=Definition.=—A constitutional disease, characterized by extreme
general weakness, anemia, spongy condition of the gums, disintegration
of tissue and a tendency to hemorrhages.
=Etiology= and =Pathology=.—In comparison with former times scurvy is
now a rare disease. Lack of fresh vegetables or their substitutes,
over-crowding, dampness, bad hygienic surroundings, and prolonged
fatigue under depressing influences are the predisposing causes. Arctic
explorers have shown that fresh bear’s meat and bear’s blood are a
preventative.
There are extravasations of blood into the skin, muscles and mucous
membranes. Hemorrhages may occur in the internal organs, especially
the kidneys and liver, and in the serous membranes. The gums are
swollen and spongy. The teeth decay. The spleen is soft and enlarged.
Parenchymatous degeneration of the heart, liver and kidney is frequent.
Ulcers occasionally occur in the skin and bowels. The blood is thin but
there is no leucocytosis.
=Symptoms.=—The disease is usually slow in development. The general
manifestations of anemia with debility are among the first symptoms.
The gums are swollen, soft and spongy, they bleed easily and in severe
cases there is ulceration. Petechial spots appear upon the body.
Subcutaneous ecchymosis occurs, first on the legs, then on the arms
and trunk. The eyes and face are swollen; the patient appears as if
he had been bruised. Hemorrhages from the mucous membrane frequently
occur. The temperature is usually normal. The pulse is small, feeble
and frequent; sometimes irregular and slow. The appetite is impaired
and constipation is present at first, as a rule, although this may be
followed by scorbutic dysentery.
=Diagnosis.=—The disease is readily recognized when several cases occur
together. It is somewhat hard to recognize in isolated cases, and to be
able to distinguish it from certain forms of =purpura=. The etiology,
the gingival changes and the hemorrhages usually decide the diagnosis.
=Prognosis.=—Scurvy being a disease due to malnutrition, it is
necessary to remedy such condition by attention and correction of the
faults producing it. Hygienic surroundings and a wholesome diet will do
more in curing the disease than anything else. An outdoor life and good
ventilation with anti-scorbutics, as fruit juices, especially lemons
and oranges, fresh vegetables, (onions, potatoes, etc.) and fresh milk,
are necessary.
It is held by Garrod that scurvy is caused by an absence of potash,
for a deficiency of potassium salts is found in the blood. The
anti-scorbutics named above contain potash. A careful treatment along
the splanchnics would help to improve the appetite and digestion. Treat
the gums and ulcers according to surgical indications.