Part 35

Other methods have been followed, as growing the bacillus in the blood or serum of immune animals (dog, chicken, pigeon, white rat, frog).

Of these different methods that of Pasteur has been most extensively adopted. The temperature of culture (42° C.) prevents the formation of spores and the duration of exposure to air gradually lessens the virulence until in 12 or 13 days it is not fatal to the Guinea pig and after 31 days it fails to kill the young mouse. Thus preparations of varying grades of virulence, and adapted to the varying susceptibility of different animals, are secured. The protective inoculation is made by preference in spring, when there is less chance of complication by a coincident accidental infection, it is to be avoided if possible in animals at hard work, in advanced gestation, in full milk, in extreme youth, or in ill health. To secure the best results it should be repeated with a stronger preparation 12 to 15 days after the first injection. The acquired immunity lasts a year and over, and it is probably perpetuated by new and non-fatal doses taken in casually, on the anthrax pastures. Hundreds of thousands of live stock in all parts of the world have been treated in this way with the result of reducing a mortality of two, five or ten per cent. to insignificant proportions. It can only be safely adopted on anthrax lands, as elsewhere it may lead to the stocking of new areas with a malignant germ which in young and susceptible animals reacquires its original virulence.

It can never be safely ignored that we are dealing with the living seed of a most deadly infection. Though robbed of a large part of its virulence by artificial culture at 107:5° F., yet many accidental conditions, contribute to a relapse to its original potency, and when it has once killed a victim, the reacquired virulence is usually persistent. If the virus employed for protective purposes in cattle and sheep, is inoculated on Guinea pigs of 1 to 30 days old, from these on those of several months, and from these last on sheep, the virulence is constantly and persistently enhanced. The same is true of the microbe which is inoculated on a succession of pullets of steadily encreasing ages (Roux and Chamberland), or on a succession of pigeons (Metchnikoff). The germs reinforced in potency in any such way are liable to be the starting points for dangerous infections in animals and permanent contamination of soils and waters. Fortunately an occurrence of this kind is rare, yet with a wide application of the Pasteurian inoculation the opportunities also are great, and with the free sale and distribution of the mitigated virus (anthrax “vaccine”), the evil may grow indefinitely. The method departs from the ideal one, aimed at a final extinction of the disease, and accepts in place a mere temporary protection of the herd or flock, and though in this affection eradication cannot always be secured, every effort should be made to gain it and above all to prevent an encrease of the area of infection.

Technique. The weakened virus (1st “vaccin”) is sold in tubes holding enough for 100, 200, or 300 sheep. Of this ⅛ cc. is injected subcutem on the inner side of the thigh of the mature sheep, and 12 or 15 days later a similar dose of the stronger preparation (“2d vaccin”). For the ox or horse double the amount (¼th cc.) is used, being injected behind the shoulder, and on the side of the neck in the respective animals. The dose is graduated in the different subjects according to the size and age, yet a considerable latitude is permissible. The syringe must be disinfected before and after inoculations by a 5 per cent. solution of carbolic acid, or by boiling, and the nozzle should be dipped in strong carbolic acid immediately before and after each insertion. This will greatly obviate infection of the liquid used, and of the wound by any virulent germs lodged on the surface of the skin. The liquid to be injected should be used as soon as possible after preparation, and if kept should be in a dark cold place, and if the tube is once opened the whole of its contents should be used the same day,—never kept over. The second, stronger preparation should never be used until the system has been prepared for it by the use of the first.

By the Soluble Toxins in Sterile Solution. In 1884, in an outbreak of anthrax in Skaneateles, N. Y., I drew blood from an anthrax cow, subjected it to 212° F. for 30 minutes, dissolved out the soluble toxins in boiled water, and injected the product subcutem, in the dose of 2 to 4cc. according to size, into every apparently healthy member of the herd, excepting one, which was left as a check. The check animal died of anthrax while all of the others escaped.

Since that time I have personally used it in every herd where opportunity offered, and with equally good results. In an outbreak near Elmira, Dr. Moore adopted it in a large dairy herd, and the disease was suddenly arrested.

In several experimental cases (one cow and 2 Guinea pigs) at the N. Y. S. V. College, the outcome was not so satisfactory and in a herd in Oneida Co., N. Y., it is said to have failed to check the disease.

Notwithstanding these untoward results in other hands, I am still confident that we have in this a measure of no small value, and worthy of application in suitable cases. A certain percentage of failures in immunization are to be looked for. Even cowpox vaccination is not always protective against itself; I knew one man who was successfully vaccinated every three years in a comparatively long series. Many habitually self-limiting diseases relapse in particular individuals. Even in the case of anthrax excess of glucose in the system, and the lack of some unknown influence of the spleen are respectively destructive of immunity. Even after the Pasteurian inoculation a certain number of inoculated animals are lost, it may be between the first and second injection, or it may be “two or three months” after the latter (Galtier). We must also bear in mind that in an infected herd or flock, there are always a certain number already infected at the time of the protective inoculation, and as the protective conditions are slowly established, through the action of the leucocytes, it is unreasonable to expect that serious illness and death can be obviated in such animals.

In inoculation with the Pasteur lymph, the bacillus is held not to enter the blood, a position supported by the researches of Bitter, Perroncito, Wissokovicz, Lubarsch, Metchnikoff, Chamberland and Roux, so that the resulting immunization must come from the toxins. Add to this that Chauveau (1885), conferred immunity on a sheep by injecting intravenously, anthrax blood, defibrinated and sterilized by heat: Arloing obtained immunity in the sheep by injecting, subcutem, the clear supernatant liquid from old bouillon cultures of anthrax, from which all bacilli had been precipitated. Roux and Chamberland obtained the same result by using the pulp of an anthrax spleen treated with essential oil of mustard, so as to destroy the life of the bacillus, and then evaporated in vacuo to remove the essence. Smaller doses proved effective, than when the splenic pulp had been filtered or sterilized by heating to 58° C.

The advantages of using sterilized toxins are numerous:—

1st. As the material can be derived from a case of the outbreak in hand, there is no risk of using the anthrax protective inoculation for black quarter, hæmorrhagic septicæmia or other disease which is so often confounded with it.

2d. There is no danger of the sudden enhancing of the potency of a weakened microbe on account of some condition of the animal inoculated, as no living microbe is employed.

3d. There is no possibility of planting the anthrax bacillus, on new soil, as is so liable to take place in using the weakened microbe.

4th. There is no necessity for the care and cost of holding the inoculated animals apart by themselves, under official veterinary control for 15 days, of withholding their products from market, or of disinfecting the place where they have been kept. On the contrary the animals inoculated can be treated in every way as if no such injection had been made.

Thorough Drainage and Æration of Land. The most thorough and permanent method of eradicating anthrax is by thorough æration of the soil. In dry, sandy, or gravelly soils, having a good natural or artificial drainage, and not underlaid by an impermeable damp stratum, the bacillus is never permanently found, and, if introduced, is slowly robbed of its virulence by the action of the oxygen. When a soil can be well and permanently ærated by thorough underdrainage, a few years suffice to rob it of its infecting property and render it salubrious. In many localities, however, this is actually or economically impossible, so that the owner is thrown back on the alternatives, of abandoning the soil for stock, or of immunizing all the animals placed on it.

Prevention of Importation of Anthrax. To prevent the introduction of anthrax into a country or district, the usual control must be exerted on trade in cattle and their products, as in the case of other infectious diseases. The exclusion of livestock from an anthrax-infected country or district, or the admission after 6 to 10 days of quarantine and the disinfection of the surface of the animal. Dried hides, horns, hoofs, hair, wool and bristles are even more dangerous, as they are liable to hold the microbe in the spore form which will survive indefinitely and plant the disease widely. The recent great extension of the disease along the Delaware River, in connection with the morocco factories, which draw their hides from the most virulently anthrax regions (India, China, Russia, Africa, S. America) is a strong case in point, and nearly every tannery planted on a favorable soil is an example on a smaller scale. Disinfection of all such products on arrival is essential. But this should be thorough, and no question of trouble nor expense should stand in the way. If the trade cannot stand the expense, it has no right to exist where it is, at the expense of threatened ruin, local and ultimately general, of agriculture, on which all other industries are based. Similar control is demanded of live stock products from infected regions in America.

The control of home markets, stockyards, and abattoirs is no less important. Fortunately the disease is shortlived and deadly, and is much more easily discovered and arrested than in the case of plagues with prolonged incubation and frequently occult form (glanders, tuberculosis). An inspection of the various markets, and the detention of herds that have shown anthrax infection would do much to limit extension. This would entail the disinfection of the infected places, cars, boats, harness, clothing, and other things, and of the skins of the healthy animals of the infected herd.

The Therapeutic Treatment of anthrax in animals must in the main follow in the same lines given below for the human being; locally, antiseptics (mercuric chloride or iodide, Luzol’s solution, hydrochloric acid, phenic acid, iodized phenol, creoline, cresyl, oil of turpentine, formalin, salicylic acid, scarification, excision of the primary sore or swelling with antisepsis, antiseptic injections into the swelling.) Internally, there have been employed, dilute phenic acid, creolin, terebene, calomel, quinine, hydrochloric acid, bichromate of potash, tincture of iron chloride, etc. (see below).

ANTHRAX IN MAN.

Causes: infection from animals and their products, from soil, by flies, by dust. An industrial disease, of workers among animals and animal products. Wounds as infection atria, ingestion anthrax, inhalation. Lesions: malignant vesicle, anthrax œdema, intestinal anthrax: pulmonary anthrax. Symptoms: malignant vesicle, œdematous anthrax, intestinal, pulmonary. Prevention. Treatment: caustics: antiseptics, excision of nodule and subsidiary glands, mercurial ointment, iodine, sodium bicarbonate. For intestinal anthrax: emetic, oleaginous purgatives, potassium iodide, sodium salicylate, iron muriate, heart stimulants. For pulmonary anthrax: inhale chlorine, iodine, bromine, phenic acid, eucalyptol, oil of cinnamon, sterilized cultures of prodigiosus, pneumococcus of Friedländer, bacillus pyocyaneus, staphylococcus aureus, or streptococcus: blood serum of immune animals: blood serum (sterilized) of anthrax cattle.

Causes. Anthrax in man is usually the result of contamination by infected animals or their products. It is quite possible that man, like animals, may be infected directly from the soil or water, or from the same source through the medium of flies or windblown dust, yet undoubted cases of this kind are rare or unrecognized. The animal origin of the disease, as regards man, makes this largely an industrial affection, attacking shepherds, cattlemen, horsemen, farmers, drovers, butchers, veterinarians, tanners, and workers in hides, wool, hair, bristles, furs, hoofs, bones, rags, felt, glue, and even leather. The sound skin is sufficient protection, but the slightest abrasion may form an infection atrium. Workers in tanneries and those who live near them are notoriously subject to anthrax. The hides must of course be drawn from an anthrax region. Russian, Armenian, South American, Australian and African hides have an especially bad reputation. The British Medical Journal, May 21st, 1898, records cases occurring in postal clerks who had to handle foreign parcels bound with strips of hide. Proust records cases from handling Chinese goat skins (Bull. de l’Acad. de Med. 1894). Infection may also occur through leather made from infected hides as proved experimentally on Guinea pigs.

Hair has long been recognized as a frequent medium of infection and outbreaks among brushmakers have been recently recorded by Gerode, Sarmont and Chauveau. (Compt. Rend. de l’Acad. des Sc. 1893). Trousseau reports twenty cases in Paris, all contracted from South American horse hair. Wool from infected countries is often dangerous and has given rise to special names for the disease (wool-sorter’s, rag-picker’s) which may be developed in the lungs from inhalation of the dust. In the same way those who handle bones about fertilizer, glue and rendering works, are particularly exposed. The agency of insects in man is undoubted. In sixty cases recorded by Dr. Bell, fifty-four were on the face, two on the hands, one on the wrist and one on the forearm. This is mainly due to blood-sucking flies, yet Heim incriminates the coleoptera as well (Compt. Rend. de Soc. de Biol. 1894). Wounds of all kinds contribute to inoculation, hence, the presence of burdocks, thorns, thistles and the like in the matted wool or hair is often a direct cause of infection.

The infection may be transferred on surgical instruments, and in these days of hypodermic medication the greatest care is necessary to prevent infection through the needle.

As in animals man suffers from ingestion and inhalation of the bacillus; and sometimes widespread mortality comes in this way. Meat just killed may be thoroughly disinfected by the secretions of a healthy stomach, yet the bacillus may pass through in an envelope of fat, in an undigested mass or during an attack of dyspepsia, and infect the intestines. The spores are proof against the gastric juice, and as they are produced in a few hours after death the meat of an anthrax animal must always be considered as exceedingly dangerous.

Man is much less susceptible than some other animals and the disease wherever inoculated tends to remain for a time localized, in the skin, the lungs or the bowels. The forms of the disease are malignant carbuncle (pustule), malignant œdema, intestinal anthrax, and pulmonary anthrax.

Lesions. The morbid histology is in the main the same as described in animals. In the protracted cases there is the same dark nonærated blood, forming a loose coagulum, the crenated or distorted blood globules aggregated in irregular masses, the escape and solution of the hæmoglobin so as to stain the white tissues, the enlargement of the spleen which is gorged with dark blood, and the hyperæmia of the liver and lymph glands. There is in the affected tissues and usually in the blood the characteristic large bacillus anthracis.

In the malignant vesicle there is first a minute, firm central, dark nodule like an insect bite with a lighter colored areola, and showing not only hyperæmia, but blocking of the capillaries, and minute areas of extravasation. Somewhat later the dark centre is surmounted by a small vesicle, beneath which the tissues are becoming necrotic, and the area of congestion and extravasation has extended and thus the local disease advances by a constant invasion of new tissue which in its turn becomes the seat of coagulation necrosis. On microscopic section the central necrotic part shows the cells of the rete Malpighi separated by a finely granular coagulum, and the papillæ are greatly swollen by serous and hæmorrhagic exudate. The cell nuclei are necrotic and no longer take a stain. The capillaries are gorged with red globules and bacilli. In the surrounding tissues there is much congestion and exudation, with numerous points of extravasation, but the abundant multinuclear cells retain their staining power.

In Anthrax Œdema, which appears in parts like the eyelids, neck and forearm where there is an abundance of loose connective tissue and a scanty blood supply, there is no firm central nodule, but a diffuse soft infiltration, with points or patches of a yellow or reddish color. The capillaries are congested, with minute emboli and extravasations and there is an excessive and rapidly spreading exudation. It shows a great tendency to early general infection and may end in vesication and local gangrene or in favorable cases in resolution.