STRANGLES 35 
glands. The urine generally remains alkaline; it frequently con- 
tains a considerable quantity of albumen. 
At times, strangles is accompanied by a cutaneous exanthema 
which takes the form of an eruption of wheals, nodules, vesicles and 
even pustules; these may appear, chiefly on the sides of the neck, 
shoulders and sides of the chest. These exanthemata are character- 
ized by their sudden appearance, and often by their equally rapid 
disappearance. An eruption of vesicles may break out on the nasal 
mucous membrane. ‘ The contents of the vesicles is at first limpid, 
but later it becomes purulent. Rabe states that the streptococcus 
of strangles can produce ulcers on the nasal mucous membrane. 
_Morbid anatomy. The lesions in strangles are interesting from 
the fact that in the beginning the disease is general but later in its 
course it presents a series, exceedingly variable in different individuals, 
of localized tissue changes. The lymphatic glands are most often 
affected, although any organ may be involved. As indicated by the 
symptoms, the lesions in most cases are characterized by an acute 
inflammatory process followed by suppuration. 
The glandular swellings about the head usually terminate in sup- 
puration, the pus discharging either externally or into the oral cavity. 
In other cases the pus undergoes caseation. Frequently the inflamed 
glands become confluent, resulting in a single large abscess. Small 
abscesses may occur under the pharyngeal mucosa. 
The inflammation may extend to the superficial lymph vessels of 
the skin, especially of the head, resulting in the formation of a large 
number of small abscesses. This may be followed by a diffuse 
phlegmonous swelling of the parts. Metastatic abscesses are lable 
to occur in a great variety of organs. The metastasis seems to take 
place through both lymph and blood vessels although the lymphatic 
glands are most often affected. Suppurating foci have been described 
in nearly every lymphatic gland in the body. The discharge of pus 
from the bronchial, mesenteric or other glands, within or adjacent to 
the pleura or peritoneal cavities, may give rise to 2 fatal pleuritis or 
peritonitis. There is no organ of the body free from possible sup- 
purative Jesions as a result of metastasis (bastard strangles). 
Brudeaud and Demé have described a case of strangles which 
began as polysynovitis. Bouet reports that encephalitis is not 
exceptionally rare. 
Strangles may become chronic, especially when the nasal catarrh 
extends into the sinuses of the head, the guttural pouches, or 
