Mastitis according to the vicar of Werder

A 18th century description of mastitis can be found in the Prize essay of the German Prediger (clergyman, vicar) C.G.Schmundt, of Werder. The full title of this essay (about 100 pages) was:

Preisschrift,

eine Beantwortung

einer

von der freyen ökonomischen Gesellschaft

zu St.Petersburg

aufgegebenen Frage

betreffend die Fütterung und Pflege

der milchenden Kühe,

welche

von derselben das Acceßit erhalten;

herausgegeben und mit Anmerkungen vermehret von dem Verfasser derselben,

C. G. Schmundt,

Prediger zu Werder bey Rupvin, korrespondirenden Mitglied der Churfürst'l. Sachs, ökonomischen Sozietät zu Leipzig.

Berlin, 1787.

Bey Christian Friedrich Himburg.

Which may be translated as:

Prize essay, an answer to the the question given by the Free Economic Society of St. Petersburg, considering the nutrition and care of dairy cows by which an admission to it was obtained, edited and provided with commentaries by the author, C.G.Schmundt, clergyman at Werder near Rupvin, corresponding member of the Electoral Saxon Economic Society at Leipzig.

It was not unusual in those days that clergymen were involved in scientific activities. Friends and protectors of Darwin were vicars of the Anglican Church but also professors of the universities, and Darwin himself studied theology for some time, expecting to be a vicar himself later, until he was going on a journey with the Beagle.

Here is our clergyman-agriculturist (he also co-authored a prize essay on the cultivation of flax) mister Schmundt. After a long introduction that reads as a sermon given from a pulpit, he explained what is the aim of the essay: “ What kinds of feeds in summer als well as in winter, and what treatments and what kinds of care in general are of service in Russia’s area from the 56^th grade up to the 60^th inclusive, with the aim that these cows may give more milk and more fatty milk than usual; without these feeds and these means of raising milk production equaling, let alone raising, the costs with unaffected gains?”

In an essay like this much attention is given to the post partum period. Schmundt states that is is not very wise to separate the calves from the mother immediately after calving; it is better for the calf to stay with the mother for some days (8 days seems to be the optimum time) and for the mother it is better, because “The impure comes out of the mother with difficulty: many cows grow and hold it to themselves, and from this a strong swelling and inflammation may develop easily.” The suckling of the calf is much more effective in removing milk (and impurities) from the udder than milking by hand.

Some cows do not tolerate the suckling of their calves, which must be ascribed to a failure (Fehler) in the udder. Mostly these are indurations and swellings and tough material that obstruct the openings of the teats; or they are wounds of the teats which may give rise to blood in the milk. It has been believed that such cows give pure blood instead of milk. The only thing you can do is wash the udder with lukewarm vinegar in which a little bit of butter has been molten. (the text dealing with mastitis and calves is on pages 25 and 26)

The author associates mastitis with milk upheld in the udder, which was the common etiological standpoint for the disease during the first half of the 19^th century.

It should be noted that this publication is about 20 years older than the one I cited in my first blog, which I then credited with being the oldest.

Eggs: the falsification of a theory

Sometimes a single finding may help to falsify an existing theory. I found this description of an unusual egg in The Veterinarian of 1851, vol 51. p.119.

A CURIOUS "CASE."

To the Editor of " The Lancet."

SIR, — I have lately received a communication from Dr. White, of the 13th Bengal cavalry, which may prove interesting to the readers of The Lancet. He states, " that a fowl belonging to an officer stationed at Peshawer laid an egg, so singular in appearance, on account of its great length (four inches) and narrowness, that he determined to preserve the shell. For this purpose he punctured the ends, intending to remove the interior by breathing forcibly through it; he was surprised to find the needle strike against a hard substance, and on shaking the egg he felt the more assured that it must contain something abnormal. On breaking the shell, another perfect egg was found, with a hardened shell, containing yolk and albumen, as in the first. We read of two eggs united at the ends by the membrana putaminisr and also of others containing a blasted ovum, double or triple yolks, &c.; but I believe this is the only authentic record of a perfect egg with hardened shell being found in the interior of one also normal; and it would seem to determine points on which some difference of opinion has existed among physiologists. Firstly, it proves that the shell of the egg is hardened without being exposed to the atmosphere, although it has been believed that the induration of the earthy deposit depends on the absorption of carbonic acid from atmospheric contact; as the exterior shell was perfect, this explanation can no longer be considered satisfactory. Secondly, that the membrana testae with its earthy envelope are both products of the oviduct, and that it is not the case, as has been affirmed by one author, that the shell is only an uterine secretion.

Your's obediently,

W. H. Ashley, M.D. Boyne- Terrace, Notting-hill, Oct. 1850.

This case requires some comments:

1. I am not familiar with the physiology of egg development in birds, but the way of reasoning of the authors looks OK to me: the theory of the hardening of the shell of the egg should be discarded. But was it? Was it the decisive blow to the theory? I do not think so; in scientific practice it does not work that way.

2. Why did mr Ashley send this case to the Lancet? Maybe the scientific status of The Veterinarian was so low that it was a waste of time to publish in it. Or maybe the intended reader, i.e. biologists of those days (Darwin among them?) were reading the Lancet, although it was in principle a medical journal.

To ascertain the state of the secretion

At the end of the 1970’s the Faculty of Veterinary Medicine of Utrecht University decided to introduce a course for first-year students that was called ‘animal handling’. The idea behind this was that more and more students started a veterinary training at the university who had no experience with such practical handling of animals such as walking with a horse, holding a rabbit and catching a chicken. Apparently, in the nineteenth century a similar problem was noticed in England; a mister Robert Read, from Crediton, devoted several pages of The Veterinarian to help young veterinarians who knew much but could little.¹ This is the beginning of the article:

“The anatomy and pathology of cattle and other domestic animals will not in itself form the completion of the study.

The tyro who steers from the College with a full share of the knowledge of the diseases of cattle, and launches forth into country practice, will have to surmount many obstacles ; more especially if he has not, in his younger days, been accustomed either to agriculture or to the habits of every kind of stock. To the young beginner or aspirant for country practice, who has scarcely, if ever, wandered from the busy city or fashionable town, a few hints may not, I hope, prove unwholesome. Opinions will be formed among farmers or their hinds as to your merit or demerit in your profession — your being or not being apt in all the mechanical operations belonging to cattle; therefore it behoves every young man, under such circumstances, to learn the way to hold a bullock by the nose and horns; to be able to cast him; how to take up his feet; how to head-rope him; and, likewise, how to milk.”

Now comes a part of the article that interested me very much because it has to do with my main historical research topic, bovine mastitis.  During my studies of the concept of bovine mastitis during the first half of the nineteenth entury, I found many reports about what we may call now the biomedical knowledge of the disease. This concept may be summarized as: mastitis is a swelling of the udder, with blood in the milk, followed in later stages by abcesses, induration and gangrene. The cause is high milk production after calving, exposure to cold and holding up the milk in the udder. Therapies are based on salt solutions and rubbing the udder with oils and campher (among many others).

The problem is that from these descriptions you can not decide on how mastitis was experienced in the practice of the cattle farm. But now Robert Read in his article in The Veterinarian lifted the veil a little bit when he explains why a young vet should be able to milk a cow.

“This latter circumstance [i.e. milking a cow] will be required in every case of udder-ill or mammitis, in order to ascertain the state of the secretion; for should you attempt to handle the teat and not draw any milk, or go to the wrong side of the cow, the milk-maid standing by, the laugh would be against you; and the words to the mistress would be, " A pretty sort of a cow-doctor: he didn't know the milking side of the cow."

Apparently, mastitis seems to have been so common at cattle farms that it was appropriate for vets to be able to milk the cow for a simple diagnostic test, i.e. ascertaining the state of the secretion.

1. Robert Read, On the pathology and general treatment of cattle. The Veterinarian, 16, 1843, 55-57

Cells that count: philosophy of a diagnostic test for bovine mastitis.

Cells that count: networks of a diagnostic test for bovine mastitis.

Social Epistemology, 2014, in press. 

Can be accessed http://www.tandfonline.com.proxy.library.uu.nl/doi/full/10.1080/02691728.2013.818730#.Uuoa3D3ox8E

Abstract

Somatic cell count (SCC) is a diagnostic test of milk for mastitis in cows. Its specificity and sensitivity are less than 1.0, making test results uncertain. I discuss epistemological problems of the test such as underdetermination, undercalibration and underdiscrimination, in the solution of which biomedical and economic factors may play a role.

Diagnostics of the SCC should be considered as an epistemological network, functioning in a network in which farmers, veterinarians, epidemiologists and milk industry shift their position following biomedical, technological and economic changes, which is described as an actor-network to understand how human and non-human agents in mastitis may be associated.

Introduction

The aim of the paper is to investigate and discuss the epistemology of a diagnostic test and discuss the role of such a diagnostic test in the framing of disease. The background of this investigation is a study I am performing of the history and philosophy of bovine mastitis, a disease or syndrome of lactating cows that has considerable economic consequences but was hardly a problem at all before milk became a modern commercial product at the end of the 19^th century. I use this study of the history of mastitis as an effort to frame the disease in terms of Rosenberg’s definition of framing disease: ‘In some ways disease does not exist until we have agreed that it does, by perceiving, naming, and responding to it’ (Rosenberg  1992). The way mastitis has been framed, and is still reframed continuously, is in my view driven by both biomedical and social (i.e. non-epistemological) factors, such as technology and commercial interests.

The perceiving and naming of a disease is strongly related to its diagnosis and I have argued before that the diagnosis is part of a system of biomedical knowledge of the disease in which it is interconnected to epidemiology, pathogenesis (i.e. the etiology and pathophysiology) and therapy (Nederbragt 2000). This interconnectedness and mutual dependence of the pieces of knowledge from the different biomedical disciplines result in a more or less stable knowledge of the disease as a biomedical entity. Framing a disease reaches beyond the biomedical; it is a process that must be traced back in the past and the frame can only be understood with knowledge of its history. For a diagnosis to point to a disease in this frame at least some agreement must exist of what the disease is; so both disease and its diagnosis must co-evolve. When we assume non-epistemological influences in the framing of the disease we should also assume such influences in the framing of the diagnostic test of the disease. This will be a main theme in this paper.

The framing of a diagnostic test may be seen as an effort to standardize the test, notwithstanding the uncertainties connected to the outcome of the test. I shall discuss these uncertainties in an epistemological approach, making use of more or less traditional concepts. The uncertainty of tests is a common theme in the discipline of epidemiology. Notwithstanding these uncertainties, diagnosis is, according to Rosenberg (2002), ‘central to the definition and management of the social phenomenon that we call disease’. Apparently, it is necessary that the diagnostic test as an epistemological network moves, via the network of the subdisciplines that constitute the disease as a biomedical entity, to the social phenomenon that we call a disease.

I shall proceed as follows. First I will give a description of the most important aspects of bovine mastitis. I will then concentrate on the somatic cell count as a test for subclinical mastitis in milk and discuss three epistemological aspects of this test, ­i.e. underdetermination, undercalibration and underdiscrimination. These three form key factors in establishing the diagnostic test as an epistemic network. In the final paragraph I will sketch the biomedical-statistical network in which diagnosis participates and I will argue that for understanding a patient and her disease we have to weigh the evidence of the diagnostic test against the context of the patient; to be able to do this we have to leave the biomedical-statistical network and enter a social network. The significance of this approach is that we better understand the patient when we make associations between patient, diagnosis, disease and patient-environment. I shall argue that the application of some of the approaches of the actor-network theory may help us to understand how we can associate these actors and that this may clarify the incompatibility of knowledge of disease and knowledge of the patient that I discussed before (Nederbragt 2000).

Nederbragt, H. 2000. The biomedical disciplines and the structure of biomedical and clinical

Rosenberg, C.E. 1992. Framing disease. Illness, society and history. In Framing Disease. Studies in Cultural History, edited by C.E.Rosenberg and J.Golden, pp. xiii –xxvi, New Brunswick: Rutgers University Press.

For the complete paper, see the website of the journal Social Epistemology.

Those who have no access to this journal may send me an e-mail for a copy.

Counting leukocytes to provide a wholesome milk-supply Part 3

Since in milk “good” streptococci cannot be distinguished from “bad” cocci to characterize the quality of the milk as “good” or “bad” for consumption, maybe it is possible to evaluate the quality of the milk by looking at the leukocytes in the milk.  After all, given the assumption that the consumption of milk with mastitis streptococci and sore throats and gastrintestinal disturbances in man are causally related, the determination of inflammation markers in milk may offer an alternative solution for such an evaluation. This raises two problems. First, it has to be established that increased numbers of leukocytes indeed reflect increased numbers of cocci; second, that a threshold value can be determined on which milk can be judged as safe or harmful. This subject constitutes the last part of Harris’ paper. (1)

Harris starts to discuss the use of the word “pus cell” that was common usage in his time. “All milk contains leukocytes” he quotes W.G.Savage, a British public health expert. “When does a leukocyte become a pus cell, and what distinguishes one from the other?” The presence of leukocytes in milk up to a certain point is physiological, but beyond that point is pathological. The literature shows large variations in leukocyte number, among cows and among quarters of one cow. Some authors report proportional relationships between streptococci and leukocytes, others cannot find them.

Next, Harris discusses the attempts to develop practical methods of leukocyte counting. These methods are mostly based on staining cells in known volumes of milk and counting them with a microscope and a hemocytometer; the staining procedures are complicated and time consuming, but Harris consideres them as good.  An alternative method is the use of the tube developed by Trommsdorff, that is filled with 5 ml of milk, centrifuged, and the volume of the sediment read of as a measure of cell number, bur Harris is not very positive about it.

(from a recent catalogue of Gerber Instruments)

One of the authors he mentions had stated that milk containing 500,000 cells per c.c. togther with the presence of fibrin (an inflammation marker, BN) is to be regarded as suspicious, whereas a cell number of one million per c.c. and associated with fibrin “is conclusive of the presence of pus, i.e., evidence of mastitis.

In the next blog I will discuss Harris’ conclusions.

1. N.M.Harris, ‘The relative importance of streptococci and leukocytes in milk’, The Journal of Infectious Diseases, 4 (1907) 50-62.