388 The Philippine Journal of Science ms 



and one on the right side of the neck. The temperature was 39° C. There 

 was considerable swelling of a number of the large joints which also were 

 very painful and tender to the touch. Patient was already obviously in a 

 septic condition, and, although no external lesions of any description nor 

 ulceration of the mucous membrane could be found, the diagnosis of acute 

 malignant glanders was made from the appearance of the above-mentioned 

 pustules. This diagnosis was confirmed by obtaining Bacillus mallei in 

 pure culture from the pustule. 



The laboratory findings in this case were as follows. 



The urine contained a small amount of albumin, and occasional hyaline 

 and granular casts were found. 



The leucocytes were counted on the day of admission and again four 

 days later. The first count showed 7,000 and the second 8,500 with very 

 little disturbance in the differential findings. 



Culture from the left knee joint obtained by aspiration gave a pure cul- 

 ture of Bacillus mallei. The patient grew rapidly worse from the day of 

 admission, and died on the fifteenth day of the disea.se. 



Incomplete autopsy showed a general suppurative arthritis, fairly nu- 

 merous rather superficial skin pustules similar to that described in the first 

 part, with a few small abscesses in the lungs and a few in the kidneys. 



ADDITIONAL CASES OF ACUTE MALIGNANT GLANDERS IN MANILA 



Wherry - reported 2 cases of this type of glanders. The fol- 

 lowing is abstracted from his report, 



CASE I (wherry) 



History (by Maj. Bannister, U. S. Army). — H. M., an American negro, 

 27 years of age, teamster, was admitted to the First Reserve Hospital 

 on May 29, 1904, with a diagnosis of articular rheumatism. The patient 

 had been ill for two weeks with chills, fever, and rheumatic pains. 



While at the First Reserve Hospital he had a remittent temperature 

 varying between 101° and 105° F., with an irregular morning rise and 

 evening fall. A small pus sac was found posterior to the olecranon 

 of the left arm. Aspiration yielded a few drops of lemon-colored serous 

 liquid which, microscopically, contained numerous pus cells and a few 

 capsulated rod-like bacteria. Later, a larger pus sac was found on the 

 dorsum of the left foot. 



Sputum examination. — May 30, mucopurulent, containing a few blood 

 cells; no tubercle bacilli. Blood examination, May 29, 21,000 leucocytes 

 June 3, 23,400 leucocytes; no parasites. Urinalysis, May 29, 1,021 

 alkaline, trace of albumin; no casts, many leucocytes. June 2, 1,019 

 alkaline, no albumin; no casts, few leucocytes; bile. 



Diagnosis. — Pyaemia; acute articular rheumatism, both elbows, knees, and 

 ankles; suppurative inflammation of left elbow (type undetermined). 



About June 6, he developed a cutaneous eruption which was considered 

 to be that of smallpox, since a smallpox patient had been removed from 

 an adjoining bed seven days before the eruption appeared on H. M. He was 

 removed to the military smallpox hospital, and died on the following 

 morning. The body was sent to the city morgue marked "suspected small- 

 pox case." 



'Bureau of Government Laboratories, Manila (1904), No. 24. 



