resorted to, but should be discarded whenever it is possible to
practise a method of absolute extermination. Among these may be named
the flattening of the teeth, and especially of the canines, with a
file, as advocated by Bourrel, and later by Fleming. While this is a
measure of protection, it does not remove the desire to bite, nor the
power of wounding the skin when that is delicate or tender. Another
method is to hang a block of wood from the neck, so that it may impede
the movements of the forelegs and prevent a rush and sudden attack.
The futility of such a resort need hardly be remarked upon. The
emasculation of dogs is another preventive measure advocated. The
single advantage of this is that it does away with the host of suitors
that follow a rutting bitch, and the mutual worrying and biting that
ensue. But it is not yet proved that the disease is produced by
privation of the generative act, while if it were it is still certain
that cases of spontaneous rabies are extremely rare; that the rabid
dog bites the castrated one as readily as the perfect male; that the
emasculated one contracts rabies as readily as others when bitten, and
that he communicates it no less persistently. Galtier's method of
intravenous injection of the rabic saliva, which seems to have proved
effectual in sheep and rabbits, utterly failed in the hands of Lussana
and {905} Pasteur in dogs. Besides this objection, that it is useless
for the animal which is beyond all comparison the main propagator of
rabies, it has the serious disadvantages that its practice would
necessitate the maintenance of a constant succession of cases of
rabies, that great danger attends this production and handling of the
virus, and the expense and risk of a general application of the
measure must absolutely forbid it.
More recently Pasteur has found that the virus when transmitted
through several monkeys in succession becomes so weak as to be
harmless to the animal inoculated, and yet protects the animal against
the more virulent poison. This fact he utilizes by inoculating this
mitigated ape-virus on the brain of the animal just bitten, so as to
render that refractory to the disease when the poison from the bitten
wound shall reach it by its ordinary slow channel. At the time of
writing, the method is being attempted on a man bitten by a mad dog.
Another precautionary measure which is always in place is the
diffusion among dog-owners of correct information as to the
premonitory symptoms of rabies, and the necessity for careful
seclusion when any such symptoms are manifested.
TREATMENT OF BITES.--The treatment of bites by animals supposed to be
rabid consists mainly in seeking the elimination of the poison or its
destruction by caustic. The first object should be to prevent
absorption of the poison. If the bite has been on a limb, a tourniquet
should be instantly placed above it. A stout cord or handkerchief is
always at hand, and may be tied around the limb and twisted with a
piece of wood until circulation is arrested. Sucking the wound is
usually effective in withdrawing the poison, and can convey no
additional danger to the person bitten. If the patient cannot reach
the wound with his own mouth, another may volunteer to suck it, though
in these days of diseased teeth and gums the act is pregnant of
danger. This may be largely obviated by alternately sucking and
rinsing the mouth with a solution of carbolic acid, or, better, by
applying such a solution to the wound before sucking, or finally by
sucking through a tube. Cupping over the wound is highly commendable,
though less effective than sucking. When cupping can be combined with
wringing of the wound, there is an approximation to sucking. Cupping
is especially valuable in wounds of the trunk, where a tourniquet
cannot be applied. Intermittent squeezing and wringing of the part and
steeping in warm water is an excellent resort when no better measure
can be had. Cutting the wound open to its depth, while it may in
certain cases be necessary to allow of the thorough application of a
caustic, is objectionable as multiplying the points of infection and
absorption. Drinking of liquids to excess temporarily retards
absorption by overfilling the vascular system. Ammoniacal, alcoholic,
and other stimulants are resorted to for the same purpose, being held
to cause plenitude, not only by quantity, but by rarefying the animal
fluids.
No such measures should, however, be allowed to delay for an instant
the use of caustics. This is the one effectual means of destroying the
poison, and the choice of caustic is of less consequence than its
thorough application. The hot iron in the form of a skewer, nail,
poker, or other available instrument, at a white heat, may be brought
in contact with all parts of the wound to its utmost recesses.
Of chemical caustics, solid sticks of nitrate of silver, chloride of
zinc, {906} and potassa, or the crystals of cupric or ferric sulphate,
are to be preferred to the liquid forms (mineral acids, butter of
antimony, etc.), because of the greater thoroughness with which they
can be brought into contact with all parts of the wound. Lastly, the
galvano-cautery may be used if within reach. If the liquid caustics
are employed, they may be introduced into the depth of the wound by
means of a pipette, a piece of porous wood, or a pledget of tow. For a
great number of small wounds a bath of corrosive sublimate has been
recommended.
In some cases the amputation of a badly-lacerated member or one with a
compound fracture offers the only measure of protection.
But although nothing should be allowed to delay cauterization, yet the
impossibility of an immediate application should not be accepted as a
reason for its neglect at a later date. On the presumption that the
virus is localized in the seat of inoculation until it has increased
largely and is poured into the blood in sufficient quantity to
subjugate the blood-globules to its influence, it is logical to excise
the cicatrix and cauterize the wound, though days or even weeks have
elapsed.
If it should be shown by further experiment that Galtier's intravenous
injection of virulent saliva is harmless and protective to sheep,
rabbits, and it may be other Herbivora, it would be logical to employ
this in these animals just after they have been bitten, as there will
be ample time to establish the systemic influence of the intravenous
injection before the poison shall have accomplished its recrudescence
in the cicatrix. The constantly fatal result of rabid bites in these
animals would at least warrant such an attempt, the main precaution
being that the liquid shall be most carefully preserved from contact
with any of the tissues, including even the coats of the injected
vein.
In addition to the local treatment of the sore, certain general
medication has usually been resorted to, though its real value may
well be questioned. Thus, the elimination of the poison has been
sought by profuse perspiration induced by warm, Turkish, and Roman
baths, and by the use of medicinal agents, sudorifics, sialogogues
(mercury), laxatives, and diuretics (cantharides). The neutralization
of the poison has been attempted by ammonia, the sulphites and
hyposulphites, chlorine, etc. Besides these are used nerve-sedatives
and tonics, such as venesection, belladonna, prussic acid, tartar
emetic, sulphates of copper and zinc, arsenic, strychnia, etc.
What is probably of greater importance is a sound hygiene. Stimulating
food eaten to excess is injurious alike to man and beast, and by
inducing digestive disorder and cerebral congestion will tend at least
to precipitate the attack. Costiveness or biliousness from sedentary
habits and lack of exercise in the outer air and sunshine, exposure to
intense heat or cold and over-exertion, are all to be guarded against.
Finally, psychical treatment is of the highest importance. Those about
the person who has been bitten should preserve a calm, equable, and
cheerful demeanor and avoid all allusion to the occurrence. The
patient should be protected against all sources of excitement, and
should not be allowed to see that he is an object of solicitude. If
the matter is referred to incidentally, he should be impressed with a
conviction of the efficacy of the treatment adopted.
THERAPEUTIC TREATMENT.--Almost every agent in the {907} Pharmacopoeia
has been employed as a remedy for hydrophobia, but, up to the present,
it must be acknowledged, with no measure of success. The agents
supposed to be prophylactics are those also resorted to as therapeutic
remedies. To these may be added the potent nerve-sedatives and
anti-spasmodics--chloroform, chloral hydrate, ether, bromides of
potassium, sodium, and ammonium, curare, Calabar bean, and the
sialogogue diaphoretic pilocarpine.
Chloroform is one of the most appropriate, as it may be taken by
inhalation, though with much excitement to the patient, and it at once
relieves the oppressed breathing and pharyngeal and other spasms,
while it acts as a cerebral sedative and anæsthetic; and if it cannot
be held up as a curative agent, it at least secures euthanasia.
Chloral given as an injection, so as to induce its soporific action,
is equally soothing, though nothing more. Curare injected
hypodermically overcomes the spasms, but does not usually, if ever,
retard death. Three cases of hydrophobia in man treated in this way
recovered, but we have no proof that even these exceptional cases were
rabies. Pilocarpine has been used in a number of cases, but, with the
exceptional case of a young man reported by Denis Dumont, all
terminated fatally. The committee of the Paris Academy of Medicine
reported in 1874 that in three experimental cases "it hastened death
by the fits it brought on." Morphia is often of great value in calming
the excitement and giving rest and sleep during the intervals of the
paroxysms. Daturia and atropia, administered hypodermically, are
somewhat less effectual. Inhalation of oxygen is said to arrest the
convulsions and delirium, but not to retard death. Vaccine virus and
the venom of the viper have each been tried, but with no good effect.
Of non-medicinal therapeutic measures the following are among the most
promising: Perfect seclusion, quiet, and darkness serve to abate the
hyperæsthesia, the painful acuteness of the senses, and the convulsive
and delirious paroxysms. It can no longer be doubted that a very few
cases of genuine rabies recover, but those that do so have almost all
had special advantages in the way of quiet and seclusion, and few have
had the excitement of medicinal treatment. Eight cases of the recovery
of rabid dogs are reported by Menecier, Decroix, Laquerriere, Rey,
Harold Leiney, and Pasteur. The two first were attested by successful
inoculation on other animals; Decroix's second case was caused by
inoculation with the saliva of a hydrophobous man; the next three had
been bitten by dogs undoubtedly mad; while Pasteur's was inoculated
with the brain-matter of a rabid cow. All in due time presented the
characteristic symptoms of rabies, yet all recovered, without any
record of medicinal treatment. Pasteur's case, when again inoculated,
resisted the disease. A certain number of recoveries of men from
pronounced hydrophobia under medicine and without it are on record,
but in the absence of successful inoculations it is impossible to tell
how many were cases of infecting rabies. The parallel between rabies
and tetanus in the intensity of the reflex excitability would demand
darkness and quiet as a sine quâ non of any rational treatment.
Faradization has produced a temporary relief, but no permanent
improvement. Warm baths, steam baths, and hot-air baths serve to abate
excitability and spasm, and have been lauded as specific in
hydrophobia, but have proved useless in the lower animals.
{908} Intravenous injection of warm water (two pints) in a
hydrophobous man reduced the pulse from 150 to 86 and restored the
power of deglutition. Life was prolonged for nine days, but in great
agony, from the supervention of suppurative arthritis (Majendie). In
another case the dread of water disappeared, but death ensued in
fifty-four hours. In the hands of Youatt and Mayo it proved equally
unsuccessful in dogs. A cold bath with submersion to unconsciousness
is an old remedy now abandoned. Venesection to fainting, with or
without mercury, mitigated the symptoms, but seemed to hasten
paralysis and death. The excision and cauterization of the cicatrix,
or the cutting of the nerves proceeding from it, has been useful in
delaying, or even absolutely preventing, the paroxysms. When,
therefore, the premonitory symptoms of hydrophobia have set in, and
when an aura or shooting pain is felt proceeding from the seat of the
wound toward the heart, one or other of these measures may serve to
prevent the immediate occurrence of reflex convulsions. When the
poison has actually invaded the brain, this can be looked on as a
palliative measure only, but in the many cases of lyssophobia it may
put an instant stop to the affection.
{909}
GLANDERS (EQUINIA GRAVIOR, FARCY).
BY JAMES LAW, F.R.C.V.S.
SYNONYMS.--_Greek_, [Greek: malis]. _Latin_, Malleus, Equinia Nasalis,
E. Apostimatos, Farcinia. _French_, Morve, Farcin. _German_, Rotz,
Lungenrotz, Hautrotz, Wurm, Hautwurm. _Italian_, Morva, Moccis,
Cimurro. _Spanish_, Cimorro, Lamparones.
DEFINITION.--An infectious, bacteridian disease occurring in the
horse, ass, or mule, and communicated by inoculation to various other
animals, including man. It is usually ushered in by rigors, followed
by articular pains, lameness, and the formation of a specific deposit
in the lymphatic system of some part of the body, with a tendency to
destructive degeneration and ulceration. In the form known as glanders
these deposits and ulcers take place mainly in the nasal mucosa, in
the lungs, and in adjacent glands, while in that known as farcy the
deposits occur in the cutaneous and subcutaneous lymphatic plexuses
and the dependent glands.
HISTORY AND GEOGRAPHICAL DISTRIBUTION.--Under the name of malis
Aristotle describes a fatal disease of asses, supposed to have been
identical with the malleus humidus of Vegetius Renatus and other
writers of early Christian times, and with the cymoira of other early
Roman writers. This malady was characterized by swelling of the
submaxillary glands and discharge from nose and mouth. From the
fourteenth century onward glanders is reported from different parts of
Europe at frequent intervals; thus in 1320 in England (Rogers); in
1640 in Badajoz, brought by Portugese horses (Villalba); in 1686 at
Treves (Eggerdes); again in 1776 in Southern France (Lafosse); in 1794
in Bavaria (Plank); in 1796 in Franconia (Laubender); and in 1798 in
Piedmont (Toggia). At the beginning of the present century this
affection was very widely prevalent in Great Britain, the chronic
cases being habitually worked in stage-coaches, but of recent years,
when it has been made criminal to expose or use a glandered horse, the
malady has to a great extent disappeared. To-day glanders is almost
coexistent with the distribution of the domesticated equine family,
yet its prevalence bears a direct relation to the facilities for
infection (horse-traffic, war, preservation of the diseased,
confinement in close stables, ships, etc.), and some countries appear
to be entirely free from the affection. Thus, Krabbe gives the yearly
losses per 100,000 horses for the principal countries of Europe and
Algiers as follows: Norway, 6; Denmark, 8.5; England, 14; Sweden, 57;
Wurtenberg, 77; Prussia, 78; Saxony, 95; Belgium, 138; {910} France
(army), 1130; Algeria (army), 1548. The losses in Prussia more than
doubled after the Franco-German War; thus, in 1869-70 they were 966,
and in 1873-74, 2058. In Bavaria they rose in the same period from 173
to 390 (Hahn). In Lisbon, Portugal, glanders was unknown for the
thirty years preceding the Peninsular War, whereas after the war it
proved a veritable scourge (Saunier). Charles Percivall, during an
eight years' residence at Meerut and Cawnpore, Hindostan, saw not a
single case of glanders, and so late as 1275, Fleming claims an entire
immunity for India; yet in 1877 complaints were numerous of the very
general prevalence of the disease in Upper India especially, while in
1879 the campaign in Afghanistan was seriously affected by its
ravages. Climate appears to have little influence. The disease is
virtually unknown in the island of Bornholm with 7000 horses, and in
the Faroes and Iceland with 35,000, while it is quite frequent in
Sweden. It is unknown in Australia, but is very prevalent in China,
South Africa, Abyssinia, and Algiers, and but little known in Asia
Minor, Arabia, and Egypt.
In the United States as in Europe the disease has mainly concentrated
itself in the large cities in times of peace, and spread widely on the
advent of war. It is alleged that it first entered Mexico in 1847 with
the American cavalry, though with the horses kept in the open air it
failed to gain a wide extension. The horses and mules drawn into the
Union armies in 1861 brought infection with them, and soon the disease
was most prevalent and destructive, not only in the ranks, but in
every State in which the armies operated. John R. Page says the first
case he saw in the Confederate army was a captured Federal troop-horse
on the retreat from Manassas, and that the breaking down of the
Confederate cavalry in the last two years of the war was mainly due to
glanders. At the close of the war the sale of army horses distributed
the infection widely through all the States, North as well as South.
Every year in a country district in Western New York I see several
cases of glanders, and occasionally a whole stud is carried off
through an infected purchase. In other States the case is no better.
In Pennsylvania, Ohio, Illinois, and Michigan cases are constantly
seen in the country districts, and in the three last-named States five
human victims have been reported within a short period. In Connecticut
the same is true, and the disease made one human victim in Waterbury
in 1879. In the large cities the case is still worse. Liautard of New
York in 1878, in a single visit to one car-stable, condemned 8 horses,
in another stable 18, and in a third, at two visits, 45, while a
fourth had lost no fewer than 200 horses in the course of one year
from glanders. In the Troy (N.Y.) car-stables the malady prevailed
from 1875-77, most of the subjects suffering from chronic farcy, until
in the latter year, by my advice, these propagators of contagion were
destroyed. In Springfield, Mass., in 1879, the disease assumed such
alarming proportions that it was vigorously suppressed by a city
ordinance enjoining summary slaughter. These are but indications of
what is happening all over the country, entailing losses of many
hundreds of thousands yearly as well as an enormous risk to humanity.
The following table gives the number of cases occurring in the equine
family in two of the principal countries of Europe in the last few
years: {911}
Cases of Glanders in-- Great Britain. Germany.
1878 888 2753
1879 1367
1880 2048 1941
1881 1710 1774
1882 1389 1838
As both countries systematically suppress this disease through their
veterinary sanitary officials, it cannot be doubted that the figures
for America, if obtainable, would be relatively higher.
Glanders prevails especially in horses, asses, mules, and other
solipedes, and is communicated by inoculation to all domestic animals
except the genus Bovis. In the sheep and goat the receptivity is
considerable, and the disease may prove fatal in fifteen days
(Gerlach) or it may be delayed for seven weeks (Bollinger). The
Carnivora (dogs, cats, lions, polar bears) contract the affection by
eating diseased flesh, as do some rodents (prairie-dogs, rabbits,
guinea-pigs, mice), and, by administration, solipedes. Swine contract
the disease by inoculation (Gerlach, Spinola), though in these and in
the dog the constitutional symptoms are usually slight and recovery
may follow the local affection.
The susceptibility of man is doubtless less than that of the
solipedes, judging from the few cases of glanders compared with the
frequent exposures, yet when once established in the system it can
hardly be said to be less malignant or fatal.
ETIOLOGY.--The one known cause of glanders is contagion, and the
recent experiments of Capitan and Charrin in France and of Schütz and
Löfler in Germany, demonstrating that the bacillus of the glanderous
deposits is the one essential cause of the disease, effectually
dispose of any claim of its spontaneous origin. Glanders can no longer
be considered spontaneous, further than that its germ is now proved
capable, like that of anthrax, of survival and multiplication out of
the animal economy, so that infection may come from other objects than
a sick animal; and it may even yet appear that the bacillus, living at
times as a harmless saprophyte out of the animal body, may acquire
deadly properties under certain conditions of the environment. At the
same time, the most extensive acquaintance with glanders and the
broadest generalizations from known facts do not warrant the
assumption of the extension of the disease by the growth of the
bacillus out of the living body, unless it be on the rarest possible
occasions, while the soundness of extensive countries (Australia, New
Zealand) for a century or more speaks strongly against any frequent
development from a harmless saprophyte.
To the same effect speak the experiences of the English army. At the
beginning of the century, under the teaching of Coleman, most cases
were attributed to lack of stable care, and extensive experiments were
made in the treatment of the disease, with the result of a very high
mortality from this cause. Now, when contagion is looked on as the
main or sole cause, and all suspected horses in the army are promptly
destroyed, the disease is only seen in recently-purchased animals or
after the inevitable exposures of a campaign.[1] In the French army
the doctrine of the {912} non-contagiousness of chronic glanders led
to a greater prevalence of this disease than in any other country of
Europe. Prior to 1836 it was about 90 per 1000 per annum, whereas now,
under the doctrine of contagion and a corresponding practice, glanders
kills but 2 per 1000 per annum (Rossignol).
[Footnote 1: Wilkinson, _Jour. of Roy. Agr. Soc._, No. 50.]
But while the essential cause of glanders is the specific bacillus, an
individual susceptibility is no less requisite to an attack. This may
be innate or acquired. As we have seen, it varies according to the
genus, being greatest in the solipede. But many solipedes show a
strong power of resistance. Of 138 horses similarly exposed by
cohabitation with glandered horses, but 29 (21 per cent.) suffered. Of
28 inoculated with glanders virus, but 9 (32 per cent.) succumbed
(Lamirault, Bagge, Tscherning). The accessory causes which predispose
the system to the reception of glanders may be included under one
general term--low condition and ill health. Three of these causes,
however, deserve especial mention: 1st. Impure and rebreathed air.
Prior to 1836 the yearly losses per 1000 of the French army horses
were from 180 to 197. At the date named the ventilation of the stables
was greatly improved, and the mortality fell to 68 per 1000 per annum,
one-half from glanders. Later improvements have reduced the 34 cases
to 2. During the Italian War, in 1859, 10,000 of these horses were
kept for nine months in open sheds, with but one case of glanders.[2]
In the expedition to Quibéron during the Napoleonic wars, a cavalry
contingent, believed to be healthy, shipped on new transports,
encountered a storm, and had the hatches fastened down, so that
several horses were suffocated. Among the survivors, landed at
Southampton and placed in stables hitherto unchallenged, many soon
developed glanders in its worst form. Similar results followed the
English expeditions to Varna in 1854, and that to Abyssinia in 1867.
In badly-ventilated mines and stables, especially cellar stables,
glanders, once started, is always most virulent.
[Footnote 2: Larrey, _Hyg. des Hop. Mil._, 1862, p. 63.]
2d. Cold, damp, draughty stables greatly favor the progress of
glanders. Leblanc reports the case of a stud of 240 horses that had
had no glanders for eight years, but which lost half their number in
three months after removal into a new stable, very lofty, but dark and
damp, and subject to cold draughts. It is worthy of notice that they
had also been subjected to double work, and were consequently
emaciated, but there was not known to be any unusual exposure to
contagion. In a Boston street-car stable, where glanders had long
prevailed, Thayer cut it short by destroying the infected animals and
by improving the ventilation by windows hung at the bottom and opening
inward, so that the air entered in an upward direction, and cold
draughts on the horses were avoided.