228 Purpura Hemorrhagica. 



such cases there are no petechiae on the nasal mucous mem- 

 brane, but nodules and ulceration, and at the same time there 

 is also a swelling of the submaxillary lymph glands. In addi- 

 tion to this, the rapid development of the swellings on other 

 parts of the body is always accompanied by fever and by symp- 

 toms of a general infection (it must be remembered that pur- 

 pura hemorrhagica may develop in the presence of glanders). 



Prognosis. This is very uncertain in consideration of the 

 varied course of the disease, and therefore should be made with 

 especial care. Although with proper treatment on an average 

 40-50% (according to Javorsky 60-65%) of the affected animals 

 recover, the mortality fluctuates between wide limits. The slow 

 development of the hemorrhages and swellings, and their pres- 

 ence in small numbers, are indications of a favorable course, 

 whereas their rapid increase and extension point toward an 

 unfavorable prognosis. There are cases, however, which show 

 a very severe affection from the onset, and in which after a 

 certain time sudden improvement- is noticeable, the animals 

 finally recovering. This is especially the case when by proper 

 treatment the development of threatening complications is pre- 

 vented. A recovery may be expected as long as the patients 

 are without fever or have only a slight fever, and take nour- 

 ishment at least in moderate quantities. High fever renders the 

 situation usually grave, as it points to septic infection or to 

 inflammation of internal organs. Other unfavorable indications 

 are pronounced cyanosis or yellow discoloration of the mucous 

 membranes, the presence of albumen, or blood in large quan- 

 tities in the urine, continuous lying down, frequent and weak 

 heart action, further the excessively rapid disappearance of the 

 swelling. The latter apparently favorable symptom indicates, 

 in most instances a rapid breaking down of the tissues, or that 

 great quantities of blood or blood plasma have, under the influ- 

 ence of the high fever, transuded into the internal organs. The 

 development of after affections should also be taken into con- 

 sideration in forming a prognosis, as they are of a decided 

 influence in determining whether treatment extending over a 

 long period of time is justified, in view of the inability of the 

 animals to work and the expense of such prolonged treatment. 



At the clinic at Budapest between 1887-1908, out of 296 affected horses 

 167 (56.4%) recovered; the numbers of maximum and minimum recoveries in these 

 years was 20 and 95%. In the Prussian army in the years of 1895-1903, 149 horses 

 became affected, of whicTi 110 (79%) recovered (the maximum and minimum recov- 

 eries in these years were 56.2 and 85%). 



Treatment. Symptomatic treatment has a great influence 

 on the further development of symptoms and on the termina- 

 tion of the disease, especially as it is not infrequently possible 

 to avert the danger of asphyxiation, and to prevent the appear- 

 ance of complications. 



Above all it is necessary to assure suitable feeding of the 



