After breaking down, these pustules give rise to irregular ulcers, which by their confluence lead to extensive destruction of skin.  Sometimes the nasal mucous membrane becomes affected, and produces a discharge—­at first watery, but later sanious and purulent.  Necrosis of the bones of the nose may take place, in which case the discharge becomes peculiarly offensive.  In nearly every case metastatic abscesses form in different parts of the body, such as the lungs, joints, or muscles.

During the development of the disease the patient feels ill, complains of headache and pains in the limbs, the temperature rises to 104 or even to 106 F., and assumes a pyaemic type.  The pulse becomes rapid and weak.  The tongue is dry and brown.  There is profuse sweating, albuminuria, and often insomnia with delirium.  Death may take place within a week, but more frequently occurs during the second or third week.

Differential Diagnosis.—­There is nothing characteristic in the site of the primary lesion in man, and the condition may, during the early stages, be mistaken for a boil or carbuncle, or for any acute inflammatory condition.  Later, the disease may simulate acute articular rheumatism, or may manifest all the symptoms of acute septicaemia or pyaemia.  The diagnosis is established by the recognition of the bacillus.  Veterinary surgeons attach great importance to the mallein test as a means of diagnosis in animals, but in the human subject its use is attended with considerable risk and is not to be recommended.

Treatment.—­Excision of the primary nodule, followed by the application of the thermo-cautery and sponging with pure carbolic acid, should be carried out, provided the condition is sufficiently limited to render complete removal practicable.

When secondary abscesses form in accessible situations, they must be incised, disinfected, and drained.  The general treatment is carried out on the same lines as in other acute infective diseases.

#Chronic Glanders.#—­In the horse the chronic form of glanders is known as farcy, and follows infection through an abrasion of the skin, involving chiefly the superficial lymph vessels and glands.  The lymphatics become indurated and nodular, constituting what veterinarians call farcy pipes and farcy buds.

In man also the clinical features of the chronic variety of the disease are somewhat different from those of the acute form.  Here, too, infection takes place through a broken cutaneous surface, and leads to a superficial lymphangitis with nodular thickening of the lymphatics (farcy buds).  The neighbouring glands soon become swollen and indurated.  The primary lesion meanwhile inflames, suppurates, and, after breaking down, leaves a large, irregular ulcer with thickened edges and a foul, purulent or bloody discharge.  The glands break down in the same way, and lead to wide destruction of skin, and the