474 THE HEMORRHAGIC DIATHESES 



•pains in the joints (in the ankles, in the knees, or in the joints of the hand 

 and shoulder). These joints are edematous and painful to the touch. The 

 spots characteristic of the disease appear in the majority of cases first upon 

 the extremities, particularly upon the lower, and then only up to the knees. 

 The hemorrhagic areas are of the size of a lentil or a millet-seed, light red, 

 not raised above the skin, and gradually turn a dirty brown and desquamate. 

 (The latter symptom in my experience is most often absent !) The eruption 

 occurs in crops during a period lasting often for weeks. Any change of 

 temperature, no matter how slight, may cause a new eruption. The affection 

 is mostly accompanied by fever, which is of the remittent type. 



" The disease has been confounded with morbus maculosus Werlhofii. The 

 absence of the so-called purpuric phenomena in the mouth which shows no 

 changes, the absence of free hemorrhages, the absence of nervous phenomena, 

 the character of the exanthem (never reaching the size typical of Werlhofs 

 disease, never becoming confluent, and being a light red), the affection of the 

 joints which is lacking in maculosus, the great debility and loss of strength, 

 confirm the diagnosis. 



" The clinical picture is seen in individuals with a delicate, vulnerable skin, 

 who have either previously suffered from rheumatism or in whom, as the 

 result of chilling, symptoms of peliosis simultaneously with those of rheuma- 

 tism appear." So much for Schonlein's view. 



Notwithstanding the great master's beautiful and exact portrayal of the 

 clinical picture which has been named after him, it is evident that his experi- 

 ence in purpuric diseases was not extensive. We find in this description all 

 the errors which have so long dominated this department of clinical medicine; 

 they, have been propagated in the text-books for three decades, and have 

 retarded the recognition of the true nature of this group of diseases. 



Particularly fallacious is the idea that the situation and the size, as well ' 

 as the configuration of the hemorrhages, are characteristic of this or that 

 form, as well as the isolation or the confiuence of the purpuric spots. It is 

 equally unimportant whether the hemorrhages occur only upon the external 

 skin or also upon the mucous membranes. But the erroneous interpretation 

 of the presence or absence of arthritic affections in the hemorrhagic diathesis 

 had more influence than any other factor in preventing a true understanding 

 of the nature of the malady. The recognition of the fact that in every form of 

 the hemorrhagic diathesis the joints may be implicated did not come till much 

 later. The correction of this error may properly be looked upon as the most 

 important advance in the knowledge of the hemorrhagic diseases. 



Literature furnishes but a single autopsy report of the disease described 

 under the misleading term peliosis rheumatica. This case is from Traube's 

 Clinic, and is reported by Leuthold. It deserves special consideration, because 

 Traube was for a long time Schonlein's clinical assistant, and knew exactly 

 what Schonlein meant by the designation " peliosis rheumatica." The case is 

 briefly as follows : A carpenter, aged thirty-nine, after prolonged lifting in the 

 Clinic, developed slight pain in the joints. There was edema of the feet, and 

 upon the dorsum of both several small dark red areas about the size of a 

 pin's head appeared; these areas did not rise above the level of the skin nor 



