scurvy

Definition

Scurvy is a condition caused by a lack of vitamin C (ascorbic acid) in the diet. Signs of scurvy include tiredness, muscle weakness, joint and muscle aches, a rash on the legs, and bleeding gums. In the past, scurvy was common among sailors and other people deprived of fresh fruits and vegetables for long periods of time.

Description

Scurvy is very rare in countries where fresh fruits and vegetables are readily available and where processed foods have vitamin C added. Vitamin C is an important antioxidant vitamin involved in the development of

connective tissues, lipid and vitamin metabolism, biosynthesis of neurotransmitters, immune function, and wound healing. It is found in fruits, especially citrus fruits like oranges, lemons, and grapefruit, and in green leafy vegetables like broccoli and spinach. In adults, it may take several months of vitamin C deficiency before symptoms of scurvy develop.

Currently, the recommended daily allowance (RDA) for vitamin C is 50–60 mg/day for adults; 35 mg/day for infants; 40–45 mg/day for children 1–14; 70 mg/day during pregnancy; and 90–95 mg/day during lactation. The body's need for vitamin C increases when a person is under stress, smoking, or taking certain medications.

— Altha Roberts Edgren

A disease caused by deficiency of vitamin C, characterized by spongy and bleeding gums, bleeding under the skin, and extreme weakness.

Mean; contemptible.

[From Middle English scurfy, characterized by scurf (influenced by French scorbut, scurvy), from scurf, scurf. See scurf.]

Deficiency of vitamin C, fatal if untreated. Nowadays extremely rare, but in the past was a major problem in winter, when there were few sources of the vitamin. It was especially a problem of long sea voyages during the sixteenth and seventeenth centuries; when fresh supplies of fruit and vegetables were not available the majority of the crew often succumbed to scurvy. James Lind discovered the role of citrus fruits in preventing or curing the disease; published Treatise on the Scurvy in 1753.

A disease resulting from a deficiency of vitamin C. Initial signs include bleeding gums. This may be followed by anaemia, red spots in the skin where blood has leaked out of capillaries, degeneration of muscle and cartilage, and weight loss. Most of the symptoms of the disease can be attributed to the breakdown of collagen (a protein that forms an important part of skin). The effects are reversed by treatment with vitamin C supplements. Vitamin intakes as low as 10 mg/day will prevent scurvy.

Although scurvy is rare in Western societies, it still occurs in some infants fed bottled milk, in elderly people who restrict their intake of acidic fruits because of heartburn, and in people addicted to alcohol who do not eat enough food. It may also occur in people who abruptly cease taking megadoses of vitamin C (a condition known as rebound scurvy).

. (scorbutus), a condition resulting from an ascorbic acid deficiency that is severe enough to desaturate the tissues. The development and manifestations depend on tissue storage of ascorbic acid and factors that influence the rate at which it is used in or released from the tissues. Manifestations of frank scurvy include weakness, poor wound healing, anemia, and hemorrhage under the skin and mucous membranes. Presence or severity of gingival changes is directly related to the presence of local irritants such as calculus. In a severe form and in infantile scurvy, painful subperiosteal hemorrhages occur.

Scurvy. (Neville/Damm/Allen/Bouquot, 2002)

n.a disease caused by a deficiency of vitamin C, characterized by swollen bleeding gums and the opening of previously healed wounds, which particularly affected poorly nourished sailors until the end of the 18th century.

See the Introduction, Abbreviations and Pronunciation for further details.

For more information on scurvy, visit Britannica.com.

A deficiency disease due to lack of vitamin C. Initial signs include bleeding gums. This may be followed by anaemia, cutaneous haemorrhage, degeneration of muscle and cartilage, and weight loss. The effects are reversed by treatment with vitamin C.

Scurvy, a deficiency disease caused by lack of vitamin C (ascorbic acid), was once the scourge of sailors on long voyages. It afflicted the crew of Sebastián Vizcaíno when he explored the coast of California (1602–1603), and it decimated the companions of California's first physician, Don Pedro Prat (1769). Scurvy continued to flourish even though the simple remedy for its control—plenty of fresh fruits and vegetables in one's diet—was well-known by the mid-seventeenth century. Scurvy ravaged the passengers who came to California by boat during the gold rush (1848–1853), and ship captains admitted to health officers that shipowners would not permit them to stop on the way to take fresh vegetables on board. The first person in the United States to describe night blindness (1842) as one of the symptoms of scurvy was Edward Coale, who noted that deck work had to be discontinued because so many men of the frigate Columbia could not see after sundown. Modern methods of food preservation and distribution coupled with improved eating habits have made a diet rich in vitamin C accessible to most people, and scurvy has ceased to be a major American public health problem.

Bibliography

Hess, Alfred Fabian. Scurvy, Past and Present. Philadelphia: Lippincott, 1920. Reprint, New York: Academic Press, 1982.

Watt, J., E. J. Freeman, and W. F. Bynum. Starving Sailors: The Influence of Nutrition upon Naval and Maritime History. London: National Maritime Museum, 1981.

A corruption of the earlier word "scorby," scurvy is the name given to the disease that is the consequence of a prolonged deprivation of vitamin C. The minimum daily requirement to prevent the disease is approximately 7 mg, but it takes several weeks of depletion of body reserves before the problem becomes evident. There are many descriptions of the disease as it appeared among sailors engaged in the long voyages that began to be undertaken from the end of the fifteenth century. After ten or more weeks at sea, men began to experience general pain and stiffness, while their lower body became covered with large purple spots. In addition their gums would swell and grow over their teeth, which became loose; and old wounds would reopen. Finally, sufferers would die suddenly, "in the middle of a sentence," to the astonishment of their mates. This is now explained as the consequence of impaired protein synthesis, with connective tissues weakening, so that the wall of a major artery would finally burst. It soon was discovered that the disease could be prevented, and even cured, by sailors consuming fresh fruit and vegetables. Long sea voyages were only indirectly responsible, by preventing crews from living on anything but foods that could be stored for long periods, like salt meat, dried peas, and flour that could be cooked into bread and puddings. The same disease appeared on land when fresh food was unavailable for long periods, as in the California gold rush, for example. The first "antiscorbutic" (i.e., antiscurvy) foods to be prized by sailors were oranges and lemons, but they would become moldy on long voyages, and juices preserved with brandy or rum were more stable alternatives that also proved to be more palatable. Sailors in the British navy were required, from early in the nineteenth century, to take a portion of lime juice in their daily ration of rum; men from other navies called them "limeys" as a term of abuse, implying that "real men" did not need to drink fruit juice. Another tradition among sailors on long whaling expeditions was to take a large store of potatoes. These are not very rich in the vitamin but contain enough to prevent the disease if one is eaten freshly cooked every day.

In the early twenty-first century the disease still appears occasionally in adults, typically as "widowers' scurvy," among men who have never learned to cook and, when left to fend for themselves, subsist on things like breakfast cereals and sandwiches made from bread and cheese or ham. It also has appeared in people living on very restricted "fad" diets, such as a Zen macrobiotic diet of brown rice sprinkled with sesame seeds.

With the recognition of the importance of bacteria in causing diseases, at the end of the nineteenth century, it became a practice in some cities to sterilize cows' milk by autoclaving it. Children's deaths from "summer diarrhea" were reduced greatly as a result of this practice. However, this processing also resulted in the destruction of most of the vitamin C in the milk and, when it was fed to infants with only a cereal supplement, scurvy became a common problem. The addition of orange juice to the infants' diets provided a simple solution. With modern technology, milk can be freed from pathogens and potatoes can be dried under milder conditions, so that vitamin C is preserved; alternatively, the synthetic vitamin can be added to restore vitamin C levels in foods.

Bibliography

Carpenter, Kenneth J. The History of Scurvy and Vitamin C. Cambridge, U.K., and New York: Cambridge University Press, 1986.

Hess, A. F. Scurvy Past and Present. Philadelphia: Lippincott, 1920.

—Kenneth John Carpenter

The disease caused by a nutritional deficiency of ascorbic acid (vitamin C). See also ascorbic acid nutritional deficiency.

• s. rickets — see hypertrophic osteodystrophy.

Warding off a killer disease with vitamin C in many forms
Scurvy is not a threat to most sailors these days, even those crossing oceans, because it can take months to deplete the body’s stores of vitamin C, the lack of which is the prime cause of the disease.Nevertheless, long-term cruisers living off the ship’s stores still need to watch out for it—it’s a killer if left too long. The symptoms of scurvy are weakness, anemia, spongy gums, and bleeding from mucous membranes.Small boats without refrigeration can’t keep fresh produce for long, but there are some excellent alternative sources of vitamin C that will last well if they’re kept cool and well ventilated. They include cabbage, carrots, celery, winter squash, garlic, grapefruit, onions, potatoes in their jackets, and oranges. You can also take vitamin C in synthetic form, of course. One multivitamin tablet a day will provide all you need.Nothing, however, seems to supply the vitamin in such concentrated form as fresh or bottled lemon juice. The British navy substituted lime juice for lemon juice as an antiscorbutic in the late nineteenth century but found out the hard way that it contained little or no vitamin C. So British sailors (Limeys) suffered severe outbreaks of scurvy until the Lordships of the Admiralty came to their senses and reinstated lemon juice in 1918.Another happy source of vita-min C is beer. Dr. Hannes Lindemann, who made two Atlantic crossings—one in a dugout canoe and another in a rubber-and-canvas folding boat—recommends that voyagers should carry plenty of beer to supply them not only with vitamin C, but also with other valuable vitamins and calories. His recommendation, although well received, is not widely practiced because of the difficulty of finding space for bulky beer supplies on a small yacht.See also Provisioning.

Scurvy
Classification and external resources
Scorbutic gums, a symptom of scurvy
ICD-10	E54.
ICD-9	267
OMIM	240400
DiseasesDB	13930
MedlinePlus	000355
eMedicine	med/2086 derm/521 ped/2073 radio/628
MeSH	D012614

Scurvy is a disease resulting from a deficiency of vitamin C, which is required for the synthesis of collagen in humans. The chemical name for vitamin C, ascorbic acid, is derived from the Latin name of scurvy, scorbutus. Scurvy leads to the formation of spots on the skin, spongy gums, and bleeding from the 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. In advanced scurvy there are open, suppurating wounds and loss of teeth.

Scurvy was at one time common among sailors, pirates and others aboard ships at sea longer than perishable fruits and vegetables could be stored, and by soldiers similarly separated from these foods for extended periods. It was described by Hippocrates (c. 460 BC–c. 380 BC). Herbal cures for scurvy have been known in many native cultures since prehistory. In 1536, the French explorer Jacques Cartier, exploring the St. Lawrence River, used the local natives' knowledge to save his men who were dying of scurvy. He boiled the needles of the arbor vitae tree (Eastern White Cedar) to make a tea that was later shown to contain 50 mg of vitamin C per 100 grams.^[1][2] Such treatments were not available aboard ship, where the disease was most common. It was a Scottish surgeon in the British Royal Navy, James Lind who first proved it could be treated with citrus fruit in experiments he described in his 1753 book, A Treatise of the Scurvy.^[3]

In infants, scurvy is sometimes referred to as Barlow's disease, named after Sir Thomas Barlow,^[4] a British physician who described it. (N.B. Barlow's disease may also refer to mitral valve prolapse.) Other eponyms include Moeller's disease and Cheadle's disease.

Scurvy does not occur in most animals because they can synthesize their own vitamin C, but humans, other primates, guinea pigs, and a few other species lack an enzyme necessary for such synthesis and must obtain vitamin C through their diet. Vitamin C is widespread in plant tissues, with particularly high concentrations occurring in citrus fruits (oranges, lemons, limes, grapefruits); tomatoes, potatoes, cabbages, and green peppers.

Contents 1 Prognosis 2 Pathogenesis 3 The history of scurvy 4 Modern incidence 5 Prevention 6 Scurvy in animals 7 See also 8 Further reading 9 References

Prognosis

Untreated scurvy is invariably fatal. Since all that is required for a full recovery is the resumption of normal vitamin C intake, death from scurvy is rare in modern times.

Pathogenesis

Ascorbic acid is needed for a variety of biosynthetic pathways, by accelerating hydroxylation and amidation reactions. In the synthesis of collagen, ascorbic acid is required as a cofactor for prolyl hydroxylase and lysyl hydroxylase. These two enzymes are responsible for the hydroxylation of the proline and lysine amino acids in collagen. Hydroxyproline and hydroxylysine are important for stabilizing collagen by cross-linking the propeptides in collagen. Defective collagen fibrillogenesis impairs wound healing. Collagen is also an important part of bone, so bone formation is also affected. Defective connective tissue also leads to fragile capillaries, resulting in abnormal bleeding.

The history of scurvy

Scurvy was probably first observed as a disease by Hippocrates.^[5] In the 13th century, the Crusaders frequently suffered from scurvy. 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 British civilian medical profession of 1614 knew that it was the acidic principle of citrus fruit which was lacking, although they considered any acid acceptable when ascorbic acid (Vitamin C) was unavailable. In 1614 John Woodall (Surgeon General of the East India Company) published "The Surgion's Mate" as a handbook for apprentice surgeons aboard the company's ships. In it he described scurvy as resulting from a dietary deficiency. His recommendation for its cure was fresh food or, if not available, oranges, lemons, limes and tamarinds, or as a last resort, Oil of Vitriol (sulfuric acid).^[6]

A 1707 handwritten book by Mrs Ebot Mitchell discovered in a house in Hasfield, Gloucestershire contains a "Recp.t for the Scurvy" that consisted of extracts from various plants mixed with a plentiful supply of orange juice, white wine or beer.^[7]

In 1734, the Leiden-based physician Johann Bachstrom published a book on scurvy in which he stated that "scurvy is solely owing to a total abstinence from fresh vegetable food, and greens; which is alone the primary cause of the disease." and urged the use of fresh fruit and vegetables as a cure. In 1740, citrus juice (usually lemon or lime juice) was added to the recipe of the traditional daily ration of watered-down rum known as grog to cut down on the water's foulness. Although they did not know the reason at the time, Admiral Edward Vernon's sailors were healthier than the rest of the navy, due to the daily doses of vitamin C the sailors received.^[8] However, it was not until 1747 that James Lind formally proved that scurvy could be treated and prevented by supplementing the diet with citrus fruit such as limes or lemons.^[3]

James Cook succeeded in circumnavigating the world (1768–71) in HM Bark Endeavour without losing a single man to scurvy, but his suggested methods, including a diet of sauerkraut and wort of malt, were of limited value. Sauerkraut was the only vegetable food that retained a reasonable amount of ascorbic acid in a pickled state, but it was boiled to reduce it for preservation and much of the Vitamin C content was lost. In Cook's time it was impractical to preserve citrus fruit for long sea voyages. More important was Cook's regime of shipboard cleanliness, enforced by strict discipline, as well as frequent replenishing of fresh food.^[9] The most effective regime implemented by Cook was his prohibition against the consumption of fat scrubbed from the ship's copper pans, then a common practice in the Navy. In contact with the hot copper, this fat acquired substances which possibly irritated the gut and prevented proper absorption of vitamins.^[10]

The first major long distance expedition that experienced virtually no scurvy was that of Alessandro Malaspina, 1789–1794. Malaspina's medical officer, Pedro González, was convinced that fresh oranges and lemons were essential for preventing scurvy. Only one outbreak occurred, during a 56-day trip across the open sea. Five sailors came down with symptoms, one seriously. After three days at Guam all five were healthy again. Spain's large empire and many ports of call made it easier to acquire fresh fruit.^[11]

Despite advances, British sailors throughout the American Revolutionary period continued to suffer from scurvy, particularly in the Channel Fleet. The eradication of scurvy from the Royal Navy was finally due to the chairman of the Navy's Sick and Hurt Board, Gilbert Blane, who finally put Bachstrom and Lind's long-ignored prescription of fresh lemons to use during the Napoleonic Wars. Other navies soon adopted this successful solution.^[6]

The plant Cochlearia officanalis, also known as "Common Scurvygrass", acquired its common name from the observation that it cured scurvy, and it was taken on board ships in dried bundles or distilled extracts. Its very bitter taste was usually disguised with herbs and spices; however, this didn't prevent scurvygrass drinks and sandwiches becoming a popular fad in the UK until the middle of the nineteenth century, when citrus fruits became more readily available.^[12] During sea voyages, it was discovered that sauerkraut was of limited use in preventing scurvy.^{[citation needed]} In the Royal Navy's Arctic expeditions in the 19th century 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 theory was that scurvy was caused by "tainted" meat, particularly tinned meat.^[13]

Vilhjalmur Stefansson, an arctic explorer who lived among the Eskimos, proved that the all meat diet they consumed did not lead to vitamin deficiencies. He participated in a study in New York's Bellevue Hospital in 1935, where he and a companion ate nothing but meat for a year while under close medical observation, yet remained in good health.^[14] Some Antarctic expeditions, such as Scott's two expeditions and Shackleton's Ross sea party, suffered from scurvy, mainly during inland sledge journeys when the men had access to very limited range of food, virtually none of it fresh. Scurvy was rare or absent when they had access to a wider range of stored food or relied on seal meat.^[13][15][16] Refined carbohydrates seem to accelerate the process of depleting vitamin C. Insulin in the bloodstream causes all amino acids, except for tryptophan, to be stored as fat. Tryptophan competes to enter the bloodstream, causing less vitamin C to be available to the body. This could be one reason sailors and explorers, with their rations heavy with hard tack biscuits and refined carbohydrates, were so prone to scurvy.

The use of limes by the British Royal Navy to prevent scurvy gave rise to the name "limey" for an English immigrant in the former British colonies (particularly America, New Zealand and South Africa). The use of this word has been extended to include all British people in old American slang.^[17]

In 1927, Hungarian biochemist Szent-Györgyi (who won the 1937 Nobel Prize for Medicine) for his studies in the biological functions of the compound "hexuronic acid" (vitamin C) while working with antioxidant compounds in the adrenal cortex.^[18] It was not until 1932 that the connection between vitamin C and scurvy was established by American researcher Charles Glen King of the University of Pittsburgh.^[19]

Modern incidence

Scurvy or subclinical scurvy is caused by the lack of vitamin C. In modern western society, scurvy is rarely present in adults, although infants and elderly people are affected.^[20] Vitamin C is destroyed by the process of pasteurization, so babies fed with ordinary bottled milk sometimes suffer from scurvy if they are not provided with adequate vitamin supplements. Virtually all commercially available baby formulas contain added vitamin C for this reason, but heat and storage destroy vitamin C. Human breast milk contains sufficient vitamin C, if the mother has an adequate intake.

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.^[21] Though rare, there are also documented cases of scurvy due to poor dietary choices by people living in industrialized nations.^{[22][23][24][25]}

Prevention

Scurvy can be prevented by a diet that includes certain citrus fruits such as oranges or lemons. Other sources rich in vitamin C are fruits such as blackcurrants, guava, kiwifruit, papaya, tomatoes, bell peppers, and strawberries. It can also be found in some vegetables, such as carrots, broccoli, potatoes, cabbage, spinach and paprika, as well as some pickled vegetables. Many animal products, including liver and oysters, contain vitamin C. Though redundant in the presence of a balanced diet,^[26] various nutritional supplements are available that provide ascorbic acid well in excess of that required to prevent scurvy,^[27] and even some candies and most soft drinks contain vitamin C as a preservative.^[28]

Scurvy in animals

Like humans, other primates, fruit bats, and guinea pigs incorrectly create one enzyme (L-gulonolactone oxidase) to make vitamin C and thus require vitamin C in the diet to prevent the development of scurvy.

See also

• Scurvy-grass

Further reading

1. SCURVY: How a Surgeon, a Mariner, and a Gentleman Discovered the Greatest Medical Mystery of the Age of Sail by Stephen R. Bown. Published by Thomas Dunne Books 2004.
2. The history of scurvy & vitamin C. by Kenneth J. Carpenter. Published by Cambridge University Press 1986.

References

1. ^ Jacques Cartier's Second Voyage , 1535 Winter & Scurvy
2. ^ Martini E (2002). "Jacques Cartier witnesses a treatment for scurvy". Vesalius 8 (1): 2–6. PMID 12422875. 
3. ^ ^{a b} Lind, James (1753). A Treatise on the Scurvy. London: A. Millar. 
4. ^ Evans PR (December 1983). "Infantile scurvy: the centenary of Barlow's disease". Br Med J (Clin Res Ed) 287 (6408): 1862–3. doi:10.1136/bmj.287.6408.1862. PMID 6423046. 
5. ^ Stone I (1966). "On the genetic etiology of scurvy". Acta Genet Med Gemellol (Roma) 15 (4): 345–50. PMID 5971711. http://www.seanet.com/~alexs/ascorbate/196x/stone-i-acta_genet_med_et_gemell-1966-v15-p345.htm. 
6. ^ ^{a b} Bown, Stephen R. "SCURVY: How a Surgeon, a Mariner and a Gentleman Solved the Greatest Medical Mystery of the Age of Sail", Viking 2003
7. ^ Telegraph newspaper, 5th March 2009, http://www.telegraph.co.uk/news/newstopics/howaboutthat/4943570/Cure-for-scurvy-discovered-by-a-woman.html
8. ^ "The Blood of Nelson" by Glenn Barnett — Military History — Oct 2006
9. ^ Fernandez-Armesto, Felipe (2006). Pathfinders: A Global History of Exploration. W.W. Norton & Company. pp. 297. ISBN 0-393-06259-7. 
10. ^ BBC  — History — Captain Cook and the Scourge of Scurvy
11. ^ Fernandez-Armesto, Felipe (2006). Pathfinders: A Global History of Exploration. W.W. Norton & Company. pp. 297–298. ISBN 0-393-06259-7. 
12. ^ Mabey, Richard (1972). Food for free. Collins. pp. 93,94. ISBN 9780007247684. 
13. ^ ^{a b} Scott, Robert F."The Voyage of the Discovery", John Murray, London, 1929
14. ^ http://www.biblelife.org/stefansson3.htm
15. ^ Shackleton Ernest"South: The Endurance Expedition", Penguin Books, 2008
16. ^ [1]
17. ^ Simpson, J and Weiner, E: "The Oxford English Dictionary", Oxford University Press, 1989
18. ^ Carpenter, Kenneth J. (2004-06-22). "The Nobel Prize and the Discovery of Vitamins". http://www.nobelprize.org. Nobel Foundation. http://nobelprize.org/nobel_prizes/medicine/articles/carpenter/index.html. Retrieved 2008-01-25. 
19. ^ "The Albert Szent-Gyorgyi Papers Szeged, 1931-1947: Vitamin C, Muscles, and WWII". http://profiles.nlm.nih.gov. U.S. National Library of Medicine. http://profiles.nlm.nih.gov/WG/Views/Exhibit/narrative/szeged.html. Retrieved 2008-01-25. 
20. ^ Hampl JS, Taylor CA, Johnston CS (2004). "Vitamin C deficiency and depletion in the United States: the Third National Health and Nutrition Examination Survey, 1988 to 1994". Am J Public Health 94 (5): 870–5. doi:10.2105/AJPH.94.5.870. PMID 15117714. PMC: 1448351. http://www.ajph.org/cgi/content/full/94/5/870. 
21. ^ WHO (June 4, 2001) (PDF). Area of work: nutrition. Progress report 2000. http://www.who.int//mipfiles/2299/MIP_01_APR_SDE_3.en.pdf. 
22. ^ Davies IJ, Temperley JM (1967). "A case of scurvy in a student". Postgraduate Medical Journal 43 (502): 549–50. doi:10.1136/pgmj.43.502.539. PMID 6074157. 
23. ^ Sthoeger ZM, Sthoeger D (1991). "[Scurvy from self-imposed diet]" (in Hebrew). Harefuah 120 (6): 332–3. PMID 1879769. 
24. ^ Ellis CN, Vanderveen EE, Rasmussen JE (1984). "Scurvy. A case caused by peculiar dietary habits". Arch Dermatol 120 (9): 1212–4. doi:10.1001/archderm.120.9.1212. PMID 6476860. 
25. ^ McKenna KE, Dawson JF (1993). "Scurvy occurring in a teenager". Clin. Exp. Dermatol. 18 (1): 75–7. doi:10.1111/j.1365-2230.1993.tb00976.x. PMID 8440062. 
26. ^ Rivers JM (1987). "Safety of high-level vitamin C ingestion". Ann. N. Y. Acad. Sci. 498: 445–54. doi:10.1111/j.1749-6632.1987.tb23780.x. PMID 3304071. http://www.blackwell-synergy.com/doi/abs/10.1111/j.1749-6632.1987.tb23780.x. 
27. ^ Nutrition information for "Emergen-C" product
28. ^ Nutrition information for "Halls Defense" product

v • d • e Nutrition disorders (E40-68, 260-269) Hypoalimentation/ malnutrition Protein-energy malnutrition Kwashiorkor · Marasmus · Catabolysis Avitaminosis B vitamins B1: Beriberi/Wernicke's encephalopathy(Thiamine deficiency) · B2: Ariboflavinosis · B3: Pellagra(Niacin deficiency) · B6: Pyridoxine deficiency · B7: Biotin deficiency · B9: Folate deficiency · B12: Vitamin B12 deficiency Other vitamins A: Vitamin A deficiency/Bitot's spots · C: Scurvy · D: Hypovitaminosis D/Rickets/Osteomalacia · E: Vitamin E deficiency · K: Vitamin K deficiency Mineral deficiency Zinc · Iron · Magnesium · Chromium · Selenium (Keshan disease) · Manganese · Molybdenum · Copper · Calcium · Potassium Hyperalimentation Overweight · Obesity Childhood obesity · Obesity hypoventilation syndrome · Abdominal obesity Vitamin poisoning Hypervitaminosis A · Hypervitaminosis D · Hypervitaminosis E Mineral overload see inborn errors of metal metabolism, toxicity nutrition navs: disorders, symptoms+signs/eponymous

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Dansk (Danish)
n. - skørbug
adj. - skurvet, gemen, lurvet

Nederlands (Dutch)
scheurbuik

Français (French)
n. - (Méd) scorbut
adj. - misérable, perfide

Deutsch (German)
n. - Skorbut
adj. - verachtenswert

Ελληνική (Greek)
n. - (παθολ.) σκορβούτο
adj. - ποταπός, αποκρουστικός, ψωριάρικος

Italiano (Italian)
scorbuto

Português (Portuguese)
n. - escorbuto (m)
adj. - miserável

Русский (Russian)
цинга, подлый, низкий, презренный, покрытый перхотью

Español (Spanish)
n. - escorbuto
adj. - vil, ruin, despreciable, vergonzoso, indigno, grosero

Svenska (Swedish)
n. - skörbjugg
adj. - nedrig, tarvlig, lumpen, gemen

中文（简体）(Chinese (Simplified))
坏血病, 下流的, 无礼的, 卑鄙的

中文（繁體）(Chinese (Traditional))
n. - 壞血病
adj. - 下流的, 無禮的, 卑鄙的

한국어 (Korean)
n. - 괴혈병
adj. - 상스러운, 천한, 한심한

日本語 (Japanese)
n. - 壊血病
adj. - 卑劣な, 下品な

العربيه (Arabic)
‏(الاسم) ألاسقربوط, داء من أعراضه تورم أللثه ونزف ألدم منها (صفه) وضيع, حقير‏

עברית (Hebrew)
n. - ‮צפדת (מחלה)‬
adj. - ‮שפל, נבזה‬

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