Part 91

The invasion of the bones of the jaws by actinomycosis must be regarded as one of the most serious forms of the disease. (Pls. XXXIX, XL.) It may start in the marrow of the bone and by a slow extension gradually undermine the entire thickness of the bone itself. The growth may continue outward, and after working its way through muscle and skin finally break through and appear externally as stinking fungoid growths. The growth may at the same time work its way inward and appear in the mouth. The disease may also begin in the periosteum, or covering of the bone, and destroy the bone from without inward.

Actinomycosis of the lungs is occasionally observed, and it is not improbable that at times it has been mistaken for tuberculosis. The actinomyces grains are, however, easily observed if the diseased tissue is carefully examined. The changes in the lungs as they appear to the naked eye vary considerably from case to case. Thus in one animal the lungs were affected as in ordinary bronchopneumonia as to the location, extent, and appearance of the disease process. The affected lobes had a dark-red flesh appearance, with yellowish areas sprinkled in here and there. (See Pl. XLI, figs. 1, 2.) These latter areas were the seat of multiplication of the actinomyces fungus. In another case, of which only a small portion of the lungs was sent to the laboratory, they were completely transformed into a uniformly grayish mass, very soft and pulpy to the touch, and appearing like very soft and moist dough. (Pl. XLI, fig. 3.) The actinomyces grains were exceedingly abundant in this tissue, and appeared when the tissue was incised as minute sulphur-yellow grains, densely sprinkled through the tissue, which readily came away and adhered to the knife blade. In still another case a portion of the lung tissue was converted into large, soft masses from 1 to 3 inches in diameter, each partly inclosed in very dense connective tissue. These soft, grayish-yellow masses likewise resembled moist dough in their consistency, and the actinomyces grains, though neither very distinct nor at all abundant, were easily fished out and identified as such. A portion of this growth, which was as large as a child's head, was converted into an abscess filled with creamy semiliquid pus.

This case differed from the preceding in that all appearance of lung tissue had disappeared from the diseased mass. Only on the exterior the lung tissue could be recognized, although even there it had been largely converted into very dense, whitish connective tissue inclosing the fungoid growth. In the other case the external form of the lung and the shape and outline of the lobules were preserved, but the lung tissue itself was not recognizable as such. In the case first mentioned the changes were still less marked, and actinomycosis would not have been suspected by a simple inspection. These few illustrations suffice to show that actinomycosis of the lungs may appear under quite different forms, and that the nature of the disease can be accurately determined only by finding the fungus itself. Rarely actinomycosis attacks the body externally in places other than the head and neck. Crookshank describes the case of a bull in which the flank was attacked and subsequently the scrotum became diseased. A large portion of the skin of the flank was destroyed and covered with a leathery crust. When this was pulled away the pus beneath it showed the actinomyces grains to the naked eye.

Actinomycosis may also involve the udder, the spermatic cord of castrated animals, the vagina, and, when it becomes generalized, the brain, liver, spleen, and muscular tissue.

Actinomycosis may in some cases be confounded with tuberculosis. The diagnosis does not offer any difficulties, since the presence of the actinomyces fungus at once removes any existing doubts. As has already been intimated, these grains, simulating sulphur balls, are visible to the naked eye, and their nature is readily determined with the aid of a microscope.

The course of the disease is quite slow. As the tumors grow they may interfere with the natural functions of the body. According to their situation, mastication, rumination, or breathing may be interfered with, and in this way the animal may become emaciated. Actinomycosis of the jawbones leads to destruction of the teeth and impedes the movements necessary to chewing the feed. Similarly, when the disease attacks the soft parts of the head obstructions may arise in the mouth by an inward growth of the tumor. If tumors exist in the pharynx they may partially obstruct the movements necessary to breathing, or close the air passages and cause partial suffocation. Actinomycosis of the tongue, in interfering with the many and varied movements of this important organ, is also a serious matter. There is no reason to suppose that the localized disease interferes with the general health in any other way than indirectly until internal organs, such as the lungs, become involved.

A very small proportion of the cases may recover spontaneously, the tumors being encysted or undergoing calcification. In most cases the disease yields readily to proper treatment, and about 75 per cent of the affected animals may be cured.

Prevention.--The question as to how and where animals take this disease is one concerning which we are still in the stage of conjecture, because so far we possess very little information concerning the life history of the actinomyces itself. The quite unanimous view of all observers is that animals become infected from the feed. The fungus is lodged upon the plants and in some way enters the tissues of the head, the lungs, and the digestive tract, where it sets up its peculiar activity. It is likewise generally believed that the fungus is, as it were, inoculated into the affected part. This inoculation is performed by the sharp and pointed parts of plants which penetrate the mucous membrane and carry the fungus with them. The disease is therefore inoculable rather than contagious. The mere presence of the diseased animal will not give rise to disease in healthy animals unless the actinomyces grains pass directly from the diseased into some wound or abrasion of the healthy or else drop upon the feed which is consumed by the healthy. Not only are these views deducible from clinical observation, but they have been proved by the positive inoculation of calves and smaller animals with actinomyces. The danger therefore of the presence of actinomyces for healthy animals is a limited one. Nevertheless an animal affected with this disease should not be allowed to go at large or run with other animals. If the fungus is being scattered by discharging growths we certainly can not state at this stage of our knowledge that other animals may not be infected by such distribution, and we must assume, until more positive information is at hand, that this actually occurs.

It is, however, the opinion of the majority of authorities that when actinomycosis appears among a large number of animals they all contract it in the same way from the feed. Much speculation has therefore arisen whether any particular plant or group of plants is the source of the infection and whether any special condition of the soil favors it. Very little positive information is at hand on these questions. It would be very desirable for those who live in localities where this disease is prevalent to make statistical and other observations on the occurrence of the disease with reference to the season of the year, the kind of feed, the nature of the soil (whether swampy or dry, recently reclaimed, or cultivated for a long time) upon which the animals are pastured or upon which the feed is grown.

It is highly probable that such investigations will lead to an understanding of the source of the fungus and the means for checking the spread of the disease itself. Veterinarian Jensen, of Denmark, made some observations upon an extensive outbreak of actinomycosis a number of years ago which led him to infer that the animals were inoculated by eating barley straw harvested from pieces of ground just reclaimed from the sea. While the animals remained unaffected so long as they pastured on this ground or ate the hay obtained from it, they became diseased after eating the straw of cereals from the same territory. Others have found that cattle grazing upon low pastures along the banks of streams and subject to inundations are more prone to the disease. It has also been observed that feed gathered from such grounds, even after prolonged drying, may give rise to the disease. Actinomycosis is not infrequent in cattle in the Southwest and is generally supposed to be the result of eating the prickly fruit of the cactus plant, causing wounds of the mucous membrane and subsequent infection with the parasite. Much additional information of a similar kind must be forthcoming before the source and manner of infection in this disease and its dependence upon external conditions will be known. It is not at all improbable that they may vary considerably from place to place.

Treatment.--Until recently this has been almost entirely surgical. When the tumors are external and attached to soft parts only, an early removal may lead to recovery. This, of course, can be undertaken only by a trained veterinarian, especially as the various parts of the head and neck contain important vessels, nerves, and ducts which should be injured as little as possible in any operation. Unless the tumor is completely removed it will reappear. Disease of the jawbones is at best a very serious matter and treatment is liable to be of no avail.

In March, 1892, an important contribution to our knowledge of this subject was made by Nocard, of the Alfort Veterinary School, in a communication to the French Central Society of Veterinary Medicine. He showed clearly that the actinomycosis of the tongue, a disease which appears to be quite common in Germany, and is there known as "wooden tongue," could be quickly and permanently cured by the administration of iodid of potassium. Nocard calls attention to the success of Thomassen, of Utrecht, who recommended this treatment so long ago as 1885, and who has since treated more than 80 cases, all of which have been cured. A French veterinarian, Godbille, has used the same remedy in a number of cases of actinomycosis in the tongue, all of which have been cured. Nocard also gives details of a case which was cured by himself.

All the cases referred to were of actinomycosis of the tongue, and no one appears to have attempted the cure of actinomycosis of the jaw until it was undertaken by Nˆrgaard, of the Bureau of Animal Industry. In April, 1892, he selected a young steer in fair condition which had a tumor on the jaw measuring 15-1/2 inches in circumference and from which a discharge had already been established. This animal was treated with iodid of potassium, and the result was a complete cure.

The iodid of potassium is given in doses of 1-1/2 and 2-1/2 drams once a day, dissolved in water, and administered as a drench. The dose should vary somewhat with the size of the animal and with the effects that are produced. If the dose is sufficiently large signs of iodism appear in the course of a week or 10 days. The skin becomes scurfy, there is weeping from the eyes, catarrh of the nose, and loss of appetite. When these symptoms appear the medicine may be suspended for a few days and afterward resumed in the same dose. The cure requires from three to six weeks' treatment. Some animals, generally the ones which show no signs of iodism, do not improve under treatment with iodid of potassium.

If there is no sign of improvement after the animals have been treated four or five weeks, and the medicine has been given in as large doses as appear desirable, it is an indication that the particular animal is not susceptible to the curative effects of the drug, and the treatment may therefore be abandoned.

It is not, however, advisable to administer iodid of potassium to milch cows, as it will considerably reduce the milk secretion or stop it altogether. Furthermore, a great part of the drug is excreted through the milk, making the milk unfit for use. It should not be given to animals in advanced pregnancy, as there is danger of producing abortion.

The best results are obtained by pushing the drug until its effect is seen. The many tests to which this treatment has been subjected have proved, with few exceptions, its specific curative value. In addition to this the tumor should be painted externally with either the tincture of iodin or Lugol's solution, or the drug should be injected subcutaneously into the tumor.

Godbille has given as much as 4 drams of potassium iodid in one day to a steer, decreasing the dose one-fourth dram each day until the dose was 1-1/4 drams, which was maintained until the twelfth day of treatment, when the animal appeared to be entirely cured.

Nocard gave the first day 1-1/2 drams in one dose to a cow; the second and succeeding days a dose of 1 dram in the morning and evening, in each case before feeding. This treatment was continued for 10 days, when the animal was cured.

Actinomycosis and the public health.--The interest which is shown concerning this cattle disease is largely due to the fact that the same disease attacks human beings. Its slow progress, its tendency to remain restricted to certain localities, and the absence of any directly contagious properties have thus far not aroused any anxiety in other countries as to its influence on the cattle industry, not even to the point of placing it among the infectious diseases of which statistics are annually published. Its possible bearing on public health has, however, given the disease a place in the public mind which it hardly deserves.

It has already been stated that the actinomyces fungus found in human disease is considered by authorities the same as that occurring in bovine affections. It is therefore of interest to conclude this article with a brief discussion of the disease in man and its relation to actinomycosis in cattle.

In man the location of the disease process corresponds fairly well to that in cattle. The majority of cases which have been reported in different parts of the world--and they are now rather numerous--indicate disease of the face. The skin, tongue, or the jawbones may become affected, and by a very slow process it may extend downward upon the neck and even into the cavity of the chest. In many cases the teeth have been found in a state of more or less advanced decay and ulceration. In a few cases disease of the lungs was observed without coexisting disease of the bones or soft parts of the head. In such cases the fungus must have been inhaled. The disease of the lungs after a time extends upon the chest wall, where it may corrode the ribs and work its way through the muscles and the skin. An abscess is thus formed discharging pus containing actinomyces grains. Disease of the digestive organs caused by this fungus has also been observed in a few instances.

Granting the identity of the disease in man and cattle, the question has been raised whether cattle are responsible for its occurrence in man. Any transmission of the infectious agent may be conceived of as taking place during the life of the animal and from the meat after slaughter. That human beings have contracted actinomycosis by coming in contact with diseased cattle is not shown by the cases that have been reported, for the occupations of most of the patients did not bring them into any relation whatever with cattle. While the possibility of such direct transmission is not denied, nevertheless it must be considered as extremely remote. Practically the same position is maintained at present by most authorities as regards the transmission of the disease to man by eating meat. Israel, who has studied this question carefully, found the disease in Jews who never ate pork, and who likewise were protected from bovine actinomycosis by the rigorous meat inspection practiced by that race. Furthermore, it must be borne in mind that actinomycosis is a local disease, causing great destruction of tissue where the fungus multiplies, but which very rarely becomes generally disseminated over the body from the original disease focus. The fungus is found only in places where the disease process is manifest to the eye or becomes so in a very short time after the lodgment of the fungus. Only the greatest negligence would allow the actually diseased parts to be sold and consumed. Finally, this parasite, like all others, would be destroyed in the process of cooking. Most authorities thus do not believe that actinomycosis in man is directly traceable to the disease in animals, but are of the opinion that both man and animals are infected from a third source, which has already been discussed above. How far these views may be modified by further and more telling investigations of the parasite fungus itself no one can predict. There are still wide gaps in our knowledge, and the presentation above simply summarizes the prevailing views, from which there are dissenters, of course. An attempt to give the views of both sides on this question would necessitate the summarizing and impartial discussion of all the experiments thus far made--a task entirely beyond the scope of the present work.

Whether an animal affected with actinomycosis should be used for human food after all diseased organs and tissues have been thoroughly removed is a question the answer to which depends on a variety of circumstances. Among these may be mentioned the thoroughness of the meat inspection itself, the extent of the disease, and the general condition of the animal affected.

The Federal meat-inspection regulations require that carcasses of animals showing generalized actinomycosis shall be condemned. If carcasses are in a well-nourished condition, showing uncomplicated localized lesions of actinomycosis, they may be passed after the infected organs or parts have been removed and condemned. When the disease of the jaw is slight, strictly localized, and without pus formation, fistulous tracts, or lymph-gland involvement, the tongue, if free from disease, may be passed. The heads affected with actinomycosis (lumpy jaw), including the tongue, shall be condemned, except that when the lesions in the jaw are strictly localized and slight in extent, the tongue may be passed, if free from disease.

ANTHRAX.

Anthrax or charbon may be defined as an infectious disease which is caused by specific bacteria, known as anthrax bacilli, and which is more or less restricted by conditions of soil and moisture to definite geographical localities. While it is chiefly limited to cattle and sheep, it may be transmitted to goats, horses, cats, and certain kinds of game. Smaller animals, such as mice, rabbits, and guinea pigs, speedily succumb to inoculation. Dogs and hogs are slightly susceptible, while fowls are practically immune. The variety of domesticated animals which it may attack renders it one of the most dreaded scourges of animal life. It may even attack man. Of this more will be stated further on.

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