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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![examined in the month of Marcli. Attention was of course specially directed to the vessels, but I conld find no changes either in the mncoiis membrane or in the skin, though portions of the skin were the seat of abundant luemorrhage. They were not examined for amyloid reaction until the month of November, when Dr. Vincent Harris very kindly undertook to take them out of the Canada balsam and test them for amy- loid disease. He writes to me: “ On examination of the speci- mens, my opinion is, that they are not amyloid. I am not able to find any abnormality in the blood-vessels. I fancy the larger vessels of the kidney are rather too well supplied with mnscle, but it may be only fancy; at any rate, there is no gross change.” When the lad was brought by his friends to St. Bartholomew’s Hospital. 1 felt that the question of some acute specific heemor- rhagic affection was one which had to bo discussed. He had fever and pains in the joints, together with abundant purpura. It was Saturday, and the mother then told ns that the purpura had ap- peared on the Wednesday. The condition of the patient, still fair on the fourth day of the disease, made us think tliat the purpura could hardly be due to a luBmorrhagic form of small-pox or other fever. Then was it some form of atoxic purpura? He worked in tin and other metals, and two days before the appearance of the l)Lirpura, a mixture containing three grains of iodide of potassium for a dose had been given every four hours. But I doubt if the iodide rash be ever so sevei'e or so general as in this case. It'is petechial, and more limited to the lower limbs. Then as to the morphological elements of the blood, neither I myself nor the skill of Dr. Vincent Harris could detect during life any marked increase of the white corpuscles, or any signs of the presence of bacteria. Nor could bacteria be found after death in the purpuric tissues. So that at least in one case of fatal pur])ura the Monas hcemorrhagicum of Ceci has not been found, even though care- fully looked for. The liver and spleen could not be felt, but there was evidence of disease of the mitral orifice; and there was j)roved, by the examination after death, to be great deformity of the aortic valves with stenosis of the mitral orifice and disease of the tricuspid orifice, illustrating a conclusion which may I think be drawn from Dr. Bedford Fenwick’s papeiA that disease of the tricuspid (when it is seen) often accompanies mitral disease. Was then the pur- pura due to the cardiac disease congestive in its origin, or due to numerous emboli ? Against the origin of the pnrpura in embo- lism is the fact that the spleen and the kidneys were free from ^ Bedford Fenwick, Transactions of the Pathological Society of London, 1882, vol. i.xxiii. p. 64. VOL. XI.X. N](https://iiif.wellcomecollection.org/image/b22428057_0039.jp2/full/800%2C/0/default.jpg)
