SCURVF. 813 



the form of small round petechiae, sometimes of vibices, and sometimes 

 of extensive ecchymoses. They almost always appear first upon the 

 lower extremities, and afterward spread over the rest of the body. 

 Regions exposed to the action of trifling mechanical violence are espe- 

 cially liable to become the seat of the ecchymoses. In the epidemic in 

 the house of correction at Prague, described by Cejka, the influence of 

 mechanical action was strikingly apparent. In most patients the hol- 

 lows of the knees were most affected, but, in wood-cutters and in per- 

 sons who worked at the spinning-wheel, the right arms were attacked. 

 Wool-combers and laundresses suffered in their forearms ; women in the 

 place where their garters pressed. The spots which at first were violet, 

 and of almost a blackish brown, pass through the well-known changes 

 of color peculiar to extravasations, blue, green, yellow, etc. When 

 new spots appear, while the old ones are fading, dark-blue and green- 

 ish-yellow spots are found simultaneously upon the skin. Sometimes 

 circumscribed effusions beneath the epidermis give rise to blebs filled 

 with a bloody liquid (purpura bullosa, pemphigus scorbuticus), which, 

 if they burst and are treated carelessly, may result in obstinate ulcers. 

 Ulcers also form in some patients after the receipt of trifling injuries. 

 They are characterized by the flabby, spongy, bleeding granulations 

 which cover their surface. The hard infiltration of the subcutaneous 

 and intermuscular areolar tissue forms rounded tumors beneath the 

 skin, varying in size from that of a hazel-nut to that of a fist, situated 

 usually upon the lower, more rarely upon the upper extremities, and 

 upon the belly, throat, and cheeks ; they cause more or less pain, and 

 are covered by a skin which either retains its normal color or else is 

 suffused by blood. Sometimes the indurations are extensive and dif- 

 fuse, covering the hams, the calves of the legs, and the inner surface 

 of the thighs. They are hard as a board, and, owing to the pressure 

 which they exert upon the muscles, they render all movement of the 

 affected limb impossible. The cutis remains immovable above this 

 diffuse induration, and is either of normal appearance or is suffused 

 with blood. Besides the bleeding from the gums, which, though not 

 always very profuse, is seldom absent, haemorrhage from other mucous 

 membranes occurs in some patients, especially epistaxis, haemoptysis, 

 metrorrhagia, and bleeding from the bowels. Ecchymosis of the con- 

 junctiva and effusions into the chambers of the eye, with malignant 

 ophthalmia, have occasionally been noticed. 



The inflammations of internal viscera, particularly scorbutic peri- 

 carditis and pleuritis, do not differ in any characteristic or peculiar man- 

 ner from primary inflammation. Voluminous effusions are often rap- 

 idly deposited, putting the patient in danger of suffocation ; but I have 

 also witnessed the rapid and unexpected reabsorption of large colleo 



