When secondary abscesses form in accessible situations, they must be incised, disinfected, and drained. The general treatment is carried out on the same lines as in other acute infective diseases.
Chronic Glanders.—In the horse the chronic form of glanders is known as farcy, and follows infection through an abrasion of the skin, involving chiefly the superficial lymph vessels and glands. The lymphatics become indurated and nodular, constituting what veterinarians call farcy pipes and farcy buds.
In man also the clinical features of the chronic variety of the disease are somewhat different from those of the acute form. Here, too, infection takes place through a broken cutaneous surface, and leads to a superficial lymphangitis with nodular thickening of the lymphatics (farcy buds). The neighbouring glands soon become swollen and indurated. The primary lesion meanwhile inflames, suppurates, and, after breaking down, leaves a large, irregular ulcer with thickened edges and a foul, purulent or bloody discharge. The glands break down in the same way, and lead to wide destruction of skin, and the resulting sinuses and ulcers are exceedingly intractable. Secondary deposits in the subcutaneous tissue, the muscles, and other parts, are not uncommon, and the nasal mucous membrane may become involved. The disease often runs a chronic course, extending to four or five months, or even longer. Recovery takes place in about 50 per cent. of cases, but the convalescence is prolonged, and at any time the disease may assume the characters of the acute variety and speedily prove fatal.
The differential diagnosis is often difficult, especially in the chronic nodules, in which it may be impossible to demonstrate the bacillus. The ulcerated lesions of farcy have to be distinguished from those of tubercle, syphilis, and other forms of infective granuloma.
Treatment.—Limited areas of disease should be completely excised. The general condition of the patient must be improved by tonics, good food, and favourable hygienic surroundings. In some cases potassium iodide acts beneficially.
Actinomycosis
Actinomycosis is a chronic disease due to the action of an organism somewhat higher in the vegetable scale than ordinary bacteria—the streptothrix actinomyces or ray fungus.
Fig. 30.—Section of Actinomycosis Colony in Pus from Abscess of Liver, showing filaments and clubs of streptothrix actinomyces. × 400 diam. Gram's stain.