(Glanders; Farcy; Malleus)
Definition. a rare, acute or chronic, contagious disease, due to inoculation from a specific virus derived from the horse, and characterized by constitutional disturbances and lesions of the skin and mucous membranes.
Symptoms. Following accidental infection through some abrasion of the skin or sound mucous membrane, there is a variable period of incubation of from three days to as many weeks. Then an inflammatory papule or pustule develops which soon becomes a ragged, undermined, spreading ulcer, usually accompanied by a swelling of the neighboring glands and often by general symptoms of a rheumatoid character, such as mild fever, prostration, pains in the extremities, etc. A pyemic or typhoidal state may rapidly develop and death ensue in a few days. If the entrance of the poison occurs through a mucous membrane, catarrhal symptoms appear, followed by those of ulceration, with a purulent, sanious and offensive discharge. The nasal mucous membrane is commonly the part attacked, although the disease may begin on any mucous membrane or extend to them from the nose and after the inoculation takes place through the skin, the mucous membrane does become affected in most acute or subacute cases.
The most characteristic skin symptoms of equinia arise irrespective of the point of inoculation and appear at any time from two days to a month after the development of the earliest symptoms. Groups of small red macules which rapidly become shot-like papules, then change to a yellow color, not unlike the lesions of smallpox but without umbilication, are typical. These lesions may merge and break down forming superficial, ragged, dirty ulcers or sometimes dry, gangrenous patches. Deeper and larger nodules may appear at points distant from the primary infection but are sometimes connected by swollen lymphatics. These glandular enlargements may reach the size of a walnut and in the horse they constitute the “farcy buds” which may or may not be numerous. In acute cases, these eruptions do not develop owing to the rapidly fatal course of the disease; in chronic cases they are not numerous or of rapid development corresponding with the more moderate constitutional symptoms. The average duration of a chronic case is five to six months, although it may be much longer, and rarely the acute form may supplant the chronic at any time in its course.
Etiology and Pathology. This rare disease is usually limited to male adults who work among horse, such as stablemen, grooms, etc., although rarely a case has been known to occur by transmission directly from man to man, woman or child. The contagion is probably always direct, from the contaminated secretions of the animal coming in contact with an abrasion of the skin or mucous membrane. The efficient cause is the glanders bacillus (bacillus mallen) which has produced the disease from culture inoculations. The presence of this bacillus, or its products, in the human tissues causes a dense infiltration of embryonic cells in the corium like the tubercular process. The infection spreads along the lymph vessels and bacilli may enter the blood vessels and be carried to any part of the body. Extensive or numerous foci may finally induce a condition akin to pyemia. The bacilli are readily found in all the skin lesions, blood and brain tissue, are about the same size as the tubercle bacilli but broader and shorter. They are easily stained with methylene-blue.
Diagnosis. When the general, cutaneous, lymphatic and mucous membrane symptoms have appeared, there should be little difficulty in making the diagnosis it is helpful to obtain the previous history of the person attacked and a microscopic verification.
Prognosis and Treatment. The former is always grave. In the acute form, nearly all die. In the chronic form, about one-half of the cases finally succumb.
Prophylaxis demands the immediate killing, disinfection and burial of animals affected with glanders and the thorough sterilization of abrasions and wounds happening to those caring for suspected animals. Early destruction of the lesion by excision, curetting or cauterization, with the necessary antiseptic after- treatment, should be instituted at the point where the inoculation is suspected to have taken place. After the development of the disease, physiological treatment is most important so as to put the patient in a good resisting condition. I have seen splendid results follow the continuous application of a 10 per cent. solution of creolin in glycerin in one chronic case and equally good results from the injection of mallein in another. In all cases it is wise and essential that internal medication should be instituted but the chronic type affords the best opportunity for careful prescribing. See indications for Arsenicum, Kali bich., Nitric acid, and Vipera.