Report on the Makhna Elephant Housed at the Mudumalai Elephant Camp: Physical Condition, Treatment, and Prognosis
This modified report received by email 3-1-02

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By

James Mahoney, D.V.M., Ph.D.
President
Sanctuary Support Program
Monroe, New York.
6th – 27th January, 2002.

Background

At the request of Advocate, Mr. G. Rajendran, and Ms. Deanna Krantz, Director of the India Project for Animals and Nature (IPAN), and under Order of the High Court Madras, I went to India to treat the wounds of the injured Makhna elephant who is kept at the Elephant Camp of the Mudumalai Wildlife Sanctuary, at Theppakadu. I arrived in the Nilgiris on 6th January, 2002.

I had first examined and treated this elephant at the request of IPAN in December 1998, some six months after he had been captured from the wild by the Forestry Department of Tamil Nadu and force-marched to Mudumalai in chains. During the process of his capture and march, the Makhna received severe and extensive injuries to all four feet and legs, as well as wounds to certain areas of his body, the details of which I presented in a written report dated 23rd December 1998.

Statement of Mission

My understanding of my mission was that I would examine the Makhna, determine the extent and type of his injuries, and then develop an intensive program of long-term medical treatment for him. Based on my previous experience of treating the Makhna three years earlier, in December 1998, I determined that I would need the combined assistance of Mudumalai Sanctuary staff, as well as IPAN colleagues. This team would provide me not only essential assistance in daily treatment but would, most importantly of all, allow me to develop an uninterrupted continuity in hands-on knowledge and experience that would be required to treat the Makhna over the ensuing 4 – 6 months (the time I anticipate it will take to get some of his wounds under control), long after my departure from India.

Calendar of Significant Events

Sunday, 6th January 2002: Arrival at the Log House, Theppakadu, directly after landing at Coimbatore Airport after my flight from the United States there to be introduced to the Wildlife Warden, Mr. Ashok Uprety, and other members of staff of the Mudumalai Wildlife Sanctuary, by Mr. G. Rajendran, Advocate.

My findings, reported at this meeting, were that the Makhna had superficial and deep-seated infection of wounds in all four limbs and in certain areas of his upper body. Some of these wounds were remains of injuries received at the time of his initial capture in mid-1998, while others, particularly of the left hind leg, appeared to be of more recent origin and consistent with the continued use of leg chains (please see both Summary and Detailed Report of Physical Examination Findings below). Sanctuary officials assured me, however, that leg chains were no longer used on the Makhna.

It was agreed at this meeting, however, that Dr. Manoharan, (the temporary replacement for Forestry Veterinarian Dr. Shamungrasandrum), who would depart for his station at Coimbatore the following morning, would be available to assist me in treating the elephant on his return to Theppakadu the coming Friday, 11th January.

I visited the Makhna on 8th and 9th January, but was unable to institute any meaningful medical treatment because of lack of adequate assistance in terms of man power and experience, and also because of the physical danger I would be exposed to because of the lack of adequate backup of assistance and my inability to be able to communicate my immediate needs with the mahouts.

My two veterinary colleagues, Dr. Neimanis and Dr. Lindsjo, together with Mr. Nigel Otter, IPAN field director (please see Appendix for copy of handwritten report signed by all three), were to observe a similar scene down by the river bank the following day,11th January. This and my own observations of the day before were in sharp contrast to the Sanctuary official’s statement to me on 7th January that chains were no longer used on the Makhna.

Friday, 11th January 2002: I discovered that Dr. Manoharan would not be returning to Theppakadu today, as planned, but would be available the next day, Saturday, 12 th January. In the meantime, Mr. Ashok, the Wildlife Warden, assigned a more locally stationed veterinarian to assist me, just for the day, in the treatment of the Makhna.

In this meeting (please see Appendix for enclosed copy of a handwritten Outline for Meeting which I used as a guide), I stressed the importance of accepting that the elephant, while having made considerable improvement in many areas, had injuries to his feet and legs which had already persisted for 3-1/2 years, and would likely be permanent. For this reason, I stressed, the Makhna must never be shackled in chains. I pointed out that the use of leg chains in the past on an animal already badly injured in the legs might be construed as cruelty by omission (i.e., thoughtless but unintended cruelty), but to use such chains in the future after my warning, would constitute the most grievous cruelty by commission (i.e., intended cruelty). I went on to stress that a specifically designed, physically secure kraal (enclosure) should be constructed that would allow the Makhna free, unfettered range and gentle exercise for the remainder of his life. I also emphasized that the elephant should not be transported to the zoo at Chennai, a plan which was apparently under serious consideration, because the confinement and lack of exercise for which Sanctuary officials informed me would be a 20-hour drive by lorry, over bumpy roads, would have profound deleterious affects on his already-injured limbs. I did not accept the Sanctuary officials’ explanation that a thick bed of sand on the floor of the lorry would be adequate protection against the shock and trauma of the jolting vibrations. (I must mention at this point that several days later I vetoed the Makhna’s being walked a distance of 28 Km., one way, mostly along asphalt-covered roads, to a weigh station, even though I was informed by a Sanctuary official, “This is standard procedure, and has been carried out six or seven times before.” We must all bear in mind that the Makhna really does have serious, and almost certainly permanent, injury to his feet and, as a consequence, what might be accepted by some as “normal procedure” for a “normal elephant” cannot be accepted in the Makhna’s case.

Summary of Physical Examination Findings

The scarred remains of the original, deeply penetrating chain injuries to all four legs and feet, sustained by the elephant at the time of capture are still evident. These appear as raised annular ridges encircling the legs on or just below the level of each fetlock joint (e.g., Fig 1: Inner aspect of right foreleg).

The skin of the toenail arcades is deeply cracked and fissured, indicating that there is permanent damage to the germinal layer of the skin beneath. Toenails I, IV and V are moderately to severely cracked, also indicating permanent damage to the underlying tissues.

There are two deeply penetrating, pus discharging abscesses on the lower aspects of the foot (Figs 6, 7 & 8), and the skin of the toenail arcades is moderately cracked and fissured throughout.

Detailed Physical Examination Findings

Examination of wounds and lesions affecting the limbs and general body areas was carried out on the Makhna elephant while in the standing position on 7th January and in the cast (lying) position on 20th January 2002. Findings are compared with those determined at examination three years earlier, in December 1998.

The scarred remains of the original, deeply penetrating chain injuries to all four legs and feet, sustained by the elephant at the time of capture, and described at examination in December 1998, are still evident. These appear as raised annular ridges encircling the legs on or just below the level of each fetlock joint (Fig 1). Scarred remains of abscesses and other lesions, in varying stages of healing, over various areas of the body are also evident. Additional wounds and lesions of the limbs and body, not existing at the time of the initial examination and termed as new injuries, are also described.

Left Forelimb

Antero-medial Aspect: A broad, dome-shaped deformity of the foot surface, measuring approximately 15 cm in diameter, on the high point of which sits an ulcerated abscess (Fig 2). This lesion was not apparent at the time of the December 1998 examination. The raised rim of the abscess measures 6 x 9 cm in diameter, and the denuded central area of exposed granulation tissue is approximately 3 x 3 cm in diameter. The skin of the surrounding dome-shaped deformity is deeply cracked and split, forming a whirl of thick plate-like crusts and flakes whose edges are raised and curled (Fig 3). This appearance of the skin is a clear indication of extensive, deep-seated infection of the underlying, subcutaneous tissues as well as permanent damage and infection of the basal germinal layer of the skin.

The skin of the toenail arcades is deeply cracked and fissured all around. Toenails I, IV, and especially V, are badly cracked; toenails II and III are in moderately good condition.

Right Forelimb

Lateral Aspect: Two deep fissures in the skin above and posterior to toenail V. Skin between and above toenails IV and V deeply cracked and fissured. Toenail V extensively damaged (Fig 5).

High on the inside of the leg, approx. 66 cm above ground level, is a hemispherical, subcutaneous swelling, measuring approx. 5 x 6 cm in diameter and protruding 5 cm. Soft, fluctuant to touch. When first examined, deep digit pressure appeared to produce immediate pain. At later examinations, was not able to regularly elicit pain. In close association to this structure, running in a downward course for approx. 14 cm., is a subcutaneous cord-like structure, which appears to be a vein. Differential identification of these structures is:

• An abscess in association with, but not necessarily part of, a superficial skin vein, either prominent but normal, or inflamed and distended (i.e., phlebitis),
  
• Lipoma (benign fat tumor),
  
• Hematoma,
  
• Aneurysm of vein with/without phlebitis.
  

Pressure applied distal to the cord-like structure results in partial collapse, but pressure applied proximally results in a certain degree of distention, suggesting the structure is indeed a vein. The swelling is most likely an abscess, either an inactive abscess or a cold (i.e., noninfected) abscess resulting from trauma.

Right Hind Limb

The leg below the level of the hock is distinctly enlarged, in comparison to the other three legs. This distension was even more prominent at examination in December 1998. The mahouts gave me to understand that this leg undergoes extreme distension and enlargement at times. These findings indicate deep-seated and extensive infection and damage to underlying tissues and structures (e.g., joints, tendons, ligaments and lymphatic ducts). It should be noted that the elephant frequently tended to favor this leg, often holding it across the front of his left hind leg, or stretched out backwards, changing position and weight-bearing repeatedly as if in extreme discomfort or pain. This behavior was also observed in 1998.
Lateral Aspect: An irregular, raised area, measuring 8 – 10 cm in length, approx. 23 cm above ground level, with stellar-shaped, ulcerated central area, penetrating the full thickness of the skin, is seen above and between toenails IV and III (Fig 6). This lesion oozes pus and is very sensitive to touch. Gentle probing with a small artery forceps indicated no connection with the deeper, subcutaneous tissues (Fig 7). This lesion was evident in 1998, but was even more extensive and deeply penetrating at that time.

Skin of toenail arcades is moderately cracked and fissured.

Left Hind Limb

This was the least injured of the four legs in December 1998. The skin of the toenail arcades is distinctly less cracked and fissured than in the other three feet.

Anterior Aspect: High on lower leg, just above the hock (about 50 cm above ground level), is a vertical series of three transversally-running, split-like lesions, each measuring from 3 – 6 cm in length, which penetrate the full thickness of the skin (Figs 9 & 10). The upper two of these lesions ooze pus and one are freshly bloody.

The lesions described on the lateral, posterior and medial aspects of the lower leg appear to be of recent origin and consistent with leg-chain injuries. Several ooze pus and/or fresh blood, but none penetrates into the deeper tissues of the leg. None of these wounds had been apparent at examination in 1998.

Upper Body

Left Flank and Upper Leg : Scars of several infected abscesses seen at examination in December, 1998, are now completely healed. Of particular significance are two abscesses, now healed, which communicated through an extensive fistulated tract which ran 15 cm from a point just above the left elbow down the posterior aspect of the left foreleg. Another abscess that was located in the left axilla and tracked subcutaneously down the inside of the left foreleg is also now healed.

Right Flank and Upper Leg : Several abscesses on the right side of the body, seen at examination in 1998, are now healed. A more recently formed abscess, not apparent in 1998, is seen on the anterior aspect of the right upper leg, at the level of the elbow (Fig 12). This abscess, which measures 12 x 10 cm in diameter, with a central, ulcerated area of exposed granulation tissue 2.5 cm x 4 cm, exudes a thick, cream-colored pus.

Right Cheek

A fistulated tract opens out onto the right cheek, below the level of the musk gland. This tract appears to be epithelialized. A discharge of dense, cream-colored pus, sometimes flecked with fresh blood, is often apparent first thing in the morning (Figs 13 & 14. This lesion was not evident at examination back in December, 1998.

Treatment Schedule

Daily treatments included washing and cleansing of each wound with sterile physiologic saline and iodine surgical scrub solution, debriding of tissues using sterile scalpel blades and dedicated tooth brushes, draining and irrigation of fistulous tracts and discharging abscesses with hypertonic saline solution, application of hot packs (in the form of rubber hot water bottles wrapped in towelling) to draw infection out of deep tissues, and, finally, application of antibiotic ointment (Nitrofurazone ointment) or irrigation with antibiotic solutions.

I must emphasize two aspects of the treatment:

1) Care must be taken not to allow certain of the wounds to heal too rapidly, so permitting the outer layer of tissue from closing over and trapping infection beneath in the deeper tissues. This is particularly so for the discharging abscess located on the antero-medial aspect of the left forefoot, and the discharging abscess on the front of the right elbow. Ideally, the infected, poor quality granulation tissue that forms the bases of these two abscesses would be surgically removed, the underlying infected tissue extensively debrided and removed, the lesions packed daily with fresh, sterile gauze pads or drainage catheters, and the lesions allowed to heal slowly, from the inside out (rather than by the natural tendency to heal from the outside in). This would not be a practical way of handling the wounds, however, because inadequate post-surgical care, and prevention of even worse infection, could not provided under the field conditions existing.

2) The keratinized scales and flakes of skin surrounding the base of the large discharging abscess on the left forefoot were pared away (please see Fig 3). This was not done for cosmetic appearance, however, but rather to prevent the build up of sand and dirt deep in the skin folds, scales and flakes of the area. It must not be assumed, however, that because the skin condition appears improved that the skin and underlying tissues are actually healed. Over the course of the coming weeks and months, the scales and flakes will most certainly reappear, because the deep germinal layer of the skin is permanently damaged, at which time they should again be pared away.

It took an 8-person team approximately 1-1/2 hours per day to carryout the treatment of the Makhna and to make a daily written report of procedures and results.

All materials and medical supplies were provided by IPAN, including saline irrigation solutions, iodine scrub solutions, gauze pads, scalpel blades, tooth brushes, hand soap, antibiotic ointment and antibiotic irrigation solution, sterile infant feeding tubes for daily wound irrigation, surgical instruments.

Living Conditions and Daily Activities of the Makhna

The question arises whether the Makhna is able to sleep in a lying position at night on such steep sloping land, or whether he is obliged to stand all night and every night. I pressed the issue for the need to construct a specially designed kraal, to avoid the use of chains or ropes altogether. It is my hope that Mr. Alan Roocroft of the San Diego Zoo, a world renowned expert in the care and management of elephants, will be able to develop methods and procedures in his upcoming visit to the Elephant Camp that will be helpful in such design and construction.

There is no question that a drag chain was being used, which was attached to the left hind leg, the least injured of his four legs, as a way of controlling and keeping track of the elephant during his daily foraging in the forest. There is also no question that it was this wearing of the chain that was responsible for the six wounds I observed, and have described above, to this leg. I am equally convinced, however, that during the last several days of my visiting the elephant Camp, after my repeated complaints about the use of chains, the Makhna was being taken to the forest without any form of shackle or rope: only during his evening bath in the river was a chain placed around his left hind leg, and this would be removed immediately after he left the water.

Psychological Needs of the Makhna

I noticed an overriding tendency to describe everything that the Makhna is exposed to as “normal procedure,” or as, “that’s the way it’s done with elephants.” Thus, it was explained to me by Sanctuary officials that it was “normal” to use a tusker elephant to goad and gore the Makhna into the river when he didn’t want to go of his own volition, as was described by my IPAN colleagues in their encounter on 11th January, and it is “normal” to march an elephant (presumably even when his legs are injured) a distance of 28 km. one way, just to get his body weight, and it is “normal” for elephants to wear drag chains, otherwise they will run away and escape (again, even when their legs are injured!). It might also be regarded by some as “ normal” for recently captured wild elephants to be beaten (as I witnessed and shall never forget on my initial visit in December 1998), to bring them into submission and break their spirit. It might also turn out that it is “normal” if an elephant cannot lie down at night because the land he is confined to by chains is too steep for him to lie down. I also saw the young elephant at the Camp who is chained across both front feet and has to hop four or five paces in a row before taking one large“skip” which allows him to gather up the drag chain that trails behind him so that he does not step on it or trip over it (I took video tape of this, too, which caused one of the Sanctuary officials to yell at the mahout for allowing me this opportunity). This method of shackling is used because the elephant has a tendency to walk too fast. As far as I could determine, this one elephant is never allowed to take a “normal” step, not one! Where is the compassion? one has to ask.

Synopsis

1. I had predicted in December 1998, when the course of treatment being given by myself and the IPAN team to the Makhna was abruptly terminated by the Forest Department, this elephant's severe injuries would never properly or entirely heal. Now, three years later, my prediction has been confirmed not only by my own observation but also by IPAN's team of veterinary and elephant husbandry experts. The Makhna is chronically injured as a result of these wounds and the lack of continuity in appropriate veterinary treatment and general husbandry given him.

3. There are also new injuries to the legs, caused by the continued use of chains which I and my colleagues independently observed, despite assurances given me by Sanctuary officials that chains are no longer used on the elephant.

4. During my return visit, clinical assessment and treatment of this elephant, there was virtually no participation and professional dialog with veterinarians designated to be present by the Forest Department to assist and collaborate with me. This experience confirmed my concerns that appropriate and effective daily veterinary care and expertise for this and the other elephants at the Theppakadu elephant camp would not be available.

This report is based on the daily log I maintained, as well as on correspondence and tape-recordings made at the time.

Copy of signed statement by Dr. Neimanis, Dr. Lindsjo and Mr. Nigel Otter, dated 11th January 2002, describing the use of a drag chain on the Makhna elephant.

2) Copy of Handwritten Outline of my interim verbal report on the physcial findings, treatment and prognosis for the Makhna given at the Reception Centre, Theppakadu, 12th January 2002.