MORBUS MACULOSUS WERLHOFII 479 



tion " peliosis gonorrhoica " in my article upon this subject/ because I wished 

 to point out to the profession the external connection, and also that there 

 might be no misunderstanding of what I mean by the expression, but I shall 

 not consider further the form of joint affection with cutaneous hemorrhage 

 which arises in connection with gonorrhea. 



In the main, Schonlein's description is applicable to the milder forms of 

 rheumatic purpura. Some further explanation will be given in the descrip- 

 tion of the so-called Henoch's purpura. With the appearance of purpura the 

 arthritic pains generally cease. Not infrequently the purpuric spots are asso- 

 ciated with urticarial eruptions and edema of the dorsum of the feet and 

 ankles, as well as with erythema multiforme exsudativum. The disease may 

 run its course in a few weeks. Frequently, however, relapses occur with re- 

 newed arthritic pain and fresh eruptions of purpura, and the disease some- 

 times lasts for months, even from eighteen months to two years and longer. 

 Fever may be present or completely absent. 



The more intense the affection of the joint the higher the evening rise 

 of temperature. In very severe cases, in which the clinical picture may re- 

 semble acute articular rheumatism, we find prolonged febrile rises of a remit- 

 tent character. The affection differs from true typical articular rheumatism, 

 above all, by the absence of profuse sweats and of a tendency to endocardial 

 complications, to which the hemorrhages occasionally seen in true rheumatism 

 are to be referred. Nevertheless in rare and severe cases of rheumatic pur- 

 pura, the appearance of the diseased joints may very closely resemble that in 

 true acute articular rheumatism, even to such an extent that a differentiation 

 is impossible. In a case from Traube's Clinic reported by Leuthold, which 

 ran a fatal course, the condition of the joint differed nowise from the changes 

 which are observed at the autopsy in acute rheximatism (see above). How- 

 ever, no report of purpura rheumatica is known to me in which a purulent 

 effusion was met with in the joint cavities. If the disease is very much pro- 

 longed, anemic symptoms become noticeable as in acute rheumatism, among 

 others anemic cardiac murmurs. Only rarely is enlargement of the spleen 

 observed. 



Hemorrhages into the mucous membranes are not absent; thus Kaposi 

 found in one case hematuria, in another case, which terminated lethally, ecchy- 

 mosis with subsequent gangrene of the mucous membrane of the palate, while 

 Duhring described a bloody discharge from the genitalia. These cases resem- 

 bled the form, now to be delineated : Henoch's " purpura abdominalis." 



Henoch first noted in the year 1868 as a complication of purpura the fact 

 that the eruption of purpura and the arthritic phenomena may be accompanied 

 by a number of abdominal symptoms: Vomiting, hemorrhagic diarrhea and 

 colic. Henoch represented as characteristic the appearance of these symptoms 

 in paroxysms with an interval usually lasting several weeks, and occasionally 

 even as long as a year. In the earlier literature upon purpura, with the excep- 

 tion of a case by Wittan, there is no definite report of the occurrence of this dis- 

 ease in combination with joint troubles and severe abdominal symptoms. We 



1 Dermatologische Zeiischrift, xxx. 



