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Chronic Blood Ailments

purpura, skin, hemorrhage, disease, conditions, purple and condition

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CHRONIC BLOOD AILMENTS - § 1. Purpura and Scurvy.—These two diseases have this feature in common, that they are forms of subcutaneous hemorrhage, oc curring spontaneously without pain or injury, and having no assignable cause other than a peculiar condition of the blood. Their phenomena are essentially objective; the existence of the disease being proved by the presence of dark•colored persistent spots or patches of varying size, having the appearance of purple stains or livid bruises of the skin.

These states are not identical with what has been already denominated the hemorrhagic diathesis. Spontaneous hemorrhages are liable to occur in both conditions ; the external characters differ in this respect, that in the one Wood is effused under the skin without assignable cause, and with no apparent alteration of texture, while in the other it is only poured out where there is some breach of surface, and is then stanched with extreme difficulty; fatal hemorrhage has in such circumstances followed the extraction of a tooth. It is probable that the spontaneoos internal hemorrhages in each case follow the same rule, and that there is really some abrasion of the mucous membrane, or rupture of a small vessel, in the one and not in the other.

They differ from each other (a) in scurvy being very frequently accompanied by sponginess of the gums, which is never the case with purpura, but this indication is not always present; (b) in the characters of the spots themselves. In purpura they are gene rally small and of a very dark color; the skin seems to be stained through with a purple dye; when larger patches exist, they seem to be composed of innumerable smaller ones run together, some of which are found quite distinct in the immediate neighborhood, or in other parts of the body; the spots are soft and flaccid. In scurvy the patches are generally large, and always more or less hard; their color is more livid than purple, resembling bruises rather than stains of the skin.

Purpura is not unfrequently associated with Inematuria, or in testinal hemorrhage; it is then usually called purpura hEemor rhagica. It is liable to occur in any circumstances which dete riorate the quality of the blood, and is therefore found in disease of the kidney, liver, spleen, &c. It is also met with occasionally in conditions of blood-poisoning, such as pyannia and severe smallpox ; it forms the true petechile in typhus fever. When it

arises spontaneously, there must have been some antecedent cause for the altered condition of the blood, though this cannot always be traced. Scurvy, on the other band, is especially associated with deficiency of some element ordinarily derived from the vegetable kingdom, and generally believed to be an acid, because of the prophylactic as well as curative powers of lemon-juice ; it was much more common than usual at the first outbreak of the potato disease, when the poor were deprived of their ordinary vegetable.

§ 2. Ana'mia.—In the classification of symptoms which afford indications regarding the general state of the patient, reference was made to those derived from the aspect and color of the face. None of these is more striking, or perhaps more valuable, than that presented by anemia—loss of that natural complexion which is produced in health by the fine network of capillaries spread over the skin, especially of the cheeks, and also over the mucous membrane bounding the lips and the nose—by inference defici ency of blood, but more particularly of the red coloring matter. This condition depends, therefore, either on absolute want of blood, or on disproportion between its various elements.

Its causes are very various: they may often be detected in the history of the case. The exact duration of the disease can seldom be ascertained, except when loss of blood has been occasioned by hemorrhage, because its commencement is generally insidious. Patients cannot associate their pallor with those conditions out of which it has arisen ; but more commonly, in describing the com mencement of their illness, refer to those secondary states which have first made them conscious of loss of health, such as palpita tion or dyspncea, headache, dyspepsia, general weakness, and, among females, diminution or suppression of the menstrual dis charge. The history ought, if possible, to go beyond these, to the antecedent state out of which the whole category of symptoms has sprung, and to take note of the order in which the circum stances of which the patient is cognizant have successively ap peared.

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