RHINOSCLEROM A 3 1 5 



the glanders bacilli are present. Another method is to dilute the 

 -(Tction or pus with sterile water, to varying degrees, and then 

 to smear the surface of potato with the mixture, the potatoes 

 being incubated at the above temperature. The colonies on 

 potatoes may not appear till the third day. The most certain 

 method, however, is by inoculation of a guinea-pig, either by 

 subcutaneous or intraperitoneal injection. By the latter method, 

 as above described, lesions are much more rapidly produced, and 

 are more characteristic. If, however, there have been other 

 organisms present, the animal may die of a septic peritonitis, 

 though even in such a case the glanders bacilli will be found to 

 be more numerous in the tunica vaginalis, and may be cultivated 

 from this situation. It is extremely doubtful whether the 

 application of mallein to diagnosis of the disease in the human 

 subject is justifiable. There is a certain risk that it may lead 

 to the lesions assuming a more acute character; moreover, 

 culture and inoculation tests are generally available. In the 

 case of horses, etc., a diagnosis will, however, be much more 

 easily and rapidly effected by means of mallein, or by one of 

 the scrum reactions described above. In some cases of acute 

 glanders in the human subject the bacillus has been obtained in 

 cultures from the blood during life. 



RHINOSCLEROMA. 



'I'll is disease is considered here as, from the anatomical 

 changes, it also belongs to the group of infective granulomata. 

 It is characterised by the occurrence of chronic nodular 

 thickenings in the skin or mucous membrane of the nose, or 

 in the mucous membrane of the pharynx, larynx, or upj)er part 

 of the trachea. The nodules are of considerable size, sometimes 

 as large as a pea ; in the earlier stages they are comparatively 

 smooth on the surface, but later they become shrunken and the 

 centre is often retracted. The disease is scarcely ever met with 

 in this country, but is of not very uncommon occurrence on the 

 Continent, especially in Austria and Poland. In the granulation 

 tissue of the nodules there are to be found numerous round and 

 rather large cells, which have peculiar characters and are often 

 known as the cells of Mikulicz. Their protoplasm contains a 

 collection of somewhat gelatinous material which may fill the 

 cell and push the nucleus to the side. Within these cells there 

 is present a characteristic bacillus, occurring in little clumps or 

 masses chiefly in the gelatinous material. A few bacilli also lie 

 free in the lymphatic spaces around. This organism was first 



