A treatise on the principles and practice of medicine : designed for the use of practitioners and students of medicine / by Austin Flint.
- Austin Flint I
- Date:
- 1884
Licence: Public Domain Mark
Credit: A treatise on the principles and practice of medicine : designed for the use of practitioners and students of medicine / by Austin Flint. Source: Wellcome Collection.
Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.
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![this instance, from an utter indifference to food, dietetic causes were involved. The disease is oftenei* (U'veloped in the aged than in young persons ; the causes of tlie disease will act more speedily in persons in whom the constitu- tion has been impaired by previous disease, by injurious medication, and by excesses of any kind. There is reason to believe that the morbid condition of the blood which exists in scurvy is not infrequently produced, to an extent falling short of that requisite to give rise to the striking manifestations of the disease, by an undue I'estriction of the diet to a few articles of food either from poverty or false notions of dietetics. It is important for the physician to recognize this fact in medical practice. Diagnosis In view of the striking symptomatic features of this disease, and of the fact that generally a greater or less number of persons become affected under circumstances which sufficiently account for its development, the diagnosis is easy provided the characters of the disease be marked. In isolated cases the diagnosis involves discrimination from purpura hcBmor- rhagica. This differential diagnosis will be considered in treating of the latter affection. But the morbid condition of the blood peculiar to scurvy may exist to a greater or less extent when the most striking symptomatic features of the disease are not present, namely, the subcutaneous ecchymoses and hemor- rhages from mucous outlets. Under these circumstances the disease may be overlooked. Thus, Hammond, Woodward, and others state that in cases called in army sick-reports cases of general debility, the disease is, not infre- quently, incipient or not fully developed scorbutus. The pain in the back and muscles of the lower limbs is apt to lead the practitioner for a time to consider the disease as muscular rheumatism or myalgia. When associated with other diseases, such as dysentery and the essential fevers, it is liable to be overlooked. The appearance of the gums is highly important with refer- ence to the diagnosis, in the cases in which petechia or vibices are wanting; and when, from the appearance of the gums and other symptoms, the scor- butic condition is suspected, an investigation of the diet may lead to the knowledge of facts which will tend to settle the diagnosis. This investigation is important, not only in army or naval practice, and in public institutions, but in private cases in which the symptoms point to scurvy. It is to be added that in children before dentition, and in aged persons who have lost their teeth, the characteristic appearances of the gums may be wanting. They are also wanting in rare instances irrespective of these circumstances. Prognosis.—In cases of scurvy in which the ecchymoses are many and large, or in which hemorrhage from the mucous outlets is profuse, the danger to life is great. Life may be destroyed by rapid hemorrhagic effusion into the pleural or pericardial cavities. Meningeal hemorrhage is sometimes the in^mediate cause of death. Sudden death sometimes occurs from syncope induced by muscular exertion. If the causes which have produced the dis- ease continue in operation, it proves fatal in a large proportion of cases. Before the ])athology and causation were as well understood as now, the mortality from this disease among soldiers and seamen was often very large. Associated with other diseases, it contributes indirectly to their fatal termi- nation, and it stands in the way of recovery from wounds and surgical opera- tions which otherwise would not prove serious. Prom[)tly recognized and judiciously treated, the disease may be expected to end in recovery in a large proportion of cases. It has no definite dura- tion. It continues for a longer or shorter period, according to the extent to which it has advanced, the amount and situations of hemorrhagic extrava-](https://iiif.wellcomecollection.org/image/b21198135_1132.jp2/full/800%2C/0/default.jpg)
