h/i<:moglokinuria (azoturia) in thp: horse. 255 



little disturbed, but struggling causes a steady rise in the pulse ; the 

 latter is at first full and strong, but later becomes feeble, and in cases 

 almost imperceptible. The mucous membranes, particularly the con- 

 junctivae, are injected and purplish. In many patients the temperature 

 remains normal, or only rises a few tenths of a degree ; in twenty out 

 of twenty-five cases Friedberger and Frohner found no fever whatever. 

 Nevertheless the temperature may rise considerably, sometimes more 

 than 2° C. You must understand that the absence of fever in no way 

 justifies one in regarding the disease as benign ; very grave cases, indeed, 

 may remain absolutely without fever. 



Apart from the loss of power in the hind limbs and the local con- 

 tractions mentioned, other nervous symptoms occur, including paralysis 

 of the tail, rectum, and bladder. When the kidneys become gravely 

 affected, and no longer perform their function of purifying the blood, 

 symptoms of uraemia appear. The most striking are epileptiform con- 

 vulsions, attacks of dyspnoea, and generalised cramp, alternating with 

 periods of coma, and later, profound depression of the bodily forces and 

 gradual sinking of temperature. 



To this summary of the symptoms which may appear at various 

 stages of haemoglobinuria I wish to add a few words regarding the two 

 principal clinical divisions of the disease. Considered from the point 

 of view of its development, course, and terminations, we recognise (i) 

 a rapidly progressive form, accompanied by paralytic symptoms ; and 

 (2) a benign form, in which the disease process quickly subsides without 

 producing paralysis. 



In the paralytic form, which is most common, paralysis of a limb, or 

 of both hind quarters, may be noted within ten minutes, a quarter of 

 an hour, or half an hour after the appearance of the first symptoms. 

 Patients with paraplegia fall to the ground in spite of all their efforts 

 to remain standing, and on attempting to rise are only able to lift the 

 fore-parts of the body ; the hind parts remain powerless. During the 

 first few hours they show signs of excessive excitement ; the skin is 

 damp with sweat, and steams ; the respiration is rapid and panting, 

 the pulse frequent and strong, the conjunctiva purplish. Sometimes 

 these symptoms persist ; sometimes they gradually diminish in 

 intensity ; a quiet period occurs, the sweating ceases, the breathing 

 and circulation are less rapid ; everything points to real improvement. 



When the issue is likely to prove favourable this calm period con- 

 tinues, and in from twenty-four hours to six or eight days — usually on 

 the second to the fifth day — recovery takes place. Sometimes it 

 occurs as suddenly as the attack. A patient which the evening before 

 was lying helpless is next morning found standing at the manger. 



