Symptoms. 203 



conjunctivitis, to which are added photophobia, pain and swell- 

 ing of the eyelids. The conjunctiva is bright red, has a moist 

 luster, and at times is raised above the cornea. The lachrymal 

 secretion is increased from the onset, but later the tears 

 are mixed with a mucous and purulent secretion, which, 

 to some extent accumulates in the inner canthus, sticking the 

 eyelids together, especially at night. Ulcerative keratitis 

 develops_ with relative frequency in association with the con- 

 junctivitis, small depressions appearing in different parts of 

 the cornea, which may later heal entirely. Sometimes, however, 

 these lesions extend rapidly in size, so much so that even on 

 the first day loss of substance may result which reaches the 

 extent of a lentil, and penetrates to Descemet's membrane, or 

 in some instances the entire cornea may be destroyed. The 

 borders of the depressions, as well as the entire cornea may at 

 the same time be clear, or pus may be present only at the base 

 of the depressions. Descemet's membrane thus exposed is 

 then forced out as a result of the internal pressure from the 

 eye, and in this manner a staphyloma may develop, the rupture 

 of which may result in the prolapse of the iris, followed by 

 the well-known severe results. In other cases a parenchymatous 

 keratitis develops, associated with a uniform cloudiness and a 

 marked ciliary injection of the cornea, which retains its char- 

 acter until the termination of the disease, is not followed by 

 ulceration, and gradually disappears or results in a permanent 

 white cloudiness. The pupil usually becomes constricted, Avhile 

 severe iritis with accumulation of a plastic or a purulent 

 exudate in the anterior chambex' occurs only rarely except in 

 cases in which there is a perforation of the cornea. 



The involvement of the digestive organs is shown early 

 by diminished appetite. At the onset of the disease an increased 

 thirst, as well as vomiting is observed, which is an indication 

 of acute gastritis. The patients vomit mostly slimy, yellowish 

 material mixed with bile. At the same time the buccal mucous 

 membrane is dry and warm, the tongue is coated, and the region 

 of the stomach sensitive. As a result of the intestinal catarrh 

 which IS usually present together with the gastritis^ there is 

 at first constipation; which' soon changes to diarrhea. The 

 excrements which are often passed under severe straining are 

 in a fluid state and may contain mucous flakes or blood. The 

 feces are very fetid. The abdomen is at first somewhat bloated, 

 later however it becomes drawn up and painful. 



In some cases the urine contains albumen, and occasionally 

 bile pigments as well as hyaline and cellular casts. 



Nervous symptoms are hardly ever absent even in the 

 cases which are not very severe, and sometimes they may reach 

 such a degree that they practically control the entire disease. 

 Besides the dullness and the changein the disposition of the 

 animals already mentioned, the patients sometimes manifest 

 considerable excitement which, however, usually lasts only a 



