rom small spots to bleeding which may end fatally, or in
recovery with marked anemia. There may be pain and swelling of the joints,
etc., and this may leave deformities resembling deformed arthritis. The
result is worse the earlier the disease shows itself. They may live to old
age.

Treatment.--Avoid, as much as possible, wounds and operations in
"bleeding" families. Marriage of the women should be discouraged. For
bleeding: rest, ice, tannic or gallic acid or adrenalin locally if the
bleeding points can be reached. Plug the nostrils for nose-bleed both
behind and in front.

SCURVY. (Scorbutus).--A constitutional disease characterized by weakness,
anemia, sponginess of the gums and tendencies to bleeding.

Causes.--This disease has been called "The calamity of sailors." It has
been known from the earliest times, and has prevailed particularly in
armies in the field and among sailors on long voyages. It has become a
very rare disease in the United States.

Predisposing Causes.--Overcrowding; dark unhealthy rooms; prolonged
fatigue; mental depression.

Exciting Cause.--The lack of fresh vegetables, poisoning from slightly
tainted food, or an infection. The gums are swollen, sometimes ulcerated,
skin is spotted, bluish, etc,

[BLOOD AND DUCTLESS GLANDS 255]

Symptoms.--It comes on gradually (insidiously). There is loss of weight,
progressively developing weakness and pallor, very soon the gums are
swollen and look spongy and bleed easily. The teeth may become loose and
fall out. The breath is very foul. The tongue is swollen, but it may be
red and not coated. The skin becomes dry and rough and (ecchymoses) dark
spots soon appear, first on the legs, and then on the arm and trunk and
particularly about the hair follicles. These are spontaneous or follow a
slight injury. In severe cases hemorrhages under the periosteum (the
covering of the bones) may cause irregular swelling, especially in the
legs, and these may break down and form ulcers. The slightest bruise or
injury causes hemorrhages into the injured part. Extravasion under the
skin, especially in the lower extremities may be followed by permanent
hardness (induration) and stiffness due to connective tissue infiltration
(scurvy sclerosis). There may be pains in the joints and often watery
swelling (oedema) of the ankles. Bleeding from internal mucous membranes
is less common than from the skin. The appetite is poor, palpitation of
the heart and feebleness a