GLANDERS 471 



In man it usually occurs in individuals who have been 

 in attendance upon animals affected with the disease. It 

 may occur upon the mucous membrane of the nares; but 

 its most frequent expressions are in the skin and muscles, 

 where appear abscesses, phlegmons, erysipelas-like inflam- 

 mations, and local necrosis closely resembling carbuncles. 

 Metastases to the lungs, kidneys, and testicles, as in the 

 horse, may also be seen. 



When occurring upon the mucous membrane glanders is 

 characterized by the presence of gray nodules, about as 

 large as a pin-head, that closely resemble miliary tubercles 

 in their naked-eye appearance. These consist histologically 

 of granulation-tissue i. e., of small round cells, very similar 

 to proliferating leukocytes of some lymph cells, and, in the 

 earliest stages, of a small portion of necrotic tissue. As 

 they grow older, and the process advances, there is a tendency 

 to central necrosis, with the ultimate formation of a soft, 

 yellow, creamy, pus-like material. Though strikingly like 

 miliary tubercles in certain respects in the early stages, 

 they present, nevertheless, decided points of difference when 

 examined more in detail. 



The round-cell infiltration of the glanders nodule consists 

 essentially of polymorphonuclear leukocytes, while that of 

 the miliary tubercle partakes more of the nature of a lym- 

 phocytic infiltration; in the later stages of the process the 

 glanders nodule breaks down into a soft, creamy matter, 

 very analogous to ordinary pus, while in the later stages 

 of the miliary tubercle the tendency is to an 'amalgamation 

 of its histological constituents, and ultimately to necrosis 

 with caseation. The giant-cell formation common to tuber- 

 culosis is never seen in the glanders nodule. As Baumgarten 

 aptly puts it: "The pathological manifestations of glanders, 



