Part 67

PURULENT CONJUNCTIVITIS. BLENNORRHŒA.

More purulent and more infective through dust, tongues, rubbing posts, kennels, swill; a class due to different microbes. Prevalence in dogs, swine, horses, sheep, goats, cats. Symptoms: acute conjunctivitis with excess of pus, follicular swelling and enlarged lymph bodies in cul de sac. Diagnosis. Treatment: Astringent and antiseptic lotions, injected often: silver nitrate: pyoktannin.

The forms of conjunctivitis in which there is an abundant production of pus are usually relatively more inoculable and therefore more liable to pass from animal to animal in a casual manner. Infection takes place through the dried up discharges floating as dust, but more directly by means of the tongue when the animals lick each other, and through posts against which they rub the head. Animals smelling or licking the infected genital organs and then the eyes of their fellows may convey it readily. Dogs occupying the same kennel successively, contract the disease (Guilmot). Swine feeding from the same trough and plunging the face into swill up to the eyes are especially subject to infection. In speaking of such infections one must be understood to refer to a group and not to one specific disease, as that will vary with the particular pus microbe present, and with the virulency of such microbe in the particular case. In keeping with the greater fertility of microbes in the warm season, these affections have been more commonly met with in summer than in winter, and where the animals are kept in filthy surroundings rather than otherwise. This is above all true of swine. Möller records a wide spread epizootic of gonorrhœal ophthalmia in dogs in Berlin and environs in 1883. In different cases, however, he failed to induce disease in the eyes by direct inoculation with the preputial secretion. Heinman equally failed with the gonococcus of man in inoculations on the eyes of rabbits, and dogs. Fröhner, however, succeeded in infecting the eye of the dog by applying the gonorrhœal discharge of man.

Infecting inoculable, purulent ophthalmia has been reported in the horse (Vermast, Sobornow, Blazekowic, Menard, Möller, Leclainche), in sheep (Repiquet), and in goats (Mathieu). Again Blazekowic found in an infectious ophthalmia of horses, dogs and cats a microbe which was like that of malignant œdema.

The symptoms are those of conjunctivitis with especially free production of pus, and a tendency to chemosis or to follicular inflammation in the depth of the conjunctival sac, with irregular swellings of the lymph bodies. The pus accumulates in the inner canthus, inside the lids and along their margins, and tends to mat them together. The diagnosis depends on the rapidity and severity of the course of the malady, on the depth of the congestion and on the profuse suppuration.

Treatment. Astringent and antiseptic lotions are especially indicated. Mercuric chloride (1 ∶ 5000), boric acid (2 ∶ 100), creolin (1 ∶ 100), salicylic acid (1 ∶ 1000), silver nitrate (1 ∶ 200). It is not however enough that these should be applied externally; they should be freely injected under the lids at all points so as to act on the deepest portions of the conjunctiva, and this should be repeated once or twice daily. Or they may be applied with a soft brush. In a specially virulent outbreak silver nitrate (2 ∶ 100) or pyoktannin (1 ∶ 1000) solution may be used. Setons and blisters, laxatives and cooling diuretics may be employed as in the severe types of simple conjunctivitis.

INFECTIOUS CONJUNCTIVITIS IN HERBIVORA. ENZOOTIC OPHTHALMIA.

Causes: infection, pollen, soil emanation, winter or summer; cases of extension by infection. Cattle, sheep, goats, ponies. Accessory irritants. Symptoms: severe purulent conjunctivitis. Papillary and follicular hypertrophy, uniform redness, protruding head, opacities, erosions, ulcers, photophobia, staphyloma. Treatment: rest, darkness, coolness, elevated head, purgative, diuretics, sedatives; locally solutions of pyoktannin, sublimate, silver nitrate, boric or salicylic acid, atropia, puncture.

Causes. This affection which attacks at once or in rapid succession a large portion or the whole of a herd or flock, is by many held to be infectious while others attribute it to irritant pollen or soil emanation. Its origin from vegetation in flower is held to be supported by its greater frequency in summer than in winter, and the few outbreaks seen in winter are attributed to pollen preserved in the hay. But other things being equal, organized germs are preserved, multiplied and diffused to a greater extent in the hot season so that the origin of the disease from a purely microbian source is at least equally plausible. Certain outbreaks indeed show the transmission of the infection in a most unequivocal manner. A cow suffering from the affection was brought into a stable occupied by a herd previously sound, and in a few days the cow standing next her was attacked, and thereafter a number of others in rapid succession. A small number of cattle from the Buffalo Stock Yards, but which had sore eyes on their arrival in Tompkins Co., N. Y., were placed in a sound herd and the disease spread rapidly to the other members of the herd. Similarly in both sheep and cattle the writer has seen the disease prevail in one herd or flock, while the adjacent herd or flock, separated only by a good stone wall and subject to exactly the same condition of soil, water, exposure, vegetation and pollen has entirely escaped. Kaiser has seen it introduced into a herd by a bull; Fünfstück saw a herd of 300 head attacked in a few days, and Klink 20 out of a herd of 40 head in 14 days. Trumbower has never seen an animal suffer a second time. This is the common experience and would suggest an acquired immunity, yet the comparative rarity of the disease forbids a positive conclusion, without further experience. Menard saw an outbreak among the ponies in the Jardin d’Acclimatation, and as many as fourteen weeks later in the same gardens it attacked the bovine animals.

In sustaining the doctrine of infection, however, we must not altogether ignore accessory causes. Like other affections of the eye, this has seemed to appear especially in low, damp lands, bottom lands, deltas, marshy borders of lakes and level prairies, so that a general lack of tone or a lymphatic constitution may be held to predispose. Nor is it necessary to ignore the influence of pollen, dust and other irritants, which though they may not cause the specific disease, yet prepare the way for its attack by reducing the resisting power of the tissues.

Symptoms. These are the phenomena of severe purulent conjunctivitis. Closed eyes; profuse secretion of tears, sometimes mixed with blood, changing in a few days to a thick, purulent, white or yellow secretion, which collects in masses inside the lids, along their margins, in the inner canthus and on the cheeks, gluing together the cilia, lids and hairs. When separated the lids show a mucosa of an uniform deep red, covered with pus, and irregularly swollen according to the amount of infiltration. Papillary and follicular hypertrophy are marked features, and the nictitans projects excessively over the eyeball. In many cases the cornea becomes opaque and in some instances erosions occur which may cause perforation or loss of the eye. In other instances the ulcers heal with the formation of cicatrices, or the weakened portion of the membrane yields under the internal tension and staphyloma supervenes. In such cases the pupils are contracted.

The disease is usually attended by marked hyperthermia, the secretions, including the lacteal, are materially decreased, appetite and rumination are impaired and the animal leaves the flock or herd. The disease affects cattle and sheep, and Menard and Hoffmann add horses and goats.

Treatment. This must be primarily antiseptic, but without neglecting constitutional disorder. Rest in a dark, cool stall, with the head elevated by tying to a high point. Give at once an active purgative 1½ lb. Glauber salts in 4 quarts warm water, and follow up with cooling diuretics and sedatives (saltpeter ½ oz. and tincture of aconite 20 drops, thrice a day). If the temperature runs very high a few doses of acetanilid or phenacetin may be given. Locally use silver or other antiseptic collyrium.

Locally use pyoktannin solution (1 ∶ 1000) or mercuric chloride (1 ∶ 5000) injecting under the lids so as to bring it in contact with the whole diseased surface. A cloth wet with the same solution may be hung over the eye. Boric acid (1 ∶ 100), salicylic acid (1 ∶ 1000), or silver nitrate (1 ∶ 100) may be substituted for the above when they seem to be losing their efficacy.

Ulcers are treated by pyoktannin or silver nitrate solution applied daily with a soft brush. Keratitis will demand atropia. Abnormal tension or staphyloma will demand puncture of the cornea. Improvement may be expected in a few days and recovery in a week or ten days.

VARIOLOUS CONJUNCTIVITIS.

In cow pox, horse pox, and above all sheep pox, the infection sometimes falls on the conjunctiva, giving rise to the formation of the specific eruption on that membrane. The coexistent eruption on other parts of the body (udder, heels, hairy portions of skin) of the specific variolous eruption, furnishes the means of a satisfactory diagnosis. The lesions in the eye develop rapidly to an extreme severity. The lids are swollen and closed, lachrymation abundant, and early mixed with pus, and when exposed the conjunctiva is strongly congested with circumscribed areas of elevation. In cow pox these are circular in form, raised above the surrounding mucosa, having a deep red areola and a paler, flattened center. In sheep pox the elevations have the same general character, but are liable to be more numerous and confluent, and tend to permanent opacities, cicatrices, and perforations of the cornea with loss of the eye. Short of perforation, internal inflammations are not uncommon.

Treatment. At the outset this form may be aborted by the application of silver nitrate solution (2 ∶ 100) or sodium hyposulphite (1½ ∶ 100). Otherwise the local treatment is like that for simple conjunctivitis, cooling astringent and sedative lotions, and if need be, derivatives and eliminants.

APHTHOUS CONJUNCTIVITIS. PHLYCTENULAR CONJUNCTIVITIS.

Closely allied to the last, are those cases in which vesicles appear on the conjunctiva. In exceptional cases these are seen during an epizootic of foot and mouth disease, while in other instances they are associated with eczematous eruptions on other parts of the body, particularly in dogs. In the human subject conjunctival vesicles are often associated with tuberculosis, but this has not been recorded of animals so far. The disease usually makes a rapid eruption, with symptoms of extreme inflammation, and its duration is largely determined by the general disease.

Beside the local treatment by astringent or antiseptic and sedative collyria it may be desirable to correct the hepatic, digestive or other disorder on which the eczema depends, or to improve the general health by a course of bitters or even of cod liver oil.

DIPHTHERITIC CONJUNCTIVITIS IN BIRDS.

Hens, ducks, pigeons. Local inflammation, fibrinous exudate, concreting or becoming cheesy, necrotic, sloughy. Beneath the mucosa red, raw; without epithelium, but excess of lymphoid cells, some only muco-purulent, gravity varies. Grave cases inoculable on birds, mice, rats and rabbits. Bacillus diptheriæ avium, morphology and biology. Pathogenesis. Prevention: exclude germ; cleanliness; pure air; pure food; pure water. Quarantine strange fowls, keep flocks apart, seclude manure, segregate sick, disinfect. Treatment: Antiseptics; boric acid; sublimate: ichthyol; silver nitrate. Infection to man.

A disease of the mouth, fauces, nose and eyes, associated with the formation of false membranes, has been long recognized in birds (hens, ducks, pigeons, etc.), and is known to bird-fanciers by the names of roup, and diphtheria. The disease is characterized by the presence of a local inflammation in patches, associated in the early stages, with a free serous discharge, but, later, with the formation of white, or grayish, fibrinous exudate, which may be at first firm and smooth, later soft and cheese like, and still later in many cases more or less necrotic and sloughing. In Dr. Moore’s experience this is more common on the conjunctiva than on the nares or fauces. The interior of the eye was not involved in the inflammation. Beneath the false membrane the mucosa was devoid of epithelium and the underlying tissue was red, raw and angry, bleeding readily when handled, and infiltrated with an excess of lymphoid cells.

The lesions however were by no means constant. In some even of the fatal cases, the exudate was merely muco-purulent, while in others the false membrane was quite abundant.

The gravity of the affection also varies in different outbreaks or in the same outbreak at different times. Sometimes it runs a very rapid and fatal course, while at others it becomes chronic and comparatively dormant and the great majority recover.

In its more virulent form it is readily inoculable on birds, mice, rats, and rabbits, while the milder cases are not easily propagated in this way.

The false membrane contains a variety of saprophytes, and among them the pathogenic bacillus, which may be obtained in pure culture by inoculating it on a rabbit or mouse. Emmerich believed this bacillus to be identical with the Klebs-Löffler bacillus of diphtheria in man, but Löffler recognizes it as essentially distinct.