Chapter III: Part 3

The most important resorts however, are the local applications of dilute acids, astringents and antiseptics to the pharyngeal mucosa, mouth and nostrils. In severe cases benefit may be derived from inhalation of water vapor, but this is rendered far more effective by the addition of vinegar, carbolic acid, creolin, camphor, tar, or sulphurous acid. The last may be obtained by the frequent burning of a carefully graduated quantity of sulphur in the stall, the others by mixing them with hot water, saturating cloths hung in the stall, or sprinkling them on sand laid on the floor.

Chlorate of potash or borax may be dissolved in the drinking water, care being taken not to exceed the physiological dose. Mercuric chloride (1:2000) may be used to wash the lips and nostrils, but cannot be safely injected into mouth or nose. Powdered alum or tannic acid may be used by insufflation.

As a mouth wash and general medicament a saturated solution of chlorate of potash in tincture of muriate of iron, diluted by adding thirty drops to the ounce of water, may be given every hour or two. Or a solution of chlorine water diluted so as to be non-irritating, may be substituted with somewhat less effect. Even a weak solution of hydrochloric acid may be employed.

Borax may be used in a solution of 2 per cent., or carbolic acid in one of 1 per cent., or bisulphite of soda in the proportion of ½ oz. to the pint, or salicylate of soda ½ oz. to the pint of water. The same agents may be made into electuaries with honey or molasses and smeared every hour or two on the tongue or cheek. In such cases the addition of powdered liquorice, and, if the suffering is acute, of extract of belladonna will serve an excellent purpose.

The danger of infection of the stomach and bowels may be met by combining with the above or administering separately salol in doses of 2 to 3 drachms or naphthol in doses of 4 to 5 drachms to the larger animals. For sheep or swine one-fourth of these doses may be given, and for a shepherd’s dog one-sixteenth to a twentieth.

As alternate antiseptics may be named, boric acid, permanganate of potash and salicylate of bismuth. These from their comparative absence of taste are especially useful in carnivora.

Counter-irritants to the throat are useful. For the horse, sheep, dog and cat, use equal parts of strong aqua ammonia and olive oil. For the solipeds a cantharides blister. For cattle or swine equal parts of strong aqua ammonia and oil of turpentine with a few drops of croton oil, or grains of tartar emetic.

Finally during convalescence a course of iron and bitters may be useful, especially in debilitated subjects.

PHLEGMONOUS PHARYNGITIS.

Submucous inflammation and abscess. Solipeds especially. Specific, or
due to microbian pus infection. Traumatism; from foreign bodies in
tonsillar and mucous follicles, from rough, fibrous food, instruments,
etc.

As a sequel of catarrhal pharyngitis. Symptoms; as in catarrhal form,
with more swelling and tenderness, glandular swelling, dyspnœa, and
difficulty in swallowing; local induration followed by fluctuation and
pointing. Complications; asphyxia, laryngeal œdema, purulent or
inhalation pneumonia, pharyngeal fistula, palsy of vagus, secondary
abscesses, septicæmia. Lesions, local, general. Treatment; General and
local, fomentation—hot or cold and antiseptic. Embrocations. Lancing.
Tracheotomy.

As distinguished from catarrhal pharyngitis this is inflammation of the submucous tissue and adjacent lymph glands, tending to abscess.

It is especially common in solipeds and rather rare in other classes of domestic animals. As a specific infectious disease it has its type in strangles (infectious adenitis), also in cattle in the complicated infection of purulent tubercle, but apart from such it is often the result of the penetration of the pus microbes from a catarrhal pharynx into the lymph plexuses and lymph glands. Traumatism may play an important part in causation as when vegetable barbs, awns, chaff or seeds, or strong hairs or bristles enter the open mouths of the mucous follicles, or the tonsillar cavities. Similarly trouble may arise from scratches by tough, fibrous fodder, from pricks by pointed or cutting instruments, by fractures of the hyoid, or by bruises by probangs, or tooth rasps. An overgrowth of the last molar, and a resulting wound and ulcer of the soft palate, and the presence of local deposits like those of glanders and actinomycosis, are other occasions of the entrance of the pus organisms. It will be recognized that this affection is not necessarily due to a difference in the infecting organism, but rather of the tissue involved, the microbes gaining the submucous tissues and expending their violence on these instead of confining their ravages to the surface layers of the mucosa. For this reason the deeper or phlegmonous affection may supervene on a catarrhal inflammation which may have already persisted for several days.

_Symptoms._ Beside the general phenomena of catarrhal pharyngitis, this form of the malady is characterized by a greater swelling and tenderness of the throat, extending from ear to ear, and from the trachea forward in the intermaxillary space; by nodular and painful swellings of the pharyngeal lymph glands, by the greater difficulty of deglutition, the muscular tissue being involved; by wheezing breathing amounting at times to violent roaring and threatened asphyxia. Perspiration on the throat, the ear, the side of the head or neck, of the fore arm, or of the dorsal region is not uncommon, and has been attributed to the compression of the vagus, or of the superior cervical ganglion of the sympathetic by the swelling. Fever usually runs higher than in simple catarrhal pharyngitis, which may be partly accounted for by the implication of the deeper and important structures but also in no small degree by the entrance into the circulation of the ptomaines and toxins, which in the catarrhal affection escape largely from the inflamed surface.

The resulting abscess is usually in or near a gland or group of lymph glands. The part passes through the usual succession of changes, of soft pitting swelling; firm, tense, painful condition in which the exuded lymph has coagulated; and softening and fluctuation which progresses from the centre toward the circumference. The abscess points variously according to its seat. If in the intermaxillary space it opens externally. If sub-parotidean or peripharyngeal it may burst inwardly into the pharynx or outwardly through the skin. If supra-pharyngeal (retro-pharyngeal), it may be so thickly encapsulated in unyielding walls that it may remain long indolent and inactive becoming a cold or chronic abscess. When an abscess opens into the pharynx, there is a sudden and copious flow of pus by the nose, and it may be by the mouth and a simultaneous subsidence of the inflammation.

Among the _complications_ of the affection are asphyxia, œdema glottidis; abscess of the guttural pouch; rupture of an abscess into the larynx, and the descent of pus into the lungs; the entrance of saliva and alimentary matters into the lungs; gangrenous pneumonia; pharyngeal fistula; pressure on the vagus and paralysis of the pharynx or larynx; secondary abscesses; septicæmia.

_Lesions._ Besides the general inflammatory lesions some rather remarkable ones have been observed. Fractured hyoid, dissection of the mucous from the muscular coat, by aliments, for nearly the whole length of the œsophagus (Brückmüller), purulent infiltration of the supra-pharyngeal muscles (Wakefield), ulceration of the pharyngeal or guttural sac mucosa, or even gangrene, purulent effusion in the tonsils, around the hypoglossal nerve, the lingual branch of the fifth, or the vagus, embolic inflammations, suppurations or gangrene of the bronchia, and implication of the lung tissue and pleura. Catarrhal enteritis and fatty liver and kidney are common.

_Treatment._ Beside the general measures advised for catarrhal pharyngitis, this type demands especially measures to moderate the intensity of the suffering, and when abscess appears inevitable to hasten its maturation. The first demand is met by hot fomentations persistently applied to the throat. This may be done by spongio-piline, or simply by well washed wool or cotton bound upon the throat and wet at frequent intervals with water rather hotter than the hand can bear. The addition of a little carbolic acid will secure at once some local anæsthesia and a measure of antisepsis. In warm weather the substitution of cold water has been resorted to with apparently good effect. If adopted it should be frequently removed so as to keep up the constant action of cold and moisture. These have been especially recommended in dogs injured by a tight or ill-fitting collar.

When suppuration appears imminent as shown by the dense, hard, circumscribed phlegmon, stimulating embrocations may be used to hasten its progress. Camphorated spirit is suitable for carnivora and sheep. It may be combined with tincture of cantharides for horses. For cattle and swine, oil of turpentine may be added, the three being used in equal proportions. A liniment of ammonia and oil may be used more or less frequently and energetically according to the relative thickness and insensibility of the skin of the animal affected.

When matter has formed and fluctuates, it should be at once evacuated and the cavity treated by antiseptic dressings. In this way secondary abscesses, septic infections, molecular ulcerations and other injurious sequelæ may be largely obviated.

In case of threatened asphyxia the _dernier resort_ of tracheotomy is always available, and this often acts very favorably in improving the æration of the blood, in restoring the flagging vital functions which depend on hæmatosis, and in removing the friction and irritation consequent on the passage of air through the narrowed and tender passages.

SUPRA-PHARYNGEAL (RETRO-PHARYNGEAL) ABSCESS.

A sequel of phlegmonous pharyngitis. Symptoms; masked by its depth;
pharyngeal wheezing or roaring with little local swelling; difficult
swallowing; resisting tissues tend to chronicity. Results; pharyngeal
fistula, burrowing along œsophagus, rupture into chest or
blood-vessels, lymphadenitis, compression of vagus, or jugulars,
permanent infected cavity with small orifice. Diagnosis from pus in
guttural pouches. Treatment; external opening; antisepsis.

This is a natural result of phlegmonous pharyngitis, but it is possessed of so great importance alike in its chronicity and its results that it seems to deserve a special article. Like its initial morbid condition it is especially common in the soliped, and like that may be traceable to strangles, influenza, and local traumatism.

The _symptoms_ are at first those of phlegmonous pharyngitis, and, if the local swelling, induration and tenderness are less marked than in other cases, it is due to the location of the inflammatory lesion deeply between the pharynx and the atlas and occiput. Indeed the moderate aspect of the external swelling, conjoined with the noisy wheezing or violent roaring, may be taken as important diagnostic indications. The supra-pharyngeal region is so closely confined on its lateral aspects, by the union of the fascia of the sternomaxillaris and mastoido-humeral muscles, that the swelling is confined in the early stages just as the pus is later. As this resistant fascia prevents any relief by lateral expansion, the engorged tissues press downward on the softer and less resistant upper wall of the pharynx and seriously impair both respiration and deglutition. Similarly when pus has formed, these lateral fibrous barriers, reënforced by organized lymph, stand in the way of the advance of the pus toward the skin, and lead it to dissect its way downward toward the pharynx. Even here the thickening of the tissues by the organized products of the lymph will often interpose a serious bar, and the pus remains pent up indefinitely, a source of wheezing, roaring and impaired deglutition, and a constant threat of secondary abscess or septic infection. Even the dense fibroid tissues may soften and degenerate and the pus may make its way spontaneously to the pharynx, or less frequently through the skin of the parotid, or intermaxillary region, or into the œsophagus or larynx. A fistula of the pharynx opening externally and allowing the escape of alimentary matters has been often noticed. These are especially liable to follow puncture of the abscess.

Among the less common sequelæ are fistula of the œsophagus; purulent pneumonia in connection with the purulent dissection of the œsophagean walls and rupture into the chest (Fichet, Schneider); ulceration of the blood vessels in the cow (Jonge); adenitis and lymphangitis of the neck, and the thoracic glands, followed by pericarditis and pleurisy (Cadeac); multiple embolic abscesses of internal organs (Dieckerhoff); compression and degeneration of the vagus nerve, with consequent respiratory and digestive troubles (Baudon); and compression and obstruction of the jugulars with passive congestion of the brain and vertigo. (Delamotte, Debrade). Even when the abscess opens into the pharynx the orifice is usually small, the pus escapes imperfectly, and food materials enter and the fistula may thus persist for a length of time. The same imperfect discharge is liable to take place with an external orifice and the pent up pus becomes inspissated, caseated and even calcified.

_Diagnosis._ Supra-pharyngeal abscess is to be distinguished from pus in the guttural pouches, by the lack of coincidence of the discharge with the dependence of the head in grazing, eating roots or drinking from a bucket; by the absence of the intermission when the head is elevated; and by the fact that the discharge is less frequently limited to the one nostril. The hearing too is less likely to be affected.

_Treatment._ As soon as the presence of pus can be recognized it should be evacuated. This is often attempted through the roof of the pharynx, but with such an opening there is always danger from the entrance and decomposition of alimentary matters. If fluctuation can be felt externally, it is better to be opened through the skin. The integument may be incised with a lancet, and the tissues further penetrated by manipulations with the finger nail, a grooved sound or the point of closed scissors. In this way the vessels and nerves are pushed aside and the dangers of hemorrhage, fistula and paralysis avoided. The cavity must be irrigated with an antiseptic solution (carbolic acid 3:100; or acetate of aluminum 1:20).

PSEUDOMEMBRANOUS (CROUPOUS) PHARYNGITIS.

False membranes not due to a common microbian cause. Accessory causes
in solipeds; caustics, smoke infection. Lesions: Congestion, necrosis;
croupous exudate, extending to patches on bowels and bronchia; kidney
infarctions; blood altered. Symptoms: fever, dyspnœa, mucous rattle in
throat, swelling, painful, difficult deglutition, yellow or cyanotic
mucosæ, pinched face, weakness, prostration. Duration. Diagnosis.
Treatment, as for catarrhal pharyngitis with antiseptics by inhalation
and electuary. Iron.

Pharyngites attended by the formation of false membranes are met with in all the domestic animals and may be grouped together as a special class. The collection of these in one group, however, must not be taken to imply that all of these, as met with in the different animals have the same pathology, and are due to one invariable cause. Above all it must not be inferred that they are identical with the malignant diphtheria of the human being. The bacillus diphtheriæ hominis isolated by Klebs in 1883, and proved pathogenic by Löffler in 1884, has not been successfully inoculated upon any of the larger domestic animals, and has not been found in any of the casual pseudomembranous pharyngitis of these animals. The common feature of the group is to be found in the formation of the false membrane, and the fact that a given disease is placed in the group must not be held to apply to any special character, of microbian origin, nor communicability by infection.

PSEUDOMEMBRANOUS PHARYNGITIS IN SOLIPEDS.

Cases of pharnygitis with false membranes have been seen in horses by Delafond, Targue, Rey, Bouley, Riss, Sonin, Robertson, Dieckerhoff and Schneidemühl.

They have been attributed to various causes, as caustic alkalies and acids, the smoke of a burning building (Bouley, Rey, Riss), to an infection which operated on dogs and horses (Robertson), to bacteria and other irritants.

_Lesions._ The mucous membrane of the mouth, pharynx and even the nares presents active inflammation with branching redness, petechiæ, circumscribed foci of necroses, and false membranes of a grayish, yellowish, reddish, greenish or blackish color. These are formed of a pellicle consisting mainly of fibrine and epithelium, pus globules and numerous cocci, and ovoid bacteria. The false membranes have been found on other parts of the intestinal canal (colon, cæcum); and broncho-pneumonia and pulmonary dropsy have been concomitants. The effect of the toxic products is seen in hæmorrhagic inflammation and infarctions of the kidneys, and in a black color of the somewhat diffluent blood.

_Symptoms._ Besides the usual phenomena of pharyngitis, there is intense hyperthermia (105°–106°), hurried breathing threatening suffocation, painful cough roused by the slightest pressure on the swollen throat and often causing the discharge from the nose of shreds of false membrane. Auscultation of the pharynx gives a loud gurgling sound. Deglutition is very difficult and painful, liquids and even solids being rejected through the nose. The face is pinched and anxious and the mouth is often held open and the tongue pendant. Weakness and prostration are marked symptoms from the first, and the walk may be unsteady and swaying. The visible mucous membranes are congested and usually have a more or less deep tinge of yellow. The disease makes rapid progress and may prove fatal under six days. When it takes a favorable turn, recovery and convalescence may be equally prompt.

Unless the expectoration of false membrane is detected, such cases are difficult of diagnosis, though a fair inference may be deduced from the extreme severity of the symptoms, and the unusual degree of prostration which is present. When a pharyngeal speculum, passing through the nose, can be availed of, it may become possible to reach a more definite conclusion.

_Treatment._ Beside the measures advised for catarrhal pharyngitis (poultice, counter-irritants, laxatives, antithermics, alkalies, etc.), the main reliance must be placed on antiseptics. Persistent inhalations of warm water vapor with carbolic acid, creolin, tar, lysol, camphor or sulphurous acid are in order: also a mixture of one or other of these agents or of boric acid, bisulphite of soda, or salicylic acid in honey or molasses to be frequently smeared on the teeth. One of the best agents is the saturated solution of chlorate of potash in tincture of muriate of iron, of which a drachm may be added to three ounces of water and given every hour or two. Calomel may be injected through the nose during inspiration, by means of an insufflator, care being taken not to exceed the physiological dose.

PSEUDOMEMBRANOUS PHARYNGITIS IN CATTLE.

Most common in calves. Inoculations successful on rabbits, mice and
sheep. Bacillus: its cultural characteristics. Predisposing causes.
Symptoms: nasal mucosa congested; false membranes; snuffling, wheezing
breathing; painful, rattling cough; agonized expression; salivation;
bowel disorder. Course. Duration. Lesions; intense congestion and
false membranes. Treatment: as for horse; special antiseptics;
solvents; anodynes; tracheotomy.

This has appeared especially in calves, and though apparently readily transmissible among the young, it rarely attacks aged cattle. Cadeac and others inoculated it on guinea pigs and rabbits without success. Dammann, on the other hand, had his inoculated rabbits die in twenty-four hours with hemorrhages in the seat of inoculation. Löffler inoculated it hypodermically on mice and produced extensive infiltration of the entire walls of the abdomen, and often of the peritoneum including the surface of the liver, kidneys and intestines, on which was formed a thick, yellowish exudate containing the microbe. Damman claimed to have successfully inoculated the sheep as well.

_Causes: Microbe._ Löffler found in the deeper layers of the exudate a long delicate bacillus, five or six times as long as broad, and about half the thickness of the bacillus of malignant œdema. Several bacilli were usually joined so as to form long filaments. These failed to grow in nutrient gelatine, or sheep blood serum, but grew readily in the blood serum of the calf.

Beside the specific microbe Cadeac enumerates as predisposing causes: sudden chills, rapid changes of temperature, suppression of perspiration, inhalation of irritant gases, swallowing of irritant liquids, and traumatic injuries.

_Symptoms._ The nasal mucosa is violently congested, reddened, thickened, and covered at intervals by false membranes which block the normally narrow passages and produce snuffling, wheezing, and difficult breathing. The throat is swollen, and tender, the slightest touch producing a painful gurgling cough which leads to the discharge of mucopurulent matter, shreds of false membrane and even blood. These membranes may be seen on the nose or mouth. There is high fever, rapid, small pulse, cyanosed mucous membranes, pinched countenance, and usually open mouth, pendant tongue and drivelling saliva. There may be either constipation or diarrhœa.

The course of the malady is rapid, death sometimes supervening in 24 to 48 hours. Recovery and convalescence may be prompt, or the disease may last for weeks.

_Lesions._ The congestion is intense and may invade the mouth, nose, pharynx, larynx and bronchia, with at intervals the patches of yellowish white false membranes. These may be soft and diffluent when recent, and tough and resistant when of longer standing. The deeper layers are often bloodstained. Preitsch has seen them extend to the gullet, paunch and manifolds, and attended with considerable ulceration of the subjacent mucous membrane.

_Treatment._ This does not differ materially from that recommended for the horse. Among the additional antiseptics employed have been, iodoform, oil of turpentine, sulphide of calcium, silver nitrate and coal tar. To loosen and detach the false membranes ipecacuan and sulphates of soda and magnesia have been largely resorted to. Papayin and pepsin might be tried. Also as anodynes digitalis, morphia, aconite and belladonna. Finally tracheotomy has been employed when asphyxia seemed imminent.

PSEUDOMEMBRANOUS PHARYNGITIS IN SHEEP.

Cause; infected dust on susceptible subject; inoculation. Symptoms;
movement of jaws; frothy lips; salivation; viscid nasal discharge;
difficult swallowing and breathing; swollen tender throat; extended
head; anorexia; cyanosis; open mouth; cough expels shreds of false
membrane; asphyxia. Lesions. Treatment; Glauber salts or muriatic acid
in water; antiseptic fumigation and drinking water; antisepsis of the
pharynx.

Roche-Lubin speaks of this disease as common in flocks, as the result of moving them around for twenty-four hours in a narrow enclosure covered with dust which is raised in a cloud and settles in the fleece so as to increase its weight. The fever and excitement caused by the constant driving and the local action of the infected dust on the respiratory mucous membrane is said to bring about the intense exudative inflammation. It has been seen especially in the spring in young lambs shortly after weaning. Damman claims that he transmitted the disease to sheep by inoculating the diphtheritic exudate of the calf.

_Symptoms._ There were constant movements of the jaws, with the accumulation of frothy saliva round the lips or the drivelling of this secretion from the mouth, the discharge of a viscid white material from the nose, difficulty of deglutition, hurried, panting, snuffling breathing, swelling and tenderness of the throat, and the occurrence of cough and the discharge of mucopurulent matter whenever it was pressed. The head and neck are held rigidly extended, the eyes are dull or glazed, the appetite is completely lost, the mucosæ red and cyanotic and the animal weak and unsteady upon its limbs. By the third or fourth day respiration has become so difficult that the mouth is held constantly open, the tongue protruded and the painful convulsive cough leads to the expulsion by the nose and mouth of shreds of false membrane. Careful examination of the nose or of the fauces may detect the grayish or yellowish patches of false membrane at an earlier stage. Death by asphyxia is common.

_Lesions_ do not differ materially from those seen in the calf. The inflammation and pseudomembranous exudate may extend as far as the trachea and bronchia in which case the indications of death by asphyxia are clearly marked.

_Treatment_ is the same as for the calf. Tepid drinks slightly acidified with muriatic acid, or the addition to the drinking water of one pound of sulphate of soda to every fifty sheep has been especially recommended. Fumigation with sulphurous acid or chlorine is easy of application in flocks. As alternatives for addition to the water may be named hyposulphite or bisulphite of soda, borax, carbolic acid, or spirits of turpentine. For treatment individually swabbing the throat with antiseptics and dilute caustics, electuaries, and hot poultices to the throat may be tried.

PSEUDOMEMBRANOUS PHARYNGITIS IN SWINE.

Prevalence in herds, in close pens, and in young. Relation to swine
plague and hog cholera. Symptoms: sore throat, prostration, hoarse
cough, yellowish discharge with shreds of false membrane, pellicles on
mouth, fauces, tonsils. Diagnosis from swine plague. Treatment:
Isolation, disinfection, antisepsis to throat, febrifuges.

This has long been recognized as a contagious affection, occurring especially where the animals were kept in herds and too often in close and filthy pens. These are more liable in youth than in maturity, partly no doubt because the older animals have already suffered and attained to an immunity. Modern observation has shown that pharyngitis with formation of false membranes is especially common in swine plague, and the present tendency is to refer all such cases to that category. It is however altogether probable that the occurrence of local irritation with the addition of an irritant or septic microbe altogether distinct from those of swine plague or hog cholera, gives rise at times to this exudative angina. Certain it is that septic poisoning with the food is not at all uncommon in the hog, in the absence of these infectious diseases.

The _symptoms_ are those of severe sore throat with profound prostration, a hoarse, painful cough, a yellowish discharge from nose and mouth, and great muscular weakness. The base of the tongue, tonsils and soft palate are red and tumid with here and there grayish or yellowish patches of false membranes. The identification of swine plague may be made by the history of the outbreak, the number of animals affected, the tendency to pulmonary inflammation, the enlarged lymph glands, the presence of the non-motile bacillus which does not generate gas in saccharine media, and which readily kills rabbits and Guinea-pigs with pure cultures of the germ.

_Treatment_ will depend largely on the nature of the attack—swine plague or simple pseudomembranous infection. Isolation, cleansing and disinfection will be demanded in both cases. In swine plague all additional precautions to prevent its spread must be resorted to. In the simpler exudative inflammations the antiseptic local treatment and general febrifuge measures will be demanded.

PSEUDOMEMBRANOUS PHARYNGITIS IN DOGS.

Relation to diphtheria in man and horse. Symptoms; fever, prostration;
swollen throat; cough; vomiting; false membranes on fauces and
tonsils; cyanosis. Treatment: local antisepsis; febrifuges.

Rossi and Nicholski claim that dogs contract diphtheria by swallowing the excrements of diphtheritic infants, but these observations lack confirmation, and the infrequency of such an occurrence argues against it. Robertson records cases of canine angina with false membranes occurring at the same time as a similar affection in the horse. The victims were puppies and the mortality was high. Exact observations are, however, lacking.

The _symptoms_ were dullness, prostration, anorexia, a hard cough, swollen throat, vomiting, diarrhœa, and the presence of grayish or yellowish false membranes on the fauces and tonsils. The breathing was difficult and painful and the mucosæ cyanotic.

_Treatment_ has been essentially local, consisting of swabbing with solution of boric acid (1:200), chlorate of potassa, perchloride of iron, or nitrate of silver.

PSEUDOMEMBRANOUS STOMATITIS OF PIGEONS AND CHICKENS.

Contagious and destructive nature of the disease. Mode of extension
from the mouth and pharynx. Causes: bacillus diphtheriæ columbarum;
its characters: pathogenesis to birds, mice, rabbits, Guinea pigs;
dogs, rats, and cattle immune; diagnosis from bacillus diphtheriæ.
American disease. Incubation. Symptoms: prostration; wheezing
breathing; sneezing; difficult deglutition; false membrane on fauces;
necrotic changes in mucosa; perforations; lesions of internal organs;
blood infection; nostrils stuffed; bill gapes; lesions on eye, tongue,
gullet, crop, intestine; diarrhœa; vomiting. Skin lesions. Course,
acute, chronic. Paralysis. Mortality. Prognosis. Diagnosis from
coccidiosis, from croupous angina of Rivolta, from aspergillus
disease. Treatment: isolation; destruction of carcasses; hatching;
destruction of dead wild birds and rabbits; exclusion of living;
quarantine of new birds; disinfection; locally, antiseptics by
inhalation, swabbing, and internally, iron in water.

This affection prevails in certain countries and causes heavy losses among young pigeons, so that it might with great propriety be included among animal plagues, which should be dealt with by the State. The malady is a local inflammation leading to the formation of false membranes and its usual course is to progress from the mouth and pharynx, to the nasal passages, lachrymal ducts and sacs, the larynx, trachea, bronchia, intestines and skin.

_Causes._ The essential cause of the disease is held by Löeffler to be the _bacillus dipththeriæ columbarum_, which is a short bacillus with rounded ends, a little longer than the bacillus of fowl cholera and not quite so broad. It is usually found in irregular clusters, especially in the interior of the hepatic capillaries. It is ærobic, non-motile, non-liquifying, and grows on nutrient gelatine, blood serum or potato. In gelatine it forms a white surface layer, and spherical colonies along the line of puncture, which show a yellowish brown tint under the microscope. On blood serum and potato it forms a grayish white layer.

_Pathogenesis._ The bacillus is inoculable on other =pigeons= and as it usually appears in the young birds in the nest, still fed by the parent bird, it is probable that no inflammation nor abrasion is necessary to make it take. Pure cultures inoculated in the mouth gave rise to the usual local type of the disease. When inoculated subcutem it caused a local necrotic inflammation.

In =mice= subcutaneous injections proved fatal in five days with general dissemination of the bacillus. There are congested and hemorrhagic spots on the lungs, enlarged spleen, and the liver is marbled by numerous necrotic white masses, in the centre of which the capillaries are found to be blocked with the bacilli. This is so pathognomonic that Löffler looks on the inoculation of mice as the best means of diagnosis.

Inoculated =rabbits= showed inflammation in the seat of inoculation and sometimes fibrinous peritonitis and enlarged spleen. Inoculation on the cornea produced a false membrane.

In =Guinea pigs= induration and ulceration occurred in the seat of inoculation but recovery followed in 14 days.

=Sparrows= inoculated in the pectoral muscles died in three days with yellowish necrotic tissue highly charged with bacilli.

Inoculation of the =chicken= by Löffler and Megnin produced a circumscribed redness which soon disappeared. On the other hand Krajewski, Colin, Loir and Ducloux seem to have inoculated chickens successfully, and Cadeac says that the cultures are infecting for =sparrows=, =pigeons=, =turkeys=, =chickens= and =ducks=. It rests uncertain therefore whether the pseudomembranous pharyngitis of hens is a distinct disease as alleged by Löffler and Megnin or if the chickens used by these observers were not already immune by reason of a prior attack.

Löffler’s experiments showed that _dogs_ and _rats_ were immune. Loir and Ducloux failed to infect cattle.

In infected dove-cots a comparative immunity is attained by the older pigeons, which continue to harbor the germ, but do not suffer materially from its presence. They however communicate it to the susceptible young in the milky secretion produced in the crop and with which they feed them, and these accordingly perish in large numbers. Thus pigeons that are themselves in fine condition become the propagators of the bacillus to the more impressible.

_Sparrows_ and other _small birds_ are also held to be common propagators of the germ, and if they too can secure an individual immunity and yet harbor the bacillus, their passage from yard to yard may be attended with great danger. The grains soiled by their bills and not swallowed are common media of transmission.

Loir and Ducloux found the affection transmissible between man and pigeon. The identity of the bacillus with that of genuine diphtheria in man appears to have been thoroughly disproved by the observations of Roux and Yersin.

The following differential characters have been noted:

_Bacillus Diphtheriæ _Bacillus Diphtheriæ Columbarum_
(Klebs-Löffler)._

1. In gelatine cultures grows only 1. In gelatine cultures grows at
above 23°C. 15–17°C.

2. Kills Guinea-pig and dog. 2. Guinea-pig and dog nearly
immune.

3. Mice immune. 3. Mice usually die with hepatic
necrosis.

4. Does not grow on potatoe. 4. Grows luxuriantly on potatoe.

It may be accepted as demonstrated that the common diphtheria of birds is essentially distinct from the genuine diphtheria of man, and that when such diphtheria of the bird is conveyed to man as has been often alleged (Richter, Gips, Bonig, Gerhart, etc.), it is one of the forms of pseudo diphtheria that is produced, and not that which is caused by the Klebs-Löffler bacillus. Dr. V. A. Moore, who has cultivated specimens of the bacillus diphtheriæ Columbarum obtained from Germany, considers the germ as belonging to the group of the bacillus coli communis, and as not the cause of the chicken diphtheria in America. Further investigation must settle whether the bacillus diphtheriæ Columbarum is the one cause of this affection in Europe, and what is the microbian cause or causes of the disease in America.

_Incubation._ This is very variable. False membranes may form in twenty-four hours in some cases; in other cases they may be delayed from four to fourteen days (Colin, Babes, Puscarin, Marinescu).

_Symptoms._ There is dullness, prostration, sunken head, ruffled feathers, altered hoarse voice, drooping wings, wheezing breathing, difficult deglutition, sneezing, and patches of dark red congestion in the fauces covered with a thin film, at first translucent, but soon becoming dense, adherent, opaque, whitish or yellowish. As it becomes older this deposit becomes granular, wrinkled, dry and friable. It is more adherent in chickens than in pigeons and causes bleeding when detached. Necrotic changes may take place in the mucosa leading to considerable loss of tissue, and even to perforations of the soft palate, pharynx or œsophagus. It may remain circumscribed by the region of the mouth and end in an early recovery, or it may extend to the organs of the chest and abdomen, or the germs may proliferate largely in the blood and induce fatal results. On the other hand it may become subacute or even chronic, and, as already noted in the case of the parent pigeons, it may persist as an infecting disease without materially injuring the general health of a comparatively immune animal.

The affected _nasal passages_ become filled by frothy liquid and blocked by false membranes, so that the bird is driven to breath through the open mouth. The skin around the nares, and eyelids and the cavity beneath the eye may be covered with the false membrane, by the increase of this product the bones may be driven out of place, so that the palatines press downward, the eyeball is pressed outward and the root of the beak may seem swollen. The false membranes that form on the skin or reach the surface are soft, creamy, cheesy, or dry, granular and friable.

When the _eye_ is specially affected there are swelling of the lids, profuse lachrymation, closure of the lids by adhesion, and formation around their borders or on their inner surface and on the membrana nictitans of false membranes which press the lids outward more or less unevenly, and may be easily recognized when the lid is everted. The cornea and even the interior of the eye may suffer, leading to perforation, internal tension, and in some cases atrophy, with permanent blindness.

The _tongue_ may suffer on the tip as in _pip_, or on its dorsum, from which the disease extends to the larynx, trachea and even the air sacks, which become filled with false membranes, that are coughed up, and decomposing in the mouth, add to the infection and fœtor. Dyspnœa and cyanosis of comb and wattles are marked features.

The extension may take place downward along the alimentary track, the false membranes forming on the _gullet_ or _crop_ and interfering with swallowing or digestion, or on the intestine and determining a fœtid, often greenish or bloody diarrhœa with indications of false membranes. Vomiting may be a marked symptom.

The _skin_ is usually attacked secondarily around the margin of the beak, the eyelids, the nares, the ears, the comb, the wattles, the anus, but it may develop at any point where the infecting material has touched an abraded surface.

Trinchera found that in acute cases the acme was reached in fifteen days after which improvement might be looked for. A chronic form affecting the gullet might however persist indefinitely in pigeons without proving incompatible with good health.

Paralysis of the wings or limbs may remain after the healing of the local lesions.

_Mortality. Prognosis._ The disease is very fatal to both pigeons and chickens, 50, 70 or even 100 per cent. perishing when a flock is attacked for the first time. In flocks that have previously suffered, on the other hand, a large number are practically immune, and even if they contract the disease it assumes a mild form, and they survive but may retain the germ and continue to communicate it to others. Even the young of such immune flocks suffer less severely, coming as they probably do from less susceptible and therefore surviving birds, or having already perhaps contracted a mild (non-fatal) type of the disease from their parents.

_Differential Diagnosis._ From _psorospermosis_ (_coccidiosis_) it is distinguished by its origin on the mucous membranes, and not on the skin, the skin lesion being a secondary one. In psorospermosis the primary lesion is usually on the skin, from which it extends to the mouth and especially along its floor. In psorospermosis the morbid deposit assumes the form of rounded warty-like masses, on comb or wattles; is easily propagated by inoculation, is promptly checked by antiseptics, does not tend to produce internal extension nor generalization, and on microscopic examination shows numerous spheroidal coccidia intermingled with the epidermic cells and possessing amœboid movement. By virtue of this automatic movement they make their way between and into the epidermic cells in which they multiply.

From the _croupous angina_ of Rivolta it is distinguished by the absence of the infusoria (monocercomonas gallinæ) to which he, Delprato and Pfeiffer attributed that affection. The monocercomonas is a flagellate organism 14 _μ_ to 25 _μ_ in length and 5 _μ_ to 7 _μ_ in breadth. Its rounded end bears one flagellum as long as the body, and its acute end three flagella which give it active motions. These are found in the yellowish white swellings of the mucosa, which vary in size from a millet seed to a pea, covering a hyperæmic spot and composed of epithelial cells, blood globules—white and red,—leucocytes, granules and the infusoria. The false membrane is remarkable for its lack of consistency and its tendency to invade the mouth and gullet rather than the air passages. These infusoria are not colored by picrocarminate of ammonia, but stain by methyl-violet and then appear as round or slightly irregular hyaline bodies.

From _aspergillus disease of pigeons_, by the absence of the characteristic, miliary, white nodule of that disease showing caseated contents intermixed with an abundant mycelium of aspergillus fumigatus. The aspergillus disease attacks especially the mouth but may also implicate the gullet, lungs, liver, intestine and kidneys. The microscopic examination of the exudate is conclusive, by reason of the presence of the bacillus diphtheriæ columbarum, and the comparative absence of the filamentous mycelium.

_Treatment._ This is mainly prophylactic. The first step must be to separate the sick and healthy, destroying the former, or shutting them up in a special enclosure apart from all other birds. In the case of valuable chickens, their eggs may be set under other hens and the young raised apart from the suspected flock. This may even be attempted in pigeons, the common eggs being removed and the valuable ones put in their place under a healthy sitting dove. In the case of pigeons that have been recently through the disease they should be kept strictly by themselves, even though they may appear to have regained perfect health. The dead bodies must be burned or deeply buried. Sparrows and even rabbits dying in the vicinity must be similarly disposed of, and where the disease prevails sparrows and small birds may be exterminated as probable bearers of infection.

The purchase of strange birds must be carefully guarded, none being taken that show weeping eyes, nasal discharge, labored or wheezing breathing, and all new birds should be placed by themselves in quarantine for ten to fifteen days. Finally a thorough disinfection of the place where the sick have been is of first importance. Thorough cleaning of the poultry house, followed by a coat of white-wash, every gallon of which contains four ounces of chloride of lime, or one drachm of mercuric chloride will usually prove effective. The poultry runs should be liberally sprinkled with a solution of sulphuric or hydrochloric acid, one part to 1000. The same may be used on the building, which may further be fumigated by burning sulphur.

Poultry shows should be kept under the most rigorous sanitary supervision.

_Curative treatment_ is only profitable in the case of specially valuable birds, and even then only, as a rule, when the disease is confined to the nose, mouth, larynx and pharynx. The affected parts may be brushed with a solution of chloride of iron (1 dr. of the tincture to 1 oz. water), nitrate of silver (2 grs. to 1 oz. water), sulphide of calcium (½ dr. to 1 oz. water), tannin (10 grs. to 1 oz.). Tincture of iodine may be applied direct, or a solution of carbolic acid or of creosote or creolin (1 part to 50) will often succeed. Thomassen recommends the removal of the false membranes and the application of boric acid followed by dry sulphur. Benoist says the majority recover when made to inhale the fumes of oil of turpentine evaporated at a gentle heat twice a day.

As internal medication, or to correct the intestinal affection, sulphate of iron may be dissolved in the drinking water, or salicylic acid may be given in pill form with molasses.

CHRONIC PHARYNGITIS.

Sequel of acute: or subacute from the first. Due to œstrus, in cattle
to summer catarrh, tubercle or actinomycosis. Lymphatic horses
predisposed; attends chronic indigestion; in swine tonsilitis.
Symptoms: chronic cough, easily roused, wheezy or mucous; nasal
discharge; low condition; lack of spirit. Lesions: congestion;
softenings; erosions; cicatrices; tonsilitis; abscesses; specific
deposits. Treatment: hygienic; antiparasitic; astringent; antiseptic;
derivative; counter-irritant; tonic inhalations and electuaries.
Bitters. Iron.

_Causes and Nature._ Chronic pharyngitis in animals may be a simple continuation of the acute, in a milder form, or it may assume a subacute or chronic type from the first and never rise to the intensity that would characterize the acute. It may be a simple catarrhal affection or it may become more or less follicular or glandular. Again in horses it is not infrequently a result of the hibernation form of the œstrus (bots) attached to the delicate pharyngeal mucosa, and in cattle from the extension of the chronic summer catarrh, or from the local development of tubercle or actinomycosis in the walls of the pharynx or in the adjacent lymph glands. Horses of a soft, lymphatic constitution, with a heavy coat, confined in close warm stalls, and which perspire abundantly are especially liable to the affection. It may also be an accompaniment and result of chronic gastric indigestion. In swine the affection is commonly associated with tonsilitis.

_Symptoms._ In many cases the main symptom is a chronic cough which is aroused by any cause of irritation, feed, especially dry or fibrous fodder, cold drinking water, sudden passing from the hot stable to the cold outer air, reining in, pressure on the throat, or sudden active exertion. If the cartilages are calcified it may be impossible to rouse the cough by pressure. The cough is often dry and wheezy, rather than soft and gurgling as in the second stage of acute pharyngitis, and is repeated several times paroxysmally. In the intervals there is more or less stertor or wheezing, or a distinct rattle especially when the neck is curved by drawing the nose inward. Deglutition may be interfered with but this shows most with the first swallow, which in the case of liquids may be returned through the nose, whereas those that follow go down without difficulty. A lateral swelling of the parts above the larynx or a bulging of the parotids is not uncommon. Discharge from the nose of a mucopurulent character is usually present, but often so scanty as to be overlooked. There is usually loss of flesh and lack of vigor even if the subject is well fed.

_Lesions._ In the simple catarrhal form the mucous membrane of the lateral pharyngeal walls, the posterior pillars of the palate and the back of the soft palate, is red, congested, with arborescent vessels, thickening, and puckering into rugæ. The epithelium has lost its translucency, become opaque and granular, and its desquamation in spots and patches may leave erosions, ulcers more or less deep, and white drawn cicatrices. When the follicles and mucous crypts are involved (follicular) they stand out like millet seed, peas or beans, and may show ulceration or minute abscess. In pigs especially, tonsilitis is liable to be present, and the tonsillar follicles are filled and distended with tenacious mucous, a caseous granular _debris_, or even a cretaceous material. In the vicinity of the tonsils, minute abscesses may exist in or beneath the mucosa.

Ulceration may be the result of tubercle, glanders, actinomycosis, aspergillus, sarcoma, or some local infection, and attendant symptoms of one or other of these diseases will guide the diagnosis. Thus in tubercle there will be the implication of the adjacent lymph glands and usually of distant ones; in glanders the deposits in the nose, submaxillary lymph glands and lungs will enable one to diagnosticate; in actinomycosis the hardness of the neoplasm and the presence of the yellowish tufts which present under the microscope the concentrically arranged club-shaped elements, will show its nature; and in sarcoma or carcinoma the structure of the new tissue will decide its character. The pharyngeal muscles are the seat of granular or fatty degeneration or of fibroid change. Friedenreich speaks of a fold from the vault of the pharynx which had nearly closed the passage and had killed the horse by inability to swallow.

_Treatment._ Chronic pharyngitis is usually a very obstinate affection and demands careful hygienic as well as medicinal treatment. Hot, foul stables, unduly thick coats, unwholesome food, irregular feeding, excessive meals at long intervals, overwork, undue exposure to cold and wet, lack of sunshine or of grooming are to be corrected. Next, the removal of mechanical irritants such as pharyngeal bots, actinomycosis growths, etc., will be in order. Then the use of astringents and antiseptics internally and of derivatives externally will be demanded. An occasional embrocation of mustard, or the application of ammonia and oil, will often serve a good purpose, and in obstinate cases the hot iron in points will sometimes prove effective.

Internally the inhalation of the fumes of tar, carbolic acid, creolin, oil of turpentine, or of burning sulphur kept up continually or frequently repeated. Giving all drink in the form of tar water will often have a good effect. Electuaries made with boric acid, salicylate of soda, ammonium chloride or iodide, borax, with honey, molasses, liquorice, Iceland moss, or gum arabic will often prove beneficial. Agents that stimulate the mucosa may follow, such as balsams of Peru or Tolu, copaiba, cubebs, pilocarpin, wild cherry bark, or these may be combined with the former. Finally a course of tonics are usually of the first importance; iron sulphate, copper sulphate, arsenious acid, arsenite of strychnia may furnish examples.

DEPRAVED APPETITE. STUMP SUCKING. PICA. LICKING DISEASE.

Common features of group. Ruminants; depraved appetite; objects
swallowed: hair balls. Sheep eating wool in winter. Pigs eat bristles.
Puppies swallow marbles, etc., wantonly. Solipeds swallow hair,
plaster, earth, sand, and lick manger or rack. Fowls eat their
feathers. Causes: soil exhaustion, lack of lime, soda, potash,
phosphorous; relation to osteo malacia; granitic or sandy soils, peat,
muck, causative; digestive disorder; faulty food; yearly breeding and
heavy milking; constant stabling; dry seasons. Course: chronic.
Lesions; emaciation; anæmia; serous exudate; catarrh of the bowels.
Treatment: soil; good fodder; salts of soda, potash and lime,
phosphates; tonics; apomorphine. Wool eating; example: digestive
disorders; emaciation. Treatment: open air; good fodder; salts of the
bones and soft tissues; clip nurses; apomorphine.

_Definition._ We have here a class of morbid habits, which cannot be referred to any constant lesion or group of lesions, and which appear in certain cases to result from example and to constitute nothing more than a bad habit.

_Symptoms._ _Ruminants_ without any appreciable cause, lick the clothes of their care-takers, chew and swallow articles of clothing of all kinds, bones, old shoes, gloves, socks, cuffs, collars, small forks, pocket-knives, nails, wires, needles, coins, stones, lumps of clay, hair, which may give rise to secondary troubles of a more or less serious kind. Pregnant cows are especially subject to this infirmity. The small pointed objects like pins, needles, ends of wires, etc., which are mostly taken by accident with the food are especially apt to be entangled in the alveoli of the reticulum and make their way to the heart, with fatal effect, or through the abdominal walls creating a fistula. Hair aggregates with saliva, mucus and phosphates, to form balls in the first two or three stomachs. Other indigestible objects may also become encrusted and prove sources of irritation. Licking the skin of another animal is doubtless at times encouraged by the taste of the salts of perspiration, but in other cases it has all the appearance of a mutual kind service as the cow with itching head will walk up and present it to its fellow which rarely fails to respond to the invitation. Stump licking is not uncommon.

=Sheep= shut up in the winter get in the habit of chewing each other’s wool, thus virtually depilating their fellows and accumulating wool balls in their stomachs.

=Pigs= when running at large eat human fæces often infecting themselves with the cysticercus cellulosa, and devour their own or their fellows’ bristles, which form ovoid and irritating aggregations in the stomach.

=Puppies= are proverbial for swallowing every small object that comes in their way, coal, pebbles, marbles, leather, hair, etc., with the result of inducing nausea and vomiting, or more seriously, wounds of the stomach, gastritis and enteritis. In older dogs the habit is more likely to imply rabies.

=Solipeds= will lick and swallow each others hair, eat off the hair from each other’s tails and manes, eat their clothing, lick the wall plaster, earth or sand, and even the manger or rack. The last named habits are usually connected with disease.

=Fowls= can digest almost anything they swallow, but if they take to picking their feathers, they create serious injury to the skin and indirectly to the general health.

_Causes and Nature._ In general terms it may be said that the causes of depraved appetite are very numerous, so that the trouble must be looked upon as a symptom of many morbid conditions in place of a disease _sui generis_.

_Heredity_ has been invoked as a cause, mainly, it would appear, because the disease appears enzootically on certain exhausted soils, or in herds kept in the same unhygienic conditions. In such cases the real cause is usually to be found in faulty conditions of soil, water, buildings, food, etc., on the correction of which the trouble disappears. When, however, from a long continuance of unhygienic conditions, a weakness of constitution is transmitted from parent to offspring, such hereditary debility may be accepted as a predisposing factor.

_An exhausted soil_, lacking especially the elements of lime and phosphorus, is a common cause, though by no means the only one. Nessler who analyzed the hay and water, furnished to cattle suffering from this disease in the Black Forest found a notable absence of the soda salts. In others in which osteo malacia was the prominent symptom the lack was in phosphate of lime as well. In the nature of things the soil that has been continuously cropped to exhaustion is robbed of both earthy and alkaline salts, and the animals fed on its exclusive products suffer not only as regards the nutrition of the bone, but also of the soft parts. Hence Trasbot says that in osteo malacia, pica is never absent. Roloff and Röll hold that it is the first symptom of osteomalacia. In South Africa where the land has been cropped with oats year after year without manure and as long as it will bear, the disease became prevalent in the street car horses fed on the oats, and was corrected by the addition of phosphates, or phosphate bearing food, to the ration. In the older dairying farms of New York which have been kept under grass for a great length of time, and all the milk products sold off, depraved appetite in all its forms is quite frequent. Where the land is originally light and sandy and naturally deficient in lime, osteo malacia is often a concurrent disorder. The two conditions may however occur independently of each other, and especially may pica appear alone, in keeping with the greater solubility of the soda and potash salts and the readiness with which these can be washed out of the soil, while the less soluble lime salts in part remain.

Lemcke, Haubner and Siedamgrotzky attribute the disease to a nervous disorder. Lemcke indeed traces the disorder to a lack of phosphorus, and claims that osteomalacia only supervenes where the rheumatic diathesis is also present.

It may be shortly stated that the disease prevails especially on granitic or sandy soils, or on those which are mainly composed of organic debris (peat, muck). Limestone soils and those which contain any considerable proportion of potash or soda are usually exempt.