394 The Philippine Journal of Science wis 



a case, and it, therefore, is not included in the routine mental 

 pictures that one examines in connection with cases of fever, 

 rheumatic pains, and skin lesions. 



Glanders is most frequently mistaken for dengue fever, rheu- 

 matic fever, syphilis, or typhoid fever, and less frequently for 

 pleurisy, pneumonia, and certain skin diseases, particularly im- 

 petigo contagiosa, pemphigus, or ecthyma. 



During the early stages before the appearance of the character- 

 istic skin lesion, the clinical picture of glanders may resemble 

 dengue or rheumatic fever very closely, but careful examination 

 will justify distinction even at this stage. Dengue may be elimi- 

 nated positively and absolutely by the well-known blood picture 

 of this disease. 



The mode of onset, the character of the pains, the fever, and 

 the blood picture of glanders and rheumatic fever may be indis- 

 tinguishable, and, as it often happens in acute glanders cases that 

 there is no visible primary lesion, the diagnosis may remain in 

 doubt until suppuration in the joints or the skin lesions make the 

 diagnosis clear. The value of early blood cultures as a diagnostic 

 method in glanders needs further study. 



The only excuse for confusing glanders with the skin diseases 

 mentioned is in the similarity of the local lesions. The pro- 

 nounced constitutional manifestations of glanders should obviate 

 this mistake more often than it does. 



The prognosis in this form of glanders is bad. The disease 

 probably is a general infection practically from the beginning 

 and rapidly becomes a virulent pyaemia. 



There is no known treatment that has any curative properties 

 or that influences the course of the disease further than to alle- 

 viate some of the distressing symptoms that supervene before 

 unconsciousness develops. 



