MORBUS MACULOSUS WERLHOFII 457 



MORBUS MACULOSUS WERLHOFII (PURPURA) 



(PURPURA SIMPLEX, HEMORRHAGICA, RHEUMATICA SEU PELIOSIS 

 RHEUMATIOA SCHOENLEINII) 



DEFINITION 



Purpura, on account of its obvious manifestations, has been known to 

 physicians for a very long time. Superficial hemorrhages arising from every 

 possible cause have hitherto been grouped together. Hence affections in which, 

 according to the present state of our knowledge, the purpura forms only an 

 auxiliary or symptomatic phenomenon (for example, diseases with jaundice and 

 hemorrhages) have been regarded as independent diseases. From the mass of 

 diseases in which purpura occurs upon the external skin, Werlhof, in the year 

 1775, isolated a distinct clinical picture which he designated purpura hemor- 

 rhagica, and which was subsequently named af fer him. 



Later, other divisions were made in the group of hemorrhagic diseases. 

 Purpura simplex was isolated as an independent affection, and a variety called 

 purpura urticans was also described. 



Finally, upon the authority of Schonlein, the term peliosis rheumatica 

 came into use. - It must be admitted that such a division was justified at that 

 period ; it was necessary at a time when the conception of disease entities rested 

 chiefly on a subtle differentiation of clinical symptoms. From this point of 

 view great importance was attached to a single symptom, as is shovm by the 

 fact that the term " peliosis rheumatica "" rests solely on the observation that, 

 in some cases of purpura, an affection of the joints is occasionally noted. The 

 fact was lost sight of that the latter often occurred in combination with all 

 hemorrhagic diseases, not only in those whose clinical pictures belong strictly 

 to purpura, but also in the course of scurvy and hemophilia. Of course the 

 old divisions of the different forms of purpura are no longer justified. As 

 a matter of fact, in the last twenty-five years a change in the conception of pur- 

 pura has taken place, and there is now a tendency to regard all purpuric dis- 

 eases as related, and the individual forms, previously supposed to be inde- 

 pendent, are regarded from a common standpoint. Upon the basis of my 

 own experience, which extends over many years and includes exceedingly 

 numerous observations, I believe strictly and absolutely that the individual 

 purpuric diseases are not essentially different, hut are due to the same cause, 

 and only vary in degree; that is, the " varieties " depend upon the intensity 

 of the affection. 



Occasionally these differences are clinically presented in such a manner 

 that the inexperienced believes he has before him entirely different clinical pic- 

 tures that have nothing in common with one another. This is a difficult field 

 for polemics, and convincing arguments are useless if another is fully con- 

 vinced to the contrary. The only method leading to conviction is minutely, 

 carefully, and without prejudice to weigh all the facts bearing upon the ques- 

 -tion. It will then become manifest that all these variations of the disease form 

 indefinable transitional stages which merge into each other, and only by 

 great circumspection can differentiations be made. The standard of identity 



