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Malaria as a cause of purpura hemorrhagica 
William H. DEADERICK , M. D., Mariana, Arkansas. 
Purpura simplex is not of uncommon occurrence in malaria. 
Purpuric éruptions are also occasionally noted in hémoglobinurie 
fever. But when associated with genuine hemorrhages, constitut- 
ing the true morbus maculosus Werlhoffii, it is exceedingly 
rare, so rare indeed that 1 am able to find mention of only half a 
dozen cases. 
Eisenmann (1839), Wenmarning (1846) and Tchouprina (1897), 
are said to hâve seen such cases (1). 
Bastianelli and Bignami (2) report a case of chronic malaria 
complicated by Werlhoff’s disease. In addition to severe cuta- 
neous hemorrhages there was bleeding from the gu ms, ears, and 
nose. Estivo-autumnal parasites were found in the blood. 
Hirtz and Bernheim (3) report a fatal case complicating chro¬ 
nic malaria. Besides the purpuric hemorrhages upon the skin and 
the mucous membranes of the lips, mouth and nose there was 
abundant épistaxis. 
The case of Marchiafava and Bignami (4) was in the person of 
a woman who was three months prégnant. After having suffered 
for two days with headache she was seized with bleeding at the 
nose which, beginning as a slight oozing, constantly increased 
in quantity until she was in an extremely weak State. The skin, 
especially that of the neck, breast and abdomen, was covered 
with hemorrhages and bleeding from the gums and nose'conti- 
nued. The day after the bleeding began the température was 104 0 , 
the puise small and frequent, the respiration hurried, the skin 
earthy in color, and the spleen a little enlarged. The blood con- 
tained an enormous number of unpigmented endoglobular para¬ 
sites. Heroic doses of quinine were injected hvpodermicallv. On 
fi) Cited by Mannaberg, Malarial Diseuses, Philadelphia, 1905. 
(2) Bastianelli and Bignami, Bull. del. Soc. Lancisiana, Rome, 1890, 
IX, x. 
(3) Cited by La ver an. Traité du Paludisme, Paris 1907. 
(4) Marc hiafava and Bignami, Summcr-Autumn Malarial Devers, London, 
1894. 
