Glanders.

Synonym.—Farcy.

Definition.—A specific infectious disease of the horse, communicable to man by inoculation, and characterized by the formation of nodules in the mucous membrane of the nose—glanders; and also beneath the skin and lymph structures—farcy.

Etiology.—In 1882, Loemer and Schiitz discovered the bacillus mallei, a non-motile bacillus, resembling the bacillus tuberculosis, though shorter and thicker, which, when injected into horses, reproduced the disease in its every characteristic.

The infectious material is transmitted directly from horse to man, usually through an abraded surface, and occurs most frequently among hostlers, veterinarians, farmers, and those who come in contact with horses. It has been communicated from man to man, but this is rare.

Pathology.—The granulomatous nodules are made up of lymphoid and epithelioid cells in which are found the characteristic bacilli, and are located in the nose—glanders; or beneath the skin—farcy. These nodular masses soon discharge a yellow pus, which infects any abraded surface. In the nose, ulceration follows the suppurative process, while abscesses are found when the affection is of the skin.

Symptoms.—The disease may be divided into the acute and chronic forms, whether of the nose or that found in the sub-mucous tissues. The period of incubation is from three to five days.

Acute Glanders.—The first evidence of the disease is usually a redness and swelling at the seat of inoculation, and the neighboring lymphatics become swollen and painful. Chilly sensations, headache, nausea, and fever precede or rapidly follow the local symptoms. Within forty-eight hours, small nodules develop, which in a few days suppurate and discharge an offensive, purulent material. The inflammation extends to the adjacent respiratory apparatus, the pharynx, larynx, and bronchi often being involved; the cervical lymphatics are also implicated.

A papular eruption appears on the face and trunk and quite freely about the joints; these rapidly develop into pustules, which so closely resembles small-pox that the disease has been taken for variola. The constitutional symptoms are very pronounced, the tongue showing evidence of sepsis, and typhoid symptoms are present. After eight or ten days, the patient succumbs to the force of the disease, and death results.

Chronic Glanders.—This is a rare form, and is characterized by less intense and more vague symptoms and a more protracted course. There are ulcers in the nose, with a fetid discharge, and more or less respiratory complications. Muscular and arthritic pains are common; fever, attended by progressive prostration and general atrophy, follows, and after weeks or months of suffering the patient dies, though an occasional case recovers.

Acute Farcy.—In this form the force of the infection makes itself felt in the skin and subcutaneous tissues, while the nose remains free. The nodular enlargements are found about the joints and in the course of the lymphatics. When very large, resembling tumors, they are known as "farcy buds;" these suppurate, discharging a fetid, purulent material. There is gradual prostration, irregular fever, exhausting sweats, and colliquative diarrhea, the patient dying in from ten to fifteen days.

Chronic Farcy.—The chief feature in chronic farcy, is the formation of granulomatous tumors which degenerate into abscesses; they are chiefly found about the joints and on the lower extremities. They discharge a thick, yellow pus in the early stage, but this gradually changes to a fetid ichorous fluid; in some cases the ulceration is quite destructive, extending to the bone. This may last for months or years, the system being gradually poisoned, till at last the patient dies of pyemia or septicemia.

Diagnosis.—The history of exposure or contact with an infected animal is very important, though the severity of the nasal affection, the cutaneous eruption, the ulcers, and abscesses would hardly be mistaken for other troubles. When doubt exists, pure culture should be made and injected into a rabbit or guinea-pig; if the disease exists, the animal usually dies within twenty-four hours.

Prognosis.—In the acute forms of glanders and farcy the prognosis is unfavorable, death being almost the universal termination. In the chronic forms, some cases recover, though a large per cent end fatally.

Treatment.—Excision or cauterization of the primary lesion is recommended; though this may modify the local lesion, we are not to forget the systemic poisoning that has already occurred, and, if we hope to be successful, we must use internal antiseptics. Echinacea in full doses should be used per mouth, and after thoroughly incising and draining the abscesses, wash them with the same agent. The sulphites, chlorates, and mineral acids, as indicated, should be tried. Although the outlook is decidedly unfavorable, these agents should be thoroughly used.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.