Part 32

The reduction or prevention of sudden plethora was formerly availed of to lessen the number of victims and it is well to still bear in mind that this has an appreciable though limited effect. As a means of reducing plethora a free bleeding was resorted to when the period of yearly prevalence approached, and no less when the disease had already appeared in a herd. I can mention an instance in which infection was carried on the fleam from the first animal bled (the sick one) and caused the fatal infected swelling around the phlebotomy wound in the next seven animals operated on. Another objection to phlebotomy is the tendency to a rapid reproduction of blood, which the depletion brings about, and the supervention of a greater danger than before, in the course of a month or more. Purgatives and diuretics are somewhat less objectionable in this sense. Careful feeding to keep the animal constantly in good condition does something to obviate sudden plethora and its attendant dangers, and thus an allowance of grain or linseed cake through winter and early spring, or when the pastures are bare, will bring the animals through in fine condition, and ward off the danger that comes from a sudden access of rich aliment.

Another measure was the insertion of a seton in the dewlap. The theory was to counteract plethora but the benefit probably came rather from the formation of an actively granulating wound, which came in contact with the ground and received the bacillus, but in which the abundance of air, and of active leucocytes checked the propagation of the germ and the occurrence of a fatal infection. A certain grade of immunity was the natural result in many cases.

Immunization. As the first attack of emphysematous anthrax secures for the subject of it immunity against a second, we are furnished with a reasonable basis for the practice of artificial immunization. This has been attained by a variety of methods, the essential feature of each being the subjecting of the system of the animal to be treated, to the action of the toxins of the specific bacillus.

1st. A culture of the bacillus made in the thermostat at 42 C. (107.6° F.) so as to prevent the formation of spores is then sterilized by heating to 100° C. for one hour and then injected subcutem in a dose of 2 drams, to be repeated on the second day. This, like all the other methods named should be done by some one accustomed to bacteriological manipulation and the sterilization completed by superheating the neck of the vessel containing the mixture. Any germs escaping on the hands, instruments or other objects used will prove fatal in spite of all the appearance of precautions.

2d. Roux sterilized his cultures by filtering them through a porcelain (Pasteur) filter and using only the filtrate for injection. This requires even greater precaution in manipulation as what is left in the filter is most virulent, and must be thoroughly sterilized to obviate dangers from its dissemination.

3d. Intravenous injection of a small quantity of virus, containing but a few bacilli produces no local swelling, but only a slight temporary hyperthermia and permanent immunity. The greatest care is necessary in the manipulation, to prevent any contact of the bacillus with the subcutaneous tissues or the walls of the vein. The virulent exudate swarming with bacilli is taken and a drop or two added to a normal salt solution, which is diluted and shaken in a stoppered bottle, until each drop contains but one, or at most two bacilli. Then the hands having been thoroughly washed with soap and warm water and rinsed in a 5 per cent. solution of carbolic acid, and the instruments having been boiled, the vein is raised as for bleeding, and penetrated by a short cannula and trochar, which after boiling has been dipped in the carbolic acid solution, the trochar is withdrawn, and the nozzle of the syringe containing the virulent solution is inserted through the cannula, so that its point is free in the centre of the blood stream, into which a few drops of the virulent solution are discharged. The nozzle is left in place for a few seconds to ensure the washing of any infecting matter from its point, when it is withdrawn, followed immediately after by the cannula. Great care should be taken to avoid any scratching of the inner coat of the vein with the cannula, trochar or nozzle.

4th. Another method of immunizing is by the injection of the virulent liquid into the trachea and bronchia. This appears to bring it so directly in contact with the blood, that the microbes are destroyed as rapidly as if it were introduced into the blood stream direct. The injection is made between two tracheal rings, the manipulation being essentially the same as in the cases of the vein, the tissues being first perforated by a sterilized cannula and trochar, and the sterilized nozzle subsequently inserted through the cannula.

5th. Inoculation into the tip of the tail can be successfully employed, the coldness of the region and the scantiness of the connective tissue preventing any dangerous increase of the bacilli in the cooler season. In the heat of summer, however, this is to be avoided as dangerous. The tail is first washed with soap and water followed by a 3 per cent. solution of phenol. It is then punctured with a fine trochar or needle, (sterilized), within two inches of the tip and in a downward direction and the instrument is moved slightly from side to side so as to form a small sac, and is then withdrawn. The sterilized nozzle of the hypodermic syringe is now inserted in the opening and a few drops of the virus injected into the sac. When the nozzle has been withdrawn the thumb may be placed on the external orifice and the end of the tail manipulated to diffuse the virus in the connective tissue. This is usually followed by an insignificant swelling, and a slight rise of temperature. Should the swelling exceed the size of a duck’s egg or if others appear higher up on the tail, they may be freely scarified and covered with a carbolic acid bandage. Or the tail may be amputated above the highest swelling and the stump treated with antiseptics.

6th. The virus prepared by the Pasteur institutes, that of Arloing, Cornevin and Thomas, is the most extensively employed. Forty grammes of the diseased muscle are dried rapidly at 32° C (90° F.) and triturated in 80 grammes of water. This is divided in 12 equal parts and put on plates in two thermostats, six at 100° C. (212° F.) and six at 85° C. (185° F.) where they are kept for six hours, when it forms a dry, brownish powder. One tenth of a gramme (1½ gr.) of this powder is dissolved in five grammes of distilled or boiled water and will furnish ten doses. The animal to be protected is first injected in the tip of the tail or elsewhere with the virus prepared at 100° C., and ten days later with that prepared at 85° C.

By the use of this method in hundreds of thousands of animals on infected lands the mortality has been reduced to less than one tenth of its former amount. It is attended by the one danger which is not always duly appreciated, that unless its use is restricted to herds on ground that is already infected, it endangers the infection of new districts. The spores are not absolutely sterilized at 85° C. Arloing and Cornevin and later, Nocard and Roux have shown that the addition of lactic acid to the liquid which has been weakened for inoculation, restores it to its former virulence, making it a most deadly agent. Galtier says that the virus weakened by heating to 100° C. for seven hours until it will no longer kill a mature Guinea pig, will still kill a new born Guinea pig and acquire all its original virulence in the act. Also that the injection of large enough doses will not only kill the full grown Guinea pig, but at the same time restore the microbes to their former virulence. While recognizing the great economy of the judicious use of such weakened virus, we cannot but condemn the reckless sale by the Pasteur institutes of their products, to be used on animals on all kinds of lands, the uninfected as well as the infected. A great and valuable prophylactic measure should not be used in such a way as to increase the area of prevalence of the disease which is to be prevented, and also the yearly demands for more of the preventive agent. This may appeal to the business instinct, but this should ever be held subordinate to sanitary considerations. The danger might be avoided by making the state the sole distributor of such prophylactic agents, but in any case their use should be forbidden, and as far as possible prevented, upon dense and wet soils that are not yet contaminated by the bacillus.

7th. Kitt secured immunization by inoculating once only, with dried virus which had been subjected for six hours to steam at 100° C.

8th. In different outbreaks, I have taken the blood from the sick animal, or one that has just died, and heated it for over one hour in a water bath, at 100° C., then broken up the coagulated mass in well boiled water, filtered the liquid and used the filtrate for inoculation in doses of 2 drams, repeated the second day. Great care is taken in keeping the whole mass at 100° C. for the requisite length of time; then in heating the upper part of the vessel, which was above the contents and the water so as to char anything adhering to it; to see that hands, instruments, and all articles used have been thoroughly sterilized; and to dip the hypodermic nozzle in carbolic acid before each injection.

It is not claimed that this method is perfect, since severe, advanced cases may have bacilli and even spores in the blood, and the latter would not be sterilized but only weakened. It has, however, several manifest advantages that may be held to more than counterbalance this danger.

a. It almost infallibly secures the toxins of the disease prevailing in the particular herd, thus escaping the danger of using the weakened virus of emphysematous anthrax on some other disease (anthrax, Wildeseuche, Barbone, etc.), which has been mistaken for it, and which may not be prevented by this purchased product.

b. During life the blood of emphysematous anthrax is usually free from the microbe, and even where that is present it is liable to be in very small numbers, so that we secure either the pure toxins, or if a few germs are present they are so scanty, that weakened as they are by heat, they are without danger to the animal operated on. I have never had occasion to note evil results.

c. There is no danger of the spread of the bacillus to new territory, as we secure the material from a herd in the already infected territory, and use it only on the animals on the same land.

The certainty of results with this method, and the comparative absence of danger of injury to the animal operated on, and of all risk of the extension of the area of infection appeal to me so strongly, that I would not willingly resort to the purchased products, except where it proves impossible to secure the virus on the spot.

ANTHRAX.

Definition. Synonyms. History and geographical distribution. Etiology: Bacillus anthracis. Susceptible animals: small rodents, sheep, horse, camel, ox, goat, deer, stag, man, swine, dog, white rat and bird when chilled, frog when heated; young most susceptible, races long exposed to infection are least. Soils, wet, dense, impermeable, basins, swamps, rich river bottoms, deltas, rich meadows, below tanneries, alkaline soils, wells with surface drainage; season: wet, hot and dry, late summer and autumn; flies; infected buildings, harness, vehicles, fodder, litter, butchers’ knives and wagons, surgical instruments; insolation; privation of water: plethora, starvation: overwork, exhaustion. Bacillus anthracis: rod, nonmotile, 5 to 20μ by 1 to 1.5μ, square ends, isolated in blood, often filamentous in cultures, sporogenous, ærobic, stains easily in aniline and iodine, killed at 131° F. (spores at 203° to 282° F.), action under chemical disinfectants, or septic ferments: air favors sporulation and survival; in shallow graves, water. Infection atria: ingestion, inhalation, inoculation, insects, placenta. Forms: fulminant, internal, febrile, local,—external,—gloss-anthrax, pharyngeal, hæmorrhoidal, subcutaneous. Lesions: blood normal in fulminant, dark, diffluent, crenated or disintegrated globules in prolonged cases, tissues brown or yellow, heart pale; liver enlarged, softened, pale, hæmorrhagic: spleen enlarged, blood-gorged, ruptured; lymph glands hyperæmic; serosæ congested, petechiated, hemorrhagic; lesions embolic and like the blood swarm with bacilli. Toxins, ptomaines. Incubation 1 to 6 days. Symptoms: internal cases: hyperthermia, constitutional disorder, mucosæ dusky, brownish, yellowish, bleeds, bloody urine, rectal mucosa congested, blackish, colics, pharyngeal anthrax, blood diffluent, black, broken down red globules, bacilli, abortions, death in 12 to 48 hours: fulminant cases in cattle and sheep. Local (external) anthrax, cutaneous, swellings: gloss-anthrax; pharyngeal, hæmorrhoidal; sheep and goats; horse; swine; dogs; cats; birds. Differential diagnosis: deductions from symptoms, condition of blood, animals attacked, environment or conditions of life, presence of the bacillus. Examination for bacillus. Post mortem lesions; gelatinoid, bloody exudate, petechiæ, blood-gorged spleen, lymph glands, and liver, diffluent blood, bacilli in capillaries. Inoculation intravenously. Cultures. Prognosis. Mortality often 70 per cent.

Definition. Anthrax is an acute infectious bacteridian disease occurring casually in the herbivora and omnivora and, under favorable conditions, communicable to carnivora, birds and batrachians. Its special features are the presence of the bacillus anthracis in the diseased parts, the destruction of red globules, the arrest of hæmatosis, the occurrence of capillary embolism, extravasations and exudations, and of necrotic processes in the affected parts, and a sanguineous engorgement of the spleen.

Synonyms. Malignant pustule; Splenic apoplexy; Splenic Fever; Charbon; Miltzbrand; Woolsorter’s Disease; Malignant Carbuncle; Contagious Carbuncle.

History and Geographical Distribution. As anthrax prevails in damp, undrained lands where agriculture is backward, it is not wonderful that it can be traced to near the dawn of human history when the whole race lived under primitive conditions. Moses records its ravages on the bottom lands of the Nile (Ex. ix. 9), Homer, on the plains of Troy (Iliad, Bk. 1st), Ovid, Plutarch, Dionysius, Livy, Lucretia, Columella, Virgil, Pliny and the Arabian physicians all show a familiarity with a disease of this nature. Later, Heusinger collects evidence of its prevalence in certain areas in all parts of the world from the equator to the Arctic circle. The mortality was often very high, thus Kirchner records the death of 60,000 people in a single epidemic in 1617, in the vicinity of Naples, Placide-Justin, that of 15,000 in St. Domingo in six weeks in 1770, and on the Russian and Siberian Steppes it is not uncommon for hundreds of thousands of domestic animals and thousands of human beings to suffer in a single year.

The geographical distribution of the disease is largely influenced by soil and climate. On dense, impermeable clays and hardpan subsoils, on river bottom lands, dried lake basins and deltas, rich in organic matter, and with the air driven out by water or gaseous fermentation products, the germ is preserved and propagated if once introduced. Thus it is common around the mouth of the Nile, and along the occasionally inundated banks of the Vistula and Danube, the Spree, Oder, Elbe, Rhine, Eure, Loire, Seine and Marne, and in England in the Fen district. On the rich, undrained, black soils of Siberia it is extremely prevalent and fatal. In the rich Genesee Valley, N. Y., the writer has seen 200 cattle in one herd and three human attendants attacked in the course of a fortnight, and in different meadows receiving the drainage of tanneries, the affection prevails every summer and autumn. It is much more prevalent in the rich lands of the Southern States and a widespread and deadly epizoötic prevailed in Louisiana in 1896. Where the soil is favorable, the germ may be preserved indefinitely, even in mountainous districts, and near Los Angeles, Cal., where the disease was introduced in imported sheep some years ago it has become permanently domiciled, on the dry ranges which have moist lands (Cienegas). When an outbreak occurs, the herds or flocks are usually moved to higher soil, and the carcasses being left unburned and unburied the infection is spreading year by year (McGowan, Morrison).

Etiology. Nothing is more certain than that the disease is due to the introduction into the blood or tissues of the bacillus anthracis or its spores. These microbes are always found in the anthrax lesions and in the blood of the victim in the advanced stages. When grown in bouillon cultures to the hundredth generation they retain their virulence unabridged and determine the same lesions in the animals inoculated. When the infecting culture has been passed through a Pasteur filter the virulence is lost with the removal of the bacilli. The fresh anthrax blood containing bacilli but no spores when subjected to compressed oxygen (50 atmospheres) becomes noninfecting. The same liquid when boiled proves non-virulent.

Certain conditions, however, contribute to the propagation and reception of the bacillus and these may be considered as accessory causes.

Animals susceptible. The receptivity of the animal exposed is of first importance. Young animals are the most susceptible. The small rodents, the mouse, Guinea pig and rabbit are susceptible in the order named, followed by the sheep and horse and these again by the camel and ox. Among the wild herbivora the goat, deer and stag have a high susceptibility. Man is less susceptible yet contracts the disease readily by inoculation, inhalation or ingestion. Swine and dogs are comparatively little susceptible, yet they often contract the disease by eating the carcasses or discharges of anthrax animals. White rats and birds are held to be insusceptible, yet the latter contract the disease readily when the vitality of the system has been reduced by immersing the body in water, or giving antipyrine. A similar result is observed in the otherwise immune frog if the body is heated above the normal cold blooded temperature. The receptivity may vary, however, in the same genus and species. The Algerian sheep is virtually immune from anthrax, perhaps because its ancestors have been so constantly exposed that only the insusceptible strains survived. Swine, birds and carnivora may have similarly acquired a fair measure of immunity by the survival of the fittest. Apart from this, however, a flesh diet is to a certain extent protective, thus Feser’s rats if fed vegetable food proved susceptible to inoculated anthrax, while if fed on animal food they were comparatively immune.

The animal that has survived an attack of anthrax is thereafter strongly immune. This serves to partly explain the apparent immunity of animals bred in an anthrax district, the young animal becoming habituated to infinitesimal doses of the toxins, conveyed in the secretions of the uterine glands or mammæ.

Soil is a factor so far as it preserves and propagates the bacillus. As already stated, soils that are naturally wet by reason of their impermeable character, their position on or near the water level, their conformation in basins which dry out in late summer or autumn, are especially favorable to preservation of the bacillus. Again soils that are specially rich by reason of an excess of decomposing vegetable and animal remains, or because of excessive manuring, tend to preserve and multiply the microbe. Rich, flat meadows below tanneries or abattoirs, and irrigated from these or occasionally overflowed are especially dangerous to stock placed upon them. Soils with an alkaline reaction from the lime, potash or ammonia present are very favorable to anthrax. Wells receiving surface drainage are common factors in carrying infection.