MORBUS MACULOSUS WERLHOFII 475 



disappear upon pressure with the finger. At the malleoli (which, like all the 

 joints of the feet, were particularly tender to the touch) there were areas of 

 the same kind but of larger circumference. The temperature rose. A few 

 days later there was distinct swelling in the right knee-joint; in the following 

 night there were tearing pains in the joint and a further eruption of petechige, 

 which was most profuse upon the forearm and lower extremity, occurred in 

 groups or isolated in parts of the body excepting the thorax and the face. 

 Besides this, marked edema of the hands and erythema of the finger-joints 

 developed ; in the same region after the appearance of petechia in the following 

 night with swelling of the left knee-joint, large extravasations of blood oc- 

 curred, raising the skin in the form of tense vesicles. 



While some of the petechise became pale and disappeared, new crops of 

 hemorrhagic patches appeared simultaneously with an improvement in the 

 arthritic swelling. The fever during this time was partly of the continued 

 and partly of the intermittent type. Albuminuria was present. Among the 

 autopsy findings I shall only mention those of the diseased joints : In the right 

 knee-joint, which was somewhat distended, much colorless, viscid, ropy fluid; 

 the synovial membrane very pale, only in isolated areas in the upper part here 

 and there brownish points. The fatty areas show decided injection. The 

 semilunar cartilage is transparent, somewhat yellowish upon the border. In 

 the left knee-joint also much clear fluid and around the patella fenestration, 

 transudation and vascular injection; under the tendon of the extensor of the 

 knee, brownish extravasations, partly fresh, partly fading. 



" The pathologico-anatomical flndings in this obscure process which Schon- 

 lein has described as peliosis rheumatica, differ in no respect from the changes 

 shown at autopsy in the joints in acute rheumatism." Near this the impor- 

 tant note is- found : " Not markedly different from the findings in gonor- 

 rheal rheumatism." 



A patient in the course of gonorrhea was attacked by ileotyphus, which 

 caused death at the beginning of the eighth day. In the autopsy report the 

 following is noted : " The right knee is perhaps somewhat wider than the left 

 externally ; otherwise very little that is abnormal. Internally there was a very 

 marked, fine, dark-red injection of the ligamenta cruciata, as well as of the 

 entire capsule of the joint, besides a gelatinous edema of the same, most 

 developed around the patella. The cartilage of the joint and the semilunar 

 cartilage present nothing abnormal. The fluid in the joint is scant, some- 

 what more viscid and darker than normal. In their sequels also, genuine 

 rheumatism and gonorrheal rheumatism appear to have a certain similarity, 

 as may be noted from the observation of an endocarditis, which occurred in 

 connection with the rheumatism of a long-existing gonorrhea, and, therefore, 

 must be looked upon as dependent upon it." 



Thus far the facts ! Whether or not we recognize the existence of a clin- 

 ical picture such as Schonlein described and designated as peliosis rheumatica 

 must be left to the individual judgment. Probably all will agree on one 

 point, viz. : that if we adopt the name introduced by Schonlein we must under- 

 stand by it what he understood. Nevertheless we frequently find the nanie 

 used without any clinical picture in the remotest degree resembling the condi- 



