MORBUS MACULOSUS WERLHOFII 465 



vessels of the cutis and of the subcutaneous connective tissue in scurvy, morbus 

 maculosus, and purpura rheumatica, as well as in the purpura of cachectic 

 individuals. 



In cases of scurvy and morbus maculosus, difEuse endarteritis and thick- 

 ening of all the coats of the vessels, hyaline degeneration, and partial fatty 

 degeneration of the same, narrowing of the lumen and proliferation of the 

 endothelium, could (he said) be invariably demonstrated. Besides, it was 

 found that in some areas the connective tissue surrounding the vessels and the 

 fatty tissue showed decided round-cell infiltration. 



In the hemorrhagic areas fresh and more or less altered extravasations 

 of blood were observed, i. e., coarsely granular or flaky blood pigment, em- 

 bedded between the bundles of connective tissue a:nd in the cell infiltrations. 

 On the other hand, Eiehl could never detect pigmented leukocytes, as in the 

 case of Addison's disease, etc. In both processes the cross-striated muscles 

 which were examined showed fatty degeneration. 



In purpura rheumatica and purpura cachecticorum as well as in a case 

 of hemorrhage into the skin occurring after sepsis, similar changes could be 

 determined, but the vascular alterations and infiltrations of the perivascular 

 connective tissue were less marked. In all instances the reticular stratum of 

 the cutis showed the greatest implication of the large arteries; next to these 

 the vessels of the adipose tissue, and least marked the vascular layers of the 

 subpapillary tissues. 



In all cases examined by v. Kogerer the vascular changes which have been 

 described could be demonstrated, and he therefore concludes their certain 

 connection with the hemorrhages. He assumes further that the hemorrhage 

 results per rhexin. But in order that the pathologically changed layers of 

 the vessels shall rupture during life, other local conditions, he believes, must 

 be simultaneously active. These, in his opinion, consist in thromboses of the 

 smallest arteries, and he refers to the hemorrhages in the centers of which, 

 in septic endocarditis and similar processes, emboli of micrococci are found 

 (Weigert, Litten and others). 



Besides the early investigations of Hayem and Stroganow, which have been 

 referred to, the more recent ones of Leloir and Eiehl must be mentioned. 

 They confirm the finding of vascular changes in the reticular stratum of the 

 cutis and in other areas of the body, the changes consisting of thickening, 

 hyaline degeneration, fatty degeneration of the endothelium, and formation 

 of thrombi, v. Eecklinghausen also finds these causes of hemorrhage ; I shall 

 quote two of his remarks relating to this condition {Handbooh of General 

 Pathology of the Circulation and of Nutrition) : " As regards many cases of 

 multiple capillary hemorrhage, formerly included in the category of the hem- 

 orrhagic diathesis or of blood dissolution, etc., we are able to-day to prove 

 that they occur mechanically, by occlusion of the smallest vessels with indif- 

 ferent material, or with one of specially septic constitution," and further: 

 " Occasionally, as the result of obstruction of a vein, capillary hemorrhages 

 also appear in the area of stasis; this is, however, quite rare, and we may 

 therefore conclude that here complications, for example, sende vascular 

 changes, are operative." 

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