Infantile scurvy may be mistaken for rheumatism, stomatitis, rickets, sarcoma, osteitis, and infantile paralysis. The re sult of antiscorbutic treatment is one of the most certain means of diagnosis. Crandall (Archives of Ped., July, '97).
There are two affections occurring in children for which scurvy is particularly mistaken: acute rheumatism and acute anterior poliomyelitis. There is no reason why scurvy should be confounded with the latter disease. There is, of course, absence of movement in the limbs in both cases, but in anterior polio myelitis this is due to inability to move them because of palsy. In scurvy the failure of movement is due to pain. This can very easily be decided by passive movements. Scurvy and acute rheuma tism are not so easy to differentiate. In scurvy, however, the haemorrhage is not into the joint and not into the epiphysis, hut practically always into the diaphysis of the long hones. Blood-extravasations occur at times over the tissue and occa sionally even over the carpus, but these are rare exceptions. If the bones are protected from motion it Avill be found that the joints in scurvy may be freely moved. At times in scurvy haemorrhage occurs into the joints, and this may al most hopelessly confound the disease with rheumatism: but these joint orrhages are very rare. Abram Jacobi (Med. News, Oct. 28. '99).
Attention called to the frequency with which scurvy in infancy is mis taken for acute articular rheumatism. A point of differential diagnosis is the rarity of articular rheumatism in the first five years of life. Infantile seor butus usually appears in the children of the well-to-do, in distinction from rickets, which, on the other hand, seems to be the disease of the poor. H. A. Hare (Med. News, Feb. 10, DOI).
Etiology.—Of the many cases now re corded the majority have occurred in infants between the eighth and twen tieth months. Race, sex, and season appear to excite no influence. Children of the better classes seem more prone to the disease. The use of food unsuited to the children seems to be the great cause; but just what the chief fault in the diet may be is not yet determined. Certainly the majority of cases seem to have de veloped in infants fed upon the proprie tary foods.
Three hundred and seventy-nine cases of infantile scurvy investigated. The
disease is most apt to develop between the ages of seven and fourteen months, inclusive, and has a greater tendency to occur among the rich or the well-to-do. The most important etiological factor is a dietetic one, 214 of the eases (00 per cent.) having been fed on proprietary foods. There does not seem to be evi dence that the association of rickets and scurvy is at all intimate. Very possibly the same defect in diet which produces the one produces the other also, but the rapid recovery under treatment which the scurvy underwent did not apply to the rickets. This seems to indicate only accidental association of the two dis eases: certainly not any causual rela tion between them. Committee Amer. Fed. Soe. (Med. Bee., July 2, '98).
Two cases of infantile scurvy due to a prolonged diet of sterilized milk and cream. and two clue to patent foods. The boiling of milk for infants is essen tial, except under certain circumstances. and the longer milk is boiled and the higher the temperature to which it is subjected, the less will be its antiscor Untie value and nutritive principles. E. Cautley (Lancet, July 20, 1901).
Sixteen cases of infantile scurvy under the writer's care during the last eighteen months. A study of these cases sup ports the generally accepted view that the patented foods often produce in fantile scurvy. and sonic of them show that recovery may follow the with drawal of these foods without other treatment. The cause of this action is in doubt. It may be that they are so commonly derived from or contain starch, or that they are deficient in cer tain ingredients. Two of the cases throw suspicion on barley-water. These cases indicate also that the sterilization of milk has an undoubted power to pro duce scurvy. but it is a less prominent factor than the patented foods. It is seen that scurvy can readily develop on a diet of milk which is not long heated or which is even raw. In some of the cases fruit-juice was given, and improve ment noted. without any change in the food whatever. Whereas there are (•asses of foods which are particularly apt to produce scurvy in infants, yet the individual element is remarkably present in this disease. J. P. Crozet! Griffith New York Med. Jour., Feb. 23, 1901).