THE INFECTIOUS DISEASES. 219 



This organism closely resembles the gonococcus in morphology and 

 considerably so in culture, and they are evidently closely related. 1 



GLANDERS. 



Glanders is an infectious disease incited by the presence and growth 

 in the body of the Bacillus mallei. 



It is most common in the horse, affecting the mucous membrane of 

 the nose (when involving the skin the disease has been called fa re?/), and 

 can be communicated to man and to certain other of the domestic ani- 

 mals by direct or accidental inoculations. 



The disease in man is most frequent in those who come much into 

 direct contact with horses. The seat of primary local infection is most 

 often the skin, more rarely the mucous membranes about the nose and 

 mouth. 



The local lesions are similar in man and the lower animals. In the 

 presence of the Bacillus mallei there is usually a circumscribed or more 

 rarely a diffuse infiltration of the tissue with leucocytes and young con- 

 nective-tissue cells. These whitish foci of cell accumulation may be 

 small and to the naked eye resemble miliary tubercles ; or, they may be 

 larger and nodular. The tissues about them may be infiltrated with 

 blood. But the accumulated cells are apt in the presence of the bacilli 

 to become uecrotic and disintegrate and thus lead to smaller and larger 

 abscesses, or, if near the surfaces, to ulcers. If they occur on mucous 

 membranes these lesions are often accompanied by intense diffuse catar- 

 rhal inflammation. 



As the glanders nodules soften, the bacilli are apt to diminish in 

 number or in the capacity to stain, so that it may be possible to detect 

 their presence only by inoculation or culture methods. 



The^diseasejmay^ begin at a single point, so that it may be mistaken 

 for a carbuncle or gangrenous erysipelas. But the infection is apt not 

 toTemain locaTpthe^rjacilli, todnfg^TEerr way along the lymph channels 

 into various parts of the body, set up fresh foci of inflammation and 

 necrosis. Then the skin may be covered with a pustular eruption; 

 fjiruncles^carbuucles, and abscesses may form beneath the skin and in 

 the muscles] Sodules~lire~ found in the nasal mucous membrane, the 

 lungs, kidneys, testes, spleen, and liver. The joints may be inflamed, 

 and there may be osteomyelitis. Leucocytosis may accompany infection 

 with the B. mallei. 



-~ The glanders infection may, however, pursue a more chronic course, 

 with hard, persistent nodules and sluggish ulcers. Under these condi- 

 tions the detection of the bacillus in the tissue by a simple morphologi- 

 cal examination may be difficult. 



1 For a study of cases, with bibliography, consult Flexner and Barker, American 

 Journal of the Medical Sciences, vol. cvii., "pp. 155 and 259, 1894; also Councilman, 

 M<tU.:iry. a ml Wfif/ht, "Special Report of the State Board of Health of Massachusetts," 

 1898. For agglutinative reaction see Jaeger, Zeitsch. f. Hygiene u. Infkr., Bd. xliv., 

 1903, p. 225. 



