Abscesses may also be found in the liver, pancreas, spleen, of variable size and usually as secondary formations.
The muscles and intermuscular tissue may be the seat of more or less extensive exudation, and abscess, and the bones may be congested and swollen especially in their epiphysis. This may extend to suppuration or necrosis.
The synovial membranes of joints and the tendinous sheaths are not infrequently inflamed causing distension and even suppuration.
Congestions of the skin are sometimes met with developing as multiple papules or hard nodules which advance to the formation of pustules or small abscesses. These often appear especially where the skin is thin and delicate as around the lips, nose and eyes, close to the anus or vulva, in the perineum, sheath or mammæ, inside the thighs or elbow. They may be of all dimensions from a millet seed upward, and may merge into or become complicated by the extensive engorgements of petechial fever.
Finally lesions of the nerve centres are to be looked for in the protracted or irregular types of the disease. There may be simple congestion, or serous effusion, intraventricular or subarachnoid, or finally abscess in the brain, spinal cord or meninges.
Forms of Strangles. The types of strangles vary, special forms characterizing given epizoötics or seasons, or at other times as individual deviations from the current type. Division has been made into two groups—mild and malignant, or again into regular and irregular, under each of which come several varieties. Many of these varieties consist simply in a difference in the seat of the principle lesions, which start in lymph glands or tissues at a distance from the nasal mucosa, or they depend on secondary foci of infection supervening on the primary disease in the head.
Incubation. In inoculated cases this lasts from three to five days, in those due to simple exposure it may appear to extend over eight days.
General Symptoms. In nearly all cases alike there is a marked constitutional disturbance the temperature often rising at once to 104° to 106° F., and oscillating on successive days between this and 102°; the pulse is usually normal at first and the breathing is either slightly accelerated or may be made so under slight exertion. There is more or less dulness, or at least a lack of the vivacity of youth, the head is somewhat pendent, the eyes may be semiclosed, the patient may be tardy or even stiff in his movements and the appetite may be diminished or capricious, oats being rejected by some and hay or grass by others. The bowels are somewhat confined, the stools consisting of a few small, hard, balls covered with mucus.
Specific Symptoms in the Mild Form. In the vast majority of cases the local symptoms are concentrated on the mucosæ of nose and mouth, and the submaxillary lymph glands. Along with the general febrile phenomena, there appear redness and often mottled congestion of the nasal mucosa, which not infrequently extends to the mouth and eyes, as well. Heat of the mouth, the collection of a more or less tenacious mucus, and even uneasy movements of the jaw may be seen. The nasal mucosa, at first dry, is soon the seat of a watery exudation, passing into a cloudy sticky material, and finally a thick, opaque, muco-purulent flow. This may become colored of a variety of tints, dirty white from inhaled dust, brownish or yellowish from exuded blood, or greenish from food materials. The discharge is usually profuse in the young and may be scanty in the old. Most commonly it flows from both nostrils alike, though exceptionally it is unilateral. In this it differs from glanders which is more often unilateral though at times bilateral. Small abrasions and sores may appear in connection with the softening and shedding of the epithelium, but these are not ragged, irregular and spreading as in glanders. Sneezing or snorting is an inevitable symptom. Epiphora is usually present. Exudations into the nasal sinuses are to be recognized by heat of the forehead and flat sound on percussion.
Very early in the attack a swelling is noticed in the intermaxillary space, which may be at first confined to the nodules of the lymph glands, thus forming distinct, rounded, hard swellings, but they are early covered by a diffuse exudation into the surrounding connective tissue, that completely envelopes and obscures the form of the swollen glands, and forms a more or less uniformly rounded, pasty swelling, extending to the median line of the intermaxillary space, or filling the whole space from one maxilla to the other and projecting downward below their level. This early, diffuse, pasty, evenly rounded swelling, hot and tender, is distinctive of strangles, and usually exclusive of glanders.