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Infirmary a pustule on his scalp in the region above the left ear began to attract
attention. This discharged and an ulcer formed which gradually increased in size until
it attained the size of a five shilling piece. The margins of the ulcer were irregular and
it increased in depth towards the central portion, the floor of which was down on the
bone. On August 23rd and 24th, pustules were observed making their appearance on the
face, neck, shoulders, chest, arms and legs. On August 25th the Medical Superintendent
of the Infirmary kindly afforded me the opportunity of seeing the case. The
pustules presented an appearance somewhat resembling boils, and the aspect of the patient
with respect to the eruption bore some resemblance to that of smallpox when the pocks
have become pustular. The pustules were of varying size, but few exceeded that
of a large pea. In places they formed groups or patches. On the right shoulder
there was an irregular raised mass of them covering an area of about the size of a two
shilling piece. Those on the legs were few in number and were in an early stage, presenting
the aspect of slightly reddish papules with a light yellowish centre giving the
impression of flattened vesicles. No enlargement of the lymphatic glands was noticeable.
The patient was obviously extremely ill. His respirations were hurried and the fever was
high, his temperature being between 105 deg. and 106 deg. The temperature in the
early stage of the disease ranged from two to two-and-a-half degrees higher in
the evening than in the morning. Later this difference between the morning
and evening temperatures hardly amounted to a degree. During the
last few days the temperature remained pretty steadily at about 105 deg.
In order to clear up the diagnosis which rested between typhoid fever with
septic complications, septicaemia and glanders, a specimen of the patient's
blood and specimens of the discharge from the ulcer on the scalp and the
pustules were submitted to the bacteriologist at the London Hospital. On August
27th an interim report was received that the result of Widal's test for typhoid fever was
negative but that the specimens of the discharge contained a bacillus of a, suspicious
nature. Four days later a further report was received stating that the bacilli isolated
proved to be those of glanders as shown by their morphology, staining reaction, culture
characters, and inoculation experiment.
The case terminated fatally on August 25th and a post mortem examination was
made by order of the Coroner on August 29th. The general character of the ulcer of
the scalp and the cutaneous abscesses have already been referred to. The most noteworthy
feature in connection with the ulcer was the presence of brownish, semitranslucent
flattened tubercles on the bone forming its floor. There were no signs of internal
abscesses. The viscera were gorged with blood and their general appearance was such
as is met with after death fromi a severe febrile disorder.
An inquest was held on August 30th. According to the evidence it appeared that
a horse stabled where deceased was employed was slaughtered for glanders on July
18th. 1 his horse was shod by deceased on May 25th. It was then to all appearances
well. No history was obtainable as to the man having been brought in contact with
the horse in any way after May 25th. The horse seems to' have been suspected of
being glandered for some time before it was killed, and was kept in a loose box from