By some it is recommended that the local lesion should be freely excised; others advocate cauterisation of the affected part with solid caustic potash till all the indurated area is softened.  Graf has had excellent results by the latter method in a large series of cases, the oedema subsiding in about twenty-four hours and the constitutional symptoms rapidly improving.  Wolff and Wiewiorowski, on the other hand, have had equally good results by simply protecting the local lesion with a mild antiseptic dressing, and relying upon general treatment.

The general treatment consists in feeding and stimulating the patient as freely as possible.  Quinine, in 5 to 10 grain doses every four hours, and powdered ipecacuanha, in 40 to 60 grain doses every four hours, have also been employed with apparent benefit.

GLANDERS

Glanders is due to the action of a specific bacterium, the bacillus mallei, which resembles the tubercle bacillus, save that it is somewhat shorter and broader, and does not stain by Gram’s method.  It requires higher temperatures for its cultivation than the tubercle bacillus, and its growth on potato is of a characteristic chocolate-brown colour, with a greenish-yellow ring at the margin of the growth.  The bacillus mallei retains its vitality for long periods under ordinary conditions, but is readily killed by heat and chemical agents.  It does not form spores.

Clinical Features.—­Both in the lower animals and in man the bacillus gives rise to two distinct types of disease—­acute glanders, and chronic glanders or farcy.

Acute Glanders is most commonly met with in the horse and in other equine animals, horned cattle being immune.  It affects the septum of the nose and adjacent parts, firm, translucent, greyish nodules containing lymphoid and epithelioid cells appearing in the mucous membrane.  These nodules subsequently break down in the centre, forming irregular ulcers, which are attended with profuse discharge, and marked inflammatory swelling.  The cervical lymph glands, as well as the lungs, spleen, and liver, may be the seat of secondary nodules.

In man, acute glanders is commoner than the chronic variety.  Infection always takes place through an abraded surface, and usually on one of the uncovered parts of the body—­most commonly the skin of the hands, arms, or face; or on the mucous membrane of the mouth, nose, or eye.  The disease has been acquired by accidental inoculation in the course of experimental investigations in the laboratory, and proved fatal.  The incubation period is from three to five days.

The local manifestations are pain and swelling in the region of the infected wound, with inflammatory redness around it and along the lines of the superficial lymphatics.  In the course of a week, small, firm nodules appear, and are rapidly transformed into pustules.  These may occur on the face and in the vicinity of joints, and may be mistaken for the eruption of small-pox.