Antipyrine and Nitrate of Silver internally have been extolled as possessing powerful action over the internal haemorrhages in this and other forms of purpura.
Whatever difference of opinion may exist about the value of these empiric agents, there should be none as regards the worthlessness of such drugs as tannin, ergot, alum, lead salts, and all other vegetable and mineral astringents.
Some striking results have been reported from the employment of large doses of Polyvalent Antistreptococcic Serum administered by the rectum in hremorrhagic and other forms of purpura; 30 c.c. may be injected, and repeated daily in half this close.
The loss of blood will require in some cases large doses of Normal Saline by the skin, bowel or veins, and it should he kept in mind that this treatment dilutes the toxin in the blood and therefore does good even when the amount of haemorrhage has been small.
Iron and Arsenic are always clearly indicated in the after-treatment, and some experienced observers consider that Chlorate of Potash added to the tincture of the perchloride of iron possesses almost a specific action. The following routine may be administered in all cases of purpura of mdd type: Tr. Ferri Perchlor. Div. Potassii ChWails 5j.
...1qua' Chloral. ad Fiat mistu•a. Cpt. 5ss. ter die e.v aqua post ciro.
Blood Transfusion is clearly indicated, hut with the litemorrhagic tendency there are obvious difficulties in carrying it out. In desperate cases the procedure successfully inaugurated by Emsheimer may be resorted to. He injected deeply into the gluteal region 20 c.c. of fresh whole human blood with highly satisfactory results. Tissue Extract, prepared by Hess from fresh liver or placenta, promises to he of value in increasing the coagulability of the blood when injected into the veins. Coagulene, a substance prepared from mammalian blood platelets, has been injected intravenously by Fonio; 20 C.C. of a 5 per cent. solution may be administered.
Purpura Rhematica (Schonlein's Disease, Peliosis Rheumatica).----The very close relationship of this type of purpura with acute articular rheumatism would at once lead one to expect that Salicylates should prove valuable, but though clearly indicated for the primary disease they exercise little if any action upon the state of the blood and the extent of the extravasations.
Whilst the anti-rheumatic treatment is being pursued and the patient is kept at absolute rest in bed little else as a rule need he done, since, like simple purpura, this type of the condition tends naturally to resolve itself.
Should, however, the extravasations become formidable or bleeding occur from the mucous or serous surfaces, Calcium Chloride should be freely given. This drug has a very decided influence on the group of rheumatic cases which has been styled Purpura Urticans, and in which extensive wheals or urticarious and ervthematous skin lesions complicate the cutaneous eruption, as in the next variety to be mentioned. The rational treatment of rheumatic purpura would be a vaccine obtained from the tonsil, blood or arthritic lesions; the Antistreptococcic Rheumatism Vaccine, as prepared at the Wimpole Institute, might be employed in an initial dose of io,000,000 organisms, or Polyvalent Antistreptococcic serum given by the rectum.
Henoch'sPurpura, in addition to the symmetrical petechie and arthritic manifestation, is always associated with marked gastro-intestinal symptoms and erythematous or urticarious eruptions. As the pathology of this type is allied to that of the rheumatic variety of purpura, Salicylates are clearly indicated in the presence of joint pain and swelling.
The presence of intense intestinal irritation points to the probable source of the toxin being in the bowel, and hence most authorities lay stress upon the importance of intestinal antiseptics like Calomel and Turpentine Oil, but unfortunately, owing to the frequent complication of grave nephritis, such treatment cannot be pushed without serious danger. Saline purga tives and flushing of the colon with Normal Saline solution and the free administration of Calcium Chloride and Gelatin by the mouth are not open to objection. In all serious cases Saline solution should be given in large amounts by the hypodermic or intravenous methods, and the presence of nephritis and of angio-neurotic oedema is no contra-indication to free saline treatment.
Urxmic symptoms must be met by the hot pack and other agents indicated in the treatment of acute Bright's disease. Polyvalent Anti streptococcic Serum may be given by the rectum.
The long duration covered by the frequent recurrences of the attacks supplies a rich field for the treatment of various symptoms; the condition of the heart must be closely watched, and Strychnine administered hypodermically as soon as signs of cardiac failure show themselves.