580 ACUTE GENERAL INFECTIOUS DISEASES 



ened, swollen and dark red or bluish in color. In the 

 stomach the lesions are very prominent, and consist of an 

 intense inflammatory condition. The mucosa is dark red, 

 or almost black, corrugated and at the apex of the corru- 

 gations the membrane is eroded. 



Hemorrhages take place in the membrane and give it a 

 more or less mottled appearance. Some cases present 

 extensive hemorrhages over the entire membrane. The 

 surface of the mucosa is covered by a mucus of a dark 

 brown, or chocolate color, which can be readily scraped 

 off. The contents of the stomach have a peculiar offensive 

 odor. The intestines show similar ehanges, but in most 

 cases not so extensive. The cecum and small intestines 

 show the most prominent lesions. The peritoneum covering 

 the bowels is congested and the mesenteric lymph glands are 

 enlarged. The spleen is often much enlarged and shows 

 evidence of acute inflammation. The liver and some of 

 the other organs are hyperemic. The lungs in most cases 

 do not show much on examination. They are usually 

 slightly congested, and edematous. The heart is pale in 

 color and very friable. The brain and its membranes may 

 be markedly hyperemic, or show but slight change. The 

 lesions found on autopsy are indicative of a more or less 

 intense gastro-enteritis. 



Symptoms. —The initial symptom, which is quite constant, 

 is a very persistent vomiting. The vomitus at first con- 

 sists of food particles; later mostly mucus mixed with blood 

 and bile. The attacks of vomiting often begin without 

 any previous indication of illness, and suddenly become very 

 severe, producing in a short time marked weakness and 

 prostration. The appetite is lost; there is rapid exhaustion 

 and staggering gait. The progress of the disease is quite 

 rapid. Frequently in one to three days it has reached its 

 characteristic form. Examination of the mouth reveals more 

 or less extensive lesions of the mucous membrane. Along 

 the margin of the gums will be noticed degenerative or 

 necrotic 'changes, ulcers and at the margins of the lips there 

 will be present the characteristic chocolate-colored discharge. 

 The tongue will be affected; it is sometimes partially or 



