DISTEMPER IN DOGS AND CATS.
Definition. Synonyms. Animals susceptible: dog, fox, jackal, hyena, wolf. Historic notes. Causes: contagion, inoculation, immunity, contact with sick, clothing, bedding, kennel: infection fixed—little diffusible, dogs at large, chill, domestication, high breeding, special breeds, shows, public conveyances, vegetable diet, debilitating conditions, catarrhs, change of climate, recurrent attacks, youth, native susceptibility, teething. Microbiology: micrococci, bacilli, mixed cultures, Shantyr’s observations, Lignieres’. Virulent products—all secretions and exudates. Vitality: virus survives drying, freezing, dilution in water. Destroyed by disinfectants. Forms of distemper: catarrhal, ophthalmic, cutaneous, gastro-hepatic, bronchitic, pulmonary, nervous. Duration 20 to 30 days. Mortality 20 to 70 per cent. Prognosis: unpromising conditions. Incubation 4 to 7 days. Symptoms: hyperthermia (103° to 104°), dulness, debility, anorexia, staring coat, tremors, seeking warmth, early fatigue, dry burning nose and footpads, irregular temperature, simultaneous congestion of all visible mucosæ; Respiratory phenomena; sneezing, congestion of nose, discharge, blocking, snuffling, rubbing, cough, retching, vomiting; percussion flatness in lungs, in islets or along the lower part; auscultation râles, wheezing, crepitus, creaking, etc.; epiphora, swollen eyelids, weeping, photophobia, muco-purulent discharge, sticking of lids together, opacities, vesicles, ulcers; red, hot, buccal mucosa, costiveness, fetid diarrhœa, tenesmus, weakness, emaciation; skin eruption, on delicate areas, papules, vesicles with colored contents, pustules, sticky, greasy exudate; irritability, restlessness, taciturnity, depraved appetite, spasms, delirium, paresis, epilepsy, chorea. Lesions: inflammation, degeneration, ulceration on air-passages, alimentary tract, lymph glands, kidneys, liver, cerebral and spinal meninges, leucocytic infiltration: offensive odor. Lignieres’ views of microbes. Prevention: quarantine new dogs for 14 days, wash, disinfect all collars, etc., avoid shows and meetings, exclude street dogs, protect against mice, rats, birds, shut up all dogs during an epizoötic; separate a pack into small lots; seclude the sick and all belonging to them. Immunization: by lung exudate, by weakened cultures. Treatment: hygienic, dietetic, warm baths, antipyretics, antiferments, calomel, phenic acid, eliminants, expectorants, collyria, emetic, demulcents, bismuth, etc., pepsin, quinine, nerve sedatives, tonics.
Definition. A contagious, febrile affection attacking dogs (and by inoculation cats), and tending to local inflammatory and degenerative lesions in the mucosæ, lungs, bowels, liver, skin, kidneys, and nervous system,—a first attack usually immunizing against a second.
Synonyms. Contagious catarrhal fever; Dog ill; Bronchial Catarrh; Intestinal Catarrh; Fr. Maladie des Chiens, Maladie du jeune age, Typhoïde, Typhus des chenils, Variole du chien; Ger. Staupe; It. Cimurro.
Animals susceptible. Dogs, especially puppies and young dogs, and other members of the canine race, fox, jackal, hyena, wolf. Cats suffer from inoculation (Laosson), also apes (Cadeac). Old cats and dogs are often immune, also all animals that have passed through one attack of the disease.
History. The older English veterinarians quote the epizoötics in dogs described by Virgil, Aristotle and even Homer as probably distemper. Laosson attributes to it a canine epizoötic which prevailed in Bohemia in 1028. It appears to have been unknown in Europe in the earlier third of the 18th century though prevailing in Peru. According to Ulloa, it was introduced from Peru into Spain in 1735, whence, it spread into France (1740), Germany (1748), Ionian Isles, Greece (1759), England (1760), Italy (1764) and Russia (1770), Sweden and Norway (1815), Siberia (1821). Since that time it has prevailed in Europe and many dependencies of European nations.
Causes. Its advent in Europe as a new disease in the second third of the 18th century, its steady spread, its continued prevalence, and extension, concur with the infection of kennels and districts by the introduction of a sick dog, in demonstrating its purely contagious nature, and this implies a living microbe transferred from animal to animal. If any doubt remained it must be dispelled by the inoculations which have been constantly successful when made on young puppies, or dogs that have not previously suffered, and on cats. A first attack confers immunity.
Among accessory causes may be especially named contact with the sick dog, its clothing or bedding, and above all its kennel. A kennel may retain infection indefinitely, especially if there is a constant accession of puppies or susceptible dogs. On the contrary it is not readily carried on the clothes of attendants, and the inmates of a kennel often remain sound, though only separated by a yard from the infected one, and though cared for by the same attendant. Yet so universally diffused is the contagion that few dogs escape it until they are a year old.
The habit of letting dogs run at large, to meet in roads and fields is a most prolific cause, which might easily be done away with where distemper is prevalent.
A chill is a common condition, hence injudicious washing, swimming in cold water, exposure of house dogs to cold storms, or outdoors at night, sleeping in cold, damp cellars, on cold stones or metal plates, or in passages in a current of cold air are frequent factors. Yet it often spreads rapidly in the summer, the heat favoring the preservation and diffusion of the germ.
House dogs as a rule suffer more severely, as their systems are more sensitive to the cold, and the resisting power to invading microbes is lessened. Country dogs and those living in the open air are hardier and more resistant and often have the disease in a mild form.
High bred dogs suffer more severely probably largely from the greater protection and care lavished on them and their consequent diminished power of resistance. Newfoundlands, great Danes, pointers, pugs, poodles, spaniels and greyhounds may be named as especially liable.
The exposure to infection at shows, and in traveling by rail, steamboat or other infected conveyance must be considered as among the prominent causes.
An exclusively bread diet has been recognized as a predisposing cause, by reason of its lowering the stamina of the carnivorous animal.
Any condition which induces debility whether severe or continued disease, parasitisms, impure air, under feeding, improper food, rachitis, or scurvy, etc., must be admitted to operate in the same way. Any catarrhal disease of the nose or bronchia is especially conducive to the affection by weakening the mucosa and making an easy entrance channel for the germs.
Change of climate is a strongly predisposing condition, which not only hastens an attack, but even, at times, arouses anew the susceptibility in dogs that have passed through a first attack. Dogs that suffered in England have had a second attack in India, and some have even had a third attack when brought back to Europe. Four attacks within a year, in the same dog, and without change of climate, are recorded by Friedberger and Fröhner.
Youth is much more susceptible than age, even apart from the immunity which comes to the mature dog from a first attack. Yet some puppies are insusceptible from birth.
Microbiology. No one pathogenic organism has been proved to be the constant infecting agent, yet two classes of investigators have contended in favor of micrococci and bacilli respectively.
Micrococci, 1 to 3μ in diameter, singly or in chains of 6 or 8 have been found in the blood, lungs, liver, kidneys and spleen (Semmer, Friedberger, Krajewski, Rabe, Mathis, Marcone, Meloni, Kitt).
Bacilli were found associated with micrococci by Semmer, Legrain and Jacquot, Laosson, Millais, Schantyr, and Galli-Valerio. As observed by the latter they were 1.25, to 2.5μ long, by 0.31μ broad and took the Gram stain. Cultivated on gelatine the colonies were waxy, lustrous points, which indented the gelatine without liquefying it.
Cultures of the mixed bacteria (cocci and bacilli) and their inoculation on young dogs produced the symptoms of distemper with subsequent immunity (Laosson, Millais). Legrain and Jacquot claimed immunity, as resulting from inoculations with the cocci in pure cultures. Galli-Valerio, using the mixed cultures produced all the symptoms (pulmonary and cerebro-spinal) of distemper.
Schantyr, ignoring the cocci, describes three bacilli which cause three different diseases (distemper, abdominal typhus, and typhoid), but the distinctions are not clear nor generally accepted.
Lignieres and Even, in Argentina, and dealing with the more susceptible high bred dogs (fox terriers, great Danes and carlins), found constantly in the blood of the dog, in the early stages of the disease, a long, delicate bacillus, nonmotile and easily stained in aniline, but not by Gram’s method. Inoculated on the Guinea pig it shortens, approximating rapidly in successive passages to a cocco-bacillus, and assumes the general characters of Lignieres’s pasteurella. Different bacteria may be found in the lungs, bronchial and nasal mucus, tears and vesicles.
Lignieres’s pasteurella is inoculable on the Guinea pig, mouse, rabbit, and dog, producing the symptoms of local or general infection. Two centigrammes, subcutem, in the Guinea pig, produced a local œdema, disappearing in four or five days and securing immunity. Five cc. subcutem proved fatal in 48 hours; intraperitoneal in 24 hours. In the rabbit 1cc., subcutem, caused local œdema for 2 days and hyperthermia (104°) for 3 days; 1cc. intravenously, caused fever for 3 weeks, diffluent blood and hæmorrhagic lesions in lungs, liver, kidneys, bowels, spleen, and serosæ. In the mouse, 4 to 8 drops, subcutem, caused œdema, and recovery or death in 2 to 4 days. In such cases the microbe was found in pure cultures in the blood or inoculated tissues.
Inoculations of the pure cultures on dogs produced in different cases, gastro-enteritis, pneumonia, pleuro-pericarditis, and arthritis, in various combinations. If the animal survives it is immune.
Grown on peptonized bouillon, neutral or slightly alkaline, the bacillus forms, in 24 hours, small granular colonies which fall to the bottom, leaving the liquid clear. The addition of serum renders this more abundant without causing opacity.
On pancreatic bouillon the growth is very free without indol.
On gelatine plates there are fine punctiform colonies, transparent, but becoming white and opaque in 8 or 10 days. Similar colonies form in stab and streak cultures. The gelatine is not liquefied. Cultures in milk cause neither coagulation nor acidity. There is little or no growth in hay tea, on potato, nor in vacuum. The cultures have the peculiar odor of the pasteurella.
Virulent Products. Infection is present sooner or later in all the morbid animal products. The nasal mucus, bronchial exudate, saliva, tears, contents of the cutaneous vesicle, milk, contents of the bowels, and the blood have been successfully inoculated on susceptible subjects. Inoculations with blood failed with Bryce, but proved successful with Konnhauser, Krajewski, Even, Lignieres and Physalix, so that the first named cases may be explained by a prior immunity, or by a too advanced stage of the case which furnished the matter. The virulence is not lost nor even diminished by drying at ordinary temperatures, freezing (10° F.), nor by moderate dilution in water. Prolonged exposure at ordinary temperature, however, reduces the virulence, which is greatly impaired in 15 to 25 days (Laosson), or, if dried, in three months and upward (Krajewski). Virulence is easily destroyed by disinfectants,—thorough washing (Menard) hypochlorous acid (Trasbot), chloride of lime, mercuric chloride, etc.
Forms of Distemper. This disease is extremely protean in its manifestations. Many cases, in country districts especially, are manifested by a slight fever, with a catarrhal condition of the mucosæ of the nose, eyes, and throat. In other cases there may be simply a slight conjunctivitis or keratitis, and in still others a cutaneous eruption, papular, vesicular or pastular. In some instances there is slight gastric or hepatic disorder with inappetence nausea, and vomiting or some irregularity of the bowels. In such cases recovery may take place in eight or ten days.
In the more severe forms, especially seen in house and city dogs, and in high bred and confined dogs generally, the fever is high and persistent and the disorders often predominate in particular organs, hence we see a catarrhal form, a conjunctival, a bronchitic, a pulmonary, a gastro-intestinal and hepatic, a cutaneous and a nervous. The severe cases may last for twenty or thirty days or even in their sequelæ for several months. Exposure to cold contributes greatly to a pulmonary attack even in inoculated cases (Lignieres).
The mortality varies greatly. In country dogs it may be below 20 per cent., whereas in city dogs and those kept confined in close quarters and in large numbers it may rise to 50, 60 or even 70 per cent.
Prognosis is especially unfavorable in severe cases; in those profoundly affecting the brain, lungs or liver; in high bred or pampered dogs; in the very young; in the debilitated, anæmic or rhachitic; in those that have been recently imported from another climate and are as yet unacclimated. Puppies from debilitated dams, or those raised in a large litter with insufficient nourishment, or older dogs confined to a purely vegetable diet show less power of recuperation. Profound prostration and offensive odor, from excess of toxins are always to be dreaded.
Incubation in inoculated cases varies from four to seven days (Krajewski). When contracted by simple exposure it may seem to have been extended to fourteen or even eighteen days.
Symptoms. The earliest symptom is hyperthermia (103° to 104° F.) This is accompanied and followed by prostration, dulness, impaired appetite, erection of the hairs along the spine, shivering, trembling, seeking a warm place, fatigue on slight exertion, hot dry nose, burning pads of the feet, sometimes taciturnity. Later the temperature may descend even to the normal or there may be alternations of rise and fall. One of the most characteristic symptoms of distemper is the implication of more than one set of organs, so that morbid manifestations referable to the nose, eyes, throat, stomach, skin and nervous system occurring in the same subject are to be especially noted. In enumerating the prominent symptoms caused by disease of one set of organs therefore, it is not to be implied that the absence of others referring to a different class of organs is to be understood. On the contrary a complication of several is especially significant of this disease, though the predominance in one class of organ will signify a special form of the disease.
Respiratory Symptoms. One of the earliest symptoms is usually sneezing with redness of the nasal mucosa, followed by a muco-purulent blocking of the nose, and rubbing of it with the paws. With the implication of the throat there is usually local tenderness and a hard, painful cough, which may be accompanied by retching or vomiting. The breathing becomes snuffling, especially in pugs and bull dogs, and rapid and even oppressed in case of implication of the smaller bronchia and lungs. The nostrils may become glued together, the discharge red or dark in color, vesicles and sores may appear on the mucosa, and the cough gets paroxysmal, small, weak and husky or gurgling.
Percussion of the lungs may reveal small areas of flatness from exudate or collapse, and in case of pleurisy and hydrothorax there is a lack of resonance up to a given horizontal line, varying in position according to the position of the animal and always keeping to that part of the thorax which may at the time be lowest. Auscultation will reveal various sounds according to existing lesions. There may be a loud blowing murmur over the large bronchia, or at points to which this sound is conveyed through consolidated lung. Or a coarse or fine mucous râle may be present indicating the second stage of bronchitis, or a line of crepitation, around a non-resonant area indicating pneumonia, or there may be friction sounds or, later, creaking murmurs from false membranes. Wheezing and sibilant sounds are not uncommon, also sounds of the heart, bronchia or bowels, heard in unwonted situations to which they are conveyed through consolidated lung tissue. Dyspnœa may become extreme, with puffing out of the cheeks, labial soufle, and violent inspiratory action. Fœtor of the breath is common. Emaciation, marasmus, sunken, pale or dark red eyes, putrid diarrhœa and nervous disorders usually precede death.
Eye Symptoms. Conjunctival congestion is one of the earliest and most constant symptoms. Weeping, swollen eyelids and red turgid mucosa. Photophobia may bespeak keratitis. Soon the watery tears become muco-purulent, matting together the lashes and even the lids, during the night especially, so that they must be sponged to get them apart in the morning. The exudate may accumulate under the lower lid, or may become flocculent, and usually flows down the cheeks causing matting and even shedding of the hair. Vesicles exceptionally appear on the conjunctiva; more frequently it becomes cloudy and opaque, and at points near the centre, degeneration of the epithelium leads to the formation of ulcers no larger than pinheads, but extending into the cornea and sometimes perforating it so as to allow protrusion of the membrane of Descemet or the escape of the aqueous humor. The formation and extension of the ulcers are favored by the general debility, the rubbing of the eye with the paws, and the infection of abrasions, by pus microbes. This infection may extend to the lining member of the anterior chamber and even of the posterior with panophthalmia, but, in the absence of perforation, internal ophthalmia is rare. When the ulcers heal, white cicatricial spots, or black points caused by the adhesion of the uveal pigment remain.
Digestive and Hepatic Symptoms. Anorexia and vomiting may usher in the disease. Buccal congestion, dryness, clamminess and fœtor are marked symptoms and there may be some yellowness of the mouth and eye. The patient is at first costive, but diarrhœa often sets in early, with tenesmus, much fœtor, mucus, froth and even blood, also abdominal pain and tenderness. The abdomen is habitually tense and contracted. The alvine flux may rapidly exhaust the animal, or it may continue for a month in dysenteric form with intense fœtor, weakness, emaciation and exhaustion. Ulceration of the mouth, gums and rectum, invagination, prolapsus ani, jaundice, septic pneumonia, paralysis, chorea, convulsions, or cutaneous eruptions are occasional complications. The abdominal type of distemper is especially fatal. Even in its early stages debility, prostration and even drowsiness are marked features.
Cutaneous Symptoms. Skin eruptions are observed in the great majority of cases, at some stage of the disease, and may remain as a sequel for a time after apparent recovery. Friedberger and Fröhner note cases in which the high fever and skin eruption are the only prominent symptoms, and recovery may be looked for with some confidence. The lesions are most patent on white skinned dogs with short hair, and on the more delicate parts of the skin (abdomen, scrotum, perineum, inside of the thighs and elbows) but they may extend over the whole body and even extend on the mucosæ. They vary much in different cases and stages. There may be punctiform reddish spots, changing to hard elevated papules, and, in the case of a certain number, to vesicles and even pustules. Some vesicles may be small and pointed, but more commonly they are rounded and flat, and as large as a lentil or small pea. When first formed, the contained liquid exudate may be clear and transparent, but often it is reddish or even violet. The individual vesicles tend to speedily burst, and dry up, but others appear, and thus the eruption will continue for weeks, the skin meanwhile exuding a sticky, greasy, offensively smelling exudate which mats the hairs together. Itching is usually slight, yet in given cases excoriations and sores are produced with considerable moist discharge. It tends to spontaneous recovery when the general health improves and appears to be little affected by local treatment.
Nervous symptoms. These are shown more or less from the beginning. The great dulness, depression, apathy and weakness, which usually usher in the disease, are indications of this. Drowsiness may be early shown. Even the early nausea and vomiting may be largely central in its origin. In some cases, however, the brain symptoms are more active and violent. The dog is restless and irritable, getting up and moving from place to place, starting from sleep, yelping, snapping, with twitching of the muscles of the face or limbs, rolling of the eyes, and excessive heat of the head. Krajewski even describes rabiform paroxysms, depraved appetite, spasms, furious delirium, fawning, or threatening, and finally paraplegia and maxillary paralysis Occurring in a country where rabies is familiar it would have been more satisfactory if inoculations had been made from such cases with results negativing rabies. Epileptic attacks may appear at any stage of the disease. Chorea, tonic spasms, paresis and paralysis are on the contrary habitually late manifestations and often seem to be sequelæ determined by toxin poisoning of the nerve centers, or degenerations of their structure. Choreic movements may be confined to the head, or a limb, or they may affect the whole body. Tonic spasms often affect the neck, turning the head rigidly to one side. Among other nervous disorders may be named, amaurosis with dilated pupil and atrophy of the optic nerve, deafness, anosmia, and dementia.
Lesions. These vary as do the symptoms. The nasal pharyngeal, and laryngeal mucosæ show congestion, swelling, infiltration, ecchymosis with vesicles, pustules and ulcerations. They are covered by a foul muco-purulent exudate. The same condition may often be traced to the final ramifications of the bronchial system. In pulmonary cases, the lungs show inflammation, inflammatory exudation and consolidation, collapse, splenization, œdema, and even suppuration in points or large areas. The bronchial lymph glands and often the pharyngeal are enlarged, congested and may be suppurating. The pleura over the congested lung may be the seat of exudation and false membrane, and a bloody serum may occupy the pleural cavity. The heart may show parenchymatous degeneration.
In the digestive organs there may be buccal congestion, with degeneration and the desquamation of the epithelium and formation of more or less extended ulceration. The stomach shows similar congestions and degenerations, the ulcer appearing particularly on the summit of the folds. Together with the intestines this often presents numerous petechiæ and ulcerations, and is covered by a foul but often tenacious mucus. The agminated and solitary glands are usually swollen and infiltrated, and the mesenteric glands are swollen, congested and infiltrated.
The kidneys are often congested, and show points of blood extravasation and tissue degeneration.
The meninges of the brain and cord are often inflamed with infiltrations, false membranes, and especially exudation into the subarachnoid and ventricles. Centres of congestion and softening have been noted in the brain and cord with embolism of capillaries and softening and degeneration of their endothelium. Nocard and others have noted a leucocytic infiltration of the perivascular lymph spaces. In old standing cases sclerosis is an occasional feature.
In nearly all cases there is marked emaciation and a very heavy offensive odor comes from the skin, the tissues, the contents of the bowels and the exudates on the respiratory passages.
Lignieres alleges that in the early stages, the specific bacillus is found in the blood and viscera, but that later it is only exceptionally found and that other bacteria (streptococcus, etc.,) usually take its place. In the nasal discharge it may be found at times, but in the more tardily appearing cutaneous vesicles its absence is the rule, and in the brain matter and meningeal and ventricular fluids, in cases of paralysis or chorea, it is not to be detected by culture. Hence the case cannot always be diagnosed by a successful search for, or culture of the germ, and hence also the frequently unsuccessful inoculations with the blood, tears, liquid of vesicles, and even the lung tissues or nasal discharges.
Prevention. Distemper, like any other contagious malady may be excluded from a city or district by the simple expedient of shutting out animals that bear the infection. From a kennel or pack of hounds, new arrivals should be quarantined for a fortnight, until danger is past, and should only be admitted after a good soapy wash. All clothing, collars, brushes and other material that came with them should be thoroughly disinfected. Dog shows and other meetings are to be avoided as far as possible, and any animal that has returned from one should be quarantined and all his belongings purified. Dogs that run at large should be carefully excluded from kennels where valuable dogs are kept, and from all possible contact with them. Even mice, rats, and birds have to be considered if the disease exists in the near vicinity. When the disease exists in a district a sound sanitation would demand the shutting up of all dogs on their owner’s premises, unless carefully led on chain and prevented from coming in contact with other dogs.
When the disease has broken out in a pack of hounds, or a populous kennel, the dogs should be separated into small lots of 3 or 4; the temperatures of all should be taken twice a day; any lot in which one shows a high temperature should be instantly removed to a safe distance and placed in quarantine; and the enclosure where they have been and all their belongings should be thoroughly disinfected. The enclosures where the sick are kept must be carefully quarantined so that no infection may escape on food, water, brushes, utensils, clothing, attendants, cats, vermin, or even birds.
The dogs that are still healthy should have spacious, well-aired dwellings, open air exercise (as much as possible in the fine season), good but not too stimulating food (in part at least fresh animal food), pure water, and protection against undue fatigue, cold, icy baths, especially when exhausted, rain or snow storms and cold stone or metallic beds. In the cold season artificial heat in the kennel is desirable.
Immunization may be sought in various ways based on the use of the toxins and antitoxins on the one hand, and of a weakened type of virus on the other. Bryce (1882) and others inoculated with the blood and pulmonary exudate, and produced in three-months-puppies, local swellings mainly, with subsequent immunity. The mortality from the inoculation did not exceed 10 to 15 per cent. These losses imply that in certain cases the material inoculated conveyed the microbe of the disease, and the survivors acquired all that immunity which comes from a first attack. In the cases that show local lesions only, it may be presumed that few microbes or none were inserted, while the results came mainly from the toxins or antitoxins. This would be entirely in keeping with Lignieres’ observation that the blood and pulmonary lesions often failed to furnish the pathogenic microbe, as tested even by attempts at artificial cultures. The protection secured from the antitoxins alone is shortlived, terminating with the elimination of these elements, while that coming from the action of the toxins on the leucocytes, and the stimulation by these to the production of defensive products, is much more lasting and in ratio with the quantity of the stimulus introduced and the profundity and duration of its influence on the leucocytes. This may partly explain the occasional early exhaustion of the immunity and the reinfection of the animal within a year after inoculation.
Physalix working in Chauveau’s laboratory has found the best results from the use of weakened artificial cultures. He cultivated the microbe of Lignieres in peptonised bouillon having 6 per cent. of glycerine, and allowed successive cultures to rest (without reseeding a new culture fluid), after they have attained to their full growth. The strength of the culture is in inverse ratio to the period that elapsed between successive cultures, leading up to this one, and the first inoculation is made with the weakest product that will produce a very limited local swelling which is fully developed in 48 hours, and disappears in a few days. Three or four inoculations are made successively with cultures of gradually encreasing potency, after which immunity persists for years. It is to be understood, that an overdose will overcome the immunity at any time; also that the passage of a culture of lessened potency through a dog or Guinea pig will raise it to its original virulence. Physalix operated only on young dogs, that had not shed their milk teeth, and injected 2 to 3 c.c. of the culture as a dose with only 2.5% mortality. Others had less success.
Treatment. To secure good results in the treatment of distemper every attention must be paid to good hygiene. An open air life in summer, and a roomy, clean, well-aired, warmed building in winter are most important. Chills, foul air, and filth generally are to be carefully guarded against. Food should be moderate in amount, easily digested and nutritious. Milk is especially good (sweet, skim or buttermilk); then biscuit and milk, or in patients accustomed to animal food, lean meat, minced, scraped or pulped. Warm baths are often advantageous, but they must be given with great caution to avoid chill.
Medicinal treatment is largely symptomatic. An excessively high temperature (104° and upward) may be met by warm baths, or antipyretics—quinine, acetanilid, salicylate of soda, antipyrine, phenacetin, or even damp compresses to the sides. As a rule, however, it is not well to continue such agents as acetanilid, antipyrine or phenacetin longer than is absolutely needful to reduce excessive temperature.
Attempts have been made to check microbian proliferation by antiferments, such as quinine, calomel, creolin, phenol, and phenacetin. The tonic action of quinine specially recommends it but like all bitters it is obnoxious to a dog with a delicate stomach. Calomel is especially recommended by Fröhner as a gastric and intestinal antiseptic and its indirect action on the liver renders it valuable in many cases. Creolin and carbolic acid exhaled from saturated cloths tend to disinfect the air passages and give tone to the mucosa. My colleague Dr. P. A. Fish gave carbolic acid, 2 per cent., and afterward 4 per cent. in normal salt solution, and in doses of ½ to 1 drachm, subcutem once and twice a day. In the initial stages, it seemed often to be of great value, quieting the nervous excitement, improving the general symptoms, and in some instances apparently cutting short the affection. Trasbot recommended strong infusion of coffee, and Zippelius sodium chloride, while others gave ergotin, or better hydrogen peroxide in spray or as a draught.
Eliminative treatment. As in all depressing contagious diseases, we must favor elimination of the toxins, and in this case without risking any material encrease of debility. Calomel (7 grs.), sodium salicylate or benzoate (4 grs.), sodium bicarbonate (7 grs.), potassium iodide (4 grs.), chlorate (7 grs.), or nitrate (7 grs.) may be cited. Digitalis (1 gr.), strophanthus, or caffeine are especially recommended by their power of encreasing the tone of the heart when that has become weak or exhausted.
For the respiratory symptoms we may employ the antiseptic inhalations already named, or, in place of these, iodine or sulphurous acid. The nervous cough may be met by syrup of poppies, or anise, by morphia, or codeia. (Recipe: morphinæ hydrochloras 0.1 grams: aquæ amygdal. amar. 10 grams, aquæ distill. 150 grams. M. A teaspoonful three or more times a day. Fröhner). As expectorants, ammonium chloride (5 grs), or acetate, senega, or apomorphia (⅒ gr.), may be used. In vigorous subjects ipecacuan (½ to ¾ gr.), or antimonial wine (1 drop). Hydrogen peroxide in doses of a teaspoonful is often useful. Among counterirritants and derivatives the warm bath and cold compresses are especially valuable, or tincture of iodine, or camphorated spirit, or equal parts of aqua ammonia and olive oil serve a double purpose as furnishing at the same time an expectorant inhalant.
Special pulmonary complications must be dealt with on general principles as advised for the special diseases, bearing in mind always the profound prostration and the need to avoid depressing agents.
For conjunctival symptoms bathing with tepid water to soothe irritation and remove adhesions and crusts, may be followed by a drop of aqueous solution of pyoktanin (1:1000) under each lid, twice a day, or cocaine (3:100), or silver nitrate (½:100); may be used. Fröhner advises creolin (½:100); Cadeac, cresyl (½:100); Müller, mercuric chloride (1:2000) or boric acid (1:40). Other Collyria may be substituted (see diseases of the eye). In violent inflammations atropia will find a place and in ulcerations boric acid, silver, pyoktanin, calomel, or hydrogen peroxide. When irritation and rubbing are persistent a cocaine solution may be dropped into the eye every few hours. When the ocular troubles persist during general convalescence tonics with good nourishment and hygiene are demanded.
With digestive symptoms the attendant vomiting will usually have cleared the stomach of irritant contents. In the exceptional cases it may be unloaded by apomorphia (¹⁄₁₀₀ gr. subcutem), or ipecacuan wine a teaspoonful by the mouth. More commonly a check must be placed on persistent vomiting by bismuth nitrate (3 grs.), laudanum (5 to 10 drops), creosote (5 drops), or chloroform (5 to 10 drops), and small pieces of ice. A derivative to the epigastrium is sometimes useful. The food should be of the simplest and most easily digested kind, milk, meat-soup skimmed of fat, meat juice, scraped or pulped raw meat. Demulcents like gum water, slippery elm bark, or decoction of marsh mallow may be resorted to, and in case of extreme irritability nourishment may be given by rectal injection. As vomiting may be kept up by irritants in the intestines a tablespoonful of tincture of rhubarb may be required to be repeated twice a day until relief is secured. Calomel and chalk (1:12) in grain doses will sometimes serve a good purpose. Also dilute hydrochloric acid in water (1:60) in doses of a teaspoonful with pepsin, gentian, quinine or nux vomica will often contribute much to restore tone and function. Septic intestinal fermentations may be met with beta-naphthol, naphthalin, (7 grs.), chloral hydrate (10 grs.) lactic acid (buttermilk), or salol (5 grs.). The attendant fœtid diarrhœa may demand in addition opium or silver nitrate (½ to 1 gr.). The gastric secretion is usually suspended so that it largely passes into the intestines unchanged. Of course it should not be used along with muriatic acid.
The skin eruption is usually considered of little consequence, or, by some, beneficial (Cadeac). If treatment is desired it may consist in dusting powders, demulcent soothing dressings and perhaps stimulating liniments as found under skin diseases. It usually disappears with the elimination of the toxins and the restoration of vigorous health.
For the nervous symptoms treatment must correspond to the morbid phenomena. Extreme prostration may demand diffusible stimulants. Spasms and other indications of congestion may be met by cold to the head, and inhalations of ether, followed by potassium or sodium bromide (8 grs.), sulphonal (20 grs.), trional (15 grs.) chloral hydrate in mucilage, or hypnal (15 grs.). Paralysis must be met by tonics, stomachics, easily digestible, rich food, and good hygiene. Pepsin, muriatic acid, nux vomica (½ gr.), arsenite of soda solution (5 drops), arsenite of strychnia (¹⁄₂₀ gr); orexin(3 grs.), strong coffee infusion, wine, and electricity may be tried, in addition to stimulant liniments. Chorea must be treated on the same corroborant plan. Cold douches after which the patient is carefully rubbed dry are sometimes successful, (see Chorea).
During convalescence and in all cases of debility and anæmia a similar corroborant treatment is demanded. Pulped raw meat, rich soups, stomachics, tonics including the preparation of iron, and in extreme cases transfusion of blood or a normal salt solution may be resorted to.
In cats a parallel course of treatment may be pursued, allowance being made for the smaller size of the animal and the great susceptibility of the feline patient to phenol.