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111
Report of the Medical Officer of Health.
of the ventilation of the stables visited, but it cannot be said that, comparing stables of approximately
the same size, the ventilation of the stables from which glanders was reported was much
more unsatisfactory than that of stables generally. Enquiry was made, moreover, as to the presence
of vermin. As regards stables with cases of glanders, in 18 instances the presence of cobwebs was
noted, and it was found that there was evidence of fly nuisance; in eight instances there was evidence
of the presence of mice, and in six of rats; at one stable rats were said to be numbered by
thousands, while at another a professional rat-catcher made periodical visits with a view to reducing
the number of rats, The results yielded in stables without glanders do not, however, differ greatly
from these. Generally speaking, approximately half the stables, both those with and those without
clinical cases of glanders, show evidence of the presence of vermin of one kind or another.
It must be noted that in the last two or three years there has been a reduction in the number
of clinically recognisable cases of equine glanders. During that period much more attention has been
devoted to the testing of horses in stables from which glanders was reported, and there has also been,
of course, owing to the introduction of motor traffic, a very considerable reduction in the horse population
of London. Horses in large studs, at least, ate not allowed to wander in a glandrous state, and
very rarely in an advanced condition of disease, when the discharges from the nose and farcy buds
would render them decidedly infectious, and so for this reason, for the time being, a lessened incidence
in human cases might be expected; this is, perhaps, aided to some extent by the growing knowledge
amongst those working in stables of the infectivity of the disease for man.
But though the larger studs have been in gr eat part rigidly depleted of their glandrous animals
and are carefully watched by their owners for evidence of fresh infection, there still remains a large
number of one-horse owners, who will endeavour to hide any evidence of disease in their animals so
long as they can be worked. These horses, often badly fed and overworked, and so offering little
resistance to infection, are still liable to constitute a serious source of infection, both to other horses
and to man. These form so large a number as to be almost beyond the control of the authorities, under
whose notice, indeed, they can only come when notified, and they are hence liable to be a menace
and a focus from which fresh outbreaks can arise.
It is from these cases at the present day that infection of human beings is to be expected,
and here again the men who own these horses would be, and in fact are, if they suspect themselves
to be suffering from any infectious disease, very loth to draw attention to themselves and interfere
with their freedom.
Recognising, then, the possibility of fresh outbreaks when attention is directed into other channels
of prophylaxis—a condition not unknown in the past in connection with other diseases—also the fact
that glanders in man is frequently overlooked and is commoner than hitherto thought, it will be
advantageous to state briefly the main facts concerning the appearances presented by the disease in
man, the means of diagnosis and methods of infection, with the object of facilitating the discovery
of these cases—a condition that has, indeed, been brought about to some extent in recent years, and
also to collect all the cases that have been reported as occurring in the county for some
years past.
As recently as 1906, in an exhaustive treatise on "Glanders in Man," up to which time the
author (Dr. G. D. Robins, of Montreal) had only been able to collect 156 cases from all parts, there
appeared the statement that "glanders in man is sufficiently rare to make it unlike!) that any individual
Anglo-Saxon observer should encounter more than a solitary case." That was then the generally
accepted view, but a better knowledge of the varied forms the disease assumes in man, and, more
important still, the introduction of bacteriological laboratories as adjuncts to all large hospitals, have
made it evident that this is far from the truth. There can be little doubt that to the few cases of
glanders in man reported in the past, when it is remembered that the disease was far more rife amongst
horses and was allowed to run a far longer course than now, there should have been added many others
which had been diagnosed, from clinical appearances and bacteriological ignorance, as abscesses, boils,
ulcers, syphilis, tuberculosis, pyaemia, and even smallpox, etc. This is supported by the fact that in
the past ten years, during which time equine glanders has been to an increasing extent under control,
more human cases have been reported than in the previous years.
Symptomatology.—Glanders in man may be a very acute or a very chronic disease, exhibiting
most protean characters, including abscesses, single or multiple, in the skin or muscles; chronic
ulcers of skin or mucous membranes lasting months or years, and resisting treatment; chronic nasal
discharge continuing for months and perhaps terminating with a sudden fatal acute outbreak; acute
febrile and sometimes rapidly fatal conditions; pyaemia, associated with multiple abscesses, much
malaise and pains in the limbs, etc. All these conditions have, at one time or another, been
mistaken for better-known and commoner diseases, such as boils, tuberculosis, syphilis, pyaemia,
septicaemia, acute rheumatism, smallpox, etc.
It can only be said that if any of the conditions above enumerated occur in patients in any
way associated with horses, they should be regarded with suspicion ; though at the present day,
when it is becoming more common, to diagnose abscesses and ulcers in the laboratory rather than on
their clinical appearances alone, there is less likelihood of a mistake arising.
Ætiology.—The occupation of almost all cases is in some way connected with horses. Occasionally
infection has been reported as occurring from man to man, and once in a washerwoman,
from infected clothes. Of the cases that are tabulated as occurring in London, 33 were thus occupied
(stablemen, cab-proprietor, costermonger, carmen, housekeepers, coachmen, tram-driver and conductor,