420 CHRONIC INFECTIOUS DISEASES 



Nasal Glanders. — The first symptom noted is usually 

 nasal discharge, which is very commonly unilateral. The 

 quality and amount of the discharge vary greatly. In 

 chronic glanders it is at first Serous or mucoserous; later it 

 becomes more copious, quite viscid, and often mixed with 

 blood. The discharge tends to adhere to the wings of the 

 nostrils where it dries to form brownish crusts. Coughing 

 or sneezing momentarily augments the discharge which is 

 rarely odorous. 



The nasal mucosa is swollen, of a leaden hue, and the 

 veins much distended. If low enough down in the nasal 

 cavity, nodules from the size of a shot to a pea may be seen 

 and felt. They are of a gray or yellow color, and often 

 surrounded by a red zone. These nodules soon break down, 

 forming ragged ulcers with a dirty yellow base. By confluence 

 large irregular areas of ulceration develop, especially on the 

 septum, but also on the turbinals. In some cases the whole 

 mucosa becomes an ulcerated surface. The favorite seats 

 of the ulcers are the septum nasi, turbinals, and the nostril 

 margins, particularly the internal surface of the internal 

 wing. As the ulcers age their walls become thickened, 

 bolster-like, and the base paler. Often between the ulcers 

 peculiar stellate, radiate or irregular elongated, elevated 

 proliferations of connective tissue appear, the so-called 

 "star-shaped cicatrices." Sometimes they are not associated 

 with ulcers, the latter having healed. With the development 

 of the cicatrices and the disappearance of the ulcers the 

 nasal discharge ceases. Occasionally an ulcer occurs on the 

 apex of the scar. When the mucosa is much thickened, due 

 to the chronic indurative inflammation, the lumen of the 

 nasal passages is so encroached upon that pronounced nasal 

 inspiratory dyspnea with wheezing, blowing sounds is heard, 

 on exercise. Ulceration of the lower part of the nose may 

 extend to the skin of the lips, which becomes swollen. Nodules 

 and ulcers may appear in the swollen area. 



The submaxillary lymph glands of the affected side are 

 always enlarged in nasal glanders. At first the glands are 

 diffusely swollen, somewhat hot and tender, but later they 

 become well circumscribed, painless, and nodular. In time 



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