488 THE HEMORRHAGIC DIATHESES 



symptoms in purpura; for the present we must content ourselves with this 

 fact, and await further knowledge and results from the autopsy findings of 

 the milder forms of the hemorrhagic diseases. In a case of peliosis rheuriiatiea 

 from Traube's Clinic, upon which an autopsy was held, the findings in the 

 joints did not differ from those of acute articular rheumatism and gonorrheal 

 rheumatism (see above). The autopsy report is as follows: The right knee 

 appears somewhat thicker than the left. In the external parts there is little 

 that is abnormal ; but in the interior of the joint is a very marked, fine, dark 

 red injection of the ligamenta cruciata, as well as of the entire capsule of the 

 joint, besides a gelatinous swelling of the same, especially marked about the 

 patella. The cartilage of the joints and the semilunar cartilage show no 

 abnormality. The fiuid of the joint is scant, somewhat viscid, and darker than 

 normal. 



In the main no constant changes have been found, not even such as might 

 be referred to anemia. The valvular apparatus of the heart is invariably 

 intact; in one case of fulminant purpura described by me there was a slight 

 deposit of fine warty excrescences upon the free border of the mitral leaflet, 

 as occurs so frequently in any disease running an acute course. But even these 

 have in other cases been entirely absent. 



I shall revert later to the changes in the blood, that is, in its composi- 

 tion ; here I will only briefly mention that some authors have found the coagu-, 

 lability of the blood to be diminished, a finding which still requires con- 

 firmation. 



The spleen and lymph-glands show no constant alterations, but the former 

 organ has repeatedly been found enlarged, and pappy softening of the pulp 

 has been noted (Billroth). It remains a question whether this is not due to 

 post mortem change. 



The kidneys occasionally reveal a condition of hemorrhagic infiammation. 

 In cases of chronic albuminuria I several times observed isolated small-celled 

 foci of infiltration in the cortex. In other cases in which albuminuria had 

 existed for many months these were absent. 



Hemorrhages upon the retina, as well as upon the cornea, have been deter- 

 mined during life and confirmed post mortem. Upon microscopic investiga- 

 tion of the eyes in question I found the vessels intact in both membranes of 

 the eye, which is by no means the case in analogous hemorrhages in the eyes 

 of patients with renal disease. More frequently meningeal and cerebral hem- 

 orrhages have been found at the autopsy, but these have been looked upon as 

 the cause of the epileptiform attacks and paralyses which had occurred dur- 

 ing life. 



The changes in the vessels in the course and in the vicinity of ecchymoses 

 have been described explicitly in the etiology, and the investigations of 

 V. Kogerer, Kiehl and Leloir have been mentioned. Hayem states that throm- 

 boses have formed in the finer arteries by the agglutination of leukocytes. 

 Other authors found amyloid degeneration of the capillaries in the vicinity 

 of the petechias (?). Stroganow, whose investigations I have already re- 

 ferred to, discovered in the aorta, in the vena cava, and in the veins of the 

 liver infiltrations of the intima with red blood-corpuscles which from the 



