The condition of the urine has, however, always drawn especial attention and the names red-water and hœmoglobinuria have accordingly been largely applied to the disease. When, in infected areas, the milder types of the disease have failed to show red-water (Jamaica), the identity of the affection with Texas fever has even been denied. Shortly after the rise of temperature, the urine becomes turbid, and this gradually encreases to a more or less deep red. It assumes its darkest hue when the destruction of red globules is most active and during convalescence it disappears. The suppression of urinary secretion may account in some cases for the absence of this symptom even at the crisis of the fever, yet, as a rule, it is present at such time, and, even though it may have escaped notice during life, the red-water is found in the bladder at the necropsy. It may be of all grades, from the merest tinge of redness to a reddish brown, coffee-grounds, or blackish aspect. The coloration is not due to red globules, but to the hæmoglobin which has escaped from the disintegrating globules, and been eliminated by the kidneys. It is always associated with albumen, and, in the advanced stages and during convalescence, when the elimination of hæmoglobin has ceased, that of albumen continues in small amount for weeks.
The thin, watery appearance of the blood when the disease has reached its height, is constant and even more characteristic than the red-water. A single drop drawn from the skin will show to the naked eye the pale, thin, transparent appearance, but examination under the microscope will confirm this. It remains, too, for a length of time, being recognizable for a month in cases of recovery. In connection with the watery blood, the mucosæ and the muzzle (if naturally white) assume a pallid aspect. This is best marked in the absence of icterus, yet even with the yellow discoloration, the absence of ramifying red vessels is very characteristic.
The bowels are at first constipated and the fæces passed in small, hard balls. Later they may assume a reddish brown or chocolate color, and a covering of mucus and fine blood clots. Diarrhœa supervenes in some cases. In passing the fæces, the everted mucosa usually shows a dark red color.
Course and Duration. Acute cases, above all if traveled or otherwise excited, may terminate in death in 24 to 48 hours. More commonly death will take place in 4 to 7 days. Some patients survive longer, but owing to the extraordinary loss of blood globules and the lesions of important solid tissues they are unable to rally, become steadily weaker and perish in from two weeks to three months. Such animals are pale and bloodless, weak on their limbs, careless of food, and encreasingly emaciated. The pulse is weak and irritable and the eyes sunken. The temperature becomes normal or nearly so, soon after the suspension of the hæmoglobinuria. In cases of recovery there remains for a month or more an unnatural pallor, with marked loss of condition and weakness which are only gradually overcome. Convalescent animals are liable to die of indigestion when overfed.
The mortality averages not less than 90 per cent. in susceptible mature cattle from a healthy district in the hot season. Later, from October onward, the tendency is to a milder type of disease and a greater ratio of recoveries.
Symptoms of the Mild Type. This is seen mainly in cattle indigenous to the Texas fever district, in sucking calves, and in mature cattle from healthy districts but attacked during the cool or winter season. It can be produced at will by placing a limited number of ticks (5 to 20) on the skin of susceptible cattle, especially in the cool season. Again, it occurs as a relapse in cattle that have survived an attack earlier in the season.
Though there are all gradations from the violent type, yet we may set down as mild all cases in which the temperature does not rise above 105° F., running frequently about 103° F. There is loss of appetite, dulness, languor, costiveness, scanty urine, albuminous but not hæmoglobinuric, pallor of the mucosæ, and marked loss of condition. Examination of the blood shows the presence of the parasite in the red globules but usually in the coccus or round form only, and the destruction and disappearance of the globules is much less marked so that, though the blood is anæmic and watery, it is not nearly so much so as in the violent and fatal cases. Without the examination of the blood it may be impossible to distinguish these cases from other febrile affections, yet occurring as they do in the infected district in a number of animals at once, in the cooler season, and showing albuminuria, and marked anæmic symptoms, they should lead to suspicion and a search for the boöphilus on the skin, and the oligocythemia and the protozoa in the blood.
Differential Diagnosis from Anthrax. As anthrax is the one disease with which Texas fever is most likely to be confounded, it may be profitable to collect in tabular form their differential features:
| Protozoan Cattle Fever. | Anthrax. |
|---|---|
| A disease of given districts, wooded, swampy, uncultivated, and places where cattle from these districts are taken. | Prevails in rich, swampy impermeable soils: not permanently implanted on open well drained lands. |
| Always shows Boöphilus, minute or mature, on the skin of the patient. | Has no essential connection with the Boöphilus: latter usually absent. |
| Extends in warm season, as the Boöphilus from an infected district is introduced. | Practically never conveyed by the Boöphilus. |
| Can be carried by the Boöphilus apart from cattle. | |
| Infection destroyed by winter frost above 35° of N. latitude. | Infection not destroyed by winter frosts. |
| Attacks bovine animals only. | Attacks mammals, generally, especially herbivora. |
| Lapse of 5 to 6 weeks after introduction, for tick development, precedes outbreak. | Outbreak may occur at once after introduction of infection. |
| Confined mainly to summer season. | Occurs at any season: most prevalent in summer. |
| Sucking calves nearly immune. | Sucking calves susceptible. |
| Mucosæ become increasingly pale; icteric in violent attacks. | Mucosæ dusky brownish red, not pallid, nor icteric. |
| Urine red or blackish in acute cases at height of the disease. Hæmoglobin. Albumen. | Urine exceptionally red: blood globules, in some cases. |
| Blood becomes increasingly thin and watery: Oligocythemia. | Blood becomes thick, tarry, incoagulable; not watery nor oligocythemic. |
| Blood reddens more or less in air: then becomes darker. | Blood reddens little, or not at all on exposure. |
| Spleen greatly enlarged, purplish, often firm: pulp reddens slightly in air. | Spleen greatly enlarged; pulp very dark does not redden in air. |
| Liver enlarged, congested, often yellow, with fatty and necrotic areas: remarkable yellow injection of radical bile ducts. | Liver enlarged, congested, dark red or violet. |
| Bile abundant, thick, tarry. | Bile fluid. |
| Kidneys pale, or congested, black. | Kidneys congested. |
| Lymph glands slightly enlarged, petechiated or (rarely) hæmorrhagic. | Lymph glands enlarged; often hæmorrhagic, black; peripheral œdema. |
| Pallor in violent cases, in plethoric, icterus of tissues, especially of white ones. | Tissues generally reddish, bloodvessels dark, prominent. |
| Muscles in acute cases mahogany colored. | Muscles pale, grayish, unless they are seat of congestion or extravasation. |
| Blood and its red globules show the pyroplasma in different forms. | Blood shows bacillus anthracis, but no pyroplasma. |
Treatment. Up to the present medical treatment has been essentially unsatisfactory. Lignieres gave quinia sulphate in large doses by the mouth, and in doses of 2½ drams subcutem daily, before and during infection without any visible effect on the progress of the disease. Methylene blue to (¾ to 1¼ dr.), salicylate of soda (7½ drs. daily), arsenious acid (1¼ dr. daily), cacodylate of soda (7½ grs. subcutem) were also tried with no good result. The Metropolitan Board of Health, New York, claimed a succession of recoveries under the use of carbolic acid in the drinking water and sprinkled on the ground so that the animals inhaled it. The cases were, however, the survivors after the first and more acute cases had perished, and the results no doubt depended largely on the mildness of the attacks. The same agent in other hands has not been equally successful. A large number of other agents have been used in vain.