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Updated: June 3, 2025
The bacilli multiply everywhere, but seem for some reason to focalize chiefly in the alimentary canal, and especially the middle part of it, the small intestines. This produces inflammation, followed by ulceration, which in severe cases may eat through the wall of a blood-vessel, causing profuse hemorrhages, or even perforate the bowel wall and set up a fatal peritonitis.
Acute dermatitis varying in degree from a slight erythema to deep ulceration or even necrosis of skin. When ulcers form they are extremely painful and slow to heal. When hair-bearing areas are affected, epilation may occur without destroying the hair follicles and the hairs are reproduced, but if the reaction is excessive permanent alopecia may result.
Dempster reports an instance of the lodgment of numerous live maggots within the cavity of the nose, causing sloughing of the palate and other complications. Nicholson mentions a case of ulceration and abscess of the nostrils and face from which maggots were discharged.
This mild affection of the system happens when the disease makes but a slight local impression on those who have been accidentally infected by cows; and, as far as I have seen, it has uniformly happened among those who have been inoculated, when a pustule only and no great degree of inflammation or any ulceration has taken place from the inoculation.
But the danger is and when proper treatment is not adopted early the danger is very great lest the mischief should extend beyond the surface of the eye, lest ulceration of the eye should take place, the ulceration reach so deep as to perforate it, and not merely interfere with the sight, but destroy the organ of vision altogether.
Wakefield, aged 36, had an extensive ulceration with excoriation on the upper part of the right breast, of two months continuance; it had been greatly aggravated by improper treatment. I applied the lunar caustic over the whole ulcerated and excoriated surface. It gave much pain. On the following day I was concerned to find that part of the eschar had been separated by the patient's dress.
The glands of the bowels are enlarged, actual ulceration of the stomach is often met with; while so far-reaching is the influence of this slow starvation, that even the substance of the kidneys and of the brain are often found softened and otherwise altered, though it might not unreasonably have been supposed that these organs lay quite beyond the reach of any disorder of digestion.
So intense is the inflammation, that parts of the valves may be literally eaten away by ulceration, and when these ulcers heal with formation of scar-tissue as everywhere else in the body, the flaps of the valves may be either tied together or pulled out of shape, so that they can no longer properly close the openings of the heart-pump.
This was further illustrated by the important fact, that hospital gangrene, or a disease resembling this form of gangrene, attacked the intestinal canal of patients laboring under ulceration of the bowels, although there were no local manifestations of gangrene upon the surface of the body.
If the attack has been severe, the child will be left greatly exhausted, sadly emaciated, and suffering from the effects of that ulceration of the bowels which accompanies the fever, and from which life may still be in imminent danger. But the fire is quenched; the question is no longer how to put out the conflagration, but how to repair the mischief it has caused.
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