PURPURA HEMORRHAGICA—PETECHIAL FEVER 355 



enteritis is noted. Necrosis of the extravasated areas in the 

 bowel may take place and perforative peritonitis result. The 

 patient presents violent colic symptoms and dies in twenty- 

 four to thirty-six hours. 



Diagnosis. — ^Purpiu-a hemorrhagica is characterized by the 

 typical "tied-off" swellings and petechise in the visible mucous 

 membranes. The diagnosis is easy if the case is at all typical. 

 When ulcers occur in the nasal mucous membrane it might be 

 mistaken for acute glanders. The crater-like margin and 

 lardaceous base of the ulcers, the nodules, star-shaped cica- 

 trices, enlargement of the submaxillary lymph glands, and 

 the absence of petechise in glanders suffice to distinguish 

 between the diseases. Glanders and purpura may both 

 appear in the same patient. With malignant edema the dis- 

 ease would rarely be confused (see this). Urticaria could 

 only be mistaken for purpura in the early stages of the 

 disease. Anthrax is a rare disease in horses in the northern 

 United States. In the South it usually assimies the cuta- 

 neous form, the swellings have very little resemblance to pur- 

 pura. (See Anthrax.) 



Course. — ^Very varied. Mild cases sometimes recover in 

 less than one week. Some are attacked with violent sepsis 

 and die in two or three days after the first symptoms are 

 observed. As a rule, a case of this disease lasts two to six 

 weeks, with many exacerbations and remissions. Recovery 

 is sometimes rapid and unexpected. Some patientsj give 

 the attending veterinarian great encouragement until some 

 unexpected complication (septicemia, pneumonia) occurs 

 which leads to death. Defects in the skin due to gangrene 

 may take months to heal. 



Prognosis. — ^The prognosis is generally doubtful. When 

 the swellings on the head are extensive, life is always threat- 

 ened. A high pulse (80), diarrhea, no appetite, constant 

 recumbency, with attending decubitus and severe colic, are 

 bad symptoms. The disappearance of the swellings is not a 

 good sign unless the other symptoms also improve. Blood 

 extravasations may form at any time in any organ (bowels, 

 brain, and spinal cord), precipitating sudden death. The 

 mortality varies from 30 to 50 per cent, and is largely 



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