Surgery, a practical treatise with special reference to treatment / by C.W. Mansell Moullin ; assisted by various writers on special subjects.

Mansell-Moullin, C. W. (Charles William), 1851-1940

Date:: 1893

Credit: Surgery, a practical treatise with special reference to treatment / by C.W. Mansell Moullin ; assisted by various writers on special subjects. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

95/1262 page 87

$(.LANDERS. This is another variety of infettive disease, caused by a specific germ, the bacillus Mallei. Like ])yi\iinia, anthrax, tubercle, and, to a less extent, syphilis, it varies very greatly in different cases, the severity of the attack, and the nature of the symptoms being modified by the anatomical structure of the seat of inocu- lation, the method of dissemination, and jjrobably the dose of the poison. It may be acute or chronic ; it may affect especially the mucous membrane of the nose and the respiratory tract (glanders), or it may spread slowly in the cellular tissue and lymphatics (farcy) ; and, not uncommonly, after continuing in the chronic form for a greater or less length of time (I have known it upward of a year in a horse), it suddenly becomes acute; but, in all cases, although its manifestations and its course are almost as variable as those of tubercle or pyaemia, it is one and the same disease, caused by the same species of organism. The bacillus is a small rod, somewhat shorter and thicker than that of tubercle, and usually exists in pairs. It is not capable of spontaneous movement, [and spores have been proved to exist by Baumgarten and Rosenthal]. Usually, it enters through wounds, especially at the corners of the nails; but, in all proba- bility, it posses.ses the power of infecting the respiratory, if not the alimentary, mucous membrane. It may be transmitted from man to man, but, as a rule, it is caught directly from horses, or a.sses. Other animals show varying degrees of susceptibility to it. Local changes are usually produced at the seat of inoculation ; there is a period of incubation of some days, then the part becomes red and swollen ; the skin breaks down, and a foul ulcer is left, spreading at its edges and its base, but without anything in itself characteristic. From this the organism spreads, with more or less rapidity, in the cellular tissue round, in the lymphatics, or in the blood, the severity of the symptoms and the acuteness of the attack depending to a very large extent upon this. Whenever it spreads it causes inflammation ; granu- lation-tissue is produced : and this, as in the case of tubercle and syphilis, under- goes caseation (unless it is near a mucous or cutaneous surface, when it may break down at once), so that the yellowish-white, cheesy nodules and tubercles (farcy- l)uds. when they can be felt from the exterior), are formed in various parts. Suppuration follows, whether through the action of the specific bacilli, or because of the presence of pyogenic organisms in addition, is not known : and then ulcers, abscesses, and diffuse forms of inflammation break out in all the infected regions. The bacillus exists in the cheesy masses and in the pus ; not unfrequently it can be found in the blood as well in man, but this does not seem to be the case with horses. Symptoms.—It is met with, naturally, chiefly among those whose occupa- tions render them liable to infection, and it may be acute, so that it proves fatal within three or four days, or chronic, lasting for months, and possibly ending in recovery after a long and severe illness. The constitutional symptoms depend upon the acuteness of the attack. In the worst cases they resemble those that are always present in intense blood- poisoning—muscular tremors, low-muttering delirium, etc., with high fever, and a small, feeble pulse. When it is less severe they depend practically upon the number, size, and situation of the abscesses and ulcers, and upon the extent to which suppuration and septic absorption take place. In the majority of cases they do not terminate fatally at the commencement from the intensity of the fever; either broncho-pneumonia sets in, from the constant inhalation of the odor from the foul and decomposing sloughs, or the patient sinks at length from exhaustion, utterly worn out by pain, inability to take food, profuse suppuration, and fever. The most chronic cases recover, but always seriously crippled. Glanders may commence with inflammation and ulceration 6i the mucous membrane of the nose, or this may occur later in the course of the disease. In the case of the former, it is i)robably due to direct infection. At first there is a$