494 THE HEMORRHAGIC BIATHESES 



finally disappears spontaneously without any medication. In other (but 

 much rarer) cases of morbus maculosus Werlhofii, contracted kidney develops, 

 becomes chronic and gradually leads to death. According to my observations 

 of many cases, even after a simple albuminuria (i. e., without casts and leuko- 

 cytes) has existed for many months, the hope of recovery must not be given up, 

 for this condition may disappear as suddenly as it arose. 



In regard to the changes in the eye, retinal hemorrhages have occasionally 

 been observed; they sometimes show white centers. Hemorrhages have also 

 been noted in the choroid and in the sclera. The flow of tears may also show a 

 reddish discoloration. Nettleship saw bilateral neuritis after purpura. 



We have no definite knowledge of the causes of febrile phenomena which 

 either precede the cutaneous hemorrhages or occur in the course of the same, 

 and which also are not rarely absent. A more exact insight into these condi- 

 tions can only be obtained when the etiology of the disease has been estab- 

 lished. One fact which I have demonstrated repeatedly appears worthy of 

 mention : even high temperatures may not be influenced in the slightest degree 

 by extremely profuse hemorrhages from internal organs (kidney, lungs, in- 

 testines). 



In a case of intermittent fever with temperatures up to 103.2° P. which 

 Kaltenbach observed for a long time, defervescence occurred by lysis. The 

 case was not a typical one. Sudden appearance of high temperature is always 

 suspicious, and points to the existence of some complication. 



Hemorrhages from internal organs are, in the main, rare; apart from the 

 likewise quite rare epistaxis, renal hemorrhages occasionally occur as the ex- 

 pression of a recent hemorrhagic nephritis; very scanty hemorrhagic casts 

 with normal and abnormal red blood-corpuscles in the urine determine the 

 diagnosis. The amount of albumin in such cases is always very great. Be- 

 sides the hemorrhagic form of nephritis, we may also see during the course of, 

 and in immediate connection with, the disease, a nephritis without hemor- 

 rhagic constituents. This form very frequently gets well ; in rare cases, how- 

 ever, it may lead to edema and uremia. 



Pulmonary hemorrhages rarely occur in persons with previously healthy 

 lungs. If it is certain that hemorrhagic sputum is present, the first assump- 

 tion should be that the blood may come from the bronchi. Among other hem- 

 orrhages which are, however, most uncommon, I must mention meningeal and 

 cerebral hemorrhages. 



Regarding the condition of the spleen but very little can be said ; it is cer- 

 tain that in some cases distinct enlargement has been determined and the 

 organ has been felt below the ribs as a more or less soft tumor. In the great 

 majority of cases, however, this enlargement is absent during the entire course 

 of the disease, even in the severest type, of hemorrhagic purpura running a 

 fulminant course. 



The composition of the Hood in cases of pure hemorrhagic purpura is men- 

 tioned by some authors as having shown a slight decrease of the red and an 

 increase of the white blood-corpuscles. 



Ajello found the red decreased to 2,500,000 to 3,000,000, while the specific 

 gravity of the blood was 1.043. The erythrocytes are said to undergo an 



