482 THE HEMORRHAGIC DIATHESES 



an analogous clinical picture nine years previously, in the year 1878, and also 

 described it and pictured it accurately in 1881, without, however, giving the 

 condition this very descriptive name. In all of these cases there is an ex- 

 tensive cutaneous hemorrhage which rapidly leads to death, of which Henoch 

 himself has seen three cases, while a fourth was described in 1886 by Charron 

 in Brussels. 



All these cases have in common the feature that hemorrhages upon the 

 mucous membranes are wholly absent, but with great rapidity, extensive 

 ecchymoses appear which, in a few hours, change the entire skin of the ex- 

 tremities to blue and dark red, and represent a dense bloody infiltration of the 

 cutis. The formation of hemorrhagico-serous vesicles upon the skin occurred 

 in two cases, but gangrene has never been noted and no fetid odor has been 

 observed. The course is exceedingly rapid; within twenty-four hours after 

 the formation of the first purpura death occurred; the longest duration was 

 four days. No complication was present, and, with the exception of general 

 anemia, the autopsy showed an entirely negative condition; there was no sign 

 whatever of embolic or thrombotic processes. One of Henoch's cases devel- 

 oped two days after the crisis in pneumonia, another one and a half weeks 

 after a very mild scarlatina. In both of the other cases, as well as ia mine, 

 there was absolutely no known etiology. Two analogous cases have been 

 since published by Strom and Arctander. The first of these followed scarla- 

 tina; there is no autopsy report. According to Herve three similar cases 

 were previously reported (1888) by Guelliot. 



Before describing my own case, I shall briefly mention one of Henoch's: 

 A boy, aged five ; crisis in pneumonia upon the 22d of November. Since then 

 complete euphoria. During the night of the 24th, sudden pains in the left 

 leg ; toward morning purpuric areas upon the chest and thighs, an hour later 

 upon the arms and lower legs. At eleven o'clock in the morning the entire 

 posterior and lateral area of the left thigh was of a bluish black color ; toward 

 evening also the left calf and the right knee. Temperature 101.8° P. In no 

 organ could anything abnormal be detected. During the night of the 24th 

 the entire right leg with the exception of the foot became bluish black. Great 

 apathy and weakness; urine normal. At two o'clock in the morning death 

 in collapse. Autopsy absolutely negative. 



My own case occurred in a man, aged twenty-eight, a tinsmith, who upon 

 the 23d of March, 1878, was admitted to Frerichs' Clinic in a comatose con- 

 dition, and died upon March 25th. No history could be obtained from the 

 patient nor from the relatives. Only this much was certain, that he was well 

 and able to work two days previously. The disease began upon the morning 

 of the 21st. At that time the patient is said to have had a severe chill which 

 forced him to go to bed. A physician who was called the next morning noted 

 high fever and ordered his removal to the Charite. The diagnosis of typhus 

 fever was made. 



March 23d, nine o'cloch. Patient, a very muscular man, is comatose, con- 

 stantly mumbling, beating the air with tremulous hands, and continually throw- 

 mg himself about in bed. The face appears congested, markedly cyanotic, 

 and icy cold. The middle of the upper lip shows a protrusion resembling a 



