226 Purpura Hemorrhagica, 



Rapid and labored respiration, especially in cases when the 

 upper air passages are not markedly constricted, in associa- 

 tion Avith a rise in temperature, are indicative of pneumonia, 

 and renders a careful examination of the thoracic organs 

 necessary. 



A severe and not infrequently ulcerative inflammation of 

 the stomach and intestinal mucous membrane also develops with 

 relative frequency, and causes a putrid diarrhea, which greatly 

 weakens the animal. 



In the cases with unfavorable termination the clinical 

 symptoms are almost invariably terminated by manifestations 

 of pyemia or septicemia. They usually develop either from the 

 above cited causes, or from the sores which develop on the body 

 of the animals when they persistently lie down. 



According to Payrou petechial fever as it is observed as a sequel to distemper, 

 may ^g^- manifested either as a toxemic (lymphatic) form, brought on by the 

 absorption of toxins into the blood, or in a septicemic form caused by a strepto- 

 coccus infection of the blood. The former develops in the second week after the 

 beginning of strangles, when, in the presence of a moderate fever, the extremities 

 slowly swell from below upwards, and the nasal mucous membrane manifests only 

 small peteehiae. The course is frequently mild. The second form develops with 

 high fever, and extensive peteehiae, running a peracute course, causing swellings 

 everywhere, especially on the head and on the conjunctivae, which have a great 

 tendency to necrosis. In these cases the disease usually terminates fatally in from 

 8 to 10 days. As a result of the great frequency of intermediate forms the sepa- 

 ration of these two types might often be very difficult, and it is doubtful whether 

 such a classification is justified. 



Course. The course of purpura hemorrhagica varies from 

 case to case. From the very mild forms which manifest only 

 peteehiae of the nasal mucous membrane, and a slight simulta- 

 neous swelling of the skin and the symptoms of which may dis- 

 appear inside of two or three days, to the cases of extreme 

 distortion of the body and resulting in death from asphyxiation 

 or sepsis, all the possible degrees may be observed. " In the 

 successive development of the symptoms the affection of the 

 nasal mucous membrane usually appears first, and it is hardly 

 ever absent. This is followed in one or two days by a swelling 

 of the skin, and only later by the affection of the pharynx, 

 whereas the involvement of the intestinal canal is usually ob- 

 served only in advanced stages of the disease. However, there 

 are rare cases where the sequence of symptoms differs ; thus the 

 edema of the-skin may precede the development of peteehiae in 

 the nose, or severe colicky symptoms may develop in the begin- 

 ning of the disease. 



The evolution and course of the disease depends especially 

 on the localization and the more or less rapid development of 

 the hemorrhages and oT the edematous swellings. Apparently 

 severe cases, in which however the changes are exclusively con- 

 fined to the nasal mucous membrane, the skin and the subcu- 

 taneous connective tissue may terminate in complete recovery 

 even when the skin becomes necrotic over a considerable area; 

 on the other hand affections of the internal organs, as well as 

 hemorrhages and inflammations, exert an unfavorable influence 



