ACUTE GLANDERS IN THE HUMAN SUBJECT. 349 
face, generally with the appearance of phlyzaceous pustules 
on the skin, and redness of the conjunctivae, have been 
noticed; and, of course, when present, must greatly aid in 
the diagnosis. But it is probable, I think, that their absence 
in the case of my patient may justly be attributed to the 
fortunate recognition of the malady by Dr. Mackenzie in a 
comparatively early stage, and its being consequently com- 
bated by appropriate remedies ; and that had it been suffered 
to run its course unchecked, it would in its termination have 
been attended with the additional symptoms above named. 
Besides, from a consideration of the manner of communica- 
tion of the morbid agent in this particular case (the next 
point for our observation), it may fairly be argued that the 
patient had imbibed (so to speak) only a small dose of the 
poison. 
ii. Mode of Communication. — This is a most impor- 
tant subject for our consideration with regard to the neces- 
sary prophylactic measures. It is, indeed, chiefly with 
reference to this matter that I venture to judge this case 
worthy your hearing ; as I conceive it goes far to establish a 
highly important position. Until the publication of Dr. 
Mackenzie’s interesting case in the London Journal of Medi- 
cine for September, 1851, no clear idea seems to have been 
entertained by writers on the subject, that the virus of 
glanders was communicable from the brute to the human 
system, otherwise than by the actual application of poisonous 
secretions of the affected parts of the animal to an abraded 
mucous or cutaneous surface ; although, in several recorded 
cases, and in more than one of those of which a valu- 
able abstract is given in the Association Medical Journal , 
No. 29, it appears that it was quite impossible to trace 
the source of the affection to direct inoculation ; or, indeed, 
to account in any way for its accession. , In Dr. Mackenzie’s 
case, above alluded to, that gentleman states, “ the patient 
assured me that he had no scratch or abrasion whatever of 
any surface and he suggests, therefore, that the disease 
was communicated to the patient, either by the application 
of the poison to a whole unabraded surface, or through the 
medium of the atmosphere, i.e.,hy infection, ergo (he argues), 
direct contagion (inoculation) is not essential to the commu- 
nication of the disease. This important principle, thus ad- 
vocated by Dr. Mackenzie, was not recognised by Dr. Elliot- 
son. Dr. R. Williams, in his elaborate treatise on the poison 
of farcinoma, gives no hint of his suspicion of its communi- 
cation otherwise than by contact. 
Dr. Eck, of Berlin, thus expresses himself : — “ Though 
xxvii. 4 6 
