Convulsions in purpura are not always the consequence of hemorrhage. A little girl three months old was under my care in the East London Children's Hospital for vomiting and diarrhoea. After these derangements had ceased a purpuric eruption developed on the body, and in a few days the child had an attack of convulsions and died. Here the brain was found to be unusually anaemic, and there were no signs of intra- cranial extravasation. These are, however, exceptional cases. In the child a fatal termination to the illness is rare. Usually after a longer or shorter period the hemorrhages cease, and the patient regains his colour and strength.
The course of the disease is almost always irregular. The successive crops occur at uncertain intervals, and often the disease is thought to be cured when a sudden return of the extravasations shows us that the hem orrhagic tendency is not yet overcome.
Diagnosis.—Memorrhagic purpura cannot be confounded with a ma lignant form of exanthema, for the high fever and profound general suf fering manifested in such dangerous cases are not present in the milder complaint.
In scurvy there is always a history of privation or injudicious feeding ; the special symptoms follow upon a period of ill-health ; general tender ness is a prominent feature ; and there is marked feebleness from the very first. In all these points the affection differs from purpura. Moreover, the treatment of the two diseases is different, and measures which are found to have an immediate influence upon the scorbutic condition are powerless. to check the hemorrhagic tendency in purpura.
In hemophilia, which is characterised by similar symptoms to those of purpura, the disease is a constitutional one and is almost always hered itary ; the family tendency is well recognised, and the hemorrhage is. usually first manifested as a consequence of a cut or injury. Moreover, the disposition to bleed is a chronic and permanent state, and is not a. more or less acute condition which can be made to cease by appropriate remedies.
Prognosis.—In simple uncomplicated purpura the prognosis is always. favourable. In hemorrhagic purpura the disease is more serious ; but if the child be submitted early to treatment the illness rarely has a fatal. issue.
Treatment.—In all cases of purpura the child should be confined to his bed, as rest is of extreme importance in preventing repeated relapses of the disease. The two forms of purpura, viz., that which comes on quite suddenly in healthy children and that which attacks feeble or cachec tic subjects, require a different method of treatment. In the first the old plan of energetic purgation is peculiarly valuable. Often in such cases. a course of iron or other tonic is followed by no benefit whatever, while a. few doses of some drastic aperient cause a prompt and final disappearance: of all hmorrhagic symptoms. This treatment is equally useful whether the complaint be of the simple or hmmorrhagic variety, and may be em ployed without fear even in cases where great anemia has been induced by the loss of blood. If the liver is found to be swollen from congestion,
as sometimes happens, its size is quickly reduced by the purging. It is in these cases, perhaps, that the value of aperients is most strikingly illustra ted ; but all cases of the acute variety of the complaint seem to be bene fited brthis method of treatment. The best form in which the aperient can be prescribed is a combination of the oil of turpentine with castor-oil. For a child six years old, two drachms of each may be given made into an emulsion with mucilage of tragacanth and flavoured with syrup of lemons and peppermint water. This draught should be taken before break fast every morning, or on alternate mornings, according to the effect pro duced. If the is not arrested in the course of a few days, iron and arsenic should be given in addition after each meal. A child of this age will take without inconvenience fifteen drops of the tincture of perchloride of iron and three or four of Fowler's solution, freely diluted, three times a day. Other treatment is also recommended. Werlhof, who first described the disease, relied upon quinine and dilute sulphuric acid. Ergot is pre ferred by some, especially in cases where the haemorrhages are copious ; but this drug should be always given by the mouth and never hypodermi cally by the injection of a solution of ergotin, as obstinate bleeding has been known to result from the puncture of the needle.
Special hemorrhages must be treated by special means : epistaxis by the injection of iced water, or by the use of a spray of perchloride of iron. In using the spray the nasal passages must be first cleared out completely of clot by the injection of water. Afterwards two drachms of the strong perchloride of iron solution diluted with water to two ounces must be sprayed into the nostrils. Hemorrhage from the gums may be usually arrested by an alum gargle or the infusion of rhatany ; intestinal heemor rhage by iced-water injections and the application of an ice-bag to the ab domen. In hmmaturia garlic acid should be given.
When the patient becomes stimulants (port wine or the St. Raphael tannin wine) must be given, and the child should take plenty of nutritious food.
In the cachectic form of purpura aperients are less suitable. In these cases stimulants are required from the first, and the child should take food in small quantities at a time so as not to overtask his feeble digestive powers. Iron wine may be given with arsenic, and cod-liver oil is useful. As a special styptic turpentine in ten-minim doses is of service, taken every three or four hours, or an equal quantity of the liquid extract of ergot may be administered several times in the day.