Purpura

“ It must be confessed that we do not possess a knowledge of any definite chain of morbid processes constituting a distinct disease that may be designated as purpura. And yet we are able to recognize a set of symptoms varying greatly in intensity, from the most trivial petechial eruption to profuse and fatal hemorrhages, accompanied by a train of manifestations which we are unable to connect with any of the causes already spoken of, and which, indeed, depend upon no fixed exciting cause with which we are acquainted. ”

“ Rheumatic purpura; this usually occurs in men from twenty to forty years old. There is usually pain and swelling of several joints, temperature 101 to 103 degrees, purpuric eruption chiefly on the legs and about the affected joints, often with hives and digestive disturbances: (c) Henoch's purpura; usually in children and is sometimes fatal. There are recurrent joint pains and swelling, disturbances of the stomach and bowels, skin troubles resembling it, and hemorrhage from mucous membrane. ”

“ In severe cases of purpura the eruption may be very abundant, and with the cutaneous lesions hemorrhage from various mucous surfaces may occur. The gums are usually swollen and bleed easily. Epistaxis is frequent and blood is often noted in the stools and urine. ”

“ The purpuric effusion appears to act as an irritant upon the tissues, and to excite inflammation. Gangrene of the mucous coat of the intestines has resulted from extensive hemorrhagic extravasations, and from a similar cause cutaneous gangrene has been known. These complications, however, are rare.
ETIOLOGY.—The immediate causes of purpura are quite unknown. Both sexes and persons of every age are affected by it. While it is most often seen in debilitated subjects, those in vigorous health possess no immunity. ”

“ Henoch's purpura, observed chiefly in children, resembles the above, with the erythema multiforme character and the œdematous swellings more pronounced, while the actual purpuric symptoms are less conspicuous. Gastric and intestinal symptoms and hemorrhages from the mucous membrane are commonly noted. It is fatal in about 20 per cent. ”

“ In the living these injuries are accompanied with swelling, pain, and more or less discoloration of the part affected. Among malingerers it is not an uncommon practice to bruise the body to imitate the spots of purpura and scurvy. In scurvy, the condition of the gums common to that disease, and the state of the general health, will point to the true nature of the spots. The diagnosis of purpura will be assisted by noting the diffusion of the spots over the body. In old people purpuric spots frequently extend round the limbs, chiefly on one of the lower extremities. ”

“ Purpura haemorrhagica (acute hemorrhagic purpura) is a more serious form, in which, in addition to the phenomena already mentioned as affecting the skin, there is a tendency to the occurrence of hemorrhage from mucous surfaces, especially from the nose, but also from the mouth, lungs, stomach, bowels, kidneys, &c., sometimes in large and dangerous amount. Great physical prostration is apt to attend this form of the disease, and a fatal result sometimes follows the successive hemorrhages, or is suddenly precipitated by the occurrence of an extravasation of blood into the brain. ”

“ Describe the symptoms of purpura hæmorrhagica.
Purpura hæmorrhagica (also called land scurvy) is characterized usually by premonitory, and frequently accompanying, symptoms of general distress, and by the appearance of coin to palm-sized, red or purplish hemorrhagic spots or patches, smooth, non-elevated or raised. Hemorrhage from the mouth, gums and other parts, slight or serious in character, may occur. New lesions continue to appear for several days or weeks; and in exceptional instances, repeated relapses take place, and the disease thus persists for months. It may end fatally. ”

“ This affection usually runs a brief course, although a repeated onset of fever and rheumatic pains, followed by cutaneous hemorrhages, may protract it for months. It commonly attacks those who have a rheumatic tendency but are otherwise apparently well.
There is little difficulty in the diagnosis of purpura, as the color of the lesions is characteristic and their hemorrhagic nature can be readily demonstrated by the pressure of the finger. It is well to remember, however, that cutaneous hemorrhage is not infrequently an accompaniment of the eruption in severe cases of the common exanthemata. ”

“ In the group of diseases known as purpura, where haemorrhages of varying size make their appearance on different parts of the skin, the lesion is considered to be due to a toxin or autotoxin acting directly on the vascular walls. In some cases we know it to be inorganic, such as phosphorus or mercury, in others organic as smallpox, measles, typhus or tuberculosis ”

“ Those who have labored for a long time in the damp galleries contract a chronic inflammation of the gums, together with muscular pains in the limbs, and have often intestinal troubles and spots of purpura. ”

“ It is high also among those who in the beginning of the disease have exhausted their strength in the vain effort to resist the disposition to go to bed. The chances of recovery are, on the other hand, very much improved by the removal of patients from crowded, ill-ventilated houses to the wards of a spacious, airy hospital.
Unfavorable symptoms are a profuse dark-colored eruption associated with purpura spots and vibices, general lividity of the surface, great injection of the pupils, and a dusky hue of the countenance; extreme prostration ”

“ Bleeding is forbidden, or should be used cautiously in that malignant state of fever, in which a weak morbid action, or what Dr. Darwin calls a tendency to inirritability, takes place in the blood-vessels. [346] It is known by a weak and frequent pulse, such as occurs in the typhus fever, and in the plague in warm climates. I have often met with it in the malignant sore throat, and occasionally in the pleurisy and yellow fever. The remedies here should be gentle vomits or purges, and afterwards cordials. Should the pulse be too much excited by them, bleeding may be used to reduce it. ”

“ When a Purging came on in the Course of this Disorder, if there was much Fever, with a strong throbbing Pulse, Gripes and Pain of the Bowels, some Blood was taken away; and immediately after the Patient took a Dose of Salts and Manna, or of Rhubarb; and an Opiate in the Evening after its Operation: But if there was little or no Fever, or sharp Pain, Bleeding was omitted; and if the Patient complained of Sickness, a few Grains of Ipecacuana were given previous to the Purge. ”

“ The upper part of the body is covered with frequent spots and tumours, the redness gradually changes to black, the skin is thickened, and covered with hard asperities like scales; the body wastes, but the face, legs, and feet swell; and when the disease is protracted, the fingers and toes become buried in the swelling, and a slight fever comes on, which finishes the patient’s sufferings. Such is his description of the disease. His treatment consists in bleeding at the commencement, abstinence, then supporting the strength, purging, exercise, sudorifics, and friction. ”

“ The matter in pustules and ulcers is thus liable to become putrid, and to produce microscopic animalcula; the urine, if too long retained, may also gain a putrescent smell, as well as the alvine feces; but some writers have gone so far as to believe, that the blood itself in these fevers has smelt putrid, when drawn from the arm of the patient: but this seems not well founded; since a single particle of putrid matter taken into the blood can produce fever, how can we conceive that the whole mass could continue a minute in a putrid state without destroying life? ”

“ MEDICINE.——Almost every person knows, when a fever is attended with a violent pain of the side, and a quick hard pulse, that bleeding is necessary. When these symptoms come on, the sooner this operation is performed the better; and the quantity at first must be pretty large, provided the patient is able to bear it. A large quantity of 166blood let at once, in the beginning of a pleurisy, has a much better effect than repeated small bleedings. A man may lose twelve or fourteen ounces of blood as soon as it is certainly known that he is seized with a pleurisy. ”

“ LYDIA E. PINKHAM'S Blood Purifier Is far superior to any other known Remedy for the Cure of all Diseases arising from Impurities of the Blood, such as Scrofula, Cancerous Humor, Erysipelas, Rheumatism, Canker, Salt Rheum and Skin Diseases. IMPURE BLOOD CAN BE MADE RICH AND PURE.
There is no condition of the human system so uncertain or so deceptive as the condition of the blood. Other disease makes itself known by aches or appearance, but the blood courses on with no sign of vitiation, carrying its poison to every nerve and fibre of the body. ”

“ Every internal inflammation soon affects the whole system, accompanied with considerable fever, and that fever and degree of it is easily ascertained by the heat of the breath, and the mouth, and the base of the horn, by the redness of the eye, hardness of the pulse and the loss of appetite. When Inflammation seizes any important organ, as the brain, lungs, bowels, kidneys, udder, &c., bleeding is to be immediately had recourse to, after bleeding, a purging drink is to [6] be administered, sometimes it is necessary to insert a seton in the dew lap. ”

“ At all events, so poorly are these pus-germs able to preserve their vigor and power of attack, not merely outside of the human body, but outside of some wound or sore spot, that it is practically certain that eight-tenths of all cases of wound-infection or blood-poisoning come directly from some previous festering wound, sore, ulcer, scab, boil, or pimple, in or on some other human being or animal. Practically whenever we get pus in a wound in a hospital, we insist upon finding the precise previous case of pus from which that originated, and seldom is our search unsuccessful. ”

“ In the plague there is everything which is dreadful, and nothing of this kind is wanting as in other diseases. For there are delirium, vomitings of bile, distension of the hypochondrium, pains, much sweatings, cold of the extremities, bilious diarrhœas, which are thin and flatulent; the urine watery, thin, bilious, black, having bad sediments, and the substances floating on it most unfavorable; trickling of blood from the nose, heat in the chest, tongue parched, thirst, restlessness, insomnolency, strong convulsions, and many other things which are unfavorable. ”

“ If secretion and excretion are not normally performed, the blood becomes poisoned by the absorption of unhealthy "matter" from the sore, and various constitutional disturbances occur. If, at any time during treatment, constitutional disturbances are manifested by fullness or disagreeable sensations in the head, nausea, pain, cough, chills, or fever, a thorough cathartic should be given. If the patient be robust, a repetition of the same once a week will be very beneficial. Dr. Pierce's Golden Medical Discovery, and "Pellets" will be productive of the best results. ”

“ The complication of inflammatory and putrid symptoms often puzzles the practitioner, who hesitates in doubt, whether he should bleed or not; nay more, whether he should adopt an antiphlogistic course of remedies, or give the bark.
The equivocal appearances of the vomiting and purging, whether they be symptomatical or critical, is another cause of perplexity in the physician; for what are the salutary efforts of nature, and what the ragings of a destructive disorder, he is unable to determine; and this disease is too acute to allow him time to hesitate long. ”

“ It occurs commonly in nearly all acute diseases of the lungs, especially in bronchitis and inflammation of the voice-box. These are the common causes. In all the amount of blood spat up is very small—usually merely streaks. In consumption and some forms of heart disease blood-spitting is common and is often very profuse. Other causes of profuse bleeding are the rupture of an aneurism and some diseases of the vessels of the lungs. Or the blood may come from the stomach. This is a formidable list, but we have no doubt whatever which of these caused your blood-spitting. ”

“ VII. All ordinary fever being seated in the blood-vessels, it follows, of course, that all those local affections we call pleurisy, angina, phrenitis, internal dropsy of the brain, pulmonary consumption, and inflammation of the liver, stomach, bowels, and limbs, are symptoms only of an original and primary disease in the sanguiferous system. ”

“ Blood-poisoning, as surely; with aches, pains, feverish spells, with influenza (popularly called “a cold”) , which, as can not be too much emphasized, is, strictly speaking, instead of a disease, the effort of Nature to “cure” a disease which otherwise would become so deep-seated as to demand a “run of fever” to eliminate it, and all manner of physical ailments.
I am often asked, What constitutes the scrofulous diathesis, so called, or the scrofulous “taint” supposed to be the inheritance of so many of the children of our times? ”

“ This is inflammation of the Pleura of one or both lungs, generally confined to one side. It is known by sharp pain in the side of the chest, increased by taking a long breath, or coughing, or by pressing between the ribs. The cough is dry and painful, the patient makes an effort to suppress it, from the pain it gives him; the fever is of a high grade, the pulse full, hard and frequent, with more or less pain in the head. ”