LIBRARY NEW YORK STATE VETERINARY COLLEGE ITHACA, N. Y. This Volume is the Gift of Dr. Rudolph Steffin Digitized by Microsoft® Text-book of general therapeutics for ve Digitized by Microsoft® This book was digitized by Microsoft Corporation in cooperation with Cornell University Libraries, 2007. You may use and print this copy in limited quantity for your personal purposes, but may not distribute or provide access fo it (or modified or partial versions of if) for revenue-generating or other commercial purposes. Digitized by Microsoft® TEXT-BOOK OF GENERAL THERAPEUTICS FOR VETERINARIANS BY EUGEN FROHNER PRIVY COUNCILLOR AND PROFESSOR OF SPECIAL PATHOLOGY AND THERAPEUTICS IN THE VETERINARY COLLEGE AT BERLIN AUTHORIZED TRANSLATION FROM THE FOURTH REVISED GERMAN EDITION BY LOUIS A. KLEIN PROFESSOR OF PHARMACOLOGY AND VETERINARY HYGIENE IN THE SCHOOL OF VETERINARY MEDICINE AT THE UNIVERSITY OF PENNSYLVANIA, AND DEAN OF THE FACULTY SECOND EDITION PHILADELPHIA & LONDON J. B. LIPPINCOTT COMPANY Digitized by Microsoft® Copyright, 1914, by J. B. Lippincorr Company Copyright, 1916, by J. B. Lirppincotr Company PRINTED BY J. 3. LIPPINCOTT COMPANY AT THE WASHINGTON SQUARE PRESS PHILADELPHIA, U. S. A. Digitized by Microsoft® PREFACE TO SECOND EDITION THAT a second edition of the translation of Froéhner’s General Therapeutics is called for so soon after the issuance of the first is highly gratifying to the translator, although it is not surprising that a book which has been through four editions in German should re- ceive immediate acceptance from American and English veteri- narians. In the present edition, the subject index has been continued as heretofore, but an index of remedies has been added which will facilitate the use of the book for reference and will also be an aid to the student using the work as a text-book. Louis A. KLErn. PHILADELPHIA, January, 1916, TRANSLATOR’S PREFACE THE popularity of Fréhner’s*General Therapeutics among veterinarians to whom it is accessible in German and the lack of a similar work in English suggested this translation, which it is hoped will prove equally as serviceable to American and English veterinarians. A few additions which have been made to the text, most of them of an explanatory character, have been placed between brackets ({]). The German regulations governing dis- infection for the different infectious diseases have been included in the translation; while they do not have the force of law in this country, the methods they describe, with some allowance for differ- ences in conditions, are also applicable here. The etymological footnotes explaining the derivation of the terms referring to therapeutic action have been omitted. In the descriptions of the therapeutic uses of the individual drugs, the names used in the United States Pharmacopeeia and in the United States Dispensa- tory have been employed, and these have been followed, wherever it seemed desirable, by the common or English name. Non- official drugs are indicated by an asterisk (*). Doses are given in the metric system, as in the original, with the equivalent in the apothecaries’ system. Lovis A. Kizin. PHILADELPHIA, July, 1914. iii Digitized by Microsoft® Digitized by Microsoft® PREFACE TO THE FOURTH EDITION In the new edition of General Therapeutics the chapters on chemotherapy, protective vaccination, and disinfection have been rewritten. The ‘‘therapia sterilisans magna” of Ehrlich has become of great importance to veterinarians, although at the beginning of its introduction the judgment concerning it was too optimistic (contagious pneumonia!). Considerable development has also occurred in the last ten years in the field of protective vaccination. The more complete vaccination statistics now available make pos- sible a more exact judgment concerning the value or worthlessness of the different immune sera. More recent observations have compelled a partial modification of our views in regard to disinfec- tion; this is especially true in respect to preliminary disinfection and its relation to cleaning. The new German veterinary sanitary law has been included in the revision. The reader will also find numerous changes and improvements in other chapters. E. FROHNER. BERLIN. Digitized by Microsoft® Digitized by Microsoft® PREFACE TO THE FIRST EDITION Arter I had written special text-books on Pharmacology, including pharmacognosy and pharmaceutical chemistry, on Pre- scription Writing, and on Toxicology, there remained as a final task, in my restricted department of instruction, General Thera- peutics. The present book is therefore a supplemental and con- cluding volume to the first three. The presentation of the fundamentals of general therapeutics will always remain a difficult undertaking. No department of medicine undergoes such frequent changes in methods and opinions as therapeutics. A permanent system of general therapeutics cannot be set forth, especially in our own day, in which great changes have occurred in the domain of general pathology, the for- mer absolute domination of the cellular pathology being to some extent shaken by the developments in serum therapy and the old humoral pathology again appearing in the scheme. On the con- trary, the discussion must rather be limited to a presentation and interpretation of the present status of the knowledge concerning the subject. This applies especially to the two modern questions of the day in general therapeutics,—namely, disinfection and vac- cination. But there are several other questions which at this time have not been definitely settled; for instance, the nature of the antipyretic, diuretic, expectorant, cholagogue, and derivative actions. To find the correct middle ground in the midst of all this uncertainty is not easy. If there is in anything an imminent temptation to present an extreme optimistic or pessimistic con- ception, it is certainly the case with general therapeutics. At any rate, it is always commendable in a text-book prepared for students and young veterinarians to accept the positive rather than the negative stand-point in doubtful cases. To fill a studious young man at the outset with nihilistic views concerning the efficacy of this or that therapeutic method appears to me to be more hazard- ous than if one in good faith presented some particular curative system perhaps in a somewhat too optimistic light. There will be an opportunity in practice later to test everything and to retain the best. But if the practitioner, on account of preconceived opinions brought with him from school, excludes one and another curative vii Digitized by Microsoft® viii PREFACE TO THE FIRST EDITION method from this test, there will necessarily result a narrowness in therapeutic methods. Asecond difficulty in the preparation of a text-book on general therapeutics is the abundance of material. One must here choose between a broad, voluminous discussion or a short, concise pres- entation. Iam fully aware of the advantages and disadvantages of the two plans. I decided that this book should be as concise as possible, because, for one reason, among others, we already have in our veterinary literature a large and valuable text-book on therapeutics (Ellenberger), in which the assistance of nature in healing and the history of therapeutics especially are given a large amount of space. Therefore, I have limited my discussion of the subject to a presentation of artificial assistance. There are yet to be subjoined some observations concerning the relations between veterinary curative methods and those of human medicine. There can be no doubt that in veterinary medicine we have derived very many, if not the most, of our therapeutic con- ceptions from human medicine. But it may not also be known that there are several curative methods peculiar to veterinary medicine, as, for instance, blisters, the actual cautery, lactagogues and ruminatorics; and that some methods, as vaccination and dis- infection, are much more extensively employed in veterinary than in human medicine. The prophylactic measures also show, as is well known, @ greater stage of development, especially in reference to combating epidemics (sanitary laws), in the domain of veterinary medicine than in that of human medicine, in which in our day preparations were first made for the formulation of sani- tary laws. On the other hand, different highly developed curative methods in human medicine can never obtain practical considera- tion in veterinary medicine,—for example, pneumotherapy, bal- neotherapy, climatotherapy, mechanotherapy, orthopxdics, sug- gestive therapy, etc. Those who are interested in these subjects must be referred to the text-books on General Therapeutics by Ziemssen, A. Hoffman, and others. Finally, in justification of the introduction of the numerous etymological footnotes into the book, I may remark that on account of the strangeness of many of the therapeutic terms a short explanation seemed to me to be necessary in the interest of students. BEruin. E. FROHNER. Digitized by Microsoft® CONTENTS PAGB INTRODUCTION §:c54 5a arniodaie 4 Sadie Madde uaaee Canby sie caspase Seek RS 1 THE HISTORY OF THERAPEUTICS.........00. 0.00: e ence tenes 9 1, Hippocrates v1.0 ocho sacs eaenaind oeAisie ae eee EOS 10 De Galen is ei 8 oh gases anes unis uameeaies aeenae Suara Nase e% 12 3: Paracelsus es cicid2.4. sauy sdieaiins heed 4 Std eee g aaes a 14 4, Bocrhaavesececcvidsass dabsasaseaoad setae eyes acme eg 17 Bs BLOWN sasiass a oo MGS ou Sih Des BRE eee Sas HeS DAN Aa ee 18 65 Rademacher ss s.. gasseicasscs Sv didat otinaiers ad wie da Fg dae eb ba ees 19 7. The Homceopathy of Hahnemann....................05. 19 8. The Cellular Pathology of Virchow..................5--- 21 9. The Serum Therapy of von Behring....................- 22 10. The Chemotherapy of Ehbrlich..................0000 eeu 23 GENERAL THERAPEUTICS OF THE DISEASES OF THE ORGANS OF DIGESTION 25 I. GENERAL THERAPEUTICS OF THE DisEAsES OF THE StTomacnH 25 1, Dietetic Treatment........... 0.0... c ec cece ee cence 29 2. Medicines. (Stomach Remedies. Stomachics).......... 29 8. Mechanical Treatment............. 0.00 cece cece eee eee 33 4, Operative Treatment............. 0.0 c cece eee eee eee 34 TE. SMB TICB ee ssi Vicaslin bdo ed Rice Det RS See 34 TIT. Genera, THERAPEUTICS oF THE Disnases OF THE INTESTINES 38 I... Dietetic: Treatment sci sseiasies stad Ceninds todas seeeaes 40 2. Cathartics. Laxatives............ 000 cece e nee e nee e ee 40 3. Constipating Remedies. Styptics...................... 48 4, Mechanical and Operative Treatment.................. 51 IV. GeneraL THERAPEUTICS OF THE DISEASES OF THE LIVER... 52 1. Cholagogues. Stimulants to Bile Secretion.............. 54 2. Dietetic and Mechanical Methods..................005 55 GENERAL THERAPEUTICS OF THE Diseases OF THE ORGANS OF CIRCU- LATION ivies soaien eat ck Sa ese WA ETE aS oes on Oe AE OS AE Se 56 I, GeneraL THERAPEUTICS OF THE DiseASES OF THE Heart... 56 Cardiacs. Heart Remedies...............00 eee ereereenee 57 Digitized by Microsoft® x CONTENTS II. GENERAL THERAPEUTICS OF THE Diseases OF THE Bioop... 60 Dietetic Method. Blood-forming Remedies. Blood Plastics. 63 Il. Genzrat THERAPEUTICS OF THE DISEASES OF THE BLOoD- VESSELS sc.cdiiiicad Cad disate hee deere RENTS SOA ese aE TS 64 1. Methods of Arresting Hemorrhage..............------ 66 2. Vasomotor Stimulants. Drugs that Contract Blood- VESREIB 3/5 Su darters patiaiinsen Set Gas ean MRR Lode « 71 8. Vasodilators. Agents that Dilate Blood-vessels........ 72 IV. GenerAL THERAPEUTICS OF THE EXUDATES AND TRANSUDATES. IRESORBENTS J 35.2 .aad da salon Weaaind eaulde aud em ow alierarn 73 Resorbing Medicines. Resorbents ..............2.+ 00 es 76 GENERAL THERAPEUTICS OF FEVER.......... 00000 e ener ee eee 80 Medical Antipyretics............ 0.0... ccc cece cence eee 84 GENERAL THERAPEUTICS OF THE DisEasEs oF THE NERVOUS SysTEM.. 88 Drugs Acting on the Nerves. Neurotics. Nervines......... 90 1, Stimulants to the Nervous System. Enxcitants......... 93 2. Drugs that Calm the Nerves. Sedatives.............. 97 8. Narcosis and Anawsthesia............. 00. e ee eee ee eens 101 GENERAL THERAPEUTICS OF THE DISEASES OF THE RESPIRATORY APPA- RATUS: 5.0 dave sac hisa Wee sRee RE RMAC CEE ESE BEES 103 BPxpectorantés sscassesneex24 She yea ee eet ee Seem ee ee eA 107 GENERAL THERAPEUTICS OF THE DispasES OF THE Urinary Organs. 112 DiltPeti Gis. 3 iamnnaaat anne dea deds adebGad esas Gas melons 113 GENERAL THERAPEUTICS OF THE DISEASES OF THE GENITAL OrGANS. 118 1. Ecbolics. Abortives.......... 0. c eee ce cece cece eee eens 119 2. Drugs that Stimulate the Sexual Impulse. Aphrodisiacs.... 120 3. Drugs that Depress the Sexual Impulse. Anaphrodisiacs.... 121 4, Drugs that Increase Milk Secretion. Galactagogues....... 122 5. Drugs that Depress Milk Secretion. Antigalactagogues.... 127 GENERAL THERAPEUTICS OF THE GLANDS (DIAPHORETICS AND SIALA- GOGUES) .3 ¢ wad 4c xen aw eae 8 Pe eed Sa ih, wea ue aac Sado and ae 128 1. Drugs that Stimulate the Secretion of Sweat. Diaphoretics. 129 2. Drugs that Stimulate the Secretion of Saliva. Sialagogues.. 131 GENERAL THERAPEUTICS OF THE DisEASES OF METABOLISM.......... 133 1. Plastic Remedies. Plastics................ccccceveceeues 134 2. Nutrients. Roborants..............cccceceveeceeeecees 137 3. Reducing Remedies. Antiplastics...............0..000005 138 Digitized by Microsoft® CONTENTS xi GENERAL THERAPEUTICS OF DISEASES OF THE EYE................. 141 1. Pupil-dilating Remedies. Mydriatics..................... 141 2. Pupil-contracting Remedies. Myotics.................... 142 GENERAL THERAPEUTICS OF THE SKIN AND Mucous MremBranes.... 143 1. General Therapeutics of the Diseases of the Skin........... 144 2. Cutaneous Irritants, Acric8.............. 0.0 cece eee eee 146 3. Caustics.......... SRO aie 9 ee hs ttiet ate aha nce ates ahaa 152 4, Firing. Cauterization......... 0... ccc cece cece cece eeaee 156 De ABLID BONES sili s nceind dies 2 eae nearer ee dda ae e palit 157 Drugs THAT Kitt Parasires, ANTIPARASITICS................0.005 160 1, External Antiparasitics. Antepizoa....................8. 160 2. Worm Remedies. Anthelmintics...................000085 165 DISINFECTANTS. ANTISEPTICS. ........0. 0000 cc cece eeu ee eeueeenes 169 1. Disinfection in General. .............0 0000 cece eee eee 169 2. Disinfection for Infectious Animal Diseaseg................ 183 I. Supplement A to the Instructions of the Federal Council, December 25, 1911 (Disinfection in Infec- tious Diseases)........... cece cee es 184 II. The Most Important Disinfectants for Animal Infections 201 3. Disinfection of Wounds............. 0... c cece eee ee ees 209 4, Internal Antiseptics............ 0... cece cece eee eae 213 5. The Conservation of Animal Products..................4. 214 ANTIDOTES isis bas cusiats sha na acs SAM Ae eae a Glenn a A hae ea 216 VACCINATION. IMMUNIZATION. INOCULATION.............00000eeeue 225 1. Immunity, Mitigation, and Methods of Inoculation......... 225 2. The Different Varieties of Vaccination.................65- 235 I. Protective Vaccination.......... 0... ccc cece eens 236 Veterinary Police Regulations Concerning Vaccina- tO s sits se Widder Saisie vane giv adeno arens et aategta ted 237 Protective Vaccination for the Different Animal Infections oic.cscccaacdinasdes ceacarieded veae 237 ID. Curative Vaccination.............ccce cece eee eeees 252 III. Diagnostic Inoculation............ 00. cece eee e ee 254 WatTeR AS A REMEDY. HYDROTHBRAPY.......... 0.0 cee eee eet eens 265 MASSAGE) esi seis tate nals cal nee s pian aldalin ae Nba aa Pn Se wlaweraut 276 ELEcTRICITY AS A REMEDY. ELECTROTHERAPY................000005 282 Digitized by Microsoft® xii CONTENTS BLEEDING '5.é;ca's:eaveis ce acaanal gatas ese es Bk lee aadd uate nlebaeae Geb amen apueedvan 286 GENERAL THERAPEUTICS OF THE ORGANS OF LocomoTION (MUSCLES, TENDONS, NERVES, ARTICULATIONS, BONES)..........-...00000005 288 INDIFFERENT REMEDIES. MECHANICALS..........0-00000 cee eeen eens 290 Ds PEOUECEEV CBisisifies3 ie ceahord Setup sud Wd augualbs Soran abe cea ack aubee lar eaten 290 2. EMmoMents:y.24 +20 ta00chdavoorpaiacthdesa pee kewee te pias 291 3. Cleansing Remedies. ............... 0.0 cece cece eee e nes 292 AIR AS Ay REMEDY 3204 a haarsacd hin ance hae Bk ae a RR A Oe 295 INDEX'TO REMBDIBG jos op dsle a dae Qiedd x4 Siena a Seiad Seka a oWield as Danese semees 297 Sapsecn -INDER oi) oa os aad diosa Yon sens Re ae E AGIA ea aan es 305 Digitized by Microsoft® 7 TEXT-BOOK OF GENERAL THERAPEUTICS FOR VETERINARIANS INTRODUCTION Natural and Artificial Healing.—In the healing of disease two possibilities are to be considered. The disease is healed by the curative forces of nature without the assistance of medicines (natural healing), or artificial—i.e., medical—healing processes are necessary (artificial healing). Whether a disease can be left to nature’s powers or whether medical treatment is expedient or neces- sary is the question which the therapeutist must first consider carefully in every case. What may be healed by nature? What may be healed by medical treatment? To these questions may be added a third: What is usually incurable? 1. What May be Healed by Nature?—The answer to this question may be based upon clinical observations and experi- mental investigations in general surgery and pathology. In sur- gery as well as in pathology it has been demonstrated repeatedly that the natural healing force and the regenerative capacity of the individual tissue cells and organs are extraordinarily great. The spontaneous healing of wounds and fractures of bones, the reactive protective processes of the body in inflammation (local leucocy- tosis) and in fever (general leucocytosis), the spontaneous checking of hemorrhage, the organization of a thrombus, the encapsulation of purulent areas and of foreign bodies, the restoration of epi- thelium and of nerve-fibres, the formation of anastomoses, anky- loses (spavin, ring bone), and nearthroses, the throwing off of gan- grenous parts, the resorption processes in pneumonia and pleurisy, the compensatory processes of the heart, kidneys, liver, and lungs, the spontaneous healing and natural immunity of the infectious 1 Digitized by Microsoft® 2 INTRODUCTION diseases (aphthous fever, strangles, influenza, contagious pneu- monia), the spontaneous recoveries from colic in numerous cases, and many other natural healing and corrective processes verify this statement. A clear insight into the nature of spontaneous healing is afforded by a study of the processes of inflammation. While the inflam- matory. changes were formerly regarded as harmful and were com- bated with remedies that reduce inflammation, especially cold, it is now known that inflammation is a healing reaction and should not be opposed but favored. Just as fever, pain, cough, vomiting, diarrhoea, and other disease phenomena exert a natural healing tendency in removing and combating the cause of disease, so do the processes attending infammation constitute a natural elimi- native and healing process. The dilation and hyperemia of the vessels; the change in the capillary walls by which they become permeable; the out-wandering of the white blood-cells (local leucocytosis) and the exudation of blood-plasma into the tissues; the removal of endotoxins from the inflamed area by phagocy- tosis; the proliferation of the autochthonous connective-tissue cells; the liquefaction and resolution of the solid inflammatory products by enzymes (lysins) ; the occurrence of toxin-binding, neu- tralizing antitoxins, of bacteria-destroying humoral and leucocytic bactericides (bacteriolysins), of bacteria-clumping agglutinins, and of opsonins which prepare the bacteria to be taken up by phagocy- tosis; the leucocytosis of the blood (lymphocytes, neutrophiles, eosinophile leucocytes); positive and negative chemotaxis; the regeneration of the injured tissue-cells by increased growth of cells; proliferation of tissues and capsule formation—all these are nothing more than protective and healing processes directed against the causes of disease, especially bacteria, and to the regener- ation of the injured tissue, such regeneration occurring in living, healthy animal bodies through the adaptability and reproductive powers of the cells. These natural eliminative and regenerative processes should not be disturbed by improper treatment, but should be regarded as natural healing processes and not only favored but even stimulated under certain circumstances. Digitized by Microsoft® INTRODUCTION 3 2. What May be Healed Artificially?—The problem of artificial assistance consists above all in supporting, promoting, and acceler- ating the natural healing processes. Natura sanat medicus curat. Disinfected, ligatured, and bandaged wounds, reduced bone frac- tures, and incised abscesses heal better and more rapidly than when left entirely to nature’s efforts. This is also true of the artificial removal of fluid exudates (hydrothorax, ascites, acute hydro- cephalus, laminitis), and of the medicinal treatment of heart weak- ness and dangerously high fever, pulmonary congestion, cerebral hyperemia (phlebotomy), and numerous other diseases. In many cases natural healing entirely fails to remove the dis- ease. Then it is only curable through artificial methods. Sur- gery and obstetrics are especially rich in examples of this kind. To this class of cases belong most of the neoplasms and parasitic diseases, especially mange, deviations in the position of the foetus and of the gravid uterus, invaginations and incarcerations of the intestines, herniz and prolapses, ulcers and fistule, urinary calculi, foreign bodies in the stomach and intestines, tympanites of the rumen and intestines, wounds of the carotid artery, etc. 3. What is Incurable?—The answer to this question will depend upon the present extent of medical knowledge. There is a large number of diseased conditions which are incurable in spite of all discoveries and therapeutic progress, and which will probably remain so in the future. A dead tissue or organ cannot be replaced in its original form. Incurable also are atrophic conditions, chronic hydrocephalus, chronic interstitial nephritis and hepatitis, ankyloses, many neoplasms in internal organs, fractures of the cer- vical, dorsal, and lumbar vertebre, atrophy of the optic nerve, detachment of the retina, emphysema of the lungs, progressive atrophy of the posterior crico-arytenoid muscle (roaring), general- ized carcinomatosis, sarcomatosis, tuberculosis, and actinomycosis, echinococcus disease, glanders, and rabies. In the large domestic animals (horses, cattle) fractures of the upper bones of the extrem- ities, severe pelvic fractures, purulent inflammation of the large joints, and perforating wounds of the intestines are, as a rule, incurable. Many diseased conditions are curable in man that are Digitized by Microsoft® 4 ” INTRODUCTION incurable in animals, because in the treatment of animals the external conditions necessary to healing are not obtainable in the same degree asin the treatment ofman. For instance, many bone fractures in horses and cattle are incurable because a fixation dress- ing cannot be applied to the part affected. Some operations can not be performed on large animals because of the difficulty of main- taining asepsis. Furthermore, the task of the veterinarian is essentially different from that of the physician. Frequently, the purpose of veterinary therapeutics is not the healing of disease, but to make the animal serviceable. A horse with an ampu- tated leg is, indeed, healed, but is not serviceable. Neurectomy, on the other hand, does not heal ring bone or spavin, but it makes the horse again serviceable. Even economical considera- tions (value of the animal, time required for treatment) often govern the veterinary therapeutist. Remedies and Medicines.—The remedies which may be used in the treatment of disease are numerous and various. The term remedy does not signify the same thing as medicine or drug; the latter is only a special form of the former. There is not always, as is frequently incorrectly assumed by the laity, a sharp contrast between medical and drugless treatment (so-called natural method). On the contrary, the same therapeutic effect produced by drugs may frequently be obtained from other, non-medical remedies,— e.g., through mechanical methods. In general, dietetic, chemical (medicines), mechanical (massage, hydrotherapy), thermic (heat, cold), electrical (electrotherapy), and operative measures are to be considered as therapeutic remedies. Also of importance as healing factors are rest, movement, and exercise. Disinfection, inocula- tion, and sanitary police regulations are of especial value in com- bating infectious diseases. If, after the use of this or that therapeutic measure, the disease is cured, this is not in itself proof that the treatment applied was the cause of the cure. Post hoc is not propter hoc. On the contrary, every recovery should be considered candidly and objectively to determine what share in the cure is to be credited to the healing powers of nature and what part was played by the therapeutic Digitized by Microsoft® INTRODUCTION 5 measures employed. The observance of this rule is very neces- sary, especially in veterinary therapeutics. Fallacious, speculative conclusions from meagre casuistic material, and unjustifiable com- mendation and overrating of new remedies are in veterinary medi- cine almost more common than in human medicine. Healing Methods.—General therapeutics differs considerably from special therapeutics and pharmacology. The latter con- siders in a detailed manner the actions and uses of the individual medicines in the different diseases. General therapeutics em- braces the different views concerning the treatment of diseases and the action of remedies in general. Out of the sum of indi- ‘vidual observations it constructs certain general rules and laws, on which are based the employment and systematic grouping of the curative agents. Such a consideration of the healing agents naturally leads to the formulation of the so-called healing methods. General therapeutics can therefore be defined as the study of the healing methods. Thenumber of healing methods has been large from theremotest times. From an entirely general standpoint there are usually distinguished as special healing methods the direct, indirect, and derivative, the local and general, the causal, radical, and symp- tomatic, the empirical, statistical, rational, and physiological, and the prophylactic, expectant, abortive, and vital. Concerning the nature of these methods, the following may be stated: 1. The direct healing method consists in the direct or imme- diate application of the remedy to the disease (indicatio morbi). A direct therapeutic process, for example, is the employment of antiseptics, antiparasitics, and antidotes—the bacteria, parasites, and poisons concerned being directly influenced. Other examples are the use of caustics and many operations (extirpation of tumors, removal of foreign bodies). 2. The indirect healing method attacks the disease through the medium of the circulation and the nervoussystem. Itis, therefore, also called the general method. This method includes the dietetic medicines, which influence disease through nutrition and metab- olism; the resorbents and derivatives, which act through the Digitized by Microsoft® 6 INTRODUCTION circulation; and cutaneous irritation, which operates reflexly through the nervous system upon the distant disease process. The derivative action is also regarded as an independent healing method. This action can be attained through the operation of cutaneous stimulation, cathartics, diuretics, diaphoretics, sialagogues, and bleeding. By far the greater number of cases of all diseases are treated by the indirect method, because only in isolated cases can the therapeutic measures be applied directly to the disease. 3. The causal method attacks not the disease itself but the cause, €.g.,in the infectious diseases, the bacteria; in poisonings, the poison. To this extent it agrees with the direct method. With reference to its value, it must be observed that the removal of the cause is only possible in certain diseases (surgical measures, anti- sepsis, antiparasitics, antidotes, emetics, cathartics). Further- more, after the removal of the cause the disease frequently does not cease, ¢.g., rheumatic diseases after the removal of the cold irritant; and finally, in many diseases the cause is either not acces- sible (distomatosis, echinococci) or is not known (ultravisible virus, epilepsy, diabetes mellitus). 4. The radical method is directed against the root or source of the disease and not merely to the removal of the associated dis- turbances. As the definition indicates, the radical method is related partly to the causal and partly to the direct (local) method. Goitre and actinomycosis may be treated indirectly through the medium of the blood stream with iodine. The radical method consists in the operative removal of the diseased parts. In a simi- lar manner are herniz and urinary calculi treated radically,—i.e., by operation. Unfortunately, there are only a small number of diseases in which complete restoration can be attained by the radical method. 5. The symptomatic or palliative method is directed against neither the cause of the disease nor the disease itself, but only against the symptoms of the disease. In the infectious diseases, for example, the fever is treated, in laryngeal catarrh the cough, in gastric catarrh the vomiting, in intestinal catarrh the diarrhoea, in brain diseases the psychic excitement and convulsions, in lameness Digitized by Microsoft® INTRODUCTION 7 the pain (neurotomy). Practical experience teaches that in very many cases treatment must be confined to this method. 6. The rational or physiological method is based upon scientific obseyyations and experimental investigations of the cause, nature, and pathogenesis of the different diseases, and the action of the individual medicines. The therapeutist seeks to explain scientifi- cally the action of his remedies upon the basis of the contempo- raneous knowledge of therapeutics. Inflammation and the infec- tious diseases, for instance, are caused by the action of micro- organisms and are therefore treated with antiseptics; the diseases of the heart with drugs whose physiological action upon the heart has been exactly investigated (digitalis). 7. The empirical healing method is, in contradistinction to the rational, based upon practical experience only, without the nature of the disease and the action of the remedies being considered scientifically in connection with each other. This method includes the former common employment of potassium nitrate, calomel, phlebotomy, and the other so-called antiphlogistics in the inflam- matory diseases. It should be the endeavor of scientific thera- peutics to extend the rational method more and more and to reduce empiricism. On the other hand, it must not be overlooked that our knowledge of the nature of disease and of the action of healing remedies is not yet so complete that the empirical method can be dispensed with entirely. Furthermore, many valuable thera- peutic measures, which are at this time regarded as rational, were discovered in a purely empirical manner (massage, hydrotherapy, folk-medicines). The statistical healing method is in a certain sense a subdivision of the empirical. It is based upon the statis- tical demonstration of the effectiveness of a remedy or a cure. 8. The expectant or waiting method leaves the mastery of the disease to the healing powers of nature and resorts to medication only when the automatic regulation of the body fails. It conforms in part to the dietetic method, and is very properly practised more in recent times than formerly. Especially in the infectious dis- eases with a typical course (influenza, contagious pneumonia, strangles, foot-and-mouth disease) is therapeutic interference Digitized by Microsoft® 8 INTRODUCTION indicated only when certain abnormal complications appear (very high fever, heart weakness, diarrhcea, etc.). The same principle also applies to catarrh of the upper air-passages, gastric catarrh, intestinal catarrh, and to numerous surgical conditions (distor- tions, tendinitis, spavin, etc.). 9, The prophylactic method is, strictly speaking, not a curative method, but a process of preventing the occurrence of disease and its extension to healthy animals. Nevertheless, it is of great impor- tance (“Prevention is better than cure’’). It consists in attention to hygiene, dietetics, rational breeding and feeding, disinfection, and the sanitary police measures for controlling disease. 10. The abortive method combats disease in its initial or for- mative stage. Emetics and calomel appear to have an abortive effect against certain infectious diseases (canine distemper, swine erysipelas) in consequence of their action in removing the cause of the infection from the body. In poisonings an abortive cure can be spoken of in the same sense. This is also true of arecoline and phlebotomy in laminitis and in cerebral inflammation, likewise of amputation of the tail in tetanus resulting from infection of a wound in the tail. On the other hand, the claim that contagious pneumonia of horses is influenced by the intravenous injection of salvarsan, in the sense that inflammation of the lungs does not develop or that complications and secondary diseases do not occur, does not appear to have been proved. 11. The conservative method aims at the greatest possible con- servation of the diseased organ. In veterinary surgery it has a certain importance (preservation of cutaneous flaps in abraded wounds and also in wounds of the wings of the nostrils and of the eyelids). 12. The vital method (vital cure, indicatio vitalis) concerns itself with the preservation of life when it is suddenly threatened in the course of a disease. It is really a symptomatic method (trache- otomy in pharyngitis and cedema of the glottis; bleeding in ceedema of the lungs; puncture of the pleural cavity, peritoneal cavity, the rumen, intestines, and bladder when collections of fluids or gas threaten life). _ Digitized by Microsoft® THE HISTORY OF THERAPEUTICS TueE history of therapeutics, or medicine, extends far back into the remotest antiquity. The earliest traditions are derived from Indian (Upavedas, Agurveda, Susrutah des Dramoantari), Egyptian (Isis, Osiris, Horus, Harpocrates, priest medicine), and Hebraic (Moses, Levites, prophets, Essenes) literature. Very old also is the Chinese medicine (Ching de chung Ching). But the real scientific therapeutics begins only with the Greeks, with an introductory period which may be designated as the philo- sophical (Thales of Miletus, Pythagoras, Alemzon, Empedocles, Anaxagoras, Democritus). The Grecian medicine was also in the beginning a ‘priest medicine.” The so-called Asclepiade were associations of priests, purported to be founded by Asculapius the god of medicine, who held temple-polyclinics in which they prac- tised their secret medical art, which was transmitted by oral com- munication. Out of one of these temples of Asclepiade at Cos came Hippocrates (400 B.c.), the founder of Grecian medicine. His teachings, the humoral pathology, entirely dominated Grecian and later also Roman medicine; its influence extended even through the middle ages into modern times (sixteenth and seventeenth cen- turies). The writings of Galen (131-200 a.p.), which were regarded as medical dogma of Biblical authority throughout the entire middle ages, a period of not less than fifteen hundred years, are nothing more than an amalgamation of the medicine of Hippoc- rates with the philosophy of Plato. The Arabian school (900- 1000 a.p.) introduced by Rhazes and Avicenna, and the so-called Monks’ medicine, especially the school at Salerno (about 1100 A.D.), were also founded upon the teachings of Hippocrates. The Arabian school also included the new factors of alchemy and spiritualism. In the sixteenth century, Paracelsus (1493-1541) began the actual reformation of the Galenic and Hippocratic teachings. Believing chemistry to be the basis of therapeutics, he created his 9 Digitized by Microsoft® 10 GENERAL THERAPEUTICS FOR VETERINARIANS system of chemiatrics or iatrochemistry, but, as he was strongly under the influence of the spiritualism of the Arabian school, his ideas in part acquired a mysticism. The scientific foundation of modern therapeutics was laid in the period from the sixteenth to the eighteenth century by exact anatomical, pathological, phys- iological, and clinical-pharmacological investigations. Prominent in this work were Vesalius (1514-1564), Fallopius (1523-1562), Malpighi (1628-1694), the founder of modern anatomy and his- tology; Morgagni (1682-1771), the creatorof pathological anatomy; Harvey (1578-1657), the discoverer of the circulation of the blood and founderof physiology; Ambroise Paré (1517-1590), the reformer of surgery, and Sydenham (1624-1689), the master of practical clinical medicine. A special position in the modern history of therapeutics is held by Boerhaave (1668-1738), the founder of the modern humoral pathology (hematopathology); Brown (1735-1788), the author of Brownianism; Rademacher (1772-1849), the author of the experi- ence or empirical method; Hahnemann (1755-1843), the father of homceopathy, and also several discoverers of natural healing methods, especially Hufeland (1762-1836), Schénlein (1794-1864), and Priessnitz (1799-1851). The history of modern therapeutics in the nineteenth and twen- tieth centuries lacks the prominent, central character of former periods, because it consists of the special history of the several branches into which medicine has been divided. Of general cura- tive methods, only three are of importance: the cellular therapy of Virchow, the serum therapy of von Behring, and the chemotherapy of Ehrlich. The first locates the disease and also the healing powers in the cells, the second uses the therapeutic action of the immune bodies of the blood-serum (antitoxins), and the third treats certain infectious diseases (protozoa, trypanosomes, spirilla) with specific chemical substances. 1. HIPPOCRATES Biographical.—Hippocrates was born in the year 460 B.c., on the island of Cos, in Asia Minor, the son of Heraclides, one of the Digitized by Microsoft® HISTORY OF THERAPEUTICS 11 Asclepiad and a teacher in the medical temple school at Cos. He was a contemporary of Pericles. He travelled in Asia Minor, Greece, Scythia, and Libya and resided subsequently in Thes- saly, where he died in Larissa in 364 (875?). He published the medical secrets of the priests of the Asclepiade and his own experiences in several books (Aphorisms, Prognostics, Epidem- ics, Treatment of Inflammatory Diseases, Wounds of the Head, Hernie). His expression, “ Life is short, art is long, oppor- tunity fleeting, experience deceptive, judgment difficult,” is well known. The Theory of Hippocrates.—The humoral pathology of Hippoc- rates attributed all diseases to changes in the fluids of the body. The body contained four cardinal fluids or humors: the blood, the mucus, the yellow and the black bile. The normal mixture of these four fluids (7.e., health) is the crasia, while an unequal mixture generates disease, or dyscrasia. The problem of therapeutics is to change dyscrasia into crasia. This can be accomplished in three ways: 1, by removal of the superfluous fluid,—e.g., of the blood by phlebotomy, of the bile by cholagogues, of mucus by drugs that increase the secretion of mucus (derivative, depletive method); 2, by altering or rendering harmless the superfluous fluid in the body by cooking, ripening, or transforming,—pepsis, coctio, maturatio, alteratio (alterative method); 3, by restoring deficient cardinal fluids (dietetic method). In addition to the crasia theory, Hippocrates also formulated a crisis theory. According to this latter theory the fever reaches the crisis or turning point on certain so-called critical days. The seventh day especially was regarded as the critical day and as the proper time for therapeutic interference. Depleting drugs espe- cially were administered on these days to increase the critical elimi- nations. Cathartics and emetics, especially the vegetable drastics (veratrum, euphorbium, daphne), were used for their derivative action. Phlebotomy was employed to reduce fever only in strong and full-blooded individuals. In addition to the external reme- dies, he assumed the presence of an internal, primitive healing force which induces the crisis. Digitized by Microsoft® 12 GENERAL THERAPEUTICS FOR VETERINARIANS Aristotle, also of a family of Asclepiade; lived from 384 to 322 B.c.; was teacher of Alexander the Great; pupil of Plato; founder of natural history and comparative anatomy; teacher of the elementary qualities; discovered the nerves and gave the aorta its name. Herophilus and Erasistratus, celebrated anatomists of the Alexandrine school (time of the Ptolemies). Herophilus discovered the sensibility of the nerves, the finer anatomy of the eye, distinguished between systole and diastole, and named the duodenum. Erasistratus discovered the lymph- vessels and healed liver abscesses by operative incision. 2. GALEN Biographical.—Claudius Galenus was born in Pergamos, 131 A.D., during the reign of the Emperor Hadrian. He was the son of a builder. After pursuing a course of study in philosophy, he studied four years in the school of the Pergamonic physicians. He then visited Smyrna and Corinth, Asia Minor and Palestine, and finally the then celebrated medical school at Alexandria, where anatomy especially had flourished from ancient times and where alone the dissection of the human body was permitted. In addition, toxicology was there thoroughly taught. Poisons and antidotes at that time formed the chief part of pharmacology. Returning to Pergamos in 159, he was appointed physician to the gladiators. In 165 he received an appointment under the Emperor Marcus Aurelius in Rome, where he gave lectures on physiologyand prepared the royal electuary, a mixture of 62 drugs. The prescrip- tion was written by Andromachos, the physician of Emperor Nero, and was obtained from the Alexandria school. In 180 Galen was the physician of Emperor Commodus, and in 193 of Emperor Sep- timius Severus. He died in the year 200 a.p. His numerous writ- ings, in all about 500, were destroyed in great part through the burning of the Temple of Peace in the reign of Commodus. Eighty- three medical works were preserved, among them the writings on “Healing Methods,” “Critical Days,” ‘Functions of the Parts of the Human Body,” “Combination and Force of the Simple Medi- cines,” and ‘Differentiation of the Different Varieties of Pulse.”’ The teachings of Galen were later acknowledged even by the church; doubt of their correctness was regarded as sacrilege. His Digitized by Microsoft® HISTORY OF THERAPEUTICS 13 dogmas received a consideration only equalled by that given to the Bible, and because of this were a serious hindrance to the develop- ment of medicine for the succeeding fifteen hundred years, When the students of medicine explained that dissection was necessary to discover the errors of Galen, the church forbade the opening of human bodies and stated that Galen never could have erred and that dissections were therefore not only unnecessary but would be reprehensible. Pergamos, his native city, had golden medals struck in honor of Galen, and he was for other reasons well aware of his position, as is shown by the following statement: “‘ Hippocrates indeed had made something of a track and broken the path, but I have smoothed it and made it passable, as Emperor Trajan did with the military roads in the Roman Empire.” The Galenic Theory.—The humoral pathology of Hippocrates, with its four cardinal fluids and the crasis and crisis theories, was the nucleus of the Galenic system of medicine. In addition to dys- crasia, Galen regarded as causes of disease changes in the so-called elementary qualities (heat, cold, dryness, and moisture). Natural, primary forces of the body were attraction, adhesion, secretion (apocritical), and elimination. He assumed that every medicine possessed specific elementary qualities. In his anatomical and physiological studies he came very close to the discovery of the cir- culation of the blood. He was convinced that respiration served to maintain the body heat; he compared the respiration with combustion and contended that the flame and animal life were supported by the same constituents of the atmosphere. These constituents he called “air spirits,” and, after they were taken into the blood, “life spirits” (spiritus vitalis). Fever was an unnatural change in the temperature. ‘The lightest form of fever, the “ephemeral,” occurred when only the “air spirits” were embarrassed. If the blood and fluids were affected, there arose “septic” or putrid fever. When the heart and solid parts of the body became hot, then the fever was “hectical.” A fever continuing one day was due to mucus; three days, to yellow bile; four days, to black bile. Digitized by Microsoft® 14 GENERAL THERAPEUTICS FOR VETERINARIANS Arabian Medicine.—Its foundation was the theories of Hippocrates and Galen. Added to these were the new elements of chemistry and pharmacy. As alchemists, the Arabian physicians discovered analysis, synthesis, distil- lation, sublimation, precipitation, preparation of salts, and the manufacture of alcohol. They were also believers in spiritualism, and considered medi- cines as the bearers of a spirit, to which their power was due. The most celebrated Arabian physicians were Rhazes (923 a.p.) and Avicenna (978 a.D.). Rhazes was first a teacher of medicine and philosophy in Bagdad, later director of the lazaretto in Ray. His works were: ‘On the Healing of Diseases,” “Aphorisms,” and “Antidotes.” They contain the earliest discussion of smallpox. Medicines mentioned are: mercurial preparations, copper sul- phate, arsenic, nitrate of potash. Avicenna, a native of Bokhara, studied in Bagdad, was private physician to the prince of Ray and later Vizier in Hamadan. On account of an insurrection he fled to Ispahan, dressed as a monk. To his chief works he gave the name of “Canons”; they contained nearly everything concerning the entire subject of medicine and attained a wide circulation in Europe. His catalogue of medicines was very extensive (rhubarb, silver, gold, many plants). Monks’ Medicine.—From the sixth to the sixteenth century, a period of one thousand years, in Italy, Germany, France, and other countries of western Europe, medicine was almost exclusively in the hands of the monks, who conducted special medical schools. Of the latter the most celebrated was the school at Salerno, from the tenth to the thirteenth century, a Neapolitan ‘Benedictine cloister, where pharmacy, pharmacology, and dietetics especially were taught (Regimen sanitatis Salerni, Antidotariam minus, De simplici medicini, Eros). Another Neapolitan cloister school was the one at Monte Casino. In France, in the thirteenth century, was the school of Montpellier, which later developed into the University. 3. PARACELSUS Biographical.—Philippus Aureolus Theophrastus Bombastus ab Hohenheim, called Paracelsus, was born near Zurich in 1493, the son of a physician. He studied in Basel and travelled in almost all the countries of Europe. In 1527 he became professor of physics, medicine, and surgery in Basel and also city physician, but left there secretly a year later on account of differences with the munic- ipal authorities. After that he lived an unsettled, wandering life in a number of cities in Alsace, Bavaria, Wiirtemburg, Austria, Switzerland, and other lands, until, at the age of 48 years, he died in 1541, in Salzburg, where he was buried. Besides a large number Digitized by Microsoft® HISTORY OF THERAPEUTICS 15 of philosophical and theosophical works he wrote numerous medical books. Of the latter the most important are: “Commentary on the Aphorisms of Hippocrates,” the “Three Great Books on the Treatment of Wounds,” “The Hospital Book,” the “Seven Books on Open Wounds,” “Lectures on Wounds,” “Minor Surgery,” “The Bath of the Priests,” “Booklet on the Pestilence in the City of Stertzingen,” “On the Gout,” “On Syphilis.” Opinion con- cerning the influence of Paracelsus as a reformer of medicine was formerly very much divided. Disregarding his personal short- comings, with which his pupils especially reproached him, and his inclination toward mysticism, there can be no doubt that Para- celsus, by his thorough refutation of the crasia theory and humoral pathology of Hippocrates and Galen, and through his own new, chemiatric system, exerted a very great effect upon the develop- ment of medicine. The Theory of Paracelsus.—The so-called chemiatric, chemical or spagyrical system of Paracelsus was the first to associate the chemical properties of medicines with their action upon the body. He called these properties “virtue and force in medicines.” In opposition to the humors and elementary substances of Galen, he attributed life and disease to organic processes within the body, and spoke of a “vita propria’’ of the organs. Chemistry, in his opinion, was the foundation of all therapeutics. We owe to him the intro- duction into the materia medica of several important chemicals, especially iron and its compounds, the preparations of antimony, sulphur, copper, zinc, and sodium nitrate. He also gave exact indications for the use of the mercurial preparations. His chief remedy was opium in the form of a tincture, called after him Tinc- tura Paracelsi. In place of the formerly exclusively used decoc- tions, he used tinctures, extracts, and essences. He also called attention to numerous chemical combinations that were incom- patible, and was the first to discuss the composition and action of mineral waters. His efforts in the domain of surgery were also con- siderable. He was the first to declare that the surgeon should also be a physician. Pus, he said, was a “natural balsam” which fav- ored cicatrization, and its healing action should not be interfered Digitized by Microsoft® 16 GENERAL THERAPEUTICS FOR VETERINARIANS with by the excessive use of salves or plasters. In his philosophical writings two terms frequently occur which are used in modern natural science: macrocosmus and microcosmus. The first term,- as he used it, indicated nature as a whole, the latter the separate individuals. Vesal.—Andreas Vesal (Vesalius), founder of modern anatomy, was born in Brussels in 1514, but had to flee from Belgium on account of his activity in anatomical work. He studied in Paris under Sylvius, held in Italy the posi- tion of demonstrator of anatomy, and in 1537 was called by the Republic of Venice to be professor of anatomy at Padua, after he had published his cele- brated work “De corporis humani Fabrica libri septem” in 1535. Subse- quently he was private physician to Karl V and Philip II in Madrid. Con- demned to death by the Spanish inquisition as a magician or conjurer, he was pardoned by Philip II to take a penitential journey, and died in 1564 on a pilgrimage to Jerusalem. Vesal opposed the theory of Galen, and demon- strated, among other things, that Galen’s anatomy was founded upon the ape and not upon man. Fallopius.—Gabriel Fallopius, pupil and successor of Vesal, was born in Modena in 1523, and from 1547 on was professor of anatomy and surgery in Ferrara, Pisa, and Padua. He wrote “Observationes Anatomice’’ in 1561 and discovered the Fallopian canals in the temporal bone. Malpighii—Marcellus Malpighi, 1628-1694, discovered the capillary cir- culation and laid the foundations of the microscopical anatomy of animals and plants (Malpighian corpuscles of the kidneys). He was professor of anatomy in Bologna, Pisa, and Messina, and, at the time of his death, private physician to Pope Innocent XII. Morgagni.—Giambattista Morgagni, founder of pathological anatomy, pupil of Valsalva, born in Forli in 1682, was called in 1711 to the University at Padua to the chair formerly held by Vesal. Here he attracted numerous students from all lands, especially Germany. In 1761 he issued, in five books, his famous work: ‘De Sedibus et Causis Morborum.” His name is a part of several anatomical terms (Morgagnian liquor between the lens and its capsule, Morgagnian cavity). He died in 1771, 89 years old. Harvey.—William Harvey, founder of physiology, pupil of Fabricius ab Aquapendente, born in Folkstone in 1578, elected professor of anatomy in London in 1615, discovered the circulation of the blood in 1628. He was the author of the conclusion “‘omne animal ex ovo,” and showed that, contrary to Galen, the blood was not one of four fluids, but the only vital fluid (“humor cardinalis”’). Ambroise Paré.—Ambroise Paré, founder of modern surgery and obstet- Digitized by Microsoft® HISTORY OF THERAPEUTICS 17 rics, lived in Paris from 1517 to 1590, and became known through his use of ligatures on the blood-vessels in operations. Sydenham.—Thomas Sydenham, 1624 to 1689, physician in London, reformed practical clinical medicine, bringing it back to the methods of nature and of experience. Symptoms of diseases were regarded by him as the effort of nature to eliminate the disease materials. The tincture of opium was named after him Tinctura Sydenhami. 4, BOERHAAVE Biographical.—Herman Boerhaave was born inthe Netherlands in 1668, the son of aclergyman. He becameprofessor of medicine, botany, and chemistry in Leyden, where he published his cele- brated works: ‘“Institutiones medice in usum annue exercitionis”’ (1708) and ‘“Aphorismi de cognoscendis et curandis morbus” (1709). In addition to these, he published the ‘‘Elementa chemix” (1718). He died in 1788. His best-known pupil was van Swieten (1700-1722), the private physician of the Empress Maria Theresa and the founder of the Vienna school. The System of Boerhaave.—Boerhaave can be regarded, to a certain extent, as the founder of the modern humoral pathology, since he pointed to the chemical changes in the composition of the blood as the cause and essence of disease. His humoral pathology is therefore a heemato-pathology. The treatment recommended by him was the removal from the blood of the injurious substances or irritants by means of cathartics, diuretics, disinfectants and resol- vents. He assumed the presence of different kinds of harmful irritants in the blood: acid, alkaline, salty, fatty and glutinous. In his opinion organic life consisted of motion. Fever he regarded as the effort of life to overcome death (compare the concurrence of this view with the modern idea that fever is a protective reaction against the infectious material). Worthy of note also is his concep- tion of inflammation, which he regarded as a complete stasis of blood in the smaller vessels. F. Hoffmann.—Founder of the so-called iatromechanical or mechanico- dynamic school; born in Halle 1660; professor in Halle 1694; private physician to King Frederic I and professor in Berlin 1708 to 1712; died in Halle in 1742. His name is preserved in the preparation introduced by him known as “‘Hoff- mann’s drops.” 2 Digitized by Microsoft® 18 GENERAL THERAPEUTICS FOR VETERINARIANS Stahl.—Founder of the chemical phlogiston theory and the spiritual theory (principal work: Theoria medica vera, 1701); expective method of treatment. Born in Ansbach in 1660, professor in Halle 1694; private physi- cian to King Frederic William I in Berlin 1716; died 1784. Stahl’s ointment for burns and Stahl’s pills perpetuate his name. Albrecht von Haller.—Physician, anatomist, physiologist, botanist, and poet. Discoverer of the irritability of the muscle fibres. Born in Bern 1708; professor in Gottingen 1736; president of the Royal Society of the Sciences. Died in Bern 1777. 5. BROWN Biographical.—F. Brown was born in Bumbe,England, in 1735. At first a linen weaver, he later studied theology and medicine and was a physician in London. His principal work, ‘‘Elementa medi- cine,” was written in 1780. He died in London in 1788. His most celebrated follower was the Italian, Rasori (died 1837). Brown’s Theory.—Brown was the founder of the so-called Brownianism, which was in direct opposition to the humoral pa- thology and attributed all disease to a deficiency or excess of stim- uli or excitability. A medium degree of stimulation or excitability constituted health. Disease was due to either an increase of the excitability (sthenia) or a decrease (asthenia). Medicines also were sthenic, i.e., strengthening (alcohol, camphor, arnica), or asthenic, i.e., weakening (bleeding, hunger). The one-sided Brownian theory was later transformed by Réschlaub into the so- called ‘stimulation theory” and by Rasori into the theory of “contra-stimulus” (irritant and counter-irritant). These two modifications of Brownianism are also only of historical interest. Hufeland.—An opponent of Brownianism, he contrasted the vital forces, vis vitalis, with the natural healing forces, vis nature medicatriz, and promoted especially the antipyretic method of treatment (cold-water applications). His chief work was entitled ‘‘Makrobiotik,” published in 1796. Born in Langensalza in 1762, he died in 1836 in Berlin, where he was a professor and private physician to King Frederic William III. Schénlein.—Founder of the expective method of treatment. He regarded disease as an independent process which must be allowed to run its course. He taught medicine from the stand-point of the natural sciences and intro- duced methods of clinical examination. The foundations were laid by him of the so-called natural-history school and the later physiocratic or natural Digitized by Microsoft® HISTORY OF THERAPEUTICS 19 healing method (in contrast to the technocratic or artificial healing method). He was born in Bamberg in 1793, was a professor and clinician in Wurzburg, Zirich, and Berlin from 1839 to 1859, and died in 1864, 6. RADEMACHER System of Treatment.—Rademacher (born in 1772 in Hamm, physician in Goch, on the lower Rhine, died 1849) is the founder of the system of treatment based on experience, or the empirical method. In his work, “Rechtfertigung der Erfahrungsheillehre der alten scheidekiinstigen Geheimirzte, ” he assumes, entirely upon empirical grounds, the existence of specific relationsbetween certain medicines and certain individual organs. Diseases he divided into two classes: “organic diseases” and “universal diseases,” and he also recognized two corresponding divisions of medicines: ‘organic remedies” with local action and ‘universal remedies” with multi- ple action. He tested the effect of the individual organ remedies and universal remedies upon the different diseases and named the disease after the remedy found to be effective. The local diseases, for example, were named: digitalis disease of the heart, chelido- nium disease of the liver, and antimony disease of the lungs, while the universal diseases were called: copper disease, iron disease, saltpeter disease. In this way he caused the diagnosis to be based upon the therapeutics. While the fundamental thoughts of the Rademacher system concerning the importance of experience and the specific local action of drugs may be acceptable, his nomen- clature and many of his conclusions certainly are not. Hisinflu- ence upon therapeutics was therefore only temporary. Natural Healing Method.—The author of the natural healing method— i.e., the drugless treatment of disease with water, diet, heat, exercise, rest, air, and dressing—was Priessnitz (1799-1851). With reference to his method, see chapter on hydrotherapy. In addition, the following are also to be mentioned as followers of the natural healing method: Schroth (dry diet, dry-bread cure), G. Jager (wool), Lahmann (cotton wool), and others. 7. THE HOM@OPATHY OF HAHNEMANN Biographical—Samuel Hahnemann, the founder of home- opathy, was born in Meissen in 1755. He practised medicine in Digitized by Microsoft® 20 GENERAL THERAPEUTICS FOR VETERINARIANS Kéthen from 1820 to 1835, when he moved to Paris, where he died in 1843. Hahemann came into prominence with his new doctrine in 1796. His chief works were: “ Organon der rationellen Heilkunde” (1810) and ‘Reine Arzneimittel- lehre’’ (1811). Hahnemann’s Theory.—Disease, according to Hahnemann, consists of the symptoms only. The treatment of disease, there- fore, consists of combating and removing the symptoms (symp- tomatic method). Certain drugs produce in the healthy organism symptoms like those caused by disease. Digitalis, for example, produces symptoms exactly similar to those of heart disease. In the treatment of any disease, therefore, a drug should be used that will produce in a healthy organism symptoms similar to those observed in the particular disease; in heart disease, for instance, digitalis. Hence the motto of homceopathy: Similia similibus curantur. Hahnemann further maintained that every drug acted the more powerfully the more it was diluted. For this reason a drug should always be administered in extreme dilution, 7.¢., in the smallest dose possible. | Moreover, only one drug should be used at a time. Allopathy, according to Hahnemann, acts contrary to the purpose. There are three forms of homeopathic preparations: Triturates, dilutions, and pellets. Colophony and turpentine, 6 parts of each, melted together; add, after partial cooling, powdered cantharides 3 parts, powdered euphorbium 1 part. 6 Cantharides 3 parts, digested ten hours with 10 parts of peanut oil; express and filter.] Digitized by Microsoft® 152 GENERAL THERAPEUTICS FOR VETERINARIANS 11. *Euphorbium. A very irritant epispastic; used in old, chronic surgical affections of the joints, tendons and bones; used on cold-blooded horses and cattle either alone 1 : 10-15 of lard, or as an addition to cantharides ointment (1 : 10-20). 12. Oleum tiglii. Croton oil. Also a very powerful irritant; used in obstinate chronic rheumatism, arthritis, tendinitis, paresis, etc.; also as a derivant in inflammations of internal organs; must be used cautiously. The concentration for horses is 1 : 30; cattle, 1 : 5-10; swine, 1 : 2-5; dogs, 1 : 50-100. It is diluted with olive oil, turpentine oil or cantharides ointment. 3. CAUSTICS Synonyms: Corrosives, cauterics, escharotics, catheretics. Actions.— While the cutaneous irritants produce only the alter-—- ations of inflammation, without injuring the vitality of the tissues, the caustics cause the death of those living tissues with which they come in contact. The caustic action of the individual drugs is brought about in very different ways and on this basis the following groups of caustics are classified (concerning firing, the actual cautery, see p. 156). 1. Caustic acids: Nitric, hydrochloric, sulphuric, acetic, chlor- acetic, lactic and salicylic acids and formaldehyde. Of these, the mineral acids and lactic acid operate by coagulating the albumin; they unite with the albumin, forming insoluble acid albuminates, thereby bringing about the precipitation and death of the dis- solved living albumins. Nitric acid, especially, forms with the organic albumin a yellow acid albuminate (xanthoproteic acid, nitrogen compound). The organic acids, particularly acetic acid, also unite with the tissue albumin to form acid albuminates, but these compounds are soluble and are only precipitated when the solution is neutralized. The caustic action of sulphuric acid is due to its strong affinity for water, which it withdraws from the tissues, the latter being carbonized. Salicylic acid and formalde- hyde are peculiar in their action, producing a keratolytic effect, or cornification. Digitized by Microsoft® SKIN AND MUCOUS MEMBRANES 153 2. Caustic alkalies: Caustic potash, caustic soda, caustic lime, Vienna paste. These dissolve the organic albumin by taking up water and forming soluble alkaline albuminates. Their eschar or slough is mostly moist, deep and diffuse, extending into the surrounding tissue, a contrast to the dry, circumscribed, superficial eschar of the mineral acids. 3. Metallic caustics: Zinc chloride, corrosive sublimate, potas- sium chromate, chromic acid, iron chloride, iron sulphate, copper sulphate, zinc sulphate, silver nitrate, antimony trichloride, arsenic, lead acetate and nitrate, biniodide of mercury, oxide of mercury, copper acetate, potassium permanganate. These metal- lic compounds act by forming an insoluble metallic albuminate, at the same time setting free the acid components (sulphuric acid, nitric acid, chlorine, iodine). Some of them, in addition, act also by oxidation; these include the oxygen-containing caustics, chromic acid and permanganate of potash, which give off oxygen, and also arsenic, which first takes up oxygen and then gives it off. -The halogens, chlorine, bromine, iodine, absorb the hydrogen of the tissues, in consequence of which oxygen in the nascent state (in addition to hydrochloric acid) is set free. The degree of the caustic action differs with the chemical nature of the individual drugs and also with the concentrations employed. A distinction is made between a superficial scab forma- tion and a deeper cauterization. The inorganic acids, silver nitrate, copper sulphate, zinc sulphate, iron sulphate and lead nitrate act superficially, while formaldehyde, the caustic alkalies, sulphuric acid and chromic acid have a deep action. The caustic effect upon the skin is much weaker than upon the mucous mem- branes because of the protective layer of horny epidermal cells. The dry caustics, especially the metallic salts, act upon the skin generally only when they come in contact with fluids. The color of the eschar differs very much. Nitric acid produces a yellow eschar; hydrochloric acid, a gray; sulphuric acid, brown or dark gray; chromic acid and formaldehyde, yellow, becoming brown and finally black; acetic acid, white; silver nitrate, at first white, then gray and finally black. Digitized by Microsoft® 154 GENERAL THERAPEUTICS FOR VETERINARIANS Uses.—The caustics are used to remove neoplasms when they cannot be removed by operation. In general, their use has diminished very much with the progress of surgical technic, but in veterinary medicine there are still several forms of neoplasms for which caustics are preferred to operation on practical or economical grounds. In canker of the frog especially cauterization with for- maldehyde is frequently employed instead of operating because of its greater simplicity and convenience. In addition, caustics are sometimes used in the treatment of fistule and ulcers, and also to regulate the healing of wounds, especially to remove exuberant granulations (silver nitrate). The expediency of the earlier method of treating herniz with caustics may be left in abeyance. On the other hand, caustics are indicated in infected and poisoned wounds, particularly potassium permanganate, iron chloride and chromic acid in snake bites. Form.—The caustics are used in different forms, partly alone and partly in combination with other substances (caustic pastes, pencils, points, bougies, sounds, cords, ligatures, crystals and powders). Drugs.—1. Liquor formaldehydi. Formaldehyde. The strong- est caustic; very penetrating caustic action (be cautious); best caustic in canker of the frog. 2. *Fuming nitric acid. A frequently employed and valuable liquid caustic in veterinary medicine; used in the treatment of canker of the frog and to remove warts and small neoplasms. 3. Acidum sulphuricum. A very strong caustic; used in the treatment of shoe boils, canker of the frog and other neoplasms; use cautiously. 4, Acidum trichloraceticum. Trichloracetic acid. A good but rather expensive caustic for canker of the frog, warts and granulations. 5. *Vienna paste. A mixture of equal parts of caustic lime {[calx] and caustic potash [potassii hydroxidum] with sufficient alcohol to make a paste; very powerful caustic for canker of the frog and carcinoma. 6. Zinci chloridum. A strong caustic; used in ulcers, fistule, Digitized by Microsoft® SKIN AND MUCOUS MEMBRANES 155 relaxed granulations, canker of the frog and carcinoma in the form of caustic paste or pencils. 7. Hydrargyri chloridum corrosivum. Corrosive sublimate. The strongest metallic caustic; used in the form of crystals, powder, paste (L : 1-5 flour), salve (1 : 1-10), solution (1 : 3-10 alcohol or collodion), bougies or caustic ligature. Hydrargyri iodidum ru- brum has the same action. 8. Chromii trioxidum. [Formerly official in U.S. as chromic acid.] A powerful, painful caustic for canker of the frog, car- cinoma and other neoplasms in solution, salve, paste (1 : 1-5) and bougies; superior alterative action in scratches of long standing (10 per cent. solution in water). A specific in snake bites. 9. Arseni trioxidum. Arsenic. An old caustic in breast boils, shoe boils, canker of the frog, carcinoma, quittor, etc., in the form of sticks, paste, salve and solution. 10. Argenti nitras. Silver nitrate. A mild, superficial caustic (escharotic) for granulations, fistule and ulcers, chronic conjunc- tivitis and very small warts; used in pencil form. 11. Cupri sulphas. Copper sulphate. A caustic in ophthal- mology; used for granular and pannus growths on the conjunctiva, also employed in fistule and ulcers. *Cuprum aluminatum has the same action and uses (copper pencil). 12. Ferri sulphas. Iron sulphate. A mild caustic for ulcers and fistule, canker of the frog, the foot lesions in foot-and-mouth disease and chronic affections of mucous membranes. Used in powder or in concentrated solution. 13. Plumbi acetas. Lead acetate. A mild caustic for canker of the frog. Plumbi nitras has a similar action. 14. Ferri chloridum. Iron chloride. A caustic for canker of the frog and relaxed granulations. A specific against the virus of rabies and snake bites. 15. Hydrargyri oxidum flavum. Yellow oxide of mercury. A mild caustic for wounds and ulcers (1 : 10); also used as a caustic in ophthalmology (1 : 15-25). 16. Potassii permanganas. Potassium permanganate. A spe- cific caustic for snake bites. Digitized by Microsoft® 156 GENERAL THERAPEUTICS FOR VETERINARIANS 4, FIRING. CAUTERIZATION General.—Firing is one of the oldest methods of treatment and specifically a veterinary remedy, which cannot be dispensed with even to-day, despite the large number of similarly acting chemical substances (caustics). It is, on the contrary, among the most valu- able of surgical aids. Asa rule, wrought cautery irons of various forms (knife, hatchet, button, conical form, etc.) are used in firing, in addition to which Paquelin’s platinum cautery apparatus is used in clinics and on small animals. There are several varieties of firing: superficial (point and line firing), percutaneous, perforat- ing (spavin firing) and subcutaneous. (See the text-books on operative surgery.) Actions.—The effects of firing are very numerous: 1. The immediate result is a local destruction of tissue. The heat first coagulates the albumin, then follows the formation of an eschar and carbonization. Associated with this action is the dis- infecting and hemostatic effect of the hot iron. 2. A hyperemia and inflammatory reaction develops in the region immediately surrounding the cauterized area. The circu- lation of blood and resorption are stimulated in consequence. An extensive outwandering of white blood-cells, local hyperleucocy~ tosis, phagocytosis and histolysis occurs, similar to that which follows the rubbing in of tincture of iodine (see p. 148). 3. The pronounced irritation of the cutaneous nerves acts reflexly upon the nervous system. Firing consequently operates like a powerful cutaneous irritant (principle of cutaneous irritation and counter irritation). 4. The eschar which results from firing exerts, according to the usual acceptation, a mechanical pressure upon the underlying tissues and promotes, like mausage, the resorption of the patho- logical products (?). Uses.—1. The most important indications for the employment of the firing iron are the chronic inflammatory conditions of the bones, joints, tendons and tendon sheaths: spavin, ring bone, ex- ternal spavin (rehbein), curb, splints, chronic arthritis, tendinitis, tendovaginitis and articular galls. While the firing iron should Digitized by Microsoft® SKIN AND MUCOUS MEMBRANES 157 be used only on the chronic inflammatory affections of the tendons and tendon sheaths after treatment with hydropathic dressings, massage and blisters has proven ineffective, it may be employed primarily in the aforementioned bone and deforming articular inflammations, especially spavin, ring bone and splints. The effect of firing on all these conditions consists essentially in the conversion of a chronic inflammation into a more rapidly pro- gressing acute process. The reactive inflammation set up in the affected bone, tendon or articulation brings about a more rapid resorption of the inflammatory products, promotes the inflam- matory reproductive processes, and in joints hastens ankylosis, in consequence of which the pain and lameness are removed (spavin, ring bone). 2. The firing iron is used for operative purposes on fistule, neo- plasms and ulcers; as a hemostatic, particularly in amputation of the tail, and for the disinfection of infected wounds (rabies, an- thrax, glanders, snake bites). 3. It is also employed as an excitant, although more rarely, in the treatment of paralytic conditions of the spinal cord and periph- eral nerve branches (parturient apoplexy, spinal and peripheral paralyses), 5, ASTRINGENTS Synonyms: Exsiccants, coagulants, tonics; contracting, drying, tanning, albumin-coagulating, condensing, toning remedies, Actions and Uses.—The term astringents is used to describe drugs which exert a contracting, drying, condensing action upon the skin and mucous membranes. They are most frequently em- ployed in catarrhs of the mucous membranes, with excessive catarrhal secretion or extensive swelling of the mucous membrane, é.g., in catarrhs of the intestinal, buccal, pharyngeal, bronchial, conjunctival, bladder, uterine, vaginal and preputial mucous mem- branes, and in prolapses of the vagina, uterus and rectum. They are also used in inflammatory, eczematous and ulcerous processes of the skin; in otorrhcea; as injections in fistule and serous sacs; Digitized by Microsoft® 158 GENERAL THERAPEUTICS FOR VETERINARIANS to check parenchymatous bleeding, and, empirically, in galactor- rhea, polyuria and nephritis. In their method of action they are very different. Some cause a contraction and narrowing of the capillaries with consecutive anemia (metallic salts), thus overcoming inflammatory hyperemia of the skin and mucous membranes and decreasing the secretions. Others combine with the albumin, mucus, and gelatin-containing substance of the secretions of the skin and mucous membranes and form a solid precipitate and produce, like the caustics, a super- ficial condensation and desiccation of the tissues, forming a kind of scab or protective covering (tannin). A third group operates by withdrawing water and shrinking (alcohol), and a fourth group purely mechanically through compression (collodion). Most of the astringents possess a disinfectant action and, in the stronger concentrations, are caustics. (See the chapter on caustics.) Drugs.—1. The metallic astringents: alum, aluminum acetate, ferric chloride solution, iron sulphate, lead acetate and nitrate, silver nitrate, corrosive sublimate, zine chloride and sulphate, copper sulphate, zinc oxide, bismuth nitrate, subnitrate, subsali- cylate and subgallate, aluminum hydroxide, calcium carbonate and lime water. 2. Tannic acid, tannoform and the tannin-containing vegetable astringents: white oak bark, cinchona, rhubarb, nutgall, catechu [replaced by gambir in U. 8. P.], rhatany root, tormentilla root, salvia, uva ursi, folia juglandis, coffee and roasted acorns. 38. Alcohol and all alcoholic liquids (tinctura aloes, tinctura myrrhe, tinctura iodi). 4. Iodine, especially in combination with alcohol (iodine tinc- ture) and glycerin. 5. Tar, creolin, creosote and other related substances. 6. Ethereal oils, balsams and resins (turpentine oil, turpentine, Peru balsam). 7. Glycerin and sodium chloride (withdrawal of water). 8. Collodion (mechanical compression) and other pressure agents. Digitized by Microsoft® SKIN AND MUCOUS MEMBRANES 159 9. Ergot, hydrastis, cocaine and adrenalin. (The latter con- tracts the vessels of the conjunctiva and iris.) 10. Cold in the form of ice or cold applications. Antiphlogistics.—A series of medicaments which it was formerly custom- ary to use in inflammatory conditions of all kinds were classified in the old therapeutics under the name of antiphlogistics, or remedies which combat inflammation (refrigerants, temperants). In this group were included the astringents, bleeding and other methods of local bloodletting, hydrotherapy (Priessnitz), cold, mercury and potassium nitrate. Inflammations due to infection are now treated with antiseptics (carbolic acid, iodoform, camphor, alcohol, salicylic acid, calomel). Astringents with antiseptic action are also employed (silver nitrate, copper sulphate, lead acetate, alum, tannin, cold). Moreover, inflammation is not a disease but, like fever, is to be regarded as a reactive natural healing process which in itself does not need to be combated. Drugs which have an action opposed to the antiphlogistics were formerly classified as calefacients, 7.¢., heating agents. They are indicated in abnormal sinking of the body temperature (freezing, loss of blood, last stages of poison- ing and infectious diseases). In addition to the external and internal employ- ment of heat (warm bandages, warm drinks), the calefacients also include caffeine, which rapidly increases the temperature from 0.5 to 1°C. Small doses of alcohol exert a similar effect. Anticatarrhalics.—All of the drugs used in the treatment of catarrhs were formerly classified as anticatarrhalics. The group included particularly the astringents, expectorants, antiseptics and resorbents (alkalies). Antidyscratics.—The terms antidyscratics, alterants and metasyncritics wereused in the older therapeutics to designate a series of so-called blood-purify- ing medicines which were employed empirically in the treatment of different dyscrasias and cachexias. The group was further subdivided into antiscrofu- lous, anticarcinomatous, antisyphilitic, antiscorbutic, antarthritic, anti- rheumatic. Arsenic, mercury, iodine, phosphorus, sulphur, antimony, the alkalies and the so-called ‘‘wood-drinks” for man (sarsaparilla, sassafras) were regarded as alterative drugs. The action which is really obtained from these drugs is partly specifically antiseptic (mercury, iodine), partly resorbent (arsenic) and partly diuretic or diaphoretic (alkalies, hot water). Digitized by Microsoft® DRUGS THAT KILL PARASITES. ANTIPARASITICS 1. EXTERNAL ANTIPARASITICS. ANTEPIZOA Synonyms: Antiscabious, antipsorics, antipediculous, antiphthiriacs; mange remedies. Parasites of the Skin.—The numerous epizoa infesting the skin of the domesticated animals which are to be combated with antiparasitic remedies may be divided into two groups: animal and vegetable. The animal parasites include the mange mites, of which there are four species: sarcoptes, dermatocoptes, dermato- phagus and dermatoryctes; the acarus mites [demodex follicu- lorum], fleas, lice, hair and feather insects [mallophage], ticks, forest flies, bird mites, harvest mites, cestrus larve, gad flies, flies and gnats; also the different bird mites: feather-follicle mites, feather-quill mites, feather mites, pigeon mites, etc. Of the vegetable skin parasites, the most important are trichophyton tonsurans (herpes) and achorion Schonleinii (favus). Action of the Antiparasitics—The antiparasitic medicines operate upon the skin parasites by different processes. Some apparently act like the specific nerve poisons, stunning and para- lyzing the parasites. To this group belong the ethereal oils, nico- tine, veratrin, carbolic acid, creolin and other aromatic substances of the benzol series, and hydrogen sulphide. Other antiparasitics act like the caustics, particularly the mercurial and arsenical preparations. If, for example, a louse is removed from the skin after the application of mercurial ointment and examined under the microscope, there is observed a corrosive inflammation of the digestive tract which is manifested by a bloody, profuse diarrhoea. The alkalies, soda lye, potash lye, caustic lime and soap, dissolve the external chitinous layer of the mange mites. Finally, some agents operate in a mechanical way by closing the air canals, as occurs, for instance, in the use of fatty oils on ticks. Classification—The external antiparasitics may be divided 160 Digitized by Microsoft® ANTIPARASITICS. 161 either according to their action into mange remedies, remedies against fleas, lice, ticks, gad flies, etc., or according to their chemical composition. The chemical subdivisions include antiparasitics from the group of ethereal oils: Peru balsam, styrax, turpentine oil, oil of anise, oil of caraway, flores pyrethri, petroselinum; alka- loidal antiparasitics: nicotine, veratrin, cevadilla seed, staphy- sagria; benzol derivatives: creolin, lysol, bacillol, carbolic acid, tar, creosote, salicylic acid, naphthalin, naphthol; metallic remedies: mercurial preparations, arsenic, sulphur; alkalies: soap, soda, potassium, caustic potash, caustic soda, caustic lime. The first mentioned form of classification is most suitable for practical therapeutics; according to this method the antiparasitics are divided into the following groups: Mange Remedies.—The most important are creolin, tobacco, arsenic, corrosive sublimate, Peru balsam, carbolic acid, tar, creo- sote, lysol, bacillol, sulphur, soap, soda, potassium, lime. The fol- lowing baths or “dips” are used in the treatment of sheep scab: | 1. Fréhner’s bath. Apply creolin liniment (creolin 1, alcohol 1, green soap 8) three to five days, then bathe twice in 214 per cent. creolin solution. 2. Gerlach’s bath. (a) Preparatory bath: potash 2, lime 1, water 50. (b) The mange bath proper: 3 per cent. tobacco decoction (Roloff’s modification: 5 per cent. tobacco decoction). 3. Ziindel’s bath: crude carbolic acid 1.5, lime 1, soda 3, soft soap 3, water 260. A modification of this bath is to use 2 per cent. tobacco decoction in place of the water. 4, Tessier and Matthiew’s bath: arsenic 1 to 1.5, iron sulphate or alum 10 to 15, water 100. [Lime and sulphur dip: Mix 8 pounds of unslaked lime and 24 pounds of flowers of sulphur, add 30 gallons of water and boil for not less than two hours. Allow sediment to settle, draw off the clear liquid and dilute up to 100 gallons. Use at a temperature of 100 to 110° F. and keep each sheep in the dip two minutes, ducking its head at least once; repeat in 10 days. Tobacco and sulphur dip: Take one pound of tobacco leaves for each 6 gallons of dip desired, place in a covered boiler, cover Digitized by Microsoft® 162 GENERAL THERAPEUTICS FOR VETERINARIANS with cold or lukewarm water and let stand 24 hours; bring to a boil the evening before using, and let stand over night. Take 1 pound of flowers of sulphur for each 6 gallons of dip desired and mix in a bucket with water to the consistency of gruel. When ready to use, strain the tobacco infusion, expressing the liquid from the tobacco leaves; mix the infusion with the sulphur gruel, and add sufficient water to make the desired quantity of dip. Use ata temperature of 100 to 110° F. and keep each sheep in the dip two minutes, ducking its head at least once; repeat in 10 days. Extracts of tobacco and nicotine solutions are on the market which may be used in place of the tobacco leaves, thus simplifying the preparation of the dip. These substances should be used in a quantity which will produce a mixture containing not less than five one-hundredths of one per cent. of nicotine and 2 per cent. of flowers of sulphur.] Remedies against Acarus Mites [Demodex].—Peru balsam, creolin, corrosive sublimate, sulphurated potash, cantharides oint- ment, oil of caraway, formaldehyde, bisulphide of carbon. Remedies against Lice——Mercurial ointment, creolin, lysol, bacillol, arsenic, tobacco, corrosive sublimate, insect powder, stavesacre seeds, cevadilla seeds, white hellebore, aniseed. These are also employed against the hair parasites [mallophage]. Remedies against Fleas.—Persian insect powder. Remedies against Feather Parasites——Oil of anise, insect powder, petroselinum, Peru balsam, creolin. The same remedies are used against the other skin parasites of birds. Remedies against Ticks.—Olive oil, turpentine oil, carbolic acid in oil, creolin in oil. [Arsenic has been found very effective for destroying ticks on cattle. The solution is prepared as follows: 25 gallons of water are placed in a caldron and brought to a boil; 24 pounds of sodium car- bonate are added and dissolved by stirring; 8 pounds of arsenic are then added and the mixture stirred until it is dissolved. The fire is then drawn and when the solution has cooled down to 140° F., one gallon of pine tar is slowly added and thoroughly mixed with the solution by stirring. Sufficient water is at once added to make Digitized by Microsoft® ANTIPARASITICS 163 the total volume of the solution 500 gallons. The regulations of the Bureau of Animal Industry require that when the solution is to be used as a dip for cattle which are to be shipped out of the quarantined area 25 pounds of sodium carbonate and 10 pounds of arsenic shall be used for each 500 gallons. In tick eradication, the solution is applied as a spray or in the form of a dip or bath, repeated every two or three weeks.] Remedies against Forest Flies—Creolin, tobacco, mercurial ointment. Remedies against Cstrus Flies.—Tar, creolin, asafcetida, petroleum. Remedies against Herpes and Favus.—Salicylic acid, creolin, creosote, tincture of iodine, tar, mercurial ointment, ammoniated mercurial ointment, corrosive sublimate, carbolic acid. Drugs.—1. *Creolin. Creolin (creolinum anglicum) is the most used antiparasitic. In the treatment of sheep scab it is applied for several days in the form of a 10 per cent. liniment: creolin and sapo mollis, 1 part of each, alcohol 8 parts. This is followed by a bath or dip in a 2% per cent. solution of creolin, which is repeated in 8days. Against sarcoptic mange of the horse and dog, a 10 per cent. liniment of creolin, soap and alcohol is also employed. A 10 to 15 per cent. alcoholic solution is used against acarus [demodectic] mange. Washings with 3 per cent. solution in water are em- ployed against lice, forest flies, etc. Creolin ointment is used against herpes, chicken mange and ticks. Birds infested with vermin may be sprayed with a 1 per cent. solution of creolin in water or given a bath in a warm 14 per cent. creolin solution, fol- lowed by a bath in water. *Lysol! and *bacillol! have a similar action. 2. Pixliquida. Tar. A very good remedy against horse mange in the form of Vienna tar liniment: pix liquida and sulphur sub- limatum, 1 part of each; sapo mollis and alcohol, 2 parts of each; also used against mange of dogs, herpes, etc., in ointment or in aleohol (1 : 10). [Liquor cresolis compositus, which is official in the U. §., is essentially the same as these compounds.] Digitized by Microsoft® 164 GENERAL THERAPEUTICS FOR VETERINARIANS 3. Creosotum. Creosote. A good but very poisonous remedy against mange of the dog and horse in the form of creosoted oil (1 : 10). 4, Phenol. Carbolic acid. A remedy against sheep scab, usually in combination with tobacco. 5. *Tabacum. Tobacco. A remedy against sheep scab and mange in horses. The tobacco dip or bath for scab or mange is a decoction of 714 kilograms [20 pounds] of tobacco in 250 liters [250 quarts] of water, to which is added 1 kilogram [2.68 pounds] each of pure carbolic acid and potash. A 1 to 5 per cent. decoction of tobacco or of tobacco-lye is also used against lice, fleas, etc. 6. Arseni trioxidum. Arsenic. The strongest but also the most poisonous remedy against scab in sheep and mange in horses. The arsenical dip or bath for sheep is ordinarily a 1 per cent. solu- tion (combined with potash, alum, iron sulphate or aloes). Asa wash for mange in the horse a 1 per cent. solution of arsenious acetate is used. 7. Hydrargyri chloridum corrosivum. Corrosive sublimate. A very powerful but also extremely poisonous antiparasitic against mange mites, acarus, herpes, lice, etc. 8. Unguentum hydrargyri. Mercurial ointment. A good remedy against lice. Formerly used also against sheep scab. 9. Balsamum Peruvianum. Peru balsam. A good and mild but expensive mange remedy for dogs; used undiluted or in alcohol (1:1to10). A specific against acarus [demodectic] mange. The modern substitutes for Peru balsam: *perugen (artificial Peru balsam), *peruskabin and *peruol (synthetic benzyl benzoate) have a similar action. 10. Sulphur lotum, sulphur precipitatum, sulphur sublima- tum. Sulphur. A specific against mange of cats in the form of Helmerich’s ointment (2 parts sulphur, 1 part potash, 10 parts lard). 11. *Potassa sulphurata. Liver of sulphur. A specific against acarus mange in the form of 1 to 2 per cent. baths. 12. *Insect powder. The most used remedy against fleas, feather insects, and fowl mites. Digitized by Microsoft® ANTIPARASITICS 165 18. Oleum anisi. Principal remedy against vermin of house birds; sprinkled or sprayed in 1 per cent. solution. Oleum cari has the same action. 14. Oleum terebinthinz. Oilofturpentine. A specific against ticks. 15. Acidum salicylicum. Salicylic acid. A specific against herpes in 5-10 per cent. solution in alcohol. 16. Alkalies. These are used to assist the action of mange baths or dips. 2. WORM REMEDIES. ANTHELMINTICS Synonyms: Vermifuges, antentozoa, antiteenics; worm-expelling, worm- destroying remedies; tapeworm remedies. Intestinal Worms.—Not all entozoa can be expelled from the body by medicines. Distome and echinococci in the liver and lungs, cysticerci and trichine in the muscles, giant palisade worms (Eustrongylus gigas) in the pelvis of the kidneys, strongylus arma- tus in aneurisms in the anterior mesenteric artery, ccenuri in the brain, and some intestinal worms are not accessible to medi- caments. But most of the intestinal worms can be effectively removed by medicines. The parasites of the digestive apparatus of greatest importance are: 1. Tapeworms: tenia cucumerina, serrata, marginata, coen- urus and echinococcus, and bothriocephalus latus in dogs; tenia perfoliata, plicata and mamillana in horses; tenia expansa and ovilla in sheep; tenia expansa, denticulata and alba in cattle; tenia expansa in goats; tenia crassicollis and elliptica in cats; tenia infundibuliformis, etc., in birds. 2. Round worms: ascaris megalocephala in horses, ascaris marginata in dogs, ascaris mystax in cats, ascaris lumbricoides in cattle and swine, heteracis inflexa, etc., in birds. 3. Palisade worms: strongylus armatus and tetracanthus in the intestinal canal of the horse; strongylus contortus in the abo- masum of sheep? (stomach-worm disease); dochmius trigonoceph- alus in the intestine of the dog. [2 Also affects calves in the southern part of the United States.] Digitized by Microsoft® 166 GENERAL THERAPEUTICS FOR VETERINARIANS 4, Seat-worms: oxyuris curvula, vivapara and mastigodes in horses; oxyuris vermicularis in the dog. 5. Spiroptera sanguinalenta in the stomach of the dog. Another entozoén of the digestive apparatus is the gastrus larva, which is found in the stomach of the horse and which is resistant to most of the worm medicines. The entoparasites of the respiratory apparatus which are at least partially accessible to treatment include: cestrus ovis in the nasal cavities and nasal sinuses of sheep; strongylus filaria in sheep (lung-worm disease), strongylus micrurus in calves, strongylus paradoxus in swine; pen- tastomum teenioides in the nasal cavities of the dog; syngamus trachealis in fowl. In addition to these, vegetable parasites (moulds, actinomyces) also occur in the air passages. Action of Worm Remedies.—The anthelmintics are generally regarded as specific nerve poisons which kill the entozoa imme- diately or which temporarily stupefy and paralyze them, in conse- quence of which they become detached from the intestinal mucous membrane and are in part expelled and in part digested. Accord- ing to their chemical properties, anthelmintics may be classified as ethereal oils (turpentine oil, oleoresin of aspidium, oleum tanaceti) ; alkaloids (areca nut, pomegranate bark); glucositic acids (santonin, mallotoxin, kosin, filicic acid) ; benzol derivatives (creolin, tar, creo- sote, picric acid, naphthalin, benzine) and metals (arsenic, tartar emetic, copper oxide). For therapeutic purposes, it is most desir- able to classify the anthelmintics according to the species of worms against which they are used, as follows: Tapeworm Remedies: kamala, aspidium, oleoresin of aspid- ium, areca nut, kousso, pomegranate bark, copper oxide, potas- sium picrate. Round-worm Remedies: tartar emetic, arsenic, santonin, santonica, turpentine oil. Remedies against Lung Worms: turpentine oil, creolin, tar. Remedies against Oxyuri: garlic, vinegar, soap, [quassia]. Remedies against Gastrus Larve [Bots]: bisulphide of carbon. Against strongylus armatus and tetracanthus, also dochmius, spiroptera, and other intestinal worms in the horse, one of the Digitized by Microsoft® ANTIPARASITICS 167 aforementioned round-worm remedies is used; in dogs, one of the tapeworm remedies. Drugs.—1. *Kamala. A tapeworm remedy for dogs. It is also a drastic cathartic and the simultaneous administration of a purgative is therefore not necessary. Dose for large dogs, 5-15, 3i to iv; small dogs, 2-5, grs. xxx to 51; cats and chickens, 1—2, grs. xv to xxx; pigeons and parrots, 0.5-1, grs. vij to xv. 2. Oleoresina aspidii. Oleoresin of aspidium. A very effective but very poisonous teniacide. Dose for large dogs, 2-5, grs. xxx to 3i; small dogs, 0.2-1, grs. iij to xv. 3. *Areca. Areca nut. Betel nut. A very good remedy against tapeworms and round worms. Dose for horses, 100-200, 5 iij to vj; dogs, 5-10, 31 to ijss; sheep, 5-19, 3 to ijss; swine, 5-15, 3i to iv; chickens and geese, 2-4, grs. xxx to 3; pigeons, 0.5-1, grs. vij to xv. 4. Antimonii et potassii tartras. Tartar emetic. A valuable anthelmintic against tapeworms and round worms of horses. Dose, 10-15, JZijss to iv, per day in the drinking water for 2 to 4 days. 5. Oleum terebinthinez. Oil of turpentine. A very good remedy against round worms in horses (50, 3iss). 6. Arseni trioxidum. Arsenic. The same. Dose for horses, 1-3, grs. xv to xlv.3 The new arsenical preparations, *Atoxyl and *Salvarsan, have proven effective remedies against trypanosomes and spirilla. 7. Santoninum. Santonin. A specific against round worms of horses and dogs. Dose for dogs, 0.05-0.2, grs. 34 to iij. 8. Carbonei bisulphidum. Bisulphide of carbon. A remedy against gastrus larve and round worms in horses. Dose, 8-12, 31j to iij, in capsules, every hour until 4 doses have been given. 9. Thymol. The best remedy against hook worms. Dose for dogs, 0.1-1, grs. ito xv; calves, 1-3, grs. xv toxlv. Admin- ister in milk or mucilaginous fluid; follow with a saline cathartic; do not use oil. [? Gerlach reported that 20 grains of arsenic caused acute diarrhoea in a horse.—Finlay Dun, Veterinary Medicines, 10th ed., p. 274.] Digitized by Microsoft® 168 GENERAL THERAPEUTICS FOR VETERINARIANS 10 *Coal tar creosote and gasoline are the most useful remedies against stomach worms in sheep and calves. Coal tar creosote is given in 1 per cent. solution in water in the following doses: lambs, 60-120, 3ij to iv; sheep 90-150, Siij to v; calves, 150- 300, 3v tox. Dose of gasoline for lambs, 8, 3ij; sheep and calves, 15, 3ss;administered in milk. Aromatic spirit of ammonia or a solution of strychnine in a hypodermic syringe should be at hand for the treatment of animals which may be overcome by the gasoline. These eleven remedies are sufficient for veterinary practice. The patient should be prepared for the anthelmintic by being starved a day before the medicine is administered. A few hours after the anthelmintic is given a purgative should be administered, except in the case of kamala and tartar emetic. To assist the action of the worm remedy, salted meat is given to carnivora, and sugar beets, carrots and raw potatoes to herbivora. Other anthelmintics are: Cusso (dogs, 10-25, Jijss to vj), granatum (dogs, 5-50, 3i to xij), pelletierinee tannas (dogs, 0.2-0.4, grs. iij to vj), *tanacetum (horses and cattle, 50-100, 3iss to iij), *cupri oxidum (horses, 2-15. grs. xxx to Jiijss; dogs, 0.05-0.1, grs. 34 to jss; sheep, 0.5-1, grs. vij to xv), *acidum picricum and *potassii picras (lambs, of the former, 0.1—0.2, grs. jss to iij; of the latter, 0.5-1, grs. vij to xv) ,hloroformum (dogs, 1-4, mxv to3i), *creolin, naphthalenum, pix liquida, creosotum, benzinum, *petro- leum, *absinthium, asafcetida, *allium and pepo. Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS Synonyms: Aseptics, colyseptics, antizymotics, antifermentatives, anti- putrids, conservants, preservants; putrefaction and fermentation-combating remedies; conserving remedies, preserving remedies, 1. DISINFECTION IN GENERAL Historical.—The practical application of disinfection, 7.e., the destruction of pathogenic or putrefactive bacteria or the preven- tion of their growth, is very old. In this connection, it is only necessary to mention the unrivalled technique used by the ancient Egyptians in embalming the body. The scientific foundation of disinfection, however, is of more recent date. The new era began with the investigations of Pasteur concerning the yeasts and with the work of Lister, who in 1867 for the first time studied the effect of disinfection upon the healing of wounds and introduced carbolic acid as a disinfectant. The further development of dis- infection is closely connected with bacteriology and its more recent experimental discoveries, with which the names of Pasteur and R. Koch especially are associated. The first fundamental work of the latter was published in 1881 (Ueber Disinfektion, Mitteilungen aus dem Kaiser]. Gesundheitsamte, 1881). From this time on the knowledge of disinfection is so intimately related to bacteriology that to a certain degree it forms a part of that subject. And since the science of bacteriology is in a state of continual progressive development, it naturally follows that the present principles of disinfection may undergo certain changes in the future. To direct attention to the incomplete and unsettled condition of our present knowledge and conception of disinfection at the oustet is one of the most important tasks of general therapeutics. It conse- quently follows that a conclusive statement of our knowledge of disinfection cannot be made. This is the less feasible because the infectious agents of some of the important plagues (foot-and-mouth disease, contagious pneumonia of horses, influenza, pox, etc.) have not as yet been demonstrated bacteriologically, and the knowledge concerning disinfection for these diseases will, therefore, have to be 169 Digitized by Microsoft® 170 GENERAL THERAPEUTICS FOR VETERINARIANS subsequently entirely revised on a scientific basis. Nevertheless, the investigations which have been made up to this time have furnished a series of important viewpoints concerning general and special disinfection which may be regarded as a permanent acquisition and as a preliminary foundation for a rational and scientific system of disinfection. The foundation of the modern antisepsis and disinfection must be explained first of all. This explanation will include the meaning of the different terms, antisepsis and asepsis, colyseptics (inhibit development) and antiseptics (destroy bacteria); the methods of bacteriological investigation; the differences in the individual bacteria and dis- infectants; the differences between bacilli and spores; method of action, form, concentration, application and properties of the indi- vidual medicines; the relation of the animal body or the infected object to the disinfectant; the codperation of certain factors (temperature, light); the importance of cleaning and preparation, and the time and continuance of the disinfectant action. Antisepsis and Asepsis.—Starting with the conception that infection of wounds could be prevented by the employment of antiseptics—t.e., drugs which destroy bacteria—and by a carefully applied dressing, Lister in 1867 recommended carbolic acid in con- nection with the dressing named after him as a method of dis- infecting wounds. Lister’s dressing was applied as follows: After the wound was cleaned with a 2 to 5 per cent. solution of carbolic acid in water,and the air aboveit disinfected with aspray of the car- bolic acid solution, it was covered with a piece of carbolized silk or cotton (protective); over this was laid a thick layer of carbolized gauze or cotton, which was covered with a pieceof imperviouscotton material (mackintosh), and over all was placed a bandage of moist carbolized gauze. In Germany, the Lister dressing was intro- duced into general use between 1872 and 1875. Later, the car- bolic spray was omitted and the dressing simplified. In 1880, iodoform was substituted for carbolic acid and the dry bandage took the place of the moist. Subsequently, iodoform was re- placed in part by corrosive sublimate, creolin, lysol, tannoform, tincture of iodine, and other disinfectants. Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS 171 In recent times the use of antiseptics has been limited in human surgery and for a time they were even given up entirely. Schim- melbusch and others contended that the development of germs in a wound could not be prevented with certainty by disinfectants even when they were applied as early as one minute after the. infection; disinfection was therefore not only ineffective, but also harmful, because it irritated the tissues and increased the wound secretions. In place of the antiseptic wound treatment, the aseptic method was proposed. Antiseptic fluids are not employed in the latter method, but the wound is kept as dry as possible by means of sterilized tampons, or is irrigated only with sterile water or sterile physiological salt solution, and then covered with sterilized dress- ing material. The latter is sterilized in a special apparatus by prolonged (20 to 30 minutes) exposure to live steam of at least 100°C. In asimilar manner, the instruments are made germ-free. They are most certainly sterilized, however, by prolonged boiling in a 1 to 2 per cent. soda solution. Especial care is given to the disinfection of the operator’s hands. After the nails are thor- oughly cleaned, the hands are carefully brushed with soap and warm water, then washed with warm sublimate, carbolic acid or creolin solution and finally rinsed with 50 per cent. alcohol or soap spirit. Care is also taken to keep aseptic the entire operating room, the operation table, the clothing of the patient, operators, assistants and attendants, all of the utensils used and the area surrounding the wound (field of operation). Mull masks for the mouth and nose of the operator are even used. The aseptic treatment of wounds was regarded as an important advance in human surgery because it left the healing of the wound to the natural protective forces of the tissues (leucocytes, blood- serum) and only guarded against external disturbances. More recently, after Henle and others had shown that, contrary to Schimmelbusch, local disinfection of wounds within the first hours is very effective, and after it had been proven by statistics that the results of the aseptic method were in no way more favorable than the antiseptic, numerous surgeons changed from the purely aseptic method to antisepsis (disinfection of the skin with tincture of Digitized by Microsoft® 172 GENERAL THERAPEUTICS FOR VETERINARIANS iodine). Moreover, disinfection of the hands was difficult and uncertain and the introduction of sterilized operating gloves did not improve conditions. The aseptic method is not very well suited to veterinary sur- gery. To this I have already directed attention in another place (General Surgery). In veterinary practice, old infected wounds are usually met with and for these thorough antisepsis is necessary rather than asepsis. For fresh operation wounds in the domestic animals the aseptic method is only exceptionally applicable, as for example in a clinic; and even in well-equipped veterinary hospitals the greatest difficulties are encountered in maintaining asepsis, especially in horses, as a dressing can be applied only in a very limited number of cases and infection of the wound during the operation frequently cannot be avoided even with the greatest care. Moreover, in addition to the contact infection, the air in- fection (dust, hair) is of great import, and against this asepsis has proven powerless. For these reasons, antisepsis is to be preferred in veterinary practice to asepsis as the more certain method. Colyseptics and Antiseptics—A pathogenic or putrefactive microérganism can be made harmless in two ways. Its vital activity can be destroyed or its development can be prevented. In the first instance the action is antiseptic; in the latter, colyseptic. Drugs with antiseptic properties are naturally more valuable than those which have only a colyseptic action. Therefore, a strong antiseptic action is the first essential in a good-disinfectant; it must not only prevent the development and multiplication of pathogenic bacteria but must destroy their vitality. As a general rule, the antiseptics exert only a colyseptic action when sufficiently diluted. On the other hand, there are several disinfectants which are only colyseptic in the strongest concentration and have no antiseptic action or only a very weak one. The division of the disinfectants into antiseptics and coly- septics is only possible upon the basis of bacteriological experi- ments. In order to test the colyseptic properties of a substance, bacteria capable of development are placed upon a suitable culture Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS 173 media which has been previously impregnated with the drug under examination. If the bacteria fail to develop characteristic col- onies upon the media (gelatin, bouillon, etc.), then it is to be assumed that the presence of the drug has prevented the growth of the organisms. However, it cannot be concluded from the experi- ment that the vitality of the organisms is destroyed. This fact is only established when a pathogenic organism which has been thus treated is inoculated into a suitable experimental animal and no infection is produced. Only in the latter case can antiseptic proper- ties be attributed to the drug. Non-pathogenic bacteria are tested by permitting them to dry upon silk threads and placing the threads in a solution of the substance under test. After a time the threads are removed from the solution, washed in water, and placed upon suitable culture media. If the substance being tested actually possesses antiseptic properties no growth will occur. Relative Rank of the Disinfectants.—In the beginning, the individual disinfectants were tested bacteriologically in an en- deavor to discover a drug which would destroy all known bacteria when greatly diluted, but it was found that there is no such uni- versal disinfectant. On the contrary, it was observed that specific antiseptics are required to destroy individual species of bacteria, just as certain antipyretics are required for the different types of — fever. For instance, corrosive sublimate is the most powerful disinfectant for the virus of anthrax, but has only a very weak action on tubercle bacilli and is much less effective than other drugs (creolin, lysol, alcohol, formaldehyde) for superficial dis- infection of the skin. Carbolic acid is relatively ineffective against the tetanus bacillus, rabies virus, anthrax spores and tubercle bacilli. Therefore, in disinfection the different drugs and bac- teria must to a certain extent be considered individually. In a general way, it can only be said that in the case of those micro- organisms which exist in two different forms, namely, the con- tinuous (spore) and vegetative (bacillus), the spores require much more powerful antiseptics than the bacilli. Here, again, the individual species of spores and bacilli show considerable differ- ences in their ability to resist the action of the same drug. It is, Digitized by Microsoft® 174 GENERAL THERAPEUTICS FOR VETERINARIANS therefore, difficult to make up a comparative table of the individual drugs. It can only be stated in a very general way that the strong- est disinfectants, which also destroy spores, are corrosive sublimate and the silver salts (silver nitrate); chlorine, bromine and iodine; creolin, lysol and some of the other newer cresol preparations; formaldehyde and wood tar. Contrasting with these are the weaker antiseptics, which kill only the spore-free bacteria: coal tar, carbolic acid, salicylic acid, aniline dyes, boric acid, calcium, lyes and acids. Iron sulphate and sulphuric acid, formerly highly valued as antiseptics, possess almost no antiseptic properties. The aforementioned disinfectants are arranged in the following table according to the dilutions in which they are efficient, the dilutions given being the average of the different bacteriological observations; Spore-free material. —— ———_—_———_ Spore- Colyseptic Antiseptic containing action. action. material. Corrosive sublimate 1 : 1,000,000 1: 50,000 1: 1000 Silver nitrate 1 : 75,000 1 : 5000 ? Cresols (creolin, lysol) Formaldehyde Salicylic acid Carbolic acid Halogens (chlorine, bromine, iodine) 1 : 5000-25,000 1: 5000 1:50 Boric acid 1: 1000 1: 100 0 Calcium Iron sulphate 1:50 1:3 0 Sulphuric acid 0 0 0 Resistance of the Individual Infectious Agents.—This is very variable. Many infectious agents are very readily destroyed by disinfectants. As a consequence, for many of the infectious diseases the employment of the weaker disinfectants (lime, soap, tar) is sufficient. This is due in part to the fact that many of the patho- genic organisms do not form spores. The infectious agents which are easily destroyed are the anthrax bacilli, the bacilli of swine erysipelas, the bacteria of hemorrhagic septicemia of cattle, the bacteria of fowl cholera, and the virus of foot-and-mouth disease, vesicular exanthema, pox and rinderpest. On the other hand, Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS 175 anthrax spores, tubercle bacilli, tetanus spores, black leg spores, and the contagion of lung plague and rabies are destroyed with difficulty. For the purposes of practical disinfection, the more important infectious diseases can therefore be classified in two groups, the one including those for which a mild disinfectant is sufficient and the other those which require a strong disinfectant. The following groups are arranged on this basis: A. Requiring strong disinfectants: Anthrax spores. Tetanus spores. Tubercle bacilli. Black leg spores Lung plague virus. Rabies virus. B. Requiring mild disinfectants: Anthrax bacilli. _ Swine erysipelas bacilli. Glanders bacilli. Bacteria of hemorrhagic septicemia. Foot-and-mouth disease virus. Pox and rinderpest virus. Staphylococci and streptococci occupy a position between these two classes. They are much easier to destroy than spores and spore-containing bacilli, but are considerably more resistant to disinfectants than the spore-free organisms. For these reasons, it is necessary to use the more powerful disinfectants (corrosive sublimate, creolin, tincture of iodine) in the antiseptic treatment of wounds in order to destroy the pus cocci (staphylococcus pyogenes, streptococcus pyogenes). Method of Action of the Disinfectants.—It has already been stated that infectious material may be rendered ineffective either through destruction of its vitality or through inhibition of its development. In either case the method of action may be very different. In general, disinfection is the result of the following processes: 1. By coagulating the bacterial albumins (mycoproteins) the Digitized by Microsoft® 176 GENERAL THERAPEUTICS FOR VETERINARIANS metallic salts, particularly corrosive sublimate and silver nitrate, act as antiseptics (formation of a precipitate of metallic albumi- nate). Formaldehyde acts in the same manner. 2. A specific toxic action, narcotic to a certain extent, is attrib- uted to the benzol derivatives, especially the cresols (creolin, lysol, tar, creosote) and carbolic acid. 3. By oxidation, potassium permanganate (KMnO,), potassium chlorate (KC103), hydrogen peroxide (H202), and other drugs act as disinfectants. : 4. Reduction (withdrawal of hydrogen). Chlorine and many chlorine compounds operate by reduction. Corrosive sublimate, zinc chloride and iron chloride, for example, act in part in this way. The chlorine withdraws hydrogen from the bacteria, thus breaking up and decomposing the albumin molecules, while the chlorine and hydrogen combine to form hydrochloric acid; the chlorine also decomposes the water, setting free nascent oxygen, which oxidizes the bacteria. 5. Through a change of the reaction, most antiseptics act as disinfectants, especially the acids and acid chlorides (also the acid-reacting corrosive sublimate). Bacteria grow upon a weakly alkaline or neutral culture media and merely a change of reaction is sufficient to retard their development. Growth is also effected by a considerable increase of the alkalinity (alkalies). 6. By dissolving the cell membrane, alkalies, organic acids (vinegar) and soaps operate as disinfectants. 7. Precipitation. Corrosive sublimate and the other metallic salts (iron sulphate) precipitate the bacteria from the fluids in which they are suspended. 8. Absorption. Freshly heated charcoal absorbs gases and acts as an antiseptic and deodorizer. 9. Withdrawal of water. Concentrated salt solutions (e.g., sodium chloride) and glycerin act in this way. Finally, a purely mechanical fixation is produced by certain substances like oil paints, tar and pastes. As will be seen from the foregoing, the method of action of a disinfectant may often be multiple. Corrosive sublimate, for Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS 177 example, operates by coagulating albumin, by its acid reaction, by precipitation and by the action of its chlorine. Disinfectants and the Infected Objects.—The results obtained by experiments in bacteriological laboratories cannot be applied to disinfection in practice without further consideration (compare iodoform!). Between the destruction of bacteria in artificial cultures and the disinfection of a living body, a wound, a stable or a manure pit there frequently exist very considerable differ- ences. Therefore, in practice it is well to consider the inter-action between the disinfectant and the object to be disinfected; both, the disinfectant as well as the object, may under certain circum- stances suffer changes in consequence of opposing influences which will entirely defeat the purposes of the disinfection. For the living body, the first point to be determined is whether the disinfectant is poisonous or non-poisonous. Strictly speaking, there is no disinfectant which is strongly antiseptic and at the same time absolutely non-toxic for the animal body. It is rather the rule that the toxicity of a disinfectant increases with the strength of its antiseptic power, as is observed especially in con- nection with corrosive sublimate. But if the term poisonous is used in the ordinary sense, and is to be understood to mean harm- ful results from small quantities of the disinfectant, or from weak dilutions used in the usual way for practical disinfection, then it can be said that there are disinfectants which are not poisonous. As examples, boric acid, salicylic acid, aluminum acetate and creolin may be mentioned. In regard to the former denials of the non-toxicity of the latter drug, the investigations of von Behring and experiences in practice agree that creolin may be employed as a disinfectant without any danger of poisoning. As poisonous antiseptics may be mentioned carbolic acid, creosote, the free cresols, corrosive sublimate, formaldehyde, chlorine, bromine and iodine. Corrosive sublimate is the most poisonous; it is forty times as poisonous as carbolic acid. According to von Behring, the toxicity of a disinfectant for the animal body may be calculated from the action of the drug upon anthrax bacilli sus- pended in blood-serum; most disinfectants are five to seven times 12 Digitized by Microsoft® 178 GENERAL THERAPEUTICS FOR VETERINARIANS more poisonous for the animal organism than for anthrax bacilli. Poisoning from antiseptics results from their internal, subcutaneous and epidermatic use, especially from the use of corrosive sublimate to disinfect the uterus of the cow and carbolic acid to disinfect wounds of cats. Disinfection with chlorine and bromine is very dangerous for man and animals. The blood exerts a very strong modifying influence upon the disinfectant action of many antiseptics. Corrosive sublimate, for example, destroys anthrax bacilli in blood only in a concentration of 1 : 2000 and after prolonged action, while it destroys the same organism in water immediately and in a dilution of 1 : 50,000. The cause of this surprising difference is to be found in the fact that the albumin in solution in the blood is precipitated by the sublimate in the form of albuminate of mercury, which retards the penetration of the sublimate into the deeper layers of the blood. Similar observations have been made in connection with silver nitrate, carbolic acid, creolin and other drugs. While creolin is effective against anthrax bacilli in bouillon in a dilution of 1 : 10,- 000, a concentration of 1: 200 is required to destroy anthrax bacilli in blood-serum. Since in the disinfection of wounds one has to do in part with blood disinfection, these relations should be given consideration in the antiseptic treatment of wounds and blood should be as completely removed from the wound as possible. In using disinfectants upon the skin or upon wounds, it must be remembered that many of them are caustic in strong concen- tration (sublimate, silver nitrate, carbolic acid) and are always irritant, even in weak solution (sublimate, formaldehyde). This consideration led to the substitution of asepsis for antisepsis in human medicine (see p. 170). Moreover, only a superficial dis- infection can be obtained, since the disinfectants as a rule do not operate deeply (alcohol is an exception). A superior disinfectant for superficial disinfection of the animal body and one which is to be preferred to corrosive sublimate as well as carbolic acid is, according to von Behring, the English creolin. This is also true of formaldehyde and dilute alcohol (disinfection of the hands). Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS 179 Todoform undergoes a peculiar decomposition when it comes in contact with pus; iodine is set free, and this free iodine is the cause of the antiseptic action of iodoform. In the disinfection of stables, many forms of decomposition occur. This is especially the case with corrosive sublimate when it comes in contact with organic or albuminous substances, excre- ment, urine, and water. The disinfection of dried infectious material is particularly difficult; a detailed discussion of this point will be found in a succeeding section. The effective dis- infection of infected dung and liquid manure is very difficult because the organic constituents and gases (HS, NH;) decom- pose some antiseptics; e.g., corrosive sublimate. Other disinfec- tants quickly lose their effect because they form ineffective com- binations (change of caustic lime to acid phosphates, silver nitrate to silver chloride, salicylic acid to sodium salicylate). Continuance of the Action of Disinfectants.—The rapidity of its disinfectant action is of essential importance in considering the value of any antiseptic. The shorter the action, the stronger usually must be the concentration. It is desirable in practice to continue the action of a quickly acting disinfectant as long as possible upon the object to be disinfected. Antiseptic irrigations of old wounds especially must be continued for a long time (for Yg hour and over). Disinfection of stables with autan must continue seven hours. In disinfecting with chlorine and bromine a 24-hour action is necessary. In general, a good disinfectant should destroy the bacteria acted upon within a few minutes. This standard cannot be complied with absolutely, particularly not in connection with the spore-containing bacteria, which always require a much longer time for destruction than the spore-free organisms. While carbolic acid, creolin, formaldehyde and corrosive sublimate in suitable concentrations destroy anthrax bacilli at once or at most within a few minutes, they show the following relations to anthrax spores: Formaldehyde (2 per cent.) kills anthrax spores after 7 hours. Corrosive sublimate (17 per cent.) kills anthrax spores after 1 day. Digitized by Microsoft® 180 GENERAL THERAPEUTICS FOR VETERINARIANS Creolin (3 per cent.) kills anthrax spores after 2 days. Carbolic acid (5 per cent.), anthrax spores were not killed after 20 days. Influence of Temperature.—The disinfectant power of a drug can be considerably increased by the simultaneous operation of high degrees of temperature. For this reason, it is recommended that disinfectant fluids be employed as warm as possible. This applies particularly to the disinfection of the hands (warm water and soap and sublimate solution). Anthrax bacilli are destroyed at 3° C. by a 1: 25,000 solution of sublimate, while at 36° C. they are destroyed by a four times weaker dilution, 1: 100,000. Anthrax spores, which are not destroyed with certainty after 20 days by a 5 per cent. solution of carbolic acid at ordinary tempera- tures, are killed after 3 hours’ exposure to the carbolic acid solu- tion at 37°C. Live steam kills them within the same period, and formalin vapor (1-2 per cent.) at 70° C. after 5 minutes. Soda is entirely ineffective against these organisms at the ordinary tem- perature, but a 114 per cent. solution at higher temperatures will destroy them as follows: At 80-88° C. after 10 minutes. At 77° C, after 15 minutes. At 75° C, after 20 minutes. At 70° C. after 30-60 minutes (von Behring). Influence of Concentration.—The stronger the concentration the more effective in general is the disinfectant action of the anti- septic. An exception to this rule is creolin, which is most efficient in concentrations which favor the formation of a complete emul- sion, especially 2-3 : 100; 10 to 20 per cent. solutions are not rela- tively as efficient because the greater part of the creolin is not emulsified and is therefore not entirely effective. The influence of concentration upon the action of an antiseptic is shown by the following figures: Corrosive sublimate 1:100 kills anthrax spores after 80 minutes. Corrosive sublimate 1 : 200 kills anthrax spores after 2 hours. Corrosive sublimate 1 : 400 kills anthrax spores after 4 hours. Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS 181 Corrosive sublimate 1 : 1000 kills anthrax spores after 24 hours (von Behring). i Influence of the Form of the Disinfectant.—The different conditions of aggregation exert a definite influence upon the degree of antiseptic action. Solid, insoluble bodies possess no disinfec- tant action because they cannot penetrate the mass to be dis- infected. Disinfectants in solution in water are most effective. Alcoholic solutions are also very effective when the solvent is alcohol diluted with water. On the other hand, solutions in oil are not effective, as was demonstrated by Koch in connection with carbolized oil. Disinfectants in the gaseous form are very unreliable, except formaldehyde. Koch was the first to demonstrate the inefficiency of sulphurous acid, which wasformerly so highly val- ued as a disinfectant. The practical value of chlorine and bromine in the gaseous form has been placed in great doubt by von Behring. Even calcium chloride is disinfectant in slight degree in the gaseous form only when the object to be disinfected is moist, when the bac- teria are entirely superficial and when 1) per cent. by volume of free chlorine is developed in the area to be disinfected. Many other superior antiseptics are not suitable for practical use because they are not soluble in water. These include, first of all, the ethereal oils, which in alcoholic solutions possess a very high disinfectant action. The behavior of iodoform, which is in powder form, is peculiar; it be- comes antiseptic only after it is decomposed and iodine is set free. Time of Disinfection —In many cases it is very important that the disinfection be undertaken within a certain time. This applies especially to the disinfection of wounds. Fresh wounds are much easier disinfected than old, suppurating wounds. The prompt use of a suitable disinfectant (tannoform) on fresh wounds will prevent suppuration. On the other hand, the disinfection of old wounds is difficult and frequently impossible on account of the bacteria having penetrated deeply into the tissues. In an- thrax, tetanus and rabies, disinfection should be undertaken at the earliest possible moment after the diagnosis is made, especially in anthrax, in order to prevent the easily destroyed bacilli from developing the highly resistant spores, Digitized by Microsoft® 182 GENERAL THERAPEUTICS FOR VETERINARIANS Preliminary Preparation—A thorough cleaning is an indis- pensable preliminary preparation for disinfection. This will make the infectious material more accessible to the antiseptic, so that a relatively simple and mild disinfectant will be sufficient, or it may entirely remove the infection. Water and soap alone are often sufficient for disinfection. The aseptic treatment of wounds was based entirely upon a careful cleansing of the wound, the instruments and the hands, and the exclusion of infection. Infected rooms, walls and other objects may be disinfected by thorough washing with warm water and soap. A preliminary disinfection must, however, precede the cleaning when disease- producing organisms may be scattered by the cleaning, or when the dirt cannot be collected in such a manner as to exclude the possibility of spreading the infection; in addition, when the clean- ing is done without a preliminary disinfection those doing the work are in danger of infection. In these exceptional cases the work should be done in the following order: first, preliminary disinfection; second, cleaning; third, thorough final disinfection. Cost of Disinfection.—In every disinfection the question of cost is an important consideration. In the interest of agriculture, the veterinarian is obliged to adopt the cheapest possible method of disinfection. For instance, the free use of iodoform, ichthargon, glutol or protargol by the veterinarian in the treatment of wounds must be regarded as a luxury. The use of silver nitrate as a dis- infectant in outbreaks of disease is forbidden by its high cost. Carbolic acid must also be regarded as a relatively expensive disinfectant. A 5 per cent. solution of carbolic acid is ten times as costly as the much more powerful 1 per cent. corrosive sublimate solution and 3 per cent. creolin solution. Properly carried out, chlorine and bromine disinfection is very expensive. The cheap- est disinfectants, and therefore the easiest to obtain, are lime, soda, potassium, soap and tar. Other cheap disinfectants are corrosive sublimate, creolin, lysol, solveol, solutol, bacillol and cresol-sulphuric acid. In the following table is given the present average wholesale price per pound of the most frequently used antiseptics or disinfectants: Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS 183 Burnt lime................0.00.0.0.0000. per lb. $0.08 Creolitt ss) tice cee ei eoteree Baeiaeie per lb. 65 LV SOM oe ste seine dteatecnie ote ds vs Regshat ....per Ib. 67 Carbolic acid....................0 wane per Ib. 15 Corrosive sublimate........ ..... 00.2... per Ib. 69 Tannoform..... ............0. cece eee per 0z 30 Todoform............-...00060 cee eeee per lb. 4.55 Provareoli wus Sarde cares ae eiae sees peroz. 1.25 APIStOl jrasiciecien aie dues aid eee POR peroz. 1.80 Ichthargon...............0 cece cece peroz. 3.00 Properties of Disinfectants.—The results of disinfection will depend upon other factors of importance. These include the quality and purity of the disinfectants. When calcium chloride is stored its chlorine content decreases and it finally becomes ineffective. Burnt lime, when exposed to the air, is gradually changed to the ineffective calcium carbonate. Calcium chloride and burnt lime must therefore be used in as fresh condition as possible. In regard to creolin, Henle and von Behring have demonstrated that the German creolin, in contrast with the English creolin, possesses no disinfection action worth mentioning. Finally, an effort should be made to carry out every disinfection with as little inconvenience as possible, avoiding ll unnecessary disturbance of agricultural operations. 2. DISINFECTION FOR INFECTIOUS ANIMAL DISEASES General.—Disinfection for the different infectious diseases of animals is regulated by the German veterinary sanitary law of June 26, 1909 (Supplement A to the instructions of the federal council of December 25, 1911), the law of February 25, 1876, concerning the spread of infectious materials by the transporta- tion of cattle over railroads, and the regulations of the federal council based on this law and issued June 20, 1886, with the modification of July 26, 1899 (the disinfection with 5 per cent. carbolic acid solution is not only required, as formerly, for anthrax, rinderpest and foot-and-mouth disease, but also for glanders, swine plague and hog cholera) ; also by the more recent regulations with reference to fowl cholera (February 2 and July 4, 1899) and the announcement of the federal council of July 16, 1904 (substitution of a 3 per cent. solution of the cresol-sulphuric acid mixture for the Digitized by Microsoft® 184 GENERAL THERAPEUTICS FOR VETERINARIANS 5 per cent. carbolic acid solution), by the rinderpest law (April 7, 1869), and by the military-veterinary instructions for the service horses of the army. These laws and regulations contain definite instructions concerning cleaning and disinfectant agents (water, soap water, soda lye, freshly-slaked lime, calcium chloride, solu- tions of carbolic acid and cresol, cresol-sulphuric acid mixture, corrosive sublimate, formaldehyde, fire), methods of cleaning and disinfecting, and the procedure to be followed in the different infections (anthrax, rabies, glanders, foot-and-mouth disease, lung plague, sheep-pox, swine erysipelas, swine plague, hog cholera, tuberculosis, mange, fowl cholera, fowl pest and rinderpest). I. SUPPLEMENT A TO THE INSTRUCTIONS OF THE FEDERAL COUNCIL, DECEMBER 25, 1911 (DISINFECTION IN INFECTIOUS DISEASES) Regulations for Disinfection in Infectious Diseases I. GENERAL § 1. Cleaning and disinfection is to be done according to these regulations under the observation and direction of the official veterinarian and under police supervision. § 2. The disinfection process includes cleaning and disinfection. The cleaning must regularly precede the disinfection; this does not forbid a pre- liminary disinfection before beginning the cleaning (see §5, No. 10; §6, subdivision 2). II. Creanine § 3. Persons must wash with warm water and soap the hands and other parts of the body which may have been soiled; in case of necessity these parts must also be subjected to a preliminary disinfection (§ 5, No. 10). The clothing and foot-gear, when not changed, are to be brushed with soap and water to remove attached dirt. § 4. Animals are to have the surface of the body, especially the hoofs and claws, cleaned of attached dirt by careful washing or some other suitable process. When necessary the hoofs and claws are to be trimmed out. § 5. Stables and other places of accommodation are to be treated as follows: 1. Manure and other gross dirt, straw, feed residue, straw packing, and similar substances are to be removed and disposed of according to Nos. 9 and 10. Only the upper layer need be removed from the manure piles in Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS 185 sheep and cattle stables when in the judgment of the official veterinarian this is sufficient and when the veterinary sanitary regulations will permit. 2. Wood utensils, racks and mangers and board linings are to be taken out as far as is necessary. Wood-work with a torn or splintered surface must be removed to a sufficient extent to obtain a smooth surface. The pieces of wood removed and all decaying or rotten wood, or wood that is otherwise unsuitable for use, are to be burned. 3. From clay walls a layer of sufficient depth is to be removed. Damaged or loose parts of the plaster or rough-cast on the walls are to be removed and disposed of in the same manner as the manure. 4. Loose paving and planks in the floor are to be removed. The earth under the flooring which is wet with excretions must be dug out, and the material removed is to be disposed of in the same manner as the manure. Stone and sound wood-work in which the moisture has not penetrated deeply can be again used after the damaged parts have been removed. 5. In tightly joined (impervious) floors, in case of necessity, the damaged places in the binding material or in the material itself, or cracks in the latter, can be scraped out and the spaces, after thorough cleaning and disinfection, can be filled in with new material. Similar conditions in the walls, pillars, stall partitions, pits, troughs, gutters and canals may be treated in the same manner. 6. Lime or earth floors (puddled clay and the like) should have the upper layer removed and the moist places dug out. The part removed is to be treated like the manure. 7. Earth and sand floors, in so far as they are wet with excretions, are to be removed to the depth of at least 4 inches. 8. The ceiling, walls, fittings (mangers, troughs, racks, posts, pillars, stalls, doors, door posts, windows, etc.), floor, manure gutters, canals, troughs and pits are to be thoroughly cleaned by scouring with hot soda solution (a solution of at least 8 pounds of washing soda to 100 quarts of hot water) or hot soap solution (8 pounds of soft soap dissolved in 100 quarts of hot water). The cleaning is only to be regarded as complete when all excretions from dis- eased or suspected animals and all dirt have been removed and everything has an entirely clean appearance. When necessary, scouring sand may be used with the hot soda or soap solution. The cleaning must include all parts of the stable and other places where animals are kept. Special attention is to be given to depressions in the floor, corners, niches, joints, cracks, scratches, etc. In stables and other compartments, the ceilings are cleaned first, as a Tule, then the walls and interior fittings and lastly the floors, manure gutters, etc. When the official veterinarian considers it unnecessary, stable ceilings and the upper parts of the walls which have not been soiled with the eliminations Digitized by Microsoft® 186 GENERAL THERAPEUTICS FOR VETERINARIANS from diseased animals need not be scoured with the soda or soap solution, but may be cleaned by thoroughly spraying with hot soda or soap solution or with hot water. Where hot soda or soap solution or hot water cannot be ob- tained in sufficient amount, water under strong pressure from a water sup- ply pipe or from a fire hose, garden hose or some similar arrangement may be used, if in the judgment of the official veterinarian it will answer the purpose. 9. The manure and other dirt removed in cleaning, the straw, feed residue and other substances (see Nos. 1 to 7), blood, stomach and intestinal contents and other offal from slaughtered, dead and diseased or suspected animals are to be collected together upon the infected premises. In cases where the collection of the manure upon the infected premises is impossible or undesirable it may, with official veterinary approval and with proper care, be collected in a suitable place outside of the infected premises. The soiled water from cleaning is to be collected in the manure pit or in some other general container on the infected premises. 10. When the manure and other dirt, the straw, feed residue, etc., removed in cleaning, and the dirty fluids from cleaning, cannot be collected on the infected premises or in another suitable place without danger of spreading the infection, then, if it is necessary to render those materials harmless, a preliminary disinfection must precede the cleaning, a suitable disinfection fluid being applied (§ 11 and §§ 15 to 27). In these cases, care should be taken that the manure and other dirt, straw, feed residue, dirty water, etc., are not placed even temporarily, before the final disinfection, in locations where the contaminated water may drain into other premises, where the materials are accessible to strange persons or animals, or where the fluids can flow into springs, water courses or other sources of water supply. A disinfection is also to precede cleaning when there is danger that the persons doing the cleaning may be infected without previous disinfection, as in anthrax and glanders (§§ 15, 18). §6. (Subdivision 1.) Utensils, clothing, and other objects are to be treated in the following manner: 1. Combustible articles of little value are to be burned. 2. Wood stable and driving equipment (feed boxes, buckets, brooms, forks, shovels, etc., feed carts, wagons, sledges, harness parts, wood shoes, etc.) are to be thoroughly scoured with hot soda or soap solution. 3. Utensils of iron and other metals (chains, rings, forks, shovels, curry- combs, bits, muzzles, troughs, other feeding and watering vessels and other vessels, cages, etc.) are, in so far as they cannot be disinfected by fire (part III), to be thoroughly cleaned and then washed with hot water. 4, Leather and rubber articles (halters, girths, bridles, draught harness, saddles, straps, cushion covers, leather shoes, dog collars, whips, etc.) are to be scrubbed with soap and water. Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS 187 5. Articles of cloth or vegetable fibres (blankets, girths, halters, ropes, cushion covers, pieces of clothing, bed covers, etc.) are to be freed from dirt by scrubbing with soap and water. 6. Hair, wool, feathers, cushion packing, and similar substances are to be spread out in a thin layer and exposed to the air for three days, being turned as often as possible. (Subdivision 2.) Under the conditions described in § 5, No. 10, a pre- liminary disinfection of utensils, clothing and other objects is necessary. § 7. The cleaning of railroad stock pens and similar places, slaughter houses, ships and ferries is to be carried out as directed in §§ 5 and 6. § 8. Stock-yards are to be cleaned by first collecting the manure dropped by the animals; then paved places are to be thoroughly cleaned with brooms and washed with water, and unpaved places are to be raked and harrowed level. Where necessary, the apparatus for tying-up is to be washed with water. § 9. Roads (alleys) are to be cleaned in the same manner as the stock- yards. § 10. Places in pastures where animals stand (exercise places, milking stations, etc.) are to be cleaned in the same manner as the stock yards. III. Distnrection 1. Disinfectants § 11. (Subdivision 1.) The following are used as disinfectants: 1. Freshly slaked lime. This is obtained as follows: freshly burned lime is placed, without breaking up or powdering, in a capacious vessel and covered with about half the quantity of water; under these circumstances it breaks up into a powder with the generation of considerable heat and gas. 2. Milk of lime. This is used in concentrated and dilute form. Concentrated milk of lime is prepared by adding slowly, with continual stirring, three liters [3 quarts] of water to one liter [1 quart] of freshly slaked lime. Dilute milk of lime is prepared by adding slowly, with continual stirring, 20 liters [20 quarts] of water to one liter [1 quart] of freshly slaked lime. If freshly slaked lime cannot be obtained, then the milk of lime is prepared by mixing with each liter of slaked lime, as it is found in a lime pit, 3 or 20 liters of water. In such cases, however, care must be taken to previously remove the upper layer of lime, which is changed by the influence of the atmos- phere. The milk of lime is to be shaken and stirred before it is used. 8. Calcium chloride solution. The calcium chloride should possess a pronounced odor of chlorine and should be stored in tightly stoppered bottles and protected from light. The solution is prepared by adding to each liter Digitized by Microsoft® 188 GENERAL THERAPEUTICS FOR VETERINARIANS [quart] of calcium chloride, slowly and with continual stirring, 3 or 20 liters [quarts] of water (concentrated and dilute calcium chloride solution). The solution is in every case to be freshly prepared immediately before using. 4. Dilute cresol water (2.5 per cent.!). This is prepared by adding to 50 c.c. [12 drams] of liquor cresolis compositus sufficient water to make 1 liter [1 quart] and mixing thoroughly. 5. Carbolic acid solution (about 3 per cent.). This is prepared by adding to 30 c.c. [1 ounce] of liquefied carbolic acid (phenol liquefactum) sufficient water to make one liter [1 quart] of disinfectant fluid, and mixing thoroughly. 6. Cresol-sulphuric acid solution. In the preparation of the solution, 2 parts by volume of crude cresol are mixed at ordinary temperature with 1 part by volume of crude sulphuric acid and the mixture is allowed to stand for at least 24 hours. Then for each 30 c.c. [ounce] of the mixture sufficient water is added to make a liter [quart] of disinfectant fluid, and thoroughly mixed. The solution must be used within 3 months. When the solution is to be used to disinfect places in the open (court yards, stock-yards, etc.) in cold weather, sodium chloride (0.5 to 1 kilogram {1.3 to 2.6 pounds] to each 10 liters [10 quarts]) may be added to prevent freezing, being thoroughly mixed in by stirring. Stables, yards, utensils, etc., which have been cleansed with soda or soap solution must be thoroughly washed with water to remove the remaining soda or soap before the cresol-sulphuric acid solution is applied. 7. Corrosive sublimate solution (1/10 per cent.). Thissolutionis prepared by dissolving in each liter [quart] of water 1 gram [15 grains] of corrosive sub- limate and 1 gram [15 grains] of sodium chloride with a small amount of red coloring matter, or colored tablets, containing 1 gram [15 grains] of sublimate, may be used. Stables, yards, utensils, etc., which have been cleansed with soda or soap solution must be washed with water to remove any remaining soda or soap before being disinfected with the sublimate solution. Disinfections in which large quantities of sublimate solution are used, as the disinfection of stables, yards, etc., can only be done under veterinary or police supervision. In disinfecting with sublimate solution, especially in disinfecting cattle stables, it is recommended that the disinfected surfaces and objects be washed after 24 hours with a 1 per cent. solution of sulphurated potassium. 8. Formaldehyde solution (about 1 per cent.). This is prepared by adding to each 30 c.c. [ounce] of commercial formaldehyde solution (formalin) sufficient water to make 1 liter [quart] of the disinfectant solution, and mixing thoroughly. 1 In swine plague and hog cholera a 6 per cent. cresol water is used. In- stead of 50 c.c. [12 drams] of liquor cresolis compositus, 120 c.c. [4 ounces] are required for each liter [quart]. Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS 189 9. Steam in apparatuses which have been examined by experts when erected and at regular intervals afterward and found satisfactory. Tn addition, steam from a steam boiler may be employed for small vessels with one opening, like milk cans, provided the steam is used under pressure and is introduced directly into the vessel. The interior of the vessel is first exposed to the live steam and ther the hoops, bands and external wall, the latter especially in wood vessels. 10. Boiling in water or in 3 per cent. soda or soap solution (see § 5, No. 8). The fluid must be put on the fire cold, the objects completely immersed and the boiling continued for at least a quarter hour. The vessel must be covered. Milk buckets, milk cans and other milk vessels, instead of being sub- jected to the boiling process described, may be treated in the following manner: (a) The vessel is laid’ in boiling-hot water or in boiling-hot soda solution or dilute milk of lime for at least 2 minutes, all parts of the vessel being covered by the fluid. (b) The external and internal surface of the vessels, the handles and covers are scrubbed with boiling-hot water or boiling-hot soda solution. 11. Thorough singeing and heating with fire or a suitable flame 12. Burning. (Subdivision 2.) The disinfectants described in Nos. 4 to 7 are to be used as hot as possible. (Subdivision 3.) According to further regulations of the government, other disinfectants and methods, which have been tested in regard to their effectiveness and practical application, may be employed in addition to those mentioned above. 2. Choice of Disinfectant and Method of Application. § 12. The choice of the disinfectant (§ 11) and the method of application will depend in general upon the resistance of the infectious agent, the facility with which it is carried by intermediate bodies and the special conditions existing in each case. § 13. In epizodtics, the infectious agent of which is easily destroyed and which is spread by the diseased animals, it will be sufficient to clean and then whitewash with dilute milk of lime or calcium chloride solution the ceiling, walls, posts, pillars, stalls, doors, floors, gutters and equipment. Iron parts are to be wiped with dilute cresol water or carbolic acid solution. Wood and stone and glazed tiles are to be treated in the same manner. § 14, (Subdivision 1.) In epizodtics of which the infectious agent is difficult to destroy, or when there is great danger that the disease may be further spread by intermediate objects, the following process is to be followed: 1. The bedding, manure, other dirt, feed residue, etc., removed in clean- Digitized by Microsoft® 190 GENERAL THERAPEUTICS FOR VETERINARIANS ing is to be collected together and either burned, buried, plowed under, or rendered harmless by composting or by mixing with a suitable disinfectant. The compost piles containing the manure, straw, feed residue and similar material should be placed so that susceptible animals and unauthorized persons cannot walk over them, dirty fluids flow from them to other premises, strange persons have access to them, or washings from them contaminate springs, water courses or other sources of water supply. The materials should be thoroughly mixed in the proportion of two parts of manure to three of straw, moderately moistened, and loosely piled in large heaps for three weeks. After being piled in a heap, the manure is moistened with water or urine (about 10 to 15 quarts to 1 square yard of manure). The remainder of the process is as follows: A layer of non-infected manure, straw or turf about 10 inches deep, 5 to 6 feet broad and as long as desired is first placed upon the ground and upon this the manure to be disinfected is piled in a heap 4 feet high with sloping sides. The surface of the heap is covered with a layer of non-infected manure, straw, leaves, turf or other loose material four inches deep, and over this is placed a layer of earth of the same thickness. After remaining three weeks in this condition the manure may be removed without danger. Manure and bedding material which has not been composted and which is required to be rendered harmless (see §§15 to 27) must be removed from infected premises in tight wagons without the employment of sus- ceptible animals from other premises. In case of necessity, the manure, bedding material, etc., must be wet down in layers with concentrated milk of lime, unless the character of the infection requires the use of another disinfectant. When the method of storing the manure which is permitted is such that there is danger of the infectious material being spread by contaminated water flowing into other premises, by the manure being accessible to strange persons or animals, or by springs, streams or other water supplies being contaminated, then the manure is to be treated with concentrated milk of lime in the stalls before it is removed to the place of storage. 2. Liquid manure and dirty water, in so far as they are not used in the composting of manure (No. 1), are to be disinfected with lime, concentrated milk of lime, calcium chloride or concentrated solution of calcium chloride. At least 1 part by volume of lime or calcium chloride or 3 parts by volume of concentrated milk of lime or concentrated calcium chloride solution are to be used to each 100 parts of liquid manure or dirty water. The mixture must be thoroughly stirred and allowed to stand for at least 2 hours. 8. Feed and straw stored in the rooms to be disinfected are to be removed without harm in so far as the regulations do not provide that they be disposed of in another manner (§§ 15 to 27). Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS 191 4, Ceilings and walls, fittings (mangers, troughs, pillars, posts, stalls, doors, door posts, windows, etc.), floors, gutters, canals, troughs and pits are to be whitewashed with dilute milk of lime or calcium chloride solution or brushed or thoroughly sprayed with dilute cresol water, carbolic acid, formaldehyde, corrosive sublimate or cresol-sulphurie acid solution. Tron parts are to be treated with dilute cresol water or with carbolic acid solution, 5. Impervious paving or floors in court yards, railroad stock pens, slaughter houses, stock-yards, roads (streets), ships and ferries are to be washed or sprayed in a suitable manner with dilute milk of lime or calcium chloride solution or other disinfectants (§§ 15 to 27). In cold weather the pavements are washed with cresol-sulphuric acid solution containing sodium chloride or are sprinkled with powdered, freshly-slaked lime. The same process may be used for court yards, stock-yards, roads, streeta and farm stock pens which have a paving that is pervious or which are unpaved. 6. Earth and sand floors which are not moistened with the excretions of diseased or suspected animals, including earth and sand under floors removed according to § 5,4 to 7, and the manure piles in sheep and cattle stables which are not removed in cleaning are to be sprayed with concentrated milk of lime or sprinkled with freshly slaked lime until the ground and manure are covered with a thick layer of lime. 7. Wood utensils, including vehicles and sleds used to haul cadavers, cadaver parts, straw, manure and the contents of the stomach and intestines of animals which have been killed or slaughtered, are, in so far as they cannot be burned, to be singed, or washed with dilute cresol water, carbolic acid, formaldehyde, cresol-sulphuric acid or corrosive sublimate solution. 8. Utensils of iron and other metals are to be exposed to the action of fire for a short time or washed with dilute cresol water, carbolic acid or for- maldehyde solution. 9. Articles of leather, especially foot-gear, and rubber are to be carefully and repeatedly wiped with cloths which have been saturated with cresol water, carbolic acid or corrosive sublimate solution. 10. Linen, hemp (jute), cotton and woolen articles, clothing and bed covers, hair, wool, feathers, feed sacks, cushion stuffing, etc., which cannot be burned, or which are not required to be disposed of in another manner in certain diseases (see §§ 15 to 27), are to be laid for 24 hours in dilute cresol water, carbolic acid, corrosive sublimate, or formaldehyde solution, or dis- infected by boiling or in a steam apparatus. Pieces of clothing which are only slightly soiled may be disinfected by moistening and scrubbing with dilute cresol water, carbolic acid, corrosive sublimate or formaldehyde solution. 11. Animals are to be washed with a proper disinfectant (see §§ 15 to 27), Digitized by Microsoft® 192 GENERAL THERAPEUTICS FOR VETERINARIANS especially when in places in which the skin and hoofs or claws may have been soiled with manure or other excretions. 12. Hands and other parts of persons are to be thoroughly brushed with dilute cresol water, carbolic acid or corrosive-sublimate solution and after about five minutes washed with warm water and soap. (Subdivision 2.) The government may permit deviations from the proc- esses described in Nos, 1 to 12, IV. MrtsHops PRESCRIBED FOR THE DIFFERENT D1sEasEs Anthrax § 15. 1. Persons who have come in contact with the bloody excretions from an infected or suspected animal, or who have assisted in bloody opera- tions on such animals or in the slaughtering or destruction of the same, or who have assisted in the opening or removal of the cadavers, shall immediately wash and disinfect thoroughly the hands and other parts of the body which may have been soiled, also soiled clothing and foot-gear. 2. As soon as an infected or suspected animal dies, is killed, recovers or is removed from its stall, the cleaning and disinfection must be immediately begun. This must include the stall in which the animal stood, the place where it died or was killed, and, where the disease is of frequent occurrence, certain parts of the stable or the entire stable, as the official veterinarian may in his judgment determine; also floors, walls, posts, pillars, stall divisions, mangers, racks, troughs, etc., stable and slaughtering utensils, clothing and foot-gear of the attendants and other objects which are contaminated with eliminations, blood or offal of infected or suspected animals or which may be assumed to be otherwise infected with the organisms of anthrax; stored feed or straw which diseased or suspected animals may have come in contact with or which may be assumed to have been otherwise infected; vehicles and vessels used to remove cadavers or parts of the same, offal, manure, etc., and, when necessary, con- taminated places in the pasture, burial and storage places and water troughs. 3. The disinfection is carried out as directed in § 14 and the cleaning is preceded by a preliminary disinfection (see §5, No. 10; § 6, subdivision 2). As disinfectants, calcium chloride, dilute and concentrated calcium chloride solutions, corrosive sublimate or formaldehyde solutions are to be used. Special attention should be given to the solids and fluids liberated in killing, especially the bloody eliminations from diseased or suspected animals and their cadavers and blood. This material, together with the bedding, feed residue, manure, the earth removed from unpaved floors and articles of little value, is to be disposed of like the cadavers (see the directions for the harmless removal of the cadavers). Liquid manure contaminated with blood or bloody eliminations from diseased or suspected animals is to be disinfected with calcium chloride or solution of calcium chloride (§ 14, subdivision 1, No. 2). Digitized by Microsoft® DISINFECTANTS, ANTISEPTICS 193 4. Stores of feed or straw which contain anthrax organisms, or which there is reason to believe may be infected, may be disinfected by steam in suitable apparatus or by exposure to sufficient heat through other methods. If this is not possible, the feed and straw is to be burned or buried, unless permission is given by the sanitary authorities to use it for animals which have undergone vaccination for anthrax, Black Leg and Hemorrhagic Septicemia § 16. For black leg and hemorrhagic septicemia the methods described in § 15 are employed, except the preliminary disinfection specified in No. 3. Rabies §17. 1. Immediately after the death or destruction of a diseased or sus- pected animal, the place occupied by it, especially the floors, walls, mangers, racks, troughs, partitions, posts, pillars, and stalls contaminated by it, and the utensils and other objects with which it has come in contact, shall be cleaned and disinfected as directed in § 13. 2. In rabies of the dog and cat, the bedding, muzzle, collar, leash, blanket, utensils and other objects which have been used by the diseased or suspected animal shall be burned or rendered harmless in some other way. Dog houses of wood, straw, reeds or similar material are to be burned; those of other material are to be cleaned and disinfected as directed in § 13, Glanders § 18. 1. Persons who have come in contact with diseased or suspected animals, cadavers or cadaver parts, are to immediately clean and disinfect their hands. Water, soap and suitable disinfectants (dilute cresol water, carbolic acid or corrosive sublimate solution) are to be at hand for this pur- pose in infected premises. 2. As soon as an infected or suspected animal is removed from its stall, the latter and all equipment and utensils used for the diseased or suspected animal are to be immediately cleaned and disinfected, except in so far as the latter are to be used for other diseased animals. 3. Before the removal of the quarantine restrictions, certain parts of the stable or the entire stable, as in the judgment of the official veterinarian may be necessary, the utensils and equipment (mangers, racks, posts, pillars, stall partitions, buckets and other stable apparatus, tie ropes, halters, harness, saddles, cleaning implements, covers, housing, clothing and foot-gear of the attendants, wagon poles, chains, water troughs, shoeing places, etc.) and other objects which have been in contact with diseased or suspected ani- mals, their eliminations, cadavers or cadaver parts are to be cleaned and disinfected; also, any contaminated places in the pastures. 13 Digitized by Microsoft® 194 GENERAL THERAPEUTICS FOR VETERINARIANS 4. The disinfection is to be carried out according to § 14 and the cleaning is to be preceded by a preliminary disinfection. Any of the disinfectants mentioned in § 11, subdivision 1, may be employed. Special attention must be given to objects contaminated with nasal discharge, secretions from cutane- ous ulcers, manure and urine from diseased or suspected animals. Manure, straw, feed residue, etc., may be composted and the urine or other elimina- tions from diseased or suspected animals treated with a disinfectant. Foot-and-M outh Disease §19. 1. The attendants of diseased or suspected animals in infected premises, persons who have engaged in the slaughter or transportation of such animals or in the removal of the bedding or the plowing under of the manure, and other persons who have come in contact with suspected or dis- eased animals in infected premises or who have visited stables in which such animals have been placed, must, before leaving, change or clean and disinfect the clothing and foot-gear and also clean and disinfect the hands and other parts of the body which may be contaminated. 2. Utensils, vehicles, vessels and other articles which have come in con- tact with diseased or suspected animals or their eliminations and which must be used outside of the infected premises during the continuance of the disease are to be cleaned and disinfected before being removed from the infected premises. Milk cans which must be removed from the infected premises for use outside during the prevalence of the disease are to be disinfected, after being emptied, as directed in § 11, subdivision 1, Nos. 9 and 10. 3. When manure is removed from infected stables it is to be composted on the premises or in some other suitable place from which the infection can- not spread (§ 14, subdivision 1, No. 1), or, if this is impracticable, concen- trated milk of lime is to be poured over it before it is removed from the stable. 4. Urine and manure from ruminants and swine can be removed from premises during the prevalence of the disease only under the most pressing circumstances and with the permission of the sanitary authorities. The material must not be hauled with cattle from other premises. The liquid manure must be removed in tight vessels and the wagons used to haul manure which has not been composted must also be tight. If the material is hauled over public roads and the roads cannot be closed while the hauling continues, then the manure is to be wet with concentrated milk of lime. Manure which was not composted before removal is to be immediately plowed under or composted. In the latter case, when the packing process is completed access of ruminants and swine should be prevented. 5. At the final disinfection, which is to be carried out as directed in § 11, the places occupied by diseased or suspected animals (stables, yards, exercise yards, bull stalls, breeding stalls, shoeing places, etc., stock pens, stock-yards Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS 195 and roads); the places used to store manure, cadavers and cadaver parts; the watering trough and its surroundings; harness; wagon poles; utensils used in attending to the diseased or suspected animals (watering buckets, milk pails, milk stools, milk cans, manure forks, shovels, etc.); feed sacks; skin, horns, claws, wool and other animal products which may be infected either because of their origin or place of storage, and the clothing and foot- gear of the attendants are to be cleaned and disinfected. Special attention is to be given to objects which have been contaminated with saliva or manure from diseased or suspected animals. Skin, horns, claws and other raw animal products are to be disinfected by complete drying or by immersion for 24 hours in dilute milk of lime or through treatment with other disinfectants. Wool may be removed from the infected premises if it is packed in closed sacks, 6. Feed and straw which have been stored in infected stables or which have been otherwise contaminated by the eliminations from diseased or suspected animals cannot be removed from the infected premises but must be used there or rendered harmless. 7. At the final disinfection, the claws of cattle from the infected stable are to be trimmed and the animals are to be cleaned and disinfected (§ 4 and § 14, subdivision 1, No. 1). 8. Finally, at the final disinfection all of the attendants employed on the premises which were infected and all persons who otherwise came in contact with diseased or suspected animals are to clean and disinfect the hands and arms and any other parts of the body which may have come in contact with the animals. _ 9, Any of the disinfectants named in § 11, subdivision 1, may be used. Lung Plague § 20. 1. The attendants who have cared for diseased or suspected animals, persons who have been engaged in the slaughter or transportation of such animals, and other persons who have come in contact with diseased or sus- pected animals or who visit stables in which such animals are kept, must, before leaving the infected premises or slaughter place, change the clothing and foot-gear or clean and disinfect the same, and must also clean and dis- infect the hands and the other parts of the body which may have come in contact with the diseased animals. 2. During the prevalence of the disease on infected premises, in case of the removal of a diseased or suspected animal from its stall or from the stable, the stall and its fittings and the utensils used in caring for the animal must be at once cleaned, and disinfected in accordance with the directions in § 13. Feed residue contaminated by the expired air of the animal must be burned or treated in the same manner as the manure and bedding. Digitized by Microsoft® 196 GENERAL THERAPEUTICS FOR VETERINARIANS 3. Manure and bedding must be removed from infected premises to the field and plowed under without the use of cattle from other premises. If it cannot be plowed under at once, it must be piled up in heaps and cattle must not be permitted to come in contact with it for at least 2 weeks. 4, At the final disinfection, the infected stable and other compartments on the infected premises which have been occupied by diseased or suspected animals or their cadavers, the equipment and utensils which have come in contact with such animals, and the clothing and foot-gear of the attendants are to be cleaned, and disinfected as directed in § 13. 5. Feed and straw stored in the infected stables or over such stables above a loose ceiling must not be removed from the premises after the disease has been stamped out. These materials may be used for horses, swine or sheep, but must be placed where cattle cannot come in contact with them. If they cannot be disposed of in this way, they are to be treated in the same manner as the manure. Sheep-pox § 21. 1. The attendants who have cared for diseased or suspected sheep in infected premises, those persons who have been engaged in shearing, slaugh- tering or transporting such animals, and other persons who have come in con- tact with diseased or suspected animals or who visit stables in which such animals are kept, must, before leaving the infected premises, change or clean and disinfect their clothing and foot-gear and must also clean and disinfect the hands and other parts of the body which may have come in contact with the diseased animals. 2. The manure is to be permitted to remain in the stable until the final disinfection. If it is necessary to remove it, then it is to be composted (§ 14, subdivision 1, No. 1) on the premises or in some other suitable place from which the infectious material cannot spread; or, if this is not possible, it must be wet with concentrated milk of lime before removal. Manure which cannot be composted on the premises can only be removed with the permission of the sanitary authorities; it must be hauled to the field in tight wagons and imme- diately plowed under or composted. In the latter case, access of strange sheep must be prevented until the composting is finished. 3. At the final disinfection, the stables and other compartments in which diseased or suspected animals have been kept, the equipment and utensils which came in contact with such animals or their eliminations, and the clothing and foot-gear of the attendants are to be cleaned and disinfected. Any of the disinfectants named in § 11, subdivision 1, may be used in the disinfec- tion, which is to be carried out as directed in § 14. 4, Feed and straw stored in infected stables or over such stables above a loose ceiling are to be thoroughly aired and used only on the infected premises or rendered harmless, Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS 197 Dourine and Vesicular Eranthema § 22. No disinfection is required for dourine and vesicular exanthema. Mange [Scab] § 23. 1. During the treatment of the diseased or suspected horses or sheep, or of sheep flocks in which the disease exists, the stables, hurdles, equipment, utensils, blankets, cleaning implements and other objects which have come in contact with such animals are to be cleaned and disinfected. When the animals are treated by dipping, the cleaning and disinfection is to be carried out at each dipping. If the animals are treated by hand applica- tions, the cleaning and disinfection is to be repeated at shorter or longer inter- vals according to the degree of the disease. After the completion of the curative treatment, the final disinfection is to be made. 2. Stables or other compartments and hurdles used by horses or sheep affected with mange before slaughter, or before treatment was begun, must be immediately cleaned and disinfected after the diseased animals are removed. 3. The disinfection is carried out as directed in § 14. As disinfectants, dilute cresol water, carbolic acid solution or lime are to be used. Special attention is to be given to all objects with which the diseased or suspected animals have come in contact (mangers, racks, posts, pillars, stalls, tie ropes, halters, harness, saddles, cleaning instruments, blankets, housing, clothes of attendants, wagon poles, etc., in connection with horses; hurdles, racks, mangers, posts, sheep folds, sheep shears, shovels, manure, clothing and foot- gear of the attendants, etc., in connection with sheep). 4, The manure from the infected stables is to be removed to the field and immediately plowed under. If the latter cannot be done at once, the sheep are to be kept away from the manure until the work is finished. [The regulations of the U. S. Bureau of Animal Industry (B. A. I. order No. 143) regarding disinfection for cattle mange and sheep scab are as follows: Regulation 28. Cars and other vehicles, yards, pens, sheds, chutes, etc., which have contained diseased cattle shall be cleaned and disinfected in the following manner: Remove all the litter and manure and then saturate the interior surfaces of the cars and woodwork, flooring, and ground of the chutes, alleys, and pens ‘with a 5 per cent. solution of pure carbolic acid in water, with sufficient lime to show where it has been applied. Regulation 37. Cars and other vehicles, yards, pens, sheds, chutes, etc., that have contained diseased sheep shall be cleaned and disinfected in the following manner: Remove all litter and manure and then saturate the in- terior surfaces of the cars and the woodwork, flooring, and ground of the sheds, alleyways, and pens with a solution containing 5 per cent. of pure Digitized by Microsoft® 198 GENERAL THERAPEUTICS FOR VETERINARIANS carbolic acid or with a solution containing 2 per cent. of cresol. When cresol is used it must be mixed with soft soap in order to render it easily soluble in cold water.] Swine Plague and Hog Cholera § 24. 1. Manure, bedding, feed residue, etce., removed from infected pens are to be composted (§ 14, subdivision 1, No. 1). If this is not feasible, then these materials are to be burned or buried with the cadavers of animals which die or are destroyed. The rejected parts of slaughtered diseased ani- mals are also to be buried or burned and the offal, including the water used to wash the meat and viscera, is to be rendered harmless. 2, The passageway between the pens, the place before the stable door, the entrance to the yard and the roads to the stable and on the farm are to be cleaned-and disinfected with dilute calcium chloride solution or 6 per cent. cresol water at least every 8 days during the continuance of the disease. 3. Utensils, vehicles, vessels and other articles which have come in con- tact with diseased or suspected animals or with their eliminations are to be disinfected before being removed from the premises. 4, At the final disinfection the places in which the diseased or suspected animals have been kept (pens and adjoining compartments such as the feed- cooking room, exercise place, yard, breeding pen, stock-yards, railroad stock pens, etc.), the utensils (buckets, forks, shovels, troughs, etc.) used in caring for and in slaughtering such animals, the vehicles and sleds used to haul the cadavers, straw, manure and other offal, the clothing and foot-gear of the attendants, feed sacks and other articles which have come in contact with diseased or suspected animals or which there is reason to assume may be infected, are to be cleaned and disinfected. Special attention is to be given to objects contaminated with the manure, urine and blood of diseased or suspected animals, The manure and straw are to be removed from the rooting- place and the superficial layer of earth is to be removed, after which, if pos- sible, the surface of the ground is to be thoroughly saturated with dilute calcium chloride solution or with 6 per cent. cresol water, then raked or har- rowed until level and repeatedly saturated with the disinfectants named. New swine brought on to the premises are to be kept away from the rooting- place as long as possible. Earth removed from the floors and other places is to be removed to fields not accessible to swine and buried or plowed under. 5. The disinfection of the pens and other compartments used by diseased or suspected animals is to be carried out according to the directions in § 14. As disinfectants, dilute calcium chloride solution or 6 per cent. cresol water are to be used. [The regulations of the U.S. Bureau of Animal Industry (B. A. I. order 143) contain the following regarding disinfection for hog cholera and swine plague: Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS 199 Regulation 45. Cars and other vehicles and pens or yards which have contained interstate shipments of diseased or exposed swine shall be cleaned and disinfected as soon as possible after unloading. Cars that have contained interstate shipments of swine shall not be removed until the inspector has ascertained the condition of the live animals and either released the cars or given notice that they shall be cleaned and disinfected. Cleaning and dis- infection shall be done by first removing all litter and manure and then satu- rating the interior surfaces of the cars and the woodwork, flooring, and ground of the chutes, alleys, and pens with a 5 per cent. solution of pure carbolic acid in water, or with a solution containing 2 per cent. of cresol. When cresol is used it must be mixed with soft soap in order to render it easily soluble in water. (Subsequently, it was found that a 3 per cent. solution of the official liquor cresolis compositus was more efficient than the carbolic acid solution.)] Swine Erysipelas § 25. 1. When swine erysipelas is present, the cleaning and disinfection includes, as a rule, the pen occupied by the diseased or suspected animal; when several cases occur a certain portion of the building or the entire build- ing occupied by swine is to be disinfected, as in the judgment of the official veterinarian may be necessary; also, the equipment, utensils and other ob- jects which have come in contact with diseased or suspected animals or their excretions, cadavers or cadaver parts. The pen occupied by the diseased or suspected animals, a portion of the building or the entire building, as may be required, is to be cleaned and disinfected immediately after the death, slaughter or removal of all the swine, or within 6 days after the last case of the disease. 2. The disinfection is to be made as directed in §18. Any of the disin- fectants named in § 11, subdivision 1, may be employed. Fowl Cholera and Fowl Pest § 26. 1. The coops and other compartments occupied by diseased or suspected fowl, the cages, other containers and transportation crates, the run, baths or swimming pools, the utensils and other objects which have come in contact with such fowl, their excretions, cadavers or cadaver parts, and the places where such fowl have been slaughtered are to be cleaned and disinfected as prescribed in § 14. Any of the disinfectants named in § 11, subdivision 1, may be employed. 2. Special attention must be given to the eliminations of diseased or sus- pected fowl and to blood escaping at the slaughter of the same. This offal is to be carefully collected and buried or burned with the cadavers, together with the litter, manure, feathers, feed residue, earth removed from unpaved floors and from the run, and all other objects of slight value which are con- taminated with manure or blood. Rejected parts of slaughtered, diseased or Digitized by Microsoft® 200 GENERAL THERAPEUTICS FOR VETERINARIANS suspected fowl and other slaughter offal are to be rendered harmless by being burned or buried. Offal of such a nature that it cannot be burned must be collected together and thoroughly mixed with an equal amount of milk of lime and then buried. The surface layer of earth is to be removed from the runs and the ground is then to be wet with concentrated milk of lime. Lime or concentrated milk of lime is to be mixed with the water in the swimming pools or baths in the same manner as it is mixed with liquid manure (§ 14, No. 2, subdivision 1); after 24 hours the water is to be removed and the sides and bottom of the pool or bath disinfected with concentrated milk of lime. 3. Large quantities of manure may be composted. Feathers in dry condi- tion may be removed from infected premises packed in closed sacks, with the approval of the sanitary authorities, Tuberculosis § 27. 1. Immediately after cattle in which tuberculosis is established according to law or in which its presence appears probable are removed, the stalls occupied by them are to be cleaned and disinfected. 2. The cleaning and disinfection, as a rule, includes the stall, but in the event of the occurrence of several cases, or if the diseased or suspected animal has occupied different stalls in the stable, then the official veterinarian may require the cleaning and disinfection of a portion of the stable or the entire stable, as he may consider necessary. In every case the equipment, utensils and other objects contaminated by the elimination of the animal are to be cleaned and disinfected, especially the manger, feed vessels, racks, water troughs, the alleys and walls adjoining the stall, the floor, and the cleaning and milking utensils. 8. The disinfection is to be carried out according to §13. Milk pails and other milk vessels are to be disinfected by steam, by boiling or by scrubbing with boiling hot water or boiling hot soda solution (see § 11, sub- division 1, Nos. 9 and 10). [Southern Cattle Fever The regulations of the U. S. Bureau of Animal Industry (B. A. I. order 143, amendment 4) require that cars which have carried cattle from the quarantined area shall be cleaned and disinfected as follows: ‘‘Remove all litter and manure from all portions of the cars, including the ledges and framework outside; wash the exterior and interior of the car until clean and saturate the entire interior surface, including the inner surface of the car doors, with the disinfecting material.” Boats which have carried cattle from the quarantined area must be cleaned and disinfected as follows: ‘Remove all litter and manure from the decks, stalls, and all other parts of the boat occupied or traversed by such cattle, and from the portable chutes or other appliances or fixtures used in loading Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS 201 and unloading same, and wash them until clean, and saturate the entire sur- face of the decks, stalls, or other parts of the boat occupied or traversed by the cattle, or with which they may have come in contact or which have con- tained litter or manure, with the disinfecting material.” Yards, pens, chutes, and alleyways used by cattle from the quarantined area must be cleaned and disinfected as follows: ‘Empty all troughs, racks, or other feeding or watering facilities and wash them until clean; remove all litter and manure from the floors, posts, or other parts and wash them until clean, and saturate the entire surface of the fencing, troughs, chutes, floors, walls, and other parts with the disinfecting material. ‘As materials for the disinfection of cars, boats, pens, chutes, and alley- ways which have contained cattle of the quarantined area one of those indi- cated below shall be used. (1) A mixture made with not more than 1144 pounds of lime and 14 pound of pure carbolic acid to each gallon of water. In lieu of the pure carbolic acid required to make this solution a proper quantity of s0- called ‘crude carbolic acid’ of known strength (but not less than 25 per cent. pure) may be used, sufficient to make a disinfecting solution containing 5 per cent. of the pure acid. (2) Any coal-tar creosote dip permitted in the official dipping of sheep for scabies, provided the same is used at one-fifth the maximum dilution (five times the minimum strength) specified for dipping sheep. “The litter and manure removed from cars, boats, or other vehicles, and from pens, chutes, alleyways, or other premises or inclosures which have contained cattle of the quarantined area, shall not be so located or stored that they come in contact with cattle in course of interstate transportation unless disinfected by one of the methods specified below. (1) It may be disinfected by saturating it with any disinfecting material specified in the preceding paragraph of the strength and composition indicated therein, except that the lime may be omitted. (2) It may be stored without disinfec- tion during the period from February 1 to October 31, inclusive, of each year; when stored as above indicated, the storage space shall be tightly inclosed and s0 situated or so surrounded by cattle-proof fences or other structures that no cattle other than cattle of the quarantined area may approach closer to it than 15 feet.”’] II. THE MOST IMPORTANT DISINFECTANTS FOR ANIMAL INFECTIONS ‘Calx.—Lime. Freshly slaked lime (caustic lime) is a good and easily prepared disinfectant for spore-free bacteria. It is also the cheapest disinfectant. Anthrax spores and tubercle bacilli are, however, not killed by lime. It is used in the form of a powder, Digitized by Microsoft® 202 GENERAL THERAPEUTICS FOR VETERINARIANS concentrated milk of lime (1 : 3) and dilute milk of lime (1 : 20), the concentrated solution being applied as a whitewash, and the dilute solution being used to disinfect the floors and also as an addition to manure and urine. A single application of dilute milk of lime (1 : 20) kills the bacteria of fowl cholera, a triple application (1 : 20) destroys the bacilli of glanders; a single application of concentrated milk of lime (1 : 3) kills the bacilli of swine erysipelas, the hog cholera bacillus, the anthrax bacilli and typhoid fever bacilli. Lime operates only in its free state as a caustic; it loses its disinfectant properties as soon as it combines with acids; the carbonate, phosphate, sulphate and nitrate of lime are ineffective. It must be added to the substances to be disinfected (manure, urine) in sufficient quantity to make the reaction of the mixture strongly alkaline, because, under certain conditions, the growth of microérganisms is facilitated if the reaction of an acid substance is rendered neutral or only weakly alkaline. Since the preparation of milk of lime from burned lime is somewhat difficult and complicated, lime from lime pits may be used, but the upper layer should first be removed. Special consideration has been given to the disinfection of manure from slaughter houses and cattle yards with lime, espe- cially the composting of manure with and without lime. With the exception of anthrax, black leg, glanders, rinderpest and rabies, in which it is best to burn the manure, in all other cattle infec- tions the manure can be certainly, simply and cheaply disinfected with a fresh, dilute milk of lime and without injuring its agricul- tural value. In composting without lime, a temperature suffi- ciently high (60 to 70°C.) is developed to exert a disinfectant action upon the organisms of swine erysipelas, fowl cholera, glanders, contagious pneumonia, strangles, tuberculosis, hemor- rhagic septicemia, etc., provided care is taken to have the manure moderately moist (straw: manure—3: 2), piled rather loosely and covered with material that conducts heat poorly (Pfeiler, Bohtz). Calx chlorinata. Chloride of lime. This is more powerful than lime; in a solution of 1 : 3 it kills even anthrax spores. It is therefore superior to lime for whitewashing walls, washing floors, Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS 203 etc., in infectious outbreaks; also, for the destruction of infectious material difficult to destroy, especially as a cheap disinfectant for anthrax spores and for the disinfection of urine. According to Hansen (Monatshefte fiir prak. Tierheilkunde, 1912) the addition of 0.2 per cent. of calcium chloride to liquid manure is a certain and cheap disinfectant and is not harmful to vegetation and does not destroy the fertilizing value. Chloride of lime is uncer- tain against glanders and tuberculosis. A 1 per cent. solution kills the bacteria of fowl cholera, swine erysipelas and hog cholera and the bacilli of anthrax in one minute. Freund recommends the use of a 5 per cent. filtered solution of chloride of lime for the disin- fection of railroad cars; the process is very complicated (spraying with a pumping apparatus under 114 atmospheres pressure). The formerly much used chlorine gas, in the presence of sufficient moist air and in strong concentration (1 per cent. by volume), will destroy all air-dried microdrganisms within 24 hours, but for practical disinfection it is of no value because the necessary concentration is difficult to obtain and is very costly. The proc- ess of chlorine disinfection is also very complicated and dangerous. The same applies to bromine. Lyes. The antiseptic effect of the lyes was formerly over- valued; their disinfection power is about equal to lime. Soda lye, potash lye, soda and potash are in general of the same value. Ammonia, on the other hand, is three to five times weaker. Con- centrated solutions of these substances kill the bacteria of fowl cholera and swine erysipelas and glanders and anthrax bacilli. Anthrax spores and tubercle bacilli, on the other hand, remain intact. An objection is the caustic action of solutions of the re- quired concentration. Boiling hot soda solution possesses a very high disinfection power. Soaps. The disinfectant value of soaps depends upon their alkali content; the ordinary soft soap is therefore the most power- ful. The action is increased by using boiling-hot soap water. The latter kills the more readily destroyed infectious agents and at the same time has a cleansing effect which assists the action of the stronger antiseptics. A 10 per cent. solution of the ordinary Digitized by Microsoft® 204 GENERAL THERAPEUTICS FOR VETERINARIANS soft soap (or of ordinary washing lye) will kill anthrax spores in 10 minutes if heated to 80°C. Heating the soap solution (and the soda solution) to 50° C. is not sufficient. Acids. They are in general poor antiseptics, but are coly- septics (inhibit development of bacteria). Sulphuric acid does not kill anthrax spores in 1 per cent. solution even after 20 days’ action; its irritant effect upon the skin and mucous membranes is also objectionable. The experiments with acid turf litter (foot- and-mouth disease) therefore proved unsatisfactory. On the other hand, a combination of hydrochloric acid (2 per cent.) with sodium chloride (10 per cent.) is a strong disinfectant; this “pick- ling fluid” disinfects anthrax and black leg hides with certainty. Hydrargyri chloridum corrosivum. Corrosive sublimate. The strongest and quickest disinfectant for all bacteria, especially all spore-forming microérganisms (anthrax spores), with the excep- tion of tubercle bacilli; odorless, very cheap and easily and con- veniently transported (sublimate tablets). Anthrax spores are destroyed with certainty and quickly only by sublimate. A 1:1000 solution destroys all of the organisms of the infectious diseases, | including anthrax spores. The disinfectant action is increased by the use of warm solutions. The decomposition of the sublimate by ordinary water may be prevented by the addition of sodium chloride (sublimate tablets) or organicacids. When the disinfection is done carefully, the poisonous properties of sublimateare of no con- sideration, not even in the disinfection of cattlestables (subsequent washing with 14 per cent. solution with sulphuretted potash). Phenol. Carbolic acid. A weak disinfectant (100 times weaker than sublimate, 10 times weaker than creolin, lysol, etc.); ineffective against anthrax spores. On the other hand, the glanders bacillus and the less resistant bacteria (anthrax bacilli, etc.) are quickly killed by a 2 per cent. solution. A 5 per cent. solution is necessary to destroy tubercle bacilli. The odor of carbolic acid is unpleasant and is transmitted to the meat and milk (poisoning of man). Carbolic acid disinfection is also relatively expensive. Cresol. (*Creolin, *lysol, *bacillol.) A very effective and cheap disinfectant; far superior to carbolic acid; effective against Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS 205 anthrax spores and rabies virus. Anthrax bacilli are destroyed by a solution of 1 : 5000. Used in 1 to 8 per cent. solution in water. For extensive disinfection, especially of railroad cars, Fischer and Koske (Arb. aus d. Kais. Gesundheitsamt, 1903) recommend a 3 per cent. solution in water of a mixture of 2 parts of cresol and 1 part of sulphuric acid as more effective and cheaper than *lysol or “liquor cresolis saponatus. Cresol-sulphuric acid solution to which sodium chloride is added only freezes when the temperature falls to 17 to 8.6°F., which makes it especially suitable for, winter disinfection (Kraut, ibid., 1907). Pix liquida. Tar. An excellent disinfectant covering. Wood tar kills all pathogenic microérganisms, including anthrax spores and tubercle bacilli. Coal tar destroys with certainty the bacilli of anthrax, glanders and swine erysipelas, etc. Liquor formaldehydi. Formaldehyde is recommended as a gaseous disinfectant for closed compartments, especially railroad cars; very high disinfectant power. A certain disinfectant action, however, can only be obtained by the employment of complicated apparatus (lamps). On account of the volatility of formaldehyde, the compartment to be disinfected must be made air tight (im- possible with cattle cars). Furthermore, the disinfectant action is only superficial, and anthrax spores are not destroyed. The process is very expensive (a compartment of 100 cubic metres requires the action of 500 grams of formaldehyde, or 114 liters of the official so- lution for 314 hours). Disinfection with fluids, 2 to 214 per cent. of formaldehyde, has the same disadvantages and is also injurious to health. See the investigations of von Perkuhn concerning the dis- infection of stables with formaldehyde vapor by means of Lingner’s apparatus (Monatshefte fir prakt. Tierheilkunde, 1905). *Autan. This preparation, which is used in a new method of formaldehyde disinfection, is in the form of a dry powder contain- ing a quantity of formaldehyde with alkaline peroxides; formalde- hyde vapor is liberated when water is added. Contradictory results have been obtained in the investigations of this new material and the experiments are not yet concluded (a newer and, it is alleged, an improved preparation). The same conditions are Digitized by Microsoft® 206 GENERAL THERAPEUTICS FOR VETERINARIANS necessary for autan as for formaldehyde (see above), especially the complete sealing of the compartment, and a temperature not under 10°C. is also required (not always possible with railroad cars). In addition, autan is also expensive. According to Léffler (Zeitschr. f. Vetkde., 1909), the organisms of swine erysipelas, hog cholera, strangles, fowl cholera, anthrax and tuberculosis are readily destroyed by autan. The disinfection must continue 7 hours, the compartment must be completely sealed and litter and manure must be removed. Chinosol. This preparation is very active in inhibiting the development of bacteria, but has only a slight antiseptic action. It is ineffective against anthrax spores; very expensive, gives an unpleasant odor to the animal body, is not absolutely non-toxic and cannot be used for the disinfection of iron objects, manure, etc., because it is decomposed by iron and alkaline substances. Heat.—1. A glowing heat acts the strongest (disinfection of chains and other iron objects). 2. Burning is the best method of rendering anthrax and black leg cadavers harmless; a burning process which has proven satis- factory in practice has been described by Lothes and Profé (Fort- schritte der Hygiene, 1904). 3. The disinfectant action of dry heat is generally overrated. Spore-free bacteria are killed by dry heat of 100°C. In the usual method of employing dry heat (oven), however, 100°C. of heat does not penetrate the object of disinfection because dry air is a poor conductor of heat. Spore-containing bacteria (anthrax spores) require much higher degrees of heat (140° C.) operating for hours. The spores contain an almost water-free albumin, which it is very difficult for the dry heat to penetrate. With the employment of the hot air sterilizer (oven, 140° C.), the heat in the interior of the object to be disinfected is usually insufficient. After 3 hours’ exposure to 140°C. in a hot air sterilizer, a wool- covered ball showed a temperature of only 35° C. in the centre. 4. Boiling water kills spore-free bacteria in a short time (boil- ing the milk in foot-and-mouth disease). Heating milk for 20 minutes at 65° C. kills tubercle bacilli, colon bacilli, streptococci Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS 207 and staphylococci (pasteurization). Anthrax spores withstand boiling temperature. Since the heat only penetrates large, solid objects slowly, it is recommended that the boiling be continued for at least one hour. Boiling water is not a certain disinfectant when used in the disinfection of stables because it cools rapidly when spread out on cold surfaces. In disinfecting by boiling, the water containing the object to be disinfected is placed upon the fire cold and is allowed to remain for at least 14 hour after boiling begins; the vessel is to be covered. The German veterinary sanitary laws require that when foot-and-mouth disease is present milk shall be disinfected by boiling, and that in the case of tuberculosis it shall be sufficiently heated, z.e., heated over an open fire until it repeat- edly boils, exposed to live steam at 85° C., or heated in a water bath at 85° C. for a minute or at 70° C. fora half hour. The action of hot fluids is especially effective when a disinfectant is added. 5. Live steam of a temperature of 100° C. is the most effective form of disinfection by heat (sterilizing apparatus) and should therefore be preferred, when convenient, to boiling; has not only a superficial but also a deep action. Anthrax spores and tubercle bacilli are killed in 5 minutes. The best results are obtained with an atmospheric pressure of about one-tenth. It is important that the temperature be not permitted to fall below 100° C., and that an abundant supply of steam be introduced into the apparatus in order that the air (poor heat conductor) will be expressed as completely as possible (apparatuses of Henneberg, Rohrbeck, Lautenschliger, etc.). Disinfection with steam is most suitable for blankets and clothing; on the contrary, leather articles (saddles, girths, halters) are spoiled. Stables, railroad cars and large com- partments in general cannot be disinfected with steam on account of its rapid cooling. In using steam on railroad cars, it was found that the highest temperature of the steam at the outlet tube was 90-95° C.; slightly removed from the outlet tube (4 inches) the temperature was only 60° C., 40 inches distant 50° C., 80 inches distant 20° C., while 16 to 20 feet distant the temperature was raised only a few degrees (Redard and Colin), A temperature of 100° C. cannot be attained in a stable even with steam from Digitized by Microsoft® 208 GENERAL THERAPEUTICS FOR VETERINARIANS boilers carrying 8 atmospheres pressure (Kramell, Zeitschr. f. Vet., 1901). On the other hand, milk cans and other small vessels are surely disinfected with live steam under moderate pressure (Junack, Monatshefte f. prakt. Tierheilk., 1904). The addition of a slight quantity of a chemical disinfectant increases the effec- tiveness of steam considerably; hides and leather articles (saddles) which will only bear steam at 70° C. are disinfected in a relatively short time by steam at 70° C. containing 1 to 2 per cent. of for- maldehyde, even anthrax spores being destroyed in 5 minutes (von Esmarch, Hygien. Rundschau, 12 Bd.). Cold cannot be used for disinfection. Very low temperatures (—100° C.) do not destroy anthrax spores. Even the bacteria of fowl cholera, which are rather easily destroyed, resist. a tempera- ture of —4°C. MECHANICAL DISINFECTANTS.—1. Burial is a very important method of disposing of infected carcasses, cadaver parts, manure, etc. (see the regulations for anthrax, rabies, glanders and lung plague). Bacteriological investigations have shown that the earth is free from bacteria at a depth of 5 feet, provided the excavation is not made in the neighborhood of houses, stables, manure pits, wells, etc., and does not reach the ground water. Most of the pathogenic bacteria, except anthrax spores and tuber- cle bacilli, die very soon in buried cadavers. Anthrax spores, however, retain their virulence many years and tubercle bacilli for several months (cholera and typhoid fever bacilli in human bodies die in 2 to 3 weeks after burial). Investigations have shown that the earth of cemeteries containsno more bacteria than theearth of cultivated fields at an equal depth. On account of the possibility of buried spores being disseminated (earth worms, moles), itisrecom- mended that anthrax carcasses be buried in cemented pits. 2. Drying in the air has a very slight disinfectant action. An- thrax spores retain their virulence in dry placesfor years, and most of the more readily destroyed bacteria die only after several weeks. 3. Light assists the disinfectant action of the antiseptics. Spores appear to be more susceptible to light than the bacilli: Anthrax spores are killed by sunlight in 5 hours, while the bacilli Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS 209 are destroyed only after 30 hours (Arloing, Roux). Tubercle bacilli are killed by direct sunlight in a few hours and by diffuse daylight in a few days (R. Koch). The contagion of rinderpest is affected in the same manner (Theiler). Direct sunlight exerts a powerful disinfectant action upon coli bacilli and the organisms of swine plague, hog cholera, swine erysipelas and fowl cholera, while diffuse daylight also possesses disinfectant properties but in less degree (Neumark, Dissertation, 1907). Perhaps this explains the milder course and less frequent occurrence of some of the infectious diseases in the summer (contagious pneumonia). From the foregoing it follows that the admission of light into dark stables and the airing of blankets essentially assist disinfection. Other mechanical methods include: whitewashing or painting (lime, calcium chloride, tar, varnish, paint, lacquer), which covers and fixes the bacteria and prevents their increase; scouring, cleansing, washing, sweeping, wiping, rubbing (rubbing the car- pet with bread), exclusion of air (closing a room before disinfec- tion) and above all washing with soap. The latter is sufficient in many cases, especially for infectious material that is readily destroyed. 3. DISINFECTION OF WOUNDS The Most Important Antiseptics for Wounds.—The general statements already made (p. 170) are to be considered in connec- tion with the choice and judgment of the individual antiseptics employed in the treatment of wounds. In the first place, atten- tion is to be given to the different disinfectant values of the individ- ual antiseptics and to the resistance of the microdrganisms con- cerned in wound infection to these agents. As already mentioned on page 175, the resistance of these organisms lies about midway between that of the anthrax and black leg spores, which are diffi- cult to kill, and that of the easily destroyed anthrax and swine erysipelas bacilli. The staphylococci and streptococci especially cannot be destroyed by the milder disinfectants, but require the more powerful antiseptics (corrosive sublimate, creolin, lysol, tannoform, carbolic acid, tincture of iodine, aluminum acetate, silver nitrate). Other points to be considered are the degree of 14 Digitized by Microsoft® 210 GENERAL THERAPEUTICS FOR VETERINARIANS toxicity of the disinfectant, its irritant effect upon the wound, its decomposition by the wound secretions, the duration of its action upon the wound, the concentration and form, the price, and the stage of healing in the wound. In general, the rule to follow is to choose the most effective disinfectant which can be used in solu- tion or in powder and which at the same time is the least irritant, the least liable to decomposition, the least poisonous and the cheapest; and to apply it to the wound as early as possible (tanno- form!) and to permit it to operate as long as may be practicable. A thorough cleansing should precede the disinfection. The aseptic treatment of wounds has already been discussed on page 171. In regard to the most important antiseptics for the treatment of wounds, the following may be mentioned: Hydrargyri chioridum corrosivum. Corrosive sublimate. A powerful but poisonous antiseptic. A 1 to 1000 solution quickly destroys all microédrganisms concerned in wound infection. It may be used as a wound disinfectant on all animals except rumi- nants. It is especially poisonous for cattle and it should not be used on these animals. In contact with albuminous wound secre-~ tions, corrosive sublimate is in part precipitated in the form of albuminate of mercury and in part decomposed (formation of mercuric oxychlorides). These decompositions, however, do not essentially affect the antiseptic action of the sublimate qualita- tively; and, furthermore, they can be prevented by the addition of sodium chloride, hydrochloric acid or acetic acid. The advan- tages of corrosive sublimate are its strong disinfectant properties, its lack of odor, cheapness and convenience (sublimate tablets). Its disadvantages are its high toxicity, especially for cattle; its strong irritant action, especially upon the mucous membranes of the eye (ophthalmology) and uterus (obstetrics), and its rapid formation of an amalgam with instruments. *Creolin, *lysol! and other cresol compounds. The antiseptic action of cresol preparations is very powerful and rapid. A 3 per cent.solution destroys all of the organisms concerned in wound infec- tion immediately. The disinfectant action of cresol is ten times [! The official liquor cresolis compositus is very similar.] Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS 211 stronger than that of carbolic acid; it possesses deodorizing prop- ties and is relatively non-toxic. Its disadvantages are the odor, the irritant effect of strong solutions upon the mucous membranes and the partial turbidity of the solutions. _ Phenol. Carbolic acid has a relatively good antiseptic action. A 3 per cent. solution kills most of the organisms concerned in wound infection after prolonged action. It is less effective, how- ever, against tetanus bacilli, rabies virus, tubercle bacilli and anthrax spores. Castration clamps transmitted tetanus 18 months after they were infected, although they were immersed for five minutes in a 4 per cent. carbolic acid solution. The advantages of carbolic acid are that it does not decompose and is constant in its composition. The disadvantages are the odor, high price and the irritant and poisonous properties, the latter especially for cats. Todoformum. Iodoform. An excellent, mild antiseptic, which stimulates granulation; may be employed in the form of ether solution (1 : 5-10). The disadvantages are its odor, high price, toxicity for dogs (licking) and insolubility in water. Similar preparations, which are much more expensive and therefore not adapted to veterinary practice, are *loretin, sozoiodol, *losophan, *iodophen, *europhen, “*aristol, *iodoformin, *iodoformogen, iodol, *iodine trichloride (very unstable), and others. *Tannoform. The best remedy known at this time for form- ing aseptic scabs, and also a dry antiseptic. Applied early to fresh wounds, it prevents suppuration (healing under a scab). It is to be preferred to iodoform, especially for horses, on account of its stronger antiseptic action, lack of odor and lower cost. The other condensation products of formaldehyde, *glutol, *amylo- form, etc., are more expensive and less constant in their action than tannoform. Liquor formaldehydi in 1 to 2 per cent. solution is a strong disinfectant but very irritant to wounds; in concen- tration it is a strong caustic (caution!). Tincturaiodi. Tincture of iodine has been employed recently to disinfect the skin in place of the older and more complicated process (method of Grossich), being simply painted on the field of operation. Argenti nitras, Nitrate of silver is an excellent wound remedy. Digitized by Microsoft® 212 GENERAL THERAPEUTICS FOR VETERINARIANS It possesses a high disinfection value (a 1 to 1000 solution destroys pus cocci), is an important regulator of abnormal granulations and covers the wound with a scab (silver scab). This is also true of the other very expensive silver preparations (*actol, *itrol, *protargol). *Aluminum acetas. Acetate of aluminum. An excellent, non- poisonous antiseptic in 2-8 per cent. aqueous solution (also con- tained in Burow’s mixture?); preferred on account of its cheapness to the more expensive substitutes *alumnol, *tannal, *gallal, *sozal, *boral, *saluminal, *kutol, etc. Alcohol. An important disinfectant for the hands of the operator and for the skin of the operation field; acts best in 50 per cent. solution in water or sublimate solution (absolute alcohol has only a weak antiseptic action). Soap spirit? is also recom- mended. The alcoholic tincture of aloes [tinctura aloes] is an ex- cellent antiseptic and stimulant to granulation for old wounds. Acidum salicylicum. Salicyclic acid is a very mild antiseptic, but is non-toxic, odorless and non-irritant; used especially in ophthalmology, also to wash out internal organs. Thioform (dithiosalicylate of bismuth) is recommended as a substitute for iodoform, especially because it is odorless and non-toxic (but is very expensive). . Bismuth salts. Like tannoform, these are employed as desic- cant, astringent, dry antiseptics, but are very expensive. Those most frequently used are bismuthi subnitras, subsalicylas, sub- gallas (dermatol),and dithiosalicylas (thioform), and *airol (iodized dermatol). The latter in the form of airol paste‘ is an excellent substitute for dressings and bandages for wounds; it is aseptic, non-irritant, easily applied, adhesive, plastic and dries quickly. Acidum boricum. Boric acid is a mild, non-toxic, odorless antiseptic without pronounced action (ophthalmology). Sodii boras, *magnesii boras, *boral, *antipyonin, *rotterin, *anti- septin, *borol and other preparations containing boric acid act in the same manner. 2? Alum 5 parts, lead acetate 10 parts, water 250 parts.] [? Equal parts of green soap and alcohol.] (‘ Airol, glycerin and acacia, each 1 part, argilla 2 parts.] Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS 213 Zinci chloridum. Chloride of zinc is a caustic, alterative anti- septic (2 to 8 per cent. solution) of relatively weak disinfection power (a regulator of abnormal granulations). Potassii permanganas. Permanganate of potassium is a mild antiseptic; specific against snake bites and rabies virus. Camphora. Camphor is a powerful antiseptic, especially for “flabby” granulations and phlegmonous, ulcerative and necrotic processes (camphor spirit bandage). Oleum terebinthinz, teré- binthina (old hoof remedy), thymol, oleum eucalypti, balsamum peruvianum and other ethereal oils act in the same manner. Pix liquida. Tar. An excellent antiseptic, especially for wounds on the hoof and claws; wood tar is better than coal tar. Liquor chlori compositus. Chlorine water. A strong antiseptic; specific against rabies virus and snake bites; used in ophthalmology. *Pyoctanin. A powerful antiseptic. Disadvantage: blue stain. 4, INTERNAL ANTISEPTICS A number of infectious diseases may be effectively combated by the internal use of antiseptics. The antiseptics used for this purpose include some of the specifics: salicylic acid, the principal remedy in acute articular rheumatism; quinine, the specific for malaria; mercury, salvarsan and iodine as specifics for syphilis of man, salvarsan and atoxyl as specifics against trypanosomes and spirilla, and salvarsan in contagious pneumonia of horses (“Ther- apia sterilisans magna’’) ; also creolin, whichis very effectiveagainst anthrax in cattle and horses; creosote, as an internal remedy in tuberculosis; calomel, salicyclic acid, bismuth salts, tannin and boric acid as intestinal disinfectants in dysentery, influenza, canine distemper, swine erysipelas, fowl cholera and mycotic and infectious inflammations of the intestines; and tar and oil of turpentine in infectious and parasitic affections (lung worm dis- ease) of the respiratory tract. Infectious materials in the blood are also destroyed through serum therapy (see the chapter on protective vaccination and methods of immunization). In internal antisepsis, even more than with external antisepsis, care must be taken to avoid a general poisoning of the body. Digitized by Microsoft® 214 GENERAL THERAPEUTICS FOR VETERINARIANS 5. THE CONSERVATION OF ANIMAL PRODUCTS Methods of Conservation.—The conservation of organic animal substances has for its purpose the prevention of the decom- position, putrefaction and fermentation processes which occur, as a rule, after the death of the animal organs. This is accomplished by the destruction of the microérganisms concerned in the de- composition and fermentation processes and by preventing the access and development of additional organisms. In most cases the conservation concerns meat and milk; in addition, cadavers, hides and other parts of the carcass also require attention. Since the microérganisms concerned can only multiply in an atmosphere with a certain oxygen content and a certain amount of moisture, within certain temperature limits, and upon proper nutritive media, they may be destroyed in different ways in addition to the employment of antiseptics. 1. The conserving agents which act antiseptically correspond essentially with the disinfectants. Usually, several substances are used together to increase the conserving action. A distinction must be made between the non-toxic agents, which can be used to conserve meat and milk, and the toxic substances, which serve to preserve parts of cadavers. The non-toxic meat and milk preser- vatives are: sodium chloride, potassium nitrate (salting, pickling), sodium phosphate, sodium acetate, vinegar, sugar, glycerin, smoking and hydrogen peroxide. The mixtures of conserving agents must not contain toxic substances or those which are not entirely non-toxic (boric acid, salicylic acid, sulphurous acid, fluoride of soda, ammonium acetate, formalin, potassium per- manganate). Poisonous preservatives for parts of cadavers are corrosive sublimate, arsenic, hydrocyanic acid, creosote, carbolic acid, methyl alcohol, chloroform, ether, acetone, chloral, copper sulphate, zinc sulphate, iron sulphate, zinc chloride, copper chloride, aluminum chloride, iron chloride, alum and hyposulphites. Wickersheimer’s conserving fluid for cadavers (arsenic 10 grams, sodium chloride 25 grams, potassium nitrate 12 grams, potash 60 grams, methyl alcohol 1 liter, glycerin 4 liters, water 10 liters) is well known. Digitized by Microsoft® DISINFECTANTS. ANTISEPTICS 215 2. Exclusion of air. This very simple method of conservation is usually used in connection with previous heating (sterilization, pasteurization). The simple exclusion of air is obtained by the different paints (lacquer, oil paints, tar, sealing wax, resin) and by the application of a layer of fat, oil or sugar (sardines, goose- liver pie, sweet conserves). Cotton and asbestos stoppers prevent the entrance of the bacteria contained in the air; this method is used principally in bacteriological technique. Finally, the air can be expelled by carbon dioxide (canned meat). 3. High and low temperatures have a conserving action when they are considerably above or below 4 to 45° C., the optimum temperatures necessary for the development of microérganisms. Sterilization is the process of heating to 100° C. or over. Pasteur- ization is the process of heating to 65 to 100° C. Temperatures of high degree in the form of boiling-heat (frequently with simul- taneous or subsequent exclusion of the air), hot air and live steam are essentially more effective than lower temperatures; they are especially used in the preparation of canned meats (corned beef). Lower temperatures in the form of freezing or storage in cooling- rooms, ice cellars and refrigerators are less effective because the spores are not destroyed but only hindered in their development and also because some of the bacteria are only temporarily be- numbed. Substances conserved in this manner therefore undergo decomposition very rapidly when they are removed from the in- fluence of the cold, since the microédrganisms contained in them immediately begin to multiply. This has been the experience with the cold-storage rooms in slaughter houses and with the over- sea, transportation of meat. 4. Withdrawal of moisture is attained by drying, either through the use of the sun’s heat (codfish) or through artificial heat (carna pura, meat meal). In the preparation of meat meal, the meat, after the removal of the fat and bones, is finely chopped and dried in an oven at 60° C., after which it is finely powdered and enclosed in cans. The so-called condensed milk is also pre- pared by withdrawing water (evaporated to one-fourth the volume), and sugar is added to better preserve it. Digitized by Microsoft® ANTIDOTES Synonyms: Antitoxics, antagonistics, antagonists. Classification—Medicines which are employed in different poisonings are called antidotes. They are of different kinds and operate in different ways. The following groups may be distin- guished: (1) The mechanical or physical antidotes; (2) the chem- ical antidotes; (3) the physiological (dynamic, organic, consti- tutional and empirical) antidotes or antagonists, and (4) the symptomatic method of treating poisoning. 1. The physical or mechanical antidotes operate in a purely mechanical way by removing the poison from the body: emetics, cathartics, diuretics, diaphoretics, sialagogues, washing out the stomach (horse, dog), bleeding, transfusion, artificial respiration; or by enveloping the poison and preventing its absorption or contact with the mucous membrane: protective antidotes (albu- min, milk, oil, mucilaginous substances). Of special practical importance are the emetics, which are immediately administered to the proper animals (dogs, swine and cats) in all fresh cases of poisoning. The most important emetics are apomorphine (dogs, 0.002-0.01, gr. 1/40 to 1/8; cats, 0.02-0.05, gr. 14 to 34, subcutaneously), veratrin (swine, 0.02-0.03, gr. 14 to 1/8, subcutaneously), veratrum alba (swine, 1-2, grs. xv to xxx; dogs, 0.1-0.2, gr. 1/8 to 4, per os or inclyster), ipecac (swine and dogs, 1-3, grs. xv to xlv; cats, 0.25-0.75, grs. iij to xj), tartar emetic (swine, 1-2, grs. xv to xxx; dogs, 0.1-0.3, grs. iss to iv; cats, 0.05-0.2, grs. 34 to iij), copper sulphate in phosphorus poisoning (swine, 0.5-1, grs. vij to xv; dogs, 0.1-0.5, grs. iss to vij; cats, 0.05-0.2, grs. 34 to iij), zinc sulphate (swine, 0.5-1, grs. vij to xv; dogs, 0.1-0.3, grs. iss to iv), and finally the household emetics, sodium chloride (dogs, 1 to 2 teaspoonfuls), mustard (dogs, 1 to 2 teaspoonfuls in a glass of warm water), snuff (dogs, a pinch in a tablespoonful of water), ete. Of the cathartics, eserine (0.05- 0.1, grs. 34 to iss, for horses) and arecoline (0.05-0.08, gr. 34 to 1, for horses) are especially suitable on account of their rapid action; others are aloes (horses, 25-50, 3vj to xii; cattle, 50-75, 3iss to 216 Digitized by Microsoft® ANTIDOTES 217 ijss); castor oil (horses, 250-500, Oss to i; cattle, 500-1000, Oi to ij; sheep and goats, 50-250, Jiss to viij; swine, 50-100, 3iss to iij; dogs, 15-60, 3ss to ij; cats and fowl, 10-80, Zijss to 3i), which, however, is to be avoided in phosphorus, arsenic and cantharides poisoning (solution of the poison); calomel (swine, 1-4, grs. xv to 3i; dogs, 2-4, grs. xxx to 3i; cats and chickens, 0.1, grs. iss); Glauber’s and Epsom salts (in lead poisoning, also a chemical anti- dote). The diuretics, diaphoretics and sialagogues have a much weaker evacuating action and are therefore employed only in chronic poisonings. The protective antidotes are used principally in poisonings by caustics to protect the gastric mucous membrane and to prevent absorption. Those used most frequently are milk, albumin (egg albumin alone or shaken up with water), mucilages (linseed, barley, oat and quince mucilage, acacia, decoctions of althza root, mallow leaves and salep, tragacanth mucilage), fats and oils (lard, butter, peanut oil, olive oil, rape oil, poppy-seed oil, almond oil, castor oil, emulsions). The fatty oils, however, are contraindicated in phosphorus and cantharides poisoning because they promote the resorption of these substances; this is also true of milk or any compound which contains fat. 2. The chemical antidotes prevent poisoning by decomposing the poison or by changing it into a compound which is non-toxic or less poisonous. The simplest example of a chemical antidote is presented by the caustic alkalies and acids, which in combining lose their opposing alkaline and acid characteristics and form neutral salts which are not caustic (potash lye, soda lye, caustic lime, ammonia, carbonate and bicarbonate of soda and of potas- sium, and soap on the one hand, and sulphuric, hydrochloric, nitric, acetic and oxalic acids on the other hand). This group also includes sodium chloride, the specific antidote for silver nitrate, which it transforms into silver chloride (the administration of sodium chloride in corrosive sublimate poisoning is harmful because it promotes the resorption of the sublimate); iron, iron hydroxide and iron oxide, the antidotes for arsenic (formation of arsenate of iron, which is only slightly soluble), hydrocyanic acid, mercury and copper salts; potassium ferrocyanide, the antidote Digitized by Microsoft® 218 GENERAL THERAPEUTICS FOR VETERINARIANS for copper poisoning (non-poisonous ferrocyanide of copper) and for caustic iron salts, e.g., iron chloride (formation of ferrocyanide of iron); copper salts, the important antidote for phosphorus poisoning (formation of insoluble phosphorus copper), magnesia oxide and magnesia carbonate, the antidotes for acids (formation of salts of magnesia), arsenic and metallic salts (decomposition); iodine and the iodides, the antidotes for the alkaloids in general (precipitation) and for chronic metallic poisonings (formation of metallic iodides, which are more soluble and therefore more readily eliminated from the body); potassium bromide, which combines with iodine and iodoform, forming potassium iodide; sulphur and potassium sulphide (hydrogen sulphide), antidotes for mercury, lead, copper, tartar emetic and arsenical poisonings (formation of insoluble metallic sulphides); sulphuric acid and its salts, specific antidotes for lead poisoning (formation of insoluble lead sulphate), carbolic acid poisoning (formation of non-poisonous potassium sulphocarbolate), calcium poisoning (formation of plaster-of-Paris) and barium poisoning (formation of barium sul- phate); the calcium salts (lime water, calcium carbonate, chalk, snail shells, oyster shells, egg shells, marble, sepia stones, sugar lime), antidotes for oxalic acid poisoning (calcium oxalate is insoluble and consequently not poisonous); tannic acid and the plants which contain it (oak bark, cortex salicis, salvia leaves, - coffee, tea, acorns, nutgall, ink, cinchona, catechu, rhatany root, tormentilla, walnut tree leaves), important antidotes for poison- ing by alkaloids and glucosides (formation of slightly soluble or insoluble tannates), also for poisoning by the metallic salts, espe- cially tartar emetic, lead acetate, silver chloride and iron sulphate (formation of metallic tannates); ammonia, chlorine and potas- sium permanganate, local antidotes for snake bites and insect stings; old oil of turpentine and ozone water, antidotes for phos- phorus (oxidation to phosphoric acid), albumin, antidote for the metallic salts (formation of metallic albuminates), caustic acids (formation of serum albumins) and chlorine, bromine and iodine poisoning; gelatin and gum, antidotes for metallic poisonings (sublimate poisoning), alum and tannic acid poisoning (formation of Digitized by Microsoft® ANTIDOTES 219 precipitates); fatty oils, antidotes for poisoning by alkalies and acids (formation of soap); starch, antidote against iodine (blue color), and animal charcoal, antidote for alkaloids and metals. 3. The physiological or dynamic antidotes are not directed against the poison itself but against its action (antagonists), and are administered for the purpose of producing an action which will counteract the effect of the poison (stimulation—paralysis). A distinction must be made between a single, or simple, and a multiple, or mutual antagonism. The antagonism is single when the one poison only suppresses but does not reverse the action of the other; it is multiple when a reciprocal or mutual suppression takes place. We also speak of a true (direct) and an apparent antagonism, depending upon whether both poisons act upon one and the same organ (nervous system, muscles, glands) or upon different organs; curare, for instance, is only an indirect antag- onist of strychnine because it does not act upon the spinal cord, as does strychnine, but upon the peripheral nerves of the muscles. The occurrence of a true multiple antagonism is in general question- able. A paralyzing antidote like atropine can, it is true, overcome the stimulant action of another poison, e.g., the action of eserine upon the oculomotor nerve (mydriasis, myosis), but on the other hand a paralysis of the oculomotor nerve (mydriasis) produced by atropine cannot be overcome by eserine (myotic). The important physiological antidotes are: (a) Atropine and hyoscine (scopo- lamine) as antidotes against morphine, chloroform and chloral hydrate. The antagonism is multiple but in part indirect. The paralytic action of morphine on the brain is overcome directly by the psychic stimulation produced by the atropine; on the other hand, the paralytic effect of the morphine on the heart is overcome by the stimulant action of the atropine indirectly, the atropine stimulating the nerve centres of the heart, while morphine para- lyzes the heart muscle itself. (b) Atropine as an antidote against pilocarpine, eserine, arecoline, muscarine and nicotine poisoning. (c) Potassium bromide, chloral hydrate, chloroform and ether as antidotes against the tetanics, strychnine and picrotoxin. (d) Amyl nitrite as an antagonist against the vasoconstrictors, suprarenin Digitized by Microsoft® 220 GENERAL THERAPEUTICS FOR VETERINARIANS [adrenalin] and ergot. Caffeine as an antidote against morphine, chloroform and alcohol. 4, The symptomatic antidotes are used to treat individual symptoms of poisonings. Symptoms of paralysis are combated by excitants (camphor, ether, alcohol, wine, caffeine, coffee, tea, veratrin, strychnine, atropine, scopolamine, ammonia, carbonate of ammonia); painful colics by morphine and other narcotics; diarrhoea by styptics; constipation by laxatives; persistent vomit- ing by opiates; high fever by antipyretics; cramps by sedatives, and subnormal temperatures by caffeine. Antidotes for the Different Poisons.—Aconite. Emetics, tan- nic acid, iodine, animal charcoal, atropine, digitalis, artificial respiration, excitants. Alcohol. Coffee, caffeine, ammonia, ammonium carbonate, camphor, atropine, scopolamine, cold applications to the head, warm coverings. Alkalies, caustic. Vinegar, dilute acids (hydrochloric, sul- phuric, phosphoric, tartaric and citric acids), fatty oils, milk, emulsions, mucilaginous substances, morphine. Aloes. Opium, tannic acid, mucilaginous substances. Alum. Albumin, milk, gelatin solution, lime water, magnesium oxide, ammonia, laxatives. Ammonia. Dilute acids, vinegar vapor, fats, oils, milk, muci- laginous substances, tracheotomy. Anilin. Emetics, laxatives, excitants. Arecoline. Atropine, hyoscine (scopolamine). Arsenic. Emetics, iron preparations, iron hydrate [ferri hydroxidum cum magnesii oxido, U. 8. P.], *ferric saccharate, magnesium oxide, animal charcoal, sulphur, liver of sulphur, sulphide of iron, albumin, milk, mucilage, excitants. Alkalies and fatty oils (castor oil) are to be avoided. Atropine (belladonna, henbane, stramonium). Emetics, tan- nic acid, morphine, pilocarpine, eserine; for the psychic excite- ment, chloroform, chloral hydrate, sulphonal, potassium bromide. Barium. Dilute sulphuric acid, sodium and potassium sul- phate, magnesium sulphate, emetics, atropine. Digitized by Microsoft® ANTIDOTES 221 Brine. Plenty of water, mucilage, oil, excitants, sedatives. Cantharides. Mucilaginous substances, opium, excitants; no fatty oils. Carbolic acid. Emetics, wash out the stomach, sulphates, dilute sulphuric acid, soap water, sugar lime, albumin, milk, oil, excitants (ether, camphor, caffeine, hyoscine). Carbon disulphide. Fresh air, excitants. Carbon monoxide. Fresh air, inhalation of oxygen, infusion of physiological salt solution; excitants, artificial respiration, stimulation of the skin. Chick-pea. Tracheotomy, strychnine, veratrin, caffeine, atro- pine, cutaneous stimulation, laxatives. Chlorine and calcium chloride. Sodium or magnesium sub- sulphate, inhalations of hydrogen sulphide and ammonia (diluted); internally, aromatic spirit of ammonia; albumin, mucilage. Chloroform, chloral hydrate, or ether. Excitants, especially atropine, hyoscine (scopolamine), strychnine, veratrin, caffeine, ammonia, ammonium carbonate, cutaneous stimulation, cold douches, artificial respiration. Chromic acid. Albumin, magnesium oxide, excitants. Cocaine. Tannic acid, iodine, chloral hydrate. Colchicum. Emetics, tannic acid, iodine (Lugol’s solution), opium, morphine, mucilage, warm moist coverings, excitants. Conium. Emetics, laxatives, veratrin, strychnine, caffeine, atropine, ether, camphor, ammonium carbonate, tannic acid. Convallaria. Tannic acid, excitants, camphor, ether. Copper. Laxatives, emetics, albumin, potassium ferrocyanide, powdered iron, magnesium oxide, animal charcoal, excitants. Corn cockle. Laxatives, tannic acid, mucilage, excitants. Creosote. Emetics, mucilage, dilute sulphuric acid, sodium sulphate, magnesium sulphate, soap, excitants. Croton oil. Mucilage, albumin, opium, excitants. Cystisus. Emetics, laxatives, excitants. Darnel. Laxatives, ether, camphor, atropine, caffeine, cu- taneous stimulation. Digitalis. Emetics, tannic acid, camphor, ether, atropine, Digitized by Microsoft® 222 GENERAL THERAPEUTICS FOR VETERINARIANS scopolamine, caffeine, aromatic spirit of ammonia, wine, cutaneous stimulation. Equisetum. Laxatives, camphor, ether, caffeine, atropine, hyoscine (scopolamine), veratrin, cutaneous stimulation. Ergot. Emetics, laxatives, chloral hydrate, amyl nitrite, tannic acid, symptomatic treatment. [Ether. See CHLOROFORM.] Fungi. Emetics, laxatives, excitanis, symptomatic treatment. Glauber’s salt. Mucilage, opium, camphor, ether. Hellebore. Tannic acid, opium, excitants. Hydrochloric acid. Dilute alkalies, albumin, mucilage, oil, opium. Hydrocyanic acid. Emetics, hydrated oxide of iron, hydrogen peroxide, potassium permanganate, cobalt nitrate, atropine, arti- ficial respiration, excitants, cold douches. _ Hydrogen sulphide. Fresh air, ether, camphor, inhalation of chlorine, excitants, cutaneous stimulation, bleeding, physiological salt solution subcutaneously. Illuminating gas. Fresh air, inhalation of oxygen, cutaneous stimulation, artificial respiration. Insect stings. Wash with ammonia water, chlorine water, alcohol, lead water. Iodine and iodoform. Starch, flour water, albumin, potassium bromide, sodium bromide, sodium and potassium bicarbonate, sodium hyposulphite, excitants, emetics, laxatives. Lead. Emetics, laxatives, dilute sulphuric acid, sodium sul- phate, potassium sulphate, magnesium sulphate, sulphur, hydro- gen sulphide, tannic acid, albumin, milk, symptomatic treatment (opium, morphine). In chronic lead poisoning, potassium iodide. Lupine. Change of feed, preparation of the poisonous lupines, dilute acids (no alkalies!), castor oil. Male fern. Laxatives, excitants. Mercurialis. Emetics, albumin, milk, opium, tannic acid. Mercury. Albumin, milk, powdered iron, sulphur, sulphur- ated potash, hydrogen sulphide, magnesium oxide, symptomatic treatment; in chronic poisoning, potassium iodide. Digitized by Microsoft® ANTIDOTES 223 Mine gas. Fresh air, artificial respiration, cutaneous stimu- lation, cold douches, excitants. Morphine. Atropine, hyoscine (scopolamine), caffeine, coffee, tea, cutaneous stimulation. Muscarine. Atropine, hyoscine. Mushrooms, Laxatives, demulcents, excitants, cutaneous stim- ulation, tannic acid, iodine (atropine in poisoning by agaricus muscarius). Nicotine. Laxatives, tannic acid, iodine solution, animal charcoal, excitants, rumenotomy. Nitric acid. Dilute alkalies, albumin, mucilage, oil, opium. Oleander. Laxatives, mucilage, tannin, excitants. Opium. Atropine, hyoscine, caffeine, laxatives, excitants. Oxalic acid. Lime water, sugar lime, chalk, magnesium oxide, excitants, diuretics. Petroleum. Emetics, cutaneous stimulants, ether, camphor, wine, ammonium carbonate, caffeine, artificial respiration. Phosphorus. Emetics, laxatives, old oil of turpentine, copper sulphate, copper salts in general, potassium permanganate, cobalt nitrate, hydrogen peroxide, excitants, infusion of physiological salt solution; fats and fatty oils are to be avoided. Physostigmine. Atropine, hyoscine (scopolamine), sympto- matic treatment. Pilocarpine. Atropine, hyoscine, agaricin, excitants. Poppy (wild). Laxatives, tannic acid, opium, morphine, chloral hydrate, potassium bromide, cold shower bath upon the head, clysters. Potassium chlorate. Emetics, infusion of physiological salt solution, excitants. Potassium nitrate. Mucilaginous substances, oil, ether, alco- hol, wine, camphor, ammonium carbonate, cutaneous stimulation. Ptomaines. Emetics, laxatives, tannic acid, iodine water, animal charcoal, calomel, ether, camphor, caffeine, atropine, wine, ammonia, symptomatic treatment. Ranunculus. Enmetics, laxatives, tannic acid, excitants. Sabina. Mucilaginous, demulcent remedies, opium, morphine. Digitized by Microsoft® 224 GENERAL THERAPEUTICS FOR VETERINARIANS Santonin. Emetics, laxatives, ether, chloral hydrate, camphor, wine, symptomatic treatment. Silver Nitrate. Emetics, albumin, sodium chloride, dilute hydrochloric acid. Snake venom. Locally, chlorine water, calcium chloride solu- tion, iron chloride, solutions of potassium permanganate, am- monia, carbolic acid or creolin; internally, alcohol in large doses, ether, camphor, atropine, caffeine, hyoscine (scopolamine), aro- matic spirit of ammonia. Sodium chloride. Plenty ef water, mucilage, oil, ether, cam- phor, atropine, caffeine, antispasmodics when indicated. {Sodium sulphate. Mucilage, opium, camphor, ether.] Solanine. Tannic acid, laxatives, excitants. Strychnine. Chloral hydrate, chloroform, potassium bromide, ether, sulphonal, morphine, artificial respiration, tannic acid, iodine water, emetics, irrigation of the stomach. Sulphuric acid. Dilute alkalies, lime water, soda, magnesium oxide, chalk, mucilage, oil, excitants. Tannic acid. Albumin, gelatin, mucilage, laxatives. Tartar emetic. Tannic acid, sodium carbonate, dilute acids, sulphur, sulphurated potash, opium, albumin, mucilage, excitants. Tobacco. See Nicotine. Turpentine oil. Mucilaginous substances, opium, excitants. Veratrin. Tannic acid, iodine, opium, sedatives, demulcents, excitants. [Veratrum. See HELLEBORE.] Verdigris. Albumin, potassium ferrocyanide, powdered iron, magnesium oxide. Vinegar. Soap water, soda water, chalk, calcium carbonate, magnesium oxide, milk, excitants. Yew tree. Laxatives, excitants, atropine, hyoscine, caffeine, veratrin, strychnine, camphor, ether, alcohol, ammonia, iodine (Lugol’s solution). Zinc. Albumin, mucilage, milk, tannic acid, opium, sodium and potassium carbonate and bicarbonate, sulphurated potassium, excitants. Digitized by Microsoft® VACCINATION. IMMUNIZATION. INOCULATION 1, IMMUNITY, MITIGATION, AND METHODS OF INOCULATION Immunity.—It was early observed that after recovery from certain infectious diseases the animal or human body was pro- tected against a new infection. This protection against infection is called immunity and the animal endowed with this property of insusceptibility is said to be immune or refractory to a specific infection. There are different varieties of immunity. Species immunity is the natural insusceptibility of an entire animal species to certain infectious diseases. For example, cattle are immune to glanders, the horse to lung plague and rinderpest, the dog and the cat to swine erysipelas, man to fowl cholera, the rab- bit to black-leg, and almost all species of animals to syphilis, scarlet fever, and measles. The immunity may even be limited to certain breeds of a species. The Algerian sheep, unlike the other breeds, are alleged to be immune to anthrax. The German native swine and the Yorkshire swine are much less susceptible to erysipelas than the other breeds; compared with field mice, house mice and white mice are immune to tuberculosis and gland- ers. This variety of immunity is due to certain unknown proper- ties peculiar to the species and breeds. Individual immunity refers to the insusceptibility of single individuals of the same animal species to this or that infection to which the members of the species are susceptible. It is frequently observed in an out- break of foot-and-mouth disease in cattle, or of contagious pneu- monia, influenza and strangles of horses, that a large percentage of the animals in a stable remain free from infection. Both of the aforementioned varieties of immunity, species and individual immunity, fall under the general term of natural 15 225 Digitized by Microsoft® 226 GENERAL THERAPEUTICS FOR VETERINARIANS immunity, which is also called inherited immunity. It is due to an inherited special property of the body cells and the blood which cannot be transmitted to other animal species. An acquired immunity, on the other hand, is established after an animal has passed through a single attack of a certain disease and lasts for a certain time (immunity after recovery). This variety of immunity may follow an attack of pox, anthrax, lung plague, foot-and-mouth disease, strangles, canine distemper, black leg, swine erysipelas, etc., and also scarlet fever, measles, typhoid fever and diphtheria of man. The acquired immunity is to be attributed to the presence of . specific substances in the body (blood, blood-serum) which reduce the susceptibility of the organism to the infectious agents which caused the disease. These immunizing substances either neutral- ize the toxins formed by the invading bacteria (antitoxic action, toxic immunity) or they destroy the pathogenic bacteria them- selves (bactericidal action, bacterial immunity). In contrast to natural immunity, acquired immunity may be transmitted from one animal species to another (pox from cattle to man). Finally, two varieties of acquired immunity are recognized, the active and the passive. The active immunity is acquired spontaneously by an animal in passing through an attack of the particular disease (natural or artificial infection). This immunity can be increased by a repetition of the infection and can usually be made more continuous. It is due to the formation in the blood- serum of antibodies (antitoxins, bacteriolysins, bactericides). The passive immunity is produced by the artificial introduction of the antitoxins (secondary immunity). It is only of short duration because the antibodies artificially introduced are soon used and none are formed to replace them, as occurs in active immunity (inoculation of blood-serum in contagious pneumonia of horses, foot-and-mouth disease, rinderpest, and swine erysipelas). In vacci- nation against swine erysipelas the swine are passively (serum inoculation) as well as actively (inoculation of bacilli) immunized. Digitized by Microsoft® VACCINATION. IMMUNIZATION. INOCULATION 227 Practical experience having taught that an acquired immunity often existed, attempts were early made, by intentionally intro- ducing infection, to produce an artificial protection against a subsequent infection. This variety of insusceptibility is called artificial immunity and the process of artificial infection is termed vaccination. The first vaccination for the purpose of producing an artificial immunity was Jenner’s vaccination of man with cow pox (1796).! In veterinary medicine, vaccinations of this char- acter were early undertaken (sheep pox, lung plague, rinderpest, foot-and-mouth disease). In more recent times, great scientific and practical interest has been manifested in the production by vaccination of artificial immunity against anthrax and black leg, rabies, swine erysipelas, swine plague, tuberculosis, calf cholera, chicken cholera, contagious pneumonia of horses, and tetanus. Vaccination has become a valuable method of combating the infec- tious diseases and is a species of internal disinfectant and anti- dotal treatment. Causes of Immunity.—The explanation of the establishment of immunity has always been one of the most difficult therapeutical problems. Only in recent times has light been thrown on the intricate question by histological, bacteriological, and chemical inquiries. But a conclusive investigation has not been made, nor has an entirely satisfactory explanation of the causes and nature of immunity been discovered. The best-known theories at this time are the serum theory of von Behring and the phagocytic theory of Metschnikoff. The first has his supporters chiefly in Germany, the latter in France. The truth may indeed lie between the two; namely, that the serum and the phagocytes both act as protectives of the body against infectious materials. 1 Jenner’s celebrated paper, which appeared in London in 1798, bore the title: “An Inquiry into the Causes and Effects of the Variole Vaccine, a Disease Discovered in Some of the Western Counties of England, Particularly Gloucestershire, and Known by the Name of Cowpox.”’ Jenner’s discovery has become the greatest therapeutic fact of all times. Digitized by Microsoft® 228 GENERAL THERAPEUTICS FOR VETERINARIANS 1. The serum theory of von Behring locates the immunizing substances in the cell-free blood-serum. Under the influence of the pathogenic microorganisms the body cells produce chemical substances with disinfectant properties (antibodies, alexins, im- mune proteins) which destroy the bacteria (bactericidal action) either by dissolving (bacteriolysins), clumping (agglutinins), or precipitating (precipitins) them, or which neutralize their toxins (antitoxins) or facilitate phagocytosis (opsonins). Artificially inoculating the antitoxins in the form of the blood-serum of immune animals into healthy animals produces in the latter passive immunity; if the material is injected into diseased animals recovery occurs (von Behring’s law; serum therapy). These anti- toxins have not up to this time been isolated in their pure state. According to von Behring, this is not possible principally because they are not an antitoxin material but an antitoxic force similar to the magnetic force of iron (!). Von Behring has differentiated in vaccination the isotherapeutic (inoculation of the bacteria themselves, Jennerization, cow pox vaccination, vaccination against tuberculosis of cattle) and the homceotherapeutic principle (inoculation of the specific serum in diphtheria, swine erysipelas, tetanus) (see p. 22). Modifications of the serum theory have been formulated by Buchner, Ehrlich, Brieger, Emmerlich, Wassermann, Lorenz, and others. According to Buchner, the antitoxic body is an enzyme with a ferment-like action 2. The phagocytic theory of Metschnikoff is, on the contrary, a cellular theory, which places the immunizing force in the white blood-cells (leucocytes, phagocytes). In infectious diseases, these cells remove the invading infectious agents and their pathogenic products from the blood by taking them within the cell body (leucocytosis, phagocytosis). In local infection (inflammation), they leave the blood-vessels in the form of wandering cells or pus cells in order to take up the infectious material (positive chemo- tropism or positive chemotaxis). In addition to this higher sus- ceptibility of the cells, there also occurs through adaptation an Digitized by Microsoft® VACCINATION. IMMUNIZATION. INOCULATION 229 indifference of the cells toward the infectious material, in conse- quence of which the cells avoid the pathogenic bacteria (negative chemotropism or chemotaxis). ‘Living cells, governed by their susceptibility, approach pathogenic microbes or flee from them; take them within the cell body or allow them to lie free.’”’” The Metschnikoff theory received considerable support from the dis- covery by Pfeffer of the law of the chemotropism of vegetable cells (attraction or repulsion by certain chemical substances). The behavior of the white blood-cells in inflammation, which is analogous to the chemotaxis of plant cells, was first demonstrated by Leber. Other Theories.—1. The Exhaustion Theory (Pasteur). The first at- tempt to explain the cause of immunity was made by Pasteur. In his studies of fermentation he observed that the ferment organisms became ineffective after a certain time, when they had used up a certain quantity of the nutritive material from the nutrient solution, and he concluded that the pathogenic organisms likewise withdraw from the invaded body certain substances indis- pensable to their development, so that the body is in a certain sense exhausted and microdrganisms invading the body later fail to find suitable nutritive material. Similarly, the so-called soil exhaustion is observed after long- continued planting of the same fodder crop. 2. The Aggressin Theory (Bail). Aggressins is the term used by Bail to describe the bacterial products which are formed, especially at the point of infection, to assist the bacteria in the combat between them and the leuco- cytes. The aggressins possess negative chemotactic properties, as a result of which theleucocytes arerepelled. They arefound especially in the edema at the point of infection (in anthrax) and in peritonitic and pleuritic exu- dates. The injection of such ‘aggressive exudates”’ produces active im- munity. The blood-serum of an actively immunized animal contains passively immunizing “‘anti-aggressins.”’ 3. The Opsonic Theory (Wright). According to Wright, the specific action of serum is due to opsonins, in addition to antitoxic and bactericidal substances. Opsonins are protective substances which promote phagocytosis by making the bacteria more readily digestible by the leucocytes (bacterio- tropic substances). 4, The Assimilation Theory (Baumgarten). The blood of immune animals contains no antitoxins (no onehas demonstrated them!), but is so changed chemically that the pathogenic organisms can no longer develop init. (See the colyseptic action of the disinfectants.) Digitized by Microsoft® 230 GENERAL THERAPEUTICS FOR VETERINARIANS 5. According to Much (Immunititswissenschaft, 1911), a distinction must be made between toxin bacteria and endotoxin bacteria in considering the immunizing processes occurring in the different infectious diseases. I. The toxin bacteria remain at the point of infection (tetanus, diph- theria, sausage poisoning) and act pathogenically by the excretion of poisons (bacterial poisons or toxins). The antitoxins are the antidotes, which appear in the blood-serum in consequence of the presence of the toxins. The anti- toxic serum acts against the toxins as well as against the bacteria. II. The endotoxin bacteria spread through the body (septicemia, strepto- cocci) and exert a pathogenic effect not only through the toxins excreted but also through the cell substances of the bacteria (endotoxins) when they dis- integrate in the animal body. They are not counteracted by antitoxins, but the substances which protect the body against these organisms are: 1, normal humoral bacteriocidins, z.e., the bactericidal substances which are present in solution in every normal serum (serum substances); 2, normal leucocytic bacteriocidins, ¢.e., the bactericidal substances in solution which originate from the leucocytes (plasma substances); 3, specific humoral bacteriocidins, which appear in the serum in the later stages of the infection—these three protective substances destroy the living organisms; 4, the poisonous substances of the endobacteria, the endotoxins, are destroyed through phagocytosis by the leucocytes, while phagocytosis is again stimulated by the bacteriocidins. The Weakening (Mitigation) or Attenuation of the Infec- tious Materials.—In every protective or curative vaccination it is important that the infectious material be used in a weakened, mild (mitigated), diluted (attenuated) form, since the unweak- ened, unattenuated virus will produce a severe or fatal infection. The methods and manner of attenuation are very different. The most important, arranged in historical order, are the following: 1. The introduction of a small quantity of the infectious material. The greater the number of a pathogenic organism in the body the more pronounced the effect; therefore, in vaccination care must be exercised that only a minimum quantity of the infectious material is inoculated, otherwise the original disease will be produced in undiminished strength. 2. The selection of a different entrance point for the infec- tious material. Under ordinary conditions the contagion of most infections is taken in through the internal organs, especially the respiratory and digestive apparatus. This has been demonstrated Digitized by Microsoft® VACCINATION. IMMUNIZATION. INOCULATION 231 in connection with lung plague, foot-and-mouth disease, rinderpest, pox, swine erysipelas, chicken cholera and other diseases. If the contagion of these diseases is introduced into the body through another channel, for example through the skin or subcutis, it will be brought in contact with essentially different living conditions and it will also be absorbed very slowly and in very small quantity. This method of attenuation was formerly employed exclusively in veterinary medicine and possesses for the present and for the future of vaccination a continuing importance. At the present time, for instance, the contagion of pox and of foot-and-mouth disease is inoculated in the skin or mucous membrane (cutaneous), and that of lung plague, black leg, swine erysipelas, rinderpest, etc., is injected subcutaneously for the purpose of diminishing the course of the disease. Furthermore, a place for the inoculation is selected as far removed from the heart as possible in order that the resorption will be very slow (end of the tail, tip of the wing, ear). 3. The influence of the higher degrees of temperature. Every organism has its optimum and its maximum temperature. Higher degrees of temperature weaken the vital energy and finally destroy the organism. It is therefore possible to diminish the toxic effect of the different infectious materials by the use of a certain degree of heat. The reduction of the virulence by heating for 10 to 15 minutes at 50 to 55° C. was first demonstrated by Toussaint in connection with the anthrax bacillus. The heating process is of great practical importance in Pasteur’s protective anthrax vacci- nation, in which one part of the anthrax bacilli is exposed for 24 days to a constant temperature of 42° to 43°C. (first vaccine) and the other part to the same temperature for only 12 days (second vaccine). The animals to be protected are first inoculated subcutaneously with the greatly attenuated first vaccine and 10 to 12 days later with the less attenuated second vaccine; they suffer only a mild form of the disease and acquire an immunity. Other infectious materials (black leg, pox) can also be treated in a similar manner. Digitized by Microsoft® 232 GENERAL THERAPEUTICS FOR VETERINARIANS 4. Desiccation. Just as with high degrees of heat, the viru- lence of some contagions is reduced by drying (withdrawal of water). This method of mitigation has been of practical use in Pasteur’s rabies vaccination, also in black leg vaccination (Kitt) and in part in cow pox inoculation (vaccination). In the Pasteur process small pieces of the spinal cord of a rabbit affected with rabies are suspended in bottles and dried; to hasten desiccation the bottom of the bottle is covered with small pieces of caustic potash and at the same time the bottles are held constantly at a temperature of 20°C. By this method the virulence of the rabies virus is weakened so that after 1 to 2 days’ drying 7 days are required for it to produce its effects; after 3 to5 days’ drying, 8 days; after 6 to 9 days’, 15 days, etc. As the weakest material is first injected subcutaneously and stronger material at each successive injection, the vaccinated animals (and man) gradu- ally acquire an immunity. 5. The influence of disinfectants. The addition of anti- septics to cultures of bacteria also reduces their virulence. For this purpose carbolic acid, potassium chromate, iodine trichloride, oxygen and other disinfectants have been used in anthrax, tetanus, pox, diphtheria, etc. Sunlight and certain physical factors (high atmospheric pressure) also appear to have an attenuating effect. 6. The progressive inoculation of material of increasing virulence. By inoculating first weakened, then more virulent, and finally infectious material which has not been attenuated, the organism gradually becomes accustomed to the contagion. This process is employed in Pasteur’s rabies and anthrax vaccination, in Lorenz’s swine erysipelas vaccination (first serum, then culture inoculation), in Koch’s vaccination for rinderpest (first bile, then virulent blood), and in other infections. In vaccination for swine erysipelas and rinderpest the weakened and the strong vaccine have been inoculated at the same time (simultaneous inocu- lation). 7. Long-continued cultivation of the infectious material. As was first shown by Pasteur, the virulence of a pathogenic organ- Digitized by Microsoft® VACCINATION. IMMUNIZATION. INOCULATION 233 ism decreases with its continued cultivation on artificial culture media. The anthrax bacillus especially progressively decreases in virulence with long-continued cultivation (see Pasteur’s vaccination -process) and finally loses its virulence altogether. Similar observations have been made in connection with the con- tagion of chicken cholera, lung plague, pox and other infectious diseases. 8. The passage of the infectious material through the bodies of animals of another species. The inoculation of some infec- tious materials into animals of a different species has the effect of modifying their virulence. Best known in this respect is the inoculation of cattle with the virus of pox of man and the re- inoculation of man with the considerably attenuated virus thus obtained (cow pox vaccination of Jenner). A similar effect is obtained by the same process with the virus of rabies (monkeys, rabbits), swine erysipelas, tetanus and diphtheria of man (horses, rabbits), anthrax and black leg (sheep, goats, horses) and also in other diseases. The Different Methods of Vaccination.—According to the part of the body into which the infectious material is injected, the following methods of vaccination are distinguished: 1. Thecutaneous or endermatic vaccination consists of a super- ficial wounding of the epidermis of the skin and exposing the deeper layers of the rete malpighii. By no means must the wound extend to the subcutis. The vaccination is carried out with a vaccination lancet or needle in such a manner as to avoid bleeding if possible. A flow of blood will wash the infectious material off the skin. Cutaneous vaccination is used for foot-and-mouth disease, sheep pox and small pox of man. Corresponding to the cutaneous method is the mucous membrane vaccination, in which there is only a superficial wounding of the epithelium, the sub- mucosa being avoided; cattle are vaccinated for foot-and-mouth disease upon the mucous membrane of the mouth. Vigorous rubbing of the mucous membrane is sufficient to wound it super- ficially. Corneal vaccination is also included in the term cutaneous. Digitized by Microsoft® 234 GENERAL THERAPEUTICS FOR VETERINARIANS 3. The subcutaneous or hypodermatic vaccination is carried out with a Pravaz injection syringe or by incising the skin and forming a pocket (mice, guinea-pigs, rabbits, pigeons, chickens). These methods are used for anthrax, black leg, lung plague, swine erysipelas, swine plague and hog cholera, chicken cholera, and rinderpest, in the diagnosis of glanders, for serum inocula- tion and for the injection of tuberculin and mallein. 3. The interstitial or intramuscular inoculation consists in the injection of the vaccine into the interstitial tissues or muscles. It is therefore an essentially deeper vaccination than the sub- cutaneous and is employed, for example, for the purpose of diag- nosing black leg, rabies, and tuberculosis. Ostertag prefers the intramuscular injection to the intraperitoneal for the bacterio- logical demonstration of udder tuberculosis (milk) for the reason that the disease can be diagnosed in the inoculated guinea-pigs as early as ten days after the injection (nodules of the size of a pea in the neighboring lymph glands). 4, The intravenous vaccination introduces the infectious ma- terial directly into the blood stream. The needle of the syringe is inserted into the vein and the vaccine is injected in the same manner as drugs are injected intravenously. This method is used in the protective vaccination against tuberculosis of cattle (bovo- vaccine, Tauruman) and was formerly recommended in black leg and lung plague. 5. The intracranial inoculation is used only for the purpose of diagnosing rabies. It consists in trephining the skull-cap of rab- bits and introducing the suspected material under the dura by means of a specially constructed curved needle. Analogous methods are the intracerebral (injection into the brain) and the lumbar injection (subdural injection in the lumbar region). 6. The intraperitoneal inoculation has attained a great im- portance in the diagnosis of tuberculosis. It consists in the injec- tion of suspected milk into the peritoneal cavity of guinea-pigs and is carried out simply by means of an ordinary injection syringe. The result of the inoculation, however, is only to be expected 3 to Digitized by Microsoft® VACCINATION. IMMUNIZATION. INOCULATION 235 5 weeks after the injection (tuberculosis of the peritoneum and the abdominal organs). This method can also be used in the diag- nosis of glanders (guinea-pigs). 7. The intra-ocular inoculation consists in introducing the infectious material by means of a fine injection needle through the cocainized cornea into the anterior chamber of the eye. It is used for the purpose of diagnosing rabies (rabbits, dogs) and also to obtain pure cultures of the tubercle bacillus (rabbits). 8. Galactiferous inoculation is the term used to designate injections through the teat canal into the udder by means of canula-like needles or milk tubes (mastitis bacteria). 9. “ Feeding inoculation ” is the feeding of infectious material to experimental animals (tuberculosis, anthrax, chicken cholera, swine plague, hog cholera). Intra-intestinal infection is the injec- tion of the material into the intestines. 2. THE DIFFERENT VARIETIES OF VACCINATION Purposes of Vaccination.—While formerly, vaccination was almost exclusively applied to healthy individuals for the purpose of producing immunity to a possible subsequent infection (pro- tective vaccination), it has been more recently employed for other purposes. First of all, mention must be made of the curative vacci- nation, which has latterly occupied a place in the foreground of therapeutic interest. Its object is to render assistance to the indi- vidual in which infection has already taken place (post-infection vaccination), while protective vaccination is employed before infec- tion (pre-infection vaccination). In addition, vaccination is fre- quently resorted to to establish a diagnosis. This diagnostic vac- cination has for its object neither protection nor healing but the production of the disease in question as rapidly and in as definite form as possible, or the generation of fever (tuberculin, mallein) for the purpose of establishing the presence of disease. Accordingly, the following varieties of vaccination may be recognized: (a) Protective vaccination (pre-infection inoculation). (b) Curative vaccination (post-infection inoculation). (c) Diagnostic vaccination. Digitized by Microsoft® 236 GENERAL THERAPEUTICS FOR VETERINARIANS I, Prorecrive VAccInaTION Varieties.—Depending upon how long before the outbreak of an infectious disease the vaccination is made, three varieties of protective vaccination are recognized: protective vaccination in the restricted sense, prophylactic vaccination, and emergency vaccination. Protective Vaccination in the Restricted Sense.—This is the vaccination of all animals in healthy regions and stables, at a time when the disease is not present, for the purpose of immunizing them against a possible subsequent outbreak of the disease. A good example of this variety of protective vaccination is the vacci- nation of man against smallpox. In veterinary practice, protec- tive vaccination against sheep pox (ovination) was formerly employed; 1.e., all of the sheep in a district were vaccinated al- though there was no outbreak of the disease. On account of the great danger of introducing, spreading and to a certain extent of artificially breeding the infection when vaccination is applied under these circumstances, this variety of protective vaccination has been abandoned. Prophylactic Vaccination.—This is also called precautionary vaccination (preventive vaccination) and is used in disease-free stables when the animals are threatened by an infectious disease which has broken out in the neighborhood and which may soon attack them. Prophylactic vaccination is especially important for those regions in which on account of local or agricultural condi- tions an infection is stationary (anthrax, black leg, lung plague, swine erysipelas, swine plague, rinderpest, sheep pox) and where because of the conditions an effective protection is not to be expected from the operation of veterinary police measures. Emergency Vaccination.—This is the vaccination of animals which are yet healthy but which are in an infected stable (premises, herd), and is employed most frequently in connection with foot- and-mouth disease. It is indicated: (1) when the infection of the healthy animals can not be prevented; (2) when it is assured that the artificially inoculated animals will acquire a mild form of Digitized by Microsoft® VACCINATION. IMMUNIZATION. INOCULATION 237 the disease; (3) when private and general interests will be bene- fited by the disease passing through the herd as rapidly as possible (shortening the period of continuance of the infection and conse- quently reducing the restrictions of police regulations and the economical disadvantages). When emergency vaccination is re- quired by law (sheep pox) it is called compulsory vaccination. Permitting the infection of contagious pneumonia and influenza, to spread among, a lot of horses by not separating the healthy from the sick has an effect similar to that of emergency vaccination. Veterinary Police Regulations Concerning Vaccination The only legal regulations in Germany concerning vaccination refer to lung plague, sheep pox, and swine erysipelas. The German veterinary sanitary law of June 26, 1909, in § 23, mentions the vaccination of susceptible animals among the measures which may be instituted for protection against infectious diseases. § 51 pro- vides that vaccination for lung plague can be undertaken only under official direction. § 56 contains the same restrictions re- garding vaccination of sheep for pox and forbids protective vacci- nation particularly. On the other hand, when the presence of pox is established the vaccination of all animals in the flock is required by § 53 (emergency vaccination). Under § 54, the vacci- nation of all flocks threatened by the disease and of all sheep in the same section can be officially required (precautionary vacci- nation) when sheep pox has obtained a great extension, or when there is danger that it will invade neighboring flocks. § 60 provides that when swine erysipelas becomes widespread the vaccination of the endangered swine of a herd, of a locality or of a large dis- trict may be ordered (precautionary vaccination). It is left with the government to determine when and under what conditions vaccination may be undertaken in other cases. Protective Vaccination for the Different Animal Infections Anthrax. Two methods of vaccination deserve special consideration: Vaccination according to Pasteur with attenuated cultures, and vaccination according to Sobernheim with serum and cultures. Digitized by Microsoft® 238 GENERAL THERAPEUTICS FOR VETERINARIANS 1. Vaccination Accorpine to Pasteur.—The first protective vaccina- tions were made in 1880 by Toussaint, who heated defibrinated anthrax blood at 50-55° C. for 10 to 15 minutes and then used it immediately as a vaccine. Pasteur demonstrated in 1881 that immunity could be produced by attenu- ating the bacilli. Further investigations showed that the virulence of the anthrax bacilli could be reduced by very numerous and different methods: heat (Pasteur, Toussaint, Chauveau), compressed oxygen (Chauveau and Wosnessenski), antiseptics (Chamberland and Roux), sunlight (Arloing). The bacilli can also be weakened by cultivating them upon the blood of vacci- nated sheep (Metschnikoff) or in the bodies of frogs (Lubarsch). Pasteur produced his vaccine by cultivating the bacilli at 42-43° C. in an atmosphere of oxygen for 24 days for the first or weaker vaccine and for only 12 days for the second or stronger vaccine. The animal is first vaccinated with the first vaccine and 10 to 14 days later with the second vaccine. The technique of the vaccination according to the Pasteur method is as follows: The vials sent out from the Pasteur laboratory must be used at once, the entire contents being withdrawn at one time; they must not be opened until immediately before the vaccination. A syringe holding one gram and divided into eight divisions is used to make the injections. Each time before being used the syringe must be carefully cleaned and disinfected. The lymph vial contain- ing the first vaccine is thoroughly shaken, opened and the syringe filled directly from it. One-eighth of the contents is then injected subcutaneously on the inner side of the right thigh of the sheep to be vaccinated, and the open- ing made by the needle is closed with the thumb. After 12 to 14 days, the second vaccination is made with the second vaccine in the same manner. One-fourth of the contents of the syringe is injected in vaccinating cattle, the first vaccine being injected in back of the right shoulder and the second vaccine in back of the left shoulder; the hair is clipped before the injection is made. Cows in advanced pregnancy and lambs and calves should not be vaccinated. The results of the Pasteur vaccination are as follows: For sheep it is not to be recommended. Very frequently it produces, especially in sheep, only a very slight immunity or none at all, and in the most favorable cases the immunity lasts only one year, so that it is necessary to vaccinate yearly. Moreover, the mortality resulting from the vaccination is often very great, sometimes amounting to 10 to 15 per cent. after the second vaccination. The Pasteur vaccines are also very inconstant, being at one time too strong and at another too weak, according to whether they have been kept at a tem- perature nearer to 42 or 43°C. Sometimes the vaccine shows a return of virulence, especially when it has been attenuated quickly at a high tempera- ture; on the other hand, the virulence may be entirely lost. when the vaccine Digitized by Microsoft® VACCINATION. IMMUNIZATION. INOCULATION 239 is kept too long. Then again, the same vaccine will not answer for all sheep, since the different breeds differ in their susceptibility to the same vaccine. Finally, the cost of vaccination, which is not inconsiderable, must also be taken into account. According to the favorable results obtained in France and Hungary, the vaccination of sheep can only be recommended in an experi- mental way when a good vaccine is available in regions in which the disease is stationary and is attended with regular and considerable losses (at least over 2 per cent.). For cattle, the Pasteur protective vaccination has a certain value only in badly infected anthrax districts. It is not suitable for use in other sections on account of the uncertainty and short duration of the immunity, the losses resulting and the agricultural disadvantages (illness of vaccinated animals), but especially because of the great danger of the infection of non-vaccinated animals and man. The second vaccine contains strongly virulent bacilli. Horses bear the vaccination very badly. 2. Protective Vaccination AccorDING To SoBERNHEIM.—The method of Sobernheim consists of the inoculation of serum followed by the injection of anthrax cultures (simultaneous vaccination); horses and cattle receive on one side of the body 5 c.c. and sheep 4 c.c. of immune serum and five minutes later upon the other side 0.5 c.c. and 0.25 c.c. respectively of an attenuated anthrax bouillon culture of the virulence of the Pasteur second vaccine. In 1904, 75,000 cattle were vaccinated in the Argentine Republic with a loss of only 1 in 1000; up to this time the results in Prussia have been less favorable. On the other hand, curative vaccination with the serum in so far as it has been tested has given very favorable results, corresponding with the results from the earlier intravenous and subcutaneous injection of immune serum. Lung Plague.—The oldest and most important method of vaccination is that of Willems (1851). The material for inoculation is obtained from an animal in the first stages of the disease. The animal is slaughtered and the diseased areas are removed from the fresh lungs. This diseased tissue is subjected to gentle pressure to express the lymph, which is allowed to coagulate and is then filtered through clean linen. The inoculation is made on the dorsal surface of the tail 8 to 10 cm. from the tip, the injection being made into the subcutaneous tissue in one or two places 1 to 2 cm. apart, after clipping the hair. The lymph must be clear, of a wine-yellow color, and must not be taken from necrotic lungareas, but only from placeswhich are in the stage of hepatiza- tion. On the average, the vaccination is effective in 75 to 90 per cent. of the cases. After 1 to 4 weeks there appears at the point of inoculation an inflam- matory swelling which is not larger than a hen’s egg when the course is normal; in addition, a mild fever and a slight increase in the respiration is observed. Digitized by Microsoft® 240 GENERAL THERAPEUTICS FOR VETERINARIANS If the lymph is not entirely pure, there is an extensive swelling of the whole tail with necrosis of the tip, accompanied by very high fever and symptoms of septicemia and pyemia. The same effects are produced when the inocula- tion is made into the dewlap or at the root of the tail, for which reason these places are to be avoided. When the tail becomes highly inflamed, an unfav- orable termination must be combated by free incisions into the swelling, antiseptic treatment, and, finally, by amputation of the necrosed end. The deaths always average from 1 to 3 per cent., while 5 to 15 per cent. lose the end of the tail. Sometimes, after 6 to 8 weeks, a second inoculation is made above the point of the first injection. According to Nocard, cultures of the microérganism of lung plague are better suited for inoculation than the lymph; it is more certain and milder. The vaccine, an 8-day bouillon culture, is injected subcutaneously at the tip of the tail in doses of 0.15 to 0.5 c.c.; the immunity should continue 2 years. In addition to the caudal vaccination, intravenous vaccination was under- taken by Thiernesse, Defays, Bouley, Degive, Sanderson and others, 2 c.c. of the lymph being injected directly into the jugular. The results were very good and more certain than those from caudal vaccination; in one case inflam- mation of the lungs, with marmoration, was produced. The vaccination with secondary calf lymph according to Pasteur has not proven satisfactory. With regard to the value of vaccination, there is no agreement. The advocates of vaccination base their claims upon the well-known fact that after recovering from an attack of the disease cattle are immune for life. Vaccination sets up a specific local inflammatory process exactly similar to that which takes place in the lungs in lung plague and generates an immunity of the entire body. In addition, vaccination shortens the course of the plague in a stable. The losses after caudal vaccination are declared to be entirely inconsiderable. Haubner calculates that 1 to 2 per cent. die, while 5 to 10 per cent. lose the end of the tail. In Holland, where 60,000 cattle were vacci- nated in 1878-79, the mortality amounted to 0.66 per cent. The favorable results obtained in the Spdéling district of Holland, in the province of Saxony, in the duchy of Anhalt and in Australia are presented as proof of the value of vaccination. To these are added the positive results obtained by Schiitz and Steffen. A further extension of the disease through vaccination is denied. Moreover, compared with the great pecuniary losses attending the slaughter method of controlling the disease, vaccination is by far the cheapest; while the value of sanitary laws, however stringent, is disputed. The following statistics are presented: Degive computed the results of vaccination in several countries from 1850 to 1883 and found that of 6705 vaccinated animals only 2.7 per cent. contracted the disease, and that of 2453 non-vaccinated animals 26.9 per cent. became infected, although both classes of animals were similarly Digitized by Microsoft® VACCINATION. IMMUNIZATION. INOCULATION 241 exposed to the disease, According to Piitz, the number of animals affected with lung plague in Holland was reduced by vaccination from 6079 in 1871 to 2227 in 1875, 951 in 1877, 157 in 1879 and, finally, 11 in 1882. In Hasselt, where 200,000 cattle were vaccinated with good results during the period from 1850 to 1880, the losses regularly increased when vaccination was omitted. Rochebrune relates that for years the Moors in Senegambia have vaccinated their cattle against lung plague with good results by sticking the point of a knife into the lungs of a slaughtered animal and then incising with the knife the skin of the animal to be vaccinated in the region of the nostrils. The opponents of vaccination point out that a positive case of immuniza- tion by vaccination has not been demonstrated up to this time. Even the friends of vaccination are not in a position to state how long the immunity continues, whether 14 or 1 or 2 years; others who favor vaccination speak only of partial action and immunization: and therefore vaccinate several times. The specific character of the vaccination swelling is disputed, since an entirely similar swelling arises after the inoculation of pus or milk. Furthermore, the vaccination has in no case produced a lung plague pneumonia, the principal criterion of the disease, while this alteration occurs even in those cases in which the infection is transmitted intra-uterine from the mother to the foetus. The results of vaccination are dependent upon the method and time of inocu- lation and upon the quality of the vaccine.. Animals already immune were also frequently vaccinated and the previously acquired immunity attributed to the effects of the vaccine. The disease hasbeen introduced and artificially prop- agated by vaccination. Thelosses from vaccination are under certain circum- stances very considerable; the mortalityisfrequently very great, even at times exceeding the usual fatalities from the disease itself. Inthe preamble to the German Imperial veterinarysanitarylawsthelosses from vaccination are given ag 2 to 4 per cent.; the end of the tail is lost in 25 percent. of thecases according to the observations of a French vaccination commission, in 10 to 15 per cent. according to Degive. In addition there are the economical disadvantages, decrease of the milk secretions, emaciation, etc. The disease often spreads in spite of vaccination, while in other cases it subsides without vaccination; many animals have the disease without showing perceptible symptoms. In those countries in which vaccination was most extensively practised the disease is not yet on the decline. In England, for example, and in France and Belgium, in which vaccination was obligatory, as well as in the province of Saxony, the disease still exists. In other countries, for instance Holland, the repression of the disease is perhaps not the result of vaccination but of the simultaneous enforcement of veterinary police measures, especially slaughter. In Belgium, according to Oemler, the number of cases of lung plague increased from 1481 in 1867 to 2800 in 1878 in spite of vaccination, but after that date, 16 Digitized by Microsoft® 242 GENERAL THERAPEUTICS FOR VETERINARIANS in consequence of the strict enforcement of veterinary police regulations, the number of cases rapidly decreased, until in 1880 there were 1781 and in 1883, 1187 cases. A compilation made by Kitt shows that in England the number of cases decreased only with the adoption of stringent protective regulations in 1878 from 4590 to 2144 in 1879 and to 1200 in 1882. In Bavaria, following the introduction of the Imperial veterinary sanitary laws, the number of cases decreased from 846 in 1846 to 281 in 1883. In Baden, where from 1870 to 1880 0.2 per cent. of all the cattle died yearly from lung plague, there was not a single case in 1885. The answer to the question as to the value of vaccination for lung plague depends principally upon whether it is to be used only for immunizing individ- ual animals or to combat an outbreak of the disease in a herd or in a district. In this connection the following statements can be made: (1) Vaccination, as a rule, confers a high degree of immunity upon individual cattle. (2) The value of vaccination as a veterinary police measure for combating lung plague is, on the contrary, doubtful. Experience has many times taught that not all vaccinated cattle acquire an immunity, but that about 2 per cent. remain susceptible to the disease. These apparently immune cattle, when they subse- quently suffer a latent attack of the disease, are a continuous source of infec- tion for healthy animals, especially in regions where the traffic in cattle is extensive (province of Saxony). Furthermore, lung plague sometimes runs such a mild course that no symptoms of disease are apparent and the recogni- tion of the disease in time for the vaccination of the herd is not possible. The length of the period of incubation also often prevents a prompt diagnosis or early vaccination. As a method of combating the disease, slaughter of the infected herds is much more reliable than vaccination. Rabies.—Pasteur announced in 1884 that the virus of rabies could be gradually weakened by inoculating it from the dog into a monkey and then successively from monkey to monkey. Virus attenuated in this way and in- jected subcutaneously or under the dura mater, after trepanation of the cranial cavity, does not produce rabies in the dog, but on the contrary renders the animal immune to artificial or natural infection with the disease. Subse- quently, Pasteur published another method of immunization in which the dried spinal cord of a rabid animal is used as the vaccine. The spinal cord of a rabbit affected with rabies is removed under aseptic precautions up to the lower end of the cerebellum, together with all of its coverings, and cut into pieces 6 cm. long, which are suspended on threads in bottles. The bottoms of the bottles are covered to a depth of 1.5 cm. with small pieces of caustic potash and their openings are closed with cotton plugs. They are kept at a constant temperature of 20°C. After 3 to 4 days, the pieces of spinal cord are dried into ribbon-like, very friable strips, the toxicity of which gradually Digitized by Microsoft® VACCINATION. IMMUNIZATION. INOCULATION 243 decreases with the continuance of the drying. For example, rabbits develop rabies after 7 days when they are inoculated with material which has been dried 24 to 28 hours; after 8 days, when the material has been dried 3 to 5 days; after 15 days, when the drying has continued 6 to 9 days. Animals (horses, dogs) and man are made immune to rabies by injecting them first with a very weak virus, then with a slightly more virulent virus, and so on, until at last a very strong virus is injected. After this, the full strength rabies virus can be injected without harm. This method of vaccination has proven of value also as a curative remedy when applied to human individuals bitten by rabid dogs (post-infection vaccination). Other methods of vaccination for rabies (diluted virus, intravenous injection of brain substance, serum inoculation, simultaneous vaccination) have been published by Hégyes, Helman, Babes, Galtier, Protopopoff, and others. . Foot-and-mouth Disease.—As early as the beginning of the nineteenth century (Buniva), and very frequently since then, vaccination in the form of emergency vaccination has been effectively employed to induce the regular extension and to shorten the course of foot-and-mouth disease in large herds (Ercolani, Brauell, Renner, Hoffmann, Wirtz, Spinola, Hertwig, Lewes, Brandes and others). Emergency vaccination is a measure entirely worthy of recommendation, because it not only causes a more rapid extension of the disease through a herd and consequently permits an earlier removal of the sanitary police regulations, but the vaccination disease frequently runs a milder course and is confined to the mouth. The emergency vaccinations made in the last ten years in numerous herds in almost all sections of Germany have mostly been accompanied by good results; their influence was most favorable when the vaccinations were made at the first appearance of the disease. Of the vaccinated animals, 50 to 80 per cent. became infected on the average; the others proved themselves to be immune. Emergency vaccination is only contraindicated in the malignant form of foot-and-mouth disease, in which the vaccination disease may be dangerous. The technique of the vaccination is very simple. The saliva of an affected animal is placed in the mouth of the animal to be vaccinated at a point where the mucous membrane has been previously rubbed, or it is inoculated with a lancet anywhere in the skin; impregnated threads can also be drawn under the skin of the ear or tail. Swine are inoculated on the nose with a syringe and needle. Fever occurs 24 hours after the inoculation; on the third day the vesicles appear, and healing of the ulcers begins from the sixth day on. The course of the vaccination disease is in general milder than that of the natural infection. With reference to the protective vaccination with blood-serum, the investi- gations are not yet concluded. Hecker’s vaccine and “‘seraphthin,” intro- Digitized by Microsoft® 244 GENERAL THERAPEUTICS FOR VETERINARIANS duced by Léffler in 1899, did not answer the purpose. It is doubtful if the sera employed by Nocard and Léffler on cattle (2 to 3 weeks’ immunity), sheep and swine (3 to 8 weeks’ immunity) will prove of practical value. A method of protective vaccination suitable for practice is not yet known. Léffler’s serum (1912) is not adapted to general use because of the high price (about $7 per animal), the complicated process (four vaccinations) and the short duration of the effect. Sheep Pox.—In the first half of the nineteenth century, entire flocks of sheep were subjected to protective vaccination against sheep pox (ovination) each year, with the assistance of special vaccination institutes, whether an outbreak of the disease was threatened or not. This regulation proved to be very objectionable. Not only did the protective vaccinations establish per- manently infected flocks, in which the disease became stationary, but the infection spread from these flocks to the adjoining regions, the danger of healthy animals being infected by vaccinated individuals being exceedingly great. In several countries, for example in Prussia and Austria, the spread of the disease went hand in hand with the protective vaccination. On the other hand, emergency vaccination is worthy of recommendation, and is therefore included in the requirements of the German sanitary laws (§ 53). ‘Emergency vaccination is employed only in those flocks in which the disease has already broken out. Not only does it cause the disease to run a quicker course, inducing a more rapid extension of the infection through the flock and consequently an earlier removal of the sanitary police restric- tions, but the disease itself is of a milder type and usually only local, so that frequently there are no deaths and usually not more than 2 per cent. die. Only when all external factors are unfavorable, the losses excep- tionally reach 10 per cent. In addition to emergency vaccination, precau- tionary or prophylactic vaccination may also be employed when an extensive outbreak of sheep pox prevails in the neighborhood of healthy flocks and the situation is such that there is great danger of these flocks being infected (§ 54). The vaccine, or ‘‘ovine,’”’ can only be obtained from sheep with normally developed pox and in which the disease runs a benign course. The lymph must be entirely clear and limpid, neither turbid nor purulent; it is therefore usually collected from the vaccinated sheep on the 10th to the 12th day after the vaccination, or 6 to 8 days after the eruption. The vaccinated sheep must be kept separate from the sheep from which it was inoculated, and the sheep to be vaccinated must not be permitted to come in contact with the infected sheep from which the material for inoculation is obtained, otherwise infection may take place spontaneously at the same time. The inoculation may be made on the inner surface of the ear, 4 cm. from the tip, or better on the under surface of the tail, 10 to 12 cm. from the anus. In the latter case the animal Digitized by Microsoft® VACCINATION. IMMUNIZATION. INOCULATION 245 must be laid down. Vaccination on the ear is not entirely without danger on account of the proximity of the eye. The instrument used is either a fine and pointed vaccinating needle with a speon-like excavation, or a vaccination lancet. In vaccinating an entire flock, it is an advantage, when time will permit, to make a preliminary or test vaccination of six to twelve animals. The vaccinated sheep show an entirely regular pox exanthema which is limited to the point of vaccination, and very mild general symptoms. The pox become ripe on the tenth day after vaccination. Exceptionally, the pox do not develop at the point of vaccination but in the surrounding area (accessory pox); very rarely, a general eruption of pox is observed following the vaccina- tion eruption (secondary pox). The after-treatment consists in protecting the vaccinated animals from unfavorable weather and providing them with suitable food. In addition, an examination of the flock should be made in ten to twelve days and those animals again vaccinated in which the first vaccination was not effective. In place of ovination, serum vaccination, serum therapy and simultaneous inoculation with immune serum and virulent lymph are also recommended (France, Roumania). Rinderpest.—1. Tom Oxtp Suscurangous Mrruop.—On the steppes of Russia, where this form of vaccination was practised as early as the middle of the eighteenth century, it was formerly employed as a prophylactic measure; but only in the form of emergency and precautionary vaccination, never as protective vaccination, because of the great risk of spreading the disease by the latter. At the present time there are four vaccination institutes in Russia (Kharkov, Karlovka in Poltava, Bondarewka in Kherson, and Salmysch in the Orenburg government), but vaccination is falling more and more into disuse. In Germany and the other European countries, except Russia, emergency vaccination is not permitted, because in them veterinary police measures, i.e., slaughter, are much more effective and certain and because the mortality from the vaccination of ordinary cattle is much too high. The mortality among the cattle of the steppes from vaccination is only about 10 per cent., while among the other breeds it is 36 per cent. Toward the end of the out- break favorable results from vaccination are relatively more frequent. The technique of the vaccination is simple. A clean sponge is placed in the nostril and permitted to remain there until it has absorbed its fill of nasal mucus, when it is removed and the contents expressed into a small glass vessel, which is closed. A drop of this material is then injected under the skin of the neck with a Sticker syringe. 2. Brix Inocunation Accorpina tro Kocu.—During his investigations into the cause of rinderpest in South Africa (Kimberley) in 1897, Koch found that the bile as well as the blood-serum of cattle that had passed through an Digitized by Microsoft® 246 GENERAL THERAPEUTICS FOR VETERINARIANS attack of the disease possessed immunizing properties. The bile vaccination consists simply of a single subcutaneous injection into healthy cattle of bile (10 ¢.c.) from cattle affected with rinderpest or which have passed through an attack of the disease. Six to 10 days after vaccination, an immunity is estab- lished which continues 4 to6 months. The local effect consists of a hard swell- ing of the size of the fist, which disappears after a few weeks. Protective vaccination with bile is of extraordinary value in infected regions. Kohlstock, who introduced Koch’s method of vaccination into German Southwest Africa, recommends a double vaccination of bile and rinderpest blood (emergency vaccination). This double vaccination was later approved by Koch. Accord- ing to Kolle, Koch’s bile method has the disadvantage that the animal is susceptible to infection for a whole week after vaccination. Furthermore, it is necessary to slaughter 3 to 7 diseased or recovered animals to obtain suffi- cient bile to vaccinate 100 cattle. The mixture of bile and glycerin proposed by Edington is without value, as the addition of the glycerin reduces the degree as well as the continuance of the immunity. According to Hutcheon, Koch’s bile vaccination method has been abandoned entirely in Cape Colony on account of its great imperfection. 3. Serum VaccinaTion.—This method requires 100 ¢.c. of blood-serum and produces only a passive immunity of short duration. It may be used to separate an infected region from a rinderpest-free region by creating a broad immunized area around the infected region. It has preference over the bile vaccination in that it is effective in the incubation period of rinderpest. 4, SmmutTanEous VaccrnatTion.—Kolle and Turner recommend the simul- taneous injection of 1 c.c. of virulent rinderpest blood upon one side of the body and the injection of 15 to 40 c.c. of serum upon the other. This method confers an immunity for five months. Koch and Theiler have raised the objection against the simultaneous method that piroplasme (infectious hemo- globinuria) and trypanosomes may be inoculated with the rinderpest blood in regions infected with these parasites. Black Leg.—1. Tae Lyons Metuop of vaccination was discovered by Arloing, Cornevin, and Thomas. In 1880 and 1885 they vaccinated intra- venously, but with great losses. They therefore later selected the subcutis at the end of the tail as the point of vaccination, because they had found that the black leg virus when introduced here produced only a temporary harmless swelling but nevertheless established subsequently a complete immunity. The slight reaction at this point is explained, in their opinion, by the density of the connective tissue and the low temperature existing there, both of which conditions prevent the spread of the black leg bacilli through the connective tissue spaces. In addition, they also weakened the black leg virus before injection by exposing it to high degrees of temperature. The preparation of Digitized by Microsoft® VACCINATION. IMMUNIZATION. INOCULATION 247 the vaccine and the process of vaccination according to Arloing’s method (Lyons method) is as follows: 40 grams (1 part) of diseased muscle tissue is quickly dried at 33° C. and uniformly mixed with 80 grams (2 parts) of water. The entire amount is then divided into 12 parts of 10 grams each, each part is placed in a suitable flat dish and dried for 6 hours in a thermostat. One- half is kept at a temperature of 100°C. in order to obtain the weaker-acting first vaccine, and the other half is exposed to a temperature of 85°C. to produce the stronger second vaccine. The vaccination is carried out in two sections, the first with the weaker and the second with the stronger vaccine. The dried brownish crust in the plates is used in the vaccination; this material can also be stored for a long time. For the first: vaccination, 0.1 gram of the material which was heated at 100°C. is triturated in a disinfected mortar with 5 grams of water, the contents of a 5-gram Pravaz syringe. The mixture is then filtered through a clean piece of linen and the filtrate is drawn up into the syringe, the piston of which is marked off in half-cubic centimetres and provided with a movable disk to be used in measuring the dose. The quantity of the vaccine injected into each animal is 0.5 ¢.c., so that the syringe will hold sufficient for 10 animals. The point of the first vactination is the under surface of the tail, three hand-breadths from the tip. After the hair is clipped, the trocar which accom- panies the syringe is inserted obliquely through the skin and passed up- wards between the skin and bones about 8 cm.; it is then removed, the canula of the syringe introduced through the same wound and the vaccine, after being mixed by shaking the syringe, is slowly injected. To prevent the vac- cine from flowing out, the point of entrance is compressed and the injected fluid is pressed upward with the thumb. If any bleeding occurs, the injection is delayed until the hemorrhage is checked, or another place is chosen. Finally, a rubber bandage 2 cm. in width is placed upon the point of injection and allowed to remain four hours for the purpose of preventing the escape of the vaccine. In this way, it is said, 20 to 25 animals can be vaccinated in an hour, the animals being held by three assistants. Ten days after the first vaccination, the animals are vaccinated with the second or stronger vaccine. The second vaccination is carried out in the same manner as the first except that the injection is made only two hand-breadths from the tip. The most favorable season for vaccination is spring, or the close of winter. The vacci- nation is not followed by any sequela. The vaccination experiments carried out in different countries (France, Switzerland, Austria, Germany) have established that the Lyons method of protective vaccination undoubtedly reduces the mortality from black leg very considerably. 2. Tae Monica Metsop of vaccination, or Kitt’s method, consists of a single subcutaneous injection on the under surface of the tail. The vaccine Digitized by Microsoft® 248 GENERAL THERAPEUTICS FOR VETERINARIANS solution is prepared from powdered muscle which has been attenuated by exposure to live steam at 97° C. (or by heating for six hours at 85 to 90°C.). More recently, pieces of muscle of different origin are used in preparing the vaccine (polyvalent vaccine). 3. Tae Buackiecine or THomas.—Silk or cotton threads containing black leg spores are inserted subcutaneously (back of the shoulder in calves) and permitted to remain. The method is recommended as very simple and effective and has given satisfactory results in Germany (North Dithmarsch). Swine Erysipelas—1. Taz Lorenz Merson of vaccination and the analogous Susserin consists in the simultaneous injection of immune serum (passive immunization) and bouillon cultures of swine erysipelas bacilli (active immunization). The inoculation is made at the base of the ear, where 5 c.c. of serum and 0.5 ¢.c. of the culture are injected subcutaneously at the same time (simultaneous vaccination). The immunity established by the vaccination continues about half a year. Simultaneous vaccination has proven very trustworthy in Germany as a protective and curative remedy. Recently, instead of the double inoculation only the serum is injected in many instances. 2. Top Pasteur Merson comprises twoinjections of attenuated cultures of swine erysipelas bacilli (premier and deuxiéme vaccine) on the inner sur- face of the thigh at intervals of 10 to 12 days; the first the weaker and then the stronger vaccine (attenuated by passing through rabbits). This method established a high and long-continuing immunity, but is not without danger (extension of the disease, sometimes great losses). Hog Cholera.—By the use of 10 to 20 c.c. of immune serum, obtained from swine highly immunized artificially, a passive immunity is established which begins during the period of incubation and lasts several weeks. The immune serum also has a curative effect on diseased animals. By the simul- taneous injection of immune serum (20 c.c.) and virulent blood (1 to 2 c.c.) an active immunity is produced which lasts for months; this method, however, appears to be not without danger, because a part of the vaccinated swine become affected with hog cholera and eliminate the virus of the disease. [In the United States, 20 c.c. of serum are injected for each 50 pounds of body weight both in the serum alone and in the simultaneous method of vaccination.] Swine Plague.—The several vaccines recommended for swine plague (Septizidin, Suptol, Euman, bivalent and polyvalent serum) have not proven reliable in practice. Calf Pneumonia.—The views concerning the value of the different immune sera (Septizidin, polyvalent serum) are divided and contradictory. Calf Cholera.—The serum vaccination of new-born calves with polyv- Digitized by Microsoft® VACCINATION. IMMUNIZATION. INOCULATION 249 alent coli serum (Jensen) is effective, but the protective vaccination of cows in advanced pregnancy has, on the contrary, proven to be without value. Fowl Cholera.—1. Protective VaccINATION WITH ATTENUATED CUL- TURES AccoRDING To PasteuR.—lIn 1880, Pasteur recommended the vaccina- tion of healthy individuals with cholera bacilli attenuated by cultivation as the most effective method of combating fowl cholera. He found that vacci- nation with a weakened (mitigated) vaccine produced only a local swelling at the point of inoculation and that the muscle tissue beneath underwent necrosis without suppuration. The vaccinated bird was sick, indeed, but did not die and became immune to the disease. Some chickens, however, required 2 to 3 vaccinations with mitigated vaccine before they acquired an immunity. Pasteur therefore introduced a double vaccination, first injecting a very weak vaccine (premier vaccine) and then a stronger one (deuxiéme vaccine). The bacilli were attenuated by keeping them for 3 to 10 months under conditions which permitted the entrance of air, whereby, according to Pasteur’s theory, their virulence was reduced by the oxygen of the air. Protective vaccinations were made according to this method by Cagny, Hess, and Kitt, and the results were very unfavorable (spread of the disease, fatal cases). 2. Serum Vaccination has been of doubtful value in Prussia, but in Denmark very favorable results have been obtained. Contagious Pneumonia of Horses.—The first serum vaccinations were made by Hell in 1892. The vaccinations made the same year in the Prussian army to test the new process were, however, without effect, since the disease occurred with the same intensity in the vaccinated horses as in those which had not been vaccinated, while many horses which were not vaccinated did not take the disease (P. Mil. V. B., 1892). The reports concerning the vacci- nations made in the army with blood-serum in 1893 are very contradictory (P. Mil. V. B., 1893). In 1894, vaccinations were made in four regiments, The results did not speak favorably for the vaccination; it neither shortened the course of the disease nor reduced the virulence. The isolated favorable results were only apparent and are to be explained by the benign character of the infection (P. Mil. V. B., 1894). In 1895 the serum vaccinations were also without effect, although every horse received 200 grams of serum in four days; 10 weeks after the vaccinations 10 horses in one squadron became ill with contagious pneumonia, some being very severely affected (P. Mil. V. B., 1895). On account of these results the vaccinations were discontinued in the army in 1896. In 1898 Tépper made a report of his experiences with blood- serum vaccinations and stated that the horses became immune 6 to 8 weeks after the injection of the serum. He also stated that the disease usually pre- vailed in the stable 4 to 6 weeks before the vaccinations were begun and that after the vaccinations it was always immediately checked. Not Jess than 150 Digitized by Microsoft® 250 GENERAL THERAPEUTICS FOR VETERINARIANS grams of blood-serum must be injected and it must be obtained from horses in the same stable which had recovered from the disease and which had been free from fever for at least 3 to 6 weeks. As Tépper did not make his vacci- nations until 4 to 6 weeks after the appearance of the disease, Schwarznecker pointed out that it was very questionable whether the cessation of the out- break was due to the vaccinations or to the natural course of the epizodtic. The Prussian military report for 1898 shows that the protective vaccination with blood-serum is of no practical value. Contagious pneumonia did not prevail as long in those divisions of the army in which no vaccinations were made as in those in which the horses were vaccinated. In the winter of 1898- 99, Tréster made serum injections in 17 batteries and 6 squadrons; each horse receiving 50 grams of serum. The vaccinations caused an immediate pause of 5 to 36 days in the progress of the epizodtic, but the effect did not last and was insufficient, since the epizodtic was not extinguished. This brief protec- tion, according to Tréster, is only of value in the case of a mobilization, when it may be desirable to protect a large number of horses from infection for a a few days. All attempts to cure horses affected with contagious pneumonia by vaccination with serum have failed. Further experiments were made by Troster in 1899 on 58 horses with a larger quantity of serum (500 c.c., in two portions, injected into the breast). The results of this experiment, by no means extensive, seemed to Tréster to justify the conclusion that the injection of such large doses produced asufficient immunity, although the amount of serum required was very difficult to obtain. In 1900 and 1901, he vaccinated 784 and 635 horses respectively with 100 to 150 grams of active blood-serum; some of the vaccinations were effective (40 days immunity) and some were not. In May, 1900, 518 horses in Dragoon Regiment No. 21 were vaccinated by him and no effect was observed on the spread of the disease; 195 of the vacci- nated horses developed extensive swellings and abscesses and some of them were not fit for service for 14 days. Mieckley vaccinated 200 horses with 200 grams of serum each in the Beberbeck stud in 1900. The results were nega- tive. In spite of the vaccination, 113 horses became affected with contagious pneumonia, and of these 14 died. In the light of these experiences there can remain no doubt that serum vaccination for contagious pneumonia is of no value. Cow Pox Vaccination of Man (Vaccination).—Since 1796 the lymph of cow pox (vaccine) has been used for the protective vaccination of man against smallpox (variola). Three kinds of vaccine are recognized: original, human, and animal. The original vaccine is the lymph obtained from natural cow pox, which was used in the beginning of vaccination; the human vaccine is obtained from cow pox produced artificially on children, and the animal vaccine is obtained from calves, At the present time, almost all vaccinations Digitized by Microsoft® VACCINATION. IMMUNIZATION. INOCULATION 251 are made with animal vaccine. The animal lymph is obtained in the following manner: Healthy calves (especially steer calves) one-fourth to one-half year old, which have passed the tuberculin test, are inoculated with human vaccine in special vaccine institutions (100 to 200 punctures or crucial inci- sions upon the shaved and cleaned skin of the abdomen). On the fifth day the lymph is collected from the pox which have developed with special instru- ments (clamp forceps, capillary tubes, lancets, spatule, glass plates) and conserved (exclusion of air in glass tubes, glycerin, thymol, salicylic acid, drying). The principal advantage of animal over human lymph is the certain avoidance of the transmission of disease from the vaccinated children to those subsequently vaccinated (syphilis, tuberculosis, acute exanthemas). The immunity established by vaccination continues for about ten years; after this time a re-vaccination is necessary. Tuberculosis.—For the protective vaccination of cattle against tuber- culosis von Behring, in 1902, recommended the intravenous injection of living human tubercle bacilli into calves 3 to 6 weeks old (Jennerization, Bovovac- cine). First, 0.004 gram of tubercle bacilli suspended in 4 grams of water is injected into the jugular vein, and later 25 times the quantity of tubercle bacilli, 0.01 gram, suspended in 4 grams of water, is injected. [In 1902, Pearson and Gilliland published a report of their experiments in which they had demonstrated that it was possible to immunize cattle against tuberculosis (Phila. Med. Journal, Nov. 2, 1902). These experiments were begun Sep- tember 29, 1900. They used living tubercle bacilli of the human type, injecting 0.004 of dried, tubercle bacilli suspended in salt solution intrave- nously and four weeks later twice this quantity.] A similar method of vaccina- tion was recommended by Koch and Schiitz (Tauruman), who claimed that a single intravenous injection of 0.01 to 0.03 gram of tubercle bacilli from human sources or of attenuated bacilli from cattle would immunize cattle against highly-virulent tubercle bacilli of bovine origin. These methods of protective vaccination have not proven of practical value because only a temporary immunity is established. The use of vaccine material containing virulent tubercle bacilli is also attended with several disadvantages: the infection of the vaccinated calves with tuberculosis, the infectiousness of the meat and milk of the vaccinated animals for man (excretion of virulent tubercle bacilli in the milk), the danger of the vaccination to the veterinarian, the transformation of chronic calf pneumonia into the acute form, and other dangerous vaccination accidents (embolic pneumonia, apoplectic death, severe febrile disease, emaciation, etc.). Antiphymatol and tuberculosan have proven equally inefficient. Strangles.—The serum treatment of strangles (protective vaccination, curative vaccination) has not proven reliable in Germany. Experience with Digitized by Microsoft® 252 GENERAL THERAPEUTICS FOR VETERINARIANS the different preparations of serum has been unsatisfactory, especially in the Prussian remount depots and in east Prussia. In Denmark, on the other hand, the protective action of subcutaneous injections of dead strangles cocci [bac- terin] and the curative effect of polyvalent serum have attained a great repu- tation. Fréhner’s experience with the Danish serum confirms the reports of its curative value. Protective vaccination (active immunization with cocci) has been recently recommended in Germany. II. Curative Vaccination Character.—While by protective vaccination a certain time before the entrance of infection an immunity is obtained (pre- infection vaccination), the purpose of curative vaccination (post- infection vaccination) is to accomplish the same result after infection has taken place. The first attempt to heal an already infected body by vaccination was made by Pasteur in his experi- ments in the cure of rabies (1885). Then followed the experiments of Koch, von Behring, [Pearson and Gilliland], Kitasato and others with tuberculosis, tetanus, diphtheria, pneumonia, anthrax, swine erysipelas, etc. Curative Vaccination in Rabies.—According to Pasteur, human beings who have been bitten and infected with rabies may be subsequently immunized by vaccination if they are inoculated in a systematic manner with attenuated virus. A piece of the dried spinal cord of a rabbit 2 to 3 em. long (see p. 242) is rubbed up with sterile bouillon, forming an emulsion, of which 14 to 34 c.c. is immediately injected under the skin of the abdomen. In the beginning a very weak vaccine is injected, and at each suc- ceeding injection a somewhat stronger vaccine is used. Pasteur’s work was confirmed by Contani, Metschnikoff, Ullmann, Bujwid, Bardach, R. Koch and others. It was not accepted, however, by von Frisch, Hégyes, de Renzi, Bordoni-Uffreduzzi and others. Curative Vaccination in Swine Erysipelas.—In the use of swine erysipelas serum in protective vaccination, very many cases have been observed in which swine affected with erysipelas have ap- parently been cured when the serum was injected early, 6 to 12 hours after the appearance of the first symptom, and in large (10 to 30 c.c.) and repeated doses. Digitized by Microsoft® VACCINATION. IMMUNIZATION. INOCULATION 253 Curative Vaccination in Tetanus.—The curative action of tetanus antitoxin in tetanus of man was discovered by von Behring in 1896. Since that time it has been frequently employed in veterinary medicine in tetanus of horses. At first its action as a curative agent appeared to be favorable, but later the failures increased to such an extent that it is now used only in isolated cases. In the Prussian army, from 1896 to 1907, 129 horses affected with tetanus were treated with the antitoxin and 85, or 66 per cent., died. During the years previous to the use of the serum the mortality was as follows: in 1881, 55 per cent.; 1882, 57 per cent.; 1884, 65 per cent.; 1885, 62 per cent.; 1887, 67 per cent.; 1888, 66 per cent.; 1892, 65 per cent. In the light of these figures it cannot be said that the use of the antitoxin in the years from 1896 to 1907 exerted a favorable influence upon the disease. Recently, it was announced that the preparations of anti- toxin heretofore used were too weak and that the material had been employed in insufficient quantity. It was also stated that the antitoxin must be injected as early as possible, immediately after the diagnosis is made, preferably intravenously, and the injec- tions repeated until improvement occurs. Sawamura (Bern, 1909), in experiments with rabbits affected with tetanus ascendens endo- neural, found that their life was saved when the antitoxin was injected not later than 17 hours after the appearance of the first tetanic symptom. In order to test the value of this new antitoxin, Fréhner obtained 500 c.c. of it from Marburg in the summer of 1910. The cost of the 500 c.c. was twenty-five dollars, five dollars per dose (100 c.c.). Without selection, the first two cases of tetanus entered in his clinic were treated with the antitoxin accord- ing to the accompanying directions, while the third and fourth cases received no treatment. Both of the horses which received the antitoxin immediately after the diagnosis was made in the first stages of the disease died, while the other two, which received no antitoxin, recovered. From this it would appear that the new antitoxin is not a reliable curative agent in tetanus. Digitized by Microsoft® 254 GENERAL THERAPEUTICS FOR VETERINARIANS Curative Vaccination in Hog Cholera.—The serum inoculation appears to have been proven to be also a curative method (see p. 248). Curative Vaccination in Tuberculosis.—Tuberculin, which was recommended by Koch as a specific curative agent in tuberculosis in man, did not prove to be effective for this purpose. Further- more, it is of no value as a curative agent in tuberculosis of cattle. Curative Vaccination in Septiceemia.—Several sera are recom- mended as curative and protective remedies in the diseases caused by streptococci and for the complications of contagious pneumonia; é.g., the anti-streptococcic serum of Marmorek and the sera against purpura hemorrhagica of Lignieres and Jensen. The reports concerning the action of these sera are contradictory. The Danish polyvalent serum against purpura hemorrhagica (Jensen) proved effective in a case treated by Frohner. Organotherapy.—The terms organotherapy, tissue-fluid therapy, and opotherapy are used to designate the use of animal organs as curative agents. Testicles, thyroid glands, ovaries, prostates, liver, etc., as such, or in the form of special preparations (spermin, thyroidin, iodothyrin, etc.), are used in impotence (spermin), goitre and myxcedema (thyroidin, iodothyrin) and diseases of the ovaries, prostates, liver, etc., being administered internally. Only the preparations of the thyroid gland in goitre and myxcedema appear to have an undisputed action. Experiments in Germany with the other opotherapeutic preparations have usually resulted negatively, III. Dracnostic INocuLATION ; Purpose.—The object of diagnostic inoculation is to ascertain experimentally the identity of the disease in cases in which a certain demonstration and positive recognition of the infection is not possible with the usual clinical methods. This is accomplished by artificially inoculating healthy experimental animals with infected masses (blood, nasal discharge, vaginal discharge, pus, milk, feeces) in order to produce a typical picture of the disease (inoculation of other animals), or by inoculating the originally- diseased animal (self-vaccination, auto-inoculation). In a certain Digitized by Microsoft® VACCINATION. IMMUNIZATION. INOCULATION 255 sense, injections of tuberculin and mallein belong to the latter -method of inoculation. Inoculation of Other Animals.—This method of inoculation is used for the purpose of diagnosing anthrax, glanders, tuberculosis, fowl cholera, swine erysipelas, hog cholera, swine plague, strangles, contagious pneumonia of horses, hemorrhagic septicemia, black leg, rabies, malignant cedema and Canadian horse pox. 1. AnrHRAx.—Although the protective vaccination for anthrax is subcutaneous, the diagnostic inoculation is made cutaneously in order to avoid mixed infection. The best animals for inoculation are mice, rabbits and guinea-pigs; the best inoculation materials are the blood and spleen pulp. Mice are inoculated on the end of the ear after the tip has been clipped off; rabbits and guinea-pigs are inoculated in slight scratch-wounds on the ears. If anthrax is present, the inoculated animal dies in two to three days; on post-mortem examination numerous characteristic anthrax bacilli are found in the blood. ‘ 2. Buack Lea.—Guinea-pigs are used as inoculation animals. Rabbits are immune to black leg but are very susceptible to an- thrax. If guinea-pigs and rabbits are inoculated simultaneously with the same material and only the guinea-pigs die, then black leg is probably present. Inoculated guinea-pigs continue to live if they are treated with black-leg serum. In contrast with anthrax, the inoculations are made subcutaneously only and not cuta- neously. The subcutaneous inoculation of guinea-pigs is the most important diagnostic method in doubtful cases and in question- able post-mortem findings. 3. GLANDERS.—Several male guinea-pigs are inoculated simul- taneously with the suspected material (pus). The inoculations are made subcutaneously in the abdominal region—a fold of skin is cut with small scissors and a pocket is formed into which the material is inserted; or, the material is injected intraperitoneally. Fourteen days after the subcutaneous injection, if glanders is present, characteristic symptoms appear. The point of inocula- tion has been transformed into an ulcer, in the proximity of which Digitized by Microsoft® 256 GENERAL THERAPEUTICS FOR VETERINARIANS nodular swellings of the lymph glands up to the size of a hazel- nut may be felt; later, these rupture; on post-mortem examination, purulent lymph glands and glanders abscesses are found, the latter especially in the testicles (glandular orchitis); also glandular nodules in the spleen, liver and lungs. A negative result from the inoculation does not exclude the presence of glanders. When the result is positive, a diagnosis of glanders is only justified when the bacillus mallei is also demonstrated in cultures (pseudo-glanders!). Other inoculation animals are the horse and the ass, the latter contracting acute glénders and usually dying in about 8 days; also cats, which, aftr subcutaneous (dorsal) inoculation, present symptoms similar t6 those exhibited by guinea-pigs. Concerning injection with mallein, see page 260. 4. TuBERCULOSIS.—The best inoculation animal is the guinea- pig. After the usual intraperitoneal inoculation (milk), numerous fresh tubercles of the size of millet seed appear in about three weeks upon the peritoneum and in the spleen, liver, and lymph glands. Following subcutaneous injection (mucus from the lungs), a purulent ulcer develops at the point of injection and the neighboring lymph glands become swollen; after 3 to 4 weeks numerous tubercles form in the internal organs. After intra- muscular inoculation (rapid inoculation), the neighboring lymph glands are transformed in ten days into firm nodules of the size of small peas, which may be extirpated and examined microscopic- ally. Intramammary inoculation and subcutaneous injection with simultaneous crushing of the lymph glands are followed in five days by the appearance of nodular swellings in the glands con- cerned. Test inoculations of guinea-pigs is the most certain method of clinically diagnosing tuberculosis. Concerning inoculation with tuberculin, see page 258. Fowt Cuo.rera.—A pigeon is inoculated subcutaneously with blood from a dead bird. A drop of blood from the dead bird is introduced under the skin of the breast of the pigeon by means of a lancet to the depth of a millimetre. If cholera is present, the musculature beneath the point of inoculation becomes necrotic Digitized by Microsoft® VACCINATION. IMMUNIZATION. INOCULATION 257 and yellow and the pigeon dies in 12 to 48 hours; on post-mortem examination a characteristic picture of cholera is found (hemor- rhagic enteritis) and the specific cholera bacilli are recovered from the blood. 6. Swine ErysiPELas.—Subcutaneous inoculation of mice (skin pocket) or pigeons (breast) is followed in 24 hours by char- acteristic symptoms: dejection, roughened hair, dyspnoea, mucous discharge from the eyes and agglutination of the eyelids. Mice die in 2 to 4 days; pigeons in 3 to 4 days; the specific bacilli are found in the blood. 7. StRaNGLES.—The most suitable inoculation animals are white mice, which are immune to glanders. The inoculation is made subcutaneously in the sacral region with a drop of pus or nasal discharge. Death usually occurs in 8 to 6 days and on post-mortem examination a pronounced picture of septicemia is presented (enlarged spleen, cloudy swelling of the internal organs, exudate in the body cavities, blood infiltration at the point of inoculation); in the blood, the specific strangles cocci are. found. More rarely, the animals die in 10 to 20 days with symptoms of metatastic pyemia. Field mice react only locally to strangles inoc- ulation, which is contrary to their behavior to glanders inoculation. 8. Rasies.—The best method is the intra-ocular inoculation of rabbits with the brain substance of the suspected dog; the material should be obtained in as fresh condition as possible. After 12 to 14 days, the inoculated animal dies of dumb rabies. Intramuscular and subconjunctival injection are also simple methods, but the subdural (intracranial, lumbar) and intracerebral inoculation of rabbits is more complicated. 9. Hemorruacic Septicamia.—Rabbits and mice die in 6 hours after cutaneous and subcutaneous inoculation, and in 12 to 24 hours after inoculation by feeding; large numbers of the bacilli of hemorrhagic septicemia are found in the blood; a further characteristic in rabbits is hemorrhagic tracheitis. 10. Matignant (ipema.—Only subcutaneous inoculations are effective with mice and guinea-pigs; cutaneous inoculations are 17 Digitized by Microsoft® 258 GENERAL THERAPEUTICS FOR VETERINARIANS without effect (contrary to anthrax). The inoculated animals die in 8 to 14 hours with symptoms of an extensive subcutaneous cedema, in which the characteristic bacilli are easily demonstrated. Guinea-pigs are also inoculated subcutaneously for black leg. Tuberculin Injection.—Tuberculin is obtained by the evapora- tion of bouillon cultures of tubercle bacilli and is official [in Ger- many] in two forms: as fluid (old tuberculin) and as dried tuber- culin (dry tuberculin, tuberculol). [In the United States, the evaporated tuberculin is diluted with a 14 per cent. solution of carbolic acid before it is sent out to the practitioner, the extent of the dilution varying in different laboratories.] Tuberculous animals are very sensitive to tuberculin and react to it with fever and local inflammation. This reaction indicates the presence of tuberculosis; not with certainty, it is true, but yet with great probability. Therefore, tuberculin is, after all, a very valuable diagnostic agent. It is employed according to different methods: 1. Subcutaneous (thermal reaction). 2. Conjunctival (ophthalmic reaction, eye test). 3. Cutaneous and intracutaneous (dermal reaction). 1. Tue SuscuTaNEous TUBERCULIN Tzst (thermal reaction) is the oldest method. Fluid tuberculin diluted [in Germany] with ten times the amount of 14 per cent. carbolic acid solution is injected under the skin. The dose of the tuberculin for cows is 0.5 gram, for calves 0.1 gram. [The dose of the preparations of tuberculin used in the United States varies from 1 c.c. to 4 e.c., depending upon the extent to which the evaporated tuberculin has been diluted with the 14 per cent. carbolic acid solution.] The diagnostic reaction consists of a rise of temperature of at least 2° F., which occurs 12 to 15 hours after the injection. [It is very generally agreed that a reaction may occur or begin at any time from the 9th to the 20th hour after injection, and it is therefore considered necessary to begin the temperature measure- ments not later than the 9th hour and to continue them in all cases until at least the 20th hour after the tuberculin is injected. In any case in which the temperature is rising at the 20th hour, Digitized by Microsoft® VACCINATION. IMMUNIZATION. INOCULATION 259 the temperature measurements should be continued until the temperature begins to fall or until a reaction occurs. American veterinary sanitary authorities recommend that at least three temperature measurements be taken before the tuberculin is injected, at intervals of 2 or 3 hours, and that the tuberculin be injected preferably between 6 and 9 p.m.] The disadvantages of the subcutaneous method are that it is misleading in 13 per cent. of the cases tested (incorrect diagnosis); that it requires a great amount of time, as at least two temperature measurements must be taken before and four after the injection; that it cannot be applied to animals in a febrile condition; that cattle previously injected with tuberculin will not react to the usual dose but require five times the quantity; that the general condition and the milk secretion is influenced unfavorably by the reaction fever, and that now and then chronic tuberculosis is transformed into the acute form. [According to American statistics, errors in diag- nosis are much fewer than are indicated by the German figures given above. Statistics compiled by the Bureau of Animal Industry? show that of 24,784 cattle which reacted to tuberculin from 1893 to 1908, 24,387 were found to be tuberculous on post- mortem, which is only 1.07 per cent. failures.] 2. Tae OrutHatmic Test (ophthalmic reaction, conjunctival reaction) has been recently given the preference [in Germany] over the subcutaneous method on account of its greater certainty, simplicity, cheapness, and harmlessness, and also because it is not influenced by the presence of fever or by a previous subcutaneous injection. It is applied in the following manner: four drops of a 5 per cent. solution of dry tuberculin or of a 25 per cent. solution of tuberculol are introduced into the conjunctival sac, or a quantity of a 1 to 2 per cent. tuberculin vaseline the size of a pea is placed in the conjunctival sac with a glass rod. A typical purulent dis- charge from the eye and a pronounced cedema appear in 12 to 14 hours. Rectal, vaginal, and nasal applications have the same effect. [In Pennsylvania, an alcoholic precipitate of a glycerin 2 Twenty-fifth Annual Report, Bureau of Animal Industry, p. 99. Digitized by Microsoft® 260 GENERAL THERAPEUTICS FOR VETERINARIANS bouillon culture of tubercle bacilli suspended in physiological salt solution is used. Two suspensions are made, one containing 4 per cent. of the precipitate and the other 8 per cent. Two drops of the 4 per cent. suspension are placed in the eye to sensitize it, and 4 days later two drops of the 8 per cent. suspension are placed in the same eye. The reaction occurs in6to14hours. As yet, however, the test has not been substituted for the subcutaneous test.] 3. THe CUTANEOUS AND INTRACUTANEOUS METHOD Consists in the application of a concentrated tuberculin solution to the shaved or scarified skin, or its injection into the tissue of the cutis. The dermal reaction is a pronounced cedematous, puffy swelling at the place of inoculation (lateral surface of the neck, caudal- anal fold). In order to insure the greatest possible certainty in diagnosis, it is recommended that all three tests, the subcutaneous, con- junctival, and cutaneous, be applied (simultaneous method). Mallein Injection.—Fluid mallein (raw mallein), obtained by the evaporation of cultures of glanders bacilli, and dry mallein, an alcoholic precipitate of the fluid mallein, are introduced into the animal body in order to utilize for diagnostic purposes the excessive sensibility of infected animals to mallein, manifested in the form of local symptoms of inflammation or symptoms of a general febrile affection. According to the place of application of the mallein (conjunctiva, subcutis, cutis), three methods of malleinization are distinguished: (a) The ophthalmic test or ophthalmic reaction. (b) The subcutaneous test or thermal reaction. (c) The cutaneous test or cuti-reaction. (a) THe OpatHatmic Test (ophthalmic reaction, conjunctival malleinization) is applied by introducing into the conjunctival sac with a brush or dropper a few drops of fluid mallein (0.2 c.c. or 0.2 gram per horse, 0.5 c.c. or 0.5 gram for 5 horses), or a few drops of a1 per cent. solution of dry mallein [precipitated mallein]. The other eye serves as a control. The specific reaction usually begins 5 to 6 hours after the instillation and continues 36 to 48 Digitized by Microsoft® VACCINATION. IMMUNIZATION. INOCULATION 261 hours. It consists of a purulent discharge from the eye, congestion and swelling of the conjunctiva, and swelling and agglutination of the eyelids. The result of the test is to be determined at the twelfth hour after the instillation at the earliest, and at the twenty- fourth hour at the latest. A positive reaction is a certain indica- tion of the presence of glanders. On the other hand, the presence of glanders is not positively excluded by a single negative reaction, but only when a second test three weeks after the first also gives a negative reaction. In the early stages of glanders the hypersensi- tiveness to mallein is absent; it does not appear until toward the second week after the infection. In doubtful cases (serous or mucous discharge from the eye), the eye test sometimes gives a positive re- sult when repeated on the same day (sensitization). With a positive reaction, an increase of temperature to over 38.5° C. [101.8° F.] usu- ally occurs in 24 hours which is also of diagnostic importance. The presence of fever is not a contraindication to the application of the eye test. (To be preferred to the subcutaneous method.) In recent years, the eye test has been found to be the most trustworthy, the simplest, the most convenient, the cheapest, the most rapid and, for examining large numbers of horses (remounts, imported horses), the most suitable method of diagnosing glanders, especially in Austria, where it has been recognized by the veteri- nary sanitary laws since 1910 (civil and military laws), in Denmark and in Germany (Prussia, Wiirtemburg). Recently, it has been officially prescribed in Bavaria. (b) Tus Suscutanzous Meruop or the thermal reaction con- sists [in Germany] in the subcutaneous injection of 0.02 gram of dry mallein or 0.5 gram of raw mallein. [In the United States, the evaporated glycerin bouillon culture of bacillus mallei is diluted in the laboratory with 14 per cent. carbolic acid solution, and the quantity injected depends upon the extent of the dilution.] A rise of temperature of over 2° C. [3.6° F.] during the two days following the injection, with a typical temperature curve with two apexes, is to be regarded as a positive indication of glanders, while horses which do not show any febrile reaction and those with Digitized by Microsoft® 262 GENERAL THERAPEUTICS FOR VETERINARIANS a temperature rise of less than 1.2° C. [2.1° F.] are to be considered free from the disease. The reports from different countries con- cerning the diagnostic value of subcutaneous malleinization are contradictory. [In the United States, the Bureau of Animal Industry and the Pennsylvania Livestock Sanitary Board have abandoned it for the ophthalmic test.] A disadvantage of the method is that it cannot be applied to horses in a febrile condition. [The directions for applying the subcutaneous mallein test, as published by the U. S. Bureau of Animal Industry in 1910 and 1912, are as follows: The preferable site for injection is on the side of the neck about the centre, where any local swelling is plainly visible. The hair should be clipped from an area about 2 inches in diameter, and the skin thoroughly cleansed with a disinfecting solution, such as 5 per cent. carbolic acid. Carefully sterilize the syringe and needle before commencing the injection of each group of animals, and immerse the needle in a disinfecting solution before injecting each animal. It is better to use a separate syringe, needle, and thermometer for animals exhibiting symptoms suspicious of glanders. Carbolized oil, vaseline, or lard should be used to facilitate the insertion of thermometers and also to disinfect them. On the day of injection, the temperature of each animal should be recorded not less than three times at intervals of not less than two hours; for instance, at 2,5,and 8 p.m. A careful clinical examination of each animal. should also be made, and to each one some designation should be given by which the animal will be known throughout the test. Mallein may then be injected at 8 or 10 p.m., providing the preliminary temperatures are not ab- normal. After injection the temperatures should again be recorded, starting at the expiration of not more than 10 hours, and should be repeated at intervals of approximately 2 hours until the expiration of at least 20 hours from the time of injection, and should be continued over a longer period in the case of an animal with a rising temperature at the twentieth hour, if, at the same time, a local reaction is present. What constitutes a reaction sufficient to warrant condemnation of the animal has been the subject of many articles and prolonged discussion. The Bureau of Animal Industry has adopted the following uniform principles for judging the mallein test: 1. In order that a reaction produced by mallein may be considered posi- tive it should evince the characteristics of a typical reaction; that is, a combi- nation of thermal, local, and general reactions. 2. By a typical reaction is to be understood a gradual rise of temperature of at least 3° F. and to above 104° F., the maximum temperature being sus- tained in the form of a single or double plateau. It should be accompanied by a local as well as a general reaction. Digitized by Microsoft® VACCINATION. IMMUNIZATION, INOCULATION 263 The local reaction consists of an infiltration at the site of injection, form- ing a large, abrupt, painful swelling with radiating lymphatics appearing as raised cords, generally attaining greatest prominence at from 18 to 21 hours after injection. The general reaction is exhibited by a stiffened gait, depres- sion, loss of appetite, and accelerated breathing. 3. The presence of a local reaction, especially when associated with a general reaction, should be regarded as evidence of glanders, even if the thermal reaction be slight or absent. 4, Animals giving an atypical reaction and those reaching a maximum temperature of 103° F. should be retested after the expiration of not less than 15 days.] (c) Cutaneous malleinization consists of the injection of mallein into the scarified skin and the pronounced local swelling which is produced. The method is complicated, technically difficult and the reaction varies with the method of application (superficial or deep scarification). Directions for Applying the Mallein Eye Test. I. Nature of the Test.—Horses infected with glanders are hypersensitive to mallein. They therefore react when mallein is instilled into the conjunc- tival sac with specific local symptoms of inflammation. The specific reaction is a pronounced redness and swelling and a purulent inflammation of the conjunctiva of the eyelids, especially in the inner canthus of the eye (drops of pus, flakes of pus in the discharge, purulent discharge). A serous, sero- mucous or mucous discharge is not specific. The specific reaction does not begin immediately, but at the earliest 5 to 6 hours after the instillation of the mallein; it usually continues for 36 to 48 hours, sometimes longer. The best time to observe it is from the twelfth to the twenty-fourth hour. The slight symptoms of irritation of the conjunctiva (tears, photophobia, slight redness of the conjunctiva), which occur in many horses very soon after the mallein is instilled and disappear after a few hours, must not be mistaken for the specific mallein reaction. II. Application.—Lither fluid mallein (raw mallein) or dry [precipitated] mallein is used. With a brush or dropper (eye pipette), a few drops of fluid, undiluted mallein or of a freshly-prepared 1 per cent. solution of dry [precipitated] mallein in distilled water or physiological salt solution are introduced into the right eye. The left eye serves as a control. In order that the eye may be examined for the symptoms of the specific reaction in daylight, it is recommended that the test be begun in the morning Digitized by Microsoft® 264 GENERAL THERAPEUTICS FOR VETERINARIANS or in the evening. When the mallein is instilled in the morning, the reaction will appear at the earliest in the afternoon; when it is made in the evening, the first observation of the eye can be made the next morning. Since drops of pus flowing from the eye and sticking to the hair may be thrown off by movements of the head and thus escape detection, restless horses should be tied up short during the test. The presence of fever does not interfere with the application of the test. The test does not influence the blood test. III. Judgment.—The test may terminate in three ways: positive, nega- tive, doubtful. The reaction is positive if a purulent discharge from the eye occurs in 12 to 24 hours. The reaction is negative if a discharge from the eye does not appear in 12 to 24 hours. The reaction is doubtful if after 12 to 24 hours only a serous, seromucous or mucous discharge occurs from the eye, or if only a drop of purulent secretion collects in the inner canthus of the eye without any discharge. The judgment of the test is based upon the following principles: 1. The presence of glanders is assumed as probable if a positive reaction occurs 12 to 24 hours after the instillation of the mallein. 2. The absence of glanders is assumed as probable if a negative reaction occurs 12 to 24 hours after the instillation of the mallein and if, in addition, a negative reaction is again obtained upon a repetition of the test three weeks later. (In the initial stages of glanders the hypersensitiveness to mallein is absent; this appears only toward the second week after infection.) 3. If the reaction to the first test is doubtful, a second test is begun on the same day. If the reaction to the second test is positive, the presence of glanders is assumed as probable. If the reaction to the second test is negative or doubtful, then a third test is made after 3 weeks. If the reaction to the third test is negative, it is assumed as probable that glanders is not present. If the reaction to the third test is positive, the presence of glanders is assumed as probable. If the reaction to the third test is doubtful, the horse remains under suspicion of glanders. Digitized by Microsoft® WATER AS A REMEDY. HYDROTHERAPY Synonyms: Hydrotherapy, hydriatrics, balneotherapy, Priessnitz’s! cure, water-cure. General.—Water has been employed as a healing remedy since ancient times. In spite of this, it is not possible to present to-day a clear, scientific analysis of its method of action. Some of the undoubted successes of hydrotherapy are still based upon pure empiricism (Priessnitz), and cannot at this time be scientifically explained at all, or only incompletely. The difficulty of placing hydrotherapy on a rational foundation is due to the circumstance that the effect of water upon the body is very complicated. Several very different factors apparently codperate in the water-cure. Not only the water itself, but also its temperature and likewise certain mechanical factors appear to exert a combined action. The continuance of the application and the change from cold to warm water are also of importance. Among the different proper- ties of water, the irritant action of cold water upon the skin is of the greatest consideration in veterinary therapeutics. The internal use of water (mineral water), as ordinarily employed in human medicine, is not practicable in veterinary medicine. As with the other cutaneous irritants, the effect of water upon the body is very extensive, which accounts for the frequent use of hydro- therapy in the most varied disease conditions. Actions.—1. Upon THE skin water has in the first place a cleansing effect, and consequently in a certain sense a disinfectant action. In addition, when its influence is long continued, it brings about a swelling and loosening (maceration) of the epithelial cells, with increased desquamation of the same. Since the capacity of cold water for heat is very great, it takes up heat from the body 1 Vincent Priessnitz, agriculturist in Grafenberg, Austrian Silesia; lived from 1799 to 1851, and founded in 1826 the first hydropathic establishment. 265 Digitized by Microsoft® 266 GENERAL THERAPEUTICS FOR VETERINARIANS when applied locally or generally and therefore operates as an antipyretic in conditions of abnormally high temperature. Cold and hot water act as cutaneous irritants, producing at first a con- traction of the cutaneous vessels and of the smooth muscle of the skin with a consequent anzemia, followed by a pronounced reactive relaxation of the vessels of the skin and of the underlying parts with a decided hyperemia of the same. On this account, cold water is to be regarded as an epispastic rubefacient which not only influences and changes the local circulatory relations of the skin and the tissues beneath it (subcutis, tendons, tendon sheaths, muscles, articulations, bones) but also, when used extensively, affects the blood distribution of the entire body, causing the blood to flow from the centre of the body to the periphery and depleting the internal organs. While cold water produces a passive hyper- emia, hot water, and moderately warm water when the application is long continued (cataplasms), generate an active hyperemia. These actions upon the skin point to numerous indications for the treatment of local diseases of the skin, the subcutis, the mus- culature, tendons, bones and articulations as well as general febrile and internal diseases. Furthermore, the hyperemia produced considerably stimulates the secretory activity of the skin (water, urea and metabolic products), sometimes even to the extent of pro- ducing perspiration. Since a relation exists between the secretory functions of the skin and different internal organs, especially the kidneys and lungs, a therapeutic action may be exerted upon these organs by the use of water. Depending upon the temperature, water exerts a stimulant action upon nerves or exerts a sedative effect in abnormal, painful conditions. Of great practical importance in all these cases, in addition to the temperature of the water, is the continuance of its action and a change from cold to warm. In reference to the temperature, a distinction must be made between cold (0-15° C.), tepid (15- 30° C.), warm (30-38° C.) and hot (38° C. and above). Only cold and hot water exert a pronounced action as cutaneous irritants in the manner described above. Warm water corresponding in Digitized by Microsoft® HYDROTHERAPY 267 temperature to that of the body is indifferent, and the action of tepid water is weak. The colder or the warmer the water in com- parison to the body temperature of the animal, the more pro- nounced is its action upon the skin. In regard to the continuance of action, when cold water is used for the purpose of reducing tem- perature its application must naturally be continued as long as possible. But if the water is employed as a cutaneous irritant, then the therapeutic effect is in direct relation to the shortness and frequency of the individual applications. When a single applica- tion of cold water produces a reaction in the skin in the form of a change in the circulatory relations (hyperemia), the condition dis- appears after a certain interval, and a renewal of the cutaneous irritation is naturally required to again bring about the same reaction with its healing effects upon the organism. One long- continued application of cold water produces only a single reaction, which occurs in the beginning. For these reasons frequent applica- tions are indicated, and on this account Priessnitz dressings, for example, are changed frequently (on the average every 3 hours). The effects produced under these circumstances are as follows: When the dressing which has been dipped in cold water is first applied, anemia and cooling of the skin occurs; this is gradually followed by a hyperemia, which is continued several hours and which is promoted by the warm overlying dressing. After this period, the circulatory relations are again equalized and in order to produce a new reaction the cold irritant must be renewed; @.e., a new cold dressing must be applied. Failure of a patient to show any reaction in the skin after a proper application of cold water is evidence of great weakness of the nervous system and justifies an unfavorable prognosis. For prophylactic purposes, the frequent use of cold water in healthy animals is recommended to facilitate the occurrence of the reaction and to exercise and strengthen the skin (cold rub-down for horses and cattle, washing). 2. THE CIRCULATORY APPARATUS is influenced in very different directions by hydrotherapy. As already observed, cold water Digitized by Microsoft® 268 GENERAL THERAPEUTICS FOR VETERINARIANS causes at first, in consequence of irritation of the peripheral vaso- motor centres (Lenaschew, Pliigers Archiv., vol. 26), a contraction of the cutaneous vessels with anemia of the skin, which drives the blood to the interior and also increases the blood-pressure, the activity of the heart and the internal temperature. With the occurrence of the reaction in the skin, contrary effects are pro- duced. The blood-vessels dilate, the blood flows from the centre to the periphery, and blood-pressure, heart activity, pulse fre- quency and internal temperature decrease. It is therefore pos- sible to act with hydrotherapy upon every single factor of the circu- lation: upon the lumen and tension of the blood-vessels, upon the heart, upon the blood-pressure, upon the blood distribution and upon the blood heat. Water is consequently a valuable remedy in all conditions of inflammation and congestion and in general febrile diseases. It is also a derivative remedy, particularly on account of its regulating influence upon blood distribution. Inter- esting investigations have been made by Schiiller (Deutsches Archiv. fiir Klin. Medizin, vol. 14) concerning the derivative effect of water upon the deeply situated organs, which are of therapeutic importance, especially in inflammation of the brain. In trephined rabbits, constriction of the vessels of the pia and contraction of the brain were observed after the application of warm compresses to the skin, while the employment of cold dressings on the skin or a cold bath caused a dilation of the vessels of the pia. The same action apparently extends to the spinal cord, the lungs and the other vis- cera. These experimentally established facts justify scientifically the hydropathic derivation which has been hitherto practised empirically, especially in inflammation of the brain, pneumonia, pleuritis and peritonitis. Finally, since cold water also increases metabolism, as is shown by the increased elimination of carbon dioxide and the increased absorption of oxygen demonstrated in animals experimentally by Rohrig and Zuntz, the resorbent effects of external applications of water in connection with the stimula- tion of the circulation are readily understood. 3. THE NERVOUS SYSTEM is affected in different ways, accord- Digitized by Microsoft® HYDROTHERAPY 269 ing to the temperature of the water. Cold water stimulates the activity of nerve tissue; warm water, on the contrary, has a seda- tive effect, soothing and depressing. Depending upon whether the application of the water is local or general, a local or total alteration of innervation can be brought about, either of the nature of a stimulation or depression, which is not possible with other cutaneousirritants. Upon the nerves of theskin the action is direct, while the other parts of the nervous system are influenced reflexly through the skin (counter-irritation). By the application of cold water, a weakened nervous system is stimulated, entirely inde- pendent of the change in circulation (derivation), while warm water applications depress an abnormally stimulated nervous apparatus. This is true of the brain and spinal cord as well as of the nerves of the different internal organs, such as the stomach, intestines, kid- neys, uterus, lungs, heart, etc. Well-known examples of these actions of water are the stimulant effects of cold and the sedative, anodyne effects of warm water applications in colic of the horse and the favorable action of the Priessnitz dressing in abnormal sensibility of the larynx (cough), pharynx (difficult swallowing), brain, musculature (rheumatism), articulations and tendons (inflammation). 4, THE BODY CELLS are nutritively stimulated by moist heat (cold acts reversely) and their function of forming antitoxins and their regeneration activity are thereby accelerated. Local leu- cocytosis is also promoted by heat, but is inhibited by cold (see the chapter on acrics). 5. Tue cuanps of the body (liver, kidneys, pancreas; gastric, intestinal and cutaneous glands) are also influenced in different ways by applications of water, partly through the circulation (derivation) and partly through the nervous system (counter-irri- tation). The secretions of the liver and kidneys in particular are stimulated by cold and decreased by warm water applications. 6. THE MUSCULATURE has, as is well known, special relations with the skin; the diseases caused by chilling (rheumatism, rheu- matic hemoglobinemia [azoturia]) demonstrate that the two are Digitized by Microsoft® 270 GENERAL THERAPEUTICS FOR VETERINARIANS intimately associated. In these diseases, it may be assumed, the chilling acts as an abnormal cutaneous irritant, causing a disturb- ance of the circulation, innervation and especially the metabolism of the musculature. Similar influences can be exerted upon the diseased musculature by the employment of hydropathic dressings, the disturbed circulation and innervation being affected by deriva- tion and counter-irritation. Warm water is most desirable for this purpose because it at the same time allayspain. Cold water is more suitable to the prophylactic hardening against the diseases men- tioned. Experience has taught that muscular rheumatism as well as rheumatic hemoglobinemia [azoturia] can be effectively pre- vented by accustoming the skin to the irritation from cold and hardening it against the harmful results. Avoiding too warm stabling and covering, accustoming to cold, and especially frequent cold rubbing down when rationally employed afford good protec- tion against these diseases. 7. THE RESPIRATION is stimulated by cold water. Cold appli- cations are therefore employed as stimulants in weakness and paralytic conditions of the respiratory centre (syncope, poisoning by chloroform) and to strengthen expiration in pulmonary and bronchial diseases. On the other hand, the diseased lungs are relieved by the derivation of the blood from the lungs to the skin (cutaneous respiration) by means of moist, warm applications. In these respects hydrotherapy is of importance in the treatment of pneumonia and other respiratory diseases. 8. LocaL.y, cold at first causes contraction of the arteries and anemia (checking hemorrhage, antiphlogistic action), later dila- tion and congestion of the veins with slowing of the circulation and resorption and decrease of the leucocytes. Moist heat, especially the Priessnitz dressing and cataplasms, promotes local blood cir- culation and cell activity and also local leucocytosis and the formation of antitoxins. Hot applications generate an active hyperemia, which extends to a considerable depth (musculature, peritoneum) and continues for 24 hours and longer; in addition, the circulation of lymph and consequently resorption is stimulated Digitized by Microsoft® HYDROTHERAPY 271 (hyperlymphia, cedema formation). See the experimental inves- tigations of Schaffer.? Hypereemia as a Healing Remedy.—Bier® has drawn attention to the favorable effects of chronic passive hyperemia, produced artificially by elastic bandages and by hot-air apparatuses, upon surgical suppurative and inflam- matory processes. Passive hyperemia, like active hyperemia, hasaresorbent, bactericidal and anodyne action and stimulates the formation of new tissue. The same effects are produced by the continued employment of high degrees of heat by means of Ullmann’s‘ hydro-thermo regulator, which was introduced into veterinary surgery by Bayer’ and Eberlein® and found by them to be of value especially in chronic tendinitis, tendovaginitis, shoulder boils, exostoses, thickening of the skin, articular and muscular diseases, wounds and ulcers of the horse (constant, regulated heat treatment in the form of dry or moist heat). Upon the basis of his experiences in the Vienna clinic, Schmidt? has formed the following conclusions concerning the value of Bier’s passive hyper- emia in veterinary medicine: The aspirator is most useful in diseases of the paws of small animals (phlegmon, panaritium). The rubber tubing and the elastic bandage can be used on all of the domestic animals, but the technique presents numerous difficulties, which are greater in animals than in man. Purulent inflammations of the articulations and tendon sheaths and phleg- monous processes in the hoof are best suited to the passive hyperemic treat- ment. On account of the technical difficulties and the dangers attending the treatment, however, it can only be employed in stationary clinics under con- tinual control; its use in general practice and in polyclinics is precluded. According to Réder® also, the field for the use of Bier’s passive hyperemia is limited; he recommends venous stasis by means of bandages in wounds of the coronet, in contused wounds and after resection of the lateral cartilage, and the employment of the aspirator in shoulder boils. Kriiger,® as a result 2 Schaffer, Der Einfluss unserer therapeutischen Massnahmen auf die Entziindung. Stuttgart, 1907, Ferd. Enke. 3 Bier, Die Hyperamie als Heilmittel. Leipzig, 5. Aufl., 1907. 4 Ullmann, Wirkungen und therapeutische Verwertung konstanter Warme- applikationen. Physiklinisch-medizinische Monatshefte, 1904. 5 Bayer, Der Hydrothermoregulator. Zeitschr. f. Tiermed., 1903. 6 Eberlein, Der Hydrothermoregulator. Berl. Archiv., 1905. 7 Schmidt, Die Biersche Stauungshyperimie in der Tierheilkunde. Mo- natshefte fir prakt. Tierheilkde., 1907. 8 Réder, Dresdener Naturforscherversammlung, 1907. ® Kriiger, Hyperamie als Heilmittel in der Tierheilkunde. Zeitschr. ftir Vet., 1910. Digitized by Microsoft® 272 GENERAL THERAPEUTICS FOR VETERINARIANS of his experiences in the Berlin Horse-shoeing School, agrees with Schmidt and Réder that passive hyperemia, when properly employed in suitable cases, is to be regarded as a good healing method in veterinary medicine. Eberlein and Braun? have cured four cases of inflammation of the temporomaxillary articulation in the horse with Klapp’s aspirator. Uses.—The external use of water for healing purposes is in many cases similar to the use of the cutaneous irritants (see p. 148). The indications for the employment of hydrotherapy are, however, more numerous than for the use of cutaneous irritants. More- over, the water is often preferred to these drugs because of the simplicity of its application and the cheapness of the hydropathic apparatuses. The most important diseased conditions treated with water are the following: 1. Local surgical affections of the skin, subcutis, tendons, tendon sheaths, muscles, joints, bones, and lymph glands. The application of cold water is indicated only in active hyperemia and in entirely fresh, acute inflammatory conditions in these parts. On the other hand, warm, moist applications or cataplasms are indicated in all subacute and chronic inflammations, in passive hyperemia and in extravasations in the parts named. This is true especially of fluid and solid exudates, indurations, old swellings and thickenings of the skin, subcutis, tendons, articulations, bones and muscles, and also of purulent inflammations and ripening abscesses. The moist heat in these cases dilates the vessels, accel- erates the disturbed and sluggish blood and lymph circulation, promotes metabolism and resorption, softens hard inflammatory products, encourages the outwandering of white blood-cells (phago- cytosis, histolysis), accelerates connective tissue formation and cicatrization and stimulates the formation of antitoxins. 2. General febrile diseases. The antipyretic action of cold water in the form of cold poultices, irrigations, douches, baths, fomentations and rectal infusions depends upon the withdrawal of heat; the cold must continue to operate for a long time, however, 10 Braun, Die Saugbehandlung nach Klapp bei der Arthritis purulenta des Kiefergelenks des Pferdes. Monatshefte fiir prakt. Tierheilkunde, 1912. Digitized by Microsoft® HYDROTHERAPY 273 because a temporary application causes at first a rise of the internal temperature. Warm, moist applications also exert an antipyretic effect, since under their influence blood is drawn from the centre of the body to the periphery and gives off heat; codperating with this action is the influence upon the vasomotor and caloric nerve centres. 3. Inflammation of the lungs, pleura, peritoneum, brain and spinal cord, stomach and intestines, kidneys, liver, and uterus. The hydropathic effect of warm, moist applications consists of the contraction of the dilated vessels in diseased internal organs and of the derivation of the blood to the skin. 4. Cidema of the lungs, brain, and glottis, The action is the same. 5. Muscular rheumatism. The warm, moist applications exert a derivative and anodyne action. 6. Colic and cough. The action is the same. 7. Paralytic conditions of the nervous system (cerebral, spinal and peripheral paralyses, weakness of the loins, parturient paresis, poisonings, paresis of the gastric and intestinal musculature). Cold or hot water (cutaneous irritation, counter-irritation) is indicated in these conditions. 8. Excited conditions of the nervous system (pains, spasms, hypereesthesia, increased reflex activity). Warm water (sedative action) is employed in these conditions. 9. Exudates (fluid and solid) in the internal organs. The warm, moist applications promote the circulation, leucocytosis, metabolism, and resorption. 10. Kidney and liver diseases (stimulation of the secretion, derivation). 11. Catarrhs of the respiratory apparatus (inhalation of steam). 12. Obesity (stimulation of metabolism). Forms of Application.—1. Priessnitz’s dressing. This is ap- plied in the following manner: The skin is first covered with a piece of linen or cotton cloth, or a bandage, which has been dipped in cold water, and over this cold, wet dressing a dry, woollen cover- 18 Digitized by Microsoft® 274 GENERAL THERAPEUTICS FOR VETERINARIANS ing or bandage is so applied that the surface of the dressing re- mains entirely dry (warm, moist poultice). After about 1 to 3 hours, a reactive hypersemia of the skin has taken place under the bandage in the manner before described, so that the dressing must be renewed after this period. A renewal of the dressing is also indicated when the inner layers of the bandage have become dry. On account of the early occurrence of maceration of the skin, care must be taken not to continue the use of the dressing too long; in order to avoid inflammation of the skin, it is recommended that the dressing be left off over night or every second or third day. 2. Irrigation. By this is understood the irrigation of the body or parts of it with cold water by means of a rubber hose. This serves to withdraw heat generally and locally in fever and in inflammations of peripheral parts (hoofs, tendons, joints, head). 3. Douche. This is the application of a stream of cold water with the simultaneous action of mechanical force (pressure from a syringe or from water pipes, irrigation from a higher level); it acts as a powerful stimulant to the nervous system, especially in depressed conditions of the brain and spinal cord. 4. Baths. The domestic animals are in general rarely sub- jected to complete baths for hydrotherapeutic purposes; on the other hand, cold and warm local baths are employed in different forms, especially foot baths for horses, cattle and dogs, for the purpose of reducing temperature, softening and cleansing. Ac- cording to Wenz (Dissertation, Giessen, 1911), a preliminary warm bath increases the effect of a succeeding cold bath, while the reverse of this order is unfavorable. Additional investigations on the action and use of baths on animals have been published by Lucas (Berl. Arch., 1910). 5. Cold rectal infusions. These serve to reduce the tempera- ture in fever and to stimulate intestinal peristalsis and evacuate the rectum; they are used most frequently on the horse (clysters, irrigations). 6. Clay poultices. This is the oldest form of hydrotherapy used in veterinary medicine. The cooling effect is slight, accord- Digitized by Microsoft® HYDROTHERAPY 275 ing to Bayer, the temperature being only temporarily depressed a few degrees. 7. Cataplasms. These are effective especially because of their heat and moisture. Other forms of hydrotherapy which may be mentioned are simple cold and hot poultices, the ice poultice (ice pack), Leiter’s cooling apparatus, and the different cold and warm washes. In regard to the use of the thermo-regulator, see the text-books on operations and instruments. This apparatus makes possible the uninterrupted (24 hours and more) action of radiating heat of 42 to 44°C, Digitized by Microsoft® MASSAGE Synonym: Mechanotherapy. Nature and Forms.—Massage is the application of pressure upon the skin and the parts beneath it. It has been used for a long time in veterinary medicine, intentionally in the form of rubbing and unintentionally in the application of ointments. It is also one of the oldest methods of healing used in the treatment of man (Chinese, Greeks, Romans, primitive people). After being forgotten for a long time (during the entire middle ages up to modern times), the method was to a certain extent rediscovered in Sweden by Per Hendrick Ling (Swedish medical gymnastics). Zander displaced the masseur by mechanical apparatus (mechano- therapy). Mezger, Mosengeil, Zabludowski and others have recently built up the method practically and scientifically. The following varieties of massage are distinguished: 1. StRoxkinc (EFFLEURAGE).—This consists in passing the finger tips or the flat of the hand superficially and gently over the skin. 2. Russine (Massace A Friction).—In this variety of mas- sage, the skin is rubbed under strong pressure. 3. Kneapine (P&TRISSAGE).—The part of the body concerned is pressed with the finger tips or fist as dough is kneaded. 4, Tappinc (TAPOTEMENT).—The diseased member is tapped or struck at short intervals (edge of the hand, fist, stick). Tapping is employed in paralyses of muscles and nerves and as preliminary massage in the neighborhood of articulations. In addition, compression (constant pressure), vibration (inter- mittent pressure by special apparatuses) and active and passive movement (mechanotherapy in the restricted sense, Swedish medical gymnastics) may be considered as forms of massage. Action.—As in the case of cutaneous irritation and hydro- therapy, the effect of massage upon the body is very extensive. 276 Digitized by Microsoft® MASSAGE 277 The action appears to be not exclusively mechanical but partly dynamic. The most important local effects of massage are a cleansing, stimulant, anodyne and a dynamic action. In addi- tion, massage produces important general effects. Its influence upon the individual organs is as follows: 1, The circulation of the blood and lymph is influenced by- massage first of all. The action here is the same as that which occurs during motion in the vessels of the extremities, where the venous blood and lymph is forced centripetally toward the heart by the contraction of the muscles and the tension of the fascia with the codperation of the valves of the vessels, a process which may be called a natural or physiological massage. The pressure exerted upon the body by artificial massage produces at first an anzemia of the parts concerned in consequence of the blood and lymph being pressed out of the veins and lymph vessels toward the heart. With the cessation of the pressure, a large amount of fresh blood flows into the empty spaces and the area becomes hyperemic (aspiratory and pressure action). The repeated alter- nate occurrence of anemia and hyperemia stimulates and acceler- ates the circulation in the massaged parts. 2. The acceleration of the circulation brings about an increase of metabolism, leucocytosis, histolysis, and local antitoxin forma- tion, promotes retrogressive changes and regeneration, stimulates the resorption of the products of fatigue and metabolism, patho- logical products, exudates and extravasations, and improves the nutrition of the part massaged (experiments of Mosengeil with pigments injected into the joints). 3. Solid, fibrinous exudates and-blood coagula beneath the skin, in tendon sheaths and in joint cavities are mechanically crushed by massage and thus prepared for resorption. In addi- tion, swellings of the skin and mucous membranes, subcutis, musculature, tendons and tendon sheaths, joints, etc., are reduced in volume. 4. Contractions of the musculature are overcome by tapping the muscle; simple rubbing and stroking brings about hyperemia Digitized by Microsoft® 278 GENERAL THERAPEUTICS FOR VETERINARIANS with increased nutrition and blood formation; in addition, the capacity for work is increased, as by training. 5. The nervous system is stimulated by massage in the same manner as by cutaneous irritation. The cutaneous nerves are stimulated by kneading and tapping and the stimulation acts reflexly upon the central nervous system. Paralyzed peripheral nerves (motor and sensory) especially are treated by massage. Light massage (stroking) appears to reduce increased suscepti- bility of nerves. 6. Other general effects of massage include increase of cardiac activity, pulse and body temperature, reflex stimulation of gastric and intestinal peristalsis, diuresis and diaphoresis, change in the distribution of the blood (depletion of the central organs, deriva- tive action), improvement of the general state of nutrition and strengthening of the body constitution. Uses.—Massage is used principally in surgery; it can, however, be employed with advantage in internal medicine. But its value in veterinary medicine must not be overestimated. The alleged results of massage in practice are in great part to be attributed to the healing power of nature and to the simultaneous employ- ment of hydrotherapy and medical treatment. For horses espe- cially, massage will never attain the same importance as for man, where suggestion is frequently the principal healing factor; in addition, the hair of the horse, the resistance of many animals and the bodily difficulties arising for the masseur hinder the application of the method. Furthermore, much time is often lost with massage; blisters and firmg are much more valuable therapeutic measures than massage. The most important indications for massage are the following: 1. Blood stasis, lymph stasis, cedemas of the skin, mucous membranes, and subcutis (especially prophylactically against formation of thrombi and in decubitus). 2. Contusions, hemorrhages and lymphorrhagia on the sur- face of the body (saddle pressure, hematomas of the thigh). 3. Subacute, aseptic inflammations of the skin, subcutis, ten- Digitized by Microsoft® MASSAGE 279 dons, tendon sheaths, joints, bones, glands and udder (milking). Massage should not be applied too early in fresh distortions of the joints and in acute periostitis (only after several days’ treatment). 4, Chronic inflammatory thickenings and indurations in the organs mentioned in paragraph 3, splints, galls, ulcers, badly granulating wounds, stiffness and weakness of the limbs in old horses and after hard work. 5. Muscular rheumatism, muscular paralysis, muscular atrophy and muscular cramp. 6. Paralysis of peripheral, motor and sensory nerves, spinal and cerebral paralytic conditions. 7. Chronic inflammation of the cornea (leucoma); cedema of the eyelids. 8. Colic, constipation, tympanites, paresis of the rumen, atony of the gastric and intestinal musculature. 9. Febrile general diseases, inflammation of internal organs, obesity, diabetes, anemia (Weir Mitchell’s method), cardiac failure (Oertel’s method). 10. In healthy animals, massage in the form of training and rubbing down after exercise is an important factor in maintaining health, especially in horses. Contraindications.—Since massage promotes the resorption of the products of inflammation (fibrin, serum, blood), it can be employed only in simple, non-septic inflammations. In all cases in which septic material is present in the area of inflammation, especially the bacteria of septicemia and pyemia, massage must be omitted, otherwise a general infection of the body will result from the resorption of the infectious material. Massage is espe- cially contraindicated in phlegmona, abscesses, septic mastitis, metastatic tendovaginitis (contagious pneumonia of horses), ery- sipelatous swellings (influenza), malignant cedema, black leg, all purulent, sanious and septic inflammatory conditions in general and in fresh keratitis. Massage is to be avoided particularly in phlebitis, lymphan- gitis and purulent lymphadenitis, because here the danger of a Digitized by Microsoft® 280 GENERAL THERAPEUTICS FOR VETERINARIANS blood infection is the greatest. In addition, phlebotomy fistulz and venous thrombi should not be massaged, since lung emboli may result from the disintegration of the thrombus. Massage of arterial thrombi cannot be unqualifiedly recommended because of the danger of peripheral emboli. Finally, massage is forbidden in animals in many cases by the local sensitiveness. Technique of Massage.—To massage correctly requires on the one hand good instruction and practice and on the other hand a certain adaptability of the fingers and hand. Definite rules concerning the variety and the con- tinuance of massage can not belaiddown. Massaging according to a fixed system should be especially avoided; each case is to be scientifically individ- ualized. The principle of massage is that the stroking, rubbing and kneading movements should be centripetal where possible, i.e., in the direction from the periphery toward the heart. On the legs, for example, one massages from below upward, and on the neck from above downward, following the course of the venous blood and lymph. The movements may also be circular, from above downward and the reverse alternately; the chief result is then altera- tion of the circulation. Usually, massage is begun and ended with stroking. The “introductory massage” is begun on the healthy, centrally situated parts in order first of all to clear the paths of diversion. Massage is usually per- formed with the dry hand (finger tips, surface of the hand, thumbs, fist); when massage is long-continued the hand is moistened or is anointed with pure oil, paraffin ointment, lard or with a medicated ointment (camphor ointment, iodoform ointment). The official paraffin ointment! (white vaseline) is the best. Massage is continued on the average for 10 to 20 minutes and is applied once or twice daily. In massaging articulations, flexing, extending and rotating movements are employed. Very hard indurations, as splints, etc., can be massaged with the assistance of sticks and plates. Aids of this kind are unnecessary in other conditions; this is also true of the use of objects placed upon the skin to receive the pressure or blow. Tapping is used in paralytic conditions and as a preliminary massage in distortions. The sur- face of the fingers and the hollow of the hand are well adapted for stroking, both hands being used alternately; deep-lying parts are massaged with the tips of the thumbs. Rubbing is performed with the joints of the fingers and hand held rigidly, the hands movingin straight lines or in a circle over small sur- faces. In kneading, the soft parts are grasped transversely with the hands and pressed with the fingers progressively toward the centre of the body. Tap- ping consists of elastic taps with the loose-jointed hand or slapping with the [} Petrolatum album of the U. S. Pharmacopeeia.] Digitized by Microsoft® MASSAGE 281 hollow of the hand; the fist and instruments are also used. Massage of the rumen and intestines is performed by pressing both fists into the flank region against the organ concerned; general rubbing of the abdominal wall operates indirectly. In colic of the horse, the large colon can be massaged from the rectum. Massage of the cornea is performed by placing some ointment (yellow mercuric oxide salve, 1 : 25) between the lids, drawing them over the eye and gently rubbing. The articulations, tendons and muscles are most frequently massaged. For more details of the technique of massage, see the works of von Mosengeil, Reibmayr, Zabludowski, Vogel and others. Concerning the action and uses of massage in veterinary medicine see also Kohlhepp (Disser- tation, Giessen, 1906), Goldbeck (Zeitschr. f. Vet., 1908) and Leuffen (Mo- natshefte fir prakt. Tierheilkunde, 1912). Digitized by Microsoft® ELECTRICITY AS A REMEDY. ELECTROTHERAPY Synonyms: Galvanotherapy, Faradotherapy, Franklinotherapy. General.—Although electricity has been employed for healing purposes for a long time, it is only within the last seventy years that its action upon the body has been closely examined scientific- ally (Remak, Ziemssen, Erb). Furthermore, its physiological action remains unexplained to-day in many respects. Electro- therapy is therefore still in part a purely empirical healing method. In veterinary medicine, electricity is seldom employed for curative purposes and, indeed, is used mostly only on dogs and horses. According to the form of electricity employed and the object of the treatment, the following forms of electrotherapy are differentiated: 1. GALVANOTHERAPY consists in the employment of the con- tinuous (galvanic) current generated in galvanic batteries. 2. FaRADOTHERAPY uses the interrupted (faradic, induced) current, which is generated by means of an induction apparatus. 3. FRANKLINOTHERAPY is seldom employed; static or friction electricity is used. 4. Evectrotysis (galvanolysis) is the chemical decomposition of fluids by the galvanic current, the electrodes being placed upon the skin. 5. ELECTROPUNCTURE (galvanopuncture) serves the same purposes as the needle-shaped electrodes which are used to penetrate the tissues. : 6. GaLvaNnocaustic is the use of the galvanic current to heat firing apparatus. Action.—The effects of electricity upon the living animal body are very complicated and have not been completely investi- gated. The nervous system and the musculature are influenced first of all by the electric current. But the fluids of the body, especially the blood, and the glands and other tissues appear also 282 Digitized by Microsoft® ELECTROTHERAPY 283 to be changed in certain respects by electricity. In general the following effects are recognized: 1. The stimulant action is produced most strongly by the induced (faradic) current. It causes burning of the skin (cutaneous irritation), stimulation of the sensory and motor nerves, muscular contraction, dilation of the blood-vessels (stimulation of the vaso- dilators), increase of gland activity and of metabolism. Electricity therefore operates as a stimulant to most of the organs of the body. 2. The electrotonic action consists in the alteration of the physiological electrotonus, 7.e., a change in the susceptibility of the nerves (anelectrotonus, catelectrotonus). To this are probably due in great part the curative results of electrotherapy in nerve diseases. The electrotonic action of the continuous current espe- cially is sedative, reducing the receptivity of the nerves. 3. A chemical action is undoubtedly produced by the electric current, especially in the region of the poles (anode, cathode). It acts first of all upon the fluids (serum, blood) and upon the salts contained in them. As is well known, salts and other compounds (water) are separated by electrolysis into their positive and nega- tive elements and the positive (alkaline) elements are attracted by the negative pole or cathode while the negative elements (acid) are attracted by the positive pole or anode. The electric current in muscles and nerves is probably due to a similar combination of chemical opposites. 4, A cataphoric action is manifested by substances which ordi- narily are not diffused through the tissues of the body becoming diffusible under the influence of the electric current. Because of the results obtained in experiments with potassium iodide and cocaine, it is assumed that pathological products also become diffusible. The so-called catalytic (alterative) action appears to consist essentially of a stimulation of the vasomotor and trophic nerves and consequently falls under the first-named action. Uses.—In veterinary medicine, electrotherapy is indicated in Digitized by Microsoft® 284 GENERAL THERAPEUTICS FOR VETERINARIANS the following diseased conditions in the smaller domestic animals and in horses: 1. As a stimulant in pareses and paralyses of the posterior quarters and in paralyses of the peripheral nerves and muscles (pa- ralysis of the facial and radial nerves, tongue, bladder, quadriceps and penis, and amblyopia). In these conditions, the interrupted (faradic, induced) current is used in medium strength, because every single one of the numerous interruptions stimulates the nervous system. 2. As a sedative in excitable conditions of the muscles (twitch- ings after canine distemper). The galvanic or continuous current is used as mildly as possible. 3. As a diagnostic and prognostic to demonstrate the retention or loss of sensory and motor excitability in paralytic conditions of the. nervous system and musculature (testing electric excitability). The surgical employment of the galvanocaustic and electro- puncture for the destruction of new formations has not been made use of in veterinary medicine. Technique.—The best induction apparatus for veterinary purposes is the small, handy apparatus of Spamer (price, $7 to $10). If the electric treat- ment is limited to paralytic conditions, this apparatus will be entirely sufficient. For other cases, a small galvanic apparatus can be used. The method of using these apparatuses is described in the directions which accompany them. In general, it is to be remembered that the hairy skin of animals is a poor con- ductor of electricity and that the electrodes must therefore be moistened (salt water is best) before they are applied. It is also to be remembered that the electric excitability is increased in the region of the negative electrode (cath- ode), while it is decreased in the region of the anode. Of especial practical importance are the facts already mentioned, namely: that the nerves are soothed by a weak galvanic current, while they are stimulated by a strong faradic current. In the employment of the faradic current, a weak current is used in the beginning and the strength is slowly increased until a reaction (twitching, pain) is obtained; the current is permitted to operate in the latter strength on the paralyzed part for 10 to 15 minutes, one to three times a day. If a weaker current later produces twitching it is an indication of improvement. The strength of current used can be exactly regulated with the apparatus. The application of the electrodes differs; usually one electrode is placed as Digitized by Microsoft® ELECTROTHERAPY 285 close as possible to the paralyzed nerve or muscle, while the other one is applied in the neighborhood. In spinal paresis of the posterior quarters an electrode is placed on the moistened sole of each hind foot so that the current will pass through the entire posterior parts; in paralysis of a single limb, one electrode is applied to the sole of the foot and the other in the region of the lumbar cord. The spinal cord is either treated longitudinally, with the anode placed upon the upper (anterior) and the cathode upon the lower (posterior) part; or trans- versely, with the electrodes upon the sternum (anode) and spinal column (cathode); the galvanic current, with the largest electrodes possible, operates best. The brain is treated with the electrodes applied to the back of the neck and to the forehead, the weakest galvanic current possible being used. A more complete discussion of electrotherapy will be found in Grundriss der Elektrotherapie ftir Tierarzte by Tereg (Berlin, 1902), and in the special works of Erb, Pierson-Sperling, Rosenthal, Benedikt, Levandowski, Meyer, Graupner and others. Thermopenetration.—This term refers to the generation of heat in the inner parts of the body with the assistance of the electric current. The un- limited high-frequency current can be introduced into the body in any strength desired without producing any effect upon the nervous system. It exerts a favorable influence on man, especially in neuralgias and rheumatic affections. An electric warm-current healing apparatus called the “Stangerotherm” has been recommended for animals, Digitized by Microsoft® BLEEDING Synonyms: Venesection, phlebotomy. General.—Bleeding, a healing method of the old therapeutics, has in the last several decades very correctly passed out of fashion. A critical examination of its indications has shown that in most cases in which it is employed early it is at least unnecessary, while in a large number of cases it is even directly harmful. This is especially true of its former conventional employment in all febrile and inflammatory diseases. Still, it cannot be entirely dispensed with even to-day, especially in veterinary medicine. There are some very well-defined diseases, especially of horses and cattle, in which bleeding under certain circumstances saves life. Action.—The most important effect upon the body of the decrease in the total quantity of blood (5 to 10 liters in horses and cattle) which results from bleeding is the withdrawal of a large amount of water. In this respect, the effect of bleeding agrees entirely with the action of diaphoretic, sialagogue, diuretic, and laxative drugs, especially arecoline. Following this withdrawal of water, the blood seeks to regain at least its former volume as quickly as possible by taking up any fluids in the body at its disposal (lymph, fluid exudates), creating a temporary hydremia. Upon this process rests one of the most important effects of bleed- ing. Another important effect is the derivation of the blood from the internal organs; the quicker the blood is withdrawn in bleeding the more rapidly and promptly this action occurs. The other effects of bleeding upon the body are of no special practical im- portance. It may be mentioned that bleeding also corrects dis- turbances of the circulation, removes poisons from the body with the blood and increases proteid metabolism, while the fat and carbohydrate metabolism is depressed (increased excretion of urea, decreased elimination of carbon dioxide and decreased absorption of oxygen, according to Bauer). 286 Digitized by Microsoft® BLEEDING 287 Uses.—Bleeding is still indicated to-day in the following conditions: 1, Laminitis of horses. Experience has taught that a free bleeding as early as possible in this condition, in connection with arecoline, is the best treatment for laminitis (founder). 2. In the first stages of inflammation of the brain, so long as symptoms of cerebral congestion are present (pronounced injec- tion of the visible mucous membranes of the head, increased temperature of the cranium, strong pulsation of the arteries of the head, symptoms of psychic excitement). 3. In congestion of the lungs with threatened cedema of the lungs. 4. In poisoning of the blood (carbon monoxide, illuminating gas, hemoglobin, uremia). Bleeding is also recommended in rheumatic hemoglobinemia {azoturia] of horses, as a prophylactic against parturient apoplexy and in different internal circulatory disturbances (heart diseases). In some sections it is used empirically in the beginning of fattening. On the other hand, its employment has been proven to be not without objection in inflammation of the brain and lungs, in pulmonary hemorrhage and in chlorosis (it is alleged to promote the formation of blood in chlorosis of man). Bleeding exerts no prophylactic effect against infectious diseases, as has been estab- lished experimentally by Zschokke. Transfusion.—This method is unnecessary in veterinary medi- cine and its use in human medicine is strongly contested. It con- sists in introducing into the veins of a diseased individual defibri- nated blood from an individual of the same species. Transfusion is recommended in excessive loss of blood and in poisoning of the blood (carbon monoxide). It has, however, been recently sup- planted by infusion and injections of sodium chloride in solution. Infusion.—By this is understood the introduction of solutions of medicines directly into the circulation through a vein. In human medicine, infusion of sodium chloride solution especially is recommended in place of transfusion in poisonings, cholera, etc. Digitized by Microsoft® GENERAL THERAPEUTICS OF THE ORGANS OF LOCO- MOTION (MUSCLES, TENDONS, NERVES, ARTICULATIONS, BONES) Therapeutic Methods.—The diseases of the organs of locomo- tion comprise the principal part of surgery. They include the consideration of inflammation, atrophy, paralysis and laceration of the muscles, paralysis of the nerves, inflammation and lacera- tion of tendons, inflammation and fracture of the bones, and inflammation and dislocation of the articulations. The thera- peutic methods employed in the treatment of these diseases are naturally very numerous and differ with the character of the individual case. With regard to them and the excellent natural healing processes which operate in these conditions, especially in bone fractures, the reader is referred to the text-books on general surgery. Nevertheless, there are some observations to be made from the standpoint of general therapeutics. The surgical methods of treatment most frequently used are the following: 1. The rest treatment is the most important method of healing in all painful and acute inflammatory conditions of the muscles, tendons, bones, and articulations. ‘Rest the afflicted part.” Simply permitting horses to “ stand” will alone in many cases bring about healing (natural healing). The application of a plaster-of-Paris dressing in fracture of bones and sprained joints acts in the same manner. 2. The exercise treatment, on the contrary, is indicated in some chronic inflammatory conditions of the muscles, nerves, tendons and articulations (muscular rheumatism, atrophy of muscles, paralyses of muscles and nerves, and contractions). By exercise, as by massage, the circulation, resorption, innervation and metabolism are stimulated locally and generally, muscular activity and the body constitution are strengthened, and under 288 Digitized by Microsoft® ORGANS OF LOCOMOTION 289 certain circumstances pain is decreased. In addition, exercise operates as a prophylactic against hemoglobinemia [azoturial, parturient apoplexy and stable founder. 3. Hydrotherapy (cold, heat, Priessnitz dressing), cutaneous irritants, firing, massage, and electrotherapy are very important methods of treatment in numerous acute and chronic surgical disease conditions. (See the chapters on those methods.) 4. The medical method consists in the use of direct stimulants of the muscles and nerves: veratrin and strychnine; also in the subcutaneous and parenchymatous injection of morphine, cocaine, sodium chloride, and oil of turpentine (shoulder lameness). 5. The operative treatment is either direct or indirect. Exam- ples of the direct method are: section of contracted tendons or muscles (tenotomy, myotomy), incision of purulent inflammations of muscles, bones and tendon sheaths, and resection of necrotic tendons, while neurotomy is an example of the indirect or symp- tomatic method. 6. Regulation of the shoeing is very important in numerous surgical diseases (diseases of the hoof, ring bone, spavin, diseases of tendons). 19 Digitized by Microsoft® INDIFFERENT REMEDIES. MECHANICALS Definition.—The terms indifferent and mechanical are used to designate a group of therapeutic agents which in general do not produce any chemical or pharmacological effect upon the organ- - ism -and- which are -employed-only for their mechanical action. The group includes protective, emollient, cleansing, absorbent, dilating, and uniting remedies, 1, PROTECTIVES Synonyms: Obtegents, involvents, obvolents, lubricants; covering, pro- tecting, soothing remedies, bandages or dressings. Uses.—The protectives serve to cover the skin and mucous membranes in inflammatory conditions and when wounds are present; also to guard and defend these structures against injurious influences. Wounds upon the skin are most frequently treated by the use of bandaging materials. In addition, the different varieties of eczema, erosions and burns and also the specific inflam- ‘mations of the skin require the employment of protective remedies in the form of salves. The latter are also applied to the skin prophylactically to protect it from flowing secretions (pus) and caustic substances (cantharides). The protectives are admin- istered internally in the different inflammatory conditions of the mucous membrane of the pharynx, cesophagus, stomach and intes- tines and as mechanical antidotes in intoxications (see p. 216); the mucous membrane of the bladder and rectum is also accessible to applications of protectives. Finally, they are used to prevent the dissipation of heat and moisture from the skin, to promote cu- taneous resorption in the epidermatic application of medicines and to lubricate the instruments and hands. Remedies.—1. Fats and oils: Lard, olive oil, linseed oil, pea- nut oil, almond oil, rape oil, poppy-seed oil, cod liver oil, cacao oil, 290 Digitized by Microsoft® INDIFFERENT REMEDIES. MECHANICALS 291 coca oil, mutton suet, spermaceti, ointment of rose water, and sevum salicylatum.! 2. Mucilaginous remedies: Linseed, acacia, althea, traga- canth, salep, mallow, dietetic remedies (oat and barley mucilage). 3. Paraffin ointment,’ lanolin, simple cerate. 4, Plasters and liniments: Adhesive plaster, Lund’s plaster, Carron oil (linamentum calcis). 5. Silver nitrate (silver covering of burns and other cutaneous affections). 6. Gelatin, collodion, traumaticin [gutta-percha dissolved in chloroform], water glass.. 7. Starch, lycopodium, zinc oxide, bolus, talcum, pulvis talei salicylicus (N.F.). a 8. Cotton and other dressing material, 2. EMOLLIENTS Synonyms: Demulcents, solvents; softening, loosening, liquefying, dis- integrating remedies. Actions and Uses.—The emollients operate upon the different pathological indurations of the skin,:subcutis, tendons, tendon sheaths, and muscles by mechanical diffusion and imbibition (water, oil, glycerin, soap), by preventing the dissipation of heat and water (poultices) and by chemical solution (lyes, alkalies), disintegration and liquefaction. The remedies concerned in in- ternal softening and solution have already been considered in the chapters on resorbents (p. 76), expectorants (p. 107) and diuretics (p.113.) The external disease conditions which are most frequently treated with emollients are thickenings of the skin, calluses, scabs and crusts upon the skin, squamous eczema, thickenings of the subcutis, hard swellings in the tendons and tendon sheaths as in [' Salicylic acid 2 parts, benzoic acid 1, mutton suet 97.] [?? Petrolatum album.] [? Turpentine and pitch, equal parts; liquefy by heat, mix, and spread on cloth.] Digitized by Microsoft® 292 GENERAL THERAPEUTICS FOR VETERINARIANS tendinitis and tendovaginitis, indurations of glands, udder nodules and rheumatic indurations of muscles. Remedies.—1. Water and all remedies containing water (baths, cataplasms, moist applications). 2. Moist heat, especially in the form of the Priessnitz dressing and cataplasms. 3. Fats, soaps, glycerin, and lyes (soda lye, potash lye, potas- sium sulphate). 3. CLEANSING REMEDIES Action and Uses.—The ordinary cleansing agents, water and soap, operate mechanically to remove dirt, scabs, pus, and other disease products, and particularly infectious materials. In the latter respect, the cleansing agents act at the same time as dis- infectants. As already stated (p. 182), a thorough cleansing is in many cases equal in value to a disinfection. Water and soap, when rationally used, frequently suffice as disinfectants; provided the water is clean, 7.e., free from infectious materials, that it is used in sufficient amount and, when possible, warm or hot, and that a good preparation of soap is used. An entirely neutral soap is best for cleansing the skin (soft soap irritates the skin, as may be frequently observed especially in dogs). On the other hand, for cleansing utensils and other articles a soap with a strong alkaline reaction is desired, 7.e., a soap which contains free lye, because the free lye exerts a disinfectant as well as a cleansing effect. Soft soap is therefore preferred for this purpose. Absorbent Remedies (Imbibents, Rophetics)—These serve to absorb blood, serum, pus, and other fluids. Their action is purely physical. They include dressing materials (cotton, wood wool, jute, etc.). Wood wool possesses the greatest imbibing properties. Freshly-burned charcoal absorbs gases (SH) and poisons, and starch absorbs iodine. Dilating Remedies (Dilatants)—-A mechanical dilation by means of dilating pencils (laminaria, tupelo) is used in surgery and obstetrics. Digitized by Microsoft® INDIFFERENT REMEDIES. MECHANICALS 293 Uniting Remedies (Contentives).—These serve to unite solu- tions of continuity (wounds, fractures of bones). The so-called immovable dressings are made of rubber, gelatin, water glass, plaster-of-Paris, starch paste, etc. Medical uniting substances for wounds are collodion, traumaticin (gutta-percha dissolved in chloroform], and adhesive plaster. Digitized by Microsoft® AIR AS A REMEDY General.— While the air acts as the excitant or carrier in differ- ent diseases, it is also an important healing factor in a number of diseases. As regards the harmful effects of the air, these can be referred in part to its temperature and in part to the admixture of dust, bacteria, and poisons. Stable air is an especially frequent source of diseases of all kinds. Its constant, uniform temperature, which is usually too high, exerts a relaxing effect upon the general body constitution and produces a consequent predisposition to dis- ease. The best known of the stable diseases which occur through the influence of the temperature of the stable air are rheumatism, rheumatic hemoglobinemia [azoturia]; catarrhs, brain and lung diseases, and also summer wounds in army horses. Secondly, stable air operates pathologically through its contained bacteria, gases and mechanical admixtures. These favor especially the development of tuberculosis, glanders, contagious pneumonia of horses and other infectious diseases. The carbon dioxide, ammonia and other gases which may be present act harmfully upon the respiration. The outside air can also cause disease in different ways (hot air, dusty air, arsenical fumes, lead vapors). By a careful prophylaxis all of these disease conditions may be indirectly avoided. Furthermore, air is a very important direct curative agent. Its healing action is in part due to the oxygen it contains (open suppuration, anaérobes), in part to its temperature and in part to its purity. To what extent the ozone of the air possesses healing properties has not been scientifically determined. Therapeutic Action of Cold Air.—Cold air operates first, like cold water, as a cutaneous irritant. The anemia produced primar- ily in the cutaneous vessels is followed by @ reactive hyperemia of the skin. Asa consequence the circulation is stimulated through- 294 Digitized by Microsoft® AIR AS A REMEDY 295 out the entire body and the blood is driven from the internal organs, especially the lungs, digestive apparatus and brain, to the periphery, metabolism is increased and the constitution is strength- ened. Heat is given off by the body to the surrounding cold air, provided the action of the latter continues long enough. Cold air consequently acts as a refrigerant. Upon the basis of these actions, cold air is employed in the form of ventilation of stables, and animals are exercised in cold air, bivouacked and placed in cold compartments and in shady places to make them hardy; cold air is also employed as a preventive against rheumatism and other diseases due to chilling, as a curative agent in all febrile diseases of the internal organs, and in congestion of the lungs and brain. Therapeutic Action of Pure Air.—Pure air, rich in oxygen, poor in carbon dioxide, free from bacteria and other impurities, is the best natural remedy in all catarrhal affections of the respira- tory apparatus. It is employed in the form of good ventilation, the air in the stable being renewed as often as possible, or the animal is placed in the open air (pasture, bivouac, exercise in the open). The renewal of the air in the bronchi and alveoli promotes respiration and removes the injurious air from these structures. Furthermore, the introduction of fresh air dilutes and removes the infectious material present, which is also in part destroyed by the oxygen (disinfectant action of fresh air). Especially good results have been obtained in this respect in strangles, contagious pneu- monia, tuberculosis, and other infectious diseases. Climate.—Climate can only be made use of for healing purposes in veter- inary medicine in exceptional cases, which is in contrast to the very highly- developed climato-therapy of human medicine. The importance of climate in a hygienic sense for the domestic animals has, it is true, been known for a long time. It is known, for example, that the mountain breeds, because of the vigorous climate, are more resistant to diseases of all kinds than the breeds of the lowlands. It is further known that imported animals (monkeys, parrots) are very susceptible to disease and frequently die of tuberculosis because of the change of climate. A similar effect is observed on horses, cattle and sheep when they are taken into a new region with a different climate. Digitized by Microsoft® 296 GENERAL THERAPEUTICS FOR VETERINARIANS For economical reasons, a change of climate for therapeutic purposes is per- missible with the domestic animals only in very rare cases (removal to ele- vated pastures or to distant farms), although frequently such a change ap- pears to be indicated, especially in convalescence. Light.—The use of light as a healing remedy was introduced by Finsen of Copenhagen. He uses the bactericidal (chemical action of the ultraviolet, violet and blue rays) as well as the inflammation-producing (thermal action of the red rays) forces of light and has in this manner cured numerous cases of lupus in man. His method consists in concentrating the rays of a very strong arc light by means of a rock crystal and directing them through a layer of distilled water which is continually cooled. Iwanow (Repert. d. pol. Sanit. vét., 1902) has obtained excellent results with Finsen’s apparatus in the treatment of eczemas of the horse. Réntgen’s Rays.—These are used in surgery for the local treatment of malignant neoplasms (carcinomas, sarcomas). Radium acts in a similar manner (radiotherapy). In internal medicine, the Réntgen rays have proven Jess satisfactory (employed in chronic myelomas and in lymphatic leukemia and aleukzmic splenic tumors). Digitized by Microsoft® INDEX TO Absinthe, 30, 168 Absinthium, 30, 168 Acacia, 48, 291 Acacia powder, compound, 48 Acetal, 100 Acetanilid, 86 Acetanilidum, 86 Acetophenone, 101 Acetphenitidinum, 86 Achillea, 30 Acids (as disinfectants), 204 Acidum acetyl-salicylicum, 54, 86 Acidum boricum, 212 Acidum hydrochloricum, 29, 32 Acidum hydrocyanicum, 101 Acidum hydrocyanicum dilutum, 101 Acidum nitricum, 54 Acidum picricum, 168 Acidum salicylicum, 51, 86, 116, 165, 212 Acidum sulphuricum, 154 Acidum tannicum, 50, 70, 145, 158 Acidum trichloraceticum, 154 Acoine, 100 Acorns, roasted, 158 Actol, 212 Adalin, 101 Adeps lane hydrosus, 146 Adhesive plaster, 291, 293 Adrenalin, 72, 100, 159 Aather, 52, 59, 96, 100 ARthylis carbamas, 101 Agurin, 116 Air, 294 Airol, 212 Alcohol, 31, 33, 59, 87, 96, 100, 121, 137, 158, 212 Alkalies, 165 Allium, 168. Almond oil, 290 Aloe, 30, 31, 45, 54, 121 Aloin, 45 Althea, 48, 291 Alum, 50, 71, 158 Alumen, 50, 71, 158 Aluminum acetas, 158, 212 acetate, 158, 212 hydroxide, 158 Alumnol, 212 Alypin, 100 REMEDIES Ammonia water, 32, 33, 52, 97, 151 Ammonii acetas, 131 carbonas, 32, 33, 37, 60, 97 Ammonium carbonate, 32, 33, 37, 60, chloride, 79, 109 chloridum, 79, 109 compounds, 97 Amy] nitras, 73 nitrite, 73 Amyloform, 211 Amylum, 145 Anesthesin, 100 Angelica, 31, 52 Anisum, 31, 111, 127 Anthrarobin, 145 Anthrasol, 145 Anthrax vaccine, 237 Antimonii et potassii tartras, 33, 37, 46, 110, 151, 167 sulphidum, 110, 126 Antimonium sulphuratum, 110 Antipyonin, 212 Antipyrina, 86 Antipyrine, 86 Antiseptin, 212 Anti-streptococcie serum, 255 Antitoxin, tetanus, 253 Apomorphine hydrochloridum, 37, 110 Aqua ammoniz, 32, 33, 52, 97, 151 amygdale amare, 101, 111 Areca, 167 Arecoline hydrobromidum, 33, 45, 96, 131, 132, 142 Arecoline, 33, 45, 96, 131, 132, 142 Argenti nitras, 51, 72, 145, 155, 158, 211, 291 Arseni trioxidum, 64, 138, 146, 155, 164, 167 Arsenic, 64, 138, 146, 155, 164, 167 Arsenical dip for ticks, 162 Artificial Carlsbad salts, 30, 45, 54, 78, 111, 136 Peru balsam, 164 Asafetida, 52, 168 Aspidium, oleoresin of, 167 Aspirin, 54, 86 Atoxyl, 146 Atropine sulphas, 59, 95, 142 Atropine, 59, 95, 142 297 For Subject Index see page 305. Digitized by Microsoft® 298 Aurantii amari cortex, 31 Autan, 205 Bacillol, 204 Balsam of Peru, 111, 117, 158, 164, 213 Balsams, 158 Balsamum peruvianum, 111, 117, 158, 164, 213 Barii chloridum, 47 Barium chloride, 47 Barley mucilage, 291 Benzinum, 168 Benzoinum, 111 Betel nut, 167 Biniodide of mercury, 151 Bismuth nitrate, 158 subnitrate, 32, 51, 158, 212 Bismuthi dithiosalicylas, 212 subgallas, 145, 158, 212 subsalicylas, 158, 212 Bisulphide of carbon, 32, 167 Bitter-almond water, 101, 111 Black-leg vaccine, 246 Black sulphide of antimony, 110, 126 Bolus, 291 Boral, 212 Borax, 117 Boric acid, 212 Borol, 212 Brandy, 96, 100, 121 Bromal hydrate, 100 Butyl-chloral, 100 Cacao oil, 290 Caffea, 49, 138, 158 Caffeina, 59, 95, 116 Caffeine, 59, 95, 116 Caffeine sodio-salicylas N. F., 116 Calamus, 31 Calcii carbonas precipitatus, 32, 136, 145, 158 phosphas precipitatus, 136 Calf cholera vaccine, 248 pneumonia vaccine, 248 Calomel, 46, 51, 52, 116 Calumba, 30 Calx, 201 chlorinata, 202 Cambogia, 47, 54 Camphor, 59, 86, 96, 111, 150, 213 Camphora, 59, 86, 96, 111, 150, 213 Cannabis indica, 89 Cantharides, 121, 151 Cantharis, 121, 151 Capsicum, 31, i17, 121 Caraway oil, 52 INDEX TO REMEDIES Carbolie acid, 32, 164, 204, 211 Carbon bisulphide, 32, 167 Carbonate of magnesia, 32 Carbonei bisulphidum, 32, 167 Carbonic acid, 32 Carlsbad salts, artificial, 30, 45, 54, 78, 111, 136 Carron oil, 291. Carum, 31, 111, 121, 127 Castor oil, 46 Catechu, 49, 70, 158 Centaurea, 30 Centaury, 30 Cerate, simple, 291 Cetraria, 30, 31 Chalk, 32, 136, 145, 158 Chinosol, 206 Chloral hydrate, 52, 60, 100, 122 Chloralformamidum, 100 Chloralum hydratum, 52, 60, 100, 122 Chloride of iron, 155, 158 solution, 71 of lime, 202 of zine, 154, 158, 213 Chlorine water, 213 Chloroform, 99, 168 Chloroformum, 99, 168 Chromii trioxidum, 155 Cinchona, 30, 31,.49, 70, 158 Coal tar creosote, 168 Coca oil, 290 Cocaine, 32, 100, 159 hydrochloridum, 32, 100, 159 Cod liver oil, 135, 290 Codeine phosphas, 111 sulphas, 111 Codeine, 99, 111 Coffee, 49, 138, 158 Colchici semen, 33 Colchicum, 54 Collodion, 158, 291, 293 Collodium cantharadatum, 151 Colocynth, 47, 54 Compound acacia powder, 48 rhubarb powder, 52 Condurango, 30, 31 Contagious pneumonia vaccine, 249 Copper sulphate, 37, 72, 155, 158 Corrosive sublimate, 155, 158, 164, 204, 210 Cow-pox vaccine, 250 Creolin, 32, 51, 52, 71, 111, 145, 158, 163, 168, 210 Creosote, 32, 49, 111, 158, 164, 168 Creosotum, 32, 49, 111, 158, 164, 168 Cresol, 204, 210 Cresol- “sulphuric acid solution, 205 For Subject Index see page 305. Digitized by Microsoft® INDEX TO REMEDIES 299 Croton oil, 46, 152 Cubeba, 117, 121 Cupri oxidum, 168 sulphas, 37, 72, 155, 158 Cuprum aluminatum, 155 Cusso, 168 Damholid, 136 Digitalis, 58, 86, 116 Dionine, 99 Diuretin, 116 Empyroform, 145 Ergot, 70, 120, 159 Ergota, 70, 120, 159 Eseridin tartras, 33 Eserine, 33, 45, 96, 142 Ether, 52, 59, 96, 100 Ethereal oils, 158 Eucaine, 100 Eumydrin, 142 Euphorbium, 152 Eupthalmine, 142 Extractum glycyrrhize, 111 Fats, 146, 290, 292 Fel bovis, 31 Ferri chloridum, 155 reductum, 63, 136, 155. sulphas, 63, 136, 155, 158 Ferric chloride solution, 158 Ferrum, 63, 163 Flores tiliz, 131 Fluidextractum cannabis indice, 99 hydrastis, 120 Feniculum, 31, 111, 127 Folia juglandis, 158 Foot-and-mouth disease vaccine, 243 Formaldehyde, 154, 205, 211 Fowl cholera vaccine, 249 Fowler’s solution, 64, 138, 146 Fréhner’s bath, 161 Fructis juniperi, 31 Galla, 70 Gallal, 212 Gambir, 158 Gamboge, 47, 54 Gasoline, 168 Gelatin, 291 dressing, 293 Gentian, 30, 31 Gentiana, 30, 31 Gerlach’s bath (for mange), 161 Glutol, 211 Glycerin, 47, 145, 158, 292 gelatin, 146 Glycerinum, 47, 145, 158, 292 Goulard’s water, 72 Glycyrrhiza, 111 Granatum, 168 Hematogen, 136 Hematol, 136 Heroin, 99, 111 Hog cholera vaccine, 248 Holocain, 100 Homatropine hydrobromidum, 142 Hydrargyri chloridum corrosivum, 155, 164, 204, 210 mnite, 46, 51, 52, 116 iodidum rubrum, 151, 155 oxidum flavum, 155 Hydrastis, 70, 120, 159 Hydrochloric acid, 30, 32 Hydrocyanic acid, 100, 101 Hyoscine hydrobromidum, 59, 95, 142 Hyoscine, 59, 95, 142 Hypnone, 101 Ichthyol, 145 Insect powder, 164 Iodine, 32, 158 TIodoformum, 78, 211 TIodum, 32, 158 Ipecac, 33, 37, 54, 110 Ipecacuanha, 33, 37, 54, 110 Tron, 63, 136, 163 chloride, 155, 158 solution, 71 reduced, 63, 136, 155 sulphate, 50, 68, 136, 155, 158 Itrol, 212 Jalap, 47, 54 Jalapa, 47, 54 Juniper, 111, 116, 117, 121, 127 Juniperus, 111, 116, 117, 121, 127 Kamala, 167 Kaolinum, 145 Kermes’ mineral, 110 Krameria, 70 Kutol, 212 Lanolin, 146, 291 Lard, 290 Lead acetate, 50, 71, 155, 158 nitrate, 158 oxide, 145 water, 72 Lenigallol, 145 Ligusticum, 117 Lime, 201 and sulphur dip, 161 water, 22, 50, 52, 136, 158 For Subject Index see page 305. Digitized by Microsoft® 300 Linamentum calcis, 291 Linseed, 48, 291 oil, 46, 290 Liquor ammonii acetatis, 131 calcis, 22, 50, 52, 136, 158 chlori compositus, 213 cresolis saponatus, 205 ferri chloride, 71 formaldehydi, 154, 205, 211 potassii arsenitis, 64, 138, 146 plumbi subacetatis dilutus, 72 Lithyol, 145 Liver of sulphur, 164 Lund’s plaster, 291 Lung plague vaccine, 239 Lycopodium, 291 Lye, 203, 292 Lysol, 204, 210 Magnesii boras, 212 carbonas, 32 oxidum, 32, 52 Mallow, 48, 291 Manna, 47 Matricaria, 121, 131 Meat extract, 63, 135 Medinal, 101 Melissa, 131 Mentha, piperita, 131 Menthol, 32 Menyanthes, 30 Mercurial ointment, 164 Milk sugar, 117 Morphine sulphas, 99, 111, 122 Morphine sulphate, 99, 111, 122 Mustard, 31, 117 Mutton suet, 291 Mydrin, 142 Mydrol, 142 Naphthalenum, 32, 51, 52, 168 Naphthalin, 32, 51, 52, 168 Nirvanin, 100 Nitrate of silver, 51, 72, 145, 155, 158, 211, 291 Nitric acid, 54 fuming, 154 Nitroglycerin, 73 Novocaine, 100 Nutgall, 158 Nux vomica, 30 Oil of anise, 52 of caraway, 52 of chamomile, 52 of eucalyptus, 213 of fennel, 52 INDEX TO REMEDIES Oil of garlic, 52 of melissa, 52 of mustard, 151 of peppermint, 101 of turpentine, 32, 33, 101, 111, 116, 150, 165, 167, 213 of valerian, 101 Oils, 146, 290 Ointment of rose water, 291 Oleoresin of aspidium, 167 Oleoresina aspidii, 167 Oleum anisi, 52, 165 asafetida, 101 cari, 165 eucalypti, 213 feniculi, 52 juniperi, 116 lini, 46, 290 matricaria, 101 mentha piperita, 101 morrhue, 135, 290 ricini, 46 sinapis volatile, 151 terebinthine, 32, 33, 101, 111, 116, 150, 158, 165, 167, 213 tiglii, 46, 152 valeriana, 101 Olive oil, 290 Ononis, 117 Opium, 32, 49 Orexin, 31 Orthoform, 100 Oxalic acid, 32 Oxide of magnesia, 32, 52 of zine, 145, 158, 291 Pantopon, 50 Paraffin ointment, 146, 291 Pastes, 146 Peanut oil, 290 Pelletierine tannas, 168 Pepo, 168 Pepper, 31, 117, 121 Peppermint, 131 Pepsin, 30 Peptone, 135 Permanganate of potassium, 155, 213 Peronine, 99 Peru balsam, 111, 117, 158, 164, 213 Perugen, 164 Peruol, 164 Peruskabin, 164 Petrolatum, 146, 168 Petrosulphol, 145 Phenacetin, 86 Phenol, 32, 164, 204, 211 Phosphorus, 136 For Subject Index see page 305. Digitized by Microsoft® INDEX TO REMEDIES Physostigmine salicylas, 33, 45, 96, 142 sulphas, 33, 45, 96, 142 Picric acid, 168 Pilocarpine, 33, 54, 96, 130, 132 Pilocarpine hydrochloridum, 33, 54, 96, 130, 132 nitras, 33 Piper, 31, 117, 121 Pix liquida, 111, 145, 163, 168, 205, 213 Plaster of Paris, 293 Plasters, 146 Plumbi acetas, 50, 71, 155, 158 nitras, 155 oxidum, 145 Podophyllum, 47, 54 Poppy-seed oil, 290 Potash lye, 203, 292 Potassa sulphurata, 145, 164 Potassii acetas, 117 bicarbonas, 32, 64, 136 bitartras, 117 bromidum, 60, 99, 122 chloras, 117 dichromas, 151 iodidum, 60, 78, 127 nitras, 117 permanganas, 155, 213 picras, 168 tartras, 32 Potassium acetate, 117 bicarbonate, 32, 64, 136 bitartrate, 117 ¢ bromide, 60, 99, 122 chlorate, 117 dichromate, 151 iodide, 60, 78, 127 nitrate, 117 permanganate, 155, 213 picrate, 168 tartrate, 32 salts, 97 sulphate, 292 Precipitated calcium phosphate, 136 Prepared suet, 145 Propesin, 100 Protargol, 212 Pulvis rhei compositus, 52 talci salicylicus (N.F.), 291 Purpura hemorrhagica serum, 254 Pyoctanin, 213 Pyrogallol, 145 Quassia, 30 Quercus, 70 Quillaja, 110 301 Quinina, 32, 87 Quinine, 32, 87 Rabies vaccine, 242 Radium, 296 Rape oil, 290 Red wine, 96 Resins, 158 Resorcin, 51 Resorcinol, 51 Rhatany root, 158 Rheum, 31, 47, 50, 52, 54, 158 Rhubarb, 31, 47, 50, 52, 54, 158 Rinderpest vaccine, 245 Rose water, ointment of, 291 Rotterin, 212 Rubber dressing, 293 Saccharum, 111 lactis, 117 Sal Carolinum factitium, 30, 45, 54, 78, 111, 136 Salep, 48, 291 Salicylic acid, 51, 86, 116, 165, 212 Saluminal, 212 Salvarsan, 146, 167 Salvia, 158 Sambuci flores, 131 Santonica, 121 Santonin, 121, 167 Santoninum, 121, 167 Sapo mollis, 145 Scilla, 116 Scopolamine, 59, 95, 142 Senega, 110 Senna, 41, 47 Sevum preparatum, 145 salicylatum, 291 Sheep-pox vaccine, 244 Silver nitrate, 51, 72, 145, 155, 158, 211, 291 Simple cerate, 291 Sinapis alba, 31, 117 nigra, 31, 117 Soap, 32, 145, 203, 292 soft, 145 spirit, 212 Soda lye, 203, 292 Sodii acetas, 117 ee 30, 32, 78, 110, 117, 12 boras, 117, 212 chloridum, 30, 64, 78, 110, 117, 127, 136, 158 nitris, 73 phosphas, 64 salicylas, 54, 116 sulphas, 30, 45, 54, 78, 110 For Subject Index see page 305. Digitized by Microsoft® 302 Sodium, 32 acetate, 117 et 30, 32, 78, 110, 117, 12 borate, 117, 212 chloride, 30, 64, 78, 110, 117, 127, 136, 158 phosphate, 64 salicylate, 54, 116 sulphate, 30, 45, 54, 78, 110 Somnal, 100 Sozal, 212 Spermaceti, 291 Spiritus etheris, 52, 97 ammonie aromaticus, 97 camphor, 150 glonoini, 73 glycerylis nitratis, 73 vini gallici, 96, 100, 121 Squill, 116 Starch, 291 paste, 293 Stovain, 100 Strophanthus, 116 Strychnina, 30, 31, 94 Strychnine, 30, 31, 94 Subcutin, 100 Subgallate of bismuth, 158, 212 Subnitrate of bismuth, 32, 51, 158, 212 Subsalicylate of bismuth, 158, 212 Sugar, 111 of milk, 117 Sulphonethylmethanum, 101 Sulphonmethanum, 101 Sulphur, 47, 64, 79, 110, 126, 136, 164 lotum, 47, 64, 79, 110, 126, 136, 164 precipitatum, 47, 64, 79, 110, 126, 136, 164 sublimatum, 47, 64, 79, 110, 126, 136, 164 Sulphuric acid, 154 Swine erysipelas vaccine, 248 plague vaccine, 248 Syrupus, 111 rhamni cathartice, 47 Tabacum, 33, 164 Talcum, 291 Tanacetum, 168 Tannalbin, 50 Tannic acid, 50, 70, 145, 158 Tannoform, 50, 145, 211 Tannol, 212 Tannopin, 50 INDEX TO REMEDIES Tar, 49, 111, 145, 163, 168, 205, 213 Taraxacum, 30 ire emetic, 33, 37, 46, 110, 151, 16 Terebinthina, 111, 213 Terpin hydrate, 110 Terpini hydras, 110 Tessier and Matthieu’s bath, 161 Tetanus antitoxin, 253 Tetronal, 101 Theobromine, 116 Theocine, 116 Thigenol, 145 Thioform, 212 Thiol, 145 Thymol, 167, 213 Tinctura aloes, 151, 158 arnice, 150 cantharidis, 121, 151 capsici, 150 ferri chloridi, 136 pomata (N.F.), 63 iodi, 78, 151, 158, 211 myrrhe, 158 nucis vomicz, 31 opii, 32, 50 strophanthi, 59, 116 Tobacco, 33, 164 and sulphur dip, 161 Tormentilla, 70, 158 Tragacanth, 48, 291 Traumaticin, 291, 293 Trefusia, 136 Trichloracetic acid, 154 Trional, 101 Tropacocaine, 100 Tuberculosis vaccine, 251 Tumenol, 145 ‘Turpentine, 111, 158, 213 oil, 32, 33, 101, 111, 116, 150, 158, 165, 167, 213 Unguentum hydrargyri, 164 zinci oxidi, 145 Urethane, 101 Uva ursi, 70, 158 Vaccine, anthrax, 237 black-leg, 246 calf cholera, 248 pneumonia, 248 contagious pneumonia of horses, cow-pox, 250 foot-and-mouth disease, 243 fowl cholera, 249 For Subject Index see page 305. Digitized by Microsoft® INDEX TO REMEDIES 308 Vaccine, hog cholera, 248 lung plague, 239 rabies, 242 . eapeaiie rinderpest, 245 sheep-pox,: 244 swine erysipelas, 248 plague, 248. tuberculosis, 251 Valerian, 31, 52, 60 Valeriana, 31, 52, 60 Varnishes, 146 Veratrin, 33, 37, 59, 95 Veratrina, 33, 37, 59, 95 Veratrum, 33, 37 Veronal, 101 Vienna paste, 154 Vinum album, 96, 121 antimonii, 37 ipecacuanhe, 37 rubrum, 96 Wee 255, 292 glass, 291 : dressing, 293 White oak bark, 158 _ wine, 96, 121 Wine of antimony, 37 of ipecac, 37 Yellow oxide of mercury, 155 Yohimbin, 121 Zine chloride, 154, 158, 213 gelatin, 146 oxide, 145, 158, 291 sulphate, 37, 72, 158 Zinci chloridum, 154, 158, 213 oxidum, 145, 158, 291 sulphas, 37, "72, 158 Zingiber, 121 Ziindel’s bath, 161 Zycloform, 100 For Subject Index see page 303. Digitized by Microsoft® Digitized by Microsoft® SUBJECT INDEX Abortive method, 8 Abortives, 119 Absorbent materials, 292 Absorbents of gas, 32, 52 Acid-neutralizing stomachics, 32 Acrics, 146 Air as a remedy, 104, 294 harmful effects of, 294 Alactics, 127 Alterants, 76, 159 Amara, 30 Amblotics, 119 Anzsthesia, general and local, 101, 102 Anesthetics, 97 Analeptics, 93 Analgesics, 97 Anaphrodisiacs, 121 Anexosmotics, 48 Angio-asthenics, 72 Angiosthenics, 71 Anodynes, 97 Antacids, 32 Antagonistics, 216 Antagonists, 216 Antaphrodisiacs, 121 Antatrophics, 134 Antemetics, 32 Antentozoa, 165 Antepizoa, 160 Anterotics, 121 Anthelmintics, 165 Anti-asthmatics, 97 Anticatarrhalics, 159 Anticathartics, 48 Anticonvulsives, 97 Antidepertitorics, 134 Antidiarrheeics, 48 Antidotes, 216 chemical, 217 mechanical, 216 physiological, 219 symptomatic, 220 Antidyscratics, 159 Antidysenterics, 48 Antidyspeptics, 29 Antiepileptics, 97 Antifebrilics, 84 Antifermentatives, 169 Antiferments, 52 Antigalactagogues, 127 Antigalactics, 127 20 Antihidrotics, 132 Antineuralgics, 97 Antiparalytics, 93 Antiparasitics, 109, 160 Antipediculous, 160 Antiperiodics, 84 Antiphlogistics, 159 Antiphthiriacs, 160 Antiplastics, 76, 138 Antipsorics, 160 Antiputrids, 169 Antipyretics, 84, 86 Antiscabious, 160 Antisepsis, 170 Antiseptic stomachics, 31 styptics, 49 Antiseptics, 109, 169, 172 for wounds, 209 internal, 213 Antisialagogues, 132 Antispasmodics, 52, 97 Antitznics, 165 Antitetanics, 97 Antithermics, 84 Antitoxics, 216 Antitypics, 84 Antityposics, 84 Antizymotics, 169 Antodontalgics, 97 Aperients, 40 Aperitives, 40 Aphrodisiacs, 120 Arabian medicine, 14 Aristotle, 12 Aromatic stomachics, 31 Artificial arrest of hemorrhage, 68 Asclepiade, 9 Asepsis, 170 Aseptics, 169 Astringent styptics, 49 Astringents, 48, 157 Attenuation, methods of, 230 Balneotherapy, 265 Bechics, 109 : Bladder, general therapeutics, 113 Bitter stomachics, 30 Bleeding, 286 Blisters, 146 Blood diseases, dietetic treatment, 63 general therapeutics of, 60 305 For Index to Remedies see page 297. Digitized by Microsoft® 306 Blood-forming remedies, 63 Blood plastics, 63, 134 Blood-vessels, general therapeutics of the diseases of, 64 Boerhaave, 10, 17 Bone plastics, 134 Bradysphygmics, 57 Brown, 18 Calefacients, 159 Cardiac Aaa general therapeutics ol, sedatives, 58 stimulants, 58 tonics, 58 Cardiacs, 57 Carminatives, 52 Catheretics, 152 Catharsis, results of, 43 theories of, 41 Cathartics, 40, 45 Causal healing method, 6 Causes of immunity, 227 Caustics, 152 Cauterics, 152 Cauterization, 156 Cellular pathology, 21 Cerebralics, 91 Chemical antidotes, 217 Chemotherapy, 23 Cholagogue laxatives, 54 Cholagogues, 54 Cleansing remedies, 292 Climate, 295 Coagulants, 157 Cold, 69, 159 . Colyseptics, 169, 172 Composting, 202 Compression, 68, 276 Confortants, 137 Confortatives, 137 Conservants, 169 Conservation of animal products, 214 Conservative healing method, 8 Constipating remedies, 48 Contentives, 293 Corrosives, 152 Curative vaccination, 252 Cutaneous irritants, 146 mallein test, 263 tuberculin test, 260 Demulcent styptics, 48 Demulcents, 291 Derivants, 146 Derivative healing method, 5 medicines, 146 SUBJECT INDEX Dermerethistics, 146 Diagnostic inoculation, 254 Diaphoretics, 129 Diapnoics, 129 Dietetic method, 7 treatment of blood diseases, 63 intestinal diseases, 40 liver diseases, 55 stomach diseases, 29 Digsaye organs, general therapeutics or, Digestives, 29 Dilatants, 292 Dilating remedies, 292 Direct healing method, 5 Discutients, 76 Disinfectant stomachics, 31 Disinfectants, 169 for infectious diseases, 201 for wounds, 209 mechanical, 208 relative rank of, 173 Disinfection for infectious animal diseases, 183 of wounds, 178, 209 preliminary, 182 preparation for, 182 Diuretics, 113 Drastics, 40 Ebriantics, 97 Ecbolics, 119 Eccoprotics, 40 Ectrotics, 119 Electropuncture, 282 Electricity as a remedy, 282 Electrolysis, 282 Emesis, effects of, 35 Emetics, 34, 216 Emmenagogues, 119 Emollients, 291 Empirical healing method, 7 Enterostyptics, 48 Epileptifacients, 93 Epispastics, 146 Erasistratus, 12 Erethistics, 146 Erotics, 120 Errhines, 107 Erythrotics, 63 Escharotics, 152 Euphorics, 93 Euplastics, 63, 134 Evacuants, 40 Excitants, 93 Exhilarants, 93 Expectant healing method, 7 For Index to Remedies see page 297. Digitized by Microsoft® SUBJECT INDEX Expectorants, 107 Exsiccants, 157 External antiparasitics, 160 xudates, general therapeutics of, 73 eee general therapeutics of, Fallopius, 16 Faradotherapy, 282 Febrifuges, 84 Fever, general therapeutics of, 80 Firing, 156 Foods, 134 Franklinotherapy, 282 Galactagogues, 122 Galactics, 122 Galen, 12 Galvanocaustic, 282 Galvanotherapy, 282 Gas absorbents, 52 Gas-expelling drugs, 52 General healing method, 5 Genital organs, general therapeutics of the diseases of, 118 Glands, general therapeutics of, 128 Hematics, 63 Hematinics, 63 Hematopoietics, 63 Hemostatics, 69 Hahnemann, 19 Harvey, 16 Healing methods, 4 Heart a general therapeutics of, 5 remedies, 57 sedatives, 58 stimulants, 57 tonics, 58 Heat, 69 : Hemorrhage, methods of arresting, 63 Hepatic stimulants, 54 Hepatics, 54 Herophilus, 12 Hidrotics, 129- Hippocrates, 10 ¢ History of therapeutics, 9 Hoffmann, 17 Homeeopathy, 19 Hufeland, 18 Humoral pathology, 11, 13 Hydragogue cathartics, 43 diuretics, 113 Hydriatrics, 265 Hydrotherapy, 105, 265 Hyperemia as a remedy, 271 307 Hyperinotics, 63 Hyperkinetics, 93 Hypnotics, 97 Imbibents, 292 Immunity, 225 acquired, 226 active, 226 artificial, 227 causes of, 227 individual, 225 inherited, 226 natural, 225 passive, 226 species, 225 Indifferent remedies, 290 Indirect healing method, 5 Inhalations, 105, 106 Inoculation, diagnostic, 254 methods of, 225 Internal antiseptics, 213 Intestinal diseases, dietetic treat- ment of, 40 general therapeutics of, 38 mechanical treatment of, 51 operative treatment of, 51 Intracutaneous tuberculin test, 260 Intradermal tuberculin test, 260 Involvents, 290 Irritants, 146 Kidneys general therapeutics, 113 Kneading, 276 Lactics, 122 Lactifuges, 127 Laxatives, 41 Lenitives, 41 Lice remedies, 162 Ligation, 68 Light, 208, 296 Litholytics, 113 Lithothryptics, 113 Liver diseases, dietetic treatment, 55 general therapeutics of, 52 mechanical treatment of, 55 remedies, 53 Locomotory organs, general thera- peutics of, 288 Lubricants, 290 Mallein, 260 test, cutaneous, 263 ophthalmic, 260, 263 subcutaneous, 261 Malpighi, 16 Mange remedies, 160 Massage, 276 For Index to Remedies see page 297. Digitized by Microsoft® 308 Masticatives, 131 Masticatorics, 131 Mechanical antidotes, 216 disinfectants, 208 treatment of intestinal diseases, 1 of liver diseases, 55 of stomach diseases, 33 Mechanicals, 290 Mechanotherapy, 276 Medicinal plastics, 135 Metabolism, general therapeutics of the diseases of, 133 Metasyncritics, 159 Methods of healing, 4 Mitigation, methods of, 230 Monk’s medicine, 14 Morgagni, 16 Mucous membranes, general thera- peutics of, 143 Mucus-dissolving remedies, 109 Mydriatics, 141 Myotics, 142 Narcosis, 101 Narcotic stomachics, 32 styptics, 49 Narcotics, ‘97 Nauseosa, 34 Nauseotics, 34 Nerve sedatives, 97 stimulants, 93 Nervines, 90 Nervous system, general therapeutics of diseases of, 88 Neurotics, 90 Nutrients, 134, 137 Obstruents, 48 Obtegents, 290 Obvolvents, 290 Odinegogues, 119 Operative treatment of intestinal diseases, 51 of stomach diseases, 34 Ophthalmic mallein test, 260, 263 tuberculin test, 259 Osmotics, 40 Palliative method, 6 Paracelsus, 9, 14 Paralyzants, 97 Parasitics, external, 160 Paré, 16 Paregorics, 97 Parturefacients, 119 Pasteurization, 207 SUBJECT INDEX Pellentics, 119 Peptics, 29 Peripherics, 92 Peristaltics, 40 Phlebotomy, 286 Physical antidotes, 216 Physiological antidotes, 219 healing method, 6 stomachics, 29 Plastics, 134 food, 184 medicinal, 134 Pneumatics, 107 Polysphygmics, 57 Preservants, 169 Preservation of animal products, 214 Priessnitz, 19, 265 Priessnitz’s dressing, 273 Prophylactic method, 7 Protective vaccination, 236 Protectives, 48, 290 Ptarmics, 107 Ptyalogogues, 131 Pupil-contracting remedies, 142 Pupil-dilating remedies, 141 Purgatives, 40 Pustulants, 146, 148 Rademacher, 19 Radical healing method, 6 Rational healing method, 6 Reducing remedies, 138 Refrigerants, 159 Hreulenens concerning vaccination, for disinfection, 184 Resolvents, 76 Resorbents, 76 Respiratory apparatus, general thera- peutics of the diseases of, 103 Roborants, 137 Rontgen’s rays, 296 Rophetics, 292 Rubbing, 276 Rubefacients, 146, 148 Ruminatorics, 32 Saline stomachics, 30 Schénlein, 18 Sedantics, 97 Sedatives, cardiac, 58 nerve, 97 Serum therapy, 22 Sialagogues, 131 Sialics, 131 Skin, general therapeutics of, 143, 144 Solvents, 291 , For Index to Remedies see page 297. Digitized by Microsoft® SUBJECT INDEX Somniferics, 97 Soporifics, 97 Spasmodics, 93 Spinalics, 92 Spinants, 93 Spontaneous arrest of hemorrhage, 66 Stahl, 18 Statistical healing method, 7 Sternutatorics, 107 Stimulant stomachics, 31 Stimulants, cardiac, 58 nerve, 93 Stomach arts dietetic treatment of, 29 general therapeutics of, 25 mechanical treatment of, 33 operative treatment of, 34 Stomachics, 29 Stroking, 276 Styptics, general, 70 intestinal, 48 local or topical, 69 Subcutaneous mallein test, 261 tuberculin test, 258 Sudorifics, 129 Suppletives, 29 Suppurants, 148 Suppuratives, 146 Sydenham, 17 Symptomatic antidotes, 220 healing method, 6 Tapping, 276 Temperantics, 97 Temperants, 159 Tetanics, 93 Thermopenetration, 285 Tick remedies, 162 Tonics, 137, 157 cardiac, 58 Torsion, 68 Transfusion of blood, 62 : Transudates, general therapeutics, 73 309 Tuberculin, 258 : test, cutaneous and intracuta- neous, 260 ophthalmic, 259 subcutaneous, 258 Udder, general therapeutics of th diseases of, 118 " ee Uniting remedies, 293 Urinary organs, general therapeutics of the diseases of, 112 Uterines, 119 Uterus, general therapeutics of the diseases of, 118 Vaccination, 225, 250 curative, 252 emergency, 236 for the different diseases, 237 methods of, 233 prophylactic, 236 protective, 236 purposes of, 235 varieties of, 235 Vaso-astringents, 71 Vaso-constringents, 71 Vasodilants, 72 Vasodilators, 72 Vasomotor stimulants, 71 Venesection, 286 Vermifuges, 165 Vesal, 16 Vesicants, 146, 148 Vibration, 276 Vital healing method, 8 Vomiting, effects of, 35 Vomitives, 34 Vomitorics, 34 Von Haller, 18 Waiting healing method, 7 Water as a remedy, 265 Worm remedies, 165 Wound disinfectants, 209 For Index to Remedies see page 297 Digitized by Microsoft® Digitized by Microsoft® Digitized by Microsoft® Digitized by Microsoft® Digitized by Microsoft® Digitized by Microsoft® Digitized by Microsoft® SAS ee en Se ee SSE a E! ne thd odd bptde tds rate Lt Ph * petra Shneerensa Ser oobi Saag eta hse