PURPURA HEMORRHAGICA— PETECHIAL FEVER 353 



walls of the bloodvessels, especially the capillaries, become 

 porous or rupture, allowing the blood to escape into the sur- 

 rounding tissue. Thus smaller petechise or more extensive 

 ecchymoses are produced. From the larger veins the transu- 

 dation of serum leads to the characteristic swellings. 



Symptoms. — ^Petechise in the mucous membranes of the 

 head. The hemorrhagic spots vary in size from a hemp seed 

 to a bean. Sometimes on the nasal mucosa (septum and 

 turbinates) the areas assume the form of stripes or striations, 

 the membrane being swollen. The petechise have a purple 

 color. Sometimes ulceration is noted. There is nasal dis- 

 charge of a yellowish or reddish serum or fluid blood. In 

 the eyelid conjunctivitis is present with petechise and slight 

 sanguineous discharge. The mucous membrane of the 

 mouth, though more rarely, may also be involved. 



Swellings of the skin usually appear with the petechise or 

 follow in a day or two. These are often at first isolated, flat- 

 tened, urticaria-like tumefactions from the size of a pigeon's 

 egg to that of a grape fruit, and larger by confluence. They 

 are firm or edematous on palpation. More common, how- 

 ever, are diffuse swellings of the lower portion of the head, 

 ventral part of the thorax and abdomen, udder, prepuce, or 

 scrotum and limbs. In the regions of the nostrils and lips 

 they commonly begin and rapidly extend upward toward the 

 eyes. The swellings are firm, and, especially at the flexion 

 of joints, the overlying skin cracks open and a yellow, viscid, 

 serous fluid exudes, which later dries, leaving a brown scab. 

 The swellings terminate abruptly ("tied off") in the head 

 a short distance below the eyes and in the limbs at the 

 elbow and stifle. 



As long as the lumen of the nasal cavities and larynx is not 

 encroached upon by swelling the respirations are not 

 increased. From swelling, especially of the false nostrils and 

 turbinates, dyspnea develops . If a hemorrhagic or inflamma- 

 tory infiltration of the larynx appear, pronounced inspiratory 

 and expiratory dyspnea with stertorous laryngeal sound 

 follows. (See Glottis Edema). 



The leg swellings are painful, and mechanically interfere 

 with locomotion and getting up and down. Usually the 

 23 



Digitized by Microsoft® 



