SF _wer ^JyJLjULJLc^ j H ' o xz~ (J//VW JOJJL^^ oJLJkA, <&\AAJL Ww CU^4-\ K*^b uru^^ f Glass Book- 6 |-39> >Ws- TREASURY DEPARTMENT UNITED STATES PUBLIC HEALTH SERVICE HUGH S. CUMMING, Surgeon General ON THE PROBABLE IDENTITY OF THE CHITTENDEN-UNDERHILL PELLAGRALIKE SYN DROME IN DOGS AND "BLACK-TONGUE" WITH REPORT OF NECROPSY FINDINGS IN TWO CASES OF BLACK-TONGUE BY G. A. WHEELER Passed Assistant Surgeon AND JOSEPH GOLDBERGER Surgeon, United States Public Health Service AND M. R. BLACKSTOCK, D. V. S. i Spartanburg, S. C. REPRINT No. 746 FROM THE PUBLIC HEALTH REPORTS Mat 5, 1922 (Pages 1063-1069) 01; ^fc57 2^ WASHINGTON GOVERNMENT PRINTING OFFICE 1922 Monograph ADDITIONAL COPIES OF THIS PUBLICATION MAY BE PROCURED FROM THE SUPERINTENDENT OF DOCUMENTS GOVERNMENT PRINTING OFFICE WASHINGTON, D. C. AT 5 CENTS PER COPY LIBRARY OF CONGRESS RECEIVED AUG9 1922 DOCUMENTS DIVISION \4? ON THE PROBABLE IDENTITY OF THE CHITTENDEN-LNDER- HILL PELLAGRALIKE SYNDROME IN DOGS AND "BLACK- TONGUE." WITH REPORT OF NECROPSY FINDINGS IN TWO CASES OF BLACK- TONGUE. 1 By G. A. Wheeler, Passed Assistant Surgeon, and Joseph Goldbeeger, Surgeon, "United State's Public Health Service; and M. R. Blackstock, D. V. S., Spartanburg, S. C. We desire to invite attention to the striking similarity and probable identity of Chittenden and Underbill's pellagralike syndrome in dogs and the condition known to American veterinarians as "black- tongue." 2 In August, 1917, Chittenden and Underhill reported the produc- tion in dogs of a pathological condition which they regarded as closely resembling human pellagra. The condition w T as described as follows : " The onset of the pathological symptoms is generally very sudden. Usually the first abnormal manifestation is a refusal to eat, and ex- amination will reveal nothing to account for the loss of appetite. The animal lies quietly in its pen and is apathetic. After continued refusal to eat for a day or two, the mouth of the dog will present a peculiar and characteristic appearance. The inner surface of the cheeks and lips and the edges of the tongue are so covered with pustules as to give the impression of a mass of rotten flesh. The odor from these tissues is foul and almost unbearable. When stroked with absorbent cotton the mucous lining of the mouth comes away in shreds. Intense salivation is present. The teeth appear to be solid and normal. A bloody diarrhea is present, attempts at defe- cation being very frequent and resulting in the passage of little more than a bloody fluid of foul odor. In some cases, the thorax and upper part of the abdomen may contain many pustules half an inch in diameter which are filled with pus organisms. No other skin lesions are prominent. Death usually results without any particu- larly striking features. "At autopsy two types of conditions are recognizable: In the ani- mals presenting foul mouth and bloody diarrhea the chief interest centers in the lower bowel and rectum, which exhibit an intense hemorrhagic appearance. With these animals dying rapidly from convulsions the only visible abnormality of the alimentary tract is the presence in the duodenum of one or more large ulcers." This pathological condition was induced by these workers by feed- ing a diet of boiled peas, cracker meal, and cottonseed oil. It was also induced, but with much greater difficulty, with a diet of meat, cracker meal, and lard. 1 Reprint from ths Public Health Reports, vol. 37, No. 18, May 5, 1922, pp. 1063-1069. 2 Synonyms: Sore mouth, southern canine plague, dog typhus, dog typhoid, gastroenteritis hemor- rhagica, Stuttgart dog epizootic. 108086—22 1 2 PELLAGRALIKE DISEASES IN DOGS. " Blacktongue " appears to have been first described in 1852 from Munich by Hofer as " typhoid of dogs." 3 Hofer mentions among the symptoms an abrupt onset, vomiting, retching, and loss of appetite. The mucous membrane of the mouth is described as either dirty red or yellow, with an evil smelling saliva drooling from the angles of the mouth. He remarks that he never observed the typical typhoidal stool, but in pernicious cases there was a bloody discharge. At necropsy he found congestion of the gastric and intestinal mucosa with ulceration scattered throughout the digestive tract. Nearly 50 years later, Klett (1899), without knowing of Hofer's observation, made a careful and extensive clinical study of the con- dition in the course of an outbreak at Stuttgart. A brief summary of Klett's clinical observations follows: Onset very abrupt with vomiting, followed by loss of appetite and by thirst. The dog is indifferent to his surroundings, and his strength is diminished. The buccal, less often the pharyngeal, mucosa is brownish or dark red with erosions and pustules. The mucosa of the tongue is simi- larly altered. In advanced cases the mucosa of the mouth, pharynx, and tongue becomes covered with a thick chocolate-colored coating. The mouth invariably gives off an extremely foul odor. Constipation and constipated stools are the rule, but in some cases there is uncontrollable diarrhea of a bloody character. The conjunctiva is invariably injected. The temperature is not above normal. In some cases convulsions of a clonic character may occur. Other European students have confirmed and, in some details, extended Klett's observations, as the result of which it appears that some variation in the severity of the disease, but more particularly in the prominence or severity of the individual manifestations, may occur. Thus the inflammation of the mouth may be slight — it may occur without any erosions or ulcerations; on the other hand, it appears that the inflammation may be so severe as to lead to de- struction (gangrenous) of the anterior part of the tongue. Similarly the gastric, duodenal, and rectal mucosa may be but slightly con- gested or it may be severely inflamed and ulcerated. No extensive study of the disease as it occurs in dogs in the United States seems to have been made. There are, however, several pub- lished notes describing the salient features of the disease. The fol- lowing outline is based on these American accounts and on our own observations. Onset is rather abrupt, with lassitude, loss of appetite, occasionally vomiting, and thirst; the animal, though trying often, may be unable to take water. The mouth early gives off a characteristic offensive, nauseating odor and soon becomes sore. Salivation develops early, and the drooling saliva may become bloody. s Hofer's '' Typhus der Hunde" has in the literature been erroneously translated into "dog typhus." The German typhus is the English typhoid, and it was typhoid that Hofer meant. PELLAGRALIKE DISEASES IN DOGS. 3 The buccal and lingual mucosa becomes more or less extensively injected and inflamed. In some cases .the congestion becomes very marked, the mucosa then presenting more or less extensive purplish red areas. The tongue,' more particularly the free anterior portion, may be thus affected; the margin may be bright red. Both tongue and cheeks may become covered with a dirty, gray, slimy coating suggestive of a diphtheritic membrane. It is probably this appear- ance that led Kerr (1914) to suggest the name "canine diphtheria" for the disease. The mouth may present erosions and ulcers. Vomiting may occur, and either constipation or diarrhea may be present; consti- pation is more often a symptom of the onset, diarrhea of the later stages. When there is diarrhea the stools may be bloody, particu- larly in cases with fatal termination. The temperature may at times be considerably elevated. The disease appears to end in death in about 75 per cent of cases, running its course in these in some four to eight days. The American literature on the post-mortem findings is extremely meager. The following notes are of two necropsies made by us at Spartanburg, S. C, on August 11, 1921. The dogs were Chesapeake Bay retrievers, one a male, the other a female, both under 2 years of age. One had died 24 hours and the other 10 to 15 hours previously. In both animals the lingual and buccal mucosa was found markedly but unevenly congested, the congestion involving the mucosa of the lips and opposing gums. There was also some congestion of the mucosa of the larynx and epiglottis. The gastric mucosa showed a patch of moderate congestion in the region of the pylorus. In one of the dogs there was marked congestion of the mucosa of the large gut throughout its whole length, including the rectum; in the other no gross change in this part of the bowel was apparent. The contents of the gastro-intestinal tract was small in amount; in one it was seemingly of a mucous nature, in the other more water}^. In both it was yellow-tinged, probably from the medication administered just before death. This yellow tinting was also ob- served to affect the lingual mucosa and the buccal secretion. Examination of the lungs, heart, liver, spleen, and kidneys dis- closed no gross lesions. The disease has quite generally been regarded as infectious. This view seems to be based mainly on its occasional epizootic occurrence and in a measure on the observation that at times after the occur- rence of one case in a kennel a considerable number, perhaps all, of the other dogs are affected. More commonly, however, none of the other dogs is attacked, and one finds such observations as the follow- ing: "The disease seems to be infectious, and yet I have seen dogs drink and eat with the dogs affected with sore mouth and not con- tract the disease" (Heiny). "We have five or six dogs of our own 4 PELEAGRALIKE DISEASES IN DOGS. and always have from three to five cases of black tongue at the hos- pital, but have never had more than one case of it in our own dogs" (Browning) . The results of the recorded experimental attempts at transmission from sick to well dogs do not lend much support to the conception that the disease is an infection, for with one or two doubtful excep- tions, these attempts have frankly failed. Just as Chittenden and Underbill recognized the resemblance of their experimentally induced condition in dogs to pellagra, so there have been those who have been struck by the resemblance of the naturally occurring disease " black tongue " to the disease in man. The first, as far as we have been able to find, to call attention £o this is Spencer, of Concord, N. C. In a brief note he states that " after studying these two maladies, I am forced to the conclusion that the so-called black tongue is canine pellagra and have carried on a limited number of experiments to that end." Four years later, Cary (1920), of Auburn, Ala., recognizing the resemblance of black tongue to the experimental condition reported by Chittenden and Underbill, classed "black tongue" among defi- ciency diseases and referred to the similarity of the manifestations of "sore mouth" in dogs to those of pellagra in man. Of interest in this connection is the suggestion by Saunders (1920), of Waco, Tex., of some connection between " sore mouth of dogs " and pellagra. He writes as follows: "Some five years ago I bought a very fine dog in New Jersey and brought him to Texas. The second year in Texas he died with what the veterinarian pronounced 'sore mouth.' Now, a dog dying with sore mouth was as novel to me as was a man dying with pellagra. I noticed that my dog was losing hair from his front legs (paws). In commenting on the cause of my dog's death with my friends I find that it is a relatively common disease, and that there is a large strip of country east of town on a branch called the Tehuacana, where they can not have dogs, as they all die of the sore mouth. Now, this strip of county has furnished some 40 or 50 pellagrins to the near-by doctors for treatment. The ques- tion is, How much the dog plays in the etiology, or are they both, man and dog, infected from the same source, or is the sore mouth a different disease and is it a coincidence that they are found here side by side V At this juncture it may be remarked that black tongue seems to have a geographic distribution in the United States singularly like that of pellagra. Seemingly it occurs principally, if not exclusively, in the South. Seasonally it is reported to occur most frequently in summer and autumn and to affect cur dogs less than those of higher grade. There is some evidence that it may occur more than once in the same animal. PELLAGRALIKE DISEASES IjST DOGS. 5 The resemblance of black tongue to the experimental condition described by Chittenden and Underhill is so striking that it appears to us well-nigh certain that the two are identical; but before this identity can be accepted as definitely established, much additional work will have to be done. The possibility, if not the probability, that black tongue in dogs may prove to be the analogue of pellagra in man emphasizes the importance of such further investigations. In this the individual practitioner can take an important part by observing and recording the circumstances of the occurrence of this interesting condition in dogs and the efficacy of a strictly dietary treatment consisting of milk, eggs, and fresh meat. Bibliography. The following list includes all original articles on black tongue accessible to us. The Italian, literature was not available and is not included. Pains were taken to consult and include all possible American publications. These have heretofore been pretty generally ignored. Albrecht: Eine Hundeseuche in Munchen. Thierarztliche Wchnschrift., May 27, 1899, vol. 7, p. 189. Ben-Danon: Sur une affection gastro-intestinale adynamique et athermique chez le chien et chez le chat. Rev. Veterinaire, Toulouse, May 1900, vol. 57, p. 293. Bimes and Seres: Le typhus de chien (Pasteurellose canine de Lignieres). Rev. Veterinaire, Toulouse, Sept. 1, 1901, vol. 58, p. 569. Browning: Black tongue in dogs a dietetic disease. Am. Jour. Veterin. Med., Chicago, February 1917, vol. 13, p. 113. Cary: Deficiency diseases. Jour. Am. Veterin. Med. Assn., March 1920, vol. 66, pp. 609-614. Chittenden and Underhill: The production in dogs of a pathological condition which closely resembles human pellagra. Am. Jour. Physiol., Baltimore, Aug. 1, 1917, vol. 44, pp. 13-66. Dalrymple: "Foot evil" in horses and mules and "sore mouth" in dogs. Am. Veterin. Rev., New York, October 1911, vol. 40, pp. 56-62. Davis: Cure for black tongue — maybe. Am. Jour. Veterin. Med., Chicago, March 1912, p. 116. Farmer: Diphtheria antitoxin in black tongue. Am. Jour. Veterin. Med., Chicago, 1913, vol. 8, p. 332. Fisher: Black tongue in dogs an amebic dysentery. Am. Jour. Veterin. Med., Chicago, October 1918, vol. 13, p. 515. Gundelach: Gastro-enteritis hemorrhagica in verbindung mit stomatitis. Archiv. f. Theirheilkunde, Berlin, 1901, vol. 27, p. 308. Handley: Southern canine plague. North Am. Veterinarian, Evanston, August 1920, vol. 1, pp. 231-234. Heiny: Black tongue in Mississippi. Jour. Veter. Med., Chicago, October 1911, pp. 790-791. Hodges: Black tongue or southern canine plague. North Am. Veterinarian, Evanston, November 1921, vol. 2, pp. 556-557. Hoerning: Die Stuttgarter Hundeseuche. Inaug. Dissertation, Giessen, Munich, 1909. 6 PELLAGRALIKE DISEASES IN DOGS. Hofer: Der Typhus der Hunde. Repertorium der Thierheilkunde, Stuttgart, 1852, vol. 13, pp. 201-211. Hurlimann: Staupenepidemie am Langensee. Schweizer-Arch. f. Thierheilkunde, Zurich, 1896, vol. 38, pp. 120-122. Kerr: "Black tongue" or "typhus." Am. Jour. Yeterin. Med., Chicago, December 1914, vol. 9, p. 899. Klett: Stuttgarter Hundeseuche. Deutsche Thierarztliche Wchnschrift., Hannover, 1899, vol. 7, p. 41. Klett: The Stuttgart dog epizootic (contagious gastro-enteritis and ulcerative stomatitis in the dog). Jour. Compar. Pathol, and Therap., Edinburgh, 1899, vol. 13, pp. 36-50. Koonce:' Black tongue in dogs. Am. Jour. Yeterin. Med., December 1911, vol. 6, pp. 851-854. Lucet: Sur la presence de Spirochetes dans un cas de gastro-enterite hemorragique chez le chien. Bull, de la soc. Centr. de M6d. Veterinaire, Paris, 1910, vol. 64, p. 376. Mattel: Die Stuttgarter Hundeseuche. Oesterrechische Monatschrft. f. Thierheil- kunde, Wein, 1900, vol. 24, p. 491. Mouquet: Contribution a l'etude des suites de typhus "chien." Bull, de la Soc. Centrale de Med. Veterinaire, Paris, 1911, vol. 65, p. 134. Porter: Black tongue in dogs, etc. Am. Veterin. Rev., New York, December 1911, vol. 40, pp. 368-369. Quitman: Sodium cacodylate in the treatment of canine typhus. Am. Jour. Veterin. Med., Chicago, July 1917, vol. 12, p. 474. Rabus: Seuchenartige Erkrankung bei Hunden. Wchnschrft f. Thierheilkunde u. Viehzucht, Munich, June 6, 1899, p. 215. Richter: Hundeseuche. Berliner Thierarztliche Wchnschrft., Aug. 30, 1900, p. 413. Saunders: Pellagra and the "sore mouth of dogs." N. Y. Med. Rec, July 24, 1920, vol. 98, pp. 153-154. Scheibel: Eine Eigenartige im Herbst 1898 unter den Hunden Frankfurts beobachtete Krankheit. Berliner Thierarztliche, Wchnschrft., Feb. 16, 1899, p. 73. Spencer: Is "black tongue in dogs pellagra?" Am. Jour. Veterin. Med., Chicago, April 1916, vol. 11, p. 325. Tremmel: Die Stuttgarter Hundekrankheit in Wien? Thierarztliches Centralblatt, Wien, Oct. 1, 1900, vol. 23, p. 453. Zschokke: Die Hundeseuche; Gastritis haemorrhagica. Schweizer-Archiv. f. Thierheilkunde, Zurich, 1900, vol. 42, p. 241. o LIBRARY OF CONGRESS 002 864 760 8