The _intestine_ may present a variety of lesions.[29] The mucosa is
frequently congested and swollen, and the solitary follicles and Peyer's
patches enlarged. These changes may progress to necrosis and extensive
ulceration. In an outbreak of scurvy occurring in this country in 1917,
in a large institution for epileptics, ulceration was a frequent lesion
at necropsy.[30] Dysentery, a frequent complication of scurvy in some
epidemics, may add to this ulceration and lead to even complete
sloughing of the inner lining of the intestine. Hemorrhages are found in
the mucous, serous or muscular layers. Here, as elsewhere, the
hemorrhages vary in size from petechiæ to large infiltrations of blood.
A very striking picture is sometimes presented by the pale, edematous
intestinal wall dotted or streaked with vivid red.
[29] For details regarding the intestinal lesions in infantile scurvy,
the reader is referred to Barlow's description of the case of Stephen
Mackenzie, to one necropsy report by Theodor Fischer, one by
Hirschsprung, one by Meyer, and five by Schoedel and Nauwerk. The
prevailing lesions are hemorrhages, pigmentation, follicular ulceration,
and enlargement of the mesenteric glands.
[30] The potato crop largely failed this year, and there was
considerable scurvy in the spring, as described in the chapter on
antiscorbutics.
=Liver.=--The liver is frequently congested, as would be expected in
view of the involvement of the right heart. Erdheim found congestion,
however, in only nine among thirty-one necropsies, although enlargement
of the heart was present twenty-one times. There may be hemorrhages in
the glandular tissue or under the peritoneum. "Cloudy" and fatty
degenerations occur occasionally, and in some cases an early cirrhosis.
Lind found abscess of the liver, and wrote that in a few instances "the
matter or corruption was hardened, as it were, into a stone."
=Spleen.=--This organ is usually somewhat enlarged and congested.
Charpentier, in the Paris epidemic of 1871, found it often three to four
times the normal size and very soft, and Lind tells us that "the spleen
was three times bigger than natural, and fell to pieces, as if composed
of congealed blood." It must be remembered that the pathologic as well
as the clinical picture of the scurvy of Lind and his time was generally
complicated by infection. The enlargement is usually by no means so
great, and no doubt is due in part to intercurrent infections. On
section, it is found frequently to contain much reddish-brown pigment.
Hemorrhage may also occur. In beriberi, Andrews observed frequent
congestion of the spleen and also a loss of normal markings.
=Pancreas.=--There is but one reference to a lesion of the pancreas in
scurvy, that of Sato and Nambu, who encountered hemorrhage of this organ
in one case among the necropsies performed in the course of the
Russo-Japanese War.
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