RHINOSCLEROMA 325 



inoculation of a guinea-pig, either by subcutaneous or intra- 

 peritoneal injection. By the latter method, as above described, 

 lesions are much more rapidly produced, and are more character- 

 istic. 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 serum 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. 



This 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 upper 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 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 

 observed by Frisch, and is now known as the bacillus of 

 rhinoscleroma. The bacilli have the form of short oval rods, 

 which, when lying separately, can be seen to possess a distinct 

 capsule, and which in all their microscopical characters correspond 

 closely with Friedlander's pneumobacillus. They are usually pre- 

 sent in the lesions in a state of purity. It was at first stated that 



