Glanders in Man. 731 



Glanders in Man. In man glanders seems to occur most frequently 

 when the virus gains an entrance directly into the lymph spaces or 

 into the subcutaneous and submucous connective tissue from lesions 

 in the skin or mucous membrane, or when it enters the blood stream 

 directly. Aside from positive observations along this line this view 

 is supported by the fact that persons who are frequently exposed to 

 danger of infection (stable attendants) are comparatively rarely 

 affected with the disease. Nevertheless the possibility of an intestinal 

 infection must be admitted. 



The course of the disease may be acute or chronic. In acute 

 cases a small nodule or ulcer develops at the point of infection, the 

 surrounding connective tissue is edematous and the afferent vessels 

 and the regional lymph glands are swollen. Subsequently small nodules 

 and bluish-red pustules appear on other parts of the body where they 

 are in a short time transformed into ulcers; frequently there may 

 be purulent inflammation of the articulations and of the corpus 

 cavernosum of the penis. In the course of these changes there is febrile 

 elevation of temperature with occasional attacks of chills, and the 

 patient complains of severe muscular and articular pains. In some 

 instances there is also an ulcerative inflammation of the nasal mucous 

 membrane attended at first by a thin discharge which subsequently 

 becomes purulent, reddish and viscid. The appearance of cough, hoarse- 

 ness, difficult respiration and deglutition indicate affection of the 

 larynx and lungs. These symptoms are attended with, or followed by, 

 gradual exhaustion of the patient and finally terminate in death in the 

 course of 2 to 6 weeks. 



In some cases (intestinal infection?) the morbid picture is very 

 similar to that of typhoid fever; the persistence of the fever beyond 

 the third week as well as the subsequent appearance of cutaneous 

 pustules alone make the final definite diagnosis possible. 



The chronic form develops insidiously; ivhile febrile elevations 

 of temperature continue, nodules and small ulcers appear on various 

 parts of the body; these may heal and the patients may be apparently 

 well for months or even years; later, however, fresh nodules appear 

 and symptoms of lymphangioitis and phlebitis set in and the process 

 finally becomes acute, or the disease may run a chronic course through- 

 out (in Bollinger's cases the disease continued for 11 years), although 

 this form of the disease is said to end under proper treatment not in- 

 frequeittly (50%) in recovery (superficial application of gray mercurial 

 ointment) . 



Literature. Bollinger, Ziemssen's Handbueh, 1874. 399 (Lit.). — Koranyi, 

 Nothnagel's Handbueh, 1900. V. Bd. IT. — Strube, A. f. Klin. Chir. LXI. (Lit.). 



8. Ulcerative Inflammation of the Lymphatics of the Horse. 



Lymphangioitis ulcerosa equorum. 



Ulcerative lymphangioitis is a chronic, contagions disease 

 of horses in the course of which, usually without involving 

 the regional lymph glands, there is developed a progressive 

 inflammation of the subcutaneous lymph vessels with a tendency 

 to ulceration. '' 



