GENERAL DISORDERS OF NUTRITION. 



treme emaciation and a moderate oedema, particularly of the lower 

 extremities. The integuments are of a dirty, ashy hue, and are gen- 

 erally covered by dry detached epithelium. Here and there extrava- 

 sations of variable size are found in the tissue of the cutis as well as 

 in the subcutaneous and intermuscular connective tissue. Besides the 

 liq jid effusions of blood, hard coagulated infiltrations, stained red by 

 an admixture of blood, are almost always found beneath the skin, be- 

 tween the muscles ; more rarely within the muscles themselves. The 

 blood is remarkably liquid and dark in color. The walls of the vessels 

 and the tissues about them are deeply stained by it. In the cavities 

 of the pleura, pericardium, peritonaeum, and articular capsules, there is 

 almost always a serous or serofibrinous effusion, with an admixture of 

 blood. The lungs are more or less compressed by the pleural effusion, 

 while the uncompressed portion is the seat of a bloody cedema. The 

 liver, spleen, and kidneys, are studded with ecchymoses, and appear 

 relaxed and filled with blood, which also is extra vasated, and infiltrates 

 the tissues. Ecchymoses also exist between the serous and muscular 

 coats of the intestine. The mucous membrane of the intestine is red- 

 dened, swollen, and relaxed, and sometimes is in a state of follicular 

 ulceration. 



SYMPTOMS AND COURSE. The first signs of scurvy are usually 

 those of a general cachexia ; the patients complain of great debility 

 and lassitude, and particularly of a sense of excessive weight in their 

 lower limbs. Their spirits are deeply depressed, they can no longer 

 devote themselves to the slightest work, and are excessively sad and 

 despondent. At the same time the face of the patient loses its bright 

 hue and grows pale and muddy, the lips acquire a bluish, livid tinge, 

 the eyes sink into their sockets, and are surrounded by a blue ring. 

 These symptoms are usually accompanied by darting or piercing pains 

 in the limbs and joints, which might easily be mistaken for rheumatic 

 pains. It is not usual for the characteristic local manifestations of 

 scurvy to show themselves until the precursory symptoms have con- 

 tinued for some days or even for some weeks ; although CejJca has 

 often observed the disease to commence locally, the signs of cachexia 

 not appearing until the gums had grown very sore, and all the body 

 was covered with scurvy-spots. 



In our first volume we have described the scorbutic sore mouth in 

 detail. It is the most common and generally is the first of the loca. 

 symptoms of the disease. There are exceptions, however, to this rule 

 also. Cejka mentions instances in which sugillations, tense cedema 

 of the feet, and hard, painful infiltration of the connective tissue, pre- 

 ceded the bloody cedematous relaxation of the gums. The effusions 

 of blood into the tissue of the skin, mentioned above, sometimes take 



