MORBUS MACULOSUS WERLHOFII 487 



ished by condensed Swiss milk; but with the use of B's milk it developed to a 

 great extent. Therefore, to summarize, Neumann has observed in the last 

 eighteen months twenty-one eases of Barlow's disease, of which twenty may 

 be referred to the use of the same millc. If these cases were left out of con- 

 sideration Barlow's disease would be as rare as formerly. Therefore, its in- 

 creased incidence may be referred to a purely accidental and perfectly recog- 

 nizable cause." 



PATHOLOGICAL ANATOMY 



Cases of simple purpura which terminate fatally are rare. If death occurs, 

 this is either the result of profound anemia after profuse hemorrhage or in 

 consequence of complications or sequels. For this reason autopsy findings are 

 very scanty. The cadavers are extremely pallid, also somewhat bloated, and 

 usually covered with hemorrhagic blotches, which have taken on the livid post 

 mortem discoloration of altered hemoglobin. The muscles and fatty tissue are 

 in most of the cases unchanged; only in very protracted cases is the latter 

 decreased. According to the intensity of the disease we find more or less 

 extensive hemorrhages upon the mucous and serous membranes, and under cer- 

 tain circumstances these cover large areas. Occasionally these hemorrhages 

 are distributed to an astonishing degree upon the mucous membrane of the 

 .bronchi, of the digestive canal, in the renal pelvis, ureter, bladder, etc. At 

 times the mucous membrane, if we strip off the inspissated blood crusts, may 

 show superficial erosions. Freshly effused blood is also occasionally found 

 in the mucous membranes of the bronchi with bloody mucus. This is also 

 noted in the renal pelvis and in the intestinal canal. In the cavities of the 

 serous membranes, in the pericardium, in the pleura, and in the peritoneum, 

 as well as in the cavities of the joints, besides small ecchymoses, we occasionally 

 find larger effusions of a purely hemorrhagic character, so that we are deal- 

 ing with hemopericardium, hemothorax, hemarthrosis, etc. We also find par- 

 enchymatous hemorrhages, particularly in the liver and kidneys; in isolated 

 cases the adrenals have been found containing bloody infarcts. In the mu- 

 seum collection at my hospital I have two such hemorrhagic adrenal infarcts, 

 each about the size of a medium-large apple. The spleen in a certain number 

 of cases, but by no means invariably, has been found enlarged; in isolated 

 instances it contains the same wedge-shaped hemorrhagic infarcts. In the 

 protracted cases running a febrile course there is cloudy swelling of the large 

 parenchymatous glands besides swelling of Peyer's patches and of the mesen- 

 teric glands. The same is observed in the bone-marrow, upon the endocardium, 

 the vascular intima and the neurilemma. The bone-marrow has been found 

 traversed by profuse and small hemorrhages. Pigment infiltration, due to 

 the decomposition of extra vasated blood,, has also been observed in different 

 organs, particularly in the lymph-glands. The pigment appears in flaky 

 masses and consists entirely of hydrated oxid of iron. 



Nothing is known of other constant changes; minute reports are lacking 

 in regard to the condition of the membranes of the joints and cavities, particu- 

 larly in those cases in which during life rheumatic pains were present. The 

 knee- and foot- joints are the ones which are chiefly attacked with arthritic 



