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blood, disease, purpura, condition, heart, tendency and extravasation

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PIIIIPURA is a diseased condition in which extravasations of blood take place into the skin and the substance of the viscera, and blood may be poured out from many mucous surfaces and into the serous cavities. When the extravasation takes place into the skin it is called purpura simplex ; when the is more general the disease goes by the name of purpura hcemorrhagica. Many acute forms of illness, febrile and other, are accom panied by the ready escape of blood from the vessels. In the malignant forms of scarlatina, measles, small-pox, typhus fever, and diphtheria purpuric spots and are seldom absent ; and the same symptom is found in scurvy, and is occasionally met with in cases of Bright's disease, cirrhosis of the liver, leucocythemia, and valvular lesions of the heart. Strictly speaking, however, the term purpura is applied to a temporary hmmorrhagic tendency unconnected with any of the acute specific diseases, and in which no morbid condition of organs, other than that due to the extravasation and its consequences, can be discovered.

Causation.—Purpura is "common in children, and appears iu many cases to be a consequence of insanitary conditions and insufficient food. Still, that the disease may arise from other causes is shown by the well-nour ished state and robust appearance of many of the subjects of this disorder. The lremorrhag,ic tendency is sometimes seen to come on quite suddenly without apparent cause in one member of a healthy family, the others who appear to be living in precisely the same conditions escaping alto gether. Thus, a robust little boy, aged six years, one of eight healthy children and born of healthy parents without any history of hmmorrhagic tendency, had himself been strong and well all his life with the exception of attacks of measles and whooping-cough during his second year. The boy suddenly began to bleed from the eyes, the nose, and the mouth, and soon developed all the symptoms of severe limmorrhagic purpura. In cases such as this the occurrence of the disease can never be traced to error in diet or insufficiency of vegetable food or milk. Sometimes pur pura may come on as a sequel of an exhausting disease, such as scarlatina and typhoid fever, and I have known it to occur after a severe attack of croupous pneumonia. It is said, too, to be occasionally induced by the

administration of iodide of potassium in weakly subjects, especially in those labouring under valvular disease of the heart. In many cases, how ever, no antecedent condition of any kind can be discovered capable of explaining the sudden propensity to bleed.

Morbid Anatomy.—In the skin the haemorrhage occurs in the rete mu cosum and the papillary layer of the cutis, and also into the subcutaneous tissue. The submucous tissue is also often the seat of extravasation, and sometimes much blood- is poured out from the surface of the mucous membrane. In this way, after death purple spots and extravasatious of various sizes may be discovered beneath the mucous membrane of the mouth, gullet, stomach, and intestine both small and large. So also the serous surfaces and subserous tissues may suffer in the same way, and more or less copious extravasation may be found in the serous cavities—the pleura, the peritoneum, and the pericardium. The substance of organs is not unfrequently the seat of hemorrhage, and clots may form in the lungs, the heart, the kidneys, etc. Fatal apoplexy may also result from this cause.

Pure purpura does not lead to disease of internal organs. If the anemia be extreme, fatty degeneration of the muscular fibres of the heart and a similar condition of other viscera may be found ; but this is a conse quence of the impoverished state of the blood induced by repeated haemor and is only a secondary consequence of the hemorrhagic tendency. Amyloid and other degenerations found in the liver and elsewhere must be looked upon as a result with the purpura of a common cause. When bleeding is profuse and repeated the blood undergoes the changes inci dent to an advanced stage of anemia, the amount of hemoglobin is less ened, and the red corpuscles are diminished in number as well as reduced in size. Unless the blood be impoverished by hemorrhages, no morbid change in the fluid can be detected.

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