Scurvy has long been the dread of navigators, explorers, and armies in the field; in fact wherever men are cut off from available supplies of fresh food its ravages are known. Babies fed exclusively on sterilised foods suffer from the form known as " Barlow's disease," and as Hoist first pointed out symptoms identical with those of human scurvy can be produced in guinea pigs by feeding on a restricted diet.1

The first distinct account of the disease is contained in the history of the crusade of Louis IX in the Thirteenth Century, during which the French army suffered greatly from it. In the Sixteenth Century it was endemic in various parts of northern Europe. During Car-tier's second voyage to Newfoundland in 1535 one hundred out of his crew of 103 men developed symptoms of scurvy, but were cured by the administration of a dcfeoction of fresh pine needles. In 1593 Admiral Hawkins stated that within his personal experience not less than 10,000 seamen had died of scurvy, and an appalling case is on record of the Spanish ship "Oriflamma " which was found adrift with her entire crew dead of scurvy.

In adults the symptoms come on gradually, the onset being marked only by a certain failure of strength which is manifested when any effort is called for. Breathlessness and exhaustion are easily induced, along with a corresponding mental depression. The face is sallow and pallid, the eyes sunken, and the gums tender. The muscles of the body and limbs become painful with vague pains suggesting rheumatism. Appetite and digestion may be unimpaired in the earlier stages, but gradually decline. As the disease progresses the gums become livid, spongy, ulcerating, and bleeding, the teeth are loosened and drop out, the breath becomes excessively foul. Effusions of blood from the vessels in the skin and other tissues takes place either spontaneously or as the result of slight pressure or injury to the skin. These are frequently so extensive as to cause swelling of the muscles in which they occur, giving the appearance of extensive bruises and tending to become hard and brawny. In addition there is bleeding from the mucous membranes of the nose, eyes, and alimentary and respiratory tracts, and hemorrhages into the pleural, pericardial or peritoneal cavities.

According to Hess,2 the coagulability of the blood is almost normal, the escape of blood from the vessels being due to a weakening of the walls or to a lesion of the endothelial cells. Ulcers are apt to break out in the limbs. In the later stages exhaustion becomes profound, with a tendency to syncope, and various complications such as diarrhoea and pulmonary or kidney troubles are liable to appear, any of all of which may bring about a fatal result. Diminished secretion of urine is a common symptom of both beriberi and scurvy.

1 Hoist and Frolich, J. Hyg. 7, 634,1907.

The protein metabolism is disturbed during the progress of the disease as is evidenced by the increased ammonia and amino acid output.3

Stefanson4 gives the following description of cases observed by him during 1916-17:

"Anderson complained to me of having been gradually becoming more and more unwell for a week or two. The first symptoms noted by him was dizsiness on suddenly standing up, 'lasiness,' gloom and irritability, showing itself in a tendency to condemnatory and uncalled-for argumentativeness, proneness to becoming tired, and loosening of the teeth and a swelling and recession of the gums, with a dull local ache in the gums or roots of the teeth. The appetite was normal both as to quality and kind of food desired. . . . At this time the teeth of the men were so loose that they could be plucked out with the fingers with no effort, and the gums were of such a cheese-like consistency, that they were cut (with little bleeding) by wooden toothpicks about as easily as an ordinary 'American' cheese could be. Every joint was sore and all movements painful".

Hess5 points out that the association of circulatory disturbances with latent scurvy, which has been overlooked until lately, furnishes a clinical link between scurvy and beriberi. One of the earliest symptoms is frequently tachycardia, a heart beat of 140 or 150 being quite common in infants. Still more noticeable and characteristic is the instability of the pulse rate, which may increase by from 20 to 40 beats to the minute on the slightest exertion or rise in temperature. Accompanying this may be respirations rising to 40, 50, or even 60 to the minute. These symptoms, to which Hess gives the name "cardiorespiratory phenomena," yield promptly to antiscorbutic treatment, from which Hess infers at least a functional relation between the antiscorbutic vitamin and nerve tissue. The scorbutic organism, even in the latent stages of the disease, is peculiarly sensitive to infection. Abels6 found that scorbutic guinea pigs succumbed to much smaller peritoneal injections of cultures of the slightly toxic B coli than did non-scorbutic animals. Intracutaneous injections of staphylococci, toward which guinea pigs are normally very resistive, caused distinctly palpable infiltrates, and in one case an abscess, in scorbutic pigs, while the controls presented at the most a very slight infiltrate.

He also found support for the assumption that the hemorrhages observed in scurvy are brought about by the toxic effects of infections.

2 Hess, J. Am. Med. Ass. 70, 003, 1921.

3 Labbe, Haguenea and Nepveux, Bull. mem. soc. med. Hop. 44, 1094, 1920, Chem. Abe. 1920, 3207; See also Brandt, Arch. f. Kinderheil. 07, 395, 1920. The blood in scurvy.

4 Stefanson, J. Am. Med. Ass. 71, 1715, 1918. 5 Hess, I c.

Barlow's disease was first observed in England in 1876 by Sir T. Smith and later fully investigated by Sir Thomas Barlow. It is seen principally in children from 6 to 18 months. The child is sallow and fretful before any marked physical signs appear.7 Later there appears a sensitiveness to touch, particularly about the lower limbs, and the child will refuse to move or bear any weight on the legs. Later the limbs swell, the tenderness increasing. The growth in weight find length is markedly affected.8 Comby9 urges the importance of suspecting scurvy in an infant whenever it is observed to keep its limbs still and cry if they are touched. This is said to be a constant symptom in nurslings, but not in older children. The progress of the disease is marked by great and progressive anemia, apathy, spongy gums, hemorrhages into various structures, particularly under the periosteum and muscles, with suggestive thickenings around the shafts of the long bones, producing a state of pseudo-paralysis.9a.