408 THE HEMORRHAGIC DIATHESES 



it runs its course with the symptoms of ulcerative endocarditis. It is to b( 

 hoped that we may succeed in discovering in the endocardial deposits tb 

 pathogenic agent of the disease, which so far has been unsuccessfully lookec 

 for in the blood. On the part of the digestive tract we have occasional diar- 

 rhea which may be of a dysenteric character. Several times the combinatior 

 of scurvy with true dysentery has been observed. Kidney troubles are com- 

 paratively slight ; occasionally transitory albuminuria is met with, without oui 

 being able to conclude from this the presence of genuine nephritis, which is s 

 rare complication. Eeports of marked hematuria are rare. The urine is fre- 

 quently of a dark color, which Kretschy ascribes to an increase of the normal 

 coloring material due to a greater destruction of red blood-corpuscles. In se- 

 vere cases the quantity of the urine, especially during the progress of the disease, 

 is greatly diminished; peptonuria occurs as well as albuminuria. According 

 to V. Jaksch the peptone does not originate in the blood itself, but from the 

 hemorrhages of the skin, of the subcutaneous cellular tissue, etc. To this he 

 ascribes the origin of the profuse urobilin. 



Of course, special importance has been attached to the amount of potash 

 in the urine, but the reports regarding the quantity found are very contra- 

 dictory. Phosphoric acid is said to be increased; unquestionably the amount 

 of uric acid is great, especially at the height of the disease, but it rapidl^v 

 decreases with beginning convalescence. 



In the blood, apart from Klebs' questionable nomads, nothing character- 

 istic has been found. The findings correspond in the main with those of severe 

 anemia. The amount of hemoglobin is decreased, and in severe cases not only 

 the number of erythrocytes but also their hemoglobin contents; poikilocytes 

 and microcytes I myself have frequently found, some with basophilic granula- 

 tions. Particularly common is the form of achromic cell described by me 

 resembling a pessary. Penzoldt also reports the presence in the blood of 

 granular, and some markedly refractive, bodies which he looks upon as embry- 

 onic forms of red corpuscles. Macrocytes also are said to have been found 

 in large numbers. According to the reports of Laboulbene the number of 

 leukocytes is increased ; this I am unable to confirm from my own observations. 

 The reports are contradictory regarding the amount of iron in the blood. 

 According to Opitz and Schneider it is somewhat increased; according to 

 Duchek it is nearly normal, and according to Becquerel, Eodier and Chalvet 

 it is decidedly decreased. The latter has also determined a decrease in the 

 amount of potassium. 



As a result of our review of the great number of accounts of severe symptoms 

 m past epidemics we must emphasize our impression that, at least in Germany, 

 the severe forms of the disease are now only very rarely observed. 



Frequently the symptoms are limited to great lassitude, pain in the joints 

 and limbs, extensive hemorrhages into the skin and elsewhere, and more or 

 less decided hemorrhagic inflammation of the gums. In these cases the entire 

 course is comparatively short. 



Scurvy may terminate in death or in complete or partial recovery. Gen- 

 erally recovery is exceedingly slow, and weeks and months pass before the 

 rlifterent processes have run their course. The disease of the gums, if great 



