[9] Commentaria.—Edit. Lugd. Bat. 1742. Vol. I. pp. 766, 767.
[10] This name may be either from the ancient English or the low Dutch; if the one, by tradition, if the other, from the use of it by medical men. Cancrum is an odd grammatical blunder; being, in reality, nothing but the accusative of Cancer, put instead of the nominative. The latter name was, as is well known, frequently applied by the older surgeons, in a vague manner, to any terrific and unmanageable ulcer; and, in particular, it was often applied to gangrene. The error appears to have been first made by Pearson, and copied by Mr. Cooper. Compare Muys and Vander Wiel, with Pearson, at the above references.
Article II.—Case of Purpura in an Infant, attended with Extraordinary Symptoms. By R. M. Huston, M. D., &c.
On the 28th of August last, A—— V——, after a moderate labour of four hours' continuance, was delivered of a female child. About a month previously, she had laboured under an attack of intermittent fever, which yielded, in a few days, to the ordinary treatment. She was 23 years of age, an English-woman by birth, had generally enjoyed good health, and was as well as usual at the time of her confinement. Her labour was strictly natural, and her delivery accomplished without any extraordinary assistance.
At birth there was nothing remarkable about the child. Its breathing was natural, its skin of the usual colour and appearance; in short, all the common indications of a continuance of life and health were present. A few hours, however, after birth, it became uneasy, cried much, and showed signs of colic. The nurse, supposing these symptoms to arise from flatulence, administered some warm tea; but without any apparent advantage. On the following day, I saw it again, and learned, that it had evacuated a considerable quantity of urine, and some intestinal matter, of the ordinary appearance after birth. The spasms continuing at intervals, a teaspoonful of castor oil was ordered, to evacuate any remaining meconium, that might lie in the bowels, producing irritation; upon the presence of which, it was presumed the spasms depended. It operated well, but without producing the desired relief. On the next day, viz. forty-eight hours after birth, a number of bluish or purple spots were observed on different parts of the child's body, but most numerous on the extremities. They were of various sizes, from that of a mustard seed, up to that of a grain of Indian corn. Some were slightly elevated, but most of them were not in the least so. In the majority, there was a minute central spot, or little point, more red or pink coloured than the blue areola, by which it was surrounded. In many instances, these little points projected, so as to become manifest to the touch. In the course of twenty-four hours, the spots, which had first appeared, began to decline, leaving a greenish mark, very like the remains of a bruise; but much more rapidly than these declined, others of larger size appeared on different parts of the child's body.
On the third day after birth, large blotches appeared, one behind each ear. These rapidly increased, until they covered the whole extent of the parietal bones, and considerably elevated the skin, giving it a puffy or tumid appearance, like that caused by a blow from a large or blunt instrument. The parts soon became hot and tender to the touch; and this tenderness extended over the greater part of the scalp. A blotch, similar to those upon the exterior surface, was likewise observed within the mouth, covering the whole extent of the palate bones. The child experienced great difficulty in swallowing after the third day; and the nurse thought the spasms were often excited by attempts of this kind.
But the most singular feature of the case was the appearance, on the night of the second day, of a discharge from the vagina, resembling the menstrual flux. It resembled that flux in colour, consistence, want of coagulability, and in being, withal, accompanied by a considerable quantity of slimy or mucous matter. Every diaper which was used during that night, and the greater part of the next day, was stained more or less with this discharge. It was also observed, that, during the flow of this fluid, the spasms ceased; and that, whenever the discharge was suppressed, even for a very short time, they uniformly returned. In this manner they alternated at intervals of a few hours, until the occurrence of the death of the child, which happened on the eighth day after birth.
As this case is related more for its singularity than from an expectation that any practical suggestions will be furnished by its perusal, but few remarks will be necessary, either upon its pathology or treatment. Although it will be perceived by the scientific reader, that the disease observed, differed materially from any of the forms of purpura, described by systematic writers on diseases of the skin; still I apprehend it may be justly considered as more nearly allied to that genus, than to any other.
The spots were evidently caused by an effusion of blood beneath the cutis, and the presumption is strong, that it issued from the little point discoverable in the centre of each spot. Those points were, in all probability, arterial. That they were arterial terminations, I think is evident, from the great extent to which the cellular membrane was injected, especially over the parietal bones. The force exerted must have been very considerable to elevate so large a portion of scalp, and yet no pulsation could be discovered in any one of the points.