IS INCREASED CAPILLARY FRAGILITY A SIGN 

 OF ASCORBIC ACID SUBNUTRITION? 



IT IS WELL KNOWN that the tendency to bleed is one of the main symptoms of 

 scurvy. In manifest scurvy the hemorrhages either occur spontaneously or 

 are caused by trivial traumas. This symptom is not based on any pathologic 

 changes in the composition of the blood, for both the bleeding time and the 

 coagulation time are normal, but on decreased capillary resistance, which 

 apparently is due to defective formation of intercellular substances. 



This symptom of increased capillary fragility, which usually is the first 

 morbid expression of scurvy, has also been utilized for diagnosis of milder 

 deficiency states, so-called subclinical scurvy. In this condition the hemor- 

 rhagic tendency is not severe enough to lead to manifest symptoms. It can, 

 however, be demonstrated by subjecting the capillaries to extra strain. 

 This may be done by using the well-known Rumpel-Leede test, which in 

 manifest scurvy is, as a rule, strongly positive.* In an attempt to refine the 

 Rumpel-Leede test and to bring it to a more quantitative basis, Gothlin^ some 

 years ago developed a capillary-fragility test which he thought could be utilized 

 for diagnosis of subclinical scurvy. This method consists of increasing the 

 intracapillary pressure in the arm by means of a Riva-Rocci cuff and counting 

 the petechial hemorrhages which appear in a specified skin area under standard 

 conditions. The original procedure has since been modified." Besides this 

 "overpressure" method, another form of the capillary-fragility test has also 

 been in use. This is the "suction" or "underpressure" test, originated by Hecht' 

 and later used and modified by several workers (see Jersild and Elmby^). The 

 two methods do not necessarily give concordant results. According to Gothlin" 

 the overpressure method is preferable for its basis is "clear and unassailable," 

 which "can by no means be said of the suction procedure." 



After the chief role of ascorbic acid in the etiology of scurvy had been demon- 

 strated, it was generally assumed that the increased capillary fragility as shown 

 by the above-mentioned tests would, in otherwise healthy persons, be indica- 

 tive of ascorbic acid subnutrition. Accordingly, these methods have gained a 

 wide use in assessing the nutritional status in regard to ascorbic acid. 



It is not, however, quite clear how reliable a sign the increased capillary 

 fragility is in showing ascorbic acid deficiency. There is evidence both pro 

 and con. Gothlin and his collaborators, who are the chief proponents of the 

 test, have furnished most of the evidence in favor of the test.^''''"'^ Some con- 

 firmative evidence has also come from other quarters; thus Dalldorf," Molitch,^ 

 and Cianci'" considered the test satisfactory. Also Sloan" found the capillary- 



* However, cases of scur\y have been repored which, even in spite of the presence of 

 spontaneous hemorrhages, give negative results in capillary-fragiUty tests.^"* 



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