Differwatial Diagnosis. 725 



In some districts injuries of the nasal mucous membrane and 

 from them cicatrices which have been caused by quacks in an effort 

 of treatment, are very frequent occurrences. Cicatrization may also 

 occur after fractures of the nasal bones. 



Chronic catarrh of the nasal sinuses often gives rise to 

 suspicion of glanders, the nasal discharge in this disease fre- 

 quently being unilateral and othervrise very much like that in 

 glanders while the submaxillary lymph glands are usually also 

 enlarged. However, the sensitive condition of the infraorbital 

 nerve, the temporary, profuse nasal discharge, the fluctuating 

 results obtained in percussion of the sinus, the soft and lobulated 

 structure of, and the absence of adhesion in, the submaxillary 

 glands as well as the absence of nodules and ulcers on the nasal 

 mucous membrane, are usually sufficient to enable one to recog- 

 nize the nature of the affection. In addition to this the results 

 of trephination which would be therapeutically indicated in this 

 case would decide the character of the affection, as would also 

 the determination of any special cause of the trouble (tooth 

 caries, bone necrosis, neoplasms, etc.). In chronic catarrh of 

 the guttural pouches also there may be unilateral nasal dis- 

 charge, the origin of this, however, is at once indicated by 

 the tumefaction in the subparotideal region. — Distemper or 

 strangles might be confused with glanders but only in affections 

 of a subacute character in which the intermaxillary abscess 

 appears late in the development of the disease or fails to 

 make its appearance, or in cases where the lymph vessels of 

 the surrounding region become enlarged, and finally also when 

 metastatic abscesses appear in remote regions of the body; but 

 even in this case the morbid changes present a more acute 

 character than those of glanders. There are no nodules on 

 the mucous membrane while the interior of the swellings or 

 abscesses contain only streptococci (ulceration of the niucous 

 membrane does not necessarily exclude distemper since this 

 may also be brought about by the streptococcus of strangles 

 [Rabe], See p. 373). — Stomatitis pustulosa contagiosa may 

 excite suspicion of glanders when the lips and nasal alae become 

 swollen and nodules and ulcers are present on the nasal mucous 

 membrane; aside, however, from the acute and favorable 

 course of the process the existence of similar changes on the 

 oral mucous membrane in itself would exclude glanders. — 

 Finally ulceration of the nasal mucous membrane occurs also 

 ^in the course of tuberculosis (see p. 550) as well as in epizootic 

 'iymphangioitis (see p. 737). In these cases chronic enlarge- 

 ment of the submaxillary glands may also be present (this, 

 however, may also occur in actinomycosis), consequently a 

 microscopical examination of the extirpated tumors or tissue 

 portions alone would be confirmatory. 



The following conditions may be confused with cutaneous 

 glanders: Septic Iymphangioitis, which, however, is accom- 



