PURPURIC ERUPTIONS 



1517 



Clear signs of the disease causing the purpuric eruption: — 

 {a) Yellow tinge in skin or eyes: — 



1. Urine black from haemoglobin — Blackwater fever. 



2. Urine without haemoglobin : — 



(a) Bile in the urine 

 (i.) Examine blood and urine for the peculiar 



spirochaete with its central minute 

 waves — Icterus castrensis gravis {Weil's 

 disease). 



(ii.) Spirochaetes of doubtful pathogenicity may 

 be present or they may be absent; little 

 • : : or no fever — Non-febrile jaundice {camp 



jaundice). 



(b) Bile not in urine : — 

 Severe fever; examine blood for malarial para- 

 sites — Malarial fever. 



(c) Alhitmen in urine : — 

 Epigastric tenderness. Faget's sign — Yellow 



fever. 



{b) Without yellow tinge in the skin or eyes: — 



1. Retraction of head. Kernig's sign present. Lumbar 

 puncture reveals meningococci — Epidemic cerebro- 

 spinal meningitis. 



2. With developed disease — e.g., typhoid, diphtheria, 

 scarlet fever, smallpox, measles (haemorrhagic 

 conditions known in the tropics) ■ — Septiccemic 

 condition. 



3. With buboes or marked pneumonic symptoms. Ex- 

 amine blood culturally, sputum and fluid from en- 

 larged lymphatic glands microscopically, for plague 

 bacilli — Plague. 



4. Without marked signs of any disease. Blood culture 

 — Septiccemia. 



5. VESICULAR ERUPTIONS. 



The practitioner will be on his guard to exclude vesicles which 

 are the result of bites of insects, such as sand-flies and mosquitoes, 

 as well as those due to the ingestion" of drugs, such as bromides 

 and iodides. Also the pyoses, which are without fever. Among 

 these, pyosis corletti causes bullae. 



I. Onset with severe constitutional disturbance : — 



Rash on third to fourth day; shotty papules becoming vesicles 

 fifth to sixth day. Vesicles circular, tense, umbilicated, 

 and multilocular — Smallpox. 



II. Onset with mild constitutional symptoms, but with severe local pain, 

 generally along a nerve, but in any case confined to one region : — 



