IX. EFFECTS OF DEFICIENCY IN HUMAN BEINGS 373 



connective tissue with few cells and much ungelled matrix. This zone, free 

 of trabeculae, is the roentgenologist's zone of rarefaction. The whole ir- 

 regular mass is the scorluitic lattice. The area of fibrous tissue in which 

 the irregular masses of cartilage are embedded in helter-skelter fashion has 

 been called the "Trummerfeld zone" (a field full of debris) and the "Geriist- 

 mark" (framework) in the German literature. 



Though ossification is slowed down or halted in the abnormal matrix, 

 resorption of bone continues, and the shaft and ossified center in the 

 epiphysis become thin and porous. 



These changes account for the x-ray pattern in the bones of scorbutic 

 infants. The white line of scurvy is the piled-up zone of provisional cal- 

 cification. The "halo" epiphysis is due to a similar white line surrounding 

 the epiphyseal zone of ossification with reabsorption of bone toward the 

 epiphyseal center. The radiolucent zone under the white line is the zone of 

 rarefaction through which nicking of the cortex and eventually fractures 

 and displacement of the epiphyseal end of the bone may occur. 



In general, the same abnormalities occur in the growdng flat bones but 

 they are not so conspicuous except at the costochondral junctions. 



Periosteal growth continues but in an abnormal fashion. A layer of cells 

 without intercellular material forms and separates periosteum from bone. 

 The subperiosteal hemorrhages begin at sites of fracture through the zone 

 of rarefaction and spread into this friable tissue, stripping the periosteum 

 back along the shaft and to, but not beyond, the epiphyses. 



In the teeth, growth of dentine ceases, the pulp becomes separated from 

 the dentine by liquid derived from odontoblasts. The dentine becomes 

 porous. Resorption of alveolar bone occurs, but new bone formation does 

 not take place. The teeth, therefore, become loose and fall out. 



It is presumed but not proved that similar changes occur in the capillary 

 walls. Intercellular cement substance is lost, and capillary fragility and 

 permeabilit}^ increase, leading to the petechiae, ecchymoses, and hemato- 

 mata. Rumpel-Leede and similar tests become positive. The gingival mar- 

 gins of persons with teeth are supplied by "end capillaries" which cannot 

 anastamose freely with adjacent capillary beds. A^Tien hemorrhages occur 

 in these vessels, thromboses and infarctions follow. The gums become 

 swollen, blue-red, and boggy with blood. Infection, so common around 

 poorly cared-for teeth of nutritionally deficient patients, spreads rapidly; 

 the mouth becomes foul and painful, and the gums infarcted and necrotic. 

 Alveolar bone is resorbed and patients frequently perform autoextraction. 

 Gum lesions never occur in the mouths of edentulous patients. 



Striated muscle is fragmented, and there is multiplication of sarcolemma 

 nuclei. This is not a specific pathologic lesion for it occurs in many diverse 

 diseases. Hemorrhage into muscle is conomon. 



