Anatomical Changes, Symptoms. 429 



which have died from the disease the vast majority of eases 

 will show the skin as well as the mucous membranes seriously 

 affected. 



In addition to the epithelial nodes of the skin one finds 

 croupous-diphtheritic deposits on the mucosa of the mouth and 

 throat, the nose and accessory cavities, sometimes also in the 

 larynx, trachea and bronchi as well as in the intestinal mucosa. 

 The membranes in the mouth are dark gray or brown, at other 

 points yellowish-gray, usually croupous, sometimes softened 

 and cheesy, while the subjacent mucosa is denuded of epithelium, 

 finely granular and occasionally appears necrotic to a certain 

 depth. In individual eases a croupous-easeous exudate is found 

 in the bronchi and in the cella infraorbitalis in such quantities 

 as to fill the canals and cavities involved completely. 



The intestinal mucosa also shows similar inflammatory 

 changes and small extravasations of blood. Occasionally the 

 epithelium is removed for a considerable extent, and here and 

 there shallow ulcers may form, while, on other areas, especially 

 in the caeca firm dry nodes compose'd of proliferated epithelium 

 and detritus may adhere to the inner surface of the intestine. 



In the more acute cases, in addition to the above changes 

 on the mucous membrane which may be very indefinite, a large 

 splenic tumor may be found, fine yellowish points or spots in 

 the liver, acute edema of the lungs, hemorrhages and occa- 

 sionally fibrinous membranes, on, the serpijs coats, and finally 

 a serous exudate in some joints. . , 



The microscopic examination of the f pithelioiia of the skm shows, according to 

 Polowinkin, the epithelial layers thickened and the epithelial papillae elongated in- 

 ward; in the papillary layer the vessels are dilated and, like those of the subcutis, 

 surrounded by migrating leucocytes ; in addition there are small hemorrhages into the 

 tissue of the papillary layer. Cell-inclusions are found in the swollen epithelium, 

 similar to Guarnieri's pox bodies (Loewenthal, Burnet; s. p. 293). In a general way 

 the characteristic features of the efBorescences are composed of a more or less pro- 

 nounced hyperplasia and proliferation of the cell elements of the skin, which sooner 

 or later succumb to degeneration. This is associated with the extension of the process 

 to the external skin and there follows -a condition which, according to Eeischauer, is 

 similar to' true pox; the difference lies mainly in the fact that in bird pox the more 

 chronic character of the disease causes the nodular and tumor formation to pre- 

 dominate. 



Microscopic exainination of the diseased mucous membrane shows a fibrin- 

 ous network in the siiperficial layers, in the folds of which lie irregularly formed 

 flakes and granular detritus, while in the mucous tissue are seen cellular infiltrations 

 and occasionally necrosis of the tissue elements. The exudate ma,y also show various 

 bacteria and occasionally protozoon-like .dl'ganisms, but their signi^cance has thus far 

 not been ascertained. Eivolta found a 'flagellated, spherical or ovoid protozoon, the 

 Cercomonas galUnarum, in the membranes of the oral mucosa, while Pfeiffer found 

 in membranous inflammation of the trachea ..and the intestines, flagellates in large 

 numbers with three, more rarely with two or four flagellae, which he believed to be 

 Trichomonads, and both observers were inclined to associate their findings etiologically 

 with the pathological conditions. Babes & Puscariu consider the flagellates as harm- 

 less and only accidentally present in the air passages and in the intestinal canal, 

 because they never succeeded in producing a disease of the mucous membranes with 

 them. 



Symptoms. The clinical picture of the disease depends 

 upon whether there is an affection of the skin or the mucous 

 membranes or if both these tissues are involved, and whether 



