496 THE HEMORRHAGIC DIATHESES 



In many cases very few deviations from the normal were recognized, in many 

 others the signs of anemia were distinctly observed. Anemia- is the sum and 

 substance of the blood changes in this affection, if such changes exist at all. 

 Microcytosis, poikilocytosis, numerous pessary forms, a relative and absolute 

 decrease of hemoglobin, blood-plaques increased, occasionally very much so, 

 and profuse cylinder-formation in the blood, such are the important changes 

 which I have observed. An increase of leukocytes, a slight destruction of the 

 same, and the appearance of isolated, nucleated red blood-corpuscles are occa- 

 sionally but by no means constantly seen. Moreover, the number of leukocytes 

 is subject to extraordinarily rapid change. The many "pessary forms" of 

 red cells which are quite frequently found, in fresh preparations as well as in 

 smears stained with eosin, are only a sign of the scant hemoglobin contents 

 of the erythrocytes, and it is, therefore, not remarkable that in spite of a nor- 

 mal number of red cells the hemoglobin may be decidedly diminished. In the 

 investigation of the fresh blood of patients who suffered from purpura, upon 

 a warm slide (heated to 30° C), no change in the corpuscles, either in the red 

 or in the white, was perceptible ; they resembled perfectly the blood-corpuscles 

 of healthy persons or were, for example, like those in malaria patients whose 

 blood I had used for comparison. 



TREATMENT 



Prophylaxis. — On account of the spontaneous and unexpected appearance 

 of purpura there can be no question of prophylaxis. The frequency of re- 

 lapses should be a warning to those who have recovered once or repeatedly 

 from the disease, to protect themselves for a long time against deleterious 

 external influences, particularly chilling the body. Change of climate has 

 proven very beneficial. 



General Treatment. — The patient must remain in bed for a long time, even 

 if no fever is present. The more rigidly this rule is adhered to, the more 

 certainly will relapses be prevented. He is to move about just as little as 

 possible. The more experience I have with cases of this kind, the more thor- 

 oughly I am convinced of the great value of rest in bed. The absolute neces- 

 sity of this must be impressed upon the patient, so that, from conviction and 

 not merely to please his physician, he will submit and adhere to this very 

 tiresome regime. Every arrangement must be made for the patient's comfort 

 during this prolonged rest in bed; he should be taken down into the garden, 

 or upon a shady veranda, balcony, or the like. Further, the nurses must see 

 that no part of the patient's body is subjected to external pressure, and that 

 he does not bruise or injure himself. With this end in view his bed must be 

 very carefully prepared. Above all, folds in the bed sheets must be prevented: 

 The covering is to be light, the sick room to be kept cool. Psychical excite- 

 ment and mental exhaustion are to be strictly avoided under all circumstances. 



The nutrition must be bland. All foods are to be given cool. Strong 

 coffee, tea, and alcohol are prohibited; only with symptoms of collapse may 

 the latter be made use of. Of foods, milk is most important, perhaps mixed 

 with somatose. Lemonade or orangeade may be used as a drink. 



