ANASARCA, OR PURPURA HEMORRHAGICA. 511 



septicemia. Except from the complications the blood is not altered 

 in anasarca. 



Diagnosis. — The diagnosis of anasarca must principally be made 

 from farcy or glanders. In anasarca the swelling is nonsensitive, 

 while sensitive in the acute swelling of farcy. The nodes of farcy 

 are distinct and hard and never circumscribed, as in the other disease. 

 The eruption of glanders on the mucous membranes is nodular, hard, 

 and i^elletlike. The redness disappears on pressure. In case of 

 excessive swelling of the head in anasarca, there may occur an ex- 

 tensive serofibrinous exudation from the mucous membranes of the 

 nose, poured out as a semifluid mass or as a cast of the nasal fossa?, 

 never having the appearance or tyi^ical oilj^ character which it has 

 in glanders. The inflammation of the lymphatic cords and glands 

 in anasarca does not produce the hard, indurated character which is 

 found in farcy. 



Prognosis.— SVhilQ anasarca is not an excessively fatal disease, the 

 l^rognosis must always be guarded. The majority of cases run a 

 simple course and terminate favorably at the end of eight or ten 

 days, or possibly, after one to two relapses, requiring several weeks 

 for complete recovery. Efi^usion into the head renders the prognosis 

 much more grave from the possible danger of mechanical asphyxia. 

 Threatened mechanical asphyxia is especially dangerous on account 

 of the risk of blood poisoning after an operation of tracheotomy. 

 Edema of the viscera is a most serious complication. The prognosis 

 is based on the comj)lications, their extent, and their individual grav- 

 ity, existing, as they do here, in an already debilitated subject. 



Treatment. — The treatment of anasarca may be as variable as are 

 the lesions. The indications are at once shown by the alterations 

 and mechanism of the disease, which we have just studied. 



Hygiene comes into play as the most important factor. Oats, oat 

 and hay tea, milk, eggs — anything which the stomach or rectum can 

 be coaxed to take care of — must be employed to give the nutriment, 

 which is the only tiling that will permanently strengthen the tissues, 

 and they must be strengthened in order to keep the capillaries at their 

 l^roper caliber. 



Laxatives, diaphoretics, and diuretics must be used to stimulate 

 the emunctories, so that the}'' shall carry off the large amount of the 

 l)roducts of decomposition Avhich result from the stagnated effusions 

 of anasarca. Of these the sulphate of soda in small repeated doses, 

 and the nitrate of potash and bicarbonate of soda in small quantity, 

 and the chlorate of potash in single large doses will be found useful. 

 Williams cites the chlorate of potash as an antiputrid. Stimulants 

 and astringents are directly indicated. Spirits of turpentine serves 

 the double purpose of a cardiac stimulant and a powerful, warm diu- 



