Part 21

Subcutaneous inoculation causes an enormous inflammatory œdema resulting in a sanguinolent abscess, in case the subject survives. There are also hyperthermia (106° F.), dulness, stupor, weakness, staggering, and congested, swollen, weeping eyes.

Intratracheal injection is harmless to the horse.

Lignieres finds his cocco-bacillus in the expectoration at the outset and in the nasal and guttural forms of the disease later, but not in the blood nor lungs after death, as it is then replaced by streptococci, the great reproduction of which is favored by its presence. In ordinary cases of equine influenza it is often impossible to find the cocco-bacillus in the lung or other organs after an illness of 8, 10 or 15 days. (Lignieres).

Lignieres appears to have omitted the obvious test of the infection of other horses in the same stable, from the cases produced by his experimental cultures, so that we must still call for more confirmatory proof. Cadeac, indeed, assures us that cultures of cocco-bacilli taken from cases of equine influenza, are often innocuous. Deadly as the germ cultures of Lignieres prove, they appear to lack that element of extreme infectiousness shown by equine influenza when the susceptible animals come into proximity with the sick.

Accessory Causes. The recognition of the one essential cause in the microbian invasion, need not exclude as accessory factors the many unwholesome conditions which have long been recognized as contributing to the severity of epizoötics. As the seed requires the rich field, the rain and sunshine to bring it to an abundant harvest so the microbe of equine influenza flourishes best where the conditions are most favorable and the antagonisms least.

The chill which comes from a sudden extreme fall of temperature, or the standing in a cold draught when wet or perspiring, lays the system open to this as to other microbian invasions.

The electric tension preceding a thunderstorm, to which many of the lower animals are excessively susceptible equally prepares the system to succumb to the germs. It may here be noted that September 1872, the last days of which witnessed the start of the great epizoötic, had no less than eleven thunderstorms, while in September of the previous year there were but two in the vicinity of Toronto. It is just possible that the great and frequent electric tension, lowered the animal vitality, allowing a violent invasion by the hitherto slumbering germ, and gave to the latter that encreased potency which sent it forth on that year of almost unparalleled epizoötic record.

The high barometer and low dew point similarly affect the animal economy and encrease receptivity to disease. Rain fell at Toronto 16 days in September 1872 and but 8 days in September 1871.

Impurities in the air whether originating in volcanic eruptions, telluric emanations, close, filthy overcrowded buildings or compartments or large collections of decomposing organic matter, impair the animal vigor and lay the system open to a more violent attack. For this among other reasons epizoötics of equine influenza are nearly always more deadly in the closely packed city stables than in the pure country air.

Overwork and poor irregular feeding and watering pave the way for debility, prostration and severe invasion.

Sudden vicissitudes of temperature, which are so common in spring and autumn, associated as they are with the shedding and growth of the coat, materially encrease susceptibility and sometimes determine an encreased severity in the attack.

Youth has its influence, even if it means only that the system that has never before been exposed to the poison, retains all its native susceptibility, and has none of that acquired immunity which comes from a previous exposure to the virus and successful resistance.

Acquired immunity must of course be reckoned with. After a non-fatal attack this is usually to be relied on for several years or even for the rest of the lifetime, yet it varies with the individual animals, and, under the baleful combination of a specially potent germ and strongly conducive accessory causes, it may become worn out in a year. Yet the older horses can always be trusted to show a large measure of this immunity, so that in the absence of extraordinary epizoötics it is mainly the young that suffer, and it is only when a country has had no general invasion for a length of time, or when the germ has acquired an unusual pathogenic potency, or when these two conditions conjoin, that the invasion of the equine population becomes universal, as it virtually was in the United States and Canada in 1872–3. Under other circumstances the germ, temporarily shorn of its power, lingers in city and dealers stables, biding its time until circumstances become more favorable for a new general outbreak.

Immunity largely explains the comparative mildness of the last cases in any particular locality. The more susceptible animals are attacked first and most severely, while the partially immune ones, which for a time resist, throw off the disease with greater readiness. The explanation has been sought in a lessening potency of the germ, but though this may hold true of some cases, it manifestly does not apply when slight lingering cases only are left in one locality, and the disease is advancing over the neighboring state with all its original force and vigor.

Incubation. This appears to vary within certain limits. When during an epizoötic a sick horse is brought into a new locality and stable, other cases usually develope in from one to three days. Trasbot gives examples of one day, Salle, Cadeac and others of two, others claim four, seven and even, exceptionally, fifteen days. One reason for an apparently prolonged incubation may be found in the seclusion of the germs in the alimentary canal, so that they escape only when passed with the fæces. The pathogenic potency of individual germs, and the varying susceptibility of the animals exposed must also be taken into account.

Symptoms. Equine influenza is liable to show a special predilection for a given set of organs in different epizoötics, so that we find descriptions of the different forms as independent types or even separate diseases: as the catarrhal form, thoracic form, abdominal form, bilious form, nervous form, pink eye, infectious cellulitis, and rheumatic influenza. These forms may, however, appear in different subjects in the same epizoötic, and when they are not due to complications, may be looked on as a concentration of the morbid processes on one class of organs rather than another.

Initial pathognomonic symptoms. Certain prominent and striking symptoms are so constantly present in the earlier part of the disease that they may be held as virtually diagnostic. These are the suddenness of attack, the anorexia, the profound early prostration and weakness, the high temperature, the swelling and watering of the eyes, and the specially brownish red coloration of the conjunctiva and other visible mucosæ. The attack may come on with almost lightning rapidity. The animal which yesterday, or it may be but an hour or two ago, appeared to be in the most vigorous health and spirits, is found with pendant head, resting perhaps on the manger, ears drooping, eyelids swollen and half closed, epiphora, conjunctiva of a brownish red or violet, lips loose and drooping, and one or two legs partially flexed, while the body is balanced on the others. The patient is indisposed to move, and when compelled to walk may sway and stagger from nervous and muscular weakness. The arched back, cracking limbs, and their stiff, rigid movement further indicate the suffering in muscles or joints or both. Appetite is greatly impaired or lost, thirst marked, and hyperthermia 102° to 105° or upward. Sneezing, cough or symptoms of some other special localization may be present, but the above occurring in a number of horses at once, without appreciable climatic cause, when one or two new horses have been very recently acquired, or when influenza has been prevailing in the vicinity or in a neighboring place, will usually stamp the nature of the attack.

Cadeac considers the sudden attack, high fever, and profound nervous prostration and stupor as the manifestations of the uncomplicated disease, while the localizations in the lungs, bronchia, pleura, liver, bowels, etc., are indications of complications by germs of other diseases, which find the debilitated influenza system especially open to attack. The fever which always sets in early may be little above the normal in mild cases, and may reach 107° or 108° F. in the more severe ones. It may last thus for five or six days and then rather suddenly descend to near the normal. In other cases it descends a little daily, the lowest temperature for the day being seen in the morning. Shivering is often nonexistent or passes unperceived.

The pulse does not usually encrease in ratio with the temperature. It may be at first only 40 or 50 per minute, though later, and especially with extensive disease of important organs, it may reach 60, 70, 80 or even 100. It usually lacks in firmness and force, even when the heart beats forcibly, being soft, somewhat compressible, and often irregular in successive beats, the weakest corresponding to the last part of the inspiratory act, or when the lungs are full and the heart compressed. The heart impulse behind the left elbow is usually forcible and may show variation in rhythm or even intermissions.

Mild catarrhal symptoms of the nose and throat are usually present, the discharge being at first serous and later muco-purulent. As a rule this is complicated with more or less bronchitis, but this does not indicate anything serious. Acceleration of the breathing, sneezing, and cough are present. Cough may be at first nervous, husky and paroxysmal, but later as the discharge is established it assumes a looser, mucous character. It is liable to be roused by excitement, by drinking cold water, by inhalation of dust, or by giving medicine. In connection with these symptoms there are some indications that the digestive organs are involved. The pharyngeal and submaxillary glands may be swollen and tender. If the subject has been seized just after a full meal, there may be slight tympany, and in any case, the fæces are passed in small balls, a few at a time, hard and with a baked or glistening surface. These may have an unusually strong or heavy odor, and laxatives are liable to act with dangerous energy. The urine is scanty and high colored, sometimes icteric.

In such mild attacks, which constitute the majority, improvement may be noted as early as the fourth day, and a prompt recovery follows.

With extensive thoracic lesions, the symptoms are much more severe and the danger greatly enhanced. These may occur in any patient, but there appears to be a special predisposition in the young and still very susceptible animals, in those crowded together in close, badly aired buildings, in the overworked, poorly fed or in any way debilitated subject, and in horses that have been especially excited and exposed, as by railway travel.

In exceptional cases congestion of the lungs may be so acute as to lead to speedy death, and the objective symptoms do not differ greatly from those of ordinary cases of this condition, if we except the very high temperature in influenza, associated as it is with the fact of the epizoötic prevalence of the disease.

In pneumonic cases the lesions are usually double and have a tendency to develop toward the lower borders of the lungs, just behind the elbow or farther back, and less frequently in the centre of the organ. It may be impossible to detect crepitation, but sounds of distant organs (heart beats, bronchial blowing, intestinal rumbling) are heard with unwonted clearness over the consolidated parts. A mucous râle can usually be detected behind the shoulder blade, along the line of the larger bronchia. Percussion sounds may be indefinite, as the area of consolidated lung is usually small in ratio with the hyperthermia. The area of flatness in ordinary fibrinous pneumonia is usually much greater with a high fever, and if the lesions are on one side only, right or left, it is still more suggestive. The crepitation too in pneumonia is significant. When the pulmonary lesions are extensive by reason of œdema, a marked infiltration may often be noted on the lower surface of the trunk or in the limbs as well.

Pleuritic symptoms may show in the same connection. The breathing becomes more hurried and shorter, friction sound may be heard but it is very transient and soon superseded by an absolute flatness on percussion, rising to a definite horizontal line, representing the boundary of the effusion in the lower third or half of the chest, and usually rising to the same height on both sides. Tenderness of the intercostal spaces may or may not be present. As the disease advances creaking sounds may be heard from the stretching of the consolidated false membranes. The combination of double pleuro-pneumonia constitutes a very fatal type of the disease.

The symptoms of pericarditis and of cardiac disorder usually accompany those of pleurisy. The tumultuous heart beats, often associated with soft, weak or even rapid pulse, and later, a deadening or muffling of heart sounds, as in hydropericardium are characteristic when present. With endocarditis the early tumultuous heart beats, with small weak pulse, irregular and sometimes intermittent, become complicated by a blowing or hissing murmur with the first heart-sound. In such cases clots of blood are liable to form in connection with the valves, and may cause sudden and early death. When the heart is involved the tendency to extensive infiltration of limbs and lower aspect of the trunk is much enhanced. (See diagnosis for table of phenomena in influenza, fibrinous pneumonia and contagious pneumonia respectively).

Symptoms of digestive disorder are usually in evidence. Even in the thoracic forms the mouth is dry, hot, and has an offensive odor; the tongue coated above, has often red margins and tip; it may even be yellowish; the gums may be swollen and dark red or violet especially around the incisors; mastication may be slow and unwilling; the pharynx maybe swollen; the pharyngeal and submaxillary lymph glands may be tumid and tender; and swallowing may be difficult.

Congestions of the stomach and intestines are indicated by inappetence, sometimes flatulence, passage of flatus, constipation with small, round, mucous-coated balls passed in small numbers, and by slight transient colics, pawing, looking at the flanks, and retraction of the abdomen. The retention of bile and destruction of blood elements are indicated in a deeper yellow of the conjunctiva and visible mucosæ, and in a yellow, brown or red color of the urine. There may be tenderness of the abdomen, but this, like the colics, is moderate, the senses being blunted by the attendant stupor which is usually even greater than in the thoracic forms. Urination may become frequent with straining, and the urine may become turbid, opaque, with flocculi of cystic epithelium and mucus, and even albumen. In from three to five days diarrhœa supervenes, the fæces becoming soft, pulpy, watery, glairy or bloody, and escaping through a permanently dilated sphincter. The diarrhœa may alternate with periods of torpor or complete inactivity, otherwise tenesmus of the rectum is marked. The exposed rectal mucosa is congested, of a deep red or it may be of a dark violet hue. Eversion is not unknown.