EFFECTS ON THE SKELETON 



151 



The skeletal changes in human adult scurvy have been described recently by 

 Aschoff and Koch ('19), Bierich ('19) and Comrie ('20). In children, scurvy was 

 long confused with rickets. Infantile scurvy was first clearly demonstrated by 

 Barlow ('83, '94) and is therefore commonly known as Barlow's disease. At 

 that time but little was known of the essential histological changes in the 

 skeleton during infantile scurvy, the details of which have since been thoroughly 

 investigated by numerous workers. Naegeli ('97) was the first to give a detailed 

 description of these changes, which have been confirmed and extended by 

 Schmorl ('99, '01, '07), Schodel and Nauwerk ('00), Jacobsthal ('00), Looser 

 ('05), Erdheim ('18), and others. Fraenkel ('04, '06, 08,) has studied especially 

 the skeletal changes as shown by the Rontgen-rays, including the so-called 

 "white line." The pathology and pathogenesis of scurvy have also been 







.c 



■ Jfe* 



**W-2*ff?5£?? 



Pig. 55. — From a photograph of a portion of a section through the costochondral joint of a 

 normal guinea pig; body weight 236 g. C, costal cartilage; Z, zone of enchondral ossification 

 (bony and calcified cartilaginous trabeculae, and invading marrow) ; M, costal marrow; D, 

 bone of costal diaphysis; P, costal periosteum and adjacent intercostal muscle. Zenker 

 fixation; hematoxylin-eosin stain. X40. (Preparation by Everett Rowles.) 



reviewed by Vincent ('04), Lesage I'n), Schmidt ('21) and especially by 

 Hess ('20). Hojer's ('24) recent monograph is excellent. 



The gross skeletal lesions include osteoporosis, with fragility and thinning of 

 the cortex in the shaft of the long bones, and frequent occurrence of fractures in 

 severe cases. Enlargement of the costochondral joints occurs, and has frequently 

 been mistaken for rickets (cf. Hess '20; Hess and Unger '20). The general 

 hemorrhagic condition in scurvy is manifested in the skeleton by frequent sub- 

 periosteal and marrow hemorrhages. The bone marrow undergoes changes, 

 becoming more fibrous or gelatinous in appearance, especially at the ends of the 

 long bones. Hemorrhages and fractures with enlarged calluses are most 

 frequent in pre-adult cases at the junction of the diaphysis with the epiphyseal 

 cartilage. 



The microscopic changes in the skeleton have been studied in detail, espe- 

 cially during infantile scurvy. Although there is much variation in different 



