Purpura Hemorrhagica.

This term refers simply to the existence of purple spots in the
skin, resulting from the escape of blood. It is always easy to dis­
tinguish between a spot due simply to inflammation and one due
to the escape of blood into the meshes of the skin. In the former
case (as in the rash of scarlatina or measles) there is no rupture of
bloodvessels ; hence, if we press the finger upon one of these spots
for an instant, and then remove it, the spot has disappeared and
the skin is momentarily white. When, on the other hand, the red­
ness of the spot is due to the presence of blood in the meshes of
the skin as a result of the rupture of blood vessels, such pressure
of the finger does not cause the disappearance of the color ; these
latter spots are characteristic of the disease in question.

Such spots may, it is true, occur in the course of several dis­
eases, such as typhus and typhoid fevers, and cerebro-spinal menin­
gitis ; and, as just remarked, they are present usually in large
numbers in scurvy. Yet there is recognized in medicine a condi­
tion characterized by many of the appearances of scurvy, among
them these extensive ruptures of blood vessels in the skin, whence
the disease has received the name purpura hemorrhagica. The
disease is distinguished from scurvy by the fact that there is less
swelling of the gums, which may, indeed, remain entirely unaf­
fected. There is rarely so much swelling and stiffness of the
muscles, and the disease does not seem definitely traceable to the
lack of vegetable food. Furthermore, the treatment which is so
effectual in relieving scurvy (the use of fresh food and vegetables),
is by no means so certain to effect relief in purpura as in scurvy.
Purpura seems to occur in consequence of reckless violation of the
laws of health, or of privation and suffering. The danger from it,
like that from scurvy, consists in the general exhaustion conse­
quent upon this condition, and also in the possibility that such
large amounts of blood may be lost during the hemorrhages from
mouth, nose, throat, and intestines, as to seriously endanger the
patient’s recovery.

The object of the treatment is the restoration of the natural
condition of the blood, increase in the vital powers generally, and
the arrest of hemorrhage. To accomplish these ends medicines
are of little avail without the use of food in proper quantity and
quality, and the avoidance of any unnecessary demands upon the
patient’s health or strength. The treatment, therefore, should
consist of generous diet, re-enforced by wine ; while vegetables
should, of course, constitute a part of the diet, they are not so
essential to success as is the case in the treatment of scurvy.
It sometimes becomes necessary to administer remedies which
shall check the escape of blood. For this purpose half a teaspoon-
ful of the tincture of ergot may be given every four hours until six
doses have been taken. Some have recommended the oil of
turpentine, a tablespoonful of which has been given in half a glassful
of milk. The skin may be sponged with whisky and water or with
a solution of alum (one ounce), in brandy (six ounces).

Tonic remedies are useful ; two grains of quinine should be
taken three times a day, either in powder or in the following pre­
scription :
Quinine, ------- One drachm.
Dilute sulphuric acid, -                         Four drachms.
Water, ------- To make four ounces,
Take a teaspoonful in water before meals.

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