and nutritive debility consequent on chronic disease, overwork, and
exhaustion lessens the power of resistance to specific poisons, but in
such circumstances there is always the added predisposition of an
excess of waste material in the blood, a specially abundant food for
the disease-germ. So notorious is this that it used to be held that
the specific poison of glanders was generated in connection with the
excess of creatine, creatinine, and lactic acid resulting from
muscular action. Of the effect of {913} low diet we have a striking
example, furnished by Bouley, of a stud of 120 horses, 60 of which
were attacked within a year after they had been placed on a food
insufficient to repair the body-waste, and from which the disease
disappeared after the slaughter of the infected and improvement of the
ration. So long as glandered horses were preserved for work, the then
nearly ubiquitous germ attacked nearly all that were run down by
chronic diseases; hence glanders was looked upon as the natural
winding up of exhausting diseases in the horse, as tuberculosis was
thought to be in the human subject. Modern discovery shows that
without the germ all such debilitating causes are impotent, but it can
never disprove the great potency of these in laying the system open to
attack, nor the value of vigorous health and sound hygiene in
fortifying the system against it.
The channel of infection manifestly varies in different cases. In
direct inoculations the morbid process develops first at the point of
insertion, and secondly in the nearest lymphatic glands and internal
organs. When contracted in the ordinary way, the lesions are usually
first seen in the posterior nasal passages, the larynx or the lungs,
or in the superficial lymphatics, especially of the hind limbs. This
susceptibility of the deeper portions of the air-passages seems to
imply that the bacillus, borne on the air, is lodged on different
parts of the respiratory mucous membrane, and first sets up the morbid
process in the thinnest or most susceptible portion. That it can be
thus borne on the air is shown by the experiments of Viborg and
Gerlach, who separately collected the particulate elements from the
exhalations of glandered horses and successfully inoculated them. That
the virus is not usually carried far on the air in a virulent form is
attested by the many instances in which horses have stood for months
in the same stable with a glandered animal without becoming infected.
That infection may also take place through the ingestion of infected
matters is undoubted, as glanderous products mixed with food, or even
made into balls and enclosed in paper and administered to horses in
this form, have produced the disease. The virulence is said to be lost
by passing through the digestive canal of man (Decroix), dog, pig, and
fowl (Renault), but even to Carnivora the infection may be conveyed in
the food.
While the virus is concentrated in the material of the special
glanderous deposits and the discharges from these, yet no part of the
body can be considered as free from the poison. Viborg, Coleman,
Hering, and Chauveau have communicated the disease by transfusion of
blood from a glandered horse to a healthy one; hence every vascular
organ must be liable to infect. The secretions of the diseased body
(tears, saliva, mucus, sweat, urine, and milk) have each been
successfully inoculated, and the conveyance of the disease to the
foetus in utero and to the female by coition imply that even the
generative secretions are virulent. Failures to convey the disease by
inoculation with the blood and secretions have often occurred,
however, and they must be held as less virulent than the products of
the local disease-processes.
The claims that inoculation with pus, ichor, and other irritants have
produced glanders must be entirely discredited. The deposits and
ulcers in the lungs and elsewhere resulting from such inoculations
have been either septicæmia, mistaken for glanders in the earlier days
of pathological anatomy; or the septic and other inflammations set up
by these {914} inoculations have merely served as fertile spots for
the planting and growth of the glanders bacillus accidentally present,
and which to a healthy system might have proved harmless.
In 1882, Chauveau had demonstrated the particulate nature of the
glander germ by his unsuccessful inoculations with the liquids
filtered from dilutions of pus taken from a pulmonary glanderous
ulcer. The filtrate and the liquid mixture formed by mixing the pus
with five hundred times its own weight of water retained their
virulence undiminished. In 1868, Christol and Kiener discovered in
glanderous products a bacillus which they figured as made up of a
chain of nearly globular elements apparently enclosed in a common
sheath. In 1881-82, Bouchard, Capitan, and Charrin cultivated these
microphytes in a neutralized extract of meat through five successive
cultures, using in each case a milligramme of the previous culture, or
less than 1/1000 part of the culture-liquid. Counting that the
milligramme of pus would give to each centigramme of the first
culture-liquid 1,000,000,000 bacilli, it follows that the second
culture would, on the principle of dilution, contain 1,000,000, the
third 1000, the fourth 1, while for the fifth it was as 999 to 1 that
it would receive nothing unless the germ were multiplied in the
culture-liquid. Inoculation of a cat with this fifth culture, started
originally from a nasal ulcer of a glandered horse, led to a fatal
result in twenty-five days, with suppurating tumor of the left
testicle and inguinal glands. The products of the first cat were
inoculated on a second, those of the last on a third, those of the
third on a guinea-pig, and those of the guinea-pig on an ass,
producing in every case specific lesions of glanders, including
miliary nodules and abscesses, and death respectively on the following
days: 16, 7, 31, and 10.
In September, 1882, and the two succeeding months, a similar course of
experiments was conducted by Schütz and Löfler at Berlin. The virulent
matter used for starting the culture was procured from a pulmonary
deposit and spleen of a glandered horse; the cultivation was continued
through eight successive culture-fluids. One horse was successfully
inoculated with the product of the eighth culture, and a second with
both the fifth and eighth. The first died on the fifty-eighth day, and
the second, now very weak, was sacrificed on the fifty-ninth. Both
showed the most extensive lesions of glanders alike in the skin, the
lymphatic glands, the pituitary and laryngeal mucous membrane, and the
lungs. To demonstrate the bacillus they take a thin layer of the
infecting liquid on a cover glass, dry it, stain with methyl violet,
wash with dilute acetic acid, dehydrated by absolute alcohol, and
clear by oil of cedar. Like other pathogenic microphytes this may be
preserved for months or years if thoroughly dried, but in the moist
condition it is easily destroyed by heat (133° F.; Viborg, Hofacker,
Renault), chlorine, and the disinfectant chlorides and sulphites.
SYMPTOMS.--Acute nasal glanders in horses has a period of incubation
lasting from three to five days in inoculated cases. Where in infected
subjects the incubation appears to have extended over months or a
year, there have usually (or always) been deposits in internal organs
which passed without recognition until the lesions appeared in the
nose. At the outset there is fever, which appears before any local
lesions are recognizable, even post-mortem (Chauveau), and soon with
languor, {915} and loss of appetite, there is a serous nasal
discharge, often from one side only. By the sixth day this has become
yellowish, the margin of the nostril is often swollen, and upon the
pituitary membrane may be detected elevations of various sizes of a
general yellowish tinge, dotted with minute red points and surrounded
by a bright-red or purple and slightly elevated areola. These may be
simple, pea-like nodules or more or less extensive patches, which in
certain cases extend over nearly the whole pituitary membrane. At the
same time the submaxillary lymphatic glands on the same side become
the seat of a hard nodular painless enlargement, feeling like a
conglomerate mass of peas, and often showing a tendency to become more
closely adherent to some adjacent part (bone, skin, base of tongue);
but they only ulcerate exceptionally. Extensive hot, painful
engorgements also often appear on other parts of the body, and if on
the limbs or joints cause lameness. Soon the swellings on the mucosa
become eroded and are gradually destroyed, forming large unhealthy,
chancrous-looking ulcers, tending to become confluent and to eat
deeply through the mucosa into the subjacent tissues. These are mostly
reddish gray or yellowish gray, with raised ragged red or
yellowish-red margins. They bleed readily, and may be black from
hemorrhage, or greenish or of some other shade from decomposition. The
discharge is always somewhat glutinous and sticky, but it may vary in
color from simple white to yellowish, greenish, brownish, or red,
according to the destruction of tissue, the septic changes, or the
effusion of blood.
By the sixth to the fifteenth day the acme has been reached. The alæ
of the nostrils are glued together by the drying discharge, and this,
with the general swelling of the nasal passages, renders the breathing
snuffling and difficult. The lymphatics on the side of the face are
usually inflamed and corded, and the same is true of the cutaneous
lymphatics of the hind limbs of some other part of the body (farcy).
Death usually ensues from suffocation, preceded by the most painful
dyspnoea.
Chronic glanders in horses often sets in insidiously, but frequently
also it first shows itself by constitutional disturbance, which
gradually subsides as the local lesions are formed. Among frequent
premonitory symptoms may be mentioned intermittent or continued
lameness, oedema of one or more limbs, infiltration of the testicle,
cough, and bleeding from the nose. The general health may appear good,
and if in good hygienic condition the digestion and nutrition may be
sufficient, the body plump, and the skin shining; but there is usually
some dulness of the eye, dryness of the coat, lack of endurance, and a
tendency to sweat easily and to run down rapidly under hard work or
debilitating conditions. The discharge, at first clear, becomes
turbid, grayish, sticky, and purulent, tending to agglutinate the
hairs and edges of the alæ nasi, and is expelled by snorting in
masses. The nasal mucosa, and especially over the septum, is the seat
of the peculiar elevations, ulcers, and firm white, condensed deposits
resembling cicatrices, usually low enough down to be seen or felt. The
submaxillary lymphatic glands are the seat of the nodular enlargement
described in acute glanders, and, as in that affection, there may be
pulmonary or skin deposits shown by cough or oedema, with swelling and
cording of the cutaneous lymphatics with nodules and ulcers.
These cases often maintain this indolent type for years, spreading the
{916} infection widely, but they tend sooner or later to develop the
acute type, especially under some debilitating conditions.
When the mucous membrane of the larynx and bronchi is first attacked
the nasal lesions may be delayed for a time, but the cough, the
variously colored tenacious expectoration, the excessive tenderness of
the larynx, and the nodular enlargement of the adjacent lymphatic
glands, with the general ill-condition, suggest that which is later
confirmed by the specific lesions in nose and skin.
When the affection is confined to the bronchia and pulmonary
parenchyma, there are the usual signs of bronchitis, disturbed
breathing, with hard, soft, mucous, or dry husky cough, and blowing,
mucous or sibilant râle, at points crepitation, and at others some
diminution of murmur and resonance. The breath is mawkish or fetid,
and expectoration more or less sticky and charged with bacilli; but
all these symptoms are at times equivocal, and inoculation alone can
attest the true nature of the disease. This should be practised by
preference on a donkey or an old horse in poor condition but with
general good health. Then the disease shows itself in the acute form
in six days. If solipedes are not available, rabbits or guinea-pigs
may be used for inoculation.
In acute cutaneous glanders or farcy, premonitory symptoms resemble
those of ordinary acute glanders, which indeed is usually present as
well, and always supervenes before farcy terminates in death. The
local lesions consist in inflammation of the lymphatic vessels, which
become like firm cords, the appearance at intervals along these cords
of rounded glanderous nodules varying in size from a pea to a
hickory-nut, and with a marked tendency to ulceration and the
formation of hot, painful oedematous swellings. The swelling of the
lymphatics appears by preference in the lower part of a hind limb, and
the first nodules may be near the fetlock or tarsus. The ulcers
forming about the sixth day have a yellowish-white appearance with red
points and raised irregular borders, and the discharge is grumous and
viscous, with a yellowish or reddish tinge. The disease extends toward
the body, the upper air-passages become involved, and death speedily
follows.
Chronic cutaneous glanders, chronic farcy, usually begins by a local
swelling, mostly of the fetlock, in the midst of which a careful
examination detects a small glanderous nodule. This tardily softens,
ulcerates, and discharges the characteristic ichor, the lymphatics
leading up from it become thick and rigid (corded), and new nodules
appear. Though very indolent, these finally tend to ulcerate, and in
time oedematous swellings appear in the vicinity or at distant parts
of the body, with nodules at intervals. This will go on for months, or
even for years, and recoveries occasionally take place, while in other
cases, and especially when the conditions of life are bad, acute
glanders supervene.
MORBID ANATOMY.--The lesions consist essentially in a cellular growth
in the connective tissue, determined by the presence of the specific
poison, and in destructive changes in the elements of such
growth--softening, fatty degeneration, ulceration, and discharge. In
certain cases of nasal glanders at the earliest stage there is merely
an increased proliferation of the mucous corpuscles, which become more
granular or purulent. Soon, however, the fibro-vascular layer is
involved, the affected part being the seat of dark bluish congestion,
and {917} of the proliferation of small rounded lymphoid cells,
comparable to those of the early stage of tubercle, and enclosed in
more or less dense fibrous areolæ. The common nasal nodule or patch
has a soft velvety surface, dirty gray or grayish yellow, and the
lymphoid cells are so circumscribed in nests that when soaked in water
the cells are washed out and the fibrous reticulum is left hollowed
out like a honeycomb. In this fibrous reticulum are many
spindle-shaped and a few rounded cells. Its vascularity is easily
demonstrated by injection. The centre of each nest is the palest part
of the mass, and unless stained by extravasation it contrasts with the
reddish areola. These islets of lymphoid cells, at first isolated and
each the size of a pin's head, may enlarge and become confluent,
forming the larger nodules. With this increase the centre of each
becomes turbid, and the cells are found to have become granular and
fatty, and to have in part broken up into a granular débris. This
characterizes the period of ulceration, and erosions and ulcers follow
in ratio with the extent of the neoplasm and the rapidity of its
growth. If the growth is tardy, the ulcer, with irregular eroded and
everted edges, may remain for some time stationary or even recede,
while if rapid, new tubercles form around the margin of the first, and
by the disintegration of their elements the ulcer is continuously
extended. The lesions are especially common on the septum nasi and
turbinated bones. Similar lesions may be found in the nasal sinuses or
larynx.
The nodules found in the lungs strongly resemble miliary tubercles,
but are usually less numerous. As in the nose, they have a punctiform,
central, grayish, turbid portion, encircled by a more translucent
ring, surrounded in its turn by a vascular area. They are also
composed of the same granular rounded cells, though they may,
especially in the chronic forms, have undergone caseous, fibrous, or
calcareous degeneration. The acute tubercles are often surrounded by
circumscribed pneumonia with considerable exudation. They are
distinguished from genuine tubercle by their vascularity and by the
absence of giant-cells.
The cutaneous deposits are composed of the same histological products
imbedded in the dermis or in the subcutaneous connective tissue, and
extending in some cases deeply between the muscles, with no clear line
of demarcation from the sound tissue. Not only the chains of nodules
(farcy-buds), but the connecting lymphatic trunks, are the seat of the
characteristic cellular product, and in chronic cases there is the
enlargement of the adjacent lymphatic glands as well. In these there
is a special tendency to early disintegration and ulceration.
In the diffuse glanderous swellings (infiltrated glanders,
inflammatory glanders) the affected tissues are the seat of an
inflammatory process with profuse exudation throughout, while in the
interstices of the connective tissue are numerous granular
glander-cells. The same tendency to necrobiosis is shown as in the
other forms of glanderous neoplasms, and such diffuse swellings become
the seats of very extensive, deep, and irregular ulcers, or frequently
of fibroid growth and induration, forming the so-called cicatricial
deposits. These are hard, firm, and resistant, and histologically
consist of a dense fibrous stroma interspersed with the spindle-shaped
cells. They are especially common in chronic cases, and such an
appearance on the nasal mucous membrane is always suspicious, as this
dense fibroid appearance rarely follows a simple traumatic lesion.
{918} Diffuse glanderous infiltrations in the nose may implicate the
entire mucosa of one or both nasal chambers, and the ulcers are liable
to be greater than from the nodular form of the disease. They are also
especially associated with thrombosis of the veins, which occurs to a
less extent in the nodular form and conduces to the dark-blue tint of
the mucosa.
Glanderous infiltration of the lungs is inflammatory in its nature
(pneumonia malleosa), attacking an area of two or three inches in
diameter at or near the margin of the lungs, and proceeds to caseous
necrobiosis, suppuration, calcification, or fibroid induration. In the
skin such infiltrations also frequently terminate in induration, while
ulceration and abscess tend to appear when the proliferation of
glander-cells is most abundant (farcy-buds).
The glander-nodules are not uncommon in muscles, intermuscular
connective tissue, spleen, liver, kidneys, and testicles. Leukæmia is
also a constant feature, the irritation of the lymphatic glands
manifestly stimulating the production of the lymph-cells.
DIAGNOSIS.--The diagnosis of glanders usually rests on the viscid
nature of the discharge, the painless nodular swelling of the
submaxillary glands and the indisposition to suppurate, the
characteristic appearance of the nodules, elevations, ulcers, and
indurations of the nasal mucosa, and the presence of the specific
bacillus. The diagnosis of farcy rests mainly on the nature of the
nodules and corded lymphatics, of the ulcers and their discharges, on
the extension of the affection toward the trunk, and the tendency to
implicate the respiratory organs. Usually, there are several victims,
the earlier ones chronic cases, the later ones acute, or there is a
history or presumption of exposure. Yet in many cases, and especially
in the more chronic internal forms (laryngeal, pulmonary, etc.), the
diagnosis is difficult, and inoculation of a horse, goat, sheep, or
rabbit may be the only available means of reaching a decision.
Auto-inoculations are unreliable, as parts not yet the seat of active
disease will often resist inoculation.
PROGNOSIS.--This is always unfavorable. The constancy of internal
deposits and the viability of the germ in such products render it
impossible to eliminate the poison from the system in the great
majority of cases. In external glanders only is there any reasonably
good hope, and even this is confined to the chronic cases. In stating
this much, it is not denied that recoveries even of chronic nasal
glanders do occur, yet these are few, and the majority of those that
do apparently recover usually succumb as soon as they are subjected to
hard work or specially trying conditions of life, so that but little
faith can be placed in most of the alleged recoveries.
TREATMENT.--Considering the great danger of multiplying and preserving
the germs of a disease so fatal alike to man and beast, the treatment
of glanders is never commendable. The danger is least in the case of
chronic farcy, not only because the processes are less active, but
because the virus is not being thrown out and diffused with the tidal
air of respiration, sneezing, and coughing. The unbroken farcy-buds
and swollen lymphatics may be actively treated by compound iodine
ointment, and the ulcerous nodules freely cauterized with corrosive
sublimate, biniodide of mercury, chloride of zinc, sulphate of copper,
or iodized {919} phenol. Local inflammations may demand fomentations
and astringent antiseptic lotions. Meanwhile, the system must be
supported by a tonic regimen and medication, abundance of pure air, a
liberal and wholesome diet, and the maintenance of the various bodily
functions in a healthy condition. Of medicinal agents the most
pronounced tonics have the best reputation--sulphate of copper and
iron, biniodide of copper, arsenic, and, above all, arsenite of
strychnia. Next to these the sulphites rank, and a combination of the
two last named is perhaps to be preferred.
PREVENTION.--The glandered horses and all animals attacked with acute
or obstinate farcy should be destroyed and their bodies be burned or
deeply buried. Every State should legally interdict the use of a
glandered horse or his exposure in any public or other place where
infection is likely to reach other animals by contact or through
fodder, litter, stable utensils, or any other objects employed about
animals. No less imperative should be the perfect disinfection of all
stables, harness, and other objects with which glandered animals have
come in contact. The value of such measures is sufficiently attested
by what has been stated above as to the prevalence of this disease in
the French army so long as the doctrines of non-contagion dominated in
its management, and the comparative disappearance of the disease so
soon as a change of theory and method had been inaugurated; the
absence of the disease in the English army, where the doctrine of
contagion and its extinction has long prevailed; and the entire
absence of the disease from Australia, New Zealand, etc., into which
it has never been imported, though prevailing in a corresponding
latitude and climate at the Cape of Good Hope.
Glanders in Man.