22 



leucocytes and a diminution in the eosinophils. Sometimes there is a 

 slight increase in the large mononuclears. There is usually a notice- 

 able increase in the number of the blood platelets. The coagulability 

 of the blood does not undergo any material change." With the onset 

 of convalescence there is a fall in the number of the red corpuscles 

 and in the percentage of hemoglobin. 



Hemorrhages. — A tendency to hemorrhage is one of the marked 

 characteristics of the disease. As a rule, this does not manifest itself 

 before the third day. The most common and, in a very large propor- 

 tion of the cases, the only manifestation of this tendency is bleeding 

 from the gums. The gums become more or less swollen and the blood 

 may ooze from them spontaneously or, more commonly, only after 

 some traumatism, such as a slight pressure of the examining finger. 

 Epistaxis is almost as frequent a symptom as bleeding from the gums; 

 it may occur at the onset, but more commonly, like bleeding from the 

 mouth, does not appear until the fourth or fifth day. In women, 

 menorrhagia or metrorrhagia are common manifestations. During 

 pregnancy death of the fetus and miscarriage are of common, though 

 not invariable, occurrence. 



Hemorrhage from the stomach, appearing as black vomit, occurs in 

 the graver cases only. It varies considerably in amount; in the lighter 

 grades it may be barely perceptible, as dark streaks or specks in the 

 vomited matter, but in the severer forms it may be so profuse that 

 the vomitus is uniformly dark red or black, like coffee grounds. Blood 

 originating in a hemorrhage from the nose or mouth which has been 

 swallowed may give to vomited matter precisely the same character 

 as blood which has its origin in the stomach. Black vomit, therefore, 

 does not necessarily mean gastric hemorrhage. Melsena may result 

 from passing altered blood which had its origin in the stomach, or it 

 may be due to hemorrhage from the intestine. The quantities of black 

 vomit ejected and melaena discharged per rectum are at times surpris- 

 ingly large. 



Digestive tract. — In some of the severer forms the lips become dry 

 and cracked and bleeding. In almost all cases the gums become more 

 or less swollen, and at first covered with a white epithelial coating 

 which rapidly wears off, leaving them red and spongy and disposed to 

 bleed on slight pressure. The tongue at first is commonly moist, with 

 a gray coating over the center and dorsum and with red tip and edges. 

 As the disease progresses, in severe cases, the tongue becomes dry, 

 red, fissured, and more or less streaked with blood. The appetite is 

 lost from the first, but returns rapidly with convalescence. Thirst is 

 frequently marked. Nausea and vomiting are commonly, but not 

 invariably, present. In general, they appear with or soon after the 

 onset, and, as a rule, become more or less accentuated with the prog- 



a Marks, 1906. 



