Part 94

VACCINATION.

In recent years vaccination for the prevention of certain infectious diseases has been successfully developed, and without a doubt the future has a great deal in store for this phase of prevention. At the present time vaccination has been found effective against blackleg, hog cholera, anthrax, lockjaw, strangles, rabies, hemorrhagic septicemia, white scours, etc. It is always essential, of course, that the products used for the vaccination be pure and potent; also they should be employed only with the advice of competent authorities and with proper care. The biological products prepared for the cure and prevention of infections are prepared by manufacturers who, in order to conduct an interstate business, are required to obtain a license from the United States Department of Agriculture for the manufacture of such preparations.

Since July 1, 1913, the Department of Agriculture, by an act of Congress of March 4, 1913, has had control of the manufacture of biological products for the treatment of domestic animals. The numerous complaints which were received from time to time relative to the impotency of some of the preparations, and also the fact that in some instances the use of the products were directly responsible in causing outbreaks of disease, made the necessity for such control obvious. This supervision is no doubt of far-reaching importance, as it assures the users that the preparations are reliable.

INFLUENZA.

Synonyms.--Pinkeye, typhoid fever, epizooty, epihippic fever, hepatic fever, bilious fever, etc.; flevre typhoide, grippe (French); Pferdestaupe (German); gastro-enteritis of Vatel and d'Arboval; febris erysipelatodes, Zundel; typhus of Delafond.

Definition.--The term influenza is applied to a febrile, contagious, infectious disease of horses, which is characterized by a blood infection, with inflammation of the mucous membranes, which frequently involves the lungs. Inflammatory complications also occur in the form of swellings of the subcutis, tendons, and tendinous sheaths and laminae of the feet. The causative agent has not been satisfactorily established. One attack usually protects the animal from future ones of the same disease, but not always. An apparently complete recovery is sometimes followed by serious sequelae of the nervous and blood-vessel systems. Under certain conditions of the atmosphere or from unknown causes, the disease is very liable to assume an epizootic form, with tendency to complications of especial organs, as, at one period, the lungs, at another the intestines, etc.

The first description of influenza is given by Laurentius Rusius in 1301, when it spread over a considerable portion of Italy, causing great loss among the war horses of Rome and the surrounding district. Later, in 1648, an epizootic of this disease visited Germany and spread to other parts of Europe. In 1711, under the name of "epidemica equorum," it followed the tracks of the great armies all over Europe, causing immense losses among the horses, while rinderpest was scourging the cattle of the same regions. The two diseases were confounded with each other, and were, by the scientists of the day, supposed to be allied to the typhus, which was a plague to the human race at the same time. We find the first advent of this disease to the British Islands in an epizootic among the horses of London and the southern counties of England in 1732, which is described by Gibson. In 1758 Robert Whytt recounts the devastation of the horses of the north of Scotland from the same trouble. Throughout the eighteenth century a number of epizootics occurred in Hanover and other portions of Germany and in France, which were renewed early in the present century, with complications of the intestinal tract, which obtained for it its name of gastro-enteritis. In 1766 it first attacked the horses in North America, but is not described as again occurring in a severe form until 1870-1872, when it spread over the entire country, from Canada south to Ohio, and then eastward to the Atlantic and westward to California. It is now a permanent disease in our large cities, selecting for the continuance of its virulence young or especially susceptible horses which pass through the large and ill-ventilated and uncleaned stables of dealers, and assumes from time to time an enzootic form, when from some reason its virulence increases. It assumes this form also when, from reasons of rural economy and commerce, large numbers of young and more susceptible animals are exposed to its contagion.

Etiology.--The experiments of Dieckerhoff many years ago proved that the disease may be transmitted to healthy animals by intravenous injection of warm blood from affected horses.

Further investigations revealed the fact that blood from affected horses, even when passed through porcelain filters, may transmit the disease, thereby proving that the causative agent belongs to the so-called filterable viruses. This has been further substantiated by Gaffky, who showed in his recent experiments that the disease may be transmitted with defibrinated as well as with filtered blood, in which cases the typical form of influenza developed in inoculated animals in from five to six days. These findings were also substantiated by Basset. Further observations have also proved that apparently recovered animals may harbor the infection for a long time and still be capable of transmitting the disease. Such virus carriers are no doubt responsible for numerous outbreaks of this disease when, in a locality free from the disease, it certainly appears after the introduction of an apparently healthy animal.

As one attack is usually self-protective, numbers of old horses, having had an earlier attack, are not capable of contracting it again; but, aside from this, young horses, especially those about four or five years of age, are much more predisposed to be attacked, while the older ones, even if they have not had the disease, are less liable to it. Again, the former age is that in which the horse is brought from the farm, where it has been free from the risk of exposure, and is sold to pass through the stables of the country taverns, the dirty, infected railway cars, and the foul stockyards and damp stables of dealers in our large cities. Overfed, fat, young horses which have just come through the sales stables are much more susceptible to contagion than the same horses are after a few months of steady work.

Pilger, in 1805, was the first to recognize infection as the direct cause of the disease. Roll and others studied the contagiousness of influenza, and, finding it so much more virulent and permanent in old stables than elsewhere, classed it as a "stall miasm." The contagion will remain in the straw bedding and droppings of the animal and in the feed in an infected stable for a considerable time and if these are removed to other localities it may be carried in them. It may be carried in the clothing of those who have been in attendance on horses suffering from the disease. The drinking water in troughs and even running water may hold the virus and be a means of its communication to other animals, even at a distance.

The studies of Dieckerhoff, in 1881, in regard to the contagion of influenza were especially interesting. He found that during a local enzootic, produced by the introduction of infected horses into an extensive stable otherwise perfectly healthy, the infection took place in what at first seemed to be a most irregular manner, but which was shown later to be dependent on the ventilation and currents of air through the various buildings. His experiments showed that the virus of influenza is excessively diffusible, and that it will spread rapidly to the roof of a building and pass by the apertures of ventilation to others in the neighborhood. The writer has seen cases that have appeared to spread through a brick wall and attack animals on the opposite side before others even in the same stable were affected. Brick walls, old woodwork, and the dirt which is too frequently left about the feed boxes of a horse stall will hold the contagion for several days, if not weeks, and communicate it to susceptible animals when placed in the same locality. On two successive mornings a 4-year-old colt belonging to the writer stood for about 10 minutes at the open door, fully 40 feet from the stalls, of a stable in which two cases of influenza had broken out the day before: in six days the colt developed the disease. On the morning when the trouble in the colt was recognized it stood in an infirmary with a dozen horses that were being treated for various diseases, but was immediately isolated; within one week two-thirds of the other horses had contracted the disease.

Symptoms.--After the exposure of a susceptible horse to infection a period of incubation of from four to seven days elapses, during which the animal seems in perfect health, before any symptom is visible. When the symptoms of influenza develop they may be intense, or so moderate as to occasion but little alarm, but the latter condition frequently exposes the animal to use and to the danger of the exciting causes of complications which would not have happened had it been left quietly in its stall in place of being worked or driven out to show to prospective purchasers. The disease may run a simple course as a specific fever, with alterations only of the blood, or at any period it may become complicated by local inflammatory troubles, the gravity of which is augmented by developing in an animal with an impoverished blood, an already irritated, rapid circulation, and defective nutritive and reparative functions.

The first symptoms are those of a rapidly developing fever, which becomes intense within a very short period. The animal becomes dejected and inattentive to surrounding objects; stands with its head down, and not back on the halter as in serious lung diseases. In the flanks, the muscles of the croup and of the shoulders, or of the entire body it has chills lasting from 15 to 30 minutes, and frequently a grinding of the teeth which warns one that a severe attack may be expected. The hairs become dry and rough and stand on end. The body temperature increases to 104 deg., 104.5 deg., and 105 deg. F., or even in severe cases to 107 deg. F., within the first twelve or eighteen hours. The horse becomes stupid, stands immobile with its head hanging, the ears listless, and it pays but little attention to the surrounding attendants or the crack of a whip. The stupor becomes rapidly more marked, the eyes become puffy and swollen with excessive lacrimation, so that the tears run from the internal canthus of the eye over the cheeks and may blister the skin in their course. The respiration becomes accelerated to 25 or 30 in a minute, and the pulse is quickened to 70, 80, or even 100, moderate in volume and in force. There is great depression of muscular force; the animal stands limp, as if excessively fatigued. There is diminution, or in some cases total loss, of sensibility of the skin, so that it may be pricked or handled without attracting the attention of the animal. On movement, the horse staggers and shows a want of coordination of all the muscles of its limbs. The senses of hearing, sight, and taste are diminished, if not entirely destroyed. The visible mucous membranes (as the conjunctiva), from which it received the name pinkeye, and the mouth, and the natural openings become of a deep saffron, ocher, or violet-red color. This latter is especially noticeable on the rim of the gums and is a condition not found in any other disease, so that it is an almost diagnostic symptom. In some outbreaks there is much more swelling of the lids and weeping from the eyes than in others. If the animal is bled at this period the blood is found more coagulable than normal, but at a later period it becomes of a dark color and less coagulable. There is great diminution or total loss of appetite, with an excessive thirst, but in many cases cold-blooded horses may retain a certain amount of appetite, eating slowly at hay, oats, or other feed. There is some irritation of the mucous membrane of the respiratory tract, as shown by discharge of mucus from the nose, and by cough. Pregnant mares are liable to abort.

We have, following the fever, a tumefaction, or edema, of the subcutaneous tissues at the fetlocks, of the under surface of the belly, and of the sheath of the penis, which may be excessive. The infiltration is noninflammatory in character and produces an insensibility of the skin like the excessive stocking which we see in debilitated animals after exposure to cold. In ordinary cases the temperature has reached its maximum of 105 deg. or 106 deg. F. in from 24 to 48 hours from the origin of the fever. It remains stationary for a period of from 3 to 4 days without so much variation between morning and evening temperature as we have in pneumonia or other serious diseases of the lungs. At the termination of the specific course of the disease, which is generally from 6 to 10 days, the fever abates, the swelling of the legs and under surface of belly diminishes, the appetite returns, the strength is rapidly regained, the mucous membranes lose their yellowish color, which they attain so rapidly at the commencement of the disease, and the animal convalesces promptly to its ordinary good condition and health, and rapidly regains the large amount of weight which it lost in the early part of the disease, a loss which frequently reaches 30, 50, or even 75 pounds each 24 hours. For the first three days of the high temperature there is a great tendency to constipation, which should be avoided if possible by the use of the means recommended below, for, if it has been marked, it may be followed by a troublesome diarrhea.

Terminations.--The terminations of simple influenza may be death by extreme fever, with failure of the heart's action; from excessive coma, due generally to a rapid congestion of the brain; to the poisonous effects of the debris of the disintegrated blood corpuscles and the toxin of the disease; to an asphyxia, following congestion of the lungs; or the disease terminates by subsidence of the fever, return of the appetite and nutritive functions of the organs, and rapid convalescence; or, in an unfortunately large number of cases, the course of the disease is complicated by local inflammatory troubles, whose gravity is greater in influenza than it is when they occur as sporadic diseases.

Complications.--The complications are congestions, followed by inflammatory phenomena in the various organs of the body, but they are most commonly located in the intestines, lungs, brain, or vascular laminae of the feet. Atmospheric influence or other surrounding influences of unknown quality seem to be an important factor in the determination of the local lesions. At certain seasons of the year, and in certain epizootics, we find 40 and 50 per cent or even a greater percentage of the cases rendered more serious by complication of the intestines; at other seasons of the year, or in other epizootics, we find the same percentage of cases complicated by inflammation of the lungs, while at the same time a small percentage of them are complicated by troubles of the other organs; inflammatory changes of the brain, of the laminae, more rarely commence in epizootic form, but are to be found in a certain small percentage of cases in all epizootics.

Exciting causes are important factors in complicating individual cases of influenza, or in localizing special lesions, during either enzootics or epizootics. These exciting or determining causes act much as they would in sporadic inflammatory diseases, but in this case we find the animal much more susceptible and predisposed to be acted upon than ordinary healthy animals. With a temperature already elevated, with the heart's action driving the blood in increased quantity into the distended blood vessels, which become dilated and lose their contractility, with a congestion of all the vascular organs already established, it takes but little additional irritation to carry the congestion one step further and produce inflammation.

Complication of the intestines.--When any cause acts as an irritant to the intestinal tract during the course of this specific fever it may produce inflammation of the organs belonging to it. This cause may be constipation, which can find relief only in a congestion which offers to increase the function of the glands and relieve the inertia caused by a temporary cessation of activity; or irritant medicines, especially any increased use of antimony, turpentine, or the more active remedies; the taking of indigestible feed, or of feed in too great quantities, or that has been altered in any way by fungus or other injurious alterations; the swallowing of too cold water; or any other irritant may cause congestion. This complication is ushered in by colics. The animal paws with the fore feet and evinces a great sensibility of the belly; it looks with the head from side to side, and may lie down and get up, not with violence, but with care for itself, perfectly protecting the surface of the belly from any violence. At first we find a decided constipation; the droppings if passed are small and hard, coated with a viscous varnish or even with false membranes. In from 36 to 40 hours the constipation is followed by diarrhea. The alimentary discharge becomes mixed with a sero-mucous exudation, which is followed by a certain amount of suppurative matter. The animal becomes rapidly exhausted and unstable, staggers on movement, losing the little appetite which may have remained, and has exacerbations of fever. The pulse becomes softer and weaker, the respiration becomes gradually more rapid, the temperature is about 1 deg. to 1.5 deg. F. higher. If a fatal result is not produced by the extensive diarrhea the discharge is arrested in from 5 to 10 days and a rapid recovery takes place.

Complication of the lungs.--If at any time during the course of the fever the animal is exposed to cold or drafts of air, or in any other way to the causes of repercussion, the lungs may become affected. In the majority of cases, however, after three, four, or five days of the fever, congestion of the lungs commences without any exposure or apparent exciting cause. Unless this congestion of the lungs is soon relieved it is followed by an inflammation constituting pneumonia. This pneumonia, while it is in its essence the same, differs from an ordinary pneumonia at the commencement by an insidious course. The animal commences to breathe heavily, which is distinctly visible in the heaving of the flanks, the dilatation of the nostrils, and frequently in the swaying movement of the unsteady body. The respirations increase in number, what little appetite remained is lost, the temperature increases from 1 deg. to 2 deg., the pulse becomes more rapid, and at times, for a short period, more tense and full, but the previous poisoning of the specific disease has so weakened the tissues that it never becomes the characteristic full, tense pulse of a simple pneumonia.

On percussion of the chest dullness is found over the inflamed areas; on auscultation at the base of the neck over the trachea a tubular murmur is heard. The crepitant rales and tubular murmurs of pneumonia are heard on the sides of the chest if the pneumonia is peripheral, but in pneumonia complicating influenza the inflamed portions are frequently disseminated in islands of variable size and are sometimes deep-seated, in which case the characteristic auscultory symptoms are sometimes wanting. From this time on the symptoms of the animal are those of an ordinary grave pneumonia, rendered more severe by occurring in a debilitated animal. The cough is at first hacky and aborted; later, more full and moist. There is discharge from the nostrils, which may be mucopurulent, purulent, or hemorrhagic. As in simple pneumonia, in the outset this discharge may be "rusty," owing to capillary hemorrhages. We find that the blood is thoroughly mixed with the matter, staining it evenly, instead of being mixed with it in the form of clots. At the commencement of the complication the animal may be subject to chills, which may again occur in the course of the disease, in which case, if severe, an unfavorable termination by gangrene may be looked for. If gangrene occurs it is shown by preliminary chills, a rapid elevation of temperature, a tumultuous heart, a flaky discharge from the nostrils, and a fetid breath; the symptoms are identical with those which occur in gangrene complicating other diseases.

Complication of the brain.--At any time during the course of the disease congestion of the brain may occur; at an early period if the fever has been intense from the outset, but in ordinary cases more frequently after three or four days. The animal, which has been stupid and immobile, becomes suddenly restless, walks forward in the stall until it fastens its head in the corner. If in a box stall and it becomes displaced from its position, it follows the wall with the nose and eyes, rubbing it along until it reaches the corner and again fastens itself. It may become more violent and rear and plunge. If disturbed by the entrance of the attendant or any loud noise or bright light, it will stamp with its fore feet and strike with its hind feet, but is not definite in fixing the object which it is resisting, which is a diagnostic point between meningitis and rabies and which renders the animal with the former disease less dangerous to handle. If fastened by a rope to a stake or post, the animal will wander in a circle at the end of the rope. It wanders almost invariably in one direction. The pupils may be dilated or contracted, or we may find one condition in one eye and the opposite in the other.

The period of excitement is followed by one of profound coma, in which the animal is immobile, the head hanging and placed against the corner of the stall, the body limp, and the motion, if demanded of the animal, unsteady. Little or no attention is paid to the surrounding noises, the crack of a whip, or even a blow on the surface of the body. The respiration becomes slower, the pulsations are diminished, the coma lasts for variable time, to be followed by excesses of violence, after which the two alternate, but if severe the period of coma becomes longer and longer until the animal dies of spasms of the lungs or of heart failure. It may die from injuries which occur in the ungovernable attacks of violence.

Complication of the feet.--The feet are the organs which are next in frequency predisposed to congestion. This congestion takes place in the laminae (podophyllous structures) of the feet. The stupefied animal is roused from its condition by excessive pain in the feet and assumes the position of a foundered horse; that is, if the fore feet alone are affected, they are carried forward until they rest on the heels; and if the hind feet are affected, all the feet are carried forward, resting on their heels, the hind ones as near the center of gravity as possible. In some cases the stupor of the animal is so great that the pain is not felt, and little or no change of the position of the animal is noticeable. The foot is found hot to the touch, and after a given time the depressed convex sole of typical founder is recognized.

Pleurisy.--This is a rare complication, but when it does occur it is ushered in by the usual symptoms of depression, rapid pulse, small respiration, elevation of the temperature, subcutaneous edema of the legs and under surface of the belly, and we find a line of dullness on either side of the chest and an abscess of respiratory murmur at the lower part. If it is severe, there may be an effusion filling one-fourth to one-third of the thoracic cavity in from 36 to 48 hours.

Pericarditis is an occasional complication of influenza. It is ushered in by chills, elevation of the temperature; the pulse becomes rapid, thready, and imperceptible. The heart murmurs become indistinct or can not be heard. A venous pulse is seen on the line of the jugular veins along the neck. Respiration becomes more difficult and rapid. If the animal is moved the symptoms become more marked or it may drop suddenly dead from heart failure.

Peritonitis, or inflammation of the membranes lining the belly and covering the organs contained in it, sometimes takes place. The general symptoms are similar to those of a commencing pericarditis. The local symptoms are those of pain, especially to pressure on side of the flanks and belly, distention of the latter, and sometimes the formation of flatus, or gas, and constipation.

Other occasional complications are nephritis, hepatitis, inflammation of the flexor tendons and rupture of them, and abscesses.