Glanders in Man. 287 



the dust-borne bacillus inhaled. The bacillus, is however, so 

 readily destroyed by thorough desiccation that this mode of trans- 

 mission is exceptional. Some men are immune to glanders, and 

 suffer only when predisposed through a course of ill health, and 

 yet a large proportion of the cases on record have been in strong 

 hearty men. 



Symptoms of Glanders in Man. In man as in the horse, glanders 

 occurs in the acute and chronic forms . In the acute supervening 

 on an external inoculation, incubation is from one to four days. 

 When it enters through other channels it may seem to extend to 

 a week or more. 



When a skin abrasion has been inoculated it will show in a few 

 days a soft inflammatory swelling or a firm nodule with a puffy 

 reddish areola, and it may be mistaken for a carbuncle. In not a 

 few cases the small nodule has been mistaken for small pox. In 

 my experience a horseman on a ranch on which over a hundred 

 horses showed glanders, died of an ulcerous skin affection which 

 was variously supposed to be a malignant small pox and measles, 

 though neither malady was known to exist in the district. Other 

 cases are confounded with gangrenous erysipelas. The absence of 

 these other affections from the localit}-, and the fact that the 

 patient was employed about glandered horses, should go far to 

 correct such mistakes. The early supervention of ulceration is 

 further diagnostic, and discovery of the bacillus mallei in the 

 products will be conclusive. From anthrax it is easily distin- 

 guished by the absence of the dark centre of the sore in the early 

 stages, and of the large sized bacillus anthracis. The caseation 

 or liquefaction of the necrotic centre further distinguishes it from 

 the characteristic anthrax slough, and the thickening and indura- 

 tion of the lymphatic walls are not present in anthrax. Some- 

 times the inoculated case proves mild and recovers in two or three 

 weeks with healing of the ulcer, but in other cases there is an 

 extension to adjacent tissue and a general infection with the 

 supervention of nasal glanders. 



There is a spread of the erysipelatoid inflammation and swell- 

 ing, and the formation in such newly invaded tissue of nodules 

 and ulcers in successive crops. In acute cases too, the nasal 

 mucosa becomes involved with the formation of the nodules and 

 ulcers that are so pathognomonic in the horse. The discharge is 



