A case of rheumatic purpura : with notes / by J. Wickham Legg.
- John Wickham Legg
- Date:
- [1883]
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.
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![tlie pmpiiru seen in the lo\ver limbs in heart-disease is best explained. (vi.) In former times one of the favourite ways of explaining constitutional licemorrhage was by invoking a change in the blood. It has already been said that purpura accompanies anse- mia; and it is not always that the loss of blood is the cause of the antemia, though this appears to he very commonly the ca.se. One result of hsemorrhage is an increase of the colourless blood corpuscles; and an increase in the colourless .cor])uscles seems, in its turn, to be often a cause of’ haemorrhage. How common purpura and epistaxis are in leuctemia need not be noticed. The while corpuscles form masses or balls very readily in the circulation, and these will become emboli, and the plugging of the small arteries may lead to their aneuiTsmal dilatation and ru{)ture of the vessel. (vii.) This mention of the purpura allied to the increase of the colourless corpuscles leads us to the haemorrhages seen with enlarged spleens. The conjunction of an enlarged sjdeen with epistaxis was repeatedly noticed by Hippocrates,^ and in our day Virchow has specially insisted on the concurrence of an enlarged spleen with the haemorrhagic state Dr. Habeishon has also pointed out how commotdy the spleen is enlarged in cases of [)urpura.3 Purpura is associated with many diseases in which a large .‘Spleen is seen; all the fevers, including the agues, and syphilis, (I believe that Dr. Gee was the first to point out how often the spleen in syphilis is enlarged,) cirrhosis of the liver, and many others. It thus becomes hard to say what is the precise relation of the enlarged spleen to the luemorrhages. (viii.) Dr. Ililton Fagge has drawn altention to the association of purpura with multiple sarcomata.^ It has long been known that rapidly growing tumours often show htemorrhages in their substance, and this has been explained by the tendency to rup- ture of all newly-formed vessels, whether in the foetus, sup- purating granulations, or the fungus hsematodes. (ix.) Then follows the purpura seen in some cases of rheuma- tism, to which Schonlein drew attention under the name of }>eliosis rlieuinatica.® I cannot think that there is any special variety of purpura in the case which I am about to relate; it 1 Hippocrates, Epidemics, Book iii. Littr^’s ed. t. iii. p, 121, and Epidemics, Book ii., Littr^’s ed. t. v. pp. 87 and 95. 2 Virchow, Allg. Storungen der Ernahrung und des Blutos in Handb. d. siiec. Path. u. Ther. Erlangen, 1854, p. 247. ® S. 0. Habershon, Guy’s Hospital lleports, 1857, p. 89. * Hilton Fagge, Guy’s Hospital Reports, i88l, p. i.](https://iiif.wellcomecollection.org/image/b22428057_0015.jp2/full/800%2C/0/default.jpg)
