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blood, scurvy, nutrition and affection

SCORBUTUS Scurvy is a transitory htemorrhagic diathesis which is associated with severe disturbance of nutrition, and with a tendency to ulceration and ichorization. In childhood it certainly occurs rather rarely. MA ler-Baxlow's disease which by many is termed infantile scurvy, and true scorbutus should be considered distinct.

Etiologically there may possibly be certain infectious causes such as streptococci and staphylococci, but the essential condition is a body pre pared for the development of scurvy by improper nutrition and unhy gienic conditions. Food poor in vegetable acid alkalies is held especially responsible (Immermann): long-continued nutrition with flour-foods, con densed, preserved or st eril i zed milk. inferior bread, want of fresh vegetables, fruit, fresh meat. A further necessity for the development of the affec tion seems to be continued living in dark, ill-lighted, damp dwellings.

affection never begins suddenly, but always slowly, exhibiting signs of gradually advancing cachexia, emaciation, pallor of the skin and mucous membranes, disturbances in the cardiac and intestinal functions. To this is added a specific scorbutic affection of the gums; extensive painful swelling, and loosening of the gums, which bleed at every touch, also loosening of the teeth. Frequently

there is necrotic disintegration of the marginal parts, which become desquamated and form a slate-colored, ulcerating gray surface.

To complete the pathological picture, there are numerous petechia3 and ecehymoses into the skin, the connective tissue and muscles, on mucous and serous membranes, in the periosteum and on the retina. There is also actual bleeding, especially from the nose; feces and urine tinged with blood are less frequent. Enlargement of the spleen may also develop.

Blood of the blood does not disclose any thing really characteristic. Corresponding to the losses of blood there is a diminution of h[emoglobin and red blood corpuscles. Hayem, Robin and Pent zold observed small corpuscles resembling blood plate lets of strong refractive power.

Course and always takes a chronic pro tracted course, but there is no accentuation of paroxysmal attacks. Mild cases may be cured, severe ones frequently terminate fatally, as a rule in consequence of complications, ulcerations, septic processes, pleuritis, pericarditis. The prognosis is therefore doubtful.