MISCELLANEOUS DISEASES 215 



mechanism, the styptic effect being very apparent. Thrombokinase as 

 well as fibrinogen are increased and the permeability of the capil- 

 laries altered, small doses seeming to increase the permeability, larger 

 ones to diminish it. 



Dollken therefore decided to use milk in cases of purpura and was 

 surprised to observe the rapidity of the effect on the disease. He 

 made injections of about 5 c.c. every three days, intramuscularly. 

 There was little inconvenience; on the contrary, a marked euphoria 

 was observed after the injections. In only one instance did a hema- 

 toma appear at the site of the injection and this disappeared after 24 

 hours. 



Bleeding into the tissues stopped 5 hours after the injection, a 

 most interesting feature being the observation that this clinical re- 

 sult was manifest without effect on the number of the blood platelets 

 in the circulation. The permeability of the vessels does not seem 

 to be altered as rapidly as the effect on the coagulation mechanism, 

 because small petechiaB were noted to appear until about 24 hours 

 after the injection. 



The resorption of blood from the tissues commenced promptly after 

 the alterations in coagulation had taken place. After from 7 to 8 

 hours small hemorrhages in the mucous membranes of the mouth 

 could be observed to be decreasing in size; in another 8 to 10 hours 

 the smaller ones had disappeared and the larger areas showed con- 

 siderable retrogressive change. Large areas of bleeding showed a 

 broad yellow band of discoloration from 1 to 2 c.c. wide around the 

 margin in from 18 to 24 hours where regression had occurred, and 

 the tension of the hematomas was lessened. 



Dollken details his experience in one severe case of purpura. The 

 patient bled two hours from a small skin abrasion, and the bleeding 

 recommenced on the slightest renewed trauma to the scab. The paraf- 

 fined blood coagulated in 9 minutes. Deutero-albumose (.05 gm. in- 

 travenously) merely increased the bleeding that had occurred from a 

 small skin puncture from the ear for several days. The following day 

 a puncture still bled for 14 hours; the paraffined blood coagulated 

 in 14 minutes. During this time numerous fresh areas of hemorrhage 

 had been observed over the body. The patient was then given 5 c.c. 

 milk intramuscularly. In 5 hours all bleeding ceased. After 8 

 hours the petechiae in the mucous membrane of the mouth were de- 

 creasing in size. Bleeding from a new skin puncture in the ear lobe 

 now ceased in 20 minutes and the paraffined blood coagulated in 

 8% minutes. Platelets were absent during the entire clinical change. 

 Leukocytosis was moderate. All cases that had albuminuria before- 

 hand showed clear, albumin- free urine after the injections. 



Bosanyi has found that intravenous injections of salt solution 

 have given him results that are more satisfactory in purpura simplex, 

 morbus Werlhofii and hemophilia than any other method that he had 



