122 GLANDERS 



among- vetermar}- surgeons and those having the care of 

 horses. Human glanders is reported to be quite common in 

 Russia. The parts usually first affected are the hands, nasal 

 mucous membrane, lips and conjunctiva. After a period of 

 incubation of from three to five days the infected part becomes 

 swollen and painful, with subsequent inflammation of the 

 lymph vessels and swelling of the glands. Fever is often the 

 first symptom, and it is nearly always followed by a nasal dis- 

 charge ; ulcers on the nasal mucous membrane, pustules and ' 

 abscesses in the skin, ulcers in the oral cavity, larynx, and 

 conjunctiva, articular swellings, and grave general distur- 

 bances. Sometimes there is intense gastro-intestinal trouble. 

 Xodules occur in the lungs in some cases. As a rule, death 

 takes place in from two to four weeks, and occasionally in a few 

 days. In other instances, the disease becomes chronic, with a 

 duration of months or years. Bad. viallci have been found in 

 the blood in cases of acute glanders. The positive diagnosis 

 depends on the possibility of infection having taken place, on 

 inoculation in guinea-pigs, or the proof of the presence of 

 Bad. mallei. Treatment is usually of no avail. The only 

 hopeful cases are those that are purely local in their manifesta- 

 tion. A tew of these are reported to have been cured by 

 applying deep cauterization. 



104. Differential diagnosis. Glanders is to be differ- 

 entiated from a variety of nasal and lymphatic disorders more 

 or less common in the horse kind. Before the discovery of 

 the specific bacterium of glanders or of mallein, it was neces- 

 sary to determine as closely as possible the differential anato- 

 mical characters between glanders and those of other affec- 

 tions, stich as chronic nasal catarrh, strangles, lymphangitis, 

 follicular ulceration of the nasal mucosa, cancer, sarcoma, 

 actinomycosis, melanosis and the like. Since the discovery of 

 practically a positive means of diagnosis, it does not seem wise 

 to speculate upon the chances of the correct differential diag- 

 nosis by former methods. If the diagnosis can not be made 

 from the manifestations of the disease, two reliable courses are 

 possible although in most cases, but one (mallein) is to be 

 recommended. These are ( i ) animal inoculation, and { 2 ) the 

 use of mallein. 



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