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Scurvy

rickets, fresh, milk, scorbutic, food and fed

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SCURVY is a disease which is now rarely seen in its most pronounced form even in the adult, unless under circumstances of exceptional hardship and privation. As one of the diseases to which young children are liable it has been, until recent times, completely ignored. Lately, however, owing to the observations of Drs. Cheadle, Gee, T. Barlow, and others, a form of the malady has been recognised as an occasional consequence in infants of bad feeding and injudicious management. In such subjects the disease is commonly grafted upon rickets ; and there can be little doubt that it is this conjunction of the two maladies which constitutes the state by Fiirst and others under the name of acute rickets.

Causation. —A scorbutic taint which reveals itself by the milder phe nomena of scurvy appears to be less uncommon than was at one time sup posed amongst the out-patients of large hospitals. Dr. Eade, of Norwich, and Dr. Ralfe, of the London Hospital, have both met with such cases amongst their patients ; and Surgeon-General Moore has remarked upon the frequency with which similar symptoms can be detected amongst the inhabitants of certain districts in India. In all such cases bad or insuffi cient food is no doubt the cause of the impoverished state of the system, especially the want of fresh meat, fresh milk, potatoes, and vegetables generally. In young children the causes appear to be very similar to those which have the power of setting up rickets, although they are not identi cal with them. If an infant be fed with excess of starchy food and sup plied with sweetened preserved milk instead of the fresh milk of the cow ; if he be dirty and neglected as to his person, and breathe habitually a close, foul air, the conditions are just those which are capable of up the scorbutic state. An infant so brought up quickly begins to show signs of rickets, and may perhaps be found all at once to develop the symptoms of scurvy. That every badly fed child does not manifest similar phenomena is probably owing to the fact that many articles of diet are anti-scorbutic, although. not anti-rachitic ; indeed some, while they pre

serve from scurvy, may actually aid in the production of rickets. Scurvy differs from rickets in not being a disease of general malnutrition. In the former the affection is due merely to the absence from the blood of some constituent whose presence is essential to health. In the latter the whole system suffers, and the condition is one of general impairment of nutrition from deficiency of wholesome food. Consequently as long as the indispensable element is supplied to the blood the patient does not be come scorbutic, however well the diet may be adapted to favour the oc currence of rickets. Thus a child fed largely upon potatoes may very probably grow rickety, but he will certainly escape scurvy. Again, in Eng land fresh fruit, being cheap, is largely consumed by the children of the poor. Even babies in arms are allowed to nibble at an apple or a plum as soon as they are able to hold an object in their hands. During the summer months they get strawberries and gooseberries ; in the au tumn apples, pears, and plums ; and in the winter and spring oranges. By such means a scorbutic tendency is no doubt counteracted, but general nutrition is little improved ; indeed, it is not improbable that on account of the indigestion and acidity which such indulgences must necessa rily excite at this early age the occurrence of rickets is actually pro moted.

The outbreak of scurvy often appears to be determined by some influ ence which causes a temporary depression in the child's strength. Chil dren who inherit a diathetic tendency are probably more prone than constitutionally healthy subjects to suffer readily from the want of milk and fresh and wholesome food. In many cases, however, it is noticed that the patient is enabled to resist for a long time the influence of a distinctly injurious dietary ; and it is only when the nutritive processes are brought to a sudden standstill by an attack of gastrointestinal catarrh that scorbu tic symptoms begin to be observed.

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