=Microscopic Pathology.=--Turning to the microscopic pathology, we find
that the changes are similar to those described elsewhere in connection
with human scurvy. It will be unnecessary, therefore, to give more than
a general survey of the typical alterations. Little has been added to
the description of lesions so carefully depicted in the first report of
Holst and Froelich (1907). The bone marrow at the ends of the diaphyses
in proximity to the epiphyseal junction loses its normal lymphoid
character and is replaced by a reticular or fibrillated substance, the
so-called "framework" marrow (Geruestmark of Schoedel and Nauwerk)
containing a homogeneous mucoid tissue and only a few osteoblasts and
marrow cells. The number of blood-vessels is considerably reduced and
fresh hemorrhage or blood pigment is frequently seen. The osseous tissue
itself shows marked changes, corresponding to the rarification and
brittleness noted on gross examination. The osseous trabeculæ are fewer
in number and those which remain are slender and irregular, and
frequently appear as isolated islets. The cortical substance also
becomes very thin. There are marked alterations in the intermediate
cartilages, especially of the ribs.[37] Instead of the cells being
arranged in orderly rows, they are irregularly placed, and frequently
greatly reduced in size and number. The bone trabeculæ on which they
abut are not well formed or of equal length, and do not present an even
and transverse plane, but are misshapen, small, so that the line of
junction with the cartilage is zigzag. In cases of marked scurvy the
junction may be entirely disorganized and deformed, showing fractures of
the rarefied bone and hemorrhages in the neighborhood. This leads
frequently to a macroscopic deformity of bone, a bulging of the surface
at the costochondral junction--the scorbutic "beading" or "rosary" of
the ribs. Recently Delf and Tozer have described these changes,
classifying them as those occurring in "incipient," "definite," "acute,"
"chronic definite," and "chronic acute" scurvy. Fig. 9 shows these types
in diagrammatic form. In this figure we see how varied may be the
manifestations of this nutritional disorder, according to whether it has
existed for a shorter or a longer time; in some instances the picture is
very puzzling. The "incipient scurvy" corresponds to what we have termed
clinically "latent scurvy" in infants, a condition which cannot be
diagnosed and is manifested merely by a faulty nutrition which responds
promptly to the addition of an antiscorbutic to the diet. There have
been no histologic examinations in man at this incipient stage, but we
may infer that they are similar to the bony changes found in the
guinea-pig. When the scurvy has become chronic in an animal which has
lived for months on a quota of antiscorbutic food sufficient to preserve
life but insufficient to prevent the development of scurvy, we find a
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