Causes

Scurvy is a disease of nutrition caused by the absence of certain ingredients from the diet of those who are affected with it. It is particularly apt to appear among those persons who live on insufficient food and in crowded houses, and amid filth. Hence its prevalence during periods of famine, in besieged cities, among those who are shipwrecked, or on voyages of unusual duration. But although bad ventilation, dampness, and overcrowding are often predisposing causes, they are not factors in every outbreak; the character of the food eaten is also of the greatest importance. Even too little food has caused scurvy. It has frequently appeared, however, when food enough was eaten, but when there was not enough of fresh foods.

Scurvy or a disease like it has been produced experimentally by Hoist and his co-laborers in guinea-pigs by feeding them exclusively on grain or bread and in hogs by feeding them on rye bread with occasionally boiled beef or by feeding them on rice and dried fish. He also produced it in dogs by feeding them exclusively on oatmeal and beef fat. This experimental scurvy was preventable or removable by a more varied diet and especially by feeding the guinea-pigs cabbage, carrots and dandelions. What the exact nature of the antiscorbutic in foods is has not yet been demonstrated (Hoist and Froelich, Zeit. f. Hyg. u. Infections-krank, 1912).

Among civilized people a lack of fresh vegetables during a long period of time will cause the disease. For these reasons care is now taken that soldiers, sailors, and those confined in prisons and public institutions are furnished the needed modicum of fresh vegetables and fruits. It has been supposed that the absence of such acids as citric, malic, lactic, acetic, and tartaric was its cause. This cannot be, because there are savages who never eat vegetables and fruits and yet do not know what scurvy is. This is notably true of the Eskimos. They constantly provide themselves with fresh meats, however. Freshness is apparently the most important quality of food to prevent scurvy. This conclusion is still further strengthened by the fact that scurvy is not infrequent among infants fed exclusively or chiefly on proprietary foods. Morrow's experimental scurvy is not preventable or is less so and less amendable to treatment by antiscorbutic foods which have been long preserved or dried than by fresh ones. Garrod teaches that scurvy is due to a deficiency of potassium in the blood, because in certain cases at least he found it deficient. It has not, however, been proved that there is always a lack of this salt in scurvy.

It is a disease that often occurs epidemically in communities when the conditions for its development are present. It has been known to attack most of the inmates in a prison at one time. It was widely prevalent in Ireland and England during the years of the ' potato famine.' It is more prevalent among adults than among children, and commoner among men than among women, for each of these classes is exposed to its causes in a different degree.

Scurvy is recognized by anemia and loss of flesh and strength. Hemorrhages occur beneath the skin, from mucous membranes, most noticeably from the mouth and nose, and sometimes into solid tissues, such as muscles, and into serous cavities and joints. The gums are swollen and inflamed. The teeth often become loose and drop out. The hair falls. The skin grows rough and scaly. Appetite is wanting. Patients become listless and depressed. The cutaneous hemorrhages appear as extravasations of various size, some pinhead like petechias, some as laige as a nickel or larger. They develop first upon the extensor surfaces of the extremities. Hemorrhages sometimes are so extensive as to endanger and even to terminate life. Patients may be entirely free from fever or show slight, variable elevations of temperature. Scurvy is rarely seen today, for the managers of prisons, poor-houses, and ships are now required by law to furnish those under their care with the needed amount of fresh food. Preserved vegetables and fruits can take the place of fresh ones, but should not be relied upon exclusively for any long periods of time. Although an uncommon disease, it may occasionally appear in communities where one would not expect it. For instance, during 1893-94 many patients suffering from it were seen in the hospitals of Chicago, who had acquired the disease while at work upon the Chicago drainage canal. Several came under my own care and were successfully treated in Mercy Hospital. Large numbers of foreigners worked upon this enterprise, who were housed and fed most unhygienically by the contractors employing them.

The prophylactic measures that must be enforced to prevent scurvy consist in providing those liable to it with fresh meat, vegetables, and fruits, or at least canned vegetables, fruits, and fruit-juices. Before canned goods were placed upon the market the cheaper fruit-juices, and especially lime-juice, were relied upon.

Infants should be given fresh milk rather than those prepared foods that do not contain it. To bottle-fed babies, four months or more old, orange-juice in small quantities can be given with benefit.

Treatment

Mild attacks of scurvy can be cured by diet. Lemons and oranges should be given freely, with lettuce, spinach, cabbage, or sauer-kraut, pickles, tomatoes, baked or mashed potatoes, peas, string-beans, or other easily digested and simply prepared fresh foods. If the patient is placed in a well-ventilated, clean, and dry room, and given such food, recovery is quickly effected without other aid.

When an attack is severe, the mouth is oftentimes too sore and tender to permit of mastication, and appetite is wanting. Care must then be taken that liquid and very soft foods only are used. Fresh milk, meat-juice and broths, and the juice of several lemons or oranges should be given. Usually purees of fresh vegetables can also be eaten. The patients should be fed small amounts, frequently, until appetite returns and digestion is restored to a good condition.

The patient's mouth should be kept clean by frequent washing or rinsing with mild antiseptic and astringent solutions. While feeble, he should be kept in bed. A salt bath or a shower bath, or a tepid bath, or, if well tolerated, a cool sponge bath, is a useful stimulant and improves nutrition.

Ferruginous preparations assist in restoring the blood to a normal condition. Such potassium salts as the bitartrate and citrate are used with benefit. Mild laxatives are sometimes needed. Drastics must be avoided, for they may provoke intestinal hemorrhages or precipitate diarrhea.