286 PURPURA HEMORRHAGICA. 



vidual cases of j^urpiira, are not regular, far less diagnostic, 

 symptoms. 



With erysipelas it may not be confounded because (1) of 

 the difference in their systemic developments or symptoms. 

 In erysipelas, fever is a most characteristic and constantly 

 abiding phenomenon ; in purpura it is less sthenic and not 

 diagnostic. (2) From the variations in the character of their 

 local features. In erysipelas the local phenomena are those of 

 inflammatory action invading the skin and subcutaneous 

 tissue. We have swelling, but not the swelling of purpura ; it 

 is steady, gradual, and continued, not remittent in character, 

 acutely sensitive and painful. Its physical characters are also 

 different in erysipelas from purpura ; in the former it does not 

 appear in patches and extend by coalescing ; it is not, when 

 occurring in any situation, sharply marked off" and bounded as 

 by a line. When destructive changes take place in the skin in 

 erysipelas, they do so as the natural results of the active in- 

 flammatory process ; when occurring in purpura, they are the 

 outcome of another action entirely — death of intimate tissue- 

 element is in it independent of the morbid action of inflamma- 

 tion. Although petechise may occur in erysipelas, they are 

 less pronounced than in purpura, and rarely have we the sero- 

 sanguineous or blood-discharge from the visible mucous 

 membranes so characteristic of the latter affection. The sub- 

 cutaneous infiltrations and swellings of the head and facial 

 region, so marked in purpura, are rarely seen in erysipelas. 



Treatment. — Although it is no uncommon circumstance to 

 find that both the functional and structural changes associated 

 with purpura are of so serious a character, developed so 

 rapidly, and following closely on an already weakened system, 

 that little hope can be entertained of aught save a fatal issue, 

 there are yet many cases not marked by such malignant and 

 rapidly fatal conditions, and where by judicious management 

 much may be accomplished in the direction of arresting this 

 termination. 



Acting upon the conviction that serious results are usually 

 immediately connected with changes in the vascular system, 

 the blood, and minute bloodvessels, our efforts ought to be 

 directed to the restoring of the lost equilibrium which naturally 

 subsists between the several elements of the blood, and to 



