Purpura.

Synonyms.—Hemorrhea Petechialis; Hemorrhagic Diathesis.

Definition.—A condition characterized by extravasation of blood into the skin and mucous membrane, and sometimes attended by free hemorrhage from mucous surfaces. It may accompany a variety of causes, appearing in many diseases.

The purpuric spots vary greatly as to size. Where small, like a pinpoint, they are termed petechia, while the larger spots are called ecchymoses. Although at first the spots are bright red, they grow dark or dingy with age.

Varieties.—The disease is divided into symptomatic or secondary purpura, and idiopathic purpura.

Symptomatic Purpura.—This may be due to certain diseases, and may be classed as follows:

Infectious, such as small-pox, measles, typhoid fever, septicemia, pyemia, scarlet fever, cerebral-spinal meningitis, ulceration, endocarditis, and diphtheria.

Cachectic, where it follows malignant growths, tuberculosis, Bright's disease, and the debility of old age, ecchymotic spots frequently being seen on the back of the hands of elderly people.

Toxic.—Purpura not infrequently follows the ingestion of certain drugs, as the iodids, quinine, copaiba, belladonna, rhus tox., mercury, ergot, phosphorus, chloral, potassium chlorate, and the salicylates. It may occur from the bite of venomous snakes.

Neurotic.—Lesions of the spinal cord are not infrequently attended by purpura; thus acute and transverse myelitis, locomotor ataxia, and hysteria may be cited as examples.

Mechanical.—Purpura. may attend the severe paroxysms of cough in pertussis or asthma, or it may follow severe convulsions.

Idiopathic Purpura.—Purpura Simplex.—This is the mildest form of purpura, and most frequently met with in children. The cause has not been determined. The hemorrhages usually occur on the extremities, and more rarely on the trunk and arms. They appear in the form of petechial spots in the hair-follicles, or in long streaks, vibices, or as large ecchymotic spots. There is generally impairment of the appetite and more or less gastro-intestinal disturbance.

Pupura Rheumatica.—Arthritic Purpura; Peliosis Rheumatica; Schönlin's disease. The etiology of this form is unknown, though many regard it as rheumatism occurring between the second and third decade. It occurs more frequently in males than females. It not infrequently is preceded by sore throat, attended by painful swelling of the joints, especially of the lower extremities; accompanying these symptoms, purpuric spots, frequently associated with urticarial wheals and more or less edema, develop.

There is a loss of appetite and slight fever. Epistaxis may occur, though hemorrhages from mucous surfaces are exceptional. The disease seldom proves fatal.

Henoch's Purpura.—This is a form of arthritic purpura occurring in children, and characterized by painful swollen joints, purpura eruptions, hemorrhages from the mucous surfaces, and gastro-intestinal disturbances. The disease rarely terminates fatally.

Purpura Hemorrhagica.—Morbus Maculosis Werlhofii.—This form of purpura is most frequently found among young females whose health is impaired, and is the most severe type of the purpuras. The cause has not been determined, though, from its frequent association with infectious diseases, it is regarded as due to an infection.

Symptoms.—The invasion is generally abrupt, though it may be preceded for a day or two by prodromal symptoms, such as headache, general malaise, loss of appetite, and depression. Beginning with slight fever, purpuric spots quickly appear, the extravasation often occurring quite extensively. At the same time hemorrhages may occur in the internal organs, and bleeding from the nose, stomach, kidney, and lungs, soon gives rise to great prostration and profound anemia.

Diagnosis.—The diagnosis is made by the sudden onset, the rapid appearance of the purpuric spots, the severe hemorrhage from the mucous membranes, and the profound anemia.

Prognosis.—This is the most severe form of purpura, and is always more or less grave; the prognosis should be guarded. Death may occur from the great loss of blood or from hemorrhage into the brain.

Treatment.—In selecting treatment for purpura, -each case demands a special study and when possible, the cause should be determined and remedies used for its removal. In all cases the system is below par, there being more or less impoverishment of the blood. A study of such remedies as berberis aquifolium, stillingia, rumex, corydalis, chimaphila, and kalmia will prove profitable.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.