SCORBUTUS, INFANTILE. Definition.—A constitutional disease probably identical with scurvy of adult life, but occurring in children and usu ally in those under ten years of age.
Although the disease is often associ ated with rickets. there appears to be no necessary connection between them. Many cases have been described under the title of "Acute Rickets." A disease observed in infants charac terized by acute pains in the limbs, es pecially in the direction of the long bones; frequent gastric derangements; leaden hue of the surface, with occa sional oedema of the extremities, and lllemorrhagic spots. De Mussy (La ALA Mod., Dec. 10, '92).
Symptoms. — The disease generally shows itself by great tenderness in the lower extremities and unwillingness on the part of the child to move them or have them moved. Following this some swelling may be discovered in the shafts of the leg or sometimes about the knee or ankle, in one limb or both. Some times no swelling can be discovered. In other cases other parts of the body are affected. The back becomes weak; the joints themselves are uninvolved; mia, debility, and ecchymosis may appear. The gums become swelled, spongy, and usually of a purplish blue, and often cover the teeth. Sometimes fractures of the bones take place. The eyes may become very prominent.
Infantile scorbutus occurs in every grade of life, but is more frequent among the rich than among the poor. It may appear at any period of infancy or early childhood, but is most common between the ninth and fourteenth months. The essential symptoms are divided into two groups. In the first, or primary, group are: pain on motion, painful swelling of the lower extremities, and spongy and bleeding gums. The secondary symp toms are: subcutaneous haemorrhages, pseudoparalysis, and hasmorrhages from the cavities of the body. Pain on motion is a constant symptom; it de velops early, and is frequently so intense as to cause the child to cry out at the slightest jar or motion. In the early stages it is frequently difficult to deter mine its exact seat. Painful swelling of the lower extremities is one of the most characteristic and constant symptoms; the upper extremities are rarely involved. The thigh is affected more frequently than any other region. The swelling is
above and not at the knee-joint, as in rheumatism. The gums are purplish, soft, spongy, and bleeding, and fre quently show decided ulcerations. When the teeth have not come through, changes in the gums are usually slight or en tirely absent. Subcutaneous haemor rhages as well as hemorrhages from the cavities of the body are very common, but are not necessary to a diagnosis of scurvy. A varying degree of immobility of the extremities is also common, and the condition is frequently so marked as to simulate paralysis. Fever is often present, and is usually intermittent in character. Diarrhma is more frequent than constipation. Crandall (Archives of Ped., July, '97).
Diagnosis.—The diagnosis rests upon the extreme tenderness and pain on handling, the subperiosteal swelling, and the spongy gums. The disease is often at first confounded with rheumatism, from which it is to be distinguished by the fact that there is no inflammation of the joints present. Rachitis, although sometimes combined with it, is to be dis tinguished from it by the presence of the rosary and often rickety symptoms, and by the absence of haemorrhages and intense pain. This disease can scarcely offer any difficulty.
Besides pallor and anemia there is a group of symptoms that is characteris tic: 1. A fusiform or cylindrical swelling of one or both thighs, due to subperios teal haemorrhage about the shaft of the femur. This may involve the upper part of the leg also. 2. The gums will be found to be swelled, spongy, dark purple in color, bleeding freely on touch, or per haps covered with dry blood. 3. A dark circle about the eye, as if a blow had left a "black and blue" mark. The tendency throughout the disease is to hmmorrhage. These symptoms should always enable one to distinguish the disease from ra chitis. Other diseases which may be mis taken for scurvy are acute rheumatism, infantile paralysis, periostitis, abscess of hip or knee, and sarcoma. Other condi tions to be remembered in making a dif ferential diagnosis are hmmophilia, leu kemia, purpura heemorrhagica, and ery thema nodosum. W. F. Cheney (N. Y. Med. News, Feb. 29, '96).