SCORBUTUS (SCURVY).
Definition.—A general disease charac terized by marked adynamia, spongy gums, and a tendency to haemorrhage, due to deficient or improper food.
Symptoms.—The first sign of the dis ease is fatigue and general depression, accompanied sometimes by muscular pains in the back and calves. Pallor, loss of flesh, and anorexia follow, and the typical sign of the disease then ap pears: swollen and spongy gums that bleed upon slight contact or pressure. The gingival mucous membrane becomes bluish and is more or less ulcerated, the ulcers sometimes reaching the deeper tissues and causing necrosis of the alveo lar process. The breath, owing to the presence of necrotic tissues, becomes exceedingly foul. The teeth, at first loosened, may fall out. The tongue is swelled and red; this with enlargement of the maxillary, sometimes adds much to the patient's discomfort. The tem perature is often subnormal.
Htemorrhagic spots of various forms and size appear over the surface. In some cases they resemble ecchymoses; in others, purpura, petechim, pemphigus, lichen, and other cutaneous disorders, the skin in all being rough and dry. The haemorrhages may be deep-seated, giving a bosselated appearance to the limb affected. Haemorrhages from the nose, stomach, bladder, and intestines may also occur, complicated, in some instances, by extravasations into the pleura, pericardium, meninges, and joints. The latter, especially the ankles and wrists, are sometimes oedematous. Necrosis of the bones, epiphyses, and of the callus, in recently-fractured bones, is observed. Cardiac disorders frequently appear. The pulse becomes weak, irregu lar, and rapid; the area of dullness is increased, and a hiemic murmur at the base is often distinguishable. The urine is usually albuminous and dark, the phosphates being increased. Its spe cific gravity is always high. Disturb ances of vision are occasionally com plained of. Attacks of syncope and delirium are common, convulsions are sometimes witnessed, while hemiplegia also occurs as a complication of the later stages. The mortality from this disease, which is infrequent nowadays, owing to protective legislation bearing upon the food-supplies of ships, is not great. Death usually occurs from heart-failure, haemorrhage, etc., or as a direct result of some intercurrent disorder.
Etiology and Pathology.—Scurvy has become almost extinct, owing to the changes brought about in the food sup plied to the crews of ships, in prisons, work-houses, barracks, etc. What the precise elements are is still a subject of controversy, but the best evidence tends to show that the disease is due to the insufficiency or absence of the potassium salts, the organic salts of fruit and vege tables, which, individually or collectively, maintain the alkalinity of the blood up to its proper standard, through the car bonates derived from them. These fail ing, acid intoxication results, affecting not only the tissues proper, but the blood also, especially in respect to its coagula bility. The blood is rendered dark and fluid, and resembles that of profound anemia without leucocytosis. According to Wright (Army Med. Rep., '95), the presence or absence of acid intoxication may be ascertained by determining the total acid which is being excreted in the urine. In acid intoxication there is a notable increase of the ammonia-neutral ized acid excreted as compared with the free acid. Contrary to general belief, it is not the citric acid of lime-juice which is beneficial in scurvy, citric acid having proved useless when administered alone; the antiscorbutic effects are due to the potash salts which lime-juice contains. The disease has been ascribed by others to a micro-organism or its toxins, but efforts to isolate a specific germ have so far remained fruitless.
Scurvy is a ptomaine poison ing, the ptomaines being derived from badly preserved milk, tinned meat, or salt beef. If the provisions were well sterilized and no subsequent changes took place in the food, there world be no scurvy in the ship's crew, and it would be unnecessary to take preserved vegetables or lime-juice. Regular exer cise, fresh air, and temperate habits also conduce to freedom from scurvy. Han sen (Northwestern Lancet, Nov. 1, '97) In Russian epidemic in every instance, the ocenrrence of scurvy was entirely due to lack of food. and, when the relief measures were put in force, scurvy dis appeared. There was no evidence what ever that scurvy could become infectious_ Children, it was observed, who were suckled by scorbutic mothers, in no in stance developed the disease. Editorial (Vratch, No. 29, '99).