Part 36

In Intestinal anthrax (intestinal mycosis) the lesions are usually concentrated on the small intestines, while the stomach and large intestines in the main escape. The walls of the bowel are of a dark red, and greatly thickened by exudation and extravasation which also mixes with the ingesta giving it a dark bloody tinge. At intervals on the mucosa are nodular hæmorrhagic swellings, from the size of a linseed to a pea, with commencing necrotic changes or the formation of sores. The mesenteric glands are swollen, infiltrated and hæmorrhagic, and like the other lesions abound in bacilli. Hyperæmia and engorgement of the liver and above all of the spleen are the rule.

In pulmonary anthrax (wool-sorter’s disease) a sanguineous liquid is found in the lower trachea and bronchia, and not infrequently in the pleuræ and pericardium. The bronchial glands are swollen, hyperæmic and often hæmorrhagic, and exudations and extravasations may be found in the mediastinum and lungs. Lesions of the intestines and spleen are common, and in all alike the bacilli are found.

In certain cases the anthrax lesions may be found in the brain, or any part of the body but in all they show the same general characters and the same specific microbe.

SYMPTOMS: DIAGNOSIS.

Malignant Vesicle (pustule). Symptoms may vary somewhat but are in the main as follows: An itching papule appears in the seat of inoculation, which might be mistaken for an insect bite but for the dark red color of the centre. Occurring on an uncovered portion of the skin, in an anthrax district, or near a factory where anthrax products are likely to be used, this should at once create suspicion. Soon the dark centre is covered by a small vesicle with clear contents which later become bloody. Within 24 or 48 hours the vesicle dries up, becoming firm, resistant and brownish red or blackish gray, and apparently gangrenous. The swelling has meanwhile extended to ½ or ¾ inch in diameter and a row of fresh vesicles may appear which in their turn give place to a necrotic slough. In this way extension may take place, the sore retaining a more or less rounded form, and necrosis extending from the centre in every direction. The necrotic mass, however, remains firmly adherent to the adjacent tissues until separated by the work of suppuration which ensues in favorable cases. The disease is attended with more or less fever, chill, hyperthermia, nausea, diarrhœa, with aching of head, back, and limbs and unfavorable cases may merge into acute and fatal general anthrax. The mortality is about 20 per cent., though in special epidemics it has reached 80 per cent. (With the pustule on the face 25 per cent.; on the lower limb 5 per cent., Norris). The prognosis is favorable with a free concentration of leucocytes, a moist condition of the wound and above all a liberal invasion of pus cocci. It is unfavorable when the wound is dry, when the drying slough remains firmly adherent and when the adjacent lymph glands become implicated. In non-fatal cases it may be difficult to find the bacillus.

Anthrax Œdema. This is less easily diagnosed than malignant vesicle, and appears where the connective tissue is loose, abundant and little vascular, from direct local inoculation, or as a concomitant of internal anthrax. It is a flat, rapidly extending swelling, with the skin comparatively unaltered, though at points yellowish or reddish discoloration indicates congestion and extravasation. Not being limited by firm tissues nor aggregations of accumulating leucocytes it tends to a speedy general infection with all the febrile manifestations of that condition. Thus chills, nausea, hyperthermia, dusky reddish or brownish mucosæ, cephalalgia, rachialgia and profound prostration assist in diagnosis. The bacilli in the blood and exudate would serve to confirm the conclusion.

Intestinal Anthrax. Here again the ingestion of anthrax products, and the simultaneous attack of a number of people who have taken such materials will often assist in diagnosis. There may have been for some days indications of local bowel lesions, such as chilliness, elevation of temperature, nausea, headache, and giddiness. Suddenly these become more violent, there is vomiting and sanguineous diarrhœa, extreme anxiety and debility, cyanosis, dyspnœa, and it may be the appearance of petechiæ on the skin and mucosæ or even of local swellings. In some cases there are convulsions or other symptoms of nervous disorder and in others extreme prostration and collapse. The bacillus is not always to be found in the circulating blood, but may be detected in sanguineous excretions, or by cultures.

Pulmonary Anthrax. (Woolsorter’s disease). Here again the occupation of the patient assists in diagnosis. For two to five days prodromata similar to those of intestinal anthrax may be noted. The difficulty in breathing, dyspnœa, cough, cyanosis and sense of constriction of the chest are especially diagnostic. Suddenly all these symptoms are aggravated, respirations become 30 to 40 per minute, the pulse 120 to 150, the temperature 104° to 106°, and there is a frothy bloody expectoration in which the bacilli may be detached. There may be indications of intestinal, cerebral or nephritic lesions, and bloody discharges. Death usually occurs in 12 to 48 hours from collapse, or coma, from asphyxia or in convulsions. The few recoveries are tardy and tremors and spasms persist for a length of time. In the most favorable cases the disease does not proceed beyond the initial stage.

PROPHYLAXIS AND TREATMENT.

Prevention is the most important consideration and this will include all that has been stated above with regard to the restriction of the disease in flocks and herds, the drainage and improvement of anthrax lands, the seclusion, destruction, deep burial or cremation of carcasses without autopsy or incision, the disinfection of stalls, secretions and all contaminated products, and the suppression of all traffic in anthrax products—meat, milk, blood, guts, bones, horns, hoofs, hair, wool, bristles, etc., or the thorough disinfection of the same. Above all, is the adoption of personal precautions. No one should handle anthrax animals, nor suspected products who has any sore or abrasion on hands or face, or such sore may be temporarily covered with a film of albuminate of silver, or the hands may be washed with a solution of mercuric chloride (1:500), or chloride of lime (1:200). If persons must work in wool or textile products which are open to suspicion a respirator is an obvious precaution, and this may be disinfected by live steam at intervals.

Treatment of malignant pustule is mainly surgical. At the outset the thorough destruction of the dark central point or nodule with a red hot needle or powerful caustic will be sufficient. Even when the pustule is fully formed, its free excision with as much of the surrounding infiltrated tissue as can be safely accomplished and the free application of caustics will usually succeed. Potassa fusa, or zinc chloride (1:3), or mercuric chloride or iodide in powder with or without calomel, or pyoktanin, or formaline, or iodized phenol may be named as especially applicable. Injections of carbolic acid (5 or 10:100) into the indurated centre and infiltrated periphery have proved very successful. In the case of Kaloff, when the excision of the nodule followed by the local use of carbolic acid solution, failed to prevent implication of the inguinal and pectoral glands, violent fever, prostration, and diarrhœa; the excision of the affected glands and the free use of phenic acid solution (5:100) in the adjacent tissues led to speedy improvement. Some surgeons make a crucial incision of the pustule and apply caustics freely. Muskett has been successful in excising the nodule, filling the wound with ipecacuan powder and giving the same agent internally. Many mild cases, or those that occur in refractory systems will however recover spontaneously or under a less drastic treatment. In the anthrax districts of Russia mercurial ointment is rubbed on the sore, and the application of tincture of iodine or iodized phenol to the raw sore or incised nodule and surrounding infiltration is often successful.

Camescasse has claimed great success by incising the swelling, applying tincture of iodine freely, and then wrapping in cloths kept wet with a solution of 5 drachms of bicarbonate of soda in a quart of tepid water.

When systemic reaction has set in it is desirable to have resort to general medication as for internal anthrax.

Treatment of Anthrax Œdema must follow the same rule. Free incisions into the œdematous tissues with the application of antiseptics, solution of mercuric chloride or biniodide (1:1000), or the injection of the whole infiltrated area and around it with the same agents, with phenic acid (5 or 10:100), or with pyoktanin (1:1000) will prove useful, and as in the malignant pustule the surface should be kept disinfected by a compress wet in solution of the mercuric chloride or biniodide, carbolic acid, iodized phenol, formalin or pyoktanin. If the pain of these applications is very acute cocaine will be demanded or even ether. If ether is applied to the surface its evaporation will cool the parts and retard the proliferation of the bacillus. Under other conditions cold water, pounded ice or snow may be applied.

Treatment of Intestinal Anthrax. When anthrax flesh has been eaten, or when there are symptoms of incipient intestinal anthrax, the first resort is an emetic of ipecacuan, followed by an active oleaginous purgative to clear the prima viæ of bacilli and their toxins. To these may be added potassium iodide, pyoktanin, sodium salicylate, quinine or tincture of muriate of iron, by way of keeping in check the multiplication of bacilli. To counteract depression and heart failure digitalis, strophanthus or strychnia with alcoholic stimulants may be resorted to.

In Pulmonary Anthrax the same principles are applicable. The patient may be made to cautiously inhale gaseous chlorine, iodine or bromine or a solution of iodide of potassium in an atomized condition. The vapor of carbolic acid, eucalyptol, or oil of cinnamon may be tried.

The irritable stomach may be soothed by oxide of bismuth, with milk, beef tea and other bland nutritive or stimulating draughts.

The grave character of internal anthrax, however, is such that resort may be had to one of the various antitoxins, antidotal cultures, serums, and immunizing agents that have proved useful in different hands. Unfortunately such agents do not seem to act in the same manner on all genera, and what has been effective in one of the lower animals may fail in the human being. Thus Roger found that sterilized cultures of bacillus prodigiosus retarded or obviated anthrax in rabbits, but hastened its progress in the Guinea pig.

The sterilized cultures of the pneumococcus of Friedländer (Buchner) of the bacillus pyocyaneus, or of the staphylococcus pyogems aureus, (Pawlowsky) when injected subcutem have proved antidotal to anthrax. Emmerich has successfully used erysipelas serum subcutem in the treatment of anthrax. (Münch. Med. Woch. 1894). The sterilized cultures of the streptococcus erysipelatos therefore offer themselves as promising curative agents. The same is true of the sterilized cultures of the bacillus pyocyaneus (Woodhead and Cartwright-Wood).

The blood serum of animals that are naturally immune (frog, white rat, pigeon, dog,) is bactericidal and to a certain extent antidotal to the bacillus anthracis, but that of an animal which is naturally susceptible but which has been artificially immunized has proved much more potent. In the experience of the writer this potency attaches no less to the blood of an animal in the advanced stages of the disease. In adult cattle he has found the symptoms of anthrax subside under two successive daily doses (4cc.) subcutem of the sterilized blood serum of one of the herd which had just died. Relapses were observed several days after the serum treatment was abandoned. In experiments on rabbits two check animals with anthrax inoculations died at the end of 3½ and 4 days. Of six inoculated with anthrax and injected from one to three times with sterilized (anthrax) blood serum one recovered, and the others died, one at the end of the 7th, two of the 6th and two of the 5th day. In this connection it may be stated that successful treatment by leucocytes is claimed, (Pawlowsky) and that one of the effects of serum treatment is the destruction in part of the globules and the release of nuclei, and in this we may have an explanation in part at least of the therapeutic action of the serum from the infecting and immunized animal.

Protective serums may be utilized by hypodermic injections daily or every second day for a week, giving time for the disposal of the bacilli present in the system. In the intestinal anthrax they may be given by the mouth and injected into the peritoneal cavity. In pulmonary anthrax they may be introduced into the trachea, bronchi and pleural cavity.

GLANDERS.

Synonyms. Definition: Acute, infectious, microbian disease, often localized in lymph glands and plexuses of nose and air passages, etc.; with hyperplasia, degeneration, necrosis, liquefaction. Affects solipeds, and, by inoculation, man and all domestic animals save cattle, chickens and (usually) swine. Geographical distribution and historic notes: known in Ancient Greece; now where solipeds live and fresh subjects are exposed; Central Europe; great horse trade and movement; war, Franco-German, Napoleonic, Afghanistan, American Civil War, Boer War. Unknown in Australia. Susceptibility: solipeds, Guinea-pig, rabbit, goat, cat, dog, pigeon, sheep, and swine in low condition. Cattle, chickens, white and house mice, linnets, chaffinches, and frog immune. Microbe lives in frog in water at 86° F. Cause: Bacillus mallei. Accessory causes: trade in solipeds, mingling of sound and sick, crowding, common feeding and drinking troughs or buckets and racks, debility, low condition, starvation, overwork, damp, dark, draughty stables, carriage in transports or cars. Insular quarantined lands—Australia, Tasmania, and New Zealand exempt. Bacteriology: Bacillus Mallei; 2 to 5μ by 0.5 to 1.4μ, nonmotile, ærobic grows in ordinary culture media, stains tardily but is easily bleached. Spores uncertain, easily killed by disinfectants, preserved in stables, does not grow in infusion of hay, straw or horse manure, lives 15 to 20 days in water; infection by coitus, and through placenta, by ingestion, by blood transfusion, through dust; microbe in all lesions and discharges, (unless sometimes in milk, sperm, etc.). Infection-atria: skin wound, mucosa, hair follicles, lungs. Forms: Acute, chronic, nasal, pulmonary, cutaneous (farcy), orchitic, arthritic, abdominal, occult. Symptoms: nasal; incubation, 3 to 5 days, languor, weariness, stiffness, horripilation, tremors, inappetence, thirst, hyperthermia, epiphora, snuffling, nasal discharge, serous, viscid, agglutinating, purulent, swollen alæ, violet mucosa, elevated spots and patches with central ulceration, may become confluent, and involve submucous tissues; submaxillary lymph glands swollen, nodular, not tender, non-suppurating, swollen (corded) facial lymphatics, from nose, eye or lymph glands; swellings, cutaneous and lymphatic in skin of limb or body, ulcers (farcy buds), deposits in throat or lungs; chronic cases; slow, indolent, persistent, nasal discharge—unilateral (or bilateral), viscid or not, nodules on mucosa with whitish centres or points; red areolæ, later ulceration, puckered white cicatricial lesions, submaxillary swelling, nodular, large or small, insensible; cutaneous cases; arthritis with lymphangitis, skin engorgement, corded lymphatics with ulcerating nodules, sanious discharge, intermuscular abscesses. Occult cases: lesions in internal organ;—cough, leucorrhœa, enlarged testicle, low condition, weakness, lack of endurance. Diagnosis: inoculation of male Guinea-pig in flank or peritoneum,—ulcer and orchitis, cat, dog, old soliped; mallein test,—swelling, involving lymphatics, fever, 1.5° to 2.5 F. and upward above normal, at 10th to 18th hour, lasting two days. Lesions: cell proliferation in nests in fibrous stroma, pea upward, central degeneration, fatty debris, ulcer or abscess, hyperplasia of lymph vessels, on nasal mucosa like sand-grains, peas, patches, centre grayish or yellowish, blood extravasation, necrotic degeneration, ulcer with ragged edges; fibroid degeneration—cicatricial lesion; lesions in guttural pouch or tube, larynx, trachea, bronchia; lungs—peribronchial, lobular or interlobular inflammation, cell proliferation in foci, degeneration—nodules—and caseation; skin,—cell proliferation, degeneration, rupture, fibroid hyperplasia of lymphatics, exudates in connective tissue; dependent lymph glands congested, hypertrophied, cell proliferation, caseation; lesions in pharynx, spleen, kidney, heart, brain, testicle, scrotum, mammæ, vagina, uterus, joints, bones; bone fragility. Glanders in swine, sheep, goat, rodent, dog, cat.

Synonyms. Malleus, Equinia, Farcy.

Definition. An acute infectious disease caused by the bacillus mallei, which tends to localize itself in the lymphatic glands and plexuses, especially of the nose and upper air passages but also in other parts of the body, where it produces a progressive hyperplasia, with a strong tendency to degeneration, necrosis, and liquefaction. It occurs casually in horses, asses, mules and other solipeds, and is communicable to man and all domestic animals except the bovine races, chickens, and, under ordinary circumstances, swine.

Geographical Distribution. Glanders (Malis) appears to have prevailed in asses in Greece as noted by Aristotle. Its contagious prevalence in horses is recorded by Absyrtus in the time of Constantine, and again by Vegetius Renatus in 381 A.D. At the present time its existence is almost coextensive with the equine family, but its prevalence is in a direct ratio with the facilities for the infection of fresh subjects. In the central countries of Europe where the equine population is greatest and where there is the most extensive trade and movement among horses it secures the greatest relative number of victims. War with its constant opportunities for infection, in crowded cavalry and artillery stables and the successive changing of place, tends greatly to enhance its ravages. Thus in the German army it rose from 966 to 2058 per 100,000 per annum in the year of the Franco-German war; in Spain it was practically unknown until the Napoleonic war in the Peninsula, but after this it proved a veritable scourge; in Hindostan it was hardly known until the Sepoy rebellion yet its ravages greatly hampered the army movement in Afghanistan in 1879; and in the United States it became very prevalent in the armies during the Civil War of 1861–4, and was widely scattered over the whole country on the sale of the army horses and mules. Since that time, as before, it has been most prevalent in the car stables of the great cities, though it has also gained a wide extension in many great horsebreeding establishments in the Rocky Mountain region, where however it proves much less destructive than in the East.

It is unknown in Australia, whence it is excluded by a rigid system of quarantine.

Susceptibility of Different Animals. Horses, asses and mules are the most susceptible, and it is only exceptionally that the disease is contracted casually outside the class of solipeds. The Guinea pig and rabbit are susceptible to glanders in the order named and the former is especially available for experimental diagnostic inoculations. The goat, cat and dog sometimes contract the disease from living in stables with glandered horses, but infection is much more certain when they are inoculated. The pigeon is also susceptible. In the dog the disease is rarely fatal, but the ulcerations tend to heal in 14 days and recovery ensues. In sheep and goats too, many cases recover though in other cases an internal infection takes place followed by death. Swine are comparatively insusceptible, but they may be successfully inoculated when in ill health and low condition. (Spinola, Cadeac and Malet). Cattle and chickens have uniformly proved refractory even on inoculation. White and house mice and rats, have proved immune, also linnets and chaffinches and the frog at ordinary temperature. If however the frog is placed in water at 30° C., he may be successfully inoculated and, though it does not prove fatal, the bacillus may be found in the blood and tissues after a lapse of 50 days.