Part 64

Feeding hogs after Tuberculous Cattle. Where cattle and hogs are kept on the same place, it is a common practice to let the swine clean up all food left by the satiated cattle. If there are tuberculous cattle, affected either in the air passages or alimentary tract, the pigs become infected by taking in the expectoration by which the food is soiled, or by rooting around where the cow manure has fallen.

Feeding from a Common Trough. In an infected herd, a common cause of extension is found in the use by the whole herd of a common feeding trough, in which the food soiled by virulent discharges, is taken by healthy animals. The habit of tying a cow in different stalls in succession as she happens to strike one, in place of keeping each cow by its own stall is a fruitful source of infection. Even when each cow is kept by its own stall, she often becomes infected by reaching into the feeding trough in front of the next cow on the left or right and taking in soiled and infected fodder. In swill stables the evil reaches its maximum, as the feeding trough for 50 or 60 animals is slightly inclined so that the liquid food runs from the supply end to the other, and infecting expectorations are carried in front of all in turn.

Dry, Dusty Stables. Tubercle bacilli are not carried out on the expired air, unless there is forced expulsion as in coughing, snorting or sniffing. In such cases the solid particles are thrown off in masses or fine spray and lodged on surrounding objects. These, together with infecting discharges from bowels, urinary or generative organs, open sores, etc., dry up, and rise on the dust, and, as sterilization occurs slowly indoors, they cause more or less infection of the animal inmates. Cornet, Tappenier and others have thoroughly established this as a common form of transmission, and shown the great importance of cleanliness, disinfection and the removal of infecting materials without raising dust. In an establishment in Paris, a consumptive had served for 3 years. In the following 10 years, 15 of the 20 employés died of phthisis.

Extension through Vermin. As rats and mice (and other rodents) are susceptible to tuberculosis by ingestion (Galtier) it follows that they may become the media for extension of the infection through fodder in which their droppings are scattered, or from their feeding in the same troughs as the cattle or swine. For swine in particular the danger is greater because of their carnivorous habits; the rat acquires tuberculosis through eating the offal of the abattoir, or the scraps of the butcher’s stall, or kitchen, and the sick rat is thereafter easily caught and devoured by the pig to its own undoing. To block this channel of infection the destruction of vermin about slaughter houses, stables and pig pens is a most important consideration.

Flies and Other Insects as Carriers of Tuberculosis. These congregating on tubercular sores, around the nares or lips, on the skin contaminated by the virulent bowel discharges, on dishes holding infecting milk, on objects soiled by infecting discharges, on diseased carcasses at abattoirs, rendering works and elsewhere, (Spillman, Hoffmann, Lartigan, etc.,) and on graves where the earth worms have brought the bacillus to the surface, (Lortet, etc.) become more or less active agents in disseminating the virus. In this way food and water are contaminated, and exceptionally, infection may even be implanted on sores. As the excreta of the flies contain the virulent bacilli, the latter are deposited on windows, walls, furniture, etc., and may be later disseminated in the dust of the apartment.

Dewevre found tubercle bacilli in the bedbugs infesting a bed in which successive cases of consumption had developed, showing that other parasitic or rapacious insects besides flies must be looked on as possible propagators of the bacilli. There is reason to suspect, lice, fleas, ticks and acari especially. The same is true of leeches and other rapacious invertebrates.

LESIONS. THE TUBERCLE.

The characteristic lesion in tuberculosis is the tubercle, taking its name from the small rounded nodule which, at first virtually invisible, encreases often to the size of a millet seed, or a pinhead or even larger, and which by confluence with others, forms conglomerate masses of all sizes to which the term tubercle is still applied. Where the bacillus tuberculosis is implanted, the fixed tissue cells are stimulated to an undue proliferation, and a diapedesis of leucocytes takes place from the neighboring capillary blood vessels, the whole eventuating in the formation of a rounded cluster or nest of epithelioid and giant and later small rounded lymphoid cells in a fine fibrous stroma. Baumgarten and his followers claim that the larger epithelioid and giant cells result from the karyokinesis and proliferation of the fixed tissue cells, epithelial and endothelial cells, and that the lymphoid cells which later (often after the eighth day in experimental cases) invade the lesions, are alone the product of the migrating leucocytes. Metchnikoff, Yersin and others contend, on the other hand, that epithelioid and giant cells are directly derived from the leucocytes and endothelial cells and like these are possessed of actively phagocytic qualities. As the final outcome before caseous degeneration, is the great predominance of the small lymphoid cell, it may well be questioned whether this is not the result of active encrease in both kinds of cells, as appears to happen in many other inflammations. For our present purpose it is well to note the early characters: Centrally often a large (giant) cell with a number of peripheral nuclei and at times, branching processes; around this as a second zone epithelioid cells of large size, with round or oval nuclei, and sometimes giant cells; outside this a third zone of small rounded lymphoid cells with large nuclei. There is a delicate fibrous network between the cells, but no indication of capillary blood vessels, the absence of which may partly explain the constant tendency to degeneration, necrosis, and caseation. The tissue around the miliary tubercle is red and congested.

Caseation. A striking characteristic of tubercle is the occurrence of coagulation necrosis, beginning in the centre of the specific nodule as a whitish or pale softening and degeneration of the cell elements and gradually extending toward the circumference. The cells, and even the proximate tissue elements, die and disintegrate passing into a structureless, granular or hyaline debris, which has been named from its supposed resemblance to old, ripe, soft cheese. Baumgarten has observed that the small lymphoid cells are the first to degenerate, followed by the epithelioid and giant ones.

While the formation of tubercle is at first a productive inflammation of which the cell clusters and nodules are the result, yet the tendency to necrosis, and caseation is so great that it must be looked upon as one of its most prominent features, and is rarely absent, whether the lesion exists in the connective tissue of the lungs, liver or other organ, in the lymph glands, in the respiratory or intestinal mucosa or submucosa, in the osseous cancelli, brain or skin. It is, therefore, largely pathognomonic, yet it is not peculiar to tubercle, being common in glanders, and other infective inflammations. Its presence should always lead to a search for the primary tubercle nodule, with its nonvascular cluster of lymphoid and giant cells and above all for the specific bacillus resistant to staining.

The tendency to extensive degeneration and caseation is especially marked in swine, in which the resulting debris is often so liquid that the tubercles bear a strong resemblance to abscesses.

Calcification. The deposition of lime salts (mainly phosphates) in the tubercle is a common feature of advanced cases in man and pig, but especially in cattle. It is unknown in rabbits and Guinea pigs. The tubercle assumes a hard cretaceous aspect and feeling, grates under the knife and crepitates when pressed. This is always an evidence of chronicity, but it has been observed in swine in 3½ months.

Fibroid Degeneration. Fibrosis. In this case a productive fibroid inflammation takes place in the tissue of the tubercle, and it is resolved more or less extensively into a hard, white, resistant body. This is the pearly mass which has given rise to the name of the pearl disease (perl-zucht) in Germany. It may be fibrous throughout, but usually a number of the nodules show a caseated centre while the external zone, that nearest to healthy tissue, has alone taken on the conservative fibroid development. Like cretifaction, fibrosis is an indication of chronicity in the lesion. It is often seen in man, but still more so in cattle, in which it affects particularly the abdominal cavity, but also to a lesser extent the chest and other parts. It is remarkable for the paucity of bacilli to be found in its substance, often requiring many sections and infinite patience to reveal the presence of the microbe. This comparative lack of actively multiplying bacilli is doubtless one factor, operating in the direction of conservative processes, chronicity and even partial recovery. In experimental tuberculosis the extent and rapidity of development of tubercle, as also of the degeneration are found to be closely allied to the number of bacilli introduced.

Cattle: Pulmonary Tuberculosis. One of the most frequent seats of tuberculosis, the lung, may in acute cases show a diffuse miliary tuberculosis, a considerable part of a lobe or of several lobes being congested, infiltrated, and filled with small individual tubercles, grayish or transparent in the midst of the general redness. A second form, often of old standing, is in the shape of hard masses, often circumscribed or isolated, and easily felt when the soft lung tissue is manipulated. They are respectively formed by the local aggregation, and confluence of the small miliary nodules and may vary in size from a pea to a mass of ten or twelve inches in diameter. On section the miliary tubercle may not yet show central caseation, but the larger ones do so as a rule. The caseated nucleus may be soft, cheesy and somewhat homogeneous; it may be dry, granular and yellow, resembling damp farina of maize; it may be calcified in its outer portion and invested by a firm fibrous envelope. The tubercle may be the seat of general fibroid degeneration, constituting the pearl nodules (perl-knoten) dense as cartilage and either with or without a soft caseated centre; it may show an agglomeration of nodules in all stages from the early congested nodule to advanced caseation or cretefaction, the whole embedded in a solid congested and infiltrated tissue, largely fibroid. There may be extensive abscesses, the seats of complex infections, having thick uneven walls, often showing grape like tuberculous outgrowths, and containing thick, caseopurulent, viscous, granular, yellowish or greenish and comparatively odorless contents; in other cases the abscesses have burst into the bronchia, leaving vomicæ and with the new resultant infections the contents have acquired an offensive putrid odor; finally, there may be extensive inflammatory infiltrations, affecting lobules or lobes, and interspersed with tubercles in the form of the early grayish or transparent nodule, or even more advanced caseous or cretaceous centres. These latter serve to distinguish the condition from broncho-pneumonia, the grayish centres of which might suggest miliary tubercle. The broncho-pneumonia, however, has the whitish centres confined to the bronchioles and their terminal air sacs, and represent their thickened walls and muco-fibrinous contents; they do not show the same tendency to caseation, nor necrosis of the tissue, nor to caseation of the dependent lymph glands, and, above all, they do not contain the bacillus tuberculosis.

A noticeable feature in the tuberculous lung is the great frequency of tubercles of all different ages from the initial transparent nodule to the caseated or calcified mass side by side. A tuberculous bronchitis is a familiar accompaniment, with lines of miliary tubercles, ulcers and a flocculent (sometimes gritty) muco-purulent discharge, containing elements of the necrotic tissue and bacilli. Emphysema and interlobular œdema are also met with.

The Pleuræ often suffer by continuity of tissue from the diseased lung, but they may be affected primarily through infection of the circulating blood. The earliest pleural lesions may be congestion, exudation and the formation of false membranes in fringes, but soon these become the seats of minute nodules or forming tubercles which steadily encrease to form pale red cauliflower-like growths—which have been spoken of as grapes, from their supposed resemblance to bunches of that fruit. Extensive areas of the mediastinal, costal or pulmonic pleuræ are often completely covered by these productions. Dense, and thick adhesions sometimes form, holding in their substance characteristic tubercles.

The bronchial and mediastinal lymph glands receiving as they do the afferent trunks from the lungs and the great lymph sac of the pleura, offer in their sluggish currents the most favorable culture vessels, and almost always become affected in consequence. Not unfrequently they are found to be tuberculous when the tissues which they drain appear to be sound, and we must therefore, conclude that the primary slight lesions in the latter have recovered, or that the bacilli have passed through the tissues and lymph channels without establishing any centre of disease. The glandular lesions are primarily congestion and redness, with more or less infiltration and swelling, followed by a nodular induration, with enlargement or exceptionally shrinking. When bisected they may show all stages of the tubercle from the miliary granule to the caseous, dry, yellow, granular or cretaceous necrosis. By aggregation these often grow to a large size, a long diameter of 6 to 12 inches being not uncommon.

Pericardial and Cardiac Lesions. The pericardium may be implicated from the pleuræ or independently, and though tuberculosis of the heart is rare, it may be the seat of primary tuberculosis or of extension from the pericardium or endocardium. In the N. Y. State Veterinary College Museum is a cow’s heart, greatly enlarged, and completely invested and invaded by tubercle several inches thick.

Tuberculosis of the Mouth and Throat. Tubercles sometimes form in the tongue causing nodular swelling, with a caseated centre. Much more frequently they attack the pharynx or larynx with the formation of nodular necrotic swellings, followed by ulcers and the implication of the adjacent lymph glands. The glands are liable to be invaded through the tonsillar and other follicles of the faucial and pharyngeal regions, which like the solitary and agminated glands of the intestines form excellent culture vessels. The glands most frequently attacked are the retro-pharyngeal, but the lateral pharyngeal, the intra-parotidean and submaxillary lymph glands occasionally suffer. They often become indurated, yet the formation of abscess-like sacs is not uncommon especially in the retro-pharyngeal.

Gastro-Intestinal, Peritoneal and Mesenteric Tubercles. Tubercles of the interior of the stomachs are rare, though they are frequent on the peritoneal surface of the first three stomachs, as rounded, subserous nodules varying in size from a pea upward. The mucosa of the small and large intestines may suffer, by preference in the seats of the solitary or agminated glands, and the resulting ulcers may extend in the lines of the lymph vessels from the convex to the attached border of the gut. The small greenish caseated and calcified nodules on the intestines, which are so often mistaken for tubercles, are the degenerated cysts of the œsophagastoma. Tuberculosis of the mesenteric lymph glands is much more common, the successive stages being essentially like that seen in the bronchial glands. Beside these the surface of the mesentery, omentum and abdominal parietes often becomes the seat of congestion, exudation and cauliflower-like neoplasms or grapes, as already stated of the pleuræ. In a certain number caseation or cretefaction may be detected.

Liver Tuberculosis. The liver is greatly exposed to tuberculosis as the single destination of all the blood from the gastro-intestinal tract. Tubercles also form on its surface by direct infection from the peritoneum. The hepatic tubercles are often very large and numerous, adding greatly to the bulk and weight of the viscus. There is usually coincident tuberculosis of the lymph glands of the porta.

Tubercle of the Spleen. This is also a favorite seat of the morbid process, exposed as it is to the reflux of infected blood in the portal vein, and to access of the bacillus from the peritoneum and omental lymphatics.

The pancreas is less exposed to the channels of the circulation and is less frequently affected.

Genito-Urinary Tubercles. The kidneys are always liable to suffer in generalized tuberculosis, in accordance with their function of elimination and the great quantity of blood that passes through them. The tubercles may be numerous, encroaching upon and destroying the glandular tissue, and determining congestion, nephritis and hæmorrhage (Schütz). The ovaries, when tuberculous, lead to nymphomania and sterility; they become swollen, with rounded projections, indurated, and on section show all stages of infiltration, caseation and calcification. They may encrease to a great size. Tubercles are found on the Fallopian tubes, the serous and mucous surfaces of the womb, and in the broad ligaments, in all their characteristic forms. The bladder and vagina are less frequently involved. In the male the testicle, epididymus, tunica vaginalis and prostate vesicles are sometimes affected. The swelling and induration of the affected organ, or the existence of hydrocele, may be noted.

Tubercle of the Udder. From the mass of blood passed through the udder it is specially exposed to infection whenever the bacilli enter the circulation. It may also be directly infected by the entrance through the teat, or a trauma, of the bacillus of the stable dust. There may be for a time only a slight general swelling which leads to no suspicion on the part of the milker, and as the secretion is not arrested, a dangerous product may be distributed. At this stage the lobules on section appear swollen, gray, with paler or yellowish points and minute hæmorrhages. The milk ducts contain coagula and bacilli (Bang). In other cases, usually more advanced, the gland is hard, nodular, enlarged, and shows a marked thickening of the walls of the smaller milk ducts and secreting follicles, with yellowish and even caseous and calcified centres. The gland is often greatly enlarged, the milk suppressed or completely altered, and tubercular neoplasms or ulcers exist in the larger ducts.

Tuberculosis of the Brain and Spinal Cord. As noted in Volume III. this occurs in young cattle especially in the form of tubercles of all ages attached to the pia or arachnoid, on the brain, or cerebellum, or in the ventricles, also in the cerebral matter, in or on the lumbar enlargement of the cord or on its pia. Several cases have come under my notice in the mature cow.

Tuberculosis of the Eye. This has been seen mainly as a result of experimental inoculation, yet casual cases also occur in the cornea, sclerotic, iris or choroid, the product undergoing early necrosis and softening into a yellow mass filling the different chambers.

Tuberculosis of the Bones. Though less frequent than that of internal organs this is not rare. It usually attacks the spongy tissue, near the articular extremities, or the vascular line between epiphysis and diaphysis, giving rise to considerable exudate, thickening of the bone and arthritis. The vertebræ, ribs, sternum, petrous temporal, frontal and occipital also suffer. Sections of the bone show dilatations of the cancelli, filled with the characteristic nonvascular groups of giant, epithelioid and lymphoid cells with, at times, softened and caseated centres. The adjacent bone is congested and softened, so that the detachment of epiphysis and apophyses is not uncommon. In case of invasion of the joints the cartilages and ligaments are the seat of tubercular deposits, softening, fibroid change and caseation, and there is general synovitis. The cartilages of the ear (concha) and nose (septum) may also be invaded.