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.
_Prevention._ This is most effectively secured by sanitation of the soil
and buildings. Thorough drainage to secure perfect and constant æration
leads to destruction of the anærobic germ, or the suspension of its
pathogenic quality. Thorough culture contributes largely to this
sanitary æration, while baking of the surface counteracts it. When
thorough drainage is impossible it may be desirable to subject the land
to gardening or to the production of crops that are to be used for human
consumption and not for domestic animals. Kitt’s suggestion, to soil
cattle on hay, produced on such lands, and to exclude from the infected
lands all animals that by wounds or sores near the feet, or by raw gums
from shedding of teeth, furnish infection atria for the poison, is
insufficient, as stalled cattle occasionally suffer.
When an open porous soil maintains the infection by reason of the
presence of an excess of decomposing organic matter, that may be largely
remedied by a free application of quick lime. This hastens the
decomposition of the organic matter and after a year or two, when that
has been largely disposed of, the good effects may be expected.
An important measure is to exclude from fairs, markets, and above all
from clay or other dense wet soils into which they might convey the
germs, all animals brought from infected soils.
Disinfection of the buildings where diseased and infected animals have
been is an essential measure. Wells and streams receiving the drainage
of infected lands must be carefully avoided.
Diseased animals must be carefully isolated, and all their droppings,
and products of every kind disinfected.
The carcasses are best cremated or rendered under superheated steam
under pressure. Solution in sulphuric acid may be employed. If none of
these are available they may be deeply buried in dry porous soil well
apart from any risk of drainage into wells or water supplies. The area
occupied by the graves should be fenced in so that no cattle nor sheep
can gain access to it, and any vegetation grown on the graves should be
burned. The danger of the germs being raised to the surface by soil
water or earth worms must be recognized and any consequent evil guarded
against. The carcass should not be cut open but buried in the hide, or
if the latter is preserved it should be treated with a chloride of lime
solution. If a carcass is opened for scientific purposes, great care
must be taken to avoid the distribution of the bacillus in soil
appropriate to its preservation. The meat should not be preserved for
human consumption unless it has been cooked under pressure at a
temperature of 240° F. The object is not to destroy any poison which
would be fatal to man, but rather to prevent the spread of the spores on
new soil and the extension of the area of infection.
The reduction or prevention of sudden plethora was formerly availed of
to lessen the number of victims and it is well to still bear in mind
that this has an appreciable though limited effect. As a means of
reducing plethora a free bleeding was resorted to when the period of
yearly prevalence approached, and no less when the disease had already
appeared in a herd. I can mention an instance in which infection was
carried on the fleam from the first animal bled (the sick one) and
caused the fatal infected swelling around the phlebotomy wound in the
next seven animals operated on. Another objection to phlebotomy is the
tendency to a rapid reproduction of blood, which the depletion brings
about, and the supervention of a greater danger than before, in the
course of a month or more. Purgatives and diuretics are somewhat less
objectionable in this sense. Careful feeding to keep the animal
constantly in good condition does something to obviate sudden plethora
and its attendant dangers, and thus an allowance of grain or linseed
cake through winter and early spring, or when the pastures are bare,
will bring the animals through in fine condition, and ward off the
danger that comes from a sudden access of rich aliment.
Another measure was the insertion of a seton in the dewlap. The theory
was to counteract plethora but the benefit probably came rather from the
formation of an actively granulating wound, which came in contact with
the ground and received the bacillus, but in which the abundance of air,
and of active leucocytes checked the propagation of the germ and the
occurrence of a fatal infection. A certain grade of immunity was the
natural result in many cases.
_Immunization._ As the first attack of emphysematous anthrax secures for
the subject of it immunity against a second, we are furnished with a
reasonable basis for the practice of artificial immunization. This has
been attained by a variety of methods, the essential feature of each
being the subjecting of the system of the animal to be treated, to the
action of the toxins of the specific bacillus.
1st. A culture of the bacillus made in the thermostat at 42 C. (107.6°
F.) so as to prevent the formation of spores is then sterilized by
heating to 100° C. for one hour and then injected subcutem in a dose of
2 drams, to be repeated on the second day. This, like all the other
methods named should be done by some one accustomed to bacteriological
manipulation and the sterilization completed by superheating the neck of
the vessel containing the mixture. Any germs escaping on the hands,
instruments or other objects used will prove fatal in spite of all the
appearance of precautions.
2d. Roux sterilized his cultures by filtering them through a porcelain
(Pasteur) filter and using only the filtrate for injection. This
requires even greater precaution in manipulation as what is left in the
filter is most virulent, and must be thoroughly sterilized to obviate
dangers from its dissemination.
3d. Intravenous injection of a small quantity of virus, containing but a
few bacilli produces no local swelling, but only a slight temporary
hyperthermia and permanent immunity. The greatest care is necessary in
the manipulation, to prevent any contact of the bacillus with the
subcutaneous tissues or the walls of the vein. The virulent exudate
swarming with bacilli is taken and a drop or two added to a normal salt
solution, which is diluted and shaken in a stoppered bottle, until each
drop contains but one, or at most two bacilli. Then the hands having
been thoroughly washed with soap and warm water and rinsed in a 5 per
cent. solution of carbolic acid, and the instruments having been boiled,
the vein is raised as for bleeding, and penetrated by a short cannula
and trochar, which after boiling has been dipped in the carbolic acid
solution, the trochar is withdrawn, and the nozzle of the syringe
containing the virulent solution is inserted through the cannula, so
that its point is free in the centre of the blood stream, into which a
few drops of the virulent solution are discharged. The nozzle is left in
place for a few seconds to ensure the washing of any infecting matter
from its point, when it is withdrawn, followed immediately after by the
cannula. Great care should be taken to avoid any scratching of the inner
coat of the vein with the cannula, trochar or nozzle.
4th. Another method of immunizing is by the injection of the virulent
liquid into the trachea and bronchia. This appears to bring it so
directly in contact with the blood, that the microbes are destroyed as
rapidly as if it were introduced into the blood stream direct. The
injection is made between two tracheal rings, the manipulation being
essentially the same as in the cases of the vein, the tissues being
first perforated by a sterilized cannula and trochar, and the sterilized
nozzle subsequently inserted through the cannula.
5th. Inoculation into the tip of the tail can be successfully employed,
the coldness of the region and the scantiness of the connective tissue
preventing any dangerous increase of the bacilli in the cooler season.
In the heat of summer, however, this is to be avoided as dangerous. The
tail is first washed with soap and water followed by a 3 per cent.
solution of phenol. It is then punctured with a fine trochar or needle,
(sterilized), within two inches of the tip and in a downward direction
and the instrument is moved slightly from side to side so as to form a
small sac, and is then withdrawn. The sterilized nozzle of the
hypodermic syringe is now inserted in the opening and a few drops of the
virus injected into the sac. When the nozzle has been withdrawn the
thumb may be placed on the external orifice and the end of the tail
manipulated to diffuse the virus in the connective tissue. This is
usually followed by an insignificant swelling, and a slight rise of
temperature. Should the swelling exceed the size of a duck’s egg or if
others appear higher up on the tail, they may be freely scarified and
covered with a carbolic acid bandage. Or the tail may be amputated above
the highest swelling and the stump treated with antiseptics.
6th. The virus prepared by the Pasteur institutes, that of Arloing,
Cornevin and Thomas, is the most extensively employed. Forty grammes of
the diseased muscle are dried rapidly at 32° C (90° F.) and triturated
in 80 grammes of water. This is divided in 12 equal parts and put on
plates in two thermostats, six at 100° C. (212° F.) and six at 85° C.
(185° F.) where they are kept for six hours, when it forms a dry,
brownish powder. One tenth of a gramme (1½ gr.) of this powder is
dissolved in five grammes of distilled or boiled water and will furnish
ten doses. The animal to be protected is first injected in the tip of
the tail or elsewhere with the virus prepared at 100° C., and ten days
later with that prepared at 85° C.
By the use of this method in hundreds of thousands of animals on
infected lands the mortality has been reduced to less than one tenth of
its former amount. It is attended by the one danger which is not always
duly appreciated, that unless its use is restricted to herds on ground
that is already infected, it endangers the infection of new districts.
The spores are not absolutely sterilized at 85° C. Arloing and Cornevin
and later, Nocard and Roux have shown that the addition of lactic acid
to the liquid which has been weakened for inoculation, restores it to
its former virulence, making it a most deadly agent. Galtier says that
the virus weakened by heating to 100° C. for seven hours until it will
no longer kill a mature Guinea pig, will still kill a new born Guinea
pig and acquire all its original virulence in the act. Also that the
injection of large enough doses will not only kill the full grown Guinea
pig, but at the same time restore the microbes to their former
virulence. While recognizing the great economy of the judicious use of
such weakened virus, we cannot but condemn the reckless sale by the
Pasteur institutes of their products, to be used on animals on all kinds
of lands, the uninfected as well as the infected. A great and valuable
prophylactic measure should not be used in such a way as to increase the
area of prevalence of the disease which is to be prevented, and also the
yearly demands for more of the preventive agent. This may appeal to the
business instinct, but this should ever be held subordinate to sanitary
considerations. The danger might be avoided by making the state the sole
distributor of such prophylactic agents, but in any case their use
should be forbidden, and as far as possible prevented, upon dense and
wet soils that are not yet contaminated by the bacillus.
7th. Kitt secured immunization by inoculating once only, with dried
virus which had been subjected for six hours to steam at 100° C.
8th. In different outbreaks, I have taken the blood from the sick
animal, or one that has just died, and heated it for over one hour in a
water bath, at 100° C., then broken up the coagulated mass in well
boiled water, filtered the liquid and used the filtrate for inoculation
in doses of 2 drams, repeated the second day. Great care is taken in
keeping the whole mass at 100° C. for the requisite length of time; then
in heating the upper part of the vessel, which was above the contents
and the water so as to char anything adhering to it; to see that hands,
instruments, and all articles used have been thoroughly sterilized; and
to dip the hypodermic nozzle in carbolic acid before each injection.
It is not claimed that this method is perfect, since severe, advanced
cases may have bacilli and even spores in the blood, and the latter
would not be sterilized but only weakened. It has, however, several
manifest advantages that may be held to more than counterbalance this
danger.
_a._ It almost infallibly secures the toxins of the disease prevailing
in the particular herd, thus escaping the danger of using the weakened
virus of emphysematous anthrax on some other disease (anthrax,
Wildeseuche, Barbone, etc.), which has been mistaken for it, and which
may not be prevented by this purchased product.
_b._ During life the blood of emphysematous anthrax is usually free from
the microbe, and even where that is present it is liable to be in very
small numbers, so that we secure either the pure toxins, or if a few
germs are present they are so scanty, that weakened as they are by heat,
they are without danger to the animal operated on. I have never had
occasion to note evil results.
_c._ There is no danger of the spread of the bacillus to new territory,
as we secure the material from a herd in the already infected territory,
and use it only on the animals on the same land.
The certainty of results with this method, and the comparative absence
of danger of injury to the animal operated on, and of all risk of the
extension of the area of infection appeal to me so strongly, that I
would not willingly resort to the purchased products, except where it
proves impossible to secure the virus on the spot.