Scurvy

Scorbut, scorbutus, sea scurvy, purpura nautica

Definition

Scurvy is a condition caused by a lack of vitamin C (ascorbic acid) in the diet. Signs of scurvy include tiredness, muscle weakness, joint and muscle aches, a rash on the legs, and bleeding gums. In the past, scurvy was common among sailors and other people deprived of fresh fruits and vegetables for long periods of time.

Description

Scurvy is very rare in countries where fresh fruits and vegetables are readily available and where processed foods have vitamin C added. Vitamin C is an important antioxidant vitamin involved in the development of connective tissues, lipid and vitamin metabolism, biosynthesis of neurotransmitters, immune function, and wound healing. It is found in fruits, especially citrus fruits like oranges, lemons, and grapefruit, and in green leafy vegetables like broccoli and spinach. In adults, it may take several months of vitamin C deficiency before symptoms of scurvy develop.

Currently, the recommended dietary allowance (RDA) for vitamin C is 50-60 mg/day for adults; 35 mg/day for infants; 40-45 mg/day for children 1-14; 70 mg/day during pregnancy; and 90-95 mg/day during lactation. The body's need for vitamin C increases when a person is under stress, smoking, or taking certain medications.

Causes and symptoms

A lack of vitamin C in the diet is the primary cause of scurvy. This can occur in people on very restricted diets, who are under extreme physiological stress (for example, during an infection or after an injury), and in chronic alcoholics. Infants can develop scurvy if they are weaned from breast milk and switched to cow's milk without an additional supplement of vitamin C. Babies of mothers who took extremely high doses of vitamin C during pregnancy can develop infantile scurvy. In children, the deficiency can cause painful swelling of the legs along with fever, diarrhea, and vomiting. In adults, early signs of scurvy include feeling weak, tired, and achy. The appearance of tiny red blood-blisters to larger purplish blotches on the skin of the legs is a common symptom. Wound healing may be delayed and scars that had healed may start to break down. The gums swell and bleed easily, eventually leading to loosened teeth. Muscle and joint pain may also occur.

Diagnosis

Scurvy is often diagnosed based on the symptoms present. A dietary history showing little or no fresh fruits or vegetables are eaten may help to diagnose vitamin C deficiency. A blood test can also be used to check the level of ascorbic acid in the body.

Treatment

Adult treatment is usually 300-1,000 mg of ascorbic acid per day. Infants should be treated with 50 mg of ascorbic acid up to four times per day.

Prognosis

Treatment with vitamin C is usually successful, if the deficiency is recognized early enough. Left untreated, the condition can cause death.

Prevention

Eating foods rich in vitamin C every day prevents scurvy. A supplement containing the RDA of vitamin C will also prevent a deficiency. Infants who are being weaned from breast milk to cow's milk need a supplement containing vitamin C.

Resources

Books: Stein, Jay H., editor. "Ascorbic Acid (Vitamin C) Deficiency." In Internal Medicine. St. Louis: Mosby, 1998.

Key terms

Ascorbic acid — Another term for vitamin C, a nutrient found in fresh fruits and vegetables. Good sources of vitamin C in the diet are citrus fruits like oranges, lemons, limes, and grapefruits, berries, tomatoes, green peppers, cabbage, broccoli, and spinach.
Recommended dietary allowance (RDA) — The daily amount of a vitamin the average person needs to maintain good health.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

History:

“Land Scurvy” Curse of the Crusaders!
Dec 1217 - While the Crusaders trudged through in Egypt: “..Soldiers with violent pains in the feet and ankles, their gums became swollen, their teeth loose and useless, while their hips and shin bones first turn black and putrefied. Finally, an easy and peaceful death, like a gentle sleep, put an end to their suffering.”

Later between 1249 and 1254, while Jean de Joinville traveled with the 7th Crusade he wrote: “the disorder I spoke of very soon increased so much in the army that the barbers were forced to cut away very large pieces of flesh from the gums to enable their patients to eat..”

But while the "land scurvy" of the crusades was bad, Scurvy's true golden age was about to begin...

“Purpura Nautica:” An Age of Discovery - and not all of them good. Scurvy, once rare, flourished with the advent of long sea voyages of trade, discovery & conquest. Scurvy takes approximately six weeks to set it, and on month long voyages, it struck down entire crews. There are stories of Spanish galleons found floating, staffed only by the dead. The disease was nicknamed “purpura nautica” for the purplish bruises that served as the first indication of the disease. An estimated two million sailors died of scurvy between 1500-1800.

Among those lose to scurvy were Vasco de Gama in 1499 claiming 116 to 170 men.

In 1520, Magellan’s round the world journey was wracked by scurvy, claiming most of the men not left to fend for themselves on a distant shore or killed by natives in the final battle. His voyage returned with only 18 out of the 230 men who originally set sail. Score one for scurvy.

Died from Scurvy:

• William Stark, medical doctor (1747-1770) experimented with different diets and after eight months of experimenting, died on 23 Feb 1770. Thru his experiments & record-keeping he showed to what extent human scurvy is caused by a lack of vitamin C in the diet.
• Alexander David Stewart, (September 19, 1852 – March 13, 1899) was mayor of Hamilton, Ontario from 1894 to 1895.
• Andreas Vesalius, the Flemish founder of modern Anatomy, must have died from scurvy.

Additional Reading:

• http://www.riparia.org/Medical%20History/scurvy_hx.html
• http://medical-dictionary.thefreedictionary.com/ascorbic+acid
• http://www.atlasobscura.com/articles/scurvy
• William Stark Biography
• The Origins of Intervention Studies
• Did scurvy wipe out Christopher Columbus’ crew?
• First colonists led by Christopher Columbus hit by severe scurvy
• Death of Vesalius: more evidence points to scurvy*
• Sailors' scurvy before and after James Lind – a reassessment
• Scott And Scurvy
• The Inuit Paradox - How can people who gorge on fat and rarely see a vegetable be healthier than we are?
• Magical Sour Cabbage: How Sauerkraut Helped Save the Age of Sail

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