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

  • Legg, J. Wickham (John Wickham), 1843-1921.
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.

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    Ill the same chapter he also spoke of a peliosis rhenmatica, the •<lescriptioQ of which I will give in his own words: “The patches never rim together, as they often do in morbus macu- losus Werlhofii; the patients have either suffered before from rheumatism; or rheumatic symptoms appear at the same time; pains in the joints, which are swollen and painful on movement. The patches peculiar to the disease appear in the majority of the cases first in the limbs, especially on the lower, and here only below the knee. The spots are small, the size of a lentil {Linse) or a millet-seed, bright red, not raised, disappearing on pressure with the finger, becoming later on dirty brown yellow. The eruption appears in crops, and often lasts through inany weeks. Slight changes of temperature will bring out fresh patches. The disease appears with fever which has a .remittent type.” It will be seen that the case now printed agrees with Schon- lein’s description of peliosis rhenmatica in all but the physical appearances of the patches. They were not small, but in many places confluent; they were raised above the skin, and firm, and they did not disappear on pressure; but are these differences • enough in themselves to create a new species and to separate the case from those described by Schonlein ? I think not, 'though I have known some Germans refuse the name of peliosis irheumatica to a generally diffused purpura in rheumatic fever, the size of the patches of which certainly exceeded a millet-seed, being as big as a sixpence. But to avoid using a new name, till itself not one whit better than purpura, I ]>refer to call the disorder rheumatic purpura. Since the discovery that effusion of blood into the joints was the chief cause of the “rheumatism” in haemophilia, and ‘•Scheby-Buch’s observations on the presence of joint affections in jiurpura,^ it maybe asked: are haemorrhages into the joints in •cases of rheumatic purpura the cause of the rheumatic symptoms ? This case does not give any affirmative answer to that question. The joints examined after death showed the appearances of •ordinary rheumatic fever, but no haemorrhnges into their cavities. There had been many attacks of rheumatism before the hsemor- rhage into the skin was noticed : indeed the friends denied any -similar liaernorrhagic disease before the attack of which the patient died. It may be noted that four ulcers of the colon were found. Ulceration of the intestines appears to be by no means rare in pur[)ura. Max Zimmermann has recorded a case in which he •found no less than 150 ulcers in the ileum, and the process of