INFANTILE SCURVY the term infantile scurvy is understood a scorbutic affection occurring in the early years of life, and characterized chiefly by marked anemia of the skin and mucous membranes, bleeding gums, pain upon movement and the occurrence of swellings upon the long bones of the extremities and upon the ribs. The anatomical basis of this disease is a specific affection of the bone marrow associated with anaemia and the hannorrhagic diathesis. In the majority of cases the disease appears in association with a pre-existing rachitis of slight or severe grade, but it may occur entirely independently.
(1S59 and 1S62) first described it under the name "acute rickets," as he believed the specific symptom-complex was an indication of an acute exacerbation of rachitis, though Forster was in clined to assign to it an independent position. Ingerslev (1871) and Jalland called it scurvy, though some English authorities, especially Cheadle, laid great stress upon its association with rachitis. Barlow (1SS3) first brought to bear upon the subject. numerous pathological as well as clinical observations; he regarded the affection as scorbutic and strongly emphasized the importance of dietetic therapy. When once the attention of physicians was turned to the question, appeared from many countries: from North America, Holland, Denmark, North Germany, later South Germany, France, Belgium, Sweden, Austria, Switzerland, Italy, Finland, etc. The American and French physicians called the disease scurvy, those from other countries generally Barlow's or M011er-Barlow's disease. Heubner wished to avoid the designation scurvy, as he regarded the conception of scurvy as poorly defined and because it does not usually occur where infantile scurvy is frequently observed, and furthermore, the symptom-complex of infantile scurvy differs decidedly from that of the adult type of scurvy. In addition to Barlow, we are particularly indebted to Naegeli, Jacobsthal, Schoedel Nauwerk, Schmorl and Frankel for the demonstration of the finer histological changes in this disease.
Occurrence.—Infantile scurvy is distinctly an affection of artifi cially fed children and though it has greatly increased in frequency in the last twenty to thirty years, it is yet rather rare.
Of one hundred cases, the ages at the beginning of treatment were as follows• Isolated cases have been noted throughout the third and fourth years; the oldest case, six and one half years, was autopsied by Fran kel. Boys seem to be affected somewhat more frequently than girls. The influence of season is uncertain. The occurrence of cases in Eng land, Holland and Northern Germany speaks for a geographical and climatological influence though cases occur in all countries. Favorable social conditions predispose to the occurrence of cases.
Clinical Picture.—The symptoms develop gradually and at first are not characteristic. The following is a typical clinical history: A child in good surroundings; sunny dwelling, garden, careful atten tion; nourishment, artificial with Gartner's "Fat milk." Child thrived until the ninth month, then had frequent slight digestive disturbances; then was less active than formerly, and dull. There was an increasing pallor of skin and mucous membranes, movements of the body were avoided; the child cried very frequently when handled. Legs were held as if paralysed. About the upper incisors the gums were much swollen and were of a bluish red color and bled easily.
The attending physician made a diagnosis of rachitis and ordered codliver oil and phosphorus, and salt baths. The child's condition grew worse under this treatment and it was therefore brought to the hospital.
Condition on admission, November 11, '03: a very amemic hut moderately well nourished girl of eleven months lies immovable on the bed and cries as one approaches it. No signs of rachitis. In the region of the upper and lower middle incisors marked htemorrhagic swelling of the gums; at the lower end of the left humerus there is a diffuse painful swelling and similar ones are present over the lower third of the right femur and the lower half of the tibia. No special changes in heart or lungs. Temperature 3S.5° C. (101.3° F.).