350 ASCORBIC ACID 



demonstrated its similarity to scurvy in adults.^ Since that time a synonym 

 for scurvy has been ''Barlow's disease." Pasteurization of milk greatly 

 increased the incidence of infantile scurvy until supplementation of infant 

 diets with orange juice became popular. 



Hopkins suggested that scurvy was a deficiency disease in 1906.^ In 

 1907, Hoist and Frolich produced scurvy in guinea pigs by feeding them 

 restricted diets.^ Not until 1928, however, was "hexuronic acid" isolated 

 by Szent-Gyorgyi^ and shown to be identical with vitamin C by Waugh 

 and King, who isolated it from lemons.^" For a time vitamin C was called 

 cevitamic acid, but in 1939 the Council on Pharmacy and Chemistry of 

 the American Medical Association adopted the name ascorbic acid as the 

 official designation. 



During the past ten years biochemists and clinicians have been probing 

 into the chemical relationship of ascorbic acid to body chemistry and func- 

 tion. Much has been learned. Even more remains to be learned. In spite of 

 this accumulation of knowledge in the prevention and treatment of scurvy 

 dating back to the seventeenth century, this malady continues to take its 

 toll and even now sporadic cases of scurvy in infants and adults stUl appear 

 in the admitting departments of most large municipal hospitals, just as 

 Joe S. appeared. Poverty, ignorance, and prejudice account for most of 

 them. 



B. CLINICAL ASPECTS 

 I. Incidence 



Though there is undoubtedly a great deal of subclinical ascorbic acid 

 deficiency, clinical scurvy is a rare disease in the United States of America 

 and in most of the civiUzed world today. It occurs for the most part in 

 urban areas and slum sections, and examples of the disease appear from 

 time to time in the wards of most municipal hospitals (see Fig. 4). One 

 peak of incidence occurs between the ages of 6 and 12 months^ ^ in infants 

 whose processed milk formulas are unsupplemented with citrus fruits or 

 vegetables, or because they refuse or spit out the orange juice ofiered them. 

 The disease seldom if ever occurs before the age of 4 months and only oc- 

 casionally after 18 months. Breast-fed infants are protected if their mothers 

 are well nourished. Another peak occurs in the middle and old age groups. 



«T. Barlow, On Cases Described as "Acute Rickets" which are Probably A Com- 

 bination of Scurvy and Rickets. Medico-Chirurg. Trans. (London) LXVI, 1959 

 (1883); reprinted in Arch. Disease Childhood 10, 223 (1935). 



'F. G. Hopkins, Analyst 31, 385 (1906). 



8 A. Hoist and T. Frolich, J. Hyg. 7, 634 (1907). 



» J. T.. Svirbely and A. Szent-Gyorgyi, Biochcm. J. 26, 865 (1932). 



i» W. A. Waugh and C. G. King, J. Biol. Chem. 97, 325 (1932). 



" I. Dogramaci, New Engl. J. Med. 235, 185 (1946). 



