PURPURA HEMORRHAGICA— PETECHIAL FEVER 325 



(b) Foreign body pneumonia: This is apt to follow severe 

 pharyngitis, with dysphagia, or more rarely may be due to 

 the aspiration of necrotic pieces of mucous membrane from 

 the nasal cavities and throat. Pulmonary gangrene usually 

 follows, leading to death in two or three weeks. 



(c) Septicemia usually attended by a sudden disappearance 

 of the symptoms, profuse diarrhea, recumbent position, and 

 decubitus. Pulse is elevated, temperature high. 



(d) Gastro-enteritis : Some cases begin with symptoms of 

 colic which yield to proper treatment, the purpura following 

 taking a benign course. If, however, large extravasations 

 occur in the stomach, small or large intestines, severe gastro- 

 enteritis is noted. Necrosis of the extravasated areas in the 

 bowel may take place and perforative peritonitis result. The 

 patient presents violent colic symptoms and dies in twenty- 

 four to thirty-six hours. 



Diagnosis. — Purpura hemorrhagica is characterized by the 

 typical " tied-off " swellings and petechiae in the visible mucous 

 membranes. The diagnosis is easy if the case is at all typical. 

 When ulcers occur in the nasal mucous membrane it might be 

 mistaken for acute glanders. The crater-like margin and 

 lardaceous base of the ulcers, the nodules, star-shaped cica- 

 trices, enlargement of the submaxillary lymph glands, and 

 the absence of petechise in glanders suffice to distinguish be- 

 tween the diseases. Glanders and purpura may both appear 

 in the same patient. With malignant edema the disease would 

 rarely be confused (see this). Urticaria could only be mis- 

 taken for purpura in the early stages of the disease. Anthrax 

 is a rare disease in horses in the northern United States. In 

 the South it usually assumes the cutaneous form, the swellings 

 having very little resemblance to purpura. (See Anthrax.) 



Course. — Very varied. Mild cases sometimes recover in less 

 than one week. Some are attacked with violent sepsis and die 

 in two or three days after the first symptoms are observed. 

 As a rule a case of this disease lasts two to six weeks, with 

 many exacerbations and remissions. Recovery is sometimes 

 rapid and unexpected. Some patients give the attending 

 veterinarian great encouragement until some unexpected 

 complication (septicemia, pneumonia) occurs which leads to 



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