SCURVY 407 



junctiva, hemorrhages into the anterior chamber of the eye, or choroiditis 

 hemorrhagica have been noted. The subconjunctival hemorrhages may cause 

 loosening of the conjunctiva, and to such an extent that the membrane swells 

 out under the eyelid, frequently covering the eye-ball to a great extent. Occa- 

 sionally iritis also occurs. All of these symptoms may improve or may lead 

 to corresponding permanent changes. In very severe cases, bilateral pan- 

 ophthalmitis usually occurs and leads to entire loss of sight. These cases 

 invariably terminate fatally. Seggel observed in a mild case hemorrhages into 

 the vascular wall of the retinal vessels, besides frequent repetitions of sub- 

 conjunctival hemorrhages, and a swelling due to hemorrhage into the pia 

 sheath of the optic nerve with a slight cloudiness of the papilla. Not infre- 

 quently in the course of the disease, as prodrome, or as. sequel, hemeralopia 

 or night-blindness is observed — a condition in which the sense of sight is more 

 or less lost during dusk and at night. Nothing is known of the causal rela- 

 tion of the underlying affection to these phenomena. 



A particular and important group of symptoms is that affecting the tissues 

 constituting the joints, including the cartilage and the bone. Besides the 

 more or less widely distributed rheumatoid pains in the joints, painful swell- 

 ings of the latter, due to effusions, are observed. These latter may be purely ser- 

 ous, but more frequently consist of a sanguinolent fluid. Sometimes there is 

 also suppuration of the joint with subsequent erosion and deformity, and finally 

 true ankylosis. Inasmuch, however, as the affection usually terminates in re- 

 covery, these effusions are generally absorbed without ankylosis developing. In 

 the bones, particularly after mechanical injuries not necessarily at all severe, 

 hemorrhages occur, or inflammatory periosteal effusions between the periosteum 

 and the bone arise. Indurated and very painful swellings result, which, how- 

 ever, may slowly subside, or may lead to local necrosis and the formation of 

 sequestra. At the epiphyses the coverings of the cartilage become detached. 

 The long tubular bones of the lower extremities are chiefly attacked, next those 

 of the upper extremity, frequently also the ribs, in which case the process leads 

 to detachment from the sternum. The kind of aid given by scurvy to many 

 intercurrent affections may be suspected if we notice how in fresh cicatrices, 

 or in those previously formed, it produces a softening of the callus. 



During the progress of the symptoms described the constitutional condi- 

 tion of the patient deteriorates. He becomes cachectic looking, the fat and 

 the musculature gradually disappear. Fever may be absent, in other cases 

 may be slight, without conforming to any definite type. Decided rises in 

 temperature are generally due to complications or to suppuration. Sometimes 

 swelling of the spleen is noted ; this, however, can by no means be looked upon 

 as specific. The symptoms on the part of the heart correspond with those 

 of other anemic conditions — systolic murmurs and dilatation. Clinically the 

 most prominent symptoms are cardiac palpitation and dyspnea upon compara- 

 tively slight movement and exertion. The small, frequent, and slightly irreg- 

 ular pulse is notable. In the course of the disease endocarditis occasionally 

 occurs, but clinically, in the majority of the cases, can scarcely be recognized, 

 being anatomically characterized by a delicate circle of excrescences upon the 

 free border of the mitral valve or the aortic valve. Under some circumstances 



