THE VETERINARIAN.

New Zealand Mail, Issue 764, 22 October 1886, Page 15

THE VETERINARIAN.

MILK SCARLATINA.

The Field.

A few months ago a report with tbe above heading was issued by the Local Government Board in reference to outbreaks of scarlet fever, which had been traced to the consumption of milk from a dairy at Hendon. The inquiry was conducted by one of the medical inspectors, Mr Power, who arrived at a conclusion which seemed to us to be very much more definite in terms than the evidence justified. In The Field of May 15 we commented on the report, and the following quotation from that article will put our readers in possession of the principal facts:— In Hecember last, outbreaks of scar’et fever occurred in Hendon, Hampstead, St. Pancras, and South Marylebone. All these districts, and in addition St. John’s Wood, bad received a supply of milk from a dairy farm at Hendon. St. John’s Wood remained free from fever at the date of inquiry. All the districts named were also supplied with milk from other places. For example, in South Mnrylebone, where scarlet fever was severe, the daily supply of Hendon milk was 63 gallons, of other milk 10 gallons. In Hampstead, where fever was not nearly so bad, 18 gallons of Hendon milk were distributed, to 23 gallons of other milk. In St. Pancras, where comparatively few

people were attached, 6 or 7 gallons of Hendon milk were used, to 45 gallons of other milk. In St. John’s Wood, which altogether escaped fever up to the data of the inquiry, there were 20 gallons of Hendon milk to 4 gallons of other milk distributed daily. In Hendon, where only two families had fever, 1 or 2 gallons of Hendon milk, and no other milk, were supplied daily. It may be remarked here that the inquiry was limited to the Hendon farm, and did not extend to the other sources of milk supply. No external source of contamination of milk with the virus of seralct fever was detected du-ing the inquiry, and from this negative evidence t he inquirers originate the astounding hypothesis, ‘ That the cows tbemselvos must have had something or other to do with any scarlatina which had been distributed along with their milk.’ This was the proposition to be examined, and during further investigation on the dairy farm, it was ascertained that certain fresh cows from Herby market (four in number) were brought on to the farm in the middle of November. One of these cows became affected with an eruption under the teats and udder. Hr Klein considered this affection to be a constitutional one, probably oapable of transmission /from cow to cow. Later on a large number of the cows became affected, and in January the disease extended to tbe cows in the shed from which the milk supply of St. John’s Wood was derived, and then scarlatina appeared in that district, ceasing when the milk from Hendon was withheld. Tfc was remarked that the disease on the udders and teats of the cows was not associated with any constitutional disturbance which could be detected. There was no rise of ternpeiature to indicate fever, the animals’ appetites remained good, the normal secretion of milk was maintained, and to all appearance the cows were in a state of perfect health. The eruption of the teats did not present any characters to distinguish it from the oruptiun which is common among newly-calved cows, and has hitherto been treatod as an unimportant local disorder. Since Mr Power’s report was issued, farther investigations have been carried on by Hr. Klein, and we have before us his conclusions on the subject, qualified by the suggestions that further inquiry is necessary before the fact of the origin of scarlatina in the cow can be accepted. Hr K’oin’a report was briefly summarised in the Field of July 10. In the first instance he states the symptoms which he observed in those words : -

The cows which were the first subjects of my investigations had on the teats and udders several flat, irregular ulosrs, varying in diameter from Jin to Jin ; some ulcers were more or less circular, others extended in a longitudinal direction on the teat. The ulcers were covered with a browish or reddish-brown scab, which when scraped away left exposed a granulating slightly indurated base. The margin of such ulcer was not raised, nor was there any percsptible redness of the skin around. Bat where I afterwards got the opportunity of watehing the earlier stages (especially in animal 4), it was noticed that a small vesicle made its appearance on a greatly swollen and led teat, in the course of a couple of days assuming the character of the above ulcers. In another cow an ulcer, about half an inch in diameter, was becoming covered in its central part with a scab, while at its margin vesioulation was still distinctly visible. As a rule—-i.e., in most animals—the disease affected the teats, but in some there was also on the lower part of 'he ndder here and there an ulcer. In such animals patches denuded of hair were noticed on various parts of the skin, thp tail and back particularly. Ia these patches the epidermis was scaly, and the cutis more or less thickened. Tne animals looked thin, but not strikingly eo. except in one or two cases of animals that had only a few weeks ago been admitted to the place, and which therefore had oalved comparatively re cently (see Mr Power’s report). As regards the feeding capacity of affected animals, their milking power, and their body temperature, nothing abnormal could be detected. Four calves were inocula'ed with scrapings from the ulcer on the teats of the cows, with the following results : Four days after inoculation : There was in calf 1 one place in the groin which promised to become an ulcer. Calf 2 showed on the ear one promising place, the other places of inoculation having nearly healed. At tbe same distance of time after inoculation, calf 3 showed two promising places on the ear, and calf 4 showed two promising places in both groin and ear. Calf 3 also showed a kind of vesioulation at the margin of the spot inoculated, and commencing formation of a crust in the centre. What I call promising places oE inoculation were spots that had become swollen and tender; the other and not promising places were spots that seemed healing, or were already healed and dry. On the sixth day : Calf 1 showed four successful places in the groin ; the places had become swollen and enlarged, with imperfect vesiculation at the margin, and formation of crust ia the centre. Calf 3 had four successfull places on the ear, and calf 4 had the same number in the groin. ' On the seventh day : In calf 1 all p’aces, except one in the groin, had nearly disappeared. This place was now a distinct ulcer, covered with a crust, on removing which a granulating infiltrated base wss expoeed. In calf 2 ajl places of inoculation were decreasing covered with small scabs, easily detached. In calf 3 the sores on the ear bad enlarged to about half an inch in breadth, each of them covered in their whole extent by a brownish crust. In calf 4 all except one place on ear were healing. On the eleventh day : Calf 1 had still one ulster in groin not yet healing. Calf 2 had one ulcer on ear not quite healed up. Calf 3 had four big ulcers still progressing, crusts thick, and corium much indurated. Calf 4 had an ulcer on ear much diminished in size.

By the eighteenth day : The ulcerations in calf 3 (one ulcer had been cat out for microscopic examination) had all healed up and become converted into flat scars. In the other animals the healing was completed at an earlier date.

Simultaneously with the above experiments several inoculations with materials of the ulcer of cow No. IV. bad been made into the skin of the groin of ten guinea pigs and three dogs. In the guinea pigs no result was obtained ; but in one of tbe dogs one place of inocula-

tion appeared swollen and inflamed on the third day. On the fifth day this place was an oblong ulcer of about Jin in diameter : the margin was red and swollen, but the cmt.ro was without crust (the animal had been frequently seen to lick it). On the seventh day the ulcer was much smaller, and it had nearly healed up by,.the tenth day. From these experiments there can be no doubt whatever that by inoculating a particle of matter from the sores of an affected cow a positive result has been obtained in all four calves. In calf 3 this result was best and most striking. After an incubation of about three days the places of inoculation became swollen, tender, and spreading; on the fifth to the sixth day the change was dislinct, the successful placeshaving become sores ; in the marginal part showingifresioulation, and in the centre formation of crusts. The sore enlarged during the next few days, and on removing the crust a raw surface was exposed, the corium itself being found infiltrated. According to the intensity of the process the retrogressive change sets in later or sooner; in slight cases the healing begins about the ninth or tenth day, in severe cases (calf 3) not before the end of the second week.

We may remark, in pacing, that the occurrence of ulceration as the result of introduction of the purulent matter of an ulcer into the skin, does not seem to be very remarkable, nor does it, to the ordinary mind, suggest much beyond the fact observed. Two of the cows were killed, and their organs subjected to a minute examination ; certain morbid changes were found in the lungs, liver, and kidneys, but we fail to see that they cou’d be connected in any way with the local disease of the teats.

The next step in the inquiry was the discovery (not unexpected) of in the tissues of the ulcers of the cows. This microbe was cultivated in different media, and grew rapidly. Pure milk from the diseased cows was not found to contain the microbe, but when contaminated purposely with the organism it was found to act as a good culture medium, and th« fluid, when kept at a temperature of 95° Fahr, for two days, became quite solid.

Two calves were inoculated with the third culture of the microbes (Strepfcococtus). One of the animals was found dead on the following day. The other one, about a month after inoculation, showed an eruption on thp skin of tbe nostrils and lips, and on the'hard palate and gums, which Hr. Klein considered to bear some distinct relation to the eruption of scarlatina in man. The calf was killed, and the' lungs and liver were found to be congested, ai was also tbe case in the calf which died ; but in both animals the special morbid feature was in the kidneys, in reference to which Hr Klein remarks : ‘The changes in this organ are highly interesting, siuce they completely coincide with those in acute scarlatina nephritis in man.’ A minute description of microscopic appearance of the kidney is given, but it would not be intelligible to anyone unfamiliar with morbid anatomy, and we venture to suggest that identical appearances will be found in the same structures in more than one form of disease, depending on the presence of septic or disease-producing organisms in the blood. The concluding words of the report are too important to be curtailed. Dr Klein sums up as follows : The outcome of the investigation so far and it is of importance until further differentiated observation shall have been., made—may be stated thus : By inoculating the vims directly taken from the local disease (the ulcer on the teatp) of the cow into the corium of the calf, the same local disease is produced, namely a change in the skin, which commences as a congestion of the papillae and corium, and an exudation of fluid and leucocytes. This leads in the superficial parts of the epidermis to the formation of cavities, which, enlarging and extending and opening on to the surface and extending into the depth, ultimately lead to the formation of an ulcer. But the virus, in the form of an artificial cultivation of the streptococcus derived from the above ulcer of the cow, when inoculated into the subcutaneous tissue—that is, when introduced almost directly into the vascular system (for all matter injected subcutaneously is easily absorbed by the lymphatics and carried into tbe blobd system) —sets up a general disease resembling to a considerable degree in its anatomical features human scarlatina.

Furthermore, as respects the concern that cow’s milk may have in the communication of disease—he consideration which led to the present investigations—we have some facts which appear to me to afford very suggestive indications for further pathological study. As I have pointed out on a previous page, it would seem that the milk pure does not contain the organism, but (whether or nob this observation be confirmed) the milk duriDg the act of milking is pretty sure to become contaminated by the fingers of the milker bringing down into the milk particles from the ulceration on the teat. The organism contained in these particles would find in the milk a good medium in which to multiply. Such milk would then practically correspond to an artificial culture of the streptococcus, such as we have found capade of setting up a general disease when inoculated subcutaneously into calves. It is true we have as yet no experience of the inoculation of a known milk sub-culture into the human subject, but in the case of oalves, we have learnt that the general disease resulting from inoculation of an Agar-Agar subculture had characters closely allied to, if not.identical with, human scarlatina. Then, feeding of animals with the cultures has not yet been tried, so that at present we are without information as to the characters of any disease that may be produced in calves by that means ; whether or not calves fed with milk eub-cultnre of our streptococci exhibit tbe same pathological states as we have found to be produced by inoculation of calves with an artificial culture —states that bear so maiked a resemblance to those of scarlatina in the human subject. In order completely to understand these and other relations, more experiments are required, and these I hope soon to have an opportunity of making. Until I am in a position to state at greater length the peculiarities of the infective phenomena of tbe disease under consideration I refrain from, further comment on its various interesting and promising aspects. To which we may add that, to our own

knowledge, for many years past eruptions the kind described have been common on the udders of cows shortly after calvfrgj an< j most certainly scarlatina has not followed therefrom ; and there is yet a great deal in the way of scientific experiment to be done before the teaching of long experience can be upset.