476 THE HEMORRHAGIC DIATHESES 



tion described by Schonlein. I shall mention here only the well-known cases 

 of Bamberger/ the description of which the author introduces with the words : 

 " The so-called peliosis rheumatica in the lower extremities often occurs in 

 Bright's disease. I find five cases of this kind among my observations. Usu- 

 ally the purpuric areas remain unchanged for many months. What connec- 

 tion exists here, if we do not use general expressions, is not at present clear. 

 In two instances an autopsy was held : I shall briefly describe the cases : 



" 1. A man aged thirty-nine, always well, admitted to the hospital on ac- 

 count of pain and hemorrhagic areas upon the lower extremities. After some 

 days edema; great amount of albumin. Pleurisy. Death. At the autopsy 

 hemorrhages were found in the skin, upon the mucous membrane of the stom- 

 ach, and in the kidneys. 



" 3. A woman aged thirty-six. Besides the usual symptoms of Bright's dis- 

 ease, there was stenosis of the mitral valve, also engorgement of the liver. 

 Purpuric areas upon the lower extremity had existed over a year. Death due 

 to apoplexy. Autopsy. Fresh hemorrhagic focus in the brain; stenosis of 

 the mitral valve ; wedge-shaped infarct in the spleen ; pneumonia and chronic 

 nephritis." 



These cases do not in the least resemble the clinical picture of Schonlein; 

 in each case he was dealing with a chronic nephritis with purpura the result 

 of cachexia and the hemorrhagic diathesis due to this (peliosis cachecticorum). 

 Bamberger here uses the designation " peliosis " as synonymous with " pur- 

 pura," and has no reason to speak of a rheumatic form as he in no way indi- 

 cates any disease of the joints. If one searches for the etiologic relationship 

 of the symptoms, one must surely find it in the loss of albumin which caused 

 the cachexia, and in the hemorrhagic diathesis dependent upon this. 



I have seen great numbers of cases with hemorrhages such as Bamberger 

 described, in chronic nephritis as well as also in old valvular lesions of the 

 heart, and have only here described these in order to show that the clinical 

 picture presented by prominent clinicians a comparatively short time after 

 Schonlein's teaching was so obscured that nothing was left of it but a pecul- 

 iar type of cutaneous hemorrhage. That this has been generally looked upon 

 as the main symptom of the affection is shown by an examination of the 

 literature. Here we are forcibly impressed with the fact that, step by step, 

 from the great group of purpura varieties which ran their course with arthritic 

 symptoms, one particular form was arbitrarily separated and presented as an 

 independent disease. As the number of cases accumulated it became clearer 

 that arthritic affections may occur, and do occur in every variety of hemor- 

 rhagic disease. Soon, without an exception, all those cases were described as 

 peliosis rheumatica in which the two symptoms were found. If the cases hap- 

 pened to differ very widely from Schonlein's description they were explained as 

 a form of peliosis with " an atypical course." Thus it came to pass that nei- 

 ther a definite form of hemorrhage nor any special type of Joint affection was 

 considered typical of the clinical picture in question, and on the other hand no 

 importance was attached to etiology. 



1 Wiirsiburger med. Zeitschr., Bd. i, 1860. 



