scurvy

scurvy, one of the oldest-known nutritional disorders of humankind, caused by a dietary lack of vitamin C (ascorbic acid), a nutrient found in many fresh fruits and vegetables, particularly the citrus fruits. Vitamin C is important in the formation of collagen (an element of normal tissues), and any deficiency of the vitamin interferes with normal tissue synthesis, a problem that underlies the clinical manifestations of the disorder.

Symptoms of scurvy usually become apparent within several months of vitamin C being absent from the diet, by which time lingering pools of vitamin C in fat, muscle, and other tissues have been depleted. Initial symptoms of scurvy include fatigue and soreness and stiffness of the joints and lower extremities. As the condition progresses, the gums swell and bleed, and teeth may loosen. Bleeding under the skin and in deep tissues, slow wound healing, anemia, and changes in personality are other indications of advanced disease. Left untreated, death ensues, typically as a result of bleeding or of complications from infection.

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Some of the earliest evidence for a disorder suggesting scurvy dates to 3800–3600 bce, captured in characteristic bone changes in the skeleton of a roughly one-year-old child in Egypt. Another early probable case of scurvy, described from the skeletal remains of a child in England, dates to 2200–1970 bce. In addition, accounts of what was probably scurvy are found in ancient writings. The first clear-cut descriptions of the disorder, however, appear in the records of the medieval Crusades. Later, toward the end of the 15th century, scurvy became the major cause of disability and mortality among sailors on long sea voyages. In 1753 Scottish naval surgeon James Lind showed that scurvy could be cured and prevented by ingestion of the juice of oranges and lemons. Soon citrus fruits became so common aboard ship that British sailors were referred to as “limeys.”

In modern times, full-blown cases of vitamin C deficiency are relatively rare, being limited primarily to situations involving general malnutrition, such as in impoverished parts of the world. In developed regions, scurvy may still be seen, however, in elderly adults and in individuals who follow restrictive diets (e.g., because of a food allergy) or lack basic access to fruits and vegetables and in alcoholic individuals who consume a severely imbalanced diet. Smokers, pregnant or lactating women, and persons with AIDS (acquired immunodeficiency syndrome), inflammatory bowel disease, or type 1 diabetes often require increased amounts of vitamin C in their diets because of decreased absorption by the body.

Infants fed reconstituted milk or milk substitutes without a vitamin C or orange juice supplement are also at increased risk. Symptoms peculiar to infantile scurvy (Barlow disease) include swelling and pain of the lower extremities and lesions of the growing bones.

Administration of vitamin C is the specific therapy for scurvy. Even in cases of severe deficiency, a daily dose of 100 mg (1 mg = 0.001 gram) for adults or 10 to 25 mg for infants and children, accompanied by a normal diet, commonly produces a cure within several days.