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The earliest signs are a garlicky taste in the mouth and pain in the throat and stomach. Vomited matter luminous in the dark, bile-stained or bloody, with garlic-like odour. Great prostration, diarrhoea, with bloody stools. Harsh, dry, yellow skin, purpuric spots with ecchymoses under the skin and mucous membranes, retention or suppression of urine, delirium, convulsions, coma, and death.
Ninety-seven of these patients had hemorrhages somewhere, most frequently epistaxes, sometimes hemoptysis. Janeway did not find that purpuric spots on the skin occurred early in the disease in any of his patients. Gastro-intestinal disturbances were not much in evidence unless the kidneys were insufficient. Intermittent claudication in the legs occasionally occurred.
On extraction, it is at first decidedly yellow; then after a little time it becomes green; and, finally, it settles into some shade of violet or purple. Chemical analysis has shown that in the case of the Murex trunculus the liquid is composed of two elementary substances, one being cyanic acid, which is of a blue or azure colour, and the other being purpuric oxide, which is a bright red.
Vepan mentions a lady who took 1 1/2 grains and afterward 2 1/2 grains of quinin for neuralgia, and two days afterward her body was covered with purpuric spots, which disappeared in the course of nine days but reappeared after the administration of the drug was resumed.
The tongue is dry and coated, the lips and teeth are covered with sordes, the motions are loose and offensive, and may be passed involuntarily. The temperature is remittent and irregular, the pulse small and rapid, and the urine may contain blood and albumen. Sometimes the skin shows erythematous and purpuric rashes, and the patient may cry out as in meningitis.
Any great drain on the system, whether from diabetes without nephritis, or from profuse diarrhea of any type, will cause hypotension. Occasionally a girl with chlorosis who is not menstruating may have an increased blood pressure. Many of the hemorrhagic or purpuric conditions will show a hypotension. Meningitis in various forms may show a hypertension from cerebral and nervous irritation.
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