524 
GLANDERS IN THE HUMAN SUBJECT. 
In the first stage, the skin in the situation where the vesicle 
afterwards appeared was of a peculiar pale, whitish appearance. 
In the next stage the vesicle appeared, not however exactly in the 
centre of the pale spot, but rather on one side of it. In a 
more advanced stage it became sere-purulent, then pustular, and, 
some time afterwards, the pustules began to shrink and become 
depressed in the centre. The mucous membrane of the mouth 
was inflamed and covered with a viscid adhesive mucus. The 
Schneiderian membrane was also inflamed ; but there was no 
discharge of purulent matter from it. 
The patient had the ordinary symptoms of irritative fever. 
His head was very confused, but he had no pain or raving, — his 
bowels rather free — his urine high-coloured. 
He stated that he had always been healthy ; and when questioned 
as to the nature of his occupation, said that he had been employed 
for the last four months in attending horses which were labour- 
ing under glanders. That he had been retained specially for 
that purpose, and groomed the animals once a day. He did not 
recollect that he had a wound or sore on either hand ; he had not 
drunk out of any vessel used by the horses, nor had he slept in 
the stable. He attributed his illness to fatigue after a long journey, 
and said that the first symptoms he had noticed were pains in 
his knees, followed "by headache. Four days afterwards the left 
side of the face and head began to swell, with increase of fever 
and depression of strength. 
On the 27th, the day after admission, his symptoms were 
progressing. The tumefaction of the head and face increased, 
and several livid vesicles made their appearance, accompanied by 
severe pain in both jaws. Several more began to shew them- 
selves on the anterior parts of the arms and chest — his pulse 
became smaller, and rose to 120 — his respiration was somewhat 
suspicious — his breath foetid — and he felt pain when the ends of 
the long bones were pressed on, in the vicinity of the joints. His 
head was still confused, but he had no raving. Towards eight 
o’clock in the afternon there was a further exacerbation of his 
symptoms. He made water tolerably well, but did not seem to 
be aware of passing it. He was ordered to take ten grains of 
sulphate of quinine three times a-day. 
On the 28th the eruption was still extending; his pulse 140, 
and weak ; his thirst excessive, and he raved frequently. At 
half past 3, p.m., he was restless, and tossing about in bed, with 
constant involuntary motions of the lower extremities, quick small 
pulse, and hurried respiration. Twelve new spots had now made 
their appearance ; his fever and delirium were increased ; he was 
passing both urine and faeces involuntarily. There was a dis- 
