212 GLANDERS. 



goner before his admission into the army, was received into the 

 military hospital suffering from two foul ulcers on the hard palate, 

 which had perforated the nasal fossa and destroyed the inferior 

 turbinated bones. Three weeks later a swelling appeared over the 

 eyebrow ; a fortnight afterward he complained of pain on the inner 

 side of the left knee around the internal tuberosity of the tibia. 

 Then purulent discharge occurred from the left ear, and an abscess 

 on the back of the right hand, which appeared as a deep purple 

 tubercle, with a hard circumference, and sunken toward the centre ; 

 purulent discharge oozed from the surface. At first, for a short 

 time after admission, the temperature varied, rising of an evening 

 to 103 to 104 ; later on, it fell to normal. The disease was 

 mistaken for syphilis, and iodide of potassium was given without 

 the least benefit. About ten weeks after admission he was in better 

 health and left the hospital, receiving his discharge from the army. 

 Within a few weeks he returned with extension of ulceration of 

 the hard palate; the uvula was destroyed. The characteristic 

 tubercles, the " farcy buds," appeared in the face, the metastatic 

 abscess on the back of the hand remained. The patient ultimately 

 died of exhaustion. Before death some of the tubercles were 

 extirpated ; they were found to contain microorganisms resembling 

 the glanders bacillus of Loffler and Schlitz. 



Swelling of the testicles has also been frequently observed. In 

 other cases acute or chronic pulmonary affections which simulate 

 pneumonia or tuberculosis are the most important clinical features. 

 If the disease attacks the nasal cavity, the mucous membrane pre- 

 sents hard nodules, and a copious discharge from the nose is present. 



Klittner reports a number of cases in which the skin was the 

 seat of numerous points of suppuration in the form of pustules or 

 more diffuse purulent processes. The pus found in glanders is 

 grayish-red, and quite tenacious in recent lesions, but when suppu- 

 ration continues it assumes the characters of ordinary pus. An 

 acute and a chronic form of glanders have been described, a classi- 

 fication which is accepted by Bellinger. The bacillus of glanders, 

 after localization in the organism, produces rapid tissue-changes 

 which at first consist in the formation of granulation tissue, which, 

 when it becomes saturated with the ptomaines of the bacilli, under- 

 goes transformation into pus, a stage of the disease which is indi- 

 cated by the formation of abscesses wherever localization has taken 

 place, either by direct infection, secondary infection by regional 

 diffusion through the lymphatic vessels, or by metastasis through 

 the systemic circulation. The nodules in internal organs are indi- 

 cations that general infection has taken place by embolism. 



In cases in which no positive diagnosis can be made from a 

 clinical aspect it becomes necessary to resort to cultivation and 

 inoculation experiments. 



