Petechial Fever. 179 



104° to 106° F., or even higher. The general symptoms are 

 usually those of the pre-existing disease (strangles, contagious 

 pneumonia, influenza, nasal catarrh, pharyngitis, bronchitis, 

 etc.) pursuing, it may be, a persistent course, or attended by 

 special toxsemic symptoms of prostration and other signs of 

 depression of vital functions. In some cases the hyperthermia is 

 either absent at this stage or overlooked. On the prostration 

 supervene the petechiae on the visible mucosse, and often also the 

 swellings of the skin and subcutis. One of these may be seen 

 before the other and it is difficult to decide whether the petechise 

 always appear first as has been claimed. Cadeac claims that when 

 oedema is first seen it has been preceded by petechise in that 

 tissue (skin). 



The petechia are usually first noticed on the nasal mucosa as 

 fine red points, pin's heads, or up to half an inch in diameter, 

 or a number of these have coalesced to form extensive patches, 

 and by and by to cover the entire wall. At first the mucosa is 

 spotted with purple, without any marked elevation of the surface, 

 but as the lesions extend it becomes swollen and raised at the 

 points of extravasation and immediately around them and oozes a 

 serous, sometimes a pinkish or yellow fluid. Even in the 

 smallest petechise the color is persistent and does not disappear on 

 pressure like the blush of the adjacent mucosa. 



Usually cutaneous swellings coincide with the petechise, or 

 appear within two days thereafter. The first manifestation is in 

 the form of rounded abruptly elevated nodules, about ij^ inch to 

 3 inches in diameter, strongly resembling the eruption of urticaria. 

 These show a certain predilection, for the more dependent parts 

 of the body.^limbs, abdomen, sheath, mammse, sternal or 

 pectoral region, nose, lips, face, etc.,— ^but they may develop on 

 any part or on the whole surface. Neither tenderness nor heat is 

 usually excessive. The swellings tend to run together so as to 

 form extended elevations enveloping the entire limb up to a given 

 point, forming a great pad under the chest and abdomen, or dis- 

 tending the whole face or head so that it seems more like that of 

 a hippopotamus than of a horse. In such cases the lips and 

 nostrils become so thick and rigid that prehension is impossible, 

 and breathing if it can be accomplished at all is accompanied with 

 a marked snuffling. The swollen eyelids are closed, and the 



