SCURVY 303 



SYMPTOMATOLOGY AND PROGRESS OF SCURVY 



The primary stage in scurvy is characterized by a peculiar pale- 

 ness of the skin, apathy, melancholy, muscle weakness and slight 

 dyspnea. The skin becomes yellowish, dry and scaly, and is covered, 

 especially on the lower extremities, with petechiae and larger livid 

 spots, due to subcutaneous hemorrhages. In addition, there are 

 frequently pains in the lumbar region and the legs, often re- 

 garded as rheumatic. Changes in the skin are frequently noted; 

 thus Taussig (I.e. 932) reports an exanthema of the legs. AschofT 

 and Koch (981) describe small hemorrhages near the hair papillae 

 (piquete scorbutique), and an exanthema localized in certain parts 

 of the body, mostly observed in the scorbutic cases during the war 

 in Rumania and in the Carpathians. Similar skin changes were 

 described by Rheindorf (982). Wiltshire (983) saw among the 3000 

 cases of scurvy in the Serbian army numerous skin symptoms, which 

 he called "hyperkeratosis," a condition occurring in 87 per cent 

 of his cases; later he noted an exanthema of the petechial type, 

 localized in parts of the body, already mentioned by Aschoff and 

 Koch. Wiltshire also observed conical swellings around the hair 

 follicles, v. Niedner (984) observed that infectious exanthema 

 frequently assumes a hemorrhagic appearance in the presence of 

 scurvy. According to the paper of Sato and Nambu (I.e. 925), the 

 skin, as well as the subcutaneous tissue, is often edematous. 

 According to Wassermann (985), subcutaneous, diffuse, painful swell- 

 ings appear on the thighs; Speyer (I.e. 956) occasionally noted 

 abcesses on the calves. Swellings in the knee caps also appear. 

 The gums become dark red, soft and swollen, especially around 

 carious teeth, although this characteristic sign may be entirely 

 lacking. Sometimes the gums swell so that the teeth are entirely 

 covered. Zlocisti (986) described an ulcerous, gangrenous sto- 

 matitis. Aschoff and Koch noted a falling out of the teeth with 

 resultant hemorrhages. 



In later stages, the patients suffer very much from dyspnea and 

 palpitation; they faint easily, and heart weakness progresses. The 

 sufferers becomes markedly emaciated, the muscles become atrophic, 

 and contractions are seen at times. Scherer (I.e. 908) described a 

 tip-toe position, which he believed to be the result of hemorrhage; 

 Aschoff and Koch described a characteristic position which they 



