A hand-book on tuberculosis among cattle, with considerations of the relation of the disease to the health and life of the human family, and of the facts concerning the use of tuberculin as a diagnostic test

Front matter

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Preface

This book is an evolution, its germ being an assignment to me as a member of the Boston " Herald " staff, to cover the work of the Massachusetts Cattle Commission in its attempt to control bovine tuberculosis. As I became familiar with the work, I was impressed with its importance, and with the fact that the general public had but meagre and imperfect information on the subject.

Accordingly, I attempted to gather and arrange the observations and experiences of those engaged in similar work, with the purpose of using it as a newspaper article for the better information of the public. I did not aim to instruct professional men ; nor did I especially design to influence the relatively small proportion of the public who are producers of meat and dairy products. My conviction was that the great mass of consumers — the general public — had the largest interest in the matter, and to arouse their interest, and to supply them with reliable information, was my purpose.

viii PREFACE.

The article was prepared and published ; and it was so well received and so warmly commended by the medical and veterinary profession, that I was encouraged to enlarge and complete it for publication in a permanent form.

In doing this work I have been most cordially assisted by Drs. Frederick H. Osgood and Charles P. Lyman, of the Massachusetts Cattle Commission and the Harvard University Yeterinary School ; and they have been kind enough to revise and approve the matter herewith presented.

I am also under obligation to the United States

Bureau of Animal Industry, and to Professor

J. L. Hills of the Vermont Experiment Station,

for permission to reproduce the illustrations in this

volume.

THE COMPILER.

Boston, March 1, 1895.

Contents

Chaptee Page

List of Principal Authorities ix

Introduction 1

Chapter I. General Prevalence Of The Disease

Notwithstanding the prominence which this disease has attained in the public mind during the last two years, there is yet a very indefinite and meagre idea of its true proportions. In very many minds tuberculosis and '' consumption " are considered the same, while in fact " consumption " is only one of several forms of tuberculosis. The old and indefinite term " scrofula " is more nearly a synonym ; but even this fails to convey the whole truth. Cholera infantum, cerebro-spinal meningitis, convulsions in children, and nearly a score of other ailments, are all attributed to this one cause. Dr. N. Senn says : " The frequency of tubercular affections is something appalling. At least one person out of every seven dies of some form of tuberculosis. Most of the large hospitals contain from 25 to 50 per cent of patients afflicted with this disease. The ravages of the disease are to be seen everywhere, in the shape of disfiguring scars of the neck, deformed limbs, and bent spines. Health resorts, frequented for years by tubercular patients, have become infected to such an extent that there is great danger of the whole population becoming exterminated by this disease. The sources of infection in such places have become so numerous that it is unsafe to breathe the air. to drink the water, or to eat the food prepared in houses which for years have been hot-beds for the bacillus of tuberculosis, and by persons carrying the microbe upon every square inch of their surface. That whole communities and nations, where this disease has been prevalent for centuries, liave not been completely depopulated long ago is owing to the fact that many persons possess, from the time of their birth, a degree of resistance to infection that even the direct infection by inoculation would prove harmless."

Dr. Senn also says : "• That large class of illdefined lesions which were grouped under that indefinite and vague term 'scrofula,' in the text-books of but a few years ago, have been shown by recent research to be identical with the recognized forms of tuberculosis, etiologically, clinically, and anatomically."

In another chapter he says : " It is but a few years since it was thought impossible that any other organ than the lungs should be the seat of tuberculosis. The different forms of surgical tuberculosis . . . were not correctly understood until quite recently, and consequently a rational surgical treatment was out of the question. Almost all the localized tubercular processes were included

GENERAL PREVALENCE OF THE DISEASE. 7

under the general term ' scrofula/ and were regarded as local manifestations of a general dyscrasia, and treated in accordance with this view of their pathology. The discovery of the bacillus of tuberculosis has rendered the word ' scrofula ' obsolete, and has assigned to the tubercular processes in the various organs and tissues of the body their correct etiological and pathological significance, and prepared the way for their successful surgical treatment. There is hardly a tissue in the body which may not become the primary seat of tubercular infection, or which escapes when diffuse dissemination occurs through the medium of the general circulation."

Professor Boyce includes in his discussion of tuberculosis the following diseases as belonging in the class : cholera infantum, cholera morbus, diarrhoea, dysentery, hydrocephalus, tabes, and phthisis.

Dr. Clark, of the Medford (Mass.) Board of Health, at a legislative hearing in 1892, said that in ten years there had been between 190 and 200 deaths from " consumption, or tuberculosis," in the town ; the next greatest cause of death was " heart disease," with between 90 and 100 deaths. These designations of disease are very indefinite, but the figures show an alarming preponderance of the disease we are considering.

In a hearing before a committee of the IMassachusetts Legislature, in February, 1891, Dr. Ernst said of the disease : " It is not confined, as is popularly supposed, to the lungs. Tuberculosis of the lungs is commonly known as ' consumption ' ; but it occurs in all parts of the body, — as surgical tuberculosis of the joints, as tuberculosis of the membranes of the abdominal organs, as the localized skin disease called ' lupus,' which is precisely the same thing as tuberculosis occurring elsewhere, except that it is located in the skin, and as the dreaded disease called ' leprosy '; ... for leprosy, I have little doubt, will within a short time be included under the head of tuberculosis."

Those who have most carefully considered the subject are now practically agreed that tuberculosis is by far the most fatal disease in the human family. Their opinion is thus summarized by Dr. Law : —

'' Tuberculosis is equivocal and underhand in its method, slow and uncertain in its progress, and on this account escapes recognition, and proves by far the most deadly of any single disease attacking the human family. The average ratio of deaths from tuberculosis to the total mortality is 14 per cent, or one death in every eight, while under special conditions it rises to one in three. . . . But the deaths from tuberculosis being constant and uniform, people accept them as inevitable, and fold their idle hands in true Mohammedan fatalism, instead of boldly exposing the hidden death-trap, and cutting short its destructive work.

" If the 5,490 deaths from tuberculosis which occur every year in the city of New York could be

GENERAL PREVALENCE OF THE DISEASE. 9

brought together in an epidemic lasting but one week, no small-pox, cholera, nor yellow-fever scare would approach the panic which would thus be created, for when did all those diseases create such mortality in this city ? Nay, if we take the whole civilized world, and compare with the tuberculosis mortality all the accumulated deaths from war, plague, cholera, yellow-fever, and small-pox, we find that the latter are comparatively very insignificant. Yet tuberculosis, like every germ-disease, is absolutely preventable, and is allowed to continue its career of death only because of reprehensible, ignorant, and criminal indifference."

Professor Hills and Dr. Rich say : " When conditions have favored its spread, tlie death-rate from tuberculosis has been as high as 50 per cent of all mortalities. Many of the fatal bowel troubles of infants have their origin in tubercular infection. An article in the ' Archives de Medecine ' says that ' of the population of the globe three millions die annually of consumption.' "

Dr. Abbott, at a hearing before a Massachusetts legislative committee, stated the annual number of deaths per 10,000 inhabitants in tliat State from tuberculosis to be, from 1870 to 1879, 33.4 ; from 1880 to 1889 it was 29.7. Of the apparent decrease he said : " 1 do not, and I think that the physicians generally do not, take that as an indication that the causes of consumption or tuberculosis are less {)revalent than formerly. I do think that the intelligence of the people as to the promotion of consumi)tion, and that it is an infectious disease, is one of the explanations of this variation."

Dr. Lagneau, a noted French authority, compiled the statistics of 602 localities in France, to show that the more dense the population the more prevalent is tuberculosis. The per cent who die annually from tubercular phthisis to every one thousand inhabitants appears as follows : —

Ninety-five cities, with less than 5,000 inhabitants, 1.81. Three hundred and thirty-two cities, with between 5,000 and 10,000 inhabitants, 2.16. One hundred and twenty-seven cities, with between 10,000 and 20,000 inhabitants, 2.71. Fifty cities, with between 20,000 and 30,000 inhabitants, 2.88. Forty-six cities, with between 30,000 and 100,000 inhabitants, 3.05. Eleven cities, with between 100,000 and 430,000 inhabitants, 3.63. Paris, with 2,424,703 inhabitants, 4.90.

Lehmann, of Copenhagen, gives as the results of the total deaths in that city for a period of twenty years, from revised death certificates, the following as the per cent of deaths from tuberculosis at different ages, with sex division : —

Age. Male. Female.

GENERAL PREVALENCE OF THE DISEASE, H

He remarks, in commenting on his tables, that in the female sex from fifteen to forty-five years of age, every third person died of tuberculosis.

Wahl of Essen furnishes similar tables from that city, showing the per cent of total deaths resulting from tuberculosis as follows : to 5 years of age, 3.7 per cent ; 6 to 20 years, 23.1 ; 21 to 40 years, 35.1 ; 40 to 60 years, 34.7 ; over 60 years, 12.8. The average for all ages is 15 per cent.

Dr. Salmon writes of the history of the disease that it has been known for many centuries, and legislative enactments having reference to the destruction of affected animals, and forbidding the use of the flesh, date far back into the Middle Ages. He says : " The opinions entertained regarding the nature and cause of the malady varied much in different periods, and very markedly influenced the laws and regulations in vogue. Thus, in the sixteenth century, the disease was considered identical with syphilis in man. In consequence of this belief very stringent laws were enacted, which made the destruction of tuberculous cattle compulsory. In the eighteenth century this erroneous conception of the nature of the disease was abandoned, and all restrictions against the use of meat were removed. Since that time, however, the tide of opinion has again turned against the disease."

The Vermont Experiment Station Bulletin defines tuberculosis as a general name for a class of diseases which attack various organs, and wliich both man and animals readily contract. It states that the human death-rate from the disease in its numerous forms is one in four of the total, and that its extent among cattle cannot be accurately stated, owing to a lack of systematic inspection.

Professor Walley writes : '' Tubercle is a visible local manifestation of a constitutional diathesis, ' scrof ulosis.' While this proposition is in the main correct, it must not be assumed that tubercle does not originate independently of the constitutional condition known as ' scrofulosis.' From a variety of causes, or rather from a concatenation of circumstances (not yet distinctly understood), tubercular inflammation may be established, and the usual local manifestation (tubercle) be produced ; and in different ways tuberculosis can be originated in the systems of animals in which not a trace of scrofula is to be discovered."

Of ihQ gravity of the disease, Professor Walley says : '' Looking at an individual tubercle, we might be led to despise its comparative insignificance, and to ignore its deadly meaning ; but when we see thousands upon thousands of these knots existing in the organism of a single animal, a truth is forced upon our minds which we cannot refuse to recognize, — namely, that we have to deal with an insidious, implacable, and deadly foe. And, independently of its ultimate fatality, I think I may with safety reiterate what I have before asserted, that no morbid substance known to the pathologist is so

GENERAL PREVALENCE OF THE DISEASE. 13

protean as tubercle in the number of functional derangements to which it gives rise. . . . He does not take into account the vast deterioration, the slow but certain decimation of many of our best herds, the destruction of human food, the danger — not, as it is now proved, chimerical or hypothetical — to human life and human comfort, and the insidious progress of that fell destroyer, tubercle. The other three bovine scourges sweep their victims off in a manner which is seen by all ; but the ravages of tubercle are only realized by those whose duties are connected with the public abattoirs, or who are called upon to act as arbiters on the nature of disease." It is a sad commentary on the above that within a few weeks, and after it was copied from his work, Professor Walley himself has died from the disease, acquired three years ago by inoculation in connection with his profession.

The frequent failure of proper diagnosis, and the carelessness with which death-returns are often made up, seriously complicate any attempt to definitely show the real prevalence of this disease. It appears in numerous and varied forms in the human subject ; and while a physician might be aware that they were all referable to tuberculosis, the general public has no knowledge that even suggests this fact. The list of locations of the disease in the animal body, elsewhere given, suggests something of the carelessness that is possible in defining the disease.

14 TUBERCULOSIS AMOXG CATTLE.

In a recent discussion by the Massachusetts Association of Boards of Health, the matter of deathcertificates was discussed, and there was general agreement of opinion that there is much need of a greater degree of accuracy. Dr. William Y. Fox, of Taunton, presented statistics showing that in his city, from 1889 to 1893 (four years), there were defective certificates in about 22 p>€r cent of the entire record. That Taunton is not alone in this direction he showed by citing other returns, from which it appeared that in 1893 Haverhill had 14 per cent of worthless certificates, Worcester had 1- per cent, Woburn 15 per cent. Lawrence 18 per cent, Newton 11 per cent, Marlborough 14 per cent, and Xew Bedford 19 per cent. It is quite clear that the public will remain ignorant of the real extent of the effect of tuberculosis until its numerous and varied forms of manifestation are better known through increased attention to correct diagnosis, and through general education on the subject.

CHAPTER IT.

THE DISEASE IN THE LOWER ANIMALS.

Experiments carefully made and widely observed show that tuberculosis affects a far wider range of animals than any other disease. Horses and sheep are popularly supposed to be free from infection, under ordinary conditions, but they can readily receive it by inoculation.

On the other hand, fowls, cats, guinea-pigs, rabbits, swine, and neat cattle are very susceptible to the disease, either by natural or artificial infection. While nearly all domestic animals may take on and impart the disease, fowls, swine, and cattle are recognized as most dangerous, from their favorable conditions for its dissemination.

Until the discovery, in 1891, of the efficacy of tuberculin as a detective of the disease, there was no possibility of ascertaining to what degree it prevailed in live animals. The statistics from the slaughtering establishments are of little value, because of the varying regulations in different countries. Eeports from European countries represent a wide range, — Eadcn showing only 2 per cent of disease found at the abattoirs, while France reports

5 per cent. On the other hand, Paris reports 6 per cent, HoHand 20 per cent, Pomerania 50 per cent, and Hanover 60 to 70 per cent. Such variations cannot be due to differing conditions so much as to local regulations and inspection requirements.

Professor Hills and Dr. Rich, after alluding to the conditions which make it impossible to secure positive data on this subject, say : —

" Probably many of the estimates given by various authors are based on faulty or insufficient data. The following examples may serve to some extent to indicate its prevalence. The extremes are wide, being from 2 per cent (among 2,273,547 cattle, mostly steers killed in the meat inspection districts of the United States from May 15, 1891, to March 1, 1892) to 60 or 70 per cent (at Hilderstein, Hanover, according to Haarstick). In a large number of German abattoirs it is stated that 6.9 per cent of the cows, 3.6 per cent of the steers, 2.6 per cent of the bulls, and 1 per cent of the young stock were tuberculous. Of 1,270,604 animals slaughtered in German abattoirs from October, 1888, to October, 1889, 26,352, or 2 per cent, were tuberculous. Careful post-mortems by skilled veterinarians showed 12 per cent of tuberculous animals out of 12,000 slaughtered in England as affected or exposed to contagious pleuro-pneumonia (a disease entirely distinct from tuberculosis). In seventeen counties in New York State the inspectors of the State Board of Health found 3.4 per cent of tuberculous cattle out of

20,000 inspected. Cattle slaughtered at Baltimore were found tuberculous to the extent of from 2.5 per cent to 3.5 per cent, while of 1,153 cattle from the Eastern States (mainly New England), slaughtered at Brighton, Mass., 52, or 4.5 per cent, were tuberculous. Doctors Salmon and Smith state that ' it is not far from the truth to assume . . . that one of every fifty head of cattle in the more densely populated areas of Europe and America is tuberculous.' Dr. Salmon states yet later, however, that ' the ideas in regard to the prevalence of tuberculosis have been radically changed by the facts brought out in using tuberculin.' "

As long ago as 1890 it was determined that 4.5 per cent of cattle slaughtered at Berlin were tuberculous, while one abattoir in Upper Silesia reported 9.5 per cent.

Professor J. J. Mackenzie, in discussing tuberculosis in a paper printed in 1892, said : "That the disease is common in cattle needs no specific proof from me. We may accept it as more than probable that in ordinary milch cows in the provinces [Dominion of Canada] the percentage of animals affected may reach six per cent : that, at any rate, has been shown to be the case in countries where exact data have been obtained. In the expensive in-bred stock, such as the Jerseys, the percentage is higher, — so high in fact that it is very startling to think of."

The chief of the Bureau of Animal Industry for

Maryland reports that of cows killed for beef in the Baltimore slaughter-houses about 3.1 per cent proved tuberculous. In six months, so long ago as 1889, he inspected 122 stables supplying milk to Baltimore, with 1,611 cows, and found 11.3 per cent to be badly tuberculous. This was by physical examination only ; later experience with tuberculin suggests that its use then and there would have revealed a far more serious condition of affairs.

The experience of the Massachusetts Commission in the work brought to them through the local inspectors in cities and towns indicates a much wider prevalence of the disease than appears at Nantucket. The local inspectors are required to examine all the cattle in their districts twice each year, and to report all cases suspected of tuberculosis to the Commission. All cases thus reported are tested with tuberculin by the expert agents of the board. Under this system some large herds have been almost entirely destroyed. In each of two herds, one near Boston and tlie other in the Connecticut River valley, of 65 animals each, 60 were killed from each herd, and all showed the disease on autopsy. In several other large herds fully one half were taken. In this department of their work the Massachusetts Commission has found nearly all the animals condemned to show the disease in very pronounced and advanced forms.

In connection with the report of Professor Ernst and Dr. Peters to the Massachusetts Society for

Promoting Agriculture, of their work in investigating the transmission of tuberculosis by means of milk, the latter gentleman especially discusses the prevalence of bovine tuberculosis. He quotes Fleming's Manual of Veterinary Sanitary Science or Police : " Tubercular phthisis, or tuberculosis, probably prevails among the domesticated animals over the entire globe, though its frequency will depend upon various external influences, as well as the constitutional tendencies of different species and breeds. ... In Europe, particularly in the cow-sheds of the larger towns and cities, it is extensively prevalent, and in this country [England] it has long been recognized as a common disorder among animals, but more especially as affecting the bovine species."

Professor Walley counts contagious pleuro-pneumonia, rinderpest, foot-and-mouth disease, and tuberculosis as the '' four great bovine scourges," and Dr. Peters says the last named is the only one " staring us in the face, and challenging us to combat, if we are not afraid to grapple with it."

In connection with his work. Dr. Peters sent out about 350 circulars to veterinarians in various parts of tlie United States, asking as to the frequency or infrequency of tuberculosis in their practice. Only 79 replies were received. Of these, 21 had no cattle practice, 19 reported " no cases," and only 39 reported any contact with the disease. From the last class, in seventeen different States, most of them reporting for one year only, 549 cases were reported, with 242 suspicious cases, — a total of 791 in 165 herds containing about 3,000 animals ; that is, where the disease existed, about 18 per cent were diseased, with 8 per cent suspicious, — a total of 26 per cent. It should be borne in mind that all these reports were based only upon physical examination. What would be the result if tuberculin were applied to these herds, is a matter for grave consideration.

The New York State Commission on Tuberculosis in Cattle, in their report to the Legislature, January, 1895, say: '^ During the short time since its creation this Commission has carefully studied, by a system of special inspection, the prevalence, distribution, mode of infection, and general behavior of tuberculosis in cattle, confining part of its work to a given area which was thought to be comparatively free from general infection from other sources. In this district 947 animals were examined, and out of this number 66 were condemned and slaughtered. A dissection of each animal showed it to be tuberculous, showing 6.96 per cent diseased ; and it is believed that this is a fair average if the State were taken as a whole. ^ A large proportion of these animals were common stock, which fact controverts the opinion, which obtained very generally hitherto, that common bovine animals have immunity from tuberculosis. Tuberculosis is not a respecter of breeds. The disease once introduced into a herd spreads with certainty, throughout, and with a rapidity proportionate to the unsanitary surroundings. Cattle kept in well-ventilated stables, with free admission of sunlight, are less prone to the disease, while those kept in dark, ill-ventilated stables, amid hlth and unsanitary environments, develop the disease rapidly, once it is introduced."

Dr. J. F. Winchester, of Lawrence, Mass., a veterinarian, and in 1888 a member of the State Cattle Commission, collected all attainable information on the prevalence of the disease in this State. In the report of the Board of that year, his results are given, showing that reports from thirty -four farms, with 886 animals, showed 243 animals, or 28 per cent, killed as diseased, and 189 animals, or 21.33 per cent, ''suspicious." On fifteen other farms, with 244 animals, he found over 11 per cent by physical examination showing symptoms of the disease, beside 10 per cent " suspicious."

The Tuberculosis Committee at the Veterinary Congress of America, in connection with the Chicago Exposition, 1893, in discussing the indefiniteness of statistics of the disease, said : '' We have no regular inspection of herds nor a complete inspection of meat. It is only possible to glean facts relating to the extent and distribution of the disease incidentally, when cattle are examined with other ends in view. Even if we had an organized inspection of herds, the result of such an inspection would not teach us how much tuberculosis is present among our cattle, because the disease is notoriously hard to discover in the living animal, except when advanced ; and breeders and farmers wlio have had some experience with it are clever enough to remove animals that show the first suspicious symptoms. It is only by an extensive examination with tuberculin, or a thorough and well-organized system of meat inspection, that reliable statistics can be obtained."

This committee, in discussing the dangers from the disease, place its transmission through the meat and milk to man as first, and its transmission among cattle as second in importance.

Occasionally \hQ statement appears that there is less of tuberculosis, human or bovine, now than there was a score or two of years ago. That this is a superficial and unfounded idea appears from the fact that Professor Walley, in 1874, quoted the Veterinary Record of 1847, in its allusion to a case of tumors of bovine tuberculosis as " similar to some we have occasionally seen," and saying, " On this subject our English veterinary authors are silent, and we believe the above to be the only case of the kind recorded." That the post-mortem appearances of the disease were unknown to English veterinaries of half a century ago argues that the disease itself was practically unrecognized. It is also true that at no very remote time medical men made no distinction between syphilis and tuberculosis ; and it is less than a quarter of a century since glanders and tuberculosis were considered the same disease. Professor Walley committed himself to this statement in 1872. These facts justify the conclusion that there are no statistics covering any considerable period that are of any value as a basis of comparison as to the prevalence of the disease.

Bulletin No. 27 of the Hatch Experiment Station of the Massachusetts Agricultural College, issued in December, 1894, gives a history of tuberculosis in the College herd, from which it appears that even at this presumably well-informed institution, in the year 1871, a well-defined case of the disease failed of recognition. On post-mortem examination, ''it was found that the pleural surface of the thorax was thickly studded with large and small nodular growths, some of wliich were filled with pus and others with caseous or calcareous material. The true nature of these excrescences was not recognized. No one even suspected that they were the result of disease, but regarded them as an abnormal growth and a curiosity."

Two years later another animal died, of which the Annual Report says : '' The disease was a most obscure one ; but her trachea, lungs, liver, ])lcura, and whole thoracic cavity, w^ere affected with a morbid growth, apparently of a scirrhous nature. . . . In this connection I may mention that by many cow-doctors the symptoms were referred to horn-ail ; and it was only with the greatest difiiculty that I prevented the most zealous from boring the suffering creature's horns and stuffing them with cayenne pepper, spirits of turpentine, and other soothing preparations." In the Report of IST-i this case is identified as tuberculosis.

That such clear ilhistrations of the disease could fail of identification in such an institution is suggestive of the denser ignorance which must have pervaded the public at that time, and which unfortunately is not yet entirely dissipated.

The limitation of tuberculosis to pulmonary consumption is still a popular error, and not a few medical men still fail, in their returns of death causes, to recognize the full list of diseases that are tuberculous. On the other hand, modern classification is tending to closer differentiation, as several classes of • cases once entered as '-consumption" now appear under newer names. It is therefore extremely difficult to make a fair comparison of statistics so as to determine with any certainty whether tuberculosis is or is not on the decrease in the human race.

Those writers who admit that the disease has thus decreased, find an explanation of this in the increased attention paid to sanitation under the influence of modern boards of health, and especially in the present general recognition of the infectiousness of the disease, and the consequent practicability of controlling it by preventive measures.

Chapter III. Its Varied Symptoms And Appearances

The slower progress of tuberculosis as compared with other infectious diseases has aided in the general indifference with which it has been regarded. In its acute form it often runs its course in a few weeks, but its usual manifestation is of a chronic and dilatory character, often lasting for years.

The disease attacks many of the organs of the body, and it often makes considerable progress in one organ before others are involved. This results in great difficulty in recognizing its presence in its earlier stages, or in identifying it where some difficulty or disease is indicated. Often the disease is well established before any noticeable indication is seen, and as often the symptoms are so varied, as one or another organ is affected, that there can be no certainty of recognizing it.