Diarrhcea is frequently observed, but it is seldom as violent as in cases in which the general toxamia is due to the ingestion of toxic foods. It is but a manifestation of the gastro-enteritis which attends the majority of cases.
Vomiting also occurs, but is rarely se vere. The spleen is enlarged in most cases; indeed, all the lymphatic glands show a marked tendency to become infiltrated and enlarged. The urine usually shows considerable albumin and casts.
The blood undergoes rapid deteriora tion, owing to the presence in the blood of micrococci. As a result, the skin comes pale and yellowish, and shows a punetate eruption—minute areas of cu taneous haemorrhages — sufficiently like that of scarlatina as to suggest the pres ence of the latter disease. Other cutane ous manifestations may also be witnessed and present analogies to those occurring in connection with other diseases, rose ala, herpes, superficial (edema, etc. At first the skin is hot, dry, and rough; gradually it becomes doughy, bathed in perspiration, and often cold and clammy.
Often a yellowish tinge suggests icterus; this is less marked, however, than in pyremia.
Toward the later stages, complications may develop. Endocarditis may occur, and, its appearance being very insidious, is sometimes far advanced when discov ered, the physical signs being less marked than is usually the case in this disease. Gradually the sallow hue of the skin deepens, the mental torpor lapses into stupor, and dulling of the senses be comes perceptible in every way. The tongue becomes dry and thickly furred; the urine, at first scanty, becomes con centrated and sometimes has to be drawn with the catheter. Delirium is replaced by coma, soon followed by death.
The local manifestations vary; indeed, none may appear. This is especially the case when the disease runs a very acute course. On the other hand, a severe local inflammatory process may develop, accompanied by sloughing and rapidly spreading gangrene. This is frequently observed in connection with slight in juries, such as those to which surgeons are exposed. In such cases the wounded finger becomes inflamed and painful, red streaks appear on the arm, and the lymphatic glands of the member swell.
Prompt measures may even here arrest the process or general toxaemia follows.
In accidents involving crushing the general septicaemia may follow contami nation from the dead tissues, traumatic gangrene with putrefactive inflammation of the neighboring uninjured tissues en suing. Moist gangrene, the rapidly spreading gangrene (gangrene f oudroy ante, with evolution of gas), may thus act as foci which rapidly bring on death. There is great swelling, with local em physema with crackling sounds, the mass giving off a very foul odor. The mass of tissue becomes totally decomposed if the patient lives long enough. Fortunately antiseptic methods have greatly limited the number of such cases, and they are now rarely met with.
Some cases are atypical. Some, as stated, run their course without fever; others progress in the usual way and then cease,—the abortive form,—even after the temperature has approximated 103° F. Such cases are not rare.
Attention called to the existence among children, of from four to eight years of age, of a form of gastro-ente ritis which has exactly the course and gravity of a cholera infantum. It fol lows sometimes the ingestion of food bad in quality or improper for the age of the child, sometimes without known cause. It begins as a febrile indigestion, but sud denly diarrhoea begins, vomiting becomes uncontrollable, the facies of cholera ap pears, and the child dies in three or four days. Fever may be wanting from the beginning. Comby (M6d. Mod., p. 6S9, Nov. 11, '96).
Etiology.—Any wound, no matter how diminutive, may become the starting point of Hence the com parative frequency of this disease among surgeons who, through a scratch, a slight abrasion, or a post-mortem wound, due to a slight prick of the scalpel used, etc., introduce the virus into their organism. Healthy granulations were thought to be impermeable to toxic elements, but the experiments of Maas and Hack have shown this conclusion to be incorrect.