According to the same authority radiographs of the diseased bones show characteristic features; in the lower portions of the diaphyses, in place of the fine meshwork of the spongiosa there occurs a washed out space with irregular margins. If the case recovers this disappears only after some months. Breaks in continuity and suhperiosteal hemorrhages are easily recognized. (For a personal observation see Plate 10).
After the absorption of the necrotic material at the point of frac ture (the "Triimmelfeld" zone of Frankel) the regeneration of the bone takes place through the appearance of small masses of normal lymphoid marrow cells in the pathologically rarefied marrow, and the replacement or removal of the latter by their gradual growth. After that the forma tion of new bone proceeds normally and strong osseous trabecuhe are formed. If marked dislocation occurs after a fracture a deformity may remain in the neighborhood of the joint.
Relationship to and Nauwerk believe that ra chitis plays a special role in infantile scurvy; on the other hand, Naegeli, Schmorl, Stooss and Frankel consider them as independent affections, though they recognize their frequent association which may be explained by the children's age and the artificial feeding. Cases of infantile scurvy of the severest grade exist without. a trace of rickets, and the anatomical changes in the two conditions are essentially different.
The question whether or not infantile scurvy is to be considered as scurvy cannot be decided until we possess satisfactory reports upon the histology of the bone changes in the latter disease. The macroscopic lesions seem to be very similar (Netter, Stooss). At all events, clini cally, infantile scurvy and scurvy are closely related and the majority of physicians are inclined to regard the two diseases as practically one. From a scientific standpoint the decision will first be made when the above-named condition is fulfilled.
specific cause of infantile scurvy is as yet unknown. Two factors play the principal roles in its causation: (1) the kind of food the child has had and (2) a special individual susceptibility.
Only artificially fed children are affected, and the unsuitable diet, which, considering the needs of the child, is insufficient, must have been maintained for several months. Whether breast-fed children can be affected is doubtful; the few cases of this kind reported in the literature are not free from criticism. As severe a grade of malnutrition can occur
with mother's milk as with artificial feeding when the breast-milk does not supply the special needs of the suckling (autointoxication, Variot).
The loss of certain fresh properties in the milk, through heating it, is one of the most important causes of this affection, and other impor tant factors are insufficient feeding and monotony in diet.
Individual predisposition is shown by the fact that of twins who have had the same nourishment one may thrive splendidly and the other become affected. Finkelstein saw an infant ill with the disease who, because a brother had formerly suffered with the same complaint, had received only milk heated for a short time, and fresh vegetables.
Infantile scurvy occurs with all forms of artificial feeding but cer tain methods favor its appearance. Sterilized and prepared milk of various sorts come first, then pasteurized milk and simple boiled milk. then milk and flour mixtures and prepared flour alone, and finally oatmeal gruel and rice gruel. With the use of raw cow's milk the disease is rather rare.
The manifold attempts to give to cow's milk a "human character," the undue valuation of its special natural properties and the over valuation of the modification of its gross composition to as near as possible that of human milk, have all favored the increased occurrence of this formerly almost unknown disease. The more frequent occur rence of the affection in the families of the rich than in those of the poor is explained by the fact that specially prepared milk and the many proprietary foods are, on account of their high price, more accessible to the well-to-do than to those in less easy circumstances. Besides this. an undesirable uniformity of food is not infrequent in the diet lists of well-to-do families.
One should be prepared to meet infantile scurvy everywhere, among poor and rich alike. Cheadle noted the relative immunity of the chil dren of the poor, and ascribed this fact to the circumstance that early in life these children subsist on fresh food added to their milk. In cases of this kind continued underfeeding with oatmeal gruel, rice gruel, etc., has sometimes taken place, but in general the caloric value of the food which preceded the appearance of infantile scurvy has been more nearly sufficient.