346
Equine Encephalomyelitis in India
Horse 266.—Admitted as a fever case ; suspected for biliary fever; con-
junctiva jaundiced ; œdematous swelling in all limbs ; later, slight paraplegia ;
found down in morning of third day, completely paralysed. Destroyed.
Horse 416.—Suddenly developed symptoms of acute meningitis without
any warning ; maniacal frenzy. Destroyed.
Horse 286.—Paraplegia ; temperature 103.2°; later, restlessness, pawing
the ground ; suddenly fell and unable to rise ; cervical rigidity; salivation ;
Cheyne-Stokes respiration developed; no sensation in posterior parts; con-
tracted pupils ; total paralysis. Destroyed.
Horse 312.—Admitted paraplegia at Khanewal, 25th November 1934, and
discharged as cured on 5th February 1934. Severe recurrence with cerebral
symptoms, 24th February 1934. Destroyed.
Among the general symptoms noted in these cases was a retention of urine
or incontinence, the former especially in mares, the latter in males, the urine
dribbling away when the animal was made to move. In males, paralysis of
the retractor muscles of the penis was usual; in mares, œdema of the vulva
and some sexual excitement.
The majority of cases were ushered in by paraplegia. The greater num-
ber of these did not progress beyond this symptom and many of them were
later discharged as cured. In certain of- these cases, however, the ocular
reflexes were abnormal and slight twitching of the facial muscles with occa-
sional grinding of the teeth could be observed, thus indicating that the higher
brain centres were involved, even if the symptoms appeared mainly spinal in
origin. In all paraplegic cases, however, mild, there was an inability to main-
tain balance—as Heane puts it ' the animal appeared to be feeling for the
ground '—a sure indication of cerebellar involvement. The writer feels con-
vinced, on his own clinical examinations, that no case is ever purely spinal, no
matter how mild the paraplegic symptoms. The brain is always affected at
the same time as the cord, an observation which was confirmed by later patholo-
gical examinations.
Other symptoms in common, noted in this outbreak, were :—marked
depression at the commencement, some degree of loss of sensation in the
posterior quarters, especially over the perineum, and, perhaps one of the most
important, even in mild paraplegic cases, irregularities in the heart beat, with
long respiratory pauses ; fits of yawning ; in short, clinical signs of irritation
of the root of the tenth cranial nerve. ' Sinking of the loins ' appeared a con-
stant symptom in all cases. Blood in the urine (hæmoglobinuria) was noticed
in several cases.
The fact that stands out on a clinical examination of this, as in other,
earlier outbreaks, is that there is no specific syndrome. Each case behaves
somewhat differently, the possibilities of symptomatology being permutated,
as it were, in each case. Only one or two symptoms may be present in the
milder cases, and unless such cases occurred during the course of an outbreak,
one might easily be puzzled in diagnosis of sporadic cases, or of those cases
which often occur, at infrequent intervals, at the commencement of an out-
break.
(b) The difficulties of diagnosis in atypical cases are many, and a large
number, if not the majority of sporadic cases, are atypical, presenting only