=Hemorrhages.=--Hemorrhage is such a striking manifestation that it is
not surprising to find it was regarded by the older writers as the
pathognomonic sign of scurvy. The bleeding may take place into almost
any organ, and vary from small petechiæ to very extensive
extravasations. The hair follicles and sweat glands are particularly
susceptible, as Lasèque and Legroux noticed in cases occurring in the
French prisons. Aschoff and Koch, during the recent war, noted the same
peculiarity of involvement, calling attention also to the fact that
previous skin diseases such as keratosis or seborrhea seemed to
predispose to this localization.
Trauma plays a very important rôle in determining the location of the
deeper as well as of the superficial hemorrhages. In adults, especially
in soldiers, in whom the greater number of cases have been recorded, the
lower extremity is the commonest site, between the knee and ankle, the
area most exposed to blows as well as acted upon by static congestion.
In infants, the inner aspect of the thighs is a frequent site due to the
trauma of the diaper.
The most characteristic hemorrhage, the subperiosteal, will be fully
discussed when considering the bone lesions. The deeper hemorrhages may
be very extensive. They tend to follow the connective-tissue strata, and
in the muscles are usually limited by the muscle sheaths. The blood
surrounds the muscle fibres, which appear quite intact. The neighboring
blood-vessels are congested and may contain thrombi, both venous and
arterial. Such thrombi are found also in areas where extravasation has
not taken place, and conversely, hemorrhages occur where no thrombi are
demonstrable, so that a mutual causal relationship cannot be proved.
Further evidence in regard to the mechanism of these extravasations is
presented in the discussion of the minute anatomy. Brownish pigment,
undoubtedly derived from the blood, is frequently found in the
neighborhood of the hemorrhagic areas. New connective tissue also grows
in these areas, so that in healing cases a marked formation of scar
tissue will be found. Bizarre forms of hemorrhage at times have given
rise to confusion in diagnosis; hemorrhage involving the right lower
abdominal quadrant may simulate appendicitis; when occurring in the
region of the transverse colon it has been mistaken for an epigastric
new-growth.
Certain parts of the body seem less predisposed to hemorrhage. The
central nervous system is often spared, notwithstanding extensive
bleeding elsewhere, the meninges being somewhat more frequently
involved. Hemorrhage of the lungs is also less common than might be
expected, and it is probably true as Lasèque and Legroux suggested, that
previous pulmonary disease, particularly tuberculosis, is an important
predisposing factor.
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