404 THE HEMORRHAGIC DIATHESES 



This description, after Henoch, corresponds to analogous processes in 

 scurvy with the exception of the necrosis of the jaw, and this probably occurs 

 very rarely in scurvy. Henoch, one of our greatest pediatric clinicians, in his 

 description of stomatitis fails to mention scurvy, and assigns no place to this 

 disease in his lectures upon diseases of children; I conclude from this fact 

 that he is of the opinion that the stomatitis of infancy has nothing in common 

 with scurvy and, moreover, that he has not observed scurvy in nurslings or in 

 the years of infancy.^ 



That there is, however, such a condition as infantile scurvy may be seen 

 from the American Collective Eeport, in which it is stated that among 372 

 cases which occurred during infancy, particularly during the period between 

 the seventh and fourteenth months, in only 16 cases were the gums unaffected; 

 in the remaining 313 cases there is mention of either swelling and loosening 

 of the gums or of ulcerative processes in the gums. Certainly, Henoch's cases 

 were not scurvy, for he reports in them no extravasations of blood into the 

 skin or the mucous membranes ; neither can we doubt that cases of ulcerative 

 stomatitis which are not of a scorbutic nature may occur also in adults. 



In view of the entirely different etiology of stomatitis and scurvy we must 

 clearly separate the oral affections of the two diseases, and we shall only refer 

 to scurvy if, besides the stomatitis, other symptoms, to be more minutely de- 

 scribed later, are also present. Among these are hemorrhages into the skin, 

 into the subcutaneous connective tissue, in the mucous and serous membranes, 

 into the joints, muscles, etc. 



The hemorrhages into the skin usually occur in the form of petechise which 

 vary greatly in size. They occur early and most profusely upon the lower leg, 

 particularly upon the extensor surfaces; the trunk and the other extrem- 

 ities are often affected later, the face invariably remaining entirely exempt. 

 If they appear in great numbers the impression is given that a paint brush 

 has been dipped in blood and spattered over these areas. Traumatic influ- 

 ences, a blow, pressure, especially such as is caused by the wearing of tight 

 clothing (garters, girdles, belts, etc.), not infrequently produce these hemor- 

 rhages and give to them a definite, under some circumstances a characteristic, 

 form and shape; for example, the form of streaks (vibices). Often an ex- 

 tremity is profusely covered with them, and, according to their age, they pre- 

 sent a dark red, brownish red, green or yellowish color, corresponding to the 

 well-known changes in color which extravasated blood or hemoglobin presents 

 when undergoing alteration. These hemorrhages have a special predilection 

 for the gluteal region, where they occasionally develop extensively. 



The first effusions into the skin frequently form around a hair follicle, so 



' In the latest edition of Henoch's book, in the description of Barlow's disease, there 

 is mention of a change in the gums, as follows : " To these symptoms almost invariably 

 is added a spongy swelling of the gums with fetor and tendency to hemorrhages as in 

 the case of scurvy, and this is most marked in the cases where teeth are already present." 

 Then follows another statement of importance : " For the present we may only assume 

 that we are here dealing (in Barlow's disease) with a form of the hemorrhagic diathesis 

 that has much in common with scurvy but does not appear to be identical with it." 

 A special description of scurvy is, however, not found in his latest edition. 



