THE EPIPHYSEAL CHANGES IN THE DIAGNOSIS OF SCURVY

The finer diagnostic features of infantile scurvy have been frequently overlooked, probably due to the fact that students of the disease have been primarily engaged with its hemorrhagic manifestations. Pediatric as well as roentgenologic texts usually exhibit roentgenograms of the femur with the heavy transverse line at its distal end and the subperiosteal hemorrhage as the essential features of scurvy. Though these are indeed unmistakable evidences of the scorbutic state, roentgenologically visible subperiosteal hemorrhage is comparatively infrequent. The heavy transverse line, the so-called "white line" of Fraenkel, has therefore been the deciding element in the roentgenogram. Focusing all our attention on it, we have frequently overlooked conspicuous signs equally characteristic of scurvy. In studying a large series of roentgenograms taken of a group of infants, I was impressed with the great variability of the photographic material. In any given pathologic condition, this may be due as much to the rapidly