SCURVY 393 



1893, to August, 1896, which was one of the most important voyages of scien- 

 tific investigation of all times, not a single case of this disease occurred. 

 Later, when considering the prophylaxis, we shall refer to the important meas- 

 ures by which the celebrated leader prevented an outbreak of the disease 

 which might have brought the expedition to an end. 



An important American investigation of scurvy in children, in the year 

 1898 (the American Pediatric Society's Collective Investigation of Infantile 

 Scurvy in North America), has given the following results: Of 372 cases, 

 367 occurred in the white, 4 in the black race, and 1 in the Chinese; 51 per cent, 

 were males, 49 per cent, were females. The greatest number of cases occurred 

 between the seventh and fourteenth months. We shall refer to this again. 



ETIOLOGY 



In spite of many endeavors it has been impossible to discover a cause 

 which can be considered at all reliable; all search for the pathogenic agent 

 of the disease, though it is often assumed to be of miasmatic, or even of 

 infectious origin, has been without result. 



The question of food remains the alpha and the omega in the etiology of 

 scurvy, as in so far as the food supply is influenced by the conditions of weather 

 and the seasons the latter will always have a more or less decisive influence in 

 the production of the disease. 



It is generally assumed that improper nutrition in a certain direction is 

 pre-eminently responsible for the affection, particularly a deficiency of vege- 

 table acid potash in the daily food. It has repeatedly been noted that during 

 long sea voyages in which salted or pickled meat exclusively was consumed 

 scurvy appeared. As the ash of pickled meat contains much less potassium 

 than that of fresh meat, an attempt has been made to ascribe scurvy to the 

 deficient intake of potassium, but perhaps quite improperly so, for in prisons 

 where the diet consists almost exclusively of vegetables rich in potassium, 

 scurvy is not infrequently noted. On the other hand, it has been remarked 

 that many races in the far north are often compelled for months continuously 

 to live on pickled meat or salted fish without being a,ttacked by scurvy. 



Later investigations, in which an amelioration of the scorbutic affection 

 is said to have followed the addition of fat to the diet, appear to indicate 

 that scurvy is due rather to a diet limited in variety and deficient in fat than 

 to a lessened amount of potassium salts in the food. 



Besides this, a number of other causes are considered to be active: Gen- 

 eral deficiency in food, the close huddling of many persons in cramped, unclean 

 and wet dwellings, excessive corporeal labor and psychical depression, and, 

 above all, the ingestion of tainted food (ptomain poisoning). 



In considering more minutely the factors which are mentioned, we must 

 first consider the view that scurvy is a miasmatic or infectious disease. 



The first experimental investigations of this subject were made by Murri 

 in Bologna, who injected subcutaneously rabbits with blood taken from scurvy 

 patients. A rise in temperature and small petechiaj developed in the lobes 

 of the ears of these animals. Upon killing the animals hemorrhages were 



