SCURVY 401 



infarcts over which the capsule of the spleen shows the remains of an inflam- 

 mation that has run its course (circumscribed perisplenitis). The kidneys 

 rarely reveal pathologic changes ; only when much albumin has been excreted 

 in the urine a more or less advanced parenchymatous nephritis may be noted, 

 while milder grades of albuminuria leave no trace. 



Amyloid degeneration of the kidneys I have never seen in scurvy, and this 

 as well as infarcts appears to occur very rarely. However, hemorrhages under 

 the capsule, and into the mucous membranes of the urinary passages, are not 

 rarely met with. 



The pleurse and the pericardium are very frequently covered with hemor- 

 rhages. The pleural cavities and the pericardium occasionally contain very 

 large amounts of a slightly hemorrhagic fluid or even pure blood. Fibrinous 

 deposits are not rare. 



The heart nluscle is pale, flaccid, often permeated by hemorrhages, occa- 

 sionally showing fatty degeneration. The valves are intact, provided an acute 

 endocarditis has not "complicated the course of the disease; if so, the signs 

 of an acute endocarditis verrucosa or ulcerosa may be met with. 



In the lungs there is usually hemorrhagic edema and hypostatic congestion 

 in the lower lobes posteriorly; occasionally, as severe complications, croupous 

 pneumonia or hemorrhagic infarcts, but rarely gangrene. The mucous mem- 

 brane of the respiratory passages is often covered with petechife and with a 

 hemorrhagic mucus; there is edema of the larynx. 



Besides fatty degeneration and occasionally hemorrhagic imbibition of the 

 heart muscle, the same changes are found in the muscles of the body, particu- 

 larly those of the back, thigh and arms. 



SYMPTOMATOLOGY 



The disease is characterized by two main groups of symptoms: 1. By an 

 intense swelling of the gums combined with loosening and hemorrhage, to 

 which are often added ulceration and decomposition with extreme fcetor ex 

 ore; 2. By numerous extravasations of blood under the skin, in the mucous 

 membranes, in the coats of the eye, in the muscles, into the cavities of the 

 body, into the joints, under the periosteum, etc. ; these give rise to further dis- 

 turbances which are to be looked upon partly as mechanical, as, for example, 

 the pressure of the intrapericardial effusion of blood upon the heart. In 

 severe cases a general cachexia of the most serious nature is added. This 

 cachexia is usually the first, and for a long time the only, symptom of the 

 disease, and as a rule appears gradually. At first the patients are languid and 

 show a loss of energy, without, at the onset, being unable to follow their usual 

 occupations; the lassitude, however, increases steadily, even slight exertion 

 becomes difficult, and gives rise to palpitation and dyspnea. To this is added 

 as a very important and almost constant symptom pain in the limbs, and partic- 

 ularly arthritic ^pains, which are of marked rheumatic character and may occur 

 in all the joints, but which, as a rule, are generally localized to the lower ex- 

 tremities, and are, therefore, not infrequently confounded with Schonlein's 

 peliosis rheumatica. Increasing weakness and sensitiveness upon exertion, and 

 absolute loss of appetite are combined with a growing sensation of chilliness, 

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