Part 48

Infection of Man. The first authentic record of this affection in man we owe to Valentin, who records that during the outbreak in Hesse in 1695 men suffered from inflammation of the gums, tongue and mouth. Michel Sagar says, that in 1764 men who drank the milk were affected with aphtha. In 1828 it was conveyed from animals to men in Bohemia (Nadberny), in Styria (Levitsky) and Wurtemberg (Kolb). In 1834, three veterinarians, Hertwig, Mann and Villain, voluntarily drank a quart each of the warm milk of a cow suffering from this affection. On the second day Hertwig suffered from fever, headache and itching of the hands and fingers. Five days later bullæ formed on the hands and fingers, the tongue, cheeks and lips. In the two others the eruption was confined to the buccal mucosa. Since that time records of the infection of human beings have been very numerous. During the American epizoötic of 1870 I met with the case of a farmer at South Dover, N. Y., who suffered from sore mouth and blisters along the margin of the tongue from drinking the milk. The danger is greatest in children on an exclusive milk diet and who drink it warm. Kolb in 1828, noticed acid vomiting and diarrhœa in such subjects, Hübner observed that beside the buccal eruption such children often suffered from inflammation of the stomach and bowels and that very young children fed on the milk of the diseased cows died. Balfour, Watson and others have noticed similar results in Scotland.

Allbutt saw the buccal eruption in three children in Yorkshire, England, during the local prevalence of the English epizoötic in 1883, and secured information of a number of other cases in the same district.

A number of cases were recorded during 1893 in Germany. A shepherd infected himself by holding in his mouth the knife with which he had pared the diseased feet of sheep, and another workman and a veterinarian had extensive eruptions on the hands after dressing the affected feet. A number of milk-maids were infected by milking, the eruption appearing on the hands, and in one case on the breast. A child fed on the milk of diseased cows, had chill and fever with gastric disturbance, and later an eruption of vesicles on the lips and tongue and between the fingers and toes.

Again, in 1895, during the prevalence of foot and mouth disease in the southern part of Berlin, a considerable number of the milk consumers suffered from fever with the eruption of bullæ on the tongue and buccal mucosa generally, which on early bursting left very painful ulcerations. The acute disease did not last more than five days, but left a sense of great weakness for a time. Virchow, who made an investigation, unhesitatingly pronounced it to be foot and mouth disease.

Cases of infection through butter made from infected milk are on record. A Berlin veterinary student suffered from the buccal eruption and erysipelatoid swelling of the ear, and a German clergyman had in addition a period of chilliness, fever, diarrhœa and pruritus. Similarly Schneider quotes cases determined by infected cheese, and Friedberger and Fröhner, cases caused by virulent buttermilk.

Symptoms in Man. In man there is observed the tendency to localization on the same points as in animals. As the hands are naturally exposed to infection by milking or treating the diseased animals, they are especially obnoxious to the eruption, and the same is true of the mouth when the infected milk or other dairy products are consumed. The bullæ on the buccal mucosa are generally confluent, and often extend to the fauces and pharynx, rendering speech difficult and swallowing painful, and leaving extensive and painful sores which, however, soon heal up. In women the bullæ have been seen around the congested nipples, and in exceptional cases they have been generally diffused over the body.

In cases due to drinking the milk, the early febrile symptoms are liable to be accompanied or followed by nausea, anorexia, abdominal pain and diarrhœa, and still later by the cutaneous and buccal eruption.

The duration of the disease is from 10 to 15 days and as a rule no permanent scars are left on the skin or mucous membranes.

The diagnosis is assisted by the knowledge of the prevalence of the disease in herds in the district, and that the patient has handled the diseased animals, or drunk their milk, or eaten their butter or cheese products. The predilection of the eruption for the fingers, the roots of the nails and the mouth is very significant. The disease follows an acute course and convalescence is complete in ten or fifteen days, which serves to differentiate it from most skin eruptions. From variola which pursues an equally rapid course it is distinguished by the absence of the primary nodular swelling, and of the septa or pillars that divide the mature pock into independent chambers.

Prophylactics. The best prevention for man is to exclude the disease from the country and its herds as is now the case in the United States. When the disease does exist in herds the attendants should cauterize any sores on the hands, and wash the hands with an antiseptic, such as a 10 per cent. carbolic acid solution, after handling the diseased. The milk and its manufactured products—butter and cheese—should be withheld from consumption until after the herd has recovered. Infection can be obviated by boiling the milk.

Treatment. The disease follows a rapid course and is self-limiting, and usually benign so that active treatment is not urgently demanded. The local lesions are best met by non-poisonous antiseptics, such as: borax in powder or strong solution; boric acid (4:100); sodium hyposulphite (½ oz. 1 qt.); chlorate of potash (½ oz. to 1 quart); salicylic acid (1:100); or salicylate of soda. Pounded ice may be used as a soothing agent. The cutaneous lesions may be wrapped in cloth wet with one or other of the antiseptic lotions. Any disposition to ulcerate may be met by the stick of silver nitrate.

Slightly laxative or diuretic agents may be employed for their febrifuge and eliminating properties and the food should be light, easily digestible and given cold.

Prevention in Animals. When the disease exists in a country or district this includes all measures preventive of immediate or mediate contagion. Arrest of all movement of cloven footed animals in infected districts, disinfection of cars, boats and other conveyances, of markets, yards, highways, seclusion of infected herds and pastures, exclusion of visitors, disinfection of products, certificates of soundness of origin, thorough disinfection after recovery of the herd, such are the leading points to attend to. Inspection or closure of fairs and markets is desirable and any exposure of diseased or infected animals should be visited with heavy penalty, in addition to the cost of detention and supervision. For a noninfected country a certificate and guarantee of non-exposure with each cloven-footed animal imported, and of thorough disinfection of the cars, boats, halters or other objects used upon them, and of the places, fodder and litter supplied, together with a quarantine (1 week) and surface disinfection should be required under penalty. Exclusion of fresh hides, bones, guts, hair, bristles, wool, horn, as well as of fodder and litter is essential. Cattle attendants, drivers and others whose clothes are soiled with the products of the barn, should have the same washed and disinfected.

Inoculation has been proposed, and even practiced to pass a whole herd promptly through the malady, but as immunity lasts but three months, and the attendant risks to other herds are greatly encreased it is at once an economic blunder, and a great injury to adjoining owners. Any resulting extension to other herds should be an occasion for a verdict for damages at common law.

Treatment in Animals. Provision is first made against extension of the infection. The floor should be kept clean, dry and covered with sawdust, tan bark, gypsum or litter sprinkled with these or with phenic acid. The herd should be divided into two lots—the apparently sound, and unsound kept strictly apart under separate attendants, above all separate milkers. As soon as any symptoms are shown by an animal in the sound enclosure it must be instantly transferred to the other and its stall disinfected. Antiseptics such as gaseous iodine (two tablespoonful of tincture of iodine, thrown into a quart of boiling water twice daily), sulphurous acid, salicylic acid, creolin, lysol or other ointment on the feet and teats, may also be used. In this way it may be possible to save a number from an attack, yet most commonly the exposure is common and universal and the malady develops in all simultaneously. For those already attacked, gruels, mashes, and cool pulped, finely sliced or boiled roots may be all that is required, the disease runs its course and recovery ensues in 15 days. As local dressings the following may serve as examples: for the mouth, borax, chlorate of potash, salicylate or sulphite of soda 2 drs. to 1 quart water; phenic acid, creolin, or lysol, one or two teaspoonfuls to a quart; for the foot, clean the interdigital space and apply tar and carbolic acid with bandage, or use solutions of creolin, lysol, pyoktanin or blue-stone; in aggravated cases strong mineral acids with tar; for the teats, ointments of boric or salicylic acid, creolin, lysol, naphthalin or napthol. Separation of the hoof or mammitis will require treatment according to indications.

MILK SICKNESS. “THE TREMBLES.”

Geographical distribution: timbered lands in the United States; different altitudes, and geological formations; on hills and wooded bottoms; known to Indians and pioneers; now unknown where formerly prevailed. Contagion: through milk; no specific microbe found in every case. Alleged causes: rhus; nickel; spirillum; bacillus. Prevails in dry seasons; contracted under night exposure; confined to given enclosures; to late summer and autumn. Not conveyed by contagion, indefinitely, as are plagues. Men show very varying susceptibility; young children may be relatively immune. Fatigue, debility, ill health, predispose. Exertion to fatigue rouses symptoms in animal affected. Cow in full milk eliminates toxins and does not show symptoms; the milk infects. Steers, bulls and heifers, show marked symptoms. Calves suffer through milk; swine through veal; dogs through pork; buzzard through dead dog. Incubation 8 to 12 days. Symptoms: tardy, lazy gait, drooping, anorexia, ardent thirst, inactive bowels and kidneys, milch cows when driven or excited, tremble and may suddenly die. Muscular debility, constant decubitus, complete apathy, neither evades nor resents injury. Bloodshot, fixed, glazed, unwinking eyes, pulse and breathing slow, temperature low, hebetude, torpor, coma; death 8th to 10th day. Sheep very prostrate. Calves tremble when sucking, vomit and perhaps die suddenly. Pigs and dogs vomit, and show costiveness, remarkable debility and weariness. Man is weary, languorous, weak, apathetic, loathes food, is nauseated, retches. No fever; but ardent thirst, tremulous tongue, mawkish breath, soft flabby belly, careless of own or family interests, forgetful of decency. Nausea, vomiting of blueish liquid, hebetude, inactive bowels, coma. Lesions: gastro-intestinal congestions; ingesta like hard balls of sawdust. Treatment: charcoal, mild laxatives, elm bark, egg nog, potassium permanganate. Prevention: clear timber land, let in sunshine, cultivate. Insects. Sterilize the milk.

This is an infectious disease which has been found enzoötic in certain unimproved, timbered lands of North Carolina, Georgia, Tennessee, Kentucky, W. Pennsylvania, Ohio, Michigan, Indiana and Illinois. Beach says it has never been reported on any of the Western prairies, at any point west of the Mississippi River, in New England, in the Canadas, in any islands, or in any part of the Old World. Altitude appears to have no effect in its production, nor geological formation; it has been found in the wooded mountains of the Blue Ridge of N. Carolina and Georgia (Kerr, Salmon, Phillips); in the hills of Pennsylvania and Kentucky; (Beach, Phillips); on timbered uplands (Phillips); and on the wooded bottoms of the Scioto and Miami in Ohio (Phillips, Schmidt); in the timbered bottom lands of the Wabash and White Rivers in Indiana (Phillips); and in the wooded bottoms (Beardsley), and Indian Grove in McLean, Co., Ill. (Beach). The constant conditions are the heavily timbered and virgin condition of the soil.

It was much more prevalent in the time of the early settlers, than it is to-day, many infecting localities having become salubrious in connection with the clearing away of the forests and cultivation of the soil. The disease was well known to the Indians and often proved disastrous to the pioneers, whole communities being swept off as recorded of Pigeon Creek, by Nicolay and Hay in their History of Abraham Lincoln. According to these writers it was “a malignant form of fever—attributed variously to malaria, and to the eating of poisonous herbs by the cattle—attacking cattle as well as human beings, attended with violent retching and a burning sensation in the stomach, and often terminating fatally on the third day.” Even in these early days settlers were loathe to acknowledge the existence of the infection on their lands, doubtless because it depreciated them, and to-day with a better knowledge of the necessary precautionary measures, it has literally disappeared in many places, so that it is now difficult to find a case.

Contagion. That the disease has been transmitted through the milk from animals to man and other animals has been too painfully evident from the first, but no specific microörganism has been found to be constantly present, capable of pure culture in artificial media and of causing the disease when transferred from such media to a new victim. Naturally all sorts of theories have been advanced, no one of which has been demonstrably proved. It has been attributed to eating of poison ivy (Rhus toxicodendron) by the cattle, as this plant was usually found on the infecting lands, but rhus is also common throughout New England and the Eastern States where milk sickness is unknown. It has been claimed that it was due to mineral agents, especially nickel, in the water but the mineral salts in the water are not removed by culture of the surface soil, which puts an end to milk sickness. Phillips (1876) claimed to have found the cause in an actively motile spirillum in the blood, but he had examined the blood of but one patient, and it has not been found in other patients by subsequent observers. Bitting found a bacillus but further research has not determined its constancy.

Beach furnishes a series of observations which should be useful in seeking to estimate the value of any theory propounded. 1st. Milk sickness is a disease of dry seasons. 2. In unusually dry seasons it is dangerous to leave domestic animals out over night in the localities where the disease is prevalent. 3d. It has never been considered dangerous for animals to pasture on such lands in the day time. 4th. Cattle in one field will habitually escape, and in another with apparently exactly the same conditions and the same flora they are attacked. 5th. The disease is unknown on the open prairies of the Western States, where the domestic animals are not allowed to remain over night in the timber belts. 6th. With occasional exceptions, it is a disease of late summer and autumn. The dangerous lots can, as a rule, be safely depastured in winter and spring. 7th. The pioneers found that they could protect their stock by keeping them corralled on a “tame” piece of land from before nightfall until the fogs and dews became dissipated on the following morning.

For the land to become “tame” it was only considered necessary to cut off the timber and let the sunshine act freely on the surface. Plowing and cultivation did not seem to be requisite in all cases.

A great drawback to research is the difficulty of securing cases to study. Many lots, formerly dangerous, are no longer so, and others still infecting are kept so secluded that casual cases cannot be found, without much expense for experimental animals. Again, owners do not care to depreciate their land by acknowledging that it is infecting. The experiment stations naturally enough look askance, on the proposal to institute expensive experiments on a disease which dies out when the soil is improved. Deadly as the disease is to the individual attacked (man or beast), it is not propagated indefinitely from non-milking subjects, by simple contact or proximity after the manner of plagues. It usually comes to an end by the death or recovery of the subject that has contracted it by consuming meat, milk, butter or cheese, the product of an infected animal. The demand for sanitary police measures is, therefore, less urgent. Different observers claim that cases occur in the large cities, through the consumption of meat, butter or cheese, sent from infected localities, but that the city physician fails to make a correct diagnosis. These must, however, be comparatively rare.

In addition to ingestion as a cause, certain accessory causes ought to be noted. Some men eat the infecting material with impunity, while others succumb to the deadly disease. As the observations have all been made in or near the infecting localities, individuals may be immune through a previous attack and recovery, or there may be a native immunity through unknown conditions. Young children often suffer less than adults, possibly because of the greater activity of their emunctories and consequent elimination of the toxic products and the comparative absence of exhausting or depressing conditions. Their purely animal food (milk) may exercise an influence, and this may assist in explaining the fact that certain adults appear to be refractory.

Fatigue, debility and ill health are said to predispose the system. Milk sickness attacks most violently those that have been subjected to overwork or severe exertion of any kind, especially in hot weather, those suffering from want of sleep (sitting up with the sick), those having a special cause of mental depression, those suffering from some illness—constipation, indigestion, malaria, etc.

Milch cows are probably more open to the attacks of the germ because their systems are reduced by simultaneous milking and breeding through a number of years. Exertion or fatigue has a potent influence in developing the symptoms, so that it is a common practice in the vicinity of infected localities to subject animals to a good run before purchasing. Paradoxically enough the infected milch cow which is distributing the infecting element freely in her dairy products usually shows, in herself, no distinct symptoms of the disease. If she is dry or farrow she suffers like any other animal, but if in full milk, the toxins, and even the hypothetical microbe, seem to escape in that secretion, which proves highly poisonous to other animals, while the cow retains her spirits, vigor and outward appearance of health. Steers, bulls and heifers, on the other hand, show violent symptoms.

Calves suffer so long as they suck the milk. The dead calf is eaten by swine, which suffer in their turn, and the dog contracts the disease by eating one of these animals, or by taking infected milk or cheese. The buzzard eats the dead dog and dies as the result.

Incubation is from 8 to 12 days, though it may be reduced to two. (Beach.)