Glanders in Man. 249 



then somewhat sticky and often tinged with blood. In acute cases 

 according to Senn, the nose ma)' be completely destroyed and deep 

 facial ulcers may be formed in a week. The submaxillary 

 glands are enlarged and painful and the facial lymphatic vessels 

 leading from these to the nose may be red, thickened and tender. 

 Suppuration and ulceration of the glands may ensue. Headache, 

 prostration, nausea, inappetence and vomiting with diarrhoea 

 usually supervene. Then follow dyspnoea, wakefulness, troubled 

 dreams, anxiety, nocturnal delirium, stupor and coma. The 

 pulse may rise to 120 and the temperature to 104 F. 



There may be various complications as deposits in the lungs 

 with pain in the chest, weak cough, aphonia, bloody expectora- 

 tion and offensive breath ; or the morbid process may take place 

 in the liver or spleen with pain in the hypochondrium and much 

 prostration and even icterus ; or the muscles, bones, joints or 

 testicle may suffer and the symptoms may suggest typhoid fever, 

 pyaemia, osteomyelitis, or acute general miliary tuberculosis. 

 The bacillus can usually be detected in the blood. 



Acute glanders may prove fatal in three days or it may be 

 prolonged for two, three or even four weeks. 



Chronic glanders in man usually confines itself to the cutaneous 

 muscular and osseous systems. It may take on an indolent type 

 with the formation of skin nodules in groups or chains which re- 

 main hard and show no tendency to soften nor ulcerate. The 

 adjacent lymphatic glands may become enlarged and indurated 

 and the affection strongly resembles tuberculosis of the skin. 

 L,ater when the nodules have softened and formed irregular and 

 obstinate ulcers with swollen lymphatic glands, the disease is 

 easily mistaken for syphilis. From pyaemia and septicaemia it is 

 usually to be distinguished by the comparative absence of chills, 

 and by the more sauious character of the pus. From syphilis it 

 may be distinguished by the futility of a course of potassium iodide, 

 and the general history of the case and probable exposure of the 

 patient, and for tuberculosis the same principles will apply. In 

 case of uncertainty, inoculation ma)' be resorted to on the horse in 

 suspected syphilis and on the pig when there is suspicion of 

 tuberculosis. Or conversely the ox may be employed for the lat- 

 ter disease as he is altogether insusceptible to glanders. As a 

 last resort the discovery of the bacillus may be made or the 

 mallein test may be adopted with the concurrence of the patient. 



