Chapter X: Front Matter (10)

The animal should be killed on the premises to avoid the danger of scattering the infectious discharges in transit; it must not be bled, nor cut open, as the admission of air determines the formation of the resistant spore; and the carcass must be burned, boiled, or rendered in superheated steam under pressure, or finally dissolved in strong mineral acids. If buried, it must be in open, porous soil, well apart from any well, pond, river, or bank where the liquids may leach out, and the body must be wholly covered to a depth of at least five feet. The graves must be well fenced in from all stock, for a number of years, and no forage grown on them can be safely fed to animals, as the bacillus can be brought to the surface by earth worms. I have known cattle to become infected through licking the fluid which escaped above a stratum of clay, on the deep bank of a river, at some little distance from where an anthrax carcass was buried in the surface sandy loam. A covering of coal tar, chloride of lime or of sand charged with sulphuric acid is an admirable precaution.

As a measure of economy the skins may be removed, if at once, on the spot, plunged for 12 hours in a 5 per cent. solution of carbolic acid, or cresyl, or creolin, or in a two per cent. solution of sulphuric acid, and, if the knives and other implements used are placed in boiling water for half an hour. The same will apply to fleeces.

_Disinfection._ All litter, fodder, manure, urine, and other excretions, or products; all stalls, feeding troughs, sheepfolds, covers, halters, harness, wagons, poles, shafts, and other objects used about the animals, or soiled by them or their products, should be disinfected by burning, flaming or scalding (boiling), when applicable, by one of the above-named disinfectants, by mercuric chloride (5:1000), by formalin, or other potent antiseptic. Extensive dung heaps, too wet to burn, may be sprinkled freely with strong mineral acids, or mercuric chloride in solution, piled into compact mass, covered with chloride of lime, and finally with a thick layer of earth, and fenced in from all stock.

If carcasses must be moved to the grave, rendering works, or elsewhere, they should be sponged with carbolic acid solution, formalin, or mercuric chloride, and each of the natural openings firmly plugged with tow or cotton soaked in the same material, so that no infecting material may drop on the way. They should on no account be dragged on the ground, but carried on a wagon or stone boat, which should be afterward carefully disinfected. Men or animals, entering an infected place, should be disinfected on leaving; especially hands and feet.

All roads, yards, and pastures where the sick have been, and, above all, where manure, urine, or saliva has fallen, should be subjected to thorough disinfection, or the surface layer removed and deeply buried. Where available, a concrete or asphalt floor should be placed in the buildings.

_Isolation. Movement from Infected Ground._ It has long been known that the movement of an infected herd from the contaminated pasture to another, will often, at once, check the development of new cases. In Sardinia and Auvergne the flocks and herds were yearly moved on the approach of autumn, from the rich valley, and bottom lands, to the drier hill pastures, to avoid or lessen the decimation that otherwise inevitably overtook them. This is in keeping with the enzoötic nature of the malady which arises more from the microbe preserved in the soil than from the sick animal direct. Two precautions are necessary in making such a change of locality: 1st, Animals already infected should not be moved on such new pasture; and 2d, the pasture to which the stock is moved should be entirely free from the impermeability (clays, hard pans), and saturation with water (swamps, basins, low bottoms), which would ensure the permanent preservation of any microbe planted there. Elevated, sandy, argilaceous or loamy soils are to be selected. To these the animals of the infected herd which by their appearance and thermometry may be pronounced sound, should be removed, and kept under careful supervision, especially as regards thermometric tests. Any showing symptoms of anthrax should be at once taken back to the infected herd. If they have stood in stalls, for milking or otherwise, these should be disinfected, and they should be carried in wagons, or driven by unfrequented roads. Their droppings should be carefully disinfected.

If, in the absence of anthrax symptoms, animals must be kept in the infected lot, or returned to it, they should be immunized.

_Interdiction of Sales._ No animal in the infected herd which shows a rise of temperature, should be sold even for slaughter. No animal should be sold for stock purposes until the disease has completely subsided. Any animal in the infected herd, which shows no hyperthermia nor other sign of anthrax, may be sold for immediate slaughter, subject to a critical expert examination of the cadaver for anthrax. Milk, the product of an infected herd, and butter and cheese made from such milk, should not be used as food. If those members of the herd, that show no hyperthermia or other symptom of anthrax, can be held apart as a separate herd, in a disinfected place and under careful thermometric observation, their dairy products may be used.

_Immunization._ A number of different methods have been practiced of rendering animals refractory to the bacillus anthracis, but all are apparently based on the production in the system of defensive products, as the result of a nonlethal poisoning with anthrax toxins. It is true of anthrax as of many other infections that a first attack protects against a second. In all animals there is a certain measure of defensive power against the bacillus anthracis, amounting in some cases to virtual immunity and in others having a very little effect. The object in immunizing is to stimulate to the increase of these defensive products in quantity or power until an ordinary dose of the bacillus will fail to colonize the tissues or the blood. In considering this subject a clear distinction must be made between the simple bactericidal and the antidotal or antitoxic products found in the serum of immune animals and the toxins which are produced by the bacilli. The soluble antitoxic and bactericidal agents found in the serum of the immune, may be employed for therapeutic purposes to preserve life in an animal which has received a lethal dose of the bacillus anthracis, but as these are rapidly eliminated from the system, their protective power is very short lived, and if some bacilli survive the period of their presence and potency, or if they are introduced into the system later, the animal may fall a victim to anthrax as if no such protective agent had been used. Behring showed that the blood serum of the white rat proves fatal to the bacillus anthracis, but Metchinkoff pointed out later that it must be brought in contact with the bacillus in order to prove effective, whereas if the serum and bacillus were injected at different parts of the body no protection was obtained. The antidotal or bactericidal action of the serum of an immunized animal acts at once, whereas a permanent immunity cannot be established before about fifteen days. The serum of the immune animal contains the following elements antagonistic to anthrax: _Antitoxin_ or _leucomain_ which may be poisonous to the bacilli, or chemical antidotes to their products: _globulicidal principles_ which distort or disintegrate the blood globules and release their contents including the bactericidal nuclein, and probably others. All such agents when injected into the system are present only for a limited time and while they may be made subservient to a temporary immunity, they can give no permanent protection and must be considered mainly as therapeutic agents.

A permanent immunity must depend on a stimulation or education of the system to the production of these protective agents _de novo_ or in increased quantity. This must be done by exposure of the tissues to the toxins of the bacillus anthracis, and is accomplished slowly. Precisely what tissues are stimulated to the production of the defensive agents is not fully known, though certain indications may be drawn from observant facts. The eosinophile cells of the blood are presumably important factors as the natural sources of the leucomaines. The spleen as the seat of important blood changes and as preëminently the seat of election of internal anthrax is probably involved. The dogs from which Bardach had removed the spleen were found to be three times as susceptible to anthrax as were the dogs that had not been operated on. Leo’s rats, in which he had produced mellituria by the administration of phloridzin were found to be much more susceptible to anthrax. The liver is also a favorite seat of election of internal anthrax. The products of the healthy liver, are probably in some measure protective.

No matter where the defensive products are formed, the practical problem is to secure their production without imperilling life.

_By Minimum Dose._ Chauveau and Colin secured this in the larger animals by intravenous injection of a minimum dose,—one or two bacilli. This is more lasting in effect if a second and stronger dose is injected some days later.

_By Weakened Virus._ This has been secured by heating the defibrinated blood to 55° C. for ten minutes (Toussaint); Pasteur, Chamberland and Roux accomplished the same end by making anthrax cultures at 42° to 43° C. in presence of air; Chauveau by subjecting the virulent culture for eight days to oxygen under a pressure of 8 atmospheres at a temperature of 38° C.; Chamberland, Roux and others have cultivated the bacillus in weak antiseptic bouillons as phenic acid (1:600 or 1200), bichromate of potash (1:2000 or 5000), sulphuric acid (2:100).

Other methods have been followed, as growing the bacillus in the blood or serum of immune animals (dog, chicken, pigeon, white rat, frog).

Of these different methods that of Pasteur has been most extensively adopted. The temperature of culture (42° C.) prevents the formation of spores and the duration of exposure to air gradually lessens the virulence until in 12 or 13 days it is not fatal to the Guinea pig and after 31 days it fails to kill the young mouse. Thus preparations of varying grades of virulence, and adapted to the varying susceptibility of different animals, are secured. The protective inoculation is made by preference in spring, when there is less chance of complication by a coincident accidental infection, it is to be avoided if possible in animals at hard work, in advanced gestation, in full milk, in extreme youth, or in ill health. To secure the best results it should be repeated with a stronger preparation 12 to 15 days after the first injection. The acquired immunity lasts a year and over, and it is probably perpetuated by new and non-fatal doses taken in casually, on the anthrax pastures. Hundreds of thousands of live stock in all parts of the world have been treated in this way with the result of reducing a mortality of two, five or ten per cent. to insignificant proportions. It can only be safely adopted on anthrax lands, as elsewhere it may lead to the stocking of new areas with a malignant germ which in young and susceptible animals reacquires its original virulence.

It can never be safely ignored that we are dealing with the living seed of a most deadly infection. Though robbed of a large part of its virulence by artificial culture at 107:5° F., yet many accidental conditions, contribute to a relapse to its original potency, and when it has once killed a victim, the reacquired virulence is usually persistent. If the virus employed for protective purposes in cattle and sheep, is inoculated on Guinea pigs of 1 to 30 days old, from these on those of several months, and from these last on sheep, the virulence is constantly and persistently enhanced. The same is true of the microbe which is inoculated on a succession of pullets of steadily encreasing ages (Roux and Chamberland), or on a succession of pigeons (Metchnikoff). The germs reinforced in potency in any such way are liable to be the starting points for dangerous infections in animals and permanent contamination of soils and waters. Fortunately an occurrence of this kind is rare, yet with a wide application of the Pasteurian inoculation the opportunities also are great, and with the free sale and distribution of the mitigated virus (anthrax “vaccine”), the evil may grow indefinitely. The method departs from the ideal one, aimed at a final extinction of the disease, and accepts in place a mere temporary protection of the herd or flock, and though in this affection eradication cannot always be secured, every effort should be made to gain it and above all to prevent an encrease of the area of infection.

_Technique._ The weakened virus (1st “vaccin”) is sold in tubes holding enough for 100, 200, or 300 sheep. Of this ⅛ cc. is injected subcutem on the inner side of the thigh of the mature sheep, and 12 or 15 days later a similar dose of the stronger preparation (“2d vaccin”). For the ox or horse double the amount (¼th cc.) is used, being injected behind the shoulder, and on the side of the neck in the respective animals. The dose is graduated in the different subjects according to the size and age, yet a considerable latitude is permissible. The syringe must be disinfected before and after inoculations by a 5 per cent. solution of carbolic acid, or by boiling, and the nozzle should be dipped in strong carbolic acid immediately before and after each insertion. This will greatly obviate infection of the liquid used, and of the wound by any virulent germs lodged on the surface of the skin. The liquid to be injected should be used as soon as possible after preparation, and if kept should be in a dark cold place, and if the tube is once opened the whole of its contents should be used the same day,—never kept over. The second, stronger preparation should never be used until the system has been prepared for it by the use of the first.

_By the Soluble Toxins in Sterile Solution._ In 1884, in an outbreak of anthrax in Skaneateles, N. Y., I drew blood from an anthrax cow, subjected it to 212° F. for 30 minutes, dissolved out the soluble toxins in boiled water, and injected the product subcutem, in the dose of 2 to 4cc. according to size, into every apparently healthy member of the herd, excepting one, which was left as a check. The check animal died of anthrax while all of the others escaped.

Since that time I have personally used it in every herd where opportunity offered, and with equally good results. In an outbreak near Elmira, Dr. Moore adopted it in a large dairy herd, and the disease was suddenly arrested.

In several experimental cases (one cow and 2 Guinea pigs) at the N. Y. S. V. College, the outcome was not so satisfactory and in a herd in Oneida Co., N. Y., it is said to have failed to check the disease.

Notwithstanding these untoward results in other hands, I am still confident that we have in this a measure of no small value, and worthy of application in suitable cases. A certain percentage of failures in immunization are to be looked for. Even cowpox vaccination is not always protective against itself; I knew one man who was successfully vaccinated every three years in a comparatively long series. Many habitually self-limiting diseases relapse in particular individuals. Even in the case of anthrax excess of glucose in the system, and the lack of some unknown influence of the spleen are respectively destructive of immunity. Even after the Pasteurian inoculation a certain number of inoculated animals are lost, it may be between the first and second injection, or it may be “two or three months” after the latter (Galtier). We must also bear in mind that in an infected herd or flock, there are always a certain number already infected at the time of the protective inoculation, and as the protective conditions are slowly established, through the action of the leucocytes, it is unreasonable to expect that serious illness and death can be obviated in such animals.

In inoculation with the Pasteur lymph, the bacillus is held not to enter the blood, a position supported by the researches of Bitter, Perroncito, Wissokovicz, Lubarsch, Metchnikoff, Chamberland and Roux, so that the resulting immunization must come from the toxins. Add to this that Chauveau (1885), conferred immunity on a sheep by injecting intravenously, anthrax blood, defibrinated and sterilized by heat: Arloing obtained immunity in the sheep by injecting, subcutem, the clear supernatant liquid from old bouillon cultures of anthrax, from which all bacilli had been precipitated. Roux and Chamberland obtained the same result by using the pulp of an anthrax spleen treated with essential oil of mustard, so as to destroy the life of the bacillus, and then evaporated in vacuo to remove the essence. Smaller doses proved effective, than when the splenic pulp had been filtered or sterilized by heating to 58° C.

The advantages of using sterilized toxins are numerous:—

1st. As the material can be derived from a case of the outbreak in hand, there is no risk of using the anthrax protective inoculation for black quarter, hæmorrhagic septicæmia or other disease which is so often confounded with it.

2d. There is no danger of the sudden enhancing of the potency of a weakened microbe on account of some condition of the animal inoculated, as no living microbe is employed.

3d. There is no possibility of planting the anthrax bacillus, on new soil, as is so liable to take place in using the weakened microbe.

4th. There is no necessity for the care and cost of holding the inoculated animals apart by themselves, under official veterinary control for 15 days, of withholding their products from market, or of disinfecting the place where they have been kept. On the contrary the animals inoculated can be treated in every way as if no such injection had been made.

_Thorough Drainage and Æration of Land._ The most thorough and permanent method of eradicating anthrax is by thorough æration of the soil. In dry, sandy, or gravelly soils, having a good natural or artificial drainage, and not underlaid by an impermeable damp stratum, the bacillus is never permanently found, and, if introduced, is slowly robbed of its virulence by the action of the oxygen. When a soil can be well and permanently ærated by thorough underdrainage, a few years suffice to rob it of its infecting property and render it salubrious. In many localities, however, this is actually or economically impossible, so that the owner is thrown back on the alternatives, of abandoning the soil for stock, or of immunizing all the animals placed on it.

_Prevention of Importation of Anthrax._ To prevent the introduction of anthrax into a country or district, the usual control must be exerted on trade in cattle and their products, as in the case of other infectious diseases. The exclusion of livestock from an anthrax-infected country or district, or the admission after 6 to 10 days of quarantine and the disinfection of the surface of the animal. Dried hides, horns, hoofs, hair, wool and bristles are even more dangerous, as they are liable to hold the microbe in the spore form which will survive indefinitely and plant the disease widely. The recent great extension of the disease along the Delaware River, in connection with the morocco factories, which draw their hides from the most virulently anthrax regions (India, China, Russia, Africa, S. America) is a strong case in point, and nearly every tannery planted on a favorable soil is an example on a smaller scale. Disinfection of all such products on arrival is essential. But this should be thorough, and no question of trouble nor expense should stand in the way. If the trade cannot stand the expense, it has no right to exist where it is, at the expense of threatened ruin, local and ultimately general, of agriculture, on which all other industries are based. Similar control is demanded of live stock products from infected regions in America.

The control of home markets, stockyards, and abattoirs is no less important. Fortunately the disease is shortlived and deadly, and is much more easily discovered and arrested than in the case of plagues with prolonged incubation and frequently occult form (glanders, tuberculosis). An inspection of the various markets, and the detention of herds that have shown anthrax infection would do much to limit extension. This would entail the disinfection of the infected places, cars, boats, harness, clothing, and other things, and of the skins of the healthy animals of the infected herd.

_The Therapeutic Treatment_ of anthrax in animals must in the main follow in the same lines given below for the human being; locally, antiseptics (mercuric chloride or iodide, Luzol’s solution, hydrochloric acid, phenic acid, iodized phenol, creoline, cresyl, oil of turpentine, formalin, salicylic acid, scarification, excision of the primary sore or swelling with antisepsis, antiseptic injections into the swelling.) Internally, there have been employed, dilute phenic acid, creolin, terebene, calomel, quinine, hydrochloric acid, bichromate of potash, tincture of iron chloride, etc. (see below).

ANTHRAX IN MAN.

Causes: infection from animals and their products, from soil, by
flies, by dust. An industrial disease, of workers among animals and
animal products. Wounds as infection atria, ingestion anthrax,
inhalation. Lesions: malignant vesicle, anthrax œdema, intestinal
anthrax: pulmonary anthrax. Symptoms: malignant vesicle, œdematous
anthrax, intestinal, pulmonary. Prevention. Treatment: caustics:
antiseptics, excision of nodule and subsidiary glands, mercurial
ointment, iodine, sodium bicarbonate. For intestinal anthrax: emetic,
oleaginous purgatives, potassium iodide, sodium salicylate, iron
muriate, heart stimulants. For pulmonary anthrax: inhale chlorine,
iodine, bromine, phenic acid, eucalyptol, oil of cinnamon, sterilized
cultures of prodigiosus, pneumococcus of Friedländer, bacillus
pyocyaneus, staphylococcus aureus, or streptococcus: blood serum of
immune animals: blood serum (sterilized) of anthrax cattle.

_Causes._ Anthrax in man is usually the result of contamination by infected animals or their products. It is quite possible that man, like animals, may be infected directly from the soil or water, or from the same source through the medium of flies or windblown dust, yet undoubted cases of this kind are rare or unrecognized. The animal origin of the disease, as regards man, makes this largely an industrial affection, attacking shepherds, cattlemen, horsemen, farmers, drovers, butchers, veterinarians, tanners, and workers in hides, wool, hair, bristles, furs, hoofs, bones, rags, felt, glue, and even leather. The sound skin is sufficient protection, but the slightest abrasion may form an infection atrium. Workers in tanneries and those who live near them are notoriously subject to anthrax. The hides must of course be drawn from an anthrax region. Russian, Armenian, South American, Australian and African hides have an especially bad reputation. The _British Medical Journal_, May 21st, 1898, records cases occurring in postal clerks who had to handle foreign parcels bound with strips of hide. Proust records cases from handling Chinese goat skins (Bull. de l’Acad. de Med. 1894). Infection may also occur through leather made from infected hides as proved experimentally on Guinea pigs.

Hair has long been recognized as a frequent medium of infection and outbreaks among brushmakers have been recently recorded by Gerode, Sarmont and Chauveau. (Compt. Rend. de l’Acad. des Sc. 1893). Trousseau reports twenty cases in Paris, all contracted from South American horse hair. Wool from infected countries is often dangerous and has given rise to special names for the disease (wool-sorter’s, rag-picker’s) which may be developed in the lungs from inhalation of the dust. In the same way those who handle bones about fertilizer, glue and rendering works, are particularly exposed. The agency of insects in man is undoubted. In sixty cases recorded by Dr. Bell, fifty-four were on the face, two on the hands, one on the wrist and one on the forearm. This is mainly due to blood-sucking flies, yet Heim incriminates the coleoptera as well (Compt. Rend. de Soc. de Biol. 1894). Wounds of all kinds contribute to inoculation, hence, the presence of burdocks, thorns, thistles and the like in the matted wool or hair is often a direct cause of infection.

The infection may be transferred on surgical instruments, and in these days of hypodermic medication the greatest care is necessary to prevent infection through the needle.

As in animals man suffers from ingestion and inhalation of the bacillus; and sometimes widespread mortality comes in this way. Meat just killed may be thoroughly disinfected by the secretions of a healthy stomach, yet the bacillus may pass through in an envelope of fat, in an undigested mass or during an attack of dyspepsia, and infect the intestines. The spores are proof against the gastric juice, and as they are produced in a few hours after death the meat of an anthrax animal must always be considered as exceedingly dangerous.

Man is much less susceptible than some other animals and the disease wherever inoculated tends to remain for a time localized, in the skin, the lungs or the bowels. The forms of the disease are _malignant carbuncle_ (pustule), _malignant œdema_, _intestinal anthrax_, and _pulmonary anthrax_.

_Lesions._ The morbid histology is in the main the same as described in animals. In the protracted cases there is the same dark nonærated blood, forming a loose coagulum, the crenated or distorted blood globules aggregated in irregular masses, the escape and solution of the hæmoglobin so as to stain the white tissues, the enlargement of the spleen which is gorged with dark blood, and the hyperæmia of the liver and lymph glands. There is in the affected tissues and usually in the blood the characteristic large bacillus anthracis.

In the _malignant vesicle_ there is first a minute, firm central, dark nodule like an insect bite with a lighter colored areola, and showing not only hyperæmia, but blocking of the capillaries, and minute areas of extravasation. Somewhat later the dark centre is surmounted by a small vesicle, beneath which the tissues are becoming necrotic, and the area of congestion and extravasation has extended and thus the local disease advances by a constant invasion of new tissue which in its turn becomes the seat of coagulation necrosis. On microscopic section the central necrotic part shows the cells of the rete Malpighi separated by a finely granular coagulum, and the papillæ are greatly swollen by serous and hæmorrhagic exudate. The cell nuclei are necrotic and no longer take a stain. The capillaries are gorged with red globules and bacilli. In the surrounding tissues there is much congestion and exudation, with numerous points of extravasation, but the abundant multinuclear cells retain their staining power.

In _Anthrax Œdema_, which appears in parts like the eyelids, neck and forearm where there is an abundance of loose connective tissue and a scanty blood supply, there is no firm central nodule, but a diffuse soft infiltration, with points or patches of a yellow or reddish color. The capillaries are congested, with minute emboli and extravasations and there is an excessive and rapidly spreading exudation. It shows a great tendency to early general infection and may end in vesication and local gangrene or in favorable cases in resolution.

In _Intestinal anthrax_ (intestinal mycosis) the lesions are usually concentrated on the small intestines, while the stomach and large intestines in the main escape. The walls of the bowel are of a dark red, and greatly thickened by exudation and extravasation which also mixes with the ingesta giving it a dark bloody tinge. At intervals on the mucosa are nodular hæmorrhagic swellings, from the size of a linseed to a pea, with commencing necrotic changes or the formation of sores. The mesenteric glands are swollen, infiltrated and hæmorrhagic, and like the other lesions abound in bacilli. Hyperæmia and engorgement of the liver and above all of the spleen are the rule.

In _pulmonary anthrax_ (wool-sorter’s disease) a sanguineous liquid is found in the lower trachea and bronchia, and not infrequently in the pleuræ and pericardium. The bronchial glands are swollen, hyperæmic and often hæmorrhagic, and exudations and extravasations may be found in the mediastinum and lungs. Lesions of the intestines and spleen are common, and in all alike the bacilli are found.

In certain cases the anthrax lesions may be found in the brain, or any part of the body but in all they show the same general characters and the same specific microbe.

SYMPTOMS: DIAGNOSIS.

_Malignant Vesicle_ (_pustule_). Symptoms may vary somewhat but are in the main as follows: An itching papule appears in the seat of inoculation, which might be mistaken for an insect bite but for the dark red color of the centre. Occurring on an uncovered portion of the skin, in an anthrax district, or near a factory where anthrax products are likely to be used, this should at once create suspicion. Soon the dark centre is covered by a small vesicle with clear contents which later become bloody. Within 24 or 48 hours the vesicle dries up, becoming firm, resistant and brownish red or blackish gray, and apparently gangrenous. The swelling has meanwhile extended to ½ or ¾ inch in diameter and a row of fresh vesicles may appear which in their turn give place to a necrotic slough. In this way extension may take place, the sore retaining a more or less rounded form, and necrosis extending from the centre in every direction. The necrotic mass, however, remains firmly adherent to the adjacent tissues until separated by the work of suppuration which ensues in favorable cases. The disease is attended with more or less fever, chill, hyperthermia, nausea, diarrhœa, with aching of head, back, and limbs and unfavorable cases may merge into acute and fatal general anthrax. The mortality is about 20 per cent., though in special epidemics it has reached 80 per cent. (With the pustule on the face 25 per cent.; on the lower limb 5 per cent., Norris). The prognosis is favorable with a free concentration of leucocytes, a moist condition of the wound and above all a liberal invasion of pus cocci. It is unfavorable when the wound is dry, when the drying slough remains firmly adherent and when the adjacent lymph glands become implicated. In non-fatal cases it may be difficult to find the bacillus.

_Anthrax Œdema._ This is less easily diagnosed than malignant vesicle, and appears where the connective tissue is loose, abundant and little vascular, from direct local inoculation, or as a concomitant of internal anthrax. It is a flat, rapidly extending swelling, with the skin comparatively unaltered, though at points yellowish or reddish discoloration indicates congestion and extravasation. Not being limited by firm tissues nor aggregations of accumulating leucocytes it tends to a speedy general infection with all the febrile manifestations of that condition. Thus chills, nausea, hyperthermia, dusky reddish or brownish mucosæ, cephalalgia, rachialgia and profound prostration assist in diagnosis. The bacilli in the blood and exudate would serve to confirm the conclusion.

_Intestinal Anthrax._ Here again the ingestion of anthrax products, and the simultaneous attack of a number of people who have taken such materials will often assist in diagnosis. There may have been for some days indications of local bowel lesions, such as chilliness, elevation of temperature, nausea, headache, and giddiness. Suddenly these become more violent, there is vomiting and sanguineous diarrhœa, extreme anxiety and debility, cyanosis, dyspnœa, and it may be the appearance of petechiæ on the skin and mucosæ or even of local swellings. In some cases there are convulsions or other symptoms of nervous disorder and in others extreme prostration and collapse. The bacillus is not always to be found in the circulating blood, but may be detected in sanguineous excretions, or by cultures.

_Pulmonary Anthrax._ (Woolsorter’s disease). Here again the occupation of the patient assists in diagnosis. For two to five days prodromata similar to those of intestinal anthrax may be noted. The difficulty in breathing, dyspnœa, cough, cyanosis and sense of constriction of the chest are especially diagnostic. Suddenly all these symptoms are aggravated, respirations become 30 to 40 per minute, the pulse 120 to 150, the temperature 104° to 106°, and there is a frothy bloody expectoration in which the bacilli may be detached. There may be indications of intestinal, cerebral or nephritic lesions, and bloody discharges. Death usually occurs in 12 to 48 hours from collapse, or coma, from asphyxia or in convulsions. The few recoveries are tardy and tremors and spasms persist for a length of time. In the most favorable cases the disease does not proceed beyond the initial stage.

PROPHYLAXIS AND TREATMENT.

Prevention is the most important consideration and this will include all that has been stated above with regard to the restriction of the disease in flocks and herds, the drainage and improvement of anthrax lands, the seclusion, destruction, deep burial or cremation of carcasses without autopsy or incision, the disinfection of stalls, secretions and all contaminated products, and the suppression of all traffic in anthrax products—meat, milk, blood, guts, bones, horns, hoofs, hair, wool, bristles, etc., or the thorough disinfection of the same. Above all, is the adoption of personal precautions. No one should handle anthrax animals, nor suspected products who has any sore or abrasion on hands or face, or such sore may be temporarily covered with a film of albuminate of silver, or the hands may be washed with a solution of mercuric chloride (1:500), or chloride of lime (1:200). If persons must work in wool or textile products which are open to suspicion a respirator is an obvious precaution, and this may be disinfected by live steam at intervals.

_Treatment of malignant pustule_ is mainly surgical. At the outset the thorough destruction of the dark central point or nodule with a red hot needle or powerful caustic will be sufficient. Even when the pustule is fully formed, its free excision with as much of the surrounding infiltrated tissue as can be safely accomplished and the free application of caustics will usually succeed. Potassa fusa, or zinc chloride (1:3), or mercuric chloride or iodide in powder with or without calomel, or pyoktanin, or formaline, or iodized phenol may be named as especially applicable. Injections of carbolic acid (5 or 10:100) into the indurated centre and infiltrated periphery have proved very successful. In the case of Kaloff, when the excision of the nodule followed by the local use of carbolic acid solution, failed to prevent implication of the inguinal and pectoral glands, violent fever, prostration, and diarrhœa; the excision of the affected glands and the free use of phenic acid solution (5:100) in the adjacent tissues led to speedy improvement. Some surgeons make a crucial incision of the pustule and apply caustics freely. Muskett has been successful in excising the nodule, filling the wound with ipecacuan powder and giving the same agent internally. Many mild cases, or those that occur in refractory systems will however recover spontaneously or under a less drastic treatment. In the anthrax districts of Russia mercurial ointment is rubbed on the sore, and the application of tincture of iodine or iodized phenol to the raw sore or incised nodule and surrounding infiltration is often successful.

Camescasse has claimed great success by incising the swelling, applying tincture of iodine freely, and then wrapping in cloths kept wet with a solution of 5 drachms of bicarbonate of soda in a quart of tepid water.

When systemic reaction has set in it is desirable to have resort to general medication as for internal anthrax.

_Treatment of Anthrax Œdema_ must follow the same rule. Free incisions into the œdematous tissues with the application of antiseptics, solution of mercuric chloride or biniodide (1:1000), or the injection of the whole infiltrated area and around it with the same agents, with phenic acid (5 or 10:100), or with pyoktanin (1:1000) will prove useful, and as in the malignant pustule the surface should be kept disinfected by a compress wet in solution of the mercuric chloride or biniodide, carbolic acid, iodized phenol, formalin or pyoktanin. If the pain of these applications is very acute cocaine will be demanded or even ether. If ether is applied to the surface its evaporation will cool the parts and retard the proliferation of the bacillus. Under other conditions cold water, pounded ice or snow may be applied.

_Treatment of Intestinal Anthrax._ When anthrax flesh has been eaten, or when there are symptoms of incipient intestinal anthrax, the first resort is an emetic of ipecacuan, followed by an active oleaginous purgative to clear the _prima viæ_ of bacilli and their toxins. To these may be added potassium iodide, pyoktanin, sodium salicylate, quinine or tincture of muriate of iron, by way of keeping in check the multiplication of bacilli. To counteract depression and heart failure digitalis, strophanthus or strychnia with alcoholic stimulants may be resorted to.

In _Pulmonary Anthrax_ the same principles are applicable. The patient may be made to cautiously inhale gaseous chlorine, iodine or bromine or a solution of iodide of potassium in an atomized condition. The vapor of carbolic acid, eucalyptol, or oil of cinnamon may be tried.

The irritable stomach may be soothed by oxide of bismuth, with milk, beef tea and other bland nutritive or stimulating draughts.

The grave character of internal anthrax, however, is such that resort may be had to one of the various antitoxins, antidotal cultures, serums, and immunizing agents that have proved useful in different hands. Unfortunately such agents do not seem to act in the same manner on all genera, and what has been effective in one of the lower animals may fail in the human being. Thus Roger found that sterilized cultures of bacillus prodigiosus retarded or obviated anthrax in rabbits, but hastened its progress in the Guinea pig.

The sterilized cultures of the pneumococcus of Friedländer (Buchner) of the bacillus pyocyaneus, or of the staphylococcus pyogems aureus, (Pawlowsky) when injected subcutem have proved antidotal to anthrax. Emmerich has successfully used erysipelas serum subcutem in the treatment of anthrax. (Münch. Med. Woch. 1894). The sterilized cultures of the streptococcus erysipelatos therefore offer themselves as promising curative agents. The same is true of the sterilized cultures of the bacillus pyocyaneus (Woodhead and Cartwright-Wood).

The blood serum of animals that are naturally immune (frog, white rat, pigeon, dog,) is bactericidal and to a certain extent antidotal to the bacillus anthracis, but that of an animal which is naturally susceptible but which has been artificially immunized has proved much more potent. In the experience of the writer this potency attaches no less to the blood of an animal in the advanced stages of the disease. In adult cattle he has found the symptoms of anthrax subside under two successive daily doses (4cc.) subcutem of the sterilized blood serum of one of the herd which had just died. Relapses were observed several days after the serum treatment was abandoned. In experiments on rabbits two check animals with anthrax inoculations died at the end of 3½ and 4 days. Of six inoculated with anthrax and injected from one to three times with sterilized (anthrax) blood serum one recovered, and the others died, one at the end of the 7th, two of the 6th and two of the 5th day. In this connection it may be stated that successful treatment by leucocytes is claimed, (Pawlowsky) and that one of the effects of serum treatment is the destruction in part of the globules and the release of nuclei, and in this we may have an explanation in part at least of the therapeutic action of the serum from the infecting and immunized animal.

Protective serums may be utilized by hypodermic injections daily or every second day for a week, giving time for the disposal of the bacilli present in the system. In the intestinal anthrax they may be given by the mouth and injected into the peritoneal cavity. In pulmonary anthrax they may be introduced into the trachea, bronchi and pleural cavity.

GLANDERS.

Synonyms. Definition: Acute, infectious, microbian disease, often
localized in lymph glands and plexuses of nose and air passages,
etc.; with hyperplasia, degeneration, necrosis, liquefaction.
Affects solipeds, and, by inoculation, man and all domestic animals
save cattle, chickens and (usually) swine. Geographical distribution
and historic notes: known in Ancient Greece; now where solipeds live
and fresh subjects are exposed; Central Europe; great horse trade
and movement; war, Franco-German, Napoleonic, Afghanistan, American
Civil War, Boer War. Unknown in Australia. Susceptibility: solipeds,
Guinea-pig, rabbit, goat, cat, dog, pigeon, sheep, and swine in low
condition. Cattle, chickens, white and house mice, linnets,
chaffinches, and frog immune. Microbe lives in frog in water at 86°
F. Cause: Bacillus mallei. Accessory causes: trade in solipeds,
mingling of sound and sick, crowding, common feeding and drinking
troughs or buckets and racks, debility, low condition, starvation,
overwork, damp, dark, draughty stables, carriage in transports or
cars. Insular quarantined lands—Australia, Tasmania, and New Zealand
exempt. Bacteriology: Bacillus Mallei; 2 to 5μ by 0.5 to 1.4μ,
nonmotile, ærobic grows in ordinary culture media, stains tardily
but is easily bleached. Spores uncertain, easily killed by
disinfectants, preserved in stables, does not grow in infusion of
hay, straw or horse manure, lives 15 to 20 days in water; infection
by coitus, and through placenta, by ingestion, by blood transfusion,
through dust; microbe in all lesions and discharges, (unless
sometimes in milk, sperm, etc.). Infection-atria: skin wound,
mucosa, hair follicles, lungs. Forms: Acute, chronic, nasal,
pulmonary, cutaneous (farcy), orchitic, arthritic, abdominal,
occult. Symptoms: nasal; incubation, 3 to 5 days, languor,
weariness, stiffness, horripilation, tremors, inappetence, thirst,
hyperthermia, epiphora, snuffling, nasal discharge, serous, viscid,
agglutinating, purulent, swollen alæ, violet mucosa, elevated spots
and patches with central ulceration, may become confluent, and
involve submucous tissues; submaxillary lymph glands swollen,
nodular, not tender, non-suppurating, swollen (corded) facial
lymphatics, from nose, eye or lymph glands; swellings, cutaneous and
lymphatic in skin of limb or body, ulcers (farcy buds), deposits in
throat or lungs; chronic cases; slow, indolent, persistent, nasal
discharge—unilateral (or bilateral), viscid or not, nodules on
mucosa with whitish centres or points; red areolæ, later ulceration,
puckered white cicatricial lesions, submaxillary swelling, nodular,
large or small, insensible; cutaneous cases; arthritis with
lymphangitis, skin engorgement, corded lymphatics with ulcerating
nodules, sanious discharge, intermuscular abscesses. Occult cases:
lesions in internal organ;—cough, leucorrhœa, enlarged testicle, low
condition, weakness, lack of endurance. Diagnosis: inoculation of
male Guinea-pig in flank or peritoneum,—ulcer and orchitis, cat,
dog, old soliped; mallein test,—swelling, involving lymphatics,
fever, 1.5° to 2.5 F. and upward above normal, at 10th to 18th hour,
lasting two days. Lesions: cell proliferation in nests in fibrous
stroma, pea upward, central degeneration, fatty debris, ulcer or
abscess, hyperplasia of lymph vessels, on nasal mucosa like
sand-grains, peas, patches, centre grayish or yellowish, blood
extravasation, necrotic degeneration, ulcer with ragged edges;
fibroid degeneration—cicatricial lesion; lesions in guttural pouch
or tube, larynx, trachea, bronchia; lungs—peribronchial, lobular or
interlobular inflammation, cell proliferation in foci,
degeneration—nodules—and caseation; skin,—cell proliferation,
degeneration, rupture, fibroid hyperplasia of lymphatics, exudates
in connective tissue; dependent lymph glands congested,
hypertrophied, cell proliferation, caseation; lesions in pharynx,
spleen, kidney, heart, brain, testicle, scrotum, mammæ, vagina,
uterus, joints, bones; bone fragility. Glanders in swine, sheep,
goat, rodent, dog, cat.

_Synonyms._ Malleus, Equinia, Farcy.

_Definition._ An acute infectious disease caused by the bacillus mallei, which tends to localize itself in the lymphatic glands and plexuses, especially of the nose and upper air passages but also in other parts of the body, where it produces a progressive hyperplasia, with a strong tendency to degeneration, necrosis, and liquefaction. It occurs casually in horses, asses, mules and other solipeds, and is communicable to man and all domestic animals except the bovine races, chickens, and, under ordinary circumstances, swine.

_Geographical Distribution._ Glanders (Malis) appears to have prevailed in asses in Greece as noted by Aristotle. Its contagious prevalence in horses is recorded by Absyrtus in the time of Constantine, and again by Vegetius Renatus in 381 A.D. At the present time its existence is almost coextensive with the equine family, but its prevalence is in a direct ratio with the facilities for the infection of fresh subjects. In the central countries of Europe where the equine population is greatest and where there is the most extensive trade and movement among horses it secures the greatest relative number of victims. War with its constant opportunities for infection, in crowded cavalry and artillery stables and the successive changing of place, tends greatly to enhance its ravages. Thus in the German army it rose from 966 to 2058 per 100,000 per annum in the year of the Franco-German war; in Spain it was practically unknown until the Napoleonic war in the Peninsula, but after this it proved a veritable scourge; in Hindostan it was hardly known until the Sepoy rebellion yet its ravages greatly hampered the army movement in Afghanistan in 1879; and in the United States it became very prevalent in the armies during the Civil War of 1861–4, and was widely scattered over the whole country on the sale of the army horses and mules. Since that time, as before, it has been most prevalent in the car stables of the great cities, though it has also gained a wide extension in many great horsebreeding establishments in the Rocky Mountain region, where however it proves much less destructive than in the East.

It is unknown in Australia, whence it is excluded by a rigid system of quarantine.

_Susceptibility of Different Animals._ Horses, asses and mules are the most susceptible, and it is only exceptionally that the disease is contracted casually outside the class of solipeds. The Guinea pig and rabbit are susceptible to glanders in the order named and the former is especially available for experimental diagnostic inoculations. The goat, cat and dog sometimes contract the disease from living in stables with glandered horses, but infection is much more certain when they are inoculated. The pigeon is also susceptible. In the dog the disease is rarely fatal, but the ulcerations tend to heal in 14 days and recovery ensues. In sheep and goats too, many cases recover though in other cases an internal infection takes place followed by death. Swine are comparatively insusceptible, but they may be successfully inoculated when in ill health and low condition. (Spinola, Cadeac and Malet). Cattle and chickens have uniformly proved refractory even on inoculation. White and house mice and rats, have proved immune, also linnets and chaffinches and the frog at ordinary temperature. If however the frog is placed in water at 30° C., he may be successfully inoculated and, though it does not prove fatal, the bacillus may be found in the blood and tissues after a lapse of 50 days.

_Etiology._ As already stated this disease is due to the presence of a microörganism, the _bacillus mallei_. Many secondary causes, however, contribute to its propagation. The activity of movement and commingling of horses has been already noticed. Crowding in close yards where the animals bite each other, snort out the virulent discharges on each other and eat and drink from the same troughs, leads to a rapid extension. Even on the western ranges where the disease tends to be mild, Billings observed a deadly extension when yarded during winter storms. Debility from chronic ill health, starvation, overwork and damp, dark, draughty stables, is so conducive to the disease that it was at one time considered as the sole cause. Close confinement in impure air is at once a cause of increased susceptibility and a means of concentration and transmission of the poison. Hence confinement, between decks, of military and other horses, carried by sea, is a source of wide extensions. On the other hand insular places from which strange horses are excluded or into which they are admitted under careful inspection and quarantine have succeeded in preserving immunity. Australia, Tasmania and New Zealand are examples.

_Bacillus Mallei._ Christot and Kiener claimed to have found a bacillus in the lesions of glanders in 1868. In 1881 bacilli were found by Bouchard in a glander abscess in man, and these were cultivated _in vitro_ and inoculated in a number of animals, by Capitan and Charrin in 1882. Independently in the same year (1882) Löffler and Schütz discovered the bacillus, cultivated it _in vitro_, and successfully inoculated it on animals. The microbe is rod-shaped, 2 to 5μ long, by 0.5 to 1.4μ thick, the same length as the bacillus tuberculosis but thicker. It is nonmotile, ærobic (facultative anærobic) and grows readily in a variety of culture media at a temperature of 37° C. On neutral bouillon of the flesh of horse, ox, calf or chicken with or without peptone, it grows readily, producing cloudiness in one or two days. In peptonized gelatine it forms a whitish flocculent mass. On glycerine agar with milk it forms in 48 hours a milk white layer, changing to yellowish brown. On potato it forms long slender filaments, in yellow, viscous, glistening colonies, changing to fawn and darker. It grows best at 35° to 39° C. and growth ceases below 25° C., and above 42° C. It stains tardily in aniline colors, and not at all by Gram’s or Weigert’s, but will readily take Kuhne’s stain prepared as follows: take of phenic acid in solution (5:100) 50cc., absolute alcohol 10cc., and 1 to 2 grammes methylin blue. The stain is very easily bleached by acid, differing in this from the bacillus tuberculosis. For decolorizing Löffler recommends 10cc. distilled water, 2 drops of strong sulphuric acid, and 1 drop of a 5 per cent. solution of oxalic acid. Sections should be left in this not longer than 5 seconds. The bacillus often appears granular, and unequally stained in its different parts. It may be difficult of discovery in old standing lesions of horses, but comes out clearly in recent lesions of experimental cases in Guinea pigs and donkeys.

Baumgarten claims sporulation but this is uncertain.

The bacillus has only limited power of resistance to destructive physical and chemical agents. It is killed in 10 minutes at 55° C., in 2 minutes at 100° C., or by mercuric chloride solution (1:5000), or by phenol (5:100), or by permanganate of potass (1:100). In warm dry air and sunshine it is sterilized, in thick layers in 2 months (Peuch), in moderate layers in 4 to 15 days (Galtier), and in very thin layers in 3 days (Cadeac and Malet). In moist, cool air and in the shade it is much more resistant. In stables it may remain virulent for three or four months, and thus the disease has often reappeared among the newly introduced horses after a stable has been abandoned for a length of time. The microbe does not grow in infusions of hay, straw or horse manure, and it is doubtful if it can maintain an active saprophytic existence. Its vitality and virulence, however, persists in putrefying materials for 14 to 24 days, and in water from 15 to 20 days. Hence it is largely propagated through drinking troughs and occasionally through ponds, lakes and sluggish streams. Again the virus is likely to be preserved in and transmitted by rotten or even sound woodwork, as of mangers, racks, buckets, shafts and poles, and by harness, halters, blankets, combs, brushes and rubbers. Sometimes direct transmission takes place in snorting or coughing, or by the animals biting or licking each other. As the virus is spattered on surrounding objects, the walls, stable utensils, soiled fodder and feed, and even the attendant’s clothes may be the medium of transmission. Contagion during copulation is not unknown, nor infection of the fœtus _in utero_ from a diseased mother. Carnivora (dog, cat, lion) fed on the diseased carcasses have become infected. Experimentally infection has been conveyed by administering, by the mouth, balls containing the virus (Renault, Coleman, etc.), and again by transfusing the blood from a bad case of glanders into the veins of a sound horse (Viborg, Coleman, Renault, Hering, Chauveau, Nocard). Transmission through the air on dust is counteracted by the speedy destruction of virulence on dust, and horses often stand side by side in adjacent stalls for months without communicating the infection. Such escapes may, however, in some of these cases, be attributed to the immunity secured by a previous exposure and slight attack. That the germs may be exceptionally conveyed through the air appears to have been proved by Viborg and Gerlach, who collected the floating dust in a stable containing infected animals and successfully inoculated with it.

The microbes are especially found in the visible lesions of glanders, in the mucous, cutaneous and subcutaneous swellings and abscesses, in the swollen lymph glands, in the nodules and ulcers of the mucous membranes and skin, in the morbid discharges, from the nose, eyes, pharynx, guttural pouches, larynx, trachea and bronchia, and in the discharge of farcy buds and abscesses. They are not necessarily distributed through all the tissues, and in chronic cases, with strictly local lesions, the infection appears to be often confined to these or nearly so, and the contamination of other animals is slow and uncertain. When, however, the disease is acute and advanced, or generalized, every part must be looked upon as probably infecting. Thus virulence has been shown in the blood, the exhalations of the serous membranes, saliva, the aqueous humor (Cadeac and Malet), the tears, (Viborg), the muscles, and the bones. Galtier says the milk, sperm, bile and intestinal mucous are non-virulent, also the vaccine lymph raised on glandered animals, but much must depend on the grade and stage of the disease and no one would care to run unnecessary risks with these liquids.