Hæmorrhage from the Kidneys. Vol. I. pp. 785, 600. Vol. II. p. 70. GENUS III.-PURPURA. This name is applied to an efflorescence consisting of small, distinct, purple specks and patches, attended by general debility, but with little appearance of fever. The efflorescence depends upon an extravasation of blood from the fine vessels under the cuticle. The only form of it that deserves our attention is: 1. PURPURA HÆMORRHAGICA. Diagnosis. The disease is characterized by the appearance on the skin of petechia, or purple spots of large size interspersed with vibices and ecchymoses, resembling the marks made by the stroke of a whip, or by violent bruises. They appear first on the legs, afterwards on the thighs, arms and trunk of the body; the hands are seldom marked with them and the face remains free. On their first appearance the spots are of a bright red color, but they soon become purple or livid; and when about to disappear they change to a brown or yellowish hue; the cuticle over them appears smooth and shining, but is not sensibly elevated, except in a few rare cases in which it has been seen raised into a sort of vesicle containing black blood, especially on the tongue, gums, palate, and inside of the cheek. The gentlest pressure on the skin, as that of feeling the pulse, will often leave a purple blotch like that left after a severe bruise. Purpura hæmorrhagica occurs in persons who have a constitutional tendency to hæmorrhages, from all the surfaces covered by the delicate epithelium as well as from the skin; they are therefore subject to large losses of blood which are often rapidly fatal. Sometimes the hæmorrhage occurs every day at a stated hour; at other times there is a slow, but almost incessant oozing of blood from the gums, nostrils, throat, inside of the cheeks, tongue or lips; sometimes from the lining membrane of the eyelids, the urethra or external ear; also from the internal cavities of the lungs, stomach, bowels, uterus, kidneys and bladder. Symptoms.-The appearance of the disease is preceded by great lassitude, faintness, pains in the limbs, though in some cases the patient had been in previous good health. The feelings most complained of are extreme debility and depression of spirits; the pulse is feeble and frequent; and there are heat, flushing of the surface, perspiration and other accompaniments of fever. When the disease has con tinued for some time the patient becomes sallow and emaciated; the lower extremities show oedematous swelling which afterwards extends to other parts of the body. The duration of the disease is in some cases limited to a few days, in others it has continued for months, and even years. It occurs at all periods of life, but is more common among women, and in boys before the age of puberty. CAUSES.-Depressing influences which operate by depressing the vital powers; sedentary occupations; residence in close crowded situations; consequences of acute exanthematous diseases, as small-pox, measles, or puerpural confinement; the ancients attributed the hæmorrhages which attend purpura hæmorrhagica to morbid enlargement of the spleen. In children it is often originated by insufficient or improper food; in nursing women its causes are similar to those which in other persons produce stomatitis materna. (See Vol. I., p. 740.) TREATMENT.-When it occurs in women and others too much confined within-doors or imperfectly nourished by food, the treatment will be commenced by improving the diet and prescribing change of air, exercise, travelling, at least by being carried abroad. When there has been no restriction of diet, no close confinement, and no debilitating disease has preceded, a different course may be suggested which in its details will be regulated by the peculiar circumstances and features of the individual case. 2. Purpura Urticans.- DIAGNOSIS.-This form of purpura commences with the appearance of rounded and reddish elevations of the cuticle resembling the wheals of nettle-rash, but without the itching and tingling of that disease. The tumors gradually dilate, but within one or two days they subside to the level of the surrounding skin; their hue becomes darker, and finally livid. They are most common on the legs where they appear with petechiæ, but they also appear on the arms, thighs and breasts. It usually occurs in summer, and lasts from three to five weeks. It is occasionally preceded by stiffness and weight of the limbs, and some oedema accompanies it. 3. Purpura Senilis appears principally along the outside of the forearm in elderly women, in successive dark-purple blotches of an irregular form, and various in size. Each of these continues for seven or ten days, and then the extravasated blood is absorbed. TREATMENT.—The principal remedies are: China, Hamamelis, Arsenicum, Sulphur.-acid, Gallic-acid, Ammonium-carb., Secale, Carbo-veg. Acetate of Copper.-A girl aged seven years and a half, has had on her skin for eight days, dark red spots from the size of a millet-seed to that of a shilling; the spots especially occupied the upper half of the body, the chest, upper arms, face, and mucous membrane of the mouth. Otherwise the health seemed undisturbed. The urine in normal condition. For five days the chloride of iron was administered, but the spots only increased in size. On the forehead, both eyelids, and elbows, bluish ecchymoses of the circumference and height of half a walnut arose. From one alveolar process from which the child had herself extracted an incisor tooth two days before, blood constantly flowed; her cheeks and lips were pale; her strength gone. Something of the acid order was given which checked the hæmorrhage; but after eight days' trial it was given up, for fresh spots appeared; and a boil of the size of a moderate apple developed itself on each shin-bone. The acetate of copper was given in solution, (a few drops per hour,) July 9th, and it at once arrested the progress of the disease July 13th. A smart itching of the spotted portions set in; this was followed by the usual change of the purple hue of the ecchymosis shining through the skin which became green and yellow. And by a week more all morbid symptoms had disappeared. (Dommes.) 2. A child aged seven years, complexion dark blond, showed a great number of dark purple red (but not bleeding) spots of various sizes, which had made their appearance twenty-four hours before, and occupied almost exclusively the upper part of the body, including the tongue. General health not otherwise changed, urine of ordinary color and chemical properties. Arnica was tried, but it failed to do good, and produced visible aggravation. After four days (or Oct. 31st, 1848,) frequent bleedings of the tongue commenced; the strength decreased. Acetate of copper employed after this (in a solution of gum water and cinnamon water) produced in this case also a rapid and perfect cure, preceded by the same itching of the skin and change of color. (Dommes.) 3. Dr. Marx, of Cologne, court physician, reported the following: "A man of melancholic temperament, who had been taken ill on a journey, consulted Dr. Marx in 1772. He complained of feebleness and want of appetite, had a dry cough, not very severe, and at times expectorated blood. On various parts of his skin bluish red spots were seen, and reddish blue stripes under the tongue. Pulse small and irregular; blood occurred in the urine and stool and also in the saliva. Respiration difficult, with cold and hot fits. The above solution of copper vitriol in cinnamon water. In three weeks all morbid symptoms had disappeared, and the patient was able to continue his journey. (British Jour. Hom., 1860, p. 542.) 4. Case by Dr. Searcy. (Transaction of the Med. Society of Tennessee.) A girl aged twelve years, after fever for nine days, was convalescing. Was very pale and feeble; fainted on being raised; surface unnaturally cool; restlessness; thirst; headache; tongue pale and flabby; pulse scarcely perceptible and extremely frequent; tenderness of epigastrium; bowels constipated; and constant oozing of blood from the nares and throat for forty-eight hours, causing extreme ex haustion. On the face a few red and blue patches; also on other parts, as the limbs, inside of the lips and cheeks, from the size of a pin-head to a five-penny piece. She has always been delicate, is nervous-sanguine, bleeds often from the nose in health. Hæmorrhagic tendency or scrofula not known in the family. She took small doses of Saccharum-saturni, every hour for seven hours, at which time the bleeding ceased. Solution of the same injected into the nares. A blister was applied to the back of the neck and to the calf of each leg. The pulse became stronger; still there is thirst, tender epigastrium; tongue pale and flabby. Under the use of elixir-vitrol, lemonade, light food, &c. She recovered. Sulph.-quinine and the mineral acid perhaps insured the favorable result. Under them the purpural patches ceased to appear on the skin and the old ones faded away as strength improved. GENUS IV.-TOXÆMIA.-BLOOD-POISON. 1. Toxæmia Mercuriale.-Persons long exposed to breathing mer curial vapor suffer depression of the vital powers; the process of animal calorification is imperfect; and it is quite common for such persons to be affected with ulcerations of the mouth and fauces, and with "painful or rheumatic affections of the periosteum, joints, limbs and ligaments, particularly after exposure to cold." Eruptions occur on the surface of the body with other phenomena, " to which the term pseudosyphilis has been applied; as well as many of those symptoms usually denominated cachectic." The same effects occur from what is called "a mild, but long-continued mercurial course." The poisonous influence of Mercury was exhibited on a grand scale on board the British ship referred to at Vol. I, p. 95. Thirty tons of the liquid metal was picked up and confined in bladders placed in barrels stowed away in boxes in the bread room. The bladders were wet and soon decayed; the heat of the weather caused them to burst; and the greater portion of the metal was secured in casks, though a large quantity escaped and found its way into the crevices in the lower parts of the ship, where being covered with bilge-water it soon began to be decomposed. Then efforts were made to purify the ship by removing the bilge-water, provisions and stores, and washing every part of the suspected surface: and every man employed in this work or in the steward's apartment, was speedily affected with the poison. Ptyalism began among the officers and men, and further attacks continued to occur for two months or more. Nearly all the sheep, pigs, goats, poultry, mice, cats and dogs speedily died. Canary birds, fed on food corked up in bottles, also died. Many persons suffered from severe ulcerations of the mouth, partial paralysis, bowel complaints. Old ulcers previously healed, broke out again, and assumed a gangrenous appearance. The mercurial vapor developed phthisis pulmonalis in three men who had never before been on the sick-list; they all died. Two more were left at Gibraltar with confirmed phthisis. In two ptyalism degenerated into gangrene of the cheeks and tongue and ended in death. A woman confined with a broken limb lost all her teeth, and many exfoliations took place from the upper and lower jaws. The poisonous effects were then attributed to mercury soaked in the bread, and 7,940 pounds of biscuit were condemned as unfit for use; but it was afterwards ascertained that the poison was chiefly received into the system in a state of vapor. When gradually introduced into the system, mercury produces: tumors that are slowly developed; severe ptyalism, gangrene and ulceration of the mouth and throat; palsy, various nervous and inflammatory affections in different parts of the body; protracted dysentery. The effects observed on the slaves who work in the quicksilver-mines of Almaden, are: Swellings of the parotids, aphthous sore throat; salivation, eruptions, pustules; scurvy and tremors. Merat mentions one death from profuse salivation and gangrene, and two others from mercurial marasmus. A barometer-maker and his assistant slept in a room in which mercury in a pot on a stove was heated by a fire made by mistake. The latter lost all his teeth by salivation, the former was affected with shaking palsy which lasted the rest of his life. Ptyalism is sometimes excited by a warm bath containing an ounce of corrosive sublimate in twelve gallons of water repeated every three days. The effect is seen after the third bath, if not sooner. This powerful agent is sometimes applied as an escharotic for the removal of cancers. In the case of a lady on whom we had declined to make an application of this kind an itinerant practitioner applied a plaster of this poison an inch and a half in diameter on the surface of a cancer on the breast. He encouraged her to endure the agony it inflicted by assuring her that the swelling mammary veins were only the "the roots" of the cancer ("the crabs claws "), which were being rapidly extracted. She lived several days under the local torture of the burning escharotic and the irritative fever; and then died under the constitutional effects of mercury, including the gastric inflammation and dysentery caused by the poison when taken internally. 2. TOXEMIA-from the Poisonous Effects of Tobacco.-In 1849, the French Minister of the Interior requested the Academy of Medicine to appoint a Commission to examine and report upon the health of workmen employed in the manufacture of tobacco. Dr. Mélier was appointed to perform that duty. His Report says: "The manufacture of tobacco effects, in the long run, upon a certain number of workmen, a profound and specific change deserving all at |