The direct causal factor of scurvy in infants is the continued use of food that lacks some essential nutritive elements or presents them in a form not readily assimilable. To put the whole question in a few words, the cause of scurvy in infants is continued deprivation of fresh food.
The faulty foods may be classed in the order of their potency:— 1. The different proprietary infants' foods administered without the addition of cows' milk. These foods are respon sible for the greatest number of eases, and which variety most readily induces the disease depends chiefly upon the ex tent of employment or the fashion at the time. 2. Proprietary foods employed ! with the addition of insufficient quanti ties of cows' milk. 3. Oatmeal- or wheat- gruel. Barley and other fail uacefe administered with water alone or with water and insufficient cows' milk. 4. Condensed milk and water. 5. Steril ized milk. Properly modified milk mix tures subjected to a temperature of 212° P. (100° C.) from thirty minutes to an hour or more. 6. Too dilute milk and cream mixtures. Laboratory mixtures with too low albuminoid percentage. Consideration of these groups furnishes an explanation of the greater frequency of scurvy in infants reared in luxury than in the very poor. Louis Starr (Phila. Med. Jour., April 27, 1901).
Observations upon one hundred and seventy-nine consecutive eases which have been fed during a period of from three to eighteen months, pasteurized milk being given for nine months of the year. while during the three summer months sterilized milk was used. The milk has been given out by competent nurses. Careful examination of the chil dren so fed have shown that 97 per cent. of the cases presented unmistakable signs of rickets or scurvy, most of the eases being rickets or a combination of rickets and scurvy. About 40 of the chil dren had from five to seven daily feed ings of the sterilized milk, supplemente:1 by breast-feedings. These all showed signs and symptoms of rickets, although not so marked as in those who were fed upon this modified milk exclusively. The changes most frequently seen were beading of the ribs, pot-belly, sweating.
flabby muscles, cranio-tabes, and rest lessness at night. These results would seem to add valuable evidence in sup port of the claim which has been urged so generally by competent authorities that the best substitute for mothers' milk is fresh, pure. raw cows' milk. E. M. Sill (Medical Record. Dec. 27, 1902).
Pathology.—The most characteristic change consists of subperiosteal hwmor rhages, which produce the swelling. Haemorrhage into the muscles is some times seen and haemorrhage under the mucous membranes is common. The marrow is hypermuic and rich in lymph cells and leucocytes. (Lunz.) Prognosis.—The disease tends to run a chronic course except when treated appropriately. Then the recovery is sometimes phenomenally rapid. If rec ognized and treated, or if severe compli cations are present, death is not rare. Treatment.—This consists in correct ing the diet and in giving fresh fruit juices, especially orange-juice. All pro prietary food should be abandoned. Sometimes a change from cooked to raw milk seems to be advantageous. Tonics may be needed later, but are of no service for the direct treatment of the scurvy.
Marked case treated with boiled milk and a tablespoonful of orange-juice and raw beef-juice. Next day patient some what better, but the pain still present. Ordered the milk not to be boiled and a few drops of lime-juice in addition, to be given twice a day. Three days after the diagnosis was made and change of diet begun the swellings were smaller and the pain had evidently entirely disappeared. L. S. Hughes (Australasian Med. Gaz.. Oct. 20, '97).
Brilliant results are obtained by pro viding a suitable diet, such as fresh cows' milk, or mothers' milk; beef-, orange-, or lemon-juiee; fresh vegetables, mashed potatoes, etc. The child should be placed under the best possible hygienic condi tions, good ventilation be provided, and under favorable conditions of weather the child should be out-of-doors. Cod liver-oil is especially indicated upon re covering from the scorbutic condition. Abt (Med. Rec., June II, '9S).