80 CLINICAL BACTERIOLOGY AND H^MATOLOGY 



A few cases of actinomyeosis have been treated success- 

 fully by means' of vaccines, and this method should always be 

 remembered when dealing with cases which resist the more 

 ordinary treatment by large doses of iodides. To obtain cul- 

 tures, pus from a recently opened abscess, taken under careful 

 aseptic precautions, should be inoculated into tubes of broth 

 containing a little sterile blood (Gordon). Some of these 

 should be rendered anaerobic by means of a layer of sterile 

 paraffin. Incubate at 37 C. 



GLANDERS 



This is a rare disease in man, but it occasionally occurs quite 

 unexpectedly, and its existence should be borne in mind when 

 no organisms are found in a superficial microscopic examina- 

 tion of pus from an acute or subacute abscess. (Other diseases 

 which should also be thought of are tubercle, actinomyeosis, 

 and sporotrichosis.) It occurs, of course, most commonly, in 

 those who have to do with horses, mules, etc., but occasional 

 cases occur in which no direct infection can be traced. It 

 occurs in man in tw r o forms, an acute and a chronic. In 

 the acute form the region at the site of inoculation becomes 

 acutely inflamed, lymphangitis occurs, there are marked con- 

 stitutional symptoms and a pustular rash. The internal 

 organs, and frequently the joints, are affected, and the disease 

 is rapidly fatal. The chronic form has more resemblance to 

 tubercle. The lesions break down, emitting a little pus and 

 causing a chronic spreading ulcer. The lymphatics and the 

 mucous membranes may become affected. Such cases last 

 for a long time, but are usually fatal. Vaccine treatment 

 appears to promise the only hope of success and has been 

 occasionally followed by good results. 



The bacteriological diagnosis of the disease is not easy, and 

 the services of an expert bacteriologist should be called in. 

 If this is impracticable, smears should be made from the pus, 

 stained by a simple stain, and also by Gram followed by a 

 counterstain. A pipetteful of the pus from a recently opened 

 abscess should also be taken with all aseptic precautions and 

 forwarded for examination. If expert help is unavailable, the 

 material should be plated out on agar-tubes by the method 

 described on p. 17, several tubes being inoculated, as the 



