410 THE HEMORRHAGIC DIATHESES 



in such cases, the diagnosis is difficult, it must be remembered that scorbutic 

 hemorrhages are generally of an inflammatory character, while in the other 

 diseases this is by no means the case. Finally, it must be borne in mind that 

 in scurvy we have excellent therapeutic measures under the action of which 

 the symptoms usually disappear rapidly, while in the majority of the other 

 diseases therapy is for the most part of no avail. 



PROGNOSIS 



While the prognosis during past historic epochs was usually very grave, 

 to-day, fortunately, it is very favorable, especially in cases other than the most 

 severe. ISTaturally, we must be cautious in prognosis, for even in mild and 

 moderately severe cases intercurrent affections may bring about death. The 

 earlier the therapy is begun the more favorable the ultimate result and the 

 shorter the course, although even under favorable circumstances it always 

 requires considerable time for the patient completely to regain his strength. 

 Complete recovery is, of course, only to be expected in those cases in which the 

 disease has shown itself to be mild; in other cases recovery is usually incom- 

 plete. Only in cases in which no loss of substance has occurred can a complete 

 restitutio ad integrum be expected. 



In cases which terminate fatally, the patient usually suffers for a long 

 time, and passes through many complications before he finally succumbs to 

 general exhaustion. Yet many circumstances may lead to an early death. 

 Among these by far the commonest are hemorrhages of lethal extent. These 

 may be from the gums, from the nasal mucous membrane, from cutaneous 

 ulcers, eroded arteries, or from the digestive tract. 



More frequently death results from complications, particularly dysentery 

 and croupous pneumonia, more rarely malignant endocarditis, the cause of 

 which is to be sought for in the entrance of infectious germs from the ulcers. 

 Quite often excessive effusions into the pleural cavity or into the pericardium 

 threaten life; sometimes extreme cardiac asthenia leads to a fatal result, and 

 if the patient makes an unusual exertion or rises suddenly, he collapses life- 

 less, as occasionally happens in children who have had an attack of diphtheria. 



PROPHYLAXIS AND TREATMENT 



Garrod's teaching that a deficiency in acid vegetable potassium is the chief 

 cause of the disease indicates the direction in which a prophylaxis in scurvy 

 is to be attained. The theory of Garrod, although correct in its fundamental 

 principles, does not appear to be absolutely well-founded throughout, for cases 

 of scurvy develop where there is no deficiency of potassium in the food. In 

 the epidemic in Eastatt (1851-1852), for example, there was no deficiency ia 

 fresh vegetables ; nor in that of Ingolstadt where, in spite of good food, such 

 as meat and potatoes, an epidemic occurred among the prisoners of war. It 

 has therefore been assumed that it is not the deficient administration of potas- 

 sium, but the insufficient retention of potassium in the organism, which causes 

 the disease. Unquestionably, among other conditions, the increased consump- 

 tion of potassium in the body plays an important role. If the theory of Bunge 



