As a complication, dysentery may be mentioned. This has been described
by Schreiber and others in scurvy epidemics occurring in the course of
the World War. Jaundice may appear, and might be expected to occur more
often in view of the marked congestion of the upper duodenum found so
frequently at necropsy.
Pericarditis, hydrothorax, pleurisy with effusion, pneumonia, are common
complications of severe forms of scurvy. Lind reports that the dominant
complication varies in different epidemics; that on one cruise many
cases of diarrhoea would occur and on another many pulmonary
infections.
O'Shea reports the exceptional case of a man who was operated upon for
acute appendicitis. A large hemorrhage in the wall of the cæcum was
found, as well as some other hemorrhages in the peritoneal cavity. This
report is interesting, not so much from a diagnostic standpoint as
because "contrary to what might have been expected, scorbutic cases when
operated upon showed no particular tendency to hemorrhage."
=Infantile Scurvy.=--The stereotyped picture of infantile scurvy and the
one which this term commonly suggests, is that of the acute form of the
disease. In _acute infantile scurvy_ we have to do generally with a
poorly-nourished, pale infant with a peculiarly alert and worried
expression. As we approach its bed it whimpers or cries out in terror.
Frequently its posture is characteristic, as it lies quietly on its back
with one thigh everted and flexed on the abdomen. Examination shows that
one or even both thighs are swollen and exquisitely tender, or that
there is merely tenderness, the baby shrieking at the slightest pressure
upon the lower end of the femur. If teeth are present, the adjacent gums
are red, swollen and bleed readily. This is the syndrome which the
medical student is taught to carry away to guide him in his everyday
practice. It is the acute, florid type, and presents a striking picture,
but must not be regarded as the common form of the disorder. If we are
to diagnose infantile scurvy early and not overlook its more subtle
manifestations, the classic textbook description must be augmented by
portrayals of types of the disorder which are less crude and more
difficult to recognize--of "subacute" and of "latent" scurvy.
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