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Wounds of various characters contused, lacerated, and punctured may be produced. There may be burns, vesications, and ecchymoses; arborescent markings are not uncommon. The hair may be singed or burnt and the clothing damaged. Rigor mortis is very rapid in its onset and transient. Post mortem there are no characteristic signs, but the blood may be dark in colour and fluid.
The bladder was enlarged from the thickness and induration of its parietes; the mucous membrane of it was covered with ecchymoses; the kidneys were three or four times their natural size; and the pelvis contained a calculus weighing 126 grains, composed of 58 grains of uric acid and 58 of ammonia, with 10 grains of phosphate of lime.
A careful examination, however, may reveal ecchymoses on other parts of the body which give a clue to the nature of the condition, and may prevent the disastrous consequences that may follow incision. These patients usually succumb sooner or later to hæmorrhage, although they often survive several severe attacks. After middle life the tendency to bleed appears to diminish.
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.
In 14 cases the transmission was direct from the father to the child, and in 11 cases it was direct from the mother to the infant. The hemorrhagic symptoms of bleeders may be divided into external bleedings, either spontaneous or traumatic; interstitial bleedings, petechiae, and ecchymoses; and the joint-affections.
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