VIII, B, 5 Musgravc and Sison: Acute Malignant Glanders 387 



are seen where a papulo-pustule has ruptured; the edges of these ulcers 

 are slightly beveled, neither punched out nor undermined; their bases are 

 covered with gelatinous sloughs. The palms and soles are free; the post- 

 cervical lympathic glands are numerous and faintly palpable. There is no 

 scar on the penis; the mucous membrane appears to be normal. 



The subcutaneous fat is moderate in amount and dry. The recti muscles 

 are dark red; the pectoral muscles have numerous abscesses containing a 

 gelatinous pus, measuring 1 centimeter deep and 5 centimeters wide. On 

 dissecting away the skin, many of the pustules can be seen on the subcu- 

 taneous tissues, some having penetrated them. Large abscesses 4 by 3 by 

 2 centimeters are observed beneath the skin on legs, arms, and thighs. 

 The joints of knees and ankles contain the same gray gelatinous pus, which 

 in some places is fluid in character. 



The peritoneum is gray, dry, and lusterless. 



The pericardiuiii contains a few cubic centimeters of clear, dull yellow 

 serum. The heart shows numerous punctate and conglomerate haemor- 

 rhages near the auriculoventricular septum. The heart is large and flabby; 

 it was kept for a museum specimen. 



Lungs. — Both pleural cavities are dry; there are a few recent firm adhe- 

 sions between the right apex and upper part of chest wall. Both lungs are 

 heavy, boggy, and oedematous; they do not crepitate well. They are blue- 

 gray anteriorly and darker posteriorly. There are numerous dull blue- 

 black areas 5 centimeters in diameter scattered over their surface. Cut 

 sections ooze dark blood and froth, being blue-gray in front and darker in 

 the posterior two-thirds. Anterior mediastinal glands are enlarged and 

 oedematous. 



Kidneys. — Fatty capsule preserved, fostal lobulations becoming obliter- 

 ated. True capsules strip readily, leaving a dull yellow-red surface. Cut 

 section is rather dry. The glomeruli and striations are invisible on the dull 

 pale brown surface. Pyramids have lost their blue color and striations; 

 same color as cortex. Suprarenals and ureter appear normal. 



Liver. — Anterior border presents a blunt angle; color light brown, mot- 

 tled with few large (3 by 4 centimeters) areas of dull yellow hue. Cut 

 surfaces show a dull yellow color, oozing little blood, with lobulations 

 obliterated. The dull yellow surfaces extend about 3 centimeters beneath 

 the surface. Gall bladder is slightly distended with thick black bile. 



The pancreas is dull pink and firm. 



The stomach and intestines are moderately distended with gas. The 

 mesenteric glands are large — more than 1 centimeter long — pale, dull pink, 

 and firm. 



CASE II. ACUTE MALIGNANT GLANDERS WITH SUPPURATIVE 

 ARTHRITIS — DURATION OF ILLNESS FOURTEEN DAYS — DEATH 



Filipino coachman, twenty-five years of age, previously in good health. 

 Family and personal history negative. 



Present illness. — He was taken ill rather suddenly with chills and fever 

 and aching pains over the body. Irregular temperature and chilly sensa- 

 tions continued for six days. Arthritic pains developed on the fourth day, 

 first in the right wrist, and spread rapidly to other large joints. 



Patient came into our service on the seventh day of the disease with 

 diagnosis of malaria and acute rheumatism. Examinations on the day of 

 admission showed two papulo-pustular lesions, one on the right shoulder 



