354 



ASCORBIC ACID 



If the overlying skin areas are not already involved in the hemorrhagic 

 state, they become discolored (yellowish-green) from the underlying hemo- 

 lyzed blood. Phlebothromboses are common in these areas, thereby in- 

 creasing induration, swelling, and pain. 



In 1752, James Lind^ described scorbutic skin lesions in the following 

 manner, which can scarcely be improved now, "The skin is dry, feverish, 

 rough and covered with several reddish, bluish or rather black and livid 

 spots equal with the surface of the skin resembling an extravasation under 

 it as it were from a bruise. These spots are of different sizes, from the bigness 

 of a lentil to that of a hand's breadth and larger. , . . They are usually to 



Fig. 7. Extensive confluent ecchymoses on the legs of a patient with scurv^^ The 

 ecchymotic areas were brawny and indurated. 



be seen chiefly on the legs and thighs, often on the arms, breast and tmnk 

 of the body; but more rarely on the head and face." 



Hemorrhages may occur into joints, causing swelling, pain, local heat, 

 and tenderness. Large joints subject to frequent trauma are usually affected. 

 The skin overlying the joint becomes discolored a dirty greenish-yellow 

 from the hemolyzed blood in and around it. Other signs of scurvy may be 

 so few that such patients are admitted to the hospital with the diagnosis of 

 rheumatoid arthritis. The incorrectness of this diagnosis becomes apparent 

 when the joint is aspirated and fresh or hemolyzed blood is obtained. 

 Hemorrhages of the splinter type appear under the nail beds lying side bj^ 

 side parallel to the long axis of the finger (see Fig. 8). They form a crescent 

 near the distal end of the nail. When they occur in scurvy, there are usually 

 many more of them than are ever seen in bacterial endocarditis. 



