Petechial Fever. 177 



very generally throughout the tissues, but show especially in the 

 skin, subcutis, mucosa and submucosa of the nose, eyes, pharynx, 

 guttural pouches, larynx, trachea, bronchia, mouth, stomach, 

 intestine, bladder, vagina and womb ; also in and on the lungs, 

 pleura, pericardium, heart, liver, spleen, kidneys, peritoneum, 

 pancreas, ovaries, bones, lymph glands, brain and nerves. The 

 largest extravasations are liable to be in the softest tissues, and in 

 the lungs they may reach the size of the closed fist, though 

 usually they vary from a mere spot up to this. The spleen is 

 sometimes engorged even to rupture. Beside the extravasations, 

 and associated with them in position, and probably largely as an 

 effect of them, there is more or less serous effusion infiltrating 

 the tissues, congestions, suppurations, degenerations, and necrotic 

 changes. 



The skin, if white, and the dark skins on section, are seen to 

 be marked by petechise. The cutaneous .swellings may appear on 

 any part, commencing with nodular thickenings varying in size 

 from a pea to a walnut, and merging together into extensive 

 elevated areas terminating abruptly at their margins in the smooth 

 skin. The larger and more persistent engorgements settle on 

 the lower aspect of the body and other dependent parts like the 

 limbs and face. Cracks, oozing, deep fissures, and extensive 

 sloughs are not uncommon. When the skin is incised it shows 

 serous infiltration and thickening, with spots and ^patches of 

 blood extravasation. The subcutaneous connective tissue is 

 similarly infiltrated and discolored, and often in the limbs, face, 

 and under the breast, sternum and abdomen so as to form a 

 tremulous gelatinoid cushion of several inches in thickness. The 

 capillaries may be distended to more than 20 times their normal 

 calibre. The exudate may extend deeply between the muscles, 

 and sloughs may lay these freely open and invade their substance. 

 The muscular tissue is mottled with petechise, and apart from 

 these it is pale, yellow, or grayish, having to some extent under- 

 gone granular or fatty degeneration. Detachment of the per- 

 forans and perforatus from their insertions is occasionally met 



with. 



The nasal mucosa may show only petechise and circumscribed 

 blood staining, but in fatal cases it is more likely to present 

 extensive blood extravasations involving it may be the whole 

 12 



