Part 82

Chlorid of lime, U. S. P. strength (30 per cent available chlorin), 1 pound to 3 gallons of water.

Formaldehyde, 1 quart 40 per cent solution to 5 gallons of water.

A 3 per cent solution of cresol compound, U. S. P., or accepted substitute therefor, containing at least 50 per cent cresylic acid.

All stable utensils should be thoroughly cleaned and disinfected by the application of a solution of one of the above-named disinfectants. The manure should be burned or disinfected and spread over ground (other than meadow land) that is to be turned under. No other cattle should be purchased for at least sixty days after the complete disinfection of the premises.

The success in eradicating the disease by combined quarantine, slaughter, and disinfection, as practiced in the United States, Denmark, Great Britain, and a few other countries, demonstrates in a striking manner the efficacy of slaughtering and the futility of relying upon quarantine alone to stamp out the disease.

Inoculation has been adopted in some countries in order to have the disease spread quickly through the herds, and while this practice has undoubted value where the disease is indigenous, it is not desirable in this country and should not be adopted.

As a rule medicinal treatment with a view of curing affected animals is not to be recommended under conditions prevailing in the United States, where the disease has not become established, and the first object is to stamp it out as quickly as possible. Even though most animals would recover, with or without treatment, it would be practically impossible, while they were being held for recovery, to prevent the spread of the infection to others. The disease would be liable to spread faster than it could be cured. As already pointed out, it has been found impossible to prevent absolutely the spread of the contagion by the strictest quarantine alone, under the usual farm conditions. In addition, the affected animals that have passed through the disease may become a source of further infection as virus carriers for weeks and months after they have apparently recovered, and are susceptible of reinfection, as one attack does not confer permanent immunity.

Foot-and-mouth disease in man.--Foot-and-mouth disease is primarily and principally a disease of cattle; secondarily and casually, a disease of man. It is transmissible to man through the eating or drinking of raw milk, buttermilk, butter, cheese, and whey from animals suffering from foot-and-mouth disease. It is also transmitted directly, though more rarely, from the salivary secretions or other infected material which may gain entrance through the mucous membrane of the mouth. It is doubtful whether the disease can be transmitted to man by cutaneous or subcutaneous inoculation, though it is probable that the infection may be communicated if the virus directly enters the blood through wounds of any kind. Children are not infrequently infected by drinking unboiled milk during the periods in which the disease is prevalent in the neighborhood, while persons in charge of diseased animals may become infected through contact with the diseased parts or by milking, slaughtering, or caring for the animals.

The symptoms in man resemble those observed in animals. There is fever, sometimes vomiting, painful swallowing, heat and dryness of the mouth, followed by an eruption of vesicles on the mucous membrane of the mouth, and very rarely by similar ones on the fingers. The vesicles appear on the lips, gums, cheek, and edge of the tongue, and are about the size of a pea. The vesicles soon rupture, leaving a small erosion which is soon covered by a thin crust under which the new formation of epithelium proceeds rapidly. The skin eruption mostly appears on the hands, tips of the fingers, base of the nails, and more seldom on the toes and other parts of the body. Besides these local changes, during the course of the disease headache, pain in the limbs, vertigo, abdominal cramps, vomiting, diarrhea, and weakness are occasionally observed. The disease is seldom fatal, usually appearing in a very mild form except in weakened children, in whom an accompanying intestinal catarrh may lead to a fatal termination.

Veterinarians who have had considerable experience with the disease among animals regard the human affection as by no means uncommon in countries where foot-and-mouth disease prevails, but the disturbance of health is usually too slight to come to the notice of the family physician.

But few outbreaks of the disease in man have occurred in the United States, and therefore cases of its transmission to man in this country are rather rare. Dr. James Law reports having observed the disease in man from drinking infected milk during the epizootic of 1870 in the Eastern States, but the outbreaks of 1880 and 1884 affected such a small number of animals and were so quickly suppressed that no instance of its transmission to man was recorded. A few cases have been reported by Brush accompanying the New England outbreak of 1902. Similar reports have been likewise received concerning the appearance of vesicular eruptions in the mouths of children during the 1908 and 1914 outbreaks, and the history of these cases incriminates the milk supply.

Experiments by Loeffler and Froesch, as well as recent experiments which have been made in Denmark and Germany, indicate that the infection is comparatively easy to destroy by heat or the usual antiseptics. Milk pasteurized at a temperature of 60∞ C. for 20 minutes is safe so far as infection by foot-and-mouth disease is concerned.

SEPTICEMIA AND PYEMIA.

These two names are applied to diseased conditions which are so nearly alike in their symptoms that it is sometimes difficult to distinguish the one from the other. Indeed, the name pyosepticemia, or septicopyemia, is often applied when it is impossible to make a distinction between septicemia and pyemia or where each is equally responsible for the diseased condition. The name septicemia is derived from two Greek words meaning "poison" and "blood," and signifies that the germ lives in the blood, hence the use of the term "blood poisoning" for this disease. Pyemia is likewise derived from two Greek words, meaning "pus" and "blood," and is that form of septicemia caused by pus-producing organisms and characterized by secondary abscesses.

Causes.--Neither of these diseases is brought about, strictly speaking, by any specific organism; hence neither can be looked upon as a specific disease. The organisms most frequently found in cases of septicemia are, on the whole, the same as those of pyemia, and may be pus cocci, the bacillus coli, or other pus-producing organisms. These organisms are often found as secondary invaders in other diseases, such as advanced cases of tuberculosis, in which cases they are responsible for the formation of pus.

Aside from the causative organism, or, in other words, the active cause, there are many secondary causes. The most important of these in pyemia is a break in continuity of the protective covering, as a wound, which affords an entrance into the tissues for the organisms. Among the different varieties of wounds may be mentioned cuts, bruises, punctures, burns, chemical or frozen wounds, and compound fractures of bones. Injuries received during parturition, stoppage of the milk ducts, and infection of the umbilicus in the newly born are also frequent causes of pyemia. Septicemia usually follows surgical wounds, local suppuration, enteritis, bronchitis--in fact, wherever there is a local lesion of any kind permitting germs to enter the blood. Septicemia was formerly applied to designate the condition in which the organisms were localized, but in which their toxins were diffused in the blood. Pyemia was made to represent that condition when the organisms were localized, but in which the pus was transported by the blood. These terms now are applied to conditions in which both the organisms and their toxins, or the pus, are present in the blood. The term septicemia is indicated when intoxication is the more pronounced symptom and pyemia if pus formation and metastatic or secondary abscess formation are observed.

Symptoms.--The symptoms of both diseases include primarily a high fever (104∞ to 107∞ F.). Coupled with this there is disinclination to move, the animal is depressed and not cognizant of its surroundings. The pulse is rapid, small, and feeble, respiration increased, mucous membrane injected, swollen, and of a yellowish tinge. Appetite is lost and death follows in the case of septicemia in from two to four days. In pyemia the symptoms come on more slowly and are not so intense as in septicemia, while the course of the disease is longer, lasting from six days to four weeks. The mortality is not so great as in septicemia, but the period of convalescence is always long.

Lesions.--Septicemia is characterized by the destructive changes in the blood, which is chocolate colored, noncoagulable, and swarms with bacteria. The lining membranes of the heart are studded with red spots, often running together to form a large hemorrhagic area. The lungs, liver, and kidneys may also show these hemorrhages. The spleen is enlarged and full of black blood. The cadaver decomposes very rapidly and in some cases forms great quantities of fetid gas. In pyemia, in addition to these lesions, abscesses are formed in the various organs throughout the body. If the disease develops slowly a post-mortem examination shows the abscesses to be the chief alterations. The pus content is usually greenish, stained with blood, and contains strings of fibrous tissue and necrosed matter.

Treatment.--Treatment is almost futile in advanced cases of either disease. Septicemia is usually fatal and pyemia frequently so. Prevention and the immediate treatment of local infections are the surest means of combating them. For local treatment of wounds the usual antiseptics are indicated, such as 3 per cent compound cresol or carbolic acid, or one one-thousandth bichlorid-of-mercury solution. For pyemia, where the abscesses are near the skin, they should be opened and treated antiseptically by injecting any of the previously mentioned germicides. General and heart stimulants are indicated, such as a drench containing digitalis 2 drams and alcohol 2 ounces. Quinin and calomel in repeated small doses of one-half dram each three times a day are sometimes beneficial. Camphor in the form of oil of camphor (camphor dissolved in 10 parts of sweet oil) is a good stimulant and has some antiseptic properties, which make it a valuable drug in combating these diseases when it is given in doses of 2 drams three times daily.

HEMORRHAGIC SEPTICEMIA.

Hemorrhagic septicemia is a name applied to a highly fatal, infectious disease existing in various species of domestic and wild animals, from a microorganism having definite biological characters and possessing the properties of producing clearly defined and characteristic lesions.

This causal agent, Bacterium bovisepticum, belongs to the same group of cocco-bacilli as those causing chicken cholera, swine plague, and rabbit septicemia, and may be described as an ovoid, nonmotile, polar-staining bacterium with rounded ends, 1/38000 of an inch wide by 1/20000 of an inch long, sometimes seen in pairs and sometimes in chains.

Various names have been applied to this disease, and though the causative agent and the distinctive lesions are well known, it is more than likely that the affection is seldom recognized. It was described by Bollinger in 1878, and named Wild und Rinderseuche, from its having affected deer, wild boars, cattle, and horses in an epizootic which swept over Germany at that time. Before this, however, several epizootics of what was evidently the same disease had been well described, notably that which occurred in England in 1854. Since then it has occurred in epizootic and enzootic forms in many sections of Europe, Asia, Africa, and America. In this country the disease has been observed in Texas, Tennessee, New York, Minnesota, Pennsylvania, District of Columbia, South Dakota, and Wisconsin. Other names given to it are game and cattle disease, buffalo disease, barbone, pasteurellosis bovina, ghotwa, and infectious pneumoenteritis.

In earlier times it was evidently confounded with gloss anthrax, and even now it is probably mistaken in a great many instances for anthrax, blackleg, cornstalk disease, and cerebrospinal meningitis.

The disease is essentially a septicemia, or blood poisoning, and the microbic invasion occurs from inoculation probably either through abrasions of the skin or by injury to the mucous membranes from coarse fodder, etc. Moore and Smith have found in the mouths and nasal cavities of healthy animals, including cattle, bacteria belonging to this group; but these organisms proved to be nonpathogenic. As is well known, however, many pathogenic germs at times exist in a saprophytic state, and it is not hard to conceive how a microbe may cease such existence and assume parasitic or pathogenic properties when the surroundings are eminently favorable. This may be a connecting link in the etiology of sporadic outbreaks of the disease in which all other hypotheses as to its genesis seem untenable. The disease seems to occur most frequently in swampy or mucky localities or in pastures receiving the overflow from infected fields. It is said to occur usually in the spring of the year, when the melting snows and rains bring to the surface the subterranean waters from rich soils containing nitrogenous materials in which the bacteria have been existing. In a great many instances there does not seem to be any plausible explanation for an outbreak of the disease and one can only surmise as to its origin.

Symptoms.--Three forms of the disease are recognized, based upon the distribution of the lesions--the superficial, or cutaneous, the pectoral, or thoracic, and the intestinal form. The last is a usual accompaniment of the other two and may be mild or severe. Naturally the symptoms vary according to the violence of the attack and to the particular form of disease with which the animal is affected. In the superficial, or cutaneous, form the presence of a swollen tongue, throat, and dewlap, or even of the lower portion of the legs, gives us a clew to the trouble. An entire loss of appetite occurs, and in milk cows there is a diminution of the milk secretion. The temperature may be only slightly elevated, but it is usually very high. Salivation is set up by the inflammation of the mouth and pharynx. Unsuccessful efforts at eating and swallowing are made. There may be difficulty in breathing, depending on the amount of involvement of the larynx, trachea, bronchi, or lungs. There may be a blood-stained discharge from the nostrils, and the mucous membrane thereof will often show punctiform hemorrhages. The pulmonary form shows the same symptoms as croupous pneumonia, with a frequent suffocative cough and oppressed breathing, or dyspnea. When the intestines are involved the patient strains to defecate, and passes shreds of intestinal mucus along with blood-stained feces. The urine also may be tinged with blood. Finally a severe diarrhea takes place, the animal becomes correspondingly weak, and death takes place in 24 to 36 hours. Cases may die in as short a period as six to eight hours, while in the pectoral form of the disease the animal may linger six or eight days. Cases have been reported which became chronic and in which death did not take place for a month or more. In some of the cases running an acute course, symptoms of toxemia are present; there is a lack of sensation of the skin, staggering gait, trembling, eyes fixed, neck at times bent to one side, and the eyes showing a wild expression. At times the animals appear as if in pain and look around at the flanks. In the pectoral form they may stand with the forelegs wide apart in evident effort to breathe more freely. Sometimes there is a champing of the jaws and a very free flow of glairy saliva dropping from the mouth.

The prognosis is decidedly unfavorable and 80 to 90 per cent of the cases result fatally.

Lesions.--The characteristic lesions of hemorrhagic septicemia consist of hemorrhagic areas in the subcutaneous, subserous, and muscular tissues, the lymph glands, and the viscera; in fact, they are distributed more or less widely throughout the body and vary in size from a mere speck to the diameter of a half dollar or even larger. The superficial form presents itself first as a doughy tumefaction of the skin about the region of the throat, neck, dewlap, or legs, which pits on pressure. This tumefaction consists essentially of a cerogelatinous exudate into the subcutaneous and intermuscular tissues.