Glanders as it is known in man is a specific infectious disease, transmitted usually from the horse, characterized by rapid formation of specific granulomas, particularly in the skin and mucous membranes, which quickly break down into ulcers, and by the general toxemia characteristic of any acute infection. In German it is known as Rotz, in French as morve, while its old Latin name was “malleus” (hence we speak of the bacillus mallei). It was also known in former days as equinia. In horses the disease has also been known as farcy, because of the peculiar subcutaneous nodules which farriers and hostlers, almost from time immemorial, have called “farcy buds.” The disease, while capable of transmission from man to man, is generally produced by contagion from some of the domestic animals, most commonly the horse, although sheep and goats are known to occasionally have it, and dogs are susceptible, though seldom showing manifestations of it.
Like some of the other infectious diseases glanders appears to be variable in its manifestations. While infection occurs probably through some superficial abrasion, it is almost certain that it may also occur through the unbroken mucous membrane of the respiratory organs. It is said to be also capable of transmission from mother to fetus in utero. So far as known in man, infection occurs practically invariably through some slight abrasion, either of the skin or the mucous membrane of the nose, the eye, or the mouth. The discharges from the nostrils of affected animals are extremely virulent, and infection comes usually from this source. It is said to have been communicated from one patient to another by eating from the same dish or by drinking from a pail used by a diseased horse.
Glanders is due to the specific bacillus known as the bacillus mallei. It is shorter and plumper than the tubercle bacillus, in length about one-third the diameter of a red corpuscle. It is a non-motile organism, occasionally spore-bearing, not very resistant, belonging to the facultative anaërobic forms, growing best at blood temperature, taking stains easily, and losing them in the same way.
Symptoms.
—Glanders is seen usually in workers and hangers-on in stables. The acute—the common—form has a period of incubation of from three to seven or eight days, after which both local and general symptoms supervene. About the infected region a form of cellulitis appears, assuming often a more or less phlegmonous type, with implication of the adjacent lymphatic nodes and evidences of periphlebitis and perilymphangitis. Over the affected area vesicles appear, which become hemorrhagic and later suppurate. A wound which has healed may reopen. Almost always there are accompanying constitutional disturbances of septic type, occasionally chills, pyrexia, etc. It is rather characteristic of glanders to have severe pain in the muscles and extremities, with epistaxis and formation of metastatic tumors and edematous swellings in various parts of the body. Frequently, later in the disease, appears a somewhat distinctive eruption, papular in character, merging into pustular. Hemorrhagic bullæ are also often seen. Pustulation and edema of the face change its appearance. There are also edema of the eyelids and mucopurulent discharge from the conjunctivæ and the nose. This latter discharge is often ozenous in character. Upon inspection of the nasopharynx and oropharynx a similar condition will be noted. In connection with these local signs more or less general furunculosis also will be observed. Obviously, as these local conditions intensify and multiply, septic disturbance will be increased, and the patient dying of acute glanders dies generally of septicemia or intoxication and exhaustion combined.
A chronic form is known, distinguished mainly by slowness or tardiness of lesions, though the local changes are not particularly different in character. There is perhaps more tendency to suppuration and less to lymphatic complications. The nodule which breaks down will leave a foul ulcer, the discharge from these lesions being extremely infectious.
Diagnosis.
—This is not always easy, but may be based in suspicious cases to some extent upon the occupation of the patient. The presence of multiple lymphatic lesions and subcutaneous nodes, especially when breaking down as above described, and accompanied by ozenous discharge from the nose, should at least be suggestive, and will serve to distinguish between this disease and, for instance, typhoid fever. The chronic type of glanders might be mistaken for syphilis, and here is where the real difficulty of diagnosis will probably occur. In doubtful cases the crucial tests are the microscopic examination of discharges, after staining for bacilli, and the cultivation test.
Prognosis.
—A generalized attack of glanders is a matter of gravest import, especially when acute. Scarcely more than 10 or 15 per cent. of such cases recover. In the more chronic manifestations the prognosis is more favorable, half of the patients making a final recovery.