Scurvy

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Scurvy
ICD-10 code:	E54
ICD-9 code:	267

Scurvy, known as Barlow's disease in infants, is a disease that results from insufficient intake of vitamin C and leads to the formation of livid spots on the skin, spongy gums, and bleeding from almost all mucous membranes. The spots are most abundant on the thighs and legs, and a person with the ailment looks pale, feels depressed, and is partially immobilized. Scurvy was at one time common among sailors whose ships were out to sea longer than perishable fruits and vegetables could be stored and by soldiers who were similarly separated from these foods for extended periods.

1 Symptoms
2 History
3 Modern incidence
4 Pathophysiology
5 See also
6 External links

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Symptoms

Image:Scorbutic gums.jpg Symptoms include:

weakness
joint pain
black-and-blue marks on the skin
gum disease
spongy gums
corkscrew hairs

It takes about three months of vitamin C deprivation to begin inducing the symptoms of scurvy. Untreated scurvy is always fatal, but since all that is required for full recovery is the resumption of normal vitamin C intake, death by scurvy is rare in modern times.

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History

Scurvy was probably first observed as a disease by Hippocrates. In the 13th century the Crusaders suffered from scurvy frequently, and it has inflicted terrible losses on both besieged and besieger in times of war. Scurvy was one of the limiting factors of marine travel, often killing large numbers of the passengers and crew on long-distance voyages. It even played a significant role in World War I.

The plant known as "scurvy grass" acquired its name from the observation that it cured scurvy, but this was of no great help to those who spent months at sea. The discovery by James Lind in 1747 of treatment and prevention of scurvy by supplementation of the diet with citrus fruit such as lemons and limes led eventually to the discovery of vitamins, but for many years afterwards there was still much ignorance about the cause of scurvy and lack of understanding about how to prevent it. During sea voyages, it was discovered that sauerkraut was of use in preventing scurvy. In the Royal Navy's Arctic expeditions in the 19th century, for example, it was widely believed that scurvy was prevented by good hygiene on board ship, regular exercise, and maintaining the morale of the crew, rather than by a diet of fresh food, so that Navy expeditions continued to be plagued by scurvy even while fresh meat was well-known as a practical antiscorbutic among civilian whalers and explorers in the Arctic. At the time Robert Falcon Scott made his two expeditions to the Antarctic in the early 20th century, the prevailing medical theory was that scurvy was caused by "tainted" canned food. It was not until 1932 that the connection between vitamin C and scurvy was established.

The use of limes by the Royal Navy to prevent scurvy gave rise to the name "limey" for a British sailor which has been since extended to all British in American slang.

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Modern incidence

Image:Scorbutic tongue.jpg

In modern society, scurvy is rarely present in adults. However, vitamin C is destroyed by the process of pasteurization, so babies fed with bottled milk sometimes suffer from scurvy if they are not provided with adequate vitamin supplements (breast milk contains sufficient vitamin C to prevent scurvy on its own).

Scurvy is one of the accompanying diseases of malnutrition (other such micronutrient deficiencies are beriberi or pellagra) and thus is still widespread in areas of the world depending on external food aid. (See also the report from the WHO referenced below.)

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Pathophysiology

Normal collagen synthesis depends upon the hydroxylation of proline and lysine to form hydroxyproline and hydroxylysine, respectively. These nonstandard amino acids are found abundantly in collagen and confer strength to collagen fibrils. Prolyl and lysyl hydroxylase, the enzymes that catalyzes the hydroxylation, require vitamin C. Without it, hydroxyproline and hydroxylysine are not formed, and the resulting collagen fibrils are considerably weaker than normal.

While collagen is distributed widely throughout the body, the effects of defective collagen are first experienced at sites where collagen turnover is greatest. Thus capillary endothelium, which is stabilized by collagen, is first to be destroyed resulting in hemorrhaging, the predominant symptom of scurvy. Hair follicles is one of the common sites of cutaneous bleeding.

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