JAUNDICE OF THE NEW-BORN. ICTERUS NOUVEAUX NÉS.
In mules; less frequently in horses and cattle. Bacteridian. Predisposition from alleged miscegeneration. Offspring of lymphatic mares. Spoiled fodders, foul buildings, exposure, infection by umbilicus. From gastro-enteritis, diarrhœa, dysentery. Congenital. Symptoms: refuses the teat, scours, red urine, palpitation, colics, perspirations, inflammations, or abscesses of navel, arthritis, other internal disorders. Death from exhaustion or in convulsions. Or symptoms subside and pass in 15 days. Diagnosis: prostration, palpitation, icterus, and bloody urine with omphalitis. Streptococci. Prognosis: with hæmaturia nine-tenths fatal. Lesions: icterus, heart soft, flabby, lungs congested, general ecchymosis, blood black, clot diffluent, liver congested, enlarged, spleen, swollen, softened with spots of brownish yellow, meconium bloodstained, kidneys swollen, congested, points of infarction or necrosis, urine bloody, navel lesions. Treatment: for congenital cases improve hygiene for dams; for offspring, antiseptics to navel, shelter, warm box; aloes to dam, or oil to colt, antiseptics internally, demulcents, stimulants, derivatives, opium, water, alkalies.
This has been observed in cattle (Kitt), and in horses (Levrier, Bernadin, Lhomme) but above all in mules (Villa-Roya, Carrere, Levriere, Bernadin, Lhomme, Hartmann, Dieckerhoff).
The affection is a bacteridian disease, in which there is a great destruction of red globules, and liberation of hæmatin, with hæmaturia and yellow coloration of the tissues.
Causes. Carrere attributes much to a supposed congenital weakness induced by the unnatural generation of ass with mare. Cadeac noticed that the offspring of certain mares and horses remained sound, while the progeny of the same animals, and asses suffered largely from icterus. Levrier found it especially in the mules born of mares having a lymphatic temperament or suffering from canker, grease or chronic lymphangiectasis. Bernadin and Lhomme attribute much to bad hygiene, and especially to poor or spoiled fodders. Lhomme, Lafosse and Trasbot find accessory causes in cold and wet weather. Retention of the meconium is another cause. Dieckerhoff, Hartmann, Cadeac and Bournay trace the disease to bacterial infection as the essential cause. Many cases originate in septic infection and inflammation of the navel and umbilical veins. Others commence with mucous gastro-enteritis, attended by diarrhœa or dysentery. In other cases the germs appear to have reached the liver through the circulation as the animal is already affected at birth.
Symptoms. When not congenital, symptoms are usually seen in the first few days of life, usually before the fifth day.
In congenital cases the new born animal is unable to stand at all or for longer than a very short time, it lies listlessly and makes no attempt to suck even when held up to the teat. There is acceleration of pulse and respiration, the heart beats are tumultuous, the mouth is dry, the mucosæ of a straw yellow, the bowels are costive, and the urine, whether discharged in life, or found in the bladder after death, is bloody.
When attacked later, the animal becomes dull, weak, and stupid, refuses the teat, and has the bowels relaxed. The mucosæ become pale yellow, the breathing accelerated, the heart beats violent, and the pulse rapid, small and weak. The urine is passed slowly and with effort and has a red hue more or less deep according to the severity of the attack. Colics are not uncommon, causing uneasy shifting of the limbs and tail, cries, frequent lying down and rising, and partial or general perspiration. Complications on the part of the navel and umbilical veins are to be looked for, in open sores, swellings, abscess, phlebitis, and in arthritis and secondary abscesses in different organs. Death may occur quietly, as from exhaustion, while in other cases it is preceded by convulsions.
In case of recovery, there is an improvement of the general symptoms, the heart and respirations become moderate, appetite is restored, the little animal sucking the teat, there are abundant, yellow, semi-solid defecations, the strength increases day by day, and convalescence may be fully established by the twelfth to the fifteenth day.
Diagnosis. This is mainly based on the extreme weakness and prostration, the violent heart action, the jaundiced hue of the mucous membranes, and the bloody urine. Confirmation may be sought in the presence of streptococci in the fresh urine, kidneys, liver and blood, and in the artificial cultures made from them. The presence of omphalitis is further significant.
Prognosis. Bernardin says that if hæmaturia is present nine out of ten cases are fatal, while in the absence of this feature nine-tenths recover.
Lesions. The jaundiced appearance of the conjunctiva and other tissues is constant. The heart is pale, soft and flaccid, with petechial patches of a deep red extending into the muscular substance; the lungs are congested with similar patches of blood-staining; the blood in the heart and larger vessels is dark, and fluid or only loosely clotted. The liver is congested to twice or thrice its normal size (10 lbs. in place of 3 or 4 lbs.); the spleen is enlarged, softened, and shows spots of brownish yellow. The small intestine contains a yellowish or dark red meconium, and it may contain effusions of dark blood, while its mucosa is inflamed, thickened, easily lacerated, and pigmented, or marked by petechiæ. The large intestines and especially the rectum are packed with hard dry balls.
The kidneys are enlarged, often to double their volume, and deeply congested, with infarcts, and patches of necrosis, of a pale brownish yellow hue. The urine in the bladder is deeply stained with blood coloring matter.
Treatment. For congenital cases it is manifest that treatment must be preventive and applied to the dam, before parturition. An open air life, moderate exercise, sound, easily digestible and nourishing food; grooming; in the stable, cleanliness, dryness and good ventilation; good water, are essential.
For the offspring, antiseptics (tannin, mercuric chloride lotion, copperas, calomel, iodoform), applied to the navel, and protection against cold winds and rains, and damp lairs. For mules and other young animals born in severe, winter weather a dry, warm, foaling box is desirable, and the little animal should be rubbed dry and covered with a warm woolen blanket. When the temperature approaches zero or the barn is cold, the smaller animals, as soon as they are dropped, should be placed under a box with a jar of hot water wrapped in woolen coverings, or with hot bricks similarly wrapped, and should only be let out for food when they are completely dried, or when the weather has moderated.
Therapeutic treatment may be commenced by a dose of aloes given to the dam, or of olive or castor oil or manna given to the offspring. As a substitute sulphate of soda may be used. Antiseptics like salicylate of soda, salol, or the sulphites may be added. To act as a demulcent on the alimentary and urinary tracts, well boiled flaxseed tea is usually recommended. Weakness may be met by warm strong coffee, salicin, quinia, or other bitters, and more stimulating agents like camphor, angelica, assafœtida, or even oil of turpentine may be added. Diarrhœa may be checked by linseed tea, mustard plasters, or in obstinate cases, by opium. Elimination should be sought by administering abundance of pure water or watery demulcents, and even by the use of alkalies like bicarbonates of soda or potash. A moderately free action of the bowels must be constantly maintained.
Antiseptic treatment of the navel and umbilical veins must not be overlooked.