ABSTRACTS. 57

PRIMARY UMBILICAL TUBERCULOSIS IN THE CALF.

THE first part of the author's paper is devoted to a detailed description of the lesions in twenty cases of umbilical tuberculosis in the calf. The lesiuns in the different cases were very similar, and the only important variations were those attributable: to the rapidity of the disease and the time during which it had been in progress. One of the ca~es was specially interesting because the evidence indicated that infection had occurred after birth. The author gives the following re,ume of the lesions.

The earliest lesion always consists in an ulceration or an induration situated at the umbilicus. In fourteen of the twenty cases it was an ulcer, generally of small size, and communicating by a more or less narrow fistulous canal with the subcutaneous connective tissue. In six of the cases there was a more or less extensive, cicatricial, round induration, in which on histological examination some calcified tubercles and giant cells were found. Immediately under this ulcer or cicatrix, and forming part of it, there was in the subcutaneous connective tissue an indurated mass surrounding the urachus and umbilical arteries.

The umbilical cord, which normally in a calf of two months old is fibrous, often fragmented, and about the thickness of a writing pencil, in cases of umbilical tuberculosis takes on a sausage shape and acquires a thickness equal to that of a finger or thumb. It is composed of fibrous tis'me enclosing some tubercles, and at its centre some caseous pus of a yellOWish green colour. At the level of Ihe white line and as far as the internal abdominal ring it is strangulated, but in the peritoneal cavity it increases in thickness up to the anterior end of the bladder. There one finds an agglomeration of tubercles. The umbilical arteries which emerge from this mass are also surrounded by an envelope of tuberculous tissue, which is generally continued on one of tht m for a length of several centimetres.

In nineteen of the cases the umbilical vein was not involved, but in a single case the subcutaneous tuberculous mass, instead of following the urachus, was continued on the vein, which was thus formed into a tnberculous cord about 2 cm. in diameter, and traceable as far as the liver. The liver in this case was crammed with tubercles, but the urachus presented only a few.

The peritoneum always showed more or less numerous growths, especially on the posterior surface of the diaphragm and on the omentum and mesentery. The liver always showed some lesions on its surface. In five cases there were no tubercles in its substance, and in three only were important lesions found in it. The lymphatic glands in the portal fis~ure were always hypertrophied and often contained some caseo-calcareous tubercles. The lungs appeared healthy in four of the cases. When lesions were present in them they were especially abundant at the surface of the organs, but in all the cases the lymphatic glands in the posterior mediastinum were very large and infiltrated With tubercles.

Finally, in nearly all the cases both precrural glands were hypertrophied and contained caseous lesions. Frequently the gland on one side was larger than on the other.

The diagnosis was easy to confirm by microscopic examination, and inoculation of guinea-pigs with material from the lesions set up characteristic lesions followed by generalisation.

Apparently the fact that umbilical tuberculosis of the calf has so long

58 ABSTRACTS.

escaped detection in slaughter-houses is due to the methods of the butcher in dealing with the carcases of calves. After the abdomen has been opened, seeing that the bladder adheres to the umbilicus by a sort of tuberculous sausage, the butcher hastens to cut off the whole close to the skin and throw the diseased organ away. When the inspector makes his examination he finds an abdominal tuberculosis with more or less pronounced lesions and often with tubercles in the mesenteric glands. The lungs are found to contain few tubercles and some more recent lesions, from which he draws the conclusion that infection occurred through the digestive tract.

Reference is made to the case of a calf affected with peritoneal tubercu­losis in which there were some vegetations on the posterior surface of the diaphragm and the bladder was prolonged by a tuberculous mass following the course of the urachus. This observatlOn led to an examina­tion of the umbilicus, which remained adherent to the skin and was the seat of a warty tuberculous cicatrix. Since that observation it has been the custom at the ahattoir at Villette in cases of calves showing abdominal tuberculosis for the inspectors to demand to see the bladder and to examine the umbilicus for ulceration or induration. It was in consequence of the introduction of this method of examination that the author and his colleagues were able to collect so many as twenty cases during the last seven years.

Is this Umbilz"cal Tuberculosis Congenital or Acquired ?-As is well known, the occurrence of cases of congenital tuberculosis is now generally admitted. Numerous cases of tuberculosis in new-born infants have been observed since the classical case of Charrin in 1873, and many similar cases have been recorded in calves since the first one described by Johne in J885.

In ca,es of congenital tuberculosis in the infant and in the calf the most prominent lesions are in connection with the liver and its lymphatic glarids, with or without generalisation to the abdominal, mediastinal, or bronchial lymphatic glands. Sometimes tubercles are also present in the lungs, spleen, and kidneys.

Klepp, struck with the contrast which exists between congenital tubercu­lo~is in the calf and the frequency of uterine tuberculosis in the cow, set himself to make a systematic examination of the lymphatic glands in all the nf'w-born calves brought to the abattoir at Kiel. He thus dis­covered in five months (January to July 1896) twenty-six tuberculous calves out of a total of 4068, and in the month of October in the same year he found ten out of 847 examined. The lesions took the form either of caseous centres or calcareous deposits in the affected glands. They were almost constantly present in the hepatic glands, but the liver itself sometimes showed visible lesions and in others did not. In a number of cases Klepp also found tubercles in the bronchial glands or in other organs or glands.

Malvoz and Brouvier in 1889 published a remarkable case of congenital tuberculosis in a six weeks old calf. On the surface of the liver there Wf're tW() greyish nodules about I cm. in diameter, with giant cells and bacilli. The hepatic lymphatic glands were noticeably enlarged and contained caseo-calcareous foci. The other smaller glands enclosed yellowish tracts without calcification but with bacilli. The bronchial lymphatic glands were increased in size and tuberculous but showed no calcification, and the lungs and intestine were normal. In spite of the calf's age, the seat of the lesions was held to justify the conclusion that it wa~ a case of congenital tuberculosis and not of tuberculosis acquired after birth. Evidently, as was remarked by Nocard, the older calves are the more numerous are the chances of their infection. In calves slaughtered at the age of from

ABSTRACTS. 59

six weeks to two months the possibility of a uterine infection cannot be dismissed, and the author thinks that in animals of that age it is still possible by a careful examination to recognise a congenital tuberculosis. Since the different forms of tuberculosis in slaughtered calves have been studied the congenital cases, which were at first believed to be exceptional, seem now to have become more frequent. Alongside of cases in which the disease is apparently respiratory or digestive in origin, there are sometimes found abdominal forms with extensive calcified or caseo­calcareous lesions in the liver and its lymphatic glands, and to these cases the author is inclined to attribute a maternal origin because the hepatic lesions are the promment ones, and are not accompanied by more discrete leSions in the other organs such as the lung.

It would seem that in cases of congenital tuberculosis in the human subject hepatic lesions are not nearly so striking as in calves and may be entirely absent. There is a marked tendency to simultaneous infection of several organs, indicating a generalisation from the outset.

In spite of the frequency of tuberculosis in the human female, congenital tuberculosis is rare in children and plays only an insignificant r61e in the etiology of the disease in the human species. The explanation appears to be that in the human female uterine tuberculosis generally entails the death of the foetus.

Mechanism of Infection in Congenital Tuberculosis.-The study of congenital tuberculosis in man and animals shows that infection takes place by the blood stream from a diseased placenta. It is always transmitted to the foetus by way of . the umbilical vein. This fact has been demonstrated scientifically by the positive results of examinations and inoculations of blood from the cord, or from the liver and hepatic lymphatic glands, even when these organs present no lesions visible to the naked eye.

The bacilli which thus find their way into the body of the fcetus may produce more or less numerous lesions according to the number of bacilli. In calves one often finds that the lesions are limited to the liver and its lymphatic glands, and in the opinion of Klel p the methodical examination of these glands is the best method of detecting the disease. In general the glandular lesions are more marked than those in the liver, which are often minute or hardly visible. The infection of the glands is always secondary. From the liver the diSEase is spread specially by the blood stream, but bacilli may also be disseminated by way of the lymphatics in the peritoneal cavity, and the thoracic cavity may be invaded by way of the mediastinum.

Pathogenesis of Primary TuberCitlosis if the Umbilicus.-When the lesions which characterise congenital tu berculosis are compared with those of umbilical tuberculosis it is seen that the latter differ entirely in the method of infection, the primary localisation, and the progress of the disease.

Gongenital tuberculosis, in which infection takes place by the blood stream, may affect different organs, and exhibit a marked predilection for the liver and its lymphatic glands, while umbilical tuberculosis originates from cutaneous infection and affects the umbilicus at the outset.

When the cord separates it leaves a small wound which suppurates for some days, and for the first two weeks after the animal is born the umbilical lesion offers a point at which infection may occur.

This infection may follow the umbilical arteries and vein as long as these are not completely obliterated, and these vessels play an important role in the pathogenesis of certain umhilical infections. In umbilical tuberculosis, however, it is especially by way of the lymphatics of the cutaneous cushion at the navel that the bacilli penetrate.

60 ABSTRACTS.

The disease, which at first is confined to the umbilicus, gains the sub­cutaneous tissue of the cord, which is rich in lymphatic spaces, and it then reaches the abdominal cavity by following the connective tissue surrounding the urachus and the umbilical arteries. The constituents of the cord as far as the bladder thus become transformed into a tuber­culous mass. It is only very exceptionally (one case in twenty) that lesions exist around the umbilical vein. In the peritoneum the tubercles spread by way of the lymphatics of the sub-serous tissue, and invade the posterior surface of the diaphragm, the omentum, mesentery, liver, spleen, and glands. Finally, after passing throu~h the diaphragm, they reach the thoracic cavity, and invade the mediastinal glands and lun!,s. The ulceration of the umbilicus is a constant feature of the disease, and it shows all the characters of a cutaneous inoculation. It is nearly always accompanied by a secondary lymphadenitis affecting principally the pre­crural and inguinal glands, which collect the lymph from the neighbourhood of the umbilicus. The superficial lymphatic vessels of the umbilical region are themselves more rarely the seat of disease, but the suprasternal glands are often involved. It is thus always easy to distin~uish immediately a primary umbilical tuberculosis fr(lm a congenital tuberculosis, in which such special lesions of the umbilicus and urachus are never found.

Frequency if Umbilical Tuberculosis - Tuberculosis is relatively rare in calves. Thus, in 1911 at Villette out of 235,813 calves slaughtered for food only forty-six were recognised as tuberculous (twenty. three generalised and twenty-three localised), or '195 per thousand.

From May to September 1912, the cases were more numerous, viz., thirty-eight (twenty generalised and eighteen localised) in 105,750 animals, or '360 per thousand. Among these thirty-eight cases there were five in which the disease was umbilical in origin, or 13'13 per cent.

An interesting point was that the calves affected with umbilical tllber­culosis came mostly from districts where the cattle were kept in the house, and where there was an unusual proportion of tuberculous animals. (Th. Morel, Recueil de MM. Vet., Tome XCV., 1919, p. 450.)

MYCOSIS OF THE BOVINE FCETAL MEMBRANES DUE TO A MOULD OF THE GENUS MUCOR.

THIS apparently rare case of infection of the fretal membranes was discovered by the author in the examination of a number of pregnant uteruses obtained from abattoirs. When the wall of the uterus was cut through there was found hetween uterine mucosa and chorion (uterochorionic space) a considerable amount of a turbid fluid full of small flakes. Over a region of the chorion, about 20 cm. in diameter, corresponding with or resting on the left shoulder and thorax of the fretus, the cotyledons, five in number, were separated from the uterine wall so that the latter could be lifted away from the fretal membranes over this area. The pedicles of these cotyledons (maternal caruncles) were greyish in colour, with some hremorrhagic spots. The affected cotyledons were enlarged,