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August 25, 1962


JAMA. 1962;181(8):720-721. doi:10.1001/jama.1962.03050340058012

That emotions effect cutaneous vascular reactions is verified by the characteristic blush of a shy young lady. A more severe manifestation of the same phenomenon was suggested by S. Weir Mitchell who wrote, in 1869, "We have the right to ask if certain nervous disorders are not able to weaken the vascular walls so they become permeable to red corpuscles." Recently, Agle and Ratnoff1 have suggested that essentially this mechanism is responsible for a chronic purpuric state previously attributed to autoerythrocyte sensitization. Symptoms are stereotyped in this syndrome, and are often initiated by a sudden pain or "ping." Within a few minutes the area turns pink and an ecchymosis begins to spread. No part of the body is immune, although the majority of lesions affect the lower extremities. No hemostatic defect has been demonstrated and the diagnosis rests with the Gardner and Diamond test,2 that is, the production