INFECTIOUS PARAPLEGIA IN SOLIPEDS IN EUROPE.
Definition: Infectious, non-febrile affection of solipeds with lesions of the genito-urinary mucosa and nerve centres, paresis and paralysis. History. Causes: Microbes varying; bacteria of colon group; infected urine, genital mucus, brushes, combs, rubbers, mares especially exposed; infection local or general. Lesions: Congestion, exudation, swelling, discharge from vulva, vagina, bladder, ureter, kidneys; lumbar spinal cord, brain. Symptoms: Mare, swollen open vulva, congestion and petechiæ, bloody mucus; horse, swollen sheath, pendant penis, congested papilla, discharge; paresis of hind limbs, falls, inability to get up, incontinence of urine; paresis of fore limbs, of thoracic muscles, asphyxia, fever in late stages. Recovery. Diagnosis: From hæmoglobinuria by absence of dietetic cause, the infectious progress and genital lesions. Prognosis: One-fourth to one-third die or fail to recover. Treatment: Antiseptic washes and irrigations of vagina, urethra, bladder, skin; internally oil of turpentine; slings. Prevention: Isolation, disinfection, separate attendants, litter, sponges, etc., fly nets, screens, insect powder, removal and disinfection of manure and garbage.
Definition. A contagious, non-febrile affection of solipeds, characterised by congestive and hæmorrhagic lesions of the genito-urinary mucosa, the spinal cord and its meninges, and by paraplegia or paresis of the hind limbs.
History. This was described in 1888 by Comeny, as occurring in a regiment of French cavalry. Other outbreaks have been observed in 1892 (Rancoule); in 1896 (Blin and Lambert). Earlier outbreaks have doubtless been confounded with cerebro-spinal meningitis, hæmoglobinuria or simple paraplegia, the genito-urinary symptoms having been overlooked or viewed as secondary.
Causes. The disease, as hitherto observed, has been invariably associated with microbian infection of the genito-urinary mucosa, but no one microörganism has been found to be constantly present. In the 1888 cases, Nocard isolated from the kidneys and lumbar cord a small, motile bacillus which was not stained by Gram’s method and the inoculation of which proved fruitless. Zschokke, in 1889, found in the kidneys, lungs, liver and spleen of both horses and cattle, the victims of a progressive infectious paralysis, a bacterium coli commune 1.5μ long by 0.7μ broad, which stained in methylin blue and grew in agar and gelatine, and when inoculated under the skin of a goat provoked paralysis. It had no effect on a pig. In keeping with this, Thomassen, in 1893, alleged that the bacillus coli communis in certain conditions, when colonized in the solid organs, produced a toxin which caused paresis and paraplegia. Blin and Lambert, in 1896, found in the urine, in pure cultures, a short ovoid microbe, motile, non-liquefying and bleached by Gram’s solution. It grew on gelose and peptonized gelatine as a creamy surface layer which did not extend into the medium, and assumed a brownish color as it became older. On potato it formed a superficial bright yellow film. In bouillon the surface film which formed gradually precipitated to the bottom of the vessel.
This microörganism was not found in the blood, liver, muscles nor spinal cord.
Inoculation into the pleural cavity of the horse induced pleuro-pneumonia.
The contagion appears to be transmitted through the urine and morbid discharges of the urino-genital canal, falling on the litter and floor and thus contaminating the tail, and indirectly the generative organs. The brushes, combs and rubbers used on one horse after another are similarly incriminated. The mares, having a wider exposure to infection, appear to suffer most. Comeny saw eighty sick mares to twenty-eight horses, and the mortality was thirty-four mares to three horses. The smallness and length of the male urethra and its frequent flushing throughout its whole length with urine seems to give a greater measure of immunity to the horse.
In the Blin and Lambert cases the indications pointed to a local infection and to the presence in the spinal cord of the toxins alone. It may be assumed that in such cases there was a purely local infection. In the Zschokke cases on the other hand, with microbian infection of internal parenchymatous organs the presumption is that the paralysis was due to a totally different infection, as appears to be further indicated by the morphology of the microbe. They may have been, however, but the advanced and generalized stages of a primary local infection.
Lesions. These appear to vary with the progressive advance of the malady. In an ass which was killed as soon as paraplegia appeared and the necropsy made at once, the lesions were confined to the vulva, vagina and bladder. In advanced cases the ureters and kidneys are visibly involved together with the spinal cord, especially in the lumbar region, and in certain instances the brain.
The vulva is swollen, held habitually open so as to expose the erect clitoris; the mucosa is irregularly swollen and petechiated, and there is a glairy or bloody discharge. The swelling usually extends to the inner side of the thighs, the mammary glands and the adjacent wall of the abdomen. The vaginal mucosa is congested, swollen so as to bulge irregularly at intervals and covered with a glairy muco-purulent matter often mingled with clots of blood. The urethra and bladder are red and congested, with marked thickening and ecchymosis of the mucosa and an abundant serous exudate which extends into the muscular and peritoneal coats as well. Minute extravasations are found in the two outer coats and petechiæ of the serosa is the rule. In fatal cases the ureters and kidneys are involved, the renal parenchyma is greatly congested and softened, the cortical part especially being of a dark red, and the glomeruli distinctly enlarged. An oily sanguineous liquid can be squeezed from the cut surface. The lumbar portion of the spinal cord together with its meninges, is congested and arborescent, and in bad cases this may extend upward to the head and involve the brain and its coverings.
There is general congestion of the venous system with black blood, especially noticeable in the arborescent lines on the inner surface of the skin and in the serosæ, and the liver and spleen are gorged with black blood, which, however, reddens on exposure to the air. Muscles and parenchymatous organs may show a parboiled appearance. In the male the swelling appears about the sheath and penis, the papilla, the urethral mucosa and that of the bladder are deeply congested and petechiated, and the kidneys and medulla may be implicated as in the mare.
Symptoms. In the mare the early symptoms are the swelling and gaping of the vulva, with the muco-purulent or sanguineous discharge and the presence of redness, congestion and petechiæ of the mucous membrane.
In the horse there is swelling of the sheath and a pendant condition of the penis, which in its turn may be irregularly reddened and swollen, and the papilla and orifice of the urethra are deep red and angry.
Most commonly these early local symptoms are overlooked until attention is drawn by some lack of control of the hind quarters. When moved the animal sways or staggers behind, knuckles forward at the fetlocks and drags the toe along the ground. This weakness encreases, and although for a time the animal can stand steadily, he is liable to fall when we make him take a step, and when down he will require help to get up. In advanced stages the animal remains recumbent and cannot be made to stand even with help, the fore limbs have become implicated in the paralysis, and in the end the respiratory muscles are involved and the patient dies asphyxiated. This marks the occurrence of severe lesions in the medulla oblongata. Incontinence of urine is a frequent symptom. Fever usually sets in, in advanced cases. Recoveries may take place from the first and second stages, the control of the muscular system improves, the animal lies down and rises with greater ease, the drooping penis is retracted within the sheath, incontinence of urine ceases, micturition becoming less frequent and more abundant at a time, and finally muscular control becomes once more perfect. Convalescence may be complete in eight days if it begins early, while it may require two or three months when the disease has been more advanced.
Some subjects survive without overcoming the paralysis, so that they simply eat their heads off if preserved.
Diagnosis. From hæmoglobinuria this disease is to be distinguished by the history which fails to show its supervention on a period of hard work and high feeding, followed by one or more days of rest and then sudden exercise; by the swelling ecchymosis and discharge from the vulva or sheath, and by the occurrence of several cases in animals that have had an opportunity for a common infection. In case of death the condition of the kidney, bladder and urethra, and the marked congestion of the lumbar portion of the cord is significant, the congestion, petechiæ and extravasations are deeper and the glairy discharge is present.
Prognosis. From one-fourth to a third of the animals attacked either die or are rendered permanently useless.
Treatment. Antiseptic washes and irrigations of the genito-urinary passages, and the adjacent parts, if employed early enough, would tend to abort the disease. Even if resorted to later, they would be of some value in limiting the multiplication of the microbe and the absorption of its toxins. For this purpose boric or salicylic acid, salicylate of soda, permanganate of potash, or silver nitrate may be taken as examples. They should be as thoroughly applied as possible, the bladder being thoroughly evacuated and injected several times a day. As internal medication, oil of turpentine and other stimulant antiseptics that are eliminated by the kidneys might be tried in small doses frequently repeated. Keep in slings. The patient that cannot stand up is lost.
Prevention. This consists in isolation of the healthy, thorough disinfection of the stalls, gutters, combs, brushes, rubbers, blankets, and the hands of attendants. Litter used for the sick should be burned and manure piles secluded and disinfected. Even flies are to be dreaded, so that darkness in the stable, fly nets, fly screens, and insect powder and other means of insect destruction will be in order. Sponges and other means of dressing should not be used indiscriminately on different animals.