Chapter VIII: Front Matter (8)

_Synonyms._ Contagious catarrhal fever; Dog ill; Bronchial Catarrh; Intestinal Catarrh; _Fr._ Maladie des Chiens, Maladie du jeune age, Typhoïde, Typhus des chenils, Variole du chien; _Ger._ Staupe; _It._ Cimurro.

_Animals susceptible._ Dogs, especially puppies and young dogs, and other members of the canine race, fox, jackal, hyena, wolf. Cats suffer from inoculation (Laosson), also apes (Cadeac). Old cats and dogs are often immune, also all animals that have passed through one attack of the disease.

_History._ The older English veterinarians quote the epizoötics in dogs described by Virgil, Aristotle and even Homer as probably distemper. Laosson attributes to it a canine epizoötic which prevailed in Bohemia in 1028. It appears to have been unknown in Europe in the earlier third of the 18th century though prevailing in Peru. According to Ulloa, it was introduced from Peru into Spain in 1735, whence, it spread into France (1740), Germany (1748), Ionian Isles, Greece (1759), England (1760), Italy (1764) and Russia (1770), Sweden and Norway (1815), Siberia (1821). Since that time it has prevailed in Europe and many dependencies of European nations.

_Causes._ Its advent in Europe as a new disease in the second third of the 18th century, its steady spread, its continued prevalence, and extension, concur with the infection of kennels and districts by the introduction of a sick dog, in demonstrating its purely contagious nature, and this implies a living microbe transferred from animal to animal. If any doubt remained it must be dispelled by the inoculations which have been constantly successful when made on young puppies, or dogs that have not previously suffered, and on cats. A first attack confers immunity.

Among _accessory causes_ may be especially named _contact with the sick dog_, its _clothing_ or _bedding_, and above all its _kennel_. A kennel may retain infection indefinitely, especially if there is a constant accession of puppies or susceptible dogs. On the contrary it is not readily carried on the clothes of attendants, and the inmates of a kennel often remain sound, though only separated by a yard from the infected one, and though cared for by the same attendant. Yet so universally diffused is the contagion that few dogs escape it until they are a year old.

The habit of letting dogs run at large, to meet in roads and fields is a most prolific cause, which might easily be done away with where distemper is prevalent.

A _chill_ is a common condition, hence injudicious washing, swimming in cold water, exposure of house dogs to cold storms, or outdoors at night, sleeping in cold, damp cellars, on cold stones or metal plates, or in passages in a current of cold air are frequent factors. Yet it often spreads rapidly in the summer, the heat favoring the preservation and diffusion of the germ.

_House dogs_ as a rule suffer more severely, as their systems are more sensitive to the cold, and the resisting power to invading microbes is lessened. Country dogs and those living in the open air are hardier and more resistant and often have the disease in a mild form.

_High bred dogs_ suffer more severely probably largely from the greater protection and care lavished on them and their consequent diminished power of resistance. Newfoundlands, great Danes, pointers, pugs, poodles, spaniels and greyhounds may be named as especially liable.

The exposure to infection at _shows_, and in traveling by _rail_, _steamboat_ or _other infected conveyance_ must be considered as among the prominent causes.

An exclusively _bread diet_ has been recognized as a predisposing cause, by reason of its lowering the stamina of the carnivorous animal.

Any condition which induces _debility_ whether severe or continued disease, parasitisms, impure air, under feeding, improper food, rachitis, or scurvy, etc., must be admitted to operate in the same way. Any _catarrhal disease_ of the nose or bronchia is especially conducive to the affection by weakening the mucosa and making an easy entrance channel for the germs.

_Change of climate_ is a strongly predisposing condition, which not only hastens an attack, but even, at times, arouses anew the susceptibility in dogs that have passed through a first attack. Dogs that suffered in England have had a second attack in India, and some have even had a third attack when brought back to Europe. Four attacks within a year, in the same dog, and without change of climate, are recorded by Friedberger and Fröhner.

_Youth_ is much more susceptible than age, even apart from the immunity which comes to the mature dog from a first attack. Yet some puppies are insusceptible from birth.

_Microbiology._ No one pathogenic organism has been proved to be the constant infecting agent, yet two classes of investigators have contended in favor of micrococci and bacilli respectively.

_Micrococci_, 1 to 3μ in diameter, singly or in chains of 6 or 8 have been found in the blood, lungs, liver, kidneys and spleen (Semmer, Friedberger, Krajewski, Rabe, Mathis, Marcone, Meloni, Kitt).

_Bacilli_ were found associated with micrococci by Semmer, Legrain and Jacquot, Laosson, Millais, Schantyr, and Galli-Valerio. As observed by the latter they were 1.25, to 2.5μ long, by 0.31μ broad and took the Gram stain. Cultivated on gelatine the colonies were waxy, lustrous points, which indented the gelatine without liquefying it.

Cultures of the mixed bacteria (cocci and bacilli) and their inoculation on young dogs produced the symptoms of distemper with subsequent immunity (Laosson, Millais). Legrain and Jacquot claimed immunity, as resulting from inoculations with the cocci in pure cultures. Galli-Valerio, using the mixed cultures produced all the symptoms (pulmonary and cerebro-spinal) of distemper.

Schantyr, ignoring the cocci, describes three bacilli which cause three different diseases (distemper, abdominal typhus, and typhoid), but the distinctions are not clear nor generally accepted.

Lignieres and Even, in Argentina, and dealing with the more susceptible high bred dogs (fox terriers, great Danes and carlins), found constantly in the blood of the dog, in the early stages of the disease, a long, delicate bacillus, nonmotile and easily stained in aniline, but not by Gram’s method. Inoculated on the Guinea pig it shortens, approximating rapidly in successive passages to a cocco-bacillus, and assumes the general characters of Lignieres’s _pasteurella_. Different bacteria may be found in the lungs, bronchial and nasal mucus, tears and vesicles.

Lignieres’s _pasteurella_ is inoculable on the Guinea pig, mouse, rabbit, and dog, producing the symptoms of local or general infection. Two centigrammes, subcutem, in the _Guinea pig_, produced a local œdema, disappearing in four or five days and securing immunity. Five cc. subcutem proved fatal in 48 hours; intraperitoneal in 24 hours. In the _rabbit_ 1cc., subcutem, caused local œdema for 2 days and hyperthermia (104°) for 3 days; 1cc. intravenously, caused fever for 3 weeks, diffluent blood and hæmorrhagic lesions in lungs, liver, kidneys, bowels, spleen, and serosæ. In the mouse, 4 to 8 drops, subcutem, caused œdema, and recovery or death in 2 to 4 days. In such cases the microbe was found in pure cultures in the blood or inoculated tissues.

Inoculations of the pure cultures on dogs produced in different cases, gastro-enteritis, pneumonia, pleuro-pericarditis, and arthritis, in various combinations. If the animal survives it is immune.

Grown on _peptonized bouillon_, _neutral_ or _slightly alkaline_, the bacillus forms, in 24 hours, small granular colonies which fall to the bottom, leaving the liquid clear. The addition of serum renders this more abundant without causing opacity.

On _pancreatic_ bouillon the growth is very free without indol.

On _gelatine plates_ there are fine punctiform colonies, transparent, but becoming white and opaque in 8 or 10 days. Similar colonies form in stab and streak cultures. The gelatine is not liquefied. Cultures in _milk_ cause neither coagulation nor acidity. There is little or no growth in hay tea, on potato, nor in vacuum. The cultures have the peculiar odor of the pasteurella.

_Virulent Products._ Infection is present sooner or later in all the morbid animal products. The nasal mucus, bronchial exudate, saliva, tears, contents of the cutaneous vesicle, milk, contents of the bowels, and the blood have been successfully inoculated on susceptible subjects. Inoculations with blood failed with Bryce, but proved successful with Konnhauser, Krajewski, Even, Lignieres and Physalix, so that the first named cases may be explained by a prior immunity, or by a too advanced stage of the case which furnished the matter. The virulence is not lost nor even diminished by drying at ordinary temperatures, freezing (10° F.), nor by moderate dilution in water. Prolonged exposure at ordinary temperature, however, reduces the virulence, which is greatly impaired in 15 to 25 days (Laosson), or, if dried, in three months and upward (Krajewski). Virulence is easily destroyed by disinfectants,—thorough washing (Menard) hypochlorous acid (Trasbot), chloride of lime, mercuric chloride, etc.

_Forms of Distemper._ This disease is extremely protean in its manifestations. Many cases, in country districts especially, are manifested by a slight fever, with a _catarrhal condition of the mucosæ_ of the nose, eyes, and throat. In other cases there may be simply a slight _conjunctivitis or keratitis_, and in still others a _cutaneous eruption_, papular, vesicular or pastular. In some instances there is slight _gastric_ or _hepatic disorder_ with inappetence nausea, and vomiting or some irregularity of the bowels. In such cases recovery may take place in eight or ten days.

In the more severe forms, especially seen in house and city dogs, and in high bred and confined dogs generally, the fever is high and persistent and the disorders often predominate in particular organs, hence we see a _catarrhal form_, a _conjunctival_, a _bronchitic_, a _pulmonary_, a _gastro-intestinal and hepatic_, a _cutaneous_ and a _nervous_. The severe cases may last for twenty or thirty days or even in their sequelæ for several months. Exposure to cold contributes greatly to a pulmonary attack even in inoculated cases (Lignieres).

The _mortality_ varies greatly. In country dogs it may be below 20 per cent., whereas in city dogs and those kept confined in close quarters and in large numbers it may rise to 50, 60 or even 70 per cent.

_Prognosis_ is especially unfavorable in severe cases; in those profoundly affecting the brain, lungs or liver; in high bred or pampered dogs; in the very young; in the debilitated, anæmic or rhachitic; in those that have been recently imported from another climate and are as yet unacclimated. Puppies from debilitated dams, or those raised in a large litter with insufficient nourishment, or older dogs confined to a purely vegetable diet show less power of recuperation. Profound prostration and offensive odor, from excess of toxins are always to be dreaded.

_Incubation_ in inoculated cases varies from four to seven days (Krajewski). When contracted by simple exposure it may seem to have been extended to fourteen or even eighteen days.

_Symptoms._ The _earliest symptom_ is hyperthermia (103° to 104° F.) This is accompanied and followed by prostration, dulness, impaired appetite, erection of the hairs along the spine, shivering, trembling, seeking a warm place, fatigue on slight exertion, hot dry nose, burning pads of the feet, sometimes taciturnity. Later the temperature may descend even to the normal or there may be alternations of rise and fall. One of the most characteristic symptoms of distemper is the implication of more than one set of organs, so that morbid manifestations referable to the nose, eyes, throat, stomach, skin and nervous system occurring in the same subject are to be especially noted. In enumerating the prominent symptoms caused by disease of one set of organs therefore, it is not to be implied that the absence of others referring to a different class of organs is to be understood. On the contrary a complication of several is especially significant of this disease, though the predominance in one class of organ will signify a special form of the disease.

_Respiratory Symptoms._ One of the earliest symptoms is usually sneezing with redness of the nasal mucosa, followed by a muco-purulent blocking of the nose, and rubbing of it with the paws. With the implication of the throat there is usually local tenderness and a hard, painful cough, which may be accompanied by retching or vomiting. The breathing becomes snuffling, especially in pugs and bull dogs, and rapid and even oppressed in case of implication of the smaller bronchia and lungs. The nostrils may become glued together, the discharge red or dark in color, vesicles and sores may appear on the mucosa, and the cough gets paroxysmal, small, weak and husky or gurgling.

Percussion of the lungs may reveal small areas of flatness from exudate or collapse, and in case of pleurisy and hydrothorax there is a lack of resonance up to a given horizontal line, varying in position according to the position of the animal and always keeping to that part of the thorax which may at the time be lowest. Auscultation will reveal various sounds according to existing lesions. There may be a loud blowing murmur over the large bronchia, or at points to which this sound is conveyed through consolidated lung. Or a coarse or fine mucous râle may be present indicating the second stage of bronchitis, or a line of crepitation, around a non-resonant area indicating pneumonia, or there may be friction sounds or, later, creaking murmurs from false membranes. Wheezing and sibilant sounds are not uncommon, also sounds of the heart, bronchia or bowels, heard in unwonted situations to which they are conveyed through consolidated lung tissue. Dyspnœa may become extreme, with puffing out of the cheeks, labial soufle, and violent inspiratory action. Fœtor of the breath is common. Emaciation, marasmus, sunken, pale or dark red eyes, putrid diarrhœa and nervous disorders usually precede death.

_Eye Symptoms._ Conjunctival congestion is one of the earliest and most constant symptoms. Weeping, swollen eyelids and red turgid mucosa. Photophobia may bespeak keratitis. Soon the watery tears become muco-purulent, matting together the lashes and even the lids, during the night especially, so that they must be sponged to get them apart in the morning. The exudate may accumulate under the lower lid, or may become flocculent, and usually flows down the cheeks causing matting and even shedding of the hair. Vesicles exceptionally appear on the conjunctiva; more frequently it becomes cloudy and opaque, and at points near the centre, degeneration of the epithelium leads to the formation of ulcers no larger than pinheads, but extending into the cornea and sometimes perforating it so as to allow protrusion of the membrane of Descemet or the escape of the aqueous humor. The formation and extension of the ulcers are favored by the general debility, the rubbing of the eye with the paws, and the infection of abrasions, by pus microbes. This infection may extend to the lining member of the anterior chamber and even of the posterior with panophthalmia, but, in the absence of perforation, internal ophthalmia is rare. When the ulcers heal, white cicatricial spots, or black points caused by the adhesion of the uveal pigment remain.

_Digestive and Hepatic Symptoms._ Anorexia and vomiting may usher in the disease. Buccal congestion, dryness, clamminess and fœtor are marked symptoms and there may be some yellowness of the mouth and eye. The patient is at first costive, but diarrhœa often sets in early, with tenesmus, much fœtor, mucus, froth and even blood, also abdominal pain and tenderness. The abdomen is habitually tense and contracted. The alvine flux may rapidly exhaust the animal, or it may continue for a month in dysenteric form with intense fœtor, weakness, emaciation and exhaustion. Ulceration of the mouth, gums and rectum, invagination, prolapsus ani, jaundice, septic pneumonia, paralysis, chorea, convulsions, or cutaneous eruptions are occasional complications. The abdominal type of distemper is especially fatal. Even in its early stages debility, prostration and even drowsiness are marked features.

_Cutaneous Symptoms._ Skin eruptions are observed in the great majority of cases, at some stage of the disease, and may remain as a sequel for a time after apparent recovery. Friedberger and Fröhner note cases in which the high fever and skin eruption are the only prominent symptoms, and recovery may be looked for with some confidence. The lesions are most patent on white skinned dogs with short hair, and on the more delicate parts of the skin (abdomen, scrotum, perineum, inside of the thighs and elbows) but they may extend over the whole body and even extend on the mucosæ. They vary much in different cases and stages. There may be punctiform reddish spots, changing to hard elevated papules, and, in the case of a certain number, to vesicles and even pustules. Some vesicles may be small and pointed, but more commonly they are rounded and flat, and as large as a lentil or small pea. When first formed, the contained liquid exudate may be clear and transparent, but often it is reddish or even violet. The individual vesicles tend to speedily burst, and dry up, but others appear, and thus the eruption will continue for weeks, the skin meanwhile exuding a sticky, greasy, offensively smelling exudate which mats the hairs together. Itching is usually slight, yet in given cases excoriations and sores are produced with considerable moist discharge. It tends to spontaneous recovery when the general health improves and appears to be little affected by local treatment.

_Nervous symptoms._ These are shown more or less from the beginning. The great dulness, depression, apathy and weakness, which usually usher in the disease, are indications of this. Drowsiness may be early shown. Even the early nausea and vomiting may be largely central in its origin. In some cases, however, the brain symptoms are more active and violent. The dog is restless and irritable, getting up and moving from place to place, starting from sleep, yelping, snapping, with twitching of the muscles of the face or limbs, rolling of the eyes, and excessive heat of the head. Krajewski even describes rabiform paroxysms, depraved appetite, spasms, furious delirium, fawning, or threatening, and finally paraplegia and maxillary paralysis Occurring in a country where rabies is familiar it would have been more satisfactory if inoculations had been made from such cases with results negativing rabies. Epileptic attacks may appear at any stage of the disease. Chorea, tonic spasms, paresis and paralysis are on the contrary habitually late manifestations and often seem to be sequelæ determined by toxin poisoning of the nerve centers, or degenerations of their structure. Choreic movements may be confined to the head, or a limb, or they may affect the whole body. Tonic spasms often affect the neck, turning the head rigidly to one side. Among other nervous disorders may be named, amaurosis with dilated pupil and atrophy of the optic nerve, deafness, anosmia, and dementia.

_Lesions._ These vary as do the symptoms. The nasal pharyngeal, and laryngeal mucosæ show congestion, swelling, infiltration, ecchymosis with vesicles, pustules and ulcerations. They are covered by a foul muco-purulent exudate. The same condition may often be traced to the final ramifications of the bronchial system. In pulmonary cases, the lungs show inflammation, inflammatory exudation and consolidation, collapse, splenization, œdema, and even suppuration in points or large areas. The bronchial lymph glands and often the pharyngeal are enlarged, congested and may be suppurating. The pleura over the congested lung may be the seat of exudation and false membrane, and a bloody serum may occupy the pleural cavity. The heart may show parenchymatous degeneration.

In the digestive organs there may be buccal congestion, with degeneration and the desquamation of the epithelium and formation of more or less extended ulceration. The stomach shows similar congestions and degenerations, the ulcer appearing particularly on the summit of the folds. Together with the intestines this often presents numerous petechiæ and ulcerations, and is covered by a foul but often tenacious mucus. The agminated and solitary glands are usually swollen and infiltrated, and the mesenteric glands are swollen, congested and infiltrated.

The kidneys are often congested, and show points of blood extravasation and tissue degeneration.

The meninges of the brain and cord are often inflamed with infiltrations, false membranes, and especially exudation into the subarachnoid and ventricles. Centres of congestion and softening have been noted in the brain and cord with embolism of capillaries and softening and degeneration of their endothelium. Nocard and others have noted a leucocytic infiltration of the perivascular lymph spaces. In old standing cases sclerosis is an occasional feature.

In nearly all cases there is marked emaciation and a very heavy offensive odor comes from the skin, the tissues, the contents of the bowels and the exudates on the respiratory passages.

Lignieres alleges that in the early stages, the specific bacillus is found in the blood and viscera, but that later it is only exceptionally found and that other bacteria (streptococcus, etc.,) usually take its place. In the nasal discharge it may be found at times, but in the more tardily appearing cutaneous vesicles its absence is the rule, and in the brain matter and meningeal and ventricular fluids, in cases of paralysis or chorea, it is not to be detected by culture. Hence the case cannot always be diagnosed by a successful search for, or culture of the germ, and hence also the frequently unsuccessful inoculations with the blood, tears, liquid of vesicles, and even the lung tissues or nasal discharges.

_Prevention._ Distemper, like any other contagious malady may be excluded from a city or district by the simple expedient of shutting out animals that bear the infection. From a kennel or pack of hounds, new arrivals should be quarantined for a fortnight, until danger is past, and should only be admitted after a good soapy wash. All clothing, collars, brushes and other material that came with them should be thoroughly disinfected. Dog shows and other meetings are to be avoided as far as possible, and any animal that has returned from one should be quarantined and all his belongings purified. Dogs that run at large should be carefully excluded from kennels where valuable dogs are kept, and from all possible contact with them. Even mice, rats, and birds have to be considered if the disease exists in the near vicinity. When the disease exists in a district a sound sanitation would demand the shutting up of all dogs on their owner’s premises, unless carefully led on chain and prevented from coming in contact with other dogs.

When the disease has broken out in a pack of hounds, or a populous kennel, the dogs should be separated into small lots of 3 or 4; the temperatures of all should be taken twice a day; any lot in which one shows a high temperature should be instantly removed to a safe distance and placed in quarantine; and the enclosure where they have been and all their belongings should be thoroughly disinfected. The enclosures where the sick are kept must be carefully quarantined so that no infection may escape on food, water, brushes, utensils, clothing, attendants, cats, vermin, or even birds.

The dogs that are still healthy should have spacious, well-aired dwellings, open air exercise (as much as possible in the fine season), good but not too stimulating food (in part at least fresh animal food), pure water, and protection against undue fatigue, cold, icy baths, especially when exhausted, rain or snow storms and cold stone or metallic beds. In the cold season artificial heat in the kennel is desirable.

_Immunization_ may be sought in various ways based on the use of the toxins and antitoxins on the one hand, and of a weakened type of virus on the other. Bryce (1882) and others inoculated with the blood and pulmonary exudate, and produced in three-months-puppies, local swellings mainly, with subsequent immunity. The mortality from the inoculation did not exceed 10 to 15 per cent. These losses imply that in certain cases the material inoculated conveyed the microbe of the disease, and the survivors acquired all that immunity which comes from a first attack. In the cases that show local lesions only, it may be presumed that few microbes or none were inserted, while the results came mainly from the toxins or antitoxins. This would be entirely in keeping with Lignieres’ observation that the blood and pulmonary lesions often failed to furnish the pathogenic microbe, as tested even by attempts at artificial cultures. The protection secured from the antitoxins alone is shortlived, terminating with the elimination of these elements, while that coming from the action of the toxins on the leucocytes, and the stimulation by these to the production of defensive products, is much more lasting and in ratio with the quantity of the stimulus introduced and the profundity and duration of its influence on the leucocytes. This may partly explain the occasional early exhaustion of the immunity and the reinfection of the animal within a year after inoculation.

Physalix working in Chauveau’s laboratory has found the best results from the use of weakened artificial cultures. He cultivated the microbe of Lignieres in peptonised bouillon having 6 per cent. of glycerine, and allowed successive cultures to rest (without reseeding a new culture fluid), after they have attained to their full growth. The strength of the culture is in inverse ratio to the period that elapsed between successive cultures, leading up to this one, and the first inoculation is made with the weakest product that will produce a very limited local swelling which is fully developed in 48 hours, and disappears in a few days. Three or four inoculations are made successively with cultures of gradually encreasing potency, after which immunity persists for years. It is to be understood, that an overdose will overcome the immunity at any time; also that the passage of a culture of lessened potency through a dog or Guinea pig will raise it to its original virulence. Physalix operated only on young dogs, that had not shed their milk teeth, and injected 2 to 3 c.c. of the culture as a dose with only 2.5% mortality. Others had less success.

_Treatment._ To secure good results in the treatment of distemper every attention must be paid to good hygiene. An open air life in summer, and a roomy, clean, well-aired, warmed building in winter are most important. Chills, foul air, and filth generally are to be carefully guarded against. Food should be moderate in amount, easily digested and nutritious. Milk is especially good (sweet, skim or buttermilk); then biscuit and milk, or in patients accustomed to animal food, lean meat, minced, scraped or pulped. Warm baths are often advantageous, but they must be given with great caution to avoid chill.

Medicinal treatment is largely symptomatic. An excessively high temperature (104° and upward) may be met by warm baths, or antipyretics—quinine, acetanilid, salicylate of soda, antipyrine, phenacetin, or even damp compresses to the sides. As a rule, however, it is not well to continue such agents as acetanilid, antipyrine or phenacetin longer than is absolutely needful to reduce excessive temperature.

Attempts have been made to check microbian proliferation by antiferments, such as quinine, calomel, creolin, phenol, and phenacetin. The tonic action of quinine specially recommends it but like all bitters it is obnoxious to a dog with a delicate stomach. Calomel is especially recommended by Fröhner as a gastric and intestinal antiseptic and its indirect action on the liver renders it valuable in many cases. Creolin and carbolic acid exhaled from saturated cloths tend to disinfect the air passages and give tone to the mucosa. My colleague Dr. P. A. Fish gave carbolic acid, 2 per cent., and afterward 4 per cent. in normal salt solution, and in doses of ½ to 1 drachm, subcutem once and twice a day. In the initial stages, it seemed often to be of great value, quieting the nervous excitement, improving the general symptoms, and in some instances apparently cutting short the affection. Trasbot recommended strong infusion of coffee, and Zippelius sodium chloride, while others gave ergotin, or better hydrogen peroxide in spray or as a draught.

_Eliminative treatment._ As in all depressing contagious diseases, we must favor elimination of the toxins, and in this case without risking any material encrease of debility. Calomel (7 grs.), sodium salicylate or benzoate (4 grs.), sodium bicarbonate (7 grs.), potassium iodide (4 grs.), chlorate (7 grs.), or nitrate (7 grs.) may be cited. Digitalis (1 gr.), strophanthus, or caffeine are especially recommended by their power of encreasing the tone of the heart when that has become weak or exhausted.

For the _respiratory_ symptoms we may employ the antiseptic inhalations already named, or, in place of these, iodine or sulphurous acid. The nervous cough may be met by syrup of poppies, or anise, by morphia, or codeia. (Recipe: morphinæ hydrochloras 0.1 grams: aquæ amygdal. amar. 10 grams, aquæ distill. 150 grams. M. A teaspoonful three or more times a day. _Fröhner_). As expectorants, ammonium chloride (5 grs), or acetate, senega, or apomorphia (⅒ gr.), may be used. In vigorous subjects ipecacuan (½ to ¾ gr.), or antimonial wine (1 drop). Hydrogen peroxide in doses of a teaspoonful is often useful. Among counterirritants and derivatives the warm bath and cold compresses are especially valuable, or tincture of iodine, or camphorated spirit, or equal parts of aqua ammonia and olive oil serve a double purpose as furnishing at the same time an expectorant inhalant.

Special pulmonary complications must be dealt with on general principles as advised for the special diseases, bearing in mind always the profound prostration and the need to avoid depressing agents.

For _conjunctival symptoms_ bathing with tepid water to soothe irritation and remove adhesions and crusts, may be followed by a drop of aqueous solution of pyoktanin (1:1000) under each lid, twice a day, or cocaine (3:100), or silver nitrate (½:100); may be used. Fröhner advises creolin (½:100); Cadeac, cresyl (½:100); Müller, mercuric chloride (1:2000) or boric acid (1:40). Other Collyria may be substituted (see diseases of the eye). In violent inflammations atropia will find a place and in ulcerations boric acid, silver, pyoktanin, calomel, or hydrogen peroxide. When irritation and rubbing are persistent a cocaine solution may be dropped into the eye every few hours. When the ocular troubles persist during general convalescence tonics with good nourishment and hygiene are demanded.

With _digestive symptoms_ the attendant vomiting will usually have cleared the stomach of irritant contents. In the exceptional cases it may be unloaded by apomorphia (¹⁄₁₀₀ gr. subcutem), or ipecacuan wine a teaspoonful by the mouth. More commonly a check must be placed on persistent vomiting by bismuth nitrate (3 grs.), laudanum (5 to 10 drops), creosote (5 drops), or chloroform (5 to 10 drops), and small pieces of ice. A derivative to the epigastrium is sometimes useful. The food should be of the simplest and most easily digested kind, milk, meat-soup skimmed of fat, meat juice, scraped or pulped raw meat. Demulcents like gum water, slippery elm bark, or decoction of marsh mallow may be resorted to, and in case of extreme irritability nourishment may be given by rectal injection. As vomiting may be kept up by irritants in the intestines a tablespoonful of tincture of rhubarb may be required to be repeated twice a day until relief is secured. Calomel and chalk (1:12) in grain doses will sometimes serve a good purpose. Also dilute hydrochloric acid in water (1:60) in doses of a teaspoonful with pepsin, gentian, quinine or nux vomica will often contribute much to restore tone and function. Septic intestinal fermentations may be met with beta-naphthol, naphthalin, (7 grs.), chloral hydrate (10 grs.) lactic acid (buttermilk), or salol (5 grs.). The attendant fœtid diarrhœa may demand in addition opium or silver nitrate (½ to 1 gr.). The gastric secretion is usually suspended so that it largely passes into the intestines unchanged. Of course it should not be used along with muriatic acid.

The _skin eruption_ is usually considered of little consequence, or, by some, beneficial (Cadeac). If treatment is desired it may consist in dusting powders, demulcent soothing dressings and perhaps stimulating liniments as found under _skin diseases_. It usually disappears with the elimination of the toxins and the restoration of vigorous health.

For the _nervous symptoms_ treatment must correspond to the morbid phenomena. Extreme prostration may demand diffusible stimulants. Spasms and other indications of congestion may be met by cold to the head, and inhalations of ether, followed by potassium or sodium bromide (8 grs.), sulphonal (20 grs.), trional (15 grs.) chloral hydrate in mucilage, or hypnal (15 grs.). Paralysis must be met by tonics, stomachics, easily digestible, rich food, and good hygiene. Pepsin, muriatic acid, nux vomica (½ gr.), arsenite of soda solution (5 drops), arsenite of strychnia (¹⁄₂₀ gr); orexin(3 grs.), strong coffee infusion, wine, and electricity may be tried, in addition to stimulant liniments. Chorea must be treated on the same corroborant plan. Cold douches after which the patient is carefully rubbed dry are sometimes successful, (see Chorea).

During _convalescence_ and in all cases of debility and anæmia a similar corroborant treatment is demanded. Pulped raw meat, rich soups, stomachics, tonics including the preparation of iron, and in extreme cases transfusion of blood or a normal salt solution may be resorted to.

In _cats_ a parallel course of treatment may be pursued, allowance being made for the smaller size of the animal and the great susceptibility of the feline patient to phenol.

INFECTIOUS BRONCHIAL CATARRH. BENCH SHOW DISTEMPER.

Under this name Glass describes an affection, milder than the usual distemper, but showing similar lesions and demanding an equivalent treatment. It is not self-limiting the same patient having suffered twice in the same year (an occurrence which is occasionally seen in distemper.) The incubation is 3 to 5 days. Diarrhœa is invariably present from the first, and the fæces slimy and at the end of a week slightly bloody. The affection is characterized by the predominance of the digestive disorder, the absence of skin eruption, the free shedding of the hair in long coated animals, the ulceration of the gums, tongue and lips, and the low mortality.

Bacteriological research must be invoked to determine whether this is only a form of distemper or if it is one of a group of diseases which have hitherto been known by that name.

EMPHYSEMATOUS ANTHRAX.

Definition. Historic notes. Geographical distribution. Animals
susceptible: Young cattle after weaning, sheep, goats; horses, asses
and white rats, have local swelling; dog, cat, pig, bird and man
immune. Immune animals succumb if injected with lactic acid, or
proteus vulgaris, or violently exerted (sarco-lactic acid). Causes.
Bacillus anthracis emphysematosa, 3 to 10μ by 5μ, stains violet with
iodine, anærobic, sporulates in living body, hence seen as rod, club,
and round, spore. Lives in exudate, not in blood nor on surface. Table
comparing with anthrax bacillus. Vitality: resists drying, cold, 98°
F., weakened by 139°, sterilized by 212° F. for 20 minutes, by strong
antiseptics. Lives in dense clay, hard pan, and waterlogged soils
holding little oxygen. Accessory causes: lactic and other organic
acids, overwork, potash salts, alcohol, salt, proteus vulgaris,
micrococcus prodigiosa, low condition, debility, plethora, chills,
change to warmth, youth, melting snows, freshets, drying of wet lands.
Symptoms: incubation a few hours, disease 12 to 70 hours.
Hyperthermia, swelling in loose connective tissue, shoulder, quarter,
arm, thigh, neck, trunk, palate, base of tongue, pharynx, tender
point, rapidly enlarges, spreads, crepitates, percussion resonance,
finally cold, insensible, and withered. On incision black, bloody
pulp, or frothy. Peripheral gelatinoid exudate. Subsidiary lymph
glands enlarged. Cases with deep seated exudate. Diagnosis: from
malignant œdema and anthrax. Lesions: early decomposition, bloating,
in swelling blood extravasation with gas bubbles and lymph exudate,
muscle beneath dirty brown or black, breaking down when pressed, shows
waxy or fatty degeneration, and many leucocytes and cell forms. Lymph
glands and plexuses blood gorged. Extravasation may be in internal
organs. Liver congested. Spleen rarely enlarged. Treatment: Chloride
of iron internally, ammonia iodide and ol. terebinth externally.
Scarify and use hydrogen peroxide or potassium permanganate.
Antitoxins. Prevention: drain and till soil, apply quicklime to muck,
exclude new animals just from infected districts, disinfect buildings,
close infected wells and streams, seclude the sick, burn, cook or
dissolve carcasses, or fence graves. Bleeding purgation, diuresis,
uniform good feeding, setoning. Immunization by heated and sterilized
culture; by toxins passed through a porcelain filter; by minimum dose
intravenously; by injection into trachea; by inoculation on tip of
tail; by inoculation with Pasteur weakened virus; by heat sterilized
virus.

_Synonyms._ Symptomatic Anthrax; Black Quarter; Quarter Ill; Black Leg; Rauschbrand; Charbon Symptomatique.

_Definition._ An acute infectious bacteridian disease manifested by hyperthermia, lameness, and a localized, hot, painful swelling on the shoulder, quarter, leg, neck, trunk or elsewhere, tending to emphysema, and gangrene and when incised showing black extravasated blood, clotted or frothy.

This affection was long confounded with anthrax proper, but was differentiated by the observation of Wallraff (1856), Boulit-Josse, Vernant, Pfisterer, Feser, and others and finally Bollinger in 1875 found the motile bacillus. Arloing, Cornevin and Thomas (1879–84) thoroughly substantiated this position, and devised a method of immunizing by inoculation. Feser had however seen the motile sinuous rods in the exudate as early as 1860, and even produced the disease by the inoculation with mud from infected Alpine pastures.

_Geographical distribution._ Emphysematous anthrax prevails in limited areas, and particular buildings in Europe, Asia, Africa, Australia and America, and in all climates from the tropics up to the sub-Arctic. It is however most prevalent in spring, summer and autumn. It is not uncommon at the breaking up of the winter snows. It is especially prevalent on damp, undrained land or on such as has dried up in the heats of summer, and has become less prevalent in many localities in connection with drainage and careful cultivation.

_Animals susceptible._ The disease is especially common in young cattle, from three months to four years of age. Calves fed on milk are rarely attacked, being in a sense carnivorous and sometimes immunized by toxins from the dam. Cattle over four years usually escape, having already become immune if kept in an infected locality. If brought from a noninfected place they are, at any age, as susceptible as the young. Sheep and goats contract the disease only exceptionally, but like the Guinea pig are easily infected by inoculation. Horses, asses and white rats have only a circumscribed swelling in the seat of inoculation, and foals and buffalo calves sometimes contract it casually. Carnivora and omnivora, (dog, cat, pig, bird, man), and the rabbit are virtually immune.

Immune animals may, however, be made to succumb under special treatment. In a rabbit inoculated at the same time with the microbe of black quarter and proteus vulgaris, or micrococcus prodigiosus, or if injected with a little lactic acid, the disease develops promptly and fatally. Over-exertion, producing sarco-lactic acid will also lay the system open to attack. The reduction of the vitality and resistance of the muscle of the rabbit by a contusion, bruise or lacerated wound, or by injecting it with acetic acid, potash salts, alcohol, or common salt, will render the inoculation pathogenic. Again, the introduction of the black quarter microbe into the aqueous humor of the rabbit, where there are so few defensive leucocytes, entails an active proliferation and a fatal result.

_Causes._ The essential cause of emphysematous anthrax is a rod-shaped germ, variously known as =bacillus anthracis emphysematosa=, =bacillus Chauvæi=, =Rauschbrand bacillus=. This is a rod-shaped microbe, with rounded ends, found singly or connected in pairs, or very short filaments. The bacilli are 3 to 10µ long, by .5µ broad, or when sporulating, 1.1 to 1.3µ. They form spores even in the body of the affected animal, often assuming a club shape by reason of the spore formation near one end. If the spore develops in the center they appear fusiform. They take aniline colors readily, and iodine slightly, assuming in the last case a violet tint. The staining is unaffected by heating in melted balsam. The bacillus grows readily in ordinary culture media, (peptonized gelatine, bouillon, milk, etc.), but, being anærobic, only under the surface in stick cultures, or under a neutral gas or vacuum. It grows most rapidly at a temperature of 36° to 37° C. but also as low as 15° C. The bouillon at 37° C. becomes milky and opaque in 24 hours, and later it clears up, the microbes being precipitated as a free white powder. In gelatine cultures liquefaction takes place in three days, and in twenty days the whole mass may be dissolved and the microbes precipitated to the bottom. Spores may form in the living body and as these are set free by the granular degeneration of the bacilli, the virulent exudate and cultures usually show the microbe in three different forms: 1st; the straight, motile bacillus of one thickness throughout its whole length; 2d; club-shaped or fusiform bacilli, the thickening of the end or median part being due to the endogenous formation of a refrangent spore or spores; and 3d; the free refrangent spores which have been set free by the degeneration and destruction of the sporulating bacilli. The microbe is not found on the surface of the living animal, nor in the blood, for in both the supply of oxygen is too abundant; it forms its colony under the skin, in the tissues, and above all, in the mass of extravasated blood or gelatinoid exudate which its irritation has produced and where air is lacking.

The most marked differential features of the microbes of anthrax and emphysematous anthrax are contrasted in the following table:—

=Bacillus Anthracis.= =Bacillus of Emphysematous
Anthrax.=

5 to 20μ × 1.25μ. 3 to 10μ × 0.5 to 0.6μ.

Ends square or cupshaped. Ends rounded.

Occurs singly in the living body. Often in pairs or threes in body.

Long filaments in cultures. No long filaments.

Nonmotile. Motile (sluggishly).

Ærobic. Anærobic.

No spores formed in living body. Sporulates in living body.

Sporulates in air; in surface Sporulates in vacuo; deep in soil.
soil.

Bacilli only. Bacilli; sporulating bacilli; free
spores.

Multiplies freely in blood stream. Dies in blood stream unless
charged with toxins.

Rabbit very susceptible; man less Rabbit, pigeon and man immune.
so.

Produces no gas. Gas producing.

Inoculation swelling very Inoculation swelling very
restricted. extensive.

Bacillus destroyed by Not destroyed by putrefaction.
putrefaction.

_Resistance of bacillus of black quarter to physical and chemical agents._ The microbe is possessed of great vitality. Thoroughly dried at a temperature of 95° F. it retains its virulence. The spores may be preserved indefinitely in dry soil, buildings, fodder, litter, harness, etc. Cold is equally harmless to it. It has been exposed to a temperature of 98° F. below zero without losing its virulence. Its virulence is lessened by exposure for an hour to 139° F., and it is sterilized at a temperature of 212° F. for twenty minutes. The dried spores are virulent after six hours of the boiling temperature but are sterilized at 230° F. if maintained for the same length of time. Diffused in water the virus is sterilized in thirty-five minutes at the boiling temperature. Some waters at ordinary temperatures destroy the virulence in twenty-four hours; others not for many months. It is destroyed by the more potent disinfectants, mercuric chloride (1:1000), silver nitrate (1:100), acid salicylic (1 to 2:100), acid carbolic (2 to 4:100), copper sulphate (20:100), boric acid (20:100), muriatic acid (1:2). Quicklime, copperas, zinc chloride, sulphuric acid and an alcoholic solution of phenol have proved unsatisfactory.

In clay soils, hard pans, waterlogged soils, and in some that are over manured so that the atmospheric air is excluded, it may be preserved indefinitely. Feser, Gotti and others have produced the disease by inoculating with the washings of infected marshy soils, and this is doubtless a common source of casual cases of the malady.

_Accessory causes_ are important. The predisposing influence of lactic acid, of other organic acids, and of overwork have been already named. Potass salts, alcohol, common salt and the products of proteus vulgaris, or micrococcus prodigiosus increase the susceptibility. Low condition, debility, or suddenly induced plethora have a similar influence. Sudden changes of weather, chills, and particularly the access of hot weather in spring, when the animal is changing its coat lays, the system open to attack. Youth, after the period of suckling, and under three years old, seems to increase the predisposition, though this is largely the result of the absence of a previous exposure. Then impermeable, clay, wet, marshy soils, or those charged with organic matter are conditions of the presence of the microbe. It often appears in spring in connection with the melting of the winter’s snows, the occurrence of freshets, and the washing out of soil infection which would otherwise remain buried. Also in advanced summer and autumn when swamps, ponds, basins, deltas, river bottoms, etc., are drying out and furnishing pasture. Pease records its great prevalence in the rainy season in the swamp districts of the Punjab and North Western provinces of India, and the same is largely true of our Gulf coast states.

_Symptoms._ Emphysematous anthrax develops suddenly, the incubation in experimental cases, lasting only for a few hours, and the whole course of the disease does not usually exceed ½ to 3 days. The local swelling may be the first observed symptom or there may be first febrile disturbance followed by the local swelling. _The swellings_ show where the connective tissue is loose and abundant as on the shoulder, quarter, arm, thigh, neck, face, or trunk, and practically never where the areolar tissue is very spare and dense as on the end of the tail, or ear, or on the limb below knee or hock. They sometimes form on the palate, base of the tongue, or pharynx. The muscular system is especially liable to suffer, the looseness of the texture and the presence of lactic acid making a particularly favorable field for the propagation of the microbe. The comparative absence of muscle in the region below the metacarpus, the tail and ear is an important cause of this immunity.

The _swelling_ is at first very small and tender, but it encreases rapidly, and in a few hours may extend to one, two, or three feet in diameter. At first smooth, rounded, pitting on pressure and destitute of crepitation on handling, it becomes softer and less sensitive and when pressed or kneaded it gives a crepitant sensation and sound, or it even appears to gurgle. When percussed the resonance is drumlike. Finally, the skin may become cold, insensible, and withered like a piece of parchment. When incised the tissues are found to be gorged with blood, and of a black or dark red color; they break down under pressure into a bloody pulp, and from the wound flows a bloody fluid which may be red in the early stages, black in the advanced, and frothy in the latest. Where the connective tissue is very loose and abundant, the bloody extravasation is surrounded by an extensive straw colored œdematous infiltration. The swelling is sometimes single, but more frequently several appear and become confluent. The lymph glands in the vicinity become greatly enlarged.

_Fever_ is a constant condition as the swelling advances and sometimes it precedes the local engorgement. There is erection of the hair, with it may be, distinct shivering, recurring again and again. Then general stiffness, dulness, prostration, loss of appetite and rumination, accelerated breathing sometimes attended by a grunt or moan, and rapid pulse. The temperature usually reaches 104° F., and may rise to 109° F. The breathing becomes more and more labored and plaintive, colicy symptoms may set in, the prostration advances to complete adynamia, the patient can no longer stand, the temperature drops to 100° F., or 98° F., and death supervenes in from eight hours to two days from the first sign of illness.

In some cases the swelling may be invisible because it is situated deeply or it may perhaps be entirely absent, and the constitutional symptoms are the only ones observed.

_Diagnosis._ From _malignant œdema_, which it resembles in producing gas and crepitating tumors, emphysematous anthrax is distinguished by the greater length of the microbe, by its formation of spores at the pole and not in the centre of the bacillus, by the more sluggish motions of the germ, by the restriction of the germ to given infected districts instead of being generally diffused as in malignant œdema, by its not attacking man, rabbit, nor pigeon, which are subject to malignant œdema, by its deadly action on mature cattle which are usually immune from malignant œdema, and by the abundant blood extravasation on the swelling.

From _anthrax_ it is distinguished by the motility of the bacillus, by its polar sporulation and club shape, by its rounded ends, by its absence from the blood in the earlier stages, by the presence of gas and crepitation in the swellings, and by the deadly action of the infection on Guinea pigs, but not on rabbit, man, nor pigeon. Anthrax is easily inoculable on a cutaneous sore or intravenously whereas emphysematous anthrax is not.

_Lesions._ The carcass is liable to be bloated with gas and a reddish, frothy liquid often escapes from mouth nose and anus. Gas is particularly abundant in the substance of the tumor, and the skin covering it may be dry and crackling. An incision made into the swelling exposes a mass of blood extravasation and lymph exudate, the blood predominating in the centre so that it may appear clotted and black, and mixed with gas bubbles, while the yellowish lymph forms the periphery of the tumor, yet streaked more or less with blood, or even pink throughout. The abundance of gas is usually in inverse ratio to the amount of œdema. The muscles beneath or surrounded by an exudate are of a dirty brown or black, and are disintegrated so as to break down readily under pressure of the finger into a blackish pulp. They are infiltrated with gas, crepitate under pressure and assume a golden yellow color on exposure to the air. The gas is comparatively inodorous immediately after death, being mainly carbon dioxide and carbide of hydrogen. Later it may show distinct and even offensive odor, from the formation of hydrogen sulphide, or lactic acid. The muscular fibres are easily teased apart, and show under the microscope masses of blood globules, leucocytes, lymph cells, free nuclei and granules, with, in some points, fatty or waxy degeneration of the fibres, or granular masses that are stained black by osmic acid. The bacillus is present in large numbers, and this with its absence immediately after death from the blood becomes characteristic. The lymph glands near the swelling are usually enlarged and gorged with blood. The lymph plexuses and vessels contain bubbles of gas.

The swellings may be subcutaneous, or submucous in the tongue or pharynx, but they occur also in the pleuræ, lungs, heart, pericardium, mediastinum, the peritoneum, the sublumbar connective tissue, and even the walls of the stomach or intestine. It is not uncommon to find a pink effusion into one of the serous membranes. The liver is usually hyperæmic, as may be also the kidneys, but the spleen is rarely enlarged. In this and in the integrity of the blood globules this affection differs from anthrax.

_Treatment._ This disease is so often speedily fatal, cutting off its victim in eight hours, often during the night, that no opportunity is allowed for treatment. Even in those that survive for two days, the affection must always be looked on as exceedingly grave, and as little amenable to treatment. Yet much depends upon the patient and the country. Dr. Phares in Mississippi found that it yielded readily in many cases to ½ oz. doses of tincture of chloride of iron every four hours, and a local application composed of equal parts of tincture of iodine, aqua ammonia and oil of turpentine. Galtier tells us that recoveries are frequent in Algeria, while they are rare in France. Tisserant gives the French recoveries as 2 per cent. It is probable that in districts and countries where the malady is all but ubiquitous, the surviving animals are racially immune, or they have been largely exposed and in some degree virtually immunized at an early age.

Wallraff mentions a success from applying a tight ligature around an infected limb, above the seat of the tumor and freely scarifying the latter so as to freely admit the air. For swellings elsewhere, scarifications and the free application and injection of peroxide of hydrogen or potassium permanganate (2 to 3:100) would be rational treatment. The same agent might be given by the mouth in doses of 2 or 3 ozs. at frequent intervals. Antiseptics and tonics have been freely employed, including phenol, salicylic acid, sodium salicylate, potassium iodide, quinia, alcohol, phosphorated oil, ammonia acetate, and as an eliminant soda sulphate, but with no very good result. Locally, scarification, antiseptics and caustics, have been employed.

Another line of treatment which deserves to be further exploited is the use of antitoxins on infected animals. An immunized animal may be again and again inoculated at intervals of a week or two until it has been stimulated to produce antitoxin in large amount. Then after three weeks interval its blood serum or blood, may be sterilized by heat, the resulting coagulum washed in distilled or boiled water, and filtered, and the filtrate injected subcutem on the infected animal.