A new era in the pathology of scurvy was inaugurated by the availability
of experimental scurvy and also by the stimulation occasioned by the
recent conception of vitamines and the so-called deficiency diseases. In
endeavoring to elucidate this fascinating problem, it has gradually been
realized that pathology may be of service--for example, in relation to
the involvement of the endocrine glands. Accordingly, studies of the
minute pathology of the various organs have been undertaken in many
laboratories throughout the world (Italy, India, England, Germany and
the United States). An additional stimulus to investigation in pathology
has been furnished by the recent war, which, as shown elsewhere, led to
a great increase in scurvy among both the military and civilian
population. The excellent report of Aschoff and Koch from Roumania was
made possible by this catastrophe, and will no doubt soon be followed by
others of similar character.
=Gross Pathology.--General Appearance.=--The skin usually is pale,
livid, and dotted with numerous petechiæ. These vary in size from the
tiniest pin-points, barely recognizable to the naked eye, to ecchymoses
of moderately large size. The most frequent site is the lower
extremities. The trunk is always less affected, hemorrhages tending to
occur along the mid-line and especially around the umbilicus. There may
be also larger superficial hemorrhages, showing great differences in
color, from the redder tone of the more recent, to the blues, browns and
greens of the older lesions. Bleeding from the nose and mouth is not
uncommon in fatal scurvy, and occasionally exophthalmos is present,
usually unilateral, and due to subperiosteal hemorrhage of the orbital
plate of the frontal bone. Rigor mortis is generally slight, and,
according to Lind and to von Opitz, decomposition takes place rapidly.
There may be great emaciation, especially where secondary infection has
supervened. General wasting occurs, however, in uncomplicated scurvy due
to starvation--the result of lack of appetite or a deficiency of the
general food supply. Children, especially infants, are undersized, as
illustrated in treating of the symptomatology, and their bones may be
decidedly smaller than normal. Generally there is some edema about
the ankles, and in children a somewhat characteristic puffiness about
the eyes. General anasarca also occurs, in some cases associated with
renal involvement. Peculiar boggy, "tumor-like" masses of localized
edema may be present, which were considered by the earlier writers
(Lind) to be one of the typical lesions of this condition.
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