VIII, B, 5 Miisgrare and Sison: Acute Malignarit Glanders 389 



Incomplete autopsy 987 (about twenty-four hours after death). — No 

 autopsy was requested, but Dr. W. E. Musgrave and Dr. W. R. Brinckerhoff, 

 who happened to be at the morgue, noticed the peculiar cutaneous eruption 

 and brought pieces of the skin to the laboratory for further examination. 

 Large areas of skin surface were covered with the numerous, closely set 

 vesicles of miliaria, and among these were numerous pustules of varying 

 size. Some of these pustules were capped by a vesicle, which in some 

 instances showed a central depression giving an appearance of umbilication. 



None of us thought of human glanders until a microscopic examination 

 showed that pustules contained numerous bacteria morphologically resem- 

 bling Bacterium mallei — rods about the length of, and somewhat thicker 

 than, the tubercle bacillus, which stained irregularly with Loffler's methy- 

 lene blue and lost the stain in Gram's method. No such bacteria were 

 found in smears made from the abscess in the left ankle. 



Bacferium mallei was isolated by the usual bacteriologic methods. 



Histologic examination (by Doctor Brinckerhoff). — A section through one 

 of the larger pustules (about 4 millimeters in diameter) shows a densely 

 infiltrated area in the skin and subcutaneous tissues. This inflammatory 

 exudate lies chiefly between the muscular layer and the Malpighian cells 

 of the epidermis. The epidermis is raised to a considerable distance above 

 its level in the adjacent normal skin. At the point where it leaves its 

 normal level the deeply pigmented cells of the rete malpighii are seen to 

 be greatly elongated, and just before it reaches its greatest elevation there 

 is a splitting away of the horny layer, which, continuing to a similar 

 point on the opposite side, leaves a space which constitutes the vesicular 

 portion of the pustule. 



Under a high-power lens the contents of the vesicle is seen to be composed 

 of degenerated polynuclear leucocytes and cells from the stratum gran- 

 ulosum, nuclear fragments, and a granular detritus which represents the 

 products of cell degeneration and coagulated serum. Beneath the area the 

 cells of the rete show marked infiltration and vacuolation, many of their nuclei 

 staining but faintly or not at all. The deeper infiltrated area is composed 

 of a dense collection of more or less degenerated leucocytes and erythrocytes, 

 degenerated epithelial cells, and nuclear fragments, many of which seem 

 to have coalesced to form irregular, deeply staining masses of chromatin. 

 Here some islands of degenerating epithelial tissue, probably the remains 

 of papillary pegs, may be seen. No giant cells are present. A very prom- 

 inent feature is the widespread and extensive destruction of the nuclei of the 

 fixed and infiltrating cells. This varies from simple vacuolation to complete 

 karyorrhexis. A number of normal polynuclear cells may be seen with 

 their protoplasm filled with rounded or rod-shaped nuclear fragments. The 

 blood vessels of the subcutis show great congestion. The underlying mus- 

 cular and glandular tissues appear normal. There are no signs of prolifer- 

 ation — everywhere those of degeneration. 



CASE II (wherry) 



A. C, Filipino, 38 years of age, married, a clerk by occupation, was taken 

 sick on October 2, 1903, with chills and fever. In December of the same 

 year he had an abscess on the posterior portion of the right leg, which was 

 opened by the physician who attended him. Again, in February, 1904, he 

 had an abscess in the anterior and upper portion of the right side of the 

 chest, which underwent resolution without operation. On June 27, 1904, 



