SCURVY.
The scorbutus of adults, formerly very common, is now, owing to ad vances in preventive medicine, very rarely seen.
Prophylaxis.—The etiology of the affection shows that though the absence of fresh vegetables is the usual cause of the condition, life may be maintained for indefinite periods without any vegetable juices if the individual is provided with a supply of fresh animal food. This has been abundantly proved by Arctic explorers, who have been able to procure fresh bear and seal flesh, whilst scurvy attacked their companions living exclusively on tinned meat and tinned vegetables. The ration of fresh Lime Juice—compulsory in the mercantile marine since 1867—and the introduction of steam, which shortens the voyages, have entirely removed the disease from the seagoing population. The best preventive is i oz. fresh Lime or Lemon Juice daily, or in the absence of these, any form of fresh fruit or vegetable, and when these are not available, fresh under cooked animal food. Overcrowding, mental depression and physical exhaustion are powerful predisposing causes. A bacillus is believed to be the final determining factor, and that microbic infection is inhibited by the free use of fresh vegetables, fresh milk and fresh animal food.
The treatment of the established disease will consist in rest in bed, with moderate warmth, fresh air and sunlight, and an abundant supply of fresh vegetables, diluted lemon juice, fresh milk and raw beef juice. As the condition of the gums will often render mastication difficult or impossible, the nutrition of the patient can be maintained by a good beef or mutton broth, to which a large proportion of fresh vegetables is added at the termination of the boiling process; these should be strained out before serving up. Raw meat juice and lemon juice drinks should be given between the meals of broth or soup, and as soon as the patient is able to chew he should get raw or undercooked fresh beef. 'emorrhagic tendency is rapidly controlled by such a dietary, and often drugs are quite unnecessary, but Calcium Chloride and Normal Serum are clearly indicated when the loss of blood is great, and Iron should be given later on to control the anremia. The spongy, ulcerated or sloughing gums will require attention. In mild cases the use of a vegetable astringent is all that is necessary. The following is a useful combination: R . Tina. illyrrhre 3iv.
Tinct. Kramerice Tina. Catechn Decoct. Quercus ad 5xx. Illisce.
When the gum tissue is ulcerated it may be painted with a 3o gr. to the oz. solution of Nitrate of Silver, and factor may be relieved by mouth washes of weak Chlorinated Soda, Permanganate of Potassium, or a solution (r in 4o) of Chlorate of Potassium. Alum oz. and Lemon Juice 2 OZ. to a pint of water make a very efficient mouth-wash under which ulcers heal rapidly.
Excessive bleeding from the gums, when not readily controlled by these applications, should be checked by Adrenalin Chloride, applied with a soft brush, and excessive salivation may be checked by small doses of Atropine.
For the cardiac weakness, which may cause syncope when the patient assumes the erect posture, prolonged rest in the horizontal position is necessary, and Strychnine hypodermically may be required. Brawny swellings, due to extravasations of blood in or around the muscles, shouk be let alone till the general blood condition has been improved by the dietary; afterwards their dissipation should be hastened by gentle massage, douching and passive movements of the neighbouring joints.
Dysenteric symptoms, pleuritic, pneumonia and other complication: are to be dealt with on recognised therapeutic principles.
Infantile Scurvy, or Barlow's Disease, has been confused with ticket but it differs in no respect from scurvy of the adult.
Prophylaxis.—The disease occurs in the infants of the better class o the community, at the age of about 12 months, and is invariably due to errors in dietary caused by the destruction of the antiscorbutic quality o fresh milk by prolonged boiling, I'asteurisation, desiccation or peptonisa Lion, or to the exclusive feeding of the infant on patent foods. Preventive measures obviously consist of the administration of pure fresh milk fron the cow, diluted as required, or, better still, of the services of a health) wet-nurse.
The mere bringing of cow's milk up to the boiling-point or near to it does not destroy the antiscorbutic qualities of the fluid, but the craze against microbes tends to prolong the boiling. A little raw meat juice is a valuable prophylactic where the milk must be boiled.
The treatment of the established disease must be conducted upon the same lines, and the speediest and most satisfactory remedy is the service of a wet-nurse when procurable. Failing this, fresh cow's milk, diluted with weak beef juice, should be employed as a dietary to the exclusion at first of farinaceous foods, and a little fresh vegetable juice should be ad ministered. It is not enough to take away the patent food on which the scorbutic infant has been living by substituting cow's milk for it, though this latter of itself is a reliable prophylactic. Cheadle and Colman's plan of boiling potatoes without removing the skin of the tubers and passing the mashed potato through a fine sieve before adding it to the milk is a most satisfactory method of treatment. Soup or broth, to which plenty of fresh vegetables have been added at the end of the boiling process, the latter being strained out before the soup is added to the milk, is a valuable addition to the food. Teaspoonful doses of fresh Orange juice, given between meals, meet every requirement.