IX. EP^FKCTS OF DEFICIENCY IN HUMAN BEINGS 



351 



Bachelors and widowers who hve alone, cook for themselves, or eat alone 

 in restaurants are particularly prone to develop the disease. In this age 

 group, the disease occurs predominantly in males. The elderly woman al- 

 most always has someone looking after her, and fruits and vegetables 

 occupy a more prominent place in her diet. 



Most cases of scurvy in adult persons occur in the spring, with a second 

 but smaller peak in the early fall months along with other deficiency dis- 

 eases. In 241 infants, the peak occurred in August and September. '^ Spring 

 and fall fluctuations in incidence hold true, whether the disease occurs 

 because of a primary dietary inadequacy in ascorbic acid or is conditioned 



ADMISSION OF SCURVY BY YEARS 

 Cincinnati General Hospitol 1935-1950 



• • Adults 



X X Infants 



T— I 1 1 f 1 T 1 1 1 r 



1935 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 

 YEAR 

 Fig. 4 



by the increased requirements for the vitamin imposed by hypermetabolism, 

 chronic infection, or the increased loss which occurs in persons with chronic 

 diarrhea (see Fig. 5). 



2. Prodromata 



It is difficult to say at what stage of ascorbic acid tissue depletion the 

 first deleterious effect occurs. Chemical processes within the cells are prob- 

 ably impaired long before symptoms or physical manifestations occur. It 

 has been alleged that chronic gingivitis, pyorrhea, and bleeding gums are 

 the result of chronic mild ascorbic acid depletion'^ based on low plasma 

 ascorbic acid levels and tissues half saturated with the vitamin in many of 



"W. J. Linghorne, W. G. Mcintosh, J. W. Tice, F. F. Tisdall, J. F. IMcGroary, 

 T. 0. H. Drake, A. V. Greaves, and W. M. Johnstone, Can. Med. Assoc. J. 54, 106 

 (1946). 



