Scurvy, Past and Present

CHAPTER II

PATHOGENESIS AND ETIOLOGY 23

PATHOGENESIS: THEORIES; POTASSIUM DEFICIENCY; ACIDOSIS; TOXIC; BACTERIAL; VITAMINE (ACCESSORY FACTOR)

ETIOLOGY: BREAST-FED INFANTS 35

ARTIFICIALLY FED INFANTS: PASTEURIZED MILK; BOILED AND STERILIZED MILK; DRIED MILK; CONDENSED MILK; PROPRIETARY FOODS (EFFECT OF ALKALIZATION) 40

AGE, SEASON AND CLIMATE; ECONOMIC STATUS; PSYCHIC ELEMENT; PREDISPOSITION; EFFECT OF OTHER FOOD CONSTITUENTS; EXCITING FACTORS

CHAPTER III

THE ANTISCORBUTIC VITAMINE 62

CHARACTERISTICS: RELATION TO HEAT, DRYING, AGING, ULTRA-VIOLET RAYS, SHAKING 65

MODE OF ACTION--(a) DIRECT: AS A NUTRIMENT; ANTITOXIN; CATALYZER; (b) INDIRECT: ENDOCRINE ACTION 69

FATE IN THE BODY: STORING; CONTENT IN BLOOD; EXCRETION; FATE IN GASTRO-INTESTINAL TRACT; EFFECT ON DIGESTIVE PROCESSES 74

IRREGULARITIES OF ACTION; EFFECT ON GROWTH

CHAPTER IV

PATHOLOGY 81

(a) GROSS: GENERAL APPEARANCE; HEMORRHAGES; ANASARCA; HEART; LUNGS; ALIMENTARY TRACT AND ITS GLANDS; URINARY TRACT; LYMPH NODES; ORGANS OF INTERNAL SECRETION; BRAIN AND SPINAL CORD; BONES;

(b) MICROSCOPIC: SKIN; MUSCLES; BLOOD-VESSELS; LUNGS; HEART; INTESTINAL TRACT AND ITS GLANDS; KIDNEY; ADRENALS; PANCREAS; THYMUS; CENTRAL NERVOUS SYSTEM; PERIPHERAL NERVES; RETINA; BONES

CHAPTER V

EXPERIMENTAL SCURVY 111

HISTORICAL REVIEW

PATHOGENESIS 116

PATHOLOGY: EFFECT ON THE FOETUS; SCURVY IN THE MONKEY; MICROSCOPIC PATHOLOGY; BONES; TEETH; NERVES; BLOOD VESSELS; INTERPRETATION OF BACTERIA IN THE TISSUES 122

SYMPTOMS 135

CHAPTER VI

ANTISCORBUTIC FOODS 143

HISTORICAL REVIEW 143

MILK: RAW; PASTEURIZED; DRIED 150

FRUITS AND FRUIT JUICES: DRIED 153

VEGETABLES: CABBAGE; EFFECT OF HEATING. POTATO. SWEDE 158 DEHYDRATED VEGETABLES: CANNED FOODS (TOMATOES) 166

GERMINATED CEREALS AND PULSES; MEAT AND EGGS; BEER AND ALCOHOLIC BEVERAGES; MISCELLANEOUS

CONCLUSIONS 173

CHAPTER VII

SYMPTOMATOLOGY AND DIAGNOSIS 176

IN ADULTS 176

IN INFANTS: (a) ACUTE; (b) SUBACUTE; (c) LATENT.--HEMORRHAGE OF GUMS; SUBPERIOSTEAL HEMORRHAGE: SKIN; MUCOUS MEMBRANES AND SUBCUTANEOUS TISSUES; HEMORRHAGES OF INTERNAL ORGANS; NAILS AND HAIR; ECZEMA; EDEMA; TENDERNESS; BEADING OF RIBS; SEPARATION OF EPIPHYSIS; "WHITE LINE"; CARDIOVASCULAR SYSTEM; "CARDIORESPIRATORY SYNDROME"; NERVOUS SYSTEM; URINARY SYSTEM; THE BLOOD AND BLOOD-VESSELS; NUTRITION AND GROWTH; FEVER; COMPLICATIONS; EPIDEMIC FORM 183

DIFFERENTIAL DIAGNOSIS: RHEUMATISM; PURPURA; CONGENITAL SYPHILIS; BONE TUMORS; OSTEOMYELITIS; POLIOMYELITIS, ETC. 219

CHAPTER VIII

PROGNOSIS 225

CHAPTER IX

TREATMENT 230

PREVENTATIVE; CURATIVE

NON-DIETETIC

CHAPTER X

METABOLISM 241

IN ADULTS: BODY EXCHANGES 241

IN INFANTS: BODY EXCHANGES; ANALYSIS OF ORGANS; CHEMISTRY OF BLOOD 242

IN ANIMALS: MONKEY; GUINEA-PIG 245

CHAPTER XI

RELATION OF SCURVY TO OTHER DISEASES 248

BERIBERI; SHIP-BERIBERI; PELLAGRA; RICKETS; OSTEOGENESIS IMPERFECTA; OSTEOMALACIA; HUNGER EDEMA; "MEHLNAERSCHADEN"; EXUDATIVE DIATHESIS; DISEASES DUE TO A FOOD EXCESS

APPENDIX: LIND'S RECIPES FOR PREPARING STABLE ANTISCORBUTICS 259

BIBLIOGRAPHY 261

ILLUSTRATIONS

FIG. PAGE

1. Dependence on potato as antiscorbutic 7

2. Weight curve of scorbutic baby. Effect of alkalization of milk 51

3. Lumbar cord in case of scurvy 104

4. Lumbar cord in case of scurvy. Focal degeneration 104

5. Bone in scurvy. Microscopic pathology 105

6. Subperiosteal hemorrhage and separation of epiphysis. Roentgenogram 108

7. Complete restitution of epiphysis without deformity. Roentgenogram 109

8. Curve of fecal excretion in scurvy 120

9. Diagrammatic representation of guinea-pig scurvy 128

10. Loss of weight in guinea-pig scurvy 139

11. Dried milk as an antiscorbutic 140

12. Dehydrated vegetables as a cause of scurvy 164

13. Cure of scurvy by addition of canned tomato 166

14. Failure of yeast as prophylactic 171

15. Temperature, pulse, and respiration in scurvy 186

16. Subperiosteal hemorrhage and separation of epiphysis. Roentgenogram 192

17. Periosteal "tags" and "streamers." Roentgenogram 193

18. Infant with marked scurvy. Characteristic position 198

19. Scorbutic beading of ribs. Roentgenogram 198

20. "White line." Roentgenogram 199

21. Cardiac enlargement. Roentgenogram 200

22. Electrocardiogram showing "cardiorespiratory syndrome" 201

23. Stationary weight during cure of scurvy. Oliguria followed by polyuria 206

24. Development of scurvy in spite of normal gain in weight 214

25. Retardation of growth in length when no orange juice was given and supergrowth when given once more 216

TABLES

TABLE PAGE

1. Fecal flora of scorbutic infants 29

2. Necropsy reports of scurvy 82

3. Relative distribution of the antiscorbutic factor in the commoner foodstuffs 157

4. Platelets and other blood cells in scurvy 209

5. Data of epidemic of scurvy 218

6. Duration of treatment before marked improvement was noticed 237

SCURVY PAST AND PRESENT

CHAPTER I. History of Scurvy[1]

HISTORY OF SCURVY

The best historical review of scurvy is to be found in Hirsch's Handbook of Geographic and Historical Pathology, from which account we have drawn many facts.

=Outbreaks on Land.=--Like many other diseases, the life history of scurvy shows several distinct phases. We hear of it first as a plague, infesting armies and besieged towns; then as a dread disease, decimating the sailors of the navy and of the mercantile marine, and, since the end of the last century, more often as a nutritional disturbance, endangering the health of infants. Very recently it has acquired an entirely new interest, as the representative of a class of disorders which has revealed the essential importance to man of unknown dietary factors.

It is difficult, as may be imagined, to define with precision the earliest description of scurvy, as the older references are so vague as to be open to individual interpretation. The reference of Hippocrates to a large number of men in the army who suffered from pains in the legs and gangrene of the gums, which was accompanied by loss of teeth, seems sufficiently definite to be identified as this disease. The Greek, Roman and Arabian writers do not seem to have been acquainted with scurvy. This is as we should expect, for fruits and vegetables grew in such plenty in these southern countries that scurvy must have been a disorder of rare occurrence.

An interesting early description of scurvy, and one which is quite convincing, is that of de Joinville, who accompanied the Crusaders in their invasion of Egypt under St. Lewis, about the middle of the thirteenth century. He refers to the lividity and spongy condition of the gums, and describes how "the barber surgeons were forced to cut away the dead flesh from the gums to enable the people to masticate their food"; he describes their debility, their tendency to faint, and the black spots on their legs. The disease broke out in Lent, during which time the soldiers partook of no meat, but consumed a species of eel which they believed "ate the dead people" and therefore led to this loathsome disease.

It is probable that scurvy existed in the northern parts of Europe and Asia ever since they were settled by man. We should hardly expect to have records of this condition, in view of the low educational status of the people, their greatly restricted literature, and their lack of intercourse with the people in the southern countries. In the sixteenth century, with the development and spread of education, we begin to hear of scurvy from various sources. Claus Magnus, in his "History of the Northern Nations," published in 1555, described the disease which he tells us flourished among the soldiers in the camps and in the prisons. About this time Ronsseus, Echtius and Wierus wrote special treatises on this disease, and recommended many dietary measures which we recognize to-day as most efficacious. The number of monographs on this subject multiplied with great rapidity in the course of the next twenty-five or fifty years; none of them, however, added anything essential to our knowledge. In 1645 the Faculty of Medicine at Copenhagen published a "consilium" for the benefit of the poor, treating of the causes, prevention and cure of this disease, which was prevalent among the Danes and other northern nations.

The colonists of the northern part of America were sorely afflicted with scurvy. It is said that the French met with such high mortality during the severe winters in Canada, that they frequently debated the wisdom of abandoning this settlement. This was true also in regard to the English and their settlement in Newfoundland. Indeed, it was scurvy which forced the early settlers in Hudson Bay to discontinue their intentions of colonizing that region.

In an essay published in the eighteenth century (1734), Bachstrom described an epidemic of scurvy which occurred in 1703 during the siege of Thorn, in Prussia, by the Swedes, which caused the death of 5000 of the garrison, in addition to a large number of the inhabitants. It is interesting to note that this epidemic took place in the middle of the summer, and not in the cold season. From this time on we meet with many descriptions of scurvy in connection with the wars at various periods. For instance, in the Russian armies, in the war between the Austrians and the Turks in 1720; in the English troops who had taken Quebec from the French in 1759; among the French soldiers in the army of the Alps in the spring of 1795. It is unnecessary to review these accounts in detail. This period is distinguished rather by the appearance of a great classic on Scurvy, the work of the English naval hygienist, Lind (1752). This book has intrinsic value to-day, and, at the time it appeared, served to crystallize the conception of scurvy, which had been stretched out of all proportions to include an ever-increasing conglomeration of clinical conditions. Scurvy had become the Alpha and Omega of professional routine, the catchword of the day, the asylum ignorantiæ of the practical man. Into this chaos, as Hirsch expresses it, "the first beams of light fell when Lind's classical work appeared."

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