MORBUS MACULOSUS WERLHOFII 489 



lumen of the vessels appeared to have directly penetrated the intima per dia- 

 pedesm. But this latter observation explained the nature of the disease and 

 the occurrence of the hemorrhages as little as any of the previously mentioned 

 researches. 



Among the complicating processes which occasionally result in death I 

 shall enumerate the following: Large effusions into the pleura and abdomen, 

 pulmonary^ infarcts, purulent peritonitis, croupous-diphtheritic processes of 

 the small intestine, pneumonia, necrosis of the intestine, perforative perito- 

 nitis, gangrene of the large intestine with swelling of the mesenteric glands, 

 ecchymoses and ulcers of the descending colon. 



Kegarding the hacteriologic findings, besides those described in the etiol- 

 ogy, I should like to discuss here some further points. Tizzoni and Giovannini 

 isolated from a case of purpura hemorrhagica in which secondary impetigo 

 contagiosa developed, and upon which autopsy was held, a bacillus, the bacillus 

 hemorrhagicus velenosus. In the pustules of impetigo surrounded by the 

 purpuric areas of the skin this bacillus was found with the staphylococcus 

 pyogenes aureus ; it was also found in the liver and in the venous blood, but 

 not in the spleen nor in the kidneys. The staphylococcus was present in the 

 pure hemorrhagic foci of the skin, as well as in the kidneys. The bacillus 

 hemorrhagicus velenosus is immotile, 0.2-0.4 /t broad, 0.7-1.3 ^ long; it stains 

 ivell with anilin colors, but not according to Gram. Spore formation was not 

 observed; but there was a certain resistance to drying. The colonies showed 

 irregular contours which resembled coiled locks of hair, and did not become 

 fluid. In a stab culture they showed granular growth, and upon agar a 

 growth similar to that upon gelatin. In older cultures a pungent odor is 

 noticeable. Upon potato only a superficial growth of an indistinct nature 

 with a dark yellowish discoloration at the point of inoculation is observed. 

 Upon culture in bouillon moderate turbidity appears, later becoming mucoid. 

 The bacillus is pathogenic in rabbits, dogs, and guinea-pigs, but not in pigeons 

 and mice. The bacilli increase only locally with formation of edema. They, 

 however, give rise to fever, hemorrhagic nephritis, vomiting, hemorrhagic 

 diarrhea, cutaneous hemorrhages. Upon autopsy of the infected animals 

 there are found incoagulability of the blood, coagulation necrosis of the liver 

 and renal epithelium, with a normal condition of the spleen. Cultures steril- 

 ized at 70° C. produce albuminuria. Eepeated injections of such cultures 

 confer immunity to subsequent infection. 



Kolb,^ of the Imperial Bureau of Health, investigated bacteriologically 

 five cases of true idiopathic purpura: Among these were three cases of pur- 

 pura fulminans which terminated fatally after a brief course; the other two 

 cases recovered. Microscopic investigation, cultures and inoculation of the 

 blood taken from the living patient into mice, guinea-pigs, rabbits and pigeons, 

 gave no results. Positive results were, however, obtained by the hacteriologic 

 investigation of the cadavers. There were examined: {a) Blood from the 

 heart and from the portal vein; (&) some areas of the skin containing char- 

 acteristic purpura; (c) particles of hemorrhagic portions from the lung; {d) 



1 Arbeiten aus dem kaiserlichen Gesundlieitsamte, Bd. vil, 1891. 



