VIII. B, 5 Musgrave and Sison: Acute Malignant Glanders 393 



in one or more joints. The aspirated contents of the joints 

 shows pure culture of B. mallei. 



The lymphatic glands in various parts of the body and par- 

 ticularly around the primary focus of infection, when one is pres- 

 ent, rapidly become swollen and tender and gradually suppurate, 

 and in some instances, when the patient lives long enough, break 

 down and cause open ulcers. In cases I and II that are reported 

 here, there was, however, striking absence of enlargement of the 

 lymphatic glands that could be detected by physical examination, 

 and there was but slight lymphadenitis. Exception is made of 

 the mediastinal glands which were found at autopsy slightly 

 enlarged and oedematous. 



The skin lesion is a very striking and characteristic one. The 

 lesions never are exceedingly numerous, and sometimes only a 

 few will be found until toward the end when they usually become 

 very numerous. They appear one or a few at a time, and, while 

 showing a predilection for the face, neck, back, and chest, may 

 be seen on any part of the body. The first skin lesions usually 

 appear in from four to seven days after the onset of the disease, 

 and others continue to appear throughout the course of the 

 disease. However, we have seen one patient who did not have 

 more than 20 of these lesions before the twelfth day of the 

 disease. 



The lesions appear at first as simple superficial papules which 

 rapidly enlarge and soon become vesicles, then pustules, and 

 then break down and become open sores. The lesions always 

 appear to be superficial, although careful examination reveals a 

 surrounding area of infiltration, and section shows that the infil- 

 tration extends through all layers of the skin. 



During the vesicular stage, the superficial raised character of 

 the lesion resembles that seen in impetigo contagiosa. Cultures 

 from the skin lesions usually show pure culture of B. mallei. 



One very striking clinical feature of acute glanders is the 

 marked depression and general appearance of serious illness that 

 develops early in the disease and continues throughout its course. 

 The patients gradually sink into unconsciousness a few days 

 before the end. 



Diagnosis. — The disease frequently is not diagnosed during life 

 and rarely during its early stages. This, too, in spite of the fact 

 that the diagnosis is very easy to make clinically and its confir- 

 mation by laboratory methods a simple and easy procedure. 



The reason why the diagnosis is not more often made is due 

 to the rarity of the infection. Most physicians never have seen 



