PURPURA.
As regards treatment. the best view to accept at the present time is that in the confused group of ailments labelled " purpura" many causal factors are probably at work of which the purpuric symptoms and signs are the chief manifestation, and since these factors are in most instances unknowable, treatment resolves itself into an attempt to alter or improve the blood condition and relieve the varied symptoms as they arise.
Septic foci, as in gonorrhcea, tonsillitis, caries of teeth, rheumatic infection, etc., should be looked for and dealt with. In the large group recognised by Osler as possibly anaphylactic„ in persons sensitised for certain proteins, further research may demonstrate valuable preventive measures.
Simple Purpura (Purpura Simplex) occurs mainly in children, and usually without any arthritic manifestations; its natural tendency is towards resolution after a few weeks in bed. Rest in the horizontal position is an essential in the treatment of every variety of purpura, and its importance is demonstrated by the speedy return of the petechice in most cases on resuming the vertical position before the complete disap pearance of the hemorrhagic; spots.
The diet in simple purpura, as in all the other forms, must be of the most digestible and nourishing kind, and every article liable to favour gastric and intestinal fermentation or decomposition must be avoided. llence milk should largely enter into it, and in many cases an exclusive milk diet meets all requirements, supplying a large percentage of lime salts. Buttermilk, by supplying the lactic-acid-forming organisms, is especially indicated. Constipation must be guarded against by the occasional use of saline purgatives.
Drugs in simple purpura are seldom dearly indicated; the best routine will be Is to 20 gr. doses of Calcium Chloride or Lactate; where these have been employed, the tendency is to award them the.credit of a curative action, but, as already remarked. the natural tendency of the condition is towards resolution, and it is noteworthy that the symptoms are not likely to recur after the patient has been kept for a few weeks in the horizontal position even when drugs have been withheld.
Purpura licemorrhagica (Werlhofs Purpura, Land Scurvy or Morbus Maculosus), as its name implies, is characterised by a marked tendency towards from the mucous and serous surfaces and into the planes of areolar tissue. Though the septic nature of this condition is
highly probable, it affords no help in treatment, since we cannot do more than guess at the origin or site of the sepsis, and though an attempt might be made to hasten the elimination of the toxin by stimulating the bowel, kidney or skin, the danger of powerful cathartics and diuretics is obvious where a tendency already exists towards intestinal and renal haemorrhage.
The only available treatment in such cases is to increase the coagula bility of the blood as rapidly as possible by the administration of such drugs as Calcium Salts in full doses. It has, however, been maintained by several authoritic that this is useless, since the small vessels are always diseased m purpuric conditions. This should not deter the physician from attempting to save life by stopping the haemorrhage by such means as he knows have often saved life—by lime salts when the bleeding has been due to the rupture of an internal vessel.
Gelatin sterilised and dissolved in water or saline solution (40 grs. in 5 oz.) may be injected into the deep tissue of the buttock; ro oz. of a to per cent. solution may be injected into the rectum, or gelatin in the form of a flavoured jelly may be freely given by the mouth, and is un doubtedly advantageous in bleeding from the gastrointestinal tract.
Adrenalin Chloride solution has been indiscriminately employed in this condition. Whilst the liquid may he advantageously applied to a bleeding spot, as on the gums, mouth or interior of the nose, or swallowed when the haemorrhage is proceeding from the stomach, its internal administration can only do harm in severe haemorrhage in other regions by raising the blood-pressure and increasing the tendency towards escape from the vessels. When these drugs fail, others may still be resorted to upon purely empiric grounds. Turpentine has been largely employed; it may be given in io-min. capsules every 3 or 4 hours, and sometimes appears to exert a marked htemostatic action.