The serous and muco-purulent discharge becomes rusty or reddish-brown, soon acquires a very fœtid smell, and is found to contain epithelial débris and yellowish-green false membranes. After the least effort to cough or the slightest touch on the membranes themselves—sometimes without any visible cause at all—epistaxis sets in, the blood being mixed with the discharge or simply escaping in the form of reddish strings, like that occasionally seen in glanders.
The mucous membrane of the nasal cavities is red, turgid, apt to bleed, and painful to the touch.
Percussion of the nasal cavities, sinuses, and even of the horns reveals everywhere exceptional sensibility.
Sometimes, but only in certain subjects, the lower portions of the head, including the muzzle, nostrils, lips and forehead, become infiltrated, as though the case were one of purpura. Thoracic complications are rarely absent, unless the disease is treated. Towards the end of the first week the respiration, still painful and snoring, becomes more rapid; and auscultation reveals at various points in the lungs areas of bronchitis and of broncho-pneumonia, indicated by bronchial râles, rattling breathing, and tubal souffles, etc. These complications are accompanied by attacks of coughing, which increase the discharge, and may threaten to end in suffocation. This happens when large masses of false membranes from the bronchi are thrown into the larynx and cannot readily be ejected through the glottis, which has been reduced in size by œdematous infiltration and inflammation.
Percussion is generally useless. The appearance of the eyes is also very significant. These symptoms develop simultaneously with the respiratory disturbance, and are marked by infiltration of the eyelids, œdematous conjunctivitis, and ophthalmia. The cornea becomes whitish, infiltrated, opaque, and sometimes shows ulcerative keratitis; or, on the other hand, it remains simply semi-transparent, and through it the media of the eye may be seen to have become opalescent. Ulcerative keratitis may develop rapidly and end in perforation of the cornea.
In certain rare instances examination with the ophthalmoscope has revealed the existence of exudative iritis; this condition may be complicated with syncchia, intra-ocular hæmorrhage, and result in permanent loss of vision.
These ocular symptoms are accompanied by continuous, abundant and prolonged discharge of tears, intense photophobia, and exceptional sensitiveness to manual examination, etc.
Digestive disturbance appears less important, and may be regarded as consequent on the febrile reaction, the general disturbance, or the condition of the respiratory apparatus. But complete examination will show that from the onset of the disease a special form of stomatitis occurs. From the first the mouth is hot and dry: soon afterwards abundant reflex salivation occurs, and the discharge, like that from the nose, becomes excessively fœtid. This stomatitis differs entirely from ordinary forms of stomatitis and from the stomatitis peculiar to foot-and-mouth disease, and is characterised by the necrosis of fragments of epithelium forming false membranes. These on being shed leave exposed numerous ulcers distributed over the tongue, cheeks, and lips. Neither vesicles nor pustules are produced, but merely false membranes of small dimensions.
The false membranes and ulcerations occur on the soft palate and in the pharynx.
When the patients survive for a certain time, croupal enteritis and ulcerative enteritis, sometimes accompanied by hæmorrhage, develop. The administration of enemata is followed by the passage of fæces containing considerable fragments of epithelium or of streaks of blood. From the outset these digestive complications are indicated by failure to ruminate, by cessation of peristalsis and by constipation, which is usually succeeded by abundant fœtid diarrhœa.