Used To Be Is To Be

*The following is the presentation Dr. Vaughan gave at the 2016 J.T. Vaughan Equine Conference in November.

I got a call from Ms. [Kris] Street [the college’s continuing education coordinator] to say the constituent survey is back in. They said, in essence, “O.K., he called our bluff. After two years of poetry, we give up. He can come back and talk about the old days. He can even give us advice. We can just ignore the advice, and indulge him, as we would our grandfather, on those days of yore when he walked five miles to school barefoot in the snow. Mercifully, it won’t last but a half hour or so.”

So I thank you for another opportunity to renew this old association.

In prehistory, man learned to recognize animal diseases for his very survival, since, with the more stable existence of an agricultural lifestyle replacing the nomad culture, he became dependent on the herd or flock. As long as the animals were healthy, a supply of meat, milk, and fiber (wool, hides, feathers) was assured. Of course, to maintain their health and productivity, the animals also depended on their human owners. Medicines as we know them today were nonexistent, however, living with the herd/flock taught which practices were favorable and which were not. These good ways came to be known as husbandry, which is as true today as 10 thousand years ago. But again, common-sense husbandry was learned from living with the herd, observing the natural processes, behaviors, needs—growth and reproduction, eating habits, dealing with bad weather, predators, insect pests, and various other stresses to patterns of behavior throughout the day and from one season to another. Not constrained by religious taboos on handling the dead human body, knowledge of the anatomy and pathology of animals in the early years was in many instances more advanced than that of humans. A classical example was in the case of Leonardo da Vinci’s anatomical illustration of the human fetus in which the placental membranes were beautifully drawn images of the cotyledonous placenta of the bovine rather than the diffuse placentation of the human.

Over the course of time, many lessons were learned, but regrettably, some have been forgotten, and others have simply been casualties of human lifestyles as we have grown farther apart from basic agriculture. Without a farm background in which we literally “grow up” with the animals, it is virtually impossible to provide the knowledge in a classroom, even with live labs in the field; that comes with years of direct experience. One example is when we become dependent on mood or performance-altering drugs for restraint of the awake patient rather than the use of animal psychology, especially to quell bad behavior. During my years on the professional liability insurance trust, there were several costly litigation suits for serious injuries to horses being treated standing in stocks, in which the patient was given drugs to subdue him that resulted in ataxia and disorientation and a subsequent fall on concrete with severe head or leg injuries. There were also several instances in which the doctor was seriously injured from trying to work on a horse snubbed by a rope tied to a stationary object. For many years, restraint methods and equipment was the first course taught, along with physical diagnosis, when veterinary students entered the Large Animal Clinic. The students laughingly referred to it as “knot-tying 101.” Of course, this was in the days before tranquilizers and all the other drugs used today with abandon. Of special importance is appreciation of the fact that large animal medicine is, first and foremost, the child of animal agriculture, and, secondly, the grandchild of medicine. Only when we know good animal husbandry can we expect to practice good medicine.

Perhaps no better example can be found to illustrate the proximity between good medicine and good husbandry than in the case of the third dean of veterinary medicine—Dr. Redding S. Sugg—who devoted more than 40 years of his life to this Dr. Redding Sugg college. Graduating under Dean Cary in 1915, he served until he died in office in 1958, that period interrupted twice by military duty in the U.S. Army Veterinary Corps in both World War I and II, retiring with the rank of Colonel. During the 1930s, in the midst of the Great Depression, he served in the A.P.I. Agricultural Research Service as a livestock specialist, advising farmers and county agents statewide on matters of prevention and control of livestock diseases, but also on good nutrition, improved feeds and feeding practices and the need to upgrade bloodstock and protect against bringing uninspected and untested replacement livestock into the herd. Violations of shipping regulations were rampant with “pinhookers” peddling diseased animals across state lines and from one stockyard to another. He was most famously quoted as saying, “I won’t say everybody who owns a pickup truck is an S.O.B., but every S.O.B. I know drives one.” In 1940, President Luther Noble Duncan, who was the father of the Alabama Cooperative Agricultural Extension Service, named Redding Sugg third Dean of Veterinary Medicine. He also served as Alabama State Veterinarian until 1952, but one of his greatest contributions was the establishment of the regional contract program of the Southern Regional Education Board which has now enjoyed 65 consecutive years (1951-2016) of educational partnerships with the southeastern states. Throughout his career, he remained a staunch advocate of veterinary medicine’s reliance on a close cooperation with agriculture including animal husbandry and good farming practices. I readily acknowledge the impact he had on my own priorities.

NUTRITION

We all know what iatrogenic illness is — one caused by the doctor. But of far greater significance are the diseases caused by imposed lifestyles such as eating habits.

Our daughter who has practiced veterinary medicine in Seattle, Wash., for more than 31 years, operates two referral clinics—one in Tacoma—specializing in nuclear medicine for cats with thyroid problems. Reminding us that cats are obligate carnivores, she says that the ubiquitous thyroid disease is a man-made disease that doesn’t exist in nature. Ditto obesity, both diet-related in addition to other factors.

My thoughts immediately transferred to gastric ulcers in horses, which were unknown two generations ago. As many horses as I have seen in the postmortem room, the only stomach ulcers I ever saw were the rare ones associated with bots which were incidental findings unrelated to the cause of death.

In today’s modern society, beset with various addictions and abuses, I contend that a more common cause of death is not the bottle or the glass, but the fork.

But back to the horse, not only are feeding practices to be considered, but the quality of grains and forage, for example, moldy corn and damaged hay and grasses that are subject to seasonal conditions that produce moldy forage.

Yet another forage concern is the existence of toxic plants and damaged plants, such as wild cherry within access to pastured horses.

Diets with an imbalance of certain minerals such as calcium may require specific supplementation such as ground limestone added to the daily ration or amendment of certain feeds, such as addition of alfalfa hay to provide additional calcium. And, of course, hot climatic conditions and work schedules that cause salt and water depletion call for that addition to the diet.

PARASITISM

In close association with nutrition and knowledge of the environment is control of sources of infestation, notably pastures and water sources. Rotation of pastures is not only provision of better forage, but also reduces parasitic reinfestation. Bogs and poorly drained low-lying areas are also sources of pestiferous insects. Drainage is preferred, but if not practicable, fencing off such areas is an alternative. For stables, pens, and small paddocks, regular manure disposal and treatment of such areas will reduce fly problems in addition to use of repellants. Identification of problematic parasites will help with the interruption of their life cycle even to the endpoint of eradication such as was done with the Texas Fever tick and the screw worm. Of course, all of these are in addition to regular schedules of deworming and spraying for insect control.

REPRODUCTIVE MANAGEMENT

Perhaps the first surgery performed on livestock was castration, initially to limit the number of breeding stock, but also to increase the supply of animals used for meat and for draft (oxen). Saving the best for breeding assured the quality of the herd. Corollary to this was selection of the best females to retain as breeding stock. With the advances in theriogenology in the 20th century, it would seem to be axiomatic that reproductive management would have kept pace. However, in Dr. Dwight Wolfe’s excellent paper at the annual conference this past April, he noted that a recent report by the U.S.D.A. called attention to the fact that only 18% of U.S. beef producers used pregnancy testing in their cows, that less than 20% conducted breeding soundness exams on their bulls, and that less than 40% vaccinated for any reproductive diseases. To compound these shortcomings, nine easily detectable genetic diseases and seven infectious diseases were commonly purchased in making additions to the herd. Doctors, this isn’t bad medicine; this is just plain poor husbandry, scarcely the wise stewardship of our resources.

DISEASE CONTROL AND PREVENTION

I have arbitrarily listed five measures for the detection, prevention, and control of common contagious and infectious diseases of all livestock:

1. Notice altered behavior: appetite, bowel movement, urination, breathing, weight loss, gait, conformation, and others.
2. Separate and examine, first physical measurements and recording of temperature, pulse, respiration, appetite, bowel movement, urine, abnormal discharges, and any other departures from the normal. If felt advisable, collect specimens for clinical pathology.
3. Isolate and quarantine if signs suggest contagious or infectious disease, and instruct personnel how best to eliminate or minimize cross contact with other members of the herd, and to avoid overcrowding. When Dr. Floyd Sager, the venerable, old sage of Claiborne Farm in Lexington, Ky., was asked what was the desirable number of stalls in a horse barn, he said, “When you have an outbreak of Strangles or flu, one.”
4. Dead or dying animals should be necropsied either on site or in a diagnostic lab, and premises sanitized and walled off. Bear in mind that diseases such as blackleg and anthrax are notorious for leaving long-lasting spores in the ground. It has been 150 years since Louis Pasteur’s proof of the germ theory (1860) and Sir Joseph Lister’s description of the use of carbolic acid (phenol) to disinfect the patient and the operating room, and we have not gotten away from the use of these and other comparable inorganic germicides to sterilize physical premises and, to some degree, the patient. Antibiotics are certainly not the answer.
5. Increase surveillance of Louis Pasteur other unaffected animals and institute preventative measures as dictated by findings, including vaccinations. Edward Jenner’s discovery of the use of cowpox vaccine to protect against smallpox was announced in 1798. Louis Pasteur’s development of attenuated vaccines for anthrax and rabies and Robert Koch’s work on anthrax and tuberculosis were all done before 1880. And, yes, we are still confronted by inexplicable lapses in the application of modern medicine as disclosed in Dr. Wolfe’s report.

I admit to being a throwback to an age when penicillin was still on Dr. Fleming’s lab bench and the Germans were just marketing sulfanilamide. I lost a brother to an infection in 1934 who might be alive today with the benefit of either of those. But now, over three quarters of a century later, we’ve already run through a laundry list of antibiotics and are seeing a new crop of what are called “emerging diseases” that are new versions of old diseases that we thought were almost eradicated, such as tuberculosis and resistant staphylococcus.

Several years ago when I was on the large animal clinic floor at Cornell, we had a baby elephant patient with a distressing oral infection that had resisted everything. After a consultation with Dr. Gandal at the Bronx Zoo, I asked the pharmacist for a solution of crystal violet which we used liberally to swab out the oral cavity. Presto, problem solved. Crystal violet has long been used to treat thrush, a common fungal infection in human infants. The walls of the stall were covered with ceramic tile which the baby elephant enjoyed decorating in a beautiful shade of violet.

Anecdotal accounts and personal testimonials are the weakest of all arguments, but I still make a case for the inorganic antiseptics, disinfectants, and fungicides many of which have been abandoned by modern medicine. I contend that the baby has been thrown out with the bath water. I could no more treat the abscess of a horse’s foot without iodoform and bismuth subnitrate than I could practice without iodine or phenol. Anyone who has never treated screw worms with benzene cannot imagine the instantaneous effect. I could go on, but these are but a few of an entire armamentarium that used to fill our pharmacy shelves. Like Maurice Chevalier, in some respects, I’m glad I’m not young anymore.

So, doctors, all of this is to say that the question is not “To be or not to be,” rather, “How did it used to be and how will it always be?” The eternal verities are not blown off course by the winds of fortune. It was Churchill, the consummate historian, who said, “The farther backward you look, the farther forward you are likely to see.”