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Report of Medical Officer of Health.] 27
short note on it will be of general interest. Moreover, there has been no case recorded of exactly
the same kind.
J. A., male, aged 37, a carman, residing in Kensal Eoad, had been ailing for about two
weeks prior to date of inquiry (October 30th). He had felt cold and stiff, but had not had
any rigors until 29th, and then only very slightly.
He had been under treatment since October 25th for "nasal and bronchial catarrh."
He had also complained of his throat, which, however, to the naked eye presented no
abnormality except slight redness. On October 29th he could not swallow well. His
condition then was: "Temperature 99°, pulse fair and not rapid; glands of neck swollen, but
not the tonsils; considerable infiltration of cellular tissues of neck, shoulders, and trunk
(back and front), extending slightly down the thighs; inguinal glands not enlarged; nasal
catarrh very marked; bronchial catarrh better." When seen by the Medical Officer of
Health on the 30th, the two features which drew the attention were, first, the profuse
discharge from the nose and the pachydermatous condition of the skin. The actual note
on the latter was " skin of neck (all round) infiltrated, slightly red, and board-like; skin of
chest and abdomen in same state, also that of upper arms." The skin was too resistent
to pressure to allow any of the lymphatic glands to be made out. An examination of
the nose revealed nothing. There was some difficulty in breathing, and the heart's action
was somewhat laboured—both being evidently due to the state of the skin.
The man's occupation naturally brought him into contact with horses, and although he
stated that there had not been any cases of glanders in the yard where he worked, the result
of the examination led to a suspicion that that was the disease he was suffering from. As
however the case was altogether novel, it was decided to take steps to absolutely exclude all
possibility of plague infection. Accordingly the Medical Officer of Health of the County was
consulted, and Mr. Cantlie and Dr. Hamer, Assistant Medical Officer of the County, saw the
patient on the evening of the 30th. The examination then made had the same results as
already recorded, but two small somewhat-inflamed sores were then noted, one on each hand.
There were no lines indicative of inflamed lymphatics. Samples of blood, sputum, &c.,
were taken for bacteriological examination.
Mr. Cantlie decided that the case was not one of plague, and was inclined to agree to the
possibility of its being glanders. The man was sent to University College Hospital, where
he remained for some time, and whence he was subsequently discharged much improved
in health.
The specimens mentioned were examined at the London School of Tropical Medicine and at
the Jenner Institute of Preventive Medicine. The report from the former was that the bacillus
mallei (glanders) had been identified, but in a motile form. From the latter, it was reported that
the specimens from the nasal secretion had been cultivated with negative results. The serum from
the blood gave a "Widal reaction" with bacillus mallei, but the value of such reaction is doubtful.
Bacteriological tests at the hospital were entirely negative as regards glanders. It may be memtioned
here that the case was ultimately diagnosed by the hospital authorities as "scleroderma."
In consequence of the suspicions aroused, the Veterinary Inspector of the Council was directed
to visit the yard where J. A. was employed. The yard is jointly occupied by seven horse-owners, the
total number of horses standing there being 23 (more or less). All the horses, except those of one
owner, used the watering trough in common. In the stud of E. A.'s employer was found a recently
purchased horse which presented suspicious symptoms and reacted to the mallein test. The horse
was slaughtered and was found to be glandered. In the absence of compulsory powers the
Veterinary Inspector was unable to say whether any of the other horses in the yard were similarly
affected.