Scurvy

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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

Dictionary: scur·vy  (skûr'vē)

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 & 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 (N.Lat. scorbutus) is a deficiency disease that results from insufficient intake of vitamin C, which is required for correct collagen synthesis in humans. The scientific name of vitamin C, ascorbic acid, is derived from the Latin name of scurvy, scorbutus. Scurvy leads to the formation of liver spots on the skin, spongy gums, and bleeding from 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. In advanced scurvy there are open, suppurating wounds and loss of teeth.

Scurvy was at one time common among sailors, pirates and others who were on ships that 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. It was described by Hippocrates (c. 460 BC–c. 380 BC). Its cause and cure have been known in many native cultures since prehistory. For example, 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] However it was a Scottish surgeon in the British Royal Navy, James Lind (1716–1794) who first proved it could be treated with citrus fruit in experiments he described in his 1753 book, A Treatise of the Scurvy.

In infants, scurvy is sometimes referred to as Barlow's disease, named after Sir Thomas Barlow (1845–1945),^[3] 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.

Symptoms

Girl with a scorbutic tongue

• Dark purplish spots on skin, especially legs.
• spongy gums, often leading to tooth loss.
• bleeding from all mucous membranes.
• Pallor.
• Bleeding gums.
• Sunken eyes
• Opening of healed scars and separation of knitted bone fractures.

Prognosis

Untreated scurvy is invariably fatal. However, 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.

Pathophysiology

Normal collagen synthesis depends upon the hydroxylation of proline and lysine residues in the endoplasmic reticulum, to form hydroxyproline and hydroxylysine, respectively. Prolyl and lysyl hydroxylase, the enzymes that catalyze the hydroxylation, require ascorbic acid (vitamin C) to function correctly. With no ascorbic acid, the enzymes cannot hydroxylate proline and lysine, and so normal collagen synthesis cannot be performed.

History

Scurvy was probably first observed as a disease by Hippocrates.^[4] 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 British civilian medical profession of 1614 knew that it was the acidic principle of citrus fruit which was lacking, although they considered any acid as acceptable when ascorbic acid (Vitamin C) was unavailable. In 1614 John Woodall (Surgeon General of the East India Company) published his book "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).^[5]

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. 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 lemons and lime. Although James Cook succeeded in circumnavigating the world (1768-71) in HM Bark Endeavour without losing a single man to scurvy, his suggested methods, including a diet of sauerkraut and wort of malt, did not reproduce his success, and 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.^[5]

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. During sea voyages, it was discovered that sauerkraut was of extremely limited use in preventing scurvy. 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 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.^{[citation needed]}

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.^{[citation needed]}

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.^[6] 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; however heat and storage destroy vitamin C. Human breast milk contains sufficient vitamin C, if the mother has an adequate intake to prevent scurvy on her 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.^[7] Though rare, there are also documented cases of scurvy due to poor dietary choices by people living in industrialized nations.^[8]

Prevention

Scurvy can be prevented by a diet that includes certain citrus fruits such as oranges or lemons. Other good sources of vitamin C are fruits such as blackcurrants, guava, kiwi, papaya, tomatoes and strawberries. It can also be found in some vegetables, such as bell peppers, broccoli, potatoes, cabbage, spinach and paprika, as well as some pickled vegetables. Though redundant in the presence of a balanced diet,^[9] various nutritional supplements are available that provide ascorbic acid well in excess of that required to prevent scurvy,^[10] and even some candies contain vitamin C.^[11]

Scurvy in animals

Like humans, primates and guinea pigs lack the gene that makes vitamin C and thus require vitamin C in the diet to prevent the development of scurvy. Scurvy is sometimes seen in pet guinea pigs that are not fed an adequate diet. To prevent scurvy in guinea pigs, they can be fed guinea pig food such as guinea pig pellets supplemented with fresh fruit and vegetables or vitamin c drops in their water.^[12]

See also

• Scurvy-grass

References

1. ^ Jacques Cartier's Second Voyage , 1535 Winter & Scurvy
2. ^ Jacques Cartier witnesses a treatment for scurvy. NCBI Pb Med, 2002 Jun, Martini E.
3. ^ (December 17, 1983) "Medical History - Infantile scurvy: the centenary of Barlow's disease" (PDF). British Medical Journal 287. 
4. ^ Stone, Irwin (1966). "On the Genetic Etiology of Scurvy". Acta Geneticae Medicae et Gemellologiae 15: 345–350. 
5. ^ ^{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
6. ^ Hampl JS, Taylor CA, and Johnston CS. (2004). "Vitamin C Deficiency and Depletion in the United States: The Third National Health and Nutrition Examination Survey, 1988 to 1994". American Journal of Public Health 94 (5): 870–875. PMID 15117714. 
7. ^ WHO (June 4, 2001). "Area of work: nutrition. Progress report 2000" (PDF).
8. ^ Davies IJ, Temperley JM (1967). "A case of scurvy in a student.". Postgraduate Medical Journal 43 (502): 549–50. PMID 6074157. 
   Sthoeger ZM, Sthoeger D. Scurvy from self-imposed diet. Harefuah. 1991 Mar 15;120(6):332-3.
   Ellis CN, Vanderveen EE, Rasmussen JE. Scurvy. A case caused by peculiar dietary habits. Arch Dermatol. 1984 Sep;120(9):1212-4.
   McKenna KE, Dawson JF. Scurvy occurring in a teenager. Clin Exp Dermatol. 1993 Jan;18(1):75-7.
9. ^ Rivers, Jerry M., "Safety of High-level Vitamin C Ingestion", Annals of the New York Academy of Sciences 498 (1): 445-454, <http://www.blackwell-synergy.com/doi/abs/10.1111/j.1749-6632.1987.tb23780.x>
10. ^ Nutrition information for "Emergen-C" product
11. ^ Nutrition information for "Halls Defense" product
12. ^ http://www.petplace.com/small-mammals/vitamin-c-deficiency-scurvy-in-guinea-pigs/page1.aspx

Nutritional pathology (E40-68, 260-269)
Malnutrition	Kwashiorkor - Marasmus
Other underconsumption	B vitamins: B1: Beriberi/Wernicke's encephalopathy, B2: Ariboflavinosis, B3: Pellagra, B7: Biotin deficiency, B9: Folate deficiency, B12: Vitamin B12 deficiency other vitamins: A: Vitamin A deficiency/Bitot's spots, C: Scurvy, D: Rickets/Osteomalacia mineral: Iron deficiency, Magnesium deficiency - Chromium deficiency
Hyperalimentation	Obesity - Hypervitaminosis A - Hypervitaminosis D

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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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