Extracted from The American Journal of the Medical Sciences, December, 1893. 
PELIOSIS RHEUMATICA IN A BLEEDER. 
By T. D. Dunn, M.D., 
PHYSICIAN TO THE CHESTER COUNTY HOSPITAL, WEST CHESTER, PA. 
Through the kindness of Dr. Okie, of Berwyn, I present the report 
of this interesting case of peliosis rheumatica. Dr. Okie has given me 
the following notes made of the case prior to consultation with me: 
“ I first saw Robert L., aged eight and a half years, January 5,1893. 
Found slight congestion at base of both lungs. Carbonate of ammonium, 
counter-irritation, and cotton packing were prescribed. 
“ He was much better next day. I then noticed discoloration at top of 
right ear. As the weather was intensely cold, I supposed it had been 
frost-bitten. January 7th, ear much worse, discolored and enlarged, 
with many spots appearing on face, neck, and thighs. Pain in knees 
and ankles. Was then told for the first time that the boy had com- 
plained of pain in knees several days before he was taken sick. Put 
patient on salicylic acid and soda, grains each, every two hours, and 
wrapped the joints in cotton; also gave tincture of chloride of iron, 20 
drops, with acetate of potassium, 2 grains, every four hours. Temperature 
102-|° ; pulse 120.” 
Condition, January 8th, when first seen by me: Pain in joints im- 
proved but joints still tender and motion painful. Temperature 102° ; 
pulse 120 and feeble. Purpuric spots present on both ears, cheeks, neck, 2 
DUNN: 1J ELIOSIS RHEUMATICA in a bleeder. 
shoulders, back, legs, and ankles, and some spots over trunk ; also spots 
seen on gums, roof of mouth, and throat, which was sore. Swallowing 
painful and nourishment taken with difficulty. Ears, lips, eyelids, and 
chin greatly swollen and tender; conjunctivse ecchymotic and cedematous; 
some vesicles formed on right ear and cheek, but no tendency to exu- 
dative erythema or urticaria. Slight bronchial cough, but no pulmonary 
congestion. 
January 11. Slight increase of pain in joints, which quickly yielded 
on return to salicylic acid. The pain preceded the appearance of a few 
fresh purpuric spots. Temperature 100°; pulse 108. On account of 
weakness he was given, by suppository, quinine, digitalis, and small dose? 
of opium. 
13th. Swelling of ear, chin, and eyelids diminished, and general con- 
dition much improved. The accompanying photograph was taken on 
the eighth day of the disease. 
17th. Swelling of joints and tumefaction of face had entirely subsided. 
Temperature normal; pulse 100 and feeble. Liquid nourishment taken 
freely. No diarrhoea or mucous hemorrhages. Anaemia marked. Ex- 
amination of blood showed 3,000,000 corpuscles to the cubic millimetre, 
in proportion of 1 white to 500 red ; haemoglobin 60 per cent. ; numerous 
microcytes 11 to 3 micro-millimetres in diameter. Under continuance 
of iron, general tonics, and a nutritious diet, the patient rapidly im- 
proved, and February 1st, notwithstanding marked anaemia, was able to 
walk about the house. 
The subject of this interesting clinical picture is the sixth of a family 
of seven boys. They, as well as the father, suffer more or less from 
rheumatism in joints and muscles, but have no articular deformity. No 
tendency to hemorrhage has shown itself except in this little patient and 
an older brother, aged fifteen years. These have had frequent attacks 
of epistaxis from infancy and severe hemorrhages after trivial injuries. 
In 1888 I opened a large axillary abscess for Robert, which bled for 
some time. A profuse bleeding, lasting several days, followed the ex- 
traction of a tooth. An operation, which I performed on the father in 
1890, for necrosis of sternum, was not attended by unusual hemorrhage. 
Neither father nor grandfather of the patient was a bleeder. The 
grandfather, however, came from a very remarkable bleeder family, 
which I reported in The American Journal of the Medical 
Sciences, January, 1883. Of his three brothers, Mordecai died of 
hemorrhage of the stomach at forty; George, from same cause, at twenty; 
and Davis, from hemorrhage following venesection, at twelve. 
Professor Osier, in his Practice of Medicine, p. 318, states that “Schon- 
lein’s peliosis is thought by most writers to be of rheumatic origin ; and 
certainly many of the cases have the characteristics of ordinary rheu- 
matic fever, plus purpura. By many, however, it is regarded as a 
special affection of which the arthritis is a manifestation analogous to 
that which occurs in luemophilia.” 
This Gase certainly supports the latter view—as does the fact that the 
disease sometimes, appears in several members of the same family.