220 Purpura Hemorrhagica. 



ably enlarged due to hemorrliages in its tissue and under its 

 capsule, and sometimes a rupture of the spleen and a fatal 

 internal hemorrhage may be observed. Far less often are 

 instances of fatal bleeding into the retroperitoneal or into the 

 perirenal connective tissue, into the digestive tract, or into the 

 air passages; finally hemorrhages may also be found in some 

 cases in the inside of the eyes, in the bone marrow, in the 

 heart muscles, and under the pericardium. 



The immediate cause of death usually is septicemia, pyemia 

 or gangrenous pneumonia, less frequently asphyxiation may 

 be observed. Autopsy may reveal the mode of origin of the 

 disease by disclosing the presence of older organic changes. 



Symptoms. The disease usually commences with the 

 appearance of small punctiform or linear hemorrhages in the 

 nasal mucous membrane. In some, instances the animals do not 

 manifest any indications of disturbed health, while in other 

 cases the appetite becomes somewhat diminished in the earlier 

 stages, and the patient manifests slight dullness and depression. 



Later the hemorrhages in the mucous membranes become 

 more numerous, and those lying close together confluate, so that 

 extensive blood extravasations result. At the same time there is 

 a yellowish mucous discharge from the nasal mucous membrane 

 which dries on the surface first to yellow, later to dirty brown 

 crusts. In severe cases the mucous membrane covering the 

 hemorrhages becomes necrotic, and ulcerations develop. In this 

 condition the discharge which at first is scanty becomes more 

 profuse, discolored, mixed with shreds of necrotic tissue, and 

 not infrequently also with blood The discharge emits a fetid 

 odor. In the meantime swelling of the eyelids is frequently 

 observed and if they are forcibly spread apart a reddish fluid 

 or even pure blood flows out of the slit ; in such cases the bulbar 

 as well as the tarsal conjunctiva, shows shallow hemorrhages 

 (exceptionally necrosis of the conjunctiva and hemorrhages into 

 the inside of the eyes [Roell] may be observed, also atrophy 

 of the optic nerve [Schindelka]). 



In all of the 148 cases observed by Javorsky hemorrhages were present on 

 the nasal mucous membrane On the other hand they were found in only 58 cases 

 in the mouth and m only 38 cases on thj conjunctiva. 



'Immediately after the appearance of the hemorrhages in 

 the nasal mucous membrane, swelling of the skin and the subcu- 

 taneous connective tissue make their appearance. In some 

 cases numerous urticaria-like vesicles develop over the entire 

 body, which disappear after a certain time, or confluate form- 

 ing dollar-sized flat roundish swellings (Figure 39; Kleinpaul 

 observed simultaneous shedding of the hair). In most instances, 

 however, diffuse swelling developed, especially on the extremi- 

 ties, on the chest and abdomen, especially on the sheath and 

 udder, and sometimes on the front part of the. head (Figure 



