490 THE TREATMENT OP DISEASES. 



and a disinclination for exertion either mental or physical. The patient usually 

 complains of pains in the limbs, which he generally attributes to rheumatism. He 

 seldom displays any anxiety about his health, and seems quite indifferent on the 

 subject. He is keenly alive to any change in the appearance of his companions, but 

 it is often a matter of no little difficulty to make him understand that he is suffering 

 in the same way, or that anything is the matter with him. At first his appetite 

 remains good, and his digestion continues tolerably perfect, but usually the bowels are 

 confined. After a time petechise, or little spots like flea-bites, make their appearance 

 on the legs and arms. They are small, of a reddish-brown colour, and are not 

 elevated above the surface of the skin. Besides these, larger spots of an irregular 

 shape, and apparently formed by the coalescence of several petechiae, are observ- 

 able about the lower part of the legs and on the feet. In many cases they so 

 closely resemble bruises as actually to be mistaken for the result of violence. The 

 general aspect of the patient is that of indifference or dejection. The face usually 

 wears a peculiar bloated appearance. The eyes are often puffed up so that the 

 patient looks as if he had been fighting. The gums present a peculiar condition, 

 which is nearly always present, and may be considered as being characteristic of the 

 disease. At a very early period they begin to swell at the edges, and this gradually 

 progresses so that the teeth are encroached upon, and eventually almost disappear 

 from sight in the huge fleshy masses which encompass them. The swollen gums are 

 spongy, of a dark red colour, and display a disposition to bleed upon the slightest 

 irritation. The teeth frequently become loosened in their sockets, and sometimes 

 fall out. As may readily be imagined, chewing is out of the question, and even 

 fluid nourishment is taken with difficulty. The smell from the breath, in conse- 

 quence of the state of the gums, is generally most offensive. The skin is very dry, 

 and often scales off with great readiness. 



As the disease progresses, large swellings or tumours make their appearance in 

 the bend of the elbow and at the back of the knee. The skin over these enlarge- 

 ments may retain its natural appearance or may become greatly discoloured. 



Whilst these symptoms are gradually progressing, the patient suffers greatly 

 from shortness of breath. He is frequently subject to attacks of fainting, and 

 these have been known in many cases to prove suddenly fatal. The intellect, as a 

 rule, remains unaffected, but listlessness is a constant symptom, and is often associated 

 with great depression of spirits. 



In confirmed cases the slightest blow or pressure breaks the skin, giving rise to 

 the formation of the most obstinate ulcers, which heal with the greatest difficulty. 

 They increase rapidly in size, and often eat into the flesh so as to lay bare the blood- 

 vessels and nerves, and even the bones. They often give rise to dangerous bleeding, 

 the exhaustion consequent upon which sometimes proves speedily fatal. 



A peculiar affection of the sight often makes its appearance during the course of 

 the disease. The patient can distinguish objects well enough by daylight, and even 

 at night can read a book held close to a candle, but the moment he passes from the 

 influence of the light he becomes absolutely blind, and has to be led about. 



We must now consider the best method of treating scurvy. This necessarily 

 consists of supplying the patient in the most easily assimilable form with that 



