other
hand, a chronic type of the affection ensues.

In France, according to Cagny, they distinguish a mild and severe
form of acute swine erysipelas; to the latter belongs the ‘‘rouget foud-
royant’’ which terminates in a very short time in death, and the
“‘rouget blanc’’ in which death results so quickly that the reddish
coloration of the skin cannot develop (also observed by Zschokke in
Switzerland).

3. Chronic erysipelas. It occurs most frequently as
chronic erysipelatous-endocarditis in animals which have recov-
ered from the acute affection. After the disappearance of the
acute manifestations the pigs are usually lively and have a good
- appetite for a time, but on careful observation it may be no-
ticed by comparison that they are stunted in their development.
After 6 to 12 weeks they eat less, are dull, dislike to move
around, and lie down much, and almost always on the sternum
and elbows. In the meantime a cough, accelerated and super-
ficial respiration as well as a bright red discoloration of the
skin, ears, neck and sometimes the rump, is observed. If the
animal is urged to move about the dyspnea and cyanosis in
a short time become more marked. The heart action is in-
creased, at times pounding, and may be easily detected over
the region of the heart. The pulse is threadlike; besides this,
instead of one, mostly the systolic, or both heart sounds, a
blowing or harsh murmur may be heard (endocarditis verru-
cosa, stenosis of theeorifices). The body temperature is nor-
mal or sometimes increased from one to one and a half degrees.

With such manifestations the animals may live for several
weeks. However, they become emaciated, very weak, a crusty
eczema frequently develops on the skin and even paralysis of
the hind quarters may result. (According to Eisenmann, the
duration of the disease in four cases was 34 to 112 days.)

As a particular form of chronic erysipelas Cornevin, Hess
and recently Eisenmann describe an affection which is in gen-
eral only manifested by chronic debility. It develops several
weeks after the acute affection and consists principally in
accelerated and difficult respiration, digestive disturbances,
emaciation, hemorrhages and ulceration of the buccal mucous
membrane, hemorrhages into the hair follicles with subsequent
falling out of the bristles, eczema or also necrosis of the skin,
edema of the extremities as well as serous inflammation of the
joints and tendons which may later result in deformity (most
frequently the hip joint).

Course and Prognosis. The urticaria of erysipelas termi-
nates as a rule in recovery. Excteptionally, however, manifesta-
tions of a general infection or a chronic disease may develop,
when it results in death. The septicemic form terminates in the
majority of cases in death, but the number of fatalities varies
Course and Prognosis, Diagnosis 71

within wide ranges in different years and territories. In Hun-
gary it fluctuated in the last ten years between 53.2% and 83.8% ;
-according to Friedberger & Frohner the average loss amounts
to 50-85% ; according to Lydtin to 50-75%. Chronic erysipelas
always terminates fatally.

If, in the acute cases, the affection lasts over four days, it
is a favorable indication; otherwise the disease takes a threat-
ening character particularly in poorly nourished and badly de- °
veloped young animals. Complete recovery is sometimes very
slow and takes place only after several weeks. In most cases,
however, the convalescence lasts only a few days. Nevertheless
there always exists the possibility that the chronic form of the
disease may develop.

Diagnosis. The septicemic form of erysipelas may be
especially easily mistaken for swine plague and hog cholera,
but these diseases may be distinguished from it by their usual
slow course as well as by the predominating affection of the
lungs and intestinal tract, or by the development of symptoms
indicating a diphtheritic inflammation of the throat. Red dis-
colorations may occur in the course of the above diseases but
they result usually from hemorrhages and therefore do not
disappear on pressure. On autopsy erysipelas is distinguished
from the peracute cases of hog cholera and swine plague only
by the more pronounced hemorrhages, whereas from the more
frequent chronic cases it can be differentiated by the necrotic
pneumonia and fibrinous pleuritis or round intestinal ulcers,
further, by the extensive exfoliation of the intestinal mucous
membrane and caseation of the lymph glands which do not
occur in erysipelas.

. Anthrax, which rarely occurs in hogs, is differentiated from
erysipelas by the frequent swelling in the region of the neck
and the difficulty in swallowing, on post mortem by the charac-
teristic affection of the tonsils as well as by the difference in
the bacteriological findings. Wound erysipelas occurs only on
the head when the reddened skin is greatly swollen and painful
and the temperature higher. The cerebral hyperemia which
causes death during transportation in the warm weather is
characterized by sudden death of animals which were well only
a short time previous, and usually occurs in older and well-
fattened. animals. The autopsy reveals marked lesions of
asphyxiation. On the other hand, there are no lesions of
gastro-intestinal inflammation, or of acute swelling of the lymph

lands.
? The erysipelatous nature of urticaria, is indicated by the
preexisting general symptoms of the infection, whereas chronic
erysipelas is distinguished from other similar affections (rheu-
matic arthritis, catarrhal pneumonia, chronic swine plague)
only by the post mortem lesions.
72 Swine Erysipelas

In doubtful cases, especially if acute swine plague be suspected,
the diagnosis of erysipelas can only be assured by microscopical demon-
stration of the erysipelas bacilli in the blood or in the tissue of the
spleen, kidneys or lymph glands, and if necessary by subcutaneous
inoculation of such material into mice or pigeons. (See also diagnosis
of swine plague.)

In shipping material to laboratories for examination, squeeze preparations or
thin smears from the spleen or kidneys should be made, as according to Joop,
the virulence of the bacilli of such material is retained for 10 to 12 days, while they
remain alive from 16 to 18 days.

Treatment. In acute cases the treatment with immune
serum gives the best results, provided the animals are treated
immediately after the onset of the disease, as the injections
when undertaken not later than 6 to 12 hours after the appear-
ance of the first symptoms, exert a curative action in many
eases (Leclainche; according to Schiitz the serum destroys the
bacilli which are present in the body or which may enter the
body later). The blood serum is the same as is used for pro-
tective inoculation (see page 76), only it is necessary to use
considerable amounts; 10 to 30 cc., according to the body
weight, should be injected subcutaneously; it is also advisable
to repeat the treatment every 6 to 8 hours until the appearance
of a decided improvement.

In Germany 1315 hogs affected between 1897 and 1901 with erysipelas were
treated with Lorenz’s serum, of which 1111 that is 84% recovered, of 656 affected
animals treated with susserin 535, that is 82%, recovered. In Hessen 1451 out of 1570
treated animals, that is 92.5%, recovered between 1901 and 1903 (Lorenz); in Hol-
land 88.3% of 5830 animals were successfully treated (Wirtz); in Hungary Detre’s
serum was employed in 1903 on 711 animals of which 677, that is 95%, recovered;
and since then results have also been favorable in different localities in which
the serum treatment has been employed. According to Nocard, in France 8483
hogs affected with erysipelas had been successfully treated up to 1901 with Le-
clainche’s serum.

The symptomatic treatment has hardly any beneficial influ-
ence upon the disease. Nevertheless, the occasional internal
administration of remedies which possess an intestinal disin-
fectant action may be tried, and for this purpose is recom-
mended; calomel (2-3 gms.; only in the early stages of the
disease, as later when the kidneys are affected it is harmful),
ereolin or lysol (5% solution in tablespoonful doses), which
may be given with mild cathartics. Besides, the nervous system
may be stimulated by douches and washing with cold water.

Prevention. The fact that the erysipelas bacilli remain as
_saprophytes for a long time in the ground in infected localities,
and that they are also frequently present in the tonsils as well
as the intestinal canal of healthy animals, renders the com-
bating of the disease very difficult. As, however, the infection
is most successfully conveyed by affected hogs and their car-
casses, healthy animals must in the first place be protected from

¢
Prevention, Immunization 73

this source of danger. Accordingly, healthy animals should be
separated from the affected ones, and they should be kept from
contaminated pastures and stables. Carcasses should be deeply
buried, or still better cremated. Infected stables and premises
should be properly disinfected, and the excrement of the
affected animals collected and destroyed. Infected pastures
should not be used as ranges for swine for a long time.

If the disease has already appeared in a herd it is advisable
to place the apparently healthy animals in an unsuspected
pasture, or in the absence of such, pasturing should not be per-
mitted until the complete disappearance of the disease; in this
way it is frequently possible to eradicate the outbreak. Inas-
much as the infective agent is present in all parts of the emer-
gency slaughtered hogs the disease may be disseminated by
the marketing of such carcasses, and therefore the sale of meat
_ of such carcasses should not be permitted until it has been

sterilized. Such a procedure appears the more advisable, as
according to Petri’s and Stadie’s investigations ordinary con-
servation of the meat and the products prepared therefrom
(salting, pickling, smoking) destroys the erysipelas bacilli only
after a long time. (See page 62.)

When the possibility or even probability of an infection ex-
ists, the occurrence of the disease may be successfully pre-
vented by means of protective inoculation.

Immunization. One attack of erysipelas conveys immunity
to hogs against later natural infection. This experience would
also indicate that the artificially produced mild affection affords
a similar immunity. This idea was practically demonstrated
by Pasteur in 1882 by inoculations of artificially attenuated cul-
tures, while later Lorenz as well as Leclainche established the
value of protective inoculation with immune serum and cultures

in practice.

I. Protective inoculation with attenuated cultures (Pas-
teur’s method). Pasteur showed in his experiments that the
passage of erysipelas virus through the body of rabbits in-
creases its virulence for these animals. On the other hand, it
reduces it for hogs, so that the inoculation with such virus in
the latter animals causes only a slight febrile disease. Virus
attenuated up to a certain degree retains this degree of viru-
lence even if transferred from the rabbit hlood to a suitable
artificial medium, for instance, bouillon and if further cultivated
at body temperature. The bouillon culture attenuated by the
above method produces the vaccine which is injected subcu-
taneously into young pigs in form of a weaker and a stronger
modification.

The effectiveness of Pasteur’s protective inoculation has
been positively established. Besides Pasteur, Schiitz, Schotte-
lius and others found that vaccinated hogs cannot be infected
74 Swine Erysipelas

either by subcutaneous injections of highly virulent virus nor
by feeding with organs from animals which died of erysipelas;
on the other hand, the experiences made in practice proved
that the immunity produced by the inoculation, protects the
animals against natural infection.

In Hungary the considerable losses caused by erysipelas have been
reduced to 1 to 2% in formerly badly infected herds. In the great
majority of cases erysipelas has not caused losses either immediately
after the inoculation or later during the favorable summer weather
among the vaccinated animals, whereas among the control animals
which were not vaccinated, the disease raged, and in many cases the
vaccination suppressed already existing outbreaks. The age of the
animals influenced the results of the vaccination in such a way that
the inoculation failed to produce in the sucking age a sufficient im-
munity or none at all; on the other hand, it has not proven dangerous
in animals even up to 3 years of age. The vaccinated animals were
partly of the native Mangalicza breed. However, animals of the Poland--
China and Suffolk breeds were also vaccinated with the same beneficial
results (Wirtz also found that vaccination of the Mangalicza breed
was without danger), whereas in Yorkshire hogs sometimes dangerous
affections resulted (Bleyer).

Pasteur’s protective inoculation accordingly appears to be
especially effective in herds of common or less highly bred
animals, particularly in localities where erysipelas annually
causes considerable loss, and it may be employed without dan-
ger in already affected herds of such breeds.

At the initiative of Azary, Pasteur’s vaccination has been extensively used
in Hungary since 1887. From 1889-1894, 1,085,686 hogs were vaccinated and after
the first vaccination 0.14%, after a second 0.07%, and later in the year 0.54% died
of erysipelas. On account of hog cholera which appeared in 1895 the results of the
later inoculations cannot be determined accurately as the affections and deaths which
resulted from the heretofore unknown hog cholera were often simply attributed to
erysipelas. But since greater stress was placed on differential diagnosis the re-
sults appear favorable. Thus in 1907 of 28,642 hogs in already infected herds
637 died after the vaccination, later 421 additional fatalities were observed. In
healthy herds out of 288,950 vaccinations 125 and 623 died.

Pasteur’s vaccination is used less extensively in France and Russia probably
on account of the fact that in some of the herds the losses following vaccination
amounted to 6 to 10%, which condition may be attributed to a feebler resistance
of the native breeds. In Germany this method has not attained extensive ap-
plication owing to the unfavorable results obtained by Lydtin & Schottelius, but in
recent years it has been more extensively used, especially in the southern part of
the Empire.

Technique of Vaccination. The vaccination is carried out in the same
way as anthrax vaccination in sheep (see page 27); the quantity of the im-
munizing material is in this case also 0.12 cc. (% of the contents of Pasteur vac-
cination syringe), andthe second vaccination follows 12 days after the first. It
is advisable to vaccinate pigs in the spring after weaning at the age of 3-5 months,
before the appearance of hot weather.

Direct results of vaccination. This is manifested in some cases by debility
lasting from 1 to 2 days, impaired appetite, and sometimes a weakness of the
hind quarters; on the second and third day after the vaccination the temperature
rises on an average of 0.8°C. Sometimes, however, it may rise up to 41.7°C.
(Mihaly), whereupon the animals rapidly recover their normal condition. Occa-
sionally a swelling of considerable size may appear at the point of inoculation,
and stiffness of the joints may also develop, particularly in the higher breeds, and
here and there death may result from erysipelatous endocarditis,
Immunization 75

_ II. Protective inoculation with immune serum and cultures
(Simultaneous method of Lorenz and of Leelainche; sero-
vaccination). Blood serum of animals which have been highly
immunized by repeated subcutaneous or intravenous injections
of living cultures of the erysipelas bacillus will protect healthy
animals for a short time against fatal infection. The passive
immunity produced in this manner may be changed into active
immunity by simultaneous or subsequent injections of virulent
cultures of the bacilli.

After Emmerich and Mastbaum (1891) found that the blood serum
of rabbits which had been immunized against erysipelas possessed im-
munizing properties, Lorenz (1893) produced an effective serum from
artificially immunized hogs. This serum, concentrated to one-third of
its original volume, was effective for protective inoculation of hogs.
As hogs as well as sheep (Voges) produce only small quantities of serum,
Leclainche (1898) and Schiitz & Voges hyperimmunized horses for that
purpose, and at the present time serum for the inoculation of hogs is
obtained almost exclusively from these latter animals. Potent blood
serum may also be prepared from cattle (Schreiber, Kitt), and the
“double serum’’ of Landsberger consists of a mixture of horse and
cattle immune serum (Schubert).

The results of protective inoculations with immune serum
and bacilli culture have generally given good satisfaction in
practice. Hogs which have not yet become infected withstand
the vaccination as a rule without marked reaction, and they will
later resist natural infection. As a sequel of the vaccination,
however, urticaria, swelling at the point of inoculation extend-
ing to the throat, stiffness of the joints, occasionally erysipe-
latous endocarditis, and even death after 36 hours from severe
toxic action, have been observed to follow injections of the
culture. The advantage of this method over Pasteur’s consists
in the development of the passive immunity immediately after
the serum injection, which condition in case of immediate dan-
ger of infection is of great importance—and further it is well
tolerated even by breeds of hogs with low resistance. The some-
what high cost of the vaccinating material is a disadvantage.

Latent diseased processes are unfavorably influenced by the inocula-
tion. Thus, it was repeatedly observed in Germany that chronic pneu-
monia of pigs (the so-called chronic swine plague of pigs). became aggra-
vated after vaccination, and in Hungary also it was noticed that the
first year after the appearance of hog cholera severe outbreaks of the
latter disease developed following the vaccination of herds against
erysipelas.

In Prussia 217,376 hogs were vaccinated in the years 1897-1899 by Lorenz’s
method, and after the first injection 0.018%, after the second 0.042%, later in the
course of the year 0.058% died as a result of erysipelas (Joest & Helfer). In
Baden 102,448 hogs were vaccinated in the years 1899-1906 of which 21,466 animals
received the serum alone; of these 116 (0.09%) died inside of 3 days, later until
the close of the year, 108 (0.08%) succumbed. In Hessen only 2 out of 35,258 in-
oculated animals died in the period from 1901 to 1903 (Lorenz). In Wiirttemberg
76 Swine Erysipelas

only 4 out of 59,625 hogs vaccinated in the years 1904-1905 died of acute erysipelas;
of the original number, however, 29,249 animals received the usual two injections
(Beisswanger), while in the Province of Saxony in the year 1904-1905 of 175,150
animals, 12 died of vaccination erysipelas, 6 of endocarditis, and 15 succumbed to
erysipelas later (Raebiger). In Holland in the years 1899 to 1905 out of 165,884
inoculated hogs 136 (0.08%) died as a result of the vaccinations. Reports from
Baden (Fehsenmeier), Moravia (Rudovsky), Cantonzurich (Zschokke) and others
are much in favor of the value of the simultaneous injections, and the Leclainche
method is also used extensively in Hungary with favorable results.

Preparation of the immune serum. For this purpose healthy horses are
used which receive weekly injections, into the jugular vein of virulent bouillon
cultures of erysipelas bacilli in increasing quantities (50 to 500 cc.). The animals
react to the injection with fever, muscular trembling and sometimes with diarrhea.
After 2 to 3 months of such treatment they produce a blood serum which strongly
agglutinates the erysipelas bacilli of which 0.5 cc. protects a pigeon against a like
quantity of virulent culture which ordinarily would kill it in 2% to 3. days
(Leclainche); exceptionally 0.1 of such serum has such a protective action
(Deutsch) ; it retains this action for months after heating for 14 hour to 55° U. In
Germany only serum can be marketed, 0.015 ec. of which will protect a mouse of 15-
grams weight against a simultaneous subcutaneous (Lorenz), or against an intra-
peritoneal (Marx) injection of 0.1 cc. of virulent bouillon culture 24 hours later.

The immune serum used for the inoculation of hogs must possess the strength
mentioned and should not be more than one year old, but the virulent bouillon
cultures should be fresh and not over a week old. In Germany the immune serum is
prepared in various laboratories under different names (Prenzlauer & lLands-
berger’s serum, Susserin), and is placed on the market with the necessary direc-
tions for its use.

Technique of vaccination. Leclainche’s method: In a earefully sterilized
syringe of 10 cc. capacity, 1 ce. of the bouillon culture is drawn up and then
the syringe is filled up with the immune serum. After the contents are well mixed
hogs of not over 50 kg. weight are injected subcutaneously with 5 cc. on the inner
surface of the thigh. If the hogs are heavier, 1 cc. of additional blood serum is
given for each 10 kg. above 50 kg., or in general each heavy hog is injected sub-
cutaneously with 9.5 ec. of serum and 0.5 ce. of culture. The second injection
follows 10 to 12 days after the first, when the syringe is filled with Louillon
culture, and of this each animal receives 0.5 cc. without consideration of the animal’s
weight. The injection is also made on the inner surface of the thigh.

Method of Lorenz. In this method the immune serum is first injected
under the skin of an ear and immediately afterwards 0.25 to 1 cc. of culture is in-
jected into the other ear; 12 to 15 days later the hog is injected with double
the quantity of the culture used in the first dose. The second injection is also
made under the skin of an ear. Relative to the results of the inoculation, it is
immaterial whether the blood serum and virus are injected in a mixture (Leclainche)
or simultaneously, but in different parts (Lorenz, Schiitz), or if the virus is in-
jected several days following the serum (Lorenz).

A sufficient protection is only assured after both inoculations, as the first
simultaneous inoculation produces only a passing rise in the resistance as proven
experimentally by Prettner, inasmuch as the bacteria are influenced by the injected
serum to such an extent that a sufficient quantity of immune bodies is not pro-
duced.

III. Passive immunization. The immune serum may also
be used by itself for the immunization of already infected herds
(5 to 10 ce.). The serum very rapidly produces a passive im-
munity which prevents the development of the disease in ani-
mals threatened by the infection or when the infection is in
the stage of incubation (see also page 72). The immunity
produced in such a way lasts, however, only a short time.
(According to Leclainche, 17 days.) Therefore, these animals
should be given the combined or Pasteur’s inoculation after
their recovery or from 8 to 10 days after the serum treatment
in order to produce a lasting immunity.
Immunization. The Disease in Man 77

_ Veterinary Police. Police measures adopted for other con-
tagious diseases may also be recommended for erysipelas, and
particularly quarantine of the premises—in more extensive
outbreak even the township, prohibition of marketing the ani-
mals, harmless disposition of carcasses, disinfection of infected
localities, ete. From the quarantined premises or townships
the transportation of animals to abattoirs for immediate
slaughter should be permitted. The observation period after the

apparent disappearance of the disease should extend from 1°
to 15 days.

Literature. Pasteur, Rev. vét., 1883, 39.—Pasteur & Thuillier, Bull. de
VAcad. de méd., 1883, Nr. 45.—Eggeling, D. Z.'f. Tm., 1884, X, 234,—Loeffler,
Arb. d. G.-A., 1885, I, 46.—Schiitz, Ibid. p. 56.—Lydtin & Schottelius, D. Rotlauf 4.
Schweine, Wiesbaden, 1885.—Bang, D. Z. f. Tm., 1892, XVIII, 27.—Jensen, Ibid.,
p. 278.—Kitt, Monh., 1894, V, 19.—Lorenz, D. t. W., 1897, 91; Obl. f. Bakt., 1893,
XIII, 357.—Leclainche, Soc. biol., 1897, 428; 1899, 346—Voges & Schiitz, A. f.
Tk., 1898, XXIV, 173.—Bauermeister, 1902, XXVIII, 66 (Lit.).—Preisz, Hb. d. p.
M., 1903, III, 710 u. IV., 1236 (Lit. on etiol. and immunization).—Stadie, Diss.,
Berlin, 1904 (Lit. on biol. of erysip. bae.).—Eisenmann, Monh., 1906, XVII, 07.—
Schipp, D. t. W., 1910, 98.

The Disease in Man. From the literature a considerable number of
cases are known (Casper, Nevermann, Welzel, Hennig, Gleich, Zipp and
others) to have occurred in men occupied in handiing hogs affected
with erysipelas, or who worked with cultures of the bacilli (immuniza-
tion). It was observed that after slight injuries to the skin erysipelas-
like reddening of the skin and swelling of the neighboring lymph gland
developed sometimes even exfoliation of the blackish-red epidermis with
exudation of serum, and occasionally even swelling of the neighboring
joints. The disease usually terminated within four weeks in recovery
(in: Réder’s case it lasted for 12 weeks), which is considerably hastened
by subcutaneous injections of immune serum (10 ec.).

From eating meat of hogs affected with erysipelas no attacks have
been observed. Lubowsky, however, found large quantities of bacteria
in the feces of a boy which were identical with the erysipelas bacillus.
The boy suffered from jaundice and intestinal catarrh, the cause of which
was unknown.

Literature. Rosenbach, Z. f. Hyg., 1909, LXTIT, 343 (Lit.).—Roder, Mitt.
d. bad. Ti. 1908, [T.—Gleich, B. t. W., 1909, 576.—Zipp, Tijdsskr., 1909, 98.—
Lubowsky. Dem. W., 1910, 116.

5. Hemorrhagic Septicemia, Septicaemia Hemorrhagica,
Hueppe

(Septicaemia pluriformis, Kitt; Pasteurellosis, Ligniéres.)

Under the collective name of hemorrhagic septicemia are
included all those diseases which are produced by varieties of
the bacillus bipolaris septicus (Bac. multocida s. plurisepticus,
Katt; Pasteurella, Ligniéres) and in which the acute cases are
characterized by manifestations of a general infection and
hemorrhagic inflammatory processes of the internal organs.

History. Perroncito and Semmer (1878) and later Pasteur (1880)
by the study of chicken cholera, Gaffky (1881) of rabbit septicemia,
78 Hemorrhagie Septicemia

Kitt (1883) of Bollinger’s Wildseuche, and Léffler (1886) of swine
plague, proved that these diseases are caused by small bacilli, all of
which showed the same characteristics by taking the stain intensely at
the poles and only very slightly or not at all in the middle, therefore
resembling somewhat the figure 8.

Based on a comparative study of these four diseases, Hueppe (1886)
came to the conclusion that their causative agents coincided in all their
principal morphological and biological characteristics, and that the
diseases greatly simulated each other in their course and anatomical
changes. From these he concluded that the causative agents of the
diseases mentioned represent one species of bacteria, and that the existing
differences, especially with reference to their virulence, justified his
conclusion that they were varieties of the same species. Inasmuch as
in the acute cases there are manifestations of a general blood infection
and the presence of hemorrhages in the internal organs, Hueppe inciuded
the four diseases in one group and recommended the name of hemor-
rhagic septicemia for their designation.

The observations made since these investigations proved the cor-
rectuess of this conclusion, and have at the same time shown that similar
bacteria play an important part in the etiology of other diseases. Thus,
this was established by Poels (1886) for the infectious pleuro-pneumonia
of calves, by Oreste and Armanni (1887) for the barbone disease of
buffalo, by Galtier (1889) for the infectious pneumo-enteritis in sheep.
Therefore these diseases may also be included in the group mentioned.

In the diseases mentioned and also others of less importance the
bipolar bacteria appear to be the exclusive factors in the development
of the pathological processes. Ligniéres (1900), however, includes those
diseases in which the bipolar bacilli are usually involved only indirectly,
by predisposing the body for an infection with other bacteria. Such
diseases are influenza or pleuro-pneumonia of horses, and distemper of
dogs and cats, to which Nocard, on the strength of his own investiga-
tions, added white scours and the catarrhal pneumonia of calves which
are due to navel infections. In the meantime Ligniéres in supporting
Trevisan’s suggestion, named the bacteria of chicken cholera and of the
related diseases, pasteurella, and the diseases caused by these bacteria
pasteurellosis. This nomenclature has been accepted in general by the
French authors.

Recent experiences with the diseases mentioned and a more accurate
consideration of the etiological part of the ovoid bacteria, make the cor-
rectness of Ligniéres’ conception very doubtful, and at least they appear
to be remote. While it cannot be doubted that the bacteria under dis-
cussion may independently produce diseases, their occurrence in affected
organs and tissue fluids is not a sufficient proof that the disease was
originally produced by them. ‘Since they may not infrequently be met
in healthy animals, it is possible for them to invade secondarily the
tissues which have been already affected from other causes. It will
require further investigations to establish the significance of their pres-
ence. However, their part in distemper of dogs, in pneumonia of calves
and pigs, in the pectoral form of hog cholera, and in influenza, may even
now be accepted as secondary. On these grounds it appears advisable
to restrict the conception of Ligniéres’ pasteurellosis, and therefore
only those diseases will be considered here in which it has been positively
established that the ovoid bacteria play the primary etiological part.
The results of investigations in the future will show whether a change
of this viewpoint will be necessary.
History. Morphology and Biology 79

In the designation of the diseases belonging to this group the former appropiate
name of hemorrhagic septicemia will be used as it appears justifiable from a
pathological-anatomical standpoint. The causative agent is the species of bacteria
known as bacillus bipolaris septicus, while the various organisms of the group
causing this disease will be designated according to the species of animals affected,
viz., Bac. avisepticus, Bae. bovisepticus, Bac. suisepticus, ete.

Morphology and Biology of the Infective Agent. The
bacillus bipolaris septicus (Bac. multocida s. plurisepticus,
‘Kitt; pasteurella, Ligniéres, ovoid or girdle bacterium) mani-
fests the following charactéristics without consideration of the
diseases belonging to this group or from what species of ani-
mals it originates (Ligniéres). It is short, stains intensely
at the poles but only slightly in the middle, polymorphous,
non-motile, does not form spores, principally aerobic; does not
stain by Gram, grows in bouillon, gelatin and agar, but does
not grow on acid potatoes, nor liquefy gelatin, nor coagulate
milk; it does not produce indol in pancreatic bouillon, nor
redden Wirtz’s agar; the bouillon cultures have a peculiar
characteristic odor. ;

Besides these characteristics of the bipolar bacillus, the special
characteristics of the bacteria belonging to this group are the following:

Form. In the tissue fluids and stil] more so in cultures the bacillus
_ represents a short rod about 14 long, with rounded ends (Fig. 23).
It also occurs in the form of cocci, diplococci; exceptionally also as
longer rods, threads and streptobacilli. Its dimensions vary according
to the origin of the disease in certain although not wide limits.

  

Fig. 23. Bacillus bipolaris septicus. Fig. 24. Bacillus bipolaris septicus.

Smear prepared from a fresh Smear from the blood of a chicken

agar culture of the bacillus dead from fowl cholera. Polar

of fowl cholera. Fuch- staining with fuchsin, and subse-
sin staining. quent washing with a 1%

acetic acid.

Staining. The bacilli stain quite readily with the aqueous aniline
dyes, and in the preparations made from the tissues or from the body
fluids (best in the blood of affected chickens) they appear stained only
at the poles, while the middle remains unstained (Fig. 24). These
results are obtained when the preparations are not stained too intensely
80 ; Hemorrhagic Septicemia

or after subsequent washing in alcohol or 14 to 1% acetic acid. On the
other hand, it is difficult to obtain the polar stain in bacilli originating
from artificial cultures.

Cultivation. The bacilli are easily isolated from
cases of an acute septicemic character, while from
chronic cases this is more difficult and sometimes im-
possible. The requirements of artificial cultivation are:
temperature of 13-28°C. and alkaline or at least neutral
reaction of the medium. In vacuum the bacteria grow
only when the medium is inoculated with numerous
organisms, and then only for a short time.

A frequent characteristic of the
cultures is their viscosity (this is also
striking in the peritoneal exudate of
inoculated guinea pigs), probably due
to the sticky eepanls which covers the
bacteria.

The colonies trigeea on gelatin are
no larger than a millet seed. They are
at first transparent, often resembling
a dew-drop, and frequently iridescent.
Later they are whitish, of a hyaline-
cartilage-like appearance. In the depth
of the medium the punctiform colonies
unite along the stab and form a con-
tinuous white streak (Fig. 25). Sim-
ilar colonies develop on the surface of
the agar cultures, but do not extend.
to the wall of the test tube (Fig. 26) ;
cultures several days old are viscid;
when still older they adhere firmly to
the medium On coagulated blood
serum a very fine membrane forms
which is at first transparent and later
whitish. Bouillon with the addition of
peptone or blood serum usually be-
comes more or less uniformly cloudy; , ,
eas Ge aes in some of the varieties, however, the Tig, 86. Agar
tin stab culture fluid clears, sometimes first forming a slant culture of
ofthe bacillusbi- slimy and later a fine granular sedi- the bacillus bi-
polaris septicus. ment; occasionally also a delicate, polaris septicus.

whitish membrane develops on the sur-
face. The addition of sugar or glycerin does not promote, but rather
retards the growth. Dextrose bouillon is not fermented. ‘No growth
takes place on potatoes with a natural acid reaction; when artificially
alkalinized a grayish-yellow deposit forms.

 

 

 

Animals inoculated with a certain variety produce a serum which will have
the highest agglutination for that particular variety (up to 1:60,000), but it will.
also agglutinate to a lesser degree other varieties (1:1000-6000). Sometimes, how-
ever, some of the varieties are in no way influenced. Therefore the agglutination
eannot be utilized for the identification or separation of the different varieties.
(Chamberland & Jouan). ‘
Cultivation. Pathogenicity 81

Pathogenicity. In contradistinction to the common char-
acteristics described, there are marked differences in the viru-
lence of the bacilli which depend on their origin, the nature
of the disease and the species of animals affected. However,
all the varieties coincide in exerting their strongest pathogenic
action when inoculated with blood or exudate of animals which
died of the disease (aggressin action, see page 84).

Another common characteristic of the bacteria belonging

_to this group is that they develop the highest virulence towards
that species of animals for which they are naturally pathogenic,
while towards other species their action shows a great variance.
It is, however, possible to increase the virulence for other
species through repeated reinoculations, but such a strain of
the bacilli will even then possess the strongest pathogenic action
for the species from which it originated.

The animals which are susceptible to the bipolar bacteria,
although not to the same extent, are the guinea pig, rabbit and
mouse, while the domestic animals show a great variation in
susceptibility. The guinea pig is best adapted for test inocu-
lations, and by using this test animal for repeated intraperi-
toneal reinoculations the virulence of any of the varieties may
be greatly increased.

The result of artificial infection depends also on the nature
and method of the inoculation. The most pronounced action is
obtained by direct injection into the circulation, by which means
the disease may be transmitted to any species. Somewhat less
effective is the intraperitoneal and intratracheal injection of
cultures, whereas the subcutaneous and intramuscular ‘inocula-
tion produces a severe affection only in very susceptible species
of animals. The feeding of virulent material only exceptionally
gives positive results, these being most frequently obtained
when the cholera virus of chickens is fed.

' Variability of the Virulence. The bipolar bacilli are very
widely spread, and may produce disease in any species of ani-
mals, particularly in the domestic animals. As original sapro-
phytes they occur in nature in the soil, in slow-flowing or
stagnant water, on various plants, and in all kinds of dead
organic material. Under normal conditions they do not mani-
fest pathogenic characteristics. Hence they occur not infre-
quently in the digestive tract and in the air passages. Under
certain conditions, which at present are still unknown, they be-
come virulent and then they may attack the tissues of the
healthy body. On the other hand, their pathogenic action is
favored by all those influences which weaken the resistance of
the organism, as colds, exertion, anemia, starvation, mixed in-
fection, catarrhs, etc. Parasites‘in the air passages and digestive
tract also favor the development of infection by loosening the
epithelium of the mucous membrane, or by causing penetrating
injuries to the mucous membrane, whereby the entrance of the
bacteria into the lymph vessels is facilitated.

6 ’
82 Hemorrhagic Septicemia

The bacteria which through some cause become parasitic
lose in some of the cases their pathogenic character after leav-
ing the affected animal, and may change again to saprophytes.
In the majority of cases, however, after having become accus-
tomed to the organism of a certain animal, they attain an in-
creased virulence for animals of this particular species, and
therefore infect the animals more easily even without the
influences of predisposing causes. This relative virulence may
even increase for a time in the course of further generations,
or may become constant. More frequently, however, it dimin-
ishes again after a certain time.

These characteristics of the bipolar bacteria explain the
variation which is observed in the appearance and spread of
the diseases belonging to this group. The common experience
with these diseases is that they appear periodically in certain
localities without any apparent connection to which the intro-
duction could be traced. In such cases the outbreaks can be
explained by a sudden increase in the virulence of the bacteria
which are present in the soil or in the healthy animal favored
by influences which reduce their resistance. Some of the infec-
tions develop through such conditions. In these the disease
does not, or only exceptionally, spread from animal to animal,
and it therefore remains sporadic, or at least confined to cer-
tain localities. In other cases although the disease appears
spontaneously the organisms which pass through the body of
the animals retain their pathogenic character for a long time,
thus spreading the disease by direct or indirect infection, and
disseminating the contagion to distant localities. Further,
among the diseases of this group there are some in which the
bacteria adapt themselves in the course of time to the animal
body to such an extent that as saprophytes they are no longer
capable of propagation, and therefore these diseases spread
almost exclusively by being introduced from outside or by
direct communication.

The acquired or inherited virulence of the different varie-
ties of the bacteria is usually only manifested for certain species
of animals, so that a certain disease spreads usually only
among the animals of the same species. Exceptionally how-
ever, the infective agent may become dangerous for other
species. Thus frequently the infection of buffalo disease and
hemorrhagic septicemia of cattle causes in hogs symptoms re-
sembling swine plague. On the other hand, the virus of swine
plague sometimes produces a septicemic affection in sheep,
while feeding it to chickens causes a disease which corresponds
to fowl cholera.

Ligniéres succeeded in artificially producing a variety of forms of hemorrhagic
septicemia in different animals by injections of cultures of the bipolar bacillus of
different origin. Koske successfully infected different species of fowl per os with
swine plague bacteria. On the other hand, he failed in hogs to produce a disease
resembling swine plague with the fowl cholera organism.

The ovoid bacteria may retain their virulence for months in the original

 

 

 
Pathogenesis 83

exudates or body fluids under artificial conditions, if light and air are excluded;
whereas, in artificial media in the presence of air they are sometimes very rapidly
attenuated and finally lose their virulence.

Pathogenesis. Bipolar bacilli which penetrate into the
tissue fluids of the animal organism, produce different patho-
logical changes, according to the degree of their virulence and
the susceptibility of the animals. In case of a severe infection
a peracute hemorrhagic septicemia develops. The bacilli mul-
tiply very rapidly and in a short time permeate the entire body,
causing death in from 18 to 24 hours. The animals manifest
high fever, weakness of the heart, debility, sometimes diarrhea.
Autopsy reveals numerous hemorrhages in the tissue of the
serous and mucous membranes and parenchymatous organs.
The spleen is only slightly swollen, while the lymph glands show
a marked acute swelling.

When the infection is somewhat less severe the acute attack
lasts for several days when frequently a sero-fibrinous inflam-
mation develops on the serous membrane, while the mucous
membranes are affected with a hemorrhagic inflammation. With
these an inflammation of the joints and tendons is not infre-
quently associated. The autopsy reveals in these cases a mod-
erate acute swelling of the spleen and a pronounced swelling of
the lymph glands in addition to blood extravasations.

An infection of a milder degree, for instance an intravenous
injection of a small quantity or very weak virus, results in
some cases in a chronic affection, lasting for several weeks
or months. The animals become emaciated slowly but gradu-
ally, frequently in spite of their good appetite; they have an
intermittent fever, and inflammatory processes develop in dif-
ferent joints, especially in the knee, carpal and tarsal joints.
The animals also show a marked predisposition for secondary
infections, especially for catarrhal pneumonia.

The bipolar bacillus may produce these varied clinical
manifestations independently. In the acute cases the organism
is found in great numbers in the blood and also in the exudates
in pure culture. The pathological processes in some of the
chronic cases may be also attributed to its action even if the
bacilli have since disappeared from the body.

The local action of bipolar bacilli is manifested in the
production of serous and fibrinous inflammations, later in
degeneration of the exudate and tissue elements, as a result of
which dry caseous masses occur, while necrotic areas develop
in the affected organs. The necrosis is very probably the result
of the action of toxins. Filtrates of bouillon cultures free from
bacteria usually produce only a very slight or no toxic action.
Killed masses of bacteria, however, possess distinct toxic prop-
erties. Inasmuch as in the body of the animal both multipli-
cation and destruction of bacilli take place, and as dead bacilli
are dissolved in the tissue fluids the toxins which are eliminated
may cause general effects and local necrotic processes. There
84 Hemorrhagic. Septicemia

is also a possibility of the bacteria producing strongly acting
exogenic toxic substances and aggressins in the living body.

According to the investigations of Klett & Braun, the bacilli of
fowl cholera and swine plague secrete even in artificial fluid cultures
soluble poisons in large quantities which can be demonstrated. These
toxins have an identical poisonous action (in pigeons and chickens
lethargy and intoxication) and their endotoxins are also identical; a
difference is indicated in that the Bacillus avisepticus produces greater
quantities of filterable toxins and endotoxins, and these are also more
constant.

According to Weil the virulence of the bacteria is considerably
increased when heated to 44° C. in the exudate of artificially. infected
animals, and also, according to Citron, in extracts of cultures. Accord-
ing to Bail’s theory the bipolar bacilli, like the other pathogenic bac-
teria, produce specific substances in the animal body (aggressins) which
possess the character of changing non-fatal amounts of bacteria to
fatal ones, without themselves having marked toxic properties. Further,
Tschistovitch believes that virulent fowl cholera bacilli contain strictly
specific thermo-stable antiphagins which protect them from the digestion
by leucocytes.

The bipolar bacilli manifest a particular affinity towards
certain organs, and therefore pathological changes develop in
the less acute cases only in certain organs. In such predisposed
organs either acute or chronic inflammations may be present.
The serous membranes in general, the lungs, the synovial mem-
branes of the joints and tendons and probably the liver are the
favored organs.

According to Ligniéres the bipolar bacilli may also give
rise to the development of secondary disease processes.
Through their toxins and probably indirectly through a tem-
porary arrest of the phagocytosis, the resistance of the body
may be reduced, whereby bacteria which are more or less harm-
less may produce disease processes, while the bipolar bacilli
may in the meantime disappear from the body. Even in many
of the acute cases which are associated with an inflammation
of the lungs and joints other probably pathogenic organisms
may be found in the affected tissues, or in the inflammatory
products in addition to the bipolar bacilli. However, in the
chronic cases only secondary bacteria are as a rule present.

The intravenous injection of a weak virus, for instance older
cultures of the bipolar bacillus, produces as has already been mentioned,
a chronic affection which results in cachexia. In these cases the bac-
teriological examination of the affected tissues and exudates discloses
other bacteria (streptococci, colon bacteria, ete.) in spite of the fact that
the infection was brought on by the bipolar bacilli. Similar results may
occasionally be obtained from the injection of filtrate free from bacteria
made from cultures of the bipolar bacillus.

The very frequent occurrence of mixed infections makes it
possible for other bacteria to prepare the field for the propa-
Pathogenesis, Immunization. 85

gation of the bipolar bacilli. Through the destruction of the
tissues by the other organisms the entrance and propagation
of the ovoid bacteria are favored.

Their invasion is without doubt of a secondary character
in those cases in which a general septic affection is caused by
an ultravisible virus, as for instance in dog distemper and hog
cholera (see those diseases). In these affections disease proc-
esses may develop subsequently which are exclusively or at
least partly the result of the action of the ovoid bacteria. In
recognition of this fact, the etiological importance of these bac-
teria has already been considerably limited.

Immunization. Pasteur proved that cultures of the chicken
cholera organism when attenuated by keeping in the air pro-
duce a suitable vaccine for the immunization of chickens against
artificial infection.. Similar results are obtained with cultures
attenuated by higher temperature or by disinfectants. How-
ever, the results of such immunizations which are mostly limited
to laboratory experiments are by no means uniform. This
irregularity is probably due, on the one hand, to the variance
of the virulence of the cultivated bacteria, and on the other
hand, to the difference of action of the methods employed in
the attenuations, accurate control of which is almost impossible.

More recently J. and M. Ligniéres (1902) produced a potent vaccine for all the
diseases of this group from cultures which had been reinoculated several hundred
times from agar to agar at two days’ intervals, as a result of which they possessed a
uniform virulence. Flasks with a wide bottom are filled to a height of % em.
with peptone-bouillon and inoculated with the stock culture. The flasks are then
placed in a thermostat and kept at a temperatire of 42-43° C, The cultures
which are grown for five days at this temperature produce the first, while those
grown only for two days, the second vaccine.

With the attenuated cultures immunity may be produced
not only against the same variety but also against related
varieties of the bipolar bacillus. Kitt was the first to point out
the possibility of a uniform procedure for the control of the
diseases of this group. He successfully immunized chickens
against fowl cholera with the virus of rabbit septicemia. Later
Jensen obtained the same results with the virus of infectious
pneumonia of calves. Ligniéres also proved that this reci-
procity obtains with regard to all strains of the varieties of
bacteria belonging to this group. He succeeded in demonstrat-
ing experimentally that a vaccine prepared from a culture of
a certain variety is potent in the first place against this variety,
but that it also has a protective action, although of a lesser
degree, against the bipolar organism of the other diseases of
this group. But its protective action for the latter diseases is
so slight and uncertain that it does not meet with practical
requirements, and besides the preparation of the different vac-
cines for each of the diseases would be very troublesome.
Ligniéres therefore prepared a so-called polyvalent vaccine
86 Hemorrhagic Septicemia.

which is potent against all the diseases of this group. The
vaccine is prepared from mixed cultures of the hemorrhagic
septicemia bacteria of sheep, cattle, dogs, horses, hogs and
chickens and attenuated at a temperature of 42-43°C.

The vaccine prepared from the six varieties of virus is supposed to immunize
against all of the six diseases. Test animals inoculated with this vaccine will
show a resistance against a virulent infection, while control animals will die or
become severely affected (with the exception of very virulent intravenous infections).
In practice the vaccinations are supposed to have given good results, especially
against the acute septicemic forms of hemorrhagic septicemia, as for instance against
chicken cholera and hemorrhagic septicemia of sheep. On the other hand, the re-
sults in the slower forms which are frequently associated with mixed infections
were less favorable, although even in these cases the mortality has been supposedly
reduced from 50% to 12%.

The immunization consists in a subcutaneous or intraperitoneal injection of
the vaccine; the second inoculation follows in from 12 to 15 days. In infected
localities it is advisable to undertake the vaccination on sucking animals 8 to 10 days
after their birth, or at least shortly before weaning. The immunity produced by the
vaccination lasts for about a year, and therefore it is advisable in infected localities
to repeat it annually. :

Serum Immunization. Kitt (1897) found that animals
(among others, horses and cows) which have been injected
with the virus of chicken cholera produce a,blood serum which
protects chickens against an artificial infection of virulent
material. This fact was later confirmed in connection with
swine plague by Schweinitz and Leclainche while Ligniéres &
Spitz (1902) showed that this principle applies to all diseases
of the hemorrhagic septicemia group.

With regard to the immune sera, there exists a similar
reciprocity as in the case in which the vaccines are prepared
from living cultures. Kitt & Mayr have established these facts
for swine plague and fowl cholera, Grosso for hemorrhagic sep-
ticemia of cattle, fowl cholera and swine plague, while Ligniéres
generalized the principle. Accordingly an immune serum pre-
pared from certain varieties of the bipolar bacillus protects, in
the first place, against a virulent infection caused by the respec-
tive varieties. However, it is also protective, although in a
lesser degree, against the other related varieties. Blood serum
of’ animals which have been hyperimmunized with different
varieties of the bipolar bacillus has likewise a protective action
against all the varieties which were used in the preparation of
the serum. ,

Based on these experimental observations Ligniéres & Spitz pre-
pared a so-called polyvalent immune serum against all the pasteurellose.
The serum is prepared by inoculating peptone bouillon with the above
mentioned six varieties of the bipolar bacillus, and with the mixed
cultures prepared in this manner horses are at first subcutaneously,
later intravenously injected with increasing quantities (5 to 20 ec.).
Horses highly immunized in this way produce a serum which affords
protection against all of the diseases of this group, and it even possesses
a curative action to a certain degree if employed in the early stages of
the disease. Similar results were also obtained by Klepzoff, while Broll
Fowl Cholera. 87

& Angeloff showed that by the use of swine plague serum the opsonic
index is not only raised for swine plague but also for the bacteria of
hemorrhagic septicemia of cattle and fowl cholera.

_ _.The polyvalence should be considered here in a different sense from that applied
in the Wassermann-Ostertag’s polyvalent swine plague serum (see swine plague).

The very close morphological resemblance of the bipolar
bacilli from the various sources, the similarity of the cultures in
their principal cultural characteristics, the great similarity of
the pathological processes produced by them, the possibility
of intertransmissibility to the different species of animals, like-
wise the common immunizing properties, indicate that the
bipolar bacilli belong to one species of bacteria, while the few
deviating characteristics such as the variance of virulence are
only characteristics peculiar to the different strains or varieties.
The bacteria which probably developed from a common strain
originally have undergone modifications in the bodies of the
different species of animals by adapting themselves to exist-
ing environments similar to that which occurs in other species
of bacteria, and which may also be produced artificially. On
the other hand, the differences in the pathological processes in
the various diseases may be satisfactorily explained by the
special characteristics of the different animal species. The
close relationship of the causative factors of the several dis-
eases brings the affections produced by them into closer rela-
tion. Moreover, the similarity of the etiological factors also
indicates uniformity in methods to be used in the control of
these diseases.

Literature. Hueppe, B. klin. W., 1886, 753.—Ligniéres, Bull. 1900, 329,
(Lit.).—-Kitt, Hb. d. p, M., 1903, II, 559, (Lit.).

(a) Fowl Cholera. Cholera Gallinarium.

(Fowl typhoid; Pasteurellosis avium, Choléra des poules
[French]; Hithnercholera [German]; Cholera
; dei poll (Itahan].)

Fowl cholera is an acute, contagious and usually an epizo-
otic affection of fowls, particularly of chickens, geese and
ducks, and is manifested in a general infection associated with
a profuse diarrhea. It is caused by a bacterium of the type
of the hemorrhagic septicemia organism, the bacillus avi-
septicus.

History. This dangerous fowl plague was described by _veter-
inarians as early as the 18th century, and in the middle of the last
century some of the authors (Benjamin, 1851, Delafond & Renault,
1851, and Hering, 1858) have recognized its contagious nature and
also substantiated it experimentally. Perroncito (1878) and also Sem-
mer described a diplococeus as the cause of the disease which they
constantly found in the blood of chickens dead of the disease. Toussaint
88 Fowl Cholera.

(1879) and later Pasteur (1880) confirmed their findings and succeeded
in growing the bacteria in artificial bouillon, thus enabling them to
study their pathogenic characteristics. Pasteur carried out his first
fundamental experiments on the attenuation of bacterial cultures and
on immunization with such attenuated cultures with the bacilli of fowl
cholera. Valuable contributions regarding the etiology of the disease
were also furnished by Kitt and Ligniéres. ,

Occurrence. Fowl cholera occurs extensively in Europe
(with the exception of Great Britain), in North America and
in South Africa, and causes very heavy losses, especially among
the finer breeds. The extent and value of the losses cannot
be accurately estimated; as a matter of fact, in some of the
localities, occasionally half or even a larger proportion of the
flocks are annihilated. Aside from the money value of the
dead and slaughtered. fowls, the total loss is considerably in-
creased by the temporary retrogression of fowl breeding in
the affected localities as well as by the reduction of the egg
production.

In the year of 1908, 14,397 chickens, 13,877 geese, 4,795 ducks, 272 pigeons and
256 other fowls died or were slaughtered in 776 townships in Germany on account
of cholera. The greatest number of losses occurred in the government districts,
Potsdam, Bromberg, Oppeln, Allenstein, andPosen (in the last 3 years the number of
cases was reduced from 74,329 to 33,597). The losses of the other countries are
not known, but the disease exists at the present time to a great extent in Russia,
Italy, Austria, Hungary, France, Bulgaria, California, etc.

Etiology. The bacillus (bipolaris) avisepticus (bacillus
cholerae gallinarium s. avicida, pasteurella avium) belongs to
the smallest of the bipolar bacilli with which it, however, cor-
responds in the morphological and cultural characteristics (see
page 79). In fowl blood the bipolar staining is particularly
well marked (see fig. 24 on page 79); peptone bouillon is made
uniformly cloudy with or without the formation of a slimy sedi-
ment (according to Hertel the bacilli sometimes pass through
a porous Berkefeld filter).

Tenacity. The bacteria of fowl cholera remain alive in manure for at least
3 months (Gaertner), in putrefactive carcasses and in garden soil for 3 months
(Kitt), in water with the exclusion of air and at a temperature of 5 to 6 de- ,
grees for 18 days (Hertel). They also show a considerable resistance to eld
(according to Kitt they resist freezing for 14 days, and according to Hertel their
virulence is gradually reduced at minus 13 degrees), but they are less resistant
towards other harmful influences. Thus, when dried in exudate in the air, and
under the influence of sunlight they lose their virulence in 48 hours, if the light is
excluded in 72 hours (Helfer), whereas organs of carcasses are sterilized by a
temperature of 45 to 50° C. in % hour, and in 10 minutes at a temperature of
80-85°C. (Kitt). The following disinfectants have a destructive action on the organ-
isms: 1% carbolic acid, 44% sulphuric acid (Salmon), 1% chlorate of lime, and 5%
milk of lime (Jager). The blood and loose excrements are positively disinfected
by thoroughly mixing them with a 5% copper sulphate solution (Colin). Turf
dust has also a disinfecting action (Ulmic acid), for when bloody intestinal con-
tents i mixed with it the infectiveness of the bacilli is destroyed in 48 hours
(Hertel).

Pathogenicity. The blood of chickens affected with cholera
as well as fresh pure cultures produce the disease in fowls after

 
Pathogenicity. 89

cutaneous or subcutaneous injection even in minimal doses.
The transmission may be made successfully by taking the point
of a needle dipped in blood and scarifying or pricking the
skin at any part of the body. In this manner as well as by
subcutaneous and intramuscular inoculations most of the dif-
ferent species of domestic fowl (chickens, ducks, geese, turkeys,
pigeons, pheasants and fancy birds) and small wild birds
(sparrows, finch, etc.) are easily infected. These birds also
become affected by the dropping of a culture into the conjunc-
tiva, nose or the laryngeal mucous membrane, as well as on
superficial wounds of the comb, wattles and feet (Hertel).
Further, the disease may be produced by feeding of blood, meat,
organs and intestinal contents of affected animals as well as
of pure cultures. The disease produced by inoculation usually
results in death in from 12 to 24 hours, while when produced
by feeding of the virus it terminates only after a longer period
(according to Semmer sometimes only after 8 to 12 days).

Of other animals rabbits and mice are susceptible to the
disease, whereas in guinea pigs (Pasteur), cattle, sheep and
horses (Kitt) the subcutaneous inoculation produced only an
abscess at the point of injection (guinea pigs, however, are
easily infected by intraperitoneal inoculation). Intravenous
injections of very virulent cultures are pathogenic for domestic
mammals (hogs, dogs and cats), while through feeding of such
material infection is successful only in rabbits. Stange &
Persdorf observed a simultaneous infection in chickens and
hogs which they traced to an infection with the fowl cholera
virus. On the other hand, Koske has not succeeded in infecting
hogs artificially with the cholera virus. On man the eating of
affected fowl has apparently no harmful effects.

Repeated passage of the bacteria through the bodies of
chickens, pigeons or sparrows increases their pathogenicity
which is still more increased by passage through guinea pigs
(intraperitoneally). In this way the virulence may be increased
to such an extent that intravenous injections of such virus
may kill domestic mammals in a few hours (Ligniéres). On
the other hand, the air, and more so the combined action of
air and sunlight, attenuates the virulence of the bacteria
(Pasteur, see page 94).

The bacteria produce toxins in artificial cultures. Pasteur found
that the subcutaneous injections of large quantities of filtrate of bouillon
cultures free from bacteria cause in chickens a somnolence and stupor
lasting for several hours, similar to that seen in the disease. This fact
was later confirmed by Salmon, Stange, Kitt, as well as by Klett &
Braun. (See page 84.) On the other hand, Calamida obtained from
a 12-day old bouillon culture a hemolysin which has the strongest

‘action on rabbits, less on guinea pigs and still less on the red blood
corpuscles of chickens.

Natural infection usually results from the ingestion of
droppings or saliva of affected fowls, contaminated feed, viscera
90 Fowl Cholera.

of slaughtered or any parts of the body of affected animals;
besides, when healthy fowl drink from the same vessels or from
a pond from which infected birds have watered. The infection
from cages as well as from the premises may also be dissemin-
ated in various ways to neighboring localities where an outbreak
may follow. .

The disease is mostly introduced into premises, which have
been free from the disease, by the introduction of infected fowls,
and less frequently by the sale for food purposes of birds
which have been slaughtered while ill. The disease is also very
frequently disseminated by poultry shows in which the veteri-
nary supervision is very deficient. Further, it may also be
disseminated by pigeons which take up the contagion in in-
fected premises, become infected themselves and by their in-
testinal excrements infect the other birds of the premises
(Cagny, Nocard). Finally, the disease may be spread by wild
birds, particularly sparrows (Hertel demonstrated virulent
bacilli in dermanyssus mites which he took from the body of
sick chickens).

The possibility of the spontaneous occurrence of fowl cholera in
localities in which this disease or one of this group has existed is not
excluded in view of the general statements made on page 81, but this
possibility has not yet been demonstrated by satisfactory observations
(according to Gamaleia the intestinal canal of healthy pigeons contains
fowl cholera bacteria, but Joest did not succeed in demonstrating them
in the intestinal contents of chickens. Ostertag & Ackermann likewise
failed to find them in chickens and geese).

A fluctuation of virulence in the cholera virus is observed under
natural conditions as some outbreaks are limited to certain species of
fowls, while other species in spite of exposure to the infection fail to
contract the disease (for instance, chickens and water fowl are exclu-
sively affected). These observations show a still closer accommodation
of the virus to the organism of a certain species, as a result of which
such accommodated bacteria are strongly virulent for only a certain
species of fowl, whereas for another species they are less virulent or
non-pathogenic. However, such differences in the virulence are rare
and are not constant, and therefore the infections of various species of
fowls should not be considered on this basis alone as independent
affections.

Susceptibility. Purebred and water fowl are particularly
susceptible to natural infection, whereas the common breeds
of fowl show greater resistance. Fowl which have withstood
an infection by ingestion a short time before are more suscepti-
ble to a second infection.

Pathogenesis. The bipolar bacilli penetrate the intestines,
probably even through the uninjured mucous membrane, into
the lymph spaces of the intestinal wall, and soon gain entrance
to the blood stream where they multiply with great rapidity
and cause the death of the animals. If the entrance of the
bacilli takes place through a separation of the continuity of

Feb
Pathogenesis. 91

the skin or mucous membrane directly into the blood stream,
death results in a shorter time (Tiede found bacilli in the in-
ternal organs of a mouse 15 minutes after subcutaneous inocul-
ation). Death is caused in the first place by the action of the
toxins which without a doubt form in the animal body in such
a manner that through the negative chemotaxis of the virulent
bacteria the phagocytes are unable to exert their action (Gabrit-
schewsky, Silberbeg & Zeliony). The chemotaxis of the at-
tenuated bacteria is on the other hand positive, and this ex-
plains the local suppurative inflammation which usually ter-
minates in recovery after a subcutaneous injection of such a
virus.

Injections of attenuated virus into the chest muscles of
chickens produce a serous inflammation of the connective tissue
and degeneration of the musculature (see page 95).

The bacteria penetrate from the blood circulation into eggs, and
they have been found in the yolks of eggs of affected animals (Celli
& Marchiafava, Barthelémy). The first two authors have also demon-
strated the transmission of the disease to the progeny; on the other
hand, Kitt found that young rabbits (4-6 weeks old) descending from
artificially immunized animals resist a virulent infection.

Anatomical changes. The principal anatomical findings in
acute cholera consist in an acute hemorrhagic inflammation
of the intestines and lungs in association with small hemor-
rhages on the serous membranes and sometimes a fibrinous
exudate on the same. The blood vessels of some of the loops
of the intestines are injected and their peritoneal covering
also contains small punctiform hemorrhages. The intestinal con-
tents are fluid, mixed with mucus and fine bloody streaks, or
of a uniform reddish color from the admixture of a considerable
quantity of blood. The intestinal mucous membrane appears
reddened sometimes only in spots and again in longer portions,
particularly in the duodenum. It shows an inflammatory swell-
ing and is studded with dark red hemorrhages; exceptionally
small round diphtheritic ulcers are also found on the intestinal
mucous membrane (frequently in water fowl).

The serous content of the pericardium is frequently cloudy
and contains small fibrinous flakes; the epicardium appears as
if sprinkled with blood and is frequently covered with fine
fibrinous membranes, particularly in water fowl.

The lungs are congested and edematous, sometimes dark
brownish red in spots and hepatized as an indication of a
croupous hemorrhagic inflammation which is sometimes as-
sociated with a fibrinous pleuritis. The mucous membrane of
the upper air passages shows catarrhal reddening and swelling.

In the parenchymatous organs the first stages of parenchy-
matous degeneration may be observed. The regional lymph
glands of the spleen and cecum are almost invariably decidedly
swollen and hemorrhagic. Exceptionally a fibrinous inflamma-
92 Fowl Cholera.

tion (Kitt, Ratz) is present in all the air cells and on all serous
membranes.

In the less frequent chronic cases yellowish, grey, dry
easeous foci are frequently present in lungs, liver and on the
intestinal mucous membrane, sometimes also under the en-
docardium, which may become quite extensive, especially in the
lungs. Exceptionally even both lobes of the lungs may show
hepatization resembling caseous pneumonia (Jungklaus). At
the same time there may be a fibrinous pleurisy and pericarditis,
and in some of the joints and tendon sheaths a caseous exudate
may be present (Sticker, Hensel, Willach).

In the acute form bacteria may be found in great numbers in
the blood, between the blood corpuscles and only sparingly in the white
blood corpuscles as well as in the exudates. The intestinal contents are
also virulent. In chronic cases the caseous foci also contain virulent
pee bacilli, while they are present in only small numbers in the

ood.

Symptoms. Ostertag & Ackermann’s experiments showed
the time of incubation after a single feeding with organs of
fowl affected with cholera to be 1 to 2 days in geese, and 4
to 9 days in chickens. After the recovery from a feeding in-
fection a new infection produced death in geese (feeding) as
early as 19 hours and in chickens (subcutaneous infection) as
early as 8 hours. The-time of incubation is very likely the
same in natural infection.

The acute form of the disease sometimes runs a very rapid
- course; the animals drop to the ground while running, or they
fall to the ground from an elevated place, such as the rod of a
cage, or from a tree, and die after flapping their wings a few
times.

In the large majority of cases, however, conspicuous symp-
toms precede death. The birds suddenly become depressed, they
assume a crouching position, seek secluded places, and sit
trembling. Sometimes the head is hidden under the wing or
it may be turned backwards. The plumage is ruffled, the wings
may droop, and if they move a staggering and wabbling gait
is manifest with the wings hanging and the head drooped.
The appetite is impaired from the onset, while thirst, on the
other hand, is increased. A foamy slime drips from the nasal
and oral openings; and from time to time the birds turn their
necks convulsively, or stretch out their heads on which the
bills, combs and wattles show a bluish-red discoloration. At
the same time they may vomit a greyish-yellow slimy mass.
At the height of the disease a profuse diarrhea develops; the
droppings are at first yellowish-grey, mushy in appearance,
later very fluid, dirty, greenish or reddish, mixed with coagu-
lated albumin-like flakes, and of a repulsive odor. The plumage
around the rectum becomes soiled and matted with the feces.

The affected birds show difficult respiration which is mani-
Symptoms 93

fested by opened mouth, inspiration as well as expiration being
associated with moist rales. As the weakness progresses they
he with closed eyes and in a stupor in one place. If they at-
tempt to rise they soon collapse and finally die with manifesta-
tions of convulsions or coma.

In the chronic form of the disease progressive anemia de-
velops after the disappearance of the acute symptoms, or from
the onset of the disease, attended by emaciation; finally a per-
sistent diarrhea occurs. Sometimes one or more joints of the
wings or feet swell; later the swelling bursts, whereupon a
caseous purulent mass containing bacilli is discharged from
the joints. The arthritis interferes to a great extent with the
movements of the already weakened birds.

The duration of the disease is from 1 to 3 days in the
majority of acute cases with the exception of the peracute
cases. It may, however, exceptionally extend from 7 to 12
days. In these cases the symptoms are less severe from the
onset, and the exhaustion appears later. The course of the
chronic form extends over several weeks.

The prognosis is very unfavorable. Frequently entire flocks
of chickens succumb to the infection, while in other cases a cer-
tain percentage of the birds escape probably owing to a slighter
intensity of the infection. However, in exceptional cases re-
coveries may take place.

Diagnosis. Chicken. cholera in its course and symptoms
greatly resembles chicken pest. The latter comes into con-
sideration particularly when it affects chickens exclusively.
From this as well as from other septicemic affections of fowls,
and also from acute poisonings which are frequently suspected
by the owners, the disease can be differentiated with certainty
by an autopsy and bacteriological examination (see also
chicken pest.) Intestinal worms (for instance, the trichosoma
collare) may also produce cholera-like symptoms.

Chronic cases, particularly those which are associated with
arthritis, may be mistaken for tuberculosis and gout. <A dif-
ferentiation is here also only possible by microscopical exam-
ination of the exudates from the joints, as well as by autopsies.

On autopsy the presence of intestinal inflammation, the
fibrinous exudate contained in the serous cavities, and the
hemorrhages are strongly suggestive of fowl cholera, but to
establish a definite diagnosis even in such eases a bacteriological
examination of the blood and the inflammatory products is
necessary.

The microscopical examination consists in the preparation of cover-glass smears
in which usually large masses of bipolar rods can be easily recognized by the aid
of the previously mentioned staining methods (see page 79). Pigeons are best
suited for test inoculations, especially since they are not susceptible to chicken
pest. For this purpore the point of a knife is dipped into blood or exudate and then
used for searifying the skin, or a small quantity of the material is injected, sub-
eutaneously or it may be introduced into the breast muscles. The inoculation
usually results in a short time in the death of the test animals and when the in-
94 -Fowl Cholera

fection is produced by an injection into the breast muscles, a yellow gelatinous in-
filtration of the subcutaneous tissue develops at the point of inoculation around
which the surrounding muscles show a yellow discoloration and necrosis. Mice may
also be used for diagnostic purposes. In these the bipolar bacilli may be demonstrated
in large numbers in the blood.

Treatment. At the onset of the disease the treatment of
the affected as well as the exposed fowls with highly potent
immune serum is indicated (see page 95); otherwise, the af-
fected birds are given the customary weak solutions of disin-
fectants, which may be added to the drinking water. These
solutions, viz., iron sulphate, salicylate acid, tannin (14 to 1%),
sulphuric or hydrochloric acid (2:1000), may also be given in
tablespoons or teaspoons (Ward and Stange give a 1 to 1500
or 2000 corrosive sublimate solution as drinking water). The
same methods may be also applied as preventive measures
against the disease in healthy birds which are threatened by
infection. The subcutaneous injection of a 5% ecarbolic acid ©
solution (Nocard, Barberio) is followed by little or no bene-
ficial results.

Prevention. Great care should be exercised in order that
the introduction of the disease by the purchase of new birds
may be prevented. In addition to careful examination of the
source, it is advisable to keep new birds separated for at least
1 week, and only after that period should they be allowed to
mingle with the birds of the flock.

If the disease has already appeared in a flock, entirely
healthy birds should be taken to an absolutely clean place with-
out delay. Those already affected or suspected should im-
mediately be slaughtered or taken to a separate place for treat-
ment. The carcasses should be buried deep, or, still better,
burned. After burning or burying the droppings, the walls
and roosts of the chicken houses as well as the drinking vessels
and containers used for feeding, should be scalded with hot
water or washed with hot lye. They should also be sprinkled
with lime, and the previously cleaned floors should be sprayed
with a 3% creolin or lysol solution. Airing of the chicken
houses for several days promotes good results from this method
of prevention. The droppings from the affected as well as the
healthy birds should be collected at least once daily and burned.

Immunization. Formerly attenuated cultures were used
for this purpose, while recently the immunization with blood
serum is more extensively employed.

I. Immunization with attenuated cultures (Pasteur’s
method). According to the investigations of Pasteur (1880)
the bacteria of chicken cholera in bouillon cultures are gradually
attenuated under the influence of the atmospheric air until after
about two months standing they lose their virulence entirely.
Tf allowed to stand for a shorter time the bacteria are attenuated
Immunization. 95

to a certain degree, which virulence they retain if their culti-
vation is continued. Cultures attenuated to two different de-
grees produce two vaccines with which chickens may be im-
munized against virulent infections.

This method of immunization is of great scientific im-
portance but has not proven successful in practice. Irrespec-
tive of the inconvenience of this method, in consideration of
the relative small value of fowls, the inoculations in their prac-
tical applications sometimes cause considerable losses. Fur-
thermore, the desired protection is not afforded which is very
probably due to the uncertainty of the applied attenuation.

Pasteur’s vaccine produces local necrosis of the muscles and serous
inflammation of the connective tissue when injected under the skin of
the breast of chickens. The corresponding part of the breast muscle
separates from the living tissue towards the end of the second week,
whereupon the sequestrum is reabsorbed in 3 to 4 weeks, or is cast off
through a fistula which may have formed. Kitt found by repeating
Pasteur’s experiments with the two original vaccines that both produced
such local affection in chickens and ducks, and in the majority of these
birds produced an effective immunization. On the other hand, pigeons,
rabbits and small birds were killed by the inoculation.

Attempts to prepare suitable vaccines from cultures through
attenuation at higher temperatures (Salmon, Jess) and through the
addition of chemicals (Jess) were unsuccessful.

Ligniéres recommends his polyvalent vaccine (see page 84) against
chicken cholera, and in this disease the best results are supposed to
have been obtained. The dose consists of 14 ce. (subcutaneously).

II. Immunization with immune serum. Kitt (1892) es-
tablished by experiments that the blood of chickens immunized
against cholera has an immunizing effect upon healthy chickens,
and further that the white and yolk of eggs of immune chickens
(5 to 10 ec.) possesses a similar effect. Later Kitt & Mayr
(1897) prepared a serum by means of intravenous injections
of virulent cultures in horses of which 2 to 20 cc. produced pas-
sive immunity in rabbits and 14 to % ce. in mice, nevertheless
it was ineffective in chickens. Still later Kitt (1902-3) produced
an active immunity in rabbits by injecting them subcutaneously
first with immune serum from chickens or horses (1 to 10 cc.)
and following this with the injection of virulent cultures.
Rabbits highly immunized in this manner produce a serum of
which 1% to 3 ec. protect rabbits and mice against a virulent
infection, and in some cases chickens and pigeons were also
immunized with it. Finally Kitt obtained a serum from horses
by subcutaneous injection of virulent cultures, of which 2
to 5 ec. conveyed effective protection to rabbits, geese, ducks,
chickens and sometimes also to pigeons against a fatal cutaneous
or subcutaneous infection. The immunity develops not later
than 24 hours, and is also effective against intestinal infection.

The serum inoculations naturally produce a passive im-
munity lasting only from 1 to 2 weeks, and therefore their
96 Fowl Cholera.

application is indicated only in flocks already infected or in
those which are threatened by infection. (Experiments to
change immunity through subsequent inoculation of virulent
material into an active form have thus far been unsuccessful.)

Through a procedure similar to that of Kitt & Mayr, Schreiber
succeeded in preparing a blood serum of which .5 ce. protected a pigeon
against a virus which was fatal in 24 hours. The dose of this serum
is for geese or ducks 1 cc., for smaller birds .5 cc. Hartel obtained a
serum by treating an ass with living bouillon cultures (intravenous)
of which .5 cc. protected a pigeon against a dose of virus of which
1-10,000 part was fatal. :

Jess & Piorkowski inject fresh horse serum containing alexin under
the skin of fowl before the use of the immune serum in order that the
antibodies contained in the horse serum may find a sufficient quantity
of alexins in the tissue fluids. The single dose is .5 to 4 ec. of immune
serum, depending on the size of the bird, and 1 to 8 ce. of normal serum.
The mixture is supposed to effect also a curative action when applied
not later than 6 hours after the infection has taken place. Mosler found
the mixture also more effective in mice than the immune serum alone.
The experiments made in Prussia are, however, contradictory (Rae-
biger).

: iced & Braun immunize horses with 4-day old bouillon cultures
of the fowl] cholera bacteria which have attained the highest degree of
virulence by passage through the bodies of sparrows. The treatment
commences with a dose of .25 cc. of culture subcutaneously and intra-
venously, which quantity of culture is gradually increased to 20 ce. and
is later injected only into the circulation. Horses thus prepared
produce an immune serum of which 0.0015 to 0.005 ce. will protect
gray mice for a period of about 3 weeks against the fatal action of a
loopful of a 4-day old bouillon culture. The results obtained in practice
met the expectations based on the laboratory experiments, and the sera
sometimes appear to have a curative action in animals already affected.

In consideration of the close etiological relation of swine plague
and chicken cholera Schreiber employed for the inoculation of fowl a
serum (septizidin) which affords protection against the former disease,
and some other authors (Hartenstein, Graffunder, Schmidt and others)
also obtained with it satisfactory results. The official reports, however,
of Prussia and Saxony are mostly unfavorable. Finally, Ligniéres’
polyvalent serum may also come into consideration.

The ‘‘Hochst Farbwerke’’. prepare a polyvalent serum (Galloserin) with
which Kovacs, Széke & Szab6 and others obtained quite satisfactory results in ex-
posed as well as already affected birds. Raebiger made comparative experiments with
the various vaccines on the market and found that pigeons inoculated with Héchst
serum or with septizidin withstood the infection in 66%, while those injected with
Gans’ (Frankfurter) and Piorkowski’s (Berlin) sera died. The serum of Klett-
Braun proved effective in laboratory experiments and also once in practice. Del-
fino found Ligniéres’ vaccine effective in rabbit experiments.

Technique of vaccination. Pasteur originally inoculated into the point of
the wing, later the inoculation was made under the skin of the breast or into the
breast muscle. According to the suggestion of Jess it is more satisfactory when
made under the skin of the neck. An assistant secures the bird with both hands
on the rump while the operating veterinarian raises a fold of the skin of the neck
with his left hand. The dose to be inoculated is indicated specially for each
preparation.

III. Immunization with Aggressins. Weil employs, according to
the procedure of Bail, a pleural exudate produced by injections of
Immunization. 97

fowl cholera bacteria into rabbits. After the addition of .5% carbolic
acid this is heated for 3 hours at 44° C. Repeated injections of small
doses (.5 to 3 cc.) or a single injection of 5 cc. protected guinea pigs
and rabbits as well as a hen and a pigeon against a subsequent lethal
infection. Rabbits highly immunized with sterile exudate produce serum
of which .5 cc. protected rabbits against a dose of the culture which is
fatal in 20 hours. According to the aggressin theory (see page. 30)
the body is supposed to form an anti-aggressin as a result of the injec-
tion of aggressins which destroys the aggressiveness of the bacteria
and their unlimited power of multiplication. Huntemiiller, however,
found that similar good results may be obtained in rabbits with wash-
ings of cholera cultures heated to 44° C. He also learned that the
filtrate of exudates was ineffective, and he therefore concurs in his
belief with Wassermann and Citron, that in immunization the toxic
body substances of the bacteria are the effective agents. Bisanti’s
experiments suggest also the possibility of a toxin immunization. This
investigator sewed collodium sacs filled with virulent cultures into the
abdominal cavity of rabbits and thereby protected them against a
cerebral infection.

Veterinary Police. Chicken cholera has been recently in-
cluded among the diseases requiring compulsory official notifica-
tion in Germany, Austria and Hungary. Upon the appearance
of the disease the infected premises or in case of a greater ex-
tension, localities and even entire townships are quarantined
against traffic in fowls. The inland and foreign traffic in fowls
as well as the premises of dealers are subject to official super-
vision.

Literature. Renault, Rec., 1851, 321—Hering, Spez. Path., 1858, 355 (Lit.).—
Perroncito, A. f. Tk., 1879, V, 22.—Toussaint, Ree., 1879, 946.—Pasteur, C. R.,
1880, XC. u. XCI.—Ziirn, D. Gefliigelkrankh., Weimer 1882.—Kitt. D. Z. f. Tm.,
1888, XIII, 1; Hb. a. p. M., 1903, II, 543 u. 1904, IV, 969 (Lit. on etiology
and immunization).—Ligniéres, Bull., 1900, 332, u. 1902, 444.—Klett & Braun, D. t.
W., 1904, 545.—Weil, A. f. Hyg., 1905, LIT, 412; 1908, LVX, 85.—Ostertag &
Ackermann, Z. f. Infkr., 1906, I, 431—Jungklaus, Diss. Leipzig 1906.

Other Diseases of Fowl of a Septicemic Character. Various ob-
servers have described in the course of the last decade different epi-
zootie affection in fowl in addition to chicken pest which simulate
chicken cholera more or less. In some of these their identity with
chicken cholera was established. Others, however, were shown to be
different, while the nature of some of the diseases is doubtful even at
the present time. On account of their relatively slight importance and
their prevention by other means than immunization for which it is
essential to establish the causative agent, the same principles mentioned
for chicken cholera are also applicable. Therefore these diseases will
only be briefly mentioned here, emphasis being placed on their most
important differences from fowl cholera.

The following diseases are identical with chicken cholera:

Lisi’s chicken septicemia (Clin. vet., 1895, 176), and the hemor-
rhagic septicemia of ducks and chickens described by Rabieanx (Soc.,
biol., 1900, 141).
98 Fowl Cholera.

Diseases simulating chicken cholera:

Infectious enteritis of chickens; observed repeatedly in England
and Ireland by Klein. The causative agent (Bac. gallinarum) greatly
resembles the bacillus of fowl cholera. However, it does not kill pigeons
and only exceptionally rabbits. (Obl. f. Bakt., 1889, V, 689; 1895,
XVIII, 105.)

Enzootic pneumo-pericarditis of turkeys; observed by M’Fadyean
and later by Jowett. The bacillus also resembles that of chicken cholera.
However, it is motile and non-pathogenic for chickens as well as for
water fowl. (J. of Comp. Path., 1893, VI, 334; Ibid., 1908, X XI, 324.)

Cholera of water fowl; observed in Germany, by Willach. The
bacillus is distinguished from that of fowl cholera by its motility, is
only slightly pathogenic for hens, and non-pathogenic for pigeons. (Cbl.
f. Bakt., 1896, XX, 187.)

Disease of swans; observed in the Zoological Garden of Antwerp
by Trétrop. The bacterium develops only slightly on potato, and causes
in swans a caseation of the lymph glands; chickens are not susceptible.
(A. P., 1900, XIV, 224.)

Diseases apparently different from fowl cholera:

Cholera of ducks; observed in the Zoological Garden of Paris
by Cornil & Toupet. The bacillus stains well by Gram’s method dnd
grows well on potato; chickens, pigeons and guinea pigs are not sus-
ceptible, rabbits to only a slight extent. (C. R., 1888, CVIII, 1747.)

Epizcotic dysentery of chickens and turkeys; described by Lucet.
The course of the disease is from 9 to 13 days. The bacillus thrives
well on potato and kills guinea pigs by intravenous inoculation. (A. P.,
1891, V, 312.)

Disease of ring-dove; observed in France by Leclainche, and is
characterized by its rapid course, somnolence and diarrhea. The bacillus
(Bac. cholere columbarum) thrives on potato; chickens are not at all
susceptible, while other fowl show only a slight susceptibility. (A. P.,
1894, VITI, 490.)

Disease of pigeons; observed in New Jersey by Moore. Cerebral
symptoms predominate in this disease. On autopsy meningitis is found
to be present, while intestinal symptoms are absent. The bacillus re-
sembles Bac. suipestifer; it grows on potato. (Bur. Anim. Indus., Bull.
No. 8, 1895, 71.)

Infectious enteritis of pheasants; observed in the Zoological Gar-
den of Milan by Fiorentini. The affected animals are not somnolent.
Autopsy does not reveal small hemorrhages. The bacillus is not motile;
it forms on potato a honey-like growth and produces indol in peptone
bouillon. Chickens, guinea pigs and rabbits are not susceptible. (Soc.
ital. di. se. nat., 1896, 89.)

Septicemia of ducks; observed in Italy by Lisi. The affected birds
show purulent conjunctivitis and keratitis. The bacillus liquefies gelatin
gradually and forms a brownish growth on potato; chickens are not
susceptible to artificial infection. (Il Med. zooiatrio, 1890, 415.)

ed
Differentiated Diseases. 99

Hemorrhagic septicemia of swans; observed in the Zoological Gar-
den of Milan by Fiorentini in pheasants and Egyptian geese. The
bacillus is motile, bouillon is made cloudy and of a yellowish discolora-
tion, grows on potato in the form of chocolate-brown colonies; the cul-
tures liberate a fetid odor. (Chl. f. Bakt., 1896, XIX, 932.)

Exudative septicemia of geese; diagnosed first in Mecklenburg
by Riemer, later in Stralsund by Frosch & Birnbaum (the disease
described by Bugge as infectious inflammation of the air-sacs of geese
is probably identical). Characteristic lesions; pronounced sero-fibrinous
pericarditis and fibrinous peri-hepatitis. The slender rod-shaped bacil-
lus (Bac. septicemiz anserum exsudative) which resembles Pfeiffer’s
influenza bacillus forms threads in cultures, is not motile, does not form
spores, decolorizes by Gram, and is strongly pathogenic for geese and
less for ducks. (Lit. Chl. f. Bakt., 1909, LII, 433.)

Epizootic pneumo-enteritis of turkeys; described by Dodd, is char-
acterized by swelling of the sub-orbital region, emaciation and diarrhea
or hepatization and small necrotic nodules in the lungs, as well as
fibrinous exudates in the pleural cavity. The causative agent resembles
the ovoid cholera bacillus. (J. of Comp. Path., 1905, XVIII, 239.)

Infectious leukemia of chickens; studied in the United States by
Moore; its course extends from 1 to 3 weeks with symptoms of a severe
leukemia. The causative agent (Bac. sanguinarium) ; forms yellowish-
white colonies on potato. (Bur. Anim. Indus: Rpt. 1895-96, 185).

Chicken plague; observed by Mazza in northern Italy. In the
course of the disease caseous foci develop in the lungs. The bacillus
is motile, develops gases in bouillon containing sugar, grows on potato
in the form of colorless, lustrous deposits; rabbits are slightly sus-
ceptible. (Chl. f. Bakt., 1899, XX VI, 181.)

Disease of canary birds; described by Rieck. A soot-like dis-
coloration of the skin develops, while the liver contains punctiform
necrotic foci. The bacillus is motile and grows on potato in the form
of yellowish-gray colonies. (D. Z. f. Tm., 1889, XV, 69.)

Cholera of canary birds; studied in Budapest by F. Kern. The
bacillus does not take bipolar staining, is not motile, develops fetid
gases in agar containing sugar, and forms yellowish colonies on potato,
the medium showing a bluish discoloration. Chickens and pigeons
are not susceptible. (D. Z. f. Tm., 1896, XXII, 171; according to
Nocard Ziirn’s canary plague is supposed to be identical with this
disease. )

Infectious malady of canaries; described by Pfaff as a different
disease from the above. The bacillus is somewhat larger than that of
Kern, forms fine flakes in bouillon, does not grow on potato, is harmless
for chickens, and pathogenic for pigeons. Constant lesions; small ne-
crotic foci in the liver and spleen (Cbl. f. Bakt., 1905, XX XVIII, 275) ;
a similar disease was described by Wasielewsky & Hoffmann (A. f. Hyg.,
1903, XLVII, 44) and recently by Zwick (Z. f. Infkr., 1908, IV, 33.)

Septicemia of canary birds; described by Freese as a very severe
disease similar to the cholera of canaries, but does not liquefy gelatin
100 Fowl Cholera.

and is Gram positive; milk is coagulated and it does not ferment
dextrose. There. is no necrosis of the liver or spleen. (D. t. W.,
1907, 501.)

Infectious necrosis of canary birds; described by Miessner & Schern
as a very infectious disease which is characterized principally by ne-
erotic foci in the spleen and liver, and is also frequently associated with
diphtheria of the buecal mucous membrane. The causative agent is a
short stubby, Gram negative, non-motile organism (Bac. canariensis
necrophorus). (A. f. Tk., 1908, XXXIV, 133.)

Typhoid of canary birds. As Joest had done before him, Zsupén
mentions under this name a disease of canary birds caused by bacteria
of the enteritis group. It runs a rapid course with symptoms of marked
debility, difficult respiration and diarrhea. The constant lesions are
acute gastro-intestinal catarrh, and besides, from case to case acute
spleen-tumor, fibrinous inflammation of the serous membranes, cloudy
swelling of the liver and kidneys. The causative agent (Bac. typhi
canariensis) is very similar.to Eberth’s typhoid bacillus, and is patho-
genic in general for small birds, as well as for rabbits, guinea pigs,
rats and mice. (Dresdn. Ber. pro 1906; Kézl., 1909, VIII, 149.)

Disease of guinea keets (Mykosis intestinalis phasianidum) ; ob-
served in Germany by Enders; affects exclusively species of chickens.
The causative agent resembles that of fowl cholera, is pathogenic for
pigeons and water fowl, and grows well on potato. Autopsy shows
hemorrhagic enteritis and osteomyelitis. Maggiora & Valenti consider
the disease identical with chicken pest, and the described bacillus is
supposed to be a frequent inhabitant of the healthy intestines of fowl
(D. t. W., 1902, 339).

Septicemia of chickens caused by coli bacteria; according to
Claussen it is supposed to develop spontaneously in chickens which
are exposed in long railroad transportations to thirst, hunger and cold
as a result of which the normal coli organism becomes virulent. The
symptoms and post mortem lesions resemble those of fowl cholera, but
the blood contains bacteria of the coli bacillus type (Z. f. Infkr., 1907.
IIT, 69).

White diarrhea of chicks; according to Rettger this disease affects
chicks'in the first three weeks of life, and is caused by a bacterium of
the coli-typhus group which is present in the blood, internal organs
and also in the yolk (J. of Med. Research, 1909, XXI, 115).

Salmonellosis of chickens; described by Ligniéres & Zabala as an
infectious and mostly fatal disease which in its course resembles fowl
cholera (spleen always swollen). The bacillus resembles the Bac.
suipestifer, but is non-motile. Besides chickens, pigeons and rabbits
are also susceptible (Bull. 1905, XXXII, 453).

Mycosis of parrots (Psittacosis) ; a disease of parrots imported
to Europe from Africa and America, characterized by dullness, diarrhea
and later by marked debility. In its course small grayish-white foci
develop in the internal organs, especially in the liver. The causative
agent is, according to Ajello & Parascandolo, a specific bacillus; ac-
cording to Rho, a paracolon bacillus which produces toxins in eultures.
Differentiated Diseases. 101

With this disease the cause of some forms of pneumonia in man is
associated, but according to the investigations of Lichtenstein this sup-
position is not well founded (O. M., 1902, 385; Chl. f. Bakt., 1899,
XXV, 651).

Grouse disease; described by Klein as a very fatal disease of
Scottish grouse. The principal symptoms are quick tiring on flying,
hoarseness, cyanosis of the conjunctiva, emaciation. On autopsy ne-
crotic foci in the liver and small blood extravasations are observed.
The bacillus is motile, Gram negative, thrives on potato, quickly
See milk, and produces indol (Cbl. f. Bakt., 1899, VI, 36; 1890,

; ‘

Cholera-like gastro-enteritis of fowl (Vibrionen-cholera, gastro-
enteritis cholerica avium). Gamaleia, who observed the disease in
Odessa, described as the cause a short, curved bacillus (Vibrio
Metschnikovi), which morphologically and culturally closely resembles
the comma bacillus of Asiatic cholera. Affected fowl die with symptoms
of somnolence and diarrhea within 2-3 days. The bacilli are present
in the lumen of the inflamed intestine, and produce the symptoms by
the eliminated toxins (A. P., 1888, II, 482).

Apoplectic septicemia of chickens; this very disastrous American
disease runs its course in from 12 to 24 hours with paralytic symptoms
and is caused, according to Norgaard & Mohler, by a very virulent
streptococcus which in addition is pathogenic for chickens and also for
rabbits, mice, ducks, pigeons and dogs. It is harmless for guinea pigs
and sheep (Bur. Anim. Industry, Bull., 1902, No. 36).

Sleeping sickness of chickens; was found by Dammann & Mane-
gold in the vicinity. of Hannover, later by Greve in Oldenburg. The
most striking symptom is the more or less pronounced somnolence.
Further, reddening and swelling of the conjunctiva, if the course is
prolonged, also paleness of the comb and wattles, diarrhea and emacia- .
tion. In the heart blood the Gram-positive encapsulated streptococci
are found in great numbers (Str, capsulatus gallinarum) thriving best
on coagulated blood serum and in milk. It is also pathogenic for
pigeons, rabbits, mice and lambs (D. t. W., 1905, 577; 1908, 213).

Septicemic and Pyemic Affections of Rabbits. Among rabbits
mostly in laboratories, but not infrequently also in valuable rabbit
breeding establishments septicemic affections occur, some of which will
be described briefly.

Rabbit Septicemia. Davaine, later Koch & Gaffky produced this
disease in rabbits by subcutaneous injections of putrid fluids, unclean
river water and putrid pickling fluid. After such injections the animals
die in from 16 to 20 hours with rapid falling of the body temperature,
diarrhea and convulsions. On autopsy the spleen and lymph glands
are swollen, the lungs hyperemic, the intestinal mucous membrane in-
flamed, serous membranes sprinkled with petechiae. The blood con-
tains small bacteria (Bac. cuniculisepticus s. cuniculicida), which in
their form and cultural characteristics are practically identical with
the fowl cholera bacterium and are very probably identical organisms
(Kitt). Cultures kill fowls with manifestations of septicemia. On
the other hand, rabbits infected with the virus of fowl cholera also
102 Rabbit Septicemia, Ete.

die within a short time. Therefore there is a possibility that the
appearance of fowl cholera may be associated with the cause of rabbit
septicemia and vice versa. Selter observed the disease in a spontaneous
enzo-otic form, and found swine plague serum effective in the treat-
ment. (Koch & Gaffky, Mitt. d. G.-A., 1881, L—Ligniéres, Bull., 1900,
356 [Lit.]—Selter, Cbl. f. Bakt., 1907, XLI, 482.)

Pleuro-pneumonia of Rabbits. Various authors describe the dis-
ease under different names, thus Beck, and recently Kurita as ‘‘pleuro-
pneumonia,’’ Kraus as ‘‘influenza-like rabbit plague,’’ Volk as ‘‘rabbit
plague,’’ Siidmersen as ‘‘infectious rabbit pneumonia,’’ Eberth &
Mandry as ‘‘spontaneous rabbit septicemia,’’ all these are, however,
probably identical or closely related. In all cases there was a fibrinous
inflammation of the pleura, sometimes also of the pericardium, fre-
quently associated with a catarrhal pneumonia. The symptoms con-
sisted in a purulent nasal discharge, difficult respiration, emaciation
and rapid course. As the causative agent a fine, Gram-negative, spore-
less aerobic bacillus was described which resembles the influenza bacillus
of man. They are distinguished from each other by unimportant char-
acteristics. (Lit. see Z. f£. Tm., 1906, X, 429; also Chl. f. Bakt., 1906,
XLIX, 508.)

Rabbit Distemper. Described by Lucet as ‘‘septic disease of
rabbits.’’

It manifests itself in a phlegmonous swelling of the tracheal and
laryngeal regions, nasal discharge, difficult respiration and emaciation.
The autopsy shows, in addition to a purulent inflammation of the
subecutis at the places mentioned and regional inflammatory edema,
pronounced acute swelling of the spleen, enteritis and serous exudate
in the thoracic and abdominal cavities. A small bacillus (Bac. septicus
cuniculi) is indicated as the causative agent. (A. P., 1892, VI, 558.)

Pyemia of rabbits; observed by Koppanyi in Belgian hares usually
as a severe affection. In acute cases purulent fibrinous pleuritis and
pericarditis are present, while in chronic cases subcutaneous cold
abscesses develop which may reach the size of a man’s fist. After
rupturing, which sometimes only occurs after 6 to 8 months, recovery
follows not infrequently. The disease is caused by a polymorphous
ae bacillus (Pyobacillus capsulatus cuniculi). (Z. £. Tm., 1906,
X, 429.

Streptothrichosis of rabbits is characterized by a progressive
necrosis of the skin which extends to the muscles and tendons. Thrombi
develop in the blood vessels and as a result emboli occur in the inter-
nal organs, especially the lungs. The streptothrix cuniculi which was
demonstrated by Schmorl as the causative agent of the disease, is
identical with Bang’s bacillus necrophorus. Basset produced an effec-
tive immune serum by treating a horse with pure cultures. (D. Z. f.
Tm., 1891, XVII, 375; Bull., 1908, 345.)

Myxomatous affection of rabbits; observed by Sanarelli in Monte-
video and by Splendore in Sao Paolo. At the onset a purulent blepharo-
conjunctivitis develops and is rapidly followed by a large swelling of
the head, also in. the vicinity of the rectum and the opening of the
urethra and genital organs. Post mortem examination reveals tumors
in the subeutis which have a gelatinous appearance. Further, there
Hemorrhagic Septicemia of Cattle. 103

is hypertrophy of the lymph glands, orchitis and spleen tumor. The
disease is very easily transmitted artificially and appears to be caused
by a filterable virus. (Cbl. f. Bakt., 1898, XXIII, 865; 1908, XLVIII,
300.)

(b) Hemorrhagic Septicemia of Cattle. Septicaemia hemor-
rhagica bovum.

(Bollinger’s Wild- und Rinderseuche, Hemorrhagische Septi-
kamie der Rinder [German]; Pasteurellosis bovum,
Pasteurellose ou Sépticémie hémorrhagique

: du boeuf [French].)

Hemorrhagic septicemia is mostly an acute, less frequently
a subacute, infectious disease. In its course the febrile symp-
toms are usually accompanied by manifestations of an acute
gastro-enteritis, inflammatory edema of the skin or frequently
a necrotic pneumonia associated with edema of the interalveolar
connective tissue. The causative agent is Bac. bovisepticus.

History. Bollinger described in 1878 a very fatal disease, which
was previously unknown, occurring in the vicinity of Munich among the
deer and wild boars. Later it was observed in cattle, and in some
instances among horses and domestic hogs. The infectious character of
the disease has been established by Bollinger and later by Franck
(1881) as well as. by Friedberger (1881). The causative agent, how-
ever, was discovered by Kitt (1885) and somewhat later studied by
Hueppe (1886). Recently especially Jensen (1889) and Ligniéres
(1898 and 1900) investigated the etiology of the disease.

Occurrence. The disease occurs everywhere either sporadi-
cally or enzootically, especially during the summer. Some-
times it originally occurs in deer and wild hogs, spreading later
a see a cattle, and from the latter hogs may often become
affected. :

In the beginning of the eighties of the last century the disease was repeatedly ob-
served in northern Bavaria, but it has been since found in other parts of Germany
as well as‘in different European countries. The losses were sometimes consider-
able. In the year 1878, 153 deer and 234 wild hogs died in the Reservations in the
vicinity of Munich; in 1887 in the District of Bindlach more than 100, and in
one district of Prussia the annual loss was more than 100 cattle. In recent times
it is principally observed in Prussia (Government districts Posen and Bromberg)
as well as in Bavaria. In 1905, 57 cases were reported from Posen and 30 from
Hannover,

In Austria the disease occurs in Bohemia, Moravia and Silesia. In Moravia
155 cattle and 29 hogs were affected in 1900, in 44 townships, of which number 15
cattle and 15 hogs died. One hundred and one cattle and 14 hogs were slaughtered
in emergency (Taufer). In Hungary the disease was first observed in 1900 in
the County of -Gémér, in one township where 17 cattle were affected. During the
period from 1901 to 1902, 12 yearlings and 2 cows died in Hansag; in 1904, 14 ont of
a herd of 49 yearlings in the vicinity of Kapuvar became affected. From time to
time sporadic eases occur in fattening establishments.

In France the disease was observed by Leclainche and in Switzerland by
Guillebeau and Hess.

The disease also exists in North America (the broncho-pneumonia of cattle
deseribed by Nocard is a form of this disease), in Indo-China, in the Malayean
Peninsula, in the Philippines and in Java.
104 Hemorrhagic Septicemia of Cattle.

‘There is sometimes observed a septic pleuro-pneumonia in calves which occurs
simultaneously with hemorrhagic septicemia in adult cattle. This disease is either
closely related to or identical with hemorrhagic septicemia of cattle (See page
111).

Etiology. The cause of the disease is the bacillus (bipolaris)
bovisepticus which is a variety of the bacillus of hemorrhagic
septicemia. In its principal characteristics it conforms to the
organisms of this group (see page 79).

Hueppe succeeded in growing it in spring water containing a large amount of
organic substances, and also in garden soil. It grows best at body temperature,
while at a temperature from 12-13°C. it no longer propagates. A 1:5000 sublimate
solution kills it in 1 minute, 3% carbolic acid in 6 hours, moist heat of 80°C. in 10
minutes (Hueppe). The gastric juice appears also to have a bactericidal action
(Taufer). Dried virulent blood loses its infectiveness in 14 days (Kitt).

The virulence of the contagion varies in the different enzo-
otics within wide limits. Deer and wild hogs are very suscep-
tible, cattle and domestic hogs are somewhat less predisposed.
Under natural conditions the disease affects only animals of
these species, but sometimes solipeds and also goats may be-
come affected. Subcutaneous inoculations of virulent bouillon
cultures produce a severe inflammatory edema which is fol-
lowed by suppuration and finally by recovery. Calves, how-
ever, have died within several days after such an injection.
Intravenous injection acts more energetically. By this method
calves may be killed with 10 cc, and cattle with 100 cc. of
the culture in 1 to 3 days, with manifestations of acute septi-
cemia. After a less severe infection the animals gradually
emaciate in spite of a good appetite; at the same time an in-
flammation develops in the knee and hip joints, as well as a
broncho-pneumonia, whereupon the animals die from extreme
exhaustion. Autopsy reveals in such cases as a rule only
foreign bacteria in the inflammatory products (Ligniéres).
Among other animals rabbits are susceptible to artificial infec-
tion; horse, guinea pig, dog and pigeon are less susceptible,
while domestic fowls are not susceptible to this disease
(Bollinger, Kitt, Taufer).

The natural infection results in most cases through the
digestive tract; exceptionally the virus may enter the circula-
tion through injuries in the buccal mucous membrane and the
skin. The latter method of infection is possibly transmitted
through flies and mosquitoes (Franck, Dammann & Oppermann
recently connected an outbreak of the disease in the Province
of Hannover [1905] with swarms of insects [Simulia ornans]
as they succeeded in finding in their bodies bipolar bac-
teria, although these were only slightly virulent for rabbits).
Bollinger also believes a pulmonary infection possible, but this
mode of infection has been proven so far only in rabbits. The
virus may also be disseminated into remote localities through
the meat and hides of affected animals.

The sporadic cases as well as the first attacks of an enzo-
Natural Infection. 105

otic outbreak occur as a rule through infections of the soil,
the causative agent in some localities acquiring a strong viru-
lence through unknown influences, or they may he due.to a
diminished resistance of the animals. As local enzootics fre-
quently develop first among deer and black game the moist soil
of the forests appears to be especially favorable for the propa-
gation of the bacteria and for the change in their virulence
mentioned above. The warm spring weather is particularly
favorable for the development of the bacteria. During this
period the disease occurs most frequently among cattle.

The virus which originates from the soil retains its in-
creased virulence for a certain time in the body of the animals,
and this may even be increased further. The blood is highly
infectious. in the latter stages of the disease, and during this
time the blood as well as other body fluids and excrements may
also infect other animals, and in this way the enzootic may
continue to spread in a contagious form. (Bollinger observed
an infection in a steer which died from pneumonia within 54
hours after the ingestion of 1 gram of feces from a calf affected
with an acute form of the disease.) After a certain time these
enzooties which do not as a rule extend over large territories,
usually subside very probably as the result of an attenuation
of the virus which takes place in the meantime (Carrougeau.
observed a gradual attenuation of the virus from repeated re-
inoculations of cattle).

The cornstalk disease or corn fodder disease which occurs among
cattle in America, especially in the middle and upper Mississippi
Valley, is also supposed to be caused by an ovoid bacterium, and to
be identical with hemorrhagic septicemia of cattle. This disease usually
oceurs in the fall and early winter after the animals are turned into
the cornstalk fields. It is characterized by a very rapid course. The
autopsy reveals numerous hemorrhages in the internal organs, espe-
cially in the serous membranes. Recently, however, Moore showed
that the disease was not of an infectious nature, but was due to toxic
substances (according to Mayo, potassium nitrate) which are sometimes
present in large quantities in the stalks, and which are responsible
for the intoxication. As a matter of fact the disease may be actually
prevented by cutting the stalks early and only feeding them after they
have been carefully cured and removed from the field.

Anatomical changes. The autopsy reveals a marked
hyperemia of the internal organs as well as fresh hemorrhages
in the serous and mucous membranes, and in some of the
organs, especially the lungs and muscles. The spleen has either
a normal appearance or contains circumscribed bloody areas;
the liver and kidneys show cloudy swelling. The other ana-
tomical changes vary in the different cases.

In the edematous or exanthematous form the subcutaneous
connective tissue of the head, the throat region and the neck,
show a gelatinous infiltration, which may in some places be
studded with hemorrhages. The serous infiltration may extend
106 Hemorrhagic Septicemia of Cattle.

to the deeper layers of the muscles. The tongue appears more
or less enlarged, dark, of a dirty brownish-red color, and of a
very firm consistency. On incising this organ a large quantity
of a light yellow serous fluid escapes, while in parts of the
infiltrated tissue, especially under the mucous membrane, flat,
diffused, fresh hemorrhages are present. The frenum of the
tongue and the surrounding parts as well as the submucous

 

Fig. 27. Pneumonia in hemorrhagic septicemia of cattle. Above, brownish-red
hepatization with hemorrhages; below, grayish-red hepatization with
commencing necrosis. Inter-lobular connective tissue edem-
atously infiltrated, lymph spaces dilated in parts.

connective tissue of the pharynx and the larynx show gelatinous
infiltration and appear as flabby masses. The mucous mem-
brane of the upper air passages shows a catarrhal swelling
and is sometimes covered with croupous membranes. The
retropharyngeal lymph glands and those of the neck show pro-

nounced acute swelling.
Anatomical Changes. 107

The abdominal cavity sometimes contains several liters of
a yellowish or reddish serous fluid. The small intestine mani-
fests lesions of a pronounced acute hemorrhagic inflamma-
tion, which while also present in the large intestine are less
marked there. The content of the intestinal canal is thin,
fluid, yellowish-gray, or from an admixture of blood, dirty-
reddish in color. The spleen is normal, or at most in parts,
somewhat swollen. The blood is also normal in color.

In the pectoral form the thoracic cavity contains serous
or sero-fibrinous exudate which is sometimes mixed with blood.
The pleura is inflamed and studded with small hemorrhages,
especially the visceral layer which appears to be covered with
fibrinous membranes. In one or both lungs smaller or larger
connecting parts are hepatized and friable. The cut surfaces
are uniformly dark, brownish or reddish in color, finely gran-
ular, and contain, in less acute cases, small, dry, caseous areas.
Sometimes the interlobular connective tissue septa appear
thickened and yellowish-white through serous infiltration, so
that the cut surface of the lung has a mottled marbled appear-
ance (the appearance in such cases is very similar to the lungs
in contagious pleuro-pneumonia [Fig. 27]). The parts which
are not hepatized show marked hyperemia and edema. The
pericardium may also contain an exudate mixed with fibrinous
flakes. The connective tissue of the mediastinum is gelatinously
infiltrated and studded with hemorrhages. The peribronchial
lymph glands are acutely swollen; usually there is also an
acute enteritis present, while the spleen preserves a normal
‘appearance even in severe cases.

Nocard, who diagnosed the disease in cattle imported from America
to Paris, (broncho-pneumonia of American cattle) emphasizes the fact
that the serous fluid in the lungs differs from that of contagious pleuro-
pneumonia. It is not so markedly yellow, and has not the appearance
of lymph, also the thickened lymph spaces are filled with a whitish,
tenaceous, fibrinous coagulum. The individual lobules appear firmer in
the center and more markedly hepatized than in the periphery, which
is probably, on account of the fact that the inflammatory process
extends from the bronchi and not from the interlobular connective
tissue.

According to the anatomical findings in the different cases, Bollinger
distinguished a pectoral and an exanthematous form of the disease,
the former occurring principally in wild animals, while the latter is
supposed to be more frequent in cattle. Later a so-called intestinal
form was also described, which, however, does not occur independently,
but only in association with one of the previously mentioned forms (the
designation ‘‘exanthematous form’’ is not appropriate as there is
no exanthema present but only an inflammatory edema).

Symptoms. The time of incubation of the disease in inocu-
lation and feeding experiments proved to be from 6 to 24 hours.
In natural infections it is probably somewhat longer, but it
hardly ever extends over 2 days.
108 Hemorrhagic Septicemia of Cattle.

As the first symptom a rapid rise in the body temperature
to over 40°C. is observed. This is accompanied by an acceler-
ated pulse, dullness, rough coat and muscular trembling. At
the same time the surface of the body feels alternately hot and
cold, while the muzzle is cold and dry. There is also cessation
of appetite, rumination and milk secretion. The peristalsis
of the rumen and intestines is retarded; constipation at this
stage may also be noticed. Later, symptoms of colic appear
with much straining when the animals pass instead of the
usual dry, dark brown feces, a mushy and finally a thin, fetid
fluid which is not infrequently mixed with fibrin and mucous
flakes as well as with blood. In.the meantime blood frequently
exudes from the nose and sometimes the urine may also con-
tain blood. In addition to these manifestations one or the other
form of the disease finally develops during the further course
of the malady.

According to Carrougeau as well as Reynolds, Wilson and Brim-
hall, the temperature may be either normal or subnormal, and Mezey
observed in a fallow deer a temperature of only 37° C. with symptoms
of a marked apathy, inappetence and bloody excrements.

Guerrieri observed the disease in Sardinia (Male della ferula) in
a peracute form when the animals, while ruminating. or feeding, sud-
denly ran away like mad, staggered, collapsed, and died with escape of
blood from the nose.

In the edematous (exanthematous) form the head and neck
swell, especially in the region of the throat and dewlap, as a
result of the rapidly increasing inflammatory edema of the
subeutaneous connective tissue, causing a deformity of these
parts. There is also swelling of the legs and in rare cases
the swelling may commence at one of the extremities and spread
from there to the neck and body (Ratz). In such cases in-
flammatory enlargement of the different joints may be observed.
Over the swollen parts of the body the skin is very tense, warm
and sensitive. On the eyes an acute conjunctivitis develops,
frequently with a yellowish coloration of this membrane. There
is profuse lachrymation, the tears running down the face. The
buceal mucous membrane is bright red, warm, dry and swollen.
Deglutition is difficult or impossible, so that the saliva accumu-
lates in the mouth, and dribbles from the corners of the mouth’
in long, tenacious strings. The tongue swells to such an extent
that it entirely fills the buccal cavity, and a part of it may even
protrude between the teeth. It is bluish-red, or dirty reddish-
brown and shows on its lower surface impressions of the teeth,
while at both sides of the frenum the mucous membrane of
the floor of the mouth is bunched up in thick, flabby, gelatinous
rolls.

Respiration is very difficult and frequently stertorous. All
the mucous membranes are cyanotic, often studded with hemor-
rhages, and finally the. animals die of asphyxiation, or the
Symptoms. Course. Diagnosis. 109

ue which is caused by the marked enteritis, produces
eath.

Taufer observed the following additional symptoms during an
outbreak of the disease: A very extensive infiltration of the masticatory
and cheek muscles as well as of the back of the nose, the lips and the
nasal mucous membrane (hippopotamus head), cloudiness of the cornea
(in two cases also panophthalmia). In one case he observed necrosis
of the cheeks and lips, and lastly in 24 cattle a skin eruption over
the entire body. These skin lesions were developed most extensively
above the carpal and tarsal joints, and resulted in circumscribed
necrosis. Carrougeau has also observed skin eruptions in the form of
nodules which were closely set in rows, from which the thickened
epidermis separated in thick shreds.

According to Robertson and Spreull the disease of cattle known
in South Africa as ‘‘lamziekte’’ is supposed to belong to hemorrhagic
septicemia. However, a confusion with ‘‘heart water’’ (see this disease)
is not excluded.

The pectoral form is characterized by symptoms of an acute
pleuro-pneumonia. The animal stands immovable with back
arched, has a dry and painful cough, and a colorless or reddish,
foamy serous discharge from the nose. On one or both sides
of the thorax there is dullness over different areas with
bronchial breathing and vesicular rales. There may be a total
absence of respiratory sounds. Friction sounds may be heard
over the hepatized areas. Respiration is greatly accelerated
and labored. Rumination ceases. Peristalsis of the rumen and
intestines is frequently suppressed. Constipation is followed
by bloody diarrhea, whereupon the greatly weakened enimal
rapidly succumbs.

According to Carrougeau the disease may take a chronic course.
The emaciated, feverless animals cough frequently; their appetite is
capricious, and there is profuse lachrymation. At the same time a
persistent diarrhea is present in which feces mixed with blood are
passed. Over the lungs rales can be heard, and percussion sounds are
sometimes dull. The disease may terminate in recovery, but in such
cases the cough persists for a long time. In other cases the animals
die from exhaustion as a result of the long continued sickness and
emaciation. The autopsy of such animals reveals caseated areas in
the lungs, chronic catarrh of the stomach and intestines, enlargement
of the lymph glands and indications of cachexia (in some cases only
the latter lesions are present).

The belief of Simader that the ‘‘endemic pharyngeal paralysis (Wasenmeister-
krankheit)’’ is a form of hemorrhagic septicemia is not substantiated as aside from
the different post mortem findings and its continuous afebrile course (Schmid) there
are no proofs, and especially since an identical etiological factor has not been
established.

Course and prognosis. The duration of the disease varies,
with the exception of the chronic cases, between 6 hours and
8 days. The edematous form usually runs the more rapid
course, mostly from 12 to 36 hours, while the pectoral form,
110 Hemorrhagic Septicemia of Cattle.

which occurs very frequently in some enzootics, rarely ter-
minates in less than 3 days.

The prognosis is very unfavorable. According to past
observations 85 to 95% of the affected animals die. Recovery
may exceptionally be observed in the pectoral form, but even
in these cases it is not complete, as in the patients a chronic
lung affection usually follows.

Diagnosis. The disease resembles first of all those cases
of anthrax in which edematous swelling and signs of enteritis
are present. Hemorrhagic septicemia is indicated by the de-
velopment of edematous swelling of the throat, marked swelling
of the tongue and the fact that hogs may be simultaneously
affected. On the other hand, in anthrax the edema which is
less frequent is more apt to develop on the neck, dewlap and in
front of the chest; hogs are only exceptionally, while sheep are
frequently affected. On autopsy the absence of acute swelling
of the spleen excludes anthrax with a high degree of certainty,
while bacteriological examination of the blood from carcasses
recently dead of the disease makes differentiation easy on ac-
count of the great difference in the appearance of the causative
agents. If the carcass is no longer fresh cutaneous or sub-
cutaneous inoculations of the blood or inflammatory products
are advisable, as the blood of such test animals (mice, rabbits
‘ and pigeons) contains the respective bacteria in great numbers.

From rinderpest hemorrhagic septicemia may be differ-
entiated by the fact that the latter may occur without being intro-
duced from outside into a locality, and that in its course the
mucous membranes, especially those of the air passages, do not
show an intense croupous inflammation and ulceration. Blackleg
and malignant edema are characterized by crepitating, edema-
tous swellings; moreover, these diseases cannot be transmitted
to test animals by cutaneous or small intravenous injections.

The pectoral form of hemorrhagic septicemia can easily
be mistaken for pleuro-pneumonia. In the majority of cases
hemorrhagic septicemia may be recognized by the appearance
of inflammatory changes in the lungs, as they occur in this
disease in larger extension or in numerous centers of the same
stage of development. Occasionally, however, the lesions may
simulate acute or subacute pleuro-pneumonia to such an extent
as to render diagnosis from the macroscopic findings almost
impossible. In such cases a microscopical examination will
establish the correct disease, as in hemorrhagic septicemia the
serous fluid of the lungs contains bipolar bacilli, while in pleuro-
pneumonia the findings are negative. Test inoculations may
also be made to differentiate the disease, as the virus of sep-
ticemia is pathogenic for practically all test animals, while
that of pleuro-pneumonia is harmless (in calves infected sub-
cutaneously with the latter an edematous swelling develops at
the point of inoculation in 1 to 2 weeks). The presence of
Diagnosis. Treatment. 111

small hemorrhages in the tissue of the inflamed pleura, and
the sudden appearance and rapid course of the disease are
suggestive of hemorrhagic septicemia.

Sometimes bacteriological examination may be diffieult as occasionally the
blood as well as the exudates of animals affected with hemorrhagic septicemia con-
tain few bacteria and the virus may be greatly attenuated. In doubtful or negative
cases, it is therefore advisable to inoculate several test animals, especially rabbits.

Lastly, the disease is differentiated from simple asphyxia-
tion by the absence of inflammatory changes; from spontaneous
(mycotic) or toxic enteritis by the absence of hemorrhages in
other organs which will also differentiate septicemia from in-
flammatory changes in the lungs and inflammatory edemas of
the subcutaneous connective tissue. :

Treatment and prevention. The treatment of affected
animals has so far been unsuccessful and can at best consist
in the searification of the swellings, washing of the wounds
and disinfection of the intestinal canal.

For the suppression of the disease it is advisable to re-
move cattle and hogs from the infected premises to dry, and
if possible, to elevated places. When the disease has appeared
in a stable, it is well to withhold the suspected feed and to dis-
infect the premises.

The method of immunization which has been recommended by
Blin & Carrougeau against buffalo disease (see page 118) might
perhaps be applied to hemorrhagic septicemia in cattle.

Veterinary police. Before requiring the inclusion of hem-
orrhagic septicemia among the diseases for compulsory report-
ing, it is necessary to take into consideration the fact that it
is a disease of the soil. Far reaching traffic restrictions do not
appear justified, while hides may be rendered harmless by
simple drying.

Ostertag found in his investigations that dried hides from affected cattle are
always free from the infectious agent as soon as their moist and pliable condition
is lost and they become hard. Submerging pieces of skin in milk of lime or in
fresh tanning fluids destroys the organisms in 24 hours. In meat the infective agent
is destroyed by advanced putrefaction, by heating to 70°C. (immediately), with less
certainty by salting, pickling or injections of brine (sometimes only after 45 days).

Literature. Bollinger, Ub. eine neue Wild- und Rinderseuche usw. Miinchen
1878.—Franck, D. Z. f. Tm., 1881, VII, 293.—Friedberger, Mch. Jhb. 1880-81, 21.—
Kitt, Sitzesber. d. Ges. f. Morph. Miinchen 1885; Mech. Jhb. 1885-86 u. 1886-87.—
Nocard, Bull, 1891, 424.—Jensen, Monh., 1894, IT, 188.—Ligniéres, Bull., 1897,
761; 1900, 537 (Lit.).—Taufer, Fortschr. d. V.—Hye., 1904, II, 188 (Lit.). —
Ostertag, wz. £. Infkr., 1908, TV, 1.—Simader, W. f. Tk., 1908, 397 (Lit.).

 

Septic pleuro-pneumonia of calves. The disease was first
described by Poels in Holland (1886) and since that time by other
authors (Jensen, Liénaux, Bongartz, Galtier and others). It evidently
represents a form of hemorrhagic septicemia of cattle, and the close
112 Septic Pleuro-pneumonia of Calves.

relation of the two diseases appears especially indicated by the fact
that in certain herds adult cattle and calves are frequently affected
at the same time.

The causative agent (Bac. vitulisepticus) is identical with the
organism of septicemia, and natural infection appears to occur princi-
pally through the digestive tract. All excretions of the infected animals
may transmit the infection. | ;

The autopsy reveals a large amount of sero-fibrinous- exudate in
the pleural cavity, punctiform hemorrhages in the serous covering of
the lungs, reddish-brown or grayish-red hepatizations with serous
infiltration of the interalveolar connective tissue in the lungs, and
sometimes dilatation of the lymph vessels contained therein (marbled
appearance). The finding is. completed by the presence of small
hemorrhages in the serous and mucous membranes, acute catarrh of
the air passages and the gastro-intestinal canal, acute swelling of the
lymph glands, and cloudy swelling of the parenchymatous organs.

The symptoms consist in high fever, weakness, inappetence, indi-
cations of acute pleuro-pneumonia such as painful cough, difficulty in
respiration, sensitiveness over the thorax, dullness over the lower parts
of the lungs with friction sounds, bronchial breathing, or a total absence
of respiratory sounds. Difficulty in respiration increases, and in most
eases death results in 1 to 2 weeks after diarrhea sets in, or after a
temporary improvement a chronic form of the disease may develop.

For prevention immune sera (calf-pneumonia serum, septizidin)
prepared from horses and cattle by injecting them with cultures of the
bipolar bacillus were used with varied results. According to the
investigations of Schirop promising results can be expected only from
the use of polyvalent sera (see page 85). However, he succeeded in
immunizing rabbits and guinea pigs with aggressins.

On the relation of the disease, especially in its chronic form, to other pneu-
monias of calves see the chapter on enzootie volume II.

Literature. Poels, Fortschr. d. Med., 1886, IV, 388.—Jensen, Monh., 1890, II,
1.—Liénaux, Ann. vét., 1892, 465.—Bongartz, B. t. W., 1892, 529.—Schirop, Zbl. f.
Bakt., 1908, XLVII, 307 (Lit.).

 

Hidebound. Enteque. The disease is designated in Argentine
by this name, and occurs there especially along the shores of the Atlan-
tic Ocean in certain marshy localities, where the outbreaks cause
considerable annual losses. It was described by Monfallet, Even, and
particularly Ligniéres who gave a careful and full description of the
disease. In acute cases occurring in animals from 12 to 24 months
old, a persistent painless diarrhea and gradual emaciation are observed
in spite of a good appetite, until the animals finally die of exhaustion
in from 3 to 4 months. In the ecachectic form of the disease, which
occurs mostly in animals which recover from the acute affection, the
course may extend over several years. In these cases the progressive
emaciation and anemia which develop in- the meantime and a marked
exhaustion are the most conspicuous symptoms. Normal appetite is
suppressed, but the animals manifest a desire to eat bones. Along the
neck in the jugular groove the calcified carotid may be felt. in some
animals, while in others inflammation of the joints appears, resulting
in deformities.

On autopsy in acute cases besides the general anemia and emacia-
tion, sometimes a pleuritis, broncho-pneumonia or a fibrinous pneu-
Hidebound. Buffalo Disease. 113

monia may be observed. In the chronic cases the lungs sometimes
show islands or cords consisting of spongy osseous tissue which crepi-
tate on pressure and which have developed by ossification of the vessel
walls. In the large blood vessels of the body, and in exceptional cases
in the small arteries, especially those of the heart, a pronounced
arterio-sclerosis exists; the endocardium may show a chronig, endo-
carditis, while the different joints may show indications of chronic
inflammation (similar changes were found by Moussu in France in
chronic forms of diarrhea and by Brusaferro in a yearling steer
slaughtered in Turin).

The disease was also observed in horses and sheep but the lungs
failed to show the processes of ossification.

According to the investigations of Ligniéres, the causative agent of
the disease is a very small variety of the Bac. bipolaris septicus. Intra-
venous injections of large quantities of fresh cultures produce septi-
cemia which is fatal in 1 to 3 days; following injections of older cultures
in cattle and sheep an articular and peri-articular inflammation develops
which results in the formation of new connective and cartilaginous
tissue.

Natural infection occurs in marshy localities from the water and
food. The results are sometimes an enteritis, or a chronic inflammation
of the joints and an affection of the vessel walls.

Ligniéres obtained satisfactory results in the treatment of the
acute form of the disease by intrajugular injections of diluted blood
serum of healthy animals (400 cc. serum and 500 ce. sterile water),
or artificial serum (1000 ce. boiled water, 9 grams sodium chloride
and 4 grams sodium sulphate). In cases where recovery was prolonged,
the injections were repeated.

Literature. Even, Revista vet., 1896, 301—Ligniéres, Bull., 1898, 761.

(c) Buffalo Disease. Septicaemia hemorrhagica bubalorum.

(Barbone disease, Pasteurellosis bubalorum, Pasteurellose des
buffles [French]; Biffelseuche [German];
Barbone bufalino [Italian].)

This affection is an acute, febrile, infectious disease of
buffalo, and is characterized by febrile manifestations, difficult
respiration and especially by an edematous swelling of the
throat region. It is caused by the bacillus bubalisepticus.

History. The disease was first studied in Italy by Oreste &
Armanni (1886), and included in the hemorrhagic septicemia group.
They also undertook immunization experiments, In Hungary the oc-
currence of the disease was first established by Sequens (1889), while
Ratz undertook a more thorough investigation of the pathogenicity
of the infective agent.

Occurrence. Buffalo disease occurs frequently in localities
where large numbers of buffalo are kept during the summer,
and at times causes considerable loss in some herds. It usually
occurs as a disease of the soil in marshy pastures and in dry
stubble fields. Exceptionally, however, cases may occur in
animals fed in stables. The economic importance of the disease

8
114 Buffalo Disease.

is increased by the fact that it may be transmitted to hogs,
among which it may also cause considerable loss.

In Italy the infection is especially widespread in the districts of Salerno, Rome
and Terra di Livorno. In Hungary the disease occurs almost exclusively in the
southeastern counties (in 1908, 98 buffaloes were affected in 56 townships, and 95
of them died; considerably less than in former years). In Russia, Egypt, East
and West Indies, and Indo-China the disease frequently occurs in enzootie form.

; The dangerous character of the disease is readily recognized by the following
data: In Italy, in a herd of 1,400 buffaloes, 200 died in the year 1882 within ten
days; in another herd of 1,300 buffaloes, 530 succumbed. In one township of the
infected districts of Hungary, 52 of 237 buffaloes died within one week; in another,
of 663, 89 died within a short time. The losses in the Netherland-West Indies (in
Bantam and Batavia alone) amounted, between 1888 and 1891, to 11,000 buffaloes.

Etiology. The established cause of the disease, the bacillus
(bipolaris) bubalisepticus, appears in all its principal charac-
teristics as a variety of the bacillus bipolaris septicus (see
page 79).

Tenacity. Blood dried in the air loses its infectiveness in 24 hours. On the
other hand, when kept in closed glass tubes at room temperature its virulence is lost

in 40 days. Carbolie acid (2%), sulphuric acid (5%), and alcohol (87%) render
equal quantities of blood harmless (Oreste & Armanni, Sanfelice).

Pathogenicity. According to the
investigations of Ratz, rabbits are
most susceptible to artificial infec-
tions; somewhat less susceptible are
the guinea pig, the mouse and the
pigeon; to a still lesser degree,
chickens, while the dog and duck are
not at all susceptible. Of the large
animals the horse succumbs to sub-
cutaneous infection in an average of
20 hours, cattle in from 20 to 48, and
Fig. 28. Bacillus bubalisepticus. hogs in from 20 to 40 hours. The in-
Smear preparation from rabbit Oculations result in manifestations of

blood. Polar staining. a general infection with edematous

; swelling at the point of infection.

Buffalo calves die from a cutaneous or subcutaneous infection

inside of 24-36 hours with similar symptoms, while infection is

not successful when virulent cultures are fed, but buffalo calves

treated in the latter manner will develop an immunity against

a subsequent virulent infection. Sheep inoculated with virulent

buffalo blood die with symptoms of an acute. pharyngitis
(Reischig). 4O..

The bacteria are present in large numbers in:-the blood,
in the serous exudates and the feces of the infeeted'.animals.
They may also pass into the saliva, bile, milk and the urine.

Natural infection may occur through wounds of the skin
and mucous membranes. Such infections are favored in pas-
tures which contain thorny plants and pools of water in which
the animals lie for hours, thus constantly reinfecting the water.

In the great majority of the cases, however, natural in-

 
Natural Infection. Anatomical Changes. 115

fection probably results from the ingestion of infected food
and water through the uninjured mucous membrane of the
digestive tract. This mode of infection is indicated by the con-
stant swelling in the region of the throat and also by the
relatively frequent acute inflammation of the abomasum. On
the other hand, infection through the air passages is less prob-
able, as intratracheal injections of virulent material fail, in
most cases to produce the disease. <A direct transmission from
animal to animal or a spreading over extensive territories is
not observed in the buffalo disease.

In premises where the disease has appeared according to
the experience of Hungarian veterinarians hogs also frequently
become affected with symptoms of an acute pharyngitis and
general infection; in many cases this has been observed after
the ingestion of meat from buffaloes which had died from:
Buffalo disease. In exceptional cases it may also occur that
hogs are first affected and the disease in buffaloes is observed
only later (Sequens). The disease does not spread to hogs
kept on other premises.

Exceptionally the infection may be observed simultaneously
in buffalo and cattle probably as a result of an infection with
the same virus (Betegh, Sequens, Sanfelice).

Anatomical Changes. <A serous infiltration of the sub-
cutaneous tissues in the region of the throat and trachea is
almost a constant lesion and more or less characteristic of
the disease. This may extend posteriorly reaching to the ster-
num. In the region of the swelling the perilaryngeal and peri-
tracheal loose connective tissue as well as that of the lig. ary-
epiglottica and of the frenum is saturated with a clear watery,
slightly yellow serous fluid. In rare cases the edema extends
on one side to the cheeks and on the other side also to the
mediastinum in which case the thoracic cavity sometimes con-
tains yellowish clear transudate (Gal). Occasionally the serous
fluid shows red coloration, and the infiltrated connective tissue
is studded with small hemorrhages.

The other changes usually indicate in general a septic in-
fection. The mucous membrane of the air passages, especially
of the larynx and of the bronchi, shows a catarrhal swelling,
redness and occasionally punctiform or linear hemorrhages.
The lungs show a pronounced acute edema. The blood vessels
of the serous membranes are highly injected, the peritoneum
is sometimes covered with a fibrinous membrane.

The mucous membrane of the abomasum appears highly
reddened and swollen, either over its entire surface or over
certain places, while in the intestines the catarrhal manifesta-
tions are less pronounced. The spleen is congested, but only
very slightly swollen or not at all. The liver and kidneys
usually show no changes. The lymph glands of the mesentery
as well as in other parts, manifest an acute swelling.
116 Buffalo Disease.

Piot observed an affection of the lungs in Egypt which re-
sembled pleural pneumonia, the lesions resembling those of
hemorrhagic septicemia of cattle (see page 107). Sohns has
also observed a pectoral form of the disease.

Symptoms. The time of incubation after artificial infec-
tion is usually only 12 hours, and under natural conditions it
very probably extends only from one to two days.

The disease commences with a rapid rise of the body
temperature to 41-42°C. The affected animai stands indifferent
with extended neck and closed eyes. From the corners of the
mouth foamy saliva drips in long strings. In the meantime
the swelling of the throat region develops, becomes hot, painful,
first of a doughy, later of a denser consistency. It does not
crepitate on touch. During the development of the swelling
the animals manifest a short and painful cough; soon the swell-
ing extends over the cheeks, also over the parotid region and
backwards along the neck to the breast, and even over the
region of the shoulder. The conjunctivae of the eyes as well
as the mucous membrane of the nose and of the mouth is bright
red in color, and at the same time hot and dry. There is
lachrymation from the eyes and a yellowish mucous secretion
is discharged from the nose. On opening the mouth the tongue
appears usually normal, only the surrounding of the frenum
of the tongue shows a serous infiltration and swelling. In some
cases, however, the tongue may swell considerably so that it is
dark brownish-red, and its tip protrudes from the mouth to
the length of several centimeters.

With the increase of the swelling, respiration becomes
more difficult, accelerated and later rattling. The action of the
accessory respiratory muscles is greatly increased, the nasal
openings are widely distended. The long inspiration is fol-
lowed by a short, jerky expiration accompanied by painful
grunting.

The appetite is suppressed from the onset of the disease

_or may be capricious. Rumination ceases. There is first con-
stipation while towards the termination of the disease diarrhea
may set in when the feces are thin, fetid and mixed with dirty
red mucus. The animals look from time to time towards the
abdomen, otherwise they hardly move from the place and can-
not be urged to walk. In case there is a water pool near by
the animals like to lie down in it. The vulva and the surround-
ing parts of the rectum are often swollen during the later
course of the disease. Pregnant cows frequently abort.

With the rapid progress of the symptoms the animals,
shortly before death, grunt painfully, and the rattling respira-
tion may be heard at a distance from 30 to 40 steps, they grind
their teeth or bellow loudly. Finally the animal suddenly rises
from the ground, takes several staggering steps, suddenly col-
Symptoms. 117

lapses, whereupon death ensues in a few minutes under mani-
festations of asphyxiation and convulsive movements.

There are occasionally deviations from the described
symptoms. Thus the swelling of the throat region may be
absent, and the autopsy may show only very slight changes
in the mucous membrane of pharynx and larynx, in spite of
the fact that the animal died with symptoms of asphyxiation
(Bird). In less acute affections symptoms of a malignant
catarrhal fever develop sometimes (Makoldy).

In localities where rinderpest prevails, as for instance in Eastern
Asia, buffalo disease has been frequently mistaken for the former,
especially in cases of severe catarrhal symptoms of the nasal and
intestinal mucous membrane as well as in the cases of somewhat more
chronic forms. However, the noncontagious character of the buffalo
disease and the great susceptibility of rabbits for its virus offer suffi-
cient differential signs.

In cattle which in rare cases become affected simultaneously with
buffaloes similar clinical manifestations are observed, especially high
fever, extension of the head, protrusion of the swollen tongue, rattling
respiration, cyanosis of the mucous membranes, further an edematous
swelling of the region of the throat and cheeks.

In hogs, which sometimes also become affected on premises where
buffaloes are sick, the disease runs a course of severe pharyngitis with
marked swelling of the region of the throat, which sometimes extends
also over the neck, when the debilitated animal suffers from difficult
and rapid respiration.

Course and Prognosis. In rare cuses the disease lasts only
six to eight hours, but as a rule death results on the second
day. Exceptionally the course may extend up to eight days, and
such protracted cases sometimes terminate in recovery, espe-
cially if no swelling of the throat develops in the meantime.

According to Italian authors the percentage of mortality
amounts to from 50 to 60 per cent. According to the observa-
tions made in Hungary it varies from 87 to 98 per cent and
averages 94.2 per cent.

Treatment and Prevention. The treatment of affected
animals promises little success. The scarification of the swell.
ings in the region of the throat followed by washing of the
wounds with a disinfectant, for instance three per cent carbolic
acid solution or turpentine, appears most appropriate. Re-
peated injections of the first solution into various parts of the
swelling without previous scarification may also be beneficial.
Beside cold applications to the region of the throat, cold
showers and laxatives (salines in large doses) as well as inter-
nal administration of disinfectants (creolin, lysol) are
indicated.

The most effective method against the spreading of the
disease is. the removal of the healthy animals from the infected
pastures, or at least the abandonment of low-lying, marshy
118 Hemorrhagic Septicemia of Sheep.

pastures. In many cases the disease ceases immediately after
the animals are stabled. Further preventative measures are
the disinfection of the infected stables and premises as well as
the amelioration of the dangerous pastures by drainage and
drying of the swampy areas.

Immunization. According to Oreste & Armanni (1887) the blood.
of pigeons which have been inoculated and have died in from three
to four days becomes attenuated and adapted for immunization. Three
injections of 0.1 ce. of such blood is supposed to produce an active
immunity in buffalo. Such immunizations were carried out by the
authors in their practice with good results.

Oreste and Marcone (1889) prepared a vaccine by growing the
bacteria in the presence of air at a temperature of 30° to 32° C. which
supposedly protected sheep and buffaloes against a virulent infection.

Blin and Carrougeau (1902) produced an immune serum by
careful immunization of horses with old, then with fresh cultures
(inside of 5 months 150 ce. of cultures were injected subcutaneously )
of which the protective action has been increased by the addition of
killed cultures. Simultaneous injections of the serum and 14-14 ce.
of virulent culture produced a lasting immunity, but still more effective
was the subcutaneous injection of a serum-culture mixture (20 ce.
serum plus 2 ce. culture). The serum must have such a strength
that 20 cc. of the same will protect a 20 months old calf against an
infection with 2 cc. of culture of which 1 ce. ordinarily kills the
animal in from 24 to 30 hours. The results are supposed to be satis-
factory in buffalo as well as in cattle.

Veterinary Police. A similar procedure as in hemorrhagic
septicemia of cattle is advisable. Besides buffalo, hogs should
be also protected against infection.

Literature. Oreste & Armanni, Rev. Vet. Jhb., 1887, VII, 45.—Oreste &
Marcone, Clin. vet., 1891.—Sequens, Vet., 1894, 504.—Ratz, D. Z. f. Tm., 1896,
XXII, 331—Ligniéres, Bull., 1900, 541 (Lit.).—Blin & Carrougeau, Rec., 1902,
571.—Yersin, A. P., 1904, XVIII, 440.

(d) Hemorrhagic Septicemia of Sheep. Septicaemia
haemorrhagica ovum.

(Catarrhal Fever of Sheep; Septicemia pluriformis ovum,
Pasteurellosis Ovum, Lombriz [Spanish];
Schafrotz [German].)

Hemorrhagic septicemia of sheep is characterized in acute
cases by septicemic manifestations, in subacute and chronic
cases by a discharge from the eyes and nose as well as by a
pleuro-pneumonia. The cause is the bacillus ovisepticus.

History. Galtier (1889-1890) observed in the Alps of France a
disease of sheep which he associated with swine plague, describing an
ovoid bacterium as its cause. Later Liénaux (1895) described an
organism as the cause of infectious pleuro-pneumonia of sheep which
entirely corresponded with the bipolar bacillus. Conte (1897) as well
History. Occurrence. 119

as Besnoit and Cuillé (1898) obtained similar results during their
studies of diseases of sheep in France.

Ligniéres (1898) studied this disease more thoroughly when he
established that the disease which is known in Argentine under the
name of Lombriz on account of the usual presence of intestinal para-
sites, represents in its character a disease of the hemorrhagic septicemia
group. He as well as Besnoit and Cuillé interestingly demonstrated
its relation to verminous bronchitis and verminous gastritis of sheep.

Similar results were recently obtained by Miessner & Schern (1910)
when they established the etiological relation of the bipolar bacilli in
a disease of sheep which was considered by Spinola (1863) as catarrhal
fever and by Friedberger (1883) as glanders of sheep, according to
their clinical and anatomical manifestations. The first mentioned
authors succeeded in demonstrating virulent bipolar bacilli in the lymph
glands and sometimes in the blood of animals dead from this disease.
The presence of this bacterium was sometimes only demonstrable by
inoculations. Pure cultures of this organism produced artificially the
acute and subacute form of the disease. Accordingly the so-called;
glanders of sheep (septicemia pluriformis ovis) is identical. with.
Ligniéres’ Pasteurellosis. On the other hand it is distinguished from
the South African catarrhal fever of sheep (see that disease; infection
experiments with filtered material were not made). This new con-
ception will be given consideration in the following description, espe-
cially concerning the chronic cases.

Occurrence. The disease caused considerable loss, espe-
cially among lambs, while older animals are rarely affected,
and then usually in a chronic form. Most frequently it is ob-
served in low marshy localities, more rarely in higher sections,
and especially during the weaning of lambs.

In Argentine the disease occurs almost annually in an enzootic form, fre-
quently associated with verminous bronchitis and gastritis, which has also been found’
to be the, case in France (Ligniéres, Besnoit & Cuillé). In Germany the disease
appears to be quite extensive as Miessner & Schern established its presence, in 1907,
in eight herds of sheep where it usually caused great loss among the lambs (some-
times 50% of the increase of lambs). In Hungary it was observed by Keleti in
1896 when it appeared in association with an outbreak of swine plague. In this
instance, out of 300.sheep of Oxford and Cotswold breeds 23 died within seven days.
The disease has also been observed in Belgium, England and Turkey, and the fatal
disease known in Algeria as ‘‘El K’och’’ is probably identical with this disease
(Caze). *,

Etiology. The bacillus (bipolaris) ovisepticus represents
a variety of the bacillus bipolaris septicus with which it is
identical in its principal characteristics (see page 79). It is
difficult to isolate the organism from the affected organs, and
sometimes its growth suddenly ceases.

Pathogenicity. Several loopfuls of virulent culture in-
jected into the circulation of a young sheep, and 5 ce. in an old
animal, cause death inside of one to three days under manifesta-
tions of hemorrhagic septicemia. Subcutaneous injections of
a culture produce a serous inflammation at the point of injec-
tion, further acute catarrh of the conjunctiva as well as of the
nasal mucous membrane: The animals then become emaciated
120 Hemorrhagie Septicemia of Sheep.

and finally die with symptoms of enteritis, diarrhea and anemia.
The same results may also be obtained by repeated injections
of one-third to one-half ce. of a fresh virulent culture as well
as by intravenous injections of 5 to 10 ce. of an older culture
(Ligniéres). The infection may also be produced with ground
lymph glands and should the animals remain alive for a longer
time certain parts of the lungs become hepatized, and as in the
acute cases the lymph glands are markedly swollen (Miessner
& Schern). By feeding 50 to 60 cc. of culture Ligniéres pro-
duced the disease in sheep, although the attack was only slight.
On the other hand similar experiments by Miessner & Schern
with 150 ce. of culture gave negative results. Inhalation of 50
cee. of culture killed a lamb in three days.

In animals which died from the acute form of the disease
the bipolar bacilli may -be found in all the organs, while in
the chronic cases they are frequently absent and other bacteria
may be demonstrated in the affected tissues. Mice, guinea pigs
and rabbits can be easily infected while birds are more resist-
ant. In large animals the subcutaneous injection of the virus
produced a serous inflammation at the point of infection. Intra-
venous injections (50 to 100 ce.) cause the death of the animals
from septicemia within a short time (Ligniéres). The chronic
form of the disease could not be produced artificially.

Natural infection occurs very likely through the digestive
tract as a result of the ingestion of infected food or drinking
water on infected pastures or in contaminated stables. Young
sheep are particularly susceptible immediately after weaning,
and the disease usually runs a rapid course in these animals,
while in older animals it is more likely to take on a chronic
character.

Infectious excrements and excretions of affected animals
naturally add substantially to the dissemination of the disease.
In herds which are kept in a small pasture or in stables the
disease usually occurs in a more severe form. Affected animals
may spread the disease to healthy herds.

External influences which reduce the natural resistance of
the animals, such as continued cold and exposure to rain, etc.,
increase the susceptibility, and therefore the disease usually
occurs after damp weather and in general in marshy localities.

Furthermore, according to Ligniéres’ view, thread worms
(strongylides) favor the infection through injuries of the
mucous membrane of the stomach and intestines thereby render-
ing possible the entrance of the bipolar bacilli, which are pres-
ent in the feces or in the mucous secretions of the air passages,
into the lymph spaces of the mucous membrane (according to
oon, & Cuillé the dystomas in the bile ducts exert a similar
action).

Ligniéres’ view on the close connection of the bacterial infection with the
lung and intestinal worms must be considered as too far fetched, Admitting that
Natural Infection. Pathogenesis. 121

these parasites may independently cause a severe infection and on the other hand
that they may be found in apparently healthy animals, their relation to the etiology
of this disease is diminished by the fact that not infrequently hemorrhagic septicemia
of sheep is present even when such parasites are not found in the animal. (Miessner
& Schern do not even mention the presence of parasites in their anatomical findings.
Lambs only a few months old may become affected with the disease, and the dis-
ease may be produced by inoculation of pure cultures.)

Pathogenesis. After a severe infection the bipolar bacilli
multiply very rapidly in the body and produce death in a short
time by hemorrhagic septicemia. If on the other hand the infec-
tion was less severe or the resistance of the animal relatively
-higher, the action of the bacilli would be manifested only in a
chronic intoxication which would result in progressive emacia-
tion and anemia. In these more frequent forms the debility of
the animals favors the entrance of other bacteria (especially
streptococci) from the intestinal canal and the air passages into
the tissues and body fluids. As a result of this secondary infec-
tionchanges develop in the internal organs and the bipolar bacilli
in the meantime may have entirely disappeared from the blood.
The relatively frequent broncho-pneumonia as well as the less
frequent arthritis and tendonitis are as a rule the results of
such secondary infections, while the pleuro-pneumonia may be
produced independently by the bipolar bacilli.

Anatomical Changes. In the peracute cases the autopsy
reveals the typical findings of a hemorrhagic septicemia (see
page 83).

In the acute form the subcutaneous connective tissue of the
anterior portion of the body sometimes shows a gelatinous
hemorrhagic infiltration. The mucous membranes of the head,
the air passages and of the intestines also those of the aboma-
sum are usually inflamed, reddened and swollen, the lymph
glands are enlarged, their cut surface is moist and in parts
shows diffuse reddening. Frequently there are small hemor-
rhages in the serous membranes, in the kidneys and in the lymph
glands. In-some cases the lungs contain even in this stage dark
brownish-red broncho-pneumonic foci, besides serous infiltra-
tion of the intralobular connective tissue. The spleen has
usually a normal appearance.

In the subacute form lesions of broncho-pneumonia in the
anterior and inferior portions of the lung are almost invariably
present. In such cases the pleura, sometimes also the peri-
cardium, is frequently covered with fibrinous pseudo-mem-
branes, and the serous cavities contain smaller or larger quan-
tities of a yellow clear or cloudy fluid. The mucous membrane
of the bronchi is usually inflamed, reddened and swollen, while
that of the intestines is affected less frequently; in some cases
the nasal mucous membrane also shows yellow mucous or
fibrinous deposits. The lymph glands of the thoracic cavity
are moderately swollen.

Tn the chronic cases larger areas of the lungs usually show
122 Hemorrhagic Septicemia of Sheep.

a grayish-red hepatization, the pleural covering of these parts
of the lungs manifesting indications of a former pleuritic con-
dition (thickening and adhesions). The hepatized lung tissue
contains numerous necrotic foci which may sometimes be en-
closed in a connective tissue capsule. Some of these smaller
lesions appear in the form of onion-like layers, from the center
of which a tenacious, pus-like mass may be squeezed out, while
the larger ones consist of a smeary, grayish-yellow mass which
is intermixed with granules. In some of the chronic cases there
may only be present manifestations of severe anemia and
cachexia without any affection of the internal organs.

Bacteriological examination may readily reveal the presence of the bipolar
bacilli, particularly in the lungs, the exudates of the serous membranes, the lymph
glands, and in the nasal discharge. On the other hand in chronic cases the
bacteriological examination is quite frequently negative, or the presence of other
bacteria only can be demonstrated (streptococci, coli bacilli, bacilli of pseudo-
tuberculosis, etc.), although Miessner & Schern do not mention secondary organisms
in either subacute or chronic cases. In some of the cases the presence of the
bipolar bacteria can be proved only by test inoculations (especially with material
from lymph glands) or not at all; thus Ligniéres succeeded in demonstrating
the organism in only 77 out of 258 acute and chronic cases.

Symptoms. In the acute form, which usually runs its
course in from two to five days, sometimes even more rapidly,
symptoms of severe febrile infections are present. Marked
dullness, rising temperature to 41° C. and higher, inappetence,
increased thirst, colicky pains, difficult respiration, albuminuria,
muscular trembling, ete., are the indications of this form of
infection.

In the subacute cases, which extend from one to three
weeks, the symptoms consist of febrile changes in the tem-
perature, disturbed appetite and weakness; at first serous later
purulent discharge from the eyes and nose. In addition there
may be present either an acute pneumonia or pleural pneu-
monia, or an enteritis. In the presence of enteritis the excre-
ments are of a greenish-yellow, later of a dark color, and fetid.
Sometimes there may be present granulations and also ulcera-
tions on the mucous membrane of the lips and in the surround-
ing parts and possibly caries of the teeth (Miessner & Schern).
In such cases the lips, the cheeks and the tongue swell, they
show a dark red discoloration (exceptionally an ulcerative
keratitis has been observed) (Friedberger, Tiede). The ani-
mals are very weak and die with symptoms of cachexia. Only
in rare cases do the symptoms subside after a while. However,
the recovery is not complete, the animals often developing later
symptoms of a chronic affection of the lungs with cachexia.

The chronic form, which usually develops in older sheep,
sometimes from an acute form, is characterized by the appear-
ance of a severe chronic affection of the lungs. The animals
cough frequently, they have panting respiration, there is muco-
purulent discharge from the nose and eyes and gradual emacia-
Symptoms. Diagnosis. 123

tion. In some cases there develops a swelling of the carpal and
tarsal joints, or a suppurative inflammation of the coronary
band and of the sensitive lamina.

In some outbreaks thread worms may be found in the
abomasum and the air passages, or in both places, or tape
worms in the small intestines, while in the bile ducts dystomas
may be present in varying numbers.

Diagnosis. The acute cases may easily be mistaken for
anthrax, from which the disease differs clinically only by the
absence of the hematuria. On autopsy, however, the absence
of extensive gelatinous infiltrations and hemorrhages as well
as the absence of an acute swelling of the spleen makes a prob-
able differentiation possible. In the subacute and chronic cases
the presence of inflammatory changes in the lungs and serous
membranes is indicative of hemorrhagic septicemia, especially
in eases in which the lungs contain no lung parasites. ‘‘Bradsot’’
usually affects only older sheep during the fall and winter
months, and is characterized principally by rapid putrefaction
as: well as by the severe inflammation of the abomasum and
duodenum. In piroplasmosis there is a pronounced acute
swelling of the spleen in addition to the characteristic condition
of the blood. In cases in which the lungs and intestinal canal
contain intestinal parasites in great numbers, especial care
should be taken in the diagnosis inasmuch as the demonstration
of a few bipolar bacilli does not of itself prove the presence of
hemorrhagic septicemia.

Treatment and Prevention. As there is no method of suc-
cessful treatment it is advisable to kill the chronically affected
animals. The remaining animals in the band may be immunized
and a further spread of the disease avoided. For this purpose
the affected flock should if possible be taken to a large pasture
and from this pasture the animals should be changed to others
from time to time. If on account of unfavorable weather
stabling cannot be avoided, the stables should be cleaned and
disinfected’ at frequent intervals in addition to the isolation of
the affected animals. As animal endoparasites favor the bacte-
rial infection, the animals should not be pastured on damp
ground, in order to prevent the disease.

Immunization. Ligniéres obtained good results with his poly-
valent vaccine (see page 85) of which he injected one-quarter cc.
subeutaneously to sucking lambs. Animals inoculated by this method
later resisted an intravenous injection of virulent culture, while the
control animals died either from an-acute or a chronic form of the
. disease. The polyvalent immune serum (see page 124) is also sup-
posed to have proved effective against the disease.

Miessner & Schern obtained satisfactory results in protecting, and
sometimes also in curing, animals from the disease with the serum
of horses which had been hyperimmunized with cultures of the bacillus
ovisepticus. However, for. practical purposes they preferred a simul-
124 Infectious Pneumonia of Goats.

taneous vaccination with immune sera and bacterial extracts. But
as the simultaneous inoculation produces an immunity which lasts
only about 6 weeks it is advisable to vaccinate again after 4 to 6 weeks
with bacterial extract. The simultaneous method has proven satisfactory
in large flocks of lambs by checking the outbreak of the disease, and
in most cases affected animals recovered after this form of vaccination.

The bacterial extracts are prepared by washing 24-hour agar cultures
with salt solution. They are killed with formalin and shaken for 7 days in a
ball-mill run by electricity. Then the formalin is abstracted from the fluid, it is
centrifuged and the clear fluid is utilized for the vaccination. The dose for the
vaccination in practice varies between 2 and 5 ce. The bacterial extract is injected
subcutaneously. The immune serum is used in doses varying from 5 to 18 ce.
The subsequent vaccination was made in one case with 4 cc. of extract. If serum
alone is used for the inoculation (10 to 20 ec.) it is advisable to repeat the injec-
tion after 4 weeks.

The serum inoculation alone was used in five herds with good results. On
the other hand in the sixth herd 68 out of 171 lambs died in spite of the inocula-
tions. In five herds over 500 lambs were inoculated with serum and bacterial
extract, 364 of which received two inoculations, and all of which showed uniformly
favorable results.

Literature. Friedberger, Miinch. Jahrb. 1882-1883 (Lit.)—Andum, Unters.
iiber den Schafrotz. Dorpat 1888.—Galtier, J. vét., 1889, 58 u. 1890, 481.—Liénaux,
1896, 625.—Conte, Rev. vét., 1897, 516.—Besnoit & Cuillé, ibid., 1898, 465.—Lig-
niéres, Bull., 1898, 797; 1900, 529 (Lit.)—Miessner & Schern, A. f. Tk., 1909,
XLIV, 44 (Lit.).

Infectious pneumonia of goats. Nicolle & Refik-Bey (1896)
studied in Anatolia a pneumonia which caused periodically great losses
in the goat herds, and especially among the kids. The disease is
probably identical with the affection observed by Hutcheon & Steele
in South Africa, which had been introduced there in 1880 from Angora,
causing a loss of more than 12,000 goats.

The clinical manifestations are those of acute pneumonia, such as
fever, cough, mucous nasal discharge, dullness on percussion, bronchial
breathing and rales over one or both sides of the thorax. Towards
the termination of the disease, which on the average lasts for 10 days,
paralysis of the extremities usually appears. Manifestations of enteri-
tis are as a rule absent. Three-fourths to four-fifths of the affected
animals succumb, while those which remain alive retain a persistent
cough for a long time.

The autopsy reveals a lobular pneumonia of the lower anterior
parts of one or both lungs. The cut surface of the hepatized areas,
is dry, granulated, its color violet red or reddish-gray. The adjacent,
.pleura is covered with a moist fibrinous membrane. In exceptional cases,
the affected part of the lung becomes necrotic and may be found,
lying as a soft caseous mass, in a cavity formed by the thickened pleura
and the hepatized lung tissue. The bronchi frequently contain strongy-
lides in great numbers. ,

Bacteria which morphologically and in their cultural character-
istics are identical with the bipolar bacilli may be demonstrated in
the lung tissue and in the nasal discharge. Intrapulmonary or intra-
peritoneal injections of virulent cultures, especially when mixed with
lactic acid, kill goats in a few days. When injected intravenously they
succumb in a few hours. Subcutaneous injection results in a pro-
tracted infection towards the end of which paralysis sets in. The
intratracheal infection is negative. Mice, guinea pigs, rabbits ‘and
pigeons are also susceptible to the virus. In the abdominal cavity of

MY

 

 
Swine Plague. 195

guinea pigs the virulence of the virus is increased, while passage
through a pigeon increases its virulence still more.

Goats which after a subcutaneous injection remain alive acquire, to
a certain degree, immunity against subsequent virulent infection. (See
also Infectious Pleuro-pneumonia of Goats.)

Literature. Hutcheon, Vet. J., 1881, XIII, 171, u. 399.—Steele, ibid., 1889,
XXIV, 153.—Nicolle & Refik-Bey, A. P., 1896, X, 321.

Takosis of Angora Goats. Under this name Mohler and Washburn
(1902) described a very malignant chronic infectious disease of angora
goats which occurred in various localities of the United States. The
principal symptoms are at first moderately high, later a subnormal
temperature, pronounced weakness, gradually progressive anemia and
emaciation, later diarrhea and indications of pneumonia. The disease
results in death in from one to eight weeks. The autopsy reveals,
besides a pronounced general anemia, small hemorrhages in the serous
membranes, catarrhal pneumonic foci in the lungs, accumulation of
transudate in the pericardium, finally chronic catarrh and, in parts,
superficial necrosis of the intestinal mucous membrane.

In the blood as well as in the transudates a small Gram positive
coccus (micrococcus caprinus) was demonstrated. Grown on artificial
media the cultures showed great resemblance to those of the staphylo-
coccus pyogenus albus. They are pathogenic for goats, chickens, rabbits,
guinea pigs and white mice: Intra-abdominal injection of cultures pro-
duced in angora goats a fatal infection similar to the natural disease.

The disease which has been previously observed by Pegler (1885)
causes in the infected herds losses amounting from 30 to 85 per cent,
which ean be reduced only by an early isolation of the affected animals.
(An. Ind., 1902, XTX, 354.)

(e) Swine Plague. Septicaemia suum.

(Pasteurellosis suum; Septicémie,Pneumonie contagieuse du
porc, [French]; Schweineseuche, [German]).

Swine plague is usually a sporadic, less frequently an
enzootic infectious disease of hogs which with the exception
of the peracute septicemic cases is characterized principally
by a multiple necrotic pleuro-pneumonia. It is caused by the
bacillus suisepticus.

History. Swine plague in its septicemic form was first differ-
entiated from swine erysipelas by Léffler (1885) and recognized as an
independent disease. Shortly afterwards Schiitz (1886) established the
etiological identity of the pectoral form with the septicemic form.
Later the disease was identified by various authors (Billings, Silber:
schmidt, Voges) with hog cholera. In America Salmon (1886) and
Smith (1890) separated swine plague sharply from hog cholera, while
in Europe Schiitz, Jensen, Bang and especially Preisz established its
independent nature. (See Hog Cholera.) It was supposed until very
recently that swine plague very frequently occurred in association
with hog cholera as an independent disease. However, with the
126 Swine Plague.

establishment of the etiology of the latter disease (see that disease) it
has been proven that in hogs affected with the filterable virus of hog
cholera the bipolar bacillus usually produces only secondary processes,
so that these cases should properly be considered as hog cholera.

The over-estimation of the importance of the ovoid bipolar bacilli
being present in the affected lung tissue caused many to connect with
this disease the chronic catarrhal pneumonia of pigs as the so-called
chronic swine plague, but there are no satisfactory proofs for such a
conception. On our part we separate this disease from the true swinc
plague and consider it closely related to other similar pneumonic
processes of young animals, and principally as the result of a mixed —
infection. Likewise the diseased processes caused by the bacillus pyo-
genes suis will be discussed here under a separate heading (see pyo-
bacillosis), while the name swine plague will be retained for the disease
caused by the bacillus suisepticus. This is the disease which is origi-
nally and exclusively, or at least principally, caused by this organism _
and which in its anatomical changes corresponds with the pathogenic
nature of this bacterium, and which in its classical form was first
described by Loffler and Schiitz.

Occurrence. Pure swine plague occurs mostly in a sporadic
form in otherwise healthy herds. Exceptionally it may also
attain an enzootic form, but even in such cases it remains con-
fined. to the directly affected herds without spreading in the
usual way of epizootics from place to place. In Hungary the.
disease occurred as early as in the eighties in the last century
as a necrotic pneumonia among fattened hogs, but always in
a sporadic form.

In the conception given above for pure
swine plague the disease is only of slight
economic importance. The losses which are,
even at the present time, attributed to swine
plague are actually the result of either hog
cholera or of the catarrhal pneumonia of pigs.
The occurrence of acute and destructive epizo- ©
otics of pure swine plague has, at least in cen-
tral Europe, never been positively established.

Borzoni (1908) reported a fatal disease in
Sardinia (Angina, su fogale, su mali, de sa ’ula)
which occurred especially after long floods, pro-
tracted rains, or in poorly fed animals, which
caused a loss up to 90 per cent, the blood of the
affected animals showing a ‘‘cocco bacillus;’’
but in this disease inflammatory and necrotic
changes are absent in the organs of the thoracic
eavity. Jowett (1908) reports an outbreak of
pure swine plague in Capland in which on one
farm out of 100 hogs 40 died of pleuro-pneu-
monia. The lungs in these eases contained
only bipolar bacilli. The diagnosis of this out-
break was, however, based on the autopsy find-
ing of only five carcasses. Theiler observed in South Africa in the course of years
only one case of swine plague in which hog cholera could be excluded.

 

Fig. 29. Bacillus suisepticus.

Smear preparation from the fluid

of the lung of a hog. Fuchsin

staining ; and subsequent wash-
ing with 1% acetic acid.

Etiology. The bacillus (bipolaris) suisepticus is charac-
terized by the peculiarities of the bacilli of hemorrhagic septi-
cemia (see page 79), but it is usually somewhat larger, can be
quite readily isolated from the animal body (especially from the
Etiology Pathogenicity. 127

lungs and lymph glands), and also grows somewhat better
anaerobically than do the other varieties of this organism.

: Tenacity. In distilled water the bacilli retain their virulence up to 14 days;
heating to 58° C. kills them in 20 minutes, direct sunlight in 6 fo 8 minutes,
diffused daylight in about one hour (Joest). Exudate dried on silk threads
loses its virulence in «daylight after 48, in darkness after 72 hours, In
sterilized milk the virus retains its virulence for 14 days, in sour milk not more
than a few days. In hog and cow manure, at a depth from 20 em. to 11%4 m., they
remain alive for about 14 days (Beck & Koske). Disinfectants have an effective
action on the organism even in mild solutions, Thus their development is checked
by carbolie acid 1:2000, sulphuric acid 1:5500, potassium hydrate 1:900; while
corrosive sublimate 1:15000 as well as 4% creolin solution destroys the bacteria
in one minute, 1% copper sulphate solution in three, 1% solution of lime water and
chlorate of lime in 20, 1:2000 formalin in 40, lastly iron sulphate solution in 40
minutes. (Erdés & Koppanyi.)

Pathogenicity. The virulence of various strains of the
bacillus varies within very wide limits and changes sometimes
very rapidly even in cultures of the same strain. Aside from
hogs, animals susceptible to artificial infection are mice, rabbits,
guinea pigs and domestic fowl. All animals of these species
succumb to a subcutaneous infection of 0.1 to 0.5 ec. of bouillon
culture inside of 24 hours, dying of septicemia. Rabbits are
especially susceptible, and they are killed in 36 hours by 0.1
ec. of a bouillon culture diluted to a trillionth part (Preisz).
Some strains are so much less virulent, that they kill guinea
pigs injected intraperitoneally and rabbits intravenously only
with difficulty, and are altogether harmless for chickens, which
may, however, develop a chronic affection of the joints (Lig-
niéres). Carnivorous animals succumb to intravenous infec-
tions. In large animals a subcutaneous injection results in a
local inflammatory process (calves, however, may die), while
intravenous injections result occasionally in death. Feeding of
cultures is not as effective, but rabbits may easily be affected
by this method. After repeated inoculation horses develop a
diseased condition with indications of a chronic intoxication
and interstitial hepatitis.

Intrapulmonary injections cause multiple necrotic pneu-
monia in hogs (Schiitz), and sometimes this may also be pro-
duced by inhalation of a virulent: culture (Schiitz, Olt, Piitz,
Beck & Koske). Intertracheal injections of the culture have a
similar action (Ligniéres, Karlinski), and intravenous injec-
tion produces. a double pneumonia, pleurisy and pericarditis
(Smith). After subeutaneous injection in the thigh an inflam-
matory growth develops occasionally at the point of injection,
with which then a lymphangioitis becomes associated, where-
upon the animal dies in 4 to 5 days or may linger for several
weeks (in the latter cases not infrequently inflammatory mani-
festations of the different joints develop in addition to the
- eachectic manifestations. Autopsy frequently reveals in acute
cases a necrotic pleuro-pneumonia with hemorrhages (Preisz).
In the majority of cases, however, the local inflammatory pro-
cesses subside, and the animal recovers, or the inoculation does
128 Swine Plague.

not produce any perceptible symptoms. After intraperitoneal
infection an acute croupous diphtheritic enteritis develops.
Vigorous hogs cannot be infected fatally by feeding (Gnichtel
succeeded in doing so by weakening the pig by continued
cooling).

According to Ostertag it is possible to produce the so called chronic swine
plague, or the indulent pneumonia of entirely chronic catarrhal nature, which charac-
terizes this disease, by inhalation of pathologic lung substance as well as with pure
cultures of the ovoid bacterium. However, the limited number of experiments do
not appear sufficiently conclusive proof for Ostertag’s contention, inasmuch as
other authors always produced by inhalation an acute form of necrotic pneumonia
if any disease at all.

Toxins. Novy isolated from cultures of the bacillus suisepticus
a basic substance which he named ‘‘Susotoxin,’’ and which in a watery
solution in quantities of 0.125 to 0.25 cc. subcutaneously injected into
rabbits produced death in 36 hours. Schweinitz isolated from the
cultures a toxin and an albumose which he named ‘‘Suplagotoxine’”’
and ‘‘Suplagoalbumin.’’ Filtrates of fresh bouillon culture, if free
from bacteria, are not toxic. On the other hand, killed masses of
bacteria produce a toxie action on small test animals. (Guinea pigs
are destroyed by 8 to 10 mg. of killed bacteria [Voges]). Klett & Braun.
could by their method demonstrate toxins in large quantities in the
filtrates of cultures which produced the characteristic symptoms of
cholera in pigeons and chickens, viz., somnolence and intoxication. At
the same time the toxicity of the cultures did not run parallel with
their virulence (see page 137). According to Beck & Koske fresh
filtrates of cultures produce a temporary rise in temperature while
killed cultures as well as filtrates of old cultures are very toxic.
McFadyean succeeded in extracting from the bacterial cells a filterable
poison which was found to be very toxic for rabbits, guinea pigs and
mice.

Natural infection. The experience that pure swine plague
occurs usually in a sporadic form or only in a limited enzootic
extension indicates that the transmission from animal to ani-
mal has only an insignificant part. On the other hand, the fact
that bacteria which correspond with the true swine plague
organism in all their characteristics, are present in the soil and
accordingly also in the food and drinking water as well as in
the air passages and intestinal canal of healthy hogs proves
that the development of the disease is associated with these
facultative pathogenic bacteria. It may be accepted as highly |
probable that, in a similar way as in the other diseases of
the hemorrhagic septicemia group, the usually harmless habi-
tants of the hog produce a pathogenic action under certain
conditions, which are unknown at the present time. It is possi-
ble that the bacteria attain a higher virulence before entering
the animal body so that they are capable of attacking the
normal tissues of the animal. However, it probably happens
more frequently that the normal resistance of the organism is
diminished by various weakening influences, so that now even
the less virulent bacteria may exert a pathogenic action. Lig-
Natural Infection. 129

niéres, Uhlenhuth and Gniichtel proved the predisposing influ-
ence of colds by experiment, while Salmon and Ratz established
the fact that the infection is facilitated by the presence of
parasites in the intestinal canal and in the air passages (Ascaris
lumbricoides, Hchinorhynchus gigas, Strongylus paradoxus).
In the presence of such parasites the bacteria may more readily
penetrate the affected or injured mucous membrane. There
may be also other influences, such as poor condition, exhaustion
during transportation, ete., especially in young animals increas-
ing the susceptibility to the pathogenic action of these ubiqui-
tous organisms, which is usually not-marked. The most impor-
tant part, however, in the infection with the swine plague
organisms may be attributed to the virus of hog cholera and the
primary infection caused by it, and as a matter of fact in hog
cholera outbreaks there are very frequently found changes of
organs which are analogous to the swine plague infection (see
hog cholera).

Ovoid bacteria which closely correspond morphologically and in
their cultural characteristics with the swine plague organisms were
first found in healthy animals by Smith then by Moore, Bang, Jensen,
Karlinski, Kitt, Klein and Haushalter. Sometimes they were only
slightly virulent, or not at all. In Jensen’s experiments, however,
various strains killed mice promptly and Bauermeister found that
bacteria which he grew from acinous glands were very pathogenic
for test animals, while, on the other hand, Karlinski as well as Beck
& Koske succeeded in markedly increasing the virulence of the originally
slightly virulent strains.

While the first appearance of swine plague in healthy herds
may be associated with soil infection, and also frequently with
weakening influences acting upon the animals, the occasional
direct or indirect infection from the first affected animals, like
in the other diseases of the hemorrhagic septicemia group,
cannot be left out of consideration. Affected hogs pass with
their excretions, and especially with the mucus which they
cough up, great numbers of very virulent bacilli which then
enter the bodies of healthy hogs and may by their great numbers
and high virulence produce inflammatory processes in them. In
this manner an infected animal which has been purchased and
added to a healthy herd may produce the disease among the
other animals. As a matter of fact, however, healthy hogs resist
such an infection in most instances. The fact that local out-
breaks usually die out rapidly, even without any particular
measures of eradication may be attributed to a rapid diminu-
tion of the virulence of the infective agent outside of the ani-
.mal body. :

As the ovoid bacteria occur also in animals affected with
other diseases, or may subsequently enter such affected bodies,
they may exert a specific pathogenic action in already affected
organs. In this manner a preexisting catarrhal pneumonia may

9
130 Swine Plague.

by secondary infection pass into a fibrinous or necrotic pneu-
monia (such cases, which are observed especially after long
transportation, have been taken repeatedly as proof for the
identity of the primary chronic and the superimposed acute
processes).

In the pneumonic lungs of animals affected with swine plague other
bacteria than the ovoid bacilli may often be found in varying numbers
in the acute cases, but more so in the chronic cases. Of these strepto-
cocci, staphylococci, colon bacilli, bac. viscosus (Preisz), bac. pyogenis
suis, bac. necrophorous and others are frequently present. They come
into consideration only as secondary invaders which produce local
changes in the already affected tissues (small suppurative centers, etc.).
The presence of these organisms may be explained by the fact that
they are also frequent inhabitants of the air passages, and may occa-
sionally multiply under abnormal conditions. Clearly different are
conditions in the enzootic pneumonia of pigs, this disease being in all
probability the result of a mixed infection, and the ovoid bacteria play
here probably. an unimportant role. This is indicated by the fact that
in about one-third of the cases the demonstration of this organism from
the pneumonic tissue is not possible.

The susceptibility of hogs for this disease is principally
affected by their condition of health or by the reduction of
their natural resistance as a result of weakening influences.
Very young animals rarely become affected, otherwise age does
not seem to have any influence.

Those diseases of hogs which sometimes develop in association with
hemorrhagic septicemia of other animals are identical in their nature
with true swine plague. Thus, simultaneous affection in hogs may
especially be observed during outbreaks of hemorrhagic septicemia in
cattle as well as in outbreaks of buffalo disease (see the latter). Occa-
sionally also hogs may be affected while influenza of horses is prevalent
(Schindelka), or chicken cholera (Gorges). On the other hand, in
outbreaks of swine plague other species of animals may become affected.
Thus Galtier observed affections in. sheep which were kept in the same
stable with affected hogs, or which were pastured in the same field
where careasses of hogs were buried, while Keleti saw lambs die during
outbreaks of swine plague. Both authors demonstrated in the organs
of the affected sheep bipolar bacilli (see page 119). Lastly Goldstein
as well as Chamberland & Jouan observed the death of all the chickens
in a flock with manifestations of cholera-like symptoms after they had
eaten from a carcass of a hog which died from swine plague. Gorges
also has observed geese dying after ingestion of food contaminated
by affected hogs.

Anatomical Changes. In peracute cases the autopsy reveals
lesions of typical hemorrhagic septicemia, viz., numerous small
hemorrhages in the skin or subcutaneous fat, in the serous and
mucous membranes, in the kidneys and under the endocardium,
larger hemorrhages in the perirenal connective tissue, in the
maucous membrane of the pelvis of the kidney and the bladder,
Anatomical Changes. 131

as well as in the meninges. There is also acute hemorrhagic
ee lymph ace ne gelatinous serous infiltration
of the subcutaneous connective tissue, especially i i
of the throat and neck. eS ihe ee
In the more frequent acute cases lesions in the thoracic
organs are constantly present. The lungs contain either small
or larger hepatized areas, of which the cut surface, according
to the duration of the disease, is either blackish-red or dark
brownish-red to
light gray, and
studded with mil-
let seed to hemp
seed sized pale
yellow granules
(croupous hemor-
rhagic or multiple
necrotic pneu-
monia; Fig. 30).
Some of the hepa-
tized areas are sur-
rounded by a pale
yellow necrotic
zone. In older
cases, however,
larger areas, some-
times even entire
lobes of the lungs,
are changed into a
mass of cheesy de-
tritus. The inter-
lobular connective
tissue is thickened
and shows a serous
or bloody infiltra-
tion as a result of
which the cut sur-
face has a mottled
appearance. The
pleura over the af-
fected areas of the
lungs is covered
with loose or more Fig. 30. Multiple necrotic pneumonia in swine plague.
adhesive fibrinous (a) Congested lung tissue still containing air; (b) brown:
deposits under 'hred lepatiztion: (0) marie peers earate
which the pleura focus (center dark red, border pale yellow) ; (g) bronchus.
contains small
hemorrhages or shows bloody infiltration. In the thoracic
cavity sero-fibrinous exudate may be present in varying quan-
tities (exceptionally pleurisy may occur without pneumonia).
A similar inflammatory process exists frequently on the

 
132 Swine Plague.

pericardium. The peribronchial lymph glands are acutely
swollen, and not infrequently studded with small hemorrhages.

The mucous membrane of the stomach and intestines shows
a catarrhal swelling and frequently also numerous hemorrhagic
spots. In some cases the surface is covered with fine croupous
pseudo-membranes, or it may appear as though sprinkled with
bran as a result of the necrosis of the epithelium. These
changes are especially marked in the posterior part of the small
intestines or in the large intestine. The solitary follicles and
the Peyer’s patches are swollen or contain shallow ulcers.
The spleen usually shows no changes or only a slight swelling.
Sometimes it contains several pale-red firm areas. ‘The kidneys
are hyperemic, and some wedge-shaped portions are sometimes
grayish in color.

In the chronic cases the lungs of the greatly emaciated
careass show extensive necrotic foci without any signs of acute
inflammation. Exceptionally there may be sequestra inclosed
in thickwalled cavities or cavities which communicate with
the bronchi. In other cases fairly large hepatized areas of the
ae are studded with numerous small yellow or gray necrotic

ocl.

Caseous foci may also be found in the peribronchial and
mesenteric glands, in the tonsils, in some joints, in bones and
in the subeutaneous connective tissue. Possibly also so-called
caseous inflammation of the intestines, in which the mucous
membrane of the large intestines is broken down forming a dry
mushy mass, belongs to the anatomical lesions of swine plague
(Schiitz, Peters).

In the peracute cases the bipolar bacteria are present.
usually in great numbers in the blood and in all organs. In
subacute cases they may be found in the affected parts of the
lungs, the bronchial secretion and in the exudate of the serous
membranes, sometimes also in the blood and likewise in great
numbers. On the other hand, in the chronic cases they may be
demonstrated only in the necrotic regions, mostly in association
with other bacteria and even in such cases they may be detected
only with great difficulty.

According to the histological examinations of Marek the hemor-
rhages develop either as a result of bacterial emboli or as a result of
a toxic affection of the walls of the blood vessels (the latter especially
in the kidneys). The infarcts of the lungs and kidneys may also
result from thrombosis of blood vessels. The pneumonia is rarely
catarrhal but more frequently croupous, developing in its later course
a coagulation necrosis. Coagulation necrosis may also be observed
jn small foci in the liver and in the adrenals. The nephritis, which
is present in all acute cases, leads to parenchymatous degeneration of
the epithelial cells, serous infiltration of the interstitial tissue, hemor-
rhages and necrotic foci.

Symptoms. After artificial infections by subcutaneous or
intratracheal injections or by inhalation of virulent material,
the time of incubation is usually only a few hours or one to
Symptoms. 133

two days. _Under natural conditions also it is probably very
short, particularly if some predisposing factor exists.

The peracute cases of the disease manifest the typical
symptoms of hemorrhagic septicemia. As the fever rises to
40°C and over, the animals become weak, lose their appetite
and lie motionless on the ground. In the pasture they separate
from the herd, and in the stable they usually crawl under
the straw. If urged to move they have a staggering gait, may
move in a circle or execute other forms of involuntary move-
ments. Red spots develop on different parts of the body, espe-
cially under the ears, on the neck and on the rumps which do
not disappear on pressure, and hemorrhages may occur from
the nose, the intestines and urinary organs. In some animals
symptoms of a severe acute pharyngitis may be observed. The
patients usually die in 12 to 24 hours after the appearance of
the first symptoms.

In the acute course the clinical picture corresponds in the_
majority of cases with that of acute pneumonia. The fevered
animals have a short, dry and spasmodic cough, assume fre-
quently squatting position like dogs, while slimy material is
expelled from their mouths. The respiration is accelerated
and labored, especially during expiration, the animal frequently
standing with legs spread apart and with mouth open. The
patient manifests pain on palpation of the thorax. The nose
discharges a sticky, slimy secretion. Later the paroxysms of
coughing become more frequent and more severe; the respira-
tion is very labored, rattling, the temperature remaining con-
stantly around 41°C. The animals become visibly emaciated
and finally they can hardly rise from the ground.

The mucous membranes are cyanotic, a purulent conjunc-
tivitis may sometimes be observed.” The heart action is accel-
erated, later throbbing. There is at first constipation, later
diarrhea sometimes with bloody excrement. Towards the
termination of the disease red'spots may also be observed on
the skin.

The duration of the acute form usually extends from 1 to
2 weeks. Complete recovery is very rare, although occasionally
the condition temporarily improves, but usually it passes into
the chronic form of the disease.

The chronic form usually follows the acute. After the
subsidence of the acute symptoms indications of a lung affec-
tion with periodical coughing and difficulty in respiration will
persist for a long time. In such cases the animals show dis-
turbed appetite, progressive emaciation, and occasionally
chronic inflammation develops in the joints. Towards the ter-
mination of these cases also there is fetid diarrhea, and the
animals die in from 3 to 6 weeks from complete exhaustion.
Not infrequently, however, the affection in the lungs remains
stationary and the animals may even be fattened in spite of
the encapsulated foci in these organs.
134 Swine Plague.

In the swine plague observed by Borzoni in Sardinia (see page
126) one form of the disease is manifested by symptoms of a general
febrile affection, greenish fetid diarrhea and red spots on various
parts of the body, as well as by a very pronounced acute edematous
swelling of the throat region. The other form commences with a marked
bloody serous infiltration of the subcutis on the extremities, with whic
an inflammatory swelling of the neck becomes associated in the course
of a few days. The autopsy shows bloody serous infiltration of the
subcutaneous and intramuscular connective tissue and of the tongue,
and in addition to this only an acute swelling of the lymph glands and
2 slight intestinal catarrh. :

Diagnosis. The peracute septicemic form of the disease
may be mistaken for acute hog cholera, from which it can be
distinguished only by the demonstration of the bipolar bacilli
in the blood.
The recognition of the lung affection in process of devel-
opment is quite easy but the diagnosis of its exact nature is
‘much more difficult. Verminous bronchitis is very similar in
its manifestations. This, however, has a much slower course
and attacks usually only young animals.
The greatest difficulty is met with in differentiating swine

plague from hog cholera. The sporadic appearance of the dis-
ease or its confinement to individual premises, with symptoms
pointing to an affection of the lungs, are indicative of swine
plague. However, if there exists a possibility of hog cholera
or the very frequent mixed infection its differentiation in the
living animal is impossible.

On autopsy pure swine plague may be accepted with a
certain probability when in addition to the described changes
in the lungs (acute croupous-hemorrhagic or necrotic pneu-
monia), the hemorrhages and acute swelling of the lymph
glands, there are no diphtheritic or caseous inflammatory areas
present. The differentiation from hog cholera even in such
cases is absolutely established only by filtration experiments,
in which positive results are indicative of the presence of hog
cholera. On the other hand a negative finding does not estab-
lish the absence of hog cholera, inasmuch as the virus of the
latter disease may already have disappeared from the body
either partly or entirely. In such cases the sporadic character
of the disease in herds which otherwise continue to remain
healthy speaks for pure swine plague. The epizootic character
should therefore be given a weighty consideration in the estab-
lishment of a diagnosis.

Less difficult appears the differentiation from catarrhal
pneumonia of pigs. This affection occurs only in very young
animals; the pneumonia has a purely catarrhal form, with or
without fibrinous exudate. This applies also to those cases
in which the affection proves clinically and anatomically to have
commenced with a chronic catarrhal form of pneumonia, and
only later developed into an acute form. In such cases, the
Diagnosis. Treatment. Immunization. 135

upper and posterior parts of the lungs usually show in addition
to catarrhal pneumonia a croupous-catarrhal inflammation.

The demonstration of bipolar ovoid bacilli even though they are
highly virulent has only a very restricted and subordinate diagnostic
value. Their presence is of itself by no means sufficient to establish
the diagnosis of swine plague, as these bacilli may be present quite
accidentally or may have taken only a secondary part in the development
of the pathological processes. Only if they are present in great num-
bers and exclusively, or almost exclusively, in the inflammatory pro-
ducts, may they be accepted as the direct causative agents of the
disease and even in such cases the possibility must be considered that
the disease was caused primarily by the much more vigorous hog
cholera virus.

Swine erysipelas usually runs a more rapid course and
manifestations of pneumonia are absent. On autopsy this
disease may be distinguished, aside from the different bacterio-
logical findings, by the absence of post mortem lesions. In
chronic cases tuberculosis comes into consideration and the
positive differentiation is only possible by a bacteriological
examination. The pyobacillosis of pigs or its complications are
characterized by purulent catarrh as well as yellow or greenish
suppurative areas in the lungs and in other organs, by which:
it may be differentiated from swine plague.

Treatment and Prevention. Medicinal treatment has up to
date proved without effect.

Becker, Spitzer and Széllés reported favorable results with the
proprietary remedy called suptol and prepared by Burow (according
to Andrejew it is a preparation of swine plague bacilli). On the other
hand Tatray employed this remedy in 17 herds on several thousand
animals with varying results, which agrees with the findings of the
Prussian Official Veterinarians. Andrejew and Gellmann deny its
protective and curative action.

Immediate separation of the affected animals, effective
disinfection of stable and feeding trough, destruction of the
affected organs and secretions and of the manure appears to
be advisable; even though the danger of infection is slight,
nevertheless it should be considered. From a standpoint of
veterinary police it is advisable to separate swine plague from
hog cholera, and to treat it in the same manner as hemorrhagic
septicemia of cattle.

Immunization. Since the etiology of hog cholera has been
studied more closely the former attempts of elaborating effec-
tive methods of immunization against this disease, as well as
against swine plague which is frequently associated with it,
from the cultures of the bacillus suisepticus, have proven of
very doubtful practical value. Considering that an immuniza-
136 Swine Plague.

tion against pure swine plague does not appear necessary,
because of its rather harmless character, vaccines prepared
from this organism could at best be considered as a probable
protection against the secondary infections of hog cholera, and
also perhaps to a certain degree as protective against the pneu-
monia of pigs depending on a mixed infection with the swine
plague organism. Nevertheless the numerous experiments for
the establishment of a method of vaccination which would pro-
tect against the infection with the bacillus suisepticus have a
practical importance inasmuch as some of them, especially the
inoculation with immune sera against the so-called chronic
swine plague of pigs (see page 142), are extensively employed
in Germany.

1. Active Immunization. In rabbits and guinea pigs this may be
attained with cultures killed at 58° C. (Smith & Moore), as well as with
the toxic substances isolated from the cultures (Suplagotoxin and Sapla-
goalbumin (see page 128), with which Schweinitz succeeded in pro-
tecting hogs against artificial infection.

More recently Veil immunized hogs with an exudate (aggressin)
obtained from infected rabbits and hogs of which 10 ec. injected in
two parts or as one dose into the blood afforded a protection against
a lethal artificial infection. In order to protect the animals against
natural infection, which is especially dangerous at the cominencement
of the treatment, the simultaneous use of antiaggressive immune serum
is recommended. Similar favorable results were obtained by Citron
in rabbits and guinea pigs with exudate as well as with extracts from
cultures; and animals immunized by his method withstood a hundred
thousand times larger dose than that necessary for fatal infection.
Titze employed shake-extracts of filtrates made from cultures, and
recently Miessner & Schern used pleural exudate and heart blood from
rabbits containing aggressins and sterilized at 44°C. with which
they produced an active immunity in guinea pigs against virulent
infection with swine plague bacteria.

Beck & Koske produced an active immunity in pigs by injecting
them intraperitoneally first with 0.5 ec. of fresh bouillon culture heated
to 55° C. for 20 minutes, and seven days later with 1 cc. of virulent
culture into the muscles of the thigh. Broll, however, found that the
animals occasionally became fatally affected with peritonitis and enter-
itis as a result of the first infection, due to the poisonous toxic action
of the killed bacilli, and further that the vaccination in infected herds
favored the development of new cases before immunity had been
established.

According to Broll’s experiments the administration of living fowl
cholera bacteria, or of such killed by heating for 20 hours at 52° to
55°C. does not produce a sufficient resistance against swine plague infec-
tion, whereas swine plague bacteria killed in a similar manner produced
in pigs a high grade of protection. The best results against artificial
infection were obtained with a 48-hour shake-extract prepared by the
method of Wassermann & Citron. The extract is not filtered, and is
sterilized by the addition of mustard oil. The vaccination of new
born pigs is recommended with such extract and immune serum (the.
serum is supposed to prevent an infection during the negative phase),
Immunization. 137

and in case the protection is not sufficient the animals may be revac-
cinated shortly before weaning with the bacterial extract. —

2. Serum Immunization. Blood serum from animals treated
with virulent cultures of the bacillus suisepticus protects test
animals for a short time against a subsequent virulent infection.
As a result of these experimental findings serum of horses
hyperimmunized by subcutaneous and intravenous injection of
increasing doses of virus has been used in numerous instances
for the immunization of hogs (see also page 141).

Schweinitz had already in 1890 immunized horses, mules and eattle
with either living or dead cultures, as well as with filtrates, and also
with toxic substances isolated from cultures. He proved that the serum
of such immunized animals afforded a protective action against an
infection with the bacillus suisepticus or against the action of its
toxins. The serum was usually employed together with the hog cholera
serum against the mixed infection, which occurs in America, but with
doubtful results.

’ Later Schreiber obtained an immune serum from horses treated
with cultures, which was placed on the German market under the name
“‘Septizidin.’’ According to his views his product possesses both a
protective and also a curative action, and is often used against the
septic pneumonia of calves.

Polyvalent immune serum. According to Wassermann & Ostertag
blood serum of artificially immunized animals usually protects only
against the variety of the bacillus suisepticus which had been used for
the immunization. On the other hand its action against the other
varieties of this organism is ineffective in spite of the fact that morpho-
logically and in their cultural characteristics they are identical. Ac-
cording to their conception the protoplasm of the bacterial cell consists
of different components which, in the different varieties of the same
bacterium, are to some extent not identical. Besides a common domi-
nant receptor which is to be considered as the carrier of the special
characteristics of the species of bacteria, the different varieties may
contain individually different side-receptors. Inasmuch as during the
process of immunization the various components produce corresponding
immune bodies (amboceptors) by binding the receptors adapted to them
(Ehrlich’s theory), all these immune bodies bind the dominant re-
ceptor; but the side-receptors of the variety which have been used
for the immunization, thereby afford a protection only against the
latter, and are ineffective against varieties containing other side-
receptors. The above mentioned authors accordingly treated horses
with as many varieties as possible of the bacillus suisepticus and found
that the serum proved effective against all the different varieties. This
polyvalent or multipartial serum with a titre of not less than 0.01 ee.
for mice against a dose ten times the fatal dose of a living culture
has been used especially against the pneumonia of pigs.

Immunization with chicken cholera serum. Klett & Braun employ serum of
horses which have been treated for a long period with a mixture of toxins from
killed cultures and their filtrates, and which afterward have been inoculated with
fully virulent chicken cholera bacteria. These authors contend that the bacilli of
fowl cholera produce the same toxin, only in larger quantities, as the bacilli of
swine plague. Serum from horses treated in the above manner protects gray mice,
in quantities of 0.0015-0.005 gm., against a fatal infection of a loopful of virulent
138 Enzootic Pneumonia of Pigs.

swine plague culture, while if the serum treatment has been given 24 hours pre-
viously, it also has protective action against the toxins of chicken cholera and
swine plague bacteria. The passive immunity lasts from 3 to 4 weeks, while active
immunity could not be produced even in mice by serum and culture injections.

Literature. Léffler, Arb. d. G.-A., 1886, 1, 46.—Schiitz, A. f. Tk., 1886,
XII, 210.—Salmon & Smith, Bur. of Anim. ind., 1886-1894. — Smith, Spec. rep.
of the cause of swine plague, Washington, 1891. —Preisz, Z. f. Tm., 1898, II, 1,
u. 1907, XI, 161.—Ligniéres, Bull., 1900, 389 (Lit.)—Beck & Koske, Arb. d. G.-A.,
1905, XXII, 181.—Joest, Schweineseuche u. Schweinepest, Jena 1906 (Complete
Lit.).—Ostertag & Stadie, Z. f. Infkr., 1907, II, 112, u. 425.—Hutyra, ibid., pp. 281,
and III, 235.—Citron, Z. f. Hyg., 1906, xi, 938 —Uhlenhuth, Xylander, Hiibener
& Bohtz,. -Arb_d_G.-A., 1908, XXvu, “l (Lit.).—Broll, Z. f. infkrkh, 1908, V, 81
(Lit. on immunization) .—Gniichtel, Diss. Leipzig 1909 (Lit.).

Enzootic Pneumonia of Pigs (so-called chronic swine plague of
pigs). According to the view of Ostertag, which is also accepted by
a great number of other investigators, the classical form of swine plague
described above has changed since the middle of the nineties of the last
century to a milder form, so that at the present time it occurs mostly
as a chronic pneumonia affecting only very young pigs. Among these
young animals, however, it occurs widely distributed. According to
this conception the disease is generally known as ‘‘chronic swine plague
of pigs,’’ but in some localities it is also designated as pig disease, pig
cough and cement disease (as it occurs frequently in new stables with
cement floors).

The disease causes considerable loss, especially among the improved breeds,
and occurs principally in Northern Germany (Eastern and Western Prussia, Silesia,
Brandenburg, Pommerania, Schleswig-Holstein, Hessen-Nassau, etc.). Thus for
instance in the abbatoir of Hamburg about 50,000 hogs annually show the ana-
tomical lesions of the disease.

The symptoms of the disease develop sometimes early in the
first days of life, more commonly, however, between the second and
fourth week after birth. The animals lose their sprightliness and appe-
tite, sometimes manifesting also a perverted appetite (eating of manure,
filth, ete.). A catarrh of the nose (frequent sneezing and blowing,
especially during eating), as well as of the deeper air passages, fre-
quently develops. The young animals have a short, sharp spasmodic
cough which is especially brought on by rising and eating. The cough
sometimes is associated with rattling and choking. At the same time
the respiration is more or less accelerated and labored, the animals in
the more severe affections lying on the sternum or on the side, or they
stand with arched back and legs spread apart.

Of the other symptoms conjunctivitis, muco-purulent nasal dis-
charge, and frequently a peculiar skin eruption may be observed. This
is manifested in the form of red spots on the head, on the ears and on
the sides of the body, which show a slight exudation and soon become
covered with scabs and scales. In other cases vesicles form which
after bursting also become covered with scabs, so that finally the dry
and exfoliated skin appears covered to a great extent with blackish-brown
crust.

With the advance of these symptoms the affected animals are re-
tarded in their development, the appetite being changeable or con-
tinually absent. Subacute inflammations appear in the different joints,
especially in the knee and elbow joints, as a result of which the animals
walk with evident pain and stiffness, and after the appearance of
diarrhea and bloating the completely exhausted patients usually die
in the course of the second or third month of their lives.
Symptoms. Anatomical Changes. 139

_ In the cases terminating in recovery the animals become gradually
brighter, the cough becomes less frequent, the scabs fall off, the skin
regains its normal color, the appetite also improves, and the food is
utilized in the normal manner. Such animals are considered as re-
covered; according to Foth, however, this is not the case as the cough
never disappears entirely. On the other hand, animals which are
still sickly may, under new conditions, become again affected with the
acute manifestation, especially if exposed to cold in the presence of
digestive disturbances or after infections with virulent pathogenic
germs. In such relapses the animals: usually die from pleural pneu-
monia or pericarditis (Hinrichsen).

In pigs about 4 weeks old the course of the disease may be so
unfavorable that 50 to 80% of the affected animals succumb. On
the other hand, the mortality in older animals hardly ever exceeds
1 to 2%. The average loss is about 10%, while an additional 10%
remain runts. The majority, however, become only slightly affected
(Grips, Glage & Nieberle).

The anatomical changes consist principally in a chronic broncho-
pneumonia, frequently associated with a sero-fibrinous inflammation
of the serous membranes. The autopsy reveals in the lower anterior
part of the lungs, either in a large portion or only at the borders,
wedge-shaped sharply circumscribed hepatized areas which have a
peculiar semi-solid consistency, or the organ may be similar to the
normal consistence of the pancreas (Joest). On the cut surface the
affected lung is grayish-red, smooth, moist or somewhat dry, and studded
with yellowish spots. At the same time the pleura over the correspond-
ing areas is lusterless and rough or covered with fibrinous membranes
which cause adhesion of the anterior lobes, and also with the costal
pleura. Between the pleural layers a reddish-yellow fluid may be
present in small quantities which may also contain fibrin-coagulums.
Similar inflammatory changes are not infrequently found also on the
pericardium. The recovered cases often show only adhesions of the
serous membranes, some atelectic areas on the borders of the lungs
and hardening of the thoracic lymph glands. The bronchi are usually
filled with a muco-purulent secretion.

In some of the cases the affected areas of the lungs contain
greenish purulent foci, and such may also be found in other organs
(see pyobacillosis, page 141).

According to the histological examinations of Liipke and Joest the changes
in the lungs are, at the incipient stages of the disease, those of a typical catarrhal

pneumonia, while later the productive granulating character becomes more and more
prominent in which cell forms predominate such as are found in inflammatory

granulation tissue.

The bacteriological examination always reveals various kinds of
bacteria in the affected parts of the lungs. The bacillus suisepticus is
present in about two-thirds of all cases. Frequently, however, they are
few in: number and of a very slight virulence, so that it is possible
to kill test animals only with large quantities of suspected material.
Simultaneous with this bacillus, but occasionally without it, streptococci
and staphylococci, coli bacilli, bacillus pyocyaneus, further in about
60% of the cases the bac. pyogenes suis may be found.

The varying bacteriological findings and especially the frequent absence of

the bacillus suisepticus in the pneumonie tissues make its exclusive primary
etiological importance very doubtful. It appears more probable that the pneumonia
x

140 Enzootic Pneumonia of Pigs.

of pigs commences with catarrhal processes of the air passages which develop in a
broncho-pneumonia when the bacteria which.are normally present in the respiratory
passages, among them also the bac. suisepticus, will subsequently multiply and
aggravate the inflammatory processes; that the bac. suisepticus is not the true
causative agent of the disease is further substantiated by the fact that this
organism, at least in the artificial infections, always produces acute inflammatory
and later necrotic processes, and consequently the anatomical lesions of the pneu-
monia of pigs do not correspond with the pathogenic characteristics of this bacillus
(see also chapter, Enzootic Inflammations of the Lungs of Young Animals, in
Vol. IJ.). For the correctness of the conception that the former acute swine
plague has changed in Germany to a chronic catarrhal pneumonia, there are no
convincing proofs. It is only established that in certain localities this disease
occurs quite extensively; it is, however, probable that the disease existed there in
former times. The occurrence of the disease is in the first place influenced by
local conditions and especially by exposure of the delicate young animals to cold
moist stables, and possibly also by attempts to improve the breed by intensive
breeding, by the confinement of too many animals in close quarters, the feeding
of creamery products, ete. :

Uhlenhuth and his co-workers have proven experimentally the correctness of
the conception that the catarrhal affection of the lungs in question is independent
of swine plague, and that the disease may develop without the codperation of the
bac. suisepticus in animals in which the vitality has been reduced. They placed
pigs in enameled troughs or in sheds in which the floor was covered with cinders
which were frequently moistened. These animals became affected with a typical
catarrhal pneumonia and the lung tissue contained only streptococei or staphy-
lococci.

The infection from animal to animal may also play an important part in
the spread of the disease. The animals weakened by the debilitating influences
above mentioned will be rendered more susceptible to infections, if they ingest,
with the expectoration and excrements of affected animals, various kinds of faculta-
tive pathogenic bacteria in large numbers. Such organisms originating from
affected organs possess usually a high virulence compared with the organisms of
the same species present in the air passages of healthy animals. An infection of
adult animals through affected young hogs has not yet been established.

The recent findings of Frosch & Broll regarding the nature of the enzootic
pneumonia of pigs cannot yet be accepted as conclusive. They succeeded in pro-
ducing hog cholera in pigs with filtered and unfiltered material of affected pigs
from 4 to 6 weeks old, although it is known from experience that animals of that
age very rarely become affected with hog cholera.

The medicinal treatment promises no results. On the other hand,
improvement of the hygienic conditions and good nutrition have a
favorable influence on the course of the disease.

A proprietary remedy which is marketed in Germany under the name of
‘«Wassermann’s Vaccine for the Cure of Swine Plague’’ (aggressin preparation?)
gave Mucha, Raebiger, Willenberg and Dien satisfactory results.

According to Ostertag in the prevention of the disease, which
should extend also to the protection of the healthy animals in the herd
where the disease has already appeared, great caution should be exer-
cised in the purchase of animals in limiting to some extent the in-
breeding, keeping of the pigs in warm and dry stables with access
if possible to outside range. For parturition the animals should be
placed in separate stables (cow or sheep stables), the pigs should not
be weaned too soon, those pigs stunted in growth should be removed, and
lastly the stables and stable utensils should be regularly disinfected
with a 2% hot soda solution.

Evers considers frequent disinfection as a very difficult procedure in practice,
and in the winter time not without danger; on the other hand, he lays especial stress
on the proper building of isolation stables as well as the destruction of all runts.

Immunization. In Germany the polyvalent swine splague serum of
Wassermann & Ostertag is used quite extensively (see page 137). The
Pyobacillosis of Hogs. 141

results cannot be estimated satisfactorily, but it appears that it gives
especially good results in the places where proper care is taken in
general for the welfare of the pigs.

_. According to Ostertag’s report in 218 herds which were exclusively affected
with swine plague in 1902, 7,944 hogs under 3 months and 2,238 older animals were
inoculated. Of these, 633 young pigs (7.9%) and 11 (.5%) old hogs died, 47
(.6%) young and 42 (1.9%) old hogs had to be slaughtered in emergency. 376
(4.7%) young and 28 (12%) old hogs became stunted in growth, while 6,888
(87.7%) young and 2,757 (96.4%) old hogs remained healthy. In some of the
herds in which before the vaccination 50 to 75% or almost all pigs died, the dis-
ease almost entirely ceased after the vaccination, and in numerous formerly
infected herds breeding became again satisfactory and remunerative after the vac-
cination. According to Wassermann 17,769 pigs were vaccinated in the years of
1903 and 1904, in infected herds of which in the animals up to 3 months of age
90.7% remained healthy, while of 1,490 older hogs 94.3% also remained healthy.

It is advisable to vaccinate the pigs on the first day of their lives and to
repeat it shortly before weaning, at which stage the animals are most susceptible
to the infection, and are also especially exposed. The injection may be repeated
when one inoculation fails to produce a sufficient protection and the disease has
newly appeared. The inoculation of the affected animals is unsatisfactory. The
dose of the serum is from 3 to 5 ec.

Raebiger as well as Joest and Ripke also reported favorable results from the
polyvalent serum (of 2,227 pigs 19.5% remained healthy). The reports. of the
Prussian district veterinarians (1902-1906) indicate partly favorable and partly
less favorable results.

Immunization with extracts of swine plague bacteria and immune
serum (see page 137) gave Pfeil and Diem favorable results, while
Majewski and Klipstein failed to obtain such. The preparation known
as Euman appears to be prepared from cultures of the bac. pyogenes
suis.

Literature. Ostertag, Z. f. Flhyg., 1905, XV, 266; B. t. W., 1905, 205 u. 234;
Z. f. Infkr., 1907, II, 118, u. 425.—Grips, Glage & Nieberle, F. d. Vhyg., 1904, II,
5 (Lit.).—Hutyra, Z. f. Infkr., 1907, I, 281 u. III, 235.—Evers, Schweinepest.
Jena 1906 (Lit.)—Uhlenhuth, Xylander, Hiibener & Bohtz, Arb. d. G.-A., 1908,
XVIII, 1 (Lit.).

Pyobacillosis of Hogs. (Pyemic cachexia). Grips claimed in 1903
that the cause of swine plague is not the ovoid septicemia bacterium
described by Loffler & Schiitz, but an organism which he found in the
encapsulated caseous foci of the lungs and named bacillus pyogenes
suis. Then Grips, Glage & Nieberle attempted also to prove that the
enzootic pneumonia of pigs which occurs extensively among the pigs
of Northern and Northwestern Germany, and which is characterized
by catarrhal suppuration and severe inflammation, by nervous symp-
toms, disturbances of nutrition and skin eruptions (see page 138), should
be considered as the true swine plague, and that it is caused by the
above nientioned organism, whereas Loffler’s ovoid bacteria only occa-
sionally cause acute complications in the normal course of the disease.

This view stimulated Olt, Casper, Ostertag, Piitz and Preisz to
undertake bacteriological work in this line, and they proved the in-
correctness of the above conception. They have proven that the bac.
pyogenes suis produces suppurative processes in the lung tissue only
secondarily, but on the other hand they showed that the new bacillus
may also produce similar processes in other organs. Its biological
characteristics were studied more extensively by Berger and Holth.

In most of the cases the disease represents the enzootic pneumonia
of pigs, known also as chronic swine plague, in which there is a more
142 Pyobacillosis of Hogs.

profuse muco-purulent nasal discharge, a complication of inflammations
of the joints and abscesses in various parts of the body as a result of
associated infection with the bac. pyogenes.

In such eases the autopsy reveals a pronounced purulent bronchitis,
and numerous small greenish suppurative foci which are in the lung

tissue enclosed in connective tissue capsules. Sometimes nodules of ©

the size of a hen’s egg may be present which consist of a purulent mass,
at times dry at the periphery, softened towards the center, or which
may be entirely purulent. The contents of the nodules may easily
be removed from the connective tissue capsule.

The intestines, especially the large intestines, frequently manifest
a eatarrhal purulent inflammation; in the submucous tissue there may
frequently be found nodules in size from a hazel to a walnut, with
dense fibrous walls and greenish caseous contents. The nodules cause
the intestinal wall and the mucosa to bulge, and over them the serous
membrane frequently shows inflammatory changes.

Occasionally generalization of the pathological process may occur
in which ease the various tissues may become affected more or less
frequently in the order given; muscles, joints, tendon sheaths, sub-
cutaneous fat, liver, spleen, lymph glands, bones, more rarely the
kidneys may contain greenish-yellow sup-
purative foci. The exudates are usually
thin, mucous, of whitish-yellow or reddish-
gray color, frequently with a greenish hue.

The bac. pyogenes suis which is recog-
nized by Grips, Glage & Nieberle as at
least the principal cause of these suppura-
tive processes, is present in the bronchial
secretion (see Fig. 31), in the exudate of
the serous cavities and in the suppurative
foci. It is usually associated with other
bacteria and among these also with Léffler’s
bipolar bacillus, more rarely it may be

. . . present in great quantities in pure cultures
pa eee (especially in greenish pus). It is also
a hog. Carbol-fuchsin staining; found in great numbers in the intestinal
and subsequent washing with contents, while in older suppurative foci

1% acetic acid. the bacilli are present only in small num-
bers, or may be entirely absent.

 

According to the investigations of Glage, Berger and Holth the bacillus is
identical with the organism described by Poels (1897) as the cause of arthritis in
calves and known as the polyarthritis bacillus as well as with the bac. pyogenes
bovis which was found by Kiinnemann in abcesses of cattle (see page 144). Dunkel
considers it identical with the bac. pseudotuberculosis ovis (see that disease).

In hogs Pitz found the organism in inflamed tissues and in the secretion of
the bronchi in 36% of the cases; in necrotic foci of the lungs in 50%; in softened
purulent nodules in 100% of the cases. Preisz demonstrated the organism in 16
out of 77 cases of acute swine plague pneumonia. Olt on the other hand proved
that the bacillus is present in great numbers in the pale gray mushy plugs in the
tonsils of healthy hogs.

The bacillus represents delicate non-motile and sporeless rods,
which in the exudate resemble the erysipelas bacillus (Fig. 31), but
in cultures appear somewhat shorter and sometimes club shaped. It
stains with the basic anilin dyes, and especially well with carbol
fuchsin which stains it uniformly and intensely, after a sufficiently
long action of Lugol’s solution; it may also be stained by Gram.

 

 
Pyobacillosis of Hogs. 143

The cultivation, although somewhat difficult, succeeds aerobically
as well as anaerobically, but only at temperatures of between 24 and
40°C., (the best growth being obtained at 37°C.), and only in the
presence of proteid. As nutritive media coagulated horse, cattle or
hog blood serum is most suitable on the surface of which fine bluish
points, and corresponding with these through liquefaction of the
medium, small cup-shape depressions develop in from 2 to 7 days.
Stab cultures in coagulated serum show a grayish thread consisting
of little round colonies or a continuous growth, which, after liquefac-
tion of the serum, soon sink down and form a flaky gray mass. On
serum agar small transparent drop-like colonies develop in the stab
which confluate, forming a lustrous transparent thin layer. On serum
agar plates the colonies form small thorn apple-like and later round
colonies. Luxuriant growth is obtained in milk which commences to
coagulate from the bottom up in 48 hours, and finally turns to a
uniform whey from which a water-clear serum separates later.

The resistance of the bac. pyogenes is very slight. In cultures it does not re-
main active longer than from 2 to 3 months. A temperature of 57°C., drying, for-
malin vapors or sulphuric acid kill it rapidly. (Piitz, Berger).

According to the investigations of Grips, Glage & Nieberle the
pathogenic characteristics of the organism develop in small test animals
only after the injection of large doses of cultures, in which case they
produce suppurative processes. In sucking pigs the feeding of pure
cultures produces a chronic gastro-intestinal catarrh, which, especially
during weaning time, results in fatal diarrhea. In addition atelectasis,
exudative pleurisy and peritonitis as well as nervous attacks may de-
velop not infrequently. The animals which recover from the disease
remain runts. Intratracheal injection produces suppurative bronchitis.
Subcutaneous injection causes a spontaneously perforating abscess at
the point of inoculation. In older weaned pigs the action of the inocula-
tion is manifested in similar changes, only that in this case also skin
lesions in the form of pox-like eruptions and scabs are frequently
observed. Intrapulmonary injections result in catarrhal pneumonia,
exudative pleuritis or abscess formations surrounded by a hepatized
area. Metastatic lesions may develop in the joints. Intrapleural in-
jections cause a specific pleuritis with catarrhal pneumonia in the ad-
joining lung tissue, as well as chronic pericarditis. Intraperitoneal
injections produce a specific peritonitis, while intravenous injections
result in a fatal pyemia. Healthy pigs which are placed in contact
with experimentally infected animals become stunted in growth as a
result of chronic gastritis.

The later experiments of Piitz, Berger & Holth gave practically
the-same results, as they have proved that the pyobacillus produces
suppurative inflammation in the animal tissues, which is characterized
by its chronic and slow character. A marked prolification similar to
the condition occurring in actinomycosis, precedes the breaking down
of the tissues (Holth). The authors mentioned above failed in pro-
ducing catarrhal pneumonia in hogs by inhalations or tracheal. in-
jections of cultures. ; ; ;

According to these experiments the diseased condition occurs in
hogs, especially in young pigs, principally associated with suppurative
processes. They are caused by specific bacilli and may be artificially
produced in healthy animals. The nature of the anatomical changes
144 Pyobacillosis of Hogs.

consists in a specific chronic granular suppurative inflammation which
sometimes is confined to the digestive tract, at other times affecting
also the mucous membranes of the air passages and especially the
bronchi, in which case the lungs develop a catarrhal suppurative or
a purely suppurative inflammation. With the affection of the mucous
membrane an exudative inflammation of the serous membranes be-
comes associated and a generalization of the suppurative processes
may also take place.

The changes, however, do not correspond with those pathological
processes which have customarily and undoubtedly with justice been
considered as swine plague lesions. Acute catarrhal croupous or
necrotic pneumonia, such as is observed in acute outbreaks of pure
swine plague, as well as in a more frequent mixed infection with hog
cholera, has in no case been produced in the above experiments. These
facts have been pointed out by Olt, Casper and Ostertag (the changes
which were indicated as such were always atelectatic). The bacillus
pyogenes suis exerts in all cases purely pyogenic properties.

According to Olt the disease caused by the pyo-bacillus and desig-
nated by him as ‘‘pyemic cachexia of hogs’’ (the name pyobacillosis
was suggested by Liipge) occurs in the majority of cases as an in-
dependent affection, but also in association with, or as a result of
other infective diseases. Contrary to this Ostertag maintains, without
disputing the independent occurrence of pyobacillosis, that most cases
of the affections of the lungs described by Grips are chronic affections
of swine plague caused by ovoid bacteria. He claims that in the course
of the disease the Grips bacillus as well as other bacteria may localize
especially in the bronchial mucous membrane, and this is the more
possible as it is known that this organism occurs as a saprophyte in
the upper air passages of healthy hogs. The primary etiological part,
the ovoid bacterium, in pneumonia of pigs has been authoritatively
established in accordance with the description on page 139. Considering,
however, the fact that the pyo-bacillus occurs in pure cultures only
in metastatic abscesses, while in the pneumonic lungs it is always
present in association with other pathogenic bacteria, it probably takes
only a secondary part in the lung affections of hogs. In such cases
it is the cause of severe changes, especially of extensive suppurations.

The pyo-bacillus exerts a similar action in the suppurative
processes of ruminants. According to the investigations of Poels,
Kiinnemann, Roux, Holth and Olt it occurs in inflammation of different
organs in cattle (Poels found the organism in 38 out of 56 cases).
However, it is mostly present in association with staphylococci,
streptococci, colon bacilli, necrophorous bacilli and other bacteria. It
occurs especially in cases of peritonitis caused by foreign bodies, in
bacillary pyelonephritis, metritis, to which inflammation of the valves
of the heart may be added; further in arthritis in calves, various
broncho-pneumonias in young as well as in old animals; finally in
mastitis, especially in those cases which are associated with septic
and catarrhal metritis (according to Holth the presence of the bacillus
pyogenes is especially indicated by a thin milk-like secretion of the
udder with dense yellow irregular flakes; further by a purulent fetid
secretion). As a causative agent of mastitis it-has been established
in goats (Dammann & Freese, Olt) and in sheep (Olt): Olt also found
the organism in broncho-pneumonia of lambs and sheep in which
especially the terminating bronchi were in parts almost entirely ob-
structed with masses of bacilli.
White Scours of Sucklings. 145

Literature. Grips, Diss., Giessen 1902.—Kiinnemann, A. f. Tk., 1903, XXIX,
128.—Grips, Glage & Nieberle, F. d. Vhyg., 1904, II, 5 (Lit.)—Olt, D. t. W.,
1904, 325; 1908, 617 (Lit.).—Ostertag, Ibid., 1903, 185.—Piitz, Diss., Giessen
1904.—Koske, Arb. d. G.-A., 1906, XXIV, 181.—Berger, Z. f. Infkr., 1907, III,
101.—Holth, Ibid., p. 155 (Lit.).—Dunkel, Z. f. Bakt., 1909, LIII, 61.

6. Septicemic Affections of New Born Animals. The acute
septicemic affections of the newborn may clinically be collected
into two groups. In the first group all those affections are
considered in which manifestations of an acute gastro-intestinal
catarrh are present, and its most conspicuous symptom. is
diarrhea, while the affections of the second group are charac-
terized by suppurative inflammatory processes in various
organs and about the body, especially in the joints and extremi-
ties. In spite of the variance of the symptoms the more recent
investigations indicate with great probability that the same
bacteria produce the diseases belonging to both these groups.
It is also probable that several species are concerned in the
etiology of the diseases and that the differences in the course
of the disease depend especially on the mode of infection.

While the two forms of disease are apparently very closely
related, or possibly even identical in their etiological relation,
we consider that the question has not been completely solved,
especially as in some of the enzootics frequently only one or
the other form comes under observation. Accordingly from a
practical standpoint it is deemed advisable in discussing the
diseases to separate the forms from each other.

(a) White Scours of Sucklings: Dysenteria neonatorum

(Diarrhea neonatorum, Diarrhée des nouveaunés [French];
Ruhr der Sduglinge [German].)

White scours of newly born is an acute, contagious, infec-
tious disease affecting the animals in the first days of their
lives, and is observed usually as a stable affection characterized
by profuse diarrhea and by rapid exhaustion.

History. The cause of this dangerous and fatal disease has been.
thought until recently to be either due to dietetic errors, especially
as a result of feeding milk of improper constitution (Tolnay 1799);
and also caused by improper feeding of the mother animal, or else as
a result of climatic conditions. Based on this supposition the affection
has been associated with the gastro-intestinal catarrh of adults which
results from similar causes. However, Obich (1865) and Roloff (1875)
proved that the disease is transmissible from stable to stable, and
further investigations proved beyond a doubt the infectious nature
of the disease. Frank (1876) concurred in these findings, and at
the present time this view is generally accepted. The recent investiga-
tions of Poels (1899) and Joest (1902), and especially those of Jensen
(1893 and 1905) have cleared the etiology of white scours in most
points.
146 White Scours of Sucklings.

Occurrence. The disease which with the development of
intensive agriculture always attains greater extension, occurs
especially in the spring and in the fall, while in winter and
summer it is more rarely observed. Calves become affected
most frequently. Sometimes, however, the disease also occurs
among foals, lambs and pigs (very rarely also among dogs
and cats). It causes
considerable loss due
‘to its contagious na-
ture as well as by its
destructive course in
the affected herds.
Occasionally all the
young of an entire
year succumb to this
malady, which more-
over frequently reap-

. pears in an infected
Fig. 82. Bacillus coli communis Stable during the con-
Agar culture; fuchsin staining secutive periods of

parturition.

Etiology. Up to the present time white
scours has been studied bacteriologically very
extensively, and according to the uniform results
of these studies the disease was in most cases
caused by the bacillus coli communis, or by one
of its several virulent varieties (Jensen, Poels,
Joest, Bongert, Titze & Weichel).

The bacillus coli communis is a small rela-
tively thick rod-shaped or slightly oval bac-
terium (Fig. 32). Itis motile (one, two or more
flagella), does not form spores, and stains uni- Fig. 33. Gelatin
formly with aqueous anilin dyes; does not stain St2>, culture of

the Bacillus coli
by Gram’s method. communis.

 

me

 

SS
7

soa

i

 

Cultivation. The bacillus is aerobic. In the depth of gelatin it
“produces round or whetstone-shaped, brownish colonies which spread
more on the surface of the media. They are first transparent, later
white, veined like grape leaves, and irregular. Along the stab the
colonies are white and small and the medium does not liquefy (Fig. 33).
On agar it forms gray transparent, later white, colonies. The bouillon
becomes uniformly cloudy. On potatoes a grayish, later yellowish-
brown, thick deposit forms. Milk is acidified and coagulated. The
bacillus causes the formation of indol and hydrogen sulphide as a
result of which the cultures have a disagreeable odor. In media con-
taining sugar the organism causes an alcoholic fermentation, but colon
bacilli of different origin show in this respect marked differences,
which are even more pronounced relative to their virulence.

The colon bacillus is almost a constant inhabitant of the intestinal
canal of most animals and of man. In guinea pigs and chickens, how-
ever, it is usually absent.
Pathogenicity. 147

Pathogenicity. Colon bacilli originating from the bodies
of calves which die from white scours exert a severe pathogenic
action on newly born calves. If a one-day-old calf is given 5
to 6 ce. or even only 4 to 1% ce. of the bouillon culture mixed
with milk, fever and diarrhea set in the following day and
the animal dies in from 11% to 3 days. The autopsy reveals a
hemorrhagic inflammation of the abomasum, and to a slight
extent also of the intestines. The contents of the intestines are
fetid and the mesenteric lymph glands show hemorrhagic swell-
ing. The injection of 5 ce. of bouillon culture into the rectum
of a new born calf has similar results, and sometimes the sub-
cutaneous injection of such a quantity of culture is fatal, while
1 ec. of culture has no ill effects upon the animal (Jensen).
A fatal infection per os may be much more easily produced
in calves in which the organs have not yet performed their
functions than in those in which the stomach and intestines
have already been set in activity by the ingestion of food
(Joest). Injection of culture into the umbilical vessels, in the
amniotic sac or into a vein produces in some cases a fatal
septicemia (Poels, Joest). Intraperitoneal inoculation of rab-
bits and guinea pigs causes a fibrinous peritonitis (Jensen,
Willerding), and sometimes subcutaneous injections of large
quantities of culture are also fatal to these animals as well as
to mice (Mazzanti & Vigezzi, Joest).

The colon bacilli which are found in calves affected with diarrhea
correspond in all their morphological characteristics with the colon
bacilli isolated from the excrements of healthy calves. They differ,
however, from them by their severe -pathogenic action on calves. Ac-
cording to Jensen the pathogenic colon bacilli are facultative parasites
which enter the digestive tract soon after birth, either with the first
milk or with other material swallowed by the animals (for instance
with mucus contaminated with straw). Under normal condition the
bacteria multiply in the intestinal canal only to a moderate extent,
and are harmless, as they are not capable of attacking the mucous
membrane of the healthy intestines. If, however, the resistance of
the tissues is weakened from some cause (cold, poor nutrition, etc.),
the bacteria penetrate into the intestinal wall and later also into the
distant organs as well as into the circulation and produce in this
manner an affection of the animal.

The great susceptibility of calves which have not yet taken any
food may be explained by the fact that the colon bacilli which enter
the stomach before the ingestion of the colostral milk pass without
interference into the small intestines as the stomach has not yet pro-
duced any gastric juice. Owing to the absence of the intestinal juices
the meconium which is present in the intestines affords a favorable
medium for the multiplication of bacteria. Their penetration into the
mucous membrane is probably also facilitated by the fact that the
intestinal epithelium does not at that period possess a mucous covering,
and is therefore easily penetrated (Joest).

-Colon bacilli which have attained a higher virulence in the animal
body retain it for that respective species of animals. Leaving the
148 White Secours of Sucklings.

animal body they may again be taken up by the digestive tract of
other newborn animals and produce the disease. Repeated transmission
increases the relative virulence of the bacteria which then retain the
severe pathogenic action until they again lose their virulence through
the influence of certain conditions.

The lowered natural resistance of the animal is considered
by Jensen to be of great importance, as he succeeded in pro-
ducing the disease by feeding material which has a weakening influence
only on the intestinal wall. Thus the disease developed after two
administrations of 5 gm. doses of creolin, and after repeated doses
of pyoktannin (in all 0.75 gm.) or trichloride of iodine (0.65 gm.
given inside of 30 hours). This is also substantiated by the fact
that the disease will appear when the newborn calves are fed boiled
milk instead of colostral milk.

It is not yet positively established whether the causative agent
of the disease represents a ‘‘pathogenic variety’’ of the colon bacillus
(Jensen, Titze & Weichel) or is a ‘‘virulent colon bacillus’’ (Poels)
or again whether it is ‘‘a variety of the bacillus coli communis which
is pathogenic only for calves’’ (Joest found the isolated bacillus
identical with the organism isolated by the other two authors). Of
great importance is the fact that among the colon bacilli very widely
distributed in nature there are such, which may as facultative parasites
sometimes attain a high virulence for calves and when possessing such
properties may form a dangerous virus. :

In some cases other bacteria have been demonstrated to be
the cause of white scours, as the bacillus aerogenes, paracolon
bacilli (identical with Gaertner’s enteritidis bacillus?) as well
as varieties of the proteus. These are found as a rule only when
the disease develops somewhat later in life (Jensen). Further
the bacillus enteritidis Gaertner and the bacillus pyocyaneus
(Poels) enter into the etiology of this disease. According to
the causative agent the disease may show marked clinica] differ-
ences (Jensen; see page 151). 5

Titze & Weichel found among 210 strains from white scours from different
parts of Prussia 160 colon, 4 paracolon and 16 pseudocolon strains, further 24
strains of the bacillus enteritidis of Gaertner and two strains each of bacillus para-
typhosus B, bacillus lactis aerogenes and of the bacillus proteus mirabilis. (Para-
colon bacilli or Gaertner’s bacilli and bacillus paratyphosus B can be only dis-
tinguished from each other by agglutination tests; pseudocolon bacilli resemble
colon bacilli, but they coagulate milk). In cultures of colon bacilli the presence of
toxins could not be demonstrated, but they were found in cultures of Gaertner’s
bacillus that were at least ten days old, and also in cultures of paratyphosus B
bacilli and paracolon bacilli. The toxic action was somewhat diminished by heat-
ing the filtrate containing the toxins for a half hour at 60°C., and at 80° the
toxicity was entirely destroyed. The administration of potent toxins per os caused
diarrhea in test animals. Schmitt repeatedly found also, in calves affected with
scours, bacilli of the paratyphosus B group, which finding deserves especial consid-
eration, as this bacterial group plays an important part in meat poisoning. (Titze
& Weichel could never demonstrate such bacilli in healthy animals).

Recently Krautstrunk isolated a diplococeus from the blood and organs of
ealves affected with scours which resembles the pneumococeus of man. The cultures
of this organism even in small quantities (few loopfuls of agar culture) adminis-
tered to newborn calves, either in milk or by intravenous injections within a few
days produced a fatal typical white scours which was sometimes accompanied by
swelling of the joints. The diplococeus which is Gram positive and has been ob-
tained in pure cultures, in 9 out of 73 cases, and in 16 cases was found in associa-

 

 
Pathogenicity. Natural Infection. 149

tion with colon bacilli, appears in smear preparations to be surrounded by a broad
capsule. It grows only in alkaline media, especially well on blood agar, and also
in serum bouillon.

The affection of the newborn of other species of domestic
animals is probably similar in its etiological relation. Thus
according to Hecker’s investigations diarrhea in lambs is pro-
duced by the same bacteria as in calves, while Baldrey demon-
strated in white scours of a foal colon bacilli as the cause.

Natural Infection. Sometimes the disease will appear in
localities which have previously been free from it, without
apparent introduction from the outside. In such cases it may
be assumed that the ordinary colon bacilli which have been
present in the stable, have for some reason attained virulent
properties in the intestines of the newly born animals (for
instance as a result of dietetic errors, feeding of boiled milk
immediately after birth), and that this virulence is being
retained for later born animals.

In affected stables the virus may be present in the vagina
of the mother, on the floor of the stable or in the litter, from
which the external genitals and the udder of the mother become
contaminated. The infection results usually during the sucking
of the contaminated udder, but also has taken place during
parturition, and later through contact with litter, from licking
of the stable walls, ete. Exceptionally the infection may also
take place through the umbilicus (Poels, Jensen). The affected
animals may then infect their surroundings with their excre-
ments and urine, thus increasing the possibilities for infection
of animals born later. Newborn animals fed artificially with
‘boiled milk may become infected by the contaminated hands
of the attendants as well as by the use of dirty feeding vessels.
In many instances the unfavorable experiences, gained in places
where animals are raised artificially (numerous affections with
diarrhea) may be attributed to a large extent to such infections,
but in such cases consideration should also be given to the fact
that by heating the milk substances are destroyed which are
valuable for the digestion (ferments), which, if undisturbed,
counteract to some extent the development of diarrhea by stim-
ulating the function of the digestive glands, thereby preventing
the excessive multiplication of the normal intestinal bacteria.

The contagion may retain its virulence in infected stables
for a long time, which may explain that in some premises where
nothing is done for the prevention of the disease it reappears
from year to year in the spring and in the fall. On the other
hand, the infective agent may be introduced into premises, as
yet free from disease, by infected sucklings as well as by adult
animals. The transmission of the disease by breeding animals
is especially suggested by the fact, that, where cows in advanced
pregnancy are taken from an infected stable and placed on
premises free from the disease, the calf born there is frequently
150 White Scours of Sucklings.

affected with diarrhea (Dieckerhoff). Besides affected animals
may spread the contagion among sucklings of other species of
animals, especially lambs may become affected when an infected
calf is placed among them (Kotelmann).

The possibility of an intrauterine infection was proven by
Kitt when he injected 3 ec. of a washed agar culture of colon
bacilli intravenously into a cow in advanced pregnancy. This
immediately caused a profuse diarrhea in the calf which was
born eight days later.

Newborn animals are more susceptible or predisposed to
the disease immediately after birth, while later the suscepti-
bility diminishes rapidly. As a matter of fact the animals
become affected in the majority of cases within 24 to 48 hours,
much more rarely from 3 to 8 days after birth, whereas older
animals usually do not contract the disease. Conditions which
predispose the body, such as poor nutrition, congenital weak-
ness, etc., favor the development of the disease, particularly as
the animals have not a great resistance in the first days of
life. Besides, the withholding of colostral milk from the calf
and the immediate feeding of boiled milk after birth results
almost always in the appearance of the disease.

An abnormal composition of the mother. milk, high fat contents
or the opposite too high dilution, as well as indirectly the feeding
of the mothers with oil meal cake or swill (Kovacsy) may have an
influence on the development of the disease, since such conditions
favor an abnormal multiplication of colon bacilli in the intestines of
sucklings.

Pathogenesis. Bacteria which accumulate in great num-
bers in the intestinal tract of sucklings enter the tissues of the
intestinal mucous membrane, the lymph spaces and the lymph
follicles. The penetration of these organisms in the first days
of life is facilitated by the absence of the ‘‘mucous layer’’
(Disse) from the intestinal epithelium which at a later age
prevents to some extent the penetration of the bacteria. From
the intestinal walls the bacteria enter the mesenteric lymph
glands and cause acute swelling. Later they may enter the
blood circulation and flood the entire body.

According to Jensen white scours is not a simple inflamma-
tory condition of the digestive tract, but an inflammatory
process complicated with a septicemic condition, which is caused
by the entrance of the bacteria into the blood circulation. It is
very probable that the manifestations of the disease are to
some extent caused by toxic products of the bacteria. Although
filtrates free of bacteria from virulent colon cultures have
proven harmless (Jensen), the negative results do not exclude
the development of toxins in the animal body. Bacilli of the
paratyphus group B produce severely acting toxins even in
artificial culture (see page 148).

aude a,

 
Anatomical Changes. 151

Anatomical Changes. The carcasses are greatly emaciated,
anemic, the parts around the anus are soiled and the mucous
membrane protrudes. The mucous membrane of the stomach
appears highly reddened, in ruminants, only in the abomasum,
and in this especially around the pylorus, it is edematous,
swollen, covered with a great quantity of glary mucus. The
ridges of the folds are sprinkled with punctiform and linear
hemorrhages and erosions. The loosened superficial layer can
be easily scraped off with a knife. The small intestines contain
a very fetid, yellowish or dirty gray, and sometimes reddish
fluid contents, which may be mixed with mucous flakes, and
a great quantity of gas. The intestinal mucous membrane is
highly reddened, covered with sticky mucus and may be studded
with hemorrhages. Its solitary follicles and the Peyer’s patches
are swollen, the submucosa and the muscular coats are edema-
tous. Similar changes, although not to the same extent, are
present in the mucous membrane of the large intestines. The
mesenteric lymph glands are always intensely swollen and fre-
quently contain ‘small hemorrhages.

The parenchymatous organs are conspicuously pale, the
spleen is not enlarged. The lungs show acute edema, and in
exceptional cases catarrhal pneumonic foci. The serous mem-
branes, especially the pericardium and the endocardium, show
hemorrhages. The umbilical vessels are either filled with nor-
mal blood coagula or are empty.

The lesions described are not in all cases distinct, but may be
only slight even in cases where the pathogenic bacteria are pres-
ent in all organs and even in the muscles (Titze and Weichel).

According to Jensen the following forms of white scours in calves
may be distinguished, depending on the cause of the disease:

1. Colibacillosis. In one form of this affection which usually
oceurs shortly after birth and runs a rapid course, the lesions consist
in a pronounced enteric condition, the mesenteric lymph glands are
red and swollen, the spleen is in most cases enlarged, and large numbers
of bacteria are present in the blood and in the organs. The other
form appears from 3 to 5 days after birth and causes death of the
animal in 3 to 5 days. The intestines are distended by gas and are
pale, the mesenteric lymph glands are swollen, but mostly pale; swell-
ing of the spleen is rare, the blood and the organs contain no bacteria,
or only sparingly: so.

2. Aerogenes bacillosis; resembles the first form of the coli-
bacillosis.

3. Paracolon bacillosis or pseudocolon bacillosis. This may run
a course of hemorrhagic enteritis; frequently, however, the enteric
changes are not very marked while the swelling of the mesenteric lymph
glands, the enlargement of the spleen and degeneration of the internal
organs is very pronounced. In rare cases the serous membranes may
contain fibrinous exudate, the blood and the internal organs always
contain numerous bacteria. ;

4. Pyocyaneus bacillosis (Poels). It is manifested as a severe
diarrhea and the autopsy reveals a red spotted intestinal mucous mem-
152 White Secours of Sueklings.

brane, degeneration of the liver, but no swelling of the spleen. In
the intestinal contents the pyocyaneus is found in almost pure cultures;
the blood on the other hand is sterile.

5. Proteus bacillosis. This usually occurs when the calf is several
days or about a week old and runs a slow course. Feces are fetid,
never mixed with blood. On the autopsy the intestinal tract is greatly
distended, pale, the mucous membrane becomes macerated shortly
after death. The spleen is normal, the mesenteric lymph glands are
slightly swollen but not hyperemic. Proteus organisms are present in
great numbers in the intestinal contents, but are not found in the
blood or in the organs.

In the cases which are caused by the diplococcus found by Krauts-
trunk the autopsy reveals changes similar to those found in colon
bacillosis, the intestinal glands being always markedly swollen and
reddened.

Symptoms. In animals born healthy the first symptom
usually appears in from 1 to 3 days, exceptionally in a few
hours after birth; in rare cases in from 4 to 8 days. The
newborn cease to suck and stand in one place with a staring
look. They are depressed and lie down a great deal of the
time.

On the first day, or not later than on the second day, the
diarrhea appears; the expelled very fluid and fetid feces is
yellowish-brown in foals and pigs, while in calves and sheep it
is first yellowish, later grayish-white, frequently foamy, and
contains lumps of clotted milk as well as blood streaks (white
and red diarrhea). The parts around the anus are soiled and
the hair or the wool is matted. The consistency is at first
slightly mucous, later watery; the odor is intensely sweetish,
later penetrating, putrid (Hess). The feces are passed at first
under severe straining, later it is painless and towards the
end of the disease involuntary passing of the feces is observed.
Colts suffer severe colicky pains before and after the passing
of the feces, they show restlessness, paw with the front feet,
look towards the abdomen or they draw the feet under the
body. ‘Similar, although not so pronounced, restlessness is
observed in calves. At the same time there is bloating, or on
the contrary the abdomen may be contracted, the flanks are
sunken and the pressing of the abdominal walls causes paius.
After the passages the animals stand in one place with feet
drawn together, arched back and lowered head, or they lie for
a long time motionless on the ground.

The weakness increases during the course of the disease,
the eyes sink into their sockets, the cornea loses its lustre,
saliva flows from the mouth, the dry tongue is covered with a
viscid mucus, the anus is continually open, the hair is rough,
the skin is sticky from the perspiration, the body disseminates
a disagreeable sweetish odor, and finally the greatly emaciated
animals enter into a comatose state and die.

At the onset of the disease the body temperature rises
from 1 to 2°C.; later, however, with the appearance of
Symptoms. Diagnosis. Treatment. 153

the weakness, it returns to normal, and before death it may
even become subnormal. The respiration is superficial and later
accelerated. The heart action becomes more frequent and
weaker, towards the termination of the disease, and towards
the end it is hardly perceptible.

In the more protracted cases some animals develop later
inflammations of the joints as well as manifestations of a
pyosepticemia, which makes the close relationship of the two
diseases apparent.

Course and Prognosis. The course of the disease is in most
cases unfavorable. The sooner the first symptoms appear after
birth and the sooner they become aggravated, the more un-
favorable is the prognosis. Bloody diarrhea or a rapid drop
in temperature are forerunners of death. These may appear
on the second day of the disease; mostly, however, between two
and three days, exceptionally even after ten days.

In some outbreaks practically all the affected animals die .
and even in more favorable cases the losses are rarely less
than 80%. The high mortality is partly the result of catarrhal
pneumonia which frequently develops as a complication in cases
of less severe primary infections. (See Vol. II, Enzootic
Pneumonia of Young Animals.)

Diagnosis. The disease is differentiated from the simple
acute gastro-enteritis caused by dietetic errors by its appear-
ance shortly after birth, by the predominating diarrhea and by
the enzootic character of the disease. Acute gastro-enteritis
usually affects older animals and is characterized by less severe
symptoms. In calves in this disease the intestinal contents are
thick to mushy in consistence, later almost constantly of a
clay-yellow color, and have an intensely sourish or somewhat
putrid odor (Hess).

The pyosepticemia of the newborn resulting from umbilical
infection is characterized by an early affection of the umbilicus
and by the early appearance of metastatic inflammatory
processes, especially in the joints.

For distinguishing the different forms of the disease in
accordance with the etiological factors the descriptions given
on page 151 offer sufficient points of differentiation.

Treatment. At the onset of the disease suitable immune
sera (see page 156) may have beneficial effect and should be
employed intravenously, and if necessary the injection should
be repeated (5 to 20 ec.), but even in such cases suitable dietetic
treatment should be carried out. This is commenced with a
mildly acting purgative in order to remove the fermenting
intestinal contents. Especially to be recommended is castor
oil (colts and calves 40 to 50 gm., lambs 10 to 15 gm.), or calomel]
(colts 0.2 to 0.3 gm.). After the appearance of the purgative
action it is advisable to administer various slimy gruels (barley
154 White Secours of Sucklings.

gruel, lime water, decoctions of linseed, barley and oats, further
of althaea or senega roots). They may be administered with
or without opium (0.5 to 1 ce. or 0.05 to 0.10 gm.) to which
some chalk or magnesia (3 to 5 gm.) may be added. Hertwig’s
mixture has a good reputation and consists of Pulv. Rad. Rhei
4, Magn. Carb. 1, Opii puri 0.3 in 100 gm. cammomile tea or
in 50 gm. of diluted alcohol, given twice daily to small animals
in tablespoonful doses. Of the intestinal disinfectants salicylic
acid (0.2 to 0.5 gm.) may be given together with tannin; further
tannoform (colts 0.2 to 0.5 gm., calves 1 to 2 gm.), tannalbin
(3 to 5 gm.), napthalin (1 to 2 gm.), salol (5 to 8 gm.), ete,
may be used with beneficial results.

Creolin and lysol are suitable per os (1 to 2 gm.) as well
as in a 1% solution of enemas. Boracie acid (3 to 4%) may
also be utilized for this purpose. In the presence of severe
trismus starch flour enemas containing tincture of opium may
be given.

Evers recommends the intravenous injection of collargol as an
abortive remedy (0.05 gm. collargol in 5 gm. of 144% carbolic solution).
This method of treatment was also found satisfactory by Stampel
and Trost. Fumagalli obtained good results from it in well developed
cases (four injections daily of 0.15 to 2 gm.). Mobius was successful
with phosphoric acid (5% solutions in teaspoonful doses). Schmidt
recommends the administration of 1 gm. tannargentan every 3 hours,
to be given in a tablespoonful of milk, while Eber obtained satisfactory
results in mild cases from tannothymol (4 to 5 gm. per dose).

In addition to the medicinal treatment attempts should be
made to preserve the strength of the animals. For this purpose
eggs should be given either raw with a small quantity of alum,
or in warm wine soup. The weakness is treated advantageously
with wine (port wine), further with black coffee or with sub-
cutaneous injections of caffein. Infusions of a slightly alkaline
physiological salt solution (0.8 of 1% salt and 0.25% sodium
carbonate) into the subeutis of the neck or into the rectum
(2 liters, repeated if necessary in from 2 to 5 hours) have often
given surprisingly good results (Eber). Further rubbing with
alcohol and warm blanketing of the abdomen is indicated.

As the infective agent is contained in the excrements of
the animal the immediate isolation of the infected animals and
the destruction of the feces should be carried out. Besides this
a thorough disinfection of the stables, to be repeated at frequent
intervals, is indicated.

Prevention. In order to prevent the infection of the
newborn the greatest cleanliness should be exercised during
births (disinfection of the stables at intervals of 3 or 4 weeks,
fresh straw under the parturient animals, clean hands of the
stable attendants, etc.). If the disease is already in existence
it is advisable to remove the highly pregnant breeding animals
Prevention. 155

a few weeks before birth into suitable clean stalls (Roloff,
Franck), and immediately before birth to place them in a box
stall especially used for that purpose. Sometimes the disease
does not recur in infected stables if the stable: floor and the
cribs have been thoroughly disinfected and if the newborn calves
are not placed in common pens, but are kept tied with the
mothers for two weeks.

Further it is advisable to disinfect the litter and the vagina
of the mother animal before as well as after birth, and to care
for the newborn with the utmost cleanliness. In order that
the calves may pass the meconium they should, as soon as
possible, suck the collostral milk from the previously washed
udder, and if they are kept in special pens they should be
allowed to feed from the mothers at regular intervals. Further
they should be protected against taking cold and therefore kept
in a moderately warm, clean place, free from draughts.

In places where the calves are brought up artificially, steri-
lized milk should be given only after the animal has partaken
of the collostral milk, and not earlier than the second day, and
in such cases a painstaking vigilance should be maintained as
to_cleanliness, especially of the vessels and the hands of the
attendants. The milk should be heated shortly before feeding
and given to the calves cooled to 40°C. in clean sucking pails.
In various places keeping the calves in single stalls for the
first two weeks after birth has given splendid results.

Behring recommended the feeding of raw formalin milk (1 to
10,000). The raw milk is supposed to have the preference over the
sterilized milk as the activity of the glands of the stomach and in-
testinal mucous membrane are stimulated by the presence of ferments.
The addition of formalin prevents the spoiling of the milk, and exerts
also to some extent a slight inhibiting action on the intestinal bacteria
(according to the investigations of Kolles the addition of formalin to
milk in 1 to 40,000 or 1 to 25,000, inhibits only the development of
the lactic acid bacilli but not the peptonizing bacteria). Unfavorable
results, however, were observed «from this method of treatment
(Raebiger), and it will probably not meet with favor as the
formaldehyde retards or inhibits the digestion of the casein by the
pepsin and the trypsin, and besides the milk containing formaldehyde
no longer acts on the rennet (Ldwenstein).

Poels Method. The external genitals of the mother as well as the tail and
the udder are washed with a 3% ecreolin solution. The vagina is irrigated with a
corrosive sublimate solution of 1 to 5,000, or with a liberal quantity of luke warm
followed by cold water. The calf is caught in a clean sheet, the umbilical cord is
ligated as close as possible to the abdominal wall, severed and the stump is painted
with a 5% solution of potassium permanganate. | Then the mouth is cleaned and a
tightly woven muzzle applied. The calf should immediately suck out the collostral
milk; however, it is recommended to first milk from each teat a few strokes into the
straw, as the first few strokes may be infected. The milk may be also drawn into
clean vessels and fed to the calves (immediately after birth, and again after % to 1
hour, % to 1 liter each time). The quantity of milk required by newborn calves is
on the first day 34 to 1 liter collostral milk, on the second day 1¥ liter on the third
day 21% liters, and later up to the sixth day it increases 14 liter per day. Later the
milk should be given fresh and in small rations. The muzzle is removed only during
sucking or feeding. By this method, which of course can be also applied to foals,
156 White Scours of Sucklings.

the disease has been eradicated in many small farms where formerly all calves died.
Raebiger recommends washing with pure water and drying with a clean cloth for
cleansing the udder. Guillebeau advises to follow the drying by the application of
fat to the udder by means of a cloth (for the treatment of the umbilicus see also
under pyosepticemia. )

Evers obtained very good results from placing the calves in a transportable
box in which they are retained for 4 to 5 days, and meanwhile are fed with milk
freshly obtained from their mothers. Inasmuch as the box is thoroughly cleaned and
disinfected before its use, infection of the newborn may be prevented, and should it
oceur the dissemination of the infection is limited.

Immunization. Jensen treated a horse partly with dead
and partly with living cultures of the colon bacillus and pre-
pared a serum which had a decided bactericidal action in experi-
ments on guinea pigs. It protected the animals against an
otherwise fatal artificial infection, but proved only effective
against the particular strain of the colon bacillus with which
the horse had been tyeated, while against other strains it
afforded only slight protection or none whatever. As the appli-
cation of the monovalent serum proved unsatisfactory in prac-
tice he produced a polyvalent serum by using colon strains of
different origins with which far better results were obtained.
White scours also being caused sometimes by paracolon bacilli
it was necessary to produce also a paracolon serum which in
suitable cases exerted a protective action.

In the preparation of polyvalent colon serums carefully selected strains of the
colon bacillus are separately cultivated in bouillon at 37°C., then the cultures are
mixed in measured quantities and the mixture is injected intravenously into horses
in quantities of 0.25 to 0.50 ec., and after each 12 to 14 days in increased doses up
to 10 and 20 ec. If after a certain time the serum of the horse produces precipita-
tion in a bouillon culture of a certain colon strain in the dilution of 1 to 500 to
2000 it is probable that the protective serum may be utilized with satisfactory re-
sults against infections with that particular strain.

Bongert and Raebiger recommend goats and sheep for the serum production.
At the present time, however, only large animals are used for the production of
serum,

The preparation of the paracolon serum is more difficult, as the paracolon
bacilli possess higher virulence, so that an injection of even 0.1 to 0.25 ec. of a
bouillon culture may cause a serious infection.

As a colon serum is effective only against colon bacillosis (the
action is principally bacteriolytic), favorable results can be expected
only in those cases in which the disease is caused by colon bacilli. The
results obtained in practice are not always uniform in this respect;
thus Jensen succeeded in reducing the number of cases and the
mortality to 0% in numerous premises where the disease had prevailed
in an enzootic and malignant form, causing sometimes a loss of 100%.
These results were obtained without the inauguration of any other
protective measures, and all the control animals died. In other
premises the mortality was only reduced from 70 to 20%, or the serum
treatment had no apparent effect on the disease.

The results in practice have since revealed the favorable action of the serum
treatment (Raebiger, Jansson, Heurgren, Schupp, Piethrisen, etc.). The colon
serum is injected subcutaneously into the newborn calves as soon as possible after
birth in 20 ce. doses. If the animals do not show an improvement the paracolon
serum may then be used.

Raebiger observed only one death among 62 injected calves; in addition he also
reports 278 inoculations in previously infected premises in which none of the new-
born calves have become affected since this protective measure has been adopted.
Active Immunization in Advanced Pregnaney. 157
4

Active Immunization in Advanced Pregnancy. Based on the
experimental observations that protective bodies formed in the maternal
organism are transmitted by way of the foetal circulation to the foetus,
and that these protective bodies will convey a specific protection against
a later infection to the offspring, Sande aimed to immunize calves
before their birth, He repeatedly injected pregnant cows sub-
cutaneously with sterile extracts obtained from white scours bacilli
(shake-extract from colon bacilli cultures?), and the calves of cows
treated in this manner are said to have withstood the natural infection
in infected premises.

Sande reports the inoculation of 215 cows with good results in that 91.6% ot
the calves were protected from white scours. Six per cent became affected with the
disease and died, and 2.3% had diarrhea which, however, disappeared soon after the
‘administration of the serum treatment. ‘Favorable results are also reported by
Fehrmann in 22 cows (only 2 calves of cows which had not been vaccinated became
affected), by Grajewski in 8 and by Kronacher in 16 cows (only 3 control calves
became affected). Schmitt found, however, that the vaccines for mother animals
which are marketed bear no relation to the bacteria of the colon and paratyphoid
group nor to the ovoid bipolar bacilli, and claims that this form of vaccination has
not proven the efficiency of the treatment.

The vaccination of the cows is carried out by injecting under the skin of the
neck 10 ec. of extract 6 weeks before parturition, and ten days later 20 ec. The
animals stand the inoculation without any disturbance in their health. However,
cows should not be vaccinated in the last month of pregnancy as they may abort or
become fatally affected. It is dangerous also to employ fully virulent cultures.

Literature. Obich, W. f. Tk., 1865, 101.—Roloff, Trzt., 1876, 83—Franck,
D. Z. f. Tm., 1877, 376.—Hess, Landw. Jahrb. d. Schweiz, 1897.—Poels, B. t. W.,
1901, 290.—Willerding, A. f. Tk., 1899, XXV, 93 (Lit.).—Joest, Z. f. Tm. 1903,
VII, 377.—Jensen, Monh. 1892, IV, 97; Hb. f. p. M. 1908, III, 761; Z. f. Tm.
1905, IX, 321 (Lit. on Etiology and Vaccination).—Bugge Kialberrukr u. ihre
Behdlg., 195.—Schmitt, D. t. W., 1908, 673; Z. f. Infkrkh., 1909, V, 435; 1910, VII,
71.—Sande, B. t. W., 1909, 261.—Titze & Weichel, Arb. d. G.-A., 1910, XXXTIT,
516 (Lit.).—Krautstrunk, Z. f£. Infkrkh., 1910, VII, 256.

Other Colonbacilloses in Cattle. Thomassen (1897) described a
new septicemia in calves which causes in Holland every spring great
losses. The animals become affected at the age of from 4 to 5 weeks
and manifest fever of 40-41°C., great debility, depressed appetite, in
some calves a severe dry cough, normal action of the bowels and, only
in very exceptional cases, diarrhea. The urine contains great quantities
of albumen and a small amount of blood pigment as well as casts.
In some severe forms epileptic convulsions, opisthotonus and trismus
may be observed. The disease usually terminates in death in 5 to 6
days. The autopsy reveals small hemorrhages in the endocardium,
on the peritoneum, the mucous membrane of the abomasum and
bladder. Acute hemorrhagic swelling of the mediastinal glands, marked
acute swelling of the spleen and acute nephritis.

Bacilli resembling the bac. coli communis, but more so the bacillus
typhi hominis were isolated from the blood, from the fluid of the
abdominal cavity, from the liver, kidneys and urine. Bouillon cultures
of these organisms when inoculated subcutaneously into calves in
quantities of 1 to 2 ec., or when fed in larger quantities, caused an
attack of the original disease fatal in 3 to 7 days. The cultures were
also pathogenic for rabbits, guinea pigs and mice. Good results were
obtained in treatment of some of the cases from a mixture of carbolic
acid (1 part), alcohol (30 parts), milk of lime (800 parts), and oil
menthae (3 parts). (A. P., 1907, XLVI, 542.) ;

Mohler and Buckley (1902) observed in America among cows
158 Pyo-Septicemia of Sucklings

a similar and probably etiologically identical disease. In the acute
eases the clinical manifestations as well as the anatomical changes
were very similar, while in 1 cow which died only after 26 days,
necrotic foci were found in the liver substance in addition to hemor-
rhages of the serous membranes. As the cause of the disease an
organism of the paracolon type was demonstrated which possessed
pathogenic properties also for pigeons, sheep and dogs. (Bureau Anim,
Industry, 1902, XIX, 297 [Lit.].)

(b) Pyo-Septicemia of Sucklings. Pyo-septicaemia neonatorum

(Pyemic and septic joint disease of sucklings, Joint evil, Navel
ill; Omphalophlebitis septica, Pasteurellosis neonatorum)

Pyo-septicemia of sucklings is an acute contagious, infec-
tious disease of newborn animals occurring in the first days
of life and not later than in the first four weeks. It is charac-
terized by purulent inflammation of the joints and general
pyemic manifestations. It develops as a result of umbilical
infection, exceptionally as a result of an intrauterine infection
of the foetus.

History. In former times all affections of newborn animals were
combined under the term navel ill (joint-evil) in the course of which
lameness and disturbance in walking was present. Fuerstenberg (1864)
recognized the fatty degeneration of muscle in young animals as an
independent disease, and Roloff (1864) indicated that rachitis may
also manifest symptoms resembling those of the pyo-septicemia. Later
the enzootical acute gastritis and white scours of sucklings was sep-
arated from this group of infection, which left only the cases in which
the suppurating processes occurring on different parts of the body
are characteristic. Bollinger (1873 and 1875) proved that one part
of these cases, especially the so-called ‘‘navel ills’’ and ‘‘joint evils,’’
are a pyemia resulting from septic umbilical infection, more rarely a
septicemia, and that the infection of the umbilicus occurs immediately
or very-soon after birth. This conception may well be made to agree
with the possibility of a uterine infection in spite of Bollinger’s ex-
clusive view point, and recently Tatray, Pfeiffer and especially Sohnle
confirmed the possibility of this method of infection.

The etiology of the disease has recently been more extensively
studied in calves by Gmelin, Hess, Lesage & Delmer, in colts by Casper,
Sohnle and Ostertag.

Occurrence. The disease occurs principally in sucking colts
and sucking calves, less frequently in sucklings of other species.
In some of the breeding districts it attains not infrequently an
enzootic character. The best opportunity for the spreading of
the disease is present in the studs or dairies where all of the
newhorn animals may become affected, and as a result the
breeding industry is endangered to a great extent.

Up to the year 1887 the disease caused an annual loss of at least 15% in the
stud of Mezshegyes (Hungary); since that time disinfection has been carried out
Oceurrence. Etiology. 159

systematically, and recently the disease has not occurred. In Salzburg out of 336
colts 172 became affected in the year 1884, of which 152 (92.4%) died. In the
year 1885, 98, in 1886, 120 succumbed to the disease.

Etiology. The etiology of pyo-septicemia has up to the
present time been only elucidated to the extent that the investi-
gations showed as the causative factor of the disease on one
side a variety of the bacillus (bipolaris) septicus (Pasteurella;
see page 79), on the other a virulent colon bacillus.

The bacillus bipolaris septicus isolated from the body of affected
animals is pathogenic for rabbits, guinea pigs, mice, and in larger
quantities also for pigeons. Injections of 8 to 5 ee. of fresh virulent
bouillon culture into the umbilicus of a 4 to 5-day old calf causes an
inflammation of the umbilicus and softening and thrombi of the um-
bilical vessels, resulting in a serofibrinous inflammation of the joints
(Gmelin). Intravenous injections of 3 cc. of culture into a 1-day old
ealf causes a slight rise in temperature; on the following day the
animal is debilitated and at the same time the temperature drops
below normal (34.6°). The animal passes white, foamy, later bloody,
fluid, fetid feces with much straining, and succumbs after 30 hours
to complete exhaustion. The autopsy reveals manifestations of hemor-
rhagic septicemia, and also extensive inflammation of the large in-
testines. The blood and the exudate of the serous cavities contain
the bipolar bacillus in pure cultures. On the other hand, the mesenteric
glands and the liver contain shortly after death foreign bacteria,
principally colon and paracolon bacilli in great quantities. Animals
recovering from the disease react after 4 weeks to an intravenous in-
jection of 10 ce. of culture only with a rise in temperature which
lasts for one day (Nocard).

Bacteria of the bacillus coli communis type (see page 146) were
isolated by Zschokke and Wilhelmi from the joints of calves dead
from the disease either in pure culture or mixed with some other
bacteria. Wilhelmi produced in 8 cases in young calves, by intravenous
injections of pure cultures, a sero-fibrinous inflammation of the joints,
acute endocarditis and diarrhea, whereupon the animals died within
a short time or after longer ailing. In one ease Zschokke produced only
a passing arthritis. Poels and Joest also produced fatal infection
in calves by injecting colon bacilli into the umbilical vessels. The
disease, however, corresponded with the white diarrhea of calves, and
inflammation of the joints was absent.

The results of the investigations accordingly appear to indi-
eate that the disease following the umbilical infection develops
as a result of infection with various micro-organisms. The
organisms which are implicated are on the one hand the bipolar
bacillus of hemorrhagic septicemia, and on the other hand a
strong virulent variety of the colon bacillus. According to
Lesage & Delmer the colon bacillus prepares the field for the
pathogenic action of the bipolar bacillus, as the injection of
both bacteria under the skin of a calf produces the disease, while
the bipolar bacillus alone causes only a local inflammation (in
the first case the colon bacillus remains at the point of inocula-
tion, while the bipolar bacillus passes into the blood).
160 Pyo-Septicemia of Sucklings.

Relative to affections of sucklings of other species of animals there
is a possibility that the diseases which clinically and pathologic-
anatomically are practically identical in various species of animals,
bear a very close relationship etiologically. As a matter of fact, how-
ever, the investigators of pyo-septicemia of foals have not proven such
relationship. Casper and Ostertag obtained from all organs of affected
colts, sometimes only from the heart blood or from the joints and
bone marrow, the streptococcus pyogenes, while Sohnle obtained from
the blocd and the joints of colts, as well as from the uterus of mares a
highly virulent variety of the staphylococcus pyogenes aureus. Whether
these bacteria are the original causative factors of the disease or
whether they play only a secondary part will have to be established
by further investigation.

The natural infection results mostly through the torn or
not yet closed umbilical vessels immediately after birth, excep-
tionally also during birth. The stump of the loose, juicy
umbilical cord which is no longer nourished, as well as the blood
present on the torn end of the cord, present a suitable medium
for the propagation of the micro-organisms, until drying of the
stump has taken place. Bacteria which reach the surface of
the stump find favorable development in the thrombi inside of
the vessels. Then they penetrate along the thrombus, pass the
navel ring and finally spread even in the abdominal portion
of the umbilical vessels.

The extra uterine infection which causes the disease in the
majority of cases occurs through the soiling of the umbilical
stump with the contaminated straw immediately after birth,
as well as by coming in contact with the stable floor containing
pathogenic bacteria or else with the infected hands of the
attendants. The sucklings which have first become infected
in the course of the disease contaminate the straw and the stable
floor with their excrements, especially however with the puru-
lent exudate of the umbilicus. In this way the infection accum-
ulates in the stable, and as a result of this the animals which
are born later are more exposed to the infection. In this way
the disease which was at first sporadic may later occur with
greater frequency, so that after a certain time almost all the
newborn animals become victims of the disease.

The cases in which the animals are affected at the time of
birth, or in which autopsy reveals extensive and progressive
changes which could hardly have developed since the time of
birth, can be accepted as due to intra-uterine infection. This
is transmitted by the placental circulation in such a way that
the bacteria which are present in the blood of the mother enter
through the placenta into the blood circulation of the foetus,
where they then multiply. For the intra-uterine infection to
occur it is of course necessary that the mother suffer from
an infectious disease as a result of which pathogenic bacteria
circulate periodically in the blood. This form of infection has
been observed during the course of outbreaks of influenza, when
Anatomical Changes. Pathogenesis. 161

the foals of affected mares are infected at the time of birth
(Tatray, Sohnle).

The possibility that the infection may also occur from the
external genital organs cannot be excluded. The contagion
which may enter the mucous membrane of the uterus might
localize there and later enter the vascular system of the devel-
oping placenta, and in this manner also the body of the foetus.
In this way it may be explained that some animals give birth
for several consecutive years, to affected offspring, a condition
not infrequently observed, especially in thoroughbred mares.
In case of an intrauterine infection the infective agent remains
lodged only in the finer blood vessels of the internal organs
and causes at these places alone inflammatory processes, while
the umbilical vessels remain intact (Peiffer found only 37% of
affected foals with umbilical vessels diseased).

The infection probably does not occur through the digestive
and air passages; at least up to the present time the disease
could not be produced artificially in this way in calves (Nocard).

The greater or lesser frequency with which the disease
occurs can in various localities be referred to existing local con--
ditions. The fact that the disease is only rarely observed among
common bred stock which is kept out of doors most of the time,

-as well as in stables with only few animals can be readily
explained by the fact that under such conditions the animals
are not confined in close quarters and therefore there is less
chance for infection.

Since the infective agents, the bipolar bacterium, as well
as the colon bacillus, can propogate in the soil, the disease may
appear without introduction from outside, as a result of direct
infection from the soil; nevertheless it is most frequently the
result of an introduction from adjoining farms, while if the
disease has already been introduced in certain premises it is
propagated by the secretions and excrements from the infected
animals. :

Formerly breeders attributed great importance to heredity
in the appearance of pyosepticemia. However except for the
eases of intrauterine infection, in which the infection of the
foetus is directly associated with the infection of the mother,
the disease occurs only when the conditions for the infection
of the sucklings are favorable.

Pathogenesis. The bacilli which enter the umbilical veins
commence to multiply in the coagulated blood of these vessels,
on the one hand cause the thrombus to break down, and on the
other hand produce an inflammation of the intima and probably
also of the external layer of the walls of the vessels. The
breaking down of the thrombus progresses gradually inward
until it reaches the end, when the infection may come in contact
with the liquid blood contained in the same vessel, or in the
portal vein, coming in direct contact with the circulating blood.

ia
162 Pyo-Septicemia of Sucklings.

Small particles of the softened thrombus may be carried off.
by the circulating blood, and with these the bacteria may enter
the free blood circulation. They are taken either into the liver
or with the blood of the vena cava into the general circulation.

The micro-organisms which enter the umbilical vein from
without do. not necessarily remain confined in the immediate '
surroundings of the umbilical ring. While the circulation
ceases after birth in this blood vessel, the passing blood stream
of the portal vein or of the ductus Arantii, as well as the-
respiratory movements, produce a suction on the fluid which
is present in the umbilical vein, by which the blood serum
separates from the blood coagulum, is diverted toward the’
portal vessel, carrying with it the micro-organisms which may
be contained therein. They may remain attached to any part
of the intima of the umbilical vein, where they produce a local
inflammation as a result of which’ deposits of blood coagulum'
occur, or a softening of the thrombus which is already present..
The bacilli may even penetrate the portal vein without stopping,
whence the blood conveys them into the heart. In the first’
case that section of the umbilical vein which is nearest to
the umbilical ring remains healthy; in the other case the entire
umbilical vein will be intact although the infection has passed
through it.

In ruminants the infective agent enters with the blood
either through the ductus Arantii or through the ramification
of the portal and hepatic veins into the vena cava, and
thence into the general circulation. In foals all septic material
enters through the latter channels. In these animals, however,
breaking down of the blood coagulum is also frequently
observed in the umbilical arteries (Gmelin), as a result of which
the infective agent may pass into the posterior part of the
abdominal aorta; and with the blood of these vessels into the
peripheral arterial ramifications of the posterior extremities.

Certain organs appear to have a special predisposition for _
attacks by the micro-organisms circulating in the blood. Of:
these the Iungs and the liver should be mentioned first, and in
addition metastatic inflammations develop frequently. on the
synovial membranes of certain joints.

In acute cases of the disease the flooding of the blood with
pathogenic bacteria, as well as the inflammatory processes which
develop at different parts of the body, cause the death of the
animal. In some cases, however, the acute affection is suddenly
checked, and the disease process appears to turn towards.
recovery. After several weeks, or in one to two months, how-
ever, manifestations of the chronic affection, especially of the
lungs, make their appearance. These manifestations may be
associated with the pre-existing infection. According to Nocard*
bacteria of hemorrhagic septicemia may disappear after a time ©
from the blood; the toxins, however, have in the meantime
exerted a paralytic action on the cells by which the resistance of’
Pathogenesis. Anatomical Changes. 163

the animal has been reduced to such. an extent that other, bac-
teria, especially the Preisz-Nocard bacillus of. pseudo-tubercu-
losis (see that disease), may attack the tissues of the body and.
produce an inflammation of the lung tissue.

In these cases which have become chronic, catarrhal pneumonia
leading. to caseation and suppuration can usually. be discovered.
Bacilli of pseudo-tuberculosis may be demonstrated in the affected
tissucs in association with other bacteria (pus cocci, bacillus necrophorus,
streptothrix, colon and paracolon bacilli). Their occasional pathogenic
action has been proven by Nocard by the following experiment: A.
calf three weeks old was injected intra-peritoneally with 100 cc. of
culture of the bipolar bacillus, which had previously been heated for
one hour to 60°C., and after six hours it was made to inhale a bouillon.
culture of the bacillus of pseudo-tuberculosis for five minutes. The
autopsy which. was performed eight days later, revealed numerous
eatarrhal-pneumonic areas in the lungs. In a second calf, which was
not given the injection of the killed culture of the bipolar bacilli, the ©
inhalation of the pseudo-tubercle bacilli caused no changes in the lungs.

According to Moussu broncho-pneumonia may develop in sucking
calves also, from the aspiration of the amniotic fluid into the air passages .
during difficult births. The infection occurs in these cases while. the .
head is lodged in the vagina, and with the commencing respiratory
movements the aspiration of the fluid takes. place.

‘Anatomical Changes. In some of the acute cases the um-.
bilicus is swollen. and dense. The borders of the umbilical .
opening of the ring which has not closed are infiltrated; some-
times they are ulcerated, anda purulent ichorous secretion may
be pressed out.of the same. An incision frequently reveals an
abscess lying in the abdominal wall.

' The umbilical vein in. colts, also one, or both umbilical
arteries (Gmelin), are greatly thickened and of.a firm or fluctu-
ating consistence in their entire length, or only in parts. In.
different places the lumen is filled with blood coagulum, which
in various parts or along its entire length appears of a dirty
red. color, and sometimes liquefied to a thick fetid mass. The.
surface of the intima is covered with fibrinous shreds or, with:
puriform softened masses under which there may be ulcerations..,
Thé.other layers of the wall of the vessel, as well as the sur-
rounding connective tissue, are sometimes only infiltrated with
the, serous fluid, in other cases again with fibrinous purulent
exudate. In case the inflammation has extended to the adjacent
peritonenm the abdominal organs lying close to the affected
areas usually show adhesions by fibrinous pseudo-membranes
(intestines, omentum, liver, in colts also the bladder). All these
changes may be present without an affection of the umbilicus.
In the branches of the portal vein, inside of the liver tissue,
similar thrombi may occur, while on the other hand, the throm-
-bus of the vein may occasionally extend into the ductus Arantii,.
and may even penetrate with its blunt end. into the lumen of
the vena cava. The thrombi of the umbilical arteries may reach,
164 Pyo-Septicemia of Sucklings.

the aorta. The internal organs present indications of an acute
blood infection, the lungs sometimes showing areas of broncho-
pneumonia.

Metastatic abscesses occur with relative frequency in the
lungs, where they are always associated with a bronchial
catarrh, and sometimes also with a fibrinous or purulent pleu-
risy. They may also occur in the liver in the peribronchial,
mediastinal and mesenteric lymph glands, in the brain, in the
kidneys, etc. Exudative inflammations of the peritoneum, peri-
cardium, and of the meninges of the brain, are also frequently
associated with the disease. Not infrequently ophthalmitis,
with an accumulation of fibrinous and purulent exudate in the
anterior chamber of the eye, is present, sometimes also a lique-
faction of the crystalline lens.

Purulent inflammation is found in the majority of cases in
the joints of the extremities, most frequently in the hock and
knee joints. The more or less swollen joints contain a yellow
or reddish semi-liquid, pus-like synovia. The synovial sack
appears greatly swollen, bright red and in places ulcerated; the
surface of the cartilage is uneven, its tissues softened, some-
times covered with a fibrinous or purulent exudate, which occa-
sionally may be traced even into the spongy substance of the
bone and into the bone marrow. The pariarticular connective
tissue is saturated with serous fluid or with a sero-fibrinous or
sero-purulent exudate and in these cases abscesses may also
be found, as well as fistulous tracts communicating with the
cavity of the joint. The surrounding tissue is always edema-
tously infiltrated and the muscles frequently show a fatty degen-
eration. The tendon-sheaths may contain a sero-fibrinous or
purulent exudate, the tissue of the tendons in such cases show-
ing serous infiltration and loosening. Purely metastatic ab-
scesses may be present in the subcutaneous as well as in the
intra-muscular connective tissue, also in the muscles proper.

In the peracute cases the changes are less conspicuous, and
usually point to general septic infection. The lesions consist
of a cloudy swelling of the parenchymatous organs, acute
catarrh of the mucous membranes, hyperemia of the spleen,
small hemorrhages in the tissue of the serous and mucous mem-
branes, sometimes in the small intestines an ulceration of the
Peyer’s patches, marked acute swelling of the lymph glands, ete.

In chronic cases (in calves) when the disease has not pro-
gressed to an advanced stage, the lungs show signs of broncho-
pneumonia, and there exist frequently fibrinous or sero-fibrinous
pleurisy and pericarditis. In later stages the broncho-pneu-
monic areas show small yellow caseous foci, and still later the
lungs contain large firm nodules, which inclose small cavities
containing a white or greenish caseous substance. The medias-
tinal and peribronchial lymph glands are enlarged and some-
times partially caseated.
Anatomical Changes. Symptoms. 165

The carcasses of animals dead from the disease are always
greatly emaciated, and show manifestations of a general anemia
and cachexia.

Symptoms. The symptoms usually appear inside of 24 to
48 hours after birth; exceptionally the disease may also occur
somewhat later, and in rare cases the animals may be som
affected. with it.

In some of the cases symptoms of a local affection of the
umbilicus precede the general affection. The umbilicus swells,
becomes sensitive and feels warmer than normal to the touch.
The stump dries more slowly, while from the opening of the
umbilical ring purulent or ichorous secretion may be pressed
out. In the median line between the swollen umbilicus and the
xyphoid cartilage, on the inner surface of the abdominal wall,
a dense cord of the thickness of a finger may be felt. The
affected animal moves but little, its gait is laborious and stiff,
the desire for sucking is diminished, the body temperature is
somewhat elevated.

The symptoms of inflammation of the umbilicus may sub-
side after a few days, especially when appropriately treated,
and the patient may even completely recover. In the majority
of cases, however, the local. inflammatory processes increase
in severity, and symptoms of a general septic infection develop.
sometimes rapidly, in other cases gradually. In rare cases the
disease may develop without any preliminary inflammation
of the umbilicus, with symptoms of a general infection.

The general affection is indicated by symptoms of a general
febrile condition. The animals lose their desire to suck, they
will not look for the udder of their mother on their own accord,
and if led to it they suck only a little or not at all. At the same
time they are depressed and dull, and lie continually on the
ground. When stood up on their feet they remain with droop-
ing head in one place, or soon collapse. The body temperature
is elevated and unevenly distributed over the body surface.
The pulse:and respiration are accelerated. This condition is
soon followed by symptoms indicating a metastatic inflamma-
tion in some of the internal organs.

Inflammations of the joints make their appearance most
frequently and earliest. One or more joints, preferably at the
extremities (hock and knee joints), swell simultaneously, or one
after the other, they become warm, painful, and tense, while
the surrounding connective tissue is edematous. In some cases
the swelling soon disappears; more frequently, however, a fluc-
tuation may after a certain time be noticed in different parts
of the swelling. This is followed by a breaking at one or more
points, and from the resulting opening a tenacious purulent
secretion is evacuated, first in great quantities, later more spar-
ingly. By introducing a probe into the opening, a rough carti-
laginous or bony surface may be felt at different places, while
‘166 ‘Pyo-Septicemia of Sucklings.

“with the secretion small tissue shreds or cartilaginous and bone
particles may be discharged. ‘The motility of the affected joints
is interfered with by the pain and by the tense and swollen
condition. The animal does not support the body with the
affected extremity, and protects it from touching the‘floor. If
several joints are affected at the same time, the animal ‘no
longer’ moves around, but lies constantly on the ground.

The affection of the lungs is indicated by a painful cough
‘and rapidly increasing difficulty i in respiration, which is later
associated with a- profuse nasal discharge, as ‘an indication of
a developed purulent bronchitis. Percussion reveals only in
‘circumscribed areas a dull or tympanitic sound; by auscultation,
“however, the most varied catarrhal sounds, such as whistling,
roaring, moist rales, and in parts also bronchial breathing, may
be distinguished. Sometimes friction sounds may also be heard
over some parts of the lungs and the heart, indicating an acute
éxudative inflammation of the corresponding serous membranes.
In stich cases the: patients lie much on the chest with extremi-
ties drawn under the body, or with legs extended.

In the presence of an‘inflammation of the brain and its
membranes, the patients are much depressed and apathetic.
Sometimes chronic spasms may be noticed in some of the mus-
cles’ or groups of muscles, or the animal may struggle’ consid-
erably. With relative frequency, symptoms of meningitis’ may
be present as'the result of the’ extension of the inflammation
to the medulla; still later paralysis may ‘appear in the extremi-
ties, or in the territory of some of the facial nerves.

‘Symptoms showing disturbances of the digestive organs
are hardly ever absent, and in some cases they may even be
‘present at the. onset of the disease. Severe colicky symptoms
may appear when the animals lie in a cramped condition on
the ground with the head turned toward the abdomen; touching
of the abdomen causes considerable pain. The constipation
which is at first present is followed by diarrhea, the animals
‘passing first light, later dark colored, and very fetid, fluid feces.
The feces soil the parts around the anus, and later’ the excre-
ments and urine are passed involuntarily.

In the meantime the animals become greatly emaciated,
they lose ‘their strength, the eyes are sunken deep into the
orbits, the action of the heart becomes accelerated and weak,
‘the body temperature drops below normal, the extremities, ‘the
face and the ears become cold, the body is covered with per-
spiration, and finally the patients die, with symptoms of con-
vulsions or without any struggle. Death may occur before the
progress of the disease through the stages described, from
asphyxiation or paralysis of the brain.

In cases of pure septicemia only high fever and severe
diarrhea, sometimes also hematuria are observed; in such casés
the patients die within a few days as they rapidly lose strength.
Symptoms. Course. 167

In these instances the umbilicus manifests no inflammatory
changes. be
‘Animals which recover from the acute inflammation may
later become affected with a chronic form of the disease. This
form may develop exceptionally even at the onset, with latent
symptoms. The animals fail to take proper nourishment, and
therefore they do not develop well; they gradually become
emaciated, and toward the termination a rise in the body tem-
perature and diarrhea appear. Some of the joints become
swollen, painful, and hinder the patient in its movements

 

(Fig. 34). In the meantime, symptoms of a lung affection are
‘manifested. The animals cough, there is a muco-purulent dis-
charge from the nose, over the lungs numerous rales may be
heard.. Finally the animals die after several weeks, from
exhaustion. -

Course. The very acute septicemic cases result in death
in from two to three days. In some less acute cases the disease
may remain confined to the umbilicus until the termination of
168 Pyo-Septicemia of Sucklings.

the disease, and the opening of the umbilical ring may perma-
nently close after the breaking or opening of the abscess. Such
a favorable termination is principally observed in cases where
the disease appears somewhat later after birth; that is, when the
thrombi of the umbilical vessels are already more solid, the
fluid parts have been absorbed, and the penetration of the micro-
organisms has thereby been rendered more difficult. The in-
flammation of the joints may also improve after a time, but
the recovery is only exceptionally complete, as usually chronic
changes, such as shortening of the ligaments of the joints,
deformities of the cartilaginous surface, ankylosis, etc., will
remain as permanent injuries.

Severe general symptoms, such as a persisting high fever,
severe diarrhea, grave and multiple arthritis, metastasis in the
internal organs, etc., have a very unfavorable prognosis. In
such cases the animals usually die in from two to three weeks
(colts on an average in 26 days) (Gmelin).

The chronic form of the disease usually leads to complete
exhaustion in from two to three months; exceptionally, however,
recovery takes place, when only a thickening of the pleura is
left as a result of the affection.

The percentage of mortalities varies with the different out-
breaks; as a rule, however, it amounts to over 50%, and only
in calves appears ‘somewhat more favorable (according to Hess
it is 40, and according to Strebel 35%).

Diagnosis. The inflammation of the umbilicus can be rec-
ognized easily, and with certainty. An affection of the joints,
or of internal organs, in association with the umbilical affection,
leaves no doubt as to the nature of the disease. In cases where
the urachus remains open, there may be also intense inflamma-
tion and swelling of the umbilicus. However, in such instances
the dripping of the urine is sufficient to reveal the nature of
such an abnormality (Baillet & Sérés observed as a result of a
urachus infection, pyelo-nephritis, with septic symptoms).
Mistakes in diagnosis may only occur in cases when the local
affection of the umbilicus is absent, or present only to such a
very slight degree that it may pass unnoticed. The very young
age of the patient, and the purulent consistency of the exudates
from the joints, differentiate the disease from rachitis, in which
moreover the synovial capsule is not distended but the carti-
laginous diaphyses of the bones are thickened. From trau-
matic inflammations of the joints it is differentiated by the
absence of any traces of traumatism, and by the presence of
symptoms of a general disease. Internal inflammation of the
eye occurs in such an early age, from almost no other cause than
from a pyemic umbilical infection.

White scours of sucklings cannot be separated from the
acute septicemic form of the disease. From the other forms
it is distinguished by the absence of lesions in the lungs and
in the joints. (According to the introductory remarks of this
Diagnosis. Treatment. Prevention. 169

chapter there exists a possibility that both diseases have an
identical etiological basis.)

Treatment. The inflammation of the umbilicus should be
treated according to the rules of surgery, by disinfection of the
wounds, and if necessary by opening of the swellings. The
commencing inflammation of the joints may be treated in colts
by inunctions with gray mercury ointment. However, if the
joint contains a great quantity of exudate, this should be re-
moved by puncturing or incising the joint, and by subsequent
disinfection of the joint cavity. This course is particularly
indicated when the inflammation exists only at one place, and
the internal organs are not affected. If the contents of. the
joint prove to be serous or sero-fibrinous, recovery not infre-
quently takes place in from one to two weeks after a single
puncturing. In the presence of a general infection the treat-
ment can only consist in the systematic internal administration
of stimulants; further in controlling the gastro-intestinal
ceatarrh which may be present. At the same time appropriate
nutrition should be provided for the patient, such as milk, eggs,
wine-soup, or nutritive enemas. The affected animals should
be kept in a moderately warm, clean, and airy place. Gott
recommends for colts intravenous injections of collargol (80 g.
of a 14% solution, for three days successively), while Bernhardt
recommends ichthargan (according to Ziirn it should not be
used in stronger solutions than 1/10 to 1/5%, on account of the
destructive action on the blood corpuscles).

Prevention. The infection of sucklings may be successfully
controlled by scrupulous cleanliness in the stables. For this
purpose disinfection of the stables at intervals of one to two
months is recommended; but even with such precautions it is
advisable to place the highly pregnant animals shortly before
giving birth, in a stable or in a parturition box stall kept only
for such purposes. Such places should be thoroughly disin-
fected before the pregnant animal is installed in them, and at
the same time provision should be made that the newborn
animal may be received on fresh straw or on a clean sheet.
Animals affected with suppurating wounds should be kept away
from the places used for parturition, as well as from the stalls
of the sucking animals. Operations (opening of abscesses)
should not be undertaken in these quarters. Satisfactory ven-
tilation and dry stable air also deserve especial consideration.
These measures should of course be carried out with increased
vigilance when the disease has already appeared, that is, when
the stable or the parturition stand are proved already infected.
Cleaning of the external genital organs of the mother animals,
as well as irrigation of the vagina with a disinfecting fluid,
for instance with 2% lysol or creolin solution, aid also in the
prevention of suckling infection. .

In places where the veterinarian is present, disinfecting
‘170 Pyo-Septicemia of Sucklings.

‘treatment of the umbilical stump is very desirable. This can
also be executed by a competent attendant.

. Technique of the Treatment of the Umbilicus. In this method the umbilicai
-cord is washed with disinfecting fluid, (3% carbolie acid, 1 to 1000 corrosive sub-
limate, 5% creolin solution.) It is then ligated about. three to five em. from the
navel with « previously disinfected string. The ligation should be carried out after
the pulsation ceases. The cord is then severed with scissors below the ligature, and
the eut surface is moistened either with the same fiuid or with a more concentrated
disinfectant, for instance, concentrated carbolie acid, (Gmelin.) On the following
days sponging with one of the above-mentioned fluids, or with Burow’s solution con-
, taining camphor should be repeated until the complete drying of the stump, while
the cut surface may be sprinkled with disinfectant and drying powders. The parch-
ment-like dried stump may be cut off after 4 to 5 days, and the navel wound should
be. treated daily with 1%. corrosive sublimate gelatin until cicatrization is complete.
Nocard washes the stump of calves first with Lugol’s solution, (25 parts iodine, 4
parts iodide of potassium, 1000 parts water,) then with iodine-aleohol, (2 parts
iodine, 1000 methyl-alcohol,) and after the evaporation of the alcohol he seals the
,Stump. and the navel with a thick layer of a 1% iodine collodion, Reindl recom-
mends for washing the umbilicus tincture of iodine containing carbolic acid; for
further treatment, linseed oil containing 5% carbolic acid. Wilhelmi cleans tne
navel and the umbilical stump with a 1% lysol of creolin solution, whereupon he
opens the sheath of the umbilical cord, paints it outside and in with a liniment con-
sisting of iodine, tannin, and glycerine, and then knots the lower end with two
fingers. In. places where the owner is poor, repeated painting of the navel region
with wood tar dissolved in oil and turpentine, gives good service.
; _The disinfection of the umbilicus, if earried out with sufficient thoroughness
and cleanliness, gives very good results, and in this manner the disease has been
checked among colts and calves, (Gmelin, Nocard, and others.) In some cases, how-
ever, an aggravation of the condition has been okserved to follow, probably tecaure
.the persons in charge of the treatment have directly infected the umbilical cord
with their contaminated hands and instruments.

.. _ Immunization. As in some of the cases, the causative agent proved

to be the colon bacillus, and owing to the close relation between pyo-
septicemia, and white scours of the newly-borns, the immune serum
of animals treated with colon bacilli may be also recommended for
this disease (see page 156). Considering that. the bipolar bacilli have
also an etiological part in this disease, the use of the serum which
serves against this bacterium appears to have at least an experimental
foundation.

Literature. Fliirstenberg, V. A., 1864, XXIX, 152.—Roloff, Ibid, 1866,
XXXVIi, 434.—Bollinger, Ibid., 1873, LVITI, 329; D. Z. f. Tm., 1875, I, 50.—
Pfeiffer, A. f. Tk., 1891, XVII, 81—Gmelin, Monh., 1891, II, 196 (Lit.) ; 1897, VIIT,
259.—Hess, Landw, Jahrb. d. Schweiz, 1897.—Casper, D. t. W., 1897, 159.—Sohnle,
Monh., 1901, XII, 337.—Ostertag, Ibid., 8. 385.—Krautstrunk, Z. f. Infkr., 1910, VII,
256. :

7. Influenza of Horses. Influenza equorum.

(Equine influenza, Pink eye, Typhoid fever, Stable pneumonia,
Influenza catarrhalis s. eryswpelatosa et pectoralis,
Pleuro-pneumonia contagiosa equorum; Grippe,
Fiévre typhoide, Pneumonie infectieuse, Pas-
teurellose du cheval [French]; Febbre
tifosa [Italian]; Pferdestaupe,

Rotlaufseuche, Brustseuche
[German].)

Influenza is an acute febrile, contagious infectious disease
of horses, which occurs frequently in stables in an enzootic
form. It is characterized either by acute catarrh of the mucous
History. 171

‘membranes or by severe inflammation of the lungs and pleura.
Accordingly two forms of the disease may be. distinguished,
namely: the catarrhal influenza, and the pectoral influenza.

_.. History. The term ‘‘influenza,”’ taken from the Italian nomencla-
,ture of human medicine (in Italian identical with ‘‘contagio’’=infec-
tion), has been used since the beginning of the last century for all
acute febrile affections of horses which spread rapidly and have a
.pronounced miasmatic, or miasmatic-contagious character. Even in
the middle of the century various diseases have been collected under
this term, and among others the petechial fever has also been con-
_Sidered in this group. Later Falke (1862) applied the term ‘‘Infiuenza”’
only to the febrile catarrhal affections of the mucous membranes, while
to the cases in which the inflammation extended to the internal organs,
especially to the respiratory apparatus, he applied the name of
‘“Typhus.’’ _ At the same time he considered the two forms to be
different in their etiological nature.

Similar to this was the conception of Dieckerhoff, only that he
“designated the first form as ‘‘horse distemper,’’ and the latter as
‘‘eontagious pleuro-pneumonia.’’ At the same time he separated from
these, as independent affections, the ‘‘Skalma’’ under which he col-
lected those cases in which a moderate fever,'a diffuse infectious
bronchitis, with a subacute course, without an affection of the con-
junctiva, or edematous infiltration of the subcutaneous connective tis-
.Sues, were the characteristic indications. Further, he also considered
‘‘infectious ‘laryngitis,’ ‘‘infectious pharyngitis,’ and ‘‘endemic
cough’’ as independent diseases. Other authors have not recognized
_these four different fornis of’ disease, otherwise, howéver, the majority
of German authors, as well as many French writers, have accepted the
classification of Falke and Dieckerhoff. : —

_ As a matter of fact, even at the present time there are no experi-
mental’ proofs which would convincingly establish either the identity,
or the difference of the two diseases. Purely practical experiences,
-however, speak rather for their close relationship. It has frequently
‘been observed in outbreaks ‘in large stables, that while some of the
animals become affected with catarrhal manifestations, often with
‘serous inflammation of the tendons, in others again, severe symptoms
of pleuro-pneumonia develop, the, characteristic affection of the eyes
being frequently present in both forms of the disease. As a result
of these observations the relation of these forms appears evident,
particularly as the etiological studies of their nature, by which the
possible difference of the two forms of the disease could be established,
have not-yet been completed. In spite of the marked differences of
‘these two forms, in which, however, transitory forms are frequently
observed, it’ appears advisable to follow the view of Siedamgrotzsky, and
treat the disease as two different manifestations of the same affection ;
namely, catarrhal influenza and pectoral influenza.

Influenza has been known from earliest times under various names
_(Febris nervosa, F. maligna, Typhus, etc.), and its infectious nature
‘has been recognized since the second half of last, century. Schiitz
(1887) undertook extensive bacteriological experiments to. establish the
‘nature of the disease, and indicated a diplococcus as the causative
‘factor of the disease. Hell, Foth and more recently Ligniéres, however,
proved that this bacterium is really a streptococcus, and is at least
closely related to the streptococcus of strangles. On the other hand,
172 Influenza of Horses.

Babes, Starcovici & Calinescu (1889), as well as Galtier & Violet (1890),
demonstrated in the tissue of affected lungs bipolar staining bacteria,
besides the diplococcus of Schiitz. They suggested the etiological
relation of this organism; Ligniéres (1897 to 1900) established its
identity with the causative organism of hemorrhagic septicemia, and
expressed his view that influenza is caused by these bacteria, while
the diplococcus of Schiitz plays an insignificant part in the etiology
of the pathological processes. Exception may also be taken to this
view, the same as against those of Schtitz, and it may especially be
mentioned that with neither of these two bacteria may a typical pneu-
monia be produced, as well as that the bipolar bacilli probably exert their
pathogenic action only secondarily in the affected animal; therefore the
question of the true cause of influenza, or of its two forms, must be
considered at the present time as unsolved.

Occurrence. The disease occurs everywhere either sporad-
ically, or in a pronounced enzootic form, and in the latter case
it spreads rapidly among the horses of large territories. With
the greatly varying character of the disease it sometimes causes
only slight losses, while at other times a considerable percentage
of the affected animals succumb to the disease, principally as
a result of pleuro-pneumonia which develops in its course.
Owing to the latter condition the disease is of great economic
importance, but the owners also sustain considerable loss
in the milder outbreaks as a result of the incapacity of the
horses for work.

Large outbreaks oecurred in Europe during the last century in the years of
1813-1815, 1825-1827, 1836, 1846, 1851, 1853, 1863, 1870-1873 (in connection with
the German Freneh war), and finally in the years of 1881-1883, at which time the
disease spread over almost the entire continent. In 1872-1873, the disease occurred
extensively in America; starting in the eastern parts it extended all over the
United States. It was introduced in South Africa by the English troops in 1899.

In 1908 the reports from the German Empire show in Prussia 622 deaths from
the disease; in Bavaria and Saxony 55 and 210 eases resp., were affected with the
pleuro-pneumonic form, while 12 and 48 cases respectively were affected with the
catarrhal form. In Wiirttemberg 88 cases with 12 deaths resulted from the disease.
However, there numbers are not considered as complete. .

Among the horses of the Prussian army, in the years between 1899 and 1908,
861, 4,325, 1,066, 594, 2,223, 1,367, 487, 1,811, 8,058, and 1,010 horses, were
affected with the catarrhal form, while the pleuro-pneumonic form occurred in 2,301,
1,608, 1,078, 1,937, 1,263, 1,675, 3,877, 7,581, 3,502, and 2,750 horses, respectively.

Etiology. The true primary cause of the disease has, up
to the present time, not been established. Bacteriological ex-
aminations prove only the fact that in the pectoral form (con-
tagious pleuro-pneumonia) two bacteria are principally pres-
ent, the streptococcus, pyogenes equi, and the bacillus equi-

septicus.

I. The streptococcus pyogenus equi, which has been de-
scribed by Schiitz as the cause of contagious pleuro-pneumonia,
under the name of diplococcus pneumoniae, is in its principal
character identical with the streptococcus of strangles, or at
least is closely related to the same. In the affected tissues
it is present in the form of mono and diplococci; in the exudates
in somewhat longer chains. It stains readily with aqueous
Etiology. 173

aniline dyes as well as by Gram’s method. On artificial media,
it grows in the same way as the streptococcus of strangles
(see that disease).

Pathogenicity. Cultures kill mice in two to three days,
while rabbits are less susceptible, guinea pigs show a con-
siderable resistance against the infection. In the experiments
of Schiitz 4 cc. of a bouillon culture injected in various parts
of the lungs of a horse produced a gangrenous pneumonia and
a sero-fibrinous pleurisy which extended from the point of
inoculation. On autopsy great numbers of cocci identical with
those inoculated were found in the gangrenous areas and in
the tissues surrounding them, as well as in the pleural exudate.
They were present in smaller numbers in the spleen and in
the kidneys: The inhalation of a sprayed culture produced
in the horse a circumscribed, chronic inflammation in one lobe
of the lungs.

According to Ligniéres the streptococcus in question is identical with the diplo-
eoccus of contagious pneumonia of Schiitz, with the streptococcus of Delamotte &
Chantemesse, as well as with the streptococcus of Violet & Galtier, and is closely
related to the streptococcus of-strangles.

II. The bacillus (bipolaris) equisepticus (Pasteurella equi),
which is considered by Ligniéres and even before him by Babes,
as the true cause of the disease, represents a variety of the
_ bacillus bipolaris septicus of the hemorrhagic septicemia. In
regard to its staining and culture characteristics it is identical
with the other varieties of this bacillus (see page 79).

Pathogenicity. Cultures obtained from the affected body
of a horse produced a severe pathogenic action on rabbits and
guinea pigs. The former succumbed to an intravenous in-
fection in 18 to 24 hours, while the latter died in the same
length: of time from an intraperitoneal infection. Carnivorous
animals and sheep also die of septicemia following an intra-
venous injection. Subcutaneous injection of 0.25 ee. of culture
produces in the horse fever and a local inflammatory edema
which later changes to suppuration. Sometimes however such
an infection causes the death of the animal inside of four days.
The abdominal exudate of guinea pigs which die as the result
of an intraperitoneal infection acts much more severely. One-
quarter to one-fifth ec. of such exudate, when injected sub-
cutaneously into a horse may cause the death of the animal
in 24 to 48 hours, while 1 to 2 ce. injected intravenously kills
the animal in a few hours. In such cases the horse manifests
high fever, great debility, accelerated and small pulse, throbbing
heart action, muscular trembling, diarrhea, injection of the
conjunctiva, and lachrymation. Less severe infection produces
an edematous swelling of the extremities, and in some of the
joints a sero-fibrinous inflammation. Subcutaneous injections
of culture are sometimes followed by sero-fibrinous pleurisy,
174 Influenza of Horses.

in which the exudate contains streptococci in great. numbers,
in addition to the bipolar bacilli.

The bipolar bacilli may sometimes be demonstrated in the,,
blood at the beginning of the febrile stage, they are very fre-
quently found in the hepatized tissue of thé affected lungs, and
also in the pleural exudate. In the exudate they are usually
present in association with streptococci, and also with. other.
bacteria. They may also be found during the lung affectior..
in the nasal discharge.

In repeating the investigations of Ligniéres, Hutyra, found the bipolar bacilli,
only very exceptionally in the blood and in the nasal discharge of affected ‘horses;
on the other hand they were present in great numbers in the affected lungs, “however,
usually associated with streptococci and also with other bacteria _ (colon bacillus,
bacillus pyocyaneus, “and others). In’ the small hemorrhagic, or ‘reddish brown,
hepatized areas the bipdlar bacilli are usually present in great numbers, while’ they
lodge in the gray hepatized or gangrenous areas, and in the pleural exudate, only
sparingly, or their presence cannot at’all be demonstrated. The bipolar bacillus, as
well'as the streptococets, apparently’ exert their pathogenic action through toxins,
Filtrate of a bouillon culture of the bipolar bacillus, several days old, injected intra-
peritoneally into a horse in a dose of 500 g., produced symptoms of severe intoxica-
tion (rapid small pulse, diarrhea, profuse sweating). The filtrate of streptococcus
cultures is less toxic, nevertheless 350° ec. of the same injected intravenously may
also produce symptoms of severe poisoning which Jast’for several hours.

The presence of pyogenic streptococci in the nasal discharge, and in the
thoracie organs has also been established by other authors (Hell, Foth, Sven Wall,
Ostertag, Tartakowsky and others). Pfeiler observed after an ‘intravenous injéetion
of bouillon cultures (35 to 120 ec.) persistent fever, nasal discharge, yellowish-red .
discoloration of the conjunctivae, as well‘as serous or fibrinous inflamniation of the
pleura, and in some cases also pneumonia. Tabusso found that cultures of the
bacillus equisepticus exert a severe toxic action, | and that the intrapleural injection
may produce lobar pneumonia. Dreyer is of the opinion that the disease may be a
transmitted with the fresh blood of affected horses. However, “Ostertag proved in
his varied experiments, which he carried out for many years, that the typical disease
can be produced with neither of the two described bacteria, nor with the diplo- _
bacillus, which he found in the nasal discharge and, more rarely, in the blood of*
affected horses. He further showed that the ‘disease cannot be. transmitted to
healthy horses by means of the nasal discharge, exhaled air, plevral exudate, urine
and blood of affected animals.

*- The experiments of Hempel & Pfeiler also speak against the streptococci and
bipolar bacilli as being’ the primary causes’ of thé ‘disease,’ as they’ failed to
demonstrate complement fixing substances for these respective bacteria in the blood *
of horses affected with the disease.

The view of Lorenz, according to which the cause of the disease is a pleomor-
phous micro-organism, usually present on thé surface of the skin of the pastéri,”
is a priori extremely improbable and has never been substantiated by others, “The _
claim of Baruchello & Pricolo that the causative agent of the ‘disease isa plood
spirochete, and thé more recent assertion of Baruchello. & Mori that it is a piro-
plasma, are contradicted-by the fact that the numerous blood examinations of other
authors failed to demonstrate the presence ‘of these organisms, and can be only
explained by assuming that these Italian authors studied'a disease of horses which _
differs from the influenza occurring in middle Europe. '

The etiological action of the bacteria found up to the present,.
in influenza cannot as yet be established accurately. For none of these |
organisms has sufficient proof been advanced that. they can produce
the disease primarily, and no one has ever succeeded in producing ~
croupous pneumonia in its typical course artificially. It is therefore
possible that the primary cause of the disease, or the infective agent
which transmits the disease from animal to animal, is a micro-organism ™
which is not yet known, and that the streptococci, as well as the ovoid
bacteria, which are normal habitants of the healthy air passages, exert_.
their pathogenic action only after the specific virus has already. affected
Pathogenicity. Natural Infection. 175

the animal, and they then subsequently produce the inflammatory
changes attributed to them. The resistance of the horse may be’
weakened also by other influences such as colds or overexertion, in
which condition the action of the bacteria mentioned may be exerted
and lead to the development of the inflammatory processes in’ the
lungs. The pleuro-pneumonia which develops in such cases would
anatomically and bacteriologically manifest the same character, inas-
much as it is caused by these same bacteria, but it would differ from
influenza by the absence of all contagious properties. This conception,
which. is based only on theoretical considerations, tends to explain the
peculiarities in the development of the disease, which sometimes appears
as an’ enzootic, at other times only in a sporadic form, while the clinical
and anatomical manifestations, especially the croupous pneumonia, are
practically the same.

Poels’ observation, which refers to a stallion, deserves special mention. This
animal for months infected, in the act of coitus, the mares which he covered, and
its semen, fresh as well as filtered, when injected intravenously in healthy animals,
produced: influenza after an incubation of from 5 to 6 days. The blood of horses
infected in this manner also proved virulent, even after being filtered through a™
Berkefeld filter. fe R

The natural infection is evidently transmitted usually by
secretions of the lungs, and by the feces of affected animals,
while infectiousness of the exhaled air is very improbable.

The secretions and excrements are especially infectious
during the development and at the height of the disease. The
conyalescing animals may also infect, and even apparently re-
covered animals may do likewise, in cases when the lungs still
contain gangrenous areas after the disappearance of the acute
symptoms. The development of the disease among horses, by
the introduction of an apparently healthy animal,.can be ex-
plained by such a mode of infection. The animal introduced -
had probably been affected with the disease but a short. time
before. This may also explain the continued existence of the
disease in some stables, when it is continuously transmitted to
other animals from one which has not completely recovered —
from the disease. Such apparently recovered animals, whose
lungs contain necrotic lesions, which are not encapsulated, may
carry the infection for months (Siedamgrotzky). Usually, how-_
ever, the disease is introduced by animals which are in the in-
cubation period or in the first stages of the disease, and in
this respect animals bought in horse exchanges are especially
dangerous, while among army horses the disease frequently
breaks out after the introduction of remounts.

According to some English authors (Pottie, J. Clark, Rieks), as well as the
observations of Jensen, stallions which recover from influenza may transmit the -
diseasé to mares in the act of coitus months later and even after one to two years.
Grimme reports a case in which apparently 14 out of 22 mares were said to have
been infected by a stallion, which, besides a slight reddening of the conjunctivae, ©
manifested no other indications of the disease. (See also the observation of Poels,

above.)

Indirect infection is transmitted by the most varied objects
which may be contaminated. Such are the secretions and ex-
176 Influenza of Horses.

erements of affected horses, contaminated food, straw, manure,
stable utensils, cribs, pails; people who are employed in hand-
ling sick animals, their clothing, ete. The virus may retain its
virulence for a long time in poorly ventilated, musty and damp
stables, while in pure, dry air and under the influence of sun-
light it loses its virulence within a short time. These condi-
tions may explain the fact that outbreaks usually remain con-
fined to individual stables or townships, or to limited localities,
and that a wide extension of the disease, such as is the case,

for instance, in foot-and-mouth disease, is rarely observed.

The possibility of the infection being transmitted by flies, as intermediate
carriers of the virus (Giesecke), is not at all probable in consideration of the mode
of appearance and extension of the disease, and especially in view of the frequent
localization of the affection in individual stables.

The infective agent, as a rule, enters the animal body
with the feed or drinking water, and very probably through
the intestines or through the lymphatic pharyngeal ring
(Walther); however the possibility of infection through the
air passages should not at the present time be disregarded.

Pecus reports on observations of outbreaks in which the infection could only
have occurred through the digestive tract; in several stables only those horses became
affected which drank from a common trough, whereas the horses which were watered
with individual pails escaped the disease. One particular horse drank from a pail
the contents of which was contaminated by the discharge of an animal affected with
influenza, and this horse developed the disease in six days.

Of the predisposing causes of the disease colds should
come first in consideration. Experience also points to this
fact, that the beginning, and the greatest extension of the dis-
ease, is frequently associated with northern or eastern winds,
and the frequent occurrence of the disease in the cold, damp
periods of the year can be traced to this. -Catarrhal affection
of the mucous membranes is another predisposing cause for
the disease, and owing to this fact the mortality,among horses
which are kept in badly ventilated stables is usually greater
than under more favorable hygienic conditions.

The age of the animals has an influence on their suscep-
tibility, inasmuch as horses over one year of age are most
readily affected with the disease, while it occurs less frequently
among very old animals. The disease occurs with greater
frequency and in a more severe form among horses of high
breeding, as well as among the heavier breeds. All solipeds
are susceptible to the disease.

One attack of the disease diminishes the susceptibility to
infection for only a short time. We have observed horses at-
tached to the medical (army) service which passed almost every
year through a slight attack of influenzal pneumonia.

Pathogenesis. As the primary cause of the disease is at
present unknown, only suppositions are admissible relative to
its method of action. The infective agent produces a general
blood infection which is manifested in general febrile and
Pathogenesis. 177

catarrhal symptoms. The disease which develops in this
manner may, after the disappearance of the infective agent
from the body, terminate in recovery within a short time. Most
cases of the catarrhal form of influenza follow this course,
while an unusually severe infection may result in a very severe
septic manifestation, and cause the death of the animal within
a few days. The autopsy findings in such cases are similar
to those of hemorrhagic septicemia, with hemorrhages in the
serous and mucous membranes, hyperemia, and small hemor-
rhages in the parenchymatous organs, especially in the lungs
and kidneys, but as in such eases the bacteriological examina-
tion not infrequently shows the presence of the bipolar bacilli
in the organs as well as in the blood, there exists a possibility
that they have taken part in the fatal termination of the disease.
These organisms enter the blood in an early stage of the dis-
ease, multiply in the same very rapidly, and are frequently
the direct cause of death, or at least they hasten death.

The primary infection, that is, the general febrile condi-
tion, may weaken the body to such an extent that the facultative
pathogenic bacteria, especially the ovoid bacteria and strepto-
cocci, can exert their specific infective action. As a result of
their invasion inflammatory processes develop, especially in
the lungs, in the form of pneumonia or pleuro-pneumonia, while
the primary infective agent has possibly in the meantime dis-
appeared from the body.

The bipolar bacillus, as well as streptococci, may produce
such inflammation; usually, however, in the cases where pleuro-
pneumonia caused the early death of the animal, under mani-
festations of a violent septicemic character, the pleural exudate
and the affected lung tissue contain the ovoid bacteria ex-
celusively, while the streptococci appear to multiply more rapidly
only later in exudates which have already developed as the re-
sult of the disease. These latter are present in predominating
numbers or sometimes even exclusively in the hepatized and
necrosed lung tissue, while in the pleural exudate they are
usually found exclusively (the pleurisy apparently being caused
only by the streptococci which pass from the lungs into the
pleura). Streptococci may also’ enter the blood, and in this
way they may reach the parenchymatous organs when they may
be found on autopsy in the spleen, the kidneys, and in the
lymph glands.

Other bacteria may in some cases cause a secondary infection;
thus, in one of our cases, besides the bipolar bacillus, the diplococcus
lanceolatus (recently also demonstrated by Meyer), in another case
the bacillus pyocyaneus, were present in great numbers. Besides these
the colon bacillus may often be found in the inflamed lung tissue.
The eventual necrosis of the inflamed lung tissue may be due to the
bipolar bacillus or to the streptococcus. In several cases the gan-
grenous lesions have contained the bacillus necrophorus, which indi-
cates that in this process, at least under suitable conditions, this
2
178 Influenza of Horses.

bacillus probably has an active part. Bourget & Prevost finally found
a virulent form of proteus in the pleural exudate of several horses.

Anatomical Changes. In the catarrhal form of influenza
an acute hyperaemia of the mucous membranes develops in
the digestive tract or in the air passages, or possibly in all
the mucous membranes. This condition is associated with an
edematous infiltration of the submucous connective tissue, as
a result of which the mucous membrane, especially in the larynx
and in the pyloric portion of the stomach, and in the small
intestines, forms thick gelatinous folds. In the small intestine
the solitary follicles, and the Peyer’s patches are swollen, and
moreover the reddened mucous membrane contains in places
superficial erosions or even deep ulcers (Rips). The mesen-
teric lymph glands are greatly swollen, their tissue is reddish-
gray and moist.

Very frequently the subcutanous connective tissue is in-
filtrated with a clear, or somewhat cloudy, readily coagulating
serous fluid. These infiltrations may occur at different parts
of the body, especially in the parts surrounding some of the
tendons of the extremities. A similar fluid may be contained
in the tendinous sheaths in considerable quantities. The yellow,
gelatinous tissue is in such cases studded with small hemor-
rhages, and similar changes are sometimes present in the sub-
and retroperitoneal connective tissue, especially in the imme-
diate vicinity of the kidneys. The body cavities may also
contain various quantities of a pure or slightly cloudy, reddish
exudate.

The other internal organs are not much changed. A mod-
erate, acute swelling of the spleen may be present, also
hyperaemia or acute edema of the lungs, cloudy swelling of
the heart muscles, of the liver, and of the kidneys. Hyperemia
of the meninges, and even a slight acute hydrocephalus internus
may be found.

In the pectoral form of influenza, necrotic pneumonia, in
association with sero-fibrinous pleurisy, represents the most
important and common anatomical change. The pneumonia
sometimes occurs in the form of lobular broncho-pneumonia,
or the inflammatory process extends in the form of a lobular
pneumonia, affecting at the same time, large contiguous areas
of one or both lungs. In the first case the lung contains only
a few dense hepatized catarrhal or hemorrhagic areas; the
tissue in immediate surroundings of these areas is serously
infiltrated; while in the second case, the lower sections of the
lungs are uniformly hepatized throughout large areas. The
affected lung tissue breaks readily, the cut surface i is granular,
and depending on the stage of formation, it is either grayish-
brown, grayish- red, or yellowish-gray. In the parts still con-
taining air, besides the hyperemia or acute edema, the con-
nective tissue walls are gelatinously infiltrated.
Symptoms. 179

In the hepatized tissue numerous necrotic areas may fre-
quently be disseminated, which vary in size from that of a
poppy seed to a hazelnut. They are of a dirty, grayish-brown
or greenish color, and of a mushy consistency. In some cases
a circumscribed portion of the affected lung is changed into
a necrotic mass which may attain the size of a fist or a child’s
head, and may sometimes be surrounded by a layer of pus.

The mucous membrane of the bronchi and trachea is bright
red, swollen, not infrequently sprinkled with hemorrhages, and
profusely covered with sero-purulent secretion.

Inflammation of the superficial layers of the lung is always
associated with pleurisy. The pleura loses its luster as a
result of a desquamation of the epithelial layer, is dull, rough,
and covered by loose, moist, smeary pseudo-membrane. This
peels off readily, and is of icteric yellow color, and somewhat
resembles pudding. Between the two layers of the pleura there
is a yellowish fluid which contains flakes of the fibrinous mem-
brane. This exudate is cloudy, and is sometimes present in
considerable quantities, exerting more or less pressure on that
portion of the lung which is not hepatized. In less acute cases
there is a thick, wide connective tissue layer under the loose
false membrane. If the pleurisy develops in connection with
superficial necrotic fields, or as a result of the rupture of such
an area, the exudate is always of a purulent or ichorous char-
acter. In case the gangrenous area which opened into the
pleural cavity communicates with the bronchi, pneumothorax
or pyo-pneumothorax will develop.

In other respects the autopsy reveals conditions similar
to those present in the catarrhal form of influenza, only the
changes are usually somewhat more pronounced. On the
mucous membranes not infrequently superficial ulcerations may
be found besides the catarrhal reddening and swelling. The
parenchymatous degeneration of the heart muscles, the liver
and in the kidneys, frequently passes into a fatty degeneration.
Small hemorrhages or even extensive suffusions are often
present in the tissue of the serous membranes as well as in
the endocardium. The lymph glands, especially those of the
thoracic cavity are greatly swollen. Suppurative areas may
exceptionally be found in various organs, and purulent inflam-
mation of the joints.

Symptoms. The time of incubation in influenza extends
in the majority of cases from 3 to 7 days; less frequently, es-
pecially after the animal has contracted a cold, the first symp-
toms may appear after 24 to 48 hours, while in other cases the
disease may remain latent for 8 to 9 days. In some cases
the animals are affected for a time only with a slight bronchial
and stomach catarrh, while the manifestations of the pectoral
form of influenza gradually develop later. Jn these cases the
time of incubation appears to be considerably longer, although
180 Influenza of Horses.

the preexisting catarrhal manifestations were really indica-
tions of infection with influenza.

According to Siedamgrotzky the time of incubation in influenza is from 4 to
5 days, while Dieckerhoff claims that the first manifestations appear in from 12 to
24 hours. On the other hand, even 14 days may in exceptional cases elapse before
the onset of the disease. In infections which are transmitted by coitus the disease
usually develops in from 6 to 9 days (Clark, Jensen, Grimme).

The disease commences almost invariably with marked de-
pression, dullness of the sensibility, and capricious appetite.
The animals stand with eyes half closed, ears drooped, support-
ing the head to the crib or the strap of the halter, sometimes
standing in the stall, apathetic and in abnormal positions.
They take the food offered them with hesitation, masticate it
slowly, and with frequent interruptions. They frequently do
not swallow the bolus, but it lies in the mouth on the outside
of the molars apparently forgotten. If urged to move they
walk lazily and with some difficulty; frequently the gait is
staggering.

The body temperature is first elevated, and reaches on the
first day of the affection 40 to 40.5°C. At this point the temper-
ature remains for two or three days with only slight variations,
whereupon in the catarrhal form, after one to two days more
it drops rapidly to normal (Fig. 35 on page 181).

In the case of pure or predominating pneumonia the tem-
perature continues to remain high, with slight variations, and
returns to normal only after the regeneration of the changes
in the lungs (Fig. 36 on page 183). In severe cases the fever
persists continuously or remittently until death. In slowly
progressing cases however the fever is interrupted periodically
by afebrile intervals (Fig. 37 on page 186). During the period
of high fever the heat over the surface of the body is unevenly
distributed, the coat is rough; muscular trembling may be also
observed in some parts of the body. The skin sometimes mani-
fests nodular eruptions or urticara. The heart’s action is from
the beginning more or less excited, in severe cases it is greatly
accelerated and weak, as a result of the developing parenchy-
matous degeneration of the heart muscle. The pulse is usually
from 50 to 60 per minute; in severe cases, however, the number
may increase to from 80 to 100, with throbbing heart and small,
wiry pulse.

Special Symptoms of the Catarrhal Form of Influenza.
In this form of the disease catarrhal manifestations of the
mucous membranes develop in association with the ahove de-
scribed febrile symptoms.

In the eyes the conjunctivae appear reddened (mahogany
or brick red), frequently with a yellowish tint, the submucous
connective tissue containing a serous infiltration. There is
always photophobia as well as lachrymation present. The
eyelids swell, and the opening of the eye is thereby narrowed.
Symptoms. 181

If it is forced open, tears escape profusely, or in the later stages
a secretion which is mixed with mucus or pus. The swelling
may extend to the sclerotic conjunctiva, as a result of which
the cornea is surrounded by a yellowish-red, somewhat elevated
ring. The cornea proper is often cloudy, and the epithelium is
desquamated from the anterior portions. In some cases an
iritis may also develop, with a contraction of the pupil, and
the deposit of a yellow

fibrinous exudate in [T[p[rf:]2]sfulslelzlalel ola
the anterior chamber or
of the eye.

The catarrh of
air passages is first
manifested by a rough
and dry, later by a
moist but always
strong and sometimes
painful cough, which
comes on spasmodi-
cally. From the red-
dened mucous mem-
brane of the nose first
a small quantity of a 60 | 20
serous, later more pro-
fuse muco-purulent 40
discharge escapes,
which during spells of
coughing is also ex- Fig. 35. Fever curve in catarrhal influenza.
pelled through the
mouth and nose. If the nasal catarrh is severe the sub-
maxillary lymph glands are usually swollen and sensitive.
Respiration is more or less accelerated and superficial. Per-
cussion reveals normal conditions over the thorax, whereas
on ascultation, raw, vesicular breathing, dry and moist rales
of varying intensity and numbers, may be heard. Sometimes
an increased sensitiveness of the thorax may also be present.
The appetite is at first depressed, while the animals willingly
take water, although only in small quantities. The mucous
membrane of the mouth is warm and dry, the tongue is also
dry and coated. Not infrequently difficulty in swallowing may
be observed as an indication of the coexisting pharyngitis.

Gastric catarrh is indicated by the disturbance or entire
disappearance of the appetite, also by frequent yawn and a de-
sire to lick cold objects. At first there is constipation, during
which the feces are dry, forming small balls, covered with
mucous shreds. The abdomen is sometimes moderately bloated.
Later the feces become softer, or even fluid, and towards the
third or fourth day frequently fetid. Sometimes they are of
a dirty reddish color, and expelled with straining. Peristalsis
is at first depressed, later lively, and in some instances may

 

30} 10
182° Influenza of Horses.

be uninterrupted. Not infrequently mild colicky symptoms may
be observed. The persistent diarrhea and the absence of ap-
petite weakens some of the patients considerably.

During the entire existence of the febrile condition urine
is passed in only small quantities. It is of a high specific
gravity, and dark yellow in color, containing a small quantity
of albumen, and sometimes bile pigments. The chemical re-
action in the later stages, and in the presence of continuous
bad appetite turns acid. If allowed to stand a great amount
of sediment precipitates, which may contain epithelial cells
from the bladder and the pelvis of the kidneys, exceptionally
also casts may be noted. In the presence of catarrh of the
bladder and urethra the animals urinate frequently and strain
during each passage. A transient polyuria may develop after
the subsidence of the other symptoms. In females the mucous
membrane of the vagina may show catarrhal inflammation, and
in such cases a muco-purulent discharge escapes.

In some cases edematous swellings develop in the subcutis,
especially on the chest and lower abdomen, or on the lower
extremity of the sheath. Occasionally urticaria-like eruptions
may occur on the rump; these present the form of round, beet-
like elevations. Such subcutaneous and cutaneous edema may
be observed in some outbreaks on practically every patient.
In other instances it may be observed only in isolated cases.
In some outbreaks there may be found an inflammation of
the flexor tendons and tendinous sheaths of the extremities,
with an accumulation of serous exudate in the latter. As a
result of the pain which is associated with this form of affec-
tion the patients rest the legs intermittently and keep them
flexed as much as possible.

The symptoms described may reach various degrees in the
different cases. In mild- forms they may disappear in one to
two days, whereas severe symptoms develop only in very few
instances.

Kramell reports a peculiar form of influenza in 39 out of 72
army horses. The fever, lasting from one to six days, varied between
38.6 and 41°C., at the same time the frequency of pulse dropped
to 30 and 28 beats. In about one third of the cases a disturbance in
the gait of the animals was observed, which was evinced by stiffness
of gait, resembling a rooster’s step, or lameness in the different extremi-
ties. Respiration was not affected, the conjunctivae were usually nor-
mal, and the appetite was capricious.

Special Symptoms of the Pectoral Form of Influenza. This
form is also inaugurated by febrile and catarrhal symptoms,
as is the case in the catarrhal form, only they are more intense
in character. In the meantime symptoms arise which point
to an affection of the respiratory organs, and this develops
in a short while into characteristic acute pneumonia or pleuro-
pneumonia. The affection of the lungs represents either lobar
Symptoms. 183:

croupous pneumonia, or lobular broncho-pneumonia, but the
definite differentiation of these forms is only in rare cases
possible because the latter also has a very acute development
and a rapid extension.

In some cases the pneumonia develops in a manner similar
to genuine croupous pneumonia (see Fig. 36). Accordingly
the symptoms consist of difficult, costal-abdominal breathing ;
first a tympanic, later a dull sound on percussion over the lower.
parts of one or both sides of the thorax, which later changes
into a tympanic and finally into a normal sound. On asculta-
tion rales may be heard, later bronchial breathing or the ab-
sence of any respiratory sound. This may be again followed

10

 

Fig. 36. Fever curve in pectoral influenza. Type of the croupous pneumonia;
recovery.

by moist rales. In numerous cases there is a saffron, or rust-
colored nasal discharge (for detailed information see Vol. 2,
Chapter IV). On the other hand, if the affection of the lungs
develops as a lobular pneumonia the symptoms of hepatization
(dullness, bronchial breathing), may be entirely absent, or they
may be established only over small irregular areas, so that
the existence of pneumonia is suggested only by the marked
respiratory difficulties, the high fever and possibly the rust-
' eolored nasal discharge.

The pleurisy which frequently develops in association with
the pneumonia is manifested by a sensitiveness of the thorax,
and also by superficial abdominal breathing, later by double
184 Influenza of Horses.

breathing, friction sounds, and if a pleuritic exudate forms, also
by dullness below a horizontal line (see Vol. 2, chapter on Pleu-
ritis. )

In the Prussian army, in the years of 1899 to 1908, out of 9462 cases in which
3198 were affected with pleuro-pneumonia, in 1817 cases pneumonia on the right,
and if 1780 pneumonia on the left side, in 1336 double pneumonia, and in 100
cases pleurisy only was present. In the clinics of Budapest, in the years of 1904
and 1906, in 169 cases the pneumonia was unilateral, in 195 cases it was bilateral,
while in 106 cases pleuro-pneumonia was established.

In association with the pneumonia, gangrene of the lungs
develops subsequently with relative frequency, and to a certain
degree this is characteristic of the lung affections in influenza.
In such cases the symptoms consist of a disagreeable odor of
the exhaled air, cavity formations in the hepatized lung tissue,
high fever, weak- heart action, etc., which usually develop in
the course of the second week of the affection. A nasal dis-
charge is observed in almost every case. The secretion con-
sists first of only yellowish drops, later it becomes more profuse
and purulent, or rust-colored, and tenacious, in exceptional
cases it may also be bloody. After the appearance of gangrene
the discharge becomes of a greenish-brown color, and has an
intensely disagreeable odor.

The urine invariably contains albumen, sometimes also
blood. During the incipient stage of the pleuro-pneumonia the
quantity of chlorine salts is diminished, but it increases again
at the convalescing period as a result of the absorption of
the exudate. The appetite is entirely absent and the chemical re-
action of the urine is acid. Microscopically the sediment shows
epithelial cells from the urinary passages, sometimes hyaline
or granular casts, and even red blood corpuscles.

The number of lymphocytes in the blood increases from the
beginning of the disease, and by the fifth to seventh day may
exceed the normal number by 40%. After recovery has taken
place, normal relation is not established until a long time after
the disappearance of the clinical symptoms (Sturhan).

The patients become emaciated in the course of the dis-
ease as a result of the fever and inappetence. They usually
do not lie down, or in the presence of a painless pure pneumonia
they lie only on the affected side, and in the unfavorably ter-
minating cases they succumb as a result of septicemia or
asphyxiation.

Complications occur quite frequently in the course of the
disease, and may lead the otherwise mild affection to a fatal
termination. Of relatively small importance are the inflam-
mations of the tendons and tendon sheaths of the extremities,
especially of the flexor tendons, also inflammations of the sensi-
tive lamina of the hoof; this applies also to the edematous
swellings of the skin, which may appear as long as the heart’s
action is sufficiently strong, as these processes soon disappear
after the improvement of the inflammation of the respiratory
organs (Frohner observed in the later stages of contagious
Symptoms. 185

pleuro-pneumonia the development over night of a weeping
exzema around the ankles of the hind legs and over the hoofs
which later extended also to the front legs, causing suppuration
and scab formations). The paralysis of certain nerves, which
develops in the course of the first or second week of the dis-
ease is likewise usually only temporary; the nerves most fre-
quently affected are the N. recurrens vagi, N. facialis, N.
trigeminus or the N. ischiadicus. In some cases, however, the
paralysis subsides only after a longer period.

A more dangerous and quite frequent complication is the
parenchymatous or fatty degeneration of the heart muscle,
and the paralysis of the heart which develops as a result of
it, or owing to a pericarditis which develops at the same time.
The parenchymatous degeneration of the kidneys which is
almost constantly present may later pass into an acute nephritis,
manifested by a diminution of the quantity of urine, marked
albuminuria, and the presence of numerous other constituents.

The manifestations of intestinal catarrh may increase in
severity and a profuse diarrhea develop. If this does not per-
sist for a long time recovery may follow. Severe intestinal
symptoms however which indicate deep-seated inflammatory
changes of the intestinal mucous membranes, always aggravate
the course of the disease, inasmuch as it causes in the weakened
patient an almost complete exhaustion ; and besides the diarrhea
is not infrequently a symptom of developing septicemia.

Septicemia, exceptionally pyemia, usually terminates the
course of the disease, especially when the grangrenous processes
in the lungs have reached great extent. Persistent high fever,
chills, very weak and frequent pulse, as well as diarrhea, indi-
cate the development of the disease in this direction.

As further complications may be mentioned pronounced
icterus,’ hemorrhages in the lungs (into cavities and thence into
the communicating bronchi), or between the layers of the
pleura, marked nervous irritation, sometimes associated with
spasms and trismus (Wohlmuth; Wilden observed in a case
the development of general tetanus 8 days after the onset of
the disease, which lasted for four days and suddenly disap-
peared on the fifth day). Inflammation of the cerebral and
spinal meninges, paralysis of the sphincter muscles of the
rectum and bladder, as well as of the tail (Friedberger), oc-
casionally develop during the course of the disease. Further,
inflammation of the eye, sometimes with hemorrhages into the
interior of the eyeball, serous and sero-fibrinous inflammations
of the joints, verrucose and ulcerative endocarditis, necrosis
of the skin over the edematous swellings, phlegmonous inflam-
mation of the subcutaneous connective tissue, breaking through
of a cavity in the lung under the skin of the thorax, falling of
the hair from mane and tail, may also result during the disease.
Pregnant mares may abort in the course of the affection.
186 Influenza of Horses.

In the Prussian army in the years of 1899 to 1908, among 9,925 affected
animals tendonitis and tendo-vaginitis (724 cases), roaring (330), internal opthalmia
(189), purpura hemorrhagica (53), skin eruptions (62), inflammation of joints (32),
etc., occurred as the most frequent complications, or sequelae of contagious pleuro-
pneumonia.

Course. The catarrhal form of influenza lasts in the great
majority of cases about one week, sometimes, however, only
two to three days, in which cases the fever rapidly subsides,

‘ and the animals soon
recover. In other
cases the course may
extend to two weeks,
and then it requires
considerable time un-
til the animals regain
their health. Fatal
terminations are ex-
ceptional, and only
occur when severe
complications become
associated with mild
forms of the affec-
tion (pneumonia, hy-
peremia or acute in-
flammation of the
brain, enteritis, de-
generation of the
heart muscle, ete.).

Much more va-
ried is the course of
the pectoral form of
influenza. In the
typical cases in which
the different stages
of lobar pneumonia
follow each other
with regularity, and
the resolution is also
undisturbed, the
pleurisy being pres-
ent in a mild form or
not demonstrable at
all, the fever may
subside at the end of
the first or at the be-
ginning of the second week. Here, however, complications and
sequelae which develop frequently in association with the dis-
ease, more often cause a deviation of its regular course.
Especially in cases of pleurisy in which a great quantity of
exudate develops, the affection may extend for weeks (Fig. 37),
and even for months, the patients manifesting temporary im-

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4

 
Symptoms. 187

provement and repeated relapses, until finally the animal dies
from exhaustion, or remains broken-winded for the rest of
its life. Death may result however even earlier at the height
of the pneumonia, usually following paralysis of the heart.
Convalescence in this form of influenza takes a considerably
longer time, and as a rule extends over a period of more than
two weeks.

The termination of the disease is naturally also influenced
by the existing hygienic conditions, and especially the continued
working of animals already ill will usually render the course
of the disease, which otherwise might have been only mild, an
unfavorable one.

After the termination of the acute disease, chronic processes
sometimes develop as sequelaca After a severe pneumonia,
and especially when the tissues in different parts have
become gangrenous, chronic granulating inflammatory proc-
esses, with shrinkage of the lung tissue, may develop. This
condition may also result in the formation of bronchiectasis,
while after an exudative pleuritis, adhesions of the pleural
layers may follow, as a result of which the animal may suffer
from dyspnea until its death. A frequent result of pleurisy
is the paralysis of the N. recurrens vagi, which causes roaring
in ‘the animal. The acute catarrh of the intestines may develop
into a chronic form, which results in the gradual emaciation
of the animal. Other after affects that may occur are paralysis
of the hind parts, shortening and even necrosis of some of the
tendons, chronic inflammation of the joints, exostoses, hemo-
globinemia, and as a result of the inflammation of the eye,
amaurosis. Finally, horses recovering from influenza may later
become affected with purpura hemorrhagica, and the internal
inflammation of the eye may also develop only two to three
weeks after the passing of the disease (Hell).

- The character of the disease varies greatly in the different
outbreaks. While in some periods the course of the disease is
very mild, so that the great majority of the animals are only
slightly affected with the catarrhal symptoms, and while also
the infrequent pneumonia almost invariably terminates in re-
covery, there are outbreaks in which the disease is of a re-
markably malignant character. This form is characterized
especially by frequent hemorrhages, as well as by pneumonias
which frequently assume gangrenous forms. The character of
the disease may also change in one and the same outbreak;
thus in some instances it may occur that at the beginning of
the outbreak only cases of the catarrhal form of influenza
are observed, while later the pleuro-pneumonic form becomes
more frequent, and towards the termination of the epidemic
the affections return again to the milder form.

Diagnosis. The catarrhal form of influenza may he easily
mistaken for catarrhal manifestations of the mucous mem-
188 Influenza of Horses.

brane from other causes, while pectoral influenza may easily
be confounded with sporadic croupous pneumonia. Although
the edematous infiltrations of the subcutis, as well as the
tendonitis and the tendo-vaginitis, also the icteric discolora-
tion and chemotic infiltrations developing in association with
the conjunctivitis, are quite characteristic of influenza, these
symptoms are not infrequently absent, especially in the early
cases of an outbreak. In such cases the infectious character
of the disease, and its rapid spread among horses, reveals the
nature of the affection. In practice it is advisable therefore
to suspend diagnosis in the first cases, until the appearance
of new cases, or dependable data disclose the infectious nature
of the disease, or until characteristic symptoms develop, or
on the other hand, until the infectiousness of the affection may
be excluded. In consideration of these diagnostic difficulties
every suddenly appearing catarrhal affection, and particularly
every croupous pneumonia, should be considered as if it were
an attack of influenza, that is, as an infectious disease, Ac-
cordingly an immediate isolation of the affected animal is in-
dicated in all such cases. Influenza is distinguished from
the non-infectious catarrhs, principally by the fact that in the
former the catarrhal manifestations are preceded by high fever
of sudden development, while in the latter the catarrhal symp-
toms are rather latent and develop only with slight rises in
temperature.

If influenza has been established in a stable, or if the dis-
ease is present in nearby localities, all febrile affections should
be considered as suspicious of the disease. Further, as the
febrile rise of the temperature represents the first symptoms
of influenza, it is advisable in order to separate immediately
the newly affected animals, to take the temperatures of the
horses in the infected or endangered stables systematically
twice a day. A rise in the temperature of two degrees or over
is sufficient to indicate the probable presence of the disease.

Infectious anemia may possibly be mistaken for the
eatarrhal form of influenza, especially when it is associated
with severe intestinal disturbances. The condition of the blood
affords a means of differentiation since in anemia it coagulates
incompletely, at the same time the serum frequently appears
opalescent and of a more reddish color (Vallée). The appear-
ance of pneumonia, or pleuro-pneumonia, or the development
of similar symptoms in other horses of the stable would be
indications of influenza; on the other hand, rapid emaciation
and cachexia, without organic affection, as well as the pres-
ence at autopsy of a greatly enlarged spleen, would suggest
the presence of infectious anemia. Strangles may also be
considered in the beginning of the affection, from the standpoint
of a differential diagnosis; in this, however, the swelling and
suppuration of the lymph glands reveals the nature of the
affection.

ay
Prognosis. 189

Prognosis. The prognosis of the catarrhal form of in-
fluenza is usually favorable, as deaths seldom occur except as
a result of complications, the appearance of which are com-
monly associated with unfavorable hygienic conditions. Under
favorable conditions the loss hardly ever exceeds 0.5 to 1%; it
may however reach 4% and even more. Accordingly in the prog-
nosis all existing circumstances, as well as the benign or the
malignant character of the disease should be taken into con-
sideration.

The prognosis of the pectoral form of influenza is much
more unfavorable. In this form the losses are never less than
4 to 5%, and frequently considerably higher (according to
Dieckerhoff the average is 16%). Besides it should be also
considered that in addition to the losses resulting from death
some of the animals do not completely recover, and that their
protracted convalescence may greatly diminish the value of the
animals through the lessening of their ability to work.

The life of the affected animal is imperiled in the first
place by danger of paralysis of the heart. Indications of a
weak heart always render the prognosis unfavorable, and in
the presence of a soft empty pulse of over 80 beats, as well
as when a venous pulse can be detected, the chances of recovery
are very slight.

The termination of the disease depends also on the extent
of the pneumonia and pleurisy. A unilateral pneumonia with
only slight pleuritis usually terminates favorably; on the other
hand a bilateral affection, and especially the formation of
great quantity of pleura] exudate is always grave. In such
cases, even at the best, the course of the disease is very pro-
longed, and chronic changes of the respiratory organs usually
remain as a sequel to the disease.

Moderate fever, and at least a fair appetite, are favorable
prognostic signs. The more regularly the different stages of
the disease follow each other, the more favorable is the prog-
nosis, while a rapid change for the worse in the respiration,
with very high fever, without a distinctly demonstrable dullness
(pneumonia centralis!), usually results in death after a few
days. The dangers from cases of a hemorrhagic character
are in most instanees great (bloody nasal discharge, similar
pleural exudate!).

According to Fréhner, prognostic conclusions can be made in every case of
contagious pleuro-pneumonia, from the consistence of the exudate which may be
obtained by aspiration. If the exudate contains no bacteria the prognosis is always
favorable; on the other hand, in the presence of bacteria (streptococci) the disease
as a rule has a fatal termination.

The course of the fever is of great importance in the prog-
nosis, especially in the pectoral form of influenza. If the tem-
perature, after rising rapidly, remains for several days ap-
proximately at the same height, and if it falls towards the
end'of the first week just as rapidly, or even gradually, the
prospect of a favorable termination is excellent. If, on the
190 Influenza of Horses.

other hand, the fever curve shows a remittent character, and
if the febrile condition lasts over a week, and also if a new
rise in temperature takes place after the appearance of the
apyrexia, an unfavorable prognosis is indicated. In the latter
instance a rise in the temperature lasting only for one day
(perturbatio critica), has no special importance; continuous
fever is, however, always grave, as it either points to an ex-
tension of the pleurisy, or to the development of some other
complication.

Unfavorable terminations are also indicated by the pres-
ence of severe inflammations of the tendons, which interfere
with the standing of the animal; also persistent diarrhea, hem-
orrhages in the lungs or other organs, the appearance of
pulmonary gangrene, or an affection of the brain, ete. A
rapid reaccumulation of the pleural exudate after aspiration
is also an unfavorable sign, although in exceptional cases, even
after repeated aspirations recovery may finally take place,
which, however, is usually incomplete. In all of these cases
the dictetic conditions, the care and nursing of the patients,
as well as the general strength of the animals should be given
relative consideration. The more favorable the conditions are
in this respect the milder a course of the disease may be ex-
pected.

In the Prussian army, during the period of 15 years (1894 to 1908), out of
26,678 horses affected with the catarrhal form of influenza, 40 died (or 0.15%),
in most instances as a result of subsequent pleuro-pneumonia; while in the same
period 38,671 horses were affected with the pectoral form of influenza, of which
1,527 succumbed (3.94%). Among the horses of private stables in which the
hygienic conditions are usually more unfavorable, the losses are correspondingly
higher. “

Treatment. This consists in the first place, in a suitable
regulation of the dietetic conditions. It is of particular im-
portance that the animal should immediately be taken from
work and placed in a clean, quiet and moderately cool stable.
If the weather is favorable it should be allowed to remain
outdoors, although protected against wind or rain. The diet
should consist of easily digestible, palatable, and if possible,
of fresh green food, and the animal should be given fresh
drinking water in sufficient quantity (when the disease ap-
peared among army horses the bivouacking of all the animals
in the open air has repeatedly proved beneficial). As long
as the course of the disease is normal, and there are no alarm-
ing symptoms, the expectant method of treatment may be fol-
lowed. In such cases medicinal treatment may be omitted, with
perhaps the exception of aleohol rubs which are always favor-
able, and the regulation of the bowels. In the presence of an
extensive bronchial catarrh, inhalations of turpentine or tar
vapors are advantageous (Lugano recommends also intra-
tracheal injections of 10 to 12 ce. of a 4% formalin solution).

The fever does not require special treatment, as it usually
Treatment. 191

subsides, without interference, after several days. Cold water
in the form of douches, once or twice a day, or as rectal enemas,
gives favorable results, especially during warm summer
weather. Its beneficial action, however, is due rather to the
stimulation of the nervous system and the heart’s action, than
to its antipyretic action, although continued application of cold
water douches does reduce the temperature from one to two
degrees. Direct antipyretic treatment appears to be indicated,
when the body temperature remains abnormally high, even in
the later stages (over 40.5 to 41°C.). In such instances the
internal administration of antipyrin and of anti-febrin (15 to
30 g.).1s advised.

If pneumonia or pleuro-pneumonia develops in association
with catarrh of the air passages, or if the affection develops
in this form from the beginning the application of Priessnitz
bandages, as well as rubbing with camphor and spirits of tur-
pentine, act favorably. During the summer weather, cold
douches once or twice daily may be applied advantageously.
The heart’s action requires special watching, and in case it
is accelerated, while still strong, the administration of alcohol
in drinking water (25 to 50 g. alcohol, 1%4 to 1 liter of wine)
will give beneficial results. In case the heart’s action is greatly
accelerated, and the pulse is weak, heart stimulants are in-
dicated, such as digitalis leaves (2 to 5 g.), tincture of strophan-
thus (10 to 25 g.), caffeine (1 to 2 g.), camphor (2 to 5 g.
subeutaneously every 3 to 4 hours), or barium chloride (2 g.).
Strophantine may be given subcutaneously (0.003 g. in 10 g.
of water, injected at 2 places).

Fréhner recommends instead of the natural campbor, the cheaper
preparation made artificially from oil of turpentine, for the treatment
of contagious pleuro-pneumonia. The horses should receive daily 100
to 200 g. of oleum camphoratum (syntheticum) forte, or as a single
dose 50 to 100 g. injected on both sides of the thorax.

~ Recently Eberlein & Toepper obtained very favorable results in the
treatment of influenza by oxygen inhalations. The animals were given
the oxygen inhalations twice daily for 10 to 15 minutes. According
to observations in the German army, however, the effect of this treat-
ment consists only in a general improvement for 15 to 30 minutes,
as well as a diminution of the rate of respiration and pulse, while
the treatment has no influence on the pneumonic process, and even if
inaugurated at the onset of the disease does not prevent an unfavorable
course (Fiichsel). Hermann observed rapid absorption of the exudate
and recovery in a severe case from two subcutaneous injections of a
25% iodipin solution (50 g. for each injection) ; such an effect, however,
was not observed in the Budapest clinic. The German army veterin-
arians had variable results from the intravenous injections of tallianin
(10 g. doses). (Eichhorn found this remedy effective in the beginning
of the disease.)

If the exhaled air indicates by its fetid odor that decompo-
‘sition of: the secretion in the air passages, or gangrene of
192 Influenza of Horses.

of the lung tissue is progressing, the inhalation of finely
atomized disinfecting fluids is advisable. For this purpose a
solution of corrosive sublimate is recommended (1 to 2000-4000).
If this treatment is applied sufficiently early the fetid odor
frequently disappears; extensive gangrene of the lungs how-
ever is not checked by this method of treatment, likewise has
it no influence on the development of a general infection as
the result of absorption of septic substances.

Masson & Vazeux recommend for the treatment of pulmonary
gangrene, daily intratracheal injections of creosote (20 cc. of a solution
of 1 g. of creosote in each 40 g. of alcohol and water), while Gotti
recommends formalin (10-20 ce. of a 4% solution).

The pleurisy should be treated in the beginning with cold
applications or cold douches; however after the subsidence of
the symptoms of irritation these should be changed to warm,
moist compresses. The accumulation of fluid pleural exudate
should be relieved by an early aspiration of the thoracic cavity.
Repeated aspirations result sometimes, even in severe cases,
in recovery, but in such cases the chances are not very promis-
ing, as the pleurisy frequently develops in conjunction with
gangrenous processes of the lungs. The absorption of the
exudate may also be promoted with diuretics, such as potas-
sium acetate (100 to 180 g.), oil of turpentine (10 to 15 g.),
juniper berries (15 to 25 ec.), ete., as well as by rubbing with
irritating liniments (6 to 10% mustard, or chloroform liniment
10 to 40), followed by the application of moist; warm com-
presses.

The aspiration of the fluid should be stopped as soon as the patient manifests
uneasiness, accelerated respiration, or coughing spells. The subsequent irrigation of
the pleural cavity with a physiological salt solution, or a mild disinfecting solution
does not appear to act favorably. Strictly aseptic technique is naturally the most
essential requirement for satisfactory results. Boucheriou, after aspiration, recom-
mends a subcutaneous, while Almy, an intravenous injection, of 2 to 8 liters of a
physiological salt solution. Fairise advises an intrapleural injection of 1.5 to 4
liters of a 1 to 1.5% gelatin solution in order to prevent a possible hemorrhage,
as well as the rapid re-accumulation of the exudate, the injections to be made
immediately after the aspiration of the fluid.

In the presence of symptoms of a gastro-intestinal catarrh
laxative salts should be given daily to the patients, or Karlsbad
salts (40 to 60 g.), with bitter remedies (rheum, gentiana, oak-
bark, ete.). In consideration of the infectious character of
the catarrh, especially in the presence of fetid excrements, in-
testinal disinfectants are indicated, such as resorcin (10 to
15 g.), creolin or lysol (10 to 20 g.), creosote (5 to 10 g.),
naphthalin (10 to 15 g.), ete. If diarrhea exists astringents
(oak-bark, bismuth sub-nitrate, ete.), with opiates, as well as
enemas containing powdered starch are beneficial. If, however,
the diarrhea is profuse, which usually is an indication of a
general septic infection, the results from such treatment are
not favorable.
Prevention. 143

The conjunctivitis may be treated with washes of mild
collyriums, such as boracic acid or creolin solution, later astrin-
gent washes may be applied (0.5 to 1% tannin, or sulphate of
zine solution, collyrium adstringens luteum). In the presence
of a chemotic swelling of the conjunctiva, and keratitis, moist
warm applications are advantageous. If the iris is also affected
a 1% atropine solution may be dropped into the eye.

Swellings of the skin are benefited by rubbing with alcohol
containing oil of turpentine. Acetate of lead (5%) or Burow’s
solution, with the addition of camphor, may also be applied
to this form of affection.

In the convalescing stage the animals require good nourish-
ment and rest, although moderate exercise in favorable weather
is rather profitable than injurious. Animals should be used
for work only when all symptoms of the disease have disap-
peared, and after they regain their former strength.

The symptomatic treatment is similar to that followed in the pneumonia or
pleurisy and enteritis resulting from other causes; see accordingly their respective
chapters in the second volume.

Serum Treatment. Ligniéres recommends his polyvalent Pas-
teurella serum for the treatment of influenza (see page 86). In acute
eases of the catarrhal form of influenza, in the presence of a fever
(40.5 to 41°), he injects 40 to 60 ce. of the serum intravenously, where-
upon the fever is reduced, the patient becomes brighter, and recovers
inside of a few days. In subacute cases (39 to 39.5°), the temperature
usually rises somewhat after the injection, but drops after 10 to 12
hours, to normal. He also observed improvement in the presence of
pneumonia, when the serum was administered within the first 24 to
86 hours, while later treatment promises little result, because of the
associated streptococcus infection. Believing that the inflammatory
processes may also be caused or aggravated by streptococci, Joly recom-
mends the subcutaneous injection of anti-streptococcus serum(25 to 30
ec. daily).

Prevention. Healthy horses should be separated from
affected animals, as well as from attendants and utensils that
come in contact with diseased animals or with their secretions.
It is advisable to isolate a newly acquired horse for two weeks
for observation, and it should be placed among the other horses
only after that period. This applies particularly to regions
in which the disease is prevalent.

If the disease has already appeared the affected animals
should first of all be separated, and their stalls, as well as the
neighboring stalls, should be thoroughly disinfected. As in
the first place the immediate neighboring animals are under
suspicion of becoming affected, they, as well as all animals
showing an elevated temperature or catarrhal symptoms,
should be segregated in different isolated places. At the same
time the healthy animals which have no fever should be kept
out of doors, as far as place and weather conditions permit,
or in places which are free from the infection. They should
be divided in groups, and only animals which are entirely free.

13
194 Influenza of Horses.

from fever should be used for work. The infected stable should
be thoroughly disinfected, and scrupulous cleanliness, as well
as free ventilation of the stable, should be carried out.

As the development of the disease is favored by influences
which: have a weakening effect on the animals, the protection
of the horses from such influences, and especially from taking
colds, should be given due consideration.

Animals which have passed through the disease may, in
the majority of cases, and usually in the catarrhal form of
influenza, be considered as recovered and free from the in-
fection two weeks after cessation of the fever, and the dis-
appearance of all the symptoms. Convalescent patients from
the pectoral form of influenza if the changes in the lungs have
not entirely disappeared, and especially if in the meanwhile
relapses have occurred, are for a much longer time capable
of infecting other animals.

Immunization. Shortly after the discovery of Schiitz’ diplo-
coccus, Hell undertook the inoculation of over 1000 animals, with
bouillon cultures of this bacterium... Healthy animals were injected
3 or 4 times with 40 ce. of the culture into the trachea, and some of
the animals were given in addition subcutaneous injections of 5 to
10 ce. The injection was followed by a fever lasting from one to two
days, whether the. animals had had the disease or not. The subcutaneous
inoculation was also followed by abscess formation. Further observa-
tion showed that animals immunized against the Schtitz diplococcus
did not withstand the influenza infection, and therefore this method
of immunization was later entirely abandoned.

Immunizations with blood serum from horses which had shortly
before recovered from the pectoral form of influenza have not given
uniform results. Although Hell, at first, reported favorable results,
the continued experiments among the horses of the German army
showed that the serum treatment of affected animals was entirely
unsuccessful and moreover produced such contradictory and even
unfavorable results, that this method has also been gradually aban-
doned. According to the tabulation of Christiani, in the years of
1892 to 1898 the results of 17 inoculation tests showed that in 9 cases
they were favorable, and in 8 they were unfavorable. In opposition
to the advocates of immunization (EKichhorn, Toepper, Garrey, Giancola
and especially Friis, Jensen & Nielsen), others (Pilz, Neusse, Wittich,
Zschokke, Troester, Mieckley) found it ineffective. The contradictory
results may he explained to some extent by the fact that the effective-
ness of the serum varies in accordance with the intensity of the disease,
and also with the time which has elapsed since the recovery of the
animal.

At best serum inoculation affords the animals a passive immunity
which lasts but a few weeks. Such results do not meet the require-
ments of practice, even when the serious difficulties encountered during
the execution of the inoculations are not taken into consideration.
It would therefore be indicated only when it appears desirable to protect
the animals, even for a short time, against a threatening infection, such
as immediately before or during cavalry maneuvers.

Vaccination Technique. For the serum inoculations blood is taken under
strictly aseptic precautions from a horse which has recovered from the pectoral form
of influenza not more than six weeks previously. The quantity of blood drawn
~

Immunization. 195

is usually between three and four liters, collected in sterilized high test tubes, and
stored in a dark, cool place. The serum which separates on the following day from
the blood clot, may be utilized for the inoculations immediately, or several days
later. Until its use it should be kept in a cool place.

The serum is injected subcutaneously in doses of 40 to 100 ce. and the
procedure is repeated four to six times during the following days (Krueger recom-
mends the intravenous, Della Noce the intratracheal injection). To the serum
several drops of chloroform may be added (Friis, Jensen, Nielsen), or 0.8% of
oxalic acid, in the proportion of 1 to 10 (Prussian army). The inoculation causes
in most instances only a transitory indisposition, but in one Prussian regiment,
among 195 horses, extensive swellings and abscess formations were also observed
(evidently the serum was contaminated). Recently various serum preparations have
been recommended, for the purpose of immunization, which however have not proved
satisfactory in practice; thus the results which were obtained by Bues with Deutsch-
mann’s yeast serum (and with polyvalent hog serum), gave absolutely negative
results in contagious pleuro-pneumonia. Thomann experienced similar unsatisfactory
results with the vaccines prepared by Lorenz from cultures of his pleomorphic
bacterium. The same probably also applies to the serum of Willerding, prepared
from the cultures of a diploccocus which he isolated from the secretions of the
nose and eye, as Lorenz found it equivalent to his own in his laboratory experiments.

Immunization with Killed Cultures. Vallée & Carré used a vaccine
prepared from killed cultures of six varieties of ‘‘Pasteurella’’ for the
immunization of horses. The administration of this vaccine to the
horses of an infected stable was followed in several animals by severe
symptoms of depression and dullness, some became affected with the
typical form of contagious pleuro-pneumonia, and three of them died
as a result of the infection (latent infection ?).

Veterinary Police. In the German Empire compulsory
notification of influenza in horses was inaugurated in the year
of 1908. The official measures require the separation of the
affected and suspected animals, quarantine and disinfection of
the infected stables. The observation period extends over five
weeks.

Literature. .Falke, Die Influenza des Pferdes usw., Jena 1862.—Dieckerhoff,
Die Pferdestaupe, Berlin, 1882.—Siedamgrotzky, Sachs. Jhb., 1€91-1893.—Sehiitz, A.
f. Tk. 1887, XIII, 27.—Hell, Z. f. Vk., 1890, JT, 97; 1892, IV, 452; 1906, XVIII,
159. Jensen, Monh., 1891, II, 196.—Foth, Ibid., 1891, ITI, 192.—QLeclainche, Rev.
vét., 1892, 78 (Lit.).—Ligniéres, Bull., 1897, 355 u. 437; 1900, 524 (Lit.); Rev. gén.,
1907, IX, 599.— Jensen & Nielsen, Maanedsskr., 1897, VIII, 401.—Sturhan, Z. f. Vk.,
1905, XVII, 248.—Dreyer, Z. f. Vk., 1908, XX, 307.—Ostertag, Z. f. Infkr., 1909,
V, 180.—Pfeiler & Hempel, Ibid., 1909, VI, 28.

Influenza in Man. In human medicine influenza represents an acute,
contagious, infectious disease, which at times spreads with extra-
ordinary rapidity. The symptoms consist in pain in the joints and
muscles, occasional muscular tremors in different parts of the body,
sudden and intense fever with severe headache. There is also marked
debility, and a progressive acute catarrh of the air passages, conjunc-
tivitis, and frequently gastro-intestinal catarrh. The disease usually
terminates in from two to six days in recovery, however it may extend
to two weeks. In older, and exceptionally among younger persons,
severe disease processes may develop in association with catarrh of
the mucous membrane, such as pharyngitis, catarrhal and croupous
pneumonia, occasionally also pleurisy and pericarditis, as well as
inflammation of the middle ear. In the latter cases the course is usually
protracted and not rarely fatal.

The disease, which has no association with influenza of horses,
is caused by the very small influenza bacillus, which has been discov-
ered. by Pfeiffer (Beck, Ergebn. d. allg. Atiol., 1896, I, 742).
196 Dengue Fever.

Dengue Fever. This disease of man occurs in the tropics, espe-
cially in America, East Indies and on the coast of the Mediterranean.
It sometimes is very widely distributed, and is characterized by suddenly
appearing chills, pains in the joints and muscles (dengue-dandy, so called
from the peculiar stiff gait as the result of pain in the knee joints),
further in a polymorphous, exanthema of the skin. According to some
observers (DeBrun, Cubillas, Martialis), the disease also occurs among
domestic animals. Piot-Bey observed in 1895, in Egypt, enzootic
affection of cattle which he identified with dengue fever. The animals
suddenly became affected with a striking muscular weakness, which
was so marked that they staggered and trembled in walking, or béecom-
ing exhausted they lay down on the chest. The body temperature was
moderately elevated (89.5 to 39.6°C.), respiration and pulse accel-
erated (25 to 30, and 60 to 90 per min.). At the same time there was
complete inappetence and constipation. Usually after three to four
days diarrhea appeared, which was soon followed in all cases by
complete recovery. (Fiévre dengue sur l’espéce bovine, Extrait du
Bull. de l’Inst. Egyptien, Le Caire, with literature).

Three Days’ Sickness, Stiff Sickness, Ephemeral Fever. In South
Africa there occurs a disease among cattle which Schweinfurth observed
in 1867, but to which the attention of the experts has only in recent
years been directed, when it spread extensively in Rhodesia, in the
Transvaal, Natal and in the Cape Colonies. It was first demonstrated
in November, 1906, by Edmonds, and later described by Bevan, Theiler
and Freer (it is possibly identical with dengue fever).

The symptoms in the majority of cases develop and disappear
within three days, or the disease may terminate in death. Manifesta-
tions are, stiffness of the muscles of one or all extremities, extending
to the neck, or even over the entire body. As a result of this condition
the animals are lame, and later they are hardly able to move and seem
obliged to lie helplessly on the ground. Development of this condition
is preceded by diminishing appetite and rumination, and also by an
elevation of the body temperature, while later on there appears a
conjunctivitis, with swelling of the parts surrounding the eyes, frequent
respiration, very weak pulse, distinct veinous pulse and constipation.
The termination is usually favorable, as not more than 3% of the
affected animals succumb, and part of these as a result of inhalation
pneumonia.

The cause of the disease is unknown at the present time, but
Robertson and Theiler showed that it may be transmitted with the
blood of affected animals, in which case the symptoms develop after
an incubation of from 2 to 3 days. It is possible that the infection is
communicated by insects (mosquitoes?). Animals which have recovered
from the disease acquire an immunity which only lasts about six weeks
(Robertson), reinfections being therefore not infrequently observed
(Freer).

Literature. Bevan, J. of comp. Path., 1907, XX, 104.—Theiler, Rep. of
the Transvaal Gov. Bact., 1907.—Freer, V. J., 1910, 19.

Malta Fever. (Mediterranean Fever.) Malta fever is a febrile
disease of man, which most frequently occurs on the Island of Malta,
then in the countries around the Mediterranean Sea, and probably
also in other tropical countries. The disease is very protracted, remit-
tent in its course, and associated with anemia, headaches, rheumatic
difficulties, constipation, and swelling of the joints. A fatal termination
Malta Fever. Distemper of Dogs. 197

occurs only in about 3% of the cases. Bruce (1887) established as
its cause a very small, motile, Gram-negative, oval coccus (micrococcus
melitensis). The organism can be cultivated on the ordinary media,
and shows considerable resistance against drying. In affected persons
the coceus is usually present in the blood, from which it is frequently
eliminated with the urine.

Natural infection occurs in most cases through the ingestion
of raw goat milk. Zammit (1905) proved that about 10% of the goats
at Malta eliminate the causative agent of Malta fever with their milk,
and that many of these animals harbor the organism in their blood.
He further found that the serum of about 50% of all goats gives a
positive agglutination reaction. As it has been proved that the infec-
tion may be readily transmitted through ingestion of infected milk,
the drinking of raw goat milk was prohibited in the army, whereupon
the morbidity immediately dropped to one tenth of its former rate.

Goats which pass the microccocus melitensis with the milk, and
also with the urine, usually show no, or only slightly marked symptoms,
but if they are killed, hyperemia and acute swelling of the spleen,
together with swelling of the lymph glands, especially of the mesen-
teric and inguinal will frequently be found. Exceptionally nephritis
and lobular pneumonia are present. The causative factor may be
isolated by culture procedures from the lesions in the organs, as well
as from the blood and from the udder (in chronic cases only from
the latter).

Goats are easily infected per os, and it appears that the natural
infection occurs by this method, especially by the ingestion of feed
contaminated by urine of affected animals. The virus then becomes
localized in the internal organs and in the udder, where it produces
inflammatory changes, from which the bacteria pass into the milk.
Intravenous or subcutaneous injections of cultures produce, sometimes,
a severe affection, with symptoms of septicemia. It is also possible
to produce a mild form of the disease in monkeys.

The infectious properties of the goat milk may in some cases he
established by the presence of the virus; it may also be considered
infectious if: the blood serum of the suspected animals agglutinates
cultures of the organisms in dilutions of at least 1 to 30. The aggluti-
nation test may be also made with milk (Zammit), or with milk serum
(Pulvirenti), and Wright’s opsoniec test also gives good results.

Literature. Babes, Hb. d. p. M., 1903, ITI, 438, Report of the English Com-
mission, London, 1905-1907, Vol. I-VIL—Mohler & Hart, Bureau Anim. Industry,
1908, 279.

9, Distemper of Dogs. Febris catarrhalis et nervosa canum

(Dog ill; Pasteurellosis canum, Maladie des chiens, Maladie du
jeune age [French]; Staupe der Hunde | German] ;
Cimurro, Moccio canino [Itahan].

Distemper is an acute, contagious infectious disease of
young carnivorous animals, and is characterized by febrile
manifestations, and an acute catarrh of the mucous membranes,
which is frequently followed by catarrhal pneumonia, and in
some cases by the development of nervous symptoms. The
disease is caused by a filtrable virus.
198 Distemper of Dogs.

History. The frequency of the disease among dogs, and its im-
portance, is well illustrated by the fact that it is known in almost all
languages as the ‘‘dog disease.’’ In Europe it is supposed to have
occurred since the second half of the eighteenth century, having been
introduced from Asia (Spinola) or from Peru (Heusinger). The
infectious nature of the disease was proved in the middle of the last
century, by successful experiments of transmission, with the nasal dis-
charge (Renner & Karle, Weisz, Laosson, Krajewsky), with saliva
‘(Venuta), and with the contents of the skin pustules (Trasbot), from
affected animals to young dogs. Its etiology, however, was first
cleared up by the investigations of Carré (1905), which established that
the disease is caused by a filtrable virus.

Occurrence. Distemper is a remarkably frequent disease
of young carnivora, especially of young dogs, so much so that
the great majority of the latter become affected before reaching
the age of one year. In kennels young animals usually become
affected in great numbers, but not infrequently the disease
occurs in an epizootic form affecting entire townships or even
large territories. It is more prevalent during warm weather,
but is also quite frequent during the winter.

' Etiology. According to the investigations of Carré which
have since been confirmed by Ligniéres, distemper is caused
by a filtrable virus which in the beginning of the disease is
contained in the nasal discharge.

Subcutaneous injections of two drops of the serous dis-
charge from the nose kills young animals within 6 or 7 days
with symptoms of coma and a fall of the temperature at the
termination of the disease. The autopsy shows only an accumu-
lation of clear, yellow serous fluid in the pericardium. Injec-
tion of a filtered nasal discharge, or of filtered pericardial
fluid produces a rapid rise in temperature after 3 or,4 days,
eatarrh of the conjunctivae and the nasal mucous membrane,
cough, and after 8 to 10 days a pustular exanthema on the
parts which are thinly covered with hair. The nasal discharge
becomes more profuse and purulent, whereupon death results
in from 2 to 3 weeks. The autopsy reveals catarrhal pneu-
monia, the heart muscle appears to be sprinkled with small
hemorrhages and yellow spots, while the pericardium, some-
times also the pleural and the abdominal cavity, contains a
serous fluid in varying quantities. The exudate is only ex-
ceptionally virulent, unlike that of acute cases. The blood is
only virulent at the beginning of the fever, while later, even
in an unfiltered condition, it will not produce the disease; this
applies also to the nasal discharge which has become purulent,
and to material from the hepatized lungs. Healthy dogs may
be artificially infected by cohabitation.

In view of the results of the investigations, the different bacteria
which have been found by various investigators in the tissues of dogs
affected with distemper must be considered as secondary participants
Etiology. 199

in producing the disease processes. The filtrable virus which attacks
the body, prepares the field of action for the other organisms which
produce inflammatory local changes. Thus Jensen found strepto-
cocci, staphylococci and a slender bacillus, Mathis isolated a diplo-
coccus from pustules on the skin, the cultures of which resembled the
ordinary staphylococcus, Schantyr obtained a motile bacillus resembling
the organism of abdominal typhus, Perez incriminated the cocco-bacillus
ozoenae foetidus, while Galli-Vallerio found a bacillus resembling
the colon bacillus, which, however, stains by Gram. Ligniéres, Ceramicola
and Wunschheim attributed the disease to an ovoid bacterium, and Pior-
kowski obtained a slender, delicate capsulated bacillus, ete. :

All of these organisms appear to be normal inhabitants of the
dog organism. In different cases one or the other, or several of these
organisms commence to multiply more rapidly in the affected dog,
and then exert their pathogenic action. This applies especially to
the bacillus bipolaris septicus, which was considered by Ligniéres as
the true cause of the disease. Cultures of this organism (they can
only exceptionally be isolated) produce severe septic symptoms in dogs
after intravenous injections, and frequently also secondary inflamma-
tions in various organs. Whether there exists an independent pas-
teurellosis of dogs, as claimed by Ligniéres, in addition to the distem-
per caused by the filtrable virus, is not established at the present time.

Contrary to the described etiological findings, Kregenow succeeded in producing
the disease with filtrable virus in only two instances out of 10 inoculations, and
even the two positive cases he attributes to natural infection. Accordingly he is
of the opinion that the virus is not filtrable, and must be one of the numerous
visible organisms. However, the experiments, as indicated by his notes, were not
carried out as suggested by Carré, with the serous nasal discharge, but with a puru-
jent discharge and material obtained from pneumonic lungs. It is possible, therefore,
that the filtrable virus contained therein was retained during filtration.

Natural infection occurs through direct or indirect contact
with affected animals. The virus is present in the catarrhal
secretion of the mucous membranes and is evidently in most
instances taken into the digestive canal with the food and water.
The infection is probably favored by influences which reduce
the resistance of the body, such as colds, insufficient or im-
proper food, such as bread, kitchen refuse, etc. The disturb-
ances of digestion caused by these, together with loss of blood,
exhaustion, weak constitution, etc., favor the development of
the disease.

Young animals are most susceptible. They may excep-
tionally become affected when only 2 to 3 weeks old (Fried-
berger & Fréhner), but usually dogs several months old up to
one year suffer most frequently from the disease (this is prob-
ably due to the fact that the animals at that age move around
‘more freely and are more exposed to the infection). The
susceptibility diminishes with advancing age, so that animals
over three years old are but rarely affected. The great re-
sistance of older animals is in all probability due to the fact
that the great majority have been affected with the disease
at a younger age and have thereby become immune to it.

Pampered and weakly dogs, as well as animals recently
200 Distemper of Dogs.

imported, especially those of the finer breeds, are more sus-
ceptible and usually become more severely affected than do
dogs which are kept in the country and are hardened.

Pathogenesis. The action of the specific virus produces a
febrile condition, and in direct association with it catarrh of
the mucous membranes, as well as inflammation of the serous
membranes, especially of the pericardium. If the animal lives
through the acute attack, its weakened resistance favors the
development of secondary processes by other micro-organisms.
These are usually facultative pathogenic bacteria, which are
mostly, or probably invariably, frequent habitants of the healthy
dog. Of the secondary inflammations the most frequent are
pneumonia, purulent inflammations of the conjunctivae, the
mucous membranes of the air passages and of the intestinal
canal, pustules on the skin, and also inflammatory changes
in various parts of the nervous system as a result of metastasis.
The later course of the disease depends on these secondary
diseases, while the filtrable virus usually disappears before,
or not later than at the beginning of their development.

Anatomical Changes. In the rare peracute cases a large
quantity of serous fluid is present in the pericardium, and
possibly there are small hemorrhages in the heart muscles.

In the great. majority of cases the respiratory organs, es-
pecially show severe changes. The mucous membranes of the
air passages are bright red, swollen, and profusely covered
with sero-purulent secretion. If the smallest bronchi are af-
fected simultaneously numerous small purulent plugs may be
squeezed out of the cut surface of the lungs (bronchitis
capillaris). In most cases there is also a catarrhal pneumonia.
Sometimes small broncho-pneumonic areas may be disseminated
throughout the lungs, or larger lung portions, especially near
the anterior and lower borders are found dense, hepatized, and
according to the duration of the inflammation either dark
brown-red or grayish-red. The cut surface is smooth or finely
granulated, and sometimes studded with small purulent foci.
The borders of the unaffected lobes of the lungs show bluish-red,
depressed, club-shaped atelectatic areas. The pleura covering
the affected parts of the lungs is either smooth and lustrous,
or dull and covered with fine fibrinous membranes.

The mucosa of the stomach and intestines show frequently
manifestations of acute catarrh; the solitary follicles, as well
as Peyer’s patches are swollen. Exceptionally there may also
be superficial erosions and catarrhal ulcerations present.

The lymph glands of the thoracic cavity, and of the
mesentery show inflammatory swellings; the pericardium con-
tains sometimes a great quantity of a clear serous fluid. The
heart muscles may be interspersed with small hemorrhages and
yellow fatty degenerated areas. The liver and the cortical
portions of the kidneys show parenchymatous or fatty de-
Symptoms. - 201

generation. The spleen is only slightly, or not at all enlarged.
‘The eyes are usually affected with a more or less intense catarrh
_of the conjunctivae sometimes an ulcerative keratitis, and oc-
easionally by a panophthalmitis.

The central nervous system may in some cases show
changes corresponding to a myelitis disseminata (Mazulewitsch,
Bohl, Dexler).

According to Dexler’s investigations the changes of the central nervous system
show a pronounced disseminated myelitis and poliomyelitis, in which the inflam- ,
matory foci are not confined to the gray anterior lobes alone, but are always
present in the entire nervous system without any regular arrangement. Virulent
streptococci are frequently found in the affected areas.

Confirming similar reports of Standfuss, Lentz describes small roundish or
oval formations which he calls distemper corpuscles and which are supposed to
develop from the action of the distemper virus on the plastin substance of the
nerve cells which is destroyed, and causes the chromatin substance to roll together
in peculiar granules. These formations which have been found in dogs dying from.
a severe nervous form of distemper are distinguished from the somewhat similar
Negri’s rakies bodies, in that they occur outside of the nerve cells, or in the greatly
degenerated cells, and possess no inner structure.

Symptoms. The time of incubation after an artificial in-
‘ fection is usually from 3 to 4, and at least 2 days (Carré);
although it is probably somewhat longer under natural con-
ditions (according to Krajewszki it may extend up to 2%
weeks).

The peracute form of the disease is manifested in a sud-
denly appearing inappetence, depression, groaning, fatigue, as
well as high fever. After 2 or 3 days the temperature rapidly
drops below normal (to 35-33°C ), whereupon death soon ap-
pears under comatous symptoms (Carré).

The acute form also is inaugurated by high fever (Fig. 35),
the temperature rising rapidly to 40°C. or over, and remains
at this height for 1 to 2 weeks or it falls slightly in 1 to 2 days,
and then there exists only moderate fever, of a continuing or
remittent character in the further progress of the disease.
In severe cases the temperature rises again owing to the de-
velopment of pneumonia, but towards the termination of the
disease it falls gradually or rapidly below normal (to 32°).

The beginning of the disease is usually indicated by a
change in the disposition of the animal. The animals, or-
dinarily bright and playful, become capricious and less lively;
they obey the call only with hesitation and unwillingly, pre-
ferring to find secluded places where they remain lying for
long periods. Meanwhile they tremble over the entire body,
or at times appear suddenly startled. The hair is roughened,
the appetite diminished and capricious. After 1 or 2 days the
more characteristic symptoms of the disease develop.

In most cases an acute catarrh of the air passages appears.
The animals feel an itching in the nose because of which they
frequently sneeze and puff, wiping the nose with their paws
or on the forelegs. There is at first a serous or mucous, later
a purulent secretion from the nose, which soils the surrounding
202. Distemper of Dogs.
parts and dries around the nasal openings in brown crusts.
The secretions may also contain streaks of blood, or become
ichorous, and irritate the skin of the upper lip and of the
nasal wings, which then become raw. If the swelling of the |
nasal mucous membrane is pronounced the respiration becomes
sniffing (this is an
especially frequent
manifestation in
breeds of dogs with
short heads).

- The catarrh of
the larynx and the
bronchi is indicated
by a cough which at
first is short and dry,
later more prolonged
and moist. It some-
times appears spas-
modically, and in
such cases it tortures
the animals greatly,
and also causes vom-
iting. Respiration is
accelerated and lab-
ored. Auscultation of
the thorax reveals
rough vesicular
breathing, and dry
or moist rales, as well
as other catarrhal
sounds. If in the fur-
ther course of the
disease capillary
bronchitis or ea-
tarrhal pneumonia
develops, the number
of respirations ~ in-
creases to 60-80 and
even more per min-
ute. The accessory
respiratory muscles
are utilized to a
great extent, and at each expiration the cheeks become dis-
tended. In such cases percussion shows dullness, or a tym-
panitic sound in places, while on auscultation, extensive
catarrhal murmurs are heard, in other places bronchial breathing
or no respiratory sounds at all are observed. The cough now
becomes very weak and feeble.

The affection of the eyes mostly develops simultaneously
with the catarrh of the respiratory organs. It commences with

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Symptoms. 203

conjunctivitis, to which are added photophobia, pain and swell-
ing of the eyelids. The conjunctiva is bright red, has a moist
luster, and at times is raised above the cornea. The lachrymal
secretion is increased from the onset, but later the tears
are mixed with a mucous and purulent secretion, which,
to some extent accumulates in the inner canthus, sticking the
eyelids together, especially at night. Ulcerative keratitis
develops with relative frequency in association with the con-
junctivitis, small depressions appearing in different parts of
the cornea, which may later heal entirely. Sometimes, however,
these lesions extend rapidly in size, so much so that even on
the first day loss of substance may result which reaches the
extent of a lentil, and penetrates to Descemet’s membrane, or
in some instances the entire cornea may be destroyed. The
borders of the depressions, as well as the entire cornea may at
the same time be clear, or pus may be present only at the base
of the depressions. Descemet’s membrane thus exposed is
then forced out as a result of the internal pressure from the
eye, and in this manner a staphyloma may develop, the rupture
of which may result in the prolapse of the iris, followed by
the well-known severe results. In other cases a parenchymatous
keratitis develops, associated with a uniform cloudiness and a
marked ciliary injection of the cornea, which retains its char-
acter until the termination of the disease, is not followed by
ulceration, and gradually disappears or results in a permanent
white cloudiness. The pupil usually becomes constricted, while
severe iritis with accumulation of a plastic or a purulent
exudate in the anterior chamber occurs only rarely except in
cases in which there is a perforation of the cornea.

The involvement of the digestive organs is shown early
by diminished appetite. At the onset of the disease an increased
thirst, as well as vomiting is observed, which is an indication
of acute gastritis. The patients vomit mostly slimy, yellowish
material mixed with bile. At the same time the buccal mucous
membrane is dry and warm, the tongue is coated, and the region
of the stomach sensitive. As a result of the intestinal catarrh
which 1s usually present together with the gastritis, there is
at first constipation; which soon changes to diarrhea. The
excrements which are often passed under severe straining are
in a fiuid state and may contain mucous flakes or blood. The
feces are very fetid. The abdomen is at first somewhat bloated,
later however it becomes drawn up and painful.

In some eases.the urine contains albumen, and occasionally
bile pigments as well as hyaline and cellular casts.

Nervous symptoms are hardly ever absent even in the
cases which are not very severe, and sometimes they may reach
such a degree that they practically control the entire disease.
Besides the dullness and the change in the disposition of the
animals already mentioned, the patients sometimes manifest
considerable excitement which, however, usually lasts only a
204 Distemper of Dogs.

few hours. In many cases muscular tremors or clonic spasms
develop, and are either confined to certain groups of muscles,
or extend over the entire body. Local spasms are usually
observed in the face, especially on the lips, nasal wings, cheeks,
and in the muscles of mastication (chattering teeth and foaming
lips). In other cases spasms occur in the muscles of the neck
or extremities so that the affected portion of the body, in the
former case the head .and the neck, trembles sometimes con-
stantly or only at certain periods, or again it may be moved
regularly in a certain direction.

The spasms of the entire body muscles which frequently
develop from the above condition are manifested either by con-
tinuous trembling or by periodical epileptiform fits. In the
latter case the animal becomes restless, then suddenly collapses
unconscious, while chronic spasms occur over the entire body,
and the rapid movements of the jaws churn the saliva to a foam. .
The expression of the face is distorted, and the head is forcibly
extended forward or turned sidewise. During the attack feces
and urine may be passed involuntarily. These attacks exhaust
the animals greatly, and sometimes occur several times within
an hour, whereupon a deep coma develops which soon is fol-
lowed by death. As the reflex irritability is greatly increased
the local, as well as the general spasms may be brought on by
slight external irritations, such as loud calling, irritation of the
skin, sudden exposure to light, ete. Occasionally involuntary
movements may be also observed.

The convulsions may gradually become less frequent and
finally disappear; in some cases, however, they terminate in
paralysis, which may appear in certain parts of the body, while
others are still irritable. The paralysis is most frequent in
the hind parts, and is associated with movements of incoordina-
tion, and not infrequently by paralysis of the sphincter muscles
of both bladder and rectum. Paralysis of a facial nerve
results in a distortion of one-half of the face; paralysis of an
oculomotor nerve causes an abnormal position of the eye,
strabismus and inequality of pupils. Simultaneously with the
paralysis contractions may develop in some of the extremities.

According to Dexler the virus of distemper may produce three
great groups of nervous disturbances: 1, local clonic-tonic continued
spasms of different parts of the body, and chorea-like movements; 2,
flaccid paralysis of the extremities and sphincters; 3, clonic-tonic epi-
leptiform fits occurring during attacks of unconsciousness. All these
symptoms are brought on by isolated or general inflammatory changes
which can be demonstrated histologically (see p. 201), and since the
motor disturbances differ from those of chorea of man, Dexler appears
to be justified in his conception that the convulsions of distemper do
not represent a neurosis, and accordingly should not be designated as
chorea, but that the affection should be considered as an independent
condition, and for the present should be named ‘‘distemper-Tic,’’ or
rhythmical post-infectious convulsions.
Course. 905

In about one-half of all cases a peculiar pustular exanthema
(distemper exanthema) is observed on the skin. Small red
spots may appear on the inner surface of the thigh, on the
contiguous abdominal wall, or more rarely on the parts sur-
rounding the nose and the eyes, in the external ear, on the
conjunctiva, and exceptionally on the entire surface of the body.
At these places small nodules soon develop, which change to
lentil-sized purulent vesicles. They dry to brown crusts, or
burst, leaving reddened moist places which later become also
covered with scabs. If the eruptions become extensive the
animals at this stage diffuse an unpleasant sweetish odor.
Finally the scabs drop off, and in their place reddish spots
covered with epithelium are left, which gradually become paler,
and finally disappear entirely. In rare cases the pustular
exanthema may also develop on the borders of the lips, whence
it may even extend to the buccal mucous membranes, and there
produce a severe ulcerative condition which may even lead to
a general septic infection. (Semmer, Arnous, Hiirlimann; see
also typhus of dogs, p. 213.)

Trasbot considered the pustules of the skin as true pox eruptions, and this
conception appeared to be strengthened dy successful experiments of transmission.
Alowever, their rapid development, as well as che lack of the characteristic structure
of the true pox vesicles, further the fact that the artificial production of such
vesicles does not influence the susceptibility of the dogs for distemper infections,
contradicts this supposition. Moreover, Carré succeeded in producing the exanthema
even with the virus of foot-and-mouth disease.

The action of the heart is more or less disturbed according
to the severity of the different cases. In severe cases the heart
beat is greatly accelerated, irregular, throbbing, and the pulse
wiry, owing to the parenchymatous degeneration of the heart’s
muscles.

Lange observed in about 50% of animals affected with distemper,
a painless external otitis, with a thin fluid secretion and moist eczema
of the external ear passage. Sabrazés & Muratet found in the blood
of dogs affected with distemper a neutrophilic polynuclearcytosis and
hypoeosinophilia, as well as an iodophilia.

The animals usually become greatly emaciated in the course
of the disease. At the approach of death they lie in a deep
stupor, trembling on the ground, until they finally die of the
convulsions.

Course. The disease shows a most varied course. Fre-
quently, especially in benign cases, only a certain group of the
symptoms described are present, and even these may be
developed in different cases with varying intensity. Thus
in some cases catarrhal symptoms are present exclusively, while
in others only nervous manifestations are seen. Sometimes the
disease is manifested by pustular exanthemata of the skin only.

Taking the etiological identity of these cases into consid-
206 Distemper of Dogs.

eration, a catarrhal, a nervous and an exanthematous form of
distemper may be distinguished. Such sharp characteristic
forms of the disease, however, are only rarely observed, as in
most instances the symptoms of two or even of all three forms
are present simultaneously, although in such a way that the
symptom complex of one of the forms usually predominates.
Most frequently the catarrhal or nervous form occurs separ-
ately, while the skin exanthema usually occurs conjointly with
one or the other. Besides the character of the disease may
not infrequently change during its course, as it is often noted
that nervous manifestations associate with the catarrhal symp-
toms, and later these may even predominate.

Just as there are great variations in the clinical appearance
of the disease, so its duration varies greatly from case to case;
very mild cases may thus terminate in recovery inside of a
week, whereas severe cases may extend over several months.
The average duration, however, is from three to four weeks.
The recovery is not infrequently incomplete, or it may become
complete only after a long time. The symptoms of paralysis
are most prone to persist, or may improve only after several
weeks. Incurable degenerations may be present in some of the
nerves of the brain, leading sometimes to blindness, deafness,
loss of the sense of smell, ete.

Occasionally after the acute stage of the disease has passed
‘a certain predisposition of the mucous membranes for catarrhal
affections becomes noticeable which leads for months after-
wards to repeated catarrhs. The catarrhal pneumonia may
develop into a chronic inflammatory condition leading to casea-
tion of the exudate and an increase of the connective tissue,
which considerably interfere with the later development of
the young animals.

Permanent changes sometimes develop in the eyes, such as
white cicatrices at the sites of the cornea ulcerations, synechiae
after a perforation of the iris, and occlusion of the pupil or
atrophy of the eyeball after a severe iritis.

Diagnosis. Distemper may be readily distinguished from
other catarrhal affections whenever nervous or pustular exan-
thema are present in addition to catarrhal symptoms. This
also applies to older animals, in which the diagnosis is other-
wise more difficult. In the presence of purely catarrhal symp-
toms, the high fever which occurs in the beginning. of the
disease, the pustular exanthema, the early age of the animals,
and frequently also the possibility of tracing the infection,
may reveal the nature of the disease. Gastro-intestinal catarrhs
originating from other sources, such as for instance from.
dietetic errors or from poisoning, are differentiated from dis-
temper by the absence of the catarrh of the air passages and
conjunctivae. The change in the disposition of the animals,
Prognosis. Treatment. 207

especially the occasionally noticeable excitement and also the
convulsive mastication with the formation of foam at the
mouth, may create a suspicion of rabies. However, this condi-
tion exists in distemper only for a very short time, and is soon
followed by a period of depression, then by muscular spasms,
while the paralysis of the muscles of the pharynx and of the
muscles of mastication which are characteristic of rabies, are
absent. The severe convulsive attacks are distinguished prin-
cipally from those of epilepsy by the fact that in distemper
they occur at frequent intervals, are preceded by iocal muscular
a lpetie and that these spasms are present even between the
attacks.

Prognosis. The average mortality in the disease amounts
to about 50%. The cases in which the purely exanthematous
and catarrhal symptoms are present are the most favorable with
about 70% recoveries. Least unfavorable are the cases in which
the nervous manifestations predominate, as in these the recov-
eries sometimes do not reach 10 to 15%. The more rapidly
the symptoms increase in severity and the higher the degree
they attain, the more unfavorable becomes the prognosis. The
convulsions which affect the entire body, as well as the appear-
ance of catarrhal pneumonia, and a severe persistent diarrhea
are unfavorable prognostic indications. Continuous high fever
indicates a severe infection as a result of which grave changes
in the myocardium may be expected. A still more unfavorable
sign is the rapid fall in the temperature below normal, as it
usually indicates the approach of death.

Pampered, very young or improperly nourished dogs usu-
ally become more severely affected than older and hardened
animals of ordinary breeds. The existing hygienic conditions
should also be given consideration in the prognosis.

According to statistics of Wirth, which include 2855 cases, an average of
35 8% succumb to the disease. In these cases the mortality was the lowest among
fox terriers, and highest in hounds. Nervous symptoms were observed in 15.1%
of the cases, females appearing to be more predisposed to this form of affection;
in some outbreaks the exanthema was entirely absent.

In Jocalities i which the disease occurs only periodically as a result of intro-
duction trom the outside, it rages with peculiarly destructive force, and it has
been observed, for instance in Greenland, that sometimes such outbreaks destroy
about one-third of the entire number of dogs (Hjortlund).

Treatment. First of all the hygienic condition, and espe-
cially the diet, should be suitably regulated. The affected
animals should be placed ini a clean, uniformly warm place,
they should be protected from draughts, and if possible should
be furnished concentrated nourishment. For this purpose milk
and good strong meat broth, with the yolk of an egg beaten
into it, is most suitable. Several daily feedings with chopped,
salted meat cooked in steam, is very beneficial (Gerstner). In
the presence of gastro-intestinal catarrh, gruel may be given
to advantage. is
208 Distemper of Dogs.

As an abortive treatment subcutaneous injections of tri-
chloride of iodine (3 times daily, 3-5 g of a solution of 1 to
1000-500), as recommended by De Bruin, are indicated. This
method of treatment when applied in the early stages of the
disease is very beneficial, as the animals after a few days
become much brighter, their temperature returns to normal,
and the catarrhal manifestations diminish. In some of the ani-
mals, however, in spite of the greatest care, a necrosis of the
skin at the point of injection develops. Bass recommends for
the early treatment, Ichthargan (Ichthargan, gummi arab. aa.
5.0, aqu. 100.0, 3 times daily in teaspoonful to tablespoonful
doses), while Liebert & Schmidt recommend tannargentan (1
g. 2 or 3 times daily). |

For the depression and weakness nervous stimulants are
recommended, such as alcohol (wine, cognac) in proper dilu-
tions, and in small but frequently repeated doses. In severe
cases coffee or caffeine, liquor ammonii anisatus in any desired
infusion, also subcutaneous injections of 30 ce. of a physiological
salt solution (Parent) are indicated. To the salt solution it
is advisable to add 10-20 cg. caffeine (Cuny).

The fever does not require any special treatment, unless
very severe (over 40°), when the administration of antipyretics
(phenacetin, antipyrin, in doses of 0.25-0.50 g.) is recommended.

The catarrh of the respiratory organs is treated to the
best advantage with inhalations of warm vapors, containing
expectorants (1 to 3% solution of carbonate or bicarbonate of
soda). If the secretion is very profuse inhalations of disinfec-
tant fluids (creolin 2-3%, creosote 0:5%, turpentine, aqua-picis,
septoform) may be given three or four times daily with Siegel’s
or Bulling’s apparatus. In painful dry cough antispasmodics
such as Morpheum salts (morphii muriat 0.10, aqua. amyegd.
amar. 12.0, 10 to 15 drops every 2-3 hours), or codein (cod.
phosph. 0.30, aqu. 150.0, 1 to 2 teaspoonfuls every 2-3 hours)
give beneficial results. In the presence of profuse secretions,
however, suppression of the cough is rather harmful. In such
cases ipecacuanha infusions and senega decoctions, given either
with apomorphine (1 to 2 mg. per dose) or with ammonium
chlorate (0.1-0.5 g.) may be used to better advantage. If pneu-
monia has appeared inhalations of oxygen may be tried
(Kantorowicz).

The gastro-intestinal catarrh should be treated first by
regulating the diet as already described, and in the first days
of the affection a cathartic such as castor oil or calomel (0.02-
0.05 g. 2-3 times daily), as well as salol, should be given. If
vomiting 1 is present this may be controlled by the administration
of ice, water containing soda, salicylate of bismuth (0.5 g.),
in emergency with opium (0. 05 to 0.10 g.). For the stimulation
of the digestion hydrochloric acid (0.2 to 0.5 g.) in-the drinking
water, or pepsin (0.1 to 0.5 g.) alone or with the hydrochloric
acid, is advisable. Besides the various bitter tinctures (Tinct.
Treatment. 209

rhei aquosa and vinosa, Tinct. gentianae, Tinct. chinae com-
posita 5-10 g. per dose) are often used. If diarrhea has appeared
it is advisable to administer opiates (0.1 to 0.2 opium or 5
times that amount of the opium tincture every 3-4 hours) ; this
may be given together with tannin (0.1 to 0.5 g.), bismuth sub-
nitrate (0.2 to 0.5 g.), tannoform, tannalbin, tannopin (0.5 to
1 g. of each), or with red wine (in teaspoonful doses).

Raleigh obtained recoveries in 60% of his cases by treating the affected animals
first with 0.25 to 0.40 g. of calomel, and followed four times daily with 0.60 g.
sodium hyposulphite, while Liebert & Schmidt obtained splendid results from the
administration of tannargentan (2-3 times daily 1 g. doses).

In the presence of nervous symptoms anodynes and anti-
spasmodics are recommended. However a beneficial action
from their use on the neuritic or myelitic affection, can hardly
be hoped for. Of these may especially be mentioned bromide
of potassium and bromide of sodium (1:250 4 or 5 times daily
in tablespoonful doses), chloral hydrate (0.5 to 2 g.), sulfonal
(1 to 2 g.), or morphium in larger doses (0.05 to 0.1 g.) sub-
cutaneously. Paralysis may be treated with massage, alcohol
rubs, or by the application of electricity, as well as by sub-
cutaneous injections of veratrin (1 to 5 mg.) or strychnia
(0.5 mg.).

The conjunctivitis, while the symptoms of irritation last,
should be treated with warm applications 2-3 times daily, and
washing with a 1% creolin and boracie acid solution, while
astringents are indicated only after the subsidence of the acute
symptoms. Of such astringents may be mentioned 0.5 to 1%
solutions of sulphate of zinc, alum, or tannin, as well as the
‘‘eollyrium adstringens luteum’’ (diluted 1-3 to 1-2). If the
catarrh has become chronic, or if there exists a continuous
purulent secretion, the painting of the eye with a 1% silver
nitrate solution may be tried. It should be applied with very
great care, and the superfluous portion should be neutralized
with a 1% salt solution. For the keratitis, as well as for the
internal inflammations of the eye, warm applications and the
dropping of a 1% atropin solution into the eye are recommended.
For clearing away the cloudiness in the cornea, the applica-
tion of powdered calomel! or iodide of mercury salve (1-20),
with subsequent massage of the eye, is often beneficial; this,
however, should be only undertaken after the disappearance
of the acute symptoms. For threatening blindness as a result
of paralysis of the optic nerve, injections of strychnia into the
temporal region might be favorable. : ;

The exenthema of the skin does not require a special treat-
ment, but the sprinkling of the moist surfaces with a drying
powder, or the application of a salve, may assist in the healing
of these lesions.

Prevention. Since the affected animals easily infect others,
they should be kept from healthy young dogs and cats, and the
14
210 Distemper of Cats.

place where they are kept should be disinfected. Young animals
should be kept from contact with sick ones, and by this the
advantage will at least be gained that the animals may not
become affected until an older age, when, according to observa-
tions the chances for recovery are much better. _

Immunization. The various sera for distemper.are not very prom-
ising, as they are prepared with the aid of bacteria, which at best are
of importance only in the secondary organic lesions.

Ligniéres uses for this purpose partly attenuated cultures of bipolar bacilli
obtained from affected dogs, partly his polyvalent vaccine and his polyvalent serum
(see pp. 85 and 86). Physalix uses cultures of the same organism grown in glycerin
bouillon, while Piorkowski prefers a serum prepared with the aid of his ‘‘ distemper
bacillus.’’ But with none of these preparations was it possible to obtain satisfac-
tory results in practice. Richter proved that the vaccines of Physalix and Piorkowski
are valueless for the treatment of the disease, and Boden also found that Piorkowski’s
serum at the best only produced an improvement in the first stages of the purely
eatarrhal form of distemper.

Bissauge & Naudin recommend the antistreptococeus sera of the Pasteur Insti-
tute, and of Dassonville & Wissoeq (twice daily 2-4 doses of 4 ec. each); and at the
same time the administration of Pury’s Swiss yeast in warm milk.

The yeast serum (antistreptococeus serum), obtained by Deutschmann by
treatment with increasing amounts of yeast, is according to Lamche absolutely
useless as a prophylactic agent, and as a curative it has only a moderately beneficial
action in those cases which show no complicating intestinal affections. Blanck and
Wolff, however, report favorable results from this method of treatment.

The distemper-antigourmin (Furonculine), which has been highly recommended
by Diffiné and is prepared from equal parts of yeast and starch, proved unreliable
in the experiments of Meltzer, Hochstein, Meckelburg and Lamche both as a
curative and prophylactic. :

Literature. Bollinger, A. f. Tk., 1878, IV, 214.—Krajewski, Rev. f. Tk.,
1881, 177 (Lit.); D. Z. f. Tm., 1887, XIII, 324.—Laosson, Diss. Dorpat, 1882
(Int.).—Dexler, Arb. d. Wiener Inst. f. Nervenanat., 1892; D. t. W., 1909, 313
(Lit.).—Jensen, Maanedsskr., 1895 and 1896.—Jess, Zbl. f. Bakt., 1899, XXV, 541.—
Ligniéres, Bull., 1900, 469 (Lit.); 1906, 622.—Physalix, Bull., 1901, 131.—Carré,
Bull., 1905, 335; Rev. gén., 1906, VII, 649; C. R., 1906, 962.—Piorkowski, B. t. W.,
1905, $30; 1906, 377.—Wirth, T. Zbl., 1908, 200.—Richter, Die Hundestaupe, Diss.
Bern, 1908 (Lit.)—Kregenow, Zbl. f..Bakt., 1909, L, 326 (Lit.).—Lamche, Diss.
Zirich, 1909 (Lit. on yeast treatment).

Distemper of Cats. Although young cats are also suscep-
tible to the virus of distemper (Krajewski, Laosson), the dis-
ease occurs in these animals much less frequently than in dogs.
The symptoms and the anatomical changes correspond with
those of dogs affected with distemper, but according to Fried-
berger & Frohner nervous symptoms are less common and the
exenthema of distemper is usually absent. In the treatment
the above-described principles should be followed. (Literature
same as in dog distemper.)

A new disease of cats was described by Gaertner, in which the
symptoms consisted of depression, conjunctivitis, muco-purulent dis-
charge from the nose, and marked difficulty in respiration. The disease
usually terminated in death in from three to six days; exceptionally,
however, it lasted for several weeks. The autopsy revealed a multiple
necrotic pneumonia, principally of the posterior lobes of the lungs,
and as the causative agent a bipolar ovoid bacillus (Bact. pneumoniae
felis) was established (Cbl. f. Bakt., 1909, LI, 232).
Typhus of Dogs. 911

An ovoid bacterium (Bae. felisepticus) was also found by Boucek
in young cats, which died in an enzootic. These animals suffered
from disturbed appetite, vomiting and convulsions, while the autopsy
revealed a mild intestinal catarrh, moderate swelling of the spleen and
of the mesentery lymph glands, as well as punctiform hemorrhages -
in the pericardium and in the heart muscles (Cbl. f. Bakt., 1909,
LIT, 279).

II. Typhus of Dogs. Typhus canum.

(Hundetyphus, Stuttgarter Hundeseuche; Gastro-enteritis
haemorrhagica.)

Typhus of dogs is an acute infectious: disease which
periodically occurs in an epizootic form, in the course of which
severe symptoms of a gastro-intestinal inflammation are ob-
served frequently complicated by ulcerative stomatitis and
severe nervous symptoms. The etiology of the disease has not
been determined up to the present time.

History. Hofer described the disease under the name of ‘‘typhus’’
in 1850; however, it did not create a general interest until it appeared
in Germany in 1898, and in the following years also in other countries,
as a severe plague. In this outbreak the disease was first described
clinically by Klett; who observed it in the fall of the year in and
around Stuttgart (hence the name ‘‘Stuttgart dog disease’’). Other
outbreaks of the affection, and also deviations from the usual mani-
festations were described by Scheibel of Frankfort, Albrecht of
Munich, Zschokke of Switzerland, Trevisan & Gambarotte of Italy, Bimes
& Sérés and others of France, Hébrant of Belgium, Némo of Edin-
burgh, Mattel & Tremmel of Vienna and vicinity. A similar disease
was observed in 1903 at Budapest, when several cases came under
observation. .

Occurrence. According to the above mentioned writers the
disease existed in the years of 1898-1900 in Middle Europe in
the form of a wide spread, epizooti¢ extension; since that time
however it has again disappeared. In the period mentioned
the disease caused great losses especially among older dogs
of the affected localities.

Etiology. The epizootic occurrence of the disease in
various localities which are not far apart, appears to indicate
its infectious nature. On the other hand various investigators
have observed almost uniformly that direct transmission has
no, or only an insignificant, importance, In its appearance and
spread. Frequently dogs became affected which had not pre-
viously come in contact with affected animals, while on the
other hand among dogs kept in kennels, not infrequently only
isolated cases were observed. Test inoculations have not given
uniform results up to the present time.

In the outbreaks which have occurred usually the older
dogs and not infrequently those over 10 years old became
212 Typhus of Dogs.

affected. Some of the animals contracted the disease in spite
of the fact that they had passed through an attack of distemper.
The condition, sex and breed of the animals appeared to have
no noticeable influence on their susceptibility.

Attempts at artificial transmission have so far given variable
results. Pirl observed after subcutaneous injection of the bile of a
severely affected animal (5.0 or 2.0 em.) into two healthy dogs, that
an inflammatory edema developed at the point of inoculation, followed
by fever, salivation, vomiting, bloody diarrhea and convulsions. One
of the dogs died after three days, the other recovered after six days.
The subcutaneous injection of blood, fluid from the lungs, or an emul-
sion prepared from the walls of the stomach or intestines, produced
only a local suppuration (Albrecht, Scheibel), while the feeding of
organs and of the contents of the stomach of animals dead from the
disease proved harmless. Scheibel observed in only one instance the
development of a gastro-intestinal inflammation, after he had previously
neutralized the gastric juice in the animal which was fed with the
infected material. Scheibel & Zschokke found a bacterium in the blood
resembling the organism of fowl cholera or swine plague, while
Leclainche & Vallée demonstrated in the pathologic secretions and
tissues the presence of a ‘‘Pasteurella.’’ Based on these findings Bimes
& Sérés identified the disease with dog distemper (?).

In the winter of 1903 to 1904 several cases were observed at the
Budapest clinic which in their manifestations, except for the absence
of the ulcerations in the mouth, were similar to the cases observed
in Germany. From the contents of the severely inflamed and hemor-
rhagie intestines, also from the intestinal mucous membrane and the
mesenteric lymph glands, a colon bacillus and a virulent type of proteus
has been isolated in every instance. An intravenous injection of 1 g.
bouillon culture of these bacilli per 1 kg. of body weight, produced
in dogs a very intense hemorrhagic gastro-enteritis, which produced
death inside of six hours, while the subcutaneous injection of the colon
bacillus caused extensive but painless suppuration, and necrosis of the
skin. It was impossible to produce the disease by feeding the bouillon
or meat cultures, not even after a previous neutralization of the hydro-
chloric acid of the stomach (Hutyra).

Anatomical Changes. The autopsy establishes in all cases
severe inflammatory changes in the digestive tract. The mucous
membrane in the entire stomach and in the duodenum, is greatly
swollen, corrugated, and of a blackish-red color. Its surface
shows numerous hemorrhages varying in size from that of a
lentil to a pea, and is covered profusely with mucous or with
a chocolate brown, semi-liquid mass which has an alkaline reac-
tion (exceptionally fresh blood may be also present in the
stomach). Similar, but less plainly marked inflammatory
changes, are present in the intestinal canal, especially in the
small intestines and in the cecum. The peritoneum over the
stomach and the intestines is markedly injected, the mesenteric
lymph glands, and to a greater or lesser extent the spleen also
show acute swelling. The liver and the kidneys are hyperemic,
the latter also contain small hemorrhages; the bladder is
Symptoms, 913

usually distended, its mucous membrane is usually smooth and
pale red. The lungs show only hyperemia and acute edema.
The muscle of the heart often tears easily, and on the cut surface
it is sprinkled with butter-yellow streaks. The brain and its
meninges are hyperemic. The buccal cavity frequently con-
tains inflammatory. as well as necrotic changes (see symptoms),

Symptoms. The disease almost invariably commences with
sudden vomiting, which usually attacks the animal while eating
or drinking, and which may re-appear very frequently. The
vomited material consists of remains of the ingested food or
water stained yellow by ‘the bile, but may later become bloody.
From this stage on, the animals refuse to eat, or they accept
food unwillingly; on the other hand they drink water very fre-
quently and feverishly. There is first constipation, but later
diarrhea appears. ‘

The animals are greatly depressed from the beginning of
the disease, and are unwilling to move about, and in doing so
they manifest a staggering gait. They show indifference to
their surroundings, which condition later develops into great
dullness and sleepiness. .' The animals become greatly emaciated
as a result of the frequent vomiting, and persistent inappe-
tence, and the disease develops in its characteristic form in
from 3 to 5 days.

The conjunctivae show a brownish-red discoloration, are
greatly injected, the eyeballs are sunken in their sockets, the
pupils are dilated. The nasal mucous membrane is of a similar
color and dry.

The mouth emits a very unpleasant, penetrating odor, which
sometimes may be noticeable at a great distance. The buccal
mucous membrane is dry, dark brownish-red, and covered with
a tenacious coating which is at first gray, later thick and
chocolate brown; this coating is especially noticeable on the
tongue. Later the mucous membrane loses its luster in spots,
these areas soon changing into erosions, and becoming covered
with pale yellow or dirty brown, tinder-like scabs; sometimes
they are surrounded by bright red inflammatory tissue. These
lesions are principally observed on the inner surface of the
cheeks opposite the rows of teeth, on the gums, in the corners
of the mouth, on the inner surface of the lips, especially in
the region of the corner teeth, and on the borders of the lower
surface of the tongue. Later the scabs drop off and in their
place dark red ulcerations appear, which are covered with tissue
shreds or with a dirty brown debris. In severe cases the ulcers
may confluate forming large ulcerative areas, while the tongue
may change into a dry, chapped, frequently entirely insensitive,
shrunken body. ;

The abdomen is very sensitive, especially over the region
of the stomach, and it is either bloated or drawn up; loud
peristaltic sounds may be heard when close to the animal. The
214 Typhus of Dogs,

movement of the bowels is at first retarded, sometimes the
animals after severe straining, pass balls of feces covered with
mucous or blood, which may also contain blood; in other cases
again severe diarrhéa may appear, the feces being fluid, bloody
and very fetid. The mucous membrane of the rectum is occa-
sionally greatly inflamed, very painful, and exceptionally also
ulcerated. The body temperature is usually normal, only to-
wards the end of the disease it sometimes drops below normal.
The heart’s action becomes accelerated in the later stages of
the disease, being weak and beating arhythmically. The respira-
tion is quiet, and deep, exceptionally however in the presence
of pneumonia it becomes accelerated. The urine which fre-
quently can be passed only on pressing the greatly distended
bladder, contains in severe cases a great amount of albumen,
and more or less bile pigment. In some cases clonic spasms
of the muscles of the head, or over the entire body, may be
present.

From the described clinical appearance of the disease, which was
observed by Klett at the time of the outbreak at Stuttgart, various
deviations are observed in the different outbreaks, especially in the
extension and intensity of the ulcerative and necrotic processes on the
buccal mucous membranes, which may even be entirely absent in fatal
cases (Albrecht). In other cases there occurs considerable swelling
of cheeks and lips, without ulcerations, a livid discoloration of the
buccal mucous membrane, profuse salivation, and an acute swelling
of the cervical lymph glands (in Scheibel’s cases the disease was always
introduced by high fever). In some of the outbreaks nervous symp-
toms predominated over the clinical manifestations (Bimes & Sérés).

Among other symptoms may also be mentioned rigidity and ten-
derness of the muscles, similar to those occurring in rheumatism; total
paralysis of the hind quarters, hematuria (Mattel); in some of the
otherwise typical cases the body temperature may be high at the
beginning of the disease, and may be associated with severe chills
(Mattel, Tremmel). There may be hemorrhages into the anterior
chamber of the eye (Richter) with which keratitis may become asso-
ciated (Pirl). Some patients may become hard of hearing, and later
deaf (according to Richter probably as a result of the extension of
the inflammatory process from the pharynx to the internal and
middle ear).

Course and Prognosis. The average duration of the disease
is usually from 8 to 10 days; in most severe cases the animals
usually die in from 4 to 6 days, exceptionally however death
ensues towards the end of the second day. The rate of mortality
fluctuates between wide limits in different epizootics. In the
beginning of an outbreak sometimes almost every animal dies,
while later the course of the disease becomes less and less
severe. A very rapid development of the disease, complete
inappetence, profuse diarrhea and great debility indicate un-
favorable terminations, whereas a slow course and mild symp-
toms warrant hopes for recovery. Young animals are more
apt to withstand the disease than older ones.
Diagnosis. Treatment. 215

In the favorable cases the animals sometimes recover en-
tirely within a short time, even the ulcers in the mouth heal
with remarkable rapidity; as a rule it requires from 2 to 3
weeks for the animals to regain their former appetite and dis-
position. The recovery is usually complete; permanent sequelae
develop only in exceptional cases (paralysis of a posterior ex-
tremity, deafness).

Diagnosis. The sudden vomiting, the inappetence and
great depression, the ulcerations on the mucous membrane of
the buccal cavity, the striking injection of the sclerotic conjunc-
tiva, in connection with the infectious character of the disease,
usually afford sufficient grounds for a diagnosis. Distemper is
distinguished from this disease by the almost invariably present
eatarrh of the conjunctivae and air passages, as well as by the
fact that in distemper usually young animals become affected.
In cases of gastro-enteritis resulting from dietetic errors or
poisonings (meat poisoning), the ulcerative condition in the
mouth is absent, besides the more uniform development of the
clinical manifestations, the appearance of the disease in numer-
ous localities, as well as the exclusive affection of dogs, are
indications against poisoning. Ulcerative stomatitis and scor-
butus develop more slowly, furthermore the violent vomiting
and great depression seen at the beginning of this disease
are absent.

Treatment. For the violent vomiting washing of the stom-
ach appears to be indicated; besides this Klett recommends sub-
cutaneous injections of morphine, swallowing of ice, and the
placing of ice bags over the region of the stomach. Mattel
advises the administration of mild Russian or bitter tea, Wohl-
muth prefers a tablespoonful of black coffee every hour, and
tincture of valerian, 15 drops 3 times daily, later warm or
Priesznitz bandages applied to the abdomen may diminish the
pains. In obstipation or diarrhea, enemas (4% boracic acid,
1% alum solution) may be used. Bass administers internally
ichthargan (ichthargan, gummi arab. aa 15.0, aqua 50.0, tea-
spoonful doses every 2 hours), and ichthargan ointment exter-
nally to the inner surface of the thighs. It is advisable to
wash the buccal cavity carefully several times daily with fresh
water or a mild disinfectant (potassium hypermang. in a 1%
solution). The animals should be kept in a quiet place, and if
they evince great weakness or lose considerable blood, subeu-
taneous infusions of luke warm salt solution (0.8%) are indi-
cated (Klett). a ‘ .

After the vomiting subsides it is advisable to give the
animals water acidified with hydrochloric or citric acid, while
in the period of convalescence the animals should be given
highly nutritious food (gruels, milk, eggs, and later meat).
916 Purpura Hemorrhagica.

Literature. Hofer, Repert., 1852, XIII, 201.—Hiirlimann, Schw. A., 1896,
120.—Klett, D. t. W., 1899, 43.—Scheibel, B. t. W., 1899, 73.—Albrecht, D. t. W.,
1899, 189.—Zschokke, Schw. A., 1900, 241.—Mattel, O..M., 1900, 491.—Tremmel,
T. Zbl., 1900, 454——Wohlmuth, T. Zbl., 1905, 113.

°

9. Purpura Hemorrhagica. Morbus maculosus equorum

(Petechial fever, Acute haemorrhagic-anasarcous toxemia,
Typhus equorum, Anasarque essentielle ou rdiopathique,
[French]; Blutfleckenkrankheit der Pferde, [German];
Febbre petechiale, Morbo maculoso, [Italhan].)

Purpura hemorrhagica represents an acute, non-infectious
disease or process, probably caused by a septic bacterial intoxi-
cation, as a sequel to a specific infection. It is principally
characterized by extensive edematous infiltrations of the stb-
cutaneous connective tissue, and by hemorrhages in the sweil-
ings as well as in the mucous membranes, and in the internal
organs.

History. In olden times the disease was grouped among the
putrid fevers (Febris putrida) or with the typhus affections (horse
typhus), and it was thought to be essentially a primary decomposition
of the blood. Later it was considered by some to be a form of anthrax
(Roell), by others an affection related to scarlet fever of man (Perci-
vall, Zschokke). Hering (1841-1850) recognized, its non-infectious
nature and at the same time separated the disease as an independent af-
fection (petechial fever) from other similar ailments. Recently the idea
became generally accepted that the disease is to be taken as an intoxi-
cation caused by bacterial toxins (Dieckerhoff, Ligniéres and others).

The names given at the present time to the disease (petechial
fever, Hering, purpura hemorrhagica) are based upon important
symptoms, particularly the hemorrhages into the mucous membranes.
The designation of horse typhus which was used in former times does
not appear to be appropriate, as the disease differs decidedly from
typhus affections of man, and especially from the abdominal typhus.

Occurrence. The disease usually occurs sporadically, but
many cases may appear within a short time, especially in stables
where. influenza and strangles have existed. The disease is
of importance on one hand because of its frequently fatal ter-
mination, and on the other hand by the very slow course and
the loss sustained by the continued disability of the patient
for work.

According to Javorsky in 1892-1901, 544 eases occurred in Moscow; the mor-
tality among the animals received in the city hospital was as high as 0.3 to 0.8%,
the average being 0.42%.

Etiology. Purpura hemorrhagica with rare exceptions
develops as a secondary affection, as a sequel to diseases in
which suppuration or necrosis of tissue have occurred in any
part of the body. Such diseases are especially strangles, pneu-
Etiology. 917

monia, pharyngitis, influenza, in rare cases catarrh of the upper
air passages or of the intestines, and pyemia of the sinuses of
the head, caries of bone, exanthema of the skin, abscesses from
any cause, and gangrenous areas in the subcutaneous connective
tissue, or in the internal organs. As all of these diseases are
associated with the presence of micro-organisms, and as the
purpura hemorrhagica sometimes occurs in the form of an en-
zootic, it may be accepted that micro-organisms are either
directly or indirectly incriminated in the development of the
disease. The indirect influence of the microbes, and the appear-
ance of the disease, is substantiated by the fact that the affec-
tion is not transmitted from infected to healthy animals, and
cannot be transmitted artificially either by inoculation of secre-
tions from the affected animals, or with blood (Haubner, Her-
ing), nor by direct transfusions of blood (Arloing).

The characteristic hemorrhages and serous exudations in
the disease indicate a severe affection of the vessel walls which
in all probability may be explained by the fact that chemical
substances which circulate in the blood reduce the normal elas-
ticity and resistance of the vessel walls. While this may be
the result of a change in the blood, through which the nutrition
of the walls of the vessel becomes diminished, and the watery
consistency of the blood in itself facilitates the transudation of
the blood plasma, a direct toxic action appears much more
probable in consideration of the quick, sometimes very abrupt
hemorrhages and serous infiltrations. Since, according to
observations, pathogenic bacteria produce toxic substances,
poison of similar origin may be suspected as the etiological fac-
tor of this disease. :

According to Dieckerhoff’s conception these toxins form in
necrotic or suppurative lesions which develop in any part of the
body through the action of the. micro-organisms during the
course of the primary disease. This supposition is very prob-
able, as the diseases preceding petechial fever as a rule are
those in which the abscesses or gangrenous areas which develop
in the course of the disease communicate either originally or
later with the outside world, whereby micro-organisms may
readily gain entrance into the body. These organisms may then
multiply in the exudates or the necrotic tissues, and produce
chemical poisons which are later absorbed by the circulation.
In-rare cases petechial fever apparently develops independently
of other diseases, or in connection with fresh injuries (castra-
tion), but even in such cases local necrotic processes cannot be
excluded with certainty. Accordingly purpura hemorrhagica
should be considered as an infectious disease in which, however,
the incriminated virus (probably the pyogenic streptococcus
which because of its ubiquity easily gains entrance into the
necrotic tissue), exerts its pathogenic action indirectly with
its specific toxic products.
218 Purpura Hemorrhagiea.

According to the bacteriological examinations of Ligniéres (1895-
1898), the internal organs and the blood of animals dead from purpura
hemorrhagica contain, as a rule, besides other bacteria, streptococci,
principally pyogenic, and more rarely streptococci of strangles. The
bacillus equisepticus is also met with relative frequency (among 26
cases this organism was found in 9 instances), and this seems to indicate
that both diseases are closely related. This may be also substantiated
by observations in Argentine where influenza occurs mostly in a very
acute form without inflammation of the thoracic organs and purpura
hemorrhagica very frequently develops as a sequel (similar observa-
tions were made by Theiler in Transvaal). Accordingly both bacteria
play a part in the etiology of purpura hemorrhagica, the severe symp-
toms, however, are caused by the streptococci or their toxins.

Ligniéres failed to produce the disease even in a single instance
in its characteristic form, in spite of the fact that he injected horses
intravenously with quantities up to 8000 g. of streptococci culture, and
subsequently exposed the animals to cold rains. He considers the im-
portance of the streptococci proven, however, from the cbservations
made by Frasey, who has seen a disease corresponding clinically with
purpura hemorrhagica develop in two horses, which had been injected
with highly virulent cultures of streptococci for the preparation of anti-
streptococcic serum. The fact that purpura hemorrhagica develops
quite trequently as a sequel to strangles and influenza, appears te
indicate the indirect association of streptococci with the disease (Bruin
observed the development of purpura hemorrhagica in its severe form
in two cases after the accidental injury of a vein in puncturing an
abscess in strangles)

Cadéae also considers purpura hemorrhagica as an intoxication, which,
according to his view develops as the result of vasodilatatory toxins of various
bacteria, especially of different pyogenic cocci, in animals which have been weak-
ened by another disease. Mouilleron & Rossignol, as well as Cormier, also attribute
the greatest importance to the streptococci, especially on the ground of the favorable
results which they have obtained in the treatment of the disase with antistrepto
coceus serum, although they do not deny the possible action of other micro-organisms.
Coquot considers the disease as a Pasteurellosis.

Contrary to other observers Javorsky succeeded in only 7 cases out of 148,
in demonstrating the occurrence of purpura hemorrhagica as a sequel to other
affections (twice strangles, 5 times pleuro-pneumonia). Wohlmuth also believes
that the disease may develop independently, and therefore he distinguishes an
idiopathic and symptomatic form, in which the vascular system, especially the intima
of the capullaries, is always the point of attack for the toxins which produce the
disease.

Recently Baruchello & Nori, and later also Perruecci expressed the improbable
view that purpura hemorrhagica represents a piroplasmosis, as they found protozoa
resembling piroplasma in the red blood corpuscles of four affected horses. However,
the severe initial symptoms (high fever), which were observed ir these cases indicate
that these affections were not true cases of purpura hemorrhagica.

The mode as well as the determining factors of natural
infections are not yet sufficiently clear. It has been observed
that the disease occurs principally in badly ventilated stables,
with dirty floors, but it also occurs in well groomed horses kept
under favorable conditions. The disease is most frequent in the
spring and in the beginning of summer.

The age of the animals appears to have no influence except
that colts under two years of age do not become affected (Dieck-
erhoff) ; otherwise there appears to be no factor which affects
Anatomical Changes. 219

the susceptibility of the animal, nor does the care the horses
receive or the work they do exert any influence.

Anatomical Changes. The characteristic lesions of the dis-
ease are the hemorrhages in the skin and in the mucous mem-
brane, as well as in the subcutaneous and submucous connective
tissue, in association with extensive, very marked, edematous
swellings. Inflammation and tissue necrosis may develop as
eee processes with swelling of the affected parts of the

ody.

Upon the cut surface of the edematous swelling the subcu-
taneous connective tissue forms a yellow, gelatinous layer of
several centimeters thickness, which shows dark red hemor-
rhages and in some cases contains cavities filled with purulent
ichorous fluid, or with necrotic tissue. The gelatinous infiltra-
tion extends also between the muscles while the muscle sub-
stance itself appears pale grayish-brown or clay color, and
friable, as a result of parenchymatous and fatty degenerations
of the muscle fibers. The affected muscies feel greasy to the
touch, and are sprinkled with small hemorrhages. In different
places small areas of the muscles are necrotic and changed to
a clay-like detritus, which sometimes appears dirty brown-red
from admixture of blood. Hemorrhages may also occur in the
tendons and tendon sheaths, under the periosteum, or in the
joints; in the latter the cartilaginous tissue may even become
necrotic (Prevost).

Of the mucous membranes those of the nose, pharynx and
larynx become affected in the first place, then those of the stom-
ach and the small intestines. The mucous membrane is affected
less frequently in the deeper air passages and in the cther parts
of the digestive tract, as well as in the genital organs. In addi-
tion to catarrhal injection and swelling, the mucous membrane,
as well as the submucous connective tissue of the intestinal
canal, also in the muscular layer and under the serosa, small
punctiform or streak-like or even larger hemorrhages may be
present. The loose connective tissue surrounding them is always
more or less gelatinously infiltrated. Over the larger extravaza-
tions the mucous membrane is often necrotic, or after tle pale
yellow necrotic parts have been thrown off, irregularly formed
ulcerations develop which are covered with dirty tissue shreds.
In the intestines they may extend to the peritoneum, or the
intestinal wall may be perforated and lead to purulent or
ichorous peritonitis, while in the nose the ulcerative process may
cause a destruction ot the nasal septum.

Hemorrhages are as a rule present also in some internal
organs, especially in the lungs and the spleen, and also under
the capsule of liver and kidneys. The lungs may contain hemor.
rhagic areas the size of a fist, the cut surface may show spots
like those of a tiger’s skin, which are the result of blood
aspirated into the bronchi. The spleen is sometimes consider-
990 Purpura Hemorrhagica.

ably enlarged due to hemorrhages in its tissue and under its
capsule, and sometimes a rupture of the spleen and a fatal
internal hemorrhage may be observed. Far less often are
instances of fatal bleeding into the retroperitoneal or into the
perirenal connective tissue, into the digestive tract, or into the
air passages; finally hemorrhages may also be found in some
cases in the inside of the eyes, in the bone marrow, in the
heart muscles, and under the pericardium.

The immediate cause of death usually is septicemia, pyemia
or gangrenous pneumonia, less frequently asphyxiation may
be observed. Autopsy may reveal the mode of origin of the
disease by disclosing the presence of older organic changes.

Symptoms. The disease usually commences with the
appearance of small punctiform or linear hemorrhages in the
nasal mucous membrane. In some.instances the animals do not
manifest any indications of disturbed health, while in other
cases the appetite becomes somewhat diminished in the earlier
stages, and the patient manifests slight dullness and depression.

Later the hemorrhages in the mucous membranes become
more numerous, and those lying close together confluate, so that
extensive blood extravasations result. At the same time there is
a yellowish mucous discharge from the nasal mucous membrane
which dries on the surface first to yellow, later to dirty brown
crusts. In severe cases the mucous membrane covering the
hemorrhages becomes necrotic, and ulcerations develop. In this
condition the discharge which at first is scanty becomes more
profuse, discolored, mixed with shreds of necrotic tissue, and
not infrequently also with blood The discharge emits a fetid
odor. In the meantime swelling of the eyelids is frequently
observed and if they are forcibly spread apart a reddish fluid
or even pure blood flows out of the slit; in such cases the bulbar
as well as the tarsal conjunctiva, shows shallow hemorrhages
(exceptionally necrosis of the conjunctiva and hemorrhages into
the inside of the eyes [Roell] may be observed, also atrophy
of the optic nerve [Schindelka]).

In all of the 148 cases observed by Javorsky hemorrhages were present on
the nasal mucous membrane On the other hand they were found in only 58 cases
in the mouth and in only 38 cases on thu conjunctiva.

‘Immediately after the appearance of the hemorrhages in
the nasal mucous membrane, swelling of the skin and the subcu-
taneous connective tissue make their appearance. In some
cases numerous urticaria-like vesicles develop over the entire
body, which disappear after a certain time, or confluate form-
ing dollar-sized flat roundish swellings (Figure 39; Kleinpaul
observed simultaneous shedding of the hair). In most instances,
however, diffuse swelling developed, especially on the extremi-
ties, on ‘the chest and abdomen, especially on the sheath and
udder, and sometimes on the front part of the head (Figure
Symptoms. 991

40). The swellings often grow rapidly assuming great dimen-
sions, so that the outline of the affected part of the body which
is much deformed, becomes lost. In severe cases the circum-
ference of the extremities becomes enormous, so much so that
sometimes the legs from the coronary band to the elbow or
to the knee swell to 2 or 3 times their normal size, and they
appear like posts on which some transverse furrows are the
only indications of the joints. On the head the swelling first
affects the alae of the nose and the lips, soon however the lower
part of the face becomes affected, and the fore part of the head

 

aN a ys SS ie Ee SB

 

Fig. 39. Purpura hemorrhagica. Eruptions resembling urticaria at the beginning of
: : the disease.

may become so broad that the transverse diameter greatly ex-
ceeds that of the upper portion of the head, the nose piece of
the halter making a deep impression, and the head in such cases
resembles somewhat the head of a rhinoceros (Figure 40). The
swellings are characterized by being always sharply defined
from the healthy surrounding parts. They are firm, almost of
the hardness of a board, so that the surface may be pitted only
with difficulty, the resulting depressions disappearing but slowly.

The skin over the swelling becomes stretched, and from
its surface a yellowish tenacious serous fluid oozes out which
later dries, forming brown crusts. In the flexor side of the
999 Purpura Hemorrhagica.

joints the skin shows cracks which expose a moist reddened
wound. In places where the stretching of the skin is the great-
est, therefore, especially over the bony protuberances, as well
as in the places where it is exposed to outside pressure, excep-

 

Fig. 40. Purpura hemorrhagica. Swelling of the forehead and of the lower chest.

tionally also in other parts of the body, for instance on the
upper lip (Figure 41), the skin becomes insensitive in circum-
scribed areas, cold and dry, and takes on a darker color. Soon
dry, round portions of skin as large as‘a dollar or even larger,
dark brown and parchment-like are separated and fall off. The
Symptoms. 223

gangrenous process may extend deeper, affecting the muscles,
while on the bridge of the nose and below the carpal and tarsal
joints it may extend to the bone, leading to ugly ulcerations,
which continually discharge a purulent, ichorous, fetid secretion
containing necrotic tissue shreds.

According to Javorsky’s statistics swellings on the abdomen are observed in

47.3%, on the posterior extremities in 74.3%, and on all 4 extremities in 45.5%
of the cases. ;

The swelling impairs the physiological functions and the
mobility of the affected part of the body. With the increase of
the swelling of
the nasal mucous
membrane the res-
piration becomes
snuffing, and is
especially difficult
during the act of
inspiration. The
labored respira-
tion is still more
severe -when the
swelling extends to
the folds of the
mucous membrane
in front of the
larynx, or to the
mucous membrane
of the larynx itself.
In such cases the
animals show all
the indications of
an inspiratory
dyspnea (anxious
look, whistling or
rattling respira-
tion, spreading of
the legs, forced CX- Fig. 41. Purpura hemorrhagica. Commencing necrosis
tension of the : of the skin on the swollen upper lips.
thorax, with the
intercostal spaces sunken in) and with further progress of the
stenosis asphyxiation may result.

The great swelling of the forehead renders the motion of
the jaws and with it mastication more difficult, while the infiltra-
tion of the pharyngeal mucous membrane and of its underlying
connective tissue interferes with deglutition, so that in severe
cases the animals are unable to take nourishment, although their
appetite is not impaired, or they succeed only with great effort
in swallowing small quantities of food or a little water.

The swelling of the extremities interferes more or less with
the gait of the animals. At first and even later in mild cases,

 
224 Purpura Hemorrhagica.

the disturbance is manifested only by stiffness and clumsiness
in gait and inability to lie down, or if they succeed in this, in
their inability to rise. In the presence of large swellings they
remain motionless-in one place, and it is impossible to make
them move (the inability to move may be partly due to involve-
ment of the muscles). The swelling of the’ sheath hinders the
animal from protruding the penis, so that the urine trickles
out of the narrow opening of the sheath, and its borders as well
as the surrounding parts of the skin become irritated by it.

The nutrition of the animals, except in the very mild cases,
is always insufficient, through the difficulty in mastication and
deglutition which has already heen mentioned. Although the ap-
petite remains unimpaired fol: a considerable length of time, and
in mild cases even during the entire course of the disease and
the thirst is even increased; in severe cases disturbances in
the appetite are noticeable which are due to the involvement
of the gastric mucous membrane. Symptoms of colic some-
times follow the severe changes, and these indicate hemorrhages
and inflammatory edematous infiltrations of the gastric and
intestinal wall. The colic may occur either in severe attacks
or less severely but more continuously. In some cases they
are followed by manifestations of a rapidly progressing anemia
and by collapse, which is an indication of an internal bleeding
into the abdominal cavity, while in other cases paralysis or
perforation of the intestine lead to sudden death. Feces are
passed in moderate quantities, a bloody consistency pointing
towards intestinal bleeding, while frequent movements of ‘the
bowels and a covering of the feces with a muco-purulent ma-
terial points to inflammation of the rectum. In the presence
of a severe inflammation of the intestines profuse diarrhea
appears. In severe cases the urine contains albumen and also
blood.

In mild cases the body temperature remains through the
entire course of the disease at normal height, or is only very
slightly elevated. In the presence of necrosis and ulceration
of the skin, and of the mucous membrane, the fever may rise
high from absorption of septic substances. The character of
the fever in such cases indicates a septic form. The tempera-
ture may also change in those cases in which the affection devel-
oped immediately after a febrile affection (Fig. 42), or if com-
plications arise during the course of the disease.

In the beginning the heart’s action is somewhat accelerated
but sufficiently strong. Later it becomes excited, and because
of the difficult respiration or the changes in blood pressure due to
hemorrhage and to pyemia or septicemia, the heart’s action
becomes very rapid and throbbing, while the pulse steadily
diminishes in volume.

A microscopical examination of the blood shows nothing
characteristic, with the exception of an occasional hyperleuco-
eytosis (according to Smith the quantity of albuminous sub-

gece

 
Fever Course. 995

stances and fats in the blood is increased, that of fibrin, water
and iron is diminished). ;

Modification
of the Course.
The clinical
picture de-
scribed may
show marked
modifications.
The disease
may become
checked in any
stage of its de-
velopment, and
pass on to re-
covery. On the
other hand in
some cases in
the early stages
the original
disease, to
which purpura
hemorrhagica
forms a sequel,
may yet per-
sist; but in a
still greater
number of
eases t h e New Petechiae
disease _ itself
may be changed
by the appear-
ance of compli-
cations arising
during its de-
velopment.

One of the
most frequent New Petechiae
complications
ig pneumonia,
which usually
is lobular in
character, and
develops in
connection with
hemorrhages
into the lung
tissue ; and may . ;
be, less frequently, the result of the aspiration of necrotic parts
of mucous membrane, assuming then often a gangrenous form.

Urticaria

in the

Bwelling of Legs

Swelling of Nostrils

Fever curve in purpura hemorrhagica.

Fig. 42.

Ge | ve | 2] OE}; Se} te] ce} se] te | OF

 
226 Purpura Hemorrhagica,

Rapid and labored respiration, especially in cases when the
upper air passages are not markedly constricted, in associa-
tion with a rise in temperature, are indicative of pneumonia,
and renders a careful examination of the thoracic organs
necessary.

A severe and not infrequently ulcerative inflammation of
the stomach and intestinal mucous membrane also develops with
relative frequency, and causes a putrid diarrhea, which greatly
weakens the animal.

In the cases with unfavorable termination the clinical
symptoms are almost invariably terminated by manifestations
of pyemia or septicemia. They usually develop either from the
above cited causes, or from the sores which develop on the body
of the animals when they persistently lie down.

According to Payrou petechial fever as it is observed as a sequel to distemper,
may be™manifested either as a toxemic (lymphatic) form, brought on by the
absorption of toxins into the blood, or in a septicemie form caused by a strepto-
coceus infection of the blood. The former develops in the second week after the
beginning of strangles, when, in the presence of a moderate fever, the extremities
slowly swell from below upwards, and the nasal mucous membrane manifests only
small petechiae. The course is frequently mild. The second form develops with
high fever, and extensive petechiae, running a peracute course, causing swellings
everywhere, especially on the head and on the conjunctivae, which have a great
tendency to necrosis. In these cases the disease usually terminates fatally in from
8 to 10 days. As a result of the great frequency of intermediate forms the sepa-
ration of these two types might often be very difficult, and it is doubtful whether
such a classification is justified. ,

Course. The course of purpura hemorrhagica varies from
case to case. From the very mild forms which manifest only
petechiae of the nasa] mucous membrane, and a slight simulta-
neous swelling of the skin and the symptoms of which may dis-
appear inside of two or three days, to the cases of extreme
distortion of the body and resulting in death from asphyxiation
or sepsis, all the possible degrees may be observed. In the
successive development of the symptoms the affection of the
nasal mucous membrane usually appears first, and it is hardly
ever absent. This is followed in one or two days by a swelling
of the skin, and only later by the affection of the pharynx,
whereas the involvement of the intestinal canal is usually ob-
served only in advanced stages of the disease. However, there
are rare cases where the sequence of symptoms differs ; thus the
edema of the-skin may precede the development of petechiae i in
the nose, or severe colicky symptoms may develop in the begin-
ning of the disease.

The evolution and course of the disease depends eapecially
on the localization and the more or less rapid development of
the hemorrhages and of the edematous swellings. Apparently
severe cases, in which however the changes are exclusively con-
fined to the nasal mucous membrane, the skin and the subcu-
taneous connective tissue may terminate in complete recovery
even when the skin becomes necrotic over a considerable area;
on the other hand affections of the internal organs, as well as
hemorrhages and inflammations, exert an unfavorable influence

al
Course. Diagnosis. 227

on the course of the disease, and such cases usually terminate
fatally. ,

In the favorable cases the swellings after reaching a certain
degree retrogress either rapidly or gradually. Frequently,
however, the improvement is only temporary, as the condition
later becomes aggravated again, and with such variations the
disease may run for several weeks until finally the animal recov-
ers. The average duration of the mild cases may be placed at
about two weeks, although it may occasionally extend over a
period of 6 to 8 weeks. In cases where large areas of the skin
become necrotic it may require several months until a definite
recovery takes place, and even in such cases the recovery is not
complete, as in place of the extensive wounds contracted scars
remain which interfere with the function of the extremities, and
thereby reduce the value of the horse for work.

In fatal cases the duration of the disease also varies. There
are cases in which the swellings form with such rapidity and
become so extensive that death ensues in from 3 to 5 days (Dern-
bach saw a horse in which death occurred after 7 hours as a
result of a hemorrhage in the neighborhood of the medulla
oblongata). Complications (gangrenous pneumonia, enteritis,
pyemia, septicemia) usually develop only after the swellings
have progressed extensively and have produced functional dis-
turbances as well as necrotic processes; up to that time, how-
ever, usually 1 or 2 weeks have elapsed. If any of these com-
plications have appeared death always ensues after several

days.

Diagnosis. Recognition of the disease is difficult as a rule
only when it is associated from the beginning with fever, or
when edematous swellings and hemorrhages appear in the
course of a preceding febrile affection. Hdematous infiltrations
may develop from local causes (phlegmons, lymphangioitis)
as well as in general infectious diseases (anthrax, malignant
edema) ; they may, however, be distinguished from the swellings
of purpura hemorrhagica by the diffused borders and by the
localization of the inflammatory processes. Besides this the
swellings in purpura hemorrhagica are usually sharply circum-
scribed and occur in most instances symmetrically on both sides
of the body; they also appear after or simultaneously with the
development of petechiae on the nasal mucous membrane. In
the early stages of the disease urticaria may also come under
consideration, as it is sometimes manifested by extensive and
sharply circumscribed swellings of the skin; however, in this
affection the petechiae are absent on the nasal mucous mem-
brane, and the eruptions disappear entirely after a short time.
Acute glanders may likewise resemble purpura hemorrhagica
to some extent, especially in cases in which the swelling of the
nasal mucous membrane and its surrounding tissue, as well as
of the extremities and abdomen develops rapidly; however, in
998 Purpura Hemorrhagiea.

such cases there are no petechiae on the nasal mucous mem-
brane, but nodules and ulceration, and at the same time there
is also a swelling of the submaxillary lymph glands. In addi-
tion to this, the rapid development of the swellings on other
parts of the body is always accompanied by fever and by symp-
toms of a general infection (it must be remembered that pur-
pura hemorrhagica may develop in the presence of glanders).

Prognosis. This is very uncertain in consideration of the
varied course of the disease, and therefore should be made with
especial care. Although with proper treatment on an average
40-50% (according to Javorsky 60-65%) of the affected animals
recover, the mortality fluctuates between wide limits. The slow
development of the hemorrhages and swellings, and their pres-
ence in small numbers, are indications of a favorable course,
whereas their rapid increase and extension point toward an
unfavorable prognosis. There are cases, however, which show
a very severe affection from the onset, and in which after a
certain time sudden improvement: is noticeable, the animals
finally recovering. This is especially the case when by proper
treatment the development of threatening complications is pre-
vented. A recovery may be expected as long as the patients
are without fever or have only a slight fever, and take nour-
ishment at least in moderate quantities. High fever renders the
situation usually grave, as it points to septic infection or to
inflammation of internal organs. Other unfavorable indications
are pronounced cyanosis or yellow discoloration of the mucous
membranes, the presence of albumen, or blood in large quan-
tities in the urine, continuous lying down, frequent and weak
heart action, further the excessively rapid disappearance of the
swelling. The latter apparently favorable symptom indicates
in most instances a rapid breaking down of the tissues, or that
great quantities of blood or blood plasma have, under the influ-
ence of the high fever, transuded into the internal organs. The
development of after affections should also be taken into con-
sideration in forming a prognosis, as they are of a decided
influence in determining whether treatment extending over a
long period of time is justified, in view of the inability of the
animals to work and the expense of such prolonged treatment.

At the clinic at Budapest between 1887-1908, out of 296 affected horses
167 (56.4%) recovered; the numbers of maximum and minimum recoveries in these
years was 20 and 95%. In the Prussian army in the years of 1895-1903, 149 horses
became affected, of which 110 (79%) recovered (the maximum and minimum recov-
eries in these years were 56.2 and 85%).

Treatment. Symptomatic treatment has a great influence
on the further development of symptoms and on the termina-
tion of the disease, especially as it is not infrequently possible
to avert the danger of asphyxiation, and to prevent the appear-
ance of complications.

Above all it is necessary to assure suitable feeding of the
Treatment. 229

affected animals, and to provide a sufficient supply of fresh
water. Hydrochloric or sulphuric acid (8-10 g. to a pail) may
be added to the water and in the presence of fever wine or alco-
hol (11%-1 liter to a pail). If the animals show difficulty in
mastication and swallowing they should be given green food
and bran—or flour—gruels. If this condition becomes aggra-
vated the animals may be fed artificially per rectum, and in
this manner they may retain their strength for a considerable
time. Pure fresh air is likewise an important requirement for
a favorable course, and it is advisable to keep the animals out
of doors in the summer time and in bad weather in roomy box
stalls. The halter should be removed as it may have a harmful
effect by its pressure on the swollen cheeks and nose.

Wounds, ulcers and abscesses require antiseptic surgical
treatment. In the presence of a considerable swelling of the
nasal mucous membrane the nasal cavities should be carefully
syringed 2 to 3 times daily with a non-irritating disinfecting
solution (3-4% boracice acid, 2-3% creolin or lysol solution,
144-1% alum solution). The swellings of the skin are in many
eases favorably influenced by rubbing with spirits of turpentine
2 to 3 times daily, since under this treatment gangrene of the
skin occurs more rarely. Various other fluids may be used for
the same purpose, especially Burow’s solution with camphor,
which is highly recommended by Dieckerhoff (Camphorae 50.0,
Plumbi acet. 200.0, Alum. 100, which is used in the proportion
of 1 tablespoonful to 1 liter of water), Goulard’s extract, sub-
acetate of lead or alum solution (5%), spirits of camphor, etc.
Counterirritants should positively be avoided as the stimula-
tion of an inflammation enhances the development of necrosis
of the susceptible skin.

If in spite of this treatment gangrenous abscesses develop
over the swellings of the skin, such defect as well as tears

‘ should be treated after the removal of the necrotic tissue shreds,
by washing with one of the above mentioned solutions, or still
better they may be dusted with a drying powder. For this pur-
pose charcoal powder containing corrosive sublimate (charcoal
mixed with a 1% corrosive sublimate solution and then dried),
further Dermatol, Alumnol, Iodoform, Thioform, Tannoform,
etc., may be used to good advantage. A 5-7% creolin liniment
(smeared on wool and placed on the wound) may also act bene-
ficially whereas tinctures (tincture of myrrh, tincture of aloes)
are less effective. This treatment should be continued until the
wound has filled up and healed over, but in the meantime pro-
tuberant granulations which may develop should be controlled
by cauterization (nitrate of silver or with fuming nitric acid).
Sores of decubitus should be treated in like manner. 'T'he con-
junctivitis may be controlled by blowing sodium borate into the
eye, while in gangrene of the conjunctiva washing with a 2%
ereolin solution is advised.

If the patient is threatened with asphyxiation as the result
930 Purpura Hemorrhagica.

of marked constriction of the upper air passages, the perform-
ance of tracheotomy is advisable. The stenosis of the nose may
be relieved by elevating the median alae of the nostrils passing
threads through them and tying them together over the
bridge of the nose, or according to Johne’s suggestion, by the
introduction of tin tubes into the nostrils. These | methods, how-
ever, are not to be recommended as the threads and even more
the tin tubes may produce necrosis of the skin and of the
mucous membrane. The wounds caused by tracheotomy should
be cleaned 2 or 3 times daily, and in order to prevent a harmful
pressure between the outer plate of the tube and the skin a
ring of cotton should be inserted. The operation may even be
undertaken before asphyxiation threatens, especially in cases
when a rapid development of the swellings indicates the ap-
proach of a dangerous nasal stenosis.

In consideration of the difficulty in swallowing which is
present in most instances only such remedies should be used
in the treatment of gastro-enteritis as may be administered in
the drinking water or in soft food. Calomel is to be mentioned
as a remedy, as it not only has a disinfecting action, but also
facilitates the absorption of the transudated serous fluid as a
result of its uniting with the blood albumen (Jendrassik) (3-4.0
g. daily, divided in several doses), then boracic acid, tannin,
sugar of lead, also ichthyol (sodium or ammonium, sulfo-ichthy-
olicum, 20-30 g. pro die), cinchona bark, etc., may be given. In
cases where the rectum is severely affected enemas of astrin-
gents and disinfecting fluids (for instance 2-4% lukewarm
boracic acid) are indicated.

If improvement becomes apparent the convalescing animals
should be exercised out of doors for a short time 2 or 3 times
a day, as soon as the fever disappears, and the loss of the body
fluids should be restored through profuse, rich nourishing.

Various remedies were recommended for the purpose of an
abortive treatment, but none of these can be considered as specific.
Thus Azary recommended the fluid extract of hydrastis canadensis
(5-8.0 g. subcutaneously). Payrou advised adrenalin (15-25 drops in
¥, 1. of water) early in the disease, because of its vasoconstrictor action ;
while recently iodine and silver preparations are used very extensively.
Dieckerhoff employed intratracheal injections of Lugol’s solution
(iodi puri 1.0, potass. iodati 5.0, aquae dest. 100-200.0; 30-40 g. for
one dose; at the same time 10-20 g. of iodide of potassium may be added
to the drinking water). This treatment has been given extensive trial
in practice, but without any remarkable results. The literature shows
that out of 96 cases treated in this manner only 61 horses (63.5%)
recovered (in the Prussian army inside of three years out of 41 horses
31 recoveries, 75%) and some of the authors (Zschokke, Cadéac, Lemke,
Johne) have even observed bad effects from this treatment (gangrene
of the mucous membrane of the trachea, symptoms of poisoning).
Jodvasogen, which has been introduced into veterinary practice
by Jess, has also been tried (intratracheal injections of 15-20 g. of a
6-10% solution, or 50-80 g. per os daily). The results, however, have

 beetegt
Treatment. 931

been doubtful, as alongside of the favorable results reported by Straube,
Thomas, Clausen, Richter & Feuerhack, there are those of Zerler &
Giesenschlag as well as Gutzeit, which are unfavorable. The value of
the iodipin treatment as recommended by Franz, Thomas and Tantos

(10 g. of a 25% solution of iodipin injected daily subcutaneously, and
on every second day 50 g. of a 10% iodipin solution per os), cannot
be judged at the present time.

_ Of the silver preparations Dieckerhoff recommended Crédé’s colloid
silver or Collargol (50 g. of a freshly prepared 1% solution intra-
venously 2-4 times a day at the beginning of the disease) ; the results
from this method of treatment varied. While Thomassen, Zimmermann,
Roder, Dresdow, Mollerau and others obtained satisfactory results, the
experiences with this method in the Prussian army were not so encour-
aging; in the years 1899-1902, 51 animals were treated, with Collargol,
of which 40 (78.5%) recovered, while of 35 animals which were treated
by other methods or were not given any treatment 26 (74.3%) recov-
ered. At the Budapest clinic in the years of 1898-1902 25 animals
received the silver treatment, and 14 (56%) recovered, while 16 other
cases were treated otherwise, of which 8 (50%) recovered. It was
observed that even when this remedy was employed at the earliest
stages of the disease it did not influence its normal course (Fettick).
Payrou declared this remedy to be worthless, and Brohle observed a
fatal termination in three cases as a result of embolism of the pulmonary
arteries following an intravenous injection of 0.4:40.0 g. Collargol.

Conditions are similar in the case of Ichthargan (50 g. of a 1%
solution intravenously), as recommended by Lange and Jost. The
results obtained with this preparation in the Prussian army in the years
of 1904-1905 were not uniform. Ztirn calls attention to the hemolytic
and strongly irritating action of this remedy, and therefore recommends
only 0.1 to 0.2% solutions for intravenous injections. (Lévy saw after
an injection of 0.5 g. of a 1% solution, the development of severe
toxic symptoms in a horse of advanced age).

Bertelotti employed spirits of turpentine (5.0 g. intravenously),
Howe oil of turpentine (per os), Pelz, Thomas and Feuerhack tallianin
(10-30 ec. intravenously), Gorjaew corrosive sublimate (10 cc. of a 1%
solution intravenously), Beck lastate of silver or Actol (40 ce. of a 1%
solution 3 times daily intravenously), apparently with good results.

Serum Treatment. Stimulated by the good results obtained in
human medicine with Marmorek’s anti-streptococcus serum in strepto-
coccus infections, various authors used the serum for the treatment of
purpura hemorrhagica in horses, according to the prevailing idea that the
disease is also caused by a streptococcus infection. This appeared justi-
fied in view of Ligniéres’ assertion that the streptococci associated with
purpura hemorrhagica was identical with the pyogenic streptococci of
man, and in view of his good results with Marmorek’s serum in mice.
The treatment consists of subcutaneous injections of 10-40 g. serum,
3 to 6 times daily, or repeated even every hour. (Sommermeyer
injects first 10 g. of immune serum subcutaneously and later 20 g.
normal serum intravenously).

The reports published so far on the use of Marmorek’s serum are
favorable (Ligniéres, Mouilleron & Rossignol, Peuch, Pecus, Maier who
used in one case 190 and in another 440 g. serum inside of two weeks!),
as well as about the Jess-Piorkowski serum prepared in a similar way
(Sommermeyer, Bolz). Ligniéres’ results show only two deaths in
232 Purpura Hemorrhagica,

15 patients, the tabulation of Mouilleron and Rossignol only 11 deaths
with 62 patients, while of 209 cases treated by other methods 126 suc-
cumbed to the disease. The Pasteur Institute of Paris has recently
prepared a polyvalent serum with: the aid of streptococci of man and of
the horse, and with this serum Payrou obtained favorable results in

army horses (of 45 cases only 7 died, 15.5%). However, as in the’

etiology of purpura hemorrhagica other bacteria appear to have also
a part and Cadiot obtained equally good results with normal blood
serum (100-125 g.), the value of the rather expensive serum treatment
cannot be definitely judged at the present time.

Literature. Percivall, The Vet., 1844.—Hering, Spez. Path., 1858, 871 (Lit.).—
Dieckerhoff, Spez. Path., 1392, 417; "BL t. W., 1898, 541 —Mouilleron & Rossignol,
Bull., 1898, 168. —Lange, Z. f. Vk., 1903, XV, 117. Jost, B. t. W., 1904.—Ligniéres,
Bull., 1895, 587; 1898, 722; 1903, 363.—Javorsky, A. £. Tk., 1905, XXXI, 601.—
Payrou, Bull, 1905, 491,—Mollerau, Rec., 1905, 24.—Drouin, Rev. gén., 1906, VII,
289.—Barthel, Z. f. Vk., 1906, XVILL, 430 (Lit.).—Franz, D. t. W., 1906, 38.

Purpura Hemorrhagica of Cattle. Recent literature contains
several reports (Schleg, Hichhorn, Frank, Réder, Plate, Ehrhardt, Kop-
pitz, Reinhardt and others), which render the occurrence of purpura
hemorrhagica among cattle, especially younger animals, and perhaps
also in buffalo (De Does) probable. In the respective cases there was
a diminished appetite and cessation of rumination, as well as great
depression and weakness. At first small, later more extensive hemor-
rhages occurred in the skin, and in the subcutaneous connective tissue,
in the conjunctivae, in the mucous membranes of nose and lips, and
in the udder; while in some cases edematous swellings, although usually
only: in a moderate development, were observed on the extremities, and
on the abdomen. From the surface of these swellings a bloody serous
fluid oozed out. At the same time a bloody discharge from the nose and
the vagina was occasionally observed, and the mash-like excrements
were also mixed with blood. In exceptional cases there appeared a
necrosis over the hemorrhages in the buccal mucous membrane, and in
the conjunctivae, as well as in the skin. In some of the cases the
temperature remained normal, in others, however, the disease was inau-
gurated with high fever. In the cases where the animals were not
slaughtered during the disease, recovery usually followed in from six
to ten days, but in some instances not for three weeks, while some of
the animals died from intestinal hemorrhage or septicemia. Autopsy
usually revealed more or less extensive hemorrhages in the muscles, in
the serous and mucous membranes, in the subserous and submucous
connective tissues,as well as in the internal organs. In some cases there
was also yellowish-gray or grayish-brown discoloration of the liver. The
spleen usually appeared normal.

In the majority of cases the healthy animals became affected with-
out any apparent cause; exceptionally the disease developed in connec-
tion with a local inflammatory process, especially mastitis (Robert),
puerperal inflammation of the uterus (Augstein), or rheumatism of the
joints (Zehl). The disease was also observed as a stable infection,
although a transmission from animal to animal could not be established
in these cases. ;

Before establishing a diagnosis of purpura hemorrhagica it should
be differentiated from other diseases in which hemorrhages occur, espe-
cially the various kinds of septicemias (anthrax, malignant edema,
hemorrhagic septicemia, ete.). The disease is mairily distinguished
from these affections by the absence of fever in the early stages.

 

 
In Dogs. In Man, 933

In the treatment the same principles apply as given in purpura
hemorrhagica of the horse. In the cases where in one stable several
animals became affected consecutively, the disease was checked by
changing the feed and the drinking water (Minder) as well as by dis-
infecting the stable (Eichhorn).

Literature. See Reinhardt, Monh., 1909, XXI, 221.—Zehl, B. t. W., 1909, 715.

Purpura Hemorrhagica of Dogs. Lellmann observed in a 6-year
old dog symptoms which indicated an affection of purpura hemorrhagica.
The emaciated animal, which had no fever, showed weakness and a
weak heart action, also swelling of the hind parts, ascites, epistaxis,
hematuria, and bloody excrement. The autopsy revealed hemorrhages
in the spleen, liver, kidneys, in the serous membranes, in the skin, in
the subcutaneous connective tissue, and in the muscles. In another
case there was anemia (pale mucous membrane, small pulse, anemic
heart murmurs) bloody vomiting and diarrhea, also numerous hemor-
rhages in the skin which comprised the principal manifestations.
The autopsy findings in this case resembled those of the first. Lellmann
considers both cases identical with purpura hemorrhagica of the horse.
(B. t. W., 1897, 509; 1902, 266.)

Raitsits observed in a dog bluish-red, later confluating spots
on the abdomen and on the inside of the thighs, petechiae on the con-
junctivae, swellings of the gums, hazel-nut sized abscesses on the phre-
num of the tongue, albuminuria and hematuria. The autopsy revealed
hemorrhages under the skin, also in the conjunctivae. and a hemorrhagic
inflammation of the rectum. (A. L., 1906, 421.)

Purpura Hemorrhagica of Man. This disease (morbus maculosus
Werlhofii, purpura hemorrhagica), is caused according to Kolb, by a
small Gram-positive bacillus, the bacillus haemorrhagicus, while accord-
ing to Letzerich it is caused by the bacillus purpurae haemorrhagicae.
The hemorrhages which appear in different parts of the body in asso-
ciation with the disease cause it to somewhat resemble purpura hemor-
rhagica of animals; however, the possible relations of the two diseases
have not yet been established. It should be mentioned that in a case
reported by Bock a stable attendant became affected with Werlhof’s
disease several days after the death of a horse with purpura hem-

orrhagica.

Literature. Kolb, Arb. d. G.-A., 1891 VII, 60.—Bock, Z. f. Vk., 1902,
XIV, 117.

Scarlatinoid of Horses. Under this name Champetier described a
disease of young horses which resembled scarlet fever of man. In a
mild form of the affection there is a fever reaching 103-104°F., inappe-
tence, frequent pulse and cough, injection and petechiae of the mucous
membranes, further a peculiar pustular exanthema of the skin, and
edematous swellings of the extremities. In the more severe form the
enumerated symptoms are more intense and bronchial catarrh, catarrhal
pneumonia, and nephritis may also develop. (Les maladies du jeune
cheval. Paris, 1892.) s

The latter of these forms has also been observed by. Marek in
an 8-year old mare. Simultaneously with a marked swelling of the
nasal mucous membrane diffuse edematous swellings appeared on the
abdomen and on the hind extremities; nodules developed on the skin
of the rump, the head and neck, and later round ulcerations appeared
934 Scarlatinoid. Rinderpest.

in their places. The autopsy on the animal, which died sixteen days
after the appearance of the disease, revealed a partial necrosis of the
nasal mucous membrane, fresh ulcerations on the tracheal mucous
membrane, and a hemorrhagic nephritis. There was also present a
striking inflammation of the lymph vessels, and a pronounced acute
congestion of the lymph glands of the mesentery. (Monh., 1896, VII,
346.)

Scarlatinoid of Cattle. Hetzel observed in a 114-year old steer
an- affection resembling the clinical appearance of the preceding disease
of the horse. The symptoms consisted in a high fever with sudden
onset, great depression, catarrh of the pharynx and larynx. Two to four
days later petechiae appeared on the nasal mucous membrane, and
various kinds of erythematous spots on the skin. At these places nodules
developed in the later course some of which disappeared, while others
developed into pea-sized vesicles containing clear serous fluid. Later
the contents of these vesicles became purulent, and finally they turned
into thick scabs, the animals manifesting severe itching. Purulent con-
junctivitis and bronchitis had also developed, and diarrhea exhausted
the animals to a great degree. The fever subsided after a duration
of six to twelve days, the catarrhal symptoms became milder, and after
a desquamation of the scabs complete recovery took place. (A. L,,
1903, 33.) ,

10. Rinderpest. Pestis Bovina

(Cattle plague, Typhus bovum contagiosus, Peste bovine; Ty-
phus contagieux [French]; Orientalische Rinderpest
[German]; Peste bovilla [Italian].)

The oriental rinderpest represents an acute febrile, con-
tagious, infectious disease of cattle, caused by an ultra-micro-
scopical micro-organism, and which aside from its typical
course is characterized by a croupous diphtheritic inflammation
of the mucous membrane. Exceptionally the disease passes
from cattle to other ruminants.

History. The attention of experts has been directed to rinderpest
from earliest times, because of its destructive character, and the most
varied theories have been formulated regarding its nature. At times
the affection was considered identical with human pox (Ramazzini, Vieq
D’Azyr, F. Miller), and again with typhus (Veith, Spinola) and dysen-
tery of man (Lorinser). Its infectious nature was recognized early,
and was established by successful inoculations (Dodson, 1744; Camper,
1770), and veterinary police measures were inaugurated against the
spread of the disease (in Prussia in the year of 1711, in France in
1714). Since the beginning of the last century the belief of a spon-
taneous origin of the disease has been more and more abandoned, but
the causative agent remained unknown up to the most recent times in
spite of the numerous investigations conducted along this line (Semmer,
Gamaleia, Nencki and others), until Nicolle & Adil-Bey (1902) estab-
lished its filterability through porcelain filters. Deliberate experiments
conducted by Semmer & Raupch, more recently by Nencki and his
co-workers in Russia, Koch, Danysz & Bordet, Edington, Koller &
Occurrence. 235

Turner in South Africa, Nicolle & Adil-Bey in Turkey, led to the
elaboration of several methods of immunization adapted for practical
requirements.

_ . Occurrence. Rinderpest causes enormous losses in the
infected herds of cattle, and may even result in the almost com-
plete extinction of animals in large territories. Sometimes it
may also cause considerable losses among flocks of sheep and
goats. At the present time it prevails in Europe only in the
southern part of the Balkan peninsula, but in Asia it is con-
tinually present, and recently it has become prevalent in Africa.

; Rinderpest was probably known in the early ages, and not only
in its original home, Asia, but also in Europe. With the great migra-
tions of people it was introduced from the Black Sea over the entire
continent westward, where it has raged almost continuously since that
time until the ’70’s of the last century. Extensive outbreaks usually
appeared associated with great wars, inasmuch as the cattle which were
driven after the troops disseminated the disease over distant territories.
Such invasions occurred in Germany during the period of Charles the
Great in connection with his wars; in France and Italy at the same
time; in the thirteenth century after the intrusion of the Mongolians;
at the time of the thirty-years’ war, etc.

In the first two decades of the eighteenth century the disease existed
throughout Europe with such vehemence that for instance in the years
1711-1714, one and a half million of cattle fell victims to it (Paulet).
Later Holland lost almost its entire stock of cattle as a result of the
disease. Through the great Napoleonic wars the disease attained again
a great extension especially in Germany and in France (the first French
veterinary schools were established as a result of the great losses caused
by rinderpest at that time).

Since the middle of last century it has generally been accepted that
the disease spreads only by infection through which knowledge the only
rational way of control and eradication of the disease has been estab-
lished. The complete eradication of the disease, which in some coun-
tries caused severe losses, appeared as a very urgent necessity, and
consequently the European governments adopted measures by which
they succeeded in pressing it back to the far East. The plague attained
considerable extension in middle Europe for the last time during the
Franco-Prussian war, but in the course of the following decade it was
completely suppressed, so that since 1881 it is confined to Russia and
Turkey and more recently has apparently disappeared even from Euro-
pean Russia.

The losses in Germany during the eighteenth century are estimated at 30
million cattle. The disease was distributed most extensively in the beginning of
the last century during the Napoleonic wars, in the ’30’s through the Polish Revo-
lution, and. later through the Franco-Prussian war. During the latter, 13,000
cattle and 4000 sheep died in Alsace-Lorraine, while in Germany 8151 cattle suc-
eumbed or were killed (the disease was also brought to Switzerland by the eastern
army which entered that country). In 1877 the disease was spread from Poland
to Posen and from Austria to Wiesbaden and caused a loss of 1591 cattle, and in
the following year 2349 cattle died in Prussia from the disease. It appeared for
the last time in 1881 in the province Schlesien, and since its eradication from this
territory the German Empire has remained free from the plague (Dieckerhoff).

In France the disease raged to an alarming extent during the great Revolu-
tion and the Napoleonic wars, especially after the unsuccessful Russian expedition.
2936 Rinderpest,

It appeared for the last time after the Franco-Prussian war, and caused in the
course of two years, in 43 districts, a loss of 56,533 cattle valued at 15,000,000 frances.

Great Britain was free of the disease from the middle of the eighteenth
century for a period of 120 years. In 1865 the disease was brought to the London
stock market, and at the same time to different provincial cities by a cattle boat
from Finland, and towards the end of that year 85 counties were infected. During
the 1%4 years of its prevalence 500,000 cattle died, valued at 100,000,000 francs.
The last outbreak occurred in 1877 as a result of its introduction from Hamburg,
and caused a loss of 1198 cattle. :

In the middle of the year 1866 the disease spread from England to Holland,
where it extended rapidly and in barely a year’s time had affected 156,594 cattle,
of which 78,110 died and 36,919 were slaughtered, while 41,565 recovered.

The disease was introduced into Italy toward the end of the eighteenth century
by Austrian troops, and spread southwards with such rapidity that inside of three
years over 3,000,000 cattle became its victims. Later in the years 1862-1868, the
disease was widely distributed, having been introduced from Dalmatia, in which
time the kingdom of Naples alone sustained. a loss of 50,000 cattle. Rinderpest
occurred in Italy for the last time in 1878 in the province of Naples. 2

In Austria, Galicia and Bukowina sustained great losses in the middle of the
last century. In both of these crown possessions about 54,000 cattle succumbed in
the years of 1848-1864, and about 35,000 head in the years 1868-1877. In the first
period Moravia suffered a loss of 12,000, while southern Austria lost 4,500 head.
The plague invaded Dalmatia for the last time during the Bosnian War, in the
year of 1878, and towards the end of the following year Slavonia, Styria and the
Krain experienced a visitation. During this outbreak, in a period of three months
1785 cattle died of the disease. Since the year 1880 Austria has been free of
the disease.

Hungary suffered most severely after the invasion of the Mongolians, and
during the time of the Turkish wars, but the disease appeared repeatedly in that
country in later years. During the time of the Russian-Turkish war, in the years
1827-1828, the disease was introduced from Moldau and from Roumania, and
prevailed continuously until 1842, the losses in the first two years amounting to
30,000 head of cattle. After the conclusion of the wars of 1848-1849 the disease
was almost entirely eradicated from the western part of Europe, but was brought
to Hungary in 1849 by the Russian army, where it raged continuously until 1861.
(The loss in this period amounted to over 350,000 cattle.) After the war between
Austria and Prussia the plague again increased, and lasted up to 1874. From
the middle of the year of 1861 until the end of 1873 the total loss was 165,732
eattle, valued at over 8,000,000 florins; while the execution of the veterinary police
measures required an expenditure of over half a million of florins (Roll). The
creation of the Rinderpest law in 1874 finally resulted in a complete eradication
of the disease in the year of 1881. 3

In Russia during some of the outbreaks more than a million cattle, in some
localities even 3 to 5% of the total stock, were annihilated by the disease (Jewta-
chiew). In more recent years it was possible, with the aid of the measures of
eradication adopted in 1879, to restrict the disease within narrow limits. In
1892 it again commenced to spread westward, but gradually diminished since 1894,
and since 1897 it recurs only east of the Caucasian Mountains, where it prevailed in
1907 in six government districts affecting 812 townships. In November, 1908, three
infected transports were brought from Petropawlowsk (Siberia) to the abattoir of
St. Petersburg, but the localization of the disease appears to have been successful.

Rinderpest occurs continuously in Turkey, and appears especially in the vicinity
of Constantinople, as well as on the coast of the Marmara Sea. Detailed statistics
of its oceurrence are not available.

The entire territory of Asia, including the East Indian groups of islands, is
infected; and in Asiatic Russia alone the losses in 1906 amounted to 25,093 cattle;
(according to Yersin the disease rages in Indo-China also among the buffaloes).
In 1892 the plague was carried from Corea to Japan, but in two years its successful
eradication was accomplished with energetic measures.

Previous to 1864 rinderpest was known to exist in Africa only in Egypt,
but during the Italian invasion of 1890 it spread southward along the Nile, and
inside of five years reached the South African States as well as the West African
Colonies of Germany. Transvaal lost 980,000 cattle in 1897, while in the Cape
Colony 1,300,000 animals died of the disease in the years of 1897-1898. After
that time the plague diminished somewhat, but gained again in severity in the years
of 1901 and 1904, until during recent years it has been considerably limited by the
persistent employment of protective vaccination. According to Littlewood the
disease was again introduced fnto Egypt from Minor Asia in June, 1903, appearing
in the Province Behera, where it spread with great severity, and according to

 

 

 
Etiology, Pathogenicity. 237

official reports, 147,285 animals, out of a total number of about 3,000,000 cattle
and buffaloes, had fallen victims to the disease up to the end of 1906. Ninety-three
thousand cases of these occurred in northern Egypt. Arloing estimates the losses
at 5,000,000 cattle, and the valuation at 150,000,000 francs.

Etiology. Nocard, as well as Tartakowsky, proved that the
pure tissue fluids of affected animals contain no micro-organ-
isms visible with the microscope, and that no organisms could
be cultivated with the ordinary methods of procedure. Nicolle
& Adil-Bey demonstrated that brain emulsion, intestinal con-
tents, cerebro-spinal fluid or peritoneal exudate, when diluted
with water pass through the Berkefeld or Chamberland
filter; that such filtrates are infectious, and that therefore the
contagion belongs to the group of ultramicroscopical micro-
organisms.

Pathogenicity. The contagion is present during the entire
disease in all tissue fluids (the nasal seeretion of inoculated ani-
mals is infective twenty-four hours after inoculation according
to Raupach). Blood taken at the height of the disease and
injected subcutaneously into a full grown animal in as small
a quantity as 0.001 g. will produce the disease with the same
intensity as if for instance 41. of blood had been injected
subcutaneously (Nicolle & Adil-Bey). Besides the tissue fluids
the virus is present in the different secretions (saliva, nasal dis-
charge, urine, feces, bile, tears, vaginal discharge, perspiration),
while the infectiousness of the exhaled air is doubtful. Infec-
tion with such substances is readily accomplished by subcutane-
ous injections or by feeding, while by intravenous injections in-
fection results only exceptionally (Kolle). Repeated passage
of the virus through the bodies of cattle does not modify its
virulence (Nicolle & Adil-Bey) ; on the other hand when passed
through the bodies of sheep and goats it becomes attenuated
(Galambos, Koch).

Besides cattle and buffaloes, sheep (Galambos) and goats
(Woronzow & Eckert) as well as camels (Tartakowsky) may be
infected by subcutaneous injections, while infection is less cer-
tainly transmitted by feeding infectious material.

The question whether hogs are also susceptible to the virus of
rinderpest has not yet been positively established. While Carré &
Fraimbault succeeded in infecting these animals with subcutaneous
injections of virulent blood, and Penning obtained positive results on
wild hogs, and later reinfected calves from them, Theiler failed in
all attempts to produce the disease in hogs in a similar manner.

‘Tenacity. Blood or other infectious fluids, sealed in a glass tube, remain
virulent for several months (Semmer); the same applies to spleen tissue when kept
in a dark place. Distilled water mixed with blood loses its virulence within 4 to 5
days (Nencki), and if mixed with glycerin inside of 8 days (Edington); blood
mixed with an equal quantity of. bile becomes avirulent in two hours (Lingard).
According to older observations (Haubner, Dieckerboff) the virus remains virulent
on hay kept.in the stable, or in the hay loft for 3 to 4 months (?), but when exposed
to the sunlight it is destroyed in two days. When dried on wool out of doors
it becomes avirulent in three days (Woronzow & Eckert). Hides salted for two
238 Rinderpest.

to three days, then kept for 4 or 5 days in a shady place, also bone marrow after
the kone has been dried for 30 days, may still contain infectious virus. By heating
to 58-60°C. it is destroyed immediately, whilé a temperature of 20-25°C. destroys its
virulence only after it has been subjected for a longer period. Blood becomes
avirulent when subjected to a temperature of 37°C. for 2 to 3 days (Theiler).

According to older data the virus is destroyed very slowly by putrefaction.
Thus meat which has been buried for three months is supposed to have been still
infective (Vieq D’Azyr). Arloing, however, found that the virus retains its
virulence in meat only for 4 days. The infectiveness of manure which has been
contaminated with the excrements of affected animals contains the virus for one
month, according to Bouley, and according to Krajewski it may sometimes be
infectious even after five months. More recent investigations in this direction
proved, however, that the virus is destroyed by putrefaction in a few days (Kolle).

Besides glycerin carbolic acid (2%), sublimate (1-1000), milk of lime (1%)
are effective as disinfectants; on the other hand the virulence of the klood is not
modified by a 144% carbolic acid solution (Kolle).

Natural infection results either by direct contact with
affected animals or is transmitted through the raw products of
such animals, such as parts of carcasses, as well as by persons
contaminated by such carcasses or by infected secretions and
excretions. Food, drinking water, stable utensils, clothes, etc.,
may also transmit the infection. In most instances, however,
the infection is disseminated by affected animals in the ordinary
traffic with cattle, which mode of transmission is the more im-

portant as some animals may be only very slightly affected and.

yet retain the virus in the body for 14 days, in chronic cases
probably even somewhat longer (Stockman; the maximum time
in which the animal may be infectious for others is supposed
to be 30 days).

The infection usually occurs through the digestive tract,
probably through the lymph spaces, even of healthy mucous
membranes. The possibility of infection through the air pas-
sages has not been positively established, as it is questionable
whether the contagion is disseminated through the air. Out of
doors the spread of the disease may be prevented by digging
a trench around the infected herd which the animals are unable
to pass, and in such eases cattle on the other side of the trench
remain healthy (Raupach). Likewise it is possible to prevent
its spread by isolating affected cattle for a distance of 10
meters, when it will be found that healthy animals will not
contract the disease (Piot-Bey). In the stable healthy cattle
may be protected from the neighboring infected animals by
simple board partitions (Nencki).

The susceptibility is very great in cattle, especially in the
young animals, although there appears to be considerable differ-
ence in the various breeds. According to some authors (Jessen,
Haupt) cattle exposed to the infection become affected as a
rule without consideration of the breed. Some Russian authors,
however, claim that the long horned ranch cattle are less sus-
ceptible to the infection than the breeds of Western Europe.
Cattle of the gray breeds show a greater resistance to artificial
infection, and the course of the disease in them is usually milder.

According to Semmer only 5 to 10% of ranch cattle succumb to an artificial
infection with virulent.virus; against 90 to 98% of other breeds. Nicolle & Adil-Bey

 

 

 

 
Pathogenesis, 239

also observed that the time of incubation after virulent inoculations is 24 hours
shorter in the higher bred animals, and death as a rule follows half a day earlier
than in the black Anatolian cattle, and that these latter may be much more readily
immunized. In South Africa (Stockman) and in India (Rogers) the cattle of the
mountains appear to be much more susceptible than the animals in the lowlands.

_ Buffaloes are much less susceptible. During the existence
of an outbreak they become affected only exceptionally, and even
young animals may withstand artificial infection (Nicolle &
Adil-Bey; although the disease exists among buffaloes on the
‘Hast Indian islands in an epizootic form, Van Ecke, Blin &
Carrougeau).

Of other animals camels are susceptible (according to Tar-
takowsky the disease is always mild in these animals); also
sheep, goats and ruminants living wild, especially deer, zebu,
gazelle, etc., and these animals bear an important part in the
distribution of the disease. Solipeds and carnivora are not sus-
ceptible, and the reliability of the observations relative to the
occurrence of the affection in hogs (Percari, Driessa, Pluning)
has not been proven beyond a doubt (see p. 237). Man is
not susceptible to rinderpest.

One attack of the disease usually abolishes the susceptibility
of the animal; and while repeated attacks were observed in
exceptional cases the infection was usually of a mild form. (In
the Vaccine Institute of Karlowka it was not possible to repro-
duce the disease in a steer which had recovered from the affec-
tion produced by inoculation six years previously.) Calves
from cows which became ill during advanced pregnancy are also
resistant against the infection (Gerlach, Semmer, Rogers), or
they become affected only with mild symptoms (Yersin).

Pathogenesis. The first symptoms are apparently produced
by the virus which enters the blood and propagates with great
rapidity. The virus appears to have a predilection for exerting
inflammatory changes on the mucous membranes, producing
catarrhal symptoms in the very beginning of the disease. The
croupous-diphtheric inflammation which then develops with
great rapidity is evidently the result of secondary infection by
other micro-organisms from the digestive tract attacking the
weakened mucous membrane. These bacteria cannot be desig-
nated exactly at present (colon and necrophorus bacilli ?) in the
absence of accurate bacteriological and histological examina-
tions. The tissue changes consist principally in that the ep-
ithelial layer of the hyperemic and swollen mucous membrane
changes together with the exudate which comes from the blood
vessels into an easily detachable and friable pseudo-membrane.
Sometimes the tissue of the mucous membrane proper becomes
necrotic to a certain depth, forming thicker membranes that are
more adherent. The mucous glands, especially those of the intes-
tinal mucous membrane swell as a result of cellular infiltration,
and later become necrotic. The inflammatory process is some-
240 Rinderpest.

times also observed in the cutis of the skin, which is a direct
result of the softening and sloughing of the epithelial layer.

The continuous high fever and great debility, the weakness
of the heart, the hemerrhages of the serous and mucous mem-
branes, as well as the pronounced difficulties in respiration, indi-
cate also a severe action of the filterable virus on the central
nervous system.

Anatomical Changes. Carcasses dead of rinderpest are
greatly emaciated. The skin surrounding the sunken eyes, the
nostrils and the lips are profusely covered with tenacious
mucus and saliva, the anal region is soiled with dried feces,
the mucous membrane of the rectum is greatly swollen and
cyanotic. In some of the cases the skin shows the changes which
can be noticed already during life (see p. 246), while in the sub-
cutaneous connective tissue the flabby and easily torn veins are
dilated and filled with blood. The abdominal and thoracic
cavities contain in some cases a yellowish-red or dirty-brown
fluid, which is odorless or may have a sickening, sweetish odor.

The most important changes appear in the mucous mem-
branes, and especially on that of the digestive tract.

In the mouth, especially on the mucous membrane of the
lips, lying opposite the gums, under the tongue and on the phre-
num, more rarely on the cheeks and on the hard palate, on the
soft palate and on the borders of the tongue, there are yellowish-
gray nodules and granular pulpy deposits. There may be also
areas the epithelial layer of which has exfoliated, or even deeper
ulcers, while in other spots the mucous membrane usually shows
reddish maculae, or appears as if it had been sprinkled with
bran as a result of a necrosis of the epithelial layer (sometimes
pin-head sized ulcerations are present on the tongue, gums and
in the pharynx). The mucous membrane of the pharynx is
hyperemic, and contains small hemorrhages, while in the cesoph-
agus it is usually normal; exceptionally a necrosis may be
observed in the superficial layers of the esophagus which are
of hemp-seed to lentil sized dimensions.

The omasum contains very dry food; the abomasum, which
usually contains only a small quantity of a tenacious mucus,
shows the most varied shadings from a brick-red to a dark-
brown coloration in its mucous membrane. The reddening is
most intense in the region of the pylorus, and especially on the
tops of the folds. At the same time the mucous membrane is
swollen, and the submucosa thickened as a result of an edema-
tous infiltration. In a later stage plate-like deposits may be
observed, especially on the folds of the mucous membrane, which
are hemp-seed to lentil in size, dirty-gray or brownish in color,
and flat or rounded in form. These deposits are only loosely
attached with their soft borders, while in the center they adhere
more strongly to the base. If they are picked off highly red-
dened depressions remain in their places.
Anatomical Changes. 241

The intestinal canal contains dirty-gray or from the admix-
ture of blood, darkish-brown, very liquid feces which have a
sweetish stale odor and are often mixed with membranous
shreds.. The mucous membrane is much reddened, the subjacent
connective tissue gelatinously swollen. The mucous membrane
of the duodenum and of the jejunum shows plate-like deposits
similar to those in the abomasum, and occasionally they are also
found in the ileum. The solitary follicles are swollen to the
size of a hemp seed or even larger, and form small nodules
from which a purulent or yellow caseous mass may be squeezed.
(If the necrotic epithelial cells are not thrown off, they together
with the swollen glands cause the mucous membrane to resemble
the skin of a boiled eel.) The Peyer’s patches are at first uni-
formly swollen, and rise with a flat prominence over the sur-
rounding tissue; later small dirty-gray deposits appear around
them, which subsequently confluate to a dry, caseous and strongly
adherent or a mush-like, soft deposit, several millimeters in
extent. In rare cases the epithelial layer forms with the coagu-
lated exudate a membranous cylinder several millimeters thick
on the inner surface of the intestinal tube; in other cases the
necrotic tissue of the mucous membrane changes into a friable,
dry, caseous mass, when after its removal the smooth muscular
layer is exposed.

The large intestines show similar changes, but in these the
lesions are less pronounced than in the small intestines. Fre-
quently they show only indications of a simple acute catarrh,
or the mucous membrane appears as if sprinkled with bran
because of the superficial necrosis of the epithelial layer. Some-
times the mucous membrane of the large and small intestines
presents broad, bright-red transverse stripes or extravasations
of blood so that it greatly resembles the skin of a zebra
(Verney).

In the bright-red air passages, punctiform or linear hemor-
rhages and catarrhal swelling of the mucous membrane, as well
as edematous infiltration of the submucous connective tissue,
especially in the nose and in the larynx, are almost constant
lesions. There are frequently croupous, pseudo-membranous
deposits in the nose, and especially on the nostrils, also in the
larynx and in the trachea, under which ulcerative erosions are
found. The mucous membrane of the bronchi usually manifests
only a ring-form deposit, and is covered with a purulent secre-
tion, which may in places entirely fill the small bronchi and
pop out on the cut surface on slight pressure in the form of
white plugs.

Similar changes may frequently be observed on the mucous
membrane of the female genital organs, and especially in the
anterior part of the vagina, while further back the lesions are
usually less marked. mS

The liver shows parenchymatous or fatty degeneration.
The gall bladder is distended and contains thin, green or yellow,
242 Rinderpest.

or even dirty-gray bile. The mucous membrane is in some
instances at first covered with vesicles and ulcers, later with
greenish-yellow patches of necrotic tissue. The spleen is usu-
ally unchanged, sometimes, however, it may here and there be
acutely swollen. The kidneys manifest cloudy swelling or fatty
degeneration, the mucous membrane of the hylus_of the kidneys
and of the urinary bladder shows catarrhal swelling and small
hemorrhages.

The lungs show an acute hyperemia, and sometimes contain
scattered areas of catarrbal pneumonia. Frequently an inter-
stitial emphysema is present, and in some cases air bubbles are
found under the pleura, in the mediastinum, in the surrounding
tissue of the trachea, as well as in the subcutaneous and sub-
peritoneal connective tissue. The heart is flabby, the muscles
are friable, of a dull, grayish-brown color, sometimes showing
butter-yellow streaks. Under the pericardium as well as _be-
neath the endocardium, hemorrhages are frequent. The blood
is dark red and only partially coagulated.

The lymph glands, especially in the mesentery, show an
acute swelling, their tissue is reddened and moist, but contains
no hemorrhages.

In the brain and in the cerebral meninges only a hyperemia
and moderate edema of the white brain Substance may be found.

The described anatomical changes are present in animals which
die at the height of the disease, or which were killed not earlier than
on the third or fourth day of the affection. Pronounced lesions on
the mucous membrane of the digestive tract, and especially in the
abomasum, are present in almost every instance, while the mucous
membrane of the air passages and genital organs may only occasionally
manifest an acute catarrh. However the affection of the intestinal
tract is not always uniform, for instance, the very decided affection
of Peyer’s patches which was observed in every case by Gerlach is
according to Bristowe, Murchison and Dieckerhoff in some cases en-
tirely absent. Again Koch observed in South Africa, and Nicolle
in Turkey, that the diphtheritic changes in the buccal cavity and in
the intestines were only slightly pronounced in those countries in the
rinderpest of cattle. In the gray range cattle the anatomical changes
are usually less prominent than in cattle of Western European breeds.

Symptoms. The time of incubation in cattle extends from 3
to 9 days.

Raupach inoculated 865 cattle, of which 70 (8.1%) developed the disease on
the fourth, 227 (26.25%) on the fifth, 303 (35%) on the sixth, 208 (24.15%) on
the seventh, and 57 (6.6%) on the eighth day. Sanderson and Semmer have
observed in exceptional cases a febrile rise in temperature 36 to 48 hours after
inoculation. Of 390 animals inoculated by Tode 55 became affected on the fourth
to tenth, 21 on the eleventh to twentieth, 20 on the twenty-first to twenty-sixth day.
Of the more recent authors Koch observed the development of fever as the first
indication of the disease in from 3 to 9, Theiler from 3 to 6, Nicolle & Adil-Bey
from 4 to 6 days.

The establishment of the accurate time of incubation was of special impor-
tance during the time when cattle imported from Roumania and Russia to Austria-
Hungary and Prussia, were subjected to a quarantine on the borders. For this
reason the international veterinary congresses repeatedly discussed this question (in
Symptoms. 9A

1863 in Hamburg, in the years 1865 and 1867 in Vienna). Nine days was estab-
lished as the maximal duration, and after the international hygienie conference in
1872 had also substantiated this finding, the duration of the quarantine was reduced
from 21 to 10 days.

The first symptom of the disease which usually precedes
the other manifestations by one or two days is the rise in the
temperature which in the Western European cattle reaches on
the first or not later than on the second day 40-42.2°C. (Gerlach).
In range cattle however it usually does not reach that height
(Medvedski. According to Dieckerhoff the rise in the tempera-
ture commences in exceptional cases only 10 to 20 hours after
the appearance of the other symptoms). ;

At the same time the animals manifest a marked depression
and dullness. They stand in the stable, or apart from the
other animals in the barnyard or pasture, with head drooped,
sometimes supporting it on the crib, the ears drooped, and
the back arched. Exceptionally the affected animals first show
great excitement, constantly moving about, attempting to break
loose when tied, shaking their heads, tearing up the ground
with their horns and feet, and sometimes even assuming a
fighting attitude. This excitement however lasts only a short
time, not longer than a few hours, and is soon relieved by the
above-mentioned depression.

The appetite is depressed, the thirst on the other hand
being sometimes increased (according to Dieckerhoff many
animals manifest frequent yawning, and the swallowing of
pieces of mortar); rumination is delayed or sometimes ceases,
the feces which are passed at long intervals are dry, dark-
colored, and do not form curled cakes. The urine is diminished
in quantity and of a darker color. The milk secretion is con-
siderably diminished from the beginning of the disease.

In the meantime the animals tremble, shaking severely
over the entire body at short intervals. They grind their teeth,
and certain groups of muscles, especially on the neck and near
the flank, show fibrillar twitching. The temperature is unevenly
distributed over the body surface, the horns and the ears feel
warm to the touch, the muzzle is dry, the skin at the flexor
surfaces of the extremities and in the surrounding parts, is
covered with perspiration, the hair especially over the vertebral
column is lusterless and erect.

Respiration and pulse become somewhat accelerated, and
the frequency of the pulse is affected by even slight external
influences. Many of the affected animals cough frequently, even
in the first stages of the disease, without it being possible to
detect any changes in the thoracic organs.

From the second day of the manifest affection inflammatory
changes of the mucous membrane appear in the foreground,
which render the symptoms of the disease characteristic.

The conjunctivae are bright red, the lids are swollen,
cushion-like, while tears run profusely from the narrow opening
of the eye. Later the secretion becomes mucous and soon
944. Rinderpest.

purulent. On forcibly separating the lids a great quantity of
discharge runs out, and dries below the inner canthus of the .
eye into-dry crusts. On the surface of the inflamed conjunctivae
fine pseudo-membranes form, and sometimes the cornea becomes
cloudy (according to Krajewski especially in dry warm
weather).
From the nasal opening there is first a glassy transparent,
tenacious, later a more purulent and at last a dirty gray or
brown, fetid, ichorous or bloody discharge running down the

 

 

 

 

 

Fig. 43. Stomatitis in rinderpest. (After the reports of the English Commission
of the year 1866.)

muzzle. The nasal mucous membrane as far as it may be
examined, is at first spotted, later uniformly reddened, and
sprinkled with dark red, punctiform hemorrhages. The itching
produced by the inflammation of the mucous membrane causes
the animals to blow frequently, and to continuously move the
head up and down, or from right to left, and sometimes to
even shake it violently. As a result of the developing difficulty
in respiration the animals sometimes shake their whole bodies,
Symptoms. 245

thus causing a rattling of the chain with which they are fastened
by the head or neck, by the sound of which affected animals may
frequently be recognized in an infected ‘stable.

In the buceal cavity the mucous membrane is at first red-
dened in spots, later assuming a uniform, livid or bright red
color, and not infrequently becomes covered with dark red
ecchymoses; these changes appear first on the gums, and on
the inner surface of the lips, later in the corners of the mouth,
on the borders of the tongue, in the vicinity of the phrenum
of the tongue, on the upper lips, and on the cheeks. Soon
hemp-seed to lentil-sized gray spots appear on the surface,
which confluate forming larger, connecting, gray or grayish-
yellow, patch-like deposits; after their loosening, wiping off
or throwing off, the bright red, bleeding, deeper layer of the
mucous membrane becomes visible (so called erosion ulcera-
tions; see Fig. 43).

As a result of the affection of the intestinal tract, there
is in the first two days obstipation, later profuse diarrhea.
The feces which at first were firm and sometimes mixed with
blood, become softer and later very thin; they are passed under
great strain, in which the dark red, or livid, greatly swollen
rectal mucous membrane protrudes. The parts surrounding
the anus are soiled by the watery, later dirty gray and then
dark brown, fetid, sometimes bloody feces, which contain
mucous shreds, gray detritus, or even large pieces of pseudo-
membranes. Towards the end of the disease, about the fifth day,
involuntary passages of the bowels take place at short intervals
and in small quantities, from the flabby and open rectum of the
animals which lie on the ground at this stage.

Even in the earliest stages a mucous or muco-purulent dis-
charge, which is sometimes mixed with blood-flows from the
vagina of cows and heifers, the vulva showing a swelling and
higher temperature. The mucous membrane of the vagina and
the vulva is reddened, and on the surface small gray, or yellow,
pseudo-membraries form, which later are thrown off leaving
dark red, bleeding, superficial erosions in their places.

The animals urinate frequently. The urine flows almost
continually in drops at short intervals, and is sometimes
yellowish-red to coffee brown in color (Eggebrecht).

As an indication of an affection of the respiratory organs
a frequent painful cough is observed as the first symptom,
which however disappears after the disease has completely
developed (Dieckerhoff). The respiration is accelerated, 40-60
per minute, later it is labored to a high degree, and the grunt-
ing of the animal is audible for a great distance. Percussion
of the thorax reveals nothing abnormal, or only a louder per-
cussion sound. Auscultation reveals intensified vesicular breath-
ing, later dry and moist rales. In some cases a subcutaneous
emphysema develops in association with the interstitial lung
emphysema, which results from the very difficult respiration.
246 Rinderpest.

In such cases the emphysema is first indicated on both sides
of the vertebrae, then on the neck, shoulders and thorax.

The heart’s action is-at first sufficiently strong, but grad-
ually weakens. The constantly increased frequency in pulse
is at first 50-60, later 80-100 and even more per minute. The
pulse is weak, small, and toward the end of the disease wiry.

The leucocytes increase in the blood with the onset of the fever
up to the fifth day of the affection. From this time on their number
diminishes to 4,000 per cubic millimeter in the unfavorable cases. If
the animal remains alive their number increases towards the sixteenth
or seventeenth day of the disease to 28,000-30,000, which is again
followed by a rapid diminution, whereupon by the twentieth day the
normal condition is re-established.

a] t 6 The continuous fever usu-
ally reaches its height on
the fifth or sixth day, the
daily differences varying by
one degree, and rapidly drops
with the onset of the diarrhea
in the severe cases to below
normal; whereas if there is
an indication of improvement
the fever subsides gradually
(Fig. 44). The height of the
fever does not always cor-
respond with the severity of
the other symptoms.

In some cases, particularly
in range cattle, the skin be-

 

Fig. 44. Fever curve in rinderpest, follow- . k
ing a subcutaneous injection of a drop of comes affected in a peculiar

virulent blood; three year old cow. (Af- manner. Two or three days

ter Nicolle and Adil-Bey.
er Nicolle an y) after the appearance of the

disease, sometimes even earlier, small protuberances and
vesicles develop on the neck, before and behind the shoulders,
along the vertebral column, on the shanks, on the udder or on
the scrotum, and in the flank. Over these areas the hairs stick
together, later thick scabs cover the wrinkled skin. In case
the animal improves the scabs are thrown off, the epithelium
desquamates, at the same time the hair falls out, and sometimes
the animals may even lose the hair from the tips of their tails.

Russian authors and also ZlamAl, laid great stress on the affection
of the skin which occurs quite frequently in range cattle, and accord-
ingly they distinguished an exanthematous form of rinderpest, from
one in which no exanthema developed. In confirmation of older con-
ceptions, they consider the appearance of the exanthema a favorable
prognostic indication. The skin affection however which develops in
some of the outbreaks quite frequently, in others but rarely, may
exceptionally occur also in Western European cattle and in spite. of
this favorable symptom the disease may terminate unfavorably. (The
exanthema was frequently observed in Hungary in the outbreak of 1852,

ogee
Course of Disease. 247

whereas in the years 1861-1863 it was not observed in a single instanéé.
[Zlamal] .) ae

With the diminishing milk secretion the udder becomes.
flabby, wrinkled and cold; the milk which is secreted in small
quantity is watery and of a pronounced yellow color. Pregnant
animals usually abort at the height of the disease.

_ During the development of the described symptoms the
animals have no appetite and do not ruminate, become rapidly
emaciated and steadily lose in strength. The skin loses its
elasticity, becomes stiff and dry, the hair dull and Iusterless:
The advanced stage of the disease appears characteristic in
the presence of a dull look from the deeply sunken eyes, purulent
secretions from the eyes, dirty nasal discharge, foamy. saliva
in the corners of the mouth, grinding of the teeth, accelerated
and grunting respiration accompanied by shaking of the body,
muscular trembling, and the peculiar repulsive odor of the
excrements. Soon the animals are not capable of standing
up, they lie constantly on the ground with head extended or
turned on the shoulder, and finally they succumb, completely
exhausted, in convulsions or without struggle.

Course. The described symptoms do not all develop in
every case of rinderpest. Furthermore according to Lorinser
the entire symptom complex is never present in one animal or
even in the herd, but from case to case the changes in the
respiratory organs, or those of the digestive tract predominate,
and in other instances symptoms of the genital organs; in most
instances all the organs mentioned may be affected, at the same
time but in varying intensity.

In the great majority of the severe cases the disease lasts
on an average of from 4-7 days. The affection of the mucous
membrane can usually be detected on the second day after
the appearance of the febrile symptoms. The clinical mani-
festations develop in their full intensity on the third or fourth
day; in exceptional cases the condition becomes very rapidly
aggravated, when death may result on the second or third day,
while in other cases the course may extend from 14-16 days.
The convalescence lasts from 2-3 weeks, and the symptoms,
especially those of the intestinal inflammation diminish very
gradually.

In the milder cases, such as are usually observed among
range cattle, the symptoms do not develop to such a degree, and
usually commence to recede about the fourth or fifth day. Ac-
cording to the observations of Russian authors and Eggebrecht,
the disease among these breeds of cattle may be manifested

“only by a febrile condition lasting for a few days, and by a
mild catarrh of the mucous membranes of the respiratory
organs, as well as of the digestive tract. As a result of these
the disease may sometimes even pass unnoticed in the larger
herds. This mild form of rinderpest is observed in very
248 Rinderpest.

exceptional cases also among cattle of the Western European
breeds (Dieckerhoff; according to Stockman the disease some-
times may run a very chronic course in the presence of mild

symptoms).

In Turkey, Russia and Africa animals frequently become affected
which have previously been infected with the parasites of infectious
hemoglobinuria, or coast fever. In such animals rinderpest runs the
usual course, but at the same time the piroplasma which were present
prior to the infection with rinderpest only in unimportant numbers
in the blood inerease very rapidly (Nicolle & Adil-Bey, Kowalewsky,
Theiler, Koch). Latent cases of trypanosomiasis are likewise influenced
by rinderpest (Holmes, Woolley).

Rinderpest as a plague does not spread very rapidly in
large herds. After placing an affected animal in a stall, usually
after 1-2 weeks the animals in -close proximity first become
affected, whereupon however the disease attacks the other
animals with a greater rapidity in a similar way. According
to Haupt it requires from 5-6 weeks for the disease to affect
all the animals in a herd of 15-20 head.

Diagnosis. The sudden appearance and the rapid develop-
ment of the symptoms, among which the characteristic affection
of several mucous membranes is of great importance, aid in
the recognition of the disease. In establishing a diagnosis
careful data on the history, first on the possibility of an intro-
duction of the infection as well as the mode of spreading in
the affected herd, must be carefully considered, because of the
far-reaching consequences which may follow the presence of
the disease. The diagnosis is formed with difficulty, in the
beginning of an outbreak, especially if the disease affects the
first animals in an unusually mild form, but a sudden rise in
the temperature is sufficient to justify a suspicion of the pres-
ence of rinderpest.

From the standpoint of differential diagnosis the follow-
ing diseases are principally to be considered:

1. Coccidiosis (red scour). The resemblance consists in
the fact that in this disease there is also a febrile diarrhea
and rapid loss of strength; further autopsy may reveal necrosis
of the epithelium and even of the deeper layers of the gastric
and intestinal mucous membrane. It is distinguished from
rinderpest in that the digestive disturbances precede the febrile
rise in temperature, further the excrements retain their original
color for a longer period, but may become mixed with blood
even at the beginning of the disease. The affection remains
exclusively confined to the gastro-intestinal canal, and in older
animals the affection of the rectum is especially marked;
whereas the mucous membranes of the head, and of the eyes,
remain normal. Further the disease is not contagious, and
cannot be transmitted, even by inoculation. Similar differences
Diagnosis, Prognosis. 249

exist between the acute gastro-intestinal catarrh, the mycotic
and toxic enteritis, on one side, and rinderpest on the other.

Tschudinow observed an affection in cattle after feeding swill heated to a
temperature of 53-54°, which consisted in fever of 40-42°, difficult respiration, red
spots on the buccal mucous membrane, catarrh of the conjunctivae, scanty hair,
mucous discharge from the nose, and a bloody mucous diarrhea. The autopsy
revealed in one case hyperemia, and hemorrhages in the mucous membrane of the
rumen and of the intestinal canal.

2. Malignant catarrhal fever of cattle, with which rinder-
pest has been frequently confounded. This disease resembles
rinderpest inasmuch as it also runs a severe course, and as
all mucous membranes may become affected. However the
most severe changes are found in the mucous membranes of
the eyes, nose and sinuses of the head, while the digestive tract
and the genital organs are usually only slightly affected. The
head feels warm to the touch, the horns sometimes fall off, the
depression of the animals is pronounced from the onset of the
disease. Besides cloudiness of the cornea, a fibrinous iritis may
also develop, and it should be taken into consideration that the
disease is not contagious and usually occurs only sporadically.

3. Foot-and-mouth disease can only be mistaken for rinder-
pest when the ulcerations in the mouth extend to the deeper
parts, and when the ulcerations later become covered with tissue
detritus and coagulated exudate; further when high fever and
indications of enteritis can be associated with the disease. In
foot-and-mouth disease however the ulcerations develop at the
site of the vesicles; the nose and the eyes are not affected, while
frequently inflammatory changes are present in the interdigital
spaces; furthermore foot-and-mouth disease spreads more
rapidly through the affected herds than rinderpest.

4. Piroplasmosis may cause suspicion of rinderpest,
especially on autopsy, in cases where the mucous membrane
of the abomasum and of the small intestines contain ulcerations,
and even patch-like deposits. Normal appearance of the mucous
membrane of the mouth, air passages and genitals, the presence
of hemoglobin in the urine, acute swelling of the spleen,
yellowish discoloration of the subperitoneal fat, as well as an
enzootic character of the outbreak, afford sufficient grounds
for excluding rinderpest. However the establishment of the
piroplasmosis, or the presence of piroplasma in the blood does
not exclude the simultaneous presence of rinderpest, as mixed
infections of this kind occur quite frequently (see pp. 248 and
255; according to Arloing & Ball the swollen lymph glands are
free from hemorrhages only when piroplasmosis exists in asso-
ciation with rinderpest). A demonstration of trypanosomes in
the blood also has no importance from the standpoint of a

differential diagnosis.

Prognosis. The termination of the disease depends in the
first place on the character of the outbreak, and on the breed
250 Rinderpest. ;

of the affected animals. The mortality fluctuates within wide
limits, and is estimated among cattle of the colored breeds at
79%, in range cattle at less than 50%.

it

In England during the outbreak in 1866 the affected animals died almost
without exception, whereas at the same time in Holland only two-thirds of the
diseased animals succumbed, and in France in 1871 the mortality amounted in
places to only 20%. In Hungary the losses in 1852 did not exceed 10%, on the
other hand in the years 1861-1863 they reached 75%. According to Krajewski the
disease sometimes runs a mild course, especially after a rapid spread through large
herds (losses of 15 to 20% or even less), but occasionally, even among range cattle,
85% may die. In India the mortality among cattle of the lowlands is ‘about 20%,
while in mountain cattle it reaches 90%.

Experience has shown that if the disease returns after a
long period of absence, a greater number of animals fall victims,
and on the other hand the mortality immediately after the out-
break is greater than in its later course. Under favorable
hygienic conditions, pure air and dry weather, the losses are
lighter than under adverse conditions.

Treatment. Medicinal treatment of the affected animals
gives no result, as was proven by the completely negative re-
sults obtained in experiments in England and Holland on the
occasion of the last outbreak. A favorable influence can be
hoped for only from serum treatment, in which the patient
should be given 40-80 cc. of immune serum subcutaneously or
intravenously at the beginning of the febrile stage, or not later
than the appearance of the first manifestations (see p. 252;
Fedetzky found the curative inoculation valueless).

The opportunities for therapeutic treatment are remote,
as all of the European countries which are free from the
disease, with the exception of Turkey, require the killing of all
affected and suspected animals.

Immunization. The possibility of an effective immuniza-
tion against rinderpest is indicated by the numerous instances
in which recovery from the disease has afforded the animals
an immunity lasting for a long time, usually as long as they
live. The intensity of the immunity thus obtained develops
in a degree relative to the severity of the affection. However,
as affected animals infect others during the course of the dis-
ease, and as they may disseminate the infection, immunization
except with pure serum inoculations, is only indicated in badly
affected localities, in order that the otherwise very great losses
may be reduced.

As this purpose was not attained with older methods of
immunization, owing to the considerable losses from the im-
munization, it has been abandoned not only in the Central and
Western European countries but also recently in Russia. The
occurrence of the disease with great severity in the last decade,
especially in South and North Africa, has again placed the*
question in the foreground and the experiments conducted

 
Immunization. 251

there have resulted in more effective methods by which more
satisfactory results are being obtained in affected localities.

_ I. Immunization with Secretions of Affected Animals.
Stimulated by the favorable results of smallpox vaccination,
immunization against rinderpest was undertaken in the middle
of the eighteenth century (1744) in England (Dodson), in
France and in Germany, as well as in Holland, and later was
employed to a great extent in Russia.

The procedure consisted in the introduction of the nasal discharges or lachrymal
secretions of affected cattle into healthy animals, under the skin of the tail or
other parts of the body. After the inoculation the disease developed in a very mild
form, especially in the gray range cattle, and the mortality reached only a small
percentage. Jessen experimented later with a supposedly attenuated virus, which
he carried through several generations of cattle. After such inoculations in the
Vaccine Institute of Karlowka, in the years 1857-1873, the entire loss among
2629 cattle amounted to only 5.97%.

This method of immunization, however, did not appeal to Western Europe,
-- inasmuch as the breeds of cattle in those countries became severely affected from
the inoculation and the losses were considerable, and further than this, the inoculated
animals endangered the lives of those which had not been treated. After the inter-
national conference in Vienna in 1872 had resolved that the immunization against
rinderpest should not be considered as a valuable method, it was abandoned even
in Russia, and in 1874 the last serum institute was given up.

II. Immunization with the Bile of Affected Animals. The
blood and the bile of animals dead from rinderpest has been
used for a long time for immunization purposes by the Boers
in the Transvaal and in the Orange Free States. Koch later
demonstrated (1897) that the bile of such animals in quantities
of 100 cc. injected into healthy animals afforded them a very
valuable immunity against the infection. The immunity can
be established by the tenth day following the immunization,
and is of such intensity that the immunized animals withstand
an injection of 40 cc. of virulent blood without ill effects even
four weeks after the inoculation, and they are also able to
resist natural infection. The immunity probably results from
the virus contained in the bile which gives the animals a mild
local affection, due to the retention of the virus at the point
of inoculation through the action of certain ingredients of the
bile (Kolle).

The immunization employed in practice showed that the immunity
following the injection of bile sometimes appears on the sixth day,
and lasts from four to six months (Kolle). Jn other cases, however,
it lasts only from 3-4 weeks (Kohlstock), and the inoculation occa-
sionally causes not only a local swelling at the place of inoculation,
but it may also cause a severe general affection, and exceptionally
the death of the animal, especially if the bile contained some blood
(Theiler). Further, as the bile inoculation in already infected animals
‘during the time of incubation is entirely without effect, the applica-
tion of this method could only come into consideration if rinderpest
suddenly broke out in certain localities and a more effective method
of immunization could not be employed.

Potent bile can be obtained only after the seventh day of the dis-
952 Rinderpest.

=

ease; it should be of a green color, odorless, and on shaking should
form a white foam. An animal dead from the disease produces a
quantity sufficient for not more than 20-25 cattle.

In South Africa in the years from 1896 to 1898 over 2,000,000 cattle were
immunized with bile with apparently satisfactory results, and according to Adani
it has proved beneficial in Erythraa. Rogers also found this method effective in
India, however only in cattle of the iowlands, since mountain cattle, which are
much less frequently exposed to the infection, nearly all succumbed to the disease,
when inoculated with virulent blood 10 days to 41%4 months after they had been
immunized with bile. (In some localities of South Africa the immunizations were
repeated every three months, and in spite of this deaths from the disease were
occasionally observed).

Edington mixes bile (2 parts) with glycerine (1 part) and injects this mix-
ture subcutaneously, 20 to 25 cc. to adult cattle and 15 cc. to calves. According
to Turner immunity cannot be established by this method, as the glycerin kills the
virus contained in the bile; Rogers likewise asserts the ineffectiveness of the addition
of glycerin. Filtering the bile before the injection through a porcelain filter (Turner
& Kolle) also reduces its immunizing action, and at best only has the advantage
that by this procedure bile which is no longer fresh may be utilized for immunization
(Rogers). Lingard on the other hand found that bile from healthy animals if
subeutaneously inoculated four times at several days intervals in 50 cc. doses, also
gave an effective immunity against subcutaneous virulent infections.

Lingard uses instead of fluid bile a precipitate which he obtains by the
addition of Almen’s reagent (5 g tannin, 10.0 ce. acetic acid, and 240 cc. of 45%
alcohol). The precipitate which is washed in a 1% soda solution, neutralizes the
virus in vitro, and inoculations by this method are supposed to have given good
results in India even in the mountain cattle.

Active immunization with bile and with virulent blood. In
order to produce a more lasting immunity, Kohlstock, and later also
Henning & Edington injected subcutaneously virulent blood (0.2 ec.)
about two weeks following the bile inoculation. The animals thus
injected became sick, however with only a few exceptions they re-
covered and later proved that they pessessed a lasting immunity. In
German South Africa this method has found extensive use, and with
its aid the disease was successfully eradicated in a few months at
the time of the severe outbreak of 1897 (Rassau). It has likewise
proven satisfactory in Tientsin (Asia) where of the immunized animals
66% showed no disease whatsoever, while 24% became only slightly
affected, and 10% died as a result of the inoculation (Haedicke) ;
Edington on the other hand observed at Kimberley great losses from
such combined inoculations.

III. Immunization With Blood Serum. Semmer found in
1893 that blood serum from cattle which recovered from rinder-
pest possessed immunizing properties, and these findings have
since been confirmed. However such serum exerts its protective
action only when relatively large quantities are used (100-200
ec.), still its action may be increased by injecting the animals
with large quantities of virulent blood.

The passive immunity produced by the serum inoculation
only lasts from 10-21 days, and the duration cannot be increased
to over four months even by the use of greater quantities of
serum (100-200 ce.). Accordingly it may be suitably applied
whenever, after the slaughtering of the affected animals, the
remaining cattle, if treated with serum, will not be likely to
become exposed later to the infection; further it may be used
where infection is threatened by outbreaks in neighboring

 

 
Immunization. 253

localities when the serum will be found to afford protection
for at least a short time. One advantage of this method lies
in the fact that it is also effective during the period of incuba-
tion, and that the inoculated animals do not become affected
and therefore do not spread the disease.

Tokishige (1897) in Japan, and Pitchford & Theiler, as well as
Bordet & Danysz, during the invasion of the disease in South Africa,
aimed to increase the potency of the blood serum of recovered (so-
called salted) cattle, by injections of virulent blood. Kolle & Turner
injected at first 100 cc. subcutaneously in recovered animals after the
disappearance of the fever, then at intervals of several days increasing
quantities of virulent blood (the last time 5 liters in one injection).
After 3-4 pronounced reactions the animals produced a serum of which
20 ce. protected an animal weighing 300 kg. against a pathogenic
action of 1 ec. of virulent blood (for use in practice the blood serum
must have at least such a potency). Animals which have not recovered
from rinderpest must be treated first with bile, or with blood serum
and blood, and only later with virulent blood.

Nicolle & Adil-Bey observed in Constantinople that animals which
recovered from rinderpest could not again be made sick by a sub-
cutaneous or intraperitoneal injection of a large quantity of virulent
blood (up to 10 liters), even when inoculated immediately after the
recovery. Accordingly recovered animals were injected subcutaneously
at first with 4 liters of blood, and later the quantity was increased.
Another method of these authors consists in the injection into the
abdominal eavity of an affected animal which already has diarrhea,
of 6 liters of a physiological salt solution containing peptone. Three
to six hours after the injection the animal is bled to death, and a
healthy animal is then injected subcutaneously with 2-3 liters of the
fluid collected from the abdominal cavity. The blood taken after 10,
15 or 20 days from this animal produces a potent serum; later the
animal again receives the abdominal fluid subcutaneously, and the
method is continued in this manner. Two weeks following the injection
of 4 liters of blood the animals produce a similarly potent serum,
no matter whether this quantity has been injected immediately after
the first opportunity or only in gradually increasing quantities. Sheep
are also adapted to the production of immune serum, the horse and
the goat however are not. By adding to the immune serum 14 to
1% of earbolic acid and keeping it in a dark place it remains potent
for four years (Theiler).

The dose of the serum is 50-100 cc., according to the size of the animal. In
India the very susceptible mountain cattle are injected with 18 times larger doses
than are given to the cattle of the lowlands, and the quantity also depends on the
severity of the disease before the inoculations have been undertaken (Walker).

According to the statistics of Turner, in 1897 33 herds on several farms,
with a total of 3318 cattle, of which 455 animals had already been affected, were
subjected to the serum treatment. Of these inoculated animals 455 died, while
2857 (86.1%) remained healthy. In the English Egyptian Soudan Head lost 2%
out of 7386 inoculated animals. The serum inoculation has been applied in China
to about 11,000 eattle, with very satisfactory results (Keylock). ats

As it is sometimes difficult to obtain virulent blood, Ridiger injects cattle
intraperitoneally with 5 liters of a 4% potassium citrate solution. The animals
are slaughtered an hour later. The fluid thus injected proves very virulent and
when mixed with equal quantities of virulent blood produces a very effective and
@ correspondingly cheaper material for the preliminary treatment of serum cattle.
254 Rinderpest.

Dschunkowsky & Kupziz produced a dry preparation from the liquid serum
by evaporation, at 30.32°, and by adding at the same time 1-5% of sodium hydrate;
this has, however, not yet been tested in practice.

IV. Immunization With Immune Serum and Virulent Blood.
(Simultaneous Method.) Kolle & Turner produced an immunity
in cattle which lasted for at least five months, by injecting the
animals subcutaneously on one side of the rump, with one ce.
of virulent blood, and on the other side, according to the size
and age of the animal, 8 to 25 ec. of immune serum. This
immune serum is the same as that which is used for ordinary
serum inoculations, while the blood originates from animals
either affected with the natural disease or from such as were
artificially infected, and should be taken on the fifth or sixth
day of the disease (sheep infected with blood are also suitable
for this purpose). Some of the animals inoculated by this
method react with a fever lasting for several days, while about
10% of the vaccinated cattle, especially common range cattle,
do not manifest any reaction whatsoever. The blood of the
reacting animals. is infectious during the febrile stage. In
exceptional eases severe symptoms of rinderpest develop in
the inoculated animals, and some (about 1%) may even die
with the disease.

The simultaneous method has the advantage over the other
methods that it causes a relatively small loss, and with very
rare exceptions it produces a lasting immunity. However while
only a small proportion of the inoculated animals become
affected with severe symptoms, they may transmit the disease
to healthy animals, and therefore its application is only indi-
cated in already infected territories, and in these localities
only under assurances that the blood does not contain other
poisonous substances in addition to the virus of rinderpest,
and it should especially be free of protozoa (see p. 255).

This method has been employed for several years in Africa, in
Asiatic Russia (Nencki, Siebert & Wyznikiewiez), in Turkey (Nicolle
& Adil-Bey), and in India (Rogers), and the first reports from all
these places indicated favorable results. In India, however, in the
less resistant mountain cattle the immunity obtained was not sufficient,
although the dose of the serum was increased 6 to 9 times. Rogers
therefore injects another 10 cc. of virulent blood subcutaneously 10
days after the simultaneous inoculation. The simultaneous method may
be also adopted for the immunization of buffaloes as well as goats
(8 to 5 ee. of blood serum, and 1 ec. of blood).

According to Turner, 10,407 cattle were inoculated by this method in South
Africa (Rhodesia, Cape Colonies and Pretoria), and the loss from inoculation
amounted to 136 animals (1.31%); Head inoculated 7,386 animals in the Egyptian
Soudan, with a loss of only 2%, Fedetzky and Gorain observed a loss of 1-2%,
Stockman on the other hand observed in one herd deaths amounting to 12%. Very
good results are reported by Eggebrecht in Eastern Asia.

For a time another method of immunization was used in South Africa, which
has since been introduced into practice by Bordet & Danysz, as well as by Pitchford
& Theiler, and which consisted in injecting subcutaneously into the animals
100-200 ce. of defibrinated blood from animals which had recovered from rinderpest.
Complications. Quarantine. 255

This injection was followed by rubbing infectious saliva or blood into the nose,
and after five days 100 cc. of blood was again injected subcutaneously. Conti
immunized animals with 20 ce. of serum from animals which had recovered from
the disease, to which 3 ce. of blood from an animal which had been affected for
47 hours with rinderpest was added. The author reports favorable results from
this method of immunization.

Complications. Several years ago Koch (1904) and later Theiler
and Woolley, pointed out the dangers in the application of the simul-
taneous Inoculation. In localities where piroplasmosis or trypano-
somiasis 18 prevalent there is the danger that parasites of the mentioned
diseases may be transmitted with the blood from cattle affected with
rinderpest, causing diseases from which the animals die; thus in Egypt
in 1903 of animals which had been inoculated with serum obtained
in Constantinople (25 ec.), and virulent blood (1 ee.), 80-90% died
within a short time, and the losses appeared at least partially to be
caused by a piroplasmosis which resembled the East African coast
fever. The existence of this disease in Egypt has been established
by Koch (he therefore recommends large serum doses of 100 cc. to
be used repeatedly instead of the simultaneous inoculation). Theiler
also observed a mortality of 6.8% among 452 cattle in South Africa
which were inoculated by the simultaneous method. In cattle coming
from localities free of Texas fever (124 head), for which a possible
piroplasma infection is much more dangerous, the loss amounted to
27.4%. As it is impossible in practice to exclude the blood from animals
which have recovered from Texas fever, but still contain in their blood
piroplasms, it was deemed advisable in the Transvaal to abstain from
the simultaneous inoculation, and serum has been used exclusively, by
which means an eradication of rinderpest was accomplished in 1903.
‘Woolley reports a case in which all of the 56 cows imported from
the United States to the Philippines died after the simultaneous inocula-
tion, probably from piroplasmosis, while according to Nesom’s observa-
tions, in the Philippines, the otherwise effective simultaneous inocula-
tion causes a loss of 4% as a result of trypanosomiasis, which develops
after the injection. Spirillae, or the virus of heart water, may also be
the cause of possible bad results from this method.

Veterinary Police. The safest prophylactic measure con-
sists in a quarantine against countries in which rinderpest pre-
vails. Since the practical application of this principle Western
and Central Europe have been freed of the disease, although
the plague has appeared repeatedly in an epizootic form in
Russia and on the Balkan Peninsula. The introduction of the.
disease may also be prevented to some extent by establishing
a carefully executed registration of cattle at the endangered
borders of the countries, which would considerably facilitate
the establishment of the origin of the disease, if it has been in-
troduced.

If the disease should make its appearance in any locality
the immediate slaughter of all affected, as well as all exposed
animals, together with the thorough disinfection constitutes the
surest method for its eradication. If however such a procedure
cannot be executed it is advisable to segregate the infected
herds into small groups, keeping them completely isolated under
observation. (According to Piot-Bey better results were ob-
956 Hinderpest.

tained in Egypt with this method than from serum inocula-
tions.) At the same time the other ruminants, especially sheep
and goats, should also be considered as carriers of the virus.
In the meantime the losses in infected herds may be diminished
by the application of one of the above-described modes of im-
munization and in neighboring herds the animals should all
be given serum inoculations thereby producing an immune zone
around the infected herds.

Literature. Dieckerhoff, History of Rinderpest and Its Literature, Berlin,
1890.—Semmer, B. t. W., 1893, 590.—Koch, Zbl. f. Bakt., 1897, XXI, 526; Veréff.
d, G.-A., 1904, V, 681.—Kohlstock, Ibid., 1897, XXII, 787—Kolle, Z. f. Hyg., 1898,
XXVII, 45; Ergebn. d. allg. Path., 1899, VI, 470 (Lit.)—Kolle & Turner, Z. f.
Hyg., 1898, XXIX, 309.—Theiler, D. t. W., 1898, 205; Monh., 1901, XIII, 145.—
Rogers, Z. f. Hyg., 1900, XXXV, 59.—Nicolle & Adil-Bey, A. P., 1899, XIIT, 329;
1902, XVI, 56.—Blin & Carrougeau, Bull., 1902, 107.—Yersin, A. P., 1904, XVIII,
417.—Hidicke, B. t. W., 1904, 823.—Arloing, Journ. de méd. vét., 1905, LVI,
385.—Holmes, J. of comp. Path., 1905, XVIII, 207.—Stockman, Ibid., p. 207.—
Head, Ibid., 1906, XIX, 12.—Rassau, Z. f. Infkr., 1906, I, 382.— Woolley, Rev. gén.,
1907, X, 68.—Kowalewsky, J. vét., 1908, 146.—Riidiger. D. t. W., 1909, 400.—
Eggebrecht, Z. f. Infkr., 1910, VII, 54.

Rinderpest in sheep and goats. In 1861 Galambos established
with certainty a disease in sheep identical with rinderpest, and he
succeeded also in transmitting it artificially to sheep (6 animals in-
oculated became affected on the 10th day). Since that time the sus-
ceptibility of sheep as well as of goats has been confirmed repeatedly,
and according to Roll only about 55% of these animals resist artificial
infection.

Extensive outbreaks among sheep were observed in 1862 in Poland,
where 64-74% of the flocks became affected (Seifmann) ; in 1863 in
Sicily, where 20,000 sheep and goats succumbed to the disease (Chicoli) ;
further in 1870-1871 it affected the sheep in France and Alsace-Lorraine,
in the latter provinces causing a loss of 4,000 animals (Zundel).

The clinical manifestations consist in the milder forms, in fever,
catarrh of the conjunctivae and the nasal mucous membranes, accelerated
respiration, dry cough, and passing of very dry feces. In severe cases
there is great debility and apathy, a yellowish-white discharge from
the eyes and nose, moist cough and frequent passage of thin, greenish-
brown excrements mixed with mucus.

In favorable cases the patients improve very rapidly after an
illness lasting 4-5 days, while in severe cases death ensues in the same
-length of time. The mortality in sheep and goats is generally smaller
than in eattle, rarely exceeding 25-30%, Tamilini however observed
a loss of 75%.

The anatomical changes resemble those in cattle, but extensive
pseudo-membranes and ulcerations on the mucous membranes do not
usually occur. The ordinary changes consist in a hemorrhagic inflam-
mation of the mucous membrane of abomasum and intestines, with
reddish-yellow, loosely adhering deposits. Similar changes are also
present in the mucous membrane of the air passages and in the bladder.
There is also anemia of the lungs, and an interstitial emphysema
(according to Réll a catarrhal pneumonia is noted with relative fre-

quency).

Literature. Galambos, Gyégydszat, 1862, Nr. 4.—Maresch, 0. Vijschr., 1863,
XIX, 34.—R6ll, Rinderpestihnl. Krankh. d. Schafe u. Ziegen. Wien., 1864.

 
Heartwater. Hog Cholera. 257

Heartwater. According to Theiler a disease of cattle occurs in
several localities of Transvaal, which is known there as Veldt-sickness.
The most striking symptom of the disease is the filling of the pericardium
with a colorless or yellowish fluid (hence the name heartwater). There
is also a pronounced indication of acute gastro-enteritis present. The
micro-organism is, according to Counsbury, transmitted from the af-
fected to the healthy animals, by a tick (Amblyomma hebraeum) ;
sheep and goats are also very susceptible.

The same disease occurs also among sheep and goats, and may
readily be produced by the subcutaneous or intravenous injection of
blood, but not of the pericardial fluid. The transmission may be made
from sheep to cattle, and vice versa. The symptoms develop 5-15 days
after the injection, and consist of high fever, dullness, exceptionally
also in nervous symptoms, such as continuous moving of the tongue
and the jaws, turning in a circle, later a stiffness of the neck (hence
the name ‘‘brainwater’’). The autopsy reveals a great quantity of
fluid in the pericardium and pleural cavity, also petechiae on the peri-
cardium, edema of the lungs and moderate acute swelling of the spleen.

The disease, which has been known in South Africa for about
40 years occurs only in certain localities, principally during the summer
time, and in pastures located upon high lands. The Kaffir goat and
the native fat-tailed sheep are not susceptible, while the Persian sheep
are only slightly susceptible to the disease.

Hyperimmunized cattle, sheep and goats produce an effective
serum for their respective species, a practical immunization however
has not yet been established.

The supposition of Edington that the disease is identical with
‘‘horse-sickness’’ is considered by. Theiler as incorrect, as horse-sickness
can be transmitted artificially only to horses (see page 286).

According to Edington’s view the disease is identical with the. African horse-
sickness (see that disease). Spreull on the other hand contends that the diseases
of cattle occurring in South Africa under the names Lamziekte, Gall-sickness, Veldt-
sickness, Blood-lung and Inapunga are identical with Heartwater, and he considers
their causative agent to be a motile bipolar bacillus. Clinically he distinguishes an
edematous form, with swellings on the neck and head, a thoracic form with con-
gestion and hepatization of the Jungs, and a paralytic form which is associated
with a stiffness of the gait. a 7S yee

Literature. Theiler, The Vet. J., 1904, IX, 300; The transv. agric. J., 1904,
II, 163; Bull. Pasteur, 1905, III, 617; J. of comp. Path., 1905, XVIII, 155.—Eding-
ton, J. of comp. Path., 1904, XVII, 141—Spreull, V. J., 1908, 358. |

11, Hog Cholera. Pestis suum.

(Swine fever, Typhoid fever; Schweinepest [German]; Cholera
suum, Peste du pore [French]; Peste porcina [Italian].)

Hog cholera is usually an acute, sub-acute or chronic, more
rarely a peracute, contagious, infectious disease of hogs, caused
by a filterable virus. In the course of the disease, with the excep-
tion of the peracute cases, inflammatory and necrotic processes
develop, produced either by the bacillus suipestifer when the
lesions occur in the intestinal canal and in the abdominal lymph
glands, or by the bacillus suisepticus when the lesions are mani-

fested in the lungs.
958 Hog Cholera.

-

History. The disease has been recognized in their studies - of
American diseases of hogs by Salmon & Smith (1885) as an independent
affection (hog cholera) as the cause of which they designated a short
motile rod. Based on these findings they sharply separated the disease
from swine septicemia (swine plague), considering this as identical with
swine plague of Germany, which was recognized just about that time. At
the same time they proved that the two diseases are frequently present
in one and the same animal, and that the severity of the American
outbreaks is brought on by such mixed infections. The same stand-
point was accepted in America by Moore and de Schweinitz, in Europe
by Raccuglia and Affanasieff. The frequent simultaneous occurrence
of the two forms of diseases, that is the frequency of the mixed infec-
tions, caused Billings in America, and Silberschmidt and Voges in
Europe, to take a stand against the identity of these two diseases and
their supposed causative agent (the common name of ‘‘pneumonoentérite
infectieuse’’ used in France and England corresponds with this con-
ception), while Bang, Schiitz, Jensen and Preisz (1898) confirmed the
correctness of the original stand of Salmon and Smith.

Through the experimental investigations of the last decade the etiol-
ogy of the disease appears to have been definitely established. In 1904
the American investigators de Schweinitz & Dorset made the discovery
that a disease occurring in the State of Iowa which clinically resembled
hog cholera was transmissible from affected animals to healthy hogs
by filtered bacteria-free blood. Soon afterward Dorset, Bolton and
McBryde proved that the disease was identical with hog cholera, and
therefore that this disease is also caused by a filtrable virus, whereas
the formerly supposed causative agent, the bacillus suipestifer, produces
the characteristic changes in the intestines only secondarily in the
already affected animal. Similar results were also obtained in Michigan
almost at the same time by Boxmeyer (1904), while Hutyra (1906),
then the Board’s Laboratory of England, Ostertag (1907), as well
as Uhlenhuth, Xylander, Hiibener & Bohtz (1907), later Carré,
Leclainche & Vallée, also Wassermann, confirmed the correctness of
the new conception of the disease in Europe and Theiler in South
Africa. At the same time the views concerning the part of the bacillus
suisepticus in the production of the secondary affection of the organs
were changed, whereby the disease formerly considered swine plague,
is now considered in most cases to be a complication of hog cholera.

The accurate determination of its etiology directed the combating
of the disease into new lines, and the attempts at immunization by
Dorset, McBryde and Niles, as well as those by Uhlenhuth and his
co-workers, also those by Hutyra, have given valuable practical results.

Occurrence. Hog cholera is at present very widely spread
in America, and in almost every European country, causing
annually great losses among hogs. The disease, which in
itself is not very malignant, becomes very fatal as a result of
the frequent, secondary inflammatory processes in the in-
testines and in the lungs, which, especially in ‘young animals,
exist in an epizootic form. It causes the greatest loss in places
where hogs are kept in large herds, whereas in localities with
smaller droves the disease is combated with better success.

Hog cholera is supposed to have first appeared in North America
in the State of Ohio in 1833, and from there it spread over the entire
Occurrence. 959

territory of the United States. It was probably carried to Europe
in the 60’s of the last century. Its occurrence was first established
in England in 1862 (swine fever, typhoid fever), where it has since
appeared from year to year, causing in 1896 the loss of as high as
30% of all hogs in the country. From England it was supposed to
have been spread to Sweden in 1887, with an importation of boars,
and from there in the same year to Denmark, to the Island of Amagar,
and from there it later extended to other localities in the country. At
the same time it appeared in France in the vicinity of Marseilles
(it is supposed as a result of an introduction from Algeria), spreading
to all parts of this country, as well as Spain and Italy.

Roloff reported in 1866 in Germany the occurrence of an infec-
tious ‘‘caseous intestinal inflammation’’ in young hogs of English
breed in the Province of Saxony, which according to the accurate de-
scription of the changes in the caecum and colon was possibly identical
with hog cholera. Hog cholera was observed in 1893 as a severe fatal
affection in Posen, and shortly afterwards in Prussian-Silesia, from
which country it has been disseminated to the neighboring territories
of Austria. Extending in an eastern and southeastern direction it
reached Hungary in 1895, where it first made its appearance in the
fattening establishments of Kébanya and Gyér, causing great losses.
At the occurrence of the outbreak at Kobanya of the 180,000 animals
8,368 died, or had to be slaughtered in May; 10,288 in June, and at
the end of that year with the exception of Siebenbiirgen, all counties
were infected. In the following year the disease existed throughout the
entire country.

In Germany during the period of 1898-1906 the number of townships infected
with hog cholera and swine plague increased from 1,817 to 11,513, and the number
of the affected animals from 11,813 to 104,728. Subsequently up to the year of
1908 the number of townships infected diminished to 8,782, and the number of
cases to 75,688. The total loss amounted in 1908 to 60,101 hogs, and the disease
was most widely spread in the government districts of Breslau, Liegnitz, Posen,
Bromberg, Potsdam, Frankfurt, and Oppeln. At the end of 1907 there were
infected 1,339 townships, and 86.6% of all outbreaks were confined to Prussia.

Hog cholera is widely spread in France, and all parts of the country are
infected with the disease. In 1908 from 13 to 20 districts were said to be
infected during different months; however the reports are not accurate.

For a time the disease has greatly diminished in Great Britain, as a result
of the measures of eradication which were inaugurated in 1893. While in 1894
5,862 outbreaks were established in 73 counties, in 1905 only 817 outbreaks occurred
in 58 counties. In 1894 to 1896 the number of hogs, which were excluded from
traffic on account of the disease or on suspicion, amounted to 56,296, 69,931
and 79,586, while in the year 1905 only 3,876 animals were affected by this
measure. In 1906 the disease spread again more extensively, and in 1908 there
occurred 2,067 outbreaks in 68 counties, and 14,096 affected or suspected hogs
were slaughtered. .

The disease diminished in Austria as a result of regulations passed in 1895,
and consequently from 1896 to 1898 a gradual decrease in the number of outbreaks
resulted; later however it again spread to a considerable extent. In 1895, 2,767
outbreaks with 28,142 affected animals were recorded; in 1898, 654 outbreaks with
4,610 affected animals; and in 1900, 1,100 localities with 35,984-affections. In
1908 the weekly number of outbreaks fluctuated between 104 and 208. The disease
was most extensive in Galicia, Bohemia, Moravia and Lower Austria, while Dalmatia
was free from it. / ihe od

In Hungary in the first year (1895) after the appearance of the affection
1,478 and in the following year 3,569 townships, with 413,562 and 868,777 animals,
were affected. From this time on the disease gradually diminished, but even in
1908 2,200 townships were noted, with 263,945 cases, of which 148,110 (56.8%)
died (in‘the first 2 years the mortality amounted to 81.4% and 73.6%). _ The
disease is most widely spread in the section south of the Tisza and Danube rivers.

Of other countries the disease was discovered in 1908 in Bulgaria, affecting
260 Hog Cholera.

73 townships, in Italy 14,499, in Roumania 1,829, in Russia 27,223, in Servia 45
cases, while in Denmark and in Holland the disease appeared less frequently, in
Sweden and Norway (in 1903 468 cases, of which 450 occurred in Dép. Akershus)
only sporadically.

In the United States the disease (hog cholera and swine plague) caused
in the year of 1873 losses amounting to 20 million, in 1882 13 million, in 1884
and 1885 25 and 30 million dollars respectively, while in 1888 the loss was estimated
to have affected 45,000,000 hogs of a value of 200 million dollars, and in 1903
Salmon estimated the loss at 50 million dollars.

Etiology. According to the results of investigations by
Dorset and his co-workers which, a8 already mentioned, have
since been substantiated by other investigators, hog cholera is
caused by an ultra-microscopic virus, which passes the ordinary
porcelain filter. Attempts at cultivation, or even increasing the
amount of virus have up to the present been fruitless.

Pathogenicity. Subcutaneous injections of 1-2 cc. of filtered,
defibrinated blood, blood serum or organ juices, produce in
young hogs, after an average incubation period of 8 to 10 days,
sometimes however in four days or only after 20 days, and
without any local reaction, an acute febrile affection with inflam-

21 | 22) 23 | 24] 25 | 26) 27 | 28} 29) 30} i ta 3 4 6

 

Fig. 45. Hog Cholera. Artificial infection with filtered material from a hog affected
with cholera. The first rise up to the fourth day of sickness is caused by the primary
infection, the second by the secondary infection.

matory swelling of the conjunctivae, eczematous eruption of the
skin, followed by diarrhea (Fig. 45; the quantity of blood does
not affect the outcome of the disease). In some of the cases
the animals die in 3 to 4 days with an acute affection, whereupon
the autopsy reveals exclusively hyperemia and acute swelling
of the internal organs, as well as hemorrhages on the serous and
mucous membranes (sometimes also a great quantity of serous
transudate in the pericardium). If the animals remain. alive
for a longer time ulcerative and necrotic processes may be found
in the intestines, in other cases again pneumonic changes
will be observed which are similar to those found in the acute
pure swine plague. If the animals remain alive still longer the
affection of the intestines and the lungs develops in a more
chronic form, whereupon the animals die greatly emaciated,
Pathogenicity. 261

or recover completely. Such recovered animals are subsequently
immune against artificial, as well as against natural infection.

Animals artificially infected in the above manner may
readily transmit the disease to healthy hogs by cohabitation,
and their blood even in a filtered condition, and in small quan-
‘tities, is also infectious. By serial re-inoculations the virus may
be propagated from generation to generation.

The artificial affection is, although with less certainty, also
successful, by the administration of blood and blood serum in
gelatine capsules per os, or by feeding the same with food, when
unfiltered material acts more strongly than filtered. The virus
is as a rule also present in the bile and the urine, while the intes-
tinal contents frequently prove noninfectious (Uhlenhuth). By.
feeding internal organs of diseased hogs the disease may readily
be produced artificially. Other species of animals aside from
the hog are not susceptible to the virus.

Tenacity. Fluid material containing the virus retains its virulence at room
temperature for 10 to 14 weeks. Heating for one hour at 60 to 70°C. destroys
the virus, while in the dried condition subjected to 72 to 76° it requires an hour
to destroy its virulence. Blood frozen below —18° and thawed out after 24
hours, proved fully virulent, likewise blood which had been dried for three days.
The addition of a 1:1000 corrosive sublimate solution in the proportion of 1 to
2, or of a 5% glycerine-carbolic acid solution in the proportion of 2:5 does not
destroy the virus inside of 8 days; on the other hand the virus in serum is rendered
ineffective by the addition of 2% formalin in 15 days, by 2.5% antiformin in
2 hours. The virus in old putrefied organs loses its virulence in eight days
(Uhlenhuth).

Besides the filtrable virus, two species of bacteria, the
bacillus suipestifer and the bacillus suisepticus, play an impor-
tant part in the etiology of hog cholera. The secondary affec-

 

Fig. 46. Bacillus suipestifer. Agar cul- Fig. 47. Bacillus suipestifer, with fla-
ture, fuchsin staining. gella. Agar culture.

tions of the intestines and of the lymph glands or of the lungs
are usually produced by the pathogenic action of these bacteria.

1. The bacillus suipestifer (Bac. cholerae suis) resembles
the colon bacillus and belongs to the paratyphus B-group. It
is motile, possessing peritrically arranged (3-9) flagellae, and
multiplies exclusively by fission (Fig. 46 and 47). In tissues
262 Hog Cholera.

it occurs singly or in pairs, in cultures however it also forms
longer chains or even slightly curved filaments.

Staining. With aqueous aniline dyes the organism usually stains
uniformly, sometimes, however when stained with diluted methylene
blue solution, it may: stain more intensively on the poles. It does not
stain by Gram’s method.

Cultivation. The bacillus grows aerobically as well as
anaerobically on all artificial media, in room temperature
as well as body temperature; in the latter however con-
siderably faster (the temperature limits are according to
Frosch +8 and +42°C.). On gelatin plates bluish, trans-
parent, uniformly rounded. colonies de-
velop, while in stab cultures a continuous
grayish-white streak forms along the stab,
surrounding which the nutritive medium
is sometimes turbid. Gelatin is not lique-
fied (Fig. 48). On agar bluish, trans-
parent, flat, round colonies develop which
do not closely adhere (Fig. 49) ; the growth
on coagulated blood serum ‘is similar. On
Loffler’s malachite-green plates, and on
endo-plates, colorless colonies form, while
on Drigalski’s plates the colonies are blu-
ish. Peptone bouillon becomes uniformly
cloudy, later a loose sediment settles on
the bottom of the tube; indol does not
form in the cultures. On potatoes a color-
less, moist, lustrous, or a brownish-yellow
deposit forms (the variance is probably
due to the different kinds of potatoes).
Milk becomes grayish, in 3 to 4 weeks sa-
ponified, and still later it is changed to a
stiff, alkaline jelly. Litmus milk is some-
what reddened, but after 2 to 4 days it be-
comes decidedly bluish. Dextrose is fer-
mented by the bacillus, lactose on the other
hand is not.

Tenacity. The cholera bacillus withstands

es ae eo aoe sone eg a the a

: uence of sunli an ernate drying an :
qo moistening it ia. quickly islled. In ordinary drink. ie i ao
stab cultureof 12g water, also in soil infected with feces of uiture of the
the bacillus  attected animals, it retains its virulence for 65 4 acillus sud

suipestifer. +%0 95 days, while atemperatureof 50° destroys it pestifer.

in 66 hours, and one of 55° in one hour (Preisz).

Of the disinfectants the growth of the bacillus in inhibited by 1:4000 sulphuric
acid, 1:900 potassium hydrate; it is destroyed in one minute by a 1% carbolic acid,
solution, 1:10,000 corrosive sublimate, 1% creolin, in 10 minutes by 1% milk
of lime, inthree minutes by a 1% copper sulphate solution, in 114 minutes by 0.1%
formalin solution, and in three hours by a 2% iron sulphate solution (Koppanyi &
Erdés). The bacillus suipestifer is considerably more resistant than the bacillus
suisepticus,

 

 

 

 

Pathogenicity. Mice are susceptible to artificial infections,
and after an inoculation with 0.1 mg. of bouillon culture they die
of septicemia in from 3 to 5 days. The guinea pig and rabbit
Pathogenicity. Natural Infection. 263

are less susceptible (after a successful subcutaneous infection
they die in 6 to 7 days; showing enlarged spleen and necrotic
foci in the liver). Pigeons are only very slightly susceptible
(muscle necrosis develops after an intra-muscular infection),
while. chickens are not susceptible. If the culture is injected
into the cecum of a rabbit, small white dots at first develop on
the mucous membrane (swollen lymph follicles); later ulcers
appear in sizes up to a lentil.

By feeding large quantities of cultures or injecting cultures
into the intestines of hogs, either acute or more chronic inflam-
matory and necrotic processes develop, in some cases according
to the intensity of the infection (dysenteric necrosis and ulcera-
tions on the intestinal mucous membrane, swelling and caseation
of the lymph glands, etc.). After previous starvation or neu-
tralization of the hydrochloric acid of the stomach, the disease
results in a much more acute and severe form, and the animal
may die on the third day with symptoms of septicemia (Salmon
& Smith). The subcutaneous injection of the culture results
in an inflammation of the neighboring lymph vessels and lymph
glands, leading to necrosis, and the animals die in from 2 to 3
weeks, or even later. In some of the cases ulcerations develop
in the meanwhile on the intestinal wall, and metastatic, caseous
areas appear in various internal organs. Intravenous injec-
tions may result in a hemorrhagic septicemia producing death
in 1 to 3 days. The infection cannot be produced by inhalation.

Contrary to the infection produced by virulent blood, hogs
which are infected with pure cultures of the bacillus suipestifer
do not transmit the disease to healthy hogs, and if they recover
they continue to be susceptible to natural infection.

2. The bacillus suisepticus is in every particular identical
with the organism of pure swine plague (see p. 125).

Natural infection results apparently from the digestive tract
and appears to be transmitted especially by the strongly viru-
lent urine of affected animals, while the excrements are fre-
quently only slightly or not at all virulent, and therefore play
a less important part in the transmission of the disease. In
piggeries of localities which were previously free of the disease
it always results from an introduction from the outside, while
in already infected premises and stables the affection may re-
peatedly appear without a new introduction, as the virus retains
its virulence for a long time outside of the animal body, in
fluids as well as in a dry material. This is proved by the fact
that the disease which was formerly unknown in Europe spread
in the course of the last decade along the road of swine traffic,
and then remained permanently in the infected countries, caus-
ing severe losses from year to year. ; ;

The very extensive traffic in hogs which exists everywhere
and which is difficult to control, is generally the most effective
disseminator of the disease, and in this the hog markets, the
964 Hog Cholera.

stock dealers, castrators and wandering gypsies (the latter by
taking with them the hog carcasses and throwing the viscera
about in different pastures) contribute materially to the spread
of the contagion.

In herds of hogs which have been healthy the disease is in
most cases introduced by sick animals, and not alone by those
in which acute symptoms may be detected, but also through the
so-called runts in whose bodies the filterable virus may also be
concealed. Infection may also occur during the pasturing of
the animals, in the piggeries, during driving on highways or
transportation in railroad cars, which have been contaminated
by the excrements of affected animals days or weeks previously.
The contagion may be spread from one locality to the other
by flowing water, into which carcasses of hogs have been thrown,
and carcasses which have been left in pastures or which have
not been buried satisfactorily may also occasionally be the cause
of an outbreak of the disease.

Although hogs of all breeds and of any age may become
affected with hog cholera, the higher bred stock and young hogs
are much more susceptible to the disease. Sucking pigs become
affected only very exceptionally, and as a rule the influence of
age is especially marked in localities in which the disease has
existed for a long time. Thus during the first years of the
existence of the disease in Hungary the older hogs became
affected quite frequently, while since that time the disease is
confined more and more to younger animals. The greater
resistance of the older animals in infected localities is in all
probability due to the fact that they passed through a mild form
of the disease while young.

Pathogenesis. According to the most recent experimental
investigations the disease is without a doubt caused by a fil-
terable hog cholera virus, which enters the body fluids and multi-
plies there. It causes directly a febrile condition, with acute
eatarrh of the mucous membrane, and in ease of a severe infec-
tion death results with manifestations of hemorrhagic septi-
cemia. In the great majority of cases however secondary inflam-
matory changes of different organs may become associated with
the general blood infection. Such secondary changes occur espe-
cially in the pharynx, stomach and intestines, in the correspond-
ing lymph glands and in the lungs, being caused without a doubt
by the bacillus suipestifer or the bacillus suisepticus. The
etiological part of these organisms came into the proper light
only after the virulence of the filtered blood of affected animals
had been established.

Contrary to the former conception by which the bacillus
suipestifer was considered as the original and true cause of the
disease, there now exists hardly any doubt that it participates
only in a secondary manner, yet though it is only granted an
inferior part in the transmission of the disease it is very active,
Pathogenesis. 965

and has a great share in the development of the organic affec-
tions which develop in association with the primary affection.
According to Dorset, McBryde and Bolton the following factors
proved that this organism is not the primary cause of hog
cholera: 1. The artificial transmission of the disease can be
much more readily affected by blood from an affected animal,
than by subcutaneous injection of pure cultures of the bacillus
suipestifer. 2. Hogs which were affected either by natural
infection or by subcutaneous injections with virulent blood
transmit the disease very readily to healthy animals, whereas
animals which were infected with cultures of bacilli do not infect
healthy hogs. 3. Blood from hogs which have been infected with
blood, proves virulent by subcutaneous injection, while the blood
from hogs infected with cultures of the bacilli is harmless for
healthy animals. 4. Recovery from the natural or the artificially
produced disease confers a lasting immunity, whereas hogs inoc-
ulated with the bacillus suipestifer continue to be susceptible to
the natural infection.

_ Besides these considerations it should also be noted that the bacillus
suipestifer cannot be demonstrated bacteriologically in all cases of true
hog cholera. Thus Uhlenhuth found the organism only in 76 out
of 178 affected hogs, while in the other cases in seven so called varieties
of this organism (some of which do not ferment dextrose) three times
varieties resembling the paratyphus A-Group, once the bacillus en-
teritidis Gartner, 50 times the bacillus pyocyaneus, 36 times streptococci,
27 times staphylococci, and 110 times colon bacilli, were isolated from
the organs; while in 14 cases the organs proved sterile. In some of
the outbreaks the bacillus appears to occur only rarely, as Boxmeyer
in Michigan and Theiler in South Africa failed to demonstrate the
bacillus in typically affected hogs. These findings make it probable
that in different localities various bacteria, especially of the paratyphus
B, or of the hog cholera group, may produce the usual changes in the
intestines found in hog cholera.

According to views accepted at the present time the bacillus
suipestifer forms a group in common with the bacillus paratyphi B
and Bae. botulinus, which are pathogenic for man, also including the
mice typhus and the psitticosis bacillus, as well as the Bac. Sanarelli.
This group is designated as the hog cholera, or the paratyphus B-Group,
and the various organisms of this group cannot be distinguished from
each other, either by their morphologic and culture characteristics, or
by sero-diagnostic methods (agglutination). The only distinguishing
signs consist, excepting when their origin may be demonstrated, in
certain, not constant, and therefore not characteristic pathogenic prop-
erties. The very close relation which almost borders on identity, would
explain in hogs, for instance, why it is that various representatives
of this group may produce very similar pathological changes, and
attain pathogenic properties for man (this theoretical possibility has
not yet been proven for the true suipestifer bacillus). Bang and Th.
‘Smith, also Uhlenhuth and his co-workers cultivated strains of the
bacillus suipestifer from hog cholera pigs, which showed certain
deviations from the common type, and therefore are considered as
varieties (some strains produce no gas in dextrose, others coagulate
milk, and Smith & Moore even described a non-motile variety).
266 Hog Cholera.

Against the idea that the bacillus suipestifer is the primary virus
of hog cholera are the experimental observations of Uhlenhuth and his
co-workers, who found that virus which was treated for one hour with
2.5% antiformin still proved virulent, while cultures of the bacillus
suipestifer lost their pathogenic action even for the very susceptible
rabbit, after being subjected to such a solution from 30 to 40 minutes,
the organism being readily dissolved by the antiformin. A similar
difference is also shown to exist by the fact that the hog cholera virus
is destroyed by shaking with a 10% uric acid only in four days
(Marxer), whereas the bacillus suipestifer is killed in 23 hours
(Stiling); the observation that the bacillus suipestifer agglutinates
the serum from hogs affected with acute cholera in dilutions of only
1:5-20 (Uhlenhuth), whereas in animals artificially infected with this
bacillus the agglutination takes place in higher dilutions (1:1000 and
over) should also be noted. Moreover in virulent hog cholera serum
there are no opsonins or bacteriotropins, which have an influence on
the bacillus suipestifer (Broll). .

Recently (1907) Lourens took a stand relative to the importance of the bacillus
suipestifer as the primary cause of hog cholera, when he proved that this bacillus
passes through the porcelain filter in a granular form, and that it may later
multiply in the filtrate. Filtrates containing bacilli, however, produce inflammatory
changes at the place of injection, and since the disease always develops in one
to two days, Lourens’ findings are in no way sufficient to weaken the importance
of the results obtained with fresh blood and filtrates of organs, or to shake general
belief in the correctness of recent discoveries. Moreover McBryde found recently
that the bacillus suipestifer may pass through some of the Berkefeld filters, but
not Chamberland B and F, which however allow the hog cholera virus to pass.

The same applies to the theory of Schreiber, according to which the blood of
hogs affected with hog cholera supports, through the agressins which it contains,
the pathogenic action of the bacillus suipestifer, or mobilizes the same, the bacillus
being a frequent habitant of the intestines of hogs. This theory stands in contra-
diction to the fact that even small quantities of blood, and especially from hogs
which have not yet developed intestinal changes, produce the disease, and further
that artificial infection may also result from feeding such blood, and that antiformin-
blood mixtures prove effective, in spite of the fact that the endotoxins of the
bacillus suipestifer are destroyed by this product.

The view that the bacillus suipestifer plays only a secondary part
in the etiology of hog cholera is further substantiated by the discovery
that bacilli which morphologically, culturally, and biologically corres-
pond to the bacillus suipestifer not infrequently occur in the intestines
of entirely healthy hogs; thus Garbert succeeded in demonstrating such
in seven out of 23, Uhlenhuth in 8.4% of 600 healthy hogs. Similar
results are also reported by Morgan from England, Gardenghi from
Italy, and Velzen from Holland. Furthermore Titze & Weichel found
organisms in the intestinal contents of calves affected with white scour,
which absolutely corresponded to hog cholera bacilli, and also in one
healthy calf.

The facts mentioned here, as well as the experimental
observation that hogs which were inoculated with the filtrable
virus develop intestinal changes caused by the bacillus suipes-
tifer, lead to the belief that the bacillus suipestifer being a
frequent normal habitant of hog intestines, penetrates into the
tissues injured by the filtrable cholera virus, and exerts in the
same its pathogenic properties.
Pathogenesis. 267

A similar view would probably also apply to the part-of the
bacillus suisepticus. Ovoid bacteria which correspond in all
their characteristics to these organisms occur as saprophytes
in healthy hogs (see p. 129). Animals which have been injected
subcutaneously with filtered cholera blood frequently develop
acute, fibrinous, catarrhal or necrotic pneumonia, in which the
ovoid bacteria are present in great numbers.

These findings can be explained satisfactorily only by con-
sidering that the bacillus suisepticus, like the bacillus suipes-
tifer, finds favorable conditions for its propagation in the body
affected by the cholera virus, and thereby exerts its pathogenic
action in the production of a multiple necrotic pneumonia.
.From case to case one or the other of these bacilli, and fre-
quently both at the same time or following each other, may
become conspicuous in the pathological changes.

Therefore in association with the primary cholera infection
there may be not only the characteristic anatomical changes of
hog cholera present, but also those of swine plague; thus not
only the anatomical hog cholera, but also the anatomical swine
plague as it occurs in outbreaks of cholera, either in association
with the former, or alone, is primarily brought on by the filtera-
ble cholera virus. In all of these cases only one disease comes
into consideration, and that is hog cholera, which however mani-
fests itself in various clinical and anatomical pictures, depending
on the secondary infection, namely either as a pure septicemia,
as hog cholera or as pure swine plague, or the changes may indi-
cate a mixed infection with the last two forms. Accordingly a
septicemic, a pectoral and a mixed form of hog cholera may be
distinguished. It should however be distinctly understood that
the intestinal and the pectoral changes in the organs are only
secondary complications, and that strictly they should not be
considered as belonging to the manifestations of hog cholera.

Contrary to the above-aescrived views relative to the secondary
action of the bacillus suisepticus, Ostertag contends that pure swine
plague may occur as an independent acute disease even under favorable
hygienic conditions, infecting old, as well as young animals, and causing
losses amounting to 75%. He further claims that chronic swine plague
is directly connected with the acute, destructive, classical swine plague.
He bases this view mainly on the observation that the acute form
may pass into chronic, and as such may again introduce the acute
fatal form, and that with the material of both forms, either of the
forms may be alternately produced (see also p. 128).

On the other hand Uhlenhuth and his co-workers perfectly agree
with the view of Hutyra. They found that pigs infected with filtered
blood frequently develop a pleuro-pneumonia, and that the treatment
of pigs with immune serum protects them also against a secondary
pneumonia. They therefore emphasize the suggestion that changes
in the lungs belong to the accompanying hog cholera symptoms, and
therefore are to be considered as symptoms of the disease. Therefore
the so called pure cases of swine plague in outbreaks of cholera should
be considered as cholera infections, and the previously considered mixed
968 Hog Cholera.

forms, that is the cases which were heretofore considered as results
of two entirely different infectious diseases, are etiologically due to
ohe primary cause, namely to the infection of the body by the cholera
virus.

At the present time it cannot even be imagined in what way the
filterable virus exerts its pathogenic action; on the other hand the
pathogenicity of the bacillus suipestifer and the bacillus suisepticus
is quite well understood. Regarding the first one it must be accepted
that as a rule it penetrates into the follicles of the already catarrhal
intestinal mucous membrane, where it produces a cellular infiltration
of the follicles, with which a necrosis of the tissues soon becomes
associated. In this manner nodules first develop, then small, deep
round ulcerations covered with caseous material, which gradually
become larger. At the same time usually, but in some instances quite
independently, a necrosis of the epithelium and of the superficial layers
of the mucous membrane results from the immigration of the bacilli
into the lymph spaces of the mucous membrane, whereupon diphtheritic
or croupous inflammation results. Such deposits also develop very fre-
quently on the mucous membrane of the stomach, and of the pharynx.

From the intestinal wall the bacilli pass through the lymph vessels
into the mesenteric lymph glands, where they produce a cellular infiltra-
tion, and consequently a tissue necrosis, as a result of which dry caseous
areas develop in the enlarged glands. In chronic cases the process
may remain confined to the intestinal wall and to the mesenteric lymph
glands, and may by disturbing the digestion finally result in complete
exhaustion of the animals.

In other cases the bacilli may be disseminated along the lymph
vessels, to distant lymph glands and into the blood circulation. The
infection of the blood may sometimes occur in the early stages, and
contribute to the aggravation of the already existing septic condition.
Besides bacillary emboli may cause the development of metastatic
inflammatory lesions, which will later caseate beginning at the center
(such caseated areas are most frequently found in the lungs, kidneys,
spleen and the liver).

The necrosis (caseation) which is quite characteristic of hog cholera,
is probably to some extent the result of an obstruction of the blood
vessels by masses of bacilli, and the consequently developing nutritive
disturbances. In the first place however it is probably due to the
toxic action of the bacilli.

Up to the present time experiments for the demonstration _of toxins in eul-
tures of the bacillus suipestifer have not given uniform results. While Preisz found.
that neither inactivated cultures nor bacteria-free filtrates of cultures were toxic for
test animals, Voges and Karlinski claimed that the killed bacteria contain an
intra-cellular toxin (according to Voges 10 mg. of killed bacteria ate fatal to guinea
pigs). De Schweinitz produced a ptomaine from cultures by precipitation with,
aleohol (Sucholotoxin) and also a poisonous albumose (Sucholoalbumin). He fur-,
ther found two kinds of enzymes in aqueous extracts of agar cultures, as well as
in milk in which the bacilli were grown for three weeks, of which the one converts
starch into dextrose (Diastase), while the other liquefies gelatin and digests fibrin
and albumen (trypsin-enzym). Prettner also found in the cultures bacteriolytic
enzymes, which slowly dissolve gelatin. According to the investigations of Prett-
ner and Emmerich the bacillus produces nitrous acid in material containing nitrates,
as well as in the intestinal canal, which may cause a nitrite poisoning in the body
of the animal (cyanosis, necrosis of the intestinal epithelia, paralysis or gangrene
of the sympathicus, serous transudations in the intestinal lumen, formation of
methemoglobin in the blood). F. Schmidt aimed to obtain specific substances from
cholera bacilli, by the use of Brieger’s method (suspension of cultures grown on
agar in water "and shaking) as well as through the method of Conradi (autolysis),
Pathogenesis. 269

and further with the aid of McFadyean’s apparatus for breaking up bacteria,
but he failed in immunizing test animals with the substances obtained by any of the
three methods. The toxicity of killed bacilli (endotoxins) is shown by the experi-
ments of Uhlenhuth and his co-workers, who succeeded in producing a typical ana-
tomical picture of hog cholera by intravenous injections of cultures heated to 60°C.

According to Bang’s investigations, the necrophorus ‘bacillus is also a partic-
ipant in the production of the necrotic processes, and as a matter of fact it
is very frequently found in large clumps at the base of the ulcers as well as in
the nodules along the border between the necrotic and living tissue.

The bacillus suisepticus exerts its pathogenic action in a similar
way in cases of pure swine plague (see p. 127). In the peracute cases
it is found quite frequently in the blood more often than the bacillus
suipestifer. The lesions of hemorrhagic septicemia which are found
at-the autopsy of such cases are evidently largely due to its action.
Often, however, the frequent pneumonia and pleurisy is directly asso-
clated with the activity of this organism.

The fact that the bacillus suipestifer and the bacillus suisep-
ticus are very frequently actively concerned in hog cholera
besides the filtrable virus, explains why clinical as well as ana-
tomical findings should vary to such a great extent from case
to case. In the majority of the dead or emergency slaughtered
animals in infected herds examination discloses an ulcerative
inflammation of the intestines and caseation of the lymph glands,
also necrotic inflammation of the lungs, fibrinous deposits on the
serous membranes, as well as hemorrhages, while careful bac-
teriological examinations prove the presence of both species of
the bacteria mentioned. In the course of some outbreaks, as
well as after the artificial infection of herds (by introducing
affected animals into healthy herds, the placing of a healthy
herd on infected premises), septicemic affections usually pre-
dominate. The first animals dead from the disease, which
probably had the least resistance, show acute catarrh of the
mucous membranes ‘exclusively, and more or less numerous
‘hemorrhages, somewhat later pleuro-pneumonia may also be
‘present, while on the mucous membranes of the intestines small
follicular ulcerations or superficial desquamation of the mucous
membrane may be seen here and there. Later the characteristic
intestinal changes of cholera develop, in constantly greater ex-
tension and intensity; first a superficial desquamation of the
epithelium, then a follicular ulceration, or a diffuse, diphtheritic
inflammation of the mucous membrane. At the same time the
pleuro-pneumonia occurs with greater frequency, so much so
that toward the end of the outbreak it is present in«the great
niajority of cases. In the animals which still remain debilitated
after the acute outbreak has passed off changes. of a chronic
character are present either in the intestines orin the lungs.

These successive anatomical findings may be explained by
the fact that the most susceptible and the least resistant animals
are killed by the specific cholera virus at the beginning of the
outbreak, whereas the more resistant withstand the primary
infection for a time and are only exhausted by the organic affec-
tions which develop later.
270 Hog Cholera.

Anatomical Changes. According to the presence and the

nature of the secondary infection, the following forms of the
disease may be distinguished:

1. Pure Hog Cholera (septicemic form). In this the autopsy
findings correspond to those of an acute hemorrhagic septicemia,
namely hemorrhages in the serous membranes and in the
mucous membranes of the pharynx, stomach and intestines, in
the acutely swollen lymph glands and probably also in the kid-
neys. Jurther there is also a moderately acute swelling of the
spleen. In the
meantime in
some cases the
peritoneum is
covered with a
fibrinous pseudo-
membrane, and
the intestinal
walls are hemor-
rhagic. Even in
such cases fine,
eroupous pseu-
do-membranes
may frequently
be found on the
swollen and hy-
peremic mucous
membranes of
the stomach and
intestines, some-
times also a dif-
fuse, superficial
necrosis (bile
stained, mushy
deposits), orhere
and there yel-
lowish scales.

2. Intestinal
Form. In this
most frequent
form of the dis-
ease, the intes-
tinal tract, es-
pecially the cx-
Fig. 50. Intestine of hog with follicular ulceration of hg cum and the

pats large intestines,
show intensive changes. In the less acute cases a hard
round nodule may be felt on palpation of the wall of the large
intestines, or the wall is thickened either in part or uniformly

 

 

 

 
Anatomical Changes. 271

in its entire length. At the same time the flexures of the intes-
tines may stick together, and this condition may also be seen in
the convolutions of the small intestines, or there may even be
adhesions. In acute cases there are lentil to dollar-sized, flat,
round, yellow, greenish-yellow, brown or blackish-gray, dry
scabs on the mucous membrane of the colon and cecum, espe-
cially around the Bauhin’s fold (ileo-caecal valve), and some-
times also in the adjoining small intestines, under which the sub-
mucosa or the muscularis is infiltrated or thickened. Between
these the follicles are swollen to hemp-seed size hard nodules,
from which a caseous mass may be squeezed. In some cases
the affection may be confined exclusively to an ulceration of
the follicles, in which deep ulcerations, with raised, thickened
margins, cover the mucous membrane of the intestines. These
ulcerations increase in numbers posteriorly, and are of the size
of lentils, round and covered with dry tissue debris (Fig. 50).

In more chronic cases the inner surface of the intestines
usually contains thick, hard scabs, in small numbers, sometimes
flat, at other times hemispherical, colored similarly to the above-
described lesions, so-called buttons or boutons, which protrude
over the neighboring mucous membrane (Fig. 51). The cut sur-
face of these buttons appears sometimes in layers, they adhere
firmly to the submucosa or the muscularis, and are surrounded
by a thickened ring of the mucous membrane. Around these
nodules the intestinal wall is frequently thickened and stiff.

In some cases the mucous membrane may be necrotic over
large sections of the large intestines; in less advanced cases the
necrotic epithelium forms a mushy deposit on the surface of
the mucous membrane, while later it may change in its entire
thickness to a dirty yellow, or greenish-yellow, dry, mushy detri-
tus. At the same time the outer layers of the walls of the large
intestines are greatly thickened, so much so that the affected sec-
tion represents a stiff tube with a constricted lumen.

The mucous membrane of the stomach, especially in acute
eases, shows a pronounced hemorrhagic inflammation, and is
frequently covered with croupous pseudo-membranes. me

Tn the acute cases the lymph glands are swollen, hyperemic,
and even hemorrhagic. In the later stage they contain small,
grayish points, disseminated in reddish tissue; in still more
severe cases they change to hard growths up to the size of a
hen’s egg, which on the cut surface prove to consist of a gray-
ish-red, dry, homogenous necrotic tissue, or of a dry or soft
caseous mass. These changes are most frequently and most
prominently present in the mesenteric glands, less frequently in
the other lymph glands of the abdominal cavity, are sometimes
also to be found in the oe : poo cavity, and in

even in the body lymph glands.
or ous cases tumor-like lesions which resemble those of
the lymph glands may be found in other internal organs, which
972 Hog Cholera.

may reach the size of a walnut, and contain caseous masses.
Such are most often found in the liver, the kidneys, lungs, spleen,
udder, bone marrow, etc. The lungs may in exceptional cases

also contain circumscribed pneumonic areas, with a yellowish-—

gray cut surface, without necrosis or pleurisy (Preisz).

In the pharynx, at the base and on the borders of the tongue,
sometimes also in other parts of the buccal cavity, and in the
larynx hemorrhagic inflammations of the mucous membrane,
with croupous psendo-membranes and ulcerations, together with
a superficial or deep necrosis may very frequently be found.

Among other changes which may occur are necrosis of the
mucous membrane of the gall bladder, the vagina, and the blad-
der, localized or extensive necrosis of the skin, cloudy swelling
of the parenchymatous organs, ete.

 

 

 

 

 

Fig. 51. So called button on the mucous membrane of the Jarge-intestine in hog cholera.

The intestines of animals slaughtered during convalescence

show at the places of the thrown-off necrotic nodules, ulcera- |

tions with a granulating base, or small white scars may serve
to indicate the pre-existing ulcerations (Gerosat and Bilitz ob-
served in exceptional cases cicatrized constrictions of the intes-
tines). The lymph glands of other organs may at times also
contain caseous foci.

The bacillus suipestifer may be demonstrated only in acute
cases in the blood, and even then only in small numbers, while
in the spleen it may be present in greater numbers. The same
organism may also be found in the affected lymph glands, in
the necrotic nodules of the intestinal mucous membrane and in
the caseous metastatic lesions of the internal organs.

The necrotic and ulcerative processes on the intestinal mucous membranes
develop quite slowly. Thus in an animal 12 days after the infection there. are,
besides the bean-sized mesenteric lymph glands, only hemp-seed size yellow
deposits of exudate on the intestinal mucous membrane; after 14 days they attain
the size of a lentil, and after 18 days the exudate or ulcerations may be the size
of a dime. At this stage the mesenteric lymph glands reach the size of an almond;

 

Oe ene
Anatomical Changes, - 9793

21 days after the infection large sections of the intestinal mucous membrane may
be covered with a deposit or exudate, and the intestinal wall may be 3 to 4 mm.
in thickness. The- mucous membrane of the cecum however may show necrotic
areas as large as a quarter in size.

i According to Marek’s histological examinations the nature of the changes
in the intestinal mucous membrane are those of a croupous, or croupous-diphtheritic
character. The epithelial layer and the propria mucosae changes through a coagu-
lation necrosis, into a homogenous layer, which contains fibrinous threads and
okstructed blood vessels. This layer is surrounded by a wall of polynuclear leuco-
eytes. The bacillus suipestifer and the Bac. necrophorus are found in great
numbers on the border line between the necrotic and healthy tissue. The patho-

 

Fig. 52. Hog Cholera. Pig affected for two weeks.

logical process. frequently commences in the follicles, occasionally however the
necroti: layers may contain healthy follicles. {f larger bacterial colonies develop
in othr organs they may cause coagulation necrosis in such places, which later
result’; in the formation of sequesters. i .

3. Pectoral Form. This form is characterized by an acute,
usually croupous, more rarely catarrhal pneumonia, which in the
later stages passes into multiple necrosis. Frequently there is
also a fibrinous or sero-fibrinous pleurisy and in some instances
also a similar pericarditis. Besides this, the mucous membrane
of the gastro-intestinal tract reveals a diffuse, acute inflamma-
tion, while in acute cases the other organs indicate a general
septic infection. Otherwise the autopsy findings are identical
with those of swine plague (see p. 130), and the disease can
only be distinguished from this by the fact that the filtered blood
or material from the organs is virulent (see diagnosis).

4, Mixed Form. The great majority of cases which are
found in infected herds belong to this class. The lesions of the
intestinal and pectoral forms, with the corresponding changes
of the organs, are present simultaneously from case to case
_ but in varying intensity; therefore the autopsy findings vary
greatly, even in the animals of one and the same herd. In
974 Hog Cholera.

acute cases the mucous membranes of the gastro-intestinal
tracts, as well as of the lungs, are simultaneously affected in
the above-described manner, while in chronic cases one or the
other form is often exclusively present.

Symptoms. The time of incubation of hog cholera in arti-
ficial infections, carried out as closely to the natural mode of
infections as possible (cohabiting healthy animals with affected
hogs, or in infected premises, Preisz, Hutyra), is at least 4
days, usually however 13 to 18 days. After a subcutaneous
injection of virulent blood the first symptoms also appear at the
earliest on the fifth day, more frequently however in 8 to 10
ache and in some cases only after from 2 to 3 weeks (Uhlen-
huth).

1. Pure Hog Cholera (septicemic form). Excepting the
very rare peracute cases which develop almost exclusively at
the beginning of an outbreak and terminate in from 2 to 3 days
with manifestations of an acute hemorrhagic septicemia, the
clinical development of the acute cases is usually somewhat
slow. One of the first indications of the presence of the disease
is impairment of the appetite. The animals take their food less
eagerly, they separate, apparently quickly satisfied, from the
other animals of the herd, stand at one side, alone, or crawl into
some secluded corner of the stable or yard. Later they appear
only hesitatingly or not at all for their feed. If urged to leave
their place they show great reluctance to move, and do so slowly
and feebly. They soon stop, and remain for long periods in
one place with back arched, and with head depressed.

One of the first symptoms and one almost invariably present
is an acute conjunctivitis, with the production of a mucous or
muco-purulent secretion. Vomiting is frequently observed on
the first or second day, the vomited material containing mucus
and being stained yellow by bile. There is at first constipation,
but diarrhea sets in after a short time. The feces are thin and
sometimes bloody. In this stage the patients become more
or less weakened, and if the disease does not turn toward im-
provement, or if it does not become chronic, death ensues in
from 4 to 7 days, with septic manifestations.

2. Intestinal Form. This develops like the first form, but
is less acute. The more intense affection is indicated by a dis-
tinctly yellowish or greenish coloration, and by the very fetid
odor of the feces. At the same time inflammatory or diphtheritic
changes appear on the buccal mucous membrane. The borders,
the dorsum and the base of the tongue, the cheeks and the
pharynx become covered with a dirty gray or yellow, loose de-
posit of exudate, the tonsils are greatly swollen, or ulcerations
covered by a mushy mass develop upon them. These changes
may be observed by examining the buccal cavity. There is also

eee

 

 
Symptoms. 275

pharyngitis, associated with difficulty in swallowing, frequently
also by difficult, rattling respiration, and death may result from
asphyxiation. ;

In the less severe form these symptoms continue to exist,
and in some cases several small or larger growths may after
a time be felt in the abdominal cavity by palpating the relaxed
abdominal wall (lymph glands and adherent intestinal loops).

Tn severe cases the animals, having lost their appetite, be-
come more and more emaciated, the diarrhea alternates with
constipation (this is sometimes also observed in extensive ulcera-
tions of the intestines), they become very weak and anemic,
move only with difficulty and with a staggering gait, or they
stand in one place with back arched, and with croup sunken
(Fig. 52). Towards the end they continuously lie on the ground,
and die completely exhausted, at the earliest on the 11th day
after the infection, mostly however in from 2 to 3 weeks.
"Tn other cases the acute symptoms of an intestinal affection
diminish in 1 to 3 weeks, the appetite gradually improves, the
diarrhea ceases, the animal moves about more lively, and finally
a complete recovery takes place. Sometimes the animals con-
tinue to be sickly, in spite of the fact that the acute symptoms
become milder. The appetite remains irregular, normal move-
ment of the bowels alternates with diarrhea, the animals do not
show a normal development, gradually a severe anemia and
cachexia sets in, which finally leads after some months to com-
plete exhaustion.

3. Pectoral Form. With the initial symptoms of pure hog
cholera manifestations of an acute pneumonia or pleuro-pneu-
monia become associated after several days and from this stage
on the clinical development is identical with the acnte or chronic
swine plague (see p. 132).

4, Mixed Form. In this form symptoms of varying inten-
sity develop in connection with the symptoms of hog cholera
infection, which indicate gastro-intestinal trouble, as well as
an affection of the thoracic organs. Besides inappetence and
diarrhea there is a cough, and increasing difficulty in respira-
tion, and in unfavorable cases death results as a rule directly
from the affection of the thoracic organs. In the later course
the symptom-complex of both forms may exist for a long time,
and they are not infrequently observed simultaneously even in
the chronic cases; while occasionally the manifestations of the
lung affection are less pronounced in the early stages, they later ©
become milder, and the dominating symptoms then consist of
a changeable or depraved appetite and diarrhea.

The cases belonging to this form manifest with relative
frequency changes in the skin. Aside from the extensive necro-
sis which is sometimes present, resulting from the action of the
hog cholera bacillus, and being principally observed on the ears,
276 Hog Cholera. : :

red spots frequently appear on the finer parts of the skin, which
develop as a result of a simple dilation of the vessels. Later
small vesicles form in these places, and soon the superficial
epithelial layer separates in fine lamellae. The abdomen some-
times shows numerous punctiform hemorrhages, which remain
noticeable for a long time even after recovery. Occasionally
urticaria may develop, when vesicles will appear on the flat,
raised lesions (Schindelka). In some cases the bristles may
fall out on different spots or over the entire body, animals with
dark pigmented skin may become white, and‘if the animals re-
main alive white bristles grow on the bald places, which however
may later be replaced by black.

Diagnosis. The clinical symptoms do not afford sufficient
grounds for the establishment of a positive diagnosis. Although
they cause a well-founded suspicion of hog cholera, especially in
already affected herds or if the disease is prevalent in the local-
ity, the determination however must be made dependent on
the autopsy findings. As in accordance with the present state
of our knowledge the bacillus suipestifer or other bacteria of
the hog cholera group under natural conditions produce only
in the body weakened by the filtrable cholera virus follicular
lesions on the intestinal mucous membrane, and the ulcerations
and buttons resulting from these with simultaneous caseation of
the regional lymph glands, these changes must be considered as
characteristic of hog cholera. Therefore where they are pres-
ent the diagnosis of hog cholera may be established without
consideration of accessory circumstances.

The fact that it is sometimes possible to produce the anatomical hog cholera
artificially, with the bacillus suipestifer alone, does not indicate that this occurs
under natural conditions, especially as positive results have only been obtained in
feeding experiments with very large quantities of culture. Glasser is nevertheless
of the opinion that an organism which he isolated from two apparently sponta-
neously affected pigs, and which biologically differed from the bacillus suipestifer
resembling more the human typhoid bacillus (Bac. typhi suis), may independently
produce a contagious epizootic infection (typhus of hogs). However the occurrence
of such a spontaneous enzootic, or even epizootic, has not been confirmed from any
other source. According to a preliminary report of Stedefeder the bacillus suipes-
tifer also may produce spontaneous affections independently, without any pre-
existing accessory influence of an ultravisible virus.

Contrary to the formation of intestinal lesions, the presence
of a necrotic pneumonia, even in a typical form, has not the
same pathognomonic significance, as this form may occur inde-
pendently without any participation of the filterable hog cholera
virus, and in such case it must be considered as pure swine
plague. The decision whether in a single case one is dealing
with pure swine plague, or hog cholera with swine plague symp-
toms, is in practice sometimes very difficult. If besides the
inflammatory infection of the lungs there are at the same time
seabs, round ulcers with discolored covering, or even button-
like scabs on the mucous membrane of the intestinal canal, with
or without swelling of the lymph glands, a cholera infection
Diagnosis. 217

must always be considered. On the other hand, 1 there is pres-
ent a pure hemorrhagic septicemia, or only an acute croupous
catarrhal, hemorrhagic, or a necrotic pneumonia, with or with-
out a fibrinous pleurisy, or if the case shows chronic remnants
of a pre-existing acute pneumonia(large necrotic areas, seques-
ters) then the anatomical changes, together with the micro-
scopical and cultural findings, do not clear the true nature of
the affection. In such cases filtration tests are final, and if a
positive result is obtained with these the presence of a cholera
infection is thereby established. Still, a negative result of -
such a test is not conclusive; as the cholera virus which has been
present in the body fluids may already have disappeared from
the body to a great extent or entirely. In such cases the diag-
nosis must depend upon whether the animal comes from a herd
infected with hog cholera, and whether in any of the other ani-
mals there were any lesions pointing to an infection of hog chol-
era, or if a case represents a sporadic affection from a herd
which has proved healthy. It is essential therefore, in such
cases, to consider the epidemiologic factors, and to attach to
them their appropriate value, establishing the diagnosis.

Of course this presents far greater difficulty in reaching
a diagnosis, when compared with the former conditions, in which
the bacteriological demonstration of bipolar ovoid bacteria or
cholera bacilli in the organs showing the inflammatory changes
were alone sufficient for the determination of the disease. By
such findings the disease was designated as hog cholera or
swine plague. At present however the demonstration of these
bacteria, whether in the blood or in the organs, is not of con-
clusive importance for the establishment of the diagnosis of
hog cholera or swine plague. It now becomes necessary to
consider the gross anatomical changes of the organs, in doubt-
ful cases also the epidemiologic accessory circumstances, and
the nature of the affection of other animals in the same herd.

In bacteriological examinations the simple microscopic examination does not
always give positive results, but with the aid of culture and agglutination tests
it is in most isistances possible to demonstrate the bacteria which participate in
causing the pathological processes. Animal inoculations with material from lesions
as a rule is only adopted for the demonstration of the septicemia bacillus, as
small animals are killed by these organisms in from 24 to 36 hours, and their blood
or the exudate of the abdominal cavity contains in such instances only this bacillus,
even though the inoculated material also contained the cholera bacillus.

Swine erysipelas frequently greatly resembles a septi-
cemic form of hog cholera, especially when there are only few
and small hemorrhages present in the internal organs, such
cases usually occurring in the beginning of outbreaks. The
microscopical finding of erysipelas bacilli in the blood or in
the spleen of course establishes the diagnosis of erysipelas. It
is advisable however to postpone the final decision in negative
findings and to depend on the autopsies of other animals which
may die or which are slaughtered in emergency. If hog cholera
978 Hog Cholera.

exists it is certain that in one of the other animals there will be
found intestinal or pulmonary lesions pointing to the disease.

Chronic cases of hog cholera may be mistaken for tuber-
culosis; a distinction is only possible by a bacteriological exami-
nation, unless the intestines contain the characteristic uleera-
tions of hog cholera.

Neither the allergic cutaneous, the ophthalmo-reaction, nor the complement
fixation method can be utilized for the diagnosis of hog cholera (Uhlenhuth and
others; the authors also failed to obtain satisfactory results with the second of
these methods).

Course and Prognosis. The septicemic and the intestinal
form of hog cholera is considered among the less fatal dis-
eases, as it leads to recovery with relative frequency. In herds
infected with the mixed infection those animals usually recover
in which symptoms of a lung affection are absent or occur only
in a mild form.

On the other hand the pectoral and the mixed form has a
much more malignant character, but even in these cases the
mortality fluctuates within wide limits. While in localities in
which the disease has appeared for the first time, the mortality,
especially among the young hogs, may reach 80-90%, in later
years it will be much lower. In herds which are kept under
favorable hygienic conditions very frequently only 10-15% of
the animals may die, and by taking proper precautions it is
possible to reduce even this number.

Herds in which cholera has already caused a loss of about
15% and over usually resist later infections permanently, there-
fore a repeated appearance of the disease in the same herd is
observed only very exceptionally.

The case reported by Téth is probably isolated, in which in a herd of 550
hogs 18% died first, several months afterwards 32%, and after another two
months 12%. :

In giving a prognosis the character of the disease should
be considered, that is the more the septicemic and the pectoral .
manifestations predominate, the less favorable is the prognosis.
Hemorrhages from the body cavities are almost certain fore-
runners of approaching death; likewise the severe pneumonias
terminate in most instances unfavorably. On the other hand
in cases where only the intestinal affection appears to be pres-
ent, the recovery of the animal is more or less certain, accord-
ing to its intensity.

Treatment. At the beginning of the disease, when no com-
plications, especially of the thoracic organs, have become asso-
ciated with the affection, therefore in the first 4 or 5 days of
the febrile condition, treatment with the specific immune serum
frequently gives good results. Quite often a rapid recovery
takes place after a single injection of serum, while in other
Treatment. Prevention. 279

cases 1 to 2 repetitions of the injection bring about recovery.
(See further under immunization.)

Medicinal treatment has not given any decided results. In
consideration of the supposition that the infection results from
the intestinal canal, the administration of disinfectants was
tried, but without much benefit. Of such remedies milk of lime,
naphthol, iron sulphate, carbolic acid, calomel (2 g.), creolin
(2% solution), arsenous acid (0.2 g.), and formalin milk
(14-14%) have been tried. According to observations such a
treatment could be only considered for the purpose of protecting
if possible healthy animals from the infection. (The carbolic
-acid enemas recommended by Trevisan, 800-1500 g. of a 0.5%
solution twice daily, has also been found effective in several
eases by Kolisch). :

Some authors recommended the intravenous or subcuta-
neous injection of antiseptics; thus Marenghi advised corrosive
sublimate (1 part corrosive sublimate, 3 parts salt, 1000 parts
water ; 0.5 to 2 g. of this injected into the auricular vein) ; Hajnal
suggests lysol (subcutaneous injection of 5 g. of a 20% alcoholic
solution) and also antipyrin; Révész chinosol (3 ec. of a 2%
solution subcutaneously). The.effectiveness of these treatments
however has not yet been confirmed by other observers. __

It is essential to place the patients in a clean airy place,
and they should be given easily digestible feed; if the clinical
manifestations indicate a severe infection the early slaughter
of the animal should be recommended.

Prevention. Herds which are free from the disease should
be protected as much as possible from infection. Animals just
purchased should be kept isolated for at least three weeks. In
large herds infection of the animals is not infrequently avoided
by preventing the contact of the herd with strange hogs, espe-
cially with those belonging to the farm hands, as well as by
keeping them from strange pastures and highways. Cleanli-
ness of the piggeries and their’surroundings, as well as peri-
odical disinfection aid considerably in maintaining the health
of the hogs.

If the disease has already appeared, the affected animals
should be slaughtered or left in the infected locality, while the
healthy hogs should if possible be divided into small groups,
and driven to uninfected places. Should new cases develop in
these parts the procedure should be repeated, and the infected
pasture should always be avoided. If the disease has appeared
in the public pasture, and if it is not possible to remove the
remaining healthy animals to a clean pasture, the spread of the
disease may be prevented by subjecting the animals to a con-
tinuous stabling, for at least two weeks. Of course the premises
should be placed under veterinary supervision, and where the
disease appears the contagion should be destroyed rapidly by
early slaughter of the affected animals and thorough disinfec-
tion of the stables.
280 Hog Cholera.

Immunization. Practical results can be only hoped for from:
a method of immunization which will afford effective protection
against primary infection with the filterable cholera virus. After
the demonstration of the latest facts regarding the etiology of
the disease by establishing the virulence of the filtered tissue
fluids of affected animals, experiments were undertaken to work
out a suitable method of immunization, and they have already
led to valuable results.

. Purely practical observations showed years ago that animals recovering from
hog cholera were usually immune for their entire lives. This fact has been utilized
by Hungarian hog feeders, as they prefer to feed animals from herds in which
the disease has already caused some losses. As a matter of fact they pay consid-
erably -higher prices for such animals.

The idea of using serum from hogs which sonciaenedl from cholera for immu-
nizing purposes, was first utilized by Preisz (1897). He obtained serum from a
hog which had been convalescent for three weeks after a severe attack of cholera,
and in which the autopsy revealed marked lesions of cholera in the intestines and
mesenteric lymph glands. The serum was injected into 30 pigs from 3 to 4 months
old, each animal being injected with 10 ec. of such serum. These 30 animals were
later placed in a stable with 30 healthy pigs, and with several affected hogs. In
the course of one month, 18 of the inoculated animals became sick, and 9 of them
died, while all of the control animals succumbed (the last one after 4 months).

As a result of these findings immunization with blood serum from slaughtered
or recovered animals has been used extensively in Hungary. The results however
failed to come up to expectations, which probably was due to the fact that the
material was not always taken from recovered animals which had passed through a
severe form of the affection.

After the presence of the causative factor of the disease had
been recognized in the filterable virus, the attempt was imme-
diately made to hyperimmunize hogs artificially, according to
the method of immunization used against rinderpest, and
thereby prepa: > a suitable serum for passive immunization, and
by the simultancous use of virulent blood to produce, if possible,
an active immunity. These expectations have been fulfilled,
insofar as satisfactory methods of immunization have been de-
veloped which are practical for both purposes. :

1, Immunization with Immune Serum, (Passive Immuniza-
tion.) According to the experiments of Dorset, McBryde &
Niles, Uhlenhuth, Xylander, Hiibener & Bohtz, Ostertag and
Stadie, as well as Hutyra & Wetzl, hogs which acquired an
immunity from a natural or artificial infection of hog cholera,
when injected by a single large dose, or by several small doses
of virulent blood, produce a serum which protects susceptible
hogs for at least three weeks against artificial, as well as against
natural infection. This immunity is also effective during the
first six days of the incubation period (Hutyra & Wetzl). The
results in practice proved satisfactory, as with the aid of this
method it is possible to considerably reduce the losses in herds
which have been affected only for a short time, and in many
eases to check the outbreak abruptly. Besides this, in animals
which are in the stage.of incubation, or which have only been
affected for a few days, the serum possesses a curative action.
It was found further that in infected herds the animals which
Immunization. 281

were protected by the serum inoculation will not become affected
by, the disease later on, or only exceptionally, in spite of the
existing dangers of infection. This leads to the belief that the
animals which were given a passive immunity by the immune
serum, have acquired an active immunity as a result of a natural
infection which has taken place in the meantime.

On the basis of this experience it is advisable to treat all
herds which are threatened by the infection with the immune
serum, and especially those in which the disease has already
appeared, and to retain the drove in the same place until the
infection is eradicated. At the same time the apparently
affected animals should be separated, and those which are af-
fected severely should be slaughtered. In case the disease
appears again in the herd it is advisable to repeat the injection
with the immune serum.

Dorset, McBryde & Niles (1905-1907) treated immune hogs by
two methods. In the ‘‘quick method’’ they injected one dose of 900
to 1500 ec. of virulent blood (10 ce. per pound of body weight) sub-
cutaneously, in the ‘‘slow method’’ gradually increasing doses of 500
to 900 ec. (1 to 5 ce. per pound of body weight) of such blood at
intervals of 3 to 4 weeks or even longer periods. About three weeks
after the single injections, or after the last injection, as well as later at
various intervals, they have drawn blood from the injected animals.
The serum from such blood when obtained by defibrinating, or by allow-
ing it to stand immunized animals weighing from 25 to 50 pounds when
injected in 20 cc. doses, against a simultaneous infection of 1 to 2 g.
of virulent blood, and also against subsequent natural exposures.

Later the forced immunization was accomplished by injecting the hogs once
or twice intravenously with 5 ce. of virulent blood per pound of body weight, or
with 10 cc. intraperitoneally by a single injection.

The immune serum is used in the United States mostly for simultaneous
inoculations (see below), and is only rarely employed alone. Experiments regard-
ing the curative action of the serum showed that if the serum treatment is under-
taken not later than four days after infection, the outbreak of the disease may
be prevented. According to the reports of the Bureau of Animal Industry the
results from the practical application of the serum are very satisfactory.

Uhlenhuth and his co-workers (1907) produced a similarly potent
serum from hogs, to which they had given several subcutaneous injec-
tions 6f 25 to 100 cc. of virulent material, mostly blood. The serum
in doses of 10 to 50 ec. protected healthy pigs from a subsequent
severe, natural infection, while animals which were not inoculated,

‘or which were given large doses of horse serum, died from hog cholera.
Doses of 10 to 20 ce. also protected against the pathogenic effects of
0.5 ce. of virulent blood, when injected subcutaneously at the same
time. Potent serum can be prepared only from hogs, not from horses
or asses.

Practical experiments with immune serum have been made in various herds,
most of which were severely affected, 330 out of 743 hogs being immunized while

413 were not given the treatment. The loss among the inoculated hogs was 61
(18.4%), among those which were not inoculated 212 (51.3%). The dose of the

serum was 20 to 50 ce.

Ostertag’s laboratory experiments with serum of successively
highly immunized hogs have also given good results. With this serum
982 Hog Cholera.

pigs may be protected against an infection of cholera, and Stadie &
Raebiger have obtained mostly good results in practice with his serum,
testing it upon 24 herds.

In Germany a serum prepared by Gans is also in use, and Spitzer, Stock and
Pfeil obtained beneficial results from its application.

Hutyra & Wetzl treat hogs weighing from 60-100 kg. which have
recovered from the disease, either with a single injection of 1000-1200
ee. or 2-3 injections of 500-600 ec. of fresh defibrinated blood from
slaughtered hogs affected with hog cholera. Ten days after the last
subcutaneous injection, and at intervals of 2 to 38 weeks afterwards,
they are bled from the tail, and finally they are bled to death. The
blood is used for immunizing purposes, either defibrinated, or it is
used after centrifugation as pure serum. Finding that the pre-
liminary tests gave favorable results, serum immunizations have been
employed regularly in Hungary since 1909,' and on the whole with
satisfactory results.

In the preliminary tests 285 hogs of five herds were injected once or twice
with 10 cc. of filtered serum, or 15 cc. of defibrinated blood, while 240 animals
were not injected. After placing the animals in badly infected stables, the losses
among the inoculated animals in the various herds amounted to 6.1 to 35.4%, among
the hogs which were not inoculated 40 to 66%, the difference in favor of the inocu-
lated animals amounting to 20 to 60%.

Up to October 15, 1909, reports from 106 farms, with a total of 10,661
apparently healthy hogs, gave the results of the serum treatment as follows: in
42 herds with 3,125 inoculations the disease was immediately checked; in 22 herds
with 3,754 inoculations the loss amoufted to 1.9%, in 7 herds with 730 inoculations
the loss was 8.2%, in 14 herds with 1611 inoculations 15.7% succumbed, in the
remaining 21 herds the losses amounted to 23.7 to 57.6%. In 46 herds in which
4,189 animals were inoculated, 5,008 hogs not being given the treatment, 8.8% of the
inoculated animals died, and 30.9% of those which were not inoculated. The inocu-
lations were absolutely without results in only eight herds, with a total of 599
inoculated, and 659 non-inoculated animals, ‘The losses in these cases amounted
to 63.8 and 57.9%, respectively.

The treatment of animals which were already manifestly diseased (2,681
cases) was in only a few cases successful and then the animals improved very
rapidly and recovered.

The recurrence of the disease in herds which had been treated previously
with the serum, and from which the disease had been eradicated, has up to May,
1910, been observed in only five instances. (The dose of serum was 10 ce. per
animal weighing from 20 to 40 kg.) :

Favorable results with the serum are also reported by Szuran, Szab6, Tokayer
and Ma4rton, but Szurin andMarton failed to obtain good results in one herd
each where the majority of the animals were already affected. In one instance
the outbreak was abruptly checked by the immunization, but 55 days later the
disease recurred with great severity.

2. Immunization with Immune Serum and Virulent Blood.
(Simultaneous Method.) In the United States this method is
mostly used according to the procedure of Dorset, McBryde and
Niles, the animals being injected subcutaneously with 20 ce. of
immune serum, and 1-2 ec. of virulent blood. This treatment
has also by our numerous observations been proven to confer
an active immunity upon the animals which lasts at least six
months, and probably even a longer time. Nevertheless the
practical application of this method does not, at least for the
present, appear to be altogether without danger, as some of the
inoculated animals apparently become affected, and scatter
Immunization. 283

the virus. Such accidents cannot be excluded at the present
time, as the virulence of the blood fluctuates considerably in
the affected animals, and there is no satisfactory method by
which the virulence of each can be established rapidly; there
is likewise no quick method for the standardization of the serum.

In 1905-1906 168 hogs were treated in the United States by the simul-
taneous method (2.5-20 ce. serum, and 0.25-5.0 cc. of virulent blood, each separately,
but simultaneously injected). Of these 35 (21%) became slightly affected, while
15 (9%) succumbed. On the other hand 54 hogs became affected after the injection
of the same quantities of virulent blood, and 50 (92.5%) of these succumbed
to the disease. When the hogs which had been treated by the method described
were exposed on infected premises, they remained healthy with very few exceptions,
while all control animals became severely ill, and most of them died. Some experi-
ments on suckling pigs showed that immunization may also probably be used with
good results at a very early age (Dorset, McBryde & Niles). Up to November, 1909,
about 2,000 hogs were treated with satisfactory results, the losses among the inocu-
lated animals in infected herds amounting to 5-15%, in herds free from the,
disease 0%, whereas among the animals which were not inoculated the losses
amounted to 75-89 and 35% (Melvin).

3. Other Methods of Immunization. The preparation of a
potent serum from horses and cattle has not been successful
(Uhlenhuth and Hutyra), and except for the method described
above there is at the present time no procedure which has
been tried in practice sufficiently.

Marxer prepared a vaccine by shaking. virulent hog blood at 37°C. for four
days in 10% uric acid, or for three days with 25% galactose, this vaccine proving
effective in immunizing pigs in laboratory experiments. Inoculated animals did
not become infected, and failed to infect healthy pigs. For its practical appli-
cation it is recommended to inject the animals at intervals of several months,
from 3 to 4 times, with 5 cc. of the vaccine. Uhlenhuth and his associates found
on the other hand that pigs treated by this method do not acquire an immunity,
and that it is not possible to establish an immunity with virus attenuated or killed
by either physical or chemical means.

King employed for a vaccine the serum of horses which had shortly before
been injected intravenously with 85-200 ce. of virulent hog serum. On the assump-
tion that the virus is gradually attenuated in the body of the horse, he used the
blood of a horse which was drawn six hours after the intravenous injection as a
vaccine. He treated several hundred hogs by this method in practice, the results
however were varied. While apparently favorable results were obtained in several
herds, the disease appeared shortly after inoculation in 11 other herds which had
hitherto been free from the disease.

Immunization Against the Bacillus Suipestifer. Before the establishment of
the etiology of hog cholera, the immunization experiments were directed against
the bacillus suipestifer, as the supposed causative factor of the disease. The prac-
tical results however proved entirely unsatisfactory in spite of the apparent good
results in laboratory tests on small animals. At present the tedious experimental
investigations are only of generally scientific interest, as it appears very improb-
able that the treatment of hogs with a serum which, although successful against
the secondary infection of the bacillus suipestifer, will ever prove of any advan-
tage in its practical application. : ; .

Recently Stedefeder reports on several experiments in which he succeeded in
immunizing pigs against the suipestifer disease, which is said to occur independently
(see p. 276). The serum was obtained by a preparatory treatment of rabbits,

horses and hogs.

Veterinary Police. The observations made in recent years
have proved repeatedly that hog cholera may be limited to
single premises or farms, and the losses be reduced in a great
measure by the immediate application of suitable methods of
284 Hog Cholera.

prevention and eradication. Accordingly the veterinary police
measures (compulsory reporting, isolation of affected animals, .
farm or town quarantine, isolation and if possible slaughtering
of the affected animals, destruction of the carcasses, closing
up of the hog markets, and prohibition of the peddling of ani-
mals, ete.), when applied at the right time and if energetically
executed will lead to favorable results.

As hog cholera always develops as the result of the intro-
duction of the virus, and as it is of a decidedly contagious
nature, there remains no doubt that it may be eradicated from
large territories by obligatory slaughter of the affected and sus-
pected animals. This procedure, when vigorously executed, has
brought good results in several places in which the disease has
not become prevalent to a great extent, and where hogs were
kept in small groups, and the traffic with these animals was not
very extensive (for instance in Sweden and Norway). Such a
method of eradication would also bring about the desired re-
sults in countries in which hog breeding is well developed, where
the traffic in hogs is very extensive, and the disease has already
spread considerably. Eradication based on this principle
would of course necessitate a corresponding indemnity to the
owners, and would also have to be aided by immunization. At
the present time the most powerful obstacles in the way of such
a procedure are the financial difficulties.

The eradication has been in progress in Great Britain since 1893, and the
results are indicated, at least up to 1905, by a marked reduction in the number
of cases (see p. 259). '

In Austria a law of 1899 requires the obligatory slaughter of affected, exposed
and suspected animals, for which an indemnity reimburses the owners. Until
the end of 1901 102,769 hogs were slaughtered, and the entire cost of the eradica-
tion amounted to 2,625,470 crowns. The results of the eradication did not come
up to expectations, as repeated introductions from foreign countries have greatly
hampered it, although in recent years a diminution of the disease has been observed
in the Alpine countries. ¥

Veterinary police measures may be aided greatly by im-
munization, inasmuch as outbreaks may be checked and the
spreading of the disease to surrounding herds may be pre-
vented by serum inoculations.

In ‘the United States a procedure is followed to a great extent, in which
the newly infected herds are treated with serum, and the droves of the immediate
vicinity which are not yet infected are inoculated by the simultaneous method.
At the same time further extension is prevented by quarantine of the infected
herds, slaughter of the affected animals, and the disinfection of the premises
(Melvin).

Literature. Up to the year 1905 Joest, Hog Cholera and Swine Plague,
Jena, 1906.—De Schweinitz & Dorset, Bureau of Animal Industry, XX, Rep., 1903,
157.—Dorset, Bolton & McBryde, Ibid., XXI, Rep., 1904, 138; Ibid. Bull. Nr., 102,
1908.—Clintock, Boxmeyer & Siffer, Journ. of Diseases, 1905, II, 351.—Hottinger,
Schw. A., 1905, XVII, 255.—Hutyra, B. t. W., 1906, 607._Ostertag, Ibid., p. 623.—
Ostertag & Stadie, Z. f. Infkr., 1907, II, 113 u. 425,—Theiler, F. d. Vhyg., 1906,
IV, 121.—Glasser, D. t. W., 1907, 617.—Lourens, Zbl. f. Bakt., 1907, XLIV, 420.—
Uhlenhuth, Xylander, Hiibener & Bohtz, Arb. d. G.-A., 1908, XXVIT, 1 (Lit.);
1909, XXX, 217 (Lit.).—Marxer, B. t. W., 1908, 401—Hutyra & Wetzl., Z. f
African Horse-Sickness. 285

Infkrkh., 1909, VI, 1; B. t. W., 1909, 863,—Stadie, B. t. W., 1909, 113.—Stede-
feder, D. t. W., 1909, 546.

12. African Horse-Sickness. Pestis equorum.

(Stidafrikanische Pferdesterbe, [German]; Peste du cheval,
[French]; Paardenziekte, Perreziekte, [Holland].)

_ African horse-sickness is an acute or subacute, infectious
disease of solipeds, caused by an ultravisible virus. It exists
im an epizootic form in Africa, and is characterized by exten-
sive edematous swellings, and hemorrhages of the internal
organs.

History. The disease, which has been known in South Africa
for over a century, has in recent times been confused either with
anthrax (Lambert, Sander), or with piroplasmosis (Rickmann, Eding-
ton).. Both views were abandoned since McFadyean (1900), and later
Nocard (1901), proved that the virus passes through the porcelain
filter. The disease has been studied especially by Theiler, from its
etiological and clinical standpoints, while the question of immuniza-
tion has also been investigated by Edington, Koch and Rickmann.

Occurrence. The disease occurs annually in South Africa
during the rainy, warmer months, January to March, especially
in low, moist localities. In years with great precipitation the
disease rages among horses and mules to such an extent that in
the affected localities 35% of the animals succumb, and some
of the localities are devastated to such a degree that not a sin-
gle horse remains alive unless some of the animals have pre-
viously withstood the disease in some other place (has: been
‘“salted’’).

In the Cape Colony 64,850 horses and mules perished from horse-sickness in
1854 and 1855. Since that time the annual losses are estimated at 14,000 animals.
In German Southwest Africa the losses amounted in some years to 66%, in
Rhodesia to as much as 90% of the entire number of animals.

According to Memmo and Brumpt the disease occurs also in Abyssinia, and
according to Friedrichsen in East Africa.

Etiology. The causative factor of the disease belongs to
the ultra-microscopical micro-organisms, as the filtrate of the
blood diluted: with physiological salt solution (Berkefeld or
Chamberland B and F filters) proves infectious. Blood taken
from affected horses in any stage of the disease, and injected
subcutaneously, intratracheally, intravenously or into the lungs
(0.01-1.0 ce., or only 0.0005 ec.) or administered per os (100-150.0
ec.), produces the disease in the horse. The exudates and the
bronchial secretions also contain the virus, but the infectious-
ness of the excrement is considered to be doubtful. Blood from
recovered animals.has no infectious action.

Horses are highly susceptible to artificial infections, mules
and asses to a lesser extent. According to Edington it is also
possible to infect cattle fatally, and to produce febrile reactions
in goats and sheep. Theiler & Stockman found, however, that
986 African Horse-Sickness..,

this is only possible in young Angora goats, their blood becom-
ing infectious to horses and mules, but not for other goats. On
the other hand they succeeded by intravenous injections of large
quantities of unfiltered horse blood, to cause severe illness in
dogs, and to infect other dogs as well as horses with their blood;
McFadyean however failed to observe any manifestations of
disease in three dogs after subcutaneous injections of small
quantities of virus. Man is not susceptible, as has been estab-
lished by Rickmann and Kaestner through ‘subcutaneous injec-
tions on their own bodies.

Edington and Morton Coutts consider horse sickness and heart
water (see p. 257) as identical, or at least as closely related diseases.
They succeeded in producing in horses a disease resembling horse
sickness, with the virus of goats affected with heart water. The virus
of this disease however possessed only a slight virulence for horses.
This view is disputed by Theiler and Stockman, as their experiments
have shown that goats treated with the virus of horse sickness remain
susceptible for heart water, and likewise horses inoculated with heart
water blood may later become affected with horse sickness.

Whether there exists a close relation between horse sickness and
infectious anemia (see that disease), in the sense that the anemia rep-
resents a mild form of horse sickness, is not conclusively established,
and requires closer investigation.

Natural infection occurs in the periods of the year men-
tioned, usually out of doors and at night; keeping the horses
in the same places in day time from the time when the dew dries
until sunset, as well as during rainy weather, is not dangerous
for them. The first frost usually terminates the disease, so that
from the eighth day following it no more cases occur (in dry
weather the disease occurs only very exceptionally). Although
the disease may be produced by feeding great quantities of
virus, the observation that in the dangerous pastures horses are
not protected by muzzles, indicates that the infection is trans-
mitted by some insect or fly. According to Pitchford anopheles
mosquitoes and stegomya which have been within 48 hours upon
the body of an affected animal serve to transmit the disease to
healthy horses; Reinecke succeeded by a test in Germany in
producing a fatal disease in one horse by subcutaneous injec-
tions with an extract from ticks which he had collected in the
African horse-sickness district one year before. This may ex-
plain why smoke near the horses (Theiler), or keeping them in a
stable protected by a net (Pitchford), prevents the disease.

Anatomical Changes. The autopsy reveals in locations
varying from case to case, a gelatinous infiltration of the sub-
cutaneous and intermuscular connective tissue, especially
around the eyes and the region of the throat. There is acute
swelling of the superficial lymph glands, severe catarrhal swell-
ing of the mucous membrane of the-stomach, the anterior por-
tion of the small intestines and occasionally also of the large
Anatomical Changes. Symptoms. 987

intestines. The intestines may also show hemorrhages and
ulcerations, and in about two-thirds of the cases a well marked,
acute edema of the lungs with serous infiltration of the inter-
lobular connective tissue; sometimes gelatinous pseudo-mem-
branes will be found on the pleura, and hemorrhages under the
peri- and endocardium, as well as in the heart muscle. The
spleen is normal or only slightly enlarged, the liver hyperemic,
the kidneys show hyperemia, or an acute inflammation with
small hemorrhages.

_ Symptoms. Horse-sickness usually develops after a period
of incubation averaging 6 to 7 days in two forms (Theiler).

__ In the acute cases (Dunkop-Paardenziekte, Dun-Perre-
ziekte, pulmonal form) the body temperature rises within a few
days up to 40-42°. The patients show corresponding signs of
feeling ill, although the appetite remains unimpaired for a long
time. At the height of the disease, towards the end of the first
week, the animals are strikingly feeble, the pulse is frequent
and small, the heart throbbing, the respiration accelerated and
labored. In a small number of cases improvement and subse-
quent recovery take place in the course of the second week, the
fever diminishing. In most cases however at this time, 1 to 2
days before death, manifestations of edema of the lungs de-
velop, as a result of which the animals show very labored
respiration, at the same time passing great quantities of a
yellowish-white foam from mouth and nose, which is also ex-
pelled by spasmodic coughing. Swelling of the superficial lymph
glands may also be observed, and frequent manifestations of
metritis (Friedrichsen). In rare cases the course takes a
sudden unfavorable turn, after slight prodromal febrile mani-
festations lasting 4 to 6 days. The condition of the animal
becoming worse from hour to hour, the temperature drops and
death ensues inside of from 4 to 6 hours with symptoms of
dyspnea and heart weakness (Theiler’s peracute septicemic
form).

yy the subacute form (Dikkop-Paardenziekte, Dikkopziekte)
the disease develops in a similar manner, although considerably
more slowly. At the height of the fever, or possibly somewhat
later, the parts surrounding the orbits become edematously
swollen, and at the same time an exophthalmia develops; then in
some cases edematous swellings appear on the forehead, on the
head, on the chest and abdomen, on the back and on the extremi-
ties, and sometimes even the tongue is swollen to a great extent
(blue tongue). In the meantime marked muscular weakness is
noticeable in the animals, in the majority of cases however
recovery finally takes place.

Frei demonstrated by extensive physical-chemical blood and serum
examinations the following differences from normal blood: the volume
of red blood corpuscles and the viscosity is increased at the height
of the disease, later diminished; specific gravity, inside friction, and
288 African Horse-Sickness.

conductivity of the serum is always below the normal average. Similar
changes are also present in immune horses.

The course of the acute and peracute horse-sickness is usu-
ally unfavorable, inasmuch as horses, especially those brought
from non-infected territories, frequently succumb almost with-
out exception, while the subacute form runs a much milder
course.

The disease is distinguished from anthrax by its slower
course, and especially by the absence of the pronounced, acute
enlargement of the spleen; from piroplasmosis, by the absence
of icterus, by the edematous swellings, the severe inflammation
of the left half of the stomach and by its occurring only at cer-
tain periods of the year. Microscopical examination of the blood
in the diseases mentioned gives positive results, however the
presence of piroplasmas does not exclude horse sickness.

Prevention. The treatment attempted up to the present
time has generally proved ineffective. In order to prevent the
disease, horses are in the summer driven to high pastures, which
‘are known to be non-infectious, and in suspected places they
are allowed to pasture only in day time. By persistent breeding
of immune horses and mules it will probably be possible to
produce resistant breeds in the infected localities (Rickmann).

Immunization. Recovery from the disease reduces the sus-
ceptibility of the animals, but does not entirely eliminate it,
as even comparatively immune (‘‘salted,’’ ‘‘gezouten’’) horses
may become affected by a virulent infection (Theiler). Never-
theless this acquired immunity protects the animals from
natural infection, in about two-thirds of the cases, and when
they do become affected the course of the disease is much milder.

Immunity may be produced artificially in various ways, but
only in mules without great losses. In these animals immuniza-
tion has been applied in practice in South Africa for several
years, but it must be repeated annually, as the immunity gradu-
ally vanishes.

Koch’s Method of Immunization. Koch obtained a serum from
“‘salted horses’’ which were injected subcutaneously and intravenously
with inereased doses (up to 2000 cc.) of virulent blood at intervals of
from 3 to 4 weeks, which produced passive immunity on being injected
into healthy horses without exerting a hemolytic action, as was the
case with sera prepared by other methods. Further experiments showed
that by repeated injections of virulent blood and then of serum horses
may be actively immunized. The quantity of virus and serum must be
proportioned in such a way that the animals become affected by the
disease without dying of it.

It was found most effective to make an inoculation of 0.01 cc. of virus
and 100 cc. of serum for the first injection, the dose of the virus to be increased
to 0.05 and 0.2 ec., at the same time reducing the serum to 50 ec. and finally
continuing the inoculations with the pure virus (0.5, 1.0, 2.0 ee.). The serum is
Immunization. 989

always injected four days after the virus, while each subsequent inoculation is
made 12 days after the last. In 14% to 2 months the horses may be immunized
to such an extent that they withstand 5 cc. of virulent blood without any reaction.
The blood necessary for the immunization is taken from affected animals
shortly before death, it is defibrinated, filtered, mixed with an equal quantity of
glycerin and water, and 5:1000 carbolic acid, and allowed to stand from 2 to 3
weeks. After repeated filtration it is stored in small bottles. Immediately before
es the required quantity of virus is diluted with 5 ec. of physiological salt
solution.
. For the preparation of the immune serum older (salted) horses are injected
in the jugular with fresh defibrinated virulent blood at two-weekly intervals (the
first time 2,000 ec., later somewhat smaller doses). The blood, which is subsequently
drawn, produces the serum, and is preserved by Ehrlich’s method (to 90 parts
serum 10 parts of a mixture of 5.5 parts carbolic acid, 20 parts glycerin and 74.5
parts of water is added).

Theiler’s Method of Immunization. According to Theiler the
safest immunization consists in the injection of immune serum (300 ec.)
into the jugular, and virulent blood (1-2 ec.) under the skin; after
the appearance of the febrile reaction a second serum injection
(50-100 ce.) appears indicated.

In the Transvaal and Rhodesia 8,766 mules were treated by this method, with
a loss of 3.7% from the inoculation. Subsequently only 1.8% fell victim to the
disease from natural infection in affected territories. As it has since been found
that serum prepared with a certain virus is sufficiently effective, only against this
virus, Theiler recommends the preparation of a polyvalent immune serum.

Other Methods of Immunization. Rickmann employs material
originating from mules which are first injected subcutaneously with
0.1 ec. of virulent blood, three days later with 100-200 cc. of serum,
and after 12 to 14 days again with 1 cc. of virus (incubation method).

A second method consists in the simultaneous but separate sub-
cutaneous injection of 0.2 cc. of virus, and 200 ec. of serum, and 21
days later the subsequent subcutaneous inoculation of 25 ec. of virus
(simultaneous method).

According to Reinecke of 280 mules treated by the first method, and of 160
injected by the second method 8% died, and the percentage being somewhat
higher in the simultaneous than in the incubation method. Practically all of the
inoculated animals remained well, while the losses among the mules which were
not inoculated, and kept at the same place, amounted to 3.38% as a result of
natural infection. :

Leipziger gives for the first dose subcutaneous injections of 1 ec. of virus,
and 300 cc. of highly potent serum; for the second dose 20 ec. of virus. The losses
from the inoculations amounted to 3.5%. For the immunization of horses he
recommends first the subcutaneous simultaneous method, with 0.1 ec. of virus and
400 ce. of serum; three weeks later an injection of 0.3 ee. of virus and 100-200 ce.
of serum; then the animals should be injected daily, first subcutaneously, later
intravenously, with diminishing quantities (down to 0.01 ee.) and later again with
increasing quantities of virus, until a reaction takes place.

Literature. Theiler, Schw. A., 1893, 145; D. t. W., 1901, 209; Bull. P., 1905,
III, 617; Rep. of the Gov. Vet. Bact., 1905-1908.—Edington, The Vet., 1895, XLI,
595; J. of comp. Path., 1900, XIII, 223 u, 281.—Rickmann, B. t. W., 1895, 289;
A. £, Tk, 1907, XXXTII, 372; B. t. W., 1908, 883.—Sander, A. f. Tk., 1896, XXI,
249.—MacFadyean, J. of comp. Path., 1900, XIII, 1; 1901, XIV, 103.—Nocard,
Bull., 1901, 37.—Koch, A. f. TE., 1905, XXXI, 330.—Reinecke, Diss. Bern, "1909
(Lit.); Z. f. Vk., 1910, 7 6.—Leipziger, Diss. Bern, 1909 (Lit.).—Frei, Z. f. Infkr.,
1909, VI, 363.

Vol. 1—19
990 Fowl Pest.

13. Fowl Pest. Pestis avium,

(Pestis gallinarum, Typhus exsudativus gallinarum Rivoita &
Dexprato, Peritonitis epizootica ScHruERLEN & Buu,
Kyanolophiaea Lovt & Gruser; Peste aviaire,
[French]; Gefligelpest, [German].)

Fowl pest is an acute, contagious, infectious disease of
fowls, especially of geese, which in its course greatly resembles
chicken cholera; it is however caused by an ultra-microscopical
virus.

History. The disease was first described in 1878 by Perroncito,
and was shortly afterwards recognized as a disease differing from
fowl cholera by Rivolta & Delprato (1880). Later on Italian authors
treated the disease repeatedly as a dangerous plague, which caused
great losses especially in Northern Italy. Centanni & Savonuzzi (1901)
proved that the virus passes the porcelain filter, and similar results
were also obtained by Maggiore & Valenti, as well as by Lode & Gruber,
Ostertag & Wolfthiigel, Maue and others. Recently Kleine, Miller,
Rosenthal and Schiffmann established the occurrence of the disease
in geese, Prowazek, Kraus & Doerr, as well as Marchoux contributed
to its etiology, and Freese to its pathological anatomy.

Occurrence. The disease raged, especially since the year
1894, independently of chicken cholera, as a very fatal plague
in Northern Italy, from which region it was recently introduced
into Tyrol and Germany, and later into Belgium and France.

In Southern Germany it appears to have occurred since 1898 (Scheuerlen &
Buhl), but was spread more extensively by the Brunswick fowl exposition in
1891, at first in Wiirttemberg, later in the Northern states, especially in Prussia.
In 1908 the disease was officially recognized in Germany in 51 townships, affecting
1,826 chickens, 159 geese and 3 ducks (considerably less than in previous years).
In Hungary it has been known since 1903.

Marcone observed the disease in Capodimonte in a pheasantry, Eggebrecht
in Tsingtau as a severe plague of chickens.

Etiology. The infective agent is contained in the blood, in
the nervous system, in the nasal secretion and in the droppings,
as well as in the exudate of the serous cavities and in the bile
of the affected animals. By the inoculation of minimal quan-
tities of these substances (for instance 0.000,001 cc. of blood),
the disease may be positively transmitted to chickens. Simi-
larly effective, although in a lesser degree, are the filtrates of
the above mentioned substances through porcelain.

According to Landsteiner the virus appears to adhere to the blood corpuscles
as serum alone proved only slightly or not at all.virulent. Rosenthal, Kleine and
Schiffmann found in the brain, intra- and extra-cellular, round or oval, sometimes
also ring-shaped bodies, the true nature of which (protozoa or products of degen-
eration?) has not been established at the present time. Prowazek could not confirm
these findings, and believes that the carriers of the virus are 1 to 1.5 yw sized, some-
times dumb-bell shaped, forms in the brain, which frequently lie closely against
the red blood corpuscles; further fine single and double granules in the filtrates.
Marchoux reports the successful cultivation of the virus by spreading blood on
peptone-agar containing sugar; 0.2 ec. of culture of the 10th generation killed a
chicken in two days.
Etiology. Pathogenicity. 291

Tenacity. Blood placed in glass tubes, the ends of which were closed by
melting, and kept in a dark place, retained its virulence for three months, while
the filtrate was virulent for only one week. Heating to 55° destroys the virus
within a half hour, at 60° in 5 minutes, at 65° immediately (Centanni). According
to Maue the virus remains active in dried spinal cord, or liver substance, for 200
days, in blood mixed with glycerin (a) for 270 days. According to Ostertag &
Bugge it is destroyed by drying in a thin layer, or. by putrefaction after 39 days;
on being subjected to a temperature of 70° it is killed instantly. A 1% corrosive
sublimate solution destroys it in 30, a 1% sulphuric acid and a 3% chlorate of lime
solution in 10 minutes (Lode). A hot 2% soda solution, as well as a hot 5% creolin
solution are also effective (Ostertag & Bugge).

Pathogenicity. Chickens and turkeys, pheasants, sparrows,
plack-birds, sparrow-hawks, owls and parrots are susceptible to
the virus, while water fowls and pigeons as a rule resist the
natural, and frequently also the artificial infection; mammalia
are not at all susceptible. 7

Old geese can be infected only by subdural inoculations, those
only half a year old however by subcutaneous or intramuscular inocula-
tions, as well as per os. In these birds the disease manifests itself
principally in nervous symptoms (see symptoms). Lode & Gruber
and Centanni succeeded in infecting pigeons only by repeated injections
of large quantities of virus, Maggiore & Valenti only after previous
starvation with blood injections; Freese however produced the disease in
them by letting them live with chickens. Successful infections in ducks
are reported by Leclainche, and spontaneous infection of a parrot by
Stazzi.

The natural infection is probably transmitted mostly by the droppings and
the nasal secretion of affected birds, and also by the blood of: killed animals and by
the organs of those dead from the disease, which are ingested with the food by
healthy chickens (by feeding such material the disease has been produced arti-
ficially). Occasionally the virus may enter the body through injuries of the skin;
at least it was found that the disease may be produced artificially very easily and
positively in this manner (it is sufficient to dip the needle of a syringe into infected
blood, and slightly scarify the skin with it; Kleine & M@llers succeeded in pro-
ducing the disease by dropping the virus into the conjunctival sac).

Parasites living on affected fowls (Dermanyssus avium) cannot
trensmit the disease, and it cannot be even produced by subcutaneous
injections of such macerated parasites (Centanni).

Anatomical Changes. In very acute cases the autopsy
sometimes reveals negative findings, or frequently only punc-
tiform hemorrhages on the inner surface of the breast bone, on
the visceral layer of the pericardium, on the peritoneum, in the
fat tissue of the gizzard, and on its peritoneal attachment, as
well as in the mucous membrane of the air passages. There
may also be hyperemia of the spleen and of the kidneys. In
less acute cases there is an edematous swelling of the subcu-
taneous connective tissue on the neck and breast, also a great
amount of a pale yellow, slightly cloudy fluid in the pericardium,
which rapidly coagulates in the air. The layers of the pericar-
dium sometimes appear to be adherent by fine fibrinous threads.
Italian authors mention as a frequent finding a fibrinous exu-
date on the pleura and peritoneum (therefore the name of
““Typhus exudativus’’).

The comb and the wattles are dark, bluish-red, the con-
junctivae show catarrhal swelling. There is a considerable
292 Fowl] Pest.

quantity of mucus in the mouth and in the nose, which is some-
times bloody. The lungs are congested and sometimes contain
atelectatic areas.

The intestinal tract contains on the smooth mucous mem-
brane grayish-white, sometimes greenish excrement; at the pas-
sage between the glandular and muscular stomach, as well as
between and on the conical protuberances of the glandular
stomach, there are superficial or deep hemorrhages, sometimes
only very small (Freese). The mucous membrane at the begin-
ning of the small intestines shows sometimes only catarrhal
reddening, in other cases it is inflamed more markedly. The
liver and spleen show no striking changes. The kidneys are
either grayish-brown in color and cloudy or dark brown and
moist on the cut surface. The serous membrane of the egg yolk
is markedly congested, revealing sometimes hemorrhages which
may also be present in the yolk itself (Freese).

Symptoms. The time of incubation in the natural infection
is, as a rule, 3 to 5 days, exceptionally 2, or on the contrary
it may be even 7 days (Freese), while after artificial infection
death ensues not infrequently inside of 36 to 48 hours.

The disease commences with depression and diminished
appetite, which condition soon changes to a conspicuous dullness
and sleepiness. The chickens creep into dark corners, and sit
with drooping head and wings
Tepe | ee as when brooding, or crouch
motionless in one place. Even
at the onset of the disease they
do not resist being caught, and
some of the birds give a peculiar
loud ery when picked up. When
driven about they move with a
staggering, irregular walk, later
it is hardly possible for them
to move at all. Setting them on
the perch they find their eqni-
librium only after long balanc-
ing, or not at all.

In the meantime the comb
and the wattles become dark
red, and finally are blackish-
red in color (hence the name

iy Kyanolophiaea), while towards
the termination of the disease
Fig. 53. Fever curve in chicken pest grayish seales sometimes de-
Following inoculation of virulent blood : os
velop on the skin. <A similar
discoloration is also observed around the eyes, while the eyelids
are usually closed, tears accumulating under them profusely, the
conjunctivae being injected and swollen.

On pressure of the bill a grayish or reddish, tenacious

mucus oozes from the opening, and a similar secretion is also

 
Symptoms. 993

observed in the throat, while on the buccal mucous membrane
small hemorrhages may sometimes be found. Some patients
periodically shake their heads, at the same time giving a pecu-
liar sound, and expelling saliva from nose and mouth. In rare
cases profuse diarrhea is observed, the droppings being dirty
gray or greenish, fluid and exceptionally red colored.

Towards the end of the disease the affected birds hold their
heads turned toward the back, their respiration is very labored,
and finally paralysis appears, which progresses from the ex-
tremities to the head.

In artificial infection the body temperature commences to
rise after 12 hours, and later may exceed 44°C. At the approach
of death however it drops rapidly, even to 30° (Fig. 53).

Maggiora & Valenti describe a diphtheroid form of the disease,
in which a muco-fibrinous exudate forms on the surface of the swollen,
bright red mucous membrane of the mouth, throat and nose.

The same authors observed in several affected chickens peculiar
nervous symptoms in addition to irregularity in walk, and symptoms
of paralysis, which were manifested by moving the head in a circle;
Centanni has seen disturbances in the equilibrium, lasting for
weeks in pigeons which were inoculated with blood, especially turning

“the head, moving in a circle, and a desire to turn the body around
its long or transverse axis. The examination revealed as the cause
of these disturbances an exudative inflammation of the membranous,
semi-circular canals of the organs of hearing (semicirculitis specifica).
Calamida has also observed the turning of the head backwards, and
besides, shortly before death, attacks of delirium which somewhat re-
semble rabies, the birds jumping very high during these attacks.

In artificially infected geese the disease runs a slower course (an
average of 7 days), and as a rule under manifestations of striking
nervous symptoms, which are indicated by tonic-clonic spasms, involun-
tary movements, fluttering of the wings, spasmodic extension of the
neck, increased reflex irritability, etc. At the approach of death the
symptoms pass into paralysis. The blood of these birds, as well as of
artificially infected pigeons, is infectious only at the beginning of
the affection, while later the virus disappears entirely. The brain and
spinal cord, on the other hand, remain highly infective even after
death (Kleine). This may be explained by the fact that the virus
emigrates from the blood into the nervous cellular elements, and
becomes anchored there as a result of its specific affinity for the cell
plasma. This would correspond with the histological findings (prolifera-
tion .of round cells, the above-mentioned bodies) as well as with the
findings of Landsteiner, according to which the virus is, in contrast to
bacteria, quickly destroyed by a 1% saponin solution. ;

Kleine observed atrophic areas in the eye ground of a chicken,
and various kinds of chorio-retinitic areas in geese.

Course. The course of the disease is 2 to 4 days as a rule
with the exception of the very rapidly terminating cases, and
only exceptionally it extends to 7 or 8 days. The termination
appears to be fatal in the great majority of cases.

Diagnosis. The disease greatly resembles chicken cholera
in its course, and is only distinguished from it in that in this
294 Fowl Pest.

disease, at least in the somewhat protracted cases, a bloody
diarrhea develops quite frequently. The cyanosis of the comb
and of the wattles is an indication of pest, but does not exclude
cholera, as it is also frequently present in this disease. In the
autopsy decided sub-epicardial hemorrhages, fibrinous deposits
on the heart, severe hemorrhagic inflammation of the intes-
tines, and pneumonic areas are indications of cholera, and speak
against the presence of pest. The differentiation is only certain
by bacteriological examination. In pest no bacteria can be dem-
onstrated in the blood of fresh carcasses, either by a micro-
scopical examination or by cultivation, although the fresh
blood, as well as the filtrate through porcelain is virulent, but
only for chickens; whereas the virus of cholera which can be
shown microscopically and also by cultivation, is also patho-
genic for other species of fowls, especially pigeons, and like-
wise for rodents.

Treatment and Prevention. The treatment of affected ani-
mals has thus far proven ineffective.

In the prevention of the disease the same measures are
indicated as were given for fowl cholera (see p. 94), only
that in chicken pest the chickens should be especially protected °
against the infection. Germany, Austria and Hungary have
recently adopted official measures against the disease, which in
their nature are similar to those established against cholera.

According to Maggiora & Valenti serum of recovered geese which
were subsequently treated with virulent blood, is supposed to protect
chickens effectively against the disease, and is also said to possess
a curative action. According to Ostertag & Bugge the blood of chickens
which were treated in a similar manner only renders the virus ineffective
when given in large doses (10 ec.). According to Kraus & Schiffmann,
dried (at 22°) spinal cords from geese which were inoculated intra-
muscularly, protected young geese against a similar infection; on the
other hand geese may be actively immunized with virulent spinal cords
from chickens against a fatal subdural infection.

Literature. For literature see Freese, D. t. W., 1908, 173.—Also Maue, Arb.
d. G.-A., 1904, XXI, 537.—Rosenthal, Cbl. f. Bakt., 1905, XL, 204—Landsteiner,
Chl. £. Bakt. Ref., 1906, XXXVTIT, 540.—Kraus & Schiffmann, Ibid., 1907, XLIIT,
825.—Schiffmann, Ibid., 1907, XLV, 393.—Prowavek, M. m. W., 1908, 165, and
1016.—Kraus & Doerr, Chl. f. Bakt., 1908, XLVI, 709.—Marchoux, C. R., 1908,
CXLVII, 357,
Group II.

ACUTE EXANTHEMATOUS INFECTIOUS DISEASES
1. Pox. Variola.

(Pockenkrankheit [German]; Variole [French]; Vajuolo
- [Itahan].)

As pox are designated acute febrile, infectious diseases,
which usually take a typical course and are characterized by
a peculiar vesico-pustular exanthema which develops on the
skin, either over the entire surface of the body or only over
certain parts. In its first form the disease occurs in man, in
sheep, and, although more rarely, in goats and hogs; in cattle
and horses it is almost invariably observed only as a benign
local affection.

Accordingly only sheep pox, and to some extent also pox
of goats and swine, are of any economic importance, inasmuch
as sheep pox usually occurs in an epizootic form and causes
notable losses.

Etiology. All that is known at the present time regarding
the virus of variola in the various species of animals and in
man, is that in filtration of the contents of the vesicles under
high pressure it passes through moderately dense porcelain
filters, and therefore probably belongs to the ultra-microscopical
micro-organisms.

The very numerous bacteriological investigations which were made
principally with the infectious material from human and from cow
pox, have up to the present time failed to give positive results. For-
merly the causative agent of the disease was believed to be a bacterium
(Kleber, Simon, Hallier, Cohn, Toussaint, Klebs, Voigt, Garré, Marrotta
and others), in recent times it has been considered as a protozoon.
Pfeiffer & Rieck observed in the lymph of the vesicles, spherical bodies
containing a nucleus, and of a greenish lustrous color, with a move-
ment somewhat resembling that of amoebae. They considered these
bodies as parasites belonging to the species of protozoa, or to the class
of monocystidea, naming them sporidium vaccinale. Funck on the
other hand considers them as spores of these parasites, while Guarnieri
attributes the causative role to certain contents of epithelial cells
(Cytorhyetes vaccinae et variolae), which he believed to have cultivated
on the cornea of rabbits; the same view is also accepted by Siegel.
Other authors however consider them as parts of cells, or as remains
of polynuclear leucocytes which have penetrated into the epithelial cells
(Salmon, London, Schrumpf, Miihlens & Hartmann). Calmette &
Guérin are inclined to regard as the causative factor of pox, extremely

295
296 Pox.

fine granules whick they observe in the lymph with highly magnifying
lenses, and Bose describes extremely small granules in the vaccinia as
well as in the ovina, which gradually become larger, and after the
appearance of a nucleus in their bodies divide by schizogony, the nucleus
breaking up into fine granules (merozoites).

The findings of Prowazek are similar (1905). According to these,
the vaccinia contains as characteristic constituents in the smallest
epithelial fragments elongated motile bodies. These stain with hema-
toxylin, and consist mostly of two corpuscles (lymph corpuscles)
slightly varying in size, and contain in their structureless substance
one to two enclosures, 1-114u. in size, exceptionally punctiform, mostly
however rod or club-shaped, so called initial bodies. They are also
found in the cornea of rabbits after inoculation with vaccine. In
such cases they are present within and without the Guarnieri bodies,
and their development may be explained by the fact that the nucleus
of the epithelial cell reacts with the production of vaccine bodies to the
invasion of the initial body, which should be considered as the carrier
of the pox virus. According to these findings, which were confirmed
by Volpino, the pox virus would belong to Prowazek’s so called
chlamydozoa.

The spirochetes which were described by Bonhoff as the causative.
factors of pox (sp. vaccinae) were considered by Siipfle,. Carini,
Miihlens & Hartmann as artifacts.

The bacteriological examination gave positive results only insofar
as it showed that the pustules of pox always contain pyogenic bacteria;
thus Garré found in human pox the streptococcus pyogenes, Guttman
the staphylococcus pyogenes aureus, Grigorjew the same and the staph.
pyog. citreus. These, and probably also other bacteria (for instance
the bacillus necrophorus) however play undoubtedly only a subordinate
or secondary role, as compared to that of the true, as yet unknown cause
of pox.

The contagion of pox is contained in the lymph of the
nodules and vesicles, and also in the scabs which develop in
place of the latter, while the infectiousness of the blood, and
of the exhaled air, and also of the skin exhalations of affected
animals during the fever period is doubtful. The secretions
and excretions contain the infectious material only in those
instances in which they become mixed with the virulent con-
tents of the vesicles.

Pathogenicity. After inoculating infectious material into
the skin between the cells of the epithelial layer, characteristic
pox developed at the point of inoculation in susceptible indi-
viduals, sometimes however the inoculation results in a general
eruption of pox. This may sometimes also be produced by
intravenous or intra-tracheal injections of pox lymph.

Pathogenesis. The epithelial layers of the skin and of the
mucous membrane are the most favorable places for the propaga-
tion of the pox virus. If this is inoculated or rubbed into these
parts it enters directly between the epithelial cells and. if the
infection occurs by inhalation the virus reaches the same
Pathogenesis. 297

localization by transmission with the blood stream. In these
parts the virus propagates, and causes the development of the
characteristic exanthema of pox. The epithelial cells in the
stratum mucosum swell, changing to pale flakes without nucleus,
and then dissolve completely in the serous fluid. Some of these
cells resist this process, and are under the pressure of the
accumulating exudate drawn out to fine threads which then form
a loose network in the inside of the vesicle. At this stage
the contents of the vesicle are enclosed, on the inside by the
papillary body, which may be still covered by a thin layer of
epithelium, or may be entirely denuded, and at the same time
is infiltrated with small round cells. From the outside it is
closed by the corneal layer. Later a navel-like depression (pit) -
forms on the top of the vesicle, the development of which
is explained in various ways. According to Rindfleisch the
depression in the covering of the vesicle is caused by the horny
layer of the epidermis of the hair follicle, or the excretory
duct of the sweat gland around which the pox is arranged
in a concentric manner. According to the view of Virchow and
Weigert the crater-like depression is formed because the
central necrotic part of the pox, which does not take part
in the expansion, acts as a retinaculum of the covering of the
vesicle, while the progressive accumulation of pus extends the
periphery of the pox. Asa result of the migration of leucocytes
the contents of the vessels become purulent, and at the same
time the network in the inside undergoes dissolution: Finally
a scab forms, owing to the drying of the contents under which
the corium becomes covered by fresh epithelium; but if the
inflammation extended to the deeper parts, a scarred depression
remains at the place of the destroyed papilla.

This peculiar pathological process develops to maturity
as the result of the pathogenic action of the pox virus itself,
while the subsequent suppuration of the contents of the vesicles
is produced: by pyogenic bacteria, which probably penetrate
from the glandular duct and the hair follicles of the skin, into
the inside of the vesicles. According to their nature and viru-
lence the inflammatory process may be more or less intensely
influenced by them. Especially the occasional hemorrhages
and the deeper destruction of the corium, as well as the subse-
quent pyemia or septicemia should be considered only as ac-
cidental infections, and therefore the mild or severe character
of different outbreaks also depends on such secondary infec-
tion. At places which are protected from this the virus of
pox propagates without foreign contamination, and in such
cases, as for instance in the hard nodules which sometimes
occur under the skin of sheep, the contents consist of virulent
pox lymph which is free of pyogenic bacteria.

Whether the eruptions of pox remain local or become
generalized depends, aside from the susceptibility of the re-
spective animal species, upon the virulence of the virus and
298 Pox.

on the method of infection, as well as to some extent upon
the condition of the epithelial layer. The skin inoculation, even
if effected with strong virus, produces as a rule only a local
eruption, as in such cases the virus propagates only at the
point of inoculation. A portion of the virus may later be ab-
sorbed into the circulation, and be disseminated by the blood
to other parts of the skin and mucous membranes, but in these
places it is no longer capable of exerting a specific action, as
the body has already been immunized during the development
of the local eruption (Chauveau). If however inhaled virus
enters the lungs, or if it is injected directly into the blood
circulation, it is conveyed by the blood stream, to the papillae
of the skin, as well as to the tissue of the mucous membranes,
where it produces a generalized eruption of pox. The infection
is favored by injury of the epithelium, or other pathological
conditions (Calmette & Guérin), but the exanthema may de-
velop in the absence of any lesions.

Of course deviations from the rule may occur. If in skin
inoculations very virulent or large amount of virus enters the
tissue, or if the local exanthema produced by the inoculation
develops slowly, a generalized affection may result, even after
cutaneous or subcutaneous inoculation. On the other hand if
only a very small quantity, or very weak virus enters directly
into the blood cireulation, the pox eruptions develop only in a
few places or not at all.

As the virus of variola does not propagate in the blood,
the blood of affected animals is not, or only exceptionally, in-
fectious. It is infectious only when the ‘virus circulates in
the blood immediately before the development of generalized
pox eruptions. In this manner the fact may be also explained
that the excrements and secretions are non-infectious; the milk,
however, is sometimes an exception, namely, in those instances
when pox develops in the milk ducts, the contents of which
then become mixed with the milk.

Immunity. Recovery from pox produces in man and in
animals, an immunity which lasts for several years, whether
the infection was produced naturally or artificially. The im-
munity develops in a generalized pox eruption in the same
manner as after a local eruption from inoculation (according
to Chauveau a re-infection can not be produced after the fifth
day of the development of the pox), and further a pox exanthema
is not absolutely necessary for the production of immunity,
as calves may be immunized by intravenous injections of vaccine
(Strausz, Chambon & Ménard), rabbits by an inoculation into
the lungs or into the trachea (Calmette & Guérin), and shee
by intravenous injections of ovine virus (Semner & Raupach),
although in such cases the injection does not produce manifesta-
tions of variola.

Regarding the possibility of reciprocal immunization in the
Immunity. 299

different forms of pox, experiments prove that horses and cattle
may be immunized with variola against vaccinia, man with
vaccinia against the variola; but a similar reciprocal action of
vaccinia and ovina is very questionable.

The mode of development of the immunity is not yet sufficiently
known. According to Béclére, Chambon & Ménard, as well as Martins,
the blood of animals which were inoculated with vaccinia or with
variola, and in a still greater degree that of persons who have passed
through an affection of pox, contains substances which prevent the
pox lymph from exerting its action. At the same time they have an
immunizing action, and the favorable results obtained in recent times
with the blood serum of highly immunized animals, especially sheep,
inake this conception, very probable (see p. 317), however the nature
of these substances is not even remotely known. As the pox eruptions
develop only several days after the penetration of the virus into the
hlood circulation, potent blood serum may exert its immunizing action
even during the time of incubation. The immunization may be success-
fully accomplished also with lymph heated to 60° (Sitipfle) and with
filtrates through porcelain (Green).

The inoculation of virulent lymph into the skin results
in a slowly developing immunity, and in all probability is due
to the influence of the substances absorbed from the point of
inoculation, as in such instances the virus itself does not pass
into the blood circulation (Siipfle). As a rule only a local
eruption develops after such an infection; if however the
inoculated part of the skin is removed 24 hours after the
inoculation, a generalized pox eruption develops (Chauveau).
In the first instance an immunity results already during the
development of vesicles, and the virus which later penetrates
into the blood circulation can no longer attack the tissues, while
in the second case the resistance of the tissue has not been
increased to a degree in which it could oppose the pathogenic
action of the virus by the removal of the source from which
the immunizing substances develop. In infections resulting
from inhalation the virus enters directly into the blood circula-
tion, and thereby meets everywhere unresisting tissues, and
in such cases a more or less generalized pox eruption invariably
develops.

Offspring from animals which recovered from a general
or local variola during pregnancy are immune, but this im-
munity becomes gradually weaker (in lambs according to
Duclert from the 3d-4th month on), and disappears entirely
in the second generation. The pox immunity is only excep-
tionally inherited, and even in such cases it affords only a partial
and passing protection (Siipfle).

The etiological relation of human and animal pox to each
other is not sufficiently established. The uniform anatomical
structure, and the similar development of the characteristic
vesicles indicate the etiological identity of the different forms
of pox. However observations relative to the reciprocal infec-
300 Pox.

tiousness or susceptibility do not seem to corroborate this con-
ception.

Although the disease occurs in man and in sheep in the
form of a severe general disease, and with an extens:ve pox
eruption, in cattle and goats eruptions are almost invariably
confined to certain parts of the bodies, their development being
associated with only very mild general symptoms. The disease
in man and sheep may very readily become epidemic, while
among other animals the infection is usually confined within
restricted limits.

Very close relations exist undoubtedly between human and
cow pox. The vaccine of cow pox may be very readily inoculated
into man, but the inoculation produces only an eruption con-
fined to the point of inoculation, and never a general infection
analogous to variola. On the other hand human pox are less
surely transmissible to cattle. In some experimental cases
characteristic pox developed in cattle at the point of inoculation
(Numan, Ceely, Fischer, Eternod & Haccius, Simpson, Freyer,
Meder), in other cases only hard nodules developed after the
inoculation, which healed without changing into vesicles or
scabs (Chauveau) or again the inoculation remains entirely
negative (Ducamp & Pourquier obtained a positive result in
only one case, Juhel & Resnoy).

These experimental observations appear to indicate that the
virus of human pox (Variola), and that of cow pox (Vaccinia)
are two different modifications of one and the same pox virus.
Fischer and Eternod & Haccius aimed to prove this by re-
inoculating man with pox lymph of calves which had been re-
peatedly inoculated with variola lymph, whereupon in several
thousand persons only a local pox eruption developed. From
the above findings these authors, as well as Roloff and Bollinger
conclude that variola may be changed into vaccinia by passage
through the body of cattle, and that therefore the vaccinia rep-
resents an attenuated modification of variola. That such a
transformation does however not easily and constantly result is
proven by the experiments of Chauveau, who after inoculations
of lymph from cows which were inoculated with variola virus,
repeatedly observed in man the development of pox as a severe
general affection.

The very close relation between variola humana and variola
vaccinia is proven by the fact that vaccinia produces a lasting
immunity against variola. Inasmuch as the local affection
which develops after vaccination in man represents a very mild
form of human pox, vaccinia must be considered as an atten-
uated variola virus. If it is further considered that the trans-
mission of the contagion from man to man, as it has usually
been practiced in former times, produces in most cases only
a local affection, and further that pox in cows originally results
as a rule, and probably invariably, from transmissions from
Relation of Human and Animal Pox. 301

man affected with pox, the conclusion is justified that the con-
tagion of cow pox represents a modification of the human pox
virus which has become attenuated in the human body. Such
virus loses its dangerous properties for man permanently in
the body of cattle.

Jenner shared the belief of the people in the vicinity of Gloucester,
that vaccinia invariably results from an infection from horses affected
with pox, and that it is therefore identical with horse pox. His view
was later shared by Lafosse and subsequently by Bouley, and under
the influence of their authority and that of Chauveau, this opinion
has been generally accepted in France. In recent times, however, after
the findings of Warlemont & Hugues, that the horse is only very
slightly susceptible for the vaccinia, Dieckerhoff and Grawitz asserted
that the epizootic disease observed by the French authors did not rep-
resent the pox affection, but either a stomatitis or a contagious pustular
dermatitis, which diseases may be transmitted to other species of
animals, and also to man; and they opposed, in consequence, the pre-
vailing view.

Sheep pox usually spreads only among sheep, and the dis-
ease, although very fatal among these animals, does not even
pass naturally to the closely-related goats, neither is it danger-
ous for man. On the other hand human pox can only excep-
tionally be transmitted to sheep (Manson, Simond), and even
artificially a severe pox affection can only be transmitted to
these animals by intravenous injections of variola virus
(Kiichenmeister, Tappe). It is not possible to immunize cattle
with pox lymph from sheep against cow pox, and vice versa
(Peuch, Voigt), therefore sheep pox must be considered as a
specific affection of sheep.

Goats are likewise only susceptible to the contagion of
goat-pox, as sheep do not become infected in severely affected
goat herds, and it is even difficult to infect them artificially.
On the other hand the transmission of sheep pox to goats is
also difficult (Bremond, Bonvicini, Nocard), while an infection
with human pox is not possible (Voigt) ; finally cattle are not
susceptible to goat pox (Bonvicini). Accordingly goat pox may
likewise be considered as a specific affection of goats.

Pox of other species of animals, if such occurs at all, results
from an infection from man or from the disease affecting one
of the above mentioned species of animals, and therefore can-
not be recognized as independent forms of the disease.

-According to the present state of knowledge, therefore,
human pox, sheep pox and goat pox represent independent
forms of the disease, occurring and spreading independently of
each other, whereas the pox of other species of animals always
have some connection with one of the above mentioned forms
of the disease. This view however does not at all exclude the
302 Sheep Pox.
mutual relationship of these forms of the disease. On the con-
trary, the uniformity of the development of the specific patho-
logical processes points to the probability that the pox disease
was originally a specific, independent affection of one of the
susceptible species of animals or of man, and was here and
there transmitted to other species of animals. However as
the virus, in the course of time, passed through many genera-
tions of various species of animals it adapted itself in point of
virulence, and probably also in its other properties, to the
organisms of these respective species of animals. As the result
of this the pathogenicity of such an adapted virus has been
partly or entirely lost against other species of animals.
Literature. Jenner, Inqu. into the causes u. effects of the Variolae-Vaccinae.
London 1798.,—Chauveau, Rec., 1866, 305 u. 625; Bull., 1893, 51—Bouley, Dict.
de méd. vét., 1871, 1X, 451.—Roloff, Pr. Mt., 1870-71.—Bollinger, Volkmanns
Samml. klin. Vortr., 1877, Nr. 116 (Lit.).—Dieckerhoff & Grawitz, V. A., 1885,
CII, 148.—Prowazek, Arb. d. G.-A., 1905, XXIII, 535.—Miihlens & Hartmann,

Zbl. f. Bakt., 1906, XLI, 41 (Lit. on the so called vaccine-virus).—Voigt, Z. f.
Infkrkh.. 1909, VI, 101.—Siiple, A. f. Hyg., 1908, LXVIII, 237.

(a) Sheep Pox. Variola ovina.

(Scabrot, Schafpocken [German]; Clavelée, Picotte [French];
Vajuolo pecorino [Italian].)

History. Sheep pox was probably introduced from Central Asia,
_ Since human pox which is closely related to pox of animals is known
to have existed in India a long time before the birth of Christ. Sheep
pox was extensively studied for the first time by Joubert and Rabelais
towards the end of the sixteenth century; its infectiousness however
was established by Bourgelat in 1763. As a result of the customary
immunizations of sheep at that time, and through the use of Spanish
sheep for the improvement of existing breeds, the disease attained a
large distribution in Europe.

The etiology and pathogenesis of the disease were investigated
especially by Chauveau (1868) in more recent times by Borrel (1902),
whose work has created great interest in the matter of immunization,
which had been neglected for a time.

Occurrence. Pox among sheep has in recent times been
entirely eradicated in the northern and central countries of
Europe by proper measures, while in France and in the
countries lying south and east the disease occurs even now in
an epizootic form. In the affected territories extensive out-
breaks appear especially during the warm weather, but even
in these localities the disease does not attain the extension of
former times. Its economic importance results from the great
losses which occur occasionally, and also from the considerable
loss of wool which follows the disease.

Severe outbreaks are mentioned as having occurred in the be-
ginning of the last century, thus Salmuth estimated in 1804 that the
Oceurrence. Etiology. 303

annual losses of sheep from pox amounted to more than one-eighth
of the total number of animals, further Heintl, in 1823, gives the
annual loss-in Austria as 400,000 animals, and in France it is claimed
that in 1819 more than one million sheep fell victims to the disease.

Germany was entirely free in the years 1889-1899, the disease however appeared
in 1900 in a township of the Governmental District Liineberg (220 cases with
two deaths). In the following year it was discovered in four townships of the
government districts Kénigsberg and Gumbinnen, affecting 1005 sheep, of which
38 succumbed. The country was free from the disease for one and a half years,
hut it reappeared in the above districts, as well as in Marienwerder in 1903,
and on this occasion 1157 sheep became affected, of which 465 died. It is supposed
that at this.time the disease had been brought in by smugglers or butchers from
Russia. Two years later it was brought from Russia into Eastern Prussia, by
agricultural laborers, where 20 townships with 30 farms, and isolated farms in
Saxony and Anhalt, were infected. The total cases amounted to 3,220 sheep, 704
of which succumbed. Since that time several outbreaks have been observed annually
in Prussia, and in the year 1908 4 townships with 402 cases, and 154 deaths, were
recorded.

The disease formerly raged in a severe form in France, especially in the
Southern provinces, but also occurred in other parts of the country, especially after
the importation of sheep from foreign countries was restricted while large numbers
were imported from Algeria.

Austria was free from the disease in 1894, but since that time this has again
become widely spread, especially in the years 1898-1900 in Tyrol, and still more
in Dalmatia; in the latter year 21,575 sheep in 72 townships were affected, and
of these 10,007 died or were slaughtered. After that time the disease diminished
greatly, and no outbreaks have occurred since 1903.

The disease was always more or less confined in Hungary to the Southeastern
part, and in recent times it occurs almost exclusively in the counties which are
adjacent to Roumania and Servia. From 1899 to 1908 an average of 59 townships
were infected, with 15,275 cases, of which 2,175 died. Since 1904 the disease
attained again a greater extension, and occurred in 1908 in 113 townships of
27 counties with 19,131 cases, the total deaths being 4,443.,

In the same year 466 townships were affected in Bulgaria; 40,744 in Roumania;
in European Russia 23,034 animals became affected. The disease also frequently
occurs in Spain, while the other European countries have been free for many
years. It is widely spread in Asia, and is also known in Africa (Egypt, Algeria),
while there are no statistics relative to its occurrence in America and Australia.

Etiology. Regarding the nature of the virus, it is at present
only known that in diluted pox lymph and under great pressure
it passes the porous Chamberland filters (F* and F*). The
filtrate is not even under highest power found to contain formed
bodies, and attempts at cultivation fail to give positive results

(Borrel).

Tenacity. In glass tubes, closed on both ends by melting, and kept in dark
and moderately cool places, the pox lymph retains its virulence even for two years.
At a somewhat higher temperature, for instance at 35° it is active for months.
Its virulence is attenuated by higher temperatures, and at 48° it is destroyed
in a short time, while when subjected to a cold of —12-15° it does not become
attenuated for two months (Nocard). Glycerin attenuates it proportionately to
its quantity, and a mixture of equal parts of lymph and glycerin becomes avirulent
in 12 days when kept at a temperature of 25° (Duclert). Of the disinfectants a
3% boracie acid, or 2% sodium salicylate have hardly any influence on the lymph
(Galtier) and likewise 2% sulphate of zine and 10% chlorate of lime solutions are
ineffective (Peuch). Putrefaction, diluted hydrochloric acid, 14% carbolic acid,
214%, sulphurie acid, 10% wine vinegar, spirits of turpentine (Griinwald) and
also a mild iodine solution (1:10000) (Peuch) exert a quick destructive action
on the lymph. The virus dies in the fleece of sheep affected with pox, at the
latest in two months (Duclert & Conte). : :

Experience gained in practice also points to the considerable resistance of
the pox virus. When kept in a moderately warm place, protected from draughts,
304. Sheep Pox.

as for instance in sheep stables, it may retain its virulence for six months, and
even out of doors it may remain infectious for a long period of time. In
Siebenbiirgen it was noted in one case that lambs became affected with pox in
great numbers, in a stubble pasture in which 62 days previously -sheep affected
with pox had been pastured on young wheat (Dely).

Pathogenicity. A cutaneous inoculation of a small drop
of pox lymph usually produces in susceptible sheep only a local
pox eruption. In some cases, however, especially in lambs and
by using very virulent lymph, a generalized pox eruption re-
sults. In the latter case, after an incubation period of 2-214
days, a dark red nodule develops at the point of inoculation,
which from the fourth to fifth day on changes into a vesicle.
When the nodule begins to soften the body temperature rises
to 39.5-40.6° C., later to 41.5-42.6°, indicating the entrance of the
virus into the blood circulation. This is followed by the forma-
tion of nodules, which change into pox vesicles on the mucous
membrane of the lips, on the nostrils, the eyelids, later also in the
axillary region, on the thighs, around the vulva and rectum. At
the same time the general febrile symptoms reach a high degree
until at the beginning of the third week, or somewhat later, death
ensues with manifestations of septicemia. After subcutaneous
infection the temperature rises with the beginning of the local in-
flammation; this is shown by a firm swelling which may reach
the size of a fist, containing numerous nodules, later forming
confluating pox vesicles on its surface, while the general pox
eruption develops in from 5-6 days after the infection in the
same manner as though resulting from a cutaneous inoculation.
Intra-peritoneal injections of.lymph are followed by the forma-
tion of nodules on the peritoneum, with bloating and sensitive-
ness of the abdomen, while injections into the trachea lead to
a specific inflammation of the mucous membrane’ of the air
passages, with marked difficulty in respiration as an immediate
result, whereupon, in from 6-8 days a. generalized pox eruption
develops (Bose). Injections of lymph into the circulation may
produce only febrile manifestations without eruptions, but sheep
are immunized after such a short affection to the same extent
as after recovery from a typical infection (Semmer & Raupach).
An intra-cerebral inoculation results in 6-8 days in fever, the
animals dying within one week afterwards, while injections of
lymph into the milk cistern produces a pox eruption on the
mucous membrane of the milk ducts, the milk in such cases
containing the infective agent for two weeks (Nocard).

Outside of the contents of the vesicles the virus is not
present in the pure secretions or in the blood, or in the latter
only exceptionally immediately before or at the beginning of
the pox eruption (Bose; Nocard & Roux failed to obtain any
positive results from the inoculation of blood).

Natural Infection. The virus of sheep pox probably enters
the lungs with the inhaled air, and from there passes through
the alveoli directly into the blood, which disseminates the virus.
Natural Infection. 305

into the superficial vessels of the skin and mucous membranes.
The disease may be invariably produced by injecting or atomiz-
ing pox lymph into the trachea of susceptible sheep, while the
feeding of lymph, when the possibility of inhalation is excluded,
is not effective (Nocard).

The pox virus contained in the vesicles and in the scabs
becomes pulverized and disseminated in the air, as a result of
which a certain area surrounding the infected animals becomes
infectious (according to Gilbert in calm weather for 20-25 paces,
in windy weather even further). If the food is contaminated
by scabs the virus is inhaled by sheep with the dust disturbed
during feeding.

The disease usually develops in flocks of sheep when they
come in contact with affected animals or when sick or not
entirely recovered sheep are placed among healthy animals. In
this respect sheep which become ill from immunization, es-
pecially young lambs, are also dangerous. Susceptible sheep
associating with such lambs may also become affected with a
generalized, severe form of pox, as the virus used for the im-
munization is not attenuated in any way. The frequent occur-
rence of the disease among lambs in the spring of the year is
often associated with the usual immunization carried out at
that season in many localities. The infection may also be trans-
mitted by contaminated utensils or attendants, by skins, wool,
feed, manure, straw, pasture, highways, transportation wagons,
further by shepherds and their clothes, dogs, cats, fowl, etc.

The infectiousness of a diseased animal is especially great
when the eruption becomes matured on the body surface, and
to a still higher degree during the stage of scab formation
and desquamation. The contagion may remain virulent in the
scabs under the wool from 6-8 weeks, and therefore the infection
may be communicated by animals which have already passed
‘through the disease. é
The susceptibility of the various breeds of sheep is not uni-
form. The most susceptible are the Merino sheep, somewhat
less the more hardy, coarse-wooled sheep. In the first the dis-
ease develops as a rule in a more severe form than in the latter.
In northern countries it is less severe and less frequent than
in the south, which is probably due to the higher temperature
which favors the development of pox. According to Nocard
the sheep of Bretagne are not susceptible to pox, and the same
opinion is also held by Chauveau concerning the Algerian sheep.
Waldteufel & Nocard however found that pox exists continu-
ously among the sheep of Algeria, although in a very mild
-form (if affected Algerian sheep come in contact with French
sheep, the latter become severely affected).

Young sheep are more susceptible to. pox than older
animals, and in affected herds the lambs as a rule become
severely ill without exception.

Affected ewes may transmit the disease to their offspring,

Vol. 120
306 Sheep Pox.

which in such cases are born with pox eruptions; in other cases
the fetuses in utero remain healthy in spite of the infection of
the mother, such lambs having developed an immunity against
the disease.

Rickert vaccinated about 700 breeding ewes in the last week of pregnancy.
Repeated inoculations of the lambs born from these animals were ineffective, while
36 lambs, from ewes which were not vaccinated, developed pox nine days after
the inoculation. Three years later the inoculation gave positive results in the
first, while the latter failed to contract the disease. Anacker likewise failed to
produce the disease in 60, Peuch in three lambs from affected sheep.

Other species of animals as well as man, are not susceptible
to sheep pox, or only ina very slight degree. Goats occasionally
become affected as a result of contact with sheep affected with
pox, and according to Borrel & Konew the sheep virus gains
in virulence for goats by passage through their bodies, while
it becomes attenuated for sheep (see p. 327). Supposed in-
fections of horses by affected sheep are reported by Berger &
Pecus.

Anatomical Changes. The autopsy of sheep dead from
pox reveals, as a rule, besides the characteristic changes of
the skin, hemorrhagic inflammation of the mucous membrane
of the air passages and of the gastro-intestinal canal. On the
mucous membrane of the pharynx and trachea, less frequently
in the abomasum, pox vesicles are occasionally present, or
ulcerations which have developed from them. The lungs,
especially near the pleurae, contain small, gray translucent
nodules, which may show a central caseation; these nodules are
located within pneumonic areas (Morel & Vallée). In the
other internal organs changes indicating pyemia or septicemia
may be found (acute swelling of the lymph glands, petechiae
on the serous membranes, parenchymatous and fatty degenera-
tion of the parenchymatous organs, subpleural infarcts in the
lungs, initial acute interstitial nephritis, etc.).

Under the skin hard nodules the size of hazelnuts and
showing a homogenous cut surface, may occur; they consist
of thick masses of polynuclear leucocytes, lodged between
shreds of subcutaneous connective tissue, many of these
leucocytes containing broken down nuclei.

Symptoms. The pox exanthema is preceded by an incuba-
tion period of six to eight days, which is somewhat longer in
cold weather. After this has passed the disease commences
with febrile and catarrhal symptoms, which consist in dullness,
loss of appetite, and elevation of temperature up to 41-42°,
accelerated pulse and: respiration; sometimes trembling and
chills may be also observed. Pressure on the vertebral column,
especially in the lumbar region, causes many of the affected
animals to show signs of pain. The eyelids are swollen, the
conjunctivae reddened, and from the narrowed slit of the eyes
tears mixed with mucus are discharged. From the nose there
a ee gee a ee ie

‘of the prepuce, on the

-reddish nodules may be

Symptoms. 307

is also a muco-purulent discharge, and sometimes a snuffling

respiration is observed. The tongue is coated, and the exhaled
air frequently disseminates a disagreeable odor. The mucous
membranes of the cheeks and of the pharynx show either uni-
form or spotted reddening. The animals are constipated, the
urine is diminished in
quantity and has a high
specific gravity. Auscul-
tation of the. lungs re-
veals intense vesicular
breathing.

This condition lasts
from one to two days,
whereupon, round red
spots appear upon the
skin (roseola variolosa),
which in some places:
may be surrounded by a
moderate serous infiltra-
tion, manifested by an
‘urticaria - like elevation
of the affected parts of
the skin. Such spots are
found in the vicinity of
the eyes, on the cheeks,
lips, and nostrils, on the
vulva, or on the borders

(After JOEST.)

Sheep pow.

udder, or on the scrotum,
on the surface of the tail .
and on the inside of the
thigh, therefore princi-
pally on those parts of
the body which are free
from, or only slightly
covered by. wool. Less
frequently they occur al-
so on the chest and on
the lower abdomen.

On the following day
hemp-seed size, round

Fig. 54.

observed in the middle of
the red spots, which lose
their color on pressure. .
They continue to increase in size on the following days to such
an extent that the base may reach the size of a ten cent piece
(stadium papulosum). From the surface of the nodules a tena-
cious fluid oozes out; soon the superficial layers become raised,
and a clear yellowish serous fluid accumulates under them,

 
308 Sheep Pox.

whereby a fine, bluish-white vesicle develops with a transparent
wall. This continues to enlarge on the following day, and at
the same time a slight depression (navel) develops on the top
(stad. vesiculosum; Fig. 54). The development of the vesicles
occurs in the same succession as is the case in the appearance
of the red spots and the nodules, and it may take several days
for the development of all the vesicles. The vesicles attain a
size ranging from that of'a lentil to that of a bean; while the
larger vesicles are more flat and in their center the navel is
never absent, the smaller ones are less elevated, resembling
more blunt ended pins and on them the navel may frequently
be absent. The closer the vesicles are located to each other the
smaller their size, and vice versa. In pricking the vesicles their
serous contents ooze out slowly, on account of their compart-
ment-like construction.

Immediately surrounding the vesicles the skin is as a
rule hyperemic, and therefore forms red zones around them;
the skin and the subcutaneous connective tissue of the
affected parts are also edematous, as a result of which the
respective regions of the body, especially the head, and on
this particularly the eyelids and the region of the nose are
swollen, so that the corresponding openings and slits become
constricted. The development of the exanthema up to this
degree usually takes from 5 to 6 days.

In the completely developed ripe vesicles the clear yellowish
or pale red lymph-like contents changes after 2 to 3 days, or 6 to
7 days from the onset of the disease, into a cloudy fluid owing to
the admixture of pus cells, finally becoming entirely white, at
the same time the vesicle may increase somewhat in size and
the navel-like depression may also disappear (stad. pustulosum
s. suppurationis), while the edematous infiltration of the skin
in their immediate surroundings becomes as a rule still more
intense. This stage usually lasts three days.

This completes the development of the vesicles; a depres-
sion again appears on their tops, the wall becomes withered and
wrinkled, and after the horny layer has taken on a brownish
color the vesicle dries with its contents to a 14-1 mm. thick
brown scab (stad. crustosum s. exsiccationis). New epithelia
form under this from the borders and from the base of the
vesicle, whereupon the scab drops off in from 4 to 6 days (stad.
decrustationis). In its place a red spot or a red scar remains
for a time, which gradually turns pale and at the same time
becomes somewhat depressed.

The development of the eruption is associated more or less
with severe general symptoms. The sudden high fever at the
onset of the disease diminishes from the second to third day
on, and in the pustular, as well as in the vesicular stage only
a moderate fever is present. With the appearance of suppura-
tion it again increases, and again drops rapidly after 2 to 3
days, so that the drying of the vesicles, as well as the falling off
of the scabs occurs under normal temperature.
Symptoms. 309

_ With the appearance of the eruption the general condition
improves, and during the development of the vesicles the
patients usually are quite bright. They partake of some food,
and also ruminate periodically. Profuse secretion continues
to be discharged from the eyes and nose, the respiration may
be snuffling owing to the swelling of the skin of the head, and
especially of the nostrils. From the corners of the mouth a
tenacious, foamy saliva hangs in long strings; the extremities
are usually edematously swollen. The animal disseminates a
peculiar, sweetish, repulsive odor, which becomes more pro-
nounged during the period of suppuration. The general con-
dition later becomes worse, but as soon as the suppurative
process is concluded, and the drying commences and with the
disappearance of the fever the catarrh of the mucous mem-
branes also diminishes whereupon the patients usually regain
their normal health in a relatively short time, on an average
in 8 to 4 days.

The pox develop in a similar manner on the mucous mem-
brane, and simultaneously the eruptions on the skin. Their
appearance in the mouth is usually associated with profuse
salivation, and when they are present in the pharynx there is
difficulty in swallowing, while their appearance on the tongue
sometimes causes a marked swelling of this organ.

’ Pox with an Atypical Course. Deviations from the regular
course are very frequent. It is probable that the catarrh of the
air passages and of the eyes which is sometimes observed in
some sheep of an infected herd without other symptoms, and
without their developing a severe affection, is the result of a
pox infection, which however, owing to the resistance of the
animals, was not sufficiently severe to produce an eruption of
pox (variola sine exanthemate).

Frequently it is also observed that the eruptions do not
develop into the vesicular stage, but the red and frequently elon-
gated nodules remain stationary for a long time, peel off after
a few days and disappear (so called abortive or stone pox).
These abortive lesions occur sometimes also between well devel-
oped vesicles, especially on the parts of the body which are
exposed to a greater pressure (variolae compressae, flattened
pox), while in other cases the affection is exclusively manifested
in an eruption of such nodules. The disease frequently occurs
in this mild form among Algerian sheep, in which case small,
hard nodules develop only on the head, around the eyes, nasal
openings and lips; and in the outbreaks in Germany, in 1905,
the manifestations were similar, although the course was quite
severe (see p. 303).

After Ostertag had as the first recognized the disease to be pox, its
symptoms were described more accurately by R. Frohner, Kleinpaul,
Eber, Roessler, Noack, Klebba, Haak, and the autopsy findings by
310 Sheep Pox.

Joest. The difference from the usual course is not shown so much
in the general symptoms (fever, acute catarrh of the mucous mem-
branes, dullness, etc.), as these greatly resembled those of the typical
form, but in this atypical form hard nodules as large as lentils or -
hazelnuts usually developed on the
skin (Fig. 55). They were not sur-
rounded by a red zone, and showed
no indications whatsoever of vesicular
or pustular formation. Although the
exanthema often extended over the en-
tire body, it appeared that the lesions
occurred preferably in the vicinity of
the nose, lips, vulva, and on the udder.
The affected parts of the body fre-
quently showed a marked inflammatory
Fig. 55. Atypical sheep pow. swelling. Later the papules dried,
(After dOxst,} and dropped off entirely. Not infre-
quently they turned into suppuration
or gangrene, whereupon quite deep ulcerations developed, which were
covered by thick scabs andecrusts. After the scabs dropped off, cicatrices
without pigment or hair remained. Typical pox vesicles develop but rarely
and only later in an outbreak. Here and there purulent keratitis,
sometimes with subsequent panophthalmitis and blindness resulted, and
lameness resulted frequently from an inflammation of the interdigital
space, also erysipelas-like swellings of the skin of the thighs; further
a colliquative diarrhea was observed in severe cases. In some cases
goats ‘became affected with similar symptoms, and the transmission
from sheep to goats was also successful by artificial means (Foth).
Losses in affected flocks vary among the different animals from 25-50%,
or even a larger proportion. (According to Lungershausen the disease
showed a similar character in the outbreaks of 1862-3.) ©

 

The number of papules varies greatly from case to case,
sometimes they occur only sparingly, while in other cases the
parts of the body not covered by wool, as well as the other
parts, are covered with great numbers. As a rule they are
thickest and most numerous on the face. “

If the eruptions appear very closely together they may
confluate into large purulent vesicles (variola confluens), and if
this occurs in many places the neighboring skin and subcu-
taneous connective tissue becomes greatly edematous, so that
the head, for instance, becomes greatly deformed, and the face
appears as though covered by a mask. In such cases the papil-
lary layer under the suppuration forms a continuous wounded
surface, from which a general pyemia or septicemia may readily
develop. In such cases numerous papules may develop on the
mucous membrane in the mouth, pharynx and nose, the develop-
ment of these being associated with difficulty in swallowing and
respiration, purulent nasal discharge, and profuse salivation.
Vesicles may occasionally develop on the conjunctivae, and also
on the corneae. In such cases the disease usually terminates in
death, and if the animals should recover after the falling off
Pox with Atypical Course. 311

of the thick scabs, an extended ulcerative surface remains, which
heals only after a long time leaving irregular shaped cicatriza-
tions. “

Most unfavorable is the course in those cases in which, dur-
ing the development of the eruptions extensive hemorrhages ap-
pear (variola hemorrhagica s. nigra). Although disseminated
small hemorrhages may occur in the mild cases, the hemorrhagic
character of the affections is at other times pronounced. Be-
tween papules of normal appearance, dark red eruptions are
observed, which do not disappear on pressure, hemorrhages
also occurring on the smooth skin and in the subcutis. In
other cases the exanthema develops at first normally, although
accompanied by severe general disturbances. Suddenly, how-
ever, the serous contents of the vesicles become hemorrhagic
and then the eruptions appear dark red, almost blackish. At
the same time a bloody nasal discharge, hematuria and bloody
diarrhea, indicate similar hemorrhages in the internal organs.

The severity of the disease is also manifested in the be-
havior of the affected animals. They stand in one place, swing-
ing their bodies with drooping heads, and at times grinding the
teeth, or lie motionless on the ground. The respiration is very
labored, and is usually done through the mouth. The body dis-
seminates an unpleasant repulsive odor. The affected parts of
the skin turn into ulcers, which become covered with a dirty
ichorous mass, while other parts of the skin may become gan-
grenous, forming dirty brown masses. Gangrene may also ex-
tend to the muscles, and occasionally the ears, lips, eyelids, etc.,
may also become gangrenous, these parts later dropping off
(variola gangraenosa, gangrenous pox, rot pox; such necrosis is
sometimes observed in the confluent but non-hemorrhagic
papules): Death may result in any stage, even before the de-
velopment of the vesicles.

The socalled black pox does not represent a special form of the disease,
but is primarily identical with the ordinary sheep pox, while the hemorrhages:
are very likely originally associated with an especially severe accidental septic
infection.

s

Most frequent are those complications which occur in the
animals as a result of scratching and rubbing on account of
itching. Thus a severe dermatitis may sometimes develop at
the places of the ruptured vesicles, which retards the subsequent
healing, and as a result of this marked edematous swelling may -
develop, even in mild cases, especially on the head. After heal-.'
ing scarred depressions result from such wounds at the place
of the vesicles. If the patients rub their noses much, which
‘they frequently do, the inflammation may also extend to the
nasal septum, and to the periosteum of the nasal bones, and for
this reason these bones sometimes become necrotic.

Chemosis of the conjunctivae, which in severe cases of con-
junctivitis develops not infrequently, may result in an ulcerative
312 Sheep Pox.

breaking down, or necrosis of the cornea, with which occa-
sionally an acute inflammation of the internal parts of the eyes
becomes associated, leading finally to atrophy of the bulbus.
Vesicles which develop on the sclerotic portion of the conjunc-
tiva may extend to the cornea, leaving a permanent cloudiness
behind.

The catarrh of the air passages may sometimes extend to
the finest bronchi, when it causes intense difficulty in respiration,
and a catarrhal pneumonia may develop as a result.

The pox eruptions are usually associated with gastro-
intestinal catarrh; in severe cases it becomes more intense, and
the resulting complete inappetence combined with the profuse
diarrhea exhausts the strength of the affected animals.

The eruptions on the lower extremities, on the coronary
band, and in the interdigital space, lead not infrequently to
purulent inflammation of the sensitive lamina, and of the neigh-
boring joints, as in these places septic infection readily occurs,
whereupon the horny capsules drop off, and general pyemia
develops from pus absorption.

Of other complications there should be mentioned, suppura-
tion of the lymph glands, metastatic abscesses in various inter-
nal organs and in the subcutaneous connective tissue, diphthe-
ritic inflammation of the mucous membranes, pneumonia and
pleurisy, necrosis of the tendons, etc.

Course. The course of pox is always acute, and except for
some of the outbreaks (see p. 309), is in the majority of cases
typical unless the development is hindered by outside condi-
tions. The development of the vesicle occurs with few excep-
tions always in the same order, and. the other manifestations
also follow a typical course. Accordingly the average duration
of the disease, from the beginning of the exanthema until the
scabs fall off and to the new formation of the epithelium, is from
3 to 4 weeks. The course may however be influenced by external
conditions, as it is known that the disease runs a slower course
in dry winter weathér than in summer, and cold rainy weather
has an unfavorable effect on its course. Further, the disease
develops more slowly in anemic, poorly nourished animals,
and if they survive at all the period of desquamation especially
requires a longer time.

In severe cases, with very extensive pox eruptions, death
may ensue even in the early stages of the disease, possibly from
hemorrhage. Usually however unfavorable changes take place
during the suppuration period, although in exceptional cases
animals may die even if they are on the road to recovery, as a
result of exhaustion or some complication. °

The mortality varies greatly in different outbreaks. While
the loss sometimes amounts only to from 2 to 5%, in other cases,
especially when the coalescing and hemorrhagic forms are more
frequent, more than half of the affected animals die.
Course. Diagnosis. 313

If an outbreak has appeared in a large flock the cases first
appear at intervals of 10 to 14 days, later however in more rapid
succession, until finally, with the exception of about 2 to 3%,
all animals have become affected. In some cases only a small
part of the herd becomes affected at first, and only 3 to 4 weeks
later when the animals that were stricken first already show
indications of recovery does the disease break out suddenly
in a great number of sheep, and finally after a further interval
of ne animals of the flock which have been spared become
affected.

Diagnosis. The character of the exanthema and the typical
course of the disease as a rule make a positive diagnosis pos-
sible. If the danger of contagion exists the first prodromal
symptoms are sufficient to arouse a suspicion of the disease,
otherwise however the diagnosis should be suspended until
typical vesicles have developed from the nodules. The pres-
ence of vesicles and pustules is not absolutely necessary in the
clinical development of the disease, as was shown by recent
German and Algerian observations, and therefore in such an
atypical course a papular exanthema is sufficient to establish at
least a suspicion of the disease, especially when such lesions
‘develop in association with fever and catarrh of the mucous
membranes. The diagnosis may be confirmed later by inocula-
tions of the contents of the nodules into healthy animals.

The disease may be mistaken for scabies and pustular
eczema, especially in the stage of pustule and scab formation.
In these diseases however there are no severe prodromal symp-
toms preceding the development of the lesions, besides this,
eczema is not infectious, and in its course no larger vesicles
develop, while scabies, although infectious, spreads very slowly,
and scabies mites may be readily demonstrated with the micro-
scope in the scabs and crusts.

Prognosis. In cases in which the pox eruptions are few and
the individual papules develop in the regular order the prog-
nosis is favorable. On the other hand in those cases in which
the exanthema extends over a larger portion of the body, and in
which the vesicles show a tendency toward coalescing, it is
doubtful: Hemorrhages are always unfavorable indications,
irrespective of the stage in which they appear.

Very old or very young animals show, under otherwise like
conditions, feeble resistance and sucking lambs especially be-
come severely ill with otherwise mild pox on account of the usual
association of gastro-intestinal catarrh. In flocks where the
animals are confined in narrow quarters the disease runs a more
unfavorable course than in animals kept out of doors. In the
latter again great heat or damp chilly weather has a bad effect.
Sheep which come from localities in which pox is prevalent
become more readily affected than those which come from
localities where the disease has not existed for a long period.
314 Sheep Pox.

In the prognosis, the possibility of complications and after
effects (lameness, chronic ailment) should be given due con-
sideration.

Treatment. In the treatment of sheep pox, regulation of
hygienic conditions is the essential factor to be considered. The
animals should be given proper food and pure, fresh, uniformly
warm air, wherefore in favorable weather it is best to keep ..
the sheep out of doors. The early slaughter of the severely
affected animals appears indicated, because through this pro-
cedure the danger of a subsequent septic infection of the ani-
mals with a milder attack is diminished.

During the stage of incubation in the beginning of the affec-
tion, immune serum of high potency (see p. 317) may give
good service.

Pox Immunization (Ovinatio). As recovery from pox usu-
ally confers upon the animals an immunity for their entire
lives, the production of the disease in a mild form appears
advantageous in all cases in which it is feared that the sheep
will become severely affected from.natural infection (emer-
gency immunization). This danger exists especially when the
disease has already attacked some sheep in a flock, and if its
further spread is expected. The situation is similar when the
disease has appeared in nearby localities, and the local condi-
tions appear to be favorable for the transmission of the disease
to the healthy herds. Under such conditions it should be aimed
to assure as much as possible a mild course for the disease, and
at the same time to reduce its duration. The vaccination of the
herds exposed to the infection answers for both purposes. The
disease which develops subsequently usually takes a more favor-
able course than in the natural infection, provided that the
vaccination has been carried out properly and with good vac-
cine. If the entire flocks have been vaccinated the disease usu-
ally disappears within a few weeks. At the same time the
spread of the infection to non-vaccinated herds should be pre-
vented by quarantining all infected herds.

Vaccination of lambs at times when the disease does not
exist (protective or preventive vaccination) is not indicated.

This procedure is at the present time used extensively in countries
in which sheep pox is prevalent, and is in many places carried out
annually by the shepherds. It appears to have a very old origin, but
has attained a wider extension in Europe since Bourgelat in 1765 and
shortly afterwards Venel and Teisier, Hurtrel d’Arboval and others
subjected the method to scientific examination, and recommended it
as a suitable protective method. Jn the first half of the last century
farmers and shepherds applied the vaccination very generally, and,
the necessary vaccine was prepared for this purpose in specially estab-
lished institutes.

As a matter of fact the vaccination produces a lasting immunity
against subsequent natural infection. The vaccination is followed with
Pox Immunization. 315

few exceptions, by only a local and very mild pox eruption, and the
time for vaccination may be chosen according to convenience. The
unfavorable results which are observed in flocks suffering from natural
infection and the severe form which develops in unfavorable weather,
together with prolonged duration of the disease, may thereby be
eliminated. The vaccination of the animals therefore serves entirely
the purpose for which it is intended.

The vaccine is the original, not attenuated virus of pox, which
continues to propagate in this highly virulent condition in the inoculated.
animal. As a result of this, flocks which have not been vaccinated are
threatened to a great extent by the vaccinated animals, and particularly
so as the resulting infection usually appears generalized, and fre-
quently causes a malignant eruption of pox. If the vaccination were
carried out from year to year on all sheep of a country all subsequent
infection of the native animals could be excluded; since however vac-
cination is practiced only in certain localities, and there mostly in
single flocks, every vaccinated herd represents annually reproduced
artificial infection, from which the artificially propagated virus may
sometimes become disseminated and produce severe outbreaks of pox.

Considered from a general viewpoint the vaccination of lambs
is therefore positively harmful, especially as the location of the flocks
is but rarely changed, and they may be easily protected against the
infection by safer measures.

Observations on this point made in Germany afford convincing proof. Since
1875 the vaccination in Prussia has been dependent upon official permits. This
resulted immediately in a conspicuous reduction of pox, and consequently the
Imperial law on animal diseases in 1818 prohibited vaccination except in emergency
cases. The results came up to expectations, inasmuch as Germany has ‘been almost
entirely free from the disease since that time. Pox has appeared from time to
time, owing to importations from foreign countries, but in all instances the disease
has been controlled and limited to the primarily affected flocks. In Austria a
law was passed in 1880 by which the vaccination was permitted only with official
sanction, and this also resulted in a striking reduction of the disease. On the
other hand in France, Hungary, and in the eastern and southern European countries
where vaccination is still in vogue, considerable loss from pox results from year to
year among the sheep.

Téchnique of the Vaccination. The clear, yellowish, or yellowish-red, serous
contents of the ripe vesicle which is obtained from young vigorous sheep, in which
the eruption develops only in moderate extension and in association with only
slight febrile symptoms is used as vaccine. The vaccine should never be taken
from a purulent vesicle, and is still more dangerous if it originates from animals
in which the papules have coalesced, or in which the presence of hemorrhages
indicate a severe character of eruption. At the beginning of an outbreak it is
advisable to vaccinate only a few sheep from the first affected animals, and then
from these the lymph should be taken for the remaining part of the flock. In
such cases the lymph may be taken ten to twelve days after vaccination, otherwise
in from 5 to 7 days after the appearance of the eruptions. If however lymph
from the animals vaccinated the previous year is available it is best to use such
for the vaccination. 4

The contents of the ripe vesicle are collected in capillary tubes. The tubes
are previously heated, and one end of the tube is stuck into the vesicle. In an
emergency however the lymph may be collected from an open vesicle in glass bottles.
It is less advisable to utilize the scabs which develop at the place of the vesicles
for the vaccination. Vaccinations may also be carried out directly from animal to
animal by first inserting the vaccination instrument in the vesicle, and then im-
mediately into the skin of the animal to be vaccinated. Serous fluid obtained by
squeezing incised nodules may be also utilized for vaccine. 5 :

The most favorable place for vaccination is the under surface of the tail
which is free from wool, 5-10 em. from the rectum, or the inner surface of
the ear 3-4 em. below its point. Less suitable is the inside of the thigh, the scrotum
and the abdominal region. As instruments, the vaccinating lancet or still better
316 : Sheep Pox.

the vaccinating needle is used, which after the opening has been filled with lymph,
is stuck into the stretched skin in an oblique direction, in order that the vaccine
may enter the deep layers of the epithelium, and not under the skin; however the
skin may be also superficially scarified, and the vaccine rubbed into the scratched
area.

In susceptible animals a typical pox exanthema develops if the vaccination
has been carried out properly, usually a single vesicle develops at éach place of
pricking, others develop exceptionally in the surrounding parts, whereas a generalized
eruption of pox results only very exceptionally.

The vaccinated animals should be kept isolated during the entire duration
of the local affection from sheep suffering from natural infection, as well as from
those which have not been vaccinated. After a period of about a week the vaccinated
animals should be examined individually, and in those which have failed to take
the vaccination the operation should be repeated. If the vaccination is negative
this time, although good lymph has been used, the respective animals should
be considered as immune. Vaccination with contaminated material may of course
result in various wound infections (necrosis of the skin, purulent inflammation of
the connective tissue, pyemia, tetanus).

The vaccination of lambs is carried out in a similar manner, but usually with
lymph which was taken the previous year from vaccinated lambs, and kept in air
tight bottles in a cool room.

Production and Preservation of Pox Lymph. In the first half of the last
century special institutions were established for the production of pox lymph in
France, and also in other countries, where the lymph originating from natural
benign pox was propagated in more or less constant virulence by continuous trans-
mission from sheep to sheep, and was increased in accordance with the demand.
Vaccination with such lymph usually resulted in very mild, localized pox, but it
was repeatedly noted that the artificially kept vaccine was capable, without any
apparent cause, of producing a generalized eruption, although in the meantime it
had passed through 65, 98, and even 140 generations of sheep (Roll).

Recently Soulié produced a vaccine in large quantities in the Pasteur Institute
of Algeria, by injecting single drops of lymph in various places into the clipped skin
of the rump of healthy sheep. In 10 to 12 days he collects the contents of the ripe
vesicles and stores them in a diluted state (see below). Every sheep treated in this
manner produces 500 ec. of diluted lymph, which is sufficient for the vaccination
of 10,000 animals. This vaccine has been used exclusively in Algeria for several
years, and the results are uniformly satisfactory; the lymph proves effective in 80%
of the cases, and the losses amount to only 0.1-0.5%. The action of the lymph
however is not constant, as occasionally, especially in resistant breeds, the vaccina-
tion may be effective in only 20%, and even in only 8% of the cases (Martel).

Borrel strengthens the virus by injecting pox lymph and then salt solution
mixed with bread crumbs into the pleural cavity of sheep. As early as in 4 to 5 days
a considerable quantity of a virulent fluid may be obtained from the thorax.
Another method of Borrel consists in injecting subcutaneously in the abdominal
region a mixture of 10 ce. of pox lymph and 500 ec. of salt solution, of which
300-400 ec. is injected into the animal. The fluid, which should be rubbed over
as large a surface as possible, is usually absorbed by the third day, and from the
fourth day on a marked serous infiltration develops in the respective parts. On
the eighth day the animal is destroyed, and the fiuid which has collected under
the skin, together with the infiltrated tissue, is ground in salt solution; in this
manner about two liters of a liquid are obtained, of which 1/20,000 of a ce. is
effective.

Various methods are adopted for the preservation of the vaccine. The simplest
method consists in placing it in ‘capillary tubes, or in fine glass tubes, the center
of which has been blown into spindle shape. The ends of such tubes, after filling,
are closed by melting, or sealed with sealing wax. Tor the same purpose two plates
of glass of 4 centimeters square may be used; the surfaces facing each other are
painted with the vaccine and the borders are closed either with mastix or wax.
The lymph may be also preserved in clean bottles, which are closed air tight.
(According to Peuch old lymph which on cutaneous vaccination is ineffective may
produce typical pox if injected subcutaneously.) Soulié stores the lymph with
2-5 parts of a 3% boracie acid, or 2% salicylate of sodium, and immediately
before vaccination he dilutes it with 3 parts of its quantity, of boiled sterile water.
According to Bose sheep pox virus remains unattenuated for at least two years
in the intestinal canal of leeches, which have sucked themselves full on opened,
ripe pox postules.

/ Other Methods of Vaccination. In order to prevent a generalized eruption
of pox the attenuation of the virus was undertaken, but with unsatisfactory results.
Vaccination. Immunization. 317

Peuch diluted for this purpose the lymph obtained from the vesicles with 60-100-160
times its quantity of water, Nocard & Mollereau with water containing oxygen,
Semmer & Raupach by heating to 55°. After the inoculation of such vaccines no
eruptions resulted, nevertheless the respective sheep proved immune. Duclert kept
fluid lymph, Conte dried lymph, at a temperature of 25°, and both observed a
gradual attenuation of the virus. The vaccinations undertaken with such attenuated
virus, however in numerous cases failed to give positive results.

Supposing that the ovina becomes attenuated in virulence for sheep by passage
through goats Konew employs for the vaccination of sheep, edema fluid obtained
from goats (Kaprino) which have received serial subcutaneous vaccination with
ovina. Up to 1907, 91,735 sheep were vaccinated with such lymph in Russia with
uniformly satisfactory results, and Bridré also obtained the same good results
in an outbreak. Voigt also convinced himself that sheep caprinized with goat ovina
became immune, only he found that a necrosis of the point of vaccination developed
from the subcutaneous, as well as from the cutaneous injections.

Following the initiative of Sacco, sheep were vaccinated for a time with
cow pox lymph, but without results. At the same time it was learned that vaccina-
tion with cow pox lymph took only in few sheep (Pessina), and it was observed
that after such vaccinations a generalized pox eruption with considerable loss
occurred (Fiirstenberg, Gips).

Serum Immunization and Serum Therapy. Duclert (1896) found
that blood serum of sheep which have passed through an attack of
pox, and more so from those which were repeatedly treated with virulent
lymph, has a protective action for lambs against an energetic infection
of virulent lymph. Borrell (1902) inaugurated this procedure in
practice.

Sheep which have recovered from pox are injected subcutaneously every month
with 200-300 cc. of lymph prepared by his method (see p. 316). After 5-6 of
such injections the sheep produce a potent blood serum. If such serum is mixed
with lymph obtained from pox vesicles, and diluted with 53 parts of bouillon, a
cutaneous inoculation with such a mixture produces results according to the quantity
of the serum, smaller and smaller vesicles are developed as the amount of serum
is increased while a mixture of 1 cc. of diluted lymph with % ec. of blood serum
proved entirely ineffective. The cutaneous inoculation of 1 ce. of diluted lymph
produces a blister with a diameter of 6-7 cm., and subsequently a general pox
eruption. If on the other hand such sheep receive two days after the inoculation,
from 2-10 cc. of blood serum, the size of.the vesicles is diminished in accordance
with the serum used, and if 15-20 ce. of blood serum is injected, no eruption
whatever develops.

Immune serum has been used in practice in France with good
results, it is claimed, although mostly under very unfavorable condi-
tions. According to Martel’s view the serum inoculation checks the
disease in infected herds, and also prevents the eruption of pox in
already febrile (40 degrees) sheep. If the eruptions are already in
progress usually only a few small vesicles develop, and even if they do
become larger, recovery takes place within a short time. In some sheep
only small nodules which do not suppurate, develop under the skin. The
serum immunization is supposed to confer also an immunity on the
otherwise very susceptible lambs, which lasts for at least 40 days

(Borrel).

The dose of the blood serum is for the immunization proper 5 ee. for
therapeutical purposes at least 10 ec. In already infected animals the serum
affords only a protective or curative action in the incubative stage or, at best,
in the prodromal stage of the disease. : ;

The value of serum immunization cannot yet be definitely established. In
the fall of 1902, and in the spring of 1903, six herds were given the serum
treatment, in which previous to the treatment 10.3% of the animals died from
pox. Of 581 sheep and 352 lambs which were treated, 49 sheep and 24 lambs, that
ig in all 7.8% died, the loss fluctuating in the individual herds between 0.0 and
27.7%. In a herd, consisting of 500 sheep and 150 lambs, in which pox had
developed two weeks previously, the disease ceased immediately after the animals
had been injected subcutaneously with 5 ce. of serum. Conte treated 689 sheep
318 Sheep Pox.

and 63 lambs in 40 infected herds in the Department Herault, in the years 1903-1909;
of these 10 became infected subsequently, two of which died, whereas in 137
animals which were not given the treatment the mortality amounted to 38.7%.

Bose found that the serum, as well as the defibrinated blood of lambs severely
affected with pox (hyper-infected) possessed immunizing properties, inasmuch as
20 ee. injected into healthy lambs protected them against virulent infection. Lambs,
and also donkeys, which have been treated repeatedly with such serum and pox
lymph, produce a still more potent serum, which may confer total immunity, or
only prevent the generalized pox eruption.

Simultaneous Immunization (Séro-clavelisation). For producing
a lasting immunity Borrel recommends the simultaneous inoculation
with his immune serum (5-15 ec. injected subcutaneously in the rump)
and virulent lymph (0.05 cc. in the ear). ‘In Arles over 10,000 sheep
were treated by this method, and none of the animals became affected
with pox, and from subsequent complications only 0.2% died. Good
results were also obtained by this method by Bridré in Tunis, and by
Conte in France.

Poenaru vaccinated 262 sheep with threads saturated in a mixture of immune
serum and lymph, the thread was introduced under the skin, whereupon in 164
animals only a nodule developed at the point of inoculation, in 94 a small postule,
and in only one instance had several postules appeared.

Veterinary Police. Outside of the measures for compul-
sory reporting of the outbreaks, the quarantine of the premises
or townships, and the harmless disposition of the carcasses,
a compulsory immunization of the healthy animals in an affected
herd appears indicated. In case the disease is disseminated
more extensively, or if infection threatens, vaccination may
also be applied to the flocks that are in danger. The vaccination
may be omitted if the sheep which are not affected are slaugh-
tered within a short time. Vaccinated sheep should be subject
to the same police measures as animals affected with the natural
disease, and be quarantined for the duration of the affection.
The raising of the quarantine from infected premises should be
preceded by a period of observation of at least 45 days. The
pelts of sheep affected with pox may be considered non-infec-
tious after complete drying, the meat however, if its condition
permits its passing for food, is to be considered non-infectious
even in a fresh state.

Literature. Chauveau, J. vét., 1868, 548.—Gerlach, Ger. Tk., 1872, 65 (Lit.).—
Noeard, Ree. 1888, 272; Bull., 1898, 43 and 331; 1899, 263; 1900, 21.—Peuch,
C. R., 1888, CVIT, 425.—Soulié, Rev. vét., 1896, 421.—Borrel, Soe. biol., 1902, 59;
A. P., 1903, XVI, 123.—Bose, Cbl. f. Bakt., 1903, XXXIV, 413; Rev. gén., 1904,
IV, 273.—Poenaru, Arhiva vét., 1904, 339.—Joest, Z. f. Infkr., 1906, IT, 221 (Lit.

on the Jast pox invasion in Germany).—Borrel & Konew, Cbl. f. Bakt., 1907.—
Foth, Diss. Leipzig, 1907.—Conte, Rev. vét., 1910, 65.

(b) Cow Pox. Variola vaccina.

(Kuhpocken [German]; Vaccinia [French]; Vajulo- vaccino
[Italian].)

Occurrence. Cow pox, the relation of which with human
pox has already been recognized by Jenner (1796), occurs
usually only sporadically, or as an enzootic confined to indi-
vidual herds. In most cases it may be attributed to an infection
of true pox, or vaccination-pox of man.
Cow Pox. 319

In the affected herds a great number of the animals may become infected
within a short time. Thus Bartos observed among 210 cows 90 infected inside
of two weeks. In this instance the children of the owner had been vaccinated 6
days previous to the first case. The disease was observed in an epizootic outbreak
by Fréger in the Arrondissement de Bayeux, where the milkers disseminated the
disease from stable to stable. ;

According to Leese pox occurs in Pendschab among camels with such fre-
quency that most of the animals become affected in the first or second year of
their lives. As a result of this, older camels rarely become affected, but if so,
usually with generalized pox and pyemie manifestations.

Etiology. According to the investigations of Negri (1905),
which have since been confirmed by Remlinger & Osman Nouri,
Carini, Nicolle & Adil-Bey and others, the cow pox virus passes
through not too dense porcelain filters, therefore it apparently
belongs to the ultra-visible micro-organisms.

Negri filtered vaccine fluid collected: from young cows through
Berkefeld filter under 3 atmospheric pressures, and produced with the
filtrate, the characteristic vaccinia keratitis in rabbits, and true pox
postules on the udders of cows. The fact that filtrate from lymph which
has stood for some time is frequently more infective than similar sub-
stance from fresh material, is explained by Carini thus that the virus
is contained in cells, and is freed only after long maceration. (According
to Nicolle & Adil-Bey this may be hastened by pancreatic digestion).
Up to the present time only abortive pox could be produced with filtrates.

Préscher is said to have succeeded in cultivating the ultra-visible pox virus
on artificial media. On solid media prepared especially for this purpose, smeary
deposits develop by changes of the nutritive substrata, which do not contain
microscopically visible micro-organisms, but which yet produce pox postules in calves
up to the third or fourth passage.

Pathogenicity. Inoculation of cow pox lymph into the skin
of cattle results in a typical pox eruption, which is always con-
fined to the point of inoculation, or to the parts immediately
surrounding it. The eruption is associated with very slight
general disturbances. Young cattle are especially susceptible
to infection, which is favored by a previous injury of the epi-
thelium of the skin (shaving, ete.). Man, buffaloes, camels and
horses are. susceptible to a similar extent; hogs, sheep and dogs,
to a lesser degree, and in these animals cutaneous inocula-
tion results only in a local exanthema. The rabbit is very
susceptible, and according to Calmette & Guérin, the guinea pig
likewise.

Subcutaneous inoculation of the virus produces in cattle
an edematous infiltration, in horses in addition to this an erup-
tion of pox, while an intravenous infection causes only fever
without exanthema in these animals. Chauveau and Arloing
observed the development of a vesicular exanthema in young
horses following an intravenous infection.

The injection of lymph into the milk ducts of cows results
in 2 to 3 days in moderate fever, swelling and sensitiveness of
the udder, whereupon on the ninth day the secretion of the
udder becomes purulent and soon bloody. The secretion retains
320 Cow Pox.

its virulence even after 14 days. The symptoms are caused by
the development of vesicles on the walls of the milk ducts
(Liénaux & Hébrant).

The tenacity of the virus is apparently similar to that of the virus of sheep
pox. It resists drying for several weeks, but is destroyed at a temperature of
57.5° in five minutes (Power). On the other hand it is not destroyed by —180
degrees, and its virulence is not greatly influenced by the action of glycerin, as
when mixed with it and kept in a dark place the virus retains its virulence from
8 to 10 months.

Natural Infection. In healthy herds the infection usually
occurs through vaccinated persons. This has been proven by
the positive results of inoculation experiments and also by the
observations that the disease attacks quite frequently large
numbers of cows shortly after the vaccination of children. For
instance the disease is usually observed among cows in the
spring, at which time the vaccination of children is customary,
when the dissemination of the virus is given a very favorable
opportunity.

Infection usually takes place during milking, when the virus
is easily transmitted from the hands of the milkers to the
superficially injured skin of the udder.. The disease is also
frequently transmitted from animal to animal by the milkers
during milking, but contaminated straw, food and the stable
floor may play a part as intermediate carriers of the virus, and
this infrequent mode of infection has been observed in young
stock, steers and oxen. In all probability the infection is not
transmitted through the air.

True human pox may also in all probability be trans-
mitted to cattle, although the results of artificial inoculation
do not prove it (see p. 300). As a matter of fact in the
eighteenth century and at the beginning of the last century, at
which periods human pox still occurred’ frequently in an epi-
demic form, the disease was also observed with great frequency
among cows.

Symptoms. The disease usually commences after an incuba-
lion period of 4 to 7 days, with moderate febrile symptoms (rise
in temperature of 14-1 degree, diminished appetite, irregular
rumination, weakness, etc.). In many cases however these prod-
romal symptoms are so mild that they pass unnoticed. During
milking it is noted that the udder is sensitive, the milk is
thinner, of a lower specific gravity and coagulates more quickly.
On the slightly warm and swollen teats, as well as on adjoining
parts of the udder, hard nodules in size ranging from that of
a lentil to a pea appear on the second to third day, which change
inside of 1 to 2 days into bean-sized vesicles, filled with a clear,
transparent lymph. The vesicles are reddish or bluish, or
yellowish-white, of a mother-of-pearl or metallic luster, some-.
times lusterless, depending on the thickness of the skin, and on
its color. On the body of the udder the vesicles are uniformly

 

 
Symptoms. 391

round, on the teats they are oval in the direction of the long
axis of the teat, and they are surrounded by a red zone of
1 to 2mm. width. Toward the eighth to eleventh day they usu-
ally become ripe, and then they show in their center a well-
defined depression (‘‘Delle’’ navel), which however may some-
times be absent. Later the contents of the vesicles turn puru-
lent, and dry to scabs (Fig. 56). After the scabs drop off the
underlying skin is at first pale red and swollen, later however it
shows shallow, white, cicatricial depressions in the affected parts.

According to the severity of the case one, two or numerous,
but only exceptionally more than 15 to 20, vesicles develop. They
do not appear at the same time, but mostly at intervals of a
few days, thus between the appearance of the first and the last

   

Fig. 56. Cow pox on the udder. (After FREGER. )

vesicle 4 to 6 and sometimes even 14 days may elapse, as may
be seen by the varying stages of development of the vesicles.
Frequently the later vesicles are smaller than the early ones.

Outside influences, especially traumatic, have frequently an
unfavorable effect on the otherwise mild course of the disease.
During milking the vesicles may easily rupture before they
obtain their full ripeness. On such an exposed, readily bleed-
‘ing wound the scab formation cannot take place on account of
the repeated handling, and in the meantime the regeneration of
the epithelium does not take place in the usual way, but on
the contrary the inflammation of the surrounding connective
tissue is aggravated from the frequent irritation of the wound.

Vol. 1—21
322 . Cow Pox.

Occasionally infection of such wounds may lead to the develop-
ment of severe ulcerations, which considerably retard the heal-
ing process. Frequently 30 to 40 days may be required in such
cases for recovery. Exceptionally a parenchymatous mastitis
may be associated with the eruption of pox. As the milk is
mixed with the secretion of the wounds it of course becomes
contaminated.

In rare cases eruptions resembling those which occur on
the udder of cows may develop on the scrotum of male animals.

A generalized pox eruption occurs only very rarely (Dupuis
observed it in two cases, Strebel in one instance). In such
eases the eruptions, which may reach the size of hazelnuts,
appear, associated with febrile symptoms, on the udder, also
on the inner surface of the thigh, on the croup, rump, chest,
neck and in the muzzle. (In Strebel’s case paralysis of the
stomach and intestines was observed in the later course of the
disease, and after a temporary improvement of 8 to 10 days, a
fatal peritonitis developed.)

Diagnosis. The diagnosis of cow pox is based.on the pres-
ence of roundish or oval vesicles containing a depression in the
eenter. In some cases the spreading of the eruption to other
animals and a similar exanthema on the hands of the attendants
handling the affected animals, may reveal the nature of the
affection. The injuries and irritations which are usually caused
by the milking, may sometimes interfere with the establishment
of a diagnosis.

It is possible to mistake the exanthema for that of foot-
and-mouth disease, but in this the vesicles do not develop from
nodules, they are larger and less uniform in appearance, and
similar vesicles are present in the mouth and in the interdigital
spaces of the affected animals in the stable. The benign, coital
vesicular-exanthema is readily recognized by the simultaneous
affection of the genital organs. Pustules may sometimes also
develop on the udder in rinderpest, but these findings are unim-
portant as compared with the other general and local manifes-
tations of the disease.

The nature of the eruptions, which have been described by Ger-
man authors as ‘‘wind and stone pox,’’ is as yet doubtful, nevertheless
the possibility does not appear to be excluded that they represent
abortive forms of true cow pox. According to description they form
hard nodules which develop on the lower part of the udder and on the
teats, and change into purulent vesicles. Jn doubtful cases the inocu-
lation of a ealf would readily reveal the nature of the affection in a
short time.

Ehrhardt described under the name of false cow pox (pointed pox,
‘varicellae) a stable disease of cows, in the course of which desquama-
tion of epithelium from the teats occurs, causing severe inflammation.
In one ease the milker also became affected, his hand was greatly swollen,
and numerous vesicles up to the size of a pea appeared on his skin,
causing considerable pain.

‘pf OER os

 
Diagnosis. Treatment. 323

In human medicine the term ‘‘varicellen’’ (sheep pox, water pox,
wind pox), designates an acute exanthema of children, in which in
the course of only a few hours small vesicles develop on the skin, and
sometimes also on the mucous membrane, which however soon dry into
scabs. This condition is associated with mild general disturbances.
Recovery from this disease does not produce immunity against the true
pox, and therefore the affections are considered etiologically different.

Treatment. Besides keeping the affected udder clean and
dry, it is advisable to milk the animals daily with great care,
or to draw the milk with the aid of milk catheters. If ulcera-
tions have appeared at the place of the vesicles they may be
treated with neutral fats, with zine or lead ointment. If milk-

ing has been discontinued, uneventful recovery takes place
within 10 to 15 days.

Immunization. Fréger vaccinated all cows of an infected herd
with calf lymph used for man. The vaccination was carried out on
the perineum by superficially scarifying the skin. Nodules developed
upon the already affected cows, while on the healthy animals typical
pox postules appeared, and these animals did not contract the infection.
The same procedure was also employed with good results by Krause
in a large herd, in which the affection existed for 114 years; newly
introduced animals which previous to the vaccination had usually
become affected within 3 to 4 weeks, failed to develop. the disease after
the inauguration of this method. 3

Literature. Jenner, Inqu. of the causes and effects of Variolae-Vaccinae.
London. 1798.—Bollinger, Volkmann’s Samm]. Klin. Vortr., 1877, Nr. 110 (Lit.).—
Ehrhardt, Schw. A., 1896, 81.—Strebel, Schw. A., 1898, XL, 113.—Negri, Esper.
sulla filtr. del virus vacc. Pavia, 1905.—Préscher, Chl. f. Bakt., 1906, XL, 337.—
Carini, Cb]. f. Bakt., 1906, XLII, 325.—Nicolle & Adil-Bey, C. R., 1906, CXLIT,
1196.—Fréger, J. vét., 1906, 385.—Leese, Trop. Vet., 1909, I, 1.

Pox Vaccination of Man. The discovery of the English physician
Edward Jenner (1796) established the fact that the inoculation of cow
pox lymph in man produces at the point of inoculation a mild pox erup-
tion, the recovery from this producing in the vaccinated person a last- .
ing immunity against true pox. This method caused the abandoning
of the older procedure, in which the lymph of man affected with pox
was used for pox vaccination, and as a result of which the vaccinated
persons not infrequently became severely affected with generalized pox.
Jenner used at first exclusively original animal lymph, but as it was
later observed that this virus could be transmitted from man to man,
in which case its character does not change, the vaccination with such
humanized vaccine, that is, with the contents of vesicles. from man
vaccinated with original cow pox lymph, has latterly attained con-
tinuously increasing use.

In the meantime various disadvantages have been observed in this
procedure. In order to practice this vaccination, a vaccinated person
in the proper stage of the disease must be available, which is often very
difficult. This condition cannot be remedied by conserving the lymph
obtained from vaccinated persons, as in this manner only small quan-
tities of lymph may be collected. A still greater disadvantage lies in
324 Horse Pox.

the proven fact that occasionally diseases of persons producing the
lymph (syphilis, tuberculosis) are transmitted by the vaccination to
the persons being vaccinated.

On account of this danger, bovine lymph is used exclusively in
recent times for vaccination. The vaccinating lymph is cultivated arti-
ficially in state or private establishments erected for the purpose. The
lymph is constantly re-inoculated from calf to calf, and then preserved
by a special method. For the original vaccine either original cow pox
lymph, or lymph of a calf vaccinated with humanized vaccine is used.
By employing calf lymph the danger of transmitting other diseases
may be excluded with certainty, by using young calves exclusively for
cultivation, and by placing the collected lymph on the market only after
the health of the vaccinated animals has been proven by an autopsy.

At the present time the great practical value of pox vaccination
is recognized to such an extent that in most countries compulsory vac-
cination is established by law, in spite of the fact that here and there
opposition is made against it.

For the cultivation of the vaccine, weaned, healthy calves, preferably male
animals, are commonly used. These should previously be tested by tuberculin for
the presence of tuberculosis. The animal is secured lying on the side upon a
suitable table, the abdomen from the navel to. the pubic-symphysis, or one-half
of the thorax, is shaved and thoroughly cleaned. Then the lymph from a ripe
vesicle of another calf, or of a vaccinated person, is inoculated into the skin of
the calf. The procedure is carried out by puncturing the skin in 100-200 points
into the deeper epithelial layers, or in such a manner that upon the surface of the
skin superficial incisions 1-2 em. long are made, and the lymph is then rubbed into
the wounds. In from 4 to 5 days bluish nodules and vesicles on a bright reddened
base develop at the point of vaccination, from which the lymph is pressed out
with suitable clamp forceps, and preserved either as pure lymph, or together with
epithelium, that is scraped off, mixed with equal parts of glycerin.

The lymph is preserved in glass tubes, or painted in thin layers on ivory
plates 5 cm. long and*7 mm. wide, the scraped fluid is enclosed between two small .
glass plates and sealed with paraffin. As in the lymph prepared in this manner
bacteria are destroyed within a few weeks without affecting the potency of the
lymph, only vaccine which is from 2 to 3 months old is used for human vaccination.

Literature. S. Huguenin, Ergebn. d. allg. Path., 1897, IV, 246.

(c) Horse Pox. Variola equina.

(Sore heels; Pferdepocken [German]; Variole équine [French];
Vajuolo equino [Italian].)

Occurrence. Horse pox which was extensively studied by.
Jenner, supposedly existed more frequently 3 or 4 decades ago,
and at that time periodically attained an epizootic - extension
among horses. The descriptions however do not reveal a suf-
ficiently clear conception regarding the true nature of the affec-
tion observed, as English and French authors (among them
Bouley and Lafosse, also Nocard & Leclainche) understood
under the name of ‘‘horse pox’’ that disease which since the
studies of Eggeling and Ellenberger (1878) is otherwise known
as contagious pustular stomatitis, and considered as an inde-
pendent affection (see p. 360). Jenner’s horse pox is at
the present time so rare that some authors, among them Dieck-
erhoff, doubt its occurrence entirely,
Etiology. Symptoms. 325

Etiology. Jenner searched for the source of cow pox in
horse pox, and did so in that form of the disease which is mani-
fested as a vesicular eruption in the posterior part of the pas-
tern. Later, as has been mentioned, the disease was identified
with pustular stomatitis or dermatitis, and therefore the infec-
tion experiments supposedly carried out with horse pox virus
must be regarded as indecisive.

Loy transmitted horse pox successfully to man in seven cases, and Hertwig,
also Pingaud observed the natural transmission of horse pox to man. Recently
Cameron (1908) reported a case in which on the arm of a driver who treated a
horse affected with pustular stomatitis, a pox eruption developed. Chauveau, on
the other hand, produced general pox eruptions in older horses, by injections of
vaccine into the lymph vessels, and in young animals with an injection into the
blood circulation (large vesicles developed especially on the nostrils, lips and on

the rump; they first appeared eight days after the infection). Similar results
were obtained in transmission experiments by Warlemont and Pfeiffer.

Symptoms. At the present time the vesico-pustular exan-
thema, in the flexor region of the pastern of young animals, is
considered as horse pox, in which it is supposed that the disease
is transmitted to the skin of the pastern principally during
shoeing by the hands of the blacksmiths and drivers (Fried-
berger & Frohner). The sensitiveness of the pastern, and the
functional disturbance of the extremities produced by this,
sometimes also a febrile elevation of the body temperature,
indicate the development of the affection. The skin on the pos-
terior surface of the pastern is swollen and reddened, soon
vesicles develop to the size of a lentil, which burst shortly after,
whereupon scabs develop on the reddened, moist epidermis,
under which new epithelium forms. In rare cases the eruption
develops also on other parts of the body, as on the head, espe-
cially around the opening of the mouth and nostrils, exception-
ally-also on the mucous membrane (Berger observed the appear-
ance of pox in 15 horses on the conjunctiva).

Diagnosis. A disease which is manifested with the above
symptoms could be considered as pox and differentiated from
the common exanthema of the pastern only when typical pox
vesicles develop on the affected part of the skin, or when the
inoculation of the contents of the vesicles produces a typical
eruption of pox on the skin of cattle. From the standpoint of
differential diagnosis the contagious pustular dermatitis, coital
exanthema, and the contagious pustular stomatitis come into
consideration.

Literature. Jenner, s. p. 318.—Bouley, Dict. de méd. vét., 1871, IX, 451.—
Chauveau, Rec., 1866, 305 u. 625.—Hertwig, Chirurgie, 1874, 182 (Lit.).—Dieckerhoff,

Spez. Path., 1892, I, 999.—Nocard & Leclainche, Maladies microb. des animaux,
1903, I, 598.—Cameron, Brit. med. J., 1908, I, 1292. ~

(d) Swine Pox. Variola suilla,

Occurrence. Swine pox represents a very rare disease. In
some years it appears to occur in certain parts of Southern
Hungary with considerable frequency (in 1907 it existed in
326 Swine Pox.

seven counties of that territory), and recently it was also re-
ported from Roumania (Poenaru).

Etiology. The susceptibility of hogs for the pox virus was
established experimentally a long time ago. Chauveau suc-
ceeded in several cases in transmitting cow pox to hogs, Ger-
lach swine pox to goats, Koch the same to calves. Szant6 placed
two pigs affected in the pustular stage of the disease among
7 to 8 weeks old, healthy pigs, whereupon six developed typical
pox after an incubation of four days, and the disease was fur-
ther transmitted to healthy pigs by cutaneous inoculation. An
inoculation of lambs always resulted in a local, flat swelling, as
well as an acute conjunctivitis and nasal catarrh. Poenaru also
succeeded in producing the disease in pigs with blood and with
contents of pustules, in one instance in the generalized form
with a fatal termination.

Originally the disease develops in pigs through infection
from cattle, from man and probably also with material origi-
nating from goats. In the infected piggeries the disease may
easily spread to a great extent, and may also be disseminated
to other herds.

Szant6 observed 64 out of 74 pigs affected with the disease, of which 3
succumbed, while Lévy recorded a Joss of 18% in a herd of 155 pigs. Laquerriére
observed swine pox as a severe plague with usually a fatal termination as early as
in 1864 in Algeria. Old hogs became severely affected in this outbreak.

Symptoms. According to the descriptions (Spinoia, Szantd)
the disease as a rule affects young pigs, and is usually mani-
fested in an exanthema affecting a large part of the body. Sev-
eral days after infection the animals show symptoms of a gen-
eral disturbance, such as fever (41.5-41.8° C.), weakness,
loss of appetite, sluggish movement, stiff gait, straightened
tail, chills, bristles standing up and greasy, on account of the
marked evaporation from the skin. In the early stages ca-
tarrhal symptoms, especially conjunctivitis, are often observed.
Soon small red spots appear in places only slightly or not at
all covered by bristles, as on the snout, eyelids and inner sur-
face of the thighs, the abdomen, less frequently on the neck and
on the back. These grow rapidly to sizes like a ten cent piece,
in the center of which hard nodules develop. After 2 to 3 days
pea-sized vesicles develop, which at first contain pure lymph,
later pus. They dry to dark brown scabs, and fall off after
several days. The number of vesicles varies greatly, and the
intensity of the prodromal symptoms, also the course of the
disease is not uniform. In severe cases the vesicles coalesce,
their contents become bloody, eruptions appearing also on the
mucous membrane of the mouth, pharynx, in the trachea and in
the bronchi. In the meantime diarrhea sets in, whereupon the
disease terminates in death from exhaustion, broncho-pneu-
monia, or from a general infection. (Lévy also found on the
Goat Pox. 327
mucous membrane of the stomach, flat ulcers surrounded by
a red zone, we have also observed such lesions with pale yellow
elevated borders, and a dark, yellowish-red, granular base.)

Diagnosis. Before establishing a diagnosis, the various
forms of eczema, granular eruptions, and erysipelas-urticaria
should first of all be excluded. If necessary it could also be
established by artificial inoculation of the contents of vesicles
upon healthy animals.

Immunization. In emergency this could be undertaken in
a similar way, and probably with the same results as in vac-
cination of sheep for the protection of the animals which are
not yet affected. °

Literature. Spinola, Krankheiten d. Schweine, 1892, 204——Koch, 0, M.,

1887, 57.—Szanté, A. L., 1906, 541—Poenaru, Arh. vet., 1907, 67.—Livy, A. L.,
1908, 103,

(e) Goat Pox. Variola caprina.

Occurrence. Goat pox has been observed principally in
Norway, where it occurs with relative frequency in certain
localities (Boeck, Hansen); it was also established in Italy,
Spain, France, Germany and Algeria, where the disease runs
sometimes a very unfavorable course.

Etiology. The virus of goat pox may be transmitted to
goats with the contents of the pox eruptions, and also with the
saliva of the affected animals if the vesicles have appeared in
the mouth. Cutaneous inoculation results in the development
of a local pox eruption at. the point of inoculation, associated
with very mild, general symptoms. In some cases the trans-
mission to sheep was also successful, however it only produced
an incomplete pox exanthema at the point of inoculation (Bon-
vicini, Marcone). Man is not entirely without susceptibility,
as occasionally persons working around affected goats develop
an exanthema with small vesicles on the hands and arms (Han-
sen, Marcone). ‘

Goats are sometimes infected by sheep affected with pox, whereupon
they become affected either with mild or severe symptoms. — A subeu-
taneous inoculation of sheep pox virus, when the transmission 1s suc-
cessful, results in fever after the third day. On the seventh to eighth
day a papular eruption appears, and if the animals die nodules are
found in the lungs and in the liver. There is also a swelling of the
intestinal follicles, and of the mesentery lymph glands (Voigt). Sub-
sequent inoculation of the fluid from the lesions at the place of injection
into goats is supposed, according to Konew, to increase the virulence
of the virus for goats, while for sheep it becomes attenuated (see p.
306). Voigt, on the other hand, found that it later possesses a lesser
virulence, even for goats.

Natural infection results from direct contact, and in this
manner the disease spreads rapidly in goat herds, so that as
328 Goat Pox.

a rule almost every animal becomes affected (sheep kept to-
gether with goats usually escape the infection, or become only
very slightly ill, Garbuti & Reali). The disease shows no ten-
dency to spread over large territories, but is mostly confined
to single flocks.

Symptoms. The clinical appearance closely resembles that
of sheep pox. In association with moderate, febrile and ca-
tarrhal symptoms, various sized partly coalescent vesicles, con-
taining a depression on top, develop on various parts of the
body, especially however on the udder, on the inner surface
of the extremities, on the face, in the parts surrounding the
lips and eyes. They form scabs in the usual manner, and heal
with radiating scars. In some cases abscesses develop in the
tissue of the udder, when the milk may become bloody. In some
animals, especially in kids, pox also develop in the mouth and
on the mucous membrane of the upper air passages, their ap-
pearance being manifested by cough, accelerated respiration,
and purulent nasal discharge.

The course of the disease is usually favorable; although the
skin may become gangrenous at the places where the vesicles
coalesced, the recovery is however only retarded thereby, not
prevented. Cases in which the disease develops with severe
symptoms from the onset, and in which a general infection
causes death, are very rare (such severe outbreaks were ob-
served in Algeria).

Diagnosis. The disease can only be confused with foot-
and-mouth disease, as the pox vesicles in goats may sometimes
attain a size up to that of a hazelnut (Conte); the character-
istic appearance of the pox exanthema, and the absence of
lesions on the feet, together with the non-transmissibility of the
disease to other cloven-footed animals, will prevent errors in
diagnosis.

Treatment and Prevention. The indications which hold for
the treatment and prevention of sheep pox apply also to this
disease. ‘

Literature. Hertwig, Mag., 1840, 339.—Boeck, D. Z. f. Tm., 1879, IX, 298.—
Hansen, Ref. Rep., 1890, 135.—Bonvicini, Il nuovo Ercolani, 1898, 216.—Marcone,

La Rif. vet., 1900, 387.—Garbuti & Reali, Clin. vet., 1905, 234.—Voigt, A. f. Tk.,
1909, XXXV, 204,

2. Foot-and-Mouth Disease. Aphthae epizooticae.

(Maul- und Klauenseuche [German]; Fiévre aphtheuse, Cocotte
[French]; Febbre aftosa [Itahian].)

Foot-and-mouth disease is an acute, febrile, contagious,
infectious disease of cloven-footed animals, in the course of
which a vesicular exanthema develops on the mucous mem-
branes, and the skin, especially in the mouth and interdigital
spaces. The causative factor is an ultra-microscopical micro-
organism.
Foot-and-Mouth Disease: 329

History. The cause of the disease was attributed previous to the
middle of last century, to various atmospheric influences, as well as to
spoiled food, although Sagar recognized its contagious nature during
his observations in Norway in 1764. In the second half of the last
century, especially since Bollinger reached his definite conclusions, it
has been generally recognized that the disease develops exclusively as
the result of a specific infection, but its causative agent is even at the
present time not clearly established. While various authors described
certain bacteria, or protozoa, as the cause of the disease (Siegel, Schot-
telius, Kurth, Behla and others), Léffler & Frosch (1897-1900) and
Hecker (1899) showed that the virus passes the ordinary porcelain
filter, and the first authors, with Nocard, and recently also Poels, con-
tributed valuable information relative to the eradication of the disease
with serum inoculations.

Occurrence. From time to time foot-and-mouth disease
spreads rapidly over extensive territories, as a severe disease,
affecting principally cattle, in a lesser degree hogs and sheep.
Its spread was especially rapid in former times, when, spreading
from the east westward it swept unchecked during a period of 2
to 4 years, passing over the entire European continent, where-
upon a period of freedom from the disease followed its disap-
pearance which lasted for several years. In recent times the
disease usually spreads more slowly, since its dissemination is
more or less controlled by veterinary police measures. In the
course of the various historical outbreaks, recurrences were
repeatedly observed, but uniformity between the appearance
of outbreaks, and the periods of freedom from the disease is
not very regular. Formerly almost all the susceptible animals
of large territories became affected within a short time by thé
rapidly spreading disease, and therefore the disease disap-
peared of itself, when there were no longer any susceptible ani-
mals left, while in recent times the growing young stock con-
tinually affords suitable material for the perpetuation of the
virus, so that infective herds remain, even after the apparent
disappearance of the disease, from which in a short time new
outbreaks may develop.

The disease spreads with particular rapidity during warm
weather, while in the winter it does not occur so extensively.
With the appearance of warm weather, however, it frequently
gains a wide prevalence, as a result of the greater traffic in
cattle.

The economic importance of foot-and-mouth disease lies
in the severe losses, which the owners sustain from the long
period of inactivity of the affected animals, from the loss in
body weight, and from the diminished milk production, also
by the considerable limitation of the traffic in cattle, and through
the loss of calves and young stock, sometimes also of mature
cattle. These losses caused the inauguration of measures for
the eradication of the disease by the government, and the efforts
thus made. have in recent times brought gratifying results in
many places.
330 Foot-and-Mouth Disease.

The last great epizootic in Europe occurred in 1887, its starting
point being Russia. The disease invaded all the countries of the conti-
nent, and raging with varying intensity has not been eradicated even
up to the present time.

In Germany the disease commenced to spread rapidly in 1888, and in 1892
it reached its height (number of animals in the newly infected premises: 1,504,299
cattle, 2,193,187 sheep, 17,782 goats and 438,262 hogs); from that time on it
diminished, but in 1899 it again reached a wide extension (1,885,774 cattle, 1,505,830
sheep, 59,535 goats and 814,862 hogs); since then the disease has rapidly retro-
gressed, so that in November, 1905, the entire Empire was free from the infection.
However at-the-end of this month it appeared in isolated herds in western Prussia,
from which it spread to the abattoir of Berlin, and thence to the Province of
Saxony. At the end of the year 1906, 55 townships were infected. In the following
three years it again reached a great extension, first by an introduction from France
to southern Germany, later occurring also in the other states, and in the year
1908, 324 townships, 18,773 cattle, 19,450 sheep, 179 goats, and 16,081 hogs
were affected. In May, 1909, the disease was entirely suppressed, and only one
outbreak was afterward established in December at Mittlefranken.

In France the disease raged severely in 1893. Soon it spread rapidly, and
reached its height in the years 1899 and 1900, and from 1901 it gradually retro-
gressed, again gaining a great extension in 1906. In 1907 it retrogressed, and
at the end of 1908 only two premises in two townships were affected.

Great Britain was free from the disease between 1895 and 1899. Since 1900
however, several townships have been infected annually, in spite of the fact that the
importation of living cloven-footed animals from the continent has been prohibited
since that year. In each instance, the outbreaks were localized by slaughtering
the affected herds. In the years between 1903-1908 the entire territory of the
Kingdom was free from the disease, with the exception of an outbreak in the
vicinity of Ipswich in January, 1906, and another in Edinburgh in 1908... _

Holland was very severely infected in the years of 1897-1899 (868,206 and
122,867 cases of infections). Since that time however the disease has rapidly
diminished. In 1907 it gained again a greater extension (17,816 outbreaks with
341,287 cases in 11 provinces). Since the second half of 1908 only isolated cases
have occurred.

In Austria the infection was very widely spread in 1891 (247,946 cattle,
32,423 sheep, 5,013 goats, and 18,741 hogs were affected). It diminished rapidly
until 1894 (7,462 cattle, 617 sheep, 45 goats, 1,379 hogs). From that time on a
rapid extension up to 1896 took place (305,934 cattle, 11,422 sheep, 1,032 goats,
and 18,816 hogs), whereupon an improvement was noted, and the Empire was
considered entirely free in 1901. Since that time it spread again, and in the
years from 1904 to 1906 was widely spread, especially in Poland and Bohemia. In
the subsequent two years it raged with varying, but mostly with mild intensity,
and toward the end of the year only 12 premises in seven townships were infected.

In Hungary the disease which had been introduced in 1889 from the southeast,
reached its height in the subsequent year (561,950 cattle, 337,566 sheep and goats,
and 370,425 hogs); later it showed a diminution up to 1894, but in 1896 it again
attained wide extension (572,809- cattle, 178,612 sheep and goats, 82,931 hogs).
In 1901 the entire Kingdom was free for six months; in the fall of this year the
disease reappeared as the result of an introduction from Roumania, and since
that time has again attained wide extension. In 1903, in 2,516 townships, 434,221
cattle, 30,533 sheep and goats, and 10,951 hogs, were affected. From that time
on the condition improved, in 1907 however, in the northwestern part of Hungary,
on the Polish border a badly infected locality was discovered which radiated all
through the country, and in 1908, in 108 townships, 16,988 cattle, 491 sheep and
goats, and 48 hogs were still affected.

Roumania was severely affected in 1907 (677,465 cases of infection). Since
that time the disease has diminished (in 1908 11,038 cases). In Russia in 1907,
596,977 cases occurred in 6,320 townships; in 1908, in 3,274 townships, 292,302
cases. The disease also occurred in 1908 in Belgium, in 11 townships, with 147
cases; in Italy, in 47 provinces, With 138,887 cases; in Switzerland, in 96 townships,
with 13,555 cases (in 1909 the disease attained in the latter country a great
extension), while in Bulgaria 61 townships were affected; Denmark, Norway, Sweden
and Servia were free from the infection.

Since the outbreak of 1870 in the United States, only a few limited outbreaks
have occurred. In the fall of 1902 the disease appeared in the States of Massa-
chusetts, Vermont, New Hampshire and Rhode Island, but was eradicated in a few
months by energetic measures (see veterinary police). In the fall of 1908 the
Occurrence. Etiology. 331

disease reappeared in the States of New York, Pennsylvania, Michigan and Mary:
land. (See p. 353.)

Argentina was severely affected in 1900.

In Asia and Africa the disease prevails from time to time over large areas,
while Australia is free from the infection.

At certain times, and in certain localities the disease shows a deviation from
the normal course, by exhibiting a very severe character, and in such instances
many animals are destroyed by it. Thus according to Rychener 2,000 cattle died
in 1839, in the Swiss Kantons Bern and Freiburg, while in 1872 in the District
of Niévre in France 20.3% of calves and 22.2% of hogs succumbed to the disease
inside of two months. During the summer of 1892 more than 3,000 animals died
in Bavaria; in the course of 1896, 1,500 in Wirttemberg, two years later 1,300.
In 1901 the disease appeared in Spain with such a malignant character, that in
Barcelona 50-70% of the young stock succumbed, and these heavy losses caused
a suspicion that the disease in question was the oriental rinderpest. In Hungary
the disease raged in a severe form in 1899 in certain parts of the counties of Gomor
‘and Pest, in 1899 in Siebenbiirgen (in the counties of Csik, Maros-Torda and
Udvarhely of 7,498 cattle, 711 died, amounting to 9.4%).

Etiology. Loffler & Frosch, also Hecker, and later Nocard
& Roux proved that the virus of foot-and-mouth disease in dilu-
tion will pass the porous (Chamberland, Berkefeld) porcelain
filters, while it is partially retained by the denser Kitasato
filter. It has not yet been possible to demonstrate the organisms
either by methods of staining or cultivation. The virus is there-
fore an extremely minute, ultra-microscopic micro-organism.

Recently Ferni claimed that the causative agent is a protozoon 0.5 yw in size
(Cytoryctes Jenneri), which he succeeded in demonstrating in the lymph of the
cysts, and also in the internal organs of 472 affected cattle, arranged like the
pavement of a street, or radiating like the spokes of a wheel. A confirmation of
this finding has not yet been made. :

The virus is contained in the purest state in the contents
of the vesicles which develop in the course of the disease, and
greatly diluted also in the blood though only during the begin-
ning of the fever. The saliva, the tears, the nasal discharge, the
milk, and the other secretions become infectious only after being
contaminated with the contents of the ruptured vesicles. In
the later course of the disease the virulence of the serous fluid
of the vesicles diminishes, and after ten days the saliva of
infected cattle is no longer infectious for other animals (Schiitz).

Tenacity. Virus dried at room temperature and in daylight, loses its virulence
inside of 24 hours, diluted in proportion of 1:10 and kept in. glass tubes closed
at both ends by melting, it remains infective for 3 to 4 months. A temperature of
37.5 degrees destroys it in 12 to 24 hours, one of 50 degrees in 15 minutes, and
70 degrees in 10 minutes. Heating to 100 degrees destroys its virulence immediately
(Léffer & Frosch). The action of a temperature of —8-9 degrees destroys’ it in
several hours (Perroncito). Of the disinfectants, milk of lime, a 1% carbolic acid,
2% formaline 3% soda, and 1% hydrochloric acid destroy its virulence in one

: hour (Léffier & Frosch). Infectious milk which has stood for 3 to 4 days, becoming
soured and coagulated, is no longer infectious (Ebertz). In fresh. cow and hog
manure the virus is destroyed at a depth of more than 20 em. within a short
time (Hecker).

Pathogenicity. Intravenous injection of fresh pure lymph
will sometimes, even in a quantity of 1/5000 cc., produce the
disease in susceptible cattle. Depending upon the quantity
and the virulence of the virus, typical vesicles develop in from
332 Foot-and-Mouth Disease.

1 to 3 days after the injection, in the mouth, in cows also on
the udder, and 1 to 2 days later also on the feet, these eruptions
being associated with febrile manifestations. Infection may
also result from rubbing the lymph upon the superficially scari-
fied mucous membrane of the mouth, by dropping the virus on
the conjunctiva, the rectum or the vaginal mucous membrane,
and further by intra-muscular, intra-peritoneal injections, like-
wise by inoculation of the milk ducts. Placing woolen threads
dipped in lymph, between the teeth, and sometimes also feeding
gelatin capsules filled with virulent lymph, may give positive
results, while a subcutaneous infection is uncertain. Should
virulent lymph be injected into the milk cistern of a fresh milk-
ing cow, local inflammation of the milk ducts develops, and the
milk proves virulent for a period of eight days (Nocard). The
most effective is the lymph of infected hogs, then that of cattle,
while the least efficient is that from sheep. The artificial infec-
tion of goats and sheep is in general quite difficult. Young dogs
and cats are very susceptible to artificial infection (the vesicles
develop in these animals between the digits), exceptionally
guinea pigs-and rabbits may also become affected (Hecker),
while mice and fowl, as well as older, carnivorous animals, are
resistant to inoculation. Young pigs die after several days from
paralysis of the heart after an inoculation of 1/10 to 1/50 ee.
of fresh lymph. The autopsy in such cases reveals a great
amount of serous fluid in the pericardium, which contains the
virus in pure culture (Loffler, Nocard).

Natural infection often occurs directly, healthy animals
coming in contact with affected cases, in the stable, pasture, or
yards, by means of which they receive the virus upon their
mucous membranes. Infection with inhaled air has not yet been
proven, and could only occur within very short distance, in damp
weather, or in the stable.

Indirect transmission has a far greater importance in the
spread of this disease. The saliva, which flows from the mouths
of affected animals, and also the contents of the udder or the
vesicles which develop on the feet, contaminate the food, the
cribs, the drinking water, the straw, the stable floor, the pas-
ture, the highways, the railroad cars, etc., as well as the hands
and the clothes of the attendants. From such contaminations,
or from the floor, the virus reaches the mucous membrane of
any body opening, or with the food or drinking water it enters
the mouth and stomach of the healthy animal, from which points
it enters the blood circulation. The virus is accordingly dissem-
inated in the first place by affected animals during driving, rail-
road transportation, stabling, by common drinking places, com-
mon pastures, and yards. In the second place food, manure, and
raw animal products, especially raw hides, wool and milk may
be considered as carriers of the infection. Butchers, dealers,
peddlers, castrators, and other persons, first of all farm hands,

 
Natural Infection. 333

and also animals which are not susceptible, coming from in-
fected premises, may contribute to the transmission of the infec-
tion. Stock markets play an especially important part, through
trading, further also changes in farm hands.

The obscure ways by which the disease sometimes spreads are especially well
illustrated in the periodical appearance of the affection in England. Although
the importation of cloven-footed animals from the continent into that country has
been entirely prohibited since 1892, and from other parts of the world, permission
was granted only after the lapse of the period of incubation, yet since 1900 the
disease has appeared in several different places (for the outbreak in 1908 it is
assumed that it was introduced with hay from Holland). The last outbreak in the
United States originated from several calves which were inoculated with pox lymph
imported from Japan, and Mohler & Rosenau proved by experiments that this
lymph contained the virus of foot-and-mouth disease even after one year.

Whether the disease can be disseminated by blood sucking insects, especially
by the tabanus bovinus, as suggested by Roch Marra after making several experi-
ments, must at the present time be questioned.

In recent times where isolated outbreaks occur more
frequently in territories which have been free from the infec-
tion for a time, and in which careful observations have been
made, the possibility enters more and more into the foreground
that animals which pass through the disease may harbor the
virus in their bodies for a long time, and expel it periodically
or continually (so called virus carriers). This may explain
why it is that animals occasionally become affected when placed
in herds in which the animals have apparently entirely recov-
ered from the disease, or that the disease breaks out on the
premises where such animals are introduced (Pr. Vb., Barto-
lucci, Loffler, Lourens). Although an introduction by other
means cannot be excluded with certainty in such cases, and the
presence of the virus in recovered animals has not yet been
established experimentally, nevertheless the possibility cannot
be ignored that virus carriers have been recognized beyond a
doubt for other diseases (typhoid fever, Asiatic cholera, hog
erysipelas, tetanus). Therefore in ascertaining the cause of
new outbreaks this contingency should be given due considera-
tion.

According to Barsolucci cattle are infectious two months, and according to
Léffler even six (?) months after the disappearance of the vesicles, and in accord-
ance with the Pr. Vb. for 1907 a bull was supposed to transmit the disease to
other cattle after a period of 2% years (?).

Although successful infection may occur through the unin-
jured mucous membranes, nevertheless it is favored by loss
of substance and by excoriations in the mouth, on the skin of
the udder, and in the interdigital space (in feeding dry food,
also while pasturing on stubble fields, the disease spreads with
particular rapidity).

The infection of sucking animals, or those which are fed
with milk, occurs almost invariably through the milk of affected
animals, or through the skim milk from creameries, and is usu-
ally acquired through the uninjured mucous membrane of the
334 Foot-and-Mouth Disease.

digestive tract, which at that age is sensitive, owing to its cover-
ing of loosé epithelium.

Susceptibility. Cattle are most susceptible to natural in-
fection, then follow hogs, sheep and goats. Differences are
observed in this regard in the various outbreaks, inasmuch as
the last named species of animals may become affected in the
same degree as cattle, or at least in considerable numbers. Buffa-
loes may also become affected, occasionally however they remain
healthy among affected cattle, while in other cases the cattle
may become affected through buffalo. Wild cloven-footed ani-
mals, including boars (Borzoni) are also susceptible to the dis-
ease, and sometimes it exists among these animals in an epi-
zootic form. Reindeer and camels are also susceptible, and
very exceptionally horses, dogs and cats may become affected.

Among the animals of a certain species a variation in susceptibility may be
observed in the various breeds, as under the same conditions a greater number of
animals of common breeds will resist the infection, than of the finer breeds. While
under conditions favorable to the infection, animals of the western European breeds
become affected in the proportion of 95-100%, among the common breeds only
40-50% contract the disease, and even after an energetic, artificial inoculation,
not infrequently 20-30% of the animals remain healthy (Kovacsy, Born). According
to Hartenstein hogs of the Mangalicza breed are more resistant than the Polish or
the German breeds. In K6banya hogs from the lower Danube region became more
severely affected than the native hogs.

Recovery from the disease reduces the susceptibility for
a certain time. The immunity thus acquired lasts in the ma-
jority of cases longer than a year (according to Mazzini from
3 to 5, and according to Schwenck even up to 7 years). Excep-
tionally the same animal may become re-infected by the disease
within a short time. Strebel observed re-infection by the disease
in cattle after 6 to 10 weeks, Makoldy after 12 days, while
Kovacs observed a re-occurrence of the disease in a herd of
hogs 10 days after the recovery of the animals. Warnesson
reports a case in which a cow became affected three times within
a year. Calves from cows which recovered from the disease at
an advanced stage of pregnancy are sometimes immune towards
the natural, as well as the artificial infection, while the feeding
of milk from immune cows does not reduce the susceptibility
of the calf (Frohner, Loffler & Frosch).

Pathogenesis. Observations that the disease develops in
a typical form after intravenous inoculations of the virus, that
the development of vesicles is preceded by fever, and that the
blood is infectious at the onset of the disease, indicate that
the virus, at least in some of the cases, reaches the tissues pre-
disposed for the development of the exanthema, by transmission
through the blood stream. As such should be considered the
deeper epithelial layers of the mucous membranes, and the finer
portions of the skin. The frequent affection of the mouth,
udder, and feet may possibly be associated with traumatic irri-
tation, or with superficial defects of these parts of the body.,
Pathogenesis. Anatomical Changes. 335

The virus which penetrates between the epithelial cells of these
parts of the body in all probability commences to multiply im-
mediately, later however it passes into the blood stream, by
which it is distributed to distant parts of the body. The affec-
tion of feet and udder, which later becomes associated with the
affection of the mouth, may be of such metastatic origin.

The virus may be transmitted from the mother to the off-
spring, in which case the young may be born showing manifes-
tations of foot-and-mouth disease (Mébius).

Aceording to Kitt the development of the vesicle commences with hyperemia
and serous infiltration of the papillae of the skin or mucous membranes. The
serous exudate loosens the epithelial cells from the mucous layer between the
papillae, then it raises the more resistant, superficial layer of cells, while the contents
of the developed vesicles in the meantime becomes cloudy, as a result of migration
of white blood corpuscles. The epithelial defect which develops after the bursting
of the vesicles becomes covered by epithelial cells which form either from the
remaining part of the stratum mucosum, or by a multiplication from the periphery,
and complete healing takes place in this manner, except that the papillae become
somewhat smaller than they were originally. ‘

Besides the unknown virus, the fluid of the vesicles may contain
various other bacteria; such as Kurth’s streptococcus involutus, the
staphylococcus pyog. aureus, the micrococcus tetragenus, sarcinae, ete.
(Sanfelice). These pus-producing organisms may modify the later
course of the disease, and the occasional complications which develop
(deep ulcerations and suppurations, purulent inflammations of the feet,
mastitis, pyemia, etc.) may be attributed to their action.

Anatomical Changes. Autopsies on animals which are
slaughtered. during the development of the disease, or which
suddenly die, reveal as a rule, in addition to the characteristic
exanthema, only an acute catarrhal swelling of the mucous
membrane of the mouth, of the pharynx, and of the air pas-
sages, or there may also be present small hemorrhages on some
of the serous membranes, especially on the visceral layer of
the pericardium. In some cases however vesicles, or ulcerations
may be observed in the wall of the pharynx, on the mucous
membrane of the bronchi and esophagus, in the stomach (in
ruminants in the first three stomachs, Uhlrich), and in the
intestinal canal. The ulcerations may sometimes be covered by
a fine fibrinous deposit.

‘Animals which die as a result of complications, reveal
severe suppurating processes, especially on the lower parts
of the extremities, which are frequently associated with caries
of the neighboring bones. There may also be found purulent
or ichorous inflammation of the joints, or metastatic abscesses
in various parts of the body, and acute degeneration of the
parenchymatous organs. In some cases a gangrenous pneu-
monia is the immediate cause of death, which results from
inhalation of saliva or food particles.

If the animal dies suddenly in the stage of commencing
recovery, from the malignant type of foot-and-mouth disease,
336 Foot-and-Mouth Disease.

the mucous membrane of the abomasum, and of the intestines,
is found to be dark red, covered by numerous hemorrhages,
while in the rumen, especially in the vicinity of the folds, also
in the leaves of the third stomach, and in the intestinal tract,
and sometimes in the pharynx, erosions and ulcerations, some-
times of the size of a silver dollar, may be observed. The
parenchymatous organs show fatty degeneration, which change
is sometimes so pronounced in the muscles of the heart that its
cut surface appears mottled, because of the yellow spotting
(Johne, Nocard; according to Trattner there is also hyaline
degeneration in the affected parts). The spleen is moderately
swollen, dark red and softened. Hemorrhages may also be
found on the mucous membrane of the respiratory organs, and
in the serous membranes. Finally in some cases the inter-
lobular and subpleural connective tissue of the lungs may show
an edematous infiltration, and the contents of the ventricles of
the brain may be increased and cloudy (Willach).

Symptoms. After an intravenous injection of the virus,
the time of incubation in cattle varies from six hours to six
days (Loffler & Frosch) ; after inoculation into the buccal mucous
‘‘membrane it is from 48 to 60 hours (Schiitz); after natural
infection the time is between 2 and 7 days, exceptionally even
11 days (Siedamgrotzky, Born). Data regarding a longer
period of incubation (according to Schrader, Lies and Mébius
14, according to Isepponi even 21 days) are doubtful.

Without considering the manner and method of the infec-
tion as well as the place of the eruption of the vesicles, the
disease commences with fever, which is quite evident in young,
strong animals, while in older animals it may sometimes be so
moderate that it is not observed at all. The body temperature
in the first 1 or 2 days may reach 40-41°, but as soon as the
vesicles develop, possibly in from 6 to 24 hours, it rapidly
drops, and the later course of the disease runs without fever,
with the exception of those cases in which inflammatory compli-
cations resulting from a subsequent septic infection become
associated with the original disease. The rise in temperature
is usually accompanied by a somewhat accelerated pulse, and
diminished appetite.

The other symptoms vary in accordance with the localiza-
tion of the affection.

The affection of the mouth is most frequently observed in
cattle, while in sheep, goats and in hogs it occurs with consid-
erable less frequency. At the onset of the disease a diminished
appetite and retarded rumination is observed. The animals
chew their food very slowly and carefully, on account of the
sensitiveness of the buccal mucous membrane, and also swallow
the bolus slowly. In the periods between feeding times they
keep the mouth closed, and only open it now and then with a
Symptoms. 337

characteristic smacking sound. Later they entirely cease to
eat. The animals stand immovable with a staring, expression-
less look, saliva dropping in long, sticky threads from the cor-
ners of the mouth. They like to play with their mouths in the
water offered them, and some patients evince an increased thirst.

The mucous membranes on the inner surface of the lips,
and on the gums is warm, dry and reddened; the opening of the
mouth, which is followed by a flow of great quantities of
accumulated saliva, reveals a similar change in the mucous
membrane of the other parts of the mouth. On the second to

 

a

 

 

 

 

Fig. 57. Foot-and-mouth disease. Vesicles and ulcerations on the gum, the latter
also on the nostrils.

third day of the affection smaller and larger vesicles develop
on the inner surface of the lips, and on the gums lying opposite,
or on the toothless part of the upper jaw, on the top and borders
of the tongue, in the vicinity of the frenum of the tongue, as
well as on the inner surface of the cheeks (Fig. 57). These vesi-
cles are in small animals hardly ever larger than the size of
a pea, while in larger ruminants they may attain the size of a
nut, and on the dorsum of the tongue may even reach the size
of an egg. The vesicles on the tongue (Fig. 58) possess a thick

Vol. 1—22
338 Foot-and-Mouth Disease.

wall, in other parts however the walls are thinner. These con-
tain first a clear, watery, colorless or yellowish fluid, which later
becomes cloudy and grayish-white. After 1 to 3 days the vesi-
cles burst, the contents escape, the wall is thrown off, and in
their places highly reddened, moist, painful, flat erosions with
wide borders remain. After 1 to 2 days these become covered
with fresh epithelium, whereupon for a certain time yellowish-

 

Fig. 58. Foot-and-mouth disease. Sub- Fig. 59. Foot-and-mouth disease. TEro-
epithelial vesicles on the point of the sions on the dorsum of the tongue in
tongue, on the body of the tongue, and on stages of early healing.

the thick portion.

brown spots remain, which finally also disappear (Fig. 59).
soon as the erosions become covered by epithelium the a
which in the meanwhile frequently have become. greatly ema-
ciated, commence to eat.

In animals which were in poor condition previous to the affection,
sometimes a lemon-colored deposit of 3 to 4 mm. thickness develops at

 

 
Symptoms. 339

the seat of the vesicles, and healing occurs only after the shedding of
the same (Born). Russian veterinarians (Ravitsch, Korsak, Michai-
low, Schadrin) have also observed in some outbreaks the appearance of
such pseudo-membranous deposits but only in strong animals, and in
these cases vesicles were not present, or only in an abortive development.

_ Simultaneously with the affection of the mucous membrane,
similar vesicles develop, in cattle on the muzzle and at the base
of the horns (rarely), in hogs on the snout (frequently), which
may reach the size of a nut, and correspond with the described
vesicles (on the snout sometimes only a single large vesicle
develops). Vesicles may also be observed in rare cases on the
nasal mucous membrane, and on the conjunctiva. The spread-
ing of the affection to the pharyngeal mucous membrane is indi-
cated by symptoms of a pharyngitis (difficulty in swallowing,
cough, regurgitation). In cattle the cornea is sometimes uni-
formly cloudy, and small vesicles may develop on its surface.
The ulcerations which subsequently develop heal without leay-
ing a trace, or white cicatrices may remain, which however later

-disappear partly. In some instances vesicles may also develop

on the epiglottis, on the mucous membrane of the trachea and
bronchi, in which cases difficulty in respiration, or manifesta-
tions of edema of the lungs may be noticed (Leyendecker).

Foot Affection. Sheep are quite frequently and hogs are
in most instances affected only on the feet, whereas in cattle
affection of the feet may occur simultaneously with the forma-
tion of lesions in the mouth, but it usually develops subsequent
to their appearance. ©

' The first symptom, which may be recognized even from a
distance, is always the lameness or the stiff gait, which is
caused by the pain in the lower extremities, and is especially
manifested during walking on hard ground. If more than one
foot is affected the pain may bé so severe that the animals lie
down continually, and it is only with difficulty that they can
be made to rise. :

A eareful examination of the affected feet reveals the skin
of the coronary band, the heel of the foot, and the interdigital
space at first warm, swollen, painful, and in case it is not pig-
mented it appears also highly reddened. After 1 to 2 days, small
vesicles develop in these places, especially in the interdigital
space, more rarely also at the base of the dew-claws, which soon
reach the size of a hazelnut, and are filled first with a clear,
and later with a cloudy fluid. After their bursting, which at
these places results earlier than in the mouth, owing to the
continuous friction, the lymph-like fluid, together with the dirt
from the ground, dries to brown crusts. If they are removed,
the underlying surface shows sore places, which are desqua-
mated of epithelium, highly reddened, moist, and very sensitive.
The formation of new epithelium under the scab progresses
340 Foot-and-Mouth Disease.

very slowly, and the sensitiveness and swelling of the feet dis-
appears completely only after from 1 to 2 weeks.

If in cattle several vesicles develop adjacent to each other,
along the coronary band, it may frequently be observed that
the coronary seam separates from the horny border, and this
may even become loosened from the sensitive lamina. In the
course of the healing process this crack remains between the
newly formed horn and the old wall, and it is only after several
weeks that the coronary band finally becomes covered with new
horn. (Dirt and sand may penetrate the horny crack, producing
bruises and inflammation of the sensitive lamina, as a result
of which the animals remain lame for a long time.) In heavy,
fattened hogs the loss of the hoofs is often observed.

In sheep the inflammatory process quite frequently affects
the biflex gland which is located in the interdigital space, where-
upon from the excretory duct a great quantity of muco-purulent
material may be squeezed out (hoof worm).

The vesicular exanthema occurs very frequently on the
udder in cattle, simultaneously with the infection in the mouth
or hoof. As a rule vesicles develop on the teats, sometimes
reaching the size of a nut. In such cases the whole udder swells,
and appears reddened in the immediate surroundings of the
vesicles. The affected parts are very painful. The vesicles
are usually broken on the first day during milking, while in
cases in which they are protected from mechanical interference
they may remain intact for 5 to 6 days, until finally their thin
wall bursts of its own accord, and the resulting ulcer soon heals
under the formed scab. The sensitiveness and swelling, as
well as the reddening of the affected parts of the skin, may
however remain for several days.

With the exanthema a catarrh of the milk ducts may become
associated. In such cases the milk, the quantity of which is
usually considerably diminished even in healthy udders, has
a more or less colostrum-like consistence, and is therefore of a
yellowish-white color and acid reaction, coagulates easily, and
can only with difficulty be worked into butter and cheese. In
exceptional cases it is watery, and contains white mucous flakes,
which collect in the milk ducts, and therefore may render the
milking difficult. In the meantime the milk may have a rancid,
bitter taste.

The milk production’is always diminished in the course of the disease, but
the decrease varies from case to case. Relative to this, Siedamgrotzky observed
in a dairy farm of 43 cows, that during the disease in two cows the milk entirely
ceased, in the others the shrinkage was the greatest on the sixth day, at which
time the loss in old milk cows amounted to 75%, in fresh to 55%, and in those
which were about in the middle of their milking period it reached 43%, After
the disappearance of the disease the quantity of milk rose only to %4 of the former
volume. The entire quantity of milk dropped at the height of the disease from
745 to 364 liters, and after the disappearance of the disease came back to 522
liters. In a second dairy farm 32 cows gave instead of 300, only 30 liters of milk,
and the quantity remained at the same height for 8 days. In a third place the
quantity of milk dropped on the fifth day from 510 to 260 liters, it increased from
Symptoms. Complications. 341

the eighth day on, but even after six weeks it amounted to only 350 liters. According
to Weber cows in the period of the highest milk production give during the course
of the disease 5-6 liters less milk daily. Born observed on a farm that the entire
quantity of milk eight days after the outbreak of the disease diminished from
750 to 280 liters; after the next eight days it rose to 400 liters, but failed to
reach its former height at any later period. The reduction amounted on a monthly
average, to 3.6 liters daily per cow.

The milk of affected cows contains more salts (Lavena, Herberger) and
albumen (Kalantar), but less fat and sugar (Herberger; according to Kreis the
proportion of fat is increased), and in the fat the volatile fatty acids are greatly
diminished (Végler); under the microscope colostral bodies, mucous epithelial and
pus cells, and sometimes also red corpuscles may be found. .

Complications occur very frequently in the course of the
disease, and may greatly modify the otherwise mild and typical
course. .

The development of vesicles on other parts of the body
than those mentioned is of relatively slight importance. The
exanthema may sometimes be observed on any part of the body
which is not, or only slightly, covered by hair, especially on the
vulva, and on the mucous membrane of the entrance to the
vagina, also on the inner surface of the thigh, and on the skin
of the chest, or abdomen (Harns).

More frequent and of greater importance are those com-
plications which develop as the result of an extension of the
inflammatory processes to the surrounding parts, or as a result
of an infection of the erosions, or those which develop as the
result of continuous mechanical interference. In this way in
the further course of the disease, catarrh of the larynx, tra-
chea, and bronchi may develop, besides pharyngitis, and fur-
ther, owing to the difficulty in swallowing, saliva or food may
enter the air passages, and lead to a suppurative or gangrenous
pneumonia.

The superficial erosions on the mucous membrane may
sometimes change to deeper ulcerations, which are covered with
purulent matter, or a thick deposit,,as a result of which the
surrounding part is greatly swollen, through inflammatory
edema. The suppuration increases, spreading not only side-
ways, but:also in depth. The ulcers finally heal by cicatrization.

Similar severe suppurating processes occur much more
frequently on the feet, and these are much more exposed to
a subsequent infection. The inflammation is greatly increased
by walking on hard, stony, rough roads, or on stubble. Of still
more unfavorable influence is the uncleanliness to which the
affected extremities are exposed in the stables, on dirty floors,
which are sometimes soaked with ichor or other filth, as well
as the mud to which they are exposed in rainy weather. As
the result of the mechanical irritation, in association with the
local inflammatory process, great swelling of the coronary cush-
ion and of the heels develops, as a result of which the hoofs
are spread apart. The swellings may extend upward to the
hock joint. The animals suffer very severe pain, and therefore
they favor the affected feet in every possible way, or they lie
349 Foot-and-Mouth Disease.

down continually. If they are urged to walk they move very
slowly, displaying much lameness, while small animals hop on
three, or sometimes even on two feet, or they move about on
their knees.

The progressive inflammation leads finally to the formation
of abscesses (panaritium), which are mostly observed on the
coronary band above the affected interdigital space, more
rarely on the heels of the feet. The abscesses break outwardly
provided they have not been opened, or the suppurating process
continues to burrow into the deeper parts. This results in caries
or necrosis of the coronary or pedal bone, or the pus breaks into
the coronary or pedal joint, sometimes also into the sheaths
of the tendons, while in other cases the inflammatory process
extends along the sensitive lamina, resulting in the formation
of fistulas, partial loosening of the horny wall and sometimes
in the loss of the hoofs.

According to Lytdin in cattle with translucent hoofs, red spots
may be seen in the sensitive lamina of the hoof, and the loss of the
hoofs, as well as the changes of the horny wall; and the horny sole,
in cattle and hogs, when severely affected with foot-and-mouth disease,
is probably associated with an affection of the matrix of the hoof. —

The affection of the udder may lead to deep, penetrating
abscess formation in the affected quarter, due to the irritation
during milking, and to possible infection, as a result of which
slowly healing defects develop on the skin. Sometimes a con-
siderable quantity of the milk remains in the udder, and this
commences to decompose, through an infection originating in
the milk ducts, whereupon a parenchymatous inflammation of
the udder develops, which finally leads to atrophy of the affected
quarter, and sometimes also to obliterating strictures of the
canals of the teats.

In severe cases septicemia or pyemia, with their well-known
symptoms and fatal termination may result, and if death should
not immediately follow the patient becomes greatly emaciated,
and finally succumbs to complete exhaustion. Such a termina-
tion may be noticed in affected animals, which although the local
process is not very malignant, yet have remained continuously
lying, because of the pain in their feet, until decubitus gangrene
has set in.

In young animals acute gastro-intestinal catarrh is a very
frequent complication, often resulting in death. In such cases
the feeble and depressed animals do not suck, or only indiffer-
ently. The feces are fluid and fetid, the abdomen is sensitive
to pressure, the pulse is accelerated and wiry. The young
patients frequently die in from 2 to 3 days, sometimes even on

the first day after the appearance of the gastro-intestinal
infection.

The gastro-intestinal catarrh is without a doubt produced by the
pathogenic action of the virus, which is swallowed with the saliva or
Complications. 343

milk, and acts directly upon the mucous membrane of the digestive
apparatus. In sucking animals the changed chemical consistence of
the milk of the affected mother comes also into consideration. On the
other hand the virus may also enter the gastro-intestinal wall by
way of the blood circulation, and this mode of development must be
suspected in those cases in which the manifestations of the gastro-
intestinal catarrh develop in the early stages of the disease in animals
which are not fed on milk, and in which vesicles and erosions develop
in the mucous membrane of the stomach.

Of the other complications abortion, internal inflammation
of the eyes, indammation of the frontal sinuses, which some-
times leads to the dropping off of the horns, may be mentioned.
Finally the disease may run a course with febrile symptoms
only, and without a vesicular exanthema.

Malignant Foot-and-Mouth Disease. Under this designa-
tion all those cases are usually combined which appear occa-
sionally, and usually only restricted to certain territories, and
in which the disease, without apparent complications, results
in the death of the cattle.

In the cases belonging to this group the disease usually
develops in a typical form; but in the stage of the commencing
recovery, on the fifth to sixth day, a sudden change to the worse
takes place, without any apparent cause. The affected animals
which are already free from fever and commence to eat, sud-
denly become very feeble and apathetic; they cease eating and
ruminating, tremble, stagger, grind their teeth, respiration is
difficult, and they suddenly drop to the ground, when death soon
follows. In some animals, constipation, delayed or completely
suppressed peristalsis, sensibility of the abdomen, and hemor-
rhages from the intestines and vagina may be observed (Faber),
while others suddenly die under apoplectic conditions without
any apparent prodromal symptoms. Those cases should also
be included in this group, in which in the course of the foot-and-
mouth disease a paresis or complete paralysis of the hind
quarters develops, and the symptoms of paralysis extend an-
teriorly, the clinical appearance then resembling somewhat par-
turient apoplexy; in such instances the animals usually die from
paralysis of the pharynx (Wester).

The cause of this malignant type of foot-and-mouth disease has
not been established with certainty; however the, manifestations on the
live animals, as well as the severe changes found at autopsy, indicate
an intoxication. The supposition appears very probable that the
unusually strong virus attacks also the mucous membrane of the stomach
and intestines, whereby poisonous substances are absorbed into the
organism from the ulcerations developed in these places. Whether
these products originate from the virus of foot-and-mouth disease
proper, or from other bacteria present in the digestive tract has not
yet been determined. Nocard having shown that typical foot-and-mouth
disease may be produced by inoculation into cattle of degenerated
344 Foot-and-Mouth Disease.

parts of the heart muscle, the presence of the virus in the heart muscles
suggests at least the symptoms of the heart weakness. The malignant
character of the affection is not influenced by outside conditions, espe-
cially by dietetic or hygienic conditions, and Imminger observed in
Bavaria that most of the deaths during the disease occurred in clean,
well ventilated stables.

Course. In the great majority of cases foot-and-mouth
disease usually runs a typical and favorable course. The
development and healing of the vesicles require on an average
5 to 6 days. In spite of this however the disease extends even
in the mild cases, from 2 to 3 weeks, as the different parts of the
body do not become affected simultaneously, but usually suc-
cessively. The cases in which the affection is localized in the
mucous membrane of the mouth usually recover inside of a
week. Recovery is protracted somewhat longer in the hoof
affections, on account of the delayed healing of the ulcerations.
In those cases however in which the affection of the mucous
membrane of the mouth is associated with lesions in the hoofs,
a still longer time is required for recovery. After healing
of the local changes the animals usually regain their former
condition very rapidly.

In cases running an unfavorable course with the exception
of young animals affected with gastro-intestinal catarrh, death
ensues as a rule from pyemia or septicemia, as a result of
absorption of septic substances from the ulcers, abscesses or
suppurating wounds, while in other cases a gangrenous pneu-
monia is the cause of death. In the malignant form of foot-and-
mouth disease toxin poisoning, or paralysis of the heart may
be the immediate cause of death.

In a certain percentage of cases various permanent affec-
tions remain, which more or less reduce the value of the animals.
Such affections are, in the first place, chronic disturbances of
the hoofs, which develop from extensive inflammation of the
feet, and especially from the loss of hoofs. Such conditions
result in an irregular development of the new hoofs, as well
as in chronic arthritis and tendonitis. In exceptional cases a
proliferation of granulation tissue is observed, which originates
from the ulcerations on the coronary band, heels, and the inter-
digital space. In such instances the hoofs are forced apart,
and the lesions consist in sore, ulcerative masses (Schenkl).
Of further importance is the diminished milk production which
usually lasts until the following parturition, but may also
remain constant, especially when the severe affection of the
udder has resulted in atrophy of the glandular substance.

Horvath observed in the course of an acute affection a marked difficulty in
respiration, and that the animal failed to shed the hair during the summer. The
number of respirations during rest amounted to 60-80 per minute, but after
short exercise as well as in warm weather, it rapidly increased to 120-160, while
the pulse numbered 40-60 per minute. In the meantime the appetite and the milk
production were diminished; pregnant animals gave birth to poorly developed calves,
Course, Diagnosis. 345

weighing only from 10-15 kg. In 16 townships of the affected district in Hungary
a year previously 9,087 cattle were affected with foot-and-mouth disease, of which
300-400 manifested the above disturbances in respiration. A similar affection sequel
to foot-and-mouth disease was observed by Laszlo, also in Hungary, in connection
with the very severe outbreak in which out of 2,500 cattle of a township, 86 (about
20% of the animals being over 5 years of age) died suddenly from paralysis
of the heart, usually while in the stage of recovery. In the other animals the
symptoms greatly diminished during the cold winter weather; complete recovery
however was not observed in any of the cases.

Diagnosis. While in typical cases the disease may be
easily recognized, or at least suspected, in the stage of the
vesicular development, especially when several animals are
affected at the same time, the correct recognition of sporadic
cases, especially during the beginning or towards the end of
the outbreak, frequently causes considerable difficulty.

In the peracute and fatal course the suspicion of hemor-
rhagic septicemia, anthrax, and the oriental rinderpest may be
awakened, but these may be excluded by the autopsy findings.

With the infectious mouth disease there may be mistaken:
Traumatic injuries in the mouth, which occur most frequently
on the inner surface of the lips; in these cases however the
losses of substance are sharply defined, frequently straight, and.
penetrate to considerable depth. The vesicular stomatitis
(incorrectly also named as aphthous stomatitis) in cattle, in
which the mucous membrane, especially on the gums, or on
the toothless portion of the upper jaw, discloses small vesicles
and later thin pseudo-membranous deposits form in their place;
the development of this exanthema is however not associated
with fever, nor is the affection infectious. The ulcerative
stomatitis of hogs, in which however the gums become affected
only in the vicinity of the teeth, and no vesicles develop (similar
is the mercurial stomatitis). In aphthous stomatitis of calves
and lambs, the vesicles usually appear only on the skin of the
lips, while in the different parts of the mouth white, or yellow-
ish membranous deposits develop on the mucous membrane
without a previous vesicular formation. In cattle the actinomy-
cotie ulcerations on the back of the tongue may also come into
consideration. These however are always located immediately
in front of the transverse groove on the dorsum of the tongue,
and also extend to the papille fungiformes, whereas in foot-
and-mouth disease these remain intact even in the places of
vesicles or erosions (Leutsch). The stomatitis which is some-
times observed after feeding musty, moldy food, may be dis-
tinguished from foot-and-mouth disease by the absence of vesi-
cles, and by the diffuse inflammation of the mucous membrane.

Concerning affections of the mucous membrane of the mouth, which were
recently described under various names, for instance pseudo-mouth _disease, and
which may come into consideration from the standpoint of differential diagnosis,
see Chap. ‘‘Aphthous Stomatitis’’ in Vol. 2.

The affections which may be mistaken for hoof disease, are
to be distinguished in general, in that the affections on the lower
346 Foot-and-Mouth Disease.

extremities are not preceded by febrile symptoms, but that, if
they are present, they follow upon the appearance of the lesions.
Further there is no formation of vesicles, and the affection
is confined to the feet, while the mucous membrane of the mouth
is not simultaneously affected (this fact in itself of course does
not exclude the infectious foot-and-mouth disease).

The diseases which should be considered in this regard are:
The interdigital panaritium of cattle, which occurs especially
in filthy stables, also in pastures, sometimes in enzootic exten-
sion; in this affection the skin of the interdigital space swells
to a thick roll, which extends from the interdigital space and
over which the skin sometimes may even become gangrenous,
resulting in a discolored ulceration, and in a separation of the
interdigital band.—A necrotic (malignant) inflammation of the
hoofs in cattle, which occurs in cows shortly after parturition
or towards the termination of pregnancy, exceptionally also in
bulls, and which is probably produced by the bacillus necro-
phorus (Bang, Hess) ; in this affection rapid softening necrosis
of the skin in the interdigital space takes place, which also
penetrates into the deeper parts, but fever develops only in
the later stages of the affection The inflammation of the inter-
digital space in sheep (Moderhinke), from which many animals
may suffer at the same time, in continuously moist weather. The
affection consists in a serous, and later purulent inflammation
of the skin, which may easily lead to a separation of the coro-
nary band, and the horny wall; the suppuration usually occurs
at the heels, while the anterior part of the interdigital space
is less affected. The so called hoof worm (inflammation of the
biflex gland) only occurs sporadically, provided it does not
develop as the result of foot-and-mouth disease, and the inflam-
mation is confined to the vicinity of the swollen gland, which is
filled with smeary material—tThe so called malignant (French-
Spanish) disease of the hoof commences with an inflammation
of the hoof proper, which feels warm to the touch, while an
affection of the interdigital space becomes apparent only in
the later stages, frequently after suppuration of the sensitive
lamina has already developed. Furthermore this affection
spreads more slowly in the herd than is the case in foot-and-
mouth disease.

To the latter probably belongs also the disease of the hoofs known
in America as foot-rot of sheep, in England as contagious foot-rot, in
France as piétin contagieux, in which the inflammation commences on
the coronary band, whereupon small ulcers with purulent discharge of
a peculiar odor develop on the heels. The process extends to the deeper
parts, forming fistulas, and resulting in the separation of the horns of
the hoofs, and sometimes also in necrosis of the ligaments, tendons and
bones (Mohler and Washburn). :

Exanthema on the udder might be mistaken for pox,. but
this affection remains as a rule exclusively confined to the
Diagnosis, Prognosis. 347

udder, the vesicles are only the size of a pea, the surrounding
skin is. elevated, and in a certain stage of their development
navel-like depressions form on the vesicles.

_ Indications of recovery from the disease within a short
time are profuse salivation, greater moisture on the surface of
the mucous membranes, yellowish, straight cicatrices, or flat,
yellow spots on the gums and on the toothless portions of the
upper jaw, small, red points and depressions on the gums and
on the border of the muzzle. According to Koninski these
changes may be noted even 3 to 4 months after the disappear-
ance of the acute symptoms.

Prognosis. Foot-and-mouth disease is in its nature a mild
affection, death occurring only very rarely under normal con-
ditions, except in very young animals, in the malignant form of
the disease. The mortality hardly amounts to 0.2 to 0.5%, and
even these figures are principally due to unfavorable hygienic
conditions (filthy stables, using the animals for work, or driving
the affected animals on the road, negligence in the treatment,
etc.). These conditions must therefore be taken into consid-
eration in giving a prognosis.

Of the different species, cattle are most mildly affected
under similar conditions; in hogs also the affection usually
runs a mild course, except in fattened hogs, in which, owing
to the heavy weight of their bodies, the loss of hoofs is fre-
quently observed, and therefore complete recovery usually takes
a longer time. In sheep the course of the disease is less favor-
able on account of the relatively frequent after-effects to the
hoofs.

In very young animals, especially in the sucking age, the
prognosis is unfavorable on account of the associated gastro-
intestinal catarrh.

The deviation of the course, according to sex and age of cattle, is illus-
trated by Bouley’s reports, which also corréspond with the observations made by
others. In the District of Nevers in 1872, in the course of five weeks of 7469
steers 9 died (0.12%), of 6625 cows 59 succumbed (0.89%), of 3847 calves
781 (20.30%). , According to Mari the foot-and-mouth disease in Russia assumes
sometimes such a malignant character that 70 to 95% of the affected animals
die. In this form the patients suffer aside from the characteristic but severe

symptoms of the disease, from a pronounced catarrh of eyes and nose, from
diarrhea, and a severe depression of the nervous system.

The prognosis of malignant foot-and-mouth disease is unfa-
vorable, as the mortality in this form usually amounts to from
50 to 70%. As death occurs mostly after rather light symptoms
in the stage of commencing improvement, it appears advis-
able, in making a prognosis in instances when sudden deaths
had been observed in the vicinity, to take these facts into con-
sideration. 7

Further, in making a prognosis in severe affections of the
hoofs, the possibility of sequelae, and in the affection of the
udder, a lasting shrinkage in the milk production should be

given due regard.
348 Foot-and-Mouth Disease.

Treatment. Rest and cleanliness are the two principal
requirements under which mild forms of the disease terminate
in recovery within a short time, and without leaving subsequent
affections.

In the mouth affection care should first of all be taken that
the affected mucous membrane be protected from mechanical
injury, and that the animals are kept in good condition, in spite
of the existing pain which interferes with the partaking of food.
For this purpose the diet should be regulated and the animals
should be given, instead of coarse and rough food, fresh, green
food, fine hay, or silage. Severely affected patients should be
supplied with flour and bran gruels, while young animals
should be given boiled milk.

For the cleaning of the buccal cavity the animals should
frequently be given pure fresh water, besides the mouth should
be syringed out 2 to 3 times a day with pure water with the
aid of an irrigator, or with a hard rubber syringe. Medicines
are of subordinate importance, and only serve to prevent the
decomposition of the accumulated saliva, and to hasten the
healing of the erosions. For this purpose mild disinfectants
and astringents may be used for the irrigation, such as salt
and vinegar water, alum, copper sulphate, iron sulphate, potas-
sium chlorate, boracic acid, creolin, carbolic acid, lysol (in 2
to 3% solutions), pyoctanin (1:1000), formalin (0.5%), ete.
These remedies may be used in camomile-sage or flax-seed
decoctions.

In order that a possible eruption on the base of the horns should
not cause a severe inflammation of the horn matrix, and subsequent
loss of the horns, it appears indicated, especially in cows, to tie them
with chains on the neck instead of on the head.

The hoof affection is in greater need of treatment, as the
affected feet are exposed to irritating influences, although even
this affection usually heals without interference, if the ground
is sufficiently clean and dry, and the affected animals keep
quiet. If the animal is affected only with the mouth lesions, it
is advisable to wash the healthy feet at least once daily with
a disinfecting fluid, or still better, to paint them repeatedly with
tar. If the hoofs are already affected, care should be taken that
the floor under the animals is kept dry; therefore the bedding
should be changed frequently. For bedding hygroscopic and

antiputrefactive material is recommended (turf, gypsum, etc.). '

The treatment proper consists in washing the affected ex-
tremities with one of the disinfectants mentioned, or an astrin-
gent solution, which in this instance may be used in a somewhat
concentrated form. Painting with wood tar, creolin, or lysol
liniments, in milking cows with thick milk of lime, or sprinkling
with drying powders, will be found beneficial (powdered copper
sulphate mixed with oak bark, tannoform, wood charcoal mixed
Treatment, Prevention. 349

with corrosive. sublimate, see p. 229, powdered oxide of zine,
etc.). Born recommends placing oakum balls sprinkled with
alum between the hoofs, Pilger painting the ulcerations on the
hoofs with a 10% bacillol ointment, in severe cases the appli-
cation of bacillol cataplasms.

Complications which result from improper treatment, or
from unfavorable external influences should be treated in ac-
cordance with surgical rules.

In affections of the udder, first of all regular milking, if
possible with milk catheters, is necessary. In addition to this
washing with luke warm water, or with a 2% boracic acid
solution, is sufficient. If the inflammation is more intense, and
the sensitiveness is greatly increased, it is advisable to apply
warm applications to the sores, after previously softening and
loosening the scabs, also lead or zine ointment, lanolin, boracic
acid vaseline (20%), or dermatol vaseline; tincture of opium
may be added to the salves, or a 5% cocaine salve may be used
from the beginning. Rubbing with glycerin gives likewise good
results. Parenchymatous inflammation of the udder is best
treated with inunctions of green soap, containing tincture of
iodine (1:10), or camphor ointment (1:4), repeated twice daily
for 10 minutes at a time, and in order to prevent the formation
of strictures the udders should be milked out every 2 to 3 hours.
During the intervals iodoform bougies may be introduced into
the milk ducts (Born).

In malignant forms of the disease it is advisable to watch.
the activity of the heart in the affected animals carefully, espe-
cially from the fifth to the ninth day, and in case its function
is disturbed, the threatening heart depression should be treated
by stimulation. In case of severe symptoms the early slaughter
of the animals is indicated.

In 1901, Baccelli warmly recommended intravenous injections of corrosive
sublimate (0.05:0.1 g. in physiological salt solution). According to later experi-
ences this treatment is useless, sometimes even dangerous. It has no favorable
influence on the local lesions, nor does it influence the course of the disease favor-
ably, and further poisoning was occasionally observed in the treated animals, which
sometimes failed to appear until 3 to 4 weeks later (Sacchini, Lanzillotti-Buonsanti,
Léffler). The treatment with intravenous injections of collargol’ (1% solution),
which has been recommended by Winkler, was in the comparative experiments of
Barabés found to have no favorable influence on the course of the disease, and
to be incapable of preventing it.

Perroncito recommends his Hamoaphthin for the treatment of affected cattle
which he prepares as follows: blood which is taken from recovered cattle, that
have been repeatedly treated with filtered lymph, is defibrinated, filtered through
hydrophylie cotton, and mixed with 3 to 4% sulphuric ether, and 0.75% formol.
After the injection of this preparation (0.5 to 1 g. per kg. body weight), which
keeps for a long time, the recovery is supposed to be almost instantaneous (?).

Prevention, The highly contagious character of foot-and-
mouth disease, and the fact that the infection is not only trans-
mitted by living animals, but also by the most varied objects,
render its control at the time of its prevalence very difficult.
Nevertheless it has recently been observed that outbreaks which
have not yet spread very extensively may be eradicated by
350 Foot-and-Mouth Disease.

suitable measures, and herds, ‘especially those on large farms,
may be protected from the infection. The principles for preven-
tion are, in general, the same as those applied to other infectious
diseases, and expressed briefly are, that healthy animals
should be protected in every possible way from coming in
contact with the unhealthy ones, or with those which have recov-
ered within a short time (see also page 334), and also from
coming in contact with contaminated utensils.

A quarantine of at least two weeks duration for newly
introduced animals appears to give good results in this respect.
It is furthermore advisable, during threatening periods, espe-
cially in already infected herds, to prevent the calves from
sucking their mothers, but they should be given milk that has
been heated to 70 degrees.

Emergency and protective vaccination. Emergency vaccin-
ation with virulent material, and immunization proper, possess
a marked difference in their value and in their practical im-
portance.

I. Emergency vaccination. This method, in which the dis-
ease is produced in healthy animals by the inoculation of
virulent material, is employed to shorten the disease in already
infected herds, when more energetic measures of eradication are
not adopted.

The disease usually affects all of the susceptible animals

-in an infected herd owing to its remarkable contagiousness,
‘but inasmuch as its transmission from animal to animal
oceurs only successively, a long time usually elapses before the
last animal recovers and the entire herd may be considered
free from infection. In order to diminish the loss due to
inability of the animals to work by a more rapid passing of
the infection. through the herd, and to reach as soon as possible
the removal of the quarantine period, artificial infection of all
animals in the herd after the appearance of the first cases, ap-
pears indicated. The advisability of this procedure is also sup-
ported by the experience that the inoculated disease usually runs
a milder and frequently also a more rapid course than the
natural infection. In order however to prevent severe losses,
the inoculation should be undertaken only in outbreaks in which
the disease is mild in character, and in which deaths in adult
animals have not been observed in the vicinity. (In the spring
of 1904 in a county in Hungary, all of 35 inoculated cattle, and
39 sucking’ calves died within 11 days.)

Technique of Inoculations. The simplest procedure consists in rubbing or
superficially searifying the mucous membrane of the mouth lightly with a clean
coarse piece of linen, and then applying the saliva of affected cattle; or the animals
are given coarse food contaminated with such saliva. The saliva should be taken
only from animals which have vesicles in their mouths, as the saliva is rendered
infectious by their contents alone, whereas it is no longer infectious when the
erosions are healing. Likewise very simple and certain is the method in which

a piece of linen is placed in the mouth of the affected animal, which is allowed
to chew at it for several minutes, then the well saturated cloth is introduced
Vaccination, Immunization. 351

into the mouth of the next 6 to 8 cattle, and they are also allowed to chew
upon it. Less certain is the procedure in which threads impregnated with saliva
of affected animals are inserted into the subcutaneous connective tissue of the
ear, or of the tail; the feeding of affected milk is less commendable, as this may
sometimes produce a severe gastro-intestinal catarrh.

Twenty-four to 48 hours after inoculation the temperature of the animals
commences to rise, and 2 to 3 days later vesicles appear on the mucous membrane
of the mouth, exceptionally also between the hoofs, which continue to develop in
the usual form until recovery takes place, mostly in the course of the second
week. The inoculated animals should be subjected to the same treatment that
they would have received had they contracted the disease by natural infection.

Other animals than cattle are usually not subjected. to the inoculation as it
is usually less certain in them, e. g. in hogs (in these it may be undertaken on the
snout with the aid of an inoculation lancet).

II. Immunization. Although animals may easily be im-
munized by the deliberate production of the disease, and the
immunity thus produced as a rule lasts for a long time, yet
such a procedure fails to meet the requirement that the immun-
ity be produced without a pronounced affection of the animals,
especially without the development of the vesicular exanthema.
Attempts to work out a method, which would be sufficiently effec-
tive, and at the same time without danger, have so far produced
only partially satisfactory results, in establishing the possi-
bility and the nature and method of passive immunization,
while the problem of general immunization is not solved at
the present time.

1. Active immunization. For this purpose either pure
lymph or a mixture of lymph and immune serum have been
used, however, without practical results, and in some instances
even with unfavorable effect.

: Nosotti in Northern Italy attempted to immunize cattle, by injecting them
subeutaneously with pure lymph taken from closed vesicles, diluted with aqueous
humor or blood serum, the results however were not satisfactory, as a considerable
proportion of the inoculated animals became affected in the usual way.

_ *Aecording to Léffler and Frosch, virulent lymph which has been subjected for
12 hours'to a temperature of 37°, may produce an immunity if injected into the
blood in quantities of 0.01-0.1 ce. As however this method is effective only in
30 to 50% of the cases the procedure has not been inaugurated in practice.

Loéffler and Frosch later found that a mixture of virulent lymph and blood
serum from artificially hyper-immunized animals (1/50-1/40 ce. lymph plus 10-20 ee.
blood serum), if, allowed to stand for a short time, and then injected subcutaneously
into cattle and hogs, produces only a passing febrile affection, without the develop-
ment of a vesicular exanthema. The animals however become immune so that
in 3 or 4 weeks they stand an inoculation with 1/50 ec. of virulent virus without
danger.

: The mixture of lymph and blood serum was placed on the market at the end
of 1898 under the name of ‘‘Seraphthin,’’ but it did not prove satisfactory in
practice. In different localities a large portion of the inoculated animals became
affected with typical foot-and-mouth disease (Flatten, Schrader, Schmidt, Leonhardt,
Lothes and others) while the disease produced by the inoculation was sometimes
malignant, and even fatal (Schindelka, Geist). Equally unfavorable results were
obtained from application of Hecker’s vaccine. ’ nes

In Léffler’s later procedure (1905) the cattle to be immunized received sub-
cutaneous injections, first of 0.5 ec. of highly valent cattle serum, and 0.03 ce. of
fresh virulent lymph. After 24 to 26 days they receive, also subcutaneously, 0.0033
ec. of lymph, 12 to 14 days later 0.01 cc., and after another 12 to 14 days 0.04 ce.
This method has not been tried in practice because of its impracticability.

The most recent experiments of Léffler show that in the inoculation of a
lymph serum mixture, the quantity of serum must be in a certain proportion
to the lymph if it is desired to produce a uniform immunity, and that the lymph
352 Foot-and-Mouth Disease.

should be attenuated by the serum only to the extent that it should prevent
its disease producing action, but should not entirely render it ineffective, that is,
it should still be able to produce a reaction in the body for the establishment of
an immunity. The difficulty of measuring the quantity of the lymph and serum
accurately can of course hardly be overcome, and therefore, at least at present,
there is very little possibility that immunization based on this principle will prove
ractical.

v Ory recommended cow pox lymph as a vaccine against foot-and-mouth disease,
inasmuch as he supposed that in the close relation of the two diseases there exists
a reciprocal immunizing relation. He first inoculated horses with calf lymph, and
used the lymph from the vesicles for the vaccination of cattle. These are claimed to
have proven immune against foot-and-mouth disease after passing through a mild
inoculation disease. Confirmation tests by Anker and Starcovici, Calinescu and
Sitaru however proved that it is not possible to produce immunity in this manner,
and Seibert could not obtain practical results from the use of original pox
lymph.

ie The Roumanian authors just mentioned later modified the procedure, in
using as a vaccine a mixture consisting of two parts of cow pox lymph, two parts
salt solution, and one part foot-and-mouth disease lymph. The practical value of
this method is supposed to be found in that the animals only become mildly affected
and in the meanwhile may be used for work (the danger of spreading the disease is
of course present in the same degree in this procedure as in the emergency inocu-
lations).

2. Passive immunization. Blood seram from animals which
have passed through foot-and-mouth disease, in quantities from
500 to 1,000 cc., increases the resistance of the susceptible ani-
mals; by the repeated intravenous injections of virulent lymph
this resistance may be increased to such an extent that the
serum, even in small doses, will produce a passive immunity.
In this way cattle may be immunized for a period of several
weeks, and by serum inoculations repeated at intervals, the
immunity may be prolonged even for several months.

A single serum inoculation would then be indicated only
in those cases in which it is desired to protect the animals for
a period of about three weeks; thus, for instance before they
are taken to stock shows or to markets. On the other hand
inoculations repeated two or three times, at intervals of 10
days, may serve beneficially in the eradication of the disease,
inasmuch as by such a treatment of animals threatened with
infection, its spread to surrounding herds may be prevented, and
thereby the results from other measures of eradication and
prevention may be assured.

Léffler’s method of preparing the immune serum is as follows: For the im-
munization of large animals a virus propagated in the body of pigs weighing 15 to
20 kg. is used. The pigs are inoculated with 1/25 cc. of lymph, whereupon they
become ill in from 2 to 3 days, and the lymph is collected from the vesicles. They
then receive subcutaneously 10 cc. of immune horse serum, which results in their
recovery. The lymph, which is filtered through a porcelain filter, is inoculated
intravenously to cattle in increasing quantities, and after such treatment for 2 1/2-to
3 months they produce a sufficiently potent serum. The serum is suitable for practi-
cal application when 100 ec. protects cattle of 200-252 kg. weight against an in-
travenous injection of 0.1 cc. of virulent lymph, 24 hours later. Twenty ec. of
serum neutralizes the action of 0.05 cc. of lymph; as in the natural infection
usually only small quantities of virus produce the disease, it is sufficient, except
in unusually severe cases, to use 20 ce. of serum for immunization purposes. In
already affected animals the outbreak of thé disease is prevented only by a con-
siderably greater quantity (100-200 cc.), and even then not with certainty. .
Immunization, Veterinary Police. 353

The possibility of passive immunization of cattle with highly potent
serum has also been established experimentally by Nocard, Roux, Carré
& Vallée, and Nocard recommended it also for the treatment of affected
animals, as he found that 20 to 40 cc. of the serum reduced the con-
valescent period, and that in severe outbreaks with a mortality of
10 to 20%, it prevented fatal complications.

The utilization of immune serum as an aid to other measures of
eradication and prevention has been warmly recommended by Loffler,
also by Leclainche and Lourens.

Veterinary Police. Owing to the severe losses which agri-
culture sustains from the foot-and-mouth disease its compulsory
notification has been inaugurated everywhere, and various spe-
cial measures have been adopted for its eradication. The special
regulations aim to prevent the further spread of the disease,
especially by the immediate isolation or destruction of the
affected animals, and consist especially in the application of
strict farm and township quarantine. Strict measures are also
justified in the supervision of cattle markets (prohibition of
such markets in the infected towns and their vicinity), the
transportation and driving of cattle, as well as the control of
trading by dealers. The utilization of the meat of affected
animals for consumption should depend on the decision of the
veterinarian, the skins should be disinfected before they are
worked up, milk from the affected dairies or cow stables should
be permitted on the market only after boiling or after being
subjected to at least 85° of heat. Artificial infection of animals
which are directly threatened by the disease should be made
dependent on official approval. The lifting of the farm or town
quarantine appears permissible at the earliest two weeks after
the recovery of all affected animals, or after the last death.

Proper disinfection is of great importance in the control of the disease. It
is advisable to undertake this immediately after the appearance of the first cases,
likewise it should be repeated every, week, until after the subsiding of the disease.
After thorough cleaning of all parts of the stables the disinfection could be made
with a 2%. hot soda or lye solution; besides it is advisable to paint the wooden
parts with tar, and the walls with fresh milk of-lime, and if possible the feet of
the animals should also be cleansed (with lysol soap, etc).

It is advisable to cover the manure of cows and hogs with horse manure. It
should be left in the manure pit for eight days, and should only then be taken
tothe field where it is to be plowed under with horse teams. The virus is destroyed
by the heat which develops inside of the manure pile, as according to Hecker’s in-
vestigations the temperature in the inner part of the manure pile, at a depth of
30-40 em. rises to 70 deg., in a greater depth to 48 deg., and remains for several
days at this height.

If the disease appears in regions which were previously
free from the infection, immediate slaughter of the infected
herds is indicated as the most effective and also as the most
practical measure. This may be greatly supplemented by the
serum treatment of neighboring herds (see above).

With the immediate slaughter of the infected herds the eradication of several

local outbreaks was successfully accomplished in recent times in England, and the
spread of the infection in the United States in 1902-3 was also prevented, when in

Vol. 1—23
354 Foot-and-Mouth Disease.

a period of seven months in 244 herds 4712 cattle, 360 hogs and 229 sheep and
goats were slaughtered representing a value of $128,908. In a similar way Aus-
tralia has remained free from the infection after the slaughter in Victoria of
two herds in 1865. In recent times Holland and Germany also adopted the
slaughter of the infected herds in sporadic outbreaks.

Literature. Hertwig, Mag., 1842, VIII, 389.—Haubner, Veterinary Police,
1869, 359 (Lit).—Johne, 8. B., 1881, 62; D. Z. f. Tm., 1884, 186.—Siedamgrotzky,
8. B., 1892, 71—Hess, Klauenkrankh. d. Rindes, 1892.—Schiitz, A. f. Tk., 1894,
_ XX, 1Kitt, Monh., 1894, V, 319 (Revue).—Mobius, 8. B., 1895, 75.—Loffler &
Frosch, Chl. f. Bakt., 1897, XXII, 257.—Hecker, B. t. W., 1898, 61; 1899, 6 u. 130.—
Imminger, B. t. W., 1898, 517.—Loffler, D. t. W., 1899, 317; D. m. W., 1903, 685;
Kongr. Haag, 1909.—Ebertz, A. f. Tk., 1900; XXVI, 199.—Nocard, Rev. gén., 1903,
I, 369; Acad. de méd., 1901—Arb. z. Erforschung d. M. u. Kls., Denkschr. d.
kais. Ges.-Amtes 1901.—Mohler & Washburn, Bureau Animal Industry Bull. Nr.
63, 1905.—Casper, B. t. W., 1907, 399 (Lit. on immunization)—Ory, Sem. vét.,
1907.—Terni, D. t.. W., 1908, 747.

Foot-and-Mouth Disease in Horses, Carnivorous Animals and in
Fowls. Besides ruminants and hogs, carnivorous animals and the horse
are also susceptible to the disease, although in a considerably lesser
degree, so that in these animals the disease is observed only very rarely.

The disease has been noted in various places among horses simul-
taneously with its occurrence among ruminants and hogs. In most in-
stances it could be traced to direct contact of the horses with affected
cattle, to the drinking of water contaminated with infectious saliva,
or to pasturing in fields in which affected ruminants were previously
kept. (The transmissibility to horses was proven experimentally by
Brauer and Woestendieck; Albrecht, and also ourselves, failed in such
inoculation experiments.) From the affected horses the disease is
usually not transmitted to healthy horses. .

In horses the disease occurs only as a mouth affection; vesicles
develop with febrile symptoms, on the sometimes greatly swollen tongue
and on the lips, sometimes also. on the nasal mucous membrane, the
conjunctiva, and on the immediately surrounding skin. The erosions
which develop in place of the ruptured vesicles are for a time covered
with yellow, flat deposits, the horses may sometimes also show slight
indications of gastro-intestinal catarrh. Usually however recovery takes
place within a short time (although Perazzi reports two cases of death).

By its clinical manifestations alone the disease can hardly be dis-
tinguished from the contagious pustular stomatitis, except that in the
latter the development of the pustules takes place from nodules. Usually
the establishment of a diagnosis is only possible with the aid of the
history, and by determining the method and nature of the infection,
also from the fact that pustular stomatitis spreads very rapidly among
horses.

Literature. Brauer, S. B., 1876, 84.—Woestendieck, Pr. M., 1883, 9.—Albrecht,
W. £. Tk., 1896, 37.—Perazzi, Clin. vet., 1907, 633.

The disease is very rarely observed in carnivorous animals; sporadi-
cally it has been established in dogs (Adam, Lukas, Schiffer) and cats
(Uhlich, Esser), which were kept on infected premises, or used for
guarding an affected herd of cattle. Vesicles develop on the mucous
membrane of the mouth, the erosions showing a tendency to form deep,
penetrating ulcers. The development of the disease is associated with
febrile manifestations, sometimes also with vomiting and diarrhea. If.
the feet are involved a vesicular exanthema develops on the balls, be-
tween the toes, and on the soles, with which swelling and lameness
are associated.
In Fowls and Man. 355

Literature. Schiffer, A. f. Tk., 1894, XX, 331.—Hecker, B. t. W., 1898, 61.—
Borzoni, N. Ere., 1907, 292.

In fowls cases of the disease which were mentioned already by
Spinola are exceedingly rare. The location of the exanthema is either
on the head (around the nostrils, comb, conjunctiva, mucous membrane
of the bills), or the feet (claws, in water fowl on the webs). Sometimes
however the vesicles may also develop on other parts of the body.
Wildner observed the disease in two townships in an enzootic form,
where it affected chickens and pigeons severely. The buccal mucous
membrane scaled off in shreds, the feet swelled up to the tarsus and the
skin between the claws was covered with numerous small vesicles; in
some birds not only the claws dropped off, but also the last joints of
the toes. On the feet of the animals which remained alive great deform-
ities developed.

Literature. Spinola, Spez. Path., 1858, II, 883.—Schindelka, Monh., 1892, LV,
125.

Foot-and-Mouth Disease in Man. As man is also susceptible to
the virus of foot-and-mouth disease, it may frequently be transmitted
to him if it occurs in an epizootic form. The infection is mostly
transmitted by raw, or insufficiently heated milk from affected cows, or
by whey (Dieckerhoff), cheese and butter (Schneider, Frick, Froéhlich)
prepared from such milk. In rare instances persons engaged in work
around the infected animals may contract ‘the disease by direct con-
tact with the affected parts of the body, as in milking, slaughtering, or
during the treatment of the patients. Bertarelli succeeded in one case
in transmitting the disease back to a calf.

Bussenius & Siegel report 16 epizootics in the years of 1878-1896, in the course
of which entire families, sometimes all inhabitants of certain houses, and even town-
ships became affected. During different outbreaks the cases terminated fatally in
36, 23, and 16 instances respectively.

The disease develops in man usually in a mild form, except in
children, in which an associated gastro-intestinal catarrh may lead to
death. During some of the outbreaks however, adult persons also be-
came severely affected.

After the ingestion of raw milk the symptoms are as follows:
at first mild fever, sometimes with vomiting, soon a feeling of warmth and
dryness appear in the mouth, the mucous membrane of which becomes
reddened, especially on the lips, gums and on the cheeks; later vesicles as
large as peas develop at these places, sometimes also on the borders
of the tongues, and even further back. After they burst the lost epi-
thelium is soon replaced. Similar vesicles also develop occasionally on
the conjunctiva and on the skin of nose and face. The skin exanthema
appears most frequently on the hands, on the points of the fingers, on
the base of the nails, and on the volar surface of the finger tips, more
rarely also on the toes or on other parts of the body. After the vesicles
burst a thin scab forms, under which the new formation of epithelium
progresses rapidly.

Besides these local changes headaches and pains in the extremities,
dizziness, stomach cramps, vomiting, diarrhea and great dullness may
be observed from case to case.

Literature. Kordnyi, Nothnagels Handbuch, 1900, V. Bd. I. T.
356 Coital Exanthema.

3. Coital Exanthema. Exanthema vesiculosum coitale.

(Vesicular exanthema; Bldschenausschlag [German]; Exan-
théme coital [French].)

Coital exanthema is a disease of cattle and horses, more
rarely of sheep and hogs, characterized by vesicular exanthema
of the external genital organs. It is usually transmitted from
animal to animal during the act of coitus, and usually termi-
nates in complete recovery. The cause of the disease is at
present unknown.

Occurrence. The disease occurs more frequently among
cattle than in horses. It is observed annually, especially in
spring and summer, in Germany, Austria and Hungary, while
in Denmark and on the Scandinavian peninsula it also appears
sometimes. However it is probable that it is known also in
other countries (in France it is considered identical with pox).
Considerable losses are sustained in extensive outbreaks of the
disease, because of the diminished milk secretion in cows, the
inability of draught animals to work, and from the prevention
of impregnation, and consequently the deferring of the lacta-
tion period in cows.

In Germany in 1908, 206 ‘horses and 4680 cattle were affected in 1194 town-
ships, the disease occurring principally in Wirttemberg, Prussia, Bavaria and Baden.
In Austria during the period 1891-1900, on an average 26 stallions, 168 mares,
84 bulls, and 510 cows were affected; the number of the affected townships in 1908
reached 51, and in these 159 premises were infected. In Hungary between 1897
and 1908 the affected townships increased from 43 to 278, the number of affected
horses from 81 to 2780, of cattle from 134 to 1662. The disease occurs most frequently

on the right banks of the Danube, and in the territory lying between the Danube
and Theiss rivers. In other countries the disease is not recorded officially.

Etiology. The virus, which is unknown at present, is con-
tained in the serous or purulent contents of the vesicles, and
in the secretion of the ulcers, and is easily transmitted with
these fluids from the affected to healthy animals.

The infection occurs mostly during copulation, in which
male animals may infect females and vice versa; in large herds
however the disease is transmitted mainly by the males.
Stallions or bulls may transmit it without themselves being
affected, after covering an affected mare or cow, and trans-
mitting the infectious secretion with the penis to the genitals
of a healthy female. This method of infection is however
only observed when male animals repeat the copulation inside
of a few hours. The spread of the disease is probably
also facilitated by the fact that affected females show in the
early stages of the disease symptoms resembling the period
of oestrum, and consequently are taken to the male.

In some cases the disease may also occur in advanced stages
of pregnancy, or in animals which have not copulated, among
which it sometimes may spread extensively (Fenner observed
the disease in the course of one year among 746 heifers), and
Etiology, Symptoms. 357

exceptionally 14 to 1 year old colts and calves and even steers
may become affected. In these cases the infection develops by
contact with the infected animals, being transmitted by straw
coutaminated with infectious secretions, stable floors or manure,
further by sponges and by the hands of the attendants. Affected
mares may transmit the disease to the lips of their colts during
sucking.

Cattle are most susceptible to the disease, horses consid-
erably less, and to a still slighter degree sheep, goats and hogs.
Recovery from the disease reduces the susceptibility for a time;
the duration of the immunity however is unknown, and excep-
tionally the same animal may become repeatedly infected at
short intervals (Fenner, Kalb).

The relation of the affection to other diseases, which are also asso-
ciated with a vesicular exanthema, has not yet been established. The
supposition towards its identity with foot-and-mouth disease (Zlamal,
Hertwig) or with dourine (Spinola), has been discarded, but French
authors (Trasbot, Peuch, Nocard & Leclainche) consider it, even in
recent times, as a form of pox. The majority of authors consider the
affection as a disease by itself, which view corresponds with its inde-
pendent occurrence, and its almost invariable localization. upon the
genital organs.

It has likewise not been definitely established whether the disease
is-caused by the same virus in the various species of animals, as inocu-
lation experiments have failed to give uniform results. According to
observations made it usually spreads among the animals of the same
species, and does not pass from horses to cattle, or vice versa. Neverthe-
less the almost complete resemblance of the clinical appearance in the
various species indicates an identity, or at least a very ‘close relation-
ship of the affections, and the veterinary police treat the trouble among
horses and cattle in this sense.

Exceptionally the transmission of the virus to man has also been
observed, when a pustular exanthema appears on the hands and on
the face, and the affected person infected other members of the family.

_ Symptoms. The time of incubation is as a rule from 3
to 6 days, in exceptional cases the symptoms may appear even
in from 24 to 48 hours after the infection, while in some in-
stances the period of incubation may extend to 10 or 11 days
(Friedberger & Fréhner, Dieckerhoff).

The characteristic signs of the disease develop on the ex-
ternal genital organs. In female animals the reddened, and
exceptionally also the hemorrhagic mucous membrane of the
vagina, shows in from 2 to 3 days, lentil to pea-s'zed vesicles,
which are filled with a clear, yellowish fluid. The vesicles appear
on a reddened and swollen base, especially on the upper commis-
sure, and in the vicinity of the clitoris, as well as on the inner sur-
face of the vulva, in male animals on the glans penis in the vicinity
of the urethral opening, in rare cases also on the immediately
surrounding skin. Small nodules may also appear, later chang-
358 Coital Exanthema.

ing into vesicles, which at first contain a serous, later a purulent
fluid. After a short existence the thin walls of the vesicles
burst, and in their place erosions remain, which show desqua-
mation of epithelium, or deep, penetrating ulcerations may
follow, with reddened bases and sharp borders, producing a
yellowish, sticky, lymphatic or a more purulent secretion, which
dries in the air to yellow or brownish scabs. The ulcers later
become covered by granulation tissue, on which a new layer of
epithelium soon forms. In the place of the deeper ulcerations
white scars remain, which later take on a yellowish-red color,
and are almost unrecognizable.

In male animals the glans penis swells, in severe cases also
the sheath or the scrotum, and the prepuce. Vesicles may also
develop on the skin of these parts. The swelling sometimes
reaches such a degree that a true phymosis, or a paraphymosis
develops. At the same time continuous erections of the penis
are frequent, and a desire for urination exists, as well as a
yellowish, mucous or purulent discharge from the urethra.

In female animals the lips of the vulva are especially
swollen, but the edematous infiltration extends also to the sur-
rounding parts, and even to the legs. In mares frequent con-
tractions of the clitoris are observed, while the vagina dis-
charges a muco-purulent material. A similar discharge occurs
also from the genitals of cows and smaller animals.

The affected animals manifest great itching, as a result
of which the females rub their hind parts against solid objects,
they wag their tails, arch their backs, strike at the abdomen,
and stand frequently in a position for urinating.

The lymph glands of the groin and of the vicinity of the
rectum are usually swollen, elastic, dense, and more or less
sensitive.

The nervous condition is hardly affected with the exception
of the restlessness produced by the itching; sometimes slight
digestive disturbances, diminished appetite, delayed rumination,
a reduction of milk secretion, etc., are observed. In the presence
of very numerous pustules these symptoms may reach a high
degree, and in such cases symptoms of restlessness and strain-
ae are especially severe. Pregnant animals exceptionally
abort. ,

The described symptoms may become more aggravated as
a result of external, harmful influences. The original slight
inflammatory process is sometimes considerably increased by
the continuous severe rubbing, when the open surfaces of the
wounds may subsequently become infected by dirty material.
In such cases the ulcers have a malignant appearance, they are
covered by yellow crusts, and penetrate into the deeper parts,
as a result of which crater-like depressions develop at the base
of the ulcers. The edematous infiltration in the vicinity of the
genital organs may reach a high degree, and may extend also
to the lower abdomen, and to the inner surface of the thighs,
Symptoms, Course, Diagnosis, Treatment. 359

The neighboring lymph glands may suppurate, leading to
abscess formation in the vicinity of the anus and in the groins;
exceptionally such may also occur in the tissue of the udder.
At the same time the gait is stiff, sensibility is greatly depressed,
the appetite impaired, the body temperature increased, and the
fever may be remittent. Finally pyemia or septicemia with
their usual severe results may follow the local affection through
the development of a general infection.

Course. In the great majority of cases the disease runs a
course of 2, more rarely of 3 to 4 weeks, and terminates in com-
plete recovery. The severe cases may always be traced to a
subsequent septic infection, or to traumatic influences; in such
cases the infection may be so intense, and the changes in the
tissue so severe, that convalescence may extend to several
months; sometimes entire recovery fails to follow or the disease
may terminate in death. Although even larger wounds may
heal without scar formation, in some cases a chronic vaginal
catarrh follows, which may result in sterility of itself, or through
an extension to the uterus. In bulls the deep penetrating abscess
formation may result in a deformity of the penis (Kampmann),
or a weakness of the penis remains, which prevents the animals
from the act of coitus.

Diagnosis. The thin walled vesicles on the genital organs
assure the diagnosis, and distinguish the disease from the other
inflammatory local affections. If ulcers have already developed
from the vesicles, it can be distinguished from traumatic inflam-
mation only by. its infectious nature, and by the rapid recovery.
In infectious vaginitis of cattle, with which this disease has
been frequently confounded, hemp-seed size, grayish-red nod-
ules on the mucous membrane are characteristic, which remain
for a long time, and only exceptionally change to small ulcers.
In horses dourine comes into consideration; in this however
there is also no vesicle formation, and it develops with less
acute symptoms and is later associated with nervous mani-
festations. ©

Treatment. Mild cases recover without any treatment.
Keeping the genital organs clean and washing with mild disin-
fectants and astringents hasten the recovery. For this pur-
pose alum, sulphate of zine (14%), boracic acid (3%), iron and
copper sulphate (1%), acetate of lead (1-2%), carbolic acid,
creolin, lysol, or chinogol in 2-3% solutions, may be used, with
which the affected parts should be washed two or three times a
day. In the presence of a severe vaginal catarrh, irrigations of
the vagina with the same solutions may be undertaken. If the
ulcerations are unclean, with deep penetrating destruction of
tissues, they may properly be cauterized with nitrate of silver,
or copper sulphate. J. & H. Streit recommend the blowing into
the vagina of a powder consisting of four parts of sulphate of
360 Infectious Pustular Stomatitis of Horses.

zine and one part of boracic acid (1 teaspoonful per cow) ; Gallia
advises the introduction of bacillol capsules into the vagina.

Veterinary Police. The most important measures for the
prevention of the spread of the disease consist in the exclusion
of the affected animals from breeding during their disease. The
infectiousness of the animals may be considered extinct when
all inflammatory manifestations of the genital organs and the
discharge have disappeared, and the mucous membrane has
regained its former smoothness and pale red color. During a
general prevalence of the disease, the prohibition of breeding
is indicated until the disappearance of the disease in the affected
localities.

Literature. Hertwig, Mag., 1842, VIII, 269; 1847, XIII, 376.—Spinola, Spez.
Path., 1858, IV, 1486—Hamm, D. Z. f. Tm., 1901, XVII, 147.—Kampmann, O. Re-

vue, 1887, 81.—Fenner, Monh., 1891, II, 196.—Ehrhardt, Schw., A., 1896, XXXVIII,
79.—Streit, B. t. W., 1901, 496.—Nocard & Leclainche, Mal. microb., 1903, I, 598.

Infectious Sexual Disease in Rabbits and Hares. Friedberger &
Froéhner observed an infectious disease of the external genital organs
(vulva, preputium) in a rabbit breeding establishment, which was char-
acterized by swelling of these parts, and by a muco-purulent discharge.
Treatment continued for weeks, with a 1 to 2% copper sulphate solution,
resulted finally in recovery. (Spez. Path. 1908, II, 496.)

A similar disease in rabbits was noted by Strangeways, only that
in this case ulcerations developed on the genitals, and also on the lips
and nostrils. The autopsy revealed abscesses of the internal organs
(J. of comp. Path., 1906, XTX, 9).

4, Infectious Pustular Stomatitis of Horses. Stomatitis pusto-
losa contagiosa equorum.

Infectious pustular stomatitis is a benign, acute febrile
infectious disease of horses, which aside from its pronounced
contagious nature, is principally characterized by a pustular
exanthema of the mucous membrane of the mouth. The caus-
ative factor is at present unknown.

History. The disease was first described under the present name
by Eggeling & Ellenberger (1880), as an independent affection. For-
merly it was identified with foot-and-mouth disease of the cloven-footed
animals (Roll), or with coital exanthema (Hertwig), and again by some
authors (Gauthier, Silvestri, Flemming) was considered identical with
horse pox. Since the publications of the first mentioned authors, whose
observations were later confirmed by Friedberger, the independence of
the disease is generally recognized except in France and England, where
according to Bouley’s conception it is even at the present considered
as horse pox (see pp. 301 and 324).

Occurrence. The disease is observed especially in younger
horses, and mostly as a stable infection. Its economic impor-
‘tange lies in the fact that the affected horses are incapacitated
for work during its duration, and are poorly nourished.

 
Occurrence, Etiology, Symptoms. 361

Among the horses of the Prussian Army, from 1904-1906, 48, 118 and 3 cases
were observed, and in 1908, 16 cases were found.

Etiology. The virus is apparently contained in the nodules
and pustules on the mucous membrane and skin, and becomes
mixed with their contents, also with the secretions of the mucous
membrane, as well as with the saliva of the infected animals.
Horses may be infected by rubbing the infectious saliva into
the mucous membrane of the mouth or nose, or by superficial
scarification of the skin; sometimes transmission is also suc-
cessful to cattle, sheep, hogs and chickens (Eggeling & Ellen-
berger, Friedberger). Man is also susceptible to a certain
degree, as the hands and the face of persons who were employed
around infected animals (Greswell, Ellenberger, Schultz) some-
times develop a febrile dermatitis with pustular formation
associated with salivation and difficulty in swallowing. Under
natural conditions the disease occurs only among horses.

The natural infection is as a rule transmitted by the saliva
and the nasal discharge from affected animals, which reaches
the mucous membrane of healthy animals with the drinking
water, food, straw, or from the hands of the attendants. The
fact that the disease does not spread over large territories, but
disappears of itself in a relatively short time, indicates that the
virulence of the virus is attenuated during its passage from
animal to animal, or that the virus is soon destroyed in the outer
world.

Young horses are much more susceptible than older ani-
mals, but variations in the susceptibility are also noted in the
individual animals. In large stables most horses usually become
successively affected, some however remain healthy. Horses
which recover from the disease resist a new infection for a
long time, the extent of which is not known.

Symptoms. After a period of incubation which in artificial
inoculation is 3 to 5, and in natural infections 8 days, the disease
commences with a moderate fever, which is manifested by a rise
in temperature of from 1 to 1144 degrees, as well as a moderate
acceleration of the pulse and debility. The animals take their
feed more slowly, masticate cautiously, and enjoy playing with
the lips in the water offered them. At intervals they keep the
mouth closed, when from its corners pure saliva drips out in
long threads.

The mucous membrane of the mouth at first has a higher
temperature; it is painful and reddened in spots; soon the red
spots coalesce, and at the same time hemp-seed to lentil, or even
pea-size hard nodules develop on the inner surface of the lips,

on the gums lying opposite, and also on the intervening folds,
further in the vicinity of the frenum of the tongue, in the vicinity
of the commissures of the mouth, and on the inner surface of
the cheeks. Fresh nodules continue to develop for 2 to 3 days,
until they appear in great numbers upon these places and
362 Infectious Pustular Stomatitis of Horses.

coalesce in part. In mild cases however they only occur in small
‘numbers. With the reduction of the fever the nodules change
into vesicles owing to dissolution of the cellular elements and
accumulation of pus cells. Those which develop from very small

 

Fig. 60. Nodules, pustules and ulcerations in the infectious pustular stomatitis.

nodules contain clear serum, and after they burst very super-
ficial erosions remain which become covered with fresh epi-
thelium in from 1 to 2 days. The large nodules change into
pustules after the conical point turns gray and later white.

 

 
Symptoms. 363

At their places somewhat deep, round ulcers develop later, which
extend to the submucosa, and hardly ever exceed the size of a
lentil (Fig. 60).

The center of the ulcers is formed by easily-bleeding granu-
lation tissue, while the periphery appears covered for a time
with a grayish-white deposit. After granulation tissue fills the
ulcers they heal with fine scar tissue, which later gradually
becomes pale. Only when the suppuration penetrates deeper
does a thicker scab form, which becomes distinct from the other
healthy tissue of the mucous membrane by its white color and
moderate depression. :

In some cases the process also extends to the nasal mucous
membrane, when nodules, and from these, pustules develop on
the inner surface of the nostrils, more rarely on the nasal sep-
tum, but always in the vicinity of the border of the skin. The
highly reddened, and swollen mucous membrane secretes a muco-
purulent discharge, which dries on the borders of the nostrils
to brown crusts. The inflammation sometimes extends to the
eyes by transmission through the lachrymal duct, the conjunc-
tivae then showing catarrhal swelling, while from the slit of
the lids lachrymation is profuse. The secretions sometimes take
on a purulent consistency, and sometimes small pustules may
make their appearance on the eyelids. (Mieckley observed kera-
titis, and iritis, associated with an affection of the mucous
membrane.) The exanthema has exceptionally been observed
also on the inner surface of the vulva.

Nodules and pustules develop on the mucous membranes,
and sometimes on the skin, which result in ulcerations. Such are
especially observed on the skin of the lips, the nostrils and the
cheeks; in exceptional cases also on distant parts of the body, as
on the chest, on the upper arms, on the thighs, in the vicinity of
the rectum, and on the genitals, occasionally also around the pas-
tern, or over the entire skin (Rehnitz). On the affected parts
nodules up to the size of a pea develop in a similar way as on
the mucous membrane, only that dry secretions, together with
sticky tufts‘ of hair, cover the ulcers in the form of brown scabs
the healing progressing subsequently under these scabs.

Dieckerhoff observed repeatedly that the exanthema in some horses
of large stables developed exclusively on the skin, while the mouth
remained free from the infection, although the origin and the nature
of the infection could not be doubted, as typical cases occurred at the
same time in other horses of the same stable. On the other hand Fried-
berger observed a case in which the nasal mucous membrane and the
bordering skin were alone affected. _

An inflammation of the mouth similar to pustular stomatitis has been ob-
served by Bochberg, which appeared in five horses of a large stable. In this in-
stance pustules with depressions in the centers developed also in the neighboring
skin.

In regard to an epizootic stomatitis observed by Theiler in South Afriga, see
under Chap: Stomatitis vesiculosa Vol. HH.
364 Infectious Pustular Stomatitis of Horses.

The lymph glands in the immediate vicinity of the affected
part of the body, that is the retro-pharyngeal glands, become
more or less acutely swollen. The swelling diminishes with the
formation of the ulcers, and soon disappears entirely. Excep-
tionally however it may lead to abscess formation (Mariott,
Groner). The lymph vessels leading to the swollen iymph
glands are thickened to distinctly perceptible cords in those cases
in which the exanthema develops on the skin. They likewise
disappear after the glands have regained their normal condi-
tion. If the inflammation of the mouth extends posteriorly the
clinical manifestations include symptoms of a mild pharyngeal
and laryngeal catarrh. Exceptionally the hair falls out in the
course of the disease, and the animals become greatly emaciated
(Groner). :

Course. The disease lasts as a rule from 10 to 14 days,
but in somewhat more severe cases it may extend to 3 or 4
weeks. The pustules develop in from 3 to 6 days after the
appearance of the first symptoms. The suppuration requires
another 4 to 6 days, and the healing of the ulcers requires about
the same length of time. A longer course is observed in cases
in which the pustules develop in slower succession, or the sup-
puration becomes malignant, through a subsequent septic infec-
tion, in which cases the healing of the deeper destruction of tis-
sue requires a longer time.

Very exceptionally the disease may also terminate in death.
Péschl observed in a stud the deaths of three colts with mani-
festations of severe pharyngitis and septicemia, in which the
autopsy revealed marked swelling and suppuration of the folli-
cles of the mucous membrane of the pharynx and larynx, hem-
orrhages in the serous membrane, the spleen and the mucous
membrane of the stomach, also an acute swelling of the mesen-
teric lymph glands. In one case (Bayr. Mil. V.-B.), the affection
became complicated later with a diphtheritic inflammation of the
buccal mucous membrane, later diphtheritic ulcerations ap-
peared also on the skin and on the nasal mucous membrane,
and the animal died from general septicemia. Goldschmidt ob-
served the death of five affected horses from similar causes.

Diagnosis. Vesicular or follicular stomatitis somewhat re-
sembles pustular stomatitis, but in the former no nodules pre-
cede the development of vesicles, and the vesicles contain only
a clear serous fluid. Inflammations resulting from injuries or
corrosions are distinguished from this affection by the history
of the case, and by the deeper penetrating destruction of tissues
in such conditions.

A mistake is more readily possible when, besides the mucous
membrane of the mouth, that of the nose and the skin is also
affected, and still more when the affection is exclusively localized
to these parts. In such cases the following diseases enter into
Diagnosis, Treatment, Prevention. 365

consideration: contagious acne; in this however the pustules
are always larger, they usually develop only in the region of the
withers, and in its immediate surrounding, while they never
occur on the mucous membranes ;—the coital exanthema, in
which however the vesicles are confined to the mucous mem-
brane of the genital organs and the neighboring parts of the
skin, and usually develop after copulation ;—pox, which usually
occurs only on the skin, and around the flexor region of the
pastern ;—glanders, a suspicion of which may sometimes be
aroused by the affection of the mucous membrane and the neigh-
boring parts of the skin, also by the swelling of the lymph
_glands. In this disease however there are no changes in the
buccal cavity, the ulcerations in the nose develop from nodules,
and the ulcers of the skin show no tendency towards healing;
in doubtful cases the rapid spread of the disease in stables,
and the rapid and complete recovery excludes glanders.

Treatment. In the mild form of the disease a purely dietetic
treatment is usually sufficient. Less oats should be given to the
horses, and instead they should be given green feed, soft, fine
hay, or flour and bran gruels, also pure, fresh water frequently.
It is advisable to flush the mouth 3 to 4 times daily with any
mild disinfecting fluid (1 to 2% solutions of iron or copper
sulphate, or potassium chlorate, 2 to 3% creolin or lysol). The
ulcers on the skin should be treated in a similar way or with
dusting powder (dermatol, tannoform, etc.). In conjunctivitis,
sulphate of zine or tannin (14%) gives good results.

Prevention. Not infrequently the spread of the disease in
the threatened stables may be checked by immediate isolation
of the horse first affected. For this purpose it is sufficient to
separate the affected animal together with its neighbor by
an empty stall from the other animals, only they must be at-
tended by special persons, and separate utensils, special pails
and sponges must be used in their care.

td several horses are already affected in a stable, and if a
spread of the disease is expected by the existing conditions, it
is advisable to undertake emergency inoculation of the healthy
animals in order to shorten the duration of the disease. The
inoculation is readily accomplished by rubbing saliva from the
affected horses on the inner surface of the lips, which have been
previously rubbed with a coarse linen cloth.

After the disappearance of the disease the stalls of the
affected horses and all stable utensils should be washed with

a hot solution of lye.

Literature. Hertwig, Mag‘, 1841, VIII, 305.—Bouley, Dict. de méd. vét., 1871,
IX, 451—Eggeling & Ellenberger, A. f. Tk., 1878, IV, 334.—Friedberger, D. Z. f.
Tm., 1879, V, 265; Miinchn, Jhb., 1882-83, 66; 1886-87, 50; 1889-90, 141.—Diecker-
hoff, Spez. Path., 1892, I, 391—Schultz, Miinch. m. W., 1894, 201.—Gréner, Vet.
Jhb., 1895, 97.—Péschl, A. L., 1904, 681.—Rehnitz, S. B., 1906, 176.
Grovp ITI.

ACUTE INFECTIOUS DISEASES WITH LOCALIZATION
IN CERTAIN ORGANS

1. Strangles. Adenitis equorum,

(Coryza contagiosa equorum; distemper; Druse der Pferde,
[German]; Gourme [French]; Adenite equia [Italian].)

Strangles is an acute, contagious, infectious disease . of
horses, in the course of which catarrhal symptoms of the upper
air passages develop in association with suppurative inflamma-
tions in the adjoining lymph glands, and sometimes in a
metastatic form in more distant lymph glands. The strepto-
coceus equi is considered at the present time as the cause of
the disease.

History. The disease, which is very prevalent among horses, and
especially among colts, has long been considered as a specific affection of
the young, which was supposed to be essential to the normal develop-
ment of the animal, while similar affections of older animals were con-
sidered as an entirely different disease (Solleysel, Vitet, Lafosse). It
was also supposed (Spinola), that it might sometimes lead to glanders
(Traeger [1836] was the first to take a stand against this view).

Bowinghausen recognized the contagious nature of the disease
towards the end of the eighteenth century, while Viborg demonstrated
the infectiousness of the nasal discharge of the infected horses by inocu-
lation experiments at the beginning of the last century. Schiitz in
1888, and independently of him, Jensen & Sand, as well as Poels, estab-
lished the etiological importance of the streptococci which are present
in the nasal discharge and in the pus of the glands.

Occurrence. Strangles occurs almost annually in studs and
sale depots, when it usually affects practically all the young
foals in a varying degree. In later ages it is rarely observed,
and almost exclusively in horses which have not passed through
the disease while young. It occurs almost everywhere (Ireland
and Argentine are supposed to be free of the infection), and
although its course is usually favorable, yet it may cause con-
siderable loss to the horse owner through frequent disturbances
in the development of the colts, and also by occasional deaths.

In the years 1899-1908, 1753 horses were affected with strangles in the Prus-
sian Army, of which 43 died, and 49% of the affections occurred in the last

366
Occurrence. Etiology. 367

‘quarter of the year. In the French Army in the years 1900 and 1901, 18,165 cases
with 283 deaths occurred among about 100,000 horses.

Etiology. Streptococci (Streptococcus equi Schiitz) are in-
variably present in the lymph glands and in the nasal discharge
of affected horses, formed by cocci arranged in the manner of
a string of pearls; these are not always uniform in size and
are frequently split transversely. The rounded chains consist
of 50 to 60, and even more segments, but much shorter chains,
and also diplococci and single cocci may occur. They stain well
me aqueous aniline dyes, as well as by Gram’s method (Fig.
61).

Cultivation. The streptococcus equi may be cultivated aerobically
and anaerobically, at room as well as body temperature. On gelatin
very fine white points develop along the
inoculation streak, on agar the colonies
have hardly the size of a poppy seed; they
are grayish-white, not transparent, not
coalescing, and closely adhering to the
medium. On coagulated blood serum
glassy transparent, yellowish-gray droplets
develop, which later may coalesce forming
a tenacious layer. In the water of con-
densation a fine precipitation results,
which consists of very long chains, In
bouillon the organisms grow in fine flakes,
which accumulate on the bottom of the
tube and over which the fluid remains
clear; the growth is favored by the addi- Fig. 61. Streptococcus equi.
tion of blood serum. No growth results on Pus from gland; fuchsin stain-
potatoes. Milk is coagulated; dextrose is anes
not fermented.

 

The relation of streptococci from different derivations to each other has not
yet been sufficiently established. While Schiitz considers his streptococcus as an
independent species, Foth believed it identical with Schiitz’s diplococeus of influenza,
and also with the streptococcus pyogenus of man. Ligniéres considers the identity
of streptococcus of strangles and that of influenza proven beyond a doubt, while
he believes that Rosenbach’s pyogenic streptococcus, which among other diseases
plays a part in purpura hemorrhagica of horses, is an independent species. This
conception is supported also by the experience that blood serum from animals immu-
nized with 1 of the 2 above mentioned streptococci immunizes only against the respeé-
tive varieties (Ligniéres), and the serum from a horse treated with the strepto-
coceus of strangles agglutinates this streptococcus in the proportion of 1:100, while
other pyogenic streptococci from animals are agglutinated only at 1:25, and the
human, on the other hand, have only a very slight or no agglutinating powers (Pior-
kowski). Similar results were also observed by Angelici. He found that the serum
of a horse hyper-immunized with strangles streptococci had an agglutinating value
of 1:10000-20000, whereas streptococci cultivated from wounds and intestinal con-
tents agglutinated in much lower dilutions. Marmorek considers the two forms of
streptococci as not identical, based on his observation that horse streptococci thrive
in filtrates of cultures of the streptococcus of man. Besides this Ludwig found some
differences in inoculation of cultures on Léffler’s serum, which were manifested by
the fact that the streptococcus of strangles produced larger colonies than the
streptococcus of man, or the streptococcus of mastoitidis, The identity of the
streptococci of different origin is still an unsettled question, the solution of which
is surrounded by great difficulties inasmuch as in animal experiments one and the
same streptococcus may produce various disease processes (erysipelas, suppuration).

‘Baruchello found streptococci 92 times in 97 samples of feces from 87 horses,
268 Strangles.

which he considers as harmless habitants of the intestinal tract, but which may
become harmful under certain conditions, alone or in connection with colon ba-
cilii.

Tenacity. Streptococci belong to the more resistant bacteria, They resist
drying, especially in pus or blood, tor several weeks. A temperature of 70-75. de-
grees destroys them in 1 hour, while frozen bouillon cultures are still active after
two days. They are destroyed inside of 15 minutes by sulphuric acid 1:150, sodium
hydrate 1:85, corrosive sublimate 1:1500, iron sulphate 1:125, carbolie "acid or
lysol 1:200, and creolin 1:80 (Lingelsheim).

Pathogenicity. Subcutaneous inoculations of a pure cul-
ture, or pus from a gland produces in mice a purulent inflam-
mation of the subcutaneous connective tissue and lymph glands,
also metastatic abscesses in the internal organs. Rabbits are
less susceptible, and guinea pigs to a still lesser degree. Intra-
peritoneal inoculations, however, are fatal to rabbits (Ludwig),
while cutaneous inoculations into the ears produces erysipelas
(Jensen & Sand). A subcutaneous injection in horses causes a
purulent inflammation at the point of inoculation, with partial
necrosis of the tissues; an injection of pure culture into the
nasal cavity, especially if the mucous membranes have been pre-
viously rubbed, develops an acute nasal catarrh, and suppura-
tion of the submaxillary lymph glands; therefore the typical
clinical manifestation of strangles (Schiitz). Rubbing pus con-
taining streptococci upon the scarified skin produces a febrile
vesicular dermatitis, which heals within a short time. The infec-
tion of cattle is sometimes successful (Jolly & Leclainche).

Natural Infection. The results of the experiments just
alluded to indicate that the causative factor of strangles, when
reaching the nasal cavities, produces there a purulent or muco-
purulent inflammation of the mucous membrane; but there exists
also a possibility that the virus may primarily attack the tissues
from other organs, especially from the pharynx and the intes-
tines. Schiitz based the belief on his microscopical examinations
of liver sections from mice, that streptococci penetrate the walls
of the blood capillaries, and that therefore the infection may
take place through the uninjured mucous membranes. As strep-
tococci may easily colonize in the numerous recesses of the nasal
cavities, where they may continue to multiply, the nasal. secre-
tion of infected animals may transmit the disease to a healthy
horse when it reaches its nasal cavities.

Under natural conditions the infection occurs usually
through the nasal secretion or pus from affected animals enter-
ing, directly or by transmission with contaminated substances
(food, drinking water), the upper air passages of a healthy horse
(nasal cavities, buccal cavities), where it adheres to the mucous
membrane. It is also very possible that infection takes place
through the uninjured mucous membrane, where the hacteria
very likely penetrate the excretory ducts of the mucous glands.
The disease which usually attacks all the colts in a stable, ‘eould
hardly he explained otherwise; on the other hand the infection
is favored by conditions of the mucous membranes in which
Natural Infection. 369

there is a desquamation of epithelium, or by deep penetrating
injuries.

The disease occurs usually when affected or not entirely
recovered animals are introduced into the stable. The outbreak
of the disease in the studs of Mezohegyes is usually associated
with the introduction of colts purchased from different parts,
and from similar causes the disease frequently develops in colts
at remount depots. According to the investigations of Jolly &
Leclainche scabs from an exanthema of the skin of colts affected
with strangles may also disseminate the infection.

The air evidently plays an important part in the transmis-
sion of the infection, inasmuch as in the warm and moist stable
air the virus expelled during coughing and blowing may float
for a considerable time attached to the droplets, and later enter
the upper air passages of healthy animals. This form of trans-
mission through the air is less dominant out of doors, first
on account of the smaller quantity of moisture, and second on
account of its more rapid movement, which results in the rapid
dilution of the expelled virus.

Through contamination with nasal discharge and pus from
the glands the most varied objects may become carriers of the
infection, such as cribs, drinking utensils, the food, the drinking
water, straw, walls, floor of the stables, the grass in the pasture,
further the hands and clothes of the attendants. The fresher the
secretion the greater its virulence; drying however does not
wholly destroy its infectiousness. The disease usually occurs
annually almost at the same time of the year in stables of colts,
if they have not in the meantime been cleaned and disinfected.
It usually appears in the spring, and it is not possible in all
instances to prove a fresh introduction from the outside. In
such cases it must be assumed that the virus remained in the
stable after the disappearance of the disease, and was there
dormant for months until it again attacked the susceptible indi-
viduals of the new generation of colts, and thereby caused a new
outbreak of the disease.

-The infection probably enters from the digestive tract,
and especially through the intestinal mucous membranes in
those cases in which it affects primarily or exclusively, the
lymph glands of the mesentery. However up to the present
time it has not been possible to produce this form of the disease
by feeding infected food.

In copulation an infected stallion may transmit the disease
to mares, and in such cases there appear symptoms of a vaginal
eatarrh, while the lymph glands in the vicinity of the external
genital organs and of the rectum, as well as in exceptional
eases also the udder, become affected (van Leeuwen, Preuss.
V.-B., Bierstedt). Affected colts may infect their mothers dur-
ing sucking and cause an inflammation of the udder and the
neighboring lymph vessels (Bermbach; in one case necrosis of

one half of the udder and later a fatal septicemia resulted).
Vol. 1—24
370 Strangles.

There is another possibility which has been emphasized
by Schiitz, that among other streptococci which are very widely
distributed in nature the streptococci of strangles may live
outside of the animal bodies as saprophytes, and under favor-
able conditions may attack the colts, especially when the
animals are weakened by outside influences. In this manner
those cases can be explained in which the disease appears in
localities after years of absence, without any demonstrable in-
troduction.

Solipeds are exclusively susceptible to the disease, and they
become infected at the age of 14 to 5 years, mostly however
while they are colts. In rare cases the disease may occur at
the age of 1 to 2 months and also in animals over five years
of age. The greater susceptibility of young animals is as-
sociated with the lesser resistance of their mucous membranes.
The greater resistance of older animals is however probably
the result of their having already passed tlirough an attack
of the disease. According to common experience it usually
attacks animals only once during their lives, and the immunity
resulting from one attack may be proven experimentally
(Toggia). In exceptional cases the acquired immunity does
not last through the entire life, as some horses may become
affected repeatedly, but in such cases the attacks are usually
separated by intervals of several years, while cases in which
an animal becomes repeatedly infected in one year (Holterback)
are exceptionally rare.

According to Viborg and Hertwig out of 100 horses affected with strangles
70 were less than 5 years old, 20 more than 5 years, and 10 over 15 years. Accord-
ing to Humbert’s observations covering four years in the vicinity of Snippes

(France), of all horses over two years of age 2195 were affected once, 543 twice,
121 three times, and 1641 animals did not contract the disease.

Outside influences which reduce the natural resistance of
the animals, especially colds, favor the infection, by causing
a catarrh of the mucous membrane of the air passages, as a
result of which the epithelia become loosened, and thereby the
bacteria colonize more readily in the profusely accumulated
secretion, from which place they may penetrate the tissue of
the mucous membrane.

Usually weakened and poorly nourished colts are particu-
larly susceptible to the disease. In this regard, stabling in
poorly ventilated excessively warm stables, insufficient feeding,
sudden changes of weather, fatigue during transportation, also
pre-existing illness have a modifying effect on the individual
susceptibility. The cases in older horses usually have a direct
connection with such factors. On the other hand the resistance
is increased by work, acclimation to the changeable outside in-
fluences and hardening. Other accessory conditions, such as
temperament, teething, etc., have no influence on the suscep-
tibility. ;

Peterson observed an instance in which all the colts of a stud became affected
with strangles after standing for half an hour in a pond, and later being exposed on
Natural Infection, Pathogenesis. 871

a high elevation to cold winds, and being further provided with cold water to drink.
According to Cagny the disease occurs in certain localities of France less fre-
quently and runs a milder course since the colts are driven home from the pas-
tures in the month of September.

Pathogenesis. The streptococci which reach the surface of

the nasal mucous membrane, colonize in the numerous side
cavities of the upper air passages, and after multiplying there
they penetrate the mucous glands, from which they pass into
the lymph spaces of the tissue of the mucous membranes, along
which they gain entrance to the submaxillary lymph glands. In
case of an infection from the mucous membrane of the pharynx,
eee or vagina, they are held up in the neighboring lymph
glands.
Under the local influence of the penetrating bacteria
hyperemia and serous infiltration of the tissues develop, also
in some places necrosis of the superficial epithelial layer of
the mucous membrane. Serous fluid oozes from the surface,
and at the same time the secretion of the mucous glands is
increased. In the lymph glands a migration of the leucocytes
commences under the positive chemotactic action of the strep-
tococci or their toxins, and probably also because of an increase
of lymphocytes. The glandular tissue proper however becomes
partly dissolved, probably under the influence of a peptonizing
ferment. In this manner large suppurative areas develop in
the lymph glands, the tissues surrounding them showing usually
a marked swelling, due to inflammatory edema.

Superficial abscesses usually open through the outer skin,
in which case the body rids itself of the infective substance.
From the first affected lymph glands, however, the bacteria
may pass along the lymph vessels to the neighboring, as well
as distant lymph glands in the body, in which they cause similar
inflammatory processes. Besides this the streptococci may
enter the blood stream by their power to penetrate the walls
of the vessels, and may thus be carried to all parts of the body,
producing metastatic abscesses in various organs aside from
the lymph glands, or they may cause a general septicemia.

The acute inflammatory character of the local disease process, and
the associating febrile manifestations indicate that the streptococci
exert their pathogenic action through toxins. As a matter of fact the
experiments conducted with Rosenbach’s streptococcus gave positive
results (Marmorek, Baginsky & Sommerfeld, Marmier and others), and
the pathogenic action of the toxin of this streptococcus manifested itself
in local acute inflammation, fever, and diarrhea. In less severe intoxi-
cations, emaciation and sometimes paralysis resulted. Some strains
produce toxins which possess hemolytic properties (Besredka, Neisser
& Wechsberg and others).

In exceptional cases foals may be born with the affection
(Nocard, Choisy). The ability of the streptococci to penetrate
the walls of the vessels explains the occurrence of intrauterine
infection. In such cases pharyngitis and suppuration of the
372 Strangles.

submaxillary lymph glands were repeatedly observed in preg-
nant mares (Trelut).

Anatomical Changes. In addition to inflammatory changes
in the superficial lymph glands, frequently the size of a ‘fist,
autopsy exceptionally reveals abscesses the size of a child’s
head in the mediastinum and in the vicinity of the bronchi..
They are filled with white, creamy pus containing streptococci,
and are frequently divided into several sections by connective
tissue walls. By their presence the trachea or the neighboring.
bronchus may be pushed to one side and may also become
compressed. At the same time there may be present a purulent
inflammation of the pleura and pericardium. In the lungs there
is sometimes only hyperemia and acute edema, at other times
a catarrhal pneumonia, or in its tissue various sized abscesses
may be imbedded, which are sometimes very numerous. The
mucous membrane of the bronchi and trachea, also of the
pharynx is always hyperemic, loosened and sprinkled with
ecchymoses, and covered with considerable quantities of mucous
or purulent secretions. There is frequently a gelatinous in-
filtration of aryteno-epiglottic ligaments.

The lymph glands of the mesentery frequently change to
large suppurating masses, when the peritoneum shows marked.
injection, and the abdominal cavity contains larger or smaller
quantities of purulent exudate. Animals which die after long
illness are sometimes found to be affected with one or more
large abscesses with thick, purulent or caseous contents and
adhesions of the neighboring loops of intestines by dense con-
nective tissue. Abscesses may also be present in the kidneys,
liver, spleen (this is sometimes greatly enlarged. and contains
numerous suppurative areas, Lesage; fatal bleeding may take
place into the cavity of a large abscess, Berton), pancreas and
in the psoas muscle, further in the brain and in the spinal
cord, in which they are usually associated with purulent in-
flammation of the meninges. They may also be present in the
muscles of the neck, and in the axillary region, in the inguinal
region, in the tissue surrounding the anus, in the different
joints, testicles, the udder, thymus gland, heart muscle, ete. In
exceptional cases the mucous membrane of the stomach may be
separated from the muscular coat by a flat, diffused layer of
pus several millimeters in thickness.

The autopsy may sometimes reveal degenerative changes
in the parenchymatous organs indicating pyemic or septicemic
infection.

Symptoms. After a period of incubation of 4 to 8 days,
which possibly may last only 1 to 2 days, especially after
colds, exhaustion, etc., the disease commences with symptoms
of an acute febrile affection, such as debility, diminished ap-
petite, and increased body temperature. Almost at the same
time, or not later than after 1 to 2 days, symptoms of acute
Symptoms. 373

nasal catarrh appear. The mucous membrane of the nose is
_ first highly reddened, warm, and dry, soon the secretion becomes
‘profuse, consisting at first of a clear or only slightly turbid
‘finid, later it is tenacious, after 3 to 4 days it is muco-purulent,
and finally purulent (rhinitis blenorrhoica). At this stage the
discharge is profuse, and flows in great quantities from the
“nasal openings over the upper lips. In colts the discharge
is usually crumbly, less sticky, and the patients expel it in great
balls during coughing or blowing. The animals cough much,
and frequently manifest more or less pronounced symptoms
of an initial pharyngitis; in this stage an acute catarrh of the
- buecal mucous membrane and the conjunctiva may also be ob-
served.

In rare cases the mucous glands of the nasal mucous membrane
are swollen to hemp-seed sized hard nodules, or small vesicles develop
on the membrane, which later suppurate (on the basis of such experi-

 

 

 

 

Fig. 62. Strangles. Commencing swelling of the submaxillary lymph glands.

_ences Trasbot incorrectly considered strangles as a disease identical
with, or at least related to pox). Still less frequently the mucous mem-
brane may reveal urticaria-like, flat plaques, which are the result of
serous infiltrations of the submucous connective tissue. According to
Rabe the streptococcus may also cause an extensive, ulcerating inflam-
mation of the nasal mucous membrane, which can only be distinguished
from ulcers of glanders by their vivid, reddened borders, and similarly
reddened base, also by the numerous streptococci which are found in
the discharge. Peters observed in a colt a necrosis of the bony parts
of the nose as the result of an infection with strangles.

In the great majority of eases an acute swelling of the
submaxillary lymph glands may be noted with the first appear-
ance of the catarrhal symptoms (Fig. 62). The lobular struc-
374. Strangles.

ture is still markedly perceptible at this time, but the individual
lobules are larger, firmer, and painful on pressure. They soon
coalesce, forming a uniformly hard growth, which rapidly in-
creases in size, fills up the intermaxillary space, later also the
throat and parotid regions, and may extend also to the
lower border of the cheeks. It is not sharply circumscribed,
but is firm, taut, warm and painful, and the animals hold their
heads stiffly extended. After the swelling reaches a certain
size it remains apparently unchanged for several days; finally
however a distinct fluctuation appears in one or more places,
while in other parts it remains hard and tense. The hair falls
out, over the affected places, and from these hairless surfaces
a yellowish sticky fluid oozes out, the skin proper becomes
thin, and at certain points a dark brown discoloration, and
finally a conical prominence appears, which soon bursts, where-
upon from the resulting opening white or slightly yellowish,
creamy pus is evacuated in profuse quantities. If the abscess
is opened the pus squirts out. If several fluctuating places form
on the surface of the swelling ruptures may occur at several
places, usually following each other in rapid succession. Ad-
joining abscesses may coalesce by the breaking down of the sepa-
rating walls, and evacuate their pus from a single opening; or
after the bursting of an abscess the contents of the adjacent
abscess may break into the first evacuated cavity through the
sudden relaxation of pressure.

After the evacuation of the pus the inflammatory edema
of the surrounding parts diminishes rapidly, and the swelling
subsides in 1 to 2 days. From the opening however pus and
later a lymph-like fluid oozes out for several days, until finally
the cavity fills up with granulation tissue, the borders of the
opening close, the swelling disappears entirely, and recovery
takes place.

The microscopical examination of the nasal discharge discloses loosened pave-
ment and cylindrical epithelial cells, fatty degenerated cells, and leucocytes. The
discharge from the abscesses contains pus cells, sometimes intermixed with granular,
broken-down tissue elements. Cover glass preparations stained with aqueous aniline
dyes or after Gram’s method, show long, curved chains of cocci in the pus (see fig.
61, p. 367), while in the nasal discharge the chains are shorter, and other forms of
bacteria are present. According to Bermbach and Baruchello the nasal discharge
and in the early stages also the pus of the glands contain pyogenic staphylococci,
which aid the streptococci in the execution of their pathogenic action. The pus
of the pharyngeal or mesenteric abscesses may also contain other bacteria, (Cuillé
found in them a Gram-positive, thread-forming anaerobic bacillus), which evidently
gained entrance by subsequent migration.

The respiration is accelerated even in the milder cases,
but it is of a normal type if there is no severe pharyngitis
and laryngitis present. When the inflammatory process extends
to the larynx, a moist, painful and spasmodic cough is observed,
which, together with the sensitiveness of the larynx persists
for 1 to 2 weeks after the abscesses break. If there is a pro-
nounced swelling of the aryteno-epiglottic ligaments the respira-
tion becomes rattling, whistling and very labored.
Symptoms. 375

At the onset of the disease the heart’s action is only
slightly accelerated; with the advance of the suppurating
process however the number of heart beats may double, but
the pulse remains even then full and tense.

The body temperature reaches a high degree even on the
first day (40°-41°). On the following days it drops slightly,
but on the appearance of suppuration a new rise is observed,
and then the fever remains at a comparatively uniform height,
until the termination of the suppurating process, or until the
bursting of the abscesses. From this stage on the temperature
diminishes rapidly, and becomes normal after 1 to 2 days.

The nutrition is disturbed in all cases, not only on account
of the difficult mastication caused by the swelling of the sub-
maxillary tissue, but also because of the difficult deglutition
brought on by the pharyngitis. The appetite is diminished from
the onset of the disease, and the patients take, at best, only
small quantities of hay or green feed.

Defecation is at first retarded, and later an intestinal
catarrh sets in not infrequently with the well-known symptoms.

The urine is passed in diminished amount, its specific
gravity is increased, and in the later stages it often contains
considerable quantities of albumen. With the ripening of the
abscesses the quantity of indican is considerably increased,
but drops to normal after the evacuation of the pus; during con-
valescence polyuria lasting for several days is occasionally ob-
served.

During the beginning or the termination of the disease,
the skin shows not infrequently an extensive urticaria, lasting
only for a short time, or small vesicles may develop rapidly,
which are filled with clear serous fluid. Thin scabs form later
at these places, and finally fine white scars remain (according
to Woronzow such a skin eruption may precede the character-
istic symptoms of strangles). Places of predilection for the
eruptions are the cheeks, the parts around the nose and mouth,
the neck, the sides of the chest, and the flexor sides of the
joints.

Atypical Forms. In every outbreak there occur cases in
which the manifestations deviate considerably from the de-
scribed symptoms, and accordingly the course of the disease
appears varied.

In this category belong undoubtedly those catarrhal affec-
tions of the upper air passages and the pharynx, which are
observed during the disease in a smaller or greater number
of animals of the same stable, without the development of the
characteristic suppurative inflammation of the lymph glands,
or without their having any participation in the disease process.
These catarrhs also develop apparently as a result of the
specific streptococcus infection, but inasmuch as the bacteria
do not penetrate to the lymph glands, these remain intact or
show only an insignificant swelling. The catarrh of the affected
376 Strangles.

mucous membranes is manifested by the ordinary symptoms;
the nasal catarrh is sometimes very mild, but the mucous
membrane may secrete a profuse purulent discharge, while
suppurative inflammation of the lymph glands does not take
lace. .

The inflammation of the lymph glands does not in all cases
lead to suppuration and abscess formation. Especially in older
horses the swelling of the lymph glands may come to a stop
at a certain time, whereupon it gradually retrogresses, and
finally disappears entirely, only a slight thickening remaining
in some cases.

More important are those complications which result from
the extension of the inflammatory process to the immediate
surroundings, or to metastatic processes.

The inflammatory process extends most frequently to the
region of the pharynx, which then, together with the subparotid
glands, and the laryngeal region, swells to a high degree. The
swelling is usually caused by an inflammatory edema of the
subcutaneous connective tissue, which results from severe in-
flammation of the submaxillary lymph glands.

Unfavorable significance attaches to cases in which pharyn-
gitis becomes associated with purulent inflammation of the
retropharyngeal lymph glands. In such instances the swelling
always attains a very high degree, and is either uniformly
distributed on both sides, or more marked on one side. At
the same time symptoms of severe pharyngitis are present.
Excluding the regurgitation caused by the serous infiltration
of the pharyngeal muscles, swallowing is rendered difficult or
even impossible, by a marked extension of the posterior wall
of the pharynx. Besides this, the larynx may be forced down-
wards and forwards by the swelling and thereby cause inspira-
tory dyspnea and stenosis. Finally the suppurating abscesses
in the pharyngeal wall may burst in any direction. This occurs
most easily into the pharyngeal cavity, especially when the
mucous membrane is necrotic in places. In such cases a great
quantity of pus is suddenly evacuated by the mouth and nose,
and then it is always possible that the suddenly eliminated pus
may be aspirated through the laryngeal opening into the deeper
air passages. In other cases the suppurative process pene-
trates to the outside, and finally reaches the lower parotid
region, or the vicinity of the larynx under the skin; after the
perforation of this part the pus is évacuated outside. Ex-
ceptionally the perforation may take place both to the outside
and inside, which leads to the formation of a pharyngeal fistula,
the healing of which usually requires a long time. The condition
becomes still more aggravated in case the inflammation extends
to the soft palate, or downwards and forwards to the muscles
of the hyoid bone (muse. omohyoideus and muse. hyoideus), in
which cases swallowing is impossible and the danger of an
inhalation pneumonia becomes greater. The catarrh of the
Atypical Forms 377

nasal cavities may also. extend to Highmore’s cavity, and lead
to necrosis of the bony walls, and to cerebral meningitis (Nagy).
This may also develop by the suppurating process progressing
along the nerve trunks into the cranial cavity (Augustin). The
abscess may also burst into the vertebral canal, whereupon
paralysis of the fore parts develops suddenly; with this symp-
toms of general spinal meningitis become rapidly associated
(Frohner).

An affection of the subparotid lymph glands results also
in marked swelling of one or both of the lower regions, but the
abscesses burst either into the laryngeal cavity or the pus sinks
downwards along the jugular groove until it finally finds its way
out in the middle of the neck or immediately anterior to the
entrance into the thorax. The inflammatory process may fur-
ther extend to one or both guttural pouches, which in such
cases become filled with pus, and the swelling thus produced
may reach the size of a child’s head (in such cases a marked
dyspnea is always present). In rare cases the subparotid ab-
scesses burst into the guttural pouches, from which the pus
is discharged by the nose through the existing openings of
communication; a portion however may remain in the guttural
pouch and change into a caseous, or later a mortar-like mass.

If the abscess develops in the deeper layers of the laryngeal
region, directly under the floor of the buccal cavity, painful,
hard, later fluctuating swellings develop in the vicinity of the
frenum of the tongue, by which the veins and lymph vessels
of this region are compressed, and a serous infiltration of the
tongue results. This organ is then considerably enlarged, and
the tip protrudes between the teeth, while saliva flows profusely
from the mouth. The abscess usually opens into the buccal
cavity, whereupon the swelling of the surrounding parts and
the tongue diminishes promptly, and the abscess cavity rapidly
fills with granulation tissue.

The affection of the submaxillary lymph glands is some-
times associated with an inflammation of the superficial lymph
vessels of the head. In such cases the lymph vessels leading
from the eyes, cheeks, nose and lips swell to painful cords,
the thickness of a pencil, while the surrounding connective
tissue appears diffusely infiltrated. Later small nodules ap-
pear along the lymph vessels, which develop into abscesses.
At the same time the swelling of the surrounding tissues reaches
a very high degree, and the nostrils, cheeks and lips become
greatly thickened (formerly known as ‘‘benign farcy’’). There
may also be associated a diffuse purulent inflammation of the
subcutaneous connective tissue of the head and neck. In such
eases the affected parts of the body are greatly deformed, at
the same time high fever is present, and the respiration be-
cause of the swelling around the nasal openings is very difficult.
If the inflammatory process reaches such a high degree it almost
invariably results in fatal septicemia or pyemia.
378 Strangles.

The spread of the inflammation to the lymph glands of the
neck results in inflammatory swellings of one or both sides of
the neck, which later open to the outside. More dangerous are
those abscesses which develop from the retrotracheal connec-
tive tissue. In these cases bursting not infrequently takes place
both to the inside and outside, and the resulting fistulae usually
heal very slowly or not at all. Abscesses developing in this part
may also cause severe dyspnea and difficulty in swallowing
by pressing on trachea and esophagus. If inferior cervical
glands in front of the chest are involved, a marked swelling
results, which may gradually extend to the lower two thirds
of the neck. The fascia of the neck affords usually a sufficient
guard against the pus breaking into the thoracic cavity; but
sometimes the swelling exerts such a pressure on the trachea
and the large blood vessels that the animals finally die from
asphyxiation. In rare cases the inflammation may extend also
to the organs of the thoracic cavity, and in such instances there
exists danger of general fatal infection.

The inflammation of the axillary, inguinal, popliteal and
precrural lymph glands is not dangerous in itself on account of
the superficial location of these glands. Their involvement
is indicated by the inflammatory swelling of the affected parts
and by the disturbance of locomotion, which however disappears
rapidly after the abscesses burst. Suppuration in the perianal
glands, which also usually burst to the outside, may cause an
obstruction of the feces, sometimes also symptoms of inflam-
mation of the rectum; there may be added an involvement of
the pelvic lymph glands with extensive abscess formation.
An affection of the mammary lymph glands is usually asso-
ciated with severe inflammatory swelling of one or both halves
of the udder.

The inflammation of certain joints, which sometimes de-
velops in association with the disease, causes painful, hot swell-
ings and marked lameness. The knee, pastern and coronary
joints become affected relatively most frequently, and the in-
flammation occurs in one alone or in several joints at the same
time. In some cases a phlegmonous inflammation of the sub-
cutaneous tissue develops, which later results in necrosis of
the skin and inflammation of the adjacent tendon sheaths, espe-
cially in the pastern and the fetlock joints.

The mediastinal and the mesenteric lymph glands are
among the internal lymph glands most frequently affected. An
involvement of the mediastinal lymph glands can be established
in the living animals only with very great difficulty. Under
febrile symptoms severe disturbances in respiration develop
gradually without it being possible to establish an affection of
the thoracic organs by percussion or auscultation. The contrast
between the striking disturbance in respiration and the nega-
tive results of the physical examination points to an affection
of the diaphragm if there is a suspicion of infection. This
Atyptical Forms. 879

may infrequently lead to rapid death from purulent pleurisy,
through an extension of the inflammation to the pleura or the
bursting of an abscess between the layers of the pleura. In
the meantime catarrhal or purulent pneumonia may develop
with invariably fatal results. In affections of the peribronchial
glands Chaussée observed in one case a venous pulse on the
neck and murmurs of stenosis.

The affection of the mesenteric lymph glands which some-
times develops primarily, more frequently however in the later
course of typical strangles, and after the healing of the sub-
maxillary lesions,.is very difficult to recognize in the living
animal. Usually only disturbances of digestion lasting for sev-
eral weeks are observed, indicated by constipation alternating
with diarrhea, moderate colicky symptoms, and persistent fever,
as well as rapid emaciation, until finally the animals die from
exhaustion, or a purulent peritonitis sets in suddenly which then
rapidly results in death. In rare cases abscesses in the mesen-
tery may open into the intestines, whereupon recovery takes
place, while the development of abscesses in the gastric region .
may result in a rupture of the stomach (Bolz).

The primary affection of the mesenteric lymph glands is, according
to the observation of Széllés, inaugurated by a sudden illness, with
symptoms of acute gastro-intestinal catarrh, which either leads to death
in a short time, or disappears almost entirely in a period varying from
several days to 1 to 2 weeks. The symptoms reappear after a certain
time, and then in a more severe form. In these cases frequent stretching
of the hind legs, arching of the back and grunting are observed, while
in the region posterior to the xiphoid cartilage palpation causes pain.
Defecation and urination are associated with symptoms of restlessness.
After this condition has continued for a time, or in some cases suddenly,
an aggravation is observed, which leads to death from purulent peri-
tonitis in from 6 to 48 hours.

Abscesses which develop in the pelvic cavity, and which may some-
times be found by manual examination through the rectum, exceptionally
penetrate towards the perineum, or under the skin of the tail, where
they finally break on the outside (Altmann). Sometimes they compress
certain nerves (for instance the N. obturatorius), or an inflammation
results in certain nerves with subsequent atrophy of the corresponding
groups of muscles (Labat) ; in both of the latter cases the locomotion
of one or both hind extremities is greatly interfered with.

Tf metastatic abscesses in the internal organs (brain, lungs,
liver, spleen, kidneys, thyroid glands, etc.) are in the course of
development, high fever, rapid weakening of the heart’s action,
great debility and depression of the sensibility as well as rapid
emaciation are observed, which usually result in death in the
course of a few days. Extension of a brain abscess to the
meninges is sometimes indicated by sudden staggering, where-
upon the animals drop to the ground and die. (According to
Kofler an inflammation of the uveal tract of the eyes is also
a frequent complication of strangles.)
380 Strangles.

Course and Prognosis. The instances in which the symp-
toms represent typical cases, the inflammatory process being
confined to the submaxillary lymph glands and the nasal mucous
membrane, are favorable indications of the disease, while the
deviations from this type render the prognosis more unfavor-
able. In the typical cases the disease lasts two to four weeks,
and terminates in complete recovery. Localization of the in-
flammatory swellings in the submaxillary space, rapid pro-
gress towards abscess formation, and correspondingly high
fever indicate a favorable course, while in less pronounced
inflammatory symptoms the disease may persist for a longer
time. The extension of the processes to the mucous membrane
of the pharynx, or to the superficial lymph glands of other
parts always lengthens the course, but even in these cases
recovery takes place in most instances. This is likewise the
ease in affections of the retropharyngeal lymph glands, but in
these instances there is always danger of an inhalation pneu-
monia, and therefore the prognosis should be cautious. Symp-
toms indicating an affection of the intrathoracic or intra-
abdominal lymph glands, and metastasis in the internal organs,
have always an unfavorable significance.

Sometimes the course is very prolonged, inasmuch as after
the healing of one abscess others appear in other parts of the
body, and this may repeat itself (wandering strangles). Finally
however healing may take place, or the animals may die from
exhaustion or from the involvement of internal organs leading
to chronic pyemia.

The course depends considerably on the age and strength
of the patients. While in horses over one year old the disease
almost always runs a favorable course, very young or poorly
developed and badly nourished animals, or foals: which have
already been weakened by other diseases, do not stand the
disease as well.

Accordingly the mortality varies greatly. While ordi-
narily it amounts to only 1-3%, it may be considerably higher
under unfavorable hygienic conditions.

The course also depends on the character of the outbreak,
inasmuch as in some years, or in some localities, the suppurating
process, with or without participation of the submaxillary
lymph glands, attacks the abdominal and thoracic lymph glands
with remarkable frequency.

Szdllés observed in 1906 130 cases in a small territory with severe manifes-
tations, of which 37 terminated fatally. At this time the disease frequently affected
older horses. Prussian official veterinarians likewise report severe outbreaks, es-
pecially Bernt in 1904, which occurred in the District of Gumbinnen.

In the Hungarian Government studs, 1711 colts were affected between the
years 1886-9, almost all under the age of one year, of which 48 (2.8%) died. In
the same period the disease had been observed in the government stallion depots,
among 118 stallions, and in only one instance was the course so severe that it be-
came necessary to destroy the affected animal. Among the horses of the Prussian
cavalry, in the years 1900-1903, out of 3954 affected remount and service horses
82 (2.1%) died (the loss varied'in the different years between 0.0 and 3.4%). In
Course and Prognosis. 381

the French army, in the period between 1888-1897, 90,381 horses were affected with
strangles, of which 992 (1.1%) -.succumbed. In the Italian army colt ‘depots the
number of cases in the years from 1903-1907 varied between 645 and 1329, among
5000-6000 colts, the number of deaths varying between 16 and 30,

After the subsidence of the acute affection, various sequels
occasionally develop; thus the inflammation of the mesenteric
glands may come to a stop in case no acute peritonitis or
pyemia result. But the nutrition of the animals usually re-
mains more or less affected through suppuration in the glands,
through new formation of connective tissue and the resulting
thickening of the mesentery and sometimes also through a con-
striction of the intestinal lumen. Consequently a severe cachexia
gradually develops (tabes mesaraica). The inflammation of
the guttural pouches, and of Highmore’s cavities, which is at
first acute, may sometimes change in its further course and be-
come chronic, while contracted tendons, which may result from
the disease on the extremities, produce lasting lameness. In
some animals symptoms of hydrocephalus develop gradually as
a result of encapsulated abscesses in the brain (Kofler found in
12 out-of 40 horses which were slaughtered on account of hydro-
cephalus, softened areas in the brain, with streptococci in the
contents of the abscesses). Further purpura hemorrhagica may
develop in horses recovered from strangles, while roaring is a
frequent sequel and is due to paralysis of the recurrent laryn-
geal nerves (according to Wiart out of 100 colts affected with
strangles 25 later became roarers, while according to Nocard, in
Argentine, where strangles does not occur, roaring is supposed
to be unknown). ts - +

_ Diagnosis. In those cases in which the infection of stran-
gles is indicated only by acute nasal catarrh or pharyngitis,
without suppuration of the lymph glands, the specific nature
can only be established with more or less probability, by the
condition of other horses in the same stable in which attacks
with characteristic symptoms of strangles might be present.
A demonstration of streptococci in the nasal discharge would
have to be considered with caution as streptococci may be pres-
ent in the discharge without true strangles.

In affections of the lymph glands in the pharyngeal region
strangles may be confounded with pharyngitis resulting from
other causes, or with inflammation of the parotid gland. If the
disease process is exclusively localized in the region of the
throat, only the further course of the disease will reveal the
true nature of the affection, while previous to that the diag-
nosis can be based only on the mode of infection, or upon the
fact that in strangles the symptoms of pharyngitis usually
reach a very high intensity. In cases of inflammation of the
parotid gland the inflammatory swelling is less diffuse, at least
at the beginning, but is more or less sharply circumscribed fol-
lowing the borders of the glands or its lobules.

In the cases in which the affection is exclusively confined
882 Strangles.

to the lymph glands of the body cavities the diagnosis can be
established correctly only with sufficient information regarding
the development and the presence of the infection, as the symp-
toms proper usually only indicate disturbances of the functions
in the neighboring organs. Nevertheless a repeated examina-
tion of the urine for the presence of indican may be beneficial
in such cases, as its considerable increase points with a degree
of certainty to a suppurative process.

The differentiation of strangles from glanders and the so
called suspected strangles will be discussed fully in the diag-
nosis of glanders.

Treatment. Not much can be expected from abortive treat-
ment; yet aS in some cases the symptoms diminish, and the
swelling of the lymph glands retrogresses after antiphlogistic
treatment, it is advisable to attempt such treatment if it can
be done at the commencement of the disease (cold applications,
inunctions with gray mercurial ointment). If however there
is no improvement perceptible after a few days, it appears
practical to discontinue this treatment, and allow the suppur-
ative process a free course.

If expectant treatment has been decided upon, suitable
regulation of the care and nursing, as well as of the diet, should
first be carried out. The animals should be placed in clean,
and uniformly warm stables, or in warm weather they may
during the day be kept out of doors in shady places free of
dust. It is advisable to feed the animals, in addition to good
hay and some oats a few beets, or during the summer fresh
grass, clover or alfalfa; if swallowing is difficult, bran slop is
advisable. Sucking foals should be taken to their mother at
regular intervals, and during sucking they should be supported;
if however there is great difficulty in swallowing, artificial feed-
ing through the rectum must be considered (see Vol. IT).

Great care should also be exercised in maintaining the
greatest possible cleanliness, for which purpose the straw
should be removed frequently, the cribs washed during the day,
and the purulent excretion should be frequently removed from
the nasal openings and the eyes, with clean sponges or cotton
swabs, dipped in luke warm water containing boracic acid. Peri-
odical rubbing of the body with alcohol has a beneficial effect
on the general condition of the patient.

Swelling of the glands may be left without interference,
or if the progress of suppuration is too slow it may be stimu-
lated with warm or moist warm poultices. Counter irritants,
which are frequently applied in such eases (cantharides oint-
ment, mustard dough, ete.) have a doubtful value, and may
easily cause severe inflammatory swellings, especially if they
are applied in the region of the throat. If fluctuation is percep-
tible at any part of the swelling which is indicated by the soften-
ing, the abscess should be opened without delay. Although the
pus ultimately works its way to the outside of its own accord, the
Treatment. 383

destruction of tissue in these cases becomes very extensive;
and there is increased danger of breaking on the inside, when
healing will require longer time.

The abscess cavities should always be opened with a long
incision. If the opening is too small it should be enlarged after
the partial evacuation of the pus, and subsequently the cavity
should be thoroughly cleansed with a disinfectant (boracic
acid, carbolic acid, creolin, Burow’s solution), whereupon the
wound should be treated in accordance with the requirements
of surgery. After evacuation of the pus the condition of the
patient improves immediately; the temperature drops to nor-
mal inside of 12 to 24 hours, the quantity of indican in the
urine is diminished, the swelling of the abscess reduces rapidly,
rendering the movements of the head and mastication easier.

If the swelling persists after the opening of the abscess or
should it even increase and at the same time the body tem-
perature. continue to remain high, it is an indication of the
presence or development of other abscesses in the vicinity of
the one which has been opened. In such cases the separating
wall may successfully be broken by the finger introduced into
the open abscess cavity, whereby a passage into the open cavity
is provided for the pus; in other cases the abscesses must be
opened individually.

If the pharyngeal region is affected, the necessity for feed-
ing the animals with easily swallowed food (gruels, sloppy
food) becomes still more imperative. At the same time the
existing pharyngitis requires special treatment, for which the
administration of potassium chlorate (8-10 g. to a pail of
water), or the application of Priesznitz’s poultices is appro-
priate. The opening of the superficial abscesses causes no
difficulties; if however abscess formations are present in the
deeper parts, between the parotid glands and the lower jaw, or
in the retropharyngeal tissue, their opening requires special
care. These abscesses should be: opened as early as possible
on account of the threatening danger from asphyxiation. On
account of the nerves and blood vessels lying in these parts,
which may be displaced from their normal position, it is advis-
able only to split the skin with a knife at the most prominent |
place of the swelling, and then to spread apart the nerves and
vessels by boring movements with the index finger, and if possi-
ble by this means to pierce the wall of the abscess cavity. In
this way not only subparotid, but also retropharyngeal ab-
scesses may be opened. Sometimes this procedure may not im-
mediately lead to results, but in the course of 1 to 2 days the
pus penetrates without aid in the direction of the canal which has
been bored as this constitutes the place of least resistance, and
therefore ultimately it breaks through at this point.

For the local treatment of the mucous membrane Kagel introduces a thick-
walled rubber tube 60 cm. long in cases of pharyngitis through the nose into the

pharyngeal cavity, and injects a disinfecting fluid (0.5% salt solution, 1:1000 sub-
limate, or 0.8% of a potassium permanganate solution). Frick employs for this
384 Strangles.

purpose a tube perforated in several places at the end, with the aid of which
the affected nasal and pharyngeal mucous membrane is irrigated, while Payrou
injects the pharynx with « thin urinary catheter 40-42 em. in length. He injects
10-15 g. of a fluid consisting of Guaiacol, Acid. ecarbol. eryst. 7 15.0, Menthol 40.0,
Ol. oliv. 100.0. Bringard uses a stiff sound 40 em. in length, to the end of which
is tied a wad of cotton dipped in eucalyptus vaseline (1:15), with which the soft
palate and the pharyngeal walls are swabbed. This treatment is supposed to shorten
the duration of the disease considerably (in 40 horses treated in this manner the
time was reduced from 1112 days to 470 days). None of these methods are with-
out danger in lively animals, and especially if difficulty in swallowing exists,

Poéschl recommends to open the submaxillary swelling before the appearance
of suppuration. According to his observations recovery is more rapid after such a
procedure and takes place without abscess formation, and without much destrue-
tion of tissues. Sz6llés also obtained favorable results in many cases by this treat-
ment, but nevertheless abscesses not infrequently developed in distant lymph glands,
especially in older horses.

If the difficulty of respiration has reached a high degree
because of much swelling in the throat region, and the threaten-
ing danger of asphyxiation cannot be eliminated by artificial
evacuation of pus, tracheotomy should be performed, in which
case the tube should be allowed to remain in the wound until the
conclusion of the suppurating process, or until the complete dis-
appearance of the threatening symptoms.

The affection of the guttural pouches also demands surgical
treatment in order to remove the pus which has accumulated
therein; further abscesses formed in the superficial lymph
glands or in other parts, as well as the lymphangioitis and
phlegmons which become sometimes associated, also require
surgical interference.

Internal treatment is only indicated in the presence of '
digestive disturbances. If constipation exists it is advisable to
mix tablespoonful doses of artificial Carlsbad salt with the food.
Beside the administration of antimony preparations, and of
mucilaginous substances which are still given extensively, sali-
eylic acid and sodium salicylate (8-10 g. per day) may be given
advantageously (Hardon).

Inhalations of steam vapors may be used as a remedy for
the catarrh of the nose, throat and the upper air passages; it
being advisable to add to the boiling water salt, carbolic acid,
or oil of turpentine. In such cases intralaryngeal or intra-
tracheal injections of mild solutions of astringents (subnitrate
of bismuth 5%, alum, iron sulphate or tannin 1-2%, Lugol’s
solution 1:5:100), or according to Levis’ suggestion antipyrin
(2-4.0 g.) may also be used.

The fever requires special treatment only when it exceeds
41 degrees, and then the usual antipyretics, in doses adapted
to the age of the patients, are indicated. In the presence of
a weak heart cardiac stimulants should be administered (for
instance caffein 5-6 g.).

Metastases in the internal organs are excluded from direct
treatment; in such cases and also when symptoms of severe
general infection are present only stimulating treatment comes
into consideration.
Treatment, Prevention. 385

Dieckerhoff recommends in protracted cases, as well as in phleg-
monous inflammations and septic fever, intravenous injections of Argen-
tum colloideale or Kollargol (40 ce. of a 1% solution repeated for
several days) but Baumgart, Kegel and Werner failed to obtain favor-
able results from this treatment. Moretti employs corrosive sublimate
(fur 5 days 30-60 ec. of a 1:1000 solution intravenously), Franz ad-
ministers Iodipin (50 g. ofa 25% solution subcutaneously), with sup-
posedly favorable results. Lindner however found Iodipin without effect.
Bass recommends Ichthargan (50 ce. of a 1% solution intravenously,
or 1.5 to 3 g. in a 5% solution intratracheally), Kettner however ob-
served in two cases no beneficial results from this treatment. The yeast
treatment recommended by Ludwig and Petersen (100 g. of a mixture
of brewer-yeast cells and flour of starch, which is marketed ag Anti-
gourmine and Furonculine, dusted 2 to 3 times daily on the food; the
healthy horses receive as a prophylactic, thin, sour-dough soup), failed
to give results according to Hausmann, Zerler, Schultz and Mitrowitsch,
also in the Prussian remount depots, Feuerhack (only Diercks and Deich
express approval of this treatment).

In recent times the treatment with antistreptococcus serum has
been extensively used, but its value cannot yet be exactly established
(see p. 386).

Prevention. This consists in keeping healthy horses, and
especially colts, from affected animals, as well as from stables
and stands occupied by the latter. In this way it is frequently
possible to protect the animals from infection through their
early years and if they should later contract the disease it will
run a milder course. The colts born upon certain premises
should be kept as much as possible separate from strange colts."
If the disease appears in spite of it, it may be checked by trans-
porting the healthy animals as early as possible to localities.
free of the disease; in such instances the animals should be
guarded especially against cold, which would reduce their resist-
ance. After the extinction of the disease thorough disinfection
of the stables and the stable utensils is very desirable, as other-
wise it reappears annually in the infected establishments. Re-
peated disinfections will prevent the reappearance of the dis-
ease still more efficiently.

Immunization and Serum Treatment. As one attack of the
disease as a rule affords an immunity which lasts for several
years, the possibility of an artificially produced immunity is
evident. Even in former times experiments were made in this
direction, always however for the purpose of artificially pro-
ducing a mild affection in the animals, thereby protecting them
from the natural, usually more severe form which may occur
during an unfavorable time of the year.

Viborg and Toggia in the beginning of the last century rubbed the nasal dis-
charge of affected animals into the noses of healthy horses, while Tatray injected
subcutaneously in the neck near the thorax the lymph-like fluid oozing from the
broken abscesses. The affection produced in this manner is usually mild, and as
the peripharyngeal lymph glands are spared, no dangerous symptoms appear. Jolly
& Leclainche injected scabs taken from sick animals and emulsified in water sub-
cutaneously into healthy horses and thus always produced a mild attack of the
disease.

Vol. 1—25
386 Stran gles.

1. Active Immunization. At first experiments were made
with living cultures of the strangles streptococcus, but inasmuch
as this procedure proved dangerous, dead cultures have recently
been used for this purpose. As a matter of fact however there
is at present no immunization method at our command which
has been tried out sufficiently in practice.

After the discovery of the strangles streptococcus, Jensen & Sand observed that
intravenous injections of pure cultures do not produce strangles, but only an inflam-
mation of the vein, after the healing of which the horses resist an intranasal in-
fection. This method however could not be utilized in practice on account of the
severity of the local inflammation.

Kitt treated two colts which had not been affected with strangles, in the
course of two months with repeated intravenous injections of 5-10 cc. of strangles
streptococcus serum bouillon cultures killed at 53-55 degrees, and found later
that these animals resisted an artificial infection through the nasal cavities and in-
testinal canal. ;

Gabritschewsky used a bouillon culture concentrated to 1/10 of its volume,
and killed with 0.5% carbolic acid, of which he injected subcutaneously six colts
with 60 ce., in 1, 2, or 3 injections. The animals resisted an infection from rub-
bing a virulent culture on the nasal mucous membrane, and displayed also a higher
resistance against subcutaneous injections of 1.5-2 ec. of virulent culture than did
the control animals. Cultures of virulent streptococci also killed by 0.5% carbolie
acid but not concentrated, are according to Umeno used in Japan against strangles
of horses which is prevalent there.

Baruchello used as vaccine a mixture of dense streptococci culture, and pleural
exudate (aggressin) of artificially infected horses or donkeys (1:8) which ‘had
been previously sterilized with toluol (3%), and preserved with ether (2%). The
results in practice are claimed to have been satisfactory.

Wiedenmann immunized rabbits by treating them with cultures which had
been shaken for 31% days with 25% urie acid at 37°, and then concentrated by
evaporation. Baldrey recommends vaccine prepared from 24 hour agar or bouillon
cultures, according to Wright’s method, by washing them off with salt solution, and
heating to 60°. These however proved unreliable even in experiments on rabbits. \

Concerning ‘‘strangles extract’’ (shake-extracts of cultures of strangles strep-
tococci?) of Jess & Piorkowski, Otto obtained very satisfactory results from
their use in his experience with 694 horses. All healthy animals which had been
vaccinated by these methods showed no affection with strangles for a period of
eight months.

2. Passive Immunization. Blood serum of horses artifi-
cially immunized against streptococcus infections in man, is
recently being used more extensively, and this method appears
to be giving satisfactory results when utilized against strangles
in horses. According to numerous laboratory experiments it
is possible to actively immunize animals with artificially attenu-
ated streptococci, as well as with toxins, and such animals later
hyperimmunized with fully virulent material, produce a blood
serum which confers a passive immunity upon other animals,
but as a rule only against that strain of streptococci with which
the serum-producing animals have been treated. Therefore
Marmorek injected his horses with various strains of strepto-
cocci of man, and the polyvalent serums obtained thereby have
also given better results in human medicine.

Marmorek’s polyvalent anti-streptococeus serum has also
been used by French veterinarians (Jacoulet, Drouin and
others) against strangles of horses, since this is a disease also
produced by streptococcus infection. However the results were
not promising. As these more or less unsatisfactory results
Passive Immunization. 387

indicate that the streptococcus of strangles, in spite of its
morphological similarity, is different from the pyogenic strep-
tococci of man, the immunization of horses has lately been
undertaken with the specific streptococci of horses. The treat-
ment with serum obtained from horses treated by the various
strains of pyogenic and strangles streptococci consequently
gave better results.

Aecording to Rohr’s observations, the serum injection of horses
affected with strangles diminishes the quantity of the profuse purulent
nasal discharge, the fever is reduced, and not infrequently the treatment
results in the absorption of the abscesses already in the stage of devel-
opment (the serum was subcutaneously injected in doses of 10 ec. three
times on the first day, and once on the second and third day). The
results of Jacoulet’s experience with this treatment on 30 horses were
also- favorable; since the fever in this mode of treatment was of short
duration, complications and relapses were more rare, and the recovery
of the patient was hastened. (The daily dose amounted to from 20 to
30 ce.; 80 to 100 ce. brought the development of the disease process to
a standstill).

Dassonville & Vissocq produced a serum by treating horses with
virulent streptococci cultures, of which 20 to 30 cc. was supposed to
protect healthy horses against natural contact infection. By following
the serum injection with a subcutaneous injection of 3 to 5 ce. of viru-
lent cultures, it should be possible to convert the passive into an active
immunity. French veterinarians (Desoubry, Breton, Argoud and
others) obtained favorable results with this method of immunization,
and partly also with the serum alone.

Jess & Piorkowski produced a strangles serum from horses by
treating them with cultures made from growing various strains of
strangles streptococci directly from the abscesses on strongly alkaline
media, of which 0.0005 ce. is said to protect mice against double the fatal
dose of virulent culture, and to agglutinate these cultures in dilutions of
at least 1:100. The single dose in practice is 10 ce. or even more, which
if necessary may be repeated 2 to 3 times.

The reports regarding the protective and curative action of this serum vary.
While Aronson in his laboratory experiments, Angerstein, Reimers, Feuerbach and
also Prussian district veterinarians in practice found it without effect, according to
Stramnitzer it is supposed to be beneficial at the beginning of pure strangles, and
also to improve the general condition in advanced cases in 50 ce. doses. A favor-
able infilnence on the course of the disease was also observed by Brandt, Pflanz,
Franz and Otto (in 124 horses), in Hungary by Demeny & Szende; after the serum
inoculations the fever dropped and the inflammatory swelling disappeared rapidly,
mostly however after the opening of the abscesses. Likewise favorable are the re-
ports of Cederberg on the serum treatment of horses affected with strangles in the
Danish army; the preventive inoculations however failed in several cases, and
the experiments of Wucherer and Wagenheuser gave similar results.

Ruppel’s strangles serum (Gurmin) is derived from horses which
have been treated with a mixture of strains from strangles, together
with a streptococcus culture made highly virulent by passages through
animals. It is supposed to protect mice in doses of 0.005 to 0.00025 ce.
against 10 to 100 times the fatal dose of virulent culture. In 36 out of
44 horses affected with strangles it is supposed to have given a pro-
nounced curative result, in daily doses of 20 to 50 ec., while in healthy
horses it afforded a protective action.
388 Strangles.

Recently a strangles serum, which is prepared in Rome according
to Viechi and Gatti, was used quite extensively in Italy with satisfactory
results.

Finally Delvos uses a serum from horses which have recently passed
through an attack of strangles for protection of healthy and treatment
of affected animals. Of this serum previously heated to 70°, and
mixed with 14% carbolic acid, the dose amounts to 20 cc., the curative
dose from 30 to 40 ce. (if necessary to be repeated). The results are
said to have been satisfactory in the treatment of 94 horses.

Literature. Haubner, Mag., 1843, 227.—Bouley, Rec., 1849, 89; 1855, 537.—
Hering, Spez. Path., 1858, 83, (Lit).—Schiitz, A. f. Tk., 1888, XIV, 172.—Sand &
Jensen, D. Z. f. Tm. 1888, XIII, 437.—Poels, F. d. M., 1888, VI, 4.—Nocard,
Bull., 1888, 22; 1890, 187.—Foth, Z. f. Vk., 1891, III, 192.—Ligniéres, Bull, 1895,
369; 1896, 173.—Marmorek, A. P., 1902, 172.—Jess, B. t. W., 1902, 171; 1905,
242.—Piorkowski, Ibid., 1902, p. 1124.—Jolly & Leclainche, Rev. vét., 1893, 289
(Lit.).—Schniirer, Z. f. Tm., 1903, VII, 286 (Literature on Immunity).—Lingel-
sheim, Hb. d. p. M., 1903, III, 303; 1904, IV, 1185 (Literature on Streptococeus
and streptococcus immunity).—Stramnitser, A. f. Tk., 1904, XXX, 519.—Dassonville
& Vissocq, Bull., 1905, 176.—Feverbach, Z. f. Vk., 1905, XVI, 12.—Mitrovitsch,
B. t. W., 1905, 77.—Ludwig, Monh., 1906, XVII, 289. (Literature on Immuniza-
tion).—Gabritschewsky, Cbl. f., Bakt., 1906, XLI, 719.—Baruchello, Rev. gén., 1908,
XI, 497.—Otto, B. t. W., 1909, 921.

Strangles in Cattle. Nagy observed in two mature cattle marked
and painful swellings of the submaxillary lymph glands, which devel-
oped with symptoms of high fever, and purulent nasal catarrh, and led
in a few days to abscess formation. After opening the abscesses and
evacuating the creamlike pus, recovery soon resulted (the pus was not
examined bacteriologically ; according to Kuennemann the bacillus pyo-
genes bovis is most frequently found in the pus from cattle, and is
considered by Glage identical with the bac. pyog. suis, see p. 144;
streptococci and staphylococci occur in pus of cattle only very rarely).
Peschke also observed multiple abscess formation in the glands on the
heads of calves. (Peséhke, A. f. Tk., 1896, XXII, 346—Nagy, Vet.,
1897, 580.)

Strangles in Hogs. Starcovici observed in Roumania (1898) an
affection in young hogs in the course of which the submaxillary and sub-
parotid lymph glands developed an inflammatory swelling and later
suppurated. The animals also showed debility, capricious appetite and
fever. During the disease, which lasted several weeks, they became
greatly emaciated, as the condition prevented them from taking nour-
ishment. Finally however, with a few exceptions, all recovered. In
the pus from the abscess bipolar bacilli and streptococci were found,
which were pathogenic for rabbits, guinea pigs and mice. The treatment
consisted in opening and subsequent washing of the abscesses. (Revista,
1902, 11, H.)

Dog Strangles. Fréhner describes under this name a rare affection
of dogs in the course of which the lips, cheeks and the region of the
pharynx become greatly ‘swollen without a febrile rise in the tempera-
ture. On the skin of these places lentil-sized pustules develop, filled
with bloody pus. Later the submaxillary and the parotid lymph glands
swell to the size of a pigeon egg, and form abscesses (purulent lymphan-
gioitis and lymphadenitis). Following surgical treatment recovery takes
place in most instances; sometimes however metastatic suppurations may
develop in the internal organs, when the animals succumb to pyemia.
The purulent inflammation appears to commence in the hair follicles
Contagious Pleuro-pneumonia. 889

of the lips, with which an inflammation of the subeutaneous connective
tissue, lymph vessels and the lymph glands becomes associated. Treat-
ment consists in opening the suppurative formations, while in high fever
and in the later course the administration of quinine and camphor is
indicated (Monh., 1894, V, 301).

2. Contagious Pleuro-pneumonia, Pleuropneumonia
contagiosa bovum. —

(Lung plague; Lungenseuche der Rinder [German]; Peripneu-
monte contagieuse [French]; Polmonera, Pleuro-
polmonite essudativa [Italian].)

Contagious pleuro-pneumonia is as a rule an acute or sub-
acute, but sometimes chronic contagious disease of cattle, which
is characterized by an exudative inflammation of the inter-
lobular lymph vessels, and of the alveolar tissue of the lungs,
with a simultaneous, sero-fibrinous pleurisy. It is caused by
a filterable virus.

History. Since the disease was described in detail by Bourgelat
(1765), and Haller (1773), it was according to the changes in medical
views considered at one time as a severe typhus affection, and again
as a paralysis of the lungs, and the possibility of its spontaneous devel-
opment was generally accepted. Chaberts (1794) insisted upon its con-
tagiousness, which was since recognized by the majority of authors. This
view has been substantiated by the investigations of commissions ap-
pointed in the middle of the last. century in France, Germany, and
in other parts, for the study of the disease. In the meantime Willems
(1850-1852) succeeded in proving that cattle may be effectively im-
munized with fluid from the lungs of affected animals. The causative
factor was discovered by Nocard & Roux in 1898, and by the use of
pure cultures a new method of immunization has been worked out.

Occurrence. Contagious pleuro-pneumonia was extensively
prevalent in Europe prior to the last but one decade of the
last century, and caused great losses among the cattle herds
_ by its severity. Through the energetic measures which were

inaugurated at that time the disease was successfully eradicated
in a great part of the continent and also in Great Britain, so
that it exists at present only in Russia and Spain; it also pre-
vails in Africa, Australia and Asia.

Contagious pleuro-pneumonia was known as early as the end of the 17th cen-
tury in Switzerland, as well as in the neighboring mountainous regions of Germany
and France. At the beginning of the last century it caused great losses among
cattle herds in Belgium and Holland. With the expansion of animal traffic about the
middle of last century it rapidly extended over large territories, and was spread
especially by breeding stock from Switzerland and Holland, which was at that
time preferred for breeding and crossing purposes, to the east and also to distant
parts of the world. In this manner it was earried to Austria, in 1841 with Dutch
eattle to England (in this country however, it had, according to Barker, been ob-
served already in 1736), and in 1854 it was imported to South Africa supposedly with
a Friesland bull. Further the disease was in 1843 spread from England, also with
breeding stock, to Sweden and North America, and in 1858 to Australia.
890 Contagious Pleuro-pneumonia.

s

In Belgium in the period between 1882 and 1887, 5,152 affected and 451
suspected cattle were slaughtered representing a value of 2,165,938 francs. In
1890-1896 the disease was decreasing (from 893 to 3 cases), since 1897 the country
has been free from it.

In Germany the formerly wide-spread disease has in later times confined
itself to the Prussian provinces of Brandenberg, Posen, and Saxony, also to the
States of Saxony-Weimar and Anhalt. While in 1896, as many as 1608 cases were
still diagnosed, the number diminished since that time to such an extent that at the
beginning of 1904 the disease was considered to be eradicated. After 1% years
one case was discovered in Saxony and after this the entire Empire remained free
from the affection for 114 years. Since July, 1907, however new outbreaks occurred
first in Prussia, then also in Saxony and Saxony-Koburg-Gotha, and in the year
1908, 448 cases (with 28 deaths) were recorded in 24 townships.

In France 4762 animals became affected during the period from 1893 to
1903, the disease being most virulent in the northern part of the country, as well
as in the Department of the Seine. Since 1890 the number of cases diminished with
some fluctuations, in 1905 only 14 cases were recorded, in 1906 and since that time
no outbreaks were recorded officially.

Contagious pleuro-pneumonia had raged in former times in Great Britain with
such severity that in 1860 for instance, 187,000 animals, with a value of 19 million
pounds sterling, fell victim to the disease. From 1870 to 1890, 63,333 affected cattle
were slaughtered, and 7,110 died; since 1891 the disease has rapidly decreased; in
1898 it was diagnosed only in one single case, and since that time the entire King-
dom has been free from the affection.

In Holland in the period between 1833 to 1850, 64,989, and between 1851-1869,
37,706 cattle died; from 1881 to 1887, 22,183 affected and 12,783 suspected cattle
were slaughtered, by which measure the disease was entirely suppressed.

Formerly the disease raged in Austria, most extensively in Moravia, Bohemia,
Southern Austria, and Silesia. In 1890, 1857 cases were recorded, and up to 1892 the
number increased to 2,524. As a result of the eradication measures inaugurated in that
year, it has rapidly decreased, so that in 1897 only one case was observed in Gilesia.
Since that time the entire empire has remained free from the disease.

In Russia the disease has become widely spread during the last decade; in
1899 five government districts were officially recorded with 7,728 cases; in 1906,
19 government districts and 3&9 townships with 2964 cases; in 1908, 18 government
districts and 965 townships with 4,971 cases.

In Hungary contagious pleuro- pneumonia was introduced, in all probability,
in the middle of Jast century from the west and spread extensively later to the
northwestern part of the country, (in 1893 2,352 cases occurred in 351 townships of
17 counties). As a result of the measures inaugurated in 1892 the infected terri-
tory was more and more limited; in 1901 only 1 case was recorded, and since 1902
the entire territory has been free.

Spain appears to be kadly infected, as even in recent times the disease was
introduced from that country into France, while in Italy no cases have been recorded
since 1889.

The northern countries, Denmark, Norway and Sweden, have been free from the
affection for a long time, and in the countries of the Balkans it does not appear
to occur.

In Asia the disease appears especially wide-spread in the Russian territories,
(in 1908 14,115 cases in 857 townships), as well as in India; it occurs likewise fre-
quently in Central and South Africa (in Capeland alone 9,062 cases were recorded in
the period of 1897-1898, and in Egypt five cases were officially established in
1908), in Australia (Loin estimates the loss in 1889 at 16 million francs), and
also in South America. The United States of North America, where in 1886, 10,000
eattle were affected in the State of Illinois alone, has been free from the disease
since 1892.

Etiology. Contagious pleuro- -pneumonia is caused by an
extraordinarily small, polymorphic micro-organism, which
passes through the Berkefeld filter, and also through the
Chamberland F-candle. In cultures under the microscope it is
perceptible at a magnification of about 1500 and with strong
illumination, in the form of extremely small, refracting dots,
fine vibrios, and very short spirillae, as well as of branching
and asteroid bodies.
Etiology, Pathogenicity. 391

Lipschitz describes the bodies of contagious pleuro-pneumonia as roundish
protoplasmic clumps almost 4m in size which occur single or in pairs, or,
though rarely, in numerous chains containing 3-4 segments, lying close to each other.
Plump forms with angular borders may be also found (degenerated elements?).

According to Bordet spirochetes resembling the organism of syphilis develop
on blood-potato agar, and also in transfers to alkaline peptone bouillon contain-
ing rabbit serum, they are however much shorter and finer spirillae. Borrel ob-
served in preparations obtained according to Léffler’s mordant method, a pronounced
pleomorphic appearance of the virus. According to his and his co-workers’ findings,
pure cultures consist of cocci, streptococci, and morula-shaped bodies, further short,
spiral threads, which show fork-shaped branchings, and asteroid figures as well as
mycelioid moulds, and are always surrounded by fine, mucin coverings. On account
of its last-named properties he called it asterococcus mykoides.

Staining. In bouillon cultures the bodies may be stained with
aqueous, and still better with aniline dyes containing carbolic acid;
also with Léffler’s flagella stain, and according to Giemsa’s method,
while they cannot be stained by Gram’s method.

Cultivation. Nocard & Roux cultivated the virus by placing a
mixture of bouillon and a small quantity of lymph from the lungs in
eollodion sacks and sewing these into the abdominal cavity of rabbits.
By such a procedure the bacteria are protected from the phagocytes,
and the bouillon is rendered more suitable for the propagation of the
virus by osmosis between it and the peritoneal fluid. After 15 to 20
days the fluid became cloudy and opalescent, and the above mentioned
small granules were, on microscopical examination, found present in
great numbers.

Later the cultivation succeeded by a similar procedure in the
abdominal cavity of cattle (not in guinea pigs) also in Martin’s bouil-
lon, to which had been added blood serum from cattle or rabbits (6 to
8%). Outside of the animal body they may be cultivated on agar pre-
pared with such bouillon, the surface of which has been moistened with
a few drops of serum (Dujardin-Beaumetz) as well as in Léffler’s
bouillon containing 25%. cattle blood serum (Schmidt). In bouillon
the culture is noticeable after 2 to 3 days by a very delicate turbidity
of the fluid, while on agar the colonies form very fine transparent, later
whitish points adherent to the surface of the medium. The optimum
temperature is 37° to 38°; below 30° the growth ceases.

Tenacity. Cultures kept in the thermostat and transferred every two weeks,
retain their unattenuated virulence not longer than 6 to 8 days, while in glass tubes
elosed by melting at the ends, and kept at a temperature not exceeding 12°, they
retain their virulence for almost a year (Nocard, Roux & Beaumetz).

The fluid from the lungs remains virulent for eight days if kept in a cool
place; after a month the virulence has become attenuated, in the air and in sun-
light, however, the attenuation occurs much earlier. A temperature of 58° destroys
the virus, while frozen pieces of lungs kept at a temperature of —5° to —6°
contain virulent lymph even after three months (Laquerriére). The virulence is not
influenced by concentrated glycerin, nor by 0.5% carbolie acid (Schiitz & Steffen,
Nocard).

Pathogenicity. After the subcutaneous inoculation of a few
drops to 10 ce. of pure culture into the subcutaneous connective
tissue of the rump or neck of cattle, the temperature commences
to rise after 6 to 27 days. Soon an edematous swelling develops
starting at the point of inoculation, and finally the animal dies,
when the autopsy reveals a pronounced serous infiltration of
the subcutaneous and intramuscular connective tissue; or the
swelling disappears after 1 to 2 weeks and the animal recovers.
392 Contagious Pleuro-pneumonia.

Inoculation of a culture into the pleural cavity produces, after
a similar period of incubation, sero-fibrinous pleurisy and peri-
tonitis, serous infiltration of the lung tissue and acute swelling
of the mediastinal lymph glands. Inhalation of a virulent cul-
ture may result in fever and symptoms of bronchial catarrh,
which however disappear after 1 to 2 weeks, while animals
which are slaughtered in the meantime show serous infiltration
of the interstitial connective tissue of the lungs. The feeding
of cultures is without effect, likewise intravenous or intra-
tracheal injections, provided that none of the culture enters the
subcutaneous connective tissue. Intracerebral injections of a
few drops of pure culture results in 6 to 14 days in fever,
symptoms of cerebral irritation, later apathy and drowsiness,
and invariably in inflammation of the joints (experiments of
Nocard, Roux & Dujardin-Beaumetz). 2

The fluid of the lungs and the pleural exudate of affected
cattle possesses a similar pathogenic action, according to the
older investigations of Willems. The reactive inflammation
however is much less pronounced when the lymph is not injected
into the rump or the neck, but in the connective tissue at the
point of the tail, which is more tense and has a lower.temperature
(such inoculations in sucking calves frequently result in serous
or fibrinous inflammations of the joints, and Dschunkowski ob-
served similar manifestations from injections into the rump of
reindeer). Injections of lung juice into the milk cistern of a cow |
produces a severe mammitis, which results in recovery after
four weeks, but the pus-like, tenacious milk contains the virus
even after two moaths, and its virulence has in the meantime
been increased (Nocard).

Cattle which have recovered from an inoculation disease
later resist subcutaneous or intrapleural inoculations without
reaction, while by feeding and also by intravenous or intra-
ocular inoculations no immunity can be produced.

Besides cattle and closely related species (buffalo, reindeer,
camel, yak, bison) other animals and man are not susceptible
to either artificial or natural infections.

Dujardin-Beaumetz obtained cultures by cultivating the virus on media pre-
pared from mutton and from sheep serum, or from goat meat and goat serum,
which produced a typical action in cattle, and similarly also in sheep and goats.
The effusions produced in cattic, however, were no longer virulent for the last named
species of animals. :

The channels for the natural infection are not yet clearly
known. In addition to being found in the affected lung tissue,
the pleural exudate and the lymph glands of the thoracic cavity,
the virus is also present in the bronchial secretions and in the
nasal discharge, probably also in the moist exhaled air, and is
possibly introduced into the bodies of healthy animals with the
inhaled air. Up to the present however it has not been possible
to produce artificially, by inhalation of infectious exudate and
secretions or in other ways a disease which completely corre-
Natural Infection. 393

sponds to contagious pleuro-pneumonia. The possibility of
infection by means of inhaled air is proven to some extent by
the successful experiments of Nocard & Roux, as well as by an
older experiment of Chauveau, in which a cow that inhaled air
from an affected animal through a sack passed over the heads
of both animals, became affected with contagious pleuro-pneu-
monia.

As was shown by experience, the disease spreads by direct
contact of healthy with affected animals, while the transmission
of the virus by intermediate hosts has not yet been positively
established. The contagion appears to remain virulent in in-
fected stables for a long time, and infects animals which are
subsequently placed in such stables. On the occasion of out-
breaks careful investigation usually reveals the fact that at
some time previously one or more affected animals had been
introduced into the affected herd. At the same time the disease
spreads preferably among cattle which are stabled closely
for a long time, but sometimes a rapid spread may also be
observed during the pasturing season.

Affected animals may transmit the disease in all stages to
healthy individuals, the transmission being however easiest and
most effective during the acute symptoms. The virus may re-
main effective in the affected lungs for years, and may even
retain its virulence in the sequestrated and later encapsulated,
necrotic parts of the lungs. If an entirely closed connective
tissue capsule forms around such a sequestrum and other parts
of the lungs remain healthy, the infectiousness of the animal
is suppressed for a time; however as soon as a communication
opens between the cavity and a bronchus, some parts of the
sequestrum and with it micro-organisms enter the air passages,
whereupon the animal may again infect others. The disappear-
ance of the acute symptoms and improvement or apparent
recovery does not therefore mean that the animal is no longer
infectious.

According to Walley the virus may remain active in the encapsulated cavities
for 15 months; according to other authors the infectiousness may last even con-
siderably longer. Minette traced outbreaks in herds to cows purchased two and
three years previously.

The susceptibility of cattle to the disease varies greatly
in accordance with the breed and method of living, and also
with the individuals. The more hardened range cattle resist
natural infection far more than the more highly bred stable
cattle. The less frequent occurrence of the disease among range
cattle may also be explained by the fact that such animals live
more out of doors, and are therefore less exposed to an inten-
sive infection than milk cows or fattening cattle kept standing
closely in stables. Sometimes in herds of one and the same
- breed some animals may withstand the disease in spite of favor-
able conditions for infection.
394 Contagious Pleuro-pneumonia.

A commission (Commission Dumas), appointed in 1850 for the study of the
disease under the presidency of Bouley, found that out of 100 cattle 32 resisted
infection. According to Lutz on three premises in the County Bars (Hungary) out
of 246 Hungarian fattened steers four (1.63%) became affected, out of 174 fattened
steers of higher breeds 22 (17.32%), of 32 cows of the same breed 5 (15.63%), of
15 similarly bred young stock 9 (60%) were attacked by the disease, although all
animals were kept under the same conditions and were kept together in the stables.

Pathogenesis. The virus which in all probability enters the
lungs with the inhaled air, appears to propagate first in the
lymph spaces of the interlobular connective tissue, where it
causes an inflammatory process, as a result of which the spaces
become filled with serous exudate and therefore distended.
With this a serous inflammation of the surrounding connective
tissue soon becomes associated, and the inflammation spreads
to the neighboring lobules, which from their periphery towards
the center become filled with a serous, cellular, later coagulating
exudate, containing also a few red blood corpuscles. The in-
flammation gradually involves an increasingly larger part of
the lungs, producing inflammatory infiltration of the alveoli,
while the exudate contained in the previously affected parts
of the alveoli undergoes fatty degeneration. The virus also
reaches the pleural tissue, as well as the connective tissue of the
mediastinum, and there produces serous infiltration, while acute
swelling occurs in the neighboring lymph glands.

As the inflammation extends to the lymph spaces of the
walls of the vessels, it causes coagulation of the blood in parts
of these vessels, by which a smaller or larger part of the lungs
is excluded from the blood circulation, and therefore becomes
necrotic (ischemic necrosis). This affected part of the lungs
separates later from the still sufficiently nourished surround-
ings, and a connective tissue capsule forms around it, in the
cavity of which the necrotic piece of lung lies free as a so-
called sequestrum.

The sequestration represents essentially a healing process,
and as a matter of fact when only a small part of the lung
becomes necrotic, it is occasionally later absorbed, and actual
recovery may take place. Mostly however the sequestrum and
the virus contained therein remain unchanged for a long time,
until the capsule breaks, for instance by a severe coughing
spell, whereupon the virus penetrates the surrounding lung tis-
sue, causing acute inflammatory changes. Sometimes the pri-
mary inflammatory process may come to a standstill in the
tissue which is not necrotic, whereupon the enclosed lobules of
the lungs become atrophied through shrinking of the inter-
lobular connective tissue. If the inflammation was confined
only to a small area, the process may entirely heal in this
manner by the formation of cicatricial tissue.

The circulating blood does not appear to be favorable for
the propagation of the virus, as blood from affected animals
is usually not infectious, and the injection of virulent lymph
into the blood circulation is also ineffective. Exceptionally
however the blood may contain the virus and disseminate it
Pathogenesis, Anatomical Changes. 395

through the body; this is substantiated by the experience that
in sucking calves inflammations of the joints develop sometimes
by way of metastasis, and that in some cases changes charac-
teristic of contagious pleuro-pneumonia are found in the lungs
of fetuses of diseased pregnant animals.

The virus evidently exerts its pathogenic action through toxins.
This conception is supported by the character of the inflammatory proc-
esses and the fever,
also by the fact that
rabbits, in the abdomi- fs
nal cavity of which the Stl EN
virus propagates for a 5
time inside of collo-
dion sacks, die months
afterwards from ¢a-
chexia, .although the
virus proper has ap-
parently not passed
into the circulation of
the body. According
to Arloing the exudate
contains «w toxic sub-
stance, which may be
precipitated by alco-
hol, does not lose its
activity when heated
to 80°, but produces a
very severe intoxica-
tion if inoculated even
in very small quanti-
ties into the blood of
cattle and goats.

Anatomical
Changes. In acute
cases a smaller. or
larger part of the

lungs is found hep-
atized, free from air
and not elastic; on
incision a clear
serous, yellow fluid

oozes from the cut ‘Fig. 63. Cut surface of the lung in contagious pleuro-
surface in great pneumonia: (a) normal ne page ( b) zed hepati-

S48 zation; (c) gray hepatization ; incipient necrosis ;
quantities and later (e) interalveolar septum with dilated lymph spaces ;
coagulates to a gela-  (£) blood vessels with thrombus; (g) bronchi, (After
tinous mass. The 2 preparation of the pathologic anatomical collection. )

cut surface discloses ) .

-apale yellow network, formed by an increase of the interlobular
connective tissue, which separates the hepatized lung into
various sized islands, and according to the stage of hepatization

 
396 Contagious Pleuro-pneumonia.

they appear gray, pale red, or dark brownish-red in color
(variegated, marble-like cut surface; Fig. 63). In the broader
beams of the network the dilated lymph spaces are found as
round, oval or fissured depressions, filled with yellow lymph or
more fibrinous exudate, while the immediately adjoining con-
nective tissue appears uniformly gelatinously infiltrated. The
enclosed airless foci are pale red and firm especially at the
border of the hepatized lung portion, sometimes on the periph-
ery, while the center is still dark red and elastic. The walls
of the bronchi in the affected parts of the lungs also show
serous infiltration and are dilated, while their lumen contains
much fibrinous exudate. The peribronchial and mediastinal
lymph glands are swollen and filled with fluid.

The pleura over the affected parts of the lungs is sometimes
lusterless, injected and covered with a very fine, veil-like fibrin-
ous membrane. Usually however friable deposits 1-2 em. thick,
pale yellow, are found on its surface, under which the pleura
appears thickened, and the underlying connective tissue is fre-
quently serously infiltrated. In the majority of cases the
pleural cavity contains at the same time more or less (some-
times up to 15 to 20 liters) clear yellow, or turbid, yellowish-
gray exudate mixed with fibrin-flakes, and in rare cases, the
mediastinal connective tissue is also saturated by a similar
exudate.

In more chronic cases the connective tissue streaks on
the cut surface of the lungs consist of white, firm connective
tissue, while the lobules lying between them are uniformly hepa-
tized and necrotic, sometimes even calcified. In such cases
so called sequesters are found frequently in one or both lungs,
that is one or rarely several necrotic lung portions which are
from nut to fist size or even larger. Their surface is knobbed,
the outside layers mushy and softened, while the inside is still
firm, and the cut surface is diffusely mottled. The necrotic por-.
tions are enclosed in thick connective tissue capsules, to which
they are sometimes still partly adherent, and their inner sur-
face is covered with a gray, smeary mass. The capsule may be-
closed or may communicate with the neighboring bronchus
(Arloing found a sequester enclosed in a connective tissue cap-
sule as early as the fiftieth day). Exceptionally even in the
lung tissue proper, dull yellow areas may be found, which are
only partly separated from the surrounding parts and show
evidences of acute inflammation, while in other cases evidences
of fresh pneumonia may be observed in the vicinity of an old,
encapsulated sequester. In the chronic cases the pleura is usu-
ally much thickened, but the surface may still be covered with
loose pseudo-membranes, or the pleural membranes may adhere.

In some cases the autopsy may further reveal serous or
fibrinous pericarditis, similar inflammation on the peritoneum,
on the diaphragm, and in the portal portion of the liver; in
young calves sero-fibrinous inflammation may exist in different
Anatomical Changes, Symptoms. 397

joints and their surroundings, further gelatinous infiltration
of the subcutaneous connective tissue in the dewlap, on the
chest, and sometimes also on other parts of the body.

_ _ Symptoms. The period of incubation, after subcutaneous
injection of the virus, in this disease is 6 to 27 days, after in-
halation 12 to 16 days (Nocard & Roux), and it is probably
not much longer under natural conditions. The reports of a
very long time of incubation may probably be traced to the fact
that the disease may be obscured for a time even after the initial
rise of temperature, and symptoms of lung affection are only
later perceptible.

__ As the first symptom of the affection a rise in temperature
of % to 1 degree is observed, which may become even higher
during the following days.

The accurate observation of the body temperature in suspected
cases is of special importance. According to Lydtin, Fleming and
Brown animals in which the temperature is over 39.5°, and according
to Déle those in which it goes to over 40°, may be suspected of the disease
even if they fail to manifest other abnormalities.

Simultaneously with the rise in temperature the animals
manifest more or less pronounced symptoms of general illness,
depending on the more acute or more chronic character of the
disease (debility, capricious appetite, delayed rumination,
diminished milk secretion, ete.; according to Berndt, an edema
of the region of the throat appears at the beginning of the affec-
tion, which however soon disappears again). Almost at the
same time there is a short dry painful cough, which appears
especially in the morning after the animals rise at the opening’
of the stable door, or on leaving the stable, and while drinking.
This may also be brought on by percussion of the thoracic wall.

.. Later the cough becomes more frequent, although without reso-

- nance, moist and painful. In some animals there occurs a mod-
- erate muco-purulent nasal discharge.

This still indefinite clinical picture changes only slightly
for a time, ‘gradually however symptoms of difficult respiration
become more emphatic. About 2 to 4 weeks after the appear-
ance of the first symptoms the respiration becomes accelerated
(30 to 40 per minute) and labored; the stronger extension of
the thoracic wall is followed mostly by double contraction of the
abdominal muscles, with a simultaneous trembling of the rump.
During inspiration the intercostal spaces sink in, the nostrils
are opened wide, while the expiration is carried out with
grunting (later the respiration may become superficial and very
- much accelerated). At the same time the animals turn their

elbows outward, they utilize the accessory muscles of respira-
tion, and also show the want of air by an anxious expression.
On pressure on the vertebral column this is bent laterally.

Percussion reveals, in accordance with the extension of the

pneumonia, on one or both sides, behind the shoulder blade
398 Contagious Pleuro-pneumonia.

and up to a certain height, a partly or entirely dull sound, which
is limited above by a horizontal or slightly. convex line. During
percussion, as well as on pressure of the intercostal spaces the
animals manifest severe pain, and attempt to avoid the pres-
sure. Auscultation at first shows a weakened, vesicular breath-
ing and some crepitation in the anterior and lower portions
(Trinchera) ; later in the region of the partially or entirely dull
area no vesicular breathing or bronchial breathing may be
heard, but this is usually perceptible around the borders of the
affected area, while near the spinal column and, if the affection
is confined to only one lung, over that entire side the vesicular
breathing is increased, and frequently associated with moist
rales. In severe cases expiration is accompanied by grunting,
which covers up the respiratory sounds. The heart sounds are
either clear and strong, or can be heard only slightly on both
sides (in cases of serous pleural exudate). Friction sounds may
sometimes be heard in the early stages of the disease, over areas
in which the dullness has not yet completely developed.

With the progression of the lung affection the skin loses
its elasticity, the hair its smoothness and luster. The appetite
becomes worse and worse, the patients rest frequently in the
pasture, and separate themselves from the healthy animals.
Rumination is also delayed and sometimes entirely absent.
Later the patients fail to take any food, they pull away from the
crib, or remain apathetically in one place in the pasture. At the
same time rumination ceases, and instead they occasionally
eructate. The animals enjoy taking water, especially if it is
pure and fresh. Peristalsis is diminished, the flanks are sunken
in, constipation alternates with diarrhea, so that the animals
pass either dry, solid and dark brown, or fluid and fetid feces,
usually with ‘straining.

Urine is passed at long intervals and very sparingly. It
is dark yellow in color and acid in reaction, the specific gravity
is as high as 1.022-1.036, the amount of phosphoric acid is con-
siderably increased, up to 0.30%, while chlorin can only be
demonstrated in certain localities (Bugarszky).

The milk production, as already mentioned, diminishes even
in the earlier stages of the disease, and in the later course good
milking cows give hardly 1 to 2 deciliter of milk which contains
a considerably reduced quantity of fat and sugar, while the
casein and albumen are increased.

The body temperature rises in the further course of the
disease up to 41° to 42°, and the fever curve corresponds to a
‘‘febris continua.’’ The body heat is distributed unevenly over
the surface of the body, the ears and horns feel sometimes warm,
at other times cold, the extremities are cold. The muzzle is
dry and warm, later its surface is chapped and covered with
dried nasal secretion. The heart beat is correspondingly in-
creased during the height of the fever (80-100-120 beats per
minute), in the later course it is throbbing, the pulse is weak.
Symptoms, Course. 399

In fatal cases the animals become greatly emaciated while
the described symptoms become aggravated, they lie with ex-
tended neck and extremities on the ground, they breathe with
groans and with: open mouths, and‘ finally die of exhaustion.
Toward the termination of the disease a subcutaneous edem-
atous infiltration develops on the lower chest, lower abdomen,
and on the neck, and in other cases a serous inflammation of the
ions may follow. Cows usually abort in the course of the

isease.

Course. The disease commences as a rule in a latent form,
and 2 to 4 and even more weeks may pass before it is distinctly
perceptible. From this on the process progresses rapidly in
about one half of the cases, and death ensues inside of 2 to 3
-weeks more. Exceptionally the disease may have an acute
onset with severe symptoms, the pneumonia develops with a
sharp rise in temperature in from 2 to 3 days, and death ensues
even in the course of the first week. In other cases the affection
~ develops in the described manner, but before reaching an intense
degree the animal suddenly dies (paralysis of the heart due to
an inflammation of the pericardium and of the mediastinal con-
hective tissue?).

With the exception of these peracute cases the disease may
come to a standstill at any stage, whereupon the symptoms
gradually subside, the temperature drops, the cough becomes
stronger, the difficulty of respiration subsides, the appetite,
rumination and milk secretion returns, the skin becomes elastic,
and the animal is more lively in general and improves in nutri-
tion. The shorter the duration of the disease and the milder
the symptoms, the more complete is the improvement, and some
animals may appear entirely recovered after a certain time.
This condition may be permanent, especially in cases in which
the symptoms were less intense from the beginning, and no pro-
nounced dullness of the lungs could be found. Usually however
the recovery is only apparent, as after a shorter or longer time
the disease breaks out anew, and takes on a severe form, or it
is possible even later to ascertain a dullness in the lungs, with
the other manifestations of a constricted respiratory area in
the improved animals, which meanwhile may even increase in
body weight. If in severe cases improvement occurs at all it
usually requires months, until at least the digestive functions
are again performed normally. Notwithstanding this the respi-
ration may even later remain more or less difficult, a slight
cough may be noted periodically, and the animals are easily
fatigued. Such patients become again emaciated after a while,
and finally die from exhaustion, or the disease again assumes
an acute form and leads to rapid death.

The outcome of the disease can hardly be prognosticated
during its development. At present the prognosis is of no
importance, as the diagnosis of the disease, or its suspicion
requires the immediate slaughter of the animal.
400 Contagious Pleuro-pneumonia.

As an epizootic contagious pleuro-pneumonia usually runs
a slow course. After the first introduction the suspicion of
a general outbreak, because of its occurrence in several animals,
is aroused only after about 4 to 6 weeks. In stables the imme-
diate neighbors of the affected animal become first affected, and
the number of cases increases only from week to week, so that
in large herds it requires several months before all susceptible
animals are affected. If the dead or emergency slaughtered
animals are replaced by new ones, as for instance in fattening
establishments, the disease may exist with varying intensity for
years, and it may also be propagated for years among animals
in a township when kept upon public pastures.

Diagnosis. In the living animals a positive diagnosis can
only rarely be made with sufficient assurance. Physical exam-
ination shows only that the animal is affected with pneumonia,
or pleuro-pneumonia, the nature of which however can be estab-
lished accurately only by reliable historical data. If there is
a suspicion of infection every disease of the lungs which shows
a latent development and which gradually becomes more inten-
sive is a suspicious indication of the disease, especially when
several cattle become affected successively under similar mani‘
festations. Under such conditions the diagnosis of contagious
pleuro-pneumonia may be established with great probability,
especially when the disease becomes more advanced, and the
symptoms become more pronounced. Absolute certainty how-
ever is even in such cases revealed only by the autopsy.

From the standpoint of differential diagnosis, the subacute
pectoral form of hemorrhagic septicemia comes into consider-
ation in the first place. Although in most eases it is distin-
guished from pleuro-pneumonia by the sudden onset, the acute
course, the severe intestinal inflammation which is commonly
present, as well as the simultaneous affection of several animals,
isolated cases of the disease which run a slower course may be.
easily mistaken for the acute stage of pleuro-pneumonia. The
diagnosis is sometimes difficult even on postmortem examin-
ation; although in hemorrhagic septicemia a larger part of the
lung is usually uniformly affected and the cut surface shows no
marbled appearance, yet the changes in the lungs may entirely
simulate those of acute pleuro-pneumonia. Numerous hemor-
rhages in the pleural tissue and in the mucous membrane of
the air passages are indications of hemorrhagic septicemia,
nevertheless even in such cases the diagnosis can be established
with certainty only by bacteriological examination. In this
respect the difference is that in pleuro-pneumonia the exudate
of the lungs reveals no bacteria under the microscope, further
the inoculation of the fluid from the lungs has no effect on test
animals, and in calves the subcutaneous injection is followed
after one week at the earliest by an edematous swelling, while
in hemorrhagic septicemia the exudate of the lungs contains
small, polar stained bacilli; the inoculation of the fluid from the
Diagnosis. 401

lungs kills guinea pigs, rabbits, and as a rule also calves in
1 to 2 days. Nevertheless the diagnosis may prove difficult
even by this method of examination, as in some subacute cases
of hemorrhagic septicemia the lung tissue may contain only a
few ovoid bacteria, which are only slightly virulent for rabbits.

The characteristics given above hold also for the differentiation of
septic pleuro-pneumonia of calves caused by bipolar bacilli, from pleuro-
pneumonia.

Tuberculosis may be mistaken both for the early stage and
for the chronic form of pleuro-pneumonia. The severe cough,
the absence of extensive dullness, bronchial breathing and sensi-
tiveness of the thorax, further the normal temperature or only
moderate and sometimes remittent fever and the very slow
evolution suggest the probability of tuberculosis. The differ-
entiation may sometimes be difficult, as tuberculosis may take
on an acute character, and in pleuro-pneumonia the course may
become chronic after the disappearance of the acute symptoms.
Moreover the establishment of tuberculosis, for instance by
microscopical examination of the discharges, does not exclude
pleuro-pneumonia, as both affections may exist simultaneously
im one and the same animal.

Traumatic pericarditis has in common with pleuro-pneu-
monia the sensitiveness of the thorax, the dullness on per-
cussion and the difficulty in breathing. The sensitiveness how-
ever is mostly confined to the region of the heart, the dullness
is bordered by a concave line running downwards and forwards,
the heart’s action is quite easily disturbed, and besides a venous
pulse is sometimes perceptible in the neck, while on the lower
chest an edematous swelling is present. If however the lung
is simultaneously affected, the differentiation of the affection
from pleuro-pneumonia is impossible.

A genuine croupous pneumonia in which the fully devel-
oped clinical picture entirely corresponds with the symptoms
of pleuro-pneumonia, could only be suspected when the possi-
bility of contagious pleuro-pneumonia appears to be excluded,
and when the disease takes a typical course and disappears com-
pletely within a short time after a rapid dissolution of the
lung infiltration. On autopsy the slight affection of the pleura,
and the entirely uniform color of the hepatized portion of the
lung are indications of a genuine pneumonia (the cut surface
is sometimes marbled even in these cases but not variegated).

Finally in infected territories chronic bronchial catarrh,
catarrhal pneumonia, verminous bronchitis, pneumomycosis,
(nasal discharge!), the echinococcus disease (good nutritive
condition, no sensitiveness of the pleura), as well as other affec-
tions of the lungs, may give rise to suspicion of pleuro-pneu-
monia.

According to Nocard the diagnosis of pleuro-pneumonia may be made with
certainty in a short time by the examination of small portions of the lungs or of

Vol. 1—26
402 Contagious Pleuro-pneumonia,

~

the exudate in the following way: The exudate from the lung is diluted with
Martin’s bouillon 60-80 times and filtered through a Chamberland’s F-candle or
through a Berkefeld filter. The filtrate is collected in a sterilized flask, on the
bottom of which cattle blood serum has been placed in an amount corresponding
to 6-8% cf exudate. Then the flask containing the filtrate is placed in a thermostat,
and should the fluid become opalescent in 3 to 4 days without the microscopical
examination demonstrating therein distinguishable bacteria, the diagnosis of pleuro-
pueumonia may be considered as established. :

Immunization. Immunization against pleuro-pneumonia
has been employed to a considerable extent since the stand taken
by Willems in 1850, as a procedure by which healthy animals
may be protected against natural infection. Since that time
it has been employed widely, especially in Holland, Belgium,
Great Britain, France, and Germany, in recent times also in
Africa and Australia, while in England, Austria and Hungary
it has not met with favor.

I. Immunization with Fluid from the Lungs. This method
of immunization, the principle of which consists in the injection
of the living virus into the stretched subcutaneous connective
tissue of the point of the tail, which has a low temperature,
affords, as proved convincingly by Willems and later also by
other observers, the animals an immunity lasting over one year.
This can easily be proved by injections of virulent lymph into
the loose connective tissue of the dewlap or rump. While it
produces an extensive inflammatory edema in non-immunized
cattle which sometimes results in the death of the animal, in
cattle which have been immunized a swelling not exceeding the
size of a nut results at the point of inoculation, and an injection
of virulent lymph directly into the tissue of the lung does not in
any way affect their health. Practical experience coincides with
these results, it having been observed that immunized animals
become much more rarely affected through natural infection
than cattle which have not been immunized.

In Willems’ experiments 108 immunized cattle remained healthy after being
exposed to the natural infection, while out of 50 animals which were not immunized,
17 became affected under the same conditions. Thiernesse & Degive injected 96
immunized cattle with virulent lymph into the loose connective tissue of the rump,
whereupon they became affected only mildly or not at all, while of 33 animals
which were not immunized and subjected to the same infection, all contracted the
disease. Schiitz & Steffen inoculated 31 animals partly with warm, partly with
cooled lymph from the lungs; 12 were later placed among infected animals, but
remained healthy, while of four control animals three died. The remaining 19 head
received later virulent lymph injected either into the connective tissue of the
dewlap or into the lungs, whereupon they contracted the disease only in a mild

form or not at all, while all of the six control animals became severely affected
and three of them died.

Under certain conditions the immunization may prove an
effective method of controlling the disease, especially when it
is very widely spread in a country, and the general obligatory
slaughter of the suspected animals cannot be carried out for
some reason, and where the danger of subsequent exposure
must continue to threaten the animals (in case of infection
involving large herds, public herds, valuable large dairy herds,
industrial fattening establishments).

 

4
a
Immunization. ; 403

_As a matter of fact the procedure was mostly disapproved
of in the past, and played only a subordinate part in the
attempts to eradicate the disease. This may be explained prin-
cipally by the fact that in immunizing large herds those animals
are of course also inoculated which, although apparently healthy
nevertheless are already infected. In these animals the already
existing inflammatory process continues to develop in the usual
manner in spite of the inoculation and thus these animals,
which are believed to be no longer susceptible, continue to
spread the disease among those which have not been immunized.
A further disadvantage exists also in the frequent loss of the
tail as well as in the occasional fatal results of the method.

Immunization was introduced in the Spoelinger District of Holland in 1874,
as this territory had been so badly infected that the slaughter of animals could
not be carried out, and as a result of this procedure up to 1884 the annual loss
was reduced from 1,208 to 135 cattle. According to Degive 2.7% out of 6,706 immu-
nized animals acquired the disease between 1850 and 1883 in the various countries,
while out of 2,453 animals, which were not immunized, 26.9% became later affected
with pleuro-pneumonia. In the German Empire, according to official reports, out
of 3,868 immunized animals 151 (3.9%) became affected in the period of 1891-1900
in previously immunized herds, while out of 546 not immunized animals 73 (13.4%)
became ill. In herds which were immunized only after the outbreak of the disease,
out of 3,287 immunized animals 394 (11.9%,) became subsequently affected with
pleuro-pneumonia.

Results of the Immunization. After the inoculation of fresh, pure
lymph, a hard, painful and warm swelling in size like a nut to an
egg develops in about 90% of the animals, at the point of inoculation ;
the animals keep the tail quiet and slightly bent upward, and at the
same time showing marked febrile symptoms. In favorable: cases the
swelling disappears together with the febrile symptoms inside of 1 to
2 weeks; not infrequently however the swelling increases in size and
suppuration or even necrosis of the tip of the tail sets in. Occasionally
the inflammation may extend even to the root of the tail and to the
part around the anus, as well as to the connective tissue of the pelvis,
whereupon the animal dies from peritonitis which may be associated
with it, or from pyemia or septicemia. The cause of these dangerous
complications may almost invariably be attributed to the fact that the
vaccine originally contained foreign pathogenic bacteria, or that such
organisms entered it during its preparation and preservation, or during
the inoculation. The number of deaths and losses of tails varies accord-
ingly from case to case. On an average 1 to 3% of the immunized
animals die, and 5 to 15% lose their tails.

According to Haubner the deaths amount on an average to 1-2% (at the
highest 10%), the losses of tails to 5-10%. In Holland, in the Spoelinger District,
‘out of 147,971 immunized animals 1,285 (0.94%) died in the years 1878-1887, while
in Hasselt, the home of Willems, the mortality among 184,275 immunized animals
did not exceed 1%. In Germany out of 17,520 immunized animals 141 (0.8%)
died as a result of the inoculation between 1891-1901. In some cases, however, the
losses were considerably greater. Thus Hildebrandt observed among 365 inoculated
animals 69 (18.9%) deaths, while on another occasion 49% of the animals remaining
alive lost their tails. Similar unfavorable results are reported by Omler.

Technique of Inoculation. In the oldest method recommended by Willems, the
material which is used for the immunization consists of fluids from the lungs of an
animal affected with the acute form of pleuro-pneumonia, which had been slaughtered
immediately before the immunization. The hepatized part of the lung is incised
by a knife sterilized in a flame, whereupon the lymph accumulates in the depth of
404 Contagious Pleuro-pneumonia.

.

the incision. The inoculation is carried out by dipping a grooved vaccinating needle
into the lymph, and sticking the same about 10 em. from the point of the tail into
the subeutis, or the lymph may be allowed to coagulate in a glass vessel and 1-2
drops of the serum are subcutaneously injected into the same place by means of a
Pravaz syringe. é

In procuring the virus special care should be taken that the lungs are only
affected with characteristic acute changes of pleuro-pneumonia, and that the lymph
is very clear and light yellow. Lungs in which necrotic centers are already present
must not be used for this purpose, as they frequently contain pyogenic or gangrene
producing bacteria. Some filter the collected lymph through pure linen and inoculate
the filtrate. If pure serous exudate is present between the layers of the pleura,
this may also be utilized for the inoculation.

The described procedure has repeatedly been modified; thus Martin introduces
under the skin of the end of the tail, immediately under the last caudal vertebra a
hair cord three mm. broad and 8-10 em. long saturated with lymph. This is allowed
to remain in place for 8 to 12 days and is in the meantime repeatedly moistened with
lymph. A similar method is practiced by the Boers in South Africa, in which
they saturate raw, woolen threads with lymph and introduce them under the skin
at the point of the tail. Defays, Bouley, Thiernesse and Degive injected 2 ce. of
virus directly into a superficial vein, for instance into the jugular.

Others again, among them Willems, utilize the serous fluid of the swelling at
the point of inoculation as vaccine, whereas in Australia, in accordance with
Pasteur’s suggestion, the fluid of the lung is first inoculated subcutaneously into
the dewlap, or behind the shoulder of a calf two or three months old, and from the
resulting swelling after the death of the animal the lymph, which sometimes amounts
to several liters, is collected in glass tubes, the ends of which are closed by melting.
The lymph thus obtained is supposed to remain unchanged and effective for six
to eight weeks if kept in a cool place (according to Schmidt adult cattle are still
better adapted for lymph production than calves).

Laquerriére allows the lung to freeze at 5° to 6° below zero, and then places
small pieces of it in sterilized glass vessels. The lymph which: oozes out has the
same effectiveness after one year as when taken out from the fresh lung. Schiitz
& Steffen grind the fresh lung juice-in a mortar with glycerin and then place it in
a cool place. This substance remains effective for at least eight days, as coagulation
is prevented by the glycerin. Nocard incises the hepatized lungs, which have been
washed in hot water, deeply, and covers the incision with a plate. The collected
lymph is drawn off with a sterilized pipette, mixed with water containing carbolic
acid and glycerin (1 part lymph, % part of a 14% solution carbolie acid, % part
pure neutral glycerin). This is filtered through paper and kept in glass tubes in
cool dark places. Such lymph remains unchanged for months. The natives”
of Senegambia for a long time employed the method of taking the point of a knife
or dagger, dipping it first into the affected lungs, and then sticking it under the
skin of the back of the neck of the animal which was to be inoculated.

Besides the methods described Theiler recommends the administration of viru-
Jent material (fluid. of the lung or culture) per os, (6 oz. diluted with water), as
has been practiced for a long time in-South Africa. The immunity is supposed to
last for 18 months. :

II. Immunization with Pure Cultures. In France immun-
ization with pure cultures has been carried out since 1899 ac-
cording to the suggestion of Nocard & Roux, and the results
have in general been more favorable than with the old method.
An eight-day old culture of the virus in Martin’s bouillon serves
as vaccine, of which cattle receive 14 to 14 cc. subcutaneously,
inoculated into the tip of the tail. The immunity thus pro-
duced lasts for at least two years, as immunized animals, which
have distinctly reacted to the inoculation, withstand after two
years a subcutaneous injection of 0.5 ec. of pure culture without
any reaction (Constant & Mesnard).

In the beginning of 1901, 2,359 cattle were immunized by this method in
Southern France, on 597 premises; of these 3 (0.12%) died, 18 head (0.7%) lost
their tails. All of these losses occurred in one township, where a veterinarian had
not carried out the inoculation in accordance with the requirements; otherwise no
Immunization. 405

losses were observed (Nocard). During 1902, out of 1,955 immunized animals nine died,
while 257 lost their tails (the inoculations were made in this instance during unfavor-
able weather). In 1903 and 1904 attenuated cultures were used for the immunization,
a = i oceasion out of 5,554 animals only one died, and only 88 cattle lost
their tails.

According to Yohowsky’s report immunization with pure cultures also gave
satisfactory results in Russia, only he emphasizes the fact that cattle which had not
reacted to the inoculation should be inoculated the second time after 20 to 25 days.
Very favorable results are likewise reported from Russia and Siberia by Dorofeew,
Mukarewsky and Stahl.

Cattle may also be immunized effectively by intraocular injections of pure
cultures (Nocard & Roux).

III, Serum Inoculation. Although the serum of healthy
cattle and those which have recovered from the disease, pos-
sesses no immunizing properties, animals which become affected
as a result of subcutaneous injections of a small quantity of
pure culture and have again recovered, and which have sub-
sequently received during several months subcutaneous injec-
tions of up to over 6 liters of culture, produce a potent serum,
although it has no agglutinating or bactericidal properties.
A subcutaneous injection of 40 cc. of such serum produces an
immunity lasting from 8 to 10 days, while 40-60 cc. checks the
further development of an inoculation-swelling produced by
a virulent injection. After the appearance of the fever re-
peated injections of 100-200 cc. of serum are réquired to exert
a curative action; at still later stages it is not possible, even
by very large injections, to check the process in the lungs
(Nocard).

Veterinary Police. As the treatment of affected animals
does not promise results, the complete eradication of the disease
by veterinary police measures is of special importance. As
the virus remains virulent in the body of affected animals for
a long time, even in cases showing improvement, it can only
be destroyed by the slaughter of all cattle which are supposed
to harbor it in their bodies. In this regard, besides the affected
and exposed animals even those should be considered which
are suspected of having been affected, as suspicious symptoms
of the disease appear only relatively long after the infection
in a perceptible manner.

This attitude has been assumed by the legislative bodies
of those countries which earnestly desired the complete eradica-
tion of contagious pleuro-pneumonia, and by an energetic prac-
tical execution of this principle, and by satisfactory compensa-
tion of the owners, the desired end has been achieved. However
the killing of all the suspected animals in localities where the
disease is widely spread, especially in large dairy herds, fatten-
ing establishments, and public cattle herds, is hardly possible
of execution without great danger to the stock industry. There-
fore in such herds the isolation or quarantining of the suspected
animals for a period of at least six months should be considered,
and further, in order to reduce the individual susceptibility the
application of occasional immunization, particularly since by
406 Contagious Pleuro-pneumonia.

the utilization of pure cultures for immunization, the danger
has been greatly lessened as compared with former times.
Further a thorough disinfection of the infected stables, as well
as the most thorough airing possible of the evacuated buildings,
ald greatly in obtaining the desired result.

The law of 1880 concerning the infectious diseases of the German Empire
ordered only the slaughter of the affected animals; in 1895, however, this measure
was extended also to suspected animals, and the authorities were further authorized
to destroy cattle which were suspected of having been infected. In the period of
1890-1903 11,975 cattle were slaughtered by authoritative order, and the government-
indemnity to the owners amounted to 2,987,795 marks.

In Great Britain the measure of 1888 did not have satisfactory results in
spite of the fact that over 30,000 cattle were slaughtered, as the slaughter of the affected
and suspected animals and the compensation of the owners had to be carried by
the local funds; therefore by the Act of July 4, 1890, the government was entrusted
with the execution of the eradication. Since that time the situation has improved
rapidly, so that in 1898 the entire country was free from the disease (the cost of
eradication amounted to over 4 million pounds sterling).

In accordance with the contagious pleuro-pneumonia law of August 17, 1892,
the eradication was carried out in Austria until the suppression of the disease in
1897, during which time 21,013 cattle were slaughtered, at a valuation of 3,555,886
crowns; of this amount the State paid an indemnity of 2 »711,651 crowns.

In Hungary, according to the law of 1893, the slaughter of the affected and
suspected animals was ordered, eventually also of those which were suspected of
being affected, and the time of observation for the latter was extended to six months,
The owners were assured of an indemnity by the State, which in accordance with the
law of 1897, included for healthy animals the full value, and for affected cattle
90% of the appraised value. Until the eradication of the disease in 1901, 56,238
cattle were slaughtered in accordance with this law, with a total indemnity amounting
to 3,651,905 crowns. In a similar way, by obligatory slaughter of the affected and
suspected animals, with indemnity from the State, the disease has been eradicated in
Holland (1884-1888), in Denmark (1849-1856), and in North America (1887-1892).

Literature. Willems, Rec., 1852, 401; 1887, 11—Magendie & Bouley, Ibid.,
1854, 161.—Sussdorf, D. Z. f. Tm., 1879, Vv; 353.—Thiernesse & Degive, Ann., 1882,
620.——Schiitz & Steffen, A. f. Tk., 1889, XV, "217; 1890, XVI, 29; 1891, XVII, ’290.—
Mac Fadyean, J. of comp. Path., 1892, V.—Nocard, Bull, 1393, 158, 203 u. 317.—
Roeckl, Ber. iber d. Kongr in Bern, 1894, 11.—Thomassen, Ibid., 1894, 51.—Nocard
& Roux, A. P., 1898, XII, 240; 1901, 416 -—Noeard, Roux & Dujardin- Beaumetz,
Bull., 1899, 430. —Schmidt, B. 't. W., 1898, 159; Dd. +. W., 1899, 265.—Techn.
Dep. "ft. d. Vet. -Wesen, A. f. Tk., 1899, XKXV, 319. —Theiler, Schw. A, ‘1899, XLI, 57.
—Constant & Mesnard, Ree., 1903, 436; 1904, 552 —Dujardin- Beaumetz, A. PB. 1906,
XX, 449.—Bordet, A. ’P,, 1910, XXIV, 161. Borel, Dujardin-Beaumetz, Jeantet &
Jouan, Tbid., 168.

Infectious Pleuro-pneumonia of Goats. In the years of 1894 and
1895 a severe pneumonia developed in various localities of Germany,
especially in Saxony in the vicinity of Dresden (Pusch) and in Thurin-
gia (Storch, Holzendorff), among the bucks imported to this locality
from the Swiss Simmental shortly after their arrival, which later spread
also to the native goats. At the same time the disease was observed by
Leclainche in the Pyrenees, two years later by Mazzini in Italy, and the
first mentioned author established the fact that the disease is identical
with the affection of goats in Algeria known there as ‘‘boufrida,’’ and
which occurs there in some years in an epizootic form causing great
losses.

The disease appears to affect goats exclusively; the transmission to
other animals, even to sheep, has not yet been observed. According to
recorded observations the disease is prevalent only in mountainous
regions, where it usually runs a mild course. If however the affected
animals are brought to other localities the disease attains, under the
influence of the transportation and ‘the changed climatic conditions, a
severe form, and causes severe losses even among the native goats.
Symptoms. 407

Symptoms. The disease commences after .a period of incubation of
8 to 10 days (Pusch) with fever and catarrh of the air passages (cough,
nasal discharge, increased vesicular breathing). After 3 to 5 days the
respiration becomes very laborious and on physical examination of the
thorax exudative pleurisy or hepatization in a portion of the lung may
be established, which as a rule is confined to one side. Subsequently the
condition becomes aggravated sometimes rapidly, other times only
gradually, and as a rule about one half of the affected animals die.
In some animals a herpes-like eruption is observed on the lips, some-
times also on the udder, which as a rule heals without interference.

‘The course is at times so rapid that the hepatization of the lungs
develops in a few hours and death ensues in from 12 to 46 hours; mostly
however the disease lasts, even in severe cases, from 3 to 4 weeks, while
in other animals it runs a more chronie course, and the animals, which
in the meantime become greatly emaciated, finally recover.

The autopsy sometimes reveals only hepatization of a small or
larger area of the lung in which there is at the same time an infiltration
of the interstitial connective tissue. The cut surface therefore resembles
somewhat that of the lungs in contagious pleuro-pneumonia. In other
cases, which are more frequent, there is also a sero-fibrinous pleurisy
with profuse exudate in the thorax. At the same time the peribronchial
lymph glands, and the spleen show acute swelling, while the other
organs show no special changes.

Bacteriological examinations have failed to reveal, up to the present
time the presence of micro-organisms, either in the affected lungs or in
the pleural exudate. Inoculation of material from the lesions into
goats, and also into other animals was entirely negative. This condition
differentiates the disease from contagious pleuro-pneumonia of goats
(see p. 124), and also excludes a relationship with that disease. Never-
theless the infectiousness of the disease cannot be denied, especially in
consideration of the experiences in Germany, and therefore quarantine
measures, isolation, and early slaughter of the affected animals, disin-
fection of the stables, ete., are fully justified on its appearance.

Literature. Pusch, D. t. W., 1894, 403.—Storch, B. t. W., 1896, 567.—Holzen.
dorff, A. f. Tk., 1896, XXII, 346.—Leclainche, Rev. vét., 1897, 1. (Lit.). —Mazzini,
Giorn., 1898, 350.—Castelet, Progr. vét., 1906, 324.

Chronic Pneumonia of Sheep. According to Robertson (1904), a
disease occurs in South Africa among sheep, known there as Jagziekte
(hunting-disease), or Hartslagziekte, which is usually observed during
the winter months in the higher altitudes in the Cape Colonies, and is
manifested by difficulty in respiration, with flank breathing. The
autopsy reveals a chronic catarrhal pneumonia, without tendency to
degeneration, caseation or suppuration; the sharply circumscribed, hepa-
tized areas have the appearance of bacon, and are greasy to the touch;
in older lesions the connective tissue is increased to such an extent, and
is so tough, that it cuts like cartilage. In the later stages the adjoining
pleura also appears thickened and adheres to the costal pleura. The
affected lung tissue contains half-moon shaped, centrally well-stained,
and also cylindrical bodies (supposed to be protozoa?). Attempts to
transmit the disease artificially to healthy sheep failed to give positive
results. (J. of comp. Path., 1904, XVII, 221.)
,

408 Malignant Catarrhal Fever of Cattle.

3. Malignant Catarrhal Fever of Cattle. Coryza gangraenosa
bovum.

(Rhinitis gangraenosa, Bosartiges Katarrhal-fieber der Rinder
[German]; Coryza gangréneux, mal de téte de con-
tagion [French]; Febbre catarrale infettiva
[Italian].)

Malignant catarrhal fever is an acute, non-contagious, in-
fectious disease of cattle and buffalo, which is characterized
especially by an inflammation of the mucous membrane of the
head, with a tendency to formation of membranes and ulcera-
tions, with a simultaneous affection of the eyes and severe ner-
vous symptoms.

History. The disease has been observed and described repeatedly
since the end of the eighteenth century; its nature however was, even
up to the present time, not sufficiently established. Anker (1832) de-
scribes it as typhus of cattle, he as well as Spinola were of the opinion
that the benign nasal catarrh may change to the malignant type under
certain conditions. Haubner and Roll, later also Lucet, laid particular
stress on the diphtheritic affection of the mucous membranes, the disease
however was not considered as a specific infection of cattle until Bugnion
(1877) classified it as such, his view being at present generally accepted.
Transmission experiments were carried out by Brusasco (1887) and
Lucet (1892), with negative results, while Leclainche (1898) added fur-
ther contributions to the etiology of the disease.

Occurrence. The disease is observed either sporadically
or as a stable infection. In some localities, and especially in
stables of poor cattle owners it is more frequent than under
more favorable hygienic conditions.

In Europe the disease occurs everywhere, most frequently, however, in northern
parts, on the Scandinavian peninsula (in 1904, 599 cases occurred in Norway), and
in Denmark. Severe outbreaks have repeatedly been reported from Russia, but it
cannot be asserted with certainty that it was not mistaken for rinderpest or a
mixed infection. In Hungary most cases were observed in the mountainous region
of Northern Hungary and Siebenbiirgen. The disease is also known in South Africa
(in Transvaal as ‘‘Snottziekte,’’ Theiler).

The disease has been observed among buffaloes in the Netherland-Indies, and
on the island of Java (Pascola, Paszotta). :

Etiology. The etiology of the disease is not yet entirely
clear. This can only be accepted with great probability, that
the supposed infective micro-organism produces through its
toxic products a general intoxication of the organism, in the
course of which the resistance of the tissues, and especially
of the mucous membranes is diminished, so that under the in-
fluence of other bacteria which subsequently reach these parts,
inflammatory processes develop on the mucous membrane with
the formation of fibrinous membranes, and later necrosis of
the tissue.

Various authors (Ow, Semmer, Franck, Lucet and others) found
different bacteria in the deposits of the mucous membrane; their part
Etiology. 409

in the etiology of the disease has however not been definitely estab-
lished. Nocard found in the pseudo-membranes of the larynx and the
nasal cavity, bacilli resembling the bacteria of hemorrhagic septicemia.

The etiology has been more closely studied by Leclainche, and the
results of his investigations may be summed up as follows: <A virulent
variety of the colon bacillus may be demonstrated in the intestinal canal,
in the lymph glands of the mesentery, sometimes also on the nasal mucous
membrane, in the horn core and in the sub-lingual glands. This organ-
ism produces very poisonous toxins in bouillon culture, especially for
young cattle. Two cc. of a 15-day old bouillon culture injected intra-
venously or 10 ce. injected subcutaneously into a calf about nine months
old, produces after a few minutes severe symptoms of poisoning (restless-
ness, trembling, rising temperature, colic, serous discharge from the nose,
and lachrymation), which after 24 to 48 hours gradually disappears.
Intravenous injection of 10 to 40 ce. of a one-day old culture produces
diarrhea, nasal discharge, and salivation, whereupon the animal dies
in from 5 to 6 hours, and on autopsy all mucous membranes are found
markedly reddened. Feeding of one liter of the culture causes only
a passing diarrhea.

Leclainche considers these symptoms and changes as identical with
those which are observed in the early stages of the disease, and believes
that the bacteria which multiply rapidly in the intestinal canal migrate
into the neighboring lymph glands and produce toxins, which after
absorption produce a general intoxication and catarrhal hyperemia of
the mucous membranes, whereupon streptococci and other pyogenic bac-
teria subsequently cause suppuration and necrosis in these tissues. In-
asmuch however as Leclainche did not succeed in producing the disease
in its typical form, and as the observed symptoms of intoxication may
be brought on in a very similar manner by the inoculation of cultures
of other pathogenic bacteria, and as the virulent coli bacteria may also
multiply subsequently in the intestinal canal and later migrate into
the lymph glands, the conclusions drawn from the above investigation
must for the present be accepted with reservations.

The nature and method of the natural infection is not yet
known accurately. The experience that the disease occurs
mostly, although not exclusively, in poorly constructed, low
and dark, badly ventilated stables, with unclean floors, appears
to indicate that the virus propagates on the contaminated
floors of such stables, and probably also in stable filth. From
such places it reaches the digestive tract of the animal with
the food or drinking water. In rare instances animals in pas-
ture may also become affected, these cases however, are fre-
quently associated with bad, polluted drinking water.

"The disease appears to be non-contagious. Experiments
of transmitting the disease by inoculation with the nasal secre-
tions of affected animals were without results (Brusasco, Esser,
Lotzer). Furthermore, animals which stand next to the af-
fected cattle do not become affected in spite of the very close
contact. If the disease spreads in a stable, or if it appears
at the same time in various places in a township or locality,
this cannot be attributed to its contagiousness, but rather to
the simultaneous influences of a common local cause. Instances
are recorded in which the disease appears annually in certain
410 Malignant Catarrhal Fever of Cattle.

stables, which also indicates the influence of a local cause, and
likewise proves that this may continue to exist for a long time
in one place.

Frentzling observed in the course of a year and a half in one stable 32
cases of the disease, while Dieckerhoff & Junkers saw in a herd of 15 cattle, eight
fatal affections within 17 days. According to Isepponi the disease occurs en-
zootically among the cattle and goats in the mountains of the Swiss Canton Grau-
biinden, especially in the spring, for instance in the period of 1889-1892, of a total
number of 45,000 cattle, 407 became affected, while in the Canton Ziirich, out of
94,738 cattle only three fell victims to the disease in 1900. In the fall of 1893
Kramarew observed the disease in an epizootic form among pastured animals in
four townships in Southern Russia. Of 1,244 cattle 322 became affected, 139 (40%)
of which died (the mortality varied in the different townships between 34-67%).
The disease was supposed to have resulted from polluted river water.

Unfavorable outside influences, such as sudden change in
the outside temperature or moist cold weather and colds caused
by such, further fatigue during work, etc., appear to be not
infrequently accessory causes in the appearance of the disease.
If it could be proved that the disease is caused by a variety
of the colon bacillus its development could be explained in that
the otherwise harmless habitant of the intestinal canal some-
times multiplies rapidly under the above mentioned weakening
influences and at the same time attains an increased virulence
as a result of which it produces an intoxication of the organism.

The disease occurs frequently in certain localities, especially
in swampy places, while in others it is unknown in spite of other-
wise similar local conditions. It is usually observed in spring
and fall, more rarely in summer, and very exceptionally in
winter. (Mehrdorf has known a farm on which the disease
existed uninterruptedly for several years as a stable infection.)
Young animals are affected mostly; according to Ow only up
to the third year, while calves under one year show but very
slight susceptibility; steers appear to be more susceptible than
cows. A recovery from the disease does not protect the animals
from a new attack, as sometimes recovered animals become re-
infected after several weeks or months, and then usually with
more severe symptoms than the first time (Nagy).

Similar affections were observed in other species of animals than
cattle. Thus Hable has seen a similar disease in two horses, Schloss-
leitner in two hogs. In these cases the symptoms were fever, severe
nasal catarrh, conjunctivitis and keratitis, while the horses also showed
pharyngitis. According to Isepponi’s observations the disease may occur
frequently in goats.

Anatomical Changes. The most constant findings at
autopsy are the inflammatory changes on the mucous membrane
of the upper air passages. The mucous membranes of the
nose, and those of Highmore’s and the frontal sinuses, which
contain various quantities of a thick, fetid pus, are markedly
reddened or cyanotic, swollen, and sprinkled with small hemor-
rhages. Its surface is covered with purulent secretion, and
Anatomical Changes. Symptoms. 411

in places with loose, croupous, easily detachable, flat deposits,
under which the epithelium is desquamated, sometimes also
ulcerated. The ulcers may also extend into the deeper layers,
so that their base is formed by the periosteum; indeed, the
necrosis and the gangrene may even involve the bones especially
the ethmoid, or the turbinates. The inflammation sometimes
involves the cores of the horns, also the fleshy laminae of
the horns, as a result of which they appear reddened and juicy,
provided that the horns have not dropped off during life, or
are only loosely attached to the skin. The hemorrhagic or
sometimes also croupous inflammation may occur in the larynx
and in the trachea and in rare cases in the bronchi. Excep-
tionally a catarrhal pneumonia, and sero-fibrinous pleuritis may
be present.

The buccal mucous membrane is bright red in color and
shows catarrhal swelling; the gums, the inner surface of the
lips, as well as the palate may contain round, flat deposits, with
underlying erosions. Similar changes are frequently present
in the greatly swollen mucous membrane of the pharynx, which
shows a gelatinous infiltration of its deeper layers.

The eyes manifest the changes which are recognizable in the
living animal (see p. 412). The cerebral meninges are
hyperemic, and saturated with a serous fluid; the ventricles
contain a profuse yellowish, slightly turbid or reddish exudate.

Among other changes there is frequently an acute catarrh
of the mucous membrane of the stomach and intestinal canal,
with small superficial hemorrhages, in rare cases covered with
fibrinous pseudo-membranes, and necrosis of the superficial
layers, especially on the Peyer’s patches. The liquid contents
of the intestinal canal are frequently mixed with blood, some-
times also with fibrinous shreds.

The spleen shows a moderately acute swelling, the liver
and the kidneys cloudy swelling; the mucous membrane of the
urethra shows an inflammatory reddening in its entire length,
and is sometimes sprinkled with punctiform hemorrhages and
covered with fine pseudo-membranes. The lungs are hyperemic,
and show acute edema, sometimes also interstitial emphysema
and infarcts. The lymph glands, especially in the mesentery
are acutely swollen; further fresh hemorrhages.may be seen
in some cases in the subeutaneous and subserous connective
tissues, as well as in the muscles.

Symptoms. Older authors (Bugnion, Franck) estimated
the time of incubation of the disease as from 3 to 4 weeks; it
extends however very probably only to several days (according
to Lucet it is not more than 12 hours). :
og The disease commences usually with rapidly progressing

‘febrile symptoms. Within a few hours the temperature reaches
40°-42°; the heat on the body surface is unevenly distributed,
and the skin feels hot, especially at the base of the horns, and
over the cranium. The muzzle is warm and dry, the hair rough-
412 Malignant Catarrhal Fever of Cattle.

ened, the skin tight and dry. The animals manifest at the
same time great debility, and dullness of the sensorium, they
stand with staring look and drooped head or support the head
on the crib, or they lie down much of the time with extended
neck. If urged to rise they stand up only with difficulty, stagger
on their legs, and arch their backs. Some patients grind their
teeth from time to time, bellow, stand in the manger, and even
attack objects standing before them. In the meantime trembling
is observed in some of the groups of muscles, especially on
the neck, shoulders and abdomen, which, under the influence of
outside irritation, for instance sunlight, may extend to all
muscles and even increase to epileptic convulsions (Anker).
The animals show great thirst, while appetite and rumination
are suppressed. The milk secretion diminishes and constipa-
tion is present. Exceptionally the disease may commence with-
out fever or conspicuous dullness, but the manifestations are
indicated in digestive disturbances and salivation (Balog).

On the first, and not later than on the second day of the
disease inflammation of the conjunctiva, as well as of the nasal
and buccal mucous membranes develops.

The eyelids swell and are continuously kept closed on ac-
count of photophobia, at the same time tears run profusely over
the cheek from the inner canthus of the eye. After 18 to 24
hours the cornea commences to show a smoky cloudiness, which
starts at the periphery, and the entire surface gradually be-
comes opaque. In the meantime in some of the cases a serous
exudate is eliminated from the inflamed areas and the ciliary
body, which fills the anterior chamber of the eye, either partly
or entirely giving the still transparent cornea a yellowish hue.
Exceptionally the cornea remains transparent in spite of the
internal inflammation of- the eye (Bugnion, Dieckerhoff,
Tsepponi). At the same time a purulent secretion accumulates
under the eyelids, the vessels of the sclera are extended, and
a fine wreath of vessels may appear on the border of the cornea.

A nasal discharge becomes noticeable; the secretion is at
first mucoid, yellowish, but soon becomes purulent, fetid, and
mixed with fibrinous shreds, occasionally also with blood, and
dries on the nostrils into brown crusts so that it chaps the
skin. The nasal mucous membrane is highly reddened and
covered with dirty gray, loose pseudo-membranes which are
easily detachable leaving an ulcerated surface.

The inflammatory process always extends from the nose
to the neighboring Highmore’s and frontal sinuses, which is
evident by the conspicuous dullness, as well as by the increased
heat and swelling of the corresponding parts. Sometimes it ex-
tends from the wall of the frontal sinuses to the bony wall of
the matrix of the horns and in consequence the horns loosen
from their cores, and drop off either spontaneously, or as the
result of a blow.

Respiration becomes snuffled as a result of the swelling of
Symptoms. 413

the nasal mucosa, sometimes also of the larynx; later rattling
and snoring are observed. It is always accelerated and labored;
in some cases the difficulty in respiration increases to symptoms
of asphyxiation, which may finally cause the death of the animal.
Increased vesicular breathing may be heard over the chest walls,
sometimes together with moist rales. The heart’s action is
excited from the beginning, the pulse is at first full and hard,
later small and soft.

The mucous membrane of the mouth appears reddened, hot
and dry (especially striking on the dorsum of the tongue) ;
soon gray or yellowish pseudo-membranes develop in some
parts of its surface, especially on the gum, on the inner surface
of the lips, and on the hard palate, which later are thrown Off,
leaving superficial granulating ulcers. Exceptionally vesicles
lying in close proximity appear on the skin near the corners
of the mouth, and on the muzzle (Wahl), which soon leave
ulcers in their places. Still more readily the inflammation
extends to the pharynx, as a result of which difficulty in swal-
lowing appears or swallowing becomes entirely impossible. At
the same time the earlier salivation becomes still more profuse,
and the saliva itself shows a dirty discoloration, mixed with
membranous shreds, and is fetid, as is also the exhaled air
(Pascolo and Paszotta in a buffalo observed trismus). In rare
cases croupous membranes and ulcerations develop also in the
rectum and in the vagina. The feces which are at first dry
become softer, soon fluid, at the same time may be mixed with
blood and fibrinous shreds, and are passed under great
straining.

The urine has an acid reaction (Franck), is cloudy, -con-
tains considerable albumen, and sometimes also blood; under
the microscope renal epithelia and cylinders are found.

The body temperature, which usually reaches its height
on the second day, drops later 1°-2°, fluctuates then between
39°-40°, and at the approach of death it drops below normal
(Lucet).

In some cases a papular or vesicular exanthema may de-
velop on the skin of the entire body or only in some places,
such as the neck, back, udder and interdigital space, resulting
in the formation of brown scabs, which on dropping off remove
also the hair, while on the udder the thin skin bursts in places,
and subsequently a parenchymatous mastitis may develop.
Later profuse scaling of the epidermis is observed on the hair-
less parts. Finally a diffuse inflammation of the skin of the
interdigital space may result in exceptional cases. (According
to Franck in this form the horns, as well as the hoofs are most
frequently thrown off.) ;

During the disease the animals become greatly emaciated,
they lie continually on the ground, and finally die from exhaus-
tion, usually with convulsions.

The enumerated symptoms are observed in the majority of cases
414 Malignant Catarrhal Fever of Cattle.

in quite a uniform development in the respiratory and digestive appa-
ratus; sometimes however the respiratory organs are only slightly at-
fected in spite of the severe affection of the digestive tract (intestinal
form).

According to Isepponi the disease occasionally shows an atypical
course, inasmuch as in the presence of a high fever, but almost normal .
respiration and heart action, the patients suddenly pass thin, fetid,
sometimes also bloody feces, whereupon death ensues in 2 to 3 days.
The cornea in such cases is not clouded.

Lucet also described a form of the disease in which a catarrhal
croupous pleuro-pneumonia becomes associated with the inflammation
of the upper air passages after a short time. According to his observa-
tions, in this always very rapid type of the disease the affection of the
eyes is only slightly pronounced, and especially on the cornea hardly
any changes are noticeable. He considers the croupous inflammation
of the pharynx, larynx, bronchi, and of the lungs as different forms of
a special disease, the diphtheria of cattle (?). ‘

Lichtenheld reports on a malignant catarrh of cattle in German
East Africa, which with otherwise similar symptoms is differentiated
from the catarrhal fever occurring in Europe, by its epizootic form,
with losses up to 75%, further by the marked predominance of the
affection of the intestines, and the usually hemorrhagic character of the
mucous membranes.

Course and Prognosis. The disease runs with few excep-
tions an acute course. The clinical picture is usually fully
developed in 3 to 4 days, and death follows in 4 to 12 days.
In some of the cases the symptoms diminish after the disease
has rapidly developed, and the animals commence to eat, al-
though they still have fever and continue to emaciate; a little
later the condition again becomes aggravated, and the animals
finally die in 2 to 3 weeks.

The prognosis is quite unfavorable, as the mortality varies
between 50-90%. Severe nervous symptoms and a great exten-
sion of the inflammatory process should be considered as un-
favorable indications. The body temperature deserves special
attention, as from the third day on a new rise (indication of
an associating pneumonia or septic infection), or as a rapid
drop have a very unfavorable significance.

In the case of a favorable termination the local changes
are not so marked, and the necrotic processes are either absent,
or they do not penetrate deeply. After a certain time lachryma-
tion ceases, the nasal discharge becomes again mucous, and
loses its fetid odor, the respiration is no longer rattling, the
appetite and rumination return, and the animals become
brighter, while the temperature gradually returns to normal.

Recovery, which is usually preceded by a convalescence
lasting for several weeks, is rarely complete, as the animal
frequently remains blind in one or both eyes, or a chronic
eatarrh of the nose and its sinuses, and sometimes lasting
digestive disturbances remain.

Diagnosis. Besides the rapid development of the clinical
Diagnosis, Treatment. 415

symptoms, the inflammation of the eyes (cornea), and the nasal
mucous membrane, the marked depression of the sensorium
are characteristic of the affection. From these signs the dis-
ease is easily recognized when it occurs sporadically and no
intensive affections of other organs are associated. If how-
ever several cases follow each other rapidly, or if the intestinal
canal and the genital organs are severely affected, and the
course is very rapid, a differentiation from other similar dis-
eases requires great care, and very accurate observation.

The greatest similarity exists with rinderpest, especially
when at the same time there exists a severe inflammation of
the intestinal and vaginal mucous membranes. However in
malignant catarrh the symptoms of the affections of the eye
(diffuse keratitis, which may exceptionally be absent), and
sinuses of the head, as well as the severe nervous symptoms,
are in the foreground of the clinical picture, and besides the
disease is not contagious, which condition may in emergency
be established by subcutaneous inoculations of blood (in rinder-
pest in 4 to 5 days after such inoculation fever and a severe
catarrh of the mucous membranes develops).

The fibrinous rhinitis (croup of cattle), which sometimes
also occurs in an infectious character and manifests quite
similar symptoms, usually attacks cows shortly after parturi-
tion, and at the same time nervous symptoms as well as indica-
tions of an eye affection are absent (Grunth). By the affection
of the nose and its sinuses, as well as by the great dullness,
the disease is distinguished from foot-and-mouth disease, and
from the various forms of intestinal inflammation (scours,
mycotic and toxic enteritis). The croupous character of the
mucous membrane distinguishes it from the non-infectious nasal
eatarrh, while in infectious keratitis the process is confined
exclusively to the eyes. Finally tuberculous meningitis may
enter into consideration on account of the great apathy, in
which however inflammatory changes of the mucous membranes
are absent, and instead paralysis of certain nerves of the head
is observed. ,

Treatment. At present the treatment is purely symp-
tomatic. To alleviate the acute inflammation of the mucous
membranes of the head energetic cold applications, or cold
irrigation of the head are indicated first of all. The accumula-
tion of discharges should be prevented by repeatedly washing
the conjunctiva, as well as the nasal and buccal mucous mem-
branes with mild astringents and disinfectants (boraciec acid,
alum, copper sulphate, creolin, lysol, in 1-2% solutions), fur-
_ther by inhalation of water vapors, and if possible by manual
removal of the necrotic tissue. In attacks of asphyxiation
tracheotomy must be performed, and it is advisable to retain
the tube in the onening of the trachea for a time, even after
the respiratory difficulties diminish.

If a great quantity of exudate accumulates in the frontal
416 Malignant Catarrhal Fever of Cattle.

sinuses or in the cavities of the bony extensions of the horns,
this may be removed artificially by trephining, or if this does
not produce results, if necessary one or both horns may be
sawed off, whereupon the cavities should be washed 2 to 3
times daily as long as they contain the discharge. The exudate
accumulating in the maxillary sinuses usually discharges
through the natural channels from the nose.

If the apathy is very pronounced alcoholic rubs, and the
addition of coffee or alcohol to the drinking water are indicated.
Very high fever is subdued by antipyretics.

The constipation which exists at first, and later the diar-
rhea, are treated in the usual manner (see vol. II, Acute Intes-
tinal Catarrh). Suitable feeding during the disease, as well
as during convalescence must be especially provided for.

The derivative treatment, which is still greatly in favor with
French veterinarians, and which consists in the application of counter
irritants to the frontal part of the head and the neck, is hardly ever
used elsewhere. Eggeling and Esser obtained good results in some
cases from intratracheal injections of Lugol’s solution (15 to 20 g. 1
to 2 times daily), while Lotzer observed rapid recovery from the admin-
istration of large doses of iron sulphate. Tennebring, Meissner, Peter,
Werner and others recommend the colloid-silver preparations (Collargol,
Protargol; 40 to 50 g. twice daily intravenously, of a 14 to 1% solution,
for 2 to 3 days); in severe cases however even this treatment fails,
or produces at best only a temporary fall in temperature (Schloss-
leitner, Hohmann, Burgics). Périgaud obtained good results from sub-
cutaneous injections of a 0.75% salt solution (7 recovered out of 11
cases), and this procedure is also recommended by Moussu, as well as
recently by Schlotte; of the luke-warm solution 4 to 6 liters must be
injected daily subcutaneously until improvement is noticed, and later 1
liter for several days. Isepponi recommends profuse bleeding at the
onset of the disease; if no improvement is noticed after 24 hours the
animal should be slaughtered as incurable. ;

As the convalescence lasts for weeks, even in the favorable
course, and not infrequently blindness results, it is advisable
from an economic standpoint at the appearance of severe symp-
toms, to slaughter animals of little value rather than to pursue
the unpromising treatment. (Ingestion of the meat is not
harmful for man according to investigations of Esser.)

Prevention. According to our present knowledge of the
etiology of the disease, cleanliness and satisfactory ventilation
of the stables, as well as feeding good, unspoiled food, should
receive first consideration.

Literature—Anker, Schw. A., 1832, VI, 81.—Bugnion, D. Z. £. Tm., 1877, ITI,
63 (Lit.).—Semmer, Ibid., 1885, XI, 77.—Franck, Ibid., 137.—Brusasco, II, med. vet.,
1886, 145.—Lucet, Rec., 1892, 481—Kramarew, A. f. Vm., 1893, I, 53.—Pascola,
B. t. W., 1893, 562.—Paszotta, Ta. bl. f. Niederl. Indien, 1894, VIII, 16.—Theiler,
Schw. A., 1895, XXXVII, 1—Keleti, Vet., 1895, 167—Nagy, Ibid., 231—Mehrdorf
& Pesehke, A. f. Tk., 1897, XXIII, 194.—Leclainche, Rev. vét., 1898, 69.—Péricaud,
Bull., 1902, 388.—Isepponi, Schw. A., 1904, XLVI, 1.—Lichtenheld, Z. f. Infkr.,
1910, VII, 290.
Croup of Cattle. 417

7 Croup of Cattle. Grunth describes under this name a disease which
in addition to disturbances of the general condition is associated with
croupous inflammation of the nasal mucous membrane, in which the
local affections do not result from local irritation, neither do they belong
to the clinical manifestations of rinderpest, malignant catarrh, or to
croupous inflammation of the intestines. Bang however considers the
affection as closely related to the malignant catarrh of cattle.

_ The disease appears to prevail chiefly in Denmark, and especially
in Copenhagen and vicinity, where it was first observed by Sand, later
by Hansen, Kaufmann, Olsen, Bang and Jensen. Grunth made a care-
ful study of it. The fibrinous rhinitis observed by Berndt in Germany
may also belong here. :

Etiology. According to Grunth the disease is produced by an un-
known infectious substance, which weakens the resistance of the. body,
thereby rendering the mucous membrane susceptible to secondary in-
fections. Accordingly all complications, and probably also the croupous
inflammation of the nasal mucous membrane should be considered as’
secondary manifestations. Pane

Cows which have recently calved are especially susceptible, but in-
rare cases the disease may appear shortly before or several months after
parturition, if the animals have meanwhile been otherwise weakened.
Other cattle than cows are only exceptionally affected by the disease in
infected herds.

Symptoms. As a rule the animals become affected suddenly by high
fever intermittent in character. The pulse and respiration are acceler-
ated, appetite and rumination are disturbed, the milk secretion ceases.

By sufficiently illuminating the nose the nasal mucous membrane
appears more or less reddened, and sometimes covered with petechiae.
On the nasal septum or on the nostrils, more rarely in the other parts
of the nasal cavity, white or: yellowish, loosely adherent croupous mem-
branes of various extension may be observed attached to the mucous
membrane. Only exceptionally do they attain the thickness of several
millimeters, sometimes however they may even be diphtheritic in nature,
in which-‘case even perforations of the nasal septum may result. There
is always a nasal discharge, first serous, later becoming muco-purulent
and containing croupous membranes, sometimes also streaks of blood.
Here and there snuffling or wheezing respiration may be observed with
head extended and the mouth wide open.

Complications occur very frequently (according to Grunth in 70%
of the cases). Very often a broncho-pneumonia sets in (Grunth-ob-
served it in 42% of the cases) which sometimes may also give rise to
an interstitial lung emphysema, in which the air may pass under the
skin, or into the subperitoneal connective tissue. Simultaneously with
the broncho-pneumonia a croupous inflammation of the larynx, trachea
and the bronchi frequently develops.

The genital passages are also affected in some cases (according to
Grunth in 27%). -These affections take the form of a croupous, diph-
theritie or hemorrhagic inflammation of the mucous membranes of
vagina and uterus, and in some cases a parametritis and peritonitis, or
an affection of the mucous membrane of the urinary organs is asso-
ciated with it. _ f :

Likewise a profuse, fetid diarrhea is frequently observed, in which
the feces may be mixed with coagulated blood or croupous membranes.
In conjunctivitis, which is by no means rare, the eyelids swell, and there
is usually serous lachrymation, which may become purulent. An accumu-

Vol. 1—27
418 Catarrhal Fever of Sheep.

lation of blood in the anterior chamber of the eye, as well as kera-
titis has also been observed. Here and there fibrinous deposits may
form on the buccal mucous membrane.

The course is acute, and its duration averages nine days. It fiuc-
tuates however in the different cases between one and thirty days. The
convalescent stage is always protracted.

The prognosis appears to be unfavorable, as according to Grunth
45% of the patients die from the disease, or must be slaughtered. In
the recovered animals a permanent shrinkage in the secretion of milk
may result.

In croup without complications Grunth observed 33.3% deaths, while in the
cases complicated with broncho-pneumonia the mortality was 42.8%, in those which
are associated with diarrhea 48%, in complications with metritis 52.9%, and in the
cases showing a simultaneous affection with broncho-pneumonia and metritis 78.6%.

Differentiation from malignant catarrh should be based on the facts
that in the primary nasal croup there usually exists no keratitis, the
affection runs a more favorable course when compared with catarrhal
fever, it principally affects cows, and produces no cerebral disturbances.
If the pseudo-membranes developing in the nose are obscured, the disease
may be confused with broncho-pneumonia, metritis, or croupous
enteritis.

The treatment is purely symptomatic. The same remedies which
come into consideration in other inflammations of the nasal mucous
membrane or in broncho-pneumonia, enteritis, metritis, etc., are adapted.
At the same time it is advisable to separate the affected animals from
those which are healthy.

Literature. Grunth, Z. f. Tm., 1905, IX, 232.

Catarrhal Fever of Sheep. (Malarial catarrhal fever, Geel dikkop,
Bekziekte, Ouil bek, Blaw tong.)

Under this name a disease of sheep and goats is known in South
Africa, which occurs there under similar local and periodical conditions
as horse sickness (see p. 285) and which in some years causes great
losses, especially among sheep herds. It was first described by Hutcheon
and Spreull, then by Paine, and recently by Theiler.

The symptoms which develop from artificial infection, after an
incubation period averaging four days, consist in diminished appetite,
dullness and fever (up to 42.5°), severe hemorrhagic stomatitis, with
shedding of great shreds of epithelium; further a marked edematous
swelling of the forehead and the laryngeal region, and a cyanotic dis-
coloration of the tongue. Later the swollen parts become hard and wrin-
kled, sometimes ulcerative keratitis and panophthalmitis, as well as
diarrhea and icterus set in, whereupon in about 40% of the cases death
follows. In some animals an inflammation of the corium of the hoofs
develops in the meanwhile. In favorable cases the duration of the
disease until recovery is about three weeks. Quinine and calomel, also
searifications of the tongue are supposed to be beneficial in action.

The autopsy reveals, aside from the local changes on the head, only
a general blood infection, and in protracted cases anemia. The spleen
is, even in acute cases, only moderately swollen.

Although the disease is not directly contagious, Spreull succeeded
in transmitting it. with filtered blood to sheep but not to goats, and
the natural infection appears to be transmitted by insects. Sheep recov-
ered from the disease are immune against later infections, their blood
however proves virulent sometimes even after 50 days.
Calf Diphtheria. , 419

Simultaneous inoculations with serum of highly immunized sheep
(4 ec.), and with virulent blood (2 ¢c.), gave very favorable results in
a herd of 295 merino sheep. A mixture of serum and virus (2:1) is also
suitable for immunization. Theiler observed that in serial inoculations
of sheep the virulence diminishes gradually and finally from the tenth
operation, and from then on, a harmless vaccine is obtained.

Literature. Spreull, J. of comp. Path., 1905, XVIII, 321—Paine, Ibid., 1906,
XIX, 5.—Theiler, Schw. A., 1895, XXXVII, 1; Bull. P., 1905, III, 617; Z. f. Tm.,
1907, XI, 301.

4. Calf Diphtheria. Diphtheria vitulorum.
(Angina diphtheritica vitulorum.)

Calf diphtheria is an acute infectious disease of sucking
calves, in the course of which croupous diphtheritic pseudo-
membranes form on the mucous membrane of the mouth and
the pharynx, and which, as a result of a general septic infec-
tion usually results in death. The causative factor of the dis-
ease is the bacillus necrophorus, which was closely described
by Bang.

History. The disease was first described in 1877 by Dammann,
who observed it in enzootic extension in two consecutive years on an
estate near the Hast Sea. He established its contagious and transmissible
nature and considered it identical with diphtheria of man. Later
Blazekovie and Vollers observed similar affections, while Léffier (1884)
proved by histological examinations that the affection differed from
human diphtheria, and was probably caused by long rods, which were
present at the border of the necrotic tissue. Later Bang (1890). estab-
lished the identity of the Loffler’s bacillus with his bacillus necrophorus.

Occurrence. According to the observations made up to
the present time the disease occurs but rarely; in some localities
however it occurs as a stable disease
among the sucking calves and causes
by its malignant course material loss.
Thus in Dammann’s case all calves
born in the winter and spring became
affected, and with a few exceptions
they died of the affection.

Etiology. The bacillus necro-
phorus, Bang, which is considered to
be the cause of the disease, appears as
a thin slender rod, which in the tis-
sues as well as in artificial cultures, __ j i
grows into long threads, the plasma of as ae a.
which is either homogeneous or at " with methylene blue.
uniform distances contains dark, fine ce
granules (Fig. 64). The bacillus shows no motility.

Staining. The bacillus stains only slightly and uniformly with
aqueous solutions of aniline dyes, stains well with carbol-fuchsin, but not

with Gram.

 
420 Calf Diphtheria.

Cultivation. The bacillus develops only at body temperature, and
only anaerobically. Artificial cultivation succeeds on blood serum, agar
containing blood serum, bouillon, and in milk. On serum agar, colonies
2 to 3 mm. in diameter develop with striped surface and consisting of
felt-like braided threads. At the same time indol and gas are produced,
which have an unpleasant cheesy odor (Jensen, Ernst). Bouillon is
uniformly clouded in a few days, liquid blood serum is coagulated. No
growth results on potatoes.

Pathogenicity. Inoculation of pus containing bacilli or of
a pure culture into or under the skin of a rabbit causes pro-
gressive necrosis of the skin (see p. 102). Inoculation into
mice produces also skin necrosis, while guinea pigs, dogs, cats
and chickens are not susceptible to the infection. A sub-
cutaneous injection in cattle, hogs and pigeons causes only
local necrosis of the skin, in horses cold abscesses. (According
to L. Roux the experimental necrosis develops especially after
adding other bacteria to the pure culture, whereas alone it
frequently causes only cold abscess.) The introduction of
pseudo-membranes of affected calves into the nose and into
the mouth of lambs only several days old, produces a diph-
theritic stomatitis, while if sewed in under the eyelids a severe
conjunctivitis with keratitis results. Feeding experiments al-
ways give negative results.

The bacillus necrophorus, as has been proven by Bang and later by
Jensen, plays an important part in various diseases of animals, in which,
during their course necrotic and gangrenous processes develop as com-
plications. Thus the necrotic and croupous diphtheritic processes of
the mucous membranes in general, especially however of the mucous
membranes of the pharynx and the intestines (among others in hog
cholera), in sheep, on the lips and on the borders of the nostrils, or
on the external genital organs (see Vol. II), further in gangrene of
the hoofs and the teats, in necrotic dermatitis, etc., are frequently pro-
duced by this bacillus. In addition to these the occasional necrotic areas
in the liver, kidneys, lungs, ete., may be-attributed to this cause.

In the great majority of cases the bacillus necrophorus attacks
only tissue that is already affected. Successful infection experiments, as
well as metastatic necrotic areas, proved however that under specially
favorable conditions it may attack even healthy tissues. Its character-
istic location at the border of the necrotic and the living tissue, proves
that it exerts its pathogenic action, the necrosis of the tissue elements,
by the elimination of toxic products.

The bacillus necrophorus is described in literature under various names and
is identical With the: Bacillus necrophorus, Fliigge; Bacillus diphtheriae vitulorum,
Loeffler; Bacillus necroseos, Salomonsen; Bacillus filiformis, Schiitz; Bazillus des
Kalbernoma, Ritter; Streptothrix cuniculi, Schmorl; Actinomyces cuniculi, Gasperini;
Actinomyces necrophorus, Neukirch, and Streptothrix necrophora, Ernst (L. Roux).

Natural infection may probably be explained by stating that
the bacillus necrophorus, which is very extensively distributed
in nature, is among others frequently contained in the feces
of herbivorous animals, and owing to its anaerobic character
Natural Infection, Anatomical Changes. 421

remains alive for a long time on the dirty floors of damp stables,
in musty food and straw, and from there reaches the buccal
cavity of young animals. Healthy animals may become in-
fected by contact with affected ones, by licking them, thereby
introducing diseased products (shreds of pseudo-membranes
hanging from the mouth, nasal secretions) into their mouths.
The easy transmissibility of the disease has been fully estab-
lished by Dammann, since he watched a healthy calf which was
placed in a stable between two affected calves, become affected
in five days.

The disease attacks young sucking calves exclusively, which
sometimes become affected as early as on the third day after
their birth. The great susceptibility of the young can probably
be explained by the loose and delicate consistency of the
epithelia of the mucous membrane. The susceptibility of the
newly born may also be increased by any other physical weak-
nesses, the residue of the milk remaining in the mouth of such
animals being especially adapted for the localization and propa-
gation of the virus. Injuries of the buccal mucous membrane,
such as the eruption of the milk teeth, may constitute the prin-
cipal entrance for the infective agent.

Anatomical Changes. The autopsy reveals on the mucous
membrane of the mouth and pharynx, various sized and coalesec-
ing croupous membranes, which extend higher than the eleva-
tion of the surrounding tissue. They are several centimeters
thick, sharply circumscribed, dirty gray or brown in color,
ragged on the surface, and firmly adherent to the underlying
tissues. Ulcerations also occur with thickened borders and
ragged bases; between these lesions the mucous membrane is
greatly swollen, reddened, the submucosa shows serous infiltra-
tion. Preferred places for the formation of these pseudo-
membranes are, the inner surface of the cheeks, the hard palate,
the borders of the tongue, the parts surrounding the frenum
of the tongue, the gums, the soft palate and the pharynx. In
some cases the mucous membrane over a considerable area and
in its entire thickness changes to a yellowish-gray, brittle, fetid
mushy mass. The muscles of the tongue may also be necrotic
under the affected parts of the mucous membrane to a greater
or lesser depth, the destructive process on the hard palate
may even extend to the bone producing caries, and changing
it to a soft mushy mass. Similar changes occur also on the
lower parts of the nasal cavity, on the larynx and in the trachea,
where they may affect the cartilage.

The lungs usually contain either dry or purulent, softened,
necrotic areas, which are surrounded by zones of catarrhal.
pneumonia, and sometimes also a purulent pleurisy may be pres-
ent as a result of perforation of such superficial, necrotic areas.
The small intestines reveal acute catarrh, whereas posterior to
the cecum sometimes pea-sized dirty yellow, dry deposits may be
422 Calf Diphtheria.

found. The spleen is not enlarged and the lymph glands show
a moderately acute swelling.

Symptoms. The disease commences on about the fifth day
after the infection with marked weakness and diminished appe-
tite, as well as a slight rise in temperature. On the second to
third day salivation appears, and at the same time on one or
both cheeks a hard painful swelling is noted. With a finger
introduced into the buccal cavity, rough deposits may be felt
on the mucous membrane in the corresponding places,. On
inspection of the mouth however, on these as well as on other
places, especially on the hard palate and on the swollen tongue,
yellowish deposits are found, which in part show a ragged
surface.

In the meantime there is a yellowish discharge from the
nose, and the nostrils fill with dirty yellow, brittle masses, on
account of which the respiration appears snuffling. At the same
time the animals become greatly emaciated, and are able to
take, only from time to time, and with difficulty, small quantities
of water. In some cases cough, and a very labored, rattling
respiration, indicate an affection of the larynx and the lungs,
while diarrhea points to an involvement of the intestines.
(Dammann observed in one case a necrosis of the skin and
of the subcutis in the interdigital space in both forelegs.)
Exceptionally swelling and a suppuration of all glands of the
head have also been observed.

Eggeling found repeatedly that the disease commenced in calves
with high fever, difficulty in respiration, and inability to swallow. At
the same time cows which had recently calved showed a diphtheritic
vaginal and uterine involvement.

Course. The disease terminates in the majority of cases
in death after 4 to 5 days, in other cases again in about three
weeks, pneumonia being usually the immediate cause. In the
rare cases with favorable termination the convalescence lasts
several weeks, as the defects on the mucous membrane after
the shedding of the necrotic deposits heal reluctantly, and the
strength of the affected animals is regained very slowly.

Diagnosis. The thick deposits on the lesions, consisting
principally of necrotic tissue of the mucous membrane, dis-
tinguish the affection from foot-and-mouth disease, in which
the erosions are at the worst only covered with fine, loose,
readily removable pseudo-membranes. In aphthous stomatitis
and in thrush only superficial, readily removable deposits form
on the only very slightly swollen mucous membrane.

Treatment. After removing those deposits, which are not
very firmly adherent, it is advisable to paint the ulcerating
surfaces, as well as the firmly adhering pseudo-membranes
Pharyngeal Diphtheria. 423

1 to 2 times daily with a paste consisting of water and salicylic
acid (Dammann), Lugol solution (Dieckerhoff), tincture of
iodine, 10% citric acid (Poels), or with a 5% solution of per-
manganate of potash. Besides it is advisable to wash the mouth
repeatedly with lukewarm water. Salicylic acid (1-2 g.) or
potassium chlorate (2 g.) may be administered internally. At
the same time the attempt should be made to keep the animals
in good strength by supplying them with nutritious. food
(milk, eggs).

Careful ventilation and disinfection of the stables is in-
dicated for the prevention of the spread of the disease.

Literature. Dammann, D. Z f. Tm., 1877, III, 1—Blazekovic, Rec., 1878, 64.
—Vollers, W. f. Tk., 1879, 432.—Loeffler, Mitt. d. G.-A., 1884, III, 401—Bang,
Maanedsskr., 1890, II; 1892, IV.—Jensen, Hb. d. p. M., 1903, II, 693.—Eggeling,
Pr. Mt., 1903, II, 17.—L. Roux, Cbl. f. Bakt., 1905, XX XIX, 531.

Pharyngeal Diphtheria of Other Mammals. As the bacillus necro-
phorus has been demonstrated in the diphtheritie processes of various
species of animals, it appears probable that a diphtheria analogous
to the affection in calves may also occur in other animals as an inde-
pendent affection. In the cases however which have been observed the
bacillus necrophorus as a rule attacked the buccal mucous membranes
only after the animals had become sick from other causes.

Mayr observed a diphtheritic inflammation of the pharynx in three
head of cattle, while Strebel observed it in five head. The symptoms
consisted in salivation, dyspnea, difficulty in swallowing, nasal dis-
charge, sensitiveness and swelling of the throat region. The autopsy
revealed diphtheritic deposits, and ulcerations on the palate, in the
pharynx and larynx, as well as along the esophagus. In some cases ulcers
were found on the muzzle and in the interdigital space, with necrotic
deposits as large as a quarter on the mucous membrane which was
without papillae, in the pillars of the ramen, membranous inflammation
of the small intestines, etc. In these cases the disease had probably
developed as a complication to a septicemic infection, which is appar-
ently also the case in the affection of horses (Cobbett, Pr. Mil.-Vb.)
occurring as a diphtheritic process in the mouth, in which case it is
probably a complication of an influenza infection.

Roche-Lubine observed a disease among lambs which was manifested
in difficult respiration, salivation, laryngeal and bronchial catarrh. The
autopsy revealed extensive pseudo-membranes on the mucous membrane
of the upper air passages. Diem reports a similar affection which
occurred as a local enzootic, while Hasenkamp observed an outbreak of
panaritium of sheep caused by the bacillus necrophorus, in the course
of which diphtheritic processes developed on the mucous membrane of
the pharynx and mouth, in some of the animals.

In hogs the so called angina represents a frequent symptom of
hog cholera, in which the flat deposits on the mucous membrane of the
pharynx and larynx contain the bacillus necrophorus, together with
the bacillus suipestifer. This is likewise the case in the inflammations
of the pharynx, which are frequently observed as a symptom of swine
plague, especially on premises where hemorrhagic septicemia exists
among cattle. ; :

According to Johne and Kitt the pharyngeal diphtheria may also
oceur among hogs as an independent disease. In such cases the crypts
424 Avian Diphtheria and Chicken Pox.

of the greatly swollen tonsils are filled with yellowish, brittle masses,
and the mucous membrane of the surrounding part is covered with
numerous yellowish deposits which may reach the size of a pea, or the
diffuse, swollen and reddened, buccal and pharyngeal mucous membrane
appears to be covered with caseous deposits.

A severe pharyngitis, with the formation of pseudo-membranes, has
also been observed in dogs and cats (Gray, Symes, Bell), and Brandt.
reports a case in which a Scotch collie became affected with a diphtheritie
inflammation of the throat, and from which he isolated bacteria which
microscopically, culturally, and biologically appeared identical with
diphtheria bacilli (several days later a girl who attended the dog be-
came affected with diphtheria, and 314 weeks later still another girl).
During the course of canine distemper, and still more frequently in
typhus of dogs, necrotic processes occur on the buccal mucous membrane,
which are also caused by the bacillus necrophorus (Jensen), while in
one case showing also symptoms of albuminuria and hemorrhages, Ball
found only streptococci.

Literature. Wayr, Bayr. W., 1902, 185.—Strebel, Schw. A., 1899, 173.—
Cobbett, Chl. f. Bakt., 1900, XXVIII, 631.—Diem, W. f. Tk., 1900, 339.—Johne, S.
Jhb., 1893, 61.—Kitt, Munch. Jhb., 1893-94, 81.—Ball, J. vét., 1906, 449.—Gray, J. of
comp. Path. 1896, IX., 46.—Symes, Brit. med. Journ., 1896, I, 1385.—Bell, Amer.
Rev. 1901, XXV, 115.—Brandt, J. of the Americ. med. Assoc., 1908, L, 15.—Hasen-
kamp, D. t. W., 1909, 237.

5, Avian diphtheria and chicken pox. Diphtheria et epithelioma
contagiosum avium.

Until very recently avian diphtheria was considered to
be a contagious, epizootic disease of domesticated fowls, char-
acterized by croupous and diphtheritic pseudo-membranes on
the mucous membranes of the head, while chicken pox was
held to be a contagious, epizootic disease in which hyperplastic,
epithelial nodules of the skin occurred especially on the comb
and wattles, but in addition to which croupous-diphtheritic
deposits frequently developed on the mucous membranes of the
head. The two diseases were considered as independent; more
recent research, howéver, indicates that they are produced by
the same organism, and they will here be treated accordingly.

History. In avian diphtheria as well as in chicken pox investigators
were inclined, since the experiments of Rivolta and Silvestrini (1873
and 1878), to consider protozoa as the etiological factors (in diphtheria
the flagellate, Cercomonas gallinae; in pox gregarines, hence the former
name Gregarinosis). Later bacteriological experiments, particularly
those of Loeffler (1884) on pigeon diphtheria, seemed to indicate that
the diphtheria was due to a rod-like bacterium which he called Bac.

‘diphtheriae columbarum. Furthermore other observers, as Krajewski,
Moore and Galli-Valerio found the same organism in the diphtheritic
membranes of sick chickens, while subsequently Guérin demonstrated
its identity with the ovoid bacillus described by Haushalter and Loir
& Ducloux. Streit insisted on the etiological importance of his roup
bacillus for the disease called roup in America, and Miiller was of
the opinion that the virus of chicken diphtheria was a corynebacillus,
History, Prevalence, Etiology. 425

an organism similar to the human diphtheria organism. But these
and other similar findings influenced but slightly the view that bird
diphtheria is a bacillary infectious disease, and were explained by the
assumption that various bacteria participate in different cases in the
diphtheritic diseased processes, a view which indicated a degree of un-
certainty as to any positive knowledge in this regard.

The etiology of chicken pox was elucidated acceptably when Marx
and Sticker (1902) brought proof that the pock virus will pass through
a porcelain filter and therefore belongs to the filterable infectious sub-
stances. This has since been confirmed by Juliusberg, Borrel, Loewen-
thal, Burnet and others.

Experiments following this discovery have led to results which
completely shattered the existing view that the etiological factor of
the two diseases differed. It is true that Roell (1867) suspected that
the changes in the oral mucosa and skin were due to the same causative
agent, and this view is also expressed in the work of Rivolta & Delprato
(1880) as well as Pfeiffer (1889) and Kinsley (1907). Moreover
from a practical point of view, considering the difficulty in differential
diagnosis, this did not seem unlikely, but experimental support was
not obtained until Carnwath (1908) succeeded in producing a diph-
theritic disease of the mucous membranes from pure pox material, and
with diphtheritie material produced chicken pox. These experimental
results, doubted by Bordet & Fally and also by Jowett, were confirmed
by Schmid, Uhlenhuth & Manteufel, and also by Ratz, and further
experiments directed towards the solution of some contested details
such as virulence of the blood in pure diphtheria, role of the bacteria
present in the pseudo-membranes, etc., will no doubt soon establish the
etiological identity of the two forms of disease definitely.

Prevalence. Both forms of disease occur particularly in
fowls (chickens, turkeys, pheasants, peacocks), also in pigeons,
and much less commonly in water fowls. In the southern
regions (Italy, Tunis) the diphtheritic form rages with greater
virulence and sometimes presents a septicemic character, but
in northern regions the losses, especially in pedigreed fowl
farms, are heavy on account of the frequent severe invasion
of the disease and high mortality.

Etiology. The experiments of Marx & Sticker have shown
that the fluid obtained by maceration of epithelial nodules in
physiological salt solution is infectious after passing through
a Berkefeld filter, since after the inoculation of the filtrate into
the skin of chickens the characteristic epithelioma developed,
which could be inoculated from one animal to another.

Borrel, Lipschiitz, as well as Prowazek, are inclined to consider as etiological
agents, very minute, hardly 0.25 yw sized, spherical or biscuitform organisms,
found in large quantities in virus-emulsions, and which can be demonstrated by
Giemsa’s as well as by Loeffler’s flagellum stain. By penetrating into cells they
may cause the development of the frequently mentioned ‘‘inclusions’’ in the epi-
thelial cells, as products of reaction. Prowazek named them, as well as similar
formations in vaccinia, rabies, ete., Chlamydozoa, since they caused vacuoloid reac-
tion products in the infected cells.

Tenacity. The pox virus is rather resistant to external influences. Enclosed in
epithelial masses it is not destroyed by complete drying or exposure to diffuse day-
light for several weeks; heating to 60°C, for three hours, cooling to minus 12°C. for
426 Avian Diphtheria and Chicken Pox.

five weeks, and one per cent carbolic acid solution for half an hour also failed to
destroy it. Portions of the nodules preserved in glycerin for several weeks still
produced the typical disease (Marx and Sticker). The virus further resists the
effect of 10% atoxyl and 1% saponin solutions, as well as a 10% solution of
sodium taurocholate (Lipschitz). When the tumor masses are finely pulverized it is
killed at 60°C. in 8 minutes (Burnet), by 1% potassium hydrate solution, 1% acetie
acid or 1:1,000 corrosive sublimate in 5 minutes (Sanfelice).

Culture. Bordet reported successful cultivations from diphtheria
material on his blood-glycerin-potato-agar, minute colonies developing
on the surface, composed of granules staining by Giemsa’s method
and having a dimension of barely 0.2 #. With such cultures he
succeeded in producing diphtheritic membranes on the oral mucosa
of chickens, but not epithelioma on the skin. Similar attempts at culture
by Lipschitz and by Uhlenhuth & Manteufel with pox material gave
no positive results.

Pathogenicity. When finely pulverized epithelial nodes are
rubbed into the skin of the comb, wattles or eyelids of chickens
there occur after 5 or 6 days swelling and pallor of the affected
parts of the skin, and on the following day a nodule as large
as a millet seed appears on its surface. After three or four
more days hemorrhages suddenly appear over the affected re-
gion; later the blood dries forming thick scabs, beneath which
the papillae enlarge considerably and become covered with a
turbid, gray exudate. Beneath this bloody scab healing takes
place after a shorter or longer period of time; but when the
diseased portions are exposed to traumatic influences (rubbing,
scratching) there develop extensive papillary proliferations
which delay healing. The result from inoculation of the filtrate
is similar, only the incubation period is from 8 to 10 days on
account of the dilution or attenuation of the infectious sub-
stance (Marx & Sticker). Juliusberg, who demonstrated the
filterability of the infectious virus of pigeon pox, observed an
incubation period of 14 days after inoculation of the filtrate
into pigeons.

When pox material is rubbed into the scarified oral mucosa
or injected into the submucosa, there either arises a local re-
action in the form of a light yellow membrane, or there develops
a characteristic croupous-diphtheritic inflammation, which may
extend from the oral mucosa to the nasal cavities and their
sinuses (Loewenthal, Schmid, Uhlenhuth & Manteufel). Con-
junctival inoculation produces a diphtheritie conjunctival in-
flammation, which eventually causes a panophthalmia.

The results are similar when diphtheria material is em-
ployed for inoculation on the skin and mucous membrane only
here negative results are more common than after inoculation
with pox material (Schmid, Uhlenhuth & Manteufel).

Loewenthal and Burnet produced pox on the skin by in-
travenous injection of pox material. Uhlenhuth & Manteufel
used intravenous injections of pox and diphtheria material and
produced severe diphtheritic symptoms on the mucosa of the
mouth and on the conjunctivae,
Pathogenicity. 427

_ Both pox and diphtheria are easily transmitted from
chickens to chickens and from pigeons to chickens, whereas
the transfer of pox material from chickens to pigeons is ac-
complished with difficulty, and transmission of diphtheria ma-
terial has thus Zar been unsuccessful. The infective virus trans-
ferred from the pigeon to the chicken appears to undergo an
attenuation even in the first generation; but also in the pigeon
the virus becomes attenuated by successive passages even to
avirulency (Juliusberg).

Aside from its presence in the epithelial nodules and
mucous membranes the virus is also found in the blood, at
least in the beginning of the disease, for it was repeatedly
found possible to produce the characteristic changes on skin
and mucous membrane, especially with liver substance (Loewen-

_ thal, Burnet, Schmid, Uhlenhuth & Manteufel).

The above mentioned experimental results permit the con-
clusions, that epithelial nodes and diphtheritic pseudo-mem-
branes contain the same virus which produces pox on the skin
and diphtheritic processes on mucous membranes, and therefore
chicken pox and avian diphtheria form an etiological entity.
This view is supported by an experimental result obtained by
Uhlenhuth & Manteufel, according to which recovery from the
affection of the mucous membrane produced with diphtheria
material gives immunity against a subsequent artificial skin
infection with virulent pox virus.

In consideration of the present viewpoint the question arises what
significance attaches to the more or less pathogenic bacteria found by
different authors in the diphtheritic pseudo-membranes and considered
by them as causes of the disease on account of the partly successful
experiments of transmission. The following come under consideration:

1. The bacillus diphtheriae columbarum obtained in pure culture by Loeffler
from a case of pigeon diphtheria. This bacillus, which takes a bipolar stain, is similar
to the organism causing rabbit septicemia, but slightly longer and more slender;
its pure cultures, after subcutaneous inoculation, produce in pigeons a necrotic
inflammation of the skin, while after injection into the oral mucosa of chickens
circumscribed pseudo-membranes form. Loir & Ducloux no doubt found the same
bacillus in diphtheritie chickens in Tunis, only this organism was characterized by a
marked virulence, while its cultures after subcutaneous inoculation soon produced a
rapidly fatal septicemia, or heavy deposits in the throat and in the larynx in addi-
tion to general septic symptoms.

2. The ‘‘Roupbacillus,’’ an organism in many ways similar to the bacillus
pyocyaneus, deseribed by Streit as the causative factor of American ‘‘roup,’’ a
disease clinically identical with chicken diphtheria. He found it in abundance
in the disease products of sick birds and made with his pure cultures experiments of
transmission to chickens and pigeons, which were in part successful.

3. The ‘‘Chickendiphtheriabacillus’’ of R. Miiller, which he describes as
Telated to the human diphtheria organism or Loeffler’s bacillus, although a smaller
corynebacillus. He obtained pure cultures which upon inoculation in mucous mem-
branes or injection into the submucosa in pigeons produced a diphtheritic inflam-
mation.

4, <A ecolon-like bacillus, which Hausser was enabled to constantly demonstrate
in spontaneous diphtheria in the deposits, and with whose pure cultures he succeeded
several times in producing a diphtheritic inflammation in chickens and pigeons.

Finally there may be found in the diphtheritic deposits in some cases the
bacillus pyocyaneus, streptococci, chicken cholera bacteria, necrosis bacilli and some-

times swine erysipelas bacilli,
428 Avian Diphtheria and Chicken Pox.

These variable results of the several observers preclude any specific
role of the bacteria found; on the other hand, however, in view of
the positive inoculation results obtained with pure cultures the possi-
bility is by no means excluded that under certain conditions, especially
when the requirements for their propagation in the body of the fowl
are for any reason favorable, local diphtheritic inflammatory processes
may be caused or already existing processes be aggravated. When it is
considered that the disease of the mucous membrane may also be produced
by filtrates of disease products and by intravenous injection of such
filtrates the assumption or supposition can hardly be rejected that avian
diphtheria, as well as chicken pox, is primarily produced by the same
filterable virus, whereupon facultative pathogenic bacteria subsequently
settle on the mucous membranes and on their own part participate more
or less in the development of the clinical picture of the disease.

According to Bollinger and Csokor the epithelioma contagiosum of man is
identical with the epithelioma of birds, for material from the former, when inoculated
into the comb of birds, gave rise to a disease identical with chicken pox. The close
relationship is indicated further by the fact that the virus of the disease is also
filterable (Juliusberg, Casagrandi, Serra, and others).

Natural infection probably occurs in most cases by the
intermediation of exfoliated epithelial material or of exudate
discharged by the diseased animals while sneezing or cough-
ing, or otherwise. These, or the intestinal contents or
portions of internal organs of diseased or dead animals, may
come in contact with superficial abrasions on the skin or
mucous membranes. It is possible that infection may occur
also’ through the unimpaired mucosa, which is favored, no
doubt, by a preceding injury, and the frequent disease of the
eyes may be associated with the habit chickens have of rubbing
the vicinity of the orbit with their feet (according to Mégnin
older pigeons, which frequently show small caseated nodules
in the esophagus, may infect their young while feeding them).

Healthy fowls are usually infected by sick animals, con-
taminated drinking water, food, etc., serving as media of in-
fection. The disease is spread mostly through transportation
of fowls to markets and poultry exhibits; but free-flying birds
(pigeons, sparrows, etc.) may carry the infection for long dis-
tances to healthy poultry farms.

Pigeons are most susceptible to the disease, chickens less
so, and water fowls to a considerable degree less. The sus-
ceptibility to infection is in general greater in young than in
older animals.

An attack of the disease, no matter whether skin changes
or diphtheria of the mucous membranes was manifested, confers
immunity against subsequent infection, for chickens which have
recovered from the artificially produced disease, can not be re-
infected after two weeks. The immunity so acquired is, how-
ever, sometimes, only of short duration (Loewenthal).

Anatomical changes. These may be confined to the skin,
or to the mucosa of the mouth and nose, but in the animals
Anatomical Changes, Symptoms. 429

which have died from the disease the vast majority of cases
will show the skin as well as the mucous membranes seriously
affected.

In addition to the epithelial nodes of the skin one finds
croupous-diphtheritic deposits on the mucosa of the mouth and
throat, the nose and accessory cavities, sometimes also in the
larynx, trachea and bronchi as well as in the intestinal mucosa.
The membranes in the mouth are dark gray or brown, at other
points yellowish-gray, usually croupous, sometimes softened
and cheesy, while the subjacent mucosa is denuded of epithelium,
finely granular and occasionally appears necrotic to a certain
depth. In individual cases a croupous-caseous exudate is found
in the bronchi and in the cella infraorbitalis in such quantities
as to fill the canals and cavities involved completely.

The intestinal mucosa also shows similar inflammatory
changes and small extravasations of blood. Occasionally the
epithelium is removed for a considerable extent, and here and
there shallow ulcers may form, while-on other areas, especially
in the caeca firm dry nodes composed of proliferated epithelium
and detritus may adhere to the inner surface of the intestine.

In the more acute cases, in addition to the above changes
on the mucous membrane which may be very indefinite, a large
splenic tumor may be found, fine yellowish points or spots in
the liver, acute edema of the lungs, hemorrhages and occa-
sionally ‘fibrinous membranes on.the serous coats. and finally
a serous exudate in some joints. me

. oe 4

The microscopic examination of the epithelioma of the skin shows, according to
Polowinkin, the epithelial layers thickened-and ‘the epithelial ‘papillae elongated in-
ward; in the papillaty layer the vessels are dilated and, like those of the subcutis,
surrounded by migrating leucocytes; in addition there are small hemorrhages into the
tissue of the papillary layer. Cell-inclusions are found in the swollen epithelium,
similar to Guarnieri’s pox bodies (Loewenthal, Burnet; s. p. 293). In a general way
the characteristic features of the efflorescences are composed of a more or less pro-
nounced hyperplasia and proliferation of the cell elements of the skin, which sooner
or later succumb to degeneration. This is associated with the extension of the process
to the external skin and there follows-a condition which, according to Reischauer, is
similar to true pox; the difference lies mainly in the fact that in bird pox the more
chronic character of the disease causes the nodular and tumor formation to pre-
dominate. Ee

Microscopic examination of the diseased mucous membrane shows a fibrin-
ous network in the superficial layers, in the folds of which lie irregularly formed
flakes and granular detritus, while in the mucous tissue are seen cellular infiltrations
and occasionally necrosis of the tissue elements. The exudate may also show various
bacteria and occasionally protozoon-like otganisms, but their signihoancs has thus far
not been ascertained. Rivolta found.a flagellated, spherical or ovoid protozoon, the
Cercomonas gallinarum, in the membranes of the oral mucosa, while Pfeiffer found
in membranous inflammation of the tracheaand the intestines, flagellates in large
numbers with three, more rarely with two or four flagellae, which he believed to be
Trichomonads, and both observers were inclined to associate their findings etiologically
with the pathological conditions. Babes & Puscariu consider the flagellates as harm-
less and only accidentally present in the air passages and in the intestinal canal,
because they never succeeded in producing a disease of the mucous membranes with

them.

Symptoms. The clinical picture of the disease depends
upon whether there is an affection of the skin or the mucous
membranes or if both these tissues are involved, and whether
430 Avian Diphtheria and Chicken Pox, ~

the disease runs an acute or chronic course. Thus there are
several clinical forms of disease to be differentiated.

In one form, which has always been designated as chicken
pox, morbid changes develop in the skin, and in the majority
of cases the skin of the head is first affected. On comb, ears

 

Fig. 65. Chicken pox. Epithelial proliferations on the comb, on the wattles, and in
: the vicinity of the corners of the mouth. ;

and wattles, in the vicinity of the natural openings and es-
pecially on the parts of the body which are slightly covered
or totally devoid of féathers there arises at first a fine, bran-
like, gray deposit, which is soon followed by little nodules, at
first reddish-gray in color and with a mother-of-pearl luster,
Symptoms. 431

but which later assume a more grayish-yellow color, and are
composed of horny or fatty degenerated epithelial cells. By
gradual enlargement these develop to pea-sized, yellow or dark-
brown nodes whose surfaces are warty, dry and firm, the in-
terior contents being composed of a yellow, fatty paste (Fig. 65).
Sometimes they are so abundant that they touch and even
coalesce with the result that the highly reddened and easily
bleeding skin forms thick cohesive scabs. The comb and wattles
are in consequence much thickened and deformed. The margins
of the nasal orifices and still more. those of the eyelids also
become thickened so that eventually the eyes are completely
closed. Should the inflammatory process spread to the con-
junctival tissue much caseous and purulent secretion accumu-
lates in the conjunctival sac which gradually effects a pressure
atrophy of the eyes, or a corneal inflammation develops, which
may become complicated with a purulent panophthalmitis.

Nodules and nodes similar to those on the head develop
in some cases on other portions of the body, especially in the
vicinity of the cloaca, on the under surface of the wings, on
the neck, on the rump, particularly on unfeathered areas. Here
they sometimes attain the size of a hazelnut and may even de-
velop into horny or callous growths. Such large growths which
have an irregular surface, may, by the exercise of considerable
force, be removed or broken off from the skin, which will expose
the interior cavity filled with a thick cheesy mass, while vertical
sections show wavy layers running more or less parallel with
the skin surface.

As long as the disease is confined to the skin the general
condition usually remains undisturbed; only when it is widely
distributed over the surface of the skin marked emaciation
is likely to occur.

In warmer countries a virulent diffuse form of the disease occurs
whereby the skin shows no tumor formation but a flat papular thicken-
ing and the affected areas become in a few days covered with dry crusts.
Febrile symptoms may also occur, not followed by nodules but by
reddish-violet pustules, which turn later white and finally yellow, and
which eventually dry up and-form brownish crusts, or death follows
after 4 to 5 days of the disease (Reischauer). A malignant course
was also observed by Klee on a chicken farm where a diffuse inflamma-
tion developed over the body associated with seborrhoea and warty
growths. All hens so diseased died within 4 to 5 days.

The second form which has hitherto been considered ex-
clusively as avian diphtheria, begins, also without any marked
disturbance of the general condition, with a local affection of
one of the mucous membranes of the head, usually the mouth.
In some cases there develop on the otherwise smooth surface
which is at times only slightly reddened, small spherical or
oval yellowish-white spots, which gradually spread and finally
form extensive membranes. In other cases the mucous mem-
brane assumes a dark red color, soon followed by a gray deposit
432 Avian Diphtheria and Chicken Pox.

on its surface, which gradually becomes thicker and forms dense
deposits, at first gray or yellowish, later brownish-gray and
dark brown on the parts exposed to the air; when dry, the
surface becomes rough and fissured. The membranes are
usually adherent to the subjacent tissue. When they are re-
moved they leave red, uneven, slightly depressed and bleeding
surfaces, or the mucosa is covered with cheesy easily removable
masses of exudate, and beneath these the surface is only red-
dened and finely granulated, but not eroded (usual appearance
in pigeons).

The adjoining tissue which is not covered with membranes,
is edematous, but here also oftimes exudative masses occur in
the later stages; these gradually become confluent and finally
completely cover the affected cavity. Such abundant deposits
may occur within the first or second day, and after their removal
new ones form; sometimes, however, the ulcerative process ex-
tends deeper leading to extensive destruction. If the animal
survives the membranes are in the course of time loosened spon-
taneously, and the loss of substance is replaced.

Such croupous-diphtheritic membranes develop most com-
monly on the oral mucosa, especially on the gums near the longi-
tudinal cleft, on the borders and the under surface of tongue,
the corners of the mouth and cheeks, as well as on the pharyngeal
wall and in the vicinity of the larynx. The inflammatory process
not infrequently extends to the larynx and from here to the
trachea and bronchi; on the other hand it may extend from
the pharynx to the mucosa of the esophagus and crop. As
the inflammation progresses respiration and deglutition become
more and more difficult; the bird keeps its neck constantly
extended and the beak always open or opens it every few
moments gasping for air, whereby the in-rush of air is ac-
companied by whistling or rattling noises. In the meantime
the desire for food, at first unimpaired, grows less and less, and
as deglutition is more difficult or impossible, the bird ceases
to eat altogether.

The affection of the nasal cavity is at first manifested by a
serous nasal discharge, which soon becomes muco-purulent and
later dirty-gray in color. It is discharged in considerable quan-
tity on pressure over the dorsum of the nose; otherwise it dries
in the nasal orifices, closing these in part or entirely and oc-
easionally raising the upper nasal wall. In the meantime the
birds breathe heavily, show a desire to sneeze and shake their
heads thus hurling out masses of pus and single flecks of thick-
ened pus and bits of membranous shreds. From the nasal cavity
the inflammation extends to the lachrymal canal, which as a re-
sult becomes occluded; it also progresses quite frequently on one
or both sides to the cella infraorbitalis which now becomes filled
with exudate and bulges under the internal angle of the eye in
the form of a growth, which on pressure discharges a muco-
purulent fluid from the nasal orifice on the affected-side. The.

NS
Symptoms. 433

tumor is hot, painful and in the later stages shows on palpation
a harder nucleus (Fig. 66).

The constantly increasing swelling forces the orbit up-
wards and backwards while the corresponding wing of the
palate is arched against the oral cavity and later is entirely
destroyed, so that the cavity appears to be surrounded only
by mucous membrane or by a dense pseudo-membrane. This
produces a marked dis-
figurement of the head
while the movements of
the head or beak are
greatly interfered with by
the tumor. On incision the
growth discharges a yel-
lowish-white, cheesy or
caseated mass, or dry and
brittle lamps may be re-
moved from its cavity. -

When the eyes are in-
volved the first indications
are acute catarrhal symp-
toms of the conjunctiva
with edematous, swollen,
painful lids beneath which
there accumulates much fig. 66. Swelling of the cella infraorbitalis in
muco-purulent exudate chicken pox.
filled with air bubbles,
sealing the eyes over night. If the eye slit is not opened at reg-
ular intervals the exudate dries, forming thick, yellowish-white,

- easeated masses, which cause a protrusion of the lids and force
the eye backwards, forming on the surface of the cornea club-
shaped formations whose dry brownish-yellow ends project be-
tween the compressed lids. These masses are easily removed
from the conjunctival sac, but form again rapidly. In other cases
diphtheritic membranes develop on the conjunctiva; the inflam-
mation may also extend to the conjunctival sclera and from here
to the cornea, which becomes opaque or ulcerated, and finally
a general inflammation of the internal eye results.

: Involvement of the intestinal tract occurs only in the later
stages of the disease and is manifested by profuse diarrhea
with frequent discharge of creamy or fluid feces, sometimes
mixed with pus or blood, and causing a rapid weakening of the .
animal.

The general condition of the patients is at first not dis-
turbed, but later the condition changes markedly. Unable to
eat and gasping for air they sit around tired and depressed,
with neck drawn in, wings hanging down, feathers ruffled, and
do not resist attempts to catch them. The body temperature
is raised only in the late stages, while towards the end it falls

‘below normal. The comb and wattles are at first bluish-red,
Vol. 1—28

 

 

 
434 Avian Diphtheria and Chicken Pox.

later pale and cold to the touch. The discharge emanating from
the mouth and nasal orifices soils the breast and emits an
unpleasant odor. The animals emaciate considerably, until they
finally die from exhaustion due to the associated diarrhea.

Those cases in which the disease affects both the skin and
mucous membranes of the head, although not necessarily at
the same time, may be designated as mixed form. In the
majority of cases the skin of the head is first affected, and the
inflammatory process usually spreads from the corners of the
mouth, later, to the oral mucosa and from here to the neighbor-
ing cavities; the reverse order is much less commonly observed.
No matter in what direction the process progresses the two
forms coalesce in such a variety of clinical pictures that in
the lethal cases one usually finds the signs of pox and of diph-
theria simultaneously, although developed to different degrees.
‘However, cases in which the mucous membranes alone are
affected are not rare.

The acute form of the disease as it has been almost ex-
clusively observed in southern countries (Algeria, Cuba),
begins with marked symptoms of a general infection (marked
lassitude, loss of appetite, difficulty of breathing, etc.), followed
on the second or third day by small yellowish-brown pseudo-
membranes on the inflamed oral mucosa, which in a very short
period of time develop to extensive deposits. Although the
process mostly affects the nasal cavities and conjunctivae,
deglutition and respiration are markedly impaired, and in-
testinal inflammation occurs causing rapid exhaustion, and
ending fatally within a few days.

Course and prognosis. Cases in which the disease is con-
fined to the skin run a favorable course in the majority of
instances. The skin disease ceases to progress after a certain
time when the nodules have become dry and have been shed,
and spontaneous cure follows after 3 to 5 weeks. In this manner
even large nodes may fall off spontaneously; in other cases
there occur fresh nodules on other parts of the body, and in
these instances the disease runs over several months.

Less favorable is the course of the diphtheritic disease of
the mucous membranes. In a goodly number of cases spon-
taneous arrest and cure follows in these instances, but as the
process is easily carried to the larynx and bronchi and often
involves the intestinal mucosa the mortality is much higher
on account of exhaustion or dyspnea. The disease usually
lasts 2 to 3 weeks, sometimes 1 to 2 months, and with transitory
improvement the time may be even more prolonged. Accord-
ing to Friedberger the mortality is 50-70%, and is much higher
in young birds, especially in those of highly bred varieties.
Course and Prognosis, Diagnosis, Treatment. 435

The acute form so common in southern countries usually
ends fatally in 4 to 8 days.

Diagnosis. The earlier differential symptoms between avian
diphtheria and chicken pox have lost their significance since the
discovery of an identical etiology for both diseases.

The contagious catarrh of the nose (coryza contagiosa)
is confined exclusively to the nasal cavity, runs a course with-
out any development of pseudo-membranes and is therefore not
associated with as severe symptoms as diphtheria.—‘‘Pips’’
which might be mistaken for the beginning of diphtheria, is
confined to the tongue, the discoloration occurring by simple
drying of the epithelium, acute inflammatory symptoms being
absent.—In mycosis aspergillina the deposits on the palate and
nose are dryer and sometimes of a greenish color; the fungi
are easily demonstrated with the aid of the microscope.

Treatment. So long as the disease is confined to the skin
proper treatment will usually effect a cure, and the affection of
the mucous membranes may sometimes be arrested in its in-
cipiency and a cure effected. The nodules and nodes on the
skin are softened with ointments, oil or soda solution and
removed; the mucous membrane deposits are caught with
forceps and carefully stripped off or removed with a piece
of cotton on the end of a stick or other object. The exposed
surface is painted once or twice a day with 1% silver nitrate
solution (if in the mouth apply an after treatment of saline
solution), 1% corrosive sublimate solution (after treatment with
soda solution), with lactic acid, lemon juice, 2% creolin or lysol
solution, tincture of iodine (with Tinct. gallarum aa), or the
skin is painted with concentrated glycerin.

The secretion which accumulates in the eyes is washed out
with warm water and the eye is subsequently treated with 2%
borie acid, tannin or creolin. Tumors below the eyes are to
be opened early and after thorough evacuation of the cavities
these should be thoroughly cleansed.

For the difficult respiration inhalations of turpentine and
tar vapors may be tried while against intestinal catarrh tannin
or sulphate of iron (1% solution in drinking water), red wine
(spoonful doses) or other astringents (in geese, glycerin) may
be employed, but in most cases treatment is here of little avail.

Local treatment must be continued until the cleansed skin
or mucous membrane shows no new nodules or deposits. In
those instances where proper treatment is not available or
impractical, or where the birds are of little value, it will
prove more practicable to suppress the disease by killing the
diseased animals or even destroying the entire number of fowls
on the farm, and instituting thorough disinfection of the coops.

Prevention. The general prophylactic measures, such as
isolation of the diseased and removal of the dead birds, cleans-
436 Avian Diphtheria and Chicken Pox.

ing and disinfection of the coops and runs, careful examina-
tion and quarantine of the newly bought birds, etc., are identical
with those employed in fowl cholera (see p. 95). As the
disease has a latent development it is proper, in a threatened
epizootic to examine the mouths of the healthy birds from
time to time, and if the slightest changes in the skin or mucosa
are observed, the affected bird is to be at once isolated and
treated.

Preventive inoculation. Manteufel succeeded in immunizing
chickens by injecting into the circulation or under the skin a lymph
that had been prepared from the scrapings of epithelioma or mucous
membranes mixed with saline solution. Chickens treated in this manner
were immune to subsequent infection for 114 to 2 years, even though
no local signs. of reaction. followed injection. Chickens that had been
inoculated with mixtures of virus and bile resisted subsequent inocula-
tions into the comb. Serum of highly immunized chickens on the other
hand possessed no preventive or curative value.

The earlier attempts at immunization, directed as they were ex-
clusively against bacillary infection, offer very little in view of our
present knowledge, and can be considered effective only against the
secondary infections; however brief mention of them will be made here.

Loir & Ducloux immunized healthy chickens by injecting subcutaneously, first
1.0 ee. of fresh culture of their diphtheria bacillus which had been kept at a tempera-
ture of 55°C. for half an hour; ten days later they injected 1.0 ec. of a two months
old culture. One of twenty chickens so treated, and four out of five not treated,
succumbed to a later virulent infection. :

Guérin found this measure noneffective in pigeons, but obtained more favorable
results by injecting intraperitoneally 0.5 cc. of a culture that had been heated to 55°C.
for an hour. He repeated this in 12 days by employing a culture that had been
subjected to 50°C. only, for the same length of time. After an interval of 12 to 15
days the pigeons sustained a subcutaneous injection of 0.5 cc. of virulent culture with-
out any bad effects. The same procedure was later successfully employed on young
chickens. From January lst to August 31, 1905, the Pasteur Institute in Lille sent
out 24,602 vaccine doses to 74 parties. Of these, 39 parties whose observations
encompassed 10,426 animals, declared themselves as satisfied with the results, while
eight rendered an unfavorable report (Eloire).

The Behring-Roux antitoxic serum employed in human therapy against diph-
theria of children and recommended by Lang and by Eloire also against bird
diphtheria has been proved ineffective by Harrison as well as by Gratia & Liénaux.

Literature. Bollinger, V. A., 1873, LVIII, 39.—Léffler, Mitt. d. G.-A., 1884, II,
421.—Loir & Ducloux, A. P., 1894, VIII, 599.—Marx & Sticker, D. m. W., 1902, 893;
1903, 79.—Streit, Z. f. Hyg., 1904, XLVI, 407.—Miiller, Chl. f. Bakt., 1906, XLI, 621
(Lit.).—Burnet, A.-P., 1906, XX, 742 (Lit.)—Bordet, Ann. vét., 1907, 494.—Carn-
wath, Arb. d. G.-A., 1907, XXVII, 388.—Bordet & Fally, Ann. vét., 1907, 494.—
Hausser, Chl. f. Bakt., 1909, XLVIII, 535 (Lit.).—Schmidt, Ibid., 1909, LIT, 200.—
aoe & Manteufel, Arb. d. G.-A., 1910, XXXITI, 288 (Lit.).—Manteutel, Ibid.,

., 305,

Diphtheritic inflammation of the eyes in ducks. Kampmann,
Hirschbruch & Lange in Posen observed on a chicken farm during the
spring and fall of 1902 a peculiar disease in 100 out of 240 ducks, of
which 25 died, while 15 were killed and 60 recovered, while other fowls
remained healthy. The disease began with severe itching in the eyes
followed in a few days by a conjunctival inflammation with the produc-
tion of a yellow, thick exudate and diphtheritic pseudo-membranes,
to which was added an ulcerative inflammation of the cornea and a
Diphtheria in Man. 437

crusty eczema of the skin due to contamination with the conjunctival
secretion. The ducks became much emaciated and many died within
a few weeks, yet autopsy failed to reveal any marked changes in the
internal organs. Bacilli of the type of pseudo-diphtheria bacilli were
found in the conjunctival exudate. (Centralbl. f. Bakt., 1903, 214.)

Diphtheria in man. This so justly feared disease of children,
produced by the bacillus diphtheriae hominis discovered by Klebs and
more carefully studied by Loeffler, and belonging to the group of coryne-
bacteria, consists of an acute diphtheritic inflammation of the mucous
membrane of the pharynx and upper air passages, beginning usually
with fever and associated with severe constitutional symptoms. The
Klebs-Loeffler diphtheria bacillus displays its pathogenic action through
the medium of toxins which on the one hand produce a local inflam-
matory and necrotic process as well as general constitutional symptoms,
and is also responsible for later nerve paralysis which sometimes follow
diphtheria. Horses treated with the toxic filtrates of the cultures fur-
nish an effective antitoxic serum.

The relationship between diphtheria of man and that of animals
and particularly that of birds has not been fully explained.

There remains no doubt whatever that true diphtheria of man
and the diphtheria of animals are two separate diseases, occurring and
spreading entirely independently of one another. The bacillus of
human diphtheria, however, possesses a pathogenic action for animals,
among them for birds, and as some species, such as young guinea
pigs, cats and dogs, after artificial inoculation, develop even croupous-
diphtheritic processes of the mucous membranes, it cannot be denied
that this bacillus under natural conditions may produce similar
disease in animals and thus cause the latter to spread the con-
tagion. This view is supported by Ferré, and by Wheeler and Brandt,
who from cases of avian diphtheria and from the mouth of diph-
theritic pharyngeal disease of sick dogs respectively, grew cultures of
bacilli whose pathogenic action was similar to that of the Klebs-Loeffler
bacillus. Further support comes from Cobbett, who found a bacillus
in the nasal secretion of a horse suffering from laryngitis, which cor-
responded not only morphologically, but in its pathogenic action with
the bacillus of human diphtheria and against which the antitoxie diph-
theria serum proved effective. Gallez, Jr., Gratia & Liénaux also
found a bacillus similar to the Klebs-Loeffler bacillus but less virulent,
in the contagious nasal catarrh of birds.

On the other hand the possibility cannot be excluded that occa-
sionally the diphtheria of animals may produce diphtheritic processes
in man. This may be presupposed particularly for those cases where
in the products of the diphtheritic mucous membrane inflammation in
man it is impossible to demonstrate the Klebs-Loeffler bacillus, and
which in all probability results from some other etiological factor.
Close relationship between avian diphtheria and that of man has
repeatedly been affirmed, based on experiments or observations -which
appeared to indicate the likelihood of transmission of the disease from
man to birds. Loir & Ducloux have succeeded in cultivating the same
bacillus from the pseudo-membranes of a child suffering from diphtheria
which they considered to be the virus of avian diphtheria, basing their
opinion on the results of their experiments. Finally it is worthy of
note that the so called pseudo-diphtheria bacillus which several authors,
among them Roux & Yersin, Frankel, et al., believe to be an avirulent
438 Avian Diphtheria and Chicken Pox.

variety of the true diphtheria bacillus, has repeatedly been found in
birds (Gratia & Liénaux).

At present the view that the Klebs-Loeffler bacillus may ocea-
sionally produce membranous pharyngeal inflammation in animals
is justified; such cases, however, are to be differentiated from true
diphtheria of man and from the true diphtheria of animals, as cases

of pseudo-diphtheria.

Literature. Klebs, Verh. d. Kongr. f. inn, Med., Wiesbaden, 1883.—Léffler,
Mitt. d. G.-A., 1884, I.—Galli-Valerio, Cbl. f. Bakt., 1897, XXII, 500.—Gallez,
Ann., 1895, 309.—Gratia & Liéneaux, Ann., 1898, 401.—Beck, Hb. d. p. M., 1903,

II, 754 (Lit.).
Group IV.

INFECTIOUS DISEASES WITHSPECIAL INVOLVEMENT
OF THE NERVOUS SYSTEM.

1. Tetanus. Lockjaw.
(Tétanos [French]; Starrkrampf [German]; Tetano [Italian].)

Tetanus is an acute infectious disease resulting from an in-
toxication of the nervous system, characterized by persisting
spasmodic contractions of the entire body musculature or of
single groups of muscles, without impairment of consciousness.
The disease is caused by Nicolaier’s bacillus tetani and its
poisonous products of metabolism.

History. The opinions concerning the nature of this disease were
_until quite recently based on purely theoretical grounds. The associa-
tion between muscle spasm and the increased irritability of the nervous
system was recognized during the 18th century, but the real cause
of the nervous affection remained a mystery. The most generally prevail-
ing view was that tetanus, which was so often associated with injuries,
arose reflexly as the result of severe traction or contusion of peripheral
nerves and that the irritation thus originated was transmitted to the
spinal cord (tetanus traumaticus), but the efforts to produce the disease
experimentally in this manner all failed (Arloing & Trippier [1869]).
Since in other cases no preceding traumatism could be demonstrated
(T. idiopathicus) the cause was sought in other circumstances, par-
ticularly in colds (T. rheumaticus) and even in psychic excitement
(T. psychicus), although several authors (Travers, Rose, Spencer Wells)
were already inclined to consider the disease an intoxication.

Etiological research was directed into a more correct channel when
Carle & Rattone (1884) succeeded in producing the disease artificially
by inoculating the contents of an acne pustule of a person who had
died from tetanus into rabbits. Almost at the same time Nicolaier
(1884) obtained positive results by inoculation of garden earth into
rabbits, guinea pigs, and mice, and at the same time recognized the
cause of the disease in the form of a spore-bearing bacillus. Later
observations (Rosenbach, Baeumer, Bonome) have confirmed the in-
fectious nature of the disease for man, while Nocard (1887) established
the identical origin of tetanus of horses. ‘

Kitasato (1889) was the first to grow the anaerobic bacillus in
pure culture; Brieger (1887) demonstrated the presence of toxic sub-

439
440 Tetanus.

stances in mixed cultures, and Faber, (1890) in pure cultures. Finally
Behring & Kitasato (1892) worked out an effective method of immuniza-
tion against the disease, while Vaillard and Vincent, Rouget and Roux,
and Tiberti and Tarozzi furnished important contributions on the patho-
genicity of the disease.

Occurrence. Tetanus, a rare disease in the more northern
countries, occurs much more frequently in tropical regions and
sometimes attains an enzootic character among both man and
beast. In the temperate zone, as in Europe, the disease is
considered as sporadic and here cases occur in some regions
in rapid succession during the spring and fall. Considerable
loss occurs usually in horses, sometimes in sheep, while other
species of animals as a rule are much less commonly affected.
More recently, since greater attention has been given to the
cleanliness of the wounds, a decrease in the number of cases
has been-observed.

In the Prussian army during the years 1899 to 1908, in an average
of 87,000 horses, 42 to 64 (average of 52) were attacked annually with
tetanus, while in the French army during 1899 and 1900, 98 and 94
cases respectively, were reported—-In Hungary the disease appears
to be more common in the southern regions, and in certain communities
it causes considerable losses, especially after castrations.—The disease
appears to occur more frequently in the centers and the outskirts of
large cities, and during certain years or seasons.

It is much more common and widely distributed in warmer countries, and
occurs frequently in horses, especially after castration, in San Domingo, in the
Antilles, Algeria and Egypt.

Etiology. The bacillus tetani Nicolaier, is a straight,
slender rod (Fig. 67) possessing feeble motility, and propagates

 

Fig. 67. Bacillus tetani with Fig. 68. Bacillus tetani with spores
flagella. Two-day old agar in various stages of development. Four-
culture. day-old agar culture. Carbol-fuchsin

staining. :

by fission and also by spore formation. The spore is spherical,
with a diameter about twice as long as the thickness of the
bacillus, and is situated at one pole of the rod, thus giving
Etiology, Pathogenicity. 441

the spore-bearing bacillus a pin-like or drum-stick-like appear-

ance (Fig. 68). In cultures it may form longer slightly curved
threads.

Staining. The tetanus bacilli stain readily and uniformly with the
usual aqueous anilin dye stains as well as by Gram’s method.

Cultivation. The tetanus bacilli are anaerobic, but
develop also in the presence of oxygen when associated
with aerobic bacteria which energetically consume
oxygen. Under anaerobic conditions they grow readily,
especially on media containing grape-sugar, at body
temperature, less readily at room temperature. In
gelatin and agar the colonies form grayish-white spots
composed of clumps of fine threads, while a white
streak develops at the point of inoculation, with radia-
tions in all directions (pine tree shapes Fig. 69) Gela-
tin is liquefied slowly, bouillon is clouded uniformly,
milk is not coagulated; on potatoes there is sometimes
formed a colorless, transparent deposit. The interior
of an extirpated eye is also well adapted for its cultiva-
tion (Mackie). Gas (CH,, CO,) is produced on sugar-
containing media and the cultures disseminate a
peculiar burnt odor. Spore formation begins in the
bacilli, under favorable conditions, after 24 to 30 hours.

Tenacity. Since most of them are sporebearing, the bacilli
are almost as resistant as the spores. Direct sunlight destroys
them in 12 days, diffuse light in 1 to 2 months (Vaillard & Vincent).
In decomposing material they remain alive for a long time and
may increase for a time according to experiments by Bombicci.
When kept in a dark place they are still virulent after 11 years
(Henrijean), and in pus and animal tissues they retain their
vitality for months (Kitt). Cultures retain their vitality for two
years (Kitasato). The spores are killed by live steam at 115°C.
in 5 minutes, by 5% carbolic acid in 15 minutes, by 1:1000 corro-
sive sublimate and 144% hydrochloric acid solution in half an hour

 

Fig. 69. Four’

(Kitasato), by a 1% nitrate of silver solution in 1 minute, by he pg rian
5% creolin solution in 5 hours (Tizzoni & Cattani). The addi- ee bacilll anus

tion of iodine trichloride in the proportion of 0.125-0.25% to
culture decreases the virulence proportionally to the quantity of
the drug (Behring & Kitasato). The digestive juices have a very slight destructive
action (Sormani). : ,

Pathogenicity. Fresh cultures are so slightly virulent that
guinea pigs which are very susceptible to tetanus can stand a
subcutaneous injection of 0.3 or 0.5 ec. without harm, but
cultures ten days old or older will in very minute quantities
produce tetanus in susceptible animals. Filtrates of such cul-
tures free from bacilli and spores act similarly and only-after a
certain period of incubation, showing that living cultures exert
their pathogenic properties by means of toxic products (in
aerobic mixed cultures there develop similarly acting toxins
as in pure anaerobic cultures). Spores freed of their toxins by
prolonged washing or heating for 3 hours at 80° C. prove in-
effective upon subcutaneous injection even when given in rela-
tively large quantities, while these same spores when injected
subcutaneously or brought under the skin in small paper sacs
442 Tetanus.

will produce the disease when fine sand, coal dust, foreign bac-
teria (Bac. prodigiosus), or negatively chemotactic fluids (as lac-
tic acid) are added.

In animals which are infected subcutaneously or intramus-
cularly tetanus always begins with local symptoms. After such
an infection into the thigh the muscle spasm appears first in
the posterior extremity of the same, then on the opposite side
and later spreads to the anterior extremities, until it becomes
general. After intravenous injection of toxins there is general-
ized tetanus from the beginning, while after intracerebral inocu-
lation there follow excitement, intermittent spasms and disturb-
ances of motility (tetanus cerebralis) (Roux & Borrel); after
injection into the spinal cord severe attacks of pain occur with
subsequent tetanic symptoms (tetanus dolorosus) (Meyer &
Ransom, Tiberti).

The horse possesses the greatest susceptibility for the
virulent living cultures as well as for the toxins, and is followed
by the guinea pig, goat, sheep, mouse, rabbit; cattle are very
slightly susceptible, dogs and eats still less so, while chickens
are infected with difficulty with very large doses. Man is very
susceptible to both infection and toxins.

The toxic products of the tetanus bacillus were first studied by
Brieger who grew mixed cultures on beef broth and obtained four
substances (tetanin, hydrotetanin, tetanotoxin and spasmotoxin) which
caused muscular spasms after subcutaneous injection into experiment
animals. As these substances acted at once and in comparatively large
doses they could not be considered as true toxins. Later, after pure
cultures of tetanus bacilli were grown Kitasato, Behring & Knorr,
Tizzoni & Cattani, Roux & Vaillard studied the toxie culture filtrates
carefully without, thus far, succeeding in establishing the nature of
the toxic substances. It is probable that they represent specific secre-
tions of the bacilli and do not develop as the result of decomposition
of albumin-containing nutritive media as they are formed also on albumin-
free asparagin (Buchner). The toxin is soluble in water, insoluble
in alcohol, chloroform and ether; otherwise in certain characteristics
it resembles very much diastases (is not very stable, is precipitated by
alcohol, dializes, ete.).

The tetanus toxin is an extremely powerful poison. 1.0 cc. of the
filtrate of a highly virulent culture kills a horse 500 kg. in weight;
0.001 cc. kills a guinea pig of 300 gram, while other species of animals
require proportionally larger doses of toxin. If for 1 gram body
weight of horse the lethal dose is 1, guinea pigs require 2, goats 4,
mice 13, rabbits 2,000, chickens 200,000 doses per gram of body weight

Knorr).

The toxic value of toxins is usually designated by the smallest
amount of virus necessary to kill an animal of a certain weight. If
therefore 0.0000001 ce. toxin kills a 15 gram mouse, 1.0 cc. will kill
10 millions of mice of 15 gram body weight each, equivalent to 150
millions grams weight of mice (Behring).

The action of the toxin follows only upon subcutaneous, intra-
muscular, intraperitoneal, intravenous or intracerebral injection, while
large doses of toxin when given by mouth or intestine are entirely
Pathogenicity, Natural Infection. 443

without effect as the toxin is not absorbed by the mucous membrane

(Ransom ) nor is it decomposed by bile and pancreatic juice (Carriére,
Vincent).

The powder obtained from filtrates by precipitation with ammonium
sulphate is also toxic, and is so in correspondingly smaller doses (horses,
for instance, are killed by 0.006 gram).

Tenacity of the toxin. The toxicity of the filtrates suffers hardly any impair-
ment by dilution with blood, blood serum or salt solutions, but is diminished upon
addition of mineral acids and alkalis. The toxin is precipitated by small amounts of
alcohol, and decomposed by large quantities of alcohol. Direct sunlight destroys its
effect in 15 to 18 hours, a temperature of 80°C. in 3 hours, mineral acids and alkalis
in a concentration of 1% in one hour (Kitasato; Fermi & Pernossi). In powdered
form it is much more resistant; at room temperature in a dark place it remains
effective for years, while it is gradually attenuated by diffused sunlight; it can
stand constant heating to 120°C. and even 135°C. for 15 to 20 minutes, and is
destroyed only by 15 minutes’ heating to 159°C. (Morax & Marie).

Natural infection. This occurs as a rule through contami-
nation of wounds on the skin and mucous membranes with
bacilli and spores contained in the contaminating medium. The
most common carrier of the contagion is earth, less frequently
pus or tissue particles emanating from sick animals or cadavers.
The bacilli and spores are abundantly distributed in the super-
ficial humus layers, especially in such places as contain much
manure, especially horse manure; they may also be found in
large numbers in the slime of swampy areas. Nicolaier pro-
duced the disease in experiment animals by inoculation with
garden earth and since then tetanus bacilli have been demon-
strated in many regions in garden and farm earth, in street
dust, in manure, in various food substances, especially in hay.
The experiments have also shown that the bacilli occur in the
excrements of healthy horses (Sanchez & Veillon, Nocard), also
in those of cattle, hogs and smaller experiment animals
(Sormani Strauss, Molinari), for by the inoculation of such
material it is frequently possible to produce the disease arti-
ficially. (Joseph found tetanus bacilli in the intestinal con-
tents of eight cattle examined for this purpose, and believes
that they vegetate constantly in older animals. )

On account of these results which, by the way, also furnish proof that the
tetanus bacilli may be present in body cavities and canals, with external openings,
without endangering the health of the animal, Verneuil believed that the contagion
of tetanus developed originally in the intestinal tract of horses and that tetanus
in man always occurred as the result of coming in contact with horses and with
straw or earth that had been contaminated with their excrements. It is more likely,
however, that the spores gain entrance into the digestive apparatus of horses through
dusty food, remain here a time and pass on unchanged into the open (in feces of
man, as well as in all earnivora, tetanus spores are very rarely demonstrated).

Avenues of infection are offered by the various injuries
-of the skin or mucous membranes, mostly those, however, which
are associated with destruction of tissue or accumulation of
pathological secretions and which readily come in contact with
the earth on account of their location, or those in which foreign
bodies have penetrated deeply into the tissues. Especially
444 Tetanus.

dangerous in this regard, are injuries from nails, nail punctures
of the hoof or foot, about the coronary band, and particularly in-
juries about the lower portions of extremities ; fractures of bones,
wounds of castration, and harness galls; in horses tail docking ;
furthermore injuries of the mucosa of the ‘mouth (through carious
or sharp teeth) or genital passages (from aid in difficult labors),
in the newborn the contamination of the navel wound, in foals
the operation of umbilical hernia, injuries of the eyes, etc. In
any case the most varied injuries and accidents may give rise
to the disease provided that dead tissue, extravasated blood
or wound secretions facilitate the multiplication of the con-
tagion; aside from this the penetration of the anaerobic bacillus
into the deeper portions of the tissue or into hidden cavities
or pockets of wounds favors the development of the disease.

The infectious material gains entrance into the wound with
earth, necrotic tissue or wound secretion containing bacilli, or the
infection is facilitated by wood shavings, bone splinters, the har-
ness of a horse suffering with tetanus, or by hair ropes, manure
applied to a wound, further by implements, surgical instruments,
the hands of operators or those assisting them in operations. In
this way, for instance, tetanus is conveyed after castration
through the medium of the operator’s soiled hands or by clamps
which had been used before, while in other cases the virus
reaches the castration wound from the horse lying down and
contaminating it. The cases which point to the first mode of
infection are those that occur among animals which have been
castrated by the same operator within a short period of time,
even though in different places, when cases of disease occur
in rapid succession. Those pointing to the second mode of
infection are the ones where year in and year out animals from
the same farm become diseased. Since the antiseptic treat-
ment of wounds, tetanus occurs much less frequently after
such operations which were formerly considered dangerous
(castration with ligation of the spermatic cord, especially in
rams and calves).

It is therefore possible to designate the site of infection
in most of the cases, but there are cases where even the most
careful examination fails to reveal an injury of the body surface
or of the mucous membranes. Such observations, which were
formerly considered rheumatic tetanus, make it probable that
the disease may occur exceptionally without any preceding
injury. This might be assumed in parturition tetanus in the
sense that the infectious virus is propagated in the exudate
which collects in the womb and the toxins thus produced pass
from here to the lymphatic circulation. In this way could those
cases be explained where the occurrence of tetanus may be
associated with the retention and decomposition of the placenta.
In many eases of horse tetanus it is impossible to exclude the
possibility that the contagion multiplies in the follicles of the
tonsils or between the folds of the intestinal mucosa to such
Natural Infection, Susceptibility. 445

a degree that colonies are formed which produce sufficient toxins
to cause intoxication (Teyssandier observed several cases of
tetanus following colic). Infection occurs more readily by way
of inflamed mucous membranes (Thalmann) and this might
explain the occurrence of the disease in dogs after eating spoiled
meat (Alessandrini). The tetanus bacilli after passing through
the intestinal mucosa may also find a favorable medium for
development in exudates or necrotic areas of an internal organ,
for example in abscess of the liver (Keleti). Recent -experi-
ments have also shown that tetanus spores may probably pass
in. healthy animals from the intestinal canal to the lymphatic
circulation and remain latent in the internal organs, until a
time when circumstances favoring their development arise.

Susceptibility. Among the domestic animals solipeds are
most commonly affected by tetanus; the disease occurs much
less frequently in cattle, sheep and goats, while hogs and dogs
are only occasionally attacked (in dogs the disease occurs
usually after extensive and contaminated destruction of tissue,
more rarely after docking the tail). Cows are attacked in the
majority of instances after labor, only exceptionally following
a traumatic gastritis (Friedrich), calves after castration, while
in sheep castration, pox inoculation, ear marking, etc., are the
leading factors in the occurrence of infection. Among goats
the disease was observed almost exclusively in rams which
were castrated at an advanced age.

Young animals are more susceptible than older ones, and
the disease may become enzootic among lambs particularly,
sometimes also among foals, as the result of infection of the
umbilicus (tetanus neonatorum). ,

Pathogenesis. Healthy animal tissue is not a good medium
for the propagation of the tetanus bacteria. 'Toxin-free spores,
when not inoculated subcutaneously and in excessive numbers
(in guinea pigs 2,500 spores according to Vaillard, Vincent &
Rouget), are ineffective, as they are engulfed by phagocytes
and immobilized. On the other hand toxic spores produce the
disease even in very small quantity, as the phagocytes are kept
away from them by the negative chemotaxis of the toxins, and
these germinate under the protection of the toxins and enable
the bacilli to multiply. In the same manner spores are pro-
tected by the simultaneous injection of negatively chemotactic
lactic acid or trimethylamin (according to Hektoen this is not
the result of chemotactic but antiopsonic actions). This explains
the effectiveness of the toxin-containing older cultures as com-
pared with the harmless, toxin-free, young cultures.

_ When the spores enter necrotic tissue or extravasated
blood they multiply rapidly and produce toxins. By injection
of spores into such dead tissues (badly contused muscles, blood
extravasations) the disease may positively be produced, and
446 Tetanus.

experience also proves that tetanus, under natural conditions,
appears by preference associated with such wounds as are ac-
companied by destruction of tissues, hemorrhage or accumula-
tion of a purulent secretion.

Spores occurring free in nature do not contain toxins,
although an infection occurs with spore-containing earth in
healthy tissue; this finds its explanation in the fact that, to-
gether with the tetanus spores, other bacteria gain entrance
into the tissues, finding here a favorable medium for their de-
velopment, and consequently causing disease of tissue which
then furnishes a suitable medium for the growth of the tetanus
organism. Spore-containing earth loses its power of infection
when heated to 85° C.; such a temperature is not sufficient
to kill the spores, but it does destroy other bacteria present
in the earth. Earth that has been freed of its infective char-
acter by heating may again produce tetanus if simultaneously
with its subcutaneous injection there are introduced cultures
of bacteria grown from the earth before heating it. That is why
tetanus develops sometimes after comparatively slight injuries,
for instance after the introduction of a wooden splinter or
following a superficial suppurating wound covered by a scab.

Influences which reduce the resistance of the tissues and
perhaps paralyze the activity of phagocytes favor infection,
and in this sense colds or overheating (hard work in summer
heat) may be of importance.

The apparently spontaneous cases which do not appear
immediately associated with any injuries are at least partly
explained by the latency of the tetanus spores in the animal
body, in that spores which have penetrated into the body some
time previously are kept alive enclosed in cells, and later germi-
nate under the influence of a favoring factor (disease, colds,
overheating, muscular exertion) and cause a multiplication of
the bacilli.

Vaillard & Rouget found viable and virulent spores 314 months after injection
of spores into the bodies of guinea pigs, and Tarozzi also demonstrated that in
animals infected subcutaneously ‘with spore-bearing cultures _of tetanus the
spores frequently gain admission to the blood, migrating to organs far removed
from the original site of infection, where they may remain latent for 314 months
or longer. When favorable conditions arise, particularly necrosis of spore-
containing tissue, the latent spores are revived to vegetation and may cause
tetanus. Soprana, Canfora, also Reinhardt & Assim have arrived at similar
conclusions in their studies on the latency of tetanus spores. As the intesti-
nal evacuations of herbivora frequently contain spores there is always the
possibility that they may occasionally gain entrance to organic tissue, where they
multiply and give impetus to the formation of antitoxins. This would explain
Roemer’s findings in cattle over two years of age in which the blood serum
frequently showed antitoxin in demonstrable quantities (1/2400 to 1/50 units per ec.).

The influence of an increase of the body temperature on the development of
tetanus was demonstrated by Vincent who raised the body temperature of guinea
pigs in the thermostat or incubator to 40.5°C., subsequently injected spores that

had been heated to 85°C. and caused fatal tetanus in 2 to 3 days. The bacilli
were found disseminated through the entire body.

Germination and multiplication of bacilli usually occur ex-
clusively at the site of infection and therefore bacilli are rareiy
Pathogenesis. 447

found in the blood and more remote organs (spleen, brain)
and then only in minute quantities (Hohlbeck, Dor, Creite,
Nicolaier, Haegler, etc., probably they are enclosed in leucocytes
and carried there). This negative finding harmonizes with the
fact that the bacteria exert their pathogenic function indirectly,
through the toxic products absorbed from the lymphatic circula-
tion. On the other hand, the fact that the symptoms of poison-
ing, different from true poisons, such as strychnine, occur after
a comparatively long period of incubation (in guinea pigs at
least 12, in mice 6 hours) points to the fact that the toxin is
carried very slowly to the central nervous system.

Tetanus toxin exerts a pathogenic effect on the motor nerve
cells, primarily those of the spinal cord and medulla oblongata,
giving rise to an increased irritability, indirectly however caus-
ing contractions of the corresponding muscle groups. If the
source of the toxins is on the surface of the body some of them are
at once bound by the axis cylinder (nerve endings) and conducted
along the nerves to the central motor cells, whose irritation causes
local tetanic muscle spasms; the other portion of the toxins
enters the blood, is later, however, also bound by constantly in-
tercepting nerve fibers and conducted to the motor nerve cells,
so that muscle spasms occur in constantly widening areas. If
on the other hand, the toxins immediately enter the blood, as
would occur in intravenous or intraperitoneal injection, or after
an intestinal infection (so called T. splanchnicus), they are
almost simultaneously bound by all motor cells and in such cases
the muscle spasms occur later, but in almost all the muscles
simultaneously (Morax & Marie, Behring). The fact that
trismus, in both man and horse, is one of the first symptoms
of the clinical picture of tetanus would indicate that the tetanus
toxin is more readily bound by the trigeminus neuron than
by the other motor neurons. The increased reflex irritation also
points to an increased irritation of the sensitive neurons.

Bruschettini was the first to discover that the tetanus toxin was
conducted from the point of infection to the nerve centers mainly
through the nerve channels, and his discovery was confirmed by Meyer
& Ransom, Stintzing, v. Behring, Tiberti, ete. According to Meyer
& Ransom the toxin is taken up by the nerve endings containing no
axis cylinders, according to Pochhammer by the medullary sheaths;
Zupnik, however, thinks that the muscles are directly attacked by the
toxin. In the central nervous system the toxin combines electively
mostly with the motor nerve cells of the spinal cord and medulla
oblongata.

The slow progress of the toxin along the nerve channels explains
the relatively long incubation, as the toxin has to be carried to the
central nervous system along these paths; when the toxin is brought
in direct contact with the nerve centers the incubation is considerably
shortened. ;

The peculiar action of the tetanus toxin on the nervous system
is probably explained by Ehrlich’s side chain theory. According to
448 Tetanus.

this each toxin molecule is composed of one non-toxic (haptophore)
and one toxic (toxophore) atom group. The protoplasm of the motor
nerve cells is composed of a vital nucleus and numerous side chains
(receptors), of which many possess a special affinity for the haptophore
atom groups of the toxin molecule. When such molecules of the tetanus
toxin reach the nerve cells they are anchored by the aid of haptophore
groups to the corresponding receptors of the cell protoplasm, whereupon
the toxophore group attack the vital nucleus of the cell. The opposed
affinity between tetanus toxin and nerve substance is demonstrated
by the experimental observation, where it is shown that a mixture
of toxin and brain substance is non-toxic for guinea pigs (Wassermann
& Takaki).

Ehrlich also demonstrated a hemolytic substance (tetanolysin) in
culture filtrates, which was neutralized by antitetanic serum.

Recovery from one infection does not immunize the animal
against a subsequent one. Repeated occurrence of the disease
may result from renewed infection, or may follow when tetanus
spores were retained somewhere, as for instance in a scar, in an
abscess or blood coagulum and germinate at a considerably
later date. (Repeated infection in horses was observed by
Johne after 4, Hill after 5, Hell after 6, Mougneau after 10
months. )

Anatomical changes. Autopsy reveals no changes charac-
teristic of the disease. In the central nervous system, especially
in the spinal cord and its coverings, hyperemia is often seen
and punctate hemorrhages are found in the gray matter of
the brain, but such findings are not uncommon in other dis-
eases. This is also true of the microscopic examination of
the motor nerve cells which show slight degenerative vacuoles,
disappearance of Nissl’s bodies, ete. Marinesco found marked
changes also in the nerve fibrils; in many cases, however, the
appearance was entirely normal and the positive findings may
be associated with the infections accompanying wounds. Small
hemorrhages and serous infiltration are frequently found in
the peripheral nerves, especially in those leading from the
infected area. Fatty degeneration of the heart muscle is an
almost constant occurrence. The intramuscular connective
tissue of the trunk and the extremities is edematously infiltrated
and contains small hemorrhages, with muscle bundles torn and
colored yellow or grayish due to parenchymatous or hyaline
degeneration. (Hichhorn found the muscles in a cow to look
like fish meat.)

In animals in which rigor mortis sets in early the only
lesions are those pointing to death by suffocation (dark color
of the poorly coagulated blood, slight hemorrhages on the
serous and mucous membranes, hyperemia and acute edema of
the lungs) and in addition occasional subsequent changes
(pneumonia, bone fractures, signs of general septic infection).

The site of infection should if possible be disclosed in every case at autopsy.
and this requires at times a very careful examination of all the parts of the body
Anatomical Changes, Symptoms. 449

and the different organs; when external injuries cannot be found great care should
be exercised in the inspection of the canals and cavities lined with mucous mem-
branes, especially the nasal cavity, the pharynx, the gums, and the uterus. In a
case reported by Merkel the infection was occasioned by a wheat kernel that had
entered the air passages, while Hengst traced the infection in a cow back to an
injury of the paunch by. a wire.

The infectious nature of suspected material may be ascertained with certainty
by subcutaneous or intramuscular inoculation of pus or necrotic pieces of tissue
into guinea pigs or mice. This is not so easy by microscopic examination; however
the spore-bearing tetanus bacilli are found in the inflammatory products and the
diseased tissues associated with other organisms. (See Fig. 73 on page 457.)

Symptoms. The period of incubation after subcutaneous,
intramuscular or intraperitoneal injection of a medium-sized
amount of virus into smaller animals is about 2 t6 5 days and
in larger animals longer; its duration depends on the strength
and quantity of the toxin, less so on the susceptibility of the
animal. Under natural conditions the first symptoms have
been noted as early as 24 hours after infection (mostly in very
young animals); as a-rule the incubation lasts longer, and in
the majority of cases, especially in horses, it is 1 to 2 weeks.

From’ Cadiot’s “compilation of 38 horses suffering from tetanus the disease
occurred at the end of the first day in one case, on second to fifth day in six cases,
fifth to tenth day in 13 cases, tenth to twentieth day in 15 cases, twentieth to
thirtieth day in three cases. According to Hoffmann the period of incubation in
parturition tetanus in cows is 2 to 14 days, in rams and boars after castration
8 to 14 days, in lambs after pox vaccination 13 to 18 days.—Dieudonné reports on
58 cases of tetanus following docking of the tail, where the incubation lasted
8 to 42 days.—In a case of Roeder’s a calf was attacked by the disease immediately
after birth and died on the fifth day, while De Bruin noted in a colt that had stepped
on a rusty nail on the day of birth the first symptoms of tetanus two days after
the accident. Rietsch performed, artificial inoculation and observed-a period of
incubation of 15 days in mules; Kitt observed it in sheep to be 6 to 7. days, and
in dogs 2 days. é

Excluding the rapidly developing cases where the disease
is completely developed within a few hours, the beginning
of the disease causes no change’ whatever sometimes for 1 to
2 days, with the exception of a disinclination of the animals
to move and a sluggish action when they are prodded. The
legs bend less than normally and the extremities are raised
stiffly, while feeding is prolonged, the animals appearing to
chew much more carefully and apparently having some difficulty
in swallowing food; at this stage the peculiar projection of the
head and the rigid station and immobility of the ears may be
noted. These symptoms indicate beginning spasm of individual
muscle groups, which, in the majority of cases, appears first
in the head or neck, less frequently in the hindquarters and
from here spreads forwards or backwards. In some cases the
spasm begins in the muscles nearest to the site of infection,
as is the case in artificial subcutaneous inoculation. In rare
eases the spasm may be confined to a certain region of the body,
for instance the hindquarters (T. parietalis) ; usually it is uni-
versal (T. universalis); in which case the infected animals have
a characteristic appearance.

Vol, 1—29 4
450: Tetanus.

In an advanced stage of the disease in the horse the animal
will remain with stiffened, widely separated feet, and with head
and neck extended in one position (Fig. 70). The ears stand
erect approaching one another; the eyes, whose pupils become
dilated, are drawn deep into the orbits and are immobile on
account of the spasm of the eye muscles, while the anterior
surface is largely covered by the prolapsed membrane nictitans
(particularly noticeable when the head is raised). The nasal
wings are drawn upwards and as a result the nostrils have
a trumpet like appearance. The mouth is held closed, with
the commissures usually drawn outwards and slightly upwards;
it is difficult to overcome the spasm of the thick masseter
muscles so as to separate the upper and lower incisors 1-2 cm.
(lockjaw, trismus). The spasm of the constrictors of the

 

Fig. 70. Tetanus. Generalized muscular spasms in a horse.

pharynx prevents swallowing of the saliva which runs from
the mouth in long tough threads.

As the facial portion of the head is raised by the anteans
tion of the neck and upper throat muscles, the animal stretches
the head forwards and upwards, while the neck is extended
in.a straight line or is slightly curved upwards, so that its
upper margin forms a concave, its lower a convex line
(deer neck). ‘The abdominal muscles are also contracted and
the abdomen is in consequence more or less retracted. The
tail is held rigidly and slightly raised or usually pulled a little
to one side.

The spinal column usually forms a straight line (ortho-
tonus) ; exceptionally, owing to unusually violent spasms of the
long back muscles there is formed a concave arch (opistho-
Symptoms. 451

tonus) ; or in case of excess musculature on one side a lateral
curvature occurs (pleurosthotonus).

The muscular spasm of the extremities results in a straddled,
sawbuck-like position, the hind feet being but very slightly
arched at the hocks. Bending in these or other joints is im-
possible or can be accomplished only by applying considerable
force; hence it is also impossible to lift the feet from the ground,
and when this is done the disturbance of equilibrium is apt
to cause falling. The patients avoid all possible movements;
when forced they manage to move with great difficulty, lifting
the feet but slightly from the ground. "Turning is especially
-difficult, as the entire body acts like a stiff object; just as
difficult, and frequently impossible, is the motion of backing.

The musculature is tense, almost board-like to palpation;
‘some muscles project, appear of sharp contour and occasionally
show fibrillary tremors. In the course of the disease the spas-
modiec contraction of the muscles remains for some time un-
changed in the same condition, for hours and even days; in
some. cases again certain variations occur. In ‘such cases the
muscles are at times less tense, movements easier and the
general condition appears to be temporarily improved; this
apparent improvement is soon followed by renewed severe
spasmodic attacks which are easily originated by external irri-
tation. .

Reflex irritability is increased from the beginning, and the
effect of light, noise and touch or movement increases the spasm,
sometimes to such a degree that the animals bénd the head
unusually far back or even fall to the ground, trembling violently
while on the ground; or sudden contraction of. the dorsal
muscles may cause fracture of one or more vertebrae: (Ziindel).
Such paroxysms are usually accomipanied by profuse sweat-
ing, which is also observed in other cases of severe infection
with the disease. -

Consciousness is retained to the end; the expression of:
the eye indicates fear, while the facial expression appears
of a characteristic rigidity on account of the constant contrac-
tion of the musculature. Even slight excitement will cause the
animals to shrink and to become restless.

The increased irritation of the nerves leading to the genital
- apparatus causes a moderate but constant erection of the penis
in males.

The spasm of all the voluntary muscies of the body natu-
rally exerts a disturbing influence on the other functions and
thus irregularities in the respiratory and circulatory systems
as well as in digestion are observed. In addition changes occur
in the internal organs, which markedly aggravate the condition
of the patient and incidentally are the direct cause of death.
Respiration is superficial and increased on account of the
spasm of the abdominal and intercostal muscles, so that the
number of respirations may be ten times that of normal. The
452 Tetanus.

gaseous exchanges in the lungs are not sufficient in spite of
the increased respiration and soon there develop symptoms
of impaired oxidation of the blood, whenever the spasm is
continuous, such as cyanosis of the mucous membranes,
hyperemia and later acute edema of the lungs with rales over
the trachea and thorax. Breathing is frequently stertorous
or groaning in nature, and sometimes one may observe on
inspiration a whistling noise due to the spasm of the laryngeal
muscles. Aspiration of mucus or saliva or forcible administra-
tion of drugs may easily cause a pneumonia, almost always
of gangrenous character and with lethal result.

The heart action does not vary from the normal in the
beginning of the disease, and in light cases it may remain
unchanged throughout; the pulse, however, is small, the arterial
walls tense. In severe cases the heart beat becomes very fre-
‘quent and finally throbby, especially towards the fatal end of
the disease.

Internal temperature is increased in severe cases only and
then only on the approach of death, or when an inflammation
of an internal organ has become associated (pneumonia) or
when general septic infection occurs. Aside from such cases
the temperature rises in uncomplicated cases only one or two
days or even only a few hours before death, increasing rapidly,
and reaching 42-43° C. immediately before death (Fig. 71)..

tfelalaislalelals

 

Fig. 71. Fever curve in tetanus with post-mortem rise of temperature.

The increase of temperature’ continues after death, and in two hours attains
45°C. The cause of this increase in body temperature, first observed in the human
eadaver by Wunderlich, is found in the amount of heat which is produced by the
powerful muscle contraction which increases after death to scme extent and then
relaxes, for similar post-mortem. signs have been observed after poisoning by strych-
nine as well as after electrical irritation of the spinal cord (Leyden).

 
Symptoms. 453

Ingestion of food is hindered by the trismus, in spite of
a good appetite. Patients repeatedly reach for food, chew
the morsels with a lot of noise and finally swallow them with
difficulty, or the food remains in the mouth and is later expelled
by cough. The food particles which accumulate in the mouth
are mixed with saliva and undergo fermentation or decomposi-
tion, decolorizing the saliva and imparting to the exhaled air a
fetid odor. Liquid food is more easily taken, although sometimes
even the drinking of water becomes impossible, in spite of every
effort, regurgitation being often observed. The tongue is usually
coated with a thick, dirty-grayish deposit, the margins showing
the imprint of the teeth and frequently superficial injuries.
Peristalsis is suppressed, defecation delayed on account of the
tension of the abdominal walls, and only a few fecal balls are
evacuated at a time.

Micturition is also delayed and the urine is more concen-
trated, with increased specific gravity as a result of the pro-
longed retention in the bladder as well as reabsorption of the
aqueous constituents. In completely suppressed ingestion of
food the reaction is acid and the urine contains debris and
oxalate crystals in large amounts (Friedberger).

According to Tabusso’s experiments the blood contains heterolysins, also
auto- iso- and heteroagglutinins, while the freezing point is slightly diminished
(an average of 0.535 against 0.558 for normal horse serum), whereas in other
instances where dyspnea and asphyxia are present the molecular concentration is
increased. :

In fatal cases the patients, which have hitherto been
constantly standing, suddenly break down, fall to the ground
and die in a few hours under progressive increase of the
muscular contractions. The immediate cause of death is some-
times exhaustion, or suffocation, at times also a hypostatic
or traumatic pneumonia. i ,

In localized tetanus the muscle spasm is confined to certain
parts of the body, and usually to those in which the infection
occurred. When the spasm affects the muscles of mastication,
the course of the disease is usually unfavorable on account
of impaired nutrition; in other cases the disease occasions as
a rule merely a transitory disturbance of function. When the
partial tetanic spasm remains local to the end, it is usually
accompanied by light symptoms and the contraction of the
affected muscle groups does not develop to as high a degree
as in generalized tetanus. In most cases the localized tetanus
is the incipient stage of general infection. ;

The clinical picture of the disease varies but slightly ac-
cording to the species of animals affected, and deviations in the
complications are usually the only changes observed. |

In cattle bloating and distention of the left flank develop
on account of the suppression of the movements of the paunch
and of rumination due to spasms of the abdominal muscles. The
patients show a more pronounced apathy or dullness and their
454 _ Tetanus.

reflex irritability is less marked than in the horse. Dreymann
and Shadow each observed a case with marked upward curve
of the vertebral column (emprosthotonus); Balog observed
marked orthotonus. In cows a suppurative inflammation of
the uterus occurs frequently, which serves as the basic point
of the disease.

In sheep and in goats opisthotonus usually occurs; it is
pronounced when the animals are standing, but more so after
they have fallen to the ground. Moderate bloating is also
noted frequently.

The lockjaw of lambs (tetanus agnorum) which occurs as
a rule from a navel infection and is not infrequently observed
as a stable enzootic, begins with lassitude and sluggish indis-
position. Later movement becomes stiff and finally impossible;
the animals hold the head to one side or backwards, curve the
back upwards, suckle with difficulty or are unable to do so, and —

 

Fig. 72. Tetanus. Generalized muscular spasms in a dog.

finally die with symptoms of suffocation. The disease is often
associated with an acute intestinal inflammation with profuse
diarrhea.

In hogs, which usually are affected with generalized tetanus,
trismus attains a marked degree (Jakab observed the disease
in this form among 16 pigs of one drove) ; upward or downward
curvature of the vertebral column also occurs frequently.

Tetanus is not common in dogs—is usually localized and
manifests itself especially in young dogs by transitory trismus.
In severe cases one is struck by the characteristic facial distor-
tion, the forehead being wrinkled in a sagittal direction, by
the rigid erect position and approximation of the ears, the
external strabismus of the eyes and the grinding of the teeth
as well as the rigidly spread extremities; the vertebral column
is straight or curved downwards (Fig. 72).
Course, Diagnosis. 455

__, Dhe disease occurs very rarely in fowls. Dreymann observed
it in a turkey gobbler four days after a dog bite. The symptoms
were spasm of the entire musculature, stiffness of the head
and neck, trismus, close approximation of the wings to the
body, ruffled feathers and cyanosis of the comb and wattles.

_ Course. The most varied transitional stages may be ob-
served in the course of tetanus in the rapidly progressing cases
which terminate fatally in 2 or 3 days as well as in those that
progress slowly and attain only a limited degree of intensity.
Death usually follows in 3 to 10 days after the appearance
of the first symptoms, very rarely earlier and even more rarely
later. The symptoms in the fatal cases, aside from slight re-
missions, are progressive in intensity until death supervenes.
There are cases in which the patient’s condition may become
improved for a time to such an extent that recovery is hoped
for; suddenly a remission occurs, followed in a few days by
death, while no cause for the change is discernible. In favorable
cases the symptoms, especially the spasmodic contraction of
the musculature, abate towards the end of the second week,
and finally cease altogether. Convalescence will be long, how-
ever, a certain stiffness of movement being noticeable in the
animals even 4 to 6 weeks later, but this also gradually dis-
appears.

The course of the disease is influenced by nutrition in that
those cases where ingestion of food and water is difficult or
impossible on account of the trismus, exhaustion occurs earlier,
and this is accelerated by the exertion occasioned by the con-
stant muscular tension. Further, the superficial respiration
occasions danger of suffocation, which is enhanced by the easily
induced hypostatic hyperemia of the lungs. Mild cases may
be shaped unfavorably by occasional complications, and in this
respect pneumonia is especially dangerous. Itis produced almost
exclusively by aspiration of fluid or particles of food and usually
runs an unfavorable course. (Schindelka has observed a
marked decrease in the tetanic symptoms after an intercurrent
influenza in four horses.)

Diagnosis. A characteristic picture of the disease is pre-
sented by the continuous tonic muscle spasms with retained
consciousness and normal temperature. Strychnine poisoning
simulates it very closely; here, however, the spasms develop
much more rapidly and death results much more quickly.

Tetanus may be mistaken for other diseases only in the .
initial stages of the disease, as long as the muscle contractions
are confined to one part of the body and while they are not
very pronounced. Cerebrospinal meningitis comes into con-
sideration on account of the rigidity of the neck, but here symp-
toms are also present pointing to an inflammation of the brain
(dullness, paralysis in the area of certain cerebral nerves),
trismus is usually absent, reflex irritability is increased, but
456 Tetanus.

external irritants do not produce a rigidity of muscles in remote
parts of the body, while on the other hand muscle paralyses
occur in the later course of the disease.

Clonic spasms are characteristic of. epilepsy and eclampsia.
In epilepsy these are separated by intervals of freedom from
spasms. ‘Tonic spasms are exceptionally observed in single
muscle groups and then they are only transitory, while the
patients also lose consciousness during the attacks.—In rahies
trismus is absent, the ears are not stiff and here paralyses
occur later.

Acute muscular rheumatism, when very severe, occasions
a similar spasmodic condition at the parts of the body affected
as occurs in tetanus; but here the muscles are painful and
appear swollen rather than tense, the reflex irritability is not
increased and external irritation causes no.extension of the
condition.

In articular inflammations of the extremities as well as
in rickets the stiff gait also reminds one of tetanus, but the
changes in the shape of the joints protect against error, while
the cause of an apparent trismus resulting from inflammation
of the maxillary joint is differentiated by the tenderness of the
involved articulation and the laxity of the masseters.

Finally tetanus must be differentiated from tetany which
is produced by traction of certain nerves or adhesion to a
cicatrix. As soon as the nerve is freed these symptoms all
disappear (Gunning cured the disease in one case by freeing
the spermatic cord stump which had grown into the scrotum).
Tetanic symptoms are sometimes observed in painful intestinal
diseases (Hoffmann observed this repeatedly during four weeks
in a horse infested with ascaris). Recovery followed expulsion
of the worms.

Pus from wounds may occasionally reveal spore-bearing tetanus bacilli on
microscopic examination, which are mixed with other bacteria (see Fig. 73).. Such
material is also suitable for diagnostic inoculations of mice and guinea pigs.

Prognosis. The course of tetanus is unfavorable in the
majority of cases. The mortality varies in horses between
55 and 90%, in cattle it is a little lower, in sheep higher and in
young animals, especially in lambs, most unfavorable (95 to
100%). Giinther, however, saw four out of five colts 8 to 14
days old recover. The earlier the symptoms appear after in-
fection, the more rapidly the muscle spasm develops with pro-
portionate intensity, the more unfavorable is the prognosis.
and a marked locking of the jaw is of bad significance. In
a longer incubation and more gradual development of the dis-
ease, the prospects are better, and should the animal survive
the second week it may most probably be considered saved if
the respiration and nutrition are satisfactory and no complica-
tions set in.

From a prognostic point of view the internal temperature
Prognosis, Treatment. 457

is also of importance, as every increase in temperature during
the course of the disease is an unfavorable sign. Such an
increase indicates in cases without complications that the end
is near; in other cases it is due to some inflammatory process,
usually pneumonia.

The cases of localized tetanus are, as already stated, al-
ways more favorable, and the prognosis of tetanus in dogs is
usually better. -

Among 247 horses with tetanus observed at the Budapest clinic in 1886-1906,
202 died, i. e., 81.8%.—In the stables of the Prussian army tetanus was diagnosed
from 1881 to 1908 in 1,139 horses, 848, i. e., 74.4% died, while in the French army
from 1904 to 1905 among 172 cases, 115 or 66.8% died.—According to Dieudonné
the mortality from tetanus after docking of the tail (58 cases) is 75%.

_ Treatment. The first essential part in the treatment of
tetanus consists in a thorough disinfection of the seat of in-
fection. If it is possible, by removing
. the pus and necrotic tissue, as well as

‘by a subsequent disinfection of the
wound, to render the tetanus bacilli
and spores harmless, the source of the
poison is thereby eliminated, and if
the already absorbed toxin has not yet
produced severe changes in the ner-
vous system, the recovery of the ani-
mal may be hoped for, especially since
a portion of the toxin is probably ee
’ eliminated from the body with the se- a
cretions (perspiration, urine, saliva). Fis. : P . else pe een
According to these indications careful ee ood een taining
search should be made at the sup- tetanus bacilli, streptococci,
posed place of infection by means ee ae ee
of an appropriate incision, to de- ee :
termine whether it contains any purulent or ichorous secre-
tion. If so it should be washed, and if a foreign body is present
it should be removed, the suspicious tissue should be cut from
the walls of the cavity with the aid of scissors, or curetted with
a spoon, and the cavity should be thoroughly washed with a
concentrated disinfectant. For this purpose a 1% nitrate of
silver, or corrosive sublimate solution, 8% chloride of zine
solution, or 5% iodide of glycerin (Van), are satisfactory;
cauterization may also be applied. The disinfection acts also
by destroying the less resistant foreign bacteria, and thereby
rendering the conditions for the propagation of the tetanus
bacilli unfavorable. By the application of a Bier’s ligature
the absorption of the toxins may also be made more difficult.
Tf the disease appears after docking the tail it is advisable to
amputate another portion, and to apply the thermocautery to
the surface of the wound.

In practice the local treatment of horses is sometimes very difficult, as the
patients become much excited, and it is hardly possible to lift the leg from the

 
458 Tetanus.

ground. If however the place of infection is known with sufficient certainty, it
appears justified to anesthetize the animals for the purpose of local treatment.

_ Snitable quarters and proper food are of great importance.
The patients should be put in a quiet place, if possible, with
soft ground, and on account of the increased reflex irritability,
they should be protected from loud noises and from direct
sunlight (complete darkness is not necessary), and also from
unnecessary handling and examinations. It is only in severe
cases advisable to place the horses in slings, usually when the
animals are exhausted to such an extent that they can stand
up only with difficulty, for once the animals have fallen to the
ground the condition becomes very rapidly aggravated. If
the animal is found lying on the ground it is advisable to allow
it to lie for awhile on soft bedding; then it should be raised
carefully, and placed in slings if this is possible without unduly
exciting the patient.

As long as the patients are not unable to eat they should
be given soft, easily digestible food; later, when mastication
becomes difficult on account of approaching trismus, flour and
bran: gruels, to which eggs or red wine have been added, may
be given, while if trismus is fully developed nutritive enemas
(milk and eggs) may be employed. At the same time the ani-
mals should have fresh water within reach, so that they may,
at their desire, rinse their mouth and quench their thirst. In
order to prevent the decomposition of the saliva and of the
remnants of food it is advisable to rinse the mouth from time ,
to time with pure water or water containing a little vinegar.
The retained feces should be removed by manual emptying of
the rectum, or by enemas of soap water; the retention of urine
is relieved by pressure on the bladder, or if necessary by the
introduction of the catheter.

_ he internal treatment proper is of minor importance.
The administration of drugs per os is dangerous even if trismus
is only slightly developed, and for this reason usually only
such remedies are given as the patients can take with their
drinking water (salines for the prevention of constipation).
In cases where the infection appears to have occurred through
the intestines oil of turpentine (Ol. thereb., Ol. oliv. aa 100.0 g.
per diem) is now administered per os or per rectum, as advo-
cated by Hartenstein and Nocard. Inhalations of chloroform,
or chloroform and ether appear to act beneficially, by diminish-
ing the trismus somewhat, so that the animals can more easily
partake of food. Such inhalations should be given immediately
before feeding, but only up to the commencement of anesthesia.
Matozzi recommends for reducing the trismus an ointment of
cyanide of potassium (2:8), Schleg a mixture of gray mercury
ointment and camphor liniment, to be rubbed into the cheeks.
Chloral hydrate or ether (3-50 g. daily per rectum), morphine
(0.2-0.5 g. subcutaneously), cyanogen (0.3-0.5 g. subcutaneously
or injected into the trachea), extract of belladonna (2-4 g. in
Treatment, Immunization. 459

drinking water), salts of atropin (0.02-0.08 g. subcutaneously)
etc., may be used on account of their anti-spasmodic action,
relatively small doses being required for small animals. The
last mentioned remedies are preferred by some authors to
the opiates which cause digestive disturbances or symptoms of
irritation (Barrier, Friedberger, Pethe).

The value of the subcutaneous injection of carbolic acid
as recently recommended by Maccagni & Bianchini, Croce, also
by Schmid, Guerrieri, Cangini and others (20-40 ec. of a 2%
solution, according to Croce 10 ce. of a 10% glycerin solution,
and in addition carbolized water into the rectum), cannot yet
be determined. Pilocarpin (0.20-0.50 g. subcutaneously) was
recommended to promote the circulation, and to increase the
secretions through which it possibly would promote the elimina-
tion of the toxins, but the writers, as well as Friedberger, failed
to obtain beneficial results from its application. Profuse bleed-
ing (10 liters at one time possibly to be repeated in one to two
days and followed by subcutaneous infusions of several liters
of artificial serum) as recommended by Crinon and also by
Dumas, is supposed to serve the same purpose, but its action
also appears to be problematical, since together with this the
administration of bromide of potassium, and antitoxic serum
is recommended, while Habicht advises also injections of iodipin
(25-30 g. alternating with the bleeding, and as after treatment).
Chigos and Diffiné recommend daily intravenous injections of
250 cc. oxygenated water, Dabert peroxide of hydrogen (10 ce.
daily subcutaneously, or 1-2 liters per os), Mayr the iodipin
(100 ec. subcutaneously), with repéated rectal infusions of a
3% septoform solution. _ French veterinarians (Chapard,
Desoubry, Cagny, Girard & Malle) praise the tallianin (ozonized
turpentine), which is supposed to have given good results even
in severe cases (20-30 ce. daily intravenously).

The antitoxin serum has given only indifferent results in
animals affected with tetanus, but may be beneficial if em-
ployed at the beginning of the affection, and in relatively high
doses (see p. 462).

After the disappearance of the muscular spasms and during
the long convalescent period care should be taken that the ani-
mals are daily exercised quite slowly for %4 to 1% an hour, and
they should be used for work only after several weeks.

Immunization and Serum Therapy. Behring & Kitasato
(1890) successfully immunized rabbits by inoculating them first
with 0:3 ec. of filtrate of a virulent culture, and then repeatedly
injecting them subcutaneously with 3 ec. of a 1% iodine
trichloride solution. Rabbits treated in such a manner later
withstood 10 ce. of a culture of which 0.5 cc. killed other rabbits.
They also withstood 20 times the fatal dose of toxin, while
0.2 ec. of their blood serum injected intraperitoneally into
rabbits protected them against a virulent infection given 24
460 Tetanus.

hours later. If 0.033 cc. (3800 times the fatal dose) of a culture,
0.0001 ce. of which killed mice inside of two days, is injected
into mice with 5 times the quantity of immune serum (0.2 cc.)
the animals will remain unaffected. The blood serum of rabbits
which were not immunized had no protective action. Similar
results were obtained by Tizzoni & Cattani in mice and rats.
(1891) with blood of artificially immunized pigeons and dogs
(1-2 drops of dog serum rendered ineffective 0.5 ec. of toxic
filtrate of cultures).

These experiments formed the basis of the serum immuniza-
tion and serum therapy, for which the serum of horses is now
exclusively used, since Schiitz found that horses and sheep
may be also successfully immunized against tetanus, and pro-
duce a potent immune serum.

Preparation of Immune Serum, According to Behring’s method, a virulent
bouillon culture is obtained, 0.75 ce. of which is fatal for rabbits in 3 to 4 days,
and of this bouillon 80 ce. is mixed with 0.25%; 60 ce. with 0.175%; 40 ce. with
0.125% trichloride of iodine, while 20 cc. is used without any mixing. Passing
from the most attenuated to the least attenuated cultures the horses to be immunized
are treated once in eight days with subcutaneous injections of 10-20 cc. and finally
with the pure culture, 0.5 ec. being injected at first and thereafter each five days
the dose being doubled for each injection.

According to the procedure of Roux & Vaillard immunization is carried out
with filtrates of 4 to 5 weeks old cultures, of which 1/400 cc. kills a mouse. At
first a filtrate attenuated with Lugol’s solution is injected subcutaneously in
increasing doses and later the pure toxin, first injected subcutaneously, then intra-
venously or intraperitoneally. :

Standardization of Immune Serum. According to Behring’s procedure the
potency of the serum is determined in such a manner that the smallest quantity of
serum is ascertained by inoculations on mice, which renders a certain quantity of
tetanus toxin of a known strength, ineffective (toxin and sz7um are mixed and
injected subcutaneously). As a test toxin a dry tetanus normal toxin (TeTN) is
used, of which 1 g. kills 150,000,000 g. of mouse weight, that is 10,000,000 mice
of 15 g. body weight each. As normal serum .(TeAN?’) is designated that serum
of which 0.1 ce. renders ineffective 0.03 g. of normal toxin; serum, of which 0.01
ec. exerts such an action, possesses 10 times the strength (TeAN™”) etc. One ce.
of normal serum contains one antitoxin unit (A.-E.). In Germany only a serum
can be marketed which possesses not less than at least ten times the strength
(TeAN*), of which 1 cc. contains at least 10 A.-E., or 0.01 ce. neutralizes 0.03. g.
of normal toxin.

_ Serum prepared by the Pasteur Institute of Paris renders ineffective 1 ec. of a
solution diluted in proportion of 1:100,000, which is 100 times the fatal toxin
quantity (= 0.001 g. dried toxin).

Both sera when dried in the vacuum are also used in the powdered form,
10 g. of the German preparation containing 100 antitoxin units, while of . the
Parisian preparation 1 g. corresponds to 10 ec. of the liquid serum. There is also
an antitoxin prepared by Tizzoni and Catanni on the market, which is obtained
from dog and horse serum.

The blood serum of highly immunized horses when injected
subcutaneously in sufficient quantities, protects animals against
the pathogenic action of a simultaneous tetanus infection or
an infection occurring shortly afterwards. The immunity is
produced immediately, but lasts only a short time, about 3 to
4 weeks in horses, and then diminishes gradually, finally dis-
appearing entirely. A simultaneous injection of immune serum
and toxin causes local tetanic symptoms, which however last
only a few days whereupon the animals recover. Similar results
Immunization. 461

are obtained when the serum is injected after the toxin, but
before the appearance of the tetanic muscular spasms, while
if the injections of serum are made still later the fatal termina-
tion can. be averted only by large doses of serum, especially
by its administration into the blood circulation, or directly into.
the brain (Roux & Borrel). After the lapse of a cértain time
after toxin injection serum treatment is entirely without effect.
The protective and curative action of tetanus antitoxin
depends, according to the present conception, upon the fact that
the antitoxin molecules contained therein bind the toxin mole-
cules circulating in the tissue fluids and render them harmless.
The repeated action of the toxin on the nerve cells in the serum-
producing animals results in the production of excessive num-
bers of receptors, which are thrown off into the circulation,
and are therefore present in the antitoxin molecules (Ehrlich’s
Theory, see p. 463). The serum therefore protects the nerve ele-
ments from the pathogenic action of the toxin molecules which
have not yet reached them; but it is not capable of separating
toxin molecules, which have already become anchored to the
plasma of the nerve cells, and thereby restore the former con-
dition of the cells. Accordingly the serum affords protection
against infection immediately preceding or following its ad-
ministration, but if the disease has already become manifest
it exerts a curative action at best only. when the intoxication has
not greatly reduced the functional ability of the nerve cells.

I. Immunization with Immune Serum. Such an immuniza-
tion is advisable and indicated in all of those cases in which
tetanus is feared within a short time. Such a possibility exists
especially after contusions which have become contaminated
with dirt or manure, also whenever tetanus is frequently observ-
ed ‘in certain localities to follow upon certain injuries (castra-
tion, docking of the tail operation for umbilical hernia, skin
injuries, etc., and when during the operation careful asepsis
cannot be carried out. Where the necessary requirements for
a satisfactory surgical technique are present, such prophylactic
serum injections are of course superfluous. |

For immunization with Behring’s serum large animals are injected
subcutaneously with 20 A.-U., small animals with 4-5 A.-U., while with.
the .Pasteur ‘serum 20 or 6-10 ce. -respectively are used; the injections
may be. repéated after 10 to 12 days. The surgical treatment of the
wound does not become superfluous by the use of this serum since the in-
jected serum does not prevent the development of the tetanus bacilli’
(Roux & Vaillard). Besides the spores are retained in the wounds for a
long time, and if they germinate, after the disappearance of the artificial
passive immunity, they produce toxins and may cause disease in the
animal which has again become susceptible.

Immunization is employed to a great extent in France, in accordance with
Nocard’s recommendations. ‘In the period of 1895-97, 2,395 horses, asses and mules,‘
44 cattle, 82 sheep and lambs, and 206 hogs were immunized. More than 2,300
462 Tetanus.

of these animals were immunized immediately after an operation and none of
them became ill. Of about 400 animals which were treated 1 to 5 days after
an accidental injury only one horse became affected with tetanus, and this one
recovered. The 63 veterinarians who carried out the immunization ebserved tetanus
during this same period in 259 animals which had not been given the treatment.
Labat in France (703 cases) and Lang in New Caledonia likewise obtained very
good results with immunization in localities where the soil was badly ‘infected.
Dieudonné failed to observe a single case of tetanus in colts which had been treated
with serum after operations for umbilical hernia, whereas 33% of the animals
had succumbed previously under similar conditions. Good results are also reported
by Nandrin in tetanus of newly born foals; he found however that 5 g. of serum
had a toxic action and therefore considers 3 g. as a suitable dose. :

According to the recent experiences of Dieudonné (in 1,009 cases of castration
and abdominal operations), Labat (in about 2,000 clinical operations), and Chapellier
(in about 500 castrations), a single serum injection suffices to accomplish effective
results. (Merillat observed the development of fatal tetanus in a horse in spite of
the serum injection one week after it had been operated on for a nail puncture
of the hoof.)

The liquid serum keeps at least one year in a dark, cool place, while dry
antitoxin keeps much longer. This should be dissolved before using in boiled water.
According to Calmette dry antitoxin exerts its protective or curative action (in
rabbits) even when it is dusted upon the infected wounds.

II. Serum Therapy. In animals that are already affected
the serum treatment has thus far not been successful. Animals
in which the subjective symptoms cannot be utilized for the
diagnosis of the first stages of the disease, come for treatment
as a rule in an advanced stage of the disease, and mostly with
symptoms of general intoxication. Jn such cases the toxin
has already flooded the body, and consequently the nervous
system is affected to such an extent that even the prevention
of further intoxication is no longer able to save the animal.
At best the beneficial results can only be expected from serum
treatment when it is undertaken on the first day of the disease.

For curative purposes horses should receive subcutaneous injections
as near as possible to the place of infection, with at least 100 units of
Behring’s serum, 50 ec. of Pasteur’s serum (or 9,000 American units.
Trs.). If possible the injections should be repeated the following day.

Nocard could not check the progress of the disease in horses even
with intravenous injections of immune serum; not even in those eases
when the injection had been undertaken 24 hours before the appearance
of the first symptoms.

In the period of 1897-1903 there were treated with antitoxin in the Prussian
army 91 horses, of which 58 (63.7%), died, while in the French army the mortality
since the administration of immune serum was reduced from 72.7% in 1897, to
57.3% in 1901. In the clinic at Budapest of 7 horses treated with serum 4 died.
A favorable result was obtained only when the progress of the disease was slow
and the recovery of the animal was probable even without such treatment. Knorr
obtained relatively good results in some horses; however he injected 1,000 A.-U.,
repeating this dose after 1 to 3 days (the treatment of one animal cost $50.00!).

' Later reports of Dieudonné (31 recoveries in 79 cases), Ryder, Hammond, Labat,
Rickmann and others, speak more favorably of the value of the serum treatment;
all however express the necessity of using large doses repeatedly. Haubold obtained
very favorable results in sheep which became affected after shearing, castration,
or docking; two doses of 5 ce. of the Pasteur serum were sufficient to produce
recovery even in severely affected animals. Douville obtained recovery in four
dogs after the injection of 3-5 ec. of serum.

Roux & Borrel recommend the intracerebral injection of immune serum. Out
of 45 guinea pigs which received four drops of serum in each hemisphere after the
appearance of tetanic symptoms, 35 recovered while of 17 guinea pigs which had
Serum Therapy. 463

been treated under similar .conditions subcutaneously only two remained alive.
Villar treated two horses successfully in this manner (3-8 cc. of serum were injected
into the brain substance through an opening in the frontal bone). Sendrail and
Cullié on the other hand saw the fatal termination in two cases hastened, while
with the injection of serum into the vertebral canal they obtained a more satisfactory
result (30 ce. injected through the lumbo-sacral articulation on two consecutive days).

Kister and Sawanura claim a special action from endoneural serum injections.
This method is recommended as prophylactic, especially in those cases in which
muscular tissue has become injured, therapeutically in tetanus ascendens, while
not in tetanus descendens; nevertheless subcutaneous and intravenous serum in-
jections should also be used.

Hartenstein and Trélut obtain good results from the injection of blood serum
from a horse affected with tetanus; the authors however observed a pronounced
aggravation after transfusion of the blood of an immunized horse, while Pilz found
the blood serum of horses that had recovered from tetanus to be without any effect.

Treatment with Brain Emulsion. After Wassermann found that a mixture
of brain substance of rabbits and toxin in certain proportions is not poisonous,
and in consideration of Ehrlich’s theory that the antitoxins are nothing more than
receptors thrown off from the ganglion cells, Fiebiger undertook curative experiments
at the Vienna clinic, under the direction of Schindelka with the injection of brain
substance. In the course of 15 months 20 horses affected with tetanus, but excluding
the very severe cases, each received subcutaneous injections of one lamb’s brain
finely emulsified in physiological salt solution. Of these 20 horses eight (40%)
died. In most cases extensive and slowly healing abscesses developed at the point
of injection. Schuemacher also reports favorable results from this treatment.

Literature. Friedberger, D. Z. f. Tm., 1879, VI, 33 (Lit.); 1884, X, 27
(Lit.).—Carle & Rattone, Giorn. di Torino, 1884.—Nicolaier, D. m. W., 1884, 842;
V. A., 1892, CXXVIII, 2—Nocard, Rec., 1887, 617.—Kitasato, Z. f. Hyg., 1889,
VII, 225; 1892, XI, 256.—v. Behring, D. m. W., 1903, 617.—v. Behring & Kitasato,
D.’m. W., 1890, 1113.—Kitt, Monh., 1890, I, 214 (Review).—Tizzoni & Cattani,
Cbl. f. Bakt., 1891, IX, 189.—Vaillard & Vincent, A. P., 1891, 623._v. Behring,
Das Tetanusheilserum, Leipzig, 1892.—Vaillard, A. P., 1892, 224.—Schiitz, Z. f.
Hyg., 1892, XII, 58—Roux & Vaillard, A. P., 1893, 65.—Dreymann, Monh., 1894,
V;, 19.—Dieudonné, Rec., 1895, 279; 1896, 280; 1909, 433——Roux & Borrel, A. P.,
1898, 225.—Fiebiger, Z. f. Tm., 1902, VI, 161._Lingelsheim, Hb. d. p. M., 1903,
Il, 567; 1904, IV, 983 (Lit.)—Vincent, A. P., 1904, XVIII, 450; Bull. de 1’Acad.,
1907, LVIII, 233.—Hoffmann, Z. f. Vk., 1905, XVIT, 118.—Tiberti, Chl. f. Bakt.,
1905, XXXVIII, 307 (Lit. on Tetanus Toxin).—Tarozzi, ibid., 1906, XL, 305.—
Mayr, B. t. W., 1907, 931—Rémer, Z. f. Immf., 1909, I, 363.

s 2. Rabies. Lyssa.

(Canine madness, hydrophobia; Wutkrankheit, Tollwut, [Ger-
man]; Rage [French]; Rabbia [Italian].)

Rabies is an acute, contagious, and almost without excep-
tion, fatal infectious disease, the clinical picture of which is
characterized by disturbed consciousness, increased nerve irri-
tability and by subsequent symptoms of paralysis. The disease
is usually transmitted by the bite of an affected animal to
other animals as well as man. The infectious virus is a filterable

microorganism.

Historical. The disease and its contagious nature, as well as the
danger connected with the bites of mad dogs, have been well known
since the time of Aristotle, but up to the most recent times, there
has been a certain belief in its spontaneous development. — In fact, it
was supposed that hot feed, lack of drinking water, unsatisfied sexual

desire, and violent nervous excitement, might cause the disease. By.
464 Rabies.

means of inoculation experiments the infectiousness of the saliva was
determined in dogs by Zinke (1804), Griiner and Salm (1813), in
herbivorous animals by Berendt (1822), in human beings by Magendie,
while Galtier, in 1879, found the injection of the virus into rabbits
to be a convenient and harmless method of studying the disease, and
in 1880-81 made immunity tests with intravenous injections of virulent
saliva or brain emulsion. :

The very extensive investigations of Pasteur and his collaborators,
Roux, Chamberland, and Thuillier (1881-1889), proved on the one
hand that the purest and most concentrated virus is contained in the
central nervous system; they also established a method for the attenua-
tion of its virulence, and solved the important question of protective
vaccination against the disease. Finally, Remlinger and Riffat-Bey
(1903) have determined the filterability of the virus, while Negri (1903),
through the demonstration of specific cell inclusions in the nervous
system of the infected animals, has facilitated the postmortem diagnosis
considerably.

Occurrence. Rabies occurs in all parts of the world among
dogs, cats and carnivorous wild animals (especially wolves and
foxes). Other animals and human beings are seldom affected,
and then almost exclusively after having been bitten by the
above named carnivorous animals (about 80% of the observed
cases have been found in dogs). While in earlier times the
disease appeared often epizootically extending over large areas,
in the course of the last ten years it has decreased or ceased
to appear in several countries as a result of the measures taken
against it.

In Germany, the number of cases of rabies, during the years 1895 to 1898, in-
creased from 480 to 1,202, but in the year 1902 they were reduced to 612. During
the years 1903 and 1904 there was again an increase to 1,043, but since then the
disease has been diminishing. In the year 1908, 683 animals, of which 585. were
dogs and 2 cats, were found infected in 644 communities. Of these cases 87.6%
were observed in Prussia where the eastern provinces, East Prussia, Posen, and
Silesia were principally infected. Cases were also found in large numbers in Saxony
and Bavaria, while in the remainder of the territory of the kingdom only isolated
cases were observed.

In France, the disease is found all over the country. Since 1899, nearly
2,000 cases of rabies have been observed every year (in the year 1907, 1,892 cases,
and in 1908, 1,482 cases in dogs). In Paris, however, the number of cases has
decreased from 807 in 1900 to 43 in 1907.

In, Great, Britain, since 1895 when there were 672 cases in 29 counties, the
disease has decreased so rapidly, thanks to the energetic measures taken to ‘eradicate
it, that only 13 cases in 4 counties were observed in 1902, and since 1903 the whole
territory of the United Kingdom has been free from the disease. 2 #

In Austria, the disease showed a steady increase during the years 1891 to 1899
(from 815 to 1,551 cases and in 1900, 1,187 cases). It was most common in Bohemia
and Galicia, less prevalent in Moravia and Lower Austria. In many instances the
infection was introduced into Galicia and Buckovina from Russia and Roumania, in
the border districts of which countries an exceedingly large number of dogs are
kept without supervision, and where rabies is not only regularly found in dogs,
but also in wolves. During the 10 years from 1891 to 1900, 4,974 human beings
were bitten by mad dogs, 123 (2.4%) of whom developed hydrophobia and-died.
In the year 1908 the weekly number of cases at these places amounted to from
14 to 56, while the mountain and coast districts were free from the disease.

In Hungary, temporary improvement followed immediately after the veterinary
law of 1888 became effective, but since 1893 when there were 883 cases of disease,
rabies has increased considerably, and in 1908, 2,460 cases of rabies, 1,759" being
in dogs, were observed in 1,471 communities. The majority of the cases was
observed at the southern frontier. me)
Occurrence, Etiology. 465

_ Russia is heavily infected as is indicated by the frequent introduction of the
disease into Germany and Austria (in 1908 there were 7,253 cases in 4,060 com-
munities).

‘ The disease is also frequently found in Servia, Bulgaria and in Roumania
(273 cases in 1908; in 1906, 142 mad dogs were brought to the veterinary institute
of Bucharest), while it is observed more rarely in Turkey. ;

In Belgium there were 123 cases in 1908, in Italy 525, in Switzerland 2. In
Holland 41 cases of rabies were observed in 1907, and in Spain the disease also
seems to appear frequently, but Denmark, Sweden and Norway have for years
been free from the disease.

In North America rabies is very common (Frothingham) and has been in-
creasing in prevalence during the last ten years (Hart). In the United States
230 human beings were the victims of rabies in 73 cities from 1890 to 1900, while
in the District of Columbia 91 cases of rabies in animals were reported from
1893 to 1900. :

In Africa, the disease is also known, and in Asia it appears very frequently,
while Australia has thus far been free from it.

Etiology. Remlinger and Riffat-Bey produced typical
rabies in 6 out of 19 rabbits with a filtrate of highly diluted
virulent. brain emulsion which passed through a fairly porous
Berkefeld filter. According to the results of these experiments,
which were later confirmed by Di Vestea, Schriider, Bertarelli
& Volpino and others, the virus of rabies must belong to the
filterable microorganisms. The attempts at cultivation which
have thus far been unsuccessful, justify the supposition that
it multiplies only in the tissues and fluids of the body. The
purest and most concentrated virus is secured -in the central
nervous system of the diseased animals; it is also found in
the salivary glands and their secretions, and sometimes in other
glands of similar structure (lachrymal glands, pancreas, mam-
mary glands), while in the aqueous humor (Gibier, Pasteur, Al-
banesi, Courmont & Nicolas), in the cerebro-spinal fluid (Pas-
teur), and in the blood (Marie) the virus is found only in excep-
tional cases, and in the flesh not at all. (Konradi found it in the
blood of guinea pigs, but only in small quantities.)

Negri Bodies. In 1903 Negri found in dogs and rabbits inoculated
with either street or fixed virus, and also in animals which had died
or had been killed after natural infection small, round, oval or three
cornered inclusions in the large ganglion cells of the hippocampus
major, in the Purkinje cells of the cerebellum, in the ganglion cells
of the cerebral cortex, pons, and medulla oblongata, and sometimes
also in the nerve cells of the spinal ganglia and spinal cord. These
structures now known as Negri bodies, are 1 to 27 # long, 1.5 to 5 &
broad and appear red in color when stained with methylene blue-
eosin (the Mann method of staining). These cell inclosures (see Plate I)
contain in their interior very small, strongly refractile, and sharply
outlined granules. Negri believes that these bodies, which have been
found exclusively in rabid animals and persons are the parasites
(protozoa) of rabies, because among other reasons they appear in the
nerve cells only 14 to 23 days after artificial infection, and resist both

utrefaction and the effect of glycerin. ;
. These findings have later been confirmed by Volpino, Beck, Bose,
Ernst, Bohne, Lentz, and others, and the structure of the bodies has
also been subjected to a closer study. According to Volpino ’s investiga-
tions, the large bodies consist of a hyaline ground substance, in which
Vol. 1-20
466 Rabies.

sometimes very small, marginal, and, at other times, larger, cefitral
formations (small and large inner formations) seem to be imbedded,
which contain very fine ring, rod or dumb-bell-shaped inclosures. The
rod-shaped bodies contain a fine granule sometimes at one or both ends,
while the ring-shaped bodies show one or more similar chromophile
granules around a light central space.

This complicated structure at once excludes the characterization
of Negri bodies as products of degeneration; besides, their specificity
is demonstrated by the fact that they are only found in rabid animals.
There is, however, a doubt as to their parasitic nature and their im-
portance as the exciting agent of rabies. The filterability of the virus
and the fact that in the initial stage of the disease and in animals
infected with fixed virus, Negri bodies are generally lacking seem
to speak against it, but still the possibility exists that the true specific
virus consists of small formations, barely visible or completely invisible,
which develop only in the nervous system of the infected animals,
and aided by the cell reaction, first form small and simple corpuscles
and later large, complicated bodies (Di Vestea, Volpino).

Negri has recently confirmed his conception of the bodies named for him as
true rabies parasites by microscopic discoveries according to which the formations
at a certain stage of evolution contain a nucleus in a homogeneous original substance,
which breaks up into very diminutive chromatin granules, whereupon the surround-
ing plasma is divided. In this way small corpuscles are formed which consist of
a@ chromatin granule and its capsule, and later grow up to new independent bodies.
Quite consistent with this conception are discoveries by Babes, Koch, and Rissling,
who in sections of the cornu ammonis, but mainly in the degenerated ganglion cells
stained according to Cajal, Giemsa or Heidenhain, have found cocci-like formations
in large number, scarcely 1 yw, in size, surrounded by a light capsule. They are
of the opinion that these formations are the active causative agents of rabies,
while the Negri bodies which inclose them are reaction products of the ganglion
cells produced by their irritation.

Prowazek considers the capsulated small formations as protozoa and designates
them as chlamydozoae, the same as the causal factors of vaccinia, chicken pest, ete.
In favor of their protozoan character and against their bacterial nature is the fact
that rabies virus is injured by gall and glycoside (Frantzius, Kraus, Eisler, Lesieur),
which substances are known to be poisonows to protozoa and cells, but are not
poisonous for bacteria.

Finally, the specificity of the Negri body is also shown by the fact that its
abundance is in direct proportion to the virulence of the same parts of the nervous
system. According to Fermi the order of sequence is cornu ammonis, cortex cerebri,
pierre oblongata and spinalis; then, cerebellum, thalamus opticus, and nucleus
eaudatus.

Very small bodies from 0.5-2.0 yw. in size, were also found by Bertarelli,
Febré and Bonnard in the brains of dogs inoculated with fixed virus, and by
Lentz and Manqueliau in rabbits treated in the same way. Their absence or the
fact that they could not be found may have some connection with the knowledge
that this form of the disease has such a brief course that no larger formations
are developed. Schiffmann found by frequent passages that first the complex, and
then the single, smaller bodies disappear from the cornu ammonis. Lentz describes
as ‘‘rabies corpuscles of passage’’ the Negri-like formations which are larger’ in
size and also contain larger, compact, inner corpuscles, and besides are frequently
located extracellularly. They come from nuclei or ganglion cells under simultaneous
disintegration of the protoplasm.

Tenacity. The medulla oblongata of rabid animals retains its virulence for
months at ordinary room temperature when protected from drying and putrefaction
(Pasteur, Frothingham); on the other hand the spinal cord of rabbits becomes
non-virulent in 14 or 15 days when exposed in a dry, dust-free atmosphere (Pasteur)
or in 4 or 5 days if spread in a thin layer (Galtier). Fluid saliva infects even
after 24 hours (Gibier); dried saliva not later than 14 hours (Celli). The virus
is destroyed in one half hour at 52°-58° C. (Higyes), and in two minutes at
Negri Bodies, Pathogenicity. 467

80° (Bertarelli). The virus is scarcely influenced by severe cold (— 16° — 35°C.).
Butrefaction destroys the virus only after long exposure; for instance Galtier
found that the medulla of a dog that had been buried for 44 days was still virulent,
Ratz reported virulence persisting after exposure to putrefaction for 14 to 24 days,
while Klimmer found the cord of a rabbit to remain virulent which had been
undergoing putrefaction for 15 days. Of the chemical agents, glycerin acts rather
as a preservative, for according to Kempner the medulla retained its virulence in
glycerin for at least 8 to 10 days; according to Rodet & Galavielle for 10 months.
On the other hand the virus is destroyed in a few minutes when exposed to the
action of each of the following: Mercurie chloride 1:1000 (Celli), diluted chlorine
or bromine water. (10-20 drops of the official chlorine or bromine water to 10 ce.
of water), 1% solution of potassium permanganate, and 2% _ sulphuric acid
(Békay & Szilagyi), 5% hydrochloric acid, 1% creolin solution and also to lemon.
juice (Blasi & Traveli). The natural gastric juice destroys the virus of. rabies
in 41% to 5 hours (Babes & Talasescu), and bile kills it in several minutes. In a
vacuum from which the sunlight has been excluded the dried and pulverized brain
substance will remain virulent at least 9 months (Vansteenberghe).

The Negri bodies are destroyed by weak alkaline solutions; they are however
very resistant to the action of mineral acids (Negri) and are only imperceptibly
altered by drying, warmth, putrefaction, glycerin and water (Bertarelli & Daddi).

Pathogenicity. By the inoculation of virulent saliva or
oblongata emulsion the disease may be transmitted to dogs,
cats, guinea pigs, rabbits, mice, rats and also to other mammals.
The best results are obtained by the injection of the virus under
the dura mater of brain or cord, into the brain substance, into
the anterior chamber of the eye, or into the muscles. Equally
good results may be obtained by injection into the peripheral
nerves. Rubbing the virus into the scarified skin of dogs and
rabbits is successful in only 50% of the cases. Subcutaneous
inoculation in dogs rarely gives positive results. In rabbits
75% of subcutaneous injections are successful only when the
muscles or the nerves have been injured at the same time.
Intravenous injection sometimes produces the disease in dogs.
and rabbits, but not in ruminants or horses.

Konrddi has infected rabbits through the scarified skin, Galtier
through the shaved skin, Hégyes, Galtier, and Remlinger through the
uninjured nasal mucous membrane, and Galtier and Conte through
the conjunctiva, while an infection of the mucous membrane of the
vagina only succeeded in exceptional cases. Several experiments have
been conducted without results by feeding saliva, meat, and spinal
cord of rabid animals to horses, dogs and sheep (Delafond, Rénault,
Hertwig, Nocard). Nocard in the course of 2 months, had a fox ‘eat
the ‘cerebral and spinal tissue of 6 rabid foxes and 12 mad dogs, the
unusual feed not having the slightest harmful effect.

“Birds may be infected artificially, but they are not very receptive,
and the virulence of the virus seems to decrease in their bodies (Gibier,
Lite). Cold-blooded animals are also killed by the rabies virus, and
frogs succumb with paralytic symptoms.

In rabbits which have been infected successfully, the disease de-
velops in its paralytic form, as a rule the hind parts and exceptionally
the front part of the body becoming paralyzed first. The paralysis soon
becomes general, spasms in some groups of muscles are observed, and
at last the greatly emaciated animal dies in the course of 2 to 3 days.
Indications of excitement (unrest, desire to bite) are seldom observed,
but these symptoms have been often observed in guinea pigs. In
dogs the usual symptoms of rabies develop after inoculation and if
468 : Rabies.

this was intracranial, the disease usually commences with nfania and-
a desire to bite.

The virulence of street virus varies within a rather wide range,
and this is also indicated by the varying periods of incubation
after subdural inoculation in rabbits. According to d’Amato, the virus
from cats, foxes and wolves has a more violent effect than ‘that, from
dogs.

The natural infection is brought about in the majority of
cases by man or animal being bitten by a rabid animal, whereby
the virulent saliva is inoculated through the wound into the
subcutaneous tissues, muscles or nerves; in rare cases the con-
tagion has been introduced by licking of wounds and skin abra-
sions. The saliva is most virulent immediately after the onset
of the disease and in its further course but it is also infectious
in a lesser degree 2 to 5 days before the appearance of the
symptoms (Roux & Nocard, Nicholas), and in cases described
by Pampouki and Konradi even 8 days before the appearance
of the first symptoms. On the other hand during the long period
of incubation preceding these days, the saliva is not infectious
but it may be virulent for 5 days after the animal has recovered
(Remlinger). Finally, there exists a possibility of transmitting
the disease by means of milk from diseased animals (Perroncito
& Carita, Nocard).

The danger from a bite depends on the one hand on the
virulence of the saliva, on the other hand upon the size, that
is the depth of the wound, and further on the number of nerves
and lymphatic vessels in the wounded part of the body. Large
wounds offer large surfaces for absorption, and from small but
deep wounds, the virus once entered, can hardly be removed,
while from small, superficial wounds it is easily removed by
means of bleeding. Therefore, the serious wounds inflicted by
animals of prey, especially wolves and large rabid dogs, and
the deep wounds inflicted by the sharp, pointed teeth of cats
have an equally bad reputation, while the bites of the herbiv-
orous animals are less dangerous.

Rabies is particularly frequent after infectious bites in parts
of the body where nerves and lymph vessels are plentiful and
which are near to the brain or spinal cord. Wounds on the lips,
cheeks, and nose are considered as especially dangerous, and in
horses and cattle the infection comes mostly from these parts of
the body. The density and thickness of the layer of hair or wool
covering the point bitten is important as it might withhold the
saliva. Similarly human beings are often protected against in-
fection on account of the thickness and density of their clothing.
Thick wool especially renders such protection, and this is in ac-
cord with the experience, that bites of rabid animals are much
more dangerous for clipped sheep than for those that have a
dense covering of wool.

The contagion, be it ever so virulent and concentrated,
cannot penetrate through the uninjured skin, while the possi-
Natural Infection. 469
bility of infection of the uninjured mucous membrane cannot
be disputed in consideration of the recorded positive results
of experiments.

After the bite of rabid animals the disease follows only
in a portion of the cases, hardly more than half. As already
mentioned there is a possibility that the contagion will not
reach the wound or may be carried away by bleeding; besides, the
virus may be removed or destroyed by means of immediate
disinfection. Probably, in many cases, the rabies virus is de-
stroyed without causing the disease after having entered the
body. In favor of this possibility is the experience that: bites
from various animals are not of equal danger in the various
parts of the body, and also that artificially infected susceptible
animals do not always contract the disease, while a few cases
ultimately recover. The animal organism is undoubtedly capa-
ble under certain circumstances of rendering the contagion in-
effective, when the virus is present in small amount or is at-
tenuated, and this power is decidedly increased by measures
of immunization. Thus only can it be explained why barely
30-40% of dogs bitten by rabid animals eventually develop the
disease. On the other hand it is possible that latent virus
in the brain and spinal cord is stimulated to rapid increase
by external influences, such as physical exertion, cold, etc.,
whereupon the disease which until this time had been latent,
may develop within a short time (Marie, Remlinger).

According to a compilation of Friedberger & Frohner, animals bitten by rabid
dogs afterwards contract the disease as follows: According to Hertwig, 5%;
according to Haubner 40%; according to the calculations of the Lyon school 20%;
according to those of the Alfort school 33%, according to Rdll, in Austria, in the
years 1877-1887, 40% of bitten horses, 50% of cattle and sheep, 36% of hogs, and
20% of goats contracted the disease. As a general average 30% may be adopted,
although for cattle and sheep 50-60% will be reached.

Regarding susceptibility to rabies there exists no con-
siderable difference among the mammals. While the disease
has been observed very frequently in certain species of animals,
this may be explained satisfactorily by their mode of living,
their manner of commingling, and by a temperament favorable
to mutual infection. Therefore, the disease is observed most
frequently in vagrant, vicious dogs, then in cats and wild
carnivorous animals, and it is transferred to animals of this
class by means of bites, while herbivorous animals infect each
other only exceptionally.

The breed or the sex of the animal as well as climatic
factors are without influence on the susceptibility, and age is
a factor insofar as in young animals-the outbreak of the disease
will follow after a shorter period of incubation. According
to Remlinger 1 to 2 months old puppies are very susceptible
to rabies and the virus in their bodies is very virulent since
it produces typical rabies by subdural and intraocular injec-
tion in 9 to 13 days. The more frequent appearance of the
470 Rabies.

disease during summer time is sufficiently explained by the

greater intercourse between the animals, and the same fact ex-
plains the frequent appearance of the disease in densely popu-
lated districts. In various individuals, however, great differ-
ae are noticed, as some animals, even dogs, resist every in-
ection.

The relatively rare occurrence of rabies in Constantinople was formerly ex-
plained by the supposition that the breed of dogs there had greater resistance
against the contagion, that the disease there generally caused only paralytic symp-
toms, and that the rabies. virus was attenuated. Remlinger found on the contrary
that the disease follows its regular course, and that the infectious agent is very
virulent. According to his opinion, the rarity of cases of rabies may be explained
by the peculiar way of living and the distribution of the street dogs there. They
are not running about the streets, but live in groups in certain streets or parts of
streets, strictly watching their places of living, and when a strange dog appears
it is at once chased away. When a dog develops rabies, it also remains in the
street where it is born and has so far lived, while the healthy dogs by instinct avoid
their diseased comrade, and, in case it should try to escape, it will be surrounded,
barked at and compelled to withdraw to its sulking place. Only inexperienced
young dogs come near it; therefore, in Constantinople, only young animals have
been found with rabies, and human beings have been bitten by these dogs almost
exclusively.

Pathogenesis. If the rabies virus becomes introduced in
some part of the body through bites or artificial infection, it
penetrates, as suggested already by the theoretical views of
Duboué in 1879, as a rule along the nerve tracts of the involved
part of the body towards the central nervous system usually
without entering the circulation, and from there it is distrib-
uted only gradually. The researches of Vestea & Zagari
show that after the inoculation of virus into a nerve of the
hip of a rabbit the paralysis will first appear in the hind leg,
and from there proceed forwards, while after the inoculation
into a nerve of the foreleg or under the meninges, a reverse
process will be observed. If the nerve connecting an extremity
with the spinal cord is severed, the subsequent injection of
rabies virus into the respective limb will not produce the dis-
ease (Nicolas). If, before the inoculation into a peripheral
nerve, the spinal cord is cut through in its entire breadth, only
the portion connected with the infected nerves up to the place
of division becomes virulent, but not the part on the other
side. The results of the inoculation experiments have been con-
firmed by the histological researches of Schaffer, who always
found intensive changes in the portions of the spinal cord which
were connected with the nerves coming from the place of the bite.
If the disease occasionally develops after injection into the blood

stream or into the peritoneal cavity, the explanation is that sim-
ultaneously a nerve was also injured.

The virus which has reached the central nervous system,
also moves in centrifugal direction along the nerve tracts. Thus,
when the disease has a rapid course, the virus will be contained
only in the nerves connected with the place of infection and
in the cerebral and spinal tissue, but when the course is slow,
the virus after a certain time will disappear from the nerves
Pathogenesis, Anatomical Changes. 471

of the infected extremity, and reappear in the nerves of the
other side of the bedy (Roux, Hégyes) undoubtedly after having
passed the involved segment of the spinal cord. In the same
way, proceeding in centrifugal direction, it reaches the acinous
glands where the conditions for propagation are favorable;
thus the tissues of the salivary glands first become virulent,
and from there the virus invades the secretion of these glands,
the saliva. .

_In the central nervous system, the virus exerts its patho-
genic effect on the walls of the vessels, causing small-celled in-
flammatory foci in the nerve tissues, and on the other hand it at-
tacks the nerve cells. The irritation of the nerve cells causes nerv-
ous excitement, such as disturbances in consciousness, increased
reflex irritability, and, after involvement of the medulla ob-
longata, high temperature, polyuria, and diabetes. After a time
however, the degeneration of the nerve cells leads to consecutive
paralysis affecting finally the respiratory muscles which forms
the immediate cause of death. The stage of irritation preceding
the degeneration may be of a very short duration, and may be so
little pronounced, especially in rabbits, that the disease will show
symptoms of paralysis apparently from the start.

The virus of rabies probably exerts its pathogenic action
through some poisonous chemical products, the character of
which is yet unknown.

Anrep has produced out of the cerebral substances of rabid animals
a very poisonous, alkaloidal principle, 0,0003-0.0004 g. of which, in-
jected subcutaneously, caused lowering of the temperature, paralysis
of the extremities, salivation, and death from suffocation. Udranszky
has obtained a solution from the medulla oblongata, which, injected
under the meninges of rabbits, killed the animals with symptoms. of
street rabies. Babes observed only the development of marasmus after
injecting large quantities of brain emulsion of rabid animals, which
had lost its infectiousness while, according to Galtier, this substance
heated to 100 to 105° C. produced serious toxemia in sheep, goats, and
dogs (somnolence, weakness, paralysis). According to Aujeszky, the
disease in rabbits injected intracranially lasts only a few hours, while
in the experience of Remlinger rabbits injected with virus-free brain
filtrate, succumb sometimes in a short time with paralytical symptoms.
(From such animals the disease cannot be transmitted.)

Very rarely does the virus pass from the female to the offspring;
leaving a few positive experiments out of consideration (Kolesnikow,
Perroncito & Carita, Loir, Dammann & Hasenkamp). the medulla
oblongata of the offspring did not appear virulent (Pasteur, Celli,
Zagari, Galtier, Ratz; Konradi found it virulent but the virus therein
was weakened).

Anatomical Changes. The post mortem examination of an
animal infected with rabies does not show any characteristic
changes. Besides the hanging lower jaw, in carnivorous animals
and especially in dogs, the stomach is contracted and empty,
472 Rabies.

or instead of normal food products, it éontains indigestible
substances such as straw, hay, pieces of wood or bones, sand,
stones, hair, feathers, pieces of leather, etc., the mucous mem-
brane being injected and swollen, and the summits of the
rugae studded with hemorrhages (Johne) and shallow erosions.
Foreign bodies are occasionally found in the esophagus (Franke)
or in the intestinal canal in which case the mucous membrane
of the latter is likewise inflamed. In other species of animals,
the stomach is as a rule empty or contains little food. The
bladder is nearly empty, the urine as a rule containing sugar,
and the blood being varnish-colored and fluid.

Wortley Axe found foreign bodies in 90% of 200 rabid dogs on which he
performed post-mortem examinations during twenty years, while Galtier in the
course of thirteen years found foreign bodies in only 657 cases out of 1,434 rabid
animals autopsied (1,304 of which were dogs).

The post-mortem examination may also show an acute
catarrh of the mucous membranes of the respiratory and diges-
tive organs, hyperemia of the salivary glands and serous in-
filtration of their connective tissues, hyperemia of liver, spleen,
and kidneys and finally inflammation or edema of the cerebral
and spinal meninges as well of as the gray matter of the brain.

The changes in the central nervous system were the subject of investigation
some time ago by Cantani, Zagari, Babes, Csokor, Dexler, and others, and recently
Schaffer studied the subject thoroughly in connection with six cases of hydrophobia
in man. In the segment of the spinal cord where the nerves coming from the
place of infection enter, in the perivascular lymph spaces, as well as in the walls
of the vessels of the gray matter of the anterior cornu, in the vicinity of the
central canal, and also along the connective tissue trabeculae of the white substance,
Schaffer found cell infiltration, with either capillary or larger hemorrhages. These
changes became léss and less marked anteriorly and posteriorly; in the nerves
passing from the point of infection toward the cord there was also an infiltration
of small cells. In the nerve cells he found fibrillation, hyaline and vacuolar degenera-
tion, granular disintegration, and pigmentation atrophy of the cellular bodies; the
white substance contained numerous amyloid granules. In the medulla oblongata,
immediately below the floor of the fourth ventricle, and especially around the
origin of the 12th, 10th, and 7th pairs of nerves, there were noted pronounced
hyperemia, perivascular cell infiltration, and small hemorrhages, while the nerve
cells showed signs of degeneration. In the brain no changes of importance were
found, as a rule, excepting hyperemia, slight cellular infiltration, and rarely capil-
lary hemorrhages. :

Csokor and Dexler ascribe great diagnostic importance to the small scattered
foci of inflammation in the brain, and to the small cellular leucocytic infiltration
of the perivascular lymph spaces as constant lesions of rabies. Trolldenier, how-
ever, concluded after the examination of 52 cases, that these lesions are absent
in the brain and still more in the medulla oblongata (in the latter in 60% of
the cases), and that, on the other hand, they may be found in the nervous system
of dogs suffering from distemper and cancer.

Van Gehuchten and Nélis found in the cerebro-spinal ganglia and those of
the sympathetic nerve, but especially in the plexus nodosus vagi as well as in
the upper cervical ganglia of the sympathicus, a cellular infiltration of the interstices,
which later causes the censitive nerve cells themselves to degenerate and atrophy, and
in their place, inside of the inspisated endothelial capsule, there appear endothelial
and small round cells (Fig. 74). In many cases the ganglion consists exclusively
of dense connective tissue infiltrated with small cells, only once in a while atrophied
nerve cells being observed. These changes are most marked in the ganglia of rabid
dogs, and less so in those of rabbits and of human beings.

In the salivary glands Elsenberg and Kossjékow have demonstrated cellular
infiltration of the interacinous connective tissue, and partly also of the acini, as
well as granular fatty degeneration of the glandular cells,
Anatomical Changes, Symptoms. 473

According to Kolesnikoff and Babes, there exists in the immediate neighbor-
hood of the motor center of the medulla oblongata and the motor cells of the
spinal cord, an accumulation of small round cells, which also invade the plasma of
the nerve cells and cause degeneration and atrophy. Babes considers these foci
as characteristic of rabies (rabie tubercles) as they were present in 389 cases of
rabies and absent in 35 other cases, but, according to Bohl, such changes are
sometimes also found in cases of distemper.

Symptoms. The
‘period of incuba-
tion of rabies after
a natural infection
is generally sev-
eral weeks, but
may extend to
some months. Its
duration is in-
fluenced by the vir-
ulence of the virus,
the distance of the
place of infection
from the central
nervous system,
and the age of the
animal. Generally
the first symptoms
appear 2 to 8 weeks

ation one Pats Fig. 74. Rabi Cervical li fad ffect 4
‘ 7 rig. 74. Rabies. Cervical ganglion of a dog affecte

sometimes, how with rabies. The nerve cells are partly atrophied, and in

ever, they occur aS their place clumps of round cells appear. (After Van

early as the end of Gehuchten & Nélis).

the second week or

again only after several months and as late as 1 to 2 years.
In dogs and swine the period of incubation is generally
brief (frequently only 10 to 15 days) ; in horses and cattle it is
longer (mostly 1 to 3 months). The disease develops earlier
in young animals than in old ones.

 

Concerning the duration of the period of incubation, Bouley, Haubner, and
Ziindel have gathered numerous statistical data. According to a compilation by
Réll, the periods’ of incubation were as follows: Dogs: according to Bouley (144
cases) in 43% less than 30 days, in 40% between 30 and 60, in 14% between 60 and
90 days, and in 3% between 4 and 12 months. According to Haubner (out of 200
dogs) in 83% less than 2 months, in 16% 9 to 12 weeks, in 1% 13 to 16 weeks,
and in only a few 7, 8, and 24 months. Horses: According to Bouley (out of 23
horses) in 1 more than 1 month, in 11 from 24% to 3 months, in 3 more than 100
days; according to Ziindel (out of 121 cases) in 28% less than 1, in 46% less
than 2, in 9% less than 3 months, and in the rest more than 3 months. Cattle:
According to Ziindel (out of 579 animals), in 5% less than 15 days, in 23% 15
to 30, in 39% 30 to 45, in 13% 45 to 60 days, in 17% 3 to 6 months, and in
1 case each 42 and 95 weeks; according to Hauber (out of 234 cases), in 82%
less than 3 months, and in 18% 4 to 9 months. Sheep and Goats: According
to Ztindel (out of 188 sheep), in 6% less than 15 days, in 41% 15 to 21, in 10%
21 to 30, in 26% 30 to 45, in 2% 45 to 60 days, and in 7% still longer. Out of
20 goats, in 15%! less than 20, in 60% 20 to 60 days, and in 25% longer.
Swine: According to Ziindel (out of 123 hogs), in 3% less than 8 (?), in 8%
8 to 15, in 51% 15 to 30, in 27% 30 to 60 days, and in 11% still longer. According
to the observations of the official Prussian veterinarian, the average period of
474 Rabies.

incubation is: in horses 4614, in cattle 70, in dogs 22, in swine 26, in goats 14,
and in sheep 26% days. ‘Finally, Schiider found out of 395 carefully observed
cases of rabies 21 (5.3%) where the period of incubation was 3 to 7 months. -.

Unusually long periods of incubation have been observed: in horses, by
Saikowitsch 17 months, by Virag 18, Cosswinter 20, Bahr 21, Swain 25 months;
in cattle, by Szab6 323 days (bite in the snout), Mieckeley 327 days, Leipert 19
mouths and 21 days, and by Kalt 23 months. The reports relating to periods of
more than 2 years, however, must be accepted with reservation, as a new infection
may have occurred in the meantime.

After artificial infection, dogs develop the disease 13 to 19 days after sub-
cutaneous injection, 10 to 15 days after subdural injection; rabbits show symptoms
12 to 21 days after subdural injection, but in exceptional cases later, occasionally
only after 43 days. After a series of inoculations, the period of incubation following
the subdural injection may be shortened to 5 days (see protective vaccination).

The clinical picture of rabies is on the whole the same
in the various species of animals, and the only variations
observed are owing to the fact that the symptoms are more
or less subject to modifications in accordance with the individual
temperament and the physical structure of the animal.

Rabies in Dogs. At the initial stage of the disease (stadium
prodromorum or melancholicum), the animals show a peculiar
change in behavior, which, particularly in house dogs and with
the so-called ‘‘dumb rabies,’’ is so inconspicuous that it is
completely overlooked, and the owners associate with them as
usual without suspecting anything. Most dogs become capri-
cious; they are at times irritable and gloomy, and avoid all
noise, hiding in dark places under or behind furniture, in a
dark corner of the room, or in the stable. They obey the call
of their master very unwillingly, but then jump about and fawn
on him even more markedly than usual. In other cases they
show a remarkable uneasiness, scratch with the fore feet, fre-
quently change their place of rest, walking uneasily around in
the yard or in the room, suddenly stopping, becoming attentive,
and without any cause barking and biting at the air (so called
‘fly-catching’’). If resting on the ground, they frequently
become startled and attempt to catch imaginary flies, growling
at the same time.

The reflex excitability is in this stage already decidedly
increased. This is shown by the fact that the animals when
approached in,a friendly way, and still more when teased,
become excited and snap at the caressing hand and any other
objects or their companions. This excitability is particularly
conspicuous toward strange persons and dogs, even when they
are still friendly and familiar with their habitual attendants.
The reflex excitability is still more noticeable in that the pa-
tients become startled or jump up frightened even on slight
external causes, such as a strong light, sudden noises, touching
of the body, ete. During such paroxysms there are also ob-
served sudden but very transitory respiratory disturbances,
spasm of the diaphragm and dilatation of the pupils. Many
dogs scratch and gnaw or bite at the place of infection or the
cicatrix formed there.
Rabies in Dogs. 475

At the same time, a particular change of appetite or taste
is observed, as the animals scarcely touch their favorite food
or let it drop again after having it in the mouth. Later they
reject all food, although they will chew all objects within their
reach, also their own excrements, and swallow them, if possible.
It may then be noticed that the patients swallow with greater
difficulty stretching the neck forward in swallowing, allowing
the food to fall out of the mouth, and showing a desire to vomit
or actually do vomit. At the same time, the patients repeatedly
seek water, but in spite of all exertions they can swallow small
amounts of it only with difficulty.

Sometimes there is also trouble with the voiding of ex-
crement and urine, the animals frequently attempting it but
with little or no results. Besides, they continually lick their
own genitals or those of other dogs and otherwise show an
increased sexual desire.

By this time salivation exists, which symptom subsequently
becomes more and more marked.

In the second stage (stadium excitationis or aemes) which
develops in % to 3 days, the described symptoms attain a higher
degree and the unrest and excitement, probably under the in-
fluence of hallucinations, increase to a violent rage. It is now
particularly observed that the dogs frequently lick the earth
furiously, chew any objects they find, tear them to pieces, and
swallow them eagerly. They want to get away from their usual
quarters; if shut up in a room, they show this desire by stand-
ing near and scratching at the door; if tied, they try to break
their chains; if in a cage, they try to bite the walls and bars.
Once escaped, they will run aimlessly around, and sometimes
cover long distances without resting. They scarcely ever re-
turn to their homes, but if they do happen to come back, they
are usually exhausted, covered with wounds of bites, and with
hair disheveled. For a while they crawl about dejectedly fearing
punishment and fawning upon their master, or exhausted hide
away and rest. If the rabid animals on their journey encounter
other dogs, they will attack them without cause or noise, and, if
possible, bite them in the head (healthy dogs running around in
strange places are mostly scared and run away from other dogs).
If the attacked dog runs away in fright, the diseased animal will
continue its journey, but if it resists,the rabid dog will fight furi-
ously, and it will be observed that, while the attacked dog howls,
snarls, and barks, the diseased animal will hardly emit a sound.
The desire to bite and the aggressive behavior, are shown toward
other species, particularly small animals though less conspicu-
ously, and in a herd of sheep or swine a rabid dog may in a brief
time wound many animals. Human beings are less in danger,
as rabid-dogs mostly avoid them and as a rule only attack them
when irritated or excited by threats.

In dogs shut up in cages rabies generally appears in
476 Rabies. |

paroxysms. The dog, his eyes bloodshot, jumps sidewise
against the bars and grabs them between his teeth with such
violence that one or more teeth are broken; or he. takes. the
straw on the floor, the excrement or any other object, and
shakes it furiously around, always without barking or growling.
If approached with a stick or a bar and teased, the dog will make
a mad attack, hold the stick or bar between its teeth, and shake
it. The nature of the object held out is absolutely immaterial,
as the dog will bite red hot iron or burning coal without hesita-
tion. Some animals even bite their own bodies and tear the flesh
to the bone.

Such attacks of rage are interrupted by shorter or longer
periods of depression. After an animal has been wandering
aimlessly around for a time or, if shut up, has been raging,
it finally falls down exhausted and remains unconscious on
the floor breathing with difficulty. Soon it will rise, remain
standing at one place with staring eyes, dilated pupils, and
a peculiarly changed expression of the face indicating cunning
and fright (Fig. 75 and 76), until, owing to some outside in- -
fluence, such as the sight of other animals or some object, but
sometimes without any visible cause, the attack breaks out

anew. In this stage, as a

rule, symptoms of par-
alysis of some of the
nerves appear. Most
conspicuous is the pe-
culiar change in voice ~
owing to a paralysis
of the laryngeal
nerves or muscles,
which causes the bark
to become hoarse and
double and accompa-
nied by loud, long
drawn howls. This
hoarse barking, which
1s so. characteristic
that the trained ear
may suspect a case of

 

Fig. 75. Rabies. Characteristic peculiar watchful f :
and disturbed expression of the face, with an out- rabies from it alone,

ward position of the eyes; at the same time is emitted frequently

paralysis of the masticatory muscles.

by many dogs, by oth-
ers only when they
are excited. Swallowing becomes very difficult owing to the
progressive inflammation, and later to the degeneration of the
11th and 12th pair of nerves. The regular food is wholly
rejected, and the animal is at the best able to swallow only
small amounts of water with difficulty. These exertions, some-
times even taking an object in the mouth, may produce violent
Rabies in Dogs. 477

attacks of suffocation and even a rabies paroxysm by reflex
action from the mucous membrane of the mouth and throat:
Therefore, animals thus affected do not touch food or water
at all. In rare cases, the mere offer of water is sufficient to
cause an attack (hence the term hydrophobia), which is only
the result of the difficulty in swallowing, and, on the whole, is
only observed in a portion of the cases.

At this stage, salivation increases, partly because of the
more abundant secretion of saliva, and partly ‘owing to the
existing difficulties in swallowing. Difficulty in defecation and
urination is also frequently observed. |

 

Fig. 76. Rabies. The same dog as in Fig. 75.

As an extraordinary symptom, Nicolas observed spasmodic move-
ments at this stage (pushing forward and moving in circles) in 3 dogs,
and also in a goat that had been infected intraocularly.

_ The stage of irritation generally lasts 3 to 4 days and
is then followed by the paralytic stage (stadium paralyseos or
depressionis). The attacks of rage become less violent and
also less frequent, but in the meantime symptoms of insensi-
bility and dullness may appear. As a result the symptoms
of an already existing paralysis become more conspicuous, and
other parts of the body may also become paralyzed.

- As the changes in the medulla and cranial nerves already
478 Rabies.

mentioned also affect the other nerves, there develops besides
total aphony and inability to swallow, a partial and shortly
a total paralysis of the muscles of the lower jaw, tongue, and
eyes. The mouth is kept open most, if. not all the time, the
dry and livid tongue hangs out of the mouth paralyzed, and
the saliva flows in long threads from the lips. Owing to the
irregular position of the eyes the animals squint, the cornea
is dull and lusterless and the pupils are dilated. These symp-
toms give the face a peculiar cunning and troubled expression
(Fig. 75 and 76).

Owing to the process of degeneration in the spinal cord,
paralysis of the muscles of the tail and the extremities appears.
The hind limbs are generally first attacked, which causes the
animal to stagger and tumble, at first when running and later
when walking, and to drag the hind legs along the ground. The
paralysis then progresses to the tail, which hangs down between
the legs. The paralysis of the hind limbs finally reaches a
stage which makes it impossible for the animals to move and
they remain recumbent on the ground; if urged to rise they
will make only a few fruitless attempts with the fore legs.

Before the disease has reached this stage, the animals
are already quite emaciated; the exhaustion now increases
rapidly, and the patients succumb within a brief time, usually
in convulsions.

Owing to the danger connected with intimate association
with the animals little is known of those symptoms which can
only be determined by a close examination. As to the tem-
perature, Hertwig and Monin have found that it rises 1 to 3
degrees during the maniacal stage, but that during the paralytic
stage it falls down to several degrees below normal. The pulse
is rapid and tense from the beginning (Blaine). In the blood
“the polynuclear leucocytes are multiplied, and the hyperleuco-
cytosis increases toward the end of the disease (Courmont and
Lesieur). The urine usually contains sugar (Nocard; Rabieaux
& oo found sugar in the urine in 33 out of 44 examined
cases).

In artificially infected dogs the temperature is increased during the initial
stage for 4% to 3 days, but afterwards it is low; in rabbits infected with street
rabies on the contrary the temperature commences to fall at the onset of the disease
and continues thus until the death of the animal (Lite). In human beings, the
symptoms of the stage of irritation are accompanied by a moderate rise in tem-
perature, with morning and evening remissions, but before death the temperature
becomes very high and may continue to be high for some time after death
Moravesik, Schaffer).

The described clinical picture of rabies in dogs is in some
cases subject to considerable modification. Above all, varia-
tions occur in the duration of the various stages and in their
mutual relations, the several stages being briefer than here
stated, or longer at the expense of the others. This is especially
true of the second stage, that of irritation, which is often very
Rabies in Cats and in Horses. 479

short and indicated by few conspicuous symptoms of excite-
ment; then not infrequently the melancholic stage is followed
almost without-interruption by the paralytic symptoms, particu-
larly paralysis of the muscles of the jaw and throat, to which
is then added the paralysis of the hind parts of the body. This
form of the disease, during the course of which most patients
are weak from the beginning and neither bark nor bite, and
which is generally fatal in 3 to 4 days, is usually called dumb
rabies in contrast to the typical violent rabies. :

: . -The cause of the differences in the course of the disease is not
exactly known, but it seems in some way to be connected with the
species and earlier life of the animals. Experience teaches that symp-
toms of violent excitement are particularly observed in biting dogs
of a lively temperament living in the open, while gentle house dogs,
in which aggressiveness and the desire to bite appear more rarely and
less conspictiously, are attacked more frequently by dumb rabies (accord-
ing to Hjortland, in Greenland the disease nearly always assumes the
form of dumb rabies). :

Rabies in cats shows the same symptoms as in dogs, but,
these animals being of a less confiding nature, generally seek
dark corners in the beginning of the disease and do not leave
them any more or they show by continuous mewing a more
aggressive behavior and a desire to escape. Then they attack
both persons and animals, including dogs, which come in their
way, jumping at their faces or biting their legs from behind,
inflicting severe wounds with their teeth and claws. Ainslie
observed in one case that the cat jumped at objects held before
it, did not lap water, but was attacked with violent spasms
when sprinkled with water: Later the voice becomes hoarse
with a peculiar howling tone owing to paralysis of the vocal
cords, and 2 to 4 days after the appearance of the first symp-
toms, paralysis of the hind parts appears.

In artificially infected cats, Dammann and Hasenkamp first ob-
served great unrest, fright and a desire to take hold of strange objects;
later the movements became staggering, and finally total paralysis of
the hind extremities appeared (but not of the masseter muscles or
the constrictor muscles of the anus or bladder). In the beginning very
little water and no food was consumed; the animals bit furiously at
a stick held before them mewing and spitting at the same time, and
when sprinkled with water they fell into violent convulsions.

Tn horses, the increased sensitiveness of the scar formed at
the point of infection (mostly the lips, nostrils or front extrem-
ities) often gives the first indication of the beginning disease.
The animals gnaw at the site of the bite on the body or rub it
against objects, which behavior in otherwise quiet horses, par-
ticularly if they have been bitten several weeks previously by a
dog, arouses a reasonable suspicion of an approaching attack of
rabies. The increased reflex excitability is also indicated early
480 Rabies

by fright and unrest, which appear on the slightest provocation.
They change their position every moment, paw with their
feet, gnaw at the manger and other objects near them, and
show staring, restless eyes with dilated pupils; at times, they
draw the lips convulsively up and backward so that the teeth
are visible, while foamy saliva runs from the corners of the
mouth.

With increasing restlessness some horses also show an ag-
gressive behavior toward other horses or human beings, and
still more toward dogs, which they attempt to bite and kick.
They will furiously attack a stick held before them, and some-
times in biting the manger will show strength enough to break
several teeth and even the neck of the inferior maxillary bone.
Many patients do not spare their own bodies, but tear off large
-pieces of the skin; as a rule, however, such rage is not; observed..
More frequently attacks of spasms lasting 1 to 2 minutes are
observed in the masseter and respiratory muscles. Further
the appearance of increased sexual desire causes male animals
to have erections and to eject semen involuntarily, while mares
behave as when in heat; in connection herewith is also observed
a frequent desire to urinate. (Gohre once found a temperature
of 39.3° C.)

Soon the symptoms of paralysis become marked, first in the
region of the nerves originating from the medulla oblongata. On
this account swallowing is difficult and liquids are returned from
the mouth through the nostrils. Owing to the change of taste,
the animals eat nothing or at best only indigestible substances,
sometimes even their own excrements. They will smell of the
water offered them, but will not drink it, and with raised head
draw the lips upward as if attempting to yawn. When neigh-
ing, a hoarseness of the voice is observed.

Later the symptoms of excitement become less frequent and
less severe, while indications of severe paralysis develop, as a
result of which the patients fall to the ground and finally suc-
cumb on the 3rd or 4th day of the disease, in most cases with
violent convulsions.

Darmagnac observed ascending paresis in one case 4 months after
a bite in one of the hind legs. First there was paresis of the same
extremity, then paraparesis with hyperesthesia of the hind quarters,
and finally, paralysis of the muscles of deglutition; the animal died
after 3 days of sickness.

Cattle also show unrest and excitement as well as an aggres-
sive tendency, which behavior, so uncommon except in cattle
raised in the open, at once attracts the attention of the attendant.
In such cases the animals remain standing at one place, at times
drawing the upper lip backward, tearing up the earth with feet.
and horns, looking around with the head high, the eyes wild or
staring, and finally furiously attacking the other animals of the
Rabies in Cattle. 481

herd and even human beings, but particularly dogs which hap-
pen to be near. Animals tied in the stable attempt to get loose
from the chains, jump up suddenly from their resting place,
shake the head, rise on the hind legs, bite at and climb into the
manger and run the head against the wall sometimes with
enough force to break the horns. Such outbreaks of rage are
interrupted by nearly normal pauses and are then repeated at
first every 20 to 30 minutes, but later at increasingly longer
intervals.

The other symptoms are similar to those in other animals:
the increased reflex excitability, licking or biting the place
of the bite or its scar, hoarseness, sometimes rapid bellowing
which the animals may emit for hours without interruption, sali-
vation and foaming, gritting of the teeth, difficulty in swallow-
ing, loss of appetite, bloating (owing to the paralysis of the
intestinal muscles ?), cessation of rumination, constipation with
following diarrhea and tenesmus, drying up of the milk, convul-
sions in some groups of muscles (through spasmodic convulsions
of the muscles of the neck the head is sometimes turned to one
side), increased sexual desire, tenderness of the urethra on
pressure through the rectum (Bézaguet), sugar in the urine
(Nocard, Nicolas, and Rabieaux), rapid emaciation, exhaustion,
and extended paralysis, until finally the animal succumbs on the
3rd to 6th day of its illness. Similar symptoms have also been
observed in buffaloes (Esser).

In other cases the symptoms of irritation are-only slightly
marked or entirely absent, but there appear instead early weak-
ness of the hind extremities and marked downward curving of
the spine, accompanied by moderate bloating, difficulty in swal-
lowing, and constipation. In walking or in raising the head the
animals fall down readily, and then kick with their feet, they
breathe laboriously and discharge foamy saliva from the mouth;
standing up they emit a painful bellowing, move stiffly, smell at
the hay and drinking water but consume nothing or let the
water run out again through the mouth or the nose, while they
make constant movements of mastication. The next day they
lie groaning on their chest or with the head resting on the
shoulder, while spasmodic convulsions appear in the diaphragm
and in other groups of muscles, and death follows mostly at the
end of the first week with symptoms of bulbar paralysis and
rapid lowering of the temperature.

Ness] observed 9 cases of rabies in cattle which were conspicuous
by the fact that the initial symptom was vomiting while the typical
paralytic symptoms were absent. Heks saw in cows a tendency to
press against objects and to move around in a circle.

Intermittent rabies was observed by Galtier in two dogs and by
Ligniéres in one. Following the first attack there was a remarkable im-
provement, but after 36, 27 and 28 days respectively, a considerable
change for the worse occurred with fatal results.

Vol. 1—31
482 Rabies.

In sheep and goats rabies appears with quite similar symp-
toms, except that the stage of irritation is often absent or of
very brief duration. If such a stage develops, the unrest (stamp-
ing with one front foot, running to and fro, climbing the wall
of the stable or the fence, etc.) and aggressive behavior toward
their herd mates or toward dogs are the more remarkable in
sheep as these animals otherwise are shy and easily scared. In
goats the symptoms of irritation are always more violent; they
become very uneasy and pugnacious, run against the walls, other
objects, animals, and persons. Female animals butt and bite
their own kids, while in bucks a remarkably increased sexual
desire is observed. In goats sugar has been found in the urine
(Porcher).

The disease usually lasts from 3 to 5 days and ends with
symptoms of paralysis.

In swine the affection begins nearly always with very de-
cided symptoms of irritation. The animals run around in all
directions, grunt hoarsely, root the litter and the earth, gnaw
and rub the site of the bite, then hide under litter and remain
quiet for a while or continue to grunt while lying down. If they
are aroused by a noise or when touched, they jump up and run
aimlessly around, attacking other swine, their own young, other
animals, and even human beings. While rooting, they swallow
various substances and saliva runs in abundance from the
mouth. They seek water, but can only drink with difficulty.
Young pigs sometimes fall down while running around, kneel
on their front legs, lay the neck on the ground, and, in this posi-
tion, push their bodies in a straight line 25 or 30 feet forward or
move around in circles in this same position (Papp).

The other symptoms are, on the whole, similar to those in
dogs. After the appearance of paralysis, the animal succumbs
on the 2nd to 4th day of the disease, but sometimes on the first
day.

According to observations of veterinarians (Ziirn, Gibier)
the disease begins in fowl also with conspicuous fright and
unrest, when the animals run around with ruffled feathers,
frightened look, and hoarse cries, and attack the healthy birds,
other animals, and also human beings with their beaks and
claws, until they finally succumb after 2 to 3 days with symp-
toms of paralysis.

After intracranial injection, Galtier, Pasteur and Lote observed
only dullness and paresis of the feet and neck, when the animals would
awkwardly pick up grains of corn and with staggering gait. would.now
and then tumble down. In the course of the disease improvement.
was often observed and the infected birds not infrequently recovered.

Course and Prognosis. The disease generally has a course
of 4 to 7 days; in some cases it last only 3 days, but in excep-
tional cases may last 11 to 13 days (Nicolas).

The duration of the various stages and their mutual. rela-
tion, leaving out of consideration the fact that they cannot be
Course and Prognosis. 483

defined exactly, appear unlike in different cases. Increased
excitability is also present in the first stage, and most of the
symptoms differ only in intensity from those of the second
stage. In the latter stage the desire to bite and the aggressive
conduct, when these symptoms are present, are the most charac-
teristic. Just as indistinct is the transition from the second
to the third stage since, on the one hand, partial paralysis
may be apparent in the stage of irritation and, on the other
hand, symptoms of irritation, and particularly cases of suffoca-
tion are not uncommonly observed in the stage of paralysis. The
more rapid the course of the disease, the more rapidly the
symptoms change and intermingle, wherefore it is nearly impos-
sible to make an exact distinction between the various stages in
the course of the affection. In cases of dumb rabies striking
symptoms of irritation are absent.

The disease is, with very few exceptions, fatal. The pos-
sibility of recovery has been proved in cases where artificially
infected dogs have recovered from the typical disease (Pasteur,
Roux, Hogyes, Remlinger, and others). Consequently we must
not conclude that the bite is not infectious from the fact that the
biting dog has remained alive, but this opinion should only be
reached if, during the two weeks following the bite, no sus-
picious symptoms are observed in the animal. — .

_ Pasteur observed recovery from rabies in dogs; later Hégyes
noticed that out of 159 dogs, which had contracted rabies in different
ways, 13 or 8.1% recovered. Of these 6 were not treated at all, while
the remaining 7 were given the antirabies vaccination treatment. Rem-
linger found the saliva of a cured dog virulent 20 days after the
beginning of the disease and 5 days after recovery. ;

Cases where dogs were still alive while persons bitten by them had
already died from rabies, have been reported by Talko and Johne.

Diagnosis. The establishment of the diagnosis is not con-
nected with any particular difficulties in cases where the various
stages are distinctly separated and there has been an opportun-
ity to observe the whole course of the disease or at least the
greater part of it. An exact diagnosis being extremely impor-
tant and necessary, particularly in cases where human beings or
other animals have been bitten by suspected animals, it is advis-
able not to kill the suspected animals, but to keep them under
strict observation and await their natural death. The symptoms
of irritation, the aggressive conduct and subsequent paralysis,
particularly the appearance of bulbar paralysis form a very
characteristic picture of the disease, and the diagnosis is made
easier by the existing suspicion of infection. Statements to the
effect that no bite has been received must be taken with reserva-
tion, as light wounds are inflicted not infrequently without the
knowledge of the owner. In making the diagnosis the former
behavior and temperament of the animal must be taken into

consideration.
484 Rabies.

If no reliable history of the case is available or if it has only
been possible to have the animal under observation for a short
time, the diagnosis may present considerable difficulty. From a
practical point of view every animal in which a sudden change
of conduct is observed should be considered as suspicious and
only declared unaffected when for 3 to 4 days no symptoms
appear to confirm the suspicion.

Differential Diagnosis. Diseases more or less similar to
rabies are observed, especially in dogs, and they may cause con-
fusion, particularly if symptoms of nervous excitement are pres-
ent. Thus, a violent irritability, sometimes connected with
aggressive conduct and a desire to bite, may appear as a result
of acute inflammatory processes of the meninges and the cere-
bral substance. Here belongs the acute cerebral hyperemia as
well as acute meningitis and encephalitis without regard to
whether these diseases occur from unknown causes or outside
influences, or are caused by animal parasites or tumors existing
in the brain. In such instances the further course of the disease
will decide, as cases of paralysis in other diseases are not devel-
oped in the same sequence and uniformity asin rabies. Eclamp-
sia and epilepsy are characterized by clonic spasms all over the
body while in epilepsy there is also the clear conciousness be-
tween the attacks. Nervous distemper is characterized by the
simultaneous symptoms in the eyes and respiratory organs, as
well as by distemper exanthema.

Repeated or continuous pains in some parts of the body
may irritate the animal to a degree which will cause attacks of
frenzy or delirium that are sometimes confounded with rabies.
To these belong the acute inflammation of the intestines caused
by intestinal worms, particularly tenia echinococeus, foreign
bodies, poisoning, perforation of the intestines, as well as many
cases of colic with violent symptoms in horses; further, dog
diseases caused by pentastomum tenioides, eustrongylus gigas,
and spiroptera sanguinolenta, and finally dermanyssus mites
in the external auditory canal of cattle, scabies mites in the ears
of dogs, as well as muscular rheumatism. In the course of these
diseases no paralysis appears, but the clinical aspects of the
disease may, owing to the exhaustion and comatose condition
on approaching death, be very similar to rabies sometimes to a
degree that makes an autopsy necessary to determine the real
nature of the disease.

After lodgement of foreign bodies in the pharynx or
between the teeth of dogs and cats, rabies may be suspected,
because the animals show restlessness, and, owing to difficulty
in swallowing and to stomatitis, saliva is abundant and the voice
is hoarse from the perilaryngeal edema. On account of difficulty
in moving the lower jaw the mouth is kept continuously open,
which condition is very similar to the paralysis of the masseter
muscles. In such cases, as well as in the apparent paralysis
Differential Diagnosis. 485

resulting from dislocation of the inferior maxilla, the mouth
is continuously open, while in rabies the jaw moves slightly up
and down but only in limited degree. Finally a trigeminal or
facial paralysis sometimes develops independently or in the
course of distemper; however, in such cases the total absence
of other symptoms of paralysis, especially in the hind limbs, is
against rabies.

In eats, dogs, and cattle, perhaps also in other animals,
rabies is easily confounded with paralysis bulbaris infectiosa,
which disease is to be considered especially when the animals
rub and gnaw at the place of the bite (see p. 496).

Finally, owing to confinement of hitherto free animals, to
the lack of opportunity for copulation, nymphomania and saty-
rlasis, removal of the young from their dams, as well as in
many acute infectious diseases, attacks of frenzy may occur, but
they may be readily distinguished from rabies by proper obser-
vation of the accompanying conditions, particularly the absence
of paralytic symptoms.

As to the post-mortem diagnosis, the absence of normal food
and the presence of foreign bodies in the stomach form the
only finding that is in any way characteristic, but even
this does not afford any real proof, because, in exceptional
eases, foreign bodies are also found in the stomachs of dogs
not suffering from rabies, especially in young dogs and in those
with digestive troubles (in the latter the bodies are usually
found with normal food). On the other hand, the presence
of food substances in the stomach does not by any means exclude
the possibility of rabies. The presence of sugar in the urine
strongly supports the diagnosis of rabies, but even this does
not constitute a full proof, because sugar is also found in the
urine in other diseases. The difficulty of diagnosis is enhanced
by the fact that many rabid animals are killed before the com-
plete development of the symptoms, so that even partially char-
acteristic changes have no time to develop.

The existence of rabies is established definitely by animal
experiments and also by microscopical examination of the brain,
at least if the results are positive.

Complement fixation with nerve substance as antigen, has not yet succeeded in
showing the presence of the complement fixing amboceptors in the serum of immunized
or rabid animals (Centanni, Heller, & Tomarkin, Friedberger).

Microscopical Diagnosis. In this connection the detection of Negri
bodies has a ‘very high diagnostic value, while the examination of the
nerve ganglia gives less certain results.

1. Detection of Negri Bodies. The numerous experiments follow-
ing the discovery of these formations (see p. 465) ‘have shown uni-
formly that they are only present in animals or human beings suffering
from rabies, and that, through their detection, the diagnosis of rabies
may be definitely established. On the other hand, they may not be
present in the initial stage of the disease, and rabid animals are often
killed shortly after the affection develops ; therefore the negative result
486 Rabies.

of the microscopical examination does not exclude a diagnosis of rabies.
In the case of animals which have died from rabies or have been killed
at an advanced stage of the disease, the microscopical examination of
the brain (cornu ammonis, medulla oblongata, cerebellum) with positive
results right after the autopsy, makes an exact diagnosis possible, and
in such cases one may also conclude from a negative result that rabies
has not been present. In the latter case, if human beings have been
bitten by the animal, the final diagnosis should be made subject to the
results of inoculations into animals.

Negri examined microscopically 75 brains of animals suspected of rabies;
in 50 cases the results were positive, and the diagnosis was always confirmed by
the biological method, while in 5 out of 72 cases with negative results the
inoculation experiments resulted positively. According to Luzzani, up to the year
1905, 457 brains of animals had been examined by Italian students for Negri
bodies; out of these 297 were proved positive through inoculation, and in only 9 of
this number were there no Negri bodies found, while Krajuschkin in 4 out of 34,
Nicolas in 7 out of 61, Nélis in 2 out of 61, and Bohne in 10 out of 109 cases
of established rabies did not succeed in detecting Negri bodies (according to Ball,
the number of such non-confirmed findings amounts to about 3.5%). At the Berlin
institute for infectious diseases, Lentz on applying the method of Mann found
Negri bodies 370 times or in 86.4%, and, on applying his own method, in 52 out
of 55 or in 94.5%. Ratz, at Budapest, saw the histological findings confirmed by
animal experiments in 258 cases. Hart, at Vienna, found both methods to agree
in 498 cases while in 22 cases the histological examination gave negative, the
inoculation of animals positive results.

All students agree that Negri bodies appear exclusively in cases of rabies,
and in none of the many eases examined were Negri bodies found without the.
inoculation experiments confirming the presence of rabies.

Technique. For the examination the cornu ammonis is most suitable and
secondly the cerebellum; but in cats the cerebellum is more satisfactorily examined,
because, according to Luzzani, in the cornu ammonis of normal cats formations
sometimes appear which in stained preparations are very like Negri bodies in
their initial stage. Besides, Standfuss calls attention to the fact that, particularly
with nervous distemper in dogs, ganglion cells about to degenerate may contain
red colored granules; further, that the karyosome, which may be double has a
similar structure and also may be found outside of the nucleus. ‘‘Distemper-
corpuscles’? have also been observed by Lentz, partly in the tissues, partly in
highly decomposed ganglion cells; according to his opinion, they originate from
the conglomeration of the chromatin substance, and are different from Negri
bodies in that they contain no inner granules.

[At the present time the most suitable method of quickly, demonstrating Negri
bodies is by Frothingham’s impression preparations, stained according to Van
Gieson. A transverse section is cut from the Ammon’s horn and placed upon a
block of wood near the edge, thus permitting a slide to be pressed evenly upon it.
By lifting the slide with a quick motion, an impression of the cut surface of
the organ remains on the glass, and, as the histological structure is preserved, an
excellent substitute for a microscopic section is obtained. At least four such
impressions should be made on one slide, increasing the pressure for each preparation
until the tissue becomes quite flat. Before the preparations have dried in the
air; fix in methyl alcohol for one half minute, or longer; drain off the alcohol and
immediately cover the slide with Van Gieson’s stain heating gently for one-half
to one minute; then wash in water, dry with filter paper and examine without a
cover glass. The Negri bodies stain a pinkish to purplish red, their inner structure
blue. The nerve cells are blue and the red blood corpuscles colorless or yellowish.
Van Gieson’s stain consists of 10 ce. distilled water, two drops of a saturated
alcoholic solution of rose aniline violet, and one drop of saturated aqueous solution
of methylene blue; as modified by Frothingham: 20 ce. of tap water, three drops
saturated alcoholic solution of basic fuchsin, and one drop saturated aqueous solution
of methylene blue. This stain remains effective for about twenty-four hours. Trs.]

Very pretty pictures, particularly suitable for an exact study of the structure,
are given in cover glass preparations and in sections by the staining methods of
Mann, Bohne, and Lentz.

2. Detection of Changes in the Nerve Ganglia. The changes in
the ganglia of the peripheral nerves described by van Gehuchten &
‘

Microscopical Diagnosis. 487

Nélis, especially in Gl. nodosum, in Gl. cervicale supremum, and in
Gl. Gasseri (see p. 472), which are only conspicuous when the animals
have died from street rabies, merely justify a diagnosis of suspected rabies,
because, according to investigations by Bohl, McCarthy & Ravenel,
Frothingham, and others, they are also present in other infectious
diseases. Besides, according to Manquélian and Vallée, the ganglia of
old dogs show a similar microscopic picture; Raymond, however, found
that both in nervous distemper and in healthy old dogs the small cellular
infiltration was considerably less pronounced, while the nerve cells:
showed normal nuclei and no migratory round cells were contained in
the perivascular spaces. Therefore, this method may still render good
service, particularly in cases where suspicion of rabies already exists,
and when the detection of Negri bodies is not successful.

The examination always requires the preparation of regularly stained sections, :
ae be finished in 12 to 24 hours by means of the aceton-paraffin imbedding
method.

Diagnostic Inoculations. If material from the animal is successful
in producing rabies artificially in another animal, there can be no
doubt that the former was infected with rabies. For inoculation pur-
poses the medulla oblongata of the suspected animal is most suitable,
from the center of which a small piece is excised with sterilized instru-
ments, carefully rubbed into an emulsion with boiled water and then
filtered through clean, fine, linen cloth. For test animals rabbits and
dogs are most suitable, but guinea pigs (Konrddi), mice and rats
(Fermi) may also be used.

The subdural injection (Pasteur) is performed in rabbits by trephining one
of the parietal bones of the animal with a small trepan (diameter 5-6 mm.), and
then 1-2 drops of the previously prepared emulsion is injected between the dura
and the surface of the brain by means of a hypodermic needle which is bent in
a right angle. The opening is then covered with the skin, and the edges of the
wound are united by means of sutures.

For the intracerebral injection (Leclainche), a small opening is made in
the cranium by means of a fine drill, and 4%-%4 ce. of the above named emulsion
is injected about 1 cm. deep into the brain with a straight needle.

The intraocular injection (Gibier, Nocard, Johne) recommends itself owing
to its simplicity. The cornea which previously has been anesthetized by the
application of cocaine (10-20 drops of a 2-5% solution), or acoin (0.1% solution),
is perforated with the straight needle, and 1-2 drops of the emulsion is injected
into the anterior ocular chamber.

In the intramuscular injection which also has stood the test (Helman,
Klimmer), 1.0 ec. of the emulsion is injected into the muscles of the legs or
shoulders of a rabbit or guinea pig. This method is particularly to be preferred
in eases where the brain substance is not fresh, or the purity of the injection material
is questionable for some reason or other.

For the same purpose Lebell recommends thé injection under the meninges
of the spinal cord; Galli-Valerio mentions the injection into the cranial cavity
through the foramen occipitale magnum, or rubbing the infected material into the
mucous membrane of the nose by means of a piece of cotton fastened to a wire
(according to Konr4di, the period of incubation in this case is sometimes very long).
Dawson and Oshida recommend an injection in the cranial cavity through the
foramen opticum (inserted beside the inner angle of the eye, along the wall of
the ocular cavity) ; finally Szpilmann recommends the injection under the conjunctiva
(Hégyes, however, found this proceeding mostly ineffective). The subcutaneous
and the intravenous injections are very unreliable, and therefore they are not to
be recommended. It is also advisable to inject at least 2 animals by the above
mentioned methods, because sometimes the injection of the same virulent material
does not affect every animal.

The methods just described are easy to adopt in general veterinary practice,
owing to their simplicity; if, however, the laboratory of an institution has been
secured for this purpose, the test material must be sent there in a condition fit for
488 Rabies.

inoculation. For this purpose, the medulla oblongata, the cerebellum, and the cornu
ammonis, that is the whole nucleus of the brain, or the whole brain, are to be
preserved in 50% glycerin, or the whole head is separated from the trunk and
sent unopened.

Injections with infectious material by the four first methods named
result, as a rule, in producing rabies within 2 to 3 weeks, but some-
times the period-of incubation is longer. Aujesky observed a period
of incubation of 43 days after subdural injection, Gal one of 51 days
after intraocular injection, and Klimmer one of 235 days after intra-
muscular injection. This relatively long period reduces the practical
value of the method, as it does not permit the use of protective vaccina-
tion on bitten human beings who depend on the results of the diagnostic
inoculation. Besides while the positive result of the inoculation surely
indicates the presence of rabies, a negative result does not in the same
way preclude its presence; in addition the rabbits may die from septi-
cemia when the technique or the material has not been quite clean.
Unelean or putrid material, after a previous dilution with physiological
solution of sodium chloride (1:250), may be cleansed by filtration
through a Berkefeld filter, and with such filtrates a positive result may
be obtained with tissue kept for 63 days (Mazzei).

In rabbits inoculated with positive results, the disease is, asa rule,
attended with symptoms of paralysis (see p. 467), and in dogs it takes
the usual course. According to Beck, rabbits are also killed within
1 to 2 weeks by subdural injections of cerebral substance of dogs which
have died from nervous distemper, in which cases, however, the intestines
and bladder are also paralyzed, and the disease cannot be transmitted
further from one rabbit to another. In paralysis bulbaris infectiosa
(see p. 495), the inoculated rabbits violently scratch and rub the place
of injection, and as a rule become sick after 2 to 4 days, or at the latest,
after 8 days.

Treatment. Rabies which is already developed cannot be
arrested or changed in its course.

More successful is the treatment of wounds from bites for
the purpose of preventing the future development of rabies, by
destroying the infectious saliva already introduced. One of
the most effective methods consists in having the wound bleed
profusely, because the flowing blood washes the virus out of
the tissues; at the same time it is advisable to wash the wound
thoroughly with a disinfectant solution, such as strong vinegar,
absolute alcohol, permanganate of potash (1%), carbolic acid
(38%), and particularly 1% solution of bichloride of mercury.
In cases where the wound comes too late under medical treat-
ment, the elimination of the contagion may be attempted by
means of a red hot iron or of caustics. The caustics mostly used
are muriatic acid, sulphuric acid, nitric acid, iron chloride,
lunar caustic, ammonia, ete., in the most concentrated solutions.
This treatment is possibly aided by subcutaneous injections
in the region of the bite of 1:10,000 solution of bichloride of
mercury, 1:1000 of silver nitrate, 1% solution of carbolic acid,
1:1000 of collargol. In addition the application of-a Bier’s liga-
ture might also prove helpful (Fermi thus saved all test animals,
even when the ligature was applied four hours after the infec-
Treatment, Protective Inoculation. 489

tion). Experience teaches that these procedures, when applied
within the first quarter of an hour after the bite, will often suc-
ceed in postponing an attack of rabies, while later the result
becomes more and more uncertain, according to the length of
time passed after the bite.

A favorable result of the treatment, however, no matter
how soon it has-been applied, can never be predicted with cer-
tainty and, therefore, the bitten animals, in spite of the treat-
ment, must be considered as suspicious, they should be placed
under careful observation and also be subjected to a protective
vaccination (see p. 491). Dogs and cats should be destroyed
as soon as possible upon reasonable suspicion of infection.

The treatment with radium rays studied by Tizzoni & Bongiovanni seems,
according to investigations by Calabrese, Danysz, and Rhens, to be of little value
from tests on rabbits, and it can hardly be applied to domestic animals.

~~ Protective Inoculation. The disease which develops in dogs
injected with rabies virus may in rare cases come to a stop, and
finally a complete cure may be effected. Such recovered cases
cannot be infected later with rabies even with large doses of
virus, the disease having immunized the organism against the
virulent infection. This fact was first, and almost at the same
time ascertained by Pasteur and Azary, and, on account of the
-favorable results of the experiments, Pasteur later introduced
an efficient method of anti-rabies vaccination.

First of all, he ascertained the important fact (1884) that
the virus, through artificial transmission from dog to monkey
and then further to other monkeys, is gradually so attenuated
that it does not any longer cause rabies in dogs, but makes them
immune against a later artificial infection with unattenuated
virus. On the other hand, the virulence may be increased by
repeated passage through the bodies of rabbits and guinea
pigs. The increased virulence manifests itself by the fact that
material originating from later generations injected subdurally
in rabbits will cause rabies after a considerably shorter period
‘of incubation.

The rabies virus, in the shape in which it is obtained from
animals infected in a natural way (street rabies), is inconstant
since animals infected with it contract rabies after periods
of incubation which vary in their duration. Transmitted
through bodies of rabbits and guinea pigs, the effect on the ani-
mals is not only increased, but also becomes so constant that
the spinal cord from the 25th rabbit regularly causes symptoms
of rabies on the 8th day, that from the 50th on the 7th, and that
from the 90th on the 6th day. Virus that has been thus strength-
ened also keeps this quality later on, wherefore Pasteur desig-
nates it as ‘‘fixed virus of rabies.’’ (Later, Hogyes has reduced
the period of incubation to 5 days by using young rabbits for the
series of injections.)
490 Rabies.

With the increase in virulence for rabbits, a similar increase does
not seem to follow for other animals and for human beings. Thus
Helman injected 1-10 g. of fixed virus into 34 dogs and 8 monkeys 4
days in succession without rabies appearing in a single animal; further,
Nitzsch inoculated himself under the skin with an emulsion from a
4-5 mm. piece of rabbit cord without experiencing any bad results what-
ever, and also found the fixed virus without effect on dogs and
monkeys.

After securing a rabies virus of known and constant viru-
lence, Pasteur set to work to obtain its attenuation. Having had
to discontinue the passage through monkeys, owing to its high
cost, he chose the following procedure:

The medulla and spinal cord of a rabbit, which has contracted
rabies after a subdural injection with fixed virus, are suspended free
by means of threads in a bottle closed by a plug of cotton and the bottom
of which is covered with pieces of caustic potash. At a constant tem-
perature of 23° C., the spinal cord will dry, and also gradually lose
its virulent properties, so that, for instance, spinal cord dried for 5
days will produce the disease on the 8th day, cord dried for 9 days
on the 15th day, and the same dried for 14 days will be absolutely without
effect. If spinal cord from a rabbit dead of rabies is treated in this
manner daily for 14 days, there will be, after 2 weeks, material on hand
of 14 different degrees of virulence.

Pasteur then immunized dogs by injecting at first the most
attenuated virus, and then every second hour, a virus grad-
ually less attenuated until he reached spinal cord which had
been dried only one day. Dogs which had been subjected to
2-3 series of such inoculations were later bitten by a rabid dog,
and were also injected subdurally with fixed virus or street
virus, without suffering harm.

Through further experiments, Pasteur proved that this
method of immunizing likewise prevented the appearance of the
disease in dogs previously bitten by rabid animals. The im-
munity obtained by protective vaccination lasts about one year,
but is still effective after two years insofar as rabies develops
after a considerably longer period following inoculation (Pas-
teur). In exceptional cases the immunity may be effective up
to 5 years (Hoégyes); it may be further prolonged by vaccina-
tions repeated at intervals.

Finally, in July, 1885, Pasteur successfully applied the
method, which he had proved to be effective in dogs, to a boy
who had been bitten. Since then, the anti-rabies protective
vaccination has always been practiced on human beings in Pas-
teur Institutes established for this purpose, either according to
Pasteur’s or to a somewhat modified method.

I. Protective Vaccination with Dried Substance of Spinal Cord.
(Pasteur’s method.) The method which is nearly always followed in
human beings consists in taking 2 mg. of the dried substance of the
spinal cord of rabbits dead of rabies after inoculation with fixed virus,
Methods of Vaccination. 491

triturating it with sterilized bouillon into an emulsion and then injecting
it subcutaneously in the abdominal region. The first injection is made
with the spinal cord dried for 14 days, and then the substance dried
one day less is injected at first every half a day, and later every day,
until finally the cord dried for only 3 or even 2 days is injected. The
inoculation with cord dried 5, 3, and 2 days is repeated once or twice,
especially in the case of wounds from bites on the head. (Pflanz in
practice applied this method with favorable results on a dog.)

II. Protective Vaccination with Attenuated Virus. (Method of
Hogyes.) Hogyes prepared from virulent spinal cords of rabbits by
trituration with sterilized physiological solution of sodium chloride,
emulsions of different concentrations (1/5000, 1/2000, 1/500, 1/200,
1/100, 1/10) and injected them subcutaneously every second hour from
the weakest to the strongest. Dogs thus treated later resisted bites from
rabid animals as well as the subdural injection of fixed virus or street
virus, and moreover this method is effective during the incubation of the
disease. (This also proves that not the strength, but the amount of the
vaccine is of. most importance, and that with the Pasteur protective
vaccination, not an attenuation, but rather a reduction of the amount
of virus is important.) Since 1895, this method has been exclusively
applied at the Budapest Pasteur Institute and also at other places to
human beings.

Hogyes in this way produced immunity in 36 dogs, and in most cases che
immunity was absolute, as it also protected the animals against a later subdural
infection. He experimented further with 16 other dogs which were infected by
bites of rabid dogs; 8 of them were not subjected to treatment, while 8 were
inoculated according to the above named method with attenuated virus. Of the
former group 5 contracted rabies, while all the animals of the latter group
remained alive.

Kurz & Aujeszky applied the method at a stock farm, where immediately
before 3 animals had died from rabies, by injecting 44 colts, 6 of which had
wounds of bites on their bodies. The method was as follows: On the first day
about 15 ec. of the emulsion 1:2000 were injected, and 2 hours later a similar
amount of the emulsion 1:1000; on the second day, about 8-10 ce. of the emulsion
1:500, and 2 héurs later a similar amount of emulsion 1:300; on the third day
8-10 ec. of the emulsion 1:100. After an interval of 5 days the three-days’ cycle
was repeated in the same manner, and after a further interval of 3 days the colts
received 3-5 ec. according to their body weight. of the emulsion 1:10. The
vaccination had no injurious results for the colts, and none of them later contracted
rabies. Aujeszky further vaccinated a pack of hounds in the following way:
In the forenoon of the first day 5 cc. of emulsion 1:5000; in the afternoon, 3 ec.
of emulsion 1:3000; in the forenoon of the second day 4 cc. of the latter emulsion,
in the afternoon 2.5 ec. of emulsion 1:1000; on the third day, in the forenoon
2 ec. emulsion 1:500, in the afternoon 1 cc. emulsion 1:200. The hounds suffered
no ill effects from the vaccination. 7

III. Protective Vaccination by Intravenous Injection of Cerebral
Substance (Galtier’s Method). Galtier immunized sheep and goats. as
early as 1885 by injecting saliva or, in another series of experiments,
medulla oblongata from rabid dogs into the jugular vein; the animals
resisted both a subsequent and a previous virulent subcutaneous injec-
tion, while the control animals (sheep and rabbits) contracted rabies
after a similar infection. Nocard & Roux later ascertained that sheep
immunized in this way also resisted the intraocular infection, provided
that the protective vaccination was done within 24 hours after the viru-
lent infection; they found further that the immunity lasted at least 9
months. The method, applied at the latest 3 to 4 days after the bite,
492 Rabies.

is said to be effective only in ruminants, while it has not proved reliable
in horses (Nocard, Conte) and dogs (Protopopoff, Helman). Wysoko-
witz has also tried the method on 70 human beings.

The inoculation is conducted as follows: Pieces of spinal cord from dogs
having died of street rabies are ground up with sterilized water, and 5-7 ec. of
the thin emulsion, filtered through linen cloth, are slowly injected twice in
succession into cattle and horses, and 2-3 cc. into sheep or goats, with an interval
of from 6 hours to one day; the emulsion is injected into the jugular vein or one
of the ear veins.

Recently Nicolas also found the method efficacious in larger ruminants but
without effect in goats, while Forgeot and Raynaud had unfavorable results in
cattle (out of 8 vaccinated animals 5 died afterwards from rabies). According
to Remlinger and Mustapha-Effendi, sheep sometimes die after the vaccination from
rabies or an intoxication, while Delannoy states that it is only suitable for large
ruminants,

Babes found that dogs might be immunized against a subsequent virulent
infection by subcutaneous injection of cerebral substance of healthy sheep, and
also, that an emulsion of virulent cord was made harmless by the addition of
normal cerebral substance. Aujeszky, Calabrese, and others, however, did not
obtain any immunizing effect from the normal cerebral substance. In agreement
herewith, Friedberger & Eisler showed that an emulsion of fixed virus (1:100)
is neutralized by 0.005 ce. of serum from a horse which had often been treated
with such virus, while, on the contrary, normal cerebral substance was not capable
of absorbing the proved antirabie substance from the immune serum. Recently,
Fermi expressed the opinion that normal nerve substance possesses immunizing
properties, and he succeeded in immunizing rodents per os; Kraus and Fukuhara,
however, could not confirm the results of these experiments, as they proved that
normal nerve substances are not able to produce antirabic substances in animals
treated with them.

Immunizing experiments with liver tissue and bile (Marx) have not produced
good results, but Protopopoff succeeded in immunizing dogs both against subsequent’
and previous infection by means of subcutaneous or intravenous injection of virulent
cerebral substance which had been kept in glycerin for a long time (30 to 60 days).

Protopopoff and Helmann immunized dogs, sheep and goats, and Marx im-
munized rabbits and dogs by intraperitoneal injections of relatively large amounts
of virulent cerebral tissue. Marx believes, however, that only fixed virus immunizes
in this manner. The immunity is obtained after 12 to 14 days and lasts from
6 to 11 months.

IV. Serum Immunizaion. Babes & Lepp found that blood serum
from dogs which had been made immune against rabies by repeated
vaccination with rabies virus protects dogs against the subdural infec-
tion, when subcutaneously injected with doses of 5-10 ec. Later, Tiz-
zoni and Centanni prepared an effective serum by successive immuniza-
tion of sheep, 1.0 ec. of which protects 25 kg. of body-weight of rabbits
against the effect of street rabies virus, and in vitro makes 800-1600 g.
of virulent cerebral substance harmless. According to their opinion,
the dried serum keeps unchanged for a long time, and is effective both at
the beginning and at a later stage of incubation, immediately before the
appearance of the first symptoms. Recently, however, Kraus & Fuku-
hara found by numerous experiments that serum obtained from such
sheep, dogs and horses may destroy the rabies virus by direct contact,
but that neither a preventive nor a curative application has any pro-
tective action of any kind.

In order to obtain an active immunity, Remlinger repeatedly in-
jected sheep with a mixture of fixed virus and immune serum with good
results, and Schiirer succeeded in protecting dogs against intramuscular
and natural infection by a single subcutaneous injection of a similar
mixture, while Marie. obtained effective immunity against the subdural
infection of dogs by subcutaneous injection, at first, of a 20 ce. mixture
of virus and serum, and, 2 weeks later, of 12-20 ec. of fixed virus. Rem-
Veterinary Police, 493

linger also applied this method to 4 horses suspected of infection, in-
jecting subcutaneously 700 ce. of a mixture of serum and fixed virus
each in a dilution of 1:1000. The horses remained healthy.

Veterinary Police. According to the veterinary police or-
dinances, which are nearly everywhere alike, all animals suf-
fering from rabies must be destroyed, and all those suspected
of having the disease or of being infected must be placed under
veterinary observation; dogs and cats, however, with the
exception of those which have bitten human beings, are to be
killed on the first suspicion of infection. The time of observa-
tion must be at least 3 months, and even then an outbreak
of the disease cannot with certainty be excluded. Meat or milk
from rabid or suspicious animals must not be used for con-
sumption, but such products from animals only suspected of
being infected may be put on the market without hesitation as
long as these animals appear completely healthy.

The most important and effective prophylactic measure
for eradicating rabies in large sections of country is the gen-
eral obligatory dog tax. The latter has caused a reduction of
cases where it has been adopted and in some countries the com-
plete eradication of the disease by reducing the number of dogs,
particularly vagrant and ownerless dogs, and thereby reducing
the opportunity for infection. On the other hand, the obliga-
tory muzzling of dogs was found effective only in connection
with the dog tax and with other measures of prevention (killing
of bitten dogs and cats and the longest possible quarantine),
and it can moreover only be applied in larger towns and cities.
A reduction in the number of cases of rabies can only be accom-
plished by carrying out the same preventive measures in large
districts.

Bavaria offers an instructive illustration of the favorable results obtained in
the reduction of rabies. From 1863 to 1876, 14 to 18 human beings were
victims of the disease annually, while the number of rabid dogs amounted to about
500 every year. Under the influence of the obligatory dog tax introduced in 1876,
the number of rabid dogs was reduced to 61 in 1893, and from 1883 to 1898 no
human beings died from rabies. In the years 1898 to 1900 fatal cases of rabies
and suspicious instances were again observed, but only through being introduced
from outside, particularly from the East (Kitt). Like favorable conditions prevail
in Saxony: where the number of rabid dogs was reduced to 22 from 1879 to 1893.
In the Grand Duchy of Baden, the introduction of the dog tax in connection
with obligatory muzzling, in the year 1875, resulted in a rapid decrease and finally
in the complete eradication of rabies.

In Hungary, the favorable results of the dog tax were apparent during the
first years after the enactment of the veterinary law of 1888, as the number of
rabid dogs was reduced from 1,286 to 609 during the years 1890 to 1892; later,
however, the disease again increased owing to the faulty enforcement of the tax
law and to the fact that it had not been made obligatory in all communities.
Szakall showed from statistical data that rabies was more rare in communities with
a general obligatory dog tax, but appeared more frequently where exemptions from
the dog tax had been granted for certain kinds of dogs. :

' That muzzling alone is not sufficient to eradicate the disease completely
is shown in the City of Berlin. During the years 1853-1875 obligatory muzzling
was in force, but in spite of it rabies sometimes assumed an enzootic character

(1865-1867, 1871-1873). After the promulgation of the Prussian law of 1875, the
disease decreased rapidly, and since 1883 only isolated cases of rabies have been

observed.
494 Rabies.

That obligatory muzzling, at least when supported by other strict measures,
also gives good results has been shown by the experience in London where the
fatal cases in human beings immediately ceased every time after its introduction,
while such fatalities always occurred again when obligatory muzzling was abandoned.
In the same way, the cases of rabies of dogs in England varied according to
the enforcement or the repeal of the muzzling ordinance. (From 1890 to 1893
obligatory muzzling caused a reduction of cases of rabies from 312 to 129, 79,
and 38; from 1893 to 1896 the absence of obligatory muzzling increased the cases
of rabies to 93, 248, 672; since 1896 obligatory muzzling again reduced the cases
of rabies from 438, to 151, 17, 9 [Salmon].)

The efficiency of suitable measures against rabies has been proved not only
in Denmark, Sweden, and Norway, but also in Germany, where it has succeeded
in restricting the disease to such a degree that it is only observed to any extent
in the eastern border provinces of Prussia, while in the interior of the country
only very circumscribed foci exist. Finally in England the disease rapidly decreased
and in 1903 was completely eradicated as a result of obligatory muzzling, and
after the importation of dogs from the continent (1897) and Ireland (1899) had
been prohibited or made dependent on a 6 months quarantine. Rabies has not
been observed in England since its eradication in 1903.

Literature. Galtier, C. R., 1879; J. vét., 1904, 274 and 330.—Pasteur, 1881,
XCII, 1259; 1882, XCVIII, 457; 1885, CI, 705; 1899, CVIII, 1228—Roux, A. P.,
1888, II, 18; 1889, III, 69.—Nocard & Roux, A. P., 1888, II, 341; 1890, IV, 163.—
Hogyes, A. P., 1888, II, 133; 1889, III, 449.—Schaffer, A. P., 1889, III, 644.—
Kitt, Monh., 1890, I, 314 (Review).—Johne, Z. f. Tm., 1898, II, 349.—Van Gehuchten
& Nélis, Ann. vét., 1900, XLIX, 243.—Vallée, Rev. vét., 1900, 763.—Negri, Z. f.
Hyg., 1903, XLIII, 507; 1904, XLIV, 519; 1909, LXIJII, 421.—Remlinger &
Riffat-Bey, Soc. biol., 1903, July II.—Schiider, Z. f. Hyg., 1903, XLII, 362; A. f.
Tk., 1904, XXX, 610.—Remlinger, A. P., 1904, XVIII, 150; 1909, XXIII, 430.—
Schniirer, Z. f. Hyg., 1905, LI, 46 (Lit. on immunity).—Tizzoni & Bongiovanni,
Chl. f. B., 1905, XX XIX, 187; 1906, XL,. 745.—Bohne, Z. ft. Hyg., 1906, LII,.87
(Lit.).—Nitsch, Chl. f. Bakt., 1906, XLII, '647.—Panisset, Rev. gén., 1906, VIII,
113 (New lit.).—Lentz, Chl. f. Bakt., 1907, XLIV, 374; 1908, LXII, 63.—Frosch,
Hb. d. p. M., 1, Ergzbd., 1907, 626.—Nicholas, J. vét., 1908, 198.—Marie, A. P.,
1908, XXII, 271.—Standfuss, A. f. Tk., 1908, XXXIV, 109 (Lit. on Negri bodies).—
Fermi, Cbl. f. Bakt., 1907-1910, XLIII-LIII.—Ratz, Kongr. Haag, 1909 (Lit.).—
Koch & Rissling, Z. f. Hyg., 1910, LXV, 85.

Rabies in Human Beings. In countries where rabies occurs fre-
quently among the animals, it is also often observed in human beings.
In about 90% of the cases, they are infected by the bites of dogs, while
in the other cases (about 7 to 8%) cats, wolves and other animals trans-
mit the infection. Of the persons bitten by rabid animals, about 16 to
20% die of rabies (according to Babes 60 to 90% die after bites of
wolves) mostly after bites in the face or on the hands. The period of
incubation is at least 13 days, usually from 20 to 60 days, and only in
exceptional cases is it longer than 90 days (after bites from wolves the
disease usually appears in the third week).

The symptoms of rabies in human beings are at first dejection,
itching and trembling in the bitten part, also fever; soon respiratory
troubles, uneasiness, difficulty in swallowing, aversion to liquids, abun-
dant salivation, in general increased reflex excitability, and in conse-
quence attacks of delirium, appear; lastly paralysis of the muscles of
the face, eyes, and tongue, as well as the extremities and the trunk is
observed. In exceptional cases, the disease develops from the beginning
in the paralytic form.

The results of the anti-rabies protective vaccination are as a rule
favorable since, after regularly conducted vaccination, less than 1%
of persons who were undoubtedly bitten by rabid animals die subse-
quently of rabies. On the whole, results are the more satisfactory the
earlier after the bite the vaccination begins, and, everything else being
equal, they are most favorable after bites on the legs and body, somewhat.
less favorable following bites on the hands, and the least so after bites on
Rabies in Human Beings. _ 495

the head and face. The mortality figures computed according to these
points of infection on 36,891 vaccinated persons, amount to 0.32, .0.56
and 1.78% respectively.

_ During the years 1886 to 1908, 31,759 persons were subjected to protective
vaccination at the Pasteur Institute in Paris, and after the completed treatment
129 persons, or 0.41%, died. The annual percentage. of mortality during the
above named period has been lowered from 0.94 to 0.19%. In Berlin 1,416 bitten
persons were subjected to protective vaccination during the years 1898 to 1902,
and of these 12 or 0.84% died afterwards of rabies, while among non-vaceinated
persons the percentage of mortality amounted to 14.8% (Doebert). At the Pasteur
Institute in Budapest 45,067 bitten persons were vaccinated during the years 1890
to 1909. Of these 181 or 0.4% died of rabies afterwards (last year only 0.19%),
while during the years 1890 to 1903, out of 1,861 bitten but non-vaccinated persons
266 or 14.29% later contracted the disease. During the years 1890 to 1895,
Pasteur’s method was used, while subsequently that of Hégyes was employed.

According to a compilation by Bernstein in 1905, 104,357 persons were
subjected to treatment in 40 Pasteur Institutes in all parts of the world, outside
of Australia. Of these 560 persons or 0.54% died more than 14 days after the
conclusion of the treatment while 0.19% died within 14 days, making the total
of deaths 0.73%. According to the location of the bite, whether it was inflicted
on the head or on the hands, the percentage of mortality was 1.99 and 0.36%
respectively. :

Literature. S. Hégyes, Lyssa, Nothnagel’s Handbuch, 1897, V, 1, T.—
Bernstein, Vjschr, f. ger. Med. u. off. Sanititsw., 1905, XXXI, 1.

Infectious Bulbar Paralysis (Pseudo Rabies). After the inocula-
tion of rabbits with the medulla from a cow and a dog which died with
suspicious symptoms of rabies Aujeszky observed a disease in the experi-
ment animals which resulted in their death within 48 to 50 hours. The
most conspicuous symptom was a very severe itching at the point of
inoculation.

According to his and to Schmiedhoffer’s investigations the disease
may be produced by subdural, intraocular, intramuscular, or subcutan-
eous inoculations of brain substance from animals dead of the disease,
or with parts of the tissues from the point of inoculation. The disease
may also be produced in guinea pigs, rats and mice, very easily in car-
nivorous animals, cattle and sheep, while the ass is less susceptible and
horses can be infected only with difficulty. Fowls are resistant to the
infection. Artificial infection occurs also by the feeding of organs con-
taining the virus to cats and dogs, as well as rodents. The virus is
most concentrated in the tissue fluids at the point of inoculation, then in
the blood and in the central nervous system. It is not present in the
bile, saliva, or urine (0.001 ce. of blood is sufficient to produce an infec-
tion). Dense porcelain filters retain the virus, while the filtrate through
coarser filters, which however do not let bacteria pass, is infective in
large quantities. Attempts at cultivation have so far been fruitless.

Virulent brain substance remains infective for months in 50% glycerin,
while by slow drying it is rendered avirulent in from 3 to 6 days. Defibrinated
blood kept in an ice chest, retains its virulence for from 1 to 3 weeks. Heating
to 55°-60° C. destroys it in from 30 to 35 minutes, 80° in three minutes, and 100°
immediately. Of chemical agents. 14% hydrochloric acid destroys it in 3 minutes,
1% corrosive sublimate immediately, 5% carbolic acid in 2 minutes, 3% lysol in
10 minutes, 2% formalin in 20 minutes, and absolute alcohol in 30 minutes
(Schmiedhoffer).

After a subcutaneous injection a local reddening develops at. the
point of inoculation, which later results in a necrosis. The animals
seratch and rub the affected part severely; in the meantime they become
very weak, and usually die within a few hours. The experimental dis-
496 : Pseudo Rabies.

ease appears similar to the spontaneous cases in animals. After the
infection per os a marked inflammatory swelling and sensitiveness of
the lips and the buccal mucous membrane were observed. s

The disease, which up to the present time has been observed only in
Hungary, occurs not very infrequently in cats and dogs, as Marek diag-
nosed it in the clinic at Budapest from 1902 to 1908 in 118 cats and 29
dogs. Some of the cats had previously been fed spoiled meat; in the
majority of cases, however, the history relative to this point was nega-
tive. Some owners lost all their cats from the disease, without con-
sideration of sex and age. Szabo reports 16 cases occurring among a
pack of hounds. The disease has been repeatedly observed among cattle
and also in rats.

Symptoms. After an incubation period of 20 hours to 10 days
(following artificial infection), a peculiar change in the behavior of the.
animal is observed. Dogs and cats become apathetic, change their rest-
ing place often and sit crouched up; cats meow and yawn, sometimes
painfully. There is profuse salivation; inappetence is present from the
onset of the disease with frequent vomiting, and constant symptoms of
paralysis. In about half of the cases the patients manifest severe itching
on any part of the head, which they scratch with the fore paws, or rub
against some object, sometimes so severely that inside of several hours
extensive abrasions or even deeper injuries result. In other cases this
symptom is absent, but the groaning or painful meowing indicates that
the animals are in pain. With rare exceptions the examination of the:
nervous system shows paralysis of the pharynx and pruritis, also an un-
even dilation of the pupils associated with at first increased reflex
irritability, later diminished pupillary reflex, muscular sensibility, and
superficial and deep reflexes. In most cases periodical twitching may
be observed in the flexor muscles of the head and neck, sometimes also
the muscles of the lip. The respiration is markedly labored, the tem-
perature is normal or only slightly elevated and the patients succumb
almost exclusively inside of 24 to 36 hours. In cattle a persistent rub-
bing of the muzzle or of other parts of the face is observed, which
results in more or less extensive bloody areas, denuded of hair and sur-
rounded by edematous swellings. At the same time the animals bellow
loudly, and kick spasmodically with their hind legs. In the mean-
while a pronounced swelling and weakness of the hind quarters develop,
while the appetite is for a time normal. Finally the disease terminates
in death after 12 to 36 hours.

The autopsy reveals inflammatory lesions which occur at those parts
of the bodies of the animals which were painful during life; perhaps
there are also hyperemia or small hemorrhagic extravasations in the
cerebral meninges. Recovery has so far been observed only in one eat.
This animal, which on the first day had no appetite whatever, ate more.
frequently on the following day, at the same time manifesting spasmodic
contractions of the muscles. The spasms became less frequent, saliva-
tion ceased after the fourth day, and on the eighth day the cat had
recovered. By

The disease is distinguished from rabies on the one hand by. the
absence of furious attacks, aggressive behavior, and of paralysis of the
jaw; on the other hand by the fact that the blood as well: as the brain
tissue is infectious, while the saliva is not, and finally that the disease
after a period of incubation of not more than several days, runs a very’
rapid course. Especially characteristic of infectious bulbar paralysis is’
Symptoms. 497

its sudden appearance, accompanied by the very acute and usuaily fatal
course, and the severe itching of a certain part of the body; if this
latter symptom is absent the disease may be readily mistaken for acute
poisoning in dogs and cats.
The nature and mode of natural infection are not yet sufficiently
known. The observation that rats sometimes die in great numbers with
the disease simultaneously with numerous cases in dogs, cats or cattle
(Balas, Hutyra), and that the conspicuous itching occurs mostly on a
portion of the face, renders the supposition very probable that domestic
animals are infected by diseased rats (possibly also mice), although the
possibility that the infection of the various species of animals may occur
simultaneously through a common source cannot be excluded.

Literature. Aujeszky, Cbl. f. Bakt., 1902, XXXII, 353—Marek, Jahresber.
d. Hochschule Budapest, 1902-03, 1908-09.—Hutyra, B. t. W., 1910, 149.—Schmied-
hoffer, Kézl., 1910.

Epizootic of Cats with Nervous Manifestations. Mori observed
an epizootic of cats in Siena which commences with sudden severe
excitement, when the animal becomes frightened, and with widely opened
eyes runs up and down, turns in a circle, and finally collapses as if
paralyzed, passing urine involuntarily. On the following days depres-
sion and coma alternate, the attacks continually becoming more pro-
nounced and of longer duration; further there is a conjunctivitis with
paleness of the other mucous membranes, yawning, difficult respiration,
accumulation of feces in the colon, and relaxation of the anus. The
autopsy revealed in one case a marked swelling, softening and hyper-
emia of the spleen, fatty degeneration of the liver, as well as dark,
fluid blood.

This disease, the symptoms of which decidedly resemble those of
acute lead poisoning (Chyzer), is supposed to be caused by a facultative
anaerobic, Gram negative bacillus 0.8-2.0 » long, having peritrichally
arranged flagellae. The bacillus is pathogenic for guinea pigs, rabbits,
pigeons and white mice. Feeding one cc. of the culture to a cat re-
sulted in an elevation of the temperature, followed later by hypothermia
and diarrhea (Cbl. f. Bakt., 1905, XX XVIII, 40.)

Vol, 1—32
Group V.
CHRONIC INFECTIOUS DISEASES.
1. Tuberculosis.
(Tuberculose [German and French]; Tubercolosi [Italian].)

Tuberculosis is a chronic contagious infectious disease of _
man and. domestic animals. It is caused by Koch’s Bacillus
tuberculosis or one of its varieties. Anatomically it is char-
acterized, in its incipient stage at least, by small non-vascular
nodules known as tubercles which have a tendency to undergo
cheesy degeneration.

(a.) Tuberculosis of Mammals.

(Pearl disease, Grapes; Perlsucht, Skrofulose, Lungenschwind-
sucht, Stiersucht, Monatreiteret, Driisenkrankheit, Franz-
osenkrankheitt [German]; Cachexia boum tuberculosa,
Phthisis pulmonum [Latin]; Pommeliére [French];
Malattia glandolare [Italian]).

History. Tuberculosis, and particularly that form known as pul-
monary consumption, has from the remotest time been known as the
most prevalent disease of man. A large percentage of all deaths is due
to tuberculosis. The study of its nature had, therefore, until the be-
ginning of the last century, been confined almost exclusively to man.
Until recently, however, the results of these investigations amounted to
little more than theories or hypotheses. The peculiar character of the
tubercle, was necessarily recognized by pathologists in the early history
of the study of the disease. Morton, as early as 1689, regarded the tu-
bercle as the anatomical foundation of pulmonary consumption. At a
later date special stress was laid upon the importance of cheesy degenera-
tion as characteristic of tuberculous lesions. While Bayle, in 1819, re-
stricted the definition of the tubercle to non-caseating, gray and trans-
lucent nodules, he as well as Baillie (1794) and Laénnee (1819) con-
sidered pulmonary consumption and scrofula as identical morbid pro-
cesses. Laénnec held the view that the tubercle owed its origin to a
specific tubercle-producing substance, soft and homogenous in con-
sistency, which was secreted from the blood, and that the inoculation of
this primary tubercle substance could produce the local development of
tuberculous tissue. As he, however, like later on Magendie and Roki-
tansky, attached undue importance to the cheesy character of the tu-
bercle, he included many other morbid processes which consisted of
simple degenerations. a
History. 499

Virchow, in 1847, had a more restricted conception of the nature
of tuberculosis. This was based upon a histological foundation and
recognized as tuberculous such lesions only as presented small, well
marked non-vaseular nodules or groups of nodules, or cheesy masses that
were evidently the result of the degeneration of such nodules. Accord-
ing to this view, however, he excluded. several forms of diseases which
are undoubtedly tuberculous in character, viz., tuberculosis of the
lymphatic glands (scrofula), tuberculous caseous pneumonia and tu-
berculosis of animals.

Of the various forms of tuberculosis in animals, so-called pearl
disease in cattle in particular long ago attracted general attention, and
the regulations concerning meat inspection in various countries con-
cerned themselves with this question in detail. In the beginning of the
eighteenth century pearl disease was generally supposed to be identical
with syphilis of man, and supposed to be the result of unnatural inter-
course of syphilitic persons with animals (Franzosenkrankheit). As a
result of this view all cattle affected with pearl disease were excluded
from use as food. At the end of the same century, however, this view
of the nature of pearl disease was found to be incorrect. But the appre-
ciation of the true nature of the disease was the result of a very gradual
development of our knowledge. During the first half of the last century
some authors (Gurlt, Hering, Fuchs) regarded pulmonary tuberculosis
of cattle and pulmonary consumption of man as identical, and others
(Gerlach, Spinola, Leysering) placed pearl disease of ‘the peritoneum
of cattle in the same group. On the other hand, Virchow disputed the
occurrence of tuberculosis in animals altogether. Aceording to his view
which was subsequently shared by ROll, the morbid growths of the lungs
and serous membranes were in reality neoplasms, sarcomata, which might
be considered identical with lympho-sarcomata of man.

The question assumed a new aspect when in the year 1865 Villemin
proved by means of experimental infection that tuberculosis was trans-
missible from man to animals, and from animal to animal respectively.
Morgagni had already 200 years ago believed in the infectiousness of
pulmonary consumption and Klencke produced in 1843 tuberculosis in
rabbits by the intravenous injection of tuberculous material. But in
spite of this the spontaneous development of the disease according to the
humoral pathological theory continued to be asserted. Villemin obtained
positive results in his experiments with tuberculous material from man
as well as with material from cattle affected with pearl disease, and thus
furnished proof of the infectiousness of tuberculosis as well as the
identity of the disease in man and in animals. In recent years Villemin’s
experiments have been abundantly verified by numerous repetitions, and
at the same time the various modes of infection have been elucidated.
These latter experiments have shown not only that tuberculosis is trans-
missible by means of subcutaneous or intraperitoneal infection (Klebs,
Bollinger, Kitt), intraocular inoculation (Cohnheim & Salomonssen,
Baumgarten), as well as through inhalation (Tappeiner, Weichselbaum)
of. tuberculous material, but furthermore they have shown that other
foreign substances could not produce similar pathological processes
(Martin, Ponfick, Langerhans). Semmer observed that the injection
of milk and blood from a cow with advanced pulmonary pleural tuber-
culosis into the jugular vein of a pig produced a pronounced general
tuberculosis. Chauveau (1868).as well as Gerlach (1869) succeeded in
producing the disease by feeding tuberculous material from cattle.
Klebs produced pearl disease of the peritoneum by means of intraperi-
500 Tuberculosis.

toneal injection of tuberculous sputum. Bollinger obtained the same
result by the injection of tuberculous lung tissue.

As the result of a statistical study of the various feeding experi-
ments with the transmission of tuberculosis, Cohnheim declared in 1879
that the correct diagnosis of tuberculosis could no longer be made from
a purely anatomical point of view and that the etiological viewpoint
alone was justifiable. He maintained further that the cellular structure
of the nodules was as little characteristic of a purely tuberculous pyro-
cess as the tendency to cheesy degeneration which had been emphasized
by Laénnec. He held that either process could be considered as tuber-
culous only when their infectious nature had been demonstrated. Fur-
ther, since other tubercles or cheesy products are not infectious, though
similar in their anatomical structure, the infectiousness of the true
tubercle must be due to a specific virus.

Nothing now was lacking in the chain of evidence but the recogni-
tion of this specific virus in order that the infectious nature of tuber-
culosis might be recognized as a scientifically demonstrated fact. This
was accomplished by Robert Koch in 1882 when he proved by incon-
trovertible evidence that tuberculosis in man as well as tuberculosis in
animals was dependent upon the pathogenic action of a morphologically
and culturally characteristic bacterium. The theory of the infectious-
ness of tuberculosis was hereby placed upon a firm foundation and fur- ,
ther research was thenceforth directed to the establishment of the vari-
ous conditions under which infection took place and the means by which
the discovery of efficient methods of prevention was possible.

In recent years the study of the etiology of tuberculosis received
a new stimulus when Koch, in an address before the Tuberculosis Con-
gress of London in 1901, declared that bovine and human tuberculosis
were different diseases, that the human disease was not transmissible to
cattle and that it was not necessary to observe special precautions to
protect man against pearl disease or bovine tuberculosis. This opinion
was diametrically opposed to former views expressed by him or held by
the medical profession in general. The various commissions which
were thereupon appointed by the German government as well as the
English Royal Commission for the study of this question did not
express an unqualified endorsement of the views expressed by Koch.
Nevertheless they produced valuable information regarding the mor-
phological, cultural and pathogenic characteristics of tubercle bacilli
of different origin. Simultaneously the question of the exact mode
of infection was again forced into the foreground of investigation. At
this time two theories, sharply opposed one to the other, received general
recognition, viz., the view of Fliigge who held that infection occurred
chiefly through inhalation of the virus into the air passages, and that of
Calmette who held that infection by way of the alimentary canal was of
most frequent occurrence. In recent years, however, the tendency is to
accept a combination of these two views on the modes of infection, while
the importance of either mode is recognized.

These as well as the extraordinarily numerous and painstaking
investigations of other details of the tuberculosis question, the numerous
associations, congresses and conferences which were organized in rapid
succession, and the active social and economic interest which developed
with reference to this question, give cause to hope for a gradual repres-
sion of this devastating disease. As far as tuberculosis of man is con-
cerned the various public sanatoria and dispensaries have produced
happy results in the way of disseminating popular know!edge eoncern-
ing the disease. The results of a similar campaign for the suppression
‘History, Occurrence. 501.

of the disease among animals, though less far reaching in their effects,
have also been gratifying.

The results which were for a time expected from the curative value
of tuberculin (Koch, 1890) were realized to a slight extent only. On
the other hand tuberculin has proven itself a valuable diagnostic agent
and has been used with particular success among domestic animals. The
diagnostic properties of tuberculin and the recognization of the condi-
tions which produce infection constitute the basis of Bang’s system for
the extermination of tuberculosis. By means of this system the eradi-
cation of the disease can be accomplished without serious economic loss
even in badly infected herds. On the other hand, the advantages ex-
pected from protective inoculation of cattle by means of human tubercle
bacilli (Behring, 1902) have by no means been realized in the same
degree, and the problem of employing this agent in the fight against
tuberculosis remains for the future to solve.

Among the more recent discoveries which deserve special mention
are Pirquet’s local ‘‘allergic’’ tuberculin reactions and Much’s non-acid-
fast form of tubercle bacillus.

Occurrence. The prevalence of tuberculosis, especially
among cattle and swine, stands in intimate relation to the de-
velopment of intensive agriculture. Among cattle its spread
is favored to a great extent by our modern soiling system,
forced maturity of young animals and increased traffic in live
stock. Thus tuberculosis is practically unknown on the ex-
tensive prairies of North America, in Central Africa and on
many islands (Iceland, Sicily). It is almost unknown among
the cattle of the steppes of Eastern Europe, while it is par-
ticularly prevalent in the central and western countries of
Europe, especially in the neighborhood of large cities where
it is increasing in prevalence. Large dairy establishments near
cities suffer comparatively greater losses than the smaller herds
of farmers in mountainous regions. Young animals are less
frequently affected than older stock. Among swine the disease
has gained a foothold through the practice of feeding the prod-
ucts of creameries and skimmed milk to young swine. Among
other domestic animals, with the exception of fowls, the disease
is much less prevalent, although no species is entirely free from
its ravages.

The importance of tuberculosis to the cattle industry lies
in the fact that the average age of usefulness of the young
animals has decreased in direct proportion to the increased
prevalence of tuberculosis, and to the fact that the losses from
the elimination of indifferent and poor milk producers are con-
tinually increasing. The raising of young animals is attended
with greater difficulties and expense; the volume of milk pro-
duced by infected herds is decreased, and the emaciation of
affected animals reduces their food value. Moreover the large
number of carcasses of diseased animals which are condemned
for food purposes causes annually a considerable economic loss
to the national wealth. ;

Our knowledge of the prevalence of the disease has been
gained on the one hand from statistics furnished by public
502 Tuberculosis.

abattoirs and on the other hand from results furnished by the
tuberculin test. The value of slaughter house statistics where
only the more or less conspicuous lesions are noted, depends to a
great extent upon the experience and care of inspectors in
charge. The tuberculin test furnishes evidence of the existence
of the disease in its most incipient stage, hence the percentage
of cases disclosed by the latter is much larger than that in-
dicated by the former.

In Germany investigations of the Imperial Board of Hvalth for the year
1888-1889 show that from 2 to 8% of all cattle were tuberculous. Since then,
however, meat inspection statistics and the results of extensive tuberculin tests
have shown the disease to be far more prevalent. Thus according to Siedamgrotzky’s
compilations in 1,110,252 animals slaughtered in the abattoirs of Saxony, Prussia and
Bavaria in the period from 1895 to 1897, 13.1% were found tuberculous, During
the same period the abattoirs in the Empire of Germany furnished 353,162 tuberculous
animals. Of these 9,705 were condemned and 18,322 were sold under declaration.
The resulting annual loss is estimated at six and one-half million marks, or a little
over one and a half million dollars. During the same period, of 1,107,552 slaughtered
swine, 1.22% were found tuberculous. This resulted in the condemnation of the
carcasses of 2,600 head of swine while 39,000 head were sold under declaration.
The actual loss from tuberculosis in swine (carcasses) was one and three-quarter
million marks or over four hundred thousand dollars.

The following table which is taken from the official report on sanitary police
control of abattoirs of the German Empire shows the percentage of animals con-
demned on account of tuberculosis: :

Cattle Calves Swine Sheep Goats Dogs Horses
1904 17.£9% 0.26% 2.46% 0.20% 0.69% 0.86% 0.15%
1905 19.16% 0.30% 2.87% 0.22% 0.76% g 0.16%
1906 20.66% 0.35% 2.81% 0.17% 0.72% q 0.17%

Abattoir reports of the various states of the German Empire show that
tuberculosis is on the increase among cattle as well as among other species of
animals. A few localities only show a decrease in the prevalence of tuberculosis
among swine and calves (Ostertag). Thus the kingdoms of Bavaria, Prussia and
Saxony furnish the following tables of information:

BAVARIA
Cattle Calves Sheep and Goats Swine Jlorses
1898 5.7 % 0.05% 0.03% 0.35%
1900 6.0 % 0.07% 0.46% 0.03 %
1902 6.8 % 0.12% 0.66% 0.04% 0.08%
1904 9.20% 0.21% 0.09% 0.14% 0.96% 0.16%
1906 10.31% 0.28% 0.12% 0.19% 1.40% 0.11%
PRUSSIA
Cattle Calves Sheep Goats Swine Horses
1898 16.09% 0.15% 0.11% 0.50% 2.23%

1900 15.0 % 0.16% 0.09% 0.38% 2.41% 0.12%
1902 16.4 % 0.19% 0.08% 0.35% 2.80% 0.10%
~ 1904 20.83% 0.28% 0.20% 0.51% 2.64% 0.12%
1906 23.40% 0.33% 0.17% 0.61% 2.96% 0.16%
SAXONY

Cattle Calves Sheep Goats Swine Dogs Horses
1898 30.46% 0.24% 0.09% 0.41% 3.16% 0.16%
1900 29.47% 0.30% 0.29% 2.57% 3.65% 0.26% 0.19%
1902 30.98% 0.36% 0.24% 2.97% 4.31% 0.16% 0.87%
1904. 84.49% 0.46% 0.14% 1.83% 5.13% 0.31% 1.14%
1906 37.76% 0.56% ' 0.14% 1.99% 5.43% 0.25%
1908 37.58% 0.50% 0.09% 1.96% 5.07% 0.30%

The percentage of infection revealed by tuberculin tests in general has been
very high. Thus in the kingdom of Saxony for the years 1891 to 1897 it varied
between 57 and 84%. Up to the middle of the year 1904, 68% of 3,083 cattle
that were tested reacted. Thus the assumption of Klimmer that 2/3 of all cattle
Occurrence. 503

harbor germs of tuberculosis has a basis of fact. On the other hand Ostertag, basing
his estimate upon personal experience in Northern Germany and in the region
surrounding Stuttgart, estimates that 25% of all cattle are affected with tuberculosis.

In France the disease is very prevalent. In several regions (Bretagne, Nivernais,
Hautes Vosges, etc.) estimates of veterinarians place the percentage of tuberculous
cattle at 30 to 40% or more. In some instances herds that were apparently free
from disease showed by the tuberculin test that they contained from 50 to 80% of
reactors. Over ten per cent of all cattle in the French Republic are claimed to be
tuberculous (Nocard & Leclainche). In the abattoir La Vilette in Paris the per-
centage of tuberculous calves was from 1899 to 1903 reduced from 0.31 to 0.15%
(Césari). Autopsies held on dogs in Alfort in 1900 to 1904 revealed 4.6%, 3%,
7.2% and 9.1% respectively, to be tuberculous (Petit).

In Great Britain Walley found as early as 1879 tuberculosis to be a very
prevalent disease among Alderney and Shorthorn cattle. From 1897 to 1899, 4,105
or 26.6% of 15,392 cattle that were tested with tuberculin reacted.

In Austria tuberculosis occurs in all of the Crown Lands. Some abattoir
reports, however, show very low percentages of infection. Thus in 1900 lower
Austria is credited with 14%, upper Austria with 2.9% and the other provinces
with 1% of infected animals. In Vienna 1.3 to 1.8%; in Moravia, in the years
1896 and 1897, 39.8% of 2,314 tested cattle gave positive reactions and 4.4%
doubtful reactions. During the following years tests that were made in Salzburg
revealed from 41 to 44% of reactors; in Silesia 25 to 40%; in lower Austria 53.4%;
in Gallicia among Polish cattle 14.2%; among milk cows 60.3% of reactors.

The slaughter house reports of Budapest in Hungary, give the following
exact statistics:

Cattle:
Longhorned Improved Calves Buffalo Swine Horses
Breeds Breeds
1899 12.2% 13.8% 0.006% 0.07% a
1901 14.1% 13.9% 0.01 % O26% st sbigatd
1903 15.0% 16.9% 0.01 % 0.07% 26% sa aan
1905 16.6% 21.6% 0.03 % 0.11% 142% — ......
1907 19.8% 25.2% 0.04 % 0.89% 141% ~~...
1909 16.8% 21.8% 0.03 % 0.58% 158%  — ......

Tuberculin tests conducted on cattle of the colored breeds revealed the following
results:

No. of Herds Cattle under 2% years Cattle over 2% years Herds free

Tested Reacted Tested Reacted from Tuber-

culosis
1902 34 1723 170= 9.8% 1871 250 + 13.3% 3
1903 °- 34 1145 166 = 14.4% 2588 3823 = 12.6% 7
1904 56 2847 251= 8.1% 3639 966 — 26.8% 8
1905 85 3152 235— 9.0% 4404 1033 — 23.4% 22
1906 93 3859 296— 7.5% 5999 1345 — 16.5% 12
1907 88 2548 256 = 10.0% 4422 760 = 17.1% 20

According to investigations by Ujhelyi covering 20 estates, 1,517 or 75.36%
of 2,013 head of cattle tested, reacted’; of 1,495 calves and yearlings tested, 526
or 35.18% reacted. On the other hand of 117 herds belonging to peasants of
the county of Moson 53 were found free from tuberculosis. Among the remaining
herds of this district, of 501 cattle tested 25.7% reacted and of 177 calves and
yearlings that were tested only one reacted. The infected herds of these peasants
were all located near the larger states from which discarded cattle were occasionally
bought.

an Belgium in 1906 among 2,905 herds that were investigated and of 19,004
cattle that were tested, 48.8% reacted. During the year 1900, 10,269 tuberculous
cattle were officially condemned and slaughtered. In the Netherlands the large
abattoirs revealed from 2 to 13% of all cattle as tuberculous. In Switzerland
statistics show that the percentage is much lower although in several cantons (Bern,
Geneva, Zitirich, Winterthur) the percentage in slaughtered cattle is reported to be
as high as 19%. Tuberculin tests show that from 40 to 50% of all cattle are
tuberculous (Zschokke).

Denmark was free from tuberculosis at the beginning of the 19th century,
but became infected by the importation of Swiss, Holstein and English (Shorthorn)
cattle. As a result, the first tuberculin tests made in this ecuntry (1893-1894)
showed that from 38.5% to 40% of the cattle were tuberculczs. The abattoir
504 Tuberculosis.

statistics of Copenhagen for 1895 showed that 29.7% of all slaughtered cattle
and over 10% of all swine were tuberculous. In the period beginning April, 1893,
and ending with the year 1908, 19,717 herds were tested with tuberculin. of
these 11,553 were first tests. A total ‘of 503,879 cattle were tested of which 108,378
or 21.5% reacted to the tuberculin test. During this period the number of reactors
was reduced from 40% to 8.5%. Of 10,344 herds tested for the first time in the
year 1903, 2,664 herds (consisting of 33 946 animals) were found free from tuber-
culosis. Most of these herds contained jess than 25 animals each; 153 herds were
composed of from 26 to 55 animals (Bang

In Norway, in 1895 to 1909, of 25, 832 herds that were tested, 4,217 or 16.3%
were tuberculous. Of 219,925 animals tested 12,823 or 5.5% were infected (Malm).

In Sweden, from 1897 to 1908, of 12, 720 herds which were tested for the
first time, 5,527 herds were free from reactors. Of 306,372 animals tested 30.7%
reacted (Regnér).

In Finland, from 104 to 1900, of 75,447 cattle that were tested 13.7%
reacted (Héjer).

Of the other European countries tuberculosis is very prevalent in Northern
and Central Italy, in Spain and in Portugal. According to Nogueira the disease
exists to the extent of 3.8% among bulls which are reared in the open to supply
the market for bull fights. The disease is prevalent to an equal extent in Russia,
Roumania, Servia and the Herzegovina. On the other hand the cattle of the steppes
of Russia are practically free from the disease. Of 30,000 Servian cattle killed
annually in Budapest up to the year 1906, only .20 to .28% were found tuberculous.

Outside of Europe tuberculosis occurs wherever European breeds of cattle have
been imported. Thus the disease is very prevalent in North America where, accord-
ing to Salmon, among suspected herds that were tested, 25% were found infected,
while among unsuspected herds 9% were found infected. Reports of the Bureau
of Animal Industry show that of 400,008 cattle tested 9.25% reacted. According
to Melvin the disease causes an annual loss of $23,000,000 in the United States.
Tuberculosis is also quite prevalent in South America. In Buenos Ayres 3.7%
of all cattle and 10.8% of all swine were found tuberculous. In the State of
San Paoblo 20% of milk cows are tuberculous. Finally the disease is also prevalent
in Africa (Egypt and Southern Africa) as well as in Australia. In Japan where
tuberculosis has always been prevalent among human beings, it has been known
in cattle only for the past 30 years and since then has been gaining ground rapidly.
The disease was introduced by the importation of American cattle (Kanda).

Etiology. The Bacillus Tuberculosis Koch is a slender,
slightly bent bacterium, 1.5-4.0 » long and 0.3-0.5 « in
diameter, which seems to be covered with a thin waxy substance.
It is non-motile and non-sporulating. In tissues it occurs singly;
in morbid secretions it is frequently found in groups, in parallel
bundles or in pairs placed at an acute angle (see Fig. 77). In
rare cases it is composed of a chain of two or three links. In
fresh cultures it grows in wavy lines, while older cultures pro-
duce long threads which may show a tendency to branch and
form club-shaped swellings. Stained bacilli from morbid secre-
tions show colorless spaces which give them the appearance of
coceus chains.

Besides the typical acid-fast form of the tubercle bacillus
there has recently been discovered by Much a non-acid-fast
granular form which consists of small granules arranged in
straight rows. This probably represents a young culture variety
of the species from which the rod shaped acid-fast bacterium
develops (see Fig. 78 and Fig. 79). The granular form which
is found especially in pearl disease of cattle and in cold ab-
scesses of man, is just as virulent as the acid-fast rod-like
species.

By means of special staining methods the interior of the
tubercle bacillus reveals a granule (rarely two or four granules),
Abi

 

Hinman

Cultures

type, 4

of

the

weeks

Bacillus

old; B,

o

tuberculosis

Bovine type,
weeks old.

on

S

glycerin-potato.

 

weeks old; C.

Avian

type,
Etiology.

505

which Spengler refers to as ‘‘splinters’’ and regards as true
spores. ,Most investigators, however, look upon these bodies
as chromatin granules such as are found also in other bacteria
whether they are sporulating or non-sporulating species.

Staining. The typical tubercle ba-
cillus is stained most readily and charac-
teristically with a warm carbol-fuchsin
solution or with any aniline water gen-
tian-violet. After once absorbing the
stain the latter becomes so well fixed that
it is impossible to remove it with alcohol
or mineral: acid (5% sulphuric acid—
30% nitric acid). This characteristic
(acid-fast or alcohol-fast) which is met
also in the bacillus of leprosy and in sev-
eral saprophytic bacteria, is due to the
presence of fatty acids in the body of the
bacillus (Deycke). No other bacteria ex-
cept those mentioned possess this charac-
teristic.

Much’s granular form of the tubercle
bacillus may be stained by Gram’s method
of subjecting it to the action of aniline-
gentian violet for 24 to 48 hours at body
temperature. (See Diagnosis.)

Culture. The tubercle bacilli will
grow only in the presence of oxygen and
at a temperature varying from 29 to 42°
C., its growth being most prolific at blood
temperature. The best culture media are
those containing egg albumen, although
the bacillus will grow also on common
laboratory media which do not contain
this substance. The chemical reaction of
the medium must be neutral or slightly
acid. The presence of glycerin, grape
sugar or phosphoric acid favors its growth
which is tsually very slow. Cultures are
never visible before the end of a period
of at least one or two weeks.

On blood serum and on 3 to 5%
glycerin agar the cultures appear as fol-
lows: In the course of two weeks after
inoculation of material small gray dry
lusterless granules or scales make their
appearance. These are gradually sur-
rounded by a halo (Fig. 80). In the
course of time they form an irregular,
erumpled, dry granular continuous mass
which is easily removed from the surface
of the medium. On glycerin bouillon
after surface inoculation there is formed
a fine pellicle which ultimately develops

 

Fig. 77. Bac. Tuberculosis, acid-
fast form. Bronchial secretion
from cattle. Stained by Ziehl-
Nelssen’s method.

 

Fig. 78. Bac. Tuberculosis, gran-
ular form, Bronchial secretion
from cattle. Stained by Much’s
method.

 

‘Fig. 79. Bac. Tuberculosis, Stain-
ed by Hermann’s method. (The
same material as in Fig. 77-78).
506 Tuberculosis.

into a thick membrane covering the entire surface of the fluid. In the
course of time this membrane increases in thickness and becomes
crumbly. Very slight jarring of the container will cause it to break into
fragments causing portions to sink to the bottom of the flask where they
develop into globular mulberry-like white colonies. The bouillon re-
mains clear throughout its mass. Upon glycerin-potato medium, one of’
the most suitable for its growth, there develop dry crumbling masses
which unite to form a rough irregular covering. (See Plate II.) Acid-
reacting brain-agar and brain-serum are also excellent media for its
_growth.

Arloing succeeded in producing so-called homogeneous
cultures by repeated shaking, in which the unusually long
bacilli are less acid fast than usual and motile. The origi-
nal potato cultures had a shiny fatty appearance.

Morphological and Cultural Differences Observed
in Tubercle Bacilli of Different Origin. These were pointed
out by Theobald Smith in 1898. Later other investigators
(Kossel, Weber & Heuss) confirmed the results reported by
Smith. According to these investigators two types or
varieties of tubercle bacilli are recognized (human type and
bovine type). These types, however, do not include the
avian form of tubercle bacillus nor the varieties which
occur in cold blooded animals. Intermediate between the
human and the bovine type are observed many transition
forms some of which it is impossible to classify with either
group. The cultural characteristics, however, are clearly.
manifest only when the various types are grown on the
same medium and under similar conditions, particularly.
upon beef broth of amphoteric reaction with 2% glycerin.

The bacilli of the human type, when found in morbid
secretions or tissues or in pure culture, are usually more
slender and show the irregular staining to better advantage
than the bacilli of the bovine type. Further, on some va-.
rieties of potato the cultures of the human type assume a
dark red color in the course of three weeks (Arpad). They
also show more rapid growth in first cultures than the bacilli
of bovine tuberculosis. On the other hand the latter are
frequently characterized by their fine verrucose surface on
potato culture.

The bacilli of the human type grow luxuriantly on
glycerin bouillon, forming a wrinkled membrane of even
thickness which spreads over the entire surface of the
liquid, while the bovine type forms a fine, delicate and fre-
quently fenestrated pellicle upon which small nodular pro-
nite. 85. He tuberances develop in the course of time (Kossel, Weber &
cena ie ae Heuss). Then again, the mulberry shaped colonies which
cultureofthe develop after inoculation of small numbers of bacilli are
tubercle ba- characteristic of the bovine type.
aes ei On bile medium or on potato impregnated with 5%
weeks ol. glycerin bile, tubercle bacilli will develop only if obtained

from the same species which furnished the bile. Thus the
human type will grow only on bile medium produced from human bile
and the bovine type on bovine bile, the avian type on bile obtained from
fowls (Calmette & Guérin)..

 
Morphological and Cultural Differences. 507

_ Another difference observed between the two types under discus-
sion is that in cultures of the bovine type the acidity decreases until the
medium at times becomes alkaline, while media containing a growth of
the human type, though at first reduced in acidity, becomes more and
more acid with the age of the culture (Smith). According to Rothhaar,
Fibiger & Jensen this characteristic is inconstant.

These two types of bacilli, however, are not confined strictly to
definite species of animals, both types occurring in different species.
However, in the great majority of cases tuberculosis of man, dogs and
eats is caused by the human type and_ tuberculosis of cattle and other
ruminants and of swine is caused almost exclusively by the bovine type.

Tenacity. The tubercle bacillus is extremely resistant to external influences.
This is probably due to the waxy capsule by which it is protected. When exposed
to the direct rays of the sun they are Cestroyed in a few hours. In diffuse light
they will retain their virulence from 3 to 10 days (Fligge). Im artificial light
they are destzoyed in 48 hours (Galtier). Simple drying, especially when imbedded
in nitrogenous tissue or fatty medium has little effect on their vitality. Thus in
dry sputum protected from light they may remain virulent 126 days (Schill &
Fischer), in dry and pulverized tissue from cattle Jung 102 days, in large tissue
masses 150 days (Cadéac & Malet). Stone found that sputum was infectious after
three years. Decomposition affected their vitality very little. Thus decomposing
sputum harbors virulent bacilli for six” weeks (Schill & Fischer) and decomposed
cattle lung 167 days (Cadéac & Malet). In water, cultures remain virulent 70
days, in tissue 120 days.

The bacilli will remain virulent in raw milk for 10 days (Gasperini) at the
end of which period they probably succumb to the influence of lactic acid (Bollinger).
On the other hand they have been known to remain virulent 33 days in Emmentaler
cheese and 104 days in Cheddar cheese (Harrison). In sweet cream butter they
remain virulent 4 weeks. They are destroyed in the course of ten days in sour
cream butter containing 4 to 6% common salt. Sometimes 5 days suffice to destroy
them under these conditions (Petterson). On the other hand they have been known
to remain virulent 45 days in such butter (Schroeder & Cotton). . Treatment with
H,O, (‘‘Budderisierung’’) destroys the tubercle bacilli with certainty (Bergman
& Hultman). Kefir fermentation does not affect their virulence.

The influence of high temperatures varies according to the medium in which
they are found. Simple boiling or contact with live steam will destroy dry or moist
sputum in 5 or 15 minutes, respectively. On the other hand dry sputum can be
safely sterilized by the action of dry heat at 100° C. continued for one hour (Schill
& Fischer). In milk, bacilli which were originally present as well as bacilli which
have been added in cultures, are destroyed in 25 minutes when heated to 65° C.,
providing the milk was heated in a closed vessel (Forster). On the other hand
heating the milk in open vessels, which does not result in an equal distribution of
temperature throughout the mass, will not destroy all tubercle bacilli in the course
of six minutes, even if the temperature reaches 80° C. All bacilli found in the
film which forms on the surface of the milk are more or less protected from the
action of the heat (Galtier, Smith, Bang). According to Rabinowitsch & Beck
cream can be sterilized by heating for 2 minutes at 85° C. (Herr). According
to investigations of Barthel & Stenstrém bacilli will withstand an exposure of
80° or 85° C. when the milk is coagulated while they are destroyed in non-coagulated
milk at the same temperature. Thus pasteurizing at a temperature of 80° continued
for one minute will suffice to destroy the tubercle bacilli providing no coagulation
occurs. Freezing temperature of 1° to 8° C. will not destroy the bacilli in 120
days (Cadéac & Malet). ae rere . :

With respect to chemical agencies, bacilli occurring in albuminous substances
are most effectively destroyed by such chemicals as will not coagulate albumen.
Thus ecarbolie acid 5%, acetic acid 31.8%, or corrosive sublimate 1:1000—500 will
not destroy them (Schill & Fischer). Cultures are destroyed in solutions of 0.1%

‘tuberculin in 48 hours, 0.2% methylene blue, 0.1% pyoktannin in 72 hours (Jacob,

Bongert & Rosenberg); 0.2% thymol, 4% boracic acid and 4% creolin or lysol
are also effective. Brine and smoke have only a slightly destructive action, virulent
tubercle bacilli having been found in tuberculous organs after six weeks immersion
in brine (Klepzow). Glycerin acts as a preservative of tuberculous organs (Galtier).
Antiformin in solution of 15% does not affect tubercle bacilli or other acid-fast
bacilli while non-acid-fast bacilli are destroyed by this agent. On the other hand
20% solution of cholin will dissolve the tubercle bacilli at a temperature of 37°
to 56°. Neurine is even more effective (Deycke & Much).
508 Tuberculosis.

Gastric juice at 30° C. does not affect the bacilli in 3 to 4 hours. In the
course of 6 or 8 hours, however, their virulence becomes reduced and in 18 to 24
hours they are destroyed (Zagari, Strauss & Wurtz). Bile and pancreatic juice
do not affect them (Gallichi).

Pathogenicity. When susceptible animals are inoculated
subcutaneously with tuberculous secretions, tissue or virulent
cultures, there develops at the point of inoculation a tumor
which may break in the course of a few days, discharge a caseo-
purulent mass and develop into a sinuous ulcer. In some cases
the ulcer will heal and the process terminate; in other cases
the disease progresses. After a time the lymphatic glands
which are supplied by the lymph vessels of the affected region,
swell and become the seat of the formation of tuberculous foci,
which, in the course of time, undergo cheesy degeneration.
Following this the internal organs become affected almost
simultaneously, sometimes one after another along the lymphatic
circulation and at other times apparently independently through
the medium of the blood. Cutaneous inoculations (rubbing on
the scarified skin) usually produces only small rapidly healing
nodules (Chauveau). Sometimes, however, the neighboring
lymph glands become involved and a general tuberculosis may
follow (Courmont, Babes, Osman Nouri).

After intraperitoneal inoculation to which animals in
general are very susceptible, the peritoneum (especially the
mesentery) the abdominal lymph glands, the spleen and the
liver are attacked first. Adjacent organs may become involved
later. The most effective method of inoculation consists in
the injection of virus into the jugular vein. This is followed
by the development of innumerable tubercles in the lungs with
acute swelling of the lymphatic glands of the thoracic cavity.
Animals usually die in the course of a few weeks with symp-
toms of high fever and rapid emaciation. Sometimes other
organs are similarly affected. If inoculation is made in the
anterior chamber of the eye, typical tuberculosis develops in
the iris in the course of two or three weeks. This local affec-
tion is then followed by a general tuberculosis (Cohnheim,
Baumgarten).

The feeding or ingestion of pure cultures or of material
containing tubercle bacilli (sputum, milk tissue) to guinea pigs
or calves is followed either by tuberculosis of the peripharyn-
geal, cervical and mediastinal lymph glands and bronchial tubes,
or by an infection of the mesenteric lymph glands and the ab-
dominal] organs. The pharyngeal and intestinal mucous mem-
brane may remain practically healthy but on the other hand,
especially if the infection was severe, the tonsils may ulcerate
or the lymph follicles of the intestines may undergo tuberculous
ulceration. Old animals are only rarely affected by these means.

Inhalation of dry or pulverized tuberculous tissue or secre-
tions as well as culture sprays may be followed by tuberculosis
of the lungs and of the bronchial glands. The more finely the
infectious material is pulverized or divided the greater are the
Pathogenicity. 509

chances of infection. Inhalation through the mouth is more
effective than inhalation through the nostrils. The inhalation
of heavily infected air usually results in miliary tuberculosis
of the lungs, while slightly infected air may produce only
isolated tuberculous foci which develop into cheesy pneumonia
processes or cavities (Cornet & Mayer).

Infection also follows the injection of tuberculous material
into the vagina or its direct application to the mucous mem-
brane (Cornil & Dobroklonsky). Occasionally the first symp-
tom of infection is a swelling of the inguinal glands without local
changes. Finally direct application of virulent cultures to the
teats of the udder is followed by a progressive inflammation
of the milk ducts (Nocard, Nattan-Larrier).

Variations in the Pathogenic Effect of Tubercle Bacilli of Dif-
ferent Origin. The results of experimental infection vary considerably
according to the origin of the tubercle bacilli or of the material con-
taining them, as well as according to the age and the species of the
experimental animals. With rare exceptions the bacilli of the bovine
type possess a higher degree of virulence for mammals, including the
ape, than the bacilli of the human type. It seems immaterial, also,
whether the particular type of bacillus in question originates from one
species of animal or from another. The differences in the pathogenic
action are observed even in the guinea pig which is unusually suscep-
tible. These animals succumb much more rapidly to infection with the
bovine type than to infection with the human type (Smith, Gratia).
The difference in the results of these two types is much more marked,
however, in rabbits and in cattle. °

The difference between the two types in their effect on rabbits was
recognized by Villemin and later by Orth, Baumgarten, Vagedes, Smith,
Dorset, Kossel, Heuss, Rabinowitsch and others. According to Weber
this may be summed up as follows: The bacilli of the bovine type when
injected intravenously in 0.001 g. doses will kill rabbits in three weeks,
while the bacilli of the human type similarly administered produce at
first no conspicuous morbid symptoms, but in the course of several
months symptoms of chronic tuberculosis develop which affects chiefly
the articulations, the kidneys, the lungs and the testes. The bacilli of
the bovine type injected subcutaneously into the abdominal wall in
0.01 g. doses, (not under the fascia into the muscles) produce a lung
tuberculosis which terminates in death in a short time. The bacilli of
the human type will not: produce these results.

The effect of the two types of tubercle bacilli on cattle has, in
recent times, been the object of almost innumerable experiments. These
experiments as far as they have been limited to the use of pure cultures
have given comparatively uniform results, viz. that the bacilli of
the human type possess either a slight, or no pathogenic action what-
ever for cattle and that the bovine type, on the other hand, possess very
marked pathogenic properties with regard to cattle. Thus the subcutane-
ous injection of bovine bacilli, injection into the circulation or into the
peritoneal cavity usually produces severe progressive tuberculosis. Young
animals occasionally become affected in the same manner by the ingestion
of infected material. On the other hand inoculation of cultures of the
human type produce a local affection only or remain without any
pathogenic effect, This is particularly true if the dose of pure culture
B10 Tuberculosis.

is not excessive (not more than 4 cg.). The ingestion of such material will
produce local changes only in the mesenteric glands.

Kossel, Weber & Heuss, who experimented with 38 different strains of the
human type and with 27 strains of the bovine type, included in their experiments
a large number of cattle. Subcutaneous inoculation of .05 g. of culture produced
at first an inflammatory swelling at the point of inoculation which developed into
abscesses that broke and discharged their contents. This was followed by enlarge-
ment of the prescapular glands. When the bacillus of the human type was used
this swelling attained the size of a goose egg but was considerably larger in cases
where the bacillus of the bovine type was used, sometimes as large as a man’s
head. When the bacillus of the human type was used the process stopped at this
point and was followed by retrogressive changes. After seven months all bacilli
were destroyed. On the other hand the bacilli of the bovine type continued their
work of destruction and produced a progressive tuberculosis which, in 30% of
all cases ended in death in the course of 8 or 10 weeks. Feeding experiments
demonstrated that one feeding of bacilli of the bovine type sufficed to infect calves.
Of eight animals some of which were given one treatment, others repeated treat-
ments, four died in from 79 to 115 days. Post-mortem examination showed severe
lesions in the intestines and the regional mesenteric glands. On the other hand
all calves fed with glycerin bouillon cultures of the human type remained alive.
The bacilli which had been introduced into the intestinal canal were lodged partly
in the mesenteric glands where they gave rise to the formation of small yellow
calcified foci which had not caused any reaction in the otherwise normal tissue.
In the course of inhalation experiments it was shown that bacilli of the bovine
type introduced in this manner were exceedingly virulent. One mg. of bacilli was
sufficient to kill a calf four months old within 48 days. Following a period of
incubation of 12 to 14 days the animals were attacked with a high fever and
diffieult respiration. Four died in the course of 26 to 62 days with caseous pneumonia.
Four others were affected in the course of 110 to 174 days with pulmonary tuber-
culosis and tuberculosis of the adjacent lymph glands and serous membranes. On
the other hand the bacilli of the human type in these experiments produced no
tuberculous disease.

The difference in virulence is observed also where injections are made into
the milk ducts of cattle and goats. Thus tubercle bacilli of human origin produced
only a slight reddening lasting a few days, and attended with moderate sensitiveness
and swelling of the affected quarter. On the other hand the bovine bacilli produced
a pronounced tuberculosis of the udder and. mammary glands and, in addition,
probably as a result of an intoxication, rapid emaciation ending in death (Nocard,
Meyer, Calmette & Guérin, Zwick).

The differences in results referred to above apply only to charac-
teristic pure cultures. Since both types occur in man, inoculation ex-
periments with crude material, such as sputum, tuberculous tissue, etc.,
give varying results. However, these results correspond with the fact
that the human type is most frequently present in man, while the bovine
type is almost exclusively present in cattle. (For further information
on this subject refer to the chapter on the Relationship between Human
Tuberculosis and Bovine Tuberculosis. )

Results of experimental inoculations of other animals with morbid
secretions or tissue show, in general, that swine are readily infected
with either of the two types of bacilli, that sheep and goats are most
readily infected with material containing the bovine type and that dogs
may be infected with large doses of either the human or the bovine
type of bacillus (Titze & Weidanz). Other mammals possess a con-
siderable power of resistance to infection. Again, all avian species
with the exception of house birds (parrots), possess considerable resist-
ing power against infection with the bacilli of the mammalian types.

Infectious Secretions and Products. In the bodies of tuber-
culous animals the bacilli are, with the exception of miliary
tuberculosis, found usually only in the affected organs, and in
Infectious Secretions and Products. Ft

fact only in the diseased portions of these organs. They are
further found in the contents of body cavities and canals the
walls of which contain tuberculous ulcers or which may receive
pathologic products from other organs (e. g., lung secretions in
the intestinal canal). In so far as these canals connect with
the outer air, the secretions and excreta discharged through
their openings may contain more or less tubercle bacilli which
are thus disseminated (open tuberculosis, in contrast to enclosed
tuberculosis in which the bacillary foci do not communicate with
the outer air).

Even in slightly advanced cases of tuberculosis of the lungs
the bronchial secretions as well as the nasal secretions may con-
tain bacilli in varying numbers either at intervals or constantly.
The organisms may also be present in the saliva as a result of
an admixture of bronchial secretions with the secretions of
the buccal cavity.

Since animals usually swallow the secretions from the lungs
which are coughed up from time to time, these become incor-
porated with the contents of the intestinal canal and are found
unchanged in the feces. In addition to this source tubercle
bacilli which are discharged from intestinal uleers may be the
cause of infection of the feces, consequently the excretions from
animals with advanced tuberculosis are one of the most im-
portant factors in the dissemination of the disease.

The fact that tubercle bacilli may pass through the intestinal canal
without having their virulence impaired in the least, has been experi-
mentally demonstrated by Cadéac & Bourney. These investigators
inoculated rabbits with the feces of a cow that had been infected by
feeding tuberculous organs, and in this way produced tuberculosis in
nearly every ease. Even before this Zagari demonstrated that the feces
of dogs that were fed with human tuberculous sputum contained viru-
lent bacilli. The experiments by Ferranini demonstrating that gastric
juice containing 2% of free hydrochloric acid does not reduce the viru-
lence of tubercle bacilli in the least, in the course of 1 to 2 hours, are in
accordance with this fact.

Schroeder & Cotton emphasize the danger that exists in the feces of
apparently perfectly healthy cattle but which are in fact tuberculous.
They found that in a number of eases the feces of such animals contained
tubercle bacilli constantly for periods of months and years. The enor-
mous number of bacteria present in feces is indicated by the fact that
0.001 g. of such material will produce a fatal tuberculosis in guinea pigs,
the average quantity .of feces voided by a cow daily being 30 lbs. It
is evident, of course, that this infected mass of manure may easily con-
taminate the milk during milking.

In tuberculosis of the kidneys, especially of the pelvis and
in disease of other portions of the urinary apparatus, the urine
contains tubercle bacilli (Kallina); similarly tuberculosis of
the uterus, epididymis or prostate gland may cause the presence
of bacilli in the urine. In tuberculosis of the uterus, the vaginal
secretion, and in tuberculosis of the epididymis the spermatie
fluid may contain tubercle bacilli.
512 Tuberculosis.

In tuberculosis of the udder the milk is always infected,
sometimes to such an extent that 0.00001 g. of milk when in-
jected intraperitoneally into a guinea pig will produce a fatal
tuberculosis (Ostertag). Further, the milk from infected cows
which already show clinical symptoms of disease, may contain
tubercle bacilli even though the udder is apparently perfectly
healthy; since small tuberculous foci in the glandular tissue
could not of course be recognized by clinical examination. Re-
cent experiments have shown that cows in apparently perfect
health which reacted to the tuberculin test may discharge
tubercle bacilli with the milk. In such cases, of course, in the
face of all negative clinical evidence, the mammary tissue may
contain minute metastatic tuberculous foci; furthermore the
possibility cannot be refuted that tubercle bacilli may occa-
sionally gain entrance into the circulation from tuberculous foci,
be carried into the mammary glands and in this way pass into
the milk,

The infectiousness of milk from a tuberculous cow has frequently
been demonstrated since the time of Gerlach (1869). Aside from the
product of evidently diseased udders, in which case the milk almost
invariably contained tubercle bacilli in large numbers, Hirschberger
succeeded in producing tuberculosis in guinea pigs with milk from
clinically diseased cows with apparently healthy udders, by means of
intraperitoneal injection in 11 cases out of 20, Ernst in 26.8% out of
33 cases, Nocard 3 times in 54 cases.

As far as the use of milk is concerned coming from apparently
healthy cows which have reacted to the tuberculin test, the results of
experiments vary.

Ostertag was the first to conduct exact experiments to shed light upon this
subject. The milk from 49 reacting cows was collected in separate containers
with observance of every possible precaution, and injected intraperitoneally into
guinea pigs. The results show that not a single sample of milk contained tubercle
bacilli. On the other hand 14 inoculations of guinea pigs made from a mixture
of the above 49 samples produced tuberculous disease in one guinea pig. Feeding
experiments with this milk produced no positive infections. In a second experiment
the milk of 18 cows was used. In this case neither intraperitoneal injections into
guinea pigs, nor the feeding of the milk for several months to guinea pigs, swine
and calves produced tuberculosis. Similar results were obtained by Miiller and
Ascher who used the milk of 9 and 7 reacting cows, respectively, in experiments
with guinea pigs. From this Ostertag concluded that milk from merely reacting
cows contained no tubercle bacilli. ,

Bacteriological examination of milk of 5 head by MacWeeny and of 50
head of cattle by Stenstrém, some of which were clinically diseased, others affected
with latent tuberculosis but with healthy udders gave similar negative results.
Hessler obtained the same results with 61 merely reacting cows. Schroeder &
Cotton also are of the opinion that tubercle bacilli are excreted with the milk
only where the udder itself is diseased. Of 11 cows, 9 of which had generalized
tuberculosis and 2 advanced pulmonary tuberculosis, the milk proved virulent by
inoculation in 1.78% and by feeding in 0.68% of cases. These results might of
course have been due to subsequent infection of the milk.

On the other hand Gehrman & Evans found the milk virulent in 9 out of
41 reacting cows in spite of the fact that a post-mortem failed to reveal tuberculous
lesions either in the udder or in other internal organs. In 2 cows there were only
slight lesions in a few lymph glands. Ravenel demonstrated the infectiousness
of milk of 5 reacting cows none of which showed tuberculous lesions at post-mortem
examination. Mohler, of Washington, examined the milk of 56 reacting cows only
9 of which showed symptoms of tuberculosis after months of observation, and in
all cases the udder was perfectly normal. In 8 of the cows the milk proved to be
Infectious Secretions and Produets. 513

virulent in feeding as well as in inoculation experiments; in 3 cows, by inoculation
only; in one cow, by feeding only (guinea pigs used in this experiment received
80 to 120 cc. of whole milk daily for 2 to 3 months). Similar results were obtained
ty Moussu. The milk of tuberculous cows with clinically and anatomically healthy
udders gave positive results in 7 out of 57 guinea pigs that were treated. Calves
were also infected by feeding. Martel & Guérin examined 20 udders of slaughtered
animals; in all cases the parenchyma as well as the mammary glands were free
from observable lesions. The secretions of 4 of these udders proved infectious
for guinea pigs. Finally De Jong found virulent tubercle bacilli.in the milk
of 3 out of 10 cows with slight closed tuberculosis.

One reason which led Ostertag to conclude that a transmission of tubercle
bacilli into the circulation did not take place under normal conditions was that
the inoculation of a guinea pig with milk of a cow which had received a large dose
of bacillary material into the circulation 11 days previously, produced negative
results. The experiments of Prettner who made repeated injections of pure cultures
of tubercle bacilli into the circulation of 2 buffalo cows, and those of Coquot &
Césari who injected an emulsion of bacilli into the mammary artery gave similar
negative results. But Griffith demonstrated the infectiousness of milk in the course
of the first week after the subcutaneous injection of bovine tubercle bacilli; Titze
produced the same result with human tubercle bacilli. In one case they appeared
24 hours after the injection of the culture, in another they could be demonstrated
daily after the third week for 144 days and in some cases as late as 16 months
after the injection. As a rule they are excreted from one quarter of the udder
only, probably as the result of a focal infection without local symptoms. Smith
found that bovine as well as human bacilli injected intravenously into a cow,
appeared in the milk after a few days. The human bacilli appeared also in the
feces and the urine. The udder was not visibly affected in either case.

When we take into consideration that even animals with
a mild infection may at any time suffer an attack of the udder
through metastasis, and that neither the beginning of the attack,
nor the stage of the disease can be recognized by a clinical
examination, the claim that milk from merely reacting cows
may be dangerous is by no means groundless.

In milk of normal appearance tubercle bacilli when present are
evenly distributed. If the milk is coagulated, watery or flaky, the bacilli
are usually found mostly in the solid parts. If milk is allowed to stand
the bacilli have a tendency to collect in the cream. Similarly the cream
of separator milk and the walls of the centrifuge contain the bacilli in
the greatest numbers. im os

The milk of a single cow with an infected udder may infect a‘large
quantity of milk from healthy cows if added to it. For this reason the
milk from creameries or milk stations is so generally infected. Thus
Petri in Berlin found 14% of 64 samples infected ; Beck of the same city,
380% of 56 samples; Delépine & Niveau, of Manchester, 11.7% of 401
samples and 18.5% of 108 samples; Preisz, of Budapest, 13.8% of 58
samples; Eber, in Leipsic, 10.5% of 21 samples. Rabinowitsch found
that the milk from creameries which demanded the tuberculin test for
all dairies was free from tubercle bacilli, while on the other hand where
only clinically infected animals had been removed the milk was found
infected.

-Of course, milk from healthy animals may become infected with bacilli in
the process of milking. There is always abundant opportunity for this in infected
stables, especially where the floors and the bedding have been soiled with the
excretions and secretions of animals with open tuberculosis. Where stables are kept
in a generally unsanitary condition and where careful cleansing of the udder before
milking is disregarded, where the first few streams of milk are not discarded,
additional opportunities for infection are offered. Dirty milk utensils and soiled
bands of the milkers naturally play an important role in bringing about an infection
of the milk of otherwise healthy animals. :

Vol. 1-38
514 Tuberculosis.

In examinations made for the East Prussian Herd Book Association up to
July 1, 1907, by Miiller & Hassler, tubercle bacilli were demonstrated in 156. of
2,949 milkings from herds consisting of 30 to 200 animals each. The sources of
infection were afterwards found to be, the udder in 113 instances, the uterus in 17,
open lung tuberculosis in 20, pulmonary and intestinal tuberculosis in one instance.
In 5 cases open tuberculosis could not be demonstrated.

Until very recently the general impression prevailed that
the bacilli were rarely found in the blood and then only for
a short time after the discharge of a tuberculous focus, thus
especially in the beginning of acute miliary tuberculosis. This
view was based upon the experimental observations of Nocard
and MacFadyean according to which all comparatively large
masses of bacilli injected intravenously disappeared after a few
hours. In the meantime Neumann & Wittgenstein as well as
Bongert, showed that tubercle bacilli injected into the blood
could remain there for one month. More recent investigations
have shown that in the course of tuberculosis and even in the
very first stages of the disease, tubercle bacilli are by no means
infrequently present in the blood and can be demonstrated
by the microscopical examination of small quantities of blood.
In such cases providing they are not too abundant, an eruption
of miliary tubercles does not necessarily follow. Evidently the
animal organism has the power to overcome an infection by a
limited number of bacilli. Miliary tuberculosis seems to de-
velop only after an invasion of germs in large masses.

After Liebermeister called attention to the comparatively frequent occurrence
of tubercle bacilli in the circulating blood of consumptives, having demonstrated
their presence by guinea pig inoculations in 30% of the second stage cases and
in 60% of the third stage cases examined. Forsyth, Lippmann, Schnitter and
Rosenberger demonstrated their presence with the microscope. Booth showed
microscopically the presence of tubercle bacilli in the blood of two apparently
healthy cows suffering with pulmonary tuberculosis. On the other hand Schroeder
& Cotton in an examination of 42 cattle could not demonstrate bacilli in the blood
either with a microscope or by means of guinea pig inoculations. Ravenel and
McFarland arrived at similar negative results in the examination of blood of tuber-
culous human beings and expressed the belief ihat Rosenberger found acid-fast para
tubercle bacilli which are frequently present in Cistilled water. This question which
is of clinical importance is therefore, as yet, unsettled.

The muscles or flesh of tuberculous animals also contain
bacilli only in rare cases. When tuberculous masses (lymph
glands) are found between the muscles or when a general tuber-
culosis is present following an artificial intravenous injection,
the bacilli which are found in the muscles after a few days are
as a rule no longer virulent. The expressed juice from muscle,
even of badly infected cattle, is infectious only in exceptional
eases. Further, the demonstration of tubercle bacilli in such
cases has been possible only by intraperitoneal or subcutaneous
infection, while attempts to produce infection through feeding
experiments have all produced negative results.

Perroncito injected muscle juice obtained from tuberculous animals into the
peritoneal cavity of several hundred guinea pigs and rabbits with not a single.
positive result. Nocard demonstrated in this manner that the expressed muscie
juice of only one cow out of 21 with general tuberculosis was infectious. Galtier
Natural Infection. 515

found the expressed muscle juice of two out of 15 tuberculous cows infectious.
Kastners arrived at negative results in all cases as long as he confined his exper1-
ments to the muscle juice obtained from tuberculous cows at the abattoir of Munich
that were passed for beef. However, when he turned his attention to 7 cows, 6
of which had been condemned on account of advanced generalized tuberculosis, he
produced 5 positive results. According to this view, meat may contain bacilli when
the internal organs are affected with cheesy, purulent foci, while dry or calcified
lesions, do not produce infection. Swierstra found bacilli in the muscle juice of
7 out of 18 cows and of 2 out of 8 swine affected with advanced tuberculosis.
Bongert found the muscle juice virulent in 5 out of 13 cattle affected with softened
tuberculous foci. Hoefnagel arrived at negative results in cases of advanced chronic
tuberculosis and Westenhéfer obtained only one positive result of acute miliary
tuberculosis.

It seems that the feeding of meat from tuberculous animals produced positive
results almost exclusively at the time of the discovery of the tubercle bacillus (Gerlach,
Giinther, Harms). More recently only the reports of Forster & Brown give positive
results, while those of Galtier, Nocard, MacFadyean & Leclainche give results
similar to the earlier ones of Perroncito which had been negative without exception.
Vander Sluys also was unable to infect pigs by means of feeding large quantities
of muscle from animals affected with advanced tuberculosis, having produced only
one positive result and in that case only by adding tuberculous organs and bones
to the muscles.

Natural Infection. Observations in regard to the occur-
rence and dissemination of tuberculosis point to the fact that
under normal conditions tuberculosis is transmitted only after
prolonged exposure to the contagion, or after repeated infection
with the virus. It seems that a single light infection usually
produces only a local tuberculous lesion which terminates in
recovery and in addition increases the resisting power of the
individual to the disease. In other words, it produces a certain
temporary immunity. (For further information see chapter on
Pathogenesis. )

In the vast majority of cases infection occurs through the
medium of ingested food or of inhaled air.

In alimentary infection the milk of diseased animals fed
in bulk or suckled by the young is of the greatest importance.
In addition to this the skim milk obtained from skimming sta-
tions also plays an important role in the dissemination of the
disease. Skim milk is particularly infectious when the slimy
residue which collects in the separator bowl is added to it, as
this slime contains large masses of tubercle bacilli when infected
milk is centrifuged (Kjerrulf).

The infectiousness of milk containing tubercle bacilli bears an in-
timate relation to the occurrence of tuberculosis in swine which are fed
with skim milk furnished by skimming stations.

For example, in North America where swine were at one time fed almost
exclusively with grain, statistics for 1894-1895 show that of 13,616,539 swine
slaughtered in the larger abattoirs only 579 head were tuberculous, that is 0.0004%.
On the other hand in 1908 when skim milk from skimming stations came into
general use for the feeding of swine, the percentage increased to 2.05%. Of
35,113,077 swine that were slaughtered 719,309 were tuberculous. Thus the per-
centage of tuberculous swine has increased five thousand fold (Salmon). The
annual loss caused by tuberculosis in swine in the United States exceeds $3,000,000.
In some abattoirs of Holland (Amsterdam, Rotterdam) the disease is observed
in 10 to 15% of all slaughtered swine; in Denmark the disease was formerly present
in 15 to 18% of all swine; in Copenhagen 20% of all swine were infected
(Pederson); in Germany some shipments averaged 50 to 60%, and in Hamburg
516 Tuberculosis.

in one instance 90% of all slaughtered swine were found tuberculous. In Hungary
the disease is becoming alarmingly prevalent with the increasing practice of feeding
skim milk.

In an experiment conducted by the Bureau of Animal Industry at Washington,
87% of a number of swine that were fed for 3 days with tuberculous milk became
tuberculous within 3 to 4 months. When tuberculous milk was fed for 30 days
all animals in the experiment became infected with general tuberculosis within
50 days thereafter.

The danger in feeding milk containing bacilli to calves is shown
by the common experience that tuberculosis occurs much less frequently
in calves that are fed with sterilized milk than in calves that are per-
mitted to suckle their infected dams.

Finally tuberculosis occurs more frequently also in horses in those

“eountries where milk is used in the treatment of sick horses (MacFad-
yean.in England), or for food (Bang in Denmark).

Other food stuffs also and drinking water may act as the
carriers of the contagion when they are infected with the secre-
tions and excretions of tuberculous animals. Abundant oppor-
tunity for such infection is offered in all infected herds.

The feeding of tuberculous organs from slaughtered ani-
mals and the sputum of tuberculous persons are effective means
of transmitting the disease to carnivora and omnivora.

Infection by means of inhalation occurs most frequently
in stables occupied by animals affected with pulmonary tuber-
culosis. Slowly expired air from infected animals probably
contains no infection (Cadéac & Malet, Cornet). However, when
such air is expelled by coughing the minute particles of water
which are expelled with it may contain tubercle bacilli and,
similarly, particles of sputum that are thus forcibly expelled
will soil and infect the surroundings of diseased animals (Johne,
Bang, Frankel, Fliigge). Thus healthy animals standing in
stalls adjacent to those infected with pulmonary tuberculosis
are continually breathing infected air while the danger to other
animals in the same stables but farther removed from the in-
fected ones, is much less. As a matter of fact it is frequently
observed that, following the introduction of a diseased animal
into a healthy herd, the animals in the immediately adjacent
stalls are always the first to become infected.

Johne was the first to call attention to the importance of the small
solid or liquid particles which are expelled in the act of coughing. More
recently Fliigge and his pupils have shown that tubercle bacilli which
are expelled in the act of coughing, sneezing or even in the act of loud
conversation, will infect guinea pigs when properly exposed (spray
infection). The same results were obtained by Ravenel by exposing
guinea pigs to consumptive cattle in the act of coughing. The results of
numerous experiments made with sprays of pure cultures to produce
infection by inhalation conform with the former in demonstrating the
danger of the moist air of expiration. (See Pathogenesis.) On the other
hand the danger of dust infection (Cornet) or of air containing merely
dry particles of secretions is considerably less. Experiments with such
material gave negative results. Thus Cadéac obtained only 5 positive
Natural Infection. 517

results in 37 guinea pigs that were made to inhale dust produced from
sputum which had dried in the dark. A similar experiment with 11
rabbits gave negative results, while 36 guinea pigs and 8 rabbits which
were forced to inhale moist material in the form of a fine spray, all
acquired tuberculosis. Analogous experiments by Peterson gave similar
results, while investigations by Koehlisch showed that in inhalation of

a dry spray (dust) at least 50,000 bacilli must be inhaled in order to
produce tuberculosis.

The floor, food stuffs and air are liable to be infected with
bacilli particularly in dark, poorly kept and crowded stables
when the air is saturated with moisture which retards the
precipitation of the droplets expelled by coughing. (Ostertag
found that the air of a cattle stable contained a relative humidity
of 80 to 95%.) The danger of infection in such cases is in
direct proportion to the number of animals that are housed
together, because the larger the herd the greater the probability
that diseased animals are in it. The generally observed fact
that large herds of cattle are rarely free from tuberculosis
is in accordance with this statement as is also the fact that a
much larger percentage of small herds is found free from
tuberculosis. And this is true in the face of the further fact
that the sanitary arrangements, care, etc., of large stables is
usually much better than that of smaller stables (see p. 503).

In the open air the danger of infection is in general very
slight. The baciNi which are expelled with the expired air
of diseased animals are rapidly disseminated and are destroyed
in a short time after reaching the ground by the action of
sunlight. Accordingly tuberculosis is almost unknown among
animals that .are continually on pasture. The disease spreads
much more slowly in stabled animals if they are pastured a
greater portion of the time.

Infection through the act of copulation may occur when
the generative organs of either the male or the female are
diseased, in males especially the epididymis causing infection
of the seminal fluid, in females a tuberculous uterus causing
infection of the vaginal secretion.

Tuberculosis of the uterus may be produced in guinea pigs
by injection of cultures into the intact vagina. Observations,
though rare, confirm the possibility of this mode of infection
in domestic animals. Thus Franck observed tuberculosis of
the vagina in several cows that had been served by a bull with
a tuberculous penis. Similar observations are recorded by
Zippelius, Haarstick, Eber. Goerig and Schmidt record the
development of a primary tuberculosis of the epididymis follow-
ing copulation with infected cows.

The primary infection of the udder through the milk ducts
ean occur by the virus which is present on soiled litter gaining
entrance into the milk cisterns through the milk ducts where
it will propagate and disseminate (Bang, Modius, Schmidt-
Miihlheim, Conte, Alessandro).
518 Tuberculosis.

Infection from cutaneous lesions is exceedingly rare and
in such cases the disease usually remains localized or spreads
at most to the adjacent lymph glands (Lydtin, Johne). Much
greater danger as far as the source of infection is concerned
is presented by castration wounds, which are rather rare in
cattle (Bongert) but more frequent in swine as a result of the
application of milk or the infection of the litter with excre-
tions. Sometimes infection may follow. the application of
sputum to the wound by a consumptive operator (Tempel, Jahn,
Michael).

The mode of infection varies to a certain extent according
to the species of animal. Cattle, it seems, are always infected
by the products of diseased animals of the same species. Thus
ealves are usually infected by means of. infected milk while
older animals are infected by the ingestion of solid ‘food or
of contaminated drinking water or by the inhalation of infected
air. In horses tuberculosis usually begins in the alimentary
canal; occasionally this is produced by infected material derived
from tuberculous fowls (Nocard), but in most cases by infec-
tious material of human origin (Robert, Roder).—In pigs tuber-
culosis occurs in a vast majority of cases as a result of feeding
cows’ milk or whey. Feces of diseased cattle are next in im-
portance as a source of tuberculosis in swine, infection with
this material usually occurring by way of the pharynx or the
intestinal tract; a pig with diseased teats may infect its young
while suckling; and finally the inhalation of tubercle bacilli is
probably also an occasional cause.—Sheep and goats are prob-
ably always infected by diseased cattle-—The infection of dogs
and eats usually stands in causal relation with tuberculosis in
man. Asa rule pet dogs become infected by licking the sputum
of their consumptive owners or by inhaling infected air, while
cats have become infected by the ingestion of infected milk.
(The tuberculous dogs examined by Petit came, for the greater
part, from poorly kept saloons and coffee houses which were
much frequented by laborers.)

Susceptibility to tuberculosis varies according to the species
of animal. Among domestic animals cattle and swine are most
susceptible to artificial infection while other animals possess
much more resistance. The natural resistance of any species of
animal may be overcome by intensive and repeated infection.
In reality, however, buffalo, horses, sheep, goats, dogs and cats
acquire tuberculosis only rarely in spite of their frequent ex-
posure to diseased cattle or human beings.

The frequency of tuberculosis among the different species of domestic animals
is shown in statistical tables furnished by slaughter house reports (see page 502).
—Among buffalo the disease appears to be less common in Russia than it is in Hungary
where, at the abattoir of Budapest, it is sometimes found in 0.9% of all slaughtered
animals. Kanzelmacher found only 5 head infected among 2,715 buffalo slaughtered
at Tiflis, i. e., 0.02%.—Among asses Blane, Pleindoux and Nocard each observed
one case of tuberculosis. The fact’that this disease seems to be so rare in this
species may be due to the small number of observations, at least. Stockmann,
Susceptibility to Tuberculosis. 519

Chauveau and Arloing have demonstrated that asses may be readily infected by
intravenous injection of tubercle bacilli.

Among dogs and cats tuberculosis is particularly frequent in large cities.
Thus Fréhner found 27 tuberculous dogs among 62,500 patients observed in the
ambulatory clinics in Berlin, that is, 0.099. Johne and Eber in Dresden found
11 out of 400 dogs tuberculous and but one among 100 cats. Jensen in Copenhagen
found in the course of 2 years 5.7% of tuberculous animals among 28 dogs and
25 cats; Petit & Basset in Alfort found, among 2,717 dogs examined, 152 infected
with tuberculosis.

The breed of an animal may influence its susceptibility
to tuberculosis. The fact that tuberculosis occurs more fre-
quently in some breeds than in others is due in a great measure
to the different conditions under which they may be kept or
the uses to which they may be put. Cattle from the Russian
steppes, for example, become infected just as readily as the
more domesticated breeds when they are removed from pasture
and fed in stables (working oxen!). On the other hand the
young animals of the latter breeds on mountain pastures are
much less frequently affected with tuberculosis than animals
raised in barns. However that may be, a greater resistance
to artificial infection can be demonstrated to exist in the cattle
of the steppes and, according to Kitasato, in the Japanese
breeds of cattle. The observation that the breeds of the low-
lands are more generally affected than the breeds of moun-
tainous regions is explained by the fact that the former, on
account of their greater milk producing capacity, constitute the
large dairy herds and are kept in stables of large estates and
of dairies where they are milked as much as possible (Roeckl,
Bongert).

In the municipal abattoir of Budapest, in the years 1899-1902 the percentage
of tuberculous cattle among the gray breeds of the plains did not exceed’ 0.23%
and among the cows of the Hungarian breeds, which are also kept out of doors
the morbidity was 4.0 to 6.1%. The Hungarian working oxen, on the other hand,
that had been kept in stables for several years and at work were tuberculous to
the extent of 13.6-18%, while of the cows of the colored breeds 14.8-17.2% were
tuberculous. According to Kitasato the native Japanese cattle, under normal con-
ditions, are free from tuberculosis while imported breeds and cross breeds frequently
acquire the disease. The injection of highly virulent tuberculous material into
52 native calves and 19 calves from these cross breeds showed that the native
cattle withstood the subcutaneous injections without harm and that they could
be made seriously ill only by means of intravenous or intraperitoneal injections.
Similarly, Hutyra found that calves of the Hungarian long horned breeds were
difficult to infect by the inhalation of bovine tubercle bacilli in contrast to the
easy infection of the calves of the ordinary colored breeds.

Individual susceptibility is not the same in all animals of
the same susceptible breed. In large herds where the disease
has been thoroughly established, certain animals are always
found that may be perfectly healthy and live to a considerable
age, although they are constantly exposed to the same danger
of infection as their mates. In experiments of artificial in-
fection also it is noted that among animals of the same breed
and age some resist infection with large masses of virulent
bacilli. This individual immunity may be congenital, or it may
be acquired in the sense that the animals in question may have
520 Tuberculosis.

suffered a slight or passing attack of the disease and thus
acquired a certain immunity which was later perhaps intensified
by repeated infections at longer or shorter intervals of time.
The dissemination of tuberculosis was formerly explained
by assuming special individual and a family predisposition.
In human beings this was supposed to find expression in a
lymphatic constitution; and in an improper development of the.
thorax (flat and norrow chest, habitus phthisicus). As far as
our domestic animals are concerned there is no foundation upon
which to base such a supposition and the great regularity with
which we find the disease in all large herds points against the
correctness of this view. It is true that the disease is especially
prevalent in certain families or strains but this may readily be
explained by the uniformly favorable conditions for infection.

Formerly individual predisposition was supposed to be due to a
slight power of resistance on the part of the body to the tuberculous virus
as well as to an unfavorable constitution and to hypoplasia of the blood
vessels. According to Baumgarten tuberculosis of human beings is
usually congenital in the sense that the offspring is born with tubercle
bacilli in its system, where they remain latent until they develop and
produce active disease perhaps only after years under the deleterious
influence of various agencies. Tuberculosis of the lymphatic glands and
of the bones especially was supposed to originate in this manner.

The existence of such long-continued latency is contradicted by the
common observation that the human body is, especially in its earliest
infancy, highly susceptible to tuberculosis and that the disease then as
a rule runs a rapid and fatal course. According to Behring the pre-
disposition to tuberculosis is attributed to an infection in early youth,
resulting in disease of the lymph glands (scrophulosis) which, by the
destruction of certain lymphatics and their glands and the production
of changes in the walls of blood vessels, produces a hypersensitiveness to
tuberculin, and that involvement of the thoracic lymph glands gives
rise to an abnormal development of the thorax by affecting the sternal
articulations. According to this view an individual predisposition would
not be congenital but rather acquired and could be guarded against by
the preventing of extra-uterine infection in early life. But this view
must be objected to on the same grounds as the former. As a matter of
fact, we can not as yet offer a satisfactory explanation for individual
predisposition, the existence of which cannot be denied.

After careful study of the herd registers | of the estate Weidlitz, covering a
period of 59 years, Hermann concluded that in all cases of tuberculosis in this
herd one of the following predisposing causes could be established; late born
ealves in large families, lack of fresh air and of proper exercise, inbreeding,
tuberculous parents.

Heredity plays no very important role in predisposition
nor in the dissemination of tuberculosis in general. Although
tuberculosis may he directly transmitted from the mother to
the unborn calf, as has been demonstrated by the actual ob-
servation of well developed disease in the newborn animal, such
cases are very rare and occur only when the uterus itself or
the cotyledons are diseased. Aside from this, animals born
Heredity and Predisposition. 521

tuberculous do not live and are frequently born prematurely.
Calves several weeks of age are rarely found affected with
tuberculosis and among slaughtered calves the percentage of
diseased animals usually does not reach 14%, while tuberculin
tests even in badly infected herds rarely reveal more than 10
or 15% of infected animals under 6 months, in spite of the
fact that these animals have had abundant. opportunity to be-
come infected. The most convincing proof against the effects
of heredity in the transmission of tuberculosis is furnished by
the fact that the offspring of tuberculous cows remain healthy
and free from tuberculosis if properly guarded against infection
after birth.

The first case of hereditary tuberculosis was established by Johne when he
demonstrated tubercle bacilli and tubercles in the lungs and liver of a fetus eight
months of age. Since then similar cases were reported by others (Csokor, Nocard,
MacFadyean, etc.). Up to the year 1909 Albein had compiled reports of ‘107 similar
cases, 91 of which were unquestionable. At a later date Héyberg reported 6 cases
of congenital tuberculosis among 500 calves examined immediately after birth and
Bergman reported 108 personally observed cases, among them 4 fetal ; the others
in calves not exceeding three days of age. These were observed during the years
1904-8 in the abattoir of Malmoe (0.42% of all slaughtered calves).

Among slaughtered calves up to five months of age, Klepp of Kiel found
0.64-1.18% tuberculous. In a badly infected region of Jiitland, in Aarhus, Knudsen
reported 0.3% to be tuberculous. Stroh’s estimates for 1901 and 1902 gives for
Bavaria the following figures: For every 100 tuberculous slaughtered cows, 6-7
tuberculous calves; for every 100 cows with advanced tuberculosis, twenty-five
tuberculous calves, but some of these were evidently cases of extra-uterine infection
(see statistics on page 502).

In the course of his tuberculin test work in Denmark, Bang found among 24,267
calves under six months, 10.6% tuberculous. The author’s own observations on 544
calves under six months showed 59 tuberculous, that is, 10.8%. In one badly infected
herd 15 out of 48 calves or 31.2% reacted. In calves of this age, however, the
resilts of extra-uterine infection are already evident. because according to Nocard
and Bang the percentage of reactions does not exceed 5% during the first few
weeks of life, the authors themselves have observed that in one herd where 44.8%
of all cows were infected only one out of 64 sucking calves gave a positive tuberculin
reaction (1.6%).

In congenital tuberculosis of calves the periportal lymph glands are
always involved. Next in frequency are the liver, the mediastinal and
the peribronchial glands, then the lungs and, in exceptional cases only,
other organs (Klepp, Rievel). This localization points to the fact that
infection takes place in a late stage of embryonic existence, through the
placental circulation from the dam. (Bang is of the opinion that
isolated tuberculosis of the posterior mediastinal glands has the same
origin.) In regard to the rare occurrence of congenital tuberculosis
compared with the comparative frequency of tuberculosis of the uterus
of cattle, it is probable that infection of the foetus occurs only in far
advanced tuberculosis of the uterus or if the cotyledons and chorion villi
are affected (Kockel and Lungwitz have demonstrated tubercle bacilli
in the villi of the chorion and Burgmann, demonstrated them in three
instances in the placenta).

Without disease of the placenta or the fetal envelopes it would
hardly be possible for the bacilli to pass from the mother to the fetus.
Although Ravenel and Bucher each reported a case of congenital tu-
berculosis in the calf where the uterus of the dam was healthy, very
slight tuberculous changes could certainly have escaped macroscopic
observation.
522 Tuberculosis.

The possibility of a conceptional or germinative transmission of tuberculosis
has never been demonstrated and is, in addition, highly improbable. Tubercle
bacilli have never been found in a germinal vesicle or in the egg. Besides, infection
of the egg would result in its destruction before it could mature. It is true that
Maffucci, and later Baumgarten, found that in hens’ eggs, that were infected
artificially into the white with avian tulercle bacilli, normal cell division took
place and occasionally the embryo developed completely. However, what has been
found to be true for the meroblastic chick egg does not necessarily apply to the
egg of the mammal because infection did not take place directly in the egg cell
but in the surrounding albumen and consequently the tubercle bacilli would still
have to pass through the area vasculosa, the analogue of the placenta, before they
could reach the embryo (Wassermayer, Bongert). However, the chicks hatched
from eggs thus artificially infected always died of tuberculosis after a short time.

While in tuberculosis of the urino-genital tract, and especially in tuberculosis
of the epididymis tubercle bacilli are frequently present in the spermatic fluid,
infection of the ovum could occur only by the simultaneous introduction of a
bacillus with the spermatozoon into the ovum (bacilli have never been demonstrated
in spermatazoa). These theoretical conclusions are in harmony with the results
obtained from actual experiments. Gaertner, Cornet and Hansen never succeeded
in their attempts to infect the offspring of rabbits or guinea pigs by the previously
infected male.

The frequency of the disease bears a close relation to the
age of the animal. Young animals are in general more sus-
ceptible than older ones, yet the disease is more frequently met
with in the latter for the reason that they have been exposed
to infection for a longer time. As a matter of fact the per-
centage of morbidity increases gradually from the suckling
period, year after year, and in cattle more than 50% of all
cases, as revealed by the tuberculin test or in the abattoir, are
found in animals over six years of age.

In the abattoir of Budapest in the year 1899, 9,046 tuberculous cattle were
classified as follows: 3 at 3 to 4 weeks, 1 at 5 months, 4 at 7 to 9 months, 12 at
one year, 39 at 2 years, 81 at 3 years, 118 at 4 years, 326 at 5 years, 1,223 at
6 years, and 7,239 over 6 years (among the latter 5,173 Hungarian draft oxen).
In Denmark, according to Bang, 40,624 cattle (1898-1904) gave the following results
after first tuberculin tests: of 5,559 calves under six months, 12.1% reacted; of 7,744
cattle from 6 to 18 months, 27.5%; of 5,047 head from 18 to 30 months, 38.6%;
of 10, 350 head from 2% to 5 years, 44.9%, and of 11,924 cattle over five years, 48%
reacted. Of the latter 79% were already infected at the age of two years. In
Norway, according to Malm the tuberculin reaction in calves under 6 months reached
1 to 2%; at 6 to 12 months, 1.5 to 3.4%; in 1 to 5 year old cattle 4.3 to 7.9%,
and in still older animals 5.6 to 10.4% reacted. Naegeli reports similar conditions
among human beings; 1 to 5 years gave 17% of reactions; 5 to 14 years, 33%;
14 to 18 years, 50%; 18 to 30 years, 96% of reactions.

The sex influences the prevalence of tuberculosis only in
as far as it affects the conditions under which the animals may
have been kept. The disease is most prevalent in dairies com-
posed of cows of the more domesticated breeds. Among these we
frequently find from 70 to 80% and more, of reactors. Steers and
bulls of these same breeds, which are rarely allowed to reach the
same ages, give a much lower percentage. Compared with
these figures the percentage among the gray cows and bulls
of the steppes which are kept mostly in the open air are much
lower than in stable-fed oxen of the same breed that are worked
for years (see p. 519).

In the German Empire the frequency of tuberculosis was found in the abattoirs

as follows: Oxen 20.04%, bulls 15.82%, cows 27.13%, yearlings and young cattle
6.2%, calves 0.30%. In the abattoir at Budapest in 1903 the following results were
Predisposing Influences. 523

obtained of the steppe-breeds: Bulls 4.40% tuberculous, oxen 16.84%, cows 5.39%;
while the colored breeds gave the following results: Bulls 3.92%, oxen 6.98% and
cows 22.61%.

Hixternal influences which reduce the vitality of the animals
and the resisting powers of the tissues in general favor the
development of tuberculosis. This applies particularly to damp
and poorly ventilated dirty stables and to lack of exercise in
the open air. These two factors alone tend to produce super-
ficial breathing and catarrhal conditions of the respiratory tract
and thus they produce a local predisposition, which is increased
by the collection of secretions in the bronchial tubes. In addi-
tion to this close stabling affords more abundant opportunity
for infection from diseased animals, especially when frequent
purchases are made from suspicious sources.

The predisposing influence of catarrhal conditions of the air pas-
sages is particularly striking in cattle that are kept in the vicinity of
sulphur and arsenic mines and smelters. In these animals the inhalation
of the smoke from the works, which contains arsenious acid, causes a
eatarrh of the air passages and then pulmonary tuberculosis (which used
to be known as smelter smoke pneumonia) usually spreads very rapidly
(Siedamgrotzky, Johne, Pfeifer). In this connection the experiments of
Cadéac & Malet deserve mention. They succeeded in producing pul-
monary tuberculosis in rabbits by the inhalation of dust contaminated
with tubercle bacilli only in such cases where the respiratory tract was
previously irritated with fumes of bromine; also the experiments of
Plate according to which irritation of the intestinal mucous membrane
of guinea pigs with croton oil favored infection of the intestines with
tubercle bacilli in 80% of the animals.

Insufficient and improper feeding with food deficient in
nutrients (distillery slops and factory refuse) and over-exer-
tion or excessive milk production are also predisposing factors
by weakening the organism. ;

Tuberculosis frequently develops after acute inflammation
of the lungs. The diseased lung tissue and the incompletely
absorbed exudate constitute a favorable medium for the develop-
ment of tubercle bacilli. In other cases an attack of acute
disease weakens the body and prepares the soil for a renewed
and successful attack of an existing, but dormant, tuberculous
process. Finally the shedding of the milk teeth probably favors
in young animals, especially in pigs, infection through the
buccal cavity and the development of tuberculosis of the cervical
lymph glands.

Pathogenesis. The principal ports of entrance for the tubercle
bacilli are doubtless the respiratory and digestive tracts. It is an open
question, however, as to which channel is of greater importance in nat-
ural infection. .

The fact that in man as well as in animals the lungs and the ad-
jacent lymph glands are, in the vast majority of cases, affected either
alone or in conjunction with other organs or parts of the body had
524 Tuberculosis.

always pointed to the apparently well founded conclusion that the lungs
constituted the principal primary seat of infection. Infection was sup-
posed to be brought about by the inhalation of air contaminated with
the virus. It was assumed that the bacilli entered the finest ramifications
of the bronchioles and alveoli, producing a broncho-pneumonia, or that
they were taken up by the leucocytes from the mucous membranes. of
the larger bronchioles and transported to the bronchial glands through
the lymph vessels where they gave rise to the development of tubercles.
From these glands they were supposed to pass into the lungs by way
of the blood stream and produce interstitial tubercles.

This view of the possibility of an ‘‘inhalation tuberculosis’’
was based upon positive experimental evidence which, in fact
was obtained by making small animals inhale sprays of tuber-
culous material (Cornet, Fluegge, Petterson, Baumgarten,
Ribbert, Cadéac and Malet, and others). Similar results were
obtained in cattle (Ravenel, Kesselmann, Nocard &*Rosignol,
Kossel, Weber & Heuss, and others); also in goats (Reichén-
bach) and dogs (Tappeiner). In all these experiments tuber-
culosis of the thoracic organs and especially of the lungs was
produced. (See also page 508). During the past few years the
value of these experiments has, however, been questioned.

In the first place it was pointed out that tubercle bacilli
thus inhaled were precipitated on the mucous membrane directly
posterior to the nasal openings or in the diverticula of the
anterior portion of the respiratory tract, thus never gaining
entrance to the deeper-lying portions of the respiratory tract
and that the lungs, in these cases, had to become infected by
_absorption of the bacilli into the lymphatic and blood vessels
which transported them to these organs. (See p. 526). This
objection was met, partially at least, by Fluegge & Heymann,
more recently also by Bartel & Neumann, as well as by Kuss
who experimented with guinea pigs, and Weber & Titze who
used calves in their experiments. They showed that imme-
diately after the inhalation of infected sprays even the most
peripheral portions of the lungs contained tubercle bacilli (al-
though only few). In calves they were demonstrated on one
occasion each, in the middle and posterior lobes of the right
lung. Similar results were obtained with bacillus prodigiosus
by Hartmann & Hartl and with mold fungi by Hildebrand and
Ballin. -Kuss showed that soot and fine particles of pigments
(India ink) also reached the finest bronchioles by means of the
inhaled air. Anthracosis is undoubtedly caused by direct in-
halation, although this statement is opposed to the view of
Vanstenberhe & Grysez.

The important role played by inhalation is emphasized by
the fact that minimum quantities of virus (50 bacilli in guinea
pigs) are sufficient to infect experiment animals while for in-
fection through the alimentary canal, masses a hundred thou-
sand times as great are necessary (Findel). Recently Weber
& Titze showed the same to be true with calves, viz., that in-
Infection by Inhalation. 525

fection with tuberculosis resulted after inhalation of 0.01 mg.
while infection through the alimentary tract required 10 mg.
of tubercle bacilli culture.

In view of these results we can no longer doubt the possi-
bility of inhalation tuberculosis. As to the practical importance
of this mode of infection, we must remember that comparatively
few bacilli reach the terminal ramifications of the bronchial
tubes through the medium of ordinary infected air and also
that the body is provided with natural means to protect itself
against even considerable quantities of virus. Another fact
that should receive due consideration in this connection is that
it is only with difficulty that calves are infected by means of
intratracheal injections, even of large masses (10 ec. bacillus
emulsion) of virus.

The question as to whether an infectious inhalation produces pul-
monary tuberculosis primarily by aerogenous infection, or secondarily
by lympho-hematogenous infection is yet an open one. While some
authors believe that the inhaled bacilli give rise to the development of
the first tubercles in the nucous membrane and its lymph follicles (Zieg-
ler, Ponfik, Schmorl, etc.), others (e. g., Orth, Ribbert and Baumgarten)
believe that the bacilli are immediately absorbed by the mucous mem-
branes and deposited in the bronchial glands from where they reach
the lung tissue and the walls of the bronchial tubes through the lymph
and blood circulation. The tubercles and cheesy foci which here de-
velop are then supposed to give rise to a tuberculous bronchitis and
broncho-pneumonia.

This view is especially applicable to pulmonary tuberculosis of
domestic animals. According to Bongert the first tuberculous changes
in the lungs of cattle are observed in the posterior lobes to which places
tubercle bacilli would be most apt to be carried first. This is due to the
fact that the pulmonary artery passes in a straight direction from its
point of entrance toward the base of the lung, while the artery for the
anterior lobe branches off at an angle in a more or less opposite direction.
In a direct infection from the inhaled air the anterior lobes would natur-
ally become infected first because the origin of the bronchial branch
supplying this lobe as well as that of the first. branch of the main bron-
chus, according to Baerner, is situated at the lowest point of the main
bronchus. «Consequently material inhaled with the air, especially finids,
is drawn principally into the anterior lobes of the lungs. Pigs often
aspirate food particles into the lungs, and hence the fact that the most
pronounced lesions of tuberculosis are usually met with in the anterior
lobes accords with the above explanation. (In human beings, for reasons
as yet not satisfactorily explained, the superior apical lobes are affected
most frequently.) —

The great frequency of pulmonary affection does not in
itself, however, prove that the infection takes place with the
same frequency by way of the respiratory passages. Recent
experiments have shown beyond question that the lungs as
well as the thoracic lymph glands may be infected from the
digestive tract. Chauveau was the first to call attention to this
possibility (1868-1872). The latter fed tuberculous material to
526 Tuberculosis.

young cattle and produced exclusive infection of the broncho-
mediastinal lymph glands. Klebs, in 1884, supported this view
when he referred to the meat and milk of tuberculous cattle
as the commonest source of infection for human beings. Orth
(1887) emphasized the importance of intestinal infection as a
source of pulmonary tuberculosis. This question came into
particular prominence through Koch’s well known address at
the London Tuberculosis Congress (1901) and more so through
the position assumed by v. Behring (1903), according to which
the principal cause of tuberculosis was intestinal infection of
nurslings, while inhalation tuberculosis was of wholly secondary
importance, and which asserted that when this form appeared
to exist the infection usually resulted through the lymphatic
vessels of the naso-pharyngeal or intestinal mucous membranes,
thus being after all an intestinal infection. Following this a
great number of experiments were conducted by Weleminsky,
Ravenel, Kovacs, Calmette & Guérin, Vallée, Weichselbaum and
others which threw more light upon this mode of infection and
led many to regard it as the most frequent.

Formerly a primary intestinal infection was not admitted
unless the peripharyngeal lymph glands or the intestine and
the mesenteric glands were the exclusive or at least the principal
seat of disease. In direct contrast to this view experimental
feeding of tuberculous material showed that tubercle bacilli,
especially when introduced in small quantities per os, would
pass through the intact mucous membrane of the intestine and,
without necessarily lodging in the lymph glands along their
path, would pass, in part at least, to the glands in distant regions
of the body or even directly into the blood vessels and be
finally carried to the lungs where they produced a primary
pulmonary infection with all the appearances of an inhalation
tuberculosis. The usual course taken by the bacilli is then,
on the one hand, from the pharyngeal region through the cervical
lymph vessels to the broncho-mediastinal lymph glands and on
the other hand from the small intestine, especially the posterior
portion of the ileum by way of the lymphatics to the mesenteric
glands, through the latter to the thoracic glands or, through the
thoracic duct directly into the pulmonary circulation.

Behring produced characteristic inhalation tuberculosis in guinea
pigs by injecting cultures into the tissue of the tongue. The submental
glands became affected first, following these, the cervical and then the
mediastinal glands. Later, the virus reached the bronchial glands
through the blood vessels. The subpleural ramifications of the pul-
monary artery then carried the virus to the lung tissue where miliary
tubercles developed.

Weleminsky and Kovacs fed young guinea pigs repeatedly with 0.1
mg. of culture per 100 g. body weight and after a few days found the
bacilli on the one hand in the submental, submaxillary and cervical
glands and, on the other hand, in the ileo-caecal, mesenteric and portal
glands. These results agree with those obtained by Behring. Calmette
& Guérin introduced tubercle bacilli (0.1-1.0 g.) partly through a tube,
. Infection by Inhalation. 527
partly with the food, into the digestive tract of guinea pigs, goats and
cattle. In the older animals, whose lymph glands, on account of their
less dense structure allow an easier passage of the bacilli the thoracic
organs were frequently found affected exclusively. Occasionally the
bronchial glands also were involved. The younger animals showed af-
fection of the mesenteric glands. In old animals bacilli could be found
in the lungs twenty-four hours after alimentary infection had been
produced, -while in young animals they could not be demonstrated until
after the fifth day. Vallée obtained similar results by feeding infected
milk and by direct injection of the bacilli into the mesenteric glands.
Orth & Rabinowitsch got the same results from endorectal infection.
DeHaan injected tubercle bacilli into the stomach of a heifer and three
months later demonstrated a pronounced tuberculosis of the lungs and
pleura, but found the intestinal mucous membrane and its lymph’ fol-
licles intact.

The experiments of Ravenel as well as those of Nicolas & Desco
demonstrated the rapid transmission of tubercle bacilli from the intes-
tine to the thoracic organs. They fed cultures in butter, warm water,
pastry and in soups. Three or four hours later bacilli were present in
the thoracic duct. Bisanti & Panisset demonstrated the presence of
tubercle bacilli in the blood five hours after they had been ingested.
Orth &. Rabinowitsch injected an emulsion of bacilli into the rectum,
Oberwarth & Rabinowitsch injected the bacilli into the stomach of a
pig and in both instances the germs were afterwards found in the cir-
culating blood.

That tubercle bacilli may and do pass through healthy mucous
membranes has been amply demonstrated on healthy animals by num-
berless feeding and inhalation experiments with material which was
mechanically and chemically innocuous. The experiments of Dobrok-
lonsky among others showed that the mucous membranes might remain
perfectly unharmed during this process (although Baumgarten, on the
other hand, holds that the mucous membrane always suffers by the en-
trance of bacilli into its lymph follicles, especially in the intestinal
mucous membrane).

Although there is no doubt that an infection of the respira-
tory organs may follow an intestinal infection, or result from
one, the fact that the former are by far the most frequent
seat of primary disease must be explained by their greater
susceptibility. This is especially true of the lungs, thus ex-
plaining the fact that these organs, no matter what the mode
of infection, are usually more intensely involved than any
other part of the body. Occasionally we find the development
of an isolated tuberculosis of the lungs following the injection
of virus into-the subcutis or into other remote organs. Thus
we may justly consider the lungs as far as infection with tuber-
culosis is concerned, as a locus minoris resistentiae (Cohnheim,
Orth, Baumgarten, Bartel). In regard to the frequent affection
of the lymphatic glands it is significant that these constitute
a close filter for corpuscular elements, especially in young
animals, and that they arrest a considerable portion of tubercle
bacilli which are in the lymph stream, and which then in spite
of the bactericidal action of the lymph elements (Manfredi,
528 Tuberculosis. :

Bartel, Fontes and others), can more easily give rise to the
pathological process, on account of their great numbers, than
is possible in other organs.

The great predisposition of the lungs for tuberculosis is further
emphasized by the fact that aerogenic infection results exclusively in
pulmonary affection. According to Neumann & Wittgenstein this pre-
disposition is explained by the absence of certain ferments which have
the power of splitting or reducing fat molecules. Baumgarten observed
the development of pulmonary tuberculosis after the introduction of
small quantities of bacilli into the bladder of rabbits. Bartel saw pul-
monary tuberculosis develop after intraperitoneal infection. Schroeder
& Cotton produced pulmonary tuberculosis in cattle and swine by sub-
cutaneous infection at the tip of the tail. Vallée got the same result
after injection of a culture into the milk cistern of a cow’s teat. In
the latter case not only the lungs but also the supramammary, the
abdominal and the broncho-mediastinal glands became involved. It is
important to note that intravenous or peritoneal infection of goats and
rabbits causes the development of isolated pulmonary tuberculosis with
the formation of cavities, especially when the susceptibility of these
animals was previously reduced.

Weleminsky attempts to explain the frequent primary affection of the bronchial
lymph glands by the intimate relationship existing between these glands and the
entire lymphatic system. These glands constitute a sort of ‘‘heart’’ into which
lymph vessels from all directions pour their contents which are then carried through
the broncho-mediastinal trunk into the subclavian vein. The correctness of this
view has never been demonstrated as far as guinea pigs are concerned and, as
to other animals, it is at best questionable. However, these glands are also readily
infected following intravenous or intraarterial injections of virus (Baumgarten).
It has been observed that in calves infection by these methods usually results in
the development of pronounced lesions of these glands as well as of the lungs
proper.

In regard to the transportation of tubercle bacilli from Waldeyer’s
ring Behring is of the opinion that they give rise to the first lesions
in the superior cervical glands and then travel through the lymph ves-
sels to the bronchial glands and the lungs. In opposition to this view,
Bongert, Beitzke and Devrient point out that the lymphatic system of
the head and neck is entirely separate from that of the lungs and its
glands and that the bacilli from the diseased subparotideal and sub-
maxillary lymph glands pass from the great lympathic trunk into the
vena cava, thence, with the blood, to the lungs and the bronchial glands
(especially common in swine). The tonsils play no important role in
this process, especially not in cattle. With their abundant supply of
lymphoid cells they would rather act as a protection. However, should
the bacilli successfully pass through them they would cause changes in
the retropharyngeal glands (Devrient).

Isolated tuberculosis of the lungs and of the broncho-mediastinal glands in
eattle is frequently observed in abattoirs. Thus, in the abattoir of Budapest in
the years 1898-1901, of 46,092 cases of tuberculosis in cattle, 40,306 showed affection
of the lungs only, including the peribronchial and mediastinal glands. In about
one-third of the cases the lymph glands only were affected; tonsils and retro-
pharyngeal lymphatic glands in only 102 cases. Bongert found the latter glands
affected in 3 out of 1,200: cases, Devrient in 2 out of 1,400 cases. Rasmussen found
the tonsils affected in 52 out of 4,708 cases (1.1%) and the retropharyngeal
glands in 228 cases (4.8%).
Modes of Infection. 599

Of course any organ of the body may occasionally be found to be
particularly predisposed to infection and it seems that primary affec-
tion of the bones and articulations is thus explained (traumatic influ-
ences). The species of animal is also of importance. Thus subcutane-
ous infection of guinea pigs usually produces disease of the lungs,
almost never of the spleen, while in rabbits, next to the lungs, the
kidneys are particularly prone to disease, and in chickens the lungs are
practically immune to infection with avian tuberculosis (Weber). Simi-
lar differences are observed among the domesticated animals, e. g., in the
pig the spleen is particularly susceptible in contrast to other animals,
in cattle the serous membranes, and in dogs the pericardium. Finally,
the variety of tubercle bacilli is to be considered. Thus, in man, the
bovine type usually causes disease only in the digestive tract and in its
lymphatic glands.

From what has been stated it is evident that in tuberculosis
the infection of any internal organ whatever may result through
the respiratory apparatus (aerogenic infection) or through the
digestive apparatus (alimentary infection). As to which of
these modes of infection is the more common, views differ at
the present time. It is not probable either that the solution
to the problem will be an easy one. Bacilli carried with the
inhaled air to the naso-pharynx may readily be absorbed through
the alimentary mucous membrane. But, whichever view may
be the correct one, there can be no doubt as to the danger of
inhaling air laden with bacilli. The manner of infection de-
pends no doubt, at least, in a great measure, upon the conditions
already discussed. Patients with open pulmonary tuberculosis,
by virtue of the exhaled infected droplets constitute a source
of either mode of infection; an open tuberculosis of other organs *
of the body constitutes a danger for alimentary infection almost
exclusively.

The localization and character of the tuberculous lesion
is determined to some extent also by the intensity of the in-
fection. After infection with a,large mass of virulent bacilli
the morbid process usually, especially in older animals, begins
its development at the point where the largest number of bacilli
became lodged on the mucous membrane. At these points
tubercles and ulcers are formed, such as are observed in the
tonsils (especially in swine) and in the ileum. In the latter
they usually begin in the lymph follicles of the mucous mem-
brane. If the infection happens to be slight the mucous mem-
brane remains intact and the lymph glands only are affected.
This is because most of the bacilli remain lodged in these glands
and the few that happen to pass through are either destroyed
(phagocytosis) or, on account of their small numbers, produce
lesions that are not observed until a later time. Thus it may
occasionally be observed in cattle that the retropharyngeal
glands contain large tuberculous foci, the upper, middle and
lower cervicals and finally the mediastinal glands successively
smaller and more recent foci (Breuer). By this means we may
often be enabled, m the beginning of the disease, at least, to

Vol, 1—34
530 Tuberculosis.

recognize the mode of infection by the seat of the oldest lesion.
In by no means rare instances the first lesions develop in
regions or organs remotely situated from the point of infec-
tion, apparently with preference after an infection that is not
intensive. In these cases the infection was transported by the
blood or lymph circulation without producing changes along
their path. This path cannot often be determined with any
degree of exactness and consequently it is only in rare instances
that an autopsy reveals evidence uvon which reliable conclusions
could be based.

The milder the infection and the greater the resistance
offered by the body the slower will be the development of the
ensuing disease. Thus it is possible to produce artificially a
pulmonary phthisis characterized by excessive tissue destruc-
tion and the formation of cavities by the introduction of com-
paratively small quantities of bacilli of slight virulence
(Baumgarten) or by inoculating animals which had been pre-
viously partially immunized. Under these conditions it may
require months for the disease to develop in guinea pigs and
two or three years in goats (Behring & Roemer, Nocard, De
Jong). According to Calmette and Guérin a single intestinal
infection of calves is said to produce a tuberculous process
which usually heals in the course of three or four months and
results in a certain degree of immunity. On the other hand
a number of successive infections repeated at short intervals
may result in a progressive tuberculous process.

According to Behring the mother’s milk constitutes the principal
source of pulmonary tuberculosis in man. According to this author
infection takes place from the gastro-intestinal tract, conditions for
infection being particularly favorable at this period of life since, accord-
ing to Disses, the epithelial layer of the intestinal mucous membrane is
not covered with a continuous layer of mucus during the first days of
the infant’s life. As a result, as shown by Roemer’s findings, large
undigested proteid molecules and also bacteria can pass unchanged
through the intestinal mucous membrane of new born colts, calves and
the small laboratory animals, while infection in adult animals is much
more difficult and only possible either after repeated ingestion of virus
or after a single ingestion of exceptionally virulent material in large
amount. The bacilli thus taken up produce a scrofulous diathesis which
constitutes a groundwork for the infantile infection to develop into mani-
fest disease in the course of years or decades. This result is favored by
additional infections which take place in later life, as well as by the
exhausting effects of deficient nutrition, catching cold, overexertion,
long continued confinement in poorly ventilated houses, ete. This theory
has also been applied to animals. However, just as its correctness in
regard to man is generally questioned, its applicability to cattle is doubt-
ful, the more so as tuberculin reactions in calves are seldom positive
and as the percentage of reactions increases only later, but then steadily.

The development of the tubercle.: At the point of their
lodgment and propagation the tubercle bacilli give rise to an
inflammatory process resulting in tubercle formation. This
Development of the Tubercle. 531

is caused by a specific toxin produced by the bacilli and results
in the characteristic product of the disease, the tubercle. Sur-
rounding the bacilli are grouped round cells (according to
Baumgarten these are derived from connective tissue cells and
epithelial cells, according to Borrel they are large mononuclear
leucocytes). These round cells become transformed into
epithelioid cells, with vesicular nuclei, which enclose several
tubercle bacilli. As a result of repeated karyokinesis which
process the diseased protoplasm can no longer follow (Baum-
garten, Weigert) or as a result of the confluence of several
epithelioid cells (Metchnikoff) there develop in the center of
the cell mass polynuclear epithelioid cells as well as true giant
cells. These also frequently contain tubercle bacilli. Later,
as a result of reaction of the surrounding tissue, mononuclear
lymphocytes and polynuclear leucocytes migrate from the ad-
jacent blood vessels, form a dense zone around this cell group
and lodge themselves between the epithelioid cells while a
fibrinous network of coagulated exudate is deposited between
the cells of this group. As a result of the toxic action of the
chemical products of the bacilli, perhaps also on account of
the nonvascular condition of the nodules and therefore of in-
sufficient nutrition (Virchow), the completed tubercle suffers
regressive metamorphoses. The central cells die off, break
down, and together with the scanty connective tissue and the
intermingled exudate are converted into a granular, cheesy
mass in which lime salts are eventually deposited.

In cattle and swine calcified and caseated tubercles may contain
virulent bacilli, so that this metamorphosis does not indicate complete
recovery. The virulence of these bacilli is, however, as a rule, reduced
(Lubarsch, Schmitz).

The structure of the tubercle in different species of animals
exhibits variations of minor importance, which nevertheless
are responsible for the often characteristic microscopical ap-
pearance of the lesions in different species of animals. The
tubercle of cattle is characterized by an abundant groundwork
of connective tissue frequently containing giant cells but con-
taining comparatively few small round cells. These tubercles
have a great tendency to become calcified. As a result of this
dense connective tissue groundwork numerous adjacent tuber-
cles frequently become confluent and form tumors resembling
fibrosarcomata in appearance. The tubercles of sheep and
goats have a similar structure. The tubercle of the horse is
well supplied with cell substance and consequently readily
undergoes softening. This softening process may, however,
not set in until at a late stage of its development. Calcification
is only rarely observed. The tubercle in swine is well supplied
with small round cells with little connective tissue ground sub-
stance. They readily become caseated and not infrequently
ealcarious. The tubercle of the dog often undergoes mucoid
degeneration, or softening, in its later stages.
532 Tuberculosis.

The term tuberculum was formerly applied to every possible and conceivable
form of nodule or tumor. In 1794 Baillie and in 1810 Bayle applied this term
exclusively to the small gray nodule which occurs in tuberculosis. Later on Laénnec
regarded the cheesy substance as characteristic of tuberculosis and finally Virchow
laid particular stress upon the fact that the tubercle was composed of small cells
resembling lymph cells and that the structure was devoid of a vascular supply.
He regarded the tubercle as characteristic of tuberculosis. Langhals called attention
to the frequent occurrence of giant cells in the tubercle. Schueppel laid especial
stress on the importance of the frequently observed epithelioid cells. According
to the latter a true tubercle.consisted of one or several giant cells surrounded by
one or more rows of large epithelioid cells which latter were again bound by a
zone of small round cells. As a matter of fact, however, giant and epithelioid
cells may be absent from true tubercles, and giant cells occur also in other patho-
logical formations. Ziegler showed that the tubercle was the result of an inflam-
matory process, originating like ordinary inflammatory granulation tissue, that is,
principally from migrated white blood corpuscles and that other tissue elements such
as the endothelial cells of the lymph vessels played only a subordinate role in the
construction of the tubercle. According to him the true tubercle was characterized
by its non-vascularity and by its tendency to undergo cheesy degeneration. Baum-
garten maintains that the tubercle bacillus gives rise to a proliferation of the fixed
connective tissue cells exclusively (epithelial as well as connective tissue proper)
which produce the so called epithelioid and giant cells and that the peripheral zone
of round cells consists of white blood corpuscles which emigrated subsequently.
Finally, according to Metschnikoff, the epithelioid and giant cells are phagocytes
of mesodermal origin which are attracted by the positive chemotactic action of
the tubercle bacilli which they take up into their substance. -

Nodules resembling tubercles will also develop around dead bacteria and
around inorganic foreign bodies. These nodules however do not undergo cheesy
ferencration, have no progressive tendencies and cannot be transmitted by inocu-
lation!

In recent times it has been pointed out by various investigators,
especially Weichselbaum and his pupils, that tubercle bacilli may exist
for a long time in a dormant state ‘in the lymph glands without causing ©
the development even of microscopical tubercles. Before the discovery
of the tubercle bacillus Orth demonstrated by inoculation experiments
that lymph glands of normal appearance may contain microscopic tu-
bercles (1876)! The effects of the tubercle bacilli can manifest them-
selves only in lymphoid hyperplastic processes (‘‘lymphoid stage of
tuberculosis’’—Bartel & Spieler). This stage may have a variable dura-
tion, may even retrogress and possibly exert an immunizing effect.. The
process may, however, with or without subsequent infection lead to the
development of specific tuberculous changes at that point or in remote
parts of the body. Microscopically, glands in the lymphoid stage of in-
fection appear either entirely normal or show only a homogeneous
swelling. Tubercle bacilli can be demonstrated by inoculation only.
Joest doubts the occurrence of such a lymphoid stage at least in animals
with generalized tuberculosis, especially in cattle and swine. He exam-
ined 27 such glands in cattle and 4 in pigs and found specific histolog-
ieal tuberculous changes in all of them (epithelioid tubercles with giant
cells). Jonske found the same condition in five glands that produced
inoculation tuberculosis. Smit failed to find histological tuberculous
changes in seven swollen and hyperemic glands, and Rievel and Linnen-
‘brink could not discover microscopical tuberculous lesions in three out
of twelve such glands that had a normal appearance.

That lymph glands may be virulent without exhibiting microscopic
tubercles has been proven by investigations of Frothingham, Calmette,
Guérin & Deléarde. These experiments were made in calves, but the
inoculations with human tubercle bacilli proved that they may remain
latent in the body for months and, according to Ligniéres, even for a
year. Virulent bacilli may be found in partially calcified lesions (Baum-
Distribution of Bacilli. 533

garten, Lubarsch), and according to Rabinowitsch and Schmitz they
are also met with in completely calcified lymph glands, although in these
latter they have become more or less attenuated.

When inhaled into the finest ramifications of the bronchial
tubes and the alveoli of the lungs, the bacilli produce a catarrhal
inflammation resulting in a filling up of the alveoli with fibrin,
leucocytes and large epithelioid cells. This cellular exudate
soon undergoes cheesy. degeneration, the intraalveolar septa
break down and thus larger cheesy foci are formed, which are
at first surrounded by inflamed catarrhal alveolar tissue and
later on by connective tissue walls. Fresh tubercles are usually
developed in the immediate neighborhood as a result of the
“migration of bacilli through the lymphatic spaces. Bacilli
carried to the lungs with the blood produce typical tubercles
in the interalveolar connective tissue or in the bronchial walls
where they produce fibrinous proliferation.

‘After the death of the tubercle bacilli the tuberculous
process may come to a standstill in any stage of its develop-
ment. Following this phenomenon a reactive inflammation. re-
sults in the production of a fibrous envelope around the entire
focus (fibrous tubercle). In slightly advanced local affection
this process may terminate in complete recovery from the
disease.

Distribution of tubercle bacilli in the body. According to
the foregoing explanations in regard to the modes of infection
the bacilli pass along the lymph channels to the regional glands,
then, to a certain extent at least, to remoter glands and finally
into the blood stream. If they are not destroyed by the lymph
elements, or otherwise, they produce specific tubercles at points
where they happen to lodge. From the tubercle thus formed
they pass through the lymph spaces (‘‘the histological highways
of the body’’ Cohnheim), into the neighboring intact tissue
where they cause the development of new tubercles. Every
new tubercle then becomes the source of other tubercles. As
these undergo cheesy degeneration the infected focus becomes
larger and larger, cavities are formed in the lungs and ulcers
on the mucous membranes. In the periphery of these new
tubercles make their appearance.

In their further course the bacilli follow the lymph spaces
into the regional lymph glands and neighboring organs where
they produce similar changes. From the affected organs they
pass over to their serous membranes, become disseminated
through the lymph plexuses, thus not infrequently giving rise
to a diffuse tuberculosis of these membranes. The bacilli may
also penetrate the lymph spaces of the diaphragm and the
morbid process spread from the peritoneum to the pleura and
pericardium. The development of tubercles on the serous mem-
branes is not infrequently attended with a sero-fibrinous in-

flammation.
534 Tuberculosis.

From the tuberculous foci in the lungs the virus passes
from the bronchioles to the larger bronchial tubes and the
neighboring healthy alveoli. Thus the diseased area becomes
larger and larger. Secretions containing bacilli are coughed
up and lodge on the mucous membrane of the trachea and
larynx, especially on the ventral surface immediately posterior
to the attachment of the vocal chords. Thus the tuberculous
process gains a foothold here. These secretions may also reach
the mouth whence they reach the small intestine with the food,
causing the development of tuberculosis of the mucous mem-
brane, especially of the ileum. Tubercles and ulcers that are
occasionally found here are usually produced in this manner.
In a similar manner a metastatic process in the renal paren-
chyma may spread to the pelvis of the kidney and follow the
course of the ureters downward. On the other hand primary
infection of the uterus, the vagina, the epididymis and the
bladder may spread into the pelvis of the kidney and from
there attack the parenchyma.

If the bacilli enter the vessels they are transported by
the blood stream and, if not destroyed, produce embolisms in
various organs from which tubercles are developed. This is
comparatively frequent in the kidney and spleen. If the number
of bacilli entering the blood stream is excessive, numerous
tubercles may develop in several organs and give rise to an
acute miliary tuberculosis (tuberculosis miliaris acuta). This
happens most frequently when tubercles which develop in the
walls of arteries or veins of an infected organ, degenerate or
develop into ulcers from which the bacilli pass into the blood
stream. This danger is particularly great if the vessel com-
municates by a direct opening with a nearby or adjacent cheesy
focus. Exposed tubercles in the walls of the thoracic duct may
also be the cause of infection of the blood stream. (Joest re-
i two cases of open tuberculosis of the thoracic duct in
cows.

If bacilli are discharged into the lumen of a peripheral
vein or into a branch of the pulmonary artery most of the
bacilli will lodge in the lungs and produce tubercles almost
exclusively in these organs. On the other hand if tuberculous
ulcers exist in one of the pulmonary veins the bacilli which they
discharge may enter any organ of the body that are reached
by blood from the left ventricle and there produce a miliary
tuberculosis, most commonly in the spleen, liver and kidneys.

According to Roemers’ experiments, which were confirmed by Hamburger,
Courmont & Lesieur and by Leber, the body of a tuberculous animal offers more
or less resistance to subsequent external infections, Such additional external
infections are either successfully resisted or they have only a local effect; they may
even have a curative effect, as had already been shown by Koch. On the other
hand, after infection with large masses of virulent bacilli lung cavities may deve'op
instead of miliary tuberculosis, Calmette & Guérin demonstrated such an increased
resistance in tuberculous cattle. In these animals the injection of highly virulent
bovine bacilli produced chronic processes only. This increased power of reristance
is said to manifest itself also toward bacilli from the body of the animal itself
Toxins, Mixed Infection. 535

and not alone toward bacilli of a new strain, hence in metastatic autoinfection.
The fact that metastatic tuberculous infection occasionally occurs in human beings
and animals with chronic tuberculosis (Joest) does not necessarily contradict this
statement. Repeated or massive hematogenic infection from chronic foci may
establish a new focus of infection even in relatively immune tissues.

Toxins. Tubercle bacilli owe their activity to endogenic
toxins as well as to toxic products of metabolism. Necrobiosis
and caseation in the tubercle is the result of the endogenic
toxins. Subcutaneous injection of dead bacilli results in a
local sterile abscess, necrosis, caseation and cachexia. Alkaline,
ether- and benzine-extracts of the bacilli will produce a similar
result (Koch, Weyl, Auclair & Barbier, Siegenbeck van
Heukelom). On the other hand the fever which occurs in the
course of the disease is caused by the products of metabolism
which later also are to be found in the filtrates of cultures
which, in a concentrated form. are known as tuberculin (Koch,
Behring).

According to Marmorek the toxin that circulates in the blood of an infected
animal and with which the bacilli themselves are also impregnated is not the same
as that in tuberculin. This toxin is formed outside of the animal body in fresh
cultures growing in leucotoxic serum, e. g., liver bouillon. When subcutaneously
injected into horses it produces inflammatory edema. Doses of 5.0 ec. will kill
guinea pigs. According to Calmette & Bretton boiled cultures act similarly to
tubereulin. According to Vallée, Martin & Vaudremer bacilli which have had their
fat contents removed act similarly to hyperactive tuberculin. Cantacuzino okserved
that the intravenous injection of large doses into guinea pigs rapidly produced
death following hypothermia, degeneration of the kidneys and the heart and increase
of eosinophiles in the blood. Small doses produce chronic disease. Maragliano
recognizes two toxins of the tubercle bacillus, an exogenous thermolabile toxalbumin
(destroyed by boiling), producing diaphoresis and hypertrophy and an endogenous
thermostable toxoproteid (heat resisting) said to have a hyperthermic action.
Koeppen on the other hand could not discover any difference between these two
groups. De Waele inserted collodion capsules filled with cultures of tubercle bacilli
under the skin of experiment animals. A few weeks later they reacted to tuberculin.
Moussu inserted clay tubes filled with cultures of bacilli under the skin of cattle
and produced the same result.

Mixed Infection. Tuberculous organs constitute a favor-
able soil for the growth of saprophytes as well as for other
pathogenic bacteria. These are carried to open lesions by the
air or the blood stream transports them to closed cheesy foci.
They may multiply in these places and are then liable to modify
the anatomical character of the lesions as well as the clinical
course of the disease. It is also possible that pathogenic
organisms produce certain primary lesions and thus prepare
the soil for an easier infection by the tubercle bacilli. The
pyogenic bacteria are particularly important in this respect,
a purulent and soft character of tuberculous foci being fre-
quently, though not always, an indication of such a mixed
infection. Such a metamorphosis of a dry cheesy focus into
a soft purulent mass favors the dissemination of the tubercle
bacilli in the organism, if only because they are usually present
in them in large numbers (Bongert) and furthermore the fre-
quent development of tuberculosis following catarrhal affections
and acute pneumonia points to the favorable influence of other
536 Tuberculosis.

pathogenic organism in preparing a soil for the tubercle bacillus.
The pronounced intermittent fever observed in advanced cases
of tuberculosis is usually an indication of an infection with
pyogenic bacteria causing suppuration in tuberculous organs.

According to Oestern the bacterial flora in soft tuberculous foci is a very
limited one. Besides tubercle bacilli there are chiefly staphylococci, especially
staphylococcus albus; sarcina and bacteria resembling colon bacilli are rarely found;
streptococci are absent. If only tubercle bacilli are present the mass is yellow
and of a slimy watery consistency. Otherwise these soft foci are caseo-purulent or
muco-caseous. Bongert has shown however that in cattle the purulent softening
of the tuberculous tissue is caused almost exclusively by tubercle bacilli, especially
when these bacilli are destroyed in considerable numbers.

Anatomical Changes. The tubercle which is the charac-
teristic product of tuberculosis, is at first a gray and transparent
nodule, just visible to the unaided eye, but soon becomes yel-
lowish as a result of cheesy degeneration which commences
in the center. Nodules of the size of millet seeds or larger
are the result of fusion of a number of primary nodules. The
continuation of this process of fusion or conglomeration leads
to the formation of still larger, dry, yellow cheesy masses or
foci. The tuberculous nature of these is indicated by the pres-
ence of characteristic tubercles in the tissue immediately sur--
rounding them. ‘Tubercle formation and caseation are, in
general, the characteristic pathologic-anatomical changes in
tuberculosis (but considerable variations may be present in
different species as well.as in different organs).

In cattle the thoracic organs, especially the lungs and the
broncho-mediastinal lymph glands are the chief seat of disease.
In the tissue of the lungs there are foci of all sizes, which may
be firm and sharply circumscribed; the surface on section ap-
pears reddish-gray or yellow, their ‘substance consists of a dry,
crumbling, cheesy or mortar-like mass surrounded by tough
connective tissue; on the other hand they may consist of soft
yellowish-white masses of pus surrounded by a thin connective
tissue capsule. The presence of such foci is immediately
recognized by the nodular appearance of the surface of the
lung or by palpation of the deeper seated nodules. Their size
varies considerably. In advanced cases there are all transition
stages from the small gray nodules just visible to the unaided
eye up to tumors larger than a man’s fist. In the tissue sur- '
rounding the large tumors there are almost always new-formed
tubercles resulting from the migration of bacilli through the
lymph spaces. Foci of embolic origin are usually found in the
interstitial tissue of an otherwise healthy portion of the lung.
The pulmonary tissue between the various tuberculous tumors
may be either normal, or through the filling up of the alveoli
with exudate it may be of a homogeneous reddish-gray or yel-
lowish appearance. As a result of proliferation of the inter-
stitial connective tissue certain areas become thickened and
tough and partly or wholly devoid of air. According to the
severity of the disease only a portion of the organ may be
affected (in cattle usually the posterior lobes in swine the an-
Anatomical Changes. 537

terior lobes) or tubercles of all sizes may be scattered through
the entire substance of the lung.

The confluence of cheesy or caseo-purulent foci of all sizes
leads to the formation of cavities which are surrounded by
dense connective tissue lined on the inside with suppurating
granulation tissue which was formerly called the pyogenic
membrane. The interior of these cavities contains strands
of connective tissue which are obliterated blood vessels. Some
of these cavities communicate with bronchial -tubes through
which they discharge their contents to the outer world. As
a result of exposure to the air the muco-caseous material which
is retained in these open cavities decomposes into discolored
ill-smelling masses (phthisis tuberculosa).

In young animals pulmonary tuberculosis frequently occurs
exclusively in the form of catarrhal pneumonia. The diseased
parts of the organ appear uniformly firm, solid and devoid of
air. The cut surface is reddish-gray, grayish-white or yellowish-
gray and presents to view a slight quantity of cheesy matter
that can be scraped off with a knife. Here too the cheesy
degeneration of the exudate and the breaking down of the lung
tissue results in the formation of dry or soft cheesy foci of
various sizes. Tuberculosis of the superficial layers of the
pulmonary tissue is frequently attended with a productive in-
flammation of the pleura. This may lead to pleural adhesions
or to the development of excresences which will be described
below. In rare cases a sero-fibrinous pleuritis develops,

Besides the affection of the lung tissue proper there is
a catarrhal condition in the bronchial tubes of the diseased
areas. In severe cases all of the bronchial tubes may be filled
with muco-purulent secretions. The mucous membranes are
swollen and injected and frequently contain tubercles and
ulcers; they may become detached from the bronchial walls and
obliterate the lumen or cause bronchiectases. Ulceration of
the bronchial mucous membrane is not infrequent. The tuber-
culous nature of the ulcers is indicated by their irregular form,
raised borders and yellowish-red base, and by the fact that
on and around the ulcers there are small tubercles to be seen.
Sometimes dense masses of tuberculous growths are found in
the larynx, especially in the ventral angle of the glottis. They
may completely cover the vocal chords or be fused into one
large tumor. In exceptional cases the nasal mucous membrane
may be covered with yellowish-red granulations containing
numerous caseous foci (Joest). . .

Tuberculosis of the serous membranes is characterized in
the beginning by grayish-red, succulent, soft, yet tough ex-
eresences in some of which yellowish nodules may be found.
In the later stages there are firm dense globular formations
(pearl nodes) with cheesy or mortar-like foci in their interior.
The smaller excresences may be attached by means of a broad
base or may be pedunculated. They frequently become ad-
538 Tuberculosis.

herent, producing grape or cauliflower-like masses (Fig. 81).
These growtlis may be present in enormous numbers on the
serous membranes, and the membrane itself may be thickened
to the extent of several centimeters. This is especially common
in the folds of the pericardium which are frequently found in
a state of adhesion, surrounding the heart in the form of a
dense fibrous capsule several centimeters in thickness and

 

Fig. 81. Tuberculosis. Pearl Disease of the Pleura.

riddled with cheesy or mortar-like foci (so called armoured
heart—Panzerherz). This capsule is either sharply separated
from the heart, or white connective tissue septa may pass from
it into the substance of its muscular structure. The heart sub-
stance itself may contain cheesy foci which may also be present
where the epicardium is intact (embolism). Tuberculosis of
the endocardium or the valves is very rare (Bergeon found
miliary tubercles on the valves and on the intima of the aorta).
Anatomical Changes. 539

e

It is usually possible to demonstrate tubercles with giant cells in fresh
villosities. Some of these, however, do not show a tuberculous structure nor does
their inoculation into guinea pigs produce tuberculosis. (Heymans found tubercle
bacilli, virulent upon inoculation, in only 58 out of 70 excresences examined.)

The lymphatic glands in the region of the diseased organs
are always involved. On the other hand they are not infre-
quently, especially in young animals, the sole seat of the disease.
At first they are only homogeneously swollen and enlarged and

 

Fig. 82, Tuberculosis of Thoracic Organs of Cattle. a and b enlarged tuberculous
bronchial and mediastinal glands; ¢ and d pearly tumors on the pericardium and
pleura; e trachea; f esophagus. Cheesy nodules in the lung substance.

more or less hemorrhagic; later on a section will show spotted
turbidities in a grayish-red background. The turbidities con-
tain tubercles or diffuse caseous masses. At a later stage the
glands develop into large firm tumors consisting of grayish-
white fibrous tissue in which are imbedded large foci of a dry
540 Tuberculosis.

cheesy or mortar-like consistency. By confluence with other
similar tumors they may become metamorphosed into fibrous
sacks filled with a caseous, caseo-purulent or mortar-like mass.

Another picture of tuberculosis of the glands is presented
by radiating caseation. Here a section of the hard dense gland
has the appearance of a section of a radish, with strands radiat-
ing in all directions from the center. Cheesy sections alternate
with viscid tissue strands (Bongert). In pulmonary tuber-
culosis the mediastinal and the peribronchial glands in partic-
ular may attain to enormous size (Fig. 82). In alimentary in-
fection the retropharyngeal, the mesenteric and the portal
glands become similarly enlarged.

Stroh found the small lymph glands of the muscles affected in 1.4% of cases
in oxen, 3% in bulls, and 22.9% in calves. In cattle the popliteal glands were most
frequently affected (27.1%). The prescapular glands were affected in 26.7% of
cases, the precrural glands and the ischial glands in 17.2% and the axillary glands in
only 5.5% of all cases. In calves the percentages were as follows: Prescapular
glands 40.8%, popliteal glands 23.8%, precrural glands 22.3%, axillary glands
6.9%, ischial glands 6.1%. The mammary glands were affected in 1.7% of all
tuberculous cows.

In the course of the digestive tract cheesy nodules and
uleers may occur in the parenchyma of the affected tongue,
sometimes just anterior to the eminence of the dorsum (in the
tonsils of calves) and in exceptional cases in the cesophagus
(May, Nicolas). On the mucous membrane of the small intes-
tine, especially the ileum, and in the cecum isolated tubercles
as well as ulcers of variable size may be found. For them,
also, the infiltrated prominent borders of the ulcers surrounded
with tuberculous nodules and the firm base covered with* dry,
cheesy material, are characteristic. They may extend to the
submucosa or to the muscularis; are often elongated in
form and lie at right angles to the long axis of the intestine
(belted ulcers). In rare cases similar ulcers are observed
in the mucous membrane of the fourth stomach (Walley, Kitt,
F. Arloing, Zietschmann. Plate observed one case of fatal
hemorrhage from such an ulcer). Johne observed ulceration
of the mucous membrane of the abomasum. In exceptional cases
the tuberculous process assumes the form of polypous
growths on mucous membranes (Johne), or of a swelling with
ulcerating surface (such was found.in the abomasum by Joest).

Chaussée describes, three forms of intestinal tuberculosis. (1) Uleerating
tuberculosis of the mucosa and submucosa, causing necrosis and sloughing. .(2)
Hypertrophic tuberculosis in which tubercles appear exclusively in the submucosa,
the mucosa itself becoming hypertrophied, projecting in, the form of a shallow
plateau above the surrounding healthy mucosa. (3) The herpetic form of tuber-
culosis which occurs exclusively in the mucosa on the surface of which small shallow
erosions are found.

In 1905, 0.45% of all cattle slaughtered in the German Empire were affected
with intestinal tuberculosis.

The substance of the liver may be dotted with small tuber-
eles and cheesy foci or it may contain abscesses as large as
Anatomical Changes. 541

a man’s fist with contents of a mortar-like consistency or a soft
muco-caseous mass. These abscesses are surrounded by dense
connective tissue capsules and frequently give rise to enormous
enlargement of the organ. In a case reported by Streitberg
the liver weighed 64 pounds. :

_ The spleen, especially of young animals, frequently con-
tains numerous small tubercles. Sometimes only a few large
cheesy foci are present.

The kidneys, on the other hand, are more frequently af-
fected in older animals. The small firm tubercles may be dis-
tinctly seen in the brownish-red renal tissue. The large cheesy
foci are usually embedded in tough connective tissue forming
projections on the surface. By becoming confluent such foci
may involve an entire lobule and upon rupturing discharge
their cheesy contents into the pelvis of the kidney (nephro-
phthisis). The mucous membrane surrounding the point of rup-
ture may contain small tubercles or it may have been converted
into a loosely adhering cheesy mass. Tuberculous foci of the
kidneys may now and then have the appearance of lympho-
sarcomata. As a rule the ureters are indurated and their
mucous membranes converted into a cheesy mass similar to
the condition found when the process spreads upward from the
neck of the bladder. Tuberculous processes in the mucous mem-
brane of the urethra and likewise in the vagina are rare.

Of the male sexual organs the epididymis and secondarily
the testicles which then consist of tumors with cheesy interior
are most frequently affected; in females the uterus and the
Fallopian tubes with or without involvement of the peritoneum.
In slightly aflvanced cases small nodular indurations may be
recognized by palpating the horns of the uterus. In advanced
cases these changes become more pronounced, and firm solid
masses enclosing large quantities of yellowish creamy or smeary
and sometimes ichorous fluid are imbedded in the uterine walls.
The mucous membrane contains at first small firm grayish-
white nodules which develop into tumor-like structures. Some-
times the mucosa becomes extensively ulcerated. These lesions
may perforate the serous coat of the uterus and their ragged
edges project into the peritoneal cavity. As a rule the Fallopian
’ tubes, especially the abdominal third (Fischer), are involved
and appear as thick solid strands. The ovaries are usually
affected only in generalized tuberculosis of the genital organs;
in nearly all of these cases both ovaries suffer, the morbid
changes being limited to hyperplasia and the formation of
villosities on the surface (Mayfarth), or to the formation of
large tumors covered with villosities and enclosing cheesy foci.
(Gergely observed one case of extensive tuberculosis confined
to the testicles following an injury which resulted in retraction
of these organs into the pelvic cavity.)

Abattoir statistics of the German Empire show that 0.47% of all slaughtered
cows were affected with tuberculosis of the uterus. According to Ostertag 65%
542 Tuberculosis.

of all cases of generalized tuberculosis involve the uterus, while Lungwitz found
this organ involved in 152 out of 264 cases of pearl disease of the peritoneum.
In far advanced cases the affected uterus may weigh 40 kilograms (Moebius).
According to Fischer’s investigations the majority of cases spread from the Fallopian
tubes to the uterus. This seems to be true even when the lesions of the uterus appear
more advanced.

Tuberculosis of the udder is usually characterized by the
presence of large firm tumors with cheesy contents and numer-
ous small tubercles scattered through the intervening tough
connective tissue (Fig. 83). As a rule either one or both pos-
terior quarters and the adjacent regions of the anterior quarters
are affected. The diseased part which is usually enlarged, but
sometimes atrophied, is separated from the normal portion by
a well marked sinuous line of demarkation. The walls of the

 

Fig. 83. Tuberculosis of the Udder. Tuberecular foci in the glandular tissue of
the hind quarter. Supermammary gland much enlarged with cheesy foci. Mossu.

milk duets may contain tubercles or they may be enormously
distended and enclose masses of cheesy detritus and flaky or
curdled milk. Some of the veins of the udder may be found
obliterated with blood clots in which colonies of tuberele bacilli
may here and there be demonstrated (Bang). In recent embolic
infection the lobules of the affected quarters are swollen and
their gray substance sprinkled with yellow points or streaks
while the intervening connective tissue is riddled with minute
tubercles and cheesy foci ranging in size from that of a lentil
to a pea (Bang, Moser). In advanced cases the affected quarter
may have been transformed into a firm tumor containing cheesy
masses enclosed by tough fibrous connective tissue. The super-
mammary glands are always involved when the udder is af-
Anatomical Changes. 543

fected, but they may also be diseased when tubercles cannot be
demonstrated in the tissue of the udder, at least with the naked
eye.

Of the central nervous system the brain is most frequently
affected. There may be several large tumors (tyroma, tuber-
culum solitarium) or a number of smaller cheesy foci. These
always involve the meninges and produce a tuberculous inflam-
mation. In such cases recent tubercles can be found at the
base of the brain, in particular in the region of the Sylvian
fissure (meningitis basilaris tuberculosa). As a rule this is
accompanied by acute internal hydrocephalus (very common in
calves after protective inoculation—Hutyra, Weber, Titze and
others). Similar affection of the spinal cord and its envelopes
is far more rarely met with, and when present it is usually
observed near tuberculous vertebrae.

Tuberculous lesions are observed also as follows: In the
spongy substance of flat bones especially the ribs and vertebrae
but in exceptional cases also in the bones of the cranium and
of the pelvis; in long bones the marrow may be affected; in
articular cartilages of the long bones; in the joints (exudative
‘inflammation with induration of the capsular ligaments result-
ing in villous proliferation and destruction of the cartilages,
according to Hamoir most common in the knee); on the nasal
mucous membrane with occasional involvement of the cartilages,
muscles and septum; in the muscles of the body (usually cheesy
foci originating in the intermuscular lymph glands and occa-
sionally foci approaching the size of a bean scattered between
the bundles of muscle fibres); in the subcutaneous connective
tissue (firm tumors arranged in rosary-like order and cheesy
abscesses) ; very rarely in the skin, tendon sheaths of the ex-
tremities, penis, prostate gland and in the eye (tubercles in
the iris followed by caseous panophthalmia, or fibrinous iritis
without tubercles [Manleitner]).

On post-mortem examination, especially in meat inspection, we dis-
tinguish between primary and secondary tuberculosis of the various
organs. The term primary is applied to lesions resulting from direct
infection from outside and spreading into the surrounding tissue from
the point of infection, either by direct growth or through the lymph
spaces and lymph vessels, but not by means of the blood stream. Second-
ary lesions are those resulting hematogenically from infected embolisms
of the blood vessels, and are consequently found in the interstitial con-
nective tissue. They do not communicate with the outer world and
therefore rarely suppurate (Ostertag). According to the discussion on
page 530 the possibility of the occurrence of primary lesions of lympho-
genic or even hematogenic origin in internal organs is not excluded.

The term local tuberculosis is applied to lesions that have spread
or have become disseminated by direct growth only or through the lym-
phaties or one of the lesser circulations (pulmonary or portal). If the
greater circulation was the means of disseminating the virus the result-
ing affection is referred to as generalized tuberculosis (Weigert, Oster-
tag). In the latter instance, if the infection was slight the resulting
544 Tuberculosis.

disease assumes a chronic character, while if the infection was extensive,
acute miliary tuberculosis develops. Generalized tuberculosis is atyp-
ical when the organs usually attacked escape an infection from the
blood stream and localization of the morbid process occurs in remote
organs (Poppe).

Breuer’s statistics on the localization of tuberculous processes for 1900-02
(Budapest) give the following information: Of 28,968 cases of tuberculosis 98.6%
were local, 1.4% generalized. In 91% of -local affections the lesions occurred in
one thoracic organ only, in 0.8% in one abdominal organ, in 0.2% in the tonsils
and the retropharyngeal glands, while in seven instances several organs were
affected. Of 100 cases of generalized tuberculosis the lungs were affected in 92, the
liver in 76, the intestines and mesenteric glands in 59, the kidneys in 57, the serous
membranes in 70, the spleen in 40, the udder in 22 and the uterus in 8 instances.
(Ostertag observed tuberculosis of the uterus in 65% of all cases of generalized
tuberculosis. Henschel found uterus affection in 6.4% of all cases of hematogenic
origin.)—In young cattle under four years with generalized tuberculosis the spleen
is nearly always affected while the kidneys are free from lesions. In older cattle
the kidneys are attacked as frequently as the spleen (Ostertag). Meat inspection
statistics of the German Empire for 1905 show that 0.6% of all tuberculous cows
have tuberculosis of the udder, according to Bang, 2%; Ostertag, 0.5 to 1.0%;
MacFadyean, 1 to 2%; Williams, 3%; Vallée and Villejean, 5.3 to 6.5%; Stroh,
1.7%; and according to Henschel, 2.6%. :

Acute tuberculosis (tuberculosis miliaris acuta) is confined.
either to single organs, particularly the lungs, or the entire
body may be affected. This depends upon whether the virus
was distributed through a vessel supplying a limited area only
as would be the case with a peripheral artery or with the pul-
monary artery, or whether it had gained access to the greater
circulation or the pulmonary veins. This form of the disease
is characterized by the presence of enormous numbers of recent
tubercles of approximately the same age. They are usually
distributed evenly through the tissues. The surrounding areas,
contrary to what is observed in chronic tuberculosis, are usually
normal in appearance. There may however be general hyper-
emia or indications of beginning inflammation. There is always
acute swelling of the lymph glands and reddening of the cortical
substance.

In buffaloes the tuberculous foci (mostly in the thoracic
organs) are grayish-white, yellowish or entirely white and con-
tain remarkably soft cheesy masses. Liquefaction is rare and
calcification is an exceptional occurrence; pearl disease of the
serous membranes is equally rare (Breuer).

In sheep and goats the tuberculous changes are in general
the same as in cattle. The serous membranes may contain
pearly tumors and the uterus may be the seat of disease just
as in cows. Koch and Probst have observed the formation
of large cavities in the lungs of these animals. Contrary to
the usual observations in other animals sheep do not exhibit
the progressive changes of necrotization, caseation and calci-
fication. The lesions are usually calcified and surrounded with
thick fibrous walls. Delmer ascertained the presence of gener-
alized tuberculosis in a goat six months of age and Micucei
observed primary intestinal tuberculosis in the sheep.
Anatomical Changes. 545

In horses, especially in young animals, the mesenteric and
retropharyngeal lymph glands are most frequently affected
(phthisis mesaraica). The affected glands may be white and
moist on section and resemble lymphosarcomata or their in-
terior may consist of a soft muco-caseous mass. In exceptional
cases there is calcification. They may represent masses of
tumors firmly enclosing large vessels (e. g. the posterior vena
cava and portal vein); they may involve the vessel walls or
have grown into their lumen producing thrombi (Lustig), or
leading to generalized tuberculosis. Cheesy lymph glands may
communicate with the interior of the large intestine (Lothes).
In some cases the intestinal mucous membrane contains numer-
ous nodules of the size of a hazelnut, some of them ulcerated
on the crest, also irregular ulcers with smooth or ragged
borders, ranging in size up to that of the palm of a hand; their
base may extend to the submucosa and contain small tubercles.
The large intestines and the rectum alone may be thus affected
(Ratz; Darmagnac observed a case of perforation of a rectal
ulcer producing acute peritonitis). The liver may contain
similar lesions but they are rare in the spleen. The former
may reach three times its normal size and the latter has been
observed to weigh 13 kg. (Schulz) or, according to A. Marcus,
dimensions of 74 by 5814 em. (According to MacFadyean,
Johne and Kitt tumors of this sort formerly described as
lymphadenomata, which occasionally are almost tendinous in
consistency are usually tuberculous in nature.)

The disease of the lungs is usually miliary in nature. Less
frequent are tumors as large as a nut or larger, which section
appear homogeneous, like a turnip, or with soft centers con-
taining a dirty gray or yellow purulent or caseo-purulent mass;
in some cases they are enclosed in a connective tissue capsule.
The intervening connective tissue is either normal or exces-
sively proliferated. Changes indicating acute inflammation, as
are observed in glanders, do not occur in tuberculosis. The
peribronchial lymph glands are usually considerably enlarged
and contain yellowish tubercles. The mucous membranes of
the respiratory tract may also show ulcers.

Tuberculosis of the serous membranes (peritoneum, pleura
and pericardium) usually occurs in the form of typical pearl
disease (Bang, Nocard, Felisch, Foelger, Ratz). Occasionally
there is an accumulation of much sero-fibrinous exudate in the
pleural cavity and the pericardium (Aubry). Tuberculous
lesions may occur also; in the pharyngeal and cervical glands
(Froehner), in the vertebrae and ribs (Wolff, Haendel, Town
& Hobday), in the heart-muscle (Foelger), in the subcutaneous
connective tissue and in the muscles (Cadiot, Fally). Enders
described the rare occurrence of complete calcification of the
thoracic aorta where it lies adjacent to the dorsal vertebrae.
Hansenkamp describes tuberculous lesions in the marrow of
the lumbar vertebrae and in the adjacent membranes. Behr

Vol. 1—35
546 Tuberculosis.

describes calcified concave scaly lesions in the endocardium as
large as a silver dollar, also lesions as large as a lentil on the
nasal mucous membrane.

The tuberculous lesions usually contain tubercle bacilli in
large numbers.

In pigs tuberculous lesions are most. common in the diges
tive organs and their lymph glands. In some of the cases we
find, in addition to tubercles in the mucous membrane of the
pharynx and in the tonsils, enlargement of the retropharyngeal,
cervical and mediastinal lymph glands (scrophulosis). These
glands contain a thickish cheesy purulent mass. Tuberculous
processes in some of the superficial glands may even perforate
the skin. In other cases the mesenteric glands may be similarly
affected. The lumbar glands may constitute an irregular, con-
voluted tumor mass under the spinal column. In these cases
tuberculous nodules and ulcers occur also in the intestines,
éspecially in the ileum and cecum. The liver and spleen may
contain cheesy foci ranging in size up to that of a nut. In
exceptional cases wedgelike or irregular firm foci extend from
the surface of the liver or spleen toward the interior of the
affected organ. On section these areas show a homogeneous
structure, are grayish-white or yellowish-white in color and
present no evidence of caseation or calcification (Junack,
Sommer). In rare cases the peritoneum is covered with numer-
ous small nodules. (The so called cheesy enteritis of pigs
[page 133] may perhaps, in exceptional cases also develop upon
a tuberculous basis.)

In the lungs the disease may manifest itself by the presence
of a few or of exceedingly numerous small dry cheesy foci,
or a correspondingly smaller number of larger centers. Or
there may be a caseous or cheesy pneumonia with large areas
of the lung devoid of air, firm and inelastic, the sections ap-
pearing grayish-red or grayish-yellow. The adjacent portions
of the pleura are indurated, and sometimes covered with a layer
of red fibro-granular connective tissue 14 mm. thick and result-
ing in extensive adhesions (Schlegel). The same.changes may
occur in the pericardium. Small tubercles and small ulcers
are occasionally found in the tracheal mucous membrane (Graf) ;
in such cases the peribronchial, substernal and subspinal lymph
glands are usually enlarged and caseated.

Tuberculosis of the central nervous system results from
the spread of a tuberculous process of the inner or middle
ear or of the petrous bone (Schuetz) ; it may also be produced
metastatically in tuberculous disease of remote organs (Azary).
Tuberculosis of the spinal meninges is very rare. It manifests
itself in the appearance of numerous yellowish miliary nodules
on the peripheral surface. Occasionally they form large con-
glomerate tumors which produce compression atrophy of the
spinal cord (Vogt).

Tuberculosis of the bones is comparatively common,
Anatomical Changes. 547

especially of the vertebrae, the ribs and long bones. Less fre-
quent is tuberculosis of the mammary glands (Nocard). When
present it is usually in conjunction with disease of the joints
or of the muscles (Moulé, Stroese, Winter, Hasenkamp). In
rare cases there is affection of the nasal mucous membrane
which manifests itself in diffuse induration and the presence
of tubercles and ulcers (Zschokke, Balas). Tuberculosis of the
eye (Manleitner, Keil) and tuberculosis of the ovaries (Hasen-
kamp) is also rare.

Of 4,468 cases of tuberculosis in swine observed in 1902 in the abattoir at
Budapest 97.5% had local, 2.5% generalized tuberculosis. In 87% the local tuber-
culosis was confined to one organ; in 74% the tonsils and retropharyngeal lymph
glands only were affected; in 13% several organs were affected in the same animal.
The lungs were involved in 100% of all cases of generalized tuberculosis, the spleen
in 97%, the liver in 91%, the bones in 43%, the joints in 15%, the muscles in 3%
(Breuer).—According to Stroh the lymph glands of the muscles were affected in
14.4% of all cases, the prescapular glands being involved in 52.65% of these, the
precrural in 34.1% and the popliteal glands in 13.3%. In 6,107 cases of generalized
tuberculosis studied by Henschel the prescapular glands were affected in 35.8%,
the precrural in 3%, the popliteal glands in 4.3%, the ischial glands in 1.1%,
the pubic glands in 2.8%, and the udder in 0.3%.

American reports point to the extreme frequency of affection of the submaxillary
glands which are involved in 93% of all cases of tuberculosis of swine.

In dogs primary tuberculosis may occur in the lungs or
in the digestive tract. Particular attention has been given to
this form of tuberculosis in the publications of Jensen, Cadiot,
Froehner, Ratz, Petit and Basset. In the lungs we find sharply
circumscribed tumors of variable size, which may consist of
sarcoma-like tissue of an even white texture on section, or
their interior may be a viscous mass of pus. They may also
consist of dry, cheesy or chalk-like masses. Some of these
tumors may have developed into cavities, perforated a bronchial
tube or communicate with the abdominal cavity through the
visceral portion of the diaphragm (Fiebiger). In other cases
there may be broncho-pneumonic areas with small soft foci
in their grayish-red substance. The mucous membranes of the
bronchial tubes and the trachea may occasionally contain tuher-
cles or villous proliferations. The peribronchial and mediastinal
lymph glands are as a rule considerably enlarged, resemble
sarcomata on section, are grayish-white in color or their sub-
stance is dotted with cheesy foci or masses of viscous pus. If
the bronchial glands are much enlarged they may result in
an upward and backward displacement of the heart. In excep-
tional eases the tuberculous process is limited exclusively to
the latter glands or to these and the cervical glands while the
lung tissue remains normal in appearance or reveals only recent
changes. The pleura may contain tuberculous nodules or. in-
durated areas, sometimes also papilloma-like proliferations or
tumors resembling pearly nodules (Wenzel, Joest). Some-
times there is an accumulation of reddish purulent exudate in
one or both pleural sacs, or there may be more or less extensive.
adhesions. Affection of the pericardium usually results in ad-
548 Tuberculosis.

hesion of the pericardial folds, but there may be an extensive

accumulation of sero-fibrinous or hemorrhagic exudate. Cheesy

nodules are occasionally found in the muscle of the heart.

In exceptional cases the aorta, surrounded by tuberculous lymph .
glands, becomes indurated. Portions of its walls may become

necrotic (Eber) or a tuberculous nodule may perforate the latter

and project into the lumen of the vessel (Ratz).

The mesenteric glands are frequently considerably en-
:arged and present the same characteristics as the affected
thoracic glands. Frequently the peritoneum is also involved,
especially its visceral layer. A limited area may be covered
with a few large nodules or numerous small tubercles may ex-
tend over great expanses of this membrane, while the omentum
is transformed into a thick irregular cord. On the mucous mem-
brane of the intestine, especially the duodenum and ileum, only
few cheesy nodules or ulcers are occasionally found. The liver
is frequently the seat of cheesy foci, some of them as large
as an apple, the larger ones causing depressions on the surface
of the organ. Their marrow-like substance contains grayish-
white, white, soft, purulent or crumbling foci. In rarer in-
stances small or large tuberculous foci are found in spleen or
kidneys; these occasionally perforate into the pelvis of the
latter organ and set up ulcerating processes (Jensen). Ball
observed isolated tuberculosis of the mucous membrane of the
pharynx in the form of a granular pharyngitis.

Finally tuberculous changes occur in rare instances in the
sexual organs, pancreas, bones, certain joints (Cadiot), sub-
cutaneous connective tissue (Ratz observed two cases of tuber-
culosis of the thoracic lymph glands that extended to and in-
volved the overlying skin). Tuberculosis may also occur in
‘the cerebral meninges as a tubercular meningitis (Nocard,
Cadiot, Ratz, Petit), ete.

Acute miliary tuberculosis has also been observed in dogs
and Cadiot describes a case where small tubercles in the swollen
parenchymatous organs were visible with the unaided eye while
the tissues contained numerous tubercle bacilli (tuberculous
septicemia).

In 32 cases described by Petit and Basset the pleura was affected in 19
instances, the pericardium in 15, the peritoneum in 10, the myocardium in 1, the
endocardium in 2, the intestine in 3, the mesenteric glands in 5, the liver in 15,
the spleen in 1, the kidneys in 9, the lungs and bronchial lymphatie glands in

17, the bronchial lymphatic glands alone in J, the lungs alone in 2, and the mesenteric
glands were affected in one case where the large and small intestines were intact.

In cats tuberculous changes are similar to those observed
in dogs. The abdominal organs and especially the mesenteric
lymph glands are affected most frequently. The disease may
have its seat in these organs exclusively or the respiratory
organs may also be involved. Jensen observed one case of
tuberculosis of the uterus, one of the testicles, one of the joints
and two of the subcutaneous connective tissue; Hobday, one
case of generalized tuberculosis.
Symptoms. 549

Symptoms. In keeping with the extraordinary variability
-of the pathologic-anatomical changes that occur in tuberculosis,
the symptoms of the disease vary not only in different species
of animals but to an almost equal extent in individuals of the
same species. The insidious and long drawn out course of the
disease gives rise to additional variations.

In advanced stages of the disease the body temperature is
at times temporarily elevated. The course of the fever is in-
termittent or remittent, with evening exacerbations and morn-
ing remissions; sometimes the typus inversus is observed. In
the chronic course of the disease febrile attacks lasting several
weeks alternate with free intervals of the same duration. Near
the termination of the disease the fever is usually high and
continuous. The same is observed when an acute miliary tuber-
culosis develops from a chronic affection.

Tuberculosis of Cattle. The period of incubation, after
severe artificial infection, is rarely longer than two weeks. In
natural infection it is much longer; sometimes months and
even years may elapse before the appearance of the slightest
indications of disease become manifest to ordinary observation.

According to Nocard and Rossignol artificial infection by inhalation requires
19 to 32 days and alimentary infection 32 to 48 days before the animal will react
to tuberculin. In experiments conducted with calves by the authors symptoms of
fever appeared eight days after the intravenous injection of 0.02 gm. of cultures
of tubercle bacilli.

Pulmonary tuberculosis, the most frequent form of the dis-
ease, manifests itself by a short, dry, vigorous cough. At first
this occurs only when cold or dusty air is inhaled or when the
circulation is accelerated by the sudden rising of the animal
or by drinking cold water. In this stage the appetite is usually
good but symptoms of exhaustion may be observed after pro-
longed exercise.

Gradually, usually after the lapse of months, symptoms
pointing to pulmonary affection become more pronounced. The
cough becomes more frequent and painful, may be dry and coarse
or feeble and almost soundless. From time to time the animals
discharge a ropy, muco-purulent, yellowish-gray secretion from
the open mouth; as a rule however this secretion is swallowed
as may be demonstrated by observing the left esophageal grove
immediately after an act of coughing. It may also be retained
in the space anterior to the soft palate between the tongue and
last molar teeth where it may be reached by the hand (Ostertag).
Sometimes the bronchial secretion is discharged through the
nose; in this case the presence of pus corpuscles, alveolar
epithelium that has undergone fatty degeneration, fat crystals,
elastic fibres and tubercle bacilli may be demonstrated.

As the cough increases in frequency the type of respiration
begins to change; it becomes more frequent and laborious, in-
spiration assumes more of a costal type and expiration, which
550 Tuberculosis.

may be attended by groans, becomes abdominal. These symp-
toms are most pronounced after exercise or during work.

A physical examination of the thorax rarely reveals char-
acteristic changes. Vesicular respiration may be increased,
diminished or imperceptible. In slight affections there may be
dry rales, observable locally or over the entire extent of the
thorax, caused .by the presence of more or less viscous or fluid
secretions or by accumulations of mucus in the bronchial tubes.
The percussion sound may be normal or changed only slightly.
If lesions are of considerable size and located near the surface
the sound becomes dull in circumscribed areas, and in such
cases bronchial sounds may be recognized, while large con-
tiguous areas of dullness hardly occur. Cases where tympanitic
resonance points to the presence of large cavities are rare,
but an odor of decomposed bronchial secretion and necrotic lung
tissue, perceived in the expired air, points to this condition.

Where auscultation gives unsatisfactory or negative results it is advisable to
exercise the animals by running them around for a time, a procedure which usually
produces more or less distinct rales in animals whose lungs are affected. In similar
eases Roebert and Ellinger recommend closing the nasal openings with the hands
while auscultating. Nocard suggests the injection of 0.2 to 0.3 gm. of pilocarpine.
Krautstrunk suggests arecolin, 0.08 gm. Ostertag, however, observed that the
injection of 0.05 gm. of arecolin in a strong heifer, produced staggering, falling
and great dyspnoea. It should be noted here that the injection of the above sub-
stances may now and then produce rales in perfectly healthy animals,

Affections of the trachea and larynx usually produce
eatarrhal symptoms only. However, where there is suspicion
of tuberculosis it is safe to make a probable diagnosis of
laryngeal tuberculosis when we find the region of the larynx
sensitive, the cough very painful and spasmodic and degluti-
tion difficult. When tuberculous tumors exist in the larynx the
latter may be enlarged and distinct vibration may be felt at
each inspiration. At the same time the respiration becomes
stertorous, the animals holding their heads stretched forward
and avoiding lateral movements, and sometimes attacks of
suffocation are observed. On account of the incomplete closing
of the glottis, particles of food may enter the trachea during
the act of deglutition resulting in attacks of coughing and if
only for this reason, the affected animals usually eat sparingly.
Holterbach noted aphonia in a case of isolated tuberculosis
of the larynx in a cow with good nutrition. When attempting
to low, the cow would only emit a faint blowing sound. Accord-
ing to Friedberger tuberculosis of the respiratory organs in-
volves the larynx in only 0.13% of cases.

Tn rare cases the nasal mucous membrane is affected. Near
the nostrils the mucous membrane contains firm nodules up
to the siz2 of a pea which are usually yellowish in the center.
Uleers may also be visible, or thev may be situated higher up
and detected by palpation only. This condition is always at-
tended with a muco-purulent nasal discharge. The pharvngeal
glands are enlarged and contain cheesy foci (Jensen, Gutbrod).
Tuberculosis of Cattle. 551

The alae of the nostrils may be indurated and the lower jaw
enlarged (Liénaux).

Tuberculous inflammation of the pleura is not frequent but
usually occurs simultaneously with the affection of the lung.
It may be the cause of soreness of the thoracic walls which
causes the animals to flinch or cough when pressure is applied
to the part. Pleuritic friction sounds may indicate roughness
of the pleura or the presence of pearly tumors, and large masses
of the latter may produce a dull sound upon percussion, while
in fully developed cases the friction of the rough pleural sur-
faces may be felt with the hand. As a rule, however, especially
when the lung is extensively affected, it is impossible to diag-
nose pleuritic involvement.

 

Fig. 84. Cow with Advanced Pulmonary Tuberculosis.

The general nutrition of the animal suffers in direct pro-
portion as the disease of the respiratory organs advances.
Symptoms of oligemia are indicated by paleness of the mucous
membranes and increasing emaciation. The skin loses its
elasticity and adheres more firmly to the underlying structures,
the animals become ‘‘hidebound,’’ the tuberosities and angles
of the bones of the pelvis become prominent. The skin, when
raised into a fold returns reluctantly to its formal position
and the haircoat becomes staring and loses its luster (Fig. 84).
The facial expression indicates exhaustion and sickness, while
the eyes lose their natural luster and are withdrawn into their
sockets. The appetite is at first variable but finally becomes
poor; while in addition attacks of diarrhea persisting for days
552 Tuberculosis.

weaken the patients. The digestion is usually more or less
disturbed and the condition 1s aggravated by periodical attacks
of bloating, caused by compression of the esophagus by the
enlarged peribronchial and mediastinal lymph glands which.
interrupt or prevent eructations of gas and interfere with
rumination. In case of suspected animals this latter condition
always indicates the probable presence of tuberculosis! (Johne),
it is however, usually not observed until symptoms of pulmonary
affection have manifested themselves. Distention of the jugular
vein, which is occasionally observed, may be due to the same
cause.

Cardiac symptoms are usually observed only when the
pericardium is involved. There may be pericardial friction
sounds and more or less pronounced disturbance of the heart
action. But since the pericardial sac rarely contains any con-
siderable amount of fluid these sounds are usually absent. The
heart sounds are clearly audible and in rare cases only may
cardiac dullness be noted. Swelling of the skin in the anterior
thoracic region is rare as is also a jugular pulse (contrast
with traumatic pericarditis). In advanced stages of the disease
the pulse is subject to considerable variation in character as
well as in rate. In advanced cases it is much accelerated and
empty. oy

In one case observed by Liénaux there was displacement of the
heart toward the. right side, and great distention of the jugular vein
as a result of compression by the anterior lobe of the left lung which
was indurated and contained numerous cheesy and calcified foci. In
another case he succeeded in demonstrating the presence of tubercle
bacilli in the pericardial fluid which was obtained by aspirating the
pericardial sac.

Toward the termination of the disease the respiratory diffi-
culties become increasingly great. The affected animals stand
without moving from the spot, with elbows projecting outward,
the neck held low and the head stretched forward, groaning
and gasping for breath while their forced respiratory move-
ments cause the whole body to tremble. The cough is weak,
painful and frequent and is easily provoked by slight pressure
exerted upon the back. Purulent or ichorous secretion which
is discharged from the nostrils is no longer ‘‘licked away’’ by
the animal. As the animals become weaker and more and
more emaciated they lie down continuously, being no longer
able to stand. In the meantime the abdominal organs may have
become involved; there is a continuous diarrhea, and finally,
after long suffering the end approaches without spasms.

Tuberculosis of the abdominal organs which in regard to
frequency of occurrence is second to pulmonary tuberculosis
develops in an equally insidious manner. Tuberculosis of the
peritoneum may reach an advanced stage of development before
it manifests its presence by any outward indications. In cows,
Symptoms in Cattle. 583

however, when the process spreads to the serous coats of the
sexual organs there is unusual excitement during the period
of oestrum. If served by a male they either do not conceive or
they are apt to abort at about the middle of gestation. In
later stages of the disease this excitement becomes continuous
(nymphomania) and may then also exert an unfavorable in-
fluence upon the nutrition of the animal. Otherwise this form
of tuberculosis does not necessarily interfere seriously with
nutrition and animals may grow fat even with advanced and
extensive disease. The presence of the latter is often unsus-
pected until on post-mortem examination after the animals are
slaughtered. Still, in the advanced stage of the disease the
affection of other organs, especially the liver and the spleen
and also the mesenteric lymph glands will exert a disturbing
influence on the organs of digestion and gradually anemia and
emaciation become more and more evident.

Large tumors on the peritoneum may now and then be
accurately located. The presence of large pearl nodes on the
left side of the paunch or on the opposing peritoneal mem-
brane may be palpated by applying the hand to the left flank.
Tumors in the pelvic cavity, especially when located near the
internal sexual organs may occasionally be palpated through
the rectum. Any large tumors with irregular surface, or masses
of smaller structures of hard consistency, when present in the
pelvic cavity, may be looked upon as tuberculous excrescences.
These structures do not take finger impressions and the small
ones if loosely imbedded in connective tissue or if they are
pedunculated usually slip from the grasp (Storch). Enlarged
sacral, lumbar, medial iliac and mesenteric glands may also
be palpated.

In the course of the digestive tract tuberculous changes
may, in rare cases, be met with in the mouth, viz., the mucous
membranes of the pharynx, the hard palate and the fauces.
Here there are irregular ulcers with firmly adhering grayish-
yellow, cheesy deposits, sometimes knobby borders. The sur-
face of the tongue, especially at the point just anterior to the
eminence of the dorsum of the tongue may have similar
ulcers. Its substance may contain firm nodules or be uniformly
indurated which condition interferes more or less with the
movements of this organ also mastication and deglutition
(Moussu).

The symptoms of intestinal tuberculosis are very indefinite.
Digestive disorders which are hardly ever absent in advanced
tuberculosis are not infrequently caused by an involvement of
the intestines but, on the other hand, digestive disorders may
be entirely absent even in advanced disease of these organs.
The most significant symptoms are colicky pains and constipa-
tion alternating with diarrhea. The intestinal evacuations may
be quite fluid and not infrequently mixed with mucus and pus.
Sometimes there are streaks or even clots of blood. Occa-
004 Tuberculosis.

sionally microscopic examination will reveal the presence of
pus corpuscles and red blood cells when its general appearance
would not cause us to suspect them.

Tuberculosis of the liver and spleen can be recognized as
such only in cases where considerable enlargement of the organs
has taken place. There may be dullness upon percussion in
the overlying region or their posterior irregular nodular bor-
ders may be palpated behind the costal arch.

Among the sexual organs tuberculosis of the testicle may
be recognized by the presence at its superior and posterior
border, corresponding to the position of the epididymis, of
a firm painless swelling. The testicle itself does not become
enlarged until at a considerably later date and then, becoming

 

 

 

 

 

Fie. 85. Superficial lymph glands of the ow. Kg. Submaxillary gland; 0 parotid
glanl; o/f superior, mf middle, wH inferior Cervical glands; B Prescapular gland;
/./ Precrural glands; W Inguinal glands; 2 Supramammary gland.

confluent with the epididymis, the two organs constitute one
tumor. Usually there is simultaneous hydrocele. In a few
cases fistulae perforate the skin above the epididymis and dis-
charge yellowish pus. In tuberculosis of the penis, which is
very rare, we find firm nodules at the end of the organ and
occasionally induration of the edges of the prepuce (Eber,
Trotter). In tuberculosis of the uterus a turbid, mucous or
muco-purulent, yellowish, or rather ichorous and ill smelling
vaginal discharge is a constant symptom. Occasionally this
discharge contains cheesy fragments and, in exceptional cases
streaks of blood. Rectal examination may, in some cases reveal
the presence of enlarged sacral lymph glands or the. horns
Symptoms in Cattle. DDD

of the uterus which have become transformed into knotty struc-
tures the size of aman’s arm. The Fallopian tubes may present
twisted strands as thick as a finger and occasionally the uterus
is transformed into a large firm ball (Hess). Cows thus affected
do not conceive but are frequently in heat, although sexual desire
vanishes as the disease advances. Tuberculosis of the vagina
and of the vulva, which is very rare, manifests itself in the
appearance of small yellowish nodules and erosions (Fischer)
or tumors as large as peas and ulcers with raised borders.
There may also be observed a purulent discharge, hypersensi-
tiveness and swelling of the lips of the vulva and enlargement
of the perineal lymph glands. Hess observed a case of tuber-
culosis with thickening of the labia of the vulva resembling

 

Fig. 86. Tuberculosis of the submaxillary parotid and preerural lymph glands.

elephantiasis. Fischer referred to this form as lupus hyper-
trophicans of cattle.

Since the superficial lymphatic glands (Fig. 85) in the
pharyngeal and cervical regions become primarily infected and
the remaining glands become involved in most cases as a resuis
of tuberculosis of neighboring organs the determination of in-
fection of the former glands is of special importance in the
diagnosis of this disease. Large tumors, attaining to or ex-
ceeding the size of a man’s fist are now and then found in one
or several of the following locations, viz., intermaxillary space,
behind the ascending portion of the inferior maxilla in the sub-
parotid region, on the side of the neck above the jugular furrow,
anterior to the scapula, at the inside of the elhow, in the pre-
erural and inguinal regions, in the flank, at the superior border
556 Tuberculosis.

of the mammary gland. These tumors are usually only slightly
movable, round or oval in form, the very large ones usually
nodulated, firm, painless and not adherent to the overlying skin
(Fig. 86 and 87). In calves they may be elastic and fluctuating,
if incised they evacuate a white creamy pus. In rare cases in-
flammatory processes develop in and around these tumors caus-
ing them to adhere to the overlying skin, rupture and discharge
their contents outwards. There then remains a fistula with
pale red granulating borders. Very greatly enlarged lymph
elands may interrupt the functions of neighboring organs; thus
enlargement of the glands of the throat may interfere with
deglutition or respiration while that of the glands of the axillary
region and the groin occasionally produces lameness.

 

Fig. 87. Tuberculosis of the submaxillary, prescapular and inguinal lymph glands.

Tuberculosis of the udder begins with a rather diffuse pain-
less induration of one or both posterior quarters without local
hyperthermia. The process occasionally spreads to the adja-
cent quarters and gradually develops into an exceedingly hard
and nodular tumor which may approach the size of a child’s
head and cause atrophy of the remaining parts of the gland
(Bang, Fig. 88). In other instances we may observe, especially
after the udder has been milked dry, several nodules, or larger
nodes in the otherwise uniformly elastic glandular tissue of
one or more quarters of this organ. These tumors are firm,
painless, do not show an increased temperature and may exist
singly or as a conglomerate mass with nodular surface, affect-
ing a part of or an entire quarter. This may cause the teats
on one side of the udder to assume an irregular direction and
Symptoms in Cattle. 557

become parallel or converge instead of diverging (Ostertag,
Fig. 90). At the upper border of the udder either on the
affected side or on both sides the enlarged lymphatic glands
may be located by palpation (Fig. 89). In exceptional cases
the supermammary lymph glands may be enlarged and the udder
itself present a normal appearance. In these cases, however,
it may be assumed that in all probability the udder itself is
also infected. In very rare cases the affection begins with
increased local temperature and moderately painful swelling
of one quarter but in the course of a short time the above de.

 

 

 

 

Fig. 88. Tuberculosis of the right hind quar- Fig. 89. Tuberculosis of the left
ter of the udder with pronounced atrophy of the hind quarter of the udder with exten-
glandular tissue. Enlargement ofthe precrural sive enlargement of the left super-
lymph gland. mammary gland (a). (Ostertag.)

seribed characteristics appear. In other rare cases chronic con-
ditions will become acute, the diseased quarter becomes more
tumefied and painful, there is increased temperature and the
neighboring lymph glands show acute enlargement (Lucet). _
In regard to milk production, contrary to what occurs in
other inflammatory processes of this organ, no interruption
occurs for some time in the course of tuberculous disease. As
the morbid processes advance, however, the secretion gradually
diminishes until it ceases entirely in the affected quarters. In
the meantime the milk, which is at first normal in appearance,
becomes thin and greenish-yellow in color (Fig. 92). Later,
558 Tuberculosis.

white flakes and curdled masses appear and finally the secretion
assumes a watery appearance.

According to Stroh the milk obtained from the tuberculous quarters is fre-
quently alkaline in reaction, contains an increased amount of salts of sodium,
chlorine, lime and phosphorus, the fat is diminished and the milk sugar present in
only small quantities or absent altogether. The nitrogenous contents consist of
paraglobulin and albumin instead of casein and albumin as in normal milk.
Monvoisin also found the acidity considerably reduced (from 1.4 to 2.0 g. of lactie
acid—normal contents per liter—to 0.80, 0.24 and even 0.12 g.) which is in contrast
to ordinary inflammations of the udder where the acid content is usually increased
on account of decomposition of lactose. The percentage of fat may be reduced
from the normal (being instead of 3.5-45% only 1.5%). Milk sugar may he
almost entirely absent. The freezing temperature remains about the same.

According to Ostertag the examina-
tion of the mammary lymph glands is best
accomplished by grasping with the index,
middle and ring fingers the skin of that
portion of the lateral faces of the udder
which lie opposite the inner sides of the
thighs, beginning at about the middle
of the udder and pushing upward, when

 

 

 

 

 

 

 

a : Ps

 

Vig. 90. Tuberculosis of the. greatly en-

larged left hind quarter of the udder. Fig. 91. Palpation of the mammary
(Ostertag). lymph glands.

the lymph glands may he palpated from without and from below (Fig. 91). These
glands lie in the angle which is formed by the upper and posterior border of the
udder. As a rule the posterior border of these glands does not project beyond
the posterior border of the udder.

To confirm the diagnosis it is advisable to cleanse and disinfect the udder
with soap and water, rinse with alcohol and, with the aid of a harpoon, remove
a portion of tissue from the affected region for bacteriological examinations (see
pp. 571 and 574).

Tuberculosis of the kidneys or more properly speaking,
tuberculosis of the pelvis of the kidneys, is indicated by the
Symptoms in Cattle. 559

pronounced ammoniacal odor of the urine and the presence
of albumin in the turbid urine. Microscopically, pus cells
variously formed epithelial cells, irregular detritus, connective
tissue fibers and tubercle bacilli (Iro) may be demonstrated.

Tuberculosis of the central nervous system manifests itself
in two forms. Solitary tuberculous foci, according to their
location and size, either in the brain or in its nerve trunks,
produce disturbance of function. The clinical picture is the
game or similar to that produced by other tumors and for that
reason a specific diagnosis can be
made only by the determination
of tuberculous disease in other
organs.

The symptoms of cerebral af-
fection on the other hand are:
fearfulness, unsteady swaying
gait, constrained or forced move-
ments, occasional clonic spasms
which may involve the whole body
in the form of epileptiform at-
tacks; partial or complete par-
alysis of regions supplied by cer-
tain cranial nerves (incoordina-
tion of the extrinsic muscles of the
eyes [eyes awry] and impaired or
total loss of vision, comparatively
frequent) ; slow and frequently in-
terrupted mastication, holding the
head to one side, desire to push
forward or upward, hemiplegia,
arythmic and slow pulse; if the
spinal cord is involved, stiffness
of the hind quarters and _ tail,
paraparesis or paraplegia. These
symptoms not infrequently appear
suddenly in animals that were ap-
parently healthy, rapidly become
more aggravated and pronounced
and terminate in death after one

 

or two days. (In regard to loeali- Fig. ee hens from a tuberculous
. ‘i sa 7 quarter of the udder. Turbid, green-
zation of foci, see Vol. IL) ish yellow fluid with flaky cheesy

The symptoms of acute inflam- sediment.
mation of the cerebral meninges
may follow the symptoms of a
local affection or they may make their appearance without pre-
vious warning The principal symptoms are: increased reflex
excitability and fearfulness, great restlessness, delirium or rav-
ing madness; unsteady gait, muscular tremors, nystagmus, jerk-
ing of certain muscles, opisthotonus or spasms of the entire
body; symptoms of paralysis in the region of certain cranial
560 Tuberculosis.

nerves, especially incoordination of the extrinsic muscles of the
eyes and unequal size of the pupils. Later there may be ex-
treme stupor and finally complete unconsciousness; the animal
gets down, is completely helpless and occasionally makes forced
involuntary movements with the extremities. In the meantime
respiration and heart activity are subject to great variation,
not infrequently the Cheyne-Stokes type being observed.

In tuberculosis of the eye, which is very rare, we may ob-
serve tubercles up to the size of a hemp-seed in the bulbar
conjunctiva (Priewe), in the substance of the iris (Winter),
or on the posterior surface of the cornea (Schmidt). The de-
velopment of the affection is attended, either from the beginning
or not until a later stage, with turbidity of the cornea and
symptoms of an acute iritis. The process usually terminates in
panophthalmitis and atrophy of the bulbus.

In localization of the tuberculous process in the posterior portions
of the ocular globe, e. g., the posterior face of the lens, a diffuse iritis
and turbidity of the lens may be observed (Spoerer). Winter observed
nodules in the sclerotic in the external canthus of the eye in one case
and Lottermoser observed a tumor-like swelling, as large as a hazelnut,
in the lower nasal quadrant of the bulbus. The granular structure of
this growth could be observed through the overlying yellowish cornea
and sclerotic. There were observed, also, minute yellowish nodules in
the iris which latter was adhered to the turbid cornea.

Manleitner found the eye affected in five per cent of all cases of generalized
tuberculosis. The choroid is most frequently affected (70%) although clinical
symptoms are usually absent, while tuberculosis of the iris begins with symptoms
of iritis and leads to the formation of visible nodules,

Of the bones we most frequently find a few ribs involved
which become thickened in circumscribed areas, cold abscesses
and fistulae developing in the surrounding parts. In disease
of the vertebrae symptoms pointing to compression of the
spinal cord is. observed and usually sensitiveness to pressure
of the affected region of the spinal column.

Haug observed stiffness of the hind quarters and tail and contraction
of the muscles of the loins and croup in tuberculosis of the first two
lumbar vertebrae. Hamoir and Stenstroem observed inability to stand
and occasionally loss of sensation in circumscribed areas of the spinal
column, also lameness and genu-flexion. The general condition of the
animal often remained good. Wyssmann observed mydriasis in one case
of tuberculosis of the occipital condyles, also opisthotonus, heavy gait
and subsequently dullness. In a case observed by Gueldra an animal
with disease of the last two cervical vertebrae could not move its head
laterally and in another case tuberculosis of the twelfth dorsal vertebra
interfered with mastication and locomotion.

Tuberculosis of the joints, most frequent of the knee, less.
common of the carpal or tarsal articulations (Guillebeau) mani-
fests itself in subacute inflammation, moderate swelling and dis-
turbance of function of the affected joint. Upon puncture a
Symptoms in Goats and Sheep. 561

ropy, caseo-purulent exudate is usually discharged. The ten-
dons in the affected region are usually irregularly enlarged and
very sensitive. According to Hess the tendons of the M.ext.
carpi radialis and of the M.ext.digit.pedis longus are most fre-
quently involved.

In the skin and in the subcutaneous connective tissue there
occur, in rare instances, firm tumors the size of a hazelnut con-
taining cheesy or mortar-like masses in one or more locations.
Lazace observed a case in which 30 such nodules occurred in
the shoulder and arm while the remaining organs of the body
were healthy. These nodules may break spontaneously, leaving
fistulae which heal only with the aid of surgical treatment and
then leave shiny radiating scars (according to Vigadi this
affection resembles tuberculosis cutis colliquativa hom. in ap-
pearance). In exceptional cases a considerable nodular enlarge-
ment of the tail results from tubercular infection (Moulé &
Nocard).

Acute miliary tuberculosis runs its course attended with
severe febrile and general symptoms, the true cause of which
can not usually be recognized except in animals already known
or suspected to be tuberculous. The symptoms consist of ex-
treme dullness, rapid emaciation, continuous or remittent but
invariably high fever, increased heart activity and weak but
rapid pulse also respiratory difficulty without recognizable per-
cussion dullness in the lungs. Animals thus affected usually
die in the course of a week. In a few cases symptoms of acute
meningitis are observed (incoordination of the extrinsic muscles
of the eyes, nystagmus, unequal pupils, opisthotonus).

Tuberculosis of goats and sheep. Thus far only few clinical
cases have been: observed. Mathis and Leblane observed, in
a goat four years of age, emaciation, coarse cough, accelerated
and labored breathing, bloody mucous discharge from the nose,
bronchial breathing and rales upon auscultation of the lungs,
and pericardial friction sounds. Edgar described a. similar
case. In a goat that became sick one month after parturition,
Hess observed loss of appetite, frequent, moist, short and pain-
ful cough, abdominal respiration, rapid decrease in flow of milk
but-normal temperature throughout. In a goat with well de-
veloped pulmonary tuberculosis Schroeder observed that the
udder was also affected and transformed into a nodulated pain-
less tumor as large as a man’s head and as hard as a stone.
Nocard saw a similar case.

Tuberculosis in sheep always runs a chronic course and
usually manifests itself in the form of a gradually progressing
pulmonary affection. Asa result of enlargement of the thoracic
lymph glands bloating is common. Other superficial lymph
glands also become occasionally involved (Mayer).

Tuberculosis of Horses. The first symptom of pulmonary
tuberculosis in horses is an occasional dry, or slightly moist,

Vol. 1—36
562 Tuberculosis.

short, weak cough. Later on the animal is easily exhausted
after work, and symptoms of ‘‘heaves’’ make their appearance.
In some eases there is slight mucous or muco-purulent nasal
discharge which may also be intermittent. The discharge may
be streaked with blood or there may be epistaxis. Sometimes
it may be very profuse and consist of almost pure pus. In
the act of coughing similar secretions and occasionally necrotic
particles of Jung tissue are discharged from the mouth. Per-
cussion of the thorax usually reveals nothing abnormal and
auscultation usually reveals nothing except rough vesicular
breathing or, in addition, toward the end of expiration, fine
rales. Occasionally areas of dullness or an extensive but sub-
dued tympanitic percussion sound without respiratory bruits
or with bronchial bruits may be recognized in the posterior
borders of the lungs (Goedecke, Zuern). In rare cases symp-
toms may be observed that point to breaking down of Inng
tissue and cavity formation. Sometimes a pleuritis with a
tendency to latent development accompanies the affection of
the lung proper. There are friction sounds and fibrinous exu-
date which later becomes serous. At a later stage there is loss
of appetite and coincident with this a gradual or rapid develop-
ment of extreme anemia and emaciation.

In tuberculosis of the pharyngeal lymph glands Stiennon
observed dysphagia, moist cough, muco-purulent nasal dis-
charge, sensitiveness of the pharyngeal region and rattling ex-
piration.

Tuberculosis of the intestines and mesenteric glands is
more frequent, especially in colts, but presents no characteristic
symptoms. The affected animals are in a bad state of nutrition,
develop poorly, the flanks are drawn in, the abdomen is pen-
dulous or, on the contrary, ‘‘tucked up.’’ There may be oc-
casional slight symptoms of colic; defecation is irregular, con-
stipation alternating with diarrhea, the latter finally becoming
chronic and leading to exhaustion of the patient. The feces,
especially when large intestinal ulcers are present, are thin in
consistency, yellowish and ill smelling. Rectal examination may
enable us to demonstrate the greatly enlarged lymph glands
which appear as tumors the size of a man’s fist, firm, nodular
and movable. Similar structures may be felt below the spinal
column near the kidneys as well as in the liver and the spleen
(Zuern), a form of so called tabes mesaraica.

According to Nocard and Goedecke a comparatively com-
mon symptom, especially of tuberculosis of the abdominal
organs, is that of polydypsia and polyuria. The quantity of
urine may, for weeks at a time be increased four-fold and then
resemble that of the carnivora in having an acid reaction. Uric
acid is present in large quantity while hippuric acid is dimin-
ished or disappears entirely. During febrile attacks the urine
contains also albumen.
Symptoms in Horses. 563

_ In a case of tuberculosis of the abdominal organs Portet found the urine
to contain 4.5% of urea and 9.2% of uric acid. Although the urine contained no
albumen its sediment was ‘rich in homogeneous, light-refracting, casts and some
epithelial casts. Schindelka also observed polyuria in one case of tuberculosis of
the lung, while Knipscheer demonstrated albuminuria in a similar case.

The lymph glands near the surface of the body are oc-
easionally also enlarged. Thus in a case described by Rabe
the subparotideal lymph glands formed a mass 3 to 5 kg. in
weight, but hardly underwent any changes in the course of a
year. In a case observed by Johne & Siedamgrotzky and in
one by Roebert the prescapular glands were greatly enlarged,
in the last case forming a tumor weighing 25 kg. In a case
described by Davis the trachea, esophagus, blood vessels and
nerves were involved but the lungs were free from tuberculosis!
Eberhardt observed foci of thick pus in the enlarged sub-
maxillary lymph glands three years before the death of the
animal.

In very exceptional cases tuberculosis of the nasal mucous
membrane may be met with, which manifests itself exclusively
in the appearance of firm gray nodules with reddened borders
(Behr) and in size approaching that of a lentil. Or there may
be defects in the mucous membrane surrounded with raised
borders while nodules as large as small peas are seen in the
surrounding area. Eventually the commencement of the morbid
process is announced by intermittent epistaxis and enlargement
of the intermaxillary glands into painless and not sharply de-
fined tumors as large as a hulled walnut. . The overlying skin
is not adherent (Gerspach). Again, the nasal mucous mem-
brane may contain only a scar while the firm intermaxillary
glands are studded with miliary, or transparently fibrous, or
partly calcareous nodules (Joly). The latter glands may also
consist of a mass of nodules with cheesy or partly calcareous
interior (Nocard). —

Tuberculosis of the udder is very rare. Parascandolo &
Meis observed a case in the ‘‘dry’’ udder of amare. The lesion
consisted of a large tumor containing a thick cheesy purulent
substance.

Tuberculosis of the skin and subcutis is equally rare
(Schindler, Goedecke). Firm, painful tumors approaching the
size of an apple appear in numerous regions of the body, the
surrounding areas are edematous but the lymph vessels do not
become prominent. Some of these tumors may break open and
the lesions are then covered with dark brown scabs.

The temperature is from time to time elevated from 2°
to 3° F. Near the termination of the disease it ranges between
103° and 105° F. (Siedamgrotzky). Schindelka and also Batt
observed morning exacerbations and evening remissions with
comparatively slow pulse. Tabusso observed chills and profuse
sweating during the exacerbations. .

Coincident with tuberculosis of the abdominal organs the
development of miliary tuberculosis of the lungs is frequently
564 Tuberculosis.

observed. This is characterized by high fever, excessive
dyspnea and by a rapidly fatal course. The lungs give a
tympanitic percussion sound and vesicular bruits upon auscul-
tation (Goedecke).

Tuberculosis of Swine. During life the disease can be
definitely recognized only when the lymph glands are involved
(scrophulosis). In pronounced cases the submaxillary, pharyn-
geal and cervical glands are excessively enlarged and, through
confluence, constitute firm nodular tumors as large as a fist.
They are very sensitive to pressure and more or less adherent
to the surrounding tissues. This process is attended with the
development of a diffuse swelling in the parotid region which
interferes with the free movement of the head and lower jaw.
These tumors may extend along either side of the neck in rosary
fashion and additional tumors may be present in the prepectoral
region. Swelling of the lymph glands of other regions of the
body, especially those of the flexor surfaces of the extremities
may also be present. Some of these tumors may become fluc-
tuating, break open and discharge a thick purulent or cheesy
mass. This results in the production of a fistula which dis-
charges cheesy-purulent secretions for a long time. Spon-
taneous healing does not take place.

Tuberculosis of the abdominal organs, especially as a pri-
mary affection in young pigs manifests itself in slowly develop-
ing but steadily increasing impairment of digestion. The af-
fected animals gradually lose their normal vigor and liveliness,
their tails lose the curl, the back is humped, they stand around
listlessly or bury themselves under the bedding for hours at
atime. The appetite is at first impaired, the animals selecting
only choice morsels and later refusing all food. Constipation
and diarrhea alternate and during the latter ill smelling semi-
fluid feces mixed with crumbly material are discharged. Now
and then there is bloating caused by the accumulation of gases in
the intestines. Later on the flanks become hollow, the abdomen
becomes pendulous and the lower portion increased in its trans-
verse diameter. If the animals are handled they evince signs
of pain, the enlarged scrophulous lymph glands, and the loops
of intestines which have become adherent by inflammatory
process may occasionally be felt as firm irregular swellings. The
animals become more and more emaciated, the mucous mem-
branes become pale and the eyes are drawn into their sockets.
Here and there the skin is covered with brown crusts. The
weakness constantly increases until exhaustion leads to death
after several months of illness.

In tuberculosis of the lungs there is at first a dry, short,
suppressed cough as well as moderately accelerated and difficult
breathing. In the course of time the cough becomes more fre-
quent and distressing and is sometimes attended with vomiting.
In the further course of the disease the respiratory difficulties
become excessive, the animals sit on their haunches and, with
Symptoms in Swine. 965

their forelegs spread out and extended breathe spasmodically
with the aid of the accessory muscles of respiration. The nutri-
tion suffers from the beginning except in a few cases where
the disease takes a chronic course. The animals emaciate
rapidly, the mucous membranes become pale, and death results
from exhaustion after a few months or sometimes in three or
four weeks. :

Solitary tubercles in the brain produce, at first, clonic
spasms and forced involuntary movements that may be limited
to certain groups of muscles or affect the whole body. Later
there may be paralysis of certain cranial nerves, or hemiplegia.
These symptoms are particularly frequent in young pigs. Vogt
observed paraplegia and prolapsus of the rectum in tuberculosis
of the fourth lumbar vertebra as a result of pressure on the
spinal cord.

Tuberculosis of the eye manifests itself in turbidity of the
cornea and accumulation of a plastic exudate in the anterior
chamber with simultaneous affection of the posterior regions
of the ocular globe. Keil saw both eyes of a pig thus affected.
Tubercles in the background of the eye may also be recognized
with the ophthalmoscope (Azary).

The bones and joints are particularly liable to become
affected in general tuberculosis. In addition to individual ribs
and vertebrae the articular surfaces of the bones of the ex-
tremities may become involved. The corresponding joints swell
excessively and impede locomotion. Now and then the process
extends to the skin from which point the accumulated cheesy-
purulent masses are discharged. Tuberculosis of the petrous
portion of the temporal bone causes vertigo and disturbance
of bodily equilibrium. Occasionally granulating growths are
observed in the external auditory canal when the latter affection
exists.

Acute miliary tuberculosis is, as in other species, charac-
terized by high fever, dyspnea, diarrhea, rapid emaciation and
death after a short time.

Tuberculosis of Dogs. The clinical picture of this disease
in dogs has been described most minutely by Cadiot and by
Froehner. The first symptoms, though usually not very con-
spicuous, are as follows: Capricious appetite, slight emacia-
tion, exhaustion on running, difficult breathing, general weak-
ness, etc. In some cases the clinical evidence of the disease
is for a long time limited to the aforementioned symptoms
which are little characteristic. In the majority of cases, how-
ever, symptoms of tuberculosis of the lungs and abdominal
organs make their appearance.

Pulmonary tuberculosis begins with a short dry cough
which may, in some animals lead to vomiting. Later on the
cough becomes more frequent, the patients discharge muco-
purulent secretions, there may be an occasional bloody dis-
charge from the nose and respiration becomes more and more
566 Tuberculosis

labored (25 to 40 respirations per minute). Dry or moist rales
may be heard on auscultation, and percussion gives in spots
a dull or empty sound. In these areas the respiratory sounds
are either absent or they are bronchial in character. In rare
eases there may be indications of cavities (tympanitic or
amphoriec sounds, -succussion and amphoric respiration). Sen-
sitiveness of the thoracic wall, or continuous areas of dullness
which may extend over the entire field of percussion, together
with the absence of respiratory sounds may, in frequent in-
stances point to the existence of a pleuritis. If this occurs on
the left side, the beats of the heart, which organ has been
displaced to the right, may be felt on the right side. In rare
cases there may be symptoms of pneumothorax but these are
always attended with ‘accumulation of large quantities of serous
exudate (dullness and muffled heart sounds). In the advanced
stage the greatly exhausted and emaciated animals are tortured
by a frequent spasmodic cough. The secretions discharged on
coughing are purulent, gray or greenish in color and, if cavities
are present, have a bad odor. Not infrequently there is a
nasal discharge which has similar characteristics. The exhaled
air, also, has a disagreeable odor.

Tuberculosis of the pericardium occurs in the course of
the disease in the lungs or the pleurae or independently of the
involvement of any other organ. In either case it may lead
to the accumulation of large quantities of serous exudate and
manifest itself by the usual symptoms of an exudative peri-
carditis. The nature of the affection may therefore be recog-
nized or suspected only by the insidiousness of its course or
by microscopical examination of aspirated pericardial fluid. If
the thoracic glands are much enlarged the heart sounds may
in exceptional cases become less distinct, the heart may be
dislocated upward and backward, and there may be symptoms
of compression of the esophagus (Marek).

Tuberculosis of the abdominal organs is indicated in a
general way by impaired nutrition as a result of which the
affected animals become emaciated and anemic. If the lymph
glands are much enlarged they may be felt through the ab-
dominal walls. The enlarged liver may be recognized in the
same manner, also by the increased percussion dullness or by
the nodular border which may be felt behind the costal arch
and the xyphoid appendage.

In the course of the disease the temperature is periodically
elevated (1° to 2° F. or more). Toward its termination the
pulse becomes soft and. rapid, the heart beats throbbing.
Hydrothorax and ascites are comparatively frequent. The
appetite is diminished, thirst increased and the mucous mem-
brane of the mouth is dry. Constipation alternates with per-
sistent diarrhea during which the intestinal evacuations contain
much mucus and occasionally also blood. Finally, after be-
coming extremely emaciated the animals die, the temperature
finally falling very low.
Symptoms in Cats, Course. 567

: In one case Mueller observed, on the side of the neck, a deep ulcer with a
sinuous border and torpid granulating base. The neighboring lymph glands were
enlarged. Cadiot observed a fistula of the withers and chronic arthritis of tuberculous
origin.

Acute miliary tuberculosis runs a rapid course attended
with symptoms of an acute infectious disease (Petit). Accord-
ing to Cadiot tuberculosis in dogs may also assume a septicemic
character.

Tuberculosis of Cats. The clinical appearance of this dis-
ease is as yet not well known. Since the pathologico-anatomical
changes are very much alike, the clinical symptoms are probably
similar also.

Thus, Lellmann observed the following in two angora cats:
Excessive emaciation and anemia, anemic heart bruits, labored
breathing and accelerated, weak pulse; in one case the abdominal
cavity contained a milky fluid with tubercle bacilli, there was
also pronounced leucocytosis; in the other case there was dull-
ness upon percussion on both sides of the chest and bronchial
breathing; a tumor was present in the abdominal cavity, under
the spinal column. Hobday & Belcher, in a case of general
tuberculosis, found the subparotideal, the submaxillary and the
prescapular lymph glands enlarged and purulent. Finally,
Petit & Coquot described a case of tuberculosis of the skin
on the face in which the bridge of the nose, one cheek and the
corresponding lower eyelid were transformed into one ulcerat-
ing surface.

Course. Tuberculosis always has an insidious beginning,
develops in a chronic manner and usually preserves its chronic
character until its fatal termination. The development of the
disease is usually so slow that years may elapse before morbid
symptoms point to its presence and when observed in mature
animals it is usually found to have had its beginning in early
youth. The tuberculous process, in its slow and chronic course,
usually does not exert a harmful influence on the general con-
dition of the animal until after the lapse of considerable time,
which explains that animals in well nourished, or prime condi-
tion and in apparently perfect health may frequently exhibit
extensive tuberculous changes when slaughtered. This is par-
ticularly true, in a general way, with regard to tuberculosis
of cattle and especially in cases of pearl disease of the serous
membranes. In many eases this form of tuberculosis, even when
far advanced, does not in the least affect the general condition
of the animals. In other animals, especially in young animals,
the disease usually runs a less insidious course. In young pigs
that are infected by milk from tuberculous cows the course
of the disease may be so rapid that the progressive changes
may be noted from week to week. :

Tn the course of this naturally chronic affection, especially
in its later stages, acute exacerbations occur from time to time,
568 Tuberculosis.

during which previously healthy areas become involved by the
process. Bacillary emboli give rise to the development of
new tuberculous foci in remote. organs or an infection with
pyogenic organisms complicates the morbid process. The
chronic course of the disease may be accelerated by influences
that exert a weakening action on the body like catching cold,
railroad transportation, overwork, etc. Intercurrent acute
disease and parturition may have the same effect (Froehner
observed a chronic case of tuberculosis of the horse become
acute after an attack of pleuro-pneumonia and Guenther the
same in a cow after abortion). Exacerbations of this sort are
announced by elevation of temperature, symptoms of general
indisposition and occasionally more frequent coughing. After
a few weeks former conditions again prevail. In the advanced
stage of the disease these temporary improvements become
less and less frequent. Again, in other cases, especially in
young animals and after an intensive injection of virus, the
disease may become steadily progressive and lead to complete
exhaustion.

Following the entrance of numerous bacilli into the blood
stream the simultaneous development of numerous tubercles
or rapid increase of virus in the blood may lead to a fatal ter-
mination within a few weeks. Symptoms of acute miliary tuber-
culosis, which is an acute febrile disease, attend this condition.

Tuberculosis of the cerebral meninges also runs an acute
course, while solitary tubercles developing in the substance of
the brain may remain unobserved for a long time or only cause
functional disturbances of the nerves, especially spasms and
paralysis, until they finally reach the meninges and there set’
up acute inflammation.

In large herds the disease usually spreads very gradually.
Since the development of the disease in a single animal may
extend over a course of years, large herds may, in spite of
infection, be kept up for years or even decades. The prompt
removal of affected animals which show physical indications of
the disease and their replacement by younger stock may retard
a rapid deterioration of the apparently fair general condition
of the herd. However, in herds of this sort, especially if they
are dairy herds, the disease will continue to spread irresistibly.
In the course of time the age limit at which the first clinical
symptoms of disease make their appearance is: gradually re-
duced and accordingly more and younger animals must be
ranged out every year. Finally the malady will make its ap-
pearance as a clinically observable disease in quite young ani-
mals, viz., in the form of tuberculosis of the lymph glands, of
the lungs and of the bones.

Diagnosis. Even if we exclude the early stages of tuber-
culosis in which no clinical symptoms whatever are observable
it is only rarely possible even in advanced stages of the disease
Diagnosis. 569

_to recognize it with absolute positiveness. The symptoms
simply point, in a general way, to affection of certain organs,
but hardly enable us to form an opinion as to the nature of
the disturbance. Although the diagnosis is often suggested by
a suspicion of an infection, this of itself is not sufficient to justify
the positive diagnosis of tuberculosis. Symptoms pointing to
the existence of tuberculosis are as follows: Insidious develop-
ment of the disease, gradual running down in condition, stunted
growth in young animals, periodical or occasional attacks of
fever without apparent cause and a gradually progressive af-
fection of the lungs. Great importance should be attributed
to enlargement of the lymphatic glands. While the latter may
occur as an independent affection it is usually an indication
of tuberculosis of the corresponding organs. On the other
hand enlarged lymph glands may, by exerting pressure on
neighboring organs, produce disturbances of function (bloating,
venous pulse, lameness) that would justify the conclusion that
deeper lying organs are affected.

In the great majority of cases, however, an exact diagnosis
is possible only by the aid of special diagnostic methods, among
which microscopical examination of morbid tissues and secre-
tions, inoculation of experimental animals and the tuberculin
test are of practical importance.

Post-mortem examination of slaughtered animals, or of
animals that died from the effects of the disease is usually
the easiest method of determining the tuberculous nature of
existing lesions, but even in such cases a microscopical examina-
tion is almost indispensable to enable us to differentiate with
certainty between tuberculosis and other morbid conditions
which occasionally show a remarkable similarity (actinomycosis,
pseudo-tuberculosis).

Microscopic Determination of Tubercle Bacilli. The determination
of true tubercle bacilli in a tissue or secretion absolutely clinches the
diagnosis of tuberculosis. Negative results of an examination for
tubercle bacilli do not, on the other hand, justify the exclusion of the
disease because tuberculous lesions, especially cheesy foci, may contain
very few tubercle ‘bacilli. If tubercle bacilli are present in large
numbers, however, they are comparatively easy to demonstrate. But
in making a diagnosis it should always be kept in mind that there are
other bacteria with morphological and staining characteristics (acid-fast
bacteria) that give them a remarkable similarity to tubercle bacilli (see
p. 571). However, these acid-fast bacteria, except in paratuberculous
chronic enteritis of cattle, are not known to be pathogenic. They occur
merely as harmless saprophytes which have been carried from_ the
outside into exposed cavities and canals and their secretions. It is
only exceptionally that they are found in pathological tissues and thus
it is comparatively safe to regard all acid-fast bacilli that are found
in tissues and secretions not communicating with the outer world
(unopened lymph glands, deep cheesy foci, tissue of the udder) as
tubercle bacilli while similar findings under opposite conditions can
570 Tuberculosis.

not be looked upon as conclusive evidence. Strictly speaking, this is-
also true in the examination of milk because paratubercle bacilli may
gain entrance into the lactiferous ducts through the excretory canals
(De Jong). Nevertheless this is only of rare occurrence. (Ostertag,
in his extensive investigations along these lines never found acid-fast
bacilli in freshly drawn milk, while Bang failed only 26 times in 2,174
cases in which tuberculosis was diagnosed on the basis of an examination
of the milk.) Accordingly, the demonstration .of acid-fast bacilli in
milk drawn after the first few streams from the udder have been dis-
carded may, though not with absolute certainty, be looked upon as
in all probability indicating the presence of tuberculosis. In regard
to other secretions, especially those of the bronchial tubes, the possi-
bilities of contamination are much greater and consequently greater
caution must be exercised in making a diagnosis on the strength of a
bacteriological examination. But even in these cases the demonstration
of acid-fast bacilli, slender in form and irregularly stained, point with
great probability to the presence of tuberculosis while, on the other
hand, the occurrence of these forms in the vaginal secretions is of less
definite value and their occurrence in the feces has slight significance
only.

In the living animal a resected subcutaneous lymph gland or other nodule,
the purposely removed contents of an abscess, aspirated exudate from the thoracic
cavity or from the joints, suspected tissue from the udder removed with a harpoon
or milk drawn under aseptic precautions are materials best suited for examination.
Ejecta from the lungs, nasal discharge, pus from. an already open abscess
or joint, secretions from ulcers, urine, spermatic fluid and vaginal secretions may
also be examined. Since animals seldom discharge bronchial secretions directly into
the outer world (although expelled particles are now and then to be found adhering
to the wall immediately in front of the animal’s head, in the stall) these must
be obtained by specially devised artificial methods. Holding a cloth over the
mouth and nose and then forcing a cough impulse by compression of the nostrils
will enable one to obtain particles of mucus which lodge on the cloth (Leeuwen).
The same results may be obtained by forcing the animal to cough against a board
wall or a linen cloth held immediately in front of it. After the animal is through
coughing, masses of mucus are usually lodged between the tongue and molar teeth
where they can be removed by hand. The mucus which remains lodged on the
pharyngeal membrane may be removed by means of a small wad of cotton or
a sponge attached to the end of a flexible rod (Nocard, Greffier, MacFadyean).
According to Ostertag the use of a small spoon with handle about 45 em. long is
more practical. Previous injections of pilocarpine have no value, because they
simply increase the quantity of secretions, the purulent admixture containing
relatively fewer tubercle bacilli. Hasenkamp constructed a special instrument for
this purpose (‘‘Lungenschleimfaenger’’ pulmonary mucus collector) consisting of
an elastic rod with a pear-shaped cup attached to one end. The cup end is
inserted into the esophagus, the animal forced to cough and, after swallowing,
the ‘‘mucus collector’? is withdrawn, filled with mucus! Poels recommends trache-
otomy at the lower end of the trachea and the removal of secretion from the
posterior tracheal wall with a cotton swab. Neuhaus uses Dieckerhoff’s venous
trocar, inserting the same into the trachea and then, by means of small chicken
feathers passed through the canula, causes the animal to cough, whereupon the
expelled mucus is caught up by the feathers.

Forcing a cough impulse while the tongue is mechanically pulled part way
out of the mouth prevents the animal from swallowing and thus permits the
collection of expelled masses of mucus; bending the head forward and downward
while the animal is coughing may enable one to collect the discharged saliva on
a plate and then examine the particles of mucus which it may contain (Klauwers).

Microscopic examination of discharges from the lungs does not always give °
positive results even in open pulmonary tuberculosis Negative findings, therefore,
do not necessarily exclude the presence of tuberculosis. Among 77 cases attended
with bronchial rales, Ostertag found tubercle bacilli in only 27. In 11 cases
he found bacteria resembling tubercle bacilli in appearance and in 11 other cases
short thick acid-fast rods were present while the examination gave negative results
in 29 instances. He succeeded only once in demonstrating tubercle bacilli in open
tuberculosis without rales.
Determination of Bacilli. 571

Milk must always be drawn under aseptic precautions (p. 558) and allowed
to settle in a conical vessel (protected from exposure) for 24 hours, or centrifuged
and the sediment examined.

Methods of Staining. The acid-fast tubercle bacilli may be demonstrated
by various means which are all based on staining coverglass preparations, fixed
in the usual manner, with anilin dyes, the staining properties of which have been
intensified by the addition of a mordant and then treating with a mineral acid
or with alcohol. The methods in common use are as follows:

1. Method of Ziehl & Nelsen. Staining solution: 1.0 gm. fuchsin, 10.0 gm.
absolute alcohol, 90.0 gm. 5% carbolic acid solution; stain a few minutes under
the action of heat; decolorize a few seconds in 5% sulphuric acid, wash in alcohol
and re-stain in aqueous methylene blue solution. (The prepared staining solutions
keep well.)

2. Gabbet’s Method. Stain in hot carbol-fuchsin as above then place for
a few seconds in mixture of 1 to 2 parts of methylene blue and 100 parts of 5%
sulphurie acid to decolorize and double stain; rinse thoroughly in water. After
staining and drying the stained coverglasses are mounted in Canada balsam and
examined under a power of 500 to 600 diameters, preferably with an oil immersion
objective. :

Material supposed to contain only small numbers of bacteria may be treated
with antiformin before staining, as follows: Mix 20 to 30 parts of the material
to be examined with 15 parts antiformin and 55 to 65 parts of water, shake and
Jet stand for 1 to 2 hours. The antiformin will dissolve tissue cells and all non-
acid-fast bacteria but will not affect tubercle bacilli or other acid-fast bacteria
which accumulate in the sediment of the vessel (Uhlenhut and Kersten).

Much’s non-acid-fast granular rods and granules may be stained by Gram’s
method, but this requires 24 to 48 hours at body temperature. The Herman-Caan
method is more rapid, viz. Staining fluid: 3 parts of a 1% ammonium carbonate
solution in distilled water and one part of a 3% crystal violet solution in 96%
alcohol; stain with the aid of heat; decolorize with 10% nitric acid, then with
96% aleohol. ;

Spengler and Betegh recommend special staining methods for the examination
of sputa -by means of which, it is claimed, human and bovine types may be
differentiated. These methods undoubtedly produce beautiful pictures but whether
they are of value for the purpose indicated, or in determining the spore characteristic
of the granules which they bring to view, is as yet a question.

Acid-fast Paratubercle Bacilli. The property of the tubercle
bacillus which enables it to retain stains with which its tissues have
once become impregnated, even after treatment with mineral acids, is
not an exclusive characteristic of this bacillus. Soon after the discovery
of the tubercle bacillus it was found that, aside from the human lepra-
bacillus, the smegma of the genital organs and the cerumen of the
‘external auditory canal contained saprophitic bacilli that had the prop-
erty of retaining stains much like the tubercle bacillus, though not
as tenaciously. Spina, as early as 1883, demonstrated acid-fast bacilli
in decomposing blood, in sewage and in the sputum of healthy human
beings. This property of the tubercle bacillus, however, was until very
recently regarded as a distinct characteristic in the examination of
pathological secretions until Petri (1896) and later Rabinowitsch found
bacilli in butter and milk that resembled true tubercle bacilli. There
ig no doubt that these forms had previously frequently been mistaken
for true tubercle bacilli. Since that time bacteria with similar charac-
teristics have been discovered in raw animal products, food stuffs and
in human and animal secretions and excrements. The differentiation
of these various forms from true tubercle bacilli becomes the more
difficult since some of them produce lesions in experiment animals that
are very similar to those of tuberculosis.

The bacteria of this class are without exception saprophytes that
may occur in soil, water and dust, decomposing substances, food stuffs,
manure, etc., occasionally gaining access to raw animal products, par-
ticularly milk, butter and oleomargarine. Occasionally they are also
found in the bronchial secretions, intestinal evacuations and urine of
572 Tuberculosis.

man and animals and, in exceptional cases, in pathological tissues, e. g.,
pearly nodules of tuberculosis.

Of the acid-fast bacilli now known the following may be men-
tioned: The Petri-Rabinowitsch butter bacillus which was found in
52.9% of butter samples and in 6.3% of milk samples by Petri, in
Berlin, and by Rabinowitsch in 33% of butter samples in Berlin and
in 26% of butter samples in Philadelphia; Korn’s bacillus friburgensis,
once found in butter; Moeller’s milk bacillus, found once in a culture
made from butter; Moeller’s Bacterium Phlei, found by the discoverer
on timothy grass and later also on other grasses; Moeller’s grass bacillus
and dung bacillus found in the dust of dwellings and in manure. Later
on the dung bacillus was also found in the excrement of cattle, horses,
mules and swine ;—Moeller’s pearl disease bacillus, which Moeller culti-
vated from pearl growths of cattle and swine ;—an acid-fast bacillus
which Preisz found in the nasal secretion of an ox suspected of having
pearl disease ;—Binot’s butter bacillus;—Beck’s Bac. tuberculoides I,
from milk and Bac. tuberculoides II cultivated from the tonsils of a
tuberculous woman, ete—In addition to these, acid-fast bacilli were
demonstrated: By Cowie in the smegma of the horse, ox and dog as well
as in the epithelium of the udder of the cow; by DeJong in the milk
of cows with udder tuberculosis and by others in various substances,
comparatively frequently in sputum of human beings with pulmonary
tuberculosis or pulmonary gangrene.

Acid-fast bacilli have certain common characteristics which make
it possible to differentiate them from tubercle bacilli. According to
the comparative investigations of Aujeszky these characteristics are as
follows: Morphologically the paratubercle bacilli in general resemble
the tubercle bacillus and like the latter they constitute transition forms
leading to the streptothrix species. The great majority is less acid-fast
than the tubercle bacillus and they are also easily stained by the simple
anilin dyes; some of them are acid-fast only and not alcohol-fast, others
show the same tinctorial characteristics as the tubercle bacillus; in
cultures on artificial media, in contrast to the tubercle bacillus, they
grow rapidly and, with few exceptions, grow luxuriantly also at room
temperature; their cultures are moist and shiny and have a brighter
color than tubercle bacillus cultures, often a yellowish-red color; on
the surface of bouillon a massive membrane forms within a few days
and they frequently emit a pungent odor suggesting decaying vegetation
or ammonia.

Most paratubercle bacilli exert a slight pathogenic action on ex-
periment animals. This action, however, usually does not manifest itself
unless the cultures are administered in conjunction with some ‘‘envelop-
ing’’ substance like sterilized butter or oil. If thus administered intra-
peritoneally they usually produce an exudative peritonitis which often
leads to massive accumulation of deposits and to adhesions; in-addition to
this, pseudo-tubercles make their appearance which differ from true
tubercles in that they do not become caseous, or only rarely so, but
have more a tendency to become purulent or become organized; in ex-
ceptional cases only do they contain cells of Langhans; finally—and
this is perhaps the most important difference—inoculation with these
forms produces only local inflammatory processes which do not progress
from the primary foci. (The bacillus of chronic paratuberculous en-
teritis of cattle seems to occupy a unique position in this respect which
is true also of its cultures.)

In spite of these important differences between these bacteria and
Diagnostic Animal Inoculation. 573

the true tubercle bacilli there exist certain points of close relationship
which find expression in peculiarities referred to as group reactions.
These are, aside from morphological resemblances, as follows: The for-
mation of tuberculin-like products in cultures as well as their mutual
agglutinating properties when treated with sera from animals that have
been treated with tubercle bacilli or other acid-fast bacilli; also their
property of immunizing animals against the effects of true tubercle
bacilli, though this is true only in a slight degree. These and many
others of the above mentioned common characteristics are doubtless
indications of a phylogenetic relationship and hence arises the possibility
that tubercle bacilli represent acid-fast saprophytes that have become
pathogenic in the course of time, or that the latter are tubercle bacilli
that have been attenuated through the influence of external agencies.

In view of the fact that the term pseudo-tuberculosis has already
been applied to certain other morbid processes it is suggested that the
acid-fast bacilli under discussion be referred to as acid-fast paratubercle
bacilli.

Diagnostic Animal Inoculation. These often give a positive result
when the presence of bacilli in material to be examined can not be
demonstrated with the microscope on account of their small numbers.
The demonstration of the infectiousness of milk, in particular, is fre-
quently possible in no other way. In other cases diagnostic inoculations
of animals are necessary when a microscopical examination is by itself
insufficient to determine beyond question that the suspected tubercle
bacilli are genuine.

With a diagnostic inoculation as a basis the diagnosis of tuberculosis
is justifiable only when true tubercles (in a histologic sense) have been
demonstrated in the inoculated animal or when tuberculous processes
have spread from the point of infection to a neighboring lymph gland
and to internal organs, liver, spleen, lungs (see above: Pathogenic
action of acid-fast paratubercle bacilli).

The guinea pig is, above all, adapted for this purpose. It is so
extremely susceptible to tuberculosis that negative results from the
inoculation of suspected material may, in practice, be looked upon as
positive evidence that the material was free from tubercle bacilli. This
does not, of course, exclude the possibility that material taken from
the same animal at another time may contain the bacilli.

If the probability of contamination is excluded (specially drawn milk, pus
from a closed abscess, tissue juices from internal lymph glands) the material may
be injected into the peritoneal cavity without further preparation, or after being
merely diluted with water. However, if contamination is probable, or suspected
(nasal discharge, bronchial or ulcer secretions), it is advisable to inject a small
quantity subcutaneously in the abdomen or on the inner surface of the thigh or
into the muscles of the latter. In such cases the foreign bacteria will cause a local
inflammation resulting in an abscess which will break and discharge its contents
to the exterior and if tubercle bacilli were also present the characteristic patho-
logical changes will develop as usual. (According to Ostertag the intramuscular
method is just as reliable as the intraperitoneal but preferable to the latter because
results are obtained quicker. Laurier recommends intramammary inoculation.)

In from 15 to 20 days after the intraperitoneal injection of virulent material
the peritoneum, spleen, liver and lymph glands contain tubercles and the liver
which assumes a mottled appearance undergoes fatty degeneration. After subeutane-
ous inoculation an ulcer, which has little or no tendency to heal, develops at the point
of inoculation; simultaneously with the development of the ulcer the neighboring
lymph glands become enlarged, and later on the process spreads to the internal
organs, especially the peritoneum, liver and spleen, and in these numerous tubercles
may be found from the 25th to the 30th day after inoculation. After intramuscular
inoculations the neighboring lymph glands may be recognized (frequently as early
574 Tuberculosis.

as the tenth day) as hard, firm, painless, distinctly cireumscribed tumors the size
of small peas or larger (Ostertag). Later on the internal organs are also attacked.
The enlarged lymph glands may be resected and examined under the microscope,
or the inoculated animals which in positive cases gradually emaciate and whose
fur becomes rough, may be killed after three or four weeks for post-mortem
examination. After intramammary inoculation tubercles appear in the mammary
glands as early as the fifth day and the milk contains numerous tubercle bacilli.

Allergic Tuberculin Reactions. Tuberculous infection pro-
duces certain changes in the animal body as a result of which
it reacts to a second infection or to the injection of toxins of
the tuberele bacillus in a different manner than the body of an
animal that has not yet been infected. This condition, referred
to by Pirquet as allergia, i. e., altered power of reaction, mani-
fests itself in increased resistance toward the virus in question
(see pp. 530-535) and in hypersensitiveness to its toxins (a
kind of anaphylaxis). This latter manifests itself in more or
less pronounced symptoms of inflammatory reaction following
the administration of very small quantities of the toxins which
would have no effect on healthy animals.

This hypersensitiveness is particularly evident with re-
spect to the tuberculin which Koch prepared from glycerin
bouillon cultures and which was recommended as a curative
agent in tuberculosis. Expectations along this line have, how-
ever, been realized only to a limited degree but later experiences
and observations have confirmed Koch’s declaration that, on
account of its specific action on a tuberculous animal, tuberculin
is admirably adapted as a diagnostic agent. For years the
general febrile reaction which usually follows the subcutaneous
administration of tuberculin was exclusively depended upon for
this purpose. Recently however the local ophthalmic and
cutaneous reactions also have attained great diagnostic im-
portance.

Tuberculin and Its Preparation. Koch prepared tuberculin by growing
tubercle bacilli at 37-38° C. for eight weeks in veal bouillon containing 1% pepton
and 5% glycerin. The culture was then evaporated on a water bath to one tenth
of its original volume, sterilized at 100° C. and then passed through a clay filter.
Crude tuberculin thus produced is a clear brownish-yellow oily fluid which, in its
concentrated form, will keep unchanged for months but loses its.activity in dilute
solution (according to Jansen light and heat does not affect the activity of the
concentrated tuberculin). By repeated treatment of the solution with 60% alcohol
a white powder may be obtained, the so called purified tuberculin, of which 0.1
gm. produces the same effect as 0.5 gm. of crude tuberculin. This powder is readily
soluble in water but aqueous solutions are not stable. In solution with 50%
glycerin and water it keeps a long time and is not destroyed even at a temperature
of 160° C. (Brieger and Proskauer). / .

Tuberculin adapted for diagnostic purposes may be prepared in other ways
also. Thus Helman prepared it from a glycerin and water extract of cultures
grown on potatoes treated with alkaline serum-glycerin (this has only one-fourth
the strength of Koch’s tuberculin but a similar action). Bujwid makes an extract
of glycerin agar cultures by repeated treatment with water, sterilizes the fluid
at 100° C., filters through clay and then concentrates on water bath (action identical
with Koch’s tuberculin). Malm prepares tuberculin by the use of an artificial
culture medium that is free from albumen (the tuberculin thus prepared nevertheless
contains an albumose-like substance).

In actual practice the tuberculin prepared according to the original method
of Koch is generally used. Tuberculin prepared from human tubercle bacilli is
effective in animals as well as such that is prepared from cultures of the bovine
bacilli. Kanda found however that tuberculin prepared from bovine cultures acts
Subcutaneous Tuberculin Test. 575

more promptly and more energetically than that prepared from bacilli of the human
type. But the experiments of Weber and Dieterlin on cattle and guinea pigs,
agreeing with the assertions of Koch, DeJong, Wolbach and Ernst, showed that
there was no difference in the two kinds of tuberculin, provided that both have
the same titre. However, since this is not ascertained in all preparations it is
advisable, in order to be safe, especially with ruminants and swine, to use tubereulin
exclusively that has been prepared from bovine tubercle bacilli. Tuberculin may
also be prepared from avian tubercle bacilli but this has a considerably weaker
action (Borrel). s

Later Koch made other tuberculin preparations from aqueous extracts of dried

tubercle bacilli or from dried bacilli finely ground in an agate mortar. The
whitish opalescent fluid obtained by centrifuging the first named extract represented
the preparation known as ‘‘T. 0.;’? the fluid obtained by repeatedly mixing the
residue with water and centrifuging produced the tuberculin known as ‘‘T. R.’’
The latter contains only substances contained in the bodies of the bacilli, and
none of their products of metabolism. Koch ascribes to it a special immunizing
action, but since it produces no reaction in tuberculous animals it has no value
for diagnostic purposes.
‘The tuberculol of Landmann is prepared by extracting the fat from tubercle
bacilli, making further extracts by heating at various temperatures in physiological
salt solution and then concentrating the extracts in a vacuum. This preparation is
more toxic than other tuberculins.

Finally there are also the simple culture filtrates of Denys and Detre which
have however not as yet been used in veterinary medicine.

Standardization of Tuberculin. According to Koch 0.5 ee. of tuberculin
injected subcutaneously into a guinea pig that was infected four weeks before
must be sufficiently active to kill the animal within 30 hours, producing intense
inflammation at the periphery of the tuberculous foci. Von Behring indicates the
unit of toxicity of tuberculin by the minimum quantity (L-+—Limeswerth) which
will kill the test animals in 24 to 30 hours. The toxicity of the Marburg tuberculin
is sufficient for 0.2 gm. to kill a guinea pig weighing 400 gm.

1. Subcutaneous Tuberculin Test (Thermal Tuberculin
Reaction). The characteristic thermal reaction for tuberculosis
consists in a gradual rise of temperature beginning from the
6th to the 12th hour
after the subcuta-
neous injection of
the tubereulin,
reaching its maxi-
mum from the 12th
to the 21st hour,
thereupon falling
with slight interrup-
tions until the nor-
mal is reached at
the 24th to the 40th
hour. In some cases
a second rise of
shorter duration is
observed (see Fig.
93). The difference
between the maxi- Fig. 93. Typical Tuberculin Reaction.
mum temperature
after injection and the temperature recorded before injection is
usually from 2° to 4° or 5° F. In rare cases the fever curve just
described may show variations in that it may begin sooner or
much later (14th to 18th hour), and then, particularly in the
latter case, reach the maximum at a later hour also.

 
576 Tuberculosis.

Simultaneously with the elevation of temperature the pulse
and respiration often become accelerated, but not infrequently
they remain practically normal. Great depression and loss
of appetite are equally frequent and, in addition, usually from
the 6th to 8th hour, muscular tremors are observed (organic
reaction). The milk secretion is usually somewhat diminished
during the period of reaction and on the following few days,
owing to the fever and the diminished appetite.

The decrease in the: quantity of milk in reacting cows varies according to
Zschokke from 3.2 to 8%, according to Eber 3.4 to 6.1%, according to Bohm the
average is 9.2%, according to Eber & Fehsenmeier the maximum is 15%, according
to Martel 3.1%. According to the investigations of Tiraboschi the milk secretion
decreases during the first 24 hours after injection and again becomes normal on
the third day. Non-reacting cows, however, also show a slight decrease (averagé
1 kg. as compared with 2 kg. [15%] in reactors).

The intensity of the reaction and the extent of the lesions
bear no relation to each other unless this is an inverse one in
the sense that extensively tuberculous. cows, hence emaciated
and weak animals, usually react with less intensity than robust
individuals in which the tuberculous process is in its first stages,
or more or less localized. In greatly advanced cases reactions
may not take place at all.

As a rule the tuberculin test does not perceptibly infiuence
the course of the disease or the health of the animal. In ad-
vanced tuberculosis the elevated temperature (fever) may per-
sist, though to a slight degree only, and this may, to a certain
extent, excite the tuberculous process to greater activity and
hasten a fatal termination. Virchow explained the unfavorable
action of tuberculin by the supposition that the thermal process
mobilized or stimulated the bacilli to greater activity, causing
them to multiply faster in the congested areas surrounding the
tuberculous foci. In the lungs the increased bronchial secre-
tions were supposed to play an especially important part in
the dissemination of these organisms.

As a matter of fact tuberculin exerts a peculiar action on tuberculous tissues
without destroying the bacilli which manifests itself, in some cases, in hyperemia
and increased juiciness of the tissues as seen in post-mortem examinations. This
local effect explains to a certain extent why tuberculin injections occasionally
result in the development of acute inflammations in areas surrounding old tuberculous
foci, sometimes causing cicatrization and ‘‘healing’’ of the lesion. In other
eases, however, fresh tubercles will develop in this area and the tuberculous process
is fanned into renewea activity.

Healthy animals are not affected by as large or larger
doses as will produce violent reactions in tuberculous animals;
there may occasionally be an increase in temperature not ex-
ceeding 2° F. but general febrile symptoms are still less com-
mon. According to Malm intravenous injections of 25.0 gm.
of tuberculin produce no toxic symptoms. The same indiffer-
ence to the action of tuberculin is observed in animals affected
with other disease than tuberculosis, reports to the contrary
are for the most part based upon incorrect interpretation of

a ee
Subcutaneous Tuberculin Test. , 577

‘the reaction or of the post-mortem findings, or possibly also
on mistakes in conducting the test.

Tuberculin is therefore an extremely valuable diagnostic
agent, especially in the detection of latent tuberculosis. A
positive reaction to the tuberculin test is a certain indication
of the existence of tuberculosis while the absence of a positive
reaction justifies the exclusion of latent tuberculosis.

In interpreting a tuberculin reaction the following prin-
ciples are safe to follow (according to the authors) :

Animals over 6 months of age may be regarded as tuber-
culous, (a) if the highest temperature indicated in the course
of a typical reaction exceeds the highest recorded temperature
before the injection of tuberculin by 2.7° F. or more, or if the
rise was at least .9° F. and higher than 104° F.; (b) if the tem-
perature is elevated 1.8 to 2.5 or exceeds 103.1 with symptoms
of an organic reaction.

Calves under six months of age must show an increase
in temperature over 104.9° or 105° F. to indicate a positive
reaction.

The animal may be considered free from tuberculosis if
the rise of temperature was not more than 2.7, arid did not
exceed 103.1 and if the animal showed no organic reaction, pro-
vided that a systematic clinical examination revealed no evi-
dence upon which to base a suspicion of the disease.

If the results of temperature records and clinical examina-
tions are interpreted according to the above principles they
will be found to agree with post-mortem findings in about 98%
of all cases, thus possible errors will hardly exceed 2%. -

However, the rules variously laid down to be followed in the in-
terpretation of results of tuberculin tests are at present not as uniform
as might be desired. .

According to Nocard a reaction is to be considered as positive if
the highest temperature after injection exceeds the highest pre-injection
temperature by 2.7, while an increase of 1.5 to 2.5 indicates suspicion
only. In the latter case the animal should be re-tested after one month
and given an increased dose of tuberculin.

‘According to Eber. pre-injection temperatures not exceeding 103.1
followed by - post-injection temperatures of 104 or more, or at least
exceeding 103.1 and in all cases indicating a rise of at least 1.8 must
be regarded as positive reactions while post-injection temperatures lower
than 104 and exceeding 103.1, but not representing a rise of 0.9 to 1.8
must be regarded as pointing to suspicion of tuberculosis.

According to Ostertag post-injection temperatures exceeding 103.1
and representing a rise of at least 0.9 above the highest pre-injection
temperature points to the existence of tuberculosis. In calves under
six months of age post-injection temperatures exceeding 104 and rep-
resenting a rise of at least 0.9 above the highest pre-injection temperature
indicate tuberculosis. s

According to the decision of the International Veterinary Congress
held in Budapest all cattle showing pre-injection temperatures not
exceeding 103.1 and post-injection temperatures exceeding 104 must

Vol. 1—37
578 Tuberculosis. 5

be regarded as tuberculous while all post-injection temperatures above
103.1 but not exceeding 104 must be regarded as doubtful and be con-
sidered individually.

In interpreting the results of a tuberculin test the highest
temperature recorded after the injection of the tuberculin is
of paramount importance because the existence of a reaction
is based upon the presence of a distinctly febrile condition. The
difference between the highest pre-injection and the highest
post-injection temperatures is next in importance though of
less value. The highest pre-injection temperature must of
course always constitute the basis of our considerations.

Tuberculin reactions will occur in very early stages of
tuberculosis. Nocard and Rossignol observed reactions from
the 32nd to the 48th day after alimentary infection, from the
19th to the 32nd day after inhalation infection and on the 13th
day after injection of the virus into the udder, while experi-
ments made by the Royal Agricultural Society showed that
reactions occurred on the 8th day after the subcutaneous in-
jection or the alimentary administration of infectious material.
According to MacFadyean the maximum time elapsing between
infection and reaction to tuberculin is 51 days.

In some cases repeated injections of tuberculin result in
immunity to its action. Thus some cattle that are injected
subeutaneously with the usual dose, will fail to react, or will
‘react only slightly to a second application of tuberculin.
Accordingly it is only possible to judge the results of a tuber-
culin test correctly when it is positively known that the animal
in question was not treated with tuberculin at any time during
the preceding four weeks.

Noecard’s pertinent experiments showed that of 24 reacting cows
only 33% reacted to a test applied 24 to 48 hours later, 50% reacted
after one week, 60% after two weeks and nearly all of them reacted
after the lapse of one month. According to results obtained at the
Prussia sea-quarantine stations, however, cattle previously treated with
tuberculin will always react if five times the ordinary dose is. adminis-
tered, and Vallée’s experiments have shown that cattle will react to
double doses administered: 36 to 48 hours after.a previous injection
of tuberculin. In such cases, however, the reactions set in earlier (4th
to 9th hour) and are of shorter duration, hence the necessity of record-
ing post-injection temperatures at two-hourly intervals beginning im-
mediately after the injection of the tuberculin.

Malm, Ligniéres, Mettaru and Lueders report similar experiences. In experi-
ments made by Klimmer and Kiesig 88.3% of cows receiving an ordinary dose
of tuberculin reacted to a double dose administered after one to three weeks.
The second reaction usually began at or after the 7th hour, but earlier in 18.5%
of the cases and usually lasted only two hours, occasionally only one hour and the
maximum temperatures were lower than in the first reactions. On the other hand,
Zabala observed that injections of the usual dose, repeated several times at two
days’ intervals would prevent reactions to subsequent excessive doses. According
Subcutaneous Tuberculin Test. 579

to Storch the simultaneous administration of an antipyretic (e. g., 30.0 gm. acetanilid)
will prevent a thermal reaction.

A positive typical reaction to tuberculin indicates the
presence of tuberculosis with a great degree of certainty, even
in the initial stages of the disease. If the evidence revealed
at a post-mortem examination does not confirm the diagnosis
it is more than probable that the lesions were so minute, or
restricted to so small an area that they escaped detection. In
some instances the morbid process is actually limited to a single
focus as large as a pea in a lymph gland, or possibly to a diffuse
swelling of some lymph glands (lymphoid stage, see p. 532) or
a spotted reddening of their tissues (Hottinger). (Bang, in
the abundant material at his disposal, found three cases only
where reacting animals showed no lesions of tuberculosis on
post-mortem examination.)

In the past the lymph glands, which are not infrequently the sole seat of
the tuberculous process, received little attention and thus we have an explanation
of the many apparent mistakes in diagnosis. Even in those cases where post-mortem
examination of reacting animals revealed the presence of some other disease instead
of tuberculosis (actinomycosis, botryomycosis, abscesses in internal organs, ver-
minous bronchitis, distomatosis, caseated echinococeus cysts, ete.) it would be difficult
to eliminate the possibility that tuberculosis did not exist simultaneously in some
organ of the body. In this connection the fact should be noted that nearly all
animals upon which observations were made, or which served as a basis for statistics
on this subject, where slaughtered for meat and that minute examinations of all
organs, bones and joints were out of the questions for economic reasons.

The absence of a tuberculin reaction does not have the
same decisive diagnostic value because some animals with ad-
vanced disease and suffering from disorders of nutrition will
not react, at least not during the usual period of observation.
This fact, however, is of little practical importance because
cases of this kind can be detected by their clinical symptoms
or they will at least be suspected. In some of these cases post-
mortem examination has revealed calcified foci in which living
bacilli could not be found.

It is possible that in many of the cases referred to reactions actually oceurred
but were not observed during the usual period of observation (12th to 21st hour
after injection). In experimental tuberculosis of cattle and goats the reaction may
set in as early as the 2d to 5th hour and reach its maximum at the 6th to 9th hour
(Arloing). In cattle that have previously received injections of tuberculin
the reaction may pass over sooner -than normally and in advanced disease it may
set in very late. With these possibilities in mind a careful clinical examination
should be made in all cases where the least suspicion may exist.of the’ possible
presence of the disease (chronic cough, barrenness, intestinal, uterine or udder
affection, etc.). . : : .

How important, aside from the use of active tuberculin, a correct interpretation
of the reaction and the experience of the observer or veterinarian really is shown
by the results of tuberculin tests in Bavaria (1895-1899) according to which errors
in positive diagnosis fell from 13.5% to 2.6% in four years and those of negative
diagnosis from 11.1% to 5.7%. ; .

According to Bang tuberculosis may be recognized in 96% of all cases sub-
jected to careful and accurate tuberculin test. Malm gives as his estimate under
‘the same conditions 2% of failures in recognizing the disease. According to
Jensen’s compilations, of 468 tuberculous animals 90.8% reacted, 4.9% failed to
react and 4.3% gave doubtful reactions; of 290 non-tuberculous animals 14.5%
reacted, 81.7% did not react and 3.8% gave doubttul reactions. According to
580 Tuberculosis.

Eber’s statistics covering 563 cases post-mortem findings confirmed 86.9% of all
results of tests and failed to confirm 13.1%. Carini reports still less favorable
results: In 361 cattle tested, post-mortem findings failed to confirm 17% of
diagnoses based upon the tuberculin test. In a test made by the authors and
covering 156 cattle, only 2% of the diagnoses failed to be confirmed at post-mortem
examination. Schuetz reports results of accurately controlled tests including 755
cattle in which T. A. was used on 255 and T. O. on 500 animals. Only 2.9%
of unconfirmed diagnoses were noted. Finally, of 24,784 positive reactions in cattle
observed in the United States from 1903 to 1908, 98.9% were confirmed on post-
mortem examination (Mohler).—In echinococeus disease and in actinomycosis
Nocard never noted positive reactions. The authors never saw positive reactions
in actinomycosis.

In the practical application of the tuberculin test the fact
should always be considered that positive reactions indicate
tuberculous infection merely and neither the degree nor the seat
of the tuberculous process. It is a notable fact also that a posi-
tive reaction is not necessarily the result of a clinically manifest
lesion which may be present, but that it may have been brought
about by an otherwise unimportant and inconspicuous lesion
in another organ of the body (of especial importance in the
diagnosis of tuberculosis of the udder).

In other species of animals the tuberculin test has, in most instances,
given similar results. Bang found the test reliable in the horse; Kich-
horn obtained accurate results in three goats ; in swine the test proved
reliable in six cases reported by Bang, in 58 cases by Mohler and
Schroeder, while Thiro found 21 tuberculous swine among 24 reactors.
According’ to Thiro a rise of temperature above 103.7°, providing it
exceeds the pre-injection temperature by at least 1.8°, and according
to Schroeder and Mohler a rise of 1° should be regarded as a positive
reaction. In dogs the results seem to be less reliable. Although
Froehner noted a marked elevation of temperature (1.2° to 3.7°) in
eight cases, a number of tuberculous dogs did not react and in one
positively infected animal there was a drop of 0.7°. In other diseases,
excepting one case of generalized sarcomatosis, no reactions were noted.
Poenaru observed positive reactions in only 6 out of 13 dogs affected
with tuberculous exudative pleuritis. Finally, a tuberculous monkey
tested by Froehner, receiving 0.01 gm. of tuberculin, gave a reaction
of 4.5° F. Hoch also observed prompt reaction in one ease.

The nature of the action of tuberculin is as yet only imperfectly
understood. The fact that healthy animals may receive comparatively
large doses (guinea pigs 2.0 gm., dogs 1.0 gm., cattle 25 gm.) without
reacting or being otherwise injuriously affected, and that tuberculous
animals will react upon the application of much smaller doses but only
after a certain time has elapsed after its application, points to the
probability that the reaction is due to some substance which is present
in the body of an infected animal and with which the tuberculin com-
bines or in the presence of which the tuberculin forms a new substance.

Wassermann and Bruck advance the theory that the tuberculous foci become
charged with body fluids and migrating blood cells under the influence of tuberculin
and that as a result the diseased tissue undergoes a breaking down process. Certain
tubercle bacilli in the tuberculous foci die off, are dissolved and extracted by the
neighboring cells and body fluids, their tuberculin is taken up by the surrounding
fluids and the production of antituberculin is the result. Injected tuberculin is
attracted to these foci by virtue of its avidity for its antibody; this combination
causes complement fixation or concentration of complement in the tuberculous tissue
and as a result albumin is dissolved or digested. The resulting products gain
, Subcutaneous Tuberculin Test. 581

access into the circulation and, together with the pyretic action of the tuberculin,
bring about the general elevation of temperature. As a result of injecting tuberculin,
antibodies develop in the blocd and when further injections of tuberculin are made
these antibodies neutralize its effect before it can,reach the tuberculous foci and
thus no reaction takes place. In very recent cases large quantities of antituberculin
are present in tuberculous foci, but in old lesions where the cells are completely
destroyed or caseated antituberculin can no longer be formed even though tuberculin
_is present, hence the absence of reaction in such eases. According to this theory
then, reaction is the result of the attraction of tuberculin by its antibody into
the diseased centers and the concentration of the tissue-destroying forces of the
body at these points. Immunity to the action of tuberculin injections results
from the production of antibodies following the first injection which then prevent
later injections from reaching the diseased foci before the tuberculin is neutralized.
Weil and Nakayama as well as Dieterlen also demonstrated antituberculin
in tuberculous organs while, on the other hand Morgenroth and Rabinowitsch
failed in their researches to find either antituberculin or any other specific antibody
in the serum or tissues of tuberculous animals. Moussu showed that cattle that
received intraperitoneal injections of cultures of tubercle bacilli filtered through
porcelain tubes, also reacted when treated with tuberculin, thus proving that the
reaction is due to the products of metabolism of the bacilli and not to the bacilli
themselves.
_- Aecording to Eber’s view the increased physiological activity of the cells
causes tuberculin to produce tuberculopyrin and under the action of the resulting
pyretic condition of the body the autotuberculin already present in the body of
the tuberculous animal produces additional quantities of tuberculopyrin. According
to Marmorek tuberculin stimulates the bacilli in the body to the production of
toxins which, passing into the circulating fluids of the body, cause the resulting
fever. And since the bodies of animals with extensive foci of infection already
contain these toxins in large quantities a slight additional amount has no appreciable
effect and hence no reaction follows. According to Behring the active principle of
tuberculin consists in tuberculinic acid (a combination of phosphorus free protamine
and phosphoric nucleic acid) the effect of which, on guinea pigs is 100 times as
violent as that of tuberculin. Arloing and Bancel found that the injection of
serum from a tuberculous cow or the expressed juice of large masses of tubercles
did not produce reactions in tuberculous cattle, goats, dogs or guinea pigs.

Technic of the Subcutaneous Tuberculin Test. Tuberculin used for diagnostic
purposes is usually diluted with nine parts by weight of a 5% solution of carbolic
acid. The ordinary dose of common tuberculin (tuberculin A) is as follows: Adult
eattle, 0.30 to 0.50 gm. according to size, yearlings 0.20 gm., calves under six
months 0.10 gm., the doses for horses are the same as those given for cattle; goats
and sheep, 0.02 to 0.03 gm.; swine, 0.05 to 0.10 gm.; dogs, 0.05 gm. The fluid is
preferably injected at the side of the neck into the subcutaneous connective tissue
and not into the muscles. The hair should be clipped and the skin disinfected
over a small area before injection is made. :

The test should be conducted in well ventilated stables that are not kept too
warm. The animals to be tested should be perfectly rested and under normal
conditions of feed, shelter and surroundings. A pre-injection temperature should
be ascertained immediately before injection and, if possible, twelve hours previous
to this time, preferably in the morning. (A more practical and reliable procedure
is to record at least three pre-injection temperatures at intervals of three or four
hours, but not less than two hours, the last pre-injection temperature to be taken
immediately before the tuberculin is injected.—Translator.) ns

In animals affected with fever the test does not give reliable results, it is
therefore advisable to wait with such animals until they regain their normal con-
dition. It is best to make the injections late in the evening or some time during
the night, reactions that may occur can then be observed early the following
morning or some time during the day. Animals should be kept at perfect rest
and under accustomed conditions of feeding, stabling and watering. After injection
the temperature, pulse and respiration should be recorded, if possible, every two
hours, but at least every three hours. Where circumstances do not permit this
arrangement the animals should be under observation at least from the 6th to
the 21st hour after injection. The uninterrupted observation of the animal between
the 6th and 8th hours is of special importance because muscular trembling and
other general symptoms usually appear at this time. Since reactions may some-
times set in at an unusually late hour animals must be kept under observation
and have their temperature recorded after the 21st hour, if the temperature shows
a tendency to rise at that time unless, of course, a decided reaction has already
taken place. The recording of the temperatures should, in such cases, be continued
582 Tuberculosis.

until it begins to drop again, the object of our observations being to determine
the highest temperature reached after the injection of the tuberculin which is
possible only by following this rule. In order to obtain accurate results for
comparison of temperature, the same thermometer should always be used for the
same animal throughout a test. Animals should not be watered immediately before
taking the temperature.

In sucking calves the results of tests are less reliable for which reason it
is best to defer the test until they are six months of age. Animals with clinical
symptoms of tuberculosis, very old and very emaciated animals may give very .
unreliable or unexpected results and for practical purposes might as well be excluded
from the test.

Malm and Kitt recommend the intravenous injection of tuberculin on account
of the earlier appearance of the reaction. If for example the tuberculin is injected
from 7:00 to 9:00 a. M. the reaction may set in between 12:00 noon and 5:00 P. M.

(The dose of American commercial tuberculins is usually indicated in the
instructions furnished by the manufacturers.)

2. The Ophthalmic Tuberculin Test (Ophthalmoreaction,
Conjunctival Reaction). Wolff-EKisner (1907) and almost simul-
taneously Calmette also observed that a few drops of tuberculin
applied to the conjunctival sac of tuberculous persons produced
an inflammatory reaction manifesting itself in reddening and.
swelling of the conjunctiva. During the same year Vallée
demonstrated that a similar reaction takes place in cattle and
subsequent investigations of other authors have shown that
this test is quite valuable for diagnostic purposes, especially
when concentrated bovine tuberculin is used. A pronounced
positive reaction to this test may be considered as almost con-
elusive evidence of the presence of tuberculosis. However,
since animals known to be affected with tuberculosis may not
very infrequently give negative reactions to this test, the ab-
sence of a positive reaction does not necessarily exclude tuber-
culosis.

In cattle the conjunctival reaction usually sets in between the
6th and 9th hour or a little later. It manifests itself in watering of
the eyes, reddening and edematous swelling. Later, between the 12th
and 24th hour there is a production of purulent secretion which aceumu-
lates under the nasal canthus of the eye in the form of an elongated
mass (see Plate III) which finally drops off or dries up to form a
yellow crust. The reaction continues until the 36th to 48th hour or
even three or four days. To be positive the reaction must consist of
a purulent conjunctivitis (polynuclear leucocytes in turbid yellow
exudate). A catarrhal inflammation attended only with profuse water-
ing of the eyes or mucous exudate, especially if concentrated tuberculin
has been used, may follow in perfectly healthy animals. The severity
of the conjunctivitis is of course no indication of the extent, or stage,
of the tuberculous process. A simultaneous, or a previous subcutaneous
injection of tuberculin has no effect on the conjunctival reaction, except
that in some instances the conjunctivitis is even more pronounced.
Occasionally when the subcutaneous test is applied to tuberculous ani-
mals that have previously reacted to the conjunctival test the ophthalmic
symptoms may again manifest themselves. As a result of hypersensi-
tiveness of the conjunctiva following the eye test a repetition of the
latter may result in a more pronounced reaction than before. The
conjunctival reaction, even if excessive or severe, does not affect the
general condition of the animal nor reduce the secretion of milk.
 

 
Plate I1l.

 

Conjunctival Reaction in Tuberculosis.

12 hours after the instillation of crude tuberculin.
Ophthalmic Tuberculin Test. 583

_, The first conjunctival tests that were made on cattle did not give very
uniform results, probably because they were made with weak solutions of tuberculin.
While Vallée, Ligniéres, Guérin and Delattre reported very satisfactory results,
Arloing, Vanderheyden, Gratz and Reinecke would not admit any practical value
whatever for this test. Subsequently, however, Garth, Kranich and Gruenert showed
that although dilute solutions of tuberculin gave unreliable results, concentrated
material produced distinct and specific reactions. By using 50% tuberculol they
succeeded in demonstrating the presence of the disease in 96.1% of reactors at
the time of slaughter. ;

Since then nearly all eye tests have been conducted with concentrated bovine
tuberculin with results correspondingly more favorable. Thus Sekyra reports 15.9%
of errors in the diagnosis of 82 cattle, Richter 14.7% of doubtful results and
16% of positive errors in 75 cattle, Opalka and Duering had 10% of negative
reactions in 66 tuberculous cattle, while on the: other hand Klimmer and Kiessig
found 83.3% of reactors tuberculous at post-mortem examination after slaughter,
and of 14 non-reactors all were found to be free from the disease at slaughter ;
of 121 cattle that were tested by both the conjunctival and the subcutaneous methods
87.6% gave the same results for both tests, while 12.4% gave different or opposite
results. Similarly favorable results are reported by Marinescu for 820 cattle,
Meyer for 150 and Bellini for 200 test cattle. Basing his conclusions on 487
conjunctival tests of 412 Danish quarantine cattle and 66 tests of that number
of inland cattle Foth found that the test gave pronounced and positive results
in about 505 of such cattle as had ceased to react to the subcutaneous test on
account of previous applications of tuberculin.

Technic of the Ophthalmic Test. With the head of the animal secured by
an assistant a few drops of tuberculin are dropped into the conjunctival sac by
means of a pipette, or the tuberculin may be applied with a camels’ hair brush
on the lateral portion of the bulbus, whereupon the closed eyes are slightly massaged
for one-half to one minute.

The material used should be 50% of concentrated bovine tuberculin. In
Germany bovotuberculol D Sol. I and 50% tuberculin A Dohna-has been found
effective. Foth however obtained good results also with a 5% solution of dry°
tuberculin. It seems that tuberculins containing ground or pulverized bacilli
(endotoxins) are better adapted for local tests.

The result of the test is determined between the 12th to 24th hour after
application of the tuberculin. The untreated eye serves as a check or control.
Particular attention should be paid.to the character of the exudate and to the
appearance of the membrana nictitans. In positive reactions the latter is intensely
reddened and its normally sharp border is swollen or-thickened. In exceptional
cases the reaction may persist for three or four days. e

Other mucous membranes besides the conjunctiva have been found to be
hypersensitive to. applications of tuberlin in tuberculous animals, Richter calls
attention to the special adaptability of the vaginal mucous membrane for this
purpose. After application of the bovotuberculin to the accessible portion of
the mucous membrane of the vagina, the reaction, if positive, will manifest itself
in redness, swelling, and the production of a glairy, whitish mucous or sometimes
purulent exudate. - Although the results are equally as accurate as those of the
conjunctival test (20% errors) this method is hardly to be considered as practical
on account of the possibility of secondary infection which might interfere with the

diagnosis.

3. Tuberculin-Cutaneous Tests (Dermo-reaction, intra-
dermal reaction). Since Pirquet (1907) has shown that the
inoculation of minimal quantities of tuberculin into the upper
layers of the cutis of tuberculous persons produced local red-
dening and swelling at the point of inoculation, Vallée applied
this new diagnostic method in horses and cattle with the same
satisfactory and positive results. The scarified area, into which
tuberculin had been rubbed, usually showed a distinct reaction
in tuberculous animals while healthy animals showed slight
inflammatory reddening at the border of the area only in ex-
ceptional cases. Since then other investigators have verified
these results and thus proved the specific value of the cutaneous
reaction. The technic of the method has been variously modified
584 Tuberculosis.

and reactions were brought out in different forms, but all are
based upon the hypersensitiveness of the cutaneous tissue of
tuberculous patients. In all of these methods the reactions
are due to the same underlying principles and the results are
rather uniform especially in the fact that distinct positive
reactions have a considerably greater diagnostic value than
negative results. Cutaneous reactions differ from the con-
junctival reaction in that simultaneous subcutaneous injections
of tuberculin, or injections made a short time before, may pre-
vent the development of the former.

The cutaneovs reactions vary according to the method of application
of the tuberculin. In all cases, however, there is local inflammation
and serous infiltration of the tissues, the symptoms usually becoming
pronounced on the second or third day, and they may persist until
the fifth day. When the first test gives a doubtful result it is advisable
to repeat it. with equal or double doses of tuberculin. This frequently
brings out a decisive reaction.

(a) Cutaneous Reaction. According to Vallée an area about the
‘size of a silver dollar, on the shoulder or chest wall is shaved perfectly
smooth and the cutis scarified with a sharp scalpel (incisions may be
parallel or intersect each ‘other) whereupon a 50% or concentrated
tuberculin is applied with a brush to the slightly bleeding surface.

If the reaction is positive there will be a distinctly visible and
palpable infiltration of the border of the wound and an edematous
infiltration of the area surrounding the field of operation.. This per-
sists from one to three days and may occasionally result in a separation
of the epidermis. In negative cases the borders of. the wounds made
by the scalpel show only a slight swelling (mainly traumatic reaction)’
which rapidly disappears. As a control or check it is advisable to
prepare a similar scarified area to be left untreated with tuberculin.

Vallée, Moussu and Ligniéres, as well as Pirquet and Schnuerer obtained
results of definite diagnostic value with this method while Vanderheyden, Garth,
Kranich and Grunert as well as Reinecke express themselves unfavorably in regard
to results obtained. Klimmer and Kiessig who applied this method on the udder
report 42.9% of failures in diagnosis.

(b) Dermoreaction. Ligniéres applies the tuberculin to the
cleansed, arid shaved surface of the skin, without previous scarification.
In case of a positive reaction the area in question becomes reddened,
painful and edematous after about twenty-four hours. Occasionally
there are small pustules.

According to Ligniéres from 15 to 20% of tuberculous cattle fail
to react to this test. Vallée succeeded in obtaining a reaction in 13
out of 18 tuberculous animals while Klimmer and Kiessig record 37%
of negative results in known tuberculous cattle.

(c) Intradermal (intracutaneous) Reaction. This consists of a
circumscribed edematous swelling of the skin following the injection
of 0.1 ce. of 50% tuberculin into the tissue of the cutis. According to
Moussu and Mantoux the folds of the skin between the base of the tail
and the anus, stretched tense by elevating the tail are best adapted for
this test. In positive reactions the fold which received the injection
of tuberculin swells up to the size of a hulled walnut or more in the
course of twenty-four hours and forms a sharp contrast with the
Cutaneous Tuberculin Test. 585

opposite thin fold (Fig. 94). In some animals a small hemorrhage
occurs at the point of inoculation. As a rule the overlying epidermis
dries up into a brown crust or scab.

A swelling appearing immediately after the injection of the tuber-
culin but disappearing after a few hours and which, according to
Vallée is due to glycerin and salts contained in the tuberculin must
not be regarded as a positive reaction.

Ligniéres as well as Roemer and Joseph inject the tuberculin on
the side of the neck and as near as possible to the cutis. In this case
a positive reaction consists in the appearance, beginning on the following
day, of a painful edematous swelling around the point of inoculation.

 

Fig. 94. Intradermal Tuberculin Reaction. Edematous swelling of the right anal
fold following injection of 0.1 cc. of 50% tuberculin into the tissue of the cutis.

For an objective determination of a reaction the thickness of a fold of
skin about 5 em. wide is accurately measured by means of micrometer
calipers immediately before, and then again three or four days after
the injection of the tuberculin at that point. If, during that time
the fold has increased in thickness to the extent of 0.4 em. or more, the
reaction is to be regarded as positive, if the increase is only 0.2 to 0.3
em. the reaction is to be looked upon as doubtful and the test should
be repeated with 0.1 ce. of concentrated tuberculin applied on the
opposite side of the neck.

By means of their method (0.1-0.2 ce. of 10% tuberculin) Moussu and
Mantoux obtained in 70 head of cattle reactions corresponding in all respects
586 Tuberculosis.

to the results obtained by Koch’s subeutaneous test. Cattle free from tuberculosis
but affected with other diseases (Metritis, Cancer, etc.) did not react to the test.
The results of tests by Vallée were equally satisfactory, 494 cattle in 521 tests
giving the same result for each method (12 cattle with positive thermal reactions
gave no cutaneous reaction). Foth succeeded in detecting about one-half of the
tuberculous individuals among the Danish quarantine cattle by this method. By
the method of Roemer and Joseph (0.1 ec. of 50% tuberculin) Joseph records
only one error in 126 cattle as shown by subsequent post-mortem examination,
viz., one animal out of 79 tested, while no reactions occurred in 27 healthy animals
tested. Zschokke found in his experiments with 300 cattle, which were for the
most part slaughtered afterwards, that neck and tail inoculations were of about
equal value and that both were subject to about 15% error, only 85% of known
tuberculous cattle giving positive reactions.

The intracutaneous method is applicable also for swine, the tuber-
culin being injected into the skin at the base of the ear near the median
border on the dorsal surface. If the animal is tuberculous a flat swell-
ing with central reddened: zone will develop after twenty-four hours.
In some cases there may be a hemorrhage, the size of a silver dollar,
in the center of the swelling, which may lead to necrosis of*the overlying
skin.

This method, recommended by Moussu and Mantoux, was tried by Zschokke
on 266 pigs with thes result that 90% of the tuberculous animals gave positive
reactions.

(d) Local Subcutaneous Reaction. According to Vallée and
Fernandez dead bacilli with their’fat contents removed, mixed with four
parts of finely pulverized glass and injected in amounts of 1 mg. into
the subcutis of the ear produce, in tuberculous cattle, in addition to
the edematous swelling which occurs simultaneously with the thermic
reaction in the subcutaneous method, a very painful, edematous swelling
which is valuable for diagnostic purposes. This condition results from
the slow absorption of the injected mass at this point. This method has
not yet been used in actual practice.

Comparative value of the various tuberculin tests. Accord-
ing to collected experiences the best results are obtained by
och’s subcutaneous method. In this test a positive reaction
is a certain indication of tuberculosis while a negative reaction
indicates with the greatest probability the absence of the disease.
A great advantage offered by this method consists in the
possibility of recognizing the presence or absence of a febrile
reaction by the maximum temperature recorded after injectiou
of the tuberculin. The intradermal or intracutaneous test is next
in value to the subcutaneous method. This produces with the
use of 50% tuberculin good and clear results in both positive
and’ negative cases. The ophthalmic test is of less diagnostic
importance, errors being much more frequent than in the fore-
going methods, especially in that even tuberculous animals not
infrequently give no reactions whatever. The cutaneous test
has the least practical value, errors occurring much more fre-
quently than in any of the others; this is due, in part. to the
fact that the positive reaction is frequently impossible of differ-
entiation from a simple traumatic reaction.
Under these circumstances it is advisable, in all cases where
an accurate diagnosis is the first consideration, to use the sub-
Comparative Value of Tests. 587

cutaneous test. It cannot be denied, of course, that the applica-
tion of this method is attended with certain objections or at
least inconveniences, viz., the long time required to make the
observations, the repeated recordings of temperature required,
and finally the fact that positive reactions reduce, temporarily,
the yield of milk from the animals in question.

Since none of these disadvantages are presented by the
various local tests, it is advisable, in practice, where large
herds are to be tested, to apply a local test first, preferably
the intradermal (intracutaneous) or the ophthalmic test. Thus,
after the great majority of tuberculous animals have been recog-
nized the remainder of the herd may be subjected to the sub-
cutaneous test and the examination of the herd be completed.
Such a procedure is the more admissible since the occurrence

of a thermic reaction is in no way prevented or interfered with
by the previous local test.

(The above arguments would hardly apply, with equal force, to conditions as
they exist in America at the present time.—Translator. )

Agglutination Test. According to the investigations of Arloing & Courmont
the blood serum or pleural exudate of tuberculous persons or animals when added
to homogeneous liquid cultures causes clumping of the tubercle bacilli and their
precipitation to the bottom of the vessel, leaving the previously turbid fluid clear
and transparent (agglutination) while the blood serum of healthy individuals does
not possess this property. On the basis of these observations these authors recom-
mended the agglutination test as a practical means of diagnosing latent tuberculosis,
dn one of their series of experiments the blood serum of thirty healthy calves did
not, in any case, agglutinate a culture when added in proportions of one to five
while the serum from 70 mature cows, with only one exception, agglutinated cultures
when added in volumetric proportions of one to ten or even thirty.

Other authors (Beck & Rabinowitsch, Panisset) could not confirm the diagnostic
value of this method nor has the same been found of any practical importance in
human medicine.

Precipitation Reaction. According to Bonome the blood serum of tuberculous

persons or animals produces a more or Jess conspicuous clouding and precipitation
‘when added to a filtered emulsion made of fresh cheesy tubercles or cultures of dried
tubercle bacilli mixed with 5% glycerin. The serum of healthy individuals: either
does not possess this property at all or only to a slight degree. It is claimed
for this test, also, that when pure cultures of tubercle bacilli are used it is possible
to differentiate between infection with human tubercle bacilli and infection with the
bovine type.
i Calmette & Massol, Vallée and also Jousset found that the serum of highly
immune animals contained a thermolabile substance which produces decided precipita-
tions in solutions of tuberculin as well as in non-concentrated tuberculosis bouillon
and in bacillus extracts. In the bodies of tuberculous animals, however, it seems
to be present in such small and variable quantities that precipitation experiments
give too irregular results to be of value for diagnostic purposes. In correspondence
with this statement the results obtained by Zwick in his experiments with the serum
of a cow with advanced tuberculosis were negative throughout.

Complement Fixation and Opsonins. Vallée was able to demonstrate anti-
bodies in the serum of highly immunized horses (Hennepe the same in the serum
of calves treated with bovo-vaccine) which had the power to fix guinea pig comple-
ments with strains of the tubercle bacilli that had been used in the immunizing
process as antigen, Bach, however, found that sera from cattle free from tuberculosis,
as well as that from shghtly or extensively affected cattle manifested the same
peculiarities 12 complement fixation experiments and that this action was not specific.
At preseat, therefore, this method has no more diagnostic value than the opsonie
index of the blood of tuberculous animals, the study or investigation of which latter
has as yet received very little attention in veterinary medicine att :

Strubell & Felber have conducted a series of investigations alone this line with
80 beef cattle, without however getting ‘clear or decisive results. Of the tuberculous
cattle 83.3% showed tuberculo-opsonic indexes to human tubercle bacilli ranging
588 Tuberculosis.

between 0.90 and 1.10 of the normal, 57.8% giving the same results with bovine
tubercle bacilli, while 21% of the healthy animals had indexes above the normal.
Moderately subnormal indexes (0.80-0.90) were observed in 8% of diseased as well
as in 8% of the healthy animals. Marked subnormal indexes were observed in such
cattle only as had been experimentally infected.

Differential Diagnosis. Of the diseases resembling tuber-
culosis in clinical symptoms or anatomical changes the following
are of most importance.

Contagious pleuro-pneumonia of cattle in its chronic or sub-
acute form: In this disease solidification of large continuous
areas of lung tissue may be recognized by the dullness revealed
upon percussion, bronchial respiration or the entire absence of
respiratory sounds, the pulmonary affection is always attended
with an acute pleuritis indicated by pain upon percussion, fric-
tion bruits, weak, suppressed and painful cough. There is less
secretion from the respiratory passages and the disease takes
a less insidious course than that observed in tuberculosis. In
very chronic cases a differential diagnosis is hardly possible
from the clinical symptoms alone, irrespective of the fact that
suspicion of the existence of pleuro-pneumonia does not exclude
the presence of tuberculosis, or that both diseases may exist at
the same time.

Lung-worm disease in ruminants and swine. This is
usually an affection of younger animals, the cough is strong,
spasmodic and occasionally attended with attacks of choking;
there is rarely an elevation of temperature, auscultation reveals
fine rales and friction bruits, and the general condition of the
animals is usually little affected even after the otherwise pro-
nounced symptoms of disease have continued for some time.
Finally, the parasitic filaria may be demonstrated in the secre-
tions of the lungs and nostrils.

Actinomycosis in cattle and swine. In this disease the
tumors of the udder and in the pharyngeal region are frequently
firmly attached to the overlying skin; if the tumors rupture
the characteristic ray fungus may be readily demonstrated
under low magnifying power without previous staining. In
actinomycosis of the tongue the sublingual and pharyngeal
glands are not enlarged. Post-mortem examination reveals
yellowish granules imbedded in soft foci which are surrounded
by an abundant connective tissue.

Ecchinococcus disease of the lungs. In this affection the
cough is weak and coarse, febrile symptoms absent; the affected
animals may be in good condition in spite of the respiratory
troubles which may have persisted for a long period. Finally,
the disease is most frequently observed in young animals.

Traumatic pericarditis. In contrast with tuberculous peri-
carditis, symptoms of accumulation of fluids (friction bruits,
dulled heart sounds in later stages, splashing and weak cardiac
sounds) are rarely absent. There is usually, also, more or
less swelling in the anterior thorax,
Differential Diagnosis. 589

Leucemia and pseudo-leucemia. On account of the cachexia
and the enlarged lymph glands which occur in the course ot
these diseases they may be confused with tuberculosis. In them,
however, the lymph glands are enlarged to an equal degree
throughout the body and an examination of the blood in leucemia
will reveal the abnormal increase of the white blood cells.

Chronic meteorism resulting from non-tuberculous affec-
tions of the abdominal organs. When due to tuberculous
changes, meteorism does not develop to the same intensity
and after each temporary attack the accompanying digestive
disturbances immediately subside (Albrecht).

Glanders in horses, especially that form which is confined
to the internal organs. The presence of large tumors in the
abdominal cavity contraindicate glanders but otherwise a
differential diagnosis must be based upon the results of a mallein
‘or tuberculin test. Chronic enlargement of the submaxillary
glands does not in itself justify the exclusion of tuberculosis
(see p. 562).

Distemper may be confused with tuberculosis when it is
localized in the internal lymph glands and assumes a chronic
character. In the clinical examination the anamnesis alone may
enable us to make a differential diagnosis. At post-mortem
examination the presence of abscesses only and the absence
of sarcoma-like structures eliminates tuberculosis.

Hog cholera. In chronic cases the morbid picture of this
disease is very similar to that of tuberculosis. The anamnesis,
however, especially if this shows that the animals in question
have previously suffered from acute pulmonary or intestinal
affections, will indicate hog cholera as the probable disease while
the existence of chronic enlargement of the lymph glands or
inflammation of the bones and joints will point to the tuber-
culous nature of the affection. At post-mortem small gray
-or yellowish nodules in the neighborhood of cheesy foci or in
the lymph glands indicate tuberculosis. The simultaneous af-
fection of a large number of pigs that have been fed with milk
or whey is in itself a probable indication of tuberculosis.

Rachitis, especially in young swine. In this disease the
epiphyses of the bones are enlarged generally while the joints
themselves show no symptoms of inflammation. In tuberculosis
of the joints the affection is confined to a few joints and there
is also swelling of the capsular ligaments.

Aside from the above named diseases suspicion of tuber-
culosis may be aroused in other chronic affections that gradually
produce cachexia, especially chronic lung affections. Finally,
tuberculous meningitis has many symptoms in common with in-
flammation of the cerebral meninges from other causes and,
similarly, cerebral tuberculosis with neoplasms of the brain, or
with coenurosis. The same may be said with reference to acute
miliary tuberculosis and severe acute infectious diseases.

In contrast with inflammatory affections of the udder from
590 Tuberculosis.

other causes in tuberculosis of that organ, the milk retains its
normal appearance for a long period. When in the later stages
changes do occur in the physical appearance of the milk, they
are characterized by the absence of pus and mucus (sliminess),
Irregular nodules in the tissue of one or more quarters of the
udder and enlargement of the super mammary glands indicate
the tuberculous “nature of the affection. Actinomycosis and
botriomycosis produce similar swellings in the tissue of the
udder but are apt to be firmly adherent to the overlying skin,
they frequently break open and discharge their contents, and
the mammary glands are unaffected or only slightly and evenly
enlarged. In inflammation of the udder caused by streptococcus
infection the firm swelling bears a close connection with the
indurated base.of the teat while tuberculous disease usually
occurs higher up in the tissue of the udder. In the former
ease also the milk is purulent from the beginning, and while
the mammary lymph glands may be swollen or enlarged they
are never irregular or nodular in form. Finally, the secretion
of the udder contains streptococci. Milk cysts may be differ-
entiated from tuberculosis by their elastic consistency. A
definite diagnosis of tuberculosis of the udder, especially in the
less pronounced cases, cannot be made without a bacteriologi-
cal examination and demonstration of the tubercle bacilli in
the milk (see p. 558) or in the tissue of the udder (p. 570).

For the anatomical diagnosis of tuberculous processes the
presence of small gray transparent or yellowish, firm nodules
(tubercles), which usually occur either exclusively within or
in the neighborhood of cheesy foci and ulcers may be accepted
as definite evidence. Accepting this as a basis, other processes
that resemble tuberculosis (actinomycosis, botriomyeosis,
easeated parasitic nodules, chronic inflammations of the lungs,
etc.) are easily differentiated from tuberculosis. In all cases,
however, the demonstration of the tubercle bacillus is necessary
as final evidence of the tuberculous nature of any morbid product
or tissue.

Prognosis. Local morbid processes brought about by nat-
ural infection may, under favorable conditions, not infrequently
remain restricted to a definite area or end in recovery through
an inflammatory reaction in the surrounding tissue. Healthy
adult animals are almost always met with even in badly infected
herds and it seems that their condition of health is due, not
to a natural individual immunity but rather to repeated infec-
tion with tuberculosis followed by recovery and consequent im-
munity to later infections. The encapsuled and calcified cheesy
foci which are not infrequently met with on inspection of
slaughtered animals, in certain organs, especially lymph glands,
point to such a favorable course of local infections. The results
of tuberculin tests, especially in the case of young animals fre-
quently point to this possibility, as in certain cases where the
Prognosis, Treatment. 591

animals in question permanently cease to react to the tuberculin
test.

Although the possibility of recovery from tuberculosis has
thus been demonstrated the course or final termination of the
disease cannot be predicted even with a degree of probability.
In general, favorable surroundings, especially pure fresh air,
good food and care, moderate exercise and middle age have
a favorable influence on the course of the disease. Not in-
frequently, however, the disease makes rapid strides toward
a fatal termination in spite of favorable external conditions.
Under opposite conditions a gradual spread of the morbid
process is the rule and the unfavorable effect of hard work in
this respect is well demonstrated by the frequency of advanced
tuberculosis among the otherwise naturally tough working oxen
of the range breeds of Europe. The unfavorable course of
the disease in these cases is no doubt also associated with the
fact that these animals, when kept with infected herds, are
almost continually exposed to infection and reinfection, result-
ing in aggravation of already infected centers and in the pro-
duction of new areas in healthy organs.

According to the intensity and the frequency of reinfections
the disease advances with increasing certainty to its fatal ter-
mination. When clinical symptoms have made their appearance,
recovery may be considered as entirely out of the question.

Treatment. Since the incurability of tuberculosis of do-
mestic animals, after clinical symptoms have made their ap-
pearance, has been recognized from time immemorial, serious
attempts to bring about recovery are hardly ever made in recent
times. The immediate use of evidently affected animals for food
purposes has now been generally accepted as the best method
of dealing with this problem. In human medicine, also, in spite
of numberless attempts in this direction, reliable curative
methods are unknown. On the other hand, careful observations
made in recent years have shown that favorable hygienic con-
ditions, especially living in pure fresh air, nutritious food and
physical’rest may check the progress of the disease in the early
stages and not infrequently bring about a cure. Similar con-
ditions would probably have the same favorable effect in ani-
mals. Among these, however, favorable opportunities for sys-
tematic treatment along the lines suggested would rarely be
offered. while, on the other hand, the successful treatment of
an occasional individual bears no comparison with the beautiful
results that are obtained by prophylactic measures in the sup-
pression of the disease. Nevertheless the proper regulation
of hygienic conditions in infected herds, and especially the
restriction of stable life to the minimum, as well as cleanliness
in stables where these are a necessity, are of immense im-
portance in the solution of the problem of the suppression of
tuberculosis. ae fe ;

The systematic treatment with tuberculin, in spite of the
592 Tuberculosis.

undeniable favorable results occasionally obtained along this
line in human medicine, is of course out of the question with
animals both on account of the attending expense and the im-
practicability of the treatment.

Hauptmann claims to have obtained curative effects in tuberculous eattle by
treatment with iodipin (50 to 100 gm. of 25% iodipin repeatedly injected subcu-
taneously) while Jacob, Bongert & Rosenberg observed good results following in-
trabronchial injections of tuberculin and creosote (500 gm. of a 0.1 to 0.4% solution
or 0.1% solution intratracheally). These apparently favorable results, however,
require further confirmation. The same may be said of Burow’s assertion that 500
cattle, treated with bacterial preparations of unspecified character, showed ‘‘ definite
improvement’’ with few exceptions, in the course of a few weeks. The preparations
made from tubercle bacilli (Tulase, tulaselaktin, tulon, tuberculase, ete.) and recom-
mended by v. Behring for the treatment of human tuberculosis have thus far given
no tangible results. Under the direction of Roemer extensive experiments conducted
in Argentine with tulaselaktin as a curative agent for bovine tuberculosis gave
uniformly negative results. Arloing also found tuberkulase inert in his cattle experi-
ments. The same is probably also true with respect to the use of attenuated or
avirulent tubercle bacilli.

Prevention. The establishment of the most favorable ex-
ternal conditions plays an important role in the control of
tuberculosis. Out of door life, especially on pasture, diminishes,
on the one hand the chances of infection and on the other hand
prevents the tubercle bacilli from obtaining an easy foothold
in the bronchioles and alveoli by thorough ventilation of the
air passages and therefore by preventing the development of
chronic catarrhal conditions. The customary healthy condition
of young cattle in hilly and mountainous countries and the great
infrequency of tuberculosis in range cattle is due to the condi-
tions just referred to.

In order to prevent the too rapid spread of tuberculosis
in already infected herds it is advisable to keep them out of
doors as much as possible during the day time and, when the
weather permits, at night also. In addition the stables should
be equipped with modern systems for ventilation and thor-
oughly cleaned and disinfected at least every two weeks. Stable
arrangement whereby cattle are compelled to face each other,
and continuous watering troughs and mangers should be avoided
as these conditions favor the dissemination of the disease.
Above all, animals with clinical symptoms of tuberculosis or
symptoms of chronic pulmonary affections, chronic diarrhea,
chronic discharge from the uterus, emaciation, etc., that point
to the probable existence of open tuberculosis should be
slaughtered or otherwise disposed of at once in order to check
at least the principal disseminators of tubercle bacilli. Among
such animals those affected with udder tuberculosis are of
course the most dangerous. (Where attempts are made to con-
trol the disease according to the rather conservative plan here
suggested it should ever be borne in mind that animals without
clinical symptoms of disease and otherwise in apparent per-
fect health may be suffering with advanced tuberculosis and
distribute tubercle bacilli in enormous numbers through the
medium of their solid excrement.—Translator.)
Prevention, Extermination. 593

In this connection care should be taken that the young offspring
from such herds are not fed on infected milk. This is accomplished
by heating all skim milk to 85° C., or better, to the boiling point, before
feeding to calves or swine. In all cases, however, the milk from evi-
dently infected udders should be destroyed.

In feeding sucking calves it is all important that the milk be free
from tubercle bacilli. Infection is most successfully prevented by
having young calves suck dams that are known to be free from tuber-
culosis as indicated by physical examination and tuberculin tests. If
for economic reasons this arrangement is impracticable the calves should
be fed with fresh raw milk obtained from healthy cows with every,
possible aseptic precaution. Milk sterilized by heat should be used
only as a last resort. Milk thus treated has lost the ferments so im-
portant for digestion and for the prevention of abnormal gas production
in the intestines. For this reason every possible precaution should be
observed that the vessels used and the hands of the persons in charge
of this work are kept scrupulously clean. Heat sterilization is of course
always vastly preferable to the use of formalin (see p. 155) or of
hydrogen peroxide, because milk thus treated (perhydrase milk, budder-
ized milk), aside from the fact that it may contain virulent tubercle
bacilli, is unsuitable for sucklings on account of its low fat content (2%).

By careful compliance with these instructions it is possible
at least to check the too rapid progress of the disease and to
prevent for years the occurrence of very great losses. The
measures referred to are however recommended for considera-
‘tion only in cases where for economic or other insurmountable
reasons the complete extermination of the disease is out of the
question.

Extermination of Tuberculosis. Investigations showing
that tuberculosis is an infectious disease, transmissible from
animal to animal, and demonstration of the fact that heredity
plays only an unimportant role in its transmission has placed
the warfare against tuberculosis upon a new and safe basis.
The aim and object of this warfare now is to protect healthy-
born animals from infection during life; if we are successful
in this effort the animals will remain free from tuberculosis,
irrespective of whether they are the offspring of diseased
parents or otherwise.

Upon the basis of this principle Bang has worked out a
plan for the extermination of tuberculosis from dairy herds
which has been put into successful practical operation since
1892. The very satisfactory results already obtained have
demonstrated not only the correctness of this theory but also
its practical worth.

Bang’s Method of Extermination. This consists, in effect, in the
destruction of clinically affected animals, the separation and isolation
of reactors to the tuberculin test which are otherwise clinically of
healthy appearance, and the artificial feeding of calves from the latter
with milk free from tubercle bacilli. The details of the method are
as follows:

Vol, 1—88
594. Tuberculosis.

Every animal in the infected herd is subjected to careful examina-
tion and each animal which shows clinical evidence of tuberculosis,
but particularly those animals with symptoms of pulmonary, intestinal,
uterine or mammary disease are condemned and slaughtered, to be
used as food, subject to inspection under the laws of the country, or
condemned as food as the case may be. The remainder of the herd
consisting of clinically healthy appearing animals is then subjected
to the tuberculin test. All nonreactors which are free from all other
symptoms that might possibly point to the existence of tuberculosis
are then separated and isolated from the remainder of the herd. Each
herd is now placed in an entirely separate stable, the quarters for the
nonreactors or healthy portion of the herd having previously been
thoroughly cleaned and disinfected. In the absence of separate build-
ings a single building may be utilized by separating the quarters of
the two herds by means of a tight board wall-and providing separate
exits for each herd. Young stock, calves, and working oxen should have
quarters of their own. Each herd or group must have separate at-
tendants that have absolutely no contact whatever with the other herd.
If an animal in the reacting herd at any time develops clinical symptoms
of tuberculosis it must be removed at once and disposed of preferably
“ by slaughter. The remaining animals in the reacting herd may be
used as before for breeding and dairy purposes, providing they exhibit
no clinical evidence of tuberculosis. Yearlings and other young stock
reacting to the tuberculin test had best be discarded for breeding pur-
poses at once and for all time. Where special reasons exist for desiring
to breed certain reacting young heifers this may be permitted but only
on the condition that they be quartered with the reacting portion of
the herd. Reacting calves under six months of age should always be
destroyed or disposed of by slaughter.

The calves dropped by the healthy ‘‘non-reacting’’ cows should
remain with their dams while those from the reactors, after being per-
mitted to suck for twenty-four hours so that they may get the colostrum,
are removed from their dams and quartered with the healthy portion
of the herd and provided with nurse cows or fed by hand with fresh
milk from nonreactors or with milk obtained from other sources, but
sterilized by heating to at least 85° C. Particular attention should
be paid to the cleanliness of utensils used as well as to the hands of
the attendants in charge of the feeding of these young animals. It is
self-evident, of course, that the quarters where these calves are kept
should be kept scrupulously clean and occasionally disinfected. "Wher-
ever it is possible to do so, the calves might be kept in separate quarters
for the first few weeks after birth. If any of the calves become affected
. with diarrhea, they should be isolated at once and the former quarters
thoroughly cleaned, disinfected and treated with a hot solution of lye.

As soon as weaned the calves should be subjected to the tuberculin
test and all reactors disposed of (the loss in this process hardly ever
exceeds one or two per cent). After this they may be added to the
free herd or kept in separate calf quarters or with the other young
stock. Until used for breeding purposes they. should be kept out of
doors or on pasture as much as possible and under no conditions may
they be allowed to come in contact with the reacting portion of the
herd. The young heifers, after being bred, should be retested with
tuberculin and if found free from disease, added to the free herd,
otherwise isolated with the reactors. (It is only occasionally that it
is found necessary to add an animal to the reacting herd.)
Methods of Extermination. 595

_ The free herd should be retested with tuberculin every year so
that animals that were infected and failed to react at a previous test,
or that have become infected since that time, may be removed and
added to the quarantine herd. Newly acquired animals should under
no circumstances be added to the free herd unless they have been found
free from evidences of tuberculosis by physical examination and tuber-
culin test made immediately before.

Males used for breeding purposes should, if at all possible, be
free, not only from every suspicion of tuberculosis, but should other-
wise be in perfect health. If unavoidable, a reacting male may be
used but such animals should at least be free from clinical evidence of
disease. Such an animal must, of course, be kept under constant super-

vision during the act of coitus and never be permitted to run with
the free herd.

By this method the nonreacting or free portion of the herd will
constantly increase in numbers while the reacting herd may be cor-
respondingly reduced in size without interfering with the amount of
business transacted with the products. Eventually the reactors can
be entirely eliminated and a herd free from tuberculosis remain in
place of the original infected herd. This can be accomplished with
comparatively light expense, and with proper attention and occasional
retests with tuberculin the herd may then be kept free permanently
from tuberculosis.

The extermination of tuberculosis after the method of Bang has found its
widest application in Denmark, Sweden and Norway where government support
is liberally extended and favorable results have been quite general. As a result
of the personally conducted campaign of Bang, in Denmark, the average percentage
of reacting animals in 1893 (40%) has been reduced in 1908, to 8.5%. Among
calves the average percentage in 1893 (15.5%) has been reduced to 10.6 in 1898.
Up to the year 1904, 66 badly infected herds comprising 1,045 reactors and 780
healthy animals have been entirely freed from disease, the 66 herds consisting at
that time of 1,896 healthy animals. In Norway, according to Malm, the percentage
of reactions has been reduced from 8.4% in 1896 to 4.9% in 1903, and the proportion
of inspected herds that were found infected was reduced from 26.1% to 13.6%.
In Sweden, where, in the beginning of the campaign of extermination (in 1897-98)
11,089 out of 33,000 animals reacted to the tuberculin test, i. e., 33.6%, reports for
the year 1904 showed that among 34,996 cattle tested only 1,664, i. e., 4.7% reacted.
During this interval 214 herds comprising 8,205 animals were freed from the disease
(Regnér.)—In Finland reactions reached 25% in 1894 while they were reduced to
10.1%. by 1900 (Héjer). In Hungary there exists now a number of large dairies
in which the percentages of reactors have been reduced in the course of a few years
to 2 or 3 per cent without any reduction in the size of the herds. Thus on the
Mezoehegyeser government estate the first tuberculin test which was conducted in
the spring of 1898 in a herd of 329 cows revealed 44.8% of reactors while 26.6%
of the total number tested (647) reacted. In the fall of the year 1903 a test of 502
cows on the same estate gave only 2.8% of reactors and‘a test of all of the cattle
on the estate (1,132) gave 1.8% of reactors. During this period of five years the
herd on this estate was increased 75% in numbers by addition of its own offspring,
while the prevalence of tuberculosis was reduced 88% (Hutyra).

The favorable results of feeding calves with sterilized milk are illustrated by
te following: In Sdrv4r 93.8% of the calves thus reared gave no febrile reaction
o Behring’s protective inoculation while only 42.1% of the calves reared under
usual conditions responded similarly. (Behring’s protective inoculation, when applied
to tuberculous animals, gives a reaction similar to that of tuberculin.) On several
German estates, where similar experiments were conducted, the proportions were
74.2% and 48.1% respectively.

Modification of Bang’s Method. In only slightly infected herds
where the question of expense is not the first consideration the quickest
results may be obtained by slaughtering all reacting animals at once.
In this way the necessity of maintaining two herds, one healthy and
596 Tuberculosis.

the other diseased, and the artificial rearing of the calves on nurse
cows or with sterilized milk is obviated. The herd may then be kept
permanently free by replacing the reactors with newly purchased ani-
mals that have been subjected to the tuberculin test, and repeating
the test annually in order to remove any affected animal that may
have gained an entrance to the herd.

Where the separate maintenance of two herds and the artificial
rearing of the calves from the infected dams meets with insurmountable
objections a modified form of Bang’s method may be applied. Thus,
if a herd is so badly infected that it is known in advance that only
a comparatively few animals would be found free from disease, the
tuberculin test of the adult animals may be dispensed with but applied.
to the young stock and the calves reared with the same precautions
prescribed under the regular Bang method. As the healthy young
heifers drop their calves and. come into milk they may be used as a
nucleus to build up a new free herd to which nothing but healthy
cows are added, while the number of infected animals in the original.
herd may be correspondingly reduced.

Ujhelyi provides healthy nurse cows for the newly born calves or,
where necessity demands, leaves the calves with their infected dams
and subjects them to the tuberculin test when they are weaned, slaughter-
ing all reactors. (In this method the loss is somewhat greater than
in the former.) In this case the Bang method is strictly adhered to in
so far as separation of the herd into a free and an infected group is
concerned and in so far as all animals with clinical evidence of disease
are removed at once and slaughtered. This modification of Bang’s
method may be practiced where the rearing of calves with sterilized
milk meets with insurmountable difficulties. It has the advantage that
calves remain free from diarrhea even when under the care of less
careful attendants.

By means of this method Ujhelyi has succeeded in bringing about a considerable
reduction in the percentage of reactions in a number of large herds. Thus on the
estates of Vaal, Szent-Laszl6 and Martonvasar in March, 1899, of 1,031 adult cattle
884 reacted (85.7%) of 626 head of yearlings 333 (53.3%) reacted, while in
September, 1903, of 898 adult cattle only 37 or 4.1% and of 710 yearlings only 19
or 2.6% reacted to the tuberculin test. On eight ‘other estates, at the beginning
of the campaign (1898-1902), of 1,715 cattle tested 1,011, i. e., 59% reacted while
a few years later (1904 and 1905) only 63 head, 3.0%, reacted.

Method of Ostertag. Ostertag abandons the tuberculin test en-
tirely for adult animals and consequently also the separation of the
herd into reactors and nonreactors. He lays special stress upon the
importance of an early disposition of all cattle with so called open tuber-
culosis and the rearing of all calves with milk sterilized at 85° C. or
raw milk from cows free from tuberculosis. When the calves are
weaned they are subjected to the tuberculin test and the reactors are
slaughtered. In order to dispose of all cases of open tuberculosis at
the earliest possible opportunity affected herds are subjected every
six months to examination by a veterinarian and all suspicious cows
are removed at once. In addition to this the milk (of the individual
cows as well as the mixed product from the entire herd) is subjected
to periodical bacteriological examination as are also any morbid secre-
tions that may become evident.

This method, which has been made obligatory in 182 herds of the Fast
Hollandish-Prussian Herd-Book Association since 1900 and since then has been
introduced into other German districts, can hardly be expected to bring about a
Methods of Extermination, 597

complete extermination of the disease. By removing the necessity of maintaining
two separate herds it is less objected to by the owner but the results achieved are
correspondingly unsatisfactory. From 1900-01 to 1903-04 among 15,000 adult cattle
1,071 cases of open tuberculosis were diagnosed, during which time the percentage
was reduced to 1.3% but since that time and up to 1908-09 it has been reduced
only to 1.2% (Mueller, Ostertag). In the herds of the East Prussian Herd Book
Association for Mottled Red Cattle the percentage has been reduced from 3.2 to
1.24 in the course of six years; in Pommerania, in the course of five years, from
2.93 to 0.39%; in Brandenburg, in the course of five years, from 2.28 to 0.7%
(in the first 20 herds, including 2,131 animals, which were subjected to this method,
the percentage was reduced from 4.1 to 0.23%). In Schleswig-Holstein, in four
years the reduction was from 2.8 to 1.47% and in the Province of Saxony, in four
years, from 3.6 to 1.18% (Ostertag). These percentages, of course, all refer to
open tuberculosis. Whether or not the total number of all cases of tuberculosis
were correspondingly diminished or whether there may have been an actual increase
is not recorded! At all events the figures furnished show that the results obtained
bear no comparison whatever with those obtained by the Bang method.

In infected herds of swine the disease may be successfully stamped
out by eliminating the affected animals upon the basis of the outcome
of the tuberculin test, subsequent thorough disinfection of quarters
and the observation of the necessary precautions to prevent the rein-
troduction of the disease (Thiro).

Immunization. Basing his observation upon the specific
identity but varying pathogenic action of human and bovine
tubercle bacilli, v. Behring, in 1901, declared that by treating
cattle with the less virulent human tubercle bacilli they would
be protected against the more actively virulent bovine tubercle
bacilli and thus also against natural infection with tuberculosis.
On the basis of this assertion several methods of immunization
for cattle have been recommended and actually carried out in
practice. More or less satisfactory results however were ob-
tained in such cases only where hygienic and prophylactic
measures, effective in themselves, were instituted at the same >
time. ;

Double Immunization with Human Tubercle Bacilli (Immunization
with bovo-vaccine; Behring’s method). The immunizing material con-
sists of nearly full-virulent human tubercle bacilli, dried in a vacuum
-and injected into the blood circulation of calves. The first tests con-
ducted after these treatments showed that two intravenous injections
of bovo-vaccine, or of any fresh culture of the human type of tubercle
bacillus into cattle resulted in a considerable and immediate increase
in their power of resistance to artificial infection. Calves thus treated
would, as a rule, resist successfully four months later intravenous
injections of virulent bovine bacilli in doses that proved invariably
fatal in untreated calves. Further experiments, however, showed that
resistance thus artificially increased was of short duration, suffering
considerable reduction at the end of one year and disappearing entirely
six months later. On the other hand, the results of the practical
application of the method in herds showed that it had no noticeable
effect on the improvement of the health of infected herds. Since im-
munization produces no harmful effect upon previously healthy calves.
it might be possible to prolong their immunity indefinitely by annual
vaccinations. The objection to this plan, aside from its attendant trouble
and expense, lies in the fact that the bacilli introduced by the act
of vaccination remain alive and active in the bodies of the animals
598 Tuberculosis.

for a long time (according to Ligniéres, von Weber & Titze for two
years) thus making the slaughter of such animals for food a procedure
of doubtful propriety. In addition to this objection, there is the possi-
bility that the bacilli, circulating freely in the blood stream, may lodge
in the tissue of the udder and set up local tuberculous processes (Weber
& Titze).

Control experiments conducted by Hutyra showed that intravenous injections
of 2 to 2.5 eg. of highly virulent bovine tubercle bacilli (doses which would invariably
kill control animals within two months) made in calves that had been immunized
two months before, usually produced only a very few tuberculous foci confined almost
exclusively to the lungs and showing a tendency to encapsulation and healing. On
the other hand, injections of the same doses made subcutaneously resulted in lesions
confined to the area of injection. Administration of the same virus by the way of the
alimentary canal to animals previously immunized resulted in rather extensive affec-
tion of the tonsils. Similar results were obtained not only with Behring’s original
bovo-vaccine but also with culture of human tubercle bacilli 4 to 6 weeks old. When
the resistance of the vaccinated animals was tested 744 and 17 months later the con-
trol infections resulted in extensive and partly in fatal general tuberculosis.

Eber tested the resistance of four animals immunized by Behring’s method
by repeatedly exposing them to animals with experimental tuberculosis. Two years
later, when they were slaughtered they were without exception found to be affected
with focal tuberculosis of a more extensive nature than that affecting the control
animals,

In experiments conducted with 20 vaccinated animals by Rossignol & Vallée
in Melun, with the same number of controls, while giving gratifying results three
months later when 13 animals of each group were subjected to control infection,
further observation disclosed that two of the vaccinated animals became tuberculous
and another died within 50 days from the effects of subsequent intravenous infection.
Furthermore, experiments carried out by Degive, Stubbe, Mullie & Liénaux in Belgium
and under Mazzini’s direction in Italy, gave more or less unsatisfactory results.
Finally, in an experiment made by Weber & Titze with 12 calves treated according
to Behring’s instructions and which were exposed to infection from 214 to 9 months
later by subcutaneous or intravenous injections by inhalation and alimentary adminis-
tration of bovine virus, and in three instances exposed to natural infection, only one
animal, and that of the last group mentioned, remained free from tuberculosis,

On experiences in practice, Roemer (1905) reports on statistics covering 5,576

- animals with the conclusion that vaccination resulted in a considerable decrease

in the prevalence of tuberculosis in the herds treated. Very evidently, however, this
favorable showing must be ascribed to the improved hygienic conditions that were
established because other reports have been almost unanimously unfavorable. Thus
Hutyra failed to discover any improvement in the course of one to three years in
three herds that had been subjected to the Behring treatment. Eber, in 1907, in
testing 148 animals that had been treated strictly according to the prescribed
Behring method, found 56 reactors, i. e., 37.8%. Tubereulin tests conducted during
the two following years on seven estates gave 52.2% of positive reactions among
90 immunized cattle. The percentages increased with the age of the animals in
the same proportion as is usually observed in extensively infected herds (among
55 vaccinated animals 30.9% reacted at the first test, two years later, at the second
test, 58.2% reacted). Of 36 of the vaccinated cattle that died in the interval or
were slaughtered, 16 were tuberculous,

The results obtained on four estates in Galicia by Nowack were similarly
unsatisfactory. Of 105 vaccinated cattle 44% reacted at the end of the first year
and of 138 vaccinated cattle 68% reacted at the end of the second year. Thirteen
of the reactors were slaughtered and all found tuberculous.

In Sweden Regnér and Stenstroem conducted vaccination experiments since
1904 in 8 infected herds enforcing no other hygienic measures. Of 142 animals
vaccinated 61.2% reacted to a subsequent tuberculin test. After deducting 33
animals that were possibly infected at the time of vaccination 49.5% of the remaining
109 animals gave positive reactions, while 59% of the 61 control animals gave
positive reactions to the tuberculin test. On one estate 57% of 16 animals vaccinated
reacted to a subsequent test while only 20% of the 15 control animals reacted. In
a few cases, however, vaccination seemed to have a favorable influence and even
produced curative effects in already tuberculous animals. .

Finally, Weber & Titze report on the vaccination of 206 cattle located on
6 different estates. The results are summarized by the statement that while some
of the animals became more resistant by the treatment the experiment was by no
means a conspicuous success. In one herd that had previously been entirely freed
Immunization. 599

from the disease by the Bang method the disease spread just as rapidly among the
vaccinated as it had spread among the unvaccinated animals at the time when the
Bang method was introduced.

A favorable report is made by Strelinger with reference to his experience of
five years on the Domain of Sarvar in Hungary. During this time the percentage
of reactors was reduced to 9.6%, however, not without the simultaneous enforcement
of general prophylactic and hygienic measures.

Pearson & Gilliland as well as de Schweinitz & Schroeder immunized cattle
in the United States by the intravenous injection of human tubercle bacilli. Detailed
reports of the practical results obtained have, however, not yet been published.

2. Single Vaccination with Human Tubercle Bacilli (Vaccination
with Tauruman; method of Koch & Schuetz). According to the experi-
ments of Koch, Schuetz, Neufeld & Miessner it is possible to immunize
eattle against highly virulent bovine bacilli by means of a single in-
jection of 1 to 3 eg. of human tubercle bacilli (one dose of Tauruman
contains 0.01 gm. of virulent human tubercle bacilli in emulsion).
The resistance of animals thus immunized has been tested after a
period of at least 169 days in only three cases. If we consider that
a more durable immunity can hardly be expected from a single intra-
venous injection of human tubercle bacilli than from a double injection
of even larger doses of the same bacilli and further, that Tauruman
bacilli may remain active in the body of the treated animal for a
period of 214 years the results of experimental investigations above
referred to as to the practical value of bovovaccine would probably
apply with equal force to the practical value of Tauruman.

Although Tauruman has been used for -vaccination since 1905 extensive
reports on the practical results of its use are not obtainable. Eber reports on
the vaccination of 48 cattle on four different estates; after about two years 10
out of 21 of the vaccinated animals reacted to the tubereulin test. Weber &
Titze vaccinated 63 calves on two estates and achieved apparently good results
which, however, were brought about by the fact that simultaneously with the
introduction of the vaccination one cow, affected with mammary tuberculosis
was removed from the herd and all calves were thereafter reared upon boiled milk.
The only temporary character of the resistance following treatment with Tauruman
is shown by an experiment of Hutyra, in which a vaccinated calf received eleven
months after treatment an intravenous injection of 0.02 gm. of bovine bacilli
and died 18 days thereafter of acute miliary tuberculosis.

3. Immunization with Avirulent Human Tubercle Bacilli (Dresden
Method of Klimmer). According to Klimmer cattle may be immunized
for a period of one year either with human tubercle bacilli that have
been attenuated by heating at 52° to 53° C. or with pure cultures
of avirulent tubercle bacilli that have been passed through salamanders
(originally virulent human tubercle bacilli repeatedly passed through
salamanders) in the same manner as with virulent human tubercle
bacilli. Both of the viruses referred to are said to be nonpathogenic
for animals (even guinea pigs) and do not regain their pathogenicity
by simple passage through animals. On account of this nonpatho-
genicity and the fact that bacilli introduced subcutaneously into the
bodies of cattle are soon destroyed and completely removed, this method
of vaccination may be repeated every year without jeopardizing the
health of persons that consume the meat of animals disposed. of by
slaughter at any time, and thus the period of immunity may be pro-
longed indefinitely and at will. In addition, vaccination by this method
is said to exert a curative influence upon already infected animals.

Cattle twice treated with these viruses successfully resisted experimental

infection with virulent bovine bacilli after a period of from 2 to 9 months. No
difference was noted in the protective value of the two forms of virus. According
600 Tuberculosis.

to Klimmer’s reports about 10,000 cattle were treated successfully by this method
(strict prophylactic and hygienic measures, however, were always enforced—rearing
calves with pasteurized milk or the milk of healthy nurse cows, removal of all
cows with open tuberculosis, isolation of vaccinated animals as much as possible,
ete.). In the course of this work 43 vaccinated animals were destroyed and found
free from tuberculosis on post-mortem examination. Gloeckner also reports favorable
results from the vaccination of 23 cattle, four of which were slaughtered at a
later date, one of these a non-reactor before vaccination was found to be free
from tuberculosis, and the other three reactors at the time of vaccination, showed
post-mortem evidence of the curative effect of the treatment.

On the other hand Eber is of the opinion that the good results obtained are
to be attributed to the simultaneous prophylactic and hygienic measures. Weber
& Titze hold the same opinion. The latter exposed two vaccinated and two
unvaccinated control calves to infection from a cow with pulmonary tuberculosis,
after three months all were slaughtered and found affected with tuberculosis in
approximately the same degree. These experimenters are inclined to regard the
bacilli contained in the avirulent vaccine as so called piscine tubercle bacilli or
reptilian bacilli.

4, Immunization with the Products of Metabolism of Tubercle
Bacilli (Heymans’ Method). Heymans introduces human or bovine
tubercle bacilli enclosed in the membrane of reeds under the skin of cattle,
assuming that the bacilli will continue to vegetate and diffuse their
products of metabolism through the membrane, whereupon they
pass into the circulation, and immunize the body of the animal
thus impregnated with them even exerting a curative effect upon
already existing tuberculous processes. In the effort to maintain an
effective degree of immunity by annual repetition of the immunizing
process it is found that the degree of sensitiveness to tuberculin is
gradually diminished and that 50 to 60% of the animals will cease
to react to the third test. With the aid of this method it is claimed
to be possible to exterminate tuberculosis without resort to other
hygienic measures, in 80% of the herds treated. In badly infected
herds, however, this is possible only with the aid of other prophylactic
measures.

As to the possibilities of this method which has been applied to over 20,000
cattle in Belgium, thus far only Heymans’ reports have been available. According
to these the percentage of reactors in the vaccinated herds has been considerably
reduced year after year. Thus, for example, of 18 herds comprising 188 cattle
tested in 1907, and retested in the two following years, the percentages of reactors
were 45.32% and 21%, respectively. Only 50% of the reactors of the first test
responding positively two years later at the third test. That the tuberculin test
retains its diagnostic value after the subjection of animals to this treatment is
evidenced by the fact that on post-mortem inspection more than 1,400 treated cattle,
which had given negative reactions to the test, were found free from tuberculosis.

Experiments with 18 vaccinated and 13 control animals showed that vaccinated
animals possessed a higher degree of resistance to subcutaneous as well as to
intestinal infection than not vaccinated cattle. Moussu, however, found that four
eattle that had clay tubes containing cultures of tubercle bacilli imbedded in their
tissues for some time, were affected just like cattle not thus treated when subjected
to intravenous infection with virulent bacilli. The serum of similarly treated
experiment animals showed no evidence of possessing any immunizing properties.
However, animals with culture tubes of bacilli imbedded in their tissues will react
to the tuberculin test. After the bacilli have died off, or after their removal from
the body, the animals cease to react.

Technic of Immunization. In the first two methods discussed the virus
or vaccine is injected into the blood stream while in the third and fourth methods
it is applied subcutaneously.

1. Behring’s Method. The virus (bovo-vaccine) consists of cultures of
human tubercle bacilli of a certain strain dried in a vacuum. The powder-like
substance thus obtained is prepared for use in quantities sufficient for immediate
Immunization. 601

requirements by triturating in a mortar witb sterilized, lukewarm normal salt
solution, to form an emulsion. The emulsion should be prepared in two strengths.
That used for the first vaccination should contain 0.004 gm. of dried culture per
2 ee. of fluid, while that for the second vaccination should be double this strength
or contain 0.004 gm. per one ce. of fluid (1 I.-U. = 0.004 of dry vaccine). These
emulsions are used in 2 cc. doses, i. e. 1 I.-U., for the first treatment and in 5 ee.
doses, i. e. 5 1 I.-U., for the second treatment, in each case injection being made
into the jugular vein.

The most suitable age for vaccination is from one to four months, Calves
otherwise in good health are not injured in any way by the treatment. If the
calves are tuberculous at the time of the first treatment a reaction follows, similar
to that produced by tuberculin, while the second treatment gives rise to a febrile
reaction in healthy calves as well. After this reaction has subsided the animals
continue to develop and increase in weight in a normal manner. Unfavorable
results are obtained only in animals affected with some disease at the time of
treatment, especially so called calf-pneumonia. Roemer recommends that, in addition
to the vaccination of calves, as soon as possible after birth all calves should be
fed with milk free from tubercle bacilli, and that all cows with open tuberculosis
should be removed from the herd at once. Vallée & Rossignel recommend, also,
that calves should not be exposed to infection from the first vaccination or until
6 weeks after the second vaccination.

Later Behring introduced, or recommended, a new method, Tauro-vaccina-
tion, in which an agent with anti-tuberculous properties (?) is added to the vaccine,
resulting in marked attenuation of the latter which is injected subcutaneously
instead of intravenously. According to Ligniéres oily emulsions are better adapted
for vaccination than aqueous emulsions. These methods have not been applied in
practice. i

2. Method of Koch & Schuetz. Tauruman, a ready-for-use emulsion of
bacilli, (0.01 g. virulent human tubercle bacilli in emulsion) after breaking off the
point of the glass tube containing the vaccine, is drawn out with a hypodermic
syringe and injected into the jugular vein in a manner similar to that followed
in the use of bovo-vaceine. A second application is not made in this method.

What has been stated in regard to immunization with bovo-vaccine might
also be applicable in this case. Since both vaccines contain virulent tubercle
bacilli the greatest caution should be observed in their manipulation (Moeller
reports repeated serious infection of his assistant with Tauruman).

3. Method of Klimmer. In the ‘‘Dresden Method of Immunization to
Tuberculosis’’ emulsions of attenuated human tubercle bacilli (TH) or avirulent
tubercle bacilli (AV) (the latter especially for milk cows) were formerly used.
More recently, however, avirulent material only, known to the trade as Antiphy-
matol, has been in use. Of this material doses of 5 cc. are injected subcutaneously
on the side of the neck. The vaccine must be preserved in a cool dark place and
used within three weeks. Cattle may be treated from the age of three days to 18
months, or older animals that are free from tubercwhosis. Vaccination must be
repeated after three months and annually thereafter (young animals suspected of
being tuberculous are advantageously treated four times during the first year at
intervals of three months). It is recommended to protect animals from exposure
to infection and to feed calves previous to immunization, and for two months
after with milk that is free from any infection. All animals should also be sub-
jected to the ophthalmic tuberculin test before treatment. The non-reactors should
then be placed in the most favorable positions in the stables, particular care being
observed that healthy animals are not stabled so as to face reactors.

4. Heymans’ Method. The vaccine consists of dried human tubercle bacilli
enclosed in gelatinized reed sacs. The process of vaccination consists in the intro-
duction of one of these sacs under the skin of the croup or back by means of a
specially constructed trocar.

Cattle of either sex or of any age may be vaccinated whether they are free
from tuberculosis or infected, but in order to obtain permanent results the vaccina-
tion must be repeated every year. Special hygienic measures are not necessary.

Other Methods of Immunization. Aside from the very numerous, more
or less successful laboratory experiments in the immunization of small animals for
which purpose variously attenuated or dead tubercle bacilli as well as toxic sub-
stances and secretions have been chiefly used, a few other methods that have been
recommended for actual practice will be briefly mentioned.

Ligniéres introduced subcutaneous vaccination with living human tubercle
baeilli into practice in Argentine. (The human tubercle bacilli were either in
602 Tuberculosis.

“

emulsion or homogeneous liquid cultures). Baumgarten had then already shown
that a single subcutaneous vaccination with human tubercle bacilli increased the
resistance of cattle to a marked degree. Hutyra had also shown that cattle thus
vaccinated would be protected for a time against infection by intravenous injection
of 0.04 gm. bovine tubercle bacilli but that such immunity diminished noticeably
after six months. According to Arloing’s experiences subcutaneous vaccination
does not produce as high a degree of resistance as the intravenous administration
of vaccine.

2. Friedmann recommended a strain of tubercle bacilli for vaccination of
cattle which he had cultivated from a turtle, and successfully protected rabbits
against bovine bacilli. After Libbertz and Ruppel and also Orth failed to con-
firm the favorable results claimed by Friedmann, Weber & Titze showed that while
the repeated intravenous administration of large masses of bacilli derived from
cold-blooded animals, or of acid-fast grass bacilli, no doubt might increase the
resistance of cattle to infection with bovine bacilli to a slight extent, the effect
is so slight that the practical application of the method is of questionable value.

3. According to Behring as well as Calmette & Guérin it is possible to
immunize cattle against intestinal infection by the administration of a small
quantity of bovine bacilli per os. Roux & Vallée obtained good results by two
administrations, per os, to young calves, at intervals of three months, of 0.20 gm.
doses of equine tubercle bacilli or of viruent bovine bacilli. Animals thus treated
were found, in some cases to possess greater resistance to subsequent infection than
those immunized by the intravenous method. The advantage of this method of
immunization is claimed to be that bacilli thus administered are completely absorbed —
in a period not longer than 7 months. On the other hand, alimentary infection
occurring during or immediately preceding the period of preventive treatment will
give rise to a progressive tuberculous condition. Even Vallée himself admits that
attenuated human tubercle bacilli, the alimentary administration of which gives
similar results, are perhaps more suitable for this purpose.

4, Arloing uses homogenized cultures of human or bovine bacilli grown on
6% glycerin bouillon for the immunization of cattle. These cultures do not
produce microscopic tubercules in small experimental animals or in calves but only
microscopic changes of the Yersin type. The cultures are administered intraven-
ously, subcutaneously or per os. According to the first method young calves receive
0.5 ec. for the first dose; two months later 1.5 ec. of a culture one month old is
injected into the jugular vein (older animals receive 1.0 to 1.5 ec.). In the
subeutaneous method both the first and second applications are made subcutane-
ously (2 ec. of culture being injected each time in the side of the neck or in the
flank). According to the third method the first dose consists of 15 ec. and the
second dose, two months later, of 20 ec. of culture carefully injected into the
mouth so that the animal will swallow the same. In all three methods it is neces-
sary to follow up the treatment with annual subcutaneous injections of 2.0 ee. of
culture in order to maintain an effective degree of immunity. These treatments
always result in tuberculin-hypersensitiveness which, however, gradually leads in
about six or eight months to the opposite condition, that is a tolerance. Moderate
fever of short duration follows the intravenous as well as the subcutaneous admin-
istration of the virus and in the latter method a local tumor with friable cheesy
contents develops at the point of injection. This usually disappears in the course
of several months.

Results of the vaccination of 60 cattle ranging in age from 4 to 12 months,
with 30 control animals in the experiment, were only partly successful. After
exposure to infection only about 50% of the vaccinated animals remained healthy;
of the infected animals some were only slightly affected but others were extensively
diseased. Nevertheless the results as a whole were in favor of immunization. The
fact that the cultures used were harmless for cattle, as well as for monkeys, also,
deserves favorable consideration of the method. The intravenous method gave the
best results, the ingestion method came second and the subeutaneous method last in
efficacy.

5. Vallée immunized horses by intravenous injections of successively increas-
ing doses of, first, equine bacilli avirulent for guinea pigs, which then were followed
by human tubercle bacilli slightly virulent for guinea pigs. The injections pro-
duced no tuberculous processes whatever. After treatment for one or two years the
serum of these horses, though possessing only slight agglutinating power, con-
tained protective substances that could be demonstrated by the complement fixation
method, and which in doses of 100 to 200 ce. protected young cattle against experi-
Police Measures. 603

mental infection with tuberculosis. Vallée expresses the hope that such serum may
be used for therapeutic purposes, in fact some hundreds of persons have already
been treated with this material but reports on results have not as yet been available.

Veterinary Sanitary Police Measures. The extraordinary
prevalence of tuberculosis, especially among the improved
breeds of cattle, and the consequent enormous losses have been
the motive of government interference for the purpose of the
controlling, and, as may be possible, completely exterminating
the disease. On the very account of the great prevalence of
the disease however, measures of protection and extermination
that have proved successful for other animal plagues can
hardly be applied to tuberculosis. With the exception of
states and countries where the disease has as yet made little
headway, general measures for compulsory slaughter can not
be considered because such a procedure, aside from the
enormous financial sacrifice, would otherwise most seriously
affect the best interests of the live stock industry of the country
and of other interests generally. Under existing conditions,
therefore, and for a long time to come, government activity
must be confined to gradually enforced measures of repression
and the extension of every possible aid to such owners of
live stock whose earnest endeavors are aimed at the extermina-
tion of the evil.

In order to reduce the danger of exposure and infection
official regulations should require, above everything else, that
animals with open tuberculosis, and particularly cows with
tuberculosis of the udder, be excluded from trade by rigid
quarantine and destroyed as soon as_ possible, subject to
reasonable compensation to the owner from government ap-
propriations or from funds provided by a system of obligatory
live stock insurance. To aid in the enforcement of this measure
it should be made the duty of meat inspectors to report every
ease of tuberculosis to the proper authorities whereupon it
would devolve upon the latter to make an official investigation
of the herds from which the diseased animals originated and
cause any and all evidently diseased remaining animals to
be disposed of by slaughter subject to proper inspection.

The permanent professional supervision of all herds, but
particularly and primarily of dairy herds, is justified by the
importance of an early recognition of clinically affected or
suspected animals so that the milk from these animals, which
is dangerous to the health of human beings, shall not be put
on the market unsterilized. Milk from infected herds should
not be permitted to be sold unless previously heated to at
least 80° C., and the product of animals with affection of the
udder should under no circumstances be permitted to be sold,
given away or otherwise utilized. In addition, official regula-
tions should provide that all skim milk and other by-products
from creameries and skimming stations must be heated to
at least 80° C. before they may be returned to the producer
604 Tuberculosis.

or to other persons. Further, governments should offer
premiums, and otherwise aid in the acquisition of such male
animals only as have been shown to be free from tuberculosis
by the tuberculin test or by protective inoculation. This would
have the additional advantage of stimulating the breeders to
make every effort to produce healthy animals because of the
greater value of the young animals. Finally, a properly
organized and effective system of meat inspection, aside from
its value in locating centers of infection, would add to the
success of the whole undertaking by insuring the destruction
of badly infected animals or their diseased organs, and pre-
venting their sale as food,

The government may assist or support efforts on the part
of private individuals by paying the expenses of professional
advice or supervision where the Bang system for the extermina-
tion of the disease is attempted, and by furnishing the neces-
sary tuberculin free or at cost of production. Such aid, how-
ever, should be extended only on condition that the owners
of the herds carry out to the letter all necessary measures
to insure successful prevention of infection of healthy animals,
dispose of all clinically affected or suspicious animals by
slaughter within a specified time and exclude all reactors from
trade. In this connection it is advisable and necessary to
provide proper means of identification of all reacting animals
because without this the tuberculin test may merely serve to
assist certain owners to dispose of their diseased animals by
sale and thus bring about a still wider dissemination of the
disease. For the same reason the manufacture and sale of
tuberculin and its importation.from other countries should be
controlled by the government. Finally, the dissemination of
information by the state or government in regard to the
nature and control of tuberculosis would be of great aid in a
campaign of suppression directed against this disease.

Since 1909 the live-stock sanitary laws of Germany require owners to report
to the proper authorities all clinically recognizable forms of the disease affecting
the lungs, udder, uterus or intestines. Provision is made for the official condemna-
tion and destruction of such animals or their safe quarantine, disinfection of
infected premises and the marking of quarantined cattle for future identification. .
The milk from such animals must be sterilized by heat before being sold or given
away and in case of tuberculosis of the udder it is absolutely excluded from use as
food for human beings.

Austria has enforced very similar laws since 1909, requiring the notification
of all cases of clinical tuberculosis to the authorities, isolation and marking of
animals thus affected, disinfection of infected stables, compulsory slaughter of
calves (!) from diseased cows and government support for the control and
extermination of the disease.

In Hungary, since 1910, cattle with tuberculosis of the udder are confiscated
by the government and immediately slaughtered. In addition, the use of milk for
human food from cows with open tuberculosis is forbidden and all skim milk from
creameries and skimming stations must be pasteurized before it may be sold or
given away.

The most successful results in the control and extermination of
tuberculosis are to be found in the northern states of Denmark, Norway,
Police Measures. 605

Sweden and Finland, where individual efforts on the part of owners

have for years received the support of legislative measures (see also
statistics on page 502).

The endeavors of the Danish Government for the extermination of tubercu-
losis, which are worthy of emulation, began in 1903 when annual appropriations
of 50,000 crowns were made for the support of the work. These appropriations
were later increased to 100,000 crowns. At first tuberculin was furnished free of
expense for young animals only, later it was furnished for all cattle upon the
same basis, and beginning with 1898 the government assumed all expenses con-
nected with the control and extermination of the disease. The laws of 1898
prescribe obligatory Pasteurization at 85° C for all skim and butter-milk intended
for feeding animals. This resulted in an immediate reduction in the percentage
of tuberculosis in calves and even more so in swine. In 1904 the prescribed
temperature of 85° C was reduced to 80° C. The laws of 1898 also require the
compulsory slaughter of all cows with tuberculosis of the udder and provide com-
pensation to the owners. This resulted in the annual withdrawal from trade of
600 cows with udder tuberculosis out of a total of about one million cattle. For
seven years (1898-1904) the annual losses were as follows; 407, 592, 610, 584, 615,
583 and 689 respectively.

In Sweden methods of extermination inaugurated in 1897 along lines similar to
those upon which Danish operations were based gave equally happy results, While,
for example, tuberculin tests of 1370 herds comprising 48,576 animals gave 14,225
reactors (29.3%) in the beginning of the campaign, tests of the same herds in
1908, then comprising 57,660 animals gave only 1765 reactions (3.1%). This
result was obtained at a cost to the government of 830,000 crowns.

On account of the difficulties or obstacles above discussed the compulsory
official destruction of all animals affected with tuberculosis has not given satis-
factory practical results. Thus, in Belgium, in 1895, all animals affected with
clinical tuberculosis, as well as all reactors to the tuberculin test were ordered
killed within a prescribed time. As a result, of 2,905 herds comprising 19,004
cattle in 1896, 9280 were slaughtered. The surprisingly enormous expense of this
procedure and the opposition offered by the owners brought about a modification
of this order so as to apply to clinically affected animals only. Even with this
restriction the enforcement of the order resulted in the destruction of 10,269 cattle
in 1902 at a cost to the state, in indemnification expenses, of about one and one
half million franks. In the North American State of Massachusetts a similar
radical attempt inaugurated in 1895 was abandoned at the end of the first year.

The official tuberculin testing of import animals before they are permitted
entrance within the borders of a country, a practice in force in a number of
states has not been found effective except from a purely sanitary police point of
view. This is due to the fact that injections of tuberculin made immediately
before shipment (plugging) robs the tuberculin test subsequently applied of its
diagnostic value. A measure of this kind is in effect along the North German
border for all imported cattle. While 30.8% of the 74,813 quarantine cattle
reacted to the tuberculin test during the first year of the enforcement of this
measure the percentage of reactions has fallen off heavily in the following years
although a considerable percent. of the animals were found tuberculous at the time
of slaughter. Thus, of 772,037 cattle subjected to the tuberculin test in 1899 to
1908 only 9,197, i. e. 12% reacted, although 176,554 tuberculous animals were
found at the subsequent slaughter of 748,628 non-reactors, i. e. 22.2%, and of
these 2407 were affected with generalized tuberculosis (!)

Literature. VILLEMIN, Rec., 1867. 5. — CuHauveav, Ibid., 1869. 202; Rev.
gén., 1907. IX. 497. — Semeur, D. Z. f. Tm., 1876. II. 209. — Vircuow, B. kl.
W., 1880, Nr. 14. — Kocu, B. kl. W., 1882. 221; Mitt. d. G.-A., 1884. IT. 1; D.
m. W., 1897, 207. — Jounz, D. Z. f. Tm., 1883. IX. 1 (History, with Lit.). —
Bana, Ibid., 1885. XI. 45; 1890. XVI. 353; Z. f. Tm., 1902. 81. — Hess, Schw. A.,
1889, 155; 1896. XXXVIII. 210. — Jznszn, D. Z, f. Tm., 1891. XVII. 255 (Lit.
on tub. of dogs and eats). — Captor, La tub. du chien. Paris. 1893 (Lit.); Monh.,
1894, V. 97. — Capfac, J. vét., 1894. 723; 1905. 577; 1907. 65. — Kirt, Monh.,
1896, VII. 216; 1905, XVI. 267; 1907. XVIII. 385 (Review). — Maum, Rev.
de la Tub., 1898. 337. — Nocarp, Dict. de méd vét., 1892. XXI. 426; A. P., 1892,
VI. 44; Ree, 1090. 721. — ARLoine, C, R., 1898. CKXVI. u. XXVIII; Rev. gén.,
1909, XIV. 781. — Ernst, Monh., 1900. XI. 229. (Review on Law in Milk).
— Fuieen, Z. f. Hyg., 1901. XXXVIII. 1. — Beurine, Beitr. z. exp. Ther., 1902.
1; D. m. W., 1903. 689; Tuberkulose, 1905. IV. 371. — Osrertac, Z. f. Hyg.,
1901. XXXVIII. 45; Z. f. Infkr., 1910. VII. 1. — Eper, Z. f. Tm., 1905. IX. 81;
606 Tuberculosis.

Cbl. f. Bakt., 1097. XLIV 463; 1909. LIT. 389. — Catmerrz & Guérin, A. P., 1905.
XIX. 601; 1906. XX. 353 u. 609. — OsrerTac, Brerpert, Kamstner & Kravurt-
STRUNK, Arb. d. hyg. Inst. d. tierarztl. Hsch. Berlin, V. H. 1905 (Lit. on Diagnosis).
— Pearson & GiLtimann, J. of comp. Path., 1905. XVIII. 207. — Kocu, Scutrz,
Nevurep & Mrissswer, A. f. Tk., 1905. 545. — Moussu, Ree., 1905. 777; 1907. 701.
— Heymans, Arch. internat. de pharmacodynamie, 1905 — 1910, XVII — XX. —
Maver, Z. f. Tm., 1906, X. 241. — Fiscuer, Ibid., 1906. X. 82 (Lit. on Uterustub.).
— Hurvra, Z. f. Tm., 1907. XI. 241. — Pirquzr, Vakzination u. vakz. Allergie.
Wien 1907. — Weser & Trrzn, Tbk.-Arb. d. G.-A. 7., 9. u. 10 H. 1907, 1908 u.
1910 (Lit. on Immunization). — Vauuiz, Bull., 1907. 180; Rev. gén., 1908. XI.
318; 1909. XIII. 355; A. P., 1909, XXVII. 585. — Licnrbres, Bull., 1908. 112 u.
517; 1909. 146. — Mouter & WasuBurn, An. Ind., 1907. 215. — ScHRoEprr &
Corton, An. Ind., Bull. Nr. 99. — Mucus, Beitr. z. Kl. d. Tb., 1907. VIII. 85;
1908. XI. 175. — Wyssmann, Schw. A., 1908. L. 90 (Lit. on Tub. after Contrac-
tion). — Trrzz & Weipanz, The.-A. d. G.-A., 9. H., 1908. — Maver, Diss. Bern. 1908
(Lit. on sheep tub.). — Catmerts & Gufrin, A. P., 1908, XXII. 1. — Kuimmer,
Z. £. Tm., 1908. XII. 81. — Kiimmur & Kinssic, Monh., 1908. XX. 97; Z. f. Tm.,
1909. XIII. 3183. — Romer, Z. f. Infkr., 1909. VI. 393, —- Jorst. Ibid., 1909. V.
224, VI. 257; 1910. VII. 181. — Atsten, Z. f. Tm., 1909. XIII. 109 (Lit. on Con-
genial Tub.). — Bonerrt, A. f. Hyg., 1909. LXIX. 263. — Forster, Chl, f. Bakt.,
1909. LI. 417 (Lit. on sterlization of milk.). — HEnscueE, Diss. Bern. 1909 (Lit.

on anatomical statistics). — Wo.rr-E1sner, Frihdigan. u. Tbe.-Imm. Wirzburg
1909. — Ricuter, Z. f. Infkr., 1909 V. 243 (Lit. on local reaction). — JosuPu, B,
t. W., 1909. 847. — GorpscKE, Tbe. d. Pferdes, Hannover, 1909. — Frias,

Verbreitungsw. u. Bekimpfg. d. Tub. Leipzig. 1908. — Nowak, Z. f. Infkr., 1909.
VI. 313 (Lit. on immunization).

Tuberculosis in Man. At the present day tuberculosis is
the most destructive disease of mankind, estimates showing
that one-seventh of all deaths, and one-third of all deaths
occurring during the ‘‘working age’’ of human beings, are due
to this disease. .

In the majority of cases it manifests itself as a chronic
destructive affection of the lungs (consumption, phthisis
pulmonum). In cases where the disease appears primarily as
an affection of the peripharyngeal and cervical lymph glands,
the digestive organs or the bones, the development of pulmonary

‘tuberculosis is usually only a question of time. In a certain
number of cases the disease confines its entire course to the
abdominal organs (abdominal lymph glands, especially in
children). In exceptional cases the disease terminates as a
generalized acute miliary tuberculosis.

As has been found to be the case in animals, man also
with few exceptions acquires the disease in extra-uterine life.
Infection is caused as a rule by the human type of tubercle
bacillus which is disseminated in large quantities by diseased
human beings, particularly through the medium of expectorated
secretions from the lungs. The bacilli are then inhaled or
ingested by persons that come into contact with the patients,
particularly when they live with them in the same close, dirty
and poorly ventilated dwellings.

The virus of animals, and especially that of bovine tuber-
culosis plays a less important role in the infection of man.
Experimental investigations of recent years have shown, how-
ever, that man is susceptible to infection with bovine virus.
This has been demonstrated by well authenticated cases where
human beings became affected after consumption of milk from
Tuberculosis in Man. 607

tuberculous cows or after injuries acquired when making post-
mortem examinations of tuberculous animals. Even more
positive in this respect has been the evidence furnished by
the fact that tubercle bacilli, agreeing in their pathogenic
properties in every particular with those of the bovine type,
have been isolated from the lesions of tuberculous persons,
especially children (see p. 623).

If, in spite of this, bovine tuberculosis plays only a
secondary role in the dissemination of tuberculosis in man
the cause for this, may in part at least, be found in the fact
that human beings do not live in as close association nor come
in as intimate contact with tuberculous cattle as they do with
their fellow beings.

Pulmonary consumption, the commonest form of human tubér-
culosis, appears to be caused almost always by the human .type of
the bacillus. Koch only recently emphasized the fact that up to that
time the bovine type of bacillus had not been demonstrated in a single
case of human pulmonary tuberculosis. Indeed Kitasato could find
only the human type of bacillus in 152 and Dieterlen in 50 examina-
tions of sputum from consumptives. But Mohler & Washburn as
well as Beitzke report each one case in which they succeeded in ob-
taining pure cultures of the bovine type from such material. In
general the bacilli of the bovine type seem to possess only a slight
tendency to spread in the human body, consequently they produce,
in the majority of cases, only local lesions in the region of the point
of infection (peripharyngeal, cervical and mesenteric glands).

The danger which threatens man in the direction of bovine
infection demands the maintenance of every measure of pro-
tection by means of which this danger may be averted.

In this respect all raw animal products, and particularly
milk, demand adequate consideration. There seems to be no
question as to the justification of the demand that all cows
with open tuberculosis and such as have affected udders be
unconditionally excluded from dairy purposes and that all milk
offered for sale to the public should be subject to professional
or expert supervision. Herds supplying creameries and skim-
ming stations should be subjected to particularly stringent
regulations for the reason that a single infected herd or animal
may be the means of contaminating the entire product of a
large station. Control of this character should confine itself
not merely to the exclusion of diseased animals but also to
enforcement of general sanitary regulations in the production
and handling of the milk, thus insuring the healthfulness of
the various other dairy products, butter, cheese, etc.

Since suitable measures of control of this kind are at
present enforced in very few localities, it is incumbent upon
every individual to observe certain measures for his own pro-
tection. Uncertified milk should not be used as food without
previous boiling or at least heating to 80° C. Children, in
608 Tuberculosis.

particular, should be fed exclusively on pasteurized milk on
account of their susceptibility to infection.

The possible danger attending the consumption of meat
from tuberculous animals, though of much less consequence
than that attending the consumption of dairy products, may
be entirely overcome by a general system of obligatory meat
inspection. Aside from the destruction of tuberculous organs,
all tuberculous meat should be condemned and all suspicious
carcasses should be sterilized by heat before they are per-
mitted to be placed on sale.

Since human beings are exposed to the danger of contract-
ing disease in infected stables, attendants should not remain
in them for longer periods than necessary and under no cir-
cumstances use such stables as dormitories. In dwellings,
adequate measures should be taken to protect residents-from
possible infection by tuberculous dogs and birds (parrots). —

Finally, persons employed in the care, or otherwise, of
tuberculous animals and in the examination of tuberculous
carcasses should always be on their guard in the observation
of ordinary precautionary measures.

Literature. 8S. Cornet, Nothnagels Handbuch, 1900. XIV.

(b) Tuberculosis of Fowls. ‘Tuberculosis avium. Avian
Tuberculosis,

Historical. After Paulicki had recognized the similarity between
this disease in birds and tuberculosis of human beings and mammals
even before the discovery of the tubercle bacillus, Koch showed in
1882 that a disease of fowls existed which was caused by a bacillus
similar in its morphological and staining characteristics to the tubercle
bacillus. Koch as well as Ribbert looked upon the disease as identical
with mammalian tuberculosis and occasional observations that fowls
apparently became infected from the expectorations of sick persons
(Johne and others) seemed to confirm this view. Rivolta (1888) how-
ever could not succeed in his efforts at experimental infection of fowls
with mammalian bacilli and therefore declared tuberculosis of mammals
and of birds to be etiologically distinct diseases. Since this time avian
tuberculosis has been the subject of numerous investigations which,
however, have not led to uniform results and the question of the identity
or relationship of the two forms of disease is still an open one. While
Strauss and others, also the pupils of the former, Gamaleia and Wuertz,
and more recently Koch also stood for the non-identity of the two
diseases on account of the difference in virulence of the bacilli, Maffucci
took the same stand on the basis of the morphological and cultural
differences; more recently Weber & Bofinger (1904) have expressed
themselves as accepting the same view but Cadiot, Gilbert & Roger,
Fischel, Hueppe, Johne, Nocard, Behring, Roemer as well as M. Koch
& Rabinowitsch have taken the opposing position in claiming specific
identity for the two forms of bacilli (see p. 617).

Occurrence. Avian tuberculosis occasionally appears en-
zootically among fowls and pigeons, causing enormous losses
Avian Tuberculosis. 609

(Zuern found tuberculosis in 10% of deaths in these animals).
Among water fowls the disease, though generally much less
prevalent, also appears as an enzootic (Huss). Birds kept
in captivity are also affected (M. Koch and Rabinowitsch found
118 tuberculous subjects among 459 birds that died in the
Zoological Garden in Berlin).

Etiology. The bacillus tuberculosis avium obtained from
tissues is usually shorter and stains more evenly than the
bacillus of mammalian tuberculosis, but otherwise agrees with
the latter in staining characteristics (see Fig. 95).

Cultivation. On glycerin blood serum the bacillus thrives much
better than the mammalian variety, glassy, transparent, roundish
colonies being visible on the surface of the nutrient medium as early
as the 8th and sometimes even the 5th day. Later they become confluent
and form a grayish-white or yellowish-red, moist, slimy, stringy, smeary
scum that is easily emulsified in water. The bacillus thrives best be-
tween 30° and 40° C., but will grow also at 25° and at 45° C. In
cultures grown at a high temperature we find eside from short rods
also longer forms that stain uniformly or exhibit a granular appearance,
some of them thick and club-shaped or even branched (Maffucci). On
potatoes they form a grayish-white, blackish or reddish, moist, smeary,
crumpled layer (Matzuschita; see Plate II); in glycerin bouillon
granules develop on the floor and wall of the vessel while only some
of the strains form a dry wrinkled membrane on the surface of the
liquid (Weber & Bofinger). On some media,
e.g., glycerin chicken bouillon, egg yolk, etc.,
occasionally also on ordinary media, the
cultures of some strains present an appear-
ance similar to that of mammalian tubercle
bacilli.

Not all tubercle bacilli obtained from birds
will show the above culture characteristics, but
the greatest variety of transition forms occur,
ineluding the dry scaly cultures of mammalian
bacilli. (M. Koch & Rabinowitsch).

Tenacity. The bacillus of avian  tuber-
culosis is on the whole more resistant to external
influence than Koch’s bacillus. Thus a culture
two years old may still contain living bacilli.
Temperatures of 70° C. require 15 minutes to
destroy them. (Maffucci).

 

Fig. 95. Bac. tuberculosis avium.
Articular exudate from chicken ;
Stain according to Zieh]-Nelsen.

Pathogenicity. Experimental infection of fowls is most
certain by introduction of the virus into the blood stream.
One or two months later, upon the appearance of symptoms
of marasmus, small tubercles are found in the spleen and
liver, while the blood vessels of these organs are filled with
masses of bacilli. Intraperitoneal or subcutaneous inoculation
give less certain results. These are followed by local foci
only, but the affected animal may die from the toxic. effects
of the lesion. A single injection of culture masses suffices
as a rule for infection. The fowls die after one or two months

Vol. 1—39
610 Tuberculosis.

with characteristic symptoms of abdominal tuberculosis.
Geese and ducks may be infected in the same manner (Weber
& Bofinger). Pigeons possess a much greater power of re-
sistance to experimental infection. Articular tuberculosis is,
however, readily produced by injection of the bacilli into the
articulations. ;

Rabbits are very susceptible to experimental inoculation,
and the feeding of cultures to these animals produces symptoms
very similar to those following infection with bovine tuber-
culosis (intravenous administration of the virus is frequently
followed by tuberculosis of the joints and of the adjacent bones
and tendon sheaths). On the other hand, guinea pigs offer
a somewhat greater resistance to such infections; although
they get sick after treatment with rather large amounts of
virus, morbid changes (nodules and ulcers) usually develop
only around the masses of bacilli found in the body and which
always develop rather slowly (much the same as lesions oc-
curring around other foreign bodies). A progressive tuber-
culosis is a rare occurrence. Intraperitoneal infection, how-
ever, produces death from tuberculous septicemia (‘‘Type
Yersin’’) (O. Bang). The virulence of the bacilli is frequently
completely destroyed in the bodies of guinea pigs (M. Koch &
Rabinowitsch). Of ‘the larger mammals, cattle and goats
respond to subcutaneous injection much like guinea pigs. In-
traperitoneal administration causing death from tuberculous
septicemia. Animals of mature age are very resistant to the
alimentary administration of avian tubercle bacilli while very
young animals (calves, kids and colts) develop acute tuber-
culosis which affects the intestines and mesentery with par-
ticular severity, occasionally also the lungs, and which ter-
minates. fatally (O. Bang). Swine seem to be only slightly
susceptible, dogs and cats not at all, while mice and rats are
readily infected through the alimentary tract.

Natural infection of healthy "fowls is brought about by
taking up the droppings of infected birds. When intestinal
ulcers are present such droppings contain enormous masses
of bacilli. Still more frequently is infection brought about by
permitting healthy fowls to have access to tuberculous cadavers
that have been consigned to the manure pile. The liver and
spleen of such cadavers contain large masses of bacilli.

Infection from tuberculous persons. In view of the very
slight susceptibility of fowls to infection with mammalian
tuberculosis (which has been demonstrated experimentally)
infection from the sputum of human beings probably occurs
only in such rare cases in which the lung secretions of con-
sumptives contain avian tubercle bacilli (see p. 618). Infec-
tion from tuberculous mammals is undoubtedly also a rare
occurrence (parrots, however, are an exception in this respeci..
See p. 615). On the other hand, the possibility exists that
Avian Tuberculosis. 611

spontaneously infected mice or rats may be the means of
spreading the disease (Rabinowitsch).

Infection may also take place through injuries of the mouth
or of the skin; the possibility of an infection through the air
passages by means of inhaled air containing the bacilli must
also be admitted.

Heredity plays only a subordinate role in the dissemination of
the disease. Maffucci demonstrated that the embryo of experimentally
infected eggs is capable of development and the possibility also exists
that they may become infected through tuberculous ovaries. Accord-
ing to Lichtenstein, who found that all the progeny of an infected
cock had the disease, there. exists also the possibility of a germinative
infection through the male parent. Chicks however that have been
hatched from infected eggs live at most only a few months before
they succumb to the effects of the disease. On the other hand the
plague may be introduced into healthy flocks through the means of
infected eggs the albumen of which occasionally contains bacilli. (Mohler
& Washburn). Rabinowitsch observed the hatching of 8 chicks from
382 experimentally infected eggs. Of the eggs infected with avian
tuberculosis the embryos died in 90%, of those infected with guinea pig
tuberculosis 70% and of those infected with bovine tuberculosis 40%
died.

Pathogenesis. The bacilli, which usually gain entrance into
the alimentary canal with the food, usually pass through the
solitary and agminated lymph follicles of the large .and small
intestines into the intestinal walls and thence, with the blood
of the portal vein, enter the liver or they gain access into the
general circulation and lodge in other organs and portions
of the body, thus in the spleen, lungs, joints and tendon
sheaths, causing the development of specific lesions.. The in-
testinal mucous membrane may remain perfectly intact or
small nodules may develop in_its tissue. The overlying villi
may present no changes in the beginning but ulceration follows
at.a later time. These ulcers may heal with the formation of
granulation tissue (Schern). The nodules occurring in the
intestinal walls under the serosa develop from the lymph nodes
in the peripheral layers of ‘the intestinal walls, or between
the serosa and muscularis of the cecums, or from the agminated
follicles in the mucous membrane without causing any observa-
ble changes in the intestinal mucous membrane which, how-
ever, they perforate at a later stage and then communicate
with the lumen of the intestine (M. Koch & Rabinowitsch).

The symptoms of cachexia observable in diseased fowls
(emaciation, anemia, marasmus) are a result of the toxic ac-
tion of the chemical products of the bacilli. These toxins,
which kill guinea pigs with the same symptoms as those ob-
served in chickens, may be produced from artificial cultures,
particularly those grown on liquid glycerin serum (Maffucci,
Héricourt & Richet). The death of dogs and guinea pigs
612 Tuberculosis.

following the administration: of large masses of virus is
ascribed to the same cause since no tubercles develop in the
body. The same is true of the excessive irritation, fever,
suppuration at the point of injection and the temporary swell-
ing of the regional lymph glands which are observed after the
subcutaneous administration of avian tubercle bacilli in cattle
(Kossel, Weber & Heuss).

Anatomical Changes. On post-mortem examination the
liver and spleen are most frequently found affected and this
is not rarely the case when the intestine and peritoneum are
entirely free from changes. As a rule there are nodules rang-
ing in size from that. of a lentil to that of a pea, and some-
times approaching that of a hazelnut, with colorless, gelatinous
or yellowish, friable, cheesy and occasionally calcified contents
and, surrounded or enclosed by a connective tissue capsule. In
rare cases minute gray or pale yellow points, here and there
collected into groups under the serosa, are scattered through
the tissue of the liver. The diseased liver, especially in chronic
cases, is considerably enlarged and may be rather friable on
account of fatty. degeneration. Now and then hemorrhagic
areas occur near the surface of the organ.

Affection of the intestine, especially near the cecums, is
comparatively common. The mucous membrane is covered
with small yellowish nodules among which funnel-shaped ulcers
with finely nodulated or raised borders may be present. On
the serous surface there may be firmly attached coarsely
nodulated roundish tumors that may approach the size of a
hazelnut. These may also occur in the mesentery (Fig. 96).
These tumors or nodes may have a wide or narrow base or
they may be pedunculated, but they are always clearly differen-
tiated from the surrounding tissue and covered by peritoneum.
The interior of the small nodules consists of a homogeneous
grayish-yellow, tough, almost hornlike or cartilaginous tissue,
while in the larger nodules, which are otherwise of similar
structure, there are also cheesy foci, or the nodules may con-
sist throughout of a yellowish, crumbly substance. The interior
of these nodules may communicate, at the apex, with the lumen
of the intestine by means of a fistulous canal (Volkmann found,
at the end of the left cecum, a cheesy tumor of the size of |
a hen’s egg; the remaining portion of the cecum was thickened
and covered with nodules). The abdominal lymphatic glands
are much enlarged and caseated. In a few cases the visceral
layer of the peritoneum is covered with nodules.

In tuberculosis of the bones and joints, which is rather
common, the articular cavities are filled with cheesy masses;
the cartilaginous covering of the enlarged epiphyses shows
erosions while the bone substance and, occasionally the peri-
articular connective tissue contains cheesy foci.

Tuberculosis of the lungs is much less frequent. These
may present the picture of a miliary tuberculosis o1 their
Avian Tuberculosis. 613

tissue may contain large, yellowish-white, cheesy foci. The
pericardial sac may contain much fluid while the surface of
the heart may be covered with flat, grayish-red, raspberry-jike
or almost wart-like proliferations (Tietz). Among the other
organs, we find, now and then, tuberculous caseous foci on

 

Vig. 96. Avian Tuberculosis. Caseated foci in the liver and nodules on the
intestinal wall.

the peritoneum, in the kidneys, in the ovaries, in the testicles,
in the pericardium and the muscle tissue of the heart, in the
air cells, in the gizzard, as well as under the skin and the

balls of the feet.

The histologicai structure of the avian tubercle is similar in character to
that of the mammalian tubercle with the unimportant exception, that by far the
greater part of it consists of large epithelioid cells of the foreign-body giant-cell
type containing tubercle bacilli and disposed in radial or wreathlike scaly fashion
(as seen in section) around the central necrotic mass. The degenerative process of
the tubercle also corresponds more to the hyaline type. Tubercle bacilli are always
present in large numbers in the fresh tubercles as well as in the cheesy nodules
and in the contents of the involved joints. They are readily demonstrated by means
of the usual methods of staining (See p. 569).
614 Tuberculosis.

Symptoms. Tuberculosis of the internal organs results
in gradual emaciation without attendant characteristic symp-
toms of specific disease. This condition, which is readily
recognized by palpation of the pectoral muscles, progresses in
spite of the good appetite that exists in the beginning until
the symptoms of anemia, evidenced by the paleness of the
mucous membranes, wattles and comb, become more and more
pronounced. At a later stage the appetite is affected, the
animals become listless, are easily captured, ete. Finally the
onset of diarrhea leads to complete exhaustion.

The symptoms of tuberculosis of the bones and joints
are more characteristic. The tarsal, knee and shoulder articula-
tions are most frequently affected. They begin to swell
gradually and palpation reveals enlargement of the epiphyses.
Pain and attendant disturbance of function (lameness, and
drooping of the affected wing) is slight at first, but soon be-
comes more conspicuous if for no other than ‘mechanical
reasons. Occasionally the articular swelling breaks open and
discharges a cheesy secretion filled with bacilli.

In rare instances small painless nodules develop in the
subcutaneous connective tissue. At a later stage they may
ulcerate. Finally, large caseous masses may collect in the
cella infraorbitalis, causing enormous distension of the same
and attendant pressure atrophy of the eye ball.

Tuberculosis of the internal organs can hardly be differentiated
from chronic disorders of nutrition due to other causes, particularly
worms. As a rule the disease is suspected only upon the ground of
the apparent infectious nature of the malady. Tuberculosis of the
joints is very similar in appearance to rheumatic arthritis or to that
form of arthritis which is met with in chronic chicken cholera. These
three diseases, however, may readily be differentiated by microscopic
examination of the contents of the joints which are easily procured
in sufficient quantity by making an incision into the tumefactions.

The body temperature has no value from a diagnostic point of
view since it does not vary beyond the normal limits (39.5° to 41.5° C.)
even in tuberculous animals (Klimmer & Saalbeck).

The tuberculin test is also not applicable because tuberculous fowls
will not give specific reactions to tuberculin, no matter whether this
is prepared from avian or mammalian bacilli or whether injected sub-
cutaneously, dropped into the conjunctival sac or applied to the scarified
skin (Babes, Weber & Bofinger, Moore, Saalbeck).

Prevention. Since medicinal treatment is practically out
of the question and segregation of the diseased animals from
the healthy ones is hardly possible on account of the insidious
character of the disease the most practical and economical
method of procedure is to kill the entire flock as soon as the
disease is recognized. All animals in good flesh may be utilized
as food. The diseased products and organs as well as the
entire carcasses of badly affected animals should of course
Tubereulcsis of Parrots. 615

be destroyed. The poultry yard as well as the houses, coops,
etc., should be thoroughly cleaned and disinfected before new
stock is acquired. ~

Literature. Roloff, Mag., 1868. XXXIV. 190. — Paulicki, Ibid. 1872.
XXXVITI. — Zuern, Krankh. d. Gefluegels. Weimar 1882:\197. — Ribbert, D. m.
W., 1883. 413. — Maffueci, Z. f. Hyg., 1892. XI. 445. — Wolffhuegel, Monh., 1904.
XV. 457. — Weber & Bofinger, Tbk.-Arb. d. G.-A., 1904. 1, H. 112 (Lit). —
Schern, Z. f. Tm., 1905. IX. 419 (Lit.). — M. Koch & Rabinowitsch,. V. A., 1907.
CXC, Beiheft (Lit.). — Teetz, B. t. W., 1906. 244. — Moore, Z. f. Infkrkh., 1906.
I. 333, — Volkmann, W. f. Tk., 1908. LIL. Nr. 20. — O. Bang, Cbl. £.' Bakt.,
1908. XLVI. 461. — Saalbeck, Diss. Leipzig 1909 (Lit.). ae

Tuberculosis of Parrots. Since Cadiot & Roger found tubercle
bacilli in the organs of a parrot that were pathogenic for guinea pigs,
others also have shown (the authors in five cases) that tuberéulosis
of these animals (though they are susceptible also to avian tuberculosis)
is, in most cases, caused by the human type of tubercle bacillus. These
reports confirm the view entertained long before that parrots become
infected in the dwellings of consumptive persons, and conversely justify
the assumption that persons may be infected by tuberculous parrots.
Infection, however, usually proceeds from injuries in the skin ‘of the
head or of the mucous membrane of the mouth cavity; primary affection
of the lungs is much less frequent and intestinal infection is: only
occasionally observed. The bones or joints may sometimes become in-
volved through metastasis.

After M. Koch & Rabinowitsch demonstrated by experimental
infection with pure cultures that parrots are susceptible also to the
virus of avian tuberculosis, Weber, Titze & Weidanz showed, by more
extensive experiments, that parrots could be fatally infected with in-
travenous injections of 0.001 gm. of pure culture of any of the three
types of tubercle bacilli. A single ingestion of human or‘ bovine bacilli
resulted in infection just as readily while it required from 10 to 13
ingestions of avian tubercle bacilli to produce fatal generalized tuber-
culosis. ,

Tuberculosis of parrots is a comparatively common disease. Thus Froehner
found that 170 of the 700 parrots treated at the Berlin Klinik and Poliklinik from
1886 to 1894 were tuberculous, i. e. 24.3%. :

Tuberculosis of the skin and subcutaneous connective tissue is mani-
fested by the appearance of globular or oval, rather firm nodules and
tumors with smooth surface, ranging in size from that of a pin head
to a hen’s egg. In the course of time these become caseous and the
overlying epithelium becomes horny and~ forms thick scabby layers,
sometimes growing into structures several centimeters long (Eberlein).
Some of these nodules, especially those of the palpebral. conjunctiva,
are soft and bleed upon the slightest provocation. hen. they develop
near the angle of the mouth they interfere with the movements of the
bill, while those in the region of the angles of the eyes-‘may push aside
or dislocate the eyeball; those developing on the top of the head may
perforate the skull (Cadiot). If these nodules are broken by scratching,
ulcers covered with cheesy masses form in their place.

Similar nodules, though usually smaller and of softer consistency,
are comparatively frequent in the mouth cavity, especially on the
tongue, near the frenum, on the hard palate, more rarely also in
the nasal cavities. According to their seat or their size they may in-
616 Tuberculosis.

terfere with the acts of deglutition, respiration or the movements of
the tongue (speech) (!).

The symptoms of tuberculosis of the bones and joints are similar
to those observed in other birds and an affection of the internal organs
is manifested only by emaciation and anemia.

The diagnosis of the disease which offers no particular difficulties
is definitely confirmed by demonstration of the tubercle bacilli in the
nodules and in the secretions of the ulcers in which they are usually
quite numerous.

When the affection is localized on the skin or in the anterior por-
tion of the mouth cavity, it is possible, in a portion of the cases, to
bring about definite recovery by extirpating the swellings. Not in-
frequently however relapses occur and the surgical treatment must
be repeated. Cauterization of the ulcers is seldom followed by satis-
factory results. :

Canary birds are also susceptible to infection with mammalian tubercle
bacilli; while M. Koch & Rabinowitsch obtained positive results in two instances
by feeding human tubercle bacilli, Weber, Titze & Weidanz succeeded only with
bovine and avian bacilli in their attempts to infect canary birds per os. The first
named investigators succeeded also in obtaining cultures of the human type of
tubercle bacillus from two birds of prey and from one sparrow out of 118 birds
of different species furnished by a zoological garden.

Literature. Cadiot, Gilbert & Roger, Soc. biol., 1890. 542. — Cadiot, Bull.,
1894. 197; 1898. 254. — Eberlein, Monh., 1894, V. 248. — M. Koch & Rabinowitsch
V.-A., 1907. CXC, Beiheft (Lit.). — Weber, Titze & Weidanz, Tb.-Arb. d. G.-A,,
1908. 9. H. (Lit.).

(c) Etiological Relations Between Human and Animal
Tuberculosis.

The practical similarity of anatomical changes produced
in rabbits and guinea pigs with tuberculous material ob-
tained from consumptive human beings or from eattle affected
with pearl disease in itself points to the close relationship of
these two diseases. The correctness of this view has been
emphasized by the successful production of lesions very similar
to those of human tuberculosis by feeding tuberculous organs
of man to cattle, typical pearl disease having indeed thus been
produced (Klebs, Bollinger), and further, by the fact that
the feeding of tuberculous material from cattle will produce
tuberculosis in other animals, horses, swine, dogs, cats
(Chauveau, Guenther & Harms, Gerlach, Klebs, Bollinger,
Toussaint, Puetz, etc.). After Koch had demonstrated the
presence of morphologically similar bacilli in the tuberculous
organs of man, monkeys, cattle, horses, swine, goats, sheep
and fowls, as well as in rabbits and guinea pigs, and after he
had failed to recognize any material differences in their cultural
or pathogenic characteristics, the etiological identity of the
tuberculous affections of the various animal species was
generally accepted as a demonstrated fact. More recently,
however, the correctness of this view has been questioned from
several sources.

Tuberculosis of Mammals and Fowls, The continued and
Tuberculosis of Mammals and Fowls. 617

persistent investigation and study of Koch’s tubercle bacillus
has at least cast doubt upon the supposed relationship of
mammalian and avian tuberculosis. It has, for instance, been
found that the bacilli causing these two morbid processes
possess marked cultural differences, that the diseased organs
of tuberculous mammals, as well as the cultures of bacilli
obtained from them (with rare exceptions) possess only slight
pathogenicity for fowls, and that, on the other hand, the bacilli
of avian tuberculosis have a different effect upon mammals than
the bacilli of mammalian tuberculosis.

On account of these facts some authors (Rivolta, Maffucci,
Strauss & Gamaleia, more recently also Weber & Bofinger)
regard these two forms of bacilli as distinct species and con-
sequently also look upon mammalian and avian tuberculosis
as two etiologically distinct diseases. On the other hand there
is weighty evidence pointing to a close relationship between
these two forms of bacilli.

In this connection the cultural differences between the two
organisms are of slight significance for the reason that cultures of
’ hacilli from the lesions of tuberculous fowls frequently resemble those
obtained from mammals. Thus Weber & Bofinger occasionally obtained
dry crumpled cultures from fowls, a culture that had been kept up
for years could not be distinguished from cultures of human bacilli,
but after a single passage through a fowl or a mouse this charac-
teristic was lost. And again O. Bang has observed many strains of
avian bacilli, grown on glycerin potato medium, to produce dry, uneven
masses, while one bovine strain observed by this author, when cultivated
on glycerin serum resembled an avian culture in appearance. In
addition to these observations it is known that some avian strains
when cultivated on bouillon can hardly be differentiated from bovine
varieties. Among 95 strains obtained from 70 different birds Rabino-
witsch found occasional strains that exhibited characteristics of growth,
on solid as well as on liquid media, very similar to those of mammalian
bacilli. Three of these strains, however, belonged undoubtedly to that
group (pathogenic for guinea pigs, nonpathogenic for fowls). Finally,
it is possible, by means of special methods, to obliterate these differences.
Thus Fischel obtained a material by cultivating human tubercle bacilli
on egg medium and on boracic-acid-glycerin-agar that would produce
moist smeary cultures on the ordinary media. Nocard cultivated human
tubercle bacilli in collodion capsules filled with bouillon which he
imbedded in the abdominal cavity of fowls. After several months these
capsules were removed, the bacilli transferred to solid culture media
and cultures produced that resembled avian cultures in every respect.

- The marked differences in the pathogenicity of the two forms of
bacilli are of vastly greater importance. It is, for instance, impossible
to infect any of the various species of fowls by feeding with organs
of tuberculous mammals. Straus and Wuertz have fed chickens for
months with tuberculous organs and sputum of tuberculous persons,
and although some of them received as much as 58 kg. of such material
they remained healthy. Similarly negative results were obtained by
Esser, Peroncito, Nocard and others. Since, however, tuberculosis
among fowls frequently occurred under circumstances pointing to in-
618 - Tuberculosis...
w 4 b&b O a

fection with sputum’ of tuberculous persons (Johne,* Nocard, Roemer,
Darmagnac, Siegel and others) and since Zschokke cultivated a bacillus
from tuberculous fowls that had all the cultural characteristics of
the bacillus of mammalian tuberculosis, the possibility that fowls may
occasionally become infected with mammalian tuberculosis does not
seem excluded.

Intravenous and intraperitoneal inoculation of cultures: of mam-
malian tubercle bacilli does not, as a rule, produce tuberculosis in
fowls. Contrary to the numerous negative results of experimental
inoculations Cadiot, Gilbert & Roger have obtained positive results
in 10% in all cases where they simultaneously fed tuberculous organs
or injected horse serum into the tissues of the fowls. Furthermore,
Fischel obtained positive results with intraocular, and Courmont &
Dor by subcutaneous administration. Finally, O. Bang produced fatal
tuberculosis in fowls in three cases by intravenous inoculation and
in one case by subcutaneous inoculation of bovine strains of bacilli.
He found also that 12 out of 18 strains of bovine bacilli were more
or less virulent for fowls.

Mature mammals, with the exception of-rabbits, guinea pigs and
mice, are either only slightly susceptible or entirely immune to avian
tubercle bacilli. Nocard, however, found bacilli in several cases of
abdominal tuberculosis of horses that resembled avian tubercle bacilli
in their cultural characteristics as well as in their pathogenicity while
O. Bang demonstrated that very young mammals (colts, ‘calves, kids)
are very susceptible to the avian virus, becoming affected’ with acute
tuberculosis after intestinal infection (see p. 608).. Mohler & Washburn
also succeeded in infecting swine with material obtained directly from
chickens. Bacilli of the avian type have also been found in the sputum
of tuberculous persons (Straus, Nocard, Kruse, Loewenstein; Rabino-
‘witsch obtained cultures from a man that died from generalized tuber-
culosis) also in apes (Fischel, Rabinowitsch), in the tuberculous lungs
of cattle (Sanfelice, Kruse, Pansini) as well as in the caseous lymph
glands of a pig (Weber & Bofinger), while Karlinski produced tuber-
culosis of the tracheal glands, diaphragm and spleen of a goat after
intravenous injection of avian material. On the other hand, Hueppe
cultivated bacilli identical with human bacilli from a pheasant and
from a fowl. Tuberculosis of parrots, however, is in most instances
caused by human tubercle bacilli.

The specific virulence of avian tubercle bacilli is rather constant
and is not easily altered. Thus Weber & Bofinger were unable to
increase by passage through guinea pigs the virulence: of. bacilli from
fowls sufficiently to approach that of mammalian bacilli. “Similarly,
the attempts of Kossel, Weber & Heuss to transform avian tubercle
bacilli into mammalian bacilli by continued cultivation or growth in
the bodies of mammals were unsuccessful. On the other hard, how-
ever, Cadiot, Gilbert & Dor produced a virus by oft repeated. passage
of avian bacilli through guinea pigs that would cause lesions ‘very
similar to those of human tuberculosis and was also virulent for dogs
and no longer pathogenic for fowls. M. Koch & Rabinowitsch also
succeeded, by cultivation continued for years, .in giving an avian strain
the appearance of human bacilli. Nocard succeeded by. three or-four
passages of human tubercle bacilli through chickens in transforming
them into a strain that would produce disease in fowls. These results
have recently been confirmed by careful experiments conducted by
O. Bang who succeeded in ‘transforming bacilli.of the human and

a ae
Tuberculosis of Man and of Animals. 619

bovine types into the avian type. This was particularly evident when
a fowl passage was preceded and followed by a guinea pig passage.
Bang observed’ also that a bovine strain which had lost its virulence
after long, continued or oft repeated passage through fowls, regained
its virulence by passage through goats.

These positive results of experimental investigations, even
though not very numerous, cause doubts to arise in regard to
the supposed specific differences between the bacilli of mam-
malian and avian tuberculosis. If we consider in connection
with the foregoing that Héricourt & Richet immunized monkeys
and dogs against human tuberculosis with avian virus and
that MacFadyean and Behring immunized cattle against bovine
tuberculosis by the same means, and further that effective
tuberculin may be prepared from avian bacilli (according to
Maffucci cattle and sheep will react to human tuberculin, no
matter whether they were infected in the first place with bovine
or with avian bacilli), that mammalian and avian bacilli ex-
hibit reciprocal agglutination characteristics, and finally that
it is possible to produce, experimentally, avian tuberculosis
in mammals and mammalian tuberculosis in birds, the conclu-
sion that the avian bacillus is merely a variety of Koch’s
bacillus resulting from prolonged growth for numberless
generations in the bodies of fowls is probably justified. Ac-
cordingly, avian tuberculosis might be looked upon as bearing
a similar relation to mammalian tuberculosis as human tuber-
culosis bears to bovine tuberculosis.

Tuberculosis of Man and Tuberculosis of Mammals. These
*two diseases have in recent times been looked upon as etiolog-
ically identical notwithstanding the fact that conspicuous dif-
ferences have been observed to exist in the pathogenicity of
strains of different origins. Though Puetz, as early as 1882,
‘doubted the identity of human and bovine tuberculosis because
he was unsuccessful in infecting calves either by feeding or
with intravenous or subcutaneous injections of human..tuber-
culous material and Semmer (1893) expressed the opinion that
pearl disease and miliary tuberculosis of man were not identical
morbid processes, later authors assumed upon the basis of
occasional negative results in the experimental transmission
of the two diseases to other animals that this difference must
be due to modifications in the virulence of an essentially
identical virus and to the variable relative susceptibility of
the different species of animals.

Th. Smith had observed certain morphological and cultural differ-
ences between human and bovine bacilli and demonstrated that the
bacillus of pearl disease had a considerably greater and more constant
pathogenic action on experiment animals than that of human tuber-
culosis. He believed, therefore, that the bacillus of bovine tuberculosis
occupied a unique position among the various mammalian bacilli and
620 Tuberculosis.

that human beings were only slightly susceptible to the contagion
of pearl disease; in view of all this, however, he did not regard the
possibility of human infection with bovine bacilli (especially in children
ingesting large quantities of bacilli with milk from cows with tuber-
culosis of the udder) as out of the question. Even before Theobald
Smith, Sidney Martin, Frothingham and Dinwiddie had made similar
observations in regard to the variability in the pathogenic action of
these two types of bacilli, although Frothingham observed rather ex-
tensive morbid changes in the peritoneum and in the mesenteric lymph
glands of calves that were infected with bacilli from a tuberculous
child while Dinwiddie, on the other hand, found that in one case material
obtained from a tuberculous cow proved avirulent for a calf. Accord-
ing to Dinwiddie the differences exhibited by the two forms of bacilli
manifest themselves only in horses, cattle, dogs and cats, while the
human as well as the bovine types of bacillus produce generalized
tuberculosis in swine. Finally Vagedes succeeded in procuring human
cultures that had pathogenic properties very similar to those obtained
from cattle. ,

The question of identity or non-identity attracted renewed
attention when Robert Koch announced it at the London
Tuberculosis Congress in 1901 as his emphatic view ‘‘that
human tuberculosis differed from bovine tuberculosis;’’ that
the former was not transmissible to cattle and ‘‘that accord-
ingly it did not seem necessary to take any measures whatever
for the protection of milk, butter and cheese from tuberculous
cattle against infection with the germs of this disease.’’

Koch based this view on the results of infection experiments that he had con-
ducted with the co-operation of Schuetz. 19 calves were treated with the pulmonary
discharges of tuberculous persons and with cultures of human tubercle bacilli which
material was administered with the food, with the inhaled air, or the cultures were-
injected intravenously, subcutaneously or intraperitoneally; all of the calves
remained perfectly healthy, increased steadily in weight and, at post mortem
examination several months later only caseous abscesses could be detected at the
point of inoculation. On the other hand, six calves given subcutaneous, intra-
peritoneal or intravenous injections of bovine cultures of bacilli developed fever
and became very sick. At post-morten examination tuberculous changes were
found not only at the point of inoculation and in the regional lymph glands but
there was extensive tuberculosis of the internal organs, especially in the lungs and
spleen. Of six pigs that had been fed for 104 days with tuberculous sputum
mixed with the food, small scattered tuberculous nodules developed in the cervical
glands and in the lungs and mesenteric glands of two of the animals while the
remaining pigs remained unaffected. On the other hand, of six pigs that had
been fed for 70 days with cultures of bovine bacilli, all contracted extensive
lesions of tuberculosis. Subcutaneous, intraperitoneal and intravenous injections of
human tubercle bacilli proved harmless in 5 pigs while the 6th animal, which
received an intravenous injection, developed miliary tuberculosis of the lungs and
mediastinal glands. Two sheep were unaffected by subcutaneous injections of
cultures of human bacilli while one, receiving an intravenous injection, developed
slight tuberculous changes in the lymph glands of the lungs. On the other hand,
sheep treated in a similar manner with cultures of bovine bacilli became very
sick.

The large number of experimental animal inoculations that
have been made since Koch’s epoch making address, according
to which the bacillus of human tuberculosis as compared with
that of bovine tuberculosis is only slightly or not at all patho-
genic for cattle, as shown by the investigations of Koch &
Transmissibility of Human Tuberculosis. 621

Schuetz, have, in a general way, confirmed this assertion other-
wise, however they have not substantiated the claim for the
specific differences between the two forms of bacilli, but rather
that the difference in their biological characteristics was suffi-
cient, at most, to establish them as varieties or types of the
same species.

Transmissibility of Human Tuberculosis to Cattle. As a rule
human tubercle bacilli are harmless for cattle or they produce local
lesions only. In exceptional instances, however, they may produce
grave and even fatal disease.

_Thus Chauveau (1892) observed tuberculous foci in the intestinal mucous
membrane, in the mesenteric glands, in the pharynx and in the lungs, in three
cases following the alimentary administration of infected material from a human
lung; Schottelius observed the development of a caseous pneumonia as well as
tuberculous changes in the intestines, in the mesenteric glands and on the pleura
after the ingestion of tuberculous sputum, while in three out of five calves similarly
treated by Hamilton and McLaughlan Young, the cervical and mesenteric glands
were affected. Wolff observed typical pearl disease in a calf following the sub-
cutaneous injection of human virus, Fibiger and Jensen, general tubereulosis in two
ealves, Hamilton and MecLaughlan Young extensive tuberculous lesions in 7 out of 9
calves (in three the lungs also were affected and the spleen in one case); Stuur-
mann saw death follow. from generalized tuberculosis in a calf 56 days after
injection with a culture obtained from the tuberculous wife of a peasant and Eber
observed the same result from miliary tuberculosis 37 days after infection. Death
in calves following intraperitoneal infection has been observed by Prettner as
oceurring on the 46th day, by Ravenel on the 27th, by Orth on the 26th day; in
a second case reported by Prettner and in one case observed by each of Delépine,
Fibiger & Jensen, extensive tuberculosis of the abdominal organs was noted; in
one case of Eber’s there was typical pearl disease of the pleura and peritoneum
(Klebs and Bollinger each produced typical pearl disease in a cow before this time
by intraperitoneal injection of tuberculous sputum and Bollinger, in addition, pro-
duced the same condition in a goat by intraperitoneal injection of material from
a cheesy tuberculous lymph from a man). In one ease each reported by Prettner
and DeJong and in two cases reported by Ravenel intravenous infection caused
death in from 17 to 37 days as a result of generalized tuberculosis. Hamilton and
McLaughlan Young succeeded in producing extensive tuberculous pleuro-pneumonia
in two calves by inhalation infection with human tuberculous material. A calf
infected by Stuurmann by the intrapulmonary method died on the 31st day while
Thomassen observed development of tuberculosis of the cervical and pectoral glands
and of the lungs following intraocular administration. j

The results of very extensive investigations along these lines that
were conducted by special commissions appointed by the governments
of Germany, England and Sweden afforded particular information
upon the biologie and pathogenic peculiarities of those forms of tubercle
bacilli which occur in man.

- According to investigations by Kossel, Weber & Heuss of the
German Imperial Board of Health two types of mammalian tubercle
bacilli could be obtained from the organs.of tuberculous persons. These
types, aside from their morphological differences (see p. 504) also
possessed individual peculiarities with respect to this virulence in
rabbits and cattle, the human type, which was less virulent for rabbits,
-did not produce progressive lesions in cattle, while the bovine type
exhibited a pronounced pathogenic character in both rabbits and in
cattle, causing generalized tuberculosis in both species of animals.

Among 67 cases of tuberculosis in human beings the human type of bacillus
alone could be cultivated from 56, the bovine type alone in 9 cases and both of
these types in two cases. The 9 cases in which the bovine type alone could be
622 Tuberculosis.

demonstrated were all children under eight years of age, three of them having
generalized miliary tuberculosis. Among 12 cases in children under 10 years of
age five were due to infection by the bacillus of the human type alone, six to
infection by bacilli of the bovine type alone and one to infection by bacilli of
both types. (Up to April, 1907, pure cultures of the human type of bacillus were
obtained from 117 out of 138 cases of human tuberculosis [Steffenhagen]). The
bacillus of the bovine type was found exclusively in 11 tuberculous cattle, in seven
tuberculous swine and in one tuberculous sheep.

From the above noted results the authors draw the conclusion
that in those rare cases where tuberculous human beings can discharge
bovine bacilli they may be the means of infecting cattle and that, on
the other hand, infection of human beings is caused primarily from
man to man, but that the possibility must be admitted that human
beings may be infected with meat or milk from. tuberculous cattle
(and swine). They further admit, or assume, that tuberculous cattle
are always infected with bacilli of the bovine type only and that swine
and other domestic animals while generally infected with this type may
occasionally also be infected with bacilli of the human type.

The results of the experiments above referred to were augmented
by Oehlecker who obtained 45 pure cultures of human bacilli and
5 pure cultures of bovine bacilli from 50 different surgical cases of
tuberéulosis.

The British Commission (Foster, Woodhead, Martin, McFadyean
& Boyce) arrived at similar results in so far as they found pure
cultures of tubercle bacilli obtained from human beings to possess
different degrees of virulence while in pure cultures obtained from
cattle this variation was not as pronounced.

Pure cultures obtained from 60 cases of human tuberculosis could
be classified into two general groups. Group I included 14 strains
which agreed in that they did not grow readily on artificial culture
media (dysgonic strains) and that all of them produced generalized
and progressive (though not always equally pronounced) tuberculosis
in cattle as well as in other animals. Group II included 40 strains
that were characterized by their ready growth on artificial media
(eugonic strains) and by the production, in cattle, of local disease
only or, at most, isolated tuberculous foci of a retrogressive character
and by. not producing generalized tuberculosis even when administered
in large amounts, nor being very virulent even for rabbits. Finally,
this commission recognized six strains which, on account of the variable
character of their virulence, could not be classed in either of these
groups.

In 30 instances cultures which agreed in their cultural and patho-
genic characteristics with the strains of Group I were found in cattle.
All of these had a decided pathogenic action not only for cattle, hut
also for other mammals, including monkeys.

Among 60 cases of human tuberculosis there were 28 in which the clinical
symptoms indicated that infection occurred through the intestinal tract and of
these the bacillus of the Group I type was found in 13; of 9 cases of tuberculosis
of the cervical glands 3 belonged to this group and of 19 cases of tubereulosis of
the peritoneum 10 were caused by the bacillus of Group I.

In view of the existence of intermediary forms as well as the
variable virulence even of strains classified in each group the com-
mission has not found it advisable to recognize two distinct types of
bacilli. Nevertheless Cobbett called attention to the fact that it is
possible, even with only limited experience, to recognize in advance
| Pathogenic Hotton of Bovine Bacilli. 623

eee

the virulence: of a-given strain in its first genération by its cultural
characteristics:alone_» In_its summary the report of the commission lays
stress upon the fact: that the bacillus of Group I differs from that
of Group II not only in its lesser degree of virulence, but algo in
its manner of growth and that, in view of this two-fold difference
it seems impossible to believe that human tuberculosis (II) is one and
the same disease as bovine tuberculosis (I). Finally, the practical
conclusion is expressed that a certain number of cases of tuberculosis
of man and especially of children is the direct result of infection by
the bacillus of bovine tuberculosis.

Of other investigations made along these lines the following may also be
mentioned.

Hamilton repeated the experiments of Koch & Schuetz, using the same num-
‘per of cattle and was able to demonstrate tuberculous lesions in 15 animals infected
_with human material. Dammann & Muessemeier did not succeed in making calves
“very sick by feeding sputum and pure cultures of human bacilli but they succeeded
in producing progressive, though in most cases only slight tuberculosis in 13
calves by the subcutaneous administration of 8 cultures out of a total of 18 pre-
pared from every possible affected organ. One strain killed a calf in 28 days
and another, after intravenous injection, in 17 days. These authors could not
recognize two distinct and separable types with transition forms of bacilli and
believe rather’ that the different strains are merely varieties of the same species
that have adapted themselves to conditions existing in the bodies of each species of
animal.

Fibiger & Jensen investigated seven cases of unequivocal primary tuber-
eulosis of the pee. canal of;children from 4 months to 12 years of age. They
found five cases in which the bacilli possessed avery pronounced ‘virulence for
cattle (in three cases the children in question had for some time consumed raw
milk from uninspected dairies). °Other authors -(Schweinitz & Schroeder, Westen-
hoeffer, Ligniéres, Schweinitz, Mohler, Rabinowitseh) also have found bacilli. from.
tuberculous children (especially from primary » ‘intestinal tuberculosis) highly
virulent for cattle. Thus Mohler & Washburn examined twelve strains from man,
one from monkeys, four from cattle, two from dogs and one -from’ sheep - and
found that bacilli virulent for cattle may and do, occur in human. beings.. They
were of the opinion, however, that two types could be recognized although there
were intermediate transition forms and that the individual types were not neces-
sarily confined to definite ‘species of animals. Finally, Behring maintains that
there are human strains of tubercle bacilli thattta4re more virulent than material
obtained directly from cattle and Dorset, also, found many strains of bacilli of
human tuberculosis that were just as virulent as those of bovine tuberculosis.

Eber tested: the virulence of the bacilli in seven cases of intestinal tuber-
culosis of children and’ found: only two cases in which they were only shghtly or
not at all virulent, two cases in which the-virulence was of average intensity and
three cases in “which the bacilli were highly virulent for cattle. In later investiga-
tions only two out of 8 cases of human tuberculosis proved non-virulent for cattle
while repeated attempts with the remaining 6 strains were uniformly successful in
producing serious and in some cases fatal tuberculosis in cattle (especially after
combined. subcutaneous and‘ intraperitoneal administration of the virus). Two
strains exhibited only a medium degree of virulence for cattle but after being
transferred -to another. animag they became highly virulent., Since both strains
showed atypical. characteristics from a morphological point of view also, as well
as in their action on rabbits, Eber is inclined’ to look upon them as transition
forms ‘which seem to constitute a connecting link between the two extreme types
and make the gradual transition from one form to the other seem possible.

.

Pathogenic Action of Bovine Tubercle Bacilli on Cattle. The
inoculation of the pathologic products of tuberculous cattle or cultures
of bovine tubercle bacilli is usually followed by the development of
a severe tuberculous affection, which frequently ends fatally within
4 to 8 weeks. Cases are observed, however, in which local lesions
only result.

Thus Arloing | was able, in some cases, to produce only local changes
at the pomt of inoculation or in the regional lymph glands by ‘sub-
624 Tuberculosis.

cutaneous injection of bovine bacilli. In the investigations of the
Imperial Board of Health, 1 out of 11 strains of bovine bacilli had
a similar mild action (injected intravenously, however, it was quite
virulent), while Dammann & Muessemeier found the injection of 5 eg.
of a culture of bacilli into a calf absolutely ineffective. According
‘to the report of the British Commission the subcutaneous injection
of bovine bacilli occasionally produces only local changes, which, when
they become more general (as may sometimes occur) are limited to
oceasional, small foci in internal organs usually in an arrested stage
of development. Between the two extremes of rapidly progressive
generalized tuberculosis and of well marked regressive forms, every
possible intermediate form may be observed.

The feeding of bovine virus frequently fails to result in severe
disease. Thus Nocard failed to get positive results in four attempts,
Hutyra failed to produce serious infection of calves six months of
age by feeding cultures of bacilli, and the British Commission observed
tuberculous changes only in the immediately adjacent regions of the
intestinal tract following alimentary administration of milk containing
tubercle bacilli. Schweinitz, Schroeder, Nocard and Eber have obtained
bacilli from cattle that were only slightly virulent for calves, while
Preisz produced in one calf tuberculous changes in one peribronchial
lymph gland only and failed to. cause any observable changes whatever
in a second calf, both of which received intravenous injections of
a mixture of six different strains of bovine bacilli (see also experiments
of Kossel, Weber & Heuss, p. 508).

Pathogenic Action of the Two Types of Tubercle Bacilli on
Other Animals. More recent investigations have, above all, confirmed
the observations of the past that the human type of tubercle bacillus
is decidedly less virulent for rabbits and guinea pigs than the bovine
type, and that it is frequently impossible to infect rabbits at all with
bacilli of the former type (Smith, Ravenel, Kossel, Weber & Heuss).
Similar observations have been made also with regard to sheep and
goats (Dinwiddie, Ravenel, Beck) ; Karlinski, however, successfully in-
fected pregnant goats with intravenous and intramammary injections,
and kids by alimentary administration of human bacilli while Dammann
& Muessemeier observed slight tuberculosis of the lymph glands of
lambs following feeding of human material and in one ease fatal tuber-
culosis followed within 44 days after alimentary administration of
0.1 gm. of bovine culture.

In regard to the susceptibility of other species of animals the
results of experiments have varied. While, for instancé, according
to Dinwiddie and Gratia the two forms of bacilli possess much the
same action toward horses, swine, dogs and cats, Ravenel noted the
same differences that are mentioned above. Aside from the fact that
bovine bacilli are always present in the organs of tuberculous swine
the virulence. of this type of bacilli is abundantly demonstrated by
the rapid and certain infection of large herds of swine that have
been fed on skim milk. On the other hand Dean & Todd infected
swine by feeding tuberculous pus from man and Dammann. saw a
pig die within 42 days after subcutaneous infection with a culture of
human tubercle bacilli. In the feeding experiments of Kossel, Weber
& Heuss, the result of infection was always a chronic general tuber-
culosis of slow evolution. Th. Smith and Ravenel produced cultures
of typical bovine bacilli from swine, the same from one horse and
an intermediate form from a second horse.
Susceptibility of Monkeys. 625

The susceptibility of dogs to the virus of human _ tuberculosis
was demonstrated by the experiments of Tappeiner, Weichselbaum,
Leudet & Petit and F. Arloing who were almost invariably successful
in infecting dogs by the alimentary administration, and occasionally
also by inhalation of sputum or pure cultures of human bacilli. On
the other hand Titze & Weidanz found that dogs generally had a
considerable resistance toward infection with any kind of tuberculous
material, but that this could be overcome by administering excessive
doses of both types of the bacilli. Th. Smith obtained cultures from
three cats that agreed morphologically in every respect with bovine
bacilli, but only one of them was moderately virulent for cattle.

Susceptibility of Monkeys to the Virus of Bovine Tuberculosis.
Experiments relative to this question, so important because the results
permit conclusions in regard to the susceptibility of man, have been
rather uniform and almost entirely positive in their results. Years
ago Imbach successfully infected monkeys by feeding milk from tuber-
culous cattle. Of the more recent investigations, besides those of
Gruenbaum, Salmon, DeJong, Cipollino and others, the following in
particular are worthy of mention: In two series of experiments Nocard
fed four monkeys with bovine bacilli and two with human bacilli; all
of the six animals became affected with a severe form of generalized
tuberculosis, but the infections with bovine bacilli produced a more
rapid development of disease (Schweinitz & Schroeder observed a
similar difference in the pathogenic action of the two types of bacilli).
Gratia fed four apes with the organs of tuberculous cattle, four more
received the tuberculous organs of guinea pigs infected with bovine
tuberculosis, two were fed on organs from similarly infected monkeys
and three were fed with milk from cows with tuberculous udders;
of these 13 monkeys 12 died from generalized tuberculosis while one
(from the first group) only contracted an intestinal catarrh. In
MacFadyean’s experiments five monkeys that were fed on organs from
tuberculous human beings died between the 33d and 65th days, three
others that had been fed on sputum died between the 30th and the
65th days (all from tuberculcsis) while the feeding of infected material
from tuberculous cows resulted in death from generalized tuberculosis
in a similar or in a still shorter period of time. Dungern & Smith
inoculated three gibbons with human, six with bovine cultures (each
0.01 gm.) and another lot of three received repeated decigram doses
of cultures of both types; all of these animals became ill with the
only difference that those receiving the bovine virus had intestinal
ulcers and caseous mesenteric glands, while those receiving the human
virus had a solitary caseous focus in one lung and caseation of the
corresponding bronchial gland. The British Commission tested the
virulence of bovine bacilli on over one hundred monkeys and all animals,
whether they received subcutaneous or intravenous injections, or were
fed upon cultures (in some instances only 0.001 gm.) contracted severe
generalized tuberculosis. Experiments with anthropoid apes (chim-
panzees) also gave positive results and Eastwood is of the opinion
that their susceptibility to infection with tuberculosis is materially
greater than that of cattle. Rabinowitsch found on examination of
33 monkeys, most of them affected with human tuberculosis, while only
a relatively small number (3) had bovine bacilli in the lesions, In
one ease both forms were associated (one an avian culture) and in
a few other cases there were transition forms of bacilli, Kraus &

Vol. 1—40
626 Tuberculosis.

Grosz noted a considerable difference in the two types after infection
of the scarified skin, the human type producing changes limited to
the area of inoculation and showing no tendency to become destructive
while the bovine type resulted in the formation of local ulcers followed
by involvement of the regional lymph glands and later of the internal
organs also, as a rule, with fatal termination. (Cutaneous inoculation
with the typus gallinaceus resulted in very slight local changes only.)

Susceptibility of Man to Tuberculosis of Animals. Under ordinary
conditions this question is, of course, beyond the possibility of experi-
mental demonstration. Nevertheless, our literature, and especially that
of more recent date, contains numerous reports of observations that
seem to justify the assumption of such susceptibility without even
taking into consideration of numerous instances in which typical bovine
bacilli were found in the lesions of tuberculous human beings.

Tuberculous disease proceeding from injuries to the skin has
repeatedly been observed in persons who had the care of tuberculous
cattle or in veterinarians and meat inspectors who were employed
in inspecting or making post-mortem examinations of tuberculous
cattle. In the vast majority of cases (DeJong, Ravenel, Ostertag,
Jensen, Gratia, ete.) an injury of the finger or hand under such con-
ditions (in one instance injury of the face) resulted in the develop-
ment of a tuberculous nodule or ulcer at the point of infection, very
similar to those occurring from infection following injuries received
in the post-mortem examination of tuberculous human bodies. Occa-
sionally (Johne, Krause, Troje) these local affections have been followed
by swelling of the lymph glands of the elbows and axillae. In a case
reported by Weber the primary affection spread from the mucous
membrane of the gums to the tongue and the submaxillary gland.
Lassar calls attention to the fact that dermatitis verrucosa cutis is *
a particularly frequent occurrence among persons employed in slaughter
houses, having himself observed 7 cases among 365 persons examined,
while otherwise the rate of morbidity is only 0.083%. In several cases
repeated applications of milk to the face resulted in dermal tuberculosis
(Grothau, Priester, Leloir, Salmon), while in one case 60 cold abscesses
developed on various portions of the body following an injury received
during milking. In this case there was also tuberculosis of the iris
which resulted in destruction of the eyeball (Coppez). Infections
of this character that have their origin in wounds of the articulations
are particularly dangerous and infections of finger articulations have
been observed to result in death from consumption (Pfeifer, Hartzell,
Salmon, Rich).

On the other hand the experiments of an unknown physician are
worthy of mention, who treated persons affected with carcinoma with
cultures of bovine bacilli injected subcutaneously, with no observable
injurious results (Baumgarten). F. Klemperer, in experiments per-
formed on himself and on five tuberculous persons by repeated sub-
cutaneous injections of 0.25 ce. of an emulsion containing many ‘bovine
bacilli, observed only local inflammatory symptoms but in no case
tuberculous lesions, while the injected bovine bacilli disappeared from
the tissues in a short time. Spengler also injected himself with 14 mg.
of a bovine culture (subcutaneously) which resulted in an abscess that
broke after 34 days; suppuration continued for 8 months and was
sometimes quite profuse, but the lesion remained localized and the
regional lymph glands remained free.
Susceptibility of Man. 627

In general, bovine bacilli seem to have little tendency to spread
in the human body, usually causing local disease at the point of in-
fection and the neighboring tissues (mesenteric and cervical glands),
but in some cases the disease may become generalized.

In regard to the frequency of primary intestinal infection and
its relation to the ingestion of tuberculous milk, reliable data have
as yet not accumulated in sufficient quantity. In the past too little
attention has been paid to this form of disease and besides, there is
no definite agreement as to the exact characteristics of primary in-
testinal tuberculous disease. While, for instance, some authors recognize
only primary intestinal ulcers as such, others, and probably correctly
so, regard the primary affection of the mesenteric glands with intact
intestinal mucous membrane also as such.. According to modern views
in regard to the pathogenesis of tuberculosis (see p. 526) many cases
of primary tuberculosis of the thoracic and cervical glands as well
as scrofulosis must be looked upon as the result of primary intestinal
infection. The variable conceptions of this question is a sufficient
explanation of the conflicting statistical reports. While, for example,
Koch regarded primary intestinal infection (intestinal ulcers) as very
rare, and Baginsky noted only 10 such cases in the course of five
years in the Charité Hospital in the city of Berlin, Heller reports
37.8% of primary intestinal infection in post-mortem examinations
of tuberculous children in Kiel; Hueppe 25 to 35% in Prague; Council-
man 37.1% in Boston; Wagener, Eder and Ipsen in Kiel, Berlin and
Copenhagen, report 44 cases in 289 bodies of children examined. Ac-
cording to Ashby and Woodhead 10% of children that die of tuberculosis
show affection of the mesenteric glands.

Weber, in a statistical report authorized by the German Imperial
Board of . Health, ‘shows that among 360 persons, among them 151
children, who had consumed raw milk and dairy products from
69 cows affected with tuberculosis of the udder the presence of ‘‘pearl
disease’’ could be demonstrated in only two of the children (tuber-
culosis of the cervical glands). This result by no means harmonizes
with the fact that the numerous authenticated cases of tuberculosis
in human beings, demonstrated to be caused by bacilli of the bovine
type have in most instances been tuberculosis of the glands in children
that had evidently been infected by the milk of tuberculous cattle.

Constancy of Virulence of Tubercle Bacilli. The virulence of
the different types of bacilli seems to be very constant. It has always
been a difficult matter to change this artificially. Although according
to Orth, Hamilton, Karlinsky, Hamilton & M’Laughlan Young the
passage of human bacilli through cattle, according to v. Behring,
Karlinski, DeJong and Dammann & Muessemeier the passage through
goats and according to Mohler the passage through cats and rabbits
increases the virulence for cattle, experiments made by the German
Imperial Board of Health gave negative results throughout. Thus
Weber, in particular, was unsuccessful in increasing the virulence of
the human type of tubercle bacilli by five or eight consecutive passages
_ through goats, the passage of 15 strains through pigs for a period
extending over 300 days, and by four consecutive passages through
cattle for a period of 685 days. This type also fully retained its cultural
characteristics. Jancsé6 & Elfen in their experiments with 18 strains
of human bacilli to increase their virulence for chickens by passage
through fowls, or their virulence for rabbits by passage through the
latter animals, obtained negative results.
628 Tuberculosis.

The negative character of experimental attempts does not, of course,
exclude the possibility of a modification in the course of many genera-
. tions under favorable natural conditions. This possibility has recently
been demonstrated by Eber who succeeded in producing in three in-
stances an acute fatal tuberculosis in cattle with bacilli of the human
type obtained from phthisical sputum. The bacilli, after first a passage
through guinea pigs followed by intraperitoneal injection in cattle,
produced only a circumscribed peritoneal tuberculosis, but cultures
obtained from this affection and which had all the characteristics of
bovine bacilli, produced death in from 21 to 34 days.

Experimental investigations thus far carried out have
therefore not resulted in the discovery of fundamental differ-
ences between the causes of human tuberculosis and tubercu-
losis of the various domestic animals that would justify any
modification of our. former views as to the specific identity of
all tubercle bacilli.

The differences in the form or structure of bacilli of various
origin are least constant because they usually disappear within
a very short time when grown on artificial media.

Their cultural differences, however, are more constant.
These may remain unchanged through many generations, even
after passage through the “bodies of other species of animals.
In this respect, however, gradual variations are observed
which make it impossible at times to classify certain strains
of bacilli in their proper group.

The remarkable difference in virulence of strains. of bacilli
of different origin is still less adapted for the determination
of their specific character. Great variation in virulence,
especially with respect to different species of animals, with
otherwise great constancy of character, has also been observed
in other pathogenic bacteria (very marked in the bipolar
bacilli of hemorrhagic septicemia) while their specific identity
‘has never been questioned on that ground.

The inadmissibility of such'a view is further emphasized

by the fact that variations ranging from the highest degree of.

virulence (with respect to certain. species) to complete aviru-
lence may be artificially produced by successive animal passages
or by artificial cultivation and, on the other hand, by the fact
that strains of the same type, obtained from different indi-
viduals of the same species may show variations in virulence
of no inconsiderable degree.

The similar form and the similar staining characteristics
of the various strains of tubercle bacilli, the general re-
semblance of their cultures, the identity of the pathological
changes caused by them, the gradual differences observed be-
tween the different strains as well as the occurrence of transi-
tion forms, the similar effect of tuberculins prepared from
strains obtained from different species of animals, the fact
that cattle may be immunized with strains of bacilli obtained
from human beings or fowls and, finally, the fact that the
, Constancy of Virulence of Bacilli. 629

bacilli from one species of animal (at least in exceptional
cases) may produce local or even generalized tuberculosis in
other species, all point to the conclusion that tubercle bacilli
obtained from various sources all belong to the same species,
bacillus tuberculosis, and only represent varieties of ‘‘habitat’’
which differ from each other in unimportant characteristics.
These characteristics are evidently the result of prolonged
growth, generation after generation, in different hosts and may,
under favorable conditions, again be obliterated.

The pathogenic action of the bacilli of human tuberculosis,
pearl disease and tuberculosis of fowls is always most pro-
nounced for the species of animal from which they have been
respectively obtained, but none of them are harmless -for other
species. In addition to guinea pigs and rabbits the virus of
human tuberculosis is pathogenic, in general, for all carnivora,
slightly so for swine and for many species of birds (birds like
canaries and parrots kept as pets in dwellings, in particular).
The bacillus of bovine tuberculosis is quite virulent for swine
and is, in general, more pathogenic for other domestic animals
than the human type. The bovine bacillus is also occasionally
the cause of fatal generalized tuberculosis in human beings,
especially in children. The bacillus of avian tuberculosis is,
in general, only slightly pathogenic for mammals, but may oc-
casionally produce tuberculous disease in man, in the ox and
the horse.

In view of the experimentally demonstrated possibility of
the transmission of tuberculosis from one species to the other,
including man, the fact that this occurs in part only occasionally
is of subordinate importance. Neither does the fact that bovine
bacilli that have been the cause of tuberculous lesions in the
human body (or avian virus found in lesions of the horse, or
human virus found in parrots inhabiting the dwellings of human
beings) have retained for a time their original characteristics,
detract from the force of the argument. As a matter of fact,
the vast majority of medical and veterinary medical investiga-
tors admit: the etiological entirety of tuberculosis in general
and the specific identity of the various forms of tubercle bacilli
and to this day accept Koch’s original point of view, viz.: ‘‘In
spite of the anatomical and clinical differences observed in
the course of the disease, tuberculosis of animals, and particu-
larly bovine tuberculosis, must be regarded as identical with
tuberculosis of man on account of the identity of the parasites
that are the cause of the disease.

For practical purposes the recognition of a typus humanus, a
typus bovinus and a typus gallinaceus may be justified in order to
designate the morphological, cultural and pathogenic characteristics
of the different groups of bacilli, providing the fact is kept in mind
that these types represent merely habitat varieties of the same species
and that the occurrence of transition forms be kept in mind.
630 Tuberculosis.

Literature. Smriru, Transactions of the Assoc. of Amer. Physicians, 1896; J.
of exp. med., 1898. III. — Kocu, D. m. W., 1901, 549. — SzeKeLy, Chl. f. Bakh.,
1902. XXXII. 167; 1903. XXXIV. 161 (Review). — Gratia, Tub.-Kongr. Brissel,
1904 (Review). — KosseL, WEBER & Huuss, Tub.-Arb. d. G.-A., H. 1 (Lit). —
DaMMANN & MijssEMEIER, Bez. zw. d. Tub. d. Menschen-u. d. Tiere, Hannover
1905. — Exper, Cbl. f. Bakt., 1906 XXXVIII. 449; B. t. W., 1910. 317. — Rasino-
wirscH, B. kl. W., 1906. Nr. 24. — Fisicrr & JENSEN, Ibid., 1907. 4. — Second
int. Rapport of the R. Comm. appointed to inqu. into the relations of human and
animal tuberculosis, Vol. 1—4. London 1907. — MouLer & WASHBURN, An. Ind.,
1907. Bull. 96 (Lit.). — O. Bane, Chl. f. Bakt., 1908. XLVI. 461. — Zwick, Z. f.
Infkr., 1908. IV. 161 (Lit.).

Tuberculosis of Fish and Reptiles and Other Cold Blooded
Animals. The acid and alcohol-fast bacilli that Silby obtained from
a garter snake, Bataillon, Dubard & Terre from a carp, Moeller from
a hazel worm (Anguis fragilis), and Friedmann from a turtle, are
regarded by these authors as closely related to Koch’s tubercle bacillus.
The two first named, however, grow only at room temperature, like
saprophytes, but the turtle bacillus grows also at 387° C., producing
cultures very similar to mammalian cultures. It seemed also, that
Friedmann’s experiments in successfully immunizing rabbits against
human tubercle bacilli (see p. 599) as well as Moeller’s success with
the Anguis fragilis bacillus point to a close specific relationship with
mammalian tubercle bacilli. Weber & Taute, however, concluded from
the results of their experiments that the so called reptilian tubercle
bacilli belonged to the group of acid-fast saprophytic bacilli which
gain access into the bodies of cold blooded animals and produce local
disease. (True tubercle bacilli inoculated into frogs remain virulent
for a long time and produce nodules of tubercles similar to those
produced by dead tubercle bacilli in other animals.)

The bacilli of piscine tuberculosis are nonpathogenic for warm-
blooded animals. Nevertheless Dubard was successful in making the
fish bacillus very virulent for guinea pigs and Aujesky, by growing
the same bacillus at a temperature of 37° C. and by repeated passage
through the bodies of guinea pigs succeeded in producing a strain that
differed in no essential from the bacilli of guinea pig tuberculosis.

The transformation of mammalian tubercle bacilli into reptilian
or cold-blood bacilli has, as yet, not been accomplished (the reported
positive results of Sorgo-Suess were not confirmed by Tsukiyama).

Literature. Wrper & Taurs, Tub.-Arb. d. G.-A., 1905. H. 3 (Lit.). —

AUJESZKY, Orvosi Hetilap., 1906. Nr. 8. — Sorco-Suzss, Wien. klin.. W., 1907. Nr.
38. — TSUKIYAMA, Diss. Gieben 1908.

2. Pseudotuberculosis.

Since the discovery of Koch’s bacillus such pathological
processes only are classified under the head of tuberculosis
as can be demonstrated to be due to this bacillus. Changes
that resemble those of tuberculosis from an anatomical point
of view and especially those that are associated with the
formation of nodules which bear a resemblance to true tuber-
cles, but are due to the pathogenic action of other bacteria
are occasionally observed as occurring in the internal organs.
Sometimes, also, such pathological changes are due to spiro-
chetae or animal parasites. Such cases are usually classed
Pseudotuberculosis. 631

under the general name of pseudotuberculosis. Preisz, how-
ever, suggested that this term be limited exclusively to morbid
processes that are produced by bacteria other than Koch’s
bacillus. In this sense the subject will be discussed below.

Malassez & Vignal (1883) found tubercle-like nodules following
subcutaneous administration of a nodule obtained from a child that
died with tuberculous meningitis. The nodules in the guinea pig, how-
ever, contained zooglea masses composed of cocci and short bacilli
instead of Koch’s bacillus. Since then other nodular structures, some
of them the results of experimental inoculation of animals with various
substances, others accidentally discovered, have been described. After
a careful study of the literature up to 1891 and a comparison of
the bacteria found by Nocard, Pfeiffer, Parietta and Zagari, Preisz
designated the following three species of bacteria as independent causes
of pseudotuberculous processes ;

1. Streptococcus Pseudotuberculosis Rodentium Dor; a thick,
short, immotile bacillus with blunt round ends; frequently form long
chains in tissue as well as in artificial media, particularly in bouillon;
easily stained with aqueous aniline dyes, but not according to Gram’s
method; does not liquefy gelatin, forms an iridescent membrane on
agar and emits a disagreeable odor; on potatoes yellowish-brown colonies
develop, the medium taking on a greenish-gray color in the surrounding
areas. Inoculation of pure cultures produce pseudotuberculosis in
rabbits and guinea pigs with fatal termination: in 8 to 10 days.

This bacillus is identical with the bacillus described by Malassez
& Vignal, Charrin & Roger, Pfeiffer, Zagari & Parietti under various
names, tuberculose zoogléique, pseudotuberculose bacillaire, tubercuose
streptobacillaire, ete., and to the action of which various morbid
processes in guinea pigs and rabbits have been ascribed. It is also
very similar to Bact. pseudotuberculare orchitophlogogenes recognized
by Cagnetto as the cause of a certain guinea pig enzootic. This bacillus
seems to be widely disseminated in nature; Chantemesse found it in
the dust of dwellings, Grancher & Ledoux-Lebard found it in garden
soil, Ligniéres in hay infusion, Parietti in milk. According to Nocard
it occasionally causes epizootic affections of fowls (emaciation, tubercles
in the lungs). Nocard also found this organism in the nasal discharge
of a cow while Pfeiffer cultivated the same from the organs of a
horse affected with glanders. In addition to this it is probable that
the bacilli found by Labrazés in subcutaneous cheesy foci in the neck
of a pigeon, and by Galavielle and t’Hoen in nodules of a cat’s liver,
are identical, forming chain-like structures in bouillon and causing
pseudotuberculosis in cats and guinea pigs. Those mentioned by
Galavielle also produced pseudotuberculosis in the testes of guinea

pigs.

2. Courmont’s Bacillus. Up to the present time this has been
found only in nodules resembling those of pearl disease observed on
the pleura of a cow. This is a short, thick bacillus, actively motile,
does not form chains in cultures. It grows well on artificial media,
does not liquefy gelatin and forms long threads at 40° C. These latter
contained broken plasma masses. Fresh cultures cause the develop-
ment of pseudotuberculosis in rabbits while in guinea pigs acute
632 Pseudotuberculosis.

septicemia results. On the other hand cultures of three weeks’ growth
produce pseudotuberculosis in guinea pigs and are non-pathogenic for
rabbits.

3. Bacillus Pseudotuberculosis Ovis. Preisz cultivated this
bacillus from nodules in the kidney of a sheep (described on page 633).
According to later investigations this bacillus is’ identical with that
causing ulcerous lymphangitis in horses (see this) and probably also
to that causing contagious acne of horses (see Vol. 2). Kitt demon-
strated its presence in broncho-pneumonia of cattle, Sivori in broncho-
pneumonia of sheep (see p. 636), Nocard in catarrhal pneumonia of
calves (see p. 165) and Carré & Bigoteau in mal rouge of sheep (see
p. 687), Sérés & Guillaume in swine, and finally Ligniéres found this
organism in rabbits and guinea pigs.

In addition to the three above-named bacilli more recent investiga-
tions have resulted in the discovery of. other bacteria as causes of
pseudotuberculous processes. Some of these are as follows:

4. Bacillus of Pseudotuberculosis of Galves described by Vallée
(see p. 638).

5. Bacillus Pseudotuberculosis Murium found by Kutscher in a
mouse that died of pseudotuberculosis; it is immotile, sometimes staining
according to Gram’s method, forms club-shaped growths in cultures
and is pathogenic for mice only.

6. Corynethrix Pseudotuberculosis Murium described by Bongert
as a short rod, Gram positive in old cultures, its products are violently
toxic.

Structure of the Pseudotubercle. Nodules developing in
the internal organs, on serous membranes or in subcutaneous
connective tissue and, on being viewed by the unaided eye,
bearing a perfect resemblance to true tubercles, but having
a different internal structure, are characteristic of pseudo-
tuberculosis. While degeneration and necrosis of the- tissue
elements does not occur in true tubercles except at an advanced
stage of their development, the tubercles of pseudotuberculosis
undergo cheesy degeneration at an early stage. Pseudotubercles
develop more rapidly and consist throughout of necrotic
detritus encased by a narrow peripheral layer of round cells. |
Viewed with the unaided eye even the smallest nodules appear
white or yellowish white; in addition to this they are of rather
soft consistency, the larger ones usually being creamy or mushy.
Lime salts are occasionally deposited in the substance which
is encased by a gray, translucent, comparatively thick, tissue
capsule.

Pseudotuberculous processes in the sense above referred to manifest them-
selves, according to location, in the most variable morbid pictures. The Preisz-
Nocard bacillus in particular produces affections in horses that have long been
looked upon as well characterized specific forms of disease. For practica! reasons
they will be discussed under separate headings (See lymphangioitis ulcerosa Ww.
below and acne pustulosa contagiora in Vol. II
Pseudotuberculosis of Sheep. 633

Literature. Pfeiffer, Ub. d. bazillire pseuds tub. bei. Nagetieren, Leipsie 1889.

— Preisz, A. P., 1894. VIII. 231. — Bongert, Z. f. Hyg., 1901, XXXV. 449 (Lit.). —

rca ti A. P., 1905. XIX. 449 (Lit.). — Glasser, A. f. Tk. 1909. XXXV. 471
it.).

(a) Pseudotuberculosis of Sheep. Pseudotuberculosis ovum.

(Cheesy Broncho-pneumonia; Llymphadenitis caseosa ovum.)

Occurrence. The disease occurs in some flocks in the form
of an epizootic. Thus Turski observed it in 44 sheep in a
herd of 150 in western Prussia; von Zeeb in the abattoir of
Langensalza, in small herds frequently every animal being
affected. The disease has also been reported from the provinces
of Hanover and Silesia. Cherri & Bull observed the disease
in the abattoirs in Melbourne, Australia, in from 15 to 70%
of all slaughtered sheep. According to Norgaard & Mohler
it is very common in the western United States of North
America and according to Sivori it is very frequent in adult .
sheep in the Argentine Republic (the last named authorities
have furnished exact anatomical and clinical descriptions of
the disease).

Etiology. The disease is caused by the Bacillus pseudo-
tuberculosis ovis (bacillus of Preisz and Nocard). This appears.
as a delicate immotile rod (Fig. 97), which is non-sporulating
and easily stained with aqueous aniline dyes as well as according
to Gram’s method. In cultures the bacilli are somewhat thicker
and longer and have a tendency to develop oval, club-shaped
and pear-shaped forms which appear cross-striated when
stained.

Cultivation. This facultative aerobic
bacillus thrives only at body temperature
(according to Carré & Bigoteau, also at
room temperature) ; on agar it forms gray
or yellowish-white colonies which resemble
minute scalés and which are not readily
emulsifiéd ; in the deep portions of the me-
dium they form a white streak, rather thick
above and attenuated below, gradually end-
ing in minute white points; in bouillon
small granules develop on the bottom of the
vessel while the surface of the liquid is
covered with a white, rigid membrane; on

Fig. 97. Bac. pseudotubereu. coagulated blood serum the areas surround.
losis ovis. Agar culture; Gram’s ing the colonies liquefy and become yellow-
Stain, ish in color; no growth takes place on po-
tatoes; it causes fermentation of grape sugar, does not produce indol or
phenol. Cultures remain alive and virulent for months.

  

Pathogenicity. In sheep the subcutaneous inoculation of
the pure culture may produce only a local cheesy focus which
will break, discharge its contents and heal, or there results
extensive swelling of the regional lymph glands, whereupon
634 Pseudotuberculosis.

excessive emaciation gradually sets in; at post-mortem examina-
tion cheesy foci are found in the lungs and occasionally in
the liver. Intravenous infection is followed by a development
of numerous cheesy foci in the lungs and extensive swelling
of the bronchial lymph glands. According to Nocard and
Glasser it is possible also to infect lambs and kids by inhala-
tion or ingestion of pure cultures. In both instances the morbid
process may become localized exclusively in the lungs. Swine
succumb to the effects of intravenous infection in 4 to 10 days,
to intraperitoneal infection in 8 to 15 days; post-mortem ex-
amination revealing many cheesy foci, particularly in the lungs
and in the liver, while the lymph glands are found to be greatly
enlarged and partly caseated (Norgaard & Mohler). Intra-
peritoneal infection may also result in nodule formation on the
peritoneum and in the lungs, while subcutaneous infection causes
nodule formation and destruction of the tissus at the point of
inoculation (Noack). In guinea pigs and rabbits subcutaneous
.inoculation results in the formation of cheesy nodules at the
point of inoculation, while administration of the virus into
the abdominal cavity is followed by the formation of caseo-
purulent foci in the lymphatic glands, the spleen, the liver and
the mesentery; occasionally small pseudotubercles will also
develop on the peritoneum. In male guinea pigs we have, in
addition, an inflammation of the enveloping membrane of the
testes with the production of a purulent, fibrinous exudate,
but the inflammation is usually not as extensive as that follow-
ing infection with glanders (Preisz, Nocard). Pigeons and
fowls are not readily infected experimentally, and passage
through their bodies causes attenuation of the virus.

According to Carré & Bigoteau the bacillus produces toxins in
peptone bouillon in the course of 5 or 6 days. The filtrate of such
cultures injected subcutaneously into sheep in doses of 1.0 ec. produces
a diffuse subeutaneous edema, extravasation of bloody serous fluid into
the body cavities, swelling of the spleen and intestinal hemorrhages;
following acute injections into the milk ducts there was swelling of
the udder, serous exudate in the pleural cavities and bronchial
hyperemia; intravenous administration is followed by excessive con-
gestion of the lungs and death within 8 hours. The toxin possesses
a similar action on rabbits and guinea pigs, while injection of large
quantities of dead bacilli produces abscesses and cachectic symptoms
in guinea pigs. Goats are less susceptible and dogs and eats are
immune to the action of the toxin, while in horses and cattle it pro-
duces only a local inflammatory edema. Sheep that have been im-
munized against the toxin may be infected with live bacilli. Dassonville
demonstrated in cultures the presence of a toxin resembling diphtheria
toxin (see also p. 637).

Noack believed to have discovered a certain relationship existing between the
form of the bacillus and its virulence in the sense that short oval rods such 2s
oecur in the soft cheesy nodules and in other cultures, exert a much stronger
pathogenic action than longer and more slender forms, which are found in the
dry cheesy and calcified broken down foci. However, these various forms may
occur side by side in the same lesions. ,
Pseudotubereulosis of Sheep. 635

Dunkel, in his comparative investigations, arrived at the conclusion that the
bacillus pseudotuberculosis ovis and the bacillus pyogenes bovis et suis are varieties
of the same species because they are reciprocally agglutinated by their respective
immune sera; because mice, after treatment with one bacillus become immune to
the other, and further, because the Bacillus pyogenes after being passed through
the rabbit assumes the appearance of Bacillus pseudotuberculosis when inoculated
into sheep. Glasser also suspected a close relationship between the two bacilli
and in addition is inclined to look upon the bacillus of pseudotuberculosis of
sheep and that of rodents as varieties of the same species. Finally, according to
Nocard, Vallée, Panisset & Loiseau a certain relationship existed between the
pseudotuberculosis bacillus and the bacillus of diphtheria of man, while Dunkel, on
the other hand, doubts the identity of the pseudotuberculosis bacillus and the
bacillus of ulcerous lymphangitis of horses, basing his belief upon an experimental
inoculation of a horse. As a result of these various views the proper classification
of the bacteria referred to is in such an unsatisfactory state that a thorough
revision of this question is very desirable.

The natural mode of infection is as yet not definitely
known. Probably it occurs most frequently through the in-
testinal tract, and possibly also through the respiratory pas-
sages. The bacilli may also gain an entrance through wounds
of the skin and through the navel of newborn animals. In
older lambs infection may occur following amputation of the
tail, the germs entering the lymph channels of the subcutis.
The droppings of infected sheep seem to be a prolific means
of disseminating the disease, Carré having found large masses
of pseudotubercle bacilli in the droppings of apparently healthy
sheep.

Anatomical Changes. In the majority of cases the morbid
processes even in animals that have died with symptoms of
cachexia is confined to the intrathoracic and the external lymph
glands, or to the latter only, while the mesenteric glands are
only very rarely affected. The glands appear to be considerably
enlarged and contain circumscribed foci, or they have become
transformed into greenish-yellow, sticky, smeary, cheesy masses
which may consist of concentric layers resembling the structure
of an onion, and surrounded by a thick connective tissue wall
with smooth inner surface. Subsequently lime salts are de-
posited in this caseous mass giving it a grayish-white color
and a mortar-like or gypsum-like consistency.

In some cases small gray, or grayish-green nodules or even
arge tumors of a structure similar to that of the cheesy glands
are found scattered through the lungs.

In addition we may occasionally find diffuse, lardaceous,
indurated, lobar and lobular pulmonary lesions with soft,
greenish cheesy foci. This condition is usually attended with
an adhesive pleuritis and normal appearance of the regional
lymph glands (Sivori, Noack). ;

Noack mentions, as a rare observation, oval groups of
nodules the size of a pea arranged in a manner resembling
coral, in the walls of the large and small intestines. Finally,
the liver, the spleen and the kidneys may occasionally contain
similar. cheesy or caseo-calcareous nodules.
636 Pseudotuberculosis.

According to compilations made by Noack including 180 cases, the lungs
were affected in 98.3%, the lymph glands in general in 80.6%, the muscle lymph
glands in 33.3% and the liver in 17.2%. :

Symptoms. If the morbid changes are limited to the in-
ternal organs the disease is usually not discovered until the
animals are slaughtered. Such animals may, however, appear
perfectly healthy or show only indefinite symptoms of gradually
increasing anemia or cachexia. In other cases, on the contrary,
the affection of the lymph glands may be recognized during
life by the presence in various regions of the body of painless
tumors as large as a man’s fist. These tumors occur most
frequently in the prescapular and precrural regions. The
general health of the animals is affected only in so far as the
enlarged lymph glands may produce more or less conspicuous
disturbance of locomotion. In some animals, however, cough
and marked dyspnea develop in the course of the disease, at-
tended with progressive emaciation and anemia, thus indicat-
ing the existence of subacute or chronic broncho-pneumonia.

The disease always develops very gradually and fatal re-
sults have as yet not been observed in adult animals.

Carré & Bigoteau report an enzootic among lambs a few weeks
of age, which is evidently identical with pseudotuberculosis. In some
of these animals post-mortem findings were absolutely negative, while
in others multiple abscesses were found in the connective tissue and
sero-fibrinous inflammation in the carpal and tarsal articulations. In
addition, the incompletely healed navel of some of the animals con-
tained pus, the urine always contained albumen. The contents of the
abscesses consisted of a creamy, greenish-yellow pus from which the
Preisz-Nocard bacillus could be obtained in pure culture.

Bridré described a disease among lambs which proved fatal at
about the age of three weeks. Post-mortem examination revealed ab-
scesses, principally confined however, to the liver and the lungs. A
small bacillus similar to the one mentioned above, could be cultivated
from the abscess contents. This bacillus would curdle milk, liquefy
coagulated blood serum, was non-pathogenic for rabbits and guinea
pigs but caused local abscesses when injected subcutaneously into sheep,
and was followed by death within 15 to 20 days when pure cultures
were injected into the navel of newborn lambs.

Prevention. Since the active cause of this disease seems
to be widely disseminated in the litter or bedding, or on the
ground where infected herds have lived, infection per os can
hardly be effectively prevented, the disease can only be checked
by careful aseptic or antiseptic treatment of the navel after
birth and of the wounds resulting from amputation (docking)
of the tails. By this method (washing of the navel with Lugols’
solution and treatment with.1% iodine collodion) Carré reduced
the percentage of deaths in one herd from 50 to 0.3%. Bridré
also achieved good results by this method.
Pseudotuberculosis of Sheep. 637

Immunization. Carré reports very favorable results following the
treatment of young lambs in a badly infected herd, as follows: Two
vaccines were used, one of which produced only local edema in guinea
pigs, the other occasional suppuration only, while in sheep no morbid
changes whatever followed its administration (the manner of prepara-
tion was not indicated). As to results: In herds where the losses
of lambs had formerly reached 70%, the treatment of 318 lambs was
followed by abscess formation only in 5.

Literature. Preisz & Guinard, J. Vet., 1891. 563. — Zeeb, Z. f. Fihyg., 1893.
XII. 117. — Turski, Z. f. Flhyg,, 1897. VII. 178. — Cherry & Bull, The Vet.,
1899. 523.— Norgaard & Mohler, An. Ind., 1899. 638. — Sivori, Rec., 1899, 657.
— Bridré, Bull., 1905. 358. — Carré & Bigoteau, Rev. gén., Ibid. 369. u. 433
(Lit.). — Noack, Diss., Bern 1908 (Lit.). — Glisser, A. f. Tk., 1909. XXV. 471
(Lit.). — Carré, Rev. gén., 1910. XV. 65.

Mal rouge. Carré & Bigoteau made a bacteriological study of
a disease of sheep that had been described in 1876 by Teissier, and
since then by several French authors, especially Delafond, and
generally classed with anthrax. The disease, known in the infested
regions as pourriture aigué, mal de Sologne, mal rouge, eaux rousses,
jaunisse, etc., is prevalent in southern France and causes losses that
may reach 10% in infected flocks.

The symptoms consist of dullness, paleness of the mucous mem-
branes, muco-serous, and later bloody, nasal discharge, increased thirst,
bloody diarrhea and hematuria. Toward the termination of the disease
there is edematous swelling of the intramuscular region and of the
extremities. The disease terminates fatally after 2 or 3 or, sometimes,
after from 8 to 15 days. Occasionally death occurs quite suddenly.

At post-mortem examination we find hemorrhagic and serous edema
in the subcutis and mesentery, excessive hyperemia of the membranes
of the stomach and intestines, marked acute swelling of the spleen
and lymph glands, dark red, almost black discoloration of the kidneys,
hemoglobin in the urine of the bladder and finally there are usually
large masses of bloody fluid in the serous body cavities. The disease
may be differentiated from anthrax by the paleness of the muscles, the
comparative emptiness of the small blood vessels, the pale color and
the coagulated condition of the blood and finally the negative results
of experimental inoculations.

Microorganisms can be demonstrated in the body fluids by means
of bacteriological examination, although in somewhat protracted cases
small abscesses may be found in the pharyngeal and retropharyngeal
lymph glands. These contain the pseudotuberculosis bacillus of Preisz
and Nocard which may be obtained from them in pure culture. Carré
& Bigoteau are inclined to regard the disease as an intoxication caused
by the toxic products of metabolism of the bacilli in question.

In animals of considerable power of resistance the bacillar toxins
found in the lymph glands are supposed to produce a chronic intoxica-
tion resulting in the familiar clinical condition known as cachexia
aquosa, and it is further assumed that the weakened condition, the
anemia and hydremia observed in any distomatosis is not caused
by distoma but rathcr by bacterial toxizs (?). According to this
view cachexia aquosa is merely a chronic form of the above disease.

Finally Carré is of the opinion that many cases of colic in horses, especially
that form descriked as congestion intestinale by French authors, which is char-
638 Psendotuberculosis.

acterized by very severe pains, rapid course, extreme hyperemia and hemorrhagic
serous infiltration of the intestines with acute swelling of the spleen, may be
ascribed to the toxins of the bacillus of pseudotuberculosis.

Literature. Carré & Bigoteau, Rev. gén., 1908. XI 369 u. 433 (Lit.). --
Carré, C. R., 1910. CL. 350.

(b) Pseudotuberculosis of Calves.
(Pseudotuberculosis vitulorum.)

This disease was observed by Vallée on an estate which
had for a number of years suffered serious losses among calves.
They usually became infected one or two weeks after birth,
showing symptoms of great weakness, complete loss of appetite;
death following without exception in the course of 8 to 10 days.
Post-mortem examination revealed in all cases numerous tuber-
ele-like, gray, and partly confluent nodules in the liver, while
other organs as well as the portal lymph glands were appar-
ently healthy. y

Many other bacteria and a very small immotile non-sporu-
lating bacillus which readily stained according to Gram, have
been cultivated from the liver. This latter bacillus does not
liquefy gelatin and produces minute translucent colonies on
coagulated blood serum, agar and potatoes. Cultures in bouillon
cause cloudiness of the medium and accumulation of a slimy
sediment does not cause fermentation of sugar nor coagulate
milk. Intravenous injection of the pure culture is fatal to
guinea pigs, rabbits and dogs in which cases small tubercle-
like nodules may be found in the liver and occasionally also
in the lungs. Guinea pigs become affected after their adminis-
tration per os or intraperitoneally. Pigeons are affected only
after intravenous injection of cultures. :

The natural mode of infection has as yet not been satis-
factorily explained, probably it results through the digestive
canal (possibly from infected milk).

In the livers of calves slaughtered in an apparently healthy condi-
tion in which post-mortem inspection revealed swelling of the spleen,
punctiform hemorrhages of the kidneys and occasionally bronchial
catarrh, Langer found numerous minute, grayish-white nodules which
contained a facultative aerobic Gram negative bacillus of the paratyphoid
group, and the cultures of which were agglutinated by typhoid serum
(Bae. nodulifaciens bovis). Pure cultures produced no toxins but on
administration to experiment animals resulted in the formation of
nodules in the liver, in rare cases also in the lungs and kidneys. Pitt,
who observed one case in which the navel and the umbilical cord were
considerably enlarged and edematous the mesentery glands swollen
and of a marrow-like consistency, recognized as the causative agent 2
bacillus belonging to the group of Girtner’s Enteritis bacilli.

Literature. Vallée, Rec., 1898. 400. — Langer, Dics., Gieszen 1904, — Pitt,
Chl. f. Bakt., 1909. XLIX. 593.
Paratuberculosis of Cattle. 639

3. Specific Paratuberculosis of Cattle.

(Enteritis paratuberculosis bovis specifica. Johne’s disease
[English]; Enteritis chronica bovis pseudotuberculosa s.

specifica; Enteritis chronica hypertrophica bovis.)

History. In 1895 Johne & Frothingham observed a peculiar affec-
tion of the intestinal mucous membrane in an ox which manifested
itself in extensive maculate swelling and reddening, and a profuse
seeretion of mucus; tubercles and ulcers were absent. On account of
the presence of numerous masses of acid-fast tubercle bacilli they re-
garded this affection as a special form of intestinal tuberculosis, possibly
‘brought about by infection with avian bacilli. More recently this dis-
ease has also been’ observed in other countries, occasionally in the form
of an enzootic, and has been made the object of special investigation
by Markus, Liénaux & van der Eeckhout, Bongert, Bang and von
Meyer.

The name enteritis paratuberculosis bovis specifica is probably best adapted
for designating this disease, since other names that have been suggested also
apply to other enterites of cattle and because the term paratuberculosis is generally
understood to refer to acid-fast bacteria which must be differentiated, from true
tubercle bacilli, thus clearly indicating the non-identity of this disease and tuber-
culosis (better than pseudotuberculosis).

Occurrence. Up to the present time the disease has been
observed in Germany, Denmark, Holland, Belgium, France,
Norway, Sweden, Hanover and North America. It occurs
principally in young cows, but also in calves and he'fers as
well as in older cattle, usually sporadically but not infrequently
as an enzootic. In Switzerland 80% of the cases of chronic
gastro-intestinal catarrh might be ascribed to this disease, while
losses oceurring in Denmark probably approach 10%.

Etiology. The disease undoubtedly bears a certain rela-
tionship to the presence of small acid-fast bacilli which exist
in large numbers in the intestinal mucous membrane, since,
however, it has not yet been possible, in spite of numerous
attempts, to cultivate the bacilli and produce specific affection
with their pure cultures, the views expressed in regard to this
matter are rather divergent, while for example Johne &
Frothingham, Bourgeaud and Stuurman regarded them as
avian tubercle bacilli, Liénaux & van der Eeckhout, and also
Bongert looked upon them as attenuated mammalian tubercle
bacilli. More recently Liénaux considered them as a sapro-
phytic variety of bovine bacillus, while Markus, Bang, Mac-
Fadyean, Meyer & Miessner expressed the opinion that it is.a
matter of a specific disease caused by acid-fast bacteria of an
entirely different nature than the true tubercle bacilli, It was
impossible to produce a true progressive tuberculosis in ex-
periment animals (guinea pigs, rabbits, goats and fowls) by
means of material obtained from naturally infected animals:
The results of inoculations consisted merely in the development
640 Paratuberculosis of Cattle.

of local cheesy foci or abscesses, and in most cases they were
of a completely negative character. This disease occurs oc-
casionally also in herds that are entirely free from tuberculosis.
Many of the animals do not react to tuberculin and upon post-.
mortem examination are found absolutely free from any tuber-
culous lesions whatever (Bang).

Recently Stuurman reported that he has succeeded in producing pure cultures
of the organism from guinea pigs and rabbits that had been infected with material
from naturally infected animals. These cultures were similar in many respécts
to those of the avian tubercle bacillus. The results of alimentary administration
of pure cultures were however negative.

The fact that the disease is contagious was demonstrated
by Bang when he succeeded in infecting six calves by feeding
the scrapings of the intestinal mucous membranes of infected . -
cows in large quantities (300 to 1,500. gm.). Miessner also
succeeded in infecting cattle in this manner as well as by in-
travenous administration. These positive results point to the
probability that natural infection results from ingestion of
contaminated feces. However, the pathogenicity. of the disease
is also demonstrated by the observation of its introduction
into herds previously free from the same.

Anatomical Changes. At post-mortem examination we find
the following: The cadavers are frequently excessively
emaciated, the walls of the small intestine considerably
thickened, either uniformly through its entire extent or in local
areas only. These changes may extend also to the cecum and
colon. The surface of the intestines is smooth and pale. The
mucous membrane of the affected regions is increased to from
4 to 5 times its normal thickness, being transformed into ir-
regular folds running longitudinally or transversely so as to
resemble the convolutions of the brain (Fig. 98). These areas
are covered with'a dirty looking, grayish-white or grayish-
green, slimy fluid resembling meal soup. At the crest of the
folds the mucous membrane is reddened in spots or dotted
with hemorrhages, and usually smooth on the surface; between
the folds it has a delicately warty appearance (no nodules)
as though gnawed. by fine teeth. The mesenteric glands and
Peyer’s patches are slightly swollen.

Meyer found specific changes in the fourth stomach in 50% of the cases
examined. Of the various regions of the intestines, the duodenum was macro-
scopically infected in 13%, the jejunum in 68%, the ileum in 82%, the cecum in
36%, the colon and rectum in 32%, the mesenteric glands in 60%. Microscopical
examination of the hypertrophied areas of the mucous membrane revealed extensive,
diffuse, cellular infiltration, the villi having assumed irregular and clumsy forms.
The diseased cell masses frequently contained great numbers of large epitheloid as
well as giant cells and great masses of small acid-fast rods.

These rods are occasionally found also in great numbers in the feces in
which they are easily demonstrated by staining processes adapted for tubercle
bacilli (the bacilli also stained according to Gram’s method and with carbo-
imethylene blue). When the rectal mucous membrane is affected the diagnosis can
readily ke made intra vitam by removing a small portion of the mucous membrane
with the aid of the fingernai] or with a curette and examining it microscopically.
Anatomical Changes, Symptoms. 641

Symptoms. The symptoms of this disease consist in
gradual emaciation unattended with fever or pain, occasional
diarrhea (when present usually persistent), the evacuations
being thin or watery, frequently containing gas bubbles. The
affected animals, though very aneinic, do not always show symp-
toms of exhaustion even when emaciation has become excessive.
On the other hand, the appetite is quite variable, milk produc-
tion diminislies, and the disease terminates fatally after a condi-
tion of collapse often lasting several days. In rare cases
diarrhea is absent but in spite of this, the disease terminates
with symptoms of excessive emaciation and anemia.

St

As
re’ be \
Y fe, LUE Cy

 

Fig. 98. Enteritis chronica paratuberculosa. Wypertrophy of the Mucous Mem-
brane of the Small Intestines.

The course of the disease always extends through several
months. Excessive feeding of root crops, and parturition
exert an unfavorable influence on its course, while pasturing
has a beneficial effect.

Diagnosis. In some cases where the peculiar intestinal
evacuations arouse suspicion of the disease, the diagnosis may
be made by a microscopical examination of the intestinal con-
tents or of portions of mucous membrane (see p. 639; Meyer
obtained positive results in 60 to 70% of such cases). The
tuberculin test is also of value in this connection, although
tuberculin prepared from avian tubercle bacilli must be used.

Vol. 1—41
642 -Paratuberculosis of Cattle.

O. Bang found (except in advanced cases) that tuberculin. of
this kind when applied subcutaneously, would produce an ele-
vation of temperature up to 41.0° C., frequently attended with
great depression, diminished milk yield, chills and diarrhea.
While tuberculous cattle always react to this treatment the
condition may be differentiated by an application of mammalian
tuberculin either before or after the use of the avian material.
However, this disease, especially in its more pronounced form,
is hardly ever associated with tuberculosis.

The suspicion expressed by Bang that.the disease in
England is frequently confused with gastro-intestinal strongu-
losis seems, according to Meyer, not to hold with respect to
so called cold gangrene (Kaltbrindigkeit) observed in Switzer-
land and the presence of filaria in the stomach and intestines
does not necessarily exclude paratuberculous enteritis since
these two diseases, particularly in the more serious affections,
may co-exist.

Prevention. Since all attempts to treat the disease medi-
cinally have led to unsatisfactory results, and since means for
immunization are unknown, the best course to pursue with our
present state of knowledge is the isolation and destruction of
affected animals as soon as possible after recognition of the
disease, thorough cleansing of the stables and raising the off-
spring on new or uninfected pastures. This is usually attended
by more or less success.

Literature. Johne & Frothingham, D. Z. f. Tm., 1895. XXI. 438. — Markus.
Z. £. Tm., 1904, VIII. 68. — Liénaux & Van der Eeckhout, Ann., 1905. LIV. 65;
1906. LV. 84. — Liénaux, Ibid., 1905. LIV. 598. — Bourgeaud, Schw. A., 1905.
AXLIV. 221 — Bongert, D. t. W., 1906. 231. — Bang, B. t. W., 1906. 759. —
Mac Fadyean, J. of comp. Path., 1907. XX. 48 — Meyer, Arb. d. Seruminstituts
Bern 1908. — Stuurman, Miessner, Kongr, Haag 1909,

4, Actinomycosis. Lump Jaw, Big Jaw.

Actinomycosis is a non-contagious infectious disease of
cattle, occasionally affecting other domestic animals and man,
which manifests itself either in the appearance of connective
tissue tumors or in chronic processes of suppuration and is
caused by the Ray fungus, Streptothrix actinomyces.

History. The Ray fungus has been known since the middle of the
last century and demonstrated by a number of authors; in man, in
the contents of chronic abscesses (Langenbeck, 1845; Lebert, 1848;
Laboulbéne, 1853; Robin, 1871), in diseased maxillae (Davaine, 1850;
Rivolta, 1868; Perroncito, 1875), and in woody tongue in cattle (Hahn,
1870).. Its etiological significance, however, was not demonstrated
until 1877 (Bollingers’ work on Actinomycosis of the Jaw of Cattle).
After the botanist Harz demonstrated the fungus nature of the cause
of this disease, the latter assumed greater prominence through the works.
ef Israel (1878) and Ponfick (1880) who found this fungus also in
Actinomycosis. 643

the morbid products of man, and Ponfick demonstrated the etiological
‘identity of this disease in man and animals.

The literature of recent years (Johne, Bang, Harms, Azary, Jakob)
has added much information concerning the great variability of the
clinical appearance of this disease. On the other hand, Wolff, Israel,
and more particularly Bostrém, Ligniéres & Spitz have added much
to our knowledge of the etiology of the disease, while Thomassen (1885)
discovered an effective internal treatment.

Occurrence. Actinomycosis is of frequent occurrence in
eattle, particularly in young animals, especially in low, swampy,
damp regions, or regions subject to periodical flooding, and
oceasionally appears as an enzootic. However, it is in general
more frequently met with in stable-fed animals than among
those kept on pasture.

_ The disease in general is more common in regions where the live-stock
industry is conducted on an extensive scale (as in the western states of North
America) than in regions where this industry is carried on under opposite condi-
tions. In some regions the disease appears almost annually among young stock in
the form of peripharyngeal tumors. :

The disease is very common in Russia, especially in southern Russia where,
according to Ignatjew 10% of all cattle are attacked by the disease, affecting
principally the lips. It is common also in certain regions of Denmark, England,
Holland (according to Schouten 10% of all cattle) as well as in North America.
The disease is much less frequently met with in France and Germany but is
occasionally quite prevalent in western Prussia (Preusse) and in the mountainous
regions of Bavaria (Imminger). OlJendorf observed the disease in 76 annals in
a herd of 329 cattle in western Prussia, and according to Franck it was so com-
mon in certain regions that it was formally included in the list of diseases which
under the German laws were considered sufficient when present, to annul a contract
of sale. Piot assumes that 3% of all cattle in the Nile Valley of Egypt are
affected with this disease.

According to statistics compiled by Jelenevski the morbidity as
established in the various abattoirs from 1896 to 1911 was as follows:
Berlin 3.1, Vienna 0.1, Moscow 33.4, Kief 6.7, Warsaw 6.5 per thousand,
respectively (the mild form of tongue actinomycosis is evidently not
included in these statistics). f

In horses, swine, sheep and goats actinomycosis is rarely observed,
and occurs only sporadically.

Etiology. The Ray fungus (streptothrix actinomyces
Rossi Doria, actinomyces bovis Harz) according to the latest
views, is a thread-like schizomycete belonging to the group
of streptothrix (Fig. 99). It forms branching growths, propa-
gates by sporulation and under favorable conditions produces
characteristic colonies (granules) consisting of numerous in-
dividuals (Fig. 100).

Morphology. The size of these colonies varies from 0.15 mm. to
0.75 mm. Under the microscope colonies 0.01 mm. in diameter may be
observed. On the other hand many small colonies may unite to form
characteristic large granules 2.0 mm. in diameter. The more recent
and usually the smallest colonies are translucent gray, with a greenish
tinge, resembling a globule of gelatin or mucus or a granule of sage,
soft and smooth upon the surface. The older colonies are whitish-gray
644 Actinomycosis.

and subsequently assume different shades of yellow and blackish-gray
(commonest form), varying from light yellow to yellowish-brown, and
in rare cases, @ blackish-gray. These granules or colonies have, as
a rule, an irregular or warty surface; the older structures unite to
form masses which are visible to the unaided eye and bear some re-
semblance to a blackberry. They are firm, not easily crushed, and
sometimes hard as a result of calcification. ;

In each granule these may usually be recognized by a central por-
tion consisting of filaments, rods and spores and a peripheral portion
composed of the club-shaped ends of the parasite.

The individual filament consists of a membrane enclosing a body
of protoplasm and shows a distinct tendency to dichotomous branching,
each branch in its turn possessing the same habits. Transverse parti-
tions divide these filaments into short rods and the latter seem to be
divided by similar partitions into coccus-like structures, the so called

 

Fig. 100. Actinomyces colonies
and single club-shaped individ-
uals. From tumor of maxilla;
examined in caustic potash so-
lution.

Fig. 99. Streptothria Actino-
myces. Agar culture in dilute
fuchsin solution.

spores which, however, may also be found in the interior of the filament
(according to Domec, at the ends only), thus producing torula-like
structures. (These spore-like bodies, unlike the spores of bacteria or
those of some mold fungi, e. g., those of the Oidium species, are readily
stained with aniline dyes.) The so called spores, after separation from
the filament, develop into rods which finally form new branching
filaments.

Filaments thus developed intertwine and produce mycelium-like
colonies, on the periphery of which the radially-arranged club-shaped
ends project. In the old colonies in particular, these club-shaped ends
constitute a continuous envelope surrounding the central mycelium,
thus giving the colony the characteristic mulberry appearance. In
colonies obtained from infected tissue the envelope referred to is
usually broken and interrupted at some point, from which a thick
strand of filaments projects from the central mass and to a certain
extent penetrates the surrounding tissue walls (radical filaments). The
club-shaped ends which are not infrequently constricted so as to resemble
the fingers of a hand were formerly looked upon as buds (gonidia)
(Harz, Bollinger, Johne, Ponfick). At present, however, the view of
Bostrém is probably looked upon as more correct. According to this
view these so called gonidia are the result of a specific hyaline degenera-
Morphology, Cultivation. 645

tion and swelling of the external membrane of the filaments. (These
club-shaped ends may be entirely absent: when growth is prolific.)
When the conditions for development are unfavorable, granules of lime
salts are deposited in the colonies, sometimes also granules of iron
sulphate.

The typical form of colony thus described which consists of a
central mass of filaments with a peripheral envelope or mantle, is
usually found well developed only in the actinomyces of human beings,
while those found in cattle usually consist in the main of masses of
club-shaped, swollen filaments.

According to the investigations of Ligniéres & Spitz the property of forming
dichotomous filaments is characteristic of a number of species of bacteria which
may be referred to as actinophytes, while the diseases caused by their presence are
known as actinophytoses (See page 667). Among the actinophytoses we have 1.
the classic Actinomyces bovis or Streptothrix actinomyces; 2. the Streptothrix
Israeli and 3. the actinobacillus.

Staining. The filaments and spores stain readily by Gram’s method
or by that of Gram-Weigert. The club-shaped ends may be stained with
carmine, eosin, etc.

Cultivation. The Ray fungus thrives on the usual artificial media
in the presence of oxygen, but only moderately so under anaerobic
conditions (cultures will not develop unless the colonies are crushed
and the detritus thus produced transferred to the culture medium).
On gelatin or agar, but still more beautifully on coagulated blood serum,
it forms small points resembling dewdrop, which gradually become white
and project above the surface like buds. In gelatin they sink to the
bottom of the medium as a result of liquefaction of the latter. Sub-
sequently the granules assume a yellowish or reddish (the latter
especially in blood serum), occasionally also a decided brick red color,
are rather hard and, being provided with radical filaments they become
firmly attached to the bottom of the vessel; finally they become con-
fiuent and form large, dry, wrinkled and prominently projecting
colonies. When not too thickly sown on potatoes they form grayish
granules which finally develop into prominent, pitted colonies with
erumpled borders and depressed centers, usually having a sulphtr
yellow, reddish-yellow or moldy color (Fig. 101), while on the other
‘hand, when the material is thickly sown, a continuous growth occurs
from 1 to 2 mm. thick, delicately folded on the surface, yellowish-gray
in the beginning, and later becoming reddish-yellow. In bouillon
whitish granules occur which form a membranous mass on the surface
of the fluid, or confluent masses imbedded in a slimy substance at the
bottom of the vessel, while the fiuid itself always remains clear. In
fluid serum or in pleural exudate a capsule is formed around the fila-
ments (Wright). The Ray fungus will grow also on eggs, in sterilized
milk, in water and in other media.

_ Tenacity. Cultures are quite resistant to the effects of drying; if kept at
ordinary room temperature they remain active for a year or more. The spores are
not destroyed by boiling for 14 minutes; 5% carbolic acid solutions are harmless
in their effect; corrosive sublimate solutions of 1:000 will kill them in five minutes
(Liebmann). Dry spores remain active for six years and withstand continuous
exposure to the sunlight for 238 hours (Berard & Nicolas). According to Nocard
the addition of 1% votassium iodide +o the medium does not retard the develop-
ment of the fungus. bit according to Rajewsky the addition of %% of potassium
iodide completely checks development.
646

Pathogenicity.

Actinomyeosis.

Thus far it has been impossible to produce

absolutely positive results in the transmission of the disease
from man to animals. These experiments have usually con-
sisted in the subcutaneous administration of colonies of the

 
    
 

Bireptothrix
actinomyoes.

 

 

 

Fig. 101. Potato Cul-
ture of NStreptothri«
actinomyces six weeks

old.

parasite from man to animals. Submucous
membrane inoculations and administration
into the abdominal cavity or the anterior of
the eye have also been tried. Johne, Ponfick,
Israel, Rotter and Hanau believed to have
obtained positive results in calves and guinea
pigs in which nodules, ranging in size from
a pea to that of a hazelnut, developed on the
serous membranes. These lesions, however,
were invariably of a benign and never of a
progressive character. (Similar nodules are
observed to develop when other foreign
bodies had been introduced into the serous
cavities.) Affanassjew, and subsequently
also Israel and Wolff attempted experimental
infection with pure cultures which, however,
were also without convincing results, al-
though Wright observed growth and club for-
mations in the filaments found in the center
of the resulting local abscesses.

Biagi succeeded in detecting an endogenes toxin in cul-
tures, which produced marasmus in animals while Poncet,
Lacomme & Thévenot failed to 1ccognize the presence of
soluble toxins.

Natural infecticn takes place through
the mucous membranes, usually that of the
mouth, through the medium of gramineae,
particularly the awns of the heads of barley
(Johne). Bostrom found in the examina-
tion of 5 cases of human actinomycosis por-
tions of awns, only 0.2 mm. in length, im-
bedded in the more recent portions of the
tumors, in the center of masses of leucocytes
and granulation tissue, which in turn were
surrounded on all sides by mycelium and
characteristic fungus colonies. In one case
he demonstrated that the fungus had orig-
inally existed in the air spaces of the awns
where it had proliferated, penetrated the
walls of the air spaces and found its way
into the surrounding tissue elements.

This result of Bostrém’s microscopical examination ex-
plains the manner of infection in these and similar cases. Awns
of grasses which accidentally come in contact with the mucous
membrane of the upper digestive tract force themselves through
Natural Infection. 647

the mucous membrane by means of a peculiar boring motion,
particularly by way of the excretory ducts of the salivary
glands or through the depressions on the surface of the tonsils
into the deeper tissues where they are firmly held by numerous
fine barbs, the contraction of the neighboring muscles serving
to draw them still deeper into the tissues. The characteristic
tissue changes may be observed to develop along the path of
invasion of the awn by subsequent irritation through the
fungus contained in the latter (this explains the frequently
observed metastases of the actinomycomata from the base of
the mouth cavity to the region under the skin of the inter-
maxillary space. The Ray fungus exists as a saprophyte on
grass and especially the various species of grains and accord-
ing to Bostrom has a special preference for the air tubes in
the stems of these plants. Its propagation is favored by damp
soil and moist atmospheric conditions, while the considerable
resisting power of the spores insures the perpetuation of the
species under unfavorable climatic conditions. Infected plants, -
especially barley, when fed dry, may produce injuries of the
mucous membranes and thus afford opportunity for the en-
trance of the fungus into the tissues. The disease is in fact
most frequently observed in winter, and in spring, correspond-
ing to the seasons of dry feeding. On the other hand a similar
entrance may be effected on pasture, particularly in stubble
fields, and give rise to infection at the lips.

Breuer observed actinomycosis during the latter portion of winter and early
part of the spring months (period of dry feeding) in 33% of adult animals, while
during the summer months only a frequency of 16% is recorded. Liebmann
observed the development of the Ray Fungus on wheat and barley straw that had
been grown on infected soil. Berestnew observed the development of the fungus
on the straw and heads of grains that had been kept moist for some time, while
according to Bang they have been observed to thrive on grains and straw,
particularly barley. According to Brazzola the fungus thrives most luxuriantly
on a certain species of wild barley.

The enzootic development of the disease following feeding with
barley or barley straw points to the intermediary role played by the
awns of barley in the dissemination of this disease. Thus on an estate
near the Danish seacoast the majority of a herd of cattle became affected
with actinomycosis after having been fed for some time with straw
and grain that had been grown on a drained area of the seacoast. At
a subsequent date when similar material was fed, the disease appeared
anew (Jensen). According to Nicolaus the disease occurs in regions
of Silesia where barley is grown extensively, apparently as a result of
the practice of feeding barley straw, especially chaff, without prelimi-
nary steaming or scalding.

Barley awns have been found in the diseased tongues of cattle
as well as in the tonsils of swine and in a few instances (Johne, Neuwirth,
Piana, Korsak) it was possible to demonstrate the presence of the Ray
fungus on the surface or in the interior of the awns as well as in the
surrounding tissues. :

Contrary to the generally accepted view that the Ray fungus is
@ saprophyte or facultative parasite, Wright has expressed the opinion
648 Actinomycosis.

that the cause of actinomycosis of-man and animals is an obligatory
parasite which will not grow at room temperature and exists as a per-
manent inhabitant of the digestive tract from which it occasionally
penetrates the underlying tissues. Foreign bodies, according to the
latter’s view, play a part in this process only in so far as they assist
the parasite in gaining an entrance into the tissue substance. According
to Wright the saprophytic fungi that are found on grains, etc., should
be differentiated from the true actinomyces as belonging to the group
“‘Nocardia.”’

Infection is favored on the other hand by the soft and
swollen condition of the mucous membranes of the mouth and
gums or by injuries such as occur during the shedding of
the teeth (Roger, Imminger, Schouten), or in the course of
foot and mouth disease (Faletti). On the other hand infection
is favored by the anatomical structure of the tongue. The
remarkable frequency of actinomycosis of the tongue in mature
cattle bears a certain relationship to the fact that the forma-
tion of the so called ‘‘groove’’ of the tongue begins at that
time as a result of atrophy of the filiform papillae on the cres-
cent-shaped surface of the tongue, causing the mucous mem-
brane to become thinner and drawn into transverse folds. Hard
particles of food become lodged in this groove and are, by the
muscular contraction of the tongue, forced into its interior
(A. Breuer). According to Henschel, Falk and Nicolaus par-
ticles of plant food are retained especially in young animals
by the horn-like filiform papillae, and are thus afforded a
favorable opportunity for entering the pocket-like depressions
which are located just anteriorly to the dorsal prominence of
the tongue. In the more posterior portions of the digestive
tract this method of infection is not as frequently observed,
which is explained by the fact that food particles when they
reach these regions have been moistened with the saliva and
become softer in consistency. In spite of this fact infection
occasionally occurs in the esophagus and even in the intestinal
wall, especially in the region of the cecum where the feces
are dryer and are retained for a longer time.

Infection by means of the inhaled air may be assumed in
such cases only where the lungs are the primary seat of the
disease.

The skin affords an effective protection and consequently
infection is possible only through injuries. Castration wounds
in horses, more rarely in cattle and swine, constitute the most
frequent ports of entrance for the contagion. So called scirrhus
cord is the result at least in a part of the cases of contact
with infected straw (Johne). The development of actinomyco-
mata in other regions of the body as a result of superficial or
deeper injuries of the skin are much more rare (Gooch ob-
served them in cattle treated with setons, Liénaux after
rumenotomy). Finally, this parasite may gain entrance into
Pathogenesis. . 649:

the udder through the milk ducts thus causing the comparative
frequency of affection of this organ in swine.

Of the domestic animals cattle are most susceptible to
infection. The disease occurs much less frequently in swine
and only rarely in horses, sheep, goats and dogs (according
to Schouten it is quite prevalent among the goats in the Nether-
lands). Breed or sex have no influence on the development of
the disease, although the seat of the morbid process is de-
termined by the age of the animal. Thus in young cattle
actinomycosis of the pharyngeal region is quite common while
actinomycosis of the tongue is usually observed in mature
eattlé only..

Pathogenesis. As a result of the inflammatory reaction,
nodules composed of small round cells form around the para-
site. Some of the mycelia penetrate the tissue cells which
become enlarged and develop into epithelioid cells which, in
their turn, by division of their nuclei, develop into giant cells.
The cells in the interior of the nodule, which resembles a
tnberele, degenerate and thus the center of these nodules are
composed of cell detritus, nucleated and free fat globules.
These primary nodules are surrounded by granulation tissue
on the periphery of which new nodules develop which are again
enclosed by newly formed connective tissue. In this manner
large spherical and lobulated tumors so called actinomycomata
(Johne) are developed. These may resemble in structure either
a soft sarcoma or have the appearance of a dense fibroma.
Accordingly a section of the tumor may appear homogeneous,
grayish-white, marrow-like, or fibrinous and reddish-gray. In
this ground substance there may be found pale gray or yellow
foci of. loose consistency in which are imbedded grayis'. or
sulphur colored actinomyces imbedded in a mucous or purulent
substance and having the appearance of grains of sand. These
foci may become confluent and thus give rise to fistulous canals
filled with granulation tissue of a gelatinous consistency and
penetrating the substance of the tumor

Actinomyces which have gained access through the mucous
membrane of the tongue become disseminated by means of
the lymph channels and give rise to the development of small
nodules surrounded by an area interstitial inflammation. These
nodules gradually increase in size, finally breaking abruptly
through the mucous membrane from which they project like
a mushroom or cauliflower. In the so called groove of the
tongue, on the other hand, simultaneous infection with pyogenic
bacteria may give rise to deep ulcers.

‘When these tumors develop in the interior of flat bones
the granulation tissue causes destruction of the bone lamellae.
At the same time the production of new bone tissue proceeds
from the periosteum, while on the other hand the development
650 Actinomycosis.

of abundant fibrous tissue may cause the destruction of the
actinomyces and thus bring about spontaneous recovery.

Occasionally in loose connective tissue generally, especially
in swine, but also in man, there occurs emigration of large
numbers of leucocytes from the surrounding vessels as a result
of the irritation produced by the parasite. Following this,
large areas of the tissue surrounding the nodules undergo
purulent softening, become confluent with other similar areas
and thus produce large abscesses or fistulae which are always
surrounded by a thick and usually very firm connective tissue
wall. Occasionally the suppurating process is induced by
pyogenic bacteria which are met with most frequently in the
pus of the larger abscesses.

The mycelium of the parasite may penetrate the walls of
the blood vessels and be transported to other regions of the
body, thus giving rise to the development of metastatic tumors
or abscesses such as are observed quite frequently in spongy
bones, but also in the brain and other organs.

Anatomical Changes. The seat and character of the
anatomical changes vary with the species of animal.

In cattle the tongue is most frequently affected, the maxillae
coming second; tumors of the skin in the region of the head
and neck as well as larynx are also quite common, while the
internal organs are only rarely affected.

 

Fig. 102. Actinomycotic Ulcer on the Dorsum of the Tongue (food cavity) in an Ox.

Actinomycosis of the tongue frequently takes the form
of an ulcer situated immediately anteriorly to the dorsal promi-
nence of the tongue (so called ‘‘food cavity’’). In this con-
dition there are one or more ovoid lesions, or transverse bands,
consisting of loss of tissue substance; the bases of these lesions
are surrounded by raised borders and are covered by numerous
small depressions with ragged outlines. Hairs, or masses of
vegetable fibers project from the depths of these depressions,
sometimes in such quantities that they hide the entire lesion
from view (Fig. 102). Thus in a section of the tongue there
Anatomical Changes. 651

may be seen whitish-gray spots penetrating to a certain extent
below the surface of the mucous membrane; when subjected
to pressure these will discharge greenish-yellow masses of plant
food imbedded in a tough enveloping substance. The borders
of these spots are surrounded by yellowish-gray, firm nodules
which contain a cheesy or pus-like mass in which are found
gray or brownish actinomyces colonies as large as grains of
sand. In addition to this, fistulous canals may occasionally
penetrate the substance of the tongue. These canals are sur-
rounded by a firm connective tissue wall from which hairs and
small nodules project, the latter being filled with decomposing
food particles mixed with a cheesy, fatty mass emitting a
highly disagreeable odor (Breuer).

According to Breuer’s statistics this form of actinomycosis of the tongue
occurs in over 20 to 25% of all cattle one year of age, or more, and in the great
majority of Hungarian draft oxen slaughtered in the abattoirs of Budapest. On
the other hand Nicolaus found in Silesia (Glogau) 88.5% of affected cattle to
be under 4 years of age and only 19.5% above 5 years. This difference is possibly
due to the fact that Hungarian draft oxen are usually not stable fed until after
they are 4 years of age.

In some cases nodules and tumors are found, varying
in size from a millet seed to that of a hazelnut, scattered
throughout the mucous membrane and in the muscle substance
of the tongue, especially the lateral portions of this organ.
These tumors may be visible as prominences under the mucous

 

Fig. 103. Actinomycosis of the Tongue with Pyramidal Tumors on the Surface.

membrane of the tongue or project in the form of a fungoid
mass through the opening in the mucous membrane, with
characteristic, sharply defined borders resembling holes made
by a punch (Johne; Fig. 103). -
In a more advanced stage of the disease the interstitial
connective tissue of the tongue is much proliferated and usually
contains numerous nodes that have undergone softening while
the consistency of the organ which is much enlarged is very
firm and almost wood-like, hence the name ‘‘woody tongue.’’
The upper surface of the tongue may contain cicatricial con-
652 Actinomycosis.

tractions which occasionally cause marked deformity of the
organ, especially an abnormal upward curvature and a contrac.
tion of the whole organ (Axe).

In the maxillary bones the disease usually begins in the
marrow cavity or periosteum. In the first instance the spongy
bone substance is replaced by a soft sarcoma-like tissue re-
sulting in breaking down of the bony trabeculae and distension
of the lamellae. The affected bone appears much enlarged
with the external lamella considerably thickened as a result
of osteoplastic inflammation (periostitis ossificans), eventually
becoming perforated. This is followed by the projection of
soft cauliflower-like proliferations under the skin, into the
mouth or into the pharynx.

In the interior of the tumor the bony substance has been
reduced to an open network composed of thin trabeculae, as
may be recognized upon section by its white color and hard
consistency. The soft tissue proliferation surround also the.
roots of the teeth and may cause them to be forced out of
their alveoli. Thus teeth with healthy crowns may be found
to have their roots imbedded in the soft substance of a tumor.

The granulations which project from the gums consist of
hemispherical, irregular masses varying in size from a pea
to that of a walnut. Sometimes they perforate the gums or
mucous membranes and project into the mouth cavity. Fre-
quently they present an ulcerous surface.

After maceration the affected maxillary bone appears to consist. of a more
or less perforated external bony lamella and an internal open spongy structure.
This condition recalls vividly to mind the deformity formerly designated as ‘‘spina
ventosa’’ resulting from myelosarcomatous invasion. It is significant that
actinomycomata usually develop near the molar teeth and are only exceptionally
met with on the toothless portion of the gums or in the region of the incisors
(Moussu).

Tumors originating in the periosteum of the maxillary
bone are usually much firmer and tougher in consistency while
upon section they are found to contain fewer and smaller
centers of softening. They occur on the external or internal
face of the maxilla, occasionally also near the incisors and
are attached only loosely to the skin or mucous membrane,
but are firmly united with the periosteum. In exceptional
cases they may give rise to the development of so called
‘‘dermal’’ horns with bony bases (Johne).

Tumors of the superior maxillary bone are apt to spread
to the subparotideal region and to the fossa pterygo-palatina.
Tn exceptional cases they force themselves through the natural
foramina, perforate the flat basal bones of the cranium, and
enter the cranial cavity, affecting the meninges and even the
brain itself. On the other hand they may extend from the
alveolar process to the antrum of Highmore. The disease may
also develop primarily in the latter (Bang). In such cases
after filling out the antrum and breaking down the bony tissue,
Anatomical Changes. 653

the tumor may perforate the skin of the face in the temporal
region, or the hard palate, and project into the oral cavity.

When occurring in the pharynx, actinomycomata consist
of mushroom-like polypous tumors, slightly pedunculated and
occasionally filling the entire pharyngeal space. On the other
hand they may be observed as more or less prominent, irregular,
or lobulated tumors under the skin on either side of the throat.
In some instances these retropharyngeal tumors which consist
almost wholly of granulation tissue containing soft, grayish-
yellow foci, may also contain large abscesses which may per-
forate to the interior or to the exterior, as the case may be.

Actinomycosis of the esophagus is very rare. Siedam-
grotzky & Johne observed small flat subepithelial nodules, the
larger nodules containing a yellowish transparent focus. The
confluence of the smaller nodules gave rise to larger irregular
groups which projected into the esophagus. In rare instances
large polypi may be observed, or roundish tumors with smooth
surface may occur on the esophageal wall near the larynx
(Joest).

In exceptional cases actinomycosis has been observed in
the omasum (Bollinger), in the reticulum (Johne), in the
abomasum and small intestine (Perroncito, Jensen, Axe), occur-
ring either in the form of tumors resembling fibromata or
sarcomata, roundish in form or lobulated, and containing soft
foci in the interior, or in the form of morbid changes resembling
tuberculous ulcers. In nearly all cases adhesions had occurred
in the affected portions of the intestine.

In the affection of the abdominal organs we occasionally
find the peritoneum covered with numerous actinomycomata
of various sizes, the latter also being frequently present between
the tough pseudo-membranes which unite the affected organs
and loops of intestine. These tumors are frequently suppurat-
ing or ichorous. The liver often contains metastases. Whether
or not actinomycosis of the peritoneum ever occurs (as is
assumed by Jensen) is as yet an open question.

Actinomyeosis of the respiratory organs is of much less
frequent occurrence. Kitt observed involvement of the nasal
mucous membrane in the form of grayish-white nodules as
large as millet seeds and containing yellow centers. Bragadio
observed excessive proliferation and Réoders, in one instance,
saw a tumor which developed near the opening of the nostrils
and almost completely obliterated them. Stadie and Kutsera
each found in one instance diffuse infiltration of the mucous
membrane of the nose and its sinuses, the mucous membrane
was firm in consistency, irregular on its surface and in some
places 5 mm. thick. Its substance contained numerous grayish-
yellow nodules. _These nodules, some of which were as large
as peas, were frequently confluent, forming folds and ridges
or more extensive prominences (Kutsera referred to this form
as actinomycosis confluens). Similar nodules may also occur
654 Actinomycosis.

on the epiglottis (Johne), while sessile pedunculated tumors
as large as a hen’s egg, of spongy or firmer consistency, may
form in the larynx.

In the lungs the disease is manifested by numerous gray
or yellowish tubercle-like nodules or tumors which are present
in large numbers in the lung tissue and contain a thick, mayon-
naise-like pus in their centers. Now and then an atelectatic
or marbled area of lung tissue may be riddled with foci con-
sisting of pus or tissue detritus. In such cases the .pleura is
thickened, occasionally covered with pedunculated tumors, or
the visceral and parietal layers are adherent. In exceptional
cases there may be hydropneumothorax (Moussu).

The lymph glands are rarely affected and as a rule only
as a result of disease of the neighboring organs. They then
form firm tumors containing white or yellowish, glistening,
non-caseated nodules surrounded by a connective tissue capsule
and imbedded in the tough connective tissue of the substance
of the gland. The submaxillary, pharyngeal, subparotidial and
mediastinal glands are most frequently affected.

In contrast to the not infrequent occurrence of this disease in the lymph
glands of cattle, actinomycosis of these organs has never been observed in man
(Ponfick, Israel, Bostrém, etc.). Schuhewitsch has observed the disease in the
lymph glands and its dissemination through the medium of the lymph vessels in
from 15 to 20% of all cases observed in cattle at the abattoir of Moscow.

Actinomycosis is occasionally observed also in the follow-
ing organs: In the liver (Rasmussen observed 20 cases in the
course of one year in the abattoir of Copenhagen; in a case
described by Balas infection was produced by a piece of wire.
in the reticulum), in the spleen, in the kidneys, in the brain,
in the basal meninges, in the diaphragm, in the testicle
(Kowalewsky observed one case in which this organ was ex-
tensively affected), in the uterus, in the vagina, in the bladder,
in the bones and in the muscles. In the muscles the disease
appears in the form of fibroma- or sarcoma-like masses and
in the form of pus foci containing yellow, sandy formations
and enclosed by means of a thick, tough connective tissue
capsule.

Actinomycomata in the skin appear either as primary
lesions or as a result of the extension of lesions in the under-
lying tissues. This is particularly common in young animals
in which they occur below the ear and behind the lower jaw.
They are much more rarely met with in the subcutaneous con-
nective tissue, for instance, near the larynx where they appear
in the form of firm nodules, or in other regions of the body
where they appear as whitish, soft, but firm, foci. Infection of
the lips manifests itself by thickening and induration of this
organ.

Primary actinomycosis of the udder is rare, but when
present, it appears in the form of nodes varying in size from
a bean to that of a walnut, enclosing soft purulent contents and
Anatomical Changes. 655

imbedded in one or more lobes of the gland. In rare cases
the gland is enlarged; section of the udder shows enlargement
of the affected lobules which contain small, yellow points in
their centers so that the cut surface appears granulated and
suggests the picture of miliary tuberculosis (Jensen).

Generalized actinomycosis is very rare. In such cases
metastases are present chiefly in the lungs, in the liver, in
the kidneys, in the brain, in the subcutaneous connective tissue,
in the udder and, finally, also in the internal as well as external
lymph glands.

Localization of the lesions of actinomycosis seems to vary according to its
geographical occurrence. In the compilations made by Mitteldorf for Bavaria,
including 3621 cases, the head and neck were affected in 75.5%; the tongue in
23.3%, the abdominal organs in 0.77%, the udder in 0.05%. Imminger found the
head and neck affected in 85 to 90%, the tongue in only 4 to 8% of all cases
observed. In the abattoir of Budapest on the other hand, actinomycosis of the
tongue is much more frequent than disease of the maxellae (Breuer). In Russia,
according to Jelenenszki, disease of the lips is conspicuously frequent, thus 37.9%
of all cases observed in Moscow, 85.9% in Tiflis, 81.6% in Jelisawetgrad.
Kowalewsky also found the head affected in 99% (1465 cases) of which number
57% were affections of the submaxillary lymph glands 6% of the retropharyngeal
lymph glands, 8% of the lower lips. According to Mari (Moscow) on the other
hand, the skin is the most frequent seat of the disease (271 out of 541 cases),
next in order being the parotid gland, 177 cases, and last the bones of the head,
117 cases (this author classifies tumors extending. from the skin or from the glands
to the maxillary bones according to the original point of infection). According
to Schouten the tongue is the most common seat of the diseare in England, Ger-
many and Italy, the maxillary bones in France and the lips in Russia, the liver in
Denmark, the submaxillary and sublingual glands, the lungs and the maxillary
bones in Holland. In the abattoir of Amsterdam 33 to 65% of all cases were
affections of the udder.

In horses actinomycomata develop most frequently in the
inguinal canal where they may attain the size of a child’s head
and may extend into the abdominal cavity. Their tough con-
nective tissue contains yellowish gelatinous foci in which are
imbedded the actinomyces colonies (the anatomical structure
is much the same as that in botryomycosis of the spermatic
cord). Actinomycosis has also been observed in the superior
and inferior maxillae and in the submaxillary lymph glands
(Schmidt), in the cervical and bronchial glands, in the tongue,
‘the lips, the udder, the bones and the muscles (Struwe, in
generalized form), in the lung, liver and spleen (Bruschettini)
as well as in the skin and in the subcutaneous connective tissue.

In swine primary actinomycosis of the mammary glands
is the most frequent form of the disease (Rasmussen observed
in Copenhagen 52 cases in the course of 3 months). The
mammary glands become partially or wholly transformed into
a firm swelling approaching the size of a man’s head, and on
the surface of which the teats seem shrunken and not infre-
quently gangrenous. The main mass of the tumor in these
as in other animals consists of a very tough connective tissue
structure, lardaceous in appearance and in it are imbedded
small or large abscesses filled with greenish-yellow pus or foci
consisting of soft, marrow-like tissue. These foci frequently
656 Actinomycosis.

contain minute yellowish points and small cavities which sug-
gest on cross section the appearance of a sieve or a sponge.
Tumors occurring in the region of the elbow or under the
abdominal wall have a similar structure.

Actinomycosis of the tonsils is also frequent (Johne).
This may be followed by abscess formation in the peri-
pharyngeal connective tissue. The maxillary bones, the larynx,
the lungs and occasionally other bones may also become affected
in swine. Metastatic infection may occur in various internal
organs, the pathologico-anatomical changes being similar to
those observed in cattle, with the difference, however, that
actinomycosis of swine, like the disease in human beings, fre-
quently manifests itself in the form of extensive suppurations
which may extend to the subcutaneous retropharyngeal and
prevertebral connective tissue, causing a breaking down of the
tissue elements and leading to the ultimate formation of ab-
scesses and fistulous canals under the serous membranes and
the glands. This destructive process may extend from the
prevertebral connective tissue to the vertebrae themselves. As
a result the periosteum of the latter is destroyed. They be-
come rough and soft from loss of tissue, and their spongy
substance contains small pus foci. In this manner the process
may spread from the retropharyngeal connective tissue, fol-
lowing the course of the prevertebral connective tissue along
the back or to the mediastinum, and after destruction of the
bodies of the vertebrae into the vertebral canal itself.

In actinomycosis of the tongue its parenchyma contains
abscesses approaching a hazelnut in size and consisting of
coagulated masses of pus containing actinomyces colonies, or
of a conglomeration of actinomyces colonies 6.0 mm. or less
in length and surrounded by a connective capsule (Hollandt
observed such lesions in 11 out of 170 tongues).

In the generalized form of actinomycosis there are now
and then metastatic abscesses in almost any of the organs,
including the brain, the bones, the lymph glands and serous
membranes. The primary focus may have its seat in the
mucous membrane of the digestive tract or in the skin (Knoll,-
Carl, Zietsehmann, Assmann).

In sheep and goats actinomycosis is very rare, but when
present, it is usually found in the tongue. In exceptional cases
the lips, the jaws and the lungs may also be affected. (Berg
observed three cases among 400,000 sheep. Zala-Szent-Gréth
observed the disease in the tongue of three sheep in a flock of
42.) The pathological changes are similar to those in cattle.

Fumagalli observed the disease in a dog in the form of
a firm swelling of the gums (epulis) about the size of a walnut,
while Rossi found numerous nodules in the lungs of two cats
40 days, old. The lungs of one of these contained a mass of
firm connective tissue studded with actinomyces colonies, some
of which were calcified.
Actinomyeosis of Cattle. 657

Symptoms. The pathological changes deseribed above may
be recognized intra vitam as far as they are accessible by
external examination.

Actinomycosis of Cattle. In actinomycosis of the lips
which is quite common in some regions, there are to be found
round or ovoid, firm tumors that have a tendency to undergo
softening in the center. These
tumors occur in the submucous
connective tissues of one or both
lips and vary in size from a pea
to that of a walnut. In exceptional
cases excessive proliferation of
fibrinous connective tissue is noted
in the surrounding region, as a re-
sult of which the upper lip is
transformed into a firm and rigid
mass sometimes 56 em. in diameter
(Fig. 104),

The first stage of actinomyco-
sis of the tongue, when it occurs
in the form of a dorsal ulcer as
already described, is usually unob-
served. When the muscle sub-
stance becomes affected to any ex-
tent, the movement of this organ,
and consequently also mastication,
are interfered with. The animals
lick their noses, saliva flows from
the mouth while closer inspection
reveals the presence of the above
described ulcers on the rigid and
painfully sensitive tongue. The is cae

: : : Vig. 104. Actinomycosis of the
secretions of the ulcers contain goer Tip. Cured by internal
colonies of actinomyces. In more application of potassium iodide.
serious or advanced cases the
tongue becomes swollen and as a result is foreed out of the
mouth, its tip usually being ulcerated and covered with a foul
secretion emitting a disagreeable odor. The surface of the
tongue is coarsely bosselated and the organ itself is firm, almost
wood-like in consistency.

Actinomyeosis of the jaw bones (Figs. 105 and 106) is
usually not observed until the head of the affected animal pre-
sents more or less of a deformity. Myelogenic actinomycomata
produce only a uniform swelling of the body of the jaw bone,
which in itself, however, may prevent mastication. If the
process extends from the bone to the masseter muscles mastica-
tion may be seriously interfered with and the condition may
even result in trismus, which is, however, in some cases, only

Vol. 1—42

 

 

 
658 Actinomycosis.

temporary. The general nutrition of the animal may be in-
terfered with as a result of the soft pathological tissues in
which the teeth are now imbedded. In some cases tissue masses
project through the external bony plate of the maxilla and
may there be “palpated under the skin as lobulated ulcers. In
other cases the skin may be ulcerated at one or more points,
resulting in the formation of a purulent secretion containing
actinomyces colonies and covering the surface of the cauliflower-
like mass of granulation tissue. The submaxillary lymph glands
may be enlarged, firm, slightly movable and _ eventually
ulcerated.

In the skin or subcutaneous connective tissue (Figs. 107
and 108) there is usually a firm, elastic tumor posterior to
the angle of the jaw, below the ear, on the cheek or at the neck.
This firmly unites with the overlying skin, which it usually

 

Fig. 105. Actinomycosis of the Upper Jaw.

perforates, and discharges a thick creamy pus or pus-like mass
containing tissue detritus and coagulated pus elements. In
other cases the cavity thus formed becomes filled with granula-
tion tissue which may project beyond the surface of the skin
in the form of a cauliflower-like tumor, the surface of which
is covered with crust. Upon removal of the scab the surface
is bright red, the slightest contact causing bleeding. Numerous
minute yellowish points from which small drops of pus may
be pressed out may also be observed. In some cases pus foci
Actinomycosis of Cattle. 659

may appear in a number of places and discharge their con-
tents, while the surrounding skin and subcutaneous connective
tissue is swollen and edematous, thus producing conspicuous
deformity of the affected region of the body (in a case observed
by Moussu the head had the appearance of the head of a
hippopotamus, as a result of diffuse infiltration of the skin
and subeutaneous connective tissue of the face and the entire
maxillary space). In rare cases the process is arrested spon-
taneously, whereupon the tumor gradually recedes, swelling
subsides, the tenseness of the surrounding tissue disappears
and finally recovery takes place.

Large tumors may also occur on the extremities, Liipke observed
an infection of the foot beginning in the interdigital space and resulting
in a condition resembling elephantiasis. In a similar case reported by
Gulyas the leg was enlarged from the middle of the carpus down to
three times its natural size, its surface being wrinkled and covered with
nodules, the flexor surface of the pastern containing a granulating
ulcer as large as a dinner plate. The calloused subeutaneous connective
tissue and the underlying muscles contained numerous nodules ranging
in size up to that of a hazelnut, the lymph vessels were much enlarged
and numerous nodules were seattered along their course to the sacrum.
The popliteal glands formed an extensive cauliflower-like mass.

Actinomycomata
developing in the
wall of the pharynx
or in the neighbor-
ing areas will ex-
tend into the sub-
parotideal region,
and interfere with
deglutition. As a
result rumination
is interrupted, ani-
mals take less food,
there is more or
less salivation, but
in spite of this, the
general nutrition
may not be serious-
ly affected for sev-
eral months. Res-
piratory difficulties
are more pro-
nounced, the act of
respiration beimg Fie. 106. Actinomycosis of the Lower Jaw.
attended by loud
whistling or rat- ’
tling sounds which are very audible when the head is depressed.
When the head is extended tumors in the subparotideal region
may be palpated with the fingers either from the exterior or by
inserting the hand through the animal’s mouth. Animals may

 

 

 
669 Actinoniycosis.

also cough from time to time, especially while feeding, some-
times also in the act of swallowing, the cough is strong, dry
and whistling. :

Sometimes large numbers of calves in the same herd will
be found affected in the region of the larynx as manifested
by the appearance of firm tumors as large as a man’s iist in
the perilaryngeal connective tissue. The presence of these
tumors interfere with respiration much the same as tumors
within the larynx, the presence of which may be recognized by
the whistling, rattling or stenotic sounds produced during in-
spiration.

Affection of the esophagus manifests itself in difficult
deglutition (dysphagia) and other symptoms of esophagus-
stenosis. The cause of this trouble which develops very
gradually is usually not disclosed until after the death of the
animal, although it may be suspected during life when actinomy-
cotic tumors are present on other parts of the body, especially
the neck. (In one ease reported by Ujhelyi an affection of the
peribronchial and mediastinal lymph glands produced chronic
meteorism.)

The symptoms of actinomycosis of the lungs are not very
characteristic. In cases thus far observed only symptoms of
chronic pulmonary disease have been noted, the nature of which
was not disclosed until post-mortem
examination. The bronchial secre-
tions in such cases might possibly
contain actinomyces and their dem-
onstration would establish the diag-
nosis with certainty.

Actinomycosis of the udder man-
ifests itself either in a firm enlarge-
ment of the whole organ or in the
appearance of firm, sharply cireum-
seribed, somewhat painful nodes as
large as walnuts, which may be
scattered throughout the gland, but
particularly through the upper por-
tions of one or more quarters. In
ease these nodes should discharge
their contents into the milk ducts,
the milk of the corresponding milk
Bie Ald: ACARe Hee GE ALS cistern will contain pus and he of a

sin ropy consistency; in some cases

(According to Pda). there is merely a slight discharge
; of a ecaseo-purulent mass. In some
instances we may be able to recognize actinomyces colonies in
the milk with the unaided eye, though better with a microscope
(Klepzow). The supramammary lymph glands are not enlarged
as they are in tuberculous disease.

Actinomycosis of the cerebral meninges manifests itself

 
Actinomyeosis of Cattle. 661

by the appearance of symptoms of meningitis consisting at
first in disturbance of consciousness, unsteady gait, falling
down, climbing into the manger and finally, pronounced coma
(Assmann).

Gorig observed one case in which the testis was consider-
ably enlarged, very firm and sensitive. The skin of the scrotum
contained an ulcer as large as a five cent piece, which dis-
charged a caseo-purulent secretion. A similar case has been
described by Petit. Disease of the scrotum exclusively is men-
tioned by Hell—Poes observed one instance in which an
actinomycoma penetrated the spinal canal in the region of the
seventh cervical vertebra, obliterating the greater portion of
its lumen up to the fifth vertebra. This was attended by symp-
toms of general muscular weakness, fear, difficulty in degluti-
tion, attacks of mania and finally spasms of the muscles of the
anterior extremities.

 

 

Fig. 108. Actinomycosis of the Intermaxillary Space and the Subparotideal Reg‘on.

Among horses this disease is quite rare, but when present,
usually affects the spermatic cord (fistula of the spermatic
cord). Affection of other organs produces symptoms similar
to those produced in the corresponding organs of cattle.

Affection of the intermaxillary lymph glands is of par-
ticular interest. It may be primary and bear some resemblance
to glanders. However, an actinomycotic tumor is more lable
to suppurate, and the retropharyngeal and the superior cervical
lymph glands are usually also affected in this disease (Schmidt,
662 Actinomycosis.

Roettger). Tumors on the neck may attain an enormous size,
sometimes interfering with the lateral movement of the head
(Bonchet).—Actinomycosis of the superior maxilla was ob-
served in a mule by Aubry, affection of the spinous process
of the superior maxilla by Rousselot, while in a case described
by Hamburger the clinical picture of actinomycosis of the bone
resembled that of rachitis.

In swine actinomycosis of the mammary glands usually
appears in the form of a nodulated, painless swelling and in-
duration of the base of the teat. Subsequently this process
spreads to the neighboring teats and glandular substance, thus
producing the deformity of the mammae already described.
Affection of the tonsils usually does not attract attention. In
rare cases, however, they may become much enlarged and then
are accessible to palpation in the region of the pharynx. Cold
abscesses which occur in the pharyngeal region and frequently
attain the size of a child’s head are nearly always of an
actinomycotic nature. In actinomycosis of the ear the de-
formed, firm concha may attain a weight of 3 kg. (Junack).

Course. The course of actinomycosis is always chronic
and may extend over months and even years. Especially when
it kas its seat in the interior of bones, the disease develops
at first very insidiously, and in such cases it is usually not
recognized until conspicuous deformity of some external organ
of the body has developed, or, in case of affection of the maxillae,
disturbance of nutrition or respiration become evident. In
spite of the presence of the disease of the maxillae or the
tongue, affected animals may nevertheless remain for a long
time in good condition, in fact the presence of pharyngeal
tumors which may interfere with deglutition as well as respira-
tion, may not prevent the affected animal from taking on flesh.
Finally, however, such conditions will exert an injurious in-
fluence, the affected animals may no longer be able to feed
properly, they lose flesh, become emaciated and finally die from
exhaustion. In rare cases polypous tumors in the pharynx
may close the lumen of the larynx and cause suffocation.

The presence of tumors in the skin and in the subcutaneous
connective tissue may not interfere with the general condition
of the affected animal for a long time, it is only when they are
very extensive that they disturb the functions of neighboring
organs or tissues. On the other hand tumors in the region
of the larynx and especially when they occur within this organ
may produce serious disturbance of the function of respiration
hefore they become very large.

The course of the disease is unattended by fever as long
as it remains of a local nature; when suppuration becomes
more profuse (mixed infection) as well as during the develop-
ment - numerous metastases a rise of the body temperature
is noted.
Course, Diagnosis, Prognosis. 663

Diagnosis. In doubtful cases the diagnosis of actinomycosis
may be confirmed by the demonstration of actinomyces in the
tissues or secretions. The fungus colonies which are usually
yellowish and of the size of a poppy seed, may be seen by the
unaided eye. Under the microscope, however, they are readily
recognized in unstained preparation by their glistening, club-
shaped structure (in case of existing calcification treatment
with hydrochloric acid is necessary). When stained according
to Gram’s method the central mycelial mass may be recognized,
and in the same manner branching threads of mycelium may
be found in the purulent secretion. The presence of the latter
is sufficient evidence upon which to base a diagnosis.

In regard to the differential diagnosis of superficial tumors,
sarcomata, lymphomata and botryomycomata are of particular
importance. In affection of the tongue, other inflammatory con-
ditions of this organ as well as tuberculosis should be kept in
mind. The laiter disease should also be taken into considera-
tion in the occurrence of subcutaneous tumors, although tuber-
culous lymph glands usually do not in mature cattle become
adherent to the skin, and consequently do not break open and
discharge their contents. There is also no diffuse infiltration of
the surrounding tissues in the latter disease. As a matter of
fact, however, the clinical pictures of tuberculosis and actino-
mycosis, especially in affection of the udder, bones and the
lungs have much in common, and a positive differentiation
between the two diseases is possible only by an exclusion of the
presence of secondary affection of the regional lymph glands
as well as the exclusion of similar changes in more remote
organs. The positive results of microscopical examination of
secre‘ions or tissue masses are of course always final. In
regard to other affections of the udder, the differentiating char-
acteristics are similar to those referred to under tuberculosis
of the udder (see p. 591). The enlargement of the regional
lymph glands and the absence of yellowish granules in the secre-
tion of the ulcers of the tongue are sufficient to differentiate
between actinobacillosis and actinomycosis.

Prognosis. The prognosis may be considere? 1s favorable
in those cases in which the seat of the disease is superficial and
accessible to surgical treatment. Actinomycomata in the sub-
parotideal or cervical regions may in exceptional cases termi-
nate in spontaneous recovery (Bang, Jensen). In such cases
the tumor becomes encapsuled in tough, fibrous tissue, which
checks the further progress of the disease (cicatricial contrac-
tions so frequently observed in the tongues of cattle are evi-
dently, for the greater part at least, the result of actinomycotic
lesions). Since the introduction of the potassium iodide treat-
ment for actinomycosis, the prognosis of the affection of the
internal organs can be made much more favorable. However,
the prognosis of the disease in bones is always unfavorable.
664 Actinomycosis.

Treatment. The quickest and most certain results are
obtained by the total extirpation of the actinomycotic tumor,
but such treatment is to be considered only when the tumor is
sharply circumscribed and surrounded by healthy tissue, thus
permitting easy removal (pedunculated actinomycomata of the
pharynx may be removed through an opening in the subparo-
tideal region [Harms, Mayer]). Very large cutaneous tumors
are treated most satisfactorily by deep incisions followed by
thorough curetting and the application of gauze or tow dipped
in tincture of iodine. A very practical method and one which
frequently proves successful, consists in inserting a trocar and
canula into the apex of the tumor, permitting the purulent con-
tents to escape after withdrawal of the trocar, irrigating the
abscess cavity with water and then inserting with the aid of
forceps a lump of arsenious acid 1 to 2 g. in weight. This is
followed by necrosis of the tumor mass, whereupon sequestra-
tion from the surrounding tissues and recovery follows (Heine,
Kovanyi). Actinomycosis of the tongue, if not too advanced,
frequently terminates in recovery after simple scarification and
application of tincture of iodine or iodovasogen (10%).

Moussu has succeeded in bringing about recovery in actinomycosis of the jaw
by removal of the superficial tumor, curetting the interosseous tissue and internal
iodine treatment.

In cases where these methods are impracticable or im-
possible, parenchymal injections of antiseptic remedies fre-
quently produce good results. Tincture of iodine, Lugol’s solu-
tion (10 to 15 gm.) and iodovasogen (8 to 12 gm. of a 10%
solution) are well adapted for this purpose. External applica-
tions of caustics, e. g., ung. argen. (1 : 8) or cantharides oint-
ment with iodide of mereury (8 : 1) are also recommended.
After suppuration has resulted in breaking down of the tumor
mass, the latter should be incised and the abscess thoroughly
irrigated.

The internal iodine treatment, recommended in 1885 by
Thomassen on the basis of results obtained from 80 cases
treated by this method, is very effective (a special commission
investigated the merits of this treatment in the United States
and reported 131 complete cures among 185 cases treated). The
treatment is recommended particularly in such cases when sur-
gical treatment is for some reason impossible and when the
affected animals are still in good physical condition. Affection
of the tongue or larynx, as well as of the skin and subcutis, is
very responsive to this treatment, while actinomycosis of the
bones is much less so.

The treatment consists in the internal administration of potassium
iodide, ‘young cattle receiving 2 to 4 gm., adult cattle 5 to 10 gm. daily
in their drinking water. The treatment is continued from 2 to 4 weeks
or until the complete disappearance of the tumor and ulcers. In
case symptoms of iodism (nasal and conjunctival catarrh, cutaneous
Treatment, Prevention. 665

eruption, loss of hair, emaciation) appear, the daily dose must be 4e-
creased or the treatment must be suspended for 5 or 6 days. The
effect is increased by external application of tincture of iodine to the
tumor, particularly to the affected tongue, or by the injection of this
solution into the tissues of the tongue. If the heart action is affected
it is recommended that sodium iodide be administered instead of the
potassium iodide. Prietsch observed good results from the internal
administration of iodovasogen in doses of 10 gm. of a 10% solution
administered at 5-day intervals, while Blume and Dorn recommended,
in addition, the injection of the tumor with the same substance. On
the other hand Mitteldorf obtained very favorable results even in
advanced cases from the direct injection into the tumor of iodipin
(40 to 100 gm.) and the administration of similar doses per os. Franz
recommends this remedy for both external treatment (25 to 50 gm.
of a 25% solution injected into the tumor or applied to its surface)
and internally 15 gm. per day.

Prevention. In regions where the disease is enzootic it is
recommended that hay and straw from low, damp soil be
excluded from feeding. Young cattle should not be permitted
to graze on low or damp pastures. In a number of instances
it has been found that green feed which had been known to be
dangerous could be fed with impunity after being scalded or
steamed. The dangerous character of certain pastures and
meadows may, however, be ameliorated by proper cultivation
and drainage.

Literature. Bollinger, D. Z. f. Tm., 1877. ITI. 334. — Johne, Tbid., 1881.
VI. 141; 1888. XIII. 140. — Ponfick, D. Actinomykose d. Menschen, Berlin. 1882.
— Bang, D. Z. f. Tm., 1884, X. 233. — Thomassen, Echo. vét. belge, 1885. XV.
409, — Bostrom, Beitr. z. path. Anat., 1890. IX. 1. — Rasmussen, D. Z. f. Tm.,
1891. XVII. 455; 1894. XX. 299. — Salmon, An. Ind., 1891 u. 1893. — Jensen
Monh., 1893. IV. 166. — Imminger, Monh., 1899. XI. 129. — Breuer, Z. f. Flhyg.,
1901. XI. 103 — Assman, D. t. W., 1904. 63. — Mitteldorf, ibid., 1904, 402. —
Ligniéres & Spitz, Bull., 1905. 64. — Hollandt, A. f. Tk., 1905. XXXI. 417 (Lit.).

— Wright, Public. of the Massachusetts Gen.-Hospital, 1905. I. 1. — Nicolaus,
.Diss. Bern, 1908 (Lit.). — Kowalewsky, Hyg. de viande, 1909. III. 204.

 

Actinomycosis of Man. This rather rare disease is caused by the
same actinomyces which produce the disease in cattle. The localization
of the morbid processes is also very similar to that observed in actinomy-
cosis of cattle. The morbid changes which are most frequently observed
in the gums, in the lungs and the maxillae, consist either of small, firm
tumors or more frequently of larger cold abscesses or fistulous ducts
surrounded by a very tough lardaceous connective tissue. As in the
ease of animals, infection usually occurs through the medium of plant
tissues (awns of barley) either in the gums, the dental alveoli (especially
in the presence of defective teeth) or in the mucous membrane of the
mouth or larynx, the esophagus or intestine. In much rarer instances
infection may take place from the skin. Direct transmission of the
disease from cattle to man has not been established. ‘

Literature. Kordnyi, Nothnagels Spez. Path. u. Ther., 1897. V. Bd. I. T

 

Actinobacillosis. Under this name Ligniéres & Spitz (1902)
described a disease of cattle which occasionally assumed an epizootic
666 Actinobacillosis.

character in Argentine, sometimes 50% of all animals in a herd becom-
ing affected in the course of a few weeks. As a rule, however, the
disease occurs more or less sporadically. It has also been observed
in a Rambouillet ram by the same authors, while Nocard and Petit
observed it in France, Bongert in Germany and Higgins in Canada
among cattle.

The clinical symptoms and anatomical changes are almost precisely
the same as those of actinomycosis bovis. As in the latter disease the
most frequent lesions consist of large, firm swellings gradually under-
going softening: in the center, occurring in the skin and in the sub-
cutaneous connective tissue of the pharyngeal region; so called woody
tongue and polypous swellings of the pharynx constitute the most
frequent lesions. The jaw bones, the udder and the lungs are much
more rarely affected. On the other hand, however, the lymph glands
and occasionally some of the salivary glands are involved. Simul-
taneously with the development of the local changes the animals suffer
in their general nutrition and when tumors are present in the pharynx
or in the pharyngeal region, the disturbance of nutrition and respira-
tion’ may become so great that the affected animals finally succumb
to the effects of inanition.

In the purulently softened foci of the tumors are found granules
varying in size up to that of a millet seed, readily visible to the unaided
eye, but in contrast to the colonies of actinomyces they are grayish-
white in appearance. Slightly yellowish and occasionally also calcified
granules occur exclusively in the sarcoma-like tumors of the maxillae.
Fresh pus examined under the microscope contains club-like structures
which are branching at the larger end, the pointed ends converging to
form radiating colonies which, however, contain no mycelium centers.
These structures are easily stained with acid dyes or with picro-carmine-
glycerin. On the other hand they do not take Gram’s stain nor can
threads of mycelium be demonstrated in the pus.

Pus triturated in a mortar and inoculated in alkaline food media,
when kept at body temperature for 24 hours, will produce small, glisten-
ing colonies of a small bacillus hardly exceeding that of fowl cholera
in size, forming long chains in bouillon and not staining after Gram.
Cultures on agar resemble those of the typhoid bacillus. This bacillus
acidifies grape sugar agar and milk, but does not coagulate the latter.
The indol-reaction is not pronounced. Fluid cultures contain toxins
which, when injected into cattle, produce an elevation of temperature
of from 1 to 2.5° C. persisting for several hours, trembling and loss
of appetite. The cultures are only slightly resistant to the influence
of external agencies. Simple drying or heating to 52° C. destroys
them rapidly. Grown at 37° C. in the thermostat they are gradually
attenuated.

Bacilli injected under the skin of cattle collect in small groups
in the bodies of the leucocytes from which they subsequently escape
and develop into characteristic actino colonies. The center of these
colonies, the ‘‘germinative zone’’ consists of small bacilli which are
held together by a sticky substance while the outer zone consists of
club-shaped projections which continue to grow and undergo digitate
branching (‘‘vegetative zone’’).

Pathogenicity. In guinea pigs intraperitoneal injection of bouillon
cultures produces purulent peritonitis with characteristic colonies in
the exudate, while subcutaneous injection is followed by the formation
Streptotrichoses, Farey of Cattle. 667

of abscesses which do not contain these structures. In horses, asses
and cattle intravenous injection is followed by phlebitis and thrombus
formation while subcutaneous injection of these animals as well as
of sheep is followed by abscess formation. In cattle and sheep these
abscesses contain the characteristic colonies while in horses only a few
bacilli are present. In these animals as well as in dogs, cats and swine
intravenous injections are followed by symptoms of intoxication, other-
wise, however, cultures are only slightly pathogenic for the last named
species of animals. They are non-pathogenic for rabbits, white rats
and mice.

Although feeding experiments have not given positive results it
seems that natural infection results from the digestive tract. The
bacteria are probably aided in their entrance into the tissues by particles
of vegetation to which they adhere. In general, the contagiousness
of the disease is only very slight and extensive outbreaks occur only
under certain favorable conditions as, for instance, after an outbreak
of foot and mouth disease.

Todine treatment has been found effective in many cases of soft
tumors. Preventive treatment consists of the destruction of badly
infected animals and isolation of the milder cases. Recovery from
the disease does not produce immunity to a second infection.

Literature. Ligniéres & Spitz, Actinobacillose. Buenos Aires, 1902; Bull,
1902. 450. — Nocard, Bull., 1902. 695. — Higgins, Canad. Dept. Agric. Biol.
Labor. Bull., No. 1. — Petit, Bull., 1905. 268.

5. Streptotrichoses.

(Atypical Actinomykoses; Pseudoactinomykosis, Actino-
phytosis.)

The term streptotrichoses is usually applied to morbid
processes produced by fungi that resemble actinomyces, in so
far as they consist of thread-like filaments undergoing true
branching, as well as in their wavy growth, and their propaga-
tion by means of division as well as spore formation, but which
differ from actinomyces in that they do not form actiniform
colonies.

The morbid processes belonging to this group are generally
characterized by chronic suppuration.

Literature. s. in Petruschky, Hb. f. p. M., 1903. IT. 832.

(a) Farcy of Cattle. Lymphangioitis Farciminosa Bovis.
(Farcin du boeuf [French].)

This is a chronic infectious disease of cattle caused by
a species of streptothrix and characterized by purulent inflam-
mation of the superficial lymph glands and lymph vessels.

History. Lymphangioitis farciminosa bovis was first described by
Sorillon (1829) and was formerly observed frecuently in France. In
668 Farcy of Cattle.

more recent times, however, it has become more rare, while it has as
yet never been observed in other parts of Europe. On the other hand
it is a common and malignant disease in Guadeloupe and on Moritz
Island. Its etiology was cleared up by Nocard, while Maillet furnished
an accurate description of the clinical symptoms. It is evidently the
same disease that Holmes observed in oxen in Calcutta.

Etiology. The cause of the disease is a streptothrix (Str.
farcinica), the branching filaments of which are readily stained
by Weigert’s method, but do not stain according to Gram.
They thrive in artificial media in the presence of air at a tem-
perature between 30 and 40° C. On agar or on coagulated blood
serum, yellowish white finely granular colonies appear which
coalesce and form a membrane; on potatoes the colonies are
dry, crumpled, and pale yellow in color; in bouillon white gran-
ules appear in the depths of the medium, and membranes resem-
bling congealed drops of fat form on the surface of the fluid.

Pathogenicity. In guinea pigs.the subcutaneous injection
of a pure culture is followed by a purulent inflammation of the
lymph vessels and glands, in the course of which the purulent
foci become ulcerous. After evacuation of the purulent con-
tents the animals which have in the meantime become much
emaciated, gradually recover. Intraperitoneal infection is fol-
lowed by the development of numerous tubercle-like nodules in
the peritoneum, while intravenous infection causes similar
changes in the parenchymatous organs. Injection of pure
cultures into the circulation of cattle or sheep produces similar
results, while infection of superficial wounds of the skin pro-
duces chronic lymphangitis.

Natural infection probably takes place by the entrance of
secretions containing streptothrices into superficial wounds of
healthy animals.

Symptoms. The morbid changes almost invariably de-
velop on the extremities and especially on the median surface,
where firm, painless strands and nodes are to be noted along
the course of the superficial veins. Subsequently these nodes
become soft and fluctuating and when incised discharge a whit-
ish, odorless mass resembling soft cheese; local healing fol-
lows within 5 or 6 days. In exceptional cases these abscesses
may break spontaneously, but as a rule they remain intact,
becoming firm and hard and consisting of white or grayish
tough lardaceous connective tissue. The regional lymph glands
become enlarged and form firm, painful tumors.

The disease progresses for 12 to 18 months without neces-
sarily disturbing the general condition of the animal to any
serious extent. Affected animals do not even get lame but are
exhausted by work. In the later stages, however, gradual
emaciation is observed, which finally terminates in extreme
cachexia.
 

Symptoms, Treatment and Prevention. 669

The disease may be confused with tuberculosis of the lymph
glands, although a microscopical examination will readily dif-
ferentiate these affections.

According to Vryburg a special form of bovine farcy occurs on
the Island of Sumatra; this begins with chronic abscess formation
of a lymph gland, whereupon the process spreads to the neighboring
lymph glands and also along the course of the lymph vessels, producing
abscesses which break, discharge a thick, creamy, odorless, rarely,
viscous, pus and become transformed into torpid ulcers. The pre-
scapular and inguinal glands as well as the lymphatic vessels of the
pectoral and abdominal region are most frequently affected. The
disease which appears occasionally as an enzootic, runs its course in
from 1 to 9 months. About 90% of affected animals recover.

The pus found in the abscess contains an immotile aero-anaerobic,
Gram negative bacillus which produces indol in cultures. It is said that
animals may be protected against natural infection by treatment with
attenuated and then by virulent cultures or by treatment with a mixture
of cultures and immune serum.

Liénaux described a disease of cattle under the name of
Lymphangioitis pseudofarcinosa which is supposed to be caused by the
bacillus of pseudotuberculosis (see p. 633).

Treatment and Prevention. Extirpation of the tumors and
cauterization of the surrounding tissue, if resorted to before the
disease becomes advanced, will occasionally check the local
process, but even in these favorable instances recurrences are
frequent.

To prevent the spread of the plague it is recommended that
all diseased animals be isolated, their morbid products de-
stroyed and all contaminated premises and utensils thor-
oughly disinfected.

Literature. Maillet, Rec., 1829. 631. — Nocard, A. P., 1888. II, 293. —
Liénaux, Ann. vét., 1905. 297. — Vryburg, Ree., 1907. 171. — Holmes, Trop. Vet.,
1908. III. 289.

Other Streptotrichoses in Ruminants and Horses. According to
Luginger cattle are subject to endocardites as a result of hematogenic
infection with a form of streptothrix which is said to constitute a specific
species (Str. valvulas destruens bovis). When injected into the blood
stream it produces purulent pleuritis as well as pseudotuberculosis
in sheep.

Berestneff observed a delicately branched streptothrix (cocco-
bacillus pseudoactinomycosis polymorphus) in a tumor from the lip
of an ox which he designated as pseudoactinomycosis. Bonvicini isolated
a species of aerobic streptothrix from a similar cutaneous affection from
a steer, which had been transmitted to several cows. Finally Zschokke
isolated and cultivated a fungus from a goat’s tongue which Silber-
schmidt described as Str. caprae.

Zschokke described an affection under the name of actinophytosis
which manifested itself by. the appearance of a tumor as large as a
child’s head in the mucous membrane of the upper lip of a horse;
in another instance there was a similar tumor as large as a man’s fist
670 Streptotrichosis of Dogs.

on the intermaxillary bone. The small soft centers contained micro-
organisms which were characterized by a radial structure and by
giving rise to destructive changes in their periphery. Their exact
nature was not determined. Complete recovery followed extirpation of
the tumors.

An affection of a horse, described by Cuillé, which developed with symptoms
of a distemper-lymphangitis and numerous abscesses, might possibly also belong
to this group. The pus foci opened spontaneously, one after the other, the creamy
pus contained in part small, white, transparent granules or larger yellowish masses
of Gram positive intertwined mycelia. Artificial cultivation was possible only in
the vacuum. The cultures thus obtained produced abscesses in horses as well as
in guinea pigs. The horse referred to showed symptoms of improvement for the
time, but finally died with symptoms of cachexia. A post-mortem examination was
not made. <A similar species of streptothrix was observed by Dean in a hard nodule
at the commissure of the mouth of a horse.

Carougeau described an epizootic disease of mules and horses in
Madagascar under the name of sporotrichosis which is characterized
by its chronic and unfavorable course and by the development of tumors
in the most varied portions of the body. These tumors are at first
firm, but subsequently they suppurate; they do not involve the regional
lymph glands. In exceptional cases nodules and chanecre-like ulcers
develop on the nasal mucous membranes. The purulent contents of
the nodules contain Gram positive. mycelia with club-shaped ends,
vacuoles in their protoplasm and also spore-like Gram positive granules.
The parasite (sporotrichum equi) is easily grown on artificial media,
propagating by means of exospores. Horses and mules have been suc
cessfully infected with sporulating cultures. Internal treatment wit
potassium iodide has been found very effective.

Literature. Luginger, Monh., 1904, XV. 289. — Berestneff, Aktinomykose
u. ihre Erreger. Diss. Moskau, 1897. — Silberschmidt, A. P., 1889. III. 841. —
Zschokke, Schw. A. 1903, XLIV. 303. — Cuillé, Rev. vét., 1905. 816. — Dean,
Transact. of the Jenner Institute, 1899. II. 17. — Carougeau, J. vét., 1909..8.

b) Streptotrichosis of Dogs. Streptothrichosis canum.

This disease, which. has been observed only occasionally, is
caused by a specific form of streptothrix. It is characterized by
purulent inflammation of the serous membranes and by sub-
cutaneous chronic abscesses.

History. In 1888 Rabe demonstrated that the ‘‘granules’’ found
in some of the pleural and peritoneal exudates consisted of the inter-
woven mycelium of a fungus described by him under the name of
Cladothrix canis. Subsequently this fungus was minutely investigated
by Bahr (1904).

Etiology. The virus of the disease (Streptothrix s. actino-
myces canis) produces long, branching filaments (Fig. 109),
which stain by the Gram-Weigert method and form occasional
celub-shaped terminals in the course of their growth.
Etiology, Pathogenicity. 671

In some respects they are similar to those found by Wolf & Israel
in subeutaneous abscesses and fistulae as well as in exudates of serous
cavities In man.

Culture. On artificial media the fungus will grow only at body
temperature, at first only anaerobically, but after repeated transfers
to new media it will thrive also aerobically. In the deeper layers of
the agar medium white, mulberry-like colonies appear in the course
of 3 or 4 days, which consist of long branched threads with club-shaped
terminals, or of short rods and spore-like structures, easily stained after
Gram in bouillon, granules as large as pin heads develop in the course
of 4 to 6 days, the medium remaining perfectly clear. Milk is not
coagulated although its reaction becomes distinctly acid.

Pathogenicity. The intraperi-
toneal administration of pure cultures
in mice produces pus foci as large
as peas on the peritoneum, while sub-
cutaneous inoculation of rabbits is
followed by the development of nod-
ules approaching the size of hazel-
nuts, consisting of a fatty or cal-
careous substance surrounded by
fibrous tissues. Similar treatment of
dogs is followed in the course of a
few days by the development of firm _ Fig. 109. Streptothria canis.
nodules which subsequently disappear Pleurse exudate; Fuchsin Stain.
or become converted into cold ab-
scesses, the slimy, reddish-gray odorless pus of which contains
streptothrix mycelia. Guinea pigs, calves and monkeys resist
experimental infection.

 

In the brain of a dog that had died after several weeks of illness
Trolldenier found numerous light grayish-white foci ranging in size
to that of a pea, some of which contained purulent centers. One of
the bronchial lymph glands was greatly enlarged and contained a
slightly purulent substance in its interior. Myccelia similar to those
described could be demonstrated in the cerebral nodes and in the affected
bronchial lymph gland. These mycelia would grow on artificial media
at room temperature under aerobic conditions. On agar the colonies
subsequently developed yellow centers, while their periphery remained
white (actinomyces bicolor). These cultures were pathogenic for mice,
guinea pigs, rabbits and dogs. Jochim described the same fungus in
a culture obtained from a dog with a phlegmonous condition in the
cervical region and numerous nodules in the internal organs.

Symptoms and Anatomical Changes. The disease usually
manifests itself by the appearance of a peculiar inflammation
of the pleura or peritoneum, in the course of which purulent or
reddish-gray, cloudy exudate accumulates in the respective body
cavities. Pronounced symptoms of fever are absent. White
granules of the size of pin heads may be recognized in this
exudate by the unaided eye, while the pleura is covered with
fibrous masses; the lungs occasionally contain firm, gray nod-
672 Streptotrichosis of Dogs.

ules as large as peas, which may be soft inside. In some cases
inflammation of the serous membranes is a sequence to external
local affection; thus, for instance, a torpid, phlegmonous inflam-
mation or abscess of the extremities, in the subparotideal region
or neck, or a fistula in the vaginal wall or in the subperitoneal
connective tissue of the pelvis. These abscesses contain a
turbid, gray or reddish-brown, thick, muco-purulent substance,
which also contains the granules referred to. The inflammatory
process which occasionally develops as the result of an injury,
e. g., of the toes (Rabe) or side of the chest (Rivolta) gradually
progresses, attended with only slight pain, and without produc-
ing conspicuous disturbance of function. After the abscesses
have discharged their contents and healing has occurred, new
abscesses will occasionally develop in other regions of the body,
or the pus in the old abscesses may burrow downward along the
course of the loose connective tissue. Inflammation of the lungs
and pleura may also develop very gradually, attended with only
a moderate elevation of temperature, until finally physical exam-
ination of the greatly emaciated animals reveals the accumula-
tion of exudate in the pleural cavity and consequent compres-
sion of the lungs. Inflammation of the peritoneum produces a
similar effect, the exudate distending the walls of the abdomen
to a greater or less extent. In other cases the presence and
exact nature of the exudate may be definitely determined by
aspirating the contents.

At post-mortem examination other organs also (spleen,
liver, kidneys, heart muscle) may be found to contain firm or
softened nodules. Now and then pus accumulations occur in
some of the joints.

Treatment. In some cases the surgical treatment of
primary nodes may bring about a complete recovery (Gohn).
As a rule, however, new nodules will develop cubcutaneously in
other regions of the body, and the emaciated animals finally suc-
cumb to the disease (aspiration of the pleural or peritoneal
exudate has in no instance proved effective).

Literature. Rabe, B. t. W., 1888. 65. — Bahr, Z. f. Tm., 1904, VIIT. 47
(Lit.). — Trolldenier, ibid., To08, “iL, Bly = Jochim, Diss, Bern, "1909 (Lit.).

6. Botryomycosis.

Botryomycosis is a chronic infectious disease of horses
which may, in exceptional instances, occur in cattle. It usually
results in the formation of local tumors resembling fibromata,
and occasionally i in the formation of metastases in the internal
organs. It is caused by the Botryomyces equi.

History. Bollinger was the first to observe the cause of the disease
in the nodules of a horse’s tongue (1869) ; subsequently it was observed
Botryomycosis. 673

by Rivolta & Micellone (1879), Johne (1884) and by Rabe (1886)
in fistulae of the spermatic cord of horses, as well as in tumors of
the withers and pectoral region. Since then the frequent occurrence
of this disease has been confirmed by numerous observations. In more
recent years Kitt, de Jong, Galli-Valerio and Parascandolo & Meis made
special bacteriological studies of this organism.

Etiology. The botryomyces equi, Bollinger (Discomyces
equi, Rivolta; Micrococcus botryogenes, Rabe; Micrococcus
ascoformans, Johne; Botryococeus, Poneet & Dor) appears in
the diseased tissues in the form of mulberry-like or grape-like
clusters, 1.0 mm. in diameter. The individual elements in these
clusters are surrounded by a homogenous gelatinous capsule of
sharp contour, thus forming zooglcea masses (Fig. 110 and 111).

Staining. These cocci stain readily in aqueous aniline dyes as
well as according to the Gram-Weigert method. The gelatinous capsule
does not take the stain. The organisms are very resistant to the action
of alkalies and acids.

Culture. On gelatin the broken zooglea give rise to the develop-
ment of colonies, at first silver gray but subsequently grayish-yellow,
with a metallic luster, while a white streak may be observed to develop

 

Fig, 110. Botryomyces equi. Zoog- Fig. 111. Boctryomyces equi. Section
lea mass from a soft focus. Not Stain- of Zooglea. Stained according to
ed. Mag. ca. 100 diam. (according to Gram. a Ground Substance; b Cocci.

Rabe). Mag. ca. 500 diam.

along the needle puncture in the depths of the medium, gradually
causing the gelatin to liquefy along its course when the colonies sink
to the bottom. On potatoes a pale yellowish, hoar-like coating 1s formed.
The cultures emit a peculiar odor recalling that of strawberries. The
colonies are composed of micrococci without, however, any characteristic
grouping and without hyaline capsules.

Pathogenicity. Mice are not susceptible in infection ; infec-
tion of guinea pigs with pure cultures produces fatal septicemia.
Inoculation of sheep and goats is followed by an inflammatory
edema occasionally followed by necrosis of the surrounding area
of the skin. In horses inoculation of pure cultures produces

Vol. 1—43
674 Botryomycosis.

also an inflammatory edema which disappears in from 3 to 10
days, but is replaced in the course of 4 to 6 weeks by the gradual
development of lobulated boils, in the interior of the soft foci
of which groups of cocci with hyaline capsules occur, just as
after natural infection (Rabe).

According to Rabe as well as Poncet & Dor, a hyaline capsule which envelopes
the individual groups of cocci is the product of a reactive inflammation of the
surrounding tissues, while according to Johne it is a product of the cocci them-
selves. ‘
On the other hand, Ernst looks upon the capsules as a degeneration product
resulting from the mucoid degeneration of the cocci in the periphery of the groups
under the influence of lytic or agglutinating immune bodies which cause their
destruction, the growing central mass causing the peripheral cocci to be compressed
into a sealy or striated structure. The capsule thus formed is supposed to be dis-
tended and ruptured here and there as a result of central growth, the vegetating
cocci finding their way through these openings to the periphery and forming. new,
smaller encapsulated structures. The repetition of these processes at various points
results in the formation of the morula like structures.

Very frequently it is possible to cultivate organisms from,
botryomycomata that resemble staphylococcus pyogenes aureus in every
respect and for this reason de Jong as well as Galli-Valerio regarded
the Botryomyces as identical with, or at least as a variety of this
Staphylococcus. According to de Jong these cocci, when retained in
primary abscesses as a result of incomplete discharge of their contents,
suffer a check in their vitality which results in the formation of capsules
and the characteristic zooglea forms; the latter thus constitute a
permanent irritant in the tissues. As an argument against the identity
of the forms above mentioned, Parascandolo cites experiments in which
blood serum obtained from rabbits treated with staphylococci failed
to agglutinate botryomyces, and he further claims that reciprocal
agglutination on the part of these two parasites could not be demon-
strated. It has also never been possible to produce typical botryomyces
with cultures of staphylococcus aureus.

Kitt and Bodin have also succeeded in obtaining the S. aureus,
Hell the 8S. albus, Mari the S. aureus as well as the S. citreus in cultures
from botryomycomata and these authors as well as Sabazés & Laubie
and MacFadyean. are also inclined to look upon the botryomyces as
a. variety or latent form of the cocci referred to, viz., S. aureus, albus
and citreus. On the other hand Poncet & Dor as well as Parascandolo
regarded this organism as a specific variety of bacterium. Letulle
assumes a unique position claiming that the individual elements of
this organism are identical with intestinal amebae which have enveloped
leucocytic nuclei.

Natural infection usually occurs through bruises or incised
wounds of the skin (in exceptional instances following amputa-
tion of the tail, docking). The virus is usually rubbed into
superficial wounds and into the excretory ducts of the cutaneous
glands by a tight-fitting harness. When the tumor thus resulting
breaks, portions of the discharged viscous secretions adhere to
the harness and are thus transmitted to other animals on the
first opportunity (Wester). In exceptional cases botryomyco-
mata may also occur on portions of the body that do not come
in contact, with harness (for example, in the udder, under the
Natural Infection. 675

abdomen). In such cases infection evidently occurs through the
medium of previously existing wounds. Infection of the sper-
matic cord doubtlessly occurs in this manner, the contagion prob-
ably being transmitted from the bedding, and finding a fertile
soil for development and propagation in the necrotic end of the
cord and in the retained products of inflammation (Chaussée).

In the internal organs botryomycotic changes develop as
a rule as metastases resulting from superficial botryomycomata
on some other part of the body. In rare cases, however, they
_ may constitute primary lesions. Thus, in a case described by
Bollinger, the lungs and.the bronchi only were affected, indicat-
ing infection through the respiratory organs. In another case
(Rabe) a pelvic tumor communicated with the bladder by means
of a fistulous canal, possibly caused by catheterization., Finally.
the possibility that botryomyces, like actinomyces, may gain
entrance into the tissues from-the lumen of the intestine and
thence pass to other abdominal organs, does not seem excluded.

Pathogenicity. The botryomyces constitute a tissue irri-
tant with a similar action to that of the actinomyces. They
cause the emigration of round cells which subsequently become
transformed into epithelioid and giant cells, although the emi-
gration of leucocytes is more rapid in infection with botryo-
myces, consequently the formation of pus is earlier evident.
Connective tissue proliferation also occurs in the region sur-
rounding the pus foci and leads to the formation of firm, fibroma-
like tumors. Finally this fungus may be distributed through the
lymph spaces, in exceptional cases also through the blood ves-
sels, and give rise to metastases in remote regions of the body.

Anatomical Changes. Botryomycomata consist of tough,
firm, fibrous connective tissue, grayish-white or pale red on sec-
tion and lardaceous in appearance, containing yellowish-red or
brownish-yellow gelatinous foci which project above the cut sur-
face and in which whitish-gray granules are embedded, the
latter even visible to the naked eye. Very large tumors may now
and then contain large cavities or fistulous canals filled with a
muco-purulent mass. Their tough walls are lined with yellowish-
red soft granulation tissue.

These tumors are found, as a rule, in the subcutaneous con-
nective tissue and in the skin, occasionally also in the muscles.
In addition they are found quite frequently in the end of the
spermatic cord of geldings, in which cases they spread through
the inguinal canal to the peritoneum and may give rise to sec--
ondary tumor fermation in the anterior portions of the abdom-
inal cavity (Schimmel).

In the rare cases observed in the lungs, the latter organs
may contain one or more tumors that may have attained the size
of a man’s head, and occasionally very numerous smaller tumors
approaching the size of a fist; these are sharply circumscribed

‘
676 Botryomycosis,

but firmly adhere to the pulmonary tissue; they are firm, tough,
tumor-like nodes, sections of which contain the soft foci above
described, or they may be homogenously fibrous, white or gray-
ish-white in color; the milky fluid which may be expressed con-
tains fine granules. The surrounding pulmonary tissue usually
shows inflammatory changes. Lesions on the pleura or the peri-
cardium resemble tuberculosis of the serous membranes, with
the exception that the nodules are softer in their interior and
‘‘sandy’’ (Piper).

Similar tumors occur now and then in other internal organs,
usually in conjunction with involvement of the spermatic cord;
thus in the kidneys, the suprarenal glands, the liver, the spleen,
the uterus, the maxillary sinuses, the udder, as well as certain
bones (maxillae and ribs), the spongy tissue of which is de-
stroyed by the tumor mass and the external lamella here and
there perforated. The regional lymph glands may be affected,
but as a rule they remain entirely free.

In exceptional cases the morbid process is simultaneously
observed in a number of organs in a generalized form (Rieck,
Fréhner, Kofler, Tiirnau). :

Symptoms. Botryomycomata usually develop very grad-
ually and without pronounced acute inflammatory symptoms.
They may occur on any portion of the skin as roundish or lob-
ulated, occasionally pedunculated fibroma-like tumors which now
and then attain a considerable size (collar boils and shoe boils
belong to this category) without affecting the movements of the
animal to any great extent, if at all (Fig. 112). In some cases,
however, the tumor becomes more diffuse, causing the formation
of extensive, very firm enlargements almost wood-like in con-
sistency, or of shield-like formations, from the surface of which
fistulous canals pass into the deeper tissues. Innumerable addi-
tional nodules may develop in rapid succession in the tissue of
the skin. These consist of lardaceous connective tissue with one
or more purulent, cheesy, mortar-like foci; the neighboring
lymph vessels remain intact, although the regional lymph glands
are occasionally enlarged, firm and bosselated and contain small
soft foci. The nodules may become transformed into crater-
shaped ulcers with prominent borders and discharge a tough,
muco-purulent, yellow secretion. ;

Another frequent form of the disease is the (improperly)
so-called fistula of the spermatic cord which in most instances
is a result of infection with botryomyces (Johne). The process
develops very slowly and may extend over a period of 4 years
before the peritoneum is affected (Plész) ; the tumor may attain
the size of a man’s head and extend over the lower portion of
the abdomen.—In affection of the udder (quite common, accord-
ing to Sand) this organ becomes enlarged and firm nodes are
formed in its tissues. These nodes subsequently break and dis-
charge pus through fistulous canals. (In a case described by
Unterhossel the udder of a mare attained the size of that of
a cow.) In exceptional cases the disease appears also on the
Symptoms. 677

external mucous membranes; thus Frohner observed it in the
form of a soft polypous proliferation, the size of a walnut, near
the left nostril. Patrick observed the same in the form of a
tumor of the size of a hen’s egg on the upper jaw, while Gutbrod
described a case in which numerous small nodules occurred on
the inner surface of the upper eyelid, causing this organ to
appear much swollen.

Liénaux saw one case in which the right intermaxillary gland
attained double the size of a man’s fist, while about 20 nodes the size
of a hazelnut could be observed in the course of the right facial crest.

In one case small boils with muco-purulent, yellowish-red contents
were found to develop after the operation of docking; there was simul-
taneous thickening of the skin and complete alopecia; subsequently the
cutis of the head and particularly in the region of the lips became
enormously swollen, numerous fistulae were formed and there was slight
enlargement of the intermaxillary glands.

 

Fig. 112. Botryomyces of the prepectoral Region. (Plosz.)

In eattle the disease is much less frequent; Csokor and In-
melmann observed the same as an affection of the udder, Reali
in the form of tumors of the subcutaneous connective tissue of
the shoulder and croup, Bollet as small subcutaneous nodes of
the cervical region, extirpation of which was followed after two
years by the appearance of very numerous nodes in the sub-
678 Botryomycosis.

cutaneous and intermaxillary connective tissue of the thorax
and of the abdominal region.

In swine Vilbrandt observed the development of botryo-
myces in the spermatic cord within six weeks after castration,
Petit & Cozette the same within three months after this opera-
tion. The grayish-yellow pus contained granules which con-
sisted of coccus-zooglea but formed no staphylococcus groups.

Diagnosis. The symptoms of botryomycosis are similar to
those of actinomycosis, and the two conditions may be differen-
tiated with certainty by means of microscopical demonstration
of the characteristic morula-like colonies. As a rule botryo-
mycosis is most frequent in the horse and actinomycosis in
the ox.

In occasional instances, especially when diffuse swellings
exist, glanders or farcy may be suspected. These swellings,
however, are considerably firmer in botryomycosis, while the
peculiar node-like enlargements of the lymphatic vessels are not
present in botryomyces. The neighboring lymph glands are
rarely involved, and ulcers that may exist show a tendency to
luxuriant granulation. Horses affected with botryomycosis will
not react to mallein.

Treatment. The treatment for superficial botryomycomata
is purely surgical (extirpation). Iodine treatment for affection
of the spermatic cord as recommended by Thomassen has not
been effective either in this disease (Frohner, Winter) or in
affection of the udder (Vennerholm).

Literature. Bollinger, V. A., 1870. XLIX. 583; 1887. XIII. 176. — Johne,
S. B., 1884. 40; D. Z. f£. Tm., 1885. XII. 73; 1886. XII. 204. — Rabe, Ibid., 1886.
XII. 137. — de Jong, Diss. Giessen, 1899. — Kitt, Cbl. f. B., 1888, III. 177;
Monh., 1890. I. 71. — Jensen. D. Z. f. Tm., 1892. XVIII. 433. — Galli-Valerio,
Chl. f. B., 1902. XXVI. 508 (Lit.). — Glage, Hb. d. p. M., 1903. IIT. 795 (Lit.).
— Chaussée, Rev. gén. 1905. V. 425. — Parascandolo & Meis, O. M., 1805, XXXI.
433. — Ernst, Chl. f. Bakt., 1907. XLV. 121. — Letulle, J. de phys. et path. gén.,
1908. X. 256

7. Glanders. Malleus. Farcy,

(Malleus humidus et farciminosus; Rotekrankheit, Hautwurm
[German]; Morve, Farcin [French]; Morvo,
Farcino [Italhian].)

Glanders is a contagious and usually chronic disease of
Solidungula. It is characterized by the development of nodules
that have a tendency to break down or degenerate, and by ulcers
resulting from the latter process. These changes occur in the
tissues of the mucous membranes, the cutis and the internal
organs and are the direct effect of the Bacillus mallei. In excep-
tional cases carnivora become affected, Human beings are sus-
ceptible to infection by the virus.

History. Glanders is a disease that has been known since the
remotest times, having been mentioned by Vegetius 400 years before
Glanders. 679

the birth of Christ (the name, malleus, owes its origin to Aristotle,
being derived from the Greek word “1\s=bad disease or epidemic).
Its transmissibility was recognized by Apsyrtus and Vegetius in the
fourth century and in the seventeenth and eighteenth centuries it was
generally recognized as an infectious disease. In 1784 the French
government enacted stringent veterinary sanitary police laws for the
prevention of the spread of the disease. At that time Viborg (1797)
maintained that glanders and farcy (nasal glanders and cutaneous
glanders) were identical. But before Viborg’s time Abilgaard had
expressed the same view and had experimentally demonstrated by
inoculation the infectious nature of nasal glanders. Toward the middle
of the last century, however, the Alfort school, on the basis of un-
successful inoculation experiments, denied the infectiousness of glanders
and in spite of the fact that the School of Lyons took a firm stand
against this view, this new doctrine which was defended even by such
men as Renault and Bouley, found many adherents. Under their
influence the former regulations of protection and extermination were
for the greater part suspended, which resulted in an extraordinary
dissemination of the disease. This was in itself a convincing argument
against the correctness of the new conception and when Rayer (1837)
and Le Blane (1838) again demonstrated the transmissibility of the
disease by faultless inoculation experiments the former, more correct
view, gradually gained the ascendency, and at the same time the claims
of Dupuy that the disease was the same as tuberculosis, those of Bouley,
Hering and Funke that it was merely a pyemia, and the claims of
others that it was a general dyscrasia, diphtheria, etc., were perma-
nently abandoned.

After the contagious character of the disease had been generally
acknowledged, the belief still persisted that the disease now and then
developed spontaneously, or as the result of a degeneration of some
other morbid process, e. g., distemper or strangles, until Gerlach (1868)
and Bollinger (1874) demonstrated, by means that eliminated the last
doubt, that glanders resulted from the mediate or immediate contact
exclusively with diseased animals or their pathologic products.

The investigations of more recent times have demonstrated the
exact nature of the contagion. After Chauveau had shown that the
removal of the cellular elements from glanderous secretions by means
of filtration destroyed their infectious properties and thus demon-
strated that. the infectious principle was in some manner fixed to
organized elements, a number of authors directed their search for the
virus to the microscopical examination of the secretions. Thus Babes
(1881) observed in the pus and in the walls of an ulcer of a man
affected with glanders, small rod-like structures with thickened ends.
Rézsahegyi observed straight or slightly bent, homogeneous, immotile,
slender rods in the contents of a pustule of a diseased man. Bouchard,
Charrin & Captain (1882) produced bouillon cultures from the morbid
products of diseased persons and horses which produced glanders in
guinea pigs and asses in the fifth generation, but it remained for
Loeffler, with the cooperation of Schuetz (1882) to isolate and grow
pure cultures of the characteristic rod-like bacterium which he demon-
strated indisputably by means of exact animal experiments (1886)
to be the etiological factor at the bottom of this disease.

Since that time the chief object of researches has been the deter-
mination of the exact modes of infection and the perfection of methods
of diagnosis. For the latter purpose, aside from the experimental
680 Glanders.

inoculation of laboratory animals, mallein in particular had attained
considerable importance. Helman in St. Petersburg and Kalning in
Dorpat produced this in 1890 independently of each other, both
recognizing its diagnostic value. In more recent times MacFadyean,
Jensen, Schuetz & Miessner, Schnuerer and others added the agglutina-
tion test while Schuetz & Schubert as well as Miessner & Trapp enriched
our diagnostic methods by the complement fixation test.

On the other hand the view concerning the exact manner in which
infection actually takes place, as well as those bearing upon the patho-
genesis of the disease have been directed into more correct channels
by the investigations of Nocard, Schuetz, Riegler and Hutyra.

Occurrence. Glanders is at this time still quite prevalent
among Solidungula. In former times the disease was exten-
sively prevalent everywhere, independent of climatic or soil con-
ditions, and was the cause of enormous losses. Thus, for ex-
ample, 5.1% of all horses in the French army were destroyed on
account of glanders every year from 1835 to 1845. In the Hun-
garian Stud Mezdhegyes about 20,000 horses were killed on
account of glanders in the first half of the 18th century. In
recent times, however, conditions have much improved in those
states and countries in which proper measures for protection and
extermination are rigidly enforced. é

Since the introduction of mallein as a diagnostic agent it
has been found that the disease spreads much faster in large
stables than was formerly suspected when only manifest or
clinical cases of the disease were taken into consideration. -At
the same time the fact was recognized that the disease fre-
quently confines itself to the internal organs, in which form it
not infrequently terminates in recovery.

Statistical records, especially those of former years, usually include
manifest clinical cases only.

According to Krabbe’s compilations for 1857 to 1873 the number
of glandered horses per 100,000 was as follows: Norway 6, Denmark
8.5, Great Britain 14, Wiirttemberg 77, Prussia 78, Servia 95, Belgium
138, France 1130, Algiers 1548, annually.

In Germany a considerable decrease in the number of cases reported has
been noted in recent years. Thus, for instance, while in 1890, 1,417 cases occurred .
in 355 parishes of 267 districts, the number had decreased by 1908 to 418 cases
in 141 parishes of 96 districts. ,

In France the disease was formerly widely prevalent. Since 1900, however,
the number of cases has been reduced from 1,365 in that year to 398 in 1908 (in
the Department of the Seine the number was reduced from 1512 in 1895 to 179 in
1903. In 1895 the disease was so prevalent in the Compagnie générale des voitures
of Paris that 586 out of 1,200 horses had to be destroyed on account of it, and in
the following two years 607 more had to be killed (Blanc & Drouin; see also
mallein test). i :

In Great Britain the number of cases increased from 1,385 in 1898 to 2,443 in
1903, in addition to whieh 77 glandered English horses were reported from the
abattoirs of Belgium. In 1901 there were 2,370 cases, of which 1,828 were reported
from London, 67% of the latter coming from permanently infected stables (Hunt-
ing). In 1908 there were 789 outbreaks of the disease, of which 495 were in
London and 198 in the Metropolitan counties; 2,433 horses were killed on account
of the disease. :
Occurrence, Etiology. 681

In Austria the number of cases ranged from 400 to 550 from 1891 to 1900.
In 1896 there were 647, and in 1898 there were 1,043 cases (among these were 519
horses slaughtered for food in Lower Austria). In 1908 the weekly average of
infected parishes ranged from 7 to 41, most of the infected parishes being in the
provinces of Galicia, Lower Austria and the Kingdom of Bohemia, while Upper
Austria, Tyrol and Vorarlberg were free from outbreaks.

Russia is at present badly infested; about 4% of all horses are infected with
the disease, and over 10,000 horses are officially destroyed every year. In 1900 the
loss in the Cherson Government reached 2,000, in Tauris 2,067, in St. Petersburg
alone 469, in Odessa 722 glandered horses (Samborski). In 1908, 15,693 cases
were reported in 7,828 parishes.

In Hungary the annual number of cases has for years ranged between 700
and 950, although in 1895 the number reached 1,177, and in 1898, 1,683 cases. In
1908, 946 cases were reported from 261 parishes, mostly based upon the results of
mallein tests. The largest number of cases were reported from the southern dis-
tricts.

The following official figures are available for 1908: Belgium 18, Netherlands
26, Italy 535, Roumania 200, Switzerland 4 cases, while Denmark reported 21
infected stables, Bulgaria 132, and Norway and Sweden are free from disease.

The disease is prevalent also in Asia (India, Japan), in Africa (Algiers,
Egypt and South Africa; in the latter country only since recent times), as well as
in America (United States, especially in the northwestern States). Australia has
thus far remained free from the disease.

Etiology. The Bacillus mallei is
a straight, or slightly bent, slender,
immotile, non-sporulating rod with
rounded or somewhat pointed ends;
its length is about 1/3 to 2/3 of the
diameter of a red corpuscle (2-5 #
long, 0.3-0.5 “ in diameter; Fig. 13).
In tissues the bacilli are usually
found in pairs or in larger sheaf-like
bundles, while in artificial cultures
they may occasionally form filaments
or branched threads. (Marx and

 

Fig. 118. Bac. mallei. Pus
: from testis of Guinea Pig;
Conradi therefore classify them as __ Stained with methylene blue.

Streptothrixes. )

Staining. The bacilli stain slightly with aqueous anilin dyes more
readily in staining solutions containing caustic potash or carbolic acid,
often imperfectly or irregularly in diseased organs. They are de-
colorized by Weigert’s or Gram’s methods. In bacilli from cultures,
stained with carbolfuchsin or methylene blue, we may observe one or
two more intensely stained granules or bodies (usually at the ends).

Cultivation. The bacillus of glanders is an obligate parasite; on
artificial media it thrives only at temperatures above 20° C., best at
body temperature; between 41.5° and 43° C. its growth is very slow
and ceases above 45° C. Neutral or slightly acid, as well as glycerin
media are best adapted for its growth. The cultures have a peculiar
smeary or slimy consistency and thrive only in the presence of oxygen.
On potatoes there appear, on the second day, small honeydrop-like,
transparent colonies that subsequently coalesce into a fawn or chocolate-
colored, thick, shiny, ropy mass, while the culture medium in the ad-
jacent area becomes bluish or greenish in eolor (Fig. 114). On agar
there develop gray, transparent, slimy, ropy colonies with smooth out-
lines, subsequently becoming dark gray and more tenacious in con-
sistency. On coagulated blood serum pale yellow, transparent colonies
682 Glanders.

~

develop that subsequently become milky white. Bouillon is evenly
clouded but at a later stage a white, ropy, slimy sediment accumulates
on the bottom of the vessel. Milk cultures remain neutral in reaction
but cause the medium to coagulate in the course of ten to twelve days.

py peed

oy Tee
OG

Bmeatle

Oe XI 2.

 

 

 

 

 

 

 

 

 

 

Fig. 114: Potato Cultures of Bacillus
mallei. A 4 days, B 8 days of age.

which small nodules develop at

Tenacity. The bacilli of gland-
ers possess only slight powers of
resistance to the influence of external
agencies. In damp media they retain
their vitality for 15 to 30 days; in
decomposing substances 14 to 24 days
(Cadéaec and Malet) ; in 30% glycerin
they retain their vitality as well as
their virulence for 12 days (Galtier),
while drying destroys them in 1 to 2
weeks, or at the longest in three months
(Loeffler); sunlight destroys them in
94 hours (Sirena & Alessi). Heat at
55° GC. destroys them in 10 minutes,
at 80° C. in 5 minutes. Carbolic acid
in solutions of 3 to 5% destroys them
in 5 minutes, 1% solutions of per-
manganate of potassium in 5 minutes,
1:5000 sol. of bichloride of mereury
or 0.23% chlorine water (chloride of
lime water containing 23% chlorine)
in 2 minutes (Loeffler), 3% cresylic
acid or lysol solution destroys them
rapidly (Nocard), also 5% lime water
or 10 % chloride of lime (Jaeger) and
oil of turpentine (Galtier). Anti-
formin dissolves them in a few min-
utes. Cultures are destroyed in en-
closures in which 40 gm. of sulphur is
burned for every cubic meter of air
space (Thoinot). Cold does not affect
them, Wladmiroff having found them
alive after immersion in liquefied air
for 80 minutes. The natural secre-
tions of the stomach may sometimes
destroy them in 15 hours; as a rule,
however, they withstand their action
without loss of vitality for more than
40 hours (Cadéac & Malet), while
they are destroyed in urine in 40
hours or less (Nencioni). Secretions
or tissues containing virus lose their
virulence within a few days (Loefiler,
Nowikoff).

Pathogenicity. Subcu-
taneous inoculation of a pure
culture or administration of
the same to the nasal mucous
membrane of a horse or ass
results in a general febrile
affection, in the course of
the point of inoculation and

subsequently also in more remote regions of the body. These
nodules ulcerate and the lymph vessels and lymph glands in the
Bens ee become enlarged, which condition is fol-
C y rapid emaciation and death. Post-mortem examina-
tion reveals similar nodules in the internal organs, especially
Pathogenicity. 683

in the lungs. Subcutaneous inoculation also is followed by the
development of symptoms of nasal glanders.

The alimentary administration of small quantities of vir-
ulent culture of glanders bacilli (0.01 to 0.02 gm.) usually
results in the development of miliary interstitial nodules of
glanders in the lungs, especially near the pleural envelope, sub-
sequently these may develop into broncho-pneumonic foci or dif-
fuse lesions of glanders (Nocard, MacFadyean - Riegler,
Hutyra). In some, but by no means in all cases, nodules may
also develop in the abdominal organs, especially in the liver.
The mesenteric and the intermaxillary lymph glands may also
become affected. The feeding of large masses of virus is fol-
lowed by the formation of glanderous lesions in the intestinal
mucous membrane, in the lymphatics, in the lungs as well as in
other organs also (Schuetz).

Inhalation of an atomized bouillon culture produces a diffuse
inflammatory swelling, attended with the formation of nodules
and ulcers in the lower portion of the nasal cavities, also pneu-
monic areas in the lungs, which symptoms are soon followed by
a fatal general infection.

According to Johne, the character of the malleous process is dependent, upon
the virulence of the infectious material; highly virulent bacilli producing acute
lesions with tendency to ulcerous degeneration, while attenuated bacilli give rise to
connective tissue, new formations (fibroid glanderous cicatrices, proliferations) as
well as to transparent nodules that subsequently become fibrous. a

Among other animals that are very susceptible to infection
with glanders may be mentioned guinea pigs, cats and young
dogs (see diagnosis), as well as species of arvicola and field mice
(Kitt); mice die within three or four days after subcutaneous
infection, post-mortem examination revealing small pus foci
in the spleen, liver and occasionally also in the lungs (house
mice and white mice, on the other hand, are only slightly sus-
ceptible, while rats are immune). Sheep and goats may occa-
sionally be infected experimentally (Csokor, Penchu), also
swine (Cadéac & Malet, Saccharow), while camels are very sus-
ceptible (Petrowsky) and cattle practically immune. Fowls also
resist experimental infection.

Aceording to Sacharow, Aruch & Petrini, as well as according to Galtier &
Nicolas, subcutaneous inoculation of virulent glanders bacilli in cattle is followed
by local abscesses, while intravenous administration produces respiratory symp-
tems and temporary swelling of the joints. In a cow that had repeatedly been
treated with dead cultures, Riegléer succeeded in producing a fatal disease by the
intravenous injection of a virulent culture. Nodules and ulcers were found in the
lungs, mucous membranes of the nose and pharynx as well as in the lymph glands.
On the other hand, Prettner observed transitory illness in a calf following intra-
venous injection of 26 gm. of a culture of the bacilli.

The virulence of the bacilli is attenuated by passage through the bodies of
Spermophilus citillus or through rabbits (Gamaleia), while serial inoculations into
the central nervous system of susceptible animals (Tedeschi) and passage through
young cats (Foth) increases their virulence. According to Bulloch & Twodt virus
cultivated from lesions from man are extremely virulent.
684 Glanders. -

Natural infection is brought about through the medium of
the secretions of diseased animals. In diseased horses, except
in animals with acute glanders, in which case the entire body is
infected, the virus is present only in the affected organs and
their secretions. The nasal discharge and the secretions of. the
cutaneous ulcers are particularly virulent, while the saliva is
virulent only as a result of admixture of secretions from the
lungs; the same may be said in regard to the feces, although
they may become infected from intestinal ulcers also. In
affection of the kidneys the urine may be virulent. Bacilli that
gain access to the outer world by these means, though they are
incapable of reproduction under ordinary conditions (obligate
parasites) may retain their vitality for some time, especially in
damp, dark places, where they are protected from drying out,
and may then, even after the lapse of several days, gain access
to the bodies of susceptible animals in a virulent condition.

In the majority of cases infection of horses takes place
through the digestive tract by the ingestion of food or water
contaminated with the infected nasal secretions of a diseased
animal. The food as well as the water may also have been con-
taminated by infected mucus that has been coughed up out of
the lungs or by the secretions of cutaneous ulcers, the feces or
the urine. Accordingly infection is most apt to occur when
healthy horses feed out of the same manger or drink from the
same trough to which glandered horses have access: Thus, in
a large stud of horses, where the animals are not tied up, but are
all permitted to feed and drink out of the same common racks or
troughs, a single glandered horse may be the means of infecting
a large number within a very short time. Under ordinary con-
ditions, on the other hand, the disease usually spreads much
more gradually. On the range or pasture affected animals may
contaminate the grass with their nasal secretions, and thus
infect healthy horses.

According to positive results of feeding experiments, infec-
tion may also take place through the intact mucous membranes;
the presence of wounds or injuries of course favors the process.
Thus Cadéac & Malet found that horses and cats are very easily
infected if the virus is rubbed into the superficially scarified
mucous membrane of the mouth, while the same effect is produced
in asses by the simultaneous administration of fodder contam-
inated with prickly vegetation. Catarrhal conditions of the in-
testinal mucous membrane also favor infection.

Infection rarely takes place through the uninjured mucous
membrane of the respiratory tract. Aside from the fact that
primary nasal glanders is very rare, the observation that experi-
mental infection of the nasal mucous membrane nearly always
produces acute glanders argues against the theory that natural
infection usually takes place through the nasal mucous mem-
branes; glanders resulting from natural infection usually runs
a chronic course. Primary pulmonary glanders also evidently
Natural Infection. 685

develops only in exceptional instances as a result of inhalation
of the infection; this mode of infection can be assumed only
when the morbid process manifests itself exclusively in broncho-
pneumonie foci. An infection after this manner can in fact
occur only through the medium of fresh particles of secretion
that are forcibly expelled from the lungs in the act of sneezing
or snorting; dried virus loses its virulence or vitality within a
very short time.

The air normally expired by glandered horses is not infectious. This is at
least the conclusion reached in their experiments by Renault, Cadéac & Malet.
The latter investigators forced healthy horses to inspire the same air that was
expired by glandered horses by means of linen tubes passing from the head or nos-
trils of one animal to the other, but in no instance did they observe the transmis-
sion of the disease to the healthy animals. They also failed to produce the disease
by the subeutaneous injection of the precipitate of moisture from the expired air
of glandered horses. On the other hand Nocard failed to get positive results in
any case where he injected virulent cultures, that had been admixed with albumin-
ous substances and dried without the application of heat, into the peritoneal cavity
of guinea pigs, or where he blew the dried material into the nostrils of asses.
Similarly, Hutyra found that virulent nasal secretion, dried either in the presence
of light or in complete darkness, was ineffective in producing glanders by insuffla-
tion in horses, Finally Cadéac & Malet report positive results from intratracheal
injections of 10 to 20 cc. of virulent cultures in asses in only 50% of the cases.

The disease may also be produced experimentally by infection
through other uninjured mucous membranes. Thus guinea pigs may
be infected by the application of a few drops of culttre on the con-
junctiva or the mucous membrane of the vagina (Galtier). Under
natural conditions this mode of infection can of course be only of rare
occurrence (Richter observed primary glanders of the conjunctiva of
the horse and it is recorded that a Russian stallion transmitted the
disease to a number of mares in Prussia by coitus). :

A severance of continuity of the skin or at least of its horny
epithelial layers is, as a rule, necessary before infection can
occur. The domestic animals are, however, well protected
against this possible mode of infection, since infectious secre-
tions usually adhere to the hair coat, dry up and become harm-
less. This explains why primary cutaneous glanders is gen-
erally of rare occurrence as compared with metastatic affection
of this organ. As a rule the virus is rubbed into lesions of the
skin by means of the harness or combs and brushes previously
used on affected horses, or infection may take place through
larger cutaneous wounds, or through bites (Lothes).

Babes observed the development of the disease in guinea pigs following rub-
bing of virulent cultures into the previously shaved skin, as had also been observed
long before by Viborg. However, when Nocard repeated the experiment with asses
and 15 guinea pigs he obtained positive results in only three of the guinea pigs.
Probably the infection was in all cases brought about through abrasions in the
superficial layers of the skin, but nevertheless the possibility that the bacilli may
pass through the hair follicles of the intact skin and from these into the neighbor-
ing lymph spaces, can not be excluded.

The disease is usually introduced into uninfected stables
through the medium of affected horses. As a rule the horses
686 Glanders.

in the stalls immediately next to that of the affected animal
become infected first, although sometimes more remotely located
animals are attacked while the intervening ones remain appar-
ently perfectly healthy, which, however, does not necessarily
exclude the possibility that the latter were not also infected.
The disease may merely not have developed as yet to the same
degree or may have been completely arrested. In some cases
the horse that was the means of introducing the disease may
remain in apparently good condition for months and at the same
time infect other horses by its expectorated lung secretions or
‘its infected feces. If such cases are not recognized in time they
may result in the infection of the greater part of a large stable
full of horses, and thus give the disease a firm foothold for years
after.

Diseased horses disseminate the virus of glanders in vari-
ous ways. Horses belonging to express drivers, transportation
companies and miners and those handled by horse traders and
gypsies, in particular, play a very important role in the dis-
semination of the disease. Livery stables and country inns
often constitute permanent centers of infection, and horses that
have been kept in such places over night, or that have been
merely fed there or watered may transport the contagion to
other places. . Finally it is possible also that feed or hay may
be the means of transporting the infection from one stable to the
other, although infection through these means is necessarily a
rare occurrence on account of the slight degree of tenacity pos-
sessed by the virus.

Of all Solidungula the ass is the most susceptible to glan-
ders. This animal is very easily infected and usually develops
the acute form of the disease. The horse, which is usually
affected with the chronic form of the disease, is less susceptible
and may recover from its effects. The mule seems to occupy
an intermediate position in this respect. Among animals kept
under similar conditions and exposed in the same manner a few
may be hard to infect, others become lightly infected and
recover, while a few individuals seem to be immune. Horses
with reduced vitality as a result of other diseases or hard work,
or animals in a poor state’ of nutrition, are more frequently.
affected than others, but the common occurrence of glanders
among horses of this character is in a great measure due to the
fact that they are more frequently exposed to infection.

Camels are easily infected by cohabitation with glandered horses. Symptoms
of the disease, which usually point to affection of the lungs, the nasal mucous mem-
brane and the lymph glands, may occasionally appear on the 6th day after exposure.

The hereditary transmission of the disease is possible but seems
to be rare in horses (Valentini observed one instance in which the
fetus in a mare was affected in the 9th month of its development),
while it is comparatively frequently observed in small experiment
animals. This is probably explained by the fact that the bacilli are
ap Saat.

Pathogenesis. 687

rarely found in the blood of diseased horses (as a rule only during
a brief period immediately after infection or in the acute form of
the disease) while in some experiment animals, especially cats and
guinea pigs this is much more frequently the case. Bonome, however,
has demonstrated that intrauterine infection may occur not only as
a result of hemorrhage but through the intact placenta as well. The
extra-uterine disease of the horse has as yet never been demonstrated
positively to be the result of intrauterine infection.

Pathogenesis. The discovery that the lesions of the disease,
in clinically healthy appearing animals that have been killed
on account of positive reaction to the mallein test, are found
almost exclusively in the internal organs, especially the lungs,
but also the liver and spleen (sometimes only in the latter)
while the nasal mucous membranes are hardly ever affected
until the morbid processes in the internal organs have become
quite advanced, point to the conclusion that the nostrils are
usually secondarily infected or are attacked simultaneously
with the internal organs. After Renault (1851) had success-
fully produced infection by feeding infected nasal secretions,
Nocard demonstrated that horses could be infected with food
or water that had been contaminated with only slight quantities
of infected secretions and that the intestinal mucous membranes
remained intact while lesions of the disease in the form of small
translucent ‘‘tubercles’? were found in the lungs, liver and
spleen. Following this the disease continued in its usual chronic
character and gradually spread to other organs. Nocard’s
view in regard to the intestinal origin of glanders has been
fully confirmed by MacFadyean, Riegler, Bonome, Hutyra and
others. The results of Schuetz’s experiments are also in har-
mony with these conclusions in so far as they showed that
the feeding of large masses of virus resulted within a short
time in extensive affection of the lungs. The possibility of in-
testinal infection is further supported by those post-mortem
observations in which lesions of glanders are noted in the
posterior sections of the small intestines and in the cecum;
finally also by the observation that carnivora in zoological
gardens usually become. infected from the ingestion of the
organs of glandered horses.

Noeard fed virulent cultures mixed with turnip leaves, or bread,
or drinking water to 20 horses, asses and mules that had had water
withheld from them for some time and then gave them free access to
all the water they would take. All of these animals reacted to mallein
within three to eight days and in all of them small hyaline nodules
or large cheesy foci developed in the lungs; in some animals the sub-
maxillary lymph glands, the epiglottis, the turbinated bones and the
nasal septum also developed glanderous lesions (some of them in 8
days). Schuétz administered large masses of cultures enclosed in
gelatin capsules to three horses this was followed within 11 to 13 days
by serious affection of the lymph glands and of the lacteals of the
688 Glanders.

mesentery and the formation of soft nodules varying in size from a
pea to that of a hazelnut in the liver and lungs. In one of the horses
there were two nodules in the lungs, hyaline, yellowish-red in appear-
ance, the size of hens’ eggs and one as large as a man’s fist. In a
horse that had received 1/10 of a needle-loop dose of culture on 14
consecutive days, the lungs contained glanders nodules ranging in size
from pin head to that of a pea, besides similar lesions in the liver and
in two mesenteric glands; after feeding smaller masses of virus small
nodules were found in the lungs. Miessner & Trapp report similar
results obtained from feeding cultures en masse to three horses. As
a matter of fact Sadowski had some time ago demonstrated glanders
nodules in the lungs as a result of feeding infectious nasal secretions.
Dedjulin, who administered glanders cultures in gelatin capsules to
eats per os, found lesions of glanders in the lungs exclusively. Mac-
Fadyean found typical lesions of glanders in the lungs of all horses
that had been fed potato cultures of glanders bacilli while in one horse
the lungs were affected exclusively. Bonome produced nodules in the
lungs in a similar manner. Riegler observed, after intestinal infec-
tion of three horses, nodules in the lungs and affection of the bronchial
glands in every case. In one case the lesions were limited exclusively
to these organs while in one of each of the others either the intestine,
the mesenteric glands or the liver were also involved. In Hutyra’s
experiments with 13 horses that had been fed glanders cultures enclosed
in gelatin or keratin capsules in doses down to 0.01 gm., providing
the animals survived only ten days, this author observed disseminated
nodules in the lungs, but in those cases in which the animals were not
killed until the end of the third week after infection, there were large
typical nodes of glanders of broncho-pneumonie foci.

According to the experiments referred to there can be no
doubt that glanderous infection may proceed from the intestinal
canal; but it is as yet an open
7[* Te [ela question whether the affection
of the lungs is to be looked upon
as primary or secondary. While
Schuetz defends the position
that affection of the lungs is
always a sequel to primary in-
fection of the mesenteric glands
and that primary pulmonary
glanders of horses, if it ever
occurs at all, is one of the rarest
diseases of the horse, all
other authors mentioned, except
Meissner & Trapp regard pul-
monary glanders of the horse as
a primary morbid process. The
Fig. 115. Glanders. Intestinal in- correctness of this latter view
fection with 0,01 g. potato culture. Post- 18 supported by the fact that in
mortem: miliary nodules in the lungs, those experiments where intes-
acute swelling of the lymph glands. tinal infection b f Il
y means of sma
amounts of virus was successful, the occurrence of rather ex-
tensive lesions of the lungs is not attended with changes of the

gel.d a

a
q
s
3S
°

 
Pathogenesis. 689

lymph glands or of other abdominal organs; there may be, at
the most, slight swelling of the lymph glands. In addition
to this, Hutyra showed that an alimentary infection was always
followed immediately by a distinct febrile reaction (see Fig.
115), that the bacilli of glanders may be present in the circulat-
ing blood on the 4th day after intestinal infection, and finally
that hematogenic
miliary nodules of
glanders (see p.
690) will develop
within seven days
following such an
infection.

Since the inhal-
ation of virulent
cultures results in
infection of the
lungs, the possibil-
ity of natural infec-
tion taking place
through the respira-
tory organs can not
be denied. As a
matter of fact, how-
ever, experiments of
this kind (inhala-
tion of bouillon cul-
tures reduced to a
spray immediately
in front of the nos-
trils of a horse) re-
sult in the forma-
tion of nodules and
ulcers in the lower
portions of the nasal
cavities only, while
the upper regions
remain perfectly in-
tact (Fig. 116) and

os lungs eae cove Fie. 116. Glanders nodules and ulcers on the lower
tain, at most, 180- portion of the nasal septum 16 days after inhalation of a
lated nodules. This bouillon culture of glanders bacilli—36 hours’ growth.
observation sug-

gests that moist air, charged with bacilli, loses most or all of
them as a result of the whirling air currents immediately behind
the alae of the nostrils and that at most only a few bacilli ever
reach the deeper portions of the lungs in this manner. If we
consider in connection with this, that the virus of glanders 1s
rapidly destroyed after reaching the outer world and that con-
sequently the inspiration of dry air plays no role in the process

 

 
690 Glanders.

of infection and, further, the fact that normally expired air

contains no glanders bacilli and that direct transmission of
the virus from animal to animal through the act of coughing
or snorting is only exceptional, one is necessarily forced to
the conclusion that aerogenic infection plays a very secondary
role in the development of glanders.

As a rule the disease is a result of the ingestion of food
or water contaminated with the secretions (glanders bacilli)
of infected horses. The bacilli enter the lymph vessels of the
intestinal walls through the intact mucous membrane and then
pass into the mesenteric lymph vessels; during this process,
although it is undoubtedly a rare occurrence, they may give
rise to inflammatory changes in the follicles of the intestinal
mucous membrane as well as in the mesenteric glands.. Follow-
ing the course of the lymph stream they enter the thoracic duct
and are discharged into the blood with the contents of the
latter. This results in a general blood infection, attended with
febrile elevation of body temperature, inflammatory swelling
of the lymph glands (including those of the intermaxillary
space), and of the nasal mucous membranes, as the first stage
of the disease. A part of the bacilli which circulate in the blood
are deposited in the capillaries of the lungs, the organ pre-
eminently susceptible to infection, while others may lodge in
other organs—thus, also in the nasal mucous membrane—and
exert their pathogenic action; in part, however, they are evi-
dently destroyed in the blood ‘and in the lymph ‘glands. How-
ever, as Lothes had already noted in his practical observations,
the possibility exists that the virus may enter the lymphatics
of the neck and thorax directly from the pharyngeal region.

After lodging in the small ‘blood and lymph vessels the bacilli of glanders
give rise to a proliferation of the surrounding endothelial cells and of the extra-
vascular connective tissue cells which results in the formation of nodules composed
of epithelioid cells; subsequently white blood cells pass from the periphery and
lodge between the cells of the nodules, as a result of which the latter become
softer in consistency and finally degenerate into a purulent mass which contains, in
addition to well preserved pus corpuscles, large masses of degenerated cells and
cell- and tissue-detritus (Baumgarten). The nodule which is at first hyaline,
assumes a white or yellowish-white color, while the surrounding hyperemic tissue
which is infiltrated with small round cells forms a red area. As the nodules enlarge
and the cellular elements rapidly break down larger foci composed of detritus and
pus cells and surrounded by a red area are formed. If the nodule developed in the
mucous membrane or the skin, the resulting superficial necrosis is followed by grad-
ually progressive ulceration.

When only a few bacilli are present or when the tissues possess unusual resist-
ance the process may be interrupted in its initial stage, or it may not be inter-
rupted until considerable connective tissue has accumulated around the glanderous
foci; following either condition definite recovery may result, the ulcers cicatrizing,
the purulent centers becoming dry, and, in exceptional cases, calcifying.

In other cases the bacilli find their way into the surrounding tissues through
the lymph channels, the lymph vessels of the subcutis forming thick, knotty strands
and the regional lymphatic glands becoming enlarged.

If, as a result of hematogenic infection, the bacilli have
accumulated in large masses in the capillaries, they may cause
emboli and hemorrhages and edematous infiltration of the sur-
Pathogenesis. 691

rounding tissues. These serous infiltrations occur particularly
in the lungs, both in the perivascular connective tissue and in
the bronchial walls; the bacilli may then pass through to the
surface of the mucous membrane and be discharged to the
exterior with the catarrhal secretions (Nocard & Leclainche).
On the other hand they are aspirated into the alveoli with the
secretions where they give rise to catarrhal processes which
are followed by the development of broncho-pneumonic foci
which, as a result of the glanderous nature, undergo early
central softening.

According to the investigations of Schuetz glanders nodules develop in the
lungs as miliary fibrinous inflammatory foci, in which the chromatin of the nuclei
breaks up into fine granules as the process of necrosis advances (Unna’s nucleus
degeneration or chromatotexis), while calcification is said never to take place ().
Similarly, Csokor, in harmony with the views of other authors (Roloff, Rabe), is of
the opinion that the primary glanders nodule is the result of swelling, coalescence
and subsequent fatty-granular degeneration of the alveolar endothelium following
aerogenic infection. According to Nocard, on the other hand, the primary ‘pul-
monary lesions of glanders consist in the development of hyaline tubercle-like
nodules, as had already been observed by Loeffler and Schuetz in the lungs of
horses that had been infected experimentally by subcutaneous and intranasal
administration of cultures: viz., fresh, gray nodules varying in size from a millet
seed to that of a hemp seed and surrounded by a red area. More recently these
nodules have been regarded as of particular importance, especially through the
experimental investigations of Nocard, who frequently demonstrated them to be
present as the only pathological lesions in naturally infected horses that were con-
demned and killed upon the evidence of a reaction to the mallein test, and in
horses that had been infected experimentally by the alimentary administration of
small quantities of virus, in all cases the glanderous nature of the nodules having
been demonstrated by experimental inoculation of laboratory animals. Coremans
and Priesz express similar opinions in regard to the nature of these nodules, having
demonstrated the presence of glanders bacilli in them by microscopical examination
as well as by culture. On the other hand Schuetz as well as Olt and Angeloff
deny the glanderous nature of these nodules. According to their views they are
the result of infection with embryonic filaria. (nodules of this character consist for
the most part of eosinophile cells which absolutely do not occur in glanders nod-
ules); in addition to this the aforementioned authors maintain that the encapsu-
lated and frequently calcified foci are also due to the presence of these parasites.
Kitt and Johne, however, have succeeded in demonstrating virulent glanders bacilli
in partially calcified foci, and it seems, therefore, that the many conflicting observa-
tions and views on this question.are evidently due to the fact that different investi-
gators have investigated structures of a different nature.

According to Hutyra’s histological investigations of the lungs of infected
horses and guinea pigs, nodules due to hematogenic infection are caused by bacil-
lary emboli, followed by the formation of thrombi and the development of an
almost simultaneous vasculitis and perivasculitis in the peribronchial and inter-
lobular connective tissue which cause the formation of sharply circumscribed groups
of round cells which appear macroscopically as glassy, hyaline nodules (in a few
instances glanders bacilli could be demonstrated within these nodules, but in to
instance could filaria be found). As the cell groups enlarge, the inflammatory
process extends to the neighboring alveolar walls, which may, however, be involved
from the beginning as a result of the lodgment of bacilli in the interalveolar capil-
laries. In either case a miliary fibrinous inflammation is the result. Finally the
nodules which develop in the walls of the small bronchioles may perforate their
lumen and discharge their contents into them, producing an inflammation of their
mucous membranes, which is followed by bronchopneumonic processes. The coales-
cence of neighboring pneumonie foci results in the formation of larger nodes, and
the fusion of diffuse inflammatory areas in the interlobular septa results in the
formation of so-called glanderous growths. In both instances thrombus formation
in the bloodvessels of the affected area goes hand in hand with the inflammatory
process.

In regard to local susceptibility, the various organs show
considerable difference. After the lungs, the mucous membranes
692 Glanders.

of the respiratory organs, especially of the nose, are most pre-
disposed to infection. The latter is the seat of the glanderous
lesions so frequently observed in the later stages of the disease
and which are probably the result of infectious emboli or, though
only occasionally, of infection with bronchial secretions charged
with bacilli (the acute exacerbations of the morbid process
which manifest themselves in nasal lesions are undoubtedly due
to embolic origin). The lymph glands are also very susceptible
to affection and the same is true also of the lymphatic plexuses
of the skin and the subcutaneous connective tissue (the nodes
found in these localities are also usually of embolic origin),
following these the spleen, the liver, testes, bone marrow and
periosteum are next in order of susceptibility, although lesions
are much less frequently met with in these organs.

The susceptibility or resisting power of the various tissues is also
influenced by previously existing other morbid processes. Thus Cadéac
& Malet succeeded in infecting swine, the vitality of which had been
reduced by other causes (tuberculosis, prolapsus of the rectum, mammary
abscess). A horse that had just recovered from an attack of pneumonia
but in which a pulmonary adhesion persisted, was fed with cultures
of glanders by the authors; autopsy showed that glanderous lesions were
present in the immediate neighborhood of a small cavity only, and
therefore were confined to the locus minoris resistentiae.

When large masses of glanders bacilli gain an entrance to
the circulation and thus lodge in the capillaries of a number
of organs at the same time, the development of glanders nodules
will be observed in numerous places, but alvays in greatest
abundance in the nasal mucous membrane and the skin. The
resulting generalized infection is then manifested in appearance
of grave acute symptoms which however are probably caused
in part by pyogenic bacteria. (According to Sewsejenko,
streptococci can almost always be demonstrated in the blood
in the course of acute glanders.)

The bacilli of glanders exert their pathogenic action by means of
toxins. These are formed also in artificial cultures, probably in the
form of endotoxins as a result of dissolution of the bacilli, and con-
stitute the active ingredient of mallein. Similar toxins evidently also
circulate in the bodies of affected animals causing cell proliferation
and cell emigration in the neighborhood of the bacilli. The degenera-
tive processes that attack the cellular elements as well as the febrile
reactions following infection with large masses of virus and finally the
excessive emaciation and great exhaustion which are frequently entirely
out of proportion with the extent of the morbid lesions are no doubt due
to these toxins.

Toxins obtained from cultures have a disease producing effect in rather large
doses only; in small experiment animals they produce spasms, paralyses, symptoms
of congestion and occasionally edema at the point of injection (Finger, Babes).
Dead bacilli have a simiiar effect. Bromberg succeeded, in his experiments with
wats, in producing fatal acute affections resembling glanders following the injection
Anatomical Changes. 693

of dead bacilli, while Cantacuzene and Riegler observed enlargement of the spleen,
nephritis and swelling of Peyer’s patches, and of the mesenteric and bronchial
lymph glands in guinea pigs, following intrastomachal administration of dead
bacilli of glanders.

Anatomical Changes. In those cases where the skin and
subcutaneous connective tissue are affected, the skin may con-
tain nodes varying in size from a lentil to that of a pea, of firm
consistency and with soft centers, and round ulcers with ragged
edges that have developed from the latter, while on the other
hand (and more frequently) considerably larger abscesses and
nodes are present in the subcutaneous connective tissue. Sub-
sequently these may also ulcerate (see symptoms). The sur-
rounding tissue is gelatinously infiltrated or lardaceous and
glistening in appearance, firm in consistency and frequently
contains small foci composed of yellowish-gray or reddish
viscous pus. The lymph vessels between the nodes and ulcers
are enlarged and filled with a thick, yellowish-white coagulated
lymph; the regional lymph glands are much enlarged and firm
and their interior tough connective tissue is filled with small
pus foci.

The respiratory organs are found affected almost without
exception in every case, sometimes the morbid process being
limited to the lungs while in other instances the upper air
passages and the nasal cavities are also involved.

In the lungs the initial morbid changes are represented
either by small tubercle-like nodules or by large lobar pneu-
monic areas. The nodules consist of gray, hyaline or grayish-
white, firm structures ranging in size from a pin head to that
of a mustard seed imbedded in the lung tissue, occasionally
present in very large numbers and which are surrounded, in the
later stages of the process, by a hemorrhagic area (see p. 691).

The catarrhal pneumonic form of pulmonary glanders
(broncho-pneumonia malleosa) appears in the form of small
atelectatic foci which are at first of an even brownish-red
color, but subsequently, as a result of central softening, become
transformed into a yellowish caseo-purulent mass and sur-
rounded by a firm, red, inflammatory halo which, like its im-
mediate surrounding area, has a peculiar yellowish gelatinous
sheen.

In some of the more advanced cases large contiguous areas
of the lungs have become transformed into sarcoma-like, firm
though not very tough, structures (so called glanderous
growths). Upon section the surface is either uniformly grayish-
red or has imbedded in its structure numerous small purulent
or cheesy foci, in either case the peculiar gelatinous character
being evident. Glanderous foci of still greater age consist of
very tough, almost cicatricial connective tissue with cheesy or
mortar-like foci imbedded in its structure.

More extensive or more acute affections of the lungs are
always attended with an acute bronchitis while the swollen
694 Glanders.

and bright red mucous membrane is covered with a purulent
secretion, occasionally studded with small nodules and ulcers,
the bronchial walls thickened and here and there distended.
In affection of the superficial areas of the lungs the ad-
jacent visceral layer of the pleura
is indurated while wide strands
of yellow gelatinous tissue radiate
between the pulmonary lobules.
In very rare cases serous or sero-
fibrinous exudate may be present
in one or both pleural cavities.
The lesions of glanders of the
upper air passages and especially
of the trachea, the larynx, the nose
and the nasal sinuses are essen-
tially similar. The beginning of
the morbid process is manifested
by the appearance of gray or yel-
lowish, prominent nodules as large
as millet seeds (rarely larger) and
surrounded by a tumefied and
brightly reddened area. The ul-
cers resulting from the breaking
down of the nodules are at first
round, regular, and smoothly bor-
dered, but subsequently, as a re-
sult of progressive tissue destruc-
tion, they become irregular with
raised borders, ragged edges, pale
yellow lardaceous base covered
with pus and detritus or, even-
tually, a brown scab. Larger ul-
cers are formed by the coalescence
of small ones and these are usually
surrounded by fresh nodules and
uleers (Fig. 117). On the other
hand, ulcers that have ‘‘healed’’
are replaced by irregular star-
shaped, either smooth white or
prominent reddish or white callous
cicatrices, which may, in some rare
cases, extend over the entire sur-
face of one side of the nasal sep-
tum. In addition to this scar-like
Fig. 117. Glanderous Ulcers on the glanderous growths of connective
Nasal Septum. tissue nature may form without
previous ulcerative processes.

 

According to Johne, glanderous proliferations which may subsequently break
down, completely or partially, are products of attenuated bacilli, the toxins of
which are no longer able to produce coagulation necrosis of the proliferated con-
Anatomical Changes. 695

nective tissue. That from such connective tissue new formations can actually
develop without the previous existence of lesions has been confirmed by Hahn by
the demonstration of an intact mucous epithelium on their surface and by Rabe,
who demonstrated the presence of the normal elastic basement membrane of the
mucosa on the surface of the ¢icatrix.

In the trachea the above-described lesions usually occur
on the ventral wall, in the larynx usually on the arytenoid
cartilages, the lateral ventricle and epiglottis. In grave cases
the trachea may be studded with its entire course with thickly
strewn nodules, ulcers and cicatrices, the cartilages even being
exposed by some of the ulcers.

In the nasal cavity only a few nodules or ulcers are found,
usually in the upper portions and on one side only, while the
lower portion of the mucous membrane suffers no changes ex-
cept catarrhal injection and tumefaction. In cases that are
less recent or are more acute in character the mucous mem-
brane of one or both nasal cavities may be so studded with
nodules and scars that it is almost impossible to find a healthy
area of tissue; old scars from former attacks may also be
found in the midst of acute lesions. In rarer instances the
ulceration may have extended to the cartilage of the septum
or the destructive process may have resulted in the perfora-
tion of the latter and formed one or more roundish holes.
Finally, in cases that are equally rare, when the inflammatory
process has extended to the periosteum of the neighboring
bones (maxillary, nasal and muscles) bosselated enlargements
and exostoses may occur on their surfaces.

Disease of the sinuses is usually the result of an extension
of the morbid process from the nasal cavities. The antrum
of Highmore on the side of the affected nasal cavity is affected
most frequently, the frontal sinus coming next. Here also the
disease sometimes leads to the formation of nodes and ulcers,
although in most instances the surface of the mucous membrane
is smooth while its substance together with that of the sub-
mucous connective tissue forms an intensely yellow gelatinous
layer about 1-2 cm. in thickness, the corresponding sinus con-
taining much muco-purulent secretion. In rare cases cicatrices
are found here also, or the mucous membrane is simply
thickened, tough and bosselated on the surface. Similar morbid
changes are occasionally found also in the guttural pouches and
the Eustachian tubes.

The mucous membrane of the digestive tract is rarely
found affected. In exceptional instances lesions are met with
in the pharynx but only when the nasal cavities are likewise
involved; here, too, the lesions consist of gelatinous infiltration
of the mucous membrane and submucous connective tissue;
occasionally there may be ulceration, but cicatrization is not
the rule. Involvement of the intestine is still more rarely
observed. In several horses from a badly infected stable the
authors found the solitary follicles and Peyer’s patches in the
696 Glanders.

posterior sections of the ileum excessively tumefied, while the
corresponding visceral peritoneum was raised into flat bossela-
tions by the gelatinously infiltrated subserosa. (Vecchia ob-
served glanderous nodules and ulcers of the mucous membrane
in the cecum in four cases.)

The spleen and the liver quite frequently contain small
hyaline nodules or yellowish-white nodes which are centrally
softened and appear lardaceous upon section. More frequently,
however, there are yellowish pus foci or mortar-like masses
surrounded by a white, tough connective tissue capsule. In
much rarer instances similar nodes are found in the kidneys.
The testes are more frequently affected. These lesions are
rare also in the brain where they occur as gelatinous hyaline
or more or less purulent foci. Occasionally the muscles of the
body also contain glanderous nodes, in a few cases they have
been observed in the muscle substance of the heart.

Among the bones, the ribs are most frequently the seat of
morbid changes while the vertebrae or the long bones are rarely
affected. Sawed sections show pale yellowish, roundish or
irregular cavities or fistulous canals containing a viscous sub-
stance, the bone substance in the immediate surroundings show-
ing a denser structure. Affection of the ribs may be attended
with an ossifying periostitis as a result of which the diseased -
section becomes enlarged to a remarkable extent, so as to be
easily recognized by palpation; the adjacent pleura is reddish-
gray and contains gelatinous granulations.

The lymphatic glands in the neighborhood of affected
organs are almost always involved; thus in nasal glanders the
maxillary glands, in pulmonary glanders the peribronchial
glands, in cutaneous glanders or farcy- of the extremities the
axillary or the inguinal glands, as the case may be, are acutely
tumefied and juicy in recent cases, while in chronic cases they
are firm and tough, adherent to the overlying skin or surround-
ing tissues, and frequently contain small, yellow muco-caseous
or purulent foci.

In horses that have died of acute glanders we find, besides
the lesions of a general acute infection (tumefaction of the
lymph glands and the spleen, hemorrhages of the serous mem-
branes) numerous small nodules and small superficial confluent
ulcers on the tumefied and reddened mucous membrane of the
respiratory tract, and usually also older lesions of glanders;
the lungs contain nodules, catarrhal pneumonic foci and hemor-
rhagic infarcts, there are also punctiform hemorrhages in the
visceral pleura, miliary nodules in the liver and spleen, fibrino-
purulent inflammation of the testes, and finally numerous nodes
and ulcers in the subcutaneous and intermuscular connective
tissue.

Statistics on the comparative frequency of the lesions in the various organs
that have been published in the more remote past (Roell, Haubner, Bagge) do not
Symptoms. 697

correspond to actual facts, because those investigators and authors did not recog-
nize the initial stages of the disease in the internal organs, But in spite of this,
the immense frequency. of pulmonary glanders has always been recognized, the
observations made in this respect since the general use of mallein, only making it
more evident, while disease of the nose and skin is less frequently observed.

Thus, according to Roell, of 173 glandered horses dissected from 1869 to 1878
in Vienna, 145 (84%) were affected with pulmonary glanders; of 216 glandered
horses dissected at the veterinary school at Berlin only 10 failed to show lesions
of pulmonary affection, in four cases it was present exclusively in the lungs and
the nose was free in 32 instances. On the other hand, among 274 horses destroyed
in Budapest in 1896, mostly on the basis of mallein reaction, 256 were affected
with pulmonary glanders exclusively, 3 with nasal glanders exclusively, 12 with
both pulmonary and nasal glanders, while 3 of the latter showed cutaneous lesions
also.— According to Bagge’s Danish statistics there were 1,336 cases of glanders
and 167 of cutaneous glanders or farcy.—Nocard observed affection of the lymph
glands of the cecum, the testes and the right kidney in one case in which all other
organs were free.

Symptoms. The duration of incubation depends to a great
extent on the manner and on the intensity of the infection.
Following experimental infection from the skin or nasal mucous
membrane, an elevation of temperature begins as early as the
second day and local changes may be observed after from three
to five days. The alimentary administration of small quantities
of cultures is followed in three or four days by elevation of
temperature, and in some instances swelling of the submaxillary
glands and serous nasal discharge may be observed on the
eighth day. After natural infection, however, several weeks
and sometimes months may elapse before evident external
symptoms (except elevation of temperature) manifest them-
selves. (In this sense Dieckerhoff assumes the period of incu-
bation to be at least two weeks.)

From remote times it has been customary to distinguish
pulmonary, nasal and cutaneous glanders. For practical pur-
poses this classification may still be retained, provided it is
always borne in mind that these forms merge into each other
and that any or all of them may. be present at the same time.
However, this affection usually begins in the lungs, while disease
of the nose as well as of the skin is usually secondary in nature.

Pulmonary glanders usually develops very insidiously
(latent or occult glanders). Months may elapse before a horse
that is affected with pulmonary glanders begins to show the
first observable symptoms of lung trouble and these may be so
little characteristic that they will for a long time excite no
suspicion of the glanderous nature of the trouble; in the mean-
time the horse in question may have been the medium through
which many others have become infected. In some cases atten-
tion is attracted to the animal’s condition by sudden bleeding
at the nose as the first symptoms of a destructive pulmonary
process (Greve) or the animals may discharge bloody mucus
in the act of coughing (Delamotte). However, the first symp-
toms (which in fact point to nothing specific except a chronic
pulmonary disease) are generally manifested in a ‘‘run-down
condition’? and a dull, dry asthenic cough. This condition

!
698 Glanders.

which simulates heaves may persist unchanged for a long
time or it is gradually aggravated; percussion of the thorax
reveals nothing abnormal and auscultation at most dry or moist
rales. In rare instances the percussion sounds may be some-
what dulled in some regions or even quite flat as a result of
atelectatasis, glanderous infiltration or extensive glanderous
‘‘orowths’’ in certain areas of the lungs; upon auscultation the
absence of the normal respiratory sounds is noted or there
may be distinct vesicular or bronchial respiration admixed with
rales; occasionally there may be bronchial respiration in the
area in question. Respiration is of the costo-abdominal type
and more or less labored. At the trachea large moist bubbling
rales may then usually be heard while abnormal sensitiveness,
painful spasmodic cough or excessive inspiratory dyspnea as
well as stertorous or snoring respiration point to an affection
of the larynx.

In some cases after these symptoms have existed for some
time and while the animals have gradually become emaciated,
more characteristic lesions of glanders make their appearance
either on the nasal mucous membranes or on the skin or in
both regions; previous to this an edematous painless swelling
of the sheath or of the udder and of the extremities may be
observed, which may disappear and reappear from time to
time. In exceptional cases exclusive affection of the lungs may
be attended with unilateral enlargement and abscess formation
of the submaxillary glands (Eggeling).

Nasal glanders begins with inconspicuous symptoms of
nasal catarrh. The mucous membranes are moderately red-
dened and there is a slight unilateral or bilateral serous nasal
discharge which subsequently becomes more mucous. Later on
it becomes more copious and purulent or may consist of a
mixture of a greenish-yellow serous secretion with white masses
resembling coagulated egg albumen; sometimes there are
streaks of blood. The secretion adheres to the alae of the
nostrils and forms dry crusts or is ejected in large quantity
by coughing or snorting.

In the meantime the catarrhal injection and swelling be-
comes more pronounced and the veins are here and there dis-
tended. When the morbid process remains confined to the
upper portions of the nasal cavities this condition may con-
tinue for weeks or even months without material change. After
a certain time, however, gray or yellowish nodules of the size
of hemp seeds or lentils make their appearance in the lower
third of the cavities; these soon break down into small ulcers
with rather smooth and sharply defined borders, they spread
rapidly however and assume ragged outlines, raised borders
and a lardaceous base. Their favorite seat is at the lower
end of the turbinated bones and the opposite surface of the
septum. They may finally extend to the edge of the nostrils
 

Nasal Glanders

Nodules and uleers of glanders on the mucosa of the nasal septum.
   
Nasal Glanders. 699

where they coalesce into large irregular ulcerous surfaces (see
Fig. 117 on p. 694 and Plate IV). Among the ulcers, or also
in their absence, the regions in question may contain large
or small star-shaped, bulging or flat, reddish or white, glisten-
ing scars. Isolated ulcers may terminate in such scars where-
upon the nasal discharge subsides temporarily or permanently.
As a rule, however, exacerbations occur with the symptoms
just described, or with signs of some other localization. In
extensive ulceration of the nasal mucous membrane the alae
of the nose and the lip may become swollen and the skin may con-
tain nodules as large as peas and which subsequently ulcerate.
In exceptional instances a fluctuating abscess approaching the
size of a walnut may develop on the nasal mucous membrane and
occlude the nasal opening (Spassky).

The submaxillary glands are always. enlarged on the side
‘ of the affected nasal cavity. At first the tumor is somewhat
painful and indefinitely outlined, but subsequently it becomes
painless, firm and knotty. (Fig. 118.) In the beginning the
tumor is movable but soon becomes firmly united with the bone,
the overlying skin and the surrounding tissues owing to the
extension of the inflammatory process, and the overlying skin
can then no longer be raised into a fold. Occasionally, and
usually simultaneously with the appearance of fresh nodular
eruptions on the mucous membrane of the nose, acute inflam-
matory symptoms manifest themselves in the tumor, such as
increased pain and swelling, but they subside again within a
few days. In rare cases a point in the periphery of the tumor
undergoes softening, the overlying skin is perforated and a
small quantity of viscous, yellowish muco-purulent secretion
is discharged, whereupon the borders of the wound contract
and gradually heal (Trasbot, Chardin).

Disease of the nasal cavity is frequently also attended by
a catarrh of the corresponding conjunctiva. Richter observed.
a case in which the cornea showed glanderous changes, the
external border of the cornea being bluish-red and studded
with gray or grayish-yellow nodules ranging in size from a
millet seed to that of a pin head; in the course of 1 to 2 days
they broke down and formed small ulcers. DeHaan observed
an eye affection in a horse that resembled periodical ophthalmia,
there was turbidity of the cornea and a tenacious fluid exudate
in the anterior chamber.

In cutaneous glanders nodes and ulcers may develop in
the skin or in the subcutaneous connective tissue. The cutaneous
nodes, usually as large as peas or beans, soon break open and
become converted into ulcers which subsequently either heal
or extend into the surrounding tissue by the breaking down
of their borders. The subcutaneous nodes usually appear on
the extremities, on the sides of the thorax and under the
abdomen; they attain the size of a walnut, are only slightly, if
at all painful, may sometimes be fluctuating or surrounded by
700 Glanders.

edematous tissue. Subsequently, after they become adherent
to the skin, a small round opening forms and discharges a
viscous, yellowish-gray, occasionally reddish pus. By progres-
ion of the destructive process in the borders, rather deep
erateriform ulcers form, with grayish-red, easily bleeding
borders that show torpid granulations and similar but more
lardaceous bases and discolored, purulent secretion (see Plate
V). They frequently continue to progress in spite of careful
treatment, hut occasionally local healing occurs, often with scar
formation.

In the region of the
nodes and ulcers the cen-
tripetal lymph vessels fin-
ally become enlarged and
are then palpable through
the skin as slightly pain-
ful or completely insensi-
tive tense strands which
unite the nodes with the
ulcers and with the neigh-
boring enlarged lymph
glands (rosary). Fresh
nodes develop in the
course of these strands
and subsequently also ul-
cerate (Fig. 119).

In the meantime the
edematous infiltration of
the surrounding subeu-
taneous connective tissue

Fig. 118. Enlarged Submaxillary Lymph progresses and spreads
Gland in Nasal Glanders. ne over a large area so that
finally conspicuous,
doughy, painless swellings appear on the lower abdomen, the
thorax or on one or more of the extremities. In some instances
one or more of the legs become enlarged to such an extent that
they resemble logs that are sharply set off at the hoofs
(Elephantiasis malleosa), while nodes and ulcers may occur
here and there in the tense skin. Enlargements of this character
interfere seriously with the movements of the limbs, and some-
times large nodes, but especially enlarged lymph glands, may be
the cause of locomotor disturbances by exerting pressure on
neighboring nerve trunks; as a rule, however, these disturbances
are not serious on account of the painlessness of the condition.

 

Nocard & Leclainche described a special form of glanders under
the name of lymphangioitis reticularis which manifests itself in diffuse
swelling affecting in the course of a few hours one extremity or the
lower portion of the body and is attended with increased heat and pain;
after a few days the acute symptoms subside somewhat but the swelling
Cutaneous Glanders. 701

persists while nodes and ulcers subsequently develop in the skin and
subcutaneous connective tissue.

Glanders of the bones is rare and when observed it is
usually in the form of spindle-shaped, painless enlargements
of the ribs. deDoes observed the disease in one of the meta-
tarsal bones, a painful swelling extending from the hoof. to
the tarsus having appeared after the operation of shoeing and
becoming hard as stone in the course of a month, but it subse-
quently subsided and left only an enlargement the size of a

 

Fig. 119. Cutaneous Glanders (Farcy). Nodes and Strands of Lymph Vessels.

dollar. Affection of the joints with symptoms of moderate pain
and diffuse swelling is equally rare.

In male animals a glanderous inflammation of the testes,
in mares a similar inflammation of the udder (Schmidt) may
be observed in connection with other symptoms.

In the line of general symptoms disturbances of nutrition
usually make themselves manifest before the disease has ad-
vanced much; even in the latent stage of the affection. In
other cascs, especially in pulmonary glanders, the general nutri-
702

‘sapurTy “OzT “Bhd

‘sIopueppj—Areuou[Ng pue—snosurynHO—[eseN PeUAPY YIM esioy{ & JO oaO JoAaTy

go [se lez fsx [ez | po [oe jw la | or

 

Glanders.

tion of the animals may be re-
markably good for a long time.
These disturbances manifest

‘themselves in the loss of the nor-

mal gloss and smoothness of the
haircoat, the elasticity of the
skin, gradual emaciation and ex-
cessive anemia as indicated by
the decided paleness of the visi-
ble mucous membranes.

The body temperature is
subject to constant fluctuations.
At times the temperature may
rapidly approach or exceed 39°
to 40° C., but it returns to the
normal after a few days or weeks,
again undergoing a rise after a
few days, weeks, or months (see
Fig. 120). These fluctuations are
observed much more frequently
in work horses than in animals
that are permitted to rest much.

According to Eckert the
amount of fibrin in the blood
steadily increases toward the
termination of the disease while
the hemoglobin slightly dimin-
ishes, although it shows no fluc-
tuations in the course of the dis-
ease. Mikrukow observed a re-
duction in the number of erythro-
eytes and an increase in the leuco-
cytes, the proportion being 1 :125
near the termination of the dis-
ease. The red cells showed no
tendency to form rolls, they were
paler than normal, greenish in
color and of irregular form.
Burnett & Pearce also often ob-
served leucocytosis.

In very sick animals heart
weakness may develop, resulting
in many forms of venous conges-
tion (nasal mucous membrane)
and being responsible, in part at
least, for the edematous swell-
ings of the extremities, the abdo-
men and the sheath,
Acute Glanders. 703

Acute glanders, which usually develops from the chronic
form in horses, but frequently appears primarily in mules and
asses is characterized by rapidly aggravated symptoms of a
general acute infection. Attended with sudden elevation of
temperature and other febrile symptoms large numbers. of
fresh glanders nodes and their consequent ulcers appear in the
course of a few days, on any portion of the body, but particularly
in the nose and under the skin. The nasal mucous membrane
throughout its extent, may, in the course of 2 to 3 days, become
thickly studded with nodules and ulcers; coincident with this
condition is a profuse and often bloody nasal discharge; the
respiration becomes wheezing as a result of the swollen nasal
mucous membranes and of the submucous connective tissue,
while the submaxillary glands become larger and sensitive.

Simultaneously with the appearance of these conditions
acute edematous swellings with nodes or farcy buds in the sur-
rounding cutis and subcutaneous tissue make their appearance;
the nodes soon undergo softening, the resulting ulcers become
confluent, producing extensive discolored, ulcerating surfaces.
The superficial lymph glands undergo acute swelling and, in
some instances, suppuration.

In the meantime the animals, in-a constant condition of
fever, emaciate rapidly, respiration becomes labored, and pulse
accelerated and small; finally diarrhea sets in, whereupon death
usually follows in the course of the second or third week of
the acute affection. ~

Course. The course of this disease may be extremely
variable, extending over a few weeks or over several years
(Dieckerhoff was able to trace the course of one case back for
seven years while Petrowsky reports a case of six years’ stand-
ing). In the course of the disease, which is usually chronic
in character, acute exacerbations alternate with periods of
‘subsidence or of apparent complete arrest of the morbid
process; near the end, however, the chronic cases usually as-
sume an acute character and terminate with the symptoms
above described. In rare cases the fatal termination is the
result of gradual exhaustion or of a sudden pulmonary hemor-
rhage. The temperature elevations that are occasionally ob-
served in the course of the chronic disease,:are usually due to
the development of fresh glanderous foci, particularly in the
formation of glanderous lesions in the skin and subcutaneous
connective tissue. :

The acute exacerbations may occur without external cause
in the normal course of the disease, or they may appear as the
result of an intercurrent acute affection, as for instance an
influenza-catarrh of the upper air passages. In general the
disease develops more rapidly in animals in a poor state of
nutrition or in hard worked animals in which it assumes an
acute character at an earlier stage than under favorable con-
704. Glanders.

ditions. Auto-infection of animals by the contamination ot.
their food and drinking water with their nasal and pulmonary
secretions also bears a certain relationship to the gradual ag-
gravation of the disease.

In a certain proportion of cases the disease terminates in
recovery. The possibility of a local healing of the ulcers is
proved by the presence of the characteristic cicatrices on the
nasal mucous membranes and on the skin, as well as by the
frequently observed dry, cheesy and, in some instances, partly
calcified foci in the lungs and other internal organs the glander-
ous nature of which has repeatedly been demonstrated.

According to observations made in the warmer southern
countries, for instance, in Southern Russia (Noniewicz, Semmer)
the course of the disease is not infrequently benign in character,
and horses that have already presented clinical symptoms of
the disease may occasionally recover (Semmer). Finally the
possibility of recovery from the disease has been demonstrated
by observations occasionally made in connection with mallein
tests, according to which horses that have once reacted to the
test cease to react to subsequent applications of this agent
and remain free from disease thereafter, while post-mortem
examination reveals, in various internal organs, encapsuled
nodules that are in every respect similar to those of glanders.
These observations point directly to the fact that even in
northern countries (Middle Europe) the disease not infrequently
results in recovery in its initial stages, when only a few nodules
have as yet developed in the internal organs.

In the stables of the Compagnie générale des Voitures 2,037 out of 10,231
horses gavé characteristic reactions to the mallein test in 1895; of these 687 sub-
sequently developed manifest symptoms of glanders, while 338 horses ceased to
react to later injections of mallein. A part of the non-reactors were subsequently
killed for other reasons, and in all of them Nocard found fibrous or caleareous
lesions in the internal organs.

The possibility of recovery from the disease should, how-
ever, be counted upon only in those cases that present no clinical
evidences and that have been determined by the mallein reae-
tion. On the other hand, all cases showing clinical signs of
infection should, for practical purposes at least, be considered
as incurable, although local processes may heal while new
lesions develop in other parts of the body.

Diagnosis. Since the various symptoms do not present a
characteristic clinical picture in the chronic form of the disease
until the later stages, and since symptoms that are characteris-
tic in themselves, such as nodes and ulcers in the nasal mucous
membrane, do not occur until the disease is quite advanced, the
definite diagnosis of glanders upon the basis of clinical symp-
toms alone is frequently a difficult matter

In stables where the disease has already been recognized

o
Diagnosis. 705

in some of the animals, in other words, in stables that are known
to be infected, mere temporary elevation of temperature in
otherwise apparently healthy animals is in itself sufficient
evidence upon which to base suspicion, especially when a tem-
porary nasal discharge and slight swelling of the submaxillary
glands has been noted and when the elevations of temperature
recur.

Any nasal discharge of some duration, especially when it
is unilateral and possesses the characteristics described above,
and any chronic swelling of the submaxillary glands should
direct suspicion to glanders. These symptoms are, however,
not characteristic either alone or collectively, because similar
symptoms are occasionally observed in simple nasal catarrh
and especially in catarrh of the antrum of Highmore and of
the guttural pouches. The above-mentioned symptoms may,
however, be present for a long time without apparent change,
especially when the patients are kept at rest and otherwise
under favorable conditions of feeding. The nasal catarrh and
even the swollen lymph glands may then subside to some extent
and the ulcers undergo healing (cicatrization in the nasal
mucous membrane!).

The absence of a pronounced acute character of the in-
flammatory changes and the torpid character of the ulcers point
to the glanderous nature of skin lesions while any edematous
swelling, nodular enlargement or ulceration on any part of
the body, especially the ventral surface of the abdomen, on
the sheath, the udder and the extremities, if not accountable
for in some other manner must be regarded with suspicion.

The recognition of pulmonary glanders is attended with
the greatest difficulties. For months symptoms of chronic lung
affection may persist without any specific character whatever,
such as occasional weak, dull cough, rapid exhaustion during
work, poor condition, rough hair coat, now and then moderate
fever, etc. These are the symptoms of heaves in general, and
may therefore be brought on by other causes, since, however,
they may have a glanderous origin as well it is always advisable,
where the least opportunity for exposure has existed, to look
upon such an animal at least with suspicion. :

The difficulties that often present themselves in the recogni-
tion of glanders may be overcome by recourse to special methods

of diagnosis.

Extirpation of the Submaxillary Tumor. The operation is usually
performed easily on the standing animal and may be of service in those
cases where no other symptoms exist than swelling and nasal discharge.
In case the tumor is -glanderous, small cheesy foci surrounded by a
reddened area will be found in the tough, white, frequently lardaceous
connective tissue. (According to Bistroumow immersion in 5% carbolic
acid solution brings out the foci more prominently above the surface
of the section.) The presence of these lesions makes the diagnosis
of glanders very probable, and the authors have confirmed this in

Vol. 1—45
706 Glanders. _

all cases by post-mortem examination. The foci in question are adapted
equally well for microscopical examination and for the inoculation
of experiment animals. According to Rudenko glanders bacilli may
be found in lymph glands as early as two days after endo-nasal or
percutaneous infection, while no other changes, except, at most, slightly
increased juiciness of the tissues, are visible to the naked eye.

Microscopical Examination. The practical value of a microscopical
examination is limited by the fact that the bacilli of glanders are not
readily recognized as such in bacterial mixtures. Both the nasal secre-
tions as well as the secretions of ulcers always contain a mixed bacterial
flora and are consequently ill adapted for a microscopical diagnosis.
Freshly incised nodes in the skin or subcutaneous connective tissue
constitute an exception to this however, as do also the foci in the sub-
maxillary lymph glands, but the bacilli are present in these in such
limited numbers that their discovery is not always an easy matter.
However, when bacilli that resemble those of glanders in their mor-
pliological characteristics and stain according to Gram’s method are
found in such material, the diagnosis of glanders is justified.

‘The technic of the examination consists in the staining of coverglass prepara-
tions with aqueous or carbolized anilin staining solutions. Loeffler’s method
(Staining fluid: 30 ee. concentrated alcoholic methylene blue solution + 100 ee.
of a 1:10,000 caustic potash solution or: anilin water, gentian violet or fuchsin
and similarly diluted caustic potash solution or 144% ammonia aa, followed by
treatment with acetic acid) as well as the method of Sahli (Staining solution: 4%
methylene blue solution and 1% Borax solution 44) are in no way superior to the
ordinary methods.

Culture Method. This may occasionally give positive results when
the microscopical examination was fruitless. Sterile boiled potatoes or
coagulated blood serum are specially adapted for this purpose. A
small quantity of the contents of a suspected focus, obtained under
aseptic precautions, is carefully spread over the surface of the medium
by means of a platinum needle. If kept at a temperature of 25° to
27° C., distinctly visible colonies may be recognized after 3 to 4 days
by their viscous nature and, on the potato medium, by their honey-
yellow color which subsequently becomes reddish-brown. On blood
serum they have a honey-like opacity and are viscid like the potato
cultures (on potatoes some strains of coli bacilli form similar masses,
though are less distinctly reddish-brown, but more yellowish-gray and
not viscid). If the material is applied thinly the bacillus may some-
times be obtained in isolated colonies from bacterial mixtures.

Portions of organs with suspected glanderous changes are best preserved in
glycerin and sent to specially equipped laboratories for bacteriological examina-
tion. According to Galtier tissues that are infected with bacilli and immersed in
30% glycerin will retain their virulence for at least ten days, and frequently
as long as 30 days.

Diagnostic Animal Inoculations. The inoculation of experiment
animals with suspected morbid products may frequently give very
valuable results, although they are decisive only when they furnish
positive evidence. Such results are best obtained by the inoculation
of material from the interior of encapsulated nodes or abscesses or
from the base of fresh ulcers, while nasal secretion is less adapted for
this purpose because it usually contains admixtures of other bacteria
Diagnostic Animal Inoculations. 707

and may produce septicemia. (Aruch & Savarese obtained positive
results from the inoculation of aspirated pulmonary secretions). A
negative result from such an inoculation does not, however, justify
the exclusion of glanders because virulent bacilli are frequently absent
in true glanderous lesions or secretions, and because, on the other hand,
foreign bacteria, e. g., pus cocci may prevent the pathogenic action
of the glanders bacilli by stimulating phagocytosis (Panisset). Aside
from the solidungula experiment animals best adapted for this pur-
pone ere) above all others, guinea pigs, after which come the cat and
the dog.

Of the solidungula the ass is the most suitable animal, although horses and
mules may also be used. The application of glanderous material to the nasal
mucous membrane or its subcutaneous administration is usually followed by the
development of acute glanders in three or four days and terminates fatally in
about 10 to 14 days. It may be recognized with certainty long before its fatal
termination by the characteristic symptoms (nasal glanders follows also the sub-
cutaneous administration of the virus). Unfortunately the expense attending the
use of these animals for experimental or diagnostic purposes makes this method
impracticable-

The inoculation of guinea pigs with glanderous material is also followed by
the development of characteristic lesions of disease. If the material was applied
subcutaneously (Trasbot, Loeffler), a swelling develops at the point of inoculation,
followed by an ulcer with thick borders and purulent base and subsequently by sup-
puration of the regional lymph glands.—After intraperitoneal injection (Strauss)
in males the testes begin to swell in from 2 to 4 days, though exceptionally not
until the 12th day, becoming hot and painful; subsequently they rupture and dis-
charge pus that contains large numbers of bacilli; at the same time the animals
emaciate and usually die in about two weeks after inoculation. In some instances
nasal glanders also develops (sneezing, wheezing respiration, nasal discharge) and
one or more joints or extremities may become swollen. The animals may be killed
upon the appearance of the ulcers or of the swelling of the testes or lymph glands;
at post-mortem examination purulent exudate is formed between the tunics of the
testes, small white points like needle pricks or somewhat larger may be found in
the spleen, liver, testes, lymph glands, etc., and in these the bacilli of glanders can
usually be demonstrated in large numbers, either microscopically or by cultural
means. (Liénaux observed that periorchitis occasionally did not develop until after
the 12th day, while Cadéac & Malet observed in exceptional cases a chronic affec-
tion following intraperitoneal injection of the virus, which persisted for 2 to 4
months; post-mortem examination revealed dry, cheesy foci in the internal organs,
and the nasal mucous membrane contained deep and extensive ulcers. According to
these authors, inoculation glanders in guinea pigs may, in exceptional cases, ter-
minate in recovery). : ;

The subsequent bacteriological examination of the exudate of the testes and
of the metastatic foci of the-internal organs must not be neglected for the reason
that orchitis oceurs also after inoculation of other bacteria. Nocard demonstrated
this_to be the case with the bacillus of ulcerous lymphangioitis of horses (see
. 731), Preisz in regard to the bacillus of pseudotuberculosis in sheep (see p.
633), Kutcher with regard to a bacillus found with the bacillus of glanders in
@ guinea .pig that had been inoculated with the nasal secretion of a horse (see
p. 632); these bacilli, however, in contrast to glanders bacilli stain according to
Gram. According to Baruchello the Bac. Pyocyaneus may in guinea pigs occasion-
ally be the cause of periorchitis, although this is not followed by ulceration of
the swelling. Nicolas demonstrated an oval bacillus in a periorchitis following
intraperitoneal injection of a guinea pig, with nasal secretion from a horse, and
observed nodules resembling those of glanders in the internal organs. Finally,
Ligniéres produced an exudative periorchitis in guinea pigs with the actino-bacillus
Basset obtained the same result with a small Gram negative bacillus obtained
in culture from a rabbit affected with pseudotuberculosis, Cagnet with a bac-
terium obtained from pus foci in the abdominal organs of a guinea pig, Pan-
isset & Loiseau with the bacillus of human diphtheria, and Joly, Basset and
Panisset with tubercle bacilli. :

According to the observations of Russian experimentalists (Lisicyn, Malzew,
Sacharow, ete.) cats are specially adapted for diagnostic inoculations. In animals
that have been inoculated subcutaneously the temperature rises to 40°-42.5° OC.
beginning with the 2nd or 3rd day and remains at this height; at the point of
708 Glanders,

inoculation a circumscribed swelling develops, and 4 to 7 days thereafter an ulcer
appears; subsequently to this similar nodes and ulcers appear in other portions of
the body, and finally the lesions of nasal glanders make their appearance. Fol-
lowing rapid progressive emaciation the animals die, with few exceptions, on the
5th to the 12th day after inoculation. On post-mortem examination the lungs,
spleen, testes, etc., are found to contain nodules; bacilli may also be demonstrated
in the blood. (Young cats are particularly recommended as suitable subjects for
inoculation.) ~

Dogs, especially young dogs, are also adapted for experimental inoculation
(Puetz, Galtier, Gruenwald, ete.). After the application (by rubbing) of the nasal
discharge of a glandered horse to the searified skin at the forehead, ulceration may
be observed on the 3rd to the 4th day; in the majority of cases recovery takes place,
although in some instances general infection may result, leading to the formation
of miliary nodules in the lungs, spleen, ete.

Finally field mice and a certain species of arvicola may be used for diagnostie
inoculations (Kitt), but only in cases where the inoculating material is known,
beforehand, to be free from foreign admixtures. '

Technic of Inoculation. The most expedient~ method of inoculating horses
and asses is to insert the suspected material or secretion into the nasal mucous
membrane by means of an inoculating needle or applying it directly to a portion
of the mucous membrane that has previously been prepared by rubbing with a
piece of coarse linen. Inoculation of the skin is less reliable because the resulting
nodule not infrequently heals before definite results are obtained. The subcutaneous
injection of a larger mass of secretion mixed with water is more apt to produce
results,

If pure material is at our disposal, guinea pigs are best infected by intra-
peritoneal injection, otherwise (in the use of nasal secretion or material from a con-
taminated ulcer) the subcutaneous or intramuscular method is better. Under the
first named conditions a small quantity of the suspected material is thoroughly
ground up in a mortar with distilled water, filtered through a sterile piece of linen
and then injected with a hypodermic syringe into the abdominal cavity; in sub-
cutaneous inoculation the hair is clipped from a small area on one side of the
abdomen, an incision is made through the skin and a small pocket formed with the
end of the scalpel handle, whereupon «a small particle of the suspected tissue (as
large as a lentil) is inserted and the skin firmly pressed into place; the intra-
muscular inoculation consists in the injection of an emulsion, prepared as above
described, into the muscles of the thigh (according to Aruch & Savarese lesions
are produced more rapidly by this method than by subcutaneous infection). If at
all possible several animals should be inoculated, and preferably males.

Cats receive subcutaneous injections of the emulsion, while dogs may be infected
by insertion of a seton saturated with the suspected material into the subcutis of
the back of the neck (Puetz, Galtier), or the skin of the forehead may be scarified
by means of superficial incisions and the material applied directly (Nocard). A
more practical method consists in the injection of the suspected material, after dilu-
tion with sterilized water, into a joint, a serous cavity or under the skin (Balitzky).

_ Allergic Mallein Reactions. Infection with glanders pro-
duces a peculiar allergic condition of the animal body very
similar to that observed in tuberculosis (see p. 574). This
condition manifests itself by an increased susceptibility to the
toxins of the disease-producing organism. This hyper-sensitive-
ness is made use of for diagnostic purposes by administering
the toxin of the bacillus of glanders to the suspected animals
in question, and the resulting positive or negative reaction is
looked upon as an index of the presence or absence of infec-
tion, as the case may be.

Mallein constitutes the antigen or inoculating material.
It is prepared from the cultures of glanders bacilli and is in-
jected into the subcutaneous connective tissue or applied to
the conjunctiva.
Subcutaneous Mallein Test. 709

. Preparation of Mallein. Mallein contains the toxic substance, endo- and exo-
toxin, of the glanders bacillus cultivated in a liquid glycerine medium. It was first
prepared by Helman and Kalning by extraction of potato cultures. Preusse as well
as Preisz prepared the material as follows: Potato cultures that have been permitted
to grow for several months are immersed in a mixture of equal parts of water and
glycerine and kept for several days in an incubator at 35° to 37° C.; the liquid is
then sterilized by means of steam and filtered through porcelain (in order to insure
greater uniformity of the product; Preisz adds bichloride of mercury). Roux culti-
vates highly virulent glanders bacilli in glycerine-pepton-bouillon; at the end of
4 weeks the culture is sterilized, filtered and evaporated to 74 its original
volume (a similar method is recommended by Bang, also by Johne; the latter,
however, does not evaporate the filtrate, but adds nine volumes of a 2% solution of
earbolic acid). In Russia, also, mallein is used in its dilute form in 1.0 ee. doses.
It is prepared by Kresling by cultivating a specially toxic strain of bacilli in 5%
glycerine bouillon for a period of 8 months. Foth evaporates the original bouillon
culture to 5 its volume, then treats the same with absolute alcohol, and in this
way obtains a white precipitate which subsequently becomes yellow; when dry this
leaves a spongy mass, which is readily pulverized (dry mallein). Schweinitz &
Kilborne produce a pulverized form of mallein by a similar method, while A. Babes
prepares his ‘‘Morvin,’’ which is used almost exclusively in Roumania, by culti-
vating the bacilli on bouillon-potato medium; 5-7 weeks later this mass is washed
on a Witt filter until the addition of alcohol to the filtrate no longer produces a
precipitate. Finally Schniirer attempted to produce an effective mallein by dis-
solving glanders bacilli in 2% antiformin solution, evaporating to ~, of its
volume and obtaining therefrom an alcohol precipitate. This preparation, though
it possessed properties similar to those of mallein, was only 1/15 of the strength
of Roux’s crude mallein. $

Crude mallein is a dark brown, syrupy fluid possessing a peculiar odor and
having a neutral or slightly acid reaction, if kept in a cool place and protected
from sunlight it retains its activity for months. When injected in large doses
(20 to 50 ec.) into the blood of healthy horses it may produce death, preceded by
symptoms of increased heart activity, respiratory difficulties and profuse sweat; the
subcutaneous injection of doses of 1.0 to 2.0 gm. into healthy horses produces no
morbid symptoms; on the other hand in horses affected with glanders even smaller
doses will produce a characteristic reaction. Experimentally infected guinea pigs
react both locally and generally to injections of 0.2 to 0.5 gm., while the injection
of 2.0 gm. into healthy guinea pigs produces only temporary elevation of tempera-
ture (Pearson). =

The effectiveness of mallein varies according to the virulence of the strain of
pacilli used as well as to the method according to which it has been prepared. At
present we have no reliable methods of standardizing this material, aside from its
practical application in testing glandered horses.

1. Subcutaneous Mallein Test (Thermic Reaction). Fol-
lowing the subcutaneous injection of a suitable, comparatively
small dose of mallein glandered horses show a rise of body
temperature which usually begins in the fourth to eighth hour
after injection and rapidly increases for from 8 to 14 hours, in
exceptional cases not until the sixteenth or thirtieth hour, until
it reaches its maximum; after this the temperature gradually
returns to the normal, but frequently a second less pronounced
elevation may be observed (Fig. 121). In the course of the
thermic reaction other febrile symptoms may also frequently
be observed (organic reaction); thus increased heart action
and respiration, which, however, are not always synchronous
with the change of temperature, muscular tremors, which, when
they occur at all, usually appear between the sixth and eighth
hour after injection; that is, in the beginning of the febrile
attack; finally there may be depression, dullness and loss of
appetite, as well as a more or less extensive inflammatory
edematous swelling at point of injection (Fig. 122). (In the
710 Glanders.

case of glanders of the cornea before referred to [see p. 699]
Richter “observed hyperemia of the corresponding region of
the cornea after subcutaneous injection of the mallein. The
number of visible nodules on the cornea became very numerous.
On the other hand Walter observed conspicuous redness of
the cutaneous ulcers during a reaction). In some cases the
temperature remains permanently elevated after the appear-
ance of the reaction and the disease, which, up to this time,
has been chronic, takes an acute course, the general symptoms
increase in intensity and the animal succumbs in the course
of a few weeks. Healthy animals do not react to mallein; and
in horses with other diseases a reaction, though occasionally ob-
served, is of very exceptional occurrence (possibly in some cases
of alveolar emphysema of the lungs?).

TIP

Fig. 121, Z'ypical Thermic Mallein Reaction.

In interpreting the results of the mallein reaction the fol-
lowing principles should be observed:

A mallein reaction is positive (typical) if the température
after injection exceeds the preinjection temperature by 2° C. or
more and rises above 40°, providing the preinjection tempera-

ture did not indicate fever. The reaction is positive, also, if
the increase in temperature is only 1.5 to 1.9° C. or exceeds
39.5 to 39.9° C., providing it is attended with a pronounced
organic reaction.

The reaction is indefinite or doubtful if the rise in tempera-
ture equals 1.0 to 1.9° C. and no organic reaction occurs.

The reaction is atypical if the rise in temperature, no matter
how excessive this may be, is very rapid and subsides with equal

 

Reet, rites!
Subcutaneous Mallein Test. 711

suddenness, that is, if the febrile condition is of short duration
only, four to six hours at the most.

The reaction is negative if the rise of temperature does
not exceed 1.0°, or 39.0° C.

A positive (typical) reaction justifies the conclusion that
the horse in question is affected with glanders; on the other
hand a doubtful reaction as well as an atypical reaction, justifies
a suspicion only, in which case a final decision depends upon
a repetition of the test in about four weeks; finally the absence
of a reaction in a horse in good condition and not of great age,
justifies the exclusion of the disease.

 

 

 

 

Fig. 122. Organic Mallein Reaction. Edematous Swelling at the Point of In-
jection and the Afferent Lymph Vessels Following Subcitaneous Injection of
Mallein.

In regard to the interpretation of mallein reactions the views
are still quite at variance. When mallein was first introduced into
practice a reaction of 1.0° C. was considered as positive (Johne, Diecker-
hoff & Lothes). Subsequent experiences have, however, shown that
higher and longer continued temperatures only may be regarded as
such. Nocard regarded every horse which showed an organic reaction
and an extensive painful swelling at the point of inoculation and
showing a typical rise of 1.5° C. of temperature or exceeding 40° C.
as affected with glanders, while an elevation of only 1.0 to 1.4° simply
712 Glanders.

pointed to suspicion. According to Schindelka a positive reaction
consisted of an elevation of temperature of 2.0° while an elevation of
1.5° to 1.9° simply indicated suspicion, an elevation of less than 1.5°
being regarded as of negative importance. Thomassen and MacFadyean
also considered an elevation of 2° as a positive reaction, but regarded
an elevation of 1.0 to 1.4° as pointing to probable or possible infection.
Babes and Furtuna defined the term ‘‘specific reaction’’ as a rapid
increase of temperature of at least 2° C. occurring within the sixth
to eighth hour. after injection and exceeding 40° C. followed on the
next day by a second rise above the preinjection temperature, with
simultaneous local and general organic reaction (great typical reaction) ;
such a reaction only justified the diagnosis of glanders while a similar
elevation of temperature not exceeding 40°, but also with simultaneous
organic reaction (small typical reaction), as well as pronounced eleva-
tions of temperature of short duration (great atypical reaction) indi-
cated suspicion only; a similar but slight elevation of temperature
(small atypical reaction) had no significance. According. to Peter,
Preusse and Foth an elevation of temperature of 1.5° is to be regarded
as positive. These authors, with the exception of Foth, lay special
stress upon the importance of the organic reaction in the interpretation
of the results of the mallein test.

In poorly nourished overworked as well as in old glandered animals
a reaction may fail to take place or it may occur at an unusually late
period; thus in a case observed by the authors the elevation of tem-
perature did not begin until the twenty-first hour-after injection, being
typical however in other respects (Fig. 123).

Horses affected with other diseases do not give typical reactions
to mallein. Thus Hutyra & Preisz failed to observe reactions in dis-
temper, sarcomatosis, phlegmonous conditions, - pectoral influenza,
morbus maculosus and botryomycosis, while Schindelka failed to ob-
serve reactions in distemper, nasal catarrh, as well as in emphyemia of
the antrum of Highmore.

The diagnostic value of a mallein reaction has been con-
firmed by the practical experience of the last two decades.
The varying results obtained during the first few years after
the introduction of mallein into general use were due to the
fact that the interpretation of the temperature reactions were
based on different principles (an elevation of 1.0° C. was looked
upon as a positive reaction while the animal’s state of nutrition
as well as advanced age did not receive due consideration, etc.)
and the fact that the primary lesions of glanders were at that
time not as thoroughly understood. The lack of uniformity
in the mallein preparations was also at fault. At the present
time, however, it has been firmly established that mallein is
an extremely delicate and reliable agent for the diagnosis of
latent glanders. But in order to apply this agent properly and
successfully in the extermination of glanders it is necessary
that the test be made intelligently and systematically, further
that the results of observations during the period of reaction
be carefully interpreted and that all clinical symptoms receive
proper consideration. In this respect as well as in the general
technic of the test the instructions given under the head of
Subcutaneous Mallein Test. 713

tuberculin testing are equally applicable to the mallein test
(see p. 577). There seems to be a difference, however, in regard
to the immunizing effects of repeated injections of these two
diagnostic agents in that horses will usually react typically to
repeated injections of mallein made at short intervals. In
some cases the reaction becomes even more pronounced (thus
Galtier observed 11 positive reactions in a glandered horse in
the course of a month).

J.

 

Fig. 123. Late Thermal Mallein Reaction.

Reports on the use of mallein on a large scale have with few ex-
ceptions been favorable in that post-mortem examinations as a rule
‘confirmed the diagnosis of the disease. Thus according to Preusse’s
compilations of reports recorded in the literature up to 1897, positive
reactions were confirmed by post-mortem examination in 94.7%, negative
in 95.7% of all cases (Foth estimates the value of the reactions at
86% and 94% respectively, Rudovesky at 87% and 96%).

According to the compilations of Hutyra & Preisz, post-mortem examinations
were held on 85 out of 410 horses tested with mallein in Hungary up to 1893;
of these 14 gave a reaction of less than 1.5°, and 6 of them were found affected
with glanders; 12 gave a reaction of 1.5 to 2.0°, and all of them -were found
affected; 59 gave a reaction of 2.0° or more, and 58 of them were found affected
with glanders; in one the post-mortem findings were negative, but this one gave
an atypical reaction. In those cases where the temperature elevation was more
than 1,5° and exceeded 39.5°, all horses without exception were found affected.

Kitt (1901) basing his observations on reports from the Kingdom of Bavaria
since 1892 showed that mallein always produces a prompt reaction in glandered
horses, and that reactions failed to appear in more than 120 other diseases (nasal
eatarrh, disease of the maxillary sinus, heaves, etc.). According to Feist 72 out of
73 reacting horses in Alsace-Lorraine were found affected with glanders, while on
the other hand not one out of 287 non-reactors were found affected. Schindelka of
Vienna maintains that, aside from glanders, only pulmonary emphysema will pro-
duce an occasional reaction to mallein, basing his statement on the results of 503
tests and 148 post-mortem examinations. Jensen, of Denmark, collected data cover-
ing 184 cases; in 177 cases the post-mortem findings confirmed the diagnosis as
based upon the text, in six cases the results were doubtful, and in one case the
result was of an opposite character. Nocard (1897) on the basis of several thou-
sand tests conducted by him in France, concluded that a positive mallein reaction
justified the diagnosis of glanders. A negative reaction on the other hand justified
the diagnosis of an absence of glanders, irrespective of the presence of any clinical
symptoms that simulate this disease. Upon this basis he succeeded in differen-
714 Glanders.

tiating several diseases from glanders which had formerly been confused with that
affection. Thomassen in the Netherlands, MacFadyean and Wright in England,
Wirtz in Holland, Heyne, Dieckerhoff & Lothes, Johne, Edelmann, Piel and Schlegel
in Germany, Kowalewski in Russia, Babes and Fortuna in Roumania, Schweinitz &
Kilborne in America, Hoogkamer & de Haan in Lower India, and Schniirer in
Austria have all expressed themselves definitely in favor of the diagnostic value
of mallein.

The opposite view has been championed by Schiitz, who in 1884 conducted
54 autopsies on horses, of which 15 reacted to the extent of 1.5° to 2.5° C., while
7 gave a reaction of 1.0° C. to 1.4° C. (the temperature curve and the highest
post injection temperature were not reported). In the high reactions, as well
as in a portion of the others, post-mortem examination revealed only hard nodules,
aside from other immaterial changes, and in one case cheesy masses, while in several
others there were gray maculae (?), and in one yellow foci in the peribronchial
lymph glands. In another instance, among 4 horses which reacted out of a total
number of 6, post-mortem examination in three showed calcified foci in the lungs,
the liver and the peribronchial lymph glands (!) In one ease there was induration |
of the pulmonary tissue with muco-purulent foci. In-1898, 42 horses were tested
with Preusse’s mallein; 9 of these gave a reaction of 1.5° C. or more (in two this
was followed by a temperature exceeding 40.0°, in three only to 39.5°). In these
horse glanders could not be demonstrated, while three horses that were affected
with chronic glanders gave no reactions (the temperatures were recorded only up
to the 14th hour. On the other hand the post-mortem diagnosis was confirmed by
microscopical examination). In addition to the above, Olt, Robeis, Poetschke,
Schoeneck and others have expressed themselves against the diagnostic value of
mallein in practically all cases, basing their views on limited observation. (In Olt’s
experiments it is reported that nine glanderous horses did not react, while three
healthy horses gave positive reactions.)

In Hungary (1897 to 1901) 570 horses were killed on account of the disease
or suspicion of it and positive reaction to the mallein test; of these 536, i. e., 94%,
were found affected with glanders at post-mortem examination conducted under
unfavorable conditions. In 1902 to 1908, 1,385 horses were officially destroyed on the
strength of positive reactions to the mallein test and suspicion of disease, 1609
were destroyed on the ground of positive reaction to the test and suspicion of
infection or exposure; in the first group 1,313, i. e., 94.8%, in the second 1,447, i. e.,
89.9% showed anatomical lesions of glanders at post-mortem examination.

Technic of the Subcutaneous Mallein Test. The mallein is prepared in a
manner similar to that followed in the preparation of tuberculin (see page 574).
Since the normal temperature of horses does not exceed 38° C., it is recommended
that the test be applied in such cases only where the body temperature does not
exceed 38.5° at the time. Fluid crude mallein should be diluted before injection
(in ease this has not been done by the manufacturer) with 9 parts of a 14% solu-
tion of carbolic acid.

The diagnostic dose of Preusse’s mallein or of Preisz’s potato mallein is 0.50
gm., that of Roux’s condensed bouillon 0.25 gm., that of Johne’s uncondensed
(10 x diluted) mallein 5.0 gm., that of Foth’s dry mallein. 0.10 gm., that of
Russian mallein and Babes’ morvin 1.0 gm. for each injection.

In positive reactions the temperature usually reaches its maximum at the
12th to the 15th hour after injection; in view of the possibility of a late reaction
(see page 712) temperature readings should be made up to or beyond the 21st
hour. Tatray observed in 395 cases of typical reactions (his observations, how-
ever, extending only to the 21st hour) that the maximum temperature occurred in
two instances in the sixth hour; in 74 instances in the ninth hour; in 174 in the
12th; 114 in the 15th; 23 in the 18th, and in 8 instances in the 21st hour after the
injection. According to Calinescu, the intravenous injection of the mallein (0.02
gm. morvin) results in a reaction in the 5th hour.

Although glanderous horses will, as a rule, react to repeated injections of
mallein, it is recommended in cases where doubtful results have been obtained (in
order to evade every criticism) not to repeat the test until the expiration of 4
weeks, In an emergency the test might be repeated after 15 days.

2, Ophthalmic Mallein Test (Ophthalmoreaction, conjunc-
tival reaction). Following observations on the action of tuber-
culin on the conjunctiva and the skin of tuberculous persons
and cattle (see p. 583) similar experiments were made on
glanderous and healthy horses with mallein. The results of
the latter experiments, however, can not as yet be judged prop-
 
Plate VI.

 

Conjunctival (Ophthaltino) reaction in Glanders,

8 hours after the instillation of crude malleiu
Ophthalnic Mallein Test. 715

erly on account of the comparatively small number of horses
tested and the lack of sufficient post-mortem control work.
After the administration of a small quantity of dilute
mallein into the conjunctival sac the ophthalmic reaction ap-
pears in the form of a conjunctivitis, swelling of the eyelids,
intense redness of the conjunctiva tarsi et bulbi and a purulent
secretion (see Plate VI). According to observations thus far
recorded a pronounced reaction with purulent exudate seems
to point to the existence of the disease, while a negative or
doubtful reaction has only a circumstantial value since it is
known that actually infected horses may sometimes react only
slightly or not at all. (It seems that these tests not infre-
quently give negative results in the first stages of the disease.)

The ophthalmic test was first applied successfully by Choromansky; 15 glan-
dered horses that were treated with 0.1 gm. of Russian mallein reacting by the
appearance of a severe conjunctivitis, while 37 healthy horses gave a negative reac-
tion to this, as well
as to the  subcuta-
neous test which was
subsequently applied.
Wladimiroff reports a
similar result  ob-
tained in 12 affected
and 20 apparently
healthy horses; this
author, however, ob-
tained positive oph-
thalmo-reactions also
in horses that had
ceased to react typi-
cally to the usual
subcutaneous test,
consequently he did

“not consider a posi-
tive reaction to the
ophthalmic test as
necessarily indicating
the presence of dis-
ease. (An observation
made by Martel
agrees with this view;
this author obtained
a typical cutaneous
reaction on his arm
14 years after he had
been infected with
'glanders). Schntirer
expresses himself
very favorably in re-
gard to the value of
the ophthalmic test, Wig.124, Culuneous Reaction in Glaunders. Lymph Vessels
having obtained only Enlarged as Result of Inflammation Radiating from
one negative result in Searified Area.

47 glanderous horses;

while the test on 353 suspected horses and on 16 horses affected with some other
disease agreed with the results of the cutaneous and subcutaneous tests in the
negative character of all of them.

The observations of Vallée in three cases, of Dietrich in 13, of Putzey &
Stiennon in 7, of Martel in 7, and of Klimmer & Kiessig in 9 glandered horses
were less satisfactory. These authors obtained distinct reactions in only about
one-ha!f of their tests, which were made with 10 to 20% mallein solution.

Technic of the Ophthalmic Test. Since the most satisfactory results have
thus far been obtained from the use of concentrated mallein, it is recommended that

 
716 Glan ders.

this material be applied to the inner angle of the conjunctival sac by means of
a pipette or camel’s-hair brush. Before making the application the operator
should satisfy himself that the eye contains no foreign bodies, and that no symp-
toms of conjunctivitis or periodical ophthalmia exist.

The reaction begins from the 4th to the 6th hour after the dpplication, and
may continue for 24 to 26 hours, or even longer, the accumulation of pus below
the inner canthus of the eye as well as inflammatory hyperemia and swelling of the
conjunctiva are readily recognized (the purulent exudate may drop off from time
to time, or it may be removed intentionally by an attendant, so that the positive
character of the reaction may not be observed at the time!). If, in case of some
other disease or on account of suspected infection, the result of the reaction is
negative or doubtful, the test may be repeated on the following day, in which case
the reaction is in some horses decidedly more pronounced. In exceptional cases the
reaction appears also in the untreated eye, and in very rare instances there is noted
also a simultaneous slight elevation of temperature. Previous subcutaneous injec-
tion of mallein may partly or wholly prevent the local reaction, for which reason
this test should be applied after, but not before, the ophthalmic test.

3. Cutaneous Mallein Tests (Dermoreaction, intradermal
reaction). These reactions manifest themselves by local symp-
toms very similar to those observed in tuberculosis (see p. 583,
and Fig. 124). However, the small number of observations with
regard to these tests which have thus far been reported con-
stitute a very unsatisfactory basis upon which to form an
opinion in regard ‘to the value of these tests.

According to Vallée, the cutaneous test is unreliable because the thin and
sensitive skin of healthy horses may react with equal facility and because the
difference between reactions in healthy and infected horses is merely a matter of
degree; Martel and Putzey & Stiennon also expressed themselves unfavorably, but
Schniirer considers the test as of diagnostic value. But even the last named author
admits that it is probably less accurate than the ophthalmic test. According to
his observations the intradermal test is more satisfactory, the latter possibly being
of value also in standardizing the mallein, since the edematous swellings develop-

ing at the point of inoculation are usually in direct proportion to the amount of
mallein injected.

Technic of the Cutaneous Mallein Test. The skin is carefully washed and

then scarified until slight bleeding occurs, whereupon concentrated mallein is
applied to the field of operation. Schniirer recommends washing an area 10 em. by
5 em. at the side of the neck and then slightly scarifying three areas, thus # # #.
The first and third areas are treated with mallein, the middle one serving as
a control for the traumatic reaction.
; The reaction begins at about the 6th hour and increases in extent during the
following 24 hours, whereupon it gradually disappears with the subsidence of the
inflamed area. The degree of the reaction is determined by the extent of the
swelling (15-50 s 20-55 mm.) and the degree of its thickness (1-2 em.). Applica-
tion of the mallein to the scarified skin by rubbing with a rough cloth does not
give so satisfactory results.

Serum Diagnosis. Under the influence of the toxin of the
bacillus of glanders, as antigen, other antigen bodies besides
immune substances are formed as products of reaction in the
infected animal body. These may be demonstrated by suitable
methods as agglutinins, precipitins and complement-fixing sub-
stances. Since these reaction bodies possess an affinity for their
own antigen only (glanders toxin) and consequently are strictly
specific in their nature, their presence in the blood of an animal
justifies the conclusion that the animal in question is infected
with glanders.

This constitutes the basis of a number of diagnostic methods
all of which are conducted with the blood serum of the animal
to be tested and the use of cultures of the bacilli of glanders
Complement Fixation Method. 717

or of their extracts. None of these methods are infallible.
They may, however, be supplemented so that doubtful results
given by one are rectified by a positive result obtained from
another method, thus the simultaneous application of several
methods will reduce the errors to a very small percentage.

Since the methods of serum diagnosis are all laboratory methods, it is neces-
sary for the practitioner to send suspected material, properly preserved, to a suit-
able laboratory for examination. For this purpose from 30 to 50 cem. of blood are
drawn from the jugular vein (technic as in ordinary phlebotomy) into a sterilized
test tube. After supplying the tube with a cork to prevent infection, it is kept in
a cool place for a few hours to permit separation of the serum from the clot,
whereupon it may be sent to the laboratory for examination. As a rule, results may
be reported within one or two days.

Since the results obtained in serum diagnosis may he influenced by previous
subeutaneous malleinization, horses from which blood is obtained for this purpose
must not be tested with mallein until after the withdrawal of the serum.

1, Complement Fixation Method. The method of Bordet
& Gengou, inaugurated in 1901, and adapted by Wasserman &
Bruck for the practical diagnosis of syphilis in particular, is
based upon the demonstration of antibodies in the blood serum.
These antibodies, with the aid of their antigen, have the power
of fixing the complements of fresh serum and thus divert them
from hemolytic systems. This method which was worked out
by Schiitz & Schubert for the diagnosis of glanders has already
given results of such an exact nature that it may be looked upon,
at this time, as the best sero-diagnostic method for the de-
termination of this disease.

If an experiment animal is repeatedly treated with red blood
corpuscles from another species, the serum of the former develops the
property of dissolving* the red blood corpuscles of the latter within
a short time, even in very dilute solution. By heating for 30 minutes
at 56° to 58° C. this property is destroyed. However, if fresh serum
from any animal, not previously treated as above described, is added
to a mixture of serum thus incubated (inactivated) plus red corpuscles,
a solution of the erythrocytes (hemolysis) again takes place. This
_phenomenon therefore occurs as the result of the action of two sub-
‘stances: (1) A thermostabile substance which is found only in the
serum of an animal previously treated with the blood corpuscles from
another species, and which develops as a reaction product, or antibody
for red blood corpuscles, i. e., as an antigen. (2) A thermolabile sub-
stance which is present in the fresh serum of any animal and which
is designated as complement or alexin. According to Ehrlich’s theory
this process may be explained by supposing that an antibody possesses
two affinities or haptophore groups (see p. 447) (hence the name :
hemolytic amboceptor or mediating body) ; one of these combines with
the red blood corpuscles as antigen, the other with the complement.
The complement can not combine directly with the antigen, but if
anchored to it by means of the amboceptor it will act as a sort of
digestive or proteolytic ferment and dissolve the red blood corpuscles.
(According to Bordet’s theory the red corpuscles are sensitized for
the alexin by the antibody in a manner similar to the action of mordants
in the dyeing of cloth, for which reason he designates the antibody as

* :—Strictly speaking there is no complete solution of the red blood corpuscles but
only alee aes of the hawolyein on their stroma which permits the escape of the remoglobin,
718 Glanders

substance sensibilisatrice or fizateur). Red blood corpuscles+-hemolytic
amboceptor-+-complement form a hemolytic system!

The hemolytic amboceptor is strictly specific, consequently it will
combine by means of its cytophile group with its own antibody: only
(red blood corpuscles). On the other hand, the complement, which
is present in all fresh serum, is not specific, hence it may he fixed by
various amboceptors in suitable complementophile groups. Thus the
complement will fix specific immune bodies that develop in the tissues
of infected’ animals under. the action of bacteria; these immune
amboceptors attract the complement to the bacteria in question or to
the dissolved elements of their substance. Hence, if we add fresh
serum which contains the complement in suitable quantity, to a mixture
of a suspension of bacteria or a bacterial extract-+-immune serum, the
complement will unite with the amboceptor of the immune serum so
that the free complement disappears from the fluids. Now, if we sub-
sequently add to this fluid a mixture of hemolytic amboceptor+-red
blood corpuscles hemolysis will not result, because the necessary com-
plement has already been fixed by the immune amboceptors and the
free complement no longer exists. In this case, therefore, a fixation
of the complement by means of an immune amboceptor has occurred ;
in other words the complement has been diverted from the hemolytic
system. On the other hand if immune amboceptors were not
present in the first mixture, the complement remains free and can
therefore exert its corpuscle-dissolving properties on the subsequently
formed hemolytic system. These two cases may be expressed graphically
as follows:

1. Bacteria+Immune-Serum+Complement+Hemolytic :imboceptor+Red Blood Corpuscles
(Antigen) (Immune Amboceptor)

== No Hemolysis (Complement Fixation)

2. Bacteriat+Normal Serum+Complement+Hemolytic Arnboceptor+Red Blood Corpuscles
(Antigen) (No Immune

Amboceptor) = Hemolysis (No Complement Fixation)

Consequently if hemolysis fails to occur, i. e., if the complement
is fixed, we may conclude that the fluid contains an immune amboceptor ;
since, however, the latter can fix complement only with the aid of
its antigen and since the antigen (bacterial suspension or extract)
is known, the further conclusion is justified that the fluid contains
an immune amboceptor which corresponds with this antigen and thus
originates from an animal which is infected with the bacteria in-ques-
tion. For example, if glanders bacilli were used as.antigen the com-
plement fixation which followed indicates that the serum possessing
the fixing property originated from a glanderous horse. Under opposite
conditions, for instance, if hemolysis is not prevented, the conclusion
is justified that the horse which furnished the serum is not affected
with glanders.

According 1o the observations of Schttz & Schubert,
Miessner & Trapp, the authors and others, the complement
fixation method for the diagnosis of glanders has already proved
itself very valuable. Its advantage consists in that the relative
amount of immune amboceptor in the serum to be tested can
be determined quantitatively and that the result of the test is
very evident. If, for instance, carefully and progressively
eraduated quantities of serum are used with suitabie amounts
of hemolytic amboceptor and complement it is possible to de-
Plate VII.

Strongly positive Reaction.

 

 

 

 

 

Horse serum 0,2
Hemolysis 0

 

Doubtful Reaction.

      

Horse serum 0,2 0,05 0,02 0,01
Hemolysis + ++ + 4+ ++++ 4+++4-

Complement fixation in Glanders.
Complement Fixation Method. 719

termine the smallest quantity of serum that will prevent
hemolysis. The result is shown by the contrast between the
clear serum following complement fixation and the distinctly
red serum containing the hemoglobin in solution. Although
errors may occur in this method of diagnosis in those excep-
tional instances in which the serum of horses affected with
chronic glanders will not fix the complement and in the still
rarer cases in which an apparent specific fixation occurs in
healthy horses, these errors are considerably less frequent than
those. obtained by other sero-diagnostic methods.

According to the official regulations of Prussia, which prescribe that the serum
of horses which will fix complement in maximum quantities of 0.1 ¢.cm. in the pre-
scribed method of procedure (see below) are regarded as affected with glanders.
Basing their work upon this standard, the results of tests made by Miessner &
Trapp in the examination of 549 healthy horses showed that the serum of only 7
(1.27%) showed a complement fixation power equal to 0.1-0.01, while on the other
hand the sera of 69 glandered horses showed a fixing power of 0.2 in two cases and
a fixing power exceeding 0.2 in five cases. In one experimentally infected
horse the fixing power, as well as the agglutination, began to decline on the sixth
day, but in horses infected naturally with glanders the fixing power was retained
for a longer time; previous malleinization also tended to increase the fixing power
temporarily. Haan, de Bliek, and Valenti, as well as Klimmer & Kiessig, also
report favorably on the results obtained by this method, while Keyser found this
method applicable to cadavers also. Sera of horses affected with other diseases
gave no positive reaction.

Technic of the Complement Fixation Method. This consists essentially in
mixing suitable amounts of glanders-bacillus-antigen and fresh guinea pig serum
containing complement with the inactivated serum to be tested and then
incubating for one hour, in order to hasten fixation. To this mixture
are then added the inactivated hemolytic serum and_ the _ corresponding
réd blood corpuscles. This two-fold mixture, after again being incubated for
two hours, is ready for the determination of results. If complement fixation has
been complete all of the red blood corpuscles will have settled to the bottom of
the test tube, while the supernatant slightly yellow fluid is perfectly clear. On the
other hand, if hemolysis was complete all blood corpuscles will have been dissolved,
so that the supernatant fluid, which is clear also in this case, is of an even red
or port wine color. Transition stages in which only a part of the red blood cor-
puscles are dissolved, may be observed between these two extremes, in which case
the fiuid is only slightly reddened, or reddened only in the lower part of the test
tube, while a certain number of intact blood corpuscles, forming, a correspondingly
smaller mound, will have collected on the bottom of the vessel. For the sake of
convenience the different degrees of hemolysis are referred to as 0, trace, incom-
plete, nearly complete, and complete. ae ; .

This method was first applied practically to the diagnosis of glanders by
Schiitz & Schubert, but subsequently perfected by Miessner & Trapp. According to
these investigators the test is conducted with the following reagents: a

(a) The antigen usually consists of a normal saline solution of sterilized
shake-extract, or of a suspension of dead glanders bacilli; antiformin extracts or
mallein are less suitable for this purpose, although in some cases the authors
obtained more pronounced results with these than with the first. named antigens.

(b) A series of successively decreasing amounts of the serum to be tested,
which must be inactivated by incubating for 30 minutes at 56° to 60° C.

(ec) Fresh guinea pig serum, containing complement in the smallest amount
(usually 0.03-0.04 ¢. em.), in whieh it will produce complete hemolysis in a hemolytic

stem. ; . :
a (d) Hemolytic inactivated rabbit serum (from rabbits previously treated
with sheep blood corpuscles), in double the amount required to. produce hemolysis.

(e) Sheep blood corpuscles, 5% suspension in physiological salt solution.

Reagents of which only small quantities are needed should be standardized by
the addition of normal salt solution, so that equal volumes of each reagent enter
into the mixture. By providing suitable control tubes we are enabled to determine
that neither the antigen nor the serum under test have alone been the cause of the
complement fixation, and also that the hemolytic system was properly formed. The
successive steps in this test are illustrated graphically in the tables on page 720.
720 Glanders.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Shei aac eas Phys. Hemolysis after
. omple- mo- Ey
Antigen | body | “tebe | lysin [Blood/ go, |) 2 | 2 | 16
(in 1,0) tion rh
Hours
Inact. Fresh | Inact. | Desi.
Bacillus | serum guinea rabbit | prin.
emulsion of pig serum| sheep | sheep |0,85 %
1:500 |suspected| 1:25 Serum blood s
horse 1:700 | 1:20
n
5 1,0 0,1 1,0 1,0 10 | — i) 0 0
a 1,0 0,1 1,0 1,0 1,0 — 0 0 0
Gj 1,0 0,05 1,0 1,0 1,0 — 0 0 0
© 1,0 0,02 1,0 1,0 1,0 —_ 0 0 0
5 1,0 0,01 | 1,0 1,0 1,0 | — 0 fe at
n
a Bacillus
extract
1:500
1,0 0,2 1,0 1,0 1,0 — 0 0 0
1,0 0,1 1,0 1,0 1,0 —_— 0 0: 0
1,0 0,05 1,0 1,0 1,0 _— 0 0 0
1,0 0,02 1;0 1,0 1,0 a 0 + +
1,0 0,01 1,0 1,0 1,0 — 0 + +
@ | Bacillus | ‘Inact.
2 lemulsion| 2o7mal
2 | 1:500 | horse
foray serum
2] 1,0 0,2 10 | 40 | 30) ~ | ++] +++ [+444
3} 1,0 0,1 10 | 140 | 10 | — | ++) +44 [4444
& | 1,0 005 | 10 | 10 | 10 | — | ++] +44 [++4++
z | 1,0 002 | 10 | 10 | 10 | — |l+++4) +44 [+444
1,0 oor | 10 | 10 | 10 | — W4+++) +++ [+++ -
Tnact. se-
rum of
susp.
horse
cm oe 18 LO | 20) 10 4t+ tet |r ttt
—_— 0,1 — 1,0 1,0 2,0 |} 0 0 0
normal
horse
serum ;
a{ — | o1 10 | 10 | 10 | 10 +44{++++/+4++4+
E|.- 0,1 _ 10 | vo | 20 Tae 0
@ | Bacillus
5 emulsion
1,0 = 1,0 10 | 10 | 10 +++) +44 |++++
1,0 _ — 1,0 1,0 2,0 0 0
Bacillus
extract
1,0 = 10 | 10 | 10 | 30 444) +44 |++++
1,0 = — 1,0 | 1,0 | 2,0 0 0 -0
eae as 1,0 1,0 1,0 2,0 +++ t+4++ 4+4+4++
_ az _ 1,0 1,0 3,0 0 0 0
— a 1,0 _— 1,0 3,0 0 0 0
_ = == _ 1,0 4,0 0 0 0
' Examination by, qyomplenient fixation of serum of glanderous horse (fever curve-—see

p. 702; Exam, Jan,
Hemolysis: 0 aot hemolysis -+=trace, +-++"= incomplete, +-++ =almost complete,
este = complete,
Agglutination Test. 721

2. Agglutination Test. This is based upon the fact that
blood serum which contains agglutinating substances will cause
the clumping of glanders bacilli in suspensions of potato or
agar cultures, whereupon these clumps are precipitated to the
bottom of the supernatant clear fluid.

The agglutinating action of blood serum was first observed
by Dedjulin in human beings affected with glanders, by Mac-
Fadyean in horses affected with'this disease. Subsequent in-
vestigations, especially those of Schiitz and his co-workers,
showed that the serum of healthy horses may also contain
(normal) agglutinins in rather large quantities, but that, never-
theless, the reaction is specific in the sense that agglutination
is brought about by the serum of infected horses in considerably
greater dilutions than is the case with serum of healthy horses.
The following general rule has been found quite applicable and
reliable, viz., agglutination, if. appearing in dilutions of 1:400
or less, with few exceptions, indicates freedom from infection;
on, the other hand dilutions of 1:1000 or more, also with few
exceptions, indicates the presence of infection, while agglutina-
tion in dilutions of 1:2000 or more indicates recent infection.
However, in infected stables we usually find a rather con-
siderable number of horses the serum of which will produce
the agglutinating phenomenon in dilutions of 1 :500-800; a titer
of this kind has no diagnostic value in either direction. This
fact which presents a considerable disadvantage to the practical
application of this method of diagnosis is compensated for in
a certain number of cases by the discovery that the agglutina-
tion titer of glanderous horses undergoes very considerable
fluctuation from month to month, thus it may be very high
(2000-4000 or more) a few days after infection and then grad-
ually drop, while exacerbations of the morbid process may again
cause a pronounced upward tendency.

The practical value of the agglutination test is considerably
reduced by the necessity, in a considerable number of sus-
pected horses, of repeated serum tests at intervals of several
weeks.» Since healthy horses also occasionally show physio-
logical fluctuations in agglutinating power of no inconsiderable
degree, and since on the other hand these fluctuations can no
longer be recognized in horses with chronic glanders, the prac-
tical value of this test must not be ranked too high and by no
means above that of the subcutaneous mallein test. Never-
theless by giving due consideration to the possible negative re-
sults, careful attention to technic, and especially supplementa-
tion of other methods, particularly the complement fixation
method, this test constitutes a valuable addition to our diag-
nostic methods (see p. 717), and may be of much value in
doubtful cases. In recent infections it is quite reliable in itself.

The agglutination test was first recommended for practical use by ‘Bourges &
Méry, Pokschischewsky, Arpd4d, Rabieaux and particularly by Jensen, The last
named author ranks it above the mallein test because post-mortem examinations were

Vol. 1—46
722 Glan ders.

a

negative in horses which gave positive or doubtful reactions to mallein, but the
blood serum of which did not distinctly agglutinate glanders bacilli. Subsequent
experiments showed that sera which agglutinated the typhoid bacillus, the Bacillus
suipestifer, or the colibacillus, would not affect the bacillus of glanders.

In the experiments of Schiitz & Meissner the agglutination titer of the sera
of 1,911 horses which were free from glanders was 1:100-400 in 1,602 horses
(83.8%), 1:500-800 in 299 horses (15.7%) and 1:1000 in 10 horses (0.5%); on
the other hand, among 298 glanderous horses the titer was 1:400 in 6 (2.0%),
1:500-800 in 103 horses and 1:1000 in only 189 horses (63.4%). If we regard titers
of 1:400 as decisively negative and 1:1000 or more as decisively positive evidence
of infection, the errors in diagnosis in these cases were only 0.77%. However, in
18.2% of all cases and in 34.6% of the infected horses that gave agglutination titers
of 1:500-800 the diagnosis had to be held in abeyance.

Sehniirer places a similar value on the results of the agglutination test,
although according to his opinion the average amount of normal agglutinins fiuc-
tuates between 400 and 600. However this investigator, whose observations extend
over 300 cases, recommends this method strongly for practical use, as do also
Benome, Wladimiroff, Fedorowsky, Langer, Moore, Taylor & Giltner, Berns &
Way, ete., while Foulerton, Preusse, Stanciu and Riemer express themselves less
favorably. The last named author observed agglutination powers of 1:500, 1:700
and 1:1000 in glanderous horses, while the titers in six healthy horses were 1:800
(in four cases), 1:2000 and 1:4000,.respectively. In pleuro-pneumonia (Miessner)
as well as in distemper (Sustmann) the serum seems sometimes to possess greater
agglutinating power, it has also in the course of a long period of observation been
found to be more uniform, while other diseases do not influence the agglutination
titer (Langer).

After an experimental infection, the agglutinating power may rise to 1:2000
or more in 2 days (Bonome, Hutyra; according to Sustmann in 3 days; according
to Schiitz & Miessner in 6 days) remaining at this point about 4 weeks, whereupon
it gradually returns to the normal.

Subcutaneous malleinization raises the agglutination titer in healthy as well
as in infected horses. Pekschischewsky saw the titer double in the course of a mal-
lein reaction, and according to Pfeiler it sometimes reaches 4,000 in these cases,
while Meissner as well as Fedorowsky, Kleine and Bonome observed only a mod-
erate but long continued increase of titer. Schiitz & Miessner failed to observe
any change in three horses. Arp4d observed the titer increase in two days from 300
to 1,600 in healthy horses, but it dropped again to 800 in 7 days, while according
to Miessner the increase does not begin until the 5th or 7th day, reaching its max-
imum in 14 days and not beginning to gradually return to the normal until after
4-6 days. According to Sustmann the elevation continued for more than 3 months.

Practical observations of Nevermann include statistics on 3,466 horses which
were tested in the course of two years in several hundred Prussian stables or studs.
According to these statistics the temporary diagnosis based upon the agglutination
test was confirmed by post-mortem examination in 79.2% of the negative results
(titer 300-400) and in 79.5% of the positive results (titer 1,000 or more, with
fluctuations). Of 18.2% of the horses destroyed on the ground of suspicion (giving
titers of 500-800) lesions of the disease were present in 46.6%. In more than
See of the stables the test for some of the animals had to be repeated from

to 6 times.

Technic of the Agglutination Method. The test fluid is prepared with
a suspension of agar or potato culture of 2 to 5 days’ growth prepared from a
suitable strain of glanders bacilli and diluted with physiological salt solution.
After killing the bacilli by heating at 60° C. the test fluid is standardized
by adding the necessary amount of normal salt solution. For each 2.0
ce. of this fluid in test tubes the serum to be tested is added in  success-
ively decreasing amounts (from 1:300 to 1:4000) whereupon the tubes are
incubated for 36 hours. By keeping the fluid in the thermostat for one-half hour
and subsequently centrifuging for 5 to 15 minutes (the time being determined by
the number of revolutions), the result may be obtained within one to two hours.
positive reactions are indicated by the accumulation of agglutinated bacilli on the
bottom of the tubes in the form of a circular film with serrated border, while the
supernatant fluid has tecome perfectly clear. On the other hand a negative reaction
is indicated by the cloudiness of the fluid, while the precipitated but not aggluti-
nated bacilli have accumulated on the bottom of the test tube in the form of a flat
dise with a smooth outline.

King & Houghton have worked out a method by means of which the test can
easily be made in actual practice. Carefully measured amounts of properly prepared
test fluid are placed in graduated test tubes whereupon square pieces of filter paper
Precipitin Reaction. 723

of varying but definite size, that have been saturated with serum, are placed in the
fluid. In this manner varying dilutions of serum are produced in the test fluid
which is then incubated for 24 to 48 hours or allowed to stand near a warm stove.
The agglutination titers may then be determined by comparing the results in the
tubes: with a properly tabulated guide.

3. Precipitin Reaction. In this phenomenon the serum of
an immunized animal produces a fine flaky precipitate in the
culture filtrate of the organism used in immunization. It was
first observed by Kraus, subsequently by Wladimiroff, who
noted that it occurred also in filtrates of glanders cultures
after the addition of serum from glanderous horses. The
latter’s observation was confirmed by Pfeiler, Miessner and
Miller, although the investigations of the latter showed that
the sera of healthy horses also produced precipitates (normal
precipitins) but in a less degree, thus causing more or less
confusion in diagnosis. On the other hand they obtained better
results when they used bacillary extracts or mallein solutions
instead of culture filtrates and instead of mixing these with
the serum gently pouring them on the surface of the same (con-
tact or ring test). By this latter method a distinct gray band
of precipitate which may be regarded as quite specific, will
form within a few minutes at the line of contact of the two
fluids. According to observations thus far recorded this method
is giving satisfactory results in most instances while the fact
that precipitins can be demonstrated also in chronic cases of
disease presents an additional advantage.

Pfeiler, who uses extract of glanders bacilli prepared with carbol-sodium-
chloride solution or carbolized horse serum as a precipitinogenic fluid, tested 452
blood samples obtained from 306 horses suspected of the disease or exposure thereto.
He compared his results with those obtained by the agglutination and complement
fixation tests and found that they confirmed each other, particularly in recent cases
of infection. In experimentally infected horses the precipitins could be demon-
strated within 4 or 5 days after infection. Similarly favorable results were obtained
by Miessner in 18 glanderous horses by the use of extract of glanders bacilli and
10% mallein solution made with Foth’s dry mallein. In very old cases only were
the results from this method less satisfactory. Finally, Miiller was able to deter-
mine the specificity of the reaction in his guinea pig experiments.

Other Diagnostic Methods. In former times the following were frequently
resorted to: The inoculation of a suspected horse with its own secretions, a healthy
portion of the body being selected to reproduce the characteristic, glanderous
lesions; trephination of the antrum of Highmore, in order to permit direct inspec-
tion of its mucous membrane; the artificial production of a fever or of the acute
form of the disease by subjecting the suspected animal to hard work or by the
subeutaneous injection of oil of turpentine (Cagny) or by the injection of strepto-
coccus cultures (Jewsejenko). In any of these methods only a positive result had
any value, and all of them have long been superseded by modern methods of
diagnosis. :

In more recent times Baldoni and Dieckerhoff recommended the intravenous
injection of Credé’s colloidal silver, which produces a febrile reaction in glander-
ous horses and consequently might be of service in the diagnosis of doubtful cases.
Réder, Passau and Blome have also observed this action, although Poetschke and
subsequently also Réder observed that a similar reaction occurred occasionally in
the course of other internal and external diseases and even in healthy horses. ;

Carrozo recommends Ehrlich’s diozoreaction (red coloration of the urine
after the addition of hydrochloric sulphanilic acid, potassium iodide and ammonia),
this reaction being much more pronounced in the urine of glanderous horses than in
724 Glanders.

that of horses affected with other infectious diseases. The value of this method
has not as yet been confirmed by others. / oy

Fursenko tested. the blood of 25 horses for opsonins and obtained 23 positive
and two doubtful reactions. The results were better than those obtained with
mallein or with the agglutination test.

Differential Diagnosis. From a differential diagnostic
point of view the following diseases should be considered in
connection with nasal glanders; chronic nasal catarrh may
arouse suspicion of glanders when the nasal discharge persists
for a long time and there is enlargement of the submaxillary
glands; in this disease, however, the nasal discharge is always
bilateral, the tumefied lobules of the submaxillary gland may
be distinctly palpated, the nasal mucous membrane usually con-
tains no nodules, catarrhal ulcers, which may be present, never
exceed the size of lentils, are circular and regular in outline,
have sharp borders and smooth, bright red bases, while proper
treatment results in recovery. Although occlusion of the
afferent ducts of the mucous glands in the course of simple
catarrh may cause the formation of nodules as large as lentils,
these persist for a long time without ulcerative degeneration.—
Croupous inflammation of the nasal mucous membrane is at-
tended by acute symptoms, the nasal mucous membrane is much
tumefied, highly reddened and appears to be covered with ex-
tensive membranous masses, the bright red mucous membrane
beneath bleeding at the slightest touch; the submaxillary glands
which are usually swollen show increased heat and pain.—
Rhinitis chronica proliferans, and so called rhinoscleroma are
confined to the lower portions of the nasal cavity; in these
conditions cicatricial induration of the mucous membrane as
well as catarrhal ulcers may be present, while the mucous mem-
brane above as well as that of the turbinated bones is normal.
The submaxillary glands do not show the characteristic firm
enlargement.—Uleers and scars of traumatic origin are usually
found near the nasal fossa on the septum; the ulcers have a
red actively granulating base, the scars usually being elongated,
or angular, flat, rarely bulging in character; the lymph glands
show nothing abnormal.—Cauterization of the nasal mucous
membrane with lime may produce extensive ulceration but the
submaxillary glands are not involved.

Petropawlowski called attention to the fact that mineral- and
coal-dust may produce an ulcerous inflammation of the nasal mucous
membrane and Jewensko observed a severe inflammation of the nasal
mucous membrane in the horses of a regiment of dragoons in Ismail,
after feeding with dusty fodder, as a result of which 200 horses were
destroyed on account of suspected glanders!

Very obstinate catarrhal conditions may also be produced by
pentastoma and by gastruslarvae. In old horses chondromalasia may
be confused with glanders. In this disease the nasal septum may
contain ulcers with pronounced ragged borders and nodules of various
sizes while the cartilage contains cavities filled with a glassy, mucous
mass (Petropawlowski).
Differential Diagnosis. 725

In some districts injuries of the nasal mucous membrane and
from them cicatrices which have been caused by quacks in an effort
of treatment, are very frequent occurrences. Cicatrization may also
occur after fractures of the nasal bones.

Chronic catarrh of the nasal sinuses often gives rise to
suspicion of glanders, the nasal discharge in this disease fre-
quently being unilateral and otherwise very much like that in
glanders while the submaxillary lymph glands are usually also
enlarged. However, the sensitive condition of the infraorbital
nerve, the temporary, profuse nasal discharge, the fluctuating
results obtained in percussion of the sinus, the soft and lobulated
structure of, and the absence of adhesion in, the submaxillary
glands as well as the absence of nodules and ulcers on the nasal
mucous membrane, are usually sufficient to enable one to recog-
nize the nature of the affection. In addition to this the results
of trephination which would be therapeutically indicated in this
case would decide the character of the affection, as would also
the determination of any special cause of the trouble (tooth-
caries, bone necrosis, neoplasms, etc.). In chronic catarrh of
the guttural pouches also there may be unilateral nasal dis-
charge, the origin of this, however, is at once indicated by
the tumefaction in the subparotideal region.—Distemper or
strangles might be confused with glanders but only in affections
of a subacute character in which the intermaxillary abscess
appears late in the development of the disease or fails to
make its appearance, or in cases where the lymph vessels of
the surrounding region become enlarged, and finally also when
metastatic abscesses appear in remote regions of the body; but
even in this case the morbid changes present a more acute
character than those of glanders. There are no nodules on
the mucous membrane while the interior of the swellings or
abscesses contain only streptococci (ulceration of the mucous
membrane does not necessarily exclude distemper since this
may also be brought about by the streptococcus of strangles
[Rabe]. See p. 373).—Stomatitis pustulosa contagiosa may
excite suspicion of glanders when the lips and nasal alae become
swollen and nodules and ulcers are present on the nasal mucous
membrane; aside, however, from the acute and favorable
course of the process the existence of similar changes on the
oral mucous membrane in itself would exclude glanders.—
Finally ulceration of the nasal mucous membrane occurs also
in the course of tuberculosis (see p. 550) as well as in epizootic
lymphangioitis (see p. 737). In these cases chronic enlarge-
ment of the submaxillary glands may also be present (this,
however, may also occur in actinomycosis), consequently a
microscopical examination of the extirpated tumors or tissue
portions alone would be confirmatory.

The following conditions may be confused with cutaneous
glanders: Septic lymphangioitis, which, however, is accom-
‘

726 Glanders.

panied by continuous fever, extreme pain, a conspicuous dis-
turbance of function, in addition to which the abscesses after
perforation heal readily by active granulation.—Botryomycosis,
in those cases where subcutaneous tumors undergo suppura-
tion attended with edematous infiltration of the surrounding
tissue; in these cases there is also active granulation and the
efferent lymph vessels are not involved.—In ulcerous lymph-
angioitis the cutaneous ulcers are very similar to those of
glanders, but the regional lymph glands are not enlarged, a
short bacillus which takes Gram’s stain is present in the
ulcerous secretions, while in epizootic lymphangioitis the pres-
ence of coccus-like structures which do not readily stain con-
firms the diagnosis; furthermore, no reactions follow the injec-
tion of mallein in this disease——Urticaria is characterized by
its sudden appearance and the equally sudden subsidence of
the cutaneous swellings.—Contagious acne is characterized by
pustule formation and the rapid, complete healing of the small
culeers.—In morbus maculosus we have extensive swellings with
abrupt contour. Cutaneous nodes caused by nematodes are
characterized by their permanence and their hemorrhagic
character.

Chronic inflammatory affections of the lungs in general and
pursiness resulting therefrom have so much in common with
pulmonary glanders in their general symptoms, that their
presence can never be definitely excluded in suspicious cases.
Since these conditions are frequently attended by poor general
nutrition the mallein test (and in protracted cases serodiag-
nostic methods as well) may not enable us to arrive at a
definite diagnosis. It is, therefore, necessary that animals thus
affected be kept under careful observation for some time so
that any characteristic symptoms of glanders may be discovered
at once. In this respect torpid edematous swellings, bloody
bronchial secretions as well as cachectic symptoms in general
demand consideration.

As far as the pathologico-anatomical diagnosis is concerned the followiug
morbid processes are of particular importance: Peribronchitis nodosa multiplex
(Dieckerhoff) s. Nodosis pulmonum; this is characterized by uniformly gray, firm,
frequently calcified nodules ranging in size from a poppy seed to that of a lentil,
the surrounding pulmonary tissue showing no evidence of reactive inflammation;
the peribronchial lymph glands also are intact in this affection—Peribronchitis
diffusa and Pneumonia interstitialis chronica: the walls of the bronchial tubes are
uniformly thickened, the inter-alveolar connective tissue is uniformly indurated in
large surrounding areas; nodules are present and there is no gelatinous infiltration
of the tissue nor enlargement of the lymph glands.—In pneumonia catarrhalis of
young horses the hepatized pulmonary areas are uniformly red or grayish-red and
without soft centers, although there is acute swelling of the peribronchial lymph
glands they contain no caseous foci—In tuberculosis we find as a rule in addition
to gray hyaline, fresh nodules as large as poppy seeds, large sarcoma-like nodes
as well as broncho-pneumonie foci, while the thoracic lymph glands are caseated.—
Nodules caused by animal parasites (nematodes or their embryonic forms and
echinococci) are very similar to glanders nodules, but all of them, even the smallest,
are enclosed by a delicate capsule, in addition to which their peripheral layer is
frequently hyaline, while calcium salts have been deposited in their centers ; the
capsule surrounding even the larger nodes is much more delicate than those enclos-
Treatment. 727

ing the cheesy nodules of glanders; the diagnosis can, however, only be confirmed
definitely by microscopical examination (numerous eosinophile cells in parasitic
nodules! ).—In botryomycosis and in pneumonomycosis the morbid changes are gen-
erally more chronic in character, while the presence of botryomyces or mycelia and
other fungi is readily determined by the microscope—Metastatic pus foci are fre-
quently very much like embolic nodules of glanders in their general appearance,
especially those of acute glanders, but the absence of more advanced glanderous
changes in the lungs, as well as in other internal organs, is against their glanderous
nature (pus bacteria may also be present in broken-down glanderous foci!). Metas-
tases of new formations (sarcomata, carcinomata) may be recognized, aside from
their characteristic macroscopical appearance on section, by the presence of primary
tumors or by histological examination.

_ Finally, suspicion of glanders may be aroused in those
instances in which new formations (rhinoscleromata, sarcomata,
carcinomata, fibrous polyps, ete.) occur on the nasal mucous
membrane or when metastases of malignant tumors, particu-
larly melanomata, give rise to chronic enlargement of the lymph
glands in different regions of the body (Bissonge and Feiler
observed the submaxillary glands thus affected). In these cases
an exact diagnosis is possible only by careful consideration
of the anamnesis or by means of a histological examination
of portions of the tumors. Observations of the past have shown
that the mallein test gives negative results in these cases.

Treatment. Since, according to generally accepted princi-
ples of sanitary police control evidently glanderous horses must
be destroyed at once, successful treatment of this disease is
of no practical consequence. But this is true irrespective of
this fact since all the many attempts to cure the disease that
have. been made in the past have proved failures. The internal
administration of the most varied medicinal agents has been
found just as ineffective as the more recently recommended
intratracheal injections of lLugol’s solution (Delamotte,
Trinchera), even in human medicine favorable résults have
been obtained only now and then by the repeated cutaneous
application of gray mercurial ointment.

The appearance of local reactions following the injection
of mallein has given rise to the belief that repeated injections
of this kind would have a healing influence on the glanderous
process. Although the healing of ulcers and even definite re-
covery from the disease has been observed now and then to-
follow such treatment (Johne, Helman, Semmer, Pilavios,
Choromansky, Sitschew) the possibility of spontaneous recovery
in these cases could not be definitely excluded; even if we
admitted the possibility, this mode of treatment would hardly
be of practical value.

Immunization. Recovery from this disease does not protect against
subsequent infection, at least not as far as experimental observations
-on dogs treated with virulent material are concerned (Charrin, Galtier).
‘Experiments made with repeated mallein injections (MacFadyean,
Schindelka) also gave no satisfactory results. |

After Sadowsky had succeeded by the administration of cultures
killed at 62° C., in increasing the resisting power of a colt to such
728 Glanders.

an extent that the inoculation of virulent cultures produced no harmful
effect, Levy, Blumenthal & Marxer obtained happy results in horses
by the subcutaneous administration of 600 mg. or two successive in-
jections of 300 mg. of bacilli that had been killed in 80% glycerin or
in 10% urea solution. Subsequently they prepared an immunizing
powder from cultures treated in the manner mentioned and which
they named ‘‘farase.’? This is applied in doses of 0.4 g. followed in
three weeks by 0.8 g. injected subcutaneously. This substance which
keeps well even at high temperatures is said to be absolutely harmless,
treatment therewith not seriously affecting the general condition of
the animal and producing an immunity of at least one year’s duration.

According to Malzew, cattle serum in doses of 250 to 420 ec. injected sub-
eutaneously protects horses against the action of virulent cultures of glanders.
Nocard, Aruch & Petrini, as well as Prettner, found that even the serum of cattle
which had been injected repeatedly with virulent cultures was ineffective, and
Galtier & Nicolas observed that treatment with serum of this kind after experi-
mental inoculation would at most prolong the course of the disease.

Veterinary Sanitary Police. The live stock sanitary laws
of all civilized countries include glanders among those diseases
which must be officially reported, and provide also for regula-
tions requiring the immediate destruction of diseased and the
quarantine of suspected and exposed animals, including thor-
ough disinfection of infected premises. Public traffic with
horses is subjected to careful supervision for the purpose of
the prompt detection of new outbreaks. The strict enforce-
ment of these regulations, especially in those localities where
adequate compensation is provided for condemned animals, has
resulted in a marked decrease in this disease, which is strictly
contagious in its nature.

In recent years the systematic application of mallein tests
and of serodiagnostic methods has added much to the success
in the control and eradication of glanders; while formerly the
presence of doubtful symptoms or the absence of pronounced
lesions merely pointed to suspicion of disease and consequently
involved the necessity of a long period of observation while
the animal was held in quarantine, modern methods of diag-
nosis make it possible to decide the nature of the malady at
once, or within a very short time, and thus make possible the
immediate isolation (or destruction) of dangerous individuals.
These methods also enable us to remove at once such horses
from infected stables as are healthy in general appearance,
but yet may have been the cause of the dissemination of the
disease. By isolation and further observation of such animals
the healthy horses are protected against possible infection.
This makes it possible, also, to dispense with many quarantine
regulations that were formerly necessary. The advantages
thus afforded to the owner of horses and to horse traffic in
general is evident.

The application of the mallein tests and of serodiagnostic methods
is recommended in all cases where individual horses show symptoms
Veterinary Police. 729

a

pointing to possible infection with glanders, or in such cases where
the remaining horses in the stable are under suspicion of exposure.
While differences of opinion still exist in regard to the value of allergic
reactions and serum tests, nevertheless observations thus far recorded
show that the exact and intelligent application of these methods produce
very favorable results and that the supplemental use of several of these
methods enables us to reduce errors to a minimum. While the newer
methods and particularly the serum tests make the duties of the prac-
ticing veterinarian less burdensome, clinical examinations nevertheless
are still of great importance and quite indispensable, especially for
the reason that these tests will occasionally give negative results in
very chronic and extensive (and consequently the most dangerous)
cases.

Since 1910 the complement fixation method and the agglutination test ave
been used in Prussia exclusively as official tests. All animals with a fixation titer
of 0.2 or less, or with agglutination power of over 1,000 must be destroyed; all
horses with a fixation titer above 0.2 or an agglutination power below 1,000 are
regarded as free from suspicion, provided that the examination is made at least
two weeks after the animal in question has been removed from exposure. From
1906-7 to 1907-8, 648 animals were destroyed on evidence furnished by the aggluti-
nation test; of these 395 (60.9%) were found affected with glanders. The success
of the method consisted in the fact that after completion of the blood test (which,
however, had to be repeated in a number of cases) not a single glanderous animal
was found in any of the stables investigated—In Hungary all animals which give
typical, atypical or doubtful reactions to the subcutaneous mallein test and show
clinical symptoms of disease, are destroyed at once. Horses that react to the test,
but are otherwise in apparent health, must be isolated from other solidungula, but
may with the consent of the proper authority be used under certain restrictions;
thus for farm work, ete., contact with other horses must be avoided. These animals
must be examined every two weeks by a veterinarian, and in the event that any
suspicious symptoms of glanders make their appearance, the animal must be
destroyed at once. Those animals which have reacted to the mallein test but appear
otherwise in perfect health may be used by their owners without restrictions, except
that none of these animals that have been in immediate contact with diseased
horses may be sold outside of a parish before the expiration of 60 days nor without
a second examination by a veterinarian. Exposed animals which have reacted to
the test are retested after 30 days; those animals that do not react at the second
test and otherwise appear in perfect health are released from the restrictions, while
the reactors are treated as above indicated (destroyed or continued in quarantine
and again tested as the authority in charge may designate for each case).

Under these regulations (1902-1908) 1,385 suspected glanderous horses and
1,609 horses exposed to glanders (a total of 2,994 actually glanderous horses, all of
which were affected with glanders in the first stage of the disease) gave positive
reactions to the mallein test and were quarantined (60.1% of all glanderous horses
destroyed. during this period). A similar method was followed in the extermina-
tion of glanders in the Compagnie générale des Voitures of Paris without serious
interruption of the business of the company; while the disease was very prevalent
in the stables of this company in 1895 and 1896 (see page 680), only 101, 40 and
85 horses, respectively, had to be destroyed on account of disease in 1897, 1898
and 1899. In 1903 only 18 reacting horses were found in all of the stables.

During the time intervening between the mallein tests and that
of procuring the blood for serum tests the body temperature of those
horses suspected of infection or disease should be recorded systematically
twice daily. An elevation of temperature continuing for several days
points to recent infection unless it can be ascribed to some other cause
(see pp. 690 and 697), or to the continuance and the probable pro-
gression of already existing lesions.

Literature. Loffler & Schiitz, D. m. W., 1882. Nr. 52; 1883. Nr. 14, —

Léffler, Arb. d. G.-A., 1886. I. 141. — Johne D. Z. f. Tm., 1886, XVI. 321. —
Cadéac & Malet, Rev. vét., 1886. 406; 1888. 581; Bull., 1894. 555. — Schiitz, A. f.
730 Glan ders.

Tk. 1889, KX. 425; 1895. KXTI. 382; 1898, XXIV. 1; 1908, XXXIV. 74. — Olt,
A. F. Tk., 1895, XXI. 352. — Foth, Z. f. Vk., 1892. 169; D. Z. f. Tm., 1894.
XIX. 437. — Bass, D. Z. f. Tm., 1893, XIX, 217 (Historical). — Nocard, Bull,
1893, 116; 1894, 89, 225. 367; 1896, 196; 1897, 781; 1901, 387; Rec., 1897, 675;
1898, 296. — Semmer, D. Z. f. Tm., 1894, XX. 59. — Hutyra & Preisz, D. Z. f.
Tm., 1894, XX. 369. — Olt, A. f. Tk., 1895, XXI. 352. — MacFadyean, J. of
comp. Path, 1896, IX. 322; 1901, XIV. 265; 1904, XVII. 295. — Wladimiroff, Rec.,
1897, 618; Hb., d. p. M., 1903, II. 707 and 1904. III. 1020 (Lit.); B. t. W.,
1908. 50. — Jensen, B. t W., 1901, 621. — Babés, Moyens 4 comb la Morve,
Bucharest 1903. —Bonome, Patogenesi, ete., della Morva chiusa, Padova 1905. —
Riegler, Kongr. Budapest 1905, II. 338. — Schlegel, D. Rotzbekimpfung usw.,
Stuttgart 1905. — Schniirer, Chl. f. Bakt., 1905, XXXIX, 180; Z. f. Infkr., 1908.
IV. 216; D. t. W. 1910. 65 (Lit. ou Allergy). — Feodorowsky, A. f. Tk., 1905,
XXXI. 505. — Schiitz & Miessner, 1905. XXXI. 353. — Hutyra, Z. f. Tm., 1907.
XI. 1. — Levy, Blumenthal & Marxer, Z. f. Infkrkh., 1907. III. 294 (Lit. on Im-
munization). — Sustmann, Diss. Ziirich 1908 (Lit. on Aggl). — Schulz, A. f. Tk.,
1908. XXXV. 198 (Lit. on Aggl.). — Schiitz & Schubert, ibid., p. 44. — Pfeiler,
ibid., p. 323 (Lit. on Prezip.). — Miessner & Trapp, ibid. p. 85 (Lit. on Patho-
genese); Chl. f. B., 19C9, LIT. 115 (Lit. on Fixation).

Glanders in Carnivora. After the ingestion of the meat and the
organs of glanderous horses carnivora may also become infected with
glanders. In zoological gardens actual enzootics are occasionally ob-
served among the animals of the cat species from this cause, while
animals of the dog kind are much more rarely the victims of these
conditions.

In such cases the disease usually takes an acute course. As a rule
the first symptoms consist of an excessive inflammation of the con-
junctivae and of the mucous membranes of the air passages, the eyes
and nose discharging at first purulent but later a greenish-gray or
bloody secretion. Following this the respiration becomes very labored
as a result of excessive swelling of the respiratory mucous membranes.
These symptoms become rapidly aggravated, the tissues of the head
become swollen, particularly in the nasal region, while metastatic
nodules, which soon perforate the skin and form ulcers, make their
appearance in the subcutaneous tissue of various regions of the body.
Finally diarrhea sets in, whereupon the animal succumbs in the course
of the first or second week after the appearance of the first symptoms.

Glanders in Sheep and Goats. Although sheep are susceptible to
experimental infection with glanders they are not known to become
infected from natural sources. The destructive disease described by
Audum in Livland under the name of glanders, causing the death of
60 Merino sheep and the slaughter of 200 exposed animals, is evidently
not the morbid process under discussion, experimental infection of dogs
as well as of guinea pigs having been unsuccessful. (Hemorrhagic
septicemia was formerly described repeatedly as glanders of sheep;
see p. 118.)

Ercolani, Karsten-Harms, Koch and Trasbot observed glanders
in goats in stables where glanderous horses had been kept for a long
time. Of morbid symptoms were observed particularly profuse purulent
nasal discharge and in one instance abscess of the udder.

Literature. Ercolani, II. med. vet., 1891. — Harms, H., Jhb., 1874. 88. —
Trasbot, Ann. d’Alf., 1876. 521, — Audum, Unters. iib. d. Schafrotz, Diss., Dor-
pat, 1888,
Glanders in Man. 731

Glanders in Man. In man glanders seems to oceur most frequently
when the virus gains an entrance directly into the lymph spaces or
into the subcutaneous and submucous connective tissue from lesions
in the skin or mucous membrane, or when it enters the blood stream
directly. Aside from positive observations along this line this view
is supported by the fact that persons who are frequently exposed to
danger of infection (stable attendants) are comparatively rarely
affected with the disease. Nevertheless the possibility of an intestinal
infection must be admitted.

The course of the disease may be acute or chronic. In acute
cases a small nodule or ulcer develops at the point of infection, the
surrounding connective tissue is edematous and the afferent vessels
and the regional lymph glands are swollen. Subsequently small nodules
and bluish-red pustules appear on other parts of the body where they
are in a short time transformed into ulcers; frequently there may
be purulent inflammation of the articulations and of the corpus
cavernosum of the penis. In the course of these changes there is febrile
elevation of temperature with occasional attacks of chills, and the
patient complains of severe muscular and articular pains. In some
instances there is also an ulcerative inflammation of the nasal mucous
membrane attended at first by a thin discharge which subsequently
becomes purulent, reddish and viscid. The appearance of cough, hoarse-
ness, difficult respiration and deglutition indicate affection of the
larynx and lungs. These symptoms are attended with, or followed by,
gradual exhaustion of the patient and finally terminate in death in the
course of 2 to 6 weeks.

In some cases (intestinal infection?) the morbid picture is very
similar to that of typhoid fever; the persistence of the fever beyond
the third week as well as the subsequent appearance of cutaneous
pustules alone make the final definite diagnosis possible.

The chronic form develops insidiously; while febrile elevations
of temperature continue, nodules and small ulcers appear on various
parts of the body; these may heal and the patients may be apparently
well for months or even years; later, however, fresh nodules appear
and symptoms of lymphangioitis and phlebitis set in and the process
finally becomes acute, or the disease may run a chronic course through-
out (in Bollinger’s cases the disease continued for 11 years), although
this form of the disease is said to end under proper treatment not in-
frequently (50%) in recovery (superficial application of gray mercurial
ointment).

Literature. Bollinger, Ziemssen’s Handbuch, 1874. 399 (Lit.). — Koranyi,
Nothnagel’s Handbuch, 1900. V. Bd. 1 T. — Strube, A. f. Klin. Chir. LXI. (Lit.).

8. Ulcerative Inflammation of the Lymphatics of the Horse.
Lymphangioitis ulcerosa equorum.

Uleerative lymphangioitis is a chronic, contagious disease
of horses in the course of which, usually without involving
the regional lymph glands, there is developed a progressive
inflammation of the subcutaneous lymph vessels with a tendency
to ulceration. -
732 Ulcerative Lymphangioitis.

History. This disease was first described by Nocard (1892 and
1896) as a specific morbid process, this author having demonstrated the
disease (in 59 horses suspected of having glanders) to be etiologically
different from glanders. Following the latter author Mollereau and
Vallée reported the disease from France, Darmagnac from Algeria,
while Schwartzkopf observed similar diseases in the Philippine Islands.
The identity of the disease, in the latter instance, has however not
as yet been definitely determined owing to the absence of bacteriological
evidence.

Etiology. The cause of the disease is identical in all of
its characteristics with the bacillus of pseudotuberculosis of
Preisz and Nocard (see p. 626).

Pathogenicity. Subcutaneous injection of the pure culture
in a horse or ass is followed by local suppuration; the abscess
thus formed will break in the course of 6 to 10 days, whereupon
the contents are discharged and healing follows with the for-
mation of a scar (Nocard observed in one case only the develop-
ment of progressive inflammation of the lymphatics following
such inoculation). Intravenous injection produces at the most
a temporary febrile condition.

Injection of pure cultures or of pus obtained from nodes
or ulcers into the abdominal cavity of a guinea pig is followed
by inflammation of the tunica albuginea of the testes which
is usually quite pronounced at the end of the 3d to the 5th
day and in the course of which abundant purulent, fibrinous
exudate collects between the tunics of these organs. Occa-
sionally death results by the end of the first week, post-mortem
examination revealing an exudative peritonitis in addition to
periorchitis. Highly virulent cultures may cause death in from
24 to 48 hours without involving the testes.

Natural infection apparently takes place from wounds or
other solutions of continuity in the skin, and the fact that the
disease usually develops on the limbs seems to point to the
fetlocks as the ports of entrance of the infection, or the process
may be induced by the kick of a horse. However, the disease
does not usually spread direct from animal to animal, but the
bacilli probably gain access into the lymph spaces and the
cutis directly from the soil.

Symptoms. Attended with diffuse swelling of the extremi-
ties of the limbs, isolated, firm, sharply circumscribed, sensitive
nodes appear on one or both hind legs; later these nodes rup-
ture and become transformed into irregular ulcers with bulging
but not thickened borders which at first discharge a creamy, but
subsequently a thinner, viscid purulent secretion. These ulcers
are not progressive in character and yield readily to antiseptic
treatment. This is, however, soon followed by the appearance
of fresh nodes in the neighborhood or in more remote regions
Symptoms, Diagnosis. 733

of the body, which also become transformed into ulcers, while
the connecting lymph vessels form thick strands in the course
of which new nodules and ulcers develop. In this manner the
disease may continue for months, during which time it may
spread from the posterior to the anterior limbs, the trunk, the
neck, and even the facial portion of the head, and may finally
terminate in the death of the animal. In some cases the disease
may continue for years. In one case the nodes and ulcers
appeared only during the cold season while the affected horse
seemed perfectly healthy during the summer.

The lymph glands in the region of the ulcerous processes
may occasionally undergo moderate swelling, but as a rule,
there is no induration, while suppuration never occurs.

_ An unusual course of the disease is noted by Darmagnac inasmuch
as the ulcerous process spread in spite of proper treatment from the
inner surface of the thigh to the scrotum, and caused an extensive
swelling of the entire lower portion of the abdomen, fresh nodes
rapidly reappearing throughout its extent, some of them leading to the
formation of indolent fistulae. The constant loss of tissue secretions
finally caused the death of the horse, and post-mortem examination
revealed innumerable pus foci scattered throughout the firm lardaceous
connective tissue of the swelling. In addition to this there was also
simple hypertrophy of the inguinal and sublumbar lymph glands.

Cocu observed in a mare of advanced age a large paranephritic
abscess, from the interior of which a fistulous canal communicated
with the outer world in the lumbar region. The right kidney, which
was surrounded by pus, contained in its otherwise normal parenchyma
numerous abscesses ranging in size up to that of a pigeon’s egg. Nocard
demonstrated the above named bacillus in the pus.—The authors ob-
served a similar paranephritic abscess as large as a man’s head at
the post-mortem examination of an ass, they could also demonstrate the
bacillus referred to in a purulent secretion of an otherwise benign
wound of the fetlock of a horse which healed perfectly.

Diagnosis. The disease resembles cutaneous glanders in
many respects. The differences are that the small ulcers which
develop from the nodes in ulcerous lymphangioitis heal rapidly,
the lymph glands are hardly involved in the process, the nasal
mucous membrane remains intact and the mallein test gives no
positive reaction. In the pus of the nodes and in the secretion
of the ulcers short Gram positive bacilli can be demonstrated,
which do not thrive on naturally acid potatoes. Finally, intra-
peritoneal infection of guinea pigs is followed more rapidly by
periorchitis than is the case in infection with glanderous
material, the bacilli in question are found in great masses in
the purulent fibrinous exudate, while pus foci are found in the
parenchymatous organs.

Epizootic lymphangioitis is in general a more malignant
disease while the lymph glands also usually suppurate and the
pus contains large globular schyzomycetes which do not stain
readily.—Contagious acne is probably closely related etiologic-
734 Epizootic Lymphangioitis.

ally to the disease under discussion. It usually develops on
portions of the body which come in contact with the saddle and
harness.

Treatment. Application of antiseptic fluid to the ulcers
usually brings about speedy recovery; if the abscesses persist
the nodes may be incised and treated with strong antiseptics.
In exceptional cases, however, even heroic treatment does not
check the progress of the disease.

In view of the similarity of the organisms at the bottom
of this disease and Léffler’s diphtheria bacillus, Vallée tried
treatment with diphtheria antitoxin. Subcutaneous injection
of the serum (40-50 ce. at four day intervals) as well as the
local application of pulverized serum was followed by remark-
ably rapid healing of the ulcers and the checking of the morbid
processes.

Literature. Nocard, Ball. 1893. 116; A. P., 1896. X. 609. — Cocu, Bull,
1899. 232. — Schwarzkopf, Amer. vet. Rev., 1902. XVI. 111. — Dassonville, Bull.,
1907. 576. — Darmagnac, Rev. gén., 1904. IIT. 303. — Vallée, Bull., 1907, 181.

Lymphangioitis Pseudofarcinosa. Liénaux observed a very chronic
affection of cattle in Belgium which manifested itself in the appearance
of large painless nodes on the legs, approaching the size of a fist and ©
communicating with each other by means of greatly enlarged lymph
vessels; the interior of these nodes contain pus foci which, however,
do not break spontaneously; as a rule they become indurated. The
regional lymph glands become swollen and develop into firm nodes
with purulent centers. This disease which otherwise resembles glanders
(see p. 668) is etiologically related to pustulous dermatitis, described
by Liénaux. Treatment consists in early evacuation of the abscesses
and surgical treatment of the tumors (Ann. 1905, LIV, 297; see also
p. 670).

9. Epizootic Lymphangitis. Epizootic Inflammation of the
Lymphatics. Lymphangioitis Epizootica.

(African Glanders; Japanese Glanders or Farcy; Saccharomy-
cosis; Lymphangite épizgootique, Farcin de riviére, Farcin
d’Afrique, Farcwm cryptococcique [French];
Linfangite farcinoide, Farcino cripto
cocchico [Itahan].)

Epizootic lymphangitis is a chronic, contagious disease
of Solidungula caused by a yeast fungus, Cryptococcus farcimi-
nosus; in exceptional instances cattle also are attacked. The
disease is characterized by purulent inflammation of the sub-
cutaneous lymphatic vessels and of the regional lymph glands.

History. The disease was first described by Italian and French
veterinarians. Its cause was described by Rivolta (1873), while its
Occurrence, Etiology. 735

etiology and symptomatology were studied and elucidated by Rivolta

& Micellone, Nocard, Tokishige, Marcone, Tartakowsky, Sanfelice,
Pricolo, ete.

Occurrence. The disease was formerly observed only in
southern Hurope, particularly on the shores of the Mediter-
ranean, quite frequently in Italy and in France. Recent reports,
however, mention its occurrence in more northern localities
(Finland and northern Russia, England). It seems also to be
widely prevalent in Asia and Africa.

The disease was observed by Lindquist in Finland, by Tartakowsky, Dedjulin
and Awryinsky in the governmental districts of Olonetz and Novgorod in Russia,
by Tokishige in Japan (rather common), by Pearson in Pennsylvania, Fischer in
Ohio, by Does & Haan in Lower India and by Nockolds in the Philippine Islands,
where it appears as a very frequent disease with unfavorable course, on account
of which large numbers of horses have in recent times been destroyed under suspi-
cion of glanders. :

In 1902 it was transported with shipments of horses from India to South
Africa and from there with English troops that returned from the Transvaal war,
to England in which latter country it gained wide prevalence in several garrisons
and was subsequently disseminated by discarded army horses to private stables.
This plague became so prevalent that the English government formulated special
regulations for its control, the success of which is evident from the report that
only two cases of the disease were observed in 1906. — In 1901 a number of
cases were observed in a German-Russian border villages in the government district
of Gumbinnen.

Etiology. The Cryptococcus farciminosus Rivolta (Sac-
charomyces farciminosus Tokishige) forms comparatively large,
3 to 4 # long, 2.4-3.6 “ wide, doubly contoured, somewhat oval
bodies usually either somewhat pointed at the ends or pro-
vided with bud-like protuberances. These organisms multiply
by ‘budding and in this respect resemble saccharomyces, al-
though they are smaller and do not cause saccharine fermenta-
tion. They are not readily stained by the usual methods, even
earbol-fuchsin staining the contents only slightly while the cell
membrane remains unstained.

Culture. Artificial cultures are difficult to obtain and growth on
artificial media is slow. Thus on nutrient agar grayish-white granules
appear only after about 30 days, subsequently they enlarge to form
prominent colonies drawn into folds resembling the convolutions of
the intestines. On gelatin bouillon yellowish-white sandy granules
appear in the course of 56 days, on potatoes light brown masses appear
in a somewhat shorter period while in pepton bouillon white flakes
develop in the course of 17 days. Under the microscope the colonies
are seen to consist of. hyphae, spherical fungi and granules resembling
spores (Tokishige).

According to Bridré & Négre the fact that immune bodies are present in the
serum of affected horses which fit into complement fixation systems with ordinary
yeast cells points to the blastomycetic nature of these parasites.

In contrast to the above view Ducloux, whose observations were subsequently
confirmed by Thiroux & Teppaz, is of the opinion that the cause of the disease
is a protozoon (Leucocytozoon piroplasmoides). These investigators found round
736 Epizootic Lymphangitis,

or pear-shaped structures in the pus of nodes and ulcers. Some of these structures
were enclosed by mono- and polynuclear leucocytes, in the cell substance of which
karyosomes could be demonstrated with eosin-methylene blue, and which suggested
the appearance of Heliosoma tropicum, the cause of Oriental boil plague. Thiroux
& Teppaz failed in their attempts to cultivate the parasite, nor could they repro-
duce the disease by inoculation of the pus from the nodes. According to their
view, the leucocytozoons may be transported to the internal organs by means of
leucocytes and there set up their morbid process.

Pathogenicity. After the administration of pus taken from
the nodes or ulcers into cutaneous wounds of solidungula, in-
flammation and swelling of the lymphatics may occur in rare
cases in the course of 20 to 60 days. Along the course of the
lymphatic vessels nodes develop which later form ulcers (Tixier,
Chauvrat, Delamotte, Peuch). In rabbits experimental infec-
tion produces local abscesses only, while in guinea pigs swelling
of the lips and the popliteal glands usually results. Other
experiment animals are immune.

Natural infection probably occurs from superficial wounds
by immediate contact with infected objects (harness, litter,
bandages, instruments, etc.), or from contact of diseased ani-
mals with healthy ones. (Thiroux & Teppaz are of the opinion
that infection is spread through the medium of insects). The
ass is most susceptible, the horse and the mule less so while,
according to Tokishige’s observations, cattle are also sus-
ceptible.

Anatomical Changes. In the affected regions the skin and
subcutaneous connective tissue become thickened (up to 5 or
6 cm.) and firm; cross sections have a lardaceous appearance
and contain pus foci of various sizes, while the distended
lymphatics are filled with coagulated serum and pus, the walls
of these vessels being intensely reddened and having a finely
granulated appearance. The regional lymph glands are swollen
and frequently contain small pus foci or cicatrices which have
resulted from their presence. In the diseased joints we find
large masses of serous or sero-purulent exudate and the synovial
membranes are covered with villous proliferations; adjacent
tendons are much enlarged showing serous infiltration and
containing large pus cavities, in the internal organs (lungs,
testes, intestinal wall) metastatic pus foci are found only in
exceptional cases. The nasal mucous membrane is occasionally
swollen near the nostrils and contains on its surface sharply
circumscribed, flat, yellowish elevations as well as deep ulcers.

Symptoms. Inflammation of the lymph vessels begins most
frequently on the limbs, especially the anterior ones, but is
observed also on the scrotum or the udder, somewhat rarely
on the abdomen and neck where they usually develop from a
wound or a fresh scar. Such wounds refuse to heal and grad-
ually form ulcers with red luxuriant granulations, or the re-
Symptoms. 737

sulting cicatrice is transformed into a firm painless node which
may attain the size of a pigeon’s egg, breaking spontaneously
and discharging a thick, yellowish, gruel-like pus.

The local process is followed by swelling of the regional
lymph vessels which form prominent, wavy and branching
painful strands in the course of which develop firm tumors up
to the size of a fist, subsequently these become elastic and
finally fluctuating and contain the above described thick, yellow
pus. The nodes also break and discharge their contents, where-
upon they are transformed into fistulous ulcers with indolent,
easily bleeding granulating borders. The ulcers frequently
produce excessive granulations which lead to the formation of
ugly ulcerous surfaces.

The regional lymph glands swell and form firm, tuberous

or nodular tumors which do not adhere to the surrounding
tissue; they also suppurate, whereupon the abscesses break
spontaneously and gradually heal with scar formation. In
some cases an excessive but uniform swelling of the ends of
the extremities or the region of the joints may develop followed
by ulceration of the overlying skin.
_ In other instances there may be in various regions of the
body spontaneous development of flat elevations as large as
a copper cent or of nodes approaching the size of a walnut,
which break and, after discharging their muco-purulent con-
tents, are transformed into flat ulcers which heal without scar
formation. In rarer instances numberless minute furuncula
appear which partly communicate with each other by means of
strands with serous contents which later dry and form scabs.

In exceptional cases yellowish flat elevations or white
nodules as large as lentils occur on the nasal mucous mem-
brane. Some of. the nodules may have become transformed
into ulcers with projecting labiate granulating borders
(Pricolo). The intervening mucous tissue is hardly swollen
to an observable degree, though it is usually cyanotic; simul-
taneously with the appearance of these lesions the submaxillary
glands become enlarged and occasionally suppurate. On the
other hand nasal discharge is rarely observed. In a case de-
scribed by Marcone the nasal mucous membrane was covered
with numberless nodules and ulcers, while the turbinated bones
were covered with pedunculated growths which had resulted in
the partial destruction of the dental alveoli. The nasal alae
were much enlarged, firm and studded with small pus foci
covered with scabs, in addition to which a thick strand was
observed to cross from the left nasal ala toward the facial
crest. Cominotti observed a similar case except that the sub-
maxillary gland was enlarged to the size of a small apple,
only slightly sensitive, bosselated on its surface and not ad-
herent to the surrounding tissue. Finally the conjunctiva and
especially the membrana nictitans have in rarer cases been
observed to-be affected with nodule formation and ulcers

Vol. 1—47
738 Epizootic Lymphangitis.

(Carparini, Awryinsky), while deDoes observed in one instance
glanderous-like enlargement of the testis, with numerous soft
centers in its tissue (the weight of the testis was 1.5 kg.).

In cattle Tokishige observed firm painless nodes as large as walnuts
scattered through the subcutis in various regions of the body; these
remained distinctly isolated, showed a slow growth and did not result
in abscess formation nor in ulceration (see also p. 670).

The course is very protracted; the morbid process may
under favorable conditions continue for from 4 to 6 weeks;
under opposite conditions it may persist for six months; even
after apparently complete recovery the symptoms of the disease
may reappear after a certain time. The general nutrition
usually remains good, although in malignant cases the animal
may become emaciated. In the meantime exacerbation may
appear with acute symptoms, elevation of temperature to
40.6° C., rapid enlargement of the limbs, the lips and the nasal
mucous membrane, eruption of small vesicles, ete. (Awryinsky).
In a portion of the cases the disease progresses without in-
terruption until the patient finally becomes exhausted, and the
disease occasionally terminates with symptoms of hectic fever.

The mortality is about 7 to 10% (Tokishige, Pallin), al-
though in tropical countries it is considerably higher.

Diagnosis. The differential diagnosis of this disease from
glanders may occasionally be quite difficult. In recent and
well marked cases, however, the flat and actively granulating
ulcerous surfaces as well as the creamy pus in contrast with
the crateriform ulcers of glanders and their viscid secretions,
are sufficient diagnostic characteristics. In chronic cases, how-
ever, the ulcers of epizootic lymphangioitis may have a similar
appearance. In such cases microscopical examination will re-
veal the nature of the affection, in epizootic lymphangioitis
the bright parasites, partly enclosed in pus cells, are readily
observed without staining under a magnifying power of 400-500.
In addition to this, inoculation of rabbits or guinea pigs with
pus produces only local suppuration, while the mallein test
gives a negative reaction. The good physical condition
of the animal in the presence of ulcerating skin disease speaks
against the existence of cutaneous glanders.

Uleerous lymphangioitis takes a more benign course and
the pus from glanderous lesions contains small bacilli which
stain according to Gram’s method and when injected intraperi-
toneally produce orchitis in guinea pigs.

Treatment. This consists, especially in the beginning of the
affection and wherever possible, in the extirpation of the nodes
and lymph strands and the neighboring lymph glands. The
prompt incision of abscesses and careful antiseptic treatment
of pus cavities and ulcers is of course always indicated. Thiroux
Treatment. = 739

& Teppaz had favorable results in the treatment of mild cases
with atoxyl, although this gave no results in severe forms of
the disease.

Prophylaxis consists in the isolation of the diseased ani-
mals, destruction of morbid products and disinfection of stables
with strong disinfectants.

Literature. Rivolta & Micellone, Giorn, die Anat., Fis. et Patol., 1883.
143-— Nocard, Bull., 1897, 367. — Tokishige, Cb, f. Bakt., 1896. XIX. 105. —
Baruchello, Sul. fare. criptoc., Torino 1898. — MacFadyean, J. of comp. Path.,
1903. XVI. 379. — Martin, J. of comp. Path., 1905. XVIII. 81. — Sullivan, Vet.
Rec., 1905. Nr. 870. — Sanfelice, Z. f. Hyg., 1906. LIV. 299. — Mrowka, Z. f. Vk.,
1906. XVIII. 261 — Marcone, Rev gén., 1907. IX. 249. — Pricolo, ibid., 1907. X.
ae = mo Soe. biol., 1908. LXIV. 593. — Thiroux & Teppaz, A. P., 1909.

Malignant Hyphomycosis of Horses. Leeches (Hyphomykosis
destruens equi.) In India as well as on the Sunda Islands a ‘disease
occurs among horses which is known by the name ‘‘bursattee’’
(burus=rain), and which has been described in particular by F. Smith
and Stell, and more recently also by deHaan and Hoogkamer. Ac-
cording to Lyford and Bitting this same disease occurs quite frequently
in North America among horses and mules where it is known as
“‘leeches’’ while in Europe only a single case has been observed by
Drouin & Rénon in Alfort.

The morbid symptoms consist in the appearance of very firm
nodules under the skin of the lips, the nasal alae, the eyelids, the neck,
the body and the limbs, finally also in the mucous membrane of the
gums and the nasal cavities; these gradually enlarge and later become
transformed into ulcers. The ulcers have uneven, ragged, easily bleed-
ing granulating borders which communicate with deep, sinuous, fistulous
canals which occasionally extend to or into the bones (perforation of
the hard palate has also been observed). Within the ulcers and
fistulous canals as well as in the interior of the nodes are found grayish-
yellow, occasionally also calcified masses and cores which may approach
the size of an egg and have a bosselated surface, these are firmly
attached to the surrounding tissue by means of their ramifications. The
lips, nasal alae and eyelids may be extensively swollen, while the mouth
and nose discharge a bloody mucous mass. The affected regions of
the body seem to cause excessive itching. In severe cases, which how-
ever do not involve the regional lymph glands, the nutrition of the
patients suffers seriously.

The grayish-yellow cores above mentioned contain branching
mycelia and free spores of a mold fungus imbedded in hyaline con-
nective tissue bundles and leucocytes; according to deHaan these form
a delicate sod on nutrient agar while in acid bouillon they form groups
of delicate balls. Experimental inoculations have failed to give positive
results.

The treatment consists in an early extirpation or cauterization of
the affected portions of the cutis; deDoes observed healing of the lesions
in the mucous membranes after internal iodine treatment (10-30 gm.
potassium iodide daily). while deHaan & Hoogkamer found this treat-
ment ineffective.

Literature. Drouin & Rénon, Soc. biol., 1896. 425. — De Haan & Hoog-
kamer, A. f. Tk., 1903. XXTX. 395.
740 Infectious Abortion.

10. Infectious Abortion. Abortus Enzooticus.

(Abortus infectiosus; Seuchenhaftes Verwerfen [German];
Avortement épizootique [French]; Aborto
enzootics [Italian].)

Under the term ‘‘infectious abortion’’ are included those
cases which occur in otherwise healthy mothers, as a result
of external infection producing inflammatory lesions of the
uterine mucous membrane and of the fetal membrane. It
usually occurs in an enzootic form.

History. As long since as the beginning of the last century this
disease was considered as contagious in several mountainous regions
of England (Lawrence, Skellet), and since then other authors (Zindel,
St. Cyr) have maintained that an infection was the causative agent
in spite of the opposite view held by others (Hurtrel d’Arboval, Hering,
Stockfleth). The correctness of this view was however only established
by Franck (1876), and later by Lehnert (1878) and Brauer (1880),
by producing abortion artificially through the introduction of vaginal
discharge and fetal membranes into the vaginas of healthy cows. Later
Nocard (1885) called particular attention to the importance of the
inflammatory changes in the fetal membranes. Bang (1896) with the
cooperation of Stribolt, discovered the cause of infectious abortion
of cattle, which was later also investigated extensively by Preisz (1902),
while on the other hand Ostertag (1901) connected a streptococcus
with the cause of infectious abortion of mares.

Occurrence. Infectious abortion occurs most frequently in
cattle breeding establishments, more seldom in studs and in
‘the breeding of sheep and swine. The stable-fed, finer bred
animals are especially affected, but the infection may become
widely spread in range animals (Kocourek, Keleti). The intro-
duction of the disease into large cattle herds causes heavy losses,
because of the fact that a number of unviable calves perish,
and because of the decrease of the milk production, moreover
the cows conceive only with difficulty after abortion or not
at all.

Infectious abortion is widely spread in all sections in which intensive stock
farming is in vogue. In Central Europe (Belgium, Denmark, Germany, France,
Austria, Switzerland, Hungary) and in England it appears frequently, especially
in cows, while in North America it appears that mares are especially affected.—
In England Maseall called attention to the disease as early as 1567, and during
the last century it gained such a foothold in the dairies that in certain localities
50-60% of the cows slunk their calves (McFadyean & Stockman recently could
show the disease in 36 shires); besides the disease appears frequently in horse
breeding and sheep raising establishments (Penberthy).

Etiology. In cattle abortion is caused by a small, short
and comparatively thick bacillus (Corynebacterium abortus in-
fectiosi) which is non-motile, forms no spores; in artificial
Etiology, Pathogenicity. 741

cultures one end is frequently club-shaped, and sometimes
branches (Fig. 125).

Staining. _ The bacillus stains easily but not uniformly with aqueous
as well as with carbolized aniline dyes, giving the appearance of seg-
ments separated by clear spaces; the Gram and Gram-Weigert methods
give negative results.

Cultivation. The bacillus of abortion
grows especially well in a pure oxygen at-
mosphere, or in air with low oxygen con-
tents, while in the total absence of oxygen
it grows only with difficulty, and in ordi-
nary atmosphere only after it has gradually
become accustomed to such environment.
Cultures made according to these conditions
give particularly good results in or upon
gelatin-agar, a combination of agar, gelatin
and blood serum, as well as in glucose-agar.
Upon the surface of such media, kept at
body temperature there appears very fine, Fig. 125, Corynebacterium
flat, conical, evenly rounded, ontransmitted abortus infectiosi. Two-day-
light, bluish transparent colonieswhicheven °/4agar cultures ; carbol fuchsin.
if thinly seeded reach at most the size of a
pin head. When the material to be examined is mixed with the media
there develop, at a fixed distance from the surface and downward,
numerous similar colonies closely placed (Fig. 126). Coagulated calf
serum becomes liquefied in the vicinity of the colonies. In peptone
bouillon and in liquid blood serum, few small white granules form.
Milk becomes coagulated. Potato cultures show a marked resemblance
to a culture of the bacterium mallei (McFadyean & Stockman).

 

Tenacity. In cultures the bacillus dies within two weeks (Nowak found,
however, that agar cultures were even after two years still capable of development.
A temperature of 55° C. will destroy the organism in 3 minutes. It is destroyed
by 0.05% corrosive sublimate solution in 15 seconds, by 1% carbolie acid in
1 minute, by 2% acetic acid in two minutes, by 1% acetic acid in 20 minutes
(Preisz). On the other hand it may retain its virulence for many months in
uterine secretions if preserved sterile, also if uncontaminated inside of the womb
and in the dead foetus (Bang).

Pathogenicity. In Bang’s investigations the injection of
pure cultures into the vagina of pregnant cows and ewes pro-
duced in 8 to 10 weeks either abortion or premature birth;
in these cases large numbers of bacilli were present in the
vaginal discharge, in the exudate on the surface of the coty-
ledons and the chorion. Injections of 8 and 18 ce. of culture
respectively into the circulation of pregnant ewes produced
fever lasting several days, whereupon these animals gave birth
after 7 and 12 days to small lambs. Bang’s experiments, the
results of which were subsequently confirmed by McFadyean
& Stockman, demonstrated that the feeding of cultures or
exudate to cows, ewes and goats results in abortion after 1
to 2 months, with the characteristic changes in the fetal mem-
branes and cotyledons. Finally it was also possible to produce.
742 Infectious Abortion.

premature birth in a mare 28 days after the injection into the
vagina of 25 ce. of culture and the chorion exudate contained
numerous bacilli. (Nowak caused abortion in guinea pigs and
rabbits by subcutaneous, intravenous, or intraperitoneal injec-
tions of pure cultures.)

The bacilli are always found in large numbers in the
exudate of the fetal membranes and of the cotyledons, either
free in the serous exudate or enclosed in cells,
besides these locations the organisms may also
be demonstrated in the intestinal contents, in the
blood, as well as in other organs of the aborted
fetus.

In no case of infectious abortion of mares
did Ostertag find the Bang bacillus in the fetal
membranes, but in its stead he found short Gram-
negative streptococci in the heart blood, pleural
fluid, and in the stomach contents of the still-
born foals, as well as in the sub-chorial edema.
They grow on serum agar in the form of fine
deposits, which are hardly visible to the naked
eye, in stab agar as a frail thread reaching
from the surface to the bottom of the tube,
while in serum bouillon after two days’ growth
there appears a uniform turbidity which after
two more days sinks to the bottom. In seven
ceases the streptococci were obtained in pure
culture from the bodies of the fetuses, in the
other cases the streptococci were found in com-
mon with other bacteria on the surface of the
chorion; in the chorion some were present in the
epithelial cells.

One mare aborted twenty days after the in-
travenous injection of the culture, another one

Fig. 126. Agar oive birth after a vaginal injection at the normal
culture of the ba- (P. ~ :
cillus of abortion. time to a very weak foal; in the heart blood of
(After Preisz.) the fetus from the first mare the streptococci
could be demonstrated, and they were also pres-
ent in the reddish-gray, thick deposits of the uterus of a mare
killed immediately after having aborted.

Aside from the use of pure cultures the artificial produc-
tion of abortion was repeatedly made possible in pregnant
animals by the transference into their genital tracts of vaginal
discharge and portions of fetal membrane from aborting animals
of the same species, and this is not only true with reference
to cows (Brauer, Lehnert, Trinchera), but also in mares
(Ostertag, Guillerey); on the other hand the introduction of
shreds of fetal membranes from mares into 10 cows and two
goats failed to cause abortion (Ostertag).

 

According to Lignitres the bacillus of tuberculosis zooglique may also cause
abortion indirectly, when it enters the alimentary tract with food. By the elimina-
Natural Infection. 743

tion of toxins it favors the penetration of other “bacteria present in the intestines
and other tubular organs or body cavities, inte the blood circulation and other
organs, thereby indirectly producing abortion. He produced abortion successfully
in guinea pigs, rabbits and cows by feeding pure cultures.—Abortion can evidently
be occasioned by various infectious causes, since it is quite frequently observed in
the course of acute infectious diseases, but such cases should be interpreted dif-
ferently than as the independent disease of infectious abortion.

Natural infection may take place from the external genitals,
most frequently it is transmitted during copulation by males,
who have previously covered infected females. On the other
hand the straw and floors of stables become contaminated with
the vaginal discharge during and after abortion, by the amniotic
fluid and the fetal membranes, which contain enormous numbers
of bacilli, whence the contagion may likewise penetrate the
genital organs; at the same time the infection may be intro-
duced by various objects, such as sponges and other utensils
and also by attendants.

The possibility of an intestinal infection in cows, goats
and sheep, by the ingestion of food and drinking water con-
taminated with amniotic fluid and afterbirth, was proven be-
yond a doubt by the successful experiments of Bang; and this
mode of infection should be considered as the natural infection
more often than has heretofore been the case. Especially does
it play an important part in cases where the malady spreads
rapidly on a farm.

In cattle establishments free from the infection the virus is
usually introduced by an already infected female, who during
abortion infects the stable, and during copulation infects the
male. The infection then spreads on this particular farm with
every favorable opportunity, since the first cases of abortion
or premature births are given little attention, as they are fol-
lowed by new cases only after a considerable period, and con-
sequently the necessary measures to eradicate the disease are
omitted. The introduction of the disease can also be accom-
plished by means of animals that suffer from a chronic uterine
catarrh subsequent to-abortion, and also rarely by animals that
in spite of their being infected, carry the fetus the full term.
More seldom is the disease introduced by males that have re-
cently been covering animals on infected premises, and likewise
also by new-born animals from such farms.

The infection spreads as a rule only among animals of
the same species, at times however animals of other species
are attacked. As a matter of fact the Bang bacillus ‘is not
only capable of producing abortion in cattle, but also in horses,
goats and sheep (Garcia & Izcara found during an epizootic
abortion among sheep, a bacillus in the exudate which mor-
phologically corresponded with Bang’s organism) ; on the other
hand Ostertag’s streptococcus has to the present date been
found exclusively in mares.
744. Infectious Abortion.

Pathogenesis, The contagion which reaches the vagina
through copulation passes into the uterus, where it multiplies
on the surface of the mucous membrane, and later also on the
fetal membranes. The bacteria that reach the vagina during
pregnancy are evidently capable of passing the mucous plug
of the neck of the uterus, whereupon they multiply between the
fetal and mucous membranes. The bacilli may also reach the
mucous membrane of the uterus from the intestinal canal by
means of the blood stream, either before or after conception;
since it appears that this organ is an exceedingly favorable
medium for their propagation. —

The infective material produces an inflammation, as a re-
sult of which a fibro-purulent exudate forms between the
mucous membrane and the chorion, which loosens the contact
of the layers of tissues, and finally causes a partial detachment
of the fetal membranes. The inflammatory process extends in
the meanwhile also to the layers of connective tissue between
the chorion and allantois, as well as to the navel cord, on ac-
count of which they acquire a gelatinous appearance, on the
other hand the bacteria may also pass into the body of the
fetus either through the circulation, or by means of the amniotic
fluid.

In consequence of the loosening and detachment of the
fetal membranes abortion may occur in various stages of
gestation; at times, however, the uterine catarrh does not
cause expulsion, but only the death of the fetus, in which case
there is formed a gradually accumulating exudate around the
fetal membranes, enclosing a shrunken mummified fetus. Later
this exudate becomes inspissated, assuming a tenacious gela-
tinous consistency and in this the abortion bacillus may remain
viable even for nine months after the death of the fetus (Bang).
The fact that the bacilli remain alive for so long a time in
the uterus explains the etiological connection in the abortions
that occur in an advanced stage of pregnancy as a result of
infections occurring during or even several weeks before copula-
tion. It also explains the cases of abortion in females that
have previously aborted but were not exposed to any new
infection in the meantime.

Repeated abortion reduces the otherwise very great sus-
ceptibility to new infections. Cows abort quite frequently a
second time, but a third abortion is exceptional. The reduced
susceptibility of the animal, and possibly the decreased viru-
lence of the virus is also evidenced by practical experience
upon certain farms where abortion occurs in progressively later
stages of gestation, and finally by the fact that the respective
animals, if they conceive at all, carry their pregnancy to term
in spite of the infected surroundings (Sand).

Symptoms. Cows are most likely to abort in the fifth or
sixth month of pregnancy, mares in the fourth to eighth month,
Symptoms. 745

sheep in the fourth month, and swine in the eighth to twelfth
week; at times the abortion takes place in an earlier or later
period of pregnancy.

Animals which are pregnant for the first time, as a rule abort at an earlier
period of gestation than do older ones or those which have previously aborted.
The Danish veterinarians observed that abortion would most often occur in cattle
during the fifth or sixth month, but in the beginning of an outbreak, cases also
occurred in the third or fourth month. In mares Konge saw it occur in one-third
of the cases in six months, in one-fifth in 7-8 months; Guillerey as a rule in 4-7
months; Poijakow, on the other hand, reports most of the cases as occurring
from the ninth to eleventh month of gestation. According to the experiments of
Berger sows abort in the tenth to twelfth week of pregnancy; according to those
of Fritsche in eight to twelve weeks.

The abortion is usually preceded by a catarrh of the genital
passages. With the moderate swelling of the lips of the vulva
the vaginal mucous membrane becomes reddened and reddish
nodules, like millet seeds in size (swollen follicles) appear on
its surface. At the same time there appears from the vagina
a mucous or muco-purulent, exceptionally bloody, and always
odorless discharge which in cows is reddish-gray or yellowish,
in mares and sows whitish-gray in color. The milk production
becomes simultaneously diminished, the milk having a colostrum-
like appearance and coagulating on boiling.

Two to three days after the appearance of the first
catarrhal symptoms the abortion usually takes place with mod-
erate pains and with mild general manifestations. Should the
abortion occur in an early period of gestation the fetal mem-
branes are expelled together with the fetus. On the other hand
in abortions taking place at a later stage of gestation the after-
birth is passed off subsequently to the fetus, and it 1s not a
rare occurrence to have it retained for some time. Following
the abortion a continuous vaginal discharge is always observed
for one or two weeks. The secretion which is then dirty brown
or reddish-brown, odorless, or somewhat fetid, may accumulate
in the uterus, and from time to time be discharged under
straining. Gradually the discharge becomes diminished, and
finally it disappears entirely, still in spite of their otherwise
healthy appearance the animals either do not conceive, or if they
do, they abort at an earlier or later stage of gestation, and in
rare cases this may be repeated more than once. Abortion
reappears as a rule in cases when copulation occurs shortly
after the first abortion, or when the vaginal discharge was still
present, whereas in cases where copulation occurs several
months after the abortion normal births are more likely to
follow.

Fetuses aborted at early periods of gestation are usually
dead, those however that are expelled at a later period are
not seldom born alive. Prematurely born calves often emit
a loud prolonged bellowing, which reminds one of the howling
of a rabid dog. Nocard attributes this to a diseased condition
of the medulla. Poorly developed fetuses mostly die within
746 Infectious Abortion.

one or two days, with manifestations of intestinal catarrh.
The afterbirth shows a subchorial edema and a marked injec-
tion of the chorion, and a muco-purulent exudate exists between
the tufts of the cotyledons.

Poljakow frequently found a rarifying ostitis in the beginning
and towards the end of an outbreak in mares, whereas at the height
of the outbreak he found manifestations of septicemia, such as a de-
generation of the parenchymatous organs, hemorrhages in the serous
membranes, and dark liquid blood.

Guillerey observed in the course of an outbreak in which 87 out
of 97 pregnant mares aborted, the development of sequels, such as
febrile nephritis lasting from 6 to 8 days (of 15 such mares one died as
the result of it), arthritis (especially in the hock), tendonitis, acute
laminitis, hemoglobinuria, inflammation of the Vena saphena, finally
pneumonia. Desoubry saw in mares after abortion a rise of tempera-
ture up to 40° C., and with a marked depression of the sensorium
catarrhal symptoms of the genital passages, which in exceptional cases
increased to an inflammation of the uterus.

Bulls that have covered affected cows, exceptionally show a diseased
condition of the genital organs. Thus Reindl found nodules on the
penis of a bull similar to those observed in cows shortly before abor-
tion; Nohr also observed acute inflammatory manifestations on the
penis in several bulls after the infectious coitus.

Diagnosis. The infectious character of avortion is indi-
cated by the prodromal symptoms which appear 2 to 3 days
before the expulsion of the fetus. These are manifested in
a swelling of the vulva, vaginal discharge, as an indication
of an existing catarrh of the genital passages. In other forms
of abortion, excepting in infectious vaginal catarrh, the abortion
oceurs without such prodromal symptoms, or there may pre-
viously be observed disturbances of digestion and symptoms
of general illness as in general infectious diseases or in poison-
ing. The infectious nature of abortion is further indicated
by an existing vaginal discharge which continues subsequently
for a long time, and by a large amount of fibrinous purulent
exudate on the fetal membrane. Later sufficient ground is
afforded in this respect by the rapidly following cases of abor-
tion, when the diagnosis is further confirmed by the exclusion

of other causes.

In young cows, sometimes also in mares, swelling of the vulva, a
slight amount of mucous discharge, as well as debility and diminished
appetite appear sometimes toward the end of the fifth month of preg-
nancy, but these symptoms disappear after 3 to 4 days, and then the
pregnancy and parturition follow in a normal manner (Cagny).

In abortion of cows a microscopical examination of the vaginal
discharge is very advisable; in this the fine, unevenly stained bacilli
of abortion are found either exclusively: or in predominating majority,
but always in great numbers (the dried’ cover-glass preparations stain
most readily with carbol-fuchsin; see, Fig. 127).

ak eo cat stan tee ates

aes
Sero-Diagnosis and Allergic Reaction. 747

Sero-Diagnosis and Allergic Reaction. Recent investiga-
tions permit the assumption that it will be possible to deter-
mine infection with the bacillus of
abortion by bacteriological methods
long before and after the abortion. If
these results are confirmed the com-
batting of the disease will appear con-
siderably more effective, as it will be
possible to prevent the introduction of
the virus by apparently healthy ani-
mals.

1. Agglutination Test. Experiments in this
direction by MacFadyean & Stockman show that
cultures grown in serum-free media are agglu-
tinated by normal serum as a rule in a proportion

Fig. 127, Vaginal discharge © not higher than 1:25, whereas serum of infected
with bacilli of abortion; carbol COWS, but which have not yet aborted, shows fre-
fuchsin. quently an agglutination value of 1:100 or over.

These results, however, were not sufficiently uniform
for utilization in practice. Better results were obtained by Holth with serum bouillon
cultures, or suspensions of such centrifugalized cultures, as 37 out of 39 samples
of serum from cows which had previously aborted gave an agglutination value
of over 100, mostly over 500, while seven specimens from healthy heifers and
eows failed to give an agglutination, even in dilutions of 1:50. Grinsted also
found that in infected cows the agglutination value, even several weeks before
abortion, rises to 1:300 and over, and after abortion it rises to 1:2000-4000, while
in healthy animals it does not exceed 1:300.

 

2. Complement Fixation. MacFadyean & Stockman obtained, although
not in all cases, distinct complement fixation (see p. 718) with sera from cows
which had already aborted, and a still more distinct reaction with sera of infected,
still pregnant cows, while Holth showed that the complement fixation test corre-
sponds with the results of the agglutination test.

3. Allergic Reaction. MacFadyean & Stockman’s experiments with the
preparation named ‘‘Abortin’’ which they prepared from 4-(; weeks’ old glycerin
sugar bouillon cultures of the bacillus of abortion, in the same manner in which
tuberculin is obtained, showed that infected, as well as cows which had already
aborted respond after several hours, with few exceptions, to an intravenous or
subeutaneous administration of the preparation (5-10 ce.), with a rise of tem-
perature to 40.5-41° C., and some also with organic symptoms.

Course. Infectious abortion often persists for years in
infected premises when proper measures for its suppression
are not taken. After the first case of abortion new cases
appear as a rule only after several weeks, then however they
follow each other in more rapid succession, and finally normal
births occur only exceptionally. After a time however the
eases of abortion again become more rare, as animals which
have already aborted once or twice again give birth at the
normal termination of pregnancy, and only the newly intro-
duced young cows or newly purchased animals from healthy
herds abort, until finally the disease dies out of its own accord
after several years.

Prevention and Treatment. For suppressing the disease
after it has appeared in a herd, first of all the change of the
remaining apparently healthy female animals which have never
748 Infectious Abortion.

aborted, to a place free from the infection is indicated. If
this cannot be accomplished under existing conditions it is at
least advisable to keep the already infected and the suspected
animals in another stable, or at least in an isolated part of the
same stable, and to supply special attendants for them. Sub-
sequently it is necessary after removing the remnants of food
and straw in these parts, to disinfect the entire infected stable
thoroughly and repeatedly, the floor and walls as well as the
stable utensils, in addition to which the external sexual organs
of the pregnant animals should be washed daily with a non-
irritating antiseptic fluid, and their vaginas should also be
irrigated. In the meantime these animals should be subjectéd
to careful observation, and those in which prodromal symptoms
of abortion are noticed should be isolated immediately and their -
stalls disinfected. At the same time it must be taken into
consideration that the vaginal discharge has possibly already
contaminated the litter and food.

The expelled fetus together with the fetal membranes and
the afterbirth should be burned, or at least scalded and then
buried deeply. If remains of the fetal membrane were retained
in the uterus it should be attempted to remove them soon, if
possible in the course of two or three days.

Males which have covered affected females, or in which
there is a suspicion in this direction, should be subjected to
treatment by cutting the hair short at the opening of the sheath,
the prepuce sack should be washed with a 14-1% lysol solution,
44-14% septoform, or 1% soda solution, and following each
covering the washing should be repeated with pure lukewarm
water or with one of the fluids mentioned. In sheep and swine
herds where this is accompanied with difficulties it is advisable
to suspend breeding for a certain time.

The treatment of animals which have aborted consists in
irrigation of the vagina and uterus with lukewarm antiseptic
fluids, by means of an irrigator, the soft rubber tube of which
should be introduced deeply into the uterine cavity. For dis-
infecting fluids, which are also satisfactory for washing the
surrounding parts of the vulva, freshly prepared corrosion
sublimate in rain water (1:8000-10,000, concentrated solutions
cause severe straining!), 1-2% creolin or lysol solution, 1:1000
permanganate of potassium solution, ete., may be used, of which
large animals receive 3-4 liters, small animals 0.5 liters each.
This treatment should be continued at first 1 to 2 times daily,
later every 2 or 3 days, until the discharge has ceased for
several days (usually for two weeks). After the conclusion
of this procedure it is advisable to keep the animals separated
for ‘several weeks, and to breed them again, not earlier than
two months after the abortion.

Brauer recommends as prophylactic measures, subcuta-
neous injections of 2% carbolic acid, in the fifth to seventh
months of pregnancy (10 cc. weekly). He, as well as Schrader,
Prevention and Treatment. 749

Tafin and others, observed a gradual reduction, and finally a
complete disappearance of the disease from such treatment.
Haubold, Schlag, Vollrath and others, however, found this
treatment ineffective, and even in the favorable cases the dis-
appearance of the disease was probably the result of a disin-
fection which was carried out simultaneously. The same
probably would apply also to the internal administration of
carbolized water (1-1% liters of a 1% carbolic acid solution
once daily [Nuesch]), as well as the weekly prophylactic irri-
gations of the vagina of pregnant cows with 14 liter of a
214-3% solution, with which Horlyck and Dolmer have recently
obtained very good results.

In order to prevent the introduction of the disease from
outside, newly purchased pregnant animals should be observed
carefully, and should be kept isolated until calving; further
animals with symptoms of a uterine or vaginal catarrh
(leucorrhea!) should not be bred at least until completely re-
covered. The association with persons who are employed in
infected premises should also be limited as far as possible.
In male animals which have served on other premises, it is
advisable to disinfect the prepuce and the penis before the
act of covering. Furthermore, each case of abortion should
be treated as if it were an infectious form of the disease, and
particularly does this appear to be necessary in those cases
where the abortion occurs under the above-described manifesta-
tions even in a herd which has been known to be free of the
affection.

Females which have aborted one or more times should be
disposed of only if they fail to conceive after a subsequent
covering, provided that they have received suitable treatment.
By keeping pregnant animals the disease will be brought to a
standstill more quickly than if new susceptible material is con-
tinually added in their place (Bang).

If the described method is carried out accurately it almost in-
variably succeeds in suppressing the disease. In already infected
animals abortion cannot be prevented, but the infection of healthy
animals can be prevented. Authoritative measures which would pre-
vent animals from infected herds being taken to markets, animal ex-
hibitions and publie pastures, would considerably aid in the prevention
of the dissemination of the virus (such measures exist at present in
Norway).

Immunization. Bang’s most recent investigations indicate the
possibility of immunization of cattle, sheep and goats against the in-
fection. He found that several animals which repeatedly received in-
travenously living cultures (10 ce. each time) at least two months
before conception, carried the fetus to normal time in spite of the fact
that during their pregnancy they were infected per os with cultures
or exudates. As however the intravenous injection sometimes disturhed
the general health greatly, experiments were later undertaken on sheep
and goats with subcutaneous injections of cultures (5 to 7 times, a
750 Infectious Abortion.

total of 50-70 ce.), the results of which .also proved satisfactory. Of
five cattle which, a long time before breeding, were injected subcu-
taneously in eleven doses with 100 ce. of cultures of bacilli killed by
Tuluol, and which during pregnancy were fed with cultures and
exudates, two animals gave normal births. Of four cattle which re-
ceived living cultures subcutaneously in increasing doses, from 4-40 ee.,
a total of 140 ce., one gave birth at the normal time, while one aborted
shortly after the feeding of the infectious material, and two aborted
later. Based on the results of encouraging laboratory experiments
MacFadyean & Stockman recommend immunization with 150 ce. of
virulent culture 6 to 3 weeks before breeding.

Literature. Nocard, Rec., 1886. 669. — Brauer, D. Z, f. Jm., 1888. XIV. 95;
1895. XXI. 455. — Sand, ibid., 1895. XXI. 195 (Lit.). _— Berger, D. t. W., 93.
117. — Bang, Z. f. Jm. 1897. T. 241; A. f. Jk., 1897. XXXIII. S10, we Guillerey,
A. F. Jk., 19038. XXIX. 37 (Lit.). — Ostertag, Monh., 1901, XII. 386; HI. d. p.
M., 1903. III. 287. — Preisz, Chl. f. Bakt., 1903. XXXIII. 190. — Schittler,
A. f. Jk., 1904. XX. 329. — Penberthy, J of comp. Path., 1904. VII. 362. —
MacFadyean & Stockman, V. J., 1909. 459. — Holth, B. t. W., 1909. 686,
— Nowak, A. P., 1908. XXII. 541.

11. Infectious Vaginal Catarrh of Cattle. Colpitis Granulosa
Infectiosa Bovum.

(Vaginitis infectiosa granularis s. follicularis, Vaginitis verru-
cosa; Ansteckender Scheidenkatarrh der Rinder [German];
Vaginite granuleuse, infectieuse ou contagieuse [French].)

Infectious vaginitis is a chronic infectious disease of cattle,
which is principally characterized by peculiar nodule forma-
tions on the catarrhal, swollen vaginal mucous membranes. A
Gram negative streptococcus is at present considered to be its
cause.

History. The disease was recognized generally only towards the
end of the last century. After Isepponi (1887) and Ehrhardt (1896)
had observed its occurrence in Switzerland it was described in the
years of 1894-1904 by German authors (Trommsdorf, R. Froéhner,
Martens, Ellinger, Georges, Hecker, Ostertag, Raebiger and vthers),
further by Jensen in Denmark, by De Bruin in the Netherlands, by
Gratz, Keleti, Ladanyi and others in Hungary, and by Saccani and
Tosi in Italy. The cause of the disease has been described by Ostertag
and Hecker, while knowledge concerning the mode of infection and
symptomology was especially furthered by the inquiries of the
“Association of Swiss Veterinarians’’ in 1902, and by the compilation
of their results by Hess.

Occurrence. The disease appears to be quite widely spread
on the European continent, and most of the cows in the in-
fected herds usually become affected. As some of the affected
animals are impregnated with difficulty, abort easily, and sub-
sequently remain sterile, the disease causes considerable loss
in cattle breeding, which in severe cases is also increased by a
reduction in their nutrition and milk production.
Occurrence, Etiology, Pathogenicity. 751

. The disease is widely distributed in middle and northern Germany, and is
still spreading. In eastern Prussia alone about 30,000 cows appear to be affected
(Miller) j 90-98% of the cows being usually affected in the infected herds
(Raebiger), and in the corporation herds also the frequency reaches 90%. The
disease existed in 1901 in Thiiringia to such an extent that not a single township,
‘ indeed in many places not even a ‘sitgle stable, was spared (Pr. V.-B.). The

disease was reported in 1903 from almost évery government district, and about
90% of 30,000 cattle of the East Prussian-Netherlands Society were affected.

The general inquiry in Switzerland showed a-yery considerable distribution
of the disease, as among 4,322 cattle examined in 344 stables, 60% were found
to be infected. In the western part of Austria one-half of the entire number of
cattle are supposed to be affected (Reichl). In Hungary it is also widely spread.
According to the investigation of Ladanyi at the stockyards of Budapest, 43.8%
out of 5,013 cattle showed symptoms of the disease; of the improved breeds 58.9%,
and of the range cattle 43% proved to ke affected, while all of the buffalo cows
were found to be healthy. According to the origin of the animals the morbidity
in cows from Hungary was 50.7%, from Servia 43.8%, from Bosnia 57.8%, from
Croatia 52.3%, besides which the disease has also been diagnosed in calves.

_._ Etiology. The organism considered as the cause of the
disease is a streptococcus chain consisting of 6-9 cocci, the in-
dividual cocci being enclosed in a fine capsule.

Staining. The cocci are easily stained by aqueous anilin dyes
while the capsule remains unstained; by Gram’s method even the cocci
remain unstained.

Cultivation. The streptococci grow on the ordinary alkaline media
in the presence of oxygen, at body or room temperature; luxuriant
cultures grow especially on agar containing glycerin or urine. Gelatin
and coagulated blood serum are not liquefied; in bouillon a diffuse
turbidity develops; milk is not coagulated. Neither gas nor indol
form in the cultures.

Tenacity. The streptococci are killed in cultures in one minute by corrosive
sublimate 1:5000, silver nitrate 44%, lactic acid 2%, lysol or ereolin solution 244%
(Ostertag). One per cent tannin solution appears to destroy them after 20 hours,
while a 144% solution of bacillol has a rapidly destructive action (De Bruin).
From fibrinous purulent discharge of the vaginal mucous membrane, dried on
small wooden sticks, the streptococci may be grown on artificial media even after
3% years (Heckelmann).

Pathogenicity. Pure culture or vaginal discharge intro-
duced into the vagina of healthy female cattle produces in
from 2 to 3 days a purulent vaginal catarrh, in the course of
which the discharge at first (according to Thoms as early as
from 16 hours on) contains exclusively streptococci, later also.
staphylococci and colon bacilli. A transmission to other animals
is not successful (only DeBruin reports that he succeeded in
transmitting it to horses, sheep, goats and hogs).

Following the investigations of Prowazek & Halberstadter on trachoma of
man, Blahn found that the epithelial cells on the point of the follicular nodules
contain very small bodies resembling the trachoma bodies, which sometimes were
numerous, again few, and were enclosed in cells or free in great clumps. He con-
siders these bodies, which sometimes have a sickle shape, and are invariably present
only on one side of the nucleus, as evolution forms of a protozoon as yet unknown,
belonging to Prowazek’s Chlamydozoa. According to his view the disease repre-
sents a specific affection of the epithelia, with degeneration of the adenoid layer

. of the mucous membranes, probably as a result of an obstruction of the giandular
752 Infectious Vaginitis.

2

canals, and subsequently appearing follicular formations. This conception requires
confirmation, as does also that regarding the etiological importance of the trachoma
bodies (Pomayer already reports that he never observed the bodies in question).

The natural infection results as a rule during the act of
coitus; more rarely, but also easily by contact of healthy cows —
with affected animals, or by straw contaminated with vaginal
discharge, ichor, or stable utensils, further by the contaminated
hands of the attendants during the examination of the genital
organs, as well as by instruments which are used in the treat-
ment of affected animals.

Bulls may transmit the disease more readily, as some-
times they themselves may be affected, and besides the infec-
tion may retain its virulence for a long time in the pelvic por-
tion of the urethra, from the flexura sigmoidea to the neck of
the bladder (Hess). As a matter of fact bulls infected by
diseased cows may within a short time cause the appearance
of the disease at different places, by disseminating the infection
during service of cows led to them from other villages, and
the infection then extends rapidly in the herds. Young cattle
are especially susceptible to the infection, and the disease has
been observed in calves only two weeks old. Young strong
cows, and in general animals with tender, sensitive vaginal
mucous membranes are more easily, more quickly, more severely.
and more typically affected than older animals with tougher, less
sensitive mucous membranes. Accordingly the disease is ob-
served only very exceptionally in cows over ten years of age,
and animals with a chronic affection of the vaginal mucous
membrane (prolapse of the vagina, nymphomania), are es-
pecially very resistant (Hess).

Female animals are generally more susceptible than males.
The nutrition, the method of feeding, and the character of the
utilization of the animals has no influence, likewise the period
of the year, or the weather (the frequency of the disease in
the spring and summer is the result of the breeding period which
usually occurs at this time).

Pathogenesis. With the entrance of the streptococci into
the mucous membrane of the vagina, they produce on one hand
a chronic catarrh, and on the other a swelling of the lymph
follicles. They may be demonstrated in the mucous membrane
between the epithelial cells, and also in the papillary body. As
the nodules characteristic of the disease occur also in the
os, and on the mucous membrane of the uterus, and streptococci
were demonstrated not only in the secretion of the uterus, but
also in the contents of the degenerated cystic ovaries (Heckel-
mann, Raebiger), sometimes changes result which later render
conception difficult, or altogether impossible.

According to Pomayer the inflammatory process always begins at the folds
running backwards and forwards from the clitoris, as well as in the prepuce of
the clitoris, and extends only later to the lateral and superior walls of the vestibule
 
Plate VIII.

 

Infectious Vaginal Catarrh of Cattle

Nodules on the swollen and reddened mucosa of the vagina of a cow.
Pathogenesis, Symptoms. 753

of the vagina. By pressure on the anterior wall of the clitoris a drop of yellow-
ish, thick, odorless mucus may be squeezed out from the follicular cavity, which
contains diplococci in pure cultures. The specific changes never attack the cervix
or the uterine mucous membrane, and that: affected animals frequently fail to
conceive may be explained thus that during copulation the pressure of the penis on
the hypersensitive nerve endings of the inflamed clitoris, and the vulva, causes
by reflex action the -08 to be drawn upwards and to close. Mostly, however, steril-
ity, as well as abortion, is caused by a coexisting uterine catarrh- (fluor albus),
which exists independently of the specific affection of the ‘vagina.

According to the histological examinations of Thoms, the nodules of the
mucous membrane, especially in the surrounding parts of the clitoris, represent
principally club-shaped, thickened papillae of. the already normally strongly. devel-
oped papillary body, while in other parts the nodules develop from one or more
follicles, which cause a profusion of the surface of the mucous membrane.. After
recovery from the vaginal catarrh the follicles gradually retrogress, but they -persist
in part, although in somewhat less definite form. Therefore recovery from the dis-
ease 1s not necessarily connected with the entire disaypearance- of the nodules.

_ Symptoms. The incubation period of infectious vaginitis is,
after artificial infections, according to Ostertag, 2 to 3 days,
according to Hess 20 to 72 hours, after coitus usually 3 to 5 days,
sometimes, however, only 24 hours (Raebiger).

The disease commences with a moderate swelling of the
vulva, and diffuse spotted, or streaked reddening, further swell-
ing, formation of folds and increased sensitiveness of the vaginal
mucous membrane, when a muco-purulent secretion collects on
the surface. In from 1 to 2 days millet seed to half of a hemp
seed sized, more rarely even somewhat larger, smooth nodules
at first dark red and easily bleeding, appear on the mucous
membrane of the vestibule of the vagina, especially on the
clitoris and on the folds of its prepuce, as well as in the im-
mediate surroundings. They appear especially sharply promi-
nent by side,illumination, forming: dense clumps in the vicinity
of the clitoris, on the lateral walls of the vestibule of the vagina,
however, they are arranged in sagittal rows (Plate VIII), and
by stroking the mucous membrane with the fingers they are
easily palpable. The tissue of the mucous membrane lying be-
tween the nodules shows a diffuse or .pad-like swelling and a
reddish-yellow discoloration as a result of edematous infiltra-
tion.

According to Hess the first changes on the vaginal mucous membrane consist
in slightly elevated, red points, which change inside of 24-72-hours to millet-seed
sized, pale gray, transparent vesicles. With a severe increase of the. inflammatory
manifestations they burst after an additional 24 hours, forming very small, regular,
superficial, rapidly coalescing minute ulcerations. Meanwhile the mucous mem-
brane is covered with a tenacious, muco-purulent discharge, and only after its
disappearance do the highly reddened nodules become prominent on the mucosa,
which in part is still bare of epithelia. The nodules therefore are not to be viewed
as primary, but as the terminal stage of the process. The vesicular state, how-
ever, may pass unnoticed on account of its short duration; on the other hand, the
described stages may be altogether absent, and the affection manifest itself only in
a diffuse catarrhal, or catarrhal purulent inflammation. On account of the develop-
ment of the process from primary vesicles and the protracted course, the author
considers, in agreement with several Swiss veterinarians, that the disease is a severe
form of vesicular exanthema. Nielsen is also inclined to accept the view that the
vesicular eruption represents only an acute form of follicular vaginitis, as he suc-
ceeded in producing an acute vesicle formation with the mucous from cows with
chronic nodular vaginitis. Jiiterbock, however, failed to observe in 4,000 cases,
vesicles on the vaginal mucous membrane in a single instance.

Vol. 1—48.
754. Infectious Vaginitis.

Simultaneously with the development of the nodules,. a
vaginal discharge appears in the majority of cases, which is
at first very scanty, later somewhat more profuse, glassy,
tenacious, and sometimes more muco-purulent in character. It
is odorless, alkaline or neutral in reaction. The discharge soils
the parts surrounding the vulva, where it dries to brown crusts ;
exceptionally a profuse secretion forms, which passes in long
strings from the vagina.

The general health of the patient is usually undisturbed,
and the body temperature is not elevated. The catarrh of
the vaginal mucous membrane however causes frequent micturi-
tion, and sometimes also straining for action of the bowels.
At the same time frequent shifting of the feet, swinging the
tail, occasionally also standing with legs widely spread, a stiff
gait, rubbing, kicking against the abdomen, and arching of
the back is observed. Only in rare, severe cases are appetite
and rumination absent, or is the milk secretion suppressed.

This clinical picture remains almost unchanged from 3 to
4 weeks, whereupon the process gradually passes into a chronic
stage, which is manifested by the nodules becoming pale, a dis-
appearance of the discharge and of all acute, inflammatory
symptoms, the mucous membrane appearing of a light yellowish
shade. The nodules are then glassy transparent or yellowish-
gray, and no longer surrounded by a reddened zone. The
‘process may remain in this form for weeks and months, until
finally recovery ensues.

Heckelmann describes as a rare finding in the first eight days
numerous yellowish-gray-white spots on the mucous membrane, which
represent éither erosions covered with broken-down epithelia or grayish-
yellow membranes adhering strongly to the mucous membrane, while
dark red nodules appeared later. Probably similar findings caused
Ladanyi to distinguish a special eroding form of the disease, which,
according to his observation is manifested so that on the swollen
yellowish mucous membrane, poppy seed to lentil-sized, always yellowish-
white, sharply circumscribed spots appear, which are not elevated over
the surrounding parts, and which degenerate from the center, whereby
the mucous membrane obtains a peculiar, reticulated appearance, until
finally, in from 10 to 14 days, the superficial loss of substance heals
without formation of nodules.

Regarding the influence of vaginal catarrh on pregnancy
and subsequent conception, the views of the practical veteri-
narians vary widely. As nodules were found in some cases
on the mucous membrane of the uterus, apparently the result
of an extension of the inflammatory process from the vaginal
mucous membrane, and possibly also by aspiration of the in-
fected semen during copulation, an unfavorable influence on
the development of the fetus cannot be disregarded. In har-
mony with this many observers report on relatively frequent
cases of abortion in affected cows, and still more frequent are
 

Symptoms. 755

the observations in which oestrum appears repeatedly in the
animals, and conception only after repeated copulations, or
not at all. On the other hand there are also numerous observa-
tions at hand according to which the disease has no unfavorable
influence on either conception, or on the full development of
the fetus.

These contradictory results of observations are probably
due to the variations in the character of the disease. On the
other hand the possibility is not excluded that conception is
prevented by a non-specific uterine catarrh, and the abortion
to which Bang has already called attention, is not brought on
by the vaginitis, but by ‘‘infectious abortion.’’ Both forms of
the disease may be confounded with each other, as in infectious
abortion, the follicles of the vaginal mucous membrane may
also be swollen, besides the animals affected with infectious
vaginitis may very likely be affected also with the virus of
the above-mentioned affection. As a matter of fact the ob-
servations in which most, or the total number of cows, or two-
thirds, and even 80% of the animals failed to conceive, as a
result of the affection, can be hardly credited, in view of the
nature of the somewhat mild local disease process. The same
‘may be applied also to the supposed connection of vaginal
eatarrh with the severe purulent, or septic inflammation of
the uterine mucous membranes, as well as with affections of
the ovaries. In consideration of the uncertainty of this, accu-
rate and especially bacteriologic examinations would be very
desirable.

According to Heckelmann’s experience, out of 448 affected cows 65% con-
ceived with certainty, 14% probably, while 21% failed to become pregnant again.
In the district of Olpe in 1902 only 48 out of 296 affected cows gave birth to
living, well developed calves. According to Raebiger sometimes 68% of the
affected animals abort, while Ellinger claims 50-70% of normal births. Swiss
veterinarians also report on frequent sterility (30-50%, and even more) in affected
animals. Nuesch claims infectious vaginitis as the cause of non-conception in 80%,
Fasciati in 60-70%; some veterinarians, however, have failed to observe such results
in their practice, and according to Rusterholz conception fails only in a certain
form of the disease.

Bad results in these directions have keen observed in Hungary only in recent
times. Keleti established that in 20 herds, 17 out of 503 affected cows remained
sterile, and 7 aborted, while in the same locality out of 489 healthy cattle 15
remained sterile and 8 aborted. The percentage was therefore in both groups quite
uniform (4.8 and 4.7%). Likewise there was no difference in primiparae, whether
affected or not. Kovarzik failed also to observe bad results, aud Landler noted
the conception of all affected animals in a herd of 240, all of which gave birth
normally. Recently, however, he has not infrequently observed abortion and still
more frequently sterility.

In regard to the publications on the economic losses from infectious vaginitis,
Angstein states that the almost uniform sterility or abortion of the animals is by
no means as extensive in practice as might be inferred from published reports;
as a matter of fact, the disease appears very frequently in -herds without the
owners having the slightest idea of its existence, as they fail to observe any detri-
mental results.

Bulls which have covered. affected cows become affected
rarely and then usually but mildly. In such cases they show
dullness and ‘frequent micturition, which is sometimes asso-
756 Infectious Vaginitis.

ciated -with pain; the penis is highly reddened and painful, ex-
ceptionally nodules develop on its surface and on the inner
lining of the sheath a muco-purulent discharge being emitted
from the opening of the sheath. Bleeding is sometimes ob-
served during the act of covering. Swiss veterinarians further
report nodules and vesicles on the mucous membrane of the
penis, ulcerations on the orifice of the sheath, painful swelling
of the scrotum, and even necrosis of the testicles, while Jiiter-
bock regularly found on slaughtered bulls pronounced follicular
formations on the mucous membrane of the penis.

Course and Prognosis. The course is mostly very pro-
tracted. Although sometimes the acute inflammatory symp-
toms, and with them the vaginal discharge subside inside of
two weeks, in the great majority of cases they last from 2 to
3 months, and even longer. With the retrogression of the
swelling of the mucous membrane the nodules become paler,
yellowish, or grayish-transparent, whereupon they disappear
entirely, or persist in this form for months. Their healing
appears to be favored by pregnancy, but in such cases there
is probably only an apparent disappearance of the nodules,
as a result of the physiological swelling of the vaginal mucous
membrane, as in some cases they become again more prominent
after parturition (Hess).

The prognosis depends, aside from the character of the
disease, first of all on the inaugurated treatment as well as
on the existing hygienic conditions. In early and energetic
treatment it is as a rule favorable, as under these conditions
recovery of fresh cases ensues mostly in 2 to 4 weeks, chronic
cases however are usually characterized by a marked stubborn-
ness. Further the possibility of quite frequent recurrences must
also be considered, which may result either after mechanical
irritation (repeated copulation) or as a result of re-infection.

Diagnosis. For the cases running a normal acute course,
aside from the epizootic character of the disease, the develop-
ment of small nodules in association with inflammatory symp-
toms of the mucous membrane of the vagina, and especially
of the vestibule is characteristic, as well as the fact that the
nodules do not change into vesicles or pustules, and that they
do not break and form ulcers. In the exclusive presence of
nodules the diagnosis should be made with care, as the lymph
follicles may also swell in infectious abortion, and from other
inflammatory causes, as well as from simple traumatic irrita-
tion of the mucous membrane (Attinger, Jiiterbock), (some
authors even doubt their pathological nature). The diagnosis
is especially difficult in pregnant cows, as nodules possibly
present on the swollen mucous membrane in these cases are
not, or only indistinctly visible, and appear only 10 to 15 days
after parturition (Jiiterbock).
Diagnosis, Treatment. 757

The vesicular exanthema with which the disease is fre-
quently confounded, is associated with febrile symptoms, in
which on the vaginal’ mucous membrane lentil to pea-sized
vesicles, and only a small number of hard nodules develop
within 3 to 4 days, which however change into vesicles, and
later into ulcerations. Besides in this disease complete recovery
follows in 2, more rarely in from 3 to 4 weeks. In infectious
abortion the nodules: which are sometimes observed on the
vaginal mucous membrane appear only several days after the
expulsion of the fetus, and disappear shortly after. More-
over the usually profuse vaginal discharge contains the bacillus
of abortion in great numbers. Of course animals may be affected
with both diseases simultaneously. Profuse and especially
fetid vaginal discharg¢ in general indicates a complication with
one or another inflammatory affection of the genital organs.

According to Schyeider a vaginitis may develop in weakly
or poorly developed cows after copulation by mechanical means,
which is manifested by a marked reddening and frequently
follicular swelling of the mucous membrane, as well as a muco-
Pelee discharge, in’ gevere cases also in erosions and ulcera-
ions.

Treatment. One of the most important requirements for
satisfactory results consists in cleanliness, disinfection, and
most painstaking care of the stables, also in the careful
supervision of copulation, in order not to hinder the healing
process by reinfection and fresh additional inflammation.

The most varied antiseptic and astringent remedies are
recommended for treatment in various forms of application.
The results however depend not so much on the selection of
the remedies, as on the care and the accuracy of their applica-
tion, as well as on the persistence of the treatment. In general
it is recommended to repeat it in short (daily), later in longer
(2 to 3 days) intervals, and to continue at least until the com-
plete cessation of the discharge, if possible, even until the
disappearance of the nodules, therefore on an average for 5
to 6 weeks.

For local treatment, which may be supported effectively
by cleaning and washing the external genital parts with luke-
warm soda solution or with 1-2% lysol or creolin solution,
irrigation of the vagina with mildly acting disinfecting solutions
is indicated, especially in acute cases, as in such treatment
the remedies come in contact with all parts of the mucous
membrane. In less acute and more protracted cases, tampons,
painting, powdering, liniments, salves and suppositories come
into consideration, all of which exert an intensive healing action
at the point of application and in their immediate surroundings.
Considering their easy application, as well as the fact that in
this the remedy remains for a longer time in contact with the
affected parts of the mucous membrane, these methods of treat-
758 Infectious Vaginitis.

ment are especially advised in cases in which the daily applica-
tion of irrigations meets with insurmountable obstacles, or
in which the affection is found to be confined to the vestibule
of the vagina. /

The most varied disinfectants and astringents, further also
cauterizing remedies have been recommended for treatment,
thus especially for irrigation lysol and creolin (0.5-2%), bacillol
(1.5-3%), potassium permanganate (1%), nitrate of silver
(0.5%), lactic acid (2%), boracie acid (3%), liquor cresolis
compositus (1%), alum (1%), formaldehyde (1.5-1%), protargol
and ichthyol (0.5-2%; expensive), ichthargan (1:1000, expen-
sive), and others. All may be used in similar concentrations,
also for saturation of tampons for introduction into the vagina.
For painting, iodide of glycerin (1:1), tincture of iodine with
aleohol (1:2), further Lugol’s solution may be employed.
Bacillol, ichthyol, chinosol, formaldehydum saponatum (septo-
form), and recently the hydrargyrum sozojodolicum (marketed
as Bissulin, in the form of crayons), all in 10% concentration,
are most frequently utilized as ointments. If they are to be
applied in the form of suppositories, or so called vaginal balls,
they are prepared with tallow, wax or cocoa-butter. Of dusting
powders are recommended, four parts of sulphate of zinc or
alum, and one part of boracic acid; bacillol with boracie acid
(1:30); boracie acid with flour or powdered oak-bark, aa and
others. Finally for superficial cauterization of the nodules 1%
nitric acid, or 3% nitrate of silver solution may be used.

Technique of Treatment. The local treatment is inaugurated by washing the
vagina with a 1% luke-warm soda solution, in order to remove the secretion collected
therein. If severe symptoms of irritation exist, it is advisable to cover the vesti-
bule of the vagina, on the first day, with an ointment containing tincture of opium.

The irrigations are executed with the aid of a rather stiff rubber tube of an
irrigator, or with a bulb syringe having a dull nozzle, a considerable quantity of
fluid is to be introduced, in order that it may penetrate up to the uterine os, and
into all folds of the mucous membrane. Following this, a wad of cotton saturated
with the same solution, and with a long string attached, may be introduced as
deeply as possible into the vagina, where it remains until the following day, if not
expelled before that time, when it may be removed by drawing it out by the
protruding string.

For the application of ointments Raebiger’s ointment syringe, constructed
especially for this purpose is adapted, which makes possible the introduction of the
remedies into the depths of the vagina and also the accurate measuring of doses.
Besides a rolled rag may be covered with the salve, and placed in the vagina at
such a depth that the front part touches the os uteri (Rusterholz); finally the
salve may be also used in gelatin capsules. :

Vaginal balls or bougies, such as are at the present marketed by many con-
cerns and in varying compositions, are, after previous superficial warming in warm
water or over a flame, introduced with the fingers or with a spoon forceps deeply
into the vagina and allowed to remain.

Male animals also require a treatment for which it is advisable to remove
the brush of hair at the opening of the sheath with scissors, whereupon the sur-
rounding parts are washed with Juke-warm soap water, and finally the sheath is
irrigated with a non-irritating disinfecting solution, or the extended penis during
a copulation trial is covered with the salve.

To promote conception it is advisable to irrigate the vagina before copulation
with 2 luke-warm 2% solution of sodium bicarbonate.
Treatment, Prevention. 759

Prevention. For preventing the spread of the disease it
is advisable to segregate the healthy animals from the affected
ones, to disinfect repeated!y and thoroughly the infected stables,
and especially the stalls, as well as the draining gutters, and
if possible to prevent the affected cows and bulls from copula-
tion during the duration of the disease. This measure can be
carried out in practice only at considerable expense on account
of the resulting falling off in the number of calves. In bulls
which are exposed to the danger of infection the brush of hair
at the opening of the sheath should be cut short, and the sheath
should be irrigated after every copulation with a mild disin-
fecting solution. Finally, in order to prevent the introduction
of the disease, newly bought female animals should be care-
fully examined for the presence of the disease.

Literature. Isepponi, Schw. A., 1885. XXIX. 1. — Ehrhardt, ibid., 1896.
XXXVIII. 80. — Hecker, B. t. W., 1900. 445. — Ostertag, Monh., 1901. XII. 533.
— Raebiger, D. t. W., 1901. 454. — Zschokke, D. Unfruchtbarkeit d. Rindes, usw.
Ziirich, 1900; Schw. A., 1904. XLVI. 281. — De Bruin, D. t. W., 1905. 392. —
Attinger, B. t. W., 1905. 845. — Hess, Bericht ib. d. von _d. Gesellsch. schweiz.
Tjeriirzte veranst. Untersuchung betr. d. Kniétchenseuche. Bern 1905. — Keleti,

latorvosi Lapok, 1905. 409; 1906. 229. — Ladanyi, ibid., 1906. 97. — Thoms,
Monh., 1906. XVII. 198 (Lit.). Casper, T. Z., 1907. 393. — Jiiterbock, Z. f. Tm.,
1909. XIII. 354 (Lit.). Pomayer, B. t. W., 1910. 173.
Group VI.
INFECTIOUS DISEASES PRODUCED BY PROTOZOA.
1, Piroplasmoses.

(Babesioses, Malaria of Animals.)

To the group of piroplasmoses belong those diseases which
sometimes show an acute, at other times a chronic course and
are caused by a unicellular protozoa, the so called piroplasma
(pirosoma, babesia). The parasites are inoculated into the
body fluids of mammals by ticks, and in penetrating the red
blood corpuscles they produce their destruction, causing anemia,
and frequently also hemoglobinuria, as well as icterus to de-
velop in the animals.

General Morphology and Biology of the Causative Factors.
Piroplasmas are unpigmented, roundish, pear, ring or rod-
shaped protozoa with a nucleus which probably encloses a
blepharoplast (centrosom), and are closely related to the

   

Fig. 128. Piroplasma bigeminum: Typical ring and pear shapes. The upper
row stained with alkaline methylene blue, the lower after Romanowsky. (After
Kossel & Weber).

 

hemosporidia. In the inside of the red blood corpuscles, where

they are usually found, they are frequently present in pairs,

in which the pear shapes meet each other with their pointed

ends. In the fresh condition they show ameboid movements.
Their reproduction has, up to the present time, not been

accurately investigated. In the blood of the host it results

probably by the way of direct fission, or schizogony, in which

760
General Morphology and Biology. 761

the division of the plasma body is preceded by a division of
the nucleus. Besides, according to the more recent investiga-
tions changes in generation appears to occur in the body of
the ticks, as is indicated by the fact that certain species of
piroplasma are transmitted to mammals only by certain ticks,
and only by progenies of the ticks which have sucked the in-
fected blood. The nature and mode of this propagation how-
ever is not yet sufficiently clear, as the investigations along
this line with various piroplasma gave variable results (fur-
ne is given under the various forms of the dis-
ease).

Staining. In cover glass dry preparations fixed in the air or in
alcohol, the piroplasmas stain uniformly with methylene blue or other
aqueous anilin dyes, while the preparations which are stained with
one of the nuclear staining methods by Romanoswky-Ziemann, Laveran
or Giemsa, disclose one or more chromatin granules in the blue stained
plasma.

Cultivation. Attempts at cultivation in various ways, mostly in
bouillon, have given only partially positive results, however, they were
successful in keeping the parasites alive for a time outside of the
animal body, and in demonstrating in them morphological changes,
which are considered by some observers to be stages of development
(see p. 766).

The differentiation of various species of piroplasma de-
pends partly on the characteristic form and size, and first of
all on the fact that the individual species are strongly bound
to certain mammals, so that they cannot even artificially be
transmitted to other species.

Pathogenicity and Natural Infection. With few exceptions
(coast fever, tropical piroplasmosis), the piroplasma may be
transmitted artificially with the blood of an affected animal
containing the parasite, by subcutaneous or intravenous inocula-
tion, whereupon after an incubation period of several days,
or even several weeks they appear in the circulating blood,
and some species will produce the symptoms of their respective
disease.

Under natural conditions all piroplasma are transmitted
from affected to healthy animals by ticks, and not only in a
purely mechanical way, but also in that not the tick which sucked
the mammalian blood containing the piroplasmas transmits the
disease, but its immediate or more remote offspring. This is
possibly because the piroplasma undergo in the ticks in the
meantime certain stages of development. Some piroplasma,
as those of Texas fever, the piroplasma of dogs and of sheep,
pass from the female ticks which suck the blood of affected
animals, through: the eggs to the larvae, and likewise also to
the later forms, whereby the parasites are inoculated into the
762 Piroplasmoses.

body of the mammals either by the larvae nymphs (Texas
fever), or by the sexually ripe ticks (piroplasmosis of sheep
and dogs). Other piroplasma do not pass through the eggs,
but are transmitted only by the nymphs, which have sucked
the infected blood as larvae, or by matured ticks, which sucked
it as nymphs (tropical piroplasmosis, piroplasmosis of horses).

With:a few exceptions, a species of ticks transmits only
a certain species of piroplasma, while one certain piroplasma
may be transmitted in different localities by different kinds of
ticks.

The ticks are arthropodes, which as Ixodinae and Argasidae form
the family of Ixodidae. As transmitters of the piroplasma: the Ixodinae
come exclusively into consideration, while ticks of the genus Argas
transmit the infection in spirochetoses.

The Ixodinae are obligatory parasites and exist on blood which
they suck from mammals by pricking the skin with the proboscis, more
correctly with the hypostome. The females impregnated on the hosts
fall to the ground, where they lay eggs on blades of grass. The hatched
larvae look for a host in order to suck blood; in some species they
then develop on the same animal up to the nymph stage or also to
sexual maturity, while in others the larvae as well as the nymphs, or the
nymphs alone, leave the host, in order to develop into the next stage.
According to the nature of the development the Ixodidae may be
combined into the following groups (Meuleman) :

1. Species which pass through their development on the same host; here
belong the species of the Boophilus (Margaropus, Rhipicephalus, blue ticks), namely
B. annulatus, B. decoloratus, B. australis and B. argentinus (according to Neumann
only varieties of one species); all are transmitters of Texas fever, the B. decolor-
atus transmits also tropical piroplasmosis.

2. Species which leave the host as nymphs; here belong Rhipicephalus
evertsi (red tick: transmitter of East African coast fever, and the piroplasmosis
of horses), Rh. bursa (transmitter of piroplasmosis of sheep), and Hyalomma
aegyptium (transmitter of Texas fever?).

3. Species which leave host as larvae and as nypmhs; here belong Ixodes
ricinus 8. reduvius (transmitter of piroplasmosis of cattle in Europe, probably also
of piroplasmosis of dogs), Rhipicephalus appendiculatus (brown tick), Rh. nitens,
Rh. simus (dotted black tick), and Rh. capensis (transmitter of coast fever), Rh.
sanguineus and Haemaphysalis leachi (transmitter of piroplasmosis of dogs).

Pathogenesis. Some piroplasma, as for instance, the
ordinary piroplasma of cattle (Texas fever), of dogs, and of
sheep, exert their pathogenic action by penetrating the red
blood corpuscles and causing their destruction. According to
the intensity of the affection a larger or smaller number of
red cells is destroyed, as a result of which a more or less pro-
nounced anemia develops, and simultaneously the hemoglobin
of the attacked cells is eliminated into the blood plasma. If
only a small number of erythrocytes is destroyed, only a hemo-
globinemia results, the eliminated hemoglobin is then changed
in the liver into bilirubin, and eliminated as such, while in
a greater destruction of blood corpuscles a part of the hemo-
globin is passed with the urine, and icterus sets in at the same
Pathogenesis. 763

time. The debris of the cells at the same time cause emboli
in the various organs, especially in the kidneys, as a result
of which hemorrhages develop, and parenchymatous inflamma-
tion is produced in the kidneys (Smith, Betegh), manifested in
the presence of albumen in the urine, which exceeds the hemo-
globin in quantity. The rapid diminution of the number of
red blood corpuscles, and the disturbance in nutrition which
is always present, lead finally to death from exhaustion in a
large proportion of the cases.

According to the investigations of Barratt & Yorke, the haemoglobinuria
develops in piroplasmosis of dogs as a direct result of the haemoglobinemia only
when the blood plasma contains as much hemoglobin in solution as 0.5% red
blood corpuscles in proportion to the total volume of the plasma. At the.same
time the. red coloration of the urine is pronounced only in a marked and rapid
destruction of erythrocytes, while in chronic cases it is usually not observed, as
in these the destruction reaches a greater proportion, but develops only gradually.

Contrary to the above piroplasmosis, hemoglobinuria is
not observed in Kast African coast fever, or in tropical piro-
plasmosis, and only exceptionally in piroplasmosis of horses,
although a great proportion of the erythrocytes contain the
parasites. These affections are manifested in the acute cases
by more or less pronounced symptoms of a general blood in-
fection, and the anemia appears only
in the more chronic cases. The
cause of the difference in the patho-
genic action is at the present un-
known.

Animals which have recovered
from an acute attack continue to
harbor the respective piroplasma in
the red blood corpuscles, even for
years, in spite of the apparent re-
covery and satisfactory nutrition, al-
though only in small numbers; they

Sie Gat aapasas eae. ee also be present in animals
feat. Chromatin staining. which, probably on account of their
(After Theiler). high resistance, have never shown

manifest symptoms of the disease.
Such animals are constant virus carriers, and may be the cause
of the infection of ticks, thereby aiding the spread of the dis-
ease among susceptible animals. At the same time they them-
selves are usually immune against later infection with the same
piroplasma (cattle which have recovered from coast fever are
incapable of transmitting the infection).

 

Anaplasma Marginale. In America and Africa, in localities in
which the piroplasmoses are prevalent, the blood of animals, especially
of cattle, which pass through the disease, contains erythrocytes with
very small, round or oval, marginal bodies (Fig. 129), staining with
the chromatin, the nature and importance of which is still in doubt.
Smith & Kilborne described them as peripheral, coccus-like bodies,
764 Piroplasmosis of Cattle.

Theiler as marginal points. These authors, as well as Knuth, Spring-
feldt and Spreull are inclined to consider them as special blood para-
sites, while Dschunkowsky & Luhs consider them as piroplasma spores
and are of the opinion that they produce the chronic form of tropical
piroplasmosis. Theiler named them recently anaplasma marginale,
as they consist only of chromatin substance, and he proved that after
inoculation with blood which contained such bodies, they appeared in
the blood of the inoculated animals, sometimes also causing severe febrile
affections. According to his most recent experience he considers these
parasites as the cause of the so-called gall sickness which is prevalent
in Africa (see p. 783).

Literature on piroplasmas and piroplasmosis in general: Lihe, Hb. d. Trop-
enkrkh., 1906. III. 193. — Hennig, ibid., page 744. — Schilling, Hb. d. p. M,,
Erginzb., 1906. 75. — Panisset, Rev. gén., 1906. VII. 113. — Kaestner, -D. tier-
pathog. Protozoen, Berlin, 1906; Ergeb. d. allg. Path., 1907. XI 1. 496 (all with lit-
erature). — Rickmann, Tierz. u. Tierkrkh in. D. Siidwestafrika, Berlin 1908. —
Doflein, Protozoenkunde. 1909. 653. — Knuth, Z. f. Infkr., 1910. VII. 141 (more
recent literature). — Theiler, Bull. Soc. Path. exot., 1910. IIT. 135.

(a) Piroplasmosis of Cattle. Piroplasmosis Boum.

(Texas fever, Redwater, Blackwater, Tick fever, Southern
— cattle fever, Haemoglobinuria s. Babesiosis boum, Haemo-
globinaemia enzootica, Malaria boum; Piroplasmose pnb
der Rinder [German]; Piroplasmose du boeuf
Mal de brou, Mal de bois [French]; ue
Ematinuria, Piscia sangue [Italian];
Tristezza [Spanish].) \>

This febrile infectious disease, which is usually observed
in enzootic extension and in the course of which hemoglobin
appears in the urine as a result of the breaking down of red
blood corpuscles, is caused by the piroplasma bigeminum, which
is in various localities inoculated into the bodies of cattle by
various kinds of ticks.

History. The disease was first studied bacteriologically in Roumania
by Babes (1888), who considered as its cause a bacterium which usually
was present in the red blood corpuscles (Haematococcus bovis) ; he has
also proved that the disease may be transmitted with the blood and
kidney substance from affected cattle to healthy animals. Shortly
after him (1889), Th. Smith, later in association with Kilborne, estab-
lished for the Texas fever which is prevalent in North America, the
fact that the parasite represents a hemosporidium, and that the disease,
as already claimed by Reverley in 1881, is spread by a tick, the Boophilus
bovis, in such a manner that the tick inoculates blood containing the
parasites from affected animals into the bodies of healthy cattle.

The publications which have followed each other rapidly since that
time, have established the occurrence of a disease which is identical with
Texas fever, or at least very closely related to it, in many different locali-
ties. Thus Krogius & Hellen established it in Finland, Krageriid in Nor-
way, Celli & Santori in ae Nicolle & Adil-Bey in Turkey, Jackschath
and Zieman in Germany, Ligniéres in France, Gasille and de Jong in
History, Occurrence, Etiology. 765

Holland, Hutyra in Hungary, Nocard, later Stockman in England,
Bettencourt in Portugal; further Koch in East Africa, Theiler and
Hutcheon in South Africa, Stockman in India, Sanarelli and Ligniéres
in South America, finally Pound and Tidswell in Australia.

Kossel & Weber (1899) showed further for Finland, and later in
association with Schiitz & Miessner (1903) for Germany, that the infec-
tion in Europe is transmitted by the Ixodes reduvius. These same
authors, as well as Smith & Kilborne, and also Ligniéres before them,
have suggested a satisfactory method of immunization for the practice.

Occurrence. The disease occurs usually in the form of an
enzootic in the spring and in the summer in certain localities,
especially in marshy and forest pastures, whereas in the cold
periods, and during stable feeding it occurs only exceptionally.
The so-called forest disease (hemoglobinuria), which was for-
merly attributed to the ingestion of various plants, especially
to those containing turpentine, and which was accepted as an
intoxication caused by resinous substances (turpentine), is
identical with the disease is question.

According to general experience older cattle become usually
affected, and the disease sometimes causes very decided losses
among the improperly wintered cattle of poor owners.

The disease causes great losses in Germany, especially in those localities in
the northern part, where, as a rule, all animals are pastured, and among these
in unfavorable years an emphatic decimation of the animals may result. It occurs
especially frequently in Prussia and Oldenburg, then in Bavaria, Wiirtemberg,
Baden, Hessen, Mecklenburg, Braunschweig and in the imperial domains, but it .is
also observed as a permanent disease of spring and summer in other localities in
marshy and moorland pastures.

In Roumania it occurs most destructively in the inundated territories of the
Danube Delta, where the disease in some years causes a loss of 30,000 to 50,000
cattle.

In Hungary the ‘‘forest disease’’ prevails, especially in the mountainous
regions of northern Hungary and Transylvania and occurs there in some localities
almost every spring; it has also been observed in the southern part of the country.

Texas fever has for a long time been known in America around the sea-girt
portions of Mexico; in the middle of the last century the disease was introduced
to the United States with herds driven from Texas, and while it showed in its
original home a very mild course, in the North it caused enormous losses among
the native cattle, the money value of which has been estimated in some years as
$2,000,000. In the northern part of South America it also causes periodically
great losses, especially among imported cattle. It also occurs as a dangerous
disease in India (Schein observed it there also among buffaloes), in Central and
South Africa, further in Australia, where it was introduced by American cattle.

Etiology. The cause of the disease, the Piroplasma bigemi-
num (Babesia bovis, Pirosoma bigem., Apiosoma bigem.,
Ixidioplasma bigem.), occurs in the blood of febrile cattle,
mostly inside of red blood corpuscles, more rarely on their
surface, or free in the blood plasma. The parasites are found
either singly as roundish bodies of 1-2 diameter which in a
fresh state show ameboid movements, or in pairs in which
case the somewhat larger, non-motile, and pear-shaped para-
sites (pirum=pear) frequently hang together with their
elongated ends in a straight line, or at an angle (Fig. 128 on
p. 760 and Fig. 130). Smaller diplococeus-like, as well as
766 Piroplasmosis of Cattle.

rod and lancet forms are found rarely, and the presence of
more than two parasites in one blood corpuscele is also infre-
quent.

The cultivation and propagation on artificial media has not yet
been successful with a certainty.

According to Ligniéres and Miyajima they are supposed to multiply in blood-
bouillon for a time, and here, according to the observations of the Japanese investi-
gator, forms containing flagellae similar to the trypanosomes are supposed to
appear after 3-4 days; the propagation reaches its height on the 10th to 14th day;
on the 45th day, however, the culture died (it is possible that they represented
mixed infections).

According to Smith & Kilborne, as well as Laveran & Nicolle, their
propagation results by fission, or schizogony, while according to Theiler’s
former view, which was also accepted by Koch, the parasites assume, in
certain stages of development, rod- and ring-shapes, and then appear
similar to the causative factor of African horse fever (Fig. 131). Such
forms are usually found in the blood of cattle that are immune against
Texas fever, and they also appear in the blood of calves, which have
heen infected with the blood from such cattle, during or after the second
reaction. Recently, however, these forms were described hy Theiler as
a new variety, (Piroplasma mutans), (see p. 782).

 

Fig. 130. Piroplasma bigemi- Fig. 1381. Piroplasma bigemi-
num. Spherical and pear num. Rodand ring shapes. Blood
shapes. Cattle blood; stained of a cow ina stage of commencing
with methylene blue. convalescence; stained after Lav-

eran.

Koch examined material from ticks which sucked themselves full
of blood from affected animals, and found that, after leaving the blood
corpuscles, the parasites become elongated to club shape in the intestines
of the ticks and develop lancet-like projections, which may be slowly
drawn in and extended (morning star shapes). Later the extensions
become shorter, and diminish in number, whereupon the parasites change
into round or pear-shaped bodies. Such bodies are found, also, in the
eggs of infected ticks, but as they are 3-4 times the size of the piroplasma
in the blood of cattle, it is possible that between the two there are
still other transitory forms. (Kleine observed star forms also in dog
piroplasma, which he placed in strong salt solution. Hartman, however,
considered them as manifestations of degeneration. )
Pathogenicity. 767

; Tenacity. Defibrinated blood kept at 8° ©. is still virulent after 42 days,
while in the blood of cattle which have died or have been slaughtered by bleeding
the parasites remain alive for nine days. In the meat of slaughtered animals they
die at latest after twelve hours (Kossel, Schiitz, Weber & Miessner). Their rapid
death may possibly be due to lack of oxygen, as well as to the acid reaction of
the media which acts destructively on the piroplasma (Jackschath).

Pathogenicity. The disease may be transmitted to healthy
cattle with blood containing piroplasma of affected animals.
After an intravenous, subcutaneous, or intramuscular inocula-
tion of 5-10 cc. of defibrinated blood, the parasites appear
usually in from 8 to 9 days in the blood of the inoculated ani-
mals. At approximately the same time the body temperature
becomes elevated, whereupon, during the reaction which lasts
for 7 or 8 days, the number of red blood corpuscles diminishes,
and in some of the cases hemoglobin appears in the urine.
After 25 to 30 days another febrile reaction follows, usually
with milder symptoms. In some animals the artificial disease
terminates in death, in the majority of cases however recovery
takes place in one to two weeks. In the blood of such recovered
animals the parasites may be demonstrated for a long time,
although in smaller numbers (in one case the blood was still
infectious 531 days after an artificial infection, and according
to Schroeder & Cotton the parasites may persist for 10
to 12 years). The disease may also be produced, although
with less certainty, by the injection of blood containing piro-
plasma into the serous cavities, lungs, brain, further by rubbing
upon the scarified skin; feeding is, on the other hand, always
ineffective. To an infection which causes a severe affection
among older cattle, cattle under one year of age usually react
only with an elevation of temperature lasting for several days.
‘Other species of animals are not susceptible to the infection.

In America, Africa, Australia and Eastern Asia, as well
as probably in Southern Europe, the natural infection is trans-
mitted by the boophilus species, in middle and Northern Eu-
rope, on the other hand, by the Ixodes ricinus (I. reduvius).

According to Salmon & Stiles, the carrier of the parasite is the bo-
ophilus annulatus, in North America, and, according to Motas, also in
Roumania; in South America, Cuba, Porto Rico, in the Philippines and
Australia, the B. australis, in South Africa the B. decoloratus (accord-
ing to Theiler also the Rh. appendiculatus), act as carriers, while of the
sub-family ixodiae, the Ixodes ricinus has only been known with cer-
tainty to transmit the disease in Europe (according to Krageriid the I.
hexagonus acts in a similar way in Norway). ; ;

The piroplasmas of cattle transmitted by various ticks in different
localities do not appear to be entirely identical, but probably represent
varieties of one species, and Liihe even separates them into two species,
apparently on account of the differences in size, namely, into the small,
Babesia bovis, which is found in Europe and North America, and the
larger, Babesia bigeminum, which is prevalent in America, Australia
and South Africa. Their difference appears also to be substantiated by
the fact that animals immunized against one of the varieties are not
always immune against the other varieties, This has been established
768 Piroplasmosis of Cattle.

by Ligniéres for the European and Argentine piroplasmosis, by Theiler
for the English and South African redwater; (on the other hand, cattle
from Texas and from Queensland were immune against the South
African redwater).

Ligniéres describes a special species, the piroplasma Argentinum,
which is considerably smaller, usually only found singly in the erythro-
cytes, and produces in Argentine, Uruguay and Paraguay, an atypical
form of Piroplasmosis, which is frequently characterized by a protracted
and fatal course, and by nervous symptoms.

 

 

 

aed

aii u Cat naw

 

 

Fig. 132. Ixodes reduvius. 1. eggs; 2. larvae; 3. nymph, several days old;
4. sexually mature female; 5. male. Enlarged 16 times. (After Kossel, Schiitz,
Weber & Miessner.)

The parasites of East African coast fever, and of tropical piro-

plasmosis represent a decidedly independent species (see p. 779 and
p. 782).

Development of the Ticks. The Boophilus annulatus (Margaropus
s. Rhipicephalus annulatus, Boophilus bovis) transmits, according to the
investigations of Smith & Kilborne, the infection in the following way:
 

Development of Ticks. 769

The larvae migrate from the grass onto the bodies of cattle, and suck
their blood. After about eight days they change into pupas, and after
another eight days into nymphs, which after another molting develop
into sexually mature ticks. The nymphs, as well as the sexually mature
ticks nourish themselves with the blood of the host animal, following im-
pregnation however the female drops from the body of the cattle and
lays from 2000 to 4000 eggs in the grass, from which the larvae hatch
out in 3-4 weeks. They remain for a time in the grass, occasionally how-
ever they crawl on the skin of the pasturing cattle, and if the female
tick from which they originated has sucked infected blood during its
life, the larvae, and subsequently also the nymphs, inoculate the virus
into the body of the new host. Larvae and nymphs may also pass over
directly from affected animals to healthy cattle, in which ease they
transmit the blood parasites in a direct manner. (?)

The Ixodes ricinus s. reduvius transmits the infection, according
to the investigations of Kossel, Schiitz, Weber & Miessner, in a singular
manner; the female tick dropping from the body of cattle lays in the
grass 100-1000 eggs, from which the larvae hatch out after an average
of six weeks. If the larvae attach themselves to the skin of cattle or of
other animals, they suck themselves full of their blood, and drop: off
after 3-6 days, whereupon they change to nymphs on the ground inside
of four weeks. These attach themselves again to the skin of a mammal,
from which they drop to the ground in from 3-5 days, where they de-
velop in eight weeks to sexually mature ticks, which again look for a
host, where they suck the blood, and copulate. Therefore the total
development from the laying of the eggs until the dropping off of the
impregnated female takes about nineteen weeks, provided that the ticks!
in their different stages of development always meet a suitable host and
that the weather conditions are favorable for their development. <Ac-
cordingly the Ixodes distinguish themselves from the Boophilus among
others, in that they leave the host twice during their development, while
the Boophilus passes through all the stages of its development on one
and the same host.

The eggs of the Ixodes reduvius are 0.50-055 mm. long, and 0.27 to 0.33
mm. broad, of oval shape, and brownish-yellow to brownish-red in color. The
larva is 0.7-0.8 mm. long, 0.42-0.50 mm. broad, has a mite-shaped body, and three
pairs of legs; filled with blood it attains a Jength of 1.25 mm. and a breadth of
0.8 mm., when it takes on a blackish-brown color. The nymph is 1.3 mm. long,
0.74 mm. broad; the body resembles the larva, but possesses four pairs of extrem-
ities; sucked full with blood it is about 2.0 mm long and 1.25 mm. ‘broad and
of a dark grayish color. The developed female is 3-4 mm. long and 1.5-2.5 mm.
broad; impregnated and sucked full with blood it reaches a length of 10-15 mm,
and a breadth of 5-8 mm.; it is then blue or ash-gray in color, sometimes slightly
brownish or yellowish, and has four pairs of extremities. The male is similar
in appearance, although somewhat smaller (Fig. 132).

The larvae, nymphs, and the sexually ripe ticks may, with suffi-
cient moisture, remain alive for months outside of the animal body, and
they also withstand the cold of the winter without harm. In cold weather
they are benumbed, but as soon as warm weather appears they liven up,
and if conditions are otherwise favorable they continue in their devel-
opment. They are harmed however by direct sunlight.

Experiments of infection conducted with both species of
ticks showed that when larvae, hatched out from an infected
female in a glass container, are placed on the skin of healthy
770 Piroplasmosis of Cattle.

cattle, the piroplasma appear in the blood in about eight days,
and in some cases fever and hemoglobinuria sets in (Fig. 133).
The results of experiments conducted with nymphs which as
larvae sucked blood from affected cattle, are similar, and the
disease may be also produced with larvae, which have wintered
in the open (the infectiousness of the sexually mature ticks
of the species described here is as yet questionable). ;
According to these experimental results, which correspond
with practical observations, the natural infection of cattle
occurs usually on previously infected pastures in which one
of the mentioned species of ticks are present, and in which
the larvae and nymphs originated from females which had the
opportunity to suck blood from affected animals or in which
the nymphs themselves in a previous stage of development
sucked infected blood. As these ecto-parasites subsist as a

ie
ato
oS

oS
Bo
go
ay
Se

os
Ba

a
oO
ee.
o
o
S
iS
= i
pant A
234
Sa oh
Bsa
gage
e a
a ao

Very Many

Many
‘Parasites
Very Many |-
Parasites | -
Parasites
Very Many
Parasites

Many
. Parasites,

Few
Parasites
Isolated °
Parasites
Recovered.

 

Fig. 133. Hever curve in piroplasmosis of cattle. After placing several thou-
sand infected larvae on the animal. (After Kossel, Schtitz, Weber & Miessner.)

rule in marshy places, especially in forest pastures or near.
forests and bushes, the disease usually affects cattle driven to
such pastures. On the other hand its annual reappearance
may be explained by the facts that the virus passes from the
impregnated female ticks to their progeny, and that they are
capable of offering considerable resistance to unfavorable
weather conditions, especially the cold of winter. If at the
onset of warmer weather the larvae have already hatched from
the eggs, the first cases of disease among cattle driven, to in-
fected pastures usually appear after two weeks and, in case
the respective pasture was badly infected the previous year,
a great number of the animals may become affected within
a short time. With stable feeding, however, the disease is
observed only very exceptionally, and only in cases in which
Development of Ticks. 771

infectious ticks were introduced into the stables with the grass
or foliage from infected pastures.

The introduction of the disease into localities which had
been free from the infection, may be brought about by infected
animals, and the more so as piroplasma may be present in
the blood of cattle years after their recovery from the disease.
In such cases the disease may be artificially produced with
the blood of such apparently healthy cattle. If ticks which are
suitable for the transmission of the virus are present in these
localities, they suck blood from the cattle introduced into that
locality, and pass the piroplasma to their progeny, which then
infect healthy animals. Affected or healthy cattle may carry
ticks about on their bodies, and these will continue to propa-
gate in the new locality, provided the requirements for their
development are favorable, where they may then infect fresh
animals. In both cases the pasture, formerly free of the in-
fection, becomes a new source of infection, in which the disease
may possibly recur from year to year.

The extensicn of the disease was strikingly observed in America, where in
the 60s and 70s of the last century it was introduced by cattle driven from- Texas
to the north, to the states of Indiana and Illinois, whence it extended later in
a similar manner almost through the entire territory of the United States up to
-Lake Michigan. After the trailing of the cattle from the south, as a rule in
-from_ 30-50 days, which period corresponds’ to the cycle of development of the
Eee the native cattle became affected with severe symptoms (Reverley,

_-Smith & Kilborne). The disease was introduced into Australia by American cattle,
with the Boophilus ticks, which had been unknown there up to that time, and it
causes there great loss from year to year. It also spread recently in Finland to
territories which had heretofore been free from the affection (Krogius & Hellen).

Although the disease develops exclusively through infec-
tion by ticks, certain accessory conditions have an influence
on its appearance, and more so on its course. Thus as a rule
very young animals show a greater resistance against the in-
fection than older cattle. Poorly nourished, as well as gener-
ally weakened animals usually become affected with severe
manifestations; unfavorable weather conditions, especially
damp, cold weather, also exert an unfavorable influence on the
course of the disease. This explains the experience that the
affection is often observed in a severe form in the damp, cold
spring periods, and especially among improperly wintered ani-
mals of poor owners (Kragertid observed it repeatedly in such
a form in cows 12 to 14 days after parturition).

Native cattle raised in affected territories usually become
affected under much milder symptoms than animals brought
from uninfected localities. The greater resistance of the for-
mer may be explained by the supposition that they became

“infected while young, and thereby acquired for their later lives
a relative immunity, which was still more increased by infec-
tions developing in the meanwhile. Such animals, however,
may also carry the virus in their blood in spite of their healthy
appearance, and this may sometimes multiply rapidly on ac-
772 Piroplasmosis of Cattle.

count of harmful influences, and produce a severe affection
(such acute outbreaks of the previously latent disease have
frequently been observed after artificial infection with rinder-
pest blood) (see p. 255).

Anatomical Changes. Animals dead from the disease show
changes in the digestive organs and in the spleen. The mucous
membrane of the abomasum shows a catarrhal swelling and
manifests, especially in the pyloric region, numerous small
hemorrhages and erosions. Similar changes are present on the
mucous membrane of the intestines and especially on those
of the rectum, the contents of which is colored reddish on
account of the numerous and extensive hemorrhages of the
mucous membrane. The liver is enlarged, the substance flabby,
lusterless, and covered with yellowish streaks and spots on
a dull reddish-brown base. The gall bladder frequently con-
tains great quantities of thickened bile. The spleen is always
strikingly enlarged, its pulp is very rich in blood, brownish-red,
or brownish gray-red, and frequently softened, almost liquefied,
the capsule extended or even ruptured (Witt). The bladder
contains a great quantity of pale or dark-red urine, its mucous
membrane is sprinkled with red discolorations.

The autopsy findings are further: Hemorrhages in the
serous cavities, sometimes also in the brain substance and bone
marrow, cloudy swelling of the kidneys, frequently with puncti-
form hemorrhages, serous infiltration of the subcutaneous and
subserous connective tissue, hypostatic hyperemia of the lungs,
exceptionally also catarrhal pneumonia with sero-fibrinous
pleurisy. The blood is pale-red and thin, the red blood cor-
puscles of the spleen and liver contain piroplasmas in a propor-
tion even up to 80%. In some cases icterus is also present.
(According to Piot the temperature in the abdominal cavity
rises after death to 44° and over.)

Symptoms. According to experimental investigations with
larvae of ticks, the period of incubation ranges from 8 to 10
days.
The disease commences with a rapid rise in temperature,
and usually with pronounced dullness and debility, accelerated
respiration and -heart action. The temperature remains for
several days at 40° to 42° C., whereupon in mild cases it grad-
ually returns to normal, while in severe cases it rapidly drops
below normal before death.

In pasture the animals rest frequently, fall back behind
the herd and ruminate with long interruptions; exceptionally
symptoms of irritation, involuntary -movements, and even-
delirium are observed at the onset of the disease. At first
there is constipation, later the animals show symptoms of colic
and tenesmus, dry yellowish-brown, later thin, mashy feces,
mixed with mucous or blood coagulum. The milk secretion
Symptoms. 773

is immediately diminished; the milk drawn in small quantities
is sometimes yellowish and has a bitter odor.

In a later stage the animal manifests a staggering gait,
and at times may knuckle over with the hind feet. Muscular
trembling may be observed in some parts of the body, especially
on the upper arm, shoulders, and croup. There is profuse
lachrymation, the flanks are sunken, the skin feels dry and
hard. The lymph glands in the knee folds swell early in the
disease to a great extent (Schmidt). The mucous membranes
are at first’ reddened, later they become pale, and show symp-
toms of icteric discoloration.

The blood drawn from a vein is more or less pale red
and watery; after coagulation the separated blood serum also
shows a red discoloration. The number of red blood corpuscles
drops in several days from 7 to 8 millions per cmm., to one-half
or one-third, in fatal cases even one-fifth to one-sixth of the
above number. Within them piroplasma may be found in
varying proportions, in severe cases from 5 to 58% (Fig. 130
and 131). The hemoglobin content may drop to 12% (Fleischl).

The microscopical demonstration of the parasites may be successful even in
fresh blood specimens, where they appear in the blood cells as pale, shining, on
a warm object stage somewhat motile, coccus-like bodies (easily mistaken for the
plasma extensions of the crenated blood cells!). A certain result is obtained from
dry specimens fixed in absolute alcohol, or in a mixture of alcohol and ether aa,
and stained with a 1% aqueous, miethylene blue solution. The parasites on such
slides appear colored blue. For the demonstration of the finer structures, and
especially of the chromatin bodies, Romanowsky’s method of staining or one of
its modifications (Giemsa stain!) must be used. The red blood corpuscles proper
show indications of a poikilocytosis and in their interior basophilic granulations.

The urine contains even in the early stages, albumen in
various quantities; even when normal in color it has a high
specific gravity, later, sometimes as early as on the second
day, it becomes of a reddish or greenish color, as a result of
the appearance of methemoglobin, probably also of bile pig-
ments. The color gradually becomes more intense and brownish
to blackish-red; at the same time in shaking much foam forms
on its surface, while on boiling it coagulates to a jelly-like
mass. On standing a great amount of sediment. appears, in
which numerous yellow granules, likewise also kidney epithelia
and casats may be demonstrated, while red blood corpuscles
are found only very exceptionally. The passing of the urine
is always accompanied by severe straining.

In the cases with unfavorable termination the patients
become weakened after 3 to 4 days to such an extent that
they constantly lie down, the respiration is very labored, and
from time to time a painful grunting may be heard. At the
same time convulsions may appear in certain groups of muscles,
tears ooze out from between the swollen eyelids, and saliva
drops out of the mouth, until finally under a rapid sinking
of the body temperature death ensues, which however may
774 Piroplasmosis of Cattle,

occur suddenly under symptoms resembling those of anthrax
(de Jong), or even without any previous indication.

In mild cases the fever disappears about the middle of
the first week of illness, at the same time the urine clears up,
and the appetite as well as rumination returns. The animals
which in the meantime have become greatly emaciated, do not
regain their former condition for several weeks.

In some eases, especially in young animals, only a moderate
fever which lasts but a few days, somewhat accelerated respira-
tion and pulse, diminished appetite, as well as evidént dullness
are observed. The color of the urine does not however undergo
any change, and the moderate destruction of the red blood
corpuscles is only indicated by the paleness and slightly yel-
lowish discoloration of the mucous membranes. Such patients
recover very rapidly after the disappearance of the described
symptoms. ,

Sexually mature ticks may be found on the body surface
of affected animals, frequently in very great numbers in the
parts surrounding the vulva and the rectum, on the udder,
on the inner surface of the thigh, and in the inguinal region,
while the larvae and the nymphs lodge on the head, in the .
vicinity of the muzzle, on the eyelids and ears, as well as on
the udder.

According to Dschunkowsky & Luhs a piroplasmosis of the type
of Texas fever occurs in Trans-Caucasia, which runs a very rapid course
of 2-3 days. It is always associated with hemoglobinuria and char-
acterized by a high mortality. No parasites are found in the peripheral
blood, while almost all erythrocytes of the parenchymatous organs are
infested.

Course and Prognosis. If affected animals continue to
remain on infected pastures, they sometimes die with a rapid
aggravation of the symptoms as early as from 4 to 7 days,
but the course may also extend over a longer time. If they
are however removed immediately after the appearance of the
first symptoms to an uninfected place, recovery follows in most
cases. Dampness and cold, likewise very hot weather, influence
the course of the disease unfavorably. Accordingly the mor-
tality varies within wide limits (5 to 50%), and is usually higher
in southern warmer localities than in the temperate zone.

Rapid sinking of the body temperature to 37° and below,
during continual excretion of hemoglobin with the urine, in-
dicates threatening danger, while a gradual diminution of the
febrile symptoms with strong pulse, and clearing of the urine,
indicates improvement: Sometimes however the improvement
is only temporary, and may later, as a result of a reinfection,
or under the influence of unfavorable weather conditions, again
become aggravated. Cattle which have passed through an
attack of the disease are usually immune against later infec-
tions.
Diagnosis, Treatment. c 775

Diagnosis. Hemoglobinemia and hemoglobinuria which ap-
pear rapidly under febrile symptoms, characterize severe affec-
tions, and in cattle on known infected pastures a red discolora-
tion of the urine is sufficient for a well founded suspicion of
the disease. If however the last-named symptom is absent,
the presence of the disease may be suspected on the ground
of febrile symptoms, only when at the same time other animals
in the herd are affected with characteristic symptoms, in which
the probability of the diagnosis is considerably increased by
the presence of ticks in various stages of development on the
body of the animals. Absolute certainty is obtained by the
demonstration of piroplasmas in the red blood corpuscles on
microscopical examination (see p. 773), or by artificial pro-
duction of the disease in healthy animals (10 cc. of fresh or
defibrinated blood subcutaneously or intravenously).

Anthrax and hemorrhagic septicemia may be confused with
the acute cases of piroplasmosis, as in those diseases the febrile
symptoms are sometimes also accompanied by a red-colored
urine, but their course is more rapid, no anemia develops, the
urine contains red blood corpuscles, the examination of fresh
blood shows long rods, or small bipolar bacilli, between the
blood corpuscles. The disease is distinguished from hematurias
brought on by other causes, by the absence of red blood cor-
puscles in the urine, from the so called ‘‘chronic hematuria’’
it is distinguished by its less chronic course, and the much
more rapid development of anemia.

On autopsy the above-mentioned diseases should also be
kept under consideration, and especially anthrax, on account
of the acute swelling of the spleen, and the numerous hemor-
rhages which may be present.

Treatment. After an outbreak of the disease in a pasture
the herd should be removed immediately from the infected
locality to a moderately cool, shady place, and most appro-
priately to stables where they can be given careful attention.
At the same time suitable and sufficient feeding (good dry food,
with the addition of potatoes or beets), is of great importance.
In addition to this, the ticks should be picked from the body
of the patients, or destroyed by washings with creolin, lysol
or salt solutions.

Internal treatment has so far been of but little value. Salines
may be administered against constipation, and the diarrhea
treated with slimy gruels, combined with astringents or opiates.
In great weakness stimulating treatment (rubbing with alcohol,
internally, alcohol or black coffee) is indicated. The quinine
treatment (10-20 gm. of quinine hydrochlorate per os), which
has been recommended (Padovani, Hellens, Kréning), probably
on account of the similarity of.the disease with malaria in
man, has not given uniform results. Kragertid recommends
intravenous injections of formalin or collargol (100-500 gm.
of a 1% solution), and later carbolic acid or lysol internally
776 *  Piroplasmosis of Cattle.

(Acid. carbol. or lysol 10.0, Spir. frumenti 100.0, Aqua 500.0;
one tablespoonful every hour until clearing of the urine).

Evers warmly recommends damholid (a hemoglobin preparation). The treat-
ment should be introduced with the administration of 50 gm. (three times daily).
per os. If no improvement results or if even an aggravation follows, the remedy
should be injected subeutaneously or even into the blood circulation (200 gm.
damholid is dissolved in one liter of 14% itrol solution, and of this 500 ce. or
more is injected subcutaneously, or of a 10% solution 100-250 ee. is injected into
the jugular; after the subcutaneous injection of simple watery solutions malignant
edema has repeatedly been observed). Westermann and Grabe have obtained good
results with this treatment. :

Recent experiments of Nuttall & Hadwen, which have since been
confirmed by Stockman, appear to indicate that the piroplasmas are
greatly influenced by trypanred. In five artificially infected cattle in
which the blood already contained numerous parasites and the urine
was red colored, a marked improvement followed immediately after an
intravenous or subcutaneous injection of 180-200 ec. of a 15% solu-
tion, the urine cleared rapidly, and the number of blood parasites
diminished to a great extent. Later the blood was entirely free of par-
asites for 5-18 days, they again reappeared, although in moderate num-
bers; but all of the five cows remained alive, whereas one of four controls,
of which only two were affected with hemoglobinuria, died. The try-
panblue solution should always be prepared fresh with distilled water.
It stains the body tissues blue.

After the disappearance of the symptoms in the presence
of marked anemia, subcutaneous or intravenous injections of
physiological salt solution (1-2 liters daily), and the internal
administration of iron preparation (5-10 gm. iron sulphate
daily), is indicated.

Prevention. The disease may be prevented absolutely by
keeping the animals from infected pastures and excluding grass
and foliage fodder from such localities for food purposes. On
the other hand such pastures may become harmless by draining
their swampy areas. Such means of prevention however fre-
quently cannot be carried out on account of the lack of funds
of the owners. As some animals show very little resistance
to infection, as a result of improper wintering, care should be
taken that weakened cattle are not driven to low forest pastures
in the spring and early summer (according to Ligniéres alfalfa
is supposed to keep the ticks away from pastures).

In order to prevent the introduction of the disease to pre-
viously uninfected territories, it is aimed in America and
Australia to free the suspected animals of ticks. For this
purpose animals in the southern part of the United States
are dipped in vats containing 20% petroleum or Beaumont
oil, while in Australia washing with various insecticide fluids
(lysol, petroleum) is employed for such purposes. In order
to destroy the ticks farmers in South Africa usually spray
the animals in 12 to 19 day intervals, with a mixture of oil
and water (10-25:100) (Lounsbury). For the same purpose
a fluid is also suitable consisting of 0.2% arsenic .and 0.2%
wood tar,
Prevention, Immunization. 717

In the United States and North America the destruction of ticks was inaug-
urated on @ large scale in 1906. On this occasion 220,780 cattle were infested with
ticks in 29,315 examined herds, and 328,064 were found to be free (Steddom).
The procedure consists in placing the herds for three weeks in enclosed pastures
free of ticks, until the young ticks become mature anu drop to the ground. Then
the animals are driven to another uninfected pasture, and their former stands are
disinfected. It is also aimed to clear the cattle pasture from ticks by keeping the
cattle away for about six months, when the ticks are destroyed by starvation, or
large pasture areas are burned over in the spring.

_ Immunization. As cattle recovering from the disease ac-
quire a long-lasting immunity in North America (Schroeder)
and Australia (Gray), cattle brought from non-infected terri-
tories into affected localities are infected artificially with blood
of calves born in infected territories or of recovered cattle,
which, as a rule contain piroplasma sparingly. After such
inoculations the animals become sick after 8 to 10 days, some-
times with symptoms of anemia, hemoglobinuria, frequently
also with bloody diarrhea, and at the same time the number
of red blood corpuscles, some of which may contain typical
piroplasma, diminishes 10% or more. This symptom disap-
pears after 8 to 10 days; after a month, however, a second
reaction usually appears, which lasts 8 to 10 days, and
the red blood corpuscles contain only atypical piroplasma
in very small numbers (Theiler). If cattle so treated are
driven to infected pastures after the lapse of about two
months, a number of animals resist the natural infection, in
the others, however, fever appears again as a result of the
tick bites. In most of the animals récovery finally takes place,
but a certain percentage succumb to the disease (Francis).
Inasmuch as this percentage is considerably smaller than the
loss observed from non-inoculated animals under the same
conditions, the inoculation appears to be advantageous in
strongly infested localities, in spite of the fact that the inocula-
tion itself causes disturbance of nutrition, and sometimes even
direct losses. *

Blood from older cattle which have recovered shortly before
from the disease is also suitable for immunization, and gives
similar results.

The immunizing action of the blood from animals shortly before
recovered has been confirmed through experiments, by Smith & Kil-
‘borne, also Schrveder in North America, Francis in Texas, Hellens in
Finland, Koch in Africa, Theiler in Kossell, Schiitz, Weber & Miessner
in Germany.

In Germany the immunization is carried out with blood of artificially infected
ealves, and has recently been employed extensively in practice; ‘until the end of
1909, 6,153 cattle were immunized, principally in Prussia. According to the reports
on 4,261 inoculated cattle, 1.97% became mildly and 0.49% severely affected, and
recovered, and 0.09% died or were slaughtered. Besides, during pasturing 2.98%
became mildly, 0.54% severely affected and recovered, 0.54% died or were slaugh-
tered. The percentage in young stock amounted to only 0.04%, in adults 1.46%.
In 10 herds of the immunized animals 4.14% were mildly, 0.46% severely affected;
of those not immunized 19.63% mildly, and 7.48% severely affected (Schmitt).
Satisfactory results are reported by Graffunder and Bugge. Less satisfactory
778 Piroplasmosis of Cattle.

were the immunizations in Texas, where up to the end of 1901 out of 1,251 immun-
ized cattle 116 or 9.2% died later; likewise in Australia (Queensland, where immun-
ization of 35,000 cattle caused a loss of 3-4%, and besides, of 17,960 immunized
animals 679, that is 3.6% succumbed later to the natural infection. But in one
experiment, out of 95 previously immunized animals all remained healthy after
pene ticks to them, while 30 non-immune cattle became affected as a result
of it.

Technique of Immunization. For the inoculation, blood is taken from the
jugular vein of cattle which have passed through a natural or artificial affection about
two months previously. The blood is defibrinated, and either used immediately or
kept in the ice chest until the inoculation. According to Kolle, blood containing
parasites from calves reared in infected localities is best adapted, according to
Schiitz blood from artificially infected calves which have recovered at least within
83 days. Three ce. of the defibrinated blood are injected subcutaneously, and if
possible the operation should be undertaken during the winter or at the beginning
of spring. It is best to undertake the inoculation on calves. Cows in advanced
pregnancy, poorly nourished, or in general animals which are not entirely well
should not be immunized.

The immunized animals should be kept in the stable for three weeks and fed
moderately before they are driven to pasture.

Other Methods of Immunization. Dalrymple, Morgan & Dodson
also obtained satisfactory results in America, by taking from the body
of affected animals ticks sucked full with blood, grinding them, and inoc-
ulating cattle subcutaneously with the material, while Connaway &
Francis, in America, recommended the application of infected larvae
or nymphs (the first time 20-50, after a month again 200-400) on the
skin of healthy animals.

Ligniéres produces vaccine by cultivating (?) the piroplasma in
defibrinated blood from affected animals, which produce in healthy
cattle only a very mild affection at the same time immunizing them (the
immunization requires three inoculations. The experiments carried out
in Buenos Aires and Alfort gave satisfactory results, as immunized
cattle resisted artificial as well as natural infections, but there are no
reports available relative to its application in practice. The method
of preparing the vaccine is likewise unknown.

Blood serum of cattle which have recovered from the disease is
not suitable for the immunization of cattle.

Literature. Babes, C. R., 1888. CVIT. 692; V. A., 1889. CXV. 81. Smith &
Kilborne, An. Ind., 1893. Bull. Nr. 1. — Theiler, Schw. A., 1895. XXXVII. 3;
Fortschr. d. Vhyg., 1903. I. 133; V. J., 1910. 98; Bull. Soc. Path. exot., 1910. III.
135. — Ligniéres, La tristeza, etc., Buenos Aires 1900; Arch. de paras., 1903. VII.
398. — Kossel & Weber, Arb. d. G.-A., 1900. XVII. 460. — Techn. Dep. f. d. Vet. —
Wesen. A. f. Tk., 1901. XXVII. 41. — Krageriid, Z. f. Tm., 1901. V. 284. —
Kossel, Hb. d. p. M., 1903. I. 840 (Lit.). — Kossel & Schiitz, Weber & Miessner,
Arb. d. G.-A., 1904. XX. 1. — Schmidt, A. f. Tk., 1904. XXX. 42, — Knuth, Diss.
Leipzig 1905. — Koch, Z. f. Hyg., 1906. LIV. 1. — Evers, B. t. W., 1908, 458. —-
Witt, ibid., 1908. 628. — Nuttall & Hadwen, ibid., 1910. 38.

(b) East African Coast Fever.

(East coast fever, Rhodesian redwater, Rhodesian tick fever;
Ostafrikanisches Kiistenfieber [German].)

This dangerous form of piroplasmosis in cattle is dis-
tinguished from the previously described affection especially
in that it cannot be transmitted from animal to animal by
the blood. Its cause is the Piroplasma parvum.
Occurrence, Etiology, Natural Infection. 779

The nature of the disease was determined by the investigations of Theil
the Transvaal, and of Koch in Buluwayo. : es eet

Occurrence. The disease formerly existed in a latent form
along the Hast African coast, a severe outbreak however oc-
curred in 1900 when some very susceptible cattle were brought
to the Portuguese territory, to Beira (Koch; Creutz believes
that the Australian cattle introduced the virus). With the
severely affected cattle it was then spread into the interior
of Africa, especially to German East Africa, Natal, the Trans-
ee and Rhodesia, where it caused great loss among the cattle
nerds.

In 1905 about 500 farms were infected in the Transvaal, and inside of a
year about 50,000 cattle succumbed to the disease.

Etiology. The Piroplasma parvum (Babesia parva), the
smallest of piroplasma known at the present, may be seen
in its characteristic form as a fine rod-shaped intracellular
body, which on one end contains a chromatin granule, and fre-
quently appear arranged in cross or willow leaf-shaped form;
ring and dise shapes also occur, while pear-shaped twin forms
are never present (Fig. 134).

The disease cannot be produced
artificially by the inoculation of
blood containing the parasite.
Healthy cattle withstand  subcu-
taneous, intravenous or intraperi-
toneal injections of such blood with-
out harm, only when they are inocu-
lated two weeks later for the second
time, a rise in temperature sets in
immediately, and after 10 or 12 days
more a mild form of the disease ap-
pears, whereupon parasites may be
demonstrated in the blood. Meyer
obtained positive results by intro- Fig. 134. Piroplasma parvum.
ducing large pieces of spleen from fae blood, chromatin stain.

3 : fi er Theiler.)
affected animals into the abdominal
cavity of healthy cattle, whereupon
after 12 days the parasites appeared in the blood with a simul-
taneous rise in temperature.

The natural infection is transmitted by various ticks,
especially by nymphs of the sexually mature forms of Phipice-
phalus appendiculatus, further by sexually mature forms of
Rhip. evertsi, Rhip. simus, Rhip. nitens, and Rhip. capensis,
which in the earlier stages of their development have sucked
blood from affected cattle. The parasite does not pass through
the egg of the tick as is the case with the piroplasma bigeminum,
neither is it transmitted from immune animals to health cattle
(Theiler, Lichtenheld). Its development in the body of the

 
780 East African Coast Fever.

tick is similar to that of the piroplasma bigeminum (Koch see
p. 766).

Stockman succeeded in producing the disease in cattle in England with
nymphs of the brown ticks sent there from Africa.

The infection always occurs during pasturing, especially
easily after the appearance of the rainy season and during
the high grass season when the ticks, which are present in
great numbers, easily jimp from the high grass blades to the
cattle. As a matter of fact, previously healthy cattle become
affected with a dangerous form of the disease after they are
pastured in the same field with animals from infected localities,
or if they are driven over infected pastures.

In the endemicly infected territories on the coast and in
lowlands cattle under one year of age usually become affected.
In these the loss usually amounts to 60 to 90%, while older
animals are immune if they have already passed through the
disease. The infection in the highlands is less severe, as there
hardly more than 15% of the increase in stock die of the disease.
For this reason older cattle in these localities are immune only
to a slight extent, and a certain number of them fall victims to
the disease (Lichtenheld).

Contrary to the described conception on the etiology of coast fever, Ollwig,
as well as Fiilleborn is of the opinion that the cause is possibly ultra-microscopic,
as it does not produce anemia, is not directly transmissible, and that the disease
leaves an absolute immunity. Piroplasma mutans and Piroplasma parvum are,
according to their views, uot only morphologically but also etiologically identical,
and both types probably produce the piroplasmosis which extends in all tropical
and sub-tropical localities, and which shows variations only in its manifestations.
This conception is also substantiated by the experience that cattle which have recov-
ered from coast fever are no longer infectious for ticks, and thereby they ara
apparently free of the virus. 4

Anatomical Changes. The autopsy reveals punctiform
hemorrhages in the subcutis and the subserous connective
tissue, medullary or hemorrhagic swelling of the lymph glands,
edema of the lungs and of the mediastinum, hyperemia, or
ulcerative inflammation of the intestinal mucous membrane and
of the abomasum; further grayish-white spots in the liver sub-
stance, and as a specially striking leston hazelnut-sized, wedge-
shaped infarcts in the cortex of the kidneys. The spleen is
not swollen.

The specific bodies, so-called plasma spheres (Koch), are present
in the swollen lymph glands, in the spleen, further in the spots of the
liver and in the infarcts of the kidneys, as well as in the borders of the
ulcers of the mucous membrane, likewise also in the blood. By Giemsa’s
stain they appear as sharply circumscribed, blue-colored spheres, con-
taining point or comma-shaped chromatin granules, or they are covered
by such.

Collaud considers the formation of infarcts to be due to an injury of the
endothelia of the vessels by endocellular toxins of the piroplasma. Similar toxins
are supposed to be also produced by the Piroplasma bigeminum, only that they
attack the erythrocytes,
Symptoms, Prevention. 781

Symptoms. The incubation period is 10 to 12 days (Theiler,
Kleine), visible symptoms however appear usually only 20 days
after the time of exposure in infected pastures. These con-
sist in high fever, difficult respiration sometimes associated with
a cough, salivation, passing of very dry or bloody, tar-like
feces, marked swelling of the submaxillary lymph glands,
emaciation and weakness of the hind quarters. Contrary to
Texas fever the appetite remains normal for a long time, and
anemia, icterus and hemoglobinuria are only seldom observed.
At the height of the fever parasites may be demonstrated in
the red blood corpuscles, sometimes infesting 80 to 90%. At
the same time the destruction of blood corpuscles is only
slightly evident. Cattle infected with Piroplasma bigeminum
may later become affected with coast fever, in which case the
symptoms of Texas fever are also pronounced, and the para-
sites of both diseases may be found side by side in the blood.

The disease is very destructive, as in previously non-
infected herds 95% of the animals die, whereas in native cattle
on the coast of East Africa deaths are rare.

Prevention. The infection may be kept at least temporarily
from healthy herds by the careful segregation of suspected
or affected animals (fenced in!). Dipping and spraying for
the destruction of ticks, after fresh outbreaks, and driving the
cattle into non-infected fields are advantageous preventive
measures. In severely infected pastures the ticks may be in-
fectious even after eight months, and even when there have
been no cattle pastured there in the meantime. The danger
of the pasture is eliminated after 1514 months, if during that
time it is pastured only by horses, goats or sheep.

Immunization. (Koch). Animals which have recovered from the
disease are protected against a second attack even if remaining in an
‘infected pasture, repeated injections of blood containing the parasites
likewise produce a lasting immunity. For this purpose cattle are in-
jected subcutaneously at two weeks intervals for 4-5 months with 5 cc.
of defibrinated blood from cattle, which have recovered from a severe
attack of the disease. Cattle treated in this manner remain healthy in
infected pastures, and even their offspring are supposed to resist a later
infection after they have recovered from a mild form of the disease.

Theiler & Stockman failed to obtain favorable results from Koch’s method,
and the conference of South African veterinarians, held in Cape City in 1907, also
denied its practical value. According to Gray the method has been employed in
the Victoria District on 5,700 cattle without any results, as the animals became
spontaneously infected, even after 11 to 12 inoculations. | :

Cattle which have recovered from Texas fever are immune against the coast
fever, while animals which have recovered from the latter are not immune against

_ Texas fever.

Literature. Koch, A. f. Tk., 1904. XXX. 281 u. 586; D. med. W., 1905.
1867. — Theiler, Fortschr. d. V.-Hyg., 1903. I. 183; 1905, II. 256; J. of the Roy.
Army Med. Corps, 1904; Comp. Path., 1907. XX. 1; 1909. XX. 115; Rep. of the
Gov.-Bact., 1906-1908. — Theiler & Stockman, Comp. Path., 1904. XVII. 3, —
Gray, ibid., page 203. — Kleine, D. med. W., 1905. 912. — Collaud, Diss. Ziirich
1906. — Soulié & Roig, C. R., 1908. CXLVIT. 192. — Lichtenheld, A. f. Hyg.,
1908. LXI. 261; 1910, LXV. 378. — Meyer, Comp. Path., 1909. XXII. 213.
782 East African Coast Fever.

Tropical Piroplasmosis of Cattle. Dschunkovsky & Luhs observed
in southern Russia a disease of cattle resembling coast fever, in which
in the acute cases, up to 80-96% of the red blood corpuscles contained
a ring and punctiform, also a rod-shaped piroplasma, which could not
be reproduced artificially by inoculations of blood containing the para-
site, (up to several liters were injected subcutaneously, intraperi-
toneally, or intravenously). On the other hand, according to more re-
cent experiments, larvae of females of the Boophilus decoloratus, which
later suck the blood of infected cattle caused, aiter 10-15 days, a fever
lasting for several days, mostly however without any parasites in the
blood. The symptoms were fever up to 40°-41° C., at intervals of 8-12
days, then continuous at 40°-42° C., symptoms of nervous irritation,
sometimes with attacks on persons, accelerated heart’s.action and res-
piration, general icterus and pronounced emaciation, frequently bloody
diarrhea, and shortly before death sphincter paralysis. The urine was
only rarely reddish-yellow, the number of erythrocytes diminished to
as few as 800,000 per cubic millimeter—The autopsy revealed large
hemorrhages in all organs, ulcerations corresponding to the hemorrhages,
in the abomasum and small intestines, and acute swelling of the spleen.
The disease also runs a more chronic cachectic form when only 10-40%
of the erythrocytes contain the parasite, and on autopsy striped and
variegated lesions of the mucous membrane of the abomasum are found
with an ocher-yellow or dark base. (Chl. f. Bakt., 1904. XXXV. 486.).

A similar disease was observed by Kowalewsky in Taschkend, only
it ran a more rapid course, and in some cases grayish-yellow deposits
developed on the mucous membrane of the lips and cheeks, and also on
the tongues. (J. vet., 1907. 330.)

Further it appears that the disease observed by Penning in Java
is identical with the above. There it attacks buffaloes, and a transmis-
sion to sheep with larvae of the Boophilus australis was successful. (Tier-
arztl. BL f. Niederl.-Indien, 1906. XVIII. 102.)

Pseudo-Coast Fever. Lichtenfeld designates by this name a dis-
ease of African cattle which manifests itself with fever up to 41° C.,
emaciation, diminished appetite, and which
sometimes causes death. The blood appears
watery, and up to 10% of the erythrocytes
contain a small rod or ring-shaped parasite
resembling closely the Piroplasma parvum,
which had been found previously in sparing
numbers, by Theiler in the blood of cattle,
usually simultaneously with the Piroplasma
bigeminum, and described as Piroplasma
mutans. (Fig. 135.) After the inoculation
of such blood the piroplasma appears after
an incubation of 10-25 days in the blood
circulation of the inoculated animal, and
produces anemia with poikilocytosis, but

Fig. 135. Piroplasma mutans. never hemoglobinuria. The natural mode
(After Theiler.) of infection is still unknown.

 

Theiler formerly considered the parasite as an immune form of the Piro-
plasma bigeminum, while Koch was of the opinion that such cases were mixed
infections of coast fever and Texas fever. Recently, however, Theiler showed that
Pseudo-Coast Fe ver. 783

the Piroplasma mutans oceurs also in localities free from coast fever, on the
other hand he proved that cattle immune against Texas fever may be infected with
it; therefore it could not be a ee form of the piroplasma bigeminum.

; Parasites resembling the Piroplasma mutans were also found by Miyajima &
Shibajama in Japan, by Martini in China, by Does in Netherlands-India, by Schein
in Indo-China; moreover, the parasites seen by Dreyer in Egyptian fever, and by
Springefeldt in Camerun in cattle, appeared to be identical with them. Lichten-
held observed their appearance in calves 32-91 days after birth, although the
animals showed no symptoms of disease. He, as well as Broden & Rodhain, suc-
ceeded in propagating them by the injection of blood containing piroplasma.

Literature. Theiler, Rep. of the Gov.-Bact., 1905/06-1907/08; Comp. Path.,
1909. XX. 115. — Schein, A. P., 1908. XXII. 730. — Lichtenheld, Z. f. Hyg.,
1910. LXV. 378. e

 

Gall Sickness. (Galziekte). Under this name the farmers of South
Africa designate in general those diseases in the course of which a dis-
coloration and thickening of the bile, as well as an icteric condition of
the tissues develops. With the more accurate study of the diseases
it was found that the most varied diseases are grouped under that name,
(rinderpest, coast fever, Texas fever without red urine, heart water, and
poisoning by plants). Nevertheless there are enzootic infections of cattle
which cannot be classed with any of the known types of disease, and
which are also designated by professional men as gall sickness, in the
restricted sense.

The etiology of these affections has not yet been established satis-
factorily. While Hutcheon, who.in 1897 described them first as jaun-
dice or biliary fever, attributed them to a primary affection of the liver
from an unknown cause, Spreull identified them as Pasteurellosis with
the Lamziekte (see p. 109), Eddington with heart water (see p. 257).
Theiler was formerly inclined to connect it with Trypanosoma theileri,
later with Piroplasma mutans; according to his recent investigations
however he determined that they are produced by the anaplasma mar-
ginale (Fig. 129 on p. 763), in which the blood corpuscles are attacked
and destroyed, whereby an oligocythemia is produced, which is associated
with high fever, and which later leads to a degeneration of the large
parenchymatous organs.

According to Theiler’s conception the disease would be identical with the
mild form of Texas fever described by Smith & Kilbourne, which is observed espe-
cially in North America in the fall, as a second attack in cattle that recovered
from the acute affection in the summer. According to Knuth’s observations it
oceurs in a similar manner also in South America, and the cachectic form of piro-
plasmosis described by Dschunkowsky & Luhs in Trans-Caucasia is supposed also
to belong to it.

The disease named Anaplasmosis by Theiler attacks cattle exclu-
sively, and especially when they are brought from highlands into low-
lands, or from less infected localities into more infected territories.
African cattle are less suscéptible, as they have mostly passed through
the disease as calves, whereas fresh, imported animals usually become
affected severely. ;

The parasites may be transmitted to healthy cattle with the blood
of affected and recovered animals, whereupon in the first case they
appear in the blood after 27-32 days, in the second after 16 days, and
may be demonstrated during the febrile period, exceptionally also for
some time after. Animals which have recovered from the disease show a
great resistance against new infections, but they serve as virus reservoirs
for the Boophilus decoloratus tick, which according to Theiler is sup-
posed to transmit the natural infection in a way similar to Texas fever.
784 Gall Sickness.

Mixed infections occur especially frequently with redwater. According to
Theiler’s view, Texas fever, as it has been formerly described, constitutes two
different diseases, namely the Texas fever in the restricted sense (piroplasmosis,
redwater), and the gall sickness (anaplasmosis). As the Piroplasma  bigeminum
and the Anaplasma marginale occur very frequently simultaneously in the same
animal, the development of redwater with piroplasma in the blood is first observed
after an inoculation of blood; when the animal has recovered and the time of
incubation for the anaplasmosis has elapsed a new disease results, which was for-
merly considered as a relapse of redwater. Mixed infections occur also with
Piroplasma mutans, and with Spirochaeta theileri.

The symptoms of gall sickness are high fever with great debility,
labored respiration, and very frequent heart’s action. Constipation or
diarrhea, further moderate swelling of the eyelids; with lachrymation.
Edematous swellings may also appear in different parts of the body; in
the later course, anemia and icterus is observed, when the animals rap-
idly become emaciated. Some animals die within a few days, others in
1-2 weeks; the greater part of the patients, frequently even 80-90%
recover, but outbreaks with losses up to 50% may occur (Leipziger).

According to the course of the disease a more or less rapid multipli-
cation of anaplasma, with a corresponding reduction in the number of
erythrocytes is found in the blood at the beginning of the fever. Pale-
ness of the remaining blood corpuscles is observed, and in less acute
eases polychromatophilia, and basophilia, still later the appearance of
normoblasts. ;

The anatomical changes consist in pronounced anemia and icterus,
moderate gastro-intestinal catarrh, diffuse swelling of the lymph glands,
acute spleen tumor with reddish-brown, soft but not liquefied pulp, small
hemorrhages and degeneration of the heart muscles. :

For the prevention of the disease it is aimed to keep animals from
marshy pastures, especially from overgrown banks of rivers. If the
disease has already appeared it usually subsides after the herd is driven
to a dry elevation.

Literature. Edington, Comp. Path., 1905. XVIII. 155. — Theiler, ibid.,
1907. XX. 1; Z. f. Infkr., 1910. VIIT. 39. — Spreull, ibid. 1908, XXI. 193. —
Leipziger, D. t. W.. 1910. 150.

(c) Piroplasmosis of Horses. Piroplasmosis Equorum.

(Biliary fever; Babesiosis equi; Pferdemalaria [German];
_Piroplasmose équine [French].)

History. Guglielmi (1889) in Italy found in the red blood corpus-
cles of horses parasites resembling the piroplasma bigeminum, but the
disease has become better known only since the study of the South Afri-
can horse sickness (see p. 285). Although Rickmann still considered the
blood parasites as the cause of this affection, Theiler: proved that in
South, Africa there exists another disease of horses which may fre-
quently be complicated with the latter; the same author also established
more closely the symptomatology, and pathological anatomy of piro-
plasmosis of horses, and recently showed also its identity with a
similar affection of mules and donkeys. The parasites were also studied
by Laveran, Koch and Marzinowski, while Italian, English, French and
Russian veterinarians contributed especially descriptions of its spread
and symptomatology.
i oli 9 Fe
res 7

Piroplasmosis of Horses. 785

Occurrence. The disease appears to occur frequently in
Italy and Russia, in localities with forest and marshy pastures.
Native horses as a rule become affected only when young, while
animals brought from uninfected territories into infected
localities are affected at all ages, and almost exclusively in the
warm season (in Russia it is wrongly termed ‘‘Spring dis-
ease’’). The disease occurs also frequently in Africa and India.

In Germany only one case has been diagnosed by Ziemann in Oldenburg, while
in Sweden Brickmann attributed _a disease of horses to an infection with piro-
plasma.—In Italy Baruchello & Pricolo, also Mori are inclined to identify piro-
plasmosis with catarrhal influenza, while Perrucci connects it with purpura hemor-
rhagica. This supposition is based principally on the similarity of the symptoms
and evidently does not apply to other localities—In Russia the disease was observed
in various localities after the demonstration of piroplasma in horses by Michailof
(1902), also by Bielitzer, Marzinowski, Feinschmidt, Michin and Yakimoff, espe-
cially frequently, however, in southern Russia (here, also, in donkeys), causing
sometimes losses up to 50%.

It is widely spread in Africa, where it has been diagnosed and carefully studied
in the south by Theiler, in the German protectorates by Koch, also by Roger
as well as by Lafargue, Lussault & Savary in Algeria, by Piot in Egypt, by Dupuy
& Pierre in the Sudan and in Senegambia, by Thiroux in Madagascar. Lingard &
Jinnings, Axe and Williams reported on its occurrence in India.

Etiology. The Piroplasmia equi (Babesia equi) is a small
blood parasite resembling the Piroplasma parvum. It is 0.5-2.5
in size, of coccus, ring, spindle, rod or also pear shape. In the
red blood corpuscles it is present singly, in pairs, or in fours
in rosette form, which latter probably originated by direct
division of the single individuals. In the blood plasma they
are found only singly. By the Giemsa stain a clump of chromatin
granules and sometimes also a second chromatin granule
(Blepharoplast?) may be in their body.

Marzinowski & Bielitzer observed in the intestinal contents of ticks which
previously had sucked blood from infected horses, transitory forms similar to those
described by Koch in piroplasma of cattle, and by Christophers and Kleine in
piroplasma of dogs. They are also inclined to consider oval and worm-shaped
-bodies with large granular cytoplasm and small nucleus as one form, and those
with a still smaller nucleus and paler cytoplasm, as other sexual forms from which
new, worm-like actively motile forms (Ookinetes ?) develop, which occur in great
numbers in the saliva of the ticks with which the eggs are moistened. The demon-
stration of parasites in the egg of. the ticks was not successful, but various stages
of development, especially the worm forms, were found in the larvae in consider-
able numbers.

Marzinowski also reported successful cultivation experiments in blood con-
taining 10% sodium citrate solution, in which the parasites passed through similar
stages of development as in the intestines of ticks. Their multiplication was only
moderate, and they died in the third generation.

Theiler succeeded in producing by subcutaneous or intra-
venous inoculations of blood of immune horses a febrile affec-
tion in mules and donkeys which developed after an incubation of
5 to 9 days, and in the course of which the parasites appeared in
the blood. The first attack was followed by a second one, during
which the number of the red blood corpuscles diminished to one
third, and which frequently resulted in death. The disease was
likewise reproduced in horses with the blood of immune mules

Vol. 1.—50.
786 Piroplasmosis of Horses.

and donkeys. Positive results, also with the blood of affected
horses, are reported by Perrucci, Pricolo, Edington and Bie-
litzer.

According to Theiler the natural infection is transmitted
in Africa by the Rhipicephalus evertsi, in Russia according to
Marzinowski & Bielitzer by the Dermacentor reticulatus, that
is by sexually mature ticks which have sucked blood containing
piroplasma as larvae or nymphs. As horses which have re-
covered from the disease harbor piroplasma for years in their
blood, such animals may spread the virus by transmission to
ticks. Zebras and quaggas appear also to serve as virus carriers.

In infected localities native horses, donkeys, and their bas-
tards, become affected in later periods of their lives only when
their acquired resistance is reduced by overexertion, poor nutri-
tion, or by intercurrent affections to such an extent that their
latent piroplasma again rapidly multiply. Such relapses occur
especially in affections of horse sickness, the course of which
frequently becomes severe because of such relapses.

Animals of the horse genus which are brought from locali-
ties free from piroplasma to infected localities are very sus-
ceptible; thus during the Boer War in South Africa great losses
were sustained in horses brought there from Europe and Aus-
tralia, an in India horses from Australia become especially
affected.

Anatomical Changes. On autopsy the icteric discoloration
of the subcutaneous and of the subserous connective tissue, as
well as of the internal organs is conspicuous, after a somewhat
protracted course a general anemia is present which is also man-
ifested in the watery consistence of the blood. The lymph
glands and the spleen always show pronounced acute swelling,
the pulp of the spleen being moderately softened but not blackish
red. Numerous hemorrhages are present on and in the serous
and mucous membranes, as well as under the endocardium, the’
intestinal mucous membranes show inflammatory swelling, that of
the large intestine in some cases also contains follicular ulcera-
tions. The lungs are edematous, the kidneys may be sprinkled
with punctiform hemorrhages, or only anemic and filled with
serous fluid, the liver lobules are yellow, on their borders
greenish colored. The muscles, including those of the heart
show cloudy swelling, in places also fatty degeneration. The
urinary bladder frequently contains more or less reddish colored
urine. :

Symptoms. After an average incubation of about two
weeks the disease commences with slow or rapid rise of the body
temperature, whereupon the fever continues for a long time
remittent in character. The first visible symptom is a pale-yel-
low, or reddish-yellow coloration of the mucous membranes, the
intensity of which is proportionate to the severity of the affec-
Symptoms. 787

tion. In the severe cases, hemorrhages occur later in the con-
junctiva in varying number and extent. At the same time the
patients look dull, tears ooze from the half-closed eyelids, the
animals droop their heads, lie down frequently, and in general
show great dullness, which is very pronounced, especially in
cases with a chronic course, so that the disease greatly resembles
chronic encephalitis. During the fever the heart’s action is
in the acute cases, greatly accelerated and weak, the respiration
is of the abdominal type and markedly labored. In some cases
urticaria, and exceptionally herpes labialis is observed in the
meantime.

The appetite is depressed from the onset, while thirst is in-
creased; at first or through the entire disease there is constipa-
tion, the feces are passed sparingly in small balls, which are
covered with a yellowish mucus; later diarrhea appears in some
of the cases, sometimes with colicky symptoms. The urine shows
icteric or reddish-brown coloration, and is passed in large quan-
tities. The animals rapidly emaciate, their legs swell, the tissue
at the same time showing a very slight resistance against trau-
matic influences, accidental injuries healing very slowly.

Blood drawn from a vein coagulates rapidly; the coagulum
separates immediately in an upper intensely yellow, and a lower
red layer, while the serum appears brownish yellow.

According to the physico-chemical examinations of Frei in Pretoria, the blood
shows during the disease a continually diminishing volume of red blood corpuscles,
and a reduction of conductivity, as well as of viscosity, which correspond with the
progress of hemolysis; these changes set in very rapidly, sometimes 24-48 hours
after the infection, and therefore even before the rise of temperature. In the
urine a diminution of the osmotic concentration, of conductivity, and of specific
gravity may be shown, changes which appear to be dependent on the condition
of the serum, and on the polyuria which is usually present, and with which in some
cases an increase of the total quantity of the eliminated solids is associated.

Stazzo found in one instance only 24% millions cf red blood corpuscles per
cubic millimeter of blood. \

In some eases the course is very mild, inasmuch as the dis-
ease is manifested only by a slight icteric discoloration of the
‘mucous membranes, and by febrile manifestations, recovery fol-
lowing in a few days. In severe cases death ensues with a sharp
drop.of the temperature, usually in 2 to 5 days, while in a pro-
tracted course the disease lasts from 2 to 4 weeks, and may even
extend over several months.

In chronic cases the disease is manifested by the presence of an
almost continuous fever, in gradual emaciation, edematous swellings,
anemia and the discharge of a brownish urine (Stazzi).

In the disease observed by Brickmann in Sweden (‘‘Vesterbol-

s tenslau’’), which also usually followed a chronic course, the symptoms

consisted in fatigue and dullness, itching, nodular skin eruptions, per-
spiration and yellowish discoloration of the conjunctiva. The disease
rarely terminates in death. : :
Tn mules icterus is rarely present, while discoloration of the urine
never occurs; on the other hand frequent urination is almost regularly
788 Piroplasmosis of Horses.

observed (Hassie frequently observed a luxation of the patella as a
result of a relaxation of the thigh muscles). In donkeys icterus is also
rarely present, while the urine frequently shows a red coloration; a
vesicular eruption is also observed in some cases on the back, less fre-
quently also on other parts of the body, and is followed by loss of the

hair.
The autopsy reveals a large quantity of pale yellow fluid in the
abdominal cavity and in the pericardium.

Piroplasma may be demonstrated in the circulating blood in variable numbers.
While in severely acute cases and at the height of the fever they may be found
in 50-60% of the red blood corpuscles, and some of these may contain as many as
5-6 parasites, in chronic cases hardly 1-2% are infested.

Course and Prognosis. Cases with severe onset, especially
great debility, high fever, numerous hemorrhages and hemo-
globinuria, likewise cases of a chronic character, usually run
an unfavorable course, whereas cases which are acute, but
without severe symptoms, promise a favorable termination. In
these cases the improvement sets in after about eight days,
whereupon recovery progresses slowly (according to Rickmann
the benign forms are as a rule relapses).

Diagnosis. The disease differs from horse sickness princi-
pally by the presence of marked icterus, and on the other hand
by the absence of extensive edematous swellings. A positive
diagnosis is however only possible by the demonstration of piro-
plasma in the red blood corpuscles, or then by the infectious-
ness of the filtered blood in horse sickness, as well as in perni-'
cious anemia. The microscopical examination makes a positive
differentiation of pirolasmosis from trypanasomiasis possible
aside from the fact that this disease is less acute, and does not
show icterus and such marked debility. Besides this the symp-
toms of piroplasmosis to which Italian observers have repeat-
edly pointed, closely resemble also those of influenza and pur-
pura hemorrhagica.

Treatment. Horses which are attacked in the pastures
should immediately be placed in stables or in dry shady places;
where they should be freed from ticks, and nourished as freely
as possible. The threatening heart weakness is combatted
with digitalis or camphor, the constipation first with calomel,
later with salines. Arsenical preparations are recommended for
the after treatment. ,

The specific treatment has so far failed to give uniform results. Formerly
large doses of quinine (10-20 gm.) alternating with ammonium chloride were
given, whereas recently mercurial and arsenical preparations are preferred. Thus
Baroni recommends the Hydrarg. biiodatum injected into the muscle, and
Lafargue, Lussault & Savary also obtained good results from this treatment (1 gm.
Hydrarg. biiod., 2 gm. iodide of potassium, 100 gm. aqua; 10-20 gm. daily).
Saikowitsch and Marzinowski & Bielitzer praise intramuscular injections of corrosive
sublimate (10 cc. of a 2% solution daily, 3-5 times in all), and according to
Michin & Yakimoff it is possible to reduce the mortality by this treatment to 20%.
The subcutaneous application of arsenious acid, and of’ atoxyl has not proved

effective.
Treatment, Prevention. 789

Prevention. This consists in keeping non-immune animals
from infected pastures especially in the warmer periods when
ticks are numerous. Solipeds from countries free from piro-
a should be imported only while young, and during the

nter. :

_ Immunization. Based. on the experiences on immunization against
piroplasmosis of cattle with infectious blood of calves, Theiler recom-
mends the immunization of horses with 1 ce. of blood of artificially in-
fected donkey colts, fromthe fourth generation upwards. Horses thus
inoculated remain healthy, Pregnant mares and run-down animals
should not be inoculated. : The inoculation was also well borne by horses,
mules and donkeys imported from Argentine.

Literature, Guglielmi, Clin. vet., 1899. 220. — Theiler, Schw. A., 1901.
XLITI, 233; D. Z. f. Tm., 1904, VIII. 382; J. of comp. Path., 1905. XVIIT. 229 ;
1906. XIX. 283; Rep. of the Gov. Bact., 1905/06-1907/08..— Laveran, Soe. biol.,
1901. 385. —Rickmann, B. t. W., 1902. 4. — Roger, Bull., 1906. 120. — Baroni,
Clin. vet., 1906. 1033. — Perrucci, ibid., 1907. 159. — Stazzi, ibid., 1907. 46. —
Axe, Comp. Path., 1906. XIX, 222. — Williams, ibid., 1907, XX. 23. — Lafargue,
Lussault & Savary, Rev. gén., 1908. XII. 489. — Marzinowski, Z. f. Hyg., 1909.
LXII. 417. — Marzinowski ‘&,:Bielitzer, ibid., 1909. LXIII. 17. — Michin &
oe Z. £. Infkr., 1909. VI.:265. — Frei, ibid., 1910. VII. 105. — Bielitzer,
ibid., : ae

(d) Piroplasmosis of Sheep. Piroplasmosis ovum.

(Malarial catarrhal fever; Haemoglobinuria s. Ictero-Haema-
turia ovum; Babesiosis ovum; Carceag, Rowmanian.)

History. In Roumania a disease occurs among sheep, known as
**Carceag,’’ which was first observed by Mazureano (1884), and in
which Babes (1892) found similar bodies in the red blood corpuscles
to those occurring in the infectious hemoglobinuria of cattle. He also
succeeded in infecting healthy animals with pulp of the spleen from
affected animals. Since then the disease has been found by Bonome in
northern Italy, Leblane & Savigne in France, Dschunkowsky & Luhs
in Trans-Caucasia, Laveran & Nicolle in the vicinity of Constantinople,
Ziemann in Venezuela and the West Indies, Eggebrecht in China, and
Paschen believes that it occurs also in Germany. Its etiology was studied
in detail by Motas in Roumania.

Occurrence. The disease is distributed in Roumania in the
flats of the Danube and especially in the islands of the Danube
which are frequently exposed to inundations, to such an extent
that in some years up to 20% of the sheep die. It is observed
in infected localities almost exclusively during the warmer
season, especially in the low, swampy pastures, more rarely in
mountainous pastures. Native sheep are considerably more
resistant than animals brought from territories free from the
affection, which succumb in great numbers under conditions

favorable for infection.
Etiology. The piroplasma ovis (Babesia ovis is similar to

the piroplasma bigeminum, only somewhat smaller, 1-1.8 Hw)
is usually found in the red blood cells, singly or more rarely in
790 Piroplasmosis of Sheep.

double pear shapes, also in rod and cross shapes (Fig. 136).
The disease may be transmitted with the blood of affected ani-
mals artificially to older sheep,
but still more easily to lambs.
bi © @ The inoculated animals _ show,
ee after 8 to. 10 days, febrile symp-
@ & a @ toms, and at the same time para-
@ e "3.29 sites may be found in their red

6”. @® @ @ blood corpuscles.
Cay @ The disease is transmitted
@ ge%® @ under natural conditions by sex-
Gea ually mature ticks (Rhipicephalus
& F bursa), which as larvae or nymphs

@e o have sucked the blood of affected
@ @ & sheep (the infection also succeeds
artificially with such females, if

Fig. 186. Piroplasma ovis. Stained

with carbo-thionin. (After Motas.) they are placed in the fleece of

lambs [Motas]).

Dschunkowsky & Luhs have observed the disease also in goats, and
according to their observations in Trans-Caucasia these animals are
affected simultaneously with sheep, although they are of the opinion
that the piroplasma of goats (Ppl. hirci) differ from those of sheep,
. jin that they are only one-half the size of the latter (0.43-1-71 + long).
Similar bodies were observed in goats also by Panse, in East Africa.

Anatomical Changes. The autopsy findings disclose hem-
orrhagic inflammation, sometimes also superficial necrosis of
the mucous membrane of the pyloric half of the abomasum, of
the duodenum and rectum; further an acute swelling of the
spleen, parenchymatous degeneration of the liver and kidneys
(their dark brownish-red coloration frequently shows a greenish
hue), finally a gelatinous or gelatino-hemorrhagic infiltration of
the subcutaneous and the mediastinal connective tissue. Ap-
proximately 5-6% of the red blood corpuscles in the pulp of the
spleen contain piroplasma.

Symptoms. The disease commences, after an incubation of
8 to 10 days, with a rise in the body temperature to 40-42° C.,
weakness, loss of appetite and muscular trembling. Soon diffi-
culty in respiration, painful bleating appear, and 1 to 2 days
later indications of anemia, icterus, and lumbar weakness. The
initial constipation is followed by diarrhea, in which the animals
pass bloody feces under symptoms of colic. In some cases the
urine is red colored, as a result of oxyhemoglobinuria,. fre-
quently however also through hematuria. The number of
erythrocytes in the blood diminishes to 114 millions per cubic
millimeter, under the microscope they contain the small, mostly
roundish or oval parasites, which are also found on their surface
and in the blood plasma. About 50-60% of the affected animals,
mostly older sheep and 3 to 4 months’ old lambs, die in 2 to 5
Symptoms, Treatment. 791

days, while the others recover after a convalescence of several
weeks. In some cases however the affection manifests itself
only by fever lasting 2 to 4 days, slight intestinal catarrh, and
symptoms of anemia.

Recovery from the disease conveys to the animals an im-
munity of long duration against new infections.

Treatment and Prevention. Leblanc & Savigné recommend
for the treatment internal administration of sulphate of quinine
(0.5 gm. twice daily), and Glauber salts (30-60. gm.). Prevention
consists in avoiding affected pastures.

Immunization. According to Motas the inoculation of blood con-
taining only a few parasites produces a mild affection, after recovery
from which the sheep withstand an injection of 16 cc. of virulent blood,
5 ec. of which would otherwise be fatal. Blood serum of hyperim-
munized animals has no parasiticidal properties (in vitro), and at best
protects animals only against mild subsequent infections, while bile
is supposed to be effective against simultaneous and also against subse-
quent infection. Immunization with a mixture of blood containing
parasites and bile, in which the blood corpuscles are destroyed and the
piroplasma eliminated, are supposed to produce an active immunity,
although no febrile reaction appears either after the inoculation or after
a later injection of virulent blood, and no parasites appear in the blood
of the immunized animals.

Literature. Babes, C. R., 1892. CXV. 359. — Bonome, V. A., 1895. CKXXIX.
1. — Laveran & Nicolle, Soc. biol. 1899. 800. — Hutcheon, Vet. Rec., 1902.
XIV. 629. — Motas, Soe. biol., 1904. 1523; Kongr. Haag. 1909. — Paschen, Hyg.
Rundschau, 1905. XV. 545. — Dschunkowsky & Luhs, Kongr. Haag. 1909.

(e) Piroplasmosis of Dogs. Piroplasmosis canum.

(Malignant protozoon jaundice, Malignant malarial fever;
Bosartige Gelbsucht [German]; Fiévre bilieuse,
Jaunisse maligne [French].)

History. After Piano & Galli-Valerio (1895) had first discovered the
blood parasites in Italy, the disease was observed in South Africa, where
it is one of the most dangerous diseases of dogs, by Purvis, Duncan,
Hutcheon, Lounsbury and Robertson, in East Africa by Koch in
Senegal by Marchoux. In France it was diagnosed by Nocard & Almy,
at the clinic of Alfort, principally among hunting dogs, and was later
studied more closely by Nocard & Motas. In addition to the work of these
authors the biology of the parasites was studied by Nuttal & Graham
Smith, Kinoshita and Christophers, their artificial cultivation by Kleine
and Nuttall, while Nuttall & Hadwen obtained remarkable results with
the specific treatment of the disease.

Occurrence. The disease appears to occur with special
frequency in tropical countries, and particularly in imported
dogs ‘it runs a very severe course. On the other hand in mod-
erate zones it is considerably more rare, and usually runs a
792 Piroplasmosis of Dozs.

chronic course. In these locations hunting dogs usually become
affected, which have previously hunted in the forests.

In Europe the disease has been diagnosed, besides in Italy and France, by
Wetzl in Hungary, by Ljubenetzkij and by Dschunkowsky & Luhs in Russia;
Holterbach believes that a disease of dogs which he observed since 1907 in German
Offenburg, should from its clinical picture be considered as a piroplasmosis. Of
the tropical countries, excluding South Africa, India and China are especially
infected.

 

Fig. 137. Piroplasma canis. Fig. 138. Piroplasma canis.
Stained with methylene blue. Stained after Laveran.

Etiology. The piroplasma canis (Babesia canis) is mor-
phologically closely related to the piroplasma bigeminum (Figs.
137 and 138), only that the parasites found in the red blood
corpuscles and. those in the blood plasma are relatively larger
(.7-3.6 “), and that single blood cells contain more of the para-
sites, sometimes as many as 16 individuals. The extracellular
ones are roundish, those inclosed in cells are pear-shaped or
poly-angular. While living they show an active motility, in
which they send out very fine pseudopodia. The homogeneous
plasma encloses a spherical or oval nucleus. Propagation, which
1s especially prolific during the duration of the fever, is, accord-
ing to Nocard & Motas, supposed to occur by direct fission, in
which the splitting of the nucleus precedes that of the plasma
body. .

According to Nuttall & Graham Smith propagation is also supposed to occur
by direct fission. They observed free pear-shaped parasites in the blood plasma,
actively swimming around, apparently propelled by flagellae, and subsequently to
penetrate red blood corpuscles. In these they assumed a spherical shape, sent out
pseudopodia, and divided into two pear-shaped bodies, which subsequently separated,
slipped out of the blood corpuscles and looked for new erythrocytes. If they failed
to find them they died. Kinoshita saw similar phenomena, but believes that the
individuals resulting from fission should be differentiated into male, possessing
flagellae, and female forms without flagella.

If the defibrinated blood of affected dogs is mixed with equal parts of physi-
ological salt solution and is kept at a temperature of from 24°-27°.C., the piro-
plasma remain alive for four days, they show similar stages of development (star
shapes) to those described by Koch for the piroplasma of cattle in the intestines of
ticks (see p. 766) (Kleine, Nuttall). Similar forms were observed by Chris-
tophers in the intestines of nymphs and of mature ticks, besides the pear shapes are
supposed to penetrate the cells of the salivary glands and the eggs in the body of
the tick, where they break up into sporozoites (7), which then leave the body of
the tick with the saliva.
Etiology, Pathogenicity. 793

Pathogenicity. The disease may easily. be transmitted to
healthy dogs by subcutaneous or intramuscular inoculation of
blood containing parasites. These appear in the blood after 2
or 5-6 days, and the infected animals usually die in from 3-5 or
9-11 days, sometimes however the disease may extend even to 60
days, or exceptionally recovery may take place. Other animals
are not susceptible to the infection.

Tenacity. Blood containing piroplasma remains infective for 25 days

when kept in a cool and dark place. At summer temperature, however, it becomes

inactive after 14 days; the parasites die at 44° C., in 1% hours, at 50° in a half
hour.

In France the natural infection is according to Nocard &
Motas transmitted by the Dermatocentor reticulatus (possibly
also by the Ixodes ricinus).
In South Africa, according
to Lounsbury & Robert-
son, by the Haemophysalis
Leachi, in India according
to Christophers and Nuttall
by the Rhipicephalus san-
guineus. The two last
named species of ticks pass
their development as larvae
and nymphs on three hosts,
possibly also on other ani-
mals than dogs. Females
which have sucked the blood
of healthy dogs transmit the
virus by their eggs to the
larvae, in which, as well as
in the nymphs it remains
latent, and only the sexually
mature ticks are capable of
again transmitting the piro- Fig. 139. Fever curve in piroplasmosis of
plasma to dogs (Lounsbury, Godt: ae eo ae ae
Theiler), whereas the infec- soon Bae wens
tion does not succeed with
mature ticks taken from affected dogs. Ticks capable of infec-
tion may carry virulent piroplasma in their bodies even for
seven months, and transmit them in the meantime to dogs
(Nuttall).

Young dogs are much more susceptible to the infection than
adults.

It is questionable whether the piroplasma of dogs are identical in different
parts of the world. MacFadyean and Nuttall found dogs, which had recovered from
the piroplasmosis of India, to be still susceptible to infection with the African para-
sites.

2g
a
3
3
fe}
ast
s
3
o

 

Anatomical Changes. The autopsy of dogs dead with the
disease shows pronounced acute swelling of the spleen, with a
dark, bluish-red, somewhat soft pulp, hyperemia of the liver,
794. Piroplasmosis of Dogs.

kidneys, and the bone marrow. In these, and also in the lungs
and pericardium small hemorrhages, and in some cases acute
catarrh of the stomach and duodenum, with bloody contents in
the intestines may be found, and in many cases also general
icterus. The changes are generally less pronounced in very
acute cases, while in chronic cases icterus is frequently absent,
on the other hand a severe anemia is present. Piroplasma may
be demonstrated in great numbers, especially in the kidneys and
in the spleen.

Symptoms. After an incubation of 7 to 10 days, a rise of the
body temperature which inside of 2-3 days reaches 40°-43° C.,
and which is associated with languor, is observed in the acute
cases as a first symptom. The visible mucous membranes appear
at first a pale red, later cyanotic, and in about half of the cases
also icteric. The pulse and the respiration are accelerated, the
latter is moreover very labored: and panting. The patients re-
fuse food, but drink a great deal. They move listlessly and
stagger, and towards the end they can scarcely stand on their

eet.

The urine contains
albumen from the onset,
and in some of the cases
up to 314% hemoglobin,
sometimes also bile pig-
ments; for this reason:
it shows a more or less
intense red _ coloration
with a greenish hue. <Ac-
cording to Maignon the
quantity of urea in-
creases at each febrile
attack (up to 95 gm. per
liter of urine), and sugar
also appears in the urine.

The blood is pale
red, the blood serum also
: pes reddish or greenish-red
in ees ~The number of

L Se es erythrocytes diminishes
Ai} wueihcouus injection virmient ool 10 1/2 ta 1/9 of the nor
T-year-old dog; recovery. (After Wetzl.) mal or even more, while

the leucocytes appear

to be increased. Piro-
plasma are found at first exclusively in the red blood corpuscles,
later also in the blood plasma. In the later course of the
disease their number increases, so that finally even 30% of
the erythrocytes may be infested with them. With their in-
crease the percentage of the red blood corpuscles diminishes,
and an increase of hemoglobin in the plasma occurs.

TIP

 
Symptoms, Diagnosis. 795

Tn the chronic cases, which frequently result in recovery,
fever is observed only in the first days of the affection or may
be entirely absent. In rare cases intermittent fever may be
present. On account of the severe anemia the animals are list-
less and languid, their mucous membranes are strikingly pale,
while icterus is usually absent. The appetite diminishes, and the
patients become greatly emaciated. The urine frequently con-
tains albumen, while hemoglobin is only exceptionally present,
and even then only in small quantities. The number of red blood
corpuscles in the blood diminishes up to 1/4-1/5 of the normal
while a simultaneous and marked increase of the colorless cells,
especially of the polynuclear leucocytes occurs.

After the disease has lasted for 3 to 6 weeks the symptoms of
anemia gradually disappear, and finally complete recovery takes
place. Such recovered animals however harbor the parasites
for a long time in their bodies, as their blood proves infectious
even after one year (Theiler), and sometimes even after 2%4
years (Robertson). If fever is produced in such animals, the
parasites reappear in great numbers (Marchoux).

Diagnosis. This can be established with certainty only by
the demonstration of piroplasma; in those cases especially in
which no hemoglobinuria and icterus but only anemic symptoms
are observed. There exists in dogs a disease which in its clin-
ical manifestations corresponds completely with piroplasmosis
(anemia with disintegration of red blood corpuscles transition
forms and hyperleucocytosis, albuminuria and hemoglobinuria),
which probably develops as a result of the ingestion of putrefied
meat. In this disease however piroplasma cannot be demon-
strated microscopically or by animal inoculation (Szoyka).
Nevertheless the suspicion of piroplasmosis is justified in the
presence of the symptoms mentioned, especially if it concerns
hunting dogs and if ticks are found on their bodies. In the case
of negative microscopical findings a positive result may some-
times be obtained by inoculation of blood into very young dogs,
for which especially intravenous or intraperitoneal inoculations
are adapted; for after this mode of infection the disease usually
develops in a few days.

Treatment. .Nuttall, Graham Smith & Hadwen showed by
accurately controlled laboratory experiments, that trypan red,
and trypan blue, have a specific destructive action on the piro-
plasma of dogs. In dogs which already have harbored numer-
ous parasites in their blood, they disappear from the circulating
blood inside of 20 to 96 hours with the simultaneous subsiding of
the fever, after a single subcutaneous injection of 5-6 cc. of a
1% solution of one of these substances. At first the pear-shaped
subside later the roundish ameboid forms, although they re-
appear after 9 to 12 days, but the animals show no symptoms
outside of a short rise in temperature, and finally they recover
Malaria of Man. 797

Leishman have observed their transformation into trypanosome-like
flagellates in blood mixed with sodium citrate, and for this reason
Donovan himself placed the parasites under the genus Herpetomonas.
Blood-sucking bugs are supposed to transmit the natural infection to
man. Similar ‘bodies were found by Nicolle & Comte in a dog, and
Nicolle is also supposed to have succeeded in infecting dogs artificially
with splenic blood from man; Patton and Donovan however had abso-
lutely negative results. (Mathis & Léger also report a leucocytozoon
in a Chinese dog).

The parasites of endemic boil disease, (Delhi or Aleppo boils), dis-
covered by Wright and named Helcosoma tropicum, later as Leishmania
tropica, are similar to the Leishman bodies.

_,. hiterature. Liihe, Handb. d. Tropenkrankh., 1906. III. 202. — Leishman,
ibid., S. 521, — Donovan, J. of trop. Med., 1909. XII.

Malaria of Man. This disease, which occurs in all parts of the
world in marshy localities, and: in an especially severe form in the
tropics, is caused by a blood parasite the malaria pasmodium, discovered
by Laveran (1880), which differs entirely from the piroplasma of
animals. According to the duration of their asexual development, on
which also the appearance of the recurring attacks of fever depend,
Tertiana, Quartana and Perniciosa parasites are distinguished, which
correspond with each other in that besides their multiplication in the
red blood corpuscles of man by schizogony, they also multiply sexually
in mosquitoes (Anopheles-species). By the inoculation of young forms
(sporozoites) of the parasites, with the saliva of mosquitoes into human
blood, where they continue to propagate, a brief febrile attack sets in
after each development of a generation of the parasite which is mani-
fested by chills, then fever, and perspiration. As at each attack a
number of red blood corpuscles are destroyed, an anemic condition de-
velops gradually which in severe cases increases to a pronounced
cachexia; in the tropics however febrile attacks may result in early
death under manifestations of hemoglobinuria, (black water fever).
The disease is combatted successfully with préparations of quinine.
(Ziemann, Menses Handb. d trop.. Krankheiten, 1906. III. 269;—
Ruge, Hb. d. p. M., Ergzsbd., 1907. 85.)

2. Trypanosome Diseases.
(Trypanosomiases, Trypanoses.)

Investigations during the last three decades have proved
that various tropical diseases of domestic animals and also of
man are caused by blood parasites of the flagellate class of
protozoa, the so-called trypanosomes or trypanozoa. In _ the
thorough investigation of these parasites in various localities
as well as in different species of animals, and in various dis-
eases, certain differences, though of slight significance, have
been established in their morphology, and especially in their
pathogenicity, which led to the classification of a number of
not always distinctly characteristic forms of trypanosomes or
798 Trypanosome Diseases.

varieties, and of several diseases. Considering the marked
resemblance of the morphological characteristics of most of the
parasites belonging to this group, there exists a possibility that
the diseases discussed in the first part (Nagana, Surra) repre-
sent a pathological unit, while the unimportant differences noted
in the others depend chiefly on the variability in virulence of
the several kinds of trypanosomes, likewise also on the geo-
graphical and climatic conditions, whereby the differences in
the mode of natural infection, as well as the course of the disease
can be explained readily. In deference to the general concep-
tion, the diseases considered at present as independent affec-
tions will be treated separately, after previously explaining
these points of view.

Besides the pathogenic trypanosomes there exists a great number
of others which occur as harmless blood parasites in domestic animals
and in other species of animals.

General Morphology. and Biology of the Causative Agents.
The trypanosomes are unicellular, animal microorganisms,
containing a nucleus, a blepharoplast, and a flagellum. They
propagate by longitudinal division, possibly also sexually. The
parasites known to be producers of disease possess slender,
spindle-shaped bodies, the posterior ends of which are more
or less blunt; they are enclosed by a periplastic membrane.
The parasites are mostly 21-35 4 long, and 114-3 » broad, in
the middle portion they contain a spherical or oval nucleus and
close to the posterior end a shining nucleolus (centrosoma,
blepharoplast, flagella root, trophonucleus) (see Table IX).
From the latter a fine flagellum runs out, which extends forward
on the outside borders along the undulating membrane, which
is present on one side of the body, and terminates in a free
portion at the anterior point of the body. In the fine granulated
protoplasm there are distributed one or more vacuoles, and
also various sized granules in varying numbers.

By means of lashing movements of the flagellum and spiral
contraction, the trypanosomes are capable of lively motions
in fluid as well as in the blood between the blood corpuscles,
usually in the direction of the flagellated extremities.

On the addition of certain substances, especially of immune serum,
the trypanosomes unite in pretty rosette shapes (agglomeration), by
approaching each other, usually with the posterior ends, in radiating
arrangement and executing whip-stroke movements with the free flagel-
lated extremities directed outwardly.

Propagation occurs thus that first the centrosome, then
the flagellum and nucleus split longitudinally in two parts, and
finally the plasma hody breaks into two halves from front to
back. Sometimes the division of the body does not follow that
of the centrosome and the flagellum immediately, so that irregular
General Morphology and Biology. 799.

ameboid forms result, which contain two or more chromatin
substances, and only later separate into more individuals.

Besides this simple mode of multiplication, a sexual propagation,
or a special development is considered possible in the transmitting in-
sects as intermediary hosts (Ziemann, Prowazek, Koch, Schaudin,
Stuhlmann, Kleine and others).

This opinion is based principally on the investigations of the intes-
tinal contents of stinging flies (Glossinae), infected with trypanosomes,
in which besides typical, broad forms rich in plasma, very thin forms
are found containing only a small quantity of plasma with elongated
nucleus, and sometimes without flagella. According to Koch the former
are considered as females, the latter as male trypanosomes, and they are
supposed to copulate with each other. According to Kleine’s investiga-
tions of sleeping sickness, the development is supposed to extend over.
several weeks, so that infected flies may be capable of causing infection
for that period.

According to the experimental results of Battaglia, obtained by a study of
the multiplication of the Trypanosome Lewisi and the Trypanosome Brucei, a mul-
tiplication by sporogeny occurs also in the blood of the same animal, inasmuch as
after an infection with small motile, intra-globular ameboid forms, : first similar
extra-globular forms develop, later larger, roundish or pear-shaped unflagellated
forms, and only from these finally result the fully developed forms, and these
then multiply by longitudinal division. This conception is supported by the
experience that it is possible to transmit the disease artificially with filtrates of
infected blood, after passing it through Berkefeld (not Reichel or Chamberland)
filters.

Staining. The trypanosomes are even with slight magnification
easily recognizable by their peculiar form, and by their lively snake-
like movements. They stain uniformly with the ordinary aqueous anilin
dyes, while the structure may be brought out by the use of Roman-
owsky’s or a similar stain by which the nucleus, the Blepharoblast and
the flagella appear pale red (chromatin stain) and the plasma pale blue.

Recently Giemsa’s stain is used almost exclusively with the azure prepared
by him in pure form. Staining fluid: to each ec. of distilled water, one drop of
Giemsa’s: solution, always to be freshly. prepared. Staining of the smear prepara-
tion which has been fixed in alcohol or alcohol-ether (44) for 15-20 minutes, then
washing in running water.

Cultivation. Novy & McNeal succeeded in cultivating the try-
panosomes of rats and later also those of nagana on agar to which had
been added about 50% of blood, at a temperature of 25°-34° C. In the
cultures non-motile forms develop 1-2, up to 50-60+ long, and the first
of them may pass through porous filters. Trypanosomiasis was produced
artificially in rats with Berkefeld filtrates of cultures. Since then the
cultivation of other disease-producing trypanosomes was successfully
-earried out in a similar manner (Irikura cultivated them in blood
bouillon of 14-2:10).

Tenacity. The parasites can be kept alive outside of the animal body for
several days, but only in defibrinated blood, to which pure serum is added. Cool
temperature usually lengthens their lives, while against higher temperatures (43°
and oyer) and chemical influences they are in general very sensitive.

The differentiation of the various types depends, aside from
marked deviations in the form of the trypanosomes, almost ex-
800 Trypanosome Diseases.

clusively on their occurrence in certain species of animals and in
well-defined localities, further on the variance in their pathogeni-
city towards the different species of animals; and also on the
fact that animals immunized against one type are still suscepti-
ble to others. However these differences are not constant, as it
is often possible to increase the virulence of one strain of
trypanosomes for otherwise slightly susceptible or apparently
immune species of animals by passage-inoculations. Morpho-
logically the trypanosomes of surra, nagana, and dourine, as
well as of sleeping sickness, correspond absolutely, and those
of Mal de Caderas are supposed to be different from them
only in that their blepharoblast is smaller, and that they are
more difficult to stain.

Distinctly different types are: the relatively large (50:3.5-4.0+)
Trypanosome Theileri, the even much larger Trypanosome giganteum
some non-flagellated trypanosomes, thus especially the Tr. dimorphon
(see p. 837), further the Tr. Lewisi occurring in the blood of rats, which
has been most thoroughly studied, and in which the nucleus is not in
the center, but in the posterior third of the plasma body.

Pathogenicity. Artificial transmission to susceptible ani-
mals succeeds most readily by subcutaneous, intraperitoneal,
or intravenous inoculations, with less certainty by applying
blood containing trypanosomes to fresh wounds. After a cer-
tain time the parasites appear in the blood in large numbers, .
when in certain species of animals, especially in dogs, cats and
rabbits, fever appears as a usual symptom, in addition to
edematous swellings on different parts of the body, resulting
sometimes in the loss of hair, emaciation, sometimes also in-
flammation of the cornea and of the eyelids, whereupon the
anemic animals emaciate rapidly and succumb. If virulent
blood is inoculated into an animal of the same species from
which it originated, a severe or mild disease results, which is
identical with the original affection. ;

Dourine may be produced artificially by applying material
containing trypanosomes on the uninjured mucous membrane
(Vrijburg obtained in one case positive results in a horse with
surra material).

The virulence of the trypanosomes varies in different
species of animals, and may be increased for certain species
and reduced for others by passage experiments. Generally
native animals are less susceptible in infected localities than
those brought to such places from non-infected countries.

Natural infection in the domestic animals, exclusive of
dourine in which it occurs by coitus, usually results from the
stings of flies, namely, Glossinae, Tabanidae and Stomoxys
species, they transmit the trypanosomes mainly in a purely
mechanical manner by sucking blood from affected animals and
inoculating it to healthy individuals. If, however, the trypano-
Natural Infection, Pathogenesis. 801

somes may undergo sexual propagation in the insects as inter-
mediate hosts, as appears probable from recent investigations
(see p. 799), there would be a possibility that they may harbor
the parasites in their bodies for a longer time, and in the mean-
time transmit it to susceptible mammals.

The infection results apparently only exceptionally through
fresh wounds in the skin and mucous membranes, whereas an
infection through the uninjured mucous membrane of the diges-
tive tract, as it was accomplished experimentally by Yakimoff
& Schiller, has not been observed.

Pathogenesis. As trypanosomes are always present in the
blood plasma and the tissue fluids, they apparently exert their
pathogenic action only indirectly by the production of toxic
products, which principally cause the destruction of the red
blood corpuscles, and thereby anemia. They probably influence
the metabolism of the host in other harmful ways. The fever,
the marked emaciation (with good appetite!), as well as the
affection of the nervous system (neuritis, later degeneration)
can be explained only by a toxic action, but it has so far not
been possible to demonstrate the supposed toxins of the
trypanosomes objectively (Laveran, Mesnil, Mayer and others).
The fact however that the parasites multiply outside of the
animal body only on media containing a great amount of hemo-
globin appears to indicate that they require hemoglobin, and
the destruction of the erythrocytes may be explained by the
fact that they abstract this substance from them.

Following the infection a marked increase of trypanosomes
in the blood occurs periodically in the animals, and this is
usually accompanied by an elevation in temperature. Then
again they disappear rapidly, only to return again in great
numbers after a longer or shorter time, having probably matured
meanwhile in certain organs (spleen, bone marrow?) from the
young forms. Their disappearance is according to the investi-
gations of Massaglia and Rodet & Vaillet, supposed to be due
to trypanolytic substances, which appear in the blood of in-
fected animals and the quantity of which increases until the
crisis. To what extent the leucocytes participate in this has
not yet been determined; as a matter of fact their number
greatly increases during the disease simultaneously with a
hyperplasia of the spleen, and a great number of leucocytes
which contain in their bodies broken-down products of trypano-
somes are to be found in the spleen tissue, as well as in the
bone marrow.

General Symptoms. They appear after a longer or shorter
incubation period, and excluding the acute and peracute cases,
which are manifested under severe febrile symptoms, consist

in general in intermittent or recurrent fever, transitory or
‘constant edema of the lower parts of the body, and progressive

Vol. 1—51.
802 Trypanosome Diseases.

anemia ag well as emaciation, with usually a good. appetite..
Nervous functional disturbances, especially peripheric paraly-
ses, are also frequently observed. Death is usually preceded
by a comatose. condition.

Treatment. While in former years the trypanosome affec-
tions have been treated mainly with quinine, corrosive subli-
mate and iodine preparations, although without apparent re-
sults, Lingard obtained in surra, and Bruce in nagana, note-
worthy results with arsenious acid, inasmuch as with this treat-
ment the number of the blood parasites was sometimes reduced
very markedly. The improvement was however usually only
temporary, as after a certain time the trypanosomes reappear
in the blood, so that the final results, at best, showed only a
prolongation of the course of the disease.

More recent investigations, above all the great laboratory
experiments of Ehrlich and his school, show that certain
chemical substances have a specific destructive action on
trypanosomes in the infected animal bodies, or at least exert
an inhibitive action on their development, and in suitable ap-
plication may even result in permanent recovery from the
disease. Such substances, excluding some of the basic tripheny]-
methan dyes (parafuchsin, methylviolet, pyronin), are certain
azofar stains, such as the trypan red, the trypan blue, the
trypan rosan, and the trypan violet, certain arsenical deriva-
tives, especially atoxyl, arsazetin, the arsenophenyglyzin,. and
the dioxydiamidoarsenobenzol (Ehrlich-Hata 606), also some
antimony preparations, such as tartar emetic.

Special study was given to atoxyl (sodium arsanilate) first recom-
mended by Thomas and Breinl, and Mesnil & Nicolle. It was found
that this remedy, different from the basic stains mentioned, which are
effective even in test-tube experiments, does not even in concentrated
solution affect the trypanosomes harmfully in vitro, while in the animal
body it causes the disappearance of the parasite even in a dilution of
1:120000. Ehrlich believes that the action of the atoxyl in vivo is due
to the fact that the substance is reduced to paraaminophenylarsenoxyd,
which kills the trypanosomes also in the test tubes, even in dilutions of:
1:1000000. This is corroborated by the experimental results of Levaditi,
Yamanouchi & Brimont, as these authors have found that the atoxyl
is reduced in the animal body (to a hypothetical trypanotoxyl) ; al-
though later they supposed that the reduction product in such a reduced
condition, combines with proteid molecules, to form a toxic arsentox-
albumin.

Breinl & Nierenstein however believe that the atoxyl combines with
the serum proteids, whereupon arsenic is set free through oxydation
of the atoxyl in the serum, and this, in statu nascendi exerts a de-
structive influence on the parasites. The correctness of this conception
appears to be substantiated by the experimental results of Loeffler, who
obtained the best and most lasting recoveries in nagana-guinea pigs
and cats from the administration of atoxyl, together with arsenious acid
in subtoxic doses (3-5 mg. arsenic per os., and 315 cg. atoxyl subcutan.
Treatment. 803

\

eously). Similarly Holmes observed excellent curative results in horses
affected with surra, after the use of arsenious acid. However in order
to make the recovery complete all trypanosomes, even the latent forms
in the internal organs must be destroyed (therapia sterilisans magna),
therefore the remedy should be used in as heavy doses as possible, that
is in sub-toxic doses (as formerly the arsenic has been used in too small
doses, and the parasites which were not destroyed were capable of
causing relapses). The good results obtained with the auripigment can
also be explained by the fact that it usually contains free arsenious acid.

In the experimental treatment it was further observed that the
trypanosomes are capable of adapting themselves to the remedies under
discussion, for instance trypanosomes which, after atoxyl treatment
with incomplete recovery, remain alive in the animal and later again
multiply, are no longer influenced by the same remedies, and likewise
not by other derivatives of phenyl arsenious acids. This resistance is
transmitted by subsequent passages through the same species of animals
from generation to generation. This condition may become objection-
able in practice, inasmuch as from animals which have been subjected
to such specifie treatment and which have not completely recovered, flies
may later transmit to other animals atoxyl- (arsenic-, trypanblue-,
fuchsin-, etc.) resisting trypanosome strains. Such animals then resist
treatment with the same or with a related remedy. Most recently how-
ever Ehrlich succeeded in producing new arsenical preparations, the
arsenophenyglycin, and the above-mentioned arsenobenzol, which, with
a slight toxicity for mammals are capable of attacking even arsenic-
resisting strains of tryponosomes and which have also otherwise proven
most satisfactory for trypanosome affections out of the great number of
chemicals that have been tested.

Ehrlich aimed to explain the mechanism of the specific therapeutic action
through certain groupings (chemoceptors) in the protoplasm of the trypanosorres,
which possess for certain chemical substances, for instance for the trivalent arsen
as' it occurs in arsenical acids, a special affinity, and are capable of anchoring
such to the plasma. ‘The resistance of already treated strains may result from
the fact that the respective chemoceptor experiences a reduction of its affinity to
the applied remedy, therefore its resistant strain is destroyed only by a greater
quantity of the remedy, or by a more strongly avidious remedy, for instance the

arsenophenylglycin. $s

Based on these experimental results, which have repeatedly
been substantiated especially by Uhlenhuth, Hiibener & Woithe
for the treatment with atoxyl of experimental dourine, by
Loeffler with arsenic in experimental nagana, by Levaditi and
his co-workers for the action of atoxyl on various strains of
trypanosomes, arsenical preparations are used in practice for
the treatment of these diseases. They are employed either
combined with each other, or alternately; further antimony
preparations, especially tartar emetic, and with these treat-
ments satisfactory results are generally obtained, or at least
encouragement for further therapeutical experiments. In
general, the rule should be observed to administer the remedy
as soon as possible after the infection, in a single, or at most
in two subtoxic doses, as only in this manner can relapses and
the development of hypersensitiveness be prevented. (For
details see the individual affections. )
804 Trypanosome Diseases.

Prevention. Excepting dourine, which can be controlled
by comparatively simple measures in the supervision of breed-
ing and may be entirely eradicated, the prophylaxis of the
trypanosome diseases consists above all in the eradication of
the flies which play a part as transmitters, and probably also
as hosts for the virus. The procedure must of course be suited
to their habits of life and their modes of development. In the
glossinae and tabanidae, which confine themselves to certain
forests and marshy localities, and probably also to certain wild
species of animals, the eradication in practice succeeds at least
in small territories, by cutting of the. bushes, and draining of
the meadows. Besides regular cultivation of the soil, the de-
struction of the game, or keeping it from the roads of traffic,
or confining it to certain reservations would aid in the elimina-
tion of the source of infection. The species of stomoxys which
exist in close proximity to living houses and stables, may be
reduced in numbers by cleanliness, as well as by the destruction
of all vegetable refuse.

As the flies do not accompany the cattle herds for great
distances, and as they do not swarm during the night, threatened
herds may be protected from infection by driving them at night
to non-infected localities, avoiding rivers, thus keeping them
from the virus carriers.

In practice the control of trypanosomiasis is rendered more
difficult by the fact that not only affected, but also apparently
perfectly healthy, and especially the animals which have re-
covered from the disease harbor trypanosomes in their blood
for years. Such virus carriers constantly produce virulent
material for flies in infected territories, and may, on the other
hand, disseminate the virus into previously non-infected terri-
tories. By the destruction of all such virus carriers the source
of the infection for the flies could be destroyed, but such a pro-
cedure could only come into consideration in small, freshly
infected territories.

For countries which are free of certain trypanosome affec-
tions careful quarantine measures, or even the prohibition of
the importation of susceptible species of animals from infected
territories, comes into consideration.

Immunization. Immunization experiments with serum of recov-
ered animals and those repeatedly treated with virulent blood (Zie-
mann), or with blood containing parasites and subjected to high or low
temperatures, have not yet given manifest results (Uhlenhuth, Gross &
Bickel). The same applies to the experiments which have been carried
out by passage of the virus through various species of animals (Koch,
Schilling, Martini). In the efforts to work out a method for active im-
munization the fact must be considered that the immunized animals
harbor the parasites for years, and these may later become virulent, and
sometimes may be transmitted to healthy animals in such a condition.

The fact that animals acquire, through recovery from certain trypanosomiasis,
a lasting although not an absolute immunity against the same and not against other
Immunization. 805

trypanosomes, indicates that strictly specific immune bodies develop in the affected
animals. Such, however, have not yet. been demonstrated with certainty in an
objective manner. In this regard the complement fixation method, in which hlood
containing parasites or material from organs was used as antigen, gave uncertain
and varying results (Weber, Manteufel & Woithe). Better results were obtained
by Levaditi & Mutermilch, when they carried out experiments with trypanosomes
separated from blood corpuscles. They could always demonstrate complement
fixing bodies in the serum of guinea pigs treated with trypanosome extract or in
the course of infection. These substances were specific for the genus trypanosoma,
but not for the individual species and varieties, therefore they could not be differen-
tiated by this method. Further, the complement fixing substances proved different
from the trypanolysines, which form in great numbers at the height of the infec-
tion (see p. 801), and exert their dissolving action also in test tube experiments.

According to Laveran & Mesnil, human blood serum has a similar destructive
action on the trypanosomes of nagana, surra and mal de caderas, as the arsenic
acid. Serum of animals, even of those which have recovered from the disease,
or which have been repeatedly infected, has no such action, and on the other hand
the human serum is harmless for the trypanosomes of sleeping sickness.

_ Literature. Nocard & Leclainche, Maladies microbiennes, Paris 1903. IT. 575.
— Laveran & Mesnil, Trypanosomes et trypanosamiases, Paris 1904. —Lithe, Handb.
d. Tropenkrkh., 1906. III. 92. — Sander, ibid., 690. — Nocht & Mayer, Hdb. d. p.
M. Erganzgsb., 1906. 1. — Sauerbeck, Ergebn. d. allg. Path., 1906. X. 305. —
Kaestner, ibid., 1907. XI./1. 455. — Ehrlich B. kl. W., 1907. Nr. 9-12, — Man-
teufel & Woithe, Arb. d. G.-A., 1908. XXIX. 452. — Koch, Beck & Kleine, ibid.,
1909. XXI. 1. — Levaditi & Yamanouchi, Soc. biol., 1908. LXV. 23. — Levaditi
& Mutermilch, Z. f. Immf., 1909. II. 702. — Kleine, D. m. W., 1909. 924 u. 1257,
-— Doflein, Protozoenkunde, II. Aufl. 1909. 350. (Mostly with literature.)

(a) Nagana.
(Tsetse disease.)

History. The disease was described as a destructive cattle
disease by Livingstone (1857) during his voyage in Zambesia, and was
connected by him with the sting of the native tsetse fly. Its cause was
discovered by Bruce in 1894, in the territory of the Zulu Kaffirs,
(nagana=without strength, debilitated), and the first detailed deserip-
tions of the clinical symptoms were also made by him. Shortly after-
ward the disease, as well as its cause was investigated thoroughly by
Kanthack, Durham & Blandford and by Plimmer & Bradford, while
Theiler deserves special credit for the epidemiology. The problem of
the propagation of the nagana trypanosomes was studied by Koch and
recently by Kleine and Battaglia, while McNeal, and Laveran & Mesnil
were successful in their artificial cultivation.

Occurrence. The disease used to be spread widely through
the entire Central and South Africa, where it annihilated at
times the cattle of entire districts. Recently it disappeared
from the south, so that at present it occurs only in some out-
of-the-way localities of Zulu land. The infected territory was
limited partly by the driving northwards of the game, prin-
cipally however by the invasion of rinderpest in 1896 and 1897,
as at that time besides cattle, numerous game animals and
buffaloes. fell victims, and at the same time the tsetse fly also
disappeared from those localities (Theiler).

Trypanosome affections occur also in Northern Africa, but the
classification of these, with the exception of dourine, has not been cleared
806 : Nagana.

up with certainty. Some enzootics have a great similarity to nagana,
while others are more closely related to surra (see also p. 837 and
p. 812).

Etiology. The Trypanosoma brucei, recognized as the cause
of nagana, is on an average 25-33 “ long, 1.5-2.5 “ broad, and
possesses a central oval nucleus, a blunt, Indian-club-shaped
posterior end, slightly developed undulating membrane, and
long flagellum (Fig. 141). Under the microscope it exerts a
lively snake-like movement, but without pronounced locomotion.

Pathogenicity.. Inoculation of blood containing trypano-
somes, under the skin or into the blood circulation of horses,
causes after from 2 to 6 days a marked
elevation of temperature and in the
first case also a painful swelling at
the point. of injection. About the end
of the first week the fever diminishes
but reappears later at certain inter-
vals, and during the duration of the
febrile attack trypanosomes may be
‘demonstrated in great numbers in the
blood. In the meantime edematous
swellings appear on the lower abdo-
men, and in the vicinity of the ex-

Gitte. a aoe ternal genital organs; the animals
cei. “Guinea pig blood. Stain. eMmaciate in spite of continuous, and
ed after Romanowsky-Ziemaun. often ravenous appetite; marked mus-

cular atrophy and also pronounced
anemia develop. Sometimes turbidity and ulceration of the
cornea results with subsequent iritis. Finally a condition re-
sembling lumbar paralysis sets in, whereupon the animals die
from 15 days to 4 months after the appearance of the first
symptoms. In donkeys and mules the clinical picture is similar,
although sometimes with a still more protracted course after
artificial infection; the zebra is. also susceptible to artificial
inoculations (Martini).

In cattle, also in sheep and goats the inoculation usually
‘results in a chronic disease.

 

Dogs and cats are very susceptible to infection, and likewise become
affected under symptoms of recurrent fever, edamatous swelling of head,
. chest, gradual emaciation and loss of strength. Guinea pigs, rabbits, rats
and mice, are very easily infected artificially, while hogs show consider-
able resistance to artificial inoculation. Monkeys are very susceptible and
usually die a few weeks after the infection. Of fowls only geese (Schil-
ling) and chickens (Goebel) could be infected artificially, while other
birds showed no symptoms of disease.

Horses and other solipeds, then cattle, more rarely sheep
and other ruminants, become most frequently affected as a
result of natural infections.
Pathogenicity. 807

The infectidn is transmitted by the so-called tsetse fly,
which somewhat resembles the house fly although it is some-
what larger, principally by the glossina morsitans (Fig. 142),
in such a way that it sucks blood from the infected animal, and
then carries the parasites into the body by its bite. Freshly
molted flies are harmless, if however they have alighted upon
an affected animal only a single time they may transmit the
disease and trypanosomes may be demonstrated in their pro-
boseis and stomach shortly after sucking the blood. By the
transportation of affected flies the disease was successfully
produced in previously non-infected localities, while on the
other hand animals driven during the day in infected localities
became affected even when they had not partaken of food nor
water while en route. Furthermore, the extension of the in-
fected territory corresponds accurately with the geographical
distribution of the tsetse fly (between the 10th deg. north, and
30 deg. south latitude), where its appearance in great numbers
is usually followed by: severe outbreaks.

 

Fig. 142. Glossina morsitans. A with closed, B with spread wings, OC anterior
part in profile. A and B enlarged 2.5times. (After Bruce.)

Where affected animals are present or those which have
passed through the disease within a short time, the fly is
afforded ample opportunity for taking up trypanosomes; flies
may also obtain the infectious material from wild animals
(buffaloes, antelopes, hyenas, zebras and quaggas), in the blood
of which it may occur as a harmless parasite. The tsetse fol-
lows these animals everywhere; with the appearance of the
summer season the infectious material is then taken from them
by the young flies, and transmitted to domestic animals, while
with the eradication of the game the tsetse fly also disappears,
so that infected territories may thus become free.

According to Koch’s experience in western and northern | Africa,
where the glossina morsitans is unknown, the disease is transmitted by
the closely related Gl. fusca. According to Brumpt the Gl. pallidipes,
808 Nagana.

the Gl. longipennis, the Gl. palpalis and the Gl. Decorsei are also capable
of transmission.

According to former views the tsetse fly transmitted the infection
only mechanically, and as trypanosomes could be demonstrated in their
intestines 48 hours after sucking the blood, it was supposed that after
that time healthy animals could become infected only when. the flies
had in the meantime again alighted on infected animals. According to
the newer results of investigations on the generation changes of the
parasites (see p. 799), the possibility must be considered that the flies
may transmit the parasites for weeks.

In accordance with the part played by the insects in the
transmission of the disease this usually rages in low-lying
localities with damp soil, especially during warm periods and
rainy seasons, the animals being exposed to the infection es-
pecially during the day, as long as they are in the vicinity of
marshes, lakes, water canals and rivers. The transmission of
the disease from animal to animal is also possible by contamina-
tion of fresh wounds on the skin or mucous membrane, with
blood containing parasites, while the possibility of natural in-
fection through the uninjured mucous membrane of the digestive
tract has not yet been proven.

Anatomical Changes. The autopsy usually reveals pro-
nounced anemia and emaciation. The subcutaneous connective
tissue shows in many places gelatinous infiltration, and in the
serous cavities transudate is found in variable quantities.
Small hemorrhages may be present in the serous membranes,
in the mucous membrane of the stomach and intestines, as well
as in the kidneys. If the animal dies during a febrile attack
the spleen shows acute swelling, whereas otherwise a chronic
splenic tumor is usually present; sometimes however it may
have an entirely normal appearance. The lymph glands are
moderately swollen. In some cases hemorrhages and catarrhal
pheumoni¢ areas are present in the lungs. No trypanosomes
can be demonstrated in the blood or in the internal organs 24
hours after death.

Symptoms. The manifestations of the disease are similar
in their nature in the different species of animals.

In horses the temperature rises rapidly after an incubation
of 2 to 10 days, according to the severity of the infection, to
40° to 41° C., and at the same time other febrile symptoms,
such as languor, accelerated and weak pulse or diminished
appetite make their appearance. The mucous membranes are
reddened, there is profuse lachrymation, and at the same time
edematous swellings form on the extremities and lower abdo-
men, especially around the genital organs, also in the sub-
maxillary space, and on the eyelids.

The febrile condition remains unchanged for 2 to 3 days,
sometimes for a week, then the temperature drops rapidly
Symptoms. 809

to normal or below, whereupon the animals become livelier
and the other symptoms diminish or may disappear entirely.
If the fever has lasted for a longer time the patients have in
the meantime become emaciated in spite of the fact that the
appetite has not been impaired much. After a certain time
the afebrile period is again followed by fever, and from then
on several fever days alternate with fever-free intervals, only
that the rises of temperature in the later course are lower
than in the first attack.

Under such variations of temperature the animals become
emaciated, although their appetite continues very good, and
a pronounced anemia usually develops in which the hemoglobin
content may drop to 25% of the normal, while the number
of red blood corpuscles may diminish to 214 millions per cubic
mm. with a simultaneous moderate increase of leucocytes
(Sehilling; Nierenstein found in experimental nagana an in-
ereased acidity of the blood, probably due to the production
of amido acid). Accordingly the mucous membranes appear
pale and in the later stages frequently icteric in color.

The edematous swellings which develop on different parts
of the bodies vary in the first period in their intensity and
may sometimes disappear entirely; in the later course, how-
ever, they remain constant. Urticaria sometimes appears
especially at the beginning of the affection, but soon disappears
again.

With the progressive emaciation and anemia the animals
become steadily weaker, their motions are incoordinated and
staggering, the animals knuckle frequently, and gradually a
condition resembling lumbar paralysis develops, so that the
patients, in which difficulty in respiration has appeared in the
meantime, remain continually lying down until they die, greatly
emaciated and completely exhausted.

After artificial infection of dogs, Spielmeyer observed recent degeneration of
nerves in the posterior roots of the spinal cord, in the roots of the sensory tri-
geminus, and of the optic nerve.

‘In some of the chronic cases an opalescence or an ulcerative
breaking down of the cornea results later or a hemorrhage
follows into the anterior chamber of the eye, which becomes
associated with an iritis, and finally leads to blindness.

The urine periodically contains albumen in varying quan-
tities. The blood contains trypanosomes in great numbers dur-
ing the first febrile attack, while later they are found more
sparingly, usually only during the febrile attack. In the very
acute cases they usually occur constantly, and their number
may amount to 70,000 per cubic centimeter of blood. They
may also frequently be demonstrated in the serous fluid of the
swellings.

The course usually extends to 114 or 2 months, but may
sometimes last for 4 or 5 months. In some cases, which for
810 Nagana.

a time show a chronic course, a sudden aggravation of the con-
dition may develop during a febrile attack, whereupon the ani-
mals die in a few hours (cerebral embolus). Some cases may
be very acute and in these almost continuous fever is present,
the animals emaciate very rapidly, and death ensues after 2
or 3 weeks.

Recovery has so far been observed only very exceptionally
(most likely in donkeys).

In cattle the symptoms, which consist of emaciation and
anemia, periodical fever and edematous swellings (especially
on the dewlap), sometimes do not become manifest for several
weeks, or even months after the infection, and even later they
become aggravated only very gradually. The eyes are rarely
affected. The disturbance in their movements is only slightly
pronounced, while the emaciation may reach a very high degree.
Trypanosomes are present in the blood only. in very small
numbers, and frequently can only be demonstrated by inocula-
tion of the blood into susceptible animals. Acute cases are
observed only exceptionally. Recovery is more frequent than
in horses.

The disease in sheep and goats manifests similar symptoms
to those exhibited by cattle. Parasites are also found only in
small numbers.

In the advanced stages of the disease in dogs, emaciation,
labored labial respiration, acute swelling of the lymph glands,
shifting edema, especially on the extremities, edematous swell-
ings of the feet, incoordination of movements, keratitis and
iritis, as well as general falling of the hair may be observed.

Diagnosis. The sudden and rapidly changing edema as-
sociated with febrile manifestations, in the later stages the
emaciation, anemia and muscular weakness in association with
recurrent fever which progress in spite of good appetite, offer
in infected localities a sufficient basis for a probable diagnosis
of the disease. Absolute certainty however is only obtained by
the demonstration of the trypanosomes in the blood and in the
fresh edematous swellings.

For the examination of trypanosomes a drop of blood should be taken from
a superficial vein, mixed with several cc. of physiological salt solution, and the
mixture examined in fresh, unstained or stained specimens (see p. 799).

The inoculation of blood into small test animals (also dogs) is valuable in
the establishment of a positive diagnosis, especially since it accomplishes its pur-
pose not infrequently, even in cases of negative microscopical findings.

Montgomery & Kinghorn recommend puncturing of the swollen lymph glands,
as, according to their experience, trypanosomes may frequently be demonstrated in
the glandular juice thus obtained, even when the examination of the blood gave
negative results.

Treatment. At present the reports on the results of
Ehrlich’s chemo-therapy (see p. 802), which has been employed
in nagana of domestic animals in Africa are quite insufficient
(in sleeping sickness of man which is also prevalent in Africa,
Treatment, Prevention. 811

atoxyl has been used successfully for several years). Ziemann
mentions that atoxyl acts favorably in horses in chronic cases,
while Schilling recently warmly recommends arsenophenylglycin
(dose for horses: 0.05 gm. per kg. body weight) (see also the
treatment of surra on p. 814).

Bruce found that affected horses and donkeys treated with arsenical prepara-
tions lived longer than those which were not treated, and Laveran & Mesmil also
obtained favorable action from arsenious acid in experiments on animals artificially
infected with nagana trypanosomes (rats, mice and dogs). According to Bruce &
Theiler, also Schilling, the arsenical treatment is useless in nagana of cattle.

Thiroux & Teppaz recently reported lasting recoveries with auripigment and
atoxyl, in the closely related trypanosomiasis of horses in Senegambia (Tryp.
dimorphon, Cazalboui and Pecaudi). The treatment consisted either in the admin-
istration per os of 7-12 doses auripigment of 20-30 gm. each at 3 days’ intervals,
or alternating with atoxyl at 2 days’ intervals (12-25 gm. auripigment per os; 5 gm.
of a 1% atoxyl solution subcutaneously).

According to Diesing the serum of hyper-immunized donkeys is supposed to
improve the general condition of artificially infected horses and cattle, inasmuch
as the number of blood parasites considerably diminishes after each injection.

Prevention. In addition to general prophylactic measures
(see p. 804), attempts are made in infected localities to protect
the animals from the infection by keeping the flies away from
the animals by smoke and also by inunctions with disagreeably
smelling salves or oils (creolin, petroleum, also stomach and
intestinal contents of ruminants, etc.). Limiting pasturing to
the night-time also reduces the chance of infection. (In Uganda
it he found that citronella grass keeps the dangerous flies
away.

Literature. Bruce, Further rep. on the Tsetse-fly disease or nagana, London
1897. — Theiler, Schw. A., 1901. XLIII. 97. — Schilling, Chl. f. Bakt., 1902, XXXI.
452. — Laveran & Mesnil, A. P., 1902, XVI. 1 u. 785 (Lit.). — Koch, D. m. W.,
1905. 1865. — Sauerbeck, Z. f. Hyg., 1905. LI. 31. — Schilling, A. f. Schiffs- u.
Trophyg., 1909. Nr. 1. — Battaglia, Cb]. f. Bakt., 1910. LITI. 113 (Lit.). — See
also the general Lit. on page 805.

(b) Surra.

History. Griffith Evans found in 1880 in the territory of Punjab,
in the blood of horses, mules and camels affected with the disease known
there under the name of surra (=spoiled), a flagellated parasite, the
etiological importance of which he immediately succeeded in establishing
by successful inoculation experiments. Several years later the parasite
was recognized as a trypanosome. English physicians and veterinarians,
especially Lingard, have studied the disease in detail. Rogers was the
first to discover the agency of the insects as transmitters of the virus.

Occurrence. The disease occurs in eastern and western
India, also in the adjoining Chinese territories. It has also
been established on the coast of Persia, on the Mauritian,
Malayan and Philippine Islands, and,in Java and Sumatra
(it appears that it has only recently been introduced to these
islands). It exists everywhere in marshy localities, especially
during the warm season, and causes great losses among solipeds_
812 Surra.

and camels, while cattle and dogs are affected less severely.
According to some authors (Laveran, Pease and others), Mboire
and the El Debab of the camels in North Africa (see p. 838)
is supposed to be identical with surra, having been introduced
with camels from India. Surra appears to occur also in north-
eastern Africa.

In 1906 the disease was brought to New York with an importation of cattle
from India, but was suppressed by the slaughter of the infected, and prolonged
quarantine of the other animals. Camels have introduced the disease from India
to Australia.

Etiology. The Trypanosoma Evansi is morphologically
cumost identical with the producer of nagana. As an only,
although not constant difference is given a somewhat more
slender form, somewhat longer flagella, a more pointed posterior
part of the body, and a smaller proportion of chromatin
granules, and finally more active motility.

The possibility of differentiating surra from nagana consists at
the present time principally in the fact that goats and cattle immunized
against the usually more virulent nagana virus, are still susceptible to
surra (Laveran & Mesnil, Nocard & Vallée), which although a differ-
ential sign, is declared by Koch to be not conclusive.

As Trypanosoma vivax, Ziemann described in Kamerun a trypanc-
some which is characterized by very lively motility and resembles the
virus of surra in other particulars.

Relative to the pathogenicity between the trypanosomes
of surra and those of nagana, the only difference is that in
artificial infection experiments the nagana trypanosomes are
usually slightly more virulent.

The natural infection is transmitted according to Rogers
and Musgrave & Clegg by horse flies, namely, the Tabanus
tropicus, the T. lineola and the Stomoxys calcitrans, according
to Leese also by the Hamatopa fly. Carnivora may infect them-
selves also by the ingestion of blood from affected, or of meat
from dead animals, also through losses of substance in the
skin and mucous membranes (Lingard; Vrijburg succeeded in
infecting a mare by smearing the urethral secretion of an in-
fected stallion upon the mucous membrane of the vagina). —

Cattle and zebus are generally considered in the first place
as virus carriers (virus reservoirs), although they are only
slightly susceptible to the disease and usually become affected
but mildly; nevertheless they may harbor trypanosomes in their
blood for years. In the second place camels, when recovering
from the disease, may likewise carry the parasites in their
blood for a long time. Wild animals (foxes, jackals, hyenas)
may also supply the virus to stinging flies.

: For all stinging flies which have hitherto been considered as transmitters of
the natural infection of surra, it is generally accepted that they transmit the
trypanosomes entirely in a mechanical way; at least the experiments carried out
failed to show that the surra trypanosomes pass through any stages of development

 
Etiology, Anatomical Changes, Symptoms. 813

(Leese) in the bodies of the flies, which latter are infectious only the first day
after sucking the blood.

The question as to the mode and nature of natural infection cannot yet be
considered as solved, and only recently Holmes, among others, expressed himself
negatively on the exclusive transmission by horse flies, pointing out that the disease
rages sometimes in the months from October to December inclusively, whereas the
flies usually fly only in the months of June to August. :

Anatomical Changes. Besides marked emaciation and
changes indicating anemia and cachexia, a yellow, gelatinous
infiltration of the subcutis is present in different regions of
the body, also small hemorrhages in the serous and mucous
membranes, serous exudates in the pericardium and in the ab-
dominal cavity, more or less pronounced acute swelling of the
spleen (especially in acute cases), and swelling of the lymph
glands; in some eases superficial ulcerations also appear on the
tongue and on the gastric mucous membrane.

Symptoms. These resemble in general those of nagana.
In solipeds, which are the most susceptible animals to natural
infection, the disease commences after an incubation of 4 to 13
days (Lingard) with fever (rise of temperature up to 40.5-41°),
great languor and weakness, whereupon petechiae soon develop
on the mucous membranes, especially on the conjunctiva.
Urticaria-like eruptions appear on the skin, and edematous
swellings on the extremities, the genital organs, in the sub-
maxillary region, and on the lower abdomen.

A fatal termination may result even in the first days of
the disease, usually however a marked improvement sets in
after several days, but the febrile attack returns after a short
time. The febrile stages usually last for four days, and alter-
nate with fever-free periods lasting for several days, whereby
the animals become more and more weakened, the paleness,
and later also the icteric discoloration of the mucous membranes
becomes more pronounced, the superficial lymph glands swell,
the respiration becomes accelerated and labored, the pulse fre-
quent and small. In spite of good appetite the animals become
greatly emaciated, their gait is staggering, finally they lose
the use of their hind parts and die with symptoms of severe
dyspnea.

Of other symptoms there may be observed hemorrhages
in the anterior chamber of the eye, diffuse keratitis, petechiae
in the mucous membrane of the vagina, albuminuria during the
febrile attacks, continuous erection of the penis (formation
of thrombi in the corpus cavernosum?), ete.

Trypanosomes are found in the blood especially at the be-
ginning of the febrile attacks, otherwise their number finctuates
in the course of the disease within wide limits.

The course extends usually from 1 to 2 months, more rarely
from 1 to 2 weeks, or on the contrary for 3 to 4 months, the
febrile attacks becoming gradually weaker in the later stages,
814. Surra.

The disease appears almost without exception to terminate in
death.

In cattle the disease occurs much less frequently and is
manifested by less pronounced intermittent febrile symptoms,
becoming apparent only with the gradual development of anemia
and emaciation, which sometimes reach a very high degree.
In most cases ultimate recovery takes place.

There occur however outbreaks in which the disease ap-
pears in numerous cattle with severe manifestations, such as
high fever, reddening of the mucous membranes, diarrhea and
hemorrhages, and runs an unfavorable course, although even
in such instances recovery may follow.

Buffaloes rarely become affected, and then usually only in very
chronic form, although their blood frequently contains the parasites.

In camels the disease usually has a fatal termination, and-as in
solipeds it may run an acute and severe course, or it may occur in a
chronic form. Thus Pease & Gaiger observed two camels affected for
four years, during which time they noted more than 100 febrile attacks.

Of dogs, animals used in hunting become affected most frequently.
The symptoms consist in a periodical febrile temperature, reddening of
the conjunctivae, swelling of the head, the throat region and extremities,
also incoordination of movement. In some cases there is a bloody serous
infiltration in the joints, keratitis, and falling outof hair. Among im-
ported ‘hunting dogs in Indo-China the disease is severe, while native
animals sometimes recover (Blin).

Treatment. Lingard recommended arsenious acid in daily
doses of 0.8 gm. for the treatment of horses affected with surra,
Holmes recently reports continuously good, permanent results
in ten ponies after the use of considerably larger, namely,
subtoxiec doses, at the height of the febrile attack. For ponies of
150 kg. weight, 1 gm. is recommended, while for horses of
450-500 kg. weight, 3 gm. should be given in the form of bolus,
or electuary immediately after feeding, 5 to 10 doses being .
administered with intervals of one day. It is not recommended
in solution either per os, subcutaneously, or intravenously.
Somewhat less satisfactory were the results from Loffler’s
treatment with arsenious acid and atoxyl, inasmuch as out of
16 solipeds thus treated, four failed to recover (alternately
4% atoxyl solution subcutaneously and arsenic in bolus form
with one-day intervals; the dose of the atoxyl solution is 30-50
ec. for ponies, 100-150 ce. for horses and mules; of the arsenic
0.5-1 for ponies, 1.5-3 gm. for horses and mules ; 5 doses
in all

Thiroux & Teppaz found auripigment effective in 1 experimental
surra; they used it either alone, in doses of 15-25 gm. every 3-4 days,
or alternately with tartar emetic (1.0-1.2 gm. intravenously), continued
for weeks.

Gaiger, Hallot and Holmes obtained only a temporary disappearance of try-
panosomes from the blood with atoxyl, and likewise little satisfaction was obtained
from the treatment with corrosive sublimate, soamin, atoxyl and tartar emetic
(Holmes), with atoxyl and corrosive sublimate (Fraser & Simmonds), also with
methylene blue (Gaiger).
Treatment, Prevention. 815

Prevention. In this general principles apply (see p. 804
also the precautions advised for ae coil of ee i
811). In fresh outbreaks it is advisable to select the infected
animals with the aid of taking their temperature, blood examina-
tions, and inoculation of mice and rats, and subsequently their
isolation or destruction. In this way it was possible in Java,
among other places, to eradicate the disease which had been
introduced there not very long before.

Literature. Evans, Vet. J., 1881. 1.; 1882. 97. — Lingard, Rep. on Horse-
Surra, Bombay, .1893. — Rogers, Proc. -of the Roy. Soe. 1901. LVIII. 163. —
Vrijburg, Bull., 1907. 293. — Ziemann, Cbl. f. Bakt., 1905. XXXVIII. 307. —
Schein, Trop. Vet., 1908. III. 191. — Leese, ibid., 1909. IV. 107. — Holmes, ibid.,
1910. V. 1. — Thiroux & Teppaz, A. P., 1910, XXIV. 220 u. 234. — (See, also,
general Lit. on page 805.)

(c) Dourine.

(Eaanthema- coitale paralyticum, Polyneuritis infectiosa;
Beschdlseuche [German]; Maladie du coit.[French] ;
Marbo coitale maligno [Italian].)

Dourine is the name of a usually chronic, contagious in-
fectious disease of breeding horses, which commences shortly
after an infective coitus and is at first characterized by a local
infammatory affection of the external genital organs, with which
subsequently symptoms of paralysis become associated as a
result of an affection of the peripheral nerves and the inter-
one ganglia. It is caused by the Trypanosoma equiper-

um,

History. The disease was first described by Ammon, based on his
experience (1796-1799) in the Prussian stud at Trakehnen. At the be-
ginning of the last century it had already been recognized that it is most
effectively spread during coitus, and the disease has frequently been
confounded with coital exanthema of the genital organs. At the same
time, however, it was also assumed that the affection is identical with
syphilis in man, with which it doubtlessly has much similarity. This
view was also prevalent long since in Algeria, where the Arabs, in their
belief that syphilis can be cured by copulation with asses, followed such
unnatural intercourse whereby the disease was supposed to have been
transmitted from the affected female asses to the stallions (Daumas;
hence also the old designation of the disease: Lues venerea equi, which
has been introduced by Veith into the literature of this subject.) Laquer-
riére aimed to prove this view in France, in 1883, by theoretical con-
sidérations; its incorrectness, however, was esablished by Knauert &
Haxthausen (1837), and the negative results of experiments for the
transmission of syphilis to domestic animal also proved these concep-
tions conclusively as erroneous. The difference of dourine from coital
exanthema of the genitals was established by Hertwig in 1842, and still
more conclusively in 1847, and he, also Mares and later Prince &
Lafosse, proved further that the disease results exclusively through
specific infection. .

Tn the second half of the last century it was observed especially by
French veterinarians in Algeria (Signol, Viardot), and by Rodloft in
816 Dourine.

Russia. In Hungary the Department of Agriculture appointed in 1877
a special commission for the study of the disease, at which occasion
Thanhoffer (1882) examined histologically the organs of more than
30 affected horses, while Azary, besides making artificial experiments
of transmission, thoroughly studied the clinical manifestations.

Rouget (1894) found in Constantine in the blood of a stallion af-
fected with dourine, a trypanosome in which he immediately suspected
the cause of the disease. This finding and its etiological importance
was later confirmed in Algeria by Schneider & Buffard, in Netherland-
ish-India by- Does, in India by Pease, in Hungary by Marek, and in
Germany by Kleinpaul & Neumann, and Lorenz.

Artificial experiments of infection were recently carried out by
Schneider & Buffard, Marek and Zwick & Fischer, while careful clin-
ical investigations were undertaken by Marek and Fréhner.

Occurrence. Dourine was fairly prevalent in Europe
previous to the middle of the last century, and caused heavy
losses by its frequent enzootic extension, especially.in the horse-
breeding establishments. The veterinary police measures sub-
sequently adopted resulted in a rapid diminution of the dis-
ease, so that at present it prevails only in some southern and
eastern states, whereas in other parts of the world it occurs
more frequently.

In Germany the disease was formerly widely disseminated, especially in the
northern territories (Hanover, Silesia, Posen), but has been eradicated since the
inauguration of the infectious disease law. After a decade of freedom from the
disease it was, through a mare imported from Russia, introduced again in 1906
into the districts of eastern Prussia, Angerburg and Lotzen, from which it spread
into the districts of Johannisburg and Lyck. By the end of 1908, 82 horses had
been affected on 62 premises, in 40 townships.

In Hungary the disease was first observed in 1819 at Mezohegyes, and later
by Pillwax (1833) in the stud of Babolna. As a result of the measures adopted
in 1877 the disease has been observed only sporadically since the year of 1890, and
after the eradication of two local outbreaks in the counties of Abauj-Torna and
Szaboles in 1896, the entire country has remained free since 1901. In 1905, how-
ever, the disease was imported from Croatia into the county of Zala, where it spread
to 16 townships. In this, and in the following year, a total of 129 horses were
affected, but in May of 1907 the entire country was free.

In Croatia dourine was widely prevalent at the end of 1901 in nine town-
ships of three districts (26 horses had, to be destroyed during the year). In
Austria it was first observed in 1813 at the veterinary school of Vienna, the last
time in 1878 in Bohemia. In France it has recently always been confined to small
territories, occurring as a result of importation from Algeria and Spain, and par-
ticularly in the Department of Basses-Pyrénées cases occur almost annually. Spain
appears to be infected considerably, likewise Russia, where the disease was diagnosed
by Tschernogoroff in 1897-1902 among 37 stallions in the stud of Oldenburg. In
Roumania, where it was found by Motas in 1898, it is also widely distributed (Pav-
losevici).

Dourine (= dirt, unclean copulation) is widely disseminated in North Africa,
and especially in Algeria, where it causes an annual loss of at least 150,000 francs,
it likewise occurs in Asia Minor, Syria and Persia.

In America the disease was recently encountered repeatedly in the States of
Illinois and Nebraska, and also in Chili; the principal focus of infection, however,
exists on the Indian reservation of South Dakota, where in 1903, on the occasion
of the examination of the horses, 511 were found to be affected,-277 suspected,
and 1,889 stallions had to be castrated. The energetic measures appear to have
been crowned with good results, as since 1906 no other cases have been noted.

Etiology. Dourine is caused by the Trypanosoma equider-
dum, which strikingly resembles the trypanosome of nagana.
Etiology, Pathogenicity. 817

According to Laveran & Mesnil the only distinguishing signs are
the sometimes pointed, at other times blunt, or sometimes split
posterior extremity, further in the parasites originating directly
from the horse, the absence of granulations is mentioned.

Pathogenicity. Material containing trypanosomes taken
directly from horses is always virulent for horses, while it ap-
pears to possess for other animals a varying virulence, while
in Algeria, rabbits and dogs are usually infected very easily,
and a virus constantly effective for rats and mice was obtained
by further inoculations, similar material from horses in Hun-
gary proved pathogenic only for solipeds. During the last
invasion in Prussia, similar experiences were recorded, although
in. some instances mice were successfully infected. Zwick &
Fischer then cultivated a strain by further passage through
mice with which they succeeded in infecting not only small test
ao but also dogs, cats and sheep, and likewise goats and
cattle.

Mares covered by stallions, the urethral secretions of which
contains trypanosomes, develop after about 2 to 4 weeks, some-
times even later, an acute inflammation of the vagina and an
edematous infiltration of the surrounding tissue, while later
‘‘dollar-spots’’ and still later symptoms of paralysis appear
which continually become more intensive until the animal dies.
During the existence of the inflammation of the vagina, try-
panosomes may be demonstrated in the vaginal discharge, in
the edematous swellings and in the dollar-spots, much less fre-
quently also in the blood. An affected mare may also infect
the stallion, in which case the effects are first manifested in
an edematous swelling of the sheath and an accumulation of
mucous secretion in the urethra which contains trypanosomes.
The disease may also be produced artificially by smearing such
secretion or blood containing. trypanosomes on the mucous
membrane of the vagina or urethra, as well as by dropping it
into the conjunctival sack.

The injection of an emulsion of the spinal cord substance from an affected
horse, into the anterior chamber of the eye of a healthy animal, is also effective
(Nocard; Hutyra observed in a pony in such an instance the appearance of dollar
spots as early as in one week, and subsequently a rapid development of paralysis.)

After the inoculation of virulent blood under the skin of
a horse an edematous swelling appears at the point of injection
in 7 to 12 days; after 3 to 6 weeks transitory swellings of the
skin appear on different parts of the body, especially in the
vicinity of the genitals; after six weeks, sometimes not until
after five months, a paralysis of the hind parts develops with
knuckling of the hind legs, until the animal, which has become
greatly emaciated in spite of constantly good appetite, suc-
cumbs with symptoms of a lumbar paralysis. During the course
of the disease intermittent fever is observed. In some cases

Vol. 1—52.
818 Dourine.

periods of improvement are observed in the course of the dis-
ease or complete recovery may take place.

In rabbits a subcutaneous or intravenous injection results
sometimes in acute, septicemic, at other times in a chronic
affection. In the latter an inflammatory swelling of the genital
organs, falling of the hair, necrosis of the skin, crustaceous
eczema on the forehead, purulent conjunctivitis, or panoph-
thalmia is observed, while copulation of an affected with a
healthy animal produces in the latter a gangrenous inflamma-
tion of the genitals. Infected guinea pigs remain apparently
healthy in spite of the periodical appearance of the parasites
in their blood, and suddenly succumb months later.

In dogs a warm and painful swelling appears at the point
of inoculation, also extensive edematous infiltration of the
abdomen, in the parts surrounding the genitals and in the
inguinal region; also acute balanitis; in bitches inflammation
of the vaginal mucous membrane with a profuse discharge
is observed. The back is sensitive, round flat swellings of the
size of the palm of the hand which again disappear within
2 to 3 days appear on the skin, in some cases an inflammation
of the joints, purulent conjunctivitis, and ulcerative keratitis
may be present. In the later stages rapid emaciation, in spite
of good appetite, stiffness of the hind parts, general hyperes-
thesia, and in the last stages complete inappetence without
fever, marked emaciation, as well as very laborious respiration
are noted.

In dogs that are paired with affected animals an acute
inflammation of the external genital organs develops, in which
the discharge contains trypanosomes, and similar results are
obtained from an injection of blood containing trypanosomes
into the vagina of the bitch.

In sheep plaques develop in different parts of the body,
which leave in their places large bare spots; besides this an
inflammation of the genitals develops while the general condi-
tion remains undisturbed for months. In cattle a positive result
of the infection can be only established by the demonstration
of trypanosomes in the blood. Fowl] can be infected only ex-
ceptionally (positive results are reported by Yakimoff & Kohl).

The natural infection is usually transmitted by coitus.
Dourine affects almost exclusively stallions and breeding mares,
and the disease has repeatedly been reproduced intentionally
by allowing affected mares to be covered by healthy stallions,
and healthy mares by affected stallions (Prince & Lafosse,
Trasbot, Azary, Marek). In studs it is, as a rule, mares covered
by certain affected stallions that become affected, and only much
later are other stallions infected ag a result of an infection
through affected mares, and these may in their turn infect many
mares.

During coitus the healthy genital organs are infected by
the secretion of the urethra or of the vaginal mucous mem-
Natural Infection. 819

brane. Trypanosomes at times in varying numbers are present
in these for months even before the appearance of the symp-
toms, and also in the later course of the disease, even when the
animals otherwise show no symptoms or at most only a very
moderate swelling of scrotum or vulva. During the periodical
aggravations of the local manifestations, an increase of their
number may usually be demonstrated.

In the rare cases in which the disease appears in horses
not used for breeding, sometimes even in geldings, the infection

is probably conveyed by sponges or by the hands of the at-
tendants.

The possibility of transmission by stinging flies cannot be discarded
entirely. Lingard has already indicated such a possibility, and Sieber &
Gonder have observed the infection in a horse which stood in a stable
alongside of an artificially infected animal. Schubert & Kuhn also
succeeded in an intentional transmission with the aid of the stomoxys
ealcitrans. Further than this Rabinowitsch has infected laboratory
animals with dourine trypanosomes through lice and fleas, while Uhlen-
huth & Woithe, Manteufel, also Zwick & Fischer, have proved in rats
the possibility of infection through the intact skin. As however try-
panosomes occur at least in northern countries, only rarely in the blood

‘of horses, and even then but few in numbers, stinging flies have only
slight opportunity for taking up the parasites (most likely from the
fresh plaques). Therefore such a mode of transmission is apparently
of very minor importance as is also confirmed by experience in practice
(according to Sieber & Sender the trypanosomes remain viable only for
three hours in the stomachs of flies).

In former times an important part in the extension of the disease was attrib-
uted to heredity (Roloff, Jessen). With the experience acquired in its eradica-
tion, and with the establishment of the etiology of the disease, this conception is no
longer tenable.

In general the susceptibility of solipeds for infection is
considerable, but it varies individually, as not all mares covered
by an infected stallion become affected. This may however be
explained by a temporary disappearance of the trypanosomes
from the secretions of the genitals.

According to Roll about 66% of mares which are exposed to the infection
become affected. Rodloff in Sierakowo observed in all of 107 mares which were
covered by- an infected stallion,mild or severe symptoms occurring later on (54 of
these died), while in the experiments of Prince & Lafosse only 10 out of 15 mares
became infected under similar conditions. Kern reports 24 cases in 105 mares.
which were covered by an affected stallion.

Pathogenesis. The trypanosomes which penetrate into the
mucous membrane of the external genital organs first multiply
at the point of entrance where they produce a serous and in
part a cellular inflammation. Later they enter the blood and
with it pass to distant parts of the body. This mode of dis-
semination is indicated not only by the possibility of demon-
strating at times the parasites in the blood, but also by the fact
820 Dourine.

that in some cases paralysis develops in the region of some
of the peripheral nerves (Facialis!) even in the early stage of
the disease, and further that in the affected tissues the round
cell infiltration is always observed in the immediate vicinity
of small blood vessels.

The intermediate attacks of fever appear to be produced
by periodical invasions of large masses of trypanosomes into
the blood stream, or by their temporarily rapid multiplication
in the blood. Their disappearance appears to be the result
of the development of trypanolytic substances. The trypano-
somes apparently exert their pathogenic action by the produc-
tion of certain toxins, which have not yet been demonstrated ;
these on the one hand produce a serous inflammation of the
walls of the vessels, on the other hand they principally attack
the substance of the peripheral nerves, and the intervertebral
ganglia. In these a cellular infiltration of the nerve tissue
develops (neuritis interstitialis), whereupon the nerve fibres,
as well as the nerve cells, degenerate and finally disappear
entirely. The sensitive nerve bundles become involved in great
numbers, and in a more severe form than the motor fibres,
‘the affection of which results in a degeneration of the cor-
responding muscle fibres. The disturbances observed in the.
movements and in the sensibility of the living animals are
the direct result of the inflammation and degeneration of the
peripheral nerves, while the emaciation indicates the action of
a toxin circulating in the blood.

In cases in which the parasites disappear entirely from
the body a complete recovery may result even in cases in which
conspicuous nervous symptoms have already appeared, and
such instances are not rare in northern regions. As long as
the motor cells of the medulla and the spinal cord are intact,
new nerve fibres may form from the nerve cells or from the
stumps of their prolongations of the axis cylinder. This is
proved by the microscopical examination of cases in which the
disease process showed improvement, when the nerves will be
found to show fine pale stained, new nerve filaments (Marek).

The dourine trypanosomes have a pronounced predilection
for the mucous membrane of the genitals, for they may be
demonstrated in these even after subcutaneous, intravenous or
conjunctival infections. They are evidently capable of passing
out of the blood vessels, producing exudation of blood plasma
and a cellular infiltration on the irritated place, and thus
cause among other symptoms an urticaria-like eruption of the
skin, the so-called dollar spots.

Anatomical Changes. Carcasses of animals dead from
dourine are extremely emaciated, and show on the prominent
parts of the body sores resulting from continuous lying down.
The subcutaneous connective tissue is poor in fat, and in places
shows gelatinous infiltration.

In stallions the connective tissue of the scrotum is in many
Anatomical Changes. 821

cases edematously swollen; the layers of the tunica propria are
adherent by tough connective tissue in their entire extension
or only in parts, or they may be covered by shredded granula-
tions, while the cavity contains a clear or slightly clouded
serous fluid. In rare gases small purulent foci are also found
in the tissues of the te&ticles or between the pseudo-membranes,
otherwise the tissue of the testicles and the epididymis appears
unchanged, although the cord may show gelatinous infiltra-
tion. In mares the tissne of the udder and the vulva may some-
times show an edematous infiltration or sclerotic thickening.
On the glans penis, algd’on the mucous membrane of the urethra
near the outside orifigé, in mares on the mucous membrane of
the vaginal opening and the vulva, spots freed from pigments
may be observed, as:well as fine or thick radiating shrunken
cicatrices. The lymph glands, especially those in the region
of the genital organs; are swollen, soft, and show on the cut
surface a moist glistening appearance.

The muscles, esp¢éially those of the croup and of the pos-
terior extremities are pale red, in places intermixed with butter-
yellow stripes and hémorrhages, or with blackish-red or yel-
lowish-red areas. The capsular ligaments of some joints are
reddened, the cartilages of the epiphyses are ulcerated, while
the synovial fluid appears cloudy and reddish-gray in color.
The intra- and intermuscular connective tissue shows serous
infiltration or may be changed in places into cicatricial tissue.

The internal organs show pronounced anemia and edema-
tous infiltration, sometimes a hypostatic pneumonia or mani-
festations of a general septic infection. In cases which have
had a rapid course, an acute swelling of the spleen and of
the lymph glands may also be present. Frohner describes a
thrombosis of several peripheral arteries by masses of leuco-
cytes as a rare lesion.

According to the descriptions of older authors portions
of the spinal cord, especially in.the lumbar section, contain
softened areas in the gray substance, besides small punctiform
hemorrhages; as a matter of fact however changes visible with
the naked eye may be entirely absent, even in cases with fatal
termination. The meninges of the spinal cord may in parts
contain smeary, friable masses. The larger nerve branches,
especially those of the extremities, are either serously infiltrated
or changed into connective tissue cords, which are strongly
adherent to the intra- or intermuscular connective tissue.

 

The histological examination of the nervous system (Marek) in the chronic
cases shows in the extra-spinal nerve trunks, and most pronounced in the nerves
of the posterior extremities, sometimes also in some of the cerebral nerves (V., VII.
pair) a cellular infiltration, degeneration and atrophy of some of the nerve fibres,
and an increase of nuclei of the endoneurium. These changes reach the highest
degree near the sensory ganglia and in the facial nerve in the Fallopian canal. The
nerve cells of the inter-vertebral ganglia in general, especially in the lumbar
portion of the spinal canal, show an atrophy, chromatolysis, sclerosis, and peripheral
displacement of the nuclei, while the connective tissue of the nerve fibres, which
shows round cell infiltration, has partially disappeared. The peri- and endoneural
822 Dourine.

nuclei, however, are increased. The cellular infiltration extends also to the sensory
roots of the entering zone of implantation, while the degeneration of some of the
nerve fibers may be followed into the posterior trunks of the spinal cord, and up to
the nuclei of the medulla. The other trunk, as well as in general also the nerve
cells, are intact in the spinal cord, as well as in the medulla, otherwise, however, the
chronic cases which have been examined manifested no changes, with the exception
of some perivascular, inflammatory foci in the gray substance of the spinal cord.
This, however, does not exclude the occurrence of intensive inflammatory changes
in other cases.

A fatty degeneration of the muscle fibers, also perivascular cellular infiltra-
tion of the intramuscular connective tissue, the intensity of which varies in different
parts of the body, is present in the muscles. It is most pronounced in the muscles
of the croup and the posterior extremities (Fig. 143). Marek failed to find spe-
cial changes either in the corium, or in the subcutaneous connective tissue, corre-
sponding with the location of the dollar spots, whereas he met a focal cellular
infiltration under the mucous membrane of the vagina, even in chronic cases.

 

Fig. 143. Transverse section through the N. cruralis of a horse affected with dou-
rine. a pronounced, 6 slight absence of nerve fibres; ¢ distended nerve sheath; d
and ¢ epineural cell infiltration. (Marek.)

Symptoms. In the appearance of the symptoms two stages
must be distinguished, for which essentially different symptoms
are characteristic, and which moreover are separated from each
other by shorter or longer, apparently normal periods. The
symptoms of the first stage affect principally the genital organs
and differ from each other according to the sex of the animals,
while in the second stage the symptoms predominate which
point to an affection of the nervous system and which are not
influenced by the sex of the patient.

The characteristic symptoms of the first stage develop sub-
sequently to the infectious coitus, after an incubation of from
5 to 6 days up to one month, sometimes however apparently
after several months, as in some cases the disease is manifested
only by moderate febrile attacks which may be unnoticed.
Symptoms. 893

Prince & Lafosse observed after the infectious coitus an incubation of 7-60
days, Hertwig 2-8 days (?), Rodloff 8-14 days. Schneider & Buffard, also Baldrey,
LEA bs eee - ee infections the development of the first symptoms,
or at leas e first febrile attacks after 8-20 days, B fter 40-45 ys, M
Sree en diss. ys, Buoy after 40-45 days, Marek

Trypanosomes may sometimes be demonstrated in the urethral or vaginal
secretion as early as 4-5 days after the infection; in spite of this, however, except-
ing the rise of temperature, the local symptoms may not develop for. months
(according to Kern sometimes only after 9 months). -

In stallions the disease usually commences with an edema-
tous infiltration of the sheath, which gradually extends from
one place over the entire skin of the part, and especially to
the anterior pendulous portion. The swollen sheath does not

 

 

 

 

 

 

Fig. 144. Dourine. Swelling of the sheath and the lower chest; plaques on the
croup and on the neck of a stallion.

,

feel warmer and is not painful. It is of doughy consistence,
resembling somewhat a fat bag, only that the skin is stretched
and not wrinkled (Fig. 144). The swelling spreads along both
folds which pass from the orifice of the sheath to the abdomen
and forwards and backwards to the scrotum. At the same
time the glans penis also swells and the animal protrudes a
longer or shorter portion of this organ from the sheath. The
glans proper shows hardly any perceptible changes, excepting
the edematous swelling which however may also be very slight,
and a grayish transparent, or yellowish-gray mucus oozes out
824 Dourine.

from the urethra. In infrequent cases the swollen glans appears

of higher temperature and more sensitive. The border of the
urethral opening is also frequently swollen, slightly reddened
and the mucous membrane protrudes slightly (especially in
jacks). Later lentil to pea-sized, yellowish-red nodules on an
infiltrated base develop, sometimes singly, at other times in
groups, on the mucous membrane of the urethra in the vicinity
of the urethral opening, also on the glans and on the body
of the penis, and change into round, flat ulcers in 12 to 36 hours;
these usually heal after a time, leaving behind roundish white
spots. In some cases however they may persist for a long
time, and even enlarge, after which their base is lardaceous,
their borders raised, and on final healing prominent scars re-
main.

During the development of these changes the animals mani-
fest a continuous desire to urinate, but they pass only small
quantities of urine and nervously raise one of the hind legs
or arch their backs. Besides this frequent erections of the
penis are observed and the animals usually show an increased
sexual desire.

In mares the first manifestations consist in an edematous
swelling of the vulva, discharge from the vagina, also redden-
ing and inflammatory swelling of the vaginal mucous mem-
brane. The labia of the vulva usually appear swollen on both
sides, frequently however not uniformly; at the same time they
are dense, elastic, not painful, and frequently covered with
non-pigmented spots, similar to those sometimes occurring in
the vicinity of the reetum (so-called toad spots). Sometimes
the clitoris is swollen, so-that it protrudes from the lower
gaping opening in the vulva. The mucous membrane of the
vagina is loosened, shows dark red spots on a reddish-yellow
base and is sometimes thickened into gelatinous, quivering, -
longitudinal pads. The mucous follicles are also swollen,
especially in the superior commissure, and in the vicinity of ,
the clitoris gelatinously translucent, and may be felt as millet-
seed-sized, rarely larger nodules. The nodules may later break
down, whereupon in their place small round ulcers, with sharp
borders and yellowish bases appear. The ulcers finally heal,
either without leaving any trace, or in their places light yellow
spots may remain for a time (proliferated epithelium) (Fig.
145). Besides the nodules, pea-sized vesicles may develop ex-
ceptionally on the mucous membrane of the vagina and on the
vulva, in rare cases also in the surrounding portions of the
skin, these contain a yellow serous fluid, and similar small ulcers
develop after they burst.

In severe cases the ulcerations increase in size, their bases
becoming covered with necrotic tissue and the dark red borders
showing an elevated swelling. They heal very slowly, and
in their places round, smooth scars remain for a long time.
Meanwhile the discharge from the vagina increases; first it
Symptoms. 895
is white or yellowish and slimy, later more tenacious and finally
purulent, dirty yellow, or reddish, dries on the lips of the vulva
to dirty brown crusts and glues the
hairs of the tail together. The
edematous swelling may extend to
the udder and the abdomen, as well
as to the thighs.

During the development of the
local changes the mares manifest
oestrum-like behavior, they shift
their feet restlessly, swing their
tails, strain frequently to urinate,
sometimes passing only a_ little
mucus and at other times a small
quantity of urine after which they
arch the back.

The symptoms do not always
reach so high a degree that atten-
tion may be attracted to their pres-
ence. Cases are relatively frequent
in which the characteristic changes
are only observed in the later
stages, when by subsequent careful
examination the traces of the pre-
existing ulcerative processes may
be found on the genitals in the form
of white scars. If however nodules
and ulcers develop only on the
mucous membrane of the urethra,
as sometimes occurs in stallions,
not even traces of the local affec-
tion may be found on the genital
organs. The initial symptoms are

 

 

 

Fig. 145. Dourine. Unpigment-
. 7 é 5 ed spots on the lips of the vulva;
sometimes unnoticed, especially in pronounced emaciation.

mares in breeding establishments,
but carefully watched stallions may direct the attention to the
affection by the appearance of the nervous symptoms.

The ulcers on the vaginal mucous membrane are described by all
authors, with the exception of Rodloff, who never observed them. Mares
observed a discharge from the vagina only in 17 out of 197 affected
mares.

In the second stage, which, as a rule, follows the first after
several weeks, and sometimes after a temporary improvement,
exceptionally however without any period of transition, symp-
toms appear which indicate an affection partly of the skin,
partly of the peripheral nerves and the intervertebral
ganglia.

The so-called dollar spots appear first, usually on the sides
826 Dourine.

of the chest and on the croup, more rarely on the neck, shoulder,
withers or on other parts of the body (Fig. 146). They are
either round or semi-circular, or again irregular in shape. The
former have a diameter of 4-8-15 cm., and may be recognized
in that their periphery is formed by a ring 1-3 cm. broad, over
which the hair stands erect or disarranged as a result of an
edematous infiltration of the capillary bodies, on account of
which the ring appears darker and less glistening. Within the
ring the skin is not swollen, the hair is smooth, and therefore
this portion appears sleek and glistening like the skin outside
of the ring. The second
category of the dollar
spots is a very irregular,
zigzag-shaped form, fre-
quently extending 15-20
em. in one direction, and
covered with roughened
hair. Besides these spots,
lentil to bean-sized nod-
ules develop on the skin,
over which the hair is
also rough; such nodules
are mostly observed on
the inner surface of the
thighs, in the flanks, and
more rarely on the sides
of the thorax and on the
shoulders. The fourth
form resembles urticaria
Fig. 146. Douwrine. Plaques on the left side and the designation of
of the abdomen. “‘dollar spots’’ is really
appropriate only for this
form of eruption. Sometimes on the inner surface of the thigh,
sometimes in the flanks, lentil to dollar-sized, uniform protuber-
ances appear, over which the hair appears rough and dull. The
number of the dollar spots may be considerable, even exceeding
one hundred. They usually persist for 1 to 8 days, when they
disappear without leaving a trace, whereupon however fresh
plaques soon appear on other parts of the body. All forms of
eruptions are painless, are not of a higher temperature, and
are not associated with itching.

 

 

 

Strausz in Mezohegyes observed besides the dollar spots a severe
vesicular and crustaceous eczema on the abdomen, on the chest, also on
the croup, and at the base of the tail. The intensely itching eruption
(‘‘iteh disease’’) which caused the patients to rub and scratch severely,
resisted all treatment, but after a time it was arrested of its own ac-
cord, and finally healed! later however hair failed to grow on the hair-
less spots, and if in these places the pigment of the skin had disappeared
the affected part of the body showed a variegated appearance.
Symptoms. 827

Kern observed in some cases persistent perspiration and sub-
a alopecia, Fréhner saw white hair appear on the rump of a
stallion.

; Hyperesthesia either over the entire body surface or only
in the region of certain nerve trunks, may be established either
simultaneously with the appearance of the dollar spots or later.
be On account of the increased sensitiveness of the skin, some-
times a slight touch or a slight prick on the skin causes the
animal to offer opposition, while stroking the back with the
fingers causes the patients to groan and depress the back.

| At the same time an increased sensitiveness of certain nerve
trunks may be ascertained; thus the animal manifests sharp
pains on pressure or stroking over the N.. ischiadicus and
peroneus, the Nn. intercostales, the N. medianus and infraor-
bitalis. As the contraction of certain groups of muscles press
or stretch the nerves lying between them a disturbance in their
movements results owing to their sensitiveness. The walk of
the patients is stiff, they hold one or the other leg more flexed,
especially on trotting and galloping, also during quick turns
and therefore evince lameness. If the animal stands still it
periodically raises a foot spasmodically, as if tortured by
lancinating pains, and holds it high for a while. trembling.
Similar manifestations are observed when the animal starts
to move and during passage of the bowels. These spasms occur
more frequently during nighttime than during the day and are
sometimes observed when the animal is lying down. In some
animals a sudden lameness sets in, which however disappears
after a few days. On account of the sensitiveness of the inter-
costal nerves the respiration is accelerated and superficial,
while owing to irritation of the vagus nerve, the patients cough
periodically.

The increased sensibility gradually passes into a hyperes-
thesia, exceptionally into a complete anesthesia, and as a rule
paralysis of certain motor nerves appears in the meantime.
This is observed in almost every case in the hind extremities,
quite fréquently in some of the facial nerves, especially the
N. facialis, while the nerves of the anterior extremities, and
those in other parts of the body are but rarely affected.

The symptoms of paralysis are usually not even on both
sides of the body. On the head they are almost invariably
unilateral. As a result of paralysis of the nerves on the pos-
terior extremities, the animals show a staggering gait, which
is noticeable while walking in a straight direction, but more
so while walking in a circle. On trotting they hold the hind
legs spread apart or drag them with the flexed hock on the
ground; when halted they usually knuckle (Fig. 147). The
paralyses of certain nerves of the head are manifested in cor-
responding disturbances of motion and in distortions. Accord-
ing to Lorenz and Fréhner a peripheral recurrens-paralysis
828 Dourine.

occurs frequently sometimes in spite of its long existence with-
out leading to a demonstrable atrophy of the posterior muscles.
The sphincter muscles of the anus and the bladder are not
paralyzed.

The superficial reflexes are increased over the region of
the hyperesthesia, but they hecome weaker after the appearance
of the muscular paralysis and finally disappear entirely. The
tendinous reflexes, corresponding to the affected nerves, are
diminished from the beginning or entirely absent, especially
the patellar reflex. The electrical irritability of the nerves
and muscles is likewise reduced in the regions of the paralysis
or a partial and even a total degeneration reaction may be
established (Marek).

The symptoms of paralysis diminish sometimes consider-
ably after several weeks and may disappear entirely, even

a

 

Fig. 147. Dourine. Paraparesis in an affected mare. (Snapshot.)

when a degeneration reaction had previously been ascertained.
In other cases they become more aggravated, the withering
muscles become markedly atrophied, and finally the paralysis
of the hind parts reaches such a degree that the animals are
no longer capable of rising from the ground.

Frequently affections of certain joints and tendons become
associated with the nervous symptoms. The hock joint, more
rarely the fetlock joints, or some articulations of the front legs,
swell from day to day, together with the corresponding
{endinous sheaths. The swellings are produced by the ac-
cumulation of a large quantity of fluid in the synovial cap-
sule or in the tendinous sheath, but at the same time there
are no inflammatory symptoms perceptible. On palpation they
show fluctuation,
at the same time
they are not
warmer or pain-
ful. Besides they
may retrogress as
rapidly as they
develop and recur
again after a cer-
tain time.

The respira-
tion is quiet and
slower than nor-
mal, but even
after short exer-
cise it becomes
very much accel-
erated, calming
down only grad-
ually. Toward
the end of the dis-
ease a catarrh of
the air passages
or broncho-pneu-
monia may de-
velop. The heart
action is mostly
normal, only the
heart is more
easily excited, as
even after short
exercise accelera-
tion, and some-
times also an ar-
rhythmic pulse
may develop.

The superfi-
cial lymph glands,
most frequently
the inguinal,
sometimes also
the submaxillary
glands, occasion-
ally become swol-
len, when they
feel soft, elastic
and painless or
only moderately
sensitive.

 

Symptoms. 899

In the period between January 26 and

Fever curve of a mare which received on December 22 urethral mucus from an infected stallion into the vagina.

‘Trypanosomes were first found in the vaginal secretion on December 31, and from then on in varying numbers until death, while in the. blood
From January 16, swelling of the lips of the vulva.

Fig. 148. Dourine.

they were demonstrated only once, on March 2d.
“oebruary 26, absence of fever.
830 Dourine.

The number of red blood corpuscles in the blood may
diminish to one-tenth of the normal, while white corpuscles
may increase 10 to 30 times. In many cases a pronounced
eosinophilia may also be demonstrated (Marek, Frohner).

The daily quantity of the urine fluctuates within normal
limits; its specific gravity is 1,023 to 1,060 and on an average
it is lower than in healthy horses. Of the normal constituents
the quantity of phosphoric acid is markedly increased in about
70% of the cases (up to 4-5 gm.); besides the quantity of urea
is also increased (Liebermann; according to Roger the urine
contains glucose).

In the eyeground the papillae and their surroundings ap-
pear congested in some cases, and in time blood pigment is
deposited in the tissues surrounding them. These changes may
later reduce the vision and even result in blindness. Conjunc-
tival catarrh is a frequent symptom, in some cases however also
an exudative iritis develops which finally leads to atrophy of
the bulbus. Fréhner observed in one case a unilateral con-
traction of the pupil.

The body temperatures show a periodical rise of remittent
character (Fig. 148). In the later course a continuous fever
may set in, probably produced in part by suppurative processes,
especially in the genital organs, but towards the termination
of the disease also by the gangrene of the sores from constant
lying down. With the temporary febrile attacks, fresh plaque
eruptions develop frequently, but the course of the disease may
continue without fever even for months.

_ Mares which are impregnated by an infected stallion fre-
quently abort during the second or third month of pregnancy.

The affected animals become greatly emaciated during the
paralytic stage of the disease, although the appetite remains
good almost to the end. Besides the paralysis, the weakness
brought on by the emaciation contributes to the inability of
the animals to rise in the later stages of the disease. The im-
mediate cause of death is either a hypostatic pneumonia or a
septicemic affection in association with the gangrene caused by
the pressure sores.

Course and Prognosis. In northern regions dourine usually
runs a chronic course. After the local affection of the genital
organs, several weeks or even months usually elapse before
the nervous symptoms are markedly perceptible, while the dollar
spots may appear earlier, sometimes simultaneously with the
swelling of the sheath. After the appearance of the nervous
symptoms the disease may in unfavorable cases take a rapid
course, so that the animal succumbs in 3 to 4 weeks, completely
exhausted, or—and this is more frequently the case—the disease
extends over several months, frequently from 1 to 2 years. In
such cases more or less pronounced improvement may be
noticed periodically, which is however only temporary, and
Course and Prognosis. 831

finally the disease passes into the aggravated condition which
leads to a fatal termination.

In southern regions the disease appears to run a more
acute course, so that the patients may die after 1 to 2 months
and even inside of 6 to 8 days (Monod). At the same time
the febrile attacks are more conspicuous following each other
in more rapid succession, and the paralytic symptoms also de-
velop more rapidly, therefore there are no marked, and es-
pecially no chronic interstitial changes of the nerves in the dead
animals.

_The termination of the disease varies in different outbreaks.
While sometimes about half of the affected animals die (in
India, according to Pease, the mortality amounts to 70-80%),
in other cases the loss is much smaller (thus for instance in
A.-Vadasz and vicinity, out of 30 mares in which the disease.
was established with cértainty only two died). Recovery is
possible even after the appearance of the nervous symptoms,
dollar spots and paralysis, and such animals may then perform
hard work for years. It is probable that in some cases only
the local changes of the genitals develop after an infection,
which definitely heal without the later development of nervous
symptoms.

Some authors are of the opinion that the disease develops
more rapidly in stallions and that it runs a more unfavorable
course than in mares, and in Algeria it is supposed to limit
itself in asses in the majority of cases to a local affection of
the genital apparatus.

Diagnosis. In northern regions where dourine apparently
represents the only trypanosome affection of solipeds, the
diagnosis is definitely established by the demonstration of
trypanosomes; but this is associated with considerable difficulty,
as the parasites are present but rarely in the blood, and even
then only in very small numbers. Their occurrence in the
serous fluid of the dollar spots, especially immediately after
these appear, is more constant, as is also the case in the edema-
tous swellings in the vicinity of the external genital organs,
but even here the examination requires great patience. Their
demonstration in the mucous secretion of the urethra and
vagina is much easier (Fig. 149), but even there it is to be
remembered that they may disappear periodically from the
secretion.

A sufficient quantity of secretion is obtained from the vagina by scraping the
mucous membrane with a scalpel or with a glass slide. In stallions the penis is
drawn out with the left hand, and then a long-handled, bean-shaped, oval spoon
with dull edges is introduced into the urethra, with which the mucous membrane
is seraped off. F .

In doubtful cases blood may be injected subcutaneously into dogs. In the
swellings which subsequently develop trypanosomes are always present in great num-
bers (Buffard & Schneider). Mice may also be used for this purpose. Since the
material is frequently non-pathogenic for test animals, even from horses positively
affected with dourine (see p. 817), only a positive result. of the inoculation has
a diagnostic significance.
832 Dourine.

As the ring and semi-circular dollar spots have been ob-
served in northern regions only in dourine, they may be con-
sidered as characteristic for the disease, or at least accepted
as suspicious in a high degree. Their repeated appearance
for weeks and months, and frequently also their persistence
for several days, distinguish them from the ordinary urticaria.

In tropical regions the differentiation of dourine from
nagana, surra and Mal de caderas may evidently cause diffi-
culty, but as according to the reports so far available, trypano-
somes in the secretions of the genital organs are found only
in dourine, their presence there would clear the diagnosis; like-
wise an infection which may be shown to have been trans-
mitted by coitus speaks for dourine.

 

Fig. 149. Vaginal secretion of a mare affected with dourine. a trypanosomes; 6b
epithelial cells from the deeper, d from the superficial layer of the mucous membrane;
c leucocytes; e erythrocytes. After a fresh, unstained preparation.

According to Baldrey the disease may be distinguished from surra
in that the latter usually occurs in epizooties, geldings and unbred mares
become affected, the body temperatures reach high degrees and last
longer, and trypanosomes are present in the blood in great numbers at
the beginning of the fever. According to Davison, Bursattee (see p.
-739) also resembles dourine as it also is associated with a swelling of
the genitals and inflammation of the skin; these however are very
painful. ,

At times where there exists no suspicion of infection, the
initial stage of dourine is sometimes mistaken for a traumatic
it. dammation of the genitals ; however, the traumatic origin may
Diagnosis, Treatment. 833

easiiy be excluded by the absence of a visible injury, or on
the ground of the torpid character and persistent presence of
the edematous swelling. The coital, vesicular exanthema can
readily be taken for dourine, as both affections develop after
coitus with quite similar symptoms. In the coital exanthema
however the eruptions disappear much more rapidly and are
almost invariably benign; further the vaginal mucous mem-
brane is reddened, the affected parts are painful, the usually
numerous ulcers heal within a few days and with this the dis-
ease terminates, that is, no nervous symptoms develop with
the local affection. Glanders may also come into consideration,
as in its later course edematous swellings may result on the
sheath and on the abdomen, but a mistake is prevented by
the other symptoms, which are usually present. The swelling
of the submaxillary lymph glands may readily be distinguished
by its soft elastic consistency from the glandular swelling of
the glands.

The weakness of the hind parts is only characteristic of
dourine when associated with the other nervous symptoms. From
other diseases in which similar weakness of the hind parts
occurs, the paralysis of the musculus quadratus lumborum
muscle, and the tearing of the lumbo-sacral articulation should
be mentioned, in which however the animal is not capable of
backing up at all, while a horse with dourine is capable of per-
forming this function, although with difficulty and staggering.
Paralysis of the facial nerves from other causes may be dis-
tinguished from dourine by the absence of edematous swelling
of the genitals and the plaques as well as other symptoms of
paralysis.

Besides frequent accessory conditions, the affection of
several animals in association with coitus, and the multiplicity
of the symptoms in different animals are as a rule sufficient
points for establishing the diagnosis of the disease in question. _

Experiments by Uhlenhuth & Woithe, Manteufel, also Zwick & Fischer, with
the complement fixation, the precipitation, the agglomeration, as well as the
cutaneous ‘and ophthalmo tests for the diagnosis of dourine, gave negative results
throughout. : :

Treatment. Recently arsenical preparations have been
used frequently in treatment, Trélat having obtained satisfac-
tory results from the internal administration of arsenious acid
(3-6 gm. daily), Arkhangelsky & Novikoff from subcutaneous
injections (0.01-0.05 gm. in increasing doses). Uhlenhuth &
Woithe found atoxyl very effective on small animals in labora-
tory experiments. In horses the conditions for such a treat-
ment are rather unfavorable, as the large doses required at
the beginning of the disease are badly tolerated by these ani-
mals, also on account of the presence of the parasites in the
secretion of the genitals, in the edematous fluid of the swell-
ings and in cavities of joints, where they may elude the destruc-

Vol. 1—53
834 Dourine.

tive action of the remedy. Nevertheless there are reports which
appear to indicate the possibility of a recovery of the disease
processes following such treatment.

Uhlenhuth & Woithe succeeded in keeping an artificially infected horse in
good strength for one year by increasing doses of atoxyl (0.3-5.0 gm. intravenously),
its blood, however, contained trypanosomes throughout the entire period in vary-
ing quantities, and it suddenly died from acute septicemia with extensive intestinal
hemorrhages. Rennes obtained better results in an artificially infected horse, which
he injected at intervals of 3-4 days, alternately with 4 gm. of atoxyl subcutaneously
and 3 gm. kalium tartaricum intravenously; after the administration of 32 gm.
atoxyl and 21 gm. kal. tart. the horse was permanently cured. Yakimoff treated
10 horses by injecting atoxyl ten times in succession, either subcutaneously (4-8
gm.) or intravenously (0.5-3.0 gm.), in increasing doses, and this treatment was
repeated. The results were good, as a relapse was observed in only one case. Monod
also is supposed to have succeeded in permanently curing an affected stallion with
similar treatment (first 0.5 gm. intravenously, then every second day an increase of
0.1 gm. until the maximum dose of 1.0 gm. was reached).

The atoxyl solution must be freshly prepared at each application by boiling
on a water-bath.

Of other arsenical preparations, Miessner found in one
case arsenophenylglycin very effective, in which the nutritive
condition and strength of an already greatly weakened animal
was materially improved by two injections of the remedy
(dose?) and the edematous swellings retrogressed. Fréhner,
on the other hand, not only failed to observe an improvement
in one case after an intravenous injection of 24 gm. atoxyl,
but even noted severe symptoms of intoxication, such as marked
psychic irritation, severe colic and on the second day nephritis.
Finally Monod reported lasting results in three stallions, which
in part were treated with arsen-trisulfid alone (15-30 gm. per os),
the others alternately receiving atoxyl.

The local treatment of the swellings with astringent washes
and the suppuration of the testicles or lymph glands in accord-
ance with the rules of surgery are only of subordinate im-
portance.

Prevention. Stallions and mares should be examined before
coitus as to their health, and horses with inflammatory changes
on the genital organs should be excluded from coitus on general
principles. Besides this it is advisable to wash the penis of the
stallion after every covering with a sponge dipped in clean
water. —

Veterinary Police. The veterinary police measures depend
on the principle that horses affected with dourine should be
excluded from breeding once and for all. Such measures appear
to be justified in spite of the possibility of a complete recovery,
by the frequent relapses and also by the fact that trypanosomes
may be present for months in the genital organs of apparently
recovered animals.’ Accordingly affected stallions should be
castrated, while affected mares should receive a distinctive
branding. The relatively late development of the: symptoms
Prevention, Veterinary Police. 835

characteristic of the disease, as well as the possibility of a
healthy stallion transmitting the disease from an affected mare
to a healthy animal, appear to justify an action requiring that
healthy stallions which have covered mares affected with dourine
should be considered the same as those affected.

Literature. Hertwig, Mag., 1842. VIII. 269; 1847, XIII. 373, — Rouget,
A. P., 1876. 717. — Schneider & Buffard, Ree., 1900. 81; J. vét., 1902. 144; A. P.,
1905, XTX. 715. — Marek, Z. f. Tm., 1900. 1V. 401; D. t. W., 1909. 121. — Kern,
2. f. Tm., 1905. IX. 259. — Lingard, Cbl. f. B., 1904. XX XVII. 537. — Baldrey,
J. of comp. Path., 1905. XVIII. 1. — Sieber & Gonder, A. f. Schiffs- u. Trophyg.,
1908, XII. 246. — Uhlenhuth & Woithe, Arb. d. G.-A., 1908. XXIX. 403 (Lit. on
ee — Froéhner, Monh., 1909, XX. 385. — Zwick. D. t. W., 1910. Nr. 9

eibl.

(d) Mal de Caderas.

History. The etiology of the disease (Mal de caderas—hip disease)
was cleared up by Elmassian, when in 1901 he found trypanosomes in
the blood of horses at Argentine. Voges, Zabala and Ligniéres con-
firmed the finding, and furnished further contributions on the etiology
as well as symptomatology of the disease.

Occurrence. Until the present time the disease has been
diagnosed exclusively in the sub-equatorial countries of South
America: Brazil, Argentine, Bolivia and Paraguay, as well as
on some islands of the delta of the Amazon River.

According to Lacerda the disease is supposed to have been introduced from
the islands of Marajo, westward and southward, and resulted. in some localities
of Brazil in a complete annihilation of the horses. There are marshy localities in
Argentine in which up to 25% of the horses die, and it is stated that a cavalry
regiment lost 100 out of 600 newly purchased horses within half a year (Voges).

Etiology. The trypanosoma
equinum (Th. Elmassiani) is similar
to the parasite of nagana, with the
only difference that its blepharoplast,
is very small and can be stained only
with difficulty (Ligniéres; Fig. 150).

Ruminants and hogs are only

slightly susceptible to artificial infec-
tions; other animals have about the
same susceptibility as for the organ-
ism of nagana. In horses infected =
subcutaneously with blood, disturb- Fig. 150. Trypanosoma equi-
ances in locomotion develop in the [yim Himassant. Guinea Dig
later stages of the disease in a strik-  sky-Zieman.
ing manner (similarity with dourine).
The disease cannot be reproduced, even in susceptible animals,
by feeding fresh blood containing numerous parasites (Zabala).
Animals immunized against nagana or surra are still suscep-
tible to caderas and vice versa.

    

 
‘4

ae

- “grime tontains albumen and frequently some blood, the latter

836 Mal de Caderas.

The natural mode of infection has not yet been elucidated.
At first it was thought that stinging flies were the transmitters
of this disease, especially the stomoxys brava (Mosca brava)
and tabanidae as well as possibly also mosquitoes (Ligniéres-&
Zabala, Voges); according to the observation of Elmassian &
Migone, however, horses which are separated from affected ani-
mals only by a fence remain healthy in spite of being swarmed
by stomoxys flies.

Later the last-named authors connected a rodent with the appearance of the
disease (Hydrochoerus capibara, vulg. Carpincho), observing that these animals
sometimes die in great numbers, and that hunting dogs which have eaten their
flesh also become affected, whereupon the disease soon breaks out among horses.

Anatomical Changes. These consist usually in an acute
swelling of the spleen and the lymph glands, accumulation of
sero-fibrinous exudate in the serous body cavities and in the
joints, hemorrhagic nephritis, parenchymatous degeneration of
the internal organs, besides hemorrhages and serous infiltra-
tion of the muscles of the croup.

Symptoms. A weakness of the hind parts is noticeable
from the onset of the disease, as the animals show a staggering
gait, bringing forward the hind legs, dragging them on ‘the
ground, and frequently knuckling in the tarsal joints. With the
rapidly progressing emaciation, the paraparesis reaches a very
high degree, so that the patients rise from the ground with
difficulty, after which they stand with legs spread apart, and
ean not be made to move. Finally they are unable to rise,
and then the sphincter ani becomes relaxed and the rectum
fills with balls of feces or defecation becomes involuntary.

The body temperature shows a febrile elevation atypical
in character, urticaria-like swellings appear on the skin which
beeome covered with small crusts; subcutaneous edemas are
observed but rarely, and then only on the lower abdomen, while
_ swelling of some of the joints is frequently observed. The

sometimes in great quantities. Inflammation of the conjunc-

tivae and.cornea is a frequent complication. The appetite re-

mains good until the end.

’s 'The course is always unfavorable. After the appearance
of the disturbances in locomotion the animals usually succumb
in’ 1 to 2 months, but there is also a chronic form of the affec-

tion (known in Paraguay as Baacy-poy=slow emaciation),

which develops very gradually, so that the emaciation and weak-
ness of the hind parts becomes apparent only after months.
Trypanosomes are found in the blood only in acute cases
in considerable numbers, while otherwise their demonstration
is successful only by inoculation of test animals (mouse, rat).
The disease runs under similar manifestations in mules
and asses.
 

 

Symptoms, Treatment and Prevention. 837

Treatment and Prevention. Ehrlich & Shiga found trypan
red effective in experiments on mice against the trypanosomes
of Mal de caderas. For practice however no satisfactory method
of treatment is known.

In consideration of the fact that the mode of natural in-
fection is still-unknown, no certain preventive measures can
be established. Nevertheless keeping the solipeds from marshy
pastures, and the destruction of affected horses, may prove
beneficial.

Literature. Elmassian & Migone, A. P., 1903, XVII. 241 u. 1904, XVIII. 587.
— Voges, Z. f, Hyg., 1902. XXXIX. 323. — Ligniéres, Bull., 1903. 51.

Other Trypanosome Diseases. Besides the affections considered
above other diseases of domestic animals have been described, the classi-
fication of which however is at present still doubtful. The most im-
portant will be set forth briefly in the following: :

i. Gambia Fever of Horses. This is caused by the trypanosome
dimorphon discovered by Dutton & Todd in Senegambia. It occurs in
the blood of horses shortly after infection in a short tadpole form, and
in the latter stages in a longer, more slender form, in both of which the
plasma extends almost to the anterior end of the flagella. The clinical
symptoms resemble those of nagana, only subcutaneous edema is absent
(for treatment see p. 802). ,

The transmission of the parasite is supposed to oceur by the Clos-
sina palpalis. In recent times the same trypanosome has been demon-
strated in different localities of Africa, not only in horses, but also in
other domestic animals, as the cause of an affection which is mostly
chronic (Laveran & Mesnil, C. R. 1904. CXXXVIII. 732).

2. Zousfana. Observed by Szewezyk and Rennes in Algeria in
solipeds, and attributed to a particular trypanosome similar to the Tr.
sudanense. The disease runs a chronic course, with symptoms. of anemia
and hemoglobinuria, but without edema. Possibly identical with nagana
cr surra. (Szewezyk, Bull., 1903. 220.—Rennes, Ibid., 1907. 298.)

3. Soumaya (Souma). Described by Cazalbou as a disease of
horses in the French Sudan and supposed to occur also among mules,
cattle and sheep in the upper valley of the Niger and the adjoining
territories. Its cause, the Trypanosoma Cazalboui, was described as a
new species, its nucleus being placed near the rounded posterior end.
Dogs and small test animals are not susceptible. According.to Buffard
it is also virulent for cattle, and is transmitted by stomoxys flies. Symp-
toms in horses are anemia, swellings of the skin and weakness of the
hind parts. The course is sometimes acute, covering about 50 days, at
other times it may extend over a year. Thiroux & Teppaz reported good
results from treatment with atoxyl and auripigment, or with auripig-
ment alone. (Cazalbou, Acad. de méd., 1904.—Laveran, A. P., 1907,
XXI., 325.—Buffard, Soc. biol., 1907, 71—Thiroux & Teppaz, C. R.,

1908, CXL, 651.)
4, Baleri. Occurs quite frequently among solipeds in certain lo-

ealities in the Sudan, with symptoms of fever, infiltration of the skin,
anemia, emaciation, and muscular weakness, Its course is from 3-4
838 Trypanosome Diseases.

months. The Trypanosoma Pecaudi, named by Laveran, resembles the
Tr. dimorphon, and is, according to Buffard, said to be transmitted by
the Glossina palpalis. Dogs are also susceptible. Thiroux & Teppaz
found the auripigment effective. (Cazalbou, Rev. gén., 1907, IX, 564.—
Bouffard, A. P., 1908, XXII, 1.)

5. Mbori and El Debab of Camels. (Maladie de la mouche.) The
Sergent brothers in Algeria, and Cazalbou in Timbuctu, have described
this as an independent affection, but according to Laveran it is supposed
to be identical with surra. The camels become affected with symptoms
of anemia and emaciation, also turning the head and neck to the side,
while edema and disturbances in locomotion are not usually observed.
About 10% of the dromedaries are supposed to be affected in Algeria.
(Laveran, Acad. de méd., 1904.—Sergent & Ledoux, Soc. de’Path. exot.,
1908, 22.)

Other Trypanosomes. Besides those described, other species of
trypanosomes have recently been found in domestic animals; some of
these will be briefly described in the following:

Trypanosoma Theileri; first demonstrated by .Theiler in cattle in
South Africa, later by Schilling in Togo, Szewezyk & Rennes in North
Africa, Sander on the Island of Mafia of the German-East African
protectorate, Valladares in Madras, Luhs in Trans-Caucasia, Pease found
it in India also in buffaloes. It is characterized by its considerable
size (30-70 » long, 2-5 » broad, and a long flagella. First it was con-
sidered by Theiler as the cause of gall sickness (see p. 783), but it
appears to be a harmless habitant of the blood of cattle. (Theiler,
Comp. Path., 1908, XVI, 192.—Mayer, Z. f., Infkr., 1909, VI, 46 [Lit.].)

A similar trypanosome was found by Frank in great numbers
in the blood of German cattle in Stein-Wingert (Wiesbaden), and
named by Frosch Tryp. Frank. Further Knuth, Rauchbaar & Morgen-
stern succeeded in demonstrating trypanosomes of the same type by
inoculation of defibrinated cattle blood into sterile beef bouillon; in
the District of Oberwesterwald in 7 out of 25, in another stable 10
out of 17, and in a third 6 out of 9 otherwise healthy cattle, which
originated from various localities of Germany. (Z. f. Infkr., 1909, V.
313.—B. t. W., 1910, 539 u. 610.)

Also very similar is, according to Lingard, the Tryp. himalayanum
and the Tryp. indicum, further the Tryp. muktesari, this however
somewhat. smaller, and with shorter flagella (C. R., 1908, 452), also
the Tryp. americanum, which was by Crawley found frequently in
healthy cattle in North America (An. Ind. Bull.; 119, 1909).

Broden described the Tryp. congolense as a, special species, which
frequently causes disease in the Congo especially among horses, but
also among other domestic animals and has also been found in the
northern part of Rhodesia. It is smaller than the nagana trypanosome,
has no free flagella, and otherwise resembles the small form of the
Tryp. dimorphon. (Laveran, A. P., 1910, XXIV, 81.) This closely
resembles the Tryp. nanum, which was demonstrated by Theiler in
Zambesia and in Limpopo in cattle, and in Zuzuland in a horse. (Soc.
de pathol. exot., 1909.)

Mathis & Léger observed a trypanosome in a chicken, which they
named Tryp. Calmettei. (Soc. biol. 1909, LXVI, 452.)

(See also Lithe, Handb. d. Tropenkrkh., 1906, III, 124, u. Doflein,
“Lehrb. d. Protozoenkunde, 1909, 390.)
Trypanosome Affections in Man. 839

Trypanosome Affections in Man. By the findings of Nepveu
(1898), Dutton (1902) and Castellani (1903), as well as by numerous
subsequent confirmations, it was established that the so-called sleeping
sickness of the negroes is caused by a blood parasite, the Trypanosoma
gambiensis. It greatly resembles the parasite of nagana, and is also
transmitted into the healthy body of man by the tsetse fly, especially
by the Glossina palpalis. The disease, which occurs in tropical Africa,
manifests itself in the first stage (Trypanosome fever) in irregular
fever, transitory edema, and erythema, also swelling of the lymph
glands and spleen. If the patients survive, symptoms of the sleeping
sickness proper develop in a few months. Fatigue with frequent head-
aches, subcutaneous edema, diminution of the intelligence, and finally
symptoms of a severe meningitis, especially conspicuous somnolence,
whereupon the patients die in a deep comatous condition. Good results
were obtained in the treatment with arsenical preparations, especially
with atoxyl. (S. Mense, Handb. d. Tropenkrankh., 1906, III, 617.—
Koch, Beck & Kleine, Arb. d. G.-A., 1909, XX XI, 1, H.)

Chagas found in a child in Brazil a trypanosome (Tr. Cruzil),
which supposedly is transmitted by the Cinorrhinus insect. The symp-
toms were similar to those of the African trypanosome fever. (A. f.
Schiffs, u. Tropenhyg., 1909, XIII, 351.)

‘3, Spirochaetosis of Fowls. Spirochaetosis avium.

(Spirillosis or Spirochaetosis of Chickens; Spirillosis gallinarum
et anserum.)

Spirillosis represents usually a fatal septicemia of chickens,
geese and ducks, caused by a screw-shaped blood parasite, the
Spirochaete gallinarum.

History. Spirillae were first demonstrated as disease producers
by Sakharoff (1891) among geese in Trans-Caucasia, later by Marchoux
& Salimbeni (1903) in Brazil. At first it appeared as if two different
diseases were concerned, but Williamson (1908) and Galli-Valerio
(1909) have established the identity of their causative agents. In the
meantime Levaditi, Borrel & Marchoux, Neufeld & Prowazek and
Nuttall have contributed to the etiology, Uhlenhuth and his co-workers,
then Levaditi & McIntosh, Dschunkowsky & Luhs to the atoxyl treat-_

ment of the disease.

Occurrence. The disease occurs frequently as a dangerous
plague among chickens in the most varied localities, while in
geese and ducks it has been found only sporadically.

Outside of Brazil the chicken spirillosis has been met with to the
present time in Bulgaria (Gareitschnoff), in Roumania (Mezineseu),
in Cyprus (Williamson), in Egypt (Dreyer, Balfour, Bitter), in Tunis
(Galli-Valerio, Comte & Bouquet), in South Africa (Johnsohn, Bevan,
Mohr), in Australia (Cleland), and in India (Greig, Montgomery,
Rainey) ; the spirillosis of geese, outside of Trans-Caucasia (Sakharoff,

Dschunkowsky & Luhs) only in Tunis (Ducloux).
840 Spirillosis of Fowls.

Etiology. The causative agent of the disease (Spirochaete
gallinarum, Sp. anserum) is a blood parasite, probably belong-
ing to flagellated protozoa, which closely resembles the cause of
recurrent fever of man
(Spirochaete Obermeieri)
which has been known for
several decades. It occurs
in fine threads, 10-20 »
long, formed similarly to
the spiral thread of a
screw, supplied with one
or more cilia (Borrel)
which move actively be-
tween the blood corpuscles
in the blood of living ani-

 

Fig.151. Spirochaete anserina. Goose 3 2
blood. (After Cantacuzene. ) mals affected with the dis-

ease (Fig. 151). They dis-
appear from the blood shortly after death and in drawn blood
they remain alive at best only for 2 to 8 days.

Dschunkowsky & Luhs are reported to have succeeded ‘in cultivating the spiro-
chaete of geese in blood plasma of geese by means of reed sacks in the body
of a rabbit up to the third generation; later indications of degeneration became
oe on the threads, but the fluid possessed a protective action against artificial
infections.

The disease may be produced easily by subcutaneous in-
jection of blood containing spirillae from geese to geese, from
ducks to young chicks, but only with difficulty to grown chickens,
while the transmission from affected chickens to chicken species,
as well as to water fowl is readily accomplished (it was not
possible to infect monkeys with the spirilla of chickens). After
a subcutaneous infection in chickens a considerable number of
parasites appear on the second day independently of the quan-
tity of inoculated blood which continue to increase until the
fifth day, and in the meantime clump together, forming great
agglomeration masses. On the sixth day after the temperature
has fallen rapidly, they disappear from the blood, whereupon
death ensues or the animal gradually recovers.

The artificial infection is also successful by placing infected
ticks upon the birds (see lower down), further by feeding blood
containing spirillae, as well as by cohabitation of affected with
healthy chickens.

Brumpt described the Sp. Nicollei from Tunis, also the Sp. Neveuxi as varieties
of the chicken spirochaete, which are also transmitted to chickens by the Argas
persicus; between this and the chicken spirochaete only immunizing differences
exist. ,

The natural infection is in chickens transmitted principally
by the Argas miniatus tick, more rarely by the Argas persicus
and reflexus, further by the Ornithodorus moubata. These ticks
exist freely in the bushes at the borders of forests, etc., attach
Etiology, Anatomical Changes, Symptoms. 841

themselves at night to chickens and suck their blood. If the
blood contains spirochaetes, they are found for 3 to 4 days
in the digestive canal of the ticks, whereupon they disappear
from there, but they may remain infectious for a longer time,
according to Nuttall even after six months. If they are kept
at 35° C., the parasites multiply in their bodies, and after 4
to 5.days they may be found in the excretory duct of the salivary
gland of the ticks (Borrel & Marchoux). ,

_ Anatomical Changes. In birds dead with the disease the
spleen is considerably enlarged and swollen, the liver swollen,
showing fatty degeneration and focal necrosis; the heart muscle
also shows at times fatty degeneration and the epicardium is
ae ae fibrinous membranes. No spirillae are found: in

e blood.

Symptoms. The incubation is in chickens 7 to 9 days after
placing infected ticks upon them; spirochaetes may however be
demonstrated in the blood as early as from the fifth day on
(Marchoux & Salimbeni, Uhlenhuth & Gross).

The symptoms consist in inappetence, rise of temperature
as high as 42.5-43° C., marked weakness and somnolence, pale-
ness of the comb, diarrhea and emaciation, with which in some
cases paralysis of the legs becomes associated. (Mohn observed,
even before the appearance of spirochaetes in the blood, the
feet swollen and the toe turned under and backwards.)

After the somnolence has reached a high degree, the crisis
sets in 1 to 2 days later, the comb taking on a bluish-red colora-
tion, the temperature falls, and soon death follows, usually
under severe convulsions or recovery commences. Sometimes
however this is only apparent, as the paralysis of the legs in-
creases and gradually extends to the wings, the birds become
greatly emaciated, and finally die with a few rare exceptions
(chronic form). -

According to Nuttall the spirochetes are totally or mostly destroyed
by bactericidal and agglomerating substances after having multiplied
for a time in the blood. The more resistant, and therefore the surviving
parasites are then the cause of the supervening chronic affection. Serum
of ‘birds which have recovered from one attack, destroys in test tube
experiments the spirochetes of the first attack, but not those of later’
attacks. The appearance of parasiticidal substances in great quantities
in the blood before the crisis is reached has also been demonstrated by
Gabritschewsky and Uhlenhuth.

By microscopical examination spirochaetes may be demonstrated in great
numbers in fresh blood preparations made with physiological salt solution until the
appearance of the crisis, but later, and also in animals dead of the disease, they are

no longer present.

The duration of the disease in the more frequent acute
cases is mostly 4 to 5, in the chronic cases 8 to 15 days.
842 Spirillosis of Fowls.

Treatment. According to the experiments of Uhlenhuth &
Gross, which were later confirmed by Levaditi & McIntosh, three
subcutaneous injections of 0.05 gm. each, likewise two adminis-
trations of 0.1 gm. atoxyl per os, protected chickens against a
simultaneous or an immediately preceding or subsequent sub-
cutaneous virulent infection, and chickens treated in this man-
ner apparently acquired a lasting immunity.

Affected chickens, which have already harbored spirochetes
in their blood for 2 to 3 days, but which are not yet severely
affected, recover from a single intra-muscular injection of 0.05
gm. atoxyl, when the parasites disappear from the blood after
34 hours and the animals survive. In the internal application
of the remedy double doses (0.1 gm. per os) appear to have
the same action. ;

Uhlenhuth & Manteufel found atoxylate of mercury more
effective than atoxyl; by its intra-muscular application (in sus-
pension with olive oil and gum arabic), in doses of 0.1 gm.,
it produced recovery even at the height of the blood infection,
and in earlier stages it prevented a fatal termination even in
doses of 0.04-0.06 gm. Such recovered chickens remain immune
against later infections.

Dschunkowsky & Luhs obtained good results in geese with
2 or 3 subcutaneous injections of 0.1-0.15 gm. each of atoxyl,
per kilogram of body weight.

Finally, according to the favorable results in the treat-
ment of the human recurrent fever and syphilis, Ehrlich’s
amidoarsenobenzol may also prove effective.

Immunization. Blood drawn from infected chickens is no longer
infectious after 48 hours, and if injected subcutaneously into healthy
chickens produces an immunity against a virulent affection. Fresh
blood heated for five minutes to 55° C. has a similar action, whereas
when heated for 10 minutes at that temperature it no longer produces
immunity (Marchoux & Salimbeni). An active immunity may further
be produced in geese with emulsion from organs of geese dead of tthe
disease, also with atoxyl and a simultaneous injection of virulent blood,
as well as with blood from infected geese which have been kept on ice
for some time (Dschunkowsky & Luhs). Blood serum from geese and
chickens, which after recovery from the disease were treated with blood
containing spirillae, protects in quantities of 2 ec. against virulent
infection. Finally horses produce serum after repeated injections with
blood containing spirillae which in a quantity of 3-5 cc. renders ineffec-
tive in geese an inoculation made 24 hours previously (Sakharoff).

Injections of immune serum in the blood circulation of affected birds results
in death, as it produces an agglomeration of the spirochaetes and thereby thrombosis
of the blood vessels (Levaditi).

Literature. See also literature in Uhlenhuth & Gross, Arb. d. G.-A., 1907.
XXVII. 231. — Further: Sakharoff, A. P., 1891. V. 564. — Gabritschewsky, Chl.
f. Bakt., 1898. XXIII. 365. — Cantacuzéne, A. P., 1899. XIII. 529. — Borrel &
Marchoux, Soe. biol., 1905. 362. — Borrel, ibid., 1906. — Levaditi, A.'P., 1906, XX.
924, — Levaditi & McIntosh, Soe. biol., 1907, XLII. 1090. — Neufeld & Prowazek,
Arb. 7. G.-A., 1907. XXV. 494, — Uhlenhuth & Manteufel, Z. f. Immf., 1908. I. 108.
_ Dschunkowsky & Luhs, Kongr. Haag 1909. — Brumpt, Soe. path. exot., 1909. ITI,
Spirochaetes in Mammals. 843

Spirochaetes in Mammals. Parasites resembling the spirochaetes
of fowls morphologically occur sometimes also in mammals, . their
etiological part however is at present not yet cleared up, as they were
met with either in healthy animals or in such as are infected with
piroplasma or trypanosomes. Transmission experiments have not given
conclusive results. The available findings are therefore described only
very briefly in the following:

1. Spirochaete (Spirillum) Theileri. First demonstrated by
Theiler (1902) in the Transvaal in febrile animals together with piro-
plasma and trypanosomes. They are 20-30 » long, spiral-shaped bodies.
The first experiments of transmission were without results, later how-
ever Theiler reported that he succeeded in transmitting the parasite
from cattle to cattle and to sheep, and Dodd also found that they
may be transmitted from animal to animal.

According to Theiler the natural infection is transmitted by the
Boophilus decoloratus and the Rhipicephalus Evertsi, and Laveran
& Vallée succeeded in infecting a cow at Alfort, by placing larvae
of the .first-named species, which originated from ticks taken from
cattle in the Transvaal. In this case spirochetes appeared in the blood
between the fifteenth and the nineteenth day without the development

_ of perceptible symptoms. Nevertheless Theiler believes that these
parasites are independently capable of producing a disease, the autopsy
findings of which. resemble those of piroplasmosis.

Evidently the same spirochetes were found by Ziemann in Kamerun in a
calf, by Heanley in two Chinese buffalo calves, and by Koch in Daressalam in
cattle.

2. Spirochaetes Tschischir, demonstrated by Djatschenko in
Kuban (Russia) in the blood, spleen and liver of cattle which were
affected with symptoms of an infectious hemoglobinuria. The parasite
has the form of a comma or of an ‘‘S’’ and ean te cultivated artificially
(Vibrio?). Transmission experiments were negative.

3. Spirochaete Ovina, found by Martoglio & Carpano in Erythtaea
simultaneously with endoglobular parasites in a sheep affected with
febrile symptoms. It forms threads 10-20 # long, with 4-10 spiral
windings; artificially they could not be transmitted.

Theiler also reports finding spirochaete in sheep in the Transvaal, and Zie-
mann in Kamerun (Dodd considers them identical with the Sp. Theileri).

4, Spirochaete Suilla, found by Dodd in Pretoria in the tissue
of superficial ulcers of the skin, which extended over the entire body
of hogs (10-14 # long, with 2-6 spiral windings). Material from the
ulcers rubbed into the scarified skin of healthy hogs produced a similar
skin affection, which under progressive emaciation usually led to death.
Similar parasites were found by Cleland in West Australia in fibrous

nodules of castration wounds.

5, Spirochaete Equina. Stordy in East Africa found spirillae
in very great numbers in the blood of a horse which showed a fatal
affection with symptoms of high fever, swelling of the subcutis and
emaciation. A similar finding is reported by Stordy in a severely
844 Spirochaetosis in Man.

affected pony, whose blood transmitted the parasite to horses, cattle and
sheep, and he considers them identical with the Sp. Theileri.

Literature. Theiler, J. of Comp. Path., 1904. XVII. 47; Bull. P., 1905. IT.
617. — Djatschenko, Chl. f. Bakt., 1904. XXXV. 737. — Martoglio & Carpano, Ann.
d’Igiene sperim., 1904. XIV. 577. — Laveran & Vallée, C. R., 1905, CL. 1515. —
Ziemann, Obl. f. Bakt., 1905, XXXVIII. 447. — Dodd, J., of Comp. Path., 1906.
XIX. 318. — Heanley, ibid., 8. 322. — Stordy, ibid., S. 226. — Titze, Z. f. Infkr.,
1908. IV. 139. (Review with literature). — Knuth, ibid., 1910. VII. 149 (recent lit.).

Spirochaetosis in Man. Recurrent fever (Febris recurrens) is
known as a spirochetosis and is caused by the Spirochaete recurrentis
s. Obermeierei discovered by Obermeier (1868). The affection is mani-
fested by severe febrile attacks lasting from 3 to 12 days, and recurring
after 2 to 11 days. In most cases lasting recovery results after several
febrile attacks. The natural transmission appears to result through
the agency of blood-sucking arthropodes, possibly also by insects and
lice. According to the most recent observations of Iversen in Russia
the disease may be cured quickly and permanently with Ehrlich’s
Amidodrsenobenzol.

A similar affection in the tropics, the African recurrent fever, or
‘tick fever,’’ is produced by the Spirochaete Duttoni (according to.
Koch identical with the above), and is transmitted to healthy man by
a tick (Arnithodorus moubata). (Schilling, Mense’s Handb. d. Tropen-
krankheiten, 1906, ITI, 668.)

Since the discovery by Schaudinn of fine spirochaetes (Sp. pallida,
Treponema pallidum) in the syphilitic organs, syphilis is also con-
sidered as a spirochetosis. This view has received material support by
the splendid results of Ehrlich’s chemotherapy. Besides a spirochete
(Sp. pertenuis) was found by Castellani, as a probable cause of the
disease in Framboesia tropica, a skin affection of the tropies which
clinically resembles syphilis. (A. f. Schiffs- u. Tropenhyg., 1907, XJ, 22.)
STS Ne

Diseases of the Blood and Blood-
Producing Organs

1. Anemia. Anaemia...

The name anemia designates the absolute diminution of
the hemoglobin in the blood without a visible affection of
the blood-producing organs and without symptoms of abnormal
leucocytes in the blood. These pathological conditions may
depend either upon a more or less uniform diminution of all
of the constituents of the blood (Oligemia), on the diminution.
of red blood corpuscles (Oligocythemia), or on a simple dimi-
nution of the blood-coloring matter in the presence of otherwise
normal numbers of red blood corpuscles (Oligochromemia).
In the majority of cases Oligemia and Oligocythemia are
present simultaneously, and in severe cases the water contents
of the blood is considerably increased at the expense of the
other constituents (Hydremia).

Etiology. After profuse losses of blood a severe anemia
may develop in a short time, sometimes even in a few minutes
(Anemia acuta); thus after phlebotomy, epistaxis, after injury
of larger blood vessels, after bursting of aneurysms, after very
profuse parenchymatous bleeding (hemoglobinuria, intestinal
hemorrhages, ete.), also after severe hemoglobinemia.

In the majority of cases the development of the anemia.
oceurs slowly and gradually (Anemia chronica). Thus re-
peated losses of blood may in time produce anemia. A con-
tinuously insufficient nutrition has an important part in the
ctiology of anemia. The unfavorable action of the food may
become manifested either as a result of an insufficient quantity
by feeding foods deficient in proteids or iniron. The effect of a
qualitatively insufficient nutrition may be assumed in anemia of
sheep (the so-called chlorosis, Cachexia aquosa), which develops
when the animals are pastured in marshy moorland pastures,
or after failures of crops if the animals are fed in winter in-
sufficiently on poor food-stuffs such as beet leaves, ete. In
cattle a continuous feeding on food lacking in nutritive ma-
terial may also cause severe anemia (Hydremia). Thus the

845
846 Anemia.

affection results with relative frequency in cattle kept near
alcohol distilleries or sugar refineries (Jost, Hildebrandt,
Arloing), where the principal food consists of the very watery
(up to 95%) slops, beet shavings or the syrup-like fluid remain-
ing after the refining of the sugar. The affection attacks
preferably working oxen, which must utilize a part of the other-
wise insufficient nutritive substances for the execution of their
work; also because they have less opportunity after satiating
themselves with food substances abounding in water, to partake
of additional solid fodder (Roloff). Horses, sheep and goats
become affected from the same cause much more rarely. In
this form of anemia toxic substances and acids which form
during the storing of these foods apparently have an accessory
action. (Arloing attributes the development of the disease
exclusively to the action of these substances.) Werner observed
anemia and hydremia in hogs in connection with the feeding
of watery food.

The anemia of sheep and cattle previously mentioned is considered by various
authors as an independent affection under the name of chlorosis of sheep, or as
hydremia of cattle. This does not appear well founded on account of the fact that
these conditions are differentiated from the other forms of anemia only by special
etiological factors, the pathological changes corresponding with those of other
forms.

_ The investigations of, Carré & Bigoteau appear to show that the chronic
intoxication of sheep produced by the bacillus pseudo-tuberculosis ovis (Preisz)
may result in a hydremic condition of sheep.

The keeping of animals in poorly ventilated places as well
as lack of exercise, may in itself produce anemia, as is some-
times observed in fattening hogs, in milch cows, house dogs, ete.

Anemia may develop as a regular symptom in chronic
affections with disturbances of appetite or of digestion, or in
affections with great loss of proteids (long Jasting suppuration,
albuminuria, persistent diarrhea, effusion of copious transudate,
exudate, helminthiasis, ete.), or in increased splitting up of
proteids (fever, action of bacterial toxins in various chronic
infectious diseases, mineral poisons, malignant tumors).

Blood parasites may be mentioned as another cause of
anemia (piroplasma, trypanosomes, Filaria immitis).

The anemia of sucking pigs and young hogs, which has been ob-
served by Braasch in Schleswig-Holstein and which caused great losses
in some localities, is not yet sufficiently cleared up. This very severe
anemia which appears already in the first weeks of life, may be the
result of an unnatural keeping of the breeding hogs, but the action
of an infectious substance (bacillus pyogenes) cannot be excluded with:
certainty.

Guittard reported on a disease in chicks which appeared in some
localities of France as an infectious anemia with symptoms of severe
anemia and weakness, developing soon after hatehing, and resulting
in death in a few days.

The occurrence of chlorosis in animals is not yet proven. In human medicine
a disease is designated by this name, which usually oceurs during the period of
Etiology, Anatomical Changes, Symptoms. 847

puberty, especially in girls, and is associated with a diminution of the hemoglobin
contents of the red blood corpuscles. It subsides after a systemic administration
of iron. The affection of sheep designated under this name is, as already men-
tioned, not identical with this disease.

Anatomical Changes. All organs of animals which have
died as a result of hemorrhage are characterized by a con-
spicuous paleness and by the absence of blood; this is most
readily recognized in the lungs, which appear pale pink in color.
At the same time the heart and the large blood vessels con-
tain only small amounts of loose blood coagulum. In chronic
anemia blood is frequently found in nearly normal amount in
the heart and in the blood vessels, but it appears paler, more
watery, stains the hand only slightly and contains only little
loose gelatinous coagulum. Fatty degeneration of the parenchy-
matous organs, especially of the heart muscles and of the
kidneys is not infrequent. Dropsieal development is almost
constantly found in chronic fatal anemia.

Symptoms. The symptoms of acute anemia develop in ac-
cordance with the severity of the hemorrhage, sometimes very
rapidly, at other times somewhat more slowly. The animals
become much depressed, perspire profusely, stagger and sway
in walking. The mucous membranes become gradually more
and more pale, finally even porcelain white; the heart action
is throbbing, the pulse at first frequent, tense and small, later
however soft and empty. The respiration is accelerated and
labored; a conspicuous cooling off develops in the peripheral
parts of the body; there is also muscular trembling. If the
animal has lost great quantities of blood within a short time
its entire behavior expresses great anxiety, it sways, finally
falling to the ground, becomes unconscious and dies in con-
vulsions if the bleeding continues. .

The symptoms of chronic anemia develop much more
slowly and persist for a longer time. The mucous membranes
appear very pale, pink colored, in severe cases almost milky
or porcelain white. There is languor, easy fatigue even on
quiet walking; after prolonged exercise the animals commence
to sway and sometimes even fall to the ground. At rest they
appear somnolent and indifferent and lie down a great deal.
The frequency of the heart action increases considerably, even
on very slight external causes. The heart sounds sometimes
become imperceptible or indistinct owing to the false sounds;
the pulse is at the same time weak. In severe cases slight
hemorrhages appear in various organs. Further symptoms of
severe anemia are diminished appetite, irregular movement of
the bowels, accelerated and superficial respirations, lusterless
hair, in sheep dryness and dullness of the wool. The nutrition
is at first, and sometimes also in the later stages satisfactory,
the anemia however which is caused by organic affections or
insufficient feeding causes emaciation.
848 Anemia.

Corresponding to the intensity of the affection the blood
appears lighter, its hemoglobin content diminished (in the
determination with Fleischl’s or Gower’s hemoglobinometer
under 70°, in very severe cases even between. 30-40°). The
number of red blood corpuscles is diminished and may fall to
3,000,000 to 2,000,000 per cubic millimeter. Besides in severe
cases the red blood corpuscles may show a poikilocytosis; that
is they are smaller or larger, angular, elongated, supplied with
projections, club or biscuit-shaped. Not infrequently, especially
in an anemia which has developed rapidly nucleated red blood
corpuscles may be found (erythroblasts) in suitably stained
preparations (with hemotoxylin-eosin), further in some of the
red blood corpuscles basophilic granules, the remains of broken-
down nuclei of the erythroblasts are observed. The number of
white blood corpuscles is, as a rule, increased on account of the
increase of polynuclear leucocytes (in one of the authors’ cases
180,000 white blood corpuscles could be counted per cubic milli-
meter of blood). Through these, also as a result of the diminu-
tion of the red blood corpuscles, the numerical relation of the two
becomes much closer (in one case of anemia caused by the
Filaria immitis, the authors observed the relation of red blood
corpuscles to the white as 18:1), so that the examination of
unstained blood preparations may cause confusion with
leukemia. :

As the clinical methods of blood examination give only relative values of
a certain volume, the degree of anemia cannot always be established from the
number of red blood corpuscles or from the hemoglobin content, especially so
since the proportional values may be normal in spite of the present anemia, for
instance in the oligemia which occurs exceptionally without qualitative changes of
the constituents of blood, as well as in all those cases of anemia in which the

animal lost either too much water or had not taken any water, and in which
a thickening of the blood resulted in consequence (Wetzl).

After a time edematous swellings appear on different parts
of the body, on the lower abdomen, lower chest, in the sub-
maxillary space, at the lower part of the extremities, being not
sharply circumscribed, but flat swellings of doughy consistence.
The eyelids may show a pad-like swelling and an effusion may
take place into the body cavities. The edematous swellings
are especially extensive and prominent after feeding very
watery food stuffs, thus in anemias of cattle in sugar factories
the swelling may increase to such an extent that it renders the
movement of the animal entirely impossible. In this stage of
the disease the animals are usually affected with diarrhea, by
which they are weakened still more, finally they are unable to
stand up and succumb.

Jost, Hildebrandt and Moussu have described other peculiar mani-
festations in hydremia of cattle in sugar factories. Sometimes the
affected animals suddenly collapse during walking, others dic after.a
sickness lasting but a few days in the course of a few hours as if struck :
by apoplexy. Some are entirely incapable of passing feces as a result,

ue
Symptoms, Course, Prognosis. 849

of the weakness of the abdominal and body muscles. There is polyuria,
in which a very pale watery urine of low specific gravity is passed;
sometimes profuse salivation is present. In acute cases the autopsy
may reveal a gastro-intestinal inflammation.

Course. Great losses of blood may produce death inside
of a few hours, or even in a few minutes, while the duration
of chronic anemia may extend to several months and even years.
This occurs especially in anemia which develops in association
with chronic diseases. Ascites of sheep and cattle lasts at
least from 3 to 6 months or even longer, but some animals may
die in a shorter time. The last mentioned short course may
rr be only apparent if the first indications escape de-
tection.

Diagnosis. The recognition of anemia causes, as a rule,
no difficulty. It may be confounded, especially on a single
examination, with pronounced weakness of the heart and a
general collapse of the blood vessels which result also in a
conspicuous paleness of the peripheric parts of the body.
Simple anemia is distinguished from pseudo-leukemia or from
leukemia by the normal condition of the blood-forming organs,
and also by the condition of the white blood corpuscles. Fur-
ther the milder cases may be distinguished from pernicious
anemia by the normal appearance of the blood corpuscles, on
the other hand from the severe cases by the absence of giganto-
cytes and gigantoblasts, as well as by the severe general affec-
tion. In horses infectious anemia should also be taken into
consideration.

In all cases of anemia however it should be aimed to de-
termine the fundamental affections, the recognition of which is
of great value from a prognostic and therapeutic standpoint.

Prognosis. The acute anemia which develops after great
losses of blood terminates with suitable nutrition of the animal
almost without exception in a relatively short time in recovery.
By the ingestion of large amounts of water the blood attains
within a few days its original quantity, the salts and the proteids
being rapidly replaced from the food. Only the replacement
of the red blood corpuscles requires a longer time, up to several
weeks; after exceedingly large losses of blood the recovery may
require even several months, and may not follow at all even
after suitable treatment. If the animal has lost at least half
of the normal quantity of its blood within a short time, there
exists no longer any hope for its improvement,

The prognosis of chronic anemia depends on the nature
of the fundamental affection. In the independent forms how-
ever the prognosis depends, not only upon the degree of anemia,
‘but also upon the condition that the cause of the disease ig
capable of removal, although under favorable conditions the
disease usually terminates in recovery, the course of an already

Vol. 1—54
850 . Anemia,

existing dropsy can no longer be influenced in spite of suitable
care and treatment.

Treatment. In acute anemia, if bleeding still continues,
the hemorrhage should first of all be arrested; in external hemor-
rhage by surgical measures, internal bleedings by the adminis-
tration of hemostatic remedies. Most satisfactory are Ergot
(15-25.0 or 0.5-2.0 gm. of the extract; 5-10.0 or 0.2-1.0 gm.
per os; the extract may also be used subcutaneously in half
doses), ’ Ergot i in (1-2.0 or 0.02 to 0.2 gm.) Extractum hydrastis_
(10-15.0 gm. subcutaneously for horses) ; very good results may
further be obtained by intravenous injections of adrenalin or
suprarenin (1-5 ec. of a solution of 1:1000 per 100 kg. body
weight). The transfusion of blood from a healthy animal of the
same species can hardly be accomplished in practice, while the
infusion of physiological salt solution into the veins (combined
with adrenalin or suprarenin), or into the rectum is frequently
carried out and may be a life saver. In cases developing less
suddenly an increased partaking of water may increase the
fallen blood pressure, the ingestion of water should however
be permitted only after the cessation of the hemorrhage.

Berger always obtained good results by infusions of salt solutions into the
rectum (10-20 liters of a 0.6% solution for horses and cattle). The infusion should
be made slowly and the rubber tube of the irrigator should be introduced far into
the rectum.

Flatten, Dorn and Frick constructed suitable appliances for the application
of intravenous injections of physiological salt solution, but the infusion may ke
carried out in emergency with the aid of a simple rubber tube and funnel. The
solution should be sterilized by boiling and then cooled down to body temperature.

Albrecht repeatedly injected defibrinated blood drawn from healthy horses
under the skin of affected horses. The blood, which was kept at 40° C., was
injected in quantities of 80 cc. with the aid of a syringe of suitable size into
various parts under the skin of the abdomen and facilitated the absorption by mas-
saging the place of injection. In this manner he succeeded in injecting 1%
liters of blood under the skin of the abdomen in 3 short time.

In all cases of anemia special care must be taken in regulat-
ing the diet. The necessary substances for the formation of
blood (proteids and nutritive salts) should in the first place
be given in increased amounts. Best adapted are nutritious
food stuffs (oats, barley, legumin, good hay, meat, ete.), in
very weakened animals yolks of eggs, milk, strong bouillon
mixed with eggs, in the absence of appetite the animals should
be drenched with this food. In primary anemia with normal
digestion the purely dietetic treatment alone frequently pro-
duces an improvement progressing from day to day and even
complete recovery may result in a relatively short time. The
food should be given in small rations but frequently. In anemia
brought on by feeding food stuffs lacking in nutritive qualities,
above all substances saturated with water, recovery may be
obtained in such cases which are not very severe, by a suitable
change in food, particularly by the substitution of dry foods.
An edema which may be present does not require any special
treatment.
Treatment. 851

Of the medicinal agents iron is first to be considered. The
selection of the iron preparations is considerably influenced
by its price, otherwise the iron preparation should be adminis-
tered for a long time and in not too small doses. Of the
numerous preparations employed Ferrum pulveratum (2-5 gm.
for large animals, 0.5-1.0:gm. for sheep, 0.02-0.1 gm. for dogs,
should be given for a dose three times a day), Ferrum sulfuricum
(in same doses) may be mentioned. It is advisable to administer
both with stomachics and salines. For drinking water the
water in which the red hot pieces of iron are cooled in black-
smith shops, may be given. For small animals Ferrum hydr.
reductum (0.005-0.01 gm. with sugar in powder), Ferr. lacticum
(0.02-0.1 gm.), or Tinct. Ferri pomati (10-20 drops), are suita-
ble. In the presence of inappetence a small quantity of hydro-
chloric acid should be added to the drinking water. Arsenic
(of Fowler’s solution 10-30 gm. for large animals, 2-10 drops
‘for small; 0.1-0.3 gm. or 0.001-0.005 gm. of the arsenious acid)
may also be administered, as according to experience it aids
metabolism. In small animals the Tablettae ferri peptonati
cum arseno sec. Bleyer may be conveniently administered (daily
1 to 3 tablets). Evers treats anemia with Damholid (100 gm.
of a fresh solution subcutaneously for large animals, for. small
animals the same amount per os).

Literature. Arloing, C. R., 1892. 776. — Berger, B. Mt., 1902. 8. —
Braasch, Monh., 1891. II. 59. — Carré & Bigoteau, Rev. gén., 1908. XI, 433, —
Dorn, B. t. W., 1906. 433. — Dralle, A. f. Tk., 1886. XII. 71. — Evers, B. t. W.,
1905. 201. — Flatten, Ibid., 1906. 697 — Frick, D. t. W., 1904. 253. — Guittard,
Pr. vét., 1897. 32. — Hildebrandt, Pr. Mt., 1857/58. 114; 1858/59. 120. — Jost,
Ibid., 1857/58. 114. — Petzold, S. B., 1863. 86. — Pflug, W. f. Tk., 1857. 413, —
Plate, B t. W., 1906, 713. — Pr. Vb., 1902. II. 34. — Werner, W. f. Tk., 1897.
186. — Wetzl, Klinische Blutuntersuchungen, Diss. Budapest 1908.

2. Infectious Anemia of Horses. Anaemia Infectiosa Equorum.

(Swamp fever of horses, Malarial fever of the horse, River
bottom disease, Loin distemper; Infektidse Blutarmut der
»Pferde [German]; Anémie infectieuse, Anémie per-
nicieuse, Typho-anémie infectieuse du cheval
[Carré & Vallée], Anémie pernicieuse
progressive, Anémie épizootique

[French].)

Infectious anemia is a specific infections disease of the
horse species which is manifested sometimes as an acute, at
other times as a chronic septicemia, and causes a destruction
of great numbers of red blood corpuscles. It is caused by
an ultra-microscopical microorganism.

History. Originally it was without a doubt confounded with the
idiopathic simple anemia. As an independent disease it was first de-
scribed by Lignée (1843), and almost simultaneously by Charlier (1843)
852 Infectious Anemia of Horses.

and Dénoe (1843), and was associated with conditions of feeding, the
more so as later Delafond (1851) failed in its artificial transmission.
Its infectious nature was first indicated by Anginiard (1859). Later
Zschokke (1883) reported several cases of pernicious anemia observed
by him in Switzerland, which in part developed as an outbreak, and
clinically as well as anatomically completely corresponded with the
infectious anemia, the same as the cases observed somewhat later by
Fréhner (1886) and Ostertag (1890) in Germany. As a matter of
fact Fréhner considered the pernicious anemia of horses even at. that
time as an infectious disease. The nature of the disease was cleared
up in all details by Carré & Vallée (1904-1906) ; further contributions
on the disease were furnished by Ostertag (1907), Marek (1907) and
Hempel (1909).

Ekwall (1895) described an enzootic anemia of horses in Sweden,
which also corresponded with the infectious anemia clinically and
anatomically, but its identity with infectious anemia cannot be estab-
lished positively for the reason that Brickmann recently (1904-1906)
demonstrated parasites in the blood in a similar affection of horses.

Occurrence. The disease is observed among horses, al-
though other solipeds may be infected artificially, and it is
probable that they may here and there become also affected
by natural infection. It appears in more or less circumscribed
localities, in the first place in marshy places, usually as
a disease confined to single or several adjoining premises, and
causes considerable economic loss because the disease as a rule
leads sooner or later to death. Sporadic cases of the disease
may also be observed, namely, through the introduction by
newly purchased affected or infected horses, which then under
certain conditions may alone become affected, while the other
animals of the premises may be spared.

In France infectious anemia prevails in the northeastern territories, above
all in the entire valley of the Meuse, further in the districts of Aube, Marne,
Céte-d’Or, Meurthe-et-Moselle, and was recently observed by Dupas also in Chélons.

In some of the localities it causes very great losses, which according to Vallée are
estimated for the Department at 200,000 franes annually. ;

In Germany the disease occurs less extensively than in the adjoining terri-
tories of the infected French districts, especially in Lorraine (Képke, Jarmatz,
Ostertag), further in the district of Trier. Hochstein observed it in a horse stable

in Bavaria.
-In Hungary the disease was established by Marek upon three premises in

three different counties.
From what was already said it appears that the disease occurs also in

Switzerland and probably in Sweden. It was likewise observed in Mexico.

To all appearances infectious anemia of horses has a far greater geographical
distribution than appears from the data mentioned, only it is frequently confounded
with other internal diseases. Thus in certain eases the so-called skalma is probably

as a matter of fact an infectious anemia.

Etiology. The fundamental investigations of Carré &
Vallée, the results of which were later fully confirmed by Oster-
tag and Marek, showed that the contagion of infectious anemia
belongs to the ultra-microscopical microorganisms. The virus
passes the porous (Chamberland-Berkefeld) porcelain filters
and cannot be demonstrated by staining methods or by cultiva-

tion.
Etiology, Pathogenicity, Natural Infection. 8d3

The virus is present in the blood, in the urine and in the
feces of the affected, also of the apparently recovered animals.
The saliva has no infectious properties (Ostertag). Whether
there exists any kind of a relation between infectious anemia
and horse pest has not been decided (see p. 286).

Tenacity. The virus loses its virulence entirely when heated to 58° C., dry-
ing at room temperature does not influence it; thus dry blood serum was found
harmless only after seven months (Carré & Vallée). In storing the blood without
drying it loses its infectiveness only after three months. The virus resists putre-
faction for a long time, even in strongly ammoniacal substances (urine, manure).
Thus Carré & Vallée found urine of an infected horse, kept in a manure pit, virulent
even after 214 months. :

Pathogenicity. The disease may be produced artificially
in horses by intravenous or subcutaneous administrations of
virulent blood or blood serum, immaterially whether larger
quantities (up to 750 ec.) or very small quantities (1 ec.)
are injected (Carré and Vallée). The disease of the test
animals is indicated by a febrile rise of the temperature, which
according to Carré and Vallée always occurs within 5 to 9
days; in one of Marek’s cases however the incubation lasted
for 18 days. The disease in test animals rarely develops with
the same characteristics as in animals from which the blood
has been procured. To produce a successful infection per os,
larger quantities (at least 15 cc.) of virulent blood or urine
are necessary according to Ostertag, and in such cases the
incubation also extends over a longer time, 15 to 24 days. The
incubation period may however be shortened by the repeated
administration of great quantities of virulent material. Donkeys
cannot always be infected (Carré & Vallée, Marek), while other
domestic animals, also small test animals are entirely resistant
(Carré & Vallée, Ostertag, Marek). Man also resists the in-
fection.

The experiments of Ostertag. and Marek proved that, after an intestinal as
well as subcutaneous or intravenous infection, the disease in test horses not infre-
quently runs a chronic course, and aside from periodical rises in temperature, for
a long time causes no noticeable disturbances, a condition which deserves notice
in transmission tests.

Natural infection may occur indirectly through the inges-
tion of food or drinking water contaminated by urine or with
-feces of affected animals. As the urine and feces always con-
tain the virus, but especially. during the febrile attack, and as
it is very resistant against outside influences, there is an ample
opportunity afforded for indirect infection. The virus is taken
up either with the bedding or with the grass in the pasture,
or the food may become contaminated by attendants or in
other ways, especially in insanitary stables. With the ichor,
or more directly with feces or urine, the virus may contaminate
the drinking water, for instance by draining from the manure
‘pit or in the pasture. On the other hand a direct transmission
does not appear to occur. Carré & Vallée failed in demonstrat-
854 Infectious Anemia of Horses.

ing an intermediate action by any parasitic insects. Contrary
to this Ries asserts that the infection is transmitted by the
larvae of gad-flies or mosquitoes. He failed however to sub-
stantiate his contention by experimental proof.

Infection only results when either large quantities of viru-
lent material are taken at one time, or from the taking of smaller
quantities at frequent times. Accordingly the occasional in-
gestion of a mouthful of contaminated hay or straw does not
appear at all dangerous (Ostertag).

Whether the affection which sometimes occurs in the suck-
ing foals of affected mares, results from an intrauterine con-
tamination or an infection through the milk cannot be decided.

The introduction of the disease in previously uninfected
premises invariably occurs through newly bought, affected or
apparently recovered horses, whose blood however continues to
retain its infectiousness (Marek). As long remissions are by
no means rare in the chronic forms of the disease, and as in
the cases of slow course only very few apparent symptoms
are generally noticeable, it happens not infrequently that horses
suffering with the disease are offered for sale.

Anatomical Changes. The infectious anemia of horses is
characterized by the anatomical changes of an acute or chronic
septicemia, with visible changes of the blood, in which the
changes depending on the duration of the disease may show
very pronounced variations.

The spleen in acute cases, or in animals which have died
during a relapse of the disease, appears considerably enlarged,
sometimes double or four times its size. Its capsule is tense
and covered with hemorrhages, the pulp is blackish-red, dis-
tended, mushy, sometimes even liquefied, as in anthrax. Some-
times in the otherwise normal or more or less enlarged spleen,
various sized nodulated protuberances are found, which repre-
sent softened areas of a blackish-red color. The slower the
course the less marked is, as a rule, the swelling of the spleen,
while in a very protracted course it may be entirely absent,
but in such cases the consistency of the organ is rather some-
what increased. All of the lymph glands of the body show
acute swelling and a hemorrhagic condition is noted in cases
in which hemorrhages have occurred in the corresponding
organs; in chronic cases however the lymph glands either fail
to show an edematous swelling or it is but slight. Subserous
hemorrhages are usually found. In chronic cases however
they are not prominent. Hemorrhagic spots up to the size
of a silver dollar are especially numerous under the peri-
toneum of the cecum and colon, they occur also, but in
smaller numbers in other parts of the peritoneum. <A yel-
lowish or reddish serous fluid may be present in small quan-
tity in the abdominal cavities. Usually numerous hemorrhagic
spots are seen in acute cases under the capsule of the more
Anatomical Changes. 859

or less enlarged liver, the substance of which is usually yellowish,
discolored, and may be so brittle that a rupture may result
(Carré & Vallée). In the intestinal mucous membrane either
single, roundish hemorrhages appear, or the mucous membrane,
especially in the large intestines, may
manifest diffuse hemorrhages, when
a more or less bloody consistency of
the intestinal contents is noted.
Hemorrhages are less frequent in the
stomach, but they may sometimes oc-
eur. The heart, with the exception of
the very slow cases, shows subperi-
or subendocardial and intramuscular
hemorrhages, their number and size
being usually in an inverse proportion
to the duration of the disease (in very
acute cases the heart appears as if
sprinkled with blood). The kidneys
and the lungs contain small hemor-
rhages only in acute cases, at the same
time there is always a parenchyma-
tous inflammation of the kidneys,
heart muscle, and the liver substance.
The mucous membranes of the urinary
bladder sometimes show hemorrhagic
spots of recent or older origin.
Conspicuous and constant changes
are present in the bone marrow. In the
proximal long bones of the extremi-
ties, especially so in the bones of the
upper thigh or upper arm, the bone
marrow is changed, either for its en-
tire length or only in parts, to a dark
brownish-red or blackish-red mass
(Fig. 152). In the cases with slower :
course only various sized ciroum-  pTig.389. , Infections cnemin
seribed areas are found in the fat section; a dark red area in fat
marrow or this may appear normal. marrow; b normal yellow bone
At the same time however the spongy atTon: ¢ diffuse dark red dis:
ii coloration of the spongy mar-
bone marrow shows the above changes row; d small dark red foci.
or at least a reddish discoloration. The
spongy bone marrow of the vertebrae, ribs, ete., manifests simi-
lar changes. Even in the most chronic cases at least small hem-
orrhages are found, which however appear of a peculiar ink-
black color if of earlier origin. This condition of the bone
marrow does not result from hemorrhages, but represents, as
in older losses of blood in general, only a regenerative process,
and consists in an increased activity of the blood-forming ele-
ments of the red marrow areas, the normal occurrence of which,

 
856 Infectious Anemia of Horses.

in the fat or gelatinous marrow, especially in the femur and
humerus was already indicated by Skiba.

In acute cases of the disease the blood shows no peculiar
macroscopical changes with the exception of slower coagula-
tion, while in the more chronic cases indications of an anemia
appear. This is increased in proportion to the duration of
the disease. Moderate edematous infiltrations of the subcu-
taneous, perirenal, as well as in the intermuscular connective
tissue between the mesenteric layers, further icteric discolora-
tion of the tissue are not infrequent occurrences, while marked
emaciation is frequently observed.

Symptoms. The period of incubation after a subcutaneous
or intravenous infection varies between five and nine days,
and may also be the same after an intensive natural infection.
Ordinarily however it probably lasts for 2 to 3 weeks, as was
noted in the experiments of Ostertag and Marek (see p. 854).
With respect to the duration and the symptoms, two clinical
forms of the disease may be recognized to good advantage,
between which however no sharp line can be drawn, and con-
sequently Carré & Vallée have even described a subacute form.

The acute form appears quite suddenly with distinctly
pronounced symptoms. A conspicuous depression and general
weakness develops, as a result of which the animals rapidly
tire, and sometimes even fall down while in motion. Then
they rise only with great difficulty or can regain their feet only

3
a
g
3
2
a
2
a
3
°
=
S
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Fig. 153. Fever curve in the acute form of infectious anemia of horses.

with human assistance. At the same time the weakness, as
in all general infectious diseases, is distinctly noticeable in the
hind parts. Frequent tripping, or an uncertain use of the
hind leg may also be observed quite frequently. Sometimes the
position of the body is similar to that in laminitis.

Fever sets in at the same time (see Fig. 153), and after
a gradual rise of the temperature, reaches its height on the
second or third day (40-40.5°, sometimes even 42° [Carré
Symptoms. 857

& Vallée]),and then it may remain at the same height, at least
intermittently, until the fatal termination of the disease.
Sometimes intermissions of 1 to 2 days are observed (see Fig.
153). The number of pulse beats increases up to 60 to 90
per minute, the pulse appearing weak and soft, the heart’s
action however stronger. Exercise of even short duration
produces a considerable increase of frequency of the heart’s
action and a temporary irregularity of the pulse. .

The conjunctivae appear somewhat swollen and of a uni-
form washed-out red color with a somewhat yellowish tint,
sometimes showing hemorrhages up to the size of a dime, ir-
regular in shape (principally in the membrana nictitans). At
the same time slight lachrymation is present. The nasal mucous:
membrane also appears reddened and shows punctiform hemor-
rhages, especially on the nasal septum. Not infrequently there
is a scanty serous, sometimes also reddish colored nasal dis-
charge, in some instances a cough is also observed.

Diarrhea, with passing of broken balls of feces or fluid
excrement, which may be stained reddish or covered with blood
coagulum is frequently present. The urine is passed at short
intervals, and contains albumen, which may reach 1.5% in
amount but is usually found in much smaller quantities. In
oe sediment of the urine granular or epithelial casts may be

ound.

The appetite is depressed from the beginning. At the same
time a rapidly increasing emaciation is noticeable which may
progress so rapidly that the animals may lose one-fourth to
one-third of their body weight in a few days (Carré & Vallée),
or they may emaciate inside of two weeks almost to skeletons.
Very slight edematous swellings in the distal parts of the
extremities, the lower chest and the lower abdomen, are also
not infrequently observed. :

Coagulation of. the blood is retarded, the separated blood
serum appears darker yellow, or even somewhat greenish and
dichroic. The number of red blood corpuscles diminishes in
proportion to the duration of the disease, so that after 10 to
15 days a diminution of 1,000,000 to 2,000,000 may be demon-
strated. Immediately before the fatal termination however the
number may be reduced to one-half (Carré & Vallée). As the
relative number of the red blood corpuscles depends also con-
siderably on the existing water contents of the blood, there may
be decided variations in this respect, in spite of the fact that
a considerable reduction of the absolute quantity of the red
blood corpuscles exist (see p. 848).

The determination of the relative quantity of red blood corpuscles with a
test tube as first recommended by Zschokke, is particularly suitable for practical
purposes. Any desired test tube is filled with blood drawn from the veins, then is
allowed to stand in water at a temperature of 10-12° C. for a half hour; then the
length of the sections of the test tube measured are those which contain the, blood
plasma and the layer of the deposited red blood corpuscles. Finally the ratio
. between the two is calculated from these measurements. (Normally the length
85

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Infectious Anemia of Horses.

of the blood plasma in the tube, com-
pared with that of the layer of the red
blood corpuscles, is in a ratio of 6:4.)
It is advisable to employ specially gradu-
ated test tubes for this purpose.

The red blood corpuscles
appear pale, and in their cell
bodies basophilic granules
(fragments of the cell nuclei)
may be recognized, which may
be mistaken’ for endoglobular
parasites (Carré & Vallée).
Contrary to the observations
of Carré & Vallée, Ostertag
and Marek found no changes
in the form of the red blood
corpuscles.

According to the view of the authors

the apparent poikilocytoses are frequently
only artifacts. If, for instance, the blood

_is smeared onto a cover glass in a some-

what thicker layer or in a moist place,
the red blood corpuscles assume the most
varied changes of form because of the
somewhat slow drying.

Under gradual loss of the
strength, finally an apparent
paralysis of the hind parts de-
velops; not infrequently how-
ever the animals are capable
of standing almost until the
time of death. In pregnant
mares abortion results almost
invariably.

The duration of this acute
form, according to Carré &
Vallée, is from 5 to 15 davs,
on an average one week, but
according to Marek’s observa-
tions the disease may in young
foals last only 1 to 2 days, and
in adult animals, on the other
hand, not infrequently for 3
to 4 weeks (see Fig. 154). .

The chronic form of the
disease manifests itself with
periodical febrile attacks and.
with indications of anemia,
which is not recognizable in the
acute form, on account of the
peculiar diffuse red coloration
of the mucous membranes.
The febrile attacks appear at
Symptoms. 859

intervals of several days, up to several weeks or even
longer, exceptionally even after months (Carré & Vallée).
They develop without any obvious course, and last from
2 to 3 days or even for several days. The rise and also
the fall of the temperature always occurs gradually (see Fig.
154). During the febrile rise of temperature the pulse is also
more or less increased, sometimes however only very slightly.
In cases which are not too chronic a moderate increase in pulse
‘exists also in the afebrile periods which becomes well marked
even on unimportant external influence, and then appears
weaker. Other febrile symptoms, such as diminished appetite,
depression, muscular trembling are absent in very protracted
cases, so that if no systematic temperatures are taken, in these
cases they can only be recognized in the advanced stage of
their development.

The mucous membranes appear atthe beginning either

normal in color or slightly reddened, in the later stages how-
ever they become continuously paler in color, while during the
febrile attack, or during a temporary improvement of the con-
dition, they may present normal or at least nearly normal color.
Hemorrhages are rare in the visible mucous membranes, but
they may nevertheless occur. :
_ The urine usually contains small quantities of albumen
in the not very protracted cases, otherwise however it may
only appear periodically, especially during the febrile attacks.
Not infrequently a periodical fetid diarrhea sets in, and here
and there colicky symptoms are observed.

Edematous swellings of the extremities, or of the lower
parts of the rump or the head (on the head especially in pastur-
ing animals) are a not infrequent occurrence.

The blood coagulates only slowly also in this form, so that
hemorrhages resulting from external causes can be stopped only
with difficulty. The number of red corpuscles diminishes con-
siderably, even to 2,000,000 per cubic millimeter of blood
(Carré & Vallée). The number of blood corpuscles however
varies not a little in accordance with periodical improvement
or aggravation, and their diminution may in very protracted
cases persist continuously moderate; or on the contrary, after
partaking of food and water there may be present a relative
increase in red blood corpuscles (see p. 848). Changes in the
form of the red blood corpuscles are missed also in this form
of the disease in suitably prepared blood specimens.

The nutrition may be affected from the onset of the disease,
or on the contrary in a slowly progressing case it may remain
satisfactory for weeks or even for months. Finally however
emaciation becomes noticeable even in these cases. It does not
progress uniformly, but at times may come to a standstill or
the nutritive condition of the patients may improve for a certain

time.
In this form the duration of the disease is from one to
860 Infectious Anemia of Horses.

several months; not infrequently however it may even extend
over several years (Marek).

Course and Prognosis. The acute form of the disease
usually leads to a gradual aggravation of the symptoms, death
ensuing without any struggle. Sometimes however it passes
into a chronic form. Death may occur unexpectedly in the
acute as well as in the chronic forms. The chronic form de-
velops from the acute, with a gradual diminution of the severe
general symptoms, or the disease may have developed from
the beginning with a chronic character, when periodical im-
provements or aggravations of varying duration may be ob-
served. The fatal termination results either after the develop-
ment of the cachectic condition or because the disease assumes
an acute course.

Recovery is observed only exceptionally (Carré & Vallée,
Ostertag, Marek). One should not be deceived by the some-
times very lasting improvement in the chronic form, as later
a relapse, or a progressive anemia with emaciation usually
occurs.

In a large stud in Hungary with a great number of horses, in which the
disease prevailed for five years, there were several horses which originally were
affected visibly, but for several years had showed no symptoms whatsoever, but.
even in those rare cases recovery occurred only in a clinical sense, as in one case
blood from one of the apparently recovered animals proved infectious (Marek).
A similar oceurrence had previously been observed by Carré &- Vallée.

The epidemiology of the disease varies greatly with the
duration of the individual cases. Usually, in connection with
the introduction of new horses, only isolated affections occur
at first, the disease taking a rapid course from its onset, while
in very chronic cases the disease is only recognized when a
large number of the horses have already become infected and
affected because the symptoms are for a long time very obscure.
If in such cases no preventive measures are introduced, their
number increases from week to week and the animals become
attacked without reference to age or breed. In stables how-
ever, which have been infected for a long time, the newly in-
troduced animals become affected first and most severely. For
this reason the disease is usually acute in newly _ infected
stables (Carré & Vallée). At the same time animals in other
stables, or of the same stable kept in other pastures and
watered in separate places, remain temporarily free from the
disease at times even for several years.

In a stud in Hungary the disease did not appear among foals, which had been
kept in an isolated stable or on a separate pasture, until four years after
apparently recovered mares had been placed among them.

Diagnosis. In infected localities or in infected stables, the
clinical symptoms, the course of the disease, and the negative
Diagnosis. 861

findings in the various organs, usually afford sufficient indica-
tions for a diagnosis. On the other hand, in localities which
have been free from the infection the disease is recognized
with certainty only on autopsy or from animal inoculations,
while the clinical symptoms arouse only well founded suspicion.
Infectious anemia is indicated especially by changes of a sep-
ticemic character, such as hemorrhages in the serous mem-
branes or in the mucous membranes, further by the regular
discoloration of the bone marrow of the bones of the upper
extremities (not to be mistaken for the normal inclosures of
red marrow!), degeneration of the parenchymatous organs,
swelling of the spleen and edematous infiltration, without other
changes in the organs. The complement fixation has no
diagnostic value (Hempel).

From the standpoint of differential diagnosis the catarrhal
form of influenza barely comes into consideration, in spite of
the fact that its symptoms resemble the acute form of infectious
anemia not a little. Nevertheless it can always be easily ex-
cluded, above all on account of its rapid extension in the
affected stables and by the fact that its course is almost always
rapid and favorable; in influenza the catarrhal symptoms pre-
dominate while hemorrhages in the mucous membranes are
absent. The disease may be mistaken for anthrax in the acute
form of infectious anemia in the living animal as well as on
autopsy. Contrary to infectious anemia however, in anthrax
the rise of temperature is rapid, and at the same time cir-
cumscribed, rapidly extending inflammatory edemas appear not
infrequently on certain parts of the body, also colicky pains
are not infrequent, the conjunctivae are cyanotic, there is
dyspnea, and the disease usually terminates in 1 to 3 days.
If death occurs later than after 10 days anthrax may be ex-
cluded on post-mortem on this ground alone, aside from the
slight anemic indications in the subcutis, and in certain internal
organs, which in anemia are already perceptible after such
a duration. On the other hand in cases of death resulting
within a short time, the bacteriological examination of the
blood or test inoculations are confirmatory. Enzootic spinal
meningitis, the nature of which cannot be yet considered as
definitely cleared up (see Vol. IT), corresponds as described in
its original by Schlegel, clinically and anatomically with anemia
to such an extent that it can be excluded with certainty only
by careful bacteriological examination or by animal inocula-
tion. The piroplasmosis of horses is differentiated by the
distinct icteric discoloration of the visible mucous membranes,
but especially by the microscopical demonstration of piroplasma
in the blood. At the same time however it is advisable to be
cautious, as in the acute cases of infectious anemia fragments
of nuclei resembling piroplasma may be present in the red
blood cells; besides this, the piroplasmosis of horses cannot
be transmitted to healthy animals. Sclerostomiasis in its
862 Infectious Anemia of Horses.

chronic form (Glage) runs an afebrile course contrary to
chronic infectious anemia, and attacks colts exclusively, while
in its more acute form (Schlegel) only the autopsy or the
demonstration of sclerostome larvae in the intraabdominal
hemorrhages is decisive. At the same time however the pres-
ence of a few sclerostome larvae in the subserous or submucous
tissues must not be misleading. Simple anemia is distinguished
by its afebrile course and by the demonstration of dietetic
errors of some primary affection or indications of some out-
side influence.

Treatment. A treatment of infectious anemia which
promises positive results is at present unknown. The remedies
used so far, such as quinine, collargol, arsenical preparations,
have either proved powerless or at best only result in temporary
improvement, the same as intensive feeding and keeping the
animals from work. Nevertheless the arsenical preparations
appear to have a favorable influence on the disease, at least
in certain cases, thus Ostertag obtained at times a striking im-
poet from atoxyl (0.5-1.0 gm. intravenously in physio-
ogical salt solution; according to Loewenthal up to 3 gm. of
atoxyl are well tolerated). Marek observed similarly good re-
sults from the cheaper natrium arsenicosum, which he adminis-
tered in gradually increasing doses, from 1-4 gm. per os for
two weeks, and then suspended for a period.

Prevention. In order to prevent the introduction of the
disease the greatest care should be exercised in the purchase
of horses. Horses which are in any way suspicious, and
especially those which without any apparent cause are poorly
nourished, anemic, or easily fatigued, or in which the frequency
of the heart increases considerably from insignificant outside
causes, and in which at the same time the urine contains albu-
men, should not be placed in the horse stable until after sys-
tematic isolation and observation extending over three months
(for instance in the cattle stable). Every newly purchased
horse in infected localities should be subjected to a quarantine
of three months. At the same time the sanitary conditions
of the horse stables should be given full consideration.

In already infected premises the attempt should be made
first of all to isolate all affected horses by systematic tempera-
ture measurements and then to disinfect the stables thoroughly.
The excrements of the affected animals are best disinfected
by packing them for at least one month in piles of about one
cubic meter (Ostertag). At the same time the food and drink-
ing water should be prevented from coming in contact with
the feces and urine of horses. If the disease appears among
pastured horses the apparently healthy animals should be
driven to a pasture which has not yet been used’ by horses,
and the affected animals should be stabled. Finally efforts
Prevention. 863

shouldbe made to remove all affected horses as soon as possible.
This is usually carried out easily in sporadic. occurrences of
the disease or in localities where horse insurance is maintained.

Immunization. The experiments which have been undertaken by Carré &
Vallée along this line with the blood of apparently recovered animals, also with
blood from donkeys or cattle which have been inoculated repeatedly with virulent
material, were unsatisfactory; likewise Marek’s experiments with the blood of an
apparently recovered horse or with blood exposed to various high temperatures,
or which had been treated with a trichloride of iodine solution.

Literature. Brickmann, D. t. W., 1907. 724. — Carré & Vallée, Rev. gén.,
1906. VIII. 593; 1907. TX. 113 (French Lit.). — Ekvall, Tidsskr., 1895. 208. —
Francis & Marsteller, Texas Agricult. Exper. Station, 1908. — Fréhner, A. f. Tk.,
1886. XII. 382. — Hempel, Z. f. Infkr., 1909. V. 381 (Lit.). — Hochstein, W. f.
Tk., 1907. 145. — Jarmatz, Z. f. Vk. 1904. 68. -- Kopke, Z. f. Vk., 1901. 356. —
Meier, Z. f. Tm., 1906 X. 1. — Mohler, The Vet. Journ., 1909. 395. — Ostertag,
Monh., 1890, I. 127; Z. f. Infky., 1907. III..1. — Ries, Ree., 1908. 11. — Vallée,
Bull, 1907. 526. — Zschokke, Schw. A., 1883. XXV. 11. ~

3. Progressive Pernicious Anemia. Anaemia Perniciosa
Progessiva.

By the name of progressive pernicious anemia is designated
in human medicine a severe and gradually progressing anemia,
with the appearance of gigantocytes and gigantoblasts in the
blood (Ehrlich) or with a change in the proportion between
the hemoglobin content and the number of blood corpuscles
in favor of the blood coloring matter (Tallquist), in which
the form of the red blood corpuscles undergoes conspicuous
changes. The disease appears without any apparent cause
(eryptogenetic form of pernicious anemia) or in connection
with certain organic diseases (secondary form of pernicious
anemia).

History. The disease was first described in human medicine in
1868 by Biermer, but was mentioned previously already as idiopathic
anemia by Lebert and Addisson. Since that time the disease has
been observed in a large number of cases in certain localities, especially
in Switzerland, England and Sweden. There exist several publica-
tions relative to the occurrence of pernicious anemia in animals, but
most of them probably allude to the infectious anemia of horses, which
is a specific infectious disease, and according to the blood findings
does not correspond with the progressive pernicious anemia (see p. 851).
Regarding the few remaining cases it is undecided whether they should
be considered as pernicious anemia, because in these cases the diagnosis
was based only on the severity of the anemia and on the demonstration
of a poikilocytosis, which however cannot by any means be considered
as a proof of the pernicious nature of the anemia, since the poikilocytosis
may represent artifacts (see p. 857). At any rate it remains for
thorough hematological investigations to decide how frequently true
progressive pernicious anemia occurs in domestic animals.

Etiology. Nothing positive can be said at present relative
to the cause of primary cryptogenetic pernicious anemia.
Human physicians frequently associate the origin of the disease
864 Progressive Pernicious Anemia.

with certain gastro-intestinal disturbances, at the same time
accepting the action of absorbed toxic substances from the
intestines as its cause. This hypothesis recently received a
substantiation by the investigations of Tallquist, which proved
that certain lipoid substances which develop in the intestines
during qualitative or quantitative changes of the splitting of
the fat and are then absorbed, possess a distinctly hemolytic
action. Berger & Tsuchipa found in fact a lipoid substance
in the gastric and intestinal mucous membrane of such patients,
which could be extracted by ether, and showing about a ten times
stronger hemolytic action than the lipoid substances of normal
mucous membranes.

The development of the disease as a result of a lipoid action
was established experimentally also in secondary pernicious
anemia by Tallquist, which disease sometimes develops in man
in the presence of the Dibothriocephalus latus in the intestines.
A similar origin of the disease is further suspected by Tallquist
in those cases in which the disease develops in connection with
malignant growths in the gastro-intestinal canal.

Certain infectious diseases (syphilis, malaria, tuberculosis) also play an etio-
logical part in man.

From the veterinary standpoint severe anemias are fre-
quently included in this affection, which are caused by gastro-
intestinal parasites (dochmiasis, strongylosis), blood parasites
(trypanosomiasis, piroplasmosis), even those which are pro-
duced by chronic suppurations or other exhausting diseases.

To what extent this broadening of the conception of pernicious
anemia is justified can only be determined when in such cases the
characteristic changes of the blood in the presence of pernicious anemia
are established by thorough hematologic examinations. It is probable
that all of these affections belong to the simple secondary chronic
anemia, which in severe cases may be associated with poikilocytosis,
although in some cases the pernicious nature of the affection cannot
be disputed without further consideration.

Many human physicians count only those cases as pernicious anemia
which at least apparently develop independently (Grawitz).

Pathogenesis. Ehrlich explains the development of the
disease in man in such a manner that the unknown causative
agent produces on the one hand a destruction of the red blood
corpuscles, and on the other a degeneration of the bone marrow,
thereby producing the formation of megaloblasts or megalocytes
in the bone marrow. In opposition to this Tallquist lays the
principal stress on the exhaustion of the regenerative power of
the bone marrow, while he conceived the formation of megalo-
blasts only as a result of the increased functions of the bone

marrow.

Anatomical Changes. The autopsy shows outside of the
changes of the blood yet to be mentioned, in general the same
Anatomical Changes, Symptoms. 865

changes as in severe simple anemia. The bone marrow appears
to be replaced by a raspberry-like mass or sometimes resembles
embryonic bone marrow; it contains fat cells sparingly, but
on the other hand numerous different kinds of red blood cor-
puscles with one or two nuclei, which are either very small or
very large (Babes, Rindfleisch). Not infrequently a relatively
large layer of fat is conspicuous under the skin and surrounding
the internal organs.

Gréhé found iron in large quantities in the spleen and the liver, Quincke in
the spleen and in the kidneys; it was demonstrable by ammonium sulphide, and
probably resulted from the great destruction of red blood corpuscles. Quincke
found 2.1% of iron in the ash.

Symptoms. The disease always commences insidiously.
Ready fatigue, somewhat disturbed appetite, and as a result
a failing of the nutrition as well as a decrease of-the circum-
ference of the abdomen, first direct attention to its presence.
At the same time the paleness of the mucous membranes con-
tinually increases. Difficulty of respiration appears during
work or even during slow walking. The heart’s action is ac-
celerated, now and then throbbing, the pulse is later thread-
like, the heart sounds sometimes appear indistinct.

The blood is pale red in color, sometimes with a yellowish
tint, it coagulates slowly, its specific gravity, as well as its
hemoglobin content, is lower (Lindquist found in one case the
hemoglobin content diminished to 60-80%, Friedberger to
60%). In affected man the hemoglobin content of the blood
is always found to be too high in proportion to the existing
number of red blood corpuscles. The number of red blood
corpuscles diminishes considerably, and they show changes in
form. First of all their non-uniformity in size is conspicuous,
inasmuch as some appear much larger and at the same time
are frequently pale (macrocytes, gigantocytes), others again are
very small, and of an intensely yellow-red color (microcytes) ;
in addition, a variable number of nucleated red blood corpuscles
may be seen (erythroblasts). At the same time the red blood
corpuscles form small money-roll-like groups and some appear
peculiarly wasted, angular, elongated, containing one or more
projections, club or biscuit-shaped, and sometimes entirely
shrunken (poikilocytosis). Friedberger observed in one case
an increase of white blood corpuscles and blood plaquelets. In
blood of affected man large or sometimes nucleated red blood
corpuscles are sometimes found, the diameter of which may
reach up to 20 #, and the presence of which is, according to
Ehrlich, supposed to possess a high diagnostic value; this is
however disputed by some authors. As the pernicious anemia
of man and animals should not show any marked differences
in the blood findings, more attention should be attributed to
the presence of gigantocytes or gigantoblasts in the diagnosis
of pernicious anemia in animals, and also to the relation be-

Vol. 1—55
866 Progressive Pernicious Anemia.

tween the hemoglobin content of the blood and the number of
red blood corpuscles.

The examination of the blood may be carried out by placing a very small
drop of blood on a cover glass from which the fat has been carefully removed by
washing with ether, and whose borders have previously been covered with a layer
of fat, while a drop of physiological (0.9%) salt solution is placed on one of
its surfaces. The blood which is placed into the salt solution is immediately diluted
suitably and is then placed upon a clean slide with the surface containing the
blood drop. The fat-covered borders of the cover glass enclose the blood air tight,
so that the evaporation of water and consequently the shrinking of the blood
corpuscles is prevented. .

If it is desired to stain the blood corpuscles, several thoroughly clean cover
glasses are smeared with a layer of blood by placing a small drop of blood upon
the middle of the border of the cover glass, and then this cover glass is drawn
over another at an angle of 45°, so that the drop of blood is spread in a thin
layer over the lower glass. The specimens are dried in the air and fixed by dry
heat (107° to 110°) for 144-2 minutes, or in alcohol and ether (8a) for two hours,
or in methyl-aleohol for 2-3 minutes. They may be stained with a mixture of eosin
and hematoxylin, or more suitably with Ehrlich’s triacid mixture, especially when
finer details of the white blood corpuscles are desired. This is prepared as follows:
Concentrated aqueous solutions of Orange G., acid fuchsin and methyl green are
prepared in separate containers, and cleared by allowing them to stand for some
time, then 13-14 cc. of the orange solution, 6-7 ec. of the acid fuchsin solution,
15 ee. of distilled water, 15 ec. absolute alcohol, and 12.5 cc. of the methyl green
solution are mixed in the order given; after the addition of the methyl green
solution the mixture is thoroughly shaken, and 10 ce. of alcohol and 10 ce. of
glycerin are added during further shaking. (The mixture may be obtained ready
for use.) The cover glasses are laid with the smeared surfaces upon the mixture,
which should not be filtered. After about five minutes they are washed in run-
ning water and dried. In staining with the triacid mixture the cell nuclei appear
pale green, the red blood corpuscles either orange, yellow or red, the acidophilic
granules of the leucocytes copper red, the neutrophilic granules of the leucocytes
bluish red, while the basophilic granules remain unstained. Instructive pictures
are further obtained by Romanovsky’s method, with its modifications by Giemsa
or arid & Griinwald (the necessary stains for these methods may be obtained ready
mixed).

In the further course of the disease edematous swellings
develop on the lower abdomen and on the extremities. Not in-
frequently hemorrhages from the nasal and buccal mucous mem-
brane may be observed, hematuria or intestinal bleedings may
also occur. The urine sometimes contains albumen and, as in
man, probably also urobilin and more iron.

The temperature shows in some cases variable elevation.

The sensorium appears disturbed from the onset of the
disease. The nutrition always suffers, in some cases however
the emaciation is not especially pronounced in proportion to
the severity of the affection.

Course. The disease either develops acutely so that the
animals die in 6 to 8 weeks after the appearance of the first
symptoms, or it runs a chronic course and extends over several
months. In a more protracted course remissions and exacerba-
tions are observed. The animals die either from exhaustion or
a sudden hemorrhage terminates the disease within a short time.

Diagnosis. The recognition of the disease is always as-
sociated with considerable difficulty. Of importance in this
Diagnosis, Prognosis, Treatment. 867

regard is the very marked diminution of red blood corpuscles,
with which the falling of the hemoglobin content is not propor-
tionate; the striking poikilocytosis and the presence of large
erythroblasts are further indicative of the disease. The inter-
current febrile manifestations which may be present and the
relatively good appearance of the animals also deserve full
consideration.—Leukemia and pseudo-leukemia may be excluded
by the absence of swelling of the lymph glands.—In infectious
anemia of horses the blood examination reveals indications of
a simple anemia, moreover the appearance of the disease in
connection with the introduction of newly purchased horses, as
well as its infectious nature, points to that disease. It appears
to be advisable to eliminate the suspicion of infectious anemia
only when the non-infectious nature of the disease has been
established on the ground of long continued observations, his-
tory, animal experiments, and by accessory conditions.—
Although sub-acute encephilitis, and cerebral meningitis are
associated with similar depressions, in these conditions the blood
shows no important changes. Special stress should be laid
upon excluding septicemic affections of slow development,
which can usually be accomplished when the blood and the
other organs are carefully examined and all accessory condi-
tions are considered. The form of influenza of horses which
was named ‘‘Skalma’’ by Dieckerhoff often produces a long-
lasting severe anemia.

Prognosis. The prognosis is always unfavorable. In
human medicine there is not a single unobjectionable case known
which did not terminate fatally. The recoveries observed in
animals must be judged carefully, since confusion with other
diseases cannot be altogether excluded.

Treatment. According to observations made hitherto, even
a rational treatment can at the best only prolong the course
of the disease. A suitable regulation of the diet, keeping the
animals out of doors or in well-ventilated stables and moderate
exercise, should first of all be considered. Of medicinal remedies
iron and arsenical preparations (arsenic, Fowler’s solution,
atoxyl, see p. 850), natrium kakodylicum (for dogs 0.1-0.3 gm.
subcutaneously), may be employed. In human medicine intra-
venous infusion of blood and of salt solution, as well as sub-
cutaneous injections of blood give relatively satisfactory results
(Beneztr). Of these, especially the last-named method could
occasionally be utilized also in animals.

Literature. Ehrlich, Lazarus & Pinkus, Die Animie. Wien, 1898.—-Grawit7,
D. m. W., 1904. 1092. — Johne, S. B., 1884, 60. — Tallquist, Z. f. klin, Med., UXT,

427,
868 Progressive Pernicious Anemia.

Progressive Pernicious Anemia in Cattle. Imminger (W. f. Tk.
1886, 137) described under this name a disease of cattle which first
occurred around Kemnath in Bavaria sporadically, but in the years
of 1883-1889 in an enzootic form. It affected cattle mostly at an age
of from 34 to 2 years. The disease occurred more frequently in stabled
animals or in those fed on dry feed than in pastured cattle, or during
the time of green feeding.

The disease commences with a gradual emaciation in spite of
satisfactory appetite. From the fourth to tenth week a severe diarrhea,
edematous swelling of the dewlap, paleness are observed, and at the
same time yellowish discoloration of the visible mucous membranes,
and of the unpigmented parts of the skin (especially on the ears),
tightness of the skin and staggering gait. The pulse is thread-like,
accelerated (70-80 per minute), and the systolic sound of the heart
is frequently accompanied by a hissing murmur. The blood shows
poikilocytosis. In the further course the respiration is accelerated
and a cough appears. The temperature usually remains normal, very
rarely it rises toward the fatal termination of the disease or it falls
on the contrary to subnormal. After 2 to 3 weeks the appetite also
becomes suppressed, and sometimes hemorrhages occur in the retina.
With the appearance of the inappetence the loss of strength makes
rapid progress, and the animals soon succumb. Sometimes, especially
however in older animals or after parturition, the disease takes a rapid
course. The mortality amounts to about 50%.

The autopsy reveals a severe general anemia, here and there
hemorrhages in the muscles, moderate hydropic signs, and a reddish
discoloration of the otherwise softened bone marrow.

The treatment consisted in the administration of iron and arsenical

preparations (see p. 850).

Anemia of Sheep and Goats in Punjab. Walker & Baldrey (J. of
trop. vet. science, 1906, 410) observed an enzootic affection in sheep
and goats which is known to the natives as ‘‘Gillar’’ (swelling of the
neck). The disease is confined to the swampy lowlands and the terri-
tories of the Punjab, which are frequently flooded, it attains its highest
extension during the months of December to February and rapidly dis-
appears during the summer months. Its causative agent is supposed
to be some parasite, but the investigations carried on in this direction
have given negative results.

The symptoms of the disease are languor, separation from the herd,
tenacious, sticky nasal discharge and a hoarse cough. After about
one week an edematous swelling of the submaxillary space appears,
which may in severe cases extend to the breast bone and which usually
disappears during the night. After three weeks a bloody diarrhea
and increased thirst appear, the visible mucous membranes become pale
and yellowish. In the meantime ascites develops. The animals die
from loss of strength after 3 to 4 weeks; less frequently death ensues
only after six weeks or even later. The mortality amounts to 90%.

The autopsy reveals, in addition to the manifestations of a severe
anemia and ascites, inflammatory areas on the intestinal mucous mem-
brane.

Treatment is without effect; a change of pasture, with the adminis-
tration of iron sulphate and salt is recommended.
Leukemia of Mammals. 869

4. Leukemia. Leukaemia.

(Leucocytemia; Leukémische Lymphadenie [German]; Leuco-
cythémie, Lymphadenie [French].)

(a) Leukemia of Mammals.

Leukemia of mammals is a severe and general systemic af-
fection or proliferation of the lymphoid or myeoloid tissue, as a
result of which swellings of the blood and lymph-forming organs
develop and the number of white blood corpuscles increases
more or less, partly at the expense of the red blood corpuscles.
According to whether the increase affects the lymphocytes or
the leucocytes, two forms of leukemia are distinguished, namely,
the lymphatic leukemia and the myeologenous leukemia (L.
myeloides).

History. The first descriptions of the.disease were given inde-
pendently of each other in 1845, by Virchow in Berlin, and Bennett
in Edinburgh. By Virchow it received the name by which it is known
at the present ‘‘Leukemia’’ (A«x¢s—white, *a—blood). The con-
nection between the affection of the spleen or the lymph glands and
the increase of white blood corpuscles was early recognized by Virchow,
the part of the bone marrow however was first established by Neumann
in 1899.

Leisering was the first to recognize in 1858 the disease in animals,
but greater attention was paid to it only in the last two decades, so
that at present quite a number of positive cases are known. Siedam-
grotzky (1878), Johne (1879), Nocard (1880), Frohner (1885), Wolff
(1892), de Jong (1903), have carefully studied the disease, likewise
Hutyra and Marek, whose case was not published in detail. :

Occurrence. Leukemia occurs most frequently among dogs,
more rarely horses, cattle, hogs and cats are affected, whereas
nothing is known of leukemia in sheep and goats. Some of
the eases recorded in literature very probably do not belong
here, but to pseudo-leukemia or to tuberculosis.

Sommer reported 46 cases up to 1889, of which 22 occurred in dogs, 10 in
horses, 7 in cattle, 5 in hogs and 2 in cats. Among the horses of the Prussian
army 2-4 cases occur annually.

Etiology. The leukemia of mammals is probably of a
toxic-infectious origin, although nothing positive is known rela-
tive to this at the present time. The course of the disease
would correspond with this view, as well as its localization
in the various organs, but to date it has been impossible to
produce the disease artificially in mammals by feeding af-
fected organs (Nocard), or by subcutaneous or intravenous
inoculation of emulsions from organs (Mosler, Bollinger, Cadiot,
Roger, Gilbert, Marek). The bacteriological examination of
870 Leukemia of Mammals.

the blood of an infected dog was also unsuccessful (Stockmann).
On the other hand the infectious nature of chicken leukemia
(see p. 877) should be considered as proven, and in addition
several observations are known in human medicine, which in-
dicate the transmissibility of leukemia to healthy man (Eller-
mann & Bang).

Léwit claims to have found protozoa (Haemomoeba leukaemiae) in the white
blood corpuscles of man affected with myelogenous leukemia, with which he suc-
ceeded in producing a marked leucocytosis in animals, but without an affection of
the blood-forming organs. Protozoa (H. leukaemiae vivax) were demonstrable in
the blood-forming organs of lymphatic leukemia. Other authors have not substan-
tiated this finding and consider the bodies observed by Léwit as fragments of cells.
Pawlowsky found bacilli in leukemic blood, with which he failed, however, to pro-
duce the disease. Likewise negative were the attempts at inoculation of Terni,
Delbet and Lucet.

Pathogenesis. Ehrlich’s thorough hematological examina-
tions have thrown some light on the development of the disease.
According to these, the hyperplasia of the lymphadenoid tissues
develops in some cases under the influence of a still unknown
cause, whereby the blood becomes flooded with the lymphocytes
which are formed in much greater numbers (Leukaemia lymph-
atica), whereas the number of true leucocytes remains un-
changed. The hyperplasia of the lymphadenoid tissue affects
not alone the lymph glands, but also the spleen, the bone marrow,
the intestinal wall, and usually also other organs (liver, lungs,
kidneys, glands, ete.), which under normal conditions contain
only microscopically small lymph follicles. Exceptionally how-
ever the hyperplasia of the lymphadenoid tissues occurs only
in a few, or even only in a single organ (for instance in the
bone marrow).

In other cases of leukemia the causative factor effects a
proliferation of the myeloid tissue, when the leucocytes migrate
from the blood stream in great numbers, at the same time how-
ever young unripe leucocytes as well as numerous ripe leucocytes
migrate from the leucocyte-forming bone marrow, and flood
the blood (Leukaemia myelogenes [s. myeloides]). Besides the
bone marrow, other blood forming organs also become affected,
more particularly a hyperplasia of the spleen, lymph glands,
liver, and the development of areas of tissue-like bone marrow
results in these organs.

This classification of the forms of leukemia by Ehrlich ap-
pears, considering the morphology of the white blood cor-
puscles, much more appropriate than the designation of
leukemia in accordance with the blood-forming organs, which
are found alone or most strikingly affected on macroscopical.
examination, as on one hand all blood-forming organs are in
most cases more or less affected in both forms of leukemia,
while on the other hand the lymphatic and the myelogenic
leukemia probably represent even etiologically two different
diseases. As the white blood corpuscles formed in the spleen
do not appear to have any part in the leukemic cases of
Plate X.

Hutyra and Marek, Special Pathology and Therapattics of Domestic Animals Volume L.

 

 

 

 

 

Alexander Eger, Publisher, Chicago.
Explanation of Plate X.

Fig. 1. Lymphatic leukemia. (After a blood specimen from the dog illustrated
in Fig. 155, stained with Ehrlich’s tri-acid solution.) a, large lymphocytes with
darkly stained cytoplasm; b, small lymphocytes; c, lymphocytes with undiffer-
entiated protoplasmic body; d, polynuclear leucocytes (neutrophile); e, transition
form; f, red blood corpuscles. (Enlarged about 925 times.)

Fig. 2. Myelogenic leukemia. (Human blood specimen stained with Ehrlich’s
tri-acid solution.) a, myelocytes; b, lympnocytes; c, polymorphonuclear (neutro-
phile) leucocytes; d, eosinophile leucocytes; e, disintegrated eosinophile cell; f,
normal red blood corpuscles; g, poikilocytes; h, microcytes: i, macrocytes; k,
normoblast; J, megaloblast. (Enlarged 925 times. After Weichselbaum).

 

es
Pathogenesis, Anatomical Changes. 871

which have been observed, a differentiation of ‘‘Leukaemia
lienalis’’ does not appear justified.

- In view of the fact that in the designation of the forms
of leukemia by veterinary authors, the macroscopical changes
of the blood-forming organs were almost exclusively taken into
consideration, it cannot be decided how frequently the two forms
of leukemia occur in animals. In the cases observed by Wolff,
de Jong, Nocard, and -Hutyra & Marek, the examination of the
blood reveals the lymphatic nature of leukemia. In all proba-
bility the lymphatic form of leukemia occurs in animals much
more frequently than the myelogenic form.

Anatomical Changes. In both forms of leukemia the path-
ee changes visible to the naked eye greatly resemble each
other.

The spleen appears considerably enlarged, and excep-
tionally its surface is nodulated, its tissue is mostly dense, but
at the same time somewhat friable, sometimes, on the contrary,
very soft (in dogs and sometimes also in hogs). The cut surface
appears usually pale brownish-red resembling the color of rasp-
berry jelly, somewhat dry, and with a dull luster, it is not in-
frequently permeated by bluish-white, hard or soft, hemp-seed,
pea, or up to walnut-sized areas (enlarged follicles), and also
by dark red. hemorrhages. Sometimes the connective tissue
trabeculae form a conspicuous network, and at the same time
the capsule is thickened.

The spleen may at times reach enormous dimensions. Its weight may some-
times in horses reach 46 kilograms (Cunningham), in hogs 3.7 kilograms (Hel-
linger), in dogs 1.7 kilogram (Siedamgrotsky), in cattle up to six times its normal
size (Mauri). In one case of Zell the spleen had a diameter of 89 centimeters.
The cases, however, in which the spleen is so enormously enlarged were probably
in most instances of pseudo-leukemic origin.

The lymph glands are very frequently enlarged. The
glands may attain a size from a hazelnut to a walnut and
coalesce with the neighboring glands, forming large nodular
bodies. They are either denser or on the contrary softer than
normal, their cut surface is uniformly white or grayish-white,
in exceptional cases however they are permeated by red points,
and a cream-like fluid may be scraped off. ;

The bone marrow appears either grayish-red, of jelly-like
transparency, softened and entirely filling the marrow cavity,
or pale gray and in this case almost of a pus-like consistency.
The marrow tissue is changed to a lymphadenoid tissue, which
is very rich in white blood corpuscles. Sometimes the bone
‘tissue also becomes rarified and then the spaces appear filled
with numerous leucocytes.

In about half the cases the liver is found to be enlarged,
somewhat harder, and on its grayish-brown or grayish-red cut
surface pale gray points and a similarly colored network, or
lymphoma-like nodules appear sometimes between the lobules.
872 Leukemia, of Mammals.

The kidneys are also considerably enlarged on account of a
diffuse infiltration with white blood corpuscles and ‘on account
of the presence of larger or smaller lymphomas. In the intes-
tinal wall, especially in the posterior part of the small intestines,
various sized lymphomas are found, which protrude into the
lumen of the intestines, and may contract the same considerably.
In one of Olt’s cases a chylusthrombosis developed in a dog.
On the serous membranes and in the lungs nodules consisting
of lymphadenoid tissue may sometimes be found and the inter-
lobular connective tissue of the lungs may contain extensive
areas of infiltration. In the heart, the peri- and endocardium
of which may be permeated by white areas of infiltration or
small lymph nodules, a great quantity of very soft blood
coagulum may be present. The blood shows changes as de-
scribed below. Similar cellular infiltrations may frequently be
found also in other organs, thus on the cerebral meninges, in
the uterine walls, in the various glands, as well as in the con-
nective tissue of any other of the organs. Hemorrhages are
not infrequently present in some of the organs.

Symptoms. Leukemia always develops insidiously. Rapid
tiring is observed, especially during work, the animal perspires
easily and shows in general the symptoms of pulmonary
emphysema. Soon indications of languor and depression ap-
pear also during rest, the appetite becomes capricious and later
entirely depressed, while thirst is not infrequently increased.
The pale discoloration of the mucous membrane becomes more
and more conspicuous, so that the mucous membranes finally
take on a porcelain white color. The heart’s action is accelerated
and throbbing, the heart sounds being sometimes obliterated by
secondary sounds, the pulse accelerated and small. Gradually
emaciation becomes perceptible; edematous swellings appear on
different parts of the body. The hair becomes lusterless and
scanty.

In most cases a chronic swelling of the lymph glands ap-
pears symmetrically on both sides of the body. Enlargements
which vary in size, dense, roundish, not painful, are found in
the submaxillary space and in the vicinity of the pharynx, on
the neck, along the jugular groove, on the chest, in the axillary
yegion, and in both inguinal regions, as well as in all places
where lymph glands occur. The skin covering them is normal
and easily raised. Because of the enormous enlargement of
"the lymph glands locomotion is interfered with, either from
purely mechanical causes or by compression of the neighboring
nerve trunks. In infection of the internal lymph glands func-.
tional disturbances of some of the organs may result. Thus
the compression of the bronchi or of the vagus nerve may
cause difficulty in respiration, roaring, and even attacks of
asphyxiation. At first this may appear only during work, later
however also during rest. The compression of larger blood
Symptoms, 873

vessels, especially of the veins causes edematous swellings and
indications of heart weakness. The affection of the mesenteric
and other lymph glands of the abdominal cavity may result in
ascites or a chylus-thrombosis, when the enlarged lymph glands
may in large animals be palpated through the. rectum, in small
animals through the abdominal wall. Exceptionally the thyroid
or the thymus glands may also appear enlarged.

The enlargement of the spleen may be ascertained in horses
by rectal exploration, in small animals by palpation of the
abdomen. The considerably enlarged spleen of the ruminants
produces a dull sound running parallel with the posterior border
of the lungs, between the lungs and the rumen. Exceptionally
the left side of the abdomen may be distended downward and
outward by the enormously enlarged and heavy spleen.

The sensitiveness of the bones to pressure, which might
be considered as an indication of a simultaneous affection of

 

Fig. 155. Lymphatic leukemia in an old bitch. a enlarged parotid gland; b,c, d,e
enlarged prescapular, inferior cervical, precrural, and poplietal lymph glands; f dis-
tension of the abdominal wall by ‘the enlar ged liver; g distension of the abdominal
wall by the enlarged spleen; h enlarged mammary gland.

the bone marrow, was only reported by Wolff, who observed
in a calf sensitiveness in the region of the lower ribs and at-
tributed the same to leukemic hyperplasia of the bone marrow.
The disturbances in locomotion, which sometimes appear in the
course of leukemia, may also depend to a certain degree on
the painfulness of the bones.

The enlargement of the liver may be recognized in small
animals from the increased area of dull sounds over the liver
region in the anterior half of both costal arches and still more
certainly by palpation of the epigastrium. In ruminants the
874 Leukemia of Mammals.

dullness over the liver increases backwards and downwards
to a level with the point of the shoulder; in case of very great
enlargement, the posterior upper border of the liver may be
felt in the anterior angle of the right flank. In horses the
dullness over the liver appears first in the region of the last
intercostal space on the right side. The recognition of a possi-
ble enlargement of the mammary or salivary glands causes no
difficulty.

The blood appears pale red, sometimes chocolate brown,
stains less intensively, coagulates slowly, causing on the upper
surface of the coagulum a grayish-white layer or an adhering
grayish-white deposit consisting of white blood corpuscles.
The blood of leukemic horses separates on standing into three
layers, a lower violet-colored consisting of red blood cells, an
upper formed by somewhat transparent yellowish fibrine, and
a middle grayish-white consisting of white blood corpuscles,
the layers may appear of different heights in proportion to
the number of white blood corpuscles. The blood of other
leukemic animals separates on coagulating into two layers, of
which the lower, violet-colored, is formed by red blood cor-
puscles, the upper grayish-white, milk-like being formed by
fibrin and white blood corpuscles.

An inerease of white blood corpuscles may always be shown.
While normal blood contains at most 4 to 6 white blood cor-
puscles in a field, they are seen in leukemic blood in much
greater numbers, sometimes nearly as many or even as many
as the number of red blood corpuscles. On counting, the
number of white blood corpuscles is found considerably in-
creased, as compared with the normal (8,000-12,000) and the
numerical relation between the white and red blood corpuscles
(in normal conditions 1:400-800) becomes much less, as low as
1:5 (Berndt) and may be even less (jn man the relation of
2:1 has even been observed [Sticker])? A diminution of red
blood corpuscles may also always be demonstrated, and their
number per cubic millimeter of blood may diminish from 7.5
millions to two millions (Nocard).

The establishment of the morphological condition of the
white blood corpuscles in stained preparations is of especial
value (see p. 865). In lymphatic leukemia lymphocytes are
found to be increased (Wolff, de Jong, Marek), while the
number of true leucocytes remains normal or comparatively so.

The lymphocytes appear uniform in size or slightly and sometimes even
considerably .larger than the red blood corpuscles; their large roundish nucleus
igs stained less with basic dyes (methylene blue, methyl green) than the proto-
plasm surrounding the nucleus in the shape of a ring; in some large examples,
however, both are sometimes stained uniformly pale (Plate X, Fig. 1-a, b).

In the myelogenic (myeloid) leukemia, on the other hand,
the number of lymphocytes remains unchanged, and the
leucocytes are considerably increased; there also appear in the
blood unripe, mononuclear forms, which possess granulated
Symptoms, Course, Diagnosis. 875

protoplasm, although there exists as yet no positive observa-
tions in regard to their occurrence in leukemia of mammals.
The entire uniformity of white blood corpuscles of domestic
mammals with those of man permits the supposition that the
unripe forms of leucocytes occur also in the myelogenic leukemia
of domestic animals. Accordingly besides the considerably in-
creased number of normal cells in the blood there should be
found neutrophiles, a few acidophiles and probably also
basophilic polynuclear leucocytes, also mononuclear neutrophilic
leucocytes (marrow cells, myelocytes) in varying numbers and
sizes, also mononuclear acidophilic leucocytes (Plate X, Fig. 2).

The red blood corpuscles in lymphatic leukemia show, as
a rule, no, changes in form, while in myelogenic leukemia
poikilocytosis is frequent, and they are frequently nucleated
(Plate X, Fig. 2). A diminution of the hemoglobin contents
in the blood can always be demonstrated.

In some cases the temperature shows only a slight rise,
or it may rise to 39-40° C.; on the other hand, towards the
termination of the disease, a subnormal temperature is not
infrequently observed.

Frohner found in the eye of an affected horse, near the inner border of
the papilla, a lentil-sized, triangular, sharply circumscribed white spot (Retinitis
leukaemica ?) 2

Towards the termination of the disease hemorrhages occur
not infrequently, especially on the mucous membranes (gums,
conjunctivae, intestines, etc.), further on the skin and in the
muscles, sometimes even in the brain. At the same time
parenchymatous hemorrhages are very stubborn.

Course. Leukemia is usually a chronic affection and ex-
tends over several months and even years. An acute leukemia
develops only exceptionally, principally in young animals which
may succumb to the disease in a relatively short time, some-
times ,in a few weeks (Nocard observed in one case a termina-
tion of the disease in less than one week). At the same time
chronic cases sometimes are arrested for a varying space of
time, or an apparent improvement may even occur. By im-
proper keeping or by using the animals for work the course
is always influenced unfavorably. Frequently however the
animals are destroyed before the occurrence of natural death;
only rarely do they die from complete exhaustion or from
internal hemorrhage, and still more rarely the fatal termina-
tion results unexpectedly or without apparent cause (Siedam-

grotzky).

Diagnosis, The affection of the blood-forming organs, and
the considerable increase of the white blood corpuscles, offer
together sufficient indications for the correct recognition of
leukemia. Without a knowledge of the morphological charac-
876 Leukemia of Mammals.

teristics of the white blood corpuscles, the symptoms deseribed
do not by themselves justify the diagnosis of a leukemic affec-
tion, as the enlargement of the blood-forming organs without
a simultaneous increase of the white blood corpuscles may
occur in pseudo-leukemia, on the other hand, however, an in-
crease of polynuclear leucocytes without an affection of the
blood-forming organs occurs also in leucocytosis. It cannot
however be denied that the leucocytosis which develops in the
course of infectious diseases, in severe simple anemia, in various
other internal affections, and during pregnancy, is usually
associated with a slight increase of the white blood corpuscles;
but in some of the leucocytoses, as Marek’s observations proved,
the relation between white and red blood corpuscles may be-
come as close (Marek found in one case the relation 1:18) as
in the severe forms of leukemia. On the other hand it is to
be considered that in the early stages of leukemia the increase
of the white blood corpuscles need not necessarily be marked.
For the determination of the form of leukemia, staining of the
blood corpuscles is necessary.

Chronic swelling of the lymph glands may also be caused
by glanders, tuberculosis, or by malignant new-formations. The
symmetrical arrangements of the swellings on both sides of
the body and their presence in all places where lymph glands
are located, further also the involvement of the other blood-
forming organs, usually leaves no doubt as to the nature of
the disease. For the positive exclusion of tuberculosis, . how-
ever, the examination of the blood corpuscles is indispensable,
as tuberculosis may in some cases produce similar changes in
the blood-forming and parenchymatous organs, for instance,
lymphatic pneumonia (Nocard), or a pronounced symmetric
enlargement of all the lymph glands may exceptionally result
from tuberculous infection (observed by Anger in a dog, by
Marek in a cow).

Prognosis. Up to the present time neither in man nor in
animals has a single recovery been recorded in a correctly
diagnosed case of leukemia. Accordingly the prognosis is al-
ways unfavorable.

Treatment. Treatment appears only indicated when for
special reasons it is desired to prolong the life of the animals.
In such cases the nutrition should consist of foods rich in
proteids, the appetite should be stimulated by tonics, exertion
should be avoided, and fresh air should be plentifully supplied to
the animals. Of medicinal remedies, iron, quinine (may be given
combined and always in large, full doses), further arsenic
(Fowler’s solution, in doses increased every 1 to 2 weeks, is
most appropriate), and phosphorus; they must however be
administered systematically and for a long time. In special
eases transfusion of blood could be attempted, as it is supposed
Treatment. 877

to have now and then produced a lasting improvement in
leukemia of man. In human medicine relatively the best results
have so far been obtained from arsenic and with the Réntgen
rays or with both combined.

Literature. Berndt, A. f. Tk., 1889. XV. 300. — Bollinger, Schw. A., 1871.
XXIV. 272. — Cadiot & Weil, Rev. gén., 1905. V. 571. — Ehrlich, Lazarus &
Pinkus, Die Aniimie, Wien 1898. — Giittlich, Pr. Mt., 1880/81. 19. — Johne, 8.
B., 1879. 24. — de Jong, V. A., 1903. CLXXIII. 511. — Leisering, 8. B., 1858. 35;
1861. 45; 1865. 29. — Lellmann, B. t. W., 1904. 699. — Lowit, Kongr. f. innere
Med. in Karlsbad. 1899. — Lucet, J. vét., 1891. 570. — Nocard, De la Leuco-
eythémie chez les animaux dom., 1881 (Lit.); A. d’Alf., 1882. 361. — Olt, D. t. W.,
1899. 197. — Pr. Mil. Vb., 1899-1908. — Siedamgrotzky, S. B., 1876. 21; Vortr.
f. Tzte., 1878. H. 10 (Lit.). — Stockman, J. of Comp. Path., 1893. 65. — Wolff,
B. t. W., 1892. 121. — Zell, T. R., 1888/89. 49.

(b) Leukemia of Chickens.

Leukemia of chickens is an affection of the blood-forming
organs, caused by an infection, and is associated with a con-
siderable increase and infiltration of large mononuclear leuco-
cytes, atrophy of the tissues of the bone marrow, and an in-
crease of the myeloid tissue in the liver. The circulating blood
frequently shows a diminished number of red blood corpuscles,
and also a variable increase of white blood corpuscles.

History. Although Moore had already in 1896 described ‘‘an
infectious leukemia of chickens,’’ these cases represented undoubtedly
a bacterial, acute infectious disease with a simple hyperleucocytosis,
which is frequently met in various infectious diseases of chickens. The
cases described by Butterfield (1905), and Yutaka Kon (1907), are
more likely to belong to leukemia, although the blood of the affected
birds. was not examined. Ellermann & Bang (1908) were the first
to recognize and study the disease as such. Valuable studies relative
to this disease in its clinical aspect were furnished by Hirschfeld
& Jacob (1907), also by Skiba (1909).

Occurrence. The disease occurs exclusively among chickens,
and among these in an enzootic and even an epizootic form.
The disease was discovered by Ellermann & Bang in Denmark,
and ; has also been observed in Germany (Hirschfeld & Jacoby,
Eber).

Etiology. The disease is produced by some kind of an
infectious substance, the nature of which is still unknown.
Only this much is known from the investigations of Ellermann
& Bang that the cell-free filtrate from organ-emulsions may
transmit the disease, and therefore the etiological role of an
ultra-visible microorganism does not appear excluded. Hirsch-
feld & Jacoby however up to the present always obtained nega-
tive results with filtrates through Berkefeld filters of organ
emulsions of leukemic chickens.

' The virus is present in all affected organs, the spleen, liver,
bone marrow, ete. The infectious properties of the organs,
however, are lost in a few days.
878 Leukemia of Chickens.

The bodies resembling protozoa seen by Yutaka Kon were also found by
Ellermann & Bang, and these also observed in the bone marrow round bodies
resembling parasites; the authors, however, refrained from expressing an opinion
as to the nature of these bodies. Hirschfeld & Jacoby, on the other hand, found
peculiar long bacilli, which produced a temporary anemia with lymphocytosis. in
an experiment chicken; still they do not yet desire to consider this bacillus as the
cause of the disease.

Pathogenicity. The disease may be transmitted to chickens
by intravenous or intraperitoneal inoculations of affected
organs, whereas other species of birds, likewise guinea pig's
and rabbits, are not susceptible; subcutaneous injection, on the
other hand, is negative even in chickens. After an incubation
of 1 to 2 months about 40% of the inoculated chickens become
affected, and then about one-half of the birds show indications
of leukemia, the other half those of pseudo-leukemia.

Pathogenesis. The irritation of the virus produces a great
increase in the production of white blood cells in the capillaries
of the bone marrow, liver and spleen, whereby in these places
an accumulation of white blood cells results, especially of large
mononuclear cells, and also the appearance of myelocytes. The
active production at these places of white blood cells is indicated
by extensive mitosis. The tissue of the bone marrow atrophies
with the local increase of the white blood cells, while the myeloid
tissues of the liver on the contrary increase. Temporarily
the predominating intravascular process remains confined to
the blood-forming organs without flooding the blood with white
blood cells (according to Ellermann leukosis aleukaemica,
pseudo-leukemia). In about one-half of the cases, however, the
circulating blood becomes flooded with the newly formed white
blood cells (according to Ellermann & Bang, Leukosis leukae-
mica), probably for the reason that there are no agglutinines
present at the places of formation. On the other hand, in some
cases a local increase of cells occurs very strikingly in the tissue
of the peritoneum (according to Hansen, so-called multiple
sarcomatosis of the peritoneum). Hand in hand with the
leukemic process an anemia also develops, either as the result
of a check in the formation of red blood cells, or then, owing
to an increased destruction of these cells under the action of
hemolytic toxins.

In opposition to the above-described conception of Ellermann & Bang, and
Hirschfeld & Jacoby, Skiba maintains on the ground of his observations in
chickens which died of other infectious diseases, that on one hand chicken leukemia
differs from the similarly named affection of mammals, and that on the other
hand it probably represents a disease which is associated only with a marked leuco-
cytosis. Chickens are supposed to have in general a great tendency to respond
with a marked leucocytosis to infections, or to other harmful influences (insuffi-
cient exercise, improper keeping). The principal difference between leukemia of
chickens and that of mammals is supposed to consist in the main, in that in chicken
leukemia the tissue proper of the blood forming organs remains unchanged.
Schridde. maintains further that a disease simulating chicken leukemia may also
be produced by intravenous injections of organ emulsions of healthy chickens,
which, however, was not substantiated by the experiments of Hirschfeld &
Jacoby.

 
Pathogenesis, Anatomical Changes. 879

Therefore the views in regard to the nature of chicken
leukemia still differ, and a decided position in this connection
is all the more difficult, as the morphologic and biological re-
lations of the white blood cells and their part in the different
diseases of birds have. not yet been investigated sufficiently.
The qualitative changes of the white blood cells demonstrated
by Ellermann & Bang, Hirschfeld & Jacoby, namely, the ap-
pearance of abnormal cells in great numbers, establish very
nearly the leukemic nature of the disease. The study of chicken
leukemia also opens a prospect for the determination of the
nature of leukemia of mammals.

Anatomical Changes. Most striking is usually the enlarge-
ment of the spleen and liver, also the grayish-red discoloration
of the bone marrow. However, it occurs not infrequently that
the enlargement is insignificant, and the color of the bone
marrow does not always deviate noticeably from the normal.
Now and then a rupture of the greatly increased spleen or liver,
and fatal bleeding in the abdominal cavity is observed. Other-
wise fine white points or stripes may be noticed in the liver
tissue, even with the naked eye. Histological examination re-
veals a considerable increase of the leucocytic, and a diminu-
tion of the erythroblastic tissues in the bone marrow, further
very marked perivascular leucocytic proliferation in the liver,
the capillaries of which appear plugged with leucocytes, while
in the spleen numerous pale leucocytes are present and strings
may be noticed, formed by capillaries filled with leucocytes
which contain small nuclei. In all of these organs numerous
cells are undergoing mitosis. Only Eber reports an enlarge-
ment of the lymph glands on the neck and in the mesentery,
but the diagnosis in that case was not based on blood examina-
tion with consideration of the morphological relations of the
white blood corpuscles; the autopsy findings are completed by
the finding of anemia, while the blood proper manifests the
changes to be described below.

Symptoms. After an incubation of 1 to 2 months indica-
tions of anemia become noticeable, inasmuch as the comb ap-
pears pale, its turbidity is diminished and the blood obtained
by pricking shows a pale red color. In stained blood specimens
several small or large, round, nucleated and mostly polychroma-
tophilic red blood cells are noted (normoblasts and megalo-
blasts). Simultaneously, a relatively large increase of lympho-
cytes may also be observed. At the same time the number of
the red blood corpuscles, which under normal conditions, accord-
ing to Ellermann & Bang, amount to 3,000,000, according to
Skiba however, 6,000,000 per cubic millimeter, gradually dimin-
ishes to 1,100,000. Likewise a diminution of the hemoglobin
content is noted, inasmuch as the normal value of 50-65° in
young chicks, frequently only 40-50° (according to Sahli), drops
880 Leukemia of Chickens.

to 15°. During the entire course of the disease there exists a
hemorrhagic diathesis, as a result of which numerous and fre-
quently severe hemorrhages result in some of the patients, and
the wounds inflicted on the comb for drawing blood give rise
to hemorrhages which are hard to control (Hirschfeld & Jacoby).
In this stage the clinical appearance of the disease corresponds
to that of pseudo-leukemia.

As already mentioned the pronounced leukemic picture of
the blood appears only in about half of the patients. This fre-
quently develops suddenly, and sometimes the birds die quickly,
the leukemic changes of the blood being then recognized only
at autopsy. The increase of white blood corpuscles is usually
so pronounced that instead of the normal number of about
30,000, 100,000 to 600,000 white blood cells may be counted in
the different cases, and the proportion between the white and
red blood corpuscles (1:100; according to Skiba 1:250) may
fall to 1:2 or 1:3. At the same time the percentage of the
different cells has changed to such an extent that the large
mononuclear cells, instead of the normal percentage of 23, are
represented in a percentage of 60-94, while the polynuclear
leucocytes and the smaller lymphocytes are forced into the
background, and at the same time the granulated polynuclear
leucocytes contain spherical granules instead of the usual rod-
shaped eosinophilic granules (Hirschfeld & Jacoby). In con-
trast to the normal blood round nuclear cells, also with granules,
are seen in quite large numbers which may be considered as
myelocytes, and sometimes their granula may attain the size
of a cell nucleus.

Course. The disease usually lasts only 8 to 14 days, some-
times however 1 to 3 months, and unexpected deaths are ap-
parently not exceptional. Spontaneous recoveries are very rare -
(Ellermann & Bang observed such recoveries in two, Hirschfeld
& Jacoby in one case).

Diagnosis. This can be established only on the ground
of microscopical examinations, if a leukemic condition of the
blood already exists, while otherwise the disease: can at best
only be indicated by determining the relative increase of:lympho-
cytes by the infectious character of the disease, and still more
positively by the autopsy findings. The greatest difficulty may
be the exclusion of simple leucocytosis, which occurs very fre-
quently in chickens and which may at times be very severe.
In this the increase of the white blood corpuscles may*reach
such a degree that the relation of the white blood corpuscles
to the red may fall even to 1:26 (Skiba). Leucocytosis occurs
especially in chronic infectious diseases of chickens; most
noticeably in tuberculosis, and may, as shown by. Skiba, pro-
duce changes even in the blood-forming organs which resemble
those of leukemia. A careful examination of the morphological

 
Diagnosis, Treatment. 881

conditions of the white blood corpuscles in stained specimens
frequently affords sufficient grounds for a differential diagnosis.
A relatively uniform increase of all representatives of white
blood corpuscles and the absence of unripe forms of cells are
met with in simple leucocytosis. The mononuclear leucocytes
however appear to gain the upper hand even in certain cases
a en which was indicated by the observations of
iba.

Treatment. Very few experiments have been attempted in
this respect.. Ellermann & Bang observed recovery in one case
after treatment with arsenic; it cannot however be decided
whether this did not represent an accidental spontaneous re-
covery. The Rontgen treatment proved unsatisfactory in an-
other case. ‘

Literature. Eber, Leipz. B., 1907/08. 54. — Ellermann & Bang, Cbl. f.
Bakt., 1908. XLVI. (Orig.), 595 (Lit.); Z. f. Hyg., 1909. LXIII. 231. — Hirsch-
feld & Jacoby, Z. f. kl. Med., 1909. LXIX. 1 (Lit.). — Skiba, D. t. W., 1909.
405 (Lit.).

5. Pseudo-Leukemia. Pseudo-Leukaemia.

(Hodgkin’s Disease, Aleukemic Lymphadenia, Sublymphatic
Leukemia [Helly]; Lymphadenia [Virchow]; Pseudo-
leukaemia lymphatica [Pinkus].)

By pseudo-leukemia is understood a chronic affection in
which the blood-forming organs show the same changes as in
ieukemia. The increase of white blood corpuscles in the blood
is however absent.

Occurrence. Up to the present cases have been observed
in horses, dogs, cattle and in a cat (de Does). The disease
occurs more frequently than leukemia for which it is frequently
mistaken. Leukemia of chickens is in about half of the cases
also manifested by the symptoms of pseudo-leukemia (see p.
877).

Etiology. The absence of an increase of white blood cor-
puscles constitutes the only important difference between
leukemia and pseudo-leukemia; otherwise the anatomical
changes, as well as the clinical symptoms are almost identical.
As a matter of fact the lymphocytes may be present in a higher
percentage than normally, although the total number of the
white blood corpuscles remains comparatively normal. This
phenomenon occurs in pseudo-leukemia of man, was also ob-
served by A. Zimmermann in a cow, by Jaeger in a dog, and
by Hirschfeld & Jacoby in the pseudo-leukemic stage of chicken
- leukemia. ;

Based on this correspondence the view is greatly supported,
according to which pseudo-leukemia is held to be identical in

Vol. 1—56
S82 Pseudo-Leukemia.

its nature with leukemia and depends on a general affection
of the lymphatic hematopoetic tissue (Rouvier, Jaccoud, Cohn-
heim, Nocard, Hirschfeld & Jacoby). According to this view
pseudo-leukemia would therefore represent only a form of
leukemia, in which however the flooding of the circulating blood
with white blood corpuscles is absent, as agglutinines are possi-
bly present in the parts producing white blood corpuscles
(Ellermann & Bang), or there occurs no irruption of the
proliferating lymphoid or myeloid tissue into the blood stream
(Marchand, Neumann). In addition to this exceptional transi-
tory stages of pseudo-leukemia were observed in leukemia of
man, whereas in chicken leukemia, as already mentioned, about
half of the birds manifest simple pseudo-leukemic changes in
the presence of the same anatomical lesions in the blood-forming
organs and in the liver. As a matter of fact Pinkus accepts
pseudo-leukemia as identical with lymphatic leukemia, or at least

 

Fig. 156. Pseudo-leukemia: a enlarged retropharyngeal gland; b enlarged prescap-
ular lymph gland; ¢ enlarged precrural Jymph gland.

as a very closely related affection. However recently pseudo-
leukemias of myeloid types were also noted in man, and the
pseudo-leukemic form of chicken leukemia very likely also be-
longs to this group.

In opposition to this, other authors, even at the present
time, are supporting the view of the first recorder of pseudo-
leukemia (Hodgkin), according to which both diseases would
not be etiologically identical. In this they seek support in the
fact that pseudo-leukemia hardly ever passes into leucocytemia.

At the present time various diseases are comprised under the
name of psendo-lenkemia. Exeluding the pseudo-leukemia proper which
Etiology, Symptoms. 883

depends on a hyperplasia of the lymphoid and myeloid tissue, the in-
fectious granulomata which in domestic animals are usually of tuber-
culous origin and which apparently occur frequently, are also considered
_as pseudo-leukemia. Thus Nocard succeeded in demonstrating tubercle
bacilli in all affected organs of the cases which corresponded to pseudo-
leukemia, and accordingly explained also the cases described by him
formerly as lymphademia to be tuberculous in nature. The same
finding was also claimed by Brentano & Tangel in a case of pseudo-
leukemia in man, the authors expressing the view that pseudo-leukemia
is probably only a peculiar form of tuberculosis. These processes, how-
ever, of course, do not belong etiologically to pseudo-leukemia proper,
although clinically and in their gross anatomy they bear a marked
resemblance to pseudo-leukemia, the same as the lymphosarcomatous
swellings of the glands (Kundrat’s lymphosarcoma), which originate
from malignant growths, but clinically greatly resemble pseudo-leukemia.

Symptoms. The symptoms and also the autopsy findings
simulate greatly those of leukemia, while the course is, as a
rule, somewhat shorter. The general hyperplasia of the lymph
glands and the indications of a severe anemia strongly suggest
pseudo-leukemia, but the nature of the disease can be cleared up
only by the examination of the blood. Although the relation
of the red to the white blood corpuscles is not found to be greatly
changed, the red blood corpuscles may sometimes be distorted
and smaller (poikilocytosis); at the same time their number
is always diminished, while the lymphocytes are always present
in a higher percentage than in normal blood. Sometimes flat,
roundish, soft eruptions may develop on the skin, over which
the hair falls out (Liénaux).

_ Diagnosis. From the standpoint of differential diagnosis,
leukemia, tuberculosis, glanders and malignant growths of the
lymph glands come into consideration.

Prognosis. Up to the present time not a single case of
recovery has been recorded.

Treatment. Comparatively the best: results were obtained
in man from a systematic administration of iron, iodine and
arsenical preparations. On suitable occasions the treatment
with Réntgen rays may be attempted.

Literature. Cadéac, J. vét., 1907. 266. — de Does, Holl. Z., 1890. 158,—
Dorst, Z. f. Vk., 1906. 437. — Ehrlich, Lazarus & Pinkus, Die Anadmie. Wien 1898.
— McFadyean, J. of Comp. Path., 1903. 379. — Fréhner, W. f. Tk., 1885. 245. —
Haffner, Z. f. Flhyg., 1906. XVI. 418. — Hodgson, J. of Comp. Path., 1903.
382. — Jaeger, B. t. W., 1907. 563. — Liénaux, Ann., 1901. 478. — Lothes,
B. t. W., 1891. 9. — Lustig, Hann., Jhb., 1879/80. 54. — Nocard, De la Leuco-
cythimie, 1891 (Lit.); Bull., 1885, 45. — Rottke, B. t. W., 1906. 712. — Siedam-
grotzky, 8. B., 1876. 23. — Zimmermann, Vet., 1898. 473.
884 Hemoglobinemia.

6. Hemoglobinemia. Haemoglobinaemia.

Hemoglobinemia represents an affection of the blood in
which the blood plasma contains dissolved blood-coloring matter.

The paralytic hemoglobinemia, which etiologically as well as from
a symptomatological standpoint represents a special form of disease,
will be treated in a later chapter.

Etiology. The simple hemoglobinemia of domestic animals
is principally caused by blood parasites, especially by piro-
plasma (see p. 762), more rarely by trypanosomes (see p. 801).
Besides these, although much more rarely, certain chemical sub-
stances or toxins may be responsible for a dissolution of the
red blood corpuscles. Of the known chemical substances,
chlorate of potassium, phenacetin, creolin, naphthol, naph-
thalin, antifebrin, and various acids (by insect bites formic
acid enters into the body [Albrecht]) may exceptionally pro-
duce hemoglobinemia if they are administered in large quan-
tities. (Siedamgrotzky observed the disease in a horse which
was given a handful of naphthalin.) The disease sometimes
develops also in the course of acute infectious diseases (in-
fluenza of horses, distemper of dogs), under the influence of
specific infectious substances, or more often as the result of
secondary infections (with streptococci). Szilagyi observed
numerous cases of hemoglobinemia in horses, with intestinal
hemorrhage, after the ingestion of very moldy clover. Hemo-
globinemia sometimes appears also in connection with a non-
specific septicemia, extensive burning of the skin (Fréhner,
Plosz). Whether the action of cold or the cooling of the body
is capable of producing hemoglobinemia in domestic animals
remains at present undecided. Although Saur, also Leech ob-
served the affection in dogs, and Utz in a hog, occurring after
the action of cold, another origin of the disease cannot be
positively excluded in these cases. If solution of the blood
corpuscles resulted from the action of the cold itself, hemo-
globinemia would appear much more frequently after colds.
In the paroxysmal hemoglobinemia of man hemolytic substances
were found in the blood serum of the patients, which, when
cold are anchored to the blood corpuscles in the fashion of an
amboceptor, and when warm are supposed to produce solution
of the blood corpuscles with the aid of the complement (Moro &
Noda).

Szoyka observed hemoglobinemia in two dogs, and Marek in three
horses, and in enzootic extension in sheep also without being able to
prove a hematozoal origin of the affections, either by examination of
the blood or through injections or transfusions of the blood into animals
of the same species.

 
Etiology, Pathogenesis. 885

Pathogenesis. The development of the disease commences
either with the breaking down of red blood corpuscles, or with
the elimination of the blood coloring matter from the blood
cells, but not infrequently with both processes together; the
eliminated hemoglobin is then dissolved in the blood plasma
and deposited mostly in the spleen and in the bone marrow.
A considerable part however is worked up by the liver into
bile coloring matter. If the blood plasma becomes suddenly
flooded with blood coloring matter, or if the quantity absorbed
by the blood plasma exceeds the sixtieth part of the total hemo-
globin, a part of the coloring matter, as found by the experi-
ments of Ponfick, is eliminated by the kidneys (hemoglobinuria),
producing at the same time a degeneration, or even an in-
flammation of the kidneys. In severe hemoglobinemia, but ac-
cording to Affanasiew only in hemoglobinemias with destruc-
tion of blood corpuscles, the liver forms bile pigments in large
quantities from the blood coloring matter, and as the secretion
of the fluid constituents of the bile does not keep up with it,
the thickened bile accumulates, is partly absorbed, and thus
the possibility is afforded for the development of icterus.
Sometimes other organs also become affected under the influence
of the blood dissolving substances.

Anatomical Changes. The blood serum appears more or
less reddish in color; in severe cases the blood may be even
darker at the beginning, in the further course however it is
lighter in color. The spleen shows an acute swelling on account
of the taking up of blood pigments, its size corresponds with
the intensity and duration of the disintegration of blood cor-
puscles. The spongy bone marrow appears more or less red-
dened, sometimes of a dark red color. In severe cases a general
icterus may be noted.

Symptoms. Without a blood examination mild cases of
the affection may pass unrecognized. In severe cases depres-
sion, icterus and hemoglobinuria are observed. Fever also
appears, as a rule, and is brought on either by the causative
agent of the disease, or by the febrile action of products from
the disintegrated red blood corpuscles. As the coagulation
of the blood increases hemorrhages occur probably as the re-
sult of a simultaneous destruction of white blood corpuscles
in the mucous membranes and also in the other organs. The
disintegration of blood corpuscles, as well as the substances
causing the same, may further produce difficulty in respiration,
disturbance of consciousness, also convulsions, weakness and
accelerated pulse, and occasionally nephritis (renal epithelial
cells, casts in the urine). The blood shows the same changes
as in acute anemia (see p. 847), provided the blood serum

contains hemoglobin. ;
Mild cases may terminate in recovery, whereas the severe
886 Hemoglobinemia.

attacks produce death in a few days or later. The animals
which remain alive not infrequently show for a time the symp-
toms of simple anemia.

Diagnosis. A positive recognition of the disease is only
possible by the demonstration of hemoglobinuria, or by the
presence of dissolved blood coloring matter in the blood serum
drawn with great care; a severe icterus appearing without any
apparent organic affection should be considered as a suspicious
indication of the disease. An attempt should always be made
to determine the cause of the disease.

The paralytic hemoglobinemia is differentiated from the
other forms of hemoglobinemia by the entirely different mode
of onset, by the presence of the paralytic symptoms, and by:
the changes in the tendinous reflexes.

Treatment. Besides removal of the cause if it can be de-
termined, and relieving the threatening symptoms, the treat-
ment mentioned in anemia appears indicated (see p. 850).

Literature. Albrecht, Monh., 1892. III. 241. — Dieterichs, D. m. W., 1903.
293. — Marek, Z. f. Tm., 1904. VIII. 285. — Moro & Noda, Minch. m. W., 1909.
545. — Siedamgrotzky, S. B., 1892. 16. — Szilagyi, A. L., 1907. 633. — Szoyka,
ibid., 1903. 1. — Utz, B. Mt., 1885. 4.

7. Paralytic Hemoglobinemia. Haemoglobinaemia paralytica.

(Azoturia, Haemoglobinemia rheumatica [Frohner|; Haemo-
globinuria toxaemica [Bollinger]; Lumbago [Dieckerhof'].)

Paralytic hemoglobinemia is a specific acute affection of
horses, characterized by severe disturbances in locomotion
(mostly lumbar paralysis) as a result of a parenchymatous
degeneration of certain muscles, and by the presence of hemo-
globin in the urine.

History. Considering the nature of the etiological factors paralytie
hemoglobinemia of horses must have been known since earliest times,
although it might not have appeared as frequently as at present. Even
in the ’20’s of the last century, Coulboux, Charlot, Prévot and Bouley
jr. described a disease as spinal apoplexy or congestion of the spinal
cord, which etiologically and clinically corresponds with paralytic
hemoglobinemia, and which did not appear to be very infrequent at
that time. Since the middle of the last century the reports of the
disease continue to increase, especially in Germany. In former times
‘‘azoturia,’’ ‘‘lumbago,’’ ‘‘blackwater,’’ ‘‘rheumatic lumbar paralysis,’’
‘spinal meningitis,’’ ‘‘Haemoglobinuria paroxysmalis,’’ ete., were con-
sidered: as different diseases. In 1852 however Hofer introduced them
in literature as identical. Since then until the most recent times, a
great number of publications have been prepared on the subject, which
however have not yet completely cleared the etiology and the nature
Etiology. 887

of the disease. Studies on the nature of the disease were especially
carried out by Bollinger (1877), Fréhner (1884), MceFadyean (1888),
Lucet (1889), W. Eber (1892), Dieckerhoff (1895), Ligniéres (1898),
Cadéac (1899), Hink (1901), and Schlegel (1906). Schlegel at first
strictly separated the affection from enzootic spinal. meningitis
(Meningomyelitis haemorrhagica), later however he considered them
as identical affections. Furthermore paralytic hemoglobinuria has
formerly frequently been confused with enzootic spinal meningitis.
Johne (1879) described the disease in a zebra.

Etiology. The observations of many years up to the present
time have proved beyond a doubt that the development of the
disease is favored by the cooperation of certain predisposing
causes. The most conspicuous influence is the method of keeping
the horses, inasmuch as the disease usually appears after a
long rest with rich feeding at the same time. Accordingly it
occurs especially after holidays of several days’ duration. How-
ever, exceptions are not at all rare, as occasionally resting
horses may become affected even in the stables, or horses that
are hitched up every day may become affected during work,
and again poorly nourished or even starving animals may be-
come attacked by the disease (Hauptmann).

Brun observed in a large stable, in which the horses were not worked for
sixteen days and where the daily exercising was impossible, that eight cases
occurred inside of three days, while among the horses of another stable in which
the animals were exercised every day only one, and that a slight case, was noted.

The influence of breed is sufficiently proved by general
observations, in that horses of draft breeds become affected
most frequently, while the disease appears more rarely in ani-
mals of the finer breeds. Among common Hungarian horses,
as well as in the more hardened horses of poor men, the dis-
ease seldom occurs.

According to the tabulated statistics of Adam, among 63 affected horses
31% were heavy draft animals, 36% improved breeds of country horses, 20%
wagon horses, and 9% belonged to higher breeds. Immediately before the affec-
tion five horses were stabled for one day, 21 horses for two days, 11 horses for
3 days, 9 horses for 4-5 days, four horses for 5-8 days. Out of 352 cases observed
by Schindelka & Héfling, 46% belonged to heavy draft, 19% of medium weight
animals, and 35% to light weight breeds.

Horses usually become affected between the ages of five and
eight years, much more rarely at earlier or later ages.
(Razsovits and Hutyra & Marek each observed the disease in
a foal of 114 years of age; according to Kleinpaul even sucking
colts are supposed to be susceptible?)

Excessive exertions may produce the disease even without
a previous rest; besides cases are not infrequent in which the
disease develops after parturition or in horses which have
struggled considerably during painful operations (Bergstrand,
Froéhner, Leipziger, Dagés, Pr. Mil. Vb.). Likewise horses
888 Paralytic Hemoglobinemia.

may become affected which cross their foot over the pole or
the halter rope and strain their muscles (Hasse).

The arrangement of the stable is also supposed to have
an unfavorable influence to a certain degree, inasmuch as horses
kept in poorly ventilated, warm, damp stables are affected more
frequently.

The influence of the season is manifested in that the disease
generally occurs more frequently during cold weather. It may
be attributed to this condition that cold has a more or less
important, or even an exclusive etiological significance in the
development of the disease. However in this respect there
are numerous exceptions. Thus of the 91 cases observed dur-
ing 19 years at the clinic of Budapest, 42 occurred in the first
and fourth, 49 in the second and third quarters of the year.
According to the statistical data of the Prussian Army in the
last 10 years 160 horses became affected in the first and fourth
quarter, and 371 in the second and third quarter; in the second
and third quarter, that is, in that half of the year in which
there is less opportunity for the action of cold, the number
of the affections were year after year considerably higher.

Numerous hypotheses were formed for the expianation of the
true cause and nature of the disease, the more important of which
only will be mentioned. Dieckerhoff accepted as the cause an auto-
intoxication, claiming that the toxic substances (meat lactic acid and
other substances) develop from the proteids that are not utilized during
rest, and which are broken up under the influence of a supposed fer-
ment. In Egypt, recently Bollinger also considered the disease as an
auto-intoxication. According to this author a certain hemolytic toxin
is supposed to develop from the proteids under the influence of muscular
work or cold. Eber attributes it to the formation of a toxigenic sub-
stance which is supposed to change to a poison during muscular fune-
tions. Hink accuses oxidation and decomposition products, which
form rapidly during exertion of the muscles previously kept out of
function for a long time; he thinks that under the cooperation of
vasometer disturbances there results under a simultaneous attack of
cold an accumulation of lactic acid and its compounds in the muscles,
leading to a congealing of the muscle substance, paralysis of the muscles,
and to a solution of the muscle coloring matter. According to Ohler
the disease develops as a result of an excessive and rapid breaking
down of the glycogen in the muscles, in such a way that the sugar
formed from the glycogen produces a myositis and secondarily a
nephritis. According to Siedamgrotzky & Hofmeister the red blood
corpuscles are supposed to be dissolved by the urea and by the extrac-
tive substances accompanying it which are formed in large quantities
by the muscle.

MacFadyean considers an excessive production of red blood cor-
puscles under the influence of rich feeding as the cause; the profuse,
newly formed red blood corpuscles are then supposed to break down
during subsequent work.

The greatest acclaim was given to the theory of cold. Thus Lucet
attributed it to an acute nephritis brought on by cold and to subsequent
uremic or other intoxications. A great number of French authors
formerly accepted as the fundamental cause of the disease a hyperemia
Etiology. 889

of the spinal cord, produced by cold and by rich feeding. According
to the hypothesis of Fréhner the metabolism of the muscles is supposed
to be increased to such an extent by the very intense irritation of
the cold on the sensitive nerves of the skin, that it causes the con-
tractile muscle substance to break down, and consequently muscle color-
ing matter, which is identical with the hemoglobin passes into the blood
circulation, and is eliminated by the kidneys.

Various authors assert an infectious origin of paralytic hemo-
globinemia. Thus Cadiot believes in the possibility of an infection
through the intestinal canal, while Cadéac considers a streptococcus
infection probable. Ligniéres found Gram-positive streptococci in the
subarachnoid fluid of the medulla, sometimes also in the kidneys, the
inoculation of which into mice produced a red discoloration of the
urine and increase of the reflex irritability; a horse which received
300 ec. of the culture intravenously could no longer get up from the
sixth day on, and albumen was demonstrated in its urine. In contrast
to this Nowak & Hartel also found the streptococci, but could produce
no disease with them; experiments carried out with the filtrates of
the intestinal contents of affected animals were also negative.

Schlegel accepts as the cause of the disease the streptococcus
melanogenes described by him, and identified the paralytic hemo-
globinemia with the streptococcus of septicemia which is manifested
by a paralytic weakness of the hind parts (enzootic spinal meningitis,
see Vol. II).

Hutyra & Marek believe it best to hold to the hypothesis
of an auto-intoxication. According to their belief they claim
to be justified in assuming that during the function of pre-
viously rested muscles or in muscles which have worked to
excessive exertion, some substance is formed which exerts a
toxic action and which produces a degeneration of the muscle
fibers and an elimination of the blood-coloring matter from
the blood corpuscles. This process occurs either while the blood
passes through the affected muscles, or at a later stage, when
the blood circulates in other organs. During rest and rich
feeding the suspected toxin-forming faculty of the muscles
may increase. It must probably be attributed to the last-named
condition that heavy, phlegmatic horses, which, as a matter
of fact relax their muscles much more completely during rest
than horses of a livelier temperament, and young colts become
affected more frequently; as a matter of fact colts are not
used at all for severe muscular work. By the sudden action of
cold the influence of the muscular functions could evidently be
increased up to a certain extent, as the irritation of the cold
stimulates the metabolism of the muscles (heat regulation).
Of what nature however the suspected poisonous substance
may be which develops during the muscular functions could
only be determined by suitable investigations and experiments ;
simple theoretical deliberations do not lead to results.

Dispensing with detailed criticism of the above described hypotheses,
only the more important factors in favor of the myogenic auto-
intoxication will be brought out. The disease has, up to the present
890 Paralytic Hemoglobinemia.

time, been observed without a doubt only in horses, and usually after
the animals had been kept from work for a time, at the same time
were well fed and subsequently were used for some hard muscular
work, which, of course, may occur also in the stable, as for instance
after suddenly rising to the feet. Although sometimes the - disease
develops also without cooperation of these factors; in such cases an
excessive exertion may be found to be originally connected with the
development of the disease. At the same time it has frequently been
observed that in horse stables in which the disease has occurred
regularly it may be prevented by systematic exercising of the animals
or by a considerable reduction in the quantity of nitrogenous food
(Benjamin, Lavalard, Brun). The fact has further been supported by.
numerous observations that without exception the muscles usually be-
come affected and the changes occur chiefly on that side of the body,
which has to perform the greatest muscular exertion in the execution
of the work. These are especially the muscles of the hind parts, more
rarely those of the anterior extremities. In animals which are lying
down the muscles of the back may be involved.

Against the importance of the influence of cold the already men-
tioned observations may be quoted, according to which the disease
occurs in continuous warm weather more frequently than in cold seasons
(Pr. Mil. Vb., Hofling, Marek). Lassar & Nassaroff succeeded by an
excessive cooling of the body (the inner temperature of the animals
falling to 18° C.) only in producing a not especially severe degeneration
in the muscles, and more markedly in the parenchymatous organs,
which, exclusive of actual freezing to death, could not occur under
natural conditions. On the other hand Dexler failed to produce the
disease by strongly cooling the hind parts of a horse.

The signs of a nephritis which according to Lucet develops from
cold and which is said then to produce the hemoglobinemia, are fre-
quently absent.

Against the infectious origin of the disease it may be mentioned
that the respective authors have failed up to the present: time in
producing the disease in its typical form artificially in horses, and
that further the sudden appearance of the disease and its characteristic
clinical picture is difficult to reconcile with a theory of infection, as
is also the not infrequent sequel of an atrophy confined to certain
muscles, which after a time again disappears. In spite of the position
taken by Schlegel on this question, Hutyra & Marek consider their
non-committed standpoint in regard to the infectious origin of the
disease the more justified since paralytic hemoglobinemia was originally
separated by Schlegel himself from infectious spinal meningitis, and
also because Zwick, who accurately described a disease which appears
to be identical with Schlegel’s streptococcus septicemia, observed no
similarity between infectious spinal meningitis and paralytic hemo-
globinemia. It therefore remains for further investigations to elucidate
the relationship of Schlegel’s disease to paralytic hemoglobinemia and
the nature of the last mentioned disease.

Against the myogenic origin of hemoglobinemia it may be said
that in all cases investigated by Hutyra & Marek the hemoglobin con-
tent of the blood was found to be somewhat diminished (on Fleischl’s
apparatus below 70° against the normal of 70-80°). At the same time
they never succeeded in finding an increase in the specific gravity
of the blood, although it was tested very accurately with the pyknometer.
On the other hand they established im all cases a diminution of red
Etiology, Anatomical Changes. 891

blood corpuscles (up to 6,450,000-7,200,000, against the normal number
of 7,500,000 to 8,000,000). MacFadyean and Konig demonstrated an
merease of the red blood corpuscles. Schindelka and Héfling found fre-
quently and Konig regularly, a very marked increase of the hemoglobin
content of the blood, yet these findings cannot be considered as con-
clusive evidence without a simultaneous establishment of the molecular
concentration of the blood serum. Mention should not be omitted of
the fact that Kénig found a comparatively strong increase of the
hemoglobin content in the blood, but this finding may also have another
explanation, as the increase of the hemoglobin content persisted for
days after recovery, and for a long time after the disappearance of
the hemoglobinuria. The experimental findings of Wetzl are interesting
in this relation. According to these on one hand the hemoglobin con-
tent of the blood is subject to great variation, and on the other hand
a considerable loss of water by the body produces a very significant
increase of the relative percentage of blood corpuscles and the hemo-
globin content, on account of the thickening of the blood. In paralytic
hemoglobinemia there are ample opportunities for a decided loss of
water (profuse perspiration, omission in watering the animals while
lying down). The fact that in several cases examined by Schindelka
and Ho6fiing the dissolved blood coloring matter in the blood serum did
not always correspond with the higher percentage of hemoglobin in the:
blood can only be explained in this manner. On the other hand the ex-
periment of Camus & Pagniez in dogs (injecting cold distilled water into
the muscles of the thigh) by which they aimed to prove that the hem-
oglobin eliminated with the urine is muscle coloring matter, cannot be
considered as conclusive as a solution of red blood cells around the point
of injection appears far more probable under the influence of cold dis-
tilled water.

Anatomical Changes. The most striking changes are present
in the muscles. Especially the lumbar muscles and those of
the croup, as well as the psoas muscles, to a slighter degree the
muscles of the hind quarters, sometimes those of the front ex-
tremities also, and other muscles appear either uniformly gray
or yellowish in color, like fish-meat, or as if boiled and moistened
on the cut surface. They tear easily or they may be firm, but
they show on their cut surface, between the healthy brownish-
red bundles of muscle fibers, light gray or yellowish stripes,
which convey to the basic color a more or less distinctly recog-
nizable grayish tint. The degenerated parts sometimes stand
out very sharply against the healthy tissue. The cross striation
of the contractile substance can no longer be recognized under
the microscope, the sarcolemma appears to be filled up by a
mixture of fine albuminous granules, fat globules and coarse
flakes (degeneratio parenchymatosa et adiposa, sometimes also
Deg. cerea). Dexler demonstrated by Marchi’s method the
presence of fat globules arranged in longitudinal rows.

The kidneys are also affected with relative frequency,
showing cloudy swelling or even severe parenchymatous or fatty
degeneration, as well as diffuse necrosis of the epithelia
(Johne). The spleen appears swollen in areas, more rarely the
swelling is uniform. The muscle of the heart sometimes shows
892 Paralytic Hemoglobinemia.

the same changes as the muscles of the rump, but always in
a lesser degree, and probably as the result of a subsequent
septic infection. (Dexler found in the lateral and posterior
cornea of the lumbar, dorsal and sacral sections of the spinal
cord, perinuclear chromatolysis of the motor, and in a lesser
degree also of the other nerve cells; by Marchi’s method he also
demonstrated degeneration of certain nerve sheets of the lateral
and anterior columns.) The bone marrow, especially in the
femur and in the lumbar vertebrae is hyperemic, permeated by
small hemorrhages, sometimes showing a blackish-brown dis-
coloration.

The blood shows no changes recognizable by the naked eye.
The bladder contains mostly reddish or brownish-red urine.

Symptoms. The disease sets in without premonitory signs,
almost invariably with disturbances in locomotion of the hind
parts. After a certain time, sometimes as early as in 5 or 10
minutes, at other times only several hours after the animal
has been taken from the stable and used for work, a pronounced
stiffness is noted in the movement of the posterior extremities.
There is staggering of the hind parts, the feet are raised only
slightly from the ground, the horse knuckles at the pasterns,
perspires profusely, and attempts to go on in spite of it until
it finally is unable to stand up and collapses helplessly. The
disturbance occasionally progresses so rapidly that the animal.
breaks down suddenly without the rider or driver even noticing
the stiffness of the gait. It is only rarely that the horse is able
to rise again to its feet, more often it is necessary to return
it to the stable on a wagon. In the rare cases in which the
disease develops in the stable, it is as a rule observed only when
the animal can no longer rise from the ground in spite of its
attempts. The collapsed horse then lies flat on one side, mostly
with the hind extremities stretched somewhat backwards, at
the same time it makes repeated attempts to rise; with the
head raised it succeeds in standing on its front legs, but, soon
drops back again with painful groans. Sometimes it succeeds
in half-way rising even on the hind legs and dragging itself
for a short distance, but it soon falls exhausted and usually
with the hind parts first (Fig. 157). In its repeated attempts
to rise the horse strikes its head and feet against the ground
or against the wall, thereby causing injuries to these parts. The
numerous exertions, and the anxiety of the patient, which may
be seen in the expression of its face and eyes, result in a profuse
perspiration.

Sometimes the disturbances remain confined to only one
of the hind extremities, affecting only the M. quadriceps fem.
or the abductors, at other times they appear in one or both
front extremities, especially in the triceps brachii. If the dis-
turbances are only one-sided and not very extensive, the horse
usually does not collapse, and remains perfectly quiet without
perspiring-
Symptoms. 893

The muscles of the paralyzed parts of the body feel at
first, and sometimes even later, very dense, almost as hard as
a board; they are however not sensitive to pressure. At the
same time the superficial muscles may show considerable en-
largement. In the further course of the disease the muscles
usually return to their normal consistency, or even become
softer. The sensitiveness of the skin, as far as examination
because of the excitement of the animal, is possible is not
changed; sometimes it appears somewhat reduced, but no great
importance can be attributed to this finding, as the skin in the
region of the croup or the thigh possesses a somewhat slighter
sensitiveness, as compared with other parts of the body.

 

Fig.157.  Paralytic hemoglobinemia. The horse rose on the second day of the
affection, but immediately fell back to the position shown in the illustration.

Spontaneous indications of pain are however not infrequent.
The passive resistance of the muscles is at first increased, later
diminished. Dexler and Marek found an absence of tencinous
reflexes in the region of the paralyzed muscles. As the M.
quadriceps cruris is also involved, the patella reflex is, as a
rule, absent either on one or both sides. Dexler found the
faradic irritability normal in the affected muscles, the mechanic
irritability on the other hand was absent in Marek’s cases.
In mild cases as well as in the early stages of severe affec-
tions the temperature is not much elevated; but owing to the
great restlessness of the animal a rise of ¥%, to 1° C. may exist
from the beginning. In the later course of severe cases a con-
siderably higher rise in temperature may be present, either
894. Paralytic Hemoglobinemia.

resulting from an infection through decubital gangrene or from
other complications, possikly also from the hemoglobinemia
itself.

The heart’s action, except in the mild cases, is from the
beginning increased in proportion to the restlessness of the
animal (50-60 beats per minute), at the same time however
itisstrong. After the development of complications it becomes
more accelerated (80-100 per minute), correspondingly the pulse
which is at first tense and full, becomes gradually softer and
finally thread-like.

Frequently the passing of urine is retarded so that a
considerable dilation of the bladder may develop. Excepting
in a few, mostly very mild and rapidly passing cases, the
urine appears to bemore or less intensely dirty reddish-brown
or beer-brown to ink-black in color; and although it clears on
‘filtration it retains its red color. The specific gravity is in-
creased, but the reaction is mostly alkaline, more rarely acid;
at the same time it contains more or less albumen, a large
amount of phosphates, usually also uric acid salts, and less
hippuric acid. The sediment with its pale gray or yellowish
color stands out in contrast to the reddish-brown to blackish
color of the urine, and offers a certain positive means of proof
that the abnormal color of the urine originates from dissolved
blood coloring matter. The sediment.of the urine sometimes
contains hyaline or granular. casts, possibly also renal
epithelial cells, sometimes white and red blood corpuscles in
sparing numbers, which are present because of a simultaneous
inflammation of the kidneys ; hemoglobin casts are also frequently
found. (Tatray observed in one case numerous hemoglobin
erystals. )

For demonstration of the blood coloring matter in the urine the benzidine test
of Schlesinger, or the guajac-oil of turpentine test of Schumm, is best adapted,
while the spectral-analytic method or Heller’s test is considerably less suitable,
because of its sensitiveness (Mayer), when it is desired to demonstrate small
quantities of blood coloring matter, which, however, is usually not the case in
hemoglobinemia. The spectral-analytie method can, however, not be omitted for
demonstrating the various combinations of the blood coloring matter, especially
the oxy- and the methemoglobins. Two absorption bands are indicative of oxy-
hemoglobin, namely, one small dark band lying to the right of Frauenhofer’s line
D (on the border of the red and yellow color of the sun spectrum), and a lighter
and somewhat broader band lying to the left from the E-line; the presence of
methemoglobin is indicated by a band to the left of the D-line (in the field of the
red color). Frequently, however, all three bands may be seen simultaneously.

The quantity of albumen in the urine (according to Lucet
1-25:1000) is not always proportional with the intensity of the
red color, but it is considerably greater in a simultaneous af-
fection of the kidneys. The quantity of urea was found by
‘Schindelka and Frohner in some cases, and by MacFadyean al-
ways to be diminished.

Frequently the blood coagulates more rapidly, but the
coagulum remains loose for a longer time, so that only a rela-
tively small quantity of serum is separated. The blood serum
appears reddish or of a pronounced red color at the onset, and
Symptoms, Complications, Course. 895

in somewhat more severe cases, even later. The proportion
of blood corpuscles and the hemoglobin content of the blood
are subject to very great variation, as the diminished water
content of the body is manifested in varying degrees from
case to case. The observations of Marek, which were made
after the cessation of the very frequent general perspiration
and regular watering, showed a normal specific gravity of the
blood (1.052-1.0544), a slight diminution of red blood corpuscles,
and as a rule also a slight reduction of the hemoglobin content
(under 70° of Fleischl’s or Gowers’ scale). In contrast to this
Schindelka, Hofling and K6nig found an increase of one-half
‘above the normal in the quantity of hemoglobin, especially
Konig in those cases in which the percentage of the blood
corpuscles appeared quite normal. Strangely enough the
quantity of hemoglobin, although gradually diminishing, re-
mained increased for days, even after the disappearance of the
symptoms, and a considerable increase of red blood corpuscles
is frequently also present, especially in severe cases (Konig
found in one case 21,328,000 blood corpuscles), probably owing
to the reduction of water in the body (see p. 847).

The appetite remains good at the onset and in mild cases
to the end of the disease. Consciousness appears at first un-
disturbed; the animals try to relieve themselves from the un-
comfortable position, and make repeated efforts to rise until
completely exhausted. Later however they lie exhausted on
the ground. Sometimes symptoms indicative of uremia may
Be ee such as loss of consciousness and muscular con-
vulsions.

Complications appear very frequently in severe cases.
Among these gangrene of the skin from pressure should be men-
tioned in the first place, which appears on the prominent parts
of the body after lying for two or three days and may develop
under rapid extension into severe gangrene, resulting in a
general infection. Similar complications may develop from
deep tears or bruises of the skin. In other cases the continuous
lying on one side may cause a hypostatic hyperemia or later
even inflammation of the lungs. Now and then uremia develops,
which manifests itself especially by deep coma and convulsions.
When collapsing the animals may also fracture bones, especially
in the pelvis or thigh.

Course. The disease is characterized by a very variable
course. First of all there are cases where only a certain stiff-
ness in locomotion is noted, which disappears within a few
hours, or at the most after one-half to one day. In the great
majority of cases however pronounced symptoms of paralysis
appear, which persist for 2 or 3 days, sometimes even for a
week, and then change either into a rapid or slower return to
the normal condition, or on the contrary may lead to death under
896 Paralytic Hemoglobinemia.

gradual aggravation of the general condition. Finally in rare
cases there exists only a stiffness and weakness of the hind
parts, as well as hemoglobinuria, for 3 to 5 days, and complete
paralysis does not develop until later, as a result of which
the animals collapse, and soon die (according to Utz there is
a subacute form of the disease in contra-distinction to the above
acute form).

In severe cases death may ensue on the third or fourth,
exceptionally even on the first day, mostly however the animals
do not die until towards the end of the first week or at the
beginning of the second. The immediate cause of the fatal
termination is probably most frequently a general septic infec-
tion with its consequences, more rarely hypostatic pneumonia
or uremia. .

In the favorable cases the improvement makes either rapid
progress, so that the gait of the animal becomes normal within
a few days, or on the contrary a weakness of the hind parts
persists for several weeks, although it gradually subsides.
Sometimes the weakness or the paralysis of one extremity may
remain for months, even for 1 to 2 years, exceptionally even
permanently, and meanwhile lead to a rapidly progressing
atrophy of some of the muscles (the extensor quadriceps of the
leg, the abductor of the thigh or the rump).

Repeated attacks also occur, either at shorter or at longer
intervals, sometimes even after several weeks (Kronburger
observed a horse become affected three times within one week).

Diagnosis. The disease can be diagnosed with certainty
only by the presence of its two cardinal symptoms, namely, the
peculiar muscular affection and the hemoglobinuria. None of
these symptoms however suffice in themselves as a firmer con-
sistency of the muscles and their functional disturbances may
be observed also in muscular rheumatism, but in this affection
the tendon reflexes are normal. Hemoglobin may be present
in the urine also in acute infectious diseases or intoxications,
but in these pronounced symptoms of paralysis and reduction
of the reflex irritability are absent.

A traumatic injury of the spinal cord or spinal meningitis
can easily be excluded by the history of the case, in some cases
by the evident sensitiveness of the vertebral column, by the
complete insensibility of the paralyzed part of the body, by
the disturbances of the functions of bladder and rectum, and
by the action of the patellar reflex, which in contusions of the
sacral cord is normal, in the presence of a lesion anteriorly
to the lumbar cord appears to be normal or increased, while
after injuries of the middle lumbar cord on the other hand
it is not present. Moreover, in hemoglobinemia there also
exists in most instances a hemoglobinuria which is absent in
contusions of the spinal cord.— From the enzootic spinal
meningitis (infectious spinal meningitis, Schlegel) the paralytic

BRE

Mint ee to Ets
Diagnosis, Prognosis. 897

hemoglobinemia is distinguished by the history, the hard con-
sistency and enlargement of the affected muscles, and by the
hemoglobinuria, while in enzootic spinal meningitis, hematuria
may also appear frequently. Sometimes a compression of the
spinal cord (melanoma, exostosis) may also give rise to mistakes
In cases in which they produce a sudden paralysis. They may
be excluded in the same manner as contusions of the spinal cord.
In unilateral paralysis a paralysis of the peripheric nerves must
also be excluded on the ground of local examinations and with
consideration of the presence of hemoglobinuria.

Fractures of the bones (pelvis and femur), as well as
tearing of the Achilles tendon may result in clinical manifesta-
tions similar to paralytic hemoglobinemia. In such cases local
examination would reveal the true cause; in a severe paralysis
due to hemoglobinemia the urine almost invariably contains
blood coloring matter, however as traumatic influences may
simultaneously produce a hemorrhage in the urinary passages,
the examination of the sediment of the urine determines in
doubtful cases whether hemoglobinuria or hematuria is present.
Swellings and a firmer consistence of the muscles of the croup,
with absence of the patellar reflexes, have in such cases little
significance, as enlargements of muscles are also observed in
fractures of bones or tearing of muscles, with extensive hemor-
rhagic infiltration, and at such times the contractility of the
muscle or percussion of the patellar ligament may disappear. .

The thrombosis of the posterior aorta and its branches
differs in that the animals are after a certain time again capable
of standing up and walking normally; after more strenuous
exercise however they again collapse. At the same time the
presence of a thrombus or the absence of pulsation may be
established by rectal examination of the iliac or of the femoral
arteries.

Colicky affections can only be excluded by a somewhat
careful examination.

Prognosis. The prognosis appears unfavorable in propor-
tion to the completeness of the lumbar paralysis, the number
of muscles showing functional disturbances, and to the pro-
nounced character of the hemoglobinuria. If the animals can-
not rise in spite of apparent health, or if they are not capable
of standing up by themselves or in slings even for a short
time, further if they remain lying for longer than three days,
the urine containing at the same time elements indicating an
affection of the kidneys, finally if high fever is present, there
is only very slight chance for recovery, especially if extensive
decubital gangrene becomes associated with the disease. A
very accelerated and weak pulse has an unfavorable significance,
according to Konig, also the marked increase of red blood
corpuscles at the onset of the affection.

On the other hand there is always hope for an early re-

Vol. 1—57
898 Paralytie Hemoglobinemia.

covery in the presence of an incomplete and transitory paralysis, ©
if at the same time the urine is pale red in color and the pulse
strong; also in those cases in which the marked. disturbances
in locomotion rapidly diminish. In the prognosis however the
possibility should be taken into consideration that sequels to
the disease may develop, which diminish the value of the animal
for a long time, or permanently. According to Thomassen and
Thomson the paralysis of the muscles disappears in most cases
inside of three months, not infrequently however only after
5 to 6 months. Marek observed a case in which a paralysis
of the quadriceps, with a pronounced atrophy of the muscles,
persisted for seven months, in another case even for 11 months;
after that however it rapidly improved and disappeared to-
gether. with the atrophy in the ninth and twelfth months.

The statistical data relative to the mortality vary greatly, ‘as the severity of
the affection in the various localities and at different seasons may show marked
fluctuation. At the Budapest clinic in the years between 1890 and 1909, 45 — 45%
died out of 100 affected animals; the mortality, however, fluctuated considerably
in the different years. According to Friedberger & Fréhner the mortality at the
Munich clinic amounts to 20%, at the Stuttgart 40%, while Bouley estimates it at
60%, Stockfleth at 50%, and Bay, based on 368 cases, at 70%. Among the

horses of the Prussian army the mortality varied in the different years between
26% and 46%, and usually amounts to 32-36%.

Treatment. First of all care should be taken that the
animal be saved from all excitement, and especially from ex-
cessive muscular exertion. Accordingly horses which have
broken down at a distance from their stables should be carried
to shelter in wagons; further it appears advantageous to allow
the animal to lie down for a half or a whole day on richly bedded
ground, and to turn it over at 3 to 4 hourly intervals if they
show no inclination to rise by themselves. Besides they should
be prevented from injuring themselves by continuous watching.
After the lapse of the mentioned time an attempt should always
be made to make the animals stand up, which in many cases
may be accomplished with the aid of a girth placed under the
rump, at the best however by the use of pulleys. It is a
favorable sign if the animal bears more or less upon the feet.
Frequently standing in the slings even for a short time is of
great benefit. If in proper supports the animal places no
weight on the extremities it should not be forced to stand, as
it may asphyxiate; but attempts to get the animal to stand on
its feet should later be repeated from time to time, about
twice daily.

Spontaneous passing of feces should be favored by in-
fusions of water, the passing of urine by moderate pressure
with the hand in the rectum. If this procedure does not lead
to results subcutaneous injections of eserin (0.08-0.10 gm.),
pilocarpin (0.20-0.30 gm.), or arekolin (0.06-0.08 gm.), or the
administration of salines should be undertaken, and the bladder
should be emptied with a catheter if possible every six hours.
Ilour and bran gruels, green feed and good fresh hay are best
Treatment, Prevention. 899

adapted for food. It is best to offer the animal drinking water
as frequently as it is desired.

Rubbings repeated two or three times a day and wrapping
the paralyzed part of the body with moist cloths may also
be advantageous, while it is better to omit counter irritants,
as they may contribute to produce an aggravation of the con-
dition by causing restlessness. The frequently recommended
bleeding was found ineffective by various authors. If heart
weakness is present, stimulants (alcohol, black coffee, camphor
[20-30 gm. subcutaneously], caffeine [2-5 gm. subcutaneously]),
may be used to some advantage. If gangrene of the skin from
pressure develops it may be treated with drying and disinfect-
ing washes (alum and acetate of lead water [1:2:50], Goulard’s
extract), or with similarly acting dusting powders (charcoal
powder containing corrosive sublimate, iodoform, dermatol,
xeroform, etc.).

To increase the alkalinity of the blood, which is supposed to be
considerably reduced, Dieckerhoff recommended the administration of
alkalies in great quantities. He gave on the first day 150-300 gm. of
bicarbonate of sodium, and 300-500 gm. of sodium sulphate, in three
doses, and on the following days 50-200 gm. of sodium bicarbonate. The
result was said to. be satisfactory, but Hutyra and Marek failed to ob-
serve any particular results. Hink and Humann observed good results
from the use of sugar (14-1 lb. per os repeated several times), while
Braund produced recovery in 95% out of 50 cases with iodide of potas-
sium (15-25 gm. in 250 gm. of water on the first, and if necessary 10
gm. additional on the following day), and subcutaneous injections of
eserin. Atoxyl on the other hand was not effective (Rudolph). Finally
the results of the veterinarians agree in that Lumbagin lacks any thera-
peutic value whatever. ,

After improvement has commenced, the rubbing should
be diligently continued, and later the animal may be exercised
quietly, then used at first for light, and finally for the ordinary
work.

Prevention. The disease may be prevented with the greatest
certainty by exercising the horses daily and reducing the grain
food. In consideration of this, the horses should be exercised
for a short time, and fed less even on days of rest and in bad
weather. Sanitation and sufficient ventilation of the stable are

also of importance.

In a large stable of horses in which year after year cases of hemoglobinemia
appeared, new cases were avoided after the animals were only led out of doors
after stable rest, if covered with blankets (Johne). Similar observations were made
by Benjamin and Lavalard after a considerable reduction of grain food, by Brun
from systematic exercising the animals by trotting on days of rest. Ohler orders
washing the croup with cold water in the stable, after which it should be rubbed
dry, shortly previoug to the use of the horses; with this procedure he succeeded
in preventing the appearance of the disease.

‘Literature. Benjamin, Bull., 1907. 240. — Bollinger, D. Z. f. Tm., 1877.
TIT. 155; W. f. Tk., 1885. 439. — Brun, Bull., 1907. 237.~—- Cadéac, J. vét., 1897,
900 Paralytie Hemoglobinemia.

465; Path. int., 1899. VI. 100. —Cadiot, Bull., 1907. 243. — Camus & Pagniez,
Ann., 1902. 621. — Dagés, Bull., 1901. 168. — Dieckerhoff, B. t. W., 1895. 1;
1896. 37; Spez. Path., 1904. II. 524. — Eber, Monh., 1892. III. 207; A. f. Tk.,
1898. XXIV. 262. — McFadyean, Vet. Jhb., 1888. 71. — Fréhner, A. f. Tk., 1884.
X. 296 (complete lit.). — Haase, B. t. W., 1897. 484. — Hauptmann, T. Z., 1898.
582. — Hink, D. t. W., 1901. 106. — Hofer, 6. Vj., 1852. II. 151. — Héfling,
T. Z., 1905. 373. — Humann, W. f. Tk, 1907. 546. — Jobne, S. B., 1879. 94. —
Kleinpaul, B. t. W., 1904. 369. —- Kénig, Monh., 1909. XXI..1. — Lavalard,
Bull., 1907. 240. — Leipziger, Z. f. Vk., 1900. 389. — Ligniéres, Bull., 1898. 744.
— Lucet, Rec., 1889. 96; 1899. 209. — Nowak & Hartel, Vet. Jhb., 1901. 82. —
Ohler, Miinch. t. W., 1909. 829. — Pr. Mil. Vb., 1899-1908. — Razsovits, Vet.,
1894. 559. — Schlegel, B. t. W., 1906. 463; Die inf. Riickenmarksentziindung oder
schwarze Harnwinde, 1907 (Lit.). — Siedamgrotzky & Hofmeister, S. B., 1878. 115.
— Thomassen, Monh., 1902. XII. 305. — Thomson, Am. v. Rev., 1905. 309. —
Wetzl, Klinische Blutuntersuchungen, Diss. Budapest, 1908 (Hungarian).

 

Paralytic Hemoglobinemia of Cattle. There are a few publications
from which it appears that a disease, resembling the paralytic hemo-
globinemia of horses in its nature and symptomatology, occurs also now
and then in cattle. (Leech is supposed to have observed several cases
in dogs [D. t. W., 1899, 88].) As formerly all forms of hemoglobinemia
were thrown together, and as a conspicuous weakness of the hind parts
may also appear in other very frequent forms of hemoglobinemia (for
instance piroplasmosis), a positive determination of the cases originat-
ing in former times is not possible. According to the present stand of
knowledge however, it appears very probable that the observers usually
had to deal with affections caused by piroplasma or by certain blood
poisons, but not with cases of paralytic hemoglobinemia. A. symptom
complex which permits the acceptance of paralytic hemoglobinemia has
been reported by Krug, Hartle, Saur, Notz and Baer & Kurtz. These
cases referred to affections which developed in work oxen either after
several days of rest, or independently of it and also in other cattle sup-
posedly after colds. The disease was manifested mostly by disturbances
of gait in the hind parts or in weakness and stiffness (Bauer & Kurtz),
in enlargement and swelling of the muscles of the croup or thigh,
further in an elimination of a brownish-red urine, which however showed
no red blood corpuscles. Notz found at the same time in three cases,
in an otherwise negative post-mortem, a bluish-gray discoloration, swell-
ing, and softening of the muscles of the croup, back, shoulder and elbow.

Literature. Baer & Kurtz, B. t. W., 1901. 48. — Hirtle, W. f. Tk., 1896.
160. — Krug, B. t. W., 1893. 494. — Notz, W. f. Tk., 1900. 449.

7. Hemophilia. Haemophilia.

Hemophilia is a peculiar, as a rule congenital pathological
condition, which manifests itself in that, even after very in-
significant injuries or blood congestions, profuse hemorrhages
appear which are very difficult or impossible to stop.

Etiology. Up to the present time the disease has been
observed almost exclusively in horses, and especially in thor-
oughbreds (English thoroughbreds), but according to Zschokke
an affection identical with hemophilia has not yet been demon-
strated in animals. The cause of the hemorrhagic diathesis
is still unknown; in man repeatedly an insufficient development
Hemophilia. 901

of the vascular system was found (hypoplasia cordis et
arteriarum), with which the tendency to hemorrhages is sup-
posed to be inherited. In opposition to this Sahli pointed out
the insufficient formation of thrombin in the walls of the vessel.
As a matter of fact Morawitz & Lossen found a deficiency of
‘thrombin in a hereditary bleeder, probably as the result of
a change of the chemical constitution of the cellular elements
in the blood, which are to produce the thrombokinasis. In
animals inbreeding appears also to have an influence on the
development of a hemorrhagic diathesis in the progeny.

As incidental causes of the hemorrhages, rapid galloping,
castration, rope pulling and other injuries of the skin or the
mucous membranes, or even parturition may come into con-
sideration (Stahn).

Symptoms. The hemorrhage is usually external, sometimes
however it may be into a body cavity. The bleeding resulting
from external wounds is usually parenchymatous, and can be
stopped by the ordinary methods only with difficulty after
several hours, or not at all, so that the animal may even bleed
to death. Frequently the loss of blood is so great that it may
result in acute anemia from which the animals recuperate only
after several weeks. (Meyer observed in one case a diminution
in the number of red blood corpuscles to 3,000,000 in one emm.
blood.) In other cases the bleeding may cease after a time,
but may appear again later, and after frequent recurrences may
produce death. In man hemorrhages are also frequent into
the joint cavities and give rise to painful swellings of the joints.

Diagnosis. Before establishing the diagnosis of hemophilia
all diseases which according to experience may cause hemor-
rhages must be excluded (acute infectious diseases, affection of
the heart, aneurysms, kidney disease, new-formations).

Treatment. After the appearance of the hemorrhage the
customary hemostatic remedies should be applied, likewise the
borders of the wound, if present, should be united, compression
should be applied on the bleeding place, and absolute rest of
the body is required. If the hemorrhage continues in spite of
these measures the blood must be coagulated by the use of
concentrated chloride of iron solution, fuming nitric acid, or
by the actual cautery on the bleeding surface. Internally ergot
preparations may be administered. According to recent ex-
periences in human medicine the subcutaneous injection of blood
serum from other species might also be utilized to advantage.
A resulting anemia should also be given appropriate treatment
(see p. 848).

Zschokke sueceeded in preventing the recurrence of hemorrhages in a horse
in two weeks by the administration of 30 gm. of phosphoric acid daily.

Literature. Meier, Z. f. Tm., 1906. X. 1. — Stahn, Z. f. Vk., 1906. 214, —
Villemin, Ann., 1905. 154. — Zschokke, O. M., 1904, 433,
902 Animal Parasites in the Blood.

8. Animal Parasites in the Blood. Haematozoa.
(a) Filaria immitis,
(Filaria haematica.)

Occurrence. The blood affection caused by filaria occurs
in China and in Japan very frequently among dogs, but it has
also been observed in other countries, although less frequently,
especially in East India, Tonkin, Brazil and North America.
In Europe dogs that were imported from Eastern Asia, or
which were kept there for a time became affected mainly, but
native dogs are not necessarily spared (Fréhner, V. Ratz).

According to Janson about 50% of dogs in Japan are affected with filaria
immitis, but about 75% of the affected animals show no symptoms of disease
whatsoever for a long time.

Petropawlowsky in Charkow found 120 vagrant dogs infected, almost with-
out exception, while of 83 other dogs only 3 harbored filaria in the blood. Galli-
Jenne demonstrated filariosis haematica in 18.5% out of 162 autopsies on dogs in

ilan.

Etiology. The full grown filaria immitis is a long, white
worm, of about 2 millimeter thickness. The male is 12-18 cm.
long, its posterior extremity shows a spiral bending; the female
is 20-30 em. long and gives birth to living embryos.

The sexually mature filaria live especially in the right half
of the heart, more rarely in the pulmonary arteries, very rarely
in the vena-cava, and only very exceptionally in the left half
of the heart or in the arteries of the large blood circulation.
They are found at these places in varying numbers, sometimes
up to several hundred, rolled up in a ball which is difficult to
untangle, in which the females give birth to embryos about 1,
mm. long which may then gain entrance to the circulating blood
in very large numbers (Rieck estimated them in one case up
to several millions). Not infrequently however the sexually
mature filaria may be present at the same time also exclusively
in the subcutis.

The mode and manner of the natural infection is not yet
known with certainty. The infection is probably transmitted
by impure swampy water, which the frequent occurrence of
the disease in marshy localities of the warmer countries seems
to substantiate fully. The dogs probably take the larvae of
the parasite with their drinking water. These then reach the
heart with the venous blood and there they mature. The
embryos may leave the animal with some of its blood or some-
times with the excrement and the secretions of the air passages
(Janson), principally however with the urine, and may then
reinfect the drinking water. The artificial transmission of the
disease by inoculation of blood containing filaria has never been
suecessful (Frohner). According to Janson and Galep &
Pourquier the embryos are supposed to pass. sometimes to the
Etiology, Pathogenesis, Anatomical Changes. 903

fetus through the placental vessels. This however was not con-
firmed by Rosso in experiments with a bitch.

According to Manson the embryos of the filaria sanguinis hominis, a worm
resembling the filaria of dogs, are taken up by mosquitoes (culex mosquito) with
the blood of affected persons, in which they develop to larvae. When later the
mosquitoes die in the marshes, after depositing their eggs, the young filaria are
set free from their bodies, and may reach the stomach of new victims with the
water, and from there gain the blood vessels of man. A similar development of
the filaria immitis would also be expected, but Grassi proved that the majority
of the embryos of the filaria sanguinis hominis die in the intestinal canal of
mosquitoes, and that the filaria immitis cannot live in fleas and lice of dogs. Grassi
therefore believes that the embryos reach. the water with blood from occasional
wounds, and probably also with the urine, passing into the healthy animals directly
with such infected water.

Pathogenesis. The sexually mature filaria appear to cause
disturbances, especially in a mechanical way. They check the
blood circulation more or less, depending on their numbers,
either in the heart itself or in the blood vessels, with which
of course a quite considerable thrombosis produced by the
parasite usually becomes associated. After their infesting the
heart cavities the filaria produces a chronic inflammation of
the endocardium. The thrombi which develop in the heart
cavities or in the large blood vessels may again give rise to
the dissemination of emboli. The formation of emboli occurs
mostly in the branches of the pulmonary arteries, and may
then lead to necrosis of circumscribed portions of the lungs
or to abscess formation. Particles of the thrombi are excep-
tionally conveyed to the kidneys or into the brain.

The embryos of filaria produce first of all anemia with a
pronounced leucocytosis, the severity of which depends on the
number. These changes in the blood are probably brought
about by the action of toxic metabolic products, and also by
the utilization of the constituents of the blood. The purely
mechanical action of the ‘embryos produces on the other hand
at most only insignificant effects, plugging of the capillaries,
and occurs. most frequently in the capillaries of the kidneys,
more rarely in the other organs (lungs, brain).

Anatomical Changes. Sexually mature filaria surrounded
with firm blood coagulum are found in the right half of the
heart or in any branch of the pulmonary arteries, sometimes
in the vena-cava, and exceptionally also in the left half of
the heart (Hutyra found in one case almost the entire aorta
filled up by firm masses of thrombi). At the same time chronic
endocarditis, partial hypertrophy and dilation of the heart,
possibly also rupture of the heart, with symptoms of blood
stasis (hydrops, cirrhosis of the liver, ete.) may frequently be
present. The lungs sometimes show hemp-seed to pea-sized
nodules, each containing an embryo appearing as a red dot;
besides these atelectasis, splenization, abscess formation or
necrosis may be found. The kidneys may manifest a paren-
904 Animal Parasites in the Blood.

chymatous, or not infrequently a chronic interstitial inflamma-
tion; they may also contain punctiform hemorrhages. The sub-
cutaneous and intermuscular connective tissue may reveal
sexually mature filaria free or encapsulated; in these parts they
may be present even when the heart or blood vessels do not
contain full grown filaria (v. Ratz). The autopsy finding is
further completed by the presence of anemia and of the em-
bryos in the blood. If accidentally only male filaria, or only
unimpregnated females are present in the affected animal, the
blood does not contain filaria embryos. On the other hand some-
times in spite of the presence of filaria embryos in the blood
no sexually mature filaria can be demonstrated (Fréhner).

Symptoms. As long as the filaria and their embryos are
present in the blood in only small numbers, their presence is
not disclosed by disease symptoms. In severe cases however,
after a month or even after a latent stage of years, more rarely
immediately from the beginning, symptoms of severe anemia
and gradually progressing emaciation develop; sometimes an
abnormally increased appetite is also observed. Later hemor-
rhages appear in the internal organs, in the lungs, intestines
and in the kidneys.

Besides these manifestations which are of general import-
ance, local symptoms may appear in some of the cases, which
are produced either by the thrombi developing in the heart
or by embolic plugging of small blood vessels. As a result of
these, various disturbances of the heart action may develop,
which may even lead to paralysis of the heart, hydropic symp-
toms, sometimes venous or arterial thrombosis, further epilep-
tic convulsions, cough and difficulty in respiration, symptoms
of nephritis, hematuria, as well as weakness of the hind parts
which may increase to complete paralysis. Rheumatoid pains
were also observed (Frohner). The blood shows, besides indi-
cations of anemia, also a pronounced leucocytosis. (Marek
in one case found the relation between white and red blood
corpuscles to be 1:18.) All of these symptoms develop slowly, and
without fever, gradually reach a high degree, and the disease
extends not infrequently over several years.

Exceptionally the disease manifests itself only in epileptic fits (Mégnin),
which may lead to a fatal termination (Earl) or death ensues as the result of a
rupture of the right auricle (Schneider, Guittard).

In certain cases a papular erythema, with the appearance of a diffuse red-
dening of the.skin, and numerous small and hard nodules and vesicles develop, with
which severe itching is associated. Otitis externa also occurs. In the contents of
the nodules or vesicles, also in the eezematous or otitic products, embryos of filaria
may be demonstrated.

Diagnosis, The recognition of the disease is usually only
possible by microscopic demonstration of filaria embryos in
the blood. A drop of blood placed between a slide and a cover
glass without any special treatment, reveals even on slight
Diagnosis, Treatment. 905

magnification, fine, worm-shaped colorless embryos, which exe-
cute snake-like or circular movements between the blood cor-
puscles. (Hutyra & Marek failed to find a variation in the
number of embryos during the hours of the day and night,
although it is claimed by Manson and Sonsino that filaria ap-

pear in large numbers in the peripheral vessels only during
the night.)

Treatment. This promises results in strongly infected
localities only in so far as some chronic cases without pro-
nounced disturbances in nutrition and: circulation, may be ar-
rested (Janson). Good nutrition, avoiding exertion and new
infection, as well as the administration of heart tonics or
arsenical preparations come into consideration; Dorn recom-
mends atoxyl, which produces in man a diminution of the filaria
embryos. If a skin affection results this requires the applica-
tion of antiparasitic and itch-preventing remedies (see eczema
or scabies in. Vol. IT).

Literature. Cadéac, J., vét. 1897. 582. — Deffke, Monh., 1890. I. 323. —
Fettick, Vet., 1900. 245. — Fréhner, Monh., 1892. III. 494. — Grassi, Chl. f.
Bakt., 1888. IV. 615. — Janson, A. f. Tk., 1892. XVIII. 63. —Petropawlowsky,
A. f. Vet.-Wiss., 1904. 484. — v. Ratz, Vet., 1898. 395. — Roger, Bull., 1906. 119.
-—— Rosso, Mod. Zooiatrio, 1897. 185.

Filaria Sanguinis Equi. In former times repeated reports appeared
relative to the occurrence of filaria embryos in the blood of horses
(Wedl, Sonsino, Manzanti, Lange). The classification of the parasites
found was never satisfactory, while their differentiation from trypano-
somes was not attempted. Recently however Lingard proved by long
continued experiments that filaria embryos do occur in the blood and
mature filaria in the blood vessels of horses.

The filaria sanguinis equi is a thread-shaped, thin, whitish worm, the
males measuring 10-15 cm., the females about three times that length.
The caudal extremity appears rolled up and supplied with two uneven
spicules which are bordered by a papillae. The worm is ovoviviparous;
the length of the embryos amounts to 160-220 ». The grown specimens
live in the walls of the large arteries, especially in the anterior or pos-
terior aorta, while the embryos circulate in the blood.

The worms were found by Lingard in India especially in the native
horses while imported animals become affected only after long stays in
the country. The mode and manner of infection is not yet known; the
transfusion of blood containing embryos was negative in two cases. The
symptoms of the disease probably only appear after a long period of
latency, and consist of rapid fatigue, edematous swellings of the lower
parts of the extremities and the prepuce, at the same time the respira-
tion becomes much accelerated and small hemorrhages appear on the
conjunctivae. Sometimes moderate fever is observed. The heart action
is stronger and more frequent. The blood reveals embryos with a snaky
and circular movement, their number increases in the afternoon and
reaches its maximum in the evening. The embryos are especially
numerous during the hot and rainy season, but now and then they may
temporarily disappear entirely,
906 Animal Parasites in the Blood.

The autopsy reveals, besides the already mentioned changes in the
blood vessels and in the blood, numerous mustard-seed sized, caseous
or calcareous nodules in the lungs and also in the liver, and in these
are found embryos of the filaria. (Lingard, Rev. gén., 1906, VIII,
179 [Ref.].)

(b) Other Animal Parasites in the Blood.

Bilharzia crassa, B. indica, B. Bomfordi (Schistosomum crassum
s. bovis, Sch. indicum, Sch. Bomfordi). These resemble the Schistoso-
mum japonicum of man, which according to Tsuchiya is not identical
with the Bilharzia haematobia (Distomum haematobium). The disease
caused by them (Bilharziosis), occurs frequently in Egypt, India, Japan,
Mozambique, Sudan, Abyssinia, Tunis, Cape Colony, Cochin-China, also
on the Island of Martinique, and affects cattle, sheep, horses and donkeys.
In Europe the disease was known until quite recently only in Italy in
cattle and sheep, but recently a case was observed by Marotel in a cow
in the vicinity of Lyons in France. Grassi & Rovelli in Sicily found
75% of the examined sheep, Bertolini 9% of the cattle of Sardinia, af-
fected with bilharziosis. The parasites were principally found in animals
between two and four years of-age.

Publications on bilharziosis were made by Sonsino (1876), Bomford &
Powell (1886), Grassi & Rovelli (1888), Railliet (1889), Sanfelice & Loi (1899),
Montgomery (1906), Raja & Peju (1907), Marotel (1908) and Bertolini (1908).
Montgomery, Marotel and Bertolini described the cause of the disease very
accurately.

The infection probably results from drinking stagnant water, which
becomes infected with the eggs through intestinal excrements and
through the urine of animals. This mode of infection is indicated by
the fact that man, who, in infected localities drinks only filtered water,
usually does not become affected. :

The usual location of the bilharzia is the portal vein with its
branches, in the region of which they produce manifestations of stenosis;
Montgomery found them also in the liver, whereas Bertolini never ob-
served them there. The worms are recognized, on placing the blood in
a flat dish, as thin, white bodies about 14-1 em. long bent in a C-form.
Not infrequently they are found in copulation, when the females are held
by the males in groove-shaped depressions of their bodies.

The spindle-shaped eggs which are supplied at one end with spur-
shaped extensions, circulate in the blood and produce inflammatory
changes or hemorrhages especially in the walls of the intestines, also in
the urinary bladder. In cattle changes exceptionally develop in the
intestines which may give rise to confusion with rinderpest. Small,
wart-like new-formations develop in the bladder, rarely in the rectum
of cattle.

The anatomical changes show certain variations in the different
localities and in accordance with the number of parasites. Thus Ber-
tolini for instance found only hyperemia of the small intestines and
hemorrhages in the rectum, while the sections of the large intestines
as well as the bladder were free of such lesions. At the same time
nodules like sand-granules could be felt in the mucous membrane of
the small intestines, which contained female bilharzia and their eggs; in
Animal Parasites in the Blood. 907

the hemorrhagic areas of the rectal mucous membrane eges of bilharzia
were found massed together.

- The symptoms are indicative in general of a subcutaneous or chronic
eatarrh of the mucous membrane of the intestines and bladder, in which
periodically hemorrhages may be observed, according to Bertolini in
the first half of the summer. The disturbances of health are always
slighter in horses than in ruminants.

A diagnosis ‘would be possible during life by demonstrating the
characteristic eggs in the urine, feces, or by the water-like new forma-
tions in the rectum which might be present.

Treatment is not promising of results.

Literature. Bertolini, Klin. Vet., 1908. 1 (Lit.). — Marotel, Bull., 1908. 119.
jeer eee J. of trop. vet. science, 1906. 138 (Lit.)..— Raja & Peju, J. vét.,

Haematozoon Lewis. Gruby & Delafond found worms, among
others in the blood of dogs, which resembled the embryos of the Fil. im-
mitis with relative frequency even in countries where the Fil. immitis
rarely occurs (the mentioned two authors in Paris in every twentieth to
twenty-fifth, Sonsino in Pisa, Lewis in Calcutta in every third dog). They
differ from the Fil. immitis in that they attach their head ends to the
cover glass, at the same time executing lively motions with the other parts
of the body. They are remarkably resistant, so that they remain alive
for 10 days outside of the animal body at a temperature of 15° C. They
are found in the arterial as well as in the venous blood, and sometimes
in such quantities that a drop of blood may contain 3-5 and even 12-15
specimens.

Views differ in regard to the development of the parasite. Ac-
cording to Grassi they develop from larvae, which occur quite frequently
in fleas (Pulex serraticeps) and lice (Haematopinus piliferus) of dogs.

Dogs whose blood harbors the embryos may appear entirely healthy ;
Gruby & Delafond observed however epileptic fits in three dogs. The
same authors have further observed that after transfusion of defibrinated
blood, containing the embryos, into healthy dogs the embryos disappear
from the blood of the injected animals in 8-40 days; in two cases however
they remained alive for longer than three years, until the death of the
dogs. A full grown worm corresponding with the embryo is still un-
known. (Carougeau & Marotel, Rev. gén., 1903. I. 447 [Lit.].)

Strongylus Vasorum. This is a fine, thread-shaped worm (the male
is 14-15, the female 18-21 mm. long), which occurs in the right ventricle
of the heart, and in the pulmonary artery and in its branches. In the
intima of the vessel wall it causes the formation of small nodules or
elongated cords, and in the small vessels thrombi. The eggs laid by the
female remain lodged in the finer blood vessels, and lead, like the
hatched embryos, to the formation of small, up to pinhead sized, some-
times quite numerous nodules. According to Laulanié the embryos
migrate later into the bronchi, they are expelled by coughing, and are
then occasionally taken up by other dogs.

The symptoms of the disease are not very characteristic. Symptoms
of anemia, gradually progressing emaciation, frequent and irregular heart
action, possibly hypertrophy of the right half of the heart, further a
painful weak and dry cough are observed in severe cases, but the disease
908 Animal Parasites in the Blood.

usually remains unrecognized. If it is suspected the small embryos may
possibly be demonstrated in the expectorations.

Up to the present the disease has been observed in France especially
in the vicinity of Toulouse (Baillet, Lafosse, Laulanié) and in. Italy
(Bossi) where it sometimes appeared in an enzootic form and caused
considerable loss.

According to Lafosse it is possible to cure (?) the disease by the
internal administration of oil of turpentine (2-4 gm daily for one week)
(Neumann, Mal. parasitaires, 1892. 621 [Lit.].)

Strongylus Subulatus (Haematozoon subulatum) was found by Leisering
(V. A., 1865. XX XIII. 111; 8. B., 1864. 49) in the venous blood of the corp.
cavernosa of the urethral penis and the glans, while in another dog the worms
were present in nodular-shaped swellings of the lungs, the thyroid gland, and lymph
glands.
In the walls of the Jarge arterial branches there may further occur the
Spiroptera sanguinolenta (see Vol. II), Filaria Blini and F, Evansi (see Inflam-
mation of the Arterial Wall).

 
Diseases of the Spleen

The diseases of the spleen in animals are known almost
exclusively from the results of post-mortem examinations.
This is due to the fact that in larger animals examination is
very difficult owing to the unfavorable anatomical position of
the spleen, so that in most cases only marked changes in form
and size of the organ can be determined; furthermore diseases
of the spleen usually produce only very indefinite disturbances
in function. It must, however, be noted that in veterinary
medicine a careful and systematic examination of the spleen
has hitherto not received much attention. :

In view of the very small number of clinical observations
it is impossible for the present to afford a satisfactory descrip-
tion of the symptoms.

Acute Enlargement of the Spleen (Tumor lienis acutus).
This occurs very frequently. Owing to its spongy structure
the spleen contains, even under normal conditions, very much
blood, the quantity of which may vary within wide limits ac-
cording to different influences. Svoboda, for instance, found
the spleens of healthy sheep, which had been given food and
water just before being killed, enlarged two and threefold, and
Lenkey frequently observed an enlargement of the spleen in
food animals whose central nervous system was destroyed from
brain to lumbar cord by means of a stick forced into the skull.
In fact there is no other organ which, in a short time, increases
so much in size through variations in its blood contents, while
on the other hand the smooth muscular fibers and elastic ele-
ments of the spleen enable it to contract rapidly when the influx
ceases, and to remove its surplus of blood.

A pathologically increased flow of blood to the spleen is
sometimes produced by contusions or wounds of the splenic
region, and is also likely to occur in the initial stages of in-
flammatory processes as well as in impediments to the portal

909
910 Diseases of the Spleen.

circulation or to the splenic vein (as, for instance, in torsion).
The most important swelling of the organ, however, is that
which frequently occurs in acute infectious diseases. This form
of acute splenic enlargement is caused partly by the accumula-
tion of bacteria in the pulp of the spleen, partly, and to a
greater degree, by the increase in the number of lymph cells
and the deposition of leucocytes containing bacteria as well
as the deposition of disintegrated red blood cells which is
quickly followed by an inflammatory process associated with
swelling and increase of the cells and ‘swelling of the connective
tissue framework. (Splenitis hyperplastica acuta.)

The most striking pathogenic effect of bacteria and their
toxins is observed in anthrax. In this affection the spleen
may be enlarged as much as 5 to 10 times the normal size and
the swelling may increase so rapidly that the capsule, being
subjected to severe tension, sometimes tears. In other diseases
the swelling is usually less in degree and it is probably least
intense in such cases in which only bacterial toxins circulate
in the blood. A marked splenic enlargement is met with in
swine erysipelas, in acute glanders, and in acute tuberculosis
(partly due to the formation of nodules), in pyemia, hemo-
globinemia, in the acute infectious anemia of horses, while the
various forms of hemorrhagic septicemia as well as croupous
pneumonia are accompanied only by slight swelling, and this
is entirely absent in purpura hemorrhagica or in tetanus.

- In living animals, except in ruminants and in fat hogs and
dogs, acute swelling of the spleen may as a rule be diagnosed:
in horses by rectal exploration; in smaller animals by abdominal
palpation. The spleen is found to be enlarged, soft or more
or less tense to the touch. A considerable swelling may be
recognized by dullness on the left side, which is in horses parallel
to the costal arch, in dogs and hogs in the direction of the
last two intercostal spaces passing downward from the costal
arch and which is 3 or 4 fingers wide. In ruminants the swelling
is usually unnoticed because the spleen, covered by the lung, does
not protrude beyond the posterior border of the lung even if de-
cidedly enlarged. Nevertheless in severe cases careful per-
cussion may show a dullness at the border between lung and -
rumen as was recently observed by Szathmary in a buffalo
affected with anthrax.

Literature. Jawein, V. A., 1900. CLXI, 461. — Lenkey, Husszemle, 1907. 65.
— Szathmary, A. L., 1909. 525.

Purulent Inflammation of the Spleen. (Splenitis aposte-
matosa.) This occurs after the extension of a similar inflam-
mation from neighboring organs or after the lodgement of
infected emboli (as, e. g., in strangles, etc.). In a case reported
by Arndt the embolus in the spleen came from a suppurating
inflammatory focus which had been produced by a rusty needle
Purulent Inflammation. 911

in the hard palate). The suppurative foci may be isolated or
numerous, and in case of metastasis several abscesses are
usually formed. In exceptional cases gastrus larvae may pro-
duce extensive suppuration in the spleens of young horses
(Kovats). Traumatic influences usually lead to the formation
of only one abscess, but the entire organ may become subject
to the suppurative destruction. While an injury in the splenic
region may be the immediate cause of such an inflammation it
is far more frequently produced by foreign bodies which may
get into the organ from the first stomachs of ruminants and,
exceptionally, from stomach and intestine in other animals.
The spleen may be enlarged to 4 or 5 times its normal size.
According to Notz sucking calves often develop a purulent
hemorrhagic inflammation of the spleen when they are stepped
on by their mothers.

The symptoms of traumatic purulent inflammation of the
spleen are very vague. Aside from the sensitiveness and en-
largement of the organ which may be demonstrable, the clinical
picture is composed more of general disturbances an explana-
tion of which is possible only by reliable historical data to a
certain degree. There are cases in which a large abscess is
‘found in the spleen on autopsy of animals which presented
no sign of disease during life. Mobius, for instance, found an
abscess containing 3 liters of pus in the spleen of a well-
nourished cow, and Kihnau reported a similar case. In other
cases only digestive disturbances and colicky symptoms, show-
ing little that is characteristic, are observed and are followed
by a gradual or rapid emaciation (Knoll, Zimmermann; de
Meestre ordered the animal to be killed in one case because
he suspected lung plague). Fleischer observed, in purulent
inflammation of the spleen in cattle, convulsive movements
which recurred periodically. If the disease develops rather
rapidly there exists a violent fever which may be continuous
or remittent. Imminger is inclined to consider a continuous
temperature of 40-41° C., which does not yield to antipyretic
remedies, as characteristic of purulent splenic inflammation.
In this he surely goes much too far, for in the presence of
such symptoms the nature of the disease can be recognized
only then when at the same time swelling and perhaps tender-
ness of the spleen may likewise be ascertained by percussion
and palpation (van den Eeckhout found in a colt an area of
dullness, five fingers wide, below the left costal arch, the an-
terior border of which passed in front and below, obliquely
to the fifth rib and then turned vertically downwards; the
enlarged spleen weighed 914 kg.). Sometimes a large splenic
abscess may be felt from the rectum and then it will be possible
to determine fluctuation. Finally, purulent inflammation of
the spleen may give rise to the development of peritonitis or
pleurisy which will also occur after rupture of the abscess in
which case it becomes purulent. (Froéhner, Author’s case).
912 Diseases of the Spleen.

In an uncomplicated purulent inflammation of the spleen,
surgical interference is to be considered, internal treatment
affording no promise whatever of results.

Degive extirpated the spleen of a dog, which was adherent to the omentum,
without any harm to the animal.

Literature. Arndt, B. t. W., 1889, 243. — Degive, Ann., 1888. 10. —- van den
Eeckhout, Ann., 1906. 619. — Faustle, W. f. Tk., 1908. 362. — Fleischer, B. t. W.,
1906. 922, — Fréhner, Monh., 1907. XVIII. 144. — Gmeiner, Monh., 1896. XVII.
510. — Imminger, W. f. Tk., 1892. 229. — Kovats, Vet., 1895. 360. — de Meestre,
Ann., 1887. 354. — Mébius, S. B., 1888. 71. — Notz, W. f. Vk., 1891. 280. —
Richter, Z. f. Vk., 1906. 390. — Zimmermann, B. t. W., 1894. 358.

Hemorrhage of the Spleen. (Haemorrhagia lienis.) Hemor-
rhages into the spleen are not infrequent, but can hardly be
diagnosed clinically. (Rupp observed obstinate constipation in
a dog with a large splenic hematoma.) The cause of the hemor-
rhage may lie in active or passive hyperemia, or in acute splenic
enlargement. Berg and other Danish veterinarians quite fre-
quently observed diffuse splenic hemorrhage in cattle which
suddenly became ill and died soon, so that anthrax was often
suspected. Hemorrhage in the spleen not infrequently occurs
after contusion of the splenic region, but is rare after the
lodgement of non-infected emboli. The hemorrhage may cause
the spleen to burst.

Literature. Berg, Maanedsskr., 1905. XVI. 441. — Bodon, Vet., 1899. 432.
— Querrini, Monh., 1908. XX. 90. — Rupp, B. t. W., 1906. 44. — Witt, B. t. W.
1908. 625. :

Rupture of the Spleen. (Ruptura lienis.) A healthy spleen
only very rarely tears from direct injury, but in rapidly in-
creasing acute swelling this may occur without any traumatic
effect, and internal fatal hemorrhages from such a cause are
by no means rare; they are observed in anthrax with relative
frequency. Sometimes here also a traumatic accident that may
be slight in itself, such as falling down, rapid motion, cough,
ete., may form the immediate cause of the rupture, but in other
instances no external cause can be determined. Witt, who often
observed sudden death, and hemorrhage into the abdominal
cavity in cattle with ruptured spleen, took the disease to be
malaria, as he had found white corpuscles, similar to parasites,
in the blood cells. In a case of Darvas’ the rupture of the
spleen was due to the bursting of an echinococcus.

Rupture of the spleen produces in general only symptoms
of internal fatal hemorrhage, the cause of which can at best
be suspected on account of the simultaneous colicky symptoms,
the accumulation of fluid in the abdominal cavity, and still
more on account of a splenic tumor that may be detected.
(Drewien found on rectal exploration in a horse a large swell-
ing in the left side of the abdomen.) (Literature under Hemor-
rhage of the Spleen.)

Torsion of the Spleen. (Torsio lienis.) Torsion of the
Rupture, Torsion, Chronie Enlargement. 913

spleen around the splenic ligament occurs not infrequently in
hogs (Glage) and is observed occasionally also in dogs (Boston,
Johne, Author’s case). If the spleen has become heavier be-
cause of enlargement or swelling, and if the ligament has be-
come atrophic (Glage), the organ may rotate on the ligamentum
gastro-lienale during a forced motion of the body or yielding
to the pressure of other organs. When‘the rotation has taken
place, the veins passing through the ligament are compressed
so that the return flow of the venous blood is impeded and a
splenic tumor is produced which increases rapidly and enor-
mously. Simultaneously stasis takes place in the gastric veins
opening into the splenic vein, which leads to a venous hyperemia
of the stomach; this is, however, usually not intense. Torsion
may lead to necrosis of the spleen.

The affection is characterized by marked splenic enlarge-
ment and sometimes also by symptoms of gastric catarrh. Al-
though a great swelling of the spleen, together with a rather
soft consistency of the organ may suggest torsion, this cannot
be definitely recognized by clinical methods.

Literature. Glage, Z. f. Flhyg., 1898. VIII. 4. — Zietschmann, 8. B., 1903.
257,

Chronic Enlargement of the Spleen. (Tumor lienis chroni-
cus.) Strictly speaking, this always develops in consequence
of venous stasis, which by the copious effusion of nutritive ma-
terial stimulates an increase in the connective tissue elements
of the frame substance. As more frequent causes may be
enumerated: Thrombosis of the splenic vein, chronic interstitial
hepatitis, thrombosis or compression of the Vv. portae by a
swelling, by atrophy of the connective tissue or by a hematoma
of the liver, sometimes also organic heart lesions.

In the diagnosis of chronic tumor of the spleen the symp-
toms described for acute swelling are deciding, but with the
difference that here the consistency of the spleen is firmer.

Chronic swelling of the spleen may include the following
pathological conditions of the organ:

Splenitis chronica indurativa, which develops, according to K‘tt,
through the persistent influence of toxic infectious agents (for instance
in the chronic erysipelas of hogs).

The leukemic splenic tumor can usually be clinically diagnosed
with certainty. The nature of the enlargement is indicated by the
characteristic blo6d changes; greater difficulties are encountered in
the correct recognition of a pseudoleukemic splenic tumor.

Simple hyperplasia of the spleen (Hyperplasia lienis) 1s occa-
sionally found on autopsy. The spleen is usually remarkably large
(in the case of Bourret and Druille the spleen of a horse weighed
21 kg.; in that of Duschanek, 39; in that of Koch the spleen of a cow
weighed 18.5 kg.). During life gradual and progressive emaciation
and respiratory difficulty was observed.

Vol. 1—58
914 Diseases of the Spleen.

Literature. Bourret & Druille, Rec., 1887. 300. — Duschanek, T. Z., 1894,
353. — Kappel, Z. f£. Flhyg., 1904. XIV. 53. — Koch, B. t. W., 1893. 127.

New Formwiions in the Spleen. The most frequent of these
are melano-sarcomas which occur particularly in white horses
(Deste) either in the form of fairly large metastatic growths
which may become as large as a child’s head, or in the form
of diffuse infiltrations; and at times they become the cause of
considerable enlargement of the spleen. Barrier observed in
one horse first an enlargement of the circumference of the
abdomen, the desire to eat being good and the ability to work
satisfactory. Not until about three weeks before death did the
animal begin to lose weight; the appetite was disturbed, the
weakness increased progressively, the walk became staggering
ard at times colicky symptoms appeared. On rectal examina-
tion a large swelling was found in the left half of the abdominal
cavity. :

Of similar clinical significance is the enlargement of the
spleen in amyloid degeneration, in metastatic carcinoma or in
the presence of large tubercles (especially in cattle and hogs,
sometimes also in horses) or of echinococcus cysts. Direct ex-
amination can at most show the splenic enlargement which
may occasionally cause respiratory distress (Barrier), the
cause of the enlargement must be determined from other patho-
logical signs. Laendler succeeded on rectal examination in a
heifer in palpating the very knobby posterior border of the
spleen which was increased about 5 times in volume through the
presence of echinococcus.

Necrosis of the Spleen. This was found by Zietschmann
and Poetsch (S. B. 1903, 259) in an apparently healthy heifer
which had been killed for meat. As the cause of the necrosis
a complete thrombosis of the splenic vein may probably be
held responsible.

Atrophy of the Spleen. Mayer (Z. f. Flhyg. 1909, XIX,
251) found in a sow which had been killed for meat a far ad-
vanced senile atrophy of the spleen which was only 6 em. long
and 4.5 em. wide.

ce ‘Vugpcgbteagereaen ya re
Diseases of Metabolism.

 

1. Obesity. Obesitas.
Fettsucht.

By obesity is understood an excessive deposit of fat which
interferes in some way or other with the ability of the animals
to work. If the increase of the fat deposit occurs while nutri-
tion and muscular activity are normal, it is called obesity in
a limited sense of the word, in contrast to the alimentary obesity
(fattening), which is the result of generous feeding or of in-
activity. ,

Etiology. The cause of alimentary obesity lies in a dis-
proportion between the intake and the utilization of nutritive
units. This condition very frequently prevails if the animals
receive more food than they need in order to maintain their
bodily functions. It also occurs frequently enough that the
intake of caloric units does not exceed the average amount, but
that through insufficient activity the muscles of the body use
up too small an amount of energy-units. Finally, both factors
frequently combine in producing obesity.

A generous deposit of fat is promoted above all by the
fattening of animals intended for food, but although strictly
speaking a pathological condition, this does not usually form
an object for therapeutic measures. Obesity is further fre-
quent in breeding animals, especially in the males, which are,
as a rule, not only fed generously, but are moreover spared
all work, and are even not rarely prevented from taking the
most necessary exercise. The same is true of pet and house
dogs. In general, however, favoring factors are of essential
importance. Above all a vigorous appetite comes into consider-
ation; which apparently varies individually within wide limits.
Then the nature of the food is important, food-stuffs which are
rich in fat and carbohydrates producing a considerable fat de-
posit. On the other hand the deposit of fat is promoted by
all conditions which persistently diminish muscular activity.
In this respect the phlegmatic temperament which may be in-

915
916 Obesity.

herited is very important. Animals also become phlegmatic
after castration (Liithje) and then tend to put on fat. The
same is true for older animals. By diminishing muscular ac-
tivity anemia may favor the deposit of fat if it is not due to
an organic lesion or to deficient feeding. It has for this reason
become customary in many districts to promote the fattening
of the animals by periodical venesection. The diminution of
muscular activity finally becomes a favoring factor in producing
obesity in many broken-winded horses.

In all these cases the obesity develops in consequence of an
absolute or relative hyperalimentation. As to whether aside from
this there also exists in animals a true constitutional obesity we
do not possess any observations based upon examinations of the
metabolism. This form of obesity might be expected to arise
from a slowing of metabolism because in such individuals the
weight unit protoplasm would transform less potential energy
into living force, primarily into heat (v. Noorden). As a matter
of fact, v. Bergmann recently actually demonstrated the slow-
ing of metabolism in persons affected with obesity. This diminu-
tion of the oxidizing function of the protoplasm may, according
to v. Noorden, have its cause in a peculiar constitution of the
protoplasm itself or it may be the consequence of abnormal

internal secretions, especially those of the thyroid gland which -

exerts a stimulating action upon oxidation, while its function
is regulated in its turn by other organs (pancreas, sexual glands,
hypophysis, adrenals). v. Noorden thus explains constitutional
obesity as a thyreogenic obesity.

Anatomical Changes. The fat is present in very large pro-
portion, especially in the subcutaneous connective tissue whence
it may enter between the muscles and even between the muscle
fibers, also between the mediastinal folds, under the visceral
layer of the pericardium and possibly in the heart muscle, in
the omentum, the colon, in the region of the kidneys, ete. In
severe cases individual fibers of the muscles which are per-
meated with fat, for instance in the heart muscle, take on a
yellowish color owing to fatty degeneration. Of the internal

organs it is particularly the liver in which there is a great ac-.

cumulation of fat.

Symptoms. Obesity shows itself most strikingly in a
peculiar alteration in the shape of the body by which the out-
lines of the body are rounded out and the skin forms thick,
but soft and elastic folds. This change is most decided on the
trunk, especially on the abdomen, then on the thighs, the
shoulders and on the throat. The enlargud belly sometimes
has an appearance as though the abdominal walls were forced
apart by fluid or a swelling, but the actual cause can easily
be determined by palpation and percussion and still better from
the other signs of obesity. The skin feels soft and elastic;

 
Symptoms, Course and Prognosis. 917

between its folds a superficial inflammation occurs not infre-
quently.

_ Another symptom is lassitude and rapid fatigue on motion
which causes the animals to become dyspneic and to perspire.
Respiration. is frequent and superficial even at rest, be-
cause the diaphragm is forced against the thoracic cavity and
because the contraction of the respiratory muscles is impeded.
This may, however, be partly due to the weakened heart action
through which the pulse becomes rapid and soft.

Later on digestive disturbances occur frequently because
the motility of stomach and intestines is diminished by the
masses of fat, which may also account for the frequent con-
stipation. In breeding animals the ability to procreate dimin-
ishes proportionally with the obesity and eventually disappears
entirely; furthermore, the increased weight and diminished.
muscle force renders coition difficult or impossible.

Course and Prognosis. With care and moderate feeding
the diseased animals may be kept alive for a long time. But,
unless the causes are removed, there develops a gradually in-
creasing anemia leading to an aggravation of the respiratory
and circulatory disturbances, and finally death occurs from
heart failure or asphyxiation. Previous to the fatal termina-
tion there are often signs of blood stasis, such as cyanosis,
dyspnea, edematous infiltrations, etc.

The prognosis is favorable insofar as a timely and proper
regulation of diet will in most cases relieve the pathological
ecndition.

Treatment. The method which is most certain to be suc-
cessful consists in the diminution of the daily food ration and
in systematic exercise of the animals. In order to prevent
digestive disturbances the amount of the food should be re-
duced gradually down to a daily allowance which corresponds
to the. species and size of the animal. Especially in dogs
care should be taken to feed them only at certain times, once
or twice daily. It is of course necessary to pay attention
to the composition of the food-stuffs and especially the allow-
ance of carbohydrates and fats should be limited as much as
possible. On the other hand the limitation of the amount of
drinking water has only the effect of assuring a freer motion
of the animals and therefore a greater expenditure of energy.

It is advisable to attempt the systematic administration
of Carlsbad water (in dogs 1% to 1 tablespoonful once or twice
before feeding), although in most cases this treatment is super-
fluous. Of excellent service are the thyroid gland preparations
which stimulate a considerable oxidation of fat, but at the
same time cause an increased disintegration of albumin, so that
‘their administration must be supplemented by a more generous
ratio of the proteids. The various preparations that may
918 Diabetes Insipidus.

be used are Thyreoidinum depuratum (for dogs 0.2-0.3 to 0.75
gm., or 3 times daily 1 dessertspoonful of the 1:1000 solution) ;
Thyreoidinum Poehl (3 times daily 0.3-0.6 gm.); Iodothyrin
(0.1-0.2 gm.). If necessary the fresh thyroid gland of animals
killed for food may be employed. If anemia is present this
also requires appropriate treatment.

Literature. v.Bergmann, D. m. W., 1909. 611. — Krehl, Pathologische
Physiol., 1910. 430 (Lit.). — Liithje, Arch. f. exp. Path. u. Phmk., 1903, L. 169.
— v. Noorden, Arztekongr. Budapest, 1909. — Zimmermann, Vet., 1901. 657.

2. Diabetes Insipidus.

Diabetes insipidus is a functional disturbance of the kidneys
which causes the animal permanently to require large amounts
of water for the elimination of the substances that are secreted
with the urine, so that it voids large amounts of watery urine
free from albumen and sugar and having a low specific gravity.

According to this definition polyuria (Lauterstall), which is a
transitory condition, is not to be classed with diabetes insipidus;
except after excessive water drinking, it occurs rather frequently in
the most varying diseases in which copious exudates are absorbed in
a short time (pneumonia, pleurisy, etc.), then in certain chronic in-
fectious diseases (tuberculosis, glanders) and in certain affections of
the central nervous system (tumors, hemorrhages, inflammations).
That form of polyuria which occurs in the course of many acute or
chronic kidney inflammations, usually together with albuminuria must
also be considered only as a partial symptom of the diseases named
and can therefore not be classed with diabetes insipidus. The same
is true for the transitory polyuria after the ingestion of irritating
substances. In contrast to this transitory or symptomatic polyuria,
diabetes insipidus occurs as an independent anomaly.

French medical authors differentiate a diabetes insipidus verus and a diabetes
azoturicus. In the former are comprised those forms in which with an increased
total amount of urine the solid constituents are not, or only slightly, increased,
while in diabetes azoturicus the solid constituents are secreted in amounts far above
normal. (If the amount of urine is normal and only the solids are increased, the

condition is designated simply as azoturia.) In veterinary medicine exact analytical
examinations in this direction have yet to be made.

Distribution. As an independent disease in the meaning
described above diabetes insipidus has been diagnosed with cer-
tainty in animals only comparatively rarely (Hayne, Veith,
Moiroud, Dammann, Perrin, Dieckerhoff, Schindelka), but from
the point of view of the practician those far more frequent
cases may be added to it which, while occurring in consequence
of improper feeding, take a chronic course. In veterinary medi-
cine diabetes insipidus is generally understood in this sense.

Etiology. The disease is observed most frequently in
horses, especially if these are fed for some time with mouldy
feed. In this respect oats may be of importance, as it rapidly
assumes a peculiar mouldy odor when it is stored up on the
ground in large quantities without being turned over from
Etiology. 919

time to time. The feeding of such oats soon produces polyuria
which may pass into a pathological condition similar to diabetes
insipidus if the spoiled oats is continued for a long time. In
former times when oats was often transported on ships on
which it was impossible to turn it over at frequent intervals
the disease was observed more frequently, and sometimes in
an enzootic form. Today it occurs far less often because the
oats is usually shipped in bags (Dieckerhoff). Other mouldy
kinds of feed may likewise produce a similar effect ; for instance
mouldy hay, peas, vetches, etc., but these can not nearly as often
be brought into connection with the appearance of the disease,
perhaps because the coarse feed, even in large quantities, can
be ventilated more easily than is possible with oats. More-
over it is not impossible that peculiarly toxic substances are
formed in mouldy oats:

Certain plants are credited with the ability to cause diabetes. As such are
considered the different species of Adonis and Anemone, and above all the Cynanchum
s. Asclepias vincetoxicum, the latter especially since Veith succeeded in causing
polyuria in sheep by feeding it to them. According to R6ll frozen fodder and slop
are also at times the cause of diabetes. :

Aside from transitory polyuria true diabetes is occasionally
observed as a complication of affections of the central nervous
system, but such cases are hardly known to have occurred in
animals.

Other etiological factors are: The continued administration
of diuretics, cold, traumatic accidents to the liver or to the
vertebral column; some authors (Cagny, Cagnat) assume an
infection as the cause of cases which occur in greater numbers.

‘Horses which are used for heavy work and, according to
Moiroud, especially stallions appear to be most disposed to
diabetes insipidus, while age and race have no influence. The
disease usually occurs more frequently in summer than in
colder seasons.

The nature of diabetes insipidus is unknown. This much is cer-
tain that a transitory polyuria can be produced artificially by injuring
a eertain spot in the fourth ventricle near the Calamus scriptorius
(Cl. Bernard). Later it was ascertained that injuries to other portions
of the brain, especially the vermiform process of the cerebellum, as
well as the division of the lumbar cord, or of the splanchnic nerve
also produces similar results. These experiments permit the conclusion
that diabetes insipidus perhaps also originates from nervous causes,
and according to this view the effect of mouldy fodder would have to
be explained thus, that substances developed in it produce polyuria
by the intermediation of the nervous system. It may be assumed
that through disease of the vasomotor nerves in the kidneys a constant
arterial hyperemia is maintained in consequence of which the amount
of urine or its content of water is increased. Against this view stands
the demonstration recently afforded by E. Meyer and F. Miiller that
diabetes insipidus in man represents in fact only a secretory anomaly -
of the kidneys through which the organism requires very great amounts
920 Diabetes Insipidus.

of water for the elimination of solid urinary constituents, primarily
of urea and sodium chloride, or the kidneys have lost the faculty to
reabsorb the water secreted into the glomeruli.

Anatomical Changes. The autopsy findings are sometimes
entirely negative; in other cases changes are found in the
central nervous system (in Holzmann’s case the spinal cord
of a dog was surrounded in almost its entire length by myxoma-
tous tissue and several dural sarcomas) or signs of an earlier
general affection, as well as secondary changes in the organ.
The kidneys are either entirely normal or show only unim-
portant changes (cloudy swelling, hyperemia, etc.).

Symptoms. After feeding mouldy oats or other spoiled
fodder the symptoms develop in a short time, sometimes within
3 to 5 days. In other cases the evolution is gradual so that
the disease is only suspected from the striking emaciation
and debility.

The most essential and important symptom consists in a
decided increase in the amount of urine. The animals secrete
large quantities of urine at brief intervals, the total amount
in 24 hours being several times the normal daily output, so
that horses may pass as much as 40 to 60 liters, dogs 3 to 4 liters.
The urine is watery, without odor, of very low specific gravity
which may be continuously around 1.001-1.002. Foreign con-
stituents, especially albumen and sugar, cannot be found and
microscopical examination in this direction is also negative.
While the urine is usually voided easily, this may later on be-
come somewhat painful because of catarrhal swelling of: the
urethral mucous membrane.

A second symptom, which is never absent, is a considerably
increased thirst (polydipsia) which causes the animals to drink
surprising amounts, horses as much as 100 liters of water, dogs
up to 10 or 15 liters per day, and if the water is not given
them in sufficient amounts, they will drink even bad and ill-
smelling water, as well as their own urine. The amount of
urine corresponds to the amount of water ingested either alone
or with the food, or it exceeds it at most only transitorily.
(The idea that the skin and the mucous membranes of diabetics
can absorb water from the air lacks all foundation.) Com-
parative researches have proved that with an equal ingestion
of water the diabetic organism secretes more urine than the
healthy.

The appetite varies greatly. At first the animals take
palatable fodder willingly, but later they refuse even this or
eat only a little from time to time. The mucous membranes
and the skin become dry, the hair dull and coarse. Schindelka
observed in a dog cataract, abscess formation in the perianal
- glands and in the prostate. Sooner or later emaciation ¢om-
mences and may increase either gradually or rapidly.
Symptoms. Course, Diagnosis. 921

Course and Prognosis. The polyuria which develops after
the ingestion of spoiled fodder usually improves soon and dis-
appears if the fodder is changed in good time. But the longer
_the injurious factor has been active the smaller becomes the
probability of complete cure and the longer will be the period
of convalescence. In the neglected cases which have passed
into actual diabetes the condition becomes gradually aggravated
as far as the establishment of absolute cachexia, when the ani-
mals perish if a complication has not caused death in the mean-
while. The disease usually extends over months, in rare cases
it lasts even more than two years (Gréve, Dieckerhoff).

If the diabetes insipidus appears spontaneously or in con-
sequence of a nervous affection it also usually takes a pro-
longed course with fatal termination.

Diagnosis. Simple polyuria is differentiated from diabetes
insipidus by its transitory character, the polyuria of diabetes
persisting in spite of appropriate regulation of diet, and being
moreover accompanied by emaciation and debility of the ani-
mals. Diabetes mellitus is differentiated from diabetes insipidus
by the increased specific gravity and the sugar content of the
urine, chronic nephritis by the existing albuminuria.

On the basis of investigations by E. Meyer and F. Miiller true
diabetes insipidus is diagnosed by determining the toleration for sodium
chloride. This is done as follows: The daily amount of urine is ascer-
tained for several days during which food poor in albumen and sodium
chloride is given. Then 20 gm. of sodium chloride per day is added
to the same kind of food for one or several days. If the amount of
urine had previously been diminished and now shows an unduly great

“inerease, the case in question is one of true diabetes insipidus, since
in polyuria the ingestion of sodium chloride has no particular in-
fluence on the amount of urine secreted. An exception is observed
only in the polyuria of indurative nephritis which, however, is easily
recognized from other symptoms (Liithje).

Treatment. If the disease is due to faulty diet a change
of fodder is requisite, in which the spoiled fodder is replaced
by feed of unobjectionable character. If the disease has existed
not more than a few weeks and the strength of the animal is
still preserved the symptoms may be removed by a simple regu-
lation of diet. If a change of food is not possible, the fodder
at hand may be improved materially by frequent turning over
or ventilating and by removing the badly spoiled portions. It
appears, however, even more appropriate to feed small por-
tions of the spoiled food mixed with such that is perfect. It
is to be observed that a regulation of diet renders good service
also in such cases in which the disease cannot be referred to
inappropriate keeping of the animals. For horses the best
feed is good, clean and dry oats and palatable hay, but in
the warm seasons green feed should be given. According to
922 Diabetes Mellitus.

experiences in human practice the food-stuffs should be as
free as possible of albumin and table salt because the elimina-
tion of the latter and of the urea requires great amounts of
water in this disease. In true diabetes insipidus a limitation
of the water supply does not appear necessary, but it should
be carried out in those cases which are similar to diabetes but
must be classed with polyuria, which is always aggravated
after the free drinking of water (Leblanc, Cagnat)..-In horses,
for instance, the amount of drinking water should be reduced
to 20 to 24 liters per day. Finally, the animals must be kept
from work for 1 to 2 weeks after the symptoms of the disease
have disappeared.

The drug treatment of diabetes insipidus promises no
results, although vasoconstricting remedies (Ergotin, Ext.
Hydrastis) have always been employed.

Literature. Almy, Bull., 1899. 215. — Cagnat, A. d’AIf., 1884. 168. —
Dammann, D. t. W., 1898. 125. — Gerhardt, Der Diabetes insip., Wien, 1906. —
Haase, B. t. W., 1898. 109. — Hertwig, Mag., 1859. 487. — Holzmann, D. Z.
f. Tm., 1887. XIII. 197. — Meyer, D. A. f. kl. M. 1905. LXXXITI. 1. — Pr. Mil.
Vb., 1899-1901; 1906. — Schindelka, Monh., 1893. IV. 135. — Schlampp, D. Z.
f. Tm., 1884. X. 133. — Siedamgrotzky, 8. B., 1878. 57; A. f. Tk., 1895. XXI,
467. — Stockfleth, Rep., 1874. 60. — Veith, Rep., 1845. 261.

3. Diabetes Mellitus.

Diabetes mellitus is a chronic disease in which the blood,
owing to peculiar changes in metabolism, contains an excess
of grape sugar which is eliminated unchanged by the kidneys,
so that the urine contains sugar either permanently, or at least
temporarily.

The blood of healthy animals contains about 0.1% of sugar, and
this proportion is maintained with only slight variations, an excess
of sugar being promptly eliminated by the kidneys. By means of special
methods it is always possible to find traces of grape sugar in specially
heated large amounts of urine, particularly in cattle and sheep
(physiological glycosuria). Certain drugs or poisons (morphine, chloro-
form, ether, phloridzin, chromic acid, adrenalin, ete.), also certain acci-
dents to the organism (shock to the nervous system extensive convul-
sions, rabies, acute infectious bulbar paralysis, ete.) may even produce
a glycosuria which can be demonstrated with the usual methods. It
has not been determined whether an alimentary glycosuria (after the
absorption of very large amounts of sugar in the intestine) occurs
in otherwise healthy animals. All these conditions with transitory
elimination of sugar (glycosuria, mellituria) cannot be called diabetes
mellitus any more than the presence of milk sugar which appears in
the urine of nursing animals (lactosuria) after a sudden suppression
of the milk secretion, with particular frequency in the paresis of
parturition.

History. The disease has long been known in human medicine
(Dobson and Pool having demonstrated the presence of grape sugar
in human urine in 1775), but was observed in animals in only com-
Occurrence, Etiology. 923

paratively few instances. The reason may lie in the fact that urinary
analysis did not receive proper attention in veterinary medicine until
quite recently. Interesting cases of diabetes mellitus have been de-
scribed by Thiernesse, Rueff, Leblanc, Saint-Cyr, Haubner, Heiss,
Dieckerhoff, Froéhner, Eber, Schindelka, Eichhorn, Penberthy, Lind-
quist, Liénaux, Fettick, Sendrail & Cuillé, Bohl, Kriiger, Preller, Eisen-
menger and others.

Occurrence. Diabetes mellitus is, as a rule, very rare in
domestic animals, dogs being most frequently affected, horses
far less often (according to Fréhner, one out of 10,000 dogs
is diabetic; according to Eber, one out of every 1,000). Aside
from dogs and horses, the disease has been observed only in
cattle (Darbas, Girotti) and monkeys (Leblanc), which does
not, nevevel exclude the possibility of its occurring in other
animals.

Etiology. There is at present no doubt that diabetes
mellitus is etiologically not a uniform disease. It can be pro-
duced by certain organic affections of the central nervous sys-
tem, of the liver or pancreas, and occasionally occurs inde-
pendently of any demonstrable organic disease. Recent investi-
gations indicate that diabetes mellitus often develops on ac-
count. of a pancreatic anomaly, especially of the islands of
Langerhans, which may be demonstrated only with the micro-
scope.

The influence of the central nervous system upon the sugar cleavage
in the organism was shown by the well known experiment of Cl. Bernard
in which it was found that an injury to a certain portion of the
medulla oblongata, on the floor of the fourth ventricle near the vagus
root (‘‘sugar puncture,’’ ‘‘piqtire’’) leads to a transitory glycosuria.
Other authors found later that the same takes place after lesions of
other portions of the central nervous system (cerebellar worm, cervical
cord) or of the cervical sympathetic. The central nervous system
exerts its influence exclusively or mainly by the intermediation of the
splanchnic nerve, at least the ‘‘piqtire’’ does not produce such results
after the nerve is divided. ‘The glycosuria occurs here evidently by
the irritation of the puncture, causing the liver to discharge its glycogen
suddenly so that the blood becomes charged with grape sugar. This
agrees with some observations in diabetic human patients in whom
these portions of the nervous system, the abdominal sympathetic, and
principally the solar ganglion or the coeliac plexus were found altered.
All these experiences indicate that certain parts of the central nervous
system or of the sympathetic may be concerned in the origin of diabetes
mellitus (neurogenic diabetes).

The liver is an essential factor in the formation of sugar, because
in this organ the grape sugar which is ingested with the food or formed
and absorbed during the digestion of carbohydrates is transformed
into glycogen, and thus the blood is kept from being flooded with
grape sugar during each period of digestion. For this reason it is
possible, in case the function of the liver is disturbed, that a portion
of the grape sugar which was absorbed in the intestinal canal is not
924 Diabetes Mellitus.

changed into glycogen, but passes into the general circulation. While
in eases of diabetes mellitus lesions in the liver only were repeatedly
observed by several authors in human as well as in veterinary practice
(Fréhner, Heiss, Storch, Penberthy, Eber, Fettick and others), this
does not justify the assumption that in these cases the diabetes had
actually been caused by the hepatic disease. Aside from the changes
in the liver there may be slight alterations in the pancreas (Herzog),
and on the other hand the liver disease may be a consequence of the
diabetes. Especially the fatty liver which is frequently mentioned by
veterinarians and considered by some as the cause of diabetes, is very
probably due, as is fatty infiltration in general, to the deposit of fat
from other parts of the body, without interfering with the functioning
of the liver cells. The diabetes produced in dogs by extirpation of
the pancreas is almost invariably followed by fatty degeneration of
the liver (Naunyn). :

Recently the experiments of v. Mering and Minkowski have afforded
the proof that a severe diabetes follows the complete extirpation of
the pancreas, while it does not develop if at least one-fifth of the gland
is left or has been transplanted successfully under the skin before the
removal of the gland. If the entire gland has not been excised, only
a slight diabetes develops, and especially after a generous ingestion of
carbohydrates a glycosuria becomes noticeable but disappears again on
insufficient diet.

These experiments were followed by a long series of control in-
vestigations and were responsible for a great many contributions to
literature putting the theory of diabetes in an entirely new light. The
occurrence of the disease in affections of the pancreas (pancreas-
diabetes) was indeed shown to take place by older observers (Frerichs,
Windle, Hansemann), but the theory of pancreatic diabetes received
a greater vogue only since more attention was paid to the behavior
of the islands of Langerhans in the pancreas, to whose influence upon
the carbohydrate metabolism Ebner had already called attention. Many
authors (Ssobelow, Opie, Weichselbaum & Stangel, Schmidt, Herzog,
Sauerbeck, Halasz) found alterations (simple atrophy, sclerosis, colloidal
degeneration, disease of the vessel-walls) in the islands of Langerhans,
even in those cases in which the secreting glandular tissue was entirely
intact. The participation of the pancreas in the causation of diabetes
mellitus in domestic animals is proved by cases of Liénaux, Sendrall
& Cuillé and of Bohl, in which a considerable atrophy of the gland
was the only pathological finding. Eber also found atrophy in one
ease. Fettick observed carcinomatous degeneration of the gland in
a case of general carcinomatosis, while Bohl noted diffuse parenchyma-
tous degeneration in a dog, Preller chronic inflammation in the pancreas
of a horse. On the other hand diabetes failed to develop in a case
of atrophy of the pancreas in a dog observed by Miiller. It is to
be expected that diabetes mellitus will be brought more frequently into
relation to pancreatic diséase when this gland receives greater attention
by veterinary authors. In man changes in the islands of Langerhans
can not infrequently be determined simply by microscopical examina-
tion.

The views still differ as to whether pancreatic diabetes represents solely the
consequence of some disease of the islands of Langerhans, or whether it may
develop, on the contrary, through any diffuse alteration of the pancreas.

On the basis of his experiments, FE. Pfliiger has recently assumed that the anti-
diabetic action of the pancreas, which regulates the cleavage of sugar, is influ-
Etiology, Predisposition, Pathogenesis. 925

enced by a nerve center situated in the walls of the duodenum. Even in earlier
times an enterogenous or pancreato-enterogenous origin of diabetes mellitus had
been assumed.

It appears thus from the observations and experiments cited above
that a regular system of organs is concerned in the regulation of
the cleavage of sugar. The action of the liver, by which the grape
sugar, both that absorbed from the intestine and that formed in the
organism from albumin and fat, is retained by being transformed into
glycogen and yielded up again according to need, requires the co-
operation of the pancreas. This probably exerts its action by an internal
secretion, and substances are probably then formed which, immediately
or through the intermediation of the nervous system, on the one hand
influence the formation of glycogen in the liver, but on the other
hand enable the body cells, and primarily the muscle fibers, to effect
the cleavage of the grape sugar and finally to oxidize it. Besides these,
however, other organs probably also belong to the system which regu-
lates the blood-sugar, namely, the adrenals, the thyroid gland and the
hypophysis cerebri, all these sugar-regulating organs being in com-
munication through the nervous system. It follows that a prolonged
functional disturbance in any one link of this system might give rise
to diabetes mellitus, no matter whether the functional disturbance
originated in a lesion that could be demonstrated anatomically or
whether it developed without such a lesion.

Predisposition. In the great majority of cases that have
so far been reported, the disease occurred in older animals.
Schmitt observed a dog acquire it after swimming across a
broad river. Heredity also appears to be of importance.

Pathogenesis. If an excess of grape sugar passes from the
liver into the blood, or if the cleavage of the grape sugar is in-
complete a hyperglycemia follows (Preller found 0.521% of
sugar in the blood of a horse). The excess of the grape sugar
is then eliminated by the kidneys. Since the organism requires
a certain amount of energy for the maintenance of the vital
functions, it replaces the loss occasioned by the elimination of
the sugar in such a manner that it uses up, at least to a cer-
tain degree, the sugar which is formed by the disintegration
of the alimentary and of the organic albumin and which is prob-
ably more readily available, at the same time breaking up its own
fat in a greater degree. To this fact are due the gradually in-
creasing weakness and emaciation. In severe cases the sugar
formed from the proteids and possibly from the fat is used up
in always smaller amounts, which must lead to an increased
combustion of fats without limiting the active disintegration
of proteids. All these factors cause not only exhaustion, but
also an accumulation of oxidation-products of fats (oxybutyric
acid, azeto-acetic acid, acetone [Geelmuyden, Schwarz, Magnus,
Levy]) in the blood and thus lead to an acid toxemia.

The diabetic disturbance in the metabolism easily leads
to nutritional disturbances in the various tissues, especially in
the lens of the eye and in the renal tissue. The insufficient
tissue nutrition may further facilitate the localization of
926 Diabetes Mellitus.

pathogenic bacteria, although the saturation of the tissues with
sugar is here an important factor.

Anatomical Changes. The autopsy findings differ from
case to case and may indeed be entirely negative except for
secondary changes. In the central nervous system hemorrhages,
new-formations, etce., are sometimes found in the medulla ob-
longata or in its immediate neighborhood. Fatty liver or an
increase in the connective tissue of the liver are frequent in
dogs, but less so in horses. In the pancreas there is at times
connective tissue proliferation, atrophy of the glandular tissue
or calculus formation. There are finally, as a rule, evidences
of anemia and serous infiltration.

Symptoms. The clinical picture always develops insidi-
ously. At first the animals show a degree of dullness of the
sensorium, and fatigue; they perspire and easily tire whether
at work or at exercise. Simultaneously a gradual emaciation
becomes manifest in spite of a good appetite, and often in
spite of the greedy eating of large amounts of food.

The most characteristic changes are found in the urine.
The amount is, with few exceptions (diabetes decipiens), at
first more or less increased and may rise to 3 to 5 times the
normal daily output. It is discharged at brief intervals and
without effort, but later micturition may become painful, after
a catarrh of the external urinary passages or an eczema around
the urethral opening has developed. The urine is pale in color,
being almost like water if the polyuria is marked; of a peculiar
sweetish odor, or somewhat like the odor of fruit or chloroform;
it is always acid in ecarnivora, occasionally so in herbivora,
and remains unchanged on standing for a relatively long time.
The specific gravity varies between 1,040 and 1,060, but is not
rarely much lower in cases in which only small amounts of
sugar are present in the presence of polyuria. The greatest
importance must be attributed to the content in grape sugar
which, however, may vary within wide limits, not only in different
cases, but also in the same patient. In contrast to diabetes
in man, where the sugar content is usually slight in the initial
stage of the disease and only later increases gradually, in dia-
betic animals which usually come under the observation of the
veterinarian only in advanced stages of the disease, large
amounts of sugar are found as a rule (in horses 3.75-7.33% ;
in dogs 4-10%). The sugar content is also decidedly influenced
by the amount, and even more by the nature of the food. The
more sugar or amylaceous food is ingested the more sugar is
eliminated by the kidneys. On the other hand, especially in
the first stage, the sugar may disappear even entirely from the
urine after exclusive feeding with nitrogenous food-stuffs,
during the abstention from food, during the course of inter-
surrent febrile diseases, after strenuous exertion. Preller found
Symptoms. 927

in the case of a diabetic horse that the urine contained more
sugar in the morning than in the evening and that the amount
was increased after psychic excitement, while hard work did
not cause a diminution in the amount of sugar present. There
are cases where, in spite of uniform feeding, the amount of
the eliminated sugar does not remain constant, the urine being
temporarily free from sugar (diabetes mellitus intermittens) ;
if however the disease is far advanced, the glycosuria never
ceases entirely.

For the practical demonstration of grape sugar the fermentation test is best
adapted. The simplest way of making this test is as follows: A bit of yeast as
large as a pea is added to a test tubeful of urine which is closed with a perforated
cork, a U-shaped thin glass tube being inserted in the perforation. The cork is
fitted so that no air bubbles remain on the surface of the urine. The test tube is
then inverted and permitted to stand at room temperature, or better, near a stove
for 24 hours. If grape sugar is present, the action of the yeast produces alcohol,
and also carbonic acid which collects in the upper porticn, of the test tube and
forces the urine downward. In order to make quite sure if is well to prepare two
control test tubes, one of which is filled with normal urine, the other with a solution
of grape sugar, to both being added a piece of yeast, in order to determine whether
the yeast itself produces carbonic acid and whether it is active. If the fermenta-
tion test is positive, grape sugar is surely present.

For a quantitative test with the fermentation reaction graduated glass tubes
or other apparatus must be employed. None of these apparatus, not even Lohn-
stein’s saccharimeter, is adapted for an exact quantitative test, but they are quite
useable for practical work, especially for detérmining variations in the elimination
of the sugar.

Preller found the reaction with aniline dyes sufficient for practical purposes:
10 ec. of urine are heated in a test tube to about body temperature; on adding
a small amount of finely ground gentian violet or methylene blue, diabetic urine
is colored blue immediately and without shaking.

A relatively easy test is that of Trommer: One part of official potassium or
sodium hydrate is added to three parts of urine; to this mixture a 10% solution
of sulphate of copper is added drop by drop and shaken up until a trace of the
precipitate remains on shaking. The upper layer of the mixture is then heated
slowly, when in the presence of sugar a yellow or red finely granular precipitate
occurs, even before the liquid commences to boil—Porcher found a modification
of Trommer’s test useful: in this the reagent (Fehling’s solution) and the urine
are boiled in separate: test tubes and then the urine is poured carefully over the
reagent.

e In human urine physicians have ,exceptionally found levulose, pentose, dex-
trin and inosite, besides the grape sugar. There may also be found acetone, organic
acids (formie acid, oxybutyric acid, azetoacetic acid) and albumen, which mostly
appears in consequence of a complicating nephritis. (In the urine of a sick horse
the authors found very much oxybutyric acid and azetoacetic acid; the same
was observed by Preller.)

Another constant symptom is a striking increase in the
sensation of thirst (polydipsia), and an abnormally increased
appetite (polyphagia) is frequently observed. The mucous
membranes of the mouth are dry, the gums at times loosened
and sensitive.

The lens of the eye often becomes opaque (gray cataract;
cataracta diabetica) commencing from the center, usually in
both eyes and leading gradually to complete blindness; only
in isolated cases may the opacity disappear temporarily if the
disease is not too for advanced and the animals are fed suitably.
Sometimes corneal opacity is met with, possibly together with
ulcerations (Heiss), also inflammation of the iris, hemorrhage
beneath the retina or a loosening of the latter.
928 Diabetes Mellitus.

Sometimes the respiratory organs become affected second-
arily with symptoms of laryngeal or bronchial catarrh, to which
may later on be added pneumonia or even gangrene of the lungs.
Kriiger noted a sweetish odor of the exhaled air. In the ter-
minal stage there appear symptoms of cardiac debility. In
dogs an enlargement of the liver may be detected. Darras
observed in a diabetic dog necrosis of the tip of the tail, Kriiger
saw in a horse furunculosis, but Preller found phlegmosis in
the subcutis, which however healed completely in contrast to
human experience.

Other organic diseases which may have a causal connection
with diabetes are discovered only rarely during the lifetime of
the animals. In this respect the case of Preller’s is of interest,
in which it was possible to diagnose the disease of the pancreas
by means of the Cammidge test while the animal was alive.

In the further course of the disease the debility increases
more and more; finally apathy and stupor appear; the amount
of sugar gradually diminishes and sometimes the sugar dis-
appears entirely. There is diarrhea, and, after complete ex-
haustion of the patient, death occurs with symptoms of con-
vulsions or during coma.

By coma diabeticum or intoxicatio diabetica is meant in human
medicine a peculiar pathologic condition which develops toward the
end of diabetes mellitus and is usually followed immediately by death.
The respiratory movements suddenly become very deep, labored and
hastened; at the same time or a little later the patient becomes un-
conscious, or symptoms of collapse appear, or great restlessness develops,
followed immediately by death with symptoms of heart failure. In
other cases the patients are tormented by headache, their motions are
staggering and the end supervenes, the patients being in a stupor.
The exhaled air then smells strongly of azetone. This condition is
usually referred to the accumulation of organic acids (oxybutyrie acid,
azetoacetic acid) in the blood. Fréhner, Eichhorn, Liénaux have each
observed a similar condition in a dog, and the authors themselves met
with it in a horse.

Course. Diabetes mellitus always takes a chronic course.
In the cases hitherto observed its duration varied between 1
and 12 months. It must however not be forgotten that the
disease was always recognized only in a far advanced stage.
According to experiences in human medicine the disease may
persist for years, although in young animals its duration ap-
pears to be short.

Diagnosis. If the urine permanently contains considerable
amounts of grape sugar the diagnosis of diabetes mellitus ap-
pears to be perfectly certain. ‘The disease has otherwise no
characteristic symptoms and can therefore be recognized with
certainty only by means of regular urinalyses. Nevertheless
there are a number of symptoms which should cause the affec-
tion to be suspected and. should suggest a chemical analysis
of the urine; such are particularly the increasing emaciation,
Diagnosis, Prognosis, Treatment. 929

the debility in spite of good appetite, then the increased thirst,
polyuria, and the simultaneous occurrence of cataract. In the
presence of polyuria with a clear, watery urine of high specific
gravity the existence of diabetes mellitus is very probable.

Prognosis. In the cases that were observed so far in ani-
mals the disease showed a gradual progression, at most with
transitory remissions, and always ended in death. Only Walley
reports a cured case, but it is possible that either this was a
transitory glycosuria or that the supposed cure was in fact but
an intermission of the disease. The more sugar the urine
contains, the sooner the fatal termination occurs. If the sugar
content persists unaltered in spite of exclusive feeding with
proteids and fats, the prognosis is much less favorable than
if this diet leads to a diminution in the amount of sugar, or
if this periodically disappears entirely without a simultaneous
loss of weight. Complications always influence the course un-
favorably and hasten the fatal termination.

Treatment. This consists essentially in limiting the supply
of carbohydrates and in feeding with food-stuffs rich in fats
and proteids. In severe. cases even the albumins should be
diminished to such a degree that it is just possible to maintain
the N-equilibrium. The limitation of albumins appears indi-
cated for the reason'that in severe cases even that sugar which
is formed from albuminous substances is eliminated unused. In
order to determine the degree to which carbohydrates and
albumins are to be limited, it would be necessary to test the
toleration, that is, to determine the amount of carbohydrates and
albumins borne without any sugar being eliminated with the
urine. Of this method, which is quite customary in human
medicine, no advantage has as yet been taken in veterinary
practice.

Carnivorous animals are, in lighter cases, nourished most
suitably with fat meat, eggs, bran-bread, or with oat meal, to
which a generous amount of fat has been added; in severe cases
the amount of meat must also be limited and the requirements
of the organism for albumin must be supplied by the addition
of vegetable albumins (‘‘Roborat,’’ rice-albumin, etc.). If
acetone bodies appear in the urine in considerable amounts, it
is necessary, according to experiences in human medicine, to
limit the supply of albumin and especially of fat, and for a
time to return to the carbohydrates (oats, bread, milk, possibly
levulose). In herbivorous animals it is particularly difficult
to carry out an appropriate dietary; probably the best food-
stuffs for such animals are oats, good hay, bran and oil-cake.
Preller caused a decided diminution in sugar in the urine of
a horse by replacing the accustomed grain feed by oats, bran
and oil-cake, but simultaneously a deterioration. in the nutrition
of the patient was observed. All sick animals should be spared

exertion.
Vol, 1—59 Byeait ° da Sn Saree
930 Rachitis.

Of drugs, sodium bicarbonate deserves mention and should
be given regularly; in severe acidosis or diabetic coma large
amounts are to be administered by mouth, or hypodermically
dissolved in physiological salt solution. Carlsbad water or salt,
also carbonate of ammonia are occasionally of use. Opium
preparations in large doses (to dogs up to 0.5-1.0 gm. per day)
have been recommended as they. are capable of diminishing
for a time the glycosuria. No results worth mentioning have
been observed to follow the arsenic treatment.

Literature. Bohl, A. f. Vet.-Wiss., 1906. 569 (Lit.). — Cadiot, Etudes de
pathol., 1899. 327 (Lit.). — Dammann, Hann., Jhb., 1876-77. 100. — Darbas, Rev.
vét., 1890. 357. — Darras, Bull., 1906. 687, — Eber, Monh., 1898. IX. 97. — Eich-
horn, 8S. B., 1891. 184. — Falta, 7. £. i. M., 1908. LXVL. 401. — Fettick, Vet., 1899.
277 (Lit.).. — Froéhner, Monh., 1892. III. 149. — Girotti, N. Erc., 1896. 69. — ’ Herx-
heimer, V. A., 1906. CLXXXIII. 228. — Kriiger, Z. f. Vk, 1907. 488. — Liénaux,
Ann., 1898. 190. — v. es & Minkowski, A. f. exp. Path. u. Phmk., 1890. XXV.
371. — Minkowski, Ergebn. d. Path. 1894. I. 1. Abt., 69 (Lit. on pancreatic dia-
betes). — Miiller, Dresd. B., ‘1906. 162. — Naunyn, ‘Der Diabetes mell., 1906. —-
Penberthy, J. of Comp. Path., 1894. 184. — Pfliger, Pfliigers A., CIII. 1: CXVIII.
265. — Porcher, Bull., 1903. 409; Rev. gén., 1905. VI. 49. — Preller, Uber Diab.
mellitus beim- Pferde, Diss. Bern, 1908 “(Lit.). ‘— Prietsch, S. B., 1902. 63. —
Sauerbeck, Ergebn. d. Path., 1902. VIII. 2. Abt., 538-697 (complete literature on
diab. mell. in general). — Schindelka, Monh., 1893. IV. 132. — Schmitt, W. f. Tk.,
1863. 65. — Sendrail & Cuillé, Rev. vét., 1906. 229. — Walley, J. of Comp. Path.
1893. 70.

4, Diseases of Metabolism which Particularly Affect the Osseous
System.

(a) Rachitis. Rickets. Rhachitis.

(Gliederkrankheit; Englische Krankheit; Zwergwachs [Ger-
man]; Rhachitism [French]. )

Rachitis is a disease of young animals which is due to a
disturbance in metabolism and is characterized by the per-
sistence of new-formed bony tissue in: the osteoid condition,
by proliferation of the cartilaginous tissue, and by an irregular
advance of the lines of ossification, the result being manifold
deformities of the skeleton.

Occurrence. Whether the disease occurs in all parts of
the globe or, as is the case in man, is almost exclusively limited
to the temperate latitudes, cannot be ascertained by any in-
formation in veterinary literature. The affection is frequent
in all countries of the temperate zone.

Almost without exception the young animals become af-
fected only during the first year of life and most frequently
when only a few months old or after being weaned. The animals
which acquire the disease most often are young pigs and dogs,
lambs and kids, much more rarely calves and rabbits; the dis-
ease is observed quite often in wild carnivora which are raised
in captivity, also in monkeys; of fowls, chickens are affected
Oceurrence, Etiology. 931

most often, less so pigeons and water fowl (Ziirn), when they
are 4 to % year old or even younger. (Haubold observed the
disease in eight-weeks-old geese which had been confined for
fattening. Blooded and large breeds or such as mature early
or grow rapidly are in general more apt to acquire rickets than
breeds of animals that are mostly kept out doors and are
hardened. Among hogs the disease affects relatively frequently
the English breeds and their crossings, among the dogs the
Newfoundlands, the Danes and the setters. In animals living
in herds, especially in pigs and lambs, rachitis usually reaches
an enzootic distribution and this causes a very decided economic
loss. On the other hand the disease is not observed in wild-
living animals. :

Etiology. In the production of rickets in domestic animals
the deficiency in lime of the organism is undoubtedly the most
important factor. This may bé' concluded above all from the
fact that the disease commences most frequently -ir. the breeds
which mature early, at the time of the most rapid development
or after the nursing period is over, that is in that period in
which there is most likelihood that the ingestion of lime is
insufficient in proportion to the: bony growth. Moreover
numerous incontrovertible observations directly established the
relation of rickets to food which is poor in lime. Finally a
considerable number of positive experimental results in this
direction are at hand.

A deficiency of lime in the organism will probably occur
most frequently through an insufficient calcium content in the
food. In nurslings rachitis develops, comparatively rarely,
through an insufficient calcium content of the mother milk, when
the mother animals are nourished with food poor in lime.
(According to Dammann healthy young sucking animals become
ill if they are put to a mother animal whose young is affected
by rachitis.) Moussu observed a similar symptom complex as
that seen in rachitis of young pigs in sucking lambs, whose
mothers were fed generously with cut carrots, but he looks
upon it as an asthenic condition. It happens very rarely that
the artificial raising of young animals with alien milk is of
importance in this respect, although this milk may become in-
jurious in so far as it may contain less lime than the homo-
geneous milk, and further the lime salts of such milk may
be used up less completely (Uffelmann, Briining) because the
presence of alien enzymes may lead to an insufficient assimila-
tion of the milk.

The calcium content of milk varies very considerably in the different animal
species. Cow’s milk contains an average of 1.7 gm. of lime and 1.8 gm. of phos-
phoric acid; goat’s milk, 1.9 gm. of lime and 3.0 gm. of phosphoric acid; sheep’s
milk, 3.1 gm. of lime and 3.0 gm. of phosphoric acid;.mare’s milk, 1.2 gm. of
lime and 1.2 gm. of phosphoric acid; and hog’s milk, 4.3 gm. of lime and 4.0
gm. of phosphoric acid per liter (Stutzer, Kellner), while the corresponding values
in dog’s'milk are 3.01 gm. and 4.11 gm. (Wedemeyer).
939 Rachitis.

~

Concerning the assimilation of the lime salts of the milk, Uffelmann found
that in infants 78 per cent of the lime of the mother’s milk is absorbed, but only
25 per cent of the lime of cow/s milk. In calves 97 per cent of the lime of cow’s
milk is assimilated according to Soxhlet. Briining left two out of four young
dogs of the same litter with their mother and fed the other two from the sixth day
on with cow’s milk, one of them receiving the milk cooked, the other raw. The
first two dogs developed quite normally, but the other two remained back in their
development; their belly seemed enlarged, the ends of the costal cartilages thick-
ened; the dog fed with raw cow’s milk was also feeble, and the fontanelles had
remained open. Similar results were obtained in dogs fed with goat’s milk, as well
as in rabbits, guinea pigs and kids fed with alien milk.

An opportunity for a deficiency in lime to occur in the
organism is afforded more especially in weaned animals. Ex-
perience shows that rachitis develops not infrequently in
carnivora if they are put on an exclusive vegetable diet, and
aside from the small calcium content of vegetable food, the
fact is here of importance that the lime salts of plants are
used up much less completely than those of animal food (Bunge,
Bertram). On the other hand a strict meat diet from which
the bones are excluded may also give rise to the development
of the disease. In herbivora the principal blame attaches to
one-sided feeding with non-nutritious kitchen refuse, potatoes,
mealy food substitutes and cow’s whey, ground meat, barley
and bran, which are known to have a low calcium content. In
colts especially the exclusive feeding with bran causes rickets
(the so-called bran-disease) while in pigs exclusive feeding with
potatoes, barley or maize is a factor. Under the influence of
unfavorable conditions of soil and weather (see brittle bones)
of course even those food stuffs which ordinarily contain a
sufficient amount of lime may become deficient in it. The vary-
ing calcium content of drinking water, and a relatively low
calcium content of drinking water is probably of importance
only in combination with other causes. Nevertheless an ab-
normally high content of water in sulphuric acid may become
injurious by causing the formation of calcium salts which are
only slightly soluble.

By considering the calcium content of the food on the one
hand and the calcium requirements of the growing animals
on the other, which vary greatly according to the species and
breed, it is always possible to determine whether in a given
ease a deficiency in lime could occur in the organism.

Content in calcium and phosphoric acid in the most important food stuffs,
for each 1,000 parts, after Stutzer: Coarse feed—Lucerne, 25.2 parts of lime (6.5
parts of phosphoric acid); red clover, 20.1 (5.6); bastard clover 13.6 (4.1); espar-
sette, 16.8 (4.6); vetch, 16.3 (6.2); peas, 15.6 (6.3); lupine hay, 8.8 (5.8);
meadow hay of good quality, 9.5 (4.3); of poor quality, 5.4 (2.3); second crop
(‘‘grummet’’), 5.1 (4.1); wheat straw, 2.7 (2.0); barley straw, 3.3 (1.8); oat
straw, 4.3 (1.5); cornstalks, 4.9 (3.0); pea straw, 15.9 (3.5); vetch straw, 15.6
(2.7); wheat chaff, 1.7 (4.0); oat chaff, 4.0 (1.3); barley beards, 12.5 (2.4).
Green feed—Lucerne, 8.5 (1.6); red clover, 4.5 (1.5); bastard clover, 2.9 (0.9);
esparsette, 4.0 (1.1); meadow feed, 2.8 (1.2); rich grass, 2.6 (1.9); green corn,
1.4 (1.0); carrot leaves, 1.5 (1.0). Tubers and roots—Potatoes, 0.3 (1.2); beets,
0.3 (0.6). Grain—Oats, 1.0 (7.0); barley, 0.1 (6.6); corn, 0.3 (5.7). Seeds of
legumes—Soy beans, 1.5 (12.1); peas, 1.1 (10.0); vetch, 2.2 (9.9). Waste from
flour mills—Wheat bran, 1.5 (26.9); oat bran, 2.1 (34.4); barley bran, 1.9 (9.1) ;
Etiology. 933

barley feed flour, 0.7 (10.8). Waste from sugar factories—Beet-chips, 1.1 (0.2);
beet treacle, 3.1 (0.5). Waste from oil mills—Linseed cake, 4.3 (16.2) a pot
cake, 7.1 (20.0); ground-nut cake, 1.6 (11.6). Animal food stuffs—Meat (without
bone), 0.3 (4.2); ground meat flour, 3.6 (6.9). Of the lime contained in vegetable
food stuffs at most one-half is made use of (Kellner).

_ Calcium requirements of growing animals. According to C. Voit the calcium
requirement in growing dogs of smaller breeds, weighing 1.5-2.8 kg. is 0.128 gm.
daily; in dogs of large breeds (weight 3.2-4.5 kg.) 0.769 gm. daily; in pigs 1-240
days old 2.8 gm.; in pigs over 8 months old 1.7 gm.; calves require in the second
or third week 14.5 gm. daily, in the fifth month 13.3 gm. (Lehmann), one-year olds
require 21 gm. of lime (Kellner). In lambs the calcium requirement for 50 kg.
body weight is, according to Weiske, as follows: In the first month, 3.2 gm.;
at 5.5 months, 3.8 gm.; at 8.5 months, 3.2 gm.; at 11.5 months, 2.7 gm., while
in the 16th month of their lives they require only 0.6 gm. of lime.

The injurious effect of food which is deficient in lime was
proved by numerous animal experiments.

Chossat (1842), Milne-Edwards (1861), Guérin (1862), Roloff (1866), E.
Voit (1877), Lehmann (1877), Baginsky (1881), and recently Miwa & Stoeltzner
succeeded in producing a clinical picture which was in its symptoms and in its
gross pathology quite similar to rachitis in young pigs and dogs that is due to
food containing very little calcium. In these experiments they observed swelling
of the epiphyses, softening and various curvatures of the bones, while other authors,
especially Weiske and Wildt (1873), Tripier (1874), Piitz (1875), Delcourt (1899)
failed to cause the disease in this manner. The cause of their failure may lie on
the one hand in the too short duration of the experiments, on the other, and
mainly, it was probably to be found in a very far-reaching withdrawal of lime
or of all nutritive salts. It must, however, be admitted that in most of the positive
results cited the proof of the rachitic nature in the anatomical changes was not
afforded by microscopical examination; only E. Voit and Baginsky described -his-
tological changes which corresponded with those found in rickets. Neither Miwa
& Stoeltzner, nor Reimer & Boye were able to demonstrate such tissue changes in
their experiment animals which appeared clinically to be rachitic, as would have
agreed with those found in true rachitis, (For the interpretation of their results
see Pathogenesis. )

Miwa & Stoeltzner observed in a dog that was fed with fresh horse meat and
bacon, and received distilled water to drink, a waddling walk as early as the 10th
day, and a moderate epiphyseal swelling on the fore-feet was apparent already 10
days later. At the end of the fourth week the dog disliked to move about, or
crouched down,. whining after taking only a few steps; nor was he able to climb
upstairs. The swelling of the epiphyses gradually increased, on the distal ends of
the ribs strongly prominent enlargements became noticeable, which were arranged
in rosary fashion, while the long bones were bent outwards. The motor disturb-
ances did not continue to progress from the seventh week on, and the dog was
killed at the end of the eighth week. At the autopsy the authors found the compact
portion of the bones forming a network of wide-meshed bone lamellae and hollow
spaces of different sizes; the cambium layer of the periosteum was enlarged;
periosteal osteophytes were on the enchondral zones of ossification between epiph-
ysis and diaphysis; the lines of ossification were rather irregular; the layer of
proliferating cartilage extended; the columnae of cartilage cells in irregular arrange-
ment and the cartilage cells themselves enlarged. The preliminary calcification of
cartilage was, however, quite normal, as was also the bony substance which con-
tains no lime, and which surrounds the lime-containing bony lamellae everywhere
in very delicate traceries. In contrast to this autopsy result in place of the
normal delicate deposits which contain no lime, there were found in true rachitis
thick plates of tissue entirely without lime which surround on all sides the lime-
containing portions or which, in very severe cases, replace a considerable portion
of the bony lamellae. A further distinction from rachitis was found in the normal
zone of ossifying cartilage. Therefore the authors explain the process as a gen-
eralized osteoporosis with rachitis-like changes in the periosteum and in the uncalci-
fied proliferating cartilage, and they suggest that the bony changes observed after
withdrawal of lime by other authors had been similar to theirs,

In the experiments of Reimers & Boye and of Gétting the compact bone
substance was found very small, the spongiosa with extremely wide meshes; the
extension of the proliferating cartilage was only slight, a proliferation of the osteoid
tissue had not taken place at all.
934 Rachitis.

As a further cause of lime deficiency in the organism an
improper chemical composition of the food-stuffs may be men-
tioned even though the calcium content be normal. Above
all the relation between the amounts of lime salts and of phos-
phoric acid appears to be of importance (Klimmer & Schmidt,
Ingle). The intestinal contents being alkaline, it may perhaps
be supposed that in such a case a mutual precipitation of these
salts takes place in the intestinal canal, or that an excess of
free phosphoric acid is formed and, owing to this, a prolifera-
tion of the osteoid tissue (Piitz, M. B. Schmidt, Ingle). On
the other hand an abnormally high content of the food in
potassium salts is to be considered. The effect of food-stuffs
rich in potassium may be explained thus, that the chlorine of
the HCl of the stomach is bound by the potassium salts and
that therefore the formation of hydrochloric acid is reduced,
which would again lead to an insufficient solution and absorp-
tion of the lime salts that are present in the food principally
in insoluble form. According to H. Aron and Delcourt, how-
ever, the potassium salts tend to impede the deposit of lime
into the new-formed bony substance. In food-stuffs which con-
tain much sulphuric acid the lime salts help to form gypsum
which dissolves with difficulty, and they are therefore absorbed
less readily in the intestine. With this assumption, the observa-
tion of Haubner would agree, namely, that in the surroundings
of metal factories near Freiberg animals acquired rachitis and
osteomalacia, because the smoke contains arsenic, lead and
sulphurous acid. When the sulphurous acid was collected in
condensators both diseases ceased to oceur.

Digestive disturbances of whatever origin are also capable
of producing a deficiency of lime in the organism, either by in-
terfering with the formation of HCl in the stomach (Seemann,
Zander) or with the intestinal absorption; but also, and possibly
very decidedly; by increasing the normal elimination of the
calcium compounds in the intestine, a possibility that must be
considered especially in protracted intestinal catarrh.

A second etiological factor of rickets is found in intoxica-
tion. Wegener (1872) who produced rachitis in animals by
long continued feeding of phosphoric acid, withdrawing the lime
at the same time, attributed to phosphoric acid an irritating
action upon the bone-forming tissues. A similar view was
expressed later by Piitz (1874). But Kassowitz (1878) showed
that the administration of slightly enlarged amounts of phos-
phorus suffices of itself to produce a disease similar to rachitis.
On the basis of his experiments Kassowitz assumed the action
of a substance circulating in the blood which is similar to .phos-
phorus. Lehnerdt caused similar changes with strontium, but
held them to be different from rachitis because, in contrast to
rachitis the new-formed tissue is capable of taking up lime
salts. The intoxication theory received further support in the
results of experiments undertaken by Ostertag and Zuntz (1907)
Etiology. 935

concerning the licking disease of cattle-(q. v.), according to
which any toxic substance present in meadow plants interferes
with the bone-formation, an action which cannot be prevented
by the addition of lime salts to the food. Stoeltzner considers
it probable that rachitis develops through a functional insuffi-
ciency of an organ which is analogous to the thyroid gland.

The importance of infection as an etiological factor was
frequently assumed, but only through the investigations of
Morpurgos (1900, 1902) did this hypothesis gain a more solid
foundation. These results are supplemented by those of Moussu
(1903), and also Liénaux (1907) supposes that rickets has an
infectious origin.

The experiments of Morpurgos were made on white rats which had developed
osteomalacia and which belonged to a breed that had been raised in his institution
for seven years. In the bones, cord, spleen and liver of the affected animals he
found Gram positive diplococci, the cultures of which, on subcutaneous injection
into healthy rats of the same breed, produced, according to the age of the animals,
symptoms of typical osteomalacia or of rachitis. In adult animals the period of
inoculation was 8 days, but often weeks and occasionally months, while young
rats inoculated immediately after birth did not become ill until they were two or
three months old.

It must be mentioned that Piana (1889) already described an infectious
rabbit rachitis and that he obtained positive results in young rabbits, after inoc-
ulation with the microorganism which ,he had isolated. Later, however, he dis-
claimed the correctness of his observation because he failed later on to find the
supposed virus in the affected bones and because animals kept in the same place
also became ill without being inoculated.

Moussu watched a little pig become ill which was kept and fed together with
one suffering from snuffles; another pig fell ill two and one-half months after
being put in the stall of. an affected pig, which had not been cleaned previously.
By subeutaneous inoculation of the bone marrow taken from pigs in the initial
stage of the disease, he succeeded in producing a similar disease in pigs, goats
and later in rabbits. Liénaux also saw two healthy pigs become ill three and
five weeks after having been brought together with an affected pig of the same age.

It is supposed that the lime salts in the ready formed
bone substance undergo solution owing to an excessive forma-
tion of lactic acid in the intestinal canal (Heitzmann) or in
the intermediary metabolism, or then under the influence of
an acid that develops in the bony substance itself and exerts
a local action (Vierordt). In the former case it is assumed
that the alkalinity of the blood is diminished and therefore the
calcium of the bones is dissolved, while in the supposed local
acidulation the fixation of the lime salts, which circulate in
the blood, is impeded while in addition to this the already formed

bone substance is decalcified.

While according to Heitzmann animals acquired rachitis or osteomalacia
after feeding with excessive amounts of lactic acid, Siedamgrotzky and Hofmeister
found only an increased porosity of the bones, without rachitic changes, in young
kids which, in addition to the acid, received an appropriate amount of lime salts
with their food. ; a

Heitzmann’s results cannot be admitted as proof, because he limited the
supply of lime and because, moreover, other authors always got negative results
from feeding lactic acid. Nor has it been possible to demonstrate the presence
of considerable amounts of lactic acid in rachitie bones. In fact, Virchow found
the reaction of fresh rachitic bones to be always alkaline.
936 Rachitis.

Finally an insufficient assimilation of lime in the bones is
often supposed to be a cause of rachitis, the osteoid tissue
being incapable of making use of the lime salts carried there
in the circulation and of retaining those that have been de-
posited. The abnormal condition of the osteoid tissue is be-
lieved to be shown by the fact that the bone substance contains
only glutein instead of ostein. No positive proofs have as yet
been. afforded for the correctness of this hypothesis.

Not infrequently the influence of predisposing factors can
be shown. It is commonly known that an absence of sunlight,
but preferably confinement in damp stables or in similar places
(cellars, dark, damp rooms) promotes the development of
rachitis; up to a certain degree a like influence may possibly
be attributed to insufficient ventilation or exercise (Hansemann).
The possible influence of digestive disorders has already been
mentioned. It is also probable that there are individual differ-
ences in predisposition. The state of nutrition or the amount
of fat deposited in the tissue may insofar be of importance
as, other things being equal, fat animals of much greater body
weight become ill much sooner and also more severely.

The influence of predisposing factors may perhaps be explained thus that
they affect adversely the metabolism in fhe organism and indirectly the calcium
content there or in the bones, and that they also encourage the occurrence of an
intoxication or infection. It is also probable that in some species the want of
earthy ingesta is to be considered.

Although a predisposing role has often been attributed’ to
heredity its influence is probably at most an indirect one. If
in a given herd the disease appears more frequently and in
several generations, the cause must, as a rule, be looked for
in improper conditions of maintenance, also in close inbreeding
or in disease of the mother animals. Under such circumstances
weaker and less resistant individuals are born whose metabolism
is easily disturbed by insignificant influences.

For the present it still appears questionable whether Rhachitis
foetalis occurs in animals. Marchi made the observation that in the
Chiana valley in Italy the cows give, in damp years, birth to somewhat
smaller calves whose extremities show remarkable curvatures, the bones
being twisted and short, the epiphyses comparatively long, the diaphyses

_long. Histological examinations were not made. In this valley the
conditions of the soil are unfavorable and the feed consists principally
of sour grass; since the soil has been cultivated appropriately, the
disease has become much less frequent. Similar observations were
reported by Sivieri, Hansen, and before them by Siedamgrotzky. The
cases are however probably instances of abnormal development
(Osteochondrodystrophia foetalis) (Zschokke, Bourdelle & Dubois).

Hardly anything is known in animals about rachitis which com-
mences soon after birth (rachitis congenita). Only Hansen mentions
a few cases of rachitis in colts which were affected when about onc
month old. However they were all sired by the same stallion and
came from mares that had already had colts with congenital rachitis,
Etiology. 937

In a large herd of cattle in which many of the cows were affected with
osteomalacia, only poorly developed calves were born with very delicate
bony structures, which however presented no rachitis symptoms; these
symptoms appeared only after the calves were weaned and when they
received similar food as the cows (authors’ observation).

From what has been said it is above all evident that the
etiology of rachitis cannot by any means be said to be com-
pletely explained. This much may be asserted that the same
factors do not always participate in its development and that
therefore the disease does not represent an affection of uni-
form etiology. There is no doubt that in domestic animals
the most frequent cause of rachitis lies in the deficiency of
lime in the organism from whatever cause, no matter whether
the disease is sporadic or epizootic. Whether the lime deficiency
causes the bony changes immediately or perhaps only creates
a foundation on which the rachitis develops through the inter-
mediation of a resulting disturbance in metabolism cannot for
the present be decided definitely. On the other hand a toxic
or infectious origin cannot be denied for certain cases, especially
for those with excessive proliferation of the osteoid tissue, but
the investigations which have been undertaken in this respect
are not yet sufficient to justify a definite position being taken
in this problem.

Pathogenesis. If a deficiency in calcium occurs in the
organism the calcification of the developing osteoid tissue re-
mains insufficient and this leads to a lessened firmness of the
bones. The. more the firmness of the bones diminishes, the
greater is the mechanical irritation exerted upon the bone-
forming tissues by the motion of the body or of parts of the
body, and by the coincident jolts and shocks. In consequence
there occurs an increased new-formation of osteoid tissue with
proliferation of the epiphyseal cartilage and bone marrow
tissue, that is, a process similar to a productive inflammation.
The severity of the mechanical irritation depends not only
on the degree of lime deficiency but also on the body weight
of the animal, and especially upon whether, and in what degree,
the animal is permitted to move about or does move about of
its own accord. As a consequence of the lime deficiency in
the organism there occurs a partial or even a complete cessa-
tion in the ossification of osteoid tissue, through which the
solidity of the bones becomes less and less in spite of the in-
creased function of the bone-forming tissue. It is as a further
consequence of the lime deficiency, that we may consider the
abnormally increased absorption of bone tissue which had been
formed before the disease (osteoporosis).

Although the disturbances in the bone formation occur in
various parts throughout the body, they reach a considerable
degree only in certain parts under the influence of the con-
stantly changing mechanical irritation.
938 Rachitis,

It also appears thinkable that, according to the degree
of lime deficiency and to the external influences, either the
proliferating process or then the osteoporosis is more promi-
nent, the latter being indeed sometimes alone present (so-called
juvenile osteomalacia). It might be assumed that when the
affected animals are prevented from motion, or when the ani-
mals avoid all vigorous motions, because the bones are sensi-
tive in consequence of their lessened resistance, the process
of proliferation is far less intense than in animals in. which
the mechanical influences can manifest themselves fully. It
need not be settled in this connection whether the proportions
of the other salts contained in the food have any influence.

These considerations may perhaps explain why some authors produced typical
rachitis by withdrawal of lime, while with similar methods of experimentation
others could only cause osteoporosis and marked proliferation of the epiphyseal
cartilage, and still others only osteoporotic changes.

If the rachitis is based upon an intoxication or infection,
an inflammatory process in the bone tissue will probably be
primary and in such a case the bone salts may be dissolved
and absorbed, causing the bones to lose their firmness. In
the further course, however, similar reparatory processes would
occur in the bones as take place in lime deficiency under the
stimulation of the mechanical influences mentioned.

The process which takes place in the bones causes in them
various changes in form. These are partly due to the prolifera-
tion in-the bones and are therefore developed especially in
those portions of the body in which the bones are more exposed
to mechanical influences, during motion or during the chewing
of hard food-stuffs, or in rooting; this is true especially for
the epiphyses of the long bones, the maxillary or face bones,
also for the ribs which are in constant motion during respira-
tion. These external influences, which differ according to
species and breed and according to the care of the animals,
may produce the most varied combinations and forms in the
bony changes, and especially in pigs the maxillary or face bones
are often strikingly altered. The diminished firmness of the
bones leads on the one hand to curvatures, under the weight.
of the body or from muscular traction, and on the other to
fractures.

The diminished firmness of the bones is further responsible
for dragging upon the sensitive nerves in the periosteum and
in the bony tissue which in their turn cause pain in the bones
on motion. The proliferating osteoid tissue may even compress
certain nerve trunks (e. g., the nervus infraorbitalis [Hintze]).

A high degree of lime deficiency in the organism may of
itself cause disturbances in metabolism because the calcium
is necessary for the binding of certain metabolic products. In
this respect, however, a diminution of the other food salts which
is often coexistent with lime deficiency in the organism is
Pathogenesis, Anatomical Changes. 939

probably of far greater influence. This diminution of the food
salts in general may perhaps be held responsible for the in-
creased cerebral irritability which is a prominent symptom in
certain cases. If an intoxication or infection is the cause of
the disease, the presumable toxins or infectious substances may
cause disturbances in metabolism.

Anatomical Changes. The epiphyses of the long bones are
thickened, club-shaped, the diaphyses are shortened and also
thickened (Fig. 158). The bony tissue is porous and softer

 

Fig. 158. Rachitis. Skeleton of a setter.

than normal, sometimes so much so, that it ean easily be cut
with the knife. Some bones show bends and even breaks (see
Symptoms). On the cut surface of the bone, which has been
cut lengthwise, there is visible, between the periosteum and
the bone tissue, a vascular, soft, spongy layer which in part
remains adherent to the bony substance when the periosteum
is peeled off. This osteoid layer is especially thick at the
insertions of large tendons or muscles, and at these places
exostoses are frequently formed. The epiphyseal cartilage is
not separated from the diaphysis by a bluish-white or yellowish
double band of barely a few millimeters width, but there de-
940 Rachitis.

velops instead a spongy, soft, red tissue, certainly more than
a centimeter wide, which passes into cartilage and bony tissue
without any sharp border or in irregular streaks. The con-
nection between épiphysis and diaphysis appears loosened, so
that they can often be separated with slight exertion; this may
even take place during the life of the animal and then the
epiphysis will lie laterally to the diaphysis. The yellow marrow
of the long bones is more or less reddened and gelatinous if
the animal is notably emaciated. The spongy bone substance
is also reddish in color and shows a rarification of the cancellous
portion. The joints present, not infrequently, signs of inflam-
mation and of ulcerative destruction of the cartilages.

The flat bones, especially the upper bones of the skull and
the pelvic bones, are thickened, sometimes enormously bulged
out, and changed to a lardaceous, grayish-red to dark red, firm
tissue, which can be cut and which is covered only in spots by
a flexible and porous cortical substance, while in other “places
it passes into the adjacent soft parts and contains only
isolated bony islands. Owing to the bulging of the bones the
nares and the maxillary sinuses are small or even obliterated,
and in pigs the palate furthermore bulges into the oral cavity.
Sometimes the proliferating tissue of the maxillary bones con-
tains cysts which have developed from hemorrhagic foci
(Hintze, Willies). The teeth are placed rather deep and lie
loose in the proliferating tissue, without any alveolar borders;
their enamel surface in the pig is uneven, pitted, honeycombed,
or in exceptional cases the enamel layer may be entirely absent
(Preuss). Sometimes the skull bones are soft and moderately
thickened, in exceptional cases they may have become so rarified
that in spots only a thin, connective tissue-like membrane (the
single or the double periosteum) remains visible (Craniotabes),
and in such cases there are usually also signs of hydrocephalus
internus (Schiitz). The other flat bones, especially those of
the pelvis, may also be bent in various directions and present
similar changes in their substance as those in the skull bones.

The microscopic changes in the long bones (Fig. 159) may be summed
up as follows: Starting from the periosteum there develops a cellular and
vascular osteoid tissue containing comparatively large osteoblasts and bone cells
in varying numbers. In the diaphyseal part of the cartilage the cartilage cells
are larger, arranged in wavy streaks, and similar cartilage-islands extend toward
the marrow. From the marrow numerous vessels, with thin walls and surrounded by
cellular tissue, enter deeply into the cartilage tissue, opening the cartilage cell col-
umns, often in an oblique direction. Similar vessels may proliferate into the interior
of the cartilage tissue, even from the perichondrium and loosen this in their vicinity
which becomes softened. The layer of calcification between bony and cartilaginous
tissue is either entirely absent or there are only isolated foci of calcification;
instead there is avery wide layer of osteoid tissue which is similar in structure to
the layer starting from the periosteum, and is later partly changed into more solid,
bony tissue.

In the so-called snuffles or maxillary rachitis of pigs a transitional zone with
smaller decalcified bony laminae is joined to the zone of normal bony tissue,
upon which follows a tissue similar to sarcoma, consisting basically of spindle cells
or cells of various shapes, rich in protoplasm and containing large nuclei. In
this proliferating tissue there are seen numerous osteoid laminae which gradually
Anatomical Changes. 941

become more slender and finally represent a veritable lattice work of splinters.
Finally multinucleated giant cells are deposited around the laminae and cause their
disappearance by lacunar absorption (Hintze).

In addition to the changes in the bones, symptoms of
anemia, gastro-intestinal catarrh, or catarrhal affections of the
respiratory organs are often observed; in the latter organs
broncho-pneumonia is frequent.

 

Fig. 159. Rachitis. Longitudinal section through the line of ossification of the upper
diaphyseal end of the femur. «a. unchanged hyaline cartilage; 0. cartilage in the
first stages of proliferation; c. zone of proliferated cartilage columns; d. columns of
proliferated hypertrophic cells; e. vascular marrow spaces: f calcified cartilage tis-
sue; g. osteoid tissue; h. remnants of cartilage tissue between osteoid tissue; 7. tra-
beculae of osteoid tissue; k. trabeculae of osteoid and developed (lime containing)
bone tissue; J. vascular, cellular-fibrous marrow spaces. (Magnif. 50 X. After
Ziegler. )

Symptoms. The development of the rachitic manifesta-
tions proper is sometimes preceded by disturbances in nutri-
tion. The animals seem weak, their desire to eat is diminished,
the belly somewhat bloated, and at the same time obstinate
diarrhea makes its appearance. Sometimes there may be
symptoms of pica (licking disease), gnawing the walls or the
wood of the stable, drinking of manure water; these occur not
only in the initial stage, but also in the further course of the
disease. In some cases, especially in colts, the second dentition
942 Rachitis.

is retarded and irregular. All these symptoms may be un-
noticed, so that attention is not attracted to the disease until
the motor disturbances commence. The aching in the bones,
which occurs before the changes in shape, causes the animals to
step about restlessly, while at the same time they move gingerly
and their walk is stiff or lame; they lie much on the ground
and dislike to rise. Especially pigs, less so kids and lambs,
and at times other animals do not use their posterior extremi-
ties, or indeed, all extremities, at all. They seem paralyzed,
and on being forced to rise they crawl about squealing aloud.
(The cases of paralysis in chicks, which Wilke diagnosed as
poliomyelitis anterior, probably had a similar-origin.) Smaller
animals often assume a kneeling position (Fig. 160). These
motor disturbances increase with the progress of the disease
and when the shape of the bones commences to be altered.

 

 

 

 

 

 

Fig. 160. Rachitis (of pig). Aside from the motor disturbances the pig showed
shght snufiling.

In certain cases the disease becomes apparent through
severe nervous disturbances, as was pointed out by Klimmer &
Schmidt for osteomalacia and as the authors observed fre-
quently in calves and pigs. The affected animals suddenly
become somnolent, they stagger and even fall down, and occa-
sionally develop generalized tonic-clonic muscular convulsions,
which however may also be produced by external influences.
Such attacks either terminate, in some 6 or 8 hours, with the
death of the animal or are repeated a few times in the course
of some days or weeks before death results, or then they do
not appear at all, but the typical symptoms of the disease he-
come evident at once.

The changes in form are, at least in the beginning, most
striking in the long bones of the extremities. The epiphyses
are enlarged and it looks as though the joints themselves were
 

Symptous. 943

swollen, but the true nature of the swelling is casily ascertained
on palpation (Fig. 161). Similar enlargements are to be seen
on the sterno-costal articulations where the button-shaped
cartilages form two concave lines running parallel with the
sternum (rachitic rosary). These bony swellings are, especially
at the beginning, often somewhat sensitive to pressure. Cir-
cumscribed exostotic enlargements are also frequent, especially
in the ribs and the extremities (Fréhner observed a ringbone
develop in rachitis). :

The weight of the body and the traction of the muscles
causes the bones to bend and become crooked. These distor-
tions are most frequent and striking on the extremities which

 

Fig. 161. Rachitis. Setter. The skeleton of this dog is shown in Fig. 158,

assume various abnormal shapes, such as ‘‘dachshund’’ legs,
knock-knee, bandy-leg, legs bent backward, legs like bear’s paws
(Figs. 161 and 163). The thinner bones, especially those of
the metacarpus and the metatarsus are sometimes bent double
and may break transversely (Schiitz). Liénaux points out that
the Achilles tendon is sometimes torn from its attachment, and
this may be the first or even the only symptom of the disease.
The muscles of the extremities either lose their tension or
some of them become contracted and thus cause much pain.
The pressure of shoulders and elbows, and also the air
pressure cause the middle portions of the ribs to be bent in-
ward, giving rise on both sides of the thorax to a longitudinal
944 Rachitis.

shallow groove and to a shortening of the transverse diameter
of the thorax. The inward bend of the ribs causes the sternum
to recede from the vertebral column, while its borders are ap-
proximated, so that the sternum forms an acute angle or pro-
trudes (chickenbreast, pectus gallinaceum, s. carinatum).
When the animals lie down much, the antero-posterior diameter
of the thorax is diminished (Fig. 161), because its anterior
wall which rests on the ground is forced inward. In fowls
the sternum shows in such cases a single and often a double
inward bend (Ztirn). The limited motility of the thorax is
apt to cause the development of a bronchial catarrh or of
eatarrhal pneumonia.

 

 

 

 

Fig. 162. Rachitis in a lamb.

In the pelvis the acetabulum is pressed upward and inward
by the heads of the femurs, while the symphysis is forced down-
ward and forward; in consequence the pelvis is narrow trans-
versely, as is already indicated by the position of the hind
feet which are turned inward.

The vertebral column presents various deformities (hence
the name rachitis, viz., °xs=vertebral column). It is curved
either laterally (scoliosis), or upward (kyphosis), or downward
(lordosis). In most cases there are two or several antagonistic
Symptoms. 945

curvatures, for instance lordosis in addition to kyphosis, or
the scoliotic vertebral column is bent both to the right and
to the left (Figs. 158 and 161).

The deformities in the trunk and extremities may alter
the entire body conformation (dwarfism) and naturally in-
fluence the motions of the animal, which is clumsy, uncertain,
and may reel or stagger in walking even if the bones are not
painful.

The skull bones either show certain changes, like thicken-
ing and deformity of the rami of the inferior maxillary, on
close observation only, or they are so much altered that their

 

ee

Fig. 163, Rachitis in a calf.

affection forms a prominent symptom of the disease. Some-
times early, more often later the respiration becomes sniffing
and difficult with occasional attacks of asphyxiation, and as
this increases the facial bones bulge out more and more, so
that the head may in the course of 6 to 8 weeks become enor-
mously large. The bulging of the bones commences mostly
in the maxilla and gradually involves the contiguous bones
and the inferior maxilla. The vomer protrudes into the oral
cavity which therefore becomes smaller, so that the ingestion
of food is rendered difficult and even impossible (Fig. 164).

Vol. 1—60
946 Rachitis.

The teeth then seem shortened and sometimes barely stand
out from the gums; they are loose and may fall out; the enamel
is perforated in places. The bones of the skull may be thick-
ened in parts, or they may be thin and even membranous;
the fontanelles, especially between the frontal and parietal
bones, often remain open (Schiitz).

The form of rachitis in pigs in which the facial bones bulge out strongly, has
always been designated as snufiles (French: ‘‘reniflement’’). With it were classed
other diseases characterized by a sniffing respiration, especially the infectious nasal
inflammation of pigs (Vol. II). Since, however, the sniffling respiration is only
a symptom of quite heterogeneous diseases, and has all too often given rise to
misunderstanding, the name snuftles should be abandoned altogether. The same is
true for the so-called bran disease of horses, which also represents only a form of
rachitis or osteomalacia, caused by the exclusive feeding of bran.

Course and Prognosis. After the appearance of clinical
symptoms rachitis runs a chronic course lasting for months,

 

Fig. 164. Rachitic bulging of the mazillary bones and protrusion of the hard
palate into the mouth, in a pig with rachitic changes in the other bones.

except in those cases in which, as already mentioned, the onset
is associated with severe nervous disturbances, or in which
death is hastened by complications. If the conditions are un-
favorable and if the disease is not treated, it gradually
progresses accompanied by increasing emaciation of the ani-
mals whose development is noticeably retarded. Spontaneous
recoveries are not infrequent in large herds, but are observed
only in animals. which are less severely affected, or in nearly
mature animals in which, of course, growth is less rapid. By
proper regulation of the diet and by prompt treatment many,
even severely affected, animals are cured, or the bone deformi-
ties, which are not yet considerable, are made to disappear.
But deformities which have become very decided persist, the
narrowing of the pelvis and the thorax being of particular im-
portance. Under unfavorable conditions, or if the disease is
Course and Prognosis, Diagnosis. 947

far advanced and has given rise to emphatic nutritional dis-
turbances, death always follows, either through exhaustion or
through some complication. The ultimate healing of the process
is not rarely prevented by ulcers formed in the course of the
disease in the articular cartilages.

Diagnosis. The changes which occur in the skeleton,
especially in the bones of the extremities, in the ribs and in
the bones of the skull are so characteristic that rachitis can
be recognized without difficulty, especially if the slow develop-
ment and the early age of the animals are considered. Pyo-
septicemia of the new-born is differentiated by its acute onset
few days after birth, and by the inflammatory symptoms which
dominate the clinical picture. In articular rheumatism also
the acute inflammatory character of the disease is diagnostic;
moreover, the swollen joints are painful, the swelling is most
intense in the middle portion of the joints, it is tense and
fluctuating. In muscular rheumatism, which is of extremely
rare occurrence, bony swellings or deformities are absent.
Tuberculosis may produce similar changes in calves or young
pigs as they are observed in the initial stage of rachitis, but
in this affection the articular ends of the long bones remain
unaltered for a long time and the further course of the disease
is entirely different. In all the diseases just. mentioned only
one or few joints are involved, as a rule, and.these not with
almost equal intensity as is the case in rickets: New-forma-
tions occur only in some bones, while in rickets the entire skele-
ton is diseased more or less.

Treatment, Above all the diet should be regulated; the
animals are to be kept in moderately warm and well-ventilated
places, or, still better, in the open air when the weather is
favorable; they should be enabled to move about freely and
receive food that is rich in calcium. Nurslings are properly
left with their dams which are to be given nutritious food
containing much calcium; the rachitic nurslings may be given
milk to which lime water has been added, or if necessary they
are put to a healthy nurse. Weaned animals and the dams
of nurslings receive food containing much lime, in carnivora
meat with the addition of a sufficient amount of bones, in birds
fish (Merz), in herbivora first of all timothy hay, good upland
hay, straw of leguminous plants, possibly waste of oil factories
or certain leguminous foods being best adapted to their needs
(page 932)). Pasturing or green feed not rarely exert a favora-
ble action, but often the disturbances in motion are increased
at first when animals are put out to pasture, if they were not
accustomed to move about freely. The treatment of gastric
and intestinal catarrh, which may be present, also requires
close attention in order to insure undisturbed intestinal assimi-
lation.

The decided lime-deficiency in the organism is to be cor-
948 Rachitis.

rected by the administration of lime preparations, and here, of
course, the lime requirements of the particular species and the
probable lime content of the food must be considered. In many
cases chalk (calcium carbonate), which is cheap, is appropriate;
colts and calves may be given 10-20 gm.; lambs, pigs and dogs
2-10 gm. daily with their food, perhaps shaken up with milk.
In order to prevent digestive disturbances in consequence of
the HCl being bound in the stomach (an occurrence that was
not observed, however, in the experiments made on rams by
Volhard), Klimmer & Schmidt suggest to replace the chalk
partially (1/3-1/2) by calcium chlorate (not to be confounded
with chloride of lime!). The prepared bone-meal (phosphated
food-lime; food-bone-meal; precipitated calcium phosphate)
renders excellent service in doses similar to those of chalk,
and should be administered especially in those cases in which
the administered food is deficient in phosphates (page 932).
Feeding experiments made in this direction by Kohler showed
that almost all of the ingested tri-calcium phosphate was ab-
sorbed, and about one-half of bone-ash or of bone-meal from
which the gelatinous portions had been removed. In the experi-
ments of Frese in dogs, organic calcium compounds were not
found superior in their effects to the anorganic lime. The
preparations containing lime, respectively phosphates, should
be given at intervals of from.2 to 3 days (Klimmer & Schmidt),
or alternately at different feedings, in order to prevent their
precipitating each other in the intestine. If phosphorus is
deficient as well as lime, sodium phosphate may be given alter-
nately with the chalk. In human medicine phosphated codliver
oil is particularly well thought of as a remedy (colts and calves
0.02-0.05 gm. of phosphorus in 30-100 gm. of codliver oil daily;
pigs 0.002-0.005 :20-40 gm.; dogs 0.001-0.002:5-15 gm.; birds
0.0005-0.001 :2-5 gm.). Hansen & Schabad have shown experi-
mentally that the remedy produces an increased retention of
the lime and phosphorus of the food and also an increased
assimilation of the lime which is administered separately. The
systematic administration of salt (rock salt) or of HCl may
enhance the favorable action of the medicinal treatment just
described. (Harms, Klimmer & Schmidt.)

In a far advanced stage of the disease, especially when
the deformities of the bones are very marked, it appears best
to slaughter the animals early.

Prevention. The disease can be prevented almost with cer-
tainty when the animals are kept and fed properly. Care should
be taken that the animals receive sufficient amounts of rock
salt, and of course that the dams are suitably fed. In localities
where the disease is frequent or where food-stuffs poor in
lime are fed, it is advisable to administer systematically chalk
or bone-meal in addition to the food. In this manner it has
been found possible to eradicate the disease, for instance in
Prevention. 949

swine herds in which it had, year after year, taken large toll.
Colts should not be fed with bran at all, or only in small
amounts. Moreover, the young animals should be protected by
cleanliness and proper ventilation of their stables against acute
diseases which may establish a predisposition to rickets, and
they should be kept as much as possible in the open where
they can move about freely. All these precautions are called
for especially in pure-bred or high grade herds in which the
greater or lesser degree of inbreeding of itself reduces the re-
sistance of the animals.

If there is a suspicion of infectious or tcxic rachitis, the isolation
of the diseased animals and the disinfection of their stables, as well
as a change of feeding, is indicated.

Literature. Albu & Neuberg, Physiol. u. Path. d. Mineralstoffwechsels, 1906.
— Aron, Pfliigers, A., CVI. 91. —- Basset, Rec., 1907. 167 (Lit.). — Bourdelle &

Dubois, Rev. vét., 1907. 511. — Briiming, Z. f. Tm., 1906. X. 198. — Frese,
Verwertbarkeit d. Nahrungskalkes, ete. Diss. Giessen. 1908. — Fréhner, Monh.,
1904. XV. 211. — Hansen, Maanedsskr., 1908. XX. 553. — Hartenstein, S. B.,

1894. 132. — Haubold, ibid., 1906. 77. — Hintze, A. f. Tk., 1909. XXXV. 535
(Lit.). — Kassowitz, Jahrb. f. Kinderheilk., 1882. 430. — Klimmer & Schmidt,
Monh., 1906. XVII. 481 (complete Lit.) —Liénaux, Ann., 1907. 93.—Loos, W. f. Tk.,
1905. 421. — Marchi, Clin. vet., 1889. 349. — Miwa & Stdéltzner, Beitr. z. path.
Anat., 1898. XXIV. 578. — Morpurgo, ibid., 1900. XXVIII. 620; Chl. f. allg. Path.
u. path. Anat., 1902. XIII. 113. — Moussu, Byll., 1903. 303; Rec., 1908. 559. —
Ostertag & Zuntz, Z. f. Infkrkh., 1907. II. 449. — Pfaundler, M. m. W., 1903.
1577. — Piana, Clin. vet. 1899. 307. — Pommer, Unters. iib. Osteomal. u. Rhachitis,
1885. — Preuss, A. f. Tk., 1909. XXXV. 561. — Reimers & Boye, D. t. W., 1905.
496 (review). — Rievel, Ergebn. d. Path., 1905. XI. 2. Abt. 597 (Lit.). — Roloff,
V. A., 1866, XXXVII. 433; A. f. Tk., 1875. I. 189..— Schmidt, Ergebn. d. Path.,
1897. IV. 531° (complete Lit.). — Sivieri, N. Ere., 1902. 89. — Stdltzner, Jahrb. f.
Kinderheilk., 1899. 268; Path. u. Ther. d. Rhachitis, 1904 (complete Lit.). — Stutzer,
Mentzel & Lengerkes, Landw. Kalender, 1906. — Vierordt, Rhachitis u. Osteomal.,
1896. — Voit, Z. f. Biol, 1880. XVI. 55. —Wedemayer, B. t. W., 1906. 703.
— Wegner, V. A., 1872. LV. 11. — Wilke, D. t. W., 1909. 697. — Willies, A. f. Tk.,
1908. XXXIV. 623. — Zschokke, Z. f. Tm., 1899. 268.

Barlow’s Disease. In a young dog, which during life had shown
signs of rickets, rheumatoid pains and debility, and which had often
cried out in pain, Stéltzner found rosary-like thickenings of the
cartilaginous ends of the ribs, a large subperiosteal hematoma of the
scapula, a considerable swelling of the proximal epiphyseal end and
of the adjoining diaphyseal portion of the humerus, with a large double
hematoma. The lower two-thirds of the radius were thickened on
account of a subperiosteal hematoma; where the swelling was largest,
both in the humerus and in the radius, the corticalis was entirely
absent. Histological examination showed that there was not a bone
fracture, but that the cortical portion, and in places the spongy portion
also, had become rarified; osteoid trabeculae and osteoblasts were
present in only small numbers, the epiphyseal marrow contained fat
cells and the diaphysis showed a spleen-like structure. Definite rachitic
changes were not ascertained.

The author emphasizes justly the great similarity of the clinical
picture with Barlow’s Disease, which occurs in children together with
rickets and which leads to hemorrhages in bones and elsewhere, but
he nevertheless does not feel justified in identifying the affection with
Barlow’s Disease. (Schmorl, Beitr. z. path. Anat., XXXX, 215—
Stodltzner, V. A., CLXXVII, 466.)
950 Osteomalacia.

(b) Osteomalacia. Brittleness of Bones.

(Bone softening; Halisteresis ostium, Osteopsathyrosis;
Cachemie osseuse [French].)

Osteomalacia is a disease arising from general nutritional
disturbances, which causes an increased absorption of lime
salts from the bones and therefore softening and manifold de-
formities; fractures of the bones are not infrequent.

Occurrence. Osteomalacia affects most frequently cattle,
especially milk cows, less often goats and swine, and still more
infrequently horses or mules, also sheep and buffalo; dogs
and birds appear to acquire the disease only in exceptional
cases.

The disease occurs preferably in regions with unfavorable
conditions of soil, and in such regions it assumes, especially
in dry years, an enzootic distribution and causes then very
emphatic economic losses.

Osteomalacia has been observed in various parts of Belgium, Germany, France,
Austria (especially in Moravia [Rudofsky] ), then in Hungaria, and here more
especially in the regions of the upper Danube as well as in certain mountainous
regions. In other countries in Kurope it has also made its appearance, and
further in many countries of Asia, Africa, North America and Australia.

Quite extensive epizootics of the disease occurred as follows: 1778-1783 in
the province of Brandenburg; 1816-1817 in Baden; 1820-1822 in Anhalt; 1828 in
Switzerland; 1837 in Krain; 1832-1838 in Rhenish Hesse; 1833-1834 in the gov-
ernment districts of Coblentz, Trier and Aachen; 1863-1866 in Bohemia; 1868-
1869 in the grand duchy of Weimar; 1893 in Belgium and France; 1893-1894 in
Baden, the Rhenish countries, etc., 1895 in the district of Cologne, in the region
of Chemnitz and Grossenhain; 1904-1905 probably all over Germany, certainly in the
kingdom of Saxony (Klimmer & Schmidt). During the last-mentioned period
the disease was epizootic in Moravia (Rudofsky), and also in one county of upper
Hungary on the Galician borders. In the years 1908-1909 many cases occurred in
several parts of Hungary.

Osteomalacia (the so-called osteoporosis) is widely distributed in Asia, Africa
and Australia, occurring especially in Tenking, India, Japan, Madagascar, Camerun
(called by Ziemann disease of the maxillae of horses and mules), the Transvaal
and in the Cape Colony; in these regions it is an annually recurring enzootic
affecting the horses, mules and asses.

In America, also, enzootics were observed among horses in many regions.

Etiology. As in rachitis, so in brittleness of the bones of
animals, a deficiency of lime in the organism is undoubtedly of
the highest importance. This is in perfect agreement with
the constant occurrence of the disease in localities with un-
favorable conditions of soil.

In these regions the soil is usually very poor in mineral
substances, especially in phosphoric acid and lime; the subsoil
consists of porous bog- or peat-strata, or it is exposed to fre-
quent floods. If in addition the cultivation is primitive, and
particularly if the deficiency in salts is not corrected artificially
by appropriate fertilization, the food plants growing on such
a soil are likewise deficient in mineral substances. This may
be true to an increased degree in dry years, when the salts
Etiology.” 951

contained in the superficial strata of the soil cannot be dis-
solved and absorbed sufficiently. Food grown under such con-
ditions is to be compared in regard to its food value to the
sour grasses growing in very wet, boggy and swampy regions,
which are not only poor in proteids and in mineral substances
(Morgen), byt are moreover difficult to digest and easily pro-
duce gastric catarrh through irritating substances which they
contain.

The calcium content of! the food varies within wide limits, according to
the conditions of soil. Germain found, for instance, in 1,000 parts of hay, of
a region in which osteomalacia was frequent, only 2.97 parts of lime, while in
another hay of good quality the amount of lime present was 24.05 parts. Both
kinds of hay contained like amounts of phosphoric acid. Karmrodt found 6.77
parts of lime and 2.25 parts of phosphoric acid;. Morgen 3.7 and 6.7 parts of
lime and 2 resp. 2.6 parts of phosphoric acid; Dircks found in three samples of
Norwegian forest hay only 1.85, 2.79 and 2.78 parts of lime, and 1.55, 1.43 and
1.29 parts of phosphoric acid (Kellner). (For the normal percentage of lime and
phosphoric acid of the food-stuffs, see page 932.)

A deficiency of lime in the organism may, however, also
occur under favorable soil and meteorological conditions, when
food-stuffs, which naturally contain only small amounts of lime,
are taken largely and for a long time; such food-stuffs are
carrots, potatoes, grains and their waste products, grain-straw,
slops, molasses, whey. Usually the unfavorable influence of
soil or meteorological factors and of food poor in lime become
manifest simultaneously since such food-stuffs are fed in con-
siderable amounts in place of better feed when the latter is
not available in sufficient quantities.

In regard to the insufficient absorption of lime salts to
the improper chemical composition and, perhaps, to the diges-
tive disturbances which may act as causes of a deficient lime
content in the organism, the same is true that has already been
said in the chapter on rachitis (see p. 933). Haubner and Roll
have observed osteomalacia especially after the feeding of food
that had been exposed to the smoke from smelters.

Sometimes the deficiency of lime in the drinking water
appears to be of importance, at least Kasparek saw the disease,
which had become stationary on an estate, disappear after the
introduction of hard drinking water.

Further factors in depriving the organism of its lime are
pregnancy and especially lactation, since in these conditions
very considerable amounts of lime are withdrawn from the
organism (see lime content of the milk, p. 931).

With the exception of females during pregnancy and lactation the lime require-
ments of adult animals are much less in proportion to the body weight than in
growing animals, although in these also the lime requirements usually diminish
rapidly toward the end of the first year of life (see page 931). While a calf
from 2-3 weeks old and weighing 50 kg. needs a daily supply of 14.5 gm. of
calcium and of 13.8 gm. of phosphoric acid (Lehmann), this need is only 21
and 19 gm., respectively, in a calf one year old (Kellner). The calcium require-
ments of a pregnant cow are 51 gm. per day and 25 gm. of phosphoric acid (Bous-
singault), those of a milk cow with a daily milk production of 20 liters are 200

\
952 Osteomalacia.

gm. of lime and 100 gm. of phosphoric acid (Kellner), those of a resting ox are
76-78 gm. and 36 gm., respectively (Henneberg & Stohmann), the figures in the two
last cases being calculated to 1,000 kg. body weight. A ram 2 years old needs
daily only 0.57 gm. of lime and 0.05 gm. of phosphoric acid for his 50 kg. of
weight (Weiske) compared to a need of 3.2 gm. and 2.3 gm., respectively, in a lamb
1 month old.

For the content of food-stuffs in lime and phosphoric acid see chapter on
rachitis, page 932.

The etiological importance of lime deficiency in osteomalacia
was likewise proved by some animal experiments, and the same
significance must be attributed to the numerous observations
according to which the disease may be relieved by a suitable
supply of lime.

Chossat (1842) and later Gelpke (1891) succeeded in producing osteomalacia
in pigeons by feeding them exclusively with oats, while Forster (1881) obtained
positive results in dogs. Roloff (1866) in a goat and a sheep. Stilling & Mering
(1889) saw in a bitch which had been fed from the commencement of gestation
with food-stuffs deficient in lime, softness of vertebral column and pelvis, and
microscopically thick layers of osteoid tissue upon the bone trabeculae.

Further an intoxication was assumed as causative of osteo-
malacia, in so far as some irritating substance circulating in the
blood was supposed to produce an inflammatory condition in
the bones, similarly as in rachitis (p. 933). ;

The infectious origin of osteomalacia is finding more ard
more adherents, since Morpurgo and Moussu published the re-
sults of their experiments which were mentioned above
(p. 935), and even before them some authors (Kehrer, Ziirn)
had pointed out the possibility of an infection. Moussu, Liénaux,
among’ others, even assert that osteomalacia always arises in
consequence of an infection, at most a predisposing significance
being admitted for the lime deficiency of the organism.

Petrone (1892) assumed that Winogradsky’s micrococeus nitrificans was the
virus of osteomalacia, but the experiments of Tschistowitsch (1893) in this direc-
tion had a negative result. Morpurgo found the diplococci mentioned on page 935.
Pécaud (1904) in Tonking also demonstrated diplococei, in a horse affected with
osetomalacia and claims to have produced the disease with the blood of affected
animals in a horse and in a guinea pig. But on the other hand, Moussu and Liénaux
did not succeed in discovering any microorganism whatever. (Concerning the micro-
organisms found by Piana in rabbits affected with osteomalacia, see page 935.)

The osteomalacia (osteoporosis) of equides which is met with
outside of Europe was considered by Theiler (1907) to be a specific
infectious disease in spite of the fact that the inoculation experiments
of Elliot and: Robertson, and also Theiler’s own blood transfusion
yielded entirely negative results. Theiler assumed that the micro-
organism, which is perhaps ultramicroscopic, is transmitted by insects.
But Ingle showed that the food-stuffs, which were supplied to the
osteoporotic animals, were deficient in lime salts and contained relatively
much phosphoric acid, and he concludes, therefore, that the cause
of osteoporosis must be looked for in food-stuffs in which the phosphoric
acid content is relatively very high in proportion to the calcium content.
Ingle refers to some animal experiments of Weiske’s in which, after
the addition of sodium phosphate to the oats, the bones of the experi-
Etiology. 953

ment animals became thinner and fragile, while such changes did not
occur if at the same time calcium carbonate was also added to the
oats. Finally Lane saw during an enzootic the disease disappear when
the food was made ri¢her in calcium and was mixed with bone meal.
The assertion of Elliot, according to which the extra-European
osteoporosis is a climatic disease which occurs principally in wet
regions, was not confirmed by experiences in the Transvaal.

The hypothesis that the bone salts suffer solution because
of the absorption of lactic acid from the intestinal canal
(Heitzmann) or owing to the accumulation of carbonic acid in
i. 935) (Rindfleisch) has at present hardly any adherents

p. ‘

Trophoneurotic disturbances were attributed a causal rela-
tion to osteomalacia by Fehling (1890). According to this
author an increased activity of the ovaries produces, by reflex
action, a hyperemia of the bones, which in its turn would lead
to softening of the bony substance.

The hypothesis is based upon the favorable results obtained in women ill
with osteomalacia by extirpation of the ovaries and also upon the demonstration
of a so-called ‘‘physiological osteomalacia’’ in pregnant women which was made
by Hanau (1892). This author repeatedly found newly formed osteoid tissue in
the bones and in the Haversian canals of pregnantand lying-in women whose bones
were otherwise healthy. But it must be noted that Liithje failed to find any
changes in the phosphorus- and calcium-metabolism in castrated female animals,
and that Gracs4nyi saw recovery occur equally in six affected cows, although only
two of them were castrated, all being fed alike.

Honnicke (1906) is inclined to assume that osteomalacia
occurs on the basis of a thyroid gland affection and that the
disease represents a form of hyperthyreosis. (In two of his
cases in horses the thyroid gland was much enlarged.)

In a rabbit that was fed with normal thyroid substance during, and for two
months after, pregnancy, Hénnicke found a decided softening of the pelvic bones
and moderate cachexia, while two control animals, which were also pregnant,
remained well.

Among predisposing causes pregnancy and lactation merit
first consideration (see p. 951), while racial differences are of
importance only in so far as the calcium requirements of
different species vary. In regions where osteomalacia occurs
enzootically, recently imported animals are more apt to acquire
the disease than the native ones.

It is evident from these considerations that there are many
problems still to be solved in the etiology of osteomalacia, and
that osteomalacia is not a disease with a uniform etiology.
Especially the experiences in European countries do not admit
any doubt that calcium deficiency of the organism may be re-
sponsible for osteomalacia, but for certain cases another origin

cannot be denied (see p. 937).
954 Osteomalacia.

Pathogenesis. The commencement of the pathological
process in the bones is probably similar to that in rachitis
(see p. 937), whether the trouble be due to a lime deficiency
of the organism or to another cause. But since in this disease
the process occurs in fully developed bones, the later tissue
changes differ more or less from those in rachitis. In osteo-
mmalacia the peculiar proliferative processes are absent which
are noted in rachitis at the borders between the epiphyses and
the diaphyses of the long bones, and on the other hand the
decalcification (osteoporosis) predominates over the new-
formation of osteoid tissue, at least in many cases. Still, ex-
ceptions are observed not very infrequently, in so far as a
decided proliferative process may set in under the influence
of certain mechanical factors (see p. 937) and of other agencies

 

Fig. 165. Skeleton of the cow. with osteomalacia, illustrated in Fig. 168. The ribs
are bent forward, show multiple fractures, and callus formation. Both ilia are
fractured, the fractured ends being crowded into one another. Enormous callus for-
mation, moderate lordosis of the lumbar vertebrae; callus formation at the base of
the spinal processes of the anterior dorsal vertebrae.

that are not fully known. In other cases the new-formation of
osteoid tissue may be entirely lacking.

The further consequences of the diminution in the firmness
of the bones and of the disturbances in the metabolism are
the same as in rachitis (see p. 937), except that in osteomalacia
the bones are more often brittle rather than pliable.

Relations of Rachitis to Osteomalacia. While Virchow and others
differentiated rachitis sharply from osteomalacia, still other authors
declared both diseases to be closely related, or identical. Indeed the
pathogenesis and the etiological agencies of both affections agree in
many points, and it appears as though the anatomical or microscopical
differences were dependent solely upon the difference in the age of
Pathogenesis, Anatomical Changes. 955

the affected animals, the more so, as both diseases may occur simul-
taneously. According to this viewpoint rachitis and osteomalacia would
form processes which are identical anatomically, but which might
possibly be due to different causes. But since many points are still
disputed concerning the etiology and pathogenesis of both disease forms,
the identification of rachitis and osteomalacia as one clinical entity of
like anatomy and etiology does not appear justified for the present.

The relation of rachitis and osteomalacia to osteoporosis in ge.eral (rarifica-
tion of bony substance in favor of the marrow spaces) may be described as
follows: Both in rachitis and in osteomalacia osteoporosis is a constant symptom
and it is either emphasized very slightly compared with the proliferative process,

 

Fig. 166. Pelvis of a cow with osteomalacia. The pubes and ischium are bent,
the foramen obturatum being distorted. The left internal angle of the ilium is
lowered,

dependent upon the age of the affected animal, on the cause and on the variable
mechanical influences, or on the contrary it predominates, at times so decidedly
that it appears to exist alone. It is therefore not proper, at the present stage of
information, to classify general osteoporosis (with the exception of senile bony
atrophy) as an independent affection apart from rachitis or osteomalacia, as was
recently proposed by Miwa & Stoltzner, Elliot, Theiler and others.

Anatomical Changes. In well marked cases of the disease
the marrow spaces of the long bones are dilated, the bony
cortex is thin and spongy, brittle, or then so soft that it may
be cut with a knife. In very severe cases the cortical portion
of the long bones is barely a few millimeters thick, the bone
956 Osteomalacia,

marrow much reddened and studded with punctiform hemor-
rhages; if cachexia already exists the bone marrow is pale,
gelatinous, even watery (marrow-fluid). The flat and short
bones are also brittle or flexible; owing to the dilation of
the marrow spaces the spongy structure of these bones is em-
phasized and may contain fair-sized marrow spaces. The sound
of the bones is duller than that of normal bones.

In osteomalacia of equides
and hogs a considerable bulg-
ing of the skull bones is also
often observed. It is less fre-
quent in goats and dogs. All
skull bones appear enlarged
symmetrically on both sides
and the periosteum is easily
pealed off. The surface of the
bones is reddened, at times
discolored dark- or blue-red
and contains numerous small
holes which are often con-
fluent; the outer lamella of the
bones is soft and easily cut.
These changes are _ particu-
larly striking in the superior
maxilla which may bulge out
so much that the molars are
imbedded in the _ reddish,
rather fibrous bone mass down
to their masticating surfaces.

        

    
      
  

  

    

APE: wh es The weight of the macerated
ea ng ite MNS head is usually much dimin-
oh ah ‘ ished (in horses 400-1160 gm.,

as compared with the normal
weight of 4000 em. [Marcone]) ;

Fig. 167. Osteomalacia. Superior max-
jlla of a goat 20 months old. a. periosteum
with numerous osteoblasts in the deeper
layer; 0, trabeculae becoming gradually
more narrow; c. narrow trabeculae sur-
rounded by numerous osteoblasts ; d. rem-
nants of trabeculae in the cellular-fibrous
tissue; e. vascular cellular-fibrous tissue ;
f. giant cells, partially in the vicinity of
remnants of trabeculae. Magnif. 100.
After Bassett.

only if the bulging is excessive
is the normal weight main-
tained after maceration. The
bone cavities are small or en-
tirelv obliterated.

In consequence of atrophy
and softening of the bony tis-
sue the hones are subject to
all sorts of deformities. These

are most striking in the pelvis, the acetabula of which appear
pressed inward, while the ilia are much bent (Figs. 165 and
166); on the vertebral column scoliosis, kyphosis and lordosis
are to be noted and the depression of the ribs causes the thorax
to become narrow and the sterum to protrude. The pelvic
bones, and still more the long bones and the ribs often show
recent or old fractures, callus formation, and circumscribed
Anatomical Changes, Symptoms. 957

bulging; in other cases the tendons are loosened from the bones
and the articular cartilages have lost in substance.

On histological examination the spaces between the bony trabeculae and Haver-
sian canals are dilated and bulging, while the trabeculae show the structure of
bony tissues almost only in the middle, their marginal portions, which are bordering
on the narrow spaces, assuming the form of a homogeneous transparent tissue
or of a cellular, non-caleareous tissue which may be finely or coarsely granular
(Fig. 167). The finer trabeculae consist in places exclusively of this tissue. The
marrow spaces are filled with a highly vascular tissue which is at first embryonal
and fibrillary and later contains more fat. The transformation and absorption of
the bone substance proceeds from the surroundings of these vessels in which multi-
nuclear giant cells appear (so-called osteoclasts).

According to O. Weber the specific gravity of osteomalacic bones is low, the
fat content increased, the amount of inorganic constituents much diminished; the
gelatinous substances are also diminished.—Keuscher found of mineral constituents
only 3214% instead of 60 in a thigh bone; in the ribs 30% instead of 5714; in
the vertebrae and the pelvic bones 26% instead of 57. The quantity of these sub-
stances is therefore reduced to one-half, the soft tissue increasing in like proportion.
Landois found in the bones of a horse with osteomalacia 15.85% of fat; 12.59 of
ossein; 47% of water, and 22.57% of lime salts, a percentage. that was quite sim-
ilar to that of healthy tones. Hebrant & Mosselmann found the mineral constit-
uents diminished on an average by 10%, the ossein by 8-9%; the water was in-
creased by 3-4%, the fat by 8-9%. Ingle showed also a marked diminution of the
ash constituents of the bones.

Finally there are found changes suggesting anemia and
cachexia, principally edematous infiltration. 'The muscles which
are attached to the affected bones show atrophy and fatty de-
generation; in the joints and tendon sheaths inflammatory
changes are frequent, as are also ulcers-in the articular carti-
lages.

Symptoms. The signs which are characteristic of the dis-
ease are preceded, frequently in cattle, less so in the other
animals, by digestive disturbances and by symptoms of licking
disease. Such disturbances are observed also later after the
changes in the bones have become manifest. At first the ani-
mals simply lick the manger, the iron fastenings and the walls,
later they gnaw them and swallow portions of them. They
lick and gnaw preferably objects which contain lime, such as
mortar, sand, bits of stone and brick, earthen vessels, etc., also
woodwork, the latter especially if it is rotten or covered with
soot. Later on a predilection for objects which have a dis-
gusting smell and taste becomes more and more marked; those
portions of the stable which are soiled with feces and urine
are sought out and eagerly devoured, and all sorts of foreign
substances are swallowed. At first the patients behave in this
strange manner only between feeding and eat the fodder which
is put before them readily, but later the appetite becomes
gradually worse, the animals become capricious, eat reluctantly,
slowly, and steadily smaller amounts. Still later they refuse
good fodder entirely and their taste is perverted to such a
degree that they may prefer urine or ichor to pure water.
Meanwhile emaciation becomes manifest, the hair loses its gloss
and becomes rough, the skin becomes harsh and dry, rumina-
958 Osteomalacia.

tion is irregular or suppressed, the feces are thin, mushy and
foul smelling.

Klimmer & Schmidt observed the nervous disturbances
described in the chapter on rachitis in several instances in
such cattle herds in which osteomalacia was diagnosed (p. 942).

The bone disease causes pain so that the animals lie down,
dislike to rise, and move only when obliged to. On standing
they arch the back upward, stand with their feet spread apart,
trip restlessly here and there, lift one and the other foot and
groan while discharging urine or feces. The pains are often
intermittent, sometimes paroxysmal and change, similarly to

 

 

Fie. 168. Osleomalacia in a cow. Kmaciation; lordosis of the lumbar vertebrae:
the sagittal diameter of the pelvis is diminished (compare Fig. 165).

rheumatic pains, from one part of the body to another, becom-
ing often so severe that horses, for instance, roll on the ground.
The animals move carefully, their walk is stiff and a decided
lameness is evident in one or the other, sometimes in all four
feet. On walking, and also on rising, a peculiar cracking sound
is perceptible, probably owing to the loosening of the articular
capsules. In such cases the bones, still more the joints, the
vertebral column and the pelvis are sensitive to pressure. The
lower joints of the feet, also the tendon sheaths of the flexor
tendons, are frequently subject to inflammatory processes with
swelling of the respective parts of the body. According to
Liénaux the Achilles tendon is often loosened from its attach-
ment.

Meanwhile the solidity of the bones is lessened more and
 

Symptoms. 959

more so that they become bent or fractured on sudden motion,
especially on rising or lying down, sometimes even for appar-
ently very insignificant causes. The ribs and the transverse
processes of the lumbar vertebrae can at times he depressed
easily and even retain finger impressions. In goats the pliability
of the skull bones may reach such a high degree that the an-
terior portion of the inferior maxilla may be bent or turned
in an angle of 90° (Richter). Fractures occur most frequently
in the pelvic bones near the acetabulum, in the ribs, and in
the proximal long bones of the extremities, also, especially in
horses, not infrequently in the vertebral column. Multiple
fractures or bulgings are observed fairly often in the ribs and
on the pelvis. The fractures do not appear to cause much

Fig. 170.

 

Fig. 169.

 

4

 

 

 

 

  

 

Fig. 169. Osteomalacia in a cow, whose skeleton is illustrated in Fig. 165. Asym-
metry of the pelvis; bulging of the left hip; the posterior extremities are crossed.

Fig. 170, Osteomalacia. Bulging of facial bones in a horse. (After Moussu.)

pain, but they further diminish the power of motion which
has already been reduced by the spontaneous pain, because they
usually either heal not at all or imperfectly.

Deformities occur relatively most frequently in the bones
of the extremities, the ribs and the vertebral column. In the
later course of the disease, bulging of the skull bones (‘‘big
head’’) is observed exceptionally in cattle, frequently in horses,
960 Osteomalacia.

hogs and goats, sometimes also in dogs; these may also occur
in pelvic bones. The head appears much larger, the roof of
the mouth bulging into the oral cavity which therefore .becomes
smaller, or it becomes impossible to close the mouth so that
the appearance of maxillary paralysis is produced (Figs. 164
and 170). In such cases there is blood stasis in the tongue,
mastication is difficult or even impossible. The bulging of the
bones causes the nasal passages to become narrow, respiration
becomes difficult and accompanied by a sniffling or snoring
sound; even attacks of asphyxia may occur. The bulging bones
are elastic and easily depressed.

Moussu found the alkalinity of the blood diminished, the urinary phosphates
increased five-fold; Haubner & Siedamgrotzky, as well as Marcone, likewise dem-
onstrated a considerable increase in the phosphorus content of the urine.

The emaciation of the animals gradually increases. The
muscles become flabby and in some groups of muscles there
oceur at times fibrillary twitchings. With the severe pain in
some ‘bones there is associated a surprisingly high muscular
tension in the corresponding region (Siedamgrotzky, the au-
thors). The temperature is usually normal, but is raised to
40° C. during very severe pain, and also in case of extensive
decubitus-gangrene. The secretion of milk diminishes steadily
and finally ceases. On the dry skin an eczematous eruption
may develop. Finally the animals, which persistently lie pros-
trate, become totally exhausted and perish.

Course. Osteomalacia always takes a very chronic course.
Although the first symptoms usually do not become manifest
and the disease is recognized therefore only in a fairly advanced
stage, several months usually elapse from the time of its recog-
nition to that of complete exhaustion. Only the very rare cases
with severe nervous disturbances usually lead to death in a
short time. At times the disease may be arrested or there
may be improvement, but in such cases relapses may occur.
For the latter gestation, parturition and lactation are predis-
posing factors and rapidly progressive aggravations usually
oceur during such times. Sometimes the disease has been latent
for some time and becomes manifest only through such an
aggravation. With temporary improvements and relapses the
disease may thus extend over several years.

Diagnosis. As long as there are no signs of bony soften-
ing, the disease cannot be recognized positively in sporadic
cases. Licking disease may occur in the course of other affec-
tions, especially in gastric catarrh, while pain in the limbs is
observed also in muscular and articular rheumatism. In the
presence of these symptoms the suspicion of osteomalacia is
always well founded if the fodder is poor in lime salts. The
possibility of its existence must also be considered when milch
Diagnosis, Prognosis, Treatment. 961

cows become ill after repeated pregnancies. The licking disease
which occurs in the course of gastric catarrh is not continuous;
rheumatic affections, especially articular rheumatism, appear
in acute attacks with febrile symptoms, and affect usually the
higher joints of the feet, while callus formation is absent, es-
pecially on the ribs.—Actinomycosis of the facial bones is
differentiated by being mostly unilateral and limited in extent,
also by the fact that the other parts of the body are free from
disease. Rachitis is already excluded by the different age of
the animals. (According to Marcone a systematic quantitative
determination of the urinary phosphates may afford diagnostic
information, but must be made with reference to the quality
of the fodder.)

In regions where the disease is enzootic already the very
first symptoms give certain indications for a diagnosis, but
this becomes positive only when softening of the bones can
be demonstrated.

Prognosis, As long as extensive deformities or fractures
have not occurred, the animals are not too exhausted and an
appropriate regulation of their hygienic conditions can be
carried out, the symptoms may be expected to retrogress, but
under other conditions a gradual aggravation of the trouble
must be expected. When the animals can no longer rise or
when fractures or considerable deformities have occurred, im-
provement cannot be obtained by any treatment.

According to Krabbe 281 out of 3,240 sick cows, or 8.6%, were killed in Nor-
way in the year 1877 as incurable. According to Bongartz, the frequency of cures
is 20-25%, while Rudofsky observed about 16% of losses during an epizootic in
Moravia (1905).

Treatment. The removal of the affected animals into an-
other region with favorable conditions of soil can be carried:
out only in the rarest cases, although this procedure seems
‘adapted to secure healing of the disease in cases which have
not progressed too far. It is also only rarely possible to
arrange for a complete change in feeding; it will rather be
necessary to limit endeavors to a partial change of feed, in
which the daily amount of food-stuffs which in spite of un-
favorable conditions of soil contain comparatively much lime,
must be increased considerably (see p. 933). In this respect
the following must principally be considered: Clover hay, good
meadow hay, esparsette hay, bean-, pea-, lupine-, buckwheat-
straw, perhaps some waste from oil factories (see p. 933),
especially when there is a deficiency in phosphorus in the feed.
Green feed or pasturing on good pastures also influence the
course of the disease favorably, as has been observed in
the extra-European osteomalacia of equides (Grandmougin,
Sourrel). Pasturing has the disadvantage that the motor dis-
turbances increase at first, and that in some animals they only

Vol. 1—61
962 Osteomalacia.

then become evident, also that sometimes an increase in the
frequency of fractures is observed. The supply of hard drink-
ing water should also be considered, wherever the local condi-
tions permit it.

Lime salts should always be added to the food. Among
them the same preparations come first into consideration as
are used in rickets (see p. 947), but they must be given in
sufficiently larger doses; for instance, for large animals, accord-
ing to weight and employment, and to the probable lime con-
tent of the food, 30-80 to 100-200 gm.; for smaller ruminants
and hogs, 10-20 gm. in three portions with each feeding. If
there is no deficiency in phosphoric acid, chalk is efficient and
may be partially (1/3-2/3) replaced by calcium chlorate, which
corresponds to about two parts of chalk, or hydrochloric acid
may be given with the drinking water at the same time. In
coexisting phosphoric acid deficiency ‘‘opened’’ bone meal is
indicated and is, in accordance with Klimmer & Schmidt, given
suitably in alternation with the chalk, thus that the animals
receive for 2 or 3 days a calcium preparation and during the
next 2 or 3 days a preparation of phosphoric acid, for instance
sodium phosphate (tablespoonful 3 times daily). The other
preparations of lime (see p. 948) are less suitable. The
systematic administration of HCl or of NaCl is also indicated
in such cases in which calcium carbonate is not given. From
phosphorus (0.01-0.05 per day in oil) Klimmer & Schmidt saw
no results. If symptoms of licking disease appear, apomor-
phine hydrochlorate (0.10-0.20 gm. subcutaneously) is indicated
according to Lemke, who claims that after three doses the licking
disease will be relieved for 3 to 4 months (Hafner saw no im-
provement follow this treatment). In cachectic animals Klimmer
& Schmidt obtained transitory improvement in the general
condition by the administration of pilocarpine and caffeine.

The suggestion of Roloff not to milk the affected cows
empty and to exclude them from breeding during the duration
of the disease, deserves consideration if the economical condi-
tions permit it. Klimmer & Schmidt believe it more appropriate
to diminish the nitrogenous. food-stuffs in order to reduce milk
secretion, or to permit cows in advanced pregnancy to stand
dry for 6 to 8 weeks. Finally the extirpation of the ovaries
might be considered, especially if a proper regulation of the
diet is diffieult. Very ill animals should be killed as soon as
possible.

Prevention. Experience has shown that the disease can
be prevented by proper feeding, especially of the cows during
pregnancy and lactation, and by suitable cultivation of the soil.
Prophylactic measures merit particular consideration in regions
where osteomalacia is already enzootic; with appropriate fer-
tilization, especially after the use of fertilizers which contain
phosphorus, the disease usually becomes less prevalent in such
Licking Disease. 963

places. (A chemical analysis of the soil is always advisable
for the purpose of improving it deliberately.) If the feeding
of fodder poor in lime cannot be avoided, the animals should
eee receive lime preparations in the amounts indi-
cated.

If there is a suspicion of an infectious origin of the trouble, isolation
of the diseased animals and disinfection of the stable are required.

Literature. Basset, Ree., 1907. 167 (Lit.). — Collard, Bull. 1893. 431. —
Elliot, J. of Comp. Path., 1908. 206. — Grandmougin, Rev. gén., 1905, V. 500.
— Hoennicke, D. m. W., 1906. 116. — Immendorff, Fortschr. d. V.-Hyg., 1905.
11. — Ingle, J. of Comp. Path., 1907. 35. — Klimmer & Schmidt, Monh., 1906.
XVII. 481, (complete Lit.). — Liithje, A. f. exp. Path. u. Phmk., 1903. L. 268. —
Marcone, O. M., 1903. 481. — Martin, Rev. gén., 1905. V. 499, 501, — Pécaud,
Rev. gén., 1904, III. 1. — Richter, Z. f. Tm., 1909. XII. 394. — Rudofsky, O. M.,
1905. 193. — Schmidt, Ergeb. d. Path., 1897. IV. 531 (complete Lit.). — Sourrel,
Rev. gén., 1906. VII. 233. — Theiler, Monh., 1907. XVIII. 193 (Lit.). — (See, also,
literature on rachitis.

5. Licking Disease. Allotriophagia.
(Nagekrankhett. Lecksucht, [German].)

The licking disease consists in a morbid tendency, produced
by disturbances in metabolism, to lick, gnaw and devour various
objects, and carries in its train chronic digestive and nutritive
disturbances as well as nervous symptoms.

According to this definition the morbid perversions of taste which
are often observed in gastric catarrh, in rabies and in other diseases
are not classed with licking disease.

Occurrence. Licking disease occurs only in certain regions
and affects almost exclusively cattle, more particularly cows
and weaned calves or heifers. In the affected regions the dis-
ease is stationary in certain premises, but occurs enzootically
after failures of crops, causing considerable losses. The symp-
toms become manifest in winter and their intensity is the higher,
the longer the winter has lasted. The disease has not infre-
quently been observed in regions in which osteomalacia is prev-
alent (Roloff, Roll, Diem, Brauer, Hutyra & Marek).

In Germany the following parts of the country are visited by the disease:
the Saxonian Erzgebirge, the Bavarian Wald, the Western Allgau, the Badish
Black Forest, the Swabian Alp (Ostertag & Zuntz). More recently it occurred
with particular violence on the Johannisburg Heide (in Eastern Prussia), especially
in calves and heifers. This greater prevalence of the disease coincided in time
with the melioration of the peat fields.

In France cases of the affection are observed distributed fairly evenly througuout
the whole country (Moussu).

Etiology. Regarding the licking disease, which occurred
in the vicinity of Johannisburg, the investigations of Ostertag
and Zuntz showed that the causative factor is a food poison,
964. Licking Disease.

contained in peat hay and which is not known exactly. It occurs
in greater quantities in the hay of meliorated meadows than in
other meadow hay, is entirely absent in meadow plants before
they are in bloom, also in the hay of the first cut before bloom-
ing time and in the clover hay of meadows which are otherwise
dangerous. The second crop of hay is less dangerous than the
first. The poisonous substance is destroyed entirely or par-
tially by steaming, heating to 80° C. and during the preparation
of ‘‘brown hay.” It has no harmful effects on horses.

The presumable poison is present in the injurious hay in com-
paratively small amounts and therefore it produces gradually increasing
disturbances of metabolism through a cumulative action and only after
the hay has been fed for a long time. These disturbances cause a
defective formation of blood and bone tissue and eventually give rise
to a morbid tendency to gnaw and to lick. The elimination of Na, Ca
and of P is greater than the intake.

The chemical composition of Johannisburg peat meadow hay is
insufficient also in so far as the hay is poor in Na.and Ca salts and
rich in K salts. Although the quantity of the ashes was found in-
sufficient, the cause of the disease can, according to Ostertag and Zuntz,
not lie in a mineral deficiency of the fodder, because the addition of
NaCl, of calecium-, phosphorus- and iron-preparations to the hay did
not influence the toxic action and because this could be destroyed by
heating.

How far the results of Ostertag & Zuntz may be applied
to licking disease occurring in other places cannot be determined
at present. For those cases, indeed, in which licking disease
develops in connection with osteomalacia or simultaneously with
this disease, the same causes are probably active. It appears
that particularly the deficiency in nutritive salts is of essential
importance in this respect.

As other causes of the disease contagion, heredity, imitation, bad care, have
been mentioned.

From what has been said it is evident that a close relation
exists between licking disease and osteomalacia, since in both
diseases certain changes in the bones develop under the influ-
ence of disturbances of metabolism. The most important dif-
ference between the two is seemingly that licking disease occurs
apparently independently and leads to severe cachexia even
before manifest softening of the bones has developed. But since
in such cases the bones have not been examined microscopically,
the possibility cannot be excluded that changes corresponding
to osteomalacia are indeed present, only not in such a degree
that the softness of the bones could be determined by the coarser
methods of examination; and this is evident from the observa-
tions of Ostertag & Zuntz. It is thus thinkable that licking
disease actually owes its development to osteomalacia, but that
Etiology, Anatomical Changes, Symptoms. 965

in its course the debility progresses much more rapidly than
the pathological process in the bones.

Anatomical Changes. In far advanced stages of the dis-
ease there occur severe anemia and emaciation, with compu.ete
atrophy of the fatty tissue, muscular atrophy and atrophy of
glandular organs. Ostertag & Zuntz also demonstrated atrophy
and rarification of the compact bony tissue, with otherwise nor-
me chemical composition of the bones, also a brittleness of the
ribs.

Symptoms. At first the desire to eat is diminished, rumina-
tion is slow, defecation arrested. The aberrations in taste or
the peculiar characteristic phenomena appear only after these
symptoms, increasing gradually and assuming the form which
has been described in the chapter on osteomalacia (page 957).
Together with the lessened desire to eat, emaciation, timidity
and an increased sensibility become manifest in the animals.
Pregnant cows often abort during the disease. The symptoms
persist for 2-4 months, according to the severity of the disease,
lead gradually to cachexia and finally the animals die of starva-
tion.

Course and Prognosis. The affection always takes a
chronic course and extends over few to several months, some-
times even a year and more, during which time temporary
remissions in the symptoms may take place. If no change is
made in the hygienic conditions, fatal termination is the usual
outcome, but otherwise licking disease may be cured, except in
very severe cases with marked cachexia. :

Treatment. A positive result can be expected only from
pasturing, although the improvement will make only slow
progress. In several instances a favorable influence was
observed from a change of feed, the addition of linseed or
linseed cake, or feeding with slops, carrots, molasses (Klein-
paul) causing the symptoms to diminish. On the other hand,
Ostertag & Zuntz found the admixture of highly nutritious food-
stuffs or of nutritive salts to the injurious hay useless, and also
apomorphine, which, however, was employed by some veterina-
rians (Hackl, Reindl, Lemke) with lasting success, by Klein-
paul with only transitory benefit. The remedy was given hypo-
dermically ; to adult cattle and to calves in doses of 0.10-0.20 gm.
daily three times, for three days (Kleinpaul; to horses three
times daily with 3-day intervals (Hillebrand). (After the
injection calves must be put in a closed place in order to prevent
their injuring themselves, because apomorphine produces in
them a very decided excitement [Kleinpaul]).

If the disease is associated with osteomalacia, the treatment
described for this disease is indicated (page 961).
966 Wool Eating.

Prevention. If the disease has developed after feeding of
peat meadow hay, its occurrence may be prevented permanently,
according to Ostertag & Zuntz, by using the peat meadows for
pasturage, by ‘‘brown hay’’ in place of the ordinary hay, or by
sowing clover on the peat meadows. On the other hand, the
harm is only diminished if the hay is treated with scalding water
or if it is steamed; although animals may be carried through the
winter fairly well on hay treated in this manner. The poisonous
effect of the hay may also be reduced by fertilizing the meadows
with sodium nitrate. A further preventive measure consists in
feeding cattle in the affected regions only with second crop hay,
or with the first crop which has been cut before flowering.—
Brauer. and Lippold observed favorable effects from draining
the pastures.

Literature. Berndt, P. Vb., 1902. II. 30. —- Brauer, S. B., 1885. 63; 1890.
80; 1893. 121. — Hillebrand, W. f. Tk., 1906. 367. — Kleinpaul, B. t. W., 1903. 1. —
Leibenger, W. f. Tk., 1906. 542. — Lemke, D. Z. f. Tm., 1882. VIII. 102, —
Lippold, 8. B., 1890, 80. — Ostertag & Zuntz, Z. f. Infkr., 1907. II. 409. — Weigel,
S. B., 1893. 121.

6. Wool Eating.

Occurrence. Wool eating is observed in the finer breeds of
sheep only during wintering, especially toward the end of winter,
and causes considerable losses in wool, sometimes even death
owing to the formation of hair balls in the stomach.

Etiology. Apparently wool eating is often only a bad habit
which is possibly formed in consequence of the tedium of the
young animals when they are constantly kept in the stable,
and may be assumed to spread by imitation. It is, however,
very probable that in certain cases insufficient feeding or an
unsuitable chemical composition of the fodder, especially a
deficiency in nutritive minerals is a factor.

Symptoms. Ina drove of sheep a few lambs begin, usually
already in early winter, but mostly not until later, to gnaw the
wool of their mothers, preferably on the thighs, on the abdomen
and the tail, that is principally on those parts of the body which
are soiled with urine or feces. More and more of the lambs
follow the example, and eventually not only their own mothers,
but other sheep as well are attacked, the lambs gnawing at them
together. Among yearlings or older sheep also, one or at most
a few animals begin to gnaw the wool of another one, but pres-
ently more and more animals acquire this vicious habit. <At first
the gnawing sheep attack the same animal, choosing a new
victim only when they have eaten all the wool off the first one.
In this manner the evil assumes a constantly increasing exten-
sion, until finally all sheep have acquired the habit and the wool
eating has become general in the drove.
Symptoms, Diagnosis, Treatment. 967

Usually the animals appear to be in good health, only of the
lambs a few perish, exceptionally many (Moussu, Richard),
because wool balls have formed in a compartment of the stomach
and occlude the openings of some of the compartments or the
lumen of the intestine. In older sheep at most slight nutritional
disturbances are observed, although in exceptional cases symp-
toms of anemia and emaciation may occur.

Diagnosis. The fact that wool eating is indulged in pref-
erably, and at first exclusively, in day time and in the intervals
between feeding, and also the fact that the animals gnaw only
the wool of their fellows, never their own, is sufficient to dis-
tinguish this vice from other diseases which are accompanied
with itching and also from trembling disease.

Treatment. The habit can usually be removed by isolating
the wool eaters as well as their victims. It is advisable, even in
winter, to turn the animals out of doors for a certain time
during the day, when the weather conditions permit it; more-
over it is necessary to provide proper food and a sufficient min-
eral content of the food. If the ewes give little milk, the lambs
should receive cow’s milk to make up the deficiency. Lemke
obtained excellent results from the subcutaneous administration
of apomorphine hydrochloride (0.1-0.2 grn., a dose for three
days).

_ Literature. Kérte, Tierzucht; 1892. 218. — Lemke, D. Z. f. Tm., 1882.
VIII. 102.

 

Feather Eating and Feather Pulling in Birds. This vice is ob-
served most frequently in caged birds, especially in parrots and canaries,
but not infrequently also in domestic fowls, especially in chickens.

The causes of feather eating are probably various. Klee considers
as the most frequent cause the deficiency in certain nutritive substances
in the body, which is due to one-sided feeding of animals which are at
the same time confined permanently in narrow quarters, so that they
have no opportunity of picking up insects and worms, chalk or greens.
Other authors take feather eating to be mainly a bad habit originating
in play or in tedium, when the animals have but little opportunity
to move about in the open air, and although their food is unobjec-
tionable. Feather eating may also develop in consequence of itching
skin diseases and owing to the itching sensation when the young feathers
break through during moulting (Klee). In this manner the feather
eating which occurs, although rarely, in well-kept fowls may be ex-

plained.

Symptoms. In feather pulling the animals pull out either their
own feathers or those of their fellows. Among chickens the most
beautiful and valuable laying hens often first acquire this bad habit.
At first only occasionally isolated feathers are pulled out, but later
even the newly growing feathers are torn out so that the body becomes
disfigured by the bald spots which are produced,
968 Gout.

Feather eating differs from falling out of feathers in various skin
diseases or in nutritive disturbances, in that in the latter feathers are
never pulled out.

The treatment is adjusted to the cause. In most cases a change
of food and, when the weather permits, the opportunity for sufficient
exercise in the open air are indicated. Klee and others saw good
results from the administration of the blood of slaughtered animals,
which was cooked and mixed with bran or curds. In addition the
animals should receive green feed or cooked carrots, also chalk
(powdered egg-shells, burned shells, bone meal). In general the.
principal stress should be laid upon as much variety as possible in
feeding. Parrots, which are freed only with difficulty from the vice
may be given sepia or bitter chocolate. If there is itching, daily
sprinkling with water or with a 5% solution of thiol may be effective.

The feather eaters should be kept isolated and if possible in a
dark place. Sometimes apomorphine hydrochloride is useful, injected
subcutaneously in doses of 0.0005-0.001 gm. or in drinking water
0.05:100 (Friedberger & Froéhner, Klee). Inunctions with remedies
having a disagreeable odor or taste (tincture of aloes, veratrum,
asafetida, gentian, rancid animal oil, carbolic acid) do not accomplish
the purpose and may in fact be injurious.

7. Gout.
(Gicht, [German] ; Goutte, [French] ; Gotta [Italian].)

Gout depends upon the storage and deposition of urates
in the tissues of the internal organs (visceral gout), or at the
same time also in the joints (arthritis urica) and is based upon
disturbances in metabolism.

Occurrence. Gout is, almost without exception, observed
only in birds, in, which it is of rather frequent occurrence.
Among domestic fowls chickens are, according to Klee, affected
with preference, less so water fowl, and most rarely pigeons.
(Hartenstein observed visceral gout enzootically in a large
goose establishment, but described it under the name of uremia.)
Pheasants are affected not infrequently. But the disease is
met with most often in the birds of prey of the zoological gar-
dens, less often in ostriches. It develops only rarely in birds
kept in the house, and birds living at large do not appear to
become affected at all. Among mammals only a few cases were
observed so far in older dogs (Spinola, Bruckmiiller), although
Vogt claims to have seen a gouty affection also in a horse.
Finally the disease has been noted in reptiles (alligator, snakes)
(Kitt). Virchow and Mendelsohn recorded deposits of guanin
in the joints in two hogs. Pflug found a guanin deposit in a
ham. Ina cow which during life had shown poor appetite, ineffi-
cient nutrition and frequent epistaxis, Joest demonstrated
deposits of xanthin in the spleen, the lymph glands and the
kidneys,
Etiology, Pathogenesis. 969

Etiology. Without a doubt gout stands in close relation to
the diet, since it develops preferably on generous feeding with
substances containing much albumin, especially nucleoproteids.
Such substances are especially the thymus glands, the liver,
kidneys, brain, pancreas, and the flesh of animals in general
which, although poor in nuclei, yet contains much hypoxanthin;
young germinating plants also contain much of nucleoproteids
(Kionka and Bannes produced typical gout in birds by feed-
ing them for weeks and months exclusively on horseflesh). That
certain chemical substances have an etiological importance is
indicated by the experience that in man the disease may occur
in connection with chronic lead poisoning, and v. Kossa pointed
out the gout producing action, upon chickens, of chromic acid,
oxalic acid, carbolic acid, corrosive sublimate, cane sugar, aloine
and acetone. According to earlier observations smut fungi
(Ustilago maidis) also are said to be capable of causing gout
in birds. Finally the disease probably develops in birds in
certain cases in connection with disease of the kidneys or ure-
ters, for Ebstein and others succeeded in producing gout artifi-
cially in birds by ligating the ureters, and v. Kossa proved
in cases of toxic gout that nephritis must be considered as a
cause for the deposition of urates in the tissues.

Favoring factors are want of exercise or confinement of
the animals. Of birds, especially the more carefully bred and
kept large breeds are inclined to the disease (cochin-china,
brahma), then adult and especially older animals. Male animals
are affected more frequently than females. Lastly it appears
that individual peculiarities are of essential importance for the
predisposition.

Pathogenesis. The mode of development of gout is at
present not entirely cleared up. This much may be concluded
from investigations or animal experiments that have been made
that, under the influence of the enumerated causative factors,
an increased production of uric acid occurs, and also a toxic
nephritis, the latter either under the influence of the eliminated
toxins or also in consequence of the excess in uric acid. The
increased formation of uric acid, together with the inhibition
(owing to the existing nephritis) of the elimination of urates,
lead to a storing of urates in the blood (Benion, Kionka, v.
Kossa) and under certain conditions to the deposit of urates
in the tissues. According to Brugsch & Schittenhelm, the ulti-
mate cause of gout may, however, lie in a deficient transforma-
tion of the purin bases which are formed from the nucleo-
proteids (first of all of the hypoxanthin) into uric acid, and in
retarded combustion of the uric acid. owing to the absence of
certain ferments.

According to Ebstein the urates which are eliminated from the blood produee

necrotic foci in the tissues, especially in places where the circulation is very slow,
and are only later deposited in the necrotic tissue in the form of erystals. Around
970 Gout.

these foci a secondary inflammatory reaction occurs with emigration of white
blood cells. Almagia found that cartilage tissue of itself decidedly attracts uric
acid.

In disturbances of the renal function from other causes, or
in a mechanical impediment to the flow of urine, the storage and
deposition of urates occurs even without a previous increase in
the formation of uric acid.

The source of the uric acid are the albumins of the body, both those ingested
with the food and those that have disintegrated; in mammalians the nuclein bases
are here especially concerned, in birds all albuminous substances. The uric acid
content of the blood is therefore probably increased for the reason that the animal
ingests an excess of albuminous substances. The fact that among domestic animals
birds which even normally eliminate very much urie acid are affected almost
exclusively, indicates the predisposing influence of the presence of uri¢ acid in
large amounts. Nothing positive is known about the cause for the elimination
of the urates of sodium and calcium which are in solution in the blood. The fact
that the serous membranes and often the joints of the extremities are usually
affected, might in part stand in relation to their being constantly subjected to
mechanical irritation, and to the very slow blood circulation in the joints as well
as in the serous cavities, although it might also be the consequence of some metabolic
disturbance of these parts of the body.

Anatomical Changes. In visceral gout, which is by far the
more frequent form, the serous membranes of the thorax and the
abdominal cavities, especially the pleure or the peritoneum, the
membranes of the air sacs, the pericardium, also the surface of
the heart, and the liver are covered more or less densely with
masses that are dust-like or chalky, and mortar-like; the kidneys
are dotted white and the ureters are sometimes filled with white
plugs.

' Articular gout, which is much less frequent, affects prefer-
ably the articulations of the feet, less often also those of the
wings, leading to swelling of the involved joints, in and around
which white chalky swellings or deposits are seen which are
like peas to cherries in size. Similar foci are also found in the
adjoining bone tissue and bone marrow, in the articular liga-
ments and tendons, less often in the cartilages of the larynx,
in the vessel walls or under the skin.

In the chalky masses great numbers of crystals which consist of sodium
urate are seen under the microscope, especially after the addition of some acid.
These crystals may sometimes be demonstrated also in organs which present no
microscopic changes.

Symptoms. In articular gout the joints that are affected
most frequently are the metatarsal, tarsal and phalangeal
joints, and on the wings the elbow joints. There is at first
aching, the affected animals moving about only unwillingly and
going lame; they remain in one place or stand on one foot in
order to ease the pain. If the wings are affected these are kept
as quiet as possible, and when the animals are disturbed they
flap at most a few times with their wings. At the same time the
joints swell (Fig. 171), and while the swellings which are soft

_and sensitive are at first not sharply circumscribed, later on
isolated nodes (tophi s. Noduli arthritici) are more and more

/
Symptoms. 971

sharply demarcated from the surrounding tissue and form firm,
not very painful, tumors which are closely united to the carti-
lage, less often freely movable upon it. The nodular swellings
are as a rule of from hempseed to lentil size but may, in excep-
tional cases and in the larger birds, become as large as pigeon
eggs. The development of such thickenings on several joints
causes very striking deformities. The toes are spread apart by
nodes in their joints, are bent toward the soles and thus
apparently shortened.

The motility of the affected joints becomes limited more
and more and may develop into complete ankylosis. Sometimes
softening occurs
later in some joints,
the skin over the
softened places be-
coming thinner and
finally necrotic;
through the result-
ing opening a soft,
erumbly, yellow-
gray substance, like
gypsum, is dis-
charged. The bor-
ders of the ulcers |
which form in this
manner are irregu-
lar and bleed easily;
their base is formed
by cartilage or by
exposed bone tissue,
or the probe may Fig. 171. Articular gout in a hen. (After Kionxka.-)
even enter an
opened joint. These ulcers may form in succession and become
confluent.

Smaller hard nodes are sometimes found in the tendons,
skin and subcutis, and may even surround the base of the quills.

With the further progress of the disease more joints are
constantly involved, and the nutrition of the animals is inter-
fered with. The feather coat becomes rough, some feathers
fall out, the comb and wattles become pale, the animals are
finally hardly able to move from place to place, and perish of
exhaustion and emaciation.

 

In dogs nodular thickenings were observed on the lower articula-
tions of the feet and on the lower ends of the ribs.

In the supposed gout of a horse Voigt noted painful swellings
on the bones of the extremities near the joints, and lameness. Various
parts of the extremities were affected alternately, giving rise to
paroxysms. The appetite was diminished and the urine contained
uric acid crystals. The disease terminated in recovery in the course

of a year.
972 Gout.

Visceral gout is, in its ordinary course, manifested by sim-
ilar nutritive disturbances as the articular variety; but unless
the joints are likewise affected, the actual cause of the disturb-
ances cannot be recognized during life.

Course and Prognosis. The course of gout is almost with-
out exception chronic, only Hartenstein observed the disease in
an acute form in geese. In most cases only one extremity is
affected at first, and other joints not for several months, usually
the corresponding joints on the other side; in the meantime the
acute signs in the joint that was first affected have diminished,
and the general condition of the patient has improved. The
involvement of other joints is usually introduced by acute
symptoms which, however, later go down.

The prognosis is unfavorable, since complete healing is
rarely observed. This may be looked for at most in domestic
fowl that live in the open; in birds kept in captivity the disease
progresses steadily and leads the sooner to complete exhaustion.

Diagnosis. For the positive determination of gout in the
living animal the microscopical or chemical demonstration of
uric acid or of urates is absolutely necessary.

For the microscopical examination the material to be examined is rubbed
up on a glass slide with pure or slightly acidulated water, after which the crystals
of sodium urate are recognized as very fine needles which form sheaf-like groups
or radiating balls. The chemical test for uric acid is properly made with the
Murexid-reaction. The secretion is mixed in a porcelain dish with a few drops
of concentrated nitric acid and is warmed slowly until the mass is dried; if ammoniac
is added to the onion red residue after this has become cold, it assumes a purple
color, while the addition of sodium hydrate produces a violet coloration which
disappears on heating.

Tuberculosis of fowls or the chronic forms of fowl] cholera
may cause similar changes in the joints, and if other indications
of these diseases are absent, or if no information is afforded
by outside conditions, the exact nature of the disease can be
determined only by the microscopical or chemical examination
of the secretion. Purulent arthritis and periarthritis, and also
articular rheumatism are differentiated, at least in a part of the
cases by a more chronic course.

Treatment. The diet of the sick animals should be reg-
ulated in such a manner that they receive only limited rations
of nitrogenous substances, especially such as are rich in purin
bases or nucleoproteids. Alkaline salts (sodium bicarbonate,
Carlsbad salt, etc.) may be added to the drinking water. The
patients should be enabled to exercise freely, especially in
pure dry air, a desideratum which is usually not feasible in
captive birds. Experiments in birds having permitted the
conclusion that the deposit of urates is prevented when piper-
azine is present in the blood, this remedy might be tried in the
Symptoms, 973

sick animals (chickens 0.5-1.0 gm., pigeons 0.40-0.50 gm. daily,
broken up in frequently repeated doses and administered for 4-5
days). Human physicians observed in acute gout analgesic
effect from tincture of colchicum, and this remedy might also
be tried in the articular gout of birds (2-5 drops).

If symptoms of acute inflammation are present, the affected
joints are wrapped in salicylated cotton, which may previously
be dipped in alcohol or carbolic acid. Later on the operative
removal of the well cireumscribed nodes may be attempted, espe-
cially of those in the skin and in the subcutaneous connective
tissue, or the softened nodes may be opened and curetted, after
which the opened joints are irrigated with a weak disinfectant
solution.

It will be best to fatten and kill animals, which are intended
for the table, immediately on the appearance of even moderately
severe symptoms.

Literature. Bannes, vet. Jhb., 1901. 251. — Blanchard, ibid., 1891. 190. —
Friedberger, W. f. Tk., 1879. 38. — Hartenstein, Vet. Jhb., 1899. 237. — Hébrant
& Antoine, Ann., 1909. 321. — Johne, 8. B., 1877. 89; 1879. 39; 1881. 66. —
Kionka, A. f. exp. Path. u. Phmk., 1900. XLIV. 207. — Kitt, Monh., 1893. IV.
497. — Klee, Gefliigelkrkh., 1905. 51. — Kossa, K6zl., 1899. IIT. 65; 1907. VII.
101. — Pflug, Mag., 1871. 197. — Siedamgrotzky, S. B., 1872. 89. — Vogt, D.
t. W., 1906. 357.

9. Scurvy. Scorbutus.

Scurvy is a peculiar form of the hemorrhagic diathesis
which is manifested by bleeding and ulceration of the gums, also
by hemorrhages in the most various organs of the animals and
which, in severe cases, causes debility.

History. In former times all diseases, in which the tendency to
hemorrhage predominated in the clinical picture, were designated
generally as scurvy, but more recently the large group of hemorrhagic
diatheses was divided into several independent clinical pictures and,
in addition to scurvy, Barlow’s disease (p. 949), purpura, petechial
disease, Werlhof’s disease and hemophilia are differentiated. It is not
possible to draw sharp distinctions between these diseases and, indeed,
several investigators consider scurvy, Barlow’s disease and Morbus
maculosus Werlhofii only as different manifestations of the same
affection.

Scurvy in man has become known especially since the great wars
of the middle ages and since the sailing trips around the world, and
at that time it caused occasionally great losses. When the hygienic
conditions improved, the number of cases diminished steadily, and
at present only sporadic cases are met with, at least in western and
central Europe. Veterinarians also paid at first little attention to
the differences between the various representatives of the hemorrhagic
diathesis, and in consequence cases of purpura, especially in cattle,
hogs and dogs, or cases of ulcerative stomatitis in lambs have often
been described as scurvy. Some clinical descriptions by Spinola,
Siedamgrotzky, Pringle, Arnous and others suggest that scurvy does
974 Seurvy.

occur among domestic animals, especially dogs, although the disease
only rarely reaches its complete development. According to the ob-
servations of Weber, Schupp and Wolf, the scurvy of hogs does not
really correspond with the actual scurvy, but rather with purpura.

Etiology. In the occurrence of scurvy in hogs the benign
urticaria appears to be of essential importance. Weber noted
the disease in about 5% of all pigs, from 3-6 months old, which
he examined, almost all of which had passed through an attack
of benign urticaria about four weeks previously, probably after
an infection with erysipelas bacilli, and also in the cases of
chronic erysipelas of hogs which have been described by Cor-
nevin, Hess and Hisenmann. Predisposing factors are excessive
attempts at improving the species, one-sided feeding especially
with spoiled fodder, bad hygienic conditions, such as confine-
ment in damp, badly ventilated, dirty stables, insufficient exer-
cise; a severe and damp climate also seems to be of importance.

In dogs the disease develops occasionally after continued
feeding with spoiled food-stuffs, especially spoiled meat.

It is thus probable that the disease of domestic animals
described as scurvy has a toxic-infectious origin.

Anatomical Changes. Punctiform or striated, or then, more
extensive hemorrhages are particularly noticeable in the skin,
the subcutaneous and even the intramuscular connective tissue,
in the mucous and serous membranes, in the joints, within the
skull, ete., while the gums show destructive ulceration. The
parenchymatous organs show evidences of fatty degeneration.
The spleen is often much enlarged and softened. The lymph
nodes, especially of the mesentery, are swollen and hyperemic.
The blood is not infrequently pale red and thin fluid.

Symptoms. In hogs the disease commences in some cases
with the signs of gradually progressing anemia and emaciation,
the animals being less lively, moving reluctantly, eating but little
while they drink much water. In other cases the trouble begins,
without any preliminary symptoms, with bleeding (Weber). In
the skin there appear hemorrhagic spots which may be as large
as a one-cent piece and which become more and more numerous,
so that at the height of the disease the animals look as though
sprinkled with blood. Extensive hemorrhages occur in the skin
and subcutis of the ear, even on slight external causes such as
taking hold of the ears of the animals. The bristles become
loose and are easily torn out, the root-ends being surrounded
by a drop of blackish blood (bristle-red). This symptom seems
to occur less frequently or not at all in the improved breeds of
pigs with fine hair; for instance, it was absent in the cases
observed by Weber and Schupp. In the further course the
bluish-red hemorrhagic spots in the skin may change into nodes,
vesicles and even ulcers. Simultaneously with the changes in
the skin hemorrhages occur also in the mucous membranes,
Symptoms, Diagnosis, Prognosis. 975

although a special involvement of the gums cannot be ascer-
tained. The gums show macular reddening and swelling, they
bleed easily and finally ulcers form upon them. In consequence
the teeth become loosened, they fall out easily and a carrion
smell comes from the mouth of the animals. Weber and Schupp
usually noted hemorrhages also in other mucous membranes, for
instance in the orbital cavity, the eye ball being forced outward,
epistaxis, severe dyspnea due to hemorrhage in the air passages
or in the lungs, also bloody discharges from the intestines and
bloody urine. In very severe cases the joints may be swollen.

In this stage of the disease the animals are languid, those
portions of the skin which are free from hemorrhages are pale,
emaciation and debility progress rapidly and finally lead to
death. Usually, however, the animals are killed earlier or die
shortly after the appearance of the first manifest symptoms,
in consequence of severe hemorrhage in lungs or intestines.

In the cases of scurvy which have hitherto been observed
in dogs the disease commenced with symptoms of anemia, to
which the changes in the gums, and hemorrhages were added
later on. The gums are discolored bluish-red in the region
of the incisors, and soon afterward around the molars; they
become swollen, sensitive and bleed easily even on the lightest
touch and during the mastication of coarse food (kernels, bones).

Later on the mucous membrane becomes necrotic, and
gradually the picture of ulcerative stomatitis (Vol. II) develops.
Hemorrhages occur also in the conjunctivae and in the skin,
less frequent are epistaxis, intestinal hemorrhages, vomiting
of blood, bloody urine, and in exceptional cases hemorrhages
may occur in the anterior chamber of the eye and in the retina
(Frohner). Sometimes isolated joints are swollen. Death is
due either to exhaustion or to severe loss of blood, or then to
some complication (general septic infection, pneumonia).

Diagnosis. Ulcerative stomatitis of dogs differs from
scurvy in its strict localization, the absence of hemorrhages,
and also by the fact that it is not associated with cachectic symp-
toms until after the disease has lasted a very long time. In
*~Purpura (Werlhof) the changes in the gums are absent, es-
pecially the loosening, necrosis and ulcerative destruction of
the gums.

Prognosis. In the incipient stage of the disease the prog-
nosis is rather favorable, provided the harmful influences can
be removed. If, however, the symptoms of ulcerous stomatitis
and hemorrhages have developed healing can no longer be
expected.

Treatment. Scurvy can be prevented almost certainly by
suitable feeding of the animals if care is also taken to insure
976 Scurvy.

fresh air and sufficient exercise in the open. In the treatment
of scorbutic animals the best possible results are also obtained
by appropriate regulation of the diet. Hogs are best fed with
grain with which acid or bitter substances may be mixed, such
as acorns, horse chestnuts, calamus or gentialtroot, powdered
oak bark, etc.;-for dogs good fresh meat, bouillon and milk
are better adapted. In severe anemia it is proper to administer
preparations of iron (p. 851) and bitter remedies, to dogs also
wine and alcohol as well as the customary bitter tinctures. The
disease of the mouth demands local treatment.

The sick animals should be isolated and their stables dis-
infected.

Literature. Arnous, Monh., 1892. III. 193. — Gundelach, B. t. W., 1907.
490. — Hébrant, Ann., 1903. 597. — Siedamgrotzky, 8. B., 1878. 14. — Siedamgrotzky
& Hofmeister, ibid., 1878. 121. — Weber, D. t. W., 1909. 297. — Wolf, Der Skorbut
d. Schweines, Diss. Leipzig 1909 (Lit.).
Diseases of the Urinary Organs

Section I.
DISEASES OF THE KIDNEYS.

1. Albuminuria.

Etiology. Albuminuria is observed principally in those
diseases of the kidneys in which the glomeruli or the epithelial
cells are affected; affections of the epithelia of the tubuli
uriniferi may also lead to albuminuria by causing the serum
albumin of the surrounding tissues to pass into the lumen of
the tubules. Albuminuria represents therefore an almost con-
stant symptom of inflammatory and degenerative processes in
the kidneys.

In like manner other nutritional disturbances of the
glomerular epithelia may cause albuminuria; disturbances in
the circulation of the blood and also changes in the composition
of the blood in the various blood diseases aet in this manner.

The immediate cause of the albuminuria which occurs in
connection with skin diseases, with certain diseases of the ner-
vous system (cerebral hemorrhage, inflammation of the spinal
cord, convulsions) and with some very painful affections, has
not yet been determined definitely. Possibly the cause lies in
disturbances in the innervation of the renal vessels and in the
nutritive disturbances in the epithelial cells which occur in
consequence.

The glomeruli retain only serum albumen, while sther albuminous substances,
e. g., egg albumen injected directly into the blood or hemoglobin liberated through
the destruction of red blood cells, easily pass into the urine.

Traces of albumen are sometimes found in the urine of healthy individuals
(physiological albuminuria) ; in man especially after generous meals, severe muscular
exertion, sexual excitement, copious perspiration, in depressed conditions of the
mind and during pregnancy. Simader examined the urine of several hundred
healthy animals by Posner’s method, and found that minute quantities of albumen
form a normal constituent of animal urine, and that even a fairly considerable
quantity of urine, up to 0.01-0.03% in the urine of dogs and hogs, less in the urine
of ruminants and very rarely in that of horses is devoid of any pathological
significance. The albumen which occurs under normal conditions in the urine
seems, however, to be mostly nucleo-albumen and mucin. Fettick has shown that
in the dialyzed urine of healthy animals acetic acid does not cause cloudiness,

Vol. 1—62 977
978 Albuminuria.

so that an existing precipitate has not been formed by serum albumen, but by.
another substance which is as yet unknown. Henn also doubts the occurrence
of serum albumen in the urine of healthy animals.

Except in the true or renal albuminuria, albuminous sub-
stances also occur in the urine when blood serum, blood, pus,
etc., is mixed with the urine somewhere in the urinary passages
after it has left the renal tissue, or derived from the genitals
(vagina, prostata). This constitutes spurious albuminuria.

Diagnosis. The recognition of albuminuria depends upon
the chemical demonstration of albuminous substances in the
urine; but since albuminuria is only a symptom of several dis-
eases, clinical examination must discover also the underlying
organic disease.

Demonstration of the Albumens which are Preformed in the Blood. (Serum
albumen and serum globulin.) For this Heller’s ring-test.is especially adapted
and as small an amount as 0.02% of albumen can easily be demonstrated with it
(Hammarsten); it is made as follows: A small amount of the urine, which has
previously been filtered, is carefully poured into a test tube containing concentrated
nitric acid, so that it ‘‘over-lies’’ the acid. At the point of contact of the two
liquids a sharply defined white ring forms, the depth of which varies according to
the amount of albumen present.

For the boiling test a few cubic centimeters of urine are heated to boiling
in the test tube and are then acidulated by the addition of 5 to 10 drops of
concentrated nitric acid. A precipitate which has been produced by earthy phos-
phates or carbonates will then dissolve, but one due to coagulated albumen persists.

The acetic acid-ferrocyanide of potassium test is made thus that up to about
2% of acetic acid is added to the urine and then a 5% solution of ferrocyanide
of potassium, the latter drop by drop and avoiding an excess. If albumen is
present a decided turbidity or a flocculent precipitate appears. This test may be
made like Heller’s test, a mixture containing a few cubic centimeters of dilute-
acetic acid and a few drops of ferrocyanide of potassium solution being made
to over-lie the urine.

Spiegler’s test seems to be particularly sensitive and is said to be exact
for a minimum of 1:350,000. A test tube is filled one-half with a mixture containing
8 parts of mercuric bichloride, 4 parts of tartaric acid, 20 parts of glycerin and
300 parts of water; the urine is then allowed to run down the wall of the test
tube drop by drop, when a white ring is formed at the point of contact. _

In the salicylic sulfonic acid test of Roch a few crystals of salicylic sulfonic
acid are added to a few cubic centimeters of urine, when turbidity results.

The Metaphosphorie acid test after Hindenlang is made by adding an aqueous
solution of metaphosphoriec acid to the urine; the result is opalescence or cloudiness.

Esbach’s reagent, prepared by Merck in tablet form, is also adapted for
practical purposes.

In the trichloracetic acid test after Raabe a small crystal of trichloracetic
acid is added to a cubic centimeter of urine; at the point of contact a sharply
defined turbid zone occurs. .

Henn recommends the following tests for albumen: the boiling test, the
acetic acid ferrocyanide of potassium test, the metaphosphoric acid test (for dog
urine), the salicyl-sulfonie acid test (for horse and cattle urine), the trichloracetic
acid test (for horse and cattle urine), Spiegler’s test (for cattle urine).

For the quantitative determination of albumen Esbach’s albuminometer is
adapted for the requirements of practice. Acidulated urine is poured in to the
sign U, the reagent up to R (1 part of picric acid, 2 parts of citric acid, and
100 parts of water); the tube is closed with a rubber stopper and slowly turned
over severa] times without shaking; after standing at room temperature for 24
hours, the precipitate has settled and may be read off. The figure indicates the
proportion of albumen per mille. Urine which contains very much albumen must
first be diluted with water and the indicated figure must then be multiplied with
the figure of the dilution.

Tf serum albumen has been demonstrated in the urine with
the customary chemical tests, it remains to be determined
Diagnosis, Treatment. 979

whether the albumen is derived from the kidneys (albuminuria
vera) or from the urinary passages or from the near-by genitalia
(albuminuria spuria). If the urinary sediment contains no
organic form elements, and if the presence of dissolved blood
coloring matter may be excluded, if further the organic sediment
consists exclusively of form elements which are derived from
the kidneys it ean only be a question of renal albuminuria. On
the other hand, in the presence of copious organic sediment a
small quantity of albumen (less than 1%) speaks against renal
albuminuria. If the urine contains, in addition to pus cells,
also epithelia from the urinary passages or, in addition to red
blood corpuscles, comparatively much (several per cent of)
albumen, the indications point not only to a spurious albu-
minuria, but it may be inferred that the urine contains albumen
on leaving the kidneys. (In the presence of pus cells, at least
50,000 pus cells in a cubic centimeter of urine correspond to
an albumen content of 1:1000 [Goldberg].)

Significance of Albuminuria. The importance of albumin-
uria lies in the fact that a portion of the albuminous substances
which circulate in the tissue fluids of the body leave it unused,
which necessarily leads to disturbances in nutrition. Accord-
ingly a persistent albuminuria leads of itself to a gradual weak-
ening of the organism. In a given case the amount of albumen
present and the duration of the albuminuria are of importance,
aside from the basic disease.

Treatment, . As albuminuria is only a symptom of several
different diseases, the treatment must be adapted to the under-

lying pathological condition.

Literature. Fettick, Z. f. Tm., 1899. III. 329 (Lit.). — Goldberg, Chl. f.
med. Wissensch., 1893. 36. — Henn, Die Albuminurie, etc. Diss. Giessen 1909 (Lit.).
— Rievel, D. t. W., 1901. 151. — Senator, Albuminurie, 1882.

2. Hematuria.

Etiology. Blood or red blood corpuscles may become mixed
with the urine either in the kidneys already or only in the
urinary passages, and they may also get. into the urine from
the contiguous genital organs. Hematuria presupposes some
disease of the blood vessels in the kidneys or in the urinary pas-
sages, which makes it possible for the red blood cells to extrava-
sate by diapedesis or by rhexis. Thus renal hemorrhage may
occur in consequence of certain forms of acute, less often of
chronic renal inflammation, after injury to the kidney, in sévere
blood stasis, after rupture of the renal artery if this shows
an aneurismal dilatation (Liebetanz, Voltz, Hackbarth), also
in acute infectious diseases (purpura, anthrax, swine plague,
hog cholera, ete.), and likewise in hemophilia and in cachectic
980 Hematuria.

conditions in general. Of the diseases of the urinary passages
preferably the injuries produced by calculi or by parasites
(Eustrongylus gigas) and deep-seated inflammations, also cer-
tain new-formations, e. g., angiomata (Schmidt) or papillomata
may give rise to hemorrhages.

Of special importance is the so called hematuria of cattle (‘‘Weiderot?’=
pasture-red) which is, however, a hemoglobinuria produced by piroplasmas (p. 764)
and as such is not included in hematuria proper..

Symptoms. The urine is colored more or less red, some-
times contains coagula and, in contrast to urine which contains
only blood coloring matter in solution, the sediment is light
or dark red and red blood corpuscles may be found in it. In
all forms of hematuria the urine contains-as a rule hemoglobin
in solution, in addition to red blood corpuscles, owing to the
destructive action of the urinary constituents upon the blood
corpuscles. There usually also exist signs:of the underlying
disease, and after severe loss of blood the clinical picture of
acute or chronic anemia develops.

Diagnosis. Hematuria is recognized with certainty only
by the demonstration of coagula, of blood-red sediment or of
red blood corpuscles in the urine. Except in the paralytic
hemoglobinemia of horses, in which motor disturbances are
noticeable from the beginning, jaundice usually occurs in hemo-
globinuria. In piroplasmosis ticks are found on the body of
the animals and piroplasmas may be seen in suitably stained
blood specimens. Epizootic occurrence of the cases suggests
piroplasmosis as the most probable diagnosis.

The clinical investigation must determine whether the
blood has been added to the urine in the kidneys, the urinary
passages or outside of the latter. In renal hemorrhage there
are usually also form elements (epithelial cells, casts) which
come from the kidneys; by means of palpation it may be possible
to demonstrate some anomaly in the kidneys and the red blood
cells are sometimes disintegrated (Gumprecht); in profuse
hemorrhages from the kidneys or from the renal pelvis the
blood coagulates in the ureters in the shape of thick cylindrical
formations which are discharged with the urine (Ostermann.
Author’s case). In hemorrhage into the urinary passages the
urine frequently contains irregularly shaped coagula and
epithelial cells from the urinary passages; it is moreover not
infrequently possible to demonstrate a disease of the urinary
passages by means of a local examination. In case of bleeding
from the genitals the urine removed from the bladder by means
of a catheter contains no blood, and it is usually possible to
show an abnormal condition of "the genital organs.

Treatment. The mode of treatment depends upon the
underlying condition. In copious bleeding hemostatic remedies
Treatment. 981

may be employed, such as secale cornutum and its preparations,
suprarenin or adrenalin (of the 0.1% solution 1-5 ec. per 100
kgm. of body weight, intravenously in physiological salt solu-
tion) ; also astringent or styptic irrigation of the bladder with
a 0.5% solution of tannin, a 1% solution of alum or a 0.01%
solution of suprarenin.

sae ae Liebetanz, Monh., 1907. XVIII. 454 (Lit.). — Schmidt, B. t. W.,

Haematuria Vesicalis. (Stallrot der Rinder, German; Hématurie
chronique des bovidés, French.) This is a chronic hematuria of cattle
which occurs in Baden (Hink, Anacker) and elsewhere in Germany,
also in certain parts of France and Italy (Moussu), in Belgium
(Liénaux), and in Hungary, and causes in some regions considerable
losses. The trouble occurs after exclusive dry feeding in the stable, and
more particularly in older cattle. —

As causes of hematuria have been suggested: insufficient feeding
(Anacker), bacterial infection (Detroye), coccidiosis of the bladder
(Arnold), filaria or distomata (Lydtin), the action of irritating poisons
(Galtier), and Hink considers stasis in the territory of the posterior
vena cava as the probable cause. The latter view in a somewhat modified
form has recently been shared by Liénaux, who referred the develop-
ment of the disease to the periodical compression of the bladder by
the rumen when it is filled unduly with voluminous food, and to venous
stasis in the walls of the bladder produced thereby. The circulatory
disturbances produced in this manner would then result in similar
dilatations in the capillaries, in portions of the bladder, as they are
found in teleangiectasia maculosa hepatis. The consequent periodical
hemorrhages produce, according to Liénaux, a secondary proliferation
of the connective tissue and moreover prepare the soil for secondary
bacterial infections of the bladder. On the other hand, Gotz maintains
the view that certain irritations which are probably not specific but
mechanical, chemitéal, mykotic or toxic, cause at first an increased
discharge of urine which is associated with tenesmus, in consequence
of which the epithelia and the tissue of the mucosa are caused to
proliferate, while the capillaries and smaller veins are permanently
dilated.’ In this manner he assumes a gradual varicose dilation of
the blood vessels in the mucous membrane of the bladder, and from
these hemorrhages into the tissue of the mucous membrane and into
the lumen of the bladder. For this reason Gotz believes the disease
to be a cystitis verrucosa.

The anatomical changes consist at first only in the occurrence
of dark red spots in the mucous membrane of the bladder; in a more
advanced stage red or brown, sometimes yellowish or gray varicosities
are visible as large as hempseeds, and sometimes between these cellular
proliferations, as large as nuts or hen’s eggs and up to 2 kgm. in
weight, roundish or lobulated, like cauliflower (Hink’s round-cell
sarcoma). Ulcerous destruction of the vesical mucosa or perforation
of the bladder wall may also be present.and occasionally unilateral
or bilateral nephritis or hydronephrosis. The bladder contains bloody
982 Uremia.

urine and sometimes coagulated blood. In far advanced cases there
are evidences of general anemia. ‘

Symptoms. The urine is light or dark red-brown in color; it
furnishes a copious precipitate or red blood corpuscles and coagula,
with which are mingled white blood cells, bladder epithelia, and rarely
also renal epithelia if catarrh of the bladder or nephritis have occurred
secondarily. The formation of good-sized coagula, and the obstruction
of the urethra by them, frequently causes temporary retention, more
often in male than in female cattle. The general condition is disturbed
only later in consequence of anemia or through perforation of the
bladder which occurs occasionally, likewise more frequently in male
animals.

The course is always chronic, extending over weeks, months and
even years. It is not rare to observe intermissions of variable duration
(especially in cows far advanced in pregnancy the condition is strikingly
improved after parturition [Anacker]). Permanent cures are the
exception; usually the animals must be killed.

Treatment consists in vigorous feeding; if possible the food shotld
not be very voluminous. In cows irrigation of the bladder with
astringent and styptic solutions may be considered.

Literature. Delacroix, Amn., 1905. 244, — Gotz, Schio. A., 1906. XLVIII. 1
(Lit.). — Liénaux, Ann., 1905. 185.

3. Uremia.

Etiology. In the course of severe, acute or chronic in-
flammation of the kidney, also in consequence of certain dis-
eases of the urinary passages (obstruction of ureters, arrest-
ment of a urinary calculus in the neck of the bladder or in
the urethra, bilateral hydronephrosis, paralysis of the bladder,
stenosis of the urethra, etc.) in which the discharge of the
urine from both kidneys is impeded, and thereby the function
of the kidneys is disturbed, there develops a peculiar train of
symptoms which is referable particularly to an involvement
of the central nervous system and of the digestive organs.

The nature of uremia is not known definitely. It is generally
assumed that it develops owing to the retention, in the blood, of all
or most of the solid constituents of the urine.

For a long time such a pathogenic action was attributed especially to urea,
but since it was not possible to produce the clinical picture of uremia artificially
by the intravenous injection of urea, Frerichs expressed the opinion that the
retained urea is transformed by the action of a supposed ferment into carbonate
of ammonia and that the intoxication is produced immediately by this substance.
Voit on the other hand assumed the retention of all N-containing urinary constituents,
Landois believed that the extractives (especially creatinin) and salts were retained ;
according to the last named author the respective substances exert their harmful
action immediately upon the easily irritated cerebral cortex—Traube attempted
to explain the occurrence of uremia upon a purely mechanical basis by assuming
that in kidney disease the blood pressure is increased and that the blood is diluted
through a retention of water, in consequence of which edema, and after it anemia
Uremia. 983

develop in the brain.—Bouchard & Lépine found that the normal urine has toxic
properties which are considerably diminished in uremia because toxic substances
which are ordinarily eliminated are retained in the blood.—According to Brown-
Séquard the kidneys are, similar to other organs, believed to produce certain
substances, by the agency of an internal secretion, which are necessary for the
normal maintenance of organic functions; the absence of such substances would
then furnish the foundation for uremia.

_ In an acute form uremia is not observed very frequently
in animals, but chronic uremia is by no means rare, especially
in dogs, and gives rise to less striking disturbances, which
also admit of a different explanation.

Symptoms. Acute uremia occurs especially as a sequel
of severe acute, and sometimes also of chronic kidney disease,
also in consequence of complete retention of urine if the func-
tion of the kidneys has been interfered with to a considerable
degree within a brief space of time. As a constant symptom
there occurs stupor, sometimes preceded by staggering and
vertigo and usually increasing to somnolence and to complete
unconsciousness. Simultaneously the animals often show
trembling or even clonic contractions, which are often limited
to single muscles or groups of muscles; these are soon followed
by general epileptiform convulsions (Pflug observed opis-
thotonus in a cow), and on their cessation consciousness does
not return, but the animals remain prostrate and unconscious.
There are, however, isolated cases in which consciousness is
preserved even during the convulsive attacks (Liénaux), and
in some cases symptoms of excitement are observed between
times.

Respiration is sometimes retarded (owing to the uncon-
sciousness) and sometimes rendered difficult owing to the
edema of the lungs which develops; occasionally Cheyne-Stokes’
respiration is observed. The temperature may at first be con-
siderably increased, but in the stage of stupor it falls even
below normal. Sometimes strong perspiration is observed and
the skin emanations as well as the exhaled air disseminate a
urinous odor (especially after rupture of the bladder).

‘The digestive troubles are manifested in inappetence, sup-
pression of rumination, in carnivora also in vomiting, and in
all species by diarrhea. (The last symptoms are attributed
to disintegration products of urea which are eliminated through
the intestinal mucosa and cause inflammation.) The vomited
material sometimes also has an odor of urine.

Acute uremia either causes death in a short time, the fatal
termination sometimes occurring after the first convulsive at-
tack, or it is postponed for several days during which the
paroxysms are repeated in longer or shorter periods. In
animals acute uremia has hitherto always had a fatal termina-
tion with the exception of a case of the authors, in a horse
with retention of urine, in which relief of the retention caused
the uremic symptoms to disappear after a short time,
984 Hyperemia of the Kidneys.

Chronic uremia develops exclusively in chronic diseases of
the urinary organs, especially in dogs, in consequence of chronic
indurative nephritis, as also.in incomplete retention of urine.
The nervous disturbances consist sometimes in a certain sensory
dullness, sometimes in periodical epileptoid attacks, but they
are often absent. The respiration is sometimes rendered diffi-
cult by asthmatic attacks (Liénaux). The usual phenomena
of chronic uremia consist in digestive disturbances which occur
without demonstrable cause (symptoms of gastric catarrh,
vomiting, diarrhea) and which may be temporary or permanent.
Pruritus has also been observed occasionally.

Chronic uremia usually causes death sooner or later, in
most cases after the supervention of an acute uremic attack.

Treatment. With the exception of the relief of the urine
retention, which is usually operative and which sometimes
removes the affection entirely, treatment is not very promising,
especially in the presence of severe nephritis. The administra-
tion of diuretic remedies, and diaphoresis must be considered;
in convulsions narcosis or subcutaneous injections of morphine
may be employed.

Literature. Albrecht, W. f. Tk., 1901. 25. — Bédel, Bull., 1897. 266. —
Grobon, Rev. vét., 1906. 21. — Honigmann, Ergebn. d. Path., 1902. VIII. 1. Abt.
549 (Lit.). — Liénaux, Ann., 1894. 65. — Otto, S. B., 1905. 82. — Pflug, Krankh.
d. uropoét. Systems, 1876. — Senator, Erkrankung d. Nieren, 1896.

4. Hyperemia of the Kidneys. Hyperaemia renum.

Etiology. Arterial hyperemia of the kidneys develops if
irritating chemical substances are carried to them with the
blood and are then eliminated. Many diuretic remedies (squills,
turpentine, especially cantharides, the latter even on cutaneous
application) exert their action in such a manner that they
increase the arterial blood in the kidneys. The action of marty
meadow plants (Ranunculaceae) becomes manifest in a similar
manner, and especially young animals frequently show symp-
toms of renal hyperemia after the ingestion of such plants.
In this category belongs also the polyuria (p. 919) occurring
in horses after the ingestion of spoiled, musty fodder. Williams
observed polyuria in two horses after drinking a small quantity
of sea water. This form of renal hyperemia also occurs often
in acute infectious diseases in which it is produced by bacterial
toxins circulating in the blood.

Venous hyperemia usually accompanies diseases of the cir-
culatory and respiratory organs,:when the outflow of the venous
blood from the kidneys is difficult. This is most frequently
the case in organic heart trouble and valvular disease, also
in pulmonary emphysema, in chronic interstitial pneumonia,
Anatomical Changes, Symptoms. 985

in peritonitis and in edema of the thoracic organs, finally in
exceptional cases, owing to compression or thrombosis of the
posterior vena cava.

Anatomical Changes. The arterial hyperemia is manifested
by livid redness of the renal substance, in which the congested
glomeruli often stand out sharply and appear as dark red spots
on the cut surface of the cortical substance.

In venous hyperemia the kidneys are dark blue-red, some-
what enlarged and firm; the tense capsule is easily peeled off,
whereupon the smooth surface of the cortical layer, which is
traversed by venous plexuses (Stellulae Verheyenii) becomes
visible. A somewhat prolonged blood stasis leads gradually to
an increase of connective tissue which causes the kidneys to be-
come very firm (Induratio cyanotica renum), but later their vol-
ume diminishes with the atrophy of the newly formed connective
tissue, the surface becomes irregular, and the renal capsule
adheres in places to the substance of the kidneys (Atrophia
cyanotica). In stasis-hyperemia there is no cellular infiltration
in contrast to inflammatory atrophy of the kidneys, but red
blood corpuscles lie in small clumps between the tortuous
urinary tubuli (Kitt).

Symptoms. In arterial hyperemia of the kidneys an in-.

creased amount of arterial blood flows in a given time through
the kidneys, in consequence the quantity of urine increases
and its specific gravity becomes lower. Aside from polyuria
(see p. 918), which is usually accompanied by an increased
sensation of thirst, a certain sensitiveness in the region of
the kidneys and a stiff gait were noted in many cases.
In venous hyperemia of the kidneys the slowing of the
blood stream results, as an immediate consequence, in a
diminution of the quantity of urine. If the stasis of the blood
is prolonged, the nutrition of the epithelial cells suffers and
there occurs an albuminuria which is usually only slight; on
microscopical examination red blood corpuscles and hyaline
casts may sometimes be found in the urine. The specific
gravity of the latter is increased and it contains, in carnivora,
large quantities of acid urates which form, on cooling, a reddish
sediment on the bottom of the vessel and disappear when the
urine is heated.

Diagnosis. For the determination of arterial renal
hyperemia it is necessary to exclude all other diseases for
which polyuria is also characteristic—Diabetes mellitus is
distinguished by its high specific gravity and the content in
grape sugar, chronic indurative nephritis differs by the amount
of albumen present in the urine and by the long duration of
the disease—From diabetes insipidus arterial hyperemia can
986 Hyperemia of the Kidneys.

be differentiated almost only on the strength of its acute
course.

Venous hyperemia differs from renal inflammations by the
fact that the urine contains only little albumen and no real
form elements, and also by the existence of some basic disease
which has produced stasis of the blood in the kidneys.

Treatment. Arterial hyperemia disappears in a short
time after the removal of its cause, especially after an ap-
propriate regulation of the feeding. The administration of
irritating remedies should be avoided as much as possible,
especially in acute febrile diseases.

The relief of blood stasis in the kidneys is possible only
by suitable treatment of the underlying disease, and it is
especially those remedies which raise the blood pressure that
enter into consideration (see chapter on valvular diseases).

Literature. Augner, Mag., 1847. 95. — Dammann, D. t. W., 1898. 125. —

Friedberger, Z. f. pr. Vet.-Wiss., 1874. 292. — Pflug, Krankh. d. uropoét. Systems,
1876. — Williams, Vet. Journ., 1901. 263. (See also Lit. on Diabet. insipidus.)

 

Hemorrhagic Infarct of the Kidneys. The formation of infarcts
in the kidneys is always a consequence of obstruction of the arteries,
by emboli carried from elsewhere or by thrombi which form at the
location of the infarct. Infarct formation is frequent after obstruc-
tion of smaller branches of the renal arteries by emboli, especially in
valvular disease, but this is not to be discussed here because it cannot
be diagnosed clinically, or at most presents the clinical picture of
chronic indurative nephritis if numerous infarcts have formed in
succession. Those infarcts need also not be considered here which
develop after the arrestment of pyogenic bacteria (see the chapter on
purulent nephritis). It is intended.to discuss here only the hemorrhagic
’ infarction which occurs after complete occlusion or in marked stenosis
of the renal artery. It occurs probably only in the horse because
thrombosis of the larger blood vessels (usually produced by larvae
of sclerostoma) occurs with few exceptions only in this animal. It
appears to be not infrequent, although it is usually mistaken for other
diseased conditions of the kidneys. The authors have observed four
cases within a short space of time and several cases are reported in
literature (Cadéac, Lustig, Ostermann), which permit the diagnosis
of a similar kidney disease.

The cause of hemorrhagic infarct lies in the occlusion or marked
stenosis of one of the renal arteries, which causes the blood pressure
to fall in that kidney. Arterial blood then flows into the kidney
through the few anastomoses between the blood vessels of the kidney
and those of the capsule and the ureters; on account of the considerable
size of the region which is excluded from the circulation the blood
remains under low pressure for a time or permanently. The great
diminution in the arterial blood pressure causes a stasis and extravasa-
tion of the blood. (Compare Vol. II.)

The effect of an occlusion of the renal arteries was elucidated by Littéa in
animal experiments. If the vascular obstruction was not complete or if it was
relieved after a short time, the circulatory disturbances retrogresred; but if in
Hemorrhagic Infaret of the Kidneys. 987

the meantime the nutrition of the renal parenchyma had suffered, a new-formation
of connective tissue was stimulated in places.

; The thrombosis is probably only rarely situated in the renal artery proper,
but usually in the abdominal aorta. immediately before the origin of the renal
arteries or even in the anterior mesenteric artery, in which case the thrombus
projects into the lumen of the aorta. Such a thrombus may produce an occlusion
or stenosis of one or the other renal artery thus that it continues as far as: its
origin, or that the thrombus, which is freely movable in its posterior or upper
end, happens to be forced against the opening of the renal artery by the circulating
blood. ie

The most striking symptom is a profuse renal hemorrhage, the
blood extravasating from the capillaries entering in part the tubuli
uriniferi or the pelvis of the kidneys and being then discharged. The
animals usually pass light or dark red urine at short intervals, at
times cylindrical clots, which are often regular casts of the ureters,
are mixed with it. The urine contains an amount of albumen corres-
ponding to the quantity of blood present, red blood corpuscles are
found in the sediment, sometimes arranged in the form of tube casts,
and also other renal form elements. On rectal exploration the en-
largement of the one (left) kidney, which is not very sensitive, may
be ascertained.

If the hemorrhage continues unchanged, death may occur in the
course of a few days (authors’ case), but in most cases such attacks
disappear after a short time, although they may recur several times
(the authors observed such repetitions in all their cases).

The treatment must be limited to the administration of remedies
which increase the blood pressure, to intensive feeding and possibly
to the administration of iron.

.

5. Amyloid Kidney. Degeneratio Amyloidea Renum.

Etiology. Amyloid degeneration of the kidneys occurs far
less frequently than it does in the liver (Vol. IT), although
it develops upon a similar basis. The disease may be limited.
to the kidneys, but occurs more often simultaneously with a
similar affection of the liver and spleen. The process has
been observed in dogs by Rabe, Rivolta, Kitt, Dorflinger; in
a cat by Mathis; by Rabe not very rarely in horses and cattle.

Anatomical Changes. In well marked cases the kidneys
are enlarged, firm and rigid, anemic. The cut surface is very
pale and shows a waxy or lardaceous luster (for the amyloid
reaction, see amyloid of the liver).

In the kidneys it is usually also possible to find proliferation of the connective
tissue and fatty degeneration of the epithelia. Amyloid kidney can only occur
in association with chronic nephritis, and in this case small punctate, waxy, some-
what transparent and glistening granules, the degenerated glomeruli are noticeable
on the cut surface (Dorflinger).

Symptoms, The clinical picture of amyloid kidney is
known only slightly. Rabe observed emaciation and debility
of the hindquarter in his cases, also symptoms of uremia,
988 Amyloid Kidney.

especially vomiting, profound stupor and lowered temperature
(down to 35.9° C.). In two cases he saw edematous infiltration
of all four extremities, and in one case ascites which, however,
was probably due to liver disease.

The symptoms have great similarity with those of chronic
non-indurating nephritis, but with the difference that the
amount of urine is not diminished and that only little sediment
is formed in spite of the large amount of albumen present.

Diagnosis. The disease is suspected only when in a
chronic organic disease or in poor nutrition and anemia the
urine, which is voided in approximately normal amount, con-
tains rather much albumen, but furnishes only little organic
sediment with cells that give the amyloid reaction, or hyaline
casts. The probability of the diagnosis is much increased if
at the same time enlargement and firmer consistency of liver
and spleen are found to be present.

Treatment. Treatment does not promise particularly good
results. In suitable cases the treatment of the basic condition
may be supplemented by intensive nutrition and by the ad-
ministration of iron and iodine..

Literature. Ball, Arch. f. Vet.-Wiss., 1905. 362. — Dorflinger, Vet., 1897.
349. — Rabe, Hann. Jhl., 1882-83. 86. — Ries, Rec., 1903. 629.

6. Acute Inflammation of the Kidneys. Nephritis Acuta.

Acute nephritis is an inflammatory disease of the kidneys
which is manifested either by nutritional disturbances of the
renal epithelia and an only slight involvement of the interstitial
tissue (Nephritis acuta parenchymatosa), or which in addition
to changes in the parenchyma of the kidney produces very
decided inflammatory changes also in the connective tissue,
without, however, causing the formation of a purulent exuda-
tion (Nephritis acuta diffusa).

The clinical data concerning nephritis in veterinary medicine are
as yet rather incomplete, probably partly because systematic urinary
analysis does not yet occupy its proper place in veterinary practice.
In contrast to the many various forms of disease which have been
ascertained by post-mortem: examination and still more by histological
investigation in the various inflammatory processes in the kidneys,
clinical examination is able to differentiate only few clinical pictures
with the methods at its disposal.

In the following paragraphs an attempt will be made to classify
the inflammations of the kidneys according to the system which is
generally accepted in human medicine, on the basis of observations
reported in literature and of the authors’ own investigations. This
is fully justified by the pathological anatomy of nephritis in animals
which has been studied carefully, especially by Kitt.
Occurrence, Etiology. 989

Bright ineluded in the disease, which was later called after him ‘‘Morbus
Brightii,’’ all affections of the kidneys which are usually associated with albuminuria
and symptoms of dropsy. Later authors extended the meaning of the term
‘‘Bright’s Disease’’ to all hematogenous, non-purulent inflammations of the kidneys.
The comprehension of all renal inflammations under this one common name does,
however, not appear to be appropriate in consideration of the fact that these inflam-
mations represent forms of disease which differ materially, not only clinically, but
even more in their anatomical and pathological characteristics.

Occurrence. Acute inflammation of the kidney is a very
frequent disease of animals because it develops mostly from
infectious diseases which occur very often in domestic animals
(Semmer found nephritis repeatedly in chickens).

Etiology. Acute nephritis may occasionally be based upon
traumatic influences on the region of the kidneys or upon the
kidneys themselves; as such are designated particularly strain-
ing, dull force (kicks, blows) upon the region of the kidneys,
being run over, falling down, too abrupt stopping during sharp
trotting or galloping, etc. In other cases the inflammation
occurs in connection with cold (on crossing a cold river or
on transportation in open railroad cars). The manner in which
traumatic or thermic agencies exert their pathogenic action is
beyond the limitations of direct observation; but the possibility
is not excluded that they merely reduce the resistance of the
renal tissue to the actual causes of inflammation (infectious
substances). oo

Vegetable and mineral poisons are capable of giving rise
to an inflammatory process if they are introduced in consider-
able quantities. Such substances are cantharides, oil of tur-
pentine, squills, colechicum, extract of felix mas, also carbolic
acid and preparations of coal tar in general; of mineral sub-
stances phosphorus, arsenic, corrosive sublimate and the
mineral acids. Godbille observed acute inflammation of the
kidneys occurring in cows after the ingestion of acorns. Many
acid substances even cause inflammation in the kidneys when
rubbed on the skin, for instance, oil of mustard, styrax,
cantharides, etc. A similar action is also attributed to certain
caterpillars which, after being swallowed with grass or leaves,
are said to irritate the kidneys with their acrid substances
which have been absorbed in the intestine (Cruzel). Finally
insects (wasps, bees, Kolumbacs gnats ) may inoculate sub-
stances by their stings which irritate the kidneys and thus
produce inflammation. ac

In by far the most cases acute nephritis develops un-
doubtedly in the course and in consequence of acute infectious
diseases. The bacteria which circulate in the blood may become
wedged in the glomeruli and also in the intertubular blood
vessels and may injure the tissue in their immediate vicinity.
But they may also leave the blood vessels and be eliminated
vith the urine later. In this manner nephritis occurs in
anthrax, swine erysipelas, glanders, hog cholera, and swine
990 Acute Nephritis.

plague, and in septicemias in general. However, in the majority
of cases the bacterial toxins exert an immediate pathogenic
action upon the kidneys. In passing through the cellular ele-
ments of the kidneys they produce, in them and in the vessel
walls, degenerative processes and subsequently an inflammation
of the kidneys. The various toxins do not, apparently, exert
a like action in this respect, but this much may be maintained
in general that the development of nephritis is to be anticipated
the more surely, the more intense the infection has been. This
is the explanation of the development of nephritis in those
cases in which no bacteria circulate in the blood and in which
they cannot later be shown in the renal tissue, but where other
symptoms of intoxication, especially fever, permit the suspicion
that toxins are present in the blood; this is especially the
case in influenza of horses, purpura, distemper, tetanus, foot-
and-mouth disease.

In similar manner every extensive inflammation of the
gastro-intestinal canal and of the peritoneum may give rise
to a nephritis. As a matter of fact every extensive organic
inflammation may, under certain conditions, also supply the
impetus for the development of nephritis. Finally infectious
substances and their toxins are of etiological importance also
in that form of nephritis which sometimes develops after the
ingestion of spoiled food-stuffs.

The kidneys are likewise irritated by hemoglobin which
happens to be in solution in the blood plasma, a fact which
explains why in severe cases of hemoglobinemia also a de-
generation or an extensive necrosis of the epithelial cells
(Johne) develops, or even a true nephritis. In such cases,
in addition to the blood coloring matter, the agencies upon
which the hemoglobinemia is based or certain products of dis-
integration are probably of essential importance. It is evi-
dently in-the same manner that nephritis occurs after extensive
burns of the skin.

The nephritis which occurs not infrequently accom-
panying certain skin diseases (eczema, mange) probably owes
its origin to the injurious action of toxic substances which
are formed in the inflamed skin, but which are not known
exactly.

Anatomical Changes. The anatomical changes are either
easily recognizable to the naked eye or can only be demon-
strated by microscopical examination. According to Kitt, who
was the first to attempt a systematic classification of inflam-
mations of the kidneys on a histological basis, the following
clinical pictures belong to the group of acute nephritis.

Nephritis Parenchymatosa Acuta (cloudy swelling, edematous,
albuminous degeneration of the kidneys). The disease is essentially
an affection of the epithelia of glomeruli and tubuli uriniferi, it is
Anatomical. Changes. 991

due to nutritive disturbances and leads to cloudy swelling and necrosis
of these cells. The kidneys are enlarged only slightly or not at all,
fairly firm or slightly softened, their capsule is easily peeled off, the
configuration of the cut surface looks washed out, while the glomeruli,
overdistended by blood, stand out clearly in the form of red dots;
the cortical substance is grayish-red, perhaps traversed by grayish-
yellow spots and stripes; the medullary substance is colored intensely
red; the tissue is sometimes moist with serous fluid, and turbid fluid
which contains uninjured and degenerated epithelial cells, detritus,
threads of fibrin, and perhaps white and red blood corpuscles may be
scraped from the cut surface. In many cases the disease is most
marked in the glomeruli (Glomerulonephritis) ; while in others the
tubuli uriniferi appear to be involved more severely (Tubulonephritis).

Sometimes, most markedly in swine erysipelas, numerous small
hemorrhages are found especially in the cortical substance (N. par:
haemorrhagica).

Microscopical findings: The blood vessels are filled; fibrinous exudation,
perhaps slight cellular infiltration between the tubuli uriniferi and fibrinous exuda-
tion in the capsules of Bowman, the epithelial cells being granular, swollen, partly
degenerated and in process of breaking up; the tubuli contain hyaline and epithelial
casts.

Nephritis Acuta Diffusa. The kidneys are decidedly enlarged,
soft and friable, the capsule is soft, easily peeled off from the moist
and glistening surface, the cortical substance is also moist throughout,
very broad; the gray cut surface shows numerous yellow spots and
streaks, often small or (especially in swine plague) large hemorrhages,
a large amount: of a thickish fluid may be scraped off from the cut
surface (large, mottled kidney).

Microscopical findings: The blood vessels are distended; interstitial hemor-
rhages; leucocytes and epithelial casts in the tubuli uriniferi; cellular and serous
infiltration of the connective tissue; degenerative processes in the epithelial cells,
exudation in the capsules of Bowman.

According to Cagny and Nocard the epithelial cells of the convoluted and
straight tubuli disintegrate even in previously healthy kidneys during a prolonged
severe attack of parenchymatous or even fatty degeneration and become loosened
on the walls of the tubuli. In consequence a chylus-like liquid which looks like pus
is, on pressure upon the kidneys, discharged from the tubuli uriniferi; it contains
numerous epithelial cells and free fat globules. A similar liquid is found also in
the renal pelvis and in the upper portions of the ureters.

In cases of severe acute nephritis post-mortem examina-
tion usually reveals also dropsical changes in the body cavities
and in the subcutaneous connective tissue.

Symptoms. Acute parenchymatous nephritis is the most
frequent form of acute renal inflammation and_ preferably
accompanies febrile acute infectious diseases (febrile albumin-
uria). It is accompanied by moderate albuminuria, the albu-
men of the urine usually amounting barely to 1-2%. The
quantity of urine is either normal—and this is more frequently
the case—or it is somewhat diminished, mostly in consequence
of the cardiac weakness produced by the basic disease; only
in exceptional cases is the amount of urine slightly increased.
The urine either furnishes no organic sediment or this consists
only of few renal epithelia, sometimes of hyaline, granular
or epithelial casts, also occasional red or white blood corpuscles.
992 Acute Nephritis.

Parenchymatous inflammation alone does not cause any
functional, particularly generalized, disturbances.

Acute diffuse nephritis occurs much more rarely than the
preceding form, and either develops as such from the start
or out of the parenchymatous inflammation.

The rapidly increasing inflammatory infiltration causes
above all pain in the kidneys. The animals stand with feet
spread apart. or bunched below the belly, they arch the back
and dislike to move; on moving they drag the hind legs and
show in general a certain stiffness. Pressure upon the region
of the kidneys causes the animals to depress the back. The
sensitiveness to pressure on the part of the kidneys may be
ascertained in large animals by rectal examination, in small
animals by external palpation. Palpation from the hollow
in the right flank may in cattle also be successful. Horses
often show symptoms of colic, trip back and forth, look around
toward the abdomen, at times they lie down carefully but soon
rise again. These symptoms are not constant and are supple-
mented by depression, general debility, inappetence (in dogs
also vomiting) and fever.

In a portion of the cases there is also pressure of urine,
and in stallions there may occur incomplete erections. Some-
times the animals void only little urine, in spite of repeated
efforts, perhaps only a few drops. This so-called strangury
appears especially in the nephritis produced by cantharides
or oil of turpentine. The diminished quantity of urine is one
of the most striking symptoms and in some cases the elimina-
tion may be suppressed entirely for several (even 5 to 7) days.
(Funk, Friedberger.)

The appearance of oliguria finds a sufficient explanation in the reduced elim-
ination of water in the kidneys, owing to the retarded blood flow in the capillaries
of the glomeruli, also in the compression of the glomeruli and the obstruction of
the capillaries by numerous desquamated endothelia, further in the impeded outflow
of any secreted urine because the tubuli uriniferi are obstructed by renal epithelia
and casts or compressed by the interstitial infiltration.

The urine is, especially at first, dark in color, reddish
or even brown-red, cloudy but without floccules; the specific
gravity is increased. The urine contains variable amounts,
usually one or several per cent, of albumen. The quantities
of the other nitrogenous substances (urea, uric acid) are
diminished, also that of NaCl and of the phosphates, because
of the involvement of the epithelia of the tubuli uriniferi. The
sediment is copious and consists of crystalline salts (uric acid,
acid sodium urate, calcium oxalate and carbonate), of granular
renal epithelial cells, hyaline, granular or epithelial casts, also
not rarely (always in the nephritis produced by sharp sub-
stances) red blood corpuscles and leucocytes; sometimes it
contains even bacteria. (Thomassen found numerous bacteria
in the urine of calves affected with septicemia [see p. 157].)
Symptoms, Course. 993

The renal epithelia (Fig. 172) are larger than the red blood corpuscles, rounded
or quadrangular, containing a moderately large nucleus around which the protoplasm
is usually granular and covered with fat globules. The epithelial cells are some-
times united into elongated cylindrical shapes (epithelial casts; Fig. 173.2). The
other casts are either quite homogeneous (hyaline casts) or unevenly granular
(granular casts), perhaps covered with fat globules, red or white blood corpuscles,
sometimes with small crystals (Fig. 173, 174). In the urine of horses the calcium
carbonate granules are also united into cylindrical formations, but are readily dif-
ferentiated because they disappear with the development of gas after the addition
of acids.

In severe cases edematous swellings sometimes develop
in the subcutaneous connective tissue, on the lower chest and
abdomen, on the eyelids, in the larynx, on the extremities, etc.,
and sometimes serous effusion may be demonstrated in the
body cavities.

The nutrition of the animals always suffers more or less;
anemia develops after a comparatively short time the more
so as the appetite is dimin-
ished, and vomiting occurs
readily in carnivora. In
very severe cases the debil-
ity increases rapidly; the
pulse is more and more ac-
celerated and feeble. Fi-
nally pulmonary edema or
acute uremia (p. 983) termi-
nate the case.

Course. Recovery from
acute parenchymatous ne-
phritis usually occurs ina _. . ; .
dow days or in 1 to,Q-werks, Te 173, Uitagey gliuent of Bone vies
provided the basic affection with broken up, b the same with uninjured
itself does not endanger the nuclei, ec mononuclear white blood corpuscles.
life of the animal; the al-
buminuria diminishes rapidly and disappears completely with
the recovery of the animal. Only rarely the disease passes
into acute diffuse nephritis, but it sometimes probably prepares
the soil for the later development of a chronic nephritis.
Generally acute parenchymatous nephritis in itself only indi-
cates the intensity of an infection or intoxication, but does
not in itself immediately endanger the life of the animal.

On the other hand acute diffuse nephritis lasts 1 to 2 weeks
onan average, and ends in death, possibly in recovery, or
gradually passes into a chronic inflammation. The commencing
improvement is indicated by the increase in the amount of
urine, which is at the same time lighter in color; its specific
gravity becomes lower and the albuminuria gradually disap-
pears. In the cases with fatal termination the quantity of
urine is permanently diminished, it contains much blood, the
appetite is lost entirely, the temperature persistently high;

Vol. 1—63

 
994 Acute Nephritis.

finally the animals lie down constantly, a condition of stupor
or coma develops in which at times muscular trembling or
eclamptoid muscular convulsions are observed, the body is
bathed in perspiration and death finally occurs in deep coma
or with convulsions.

Diagnosis. Nephritis can be recognized positively only on
the basis of urinary analysis, because often only the urine
shows a deviation from the normal, while pain is observed also
in purulent nephritis or in pyelitis. Of importance in this re-

Fig. 174.

 

Fig. 173. Renal casts. 1 hyaline cast, granular; 2 Epithelial cast; 3 blood
corpuscle cast.
Fig. 174. Renal casts. To the left two granular casts, to the right a cylindroid.

spect are the quantity of albumen and in the sediment the
presence of renal epithelia, casts, red and white blood corpuscles.
The demonstration of the form elements and of the quantity
of albumen is of particular importance, and it is not sufficient
simply to ascertain the existence of albuminuria, because this
may exist also in chronic nephritis, in severe passive hyperemia
of the kidneys and in general nutritive disturbances, and be-
cause it affords no information as to the acute or chronic nature
of the nephritis—Albumen may also be found in the urine
in affections of the urinary passages, even in affections of the
immediately contiguous genital organs (prostate, vagina), but
Diagnosis, Prognosis. 995

here the quantity corresponds to that of the pus or blood which
is present in the urine. Further the presence of epithelial
cells from the pelvis of the kidney, from the bladder or urethra
gives information on the localization of the disease, while rectal
exploration may often make it possible to ascertain immediately
the abnormal condition of the organ.—In renal hemorrhage
(infarct, injury, rupture of the renal artery) the quantity of
the urine is unchanged, the sediment contains almost only
red and a few white blood corpuscles, the blood often coagulates
in the ureters to thick cylindrical shapes.

An exact designation of the various forms of acute nephritis
is often possible if the quantity of albumen, the quantity and
nature of the renal elements, and possibly the sensitiveness
of the kidneys to pressure are considered. Small amounts of
urine of high specific gravity, copious organic sediment, a high
percentage of albumen, sensitiveness of the kidneys, perhaps
also edematous infiltrations point especially to acute diffuse
nephritis. On the other hand the slight and transitory albumin-
uria, which is of frequent occurrence in acute infectious dis-
eases, and the presence of but few form elements as a rule
permit the diagnosis of parenchymatous degeneration or in-
flammation of the kidneys. -

Prognosis. Except for the less severe parenchymatous in-
flammation there are only few data available on the course
of acute nephritis in animals; but this much seems to be fairly
certain that even severe cases are capable of complete retro-
gression (Trasbot). During the course of the inflammation it
is impossible to make a definite prognosis, because even rela-
tively slight cases may later become aggravated or the disease
may pass over into the chronic form. A favorable outcome may
be expected in those cases of febrile diseases in which the urine
contains only small amounts of albumen and very few or no
organic form elements. But in the presence of decided oliguria
or of complete anuria, or if the urine contains much albumen
and many red and white blood corpuscles, the prognosis is very
unfavorable; uremic symptoms always are an indication of
approaching death.

Treatment. Of particular importance is the regulation of
the diet in so far as the animals should receive easily digested
food-stuffs which contain but small amounts of albumen and
of salts, and which are neither sharp nor irritating. Herbi-
vorous animals will therefore receive, if possible, fresh green
feed or good hay, tuberous vegetables, drinks made with flour
or bran, while grains should not be permitted; carnivorous
animals are most appropriately put on an exclusive milk diet,
milk may be given even to large animals if mixed with a decoc-
tion of oats or linseed, because it stimulates diuresis. It is
advisable to keep the animals in an evenly warm place, and

well covered.
996 Acute Nephritis.

In case of marked oliguria the animals must be made to
drink as much as possible, especially of carbonated water, in
order to facilitate the process of filtration in the kidneys and
to prevent the obstruction of the urinary tubuli by desquamated
epithelia and by casts. The quantity of water must, however,
be limited if dropsical symptoms already exist (Kévesi &
Roth-Schultz). In order to increase the elimination of water
through the kidneys mild diuretic remedies may be employed,
for instance, acetate of potassium (of Liq. acet. Potass. 50-100.0
or 1.0-2.0 gm. daily 3 to 4 times), potassium nitrate (10-15.0
or 0.2-0.5 gm.), also Diuretin (for dogs 0.1-1.0 gm. given to
advantage with digitalis), theozin, theophyllin.

For promoting the elimination of the products of metab-
olism through other paths, diaphoresis is particularly ap-
propriate, and may be produced in small animals by warm
water- or steam-baths, by subcutaneous injections of pilocarpine
hydrochloride (0.2-0.5 or 0.005-0.02 gm.) or of arecoline hydro-
bromide (0.06-0.08 gm. for horses). In addition to these, laxa-
tives are indicated, either neutral salts or better ‘‘Vienna
drench,’’ or castor oil, also aloes by which means not only a
portion of the urine-forming solid substances (urea and accord-
ing to Kovesi & Roth-Schultz preferably phosphates). Uremic
symptoms, which may have appeared already, are to be counter-
acted in the manner discussed farther back (p. 984).

In an inflammation of the kidneys which has developed
upon an infectious basis, especially if the action of pyogenic
bacteria may be assumed, an attempt may be made to prevent
their multiplication by the administration of bactericidal
remedies, of which sodium salicylate (20-40.0 gm. or 0.5-1.0 gm.),
and salol (15-20.0 gm. or 0.5-1.0 gm.) are appropriate.

The cardiac action must always be watched and any existing
weakness counteracted with digitalis, camphor or other heart
remedies (see valvular diseases).

In a dog with artificially produced inflammation of the kidneys Pericone pro-
duced healing by decapsulating the kidney.

Literature. Albrecht, W. f. Tk., 1901. 145. — Friedberger, Z. f. pr. Vet.-
Wiss., 1874. 171. — Gebhardt, W. f. Tk., 1904. 709. — Godbille, Rev. gén., 1906.
VL. 655. — Jacob, B. t. W., 1904. 398. — Kitt, Monh., 1893. IV. 433 (Lit.). —
Kévesi & Roth- -Schultz, Orv. ‘H., 1904, 92. — Pericone, 0. M., 1907. 49. — Pfiug,
Krankh. d. uropoét. Systems, 1876. — Roquet, J. vét., 1909. 385. — Schmidt, Die
Cystitis und Nephritis usw. Diss. Giesszen, 1909 (Lit,),

7. Chronic, Non-Indurative Nephritis. Nephritis Chronica Non-

Indurativa.

(Chronic parenchymatous nephritis; Nephritis miata [Kitt];
Nephritis chronica mixta [Marcone].)

Chronic non-indurative nephritis is a diffuse nephritis with
slow course in which considerable degeneration of the paren-
chyma takes place, with cellular interstitial infiltration, edema,
Etiology, Anatomical Changes. 997

and new-formation of connective tissue, while atrophy of the
new-formed tissue does not occur.

The differentiation of chronic non-indurative nephritis from the
chronic inflammation, with which atrophy of the new-formed tissue
is associated, appears justified for the reason that these two forms
of renal inflammation differ essentially not only pathologically but
also clinically, and because the chronic indurative nephritis not in-
frequently develops from the commencement as such.

Historical. The reports in veterinary literature concerning chronic
non-indurative nephritis are very scant and the available information
on this form of inflammation of the kidneys is less complete than is
the case in other forms. Hable, Verheyen, Thomassen, Zimmermann,
Marcone, Dell’Acqua, Boudoire, have reported cases belonging in this
category.

Etiology. In certain cases the chronic nephritis develops
out of the acute form and is therefore caused by the same
injurious influences (see p. 989). Similar causes are of im-
portance, however, also in those cases in which the chronic
inflammation develops as such from the start, except that they
exert their injurious action with slighter intensity but for a
longer period. Here also irritating substances must therefore
enter into consideration in the first place; and among these
especially bacterial toxins which are formed in certain pro-
tracted infectious diseases (chronic endometritis, chronic .in-
fectious bronchitis, pneumonia, pleurisy, intestinal ulcers,
tuberculosis, glanders), and which are eliminated by the kidneys
after their absorption into the blood. Chronic nephritis may
also develop in the vicinity of purulent foci in the ‘kidneys
(Kitt). Finally it can hardly be denied that repeated taking
cold also will occasionally lead to chronic inflammation of the
kidneys.

Anatomical Changes. As a rule the kidneys are found en-
larged and on pealing off the capsule, the internal surface of
which is more or less mottied, small shreds of renal substance
adhere to it. Both the outer and the cut surfaces of the kidney
contain red, yellow and gray spots, and likewise occasional
small hemorrhagic foci. The substance of the kidney is moist,
and if the disease has lasted for some time it is firmer than
normal, the medullary substance is poorly defined, wine-red,
dirty red and full of blood and fluid.

Under the microscope the same changes may be ascertained as in acute diffuse

nephritis (see page 991), but with this difference that a new-formation of nucleated
connective tissue is often met with in the territory of the cellular infiltration.

In the majority of cases general anemia and emaciation
are present, also serous effusions into the body cavities and
the subcutaneous connective tissue, and sometimes hypertrophy
of the heart muscle.
998 Chronic Non-indurative Nephritis.

Symptoms. If the chronic disease has developed from the
acute form, the clinical picture of acute nephritis gradually
changes, its severe manifestations become less marked, and
finally the symptoms of chronic non-indurative nephritis are
established. In the great majority of cases, however, the
chronic nephritis develops from the start, its onset is insidious
and the symptoms of the disease are quite uncertain in char-
acter, so that a suspicion of the existence of the disease is
aroused only in a farther advanced stage of the process.

In working animals attention is first attracted to the
diminution in the ability to work; the patients are easily
fatigued, out of sorts and languid, although on careful observa-
tion these symptoms may be recognized also in the other
animals. As the disease progresses emaciation becomes evi-
dent in spite of the fact that the appetite remains good or is
but slightly disturbed; at the same time the mucous membranes
become more and more anemic. In some of the cases edematous
swellings form on the lower abdomen, on the chest and about
the feet or the thighs.

Simultaneously with these symptoms, or even in their
absence, a diminution in the amount and an increase in the
specific gravity of the urine may be noticeable, and the urine
contains relatively much albumen, many renal elements like
hyaline, granular and possibly epithelial casts, fatty renal
epithelia and occasionally few red blood corpuscles.

The daily amount, the specific gravity and the relative quantity of albumen
in the urine show great variations in the different cases. If the inflammation or
the edema retrogress for a time, the specific gravity may become nearly or quite
normal and the quantity of the urine may even be greater than normal. If the
chronic indurative inflammation approaches the stage of atrophy, the amount of
urine also increases, and in this case permanently, while the quantity of albumen
at the same time becomes relatively lower. (In a case reported by A. Zimmermann
the amount of urine in a dog varied toward the end of the disease between 310 and
110 ee., the specific gravity between 1010 and 1032, and the urine contained albumen
constantly (0.05-0.1%), white blood cells and also amorphous detritus.)

Sometimes the sensitiveness of the organ is increased and
it is enlarged, but as a rule examinations made in this respect
are negative. Many animals rise with difficulty and the effort
causes pain (Chouard).

Occasionally inflammation of the serous membranes and of
the lungs supervenes and may have a fatal outcome. In the
absence of such complications symptoms of heart weakness
occur in the later course of the disease, or even from the onset;
they may consist in pounding heart beat, soft, rapid pulse,
and finally the animals perish with signs of pulmonary or
laryngeal edema or of uremia.

Course. The disease always runs a protracted course and
usually lasts several months. The clinical picture often shows
variations, and aggravations are observed especially after over-
Course, Diagnosis. 999

exertion and after taking cold. In other cases the edema which
develops in a certain stage of the disease disappears, the ap-
parent improvement being accompanied by an increase in the
quantity of urine voided. Hventually the clinical picture of
chronic indurative nephritis may develop.

Diagnosis. Chronic nephritis can be recognized only by
means of urinary analysis, all other symptoms pointing only
to general nutritive disturbances. For differential diagnosis
it is necessary to consider the change in the amount of urine
voided, the presence of albumen in considerable quantity, and
the presence of epithelia and of casts from the tubuli uriniferi.

Acute diffuse nephritis differs from the chronic form by
its more rapid evolution, by the more considerable diminution
in the amount of urine voided, and especially by the presence
in the urine of numerous red blood corpuscles. It must, how-
ever, not be forgotten that acute exacerbations may occur in
the course of chronic nephritis, which sometimes render a
diagnosis extremely difficult, in case the history or, after the
acute symptoms have quieted down, the further course of the
disease do not afford any information on the true nature of
the trouble—Amyloid kidney is very easily mistaken for
chronic non-indurative nephritis, the more so as both processes
may exist simultaneouly (see p. 987).—In venous hyperemia
of the kidneys the urine has a higher specific gravity and con-
tains at most traces of albumen and few renal elements.—
In atrophy of the kidney there is polyuria, the urine is light
in color, watery, the specific gravity low, the percentage : of
albumen small and the sediment contains only few renal ele-
ments; hypertrophy of the heart is also frequent.

Prognosis. The course varies in different cases in so far
as the animals may be kept alive for years under favorable
external conditions, while severe exertion and insufficient nutri-
tion render the course more rapid. Other things being equal, the
prognosis becomes more unfavorable, the less urine is voided,
and the more albumen and renal elements it contains, or the
more prominent the cardiac weakness becomes.

Treatment. This is the same as in acute nephritis. First of
all the diet must be regulated in such a manner that the
patients, which are to be saved from all severe exertion, should
receive only good non-irritating food (in carnivora an absolute
milk diet is here also most effective [see p. 994]).

In the presence of oliguria and of dropsy cataphoresis
and especially subcutaneous injections of pilocarpine repeated
daily for weeks may have a good effect. Diuretic remedies are
administered in order to increase the amount of urine (page
996), and in cardiac weakness heart remedies (see valvular dis-
eases) are administered. The anemia also requires appropriate
1000 White Spotted Kidney.

treatment (see page 850). The effectiveness or failure of the
treatment can be ascertained from the quantity of albumen in
the urine.

Literature. Dell’Acqua, Clin. vet., 1906. 625. — Boudoire, Rev. gén., 1906.
VII. 657. — Kitt, Monh., 1893. IV. 433 (Lit.). — Marcone, Rev. gén., 1906. VII.
345 (Lit.). — Thomassen, Ann., 1897. 9, 77. — Zimmermann, Z. f. Tm., 1898.
II. 372.

White Spotted Kidney. (Nephritis maculosa alba. Nephritis
fibroplastica.) This form of nephritis occupies a position between the
acute and the chronic inflammation and develops usually in foci.

It is frequently found in calves but occurs also in adult cattle. Blieck observed
the disease enzootically almost exclusively in fattened calves. In the abattoir in
‘Budapest nephritis maculosa alba was found during the years 1900-1902 in 2,323 out
of 291,573 slaughtered cattle (0.8%), but in only 20 out of 343,012 calves (0.006%).

Etiology. Nephritis maculosa alba probably results from a
eryptogenetic infammation (Kitt, Kabitz), which appears to be acquired
most frequently through the umbilicus. The disease is therefore
probably embolic in origin. According to Rieck, however, the trouble
is produced by the secretion of toxins which originate either through
the influence of unknown microorganisms or without them. Fattening
of calves with whole milk and confinement in dark, close and badly
ventilated quarters favor the development of renal inflammation.

According to Vaerst and Guillebeau the white spots represent foci of blastemas
which persisted from embryonal life and disappear eventually without leaving any
traces. This view is contradicted by the undoubtedly inflammatory changes found
by other authors and also by the findings in the Budapest abattoir.

Anatomical Changes. Numerous slightly prominent rounded spots
are seen on the kidney, which are from hemp seed to a one-cent piece
in size, smooth, grayish-white or yellowish. In exceptional cases they
are confluent so that normal renal tissue may be discovered in only
a few spots (Nephritis alba). The consistency of the organ is some-
times normal or somewhat soft, but usually rather firm. The cut surface
also appears mottled, light gray streaks corresponding to the spots just
mentioned, and standing out clearly from the healthy tissue which has
a brown-red or more livid red color. Sometimes the white spots are
softened in the center or show purulent disintegration (Kitt).

These changes may retrogress completely, but at other times assume
a markedly chronic character.

On microscopical examination intense cellular infiltration is found, sometimes
also fibrinous exudation between the tubules, and numerous fibroblasts or a consider-
able increase in connective tissue. The pathological alterations are sometimes
arranged thus that the cellular infiltration is evident only at the borders of the
islands, while the center of the islands consists of fibrous tissue in which only here
and there portions of the tubuli are visible. The tubuli uriniferi and their epithelia
perish apparently only secondarily by simple atrophy.

Blieck differentiates four forms of spotted kidney. In the first form the
trouble is limited to localized white foci which vary in size, and either these foci
are prominent above the surface of the kidney or the latter already contains cicatri-
cial contractions. The second form is distinguished by a diffuse inflammation of the
renal parenchyma and by the presence of white spots, the kidneys being always
enlarged. In the third form hemorrhages occur in and around the white foci, and
in the fourth form hemorrhages alone are present.
Symptoms. 1001

Symptoms. The white spotted kidney usually causes no morbid
symptoms. The investigations of Blieck showed that a moderate
albuminuria (14-1%) occurs only in those cases in which, in addition
to the white spots, a diffuse disease of the parenchyma or multiple
hemorrhages have developed. In other cases only nucleo-albumen can
be demonstrated in the urine. The sediment consists of white blood
cells which are sometimes arranged in groups, also of renal epithelia
and hyaline or granular casts, which are much more numerous in
urine that contains albumen. In severe cases the appetite is diminished,
the animals are languid and may, rarely, suffer from diarrhea.

Treatment appears indicated only when the disease is well marked
and must follow the same principles as that of chronic non-indurative
nephritis.

Literature. Basset, Rev. gén., 1903. II. 582. — Blieck, A. f. Tk., 1906. XXXII.
225 (Lit.). — Brusaferro, Mod. Zooiatro, 1903. 436. — Fally, Ann., 1907. 463
(Lit.). — Guillebeau, A. f. Tk., 1906. XXXII. 574. — Kabitz, Monh., 1901. XII.
4. — Kitt, Monh., 1893, IV. 433; Pathol. Anat., 1906. II. 493. — Panisset, Bull.,
1905. 472. — Vaerst, A. f. Tk.,.1901. XXVII. 110.

8. Chronic Indurative Nephritis. Nephritis Chronica
Indurativa.

(Granulated or atrophied kidney; Nephritis interstitialis chron-
ica, Atrophia granulosa renum.) .

Chronic indurative nephritis is a kidney disease which is
associated with atrophy of the connective tissue and takes a
very protracted course. It either develops from acute or chronic
non-indurative nephritis (secondary atrophic kidney) or occurs
independently and slowly (primary atrophic kidney), or then it
follows upon certain affections of the urinary passages (uro-
genic atrophic kidney). It always causes a destruction of the
parenchyma.

Occurrence. Chronic indurative nephritis occurs in cattle
and buffaloes fairly frequently. Dogs and hogs also are affected
quite often, horses rarely, and the other domestic mammalians
only exceptionally. Older dogs suffer from chronic nephritis
comparatively frequently; but as personal observations of the
authors show, the disease may also become manifest in dogs
that are only a few weeks old. Horn found chronic nephritis in
0.32% of 7,000 slaughtered sheep; Semmer observed a case in
a cat. In birds the disease may possibly develop upon a gouty
basis.

Etiology. The disease develops out of the chronic uon-
indurative nephritis in only an extremely small proportion of
eases. This is indicated not only by the fact that the chronic
non-indurative inflammation is observed far less often than the
disease under discussion, but also by the other fact that this
1002 Chronic Indurative Nephritis.

latter affection not infrequently becomes manifest without the
severe symptoms of the non-indurative inflammation having’
been observed; moreover, atrophic kidney is sometimes discov-
ered accidentally in animals which had always been healthy.

In regard to the primary atrophic kidney there is much to
indicate that causes primarily similar to those in the chronic non-
indurative inflammation are active (see page 996), but with
this difference that they manifest their inJurious influence less
intensely but for a longer time. There is also a possibility that
after an acute nephritis has run its course, a slowly progressive
increase of the renal connective tissue commences. This would
explain those cases in animals where the symptoms of indur-
ative nephritis become manifest a certain time after recovery
from some infectious disease. Frohner observed a case of
chronic nephritis which formed a sequel of paralytic hemoglo-
binemia. Haase found a sequel of swine erysipelas in the kid-
neys of hogs to have taken the form of isolated connective tissue
foci containing few erysipelas bacilli.

In carnivorous animals the action of toxins must be consid-
ered which develop from the food-stuffs rich in albumins, during
digestive disturbances or in chronic skin diseases. (eczema,
mange); and in such cases confinement in dark yards is said to
exert a predisposing influence. In birds the fact that the uric
acid is formed in great quantities might have an unfavor-
able action, as is made strikingly evident in gout. Joest found
chronic nephritis in a cow with urinary calculi of xanthin and
with deposits of xanthin in the kidneys.

The influence of chemical poisons may be concluded from
the occurrence of the disease in animals which have eaten sour
plants on wet pastures, and in such cases chronic hepatitis
usually develops at the same time (Vol. IT). Such an action of
chemical poisons is proved also by the experiments in which it
was possible to produce a chronic nephritis by the systematic
administration of small amounts of lead- and copper-salts (El-
lenberger & Hofmeister, Heubel & Meyer, Trasbot).

A primary affection of the arteries only rarely is respon-
sible for the production of chronic nephritis. In isolated in-
stances the disease was observed in aortic aneurism (Cadéac,
Marek) or in degeneration of the renal artery (Lustig), and in
such cases the arrestment of small blood clots may contribute in
producing the chronic inflammatory process. In dogs an indu-
rative nephritis is sometimes found simultaneously with valvu-
lar troubles, though probably not as a consequence of the heart
lesion itself, but owing to the same cause which has given rise
to the chronic endocarditis. On the other hand, repeated embo-
lisms in the kidneys may also cause a process of atrophy (em-
bolic atrophic kidney).

Mechanical irritation may produce chronic interstitial
nephritis in the presence of urinary caleuli or of worms in the
renal pelvis. The same effect may probably be produced also
Etiology, Anatomical Changes. 1003

by periodical disturbances in the outflow of urine, and this
factor probably is preferably active in ruminants and hogs.

The chronic nephritis which has been observed frequently in buffaloes in Hun-
gary (Schoppelt, Vamos) is perhaps caused by renal gravel or by periodical inter-
ference with the outflow of the urine. The facts that the affection is often uni-
lateral or that one kidney is involved far more extensively, and still more the
atrophy with dilatation of the calyces which is observed in sections of the kidney
that show only slight morbid changes, are certainly in-favor of the urogenic origin
of the process. .

Anatomical Changes. Indurative nephritis is characterized
principally by the increase of the connective tissue and there-
fore by a firmer consistency of the organ (Nephritis indurativa,
Sclerosis renum). Later on the kidney becomes smaller and
its surface uneven, in consequence of variable depressions.

On histological grounds Kitt distinguishes the following forms:

Nephritis fibrosa multiplex s. Sclerosis maculata. This occurs
in cattle, in hogs and dogs and is characterized by yellowish or gray-
white furrows on the surface of the kidney, and by white wedge-shaped
foci in the cortical substance, which consist of fibrous connective tissue,
round cells, and isolated urinary tubules with disintegrating epithelia.
These changes are probably due to embolism and may sometimes develop
out of nephritis purulenta disseminata. Degen, for instance, showed
by careful examinations that purulent nephritis which in hogs usually
is hematogenic, generally leaves the evidences of nephritis fibrosa multi-
plex on healing.

Nephritis fibrosa diffusa is an inflammation which is about evenly
distributed over the entire kidney, which is very large, firm to the touch
and, in the calf, sometimes calcified. White, yellowish-white and yellow
islands alternate and any remaining healthy tissue is only indicated
by brown-red streaks. The ground substance consists of fibrous tissue
which is poor in cells and in which few urinary tubules are imbedded;
the latter contain only occasional normal epithelial cells but much
granular detritus. The glomeruli and the vicinity of the thick-walled
capsules show cellular infiltration.

The unequal atrophy of the proliferated connective tissue causes
shallow depressions on the sirface of the kidneys, which therefore
appears finely or coarsely granular (Nephritis granulosa) and at the
same time the kidney becomes smaller (Atrophia granulosa). By the
contraction of the connective tissue some urinary tubules are constricted
in places, others are obstructed by masses of disintegrated epithelia
and by casts, and in consequence the urine is dammed up above the
constricted or obstructed places, leading to dilatation of the tubules
and of the corresponding capsules of Bowman, which then are gradually
transformed into small retention cysts (Nephritis fibro-vesiculosa).

Symptoms. Chronic indurative nephritis has only rarely
been observed clinically, and it is therefore as yet impossible to
describe its clinical picture exhaustively. The want of complete
clinical knowledge is particularly great in the indurative nephri-
tis of ruminants and hogs. The urinalyses made by Vamos in
1004 Chronic Indurative Nephritis.

affected buffaloes permit the assumption that the urine is fre-
quently altered in the course of the disease in ruminants, and
evidently also in other animals, although the animals appear
otherwise healthy. Other observations and those of the authors
even indicate that the very light forms do not noticeably impair
the health of the animals, even in bilateral disease, and do not
lead to alterations in the urine. In the great majority of cases,
however, morbid phenomena are observed during the life of the
animals.

The development of the clinical picture proceeds in exactly
the same manner as in chronic non-indurative nephritis (see
page 997). Nutritional disturbances, diminished ability to work,
listlessness, rapid fatigue, languor, diminished appetite, in dogs
recurring vomiting are observed frequently, but may occasion-
ally be absent for a long time and even to the end of the
disease.

The most constant symptom is polyuria in which the ani-
mals void large amounts of urine at frequent intervals, and
house dogs often discharge their urine in the room against their
custom. The daily amount of urine is often several times the
normal quantity, although great variations exist in this respect.
The urine is watery or almost as clear as water, sometimes it has
a greenish tinge, the specific gravity is very low, even as low
as 1001. Small amounts of albumen are present, but may disap-
pear entirely for brief periods. -On standing, very little or no
sediment forms, and occasionaly hyaline casts and epithelial
cells from the urinary tubules may be found in it (Fig. 175).

“Regenbogen observed lipuria in two cases of chronic nephri-
tis in dogs associated with fatty degeneration of the. renal
epithelia ; “the urine looked like watery milk and maintained this
appearance even on standing or after filtration; it contained
34-1% of fat, many fat globules and fatty casts.

_ e@

    

Fig. 175. Renal epithelia in the urinary sediment of a dog with chronic indurative
nephritis.

The increased quantity of urine is due to several causes. It is characteristic,
especially for the chronic indurative form of nephritis, that more or less atrophied
portions of the kidneys alternate with portions that are more or less unaffected
and may be quite healthy; the latter assume the function of the diseased portions,
owing to the power of accommodation of the renal tissue. For this reason the
watery amount of urine does not diminish, in spite of the destruction of a portion
of the renal substance. Since in the affected portions many arteries have kecome
impassable, the remaining patent arteries of the portions of the kidney, which are
still capable of excreting, dilate and this is the more likely to occur, as in many
Symptoms, Course. 1005

eases a hypertrophy of the left heart develops. Owing to the lasting hyperemia
and increased circulation the functioning portions of the kidneys actually eliminate
increased amounts of a dilute urine. On account of the raised blood pressure in
the free. renal arteries the urine passes much more rapidly through the urinary
tubules and therefore a much smaller proportion of its water content is reabsorbed
by the blood than under normal conditions. The functioning of the healthy renal
portions, however, replaces that of the diseased parts only in regard to the elim-
ination of water and not in regard to the elimination of most of the solid constit-
uents. This, together with the arterial hyperemia in the excreting portions, is
responsible for the lowered specific gravity of the urine and also affords an explana-
tion why uremic symptoms may appear in this form of nephritis.

The sensation of thirst is increased in proportion to the
increased elimination of urine.

In dogs the hypertrophy of the heart may often be recog-
nized by the fact that the heartbeat is stronger, the cardiac
dullness enlarged to the left and upward and the aortic sound
accentuated; the pulse is strong and tense.

The causal connection between the cardiac hypertrophy and the chronic inflam-
mations of the kidneys, especially the atrophic kidney, is not explained satisfac-
torily. According to Traube the hypertrophy of the heart is due to the occlusion
of numerous renal vessels, but it may be objected to this hypothesis that the
enlargement of the heart may occur also in the diffuse non-indurative chronic
nephritis. A theory which was recently expressed by Senator and which had, in
a somewhat similar form been suggested already by Bright, appeared more accept-
able. According to this the metabolic products are retained in the blood in atrophic
kidney, and produce, by irritation, an increase in the muscular elements of the
heart and at the same time an increase in the vascular tone, which in its turn
again increases the work of the heart.—Grawitz and Israel, also Lewinski, pro-
duced an artificial chronic indurative nephritis in dogs and rabbits by temporary
ligation of the renal artery, and this was later followed by a hypertrophy of the
heart.

Palpation sometimes shows enlargement, more frequently
increased consistency, but occasionally a diminution and irreg-
ular contour of the kidneys.

The respiration becomes sometimes, especially in dogs,
increasingly difficult in the further course of the disease and
ultimately asthma may actually develop (Liénaux).

When the disease is severe, cardiac weakness eventually
follows, manifested in pounding heart beat with feeble and
rapid pulse, also in dropsical effusions; the amount of urine
is then diminished, the specific gravity increased. At this stage
emaciation progresses rapidly and finally the animals die of
exhaustion, of pulmonary or laryngeal edema, possibly of in-
testinal hemorrhage or hemorrhagic enteritis. (Thomas ob-
served epistaxis in a cow.) ;

The symptoms of uremia may appear in every stage of
the disease. They usually correspond more to chronic uremia
(disturbed appetite, vomiting, occasionally diarrhea, eventually
epileptoid or asthmatic attacks) and often appear in repeated
paroxysms. Occasionally an acute uremic attack closes the

scene.

Course. The duration of the disease is always protracted.
If it is recognized by urinary examination after the appearance
1006 Chronic Indurative Nephritis.

of clinical symptoms, it has usually already existed for months
and then is apt to continue for months or even years longer
during which time frequent variations are observed in the
intensity of the clinical picture. As has already been men-
tioned, certain forms of this nephritis, preferably in ruminants
and in hogs, run their course from beginning to end without
interfering with the general health, and this may occasionally
be the case also in other species.

Diagnosis. The existence of a chronic indurative nephritis
may be assumed properly if the quantity of the urine is in-
creased, the urine watery, the specific gravity low and when
the urine contains only small amounts of albumen and at most
few renal elements. These findings are often supplemented by
the demonstration of cardiac hypertrophy and by symptoms
of chronic uremia. The polyuria of active renal hyperemia
differs by a different history and by the constant absence of
albumen in the urine. Certain difficulties may be encountered
at most in the exclusion of that hyperemia which sometimes
persists for a considerable time after acute inflammations of
internal organs and which, on account of the simultaneous
degeneration of the kidneys or of a catarrh of the urinary
passages, is accompanied by slight albuminuria. In such cases
the condition of the circulatory organs and the manual ex-
amination of the kidneys must decide.—In diabetes insipidus
the urine is free from albumen, in diabetes mellitus it contains.
sugar and its specific gravity is usually high—In amyloid
kidney copious albuminuria is usual. Chronic non-indurative
nephritis may enter into the problem in the terminal stage
of atrophic kidney, when cardiac weakness is already present
and has caused the development of edema, while the specific
gravity of the urine is increased. But even in such cases the
presence of atrophy of the kidney may be decided upon on
account of the comparatively low content in albumen, the hyper-
trophy of the heart if present, and on account of the fact
that the specific gravity of the urine does not correspond to
the severe symptoms of urinary stasis.

Prognosis. In clinically well-marked cases the disease ends -
eventually in death, which is, however, in many cases postponed
for years.

Treatment. A regulation of the diet is indicated in so far
as the animals should be protected from all severe exertion
and receive good, non-irritating food (see p. 995). In cardiac
weakness heart remedies should be employed and an existing
edema may be counteracted by diuretic remedies. For anemia
the systematic administration of iron and of bitter remedies
is indicated in addition to good nutrition.
Treatment. Purulent Nephritis. 1007

Literature. Albrecht, W. f. Tk., 1901. 25. — Ball, J. vét., 1906. 193. —
Degen Die himatogene eiter. Nephritis d. Schweines. Diss Giessen. 1907. — Iried-
berger, D. Z. f. Tm., 1890. XVI. 188. — Fréhner, Monh., 1906. XVII. 137. —
Haase, B. t. W., 1908. 427. — Horn, Beitr. «. Kenntn. d. chron. Nierenerkrank. d.
Schafes. Diss. Leipzig, 1908. — Joest, Dresdn. B., 1907. 170. — Kitt, Monh.,
1893. IV. 483 (Lit.). — Liénaux, Ann., 1894. 65. — Marcone, Rev. gén., 1906.
VII. 345 (Lit.). — Regenbogen, B. t. W., 1908. 499. — Schoppelt, Ung. Vb.,
1901. 102. — Senator, D. m. W., 1903. 1. — Vamos, B t. W., 1905. 572.

9. Nephritis Purulenta.
(Purulent Nephritis, Renal Abscess.)

Etiology. Purulent nephritis develops through the in-
fluence of pyogenic bacteria which enter the kidneys usually
by way of metastasis. The principal occasion for such metas-
tases is afforded in purulent diseases of other organs or pyemia,
especially endometritis puerperalis, purulent inflammation of
the udders, strangles, influenza of horses, gangrenous pneu-
monia, purulent lung diseases (Horn found nephritis to have
developed upon such a foundation in 0.1% of slaughtered
sheep), also phlegmonous pharyngitis, purulent bronchial
catarrh, pyemia due to umbilical infection. According to the
experiments of Arenstein an embolic purulent nephritis may
develop without the existence of purulent processes in other
organs, for instance, owing to the absorption of colon bacteria
from the intestine in severe obstipation. Degen, who found
hematogenic purulent nephritis in about 0.5% of the hogs
slaughtered in-the Dresden abattoir, not infrequently found
colon bacteria and bacilli of the enteritis group in the diseased
portions of the kidneys, which could only have come there
from the intestines. .Nevertheless he never succeeded in de-
termining the point of entrance of the infectious agents, among
which a new variety of bacteria which he had discovered, the
Bacillus polymorphus suis, was found frequently, and he con-
siders therefore the hematogenic purulent nephritis of hogs
as a disease arising from cryptogenetic and polybacterial in-
fection. Haase finally saw occasionally purulent foci as sequels
of chronic swine erysipelas, which contained few erysipelas
bacilli. ;

Traumatic agencies, especially contusions of the region
of the kidneys only in exceptional cases give an impetus for
purulent nephritis by preparing the soil for the localization
of bacteria which happen to be present in the blood.

Somewhat more frequently a urogenic origin may be recog-
nized, inflammations of the urinary passages, especially those
of the renal pelvis extending into the kidneys. (Ostertag saw
in lambs repeatedly a purulent nephritis which had been con-
tinued from the urinary passages.) Only in exceptional cases
do bacteria get into the kidneys from-their vicinity (in the case

of perirenal abscess). ; .
Purulent nephritis is particularly frequent in cattle and

hogs.
1008 Purulent Nephritis.

Anatomical Changes. If the inflammation is metastatic,
both kidneys are usually involved, in other forms usually only
one and this may be affected only partially. The embolic
purulent foci are found principally in the cortex.

According to Kitt purulent nephritis occurs in the following forms:

Nephritis purulenta (punctata, disseminata). The substance of.
the kidneys which are more or less enlarged contains numerous small
whitish or yellowish dots‘ and stripes which are surrounded by a
narrow, dark red areola (hyperemia and hemorrhage) and from which
thickish purulent masses may be lifted with the knife. The tissue
around these places is changed in variable extension similarly as in
the acute diffuse inflammation. In hogs, less often in calves and cattle,
tough white bands are seen between the purulent foci.

On microscopical examination conglomerations of pus cells are found inside
of the small foci, and cellular infiltration containing pyogenic bacteria is noted in
the surrounding tissue. The epithelial cells show fatty degeneration and are disin-
tegrated, the glomeruli are sometimes surrounded by pus, while the convoluted capil-
laries contain numerous leucocytes; in the urinary tubules casts are sometimes found
which carry leucocytes and red blood cells.

The hematogenic purulent nephritis of hogs which has been
studied more exactly by Degen belongs to this form. It commences
mostly in the cortical substance with the formation of dark red foci,
of from hemp seed to pea size. In these foci a central yellowish-white
spot soon becomes visible as large as grits or up to birdshot in size.
The foci eventually become tougher, their areola paler, the yellowish
color of the center passes into a grayish-white and gray-white; sharply
confined and slightly depressed cicatrices appear on the surface of the
kidneys, continuing into the substance of the kidney in the form of
wedges or strips. Abscesses are hardly ever formed.

On microscopical examination intense hyperemia and partial hemorrhagic infil-
tration is visible at the beginning; this soon gives way to a purulent infiltration
which proceeds from the center, while the renal structure is obliterated and the
parenchyma partially atrophied. Still later fibroblasts appear in the purulent
infiltrated tissue, young granulation tissue is formed which, in the cicatricial stage
of the disease is transformed into connective tissue. :

Nephritis apostematosa (abscessus renis). In this form small pus
foci become confluent and form larger abscesses or an abscess forms
from an embolus; variable portions of the tissue of the kidney break
down or the entire kidney is changed into a sac filled with pus (pyone-
phrosis). Larger pus foci occur, usually numerously, in horses by
metastasis of stranges and in calves from unknown causes (possibly
by umbilical infection). The connective tissue is increased around
older abscesses but atrophies later, the inflammation. of the surround-
ing tissue becoming chronic.

Symptoms. The clinical picture of purulent nephritis is
characterized by its variability. It is evident that the symptoms
will be different when the nephritis develops as a local affection
and. when it occurs as a part of general sepsis or pyemia.
Variations also occur according to the duration, the number
Symptoms. 1009

of inflammatory foci and in the involvement of adjoining tissue;
the abscesses may or may not be in communication with the
lumen of the urinary tubules or with the pelvis of the kidney;
the changes may be unilateral or bilateral.

If the inflammation develops rapidly in both kidneys, the

same objective symptoms become apparent as in acute diffuse
nephritis (p. 992). Especially the sensation of pain in the
kidney is quite marked; in horses slight attacks of colic are
observed occasionally, also arching of the rigid back; while
walking one or both hind feet are not advanced as far as usual
(Benjamin observed paralytic weakness of one posterior ex-
tremity in a horse and is inclined to refer it to a compression
of the plexus lumbo-sacralis by the inflamed kidney). In very
rare cases the enlarged kidney or the purulent perirenal con-
nective tissue produces a painful swelling above the lumbar
region.
_ The voiding of urine is often disturbed in like manner as
in the non-purulent acute nephritis. But the amount as well
as the physical and chemical properties of the urine are not
altered much, if only few abscesses are in course of slow evolu-
tion, without injuring the adjoining renal tissue noticeably and
without communicating with the renal pelvis or the urinary
tubules. In other cases, especially if the evolution progresses
more rapidly, the urine shows the same or similar changes as
in the acute diffuse inflammation (see p. 992). After the pus
enters the urinary tubules or the renal pelvis the urine becomes
cloudy, milky or mixed with floccules, it contains pus cells, renal
elements, crystals of triple phosphates, and free ammonia.
Exceptionally the sediment contains small portions of kidney
substance (Leisering) and occasionally hemorrhage takes place
in the kidneys.

If the hand is placed below the transverse processes of
the lumbar vertebrae or into the rectum it is possible to de-
termine pain, unilateral or bilateral enlargement of the kidneys
and, in the presence of large abscesses, fluctuation which may
be limited or may involve the entire kidney.

Edematous infiltrations are observed very rarely. ;

On rapid development of the inflammatory process or in
septic pyemic infection severe general symptoms are observed,
in other cases only temporary rises in temperature and grad-
ually increasing emaciation. If the purulent inflammation is
severe and affects both kidneys uremia may also follow. —

In a slower evolution of the purulent process, especially
if it is limited to one kidney, clinical symptoms seem some-
times to be entirely absent. The same is true for the hema-
togenic purulent nephritis of hogs (Degen).

Diagnosis. Purulent nephritis can be recognized with cer-

tainty only then when objective symptoms suggest this form
obaieohirilies when pain, fluctuation of the kidney, albuminuria

Vol. 1—64
1010 Purulent Nephritis.

are present, or when the sediment contains also pus in addition
to renal elements, while disease of the urinary passages can
be excluded. An abscess of the kidney may be assumed to
exist in those rare cases in which small portions of renal
tissue are found in the sediment. In other cases the disease
can only be suspected with more or less probability.

For differential diagnosis are to be considered especially
acute and chronic non-purulent nephritis, catarrh of the urinary
passages, purulent catarrh of the uterus, vagina and prostate
(see p. 994).

Prognosis. The clinically manifest. purulent nephritis ends
sooner or later in death. If the inflammation is not very
extensive, and especially if only one kidney is involved the
possibility of a relative recovery is not excluded.

Treatment. In case of unilateral disease the extirpation
of the affected kidney (nephrectomy) is to be considered; the
method of this operation in animals has been described in
detail by Parascandolo. But as it is at present impossible
in animals to make sure whether the function of the other
kidney is undisturbed, there is always danger that after the
resection of the one kidney the animal dies of uremia because
the other kidney was also affected. (Miimnich has removed
one kidney in a cow without the desired result; Maksutow
operated on a horse successfully). Punction of the abscess
rarely gives good results.

-In the clinie at Budapest experiments were made with the cystoscope which
is used in human medicine. It appeared that in dogs the catheterization of the
ureters was impossible on account of the anatomical relations of the ureteral open-
ings, while it was carried out successfully in horses. .

If operative interference is not resorted to and other-treat-
ment is desired, the therapy described for acute diffuse nephritis
(see p. 995) may be adopted.

Literature. Benjamin, Bull., 1905. 131. — Cocu, Rec., 1899, 232. — Colin,
Rec., 1900. 20. — Degen, Die himatogene eiterige Nephritis d. Schweines. Diss.
Giessen. 1907 (Lit.). — Ellis, Am. v. Rev., 1901. 113. — Haase, B. t. W., 1908.
427. — Horn, Beitr. z. Kenntn. d. chron. Nierenerkr. d. Schafes. Diss. Leipzig:
1908. — Johne, 8. B., 1875. 30, 32. — Kitt; Monh., 1893. IV. 433 (Lit.); Path.
Anat., 1906, II. 487. — Leisering, S. B., 1872. 21. — Morel, Bull., 1904. 931.
— Miunnich, W. f. Tk., 1878. 17. — Parascandolo, Monh., 1903. XIV. 228. —
Schmidt, Maanedsskr., 1899. X. 179, — Siedamgrotzky, S. B., 1875. 29; 1891. 18, —
Stiegler, 5S. B., 1904. 172.

10. Bacterial Inflammation of the Renal Pelvis and of the
Kidneys. Pyelonephritis Bacterica.

(Pyelonephritis bacillosa s. diphtherica s. myotica bovum.)-

Bacterial pyelonephritis is an inflammation of the kidneys
which usually runs a chronic course and is characterized by
small softened foci in the cortical portion, diphtheritic disin-
Baeterial Pyelonephritis. 1011

tegration of the papillae, involvement of the renal pelvis and
usually also of the lower urinary passages. The disease is
produced by various bacteria, among them the Bacillus s.
Corynebacillus renalis (C. pyelonephritidis) bovis and occurs
almost exclusively in cattle.

History. Originally bacterial pyelonephritis was included among
the common purulent nephrites or pyelonephrites, but was separated,
toward the end of the eighties of the last century, from the other inflam-
mations of the kidneys as a special disease form. Siedamgrotzky (1875)
demonstrated in one case the presence of bacteria in the affected por-
tions of the kidneys, while Dammann (1877) had already noted the
typical arrangement of the bacteria (which he called micrococci) in
the urinary tubules. Hess (1888-1892), Bang (1889) and Schmidt
(1890). studied the disease closely and called attention to the regular
occurrence, in the affected kidneys, of the Bacillus renalis, which was
later studied at greater detail by Hoflich (1891), and Enderlen (1891).
Valuable investigations were made also by Lucet (1892), Mollereau &
Porcher (1895), Masselin & Porcher (1895), Jensen (1896), Cadéac
and Morot (1897), Albrecht (1900), Liénaux & Zwaenopoel (1902)
and Sommer (1906), while Ernst (1905) particularly studied the etiol-
ogy and pathogenesis of the disease, emphasizing its polybacterial
origin which had before him been pointed out by Lucet, Cadéac and
Kits.

Occurrence. In cattle pyelonephritis is a very frequent
disease, cows being particularly affected, often shortly after
calving, while calves or male animals (oxen, steers) acquire
the disease much less often. In hogs it is also observed in
exceptional cases (Jensen, Wyssmann) and Schmidt has seen
it in a colt.

Etiology. Pyelonephritis is a polybacterial disease in the
causation of which the Bacillus s. Corynebacillus renalis is con-
cerned most often, while other bacilli also take part in the in-
fection which are capable of producing suppuration or necrosis
of the renal tissue.

The Corynebacillus renalis, Ernst (Bacillus renalis bovis
[Bollinger, Enderlen, Hess], B. pyelonephritidis bovum
[Hoflich]) is characterized by its pleomorphic occurrence, it
forms, according to Ernst, rods 2-3-4 “ long, 0.5-0.6 # thick,
which are often united to short thread-like groups and are
irregular in form; sometimes they appear as slender rods,
slightly larger in the middle and at the ends, where they also
take the stain more deeply, sometimes as long thread-like for-
mations which are wound into balls and nets.

Staining succeeds with the customary stains as well as by Gram’s
and Weigert’s methods and shows either a division of the bacillary
bodies into fields arranged in ladder-form, or then a homogeneous
1012 Bacterial Pyelonephritis.

structure. The elongated thread-forms have club-shaped terminal
enlargements and spherical bud formations, also bulgings, excrescences
and often actual branching.

Liénaux & Zwaenopoel, also Hutyra have shown that this bacillus is closely
related to, if not identical with the B. pseudotuberculosis ovis, Preisz, which is
active in several other diseases. This would agree with Ernst’s claim_that the
B. renalis is to be classed in the group of the Corynebacteria to which the B. pseudo-
tuberculosis ovis belongs also.

Cultivation. The Corynebacillus renalis is aerobic. It hardly
grows at room temperature, but kept on agar at the temperature of
the body cultures are formed which are fine, whitish, dry, sandy or
moist shining, or then dry, gray and scaly. In agar shake cultures
two zones form, one about 2 mm, the other 12 mm below the surface,
where the oxygen tension is most favorable for growth. On blood
serum tender, transparent whitish-gray dots grow which glisten like dew
drops; in bouillon the cultures form a finely granular sediment. Ernst
has shown that the bacilli grow very well in neutral or iaintly alkaline
urine, in urine agar or in urine bouillon, and that in concentrated urine
agar a deposit of crystals forms around the stab which consists of triple
phosphates. Acids and indol are not produced. Certain cultural differ-
ences permit the assumption that there exist several slightly variable
strains.

Pathogenicity. The. injection of a pure culture under the
skin of mice or chickens produces no results (Enderlen, Ernst,
Masselin & Porcher), while in rabbits and guinea pigs either
a transitory swelling or an abscess develops (Enderlen, Kiinne-
mann, Ernst) or the animals are not affected at all (Lucet,
Masselin & Porcher). The same is observed after intraperi-
toneal or intrapulmonal inoculation of the culture (Enderlen,
Ernst). An intravenous injection produced purulent-cheesy
pneumonia in a rabbit (Ernst), intraocular inoculation often
a passing iritis (Enderlen, Kitt). Intravenous injection pre-
ceded by ligation of a ureter was followed in rabbits by a
process which was similar to pyelonephritis (Enderlen). In
sheep and in cattle subcutaneous injections are usually without
result or at most a temporary swelling develops at the point
of inoculation (Ernst), while intravenous injections of cultures
either remain likewise without result (Enderlen, Hoflich,
Kiinnemann) or Corynebacilli are eliminated with the urine
for several days or weeks without other disturbances (Hoflich,
Ernst). Intravesical injections in cows do not as a rule cause
any trouble (Hess, Enderlen, Hoflich, Kiinnemann, Ernst) or
they may exceptionally be followed by pyelonephritis (Masselin
& Porcher saw this in one case). A preliminary or simultaneous
irritation of, or injury to the mucosa of the bladder enables
the bacilli to localize in the bladder (Liénaux & Zwaenopoel,
Ernst), and according to Liénaux and Zwaenopoel a pyelone-
phritis may even follow.

Schmidt claims to have faa the Corynebacillus renalis
also in a colt with bacterial pyelonephritis.
Pathogenicity. 1013

Of other causes of pyelonephritis pure cultures have been
- found of the bacillus pyogenes (in cows and calves [Ernst]),
pyogenic staphylococci (Cadéac & Morot, Ernst), streptococci
(Baillet & Sérés, Ernst), bacillus pyocyaneus (Cadéac & Morot),
bacillus enteritidis (Sommer), bacilli of the colon group (Jensen,
Kitt). Most of the énumerated bacteria were also often found
together with the corynebacillus renalis, or several kinds of
them at the same time, so that a mixed infection was present
(Kitt, Ernst, Zschokke, Sommer). In two cases of kidney
tuberculosis Ernst found similar changes as in pyelonephritis,
although the tubercle. ‘bacillus was alone present.

wed ©

The ability of the bacteria of the colon group to cause pyelonephritis after
being introduced into the:bJadder was proved experimentally by Schmidt & Aschoff,
Savor, v. Wiinschheim. Qmn the other hand J. Koch produced proofs to show that
saprophytic staphylococci 'aye’also capable of giving rise to a typical pyelonephritis
in rabbits after subcutaneous or intravenous injection.

There exists thepéfore no specific virus of pyelonephritis in the
domestic animals. Nevertheless, in consideration of what has been
observed, it is not possible to agree with Ernst’s view, according to which
the Corynebacillus renalis has hardly anything to do with the genesis
of the disease. Earlier observers and recently also Kiinnemann found
pure culture of the bacillus in question in the diseased kidneys, and
Ernst himself found it almost pure in a few cases. On the other hand,
certain diseases (Pseudotuberculosis of sheep, ulcerating lymphangitis,
pustulous dermatitis) prove that the bacteria belonging to the group of
the Bac. pseudotuberculosis ovis possess pathogenic properties under
certain conditions.

Although it is not determined with certainty how the
natural infection is produced, it is at least very probable that
the virus may be introduced into the kidneys or into the urinary
organs in general in various ways. The general experience
that the disease develops. most frequently in cows, a certain
time after parturition, if during the latter the birth canal had
been injured or the placenta had been retained or if metritis
developed, makes it very probable that the virus multiplies
promptly in the diseased genital organs and may enter the
urinary organs if opportunity serves. This can take place
the more easily as most of the enumerated pathogenic germs
are ubiquitous bacteria, and some of them (for instance the
bacteria of the colon group) are regular inhabitants of the
intestinal canal. :

‘The dissemination of the virus may also take place from
other organs which are diseased in some manner owing to a
bacterial invasion. In a case described by Ernst the trouble
developed in connection with an abscess in the region of the
xiphoid cartilage, while in a case in a young steer observed
by Hess the infection had probably proceeded from a para-
urethral abscess. In newborn animals the umbilicus appears
often to be the point of entrance of the bacteria, without it
1014 Baeterial Pyelonephritis.

being necessary that the umbilicus is primarily diseased. The
fact that male or young animals are also affected without other
primary diseases has led Bang to suppose that the virus may
possibly be introduced by way of the digestive tract. Bollinger
considers also a cryptogenetic infection to be possible. This last
hypothesis receives some support by the experiments of Ficker
which showed that bacteria are absorbed by the uninjured
intestinal mucous membrane if the animals are subjected to
hunger or to excessive exertion.

Concerning the mode of invasion of the bacteria into the
kidneys the views differ. Some authors insist upon a urogenic,
others upon a hematogenic origin of the disease. Aside from
Enderlen’s experiments in rabbits, which have already been
mentioned and which were positive, the hematogenic invasion
of the bacteria is supported by some observations of Ernst,
in which the kidneys showed typical lesions while the urinary
passages were free from alterations or only the bladder con-
tained severe inflammatory lesions while the pelvis and ureters
were normal. Of like significance is the observation of Scherzer
where in a case of pyelonephritis the valves of the heart con-
tained deposits in which the Bac. pyogenes, which was present
in the kidneys, was found in pure culture. The above men-
tioned experiments of J. Koch afford further proofs (p. 1013)
and also those of Albarden, Savor and Orth which demonstrated
that bacilli of the colon group may produce the picture of
pyelonephritis by being eliminated in the kidneys.

On the other hand the urogenic origin of pyelonephritis
cannot be denied for all cases, the more so as, according to
the experiments of Schmidt & Aschoff, Savor and v. Wiinsch-
heim, colon bacilli may lead to the development of pyelonephritis
on being introduced into the bladder.

Evidently, however, the urogenic origin is rather rare.
It is always necessary to consider that the bacteria may enter
the blood vessels of the bladder and then reach the kidneys
by the blood paths after the bladder has become affected in
consequence of an artificial or a natural infection. This mode
of infection may be thought of, especially since the experiences
of human physicians in catheterization indicate that even super-
ficial epithelial defects in the mucous membrane of the bladder
may give rise to an absorption of bacteria into the circulation.

Favoring circumstances appear to be important factors
for the origin of pyelonephritis. Aside from the frequent con-
nection of the disease with the birth act or with inflammatory
processes in the female genital organs, and possibly also in other
organs, a functional irritation of the kidneys may have a pre-
disposing effect, even after normal parturition, and still more
the elimination of septic substances in the above mentioned
organic diseases.- The predisposing influence of urinary stasis
also deserves mention, whether it be due to pressure exerted
by the pregnant uterus, especially if the embryo is excessively
Pathogenesis. 1015

large, or by the full rumen or through some disease‘ of the
urinary organs. The influence of predisposing factors may
indeed be so important, that without it the pyelonephritis
would not have developed in spite of the bacterial invasion
of the kidneys.

Pathogenesis. In the ordinary hematogenic origin of
pyelonephritis the bacteria are arrested in the capillaries of
some glomeruli in one, more frequently in both kidneys, and
not rarely already in the small arteries; they then produce
a local inflammation of the related portions of the cortex, or
a thrombosis. A considerable portion of the bacteria is
eliminated and is compressed into cap-shaped bunches in the
capsules of Bowman, and partly transported with the urine.
The experiments of Orth and J. Koch, and also the micro-
scopical examinations of Ernst have shown that the eliminated
bacteria accumulate and multiply in the collecting tubules in
the lower portions of the medullary portion, whereupon an
inflammatory process commences in the immediate vicinity, also
in the mucous membrane of the papilla, of the renal pelvis
and in the ductus papillaris. In certain cases the deleterious
action of the microorganisms which are wedged in the renal
capillaries appears to become manifest only after their elimina-
tion in the collective tubules.

The further sequels of the inflammation differ to a certain
degree with the nature of the virus and according to the
presence or absence of a mixed infection. After the entrance
of the corynebacillus renalis the more or less localized inflam-
mation results in necrosis which leads to the formation of small
softened foci in the kidney, while in the center of the papilla
a sequestrum is formed, surrounded by healthy. or at least by
not degenerated tissue in which the collective tubules break
up into fibres. Eventually caseation and perhaps calcareous
incrustation of the necrotic tissue takes place and at the
periphery the inflammatory process either progresses or the
inflammatory focus is circumscribed by a zone of demarcation.
If pyelonephritis has been produced by other microorganisms
the process differs only in so far as the inflamed tissue under-
goes softening and suppuration. The same is to be observed
in mixed infection which occurs frequently. In the surround-
ings of the necrotic foci the connective tissue proliferates and
then atrophies while the unaffected portions of the kidneys
hypertrophy. ;

Sooner or later an inflammation of the descending urinary
passages is added to the process in the kidney. Owing to
the constant contact of the mucous membrane of the renal
pelvis with the bacteria and inflammatory products which ac-
cumulate in the corners of the pelvis, the tips of the originally
affected papilla and of other papillae, as well as the mucous
1016 Bacterial Pyelonephritis.

membrane of the renal pelvis in general become involved in
the diphtheritic and suppurating inflammatory process. Of
the peripheral urinary passages the bladder is most endangered
(and also the urachus if this is not yet obliterated) because the
urine remains there for a longer time. Accordingly a very severe
inflammation sometimes develops in the bladder. The affection
of the descending urinary passages, not excepting the ureters,
is greatly favored by the urinary stasis which necessarily
occurs, at least at times during the disease, and also by the
constant irritation by the disintegration products of the urine.
Under these conditions the germs: are packed into the collecting
tubules and, after the destruction of the pelvic mucous mem-
brane, the inflammatory process continues directly into the
renal tissue. In this manner an ascending inflammation of
the kidneys is added to the original process.

In the urogenic origin of the disease, which is undoubtedly
infrequent, the inflammation of the kidney commences with
the process that was just described, after the inflammation has
existed for some time in the urinary passages.

It appears from what has been said that no sharp distinctions can be drawn
between embolic purulent nephritis and, bacterial pyelonephritis.

Anatomical Changes. In well developed cases both kidneys
or only one are enlarged more or less, 1-4 kg. in weight (in a
case of Cadéac’s the kidney weighed 6.5 kg.). The renal capsule
is thickened, adherent to the cortex in many places and in varia-
ble extension, the surface of the kidney is multi-colored; on
a red-brown ground yellowish-gray islands are prominent, and
corresponding with them striae or wider wedge-shaped bands
of similar color are visible on the cut surface. Within these
islands and within the brown portions of the kidneys there
appear yellowish-gray, turbid small foci which are suppurating
and soft or friable and cheesy, each one being surrounded by
hemorrhagic spots. Hemorrhagic infarcts are rare. Later the
consistency of the kidney increases, but in the initial stage
the tissue shows more or less serous infiltration.

The dilated pelvis of the kidney contains a dirty-gray,
grayish-yellow, yellowish-brown or brownish fluid which may
be bloody discolored, cloudy, floceulent and peculiarly milky
and which contains pus, tissue shreds, blood clots and granular
calcareous material. The mucous membrane is much swollen
or thickened, in recent cases studded with hemorrhagic spots;
in places it shows ulcerous destruction or dirty-gray deposits.
The renal papillae are covered with a viscid purulent substance,
they are reddened and terminate in dirty discolored tissue
shreds so that they have an eroded appearance. Sometimes the
places of the renal papillae are occupied by hollow spaces
filled with purulent masses (Pyelonephritis cavernosa) or if
the process progressed by multiple lobar extension, the entire
Anatomical Changes, Symptoms. 1017

kidney is transformed into a pus sac consisting of several
compartments, 4-16 kg. in weight (Pyonephrosis) (Kitt).

The ureter is changed into a tube with thick walls, up
to two fingers in width, the mucosa may present similar changes
as that of the renal pelvis. The mucous membrane of the
bladder also sometimes contains hemorrhages or a variable
inflammation which may even be diphtheritic.

The microscopical examination of the affected kidney gives the following.
result, according to Ernst: Cellular infiltration in the cortex, in places assuming the
form of small or large purulent infarcts, the dilated urinary tubules are filled with
anuclear epithelia, pus cells and casts, vascular thrombosis is frequent; in a more
advanced stage connective tissue proliferation, necrotic or purulent foci especially
in the papillae. Masses of bacteria are found in the small softened foci in the
cortex, in the capsules of Bowman and inthe thrombi of the blood vessels, while the
collecting tubules appear as though filled up with bacteria.

The fluid in the renal pelvis and the ureter contains much tissue detritus,
numerous pus cells, some red blood corpuscles, fibrin threads, pavement and cylin-
ric epithelia and crystals of triple phosphates; there are also found masses of
B. renalis, alone or more often associated with other bacteria.

Symptoms. It is impossible to indicate a definite period
of incubation because the exact time of the bacterial invasion
zannot be ascertained. It appears from the observations made
ap to the present that pyelonephritis may become manifest
in from a few days to several months after the commencement
of the primary disease.

In the more frequent chronic form the clinical symptoms
are diminished appetite, suppression of rumination, emaciation,
staggering gait, the urine is voided fairly easily. Pressure
upon the lumbar region sometimes produces manifestations
of pain. On rectal exploration the bladder is found half filled,
sometimes the dilated ureter is felt above the pelvis, below
the vertebral column, on both sides or only one, it feels like
a firm rope passing to the kidneys and is usually thickened
in its anterior portion. Palpation of the kidneys may indicate
normal conditions or enlargement, sometimes fluctuation, or
sensitiveness to pressure in one or both kidneys.

It is more frequent to find increased urination associated
with painful exertions. Pressure on the sacral region causes
pain, a thick purulent vaginal discharge soils the pubic region.
Rectal examination gives similar results as in the preceding
ease, but on inspection catarrhal reddening or swelling of the
vaginal mucosa is seen, especially around the urethral opening,
and the mucosa may be covered with superficial ulcers. In
male animals the prepuce may be inflamed (Hess). At times
colicky symptoms appear, probably due to the temporary
occlusion of the ureters by masses of exudate, blood clots or
sediment. 2

The urine is seldom clear and even then contains albumen,
and on microscopical examination cellular elements and the
bacillary clumps described above. In the great majority of
cases the urine is turbid, muddy, sometimes bloody, strongly
1018 Bacterial Pyelonephritis.

alkaline and contains as much as 2% of albumen, and also free
ammonia. Under the microscope there appear pus cells, red
blood corpuscles, epithelial cells, crystals of triple phosphates
and often renal elements. By Gram’s stain and even in un-
stained specimens of fresh urine clumped bacilli or other
bacteria are seen (Fig. 176).

Toward the termination of the disease the animals are
extremely emaciated and unable to stand. They die of ex-
haustion or of acute uremia unless they are killed. In the
rare acute form symptoms of fever (up to 39.0° to 40° C.)
and rapid pulse are observed. The local manifestations of

%

\
‘

        

af

Fig. 176. Urinary sediment of wu cow with bacterial pyelonephritis. a Clumps of
Corynebacillus renalis. 6 Squamous epithelium from the urinary passages. c renal
epithelium; d pus cells; ¢ red blood corpuscles. (Magnif. about 1000.)

the chronic form are intensified and the urinary findings are
similar. This form is probably due to a septicemic infection
from the urinary organs or to a severe acute nephritis, it may
lead to death within two weeks, but in exceptional cases the
symptoms diminish in severity and the disease passes into
the chronic form.

Recovery of a well defined pyelonephritis has never yet
been observed, although the possibility of a clinical cure is
not excluded if the disease is unilateral.

Diagnosis. As has been pointed out first by Schmidt, the
disease may be recognized positively by the microscopic demon-
Diagnosis, Treatinent. 1019

stration of the Corynebacillus renalis which is usually present.
Only upon this basis is it possible to differentiate the affection
from the other forms of nephritis or from inflammatory affec-
tions of the uterus, vagina and bladder, and also from renal
tuberculosis. Mistakes are the more easily possible as many
of these diseases also frequently occur after parturition with-
out simultaneous nephritis. If no symptoms exist pointing to
these affections, and if some weeks after'a delivery which was
not quite normal, the urine contains pus, there exists a just
suspicion of pyelonephritis which is further supported by the
demonstration of a thickened ureter and enlargement of the
corresponding kidney.

Treatment. Since all efforts at treatment have hitherto
proved in vain it is advisable to slaughter the animals as soon
as possible. In the beginning of the disease irrigation of the
vagina and bladder and internal disinfectants like salicylic
acid, Folia uvae ursi (25-59 gm.) may be tried.

Literature. Albrecht, W. f. Tk., 1900. 409. — Baillet & Sérés, Rev. gén.,
1903, I. 504. — Bartels, D. t. W., 1879. 303. — Cadéae & Morot, J. vét., 1897.
65 — Dammann, D. Z. f. Tm., 1877, III. 265. — Enderlen, D. {Z f. Tm., 1891.
XVII. 325 (Lit.). — Ernst, Chl. f. Bakt., 1905. XXXIX. 549; XL. 79 (Lit.). —
Friedberger, Minch. Jhb., 1899/90. 164. — Gillot, Rec., 1888. 159. — Hess,
Schw. A., 1888. XXX. 269; 1891. XXXIII. 157; 1892. XXXIV. 70. — Hé@flich,
Monh., 1891. II. 337 (Lit.). — Jensen, Ergebn. d. Path., 1895. II. 389 (Lit.). —
Koch, Z. f. Hyg., 1907. LVIII 287. — Kiinnemann, A. f.. Tk., 1903. XXIX. 128.
— Liénaux & Zwaenopoel, Ann., 1902. 500. — Lucet, J. vét., 1892. 220. —
Masselin & Porcher, Rec., 1895. 657. — Mollereau & Porcher, Bull., 1895. 322.
— Scherzer, B. t. W., 1903. 445. — Schmidt, Maanedsskr., 1890. II. 149; 1899.
X. 179, — Sommer, B. t. W., 1906. 400. — Wyssmann, Schw. A., 1904. XLVI. 287.

11. Inflammation of the Renal Pelvis. Pyelitis.

Etiology. An inflammation of the mucous membrane of
the renal pelvis arises usually in consequence of mechanical
irritation, particularly in the presence of urinary caleuli (in
birds ‘also when uric acid crystals are present) and of animal
parasites in the pelvis of the kidneys, also in stasis of the
urine in which fermentation is produced by bacteria. Infectious
and poisonous substances which leave the kidneys with the
urine may also exert a pathogenic action upon the mucous
membrane of the pelvis. For instance, in acute infectious
diseases the renal pelvis frequently shows catarrhal involve-
ment when the renal tissue is also affected; Dieckerhoff even
observed a diphtheritic pyelitis in a case of influenza. Occa-
sionally the bacilli of tuberculosis and of glanders produce
specific changes in the renal pelvis. Of chemical irritants,
especially cantharides, oil of turpentine and the severe diuretic
remedies in general cause pyelitis if they are administered
for a considerable time or in large amounts. Prolonged venous
stasis in the kidneys may also give rise to changes in the mucous
1020 Pyelitis.

membrane of the renal pelvis which are similar to chronic
eatarrh. Finally the disease occurs in conjunction with severe,
especially with purulent nephritis, and also with ascending in-
flammation of the bladder and of the ureters.

Anatomical Changes. Simple catarrh of the mucous mem-
brane of the pelvis (Pyelitis catarrhalis) is characterized by
increased redness and swelling, possibly. small hemorrhages,
in chronic cases by slate-gray discoloration and thickening of
the mucosa which is covered with thick mucus or pus and at
times with a granular or lumpy deposit. In severe inflamma-
tion a great number of hemorrhagic foci are found in the
mucosa and much blood within the pelvis (P: Haemorrhagica) ;
in other cases there is ulcerous destruction of the mucosa
(P. uleerosa) or this is covered with membranous deposits
(P. membranacea s. diphtherica). The inflammatory process
may be associated with a dilatation of the renal pelvis, its cavity
being filled with urine (Hydronephrosis) or largely with pus
(Pyonephrosis). ,

Symptoms. Usually the patients show symptoms of pain
which are not, however, characteristic. In larger animals rectal
exploration sometimes makes it possible to determine sensitive-
ness to pressure in one or both kidneys and, in some cases,
a dilatation of the corresponding renal pelvis; in smaller
animals pressure through the abdominal wall elicits evidences
of pain. Some animals have frequent desire to urinate, only
a small amount of urine being voided at one time, in other cases
micturition is normal.

The color and specific gravity of the urine are often normal,
but the urine contains much mucus and more or less pus. The
reaction is alkaline in herbivora, acid or alkaline in carnivora,
the latter especially in ammoniacal fermentation. In any case
the urine contains albumen corresponding in quantity to that
of the pus. In consequence there is always a fairly copious
organic sediment, containing pus cells, and also long-tailed,
epithelial cells which look like molars, have pointed projections
at one or both ends, and are derived from the deeper epithelial
layers of the mucous membrane of the renal pelvis; there are
also pavement epithelia. At times the sediment contains red
blood corpuscles, small blood clots and mucous shreds. If
urinary calculi are present in the renal pelvis the urine con-
tains whitish or yellowish sandy granules, if parasites are
present the sediment contains eggs of worms.

Since inflammation of the renal pelvis is often accompanied
by nephritis or by catarrh of the bladder, the clinical picture
may be more or less obscured by the symptoms of these
diseases.

Pyelitis is always of serious significance, because it is the
Symptoms, Diagnosis, Treatment. 1021

sequel of dangerous primary diseases (calculi, parasites,
nephritis) or leads of its own account to the development of
nephritis.

Diagnosis. The disease can be recognized only by means
of urinary examination. The presence of pus cells and of
molar-shaped epithelial cells is particularly significant, but is
characteristic only then when a ecatarrh of the bladder may
be excluded, because long-tailed, molar-shaped epithelia may
also be derived from the deeper layers of the vesical mucosa.
The pus may also have entered the urine from other yarts
of the urinary organs, especially from the kidneys, from peri-
renal abscesses, from the bladder, the prostate, etc.; and it is
often extremely difficult or impossible to ascertain its origin.
It is finally to be considered that in the presence of a balanitis,
of a uterine or a vaginal catarrh, pus may be mixed with the
normal urine.

Treatment. For the purpose of disinfecting the renal
pelvis the following remedies may be administered internally:
Salicylic acid or its salts (25-50 gm. for horses and cattle;
2-10 gm. for sheep, goats, hogs; 0.1-2.0 gm. for carnivora at
each dose); according to Walther these preparations may,
however, produce albuminuria and even nephritis by irritating
the urinary passages and the kidneys. Salol in like doses, oil
of turpentine (100-200 gm., or 5-25 gm., or 0.05-2 gm.),
urotropin (5-10 gm. for large, 0.5-1.0 gm. for smaller animals,
3 times daily with much water [Gmeiner]), helmitol (6-10 gm.
for large, 1-2 gm. for smaller animals, per dose, 3 times daily),
Folia uvae ursi (20-50 gm. for large, 1-15 gm. for smaller
animals).

12. Kidney Stone Disease. Nephrolithiasis.
(Caleuli renales.)

Occurrence. Urinary stones are in domestic animals not
infrequent and are found in various portions of the urinary
passages. They occur primarily almost always in the wider
parts of the urinary apparatus, either in the renal pelvis,
possibly already in the straight urinary tubes, or in the bladder,
and are only later carried with the urine into other portions
of the urinary passages. Stones are found most often in horses
and cattle and are much more rare in the other mammals and
in fowls. Their frequency is said to increase with the age
of the animals (Moller). Sometimes the trouble occurs simul-
taneously in many animals among cattle, sheep and hogs.

In the years 1862-1897 urinary calculi were found in the Dresden pathological

Institute in 12 out of 3,301 dogs (0.38%), in 1 out of 450 cats (0.22%), and ir
11 out of 2,100 horses (0.5%).
1022 Kidney Stone Disease.

Etiology. According to Klimmer the principal condition
for the development of urinary calculi is that the urine con-
tains an excess of salts or that slightly soluble or insoluble salts
are formed in it, already within the urinary passages. In both
cases the eliminated salts are deposited upon any foreign body
that may be present in the urinary passages, and the small
stone which is formed in this manner gradually enlarges by
the continued deposit of salts. It .is a question whether the
presence of sticky substances, especially of albuminous or
gelatinous bodies is required for the formation of stones. The
nucleus on which the eliminated salts are deposited is usually
furnished by some element derived from the urinary organs
(epithelial cells, casts, blood clots, pus- and fibrin shreds,
necrotic tissue shreds), it is rarely a foreign body which has
oe the urinary passages from the outside (straw, gravel,
etc.).

The amount of salts present in the urine is materially
influenced by the chemical composition of the food and of the
drinking water, and therefore in a way also by. the conditions
of soil. Drinking water which contains much lime or many
earthy constituents is of importance; so are food-stuffs that
are mixed with earthy substances or which are rich in calcium.
It can thus be explained why the disease is more frequent
in herbivora in regions where the soil is calcareous (Lang
observed on one estate the disease exclusively in those oxen
which had lived, at least for a time, on a certain farm). Multiple
cases may occur independently of the conditions of soil after
inappropriate feeding. Especially feeding with very large
quantities of potatoes, the waste of sugar beets, beets, and slop
may be followed in cattle by the formation of silicate con-
cretions, and a food rich in phosphorus (bran, grains) may give
rise to phosphatic caleuli (especially in sheep). Theis saw
urinary stones in two mares which had for months received
prepared bone meal.

Inflammatory diseases of the urinary passages, also in
complete retention of urine, from whatever cause, may lead
to the formation of calculi by causing the formation of slightly
soluble or insoluble compounds, owing to the disintegration
of the urine; they furnish at the same time a nucleus for the
calculus. In this direction bacterial diseases are particularly
dangerous.

The attempt has been made repeatedly to produce urinary caleuli artificially.
In Studensky’s experiments salts were indeed deposited upon foreign bodies that
had been introduced into the bladder, but actual calculi were formed only when the
bladder was at the same time subject to catarrhal affection. Ebstein and Nicolaier
observed the formation of stones after the systematic administration of oxamide.
According to these authors this substance is absorbed in the intestines, is then elim-
inated in the kidneys and, on coming in contact with the mucosa of the urinary pas-
sages it causes a necrosis of the epithelial cells, so that the albuminous substance is
supplied which is said to be required for the formation of calculus. Thomassen also
found small stones in the renal pelvis of a small dog which had been fed with
oxamide for.two weeks. . :
Anatomical Changes. 1023

In calculating the time of development of the calculi their size and chemical
composition must be considered, and also the external conditions (Klimmer). Pflug
zays that phosphatic concretions grow more rapidly than the other calculi. Rathke
observed in cattle in the space of three weeks the formation of calculi of from pin-
head- to bean-size.

Anatomical Changes. Kidney stones are sometimes quite
small, covering the mucous membrane of the renal pelvis in
the form of fine or coarse grits, and are there mixed with the
urine, in exceptional cases they are imbedded in the renal
tissue; in other cases they are good-sized actual stones and
may fill out entire calyces and even the whole renal pelvis.
The last variety of stone is sometimes round, lying free in
the pelvis, or if present in numbers, they are polished smooth
by mutual friction. Larger stones show irregular coral shapes
with knobbed surfaces from having adapted their shape to
the form of the cavity in which they formed. Sometimes each
calyx is filled by one stone, in other cases the stones are con-
nected by their extremities which point toward the ureters
or they may fuse together to good-sized masses after atrophy
of the calyces. As the stones grow, the renal substance grad-
ually disappears and finally large stones may imitate the shape
of the kidney, and are found surrounded only by a thick
capsule.

If several stones are present, the mucous membrane of
the renal pelvis is always inflamed, perhaps it contains hemor-
rhagic spots or ulcers, or is covered with diphtheritic pseudo-
membranes. The renal tissue usually. bears the signs of an
acute or a chronic inflammation.

The urinary ealeuli of herbivora are grayish-white, brown or mottled and con-
sist, according to examinations made by Furstenberg, largely of calcium carbonate
and magnesium carbonate which form multicolored layers around a nucleus consist-
ing of organic substances, rarely of calcium oxalate. In cattle and sheep the stones
are smooth, often small, yellowish or gray, spherical or angular, and have a peculiar
metallic or mother-of- read luster, which evidently is due to the very fine arrange-
ment of the layers, although Fiirstenberg believes it due to the admixture of ferrous
carbonate. Bourmer demonstrated 0.28% of iron in the renal stones of a cow.
Some stones do not show layers and are more friable. They consist of a small
amount of organic material, of calcium carbonate and of a small quantity of mag-
nesia carbonate. In a cow which had probably suffered from leukemia or pseudo-
leukemia Joest found xanthin stones which usually are formed in case of consider-
able destruction of cellular nuclei and which had already been found by Weiske
in a ram having presumably suffered with leukemia.

The calculi of carnivora contain ammoniacal’ magnesia phosphate and small
quantities of calcium phosphate or carbonate, usually also uric acid and its salts.
Cystin calculi are much less frequent and are always small, soft and of a greasy
luster.

Symptoms. Renal calculi give rise to a clinical picture
which is as a whole similar to that of pyelitis, except that
the evidences of pain are more decided and are rarely absent.
Nevertheless cases undoubtedly occur in which large stones
are found on autopsy and perhaps total atrophy of one kidney,
and in which the animal showed no signs of disease during
life. The walk becomes stiff, the region of the kidneys sensi-
1024 Kidney Stone Disease.

tive to pressure. In many cases the animals (horses, cattle,
sheep) are attacked by severe colic, either suddenly or after
violent motions, after jumping, etc., and during these attacks
repeated attempts are made to urinate. These severe colicky
pains are observed especially when the ureter is occluded by
a stone which has passed out of the renal pelvis, because both
the mechanical irritation of the ureteral walls and the stasis
of the urine cause pain until the stone is finally discharged
into the bladder. During the attacks it may be totally im-
possible to void the urine if both ureters are occluded (Barthe),
or if, in unilateral obstruction of the ureter, the function of
the other kidney has been temporarily suppressed by reflex
action (Morgagni). A prolongation of the anuria may lead to
uremia. This ‘‘renal colic’’ usually recurs, because several
small stones are present in the renal pelvis and because new
ones are always formed which from time to time pass into the
ureter.

The urine contains pus cells, perhaps epithelial cells from
the pelvis of the kidney, and. at times a sandy sediment or
small stones. It is not rarely bloody, and on microscopical
examination fine fibrinous coagulates are found in addition to
red blood corpuscles. In cattle and sheep grit-like granules
sometimes adhere to the hairs around the opening of the
sheath.

The nature of the disease may at times be discovered by
rectal examination or by palpation through the abdominal
walls, that is, in cases in which the presence of one or several
stones in the renal pelvis may be determined in addition to
the increased sensitiveness of the kidneys and of the renal
pelvis. If several stones are present a slight trembling is felt
on palpation in the walls of the renal pelvis which is produced
by the rubbing of the stones against each other. During the
colicky attacks the stone, which is wedged in the ureter, may
sometimes be felt as a swelling of pea to bean size, which is
very sensitive to pressure.

Course and Prognosis. Kidney stones always cause pro-
longed disease, in the course of which attacks of colic and
disturbances in micturition alternate in long periods. The
disease develops slowly and may lead to gradual exhaustion
of the animal. The pyelitis which has been produced by the
calculi is followed by acute or chronic nephritis or the renal
tissue is destroyed by atrophy so that the elimination of the
urine is necessarily impaired, especially in bilateral disease.
Occasionally necrosis develops in the wall of the ureter around
the arrested stone and this leads to peritonitis or to purulent
inflammation of the perirenal connective tissue. Kidney stones
may also reach the bladder, may here increase in size and
cause catarrh of the bladder, or they may later on be forced
Course and Prognosis. 1025

into the urethra where they produce retention of urine which:
may lead to death in a brief time.

Diagnosis. <A. sufficiently positive recognition of the disease
presupposes the demonstration of pyelitis, or sandy or gritty
sediment in the urine, or the direct discovery of stones in
the renal pelvis by means of palpation. The disease may be
mistaken for other colicky diseases, nephritis, paranephritic
abscess, renal tumor, ete.

Treatment. If there is a suspicion of calculus formation,
the diet must above all be regulated thus that the animals
ingest with their food or drinking water as small amounts
as possible of salts. In herbivora it is therefore necessary
to withdraw especially bran and to limit grains; carnivora
should receive only little meat; in addition, good soft water
must be supplied. The drinking of large amounts of carbonated
water is recommended to secure the solution of caleuli and
prevent their formation. In renal colic subcutaneous injections
of morphine or the administration of chloral hydrate is in-
dicated. - ae

Lorge and Rubay have attempted the operative removal
of kidney stones (nephrotomy) with satisfactory results. The
resection of the diseased kidney (nephrectomy) may also be,
thought of. eee

Literature. Albrecht, W. f. Tk., 1900. 1. — Ball, J. vét., 1906. 193. —
Barthe, Rev. vét., 1906. 289. — Bourmer, Beitr. z. Nephrolithiasis usw. Diss. Bern.
1908 (Lit.)..— Brun, Bull., 1902. 80. — Dammann, D. t. W., 1897. 435. — Fréger,
J. vét., 1907. 326. — Hébrant, Ann., 1902. 578. — Imminger, W. f. Tk., 1901.
553. — Klimmer, A. f. Tk., 1899. XXV. 336. (complete Lit. to 1899). — Prietsch,
S. B., 1901. 45. — Rabieaux, Bull., 1902. 310. — Rathke, Pr. Mt., 1865-66. 129. —
Rubay, Ann., 1895. 413. — Theis, Bull., 1905. 255.

13. Renal Dropsy. Hydronephrosis.
(Cystic Kidney.)

Occurrence. Hydronephrosis is frequently found in cattle,
hogs and sheep during meat inspection.

Lucks found the affection in 43 (0.67%) out of 6,425. hogs examined, in
female pigs almost 3 times as often as in males; in 29 animals the’ conditicn
was unilateral (10 times on the left side, 19 times on the right side), in 14 animals
it was bilateral. Horn saw hydronephrosis in 0.21% of 7,000 slaughtered sheep,
usually unilateral,.and due to kidney stones in 80% of the cases. .

Etiology. The immediate cause of hydronephrosis is sup-
plied by an impediment to the flow of the urine from one or
both renal pelvis, in consequence of which the urine, which is
steadily secreted, is dammed up behind the impediment with
a constantly increasing pressure. The affected urinary passages
gradually become dilated and the medullary substance of the

Vol. 1—65
1026 Hydronephrosis.

kidneys atrophies, until finally even the cortex becomes
atrophic; with this the process is arrested because no more
urine is secreted. If the impediment is proximal to the bladder,
only one kidney is usually affected; other impediments to ‘the
outflow of urine necessarily lead to bilateral hydronephrosis.

It is evident that only chronic or periodical abnormal conditions of the
organs which discharge the urine are capable of producing hydronephrosis, since
its development requires a period of several months. Total occlusion of both
ureters or of the urine-carrying organs from the openings of the ureters down
is not followed by hydronephrosis because the animal perishes of uremia or of
‘rupture of the bladder in a comparatively short time. But even a unilateral total
occlusion of the ureter does not produce hydronephrosis if it is permanent, because
then the pressure in the urinary passages rapidly increases, and therefore the
secretion of urine in the corresponding kidney diminishes just as rapidly and to
complete cessation (Senator).

As to the individual causes, this much is certain that the
following affections are, although comparatively rarely, of
fairly equal importance in all animal species; inflammation of
the bladder or of the ureters, obstruction of the ureters by
stones, secretions, coagulated blood (for instance in bacterial
pyelonephritis), the obliteration of the ureter-opening into the
bladder (evidently congenital [Kitt]), congenital valvular for-
mations, constriction of the ureter by muscular fibers of the
wall of the bladder (Lucks), stenosis of the urethra in enlarge-
ment of the prostate, compression through tumors, ete.

The most frequent causes are, however, of different
character. In hogs, Lucks proved by the results of careful
examinations in 30 cases that the cause of hydronephrosis
usually lies in the fact that the openings of the ureters are
congenitally placed too low in the neck of the bladder (on one
or both sides) and that in the hog the attachment of the bladder
is very loose. This makes it possible that the partially filled
bladder, which then falls lower down, presses its neck, together
with the caudal portion of the ureter against the anterior border
of the pubis and thus periodically prevents the voiding of the
urine. In cattle other causes are probably active, for instance,
the occasional bending of the left ureter by the filled rumen,
in which case the left kidney is pushed out of place (Breuer),
also the compression of the ureter by the filled stomach.

In chronic inflammatory processes in the kidneys some urinary tubuli are
at times constricted in portions by the contraction of the connective tissue which
is undergoing atrophy, or are filled with small stones or cell masses, so that the
canals which are attached to the Malpighian bodies are dilated, the urine con-
tinuing to be secreted, and are thus transformed into retention cysts. Such small
cysts are sometimes found in large numbers, the contiguous ones become confluent
and the entire kidney is transformed into a collection of cysts of variable sizes
(cystic kidney, hydrops cysticus). In this form the trouble is found especially
in eattle, and occasionally as a congenital condition.

Anatomical Changes. The dropsical alteration of the
kidney may be met with in various stages. If the process is
far advanced,-the kidney is changed into a large undulating
Anatomical Changes, Symptoms, 1027:

bladder (in cattle it may be 4% m. long and as wide [Kitt],
in pigs it may attain a weight of 42 kg. [Richter]). The wall
of this bladder is formed by the thickened capsule of the kidney
and only here and there isolated portions of the cortical kidney
substance may be seen. The lobulated kidneys now are divided
into several compartments and, if the impediment is in the
region of the bladder, these compartments form the direct con-
tinuation of the ureter which occasionally may also be dilated
excessively. In less severe cases the cross section shows a
variable layer of the renal substance, which looks firm and
anemic; in disease of slight degree, only the calyces and’ the
pelvis of the kidney are dilated noticeably.

In the cystié kidney it is usual to find partial or total sclerosis of the renal
tissue and in addition watery cysts of from poppy- to hemp-seed size, or, if they
have become confluent, vesicles as large as hazelnuts or larger, up to the size of
a fist and even of a man’s head; they have a. white-bluish luster and are wabbly.
In cattle the separate renal lobes may thus be transformed into cysts.

Symptoms. One kidney may be altered very greatly, as
above described, without causing any particular. disturbances .
in regard to the discharge of urine, because the other organ;
which has become enlarged by compensation, is capable of. at-
tending to the elimination of the urine. In bilateral disease
symptoms may become manifest much earlier, especially a
permanent or intermittent diminution in the quantity of urine,
which may even amount to complete, although transitory
anuria, dependent upon whether the discharge of the urine
is impeded continuously by the underlying cause or only from
time to time. If the anuria persists for a long time, or in
the case of a severe bilateral hydronephrosis, uremic symptoms
are not long in making their appearance. On rectal explora-
tion or on external palpation of the abdomen one or both kidneys
are more or less enlarged and fluctuating but not painful.
The dilated ureter may sometimes be palpated from the rectum.
In smaller animals the enlargement of the kidney may lead
to a considerable increase in the size of the abdomen and in
such cases exploratory puncture of the swelling yields a urine-
like fluid.

Richter observed, in a two-year-old pig, an enormous enlargement of the
abdomen which almost touched the floor and showed distinct fluctuations; the
motions of the animal were clumsy and staggering; it often assumed a sitting
position like a dog.

In the majority of cases hydronephrosis does not seem to
cause any particular disturbance of health, and none was ever
observed in cystic kidney, which usually affects only portions
of the kidneys.

Treatment. If the impediment to the flow of urine canno
be removed only extirpation of the affected kidney (nephrec-
1028 Renal Tumors.

tomy) can, in case of unilateral disease, be considered, if the
enlarged kidney interferes with the health of the animal by
compressing the abdominal organs. This procedure can, only
then be successful when the other organ is still capable of
functioning.

Literature. Barrier, Bull., 1906. 683. — Basset, Rev. gén., 1903. I. 263. —
Horn, Beitr. z. Kenntn. d. chron. Nierenerkrank. d. Schafes. Diss. Leipzig, 1908.
— Kowalewski, A. f. Vet.-Wiss., 1904. 1004, — Kukuljevié, A. L., 1905. 539. —
.Lucks, Monh., 1905. XVI. 254, — ’ Richter, Z. f. Flhyg., 1907. XVII. 429, — Suffran
& Daille, Rev. vét., 1905. 612.

14. Renal Tumors.

Among new-formations in the kidneys there are found especially
adenomas and carcinomas; primary sarcoma is very rare, but second-
arily it occurs occasionally. In dogs villous proliferations sometimes
develop in the renal pelvis and in the ureter, and impede the outflow of
the urine, thus causing dilatation of the renal pelvis and atrophy of the
substance of the kidney.

Tuberculosis of the kidneys is frequent in cattle and is also met with
in dogs and pigs. Small tubercles or larger cheesy foci are disseminated
mainly in the cortical portion where they originated through embolisms.
As the cheesy foci enlarge they may finally perforate the walls of the
renal pelvis and then the tuberculous process passes over into the
mucous membrane of the latter. Tuberculosis may in this location some-
times also arise from urogenic infection.

New-formations in the kidneys are recognized only with difficulty
and their recognition is only possible if one or both kidneys are. con-
siderably enlarged. The actual nature of the new-formation is some-
times indicated by external conditions, such as their presence in other
organs or as the enlargement of inguinal glands (in carcinoma). If an
enlargement of the kidneys exists or if the urine-carrying organs are
not affected the diagnosis of renal tuberculosis depends upon the demon-
stration of tubercle bacilli in the urine.

The treatment can at best be symptomatic.

15. Animal Parasites in the Kidneys.
(a): Eustrongylus gigas.

Etiology. The eustrongylus gigas, which sometimes occurs
as a parasite in the renal pelvis of dogs, horses, cattle; also
in many wild living animals and in man, is a blood-red thread-
worm about the size of a lead pencil; the male is 13-40 em.
long, the female 20 cm.-1 m. The eggs (Fig. 177) are oval in
shape, brownish in color; their covering is thick and shows
numerous round depressions. The eggs are 68-80 “ long and
30-44 » wide.

It is not known how the worm enters the renal pelvis.
While it grows here it produces a severe purulent and hemor-
rhagic inflammation which in its turn causes a secondary in-
\

Etiology, Symptoms, ‘ 1029

flammation and destruction of the renal tissue. The kidney
is eventually transformed into a thick-walled sac in which
the worm is coiled up, imbedded in a
purulent-bloody mass. In rare cases two
worms are found together in one renal
pelvis; Verney has even found four
specimens in the kidney of a dog.

 

Symptoms. The symptoms which
are caused by the worms vary from case pig. 177. Eggs of Hustron-
to case, and it may even occur that in gylus gigas. (After RAI-
spite of their presence no disturbances |
in health are observed; especially in
horses and cattle hardly any disease symptoms have been
reported. On the other hand, dogs suffer severe pain, are
restless and may even show mania and an inclination to
bite, simulating rabies. Sometimes the vertebral column is
eurved laterally, the concavity corresponding to the affected
side. In other cases only general indisposition and emaciation
are noted and may increase to complete exhaustion. The void-
ing of the urine may require an effort, it contains pus and
blood and indicates the existence of pyelitis.

Diagnosis. The disease can be diagnosed only by the
demonstration of the characteristic worm-eggs (Fig. 177) in
the urine.

_ Course. In the presence of severe functional disturbances
the disease usually ends in death. Lacoste saw in one case
the worm pass out through the urethra after which the dog
recovered completely. In exceptional cases the worm leaves
the renal pelvis and is arrested in the bladder where it causes
intense inflammation, or it passes on to the penal bone, causing
a swelling in the region of the perineum which may become
as large as a fist and in which the worm is coiled up (Leblanc,
Mégnin). Uremic symptoms may also occur.

Treatment. The removal of the worm from the renal
pelvis may be attempted by oil of turpentine (for dogs table-
or coffee-spoonful). If the worm is arrested in the urethra
it can be removed by incising the swelling.

Literature, Leblanc, Bull. de 1’acad. méd., 1850. 640. — Mathis, Lyon méd.,
1884. 499. — Mégnin, Rec., 1879. 223. — Neumann, Mal. parasitaires, 1892. 740
(Lit.). — Pease & Smith, Vet. Journ., 1905. 200. — Railliet, Zool. méd., 1895.
419. — Rivolta, Med. vet., 1867. 1.

(b) Other Parasites in the Kidneys.

Of threadworms the larvae of the Sclerostomum are found in the
kidneys of horses where they localize in the renal artery or its branches
and may give rise to hemorrhage in the kidney (see page ...). Petit,
1030 . Parasites in the Kidneys.

Henry & Germain (Rec. 1909, 493) found in a horse, that had been
killed on account of repeated attacks of delirium, numerous tubercle-like
foci, almost always in the cortical substance, which contained worm
larvae similar to rhabditis. The Stephanurus dentatus occurs in pigs
(frequently in the perirenal connective tissue in American pigs). Rost
found in 75% of 60 experiment animals nodules in the kidneys, which
contained larvae of nematodes (D. m. W. 1906, 446).

Of tapeworms are found: Cysticercus cellulosae (in pigs; found
also once in a dog [Railliet & Trasbot]); Enchinococeus polymorphus
(in ruminants, especially sheep; very rarely in other animals); E.
multilocularis (found once by Ostertag); Taenia serrata (found by
Wolpert in both renal pelves of a dog). Finally Railliet & Lucet have
found small nodules containing coccidia in the kidneys of geese which
had died with cachectic symptoms; Paechinger mentions a similar find-
ing in horses and dogs (Coccidiosis renalis).

Renal coccidiosis of geese is caused by the Coccidium truncatum
(Eimeria truncata) and is manifested in progressive emaciation with
extreme debility, owing to which the animals are found sitting almost
uninterruptedly. Many animals lie on their backs and spread their
feet; if they are stood on their feet they take a few steps and again
assume the sitting position. After a prolonged disease they usually lose
the desire to eat and die.
Section II.
DISEASES OF THE BLADDER.

1. Catarrh of the Bladder. Catarrhus Vesicae Urinariae.
(Cystitis catarrhalis, Urocystitis.)

Etiology. Catarrh or inflammation of the mucosa of the
bladder is usually based upon an infection. Bacteria which
get into the bladder find favorable conditions for multiplica-
tion especially in urinary stasis, for instance in stricture, com-
pression or obturation of the urethra, or in paralysis of the
bladder, sometimes in the voluntary retention of urine in house
dogs. In such cases the bacteria enter the bladder from the
urethra, especially in female animals in which the vaginal
secretion may-enter directly owing to the shortness and com-
parative width of the urethra. :

An artificial infection may be produced by catheterization.
Injuries of urethra and bladder, for instance during parturi-
tion, enable the bacteria to enter, and inflammatory processes
in the neighborhood of the bladder may be continued to its
walls or mucous lining. In this respect inflammatory diseases
of the urethra, the prostate, the internal female genital organs,
the kidneys, the renal pelvis and the ureters are to be men-
tioned.

Sometimes a bladder catarrh develops in general acute
infectious diseases because bacteria have been carried to the
mucosa of the bladder with the circulating blood. Bacteria
may also reach the bladder from the diseased kidneys, or
through the intermediation of healthy kidneys from distant
organs (especially from the intestines [see Pyelonephritis]).
Of first importance as pathogenic agents are the pyogenic
bacteria but, especially in cystitis of intestinal origin, the colon
bacteria and their related bacteria are important factors.

In many cases the occurrence of the disease is probably
to be referred .to taking cold, which reduces the resistance
to the bacteria of the walls of the bladder.

Among irritating chemicals cantharides especially give
rise to .catarrh of the bladder which may, however, also appear
after the internal administration of balsamics and of resinous
remedies (oil of turpentine, etc.). It is not certain whether
the inflammatory process is aroused immediately by the sub-

1031
1032 Catarrh of the Bladder.

stance circulating in the blood or only after it has, with the
urine, entered the bladder and thus has come in contact with
the mucous membrane (Hentrich observed catarrh of the
bladder in horses after feeding with beer slops which had
become sour).

Vesical calculi can also give rise to inflammation in the
mucosa of the bladder by mechanical irritation.

Anatomical Changes. In acute cystitis the mucous mem-
brane is vividly reddened, swollen, perhaps studded with small
hemorrhages, and covered with viscid mucus or with a purulent
deposit; the submucous layers are soggy with:serum. In more
intense inflammation yellowish, croupous fibrin membranes are
found, or dirty-gray diphtheritic deposits, or localized ulcerous
destruction; it is also possible to find small or large abscesses
in the walls of the bladder.

In chronic cystitis the mucosa is thickened, corrugated and
not infrequently covered with branched-out villous prolifera-
tions. Salts are eliminated from the urine and form a coarse
crusty deposit on the mucous membrane. The muscular layer
usually hypertrophies when the disease exists for a considerable
time.

Often inflammatory conditions are found also in the
urethra, in the ureters and in the renal pelvis; in the chronic
forms dilatation of the renal pelvis is not infrequent and is
associated with inflammation or atrophy of the kidneys.

Emphysema of the bladder of cattle was observed in one case each by Bunge
and Malm and in two cases by Trolldenier. Outside of hemorrhages, thickening
of the bladder wall was found with numerous air bubbles of various sizes in
the latter. In Bunge’s case such air bubbles had also developed in the renal
pelvis of the cow which was ill with pyelonephritis,

Symptoms. One of the most striking phenomena in acute
catarrh of the bladder is the frequent and painful micturition
(Tenesmus vesicae, Stranguria, Dysuria). The animals make
frequent attempts to urinate, during which they either void
no urine or only a small quantity with manifestations of severe
pain. The pressure to urinate and therefore the contraction
of the bladder muscles may be repeated at such brief intervals
that the urine is discharged almost uninterruptedly and in
driblets, similarly as in paralysis of the sphincter.

In male animals there occur also frequent erections of
the penis, the testicles are drawn up, and in horses signs of
colic occur at times. Pressure upon the bladder causes severe
pain and at the same time the organ will be found to be empty.
Exceptionally there. is retention of urine (ischuria), perhaps
because the sphincter is contracted convulsively or because the
mucosa at the neck of the bladder is much swollen, or the
opening of the urethra is obstructed by exudation.

The urine is usually cloudy and dark in color; it contains
variable, but comparatively small quantities of albumen
Symptoms. 1033

(albuminuria spuria), occasionally white mucus- and pus-
floccules, also gray pseudomembranes or tissue shreds. ‘The
reaction is alkaline in herbivora, but in carnivora either acid
(in catarrh due. to B. coli) or more frequently also alkaline.
Ammoniacal fermentation takes. place already within the
bladder and is recognized by the characteristic pungent odor
and also by the fact that a moistened strip of red litmus paper
turns blue when it is laid over the opening of a vessel which
contains fresh urine. The sediment is always copious and con-
sists of pus cells, red blood corpuscles, large pavement epithelia,

 

Fig. 178. Urinary sediment of a horse with catarrh of the bladder. a pavement
epithelia (superficial layer). 6 pavement epithelia (deeper layer, tailed celln). ¢
pus cells. d triple phosphate crystals. e streptococci.
also elongated, slender or molar-shaped epithelia (Figs. 178,
179, 180). Together with ammoniacal fermentation numerous
coffin-shaped crystals of ammonia-magnesia phosphate are
found, and thorn-apple-shaped crystals of acid ammonia urate.
Finally the freshly voided urine usually contains very many
bacteria. ; a oes

Simple acute catarrh is very rarely accompanied by hig
fever and lassitude, which is, however, frequent in inflammation
1034 Catarrh of the Bladder.

of the bladder. In this case the appetite is suppressed and
defecation retarded.

The clinical picture of chronic catarrh of the bladder is
similar, although the symptoms, especially pain and pressure
of urine are less severe and often absent (Gmeiner). The
urine is also similar in character, but red blood cells are less
numerous while on the other hand ammoniacal fermentation
is more frequent. (Sivieri observed, in a mare with chronic
bladder catarrh, rupture of the bladder after partial necrosis
of its thickened wall.)

Course. Simple acute catarrh of the bladder is not rarely
relieved by appropriate treatment, but in certain cases it passes
over into the chronic form which is much more obstinate. In-
flammation which is accompanied by copious pus-formation,

 

Fig. 179. Pavement epithelia (superficial Fig. 180. Pavement epithelium (deeper
layer) from the bladder of a horse with layer) from the bladder of a horse
eatarrh of the bladder. with catarrh of the bladder.

hemorrhage, ulceration or necrosis takes usually an unfavorable
course, because in such cases general infection is apt to occur,
chemical changes in the urine give rise to stone formation;
the inflammation may be transmitted to the pelvis of the kidneys
and finally to the kidneys.

Treatment. Absolute rest, non-stimulating food and the
drinking of as much water as possible are indicated in all
cases. -

In simple acute catarrh of the bladder healing is not in-
frequently produced by internal treatment only. For this the
Treatment. 1035

disinfectants are adapted first of all, for instance, according
to Gmeiner and Schmidt, urotropin (5-8 gm. for large animals,
0.25-0.5 gm. for dogs, 2 to 3 times daily in much water) which
exerts a disinfecting action after its absorption and elimination
through the kidneys, owing to its ability to split off formalde-
hyde in the acid gastric juice. The remedy may be prescribed
under the name of Hexamethylentetramin and is then much
less expensive. In ammoniacal fermentation of the urine it
is preferable, according to Uebele, to administer Helmitol
(t0-15 gm. for large animals, twice daily; 1-2 gm. for dogs,
3 times daily in- powder or 10% solution), because it can split
off formaldehyde in alkaline solution also and may therefore
be given subcutaneously. Both remedies diminish ammoniacal
fermentation and change the alkaline into the acid reaction.
Salicylic acid and its salts are further to be considered, also
salol, salipyrin, resorcin, benzoic acid, folia uvae ursi, etc.
(see p. 1020).

In chronic catarrh of the bladder the same remedies are
employed, and also balsamics, especially copaiba, and oil of
turpentine. Here local treatment by means of irrigations with
disinfecting and astringent solutions seems more useful
(Gmeiner). According to Gmeiner oxycyanate of mercury in
a solution of 1:1000-5000 is most appropriate, a small amount
of NaCl may be added. Uebele advises irrigating the bladder
with 2% solutions of helmitol. Other remedies are nitrate of
silver (0.1%), boric acid, tannin, alum, lead acetate (1-3%),
resorcin (3-5%), ichthyol solution (14-2%), ete.

The bladder is irrigated as follows: After emptying the urine artificially,
jukewarm water (35° C.) or better, a 144% solution of NaCl is allowed to run
into the bladder through a funnel which is’ connected with the catheter by means
of a rubber tube; in large animals the amount injected is about 300 cc.; in small
animals as much as 50 ce. The water is allowed to flow out by lowering the funnel.
Then the disinfecting solution is injected also lukewarm and likewise removed
after a few minutes. :

In certain cases of catarrh of the bladder operation may
be considered.

Literature. Bunge, Z. f. Flhyg., 1898. VIII. 168. —- Gmeiner, Monh., 1907.
XVIII. 61. — Hentrich, Z. f. Vk., 1905. 59. — Malm, Monh., 1905. XVI. 254. —
Nencioni, N..Ere., 1903. 447. — Schmidt, Die Cystitis und Nephritis usw Diss.
Giessen. 1909 (Lit.). — Sivieri, N. Erc., 1908. 18. — Suffran, Rev. vét., 1909.
405. — Taylor, Vet. Rec., 1905. 75. — Trolldenier, Monh, 1904 XV. 5.

 

Twisting of the Bladder. This was observed by Stroud and by
Griveaux, each in one dog, and was manifested by pressure of urine,
retention, enlargement of the abdomen; the dilated bladder could be
felt through the abdominal walls and on rectal examination, which was
painful. In Stroud’s case there existed a paralytic weakness of the
hindquarter and strong swelling of the perineal region; Griveaux met
an impediment in front of the neck of the bladder on attempting cathe-
terization. The trouble caused death in a short time.—(Griveaux,
J. vét., 1906, 393—Stroud, O. M., 1906, 219),
1036 Paralysis of the Bladder.

2. Paralysis of the Bladder.

By paralysis of the bladder is meant the inability to void
the urine voluntarily or to retain it.

According to this definition those cases may not be included in
paralysis of the bladder in which purely mechanical factors have inter-
fered with the voiding of the urine or in which the psychic functioning
of the brain has ceased to be active.

Etiology. A myopathic origin may be assumed for tran-
sitory paralysis of the Detrusor urinae, which is observed
occasionally in otherwise healthy animals when they were
obliged to retain the urine for a long time on account of pro-
tracted labor or because they were confined in a room. In
such cases the muscles of the bladder are stretched excessively
by the urine which has collected in the bladder in considerable
amount and thereby the power of contraction is reduced for
a time. A myopathic paresis of the bladder is also accountable
for the retention of urine which arises in exceptional cases
in inflammatory conditions of the walls of the bladder or in
deep-seated inflammations of the contiguous organs, especially
the peritoneum. By passing to the muscularis of the bladder,
the inflammatory process may diminish the contractility of
the muscles. In such cases it is, however, probably more often
an occlusion of the first urethral portion or a spasm of the
sphincter that causes the retention.

‘A persistent paralysis of the bladder develops only in
certain diseases of the nervous system, especially in injuries
affecting the sacral and the posterior lumbar portion of the
cord and their nerve roots and nerves. Such affections are:
inflammation, contusion, hemorrhage in the conus medullaris,
compression of the latter and of the related nerve roots in
the anterior portion of the sacral canal, during intervertebral
enchondrosis or pachymeningitis ossificans; exceptionally the
trouble may occur in consequence of a new-formation or of
an abscess. In horses it occurs rather often in inflammation
of the cauda equina (combined paralysis of tail and sphincters).
A lesion outside of the vertebral canal of the nerves which
pass to the bladder has not been observed in animals, nor
disease of the centers for the bladder muscles in the sympathetic
nerves of the pelvic cavity. In diseases of the spinal cord
above the posterior lumbar section, paralysis of the bladder
is found only in such cases in which the conductivity of the
centripetal and centrifugal tracts has been diminished or de-
stroyed. This may take place in contusion, inflammation and
compression of the cord.

Pathogenesis. In addition to the ganglion cells within the
bladder wall itself the motility of the bladder is influenced
by sympathetic, spinal and cerebral centers. As an intimate
functional reciprocity develops between these centers in the
Pathogenesis, Symptoms. 1037

course of development, the disease of one of them or of the
related tracts eliminates the function also of the other centers
which may have remained healthy. As the spinal centers
are connected particularly intimately with the sympathetic
centers which immediately influence the motility of the bladder,
disturbances in the bladder become striking and persistent,
especially in lesions of the spinal centers which lie in the
posterior lumbar and anterior sacral section of the spinal cord,
the more so as in these cases the activity of the striped muscles
of the urinary organs and the reflex action of the sensory nerves
upon the urethra and the neighboring organs is necessarily
eliminated. In all diseases of the nervous system above the
sympathetic bladder centers there occurs more or less improve-
ment in the disturbance, probably owing to the increased ac-
tivity of the sympathetic centers. :
In unconsciousness retention of the urine takes place in such a manner
that the pressure of the urine is not felt or that the inhibitory action of the brain
upon the sphincter is not exerted. The same mechanism may probably be assumed
for the occurrence of that form of retention which is sometimes produced under
the influence of certain intense psychic stimulations (excitement); and a similar

origin is probably responsible for the retention which is frequently noted in the
course of paralytic hemoglobinemia.

Symptoms. In paralysis of the Detrusor urinae the urine
fails of being voided for a considerable time (Ischuria, Retentio
urinae); owing to the constantly increasing tension of the
bladder the animals become restless and attempt to urinate,
provided the sensory conductivity is not interrupted as well.
In spite of all efforts and of the cooperation of abdominal
pressure they void only small quantities of urine in a thin
and feeble stream. Soon, however, the sphincter is relaxed by
the increasing tension, and dribbling of urine occurs. The
bladder is found to be greatly dilated on rectal exploration,
or in smaller animals by palpation through the abdominal walls
and by percussion; pressure upon the bladder causes large
amounts of urine to be discharged which ceases suddenly when
the pressure is removed (Ischuria paradoxa). If a catheter
is introduced into the bladder, the urine flows out without force.

In complete paralysis of the sphincter the animals cannot
retain the urine at all or only for a short time, and in con-
sequence this is discharged at very short intervals, in fact,
drop by drop at the commencement of total paralysis, wetting
the vicinity of the urethral opening or the pudenda (Inconti-
nentia urinae); in incomplete paralysis small quantities of
urine are voided at frequent intervals and without pain.

Usually the paralysis occurs in both muscles simultaneously
and involuntary discharge is observed, or dribbling of the
urine at first when the bladder is very full, later when it is
only moderately filled.

In the further course of the disease disintegration of the
urine commences already in the bladder, because bacteria easily
enter it through the incompletely closed neck; they multiply
1038 Paralysis of the Bladder.

readily in the dammed-up urine, and in a short time catarrh
of the bladder develops.

Diagnosis. In paralysis of the bladder due to transverse
lesions of the spinal cord above the posterior lumbar segment,
also in retention of the urine during loss of consciousness or
after violent psychic influences, the urine is voided in a strong
stream, at long intervals or after external mechanical influences
upon the region of the bladder; the discharge of the urine
does not cease immediately with the cessation of the pressure
upon the bladder, and if a catheter is introduced into the
bladder, the urine flows out in a vigorous stream. Inflammatory
processes and mechanical impediments in the lower urinary
passages can easily be excluded by local examination. Polyuria
and frequent micturition might be mistaken for paralysis of
the sphincter, but are readily differentiated by considering
the other symptoms of the basic affection.

Treatment. In order to prevent the consequences of re-
tention of urine as much as possible, the urine should be re-
moved several times daily with a clean catheter, or the bladder
should be made to empty itself by gradually increased pressure.
It is well to apply a drying or disinfecting salve to the skin
in order to keep the region of the urethra clean. In cases where
no severe organic disease exists, the relief of the paralysis
may be attempted by cold applications to the region of the
sacrum, irrigation of the bladder with cold water, or friction
on the region of the bladder. Faradic electricity (the positive
pole on the sacrum, the negative on the pudenda in retention,
on. the perineum in dribbling) is powerless.—Parascandolo be-
lieves that certain cases of paralysis of the bladder may be
relieved by operative treatment.

Literature. Luciani, Physiologie, 1906. II. 433 (Lit.). — Miiller, Deutsche

Zeitschr. f. Nervenheilk., 1902. XXV. 86 (Lit. on animal experim.). — Parascandolo,
D. t. W., 1901. 477.

 

Spasm of the Bladder. This is said to originate without local
disease of the urinary tract, when the animals are obliged to retain
urine for a long time on account of protracted work (Réll). But
psychic influences, colicky pains and tetanus may also produce the
trouble. In spite of repeated attempts the animals are not able to void
the urine (Ischuria spastica), or at most a few drops are discharged at
one time (Dysuria spastica). The bladder is greatly dilated and sensi-
tive to pressure. The history as well as the absence of local pathologic
changes (calculus, swelling, ete.) afford sufficient diagnostic indications.

In horses the spasm usually disappears spontaneously if they are
allowed to rest on clean straw or in a sheep barn. In horses and also
in other animals sponging of the region of the bladder is indicated, also
a gradually increasing pressure upon the bladder. Lukewarm enemas,
chloral hydrate (25-50.0 or 1-2.0 gm.) per rectum hasten recovery ; also
morphine injections. If in spite of these measures no urine is voided,
a catheter covered with morphine ointment may be used, or puncture
of the bladder may be required.
Diseases of the Circulatory Organs

Section I.

DISEASES OF THE PERICARDIUM.
1. Pericarditis.

Occurrence. Pericarditis is not a very prevalent disease.
It occurs most frequently in cattle in the form of traumatic
pericarditis, inflammations of the pericardium from other
causes being much. more rare, and in all probability usually
tuberculous in origin. Still more rarely the disease is observed
in horses,.in which it usually occurs as a sequel of croupous
pneumonia. It occurs a little more often in dogs, usually on
a tuberculous basis, less often in distemper or other diseases.
In hogs pericarditis is not very rare, appearing most often in
swine plague, less often in erysipelas. In fowls the disease
is also observed occasionally, usually as a complication of
cholera and chicken plague, less often in tuberculosis.

Etiology. The occurrence of pericardial inflammation is
due, almost without exception, to the immediate influence of
infectious substances, although these often become effective
only if certain predisposing conditions are also present.
Searching bacteriological examinations have not been made
very often with respect to pericarditis in animals, but those
that have been reported, and also the mode of onset of the
disease, permit the assumption that the infectious substances
mentioned below are particularly concerned in the production
of pericarditis. The Bac. bipolaris may be active in this
manner, not only alone but also in association with other
bacteria; in fact, there is hardly one of the diseases for which
this bacterium is responsible that is not occasionally associated
with pericarditis. Further, the pyogenic bacteria, the tubercle
bacillus, the virus of swine erysipelas, chicken plague, con-
tagious pleuro-pneumonia of cattle and of variola may. also
take part in the production of pericarditis.

1039
1040 Pericarditis.

Jowett observed a pneumo-pericarditis which occurred in turkeys in epizootie
extension and was characterized by a copious fibrinous exudation; a bacillus bipolaris
was found, both in the pericardial exudate and in the blood; chickens and pigeons
which were kept in the same place remained healthy, but it was possible to infect
them artificially. In Jowett’s opinion the disease is a different affection from
chicken cholera.

The point of entrance of the microorganisms may either
be in an injury of the. thorax, or more frequently the virus
reaches the pericardium by way of the blood and lymph streams.
The infection is most easily explained when traumatic influences
affect the pericardium, and when pyogenic or putrefactive
bacteria enter simultaneously with the injuring object or pass
in subsequently through the opening. Penetrating injuries of
the heart region are rather rare as a whole, and likewise rarely
an effect of contusions of the praecordia is exerted without
penetration of the wall of the thorax, so that bacteria which
have entered the blood in another manner are carried to the
pericardium and then proliferate in the contused tissue.

Those injuries of the pericardium are of greater frequency
and of the highest importance in which foreign bodies have
entered the pericardium from neighboring organs (Pericarditis
traumatica). Pericarditis of such an origin occurs frequently
in cattle, less often in goats and sheep and only exceptionally
in the other animals. In a case observed by Henniges in a
horse a needle, probably from the esophagus, entered the
pericardium; in a case of Lewin’s, from the stomach or
duodenum; in a hog a needle came from an unknown part of
the body (Teetz), or from the stomach (Nietschke), while in
a dog seen by Petit the foreign body (needle) had probably
passed with the blood of the posterior vena cava into the
heart and had partially advanced into the pericardium after
perforating the wall of the heart. In ruminants foreign bodies
which have been swallowed usually pass from the second
stomach toward the pericardium (Vol. II). The anterior
surface of the reticulum is separated from the pericardium only
by the thin diaphragm which is easily perforated even by com-
paratively short foreign bodies. In this respect needles are
most dangerous because, after having perforated the mucosa
of the reticulum they are constantly pushed farther by the
repeated contractions of the muscles of the reticulum until the
points reach the diaphragm’; then the contractions of the latter
aid in pushing the needles against the pericardium and in
finally entering it. Of similar importance are other rigid
bodies which are more or less pointed at both ends, especially
thin wire (according to Collas parts of the wire which has
latterly been used for packing pressed hay are responsible -
relatively often), nails, knife blades, etc. Together with the
foreign bodies bacteria usually enter the pericardium as a
matter of course.

The intermediation of infection by the blood- and lymph-
streams must be assumed in those cases in which the affection
Etiology, Anatomical Changes. 1041

develops in association with diseases of neighboring organs or
in the course of a generalized acute infectious disease. Aside
from inflammations of the heart muscle or the endocardium
which easily pass over into the pericardium which is connected
with the intramuscular connective tissue, pericarditis occurs
preferably as a sequel to pleurisy, pneumonia, pulmonary or
pleural tuberculosis and is produced in these cases by the virus
of the related diseases. Pericarditis may also develop directly,
by continuity, after perforation of the gullet and in consequence
of the mediastinitis due to it, also after suppuration of the
peribronchial lymph glands, ete. Of the acute infectious dis-
eases it is especially hemorrhagic septicemia, pyosepticemia
neonatorum, less often strangles, variola, articular rheumatism,
etc., which lead to pericarditis. é
The bacillus bipolaris, the pyogenic bacteria and the tuber-
cle bacillus do not necessarily exert their inflammatory action
only after a previous affection of other organs or after a
generalized infection (secondary or consecutive pericarditis)
but may in many cases do so independently (primary peri-
carditis). ,

The pericarditis observed in epizootic extension in sheep by Trasbot, Anacker
and Kowalewsky was evidently not primary, but a partial manifestation of
hemorrhagic septicemia, and as a matter of fact Kowalewsky found, on autopsy,
endocarditis and pneumonia in addition to pericarditis.

It is only exceptionally that chemical substances or me-
chanical irritants give rise to chronic pericarditis, the former
in bacterial diseases of other organs, in nephritis, etc., the latter
by new-growths, parasites, sterile foreign bodies. (Borchardt
saw serous-hemorrhagic pericarditis with nephritis and hepa-
titis in two horses which suffered from lysol poisoning.)

In infectious non-traumatic pericarditis certain predispos-
ing causes like cold, over-exertion, railroad transportation, ete.,
are of importance although they are not capable, of them-
selves, of giving rise to an inflammation.

Anatomical Changes. In acute pericarditis delicate or thick
fibrinous membranes are deposited on one or both layers of
. the pericardium which may, in larger animals, attain a thick-
ness of 2-3 cm., and a fluid exudate accumulates in varying
amounts in the pericardial cavity, which may be clear or very
cloudy; it may contain floccules of fibrin and in traumatic
pericarditis it has usually a foul odor. If fibrin is secreted
copiously, the surface of the heart becomes uneven, villous
(villous heart, cor villosum), and the fibrin masses may divide
the pericardial cavity into irregular compartments (which are
especially well marked in cattle). In many cases the exudation
assumes a purulent character and if the inflammation is pro-
longed a proliferation of connective tissue 1s more manifest.
The latter form of inflammation, and also pericarditis in its

Vol. 1—66
1042 Pericarditis.

initial stage, is sometimes limited to portions of the pericardium
(pericarditis circumscripta) in which the vicinity of the large
vessels is affected preferably, less often that of the apex. In
the majority of cases, however, the inflammation involves the
entire pericardium almost uniformly (P. diffusa), although
also in these cases the visceral layer usually shows more intense
changes. In proportion to the amount of exudate the peri-
cardium is more or less distended and sometimes occupies a
very considerable portion of the thoracic cavity. The quantity
of exudate varies within wide limits and may amount to 36
(Friedberger) and even 40 liters in horses, 1814 liters (Trasbot)
in cattle, and 1% liter in dogs. The connective tissue septa of
the heart muscle are also infiltrated with sero-cellular exudate;
if the amount of exudate is very great, compression and atrophy
of the heart may result.

Finally there are evidences of stasis, such as marked full-
ness of the veins, passive hyperemia of the lungs and of the
liver, edematous infiltration, ete.

In traumatic pericarditis of cattle the foreign bodies are
not infrequently found in the exudate, either free or with one
end penetrating the wall of the heart. It may also occur that
the foreign body is not found because it has been pushed back
into the reticulum, or because it had rusted and crumbled;
in many cases it is entirely in the heart muscle, or exceptionally,
‘in a ventricle. (It is possible for an abscess to form in the
heart muscle and break into the pericardial cavity or into
one of ‘the ventricles [Cadéac].) A traumatic origin of the
inflammation is suggested by the presence of a firm connective
tissue cord between pericardium and diaphragm, and also be-
tween the latter and the reticulum. This cord is either solid,
or it contains several cavities, either side by side or com-
municating with each other, and filled with purulent or ichorous
fluid; in rare cases a long canal-is found in the center of the
connective tissue cord, which connects the lumen of the
reticulum with the pericardial cavity.

Chronic pericarditis is characterized by connective tissue
proliferation leading either to simple thickening of the peri-
cardial layers (tendinous spots, Maculae albidae s. lacteae) or
to adhesions between them (P. fibrosa adhaesiva) ; sometimes,
indeed, a complete union of the pericardial layers results
(Concretio pericardii). In tuberculous pericarditis cheesy foci
may be found in varying numbers in the new connective tissue
which may be very copious, but this form of pericarditis occurs,
especially in dogs, also as a serous or hemorrhagic inflam-
mation.

Symptoms. The clinical picture of traumatic pericarditis
is usually preceded by prolonged digestive mesobanees, which,
Symptoms. 1043

according to Bongartz, last from 1 to 6 weeks; sometimes they
become very severe and may be associated on motion with
sensitiveness to pressure in the region of the reticulum, with
superficial respiration and evidences of pain. Later, when the
foreign body has reached the pericardium, the symptom complex
of pericarditis follows immediately; although exceptions may
be noted in’so far as the signs of traumatic gastritis may dis-
appear for a time the pericarditis becoming manifest only after
their reappearance, or the trouble may develop without previous
digestive disturbances. In similar manner a non-traumatic
pericarditis of secondary origin is introduced by the symptoms
of the basic affection.

The period between the ingestion of the foreign body and the appearance
of the pericardial symptoms depends upon the nature of the foreign body, the
manner in which the animals. are kept and fed, and upon accidental factors
(parturition, ete.).

In the initial stage of pericarditis the animals manifest
severe pain, they avoid all motion, stand with head stretched
forward, the elbows spread out, the hind feet drawn under
the belly, the back arched, they frequently look back toward
the abdomen and at times lie down carefully, only to get up
again immediately. Pressure on the region of the heart, on
the chest or on the back; also percussion of the precordia
increases the pain considerably; the animals groan, attempt
to evade the pressure or depress the back deeply. They dis-
like to move, are surprisingly fatigued after brief motion, and
then show shallow breathing, respiration becoming abdominal
in type. The pain increases markedly, especially on going
down hill. These symptoms are sometimes so mild as to fail
to arouse attention, and the first expert examination, especially
in. cows which are not worked, often shows already a fairly
advanced stage of the disease.

The heart beat is hastened from the first by 4, 2 or 3
times the normal rate and may bearhythmical. The increase
is sometimes aggravated further without any cause whatever,
or through quite insignificant influences. Especially during
motion the heart beat shakes the entire region of the heart,
and the heart sounds are sometimes heard at a distance of
3 to 4 steps, being unusually clear and loud. (Lecouturier
describes them with the word ‘‘claque-claque’’). Sonnenberg
observed bradycardia in a cow (26 heart beats to the minute),
together with epileptoid convulsions and loss of consciousness,
which ceased during periodical occurrences of increased heart’s
action (over 100 heart beats).

Friction sounds in the heart regions afford the most val-
uable symptom. These sounds are synchronous with the motions
of the heart, but they do not follow as regularly as the endo-
cardial sounds; they may be heard together with the systole or
1044 Pericarditis.

with the diastole, or then immediately before or after. They may
be soft or rough, creaking, and always give the impression of
friction, or if ‘they are very short and ‘intense they sound as
though "two liquid or solid bodies were beating against each
other. These sounds are often felt with the hand placed on the
cardiac region, and may be increased on pressure upon the inter-
costal spaces. They are limited to the region of the heart,
audible on both sides and are influenced by the respiratory move-
ments -at most by becoming less intense during inspiration,
because-then the lung has moved. between heart and thorax.

In the presence of a fluid exudate, the friction sounds
usually disappear entirely if delicate or few pseudo-membranes
are formed separating the rough surfaces of the pericardium;
in the presence of only small amounts of fluid the friction sounds
may persist. If there are very copious masses of fibrin, some
portions of the fibrin covered surfaces touch even in the pres-
ence of much fluid and produce friction sounds to the end.

' In traumatic pericarditis gases and fluid are not infre-
quently present together, and then splashing, gurgling and sim-
ilar sounds are heard in addition to the friction sounds, also the
sound of falling drops, etc., ete.

The heart beat, which is at first increased in intensity, grad-
ually becomes weaker and may at times be unnoticeable, but if
much exudate is present, wave-like movements may be felt in the
cardiac region. With the weakening of the heart beats the
intensity of the heart sounds diminishes and sometimes they
disappear entirely.

An increased cardiac dullness may be ascertained only in
the presence of much fluid, of very much fibrinous exudate or
of tuberculous new-formations. The increase then gradually
occurs upwards, forwards and backwards; upward it may reach
as high as the shoulder line and may, in small animals, reach
forward to the second intercostal space, backwards in all animals
to the 6th or 7th intercostal spaces (Fig. 181). In the lateral
position the upper border moves slightly down, because then the
heart lies somewhat further away from the thorax. In rumi-
nants an absolute cardiac dullness is at first noticeable, which
later enlarges in the manner indicated. Any dullness on the
right side is always less marked than on the left side. In some
cases of traumatic pericarditis in which the gases of putrefac-
tion form or in which gases from the reticulum have reached the
pericardial cavity, a tympanitic and even a metallic percussion
sound of varying extent may be elicited on the upper border of
the dullness.

The pulse is accelerated from the beginning; at first fairly
full and tense, often arhythmical, later it becomes very small,
thread-like, owing to compression and possibly to involvement
of the heart, and the arhythmia usually i increases.

With the increase of the exudate the veins are constantly
filled more strongly, and this is particularly noticeable in the
Symptoms. 1045

jugular veins. The jugular veins, which are dilated like thick
cords and stand out strongly, sometimes show undulations which
are synchronous with the auricular systole and slightly pre-
cede the heart beat (presystolic venous pulse). (In cattle, and
often also in horses, even under normal conditions, undulation
and perhaps a
slight presystolic
pulsation of the
jugular veins may
be noted.) At the
same time an edem-
atous swelling
develops on the
upper and lower
chest and also in
the anterior por-
tion of the lower
abdomen, further
in the region he-
hind the elbow, on
the dewlap and in
the trachea, where
it may appear
first, if the head is
held low, and may
be associated with
edema of the
larynx.

Disturbances in
respiration exist in
all cases, the
breathing being
more or less has-
tened and superfi-
cial, and labored
on the slightest
motion. From time
to time a feeble
and very painful
cou gh is heard. Fig. 181. Increased cardiac dullness in Pericarditis
With the increase with fluid exudate. .The dotted curved line shows the -

, ¢ ic margin of the normal, the solid curved line the
of the edema fluid margin of the increased dullness. The straight dotted

accumulates also line indicates the middle line of the sternum, the

in the body cav- figures give the ribs.

ities and_ inter-

feres still more with respiration, which is now labored even

when the animals are resting, the more so as the symptoms of

stasis constantly increase and may even give rise to pneumonia.
The temperature is either raised from the beginning or

 
1046 Pericarditis.

a rise occurs in the later course of the disease; it is not usually
high, unless the underlying disease causes a considerable degree
of fever. When the temperature rises within the body, chills
and trembling are frequently observed and the temperature
is unequally distributed over the surface of the body. In cattle
traumatic pericarditis may in exceptional cases run an afebrile
course. ...

With the development. of the symptoms the general condi-
tion of the animals becomes constantly worse. Large animals
avoid every movement as much as possible, and stand with neck
stretched.out straight, théy lie down only rarely, very carefully
and only-for ‘short periods; their eyes have a plaintive expres-
sion; smaller animals usually lie constantly on the ground. The
desire to eat diminishes more and more, so that the patients
become emaciated. Defecation is retarded, although in some
cases, especially in traumatic pericarditis, diarrhea occurs.

Chronic pericarditis usually arises out of the acute form,
the condition of the animals improving after a certain time, but
without complete recovery. It.is more rare for the disease to
develop insidiously from the commencement (mostly in the
presence of tumors, tuberculous swellings, etc.), and in such
cases the symptoms of the initial stage, like irregular heart
action, rapid fatigue during work, may remain unnoticed for
weeks.

The most striking symptoms are dyspnea and rapid
fatigue on moving about and still more when working, then a
decided increase and arhythmic character of the heart function.
Enlargement of the cardiac dullness is either absent or examina-
tion vives the same result as in acute pericarditis with effusion.
In the latter case the heart beat and heart sounds are weak.
Friction sounds are usually absent. Another symptom is found
in the fullness of the jugular veins. In the later stages of the
disease edema may develop on the lower chest and in the
vicinity.

b Course and Prognosis. Acute pericarditis usually ends

fatally, within the first week, in those cases in which purulent or
ichorous exudate has collected in large quantities or in which
the affection has occurred in connection with an infectious dis-
ease, especially pneumonia, pleurisy or hemorrhagic septicemia.

In the majority of cases, however, the disease takes a longer
course, 2 to 3 weeks and more, and shows at times transitory
improvement. Ultimately, however, the permanent disturbance
of the heart function or the degeneration of the heart. muscle
lead to death even in these cases, the end being preceded by
symptoms of stasis, such as venous hyperemia and edema, some-
times hemorrhagic infarcts in the lungs, chronic catarrh of the
respiratory passages and of the intestinal tract, cutaneous
edema, thoracic dropsy, ascites, etc. The animals become much
emaciated and exhausted and usually perish in this stage with.
Symptoms, Diagnosis. 1047

symptoms of pulmonary edema. Sometimes death occurs sud-
denly at a time when the general condition of the animal is
still fairly satisfactory. Recoveries are rare in cases which
are clinically well marked and usually follow upon a period of
convalescence lasting several weeks. However, even in those
cases which take a comparatively favorable course, chronic
changes remain which influence the heart action unfavorably.
In extensive adhesions the heart beat is weak and the thorax
is depressed in the region of the heart (Rdll).

The course of traumatic pericarditis varies in the several
cases, but is usually insidious, extending over weeks and months,
and even longer, during which time the symptoms usually
increase gradually or with transitory remissions. Eventually
digestive disturbances become more and more evident and finally
a soporose condition develops, accompanied by paralysis-like
debility, probably due to the absorption of putrefactive poisons
from the exudate (de Bruin). In many cases metastatic, puru-
lent inflammatory foci form in various organs, for instance in
the joints and tendon sheaths, and in such cases the disease may
terminate with the clinical picture of pyemia. Other complica-
tions are pneumonia and pleurisy, gastric and duodenal catarrh,
etc. Sudden death is not a very rare occurrence in any stage of
‘he disease and follows either upon injury or perforation by the
foreign body of the heart muscle or of the larger blood vessels
of the heart, or through the influence of sapremia. On the other
hand, protracted cases are observed occasionally, in which the
well-marked symptoms gradually diminish in intensity, the
nutrition. improves and the animals may even be put to work
(Mathis, Jensen). Sometimes spontaneous recovery occurs, the
foreign body either breaking through to the outside or returning
into the reticulum.

Diagnosis. During the initial stage the symptoms are not
sufficiently characteristic to make a positive recognition of peri-
carditis possible, although the development of an acute peri-
carditis is suggested by the very great sensitiveness of the pre-
cordia, and by the pounding, often arhythmic heart beat which is
altered decidedly by even comparatively slight external influ-
ences. Later the friction sounds or the various splashing
sounds, together with the decided enlargement and peculiar form
of the cardiac dullness unite to make up a characteristic clinical
picture, which is developed further by symptoms of blood stasis
and by edema, and which it is almost impossible to mistake. It
is, however, not to be forgotten that none of these phenomena
are pathognomic in themselves and that some of them may be
absent, not only in traumatic pericarditis but also in other
inflammations of the pericardium. ?

For the diagnosis of a commencing traumatic pericarditis the high
pulse rate (100-110 a minute) with a normal or at most maximal normél
1048 Pericarditis,

temperature (Meyer, Eber) is suggestive. According to Eber the ques-
tion may be decided even in those rare cases in which the temperature
rises more or less during the initial stage, the increased pulse rate
remaining unchanged in spite of the lowering of the temperature by the
action of antifebrin in-doses of 50-100 Gm. per day. According to Otto
a peculiar muscular trembling in the vicinity of the elbows is of impor-
tance in this respect, which occurs especially after the animal has been
standing for some time.

Fibrinous pericarditis might be mistaken for fibrinous
pleurisy when this has given rise to the so-called pleuro-peri-
cardial sounds. These friction sounds are purely pleuritic and
are characterized by being heard, together with the heart sounds,
only during either inspiration or expiration; moreover, they are
heard synchronously with the respiratory movements during the
heart-pause. Moreover, pleurisy is rarely limited to so small
a space and therefore friction sounds, synchronous with the
respiratory movements, are also heard more posteriorly. Still,
‘it must not be forgotten that pleurisy and pericarditis may occa-
sionally be present at the same time.—In rheumatism of the
intercostal muscles the intercostal spaces are painful, but fric-
tion sounds are absent or at most dull muscular sounds are
audible. If a fibrinous pleurisy should also be present, as is
the case occasionally in the so-called pleurodynia of horses, the
nature of the disease will be sufficiently cleared up by the his-.
tory of the case (Vol. II.) —From the endocardial sounds in
valvular disease the pericardial friction sounds are differen-
tiated especially by the fact that they seem to develop immedi-
ately under the ear, are sometimes increased by pressure and
become weaker on inspiration; finally by the fact that they are
‘not quite synchronous with the heart movements.—At the very
beginning general acute infectious diseases may have to be con-
sidered, in ruminants especially anthrax, but in such cases the
temperature is usually decisive, since in pericarditis the tem-
perature rises are usually slight unless the disease has developed
upon a septicemic basis.

Pericarditis with effusion might give rise to confusion with
pneumonia in those cases in which only the lower sections of tlie
lungs, in the neighborhood of the heart, have become condensed
and may therefore simulate an increased cardiac dullness. In
such cases the character of the heart beat and of the heart
sounds affords information because in pneumonia they are not
weakened at all or only slightly so, in contrast to pericarditis
with effusion.—In cattle, lung plague may cause a clinical pic-
ture which is somewhat like that of traumatic pericarditis, but
in most cases sufficient points of difference are present, for in-
stance, the preceding digestive disturbances, the comparatively
small dullness, the striking weakness of the heart-beat, the com-
plete absence of bronchial respiratory sounds, the characteristic
pericardial sounds and slight fever or its absence—In peri-
Diagnosis, Treatment. 1049

tonitis with effusion an enlarged area of cardiac dullness may
be simulated by an encapsulated exudation in the vicinity of the
heart and, in larger animals, especially in cattle, by free fluid
exudation. If free exudation is present in the thoracic cavity,
the heart beat and the heart sounds are not weakened or only
slightly, especially in smaller animals and in the sitting position;
moreover, the dullness is limited horizontally —An encapsulated
pleural exudate or a swelling in the vicinity of the heart may be
eliminated in such cases in which the heart has been displaced
(see compression of the heart). A dullness due to enlargement
of the heart (hypertrophy, dilatation) may have a similar shape,
but hardly ever extends so far forward, the heart sounds are
heard distinctly, friction sounds and sensitiveness of the pre-
cordia are absent. ,

About the nature of the exudate external conditions may
offer information in so far as pericarditis occurring after cold,
in consequence of croupous pneumonia, or of primary pleurisy
leads to the formation of a fibrinous or sero-fibrinous exudate,
while metastatic pericarditis is usually purulent and accom-
panied by high fever. In traumatic pericarditis of cattle the
exudate may be sero-fibrinous, purulent or ichorous. The
assumption of an ichorous pericarditis is justified by the greater
severity of the general symptoms, by the tympanitic and possibly
metallic nature of the percussion sound and by the presence of
splashing sounds. Traumatic pericarditis is usually manifested
by local and venous symptoms similar to those of the rather
infrequent tuberculous pericarditis of cattle (Klaber, Liénaux,
Wyssmann and others).

In doubtful -cases Gmeiner recommends a test puncture of the pericardium,
on the left side within the area of dullness, if necessary also on the right side.

Chronic pericarditis is very difficult of recognition without
an exact knowledge of the history, because most of the symp-
toms are observed also in chronic pleurisy and in chronic inter-
stitial pneumonia. Only an absolutely exact determination of
the shape of the dull area, the nature of the heart beat and the
characteristic symptoms of stasis may be of assistance. Chronic
myocarditis cannot be differentiated with certainty from chronic
fibrinous pericarditis.

Treatment. If treatment is justified by the fact that the
prognosis is not absolutely unfavorable, complete rest must
above all be assured. Any disturbance in defecation is to be
relieved by small doses of mild laxatives, and the diet must be
regulated appropriately. Herbivora should receive good hay,
if possible mixed with fresh green feed, also flour- or bran-slop ;
carnivora are fed with gruel or broths, also milk. In persistent
inappetence artificial feeding (Vol. II.) may become desirable.

The inflammatory process may be alleviated by cold com-
presses. A sac filled with snow or ice and fastened with a wide
1050 Pericarditis.

belt, or a compress made of tow or cotton, is applied to the
region of the heart and cold water poured over it from time
{o time; large animals may be put under the shower. In
primary pericarditis preparations of salicylic acid may be tried
in similar doses.as in pneumonia (Vol. II.) or in somewhat
smaller ones, because their harmful action upon the heart is
here more easily exerted. Lactophenin, salicylic acid, antifebrin,
antipyrin and salipyrin may be administered in very high fever.

For weakness of the heart, cardiac remedies are indicated,
digitalis (in large animals 2-4 gm. daily, in small animals, of a
2:150.0 infusion to which 5 gm. of potassium nitrate have been
added, one tablespoonful every two hours). Caffeine is also of
service (2-5.0 gm. or 0.2-1.0 gm. subcutaneously), camphor (cam-
phorated oil 20-30 gm. or 2-3 gm. subeutaneously), possibly wine,
aleohol, or ether.

To promote absorption diuretic remedies and mild laxatives
may be tried. In excessive accumulation of fluid, with conse-
quent compression of the heart, puncture of the pericardium
should be considered. But in these cases puncture is not as
harmless a proceeding as in pleurisy because a portion of the
exudate may flow into the pleural cavity through the opening in
the pericardium, after the trocar has been removed (Moussu,
Gmeiner, author’s case).

rw

Puncture of the pericardium is done with a simple trocar immediately above
the parasternal line, in the 5th or 6th intercostal space, but always within the
area of dullness; after removal of the exudate the pericardial cavity may be irrigated
with lukewarm sterilized water or with a mild disinfecting solution. If the exudate
is purulent it seems more advisable to open the pericardium by an incision and
to wash out the cavity thoroughly. During this operation it may be possible to
find and remove the foreign body (Bastin).

In traumatic pericarditis Meyer’s operation may also be
tried (Vol. II.). If this is not followed by improvement or if
the disease is already far progressed slaughtering of the patients
should not be delayed, because later on the flesh will become
useless for human consumption on account of emaciation or
sapremia or of general pyemic infection. In order to remove
edematous infiltration and thus make the flesh fit for consump-
tion Moussu recommends the removal of the exudate through
a puncture from the direction of the xiphoid cartilage (Fig. 182).
This procedure merits consideration also in non-traumatic peri-
carditis of cattle.

With the animal standing, the positions of the xiphoid cartilage, the linea
alba and the left costal arch are ascertained. In the middle of ‘the angle outlined
by these landmarks, above 20 em. in front of the place where the milk vein runs
toward the V. epigastrica cranialis, the abdominal wall is pierced, an incision is
made through the skin about 20 cm. long, parallel to the costal arch, through
which a portion of the serous fluid which has accumulated in the subcutaneous
connective tissue will escape promptly. The muscles in the bottom of the wound
are then separated with the scalpel as far as the neck of the xiphoid cartilage,
the subpericardial fatty connective tissue is forced apart with one or two fingers
of the right hand until the pericardium is reached, as is shown by feeling the
heart beats. The left index finger is now pushed’ up to the pericardium, and
Treatment. 1051

upon ‘it a trocar, at least 25 em. long and 5 mm. thick is carried’ forward with
the right hand until the heart beat is communicated to it. The trocar is now
pointed inward and forward and is forced with a sharp thrust about 3-4 em.
into the pericardium, the fluid being allowed to escape by removing the stylet.
A strip of iodoform gauze is placed into the wound, a compressing dressing is
applied to the chest and renewed from time to time. The edema disappears, in
the course of a few days, for a time, when the animal may be slaughtered.

    

23
ete ee ee

  

‘Fig. 182. Field of operation for puncture of the pericardium from the wiphoid carti-
lage. LB linea alba; H costal arch; VJfa milkvein; P point of incision. (After
* Moussv.)

Liénaux calls attention to the fact that in the presence of adhesions the
operation fails just at this point of punction, or that the trocar may enter the
ventricle, in which eace a stream of blood will escape through the.trocar. This
accident appears however to be of no importance.

In order to prevent possible complications (phlegmons, malignant edema),
Liénaux drains the pericardium, after punction, by introducing a rubber drain
with lateral openings through’ the canula into the pericardial sac and securing
it with sutures after removal of the canula. In a case treated in this manner
the exudate disappeared permanently so that the animal could be fattened.

Chronic pericarditis can hardly be treated successfully. At
best the animals must be saved from exertion and receive car-
diac remedies. Animals which are intended for slaughter should
be killed as early as possible.

Literature. Albrecht, W. f. Tk., 1893. 259. — Aubry, J. vét., 1905. 355. —
Bragadin, T. Z., 1904, 420. — de Bruin, Monh., 1900. XI. 1 (Lit. on traumat.
Pericarditis). — Déttl, W. f. Tk., 1908. 227. — Eber, Z. f. Tm., 1906. X. 321. —
Eisenmann, Monh., 1906. XVII. 17. — Gmeiner, B. t. W., 1906. 409. — Henniges,
Mag., 1848. 514. — Jensen, Maanedsskr., 1905. XVIII. 35. — Jowett, J. of comp.
Path., 1908. XXI. 324. — Klaber, B. t. W., 1901. 731. — Koppitz, T. Z., 1906.
537. — Leblanc, J. vét., 1905. 78. -—— Lewin, Z. f. Vk., 1894. 18. — Liénaux,
Ann., 1905. 314; 1908. 311. — Mathis, J. vét., 1904. 277. — Moussu, Ree., 1901.
465; Bull., 1905. 296. — Noack, S. B., 1889. 74; 1890. 81. — Otto, ibid., 1899.
91. — Petit, Bull., 1901. 264; 1905. 281. — Schmidt, P. Mt., 1871-72. 162. —
Sonnenberg, B. t. W., 1909. 171. — Teetz, Z. f. Flhyg., 1904. XIV. 61. — Wyssmann,
B. t. W., 1905. 387 (Lit. on tuberk Pericarditis of cattle).

'

 

Compression of the heart (so-called pseudopericarditis). Aside
from the compression of the heart which is produced by a copious peri-
cardial exudate, the organ may be crowded or displaced by formations
outside of the pericardium; this occurs especially in cattle, but some-
1052 Dropsy of the Pericardium.

times also-in other domestic animals. Abscesses (mostly traumatic in
origin) develop with preference. subpleurally or subpericardially, and
new-formations or the somewhat more frequent tuberculous swellings are
found at the base of the heart or in the anterior mediastinum. Only
rarely abdominal organs (especially the reticulum) compress the heart
by prolapsing into the thoracic cavity; in other cases, which are also
very rare, a pulmonary abscess or a very large echinococcus of the lung
exerts pressure upon the near-by heart. If such formations are present,
the diastolic dilation of the heart is more or less interfered with and at
the same time the heart muscle is made to atrophy (Atrophia cordis).
The large vascular trunks are often compressed at the same time, or
they may be affected exclusively.

The clinical picture shows great similarity with that of pericarditis;
especially similar symptoms of stasis are to be noted. On the other
hand, the pulse rate is only slightly increased, intermissions are frequent
and a displacement of the heart to the right, forward, backward or
upward may be demonstrated by the character of the heart beat or of
the heart sounds; pericardial sounds are absent. In certain cases the
dullness is much larger than is usual in pericarditis. ‘Sometimes an
exploratory puncture affords valuable indications for diagnosis.

Treatment need be considered only in the case of subpleural or sub-

pericardial abscesses or of cystic new-formations, in order to remove the
fluid contents.

Literature. Bretagnier, Rec., 1909. 156. — Huynen, Ann., 1907. 144. —
Joest, Dresd. B., 1906. — Liénaux, Ann., 1905. 1, 121, 473. — Mathis & Ball,
J. vét., 1905. 653. — Moussu, Rec., 1903. 757. — Petit & Delacroix, Bull., 1905.
133. — Seegert, Z. f. Vk., 1901. 126.

Dropsy of the Pericardium. Hydrops Pericardii.
(Hydropericardium.)

Etiology. With the exception of inflammatory processes,
which do not belong here, an accumulation of serous fluid occurs
in the pericardium either from stasis of the blood in chronic
diseases of the heart muscle or of the valves, or in chronic
pulmonary affections, and also in connection with hydremia.
On a similar foundation dropsy of the pericardium develops
in chronic inflammations of the kidneys, in chronic glanders,
chronic anemia, in liver-fluke disease, lungworm disease, ete.
The diseases which have been enumerated usually exert their
effects also upon the veins of other parts of the body, and
therefore symptoms of hydrops are in these cases observed
elsewhere also. :

Anatomical Changes. The pericardium of healthy animals
contains at most a few cubic centimeters of a serous fluid, but
in dropsy of the pericardium the quantity may amount to 100-200
times the normal. The liquid is clear or slightly turbid (because
of the admixture of desquamated and degenerated epithelial
cells), it is thin fluid, sometimes bloody; the specific gravity is
Symptoms, Diagnosis, Treatment. 1053

less than 1016, the content of albumen less than 3%. . Other
changes are present which point to the underlying condition.

_ Symptoms. Dropsy of the pericardium is always observed
in animals which have presented symptoms of the basic disease
for some time. Aside from these the most important symptoms
are an enlarged area of cardiac dullness of similar shape and
extension as in pericarditis with effusion, feeble and dull heart
sounds. If dropsy is present also in the thorax, the enlarged
area of cardiac dullness is in small animals easily determined
while they are sitting or lying on the back, because then orly
the dullness due to the fluid accumulated in the pericardial
cavity remains.

Symptoms of stasis, respiratory disturbances, albuminuria,
feeble and small pulse beats also become evident, but these.
symptoms are largely due to the basic condition itself which
indeed is of deciding influence upon the course and prognosis.

Diagnosis. Dropsy of the pericardium differs from peri-
carditis with fluid exudate by the absence of acute symptoms
(pain, fever) and of friction sounds, and by the presence of
manifestations of hydrops elsewhere.

Treatment. As hydrops of the pericardium only represents
a phenomenon of other affections, the treatment must be adapted
to the nature of the underlying condition. It is sometimes
possible to diminish the pericardial fluid by the systematic
administration of diuretic and diaphoretic remedies and of
laxatives. If the accumulation of fiuid is excessive punction
of the pericardium may be attempted.

Accumulation of Blood in the Pericardium (Haemopericardium).
Hemorrhage into the pericardial cavity may occur from the cavities of
the heart, from the blood vessels of the heart muscle or from the larger
vessel trunks. As immediate causes of bleeding may be mentioned
trauma or spontaneous rupture of the heart, rupture of the dilated
coronary artery or of a large vessel trunk, especially of the aorta, if this
is dilated above the valves. Finally bleeding may occur exceptionally
in diseases with hemorrhagic diathesis.

Hemopericardium can only be recognized with a certain degree of
probability in cases in which the bleeding is slow, because in rapid
hemorrhage death occurs as soon as in %-1 hour. The diagnosis is
based upon the demonstration of fluid in the pericardium (p. 1042),
the symptoms of internal hemorrhage and the discovery of some disease
which is known to be able to lead to hemorrhage in the pericardium.

3. Gas in the Pericardium. Pneumopericardium.

Etiology. An accumulation of gas in the pericardium
occurs usually only in cattle, when a foreign body penetrating
into the pericardium from the reticulum has formed a canal
1054 Pneumopericardium.

through which gases may pass from the reticulum into the
pericardial cavity (see p. 1042); the same occurs in ichorous
pericarditis in which putrefactive gases are formed. Atmos-
pheric air enters the pericardium only in very exceptional
cases, for instance after penetrating wounds of the pericardium
by external agencies, by fractured ribs, by breaking down of
a lung cavity which had been adherent to the pericardium.

Symptoms. An intense tympanitic percussion sound is
noticeable in the region of the heart, over an area which is
sharply limited at the periphery and corresponds to the cardiac
area;. this sound is sometimes metallic in character. In pure
pneumopericardium the heart sounds are high and metallic,
owing to the resonance of the pericardium. In most cases,
however, the pericardium contains fluid exudate as well as gases,
and this gives rise to loud splashing, clacking noises which
are sometimes audible from a distance of several steps, and
which are often compared with the noise made by a millwheel
(bruit de moulin).

The clinical picture is supplemented by the more or less
marked symptoms of pericarditis (p. 1043) which is usually
present, or the signs of gas accumulation appear cnly in a
certain stage, for instance, at the beginning or toward the
end of pericarditis. In making a diagnosis it should be re-
membered that a tympanitic sound in the region of the heart
may also be produced by infiltration of the lung portions in
the vicinity of the heart or by diaphragmatic hernia (portions
of intestine in the pericardium [Pettit]). y

Prognosis. Pneumocardium is always of very unfavorabie
significance and a chance for recovery exists only in those
rare cases of injury to the pericardium in which infection
failed to oceur.

Treatment. The same treatment is here indicated as in
acute pericarditis, but the necessity for operation is greater.

Literature. Petit, Rec., 1902. 679 (see also Lit. on pericarditis).
SECTION II.

DISEASES OF THE HEART.
1. Palpitatio Cordis.

(Tachycardia, Hyperkinesis cordis.)  -

A purely nervous palpitation which is independent of
organic heart diseases appears in domestic animals only very
rarely, but it has been observed preferably in highbred and
very vivacious horses and dogs, also once, by Brédo, in a four-
year-old cow.

The greater portion of cases reported under this name in veterinary
literature must undoubtedly be classed with spasm of the diaphragm
or with organic heart diseases. Older authors commonly considered
spasm of the diaphragm as palpitation, and more recently organic heart
diseases which, especially after external influences, also may give rise
to similar spasmodic attacks, have not been duly considered in the inter-
pretation of symptoms.

Etiology. An abnormally increased action of the normal
heart muscle may be caused either by an excessive irritation
or by an increased irritability of the N. sympathicus or by
paralysis of the N. vagus. The first mode enters into con-
sideration in those cases in which palpitation occurs after
violent psychic irritation, after fright, in case of fire, on falling,
after railroad transportation, or from over-exertion; similar
conditions may however also lead to acute cardiac dilatation
or to acute heart weakness. A congenital morbid irritability
of the nervous system in nutritive disturbances, in hemorrhages,
in Basedow’s disease, must in certain cases also be brought
into causal relation with palpitation. Then inflammation or
degeneration of the N. vagus (in chronic lead poisoning)
usually leads to tachycardia. Finally palpitation sometimes
persists after influenza (Pr. Mil. Vb.).

Martius considers palpitation as a purely secondary ‘phenomenon
which is always based upon a paroxysmal acute heart dilatation, i. e.,

an organic heart disease.
1055 5
1056 Tachycardia.

Symptoms. The entire behavior of the animals, especially
their distressed expression, reveals great anxiety, the animals
tremble, horses and cattle perspire. In the heart region thrills.
are seen which are synchronous with the heart beat and which
are sometimes transmitted to the entire trunk and to the
vertebral column. The heart beat is stronger, as a rule much
accelerated and arhythmical in so far as a number of rapid
heart beats alternate with several which are less rapid, or
as brief intermissions occur. The heart sounds are very strong
and are sometimes audible from a distance of several steps.
At the same time the pulse is usually feeble. These symptoms
permit the assumption that a heart weakness was present in
the cases in question, and this assumption is strengthened by
other signs mentioned by several authors, such as intermittent
pulse, systolic murmurs, greater fullness and pulsation of the
jugular vein.

Diagnosis. The assumption of nervous palpitation pre-
supposes the absence of any organic disease of heart or blood
vessels which could produce similar disturbances in the heart
function. Severe acute general diseases must also be eliminated.

Course. Palpitation always lasts only a short time, a few
hours, or at most one-half to one day, after which the attack
disappears either rapidly or quite gradually. In horses that
are otherwise healthy, further attacks usually occur only if
the external influences are repeated, but anemic and otherwise
predisposed animals may have attacks in rapid succession.
The tachycardia which is due to paralysis of the vagus is
usually permanent, but as a rule it is followed in a few days
by a foreign-body-pneumonia (vagus pneumonia).

Treatment. An attack of true tachycardia usually passes
over without any treatment after complete rest is secured and
the diet regulated. In nervous excitement the following drugs
may be administered: morphine (for horses 0.30-0.50 gm., for
dogs 0.02-0.05 gm. subcutaneously), chloral hydrate (20-40.0
or 1-2.0 gm. dissolved in lukewarm water, per os or per anum),
possibly potassium bromide (10-15.0 gm. or 1-2.0 gm. in the
drinking water). Other narcotics may be given successfully.
Cardiotonic remedies should be administered if cardiac weak-
ness is present.

Literature. Brédo, Ann., 1897. 31. — Kroon, Holl. Z., 1899, 388. — Martius,
Tachy-Kardie, 1895; Ergeln. d. Path., 1894. 1. 2. Abt., 59 (Lit. on tachycardia

in general). — Nordheim, Z. f. Vk., 1890. 275. -- Pr. Mil. V1., 1900. 147. —
Schmitt, B. t. W., 1897. 590.

2. Slow Heart Action. Bradycardia.

Slowing of the heart action depends upon a functional
disturbance in the heart muscle without any demonstrable
organic changes.
Bradycardia. 1057

Etiology. The cause of a decided slowing of the heart
beat lies either in an excessive stimulation of the vagus or
in certain affections of the heart muscle.

An excessive stimulation of the N. vagus may follow upon
a bilateral compression of this nerve (in the thorax cavity,
in the medulla oblongata), it may be due to slight inflammation,
to compression of the vagus center in certain brain affections,
and finally, it may be a reflex effect from the stomach or in-
testine, from the peritoneum or from the skin (Albrecht). Cer-
tain chemical substances (e. g., tannates) are also capable of
irritating the vagus. Certain diseases of the heart muscle
frequently cause bradycardia, for instance, degeneration of the
muscle in acute infectious diseases, chronic myocarditis,
atrophy of the heart, affections of the coronary arteries, finally
insufficient nutrition of the heart muscle in inanition.

From what has been said it is readily seen that bradycardia indeed occurs

as an accompaniment of various diseases, but that it must, nevertheless, be
considered separately because in many cases a cause cannot be ascertained.

Symptoms. In horses a reduction in the number of heart
beats has been observed to as few as 9 (Zimmermann), in most
eases only to 12-20 (Dieckerhoff, Nordheim, Vogel, Zschokke),
in dogs to 20-18 (Frébner, Albrecht). The heart beat remains
vigorous and the heart sounds are clear. The animals are
apparently quite well; only in severe cases they show, aside
from the symptoms of the underlying disease, languor, somno-
lence, lassitude, attacks of heart spasms or of heart weakness.

Diagnosis. Bradycardia is easily recognized and the cause
may often be ascertained. It is possible to determine by sub-
cutaneous injections of atropine (for large animals 0.02-0.05;
for dogs 0.005-0.008 gm.) whether the cause lies in the vagus
or in the heart, because bradycardia which is due to an excessive
stimulation of the vagus disappears for a time after the ad-
ministration of atropine. Symptoms of heart weakness, which
may become manifest only on motion, point to an organic dis-
ease of the heart.

Treatment. Nerve stimulants are indicated in all cases,
such as injections of atropine, alcohol, ether, also sponging,
and the relief of any digestive disturbances that may be present.

Literature. Albrecht, W. f. Tk., 1895. 225 (Lit.). — Fréhner, Monh., 1891.
II. 548. — Gutbrod, W. f. Tk., 1901. 493. — Nordheim, Z. f.“Vk., 1890, 275. —
Sonnenberg, B. t. W., 1909. 171. — Vogel, Rep., 1888. 1. — Zimmermann, O. M.,
1900. 289.

3. Intermittent Heart Action. Actio Cordis Intermittens.
(Arhythmia cordis.)

Intermittent heart action is a disturbance of the heart beats
which may be produced by the total omission of one or several
ventricular contractions or by additional systolic contractions.

Vol. 1-67
1058 Intermittent Heart Action.

‘Etiology. The omission of ventricular contractions occurs
frequently in horses as a sequel of acute infectious diseases
especially in the course, or during the convalescence, of in-
fluenza; in other animals it is hardly ever observed. As the
actual cause a reflex or immediate excessive stimulation of the
N. vagus may be assumed, since in the cases observed by the
author the omissions could always be relieved by atropine,
which is known to paralyze the vagus endings. The stimula-
‘tion of the vagus becomes manifest by the intermediation of
the central nervous system when the omissions -occur in brain
> affections, for instance, in case of increased intracranial -pres-
sure (chronic Hydrocephalus’ internus, brain tumors, .inflam-
_thation of the brain. coverings, etc.).. Digestive disturbances
(énteric. catarrh, obstipation) also sometimes give rise to
transitory intermissions which are probably produced by
~ chemical substances that have been absorbed from the intestine,
_ in such a manner that the poisons irritate the N. vagus or its
“eenter either directly or reflexly. The ventricular systole may
finally be omitted in certain cases in connection with diseases
of the heart muscle or of its nervous apparatus, for-instance,
in acute inflammatory processes in the heart muscle, in the
pericardium or in the endocardium.

Intermissions of the heart beat which are produced by
additional systolic contractions occur in all animal species and
always depend upon an abnormal stimulation of the heart.
The abnormal stimulation consists either in an increased
diastolic pressure in any one portion of the heart (in heart
weakness), or it develops in acute inflammatory processes in
the heart muscle, in the pericardium or endocardium. Some-
times poisons which have been absorbed in the intestines exert
an abnormal stimulation upon the heart. -

Pathogenesis. The physiological irritability or conductivity
of the heart-is reduced by excessive stimulation of the N. vagus,
and this oceurs’first on the points of transition between the
auricles and the ventricles, where the compartments of the
heart are connected only by small muscular bundles. In con-
sequence single contractions of the heart muscle. omit, according
to the degree of disturbance either only in the ventricles or
also in the auricles. The same occurs in diseases of the heart.

Under the influence of an abnormal stimulation at the time
when the respective heart segments are usually in diastole,
an unusual contraction, an additional systole occurs following
immediately upon a normal systole but preventing the occur-
rence of the next normal systole by reducing the irritability
of the heart for a time. The sooner the additional systole
follows upon the immediately preceding normal contraction, the
less complete are the filling and contraction of the heart, the
aortic pressure being as yet lowered but slightly, and in con-
Pathogenesis, Symptoms, 1059

sequence the arterial pulse omits in spite of tl lditiona’
contraction of the heart. pite of the additiona!

Symptoms. In omission of the ventricular systole a pause

corresponding to one heart beat can often be observed after
every 2 to 5 heart beats. The intermissions are, however, often

SUTSUTEUUUTRPETOCUQCUUECCUeCUUOOCRRCNO CO COEO CEM RUTTUTMMPUE MONUMENT TTT AUOUEAOOUOETNTUTRATEONOTAnVOTEATY

ROS ROS PHA PONTE GON

Fig. 183. Intermittent heart action in the horse. Sphygmograph of the abdominal
aorta. ‘Intermission of two successive pulse beats (Time indicated in 0.2”).

 

much less frequent, only after every 10 to 15 heart beats, and
occasionally no regularity can be observed. Usually only one
heart beat is omitted, but there are cases in which 2 to 4 suc-
cessive heart beats are missing (Fig. 183). In many cases
a very feeble, dull, short heart sound is heard in the anterior

Z fl

  
 

a
a a cc) peree
B OT areas, OT Oe a eee uve a i

Fig. 184. Intermittent heart action and contractions of the ventricles, occurring at

different times, in a horse. A Cardiograph, the small apices a correspond to the

auricular contractions, the larger bb’ to the ventricular contractions. The auricular

apex persists during omission of ventricular systole. It corresponds with a of the

Phlebigraph B of the jugular vein (negative venous pulse). After each omission of

the ventricular contraction the pressure in the vein rose, because the vein was not
emptied. (Z time in 0.2”.)

portions of the heart, which corresponds to the persisting
auricular contractions, while the vigorous systolic heart sound
which depends upon a contraction of the ventricles is omitted.
The occurrence of the auricular contraction may be assumed
positively because the negative venous pulse at the entrance
1060 Intermittent Heart Action.

of the chest can be felt even during the pause (Fig. 184). The
heart beat following upon the pause is usually stronger, while
the subsequent beats are either normal in force, or evenly
weakened, or then gradually diminish in intensity. The pulse
behaves similarly to the heart beat (true arhythmia of Caroni
and Cadiot). During motion the number of heart beats is in-
creased, the abnormal rhythm being usually preserved, although
sometimes it changes in the same animal from time to time,
so that the pauses occur at shorter, and again at longer
intervals. .

Extrasystolic arhythmia is recognized by the rapid suc-
cession of two or several heart beats, which are separated from
the other, normal, heart beats by a pause, so that bigeminous,
trigeminous, etc., heart beats are noted. The pulse beat cor-
responding with the additional systole is usually absent; only
when this systole is separated from the preceding one by a
longer interval, or if it occurs frequently a rather feeble pulse
may be felt (Fig. 185). During motion the arhythmia becomes

wes er EU ASLe NW 1 LOCO iwi ee

oJ ig i FI A a ra ji J\ :
ween A, i va alee tA a 4 “AN wae a te alee ae eae ee

 

Fig. 185, Arhythmia of the heart due to additional systole, in a dog with cardiac
dilatation and inability to close the bicuspid valve. e¢ Curve of heart beats. A//f.
Sphygmograph of the Art. femoralis, Z time in 1/5 seconds; s normal ventricular
systole, the pulse is distinctly felt; (s) in the sphygmograph; s’ additional systole,
to which at + in the sphygmograph not a beat corresponds, but at s’ a minimal
rise; s’-s” crowded additional systoles, to which in sphygmograph elevations cor-
respond which are in part minimal, are hardly or not at all to be felt.

still more striking, or if it had not been observed at rest it
then becomes manifest. It may often be relieved temporarily
by cardiotonics.

Course. If the intermission of the heart action occurs
in the course of an acute disease, it disappears together with
its removal; but if in the meanwhile lasting changes have
developed in the heart, the arhythmia persists without inter-
fering, as a rule, with the health of the animal. In chronic
heart affections, however, the arhythmia disappears at most
for a certain time and the animals show signs of being broken-
winded.

Treatment, Aside from the treatment of the basic disease,
animals which show a considerable degree of arhythmia should
Treatment. , 1061

be worked only with great care. If the arhythmia depends upon
organic diseases of the heart muscle, cardiac remedies are some-
times of value.

Literature. Cadiot, Bull., 1894. 188, — Caroni, Rec., 1894. 607. — Hering,
D. m. W., 1906. 929, — Siedamgrotzky, 8. B., 1886. 20, — Wenckebach, Die
Arhythmie d. Herzens, 1903.

4, Hypertrophy of the Heart. Hypertrophia Cordis.

Hypertrophy of the heart consists in an increase inthe
heart muscle which arises from thickening and possibly from
multiplication of the muscular fibers under the influence of
an increase in function persisting for at least four weeks.

Etiology. During severe work the normal, or usually in-
creased blood is forced against the normal or increased re-
sistance at greatly shortened intervals, and if this is repeated
time and again it is followed by hypertrophy of the heart
muscle. In horses used for rapid motion, in hunting dogs, and
exceptionally in pack-horses and draught-oxen, the relatively
great size of the heart stands in relation to the increased
muscular exertion. A comparatively large heart may be said
to be a constant finding in some species of these animals, and
it is not improbable that heredity may be of influence upon
the dimensions of the heart. This physiological hypertrophy
is always in proportion to the development of the muscles of
the body and does not require any treatment. :

On the other hand a pathological hypertrophy of the heart
does not stand in direct relation to the development of the
skeletal muscles or is limited to some portions of the heart.
In persistent disturbances of the circulation the part of the
heart which is connected with the place of the disturbance is
forced to continuously increased exertion and this is eventually
followed by hypertrophy of this portion of the heart; in dis-
eases of the left venous ostium, however, the right ventricle
also hypertrophies owing to increased work done. Pathological
processes in the heart muscle itself, such as chronic myocarditis,
tumors, echinococcic cysts, etc, also lead to an increase in
the muscular tissue in those parts of the heart which are not
immediately affected. A similar result is produced by ad-
hesions of the layers of the pericardium because it necessitates
an increased amount of work on the part of the heart. Acute
cardiac dilatation may also form a basis for the development.
of hypertrophy if the heart muscle is comparatively unimpaired.
(In chronic myocarditis the hypertrophy may at times be only
apparent being simulated by the fact that the wall of some
portion of the heart has become ‘thicker owing to cellular in-
filtration or to simultaneous new-formation of connective tissue
[E. Albrecht]). Finally hypertrophy of the heart often de-
1062 Hypertrophy of the Heart.

velops in older dogs in consequence of a chronic, especially
interstitial, inflammation of the kidneys.

Senator sees the cause of nephritic hypertrophy, which usually occurs in
the left heart, less often in both halves of the heart, in a narrowing of the vessels
which is produced by irritating substances retained in the blood, and also in an
irritation of the heart muscle by these same substances. In certain cases, which
may ke not a few, the enlargement of the heart probably occurs through the
influence of the causes which are responsible for the inflammation in the kidneys.

The secondary hypertrophy of the heart which occurs in
connection with chronic diseases of the heart, lungs, arteries
or kidneys is a phenomenon of these diseases and will there-
fore be considered in connection with them. Here only the
so called idiopathic hypertrophy of the heart is to be discussed
which arises from an acute cardiac dilatation or is possibly
produced by irritating substances that are not known exactly.

Many contributions on idiopathic hypertrophy of the heart may be found in
veterinary literature; on the basis of their clinical symptoms, however, most of.
them must be classed rather with chronic myocarditis or with cardiac dilatation.

Anatomical Changes. The determination of cardiac hyper-
trophy requires an exact knowledge of the physiological dimen-
sions, the relations between heart and body weight and a con-
sideration of the size of the respective heart cavities.

The relation of the weight of the heart to the weight of the living body
in the horse is, according to Franck & Martin, 1% on an average; according to
Frey, 1.28%; according to Schubert, 0.84%; in cattle, according to Schmalz,
0.33-0.42%; according to Schneider, in the steer 0.442%, in the ox 0.414%, in
the. cow 0.492%; according to Schubert, in the steer 0.486%, in the ox 0.42%,
in the cow 0.52%,-and in calves 0.708%; in the dog, according to Schubert, 1%
of the body weight. :

During moderate contractions the hypertrophy of the
muscle may be noticeable even on external inspection, especially
if it is only partial. The form of the heart is changed thus
that with an increased thickness of the left ventricular wall
the heart as a whole is slender, elongated, like a pointed cone,
while in hypertrophy of the right ventricular wall the heart
as a whole becomes broader and more flat, the right heart being
involved in the formation of the apex; indeed, if the hyper-
trophy is very great, the right ventricle reaches beyond the
apex of the left ventricle. The thickened muscle is usually
firm and like rubber. The weight of the heart is also increased
and may in well marked cases amount to twice the normal

weight.

The customary classification of simple hypertrophy (walls thickened, cavity
of normal width), concentric hypertrophy (walls thickened, cavity smaller) and
eccentric hypertrophy (walls thickened, cavity dilated) is well adapted for a
coreise description of the findings, but it has no particular significance, except
that the last form indicates a considerable insufficiency of the previously hyper-

trophied heart muscle.
Symptoms, Treatment. 1063

Symptoms. Physiological hypertrophy of the heart does
not give rise to any morbid symptoms. The symptoms of
hypertrophy which’ develop in connection with organic heart
diseases or arterial affections will be considered in connection
with these diseases.

In the remaining cases the hypertrophy is characterized
by an enlarged cardiac dullness, increased force of the heart
beat, accentuated diastolic heart sound and by a strong and
tense pulse.

If the energy of the heart contractions is diminished later
on, the symptoms of cardiac insufficiency appear which cor-
respond with those of dilatation (p. 1064). At first they usually
oceur only on motion, but may later be observed also at rest.
There are then noticeable languor, feeble pulse, increased full-
ness of the veins, gradually increasing emaciation, dropsical
signs, sometimes vertigo and attacks similar to palpitation.

Treatment. The treatment will have to be limited to pre-
venting, if possible, the exhaustion of the heart muscle; this
is done by careful use and proper feeding of the patients.
The animals may, even for considerable periods,: be used for
uniform and quiet work, but exertion usually decidedly aggra-
vates their condition, the circulatory disturbances are increased
and sudden death may follow. In cardiac weakness the remedies
mentioned for cardiac dilatation are applicable (p. 1067).

Literature. Kohne, Mag., 1870. 88..— Liénaux, Ann., 1904. 157. — Mauri,
Rey. vét., 1894. 121. — Schrader, D. t. W., 1902. 156. — Serling, W. f. Tk., 1888.
205. — Siedamgrotzky, 8. B., 1887. 20. — Schubert, Beitr. z. Anatomie d. Herzens
-d. Haussiiugetiere. Diss. Leipzig. 1909 (Lit.). — Vogel, Rep., 1888. 1.

5. Dilatation of the Heart. Dilatatio Cordis.

The term ‘‘Cardiae Dilatation’’ is used to designate a
deficient emptying of the heart cavities during systole, a con-
dition which is based upon a muscular force of the heart muscle
which is relatively smal] in proportion to the resistance.

In accordance with its considerable power of adaptation, the heart
is capable of taking up an amount of blood which is far in excess of the
average amount, and to expel it during the next systole, if its muscles
are unimpaired. This is a compensatory dilatation, purely diastolic,
which develops in some forms of valvular lesions and leads, after a
certain time, to hypertrophy. It will not be further discussed in this

place.

Etiology. Dilatation of the heart develops acutely from
an excessive increase of the blood pressure and usually appears
quite early upon excessive and especially upon unaccustomed
muscular exertion. Under such circumstances the heart muscle
becomes incapable of responding to the excessive increase of the
1064 Cardiac Dilatation.

demands put upon it, and the less so as, owing to rapidly
succeeding contractions, some muscular fibers:may tear. A
dilatation which has occurred in this manner either disappears
after a time, usually after a hypertrophy has developed in
the meantime, or it persists and leads to death, rarely within
a short time, although this has happened within a few minutes.
The trouble "usually occurs most frequently in army and race
horses, and is designated by German authors as ‘‘Over-exertion
of the Heart,’’ or ‘‘Acute Cardiac Insufficiency;’’ by French
authors, “Coeur forcé,’’ ‘‘Coeur fatigué,’’ ‘“‘Surmenage.’’ In
cattle and hogs the disease is not infrequent if these animals
are forced to do unusually severe muscular work (for instance,
while being driven to market) after long continued confine.
ment in the stable or after they are fattened. It is, however,
to be noted that in a number of such cases the heart muscle
possibly had previously not been quite sound. (According to
de la Camp-severe muscular work causes a dilatation only in
a heart which is already diseased.)

In the majority of cases the basis for dilatation is pro-
vided by a disease of the heart muscle or of the arteries, also
by valvular anomalies, in which case the dilatation may develop
either acutely or chronically. Extensive degeneration of the
heart muscle may reduce the muscular force of the heart so
much that this organ cannot even overcome the normal blood
pressure. Of similar significance is myocarditis, which evi-
dently enters as a factor even more frequently than degenera-
tion of the heart muscle. Disease of the coronary arteries is,
in domestic animals, probably only rarely a basis for dilatation.
The same is true of tumors and parasites which may be found
in the heart.

In the stage of. insufficient compensation in valvular lesions,
the section - of the heart which lies in front of the diseased
portion is dilated, while in diseases of the left venous ostium
the right ventricle is also dilated. The cause of this dilatation
will be discussed at greater detail under organic heart diseases.

It is also as a consequence of cardiac weakness that dilata-
tion may occur as a sequel of cardiac hypertrophy associated
with chronic nephritis.

Anatomical Changes. The affected cavities of the heart
are larger than normal. The walls are flabby, so that the
opening is not patent when an incision is made on-autopsy.
If the size of the heart was normal before the development
of the dilatation, the walls are thinner in proportion to the
degree of dilatation. If the disease has lasted for some time,
there occurs an atrophy of the muscles, which may be so ex-
treme that the visceral layer of the pericardium comes into
opposition to the endocardium (Dilatatio passiva). If, on
the other hand, the dilatation has developed in a heart ‘that
had previously become hypertrophied, the wall of the dilated
Anatomical Changes. 1065

cavity either remains of normal thickness, or appears to be
even thicker (Dilatatio activa). In this case the presence of

 

Fig. 186. Cardiac Dilatation. The dotted line gives the normal heart dullness,

the solid line indicates the enlarged heart dullness (4th to 6th intercostal space),

the dullness passes backward into the anterior border of the liver dullness, which is
also enlarged. (Same dog as in Fig. 187.)

 

Fig. 187. Cardiac Dilatation. Enormously increased cardiac dullness on the right
side. The dotted line gives the borders of the dullness, which occurs normally in
large dogs. (The same dog as in Fig. 186.)
1066 Cardiac Dilatation.

dilatation may be surmised, aside from the diameter of the
respective cavities, by the fact that the trabeculae on the inner
surfaces of the ventricular wall are narrow and separated
one from the other by wide spaces. At the same time the
chordae tendineae are usually thin and elongated. The muscles
almost always show signs of parenchymatous or fatty degenera-
tion and also of atrophy. A dilatation of the auricles is as
a rule observable at first glance and may be recognized by
the fact that the walls have become as thin as paper and that
the septum has acquired larger dimensions.

In other organs, especially in the lungs, in the liver, spleen,
kidneys, ete., there are symptoms of venous stasis and dropsical
effusions due to the same.

Symptoms. In severe cases, enlargement of the cardiac
dullness may be shown, which is sometimes very considerable,
while in animals in which normally an absolute heart dullness
is not found, above all the occurrence of such an absolute
heart dullness is noticeable. In carnivora the dilatation of
the left ventricle causes an enlargement of the cardiac dullness
upward beyond the mammary line (Fig. 186) ; in other animals,
both upward and even more backward (Fig. 188). On the
other hand, the dilatation of the right ventricle is characterized
by the occurrence of an absolute dullness on the right side, or
by an enlargement of the dullness which is normally = very slight
in small- chested animals. (Fig. 187 and 189.) Considerable
dilatation of the right ventricle, however, causes an increase
of the dullness even on the left side. It is possible, as shown
by a case of the author’s in a dog six weeks old, for the cardiac
dullness in dilatation of the right half of the heart to extend
forward as far as the second intercostal space. It is not certain
whether this is to be observed only in very young animals.
The force of the heart beat is usually increased because a
greater portion of the heart is in apposition to the chest wall.
Sometimes the trunk receives a thrill synchronously with the
heart beat. The beat appears weaker only when the heart
weakness has become considerable. The systolic heart sound
is increased in force like the heart beat, while the second sound
is usually small or not at all perceptible. The action of the
heart is not infrequently arhythmical, and the first, less often
also the second heart sounds are dicrotic. Endocardial sounds
are caused by the relative insufficiency of the valves which
develops after a while in some cases.

In contrast to the increased heart beat, the pulse is always
feeble. It may also be arhythmical and intermittent, corres-
ponding to the heart beat.

In the case of a prolonged acute, and in chronic dilatation,
sometimes a venous stasis is observed, especially fullness and
pulsation of the jugular veins. In a marked dilatation of the
Symptoms. 1067

right heart a positive (systolic) pulse of the jugular veins
may even be noticeable (relative insufficiency of the tricuspid).
Further, cyanotic discoloration of the mucous membranes is
observed; also attacks of vertigo; in more advanced cases,
considerable dyspnea, sometimes pulmonary hemorrhage,
edema, hydrops of the body cavities, diminution of the amount
of urine, ete. Some of these phenomena are at first hardly
noticeable when the animals are at rest, but they increase
decidedly even on brief motion and sometimes to such a degree
that the animal may die suddenly with symptoms of asphyxia.

 

Fig. 188. Cardiac Dilatation. The dotted line gives the borders of the normal heart
dullness, which appears in the illustration to lie too high, on account of the
swelling of the lower chest. The solid line indicates the upper and posterior borders
of the greatly enlarged heart dullness. Owing to the dilatation, the punctum maxi-
mum of the systolic sounds arising in the left venous ostium (large circle) and of
the second pulmonary sound (small circle) is displaced upward. (Compare Fig. 189.)

Course. If the animals are cared for, the symptoms may,
if they are not yet severe, diminish considerably, and in such
cases the cardiac dullness will become much smaller. In acute
dilatation a complete retrogression may be observed, which,
however, usually leaves a hypertrophy behind.

Diagnosis. The characteristic symptoms of cardiac dilata-
tion are: enlargement of the heart dullness, increase in the
force of the first heart sound, arhythmia of the heart action,
feeble pulse, symptoms of stasis. The feebleness of the pulse
differentiates the disease from primary hypertrophy of the
1068 Cardiae Dilatation.

heart. The absence of friction sounds distinguishes it from
pericarditis or from hydropericardium.

Treatment. Permanent recovery may be hoped for only .
if a previously healthy heart has become dilated owing to very
severe muscular exertion. In such cases the cireulatory dis-
turbaneces retrogress considerably or entirely under absolute
rest and through the influence of repeated administration of
eardio-tonic remedies, first of all digitalis. This improvement
may occur in a short time. (For details see the chapter on

 

Fig. 189. Cardiac Dilatation. Fleart dullness of the horse pictured in Fig. 188,
on the right side, in the 4th to 5th intercostal space; in front the upper border
reaches the scapular line.

valvular diseases.) Even dilatation which commences in the
course of acute infectious diseases may sometimes be reduced
by similar treatment; but if the heart had heen diseased pre-
viously or if there are permanent impediments to the cireula-
tion of the blood, if, moreover. signs of degenerative processes
exist, it may be possible to obtain an improvement that is at.
times quite considerable, but this will soon yield to an aggrava-
tion of the condition. Such patients ean be used for work only
to a very limited degree. It is always necessary to insure
nutritious feeding and to save the animals from work.

Literature. De la Camp, Z. f. kl. Med., 1904, LI. 1. — Goedecke, D. t. W.,
1910. 205. — Pr. Mil. Vb., 1899-1908, — Trasbot, A. d’Alf., 1878. 204; Bull,
1899. 206. — Zschokke, Sch. A, 1900, XLII. 211, (See also Lit, on hypertrophy of
the heart.)

«
Myocarditis. 1069

6. Inflammation of the Heart Muscle. Myocarditis.
(a) Acute Myocarditis. Myocarditis Acuta.

There are two principal types of acute inflammatory
processes in the heart muscle, namely, the parenchymatous
myocarditis, which is characterized by a pathological effusion
that may be very slight, and by a more emphatic degeneration
of the muscular fibers, and secondly, purulent myocarditis, in
which purulent softened foci are developed in the heart muscle.

In contrast to purulent myocarditis, the acute parenchymatous
myocarditis cannot be sharply distinguished from parenchymatous or
fatty degeneration. The essential point of differentiation is really only
in the pathological effusion which is absent in purulent myocarditis
(Kitt), but which, in parenchymatous disease, may be so inconsiderable
that it is only possible by means of microscopical examination to decide
whether the process is to be called an inflammation or a degeneration.
If the gross anatomical appearance of the heart muscle does not always
offer diagnostic information, the clinician is even less in a position to
decide whether and for how long a time the process in the heart muscle
is inflammatory or simply degenerative in nature, because both processes
usually develop under similar conditions and are manifested by the same
symptoms. It is therefore justified from a clinical point of view to
consider the parenchymatous degeneration, together with acute paren-
chymatous myocarditis.

Nor does the consideration of acute parenchymatous and of purulent
inflammation in separate chapters appear justified, because clinically
they cannot be differentiated, and, moreover, the treatment of both
diseases is similar. :

Etiology. Aside from the inflammation, which, according
to some authors (Friedberger & Fréhner, Zschokke) develops
primarily in exceptional cases in horses and hunting dogs
owing to excessive exercise, and which probably belongs more
properly to acute cardiac dilatation, acute parenchymatous
myocarditis is a secondary affection, which occurs especially
in acute infectious diseases and very rarely in certain intoxica-
tions. The toxins which, in the course of acute infectious
diseases, circulate in the blood, produce sometimes only a
parenchymatous degeneration or at the same time a fatty
degeneration of the muscular fibers, sometimes also a serous
or cellular infiltration of the interstitial tissue, and frequently
hemorrhages. This occurs especially in the septicemic diseases,
for instance, in hemorrhagic septicemia, in swine erysipelas,
anthrax, and acute glanders, while foot and mouth disease and
especially variola, seem to be complicated by myocarditis only
in their malignant forms. An inflammation which was observed
by Dieckerhoff in connection with the so called Skalma and
which was called by him ‘‘Myocarditis septica,’’ undoubtedly
1070 Myocarditis.

develops upon the basis of an influenzal infection.. Since in
infectious diseases the heart muscle behaves like a parenchyma-
tous organ, the frequency of myocarditis in infectious diseases
may best be indicated by the comparatively frequent occurrence
of renal albuminuria, which points to a parenchymatous disease
of the kidney.

Of poisons, especially the heavy metals (mercury, copper,
antimony), also phosphorus and arsenic are capable of causing
a degeneration of the heart muscle.

Myocarditis, usually purulent in character, develops if
infected emboli have been carried into the blood vessels of
the heart (myocarditis embolica), which occurs most frequently
in cattle. The emboli may be derived from any part of the
body where suppuration or gangrenous disintegration of tissues
is present, but most frequently a purulent or gangrenous in-
fHammation of the lungs or of the intestinal tract, a disintegrat-
ing thrombus of the umbilical vessels, purulent inflammation
of the hoof, puerperal endometritis, strangles, glanders or
decubital gangrene are responsible for the affection. In cattle
the necrosis bacillus sometimes gives rise to the formation
of dry necrotic foci in the heart muscle (Kitt).

There is also a possibility in the case of ulcerating valvular
inflammation that portions of the blood clots deposited upon
the valves together with pathogenic bacteria are arrested in
the smaller branches of the coronary arteries. The transpor-
tation of bacteria into the blood vessels of the valves and into
those of the heart muscle are probably simultaneous (see
endocarditis), but the inflammation may be continued directly
from the diseased valves to the heart muscle. The same is
sometimes the case in purulent or ichorous pericarditis.

Injuries of the heart muscle produce a purulent or ichorous
myocarditis most frequently:in cattle and in the same manner
as the inflammation of the pericardium which has usually
developed earlier from the same cause (see p. 1040). It ig
much less frequent that foreign bodies which have penetrated
the wall of the thorax and have entered the heart produce
myocarditis, because such injuries usually cause death even
before an inflammatory process could possibly be developed.

Anatomical Changes. A very variable number of muscular
fibers is finely granular, swollen, and they sometimes contain
fat globules. If the disease is extensive the muscular fibers
disintegrate into larger or smaller clumps (Zschokke). The
interstitial tissue frequently shows serous-cellular infiltration
and sometimes contains red blood cells (Myocarditis parenchym-
atosa). The heart muscle is of a lighter brown-red than normal,
or grayish-red. It is flabby and friable. The cut surface con-
tains light gray or even butter-yellow dots and stripes (which
are especially noticeable in animals dead of foot and mouth
disease), sometimes also dark red dots. In the case of more
Anatomical Changes, Symptoms. 1071

extensive degeneration the muscle assumes an almost uniform
gray-yellow color. These changes are not alike in all sections
of the heart. Besides healthy or comparatively slightly changed
portions there are parts of the heart, of various extent, which
show very considerable disease.

Metastasis or immediate continuation of a purulent in-
flammation from the vicinity leads to the formation of smaller
pus foci which form abscesses by gradual increase in size or
by confluence (Myocarditis purulenta). Injuries of the heart
muscle will also cause the formation of abscesses. The con-
tents of an abscess may eventually be inspissated into a cheesy
mass and even become calcified. It may also break into the
pericardial cavity or into a heart cavity. Occasionally ichorous
pus is found in the abscesses. (In the heart muscle of calves
which were apparently healthy Kitt found repeatedly a diffuse —
necrosis which was similar to the necrosis observed in hogs
in the skeleton muscles.)

Symptoms. The functioning ability of the heart muscle
is diminished not only by the degeneration but also by the
inflammation in direct proportion to their intensity and ex-
tension. Consequently, the symptoms correspond with the
clinical picture of cardiac debility only if the affection is con-
siderable. The clinical picture of myocarditis occurring in
connection with acute infectious diseases develops as a rule
gradually. The number of heart beats increases three- or four-
fold. The heart beat is at first, and sometimes permanently,
increased and can be felt over a larger territory than usual
on account of the rapid contractions of the heart muscle which
is otherwise weakened. In contrast the pulse is feeble, some-
times thready and often arrhythmical. To these symptoms are
added signs of stasis, at first only in the form of a dark red
coloration or cyanosis of the visible mucous membranes. while
at the same time the veins are filled more strongly. Later,
however, the larger veins are more prominent. All these symp-
toms may eventually retrogress slowly, the number of heart
beats becoming more and more normal, the pulse fuller and
its tension greater, while the blood stasis disappears, and with
the cure of the basic disease the cavity of the heart returns
to the normal.

In severe cases, however, the disturbances increase, the
heart beat becomes more and more rapid, the pulse more
thread-like, irregular and intermittent, venous pulsation is
noticeable, the respiration is hastened and more or less labored.
Vertigo, trembling and debility become manifest, and finally
paralysis of the heart terminates the disease. In exceptional
cases the cardiac weakness develops so rapidly that the sick
animals fall down as though of an apoplectic stroke, and die
after a short time, for instance, in the malignant form of
foot and mouth disease, and sometimes also in influenza of
1072 Myocarditis.

horses. Finally, sudden death may occur in animals that are
apparently healthy and in which autopsy shows that somewhere
in the heart muscle an abscess had existed for some time and
which had caused death by perforating into the pericardial
cavity or into one of the heart cavities. Such cases occur
preferably in animals that are continuously saved from all
exercise (cows). |

Diagnosis. Acute myocarditis may be mistaken especially
for acute peri- or endocarditis, since in both these diseases
the heart beat is usually much stronger and bounding. In
the initial stage the differentiation, on the ground of clinical
symptoms alone, is hardly possible. Later on, however, these
diseases may be eliminated by the absence of abnormal sounds.
—The general vascular paralysis which is frequent in acute
infectious diseases is characterized by the fact that the veins
are not filled very strongly and by the pale blue discoloration
of the mucous membranes. This affection is frequently asso-
ciated with acute myocarditis.

The nature of the inflammation of the heart muscle can
be ascertained only approximately by considering the basic
disease or the morbid cause; especially a purulent inflammation
can be assumed only then when other factors admit the possi-
bility of metastasis. Aside from parenchymatous degeneration
or inflammation of the heart muscle, the kidneys also become
often similarly affected in acute infectious diseases, and the
albuminuria which is due to such an occurrence may be made
use of in making a diagnosis.

Prognosis. The significance of parenchymatous degenera-
tion or inflammation depends primarily upon whether the basic
disease permits a removal of its cause. If, however, the
degeneration or the functional disturbances produced by it
have passed a certain degree, healing becomes impossible. Of
deciding importance in these cases is the tone of the vascular
walls and also the degree of impediment to the blood stream;
in general vascular paralysis, or in extensive infiltration of
the lungs the circulatory disturbances assume a threatening
character earlier, the heart changes being of like degree.

The pulse rate is of importance in so far as, with an in-
crease to more than twice the normal, an equalization of the
disturbances can hardly be hoped for. If the disturbances of
the cardiac activity are less severe, the irregularity and weak-
ness of the pulse are again of unfavorable import.—In purulent
inflammation the prognosis is always unfavorable.

Treatment. The cardiac weakness may be counteracted
by excitants or cardio-tonics. According to the intensity of
the functional disturbances, the following remedies may be
considered: Alcohol (in the drinking water); for smaller
Treatment. 1073

animals wine or brandy, digitalis (in powder form, as infusion,
maceration or dialyzation), strophanthin subcutaneously,
camphor internally, or camphorated oil subcutaneously, ether
subcutaneously, ete. Gmeiner always observed good effects in
myocarditis following upon acute infectious diseases from
caffeine (large animals 6 to 8 gms., smaller animals 0.5 to 1.0
gms.) subcutaneously every 6 to 8 hours. In very severe cases
the preparations of camphor are particularly indicated, and
occasionally even in apparently hopeless cases the occurrence
of heart paralysis may be prevented by subcutaneous injec-
tions, which are repeated every hour or every two hours.

Aside from this treatment good effects may be obtained
from spongings and the removal of retained feces. It. goes
without saying that absolute rest and good nutrition of the
patient must be secured.

Literature. Berton, Rec., 1898. 289. — Cadiot, Bull., 1893. 374. — Friedberger,
Miinch. Jhb., 1877-78. 58. — Gmeiner, B. t. W., 1906. 409. — Johne, 8. B., 1878.

19, 21. — Trattner, A. L., 1904. 489 — Zschokke, Schw A., 1900. XLII. 193;
XLIX, 320,

(b) Chronic Myocarditis. Myocarditis Chronica.

Chronic iiflammatory processes in the heart muscle oceur
in domestic animals much more frequently than used to be
assumed. A part of the cases described as idiopathic hyper-
trophy or as dilatation of the heart was evidently due to chronic
myocarditis.

Etiology. Chronic myocarditis not infrequently develops
from the acute form. Further, abscesses developing. in the
heart muscle incite an increase in connective tissue, either in
their immediate vicinity or in more distant portions. .Occa-
sionally chronic muscular rheumatism, chronic nephritis, chronic
endoarteritis, may act as exciting causes. Tuberculous foci
or abscesses with circumscribed myocarditis are sometimes
seen in cattle and dogs, exceptionally also in hogs, not infre-
quently in chickens (Félger). Chronic peri- and endocarditis
is sometimes also followed by chronic myocarditis, either from
a direct continuation of the inflammatory process or from the
same cause as the peri- or endocarditis, and in fact the in-
flammatory process may occur simultaneously in the heart
muscle. In a portion of the cases the disease undoubtedly de-
velops idiopathically for reasons that are not known. Occa-
sionally, perhaps, certain chemical substances or mechanical
influences and agencies leading to increased arterial pressure
may be of importance. Fleischer & Lode have produced necrotic
foci in the heart muscle in 59% of their experiment rabbits
after combined injections of adrenalin and caffeine, and the
necrotic foci were much smaller if adrenalin alone was injected
jntravenously.

Vol. 168
1074 Chronic Myocarditis,

A disease described by some Hungarian veterinarians (Schleiffer,
Viasz, Horvath, Liszl6) as a sequel of foot and mouth disease is prob-
ably also based upon a chronic myocarditis which has developed out of
the acute inflammation. The most striking morbid symptoms are
dyspnea, attacks of asphyxia during motion, delayed change of the hair
coat, bad nutrition and diminished milk secretion.

Anatomical Changes. The heart muscle is more solid,
either throughout or, more frequently, in portions of various
extension, and contains grayish-white spots or streaks (scars).
(In extensive degeneration of the cardiac muscular fibers, the
heart muscle may, however, become softer, even before the
occurrence of an active tissue atrophy.) More extensive scars
are bulged outward through the action of the blood pressure
(aneurysma cordis chronicum fibrosum). The heart is en-
larged in the case of extensive disease, both owing to a thick-
ening of its walls and because of a dilatation of the cavities.

Symptoms. Smaller scars in the heart muscle sometimes
do not cause any morbid symptoms. Since, however, larger
portions of the heart are usually affected, manifestations of
heart weakness nevertheless appear sooner or later. A partial
atrophy of the muscular fibers may, in certain cases, be com-
pensated by the increased functioning of the unaffected fibers,
but this compensation lasts only for a time and finally the
symptoms of heart weakness appear in such cases also.

In the initial stage of the disease, which occasionally lasts
a long time, the cardiac insufficiency becomes evident only after
severe exertion or excitement, The pulse is much increased, -
usually arhythmical and feeble. The heart beat is irregular
and bounding; the systolic heart sound loud and high. The
veins are filled strongly. There is vertigo, staggering gait,
rapid fatigue, severe dyspnea, occasionally collapse. In the
further course these symptoms become manifest even at rest,
after a dilatation of the heart has been added in the meanwhile,
owing to which endocardial sounds may be manifest. After
variable periods of time serous fluid accumulates in the serous
cavities and cutaneous edemata develop.

Course. The condition of the animals often varies con-
siderably, especially under the influence of external conditions.
In some eases, especially after over-exertion, death may occur
suddenly even before the condition has become very serious.
On the other hand, the disease may be recognized in animals
which are saved from excessive exercise only on the occurrence
of symptoms of stasis (chronic bronchial catarrh, dropsy,
gastro-enteric catarrh, etc.).

Diagnosis. Chronic myocarditis may be recognized only
then when the development of the morbid condition out of an
acute disease of the heart or of its linings can be followed
Diagnosis, Treatment. 1075

exactly by continued observation of the animals. In making
a diagnosis, chronic endocarditis, chronic pericarditis and

chronic pulmonary affections must especially enter ito con-
sideration.

Treatment. In very ill animals which have become useless
for work, no opportunity is offered for treatment, because such
animals are usually disposed of otherwise. In other cases a
similar therapeutic proceeding is indicated as in dilatation of
the heart (see p. 1068).

Literature. Ball, J. vét., 1906. 344, — Folger, Monh., 1909, XX. 348, —
Horvath, A. L., 1906. 182. — Laszlé, ibid., 1906. 219. — Pr. Mil. Vb., 1900. 147. —
Zschokke, Schw. A., 1900. XLII. 193.

Ossification of the Heart Muscle. This is an extremely rare dis-
ease, which so far has usually been observed only in older animals,
exceptionally in younger animals (by Cadiot in a five-year-old pony)
and in cattle (Marty, Joest). The cause of the condition is unknown.
Stoss speaks of an extensive irritation produced by great variations in
the blood pressure. The ossification begins almost without exception in
the wall of the right auricle. At first connective tissue proliferation
occurs, then calcification and finally islands or platelets consisting of
spongy bone substances. By union of these bone plates, which occurs
later on, the wall of the auricle may eventually be transformed into
a large connected bony plate. The process of ossification does not pro-
gress beyond the place where the veins open into the heart. The ossified
auricle is usually considerably enlarged, full and tense.

In lighter cases the ossification of the auricle does not interfere
noticeably with the heart action. If, however, the process is more
extensive, signs of heart weakness become manifest during work, and
later on also at rest. The cause of these signs cannot be determined
during the life of the animal.

Literature, Joest, Dresdn. B., 1908. 175. — Kriiger, B. t. W., 1892. 509. —
Nocard, Bull., 1884. 236. — Stoss, D. Z. f. Tm., 1888. XIII. 301 (Lit).

7, Fatty Heart. Cor Adiposum.

Etiology. In a general increase of fat deposits the thin
fat layer, which is normally present underneath the serous
covering of the heart, increases considerably, so that it covers
the surface of the heart as a connected layer up to several
millimeters in thickness, and may, moreover, form in places
considerable fat deposits and polypoid nodes. This condition
is observed preferably in obese animals, especially in fat house
dogs; exceptionally a fatty degeneration of the heart muscles
develops simultaneously with the degeneration of the proto-
plasm in intoxications and in infectious diseases.

The excessive deposit of fat becomes of importance because the
fat accumulates not only on the outer surfaces of the muscles, but also
between the muscular fibers which are then forced apart, at the same
1076 Fatty Heart.

time compressed, and are finally caused to atrophy. Even the spread-
ing apart of the muscular fibers alone renders the contractions of the
heart muscle more difficult to a certain degree, and any occurring degen-
eration or atrophy reduces the strength of the heart muscle still more.

Symptoms. In an excessive degree of fatty heart, symp-
toms of heart weakness present, such as feeble heart beat,
perhaps an increased cardiac dullness which, however, is
difficult of demonstration in obese animals; also feeble heart
sounds, possibly anorganic murmurs, feeble, small pulse; in
severe cases vertigo, and finally cutaneous edema. The pro-
duction of dyspnea and of vertigo is to a certain degree to be
credited to the deposit of fat in the respiratory muscles. These
symptoms become marked after severe exercise, or even during
simple motion. Death occurs finally through paralysis of the
heart, pulmonary edema or rupture of the heart.

Treatment. The treatment for obesity (p. 915) is indicated
in this condition. If signs of cardiac weakness are already
present, cardio-tonic remedies must be considered.

8. Rupture of the Heart. Ruptura Cordis.

Etiology. The healthy heart muscles tear at most under
the immediate influence of an injury (external injuries, falling
down in cattle, from wounds caused by a foreign body entering
from the reticulum). Dull pressure exerted upon the heart
ean hardly produce a rupture. Usually rupture of the heart
forms a secondary occurrence which is observed when the
resistance of the heart muscle has been reduced by degenera-
tion or atrophy. This is most frequently the case in animals
with valvular troubles, where, however, the permanent increase
of the blood pressure in certain portions of the heart is also
of importance. Rupture of the heart can, far less frequently,
be brought into causal relation with occlusion of the coronary
arteries or with abscess in the heart wall. In these conditions
there usually exists already a circumscribed bulging of the
diseased heart wall (aneurysma chronicum cordis) and this
persists under special conditions. A bulging of the wall of
the heart may occur exceptionally in acute myocarditis
(aneurysma acutum cordis). As further causes for heart
rupture may be mentioned tumors or parasites (especially
echinococcus), in‘horses also aneurysm of the coronary arteries,
which, however, is very rare (Walter, Gurlt, Bogmann, Cadiot,
Piot-Bey).

In literature reports may be found of rupture of a sound heart muscle from
nervous causes, but this possibility has not been proved irrefutably in a single case.

The bursting of a heart which is already diseased occurs
sometimes without any special cause, particularly under the
Rupture of the Heart. 1077

influence of a normal blood pressure, but in most cases exciting
causes may be demonstrated, such as severe exertion, straining
on defecation, bloating, excitement during mating, during an
operation, etc. As these exciting causes become active much
more frequently in horses, heart rupture is observed more
frequently in the horse than in other animals, with the excep-
tion of traumatic rupture of the heart in cattle.

Anatomical Changes. The pericardium contains more or
less fresh blood (hemopericardium). <A solution of continuity
in the fibers of the heart muscle is often found in the walls
of the ventricles, less often in the walls of the auricles. The
tear is almost always small, its borders ragged and its path
through the ventricular wall usually corresponds to a zigzag
line, so that it is only with difficulty possible to introduce a
probe into the ventricle. Sometimes the tear takes place in
the interventricular septum (Dieckerhoff), and in such cases
hemorrhage does not take place into the pericardium.

Symptoms. In general only symptoms of cardiac paralysis
or of internal hemorrhage are evident, and these cause death
rapidly because the heart is compressed by the blood or hindered
in its diastolic dilatation, or then the action of shock upon the
heart becomes manifest. The occurrence of a rupture is usually
announced by sudden signs of indisposition. In a part of the
eases death occurs suddenly, at night, or so rapidly that hardly
any symptoms are ascertained aside from collapse and con-
vulsions. ° :

Treatment. A rupture of the heart which has actually
occurred cannot be treated. Its appearance, however, may
sometimes be prevented by removing the exciting causes.

Literature. Berndt, A. f. Tk., 1893. XIX. 314. — Graux, J. vét., 1905.
931, — Maleval, Rec., 1904. 508. — Petit, Bull., 1905. 166. — Piot-Bey, Bull.
1906. 425, 430. — Vogel, B. t. W., 1906. 682. :

9. New-Formation in the Heart. Neoplasmata Cordis.

New-formations which oceur in the wall of the heart are of only
slight interest, not only on account of their rarity, but also because their
presence in the heart of living animals can rarely ever be ascertained
with even a small degree of probability. According to the communica-
tions to literature, fibroma, fibromyxoma, myxoma, lipoma, sarcoma (in
horses melanosarcoma) and fibrosarcoma, metastatic adenoma, carci- —
noma, exceptionally also lymphosarcoma, angioma, lymphangioma occur
preferably in the ventricular wall and may, with the exception of
carcinoma or sarcoma, be primary. The most frequent growths are fibro-
sarcoma, and in horses melanosarcoma. The new-formations which pro-
ject towards the heart cavities or towards the pericardial cavity are
not infrequently pediculated.
1078 New-Formation. Animal Parasites.

The muscular tissue atrophies in the immediate vicinity of the swell-
ings, but the defect in muscular force is replaced by the uninjured parts,
which later on become atrophied. A hypertrophy is more apt to develop
as the swellings which bulge out into the cavities or against the openings
of the heart, impede the free circulation of the blood. The size and loca-
tion of the swellings is of influence upon the degree of compensation and
therefore only unimportant disturbances or none at all are observed in
some cases, while in others a severe clinical picture develops. :

The morbid symptoms are very uncertain in character. In most
cases sudden death was observed, or the swellings were found on autopsy
of such animals which had not presented any symptoms of cardiac
disease during life. Only rarely disturbances of the heart function were
noticed; in horses dyspnea was often diagnosed, the basis of which had,
however, remained obscure during the life of the animal. It is probably
only in exceptional cases possible to refer disturbances in the cardiac
function to the presence of a swelling in the heart wall with any degree
of certainty, especially when the occurrence of a primary new-formation
in the organs that are susceptible to immediate investigation permit the
assumption of a metastatic swelling in the heart.

10. Animal Parasites in the Heart.

Of animal parasites cysticerci and echinococei occur most fre-
quently in the heart muscle or under the epicardium (Neumann, Rev.
Vét., 1905, 729, with literature). The cysticerci do not appear to pro-
duce any noticeable disturbances in the heart function, and echinococci
are found, not at all rarely, in the heart muscle of apparently healthy
cattle, as is proved by the findings in abattoirs. (In exceptional cases
the echinococci occur also in horses, especially in the heart muscle or in
the wall of the aorta.) If the echinococcus bladder is comparatively
large, or if several of them are present at the same time (Morot found
20 in one case) they naturally interfere with the heart action, but the
cause of the disturbance cannot be determined even approximately. In
a number of cases death occurs suddenly from paralysis or rupture of
the heart, or from rupture of the echinococcus bladder into the heart
cavity and the transportation of its contents into the pulmonary artery
(Eggeling). The predisposing cause for the occurrence of sudden death
may also lie in the presence of an infectious disease. In a case observed
by Sequens, for instance, the rupture had developed in the febrile stage
of foot and mouth disease.

Of other parasites the Sarcosporidia occur in the heart muscle of
sheep without leading to any particular cardiac disturbances; also
mature specimens of Filaria immitis in the right auricle and the
Strongylus vasorum in the heart of dogs (see pages 902 and 907). Cocu
found a living specimen of distoma hepaticum in the coagulum attached
to the chordae tendineae of the right ventricle of a cow dead with symp-
toms of severe cachexia and dyspnea.

11, Acute Endocarditis. Endocarditis Acuta.

Occurrence. Acute endocarditis belongs to the less frequent
diseases and occurs in horses usually in consequence of in-
fluenza or of pyemic affections; in cattle it develops most fre-
quently in the course of pyemia, of articular rheumatism, rarely
Occurrence, Etiology. 1079

of tuberculosis. Hogs are usually affected by an erysipelatous
endocarditis ; less often the affection accompanies swine plague,
and has only in exceptional cases another origin (Liipke, Bang,
author’s case). In dogs the disease usually follows upon
pyemia, septicemia, distemper, exceptionally also upon tuber-
culosis (Jensen observed 13 cases of ulcerating endocarditis
among 3,240 sick dogs). In cats and birds acute endocarditis
appears to occur only very rarely.

Etiology. Acute endocarditis develops as a rule through
an infection, but the various infectious substances concerned
are at present only partially known. Comparatively often the
pyogenic bacteria (cocci, streptococci, staphylococci, bacillus
pyogenes) appear to be concerned in the production of the
affection (Trasbot, Cadéac, Albrecht, Csokor, Nocard, Kitt,
Bang, Ltpke, Frohner, Joest, author’s case). In hogs the
erysipelas bacilli are usually of importance as etiological fac-
tors. In ulcerous endocarditis Jensen and Thomassen have
found the bacillus coli communis in association with other bac-
teria; Kitt several times the botryomyces in horses; Luginger
a streptothrix in cattle. The tubercle bacillus was found by
Cadéac, Cadiot and Bergeon in cattle; the corynebacillus renalis
by Cadéac and Scherzer in the deposits upon the affected heart
valves; the bacillus bipolaris also is probably frequently a
factor. For instance, Jensen found ovoid bacteria among other
microorganisms in endocarditis of dogs, and Bang as well as
de Jong observed endocarditis in swine plague (among 16,000
hogs dead of swine plague, 676 cases of endocarditis verrucosa
were found in England). Acute endocarditis has also been
noted in swine pest (de Jong).

In some cases an infectious endocarditis develops without
an affection of the other organs and must then be considered
as a primary disease. In the majority of cases, however, the
trouble is secondary in nature and the bacteria reach the
endocardium from inflamed organs (heart muscle, pericardium,
mediastinum) by direct continuity or, much more frequently,
from distant pathological foci with the blood stream. First
in this respect are pyemic and septicemic diseases. Wherever’
in the body suppurating inflammations occur, like suppurating
wounds, inflammation of the umbilical cord, variola (imme-
diately before the suppurating stage or at its beginning),
puerperal fever, strangles, fibrinous-purulent inflammation of
the serous membranes, the malignant form of foot-and-mouth
disease, etc., the opportunity for localization of pyogenic bac-
teria on the heart valves may be given. Sometimes seemingly
quite inconsiderable losses in substance (ulcers at the tip of
the tail or elsewhere on the skin of dogs, bites, pressure wounds
in horses, etc.) or inflammatory foci in other organs (in the
ease of Blanc’s, inflammation of the bile ducts). afford a point
of entrance to the pyogenic bacteria. The transmission of
1080 Acute Endocarditis.

bacteria from the blood of the mother to the fetus is also
possible, and this explanation must probably be accepted for
cases that occur successively in several young of the same
mother animal (Burke, Stephenson). Jensen and Frohner even
believe the transmissibility of the disease from animal to
animal to be not impossible.

In contrast to man, articular rheumatism is not often com-
plicated with endocarditis in animals; most frequently perhaps
in cattle, and evidently also under the influence of pathogenic
bacteria (streptococci or perhaps also staphylococci) which in
all probability produced the articular rheumatism itself.
Probably the endocarditis which sometimes follows upon rheu-
matic founders of horses must also be explained in this sense.
Inflammation of the endocardium must, especially in horses,
undoubtedly be referred to the action of streptococci when it
develops in connection with grippal or catarrhal pneumonia.

The bacilli of swine plague are deposited in the tissue of
the heart valves after a slight acute general infection, or as
Jensen, Lohnsee and Hisenmann have shown, after the erysip-
elatous urticaria has run its course, and cause there an inflam-
mation through which the apparently recovered animals perish
in the course of a few weeks (see p. 68). Marek saw an acute
endocarditis being produced by the erysipelas bacillus in two
horses which had been employed for the production of erysipelas
serum.

In many cases no bacteria are found in the territory of
the inflammation, a fact that must be explained thus, that
either the inflammatory virus had disappeared in the mean-
while, or that bacterial toxins absorbed from other organs
had produced the disease.

Predisposing factors may be of import to such a degree
that formerly many cases of endocarditis were referred to
the immediate action of such factors. Among them are: cold
(frequent in horses, according to Trasbot), over-exertion,
traumatic influences upon the heart region, fracture of ribs,
etc. The chronic form of endocarditis also predisposes to
renewed acute inflammation (Fuchs).

Pathogenesis. The bacteria which circulate in the blood
stream, probably rarely localize directly on the surfaces of the
valves which are contiguous to the blood stream while this
passes by them, less frequently on the parietal layer of the
endocardium. Usually they are arrested in the capillaries of
the valves, and also at the same time in the blood vessels of
the heart muscle. The reason why the localization of the
bacteria mentioned as the second contingency takes place also
on that surface of the valves which is turned toward the lumen
of. the heart, lies, according to Hisenmann, in the peculiar ar-
rangement of the blood vessels in the heart valves. The micro-
organisms, which have localized, and their toxins cause an in-
Pathogenesis, Anatomical Changes, 1081

flammatory condition in the tissue of the valves and in the
wall of the heart. The surface of the valves becomes rough
and masses of thrombi are deposited. These interfere mechan-
ically with the circulation and at the same time the circulatory

eres are much increased by the simultaneous myocar-
itis.

Anatomical Changes. In most cases the valves of the left
half heart are affected, less often those of the right half as well,
or even exclusively (Endocarditis valvularis) ; the pulmonary
valves are involved in exceptional cases only. In this respect
cattle make an exception in so far as in them disease of the
tricuspid valves is more frequent. An inflammation of the
endocardial lining of the muscular wall (Endocarditis
parietalis) is rare.

Endocarditis occurs in two forms, one being designated
as verrucous (Endocarditis valvularis verrucosa), the other as
ulcerous (KE. valv. ulcerosa) ; either one of them may pass into
the other. In the verrucous variety nodules are found on those
surfaces of the valves which face the blood stream, or at their
margins; these are as large as poppy seeds or larger, they
may later become confluent, forming larger nodes, and on the
surfaces of the valves coagulated blood is deposited. It may
happen that the inflammation does not progress further, the
verrucous elevations gradually becoming smaller and leaving
only a thickening of the valves. But in other cases ulcers
with red, uneven borders develop, their bases covered with
a grayish-red or yellowish deposit, or the inflammatory process
is uleerous from the beginning. Fibrin is deposited upon the
ulcerating surface of the valves in thick, uneven masses which
make the opening smaller.

In consequence of the ulcerous destruction the valve be-
comes thinner, in some cases it is bulged out by the blood
pressure (Aneurysma valvulare acutum) and is eventually
ruptured (A. valv. acut. ruptum). If the destructive process
‘is rapid, irregular cleft-like openings form with swelled, gnawed
borders (Valvula fenestrata) without aneurysmal changes.
When the inflammation is continued to the endocardial lining
of the heart, a purulent inflammation may arise in the heart
muscle, giving rise to bulging and to rupture of the thinned
muscular wall (Aneurysma cordis acutum). Occasionally the
valve is even torn from the chordae tendineae or from its
attachment.

Loose blood clots or loosened portions of the valvular tissue
lead to embolism in various organs, which may be followed by

purulent inflammation.

Symptoms. The clinical picture of acute endocarditis is
characterized by its great variability. The varying nature of
the inflammatory process and of the infectious virus, the
1082 Acute Endocarditis.

variable degree in which the heart muscle is involved, the
different localization of the inflammation and finally the pres-
ence or absence of a general infection which in itself may be
“: very variable in nature, produce symptoms which differ in
‘|: different cases. With respect to the last mentioned factor it
must be emphasized that in many cases the blood remains free
from microorganisms after the bacteria have been deposited
upon the valves, while more frequently bacteremia exists from
the beginning or develops later, in addition to the valvular
inflammation.

The disease commences with more or less marked signs
of indisposition. In this respect particularly deviations are
possible according to nature and origin of the disease, only
languor, lassitude, slight fever and fatigue becoming manifest
in some animals, while in others extreme debility, complete
inappetence and high fever are observed, as they always occur
in septicemic diseases. Between these extremes there are many
transitions. *

The heart beat is usually increased or bounding and may
produce a tremor of the chest wall which can be noticed from

SI

\

ANN ‘ NI
nM Ste NN)

 

Fig. 190. Sphygmograph of the Art. femoralis in a dog with ulcerating endocarditis
of the aortic valves. Pulse bounding and much accelerated. (Time indicated in 0.2”.)

a distance. The rate of the heart beats varies; while it is
increased by about one-half of the normal in light cases, it
rises in severe attacks in large animals to 4 to 5 times, in small
animals to 2 to 3 times the usual rate, and is frequently
arhythmic. The cardiac dullness is not altered at first, nor
in rapidly progressive cases through their entire course, but
in more prolonged cases, in which the heart is dilated, the area
of dullness is enlarged. The heart sounds may remain clear
for a long time, indeed, to the end, except that they may become
somewhat feeble and dulled, but in most cases they eventually.
become changed. Usually the two sounds run together into a
single humming or roaring noise; at other times an endocardial
murmur is heard instead of the first or second heart sound or
in place of both, which is usually, soft, blowing or even has
a certain resonance to it and is heard in varying intensity
over different portions of the heart, just as in chronic endo-
Symptoms. 1083

carditis. If the inflammation occurs in several portions of
the heart, several sounds may be perceptible which vary in
pitch, intensity and volume.

The pulse is always accelerated, although its frequency is
extremely variable in different cases; it is frequently arhythmi-
cal, irregular and intermittent; the intermissions are sometimes
so frequent that the number of heart beats is as much as twice
that of the pulse beats. At the commencement of light cases,
the pulse is strong and even vigorous in relation to the rate,
but later, and in severe cases from the first, it is weaker and
soft. The character of
the pulse depends in frepeteT?
part upon the localiza-
tion of the disease (see
valvular diseases); for
instance in inflamma-
tion of the aortic valves
it is bounding (see Fig.
190). :

In correspondence
with the intensity of
the disease circulatory
disturbances develop
which are manifested
by cyanosis, fullness of
the veins, negative
venous pulse, and by
frequent or difficult res-
piration, and which may
be aggravated into as-
phyctic attacks on the
slightest motion or
through external in-
fluences, or they only
become manifest in such
attacks, while they are

not present at rest. ve
Another consequence of TE ee ep ere ain a Cheat Dane, brought
the circulatory disturb- 5 the hospital with an ulcer on the tail, and ended

ances, especially of a fatally in four days.

severe pulmonary hy-

peremia is in many cases a bloody discharge from the nose
which may be accompanied by symptoms of pulmonary edema.
Moreover, edemas sometimes develop quite early in various
parts of the body, for instance, on the limbs and on the lower
portions of the trunk. Occasionally, and particularly in hogs,
a decided weakness of the hindquarter, or even of one posterior
extremity, is observed, which is due either to a stenosis of
the aortic opening, or to a general embolic obstruction of the
arteries, or to the debility which follows upon the severe general

disease.

 
1084 Acute Endocarditis.

The temperature is raised in all cases (Figs. 191 and 192),
but in slight attacks it is moderate, while severe cases are
accompanied by high fever. There are, however, exceptions,
and the great variability of the disease-causes makes it evident
that the type of fever may be subject to numerous variations.

Disturbances in the general condition, which are always
observed, may be so insignificant in cases running a slow
course that they are not observed at all for a time, especially
in swine which are more indolent and live in herds. In other
cases the attack commences with considerable indisposition
or debility; in horses symptoms of colic are now and then
apparent.

With the gradual increase of circulatory disturbances
death occurs in some of the cases, while in others, especially
in those affected with
the uleerous form,
symptoms of metasta-
tic inflammation in va-
rious organs become
evident. Such meta-
stases may give rise to
purulent pneumonia,
or purulent nephritis
sometimes accompanied
by hematuria; to acute
meningitis, purulent in-
flammation of the
joints, etc. Similar
causes must be at-
hens tributed to the local
of heart hemorrhages which de-

velop here and there,

for insta T-
Fig. 192. Temperature curve in endocarditis of : th th ce ander
erysipelas in a horse. Two days before death the nea € cornea.
number of heart beats was twice that of the In a very small

pulse beats. percentage of cases a

possibility of recovery

may exist; but in animals which do not die the clinical picture
of chronic endocarditis usually develops.

T.| P| A.| 9140] 44 | 424143] 44] 15] 16 48] 19

 

Diagnosis. The disease can only then be recognized posi-
tively when repeated examinations have demonstrated that
valvular insufficiency or stenosis have developed in a previously
healthy heart in a comparatively short time. A careful
supervision of the heart action and repeated examinations of
the heart are necessary the more, as the elimination of acute
febrile diseases (anthrax, severe forms of influenza, septicemia,
ete.), perhaps also of severe pulmonary diseases, is possible
only in this manner. Of foremost importance is the character
of the heart sounds and their transformation into murmurs,
but even such findings do not afford absolute proof because
Diagnosis, Prognosis. Treatment. 1085

similar phenomena may be observed in acute myocarditis and
in cardiac dilatation. If the murmurs persist permanently,
if to them are added circulatory disturbances and perhaps
emboli, the nature of the disease may be assumed with sufficient
certainty. Still it must not be forgotten that an animal ill
with chronic endocarditis may become affected with another
septicemic disease.

The differentiation of verrucous endocarditis from the
ulcerous form is usually very difficult. In general it may be
said that the more severe the symptoms, the higher the fever,
and the more turbulent the circulatory disturbances, the greater
is the probability of ulcerous endocarditis. Collateral factors
may afford information in so far as the verrucous form usually
develops in connection with swine erysipelas or with articular
rheumatism, while endocarditis ulcerosa occurs in purulent or
ichorous processes anywhere in the body.

Prognosis. Acute endocarditis is always a severe disease,
especially in the ulcerous form. Even in the lightest cases
there is little hope for complete recovery, because usually
chronic changes remain which afford a basis for permanent
valvular lesions and thus reduce both the ability to work and
the nutrition of the animals.

Treatment. Absolute rest should be procured first of all.
For the alleviation of the excitement, which is noticeable at
least occasionally, cold or ice compresses upon the heart or
cold sprays are appropriate. If the heart action is very rapid
and irregular the cautious administration of digitalis or of
its preparations or of other cardiac remedies is indicated (see
valvular diseases). In heart weakness the danger of cardiac
paralysis must be counteracted with stimulants, for instance,
with alcohol, wines, black coffee, tea, caffeine, theine, camphor,
Liq. Ammon. Anisatus internally; ether, camphorated oil, tinc-
ture of musk subcutaneously. In excessively high temperature
the fever requires lactophenin, antipyrin, aspirin, antifebrin,
etc. In endocarditis of rheumatic origin salicylic acid and
its preparations may be tried.

Literature. Albrecht, W. f. Tk., 1893. 164. — Bang, D. Z. f. Tm., 1892.
XVIII. 27. — Bergeon, Rev. vét., 1905. 320. — Coppel, Die chron. Klappenerkrank.
teim Hunde, Diss. Leipzig, 1908. — Dasch, T. Z., 1907. 518. — Hisenmann, Monh.,
1906. XVII. 97. — Frébner, Monh., 1894. V. 171. — Hartl, Z. f. Tm., 1902. VI.
450. — Jensen, Maanedsskr., 1898. X. 65. — Joest, S. B., 1905. 300. — Joest &

Réder, Monh., 1908. XIX. 158. — Luginger, ibid., 1904. XV. 289 (Lit.). — Meyer,
B. t. W., 1905. 740. — Trasbot, A. d’Alf., 1877. 921.

412. Valvular Diseases. Vitia Cordis. Heart Troubles.

The designation of valvular lesions includes the chronic
organic diseases which cause functional disturbances of the
heart valves and the cardiac ostia. They differ in their deriva-

tion.
1086 Valvular Diseases.

Occurrence. Since valvular lesions occur most frequently
in consequence of chronic endocarditis which is most common
in dogs, the valvular troubles are found most often in these
animals. (According to Cadiot 5% of dogs over one year old
suffer from valvular disease; among 793 dogs autopsied by
Johne, chronic endocarditis was found in 4.3%, and, among
1,831 dogs which were examined in the pathologic-anatomical
institute in Budapest 3.9% were found with evidences of
endocarditis). Next in frequency are horses, and then, very
much less often, the other mammalians, if the cases of acute
endocarditis are not included. The observations of: Larcher
and Hartl show that valvular diseases are not infrequent in
fowls, although they give rise to functional heart disturbances
comparatively rarely.

Etiology. Valvular heart lesions may be caused by the
following diseases of the heart:

1. Acute Endocarditis (see p. 1078), which in its less rapid
cases takes a course presenting the clinical picture of valvular
disease.

2. Chronic Endocarditis (Endocarditis valvularis chron-
ica). This disease is the basis for most cases of valvular
troubles and develops, probably principally, out of the acute
inflammation; it either occurs thus that, after the acute endo-
carditis has run its course, a proliferation with subsequent
atrophy of the connective tissue takes place, or thus that an
acute inflammation, which is not very intense of itself, recurs
periodically and produces proliferation and atrophy of con-
nective tissue after each recurrence. Accordingly all causes
and conditions which stand in etiological relation to acute
endocarditis may occasionally also lead to a chronic inflamma-
tion. In this respect those factors especially enter into con-
sideration which usually, or at least occasionally produce a
mild acute inflammation. This is particularly the case in
endocarditis following upon articular rheumatism and upon
croupous pneumonia, also in inflammation due to tuberculosis
and to erysipelas. In other cases the inflammation is chronic
from the beginning and is usually not noticed; and in such
cases an infection may be a causative factor, although it does
not give rise to acute symptoms. Further, chronic endocarditis
develops in connection with chronic endoarteritis and arterio-
sclerosis, and in dogs frequently in association with chronic
interstitial nephritis. Sonnenberg found the mitral valve of
a cachectic tuberculous cow thickened and covered with a
yellowish-gray deposit, while the endocardium of the left heart
showed diffuse grayish-yellow discoloration. Hartl found in
chickens repeatedly a chronic endocarditis the origin of which
could not be determined. Lastly, severe exertion or the
mechanical irritation of the valves which is necessarily exerted
by it upon them, and also cold are said to produce the disease. °
Etiology, Anatomical Changes. 1087

3. Injuries to the valves are also capable of injuring their
function. This occurs when a valve is perforated or when,
during severe exertion, a semilunar valve igs torn from its
base or one of the bicuspid or tricuspid valves has been torn
from the chordae tendineae by the force of the pressure which
is periodically exerted upon the valves. (In a case of Lustig’s
the valve was torn off during severe work, in a case of Cantini’s
while the horse was jumping; similar cases were observed by
Liithens, Gerlach and Schiitz). In exceptional cases the simple
over-distension of the aortic valves causes an inability to close
(Zschokke).

4. Tumors and Echinococci may cause both insufficiency
and stenosis if they grow from the annuli fibrosi or from the
wall of a heart cavity toward an ostium.

5. Diseases of the heart muscle may produce a valvular
insufficiency even if the valves are not injured (Insufficientia
relativa s. muscularis). Especially in the proper functioning
of the auriculo-ventricular valves both the relaxation of the
chordae tendineae and the contractions of the muscles around
the ostium cooperate to a considerable degree. If the con-
tractions are not sufficiently energetic, the closure of the valves
becomes insufficient. A similar disturbance results if one of
the ostia has been dilated excessively in case of cardiac dilata-
tion of high degree. Insufficiencies from this cause are by
no means infrequent and are usually due to chronic myocarditis,
sometimes they follow upon a cardiac weakness from other
causes and usually affect the right heart. Finally dilatation
of the arterial trunks close to the heart may result in an
insufficiency of the semilunar valves.

6. Congenital heart lesions must also be included here.
According to Preisz they are usually due to impeded, less often
to faulty development or to intrauterine heart diseases. A
comparatively frequent anomaly is the persistence of an open-
ing in the upper anterior portion of the interventricular septum
(Foramen interventriculare persistens) and according to Preisz
the cases described by Csokor and Johne under the name of
Septum membranaceum persistens belong to this lesion. The
Foramen ovale between the auricles remains open fairly often
and also the Ductus Botalli. It occurs only very rarely that
only one auriculo-ventricular opening or a simple arterial trunk
proceeding from the ventricle is found in addition to the above
mentioned anomalies.

Anatomical Changes. Chronic endocarditis leads to new-
formation followed by atrophy of the connective tissue; owing
to these changes the endocardium is thickened in varying
degrees, verrucous, polypoid or cauliflower-like excrescences are
formed on the borders of the valve which is in contact with the
blood stream, and the chordae tendinae are thickened. The
thickened valves become rigid and the semilunar valves are
1088 Valvular Diseases.

transformed into thick flat pads, the separate portions of the
bicuspid and tricuspid valves into thick, knobby formations;
in exceptional cases contiguous parts of valves become adherent.

The thickened chordae tendineae appear shortened. On the
parietal layer of the endocardium changes are frequent but
less striking and only rarely produce thickening. :

If the atrophy of the valves or of the chordae tendineae
has advanced to such a degree that the extended valves no
longer touch, the result is an insufficiency, but if polypoid or
cauliflower-like deposits have formed on the valves or if the
latter are very rigid, and their contiguous portions perhaps
adherent, the result is a stenosis of the respective ostium.
According to the nature and localization of the changes a
stenosis is often present together with an insufficiency. The
portion of the heart which is proximal to the diseased part
(in the direction of the blood stream) is then dilated and more
or less hypertrophic. During the stage of incompensation
there exist symptoms of blood-stasis.

As regards the seat of the changes the disease affects in
horses frequently the aortic valves (according to French
authors this is the most frequent form of heart trouble in
horses), more rarely the bicuspid valve. In cattle and goats
the valves of the right heart are as a rule affected most fre-
quently, in swine those on the left side of the heart, especially
the bicuspid valve. In dogs mitral insufficiency is observed
most often, then the simultaneous affection of bicuspid and
tricuspid valves and about half as often disease of the tricuspid
valve alone. According to Larcher and Hartl the valves of the
right ventricle are usually affected in birds.

Symptoms. According to the localization of the morbid
process the symptoms are so different ue it appears proper
to consider them separately. —

(a) Insufficiency of the Aortic Valves.

In insufficiency of the semilunar valves of the aorta a
slit-like opening persists between the valves during ventricular
systole, in consequence of which a portion of the blood which
had been forced into the aorta during the preceding systole
flows back into the left ventricle, producing a murmur in so
doing. At the same time blood flows into the left ventricle
from the left auricle, and the ventricle, receiving blood from
two directions, is dilated, owing to its power of adaptation,
but forces out its entire blood content during the next systole,
for which a stronger contraction is necessarily required. The
continuous increase in the activity of the heart gives rise to
a hypertrophy of the wall of the dilated ventricle.

The symptoms of insufficiency of the aortic valves are as
follows: The stronger contraction of the hypertrophied and
Symptoms. 1089

at the same time dilated left ventricle produces an increased
lifting heart beat on palpation of the cardiac region, especially

 

Fig. 193. Location of the greatest intensity of endocardial sounds in the horse.

a. 6. shoulder line; 1 punctum maximum of the murmur originating in the left

auriculo-ventricular opening; 2 in the aortic opening; 3 in the opening of the pul-
monary artery. In the other species similar conditions may be shown.

 

i i i i ] iginating in the right

. 194, Location of the greatest intensity of the murmur originating im

ATP dls ceuteielor opening in the horse a a The other murmurs the same as
in Fig. 193.

‘after excitement, and a diastolic thrill of the wall of the thorax
is ta Ee the left side. The area of heart dullness on the
Vol. 1—69
1090 Valvular Diseases..

left side is displaced in dogs about 3-5 em. or more upward,
while in other animals it is displaced upwards and backwards
and may reach as far as the seventh rib and beyond the middle
of the lower third of the chest. The first heart sound is clear,
but the diastolic sound is accompanied by a murmur which
is usually loud, blowing or roaring, perhaps rough or ringing,
prolonged, and which is separated from the systole by a rather
short pause. Its greatest intensity is, in all mammals, in the
left fourth intercostal space immediately below the shoulder
line (Fig. 193.2), although it may be heard, a little less clearly,
also in the same intercostal space on the right side. The
purely diastolic sound which originates in the Art. pulmonalis
can be heard in the region of the left ventricle in association
with the murmurs just referred to, but near the origin of the

 

Fig. 195. Sphygmograph of the abdominal aorta in the horse. a bounding pulse in
aortic insufficiency; b pulse of a healthy horse (Time in 0.2”).°

pulmonary artery (left third intercostal space, ‘lower half of
ate lower third ofthe chest [Fig. 193.3]) it may, be heard almost
alone. re

The pulse is characteristic. The hypertrophied left ventricle
forces an increased amount of blood into the arota and through
it into the peripheral arteries in which the return flow of the
blood during the preceding diastole had produced a very con-
siderable lowering of the blood pressure in comparison with
the normal. The increased amount of blood which is forced
out with every ventricular systole, and the greater difference
(compared with the normal) between the systolic and the
diastolic blood pressure in the arteries produce a more vigorous
Symptoms. 1091

and more rapidly increasing wave which disappears just: as
rapidly, because after the termination of the systole the blood
can flow off rapidly toward the periphery and the heart.
Accordingly the pulse is strong, large, rapid and bounding
(Fig. 195a). A bounding pulse may be felt even in the smaller
arteries, and indeed in the eye ground the pulsation of the
arteries can usually be seen clearly. The larger, and often
also the smaller arteries show systolic pulsation and sometimes
a systolic pulsation of the liver may be observed. At the same
time a clapping vascular sound may often be heard even over
smaller arteries. Finally the mucous membranes may suddenly
become reddened synchronously with each ventricular systole;
this redness may be emphasized by producing previously a cir-
cumscribed pallor by the pressure of a finger tip. This capillary
pulsation sometimes occurs in the severe cases of aortic in-
sufficiency,

(b) Stenosis of the Aortic Opening.

In stenosis of the aortic opening the left ventricle is obliged
to force the normal amount of blood through an opening which
is smaller than normal; and this leads to the development of
a systolic murmur and also requires an increased expenditure
of energy which in its turn causes an increase in the thickness
of the left ventricular wall.

The heart beat may therefore be heard over a larger terri-
tory and either more strongly or less strongly, because the so-
called closure time of the heart function is omitted. Simulta-
neously with the heart beat a systolic thrill may usually be felt.
The cardiac dullness is increased only inconsiderably. The first
heart sound is covered by a very strong, prolonged systolic
murmur, which is separated from the diastolic sound by only
a brief pause; this murmur may be so strong that it can be
heard in the neighborhood of the animal. Its maximal point
is in the fourth intercostal space immediately below the shoulder
line (Fig. 193.2). The systolic sound which originated in the
right heart, as well as the transmitted murmur are heard on
the right side also. The weakened aortic sound may be heard
in the left fourth intercostal space, below the’ shoulder line,
while the pulmonal sound is heard in fairly normal intensity
in the third intercostal space in the lower half of the left lower
third. The pulse wave is sluggish; its growth may be followed
with the palpating finger, because owing to the aortic stenosis
the systolic pressure of the arteries increases much more slowly
than is the case under normal conditions. At the same time
the pulse is remarkably small and presents a distinct contrast
to the heart beat which is usually increased. The systolic
murmur is transmitted even into the smaller arteries, for in-
stance, those of the head and of the extremities.
1092 Valvular Diseases.

(c) Insufficiency of the Bicuspid or Mitral Valve.

If the two flaps of the expanded bicuspid valve do not
touch, a part of the blood in the left ventricle flows back into
the left auricle at each ventricular systole, and the blood of
the pulmonary veins is emptied into this auricle at the same
time. This causes the pressure in the auricle to be increased,
it becomes dilated and eventually hypertrophied, although the
hypertrophy is usually not very marked. But since the
auricular wall cannot expend the force sufficient to remove the
increased pressure and since at each auricular systole blood is
forced into the pulmonary veins which are not provided with
valves, the stasis is continued upward into the pulmonary veins
and from these through the comparatively wide pulmonary
capillaries, to the pulmonary artery and the right ventricle, the
muscular wall of which is hypertrophied in consequence. There
occurs therefore an increase in blood pressure affecting the
entire lesser circulation, which is compensated in the right
ventricle. The persistent passive hyperemia of the lungs
gradually leads to the development of the socalled brown
induration of the lung tissue. The muscle of the left ventricle
also is usually thickened, although not greatly, because at each
systole it is obliged to force out a larger amount of blood.

The heart beat.is usually normal on the left side, but in-
creased on the right side; in horses a contraction is observed
commencing immediately after the beginning of the ventricular
systole, instead of the normal well-marked systolic rise in the
region of the heart during systole. Simultaneously with the
heart beat a systolic thrill may often be felt. The cardiac dull-
ness is not infrequently unchanged, but at times it is somewhat
enlarged on the right side, which may be seen by the fact that
in the fourth and also in the fifth intercostal space on the right
side a distinct cardiac dullness is manifest. On the left side
the cardiac dullness is only rarely noticeably increased. Instead
of the first heart sound a prolonged, blowing or rushing systolic
murmur is heard on the left side, the punctum maximum of
which is in the fifth intercostal space, in the middle of the left
lower third of the chest (Fig. 193.1). In the intercostal spaces
lying in front of it the systolic sound originating in the right
ventricle may also be heard more clearly, and it is audible quite
distinctly in the right 3d-4th intercostal spaces (Fig. 194.1), the
transmitted and much attenuated murmur being also percep-
tible. The diastolic sound is clear, the second aortic sound
usually normal in strength, the second pulmonic sound (in the
left third intercostal space in the lower half of the lower third
of the chest [Fig. 193.3]) much increased, clear and short, i. e.,
accentuated, because the blood column, which within the pul-
monary artery is under an increased pressure, is thrown with
greater force against the semilunar valves. The pulse presents
Symptoms. 1093

no particular deviations, becoming weaker only in severe cases.
The transmitted systolic murmur may usually be heard also
na larger arteries (carotis, first part of the abdominal
aorta). .

Owing to the continued increased blood pressure in the
lungs superficial and accelerated breathing is noted, and also
pecnenia catarrh. The patients are inclined to pulmonary
edema.

(d) Stenosis of the Left Auriculo-Ventricular Opening.

In a narrowing of the left auriculo-ventricular opening the
entrance of the blood from the auricle into the ventricle during
the ventricular diastole is impeded, so that a dilatation of the
left ventricle is produced with subsequent hypertrophy. But
as in spite of the greater work accomplished by the thin-walled
auricle it is not capable of preventing the damming up of the
blood, the stasis is continued to the right ventricle through the
pulmonary veins and arteries. This leads in its turn to an
increase of pressure in the pulmonary circulation and to hyper-
trophy of the right ventricle, while the left ventricle rather
becomes smaller.

The heart beat and cardiac dullness are the same as in the
preceding lesions. Of the heart sounds the first one is clear
everywhere, but the second is accompanied by a diastolic
murmur which is most marked in the left fifth intercostal space,
in the middle of the lower third of the chest (Fig. 193.1). The
murmur is not usually loud and either is heard through the
entire diastole, being separated from the systole only by a short
pause, or only at the commencement, eventually only near the
end of the diastole (presystolic murmur). Aside from the
murmur the second aortic sound may be, and the second pul-
monic sound always is, heard distinctly, the latter being even
more accentuated than in mitral insufficiency. The pulse is
always small and soft because the left ventricle forces less blood
into the aorta. The lungs show the same disturbances as in
mitral insufficiency.

(e) Insufficiency of the Pulmonary Valves.

In this condition the right ventricle receives blood from
two directions during each ventricular diastole, namely, the
blood which regurgitates from the pulmonary artery and that
which flows in from the right auricle; and accommodative dila-
tation of the right ventricle occurs in consequence of the exces-
sive blood supply, which is soon followed by hypertrophy.

The ventricle does more work than normally and forces
an increased amount of blood to a place where the blood pres-
sure is lowered, the blood therefore flows more rapidly into the
1094 Valvular Diseases.

pulmonary artery and this will at times eventually dilate. As
the expulsive force gradually diminishes, the right ventricle is
finally dilated to such a degree that the right auriculo-ventric-
ular opening also enlarges so far as to produce a relative insuffi-
ciency of the tricuspid valve. The insufficiency of the pul-
monary valves remains without effect upon the lungs and the
left heart as long as it is compensated by the increased work
accomplished by the right ventricle.

The heart beat and the cardiac dullness show similar con-
ditions as in diseases of the left venous ostium. The first heart
sound is clear everywhere; instead of the second sound a pro-
longed diastolic murmur which gradually becomes weaker in all
-directions is heard over the origin of the pulmonary artery
(Fig. 193. 3), while the second aortic sound becomes constantly
more distinct. No particular changes are noted in the pulse.
The disease is always accompanied by respiratory disturbances.

(f) Stenosis of the Opening of the Pulmonary Artery.

The blood which is forced out of the right ventricle against
the pulmonary artery meets, in the diminished opening of the
pulmonary artery, an impediment which increases the work of
the right ventricle and leads to hypertrophy of its muscle. The
blood pressure in the lungs is lowered permanently, and the
amount of blood in the pulmonary arteries becomes less as soon
as the energy of the right ventricle diminishes.

The heart beat and the cardiac dullness show the same
deviations as in the preceding form. Over the origin of the
pulmonary artery (Fig. 193.3) a loud, prolonged systolic mur-
mur is heard, and more posteriorly also the first heart sound
which originates in the left ventricle; the second sound is clear
but weakened over the pulmonary artery. The pulse is small
and feeble. Respiratory disturbances and cyanosis are noted
from the first.

(g) Insufficiency of the Tricuspid Valve.

If the unfolded tricuspid valve does not close completely,
a part of the blood in the right ventricle flows, during systole,
back into the right auricle through a more or less narrow open-
ing, the auricle is dilated and eventually slightly hypertrophied.

Since the auricular wall is capable of exerting only a
slight force, and since the openings of the venae cavae are not
closed by valves, the stasis of the blood is continued into venae
cavae and into the other veins of the body. ;

The heart beat differs from the normal at most in so far
as a systolic thrill is often felt simultaneously in the 3d-4th inter-
costal spaces. The cardiac dullness is not altered. The first
heart sound is heard in the left 5th-6th intercostal spaces, either
Symptoms. 1095

quite clear or together with a very faint transmitted murmur;
the systolic murmur reaches its greatest intensity in the right
3d-4th intercostal spaces toward the middle of the lower third of
the chest. (Fig. 194.1.) The diastolic sound is either of normal
intensity or frequently becomes weaker and in such cases the
pulse becomes feeble and small. The veins are filled strongly;
the jugular veins appear as thick cords and show a systolic
(positive) pulsation following immediately. upon the heart beat,
which may, however, not be perceived owing to a long hair coat,
especially in dogs. If the auricle could not remove its entire
blood content, owing to its rapidly diminished functioning
power a certain amount of blood is forced at each systole from

 

Fig. 196. Cardio- and Phlebigraph of a horse with insufficiency of the bicuspid and
tricuspid valves. A Cardiograph. Instead of the elevation which occurs normally
at the beginning of ventricular systole, a descending line is noted (a—c), due to the
omission of the closure of the right ventricle; the line is interrupted by a small
apex (b) which corresponds to the systole of the left ventricle. At the beginning
of ventricular diastole (c—d) the pressure in the ventricles suddenly increases. B
Phlebigraph. a negative venous pulse; 8 positive venous pulse; y carotid pulse;
de rapid emptying of the jugular vein at the beginning of the ventricular diastole.

the right ventricle into the right auricle and from this into the
vena cava. By the regurgitation of the blood into the venae
cavae a systolic wave is produced and is continued to the jugu-
lar veins. The systolic venous pulse represents a pathognomic
phenomenon of tricuspid insufficiency, but it must not be con-
founded with the presystolic (negative) pulsation, which also
occurs in this heart lesion and precedes the heart beat, or with
the pulsation of the carotis. Venous stasis leads soon to

edemas. ,

(h) Stenosis of the Right Auriculo-Ventricular Opening.

A narrowing of the right auriculo-ventricular opening
interferes with the flow of the blood from the right auricle into
the ventricle, thus causing slight hypertrophy and at the same
time a considerable dilatation of the right auricle. Owing to
the latter cause blood-stasis occurs in the venae cavae from the
beginning and is continued toward the periphery. On the other
hand the other portions of the heart receive less blood and
1096 Valvular Diseases.

therefore become smaller. In consequence of the diminished
pressure in the right ventricle and in the pulmonary artery
thrombi easily form in them which may lead to embolism in the
blood vessels of the lungs.

The heart beat is weak, a cardiac dullness can either not
be demonstrated at all or it is diminished in extent. The first
heart sound is clear, the second is accompanied by a presystolic
or diastolic murmur (for similar reasons as in mitral stenosis)
which is heard most strongly in the right 3d-4th intercostal
spaces in the middle of the lower third of the chest. The pulse
is feeble and small. The veins are filled strongly and a pre-
systolic (negative) venous pulsation, as well as undulation, may
be observed. The characteristic signs of severe blood-stasis,
especially marked dyspnea, possibly attacks of asphyxia, occur
already early in the disease.

(i) Congenital Heart Lesions.

Clinical manifestations of congenital heart lesions have
been described only rarely. The most decided symptom usually
consists in considerable weakness. The newborn animals are
not capable of looking for their mothers. They stand with
hardly a movement or cannot even keep their feet. Sometimes
at rest, more often on motion, severe dyspnea and cyanosis are
observed. Congenital valvular lesions give rise to the same’
local symptoms as the acquired forms, but murmurs are mostly
absent in cardiac lesions which are due to faulty development,
or they appear only in those cases in which there is a difference
in the pressure in two communicating heart portions, provided
the abnormal opening is not too large. In two cattle with per-
sistent interventricular openings Huynen observed a systolic
murmur in the left heart region and an accentuated diastolic
heart sound.

The newborn animals usually die after a short time or are
killed, as they are not fit to be raised. In rare cases they de-
velop normally and may even live a fairly long time.

(k) Combined Valvular Lesions.

The clinical pictures of valvular and ostial affections are
not always found as well marked as they have been described;
in reality the forms which have been discussed separately often
occur in combinations. The most frequent’ combinations are
those in which a stenosis of the related ostium coexists with
insufficiency of a certain valve. Since valvular insufficiency is,
in a way, the opposite of stenosis, the individual components
of the clinical picture lessen each other; an exception occurring
only in the accentuation of the second pulmonic sound in com-
bined disease of the left auriculo-ventricular opening. On.this
Symptoms. 1097

account the discernible deviations lose more or less in distinct-
ness and are often confused into a clinical picture which is diffi-
cult to analyze. In insufficiency of the aortic valves and coexist-
Ing aortic stenosis, for instance, systolic as well as diastolic
murmurs are discovered, while the pulse is either not bounding
or only slightly so, because the variations in pressure in the
arteries are not so considerable and less abrupt.

The clinical picture is even more complicated if two or sev-
eral ostia and valves are involved simultaneously. Frequently
only portions of one half of the heart are diseased, for instance,
the aortic valves and at the same time the bicuspid valve, but
sometimes morbid changes are found in the right as well as in
the left halves of the heart, as in diseases of the left venous or
arterial ostium simultaneously with tricuspid insufficiency. .

As it is possible for two anomalies to occur in each of four
places, i. e., insufficiency and stenosis, and as these eight indi-
vidual forces may enter the most variable combinations with
each other (a total of 247 combinations is possible), the vari-
ability of valvular lesions observed in the different cases is not
astonishing, and at the same time renders descriptions of the
clinical pictures suitable for all possible contingencies an impos-
sibility.

Insufficiency of a valve or stenosis of an ostium disturbs
the normal process of the circulation of the blood by producing
a permanent rise in the blood pressure in the parts of the heart
which lie proximally to the seat of the disease, and, in diseases
of the left venous ostium, also in the pulmonary vessels. In
order to maintain a normal, or at least approximately normal
velocity of the blood current in the body and a normal blood
pressure, certain parts of the heart are forced to accomplish
continuously an increased amount of work. This causes their
walls eventually to hypertrophy, and the heart is then enabled
to accomplish the plus of work without constantly drawing upon
its reserve strength. As long as the increased work of certain
parts of the heart maintains the normal velocity of the blood
current, and as long as therefore the functions of the various
organs rest undisturbed in spite of the existing valvular lesions,
with the exception of certain local disturbances which are con-
stant accompaniments of some heart lesions: a compensation
of the valvular lesion is said to exist. However, in this stage
the function of the organs is usually undisturbed only in a con-
dition of rest, in greater muscular exertions and still more in
over-exertion transitory signs of incompensation may appear.
Sometimes, especially in insufficiency of the aortic valves, the
heart may be equal even to these excessively increased demands.
On the other hand, in certain forms of valvular troubles the func-
tion of the organs is impaired to a certain degree, even while ~
at rest, in spite of existing compensation; for instance, in dis-
eases of the left auriculo-ventricular opening, the increased
pressure in the lungs causes superficial and hastened respira-
1098 Valvular Diseases.

tion, while in aortic stenosis symptoms of cerebral anemia may
exist.

The anatomical changes afford a satisfactory explanation
why in diseases of the aortic ostium the symptoms of stasis
generally become manifest later than in other valvular diseases.
Not only is the most vigorous portion of the heart back of the
affected portion in this case, but the weakening of the left ven-
tricle causes a notable stasis only in the lesser circulation, which
can moreover be compensated by the right ventricle. If, on the
other hand, the right ventricle is obliged to compensate a heart
lesion, the stasis continues, immediately to the right auricle
and to the whole venous system, when the right ventricle be-
comes fatigued. Most unfavorable are conditions in diseases
of the right venous ostium because the thin-walled right auricle
is hardly capable of producing a compensation worth mention-
ing; in valvular diseases of the last variety a stage of com-
pensation can therefore hardly be considered.

The cause of the permanent incompensation or decompensa-
tion which develops after a certain time can at present not be
explained satisfactorily for all cases. In a number of cases the
fact that the heart muscle is finally incapable of overcoming the
constantly increasing difficulties must probably be attributed to
the gradually increasing obstacles to the blood current. A
similar effect results from frequently repeated severe muscular
exertion, and from pulmonary edema which is not rare, espe-
cially in horses. In other cases the heart muscle is weakened
by myocardial inflammation which developed simultaneously
with or in consequence of the endocarditis. The strength of the
heart muscle is also reduced by an extensive degeneration, while
a slight degree of degeneration is not important in this respect.
Finally, a functional disturbance of the heart muscle must. be
assumed, in a considerable number of cases, to form the basis of
incompensation, which cannot at present be cemonstrated his-
tologically.

The incompensation is manifested by evidences of heart
-weakness, that is, by lowered arterial pressure and by venous
stasis. The slowing of the blood current and the increased
fullness of the veins become manifest in the appearance of
cyanosis, especially a bluish-red discoloration of the mucous
membranes and even of the unpigmented skin (especially in
hogs) ; sometimes dilatation and perhaps an undulating course
of the veins are also observed. The fullness of the jugular
veins is particularly striking and is not infrequently associated
with venous pulsations. Dropsical effusions into the body cav-
ities and edemas are further occurrences. Edematous swellings
appear first on the front and lower chest, on the lower abdomen
and in the lower portions of the extremities, although in the last
location they usually do not attain a considerable degree, owing
to the tightness of the skin, especially in large animals, In the
Symptoms, Course. 1099

body cavities the effusion usually occurs rather early, first of all
in the abdominal cavity.

The stasis in the brain and’ its membranes causes more or
less striking disturbances in consciousness and attacks of ver-
tigo, especially while at work, which are sometimes repeated
very frequently, even as often as 10-20 times a day. During
such attacks horses frequently fall on their knees while in
motion (Katzke is inclined to consider this as a phenomenon
which is characteristic of heart lesions).

The stasis of blood in the lesser circulation produces respir-
atory disturbances; foundering is in some of the cases due
to a valvular lesion. Chronic bronchial catarrh is a frequent
sequel of stasis in the pulmonary circulation Rarely a bloody
or saffron yellow nasal discharge occurs in consequence of pul-
monary hemorrhage which, however, in exceptional cases causes
death by asphyxia. Epistaxis occurs, though rarely. Toward
the end of the disease pulmonary edema develops almost always
as a terminal phenomenon.

The passive hyperemia in the digestive organs produces
symptoms of chronic gastro-intestinal catarrh, and nutritional
disturbances develop at the same time. The stasis in the renal
veins leads to a diminution in the amount of urine, while the
specific gravity is increased and the urine frequently contains
albumen, and occasionally hyaline casts.

A constant symptom of incompensation is presented by the
disturbed cardiac action, which finds expression in arhythmia
and feeble pulse while at rest, and still more on motion.

Loosened portions of thrombi finally may give rise to
embolism in various organs. In this manner emboli may get.
into the lungs from the right heart and into the other organs
from the left lung. Cerebral emboli and also cerebral hemor-
rhages may be followed immediately by sudden death.

Course. Valvular disease is characterized by a very
changeable course. Aside from the fact that its influence upon
the circulation varies according to localization and intensity, the
course is modified by external conditions and by work. While
dogs which often pass their lives in quiet comfort not rarely live
for years with valvular disease in animals which are employed
for work, especially in horses, this becomes aggravated, rela-
tively early, to such a degree that they become useless for exer-
tion. For the same reason symptoms of stasis, the development
of which requires considerable time, are observed in horses
more rarely; they show instead signs of rapidly increasing
dyspnea and usually die suddenly of pulmonary edema, cardiac
paralysis or rupture of the heart, during work or while in
motion. In dogs the gradual development of the sequelae of
cardiac anomalies, up to severe edematous infiltrations, can be

observed far better; in cattle and in hogs there is far less oppor-
1100 Valvular Diseases.

tunity because these animals are usually slaughtered before the
occurrence of these symptoms. | ,

The disease takes a more rapid course in very young and
in very old animals, because both lack the strength which is
required for a sufficient compensation. Congenital heart lesions
lead to death, with symptoms of severe blood stasis, usually
during the first few weeks or months of life, although occa-
sionally the animals become older. Such cases have been
observed by Thomas, Walley, Johne, Hutyra, Liénaux.

Diagnosis. The recognition of valvular disease is only pos-
sible on the basis of an exact examination, which also considers
the clinical pictures described above. In the interpretation of
the results the following points should be considered, in addition
to the conditions which have already been related.

Sometimes so-called anorganic murmurs are heard without
valvular lesions and without any impediments to the circulation
in the heart; these murmurs are heard more frequently during
systole, only very rarely during diastole. These murmurs may
be eliminated if in addition enlargement of a portion of the
heart or accentuation of the second sound can be demonstrated,
or if a thrill can be felt (‘‘frémissement cataire’’).

The absence of murmurs does not exclude the presence of
a valvular lesion, because in case of slight insufficiency or
stenosis, especially at rest, murmurs are not produced which are
transmitted to the chest wall with sufficient intensity, and
because in severe insufficiency the formation of murmurs may
not occur, as in such a case the regurgitation of the blood does
not take place through a narrow slit; finally, in the stage of
incompensation too feeble contractions of the heart may cause
the murmurs to disappear. In all these cases cardiac remedies
and muscular exertion which have the effect of strengthening
the contractions of the heart usually cause the murmurs to
reappear. It appears therefore advisable in all cases in which
a suspicion of heart disease exists, which includes all cases of
dyspnea the nature of which is not quite evident, to examine the
animals immediately after work and particularly to auscultate
the heart region. Nor should it be forgotten that in aortic
aneurysm murmurs are heard which correspond to the endo-
cardial murmurs.

In domestic animals the recognition of the several valvular
anomalies is always successful in the stage of compensation,
sometimes also in compensated cases, if the character of heart
beat, heart sounds and cardiac dullness is observed and the
punctum maximum of the murmurs is ascertained; a task which
is not particularly difficult in horses. A murmur which has
originated in any section of the heart is naturally heard most
strongly at that place where the related part of the heart is
nearest to the chest wall; but a decided dilatation of the heart
with displacement of the heart sections produces also a dis-
Diagnosis, Prognosis. 1101

placement of the puncta maxima. (Figs. 188, 189.) The
nature of the pulse is of great importance for diagnosis; in fact,
its significance is often decisive, and the same is true for the
character of the arteries and veins. Finally the frequency of
the several valvular anomalies must be considered on making
a diagnosis.

With the determination of a valvular lesion the proof has
not yet been afforded that this lesion is based upon a chronic
endocarditis, although valvular disease depends upon this in a
great majority of cases. The actual cause of a heart lesion can
only then be ascertained with absolute certainty in living
animals if the development of the disease could be traced from
an acute endocarditis, in connection with an infectious disease
or with chronic arthritis. On the other hand, the absolute dis-
appearance of endocardial murmurs and of the symptoms of
insufficiency, after the systematic administration of cardiotonic
remedies and during physical rest admits the assumption of a
muscular insufficiency.

Prognosis. Although the prognosis of chronic valvular
lesions is always unfavorable in regard to the possibility of
healing, the various forms of valvular anomaly require different
interpretation with respect to their effect upon life and the use-
fulness of the animals. Stenosis of the ostia is in general a
more severe disease than is insufficiency of the related valves,
and disease of both valves of the heart is always more dan-
gerous. Of comparatively the least dangerous significance are
diseases of the aortic opening, because the strong-walled left
ventricle maintains its functioning power for a fairly long time.
Disease of the left auriculo-ventricular opening must be judged
less favorably because the right ventricle is capable of less
exertion and because in addition oxidation is interfered with
by the persistently increased pressure in the lungs... The val-
vular lesions which are localized in the right heart are always
of very unfavorable significance; that of the pulmonary opening
because the lungs receive less blood, that of the right auriculo-
ventricular opening because the auricle which is to produce
the compensation is incapable of doing so.

The symptoms of incompensation are always serious, and
the more so the less they are to be referred to external con-
ditions. Of course, the prognosis is the less favorable
the less the animal can be protected against exciting and
exhausting influences. If the disease has existed only a short
time, the age and general condition of the patient must be con-

sidered.

Treatment. Since healing of valvular lesions is impossible
of accomplishment, the treatment must attempt to postpone an
aggravation of the fairly good condition by a proper regulation
of the diet, as long as symptoms of incompensation have not
1102 Valvular Diseases.

made their appearance. The patients must therefore be pro-
tected from all influences which impose an increased amount of
work on the heart, which suddenly change the blood pressure or
irritate the heart in any way. It is therefore necessary to regu-
late the diet thus, that the animals receive no irritating sub-
stances with their food (which must be insisted upon especially
in carnivora), that not too much food is taken in at one time, but
that the usual daily ration is eaten in several small portions. They
must be supplied with pure air or led around in the open. The
work done by the patients must be supervised very carefully.
The animals are capable of accomplishing light, quiet and uni-
form work in proportion to the mildness of their heart trouble.
Experience has shown that, if these precautions are observed,
animals with heart disease may do satisfactory work even for
years, especially in agricultural employment. Finally the diges-
tion must be watched because fecal retention increases the
abdominal pressure, and therefore the activity of the heart. In
such cases the administration of mild laxatives, especially -of
mineral salts, castor oil, rhubarb or aloes is indicated.

In the stages of incompensation (and veterinary aid is
usually requested only at this time) absolute rest must be
insured and the action of the heart regulated. Above all digi-
talis does good service because the heart contracts more vigor-
ously and less frequently under its influence, so that the muscles
obtain more rest during the longer pauses. Larger animals
should receive, if possible, powdered fresh leaves (horses 2-4
gm., cattle 4-6.0 gm. daily), dogs an infusion (1-2.0 gm.; 200.0
gm. of water; 2-3 tablespoonfuls daily), and the nitrate or
acetate of potassium may be added to increase the diuresis.
According to the investigations of Kunz-Krause & Roder it
appears better to employ Folia Digitalis dialysata (for larger
animals 5-15 ce. per os) or the Digitalysatum Biirger (20-30
drops subcutaneously for smaller animals). Maceration of
digitalis leaves (maceration in pure water for 12-24 hours) may
also be given to advantage. Digalen has an excellent action
and is to be recommended, especially if dangerous cardiac weak-
ness is present (horses 5-15 cc., cattle 20 cc., subcutaneously;
or 15-30 cc. intravenously; dogs 5-15 ee. or 0.857 ec. per kg.
of body weight), but if required for prolonged treatment it will
be employed only in valuable or valued animals. Digitalis
being rendered inactive in the stomach of the ruminants (Sal-
visberg), those preparations should be selected for these
animals which are adapted for subcutaneous administration.
Diehl observed abortion in pregnant cows after the use of dig-
italis. The tincture of strophanthus (10-25.0 gm. for large
animals, the same number of drops in smaller animals, daily)
has been found unreliable in contrast to Strophanthinum
depuratum, Merck, the good action of which is constant. It is
given subcutaneously in aqueous solution (soluble in 40 parts
of water) (0.002-0.003 gm. for horses, 0.00025-0.001 for dogs).
Treatment. 1103

At the point of injection painful swellings oceur and sometimes
necrosis of the skin (Frohner, Author’s case). Caffeine also
has an excellent effect (caffeine sodium-benzoate or sodium-
salicylate 6-8.0 gm. for large animals; 0.5-1.0 for small animals
subcutaneously).

In pulmonary stasis, and also in general, moderate vene-
section may prove advantageous.

In case of distressing palpitation cold compresses upon the
region of the heart will be found beneficial, also subcutaneous
injections of morphine (0.20-0.50 gm. or 0.01-0.03 gm.). Liénaux
treats the annoying cough of coexisting bronchial catarrh suc-
cessfully with apomorphine (0.005-0.05 for large, 0.003-0.005
gm. for smaller dogs, subcutaneously).

In edema of the subcutaneous connective tissue calomel may
be tried, since in human medicine a remarkable increase in urine
and a rapid diminution of the edemas has repeatedly been
observed after its administration (for dogs 0.05-0.10 gm. 3-4
times daily alone or with an equal amount of jalap. The other
diuretic remedies (acetate of potassium, squills, ete.) may also
be employed and at the same time the daily amount of drinking
water must be reduced. Very effective is further agurin (for
dogs daily 1-3 gm. dissolved in water), theocin (in like doses),
theophyllin (in like doses). Together with the diminution of
the subcutaneous edemas the transudations in the body cavities
frequently also become less, and these may, moreover, be
removed.temporarily by repeated punction. If this is, however,
followed immediately by a reaccumulation of serum, it should
not be repeated.

Finally an existing anemia is treated by the systematic
administration of iron and by appropriate feeding.

Literature. Balint, K6zl., 1897. II. 239. — Brunninger, A. f. Tk., 1895.
XXI. 39 (Lit. on supposed heart lesions). — Cadiot, Rec., 1892. 568. — Coppel,
Chron. Klappenerkrank. beim Hunde, Diss. Leipzig, 1909 (Lit.). —- Fiebiger,
Z. f. Tm., 1902. VI. 54. — Hartl, Z. f. Tm., 1902. VI. 450 — Huynen, Ann., 1908.
391. — Koranyi, Orv..H., 1906. 1019. — Kunz-Krause & Réder, Monh., 1906. XVII.
344, — Liénaux, Ann., 1906. 325. — Lustig, Hann. Jhb., 1884-85. 53. — Malkmus,
D. t. W., 1902. 389. — Marek, Z. f. Tm., 1906. X. 448. — Martius, Erg. d. Path.,
1894. I. 2. Abt. 38. — Oppermann, D. t. W., 1905. 307. — Preisz, D. Z. f. Tm.,
1898. XXIV. 169. (Lit.). — Regenbogen, Monh., 1904. XV. 418. — Salvisberg,
Uber die Wirkung d. Digitalis usw., Diss. Bern., 1907. — Schiitz, A. f. Tk., 1882,
VIII. 139. — Sonnenberg, B. t. W., 1908. 218. — Trasbot, A. d’Alf., 1878. 210. —
Wilhelm, 8S. B., 1881. 77, — Zschokke, Schw. A., 1907. XLIX. 322.
Section III.
DISEASES OF THE BLOOD VESSELS.

1. Chronic Inflammation of the Arterial Wall. Endoarteritis
Chronica.

(Endoarteritis chronica deformans. Atheromatosis, Arterio-
sclerosis, Atherosclerosis.)

Occurrence. Chronic inflammation of the arterial wall as
an independent disease is apt to develop at a more advanced
age; it is only rarely observed in animals, and then limited in
contrast to man to the large arterial trunks. Only Liipke saw
four cases of periarteritis nodosa in axis-deer, which affects
almost all arteries of the general circulation, not excepting the
smallest blood vessels.

According to an inquiry of M. Schmidt an endoarteritis of the aorta could
be shown macroscopically in 0.5% out of 2,069 horses autopsied in the pathologic-
anatomical institute in Budapest, according to Kitt a chronic inflammation is
frequently met with at the origin of .the aorta of older horses. Lyding found
endoarteritic changes in the aortae of 35 out of 100 cattle, and out of 10 each
of horses or dogs these changes could be ascertained in two each. These observations,
and also those made by Sequens and Caparini, permit the assumption that on careful
examination the disease may be found more often in domestic animals than has
hitherto been assumed.

Etiology. Concerning the causes of the disease nothing
positive is known. In a part of the cases the degenerative
process probably arises from an insufficient nutrition of the tis-
sues in advanced age. Whether severe exertion may be a factor,
by raising the blood pressure repeatedly, is not certain.

In rabbits intravenous injections of adrenalin, continued for several weeks,
give rise to a condition similar to arteriosclerosis, which however is limited exclusively
to the aorta. Opinions are not yet in accord, as to whether the disease proceeds
from the toxic action of the adrenalin upon the tissue elements of the media,
or from the increased pressure in the arterial system which results from the
administration of adrenalin (Erb jun., Kiilbs, B. Fischer, Scheidemandel, Kor4nyi,
K. Ziegler). Most authors take these changes to be arterionecrosis in contrast
to arteriosclerosis. In this connection the experiments of Reinecke with barium
chloride merit consideration, because the same changes were produced as by
adrenalin, and even more the experiments of Philisophow, who succeeded in effecting
the same process with salts of mercury, lead and zinc, that is, with substances
which do not raise the blood pressure. A particular importance must finally be
attributed to the experiments of Saltykow with saprophytic and killed virulent
staphylococci, in which the changes in the aortic wall are claimed to correspond
with those of arteriosclerosis.

1104
Etiology, Anatomical Changes. 1105

‘These experiments render it not impossible that the inflam-
mation of the arterial wall usually develops under the influence
of certain chemical substances or bacterial toxins. In human
medicine the excessive use of alcohol and tobacco, gout, Bright’s
disease, syphilis and metallic poisoning are believed to stand in
relation in this respect.

Circumscribed endoarteritis very frequently arises in
horses under the influence of the Sclerostomum vulgare, prefer-
ably in the Arteria mesenterica anterior, not rarely in the aorta
or in the arteries of the extremities, exceptionally also in the
arteries of the other organs, including those of the heart
(Cadiot, Piot-Bey, Magnin). A similar influence is exerted by
the much less frequent Spiroptera sanguinolenta upon the aorta
of the dog, the Filaria Poelsi (Vryburg) or the Filaria Blini
(Carougeau & Marotel) upon the aorta of buffalo in Sumatra,
sometimes also upon that of cattle, without, however, causing
disturbances in the health of the animals. In cattle the inflam-
rete process is sometimes produced by foreign bodies (Sei-

erth).

. _ The virus of periarteritis nodosa in axis-deer could not be determined by
Liipke (the cocci which were repeatedly demonstrated in the blood and in the
diseased organs failed to produce the disease in small experiment animals). -

Anatomical Changes. In the incipient stage of the process
small, elongated or round, white or pale yellow, shallow eleva-
tions are found on the intima of the artery, which are most
numerous at those places at which the blood is thrown most
strongly against the wall, for instance at the turns of main
arteries, at places where branches are given off, etc. Corre-
sponding to these spots there exists, in horses and cattle, a pro-
liferation of the connective tissue, with a slight fatty degenera-
tion and calcification, in dogs the media and intima are atro-
phied and there is fatty and calcareous degeneration. Cavity
formation is rare, ulcerous destruction (atheromatous ulcer)
is completely missing (Lyding). Eventually the arterial wall
bulges and becomes rigid in consequence of diminished elas-
ticity.

Caladinaten of the aortic wall occurs frequently in old
birds, less so in horses and cattle; in the latter it is found,
according to Ligniéres, as a sequel of the Argentinian disease
known under the name of ‘‘Entéqué,’’ not only in the walls of
the aorta but also in those of the smaller arteries. In pigeons
the Hypodectes columbarum which exists as a parasite in the
vicinity of large vessels may give rise to similar changes.

In periarteritis nodosa the arterial wall is thickened, consequently the vascular '

‘lumen is smaller or entirely obliterated. A nodose thickening of the arterial wall
is observed in varying degree. The lumen is narrowed or obliterated or it is bulged

out and often contains thrombi.
Symptoms. A generalized arteriosclerosis can, in a fairly
advanced stage be recognized only if the vessels which are imme-
Vol. 1—70
1106 Arteriosclerosis.

diately accessible to examination are involved. The walls of
the subcutaneous arteriosclerotic vessels give to the touch a
peculiar rigid and sometimes uneven firmness, the pulse is shig-
gish but at the same time fairly strong because the left ventricle
is usually hypertrophied.’ The aortic sound is sometimes
accentuated in consequence. :

The changes ‘in the vascular walls may occasionally be rec-
ognized in the abdominal aorta and in its pelvic branches. In
other cases the presence of the disease can only be assumed
when the left ventricle becomes hypertrophic without manifest
cause or when symptoms of thrombosis or embolism make their
appearance.

Periarteritis of axis-deer is, according to Liipke, manifested in gradually
increasing digestive disturbances which show much similarity with the clinical
picture of chronic intestinal catarrh. In spite ot fairly good appetite a gradually
progressive emaciation becomes noticeable which passes into a sickly condition
lasting for weeks and months.

For the symptoms of circumscribed arteriosclerosis the
following chapters should be consulted. —

_ _. Treatment. The further development of an established
inflammation of the arteries cannot be arrested in any way and
can not even be retarded. In human medicine iodide of potas-
sium is administered internally in arteriosclerosis. Koranyi
succeeded in obtaining a favorable influence upon the process,
which had been produced in rabbits by injections of adrenalin,
or with subeutaneous injections of iodipin, but Fleischer & Loeb
could not confirm his results.

Literature. Carougeau & Marotel, Rev. gén., 1903. I. 447. — Erb, A. f.
exp. Path. u. Phmk., 1905. LIII. 140. — Gulyas, A. L., 1906. 73. — Josué, Presse
méd., 1904. 281. — Koranyi, D. m. W., 1906. 679. — Lipke, Verh. d. Deutschen
Path. Gesellsch., 1906. 149. — Lyding, Z. f. Tm., 1907. XI. 359. — Philisophow,
V. A., 1910. CXC. 238. — Scheidemandel, V. A., 1905. CLXXXI. 363. — Saltykow,
Beitr. z. path. An., 1908. XLITI. 147. — Sequens, Vet., 1892. 352. ~ ey

2. Dilatation of the Aorta. Aneurysma Aortae.

_ Occurrence. The disease occurs relatively most often in
horses, much less often in dogs and cattle; in other animals it
is hardly ever seen.

_ Etiology. The walls of the aorta and those of the arteries
in general, with very few exceptions, become dilated only when
their power of resistance has been reduced, for instance in the
presence of chronic endoarteritis, especially when the blood
pressure is lastingly raised. This evidently accounts for the
fact that aortic aneurysm is observed most frequently in horses
because these animals are often employed for hard labor.

It might be interesting to ascertain in how far the relation between the

frequency of aneurysm to kind, species and employment of the animals is mani-
fested. According to Tombari the severe exertions which hunters are obliged to
Etiology, Anatomical Changes, Symptoms. 1107

undergo may be considered to stand in causal relation to the frequency of aneurysm,
and. according to Palat the same holds true for "bus horses.

In exceptional cases the commencement of the development
of an aneurysm corresponds, as to time, with external influences,
such as moving a heavy load, jumping, being thrown, or struck
on the trunk, etc., or it may be referred to such an accident with
a-degree of probability. In such cases the traumatic factor of
a sudden excessive rise in blood pressure might cause a par-
tial tear in the aortic wall, in consequence of which the weak-
ened arterial wall eventually bulges out. On the other hand it
is not impossible that even in such cases the wall of the vessel
was not quite healthy before the accident.

Anatomical Changes. A portion of the aorta is either
evenly dilated (Aneurysma cylindricum) or the healthy portion
gradually passes into a dilated segment, which again gradually
passes into the healthy part of the vessel (A. fusiforme), or
only a short segment of the vessel is sacculated (A. sacciforme).
In the latter case the sacculation either affects the entire cir-
cumference of the vessel (A. sacciforme periphericum s. axiale)
or only a part of it (A. sacciforme semiperiphericum). The
sacculated bulging may reach in horses the size of a man’s head
(Labat & Cadéac}, in dogs the size of a turkey’s egg (Barrier).
The wall of the aneurysm is usually thickened, although in
places it.may be thinned out, owing to compression by neigh-
boring organs or from other causes. The thiekening of the wall
may be aided by layers of fibrin, which are sometimes deposited
on its inner surface, and these may entirely obliterate the lumen
of smaller vessels.

The adjoining organs are crowded aside by the constantly
increasing aneurysm or they are compressed. Usually ‘the
trachea or a bronchus are found compressed, one or more ver-
tebral bodies atrophic, the Vagus or the N. Recurrens com-
pressed. Loosened portions of fibrin are carried away with the
blood and are usually. arrested in the vessels of the posterior
half of the body.

The bursting of an aneurysm almost always leads to fatal
internal hemorrhage. The break may occur into the cavity.
of the thorax or into the abdominal cavity, or the blood may
be poured into a contiguous organ to which.the aneurysm had
become adherent. In this manner hemorrhages may take place
into the bronchi, the lungs, the stomach, the intestine or between
the layers of the mesentery.

Symptoms. The symptoms of aortic aneurysm in animals
have in the past not been observed with sufficient exactness. In
the majority of cases the reports mention only increasing
emaciation and weakness or sudden fatal internal hemorrhage:

Owing to the anatomical conditions only aneurysms which
1108 Dilatation of the Aorta.

have formed on the abdominal aorta can be palpated, in larger
animals from the rectum, in smaller animals through the abdom-
inal wall. Below the vertebral column, slightly to the left, a
pulsating swelling is felt, of variable size, elongated or spherical,
firm or slightly elastic, which is continued into the normal seg-
ment of the aorta or into the two pelvic arteries. Sometimes
the character of the swelling cannot be determined exactly; that
is in cases in which edematous swellings or tough connective
tissue have formed around it.

The pulsation of the swelling does not, of itself, prove the presence of an
aneurysm, because tumors or abscesses connected with the aorta may show a similar
pulsation, although it is then only by continuation. If it can however be determined
by grasping the swelling, that it becomes harder and larger with each pulsation,
an aneurysm is undoubtedly present.

An important symptom is presented by the retardation and
sluggishness of the pulse, which may, however, be observed only
in case of a considerable thrombosis. The pulse is felt dis-
tinctly after the heart beat, distally to the dilatation, because
the copious deposit of fibrin has usually made the lumen
of the vessel narrower and has thereby impeded the flow of blood
toward the periphery; in consequence the increase in the sys-
tolic blood pressure, which is recognized as a pulse beat, reaches
its climax, in which it can be felt, later. The vessels in which
this retardation can be felt depend, of course, upon the situa-
tion of the aneurysm. If this is at the origin of the aorta, the
retardation is noticed in all arteries of the body, an aneurysm
in the posterior aorta causes a retardation of the pulse only in
the arteries of the posterior half of the body It may also occur
that the pulse is not synchronous in the two corresponding lat-
eral halves of the body, viz., if an artery branching out from
the aneurysm has become narrower.

Over aneurysms which lie superficially or which form on
the aorta, vascular murmurs are usually heard, which may be
perceived as either one or two murmurs or as£a continued roar-
ing. Over a pulsating swelling in the sacral region Tombari
heard a blowing murmur, which had more the character of rub-
bing, while over a dilatation of the first segment of the pos-
terior aorta Schmidt perceived a humming sound which was
synchronous with the heart beat. In aneurysms at the origin
of the aorta the murmurs are heard over the base of the heart
and even lower down.

The left half of the heart is hypertrophied only in those
cases in which extensive arteriosclerosis is present at the same
time as the aneurysm or in which the lumen of the dilated aorta
has become much narrower on account of thrombi. A dilata-
tion at the origin of the aorta may lead to insufficiency of the
semilunar aortic valves.

In case of considerable stenosis of the vascular lumen the
nutrition of the parts of the body which are distal to the dilata-
Symptoms, Course, Treatment. 1109

tion is impaired. In almost all cases which have been observed
for some time, weakness of the hind quarter could be deter-
mined, which was mostly noted only during motion in excep-
tional cases also at rest (Barrier). Finally there are symptoms
of cardiac weakness (rapid fatigue, strong filling of veins,
vertigo, sometimes epileptoid convulsions [Lustig]).

Nervous symptoms are observed only in exceptional cases,
when a nerve trunk has been compressed by the aneurysm. In
- Vagus compression, for instance, the heart beat may be accel-
erated; compression of the N. Recurrens may cause laryngeal
whistling. In a case observed by Schmidt the horse gave evi-
dences of severe pain on lowering the head.

Course. <A fairly long time is probably required for the
development of aneurysms to that degree in which they give
rise to decided morbid changes, probably several years (in Tom-
bari’s case the disease had existed at least three years). Death
is due either to the compression of neighboring organs or to cir-
culatory disturbances, unless the bursting of the aneurysm ter-
minates life suddenly, possibly with symptoms of internal hem-
aneeee or with symptoms of pulmonary or intestinal hemor-
rhage.

Treatment. A successful treatment of aortic aneurysm is
not possible. The stimulation of. blood clots within the aneu-
rysm by electro-puncture, injections of chloride of iron, the
introduction of foreign bodies does not enter into consideration
in animals. Nor do subcutaneous injections of gelatin promise
results (in man 50-130 gm., injected in one dose, of a 2-3%
solution). It may be mentioned, by the way, that tetanus infec-
tion should be prevented by employing Gelatina sterilisata pro
injectione (Merck). The treatment is therefore limited to sav-
ing the animals from exertion and regulating any existing car-
diac disturbances. The administration of iodide of potassium
also seems to be useless.

 

Literature. Barrier, Bull., 1894. 327. — Gerlach, Z. f. Flhyg., 1905. XV.
115. — Labat & Cadéac, Rev. vét., 1884. 105. — Petit, Rec., 1905. 273, 299;
Bull., 1906. 104. — Piot-Bey, Bull., 1905. 170. — Schmidt, A. f. Tk., 1889, XV.
295. — Tombari, Vet. Jhb., 1882. 74.

Aneurisms of other blood vessels. Even more frequently than in
the aorta, a dilatation of the anterior mesenteric artery and of its main
branches occurs in horses under the influence of the Sclerostomum vul-
gare (Vol. II.), exceptionally and also from other causes in swine (Koch,
Leibinger). In the other arteries of the abdominal cavity aneurisms
are formed much more rarely, but they occur for instance in the Arteria
coeliaca, the Arteria mesenterica posterior or in Arteria hepatica. In
other branches of the aorta dilatations are also very rare. In Cadiot’s
case in an ass, and in three cases reported by Piot-Bey in cattle a dilata-
tion of the coronary arteries had caused sudden death. Steinmeier saw
a dilatation of the carotis cause sudden death by bursting and Reimers
observed in the sacral region in a cow a tense, faintly pulsating bulging
1110 General Diminution in the Tonus of the Small Arteries.

which corresponded to a dilated Arteria ischiadica. Querippel described
a dilatation of the crural artery, Straube one of the Arteria digitorum
communis volaris, Blase one of the Arteria pharyngea in a horse 15
years old; in the last case the symptoms consisted in edema and ulcera-
tions on the head and neck, swelling of the tongue and gums, salivation,

and the usual signs of pharyngitis ; the aneurism eventually burst. into
the pharyngeal cavity. Vogel observed a dilatation of the facial artery
in a cow, Mouquet one in the cervical artery in a horse, Ravenel one
in the brachial artery in a hen. Nocard found in a young dog an
aneurism of the aorta and at the same time one of the pulmonary artery. -
Mouquet found in a horse a dilatation of the pulmonary artery;
Chardin in a horse a dilatation of the hepatic artery, which weighed
14-kg. (the horse had frequently stood still on trotting and disliked to
gallop), Dupas found varicose dilatations in the territory of the mesen-
teric veins, and Fréhner in a horse a dilatation of the external thoracic
vein.

General diminution in the tonus of the small arteries. (General vas-
cular paralysis). A reduction in the tonus of all small arteries may be
produced by certain chemical substances, like amyl nitrite, alcohol,
chloral hydrate, chloroform, if they have been introduced into the organ-
ism in considerable amounts. Romberg, Bruhns, Passler and Rolly dem-
onstrated in their experiments a similar action on the part of the toxins.
of various infectious substances. From a general relaxation of the
arteries it necessarily results that the abdominal vessels, the innervation
of which is derived from the N. splanchnicus, and which especially in
herbivora form a very wide system of blood vessels, receive a very con-
siderable portion of the total blood quantity, so that the amount of blood
in the other organs is diminished. The diminution in blood pressure
and the slowing of the blood circulation cause an acceleration of the
contractions of the heart, the pulse becoming feeble and empty, because
the retarded circulation and the overdistension with blood of the abdom-
inal organs have produced a deficient filling of the heart. Cyanosis
develops in addition, although the vessels of the mucous membranes and
the other veins are not filled unduly, because the. backflow of the venous
blood toward the heart is not interfered with; in severe cases the bluish
discolored mucous membranes are pale or livid. The anemia of the brain
gives rise to disturbances in consciousness and in respiration, and at
times the inner temperature falls below normal. Finally the slow cur-
rent in the blood vessels reduces the functioning power of the heart,
and heart weakness is added to: the original circulatory disturbances.
Severe general atony of the arteries causes death in a short time.

In fatal cases of colicky diseases in horses (especially after rupture
of stomach or intestine), also in the course of general infectious diseases
the authors have observed this clinical picture repeatedly. It probably
occurs not quite rarely, either alone or associated with the symptoms
of acute myocarditis.

The trouble is differentiated from cardiac weakness only by the fact
that the veins are never filled strongly.

If atony is not yet complete its removal may be attempted by vaso-
contracting remedies (camphor, caffeine, barium chloride, eserine, adren-
alin, suprarin or by intravenous infusions of a physiological salt solu-
tion with adrenalin or suprarenin, while vaso-dilating remedies (alco-
hol, ether) must be avoided.—(Passler & Rolly, Miinch. Med. Woch.
‘1902, 1737).
Obstruction of the Larger Arteries. . 1111

3. Obstruction of the larger arteries. Thrombosis et embolia
arteriarum.,

Etiology. In exceptional cases the aorta and its larger
branches may be obstructed by emboli which are derived from
the heart or from an aneurysm of the thoracic aorta. Usually,
however, the obstruction of a relatively wider vascular lumen
occurs through a thrombus originating at a spot in the wall
of the vessel which has become roughened or after an embolus
has become wedged in, the thrombus becoming gradually larger
by deposits of new layers of fibrin. For this reason all causes
which are capable of producing an endoarteritis chronica
deformans may also constitute the basis of thrombosis of
larger vessels. This occurs most frequently in horses and is
usually brought about by the larvae of the Sclerostomum vul-
gare (Scl. bidentatum) ; in dogs the Filaria immitis sometimes
leads to extensive thrombosis. Exceptionally the vascular
lumen may be obstructed when arteries are compressed by a
tumor (Mack, Fréhner), by exostoses (Gassner, Pirl), which
may also produce chronic inflammation, even to complete occlu-
sion of the aorta. An acute inflammation, finally (Vennerholm)
or contusion of the vessel wall (H. Bouley) may be the causes
of occlusion of arteries.

Anatomical Changes. The thrombosis in horses which is
usually produced by larvae of sclerostoma is found mostly in the
anterior mesenteric artery, fairly frequently at the posterior
end of the abdominal artery and in its. pelvic branches (artt.
iliacae, femorales, hypogastricae), from where the thrombus
may become continued downward into the tibial arteries; in
exceptional cases the vessels of an anterior extremity (art. axil-
laris, art. brachialis) or the first portion of the aorta (Berg-
strand) is found obstructed. In a case of Filariosis haematica
in a dog Hutyra found a large portion of the thoracic and abdom-
inal aorta filled up.

The thrombus is usually attached to the roughened wall of
the vessel; it is dry, tough, and usually arranged in layers. It
may cover only a part of the vessel wall and thus make the
lumen smaller (thrombosis parietalis), or it occupies the entire
periphery of the vessel wall, in which case there remains a
patent canal in the direction of its longitudinal axis (Thr.
canalisatus), or finally it obstructs the vessel entirely (Thr.
obturans). The end or the outer surface of a thrombus which
does not occlude the blood vessel completely is usually formed
by layers of fresh fibrin, which reach into the circulating blood
and perhaps into a lateral branch in the form of plugs, and are
in all probability usually the result of post-mortem coagulation.

An obturating thrombus may in time disintegrate and be
absorbed, but in the meanwhile a proliferation of connective
1112 Obstruction of the Larger Arteries.

tissue from the vessel wall takes place which may eventually fill
out the vessel, the lumen of which is already narrowed, com-
pletely and transform it into a firm connective tissue cord
(organization of thrombus). Such a change occurs, however,
more often at the places where emboli have become wedged in,
which is a fairly frequent occurrence in the smaller peripheral
arteries.

 

Fig. 197. Uhrombosis of the posterior end of the abdominal aorta and of tts

branches, in a horse, a Abdominal aorta; bb’ Art. cireumflexa ilium prof.; ce’ Art.

iliaca externa; dd’ Art. hypogastrica;{ee¢’ Art. obturatoria; ff’ Art. iliolumbalis ;
gg’ Art. glutaea sup.; hh’ Art. sacralis lateralis.

Pathogenesis. The obstruction of large arterial trunks pro-
duces a peculiar disturbance in the function of the muscles. In
the majority of cases the vessel is not completely obstructed by
the thrombus, and even if this occurs, a collateral blood circula-
tion is established in a short time by the intermediation of
branches which pass off proximally to the thrombus. The part
of the body which is to be nourished by the obstructed vessel
receives also in future a certain amount of blood, sufficient to
Pathogenesis, Symptoms. 1113 -

supply all tissues of the body part in question with the nutri-
tional substances necessary for life, and which sometimes even
enables in muscles to accomplish a certain degree of work. If,
however, the animal accomplishes prolonged and severe mus-
cular labor, the deficiency in oxygen causes an insufficient oxida-
tion and therefore the development of insufficient force, and also
a transitory accumulation of products of metabolism in the
muscle, especially lactic acid and carbonic acid, which lead to a
more rapid fatigue of the muscle. When the exercise is inter-
rupted, the products of fatigue are gradually eliminated from
the muscle, the feeling of. fatigue and the disturbance in func-

tion are abated, but reappear on renewed prolonged muscular
exertion.

Symptoms. The form and the intensity of motor disturb-
ances depend upon the arteries which are obstructed and upon
the degree of occlusion. In the rather rare thrombosis of the
posterior portion of the aorta the trotting or galloping horse
begins, after a variable time, to become uncertain in the hind-
quarter, it staggers, the feet are raised less high, and soon it can
no longer move at all, remaining standing, bathed in perspira-
tion and trembling. If urged further, it finally collapses and
falls to the ground. While lying on the ground the animal grad-
ually becomes calmed; it arises, after a time, of its own accord
and may move at a walk. :

In thrombosis of aortic branches, especially the pelvic or
femoral arteries, the motor disturbance commences in a similar
manner, but is limited to one of the posterior extremities. After
a certain time, which may be only a few minutes, the horse raises
the foot less high, it cannot move it very certainly, may interfere
occasionally against the other foot; it hangs its head and if pos-
sible bears the weight of the body upon the front feet; soon the
joints are bent less and less, the hoof scraping the ground at
each step, and finally the affected foot gives out, the animal fall-
ing upon the diseased side of the body on being urged further.
In bilateral thrombosis of the femoral artery the motor disturb-
ances correspond as a whole with those of thrombosis of the
abdominal artery, although the uncertainty in the sacral region
is less striking. . ;

Thrombosis of the axillary and brachial arteries leads to
similar disturbances in motion in the one fore foot. Here also
a gradually increasing muscular weakness becomes perceptible,
the horse stumbling on the fore foot, knocking it against impedi-
ments and scraping the ground with the hoof, until the foot
commences to tremble violently and is finally paralyzed.

Complete occlusion of the pelvic arteries causes paralysis
of the sacrum, the tail, the bladder, and of the rectum; a partial
thrombosis gives rise to motor disturbances, which occur only
on motion and is similar to sacral paralysis.

The paralysis disappears after’a certain period of rest but
1114 Obstruction of the Larger Arteries.

reappears on the next occasion, unless accidentally paralytic
hemoglobinemia has been added, to which horses with throm-
bosis of the arteries of the extremities appear to be predisposed.

General symptoms are also present as a rule. The animal
shows great anxiety, the heart action is remarkably excited and
accelerated, the respiration is also accelerated and difficult, the
mucous membranes show intense injection. Although a general
perspiration takes place, the affected extremity remains dry
(Humbert, Gal), it feels very cool to the touch (Palat). Fried-
berger & Fréhner have observed no general symptoms in throm-
bosis of the axillary artery, in spite of existing motor disturb-
ances.

Thrombosis may be recognized with absolute certainty, if
it is possible on palpation to find firm blood clots or a compress-
ing swelling in the related blood vessels. In many cases the
hand, which has been introduced into the rectum, may ascertain
the presence of the thrombus on palpating the aorta or the
larger vessels on the sides of the pelvis; its presence may also
be assumed, owing to the weakness or complete absence of pulsa-
tion or owing to a thrill which may be felt. If the thrombosis
cannot be found within the pelvis, a total or partial obstruction
of the femoral or axillary arteries may be assumed to exist from
the fact that the pulse cannot be felt at all or only feebly in the
vessels beyond the thrombus, on the metatarsus or metacarpus.

A partial thrombosis sometimes produces no disease symptoms whatever.
For instance a horse with partial thrombosis of the posterior aorta covered a
distance of 130 km. two days before autopsy (Gratia).

Gléckner has observed difficult deglutition, whistling respiration, and later the
symptoms of pulmonary emphysema in thrombosis of the carotid arteries—Siegen
saw epileptiform convulsions in thrombosis of the left carotid and the internal
earotid; the convulsions appeared only after the horse had trotted for 20-30 minutes
and lasted about 20 minutes.

Course and Prognosis. In a portion of the cases softening
or contraction of attached thrombi occurs, so that the blood
paths become more or less opened, or the obstruction persists,
but the circulation in the territory concerned is equalized by the
collateral circulation which has meanwhile been established. In
both cases the affected part of a body may after a certain time
(3-6 months) again receive a sufficient supply of blood for the
muscles to accomplish even continued and severe work. A com-
plete recovery in this meaning of the term is nevertheless very
rare, since the supply of blood through the narrowed paths or
through the new collateral tracks still remains insufficient, and
since the existing thrombosis gives rise to the further produc-
tion of fibrin or to embolism, which are followed by relapses and.
by aggravation of the condition. In exceptional cases throm-
bosis of the posterior extremities may be complicated eventually
by thrombosis of the brachial artery (Schraml).

In other cases, an equalization of the circulatory disturb-
ances does not take place, the function remains permanently im-
Course and Prognosis, Treatment. 1115

paired, and the impediment to the circulation is even increased
by the deposit of new masses of fibrin. In such cases the
affected part of the body, usually an extremity, atrophies owing
to insufficient nutrition, and the animal finally becomes unfit
even for very light and slow work. In rare cases the obstruc-
tion may become so extreme that some organs receive no blood
at all and die in consequence. Martin and Bouley saw, each
in one case, gangrene: of the muscles of the anterior extremity
after obstruction of the axillary artery, Cadéac & Malet observed
the same in a posterior extremity in thrombosis of the femoral
artery.

If a vessel has become obstructed by an embolus derived
from the first segment of the anterior or posterior aorta, the
fact must be considered in giving a prognosis that similar
emboli might be carried into vital organs (brain, kidneys, etc.).

Treatment. In order to promote the collateral circulation,
systematic exercise of the animals is indicated, the patients
being led about daily at a walk until the first symptoms of
paralysis appear (Bayer). It is sometimes possible to realize
even complete improvement by continued and gradually increas-
ing work (Bayer, Johne). It may also be attempted to massage
a thrombus which is palpable in the pelvic cavity, with the hand
in the rectum, for 5-10 minutes daily, which proceeding may also
perhaps hasten the absorption of the fibrin coagulations (Collin,
Beyer). Internal treatment which has repeatedly been pro-
posed, especially the administration of iodide of potassium,
promises no results.

Literature. Albrecht, W. f. Tk., 1901. 325. — Cadéac & Malet, Rev. vét.,
1885. 530 (Lit.). — Fréhner, Monh., 1903. XIV. 445; 1905. 553; 1907. XVIII. 136.

— Gratia, Ann., 1906. 489. — Merkt, W. f. Tk., 1904. 261. — Schimmel & Resser,
Ann., 1905. 543. — Siedamgrotzky, 8. B., 1896. 18.

 

Thrombosis of the Pulmonary Artery. The obstruction of the pul-
monary artery is not very rare and is brought about by emboli from the
right heart. The parts of thrombi may have originated in the right heart
itself, or not infrequently they are carried there with the venous blood
from distant parts of the body. In exceptional cases thrombosis forms
in the pulmonary artery after the invasion of foreign bodies (hair which
had been introduced on venesection from the jugular vein [Zschokke]
or broken hypodermic needles [Prévot]) or in the presence of parasites
(Filaria immitis, Strongylus vasorum [Ferez]). In many cases the
cause could not be determined, probably because distant organs had not
been examined carefully. Kappel succeeded in 63% of the cases diag-
nosed by him to find the source of the embolism by careful and syste-
matic examination of the organs of horses which had been slaughtered
‘(he found thrombosis of the pulmonary artery in 9%. of all slaughtered
horses, which were mostly old animals) ; the embolisms. originated in
most cases in thrombotic veins in the posterior extremities and in the
sheath. : .

Obstructions of smaller pulmonary vessels do not give rise to
pathological disturbances, but when larger branches were obstructed
1116 Obstruction of the Large Venous Trunks.

(Kappel found this to have been the case in 12 out of 38 instances),
difficult respiration occurred, like dyspnea or sudden asphyxia which
sometimes caused rapid death.—(Kappel, Z. f. Tm., 1904. VIII. 321.—
Prévot, Bull., 1908, 625.).

4, Obstruction of the Large Venous Trunks. Thrombosis
Venarum.

Obstruction of the large venous trunks is rare and is usually
due to compression (by enlarged lymph glands, tumors,
abscesses), less often it occurs in connection with endophlebitis
or slowing of the circulation.

Cases of thrombosis of the venae cavae have been observed
especially in horses and cattle, once also in a dog. In the horse
thrombosis of the portal vein has been known to occur.

 

Fig. 198. Stenosis of the anterior vena cava. Edematous infiltration of the region
of neck and shoulder; the swelling is sharply arrested near the xiphoid cartilage.

The symptoms are easily interpreted by the anatomical
arrangement of the venous trunks, because stenosis or obstrue-
tion of one vena cava produces venous stasis in that part of
the body from which the vein returns the blood to the heart.
Thus thrombosis of the anterior vena cava produces strong
filling of the veins of head, neck, anterior extremities, and
thorax, also edematous infiltration of these regions or dropsy
of the chest (Fig. 198). If the obstruction is incomplete a neg-
ative pulsation may become evident in the jugular veins.
Symptoms. 1117

Thrombosis of the posterior vena cava causes similar changes
in the hindquarter, with which abdominal dropsy is associated
if the location of the obstruction is between heart and liver.
Thrombosis of the portal vein impairs the motility of stomach
or intestine (Vol. IL.).

The circulatory disturbances may occasionally become much
enone as was shown in a case of Albrecht’s and in one of the
author’s.

Literature. Albrecht, Z. f. Tm., 1902. VI. 428 (Lit.). — Barrier, Bull.,
1906. 283. — Basset, Rec., 1905. 609. — Bretagnier, Rec., 1909. 156. — Chouleur
& Lebasque, Bull., 1908. 256. — Cuny, J. vét., 1906. 224. — Douville, Bull., 1907.
62. — Forgeot, J. vét., 1906. 362. — Friedrich, B. t. W., 1905. 4. — Petit &
Delacroix, Bull., 1905. 133. i

5. Rupture of the Large Blood Vessels, Ruptura Vasorum.

The walls of the large blood vessels rupture at times, even
without previous disease. The first segments of the aorta and
of the pulmonary artery are very thin at the level of the semi-
lunar valves (the aorta of the horse is in some places only 1 mm.
thick, while lower down the thickness is 5-7 mm.), so that they
are bulged out-somewhat by the pressure of the blood, even
under normal eonditions (Sinus: Valsalvae) and may rupture
if a sudden rise in blood pressure occurs. Among causative
factors, aside from immediate injuries, may be- mentioned the
pulling of heavy loads, severe exertion in galloping, vomiting,
labor pains (Sigl) or other exertions. Similar causes may some-
times lead to rupture 6f the gnterior or posterior vena cava or
of the portal vein. os

Usually, however, rupture is preceded by: a disease of the
vessel wall, although this may not be visible to the naked eye,
as in a case of Caparini’s. In most cases there is a sclerosis
with subsequent bulging of the vessel wall, which favors rupture.
This cause is responsible for the rupture of vessels, especially
in older animals. The same result is observed if an abscess or
uleerating process in the immediate vicinity of the vessel is
transmitted to the vessel wall from an ulcerating valve, a cari-
ous bone, or from a breaking down new growth, causing
erosion of the vessel. Finally animal parasites, in the horse
the larvae of Sclerostomum vulgare, in the dog Spiroptera san-
guinolenta may weaken the vessel wall so much in places that
it finally tears under the influence of the blood pressure.

The following facts may illustrate the manifold etiological factors: Palat
saw rupture of the aorta at the level of the valves without demonstrable external
cause, Lustig saw it occur on galloping. Sequens found in three cases the point
of rupture about 1 em. above the valves in the vicinity in which the vessel wall
was diseased, but Cadiot could not find any pathological changes in two cases.
In one case described by Vaerst hemorrhage occurred from a small aneurysm
situated opposite the valves.—In a case reported by Prietsch the healthy pulmonary
artery was ruptured while drawing a heavy load, Block saw a four-your-old stallion
bleed to death after having been thrown; the pulmonary artery was torn at the
1118 Rupture of the Large Blood Vessels.

bifurcation—Ehlers observed rupture of the portal vein after a blow on the left
side of the body.—Schrulle reports a case of fatal hemorrhage from rupture of
the left axillary artery in a horse which had been thrown. On autopsy of a
horse Biihrmann found an abscess between the pillars of the diaphragm, which
had ruptured into the aorta——In Gassner’s case an exostosis on the 16th vertebra
had injured the aortic wall, in Noack’s case a sarcoma growing behind the kidney
had done the same. Parasites may also be involved. Morgagni .found in one
dog, Mégnin in three dogs, the Spiroptera sanguinolenta in the wall of the aorta;
it was present in the form of small whitish nodes one of which had caused rupture
of the aorta. Durieux and Degive finally could demonstrate in a horse that fatal.
hemorrhage had been due to destruction of tissue by the larvae of the Sclerostomum
vulgare (in one case the aorta was apparently sound, in the other it presented
in its entire length the picture of atheromatosis).

The symptoms of rupture of a vessel indicate in general
only internal hemorrhage, the exact cause of which can usually
only be ascertained on autopsy.

Literature. Bonnet, J. vét., 1905. 147. — Caparini, Arch. scient. d. R. Soe.
ed Accad. Vet. It., 1903. 87. — ‘Ehlers, B. t. W., 1889. 4. — Gamble, V. Journ.,
1908. 345. — Lustig, W. f. Tk., 1877 241 — Magnin, Ree, 1903 693. — Pécus,
J. vét., 1902. 351. — Petit, Bull., 1905. 299; 1906 104. — Pr. Mil. Vb., 1899- 1908.
_ Prietsch, S. B., 1881. 85. — Sequens, Vet., 1892. 352. — Sigl, W f. Tk., 1905.
8. — Vaerst, Monh., 1893. IV. 185.
Lymphorrhagia. 1119

APPENDIX.
Lymphorrhagia.

__ Etiology. In horses and cattle, and exceptionally in other -
animals swellings develop sometimes in a short time, in variable
number and extent, containing a clear lymph-like fluid which may
be mixed with dead tissue shreds. According to Hoffmann and
Dratschinsky these swellings are due to tears between the skin
and fascia or between muscle and fascia, produced by some con-
siderable injury which has a pushing or pulling. action. Into
these tears lymph flows from the torn lymph vessels and is mixed
with the torn tissue particles. (Astrachanzew found once in the
lymph a worm 5 em. long, which he believed to be a kind of
Filaria medinensis. )

Bayer has seen lymph effusions in a cat, in circular arrangement
around the nipples; the lymph. vessels were dilated.

Symptoms. Sometimes the swellings form successively in
the course of several days and produce marked changes in form
if they become confluent. In the case of a cow, reported by
Zonda, which had broken down beneath an ox, swellings like those
just described formed on the lower abdomen, on the chest and
on the internal aspect of the thighs, all in the course of four
days. Although the appetite is not impaired the animals rapidly
become emaciated, owing to the loss of nutritive material. The
swellings are not painful or warm, but they show fluctuation if
situated superficially. After incision a clear, yellow odorless
lymph flows out, or sometimes a dirty yellow or reddish, ill-
smelling fluid which is mixed with tissue shreds. The quantity
may be considerable.

Treatment. The swellings are usually treated by incision,
removal of the lymph, irrigation of the cavities with disinfecting
solutions or the application of disinfecting powders, finally the
application of a compressing dressing. Sometimes continued
irrigation of the cavity with Iukewarm solutions of corrosive
sublimate is of benefit (on opening such swellings there is
always danger of septic infection [Johne]). If the skin has
been loosened over a large extent it may have to be sutured to
the underlying tissue. Small swellings disappear on the appli-
cation of warm compresses and massage. The patients must be

nourished generously.

i . Astrachanzew, A. f. Vet.-Wiss., 1893. 204. — Dratschinsky, ibid.
1904, 787 Hoffmann, Z £ Vk., 1897. 1. — Vennerholm, Svensk Vet.-Tidsskr,
1904. IX. 537. — Walley, J. of comp. Path., 1892. 360. — Zonda, Vet., 1894, 369,
Index, Vol. I.

Abortin .
Abortion, enzootic
Abortion, infectious
Abscess of kidney...........
Acetone
Actinobacillosis
Actinobacillus
Actinomycosis
Actinomycosis, atypical
Actinomyeosis of the dog.....
Actiomycosis of man........
Actinophytosis ...... 645, 667,
Actinomyces bicolor
Actinomyees bovis
Actinomyces canis
Actinomyces cuniculi
Actinomyces necrophorus
Adenitis, equorum
Adeno-earcinoma of the kidney
Adenoma of the heart........
Adenoma of the kidney.......
Adrenalin, action on blood
vessels 2.45 ses seacaeee ees
Aerogenes bacillosis
African glanders
Agglutination in glanders.....
Agglutination in infectious
abortion
Agglutination in tuberculosis. .
Ageressins in anthrax........
Agegressins of the  bipolar-
bacillus ............005- 84,
Aggressins in fowl cholera....
Aggressins in strangles.......
Albuminometer, Esbach
Albuminuria
Albuminuria, physiological ...
Albuminuria renalis
Albuminuria, spurious
Albuminuria, true
Aleppo boils ........... Rigin tee
Allergy in abortion...........
Allergy in glanders..........
Allergy in tubereulosis........
Allétriophagia
Amblyomma hebraeum
Ameisic acid in urine.........

OR eee eee eee

eee e ewer e tere ene

 

665
670
671

366
1028
1077

 

PAGE
Amyloid kidney ............. 987
ANOMIA a. sis Seca eee S45
Anemia, acute ............4. 847
Anemia, chronic ............ 847
Anemia, infectious of chicks... 846
Anemia, infectious of horses... 851
Anemia, progressive pernicious 863
Anemia, progressive pernicious
OLGA: ets ccmen.s de wade aa ars 868
Anemia of the young pig..... 846
Anemia of sheep and goats in
PUN A | occas esle areas 867
Anaplasma marginale ........ 763
Anaplasmosis ............... 783
Anasarea, essential .......... 216
Anasarea, idiopathic ......... 216
Aneurism of the aorta........ 1106
Aneurism of the blood vessels 1109
Aneurism of the coronary ar-
POTICS) is oe de are eens 1076, 1109
Aneurism of the heart, acute
diate waterube ag hale abe sate 1076-1081
Aneurism of the heart, chronic 1076
Aneurism of the heart, fibrous 1074
Aneurism, rupture ........... 1081
Aneurism, valvular .......... 1081
Angina, Vol. IT..............
Angina diphth. vitulorum..... 419
Angioma of the heart........ :
Anopheles mosquitoes ....... 197
Anthraco-muein ............. 12
INMUNT AR aces ia eee a ee eee 1
Anthrax, acute .............. 16
Anthrax, apoplectic ......... 16
Anthrax, bacterial .......... 24
Anthrax in man............. 31
Anthrax, intermittent ....... . 18
Anthrax, subacute .......... . 16
Antiphymatol ............... 85
Antistreptococcus serum ..231, 386
Aorta, aneurism of.......... 1106
Aorta, calcification of........ 1105
Aorta, rupture of............ 1117
Aphthous eruption .......... 340
Aphthous fever of carnivora.. 554
Aphthous fever of fowls...... 354
Aphthons fever of the horse.. 354
1122

Aphthous fever of man
Apiosoma bigeminum
Apoplectic septicemia of fowls
Apoplexy-intermeningialis ...
Argas miniatus
Argas perspicus
Argas reflexus
Arion subfuscus
Arteriosclerosis
Arteritis, acute
Arteritis, chronic
Artery, compression of
Artery, crushing of
Artery, plugging of
Arthritis urica
Arythmatie action
systolic
Arythmatie action
true
Atrophy of heart
Atrophy of kidney, cyanotic...
Atrophy of kidney, granular ..
Azoturia

ion of heart,
Seeeaaey ey

Babesia, see Piroplasma
Bacillus abortus infectio
Bacillus aerogenes
Bacillus anthracis .......... 3,
Bacillus anthracis asporogenes.
Bacillus anthracoides
Bacillus avicida ..... See wares
Bacillus avisepticus
Bacillus bipolaris septicus. .79,
Bacillus bovisepticus .........
Bacillus bubalisepticus
Bacillus canariensis necrophorus
Bacillus canisepticus
Bacillus chauveaui
Bacillus cholerae columbarum. .
Bacillus cholerae gallinarum. ..

Bacillus cholerae suum .......
Bacillus coli communis... .146,
Bacillus cuniculicida .........
Bacillus diphtheriae avium. 424,
Bacillus diphtheriae colum-

barum .............0.. 424,

Bacillus diphtheriae hominis. . .
Bacillus diphtheriae vitulorum.
Bacillus enteritidis Gaertner...

Bacillus equisepticus .........
Bacillus erysipelatis suis ...60,
Bacillus felisepticus .........
Bacillus filiformis ...........
Bacillus gallinarum .........
Bacillus gangraenae emphysem.

sali eid a aigianinuae deere Ban saa 20, 39,

Baéillus gastromycosis ovis....
Bacillus mallei

ee ey

PAGE
355
765
101

14
840
840
840

8
i104

1111

1104

1109

1111

Lie
968

1059

1057
1052
985
1001
886

760
740
148

19

49
57

Index.

necrophorus
necrosis
nodulifaciens bovis...
edematis aerogenes...

Bacillus
Bacillus
Bacillus
Bacillus
Bacillus
Bacillus
Bacillus
Bacillus

edematis sporogenes. .
edematis thermophilus
of Bradsot

Bacillus of Reindeerpest
Bacillus ovisepticus
Bacillus paracoli
Bacillus phlegmones emphysem.
Bacillus pneumoniae felis
Bacillus pleurisepticus ......*.
Bacillus polyarthritidis
Bacillus polymorphous suis....
Bacillus Preisz-Nocard
Bacillus pseudoanthracis
Bacillus pseudotuberculosis
courmont
Bacillus pseudotuberculosis
murium
Bacillus pseudotuberculosis
ovis
Bacillus pseudotuberculosis
vitulorum
Bacillus pyocyaneus .........
Bacillus pyelonephritidis bovum
Bacillus pyogenes bovis. ..144,
Bacillus pyogenes suis
Bacillus renalis .............
Bacillus rhusiopathiae suis. .60,
Bacillus sanguinarum
Bacillus septicemia
CRUG 4 chick dacarcia. oat ek
Bacillus septicemia murium....
Bacillus suipestifer
Bacillus suisepticus ..126, 139,
Bacillus tetani ..............
Bacillus tuberculosis 504,
Bacillus typus
bovinus ...............00.
Bacillus tuberculosis,
gallinaceus
Bacillus
humanus ..............00.
Bacillus typhi canariensis
Bacillus vitulisepticus
Backsteinblattern ...........
Bacterium chauveaui
Bacterium phlei
Baler to ssceaico sea andaesaceieeereevacace
Barbone ome vdavn ss Sxekes won
Barlow’s disease
Beschilausslag
Beschiilseuche
Big-head ............00cc0 ee
Bilharzia Bomfordi

anserum

tuberculosis,

tuberculosis,

 

edematis maligni. . .20,

PAGE
419
419
640

34
32
34
44
57
419
60
119
151

39
210
80
142
1007
633
20

631
632
633

638
151
1011
146
146
1013
72
99

100

64
262
262
440
569

506
510
Bilharzia crassa .............
Bilharzia hematobia .........
Bilharzia indica .............
Bilharziosis .................
Biliary fever
Blackleg .............000005
Blacklegine .................
Black quarter ...............
Black water ................
Bladder, catarrh of....... ae
Bladder, irrigation of.........
Bladder, paralysis of.........
Bladder, spasm of...........
Bladder, torsion of...........
Blue tongue .............0.
Blood anemia ...............
Blood éells, counting.........
Blood coloring ..............
Blood coloring matter in urine.
Blood diseases ..............
Blood in pericardium........

Blood vessel, rupture of...... :

Blood vessels, diseases of.....
Bloody urine ...
Boil disease, endemic.........
Bollinger’s Wild and Rinder-

SOUCKE! wiacs ons Se cisceenae ce
Boophilus annulatus ........
Boophilus Argentinus ....762,
Boophilus Australis
Boophilus bovis
Boophilus decoloratus ....
Botryocoecus
Botryomyces equi .........-.
Botryomycosis
Bou-frida
Bovovaccine
Bradsot
Braunschweiger bird disease. .
Braxy
Bright’s disease .............
Broneho-pneumonia of Ameri-

can cattle ...........-- 105, |

Broncho-pneumonia, caseous of

sheep
Bruit de Moulin.............
Brustseuche ........--+-- 170,
Brustseuche of rabbits........
Buffalo disease .........-.45-
Bulbar paralysis, infectious...
Bursattee .....2-eeeeeeee 739,
Butter bacillus .........+.46-

Cachexia, aqueous ........ 841,
Cachexia, osseous ............
‘Cachexia, pyemic ........ 144,
Cachexia, tuberculous ........
Caderas, Mal de........-..--
Caleuli, renal ....++--+-++05-
Carbuncle

.762, 979, 981,

987
797

103
768
768
768
768
768
673
673
672
406
597

57
290

 

1123

PAGE
CATCOAS avs as ae aedasiaiee 789
Carpincho .............00005 836
Cataract, diabetic ............ 927
Catarrhal fever, malarial...... 418
Catarrhal fever, malignant.... 408
Catarrh of urinary vessels.... 1031
Catarrh of vagina............ 750
Cattle plague ............... 234
Cement cough ............... 138
Cercomonas gallinae ......... 424
Chemotherapy .............. 802
Chicken cholera ............. 87

Chlamydozoa in fowl pest.... 290
Chlamydozoa in fowl diphtheria 425
Chlaniydozoa in pox.......... 296
Chlamydozoa in rabies........ 466
Chlamydozoa in vaginal catarrh 751
Chlorbaryum, effect upon walls

of blood vessels............ 1104
Chlorosis ..........000ee eee 846
Cholera of birds............. 87
Cholera of canary birds...... 99
Cholera of ducks............. 98
Cholera of fowl.............. 87
Cholera of swine............. 257
Cholera of water birds........ 98
Cholera vibrion ............. 101

Cholera-like gastro enteritis of

Ditds) 22s een areas 101
Chromatotaxis .............. 691
CIMUETO a siccecres eee ees 197
Cladothrix canis ............. 670
Clavele@.. aiesciseies oie arces were 302
Clostrydium sarcophysematous

std sclennd Susas a cceks seas Shien ee , 40
Coccidiosis, Vol. II......... 3
Coccidiosis renalis ........... 1030
Coecidium truneatum ........ “1030
Cocobacillus pseudo actinomy-

eosis polymorphous........ 669
Cocobacillus ozoenae foetidus.. 199
Cocobacillosis ....... 146, 152, 157
Coma diabetic .............-. 105
Complement fixation in in-

PUCN ZA, ay said sc aliers, engaagea sharers 174

Complement fixation in glanders 717
Complement fixation in abortion

WME, se gina eis racers ace wets Aco 747
Complement fixation in tuber;

CUlOSIS: saksaguwa sea cev ae es 587
Conjunctival reaction in glan-

GPS sb acitaianacy 53 el pamtener ss 714
Conjunctival reaction in tuber-

CULOSIS). a wigs irs. Hairy ee Reet 582
Cornfodder disease .......... 105
Corynebacillus abortus inf..... 741
Corynebacillus renalis ....... 1013
Corynethrix pseudotuberculosis:

AMUTIUM civeedgssweaeei see 632

Coryza contagiosa equorum... 366
1124
PAGE
Coryza gangrenosa bovum..... 408
COW POX aaccrecceens ues eva 318
Craniotabes ............0.04. 940
Croup of eattle............. 417
Cryptococcus farcinimosus .... 735
Culex mosquito’ ............. 903
Cystic kidney ...............- 1025
Cysticereus cellulesae of the
KIANGY 4 Geva riche cauaste toads 1030
Cystitis catarrhal ............- 1081
Cystitis verrucous ........... 980
Cystoscope ........ecceeeeee 1010
Cytorhyetes vaeceinae ....... 295
Cytorhyetes variolae ......... 295
Debal waves saves eseseucwes 838
Decompensation in heart valve
GOLECHS. ie. secstincaos perce descaione © 4 1098
Delhi boil ............. orca 797
Dengue fever ............... 196
Dermacentor reticulatus ..786, 793
Dermo reaction in glanders.... 716
Dermo reaction in tuberculosis. 584
Dextrin in urine.............- 922
Diabetes azoturicus .......... 918
Diabetes hepatogenic ......... 924
Diabetes insipidus ........... 918
Diabetes insipidus verus...... 918
Diabetes mellitus ............ 922
Diabetes mellitus decipiens.... 926
Diabetes mellitus intermittent.. 927
Diabetes neurogenic ......... 923
Diabetes pancreatic .......... 924
Diamond skin disease......... 67
Diathesis, hemorrhagic ....... 973
Diarrhea neonatorum ........ 145
Diazoreaction ....... Gar auias 423
Dikkopziekte ................ 287
Dilatatio cordis ............. 1063
Dilatatio cordis activa........ 1065
Dilatatio cordis passiva....... 1064
Diphtheria of birds.......... 424
Diphtheria of calves.......... 419
Diphtheria of mammalia...... 423
Diphtheria of man........... 437
Diphtheritie inflammation of
the eyes of ducks.......... 436
Diplococeus pneumoniae ...... 172
Diplococci in osteomalacia .... 952
Diplocoeci in rachitis......... 935
Discomyces equi ............. 673
Disinfection of stock car...... 23
Disinfection of skin.......... 23
Distemper in dogs............ 197
Distomum hematobium ....... 906
Distomum hepaticum in the
HOARE a eta ton ag eSNG 1078
Dollar flecks ...........-000. 825
Dourine .......... iitaneanes SLB

 

Index.

PAGE
Dung bacillus ............... 572
Dunkopziekte ............... 287
Dwarfism .............-- 930, 945
Dysentery, Vol. II...........

Dysentery of sucklings....... 145
Dysentery of hens and turkeys. 99

Dysuria .....6-.-.0 eee eaeiee 1038
East coast fever............. 778
Echinococcus in heart........ 1078
Echinococcus in kidney....... 1030
Echinococcus in liver, Vol. IT..

Echinococcus in spleen....... 914
Eimeria truncata ............ 1030
FE Deb a) sine. gy cle diateeiandaceimnna suet 838
Emphysema gangrenosa ...... 39
Endoarteritis, chronic ........ 1104
Endoarteritis deformans ..... 1104
Endocarditis, acute ...... 1078, 1086
Endocarditis, chronic ........ 1086
Endocarditis in erysipelas of

6 SWINE. sey sateen. ode avowed’ 66, 70
Endocarditis, parietal ........ 1081
Endocarditis, ulcerous ...1079, 1081
Endoearditis, valvular ....... 1081
Endocarditis verrucous ....... 1081.
Hntéqueé jew ew ean sale wear eeres 112

Enteritis hypertrophica bovum 639
Enteritis paratubereulous .... 639
Enzootie dysentery of fowls... 98

Enzootie pneumonia of pigs... 138
Enzootic pneumoperearditis of
PUTKeVS: yosier ania eames eae ee 99
Ephemeral fever ........... > 196
Epithelioma, contagious ...... 424

Epithelioma, contagious of men 428
Epitheliomyces croupogenes .. 425
Epizootie pneumoenteritis of

MUPROYS: secs wba eascr arose aah 99
Erysipelas of swine.......... 60
Erysipelotricheen ........... 65
Erythroblasts ........... 848, 865
Eustrongylus gigas .......... 1028
Exanthema, coital ........... 356
Exanthema, infectious ....... 295
Exanthema, vesicular ........ 351

Exudative septicemia of geese. 99

WAP. sind cg eg wetter Maeda te 678
Farein eryptococcique ....... 734
Farein d’Afrique ............ 734
Farein de riviere............. 734
Farein du boenf............. 667
Farey ¢.3ae0010: Pascavaue aia adice 678
Fat, alimentary............... 915
Fatty heart ..............00. 1075
Feather eating and puliing.... 697
Fever aphthous ............. 8328
Fever bilious ............0, _.. 791
PAGE
Fibroma of heart............ 1077
Fibromyoma of heart......... 1077
Fibrosarcoma of heart....... 1077
Filaria Blini ............ 908, 1105
Filaria Evansi .............. 908
Filaria hematiea ............. 902
Filaria immitis .............. 902
Filaria Poelsi .........e0000- 1105
Filaria sanguinig equi......... 905
Filaria sanguinis hominis..... 903
Fixed virus of rabies ........ 489
Flesh of tuberculous animals.. 514
Foal paralysis ...........005 158
Foot-and-mouth disease ...... 328
WOO LO eis eis Bo Hon csese Gusto 346
Forest disease ............-- 764
Formalin in milk ........... 155
Formic acid ..........-.006. 927
Fowl cholera ...........0055 87
Fowl diphtheria ............. 424
Fowl pest: ¢.c6-s sus wivis wes ww a ate 290
Fowl pox 2sasesasesiagawews 424
Fowl septicemia ............. 87
Fowl tuberculosis ............ 510
Fowl typhoid ...........0+-- 290
Forunculin ......... eee ee 385
Gall disease inf. .........026- 783
Galloserin .........seeceeees 96
Gall sickness .........eee0005 783
Gambia fever ............--- 837

Gangrene in erysipelas of swine 68
Gangrene, emphysematous .... 39
Gangrene foudroyante ....... 34
Gas in pericardium 1053
Gastro enteritis cholerica avium 101
Gastro enteritis hemorrhagica

CANUM coogi wade tac Rss aee te 211
Gastromycosis ..........+6.. 57
Geel Dikkop ....... iscisaiekepettens 418
Gigantocytes-........ee eee ees 863
GT ae tas ine ce ays ose se Ese arose ae 868
Girdle bacterium ..... i sate ete 79
Glanders: «4 0.4 ong ces siveee eesisie 678
Glanders, African ........... 734
Glanders bacilli ............. 681
Glanders infectfon .......... 687
Glanders nodules ........... 687
Glanders ulcers ...........++ 689
Glomerular nephritis ........ 991
Glossanthrax .....-.+eseeeee 17
Glossina decorsei ...........- 808
Glossina fusca ........ -seeee. 807
Glossina longipennis ......... 808
Glossina pallidipes .........- 807
Glossina palpalis ............ 808
Glossina morsitans .......... 807
Glycosuria ..-..-.-++-eeeeees 922
Gotta cccwi twee ae sese wae 968
GourMe<-ssiee ev s-e ga qoedsu see 366

 

1125

PAGE

Gout eee BE aerate tes 968
Gra POS) 556s sted sue steed ence wee 498
Grass bacillus ..............- 572
Gregarinosis ..............65- 424
GUD: 2 icon caw ode eget etle eee a 170
Grips’ bacillus .............. 142
Grouse disease .............. 101
Guanin formation .......:.... 968
GUIMMIN: Bure wuss toaies ec 387
Heart, atrophy ........ ace sren 1052
Heart defects ............... 1085
Heart defects, congenital ..... 1087
Heart dilatation ............. 1063
Heart: fatty occ scene ceed on nes 1075
Heart hypertrophy .......... 1061
Heart insufficiency .......... 1064

Heart muscle, calcification of.. 1075
Heart muscle, inflammation of. 1069
Heart muscle, inflammation of,

POUCO 6 ea ers c ene meele ae Sates 1069
Heart muscle, inflammation of,
CHYONIC pie sive es Ky ved ase 1073
Heart muscle, inflammation of,
parenchym. ............... 1069
Heart muscle, inflammation of,
purulent) oc. seed obs can ae 1071
Heart valvular defects, compen-
BALIN viva sshd wide Seve tes ake 1097
Heart valvular defects, noncom-
pensating ..............5. 1098
Heart water .............05. 257
Hemameba: leukaemiae ....... 870
Hemameba vivax ............ 870
Hematopa fly ............... 807
Hematozoa ..............4-- 760
Hematozoon Lewis .......... 907
Hematozoon subulatum ...... 908
Hematuria ................. 979
Hematuria vesicalis .......... 981
Hemoaphthin ............... 349
Hemoglobinemia ............ S84
Hemoglobinemia of eattle..... 990
Hemoglobinemia, enzootic .... 764
Hemoglobinemia, paralytic ... 886
Hemoglobinemia, rheumatic ... 886
Hemoglobinuria ............. 760
Hemoglobinuria, enzootic ..... 764
Hemoglobinuria, paroxysmal . 886
Hemoglobinuria, toxemic ..... 886
Hemopericardium ............ 1053
Hemophilia ................. 900
Hemophysalis leachi ......762, 793
Hemorrhagic septicemia ...... 77
Hemorrhagic septicemia, of
BS: i ae oeerne ins Se cae dens 87
Hemorrhagic septicemia, of
buffaloes ............ pa eRe 113
Hemorrhagic septicemia, of
CATO se s.nce aan dia Bon aan avanti Sees 103
1126
PAGE
Hemorrhagie septicemia, of
ducks ...........0eceeeeees 98
Hemorrhagic septicemia, of
fowls: vsgvies vxeeeyesvew es 87
Hemorrhagic septicemia, of
TAabbIUtS: oo. ws eck eee ee ee 101
Hemorrhagie septicemia, of
SHOC Ps Geir a ead wanes 118
Hemorrhagic septicemia, of
sucklngs ce: ces ees ee exe g 145
Hemorrhagic septicemia, of
SWaMS si sauscus eecauche cuore owes 98
Hemorrhagic septicemia, of
SWINE. ean due. sin hen seein 125
Hide botiid 2. c22eiiesseeaadss 112.
Hodgkin’s disease ........... 881
Hog cholera ...........0.005 257
Hoof disease ................ 835
Horse pox ............00000. 324
Horse sickness .............. 285
Hyalomma Atgypticum ...... 762
Hydremia ......... 0.400000. 845
Hydremia of cattle at sugar re-
fineries ,..........0ccee eee 846
Hydrocephalus, Vol. II.......
Hydronephrosis ............. 1025
Hydropericardium ........... 1052
Hydrophobia ................ 463
Hydrops ascites, Vol. II......
Hydrops pericardii .......... 1052
Hydrotetanin ............... 442
Hyperemia renum ........... 984
Hyperglykemia .............. 925
Hyperplasia liensis .......... 913
Hypertrophy of heart muscle.. 1061
Hypertrophy, idiopathic ..... 1062
Hypertrophy, nephritie ..1006, 1062
Hypertrophy, pathologic ..... 1061
Hypertrophy, physiologic .... 106/
Hypertrophy, secondary ...... LI62
Hyphomycosis destruens ...... 739
Hypoplasia cordis et arterium.. 901
Tetero-hematuria ............ 789
Icterus, Vol. II..............
Immunization, see Protective
inoculation.

Inceulation, diagnostic, of glan-

OTS: 2soieu a sctine eh eee eae 706
Inoculation, diagnostic, in
TADICS aid sutedu nse e a ee Sey Se 487
Inoculation, diagnostic, in tuber-
CUIOSIS igh ahumwacttiaur ne eA CES 573
Inoeulation, protective, against
abortion inf. .............. 749
Inoculation, protective, against
anthrax fe. sess. essweed«
Inoculation, protective, against
black lee sg. 02k saws oecdde 51

 

Inoculation, protective,
buffalo disease
Inoculation, protective,
calf paralysis
Inoculation, protective,
coast fever
Inoculation, protective,
cholera, fowl
Inoculation, protective, <
cholera, hog ;
Inoculation, protective,
diphtheria
Inoculation, protective,
diphtheria, of birds
Inoculation, protective,
distemper of dogs
Inoculation, protective,
dysentery of calves ........
Inoculation, protective, against
foot-and-mouth disease
Inoculation, protective, against
glanders
Inoculation, protective, against
hem. septicemia
Inoculation, protective, against
hem. septicemia of sheep ...
Inoculation, protective, against
horse sickness ...
Tnoeulation, protective, against
influenza
Inoculation, protective, against
lung plague of cattle
Inoculation, protective, against
malignant edema
Inoculation, protective, against
piroplasmosis 777, 789,
Inoculation, protective, against

ee ee

POK. toa vir tucaau ee 298,
Inoculation, protective, against
rinderpest ..........-..05.
Inoculation, protective, against
SNEED POK ws veusasseeraes
Inoeulation, protective, against
spirochetosis ..............
Inoculation, protective, against
swine erysipelas ...........
Inoculation, protective, against
swine plague .......... 137,
Inoculation, protective, against
TELANUS:. ee eed eae we eae ow
Inoculation, protective, against
trypanosomiasis ...........
Inoculation, protective, against
tuberculosis ...............
Incontinence of urine.........
Induratio cyanotica ..........
Infarets, hemorrhagic ........

Infectious disease of canaries. .
Infectious enteritis of fowls. .,

280
437
436
210
156
351
727
86.
123
288
194
402
38
796
314
250
314
842
73
141
461
804
Infectious enteritis of pheas-

OMNIS js tuh mada asa e. kei &
Infectious leukemia of fowls. .
Infectious necrosis of canaries.
Influenza ...................
Influenza catarrhalis ..... 178,
Influenza of man ............

Influenza pectoralis .......178,
Infusion of salt solution, intra-

venous ......... Spe ceenaesns
Infusion of salt solution, rectal.
Inhalation, anthrax ....... 14,
Inhalation, tuberculosis .......
Inosite in the urine...........
Insufficiency, muscular .......
Insufficiency, relative .........
Insufficiency, valvular, bicuspid
Insufficiency, valvular, tricus-

Pld as ske aver eee, owes
Insufficiency, valvular, semilun.

aortae .........- Sa alde dlepsbaSave
Insufficiency, valvular, semilun.

AYGe PUM toes oc. cena sds ne
Intermission of heart beats ...
Intermittent paralysis ........
Intoxicatio diabetica .........
Ischuria paradoxa ...........
Ischuria spastica .............
Ixidioplasma, bigeminum......
Ixodes, hexagonus ...........
Ixodes, reduvius .............
Txodes, ricinus .........+.06-

Japanese worm ..............
JSOSWA, tien ccaute-Giae enclereeseatate
Jaundice, protozoan .........
Jaundice, malign ............
Johne’s disease ..............
JOE: OVAL a ots de ee tend id amen

Kala Azar cic cicciesees cass
Kyanolophiaea ..............
Key pH OSIS sisceg sweet tas oie

Lactosuria .........66. 0 seeeee
Lamziekte .............-2005
Latent infection in anthrax ...
Latent infection in blackleg ...
Lead, effects of ..............
Lead chlorosis ...............
Beeches iwc discaweteseee gee ow
Leishmania Donovani ........
Leishmania tropica ..........
Leukemia. sega ick de eese cae a
Leukemia, infectious .........
Leukemia of fowls ........ 99,
Leukemia of mammals .......
Leukemia lienalis ............
Leukemia, lymphatic .........

PAGE

1087
1092

1093
1057
1113

877

877
869

 

Index. 1127

PAGE
Leukemia, myelogenic ........ 869
Leukemia, sublymphatic ...... 881
Leukanthrakozidin .......... 12
Leucocythemia .............. 869
Leucocytozoon piroplasmoides.. 735
Leucosis, aleukemic .......... 876
Leucosis, leukemic ........... 875
Levulose, in the urine ........ 927
Licking disease .............. 941
Lipoma of heart............. 1077
TOG AW. ioe dp see a Grete eine eeu Benes 439
Loin distemper .............. 851
Lombriz ....... 20. eee eee ee 118
hordosis i332 vecse vee exe eee e es 944
Lues venera equi............. 815
Lumbago 2.26. ceeas seee cece 886
Lungs, infect. inflammation in
PORLS Sie anise a. Gass slayannlage gaslecdsh 124
Lungs, glanders'in .......... 694
Lupine disease, Vol. IT.......
Lymphadenia ................ 869
Lymphadenia, aleukemic ...... 881
Lymphadenia, leukemic ....... 869
Lymphadenitis caseosa ovum.. 633
Lymphangioitis epizootica .... 734
Lymphangioitis fare¢iminosa
OVIS: 42 ecaaae een eids cme 667
Lymphangioitis malleosa ..... 700
Lymphangioitis pseudofar-
CINOSA, 4 ose wan dain dence ard 734
Lymphangioitis reticularis ...: 700
Lymphangioitis ulcerosa ...... 731
Lymphangioma of heart...... 1077
Lymph, excess of ........... 1119
Lymphorrhagia .............. 1119
Lymphosarcoma in heart...... 1077
Lymphosarcomatous swelling of
glands ............. sheds ces 878
LYSSA. eds cin ece Sow eae coves 463
MacrocyteS ....c cece e eee eee 863
Maculae albidae ............. 1042
Maculae lactae .............. 1042
Malaria of animals ....... ... 851
Malaria of man ............. 797
Malaria plasmodia ........... 797
Malarial eatarrhal fever ..418, 791
Malarial fever ........ aah oes 851
Mal de caderas ............. 835
Mal du coit..............005 815
Malignant catarrh ........... 408
Malignant edema ............ 32
Malignant malarial fever .... 418
Malignant protozoan jaundice. 791
Meallenin’  sieancgcesisieanatecaoe- sianeceties 708
Mallein reaction ............. 708
Mallein test, cutaneous ...... 709
Mallein test, organic ......... 709
Mallein test, thermic ......... 709
1128
PAGE
Malta fever 2 sce we esses sees 196
Miaiiclias. 2c scat. aie. See annie 44
Margaropus, see boophilus.... 762
Marginal points ............. 764
MG sarc sus aiake ma dhe se ace eens 812
Melanosarcoma of heart....... 1077
Melanosarcoma of spleen ..... 914
Mellituria .................. 922
Meningitis, tuberculous ...543, 559
Micrococeus, ascoformans .... 673
Micrococcus, botryogenes ..... 673
Micrococcus, caprinus ........ 125
Micrococcus, nitrificeans ....... 952
Microcytes ........... eee eee 865
Milk bacillus, Moller’s ........ 572
Milk from tuberculous cows .. 511
Miliary tuberculosis ..544, 561, 565
Molluscum contagiosum ...... 424
Moorhen infection ........... 101
Mosquito. o.0cteeseevareavews 836
Mouse septicemia ............ 64
Mycobacterium lacticola ...... 572
Mycosis of parrots ,.......... 100
Mycosis of pheasants......... 98
Myelocytes ........-..00005- 875
Myocarditis, acute ........... 1069
Myocarditis, chronic ......... 1073
Myocarditis, embolic ......... 1070
Myocarditis, parenchymatous. .
Lolaahamintoren Gust Mccnehea: Ma 1069, 1070

Myocarditis, purulent ...1069, 1070
Myocarditis, septic .......... 1069
‘Myxomatous disease of rabbits. 102
Myxoma in the heart......... 1077

Nagana wecsccscesccseeeeees 805
Navel all eects teasceva geen 158
Necrosis bacillus ............ 419
Necrosis, infectious of canaries 100
Nephrectomy ................ 1010
Nephritis, acute ............. 988
Nephritis, alba .............. 1000
Nephritis apostematosa ...... 1008
Nephritis, chronic, indurativa.. 1001
Nephritis, diffusa ........... 991
Nephritis fibroplastica ....... 1000
Nephritis fibrosa ............ 1003
Nephritis fibro-vesiculosa ..... 1003
Nephritis granulosa .......... 1003
Nephritis interstitialis chronica. 1001
Nephritis maculosa alba...... 1000
Nephritis mixta ............. 996

Nephritis mix. non-indurativa. 996
Nephritis mix. parenchymatosa. 996
Nephritis parenchymatosa hem-

orrhagica .............2--- 986
Nephritis purulenta ......... 1007
Nephrolithiasis .............. 1021
Nettle rash ...........0.000e 67

 

Index.

PAGE
New born, diseases of ....... 145
NOCATOIA oie ccs ie bee nee eee oe 648
Noduli arthritici ............. 970
Non-compensating heart valves. 1098

Obesity: cccicsned wee dati fee 915
OU BCHIES Fo. ckne rere OS ete 845
Oligocythemia ............... 845
Omphalophlebitis septica ..... 158

Ophthalmie reaction in glanders 724
Ophthalmic reaction in tuber-

CUNGSIS! as sic nceatnstindd a aan ae 587
Opsonins in glanders......... 724
Opsonins in trypanosomiasis.. 833
Opsonins in tuberculosis...... 587
Oriental boil ................ 734
Oriental rinderpest .......... 234
Osteochondrodystrophia fetalis. 936
Osteomalacia ................ 950
Osteomalacia, juvenile ....... 938
Osteomalacia, physiologic ..... 953
Osteomalacia, relation to osteo-

POTOSIS: wee ks ha ecge nd dee ees 955
Osteomalacia, relation to rachi-

GS) caecaeee dence aw is ety 954
Osteoporosis ............. 937, 955
Osteoporosis simulating rachitis. 937
Osteopsathyrosis ............. 950
Ouilbek ................000. 418
ONIN ARTO: sig chi acerca igh ce an 314
Oxybutyric acid .......... 925, 927
Palpatio cordis ............. 1055
Panaritium <3 cesses dese 346
Paracolon bacillosis .......... 151
Paralysis infectiosa ......... 495
Paralysis, vesicae urinariae ... 1036

Paratuberculosis bacilli ...572, 641
Paratuberculosis enteritis ..... 639

Pasteurella ..............05 . 9
Pasteurellosis .............0. 17
Pearl disease ..............0. 498
Pectus carinatum ............ 944
Pectus gallinaceum .......... 944
Periarteritis nodosa .......... 1105
Pericarditis .......... Suge 1039
Pericarditis cireumscripta .... 1042
Pericarditis diffusa .......... 1042
Pericarditis fibrosa adhesiva .. 1042
Pericarditis traumatica ....... 1042
Peripheral coccus-like bodies. . 763
Peripneumonia .............. 389
Perisplenitis ................ 864
Perlsucht ........... 498, 538, 549
Perlsucht bacillus ........509, 623
Perlsucht bacillus, Moller’s ... 572
Pestis avium ..... iteecmaneats 290
Pestis bovum orientales....... 234

Pestis equorum ...........05. 285
Pestis gallinarum
Pestis suum .............0.00,
Petechial fever ...............
Pheasant epidemic ...........
Phlyctenular eruption . :
Phosphorus content of milk..
Phosphorus in foods .........
Phthisis mesaraica
Phthisis tuberculosa pulin ....
ted teds eae bette © 498, 536,
PICOULG cis ues Sa crate ane ane ste
Piétin contagieux
PIR OYE co iahaeas does weecte
Piroplasma Argentinum ......
Piroplasma bigeminum .......
Piroplasma canis
Piroplasma Donovani
Piroplasma equi
Piroplasma hirci
Piroplasma horse typhus
Piroplasma hominis
Piroplasma of influenza ......
Piroplasma mutans
Piroplasma ovis
Piroplasma parvum
Piroplasmosis
Piroplasmosis, atypical
Piroplasmosis of cattle .......
Piroplasmosis of the dog.....
Piroplasmosis of the goat ....
Piroplasmosis of the horse ...
Piroplasmosis of man. 2
Piroplasmosis of the sheep...
Piroplasmosis, tropical .......
Plasmodium malariae
Pleuro-pneumonia, contagious,
of cattle
Pleuro-pneumonia,
of the horse
Pleuro-pnetimonia,
of goats
Pleuro-pneumonia,
calves
Pneumo-enteritis of turkeys ..
Pneumonia, chronic, of sheep.
Pneumonia, enzootie, of pigs..
Pneumonia, contagious, of
SWIC! ara ces d2e ih ievednaceeave wide ate
Pneumonia, multiple necrotiz-
ing
Pneumo-pericarditis, infectious,
of turkeys
Poikilocytosis
Polmonera
Polydipsia
Polyphagia
Polyneuritis infectiosa
Polyuria

contagious;

Semateese : . be 2

Pe

170
768
766
792
796
785
790
218
795
174
782

Index.

Polyvalent serum in calf dysen-
tery
Polyvalent serum in hem. septi-
cemia
Polyvalent
plague
Polyvalent colon serum.......
Pommeliere
Porcher’s sugar test..........
Pox
Pox, abortive
Pox, cow
Pox. Of POW s'sc0.2 cece ee een
Pox of the horse.............
Pox of men
Pox, pointed
Pox of sheep
Pox, stone
Pox, swine
Precipitine reaction in glanders.
Precipitine reaction in tubercu-
losis

serum in

Proteus in dog typhus
Protozoan diseases
Protozoan jaundice
Pseudo acid-fast bacilli.......
Pseudoactinomycosis

Pseudoanthrax bacilli
Pseudoblackleg bacilli
Pseudo coast fever
Pseudocolon bacillosis
Pseudoleukemia
Pseudopericarditis
Pseudorabies
Pseudotubereulosis, bacillary ..
Pseudotubereulosis, zooglique. .
Pseudotubercle

Pseudotuberculosis
Pseudotuberculosis of calves. ..
Pseudotuberculosis of cattle...
Pseudotuberculosis of sheep...
Pseudotubereular enteritis... .
Psittacosis
Pulse, bounding
Puncture of pericardium
Purpura hemorrhagica
Pustula maligna
Pustular inflam. of mouths

horses
Pyelitis
Pyelitis catarrhalis
Pyelitis diphtherica
Pyelitis hemorrhagica ........
Pyelitis membranacea ........
Pyelitis ulcerosa

ste eee eee

er a

 

1129

PAGE
156
87

140
156
498
927
295
309
318
424
324
323
1130

PAGE
Pyelonephritis bacillosa ...... 1010
Pyelonephritis bacteritica bovum 1010
Pyelonephritis cavernosa ..... 1016
Pyelonephritis diphtherica ... 1010
Pyelonephritis mycotica ..:... 1010

Pyemia of rabbits............ 97
Pyemie cachexia ......... 141, 144
Pyemic joint inflam. of suck-

TINGS! is arnecdealnw nara ogee tae 158
Pyobacillosis ..............4. 141
Pyobacillus bovis ..........¢. 144
Pyobacillus capsulatus wanloatt 102
Pyobacillus suis ............. 141
Pyocyaneus bacillosis ........ 151
Pyonephrosis ........... ae 1017
Pyosepticemia of ae 158
PynosOmi as © asic ssie sale eee eens aes 760
Quarter ill ................ . 39
Quicksilver, action on bleod ves-

SEIS oy sit ci avsigtey ges vite ase yey 1104
FRADIES: Seay cig leh may See 463
Re@chitis’ sis ey gece incsdue £ ied. Dees 930
Rachitis, relation to osteo-

MAAC Ae eis.3 1.0% eacnenel ete ae-a6 954
Rachitis, relation to  osteo-

POLOSS 4... sare vaeads Dace 937
Rachitis congenita ........... 936
Rachitis fetalis .............. 936
Red LOVER: scsis cos, 5 ig bene oes 60
Red water .............004.. 764

- ‘Reindeer pest .............0. 60
Retentio urinae ............. 1037
Retinitis lenkaemica ......... 875
Rhinitis fibrinosa bovum...... 415
Rhinitis gangrenosa bovum.... 408
Rhipicephalus appendieulatus

a oe 762, 779
Rhipicephalus bursa ..... 762, 779

Rhipicephalus capensis . ‘.762, 779
Rhipicephalus Evertsi .. 762, 779
Rhipicephalus nitens .... :.762, 779
Rhipicephalus sanguineys. .762, 779

Rhipicephalus simus ...... 762, 779
Rhodesian red water...... 762, 779
Rhodesian tick fever,....... . 778
Rhusiopathide suis ........... 61
Rickets svavseiie se ievaads ads 930
Rinderpest .............-.... 234
Rinderpest in sheep ......... 256
Rinderseuche ................ 103
River bottom disease ......... 851
Roseola variolosa ............ - 807
ROUp! vaesa Pew aghoneieks ages 427
Roup bacillus ............... 427
Ruptura COPGIS: a ceveidiscavrentane 2 1076
Ruptura W@N18: 5pase cic -e bene gue es 912
Ruptura vasorum ....... weve LIT

 

Index.

PAGE
Saccharomyces farciminosus .. 735
Saccharomycosis ............. 734
Salmonellosis of fowls........ 100
Sarcoma of the heart ,........ 1077
Sarcoma of the Iidney ee He aoe 1028

Sareophysema gangrenosum .. 39
Sareosporidia in heart muscle.. 1078

Seabrot .......... Bene taeda 302
Schistosomum Bomfordi ..... 906
Schistosomum bovis .......... 906
Schistosomum erassum ....... 906
Schistosomum indicum ....... 906 ©
Schistosomum japonicum ..... 906
Sclerosis renum ............. 1003
Sclerosis maculata ............ 1003
Sclerostomum larvae in kidney. 1029
Scorbutus «..ssceeseeces ees 973
Serofula ........... 499, 546, 564

Septicemia, apoplectic, of ducks 98
Septicemia, apoplectic, of fowls 101
Septicemia of canaries........ 99

Septicemia, erysipelatous ..... 69
Septicemia, gangrenous ...... 82
Septicemia of geese.......... 99
Septicemia, hemorrhagic ..... 77
Septicemia of mice........... 64

Septic joint infl. of sucklings.. 158
Septic pleuropneumonia of

CHIVES: hops ia esp eeaecde cae eo 111
Septizidin ...............06. 96
Sheep pox ............ faicintts 302
Sheep pox in man ........... 323
Side chain theory ........... 448
Sleeping sickness in fowls.101, 838
Sleeping sickness in man...... 839
Snuffling disease ......... 940, 946
Sore heels ...............02. 324
Souma ...... itetlenig eisteeas ee 837
Soumaya ...............005. 837
Southern cattle fever ........ 764

‘Spasmotoxin .....,.......... 442
Spiegler’s test ............00, 978
Spirillosis of fowls........... 839
Spirillum, see spirochete.

Spirochete, anserina ......... 840
Spirochete, Duttoni .......... 844
Spirochete, equina ........... 843
Spirochete, gallinarum ....... 840
Spirochete, Obermeieri ....... 840
Spirochete, ovina ............ 843
Spirochete, pallida .......... 844
Spirochete, recurentis ......... 844
Spirochete, suilla ............ 848
Spirochete, Theileri .......... 843
Spirochete, Tschichir ........ 843
Spirochete, vaccinae ......... 296
Spirochete in influenza ....... 174
Spirochetosis of fowls........ 839
Spirochetosis of geese ....... 839

Spirochetosis of mammals ... 843
PAGE.
Spirochetosis of man ...... .. 844
Spiroptera sanguinolenta ..... 908
Splenie fever ................ 1
Splenitis apostematosa :...... 910
Splenitis chronica indurativa.. 913
Splenitis-hyperplastica ....... 910
Splenomegalia ............... 796
Sporotrichosis ............... 670
Sporotrichum equi ........... 670
Staphylococci upon walls of
blood vessels .............. 1104
Stellulae Verheyenii ......... 985
Stenosi& ostii aortae ......... 1091
Stenosis art. pulm. .......... 1094
Stenosis. art. ventr. dextri..... 1095
Stenosis art. ventr. sinistri.... 1093
Stenosis ostii venosi dextri.... 1095
Stenosis ostii venosi sinistri... 1093
Stephanurus dentata ......... 1030
Stiff sickness ............... 196
Stomatitis aphthosa contagiosa. 328
Stomatitis pustulosa contagiosa. 360
Stomoxys, brava ............. 836
Stomoxys ecalcitrans....... 812, 819
Strangles ..........c. 000000. 366
Stangles in cattle ........... . 388
Strangles in dogs ........... 388
Strangles in swine ........... 388
Strangles, wandering ........ 380
Streptobacillus pseudotubercul.
rodentium ................ 631.
Streptococcus capsulatus gal-
Hari, ec hais nen ana ea 101
Streptococcus of . contagious
abortion 4 oisessess des meee 742
Streptococcus equi ........... 367
Streptococeus of inf. vaginal.
Catarch. 2. sacisacens teste tes 751
Streptococcus melanogenes ... 889
Streptococcus of pyogenes equi. 174
Streptotrichosis ............. 667
Streptotrichosis of dogs ...... 670
Streptotrichosis of horses .... 669
Streptotrichosis of rabbits ... 102
Streptotrichosis of ruminants.. 667
Streptothrix actinomycosis ... 643
Streptothrix canis ........... 670
Streptothrix caprae .......... 669
Streptothrix cuniculi ..... 102, 420
Streptothrix fareinica ....... 668
Streptothrix Israeli .......... 645
Streptothrix necrophora ...... 420
Streptothrix valvulae destruens. 669
Strongylus sublatus .......... 908
Strongylus vasorum ........- 907
Stuttgart disease of dogs ..... 211
Sucholoalbumin ............. 268
Sucholotoxin ...........5+--- 268

Index.

 

4131
PAGE
Suplagoalbumin ............. 128
Suplagotoxin ................ 128
Suptol occcc ys eae rie cece eenes 135
Surmenage ..............000. 1064
SUYTA foi dias deed ete he teres bps 811
Susotoxin ...............00, 128
Susserin ............0c eee ee 76
Swamp fever ............... 851
Swan disease ............... 98
Swine erysipelas. ............ 60
Swine fever ............... . 257
Swine plague ........... 125, 258
Swine pox .................. 325
Syphilis .................0.. 844
Tabanus bovinus ............ 333
Tabanus lineola ............. 812
Tabanus tropica ............ 812
Tabes dorsalis, Vol. II........
Tabes mesaraica ............. 381
Tachycardia ................ 1055
Takosis of goats............. 125
Tauruman .......0.ceeeeeeee 601
Tenesmus vesieae ............ 1032
Pelanin. .eiccssavewvecc sees. 442
Tetanolysin ................. 448
Tetanotoxin ..............0.. 442
PRLANUS: jo skes haw emt cnectancad 439
Tetanus agnorum ............ 454
Tetanus antitoxin ........... 460
Tetanus cerebralis ........... 442
Tetanus dolorosus ........... 442
Tetanus idiopathicus ......... 439
Tetanus neonatorum ..... 445, 454
Tetanus partialis ............ 453
Tetanus psychicus ........... 439
Tetanus rheumaticus ......... 439
Tetanus traumaticus ......... 439
Texas fever ...............4¢ 22.764
Three days’ sickness.......... 196
Thrombosis of abdominal ar-
feTleS’ cake aia ede ce sat 1113

Thrombosis of axillary arteries. 1113
Thrombosis of the  earotid .

ATUCTICS fcc eee pane dan wa ee 1114
Thrombosis of the iliac arteries 1114

Thrombosis of the portal
VEINS. ahrecr wees oye eaaeeaw 1116
Thrombosis of the pulmonary
OTLTICS © 6st ee ace ose bile osiar qed 1115
Thrombosis of the vena cava. ae
Thrombosis of the veins......
Thrombosis with embolism a
ATTEPIOS = 2 hag Sono iuae nto newest stan 1111
Thrombus eanalisatus ........ 1111
Thrombus obturans .......... 41141
Thrombus parietalis ......... 1111
1132

Tick fever
Tolerance tests in diabetes in-
sipidus
Tolerance tests in diabetes mel-
litus
Tophi arthritici
Torsio lienis
Treponoma pallidium
Tri-acid combinations
Trismus
Tristezza
Trommer’s test for sugar
Trypanolysin
Trypanosoma americanum ....
Trypanosoma Brucei ..... 799,
Trypanosoma Calmetti .......
Trypanosoma Cazalboui ..811,
Trypanosoma congolense .....
Trypanosoma Cruzi
Trypanosoma dimorphon ...
aa elaltele eacauttea eee ese 800, sil,
Trypanosoma Elmassiani ....’.
Trypanosoma equinum .......
Trypanosoma equiperdum ....
Trypanosoma Evansi
Trypanosoma Frank .........
Trypanosoma gambiense
Trypanosoma giganteum
Trypanosoma himalayanum ...
Trypanosoma indicum
Trypanosoma Lewisii .........
Trypanosoma muktesari
Trypanosoma nanum
Trypanosoma Pecaudi ....
Trypanosoma sudanese ....
Trypanosoma Theileri.783, 800,
Trypanosoma vivax
Trypanosomes
Tryvanosomes of man
Tsetse fly
Tubercle
Tubercle bacillus
Tubercle bacillus of birds ....
Tuberele bacillus of cattle ....
Tubercle bacillus of cold-blood-
ed animals
Tubercle bacillus, homogeneous
- cultures
Tubercle bacillus,
as evidence
Tubercle bacillus of man
Tubercle bacillus in milk ,
Tubercle bacillus, microscepic
determination

ee ey

ee ey

inoculation

Index.

801
806
838
837
838
838

837
835
835
816
812
838
838
800
838
838
799
838
838
838
837
838
812
798
839
807
539
504

506
630
506
573

506
512

 

Tubercle bacillus, spread in

the animal body............
Tuberele bacillus staining meth-

ods
Tubercle bacillus, virulence of

various typeS ...........665
Tubercle in birds......... 611,
Tubercle, fibrous
Tubercle-like nodules .........
Tubercle, solitary
Tuberculin
Tuberculin, reactions
Tuberculin, test
Tuberculosis
Tuberculosis, aerogenic

tion
Tuberculosis of birds
Tuberculosis of buffaloes .....
Tuberculosis of cats
Tuberculosis of cattle
Tuberculosis of cold - blooded

animals
Tuberculosis, congenital

infee-

Tuberculosis of dogs ..... 547,
Tuberculosis, eradication .....
Tuberculosis of goats ........
Tuberculosis, hereditary ......
Tuberculosis of horses ,...545,

Tuberculosis, latent ........
Tuberculosis, local and general
Tuberculosis of mammals ....
Tuberculosis of man
Tuberculosis, miliary
Tuberculosis, open and closed.
Tuberculosis pathogenesis
Tuberculosis primary and _ sec-
ondary
Tuberculosis, protective
munization
Tuberculosis, pseudo-bacillary.
Tuberculosis, respiratory infec-
TOM sos ine Bes exes eenncd or wee
Tuberculosis of sheep
Tuberculosis of swine..... 546,
Tubulonephritis
Tumor of the heart
Tumor of the kidney
Tumor of the spleen, acute ..
Tumor of the spleen, chronic. .
Typhoid fever .......... 170,
Typhus, bovine, contagious...
Typhus of canaries
Typhus, contagious
Typhus of dogs
Typhus of fowls

im-

PAGE
533
505

509
636
533
532 f
559
574
574
575
498

516
617

567
536

630
521
565
593
561
520
561
530

498

257
Index.

PAGE
Typhus of horses ........... 216
Tyroma. ge sass xa sae see nee we 543
Mirela. 2.22 G40 cows wake srs 982
Urethral catheterization ...... 1010
Uroeystitis 2.0.0... cece eee 1031
Via@Ginlay occ cd ackgeee eae 300, 323
Vaccinia, humanized ......... 324
Vaccination ................- 324
Vaginitis, inf. follicular...... * 750
‘Vaginitis, inf. granular....... 750
Vaginitis, inf. verrucous...... 750
Valvula fenestrata .......... 1081
Varicella ........ 00... c eee “322
WaTiola: occas ias kacumanane tes 295
Variola abortiva 309, 317
Variola caprina ............. 327
Variola compressa ........... 309
Variola confluens ............ 310
Variola equina .............. 324
Variola gangrenosa .......... 311
Variola hemorrhagica ........ 311
Variola humana ..../........ 324

 

Variola nigra
Variola ovina
Variola sine exanthemate .....
Variola suilla ........... ee
Variola vaccina

Venous occlusion
Venous pulse ..........--065
Vibrio Metschnikovi .........
Vibrion of cholera...........
Vibrion, septic
Water fear: <dccsnarnaadevewes
Werlhof’s disease... ... esses
White diarrhea of chickens...
White diarrhea of sucklings ..
White scour .............00.
Wild und rinderseuche,......
Wind pox ........ ee. eee eee
Wooden tongue ..............
Wool chewing ..............5
Wool sorter’s disease

Xanthin formations
Xanthin stones

Zine, effeet upon vessel walls ...
Zousfana