386 The Philippine Journal of Science ww 



On admission to the hospital on the eighth day of his illness, the patient 

 was very ill; he had high fever and a rapid pulse, a general toxic appear- 

 ance, and his joints were swollen, painful, and tender to the touch. On 

 this date a single superficial pustule about 1 centimeter in diameter was 

 noticed on the left side of the neck, and within forty-eight hours a consid- 

 erable number of these lesions were found scattered over the body, par- 

 ticularly on the face and chest. The lesion was a particularly typical one 

 (Plate I). It appeared suddenly and developed rapidly, starting as a 

 vesicle, but within a few hours became pustular. It was superficial in 

 character, umbilicated, and surrounded by a marked inflammatory zone. In 

 appearance these lesions very closely resembled ecthyma. They varied 

 in size from 5 millimeters to 1 centimeter in diameter, were easily broken, 

 and Bacillus mallei was cultivated from the contents practically in pure 

 culture. 



The only important clinical laboratory findings in this case was the 

 blood. The leucocytes, on the day of admission, were 7,800 with 



Per cent. 



Lymphocytes 11 



Large mononuclear 5 



Polynuclear 81 



Eosinophiles • 1 



Transitional 2 



Three days after admission and when the eruption was fully established, 



there were 9,000 leucocytes with 



Per cent. 



Lymphocytes 7 



Large mononuclear 13 



Polynuclear • 77 



Transitional ■ 3 



On the twelfth day of the disease, the patient's general condition was 

 much worse. The vesicular eruption had extended to the face and trunk. 

 Some of the vesicles were umbilicated, a few were pustular. A clinical 

 diagnosis of glanders was made by one of us (Musgrave), and the diagnosis 

 was confirmed by the usual laboratory methods two days later. 



The patient suffered intensely with joint pains during the two follow- 

 ing days. The fever ranged from 38° to 39°. 5 C; there were frequent ir- 

 regular chills and gTeat prostration and toxaemia. Death occurred on the 

 fourteenth day of the disease. 



AUTOPSY REPORT 



Anatomic diagnosis. — Papulo-pustular eruption of skin; glanders; mul- 

 tiple small abscesses of pectoral muscles; large abscesses near ankles; 

 pyarthrosis; pyaemia; beginning abscesses and posterior congestion and 

 oedema of lungs; subserous ecchymosis of heart; fatty and albuminous de- 

 generation of kidneys; acute exacerbation of splenic tumor. 



Pathologic diagnosis. — Body of fairly well-nourished Filipino; rigor 

 mortis moderate; skin of face, chest, abdomen, and extremities show nu- 

 merous, but not conglomerate, papulo-pustular eruptions, averaging 1 centi- 

 meter in diameter, raised about 2.5 to 3 millimeters above the surface. 

 They are dull gray in color, and very few are umbilicated ; all contain a 

 gray mushy pus, emitting an odor suggestive of mice stools. Stray ulcers 



