The surgical treatment of glanders in man does not differ materially
from that given for animals. It is more frequently possible to deal with
the local lesion in its early stages and then a thorough cauterization
of the infected sore, and a little later the complete excision of the
primary nodule, or the limited regional infiltration, the curetting of
the adjacent parts and the maintenance of thorough disinfection by
irrigation, sponging and compress will often be followed by success.
Where such radical measures are inadmissible the infected parts should
be excised and curetted as far as safe and the adjacent parts subjected
to carbolic injections (1:200). Abscesses should be evacuated, fistulæ
slit open, and thorough disinfection applied. For the affected
air-passages, iodoform insufflations and antiseptic gases, sprays, and
solutions should be freely used.
Internally, antiseptics such as sulphocarbolates and tincture of muriate
of iron, iodides, and carbolic acid have been largely employed. Whitla
recommends 5 grains of quinia in 15 grains of tincture of muriate of
iron every four hours. Tonics (arsenate of strychnia), and stimulants,
ammoniacal or alcoholic, may be called for. Special symptoms such as
pain, rigors, nausea, vomiting, diarrhœa and profuse perspirations must
be met by suitable remedies. Finally blood serum from healthy cattle or
from immunized animals may be employed subcutem. Pure air and
nourishing, easily digestible food are very essential. Every effort
should be made to check the disease at its outset, as generalized acute
glanders is speedily fatal, and recoveries in chronic cases usually
leave a broken down constitution.
LYMPHANGITIS SACCHAROMYCOTICA (FARCINOIDES: EPIZOÖTICA:ULCEROSA.) FARCY
IN CATTLE.
Geographical distribution and nature: Japan, Northern Europe, France,
Guadaloupe; caseating nodules in skin, subcutem, in mucosæ and
internal organs. In _horse_ skin nodules, and glandular abscesses,
with thick ovoid refrangent bacterium; saccharomyces (Hitt); swellings
first local, then multiple, and general, extending along lymph vessels
to glands (Hitt); along air-passages to lungs, from prepuce or scrotum
to peritoneum (Hitt), or from conjunctiva to other parts in the orbit
(Caparini and Ferner). In _cattle_, multiple, subcutaneous,
nodules—hazlenut to walnut, isolated, hard, painless. Suppurate
slowly. Same saccharomyces (Tokishige, Nocard). May invade lungs with
fatal result in a year. Mallein test gives no reaction. Treatment:
actively antiseptic; open, curette, pack with antiseptic gauze,
sublimate bandages; internally, tonics, antiseptics.
Horses and cattle in certain countries (Japan, Sweden, Finland, France,
Guadaloupe) are subject to a chronic lymphangitis resembling cutaneous
glanders, but associated with the development of bacilli or fungi in the
nodular, caseating swellings in the skin, subcutem, in mucosæ and in
internal organs.
Nocard describes the affection in the horse as characterized by skin
nodules (buttons, boils), which burst and discharge a thick, grumous, or
thin, oily, yellowish or bloody pus. The surrounding lymph plexus swells
up into corded lines, with at intervals nodules or abscesses. The
infection extends to and implicates the lymph glands and general pyemia
may follow. The thick ovoid refrangent, pathogenic, bacterium stains in
Gram’s solution.
In Northern Europe and Asia, Southern Europe and Guadaloupe an analogous
affection is described by Rivolta, Claudio-Fermi, Aruch, Tokishige and
Nocard and Leclainche. Hitt attributes this to saccharomyces. The
infection attacks horses and cattle, entering by sores and abrasions of
the skin of the limbs, or under the harness (back, breast, rump, head).
Confined at first to the point of infection it becomes multiple, being
conveyed from place to place, through the soil, floor, stall, harness,
blankets, brushes, combs, straw, etc., and may extend on the mucosæ. The
wounds fester, forming pus and crusts over a more or less considerable
swelling. In a variable time, (one to twenty weeks) the surrounding
lymphatics become swollen and tender (corded), and nodular swellings
appear on their course which fluctuate, burst and discharge a whitish or
yellowish pus, sometimes oily or slimy. The disease extends along the
lymphatics, invading the lymph glands and even the internal organs.
Tokishige describes cases in which it extended along the respiratory
mucosa, causing constriction of the nasal passages and larger bronchi,
with dyspnœa, and finally, invading the lung. In other cases it spread
from the prepuce, or scrotum, upward along the tunica vaginalis,
spermatic cord and testicle. Caparini and Ferner describe it in the
orbit, affecting the lids, nictitans, conjunctiva and adjacent parts,
with nodules and abscesses. Mazzanti describes the case of a filly which
died with pea-like nodules on the colon, and ulceration, with dirty,
black, purulent centres, and indurated borders. Tokishige describes the
affected cattle as showing a vast number of subcutaneous, hard, painless
nodules, varying in size from a hazel nut to a walnut and covered by
light colored skin. The nodules were isolated and not connected by
swollen, beaded lymph vessels. They encrease and suppurate much more
slowly than in the horse. In three cows microscopically examined he
found apparently the same branching fungus (saccharomyces), as in the
horse cases. The mortality is about 10 per cent.
In the _farcy of the ox_ of Guadaloupe there form subcutaneous nodular
abscesses, with cordiform swelling of the lymph plexus and trunks, often
proving fatal in a year through extension to the lungs. The abscess
breaks, discharging a whitish, creamy or caseous, or grumous contents,
containing a bacillus (Nocard). The abscesses usually appear under the
sternum or belly and later extend to the thighs and legs. In all such
cases the mallein test is inoperative.
The _treatment_ of such cases should be actively antiseptic to destroy
the germ while still local. After opening and evacuating the abscesses,
excise or curette the diseased tissue, or destroy with the actual
cautery, pack the cavities with pledgets soaked in tincture of iodine,
iodized phenol creolin, lysol, mercuric chloride, zinc chloride, or
copper sulphate, or dusted with aristol, iodoform, or iodized starch.
The surrounding swelling, if any, may be painted with tincture of
iodine, or covered with cloths wet with a sublimate lotion or other
antiseptic. Internally, tonics and antiseptics may be given: arsenite of
strychnia, quinia, iron or copper sulphate, sulphites or hyposulphites
of soda or potash.