GIvANDERS NODUIvES IN THE MEDIASTINUM. 



lyike tuberculosis, glanders is a disease of the lymphatic system 

 especially, and in case of a localized glanderous deposit, the 

 lymph glands which drain the lymph from that point are con- 

 stantly involved. Therefore in pulmonary glanders, the bron- 

 chial, tracheal and "even the mediastinal glands become involved. 

 As in tubercle the centre of the gland lobule is especially im- 

 plicated, its cell elements undergoing degenerative necrotic pro- 

 cesses with more or less liquefaction or caseation. The afferent 

 lymph vessels are liable to a marked hyperplasia causing these 

 to stand out in abnormally firm rigid cords. Yet the nodules 

 do not habitually attain to the large size so frequently seen in 

 tuberculosis, so that the compression of the surrounding organs, 

 and their functional derangement are less marked. There is 

 however the chronic cough, with more or less dyspnoea under 

 exertion, a slight grayish, sometimes sticky nasal discharge, and 

 often distinct glanderous deposits at other points. The presence 

 of the characteristic ulcers in the nose, the nodules or cicatrices 

 on the mucosa, the cording of the lymph vessels running toward 

 the submaxillary lymph glands, the comparatively insensible, 

 hard nodular outline of these glands, the presence of circum- 

 scribed swellings with corded lymphatics, nodules and open sores 

 on a limb or on the trunk, together with a knowledge of a 

 present or previous existence of glanders in the locality, or of 

 an exposure to the infection, would furnish ground for grave 

 suspicion. The mallein test is the final and crucial resort in all 

 suspicious cases. 



As in tuberculosis, and even more so, the preservation and 

 treatment of cases of glanders is essentially subversive of sound 

 sanitary administration, and is an infallible indication of ineffec- 

 tive and comparatively useless sanitary work. Mild cases will 

 long survive the disease and even recover, but they do far more 

 harm by the spread of the infection than can be gained pecunia- 

 rily from their preservation. (See Glanders, Vol. IV). 



394 



