Part 73

3. In a second thoroughbred herd there never lacked one or two cases of advanced tuberculosis, two of the family suffered, and the eldest son, who was fond of milk and vegetable food, died of pulmonary tuberculosis.

4. A dairy of common cows had seventeen out of twenty-six destroyed for tuberculosis, and the farmer’s wife, father-in-law, and two brothers-in-law had shortly before died of consumption. The wife felt ill in the close house air, and with her father occupied herself much about the cattle.

5. A veterinary professor, who was meat inspector of the city abattoir, died a few years ago of tuberculosis, which he handled so constantly in his daily duties.

Stalker and Niles report that 5 persons, 20 to 30 years of age, of healthy ancestry, died of tuberculosis within two years, on a farm where 17 tuberculous cattle were found, and others had died in previous years, (Bull. Ia. Agr. Exp. Stat., 29).

Leonhardt reports the death from tuberculosis, abdominal and meningeal, of two children, fed on the milk of a tuberculous cow, (Rep. N. H. Bd. of Health, 1892).

Sontag reports the death by tuberculosis of a six months old child of healthy parents, that had been fed the milk of a tuberculous cow, (Rep. N. H. Board of Health, 1892).

Dr. E. Pearson quotes the following:

“A well known veterinarian wounded in the hand in opening a tuberculous cow, had a tumid, intractable sore, the tissues of which when excised showed tubercle bacilli.

A veterinarian, of Chester Co., Pa., in opening a tuberculous cow, cut his knuckle, which healed tardily, remained swollen and when excised, showed typical tubercular lesions including giant cells.”

He quotes from Hartzell the cases of two men wounded in cleaning cattle cars, both of whom had resulting tubercle, arrested in one case by excision, but in the other advanced to generalized tuberculosis and death.

Bang gives the following Danish cases:

A merchant having two chlorotic daughters secured a fine cow to feed them fresh milk. The cow was killed tuberculous and was replaced by another which also showed tuberculosis, this time affecting the udder. The girls died of tuberculosis at 16 and 18 years. Two younger children fed on the milk of sound cows grew up healthy.

A healthy cow became tubercular, after having been placed in the same stall in which another had died of tuberculosis. A child fed almost exclusively on the milk of these two cows died of tuberculosis.

A peasant at Silkeborg drank freely of milk freshly drawn. He died of tuberculosis, as did also a cow, and later in the same stable, a pig.

A peasant had an 11 year old cow with generalized tuberculosis, implicating the udder. The wife of the peasant, formerly healthy, became tuberculous shortly after the udder became affected and died at 45. A daughter who, like her mother, used the milk of this cow, died consumptive in the same year. The husband who drank beer, and not milk, remained well.

A physician fed his two children on the milk of his tubercular cow, and lost both from tuberculosis. Neither parents nor grand-parents were tuberculous. (L. Pearson in Bull. 75, Tuberculosis of Cattle).

Thorne had reports from twenty-two Ohio physicians to the effect that they had traced tuberculosis in their patients to the use of the milk of tuberculous cows, and thirty-three who believed they had reason to suspect the meat and milk supply as the source of cases of consumption. (Ohio Exp. Stat. Bull. 108).

To these may be added the cutaneous forms of tuberculosis (tuberculosis verrucosa cutis), which occur on the hands of persons (butchers, tanners, coachmen, cooks, etc.), who handle infected products of animals. These have been described by Riehl and Paltauf, Senn, and a number of surgeons and dermatologists and the relation of the occupation to the seat of the disease is conclusive as to the source of the infection. It is the exact counterpart of the verrucosa necrogenica of the hands of persons working in the dissecting rooms of medical schools, and the source of infection is equally well established in both cases.

A strong argument for the appreciable influence of the bovine bacillus upon man (acting directly or indirectly through the pig) is that the relative death rate of Jews from tuberculosis is materially less than that of other races. It is constantly claimed that orthodox Jews who eat only kosher (rabbi inspected) beef and no pork, suffer least of all the population from tuberculosis. Dr. Gerster, judging by the burial returns of the United Synagogue and the English Registrar General’s returns, concludes that only about half the relative proportion of Hebrews suffer from consumption as do other races in the same country. Some remarkable facts come out in the report of the Royal Commission on tuberculosis in England. In England and Wales the disease had decreased 39.1 per cent, in thirty-five years, but this decrease has been mainly in pulmonary cases, while the abdominal forms decreased only 8.5 per cent. Sir Richard Thorne, indeed says, that in children of the first year there had been an actual encrease of 27.7 per cent. Northrup and Still, on the contrary, present statistics showing that in children the pulmonary form of tuberculosis is the most common (Brit. Med. Jour. 1898). If in the face of this there has been a very material encrease of the abdominal form, coincident with the notorious encrease of the disease in dairy cows and of the bottle-feeding of infants, may we not enquire how much of this is due to the greater prevalence of bottle-feeding and the infected cow’s milk? It is not for a moment supposed that the majority of infections in children come from the cow. The question is whether this encrease in the minority is not in measure chargeable on the cow. The impaired nutrition resulting in some instances from the use of cow’s milk cannot well be charged with a marked encrease of cases in which the mesenteric tubercles point so directly to infection through the food. If it is held that the tubercle bacilli in the milk are harmless, we wait for evidence of the real cause of such encrease and localization.

The experiments of Adami show that tubercle is directly transmissible from man to ox though usually with decreased virulence. More recently, Ravenel using the bacillus derived from the mesenteric glands of a child, injected intravenously two tuberculin-tested calves, with 5cc. each of the culture producing exalted hyperthermia, miliary tuberculosis of the lungs, tuberculosis and caseation of the bronchial and mediastinal glands, and death in 17 days. Dr. Garnault’s experiment on himself, now in progress, has already shown the great danger to a susceptible man, of the bovine bacillus.

As showing accommodation to environment, Battaillon and Ferre found that the bacillus (mammalian and avian) grown in frogs, Dubard that grown in fishes, Kráhl that grown in frogs, snakes, fishes and lizards, and Müeller that grown in the glow worm, thereafter grew at summer temperature (68° F.) and grew poorly or not at all in the bodies of mammalia.

The tubercle bacillus is primarily and essentially one, but this must not close our eyes to the fact that in different hosts and environments it takes on very different habits, so that for the time and in these surroundings, it is materially modified in its pathogenic attitude toward different races. Yet its ready variability when conditions are favorable to change, renders it desirable to destroy it in all its forms, and especially in those which approximate most closely to those that prey on man and animals.

An impartial review of the whole field warrants the conclusion that the nineteen young (and therefore comparatively insusceptible) cattle which in Koch’s hands failed to develop generalized tuberculosis after inoculation with the virulent sputum of man, and the smaller numbers that resulted in the same way under similar treatment in the hands of Th. Smith, Dinwiddie and Adami, while showing a very marked limitation in the susceptibility of the sound bovine system to weak bacilli from man, cannot disprove the many well authenticated cases of the transmission of tuberculosis from cow to man and the reverse. The greater potency of the bovine bacillus over that of man, in its action on the small rodents and pigs, utterly forbids the unproved assumption that it is on the contrary harmless to man.

If the object of the sanitarian were merely to delay a fatal result in his tuberculous patient, while he accepted the prevalence of tuberculosis as inevitable for all future time, the acknowledged lessened receptivity of the ox for the bacillus from man would mean more and would be at least worthy of a hearing, but as the extinction of a disease germ and its representative plague must ever be the first object, any movement toward the preservation in cattle of a germ which is deadly to man and much more so to cattle, must be held as subversive of the prime purpose of sanitary work. This is true even if we allow, for the sake of argument, that only a few of the bovine bacilli are capable of dangerously colonizing the human body, and that special environment is needful to allow of such successful colonization. On the other hand the limited receptivity of the ox for the bacillus from man is the greatest encouragement to active work to exterminate tuberculosis from our herds. It is impossible to adopt in man the summary measures that are so successful in the speedy stamping out of the plagues of the lower animals, so that tuberculosis in the human family can only be eradicated by slow degrees, and therefore there will long continue for our herds the danger from the human side, but just so far as the susceptibility of cattle to human tuberculosis is limited, in the same ratio are our hands strengthened in effective work for the extinction of consumption in our herds and for preserving their soundness after they have once been purified. If they were to be reinfected by the presence of any consumptive person we might well despair of success in face of a wide prevalence of tuberculosis in man, but since it is only exceptionally that cattle suffer from man, outbreaks coming from this source can the more easily be taken care of. In this view tuberculosis is approximated somewhat more closely to the other bovine plagues (lung plague, rinderpest) which can be stamped out with the greatest ease and certainty, so that as a purely economic measure the argument for the speedy extinction of tuberculosis in our herds is reinforced.

TREATMENT OF TUBERCULOSIS.

Like all deadly infectious diseases in the lower animals, tuberculosis is not to be profitably treated as a rule. In the case of specially valuable breeding animals, in which the prospective progeny will pay for large outlay, and when the disease is in its incipient stage, treatment may be warranted. The patient should be thoroughly separated from other animals, kept in the open air, or, in our northern winters, in roomy, well ventilated buildings facing the south, well lighted, kept immaculately clean, frequently whitewashed, and well drained. If there are more than one case every precaution named under the head of prevention must be adopted. Exercise to keep the muscular system in good tone is called for, but never to fatigue. Hence, a sheltered pasturage is ideal. Feeding must be liberal including a ration of grain or seeds, and oil bearing seeds like linseed, rape seed or cotton seed may be specially named. Cod liver oil alone, or etherized is often of great value, with iron and bitters continued for weeks or months. In the case of specially valuable animals one may use a pneumatic cabinet the principle of which is to diminish the air pressure on the body at large by an exhaust, while pure air for breathing, at the ordinary atmospheric pressure, is introduced through a tube furnished with a face piece fitting around closely beneath the eyes. This serves the purpose of attracting (sucking) the blood toward the skin and other tissues from the lungs, which in their turn are compressed by the air at the atmospheric pressure. Pulmonary congestion is in this way lessened, exudates are absorbed, necrotic tissue removed, sepsis counteracted, hæmatosis encreased, circulation of both blood and lymph stimulated, digestion and nutrition improved, and general health invigorated.

Active grooming and even the stimulating effect of cold douches may be invoked, the skin being rubbed actively until dry and warm.

If the circulation is poor, a stimulating steam or hot water bath of fifteen minutes followed by a cold sponge and rubbing till dry may be profitably substituted. In such cases it is well to put a cold sponge on the head while in the bath.