792 CHRONIC INFECTIOUS DISEASES. 



In addition to these manifestations of glanders, or independently of 

 them, when the nose is not attacked, characteristic lesions usually are 

 found upon the skin, which were formerly regarded as a pustulous 

 eruption, until Virchow demonstrated that in glanders there was no 

 elevation of the epidermis by an exudation thrown out from the sur- 

 face of the cutis, but that the skin suffered a circumscribed disintegra- 

 tion, above which the cuticle for some time remained intact. Accord- 

 ing to Virchow, the affected portions of skin at first are intensely red- 

 dened, and very small, almost like flea-bites ; they then change into 

 papules, and the little elevations afterward assume the aspect of pus- 

 tules. Beneath their epidermis we find a tolerably thick, yellow 

 liquid, filling up a hole in the corium. The contents of the glanders- 

 pustules, enormous numbers of which often appear upon the body, 

 sometimes grow bloody, and dry up into small blackish or brownish 

 crusts. Besides this scattered eruption, Virchow describes clusters 

 of larger " farcy-buttons," which lie deeper in the skin, in the form of 

 large, flat, hard, red tumors, from which the cuticle is finally separated 

 by an effusion of blood, so as to form bluish bullae. The upper por- 

 tion of the cutis, which covers these clusters, is also infiltrated by a 

 haemorrhagic exudation, and afterward breaks down into a pulpy 

 detritus. 



The " farcy-buttons " of the subcutaneous areolar tissue and mus- 

 cles arise either with diffuse inflammatory infiltration of the adjacent 

 parts and all the symptoms of a severe phlegmon, or else small cir- 

 cumscribed, hard, or boggy tumors form, which are quite painless, and 

 then may develop unobserved. Sometimes the contents of the nodules 

 are absorbed ; more commonly the skin either ulcerates or sloughs, and 

 great destruction, occasionally extending even to the bones, is the con- 

 sequence. 



Participation of the lungs and bronchial mucous membrane in the 

 disease is announced by shortness of breath, cough, and rales. The 

 deposits are too minute to admit of detection by physical examination. 



The larger the number of these symptoms simultaneously pre- 

 sented by the case, and the more rapidly they progress, so much the 

 sooner will the patient succumb with all the signs of the most intense 

 adynamy, and of the so-called typhous or putrid fever, the malady 

 always ending fatally. Death may occur as early as the first day or 

 two, while other cases drag on until the third week. 



In chronic glanders and chronic farcy the characteristic lesions of 

 the nasal mucous membrane, muscles, and areolar tissue, are more 

 sparing and less speedy of development than in the acute form, which 

 is of far more frequent occurrence. The skin usually remains intact, 

 while the lungs and bronchial lining are soon affected. Pauses not 



