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114
Annual Report of the London County Council, 1910.
results have been obtained; in the latter place 95 per cent. of glandered horses were diagnosed and
only 1 per cent. of healthy horses were wrongly diagnosed as glandrous.
This method of diagnosis is perhaps the most scientific and accurate that we have at our disposal.
Every stage can be accurately controlled, and the standardised reagents necessary for the test can
be kept in a central laboratory to which place the blood could be sent.
(7) Precipitin method. This, like the preceding two tests, depends on the formation of specific
anti-bodies in the blood of infected animals, and these cause a turbidity or precipitate in suitable
admixture with mallein. The test has not yet been widely tried.
Summary of methods of diagnosis.—These fall into three groups:—
(A) Bacteriological, resulting in the finding of the bacteria and proof positive, but only useful
in cases with obvious external lesions, and useless in the many cases of internal or generalised or occult
glanders.
(B) Inoculation methods, necessitating the introduction of a virus into the system—an undoubtedly
valuable method in the case of glanders, and the universal method adopted in this country.
In experienced hands it is probable that no cases are missed, but it is possible that some cases of
healthy animals react, and there is always the uncertainty arising from our ignorance of the effects
of such inoculations. In man we have, as far as our experience goes, never met with any ill-effects
from the use of mallein in fairly large doses, and in one case we think we have seen some improvement.
It must always be remembered that an injection may cause a local focus of disease to flare
up into a general infection, as was seen in the early days of tuberculin injections.
(C) Methods directed to the finding of anti-bodies formed in response to infection. These are
based on more scientific premises, and entail no interference with the patient beyond the withdrawal
of a few drops of blood. The test is not affected by the general condition, such as pyrexia, of the
patient, as is the mallein reaction. Analogy with other diseases, and the result of Continental
investigations holds out promise that the complement-deviation method will ultimately replace the
inoculation method.
It is obvious that, other things being equal, methods which merely necessitate the withdrawal
of a little blood for diagnosis must be given the preference over methods entailing the inoculation
of toxic materials into the system.
Attention might here with advantage be directed to the practice adopted at certain Continental
centres where official sero-diagnostic institutes have been founded, and to these places blood from
suspected cases of syphilis, glanders, etc., can be sent for diagnosis.
Conclusions.—It is probable that the small, but increasing, number of diagnosed cases of human
glanders does not include all the cases which occur, and that only the more severe varieties are reported.
Man, not being a highly susceptible subject, is often affected, however, with a chronic form of the
disease; such cases sometimes recover, but may terminate in the fatal acute form. The percent.age
of recoveries in the cases described is given varyingly from 20 to 50 per cent., but little importance
can be attached to such statistics. We have at the present time under observation a patient
who exhibits no glandrous lesions, but is suffering from advanced pulmonary tuberculosis. These
chronic cases are often wrongly diagnosed, being mistaken for much commoner diseases.
In recent. years many cases in man have been reported in Continental and American literature,
and it is evident that more cases are now correctly diagnosed than heretofore, but it seems probable
that with more widespread knowledge of the varied symptomatology, and more readily accessible
laboratories, other cases must be forthcoming.
Much invaluable assistance has been rendered to us by Mr. Shaw, F.R.C.V.S., Inspector in the
Public Control Department, and Mr. Simpson, F.R.C.V.S., of the London Parcels Delivery Company
both of whom have put their wide knowledge of equine glanders at our disposal, and given us other
facilities for following up the work. To them? our thanks are due. We are also greatly indebted to
the Chief Officer of the Public Control Department and members of his staff for help in this enquiry.