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Glanders.

Problems:

Synonym:—Farcy.

Definition:—A disease primarily developed in the horse, conveyed thence to man; due to the presence of the bacillus mallei. It is characterized by the presence of nodular masses at the seat of infection. It is called glanders when it develops in the mucous membranes of the nasal passages. Ulcers appear at the seat of infection. When it affects the skin the nodular tumors break down and abcesses form.

Etiology:—The disease in man is contracted by direct infection from contact with an animal suffering from the disease. The infection from the secretions of the animal will develop more readily upon the skin of the man than in the nasal passages. The disease occurs almost exclusively among men who handle horses. No cases among women are reported.

Symptomatology:—The disease develops in an acute form, but may subsequently become chronic. Within five days after exposure the patient complains of malaise, general distress, some weakness and fever. There is seldom any chill. At the point of infection there are swelling and other signs of local inflammation, which soon appear in the lymphatic glands and follow the course of the vessels. Small granular masses are found along the course of the lymphatic vessels, which become hardened and painful, and ultimately break down and slough. The local abscesses assume the form of boils often, although specific in their character. The development of pus in these sloughs results often in acute pyemia.

When the disease develops in the nasal passages there is a very free discharge of masses of purulent mucus, which may be streaked with blood. Epistaxis is common from the ulcers, which quickly develop. The nose and face swell and an eruption appears on the face, neck and chest. This eruption is at first papular. The papules, which first appear, develop into pustules and discharge, and a dry crust is formed, while other papules are yet developing. The mucous membranes of the entire head become involved and sometimes those of the bronchial tubes, esophagus and the gastro-intestinal tract.

As the ulcers deepen they may involve the periosteum and the structure of contiguous bones. Inflammation of the synovial membranes is common, with the development of a true arthritis. The joints become swollen, tender and painful, and the characteristic pustules are apt to form in the skin around them.

The course of the disease in an acute manifestation is very rapid. The patient becomes greatly prostrated and delirium may occur, although the fever may not be excessively high. Death occurs usually at the end of the first week.

In the chronic form of the disease the development is less rapid. Constitutional symptoms at first are not so strongly marked, but there are evidences of general infection, with the appearance of abscesses, nodular growths or ulcers upon any portion of the body surface.

Prognosis:—The disease in either acute or chronic cases is almost invariably fatal. A much larger proportion of the chronic cases than of the acute form recover.

Treatment:—The disease is greatly modified by treatment. It is necessary that the infected tissues be subjected to the action of the most active antiseptics. The nasal passages should be thoroughly irrigated three or four times each day. All sloughing surfaces should be cauterized and abscesses should be opened freely and curetted. The most active alterative measures internally should be adopted. The use of echinacea, alternated with the calcium sulphid or calcium iodid will be effective. There is no doubt that a dressing of echinacea in full strength to the abscesses and ulcers will be of service also. This remedy should be given in dram doses every two hours. Forced feeding with a concentrated nutritious diet is important. When prostration appears, stimulating tonics may be demanded, with specific measures for the support of the heart.


The Eclectic Practice of Medicine with especial reference to the Treatment of Disease, 1910, was written by Finley Ellingwood, M.D.



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