MORBUS MACULOStJS WERLHOFIl 481 



While the pupura itself causes the patient great anxiety but does not actu- 

 ally give rise to suffering, other symptoms soon become prominent and are 

 much more troublesome, e. g., disturbances on the part of the intestinal tract 

 which are characteristic in that they generally resist all treatment. Patients 

 complain of severe colic-like pains in the abdomen, particularly in the umbil- 

 ical region, which are frequently so severe as to bend the patient's hodj, and 

 evoke loud cries. The abdomen is also retracted and sensitive to pressure; 

 the bowels at the beginning of the attack are constipated. These difficulties 

 are increased by a stubborn vomiting, which at first contains the food last in- 

 troduced, then consists of yellowish green bilious masses frequently admixed 

 with blood. The pulse becomes small and rapid; the facial expression shows 

 anxiety; the entire condition is a pitiable one. 



The constipation which is present at the onset soon gives way to a more 

 or less profuse discharge of thin yellowish feces often admixed with blood, 

 the occurrence of which sometimes coincides with the cessation of the pain. 



The. colic and the vomiting occasionally last for days; the patient eats little 

 or nothing. Now and then under the influence of severe retching, epistaxis 

 occurs. Gradually all of the phenomena ameliorate, the vomiting ceasing 

 first, then the abdominal pains, while the thin fecal discharges continue to 

 be voided from time to time until the period of apparent convalescence. 



The pains in the Joints have in the meantime ceased, and the purpura has 

 faded. In case none of the complications which are to be described have 

 appeared, the patient, aside from a certain exhaustion, is comparatively well 

 and believes that convalescence has begun. Occasionally no other attack 

 occurs, and convalescence proceeds uninterruptedly; in the majority of cases, 

 however, the symptoms are repeated, wholly or in part, after a period which 

 may vary from one day to several weeks, until finally recovery ensues. In 

 relatively rare cases death takes place. 



But a schematic course such as described is not the rule; in children the 

 typical clinical picture is most often seen. The frequent deviations and 

 manifold peculiarities observed in the course of most adult cases can best be 

 explained by a description of the individual symptoms. 



These will be minutely discussed under the special symptomatology, so that 

 at this place only a few concluding remarks will be made concerning this form 

 of purpura. 



Among the peculiarities, a group of cases must be mentioned (rare and 

 in part insufficiently described) in which the arthritic affection is entirely 

 absent, and, besides the purpura, only marked intestinal disturbances exist. 

 The duration of Henoch's purpura varies within wide limits; numerous eases 

 have been recorded lasting from seven days up to nine months ; as an average 

 duration, six to twelve weeks may be mentioned. 



The prognosis in children in the main is good — among nineteen cases there 

 was but one fatal case, and this was in consequence of acute nephritis. In 

 adults it is less favorable. In twenty-two cases recorded, five were fatal. 

 A definite opinion cannot be given on account of the paucity of records. 



We now reach a special manifestation of the disease, which was also de- 

 scribed by Henoch in 1887 under the name of purpura fulminans. I described 

 33 



