GLANDERS— MALLEUS 459 



The nasal mucosa is swollen, of a leaden hue, and the 

 veins much distended. If low enough down in the nasal 

 cavity, nodules from the size of a shot to a pea may be seen 

 and felt. They are of a gray or yellow color, and often 

 sm'rounded by a red zone. These nodules soon break down, 

 •forming ragged ulcers with a dirty, yellow base. By conflu- 

 ence large, irregular areas of ulceration develop, especially on 

 the septimi, but also on the turbinals. In some cases the 

 whole mucosa becomes an ulcerated surface. The favorite 

 seats of the ulcers are the septum nasi, turbinals, and the 

 nostril margins, particularly the internal surface of the 

 internal wing. As the ulcers age, their walls become thick- 

 ened, bolster-like, and the base paler. Often between the 

 ulcers, peculiar stellate, radiate or irregular, elongated, ele- 

 vated proliferations of connective tissue appear, the so-called 

 " star-shaped cicatrices." Sometimes they are not associated 

 with ulcers, the latter having healed. With the development 

 of the cicatrices and the disappearance of the ulcers the 

 nasal discharge ceases. Occasionally an ulcer occurs on the 

 apex of the scar. When the mucosa is much thickened, due 

 to the chronic, indurative inflammation, the lumen of the 

 nasal passages is so encroached upon, that pronounced nasal, 

 inspiratory dyspnea with wheezing, blowing sounds, is heard 

 on exercise. Ulceration of the lower part of the nose may 

 extend to the skin of the lips, which becomes swollen. 

 Nodules and ulcers may appear in the swollen area. 



The submaxillary lymph glands of the affected side are 

 always enlarged in nasal glanders. At first the glands are 

 diffusely swollen, somewhat hot and tender, but later they 

 become well circumscribed, painless and nodular. In time 

 they adhere to the jaw, the skin over them becoming immov- 

 able. With the eruption of fresh nodes or ulcers in the 

 nose the submaxillary glands may show temporary inflam- 

 matory symptoms. Spontaneous rupture of the swellings 

 is very rare. Occasionally conjunctivitis and keratitis may 

 accompany nasal glanders. 



Skin Glanders. — In skin glanders so-called farcy nodes 

 (farcy-buds) and ulcers (chancres) occur in the subcutaneous 

 connective tissue and skin. The nodes vary in size from a 



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