=Skin.=--As pointed out by Aschoff and Koch, examination of skin which
to gross appearance was the seat of typical small hemorrhages, showed
various lesions. In some, perhaps the most typical forms, there had
been a fresh extravasation of red blood-cells. This condition is found
usually in the subepidermal layers, especially in the papillary stratum.
These small hemorrhages occur very frequently about the hair follicles
and sweat glands, especially when they have been diseased. Where the
bleeding has been of long standing, dark brownish pigment deposits are
found and all blood-cells may have disappeared. Phagocytic cells are
almost always present and may be of the "wandering" or of the more fixed
connective-tissue type. Many round cells may be seen in these areas
lying between the connective-tissue strands or around the blood-vessels.
Rheindorf, as quoted by Tuechler, has called attention to this
round-celled reaction, which in many instances gives a picture analogous
to the granulomas, and which leads him to infer an infectious origin for
these lesions. Other areas which appeared to be the seat of hemorrhage
are shown by the microscope to be small abscesses or new connective
tissue often loaded with pigment and detritus, apparently representing
the final stage of these lesions. Aschoff and Koch have found that
suitably-stained preparations frequently show a loss of elastic fibres,
which Rheindorf states constitutes one of the earliest changes of this
disorder. The blood-vessels in the vicinity of the hemorrhages are
congested, especially the capillaries and small venules.
=The muscles= also present a similar diverse picture of old and recent
hemorrhages, pigment deposit and round-celled infiltration. Increase of
connective tissue is usually found between the fibre bundles and in some
cases where the hemorrhages are apparently of long standing, as
evidenced by loss of contour of the red cells and pigmentation of the
surrounding areas, this scar tissue formation is very marked. Changes in
the muscle fibres themselves have not been encountered by all observers.
Hayem describes widespread fatty degeneration and a deposit of pigment
within the fibres, Leven a loss of sarcolemma, while Lasèque and Legroux
found fatty changes which were equally marked in muscles showing no
hemorrhage. On the other hand, Aschoff and Koch, in their careful
studies, did not find noteworthy fatty change of the fibres, but
observed often that the fibres within the hemorrhagic areas seemed
shrunken and were stained abnormally deep with eosin.
In monkeys dying of experimental scurvy, Hart and Lessing describe
granules in the muscles, which, judged by their staining affinities,
evidently contained calcium and were similar to those found in the
adrenal glands.
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