Scurvy used to be much more common than it is now. In the Civil War there were nearly 50,000 cases in the Union Army. Sailors and soldiers have been the common victims, but now the disease occurs most often among the poorly fed, on shore. It is caused by a diet containing neither fresh vegetables, preserved vegetables, nor vegetable juices. In the absence of vegetables, limes, lemons, oranges, or vinegar will prevent the disease. It is also thought that poisonous substances in the food may occasion scurvy, as tainted meat has experimentally produced in monkeys a disease resembling it. Certain conditions, as fatigue, cold, damp quarters, mental depression and homesickness, favor the development of the disease. It attacks all ages, but is most severe in the old.

Symptoms. Scurvy begins with general weakness and paleness. The skin is dry, and has a dirty hue. The gums become swollen, tender, spongy, and bleed easily, and later they may ulcerate and the teeth loosen and drop out. The tongue is swollen, and saliva flows freely. The appetite is poor and chewing painful, and the breath has a bad odor. The ankles swell, and bluish spots appear on the legs which may be raised in lumps above the surface. The patient suffers from pain in the legs, which sometimes become swollen and hard. The blue spots are also seen on the arms and body, and are due to bleeding under the skin, and come on the slightest bruising. Occasionally there is bleeding from the nose and bowels. The joints are often swollen, tender, and painful. Constipation is rather the rule, but in bad cases there may be diarrhea, nausea, and vomiting, and the victim becomes a walking skeleton. Mental depression or delirium may be present.

Treatment. Recovery is usually rapid and complete, unless the disease is far advanced. Soups, fresh milk, beef juice, and lemon or orange juice may be given at first, when the digestion is weak, and then green vegetables, as spinach (with vinegar), lettuce, cabbage, and potatoes. The soreness of the mouth is relieved by a wash containing one teaspoonful of carbolic acid to the quart of hot water. This should be used to rinse the mouth several times daily, but must not be swallowed. Painting the gums with a two per cent solution of silver nitrate in water, by means of a camel’s hair brush, twice daily, will also prove serviceable. To act as a tonic, a two grain quinine pill and two Blaud’s pills of iron may be given three times daily.

INFANTILE SCURVY. Scurvy occasionally occurs in infants between twelve and eighteen months of age, and is due to feeding on patent foods, condensed milk, malted milk, and sterilized milk. In case it is essential to use sterilized or pasteurized milk, if the baby receives orange juice, as advised under the care of infants, scurvy will not develop.

Scurvy is frequently mistaken for either rheumatism or paralysis in babies.

Symptoms. The lower limbs become painful, and the baby cries out when it is moved. The legs are at first drawn up and become swollen all around just above the knees, but not the knee joints themselves. Later the whole thigh swells, and the baby lies without moving the legs, with the feet rolled outward and appears to be paralyzed, although it is only pain which prevents movement of the legs. Sometimes there is swelling about the wrist and forearm, and the breastbone may appear sunken in. Purplish spots occur on the legs and other parts of the body. The gums, if there are teeth present, become soft, tender, spongy, and bleed easily. There may be slight fever, the temperature ranging from 101° to 102° F. The babies are exceedingly pale, and lose all strength.

Treatment. The treatment is very simple, and recovery rapidly takes place as soon as it is carried out. The feeding of all patent baby foods condensed or sterilized milk must be instantly stopped. A diet of fresh milk, beef juice, and orange juice, as directed under the care of infants, will bring about a speedy cure.