Causes.—­Usually hereditary through many generations.  It is transmitted through daughters, themselves usually not “bleeders,” to their male children.  It is found most often in the Anglo-German races.

Condition.—­The blood vessel walls are thin; the skin is delicate, clotting of the blood is usually retarded.

Symptoms.—­It comes spontaneously or after only slight wounds; the person is extremely delicate.  The bleedings occur from the skin, or mucous membrane, or from wounds, but rarely during menstruation or confinement.  They vary from 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