=Anasarca.=--This comprises the second characteristic lesion found in
scurvy at necropsy and was referred to in the earliest records of the
disease. In the account of his dissections Lind writes: "The breast,
belly and several other parts of the body were filled with this water
or serum," mentioning also the pericardium and ventricles of the brain.
He also noted that all the tissues seemed to contain an excessive amount
of fluid, a condition which may be so striking that the muscles appear
bathed in serum. In one of his first cases with postmortem verification,
Barlow described this appearance as follows: "The muscular walls of the
thorax were pale yellow and watery, as though they had been bathed in
serum." In many cases this edema is most marked in the neighborhood of
the hemorrhages, for example, in the muscles of the thigh when
subperiosteal hemorrhage has taken place; less frequently it is produced
by venous thrombosis.
Any or all of the serous cavities may be involved in this hydrops, the
order of frequency being pericardium, pleuræ, peritoneum, and joint
surfaces, especially the knee. The fluid is clear and straw-colored, or,
in the event of secondary infection, becomes cloudy and
fibrino-purulent. Later the exudate may become organized so that the
entire cavity is filled with a solid mass, which binds the organs
together and obliterates the cavity. The exudate may be blood-stained or
apparently consist entirely of clotted blood.
=Heart.=--In the protocols of most necropsies, the heart is passed over
with scant mention. For example, Lind's only statement in this regard is
that "all those who died suddenly, without any visible cause of their
death, had the auricles of their heart as big as one's fist, and full of
coagulated blood." Barlow accords it no attention, nor do most of the
writers who immediately followed him. The first careful description of
the heart is to be found in the excellent work of Schoedel and Nauwerk,
which contains the following record in regard to three of the five
necropsies on infantile scurvy: (1) Pericardial fluid somewhat
increased, both ventricles moderately dilated, the right somewhat
hypertrophic. (2) The heart showed a hypertrophy of the right and left
ventricles, as well as dilatation of the right ventricle. (3) The right
ventricle is dilated and slightly hypertrophied, the muscles pale and
tough. There is no word of comment relative to these cardiac changes,
which evidently were considered fortuitous. The same observation holds
true in regard to a necropsy on an eight-year-old child reported by
Ingier, which showed a moderate hypertrophy of the left ventricle. We
look in vain, likewise, for information on the subject in the work on
guinea-pig scurvy by Holst and Froelich, and that on scurvy in the
monkey by Hart and Lessing. The first linking of cardiac enlargement
with scurvy is found in a paper by Darling, who described "right-sided
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