SCURVY 307 



Cozzolino (997). He recommended the frequent inspection of the 

 gums for the purpose of the speedy recognition of the disease. 



A sort of eczema was noted by Hess (I.e. 918) in 8 cases. In one 

 instance a symmetrical erythema was observed, resembling pellagra 

 erythema very strongly. Proptosis of the eyeball, following 

 hemorrhages, was observed by Cheadle and Poynton (I.e. 968) as 

 well as by Zilva and Still (I.e. 456). It occurs usually in the left eye. 

 Schodel and Naumwerk (998) observed enlargement of the right 

 heart; Hess (999) noted the quite common occurrence of polypnea 

 and tachycardia, apparently because of lesions in the pneumogas- 

 tricus. Erdheim (1000) also described heart lesions in Barlow's 

 disease. 



DIAGNOSIS 



From the foregoing, the clinical picture of scurvy is quite obvious 

 and becomes even more simple as, a result of the newer possible 

 differential diagnosis, by the administration of vitamine C. Changes 

 in the complexion, follicular changes in the skin, petechiae, sub- 

 cutaneous hemorrhages, hemeralopia, changes in the gums, feeling 

 of fatigue, shortness of breath, rapid pulse (about 140) all these 

 are specially characteristic of scurvy. Some times it may be confused 

 with rheumatism and perhaps with hemorrhagic diathesis. In 

 order to differentiate here, the anamnesis is of value as is also the 

 result of vitamine therapy. Occasionally the hematological investi- 

 gation may be used for the diagnosis, which, however, according to 

 Rosin (1001), shows an unspecific picture of anemia. The so-called 

 "tibialgia" of v. Schrotter was designated as scurvy by Labor 

 (1002). 



In the diagnosis of infantile scurvy, the "white line," described 

 by Frankel (1003) in the X-ray of the bones, has been regarded as 

 characteristic. It is a shadow which is apparent at the epiphyseal 

 ends of the long bones. This indication was observed by Brown 

 (1004) and by many others, although Hess (I.e. 918) did not believe 

 that it was significant in the diagnosis. He observed this shadow 

 also in cases of scurvy, which had been cured for a long time. Hess 

 and Unger (I.e. 759) have introduced a capillary resistance reaction 

 for the diagnosis of scurvy, which consists in the compression of the 

 arm for three minutes with a tourniquet, whereupon petechial spots 

 appear if scurvy is present. 



