Scurvy

Scurvy (Scorbutus), a constitutional disease, characterized by debility, morbid conditions of the blood, spongy gums, impairment of the nutritive functions, and the occurrence of haemorrhagic extravasations in the tissues of the body. In former times this disease was extremely common among sailors, and gave rise to a frightful amount of mortality. It is now, however, of rare occurrence at sea, the simple means of prevention being well understood. Scurvy has also frequently broken out among soldiers on campaign, in beleaguered cities, as well as among communities in times of scarcity, and in prisons, workhouses and other public institutions. In all such instances it has been found to depend closely upon the character of the food. The precise etiology is obscure, and the modern tendency is to suspect an unknown micro-organism; on the other hand, even among the more chemical school of pathologists, it is disputed whether the cause (or conditio sine qua non) is the absence of certain constituents in the food, or the presence of some actual poison. Sir Almroth Wright in 1895 published his conclusions that scurvy was due to an acid intoxication, while Torup of Christiania believes it to be a direct poisoning from damaged and badly preserved meat. Dr Jackson and Dr Harley support this latter view, contending that scurvy occurs when meat is eaten in this condition, even when lime juice and vegetables are given in conjunction with it. The palmy days of the disease were those when sailors and soldiers had to fare on salt meat and "hard tack," or were deprived of fresh vegetables; and the fact that scurvy has been practically abolished by the supply of these latter has led to the association of this factor with the disease as a ver y causa. But how the defect in vegetable diet produces scurvy is not quite clear; nor how far other conditions may be involved.

The symptoms of scurvy come on gradually, and its onset is not marked by any special indications beyond a certain failure of strength, most manifest on making effort. Breathlessness and exhaustion are thus easily induced, and there exists a corresponding mental depression. The countenance acquires a sallow or dusky hue; the eyes are sunken; while pains in the muscles of the body and limbs are constantly present. The appetite and digestion may be unimpaired in the earlier stages and the tongue comparatively clean, but the gums are tender and the breath offensive almost from the first. These preliminary symptoms may continue for weeks, and in isolated cases may readily escape notice, but can scarcely fail to attract attention where they affect large numbers of men. In the further stages of the disease all these phenomena are aggravated in a high degree and the physical and mental prostration soon becomes extreme. The face looks haggard; the gums are livid, spongy, ulcerating and bleeding; the teeth are loosened and drop out; and the breath is excessively foetid. Extravasations of blood now take place in the skin and other textures. These may be small like the petechial spots of purpura, but are often of large amount and cause swellings of the muscles in which they occur, having the appearance of extensive bruises and tending to become hard and brawny. These extravasations are most common in the muscles of the lower extremities; but they may be formed anywhere, and may easily be produced by very slight pressure upon the skin or by injuries to it. In addition, there are bleedings from mucous membranes, such as those of the nose, eyes and alimentary or respiratory tracts, while effusions of blood-stained fluid take place into the pleural, pericardial or peritoneal cavities. Painful, extensive and destructive ulcers are also apt to break out in the limbs. Peculiar disorders of vision have been noticed, particularly night blindness (nyctalopia), but they are not invariably present, nor specially characteristic of the disease. The further progress of the malady is marked by profound exhaustion, with a tendency to syncope,and with various complications, such as diarrhoea and pulmonary or kidney troubles, any or all of which may bring about a fatal result. On the other hand, even in desperate cases, recovery may be hopefully anticipated when the appropriate remedy can be obtained. The composition of the blood is materially altered in scurvy, particularly as regards its albumen and its red corpuscles, which are diminished, while the fibrine is increased.

No disease is more amenable to treatment both as regards prevention and cure than scurvy, the single remedy of fresh vegetables or some equivalent securing both these ends. Potatoes, cabbages, onions, carrots, turnips, &c., and most fresh fruits, will be found of the greatest service for this purpose. Lime juice and lemon juice are recognized as equally efficacious, and even vinegar in the absence of these will be of some assistance. The regulated administration of lime juice in the British navy, which has been practised since 1795, has had the effect of virtually extinguishing scurvy in the service, while similar regulations introduced by the British Board of Trade in 1865 have had a like beneficial result as regards the mercantile marine. It is only when these regulations have not been fully carried out, or when the supply of lime juice has become exhausted, that scurvy among sailors has been noticed in recent times. Wright has proposed giving what he terms anti-scorbutic elements (Rochelle salt, calcium chloride or lactate of sodium) instead of raw materials such as lime juice and vegetables, as being more convenient to carry on voyages. Besides the administration of lime or lemon juice and the use of fresh meat, milk, cider, &c., which are valuable adjuvants, the local and constitutional conditions require the attention of the physician. The ulcers of the gums and limbs can be best treated by stimulating astringent applications; the hard swellings, which are apt to continue long, may be alleviated by fomentations and frictions; while the anaemia and debility are best overcome by the continued administration of iron tonics, aided by fresh air and other measures calculated to promote the general health.

Infantile Scurvy (Scurvy Rickets, Barlow's disease), a disease of childhood due to a morbid condition of the blood and tissues from defects of diet, was first observed in England in 1876 by Sir T. Smith, and later fully investigated by Sir Thomas Barlow. The chief symptoms are great and progressive anaemia, mental apathy, spongy gums, haemorrhages into various structures, particularly under the periosteum and muscles, with suggestive thickenings round the shafts of the long bones, producing a state of pseudoparalysis.