A case of rheumatic purpura : with notes / by J. Wickham Legg.

  • John Wickham Legg
Date:
[1883]
Catalogue details

Licence: Public Domain Mark

Credit: A case of rheumatic purpura : with notes / by J. Wickham Legg. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    11/49 (page 179)
    around. Tliis escape of the corpusclo would be eitlier entire or in part. In the latter case, after, say, orie-lialf of the corpuscle had made its way thiough the wall of the vessel, the remainder would stay attached to tlie wall, hut at length he waslied away and disappear in the general circulation. At the same time I also made a number of observations upon the action of iodide of potassium and bromide of potassium, with other alkaline chlorides, iodides, and bromides, thinking that they too might cause the same hiemorrliage per diapedesin as the chloride of sodium; but I saw no such esca{>e of the red corpuscles after their action. And I may say that the observations were all made at the same time of the year (I fancy in tlie spring) both the successful and the unsuccessful ones.^ (iii.) From this toxic purpura we descend by easy stages to the purpura of disease—stages so easy that it is hard to say where the toxic influence ends and that of disease begins. In a paper published iu these Keports some five yeais ago,^ I endeavoured to bring under one head, to which I gave the name Icterus gravis, several varieties of disease, some caused by drugs, others idiopathic. These states have many common symptoms, one of the most prominent of which is purpura,, and the appearances seen after death are so alike, that it would be hard even for an accomplished morbid anatomist to distinguish them. Such are chronic poisoning by phosphorus, arsenic, anti- mony, chloroform, chloral, alcohol, lead, silver, and many other drugs, yellow fever, acute yellow atro[)hy of the liver, and what is called bilious typhoid. In all these it is possible that the cause of the purpura may be the degeneration of the vessels, iu itself only a part of the wide-spread cloudy swelling, or paren- chymatous degeneration of the glands and muscles of the body, like that caused by febrile high temperatures. After these come the pm pura of anaemia, allied to the foregoing in the fatty degeneration of the tissues, the purpura of Bright’s disease and of cirrhosis, not forgetting the haemorrhages so often seen when a case of long-continued jaundice is about to end fatally. Three years ago Dr. Gee called attention to the presence of purpura in cases of chronic nephritis (and I have now under my care a case of j)ur{)ura accompanying well-marked Bright’s disease) ; some persons, it is well known, look upon Bright’s disease as one of the manifestations of long-continued intoxication with alcohol. So also iu cirrhosis. In the early stages of cirrhosis purpura is very common. I think that hardly sufficient atten- ^ I published the results in 1872 in my Treatise on Hajmophilia, p. 91, note. St. Bartholomew’s Hospital Keports, 1878, vol. xiv. p. 43. ® Samuel Gee, St. Bartholomew’s Hospital Keports, 1880, vol, xvi. p. 47.