DOI: 10.7925/drs1.ucdlib_280127
title: Small-pox with purpura haemorrhagica

description: Watercolour medical illustration depicting malignant disease of the bladder. It has the alternative reference number 1331, 27b and P6A on the front. The Richmond Hospital Museum reference is A.b.1. The entry for this in P263/1 pg. 6 reads 'Malignant disease of the bladder. Aet 60. Dr Hutton', however the typescript note on the back begins 'Small-pox with purpura haemorrhagica. Dr Gordon'. The artist's name is in the bottom right corner 'J. Connolly Del.t'. A feint handwritten note at the bottom reads 'Explanation of block in substance of kidney [?]'. Includes stamp of Thomas Creswick papermakers in bottom right corner.
description: Scope and content: The full typescript note on the back reads 'Small-pox with purpura haemorrhagica. Dr Gordon exhibited the uterus and kidneys, and coloured drawings of the external appearances of the eruption, and of the recent condition of the kidneys, in the following case: An unmarried female, twenty-three years of age, was admitted into the Harwicke Hospital during the past week, affected with small pox. She had been a servant, and appeared to have been well fed, and in tolerably comfortable circumstances. She had never been vaccinated. She was now extremely pale and very weak, the surface of the body was covered with an extensive eruption of exceedingly minute papulae, confluent and very flat on the surface, and in addition to these were observed several purpuric spots, chiefly over the extremities, some of these were very small and bright red, others much larger, and of a dark blue colour, her skin was cold, and pulse very small and rapid. It was the fourth day of her illness, the second day of the eruption, she made no compliant, except of weakness, and great pain in the loins. The same evening she was suddenly seized with menorrhagia to a very great extent, and had also hematuria, with some vomiting and diarrhoea, this last, however, was not attended with any discharge of blood. The uterine haemorrhage was controlled, but the constitution seemed to have lost all power of rallying, although stimulants and restoratives were freely administered. She expired on the day after her admission, in a manner exactly like those who die of haemorrhage after parturition. The variolous eruption had undergone no change since the previous day. Post mortem examination: The variolous eruption was general, the papulae were very small, flat, and confluent, but very easily recognized, however, with the aid of a magnifying glass, numerous spots of purpura were observed over the body, but particularly over the lower extremities, of various sizes, from that of a pin's head to a section of a pea. On opening the thorax the lungs presented a pale, anemic appearance, and were somewhat emphysematous, a few purpuric spots existed beneath the serous membrane covering the heart. The gastro-intestinal mucous membrane presented, in some places, spots of congestion and vascularity, and on raising up the intestines from the true pelvis a small quantity (about two ounces) of dark coagulated blood was found. A careful examination was instituted to discover the source of this haemorrhage, and it was at first supposed that it was a case hemorrhagic peritonitis, as described by Broussais, and similar to the more ordinary disease of hemorrhagic pleurisy, but in this case the redness observable on the peritoneum was confined to the parts contained within the true pelvis, and moreover, appeared to arise from imbibition rather than from true vascularity, as it could be removed, in a great measure, by frequent washing, and the vascularity of the serous membrane, which would be sufficient to give rise to extravasation, did not exist, there was moreover, complete absence of any exudation of lymph. It was, therefore, considered that the blood had escaped from the uterus and its appendages, through the open extremities of the Fallopian tubes, as, according to Andral, sometimes occurs in cases of purulent collections. This view was confirmed when, upon a careful examination of these parts by Dr Montgomery, he found a quantity of coagulated blood within the cavity of the uterus, and also in the canal of the Fallopian tubes, the mucous membrane throughout being greatly congested, and, moreover, that extravasations of blood had taken place beneath the peritoneum at the extremity of the Fallopian tubes. The kidneys were of a dark red colour, and, when divided, presented a very congested appearance, and blood exuded from many points when pressure was made, several spots of extravasated blood were found in the kidneys, in both the cortical and tubular portions, but particularly in the latter, and the pelvis and calyces of each kidney were distended with black, semi-coagulated blood, which was found also in the ureters. When this was carefully washed off, the mucous membrane was still indelibly dyed of a dark purple colour. The bladder was empty, its mucous membrane of a very light pinkish colour. There was no variolous eruption found in any part of the mucous system, except the mouth. Dr Gordon said that renal haemorrhage has been long considered one of the gravest symptoms in small-pox, particularly if accompanied by petechiae on the skin, or purpurae. This fact is alluded to by Sydenham and others. Rayer has noticed this combination, and delineates the post mortem appearances which he found in such cases: "Des ecchymoses dans la bassinet et des petechies dans la substance corticale". His delineations of this affection(a) are remarkably similar to that executed by Mr Conolly [sic] from the above case. Rayer considers that these cases are not rare, and quotes ones at length from Barth, called by him haematuria variolosa, and which was in many points exactly like that just recorded. Dr Gordon said he had brought forward the case principally to illustrate one of the various modes in which variola in the early stage proves fatal, that disease being at present epidemic in this city to a vary great extent, and also to point out the occurrence of haemorrhage from the mucous surface into the cavity of the peritoneum, an occurrence which has not been often observed. Feb.9 1850. Richmond Hospital Museum'.
description: Numbering/sequence: Original reference number: 1331.