INFECTIOUS DISEASES. 533 



the head may by closure of the nostrils interfere seriously with 

 breathing. Internal edema may occur in the throat, lungs, or in- 

 testines. Septicemia, or blood poisoning, may result from anasarca. 



Terminations. — The simple form of the disease most frequently 

 terminates favorably on the eighth or tenth day by resolution or ab- 

 sorption of the effusion, with usually a profuse diuresis, and with 

 or without diarrhea. The appetite remains good or is at times 

 capricious. 



Death may occur from mechanical asphyxia, produced by closure of 

 the nostrils or closure of the glottis. Metastasis to the lungs is 

 almost invariably fatal, • causing death by asphyxia. Metastasis to 

 the intestines may cause death from pain, enteritis, or hemorrhage. 



Excessive suppuration, lymphangitis, and gangrene are causes of 

 a fatal termination by exhaustion. Mortal exhaustion is again pro- 

 duced by inability to swallow in cases of excessive swelling of the 

 head. 



Peritonitis may arise secondary to the enteric edema, or by per- 

 foration of the stomach or intestines by a gangrenous spot. Septi- 

 cemia terminates fatally with its usual train of symptoms. 



Alterations. — The essential alterations of anasarca are exceedingly 

 simple ; the capillaries are dilated, the lymphatic spaces between the 

 fibers of the connective tissue are filled with serum, and the coagulable 

 portion of the blood presents a yellowish or citrine mass, jellylike in 

 consistency, which has stretched out the tissue like the meshes of a 

 sponge. Where the effusion has occurred between the muscles, as in 

 the head, these are found dissected and separated from each other 

 like those of a hog's head by the masses of fat. The surface of the 

 skin is desquamated and frequently denuded of the hair. Frequently 

 there are traces of suppuration and of ulceration. The mucous mem- 

 brane of the nose is found studded with small, hemorrhagic spots, 

 sometimes red, more frequently brown or black, often coalesced with 

 each other in irregular-sized patches and surrounded by a reddish 

 zone, the product of irritation. If edema of the intestines has oc- 

 curred, the membrane is found four or five times its normal thick- 

 ness, reddish in color, with hemorrhages on the free surface Edema 

 of the lungs leaves these organs distended. The secondary alterations 

 vary according to the complications. There are frequently the lesions 

 of asphyxia; externally we find ulcers, abscesses, and gangrenous 

 spots and the deep ulcers resulting from the latter. The lymphatic 

 cords and glands are found with all the lesions of lymphangitis. 

 Again are found the traces of excessive emaciation, or the lesions of 

 .septicemia. Except from the complications the blood is not altered 

 in anasarca. 



Diagnosis. — ^The diagnosis of anasarca must principally be made 

 from farcy or glanders. In anasarca the swelling is nonsensitive, 



