| | | | | | oz. during last | | | | | | month; v. Pir- | | | | | | quet negative. 7. | 2| 6 4|Abdomen |Mar. 7|Breast milk |Grippe; probable I. P.| | | | | for past | source of | | | | | week; past- | epidemic. | | | | | eurized milk | | | | | | previously. | -------------------------------------------------------------------- DIAGNOSIS A correct and early _diagnosis_ of scurvy is the more important in view of the fact that we possess a specific remedy, and that the disorder is not self-limited. Recognition generally presents little difficulties for those who have seen cases, but is a stumbling block where the symptomatology has been gleaned merely from the textbooks. It has been our experience that medical students who were conversant with scurvy from a theoretical standpoint failed to diagnose a case presented to them in the clinic. Where diagnosis is uncertain, the most important aid is an exact knowledge of the previous diet, and observation of the reaction of the patient to antiscorbutic treatment. These diagnostic points should be constantly remembered in relation to the discussion which follows, and will not be reiterated in the differentiation of scurvy from the various other diseases. The scurvy of adults and of infants are very similar. The main difference is the subjective symptoms in the adult--pains in various parts of the body--and the fact that the gums are frequently the site of infection and ulceration, as well as of hemorrhage. It might be thought that when scurvy occurs in epidemic form it would be readily recognized, but experience shows that for months it may permeate the ranks of troops or the inmates of almshouses, and pass as rheumatism. This is the cardinal diagnostic error in adult as well as in infantile scurvy--time and again, and in spite of urgent and repeated warnings, patients continue to be treated for _rheumatism_. Holt writes: "In fully four-fifths of the cases which have come to my own notice this (rheumatism) has been the previous diagnosis." Such has been our experience. The diagnosis should not be difficult. In sporadic cases, the individual has limited his diet usually on account of indigestion, or diarrhoea, or following some dietetic whim or medical advice given months previously. Where scurvy occurs _en masse_ it may follow an inability to obtain fresh food--as during war, on shipboard, in the Tropics or in the Arctic regions--or be the result of a misplaced reliance on some article of food--for example, dehydrated vegetables. More careful investigation will disclose that the "rheumatic" pains and tenderness are not in the joints but in the muscles and tendons. The calf muscles are frequently painful and excessively tender and somewhat