CASES OF CHRONIC PURPURA WITH AND WITHOUT CUTANEOUS LESIONS
Authors: F. H. Edgeworth
Journal: BMJ (1912)

CHRONICPURPURA.[MEDICAL JOUIIRNAL injection.We believe that in this case the intravenous injection of salvarsan saved the patient's life.CASE II.A doctor, aged 34, sent to us by Mr. Craig Dun.The primary iilfection was in January, 1908, and, in spite of treatment care- fu,ly carried out from the beginning, there was early ulceration and repeated relapses.He had been treated with hydrarg.cum creta by the mouth and initramuscular inijections of grey oil in the most thorough fashion, but, in spite of tlhis, hisIiistorv was one of constant relapses, and from the time of infectioii he was rarely free from some mainifestation of the disease.He was referred to us in Marclh, 1911.HIis chief svm- ptom then was nocturnal headache, sufficienitly severe to prevent hiim from sleeping, with boring pains in the bones of the face, also worse at night.He gave a well-marked positive Wassermann reaction.Onl March 27tlh, 1911, at 12.30 p.m., we administered ani intra- venous injection of salvarsan.-He kindly made niotes for us of his subsequent progress, from which a quotationi may be of initerest:" At 6 p.m. and 9 p.m. the bowels were move(l.The usual leadaclhe, whiclh started betweeni 8 p.m. andl 10 p.m., inever arrived, aiid I fell asleep waitilng for it.March 28th.Woke this niorninig witlh sense of relief; ate breakfast, anid swallowed with nio discolmfort whatever."It seems almost like a fairy tale, but from that day till December, 1911, when we last saw tlle patient, lie lhad no fturtlher headache nor any other symptoms of syphilis.In May lie gave a negative Wassermauni reaction, buLt it lhad changed to a slight positive in Decenmber, 1911, and on that account we gave him aniother full injection of 0.6 gram.EHe promised to let us know at once -should there be any furtlher symptoms, and, as we have not heard froma him, wve take it no sy-mptom has appeared. CASE III.A ship's captain, aged 43.Primary twelve years ago, and lhad 1had no objective symptoms for eleven vears.About fifteen months before he was seen by us lie had a temporarv paresis of the right arm and of his speech centre.W'lhen seen bv us in October, 1911, the knee-jerks were abseint lie had lancinatiiig pains in the legs, the Argyll Robertson pupil, anld the-other cardinal-symptoms of locomotor ataxia.Wassermann reaction positive.On October 21st he received an intravenous injection of 0.6 gram.On October 25th he volunteered the statement that he felt much better, and was more certain of his legs.He had had Ino lancinating pains since the day after the injection.He had to return to sea, and wvas instructed to carry out mercurial inunc- tion.On December 27th he returned, and reported that he felt very much better.He had lost all pains in the legs, though there had been a slight return after he had beeni exposed for forty-eight hours on the bridge in a storm.His speech lhad improved, his gait was better, he had more control over hiis lixnbs, and said " he could dance the Highland fling."Wasser- mann reaction being, however, still positive, we gave him on Janiuary 2nd, 1912, another injection of 0.6 gram.CONCLUSIONS.