282 PURPUIIA HvEMORRHAGICA. 



far entered upon that good hopes are entertained of a speedy 

 restoration to health. Nor from the previous history of the 

 character, course, or severity of the primary fever can we with 

 certainty predict what cases are hkely to be followed by this 

 troublesome affection ; the mildest as well as the most severe 

 attacks of these fevers are alike liable to have this condition 

 attendant on their dispersion. 



Usually the earliest symptom which awakens our suspicion, 

 or which yields indications of the onset of purpura, is the 

 appearance of the local swellings. These swellings are diag- 

 nostic ; they are sudden in their appearance, occurring in 

 different parts of the body, generally the limbs, the abdomen, 

 or the head, particularly the inferior portion of the face and 

 around the nostrils and mouth. They are sometimes limited 

 or in patches, often uniform Avhen in connection with the 

 limbs, always elevated above the level of the surrounding 

 skin, and terminating abruptly, not gradually by shading off* 

 into the level of surrounding parts. They are tense, pitting 

 slightly on pressure, but neither very hot nor very painful. 

 They owe their existence to the transudation of blood or 

 degraded blood-constituents into the subcutaneous connective- 

 tissue. 



In a number of cases, after . a variable period, bullfe, or 

 vesicles, appear, and rupturing, discharge a reddish-coloured 

 serosity ; or a uniform oozing of a similar material may occur 

 instead. The fluid thus discharged is disposed to irritate the 

 parts with which it comes in contact, and further to induce 

 discomfort by hardening in cakes, ultimately cracking and 

 disposing to fissures in the skin. When occurring in the 

 region of the head these swellings are more disposed to 

 coalesce than elsewhere, presenting a somewhat uniform 

 appearance, most severe over and around the nostrils and the 

 angles of the mouth, seldom extending above the eyes. 



A feature quite characteristic of these, particularly in the 

 early stages of the disease, is the disposition which they 

 exhibit to suddenly disappear and again return, probably in a 

 more severe form, either at the original situation or at a part 

 as yet uninvaded, and that with their return there is an 

 increase or exacerbation of the other existing untoward 

 symptoms. This disappearance of local swellings and subsi- 



