From Classic Encyclopedia 1911
PURPURA, in pathology, a general term for the symptom of purple-coloured spots upon the surface of the body, due to extravasations of blood in the skin, accompanied occasionally with haemorrhages from mucous membranes. The varieties of purpura may be conveniently divided as follows: (a) toxic, following the administration of certain drugs, notably copaiba, quinine, ergot, belladonna and the iodides; also following snakebite; (b) cachectic, seen in persons suffering from such diseases as tuberculosis, heart disease, cancer, Bright's disease, jaundice, as well as from certain of the infectious fevers, extravasations of the kind above mentioned being not infrequently present; (c) neurotic; (d) arthritic, which includes the form known as "Purpura simplex," in which there may or may not be articular pain, and the complaint is usually ushered in by lassitude and feverishness, followed by the appearance on the surface of the body of the characteristic spots in the form of small red points scattered over the skin of the limbs and trunk. The spots are not raised above the surface, and they do not disappear on pressure. Their colour soon becomes deep purple or nearly black; but after a few days they undergo the changes which are observed in the case of an ordinary bruise, passing to a green and yellow hue and finally disappearing. When of minute size they are termed "petechiae" or "stigmata," when somewhat larger "vibices," and when in patches of considerable size "ecchymoses." They may come out in fresh crops over a lengthened period.
Purpura rheumatica (Schonlein's disease) is a remarkable variety characterized by sore throat, fever and articular pains accompanied by purpuric spots and associated with urticaria and occasionally with definite nodular infiltrations. This is by many writers considered to be a separate disease, but it is usually regarded as of rheumatic origin.
Purpura haemorrhagica (acute haemorrhagic purpura) is a more serious form, in which, in addition to the phenomena already mentioned as affecting the skin, there is a tendency to the occurrence of haemorrhage from mucous surfaces, especially from the nose, but also from the mouth, lungs, stomach, bowels, kidneys, &c., sometimes in large and dangerous amount. Great physical prostration is apt to attend this form of the disease, and a fatal result sometimes follows the successive haemorrhages, or is suddenly precipitated by the occurrence of an extravasation of blood into the brain.
The treatment will bear reference to any causes which may be discovered as associated with the onset of the disease, such as unfavourable hygienic conditions, and nutritive defects should be rectified by suitable diet. The various preparations of iron seem to be the best medicinal remedies in this ailment, while more direct astringents, such as gallic acid, ergot of rye, turpentine or acetate of lead, will in addition be called for in severe cases and especially when haemorrhage occurs. Sir A. Wright considers that in all cases of purpura the coagulationtime of the blood should be estimated. In such cases the time taken for clotting may be increased to three times as long as that taken by normal blood. He therefore advises calcium chloride in order to increase coagulability. In severe haemorrhages, adrenalin is often useful.