Part 39

There may be various complications as deposits in the lungs with pain in the chest, weak cough, aphonia, bloody expectoration and offensive breath; or the morbid process may take place in the liver or spleen with pain in the hypochondrium and much prostration and even icterus; or the muscles, bones, joints or testicle may suffer and the symptoms may suggest typhoid fever, pyæmia, osteomyelitis, or acute general miliary tuberculosis. The bacillus can usually be detected in the blood.

Acute glanders may prove fatal in three days or it may be prolonged for two, three or even four weeks.

Chronic glanders in man usually confines itself to the cutaneous muscular and osseous systems. It may take on an indolent type with the formation of skin nodules in groups or chains which remain hard and show no tendency to soften nor ulcerate. The adjacent lymphatic glands may become enlarged and indurated and the affection strongly resembles tuberculosis of the skin. Later when the nodules have softened and formed irregular and obstinate ulcers with swollen lymphatic glands, the disease is easily mistaken for syphilis. From pyæmia and septicæmia it is usually to be distinguished by the comparative absence of chills, and by the more sanious character of the pus. From syphilis it may be distinguished by the futility of a course of potassium iodide, and the general history of the case and probable exposure of the patient, and for tuberculosis the same principles will apply. In case of uncertainty, inoculation may be resorted to on the horse in suspected syphilis and on the pig when there is suspicion of tuberculosis. Or conversely the ox may be employed for the latter disease as he is altogether insusceptible to glanders. As a last resort the discovery of the bacillus may be made or the mallein test may be adopted with the concurrence of the patient.

Pathological Anatomy and Diagnosis. This is fundamentally the same as in the horse. The bacillus and its toxic products act on the infected tissues to produce clusters of lymphoid cells in a fibrous stroma after the manner of tuberculosis. Like that disease it also tends to affect primarily the lymph channels and glands, showing a particular tendency to the respiratory mucosa and has a great disposition to early coagulation, necrosis, ulceration, suppuration and abscess. The giant cell of tuberculosis is not a prominent feature in glanders, and the disposition to suppuration is greater especially in the human being so that the disease often resembles pyæmia. As in solipeds, however, the glander abscess has somewhat more sanious or glairy contents and the investing wall is not smooth and regular, but uneven and ulcerous from the successive softening and discharge of the clusters of degenerating lymphoid cells in the adjacent tissue. The pallor of the adjacent tissues from exudation and from the presence of numerous nests of lymphoid cells, the thickening of the efferent lymphatics, and the presence of numerous lymphoid neoplasms in the adjacent glands, and tissues, and often in the internal organs such as the liver and spleen and in the nasal mucosa or lungs together with the history of the patient’s exposure to glanders serve to diagnose from pyæmia. From smallpox and rötheln the skin lesions are distinguished by the presence of a central coagulation necrosis bathed in a glairy seropurulent fluid, and by the infiltration and thickening of the efferent lymphatic trunks. It differs from erysipelas in the same way by the presence in the affected tissues of the small hard lymphoid masses of embryonal tissue, and in a more advanced stage by the granular fatty debris resulting from their fatty degeneration. The presence in the affected tissue of these miliary or pea-like neoplasms in all stages of development from the primary congestion, through the embryonal tissue to the coagulation necrosis and caseation or softening is characteristic of the lesions of glanders. The sanious, sticky or glairy pus is especially noticed in the newly opened abscess, as after exposure to the air it is speedily infected with pus microbes, and the discharge becomes less serous and more creamy. Another characteristic of glanders in man is the frequent implication of the bone marrow, and the formation of the lymphoid deposits in the cancellated tissue until the bone may be reduced to a mere friable shell. Even when the disease is localized in the nasal mucosa it extends rapidly, not only to the skin and muscles, but also to the cartilage and bones of the face, so that deep, wide, perforating and destructive ulcers are common. The enlarged ends of the long bones of the limbs are favorite seats of the lesion, and the synovial membrane of the joints and the articular cartilage often bear centres of lymphoid proliferation. Though usually small the intermuscular neoplasms may form abscesses as large as a hen’s egg. The affected muscle appears pale, degenerated and granular with foci of lymphoid cell growth. The swelling of the lymph glands is usually less than in the soliped though the same in character. The pulmonary neoplasms are histologically almost indistinguishable from tubercle, though the comparative absence of the giant cell, the different staining qualities of the bacillus, and the coincident lesions in the upper air passages, with the cord like infiltration of the walls of the lymphatics may assist in diagnosis. Diagnostic inoculation may be made on the basis of the susceptibility of the ox and white mouse to tuberculosis, and their insusceptibility to glanders; also the partial insusceptibility of the soliped to tuberculosis and his marked susceptibility to glanders.

The characteristic nodules and abscesses may be found in different internal organs such as the stomach, intestine, liver, spleen, kidneys, testicles and brain, especially in acute cases, whereas the lesions of the skin and nose are more common in chronic cases.

PROPHYLAXIS AND TREATMENT OF GLANDERS.

Extinction. Exclusion, in Australia, New Zealand, English army. Occision of infected, and disinfection of stables, harness, vehicles, utensils, manure and other infected things, mallein diagnosis; attendants should avoid handling suspicious horses, except with sound hands, and disinfect latter. Sheep living in horse stables, tested before slaughter, or inspected after. Malleinization on Plains and in high, dry air, in secluded herds: less hopeful elsewhere. Mallein test for all solipeds from glanders districts, and imported horses. Treatment illegal in many states, so that justice would require extinction with indemnities. Successful on high tablelands and mountains. Demands careful segregation and disinfection. Acute cases always hopeless: chronic skin cases more promising. Antiseptic injection of unbroken nodules (carbolic acid, potassium permanganate), also of open sores (mercuric chloride, iodized phenol, cupric sulphate, saturated, zinc chloride), excise nodule. For delicate mucous surfaces Lugol’s solution of iodine or iodized phenol diluted. Tonics: arseniate of strychnia, copper biniodide, baryta nitrate, iron sulphate, sulphites, bisulphites, hyposulphites, phenic acid, open air life at pasture, or thorough ventilation, sunshine, moderate exercise, generous, partly grain diet. Mild cases in separate herd, in secluded, wide pasture with rich diet, including grain, and shelter in clean, comfortable shed at will, under tonics and antiseptics, tested by mallein at intervals, to be restored individually to work after two or more tests without reaction. Serum of immune animals subcutem. Treatment in man: surgically as in the horse, excision, curetting, antisepsis, abscesses opened and disinfected; iodoform insufflations, antiseptic gases, sprays and solutions. Internally: tonics, sulphocarbolates, iron muriate, iodides, phenic acid, quinia, strychnia, arsenite, stimulants, serum treatment, pure air, out door life, rich, digestible food.

Radical efforts at prevention must look to the extinction of the disease in the soliped, and its complete exclusion from Australia and New Zealand shows that such a result is not unattainable. In the English army where every glandered horse is at once killed and all pertaining to him disinfected, the disease is now virtually unknown except in the case of newly purchased horses or regiments operating in the field. In the French army which formerly lost 9 per cent. per annum from glanders, now under similar precautions loses but .5 percent. A law providing for the prompt destruction of every glandered soliped and the safe disinfection of carcasses, stables, harness, vehicles, utensils, fodder, litter and manure that have been exposed to contamination, if enforced, would soon eradicate the disease. But this law should provide efficient machinery for its enforcement, and, under suitable safe guards, an appropriate indemnity for the owner. With the use of mallein in all infected studs, as a diagnostic agent, the campaign can be made sharp, short and effective, instead of waiting as in the past for the slow development of occult cases.

The greatest and most fundamental error in veterinary sanitary legislation is the lack of a guarded indemnity for the animals killed. I strongly urged this fact on the committee of the N. Y. legislature in 1898 but to no purpose. A bill was passed forbidding all indemnity for glandered horses, and an impetus thus given to the spread of the disease is daily bearing fruit in our great cities especially, disastrous to the health of the horses, and a constant menace to that of humanity as well. The law makes it the duty of veterinarians to report all cases of glanders, but in great horse establishments such a report would stop the use of the whole stable, at a loss of thousands of dollars per diem, and put a sudden end to the employment of the reporting practitioner by the firm or corporation in question. The owner of one or two horses can afford to report, the loss of these and their work does not mean absolute ruin, but the owner of hundreds can not safely report. For owner and practitioner alike the alternatives are presented of obedience to the law with personal ruin on the one hand, and the surreptitious dealing with cases of glanders and the preservation of their livelihoods on the other. Whatever may be said as to the constitutionality of the law which destroys private property without compensation under the right of eminent domain, this is certain, that, as applied to animal plagues, this course is unjust, oppressive, and not only useless, but positively injurious, in that it drives the owners of animals to such courses as favor the spread of the plague in place of restricting it. To-day in New York City glanders is extensively prevalent, but large horse owners dare not adopt the legal measures for its extinction, with the certainty of great loss or ruin staring them in the face as the result. It should be further considered that any law is at once bad and vicious in its tendency which places before the citizen the alternatives of disobedience with profit, and obedience with loss or ruin. Such a law is the worst possible economy because in preserving the infection, it not only perpetuates the disease and its attendant losses for all time, but perpetuates forever the official expenses of keeping it in check, when a prompt extinction of the infection would once for all time abolish all loss and all outlay for surveillance.

Until provision can be made for the enforcement of our laws against glanders, all who handle horses should be warned of the danger of working about strange solipeds, or those that show suspicious symptoms, while they have any sores on the hands, and in case they must run any risk of contact with infection, to promptly wash hands and face in a solution of hydrargyrum chloride (1:2000), or carbolic acid (2:100). Animals of susceptible races (sheep, etc.) which have lived with glandered horses should be made to pass the mallein test before they can be put upon the market for human food.

In the high, dry altitudes of the Plains and Rocky Mountains, where most cases of glanders are mild and the majority recover, resort may be had to malleinization provided the patients are kept safely secluded from all other horses. In some horses with a native tendency to immunity, the oft repeated inoculation with 0.5cc. of mallein will render the animal refractory to the infection. Animals that have recovered from casual attacks show the same immunity. Among those who have experimented with mallein may be named: Straus, Schneidemuhl, Semmer, Bonome, and Vivaldi, Mowry and Michel, Schweinitz and Kilborne. Sacharoff apparently secured immunity in the horse by inoculation with virus modified by passing through the cat. Straus found that dogs which had received mallein intravenously could be made immune against intravenous inoculations, but, as Galtier had already pointed out, were still susceptible to cutaneous inoculations. Finger, experimenting on the rabbit, found that immunity only resulted after a long series of inoculations. The frequency of successful auto-inoculations in chronic cases of glanders in the horse would tend to discredit the alleged value of single injections of mallein, so that a long series is necessary if we would aim at good results.

Altogether attempts at immunizing the equine population generally, are not hopeful where it is dense, where they must be kept stabled, where the climate is moist and where glanders is deadly, or tends to persist in the chronic form for years in the same animal.

Considering the prevalence of the disease in a mild form on many of the western breeding ranches it is well to test all horses arriving from the west. The same applies to solipeds imported from abroad.

TREATMENT OF ANIMALS.

In the majority of the states the treatment of a glandered horse is prohibited by statute. Yet without providing definite machinery for the administration of the law, and without indemnities for horses disposed of, such laws are largely inoperative. On the other hand treatment is quite successful on the pastures of our dry table lands and mountains. It can, however, be sanctioned only when careful segregation and disinfection are provided for. Acute cases of glanders are hopeless in any region, but chronic cases and especially such as have the lesions confined to the skin are much more hopeful.

The unbroken nodules may be injected with carbolic acid solution (1:200), or permanganate of potash (1:60). The open sores on the skin may be treated with the same solutions, with mercuric chloride (1:2000 to 1:5000), with iodized phenol, with cupric sulphate (saturated solution), or with chloride of zinc. A primary nodule may be excised and the sore treated with antiseptics. When the lesions are very extensive the less poisonous agents should be made use of, or tincture of iodine may be substituted. The nose lesions may be treated by the weaker solutions of iodine or of iodized phenol.

Benefit also comes from a course of tonics the most successful of which have been arseniate of strychnia, binodide of copper, sulphate of copper, nitrate of baryta and sulphate of iron. The sulphites, bisulphites and hyposulphites and phenic acid are desirable adjuncts. An open air life at pasture is the ideal condition. Otherwise thorough ventilation, sunshine, moderate exercise and nourishing easily digestible food including grain are very important.

When conditions are favorable and an absolutely secluded pasture can be secured, with shelter from storms, and where civic or state authorities do not take effective measures to stamp out glanders, nor compensate owners for animals killed, mild, chronic and cutaneous cases and occult ones that have reacted to mallein without showing any other symptom, may be subjected to treatment. They should have an open air life, a generous diet, including grain, perfect cleanliness and pure air in the shelter-shed, an antiseptic and tonic medication (sulphites, tonics) may be given, and every three months a new mallein test may be applied. If the individual horse passes two successive tests without reaction, and shows no other indication of glanders, if his general health appears perfect and his condition good, he may be returned to work as a sound animal. With effective measures of extinction in force on the other hand, and indemnity for the slaughtered animal, any such measure would be entirely unwarrantable.

Treatment by injecting the serum of immune animal subcutem has given encouraging results. Helman, Semmer and Itzkovitch, Pilavios, Bonome and Vivaldi, Johne, Schindelka, Prieur and others record recoveries in recent cases and there need be no doubt of its value in subjects that are naturally somewhat refractory to the germ. Babes introduced the blood serum of the ox, which is naturally immune, and Prieur speaks with confidence of the treatment of cutaneous glanders in man and certain cases of pulmonary glanders in the horse.

TREATMENT IN MAN.

The surgical treatment of glanders in man does not differ materially from that given for animals. It is more frequently possible to deal with the local lesion in its early stages and then a thorough cauterization of the infected sore, and a little later the complete excision of the primary nodule, or the limited regional infiltration, the curetting of the adjacent parts and the maintenance of thorough disinfection by irrigation, sponging and compress will often be followed by success. Where such radical measures are inadmissible the infected parts should be excised and curetted as far as safe and the adjacent parts subjected to carbolic injections (1:200). Abscesses should be evacuated, fistulæ slit open, and thorough disinfection applied. For the affected air-passages, iodoform insufflations and antiseptic gases, sprays, and solutions should be freely used.

Internally, antiseptics such as sulphocarbolates and tincture of muriate of iron, iodides, and carbolic acid have been largely employed. Whitla recommends 5 grains of quinia in 15 grains of tincture of muriate of iron every four hours. Tonics (arsenate of strychnia), and stimulants, ammoniacal or alcoholic, may be called for. Special symptoms such as pain, rigors, nausea, vomiting, diarrhœa and profuse perspirations must be met by suitable remedies. Finally blood serum from healthy cattle or from immunized animals may be employed subcutem. Pure air and nourishing, easily digestible food are very essential. Every effort should be made to check the disease at its outset, as generalized acute glanders is speedily fatal, and recoveries in chronic cases usually leave a broken down constitution.

LYMPHANGITIS SACCHAROMYCOTICA (FARCINOIDES: EPIZOÖTICA:ULCEROSA.) FARCY IN CATTLE.

Geographical distribution and nature: Japan, Northern Europe, France, Guadaloupe; caseating nodules in skin, subcutem, in mucosæ and internal organs. In horse skin nodules, and glandular abscesses, with thick ovoid refrangent bacterium; saccharomyces (Hitt); swellings first local, then multiple, and general, extending along lymph vessels to glands (Hitt); along air-passages to lungs, from prepuce or scrotum to peritoneum (Hitt), or from conjunctiva to other parts in the orbit (Caparini and Ferner). In cattle, multiple, subcutaneous, nodules—hazlenut to walnut, isolated, hard, painless. Suppurate slowly. Same saccharomyces (Tokishige, Nocard). May invade lungs with fatal result in a year. Mallein test gives no reaction. Treatment: actively antiseptic; open, curette, pack with antiseptic gauze, sublimate bandages; internally, tonics, antiseptics.

Horses and cattle in certain countries (Japan, Sweden, Finland, France, Guadaloupe) are subject to a chronic lymphangitis resembling cutaneous glanders, but associated with the development of bacilli or fungi in the nodular, caseating swellings in the skin, subcutem, in mucosæ and in internal organs.

Nocard describes the affection in the horse as characterized by skin nodules (buttons, boils), which burst and discharge a thick, grumous, or thin, oily, yellowish or bloody pus. The surrounding lymph plexus swells up into corded lines, with at intervals nodules or abscesses. The infection extends to and implicates the lymph glands and general pyemia may follow. The thick ovoid refrangent, pathogenic, bacterium stains in Gram’s solution.

In Northern Europe and Asia, Southern Europe and Guadaloupe an analogous affection is described by Rivolta, Claudio-Fermi, Aruch, Tokishige and Nocard and Leclainche. Hitt attributes this to saccharomyces. The infection attacks horses and cattle, entering by sores and abrasions of the skin of the limbs, or under the harness (back, breast, rump, head). Confined at first to the point of infection it becomes multiple, being conveyed from place to place, through the soil, floor, stall, harness, blankets, brushes, combs, straw, etc., and may extend on the mucosæ. The wounds fester, forming pus and crusts over a more or less considerable swelling. In a variable time, (one to twenty weeks) the surrounding lymphatics become swollen and tender (corded), and nodular swellings appear on their course which fluctuate, burst and discharge a whitish or yellowish pus, sometimes oily or slimy. The disease extends along the lymphatics, invading the lymph glands and even the internal organs.

Tokishige describes cases in which it extended along the respiratory mucosa, causing constriction of the nasal passages and larger bronchi, with dyspnœa, and finally, invading the lung. In other cases it spread from the prepuce, or scrotum, upward along the tunica vaginalis, spermatic cord and testicle. Caparini and Ferner describe it in the orbit, affecting the lids, nictitans, conjunctiva and adjacent parts, with nodules and abscesses. Mazzanti describes the case of a filly which died with pea-like nodules on the colon, and ulceration, with dirty, black, purulent centres, and indurated borders. Tokishige describes the affected cattle as showing a vast number of subcutaneous, hard, painless nodules, varying in size from a hazel nut to a walnut and covered by light colored skin. The nodules were isolated and not connected by swollen, beaded lymph vessels. They encrease and suppurate much more slowly than in the horse. In three cows microscopically examined he found apparently the same branching fungus (saccharomyces), as in the horse cases. The mortality is about 10 per cent.