MORBUS MACULOSUS WERLHOPII 495 



especially rapid regeneration and show no morphologic changes, except that 

 Spietschka found after protracted hemorrhages nucleated red-blood cells with 

 polychromatophilie protoplasm. In two cases of hemorrhagic purpura he 

 made frequent blood-examinations, counting the blood-corpuscles, estimating 

 the hemoglobin, and staining permanent preparations with gentian violet and 

 aurantia. In one case the number of blood-corpuscles in the hemoglobin re- 

 mained constant ; in another only showed transitory variations. In both cases 

 after each severe hemorrhage a conspicuously large number of erythrocytes 

 showed distinct nuclear staining. Spietschka looks upon these nucleated 

 blood-corpuscles as juvenile forms, and regards their appearance as a sign of 

 a markedly increased regeneration of the blood. 



In a child which died of anemia following purpura hemorrhagica, Billings 

 found in the blood only 500,000 to 700,000 red, 4,000 white corpuscles, and 

 17 per cent, of hemoglobin; 75 to 80 per cent, of the leukocytes showed no 

 mononuclear forms ; no poikilocytosis, no nucleated reds. The blood findings, 

 in the absence of signs of blood regeneration, resembled those of pernicious 

 anemia. 



According to my own numerous investigations, the hemoglobin is fre- 

 quently greatly decreased; more so than would correspond with the diminu- 

 tion in the absolute number of the red blood-corpuscles. 



Silbermann found in a case of Henoch's purpura most of the red blood- 

 corpuscles normal, a few containing but little hemoglobin, others entirely with- 

 out color ("shadow-corpuscles"). The leukocytes were numerous and rap- 

 idly deliquesced; the blood-plaques were markedly increased. To determine 

 any functional damage in the morphologically intact red blood-corpuscles, their 

 properties were tested according to the method of Maragliano: 1. After en- 

 closure in paraffin; 2. After heating; 3. After compression; 4. After mixture 

 with 0.6 per cent, salt solution. The result of this investigation was the follow- 

 ing : In the fresh blood examined under paraffin, he found normal erythrocytes 

 with few exceptions, and very numerous leukocytes. Two hours later, in the 

 same preparation, numerous "shadow-corpuscles" were seen, many feebly 

 stained red blood-discs, and a few microcytes ; the majority of the white blood- 

 corpuscles were destroyed. In their place there was found a granular, grayish 

 white heap. Five hours after the enclosure of the blood in paraffin but few 

 blood-corpuscles were to be seen, the majority of them being completely de- 

 stroyed. In the fresh, undiluted blood the red discs were destroyed by slight 

 pressure exerted upon the cover-glass with a needle ; the same occurred upon 

 heating of the blood at 30° C. In 0.6 per cent. NaCl solution a great number 

 of the red discs lost color at once; the white blood-corpuscles were very soon 

 destroyed, and formed glassy clumps. In sharp contrast with the results just 

 described are the blood-findings during the days of the disease when the patient 

 was still quite well. In this blood neither shadows nor numerous leukocytes 

 are to be seen, nor even greatly increased blood-plaques; tmder the mfluences 

 previously mentioned the erythrocytes show a normal resistance, i. e., they 

 neither lose color very rapidly, nor are many of them destroyed. 



For many years I have examined minutely the blood of patients attacked 

 by various forms of purpura, and have found by no means uniform results. 



