CANINE TYPHUS Epizodtic Gangrenous Stomatitis and Enteritis; Stuttgart Dog Disease Canine typhus is a disease of dogs charac terized by hemorrhagic gastro-enteritis with a great tendency to necrosis of the mucous mem brane of the mouth and other parts of the alimentary tract. As in the ease of contagious bronchopneumonia in dogs this disease has frequently been regarded as a form of canine distemper, but there are good reasons for con sidering it to be an entirely different affection, one of the most important ones being that although it may attack dogs of all ages, it most frequently affects old dogs and is much more serious in them than in young dogs, being the converse of distemper in that respect.
The actual cause of canine typhus is not definitely known, but the lesions of the stomach and intestines usually contain an enormous number of organisms of the Bac. coli type which may, however, be due to a secondary invasion. On the other hand, Bacillus coli may possibly be the cause of the affection, and this view is somewhat supported by the results which fre quently follow treatment of the disease by means of vaccines prepared from a canine strain of that organism.
The method of infection appears to be some what curious. Although the disease may occur in the form of an epizootic or enzootic with a considerable number of dogs in the locality becoming affected, one may meet with isolated cases with no history of contagion and yet showing exactly similar symptoms and lesions. Moreover, it not infrequently happens that a healthy dog may live with an affected one and still not contract the disease.
Etiology. The experimental feeding of healthy dogs with discharges from affected animals or with portions of stomach or intes tines has frequently failed to produce the disease, although there are recorded cases where canine typhus followed such procedure.
In some outbreaks the writer suspected that it was transmitted by dog lice or fleas acting as carriers, possibly mechanically. Organisms corresponding to those found in the lesions of the alimentary tract have been demonstrated in such insects taken from affected dogs.
Symptoms. The symptoms of this disease vary considerably in their intensity. When it is newly introduced into a district it runs a very acute and rapid course. When it has been in existence for some time the majority of cases run a sub-acute course, while still later a mild or chronic form of the disease obtains.
The Acute Form. In this form the disease runs a very rapid course and frequently proves fatal within twenty-four hours, although it may extend over several days. It usually commences with acute vomiting and great dulness and depression. At first the vomit is greenish in colour but rapidly becomes blood stained and very offensive in odour. In the early stages the patient may take a little food and is very thirsty for cold water, but vomits immediately solids Or liquids are taken. The faces are at first firm with a tendency to con stipation, but this is quickly followed by acute diarrhoea, the faces containing a large quantity of blood and being extremely offensive in odour. The patient becomes very weak and loses flesh with remarkable rapidity. The abdomen is tucked up, the back arched and the dog looks very dejected and miserable; the eyes become dull and sunken. The mouth is cold and clammy, and a catarrhal coating is deposited on the teeth, dark brown in colour, becoming blood-stained and extremely offensive; there is frequently dribbling of cold saliva. By this time the animal is unable to stand, and the temperature, which was elevated several degrees at the outset, becomes subnormal. In those cases that last several days extensive ulceration of the mucous membrane of the mouth, par ticularly along the gums and inside the cheeks, and sometimes at the tip of the tongue, is set up, the patient becomes very prostrate, the extreinAias very cold, and semi-coma and coma supervene a few hours before death.
This form is fatal in from 80 to 90 per cent of cases, and although it may occur in any breed, in the writer's experience it has been more frequent and more severe in bull-dogs, especially those with a previous history of chronic gastric catarrh.
The Sub-Acute Form. In the sub-acute form of the disease usually the first symptom observed is a cough, and on examining the mouth and throat a certain amount of congestion of the pharynx is observed. The dog may vomit once or twice after food, and yet is not suspected of being very ill. He is then noticed to become somewhat dull; the appetite may remain for a day or two, but the vomition becomes more frequent, the vomit being greenish or yellowish green in colour. There is a tendency to drink a considerable quantity of water, after which the dog is likely to vomit. He may cry out if picked up as from abdominal pain. There is a slight discharge from the eyes which soon become dull and sunken. For the first day or two there is some constipation, followed by diarrhoea, which is subsequently blood stained and very offensive in odour. Irritation of the lower part of the bowel causes constant straining (tenesmus), which is often mistaken as the sign of constipation. By this time there is a dribbling of saliva which is sometimes blood stained; the mouth and lips are cold and clammy; necrosis of the gums and inside the cheeks is observed in the form of yellowish, firmly adherent shreds, which become detached, leaving angry-looking ulcers. The tip of the tongue becomes slightly congested and then brown, and this is followed by necrosis, which is indicated by the tip or edge of the tongue becoming yellow. This portion may fall off and in some cases the dog may actually lose the entire free portion of the tongue. The vomit may now be blood-stained and sometimes con sists entirely of blood, and the vomiting spasms occur without food or water. The pulse becomes fast but weak; the temperature is at first elevated 2° or 3° F., but fever is never well masked; the temperature becomes subnormal as the disease advances, the extremities and body surface being cold. There are no visible signs of lung disease. By this time the patient is extremely weak and unable to stand, and presents a very dejected appearance. Emacia tion becomes very pronounced, and if a fold of skin of the neck or back be raised it is slow to resume its normal position. Death is usually preceded by coma and collapse.
The course of the sub-acute form of the disease may extend from two to ten days and is fatal in at least 50 per cent of cases. The case is more hopeful when lesions and symptoms are limited to either the mouth or stomach or intes tines, and especially so when vomiting and thirst are not very pronounced, as in those cases the patient's strength is more easily maintained.
In the mild form of this disease the symptoms more closely resemble those of simple gastric catarrh with frequent vomiting and great thirst. The patient is dull and takes very little food, the temperature may be normal or elevated 1° or 2°. In a few days coating of the teeth and ulceration of the mouth may occur, but in this form there is rarely necrosis of the tip of the tongue. The bowels are irregular, with a ten dency to slight diarrhcea. Loss of condition becomes very pronounced. The condition described elsewhere as Contagious Ulcerative Stomatitis is often regarded as a mild form of this disease, but as it is rarely accompanied by vomiting or diarrhcea it is probably a differ ent affection.
A chronic or atypical form of canine typhus is met with occasionally. The symptoms con sist of persistent vomiting of a yellowish or greenish -yellow viscid substance, irregular bowels, great thirst, and progressive emaciation. Blood-staining of the discharges may be absent throughout the course. The mucous membranes are anaemic and the temperature is normal, or in the advanced stages, often slightly sub normal. Occasionally, when the vomit has been in existence for ten days or a fortnight, mouth lesions may be developed resembling those in the acute form of the disease. Such cases are usually fatal. In other instances the diagnosis of this condition is somewhat difficult, as the symptoms closely resemble those caused by obstruction in the intestines. The writer has on several occasions recommended an explora tory laparotomy, and although no foreign body was discoverable the results were satisfactory, inasmuch as vomiting subsequently ceased.
Anatomical Changes — Acute and Sub-Acute Forms. The lesions are mainly confined to the alimentary tract. in the acute form they consist of ulcers of the mouth, brown coating of the teeth, frequently sloughing of areas of the gums and the free portion of the tongue. The stomach is devoid of food materials and often contains a quantity of clotted blood, very dark in colour and offensive in odour. The mucous membrane is inflamed, hmmorrhagic, and often ulcerated. The bowels vary considerably; in some cases they are inflamed and hwmorrhagic, particularly the small intestines, while at other times there is very little enteritis. The abdomi nal lymphatic glands are swollen, juicy, and often hmmorrhagic. There is usually great lack of fat in the carcase unless death has been very rapid.
In the chronic form of the disease it is a common thing to find no lesions whatever. At other times ulceration of the buccal mucous membrane is present.
Treatment. Isolate the patient as soon as possible, putting him in a quiet place with good ventilation and a temperature of 55° to 60° F.
Good nursing is of the greatest importance. The patient's strength must be maintained by the frequent administration of small quantities of milk and white of egg, giving at a time not more than from one to four dessertspoonfuls, according to the size of the dog. Its retention is facilitated by the addition of brandy, from twenty drops to a teaspoonful. Other milk foods may be substituted, such as glaxo, lactol, or Benger's food. Meat extracts are excellent in chronic cases, but are not so useful when the heemorrhagic gastritis is present. Drinking water should be completely withheld. The mouth must be thoroughly cleansed. At the first dressing all areas of necrosis must be re moved and the parts scraped with a curette and disinfected with tincture of iodine or carbolic acid or strong solution of permanganate of potassium, sodium, or calcium. Subsequently the mouth must be mopped out and thoroughly cleansed very frequently during the day with weak solutions of the same agents, or with hydro gen-peroxide or saturated solution of boracic acid. The stomach may be irrigated by means of a stomach pump with permanganate solution (1 in 2000) or with normal saline solutions (sodium chloride gr. When hwmor rhagic enteritis is present rectal injections of normal saline or permanganate appear to relieve the straining, and assuage the thirst at the same time.
Medicinally, in the early stages the symptoms may be relieved by the use of carbonate of bismuth, sodium salicylate as gr. ii. x., or bis muth salicylate or salol. These should be administered three or four times daily alter nated with brandy in milk. Good results may sometimes be obtained by the administration of permanganate of calcium, sodium, or potassium gr. in pill. Other agents used include chinosol gr. i. v., beta naphthol, sodium sulpho carbolate, boracic acid, and hydrocyanic acid.
It often happens that everything administered by the mouth is speedily vomited. In such cases brandy or sulphuric ether may be administered hypodermically, and food must be administered in the form of nutrient supposi tories. Hypodermic injection of nuclein will also be found serviceable.
In convalescence tincture of nux vomica, tincture of squills, and aromatic spirits of ammonia may be given in milk, and also cod-liver oil and malt. Water should still be withheld, and feeding with solids should only be resumed after several weeks, commencing with a little boiled sheep's paunch or a little scraped or finely minced meat.
Vaccine Therapy. The writer has on numerous occasions resorted to the use of a serum and also a vaccine prepared from Bacillus cols (canine strain) with apparent good results. It may be said that this organism is not the specific cause of the affection, but if it is responsible wholly or in part for the lesions, a vaccine or a serum prepared from it may reasonably be expected to reduce the severity of the lesions and to contribute towards recovery. The writer's experience supports that conten tion.