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
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
References
- ^ Jacques Cartier's Second Voyage , 1535 Winter & Scurvy
- ^ Jacques Cartier witnesses a treatment for scurvy. NCBI Pb Med, 2002 Jun, Martini E.
- ^ (December 17, 1983) "Medical
History - Infantile scurvy: the centenary of Barlow's disease" (PDF). British Medical Journal
287.
- ^ Stone, Irwin (1966). "On the Genetic Etiology of Scurvy". Acta Geneticae Medicae et Gemellologiae 15:
345–350.
- ^ 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
- ^ 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.
- ^ WHO (June 4, 2001).
"Area of work:
nutrition. Progress report 2000" (PDF).
- ^ 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.
- ^
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>
- ^ Nutrition information for "Emergen-C" product
- ^ Nutrition information for "Halls Defense" product
- ^ http://www.petplace.com/small-mammals/vitamin-c-deficiency-scurvy-in-guinea-pigs/page1.aspx
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