298 ACUTE GENERAL INFECTIOUS DISEASES 



a persistent nervous champing of the jaws. The tongue is 

 swollen and cyanotic. High fever is noted, in some cases the 

 temperature, especially after a nervous paroxysm, reaching/ 

 108° F. and over. Some authorities, however, have found 

 the temperature normal or even subnormal. 



Exanthematous Form. — This form is less frequent in Amer- 

 ican outbreaks. Inflammatory edema of the head, neck, 

 throat, and dewlap appear. The swellings may extend to the 

 body and limbs. They are pronouncedly hot and painful. 

 Conjunctivitis with profuse lacrimosis may be present. The 

 tongue is edematously swollen, filling the whole mouth cavity, 

 and is cyanotic. Drooling is noted. The patient is dyspneic, 

 the mucous membranes dark colored and show petechia?. 

 Death results from asphyxia or severe enteritis. Intestinal 

 symptoms are commonly noted in this form. 



Pectoral Form. — The symptoms of this form are those of an 

 acute or subacute bronchopneumonia with pleuritis. The 

 patients stand with arched back, have a painful cough and 

 nasal discharge. Dulness is noted on percussion. Bronchial 

 sounds, rales, and rhonchi are heard on auscultation. The 

 patient is dyspneic, appetite is lpst, and rumination suspended. 

 The constipation is later followed by diarrhea, inanition, and 

 death. 



Differential Diagnosis. — Hemorrhagic septicemia might be 

 confused with anthrax, Rinderpest and the subacute or 

 chronic pectoral form with contagious pleuropneumonia of 

 cattle. It might also resemble black-leg. The absence of 

 splenic enlargement, the normal appearance of the blood, and 

 the absence of the anthrax bacillus differentiate it from 

 anthrax. Rinderpest does not occur in the United States, 

 but is found in the Philippines. Outbreaks of Rinderpest can 

 usually be traced to an imported source (diseased cattle), 

 and in this disease, unlike hemorrhagic septicemia, a marked 

 ulcerous inflammation of the mucous membrane of the eye- 

 lids, respiratory and digestive tract is present. Contagious 

 pleuropneumonia no longer exists in this country. Micro- 

 scopically the lesions of the pectoral form of hemorrhagic 

 septicemia and this disease may be almost identical. In such 

 cases only the use of bacteriological methods can decide 



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