362 ascorbic acid 



2. Tests for Capillary Fragility 



The Rumpel-Leede test^^ almost always demonstrates an abnormality 

 in the state of the capillaries in naturally occurring scorbutics, although this 

 test does not necessarily become positive in induced scurvy in human 

 subjects.'^ It is performed by applying a blood pressure cuff above the 

 elbow, marking out a circle 2.5 cm. in diameter on the skin just below the 

 anticubital fossa, inflating the cuff to a pressure midway between the 

 systolic and diastolic pressure of the patient, and maintaining this pressure 

 for 15 minutes. Three minutes after release of this pressure, the number of 

 petechiae which have appeared in the circle are counted. One to ten are 

 considered normal, ten to twenty are borderline, and over twenty are 

 definitely abnormal. This test has been extended and modified by Gothlin.-*" 

 A similar test which utilizes negative pressure exerted through a cup has 

 been described by Dalldorf.^^ In scurvy these variations give the same 

 abnormal reactions as does the Rumpel-Leede test. These tests are not 

 specific for scurvy. They are abnormal in any disease which increases 

 capillary fragility and permeability. 



3. Ascorbic Acid Levels in Blood and Urine 



The plasma level of ascorbic acid falls too rapidly after the \dtamin is 

 removed from the diet to be of much diagnostic value, though Farmer and 

 Abt^- felt that levels below 0.5 mg. % were compatible with scurvy. How- 

 ever, in the experiment of Grand on et al.,^^ which has been confirmed many 

 times,^*' i6' 23. 24 ^Y^Q level of ascorbic acid in the plasma fell to zero after 41 

 days of ascorbic acid deprivation, whereas signs of scurv}'' did not appear 

 for 134 days. Therefore, the plasma level indicates only the state of ascorbic 

 acid nutrition for the preceding few weeks. A level of mg. % is com- 

 patible with but not diagnostic of scurvy. If ascorbic acid has not been 

 administered, any amount found in the plasma beyond the limits of ac- 

 curacy of the method is incompatible with a diagnosis of scurvy. 



Ascorbic acid almost disappears from the urine even before the level in 

 the plasma is zero. Therefore a low level of ascorbic acid in the urine has 

 no more significance than a low plasma level. This is true of single or twenty- 

 four-hour urine collections. 



The ascorbic acid level in the whole blood has more diagnostic signifi- 

 cance. The level reaches zero after 87 days of ascorbic acid deprivation. 



i»C. Leede, Munch, nied. Wochschr. 58, 1673 (1911). 

 2" G. F. Gothlin, J. Lab. Clin. Med. 18, 484 (1933). 



21 G. Dalldorf, Am. J. Diseases Children 26, 794 (1933). 



22 A. F. Abt and C. J. Farmer, The Vitamins, p. 411. American Medical Association, 

 1939. 



23 H. Rietschel and J. Mensching, Klin. Wochschr. 18, 273 (1939). 

 2* M. Pijoan and E. L. Lozner, New Engl. J. Med. 231, 14 (1944). 



