from protective vaccination, to prevent the reinfection of localities.
For this purpose it is essential, if possible, to drain thoroughly and
keep under cultivation the infected areas before animals are permitted
to pasture on them. The complete destruction of all anthrax carcasses is
also very important. This is best accomplished by burning, but as this
method of disposal is impracticable in many localities, deep burial may
be found to be better. Covering the carcasses within their graves with
quicklime adds another valuable precaution against further dissemination
of the infection. No animal dying from anthrax should ever be skinned or
cut open, as the blood from these sources is one of the most dangerous
means of spreading the infection, being charged, while in the animal,
with great numbers of bacilli, which quickly turn into spores as soon as
spread about upon the face of the ground. All discharges from the body
openings should also be burned or buried deeply, as they are frequently
of a virulent character.
GLANDERS AND FARCY.
(Pls. XL-XLII.)
_Definition._--Let it be understood at the outset that glanders and
farcy are one and the same disease, differing only in that the first
term is applied to the disease when the local lesions predominate in the
internal organs, especially in the nostrils, lungs, and air tubes, and
that the second term is applied to it when the principal manifestation
is an outbreak of the lesions on the exterior or skin of the animal. The
term glanders applies to the disease in both forms, while the term farcy
is limited to the visible appearance of external trouble only; but in
the latter case internal lesions always exist, although they may not be
evident.
Glanders is a contagious constitutional disease of the genus _Equus_
(the horse, ass, and mule), readily communicable to man, the dog, the
cat, the rabbit, and the guinea pig. It is transmitted with difficulty
to sheep and goats, and cattle seem to be entirely immune. It runs a
variable course and usually produces the death of the animal affected
with it. It is characterized by the formation of neoplasms, or nodules,
of connective tissue, which degenerate into ulcers, from which exude a
peculiar discharge. It is accompanied with a variable degree of fever,
according to the rapidity of its course. It is subject to various
complications of the lymphatic glands, of the lungs, of the testicles,
of the internal organs, and of the subcutaneous connective tissue.
[Illustration: PLATE XL.
GLANDERS.
Nasal septum of horse, right side, showing acute lesions.]
[Illustration: PLATE XLI.
GLANDERS.
Middle region of nasal septum, left side, showing ulcers.]
[Illustration: PLATE XLII.
GLANDERS.
Posterior half of nasal septum, right side, showing cicatrices.]
_History._--Glanders is one of the oldest diseases of which we have
definite knowledge in the history of medicine. Absyrtus, the Greek
veterinarian in the army of Constantine the Great, described it with
considerable accuracy and recognized the contagiousness of its
character. Another Greek veterinarian, Vegetius Renatus, who lived in
the time of Theodosius (381 A. D.), described, under the name of
"malleus humidus," a disease of the horse characterized by a nasal
discharge and accompanied by superficial ulcers. He recognized the
contagious properties of the discharge of the external ulcers, and
recommended that all animals sick with the disease be separated at once
with the greatest care from the others and should be pastured in
separate fields, for fear the other animals should become affected.
In 1682 Sollysel, the stable master of Louis XIV, published an account
of glanders and farcy, which he considered closely related to each
other, although he did not recognize them as identical. He admitted the
existence of a virus which communicated the disease from an infected
animal to a sound one. He called special attention to the feed troughs
and water buckets as being the media of contagion. He divided glanders
into two forms--one malignant and contagious and the other benign--and
he stated that there was always danger of infection.
Garsault in 1746 said that "as this disease is communicated very easily
and can infect in a very short time a prodigious number of horses by
means of the discharges which may be licked up, animals infected with
glanders should be destroyed."
Bourgelat, the founder of veterinary schools, in his "Elements of
Hippiatry," published in 1755, establishes glanders as a virulent
disease.
Extensive outbreaks of glanders are described as prevailing in the great
armies of continental Europe and England from time to time during the
periods of all the wars of the last few centuries.
Glanders was imported into America at the close of the eighteenth
century, and before the end of the first half of the last century had
spread to a considerable degree among the horses of the Middle and
immediately adjoining Southern States. This disease was unknown in
Mexico until carried there during the Mexican War by the badly diseased
horses of the United States Army. During the first half of the last
century a large body of veterinarians and medical men protested against
the contagious character of the disease, and by their opinion prevailed
to such an extent against the common opinion that several of the
Governments of Europe undertook a series of experiments to determine the
right between the contesting parties.
At the veterinary school at Alfort and at the farm of Lamirault in
France several hundred horses which had passed examination as sound had
placed among them glandered horses under various conditions. The results
of these experiments proved conclusively the contagious character of the
disease.
In 1881 Bouchard, of the faculty of medicine in Paris, assisted by
Capitan and Charrin, undertook a series of experiments with matter taken
from the farcy ulcer of a human being. They afterwards continued their
experiments with matter taken from horses, and in 1883 succeeded in
showing that glanders is caused by a bacterium which is capable of
propagation and reproduction of others of its own kind if placed in the
proper media. In 1882 the specific germ of glanders was first discovered
and described by Loeffler and Schuetz in Germany.
When we come to study the etiology of glanders, the difference of
susceptibility on the part of different species of animals, or even on
the part of individuals of the same species, and when we come to find
proof of the slow incubation and latent character of the disease as it
exists in certain individuals, we understand how in a section of country
containing a number of glandered animals others can seem to contract and
develop the disease without having apparently been exposed to contagion.
_Causes._--The contagious nature of glanders, in no matter what form it
appears, being to-day definitely demonstrated, we can recognize but one
cause for all cases, and that is contagion by means of the specific
virus of the disease. The causative organism is known as the _Bacillus
mallei_.
In studying the writings of the older authors on glanders, and the works
of those authors who contested the contagious nature of the disease, we
find a large number of predisposing causes assigned as factors in the
development of the malady.
While a virus from a case of glanders if inoculated into an animal of
the genus _Equus_ will inevitably produce the disease, we find a vast
difference in the contagious activity of different cases of glanders. We
find a great variation in the manner and rapidity of the development of
the disease in different individuals and that the contagion is much more
liable to be carried to sound animals under certain circumstances than
it is under others. Only certain species of animals are susceptible of
contracting the disease, and while some of these contract it as a
general constitutional malady, in others it develops as only a local
sore.
In acute glanders the contagion is found in its most virulent form, as
is shown by the inevitable infection of susceptible animals inoculated
with the disease, while the discharge from chronic semilatent glanders
and farcy may at times be inoculated with a negative result; again, in
acute glanders, as we have a free discharge, a much greater quantity of
virus-containing matter is scattered in the neighborhood of an infected
horse to serve as a contagion to others than is found in the small
amount of discharge of the chronic cases.
The chances of contagion are much greater when sound horses, asses, or
mules are placed in the immediate neighborhood of glandered horses,
drink from the same bucket, stand in the next stall, or work in the same
wagon, or are fed from feed boxes or mangers which have been impregnated
by the saliva and soiled by the discharge of sick animals. Transmission
occurs by direct contact of the discharges of a glandered animal with
the tissues of a sound one, either on the exterior, when swallowed mixed
with feed into the digestive tract, or when dried and inhaled as dust.
The stable attendants serve as one of the most common carriers of the
virus. Dried or fresh discharges are collected from the infected animals
in cleaning, harnessing, feeding, and by means of the hands, clothing,
the teeth of the currycomb, the sponge, the bridle, and the halter, and
are thus carried to other animals.
An animal affected with chronic glanders in a latent form is moved from
one part of the stable to another, or works hitched with one horse and
then with another, and may be an active agent in the spreading of the
disease without the cause being recognized.
Glanders is found frequently in the most insidious forms, and we
recognize that it can exist without being apparent; that is, it may
affect a horse for a long period without showing any symptoms that will
allow even the most experienced veterinarian to make a diagnosis. An old
gray mare belonging to a tavern keeper was reserved for family use with
good care and light work for a period of eight years, during which time
other horses in the tavern stable were from time to time affected with
glanders without an apparent cause. The mare, whose only trouble was an
apparent attack of heaves, was sold to a huckster who placed her at hard
work. Want of feed and overwork and exposure rapidly developed a case of
acute glanders, from which the animal died, and at the autopsy were
found the lesions of an acute pneumonia of glanders grafted on chronic
lesions, consisting of old nodules which had undoubtedly existed for
years.
In a case that once came under the care of the writer, a coach horse was
examined for soundness and passed as sound by a prominent veterinarian,
who a few months afterwards treated the horse for a skin eruption from
which it recovered. Twelve months afterwards it came into the hands of
the writer, hidebound, with a slight cough and a slight eruption of the
skin, which was attributed to clipping and the rubbing of the harness,
but which had nothing suspicious in its character. The horse was placed
on tonics and put to regular light driving. In six weeks it developed a
bronchitis without having been specially exposed, and in two days this
trouble was followed by a lobular pneumonia and the breaking of an
abscess in the right lung. Farcy buds developed on the surface of the
body and the animal died. The autopsy showed the existence of a number
of old glanderous nodules in the lungs which must have existed previous
to purchase, more than a year before.
Public watering troughs and the feed boxes of boarding stables and the
tavern stables of market towns are among the most common recipients for
the virus of glanders, which is most dangerous in its fresh state, but
cases have been known to be caused by feeding animals in the box or
stall in which glandered animals had stood several months before. While
the discharge from a case of chronic glanders is much less liable to
contain many active bacilli than that from a case of acute glanders, the
former, if it infects an animal, will produce the same disease as the
latter. It may assume from the outset an acute or chronic form,
according to the susceptibility of the animal infected, and this does
not depend upon the character of the disease from which the virus was
derived.
The animals of the genus _Equus_--the horse, the ass, and the mule--are
those which are the most susceptible to contract glanders, but in these
we find a much greater receptivity in the ass and mule than we do in the
horse. In the ass and mule in almost all cases the period of incubation
is short and the disease develops in an acute form. We find that the
kind of horse infected has an influence on the character of the disease;
in full-blooded, fat horses of a sanguinary temperament, the disease
usually develops in an acute form, while in the lymphatic, cold-blooded,
more common race of horses the disease usually assumes a chronic form.
If the disease develops first in the chronic form in a horse in fair
condition, starvation and overwork are liable to bring on an acute
attack, but when the disease is inoculated into a debilitated and
impoverished animal it is apt to start in the latent form. Inoculation
on the lips or the exterior of the animal is frequently followed by an
acute attack, while infection by ingestion of the virus and inoculation
by means of the digestive tract is often followed by the trouble in the
chronic latent form.
In the dog the inoculation of glanders may develop a constitutional
disease with all the symptoms which are found in the horse, but more
frequently the virus pullulates only at the point of inoculation,
remaining for some time as a local sore, which may then heal, leaving a
perfectly sound animal; but while the local sore is continuing to
ulcerate, and specific virus exists in it, it may be the carrier of
contagion to other animals. In man we find a greater receptivity to
glanders than in the dog, and in many unfortunate cases the virus
spreads from the point of inoculation to the entire system and destroys
the wretched mortal by extensive ulcers of the face and hemorrhage or by
destruction of the lung tissue; in other cases, however, glanders may
develop, as in the dog, in local form only, not infecting the
constitution and terminating in recovery, while the specific ulcer by
proper treatment is turned into a simple one. In the feline species
glanders is more destructive than in the dog. The point of inoculation
ulcerates rapidly and the entire system becomes infected.
While a student the writer saw a lion in the service of Prof. Trasbot,
at Alfort, which had contracted the disease by eating glandered meat and
died with the lung riddled with nodules. A litter of kittens lapped the
blood from the lungs of a glandered horse on which an autopsy was being
made, and in four days almost their entire faces, including the nasal
bones, were eaten away by rapid ulceration. Nodules were found in the
lungs. A pack of wolves in the Philadelphia Zoological Garden died in 10
days after being fed with the meat of a glandered horse. The rabbit,
guinea pig, and mice are especially susceptible to the inoculation of
glanders, and these animals are convenient witnesses and proofs of the
existence of suspected cases of the glanders in other animals by the
results of successful inoculations.
The primary lesion in any form is a local point in which occurs a rapid
proliferation of the cell elements which make up the animal tissue with
formation of new connective tissue, with a crowding together of the
elements until their own pressure on one another cuts off the
circulation and nutrition, and death takes place in them in the form of
ulceration or gangrene. Following this primary lesion we have an
extension of infection by means of the spread of the bacilli into those
tissues immediately surrounding the first infected spot, which are most
suitable for the development of simple inflammatory phenomena or the
specific virus. The primary symptoms are the result of specific reaction
at the point of inoculation, but at a later time the virus is carried by
means of the blood vessels and lymphatic vessels to other parts of the
body and becomes lodged at different places and develops in them; again,
when the disease has existed in the latent form in the lungs of the
animal and the virus is wakened into action from any cause, we have it
carried to various parts of the body and developing in the most
susceptible regions or organs. The points of development are most
frequently determined by the activity of the circulation and the
effects of exterior irritants. For example, if a horse which has been so
slightly affected with the virus of glanders that no symptoms are
visible is exposed to cold, rain, or sleet, or by the rubbing of the
harness on the body and the irritation of mud on the legs, the disease
is liable to develop on the exterior in the form of farcy, while a
full-blooded horse which is employed at speed and has its lungs and
respiratory tract gorged with blood from the extreme use of these organs
will develop glanders as the local manifestation of the disease in the
respiratory tract.
The previous reference to the existence of glanders under the two forms
more commonly differentiated as glanders and as farcy, and our reference
to the various conditions in which it may exist as acute, chronic, and
latent, show that the disease may assume several different phases.
Without for a moment losing sight of the fact that all these varied
conditions are identical in their origin and in their essence, for
convenience of study we may divide glanders into three classes--chronic
farcy, chronic glanders, and acute glanders with or without farcy.
CHRONIC FARCY.
_Symptoms._--In farcy the symptoms commence by formation of little nodes
on the under surface of the skin, which rapidly infringe on the tissues
of the skin itself. These nodes, which are known as farcy "buds" and
farcy "buttons," are from the size of a bullet to the size of a walnut.
They are hot, sensitive to the touch, at first elastic and afterwards
become soft; the tissue is destroyed, and infringing on the substance of
the skin the disease produces an ulcer, which is known as a chancre.
This ulcer is irregular in shape, with ragged edges which overhang the
sore; it has a gray, dirty bottom and the discharge is sometimes thin
and sometimes purulent; in either case it is mixed with a viscous,
sticky, yellowish material like the white of an egg in consistency and
like olive oil in appearance. The discharge is almost diagnostic; it
resembles somewhat the discharge which we have in greasy heels and in
certain attacks of lymphangitis, but to the expert the specific
discharge is characteristic. The discharge accumulates on the hair
surrounding the ulcer and over its surface and dries, forming scabs
which become thicker by successive deposits on the under surface until
they fall off, to be replaced by others of the same kind; and the excess
of discharge may drop on the hairs below and form similar brownish
yellow crusts. The farcy ulcers may retain their specific form for a
considerable time--days or even weeks--but eventually the discharge
becomes purulent in character and assumes the appearance of healthy
matter. The surface of the gangrenous bottom of the ulcer is replaced by
rosy granulations, the ragged edges are beveled off, and the chancre is
turned into a simple ulcer which rapidly heals.
The farcy buttons occur most frequently on the sides of the lips, the
sides of the neck, the lower part of the shoulders, the inside of the
thighs, or the outside of the legs, but may occur on any part of the
body.
We have next an irritation of the lymphatic vessels in the neighborhood
of the chancres. Those become swollen and then indurated and appear like
great ridges underneath the skin; they are hot to the touch and
sensitive. The cords may remain for a considerable time and then
gradually disappear, or they may ulcerate like a farcy bud itself,
forming elongated, irregular, serpentine ulcers with a characteristic,
dirty, gray bottom and ragged edges, and pour out a viscous, oily
discharge like the chancres themselves.
The essential symptoms of farcy are, as above described, the button, the
chancre, the cord, and the discharge. We have in addition to these
symptoms a certain number of accessory symptoms, which, while not
diagnostic in themselves, are of great service in aiding the diagnosis
in cases where the eruption takes place in small quantities, and when
the ulcers are not characteristic.
Epistaxis, or bleeding from the nose without previous work or other
apparent cause, is one of the frequent concomitant symptoms in glanders,
and such hemorrhage from the nostrils should always be regarded with
suspicion. The animal with farcy frequently develops a cough, resembling
much that which we find in heaves--a short, dry, aborted, hacking cough,
with little or no discharge from the nostrils. With this we find an
irregular movement of the flanks, and on auscultation of the lungs we
find sibilant or at times a few mucous rales. Another common symptom is
a sudden swelling of one of the hind legs; it is found suddenly swollen
in the region of the cannon, the enlargement extending below to the
pastern and above as high as the stifle. This swelling is hot and
painful to the touch, and renders the animal stiff and lame. On pressure
with the finger the swelling can be indented, but the pits so formed
soon fill again on removal of the pressure. In severe cases we may have
ulceration of the skin, and serum pours out from the surface, resembling
the oozing which we have after a blister or in a case of grease. This
swelling is not to be confounded with the stocking in lymphatic horses
or the edema which we have in chronic heart or in kidney trouble, as in
the last the swelling is cool, not painful, and the pitting on pressure
remains for some time after the latter is withdrawn. It is not to be
confounded with greasy heels. In these the disease commences in the
neighborhood of the pastern and gradually extends up the leg, rarely
passing beyond the neighborhood of the hock. The swollen leg in
glanders almost invariably swells for the entire length in a single
night or within a very short period. When greasy heels are complicated
by lymphangitis we have a condition very much resembling that of farcy.
The swelled leg in farcy is frequently followed by an outbreak of farcy
buttons and ulcers over its surface. In the entire horse the testicles
are frequently swollen and hot and sensitive to the touch, but they have
no tendency to suppuration. The acute inflammation is rapidly followed
by the specific induration, which corresponds to the local lesions in
other parts of the body.
Chronic farcy in the ass and mule is an excessively rare condition, but
sometimes occurs.
CHRONIC GLANDERS.
_Symptoms._--In chronic glanders we find the same train of inflammatory
phenomena, varying in appearance from those of chronic farcy only by the
difference of the tissues in which they are situated. In chronic
glanders there is first the nodule, from the size of a shot to that of a
small pea, which forms in the mucous membranes of the respiratory tract.
This may be just inside the wings of the nostrils or on the septum which
divides the one nasal cavity from the other, and may be easily detected,
or it may be higher in the nasal cavities on the turbinated bones, or it
may form in the larnyx itself or on the surface of the trachea or deep
in the lungs.
The nodules, which are first red and hard and consist of new connective
tissue, soon soften and become yellow; the yellow spots break and we
have a small ulcer the size of the preceding nodule, which has a gray,
dirty bottom and ragged edges and is known as a chancre. This ulcer
pours from its surface a viscous, oily discharge similar to that which
we have seen in the farcy ulcer. The irritation of the discharge may
ulcerate the lining mucous membrane of the nose, causing serpentine
gutters with bottoms resembling those of the chancres themselves. If the
nodules have formed in large numbers, we may have them causing an acute
inflammation of the Schneiderian membrane, with a catarrhal discharge
which may mark the specific discharge, or that which comes from the
ulcers and resembles the discharge of strangles or simple inflammatory
diseases.