MORBUS MACULOSUS WERLHOFII 469 



saw purpura in a young girl after great fright, appearing very acutely and 

 rapidly running a fatal course. Upon the skin, large, confluent hemorrhagic 

 spots were found. 



Bobrizki saw in a girl aged twelve, as the result of severe nervous shock 

 (an attempted rape), an immediate attack of morbus maculosus. The same 

 observer noted a second case in a boy aged ten, who, in consequence of a 

 fire, was severely frightened and was immediately attacked by the same disease. 



Bobrizki is of the opinion that the irritation of the nervous centers produced 

 by fright caused a paralysis of the vasomotor nerves which permitted the 

 extravasation of blood per diapedesin. 



GENERAL CLINICAL PICTURE 



By purpura we understand an affection which appears spontaneously, its 

 chief characteristic consisting in transitory hemorrhages of the external skin, 

 the serous and mucous membranes, as well as hemorrhage into the parenchyma 

 of the internal organs. 



Under purpura we include only such hemorrhages as denote the character 

 of the disease and stamp it as an independent affection, while the purely 

 symptomatic extravasations of blood which occasionally occur in the course 

 of cachectic or febrile affections (as, for example, in the course of sepsis or 

 acute articular rheumatism) are to be left entirely out of consideration. The 

 first form of the disease, in which bleeding occurs exclusively in the skin, is 

 designated "purpura simplex." When bleeding occurs aot only in the skin 

 but in the mucous membranes, the serous membranes, and the internal (paren- 

 chymatous) organs it is designated purpura hemorrhagica. Finally, when the 

 hemorrhages run their course with pain and swelling in the joints, the disease 

 is called peliosis or purpura rheumatica. This terminology might be extended 

 much further. According to the etiology or clinical symptoms, we might speak 

 of peliosis or purpura gonorrhoica or of a purpura abdominalis or dyspeptica 

 (see below). But, as has already been stated, all these apparently different 

 forms depend upon a general cause, the so-called hemorrhagic diathesis, which 

 is probably due to a microparasitic pathogenic agent (up to the present time 

 entirely unknown) and which finds expression in forms that are only clinically 

 different and merge into each other in many ways. Altogether they form 

 one and the same essential hemorrhagic disease of varying grade and varying 

 intensity. But it must be always remembered that, besides the hemorrhagic 

 symptoms, no other primary affection is present in the clinical picture. Pur- 

 pura simplex is to be looked upon as the mildest form of the disease ; we can, 

 however, never premise with certainty whether it will remain mild during the 

 entire course of the disease, or will change gradually into severe purpura hem- 

 orrhagica, or whether disease of the joints or other complications may even- 

 tually appear. For this reason we cannot look upon the various forms of the 

 hemorrhagic diathesis (mentioned by various authors) as distinct. They are 

 all aspects of one disease, produced in each individual case by separate condi- 

 tions. This disease we call morbus maculosus. 



In describing briefly the history and development of this disease, we need 

 only follow a case step by step to demonstrate the difficulties which arise in 



