THE VISCERAL LESIONS OF PURPURA AND ALLIED CONDITIONS

Abstract

IN his well-known work on Cutaneous Diseases (1808) WVillan first reported the occurrence of visceral symptoms in a case of purpura of great severity, with vomiting, excruciating abdom-iinal pain, diarrlloea and bloody stools. In addition to purpura, there wvere " anasarcous swellings on the thiglhs and lhands," evidently angio-neurotic oedema, and on tlhe back of tlle liands two gangrenous slouglhs. It is particularly interesting that Willan should have thus noted the polymorphouLs character of the skin eruption. Olivier (d'Angers),t in 1827, gave a good account of the abdomina,l comiiplications of purpura; and Henoch,2 1874, atnd Couty,3 1876, described the cases more fully, and now the combination of purpura with abdominal pains is called after the late distinguished Berlin paediatrist. Since then there have beep, scores of communications;-I lhave myself reported long series of cases; 4and Pratt lhas given a good summary of our present knowledge in vol. iv of my System of Medicine. Tlle general literature of purpura to 1909 is given in thle first and second series of the Index Catalogue of the Sil)geon-General's Library. An excellent analysis of the recorded cases with abdominal symptoms to 1889 is given by v. Duscll and Hoche in the Henoch Festschrirft, B3erlin, 1890.. CHARACTER OF THE SKIN LESIONS. From the anatomical standpoint four lesions are met with in the cases -under consideration. All are exudative, in wlich the blood elemiients-either the red blood corpuscles alone, the serum alone, or both combinedpass out of the vessels.