=Purpura= is a symptom rather than a disease. It is characterized by
extravasation of blood into the skin and bleeding from the mucous
membranes, irrespective of direct injury. These extravasations do not
disappear upon pressure and vary greatly in size. They may be small,
(petechiæ) or large (ecchymoses). They are bright red and gradually
become darker. Clotting of normal blood requires three to five minutes,
purpuric blood, ten to fifteen minutes.
It is a symptom of =infectious diseases=, as in pyemia, septicemia,
mycotic endocarditis, typhus fever, smallpox, etc. =Toxic=, as produced
by venomous snake bites and by =certain medicines=, as copaiba,
mercury, quinine, iodides and others in overdoses. =Cachectic purpura=
may be observed in cancer, tuberculosis, Bright’s disease, scurvy,
etc. In =senile purpura= the spots are generally confined to the
extremities. In certain =nervous diseases=, bleeding spots appear on
the skin, as in tabes, myelitis and severe neuralgia. =Mechanical
purpura= is seen in venous stasis; this is rare.
=Purpura simplex= affects only the skin. It occasionally follows
attacks of infectious diseases. The spots are found upon the legs, more
rarely upon the trunk and arms. Articular pains may or may not occur.
Fever is seldom present. Loss of appetite, diarrhea and slight anemia
may be manifested. The duration is one to four weeks.
=Purpura rheumatica= is a much more serious affection, characterized
by multiple arthritis of rheumatism. Seldom seen under five years,
and lasts about two weeks. The joints are swollen and painful and the
temperature rises to 101 and 103 degrees F. The amount of edema varies
greatly and occasionally it is quite excessive. In addition to the
purpura there is usually urticaria. =Henoch’s purpura= is seen most
frequently in children and is characterized by severe gastro-intestinal
disturbances as pain, vomiting and diarrhea, hemorrhages from the
mucous membranes and acute enlargement of the spleen, in addition to
the symptoms already named under the foregoing form. There is some
danger of hemorrhage into the kidneys.
The disorder of =purpura hemorrhagica= is usually associated with
rheumatism, malaria and other infectious diseases. This is the most
serious form of purpura. It is most commonly met with in delicate girls
during early life; but it may occur at any age and in the most robust
of either sex. Fever, weakness, vomiting and diarrhea are the early
symptoms. After a couple of days of languor and weakness, purpuric
spots appear upon the skin; and bleeding occurs from the mucous
membranes and may cause profound anemia. Hemorrhages into the internal
organs occur. Favorable cases recover in ten days or two weeks. Others
may end fatally. Care should be taken not to confuse the disease with
scurvy.
=Treatment.=—In the treatment of purpura the disease from which it
develops should receive due attention. Occasionally there is danger
of overlooking the primary disease and treating some symptoms of the
disease, although it is true that sometimes an important symptom is
nearly all that is manifested. Outside of treating the conditions under
which purpura arises, general measures should be considered, as a
nutritious diet, rest, fresh air, and general treatment of the patient
so that normal circulation and strength may be restored. The treatment
of the purpura locally should be such as to restore normal circulation
of the part by removing any obstruction or irritation of the blood
supply that may be found, by careful manipulation of the tissues. As
stated the management of the disease under which it arises should be
embraced in the treatment. In cases of hemorrhage from various organs
see article under hemorrhage. Some cutaneous hemorrhages are best
relieved by local manipulation.