I have seen nothing to lead me to believe that the tuberculin test had any injurious influence on the course of the disease. It is by no means our opinion that the disease has been stimulated or aggravated by the application of the tuberculin test. All animals that we have tested two or three times continue as hale and hearty as they were previously, and not one animal in our herds has broken down or failed in any way since we began testing.
I have seen nothing to lead me to believe that the tuberculin test had any injurious influence on the course of the disease. It is by no means our opinion that the disease has been stimulated or aggravated by the application of the tuberculin test. All animals that we have tested two or three times continue as hale and hearty as they were previously, and not one animal in our herds has broken down or failed in any way since we began testing.
Mr. Edwards, in December, 1901, verbally stated that his views as to the harmlessness of tuberculin remained unchanged, and that he had not seen the least ill effect in any of his cattle from its use.
Those who have had most experience with tuberculin have failed to observe any injurious effects following its use upon healthy cattle. With tuberculous cattle it produces a fever of short duration, and in the great majority of cases all derangement of the system which it causes disappears within 48 hours after the tuberculin is administered. There appear to have been a very few cases in which the disease was aggravated, and a greater number in which it was benefited by the injection of tuberculin. The cases of abortion following the tuberculin test have not been numerous, even when cows were tested within a few weeks of the normal time of calving. The few cases of this kind which have occurred may be explained by the fact that abortion in cattle is a very common occurrence, and that it would inevitably happen sometimes after the tuberculin test as a mere coincidence and without any relation between the test and the loss of the calf. The cases of abortion which have been cited appear to be no more numerous than might be expected to have occurred among the same number of cattle within the same period if the test had not been applied.
At the present time there is ample evidence to show that tuberculin is the most reliable means of detecting tuberculosis in the living animal and that its use is not attended by any harmful aftereffects.
An act of Congress was approved July 24, 1919, for the purpose of controlling and eradicating tuberculosis of animals. The official means of detecting tuberculosis in the living animal is the tuberculin test, which may be applied by three different methods—the subcutaneous, the intradermic, and the ophthalmic. It is not necessary to discuss here the details of these three methods, which are made use of in the work of eradication of tuberculosis.
The plan adopted by the State and Federal authorities in eradication of the disease is known as "The Accredited-Herd Plan." Under this plan herds are tested under State and Federal supervision, the diseased animals are appraised, removed, and slaughtered under Federal inspection. Retests are then made after definite periods of time until two successive tests show all the animals to be free from the disease. At this time the herd owner is given a certificate of an accredited herd.
Details concerning the accredited-herd plan may be obtained by applying to the Chief of the Bureau of Animal Industry, Washington, D. C.
Testing animals with tuberculin is the process of introducing tuberculin into the animal and interpreting results according to well-known standards.
From the investigations and observations that have been mentioned, it may be safely concluded—
1. That the tuberculin test is a wonderfully accurate method of determining whether an animal is affected with tuberculosis.
2. That by its use the animals diseased with tuberculosis may be detected and removed from the herd, thereby eradicating the disease.
3. That it has no injurious effect upon healthy cattle.
4. That the comparatively small number of cattle which have aborted, suffered in health, or fallen off in condition after the test were either diseased before it was made or were affected by some cause other than the tuberculin.
The most frequently used method of testing is the subcutaneous test, which consists in injecting the proper quantity of tuberculin underneath the skin into the subcutaneous tissue. If an animal is tuberculous, the action of the tuberculin causes a fever, which is indicated by a rise in temperature. This rise, under ordinary conditions, may occur any time between the eighth and twentieth hours after the tuberculin is injected, but in some cases it is desirable to measure the temperature before the eighth hour and continue to the twenty-fourth hour or longer.
The temperatures are measured at least 3 times in advance of the injection, at 2-hour intervals, to learn whether the animal is in proper condition to receive the test. The temperatures after injection are taken every 2 hours until the test is completed. The proper interpretation of the temperatures is made by the person applying the test, and a careful observance of any clinical changes is always important in determining the result. It can not be set forth too strongly that the test, including the two following methods, should be attempted only by those who are properly qualified to do the work.
The intradermic test for detecting tuberculosis is used to a considerable extent, especially in area work and on range cattle not easily controlled. When made by those who have become skilled in its application, it is very accurate. In this test the tuberculin is injected between the layers of the skin, only a few drops being used, and it is usually applied in the region at the base of the tail, where the skin is soft and nearly hairless. The intradermic test is satisfactory also for the diagnosis of tuberculosis in swine and, when so used, the tuberculin is applied into the skin of the ear near its base.
The reaction from the intradermic test consists of a swelling at the point of injection and is observed from 72 to 150 hours after the injection. The character of the swelling varies, and a proper diagnosis of tuberculosis by this test can be made only by an experienced person.
Still another method, known as the ophthalmic test, is used quite frequently and has been found to be of considerable value in what is known as "check" testing; that is, it is used in connection with either of the previously described methods. Sometimes a tuberculous animal that fails to react to those tests shows evidence of the disease upon the application of the ophthalmic test. The ophthalmic tuberculin is placed in one eye and the other eye is used as a check. A reaction is indicated by a characteristic discharge from the eye receiving the treatment, which may occur in from 3 to 10 hours after the application or even later. Some swelling and inflammation of the eye and lids are often noted.
Treatment of the disease is not seriously considered by any authorities at the present time.
The measures to be adopted to prevent the spreading of the disease must take into consideration not only the tubercle bacillus, but likewise all those circumstances that make cattle more susceptible to the disease, and which have already been dwelt upon. It would be useless to repeat here all that has been said above on the transmission of tubercle bacilli from one animal to another, and on the dangers of certain debilitating influences. A careful study of these influences will show how tuberculosis may, at least in some cases, be prevented. Great care should be bestowed upon the breeding, the surroundings, and the feed of the animal, so that the latter may be put into a condition to resist infection even when exposed to it. A tuberculin test should be applied to all strange cattle before they are introduced into the herd, and those which show a reaction should be refused.
A rigid exclusion of tuberculous animals is all that is necessary to prevent the appearance of the disease, provided cattle are not infected by consumptive persons and animals. The transmission of the disease from man to cattle is probably not frequent, but is regarded as a possible source of infection.
Tuberculosis in cattle must also be considered as bearing upon tuberculosis of other domesticated animals, particularly hogs. In Europe and the United States this disease is not uncommon among hogs, and appears to be on the increase. The reason for its existence may be looked for in the feeding of pigs with skim milk, buttermilk, and whey from creameries, with the offal of the abattoirs, with the household refuse generally, and behind tuberculous cattle. If tuberculosis is common among cattle, it is likely to be transmitted to hogs kept in this way.
The carcasses of animals which have died of tuberculosis should be buried deeply so that they can not be eaten by other animals. This is likewise true of all organs or tissues of slaughtered animals containing tubercles. These should never be fed to other animals, such as hogs, dogs, and cats, and should either be destroyed by fire or deeply buried.
When any of the animals in a herd of cattle show evident symptoms of tuberculosis, or when the tuberculin test proves that they are affected with this disease, the best method of procedure in most cases is to have the affected animals slaughtered and the stables disinfected. A large proportion of the animals which are slightly affected yield carcasses which are perfectly wholesome and fit for human food, but in all such cases there should be an inspection by an expert at the time of slaughter to determine which carcasses may be used and which should be destroyed.
The disinfection of stables may be accomplished by thoroughly cleaning them, scrubbing the floors with hot water, brushing down all loose dust from the walls, and tearing off all woodwork which is partly decayed. Then the whole interior of the stable should be covered with a good coat of limewash containing 1 part of formalin (which is a 40 per cent watery solution of formaldehyde) to 30 parts of the lime wash, or 4 ounces of formalin to each gallon of lime wash.
Similar precautions should be observed in removing the manure of the infected herd from the barnyard and other places accessible to cattle, since it is known that tuberculous cattle frequently eliminate large numbers of tubercle bacilli through the feces. The ground under the manure pile should then be disinfected, either by the above-mentioned formalin solution or by unslaked lime thickly sprinkled over the soil.
If all the animals which react are destroyed and the stables disinfected in this manner, the herd should remain free from the disease unless other affected animals are added to it. The introduction of the disease in this manner may be avoided by requiring a tuberculin test of all new animals admitted on the premises.
Unfortunately it is a fact that tuberculous animals which have been tested several times may become so accustomed to tuberculin that they will no longer react; consequently it is always advisable to purchase cattle from some one who is known to be reliable, as otherwise animals of this kind may be treated with tuberculin for the purpose of hiding the disease.
In the case of very valuable purebred animals and under exceptional circumstances it may be more advantageous to retain the reacting animals which are in good condition in order to breed from them and in that manner avoid the excessive loss which would follow from their immediate slaughter. This may be done if proper precautions are adopted.
The disposal of reactors depends upon the State laws and live-stock regulations of the State in which the herd belongs. If this policy is followed it should be attempted only after careful study of the plan known as the Bang method of controlling tuberculosis. The live-stock officials of the State should be frequently consulted and their advice followed; otherwise failure will surely ensue. The plan necessitates considerable trouble and is not recommended except under the circumstances mentioned.
The increasing amount of evidence pointing to the identity of human and animal tuberculosis, combined with the extraordinary mortality of human beings from this disease, often amounting to 10 to 14 per cent, has raised the question in all civilized countries as to how far animal, and especially bovine, tuberculosis is to blame for this high mortality. The medical and veterinary professions have approached this problem with equal zeal, and much has come to light within recent years which enables us to come to some conclusion. If this disease is transmitted from animals to man, how does the transmission take place? As comparatively few people come in direct contact with tuberculous cattle, it must be either through the meat, the milk, the butter, the cheese, or through all these products that the virus enters the human body. The question has thus narrowed itself down to the food products furnished by cattle.
It has become a very urgent question, especially in the poorer countries of Europe, whether all flesh from tuberculous animals is unfit for human food. It is argued there that if it can be shown that in the majority of cases of tuberculosis the bones and the muscular system are free from infection, there is no reason why the meat should not be put on sale under certain restrictions. The question may be resolved into two divisions: (1) How frequently does the disease invade those parts of the body which are used as food? (2) When the disease process is manifestly restricted to the internal organs, do tubercle bacilli circulate in the blood and lymph and can they be detected in the muscular tissue?
(1) Disease of the bones is not unknown, although very rare. According to Walley, it appears chiefly in the spongy bones of the head and backbone and in the long bones of the limbs. Occasionally the ends of the bones, where they are covered by the synovial membrane of the joints, are dotted with tubercles. The muscular system itself is very rarely the seat of tuberculous deposits, although the lymphatic glands lying near and among the muscles may be not infrequently diseased.
(2) Whether tubercle bacilli are found in muscle juice independent of any tuberculous deposits is a question which must be approached experimentally. There is on record a great variety of opinions on this matter, some authorities considering all flesh from tuberculous animals unfit for food, while others hold a contrary view. Experiments have shown that in rare cases the flesh of tuberculous cattle contains a small number of tubercle bacilli. In Germany the flesh of animals in which the disease is just beginning, or in which it is restricted to one or more related organs, is not rejected. When, however, the disease has affected the muscles or bones, or lymphatic glands situated on or between them, the flesh is condemned as unfit and dangerous. Animals are also rejected in which it is evident, from the general distribution of tubercles throughout the various organs, that the bacilli have been distributed by the blood and may have been carried into the muscular system (generalized tuberculosis).
Concerning the infectious nature of milk secreted by tuberculous cows, authorities have universally agreed that when the udder itself is in the slightest degree involved the milk possesses infectious properties, and is therefore dangerous. Tubercle bacilli in large numbers have been found in the milk and the udder under such circumstances. Unlike other affections of the udder, tuberculosis of this organ does not at once change the appearance and the quality of the milk secreted. Bang states that for at least a month after the disease has appeared the milk is normal in appearance and may be consumed and sold without arousing the suspicion of the owner. Considerable danger is, therefore, involved in this disease, and the necessity for the careful inspection of dairy cows seems more urgent than ever.
Authorities are, however, not fully agreed as to whether the milk from tuberculous cows in which the udder is apparently not invaded by the disease should be considered dangerous or not. Some incline to the belief that the milk secreted by healthy udders is never infectious, even when the lungs or other organs are affected; that, in other words, the tubercle bacilli are rarely, if ever, separated from the lesions which they produce, and that the udder itself must be diseased before tubercle bacilli can appear in the milk. Experiments madewith the milk of tuberculous cows in which there were no indications of udder disease do not bear out this theory, since tubercle bacilli have been found in their milk. Some authorities still believe that the udder is diseased when the milk is infected, but that the disease escapes observation. However this may be, the fact that the udder may be diseased and the disease not recognizable simply casts suspicion upon all milk from tuberculous animals. We know that the milk of tuberculous cattle may or may not contain tubercle bacilli when the udder is apparently free from disease, but we have no rapid method of determining whether in any given case the milk contains tubercle bacilli or not. Moreover, the bacilli may be absent at one time and present at another in milk from the same cow. When we consider, therefore, the extent of tuberculosis and the hidden character of the disease, a certain degree of suspicion rests upon all milk from untested cattle. Fortunately, tubercle bacilli are readily destroyed by the temperature of boiling water, and hence both meat and milk are made safe, the former by the various processes of cooking, the latter by boiling for a few moments. It is incumbent upon all communities to have dairy cows examined and tested with tuberculin. If disease is detected, the affected animal should be killed at once or else all opportunity for the sale of such milk removed by appropriate measures. Where milk or cream is sold to the trade in large towns or cities pasteurization should be required as an additional safeguard.
Recently there has been much discussion of the question as to whether human and animal tuberculosis are identical diseases and as to the possibility of the tuberculosis of animals being transmitted to man or that of man being transmitted to animals.
The fact that tuberculous material from human subjects often failed to produce serious disease in cattle was observed by a number of the earlier investigators who experimented with such virus. It was the experiments and comparative studies of Theobald Smith, however, which attracted special attention to the difference in virulence shown by tubercle bacilli from human and bovine sources when inoculated upon cattle. Smith mentioned also certain morphological and cultural differences in bacilli from these two sources, and in the location and histology of the lesions in cattle produced by such bacilli. He did not conclude, however, that bovine bacilli could not produce disease in the human subject, but said:
It seems to me that, accepting the clinical evidence on hand, bovine tuberculosis may be transmitted to children when the body is overpowered by large numbers of bacilli, as in udder tuberculosis, or when certain unknown favorable conditions exist.
It seems to me that, accepting the clinical evidence on hand, bovine tuberculosis may be transmitted to children when the body is overpowered by large numbers of bacilli, as in udder tuberculosis, or when certain unknown favorable conditions exist.
Koch, however, in his address at the British Congress on Tuberculosis, went far beyond this and maintained that "human tuberculosis differs from bovine and can not be transmitted to cattle." As to the susceptibility of man to bovine tuberculosis, he said it was not yet absolutely decided, but one was "nevertheless already at liberty to say that, if such a susceptibility really exists, the infection of human beings is but a very rare occurrence." He emphasizes this view in the following language:
I should estimate the extent of infection by the milk and flesh of tubercular cattle and the butter made of their milk as hardly greater than that of hereditary transmission, and I therefore do not deem it advisable to take any measures against it.
I should estimate the extent of infection by the milk and flesh of tubercular cattle and the butter made of their milk as hardly greater than that of hereditary transmission, and I therefore do not deem it advisable to take any measures against it.
This conclusion was so radically different from the views of most experimenters and so out of harmony with facts which had apparently been demonstrated by others that it at once aroused opposition in the congress, followed by the adoption of dissenting resolutions, and led to numerous investigations in various countries. Koch's conclusions were based upon his failure to produce tuberculosis in cattle and other animals by inoculating them with tuberculous material of human origin and his success in causing progressive and fatal tuberculosis in the same kinds of animals when inoculated with tuberculous material of bovine origin. With such positiveness did he hold to the constant and specific difference between the human and bovine bacillus that he promulgated an experimental method of discriminating between them. Speaking of the etiology of intestinal tuberculosis in man, he said:
Hitherto nobody could decide with certainty in such a case whether the tuberculosis of the intestine was of human or of animal origin. Now we can diagnose them. All that is necessary is to cultivate in pure culture the tubercle bacilli found in the tubercular material, and to ascertain whether they belong to bovine tuberculosis by inoculating cattle with them. For this purpose I recommend subcutaneous injection, which yields quite specially characteristic and convincing results.
Hitherto nobody could decide with certainty in such a case whether the tuberculosis of the intestine was of human or of animal origin. Now we can diagnose them. All that is necessary is to cultivate in pure culture the tubercle bacilli found in the tubercular material, and to ascertain whether they belong to bovine tuberculosis by inoculating cattle with them. For this purpose I recommend subcutaneous injection, which yields quite specially characteristic and convincing results.
These important and comprehensive conclusions followed from a comparatively few experiments upon animals, and apparently no effort had been made to learn to what extent human tubercle bacilli may differ in their virulence for cattle or what grades of virulence there might be among bacilli of bovine origin. Vagedes had already shown that bacilli were sometimes present in human lesions which were as virulent as bovine bacilli, but his work was wholly ignored by Koch.
A considerable number of investigators, including Chauveau, Vagedes, Ravenel, De Schweinitz, Mohler, De Jong, Delépine, Orth, Stenström, Fibiger and Jensen, Max Wolff, Nocard, Arloing, Behring, Dean and Todd, Hamilton and Young, the German Tuberculosis Commission, and Theobald Smith, have found tubercle bacilli in the bodies of human beings who died of tuberculosis which proved tohave about the same virulence for cattle as had the bacilli from bovine animals affected by the disease.
Kossel, in a preliminary report, stated that the German commission had tested 7 cultures of tuberculosis from cattle and hogs—4 from cattle and 3 from hogs. Two proved acutely fatal in cattle after eight to nine weeks; 4 likewise produced a generalized tuberculosis, but which certainly had a more chronic course, while 1 of the cultures caused only an infiltration at the point of inoculation, with some caseous foci in the adjoining prescapular gland and in one of the mediastinal glands, and there was lacking the spreading of the tuberculosis over the entire body which they were accustomed to see after the injection of cultures of bovine tuberculosis. "Hence," says Kossel, "among bovine tuberculosis bacilli there can also occur differences with regard to the virulence."
The German commission also tested 39 different freshly made cultures from tuberculous disease in man. Nineteen did not produce the slightest symptoms in cattle; with 9 others the cattle exhibited after four months very minute foci in the prescapular glands, which were mostly encapsuled and showed no inclination to progress; with 7 other cases there was somewhat more marked disease of the prescapular glands, but it did not go so far as a material spreading of the process to the adjoining glands. There were 4 cultures, however, which were more virulent and caused generalized tuberculosis in the cattle inoculated with them.
It would appear, therefore, that hereafter everyone must admit that it is impossible always to tell the source of a culture of the tubercle bacillus by its effect when it is inoculated upon cattle. One of the bovine cultures failed to produce generalized tuberculosis in cattle, and some of the human cultures did produce it in such animals. Moreover, while some of the human cultures caused no disease at all, others led to the development of minute foci in the prescapular glands, and still others to somewhat more marked disease of the glands. There were, consequently, four degrees of virulence noted in these 39 cultures of bacilli from human sources and three degrees of virulence in the 7 cultures from animal.
Now, if we accept the views of Koch as to the specific difference between human and bovine tubercle bacilli, and that the human bacilli produce only localized lesions in cattle, while bovine bacilli produce generalized lesions in them, must we not conclude that the one non-virulent bovine culture was in reality of human origin, and that the animal from which it was obtained had been infected from man? This is a logical deduction, but reverses the dictum laid down at London that human tuberculosis is not transmissible to cattle. Again, how are we to explain the human cultures of medium virulence? Are they human bacilli which, for some unknown reason, areincreasing in virulence and approaching the activity of the bovine bacillus, or are they really bovine bacilli which have multiplied in the human body until their virulence has become attenuated? In whatever manner these questions are decided it would seem that the findings of the German commission, instead of supporting Koch's views that we can decide with certainty by the inoculation of cattle as to the source of any given bacillus, really show that this method of diagnosis is extremely uncertain in the present condition of our knowledge.
It is definitely admitted that 4 of the human cultures caused generalized tuberculosis in cattle; Kossel suggest, however, that it may be possible that the bacilli in cases of human tuberculosis under certain circumstances can likewise attain a very high pathogenic activity for cattle without being for that reason bovine bacilli. Undoubtedly the German commission is confronting the two horns of a dilemma, either one of which is fatal to the views of Koch as stated with such positiveness at London. If we accept this suggestion thrown out by Kossel, we must conclude that Koch was wrong in his claim that human tuberculosis can not be transmitted to cattle, and thus with one blow we destroy the entire experimental support which he had for his argument before the British Congress on Tuberculosis. If, on the other hand, we accept the conclusion which follows from the principle laid down by Koch for the discrimination between human and bovine bacilli, and which appears to be favored by Kossel, we must admit that bovine tuberculosis is an extremely important factor in the etiology of human tuberculosis. Of the 39 cases of human tuberculosis tested, 4, or more than 10 per cent, were virulent for cattle and would be classified as of bovine origin; however, these 4 cases, were all found among the 16 cases of tuberculosis in children which the commission investigated; hence it is plain that 25 per cent of the cases tested of tuberculosis in children would by Koch's method be classified as of bovine origin.
In the Bureau of Animal Industry two distinct lines of experiments have been carried on, in order that one might serve as a check against the other. There has been, however, no discrepancy in the results. De Schweinitz, in the Biochemic Division, Bureau of Animal Industry, isolated 9 cultures from human tuberculosis. Two were derived from human sputum, 3 from cases of generalized tuberculosis in adults, and 4 from cases of generalized tuberculosis in children. By comparing these cultures with a newly isolated virulent culture of bovine tuberculosis, there were found among them 2 cultures from children which were identical in their cultural and morphological characters with the bovine bacillus. These cultures also killed rabbits and guinea pigs in as short a time as did the bovine bacillus. Hogs which were inoculated subcutaneously with these 2 cultures from children died of generalized tuberculosis. Two calves weighing more than 300 pounds each were inoculated subcutaneously with these virulent human cultures, and as a result developed generalized tuberculosis. A yearling heifer inoculated with 1 of the cultures showed generalized tuberculosis when killed three months after inoculation. Both the cattle and the hogs had been tested with tuberculin and found to be free from tuberculosis before the inoculations were made. It is important to observe in this connection that 2 out of 4, or 50 per cent, of the cultures obtained from cases of generalized tuberculosis in children proved virulent for cattle.
Mohler, working in the Pathological Division, Bureau of Animal Industry, obtained 3 very virulent cultures of tubercle bacilli from the human subject. A goat inoculated subcutaneously with 1 of these cultures died in 37 days with miliary tuberculosis of the lungs involving the axillary and prescapular glands. This bacillus was obtained from the mesenteric gland of a boy. Of still greater interest is a bacillus isolated by Mohler from human sputum. A goat inoculated subcutaneously with a culture of this germ died in 95 days of pulmonary tuberculosis. A cat inoculated in the same manner died in 23 days of generalized tuberculosis. A rabbit similarly inoculated died in 59 days of pulmonary tuberculosis. Another rabbit inoculated with a bovine culture for comparison lived 10 days longer than the one inoculated with this sputum germ. Mohler also inoculated subcutaneously a 1-year-old heifer with a culture derived from the tuberculosis mesenteric gland of a boy 4 years of age. This culture was always refractory in its growth under artificial conditions, and the bacilli were short, stubby rods, corresponding in appearance to the bovine type. At the autopsy, held 127 days after the inoculation, the general condition was seen to be poor and unthrifty, and large, hard tumors were found at the points of inoculation. On the right side the swelling measured 3½ by 5 inches, and the corresponding lymph gland was 2¾ inches long by 1¾ inches in diameter. This gland contained numerous calcareous foci; one at the apex was an inch in diameter. The lesions on the left shoulder of the animal were very similar to those found on the right side, but the dimensions of the tumor were slightly less. The lungs presented an irregular mass of tuberculous nodules, and 7 or 8 grapelike nodules were seen on the parietal pleura. Bronchial and mediastinal lymph glands contained numerous tuberculous foci, and the pericardium, peritoneum, spleen, and liver also were affected.
In order to throw some light, if possible, upon the morphological constancy of the different types of tubercle bacilli, Mohler made comparative studies of bacilli from various sources, and which had been passed through various species of animals, by making the cultures upon dog serum after the method described by Theobald Smith. Some important results have been obtained. One culture of human bacilli which had morphological and cultural peculiarities similar to those of the bovine bacillus, and which produced only local lesions in cattle, was passed through a series of five cats. It was then found to be completely changed in its morphological characters, the rods being elongated, slender, more or less beaded, and entirely of the human type. Far from decreasing in virulence, however, as might be expected from its morphological appearance, this bacillus had so increased in its pathogenic activity that it produced generalized tuberculosis in a cow. This cow was inoculated subcutaneously in front of each shoulder with 2 cubic centimeters of a salt-solution emulsion of the tuberculous omentum of the last cat of the series. The cow rapidly lost flesh, had a temperature of 104° F., with the point of inoculation and adjacent glands greatly swollen. The autopsy revealed generalized tuberculosis, involving the lungs, mediastinal glands, spleen, liver, and kidneys. Tubercle bacilli of the bovine type obtained from the mesenteric glands of a sheep, hog, and cow were similarly transformed in their morphological appearance after being passed through a series of cats and recovered on dog serum. These bacilli also increased in virulence, as the last cat in the series invariably succumbed in a shorter time than the first of the series.
These experiments and observations indicate that the types of tubercle bacilli are very inconstant, and that under suitable conditions they readily change both in morphology and in virulence. A similar conclusion was reached by other investigators in working with the avian and porcine types of tubercle bacilli several years ago, and was reasonably to have been expected with the human and bovine types.
Later investigations made by Park and Krumweide, of the Research Laboratory of New York City, Novick, Richard M. Smith, Ravenel, Rosenau, Chung Yik Wang, and others tend to show the incidence of bovine infection in the human family. Chung Yik Wang stated in 1917 that studies of 281 cases of various clinical forms of tuberculosis in Edinburgh, Scotland, resulted in the isolation of the bovine tubercle bacilli in 78.4 per cent of cases under the age of 5 years, in 70.3 per cent between the ages of 5 and 16, and in 7.8 per cent over the age of 16. This investigator states that from the prophylactic point of view any measure resorted to in combating the disease should be directed not only against the human spread of infection, but also, more particularly in children's cases, against the bovine source of infection.
Ravenel, in summarizing the work of Drs. Park and Krumweide, as well as others throughout the world, gives the following results:
Of 63 children dying of tuberculosis at the babies' hospital 59 cases proved to be human infection and 4 bovine, a percentage of 6-1/3.Of 9 children dying of tuberculosis at the foundling hospital 4 proved to have derived their infection from human sources and 5 from bovine, a percentage of 55.Of a total of 88 children under 5 years of age who died of tuberculosis 77 proved to have derived their infection from human sources and 11 from bovine, a percentage of 12½.
Of 63 children dying of tuberculosis at the babies' hospital 59 cases proved to be human infection and 4 bovine, a percentage of 6-1/3.
Of 9 children dying of tuberculosis at the foundling hospital 4 proved to have derived their infection from human sources and 5 from bovine, a percentage of 55.
Of a total of 88 children under 5 years of age who died of tuberculosis 77 proved to have derived their infection from human sources and 11 from bovine, a percentage of 12½.
Combining the cases studied in New York with those of other observers in different parts of this country and Europe, the following results are obtained:
Adults, 787 cases—777 human and 10 bovine infection.Children, 5 to 16 years, 153 cases—117 human and 36 bovine infection.Children under 5 years, 280 cases—215 human and 65 bovine infection.
Adults, 787 cases—777 human and 10 bovine infection.
Children, 5 to 16 years, 153 cases—117 human and 36 bovine infection.
Children under 5 years, 280 cases—215 human and 65 bovine infection.
The figures of the foundling hospital show the real danger of unprotected cows' milk.
The conclusion from these studies is inevitable, namely, that in children, in addition to the large number of deaths which occur from bovine infection, there are many cases of infection resulting in deformities, necessitating operations more or less severe in character and which frequently leave the patient disfigured permanently.
It must be plain to all, from these recent developments, that too much has been made of the slight differences in cultural characteristics, in morphology, and in virulence which have been observed in some cases in comparing the human and the bovine bacilli. The observations were interesting, and it was important that they be followed up until their significance was made entirely clear, but it was an almost unpardonable error, from a sanitary point of view, to promulgate sweeping generalizations calculated to arrest and abolish important measures for preventing human tuberculosis before the soundness of these generalizations had been established by a thorough course of experimentation.
When Koch said in the British Congress on Tuberculosis that he should estimate the extent of infection by the milk and flesh of tuberculous cattle and the butter made of their milk as hardly greater than that of hereditary transmission, and that he therefore did not deem it advisable to take any measures against it, he went far beyond what was justified by any experiments or observations which he reported, and he did a great deal of harm, which will be manifested for years to come, to those who endeavor to guard the human race from thedangers of animal tuberculosis. The researches which have been alluded to make these dangers more definite and certain than they have appeared before, and sanitarians should therefore most earnestly endeavor to counteract the erroneous and harmful impression which was made by Koch's address at London and his subsequent address at the International Conference on Tuberculosis at Berlin.
Variola of cattle, more correctly vaccinia, is a contagious disease of cattle which manifests its presence through an elevation of temperature, a shrinkage in milk production, and by the appearance of characteristic, pustular eruptions, especially upon the teats and udders of dairy cows. Although this is a contagious disease, strictly speaking, it is so universally harmless and benign in its course that it is robbed of the terrors which usually accompany all spreading diseases, and is allowed to enter a herd of cattle, run its course, and disappear without exciting any particular notice.
The contagion of cowpox does not travel through the air from animal to animal, but is transfused only by actual contact of the contagious principle with the skin of some susceptible animal. It may be carried in this manner, not alone from cattle to cattle, but horses, sheep, goats, and man may readily contract the disease whenever suitable conditions attend their inoculation.
An identical disease frequently appears upon horses, attacking their heels, and thence extending upward along the leg, producing, as it progresses, inflammation and swelling of the skin, followed later by pustules, which soon rupture, discharging a sticky, disagreeable secretion. Other parts of the body are frequently affected in like manner, especially in the region of the head, where the eruptions may appear upon lips and nostrils, or upon the mucous surfaces of the nasal cavities, mouth, or eyes.
Variola of the horse is readily transmitted to cattle, if both are cared for by the same attendant, and, conversely, variola of cattle may be carried from the cow to the horse on the hands of a person who has been milking a cow affected with the disease.
The method of vaccination with material derived from the eruptions of cowpox as a safeguard against the ravages of smallpox in members of the human family is well known. The immunity which such vaccination confers upon the human subject has led many writers to assert that cowpox is simply a modified form of smallpox, whose harmless attack upon the human system is owing to a certain attenuation derived during its passages through the system of thecow or horse. The results of numerous experiments which have been carried out for the purpose of determining the relationship existing between variola of the human and bovine families seem to show, however, that although possessing many similar characteristics, they are nevertheless distinct, and that in spite of repeated inoculations from cattle to man, and vice versa, no transformation in the real character of the disease ever takes place.
Symptoms.—The disease appears in four to seven days after natural infection, or may evince itself in two or three days as the result of artificial inoculation. Young milch cows are most susceptible to an attack, but older cows, bulls, or young cattle are by no means immune. The attack causes a slight rise in temperature, which is soon followed by the appearance of reddened, inflamed areas, principally upon the teats and udder, and at times on the abdominal skin or the skin of the inner surface of the thighs. In a few cases the skin of the throat and jaws has been found similarly involved. If the affected parts are examined on the second day after the establishment of the inflammation numerous pale-red nodules will be found, which gradually expand until, within a few days, they reach a diameter of one-half inch or even larger. At this period the tops of the nodules become transformed into vesicles which are depressed in the center and contain a pale, serous fluid. They usually reach their maturity by the tenth day of the course of the disease and are then the size of a bean. From this time the contents of the vesicles become purulent, which requires about three days, when the typical pox pustule is present, consisting of a swelling with broad, reddened base, within which is an elevated, conical abscess varying from the size of a pea to that of a hazelnut.
The course of the disease after the full maturity of the pustule is rapid if outside interference has not caused a premature rupture of the small abscess at the apex of the swelling. The pustules gradually become darker colored and drier until nothing remains but a thick scab, which at last falls off, leaving only a slight, whitish scar behind. The total duration of the disease covers some 20 days in each animal, and owing to the slow spread of the infection from animal to animal, many weeks may elapse before a stable can be fully freed from it. The fallen scabs and crusts may retain their contagious properties for several days when mixed with litter and bedding upon the floor of the stable, and at any time during this period they are capable of producing new outbreaks should fresh cattle be brought into the stalls and thus come into actual contact with them. Again, the pustules may appear, one after another, on a single animal, in which case the duration of the disease is materially lengthened.
Treatment.—In herds of cattle that regularly receive careful handling, no special treatment will be found necessary beyond the application of softening and disinfecting agents to such vesicles upon the teats as may have become ruptured by the hands of the milker. Carbolized vaseline or iodoform ointment will be found well suited to this work. In more persistent cases it may be found desirable to use a milking tube in order to prevent the repeated opening of the pustules during the operation of milking. Washing the sores twice daily with a weak solution of zinc chlorid (2½ per cent solution) has been found to assist in checking the inflammation and to cleanse and heal the parts by its germicidal action. When the udder is hard, swollen, and painful, support it by a bandage and foment frequently with hot water. If calves are allowed to suckle the cows the pustules become confluent, and the ulcerations may extend up into the teat, causing garget and ruining the whole quarter of the udder.
As young cows are most susceptible to variola, the milker must exercise constant patience with these affected animals so long as their teats or udders are sore and tender, else the patient may contract vicious habits while resisting painful handling. The flow of milk is usually lessened as soon as the fever becomes established, but is again normal with the return of perfect health.
The practice of thorough cleanliness in handling or milking affected cattle may, in many instances, prevent the dissemination of the trouble among the healthy portion of the herd, but even the greatest care may prove insufficient to check the spread until it has attacked each animal of the herd in turn.
Actinomycosis, also known as lumpy jaw, big jaw, wooden tongue, etc., is a chronic infectious disease characterized by the formation of peculiar tumors in various regions of the body, more particularly the head, and is due to the specific action of a certain fungus-like germ (actinomyces). This fungus is an organism which occurs in the tissues in the form of rosettes, and it has therefore been termed the "ray fungus." The disease is not directly transmitted from one animal to another, but it seems apparent that the fungus is conveyed into the tissues by various feedstuffs through slight wounds of the mucous membrane of the mouth, decayed teeth, or during the shedding of milk teeth. The ray fungus is found in nature vegetated on grasses, on the awns of barley, the spears of oats, and on other grains. Quantities of the fungi have been found between the vegetable fibers of barley which had penetrated the gums of cattle and on the awns of grain embedded in the tongues of cows.
Although actinomycotic tumors on cattle had been the object of study for many years, it was not until 1877 that the constant presence of actinomyces was pointed out by Bollinger, of Munich, and sincethat time considered the cause. This fungus was observed in these tumors as early as 1860 by Rivolta, and by others subsequently, without having been suspected as causing them.
Since Bollinger's publication much work has been done, many observations made, and many hitherto obscure disease processes brought into relation with this fungus. Furthermore, a similar disease in man was first definitely shown to be associated with the same fungus in 1878 by Israel, and in the following year Ponfick pointed out that the disease described by Bollinger in animals and that found by Israel in man were due to the same cause; that is, that the fungi described by these observers were one and the same.
The tumors and abscesses wherever they may be are all found to be the same in origin by the presence of the actinomyces fungus. When they are incised, a very close scrutiny with the naked eye, or, at most, a hand lens, will reveal the presence of minute grains which vary from a pale-yellow to a sulphur-yellow color. They may be very abundant or so few as to be overlooked. They are embedded in the soft tissue composing the tumor or in the pus of the abscess. With a needle they are easily lifted out from the tissue, and then they appear as roundish masses about one-half millimeter (1/50 inch) in diameter. To anyone familiar with the use of a microscope the recognition of these grains or particles without any previous preparation is a comparatively easy task.
When examined in the fresh condition under a microscope magnifying up to 250 diameters the general structure is made out without much difficulty. These grains consist of collections of minute, roundish masses. Their outer surface is made up of club-shaped bodies all radiating from the center of the mass (seePl. XXXIX, fig. 2), somewhat like a rosette. If the fungus is crushed, the interior is found made up of bundles of very fine filaments, which are probably continuous into the club-shaped bodies. The addition of a dilute solution of caustic soda or potash greatly aids the examination, as it removes the layer of cells adhering to the fungus, which obscures the structure. Now and then these grains are found to be in a calcified condition. The exterior is incrusted in lime salts, which are dissolved by adding some weak dilute acid, like acetic acid. Only by this procedure can the fungus be definitely recognized when in a mummified condition.
These are the bodies whose presence causes sufficient irritation in the tissues into which they find their way to set up inflammatory growths. These growths increase as the fungus continues to multiply until they reach enormous dimensions, if the affected animal is permitted to live long enough. The true nature of this parasite is not yet definitely settled, although many excellent observers have occupied themselves with it. According to earlier observers, it is a truefungus. Later ones are inclined to place it among the higher bacteria. Present knowledge concerning the actinomyces growth indicates that it should be classified with the higher bacteria or trichomycetes.
Whatever the situation of the disease caused by actinomyces may be, its nature is fundamentally the same and peculiar to the fungus. The pathological details which make this statement clear can not be entered upon in this place, nor would they be of any practical value to the farmer. We will simply dwell upon a few obvious characters.
The consistency of the tumor varies in different situations according to the quantity of fibrous or connective tissue present. When very little of this is present the tumor is of a very soft consistency. As the quantity of connective tissue is increased the tumor is firmer and of a more honeycombed appearance. The individual actinomyces colonies are lodged in the spaces or interstices formed by the meshwork of the connective tissue. There they are surrounded by a mantle of cellular elements which fill up the spaces. By scraping the cut surface of such a tumor these cell masses inclosing the fungi come away, and the latter may be seen as pale-yellow or sulphur-yellow specks, as described above.
Location of the disease.—In cattle the disease process may be located both externally, where it is readily detected, and in internal organs. Its preferred seat is on the bones of the lower and upper jaws, in the parotid salivary gland in the angle of the jaw, and in the region of the throat. It may also appear under the skin in different parts of the body. Internally it may attack the tongue and appear in the form of a tumor in the mouth, pharynx, or larynx. It may cause extensive disease of the lungs, more rarely of the digestive tract.
It appears, furthermore, that in certain districts or countries the disease seems by preference to attack certain parts. Thus in England actinomycosis of the tongue is most prevalent. In Denmark the soft parts of the head are most prone to disease, while in Russia the lips are the usual seat. In certain parts of Germany actinomycotic tumors are most frequently encountered in the throat region and in the jawbones.
A description of actinomycosis of the jaw (lumpy jaw) and of the tongue has already been given in a previous chapter, and hence they will be dealt with here only very briefly. When the disease attacks the soft parts of the head a rather firm swelling appears, in which are formed one or more smaller projecting tumors, varying from the size of a nut to that of an egg. These push their way outward and finally break through the skin as small, reddish, funguslike bodies covered with thin sloughs. Or the original swelling, in place of enlarging in the manner described, may become transformed into an abscess which finally bursts to discharge creamy pus. The abscesscavity, however, does not disappear, but is soon filled with fungus-like growths, which force their way outward through the opening.
When the tumors are situated within the cavity of the pharynx they have broken through from some gland, perhaps beneath the mucous membrane, where the disease first appeared, and hang or project into the cavity of the pharynx, either as pendulous masses with slender stems or as tumors with broad bases. Their position may be such as to interfere with swallowing and with breathing. In either case serious symptoms will soon appear.
The invasion of the bones of the jaws by actinomycosis must be regarded as one of the most serious forms of the disease. (Pls. XXXIX,XL.) It may start in the marrow of the bone and by a slow extension gradually undermine the entire thickness of the bone itself. The growth may continue outward, and after working its way through muscle and skin finally break through and appear externally as stinking fungoid growths. The growth may at the same time work its way inward and appear in the mouth. The disease may also begin in the periosteum, or covering of the bone, and destroy the bone from without inward.
Actinomycosis of the lungs is occasionally observed, and it is not improbable that at times it has been mistaken for tuberculosis. The actinomyces grains are, however, easily observed if the diseased tissue is carefully examined. The changes in the lungs as they appear to the naked eye vary considerably from case to case. Thus in one animal the lungs were affected as in ordinary bronchopneumonia as to the location, extent, and appearance of the disease process. The affected lobes had a dark-red flesh appearance, with yellowish areas sprinkled in here and there. (SeePl. XLI, figs. 1, 2.) These latter areas were the seat of multiplication of the actinomyces fungus. In another case, of which only a small portion of the lungs was sent to the laboratory, they were completely transformed into a uniformly grayish mass, very soft and pulpy to the touch, and appearing like very soft and moist dough. (Pl. XLI, fig. 3.) The actinomyces grains were exceedingly abundant in this tissue, and appeared when the tissue was incised as minute sulphur-yellow grains, densely sprinkled through the tissue, which readily came away and adhered to the knife blade. In still another case a portion of the lung tissue was converted into large, soft masses from 1 to 3 inches in diameter, each partly inclosed in very dense connective tissue. These soft, grayish-yellow masses likewise resembled moist dough in their consistency, and the actinomyces grains, though neither very distinct nor at all abundant, were easily fished out and identified as such. A portion of this growth, which was as large as a child's head, was converted into an abscess filled with creamy semiliquid pus.
This case differed from the preceding in that all appearance of lung tissue had disappeared from the diseased mass. Only on the exterior the lung tissue could be recognized, although even there it had been largely converted into very dense, whitish connective tissue inclosing the fungoid growth. In the other case the external form of the lung and the shape and outline of the lobules were preserved, but the lung tissue itself was not recognizable as such. In the case first mentioned the changes were still less marked, and actinomycosis would not have been suspected by a simple inspection. These few illustrations suffice to show that actinomycosis of the lungs may appear under quite different forms, and that the nature of the disease can be accurately determined only by finding the fungus itself. Rarely actinomycosis attacks the body externally in places other than the head and neck. Crookshank describes the case of a bull in which the flank was attacked and subsequently the scrotum became diseased. A large portion of the skin of the flank was destroyed and covered with a leathery crust. When this was pulled away the pus beneath it showed the actinomyces grains to the naked eye.
Actinomycosis may also involve the udder, the spermatic cord of castrated animals, the vagina, and, when it becomes generalized, the brain, liver, spleen, and muscular tissue.
Actinomycosis may in some cases be confounded with tuberculosis. The diagnosis does not offer any difficulties, since the presence of the actinomyces fungus at once removes any existing doubts. As has already been intimated, these grains, simulating sulphur balls, are visible to the naked eye, and their nature is readily determined with the aid of a microscope.
The course of the disease is quite slow. As the tumors grow they may interfere with the natural functions of the body. According to their situation, mastication, rumination, or breathing may be interfered with, and in this way the animal may become emaciated. Actinomycosis of the jawbones leads to destruction of the teeth and impedes the movements necessary to chewing the feed. Similarly, when the disease attacks the soft parts of the head obstructions may arise in the mouth by an inward growth of the tumor. If tumors exist in the pharynx they may partially obstruct the movements necessary to breathing, or close the air passages and cause partial suffocation. Actinomycosis of the tongue, in interfering with the many and varied movements of this important organ, is also a serious matter. There is no reason to suppose that the localized disease interferes with the general health in any other way than indirectly until internal organs, such as the lungs, become involved.
A very small proportion of the cases may recover spontaneously, the tumors being encysted or undergoing calcification. In most casesthe disease yields readily to proper treatment, and about 75 per cent of the affected animals may be cured.
Prevention.—The question as to how and where animals take this disease is one concerning which we are still in the stage of conjecture, because so far we possess very little information concerning the life history of the actinomyces itself. The quite unanimous view of all observers is that animals become infected from the feed. The fungus is lodged upon the plants and in some way enters the tissues of the head, the lungs, and the digestive tract, where it sets up its peculiar activity. It is likewise generally believed that the fungus is, as it were, inoculated into the affected part. This inoculation is performed by the sharp and pointed parts of plants which penetrate the mucous membrane and carry the fungus with them. The disease is therefore inoculable rather than contagious. The mere presence of the diseased animal will not give rise to disease in healthy animals unless the actinomyces grains pass directly from the diseased into some wound or abrasion of the healthy or else drop upon the feed which is consumed by the healthy. Not only are these views deducible from clinical observation, but they have been proved by the positive inoculation of calves and smaller animals with actinomyces. The danger therefore of the presence of actinomyces for healthy animals is a limited one. Nevertheless an animal affected with this disease should not be allowed to go at large or run with other animals. If the fungus is being scattered by discharging growths we certainly can not state at this stage of our knowledge that other animals may not be infected by such distribution, and we must assume, until more positive information is at hand, that this actually occurs.
It is, however, the opinion of the majority of authorities that when actinomycosis appears among a large number of animals they all contract it in the same way from the feed. Much speculation has therefore arisen whether any particular plant or group of plants is the source of the infection and whether any special condition of the soil favors it. Very little positive information is at hand on these questions. It would be very desirable for those who live in localities where this disease is prevalent to make statistical and other observations on the occurrence of the disease with reference to the season of the year, the kind of feed, the nature of the soil (whether swampy or dry, recently reclaimed, or cultivated for a long time) upon which the animals are pastured or upon which the feed is grown.
It is highly probable that such investigations will lead to an understanding of the source of the fungus and the means for checking the spread of the disease itself. Veterinarian Jensen, of Denmark, made some observations upon an extensive outbreak of actinomycosisa number of years ago which led him to infer that the animals were inoculated by eating barley straw harvested from pieces of ground just reclaimed from the sea. While the animals remained unaffected so long as they pastured on this ground or ate the hay obtained from it, they became diseased after eating the straw of cereals from the same territory. Others have found that cattle grazing upon low pastures along the banks of streams and subject to inundations are more prone to the disease. It has also been observed that feed gathered from such grounds, even after prolonged drying, may give rise to the disease. Actinomycosis is not infrequent in cattle in the Southwest and is generally supposed to be the result of eating the prickly fruit of the cactus plant, causing wounds of the mucous membrane and subsequent infection with the parasite. Much additional information of a similar kind must be forthcoming before the source and manner of infection in this disease and its dependence upon external conditions will be known. It is not at all improbable that they may vary considerably from place to place.
Treatment.—Until recently this has been almost entirely surgical. When the tumors are external and attached to soft parts only, an early removal may lead to recovery. This, of course, can be undertaken only by a trained veterinarian, especially as the various parts of the head and neck contain important vessels, nerves, and ducts which should be injured as little as possible in any operation. Unless the tumor is completely removed it will reappear. Disease of the jawbones is at best a very serious matter and treatment is liable to be of no avail.
In March, 1892, an important contribution to our knowledge of this subject was made by Nocard, of the Alfort Veterinary School, in a communication to the French Central Society of Veterinary Medicine. He showed clearly that the actinomycosis of the tongue, a disease which appears to be quite common in Germany, and is there known as "wooden tongue," could be quickly and permanently cured by the administration of iodid of potassium. Nocard calls attention to the success of Thomassen, of Utrecht, who recommended this treatment so long ago as 1885, and who has since treated more than 80 cases, all of which have been cured. A French veterinarian, Godbille, has used the same remedy in a number of cases of actinomycosis in the tongue, all of which have been cured. Nocard also gives details of a case which was cured by himself.
All the cases referred to were of actinomycosis of the tongue, and no one appears to have attempted the cure of actinomycosis of the jaw until it was undertaken by Nörgaard, of the Bureau of Animal Industry. In April, 1892, he selected a young steer in fair condition which had a tumor on the jaw measuring 15½ inches in circumference and from which a discharge had already been established. Thisanimal was treated with iodid of potassium, and the result was a complete cure.
The iodid of potassium is given in doses of 1½ and 2½ drams once a day, dissolved in water, and administered as a drench. The dose should vary somewhat with the size of the animal and with the effects that are produced. If the dose is sufficiently large signs of iodism appear in the course of a week or 10 days. The skin becomes scurfy, there is weeping from the eyes, catarrh of the nose, and loss of appetite. When these symptoms appear the medicine may be suspended for a few days and afterward resumed in the same dose. The cure requires from three to six weeks' treatment. Some animals, generally the ones which show no signs of iodism, do not improve under treatment with iodid of potassium.
If there is no sign of improvement after the animals have been treated four or five weeks, and the medicine has been given in as large doses as appear desirable, it is an indication that the particular animal is not susceptible to the curative effects of the drug, and the treatment may therefore be abandoned.
It is not, however, advisable to administer iodid of potassium to milch cows, as it will considerably reduce the milk secretion or stop it altogether. Furthermore, a great part of the drug is excreted through the milk, making the milk unfit for use. It should not be given to animals in advanced pregnancy, as there is danger of producing abortion.
The best results are obtained by pushing the drug until its effect is seen. The many tests to which this treatment has been subjected have proved, with few exceptions, its specific curative value. In addition to this the tumor should be painted externally with either the tincture of iodin or Lugol's solution, or the drug should be injected subcutaneously into the tumor.
Godbille has given as much as 4 drams of potassium iodid in one day to a steer, decreasing the dose one-fourth dram each day until the dose was 1¼ drams, which was maintained until the twelfth day of treatment, when the animal appeared to be entirely cured.
Nocard gave the first day 1½ drams in one dose to a cow; the second and succeeding days a dose of 1 dram in the morning and evening, in each case before feeding. This treatment was continued for 10 days, when the animal was cured.
Actinomycosis and the public health.—The interest which is shown concerning this cattle disease is largely due to the fact that the same disease attacks human beings. Its slow progress, its tendency to remain restricted to certain localities, and the absence of any directly contagious properties have thus far not aroused any anxiety in other countries as to its influence on the cattle industry, not even to the point of placing it among the infectious diseases of which statisticsare annually published. Its possible bearing on public health has, however, given the disease a place in the public mind which it hardly deserves.
It has already been stated that the actinomyces fungus found in human disease is considered by authorities the same as that occurring in bovine affections. It is therefore of interest to conclude this article with a brief discussion of the disease in man and its relation to actinomycosis in cattle.
In man the location of the disease process corresponds fairly well to that in cattle. The majority of cases which have been reported in different parts of the world—and they are now rather numerous—indicate disease of the face. The skin, tongue, or the jawbones may become affected, and by a very slow process it may extend downward upon the neck and even into the cavity of the chest. In many cases the teeth have been found in a state of more or less advanced decay and ulceration. In a few cases disease of the lungs was observed without coexisting disease of the bones or soft parts of the head. In such cases the fungus must have been inhaled. The disease of the lungs after a time extends upon the chest wall, where it may corrode the ribs and work its way through the muscles and the skin. An abscess is thus formed discharging pus containing actinomyces grains. Disease of the digestive organs caused by this fungus has also been observed in a few instances.
Granting the identity of the disease in man and cattle, the question has been raised whether cattle are responsible for its occurrence in man. Any transmission of the infectious agent may be conceived of as taking place during the life of the animal and from the meat after slaughter. That human beings have contracted actinomycosis by coming in contact with diseased cattle is not shown by the cases that have been reported, for the occupations of most of the patients did not bring them into any relation whatever with cattle. While the possibility of such direct transmission is not denied, nevertheless it must be considered as extremely remote. Practically the same position is maintained at present by most authorities as regards the transmission of the disease to man by eating meat. Israel, who has studied this question carefully, found the disease in Jews who never ate pork,[5]and who likewise were protected from bovine actinomycosis by the rigorous meat inspection practiced by that race. Furthermore, it must be borne in mind that actinomycosis is a local disease, causing great destruction of tissue where the fungus multiplies, but which very rarely becomes generally disseminated over the body from the original disease focus. The fungus is found only in places where the disease process is manifest to the eye or becomes so in a very short time after the lodgment of the fungus. Only the greatest negligencewould allow the actually diseased parts to be sold and consumed. Finally, this parasite, like all others, would be destroyed in the process of cooking. Most authorities thus do not believe that actinomycosis in man is directly traceable to the disease in animals, but are of the opinion that both man and animals are infected from a third source, which has already been discussed above. How far these views may be modified by further and more telling investigations of the parasite fungus itself no one can predict. There are still wide gaps in our knowledge, and the presentation above simply summarizes the prevailing views, from which there are dissenters, of course. An attempt to give the views of both sides on this question would necessitate the summarizing and impartial discussion of all the experiments thus far made—a task entirely beyond the scope of the present work.
Whether an animal affected with actinomycosis should be used for human food after all diseased organs and tissues have been thoroughly removed is a question the answer to which depends on a variety of circumstances. Among these may be mentioned the thoroughness of the meat inspection itself, the extent of the disease, and the general condition of the animal affected.
The Federal meat-inspection regulations require that carcasses of animals showing generalized actinomycosis shall be condemned. If carcasses are in a well-nourished condition, showing uncomplicated localized lesions of actinomycosis, they may be passed after the infected organs or parts have been removed and condemned. When the disease of the jaw is slight, strictly localized, and without pus formation, fistulous tracts, or lymph-gland involvement, the tongue, if free from disease, may be passed. The heads affected with actinomycosis (lumpy jaw), including the tongue, shall be condemned, except that when the lesions in the jaw are strictly localized and slight in extent, the tongue may be passed, if free from disease.
Anthrax or charbon may be defined as an infectious disease which is caused by specific bacteria, known as anthrax bacilli, and which is more or less restricted by conditions of soil and moisture to definite geographical localities. While it is chiefly limited to cattle and sheep, it may be transmitted to goats, horses, cats, and certain kinds of game. Smaller animals, such as mice, rabbits, and guinea pigs, speedily succumb to inoculation. Dogs and hogs are slightly susceptible, while fowls are practically immune. The variety of domesticated animals which it may attack renders it one of the most dreaded scourges of animal life. It may even attack man. Of this more will be stated further on.