CASE OF ACUTE GLANDERS. 
47 
Case. —William Wilcox, a horse-keeper, aged fifty-eight, 
was admitted into the Paddington Infirmary late in the evening 
of the 19th July. He was seen by me the following day, and 
appeared to be very dangerously ill. His face generally was 
swollen and suffused, but more especially in the submaxillary 
region. A large quantity of saliva was pouring from his mouth, 
his breath was extremely fetid and sickening, his gums were 
swollen, and his teeth loose,—some, indeed, were merely hanging 
from the gums. The tongue was much enlarged, and could not 
be protruded beyond the margin of the teeth, and it was forced 
upwards against the roof of the mouth by the swelling of the 
salivary glands below ; the throat was constricted, and conse¬ 
quently both breathing and swallowing were difficult. His 
nostrils were filled with a thick glutinous secretion of an offen¬ 
sive odour, which was with difficulty dislodged. The patient 
had been very restless all night, had been constantly throwing 
his arms about, was alternately chilly and hot, and at times 
sweated profusely ; he had a quick pulse, and was in a state of 
extreme prostration. Looking to the profuse salivation, the 
condition of the salivary glands, the extreme fetor of the breath, 
and the state of the gums and teeth, my first impression was 
that he had been severely salivated with mercury. It appeared, 
however, that he had not taken a particle of this medicine for 
some time, and his general symptoms were, moreover, incon¬ 
sistent with this view. After a great deal of trouble, occasioned 
by the difficulty he had in articulating, the following history was 
obtained. 
He had for some time past been in very destitute circum¬ 
stances, in consequence of having been out of regular employ¬ 
ment ; his food had been scanty and bad, and he had been 
accustomed to sleep about in stables, or wherever he could get 
a shelter for the night. Under these circumstances, he accepted 
the charge of some glandered horses at Islington. He began 
attending to them on the 30th of June, and, at one time, had 
thirteen under his care, but some became so bad that they had 
to be sent to the knackers. In grooming them, the secretions 
from their mouths and nostrils were frequently blown upon his 
face, and the stench of the stable in which they were kept 
was very great. A week after he had been looking after them, 
he began to feel feverish and ill; his stomach, in particular, 
became disordered, and his appetite bad. He was now anxious 
to give up his employment, but his master pressed him to stay, 
and he remained for several days longer. He got progressively 
worse, and at length applied for admission into the Infirmary, 
where I saw him at 2 P.M., on the 19th July. He was then 
worse than when admitted, his breathing was more difficult, 
and the swelling of his face was increased: this was most 
marked, as I have said, under the lower jaw, where it formed 
