SCURVY 405 



that apparently the capillary vessels of the latter may be looked upon as the 

 starting point of the hemorrhage. The effusions of blood appear as though 

 punctured by the little hairs in this area. The hair then becomes dry, fibril- 

 lates, and falls out. The region about the nails is also frequently the seat of 

 hemorrhages; when these suppurate, the process often extends to the bed of 

 the nail so that it leads to paronychia, that is, an onychia scorbutica, as the 

 result of which the nail dies. The ulcers upon other parts, particularly upon 

 the lower extremities and the buttocks, may be of extraordmary size. Some 

 are covered with dark, firm crusts, some have a dirty base which is covered 

 with decomposed purohemorrhagic shreds of tissue, or flat granulations may 

 be seen which bleed at the slightest touch. Usually the ulcers secrete continu- 

 ously a thin hemorrhagico-purulent, sometimes even ichorous, fluid which ha,s 

 a most offensive odor. Unless cicatrization of the ulcers occurs previous to 

 general improvement (and this is rare) these frequently spread to the sur- 

 rounding tissues, or even invade them deeply, thus causing the erosion of 

 larger vessels and hemorrhages which may terminate fatally. But even with- 

 out this serious outcome these cutaneous ulcers are of bad prognosis, for their 

 profuse secretion greatly debilitates the organism. 



The hemorrhages into the subcutaneous connective tissue and into the 

 muscles may be widely distributed, and attain the size of a plate or even be 

 larger. Sometimes they develop acutely, sometimes slowly; in the former 

 ease they are usually accompanied by pain and an increase in temperature. 

 The skin above them, as a rule, can be but slightly moved or not at all, it 

 has a doughy sensation, is painful upon pressure and feels hot. In the case 

 of these subcutaneous hemorrhages the lower extremities are the chief seat, 

 as they are of peteehiffi, particularly the region of the tendo Achillis and the 

 popliteal space. At the onset there is noticed a soft swelling which later 

 becomes harder, and is finally as hard as wood. The margins of the tumor 

 are not always sharply defined. The skin above the swelling is not movable 

 and the swelling is often not sharply marked off from the surrounding tissues. 

 Over the swelling the skin shows decided redness and edema; it is shiny, hot 

 and painful. After a few days these symptoms ameliorate, and the redness 

 turns to a dull brown. Then absorption occurs, the skin desquamates, and 

 always retains a dark pigmentation. But the swelling may soften and even- 

 tually rupture, and a quantity of necrosed gangrenous tissue mixed with 

 blood sloughs away. The result is a deep ulcer. The course is, however, not 

 always so acute. The swelling and hardening may occur much more grad- 

 ually; pain and fever may be absent. Upon the skin there may appear the 

 signs of a more or less well-developed suggillation, according to whether 

 the process runs its course superficially or in the deeper tissue. As a matter 

 of course such foci decidedly limit the function of the muscles, whether^ they 

 are located in the muscles themselves or in the neighboring connective tissue. 

 When disease of the muscle is combined with disease of the connective tissue, 

 it is often impossible for the physician to make a differential diagnosis. In 

 the muscles quite isolated foci may be found which are characteristic in that 

 the integument over them scarcely shows change. These foci vary greatly in 

 the symptoms which they produce; some are circumscribed, some diffuse, 



