Part 85

There are undoubtedly predisposing conditions which contribute toward the development of the disease; some of these are found in the animal body and others in the environment. An enfeebled condition caused by insufficient feed, exposure to great extremes of atmospheric temperature and insanitary surroundings, or the drain occasioned by heavy production of milk, appear to aid the development of the bacillus, and there is also a special individual susceptibility in some cases which may be otherwise described as an inability of the animal tissues to resist and destroy the bacilli when they have penetrated to the inner recesses of the body.

Among the conditions of environment which aid the development of tuberculosis may be mentioned stabling with lack of ventilation, damp buildings, the keeping of many animals together, drafts of air which cause colds and catarrhs, and, in general, everything which prevents the animals from developing and maintaining the highest condition of health. None of these conditions of body or environment are sufficient to cause the disease, however, unless the animals are exposed to the Mycobacterium tuberculosis and it penetrates the tissues of their bodies.

The ways in which the tubercle bacilli find their way into the body may be considered under four heads: (1) By inhalation into the lungs; (2) by taking into the digestive tract in the milk of tuberculous cows or with other contaminated feed; (3) during coition when the sexual organs are tuberculous; (4) from the tuberculous mother to the fetus in the uterus. The bacilli can reach the lungs by inhalation only when the bacilli are thoroughly dried and pulverized and in condition to be carried by currents of air.

It is well known that the bacilli withstand drying for months before they lose their power of producing disease. They leave the bodies of diseased animals in several ways. There may be a little discharge occasionally coughed up as a spray from the diseased lungs, or this material may be swallowed and the bacilli carried off with the excrement, or milk may be spilt, or there may be a discharge from the vagina when the genital organs are tuberculous. There may also be ulcers of the intestines, from which many bacilli escape with the feces. The bacilli from these sources may become dried and pulverized and carried in the air of the stable and into the lungs of still healthy cattle, where the disease then develops.

The disease of the stomach, intestines, and mesenteric glands is very probably the result of feed infection. Tubercle bacilli may have been scattered upon the feed by diseased animals, but the most common source of such infection is the milk of tuberculous cows. Calves may become infected in this way. The disease may remain latent until the animal becomes older. The not-infrequent occurrence of tuberculosis of the uterus and ovaries makes it probable that the disease may be transmitted by a diseased bull or carried by a healthy one from a diseased cow to a number of healthy cows.

The source of infection is always some previous case of the disease, for the disease can never rise spontaneously; hence, in those stables in which there is frequent change of cattle the introduction of tuberculosis by cattle coming from other infected stables is the most frequent source of infection. Since the bacilli when dried can be carried by the air, it is not necessary that healthy animals come in direct contact with cases of disease to become infected. In general, the greatest number of cases occur in the immediate environment of cities, where there are not only abundant opportunities for infection, owing to the frequent introduction of new animals into herds, but where the sanitary conditions may be regarded as the poorest.

The bacillus of tuberculosis was discovered by Robert Koch in 1882. It is a slender, rodlike body (see Pl. XXVIII, fig. 6) from one-third to two-thirds the diameter of a red blood corpuscle in length. As already explained, when the bacillus has become lodged in any organ or tissue it begins to multiply, and thereby causes an irritation in the tissue around it, which leads to the formation of the so-called tubercle. The tubercle, when it has reached its full growth, is a little nodule about the size of a millet seed. It is composed of several kinds of tissue cells. Soon a change takes place within the tubercle. Disintegration begins, and a soft, cheesy substance is formed in the center, which may contain particles of lime salts. When these tubercles continue to form in large numbers they run together, forming masses of various sizes. The disintegration which attacks them leads to the formation of large cheesy masses of a yellowish color, containing more or less of lime salts in the form of gritty particles. These large tuberculous masses are surrounded by or embedded in layers of fibrous tissue which in some cases becomes very dense and thick.

The disease is thus a development of these tubercles in one or more organs of the body. The distribution and number of the tubercles determine the course of the disease.

In a large number of cases the changes are limited to the lungs and the serous membranes of the thorax and abdomen. Pathologists have been in the habit of calling the lung disease tuberculosis and the disease of the serous membranes "pearly disease." Statistics have shown that in about one-half of the cases both lungs and serous membranes are diseased, in one-third only the lungs, and in one-fifth only the serous membranes. At the same time the lymphatic glands near the diseased organs are usually involved. Other organs, such as the liver, not infrequently contain tubercles. Though the disease may remain restricted to a single organ, it now and then is found generalized, affecting all organs of the body.

In the lungs (Pl. XXXIV) the changes observed vary according to the age and intensity of the disease process. They usually begin with the appearance of very minute tubercles. These may appear in large numbers on the surface of the lungs or within the lung tissue. Later the contents become cheesy and partly calcified. When these tubercles are sufficiently numerous to become confluent, large masses may be formed, which undergo the same retrogressive changes of caseation and calcification. In addition to the formation of tubercles in the lung tissue, certain other changes take place. There is usually bronchitis with abundant catarrhal secretion; this plugs up the smaller air tubes, and the lung tissue supplied with air by the tubes collapses. Subsequently it becomes filled with yellowish, cheesy matter, which greatly distends the small air tubes and air vesicles (bronchopneumonia). The connective tissue between the lung lobules, around the tubercles, and around the air tubes becomes thickened and indurated. In the larynx and the bronchi tubercles may vegetate upon the mucous membrane, and ulcers may result from their breaking down. The inflammatory irritation which the growth of the tubercles on the surface of the lungs arouses gives rise to adhesion of the lungs to the ribs and diaphragm. This adhesion is sometimes so firm and extensive that the lungs appear grown to the chest wall.

When, therefore, the lungs in advanced stages of the disease are cut open we observe large yellowish masses, from one-quarter to three-quarters of an inch in diameter, of a cheesy texture, in which calcified, gritty particles are embedded and which are surrounded by very firm connective tissue. The neighboring lung tissue, when collapsed and involved in bronchopneumonia, has the color and consistency of pale-red flesh. The air tubes, large and small, stand out prominently on the cut surface. They are distended with a pasty, yellowish, cheesy mass, surrounded and enveloped in thick mucus, and their walls greatly thickened. The larger bronchi may be sacculated, owing to the distention produced by the cheesy contents.

The disease usually attacks the bronchial glands, which are situated on the trachea and bronchial tubes at the bifurcation. The changes in the glands are the same as those going on in the lung tissue, and they frequently reach an enormous size.

The tubercle formation on the serous membranes covering the lungs and chest wall (Pl. XXXVII, fig. 2), which may go on at the same time with the lung disease or independent of it, has been called "pearly disease," on account of the peculiar appearance of the tubercles. These begin as very minute, grayish nodules, which give the originally smooth, lustrous membrane a roughened appearance. These minute tubercles enlarge, become confluent, and project above the surface of the membrane as wartlike masses, attaining the size of peas. In this stage their attachment to the membrane is by means of delicate fibers. The attachment is loose, so that the tubercle hangs by a short pedicle or neck and may be moved slightly to and fro. Large masses are frequently formed by a coalescence of many tubercles and the secondary formation of the same. These may be found on the lungs, the ribs, and the diaphragm. These tubercles likewise undergo degenerative changes. The center partly softens and partly calcifies into a grayish mortarlike mass, and is gritty. Associated with the formation of tubercles on the pleura, those glands situated back of the center of the lungs between the two main lobes (posterior mediastinal) become greatly enlarged and the center cheesy. (Pl. XXXVI, fig. 1.) They may compress the esophagus and interfere with swallowing. The size attained by these tumors and new growths is well illustrated by the fact that, taken together, they not infrequently weigh from 60 to 80 pounds. The bronchial glands, which in the healthy state are not so large as horse-chestnuts, have been found to attain a weight of more than 10 pounds.

In the abdominal cavity tubercles may be found, both in the organs and on the serous membranes covering them. They are situated usually on the omentum, or caul (see Pl. XXXVI, fig. 2), the diaphragm, and the walls of the abdomen. In the liver large and small tubercular masses are occasionally encountered. (See Pl. XXXV.) The mesenteric glands are occasionally enlarged and tuberculous; likewise the glands near the liver. Tubercles may also develop in the spleen, the kidneys, the uterus and ovaries, and the testicles.

Tubercular affection of the intestines seems to be quite rare, although ulcers of the large intestines have been observed. Nodules may also form under the serous covering of the intestines.

The brain and spinal cord are occasionally found tuberculous. Of 40 cases, Semmer found tuberculosis of the brain in 4. It is not improbable that, owing to the infrequency of exposing the brain and spinal cord, tuberculosis may have escaped the attention of pathologists, and it may be that it is not so uncommon as is generally supposed. The tubercles occur on the membranes of the brain as well as in the substance of the brain itself. They project into the ventricles as masses, varying in size from a pinhead to a hen's egg. They finally lead to various inflammatory changes. Jˆhne has observed numerous small tubercles on the membranes of the spinal cord.

Very rarely tuberculous lesions have been observed in the bones and muscles of the body. Not so rare, however, is the affection of the lymphatic glands embedded in the muscular tissue, and those which can be felt beneath the skin. These are situated at the joints, under the jaw, and along the neck.

Of late tubercular disease of the udder in cows (Pl. XXXVIII) has received considerable attention from sanitarians, owing to the infection of the milk with the virus of tuberculosis. According to those who have given this subject special attention, the udder becomes swollen uniformly and quite firm. This swelling, which is painless, frequently attacks but one quarter, more rarely two, these being usually the hind quarters. The larger milk ducts contain yellowish, cheesy particles, in which are many tubercle bacilli. Later larger nodules can be felt within the udder, which undergo the various changes to which tubercles are subject. The udder may grow very hard to the touch and become very large, weighing in some cases up to 40 pounds. The milk, at first normal, becomes thin and watery after a month or so, and is mixed with flakes and tubercle bacilli.

As regards the frequency of the tuberculous processes in the different organs, the following carefully compiled statistics of the disease in Bavaria and Baden may serve as a guide:

Bavaria: Per cent. Tuberculosis of lungs and serous membranes 41 Tuberculosis of lungs alone 33 Tuberculosis of serous membranes alone (pearly disease) 17 Tuberculosis of other organs 8

Baden: Tuberculosis of lungs alone 21 Tuberculosis of serous membranes alone 28 Both combined 39 Generalized tuberculosis 9 Tuberculosis of the sexual organs alone 3

Symptoms.--The beginning of the disease usually passes unnoticed, inasmuch as it is very slow and insidious and rarely accompanied with fever. When the lungs are involved a dull, short cough is noticed, which may later on become prolonged, convulsive, and very troublesome to the animal. The cough is more frequent in the morning after movement and drinking. The breathing varies. Only when much of the lung tissue is diseased is it labored and accompanied with active movements of the chest and nostrils. Discharge from the nose is rare or absent. At times, however, when the tubercles have broken down and cavities containing cheesy masses have formed in the lung tissue, or when the air tubes have become filled with cheesy and mucous masses, coughing will dislodge them and cause their discharge. In advanced stages the breath may have a disagreeable odor. Pressure on the chest wall may give rise to pain.

The general effect on the body is at first slight. In fact, animals may remain in good flesh for a considerable time. Invariably as the disease progresses loss of flesh and appetite and paleness of the mucous membranes become manifest. These symptoms are accompanied with a gradual diminution of the milk secretion. The debilitated condition of the animal is also manifested by a staring coat and a tough, dry, harsh skin (hidebound). Digestive disturbances are indicated by tympanites, or distention of the rumen by gas, colic, and diarrhea, alternating with constipation. The animal generally dies from exhaustion after a period of sickness which may last months or even years.

* * * * *

TUBERCULOSIS. DESCRIPTION OF PLATES.

PLATE XXXIV. Tuberculosis of the lungs of cattle. The upper figure represents a large cheesy mass, surrounded by a capsule of connective tissue, the whole embedded in healthy lung tissue. The lower figure illustrates in section a mass of tubercles which have undergone cheesy degeneration, and some of which are surrounded by dense connective tissue.

PLATE XXXV. Tuberculosis of the liver. A large portion of the lobe represented in the plate has undergone tuberculous changes. Numerous nodules are shown in various stages of the disease, the majority of which, however, contain the yellowish, partly cheesy, partly gritty areas characteristic of advanced tuberculous degeneration. This large mass involves the surface of the liver, and also extends into the liver substance.

PLATE XXXVI. Tuberculosis of lymph gland and of omentum (caul).