358 ASCORBIC ACID 



tion of the lamina dura of the teeth in dental x-rays has been observed 

 once in such a person. 



Old ulcers and scars become red and break down. New wounds fail to 

 heal, or when apparently healed break open with stretching. These observa- 

 tions, which have been recorded since the Middle Ages, are amply con- 

 firmed by tests of wound healing, tensile strength of scars, and histologic 

 appearance of biopsy material from the region of the scar in persons with 

 induced scurvy.^'- ^^'^^ In scorbutic subjects such experimental wounds 

 open after 8 to 10 days, revealing an unorganized blood clot in the base. 

 This difficulty with healing is most evident within the first 10 days after 

 the wound is made. During this time the tensile strength of the fascia is 

 reduced 50 % and of the skin 30 % below control levels. ^^ These abnor- 

 malities of the healing process occur only after clinical scurvy has appeared 

 or when tissue levels, white blood cell levels, or saturation tests indicate 

 very severe depletion of ascorbic acid from the tissues. A low plasma level 

 is not sufficient indication that a wound may fail to heal because of ascorbic 

 acid deficiency. 



In support of the relationship of ascorbic acid to tensile strength of 

 wounds, this vitamin appears in very high concentration around abdominal 

 wounds during the healing process in subjects well saturated with it. In 

 depleted subjects, little if any increase occurs in the healing tissues, and 

 when the tissue level remains zero, the tensile strength of the wound is 

 impaired. '^^ 



Petechial hemorrhages occur in the viscera, but massive hemorrhages 

 are rare. A small bloody pericardial effusion may be found. It is unusual to 

 find more than a few erythrocytes in the urine or more than a positive 

 guaiac test for occult blood in the stool. External hemorrhage is seldom 

 sufficient in the adult to cause anemia. 



The sclerae become icteric, the skin a grayish-yellow cadaveric color. 

 Fever of 101° to 102° is common is severe cases. The nail beds and lips be- 

 come cyanotic due to stasis of blood. The blood pressure gradually falls, 

 Cheyne-Stokes type of respiration appears, the patient becomes more 

 dyspneic and suffers from precordial oppression. If treatment is not forth- 

 coming, convulsions, shock, and death may occur suddenly. 



4. Scurvy in Infancy and Childhood 



Infantile scurvy differs in certain respects from the disease in adult 

 persons principally because the growing bones of infants react differently 



16 J. A. Wolfer, C. J. Farmer, W. W. Carroll, and D. O. Manshardt, Surg., Gynecol. 



Obsiet. 84, 1 (1947). 

 '^M. K. Bartlett, C. M. Jones, and A. E. Ryan, Netv Engl. J. Med. 226, 469, 474 



(1942). 



