293 
PATHOLOGY. 
climates, it did not occur fo often or fo extenfively as 
to claim their attention very ftrongly. In our prelent 
ftate of knowledge,'it is divided into three very dillindl 
fpecies. 
i. Porphyra fimplex, petechial fcurvy : fpots numerous, 
but fniall and flea-bite fhaped ; chiefly on the bread, arms, 
abdomen, and legs j palenefs of vifage. There are two 
varieties. 
a.. P. pulicofa, (Purpura fimplex, Willan and Bateman -) 
In this variety, which is exhibited on the annexed 
Plate V. fig. i. there is an appearance of petechias, or ex- 
travafations under the cuticle, without much diforder of 
the conftitution, except languor, and lol's of the mu feu- 
lar drength, with a pale or fallow complexion, and often 
with pain in the limbs. The petechias are mod nume¬ 
rous on the bread, and on the infide of the arms and 
legs ; and are of various fizes, from the mod minute point 
to that of a flea-bite, and commonly circular. They 
may be didinguilhed from recent flea-bites, partly by 
their more livid or purple colour, and partly becaufe, in 
the latter, there is a diitindt central punCture, the rednefs 
around which difappears on preffure. There is no itch¬ 
ing, or other fenfation attending the petechias. 
/ 3 . P. urticans (fee the fame Plate, fig. 2.) is diftin- 
guilhed by this peculiarity, that it commences in the 
form of rounded and reddifh elevations of the cuticle, 
refembling wheals, but which are not accompanied, like 
the wheals of urticaria, by any fenfation of tingling or 
itching. Thefe little tumours gradually dilate, but, 
within one or two days, they fubfide to the level of the 
furrounding cuticle, and at the fame time their hue be¬ 
comes darker, and at length livid.. As thefe fpots are 
not permanent, but appear in fucceflion in different 
places, they are commonly feen of different hues; the 
irefh and elevated ones being of a brighter red, while 
the level fpots exhibit different degrees of lividity, and 
become brown as they difappear. They are moll com¬ 
mon on the legs, where they are frequently mixed with 
petechise; but they fometimes appear a!fo on the arms, 
thighs, breaft, &c. The duration of the complaint is 
various, from three to five weeks. It ufually occurs in 
fummer and autumn ; and attacks thofe who are liable to 
fatigue, and live on poor diet; or, on the contrary, deli¬ 
cate young women, who live luxurioufly, and take little 
exercife. Some oedema of the extremities ufually accom¬ 
panies it, and it is occafionally preceded by a ftiffnefs and 
weight of the limbs. 
The cure of the above-mentioned varieties is often 
difficult. Viewing the difeafes as arifing from dyfpepfia, 
we fhould direct an alteration to be made in the diet of 
the patient, and the bowels to be kept regular. Indeed 
active purging has been recommended by the beft autho¬ 
rities, The ftate of the fkin, as far as regards its itching 
or other unpleafant fenfation, will alfo require palliative 
mealures, as the warm bath, See. The debility of the 
lyftem may be in fome meafure obviated (when the diet 
and bowels are regulated) by mineral acids and bark, 
or by gentian. 
2. Porphyra haemorrhagica, land-fcurvy : fpots circu¬ 
lar, of different fizes ; often in ftripes or patches, irregu¬ 
larly fcattered over the thighs, arms, and trunk ; occa- 
fional haemorrhage from the mouth, noftrils, or vifeera ; 
great debility, and depreffion of fpirits. See the Plate, 
%• 3 * 
We often fee perfons in whom the very (lighteft bruifes 
or impreflions turn black. This is moft generally the 
cafe in old perfons ; and is indeed commonly o'oferved in 
an inverfe ratio to the vigour of the mufcular ft ruff ure. 
It is evidently the refillt of want of contraff ile powers 
in the capillary veffels, which confequently give way, and 
allow extravafation 5 or in which, from the fame caufe, 
the blood ftagnates. An extreme fufeeptibility to this 
lividity is feen in the patients of P. haemorrhagica, except 
in cafes comparatively fudden in their acceffion, and at¬ 
tended from the firft with high inflammatory fymptoms. 
VOL. XIX. No. 1304. 
This fpecies, like the former, is alfo remarkable for the , 
appearance of petechias; but thefe, as Dr. Bateman fays, 
are “ often of a larger iize, and are interfperfed with vibi- 
ces and eccliymofes, or livid ftripes and patches, refem¬ 
bling the marks left by the ftrokes of a whip, or by vio¬ 
lent bruifes. They commonly appear firft on the legs, 
and, at uncertain periods afterwards, on the thighs, arms, 
and trunk of the body; the hands being more rarely 
fpotted with them, and the face generally free. They 
are ufually of a bright red colour when they firft appear, 
but foon become purple or livid ; and, when about to dif¬ 
appear, they change to a brown or yellowifh hue; fo that, 
as new eruptions a rife, and the abforption of the old 
ones flowly proceeds, this variety of colour is commonly 
feen in the different fpots at the fame time. The cuticle 
over them appears finooth and fhining, but is not fenftbly 
elevated : in a few cafes, however, the cuticle has been 
feen raifed into a fort of veficles, containing black blood. 
This more frequently happens in the fpots which appear 
on the tongue, gums, palate, and infide of the cheeks 
and lips, where the cuticle is extremely thin, and breaks 
from the (lighteft force, difeharging the effufed blood. 
The gentleft preffure on the fkin, even fuch as is applied 
in feeling the pulfe, will often produce a purple blotch, 
like that which is left after a fevere bruife. 
“The fame ftate of the habit which gives rife to thefe 
effufions under the cuticle, produces likewife copious 
difeharges of blood, efpecially from the internal parts, 
which are defended by more delicate coverings. Thefe 
haemorrhages are often very profufe, and not eafily re- 
ftrained, and therefore fometimes prove fuddenly fatal. 
But in other cafes they are lefs copious ; fometimes re* 
turning every day at ftated periods, and fometimes lefs 
frequently and at irregular intervals $ and fometimes 
there is a flow and almoft inceffant oozing of blood. The 
bleeding occurs from the gums, noltriis, throat, infide 
of the cheeks, tongue, and lips, and fometimes from the 
lining membrane of the eyelids, the urethra, and the ex¬ 
ternal ear ; and alfo from the internal cavities of the lungs, 
ftomach, bowels, uterus, kidneys, and bladder. There 
is the utmoft variety, however, in different inftances, as 
to the period of the difeafe in which the haemorrhages 
commence and ceafe, and as to the proportion which they 
bear to the cutaneous efflorefcence. 
“ This lingular difeafe is often preceded for fome weeks 
by great laflitude, faintnefs, and pains in the limbs, which 
render the patient incapable of ar.y exertion ; but, not 
unfrequently, it appears fuddenly, in the mid ft of appa¬ 
rent good health. It is always accompanied with extreme 
debility and depreffion of fpirits : the pulfe is commonly 
feeble, and fometimes quickened; and heat, flufhing, 
perfpiration, and other fymptoms of flight febrile irrita¬ 
tion, recurring like the paroxy fms of hedtic, occafionally 
attend. In fome patients, deep-feated pains have been 
felt about the prascordia, and in the cheft, loins, or abdo¬ 
men ; and in others a confiderable cough has accompa¬ 
nied the complaint, or a tumour and tenfion of the epi- 
gaftrium and hypochondria, with tendernefs on preffure, 
and a conftipated or irregular ftate of bowels. But in 
many cafes, no febrile appearances have been noticed ; 
and the functions of the inteftir.es are often natural. In 
a few inftances frequent fyncope has occurred. When 
the difeafe has continued for fome time, the patient be¬ 
comes fallow, or of a dirty complexion, and much ema¬ 
ciated; and fome degree of oedema appears in the lower 
extremities, which afterwards extends to other parts. 
The difeafe is extremely uncertain in its duration: in 
fome inftances it has terminated in a few days; while in 
others it has continued not only for many months, but 
even for years.” 
Though the indications for the treatment of this diff 
eafe are perhaps as clear as any in medicine, we are ufu¬ 
ally difappointed in our expectations of cure. The firft 
thing to be done is of courfe to diminifh the quantity of 
the circulating fluid. This practice is obvioufly cor- 
+ G reCt; 
