Etiology.—The disease occurs between the ages of nine and fourteen months, and is due to an absence of mother's milk, the child being bottle-fed on some one of the many artificial foods, and which lacks some important essential to nutrition. Even cow's milk, though sterilized, is said to give rise to it. It occurs more frequently among the children of the rich and well-to-do, since the custom among the latter class, of bottle feeding, is becoming greater each year. Barlow says, "The child that is suckled at the breast never develops scurvy."
Rickets predisposes to scurvy, and many writers believe that infantile scurvy is but a hemorrhagic fever of rachitis.
Pathology.—The osseous changes are similar to those of rickets. Intraperiosteal hemorrhages are responsible for the separation of the epiphysis from the shaft of the bone. These changes take place most frequently in the ribs and femurs, though the bones of the upper extremities and the vertebrae may also be the seat of hemorrhages. The marrow of the bones becomes gelatinous. The spleen, especially when rickets is present, is enlarged. The gums become spongy as in the adult, and subcutaneous hemorrhages may extend into the muscular tissue.
Symptoms.—As the child grows feeble it becomes cross, peevish, and restless, sleeps poorly at night, and worries during the day. The skin shows the muddy color that is seen in the adult, the face is puny and bloated, and ecchymotic spots appear about the eyes. There is tenderness of the joints, and the child cries when handled. The limbs may be flexed in the early stages, and there is swelling- in the course of the shaft or about the ankle or knee joints. As the disease progresses, the limbs are straightened and slightly everted, due to a separation of the epiphysis from the shaft. Where the child has teeth, the gums are swollen, soft, and spongy, as in the adult, and bleed very easily; but if there be no teeth, the gums may appear normal or show a bluish swollen front. Hemorrhages from the mucous surfaces may occur, and extravasation in the subcutaneous tissues is not uncommon. There may be present an irregular fever as in the adult, though generally the temperature is normal. Rickets is frequently associated with the disease. Diarrhea is generally present.
Diagnosis.—This is not usually difficult. The pains in the extremities, the swelling of the shafts of the bones and about the joints, the paralytic condition of the lower limbs, the ecchymoses in the skin, and the history of the infant being bottle-fed, leaves no room for a mistake in the diagnosis.
Prognosis.—If recognized early, the disease in infants and children is seldom fatal. In three hundred and seventy-nine cases collected by the American Pediatric Society, the mortality was eight per cent.
Treatment.—The substitution of a wet-nurse for the bottle, with the addition of beef-juice and a little orange-juice and lemonade during the day, will soon work a wondrous change. Where a wet-nurse can not be secured, cow's milk, properly modified with the fruit-juices above mentioned, will give good results. The hygienic conditions should be of the best, and the child kept much in the open air and sunshine.
The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.