366 GENERAL DISEASES. 



SCORBUTUS. (Scurvy.) 



This disease appeal's to result from imperfect nutrition under condi- 

 tions which cannot be considered in detail here, but which is usually at- 

 tributed to insufficient or inappropriate diet. The lesions are variable, 

 the most prominent being anaemia; extravasation of blood in the skiu ; 

 subcutaneous tissue and muscles; swelling and ulceratiou and bleeding 

 of the gums. Small and sometimes extensive haemorrhages are apt to 

 occur in the mucous membranes and on serous surfaces. Small ulcers 

 may form in the mucous membranes. Fatty degeneraton of the heart, 

 liver, and kidneys is not uncommon. The~spleeu may be large and soft. 

 No constant characteristic changes have been discovered, either in the 

 blood-vessels or the b.lood, which would satisfactorily account for the ex- 

 travasations and other lesions. 



The body is apt to decompose early. The skin may be mottled with 

 small and large purple, blue, brown, or blackish spots produced by de- 

 generative changes in the extravasated blood in the cutis. Sometimes 

 ulcers are produced by the perforation of effused blood on to the surface. 

 The joints may be inflamed, may contain serum or blood. Earely the 

 haemorrhages are followed by destruction of the cartilages and ends of 

 the bones. Very rarely there is haemorrhage between the periosteum 

 and bone, and in the bone itself, producing softening and destruction of 

 the bone, and separation of the epiphyses. The sternal ends of the ribs 

 are the most frequent seat of this change. Albuminous degeneration of 

 the heart, liver, or kidneys, and enlargement of the spleen, are common. 



Infantile Scorbutus. Infants (under two years) may develop similar 

 anaemia and tendency to haemorrhages. The most common location of 

 the haemorrhages is beneath the periosteum of the bones of the lower 

 extremities, especially of the femora, with separation of the lower epiphy- 

 ses. There may be haemorrhages in the skin and subcutaneous tissues, 

 the eyelids, and orbit, and in the internal organs. Haemorrhagic inflam- 

 mation and ulceration of the gums are usually limited to infants having 

 teeth and to portions of the jaw in which teeth are apparent or just 

 about to come into view. ' 



That some forms or phases of scorbutus are of infectious nature is 

 not improbable, but definite data in this direction are wanting. 



ACROMEGALIA. 



This rare disease is especially marked by an overgrowth of the ter- 

 minal portions of the extremities and of Jhe^ bones "oT'lne~facer > BTfl5 



1 For a study of scorbutus in infants, "Barlow's Disease," which was first recog- 

 nized in the United States by Northrup, consult Northrup and Crandall, New York 

 Med. Jour., May 26th, 1894. 



See also The American Pediatric Society's Collective Investigation on Infantile 

 Scurvy in North America, Trans. Amer. Fed. Soc., vol. x., 1898, p. 5. 



For a study of histological changes consult Jacobsthal, Ziegler's Beitr. z. path. 

 Anat., Bd. xxvii., p. 173, 1900. 



2 Several cases have been described in which there was enlargement of the hands 



