SF Cornell University Library SF 959.I5Z94 Typhoid fever; or contagious influenza in 3 1924 000 260 715 CORNELL UNIVERSITY THE 3flnmf r UptBrtnarg SItbrarg FOUNDED BY ROSWELL P. FLOWER for the use of the N. Y. State Veterinary College 1897 Date Due iAR 18 1959 MAR 29 :::2 ->-;^i, j~ "■ -J ,-•■ f >v ^ PRINTED IN U. S. A. By Prof. W. L. ZUILL, M.D., D.V.S. -£, NEW YORK: Sabiston, Murray & Co., Veterinary Publishers & Booksellers. gj6 Sixtli Avenue. iSgt, Nb,. If 7^ Sr ITS ( Reprinted from the American VETERiNAny "Review, Aprfl, 1894.) I ~o' TYPHOID ^EVER; OR, CONTAGIOUS INFLUENZA IN THE HORSE By Prof. W. L. ZUILL, M.D.,D.V.S. Definition. — Typhoid fever in the horse is a disease having many forms, and is propagated by infection and contagion. The disease always has similar general symptoms, even when accom.panied by diversified local lesions affecting the respiratory and digestive organs, the nerve centers and lower portions of the extremities. It always assumes an enzootic form, and isolated cases are rarely if ever observed. It is due to this fact, that every one now admits the contagious nature of this disease. Prof Trasbot of the veterinary school at Alfort, Paris, being the first to call attention to this fact. Synonyms. — One of the oldest names of this disease is . taken from the Italian, and called influenza, because it was then believed that certain atmospherical conditions was the cause of its spread and its infection. This term was appropriated, and used by the Germans, and from them passed into France. Some authors have confused typhoid with carbuncular fever or anthrax, and it is not unlikely that a superficial, and hurried examination, made some time after death, upon animals which had succumbed rapidly to this disease is responsible for this opinion. As soon as the symptomatology of this disease was well defined, the term typhoid fever was given to it. This name has created a great deal of criticism, but has nevertheless been retained. Objection has been made to its use because it indicated a similarity or identity with the disease of the same name in man. It is, however, not the same disease that is found in the human species, and is not transferable from one species to another. Typhus fever is a term that has been suggested by some writers as a name for this disease, but this would be still more objectionable, as it is a term already used to designate a contagious disease in the bovine species. Prof Lafosse, of Toulouse, proposed to call the disease typhose, indicating a certain condition of stupefaction, or coma, but the term has not been accepted by the veterinary profession, and is seldom used. Typhohemia has also been used in this sense, to indicate a state of stupefaction of the organism due to a pro- found alteration of the blood, but I think I can show this to be in- correct when we come to review the pathological anatomy of the disease. Adeno catarrhal fever is a term which can only desig- nate one of the rare forms of this condition. Bilious, hepatic, adynamic and ataxic fevers are also open to the same objections, and this is also true of such terms as epizooty, distemper, pink- eye and shipping fever; of these terms those which mean any- thing at all indicate only symptoms of the disease, rather than define its condition. The term typhoid fever, although it might seem to indicate a similarity with the disease of the same name in man, yet is the best that has been found. It will be seen that these two diseases are strangely similar in their general symptoms, most of which, from the very beginning, are almost identical; the intense fever noticed in man in the early stages of the disease is also well defined in the horse, and especially so if there be complications; this disease is also accompanied by a condition resembhng drunkenness, stupefaction and debility, and prob- ably, also, intense headache; the symptoms indicating this condition. While these symptoms are of far less importance in the horse than in man, they nevertheless show the marked resemblance between the two diseases. A large number of papers have been written upon this subject, but many of them are of little scientific value. In 1869, M. Salles presented to the Central Society of Veterinary Medicine, Paris, a competi- tive essay on this subject, containing much valuable and inter- esting information. In the year 1870, Bouley made a report on this disease, presenting some new and interesting facts, adding much to our knowledge of the subject, the symptomatology and pathological alterations being especially well studied. Etiology. — The writings of the last twenty years tend to prove that this disease, typhoid fever, or influenza, is especially characteristic of the horse, and is confined to this species. It develops rapidly in young animals, approaching or a little past the age of full growth; it seldom occurs in old horses, and if at all is usually in a mild form. Here is another instance of the similarity of this disease to that of the human species, where the disease is chiefly seen in individuals about the age of twenty, while it is an exception in old persons and infants. It has not yet been determined that colts are not exempt from this disease, for the reason that they are seldom if ever confined in stables containing a large number of horses, a,nd are away from the centers of infection, but it is not uncommon to find it in horses of from three to three and a half years old. Age, therefore, seems to be a predisposing cause, and when enforced idleness is added to this, the predisposition is greatly increased. M. Ben- jamin even goes so far as to deny the contagiousness of this disease, even when he saw that when once introduced into a stable it spread rapidly, and almost exclusively, among young animals recently brought in, even when they were scattered among older ones. Overfeeding is also considered as a predis- posing cause, from the fact that the disease may be seen in its worst form in overfed sale horses; while in underfed horses it assumes a relatively mild form. Some years ago, when typhoid fever was supposed to exist only in sporadic cases, it was quite satisfactorily explained by the over-exertion theory, especially as the products of tissue waste are found in the blood in gen- erally increased proportion, represented by urea, creatin, cre- atine, etc.; but these causes are predisposing, not determining. This disease was never considered to be contagious in character until 1872, when Prof. Trasbot, director of the veterinary school at Alfort, expressed this opinion to the Central Society of Vet- erinary Medicine, which was rather severely criticised. M. Benjamin wrote an article on this subject, intended to demon- strate an opposite view, but the evidence produced was not of sufficient value to prove the correctness of the statement. During the spring of 1893, I was most forcibly impressed with the contagiousness of this disease, as I saw over forty cases in one of the large brewery stables in Philadelphia; the disease was brought in by the purchase of some fresh Canadian horses in April; these animals infected nearly 40 per cent, of the stable, and every animal affected was under eight 3^ears old. Two other instances occurring at the same time, one in the stables of a well-known circus proprietor, who lost over 50 per cent, of his stock from this disease; the number of animals kept in the stable was about 75; the other instance was of a carter, who was almost ruined by the ravages of this disease, losing nearly three-fourths of his animals. Inoculation. — The contagious character of typhoid fever is now a well recognized fact, but up to the present time it has been a question as to whether or not typhoid fever was inocula- ble. Experiments made with the disease, to prove its trans- mission by inoculation, have by no means given satisfactory results. The experiments have been made by inoculating blood taken at the beginning of the disease, but the results up to the present time are not such as would enable us to say that the disease can be transmitted in this way. Symptoms. — The disease becomes manifest after a period of from 4 to 7 days, is the opinion of Friedberger and Frohner, but this is a question I have not been able to determine posi- tively from clinical observation, as I have found animals very sick in the morning that were in apparently perfect health the night before. The symptoms vary, however, according to the localization of the disease. Typhoid fever may run a very rapid course, one case occurring in my practice when the animal died within eighteen hours after the first clinical mani- 5 festation of the disease. In this Case there was a rapid cerebral localization, which had a fatal termination before professional aid could be obtained, and in which was manifest an intense excitement and total paralysis. Often there is localization upon special organs, followed by a rapid change which may speedily have a fatal termination; or, on the other hand, the change is a gradual one, accompanied either by a pleurisy, enteritis, pneumonia, pleuro-pneumonia, congestion of the spinal cord, anasarca, congestion of the podophyllous tissue, iritis, nephritis, hepatitis, cerebritis, and even complications of the heart and its envelopes, all of which complications I have more than once seen in my own clientage. It is by no means uncommon to find a localization upon two or more organs simultaneously or successively. When the disease .is rapid in its evolution death speedily intervenes if proper care is not immediately given. Animals will pass from perfect health into profound stupefaction and coma in a few hours. They stand motionless in the stall, head down, ears drooping, and eyelids closed; they appear to have lost all tangible sensibility, and from the very beginning there is hyperaemia of the brain 'and cord. At intervals localized muscular tumors are seen in the region of chest, shoulders and thighs; they will stagger and reel from side to side, like a drunken man, and almost fall while walking, owing to a loss of muscular coordination; this is the earliest manifestation of an interference with the functional activity of the cord; at the same time the general symptoms of the disease may be noticed. The conjunctival mucous membrane is almost tinged a greenish yellow, intermixed with a dull dark red, the yellowish tinge indicating a liver complication. The mucous membrane of the mouth is of a dark dull color, having a pasty, sticky feel, the tongue covered with a yellowish brown pus. The action of the heart is strong, tumultuous in character, and increased to 80 or 90 strokes per minute. The pulse is soft, weak and almost imperceptible, the respiration increased to 25 or 30 per minute, the lungs normal. The temperature rises quickly, and at the rectum registers io6° to io8° F. If blood is drawn in the early stage of the disease, it is often slobberish, but examinations show that it has all its physiological properties, it is dark when first drawn, but soon regains its color on exposure to the air. Co-agulation is rapid, requiring but 5 or 6 minutes instead of 10 or 15 normally; the result is a clot with very little buffy coat. This precludes the idea ot an alteration in the blood, rather indicating inflammatory changes. Vertigo and coma soon appear, interrupted from time to time by periods of excite- ment, symptoms of paralysis soon follow, and the animal falls to the ground, to be followed rapidly by death from asphyxia. These cases of rapid death may be seen in young, green ple- thoric horses, but no anthracoid changes can be found in the blood of these animals. Ordinary Course. — As a rule the disease follows a much slower course when the localization is upon some of the abdom- inal or thoracic organs; most frequent upon the digestive tract. Pneumonia and pleurisy are quite frequently seen; but compli- cations of the spinal cord, with or without oedema of the extremities, is seldom noticed. It is almost certain that the disease will terminate favorably with any of these complications, especially after the first twelve or fourteen days. A very hi"-h fever is a marked symptom of the disease from the beginning, and .strikes one as being out of all proportion to the other symptoms. In influenza or typhoid fever the febrile .symptoms decrease as the local manifestation becomes developed. A^ complete loss of appetite is one of the earliest symptoms, the | patient refusing all kinds of food, but fresh cool drinks will be readily taken at any time, which can be taken advantage of for the adminstration of food. These animals are dull and sleepy, the head hangs in the manger, and facial expression is entirely^ wanting; there is a general constitutional depression, with anl unsteady drunken gait. The respirations are increased to 20 or 25 per minute and the pulse to 70 or 80, while the action of the heart is extremely) exaggerated. The temperature ranges quite high with a' marked coloration of the conjunctival and bucal mucous mem- brane. The eyelids are sometimes swollen and blinking, witJi- tears overflowing tipon the cJieeks (a pathonomonic symptom). These symptoms are soon followed by chills, and muscular tremors of the shoulders and thighs; when covered with a blanket the skin soon becomes warm and moist; at this stage of the disease no localization can be determined. The blood contains quite a large proportion of fibrin, or plasma. Messrs. Grehaut and Trasbot have found as much as 7 grains to the litre instead of 3 to 3 J^ , the normal quantity. They find that the defibrinated blood, when exposed to air, will again co-agulate, and that about i gram of fibrin may be again extracted from it. M. Grehaut has ascertained that a large percentage of urea, creatine and creatinine is also present in the blood, and that the microscope shows nothing in the shape of foreign elements; the red corpuscles are intact, have not undergone changes or modifications; they agglutinate, and appear a little more sticky; there is an increase of white cor- puscles, which is not specific, as similar modifications can be found in all inflammatory diseases. Other changes mentioned by some writers are merely post-mortem, and have tended to propagate errors concerning the disease. Localization upon the Intestines. — This is the usual localization after the disease has reached a certain stage, and is sometimes manifested by constipation. The mouth is dry, the tongue clammy, no appetite, the dung small, dry and covered with varnish, but there are seldom false membranes on its sur- face. Often there are dull colicky pains, the animal continually pawing the ground; will lie down, rise up again, and appear to be greatly agitated. A violet-colored tint of the buccal mu- cous membrane is noticed, and by close examination a purple line is observed along the border of the gums, whichis another pathonomonic symptom of the disease. Occasionally an abundant serous diarrhcea comes on. The patients manifest an intense thirst, and rapidly lose flesh. If the fever continues, the patient will die in ten or twelve days. If, however, the diarrhcea can be controlled, the appetite will return together with other evidences of health. The alarming phenomena having disappeared, the patient recovers quickly, but for a long time will remain thin, poor, and incapable of doing his ordinary work. During the course of the disease, there is sometimes a serous cedematous infiltration into the dependent parts of the belly and legs; if mustard plasters have been applied to those parts, it is difficult to differentiate the character of the infiltration. This form of localization upon the digestive organs is the least serious, as the enteritis is usually of a mild character, and terminates in recovery. Should the diarrhoea continue for any great length of time, very marked prostration will result, the patients can not be kept on their feet; they fall to the litter, and inflict upon themselves contusions and other injuries, which are very prone to terminate in putrid infection. Localization upon the Respiratory Organs. — Pneu- monia and enteritis often appear at the same time, and in such a complication it is clearly shown that we do not have to deal with a simple inflam.mation like that of an uncomplicated pneumonia, for then one disease would act as a revulsion to the other. It is not uncommon to find this condition complicated pleuritic involvement. The respirations become very much accelerated, varying from 25 to 30 per minute. For two or three days the characteristic symptoms of pulmonary diseases are not noticed, the rusty discharges being almost always wanting. As a rule, the pneumonia begins low down, near the leg bronchus, and spreads from there slowly to the periphery. Normal sounds are heard on ausculation; percussion reveals a slight dullness in the middle and lower part of the lung, whilst the resonance is retained in the anterior, posterior and superior parts. In the majority of cases, however, the dullness is not thus accurately limited and defined between fixed lines. A tubular breathing is not infrequently heard to the end of the disease, for the obstructed zones are surrounded by tissues per- meable to air. In a certain number of cases the chest wall is 9 not sensitive to percussion, while in others a very exaggerated sensitiveness is manifest, demonstrating the presence of a pleuro- pneumonia. There are times, however, when the pleuritic com- plications will exist without any noticeable sensibility of the chest wall due to the marked depression of the nervous system with corresponding slight reaction. These symptoms, taken in their entirety, are slightly modi- fied from what they usually are. This localization is serious, for it produces the greatest mortality. Some sudden complica- tion ending in asphyxia is always possible. At a given moment the animal appears to grow better, but the next day pulmonary congestion may supervene, and death follow by asphyxia. Even without this complication of congestion, the pneumonia has a tendency to terminate in gangrene, the lungs grow tender in spots, the red mucous membrane now changes to violet color, the temperature rises suddenly to 107 3-5 F. (42 c), and even more; there is a greyish clotted fetid discharge, always accom- panied by rumblings in the bowels, and bronchial rales. Pleu- risy may manifest itself at the outset, or follow later as a complication of the pneumonia. In this last condition death often comes on in the following manner: Pleurisy at first comes on slowly, suddenly there is an aggravation of the symptoms, and the animals die of asphyxia, either in consequence of the very abundant transudation into the sac of the pleura, or by a spasm of the lungs complicating the pleuritics transudates. At other times the complication is ver)^ mild, and there is simply a catharrhal affection of the anterior portion of the respiratory tract, a bronchitis or a laryngitis. In this case the cough is thick, the discharges purulent, and accompanied by a serous infiltration into the inter-maxilary space, but which rarely run on to suppuration. Convalescence goes on regularly, and after five or six days the discharges become thicker and disappear. This form of disease is especially seen in old animals, and is accompanied with but little febrile disturbance. Localization Upon the Spinal Cord. — In the course of the disease, even with complications of enteritis, pleurisy lO and pneumonia, the animal is often struck with paralysis, falls to the ground and soon dies. In rare cases the congestion is arrested at the lumbar plexus. M. Trasbot has noticed but a single case in a horse presenting symptoms of enteritis, pneu- monia and pleurisy. This patient remained paralyzed in the hind quarters for 24 hours, and there was a total suppression of sensibility and motion. Localization Upon the Feet. — Founder is a very rare complication, but remarkable instances have been cited of this localization coming on 12 or 24 hours after the appearance of the first symptoms. It is impossible to move the foundered animal, there is extreme sensibility, and great heat of the hoof, walking is impossible, the animal supporting his weight upon his heels. Added to this an intense fever superinduced by the sufferings of the animal. Anasarca. — Anasarca is frequently a complication, not at all influenced by the localization of the disease. These infiltrations which are usually noticed, increase, and there are produced le- sions much resembling those of purpura-haemorrhagica. As in this disease the infiltration of the connective tissue of the extrem- ities may so distend the skin as to produce fissures at the folds of the articulations. This complication usually occurs with very young animals from 3 to 4 years old. A moderate infiltration of the dependent parts is a favorable symptom, and should not be confounded with purpura-haemorrhagica. Other Complications. — It occasionally happens that other irregular complications supervene to cause the death of the animal, one instance brought to my notice by a con- sultation, in which there was an intense nephritis, with an enormous hyper-secretion of urine, the animal having re- covered from all other evidences of the disease but this, which could not be controlled, and which terminated fatally in a few weeks. Another instance in my own ractice, when the animal entirely recovered, with the exception of a small, weak, rapid, intermittent pulse, which could not be influ- enced by drugs, and which terminated in death a few weeks II after apparent convalescence. Haemorrhagic Iritis is not un- frequent after complication of this disease, but which usually yields readily to ordinary treatment, the reabsorption requiring from two to three weeks. Plastic iritis is occasionally seen in this disease after an apparently complete convalescence. These complications develop rapidly, and an animal which in the evening was, to all intents and purposes, perfectly sound, is found in the morning entirely sightless. Diagnosis. — It is not a difficult matter to make a diagnosis of typhoid fever in the horse notwithstanding the different forms it assumes. There is always the same general combination of characteristic phenomena. From the very onset of the disease the debility, stupefaction and CEdema make typhoid fever of the horse differ from any other of the inflammatory diseases which affect this animal. At one time, however, this general condition was confounded with anthracoid fever to such an extent that writers have main- tained that it was only a slightly different form of this disease. But the color of the mucous membranes is by no means that of anthrax fever, in which the violet color of the gums is not seen, the blood of typhoid fever having properties which are the very opposite of those seen in anthrax, which does not coagulate or oxidize on exposure to air. Anthracoid fever always begins by a violent excitement of the animal, while in typhoid there is always a true stupefaction from the very beginning of the disease. Anthrax fever is easily produced in the rabbit and guinea-pig by inoculation, while the blood of typhoid gives no results. In all cases there are sure and simple means of distinguishing these two diseases from each other, so that a correct diagnosis may be made at the first visit, and almost all practitioners do so when they see the closed and tearful eyes of a sick animal. It is therefore only neces- sary to make a diagnosis of the localization of the disease. When, after two or three days localization is found upon the intestine, abdominal pains are noticed, the dung, which was at first hard, soon becomes thin and watery. 12 When the disease is located upon the respiratory organs, the early symptoms are somewhat obscure; after two or three days there is a slight dullness on one side of the chest, then all doubt is expelled. As regards other localizations, they are still more easily recognized, when there is congestion of nerve centers. The animals cannot support themselves, and fall to the ground; when there is founder there is then the character- istic symptoms of this disease. It is important to recognize the complication, for this fact must be taken into consideration in the treatment. Prognosis. — The prognosis of influenza, or typhoid fever, is serious, from the fact that it is contagious in its character, and tends to spread among those animals confined in those stables into which it has been introduced; it is also serious from a pecuniary standpoint, as the inability of a number of horses to work results in serious loss to the community. In addition to these facts, a large number of horses die of this disease especially in the beginning of the outbreak; these considera- tions, therefore, make the disease a very serious one. In isolated cases the disease is not so serious, but is more to be feared in young than in well-matured horses. Horses that are idle, or sale horses, suffer much more from this disease than do horses regularly at work. The prognosis will also depend largely upon the localization of the disease. If it localizes itself upon the digestive organs the animal is likely to make a good recovery; in rare instances, the patient may die from exhaustion when there is a persistent diarrhoea. Should the disease become localized upon the respiratory organs, it is then much more serious, under any conditions, and is a very common locahzation in young, green, vigorous sale horses. Other complications are more or less serious, accord- ing to the organ compromised; congestion of any portion of the nervous system may soon have a fatal termination, due to inter- ference with the function of these centers, and its influence upon respiration and circulation. T3 When influenza, or typhoid fever, is compHcated with founder the prognosis is a serious one; it is a compHcation not often met with, and which will sometimes yield readily to energetic treat- ment, but not infrequently several months are required for complete convalescence. I had two instances of this among some green brewery stock last Spring (1893); these horses suffered from the founder complication for over five months after all other symptoms of the disease had disappeared. The prognosis in other complications varies with the locali- zation. Anasarca of the head is likely to interfere with respira- tion. Oedematous infiltration of the glottis terminates speedily in death. These anasarcous complications at rare intervals will take on the form of acute suppurative erysipelatous disease. One case of this kind in my practice in May, '93, the brief history of which is as follows: Among the horses purchased for a brewing firm was a thoroughbred shire mare; three or four days after the purchase the leg of this animal was clipped, and a day or two after she developed typhoid fever, it being prevalent in the stable at the time. The disease seemed to expend its entire force upon the extremities, all four of which swelled to enormous proportions, were hot and painful, diffused suppuration of the cellular connective tissue developed, and the animal died of pysemic infection in about ten days after. It would appear that the removal of a heavy coat of hair, early in the Spring, and just at the onset of the disease, caused such irritation of the parts as to cause a localization or concentration of the disease at this point. In summing up the prognosis, therefore, it will be seen that there is abundant reason for considering this disease a very serious one; even much more serious than certain other con- tagious diseases which are under legal control, such as glanders and farcy. My experience with this disease leads me to think that a death rate of about 6 or 8 per cent, is to be expected, although a few years ago it was placed as high as 20 per cent. Anatomical Changes. — There is such a remarkable varia- tion in the anatomical changes that they have frequently been H confounded one with the other, and which for a long time tended to obscure the true character of the disease, and pre- vented the distinct recognition of the primary changes from those which were secondary. I shall first endeavor to point out those changes which are essential, and later will consider those which are secondary. We will first notice that the blood has undergone special and peculiar changes, which will be noticed before any other change or localization can be recog- nized. The disease has been described as an enteritis, or a pneumonia, due to these changes in the blood, and it was for this reason that the term typhohaemia was applied to it. In order to determine the nature of the lesions, it was necessary to keep a careful record of the conditions found in post-mortem examinations, and to carefully separate the post-mortem from the ante-mortem changes In those cases in which the disease has been described as the rapid course, the blood presents all the characteristics of asphyxia — it is black, non-coagulated, and often loaded with fat; this form of the disease is most frequently seen in very fat and plethoric horses. Post-mortem changes are almost always present which may mislead the examiner unless he bears in mind the fact that it is the early summer months (as it is at this season that the disease mostly prevails) and that the examination has been somewhat delayed, as almost invariably happens. These post- mortem changes are even more noticeable if the animal has been confined in a close, hot place; the blood is then in an advanced state of putrid fermentation; this change is due to the fact that the animals die rapidly from asphyxia, associated with violent struggles, which conditions favor rapid disintegra- tion of the blood. In these cases the blood is found black, non- coagulable, having a strong ammoniacal odor, and through the action of the ammonia upon the coloring matter of the blood there is found an ammoniacal compound, which stains the walls of the blood-vessels a deep red. Examination of this blood under the microscope shows many disintegrated and decolorized red blood corpuscles and putrefactive bacteria in large numbers; 15 these have frequently been mistaken by careless or inexperienced observers as being special bacteriological elements, or have considered them as anthracoid vibriones. In this blood there has also been found hsmatoidal crystals, which have also been considered by some writers as microbes, but these are only post- mortem changes. In order to determine exactly what changes have taken place in the blood, it must be examined before death, or immediately after, before it has undergone the slightest post- mortem change. At this time it will be found to be more fibrinous, and to be richer in excrementitious matter, such as creatin, creatine, and especially urea. This coincides with, and would be indicated by the intense fever which is noticed at the onset of the disease prior to any local alteration. It is reason- able to suppose that this extreme fever is due to the rapid combustion of tissue, and which is represented in the blood by the products of tissue waste. Why this rapid disintegration of tissue takes place I am not able to explain, nor have I been able to find an explanation by any writer. It is possible that at some future time it may be found to be due to as yet an undis- covered microbe (.''). When the disease has progressed for some little time, the white blood corpuscles will be found in increased numbers, but which is relative only, due to the destructive changes going on among the red cells as already noticed. It will be readily noticed that when making a post-mortem exam- ination immediately after death the blood is black and not coagulated; it collects in pools on the ground; by its contact with the air it absorbs oxygen and coagulates, thereby showing that it is entirely different from the blood of anthrax, or septic infection. A genuine septic infection, however, is always possible when there has been a gangrenous pneumonia, or sloughs on any portion of the body which may easily become the seat of septic invasion; then septic alteration of the blood will be found, which, when exposed to the air, remains black and non-co- agulated, the surface covered with oil drops and large numbers of septic vibriones; it is due to this fact that so many writers i6 have continued to associate this disease with anthrax and septi- caemia. Other local alterations of the disease vary as much as does the external symptomatology. An intense intestinal con- gestion is sometimes found; it is not so serious or so important, from a practical standpoint, as is the essential congestion (enteritis), but nevertheless is sufficently well marked. There are cases in which the patient will succumb to this condition, which is the first stage in the evolution of enteritis, in from three to five days, and before sufficient time has intervened to permit the development of diarrhoea. The fecal contents of the gut is hard, and covered with a brownish glaze, the large intestine filled with food material. The mucous membrane is red, injected and decidedly thickened; the sub-peritoneal connective tissue, including the intra-muscular connective tissue, is markedly infiltrated with an amber-colored serous transudate. In fact, this leakage into the connective tissue is found wherever a local lesion exists. As a general rule it will be found that localiza- tion upon the digestive organs does not have a speedy fatal termination, but rather the reverse; when these animals have lived for some time the intestinal tract is found almost entirely empty, containing only a thick yellowish liquid, consisting of hyper-secreted mucus and transuded serum. Traces of inflam- mation may sometimes be found on the mucous membrane of the stomach, but it is in the small intestine that the most decided changes are seen, its mucous membrane presenting the same changes as were seen in the large intestine — it is injected, thickened and infiltrated with serum. In addition to the serous infiltration, it is very plainly evident that Peyers patches are considerably increased in every direction, are elevated above the free surface of the mucous membrane, and not infrequently is it found that this surface has been denuded of its epithelium, which causes it to' represent in a manner true ulceration, but in no respect have I been able to recognize any similarity between this and the ulceration of true typhoid fever of man. Out of the whole number of post-mortem examinations in this disease made by me in the last ten years, I have not once found a true 17 ulceration, and my conclusions, therefore, lead me to believe that it does not exist in typhoid fever in the horse. The de- nudation of Peyers patches of its epithelium appears to be due to its serous infiltration, which not only permeates the whole con- nective tissue of the intestine, but accumulates between its two mesenteric layers, which are often greatly distended by it. The mesenteric lymph ganglions also take part in this general infiltration, they are congested, swollen and infiltrated. Throughout the whole course of the disease there is manifest a general tendency to stagnation of the blood, noticed even in the very earliest stages of the disease, if venesection is performed, by the slobbery character of the bleeding; it is this fact that explains the extensive serous transudation found in all the local lesions, and more or less general throughout the body. These are the lesions usually found in post-mortem examinations when the local lesion, or rather localization of the disease, is on the digestive tract. In 1872, in a communication to the Soc. Cent, de Med. Vet., Prof. Trasbot pointed out that in some very rare instances small, gangrenous, superficial sloughs were found on the surface of the intestinal mucous membrane; he found that these sloughs were confined to the superficial layers of the mucous membrane, that there were some tissues found in the small intestine, but were not frequent in the large colon. As he says, these sloughs may assume the appearance of genuine ulceration, but were entirely different from the ulceration of typhoid fever in man. When the lungs become the seat of the localization the complication is either pneumonia or pleurisy, sometimes both. A second invasion of the lung tissue in these cases is frequently seen, the animals then die rapidly of asphyxia, which the post-mortem will show, while at the same time gan- grenous compHcations may be found. Prof. Trasbot has described this lesion as an oedematous pneumonia, and his description of these pathological changes are certainly far more lucid and comprehensive than that of any other writer of my acquaintance, and from which we obtain these facts: "Ordinarily the pneumonia is more or less restricted, its out- "lines not horizontally marked as in free inflammation. At the "lower part there is almost always some lesions in one of the "lungs, sometimes in both, for exclusive localization in one lung "is a more rare condition than in sporadic pneumonia. In typhoid "fever there is found side by side veins of tissue obstructed by "inflammatory transudation, and portion which have remained " permeable to air. When the lungs are cut, a very marked infil- " tration is found in places where the pneumonia did not yet exist. " There, as everywhere else, is a stagnation of blood, bringing on "diffusion of the serum in the peripheric tissues, and especially "in the connective tissue spaces, which enlarge in volume. There "is nevertheless genuine pneumonia with exudation into the "interior of the acini. At the points where the inflammation is "localized, the lungs are dense, compact, friable, tearing easily, "and having a granular fracture. On a smooth cut a large "quantity of serum flows. There is also the red coloration with " small bluish tints. By a microscopic examination the evolution "of the lesion can be followed, and the completely hepatized "parts studied. Besides the infiltration of the partitions we ^' found in the vesicles the changes of pneumonia; that is to say, "an amorphous exudation containing globules of pus. These "capillaries are seen greatly distended, and around them a large "quantity of liquid, forming in mass a yellowish clot interposed " between anatomical structures. On the periphery the anatomi- "cal interspaces are markedly distended by this granulous mass. "Pleurisy may be added to the pneumonia or exist alone; in "either case the changes developed upon the pleura, with more "or less extension, does not essentially differ from those of an "ordinary inflammation of this membrane. Finally, there is in "the lungs stagnation of blood with a large serous infiltration. "Sometimes, although the lesions of pneumonia may be but "slight, death speedily ensues, pulmonary inflammation having " led to gangrene. This seems difficult to explain. Small, gan- "grenous, slate-colored, grayish foci are often found, having " a putrid and infectious odor. In this case septicaemia has com- " plicated the typhoid fever, because the mortified lungs putrefy, 19 "and there is speedy reabsorption of the septic elements and "putrid infection." When there are other localizations, the changes found upon post-mortem examination vary with the complication. I have never seen a fatal termination in those cases in which the podophyllous structure was involved. These cases of this com- plication in my practice made good recoveries after several months of idleness, without any noticeable changes in the structure of the hoof; therefore, a post-mortem examination would not have shown any thing more than a congestion of the podophyllous structure, with perhaps capillary haemorrhage on the surface. When there is localization upon the brain and spinal cord, death is usually rapid, as in the solitary case coming under my notice; here there was a well-marked congestion of the men- inges with a large quantity of serum in the pia-mater, producing a great deal of pressure, which was probably the immediate cause of death; the arachnoidal spaces were filled with transudate, but no microscopical evidence of lesion in the substance of the brain proper. The congestion and transudation is as easily explained in this case as in the lesions of other parts of the body, being entirely due to stagnation of the blood current, a prominent feature of the disease. Other rare complications of this disease are lesions which occur in the eye, all of which are evidently due to impaired circulation. The first manifestation in this organ is seen in the sub-conjunctival connective tissue, which becomes infiltrated with serum of a yellow color, intermixed with a greenish tinge, indicating a disturbance of the liver; sometimes a sudden trans- udation of serum, or coagulable lymph, takes place into the anterior chamber of the eye, producing an absolute blindness, which will continue for 15 or 18 days, but reabsorption is not complete until 30 or 35 days. Should the lesion be more forcibly concentrated on this organ, then, as above described, there will occur a veritable haemorrhage into it, due to the rup- ture of a capillary in the ciliary plexus. These coaditions 20 occur principally in the convalescing period, after all external manifestation of the disease has passed away, and perhaps after the patient has been discharged as cured. My experience with these complications is limited to one example of plastic iritis in an animal owned by one of our most prominent physicians. Dr. E. L. Dunn, and one example of hemorrhagic iritis in an animal owned by a wealthy sugar refiner. In each case one of our noted specialists. Prof Earlan, was in consultation, and appeared to be extremely interested. These cases made a good recovery in from 28 to 30 days. M. Decroix has described a case of instantaneous and complete amaurosis, a lesion quite as easily explained as either of the others, as being due to an infiltration, or haemorrhage, into the retina. A complication which is sometimes seen is a general dropsical infiltration into all the depending parts, the head, extremities, belly, etc.; these will sometimes reach enorm- ous proportions, and as ecchymotic spots appear in the conjunctiva, Schneiderian mucous membrane, and other parts, care must be taken not to confound it with purpura hsemorr- hagica. Treatment. — Drugs of every description have been used in the treatment of this disease, and often without method or judgment. The random administration of drugs usually being more productive of harm than good, and not infrequently is the pharmaceutical combination such, that the drugs counter- act each other, and produce incompatibles. Exhaustion of the system is most effectually produced by the simultaneous admin- istration of drugs, which exert an opposite therapeutic influence. There are but few articles written on this subject, that do not contain the wildest inconsistent theories, with regard to the remedies advised. Almost every practitioner pretends to have a specific for this disease, as indeed for all others that are diffi- cult to treat, and which, when tried, are found to be of little value. We will not take into consideration anything that has been written or advised on this subject, but by bearing in mind certain well-known clinical facts, will by deductive reasoning 21 try to reach what we believe to be reasonable conclusions in the treatment of this disease. The medical treatment of this condition, must entirely de- pend upon the symptomatology which the disease presents, that is to say that drugs must be administered to counteract the dan- gerous symptoms as they arise. The means used to reach this result must necessarily be as varied, as are the symptoms, and complications with which we must contend ; therefore there is no systematic treatment for influenza, or typhoid ever in the horse. There are, however, general indications which are suitable to all cases, especially when the treatment begins with the first symptom. •> It is these general measures to which M. Trasbot had called special attention in 1883, at a meeting of the Central Society of Veterinary Surgery. There are two facts to be remembered in the treatment, the first of which is, that there is, from the very beginning all the general phenomena of an intense febrile condition, and secondly a marked tendency to congestion of the most vascular organs, with blood stasis. Given these facts we naturally ask, how are we to counteract these conditions most effectually and quickly ? Notwithstanding everything that may be said to the contrary, the first indication is to bleed. The great benefits to be derived from bleeding were very clearly demonstrated by M. Trasbot in what he intended to be a series of experiments, finding no seri- ous results from small bleeding, the quantity of blood taken was gradually increased until as much as 6 or 7 litres were with- drawn from plethoric animals. This treatment instead of kill- ing the animals as was contended a priori produced an instant relief. The great advantage of this treatment, was the immedi- ate improvement of the most dangerous symptoms, the emission of blood being always followed by improvement. During the last few years I have had many opportunities to thoroughly test the value of this treatment, and in not a single instance have I had occasion to regret it, many of the cases so treated, requiring no other treatment. 22 Objection to venesection undoubtedly arose from the fact that earlier investigators erroneously supposed that this was allied to charbon or septiceaemia, in which diseases bleeding is contra-indicated. Bleeding in the early stages of influenza or typhoid fever in the horse, was first brought to my notice through the writings of Prof. Trasbot of Alfort, and so thoroughly satisfied am I of ts great value when used promptly and fear- lessly, that I do not feel as if an apology was necessary for this repetition. The practice of bleeding cannot do harm, and is not ob- jectionable in any respect, but yet there are practitioners who will learnedly argue against it, without having tried its effects in a single instance. When pulmonary congestion is threatened, bleeding is absolutely necessary, and free bleeding in these cases is the only thing that will abort that complication, which sooner or later must terminate in death. M. Trasbot recom- mends that the blood be drawn by making several small bleed- ing in the 24 hours, rather than one single bleeding, as it tends to remove a less quantity of corpuscles while taking the same quantity of liquid. This plan I have never tried, having always felt better satisfied to take at one bleeding from a good sized plethoric horse from 6 to 8 quarts of blood. Counter-irritation in the shape of mustard or turpentine, ap- plied to the skin of the extremities and belly, has been strongly endorsed by some writers, and from a theoretical standpoint, based upon the changes found upon post-mortem examination, it cannot do other than good. My own experience with it, however, is quite well, having always found that free bleeding fulfilled every indication. When used, however, mustard is probably the best, as its action is more energetic and forcible than turpentine. Counter- irritation will no doubt greatly lessen the gravity of severe com- plications that may have a fatal termination — especially those of the nerve centres, and of the lungs — by causing the serous transudation to occur in the subcutaneous connective tissue, where it would be harmless, rather than in organs where it 23 would be incompatible with life. It would certainly be of great value in cases that are not bled, and when it is associated with drugs which would powerfully influence the circulation. Turpentine, when used too freely, may cause serious complica- tions by cutaneous irritation, especially of the thinner portions of the skin. This objection also applies to mustard which may cause cutaneous sloughs requiring a very long time to heal. In addition to counter-irritation, drugs which act powerfully upon the heart and blood-vessels, thus influencing the circula- tion to a markd deegree, will be of great value in the first stages of the disease. Veratrum and aconite best fulfill these indica- tions during the first 48 hours, given frequently in small doses, and carefully watching the patient for the effects of the drug, which is capable of doing great harm if not used intelligently. When the practitioner has seen his case early, and has made a free bleeding, the indication then is to put the patient on an antipyretic treatment. There are agents — drugs if they may be so called (?) which combat fever by what is called a contra-stim- ulant action, but which I think can be better described as de- nutritive antipyretics, or antithermics, decrease the over active combustion of the body; they have been divided into two classes, those which lessen combustion by primary action upon the blood itself preventing molecular interchange, and those acting through the nervous system, and reducing fever by a second- ary phenomena, which restores the tone of the capillary ves- sels, and consequently facilitates circulation in certain organs, thereby preventing stagnation and congestion. "As a general rule, such antipyretics as are obtained from ' the mineral kingdom, may be classed as 'denutritive,' acting by their presence in the blood, and retarding molecular inter- change between the blood globules and the tissue structures."* .Salts of mercury, arsenic and iodine act in this way in arresting molecular interchange, and are especially denutritive. Iodine and its compounds act especially upon the mucous tissues and *Trasbot. 24 the lymphatic ganglions; when given to an animal in full doses it will be seen that the temperature drops below normal circu- lation and respiration are diminished in force and frequency; the pulse becomes slow, and the visible mucous membranes blanched, and if the drug is pushed beyond this point anaemia soon follows. Alkaline salts act in the same way. Bicarbonate of soda in small doses seems to increase the appetite, but in large doses it reduces temperature, bleaches the mucous membrane, and pro- duces emaciation. In typhoid fever or influenza in the horse, these remedies may be of some value, if given early. In giving iodide of po- tassium and bicarbonate of soda, even before there is localization fever — the result of too active molecular interchange — is coun- teracted, and the temperature, already reduced by the bleeding, will be kept more nearly the normal level. There is, therefore, some advantage to be gained by using these drugs. Among other drugs, sometimes of value in this disease, we find digitalis. It is of value in those cases when there is a marked and exaggerated action of the heart; it counteracts those influences which produce this condition, and stimulates those nerves which control or inhibit the over activity of this organ. In this way digitalis tends to counteract the flow of blood to points when there is a tendency to stagnation, and may there- fore be useful, and in many cases indicated. Quinine, one of the most valuable remedies in this disease, reduces temperature, and appears to act by stimulation of the ganglionary nervous system. Quinine appears to give much better results when it is combined with acetanelid, and given in 30 grain doses each, four or five times a day. In this combina- tion they seem to exert a much greater influence upon the pyrexia than either alone ; it appears as if the therapeutic action of one drug aided and influenced the action of the other, or that the effect of each upon the system was what was required in order that the action of the others may reach its full capacity. Stimulation will often be urgentl}' required, strong infusions of 25 coffee with a little good whiskey, will give the happiest results in these cases. From i6 to 32 ounces of infusion, one ounce of coffee to two ounces of finished product, with from two to four ounces of spiritus furmenti every 24 hours, will often give mar- velous results, especially if associated with from 30 to 60 M doses of the tincture of nux vomica. I know that this suggestion to use nux vomica in high fevers is likely to meet with considerable criticism, and that some will even hold up their hands in therapeutic horror, but this will only be from those who have never tried it. From a review of the indications for the general treatment of this disease, it will be seen that bleeding should be immedi- ately performed before any localization occurs. If we are liberal, and at the same time judicious, in this repect only the best re- sults can follow, the fever is counteracted, temperature lowered, and congestion prevented. This may be followed by counter- irritation with mustard to the chest, belly and extremities, as it will probably tend to prevent localization upon important viscera, and to establish it in the subcutaneous connective tis- sue. This must be followed by antipyretic remedies, such as quinine, acetanelid, salts of iodine, arsenic and mercury, bicar- bonate of soda, etc. Iodide of potassium, when used, should be given in half ounce doses three times a day; it is expensive, but is by far the best of these salts. Bicarbonate of soda is cheap, and may be used to advantage in some of these cases. When there is a tendency to blood stasis, digitalis given in small doses frequently, for a day or two, will often do much good. Quinine and acetanelid become our sheet anchor, in the majority of these cases, especially when intelligently aided by drugs to meet special conditions, and judiciously supplemented by the use of such stimulants as coffee and alcohol. Treatment of Local Complications. — The treament of the localizations must be adapted to the different conditions as they arise, so that each new phenomenon will have to be com- bated by new and special treatment, in other words medicine must be given entirely to counteract symptoms. 26 Intestinal complications will be seen in the majority of cases, and is the least serious form with which we have to contend. It is first indicated to restore the normal tone of the digestive mucous membrane; this should be done with as little irritation as possible, and is best accomplished by the administration of small doses of sulphate of soda. There are cases when abdominal pains and dull colics are preseftt; these are probably best combated by the use of suchanodines as camphor and chloral or asafcetida given in doses of from 2 to 33 each. It is not by any means infrequent to find cases of muco-albuminous diarrhoea due to the presence of irritating food masses. The first indication in treatment is to remove the cause by the administration of from 20 to 30 ounces of castor oil, containing one drachm of carbolic acid or iodine, and to continue the administration of these drugs in 10 or 15 grain doses three times daily for a few days. A very popular method of counteracting this condition is by the use of vegeta- ble or mineral astringents. The effects produced by these medicaments is but temporary, it is a delusion, and the results looked for are not obtained. The anodine treatment will often give excellent results in these cases, stopping the diarrhoea in two or three days. Preparations containing opium should be given with extreme caution, and when used at all should be in small doses and freely diluted with water. By the use of opium we may produce that complication which we most fear, that is ■cerebral congestion; as we all know how frequently this occurs in the use of this drug, and especially in a disease when there is a tendency to this complication. Sometimes a loss of appe- tite is very persistent, even after all other symptoms have passed away, this is due to a lack of tone in the digestive mucous tract, and should be treated in a way calculated to restore this lost function, bitter tonics, stomachics and stimulants best fulfill this indication. When the localization is upon the respiratory organs or pleura, the treatment must be modified to suit the •complication. As soon as the lung lesion is manifest, it should be treated 27 as an ordinary inflammatory disease. We have already resorted to bleeding and counter-irritation, this is now to be followed by ordinary treatment, good nursing, carefully watching for unfa- vorable complications in order to counteract them, and as care- fully avoiding too much curative treatment. Alcohol and turpen- tine has been highly recommended in this complication, but it is far more likely to do harm than good; except in the latter stages when benefit may be derived from its use if given in small and frequent doses. Alcohol, when given too freely, pro- duces results the very opposite of stimulation, tending to pro- duce blood stasis rather than to prevent it; its use in this way is therefore irrational. Turpentine, when used in small doses during the convalescing stage, may exert a certain beneficial effect upon the respiratory mucous membrane, but has decided disadvantages if used at any other time, owing to the irritating effects which may follow its use. The pulse in this complica- tion should be closely watched, as there is frequently an indica- tion for the use ot digitalis, which may be given in from 30 to 50 M doses of the iluid extract. The effect of the drug must be carefully noted, and if the pulsations become slow or intermit- tent, the drug must be stopped. Over active treatment in this complication is to be avoided, as the very great majority of cases will get well in a week or ten days if the patient is not killed with medicine. Bronchial irritation, marked weakness, and poor appetite, often remain for a long time, after all other symptoms have disappeared; diffusive stimulants, tonics and nutritious foods and drinks fulfill all the indications in this case. If the disease concentrates itself upon the nervous system, and does not yield to the general treatment already indicated, death almost invariably occurs. If founder is the complication, the ordinary course of treatment for this disease is to be fol- lowed, but not infrequently it will require several months for its complete recovery. In those cases when gangrene of the lungs is a complication, it should be treated in a manner indicated by this condition, such as stimulants and antiseptics; but whatever the treatment. 28 death will be the invariable termination. A large number of cases of this complication has been brought to my attention, and I have yet to see the first recovery, nor have I been able to find any recorded cases and gangrenous sloughs on the surface, whether primary or secondary, can often be successfully treated, and a general infection prevented. The treatment indicated in these cases is such as applies to all sloughing wounds. In those cases of plastic and hsemorrhagic iritis, which is sometimes in the convalescing stages of this disease; very hot local fermentation is indicated, this combined with Donovans solution, liquor arsenic et hydragri iodium, will give the best results. This preparation should be given in 6o M doses three times daily, and gradually increase to one ounce daily; in from 1 8 to 25 days; complete absorption of the transudate or haem- orrhage will have taken place. Hygienic Measures. — There can be no question as to the contagious character of this disease, and it is, therefore, neces- sary to isolate all diseased animals, or rather to separate those which are not diseased from the sick ones. Prof Trasbot advises as the surest plan of arresting the dis- ease, to turn all the animals out, and mentions several instances to prove its advisability. As soon as typhoid fever manifests itself in a stable all well animals are better off outside than inside, especially those that are young and green, and if they can be given complete free- dom in a field, straw yard, or open shed, the spread of the dis- ease will be more completely arrested than by any other method, and my experience in this respect is entirely in accord -with that of Prof Trasbot. As a further precaution it is necessary to thoroughly cleanse and disinfect the stables and whitewash, using a small quantity of chlorine or carbolic acid in the lime wash. Animals after recovery, even after every symptom and mani- festation of the disease has disappeared, will remain weak and unfit for service for several weeks, so that it is not possible nor prudent to expect service from them until it is seen that they 29 are strong and well fitted for it. This fact applies to those ani- mals that have had the disease in a very mild form, quite as much as those more seriously affected, so that they should be returned to work only after they have manifestly regained their accustomed physical vigor. BIBLIOGRAPHY. — Havemann, Hannov. Magazine, 1796 Natmann, Nach- richten von Staats u. Gelehsten Sachen, 2805. — WOLLSTEIN, Pferdeseuche, 1805. — PiLGER, Krankkeiten der Pferde, 1805. — Leblanc, De la Gastro-enterite Epizootique, Paris, 1825. — Spooner, A Treatise on the Influenza, 1S37. — Louchard, Maladie Typhoidedu Cheval, 1838. — PIurteel d' Arboval, Dictionaire Art. Gastro-enterite, 1839. — Spooner, The Vet, 1841. — Moulin, Journ. des Vet. du Midi., 1841. — GouR- DON, Ibid., 1850-51. — Damalix et Reynal, Recueil Vet., 1842. — Denoc, Ibid., 1843. — Lambert, Ibid., 1848. — Spinola, Die Influenza du Pferde, 1844. — Ernes, The Vet., 1849. — Lafosse, Journ. des Vet. du Midi, 1856. — Koll, Journ. de Lyon, 1859. — Ballip, Boiteux, Bugniet, Saint-Cyr, Ibid., i860. — Liautard, Recueil Vet., 1854. — Prange Favereau, Ibid., 1855. — Sanson, Ibid., 1856-57. — Loiset, Ibid., 1858. — ROTGIEUX, Bull. Soc. Cent. Vet., 1859. — Trelut, Recueil Vet., i860. Colin, Ibid., 1866.— Meguin, Ibid.— H. Bouley, Bull. Soc. Cent. Vet., 1850-59-^0 -67-72. — Bany, Seinol, Trasbot, Vatel, Ueber, Ibid., 1872. — Salles, Ibid., 1869-73. — Iessen, Magazine, 1870. — Copeman, Annal. de Bruxelles, 1873. — Her- TING, Magazine, 1873. — Benjamin, Recueil Vet, 1875. — Leblanc, Ibid., 1879. — Labat, Revue Vet., 1878.— Levck, Bull. Soc. Vet Prac, 1881.— Dieckerhoff, Adams' Wochenschrift, 1881-83-85 ; Die Pferdestraupe, 1882 ; Spec. Pathol., 1885. — Friedberger, Munch. lahresber, 1880-81-82-86-87. — LuSTiG, Hannor. lahresber, 1880-82-83.— Gerard, L'Echo Vet, 1881.— H. Bouley, Lament, Salle, Recueil Vet., 1881.— Macgilliveay, Buttas, Ffnis, Siewright, The Vet, 1882. — H. Pou- LEY, Soc. Cent de Med. Vet., 1881-83-84.— Arlong, Aureggio, Ibid., 1882.— Trasbot, 1884.— Eggeling, Preuss. Mettheid., 1883.— Cave, Edgar, Withworth, Gresswell, Roberts, The Vet, 1883.— Lavalard, Bull. Soc. Cent Vet, 1883.— Hartenstine, Archiv. Vet., 1884.— Adam, Wochenschrift, 1884.— Waltrrs, Ibid., 1884.— Sticker, Adams' Wochenschrift, 1887.— Sterling, Ibid., 1888.— Galtier et Violet, Journ. de Lyon, 1889.— Cadeac, Ibid.— Campagne, Recuil Vet., 1890. Cagney, Ibid., 1891, Ibid., 1885-1888.