viii, B, 5 Musgrave and Sison: Acute Malignant Glanders 391 



indistinct. The spleen is somewhat enlarged, soft, and on section its pulp 

 is diffluent. The kidneys are slightly enlarged, their capsules strip readily, 

 and on section the cut surface is yellowish white and the cortical and 

 medullary markings are very indistinct. The stomach and intestines were 

 not opened. No further examination was made. 



Bacteriologic examination (by Dr. W. R. BrinckerhofF) . — The twenty- 

 four-hour cultures on glycerin agar showed numerous barely visible, trans- 

 parent colonies. In forty-eight hours these colonies became visible, and 

 in pure cultures gave the biochemical reactions which have been described 

 as characteristic of Bacterium mallei. 



The histologic changes in the subcutis and lower layers of the cutis are 

 similar to those described in case I. The process, however, is not so far 

 advanced, for, although karyorrhexis is widespread and prominent, it is 

 not so marked in the upper layers of the cutis, where the chief changes 

 are a loss in the staining power of the nuclei and a general vacuolation 

 of the cell protoplasm. The stratum corneum has not been split off and 

 consequently the pustule is not covered by a vesicle. 



Lung. — A section through one of the subpleural nodules (about 3 milli- 

 meters in diameter) shows, under a low magnification, an irregular area 

 of consolidation characterized by intense infiltration of the pulmonary 

 alveoli and marked congestion of the blood vessels of the alveolar walls and 

 of the pleura covering the affected area. 



Under a higher power the contents of the alveoli is seen to be composed 

 chiefly of polynuclear and transitional leucocytes, a few lymphocytes, 

 pigment-carrying cells, and a few large cells which lie, for the most part, 

 near the alveolar walls and resemble desquamated endothelial cells. It is 

 apparent that many of the cells in this area are undergoing degeneration 

 and karyorrhexis, but not to so marked an extent as in the skin pustule of 

 case I. This area is surrounded by pulmonary tissue which shows intense 

 congestion and in which the alveoli are filled, for the most part, with 

 extravasated blood, granules, and threads of fibrin, desquamated endothelial 

 cells, and a few polynuclear and transitional leucocytes. Deeper within 

 the section the alveoli appear normal. 



In another field of the section several small foci of infiltration may be 

 seen, situated at some distance beneath the pleural surface, and each is 

 about the size of a single air cell. Their contents is composed of cells similar 

 to those found in the larger focus, but karyorrhexis is not so marked a 

 feature. One of these appears to have ruptured into an adjoining alveolus, 

 and such a process may indicate the histogenesis of the larger foci. All 

 the foci appear to be recent ones, and there are no signs of proliferation or 

 encapsulation. No giant cells are to be seen. 



DISCUSSION 



Etiology. — The disease is caused by a general infection with 

 Bacillus mallei, and consequently its spread must conform to the 

 usual well-known methods of transmission of diseases caused by 

 bacteria. 



When this fact is considered together with the very great 

 virulence of the organism both in human beings and in some of 

 the lower animals, the comparative rarity of the infection in man 



