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192 THE INDIAN JOURNAL OF VETERINARY SCIENCE AND ANIMAL HUSBANDRY [ IV, II.
duced. When giving instructions for reduction linear measurements are under-
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19. For detailed instructions regarding preparation of illustrations, it would be
of advantage to refer to Mr. C. M. Hutchinson's article on " Photographic Illustra-
tions " in the Agricultural Journal of India, Vol. XI, Pt. 3, July 1916, and Mr. A. W.
Slater's paper on " The Preparation and Reproduction of Scientific Illustrations "
in the Proceedings of the Third Entomological Meeting, 1919, which has been reprinted
as Bulletin No. 114 of the Imperial Institute of Agricultural Research, Pusa.
ORIGINAL ARTICLES
INCIDENCE OF EQUINE ENCEPHALO-MYELITIS IN AN
INDIAN CAVALRY REGIMENT.*
I. HISTORY OF THE OUTBREAK.
COMPILED BY
BRIGADIER H. S. MOSLEY, D.S.O.
(Received for publication on the 6th July 1934.)
(With Plate XVII and two text-figures.)
One of the most disturbing factors in veterinary medicine in India, today, is a
disease among horses commonly called Paraplegia, Kumri or Muttra paralysis.
This nervous disorder has been attributed to several causes, ranging from a
vegetable poison as ratti seed or a nutritional deficiency to a protein intoxication
and again from an obscure injury to a sequela of either an ecto or endo-corpuscular
parasitic invasion, as in the last stages of surra or piroplasmosis.
In this instance, the outbreak of paraplegia, extending over a prolonged period,
gave the pathologist and clinician a favourable opportunity to make future
investigations and they have given evidence to show that, in this particular
instance, they were dealing with a disease analogous to one prevalent in Europe
and America, and known as equine encephalo-myelitis.
Before narrating the history of the outbreak, it might interest the readers if a
brief account were given of the actual work the regiment was doing at the time,
and how the incidence of this disease affected the fulfilment of a military
programme.
It had been arranged that during the winter of 1933-34, the Loralai Cavalry
Regiment and the Jullundur Cavalry Regiment would exchange garrisons.
This move, which was to be carried out by road, necessitated a march of
45 days and 540 miles. The " halfway house " was about Khanewal, but it was
decided that the regiments should meet on the 15th November at Dera Ghazi Khan,
176 miles east of Loralai where transport would be exchanged.
Government mule transport was to be used between. Loralai and Dera Ghazi
Khan and hired bullock transport between Dera Ghazi Khan and Okara.
The march between Dera Ghazi Khan and Okara is 196 miles and occupies
16 days.
In the Khanewal, Dera Ghazi Khan and Rakhni area, Multan hay was to be
issued to the units and west of Rakhni, bhoosa supplied by local contractors.
* Published with the permission of the Editor, Royal Army Veterinary Corps Journal, for which
this article was originally intended.
( 193 ) B 2
194 THE INDIAN JOURNAL OF VETERINARY SCIENCE AND ANIMAL HUSBANDRY [ IV, III
The Jullundur regiment had been stationed there for 5 years. It left on the 16th
October, arrived at Okara on the 30th October and Dera Ghazi Khan on the 15th
November (where it halted for 24 hours), transport units were exchanged and the
march resumed on the 17th. This regiment in accordance with programme,
arrived in Loralai on the 29th November. No case of encephalo-myelitis
occurred in the regiment in Jullundur, on the line of march or since its arrival in
Loralai.
The Loralai regiment had been there for 3 years, and no case of encephalo-
myelitis had been recorded in the regiment or station.
The regiment left Loralai on the 3rd November and arrived at Dera Ghazi
Khan on the 15th.
On arrival in camp, Major " A's " charger of C Squadron was not feeding that
evening ; next day, the horse appeared well and marched with the led horses ; on
the 17th November, to Kureshi Camp, a distance of 17 miles. That evening the
horse had a rise in temperature and next morning was partially paralysed. This
was the first case (Case I).
FIG. 1.
ENCEPHALO-MYEITIS IN AN INDIAN CAVALRY REGIMENT
195
FIG. 2.
Figures between squares denote number of days.
Squares denote number of cases in one day.
196 THE INDIAN JOURNAL OF VETERINARY SCIENCE AND ANIMAL HUSBANDRY [ IV, III
For convenience, the history of the outbreak will be divided into 4 phases.
Phase I. The march between Dera Ghazi Khan and Khanewal (17th—23rd
November 1933).
The regiment arrived at Kadarpur Ran on the 21st. Next morning, a charger
(Case 2) belonging to Captain " B " of C Squardron, which had been in contact
with the first case, developed the disease. That same day, on arrival in camp at
Kabirwala, there were 3 more cases—a charger and private pony of Major " A "
and a charger belonging to Captain " C " of " B " Squadron. (Cases 3, 4 and 5.)
Uptodate, all affected animals belonged to officers, 4 occurred in C Squadron,
and 4 had marched with led horses.
All cases proved fatal except the private pony.
The Officer Commanding of the regiment reports that at Kadarpur Ran on the
22nd November, he noticed that one of the transport bullocks was lying down
in a dying condition.
Phase II. Incidence of the disease in Khanewal (23rd November to 8th
December).
The regiment reached Khanewal on the 23rd November where 2 troop horses
of " C " Squadron (cases 6 and 7) became affected.
The march was temporarily abandoned and an application made for the
services of a veterinary officer. Major Heane arrived that evening and remained
with the regiment until the 17th April 1934.
Early on the morning of the 24th, as headquarters wing and " A " Squadron
had not had a case, they were transferred to a new camp 1½ miles away and on the
far side of the city.
" A" Squadron was picketted on the grass verge of an orchard and head-
quarters wing 100 yards away, the 2 units were separated by a canal.
The 24th November was the worst day during the outbreak as 9 horses
developed the disease (cases 8-16) 2 of which were chargers of " B " Squadron.
The D. A. D. V. S., Lahore District, visited the regiment on this day and, very
rightly, considered that the situation required the services of a pathologist. He
applied to the Principal of the Punjab Veterinary College who placed Professor
Shirlaw's service at the disposal of the army. The Principal also provided
veterinary assistants for field work during the investigation.
Oh the 25th November, cases 17 and 18 occurred and on the 26th cases 19,
20 and 21.
ENCEPHALO-MYELITIS IN AN INDIAN CAVALRY REGIMENT
197
On the 26th November, as all squadrons were now affected, it was considered
advisable for administrative purposes to transfer " B " and " C " squadrons to the
camping area of headquarters wing and " A " squadron.
In this area, there was a 20 acre orchard of young trees, which, it is understood,
is ordinarily used for durbars and fairs. The two squadrons were picketted in
this orchard.
On the 27th November, 2 horses in " A " Squadron developed fever ; the next
day 1 in " A " squadron and 2 in " C ". This was the beginning of an outbreak of
equine piroplasmosis. In 10 days, there were 34 cases. Later, after the regiment
was transferred to Multan, there were 3 more cases. 4 of the 37 cases developed
symptoms of encephalo-myelitis.
On the 1st December, in consideration of the outbreak of piroplasmosis, it was
thought advisable to move the regiment back to its original camp. On the 4th
December, piroplasmosis died down but encephalo-myelitis re-started. During
the time the regiment was in Khanewal, there were 25 cases of encephalo-myelitis
and 6 deaths.
On the 6th December, the march was definitely postponed and on the 8th, the
regiment was entrained to Multan.
Phase III. Incidence of the disease in Multan, up to the time of squadron
isolation being adopted (8th December 1933 to 7th January 1934).
During this phase, headquarters wing suffered more heavily than others; there
were 13 cases in this unit and only 1 case in " A " and 2 in " B "; the total being
16 cases and 5 deaths.
" A" squadron was picketted about 200 yards away from the rest of the.
regiment; the horses were watered at the same well, although using different
troughs. It would not be right to say that "A" squadron was under strict segre-
gation.
Phase IV. Adoption of the squadron isolation (7th January to end of outbreak).
This policy was adopted on the 7th January and remained in force until each
individual squadron was entrained to Jullundur.
Headquarters wing was left in its original standings. " B " squadron occupied
" A " squadron lines. " A " squadron and " C " were transferred to a fresh camp.
In this way, each squadron was 500 yards apart and had its own watering arrange-
ments. Cases continued to occur in headquarters wing on the 7th, 16th and 18th
(2 cases) January—4 cases in all. After the 18th January, there were no further
cases.
198 THE INDIAN JOURNAL OF VETERINARY SCIENCE AND ANIMAL HUSBANDRY [ IV, III
In "A" squadron, no cases occurred until the 21st January when there were
3 cases. This squadron had been free for 38 days. There was a case on the 30th
January and one each on the 8th, 9th, 15th, 17th, 19th and 22nd February and 2
on the 18th February, a total number of 12 cases. The last case was on the 22nd
February.
" B " squadron.—After an interval of 32 days, a case occurred on the 27th
January, 3 on the 28th, 1 on the 30th, 1 on the 5th and 2 on the 7th February—
total 8 cases. The last case was on the 7th February.
" C" squadron.—A case occurred after an interval of 53 days, on the 18th
January—which was the last case.
During this phase, there were 25 cases and 6 deaths.
Information being received that cases had occurred in Germany after an inter-
val of 80 days, the squadrons were kept in segregation and under observation for
3 months after the last case.
The regiment was finally entrained by squadrons to Jullundur.
Total No. of cases 71, deaths 21 (mortality 29.58 per cent.).
Remarks—
(1) All horses had been in the affected regiment 6 months previous to the
march.
(2) Although the 2 regiments marched about the same time, over the same
area, used the same camping grounds, obtained fodder and water from the same
source, shared the same transport, yet cases only occurred in the Loralai regiment
which looks as if the source of infection was confined to this unit.
(3) No cases occurred in the mule transport.
II. CLINICAL OBSERVATIONS, TREATMENT AND EXPERIMENTS IN THE
FIELD, ETC.
BY
MAJOR C. W. HEANE, R.A.V.C.
CLINICAL OBSERVATIONS.
At the outset it should be noted that the clinical picture presented and the
degree of severity of attack in this outbreak was peculiarly varied, and ranged from
cases which fell down in the lines completely paralysed, convulsively pawing the air
and banging their heads against the ground and causing severe bruising over the
ENCEPHALO-MYELITIS IN AN INDIAN CAVALRY REGIMENT
199
eye, to those which, showed only the slightest inco-ordination of movement in the
hind quarters.
In the large majority of cases, the first indication of any thing wrong was
shown by a marked dulness and depression, and in all except the mildest cases,
off feed, and accompanied by a stiffness in gait of the hind limbs.
Temperature was seldom elevated on admission.
When the disease was definitely established, the inco-ordination and loss of
muscular power in the hind limbs became very apparent.
The hind toes were dragged at the walk and the tail nearly always elevated.
Inco-ordination was most noticeable when turning round, the animal appearing
disinclined to turn on his hind quarters and when doing so there was a marked
sinking of the loins. This was the last of the symptoms, to disappear in the process
of recovery. Varying directly with the severity of the attack partial or complete
sensory paralysis in the hind limbs was shewn, seldom or never extending sufficient-
ly far forward so as to cause complete loss of sensation and control of the fore
limbs.
In some cases partial paralysis of the fore limbs only was apparent—the horse
crossing his legs at a walk and displaying exaggerated knee action and in all cases
of fore or hind paralysis, during movement, the animal appeared to be feeling for
the ground.
Hyperaesthesia was pronounced in the early stages of an attack and then
appeared to pass off in one or two days. Dilation of the pupil and twitchings of
the facial muscles were sometimes observed.
More constant symptoms were :—Pulse, sluggish and feeble; incontinence, and
severe cases, complete retention of urine, Faeces were also found to be retained,
but without constipation. The heart beat was invariably feebler than normal, but
otherwise regular.
In geldings the retractor muscles being involved in the paralysis, the penis
would hang down out of the sheath. The lower lip was often paralysed and pendu-
lous.
Urine at the commencement of an attack would be clear in appearance but of
a treacly consistance, in severe cases sometimes becoming later muco-purulent and
offensive in odour.
200 THE INDIAN JOURNAL OF VETERINARY SCIENCE AND ANIMAL HUSBANDRY [ IV, III
Two horses showed symptoms of hemiplegia, the neck turned round to one side
and able only to move round in a circle ; one of which died and one recovered.
Other symptoms sometimes observed were swelling of both hind fetlocks and
paralysis of the jaws.
One case only developed cranial symptoms which appeared in the nature of
'' fits ", with twitchings and contractions of the muscles of the neck, the head held
down, and finally falling to the ground, unconscious and struggling. After 10-15
minutes, the horse would get up again and appear quite normal. This animal even-
tually recovered.
The large majority of fresh cases, as they were discovered, showed no apparent
relationship to the previous ones by having been in contact with them in any way
or at any time, and cases of actual incontacts developing the disease were rare.
In the last stages of the disease twitchings of the abdominal or pectoral muscles
generally supervened. Every cases which collapsed totally in slings unable to stand
even with their support proved fatal.
PROGNOSIS AND MORTALITY.
At the commencement of the outbreak from 17th to 24th November, before
comprehensive routine treatment, slinging, etc., could be put in to practice, the mor-
tality worked out at 80 per cent.
From that time until the end of the outbreak in the following February, 26 per
cent. of cases only were fatal. As a general rule those showing only slight symp-
toms when first noticed were fairly certain to recover under treatment.
In the case of those showing severe symptoms at the outset, which in this out-
break may safely be estimated at about two-thirds, prognosis is difficult.
From what I have seen the critical stage of the attack appears to be somewhere
about 24—36 hours after the commencement of symptoms. It was found as a general
rule that if the animal could be kept on his feet up to 36 hours by means of slings,
in practically every case recovery followed. Once the animal had to be left out
and was down, however the condition rapidly became worse; but so long as the
animal could stand on his fore legs and had the slings to support his hind legs and
to preserve his balance, after 36 hours his chances of recovery stood high.
PLATE XVII.
1. Patients in temporary slings.
2. Temporary loose boxes.
ENCEPHALO-MYELITIS IN AN INDIAN CAVALRY REGIMENT
201
TREATMENT.
In all but very mild cases slinging was resorted to immediately on discovery.
The type of sling constructed was as shown in Plate XVII. For " field"
use it proved 100 per cent. effective and while able to support the full weight
of the animal's body, it had the additional advantage over the orthodox hook
and pulley sling that balance was much easier maintained by having complete
support on either side as well as in front and behind.
The frame-work consisted merely of stout wooden posts about 6 feet 6 inches
high, the only detachable parts being a short post at the breast and one at the croup
which were roped on to the uprights.
The sling itself was made from good strong sacking. Four holes were made at
each end through which the rope was threaded and the holes stitched round with
stout leather to prevent tearing of the material. A rope on each side was then
passed through the rear hole and knotted the free end passing over the top bar and
down again through the next hole and so on, so that the sling could be tightened or
loosened after the manner of a boot lace. Breast plate and breeching, also of sack-
ing, kept the sling in position and were fastened to the sling itself by means of
buckles. The standing was bricked and with the downward slope forwards in order
to take as much weight as possible off the hind part of the body.
Routine method of treatment which was carried out in all cases on admission
and subsequently as a daily measure as far as was considered necessary :—
The animal was first placed in slings. In the early part of the outbreak blood
smears were taken and examined, all with negative results.
Twelve ounces of mag. sulph. was administered by stomach tube. The rectum
was emptied and an enema used. The catheter was passed in all cases, male
and female, and the bladder invariably found full.
Towards the end of the outbreak the effect of hexamine (urotropin) was being
tried for its curative properties. Actually only the last six cases received this drug
but all were severely affected and all recovered. The dose given was 25 grammes
daily in 2 ounces of water, intravenously over a period of 4 days.
Previous to this drug being tried cases were being given subcutaneously, serum
taken from the blood of convalescent and recovered cases in doses of 200 c.c. on
admission and subsequently 100 c.c. daily. In the more severely affected cases this
did not appear to have any appreciable benefit but in all others recovery was defi-
nitely more rapid than otherwise was the case. In order not to confuse the issue
the administration was abandoned for the time being for the purpose of trying out
the effect of hexamine.
202 THE INDIAN JOURNAL OF VETERINARY SCIENCE AND ANIMAL HUSBANDRY [ IV, III
From time to time the following agents were used in the treatment of this
disease without any apparent benefit whatever:—
Strychnine, adrenalin, morphine, arecoline, calcium lactate, 2 drams intrave-
nously, naganol, 4 grams intravenously, normal saline intravenously.
All cases if they were able to walk at all, even with the assistance of 4 or 5 men
to support the animal, were given forced exercise daily. The effect was very pro-
nounced—after a few paces only the improvement in gait was apparent and this
form of treatment I believe to be of real and lasting benefit.
For this purpose also two blocks of four loose boxes were constructed from
posts and planks only (Plate XVII) in order to allow convalescent cases to exercise
themselves.
Several horses that fell down in their own lines had to be brought to the sick
lines with the aid of two bamboo poles, one pushed under the chest and one under
the abdomen and a party of men on each side were able to raise the animal on to
his feet and with the poles still under him, led forward slowly to the sick lines.
When the case was considered hopeless, destruction was carried out by means
of chloroform to admit of the brain being removed intact.
The process of recovery took anything from 3 weeks to 2 months.
POST-MORTEM CHANGES.
Naked eye changes were very few but fairly constant.
There was always evidence of a mild gastro-enteritis occurring in patches.
There was always present cystitis of varying intensity with thickening of the
bladder wall. The spleen was found sometimes to be considerably enlarged.
Vessels of the cortex of the brain invariably showed some congestion.
EXPERIMENTS AND GENERAL OBSERVATION IN THE FIELD.
The disease appears to attack all classes of the horse irrespective of breed, age
or sex.
During the period in which the disease was confined to Headquarters Squadron,
on the recommendation of Major G. A. Kelly, R.A.V.C., D.A.D.V.S., Lahore District,
it was decided to test the properties of serum taken from convalescent and recover-
ed cases, in a prophylactic and curative sense.
ENCEPHALO-MYELITIS IN AN INDIAN CAVALRY REGIMENT
203
The serum was prepared as follows:—About one litre of blood was drawn off
from the jugular vein into a sterile flask and the blood allowed to clot and the
serum to be expressed in the normal way, each litre of blood yielding about 350-
400 c.c. of serum. After 24 hours the serum was drawn off and to every 100 c.c.
was added 10 c.c. of a 5 per cent. solution of phenol.
As an experiment, half the number of the horses of Headquarters Squadron,
approximately 50 were given 100 c.c. of this serum in an attempt to confer on them
passive immunity. The result unfortunately could not be considered in any way
conclusive as from the time these inoculations were carried out no further cases
occurred throughout the whole squadron, with the exception of one which had
received serum 48 hours previously and which was undoubtedly well advanced
in the incubative stage.
At one period the possibility of an excess of baru grass (Sorghum Halepense)
in the hay, said to have a cyanogenetic action, being in some way responsible for
the disease, was considered and it was decided as a test to feed this grass only to
one selected horse.
The Grass Farm at Multan collected about 60 lbs. of baru for this purpose.
However, the effect it had on the animal appeared to be nil.
Food deficiency as a contributory factor in the cause of the disease was also
thought to be a possibility.
By the orders of the D. D. V. S., Northern Command, a supply of mineral
feeding flour and pot. iodide was arranged for and was given daily to all horses
in Headquarter Squadron, 2 ounces of the flour daily being mixed in each mid-
day feed. This was commenced on the 25th of January, but subsequent to it
being put into operation there were no further cases in this squadron—the
last case having occurred on the 18th January—and in consequence this experi-
ment was not proceeded with further.
The period of incubation and method of natural infection is not definitely
known but the fact that on one occasion after "A" squadron had been clear of
the disease for nearly six weeks and 14 days in isolation 3 fresh cases appeared
in the squadron at precisely the same time, not incontact with one another in any
way, seems to indicate that the period of incubation, whatever it may be, is cons-
tant, and to the possibility that it is spread by some common transmitting agent
such as biting fly or mosquito. The way in which fresh cases appeared usually
having no apparent relationship with any previous ones would also tend to sup-
port this supposition of the means of spread,