Scurvy
Signs and symptoms
Classic scurvy
Vitamin C status follows the following stages (Hodges, 1980):
• The optimal stage with full saturation of the metabolic body pool.
• If the diet is less than optimal for some time, the metabolic body pool decreases in size, the
person remains clinically well, and plasma levels remain within the normal range.
• If a deficient diet is consumed for a long enough period, the body pool is substantially depleted
and plasma levels decline to the lower ranges of normal but with no clinical signs.
• The continuation of a deficient diet results in further decreases in the body pool size of vitamin
C to 300 mg or less, a reduction in the catabolic rate to 9 mg or less, and the whole blood
vitamin C content to a level below 0.3 mg/100 ml. Clinical signs of scurvy appear.
Manifest scurvy in adults is preceded by a period of latent scurvy whose early symptoms include
lassitude, weakness and irritability; vague, dull aching pains in the muscles or joints of the legs and
feet; and weight loss. Shortness of breath may also occur and the skin can become dry and rough.
The principal signs and symptoms of manifest scurvy in adults consist of follicular hyperkeratosis,
haemorrhagic manifestations, swollen joints, swollen bleeding gums, and peripheral oedema (Hodges
et al., 1971). Anaemia of a variable degree occurs with scurvy in a certain percentage of adults and
infants, which is considered to be due in part to undernutrition and intercurrent infection. However,
it is due chiefly to the effect of vitamin C on blood formation, folic acid metabolism, and bleeding.
In children the syndrome is called Moeller-Barlow disease, and is seen in non-breast-fed infants
usually at about 5-6 months of age when maternally derived stores of vitamin C have been
exhausted. No single symptom predominates, but the majority of infants with scurvy eventually
show signs of irritability, tenderness of the legs, and pseudo paralysis, usually involving the lower
Scurvy and its prevention and control in major emergencies
5
extremities. The “pithed-frog” position—legs flexed at the knees and hips partially flexed—is
assumed by approximately half the sufferers. Involvement of the costochondral junctions is very
common, and costochondral beading is found in 80% of infants with scurvy. Haemorrhage around
erupting teeth is consistently present. Petechial haemorrhages in the skin may occur (10 -15% of
infants with scurvy). Left untreated, scurvy in any age group can lead to death.
Experimental