GENERAL DISORDERS OF NUTRITION. 



who do not offer the slightest reason for a defective state of blood, aie 

 also sometimes attacked. 



SYMPTOMS AIO> COUKSE. Sometimes the first symptoms of Werlr 

 hops disease consist in the appearance of numerous purpuric spots 

 upon the skin ; in other instances the haemorrhages are preceded for 

 some days or weeks by digestive derangement, languor, debility, but 

 never by the signs of severe cachexia, such as generally precede the 

 onset of scurvy. The purpuric spots, though small, are generally nu- 

 merous. Their most common seat is upon the extremities and body, 

 although the face is often speckled by numerous petechiae. While the 

 first set of petechiae are passing through the blue and green stages, 

 new blood-red ones make their appearance. Now and then haemor- 

 rhages from the surface are observed ; but such phenomena cannot prop- 

 erly be called bloody sweat (p. 453). Minute, punctiform ecchymoses 

 are also found upon the mucous membranes, especially those of the 

 mouth and fauces. Epistaxis, haematemesis, haematuria, and bloody 

 evacuations from the bowels, are of far more common occurrence in this 

 disease than in scorbutus. When it attacks an otherwise healthy and 

 vigorous individual, and when the haemorrhages do not recur too fre- 

 quently, the undisturbed condition of the patient's general health often 

 forms a marked contrast with the objective symptoms. Very numer- 

 ous and oft-repeated haemorrhages may result in intense anaemia, a 

 tendency to syncope, dropsy, and even death. In previously healthy 

 persons, however, such a termination of the disease is rare. As a gen- 

 eral rule, the affection ends in recovery after a duration of between 

 two and four weeks. 



TREATMENT. The customary treatment of Werlhofs disease, 

 which originated with Werlhof himself, consists in the administration 

 of sulphuric acid and quinine. Although there is no proof that the use 

 of these articles exerts any decidedly beneficial influence upon the 

 course of the disease, yet, not to be too skeptical, and for want of more 

 certain remedies, it is advisable to give the dilute sulphuric acid or the 

 elixir of vitriol in doses of ten or twelve drops every two hours in the 

 beginning of the disorder, followed at a later period by a decoction 

 of bark with an addition of sulphuric acid. In cases of profuse epis- 

 taxis which do not readily subside under the application of cold, the 

 tampon must be employed promptly, since the longer the bleeding is 

 allowed to last, so much the more obstinate does it become. For the 

 haematemesis, bits of ice, alum-curds, and cold compresses to the abdo- 

 men, should be employed ; for haematuria, large doses of tannin. In ex- 

 treme anaemia it is of importance that the patient should preserve a 

 horizontal attitude as a precaution against swooning. 



