Scurvy, Past and Present. Alfred F. Hess

108 6. Subperiosteal hemorrhage and separation of epiphysis. Roentgenogram 109 7. Complete restitution of epiphysis without deformity. Roentgenogram 109 8. Curve of fecal excretion in scurvy 121 9. Diagrammatic representation of guinea-pig scurvy 130 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 TABLESTable of Contents 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 scurv 218 6. Duration of treatment before marked improvement was noticed 237

      

      SCURVY

       PAST AND PRESENT

       CHAPTER I

       HISTORY OF SCURVY1

      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