108 CLINICAL DIAGNOSTICS. 



become confluent, the redness is diffuse or appears in irregular 

 streaks. Petechiae are most commonly seen in purpura 

 hemorrhagica, but may also occur in severe anemia 

 (rare) and in leucemia. The spots, which are at first dark 

 red, soon fade and assume a brownish hue. Such suffusions 

 are also observed in septicemic diseases: anthrax, septicemia. 



b. Swelling of the nasal mucous mem- 

 brane is characterized by the normal surface of the mucous 

 membrane, which is granular from the many glands it con- 

 tains, becoming firm and smooth. As the membrane is 

 usually tense, the swelling is not marked. Its origin is in- 

 flammation, therefore the surface appears turbid. 



Chronic, connective tissue thickenings 

 are most commonly made manifest by irregular, wart-like 

 prominences which show the characteristics of scars. 



c. Wounds in the mucous membrane are usu- 

 ally at the lowest part of the septum, and are very often 

 caused by finger-nails, sharp straws and the like. 



d. Nodules from the size of a millet seed to that of a 

 peppercorn almost exclusively attend glan- 

 ders. Exceptionally they result from contagious stomatitis, 

 but in such cases like nodules are to be found in the mucous 

 membrane of the mouth. To prevent mistaking particles of 

 mucus for true nodules, the supposed nodule should be pal- 

 pated with the finger ; if mucus particles, we can thus wipe 

 them off. 



e. Ulcers, N ex tto nodules, ulcers form 

 the most important c r i t e r i u m in diag- 

 nosing glanders. Glanders ulcers have jagged bor- 

 ders circumscribed by rounded, elevated walls. The base of 

 the ulcer is sunken, uneven, grey in color, and of lardaceous 

 appearance. The favorite seat of the glanders ulcer is on the 

 medial border of the inner cartilaginous wing of the nostril, 

 hence 'this place should always be examined. 



In rare cases ulceration of the nasal mucous membrane 



