THE HEMORRHAGIC DIATHESES 



By M. LITTEN, Berlin 



There is a group of diseases in which the essential symptom is a tendency 

 to more or less extensive hemorrhage, which distributes itself over various 

 organs and thus becomes dangerous to life. 



We designate this tendency to external and internal hemorrhages, which 

 probably depend upon a change in the blood or in the blood-vessels, or in both, 

 as the hemorrhagic diathesis. The diseases which belong to this group, which 

 in some cases resemble one another so closely that it has sometimes been 

 thought possible to combine them as one disease, were formerly designated 

 " scurvy." But to-day there is much diversity of opinion as to how far this 

 division is Justified. 



In accordance with the present state of our knowledge, the following 

 groups will be considered separately: 1. Scurvy; 2. Hemophilia; 3. Morbus 

 maculosus Werlhofii. But even with these subdivisions it must be empha- 

 sized that our knowledge does not often permit a sharp separation ; the bounr 

 daries are partly artificial, being neither etiologically nor pathologico-anatom- 

 ically defined with accuracy. 



SCURVY 



By scurvy we understand a general disturbance of nutrition which rarely 

 occurs sporadically but usually epidemically, and almost always under the in- 

 fluence of unfavorable, unhygienic circumstances, particularly that of improper 

 food ; it is usually of insidious onset and slow course, and may terminate either 

 in complete recovery or in death. 



The disease is characterized by a severe general cachexia and by a series of 

 local disturbances chiefly due to a transitory hemorrhagic diathesis; this may 

 present symptoms that completely coincide with those of hemophilia, of pur- 

 pura hemorrhagica, or purpura rheumatica, but is sharply differentiated from 

 the first by the fact that the changes are hereditary in the former affection 

 and permanently present in the individual, while in the latter and in scurvy 

 we are always dealing with an acquired disease which is generally transitory, 

 and terminates in recovery or death, although frequently many relapses take 

 place. 



HISTORY 



The history of scurvy is exceedingly interesting and important as it dem- 

 onstrates most forcibly the progress of hygiene and of scientific investigation. 

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