Scurvy
28266
225760123
2008-07-15T07:42:49Z
71.255.229.102
typo
{{Infobox_Disease
| Name = Scurvy
| Image = Scorbutic_gums.jpg
| Caption = Scorbutic gums, a symptom of scurvy
| DiseasesDB = 13930
| ICD10 = {{ICD10|E|54||e|50}}
| ICD9 = {{ICD9|267}}
| ICDO =
| OMIM = 240400
| MedlinePlus = 000355
| eMedicineSubj = med
| eMedicineTopic = 2086
| eMedicine_mult = {{eMedicine2|derm|521}} {{eMedicine2|ped|2073}} {{eMedicine2|radio|628}}
| MeshID = D012614
}}
'''Scurvy''' (N.Lat. scorbutus) is a [[deficiency disease]]. Scurvy results from insufficient intake of [[vitamin C]], which is required for correct [[collagen]] synthesis in humans. The scientific name of vitamin C, ascorbic acid, is derived from the Latin name of scurvy, scorbutus. Scurvy leads to the formation of spots on the skin, spongy gums, and bleeding from all [[mucous membrane]]s. The spots are most abundant on the thighs and legs, and a person with the ailment looks pale, feels depressed, and is partially immobilized. In advanced scurvy there are open, [[suppuration|suppurating]] wounds and loss of [[teeth]].
Scurvy was at one time common among [[sailor]]s, [[pirate]]s and others aboard [[ship]]s at sea longer than perishable [[fruit]]s and [[vegetable]]s could be stored, and by [[soldier]]s similarly separated from these foods for extended periods. It was described by [[Hippocrates]] (c. 460 BC–c. 380 BC). Herbal cures for scurvy have been known in many native cultures since prehistory. In 1536, the French explorer [[Jacques Cartier]], exploring the [[Saint Lawrence River|St. Lawrence River]], used the local natives' knowledge to save his men who were dying of scurvy. He boiled the needles of the [[Thuja|arbor vitae]] tree (Eastern White Cedar) to make a tea that was later shown to contain 50 mg of vitamin C per 100 grams.<ref> [http://www3.sympatico.ca/goweezer/canada/z00cartier3.htm Jacques Cartier's Second Voyage] , 1535 Winter & Scurvy </ref><ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12422875&dopt=Abstract Jacques Cartier witnesses a treatment for scurvy.] NCBI Pb Med, 2002 Jun, Martini E.</ref> Such treatments were not available aboard ship, where the disease was most common. It was a Scottish surgeon in the British [[Royal Navy]], [[James Lind]] who first proved it could be treated with [[citrus fruit]] in experiments he described in his 1753 book, ''A Treatise of the Scurvy''.
In infants, scurvy is sometimes referred to as '''Barlow's disease,''' named after Sir [[Thomas Barlow (medicine)|Thomas Barlow]],<ref>{{cite journal |title= Medical History - Infantile scurvy: the centenary of Barlow's disease |url=http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1550031&blobtype=pdf |format=PDF |journal=British Medical Journal |volume=287 |date=December 17, 1983}}</ref> a British [[physician]] who described it. (N.B. Barlow's disease may also refer to [[mitral valve prolapse]].) Other eponyms include '''Moeller's disease''' and '''Cheadle's disease'''.
==Symptoms==
[[Image:Scorbutic tongue.jpg|thumb|Girl with a scorbutic tongue]]
* Dark purplish [[spots]] on [[skin]], especially [[legs]].
* Spongy gums, often leading to [[tooth loss]].
* Bleeding from all [[mucous membranes]].
* [[Pallor]]
* Bleeding gums.
* Sunken eyes
* Opening of healed [[scars]] and separation of knitted [[bone fractures]].
* [[Nosebleeds]]
* non-stopping diarrhea
* nail loss
== Prognosis ==
Untreated scurvy is invariably fatal. Since all that is required for a full recovery is the resumption of normal [[vitamin C]] intake, death from scurvy is rare in modern times.
== Pathophysiology ==
Normal collagen synthesis depends upon the [[hydroxylation]] of [[proline]] and [[lysine]] residues in the endoplasmic reticulum, to form [[hydroxyproline]] and [[hydroxylysine]], respectively. Prolyl and [[lysyl hydroxylase]], the enzymes that catalyze the hydroxylation, require ascorbic acid (vitamin C) to function correctly. With no ascorbic acid, the enzymes cannot hydroxylate proline and lysine, and so normal collagen synthesis cannot be performed.
== History ==
Scurvy was probably first observed as a disease by [[Hippocrates]].<ref>{{cite journal | author = Stone, Irwin | title = On the Genetic Etiology of Scurvy | journal = Acta Geneticae Medicae et Gemellologiae | year= 1966 |volume = 15 | pages = 345–350| url=http://www.seanet.com/~alexs/ascorbate/196x/stone-i-acta_genet_med_et_gemell-1966-v15-p345.htm}}</ref> In the 13th century the [[Crusades|Crusaders]] suffered from scurvy frequently. Scurvy was one of the limiting factors of marine travel, often killing large numbers of the passengers and crew on long-distance voyages. It even played a significant role in [[World War I]].
The British civilian medical profession of 1614 knew that it was the acidic principle of citrus fruit which was lacking, although they considered any acid acceptable when ascorbic acid (Vitamin C) was unavailable. In 1614 [[John Woodall]] (Surgeon General of the [[British East India Company|East India Company]]) published "The Surgion's Mate" as a handbook for apprentice surgeons aboard the company's ships. In it he described scurvy as resulting from a dietary deficiency. His recommendation for its cure was fresh food or, if not available, oranges, lemons, limes and tamarinds, or as a last resort, Oil of Vitriol ([[sulfuric acid]]).<ref name="bown">Bown, Stephen R. "''SCURVY: How a Surgeon, a Mariner and a Gentleman Solved the Greatest Medical Mystery of the Age of Sail''", Viking 2003</ref>
In 1734, the [[Leiden]]-based physician [[Johann Bachstrom]] published a book on scurvy in which he stated that ''"scurvy is solely owing to a total abstinence from fresh vegetable food, and greens; which is alone the primary cause of the disease."'' and urged the use of fresh fruit and vegetables as a cure. It was not until 1747 that [[James Lind]] formally proved that scurvy could be treated and prevented by supplementing the diet with citrus fruit such as [[lemon]]s and [[Lime (Citrus aurantifolia)|lime]]. [[James Cook]] succeeded in circumnavigating the world (1768-71) in [[HM Bark Endeavour|HM Bark ''Endeavour'']] without losing a single man to scurvy, but his suggested methods, including a diet of [[sauerkraut]] and wort of malt, were of limited value. Sauerkraut was the only vegetable food that retained a reasonable amount of ascorbic acid in a pickled state, but it was boiled to reduce it for preservation and much of the Vitamin C content was lost. In Cook's time it was impractical to preserve citrus fruit for long sea voyages. More important was Cook's regime of shipboard cleanliness, enforced by strict discipline, as well as frequent replenishing of fresh food.<ref>{{cite book |last= Fernandez-Armesto |first= Felipe |title= Pathfinders: A Global History of Exploration |year= 2006 |publisher= W.W. Norton & Company |pages= p. 297 |isbn= 0-393-06259-7}}</ref> The most effective regime implemented by Cook was his prohibition against the consumption of fat scrubbed from the ship's copper pans, then a common practice in the Navy. In contact with the hot copper, this fat acquired substances which possibly irritated the gut and prevented proper absorption of vitamins. <ref>[http://www.bbc.co.uk/history/british/empire_seapower/captaincook_scurvy_04.shtml BBC - History - Captain Cook and the Scourge of Scurvy<!-- Bot generated title -->]</ref> The first major long distance expedition that experienced virtually no scurvy was that of [[Alessandro Malaspina]], 1789-1794. Malaspina's medical officer, Pedro González, was convinced that fresh oranges and lemons were essential for preventing scurvy. Only one outbreak occurred, during a 56-day trip across the open sea. Five sailors came down with symptoms, one seriously. After three days at Guam all five were healthy again. Spain's large empire and many ports of call made it easier to acquire fresh fruit.<ref>{{cite book |last= Fernandez-Armesto |first= Felipe |title= Pathfinders: A Global History of Exploration |year= 2006 |publisher= W.W. Norton & Company |pages= pp. 297-298 |isbn= 0-393-06259-7}}</ref> Despite advances, British sailors throughout the American Revolutionary period continued to suffer from scurvy, particularly in the Channel Fleet. The eradication of scurvy from the Royal Navy was finally due to the chairman of the Navy's [[Sick and Hurt Board]], [[Gilbert Blane]], who finally put Bachstrom and Lind's long-ignored prescription of fresh lemons to use during the [[Napoleonic Wars]]. Other navies soon adopted this successful solution.<ref name="bown" />
The plant known as "[[scurvy grass]]" acquired its name from the observation that it cured scurvy, but this was of no great help to those who spent months at sea. During sea voyages, it was discovered that sauerkraut was of limited use in preventing scurvy.{{Fact|date=January 2008}} In the Royal Navy's [[Arctic]] expeditions in the 19th century it was widely believed that scurvy was prevented by good hygiene on board ship, regular exercise, and maintaining the morale of the crew, rather than by a diet of fresh food, so that Navy expeditions continued to be plagued by scurvy even while fresh meat was well-known as a practical antiscorbutic among civilian whalers and explorers in the Arctic. At the time [[Robert Falcon Scott]] made his two expeditions to the [[Antarctic]] in the early 20th century, the prevailing theory was that scurvy was caused by "tainted" canned food.
The use of limes by the British Royal Navy to prevent scurvy gave rise to the name "limey" for an English immigrant in the former British colonies (particularly America, New Zealand and South Africa). The use of this word has been extended to include all British people in American [[slang]]. <ref>Simpson, J and Weiner, E: "The Oxford English Dictionary", Oxford University Press, 1989</ref>
In 1927, [[Hungarian]] [[biochemist]] [[Szent-Györgyi]] (who won the 1937 [[Nobel Prize]] for Medicine) isolated the compound "hexuronic acid" while working with [[antioxidant]] compounds in the [[adrenal cortex]]. <ref>{{cite web |url=http://nobelprize.org/nobel_prizes/medicine/articles/carpenter/index.html |title=The Nobel Prize and the Discovery of Vitamins |accessdate=2008-01-25 |author=Carpenter, Kenneth J. |date=2004-06-22 |work=http://www.nobelprize.org |publisher=[[Nobel Foundation]]}}</ref> It was not until 1932 that the connection between vitamin C and scurvy was established by [[United States|American]] researcher [[Charles Glen King]] of the [[University of Pittsburgh]]. <ref>{{cite web |url=http://profiles.nlm.nih.gov/WG/Views/Exhibit/narrative/szeged.html |title=The Albert Szent-Gyorgyi Papers Szeged, 1931-1947: Vitamin C, Muscles, and WWII |accessdate=2008-01-25 |work=http://profiles.nlm.nih.gov |publisher=U.S. National Library of Medicine }}</ref>
== Modern incidence ==
Scurvy or subclinical scurvy is caused by the lack of vitamin C. In modern western society, scurvy is rarely present in adults, although infants and elderly people are affected.<!--
--><ref>{{cite journal | author = Hampl JS, Taylor CA, and Johnston CS.
| title = Vitamin C Deficiency and Depletion in the United States: The Third National Health and Nutrition Examination Survey, 1988 to 1994 | journal = American Journal of Public Health | year= 2004 |volume = 94 | issue = 5 | pages = 870–875| url= http://www.ajph.org/cgi/content/full/94/5/870 |pmid= 15117714}}</ref> Vitamin C is destroyed by the process of [[pasteurization]], so babies fed with ordinary bottled milk sometimes suffer from scurvy if they are not provided with adequate vitamin supplements. Virtually all commercially available baby formulas contain added vitamin C for this reason, but heat and storage destroy vitamin C. Human [[breast milk]] contains sufficient vitamin C, if the mother has an adequate intake.
Scurvy is one of the accompanying diseases of [[malnutrition]] (other such micronutrient deficiencies are [[beriberi]] or [[pellagra]]) and thus is still widespread in areas of the world depending on external food aid.<!--
--><ref>{{cite paper | author=[[World Health Organization|WHO]] | title= Area of work: nutrition. Progress report 2000| url= http://www.who.int//mipfiles/2299/MIP_01_APR_SDE_3.en.pdf
| format=PDF | date=June 4, 2001}}</ref> Though rare, there are also documented cases of scurvy due to poor dietary choices by people living in industrialized nations.<!--
--><ref>{{cite journal | author=Davies IJ, Temperley JM | title= A case of scurvy in a student. | journal = Postgraduate Medical Journal | year= 1967 |volume = 43 | issue = 502 | pages = 549–50|pmid= 6074157 | url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&list_uids=6074157 }} <br />Sthoeger ZM, Sthoeger D. Scurvy from self-imposed diet. Harefuah. 1991 Mar 15;120(6):332-3.
<br />Ellis CN, Vanderveen EE, Rasmussen JE. Scurvy. A case caused by peculiar dietary habits. Arch Dermatol. 1984 Sep;120(9):1212-4.
<br />McKenna KE, Dawson JF. Scurvy occurring in a teenager. Clin Exp Dermatol. 1993 Jan;18(1):75-7.
</ref>
== Prevention ==
Scurvy can be prevented by a diet that includes certain citrus fruits such as [[Orange (fruit)|oranges]] or [[lemons]]. Other sources rich in [[vitamin C]] are fruits such as [[blackcurrants]], [[guava]], [[kiwifruit]], [[papaya]], [[tomatoes]] and [[strawberries]]. It can also be found in some vegetables, such as [[carrots]], [[bell peppers]], [[broccoli]], [[potatoes]], [[cabbage]], [[spinach]] and [[paprika]], as well as some [[pickled vegetables]]. Many animal products, including [[calf]] [[liver]] and [[oysters]], contain vitamin C. Though redundant in the presence of a balanced diet,<ref>{{citation
| last = Rivers
| first = Jerry M.
| title = Safety of High-level Vitamin C Ingestion
| journal = Annals of the New York Academy of Sciences
| volume = 498
| issue = 1
| pages = 445–454
| url = http://www.blackwell-synergy.com/doi/abs/10.1111/j.1749-6632.1987.tb23780.x
| doi = 10.1111/j.1749-6632.1987.tb23780.x
| year = 1987}}</ref> various nutritional supplements are available that provide ascorbic acid well in excess of that required to prevent scurvy,<ref>[http://www.dietfacts.com/html/nutrition-facts/emergen-c-super-energy-booster-1000mg-vitamin-c-cranberry-flavored-fizzy-drink-mix-as-7-min45890.htm Nutrition information for "Emergen-C" product]</ref> and even some [[candy|candies]] contain vitamin C.<ref>[http://gethalls.imcdev2.com/products/defense_drugfacts.asp Nutrition information for "Halls Defense" product]</ref>
== Scurvy in animals ==
Like humans, other [[primate]]s and [[guinea pigs]] lack the gene that makes vitamin C and thus require vitamin C in the diet to prevent the development of scurvy. Scurvy is sometimes seen in pet guinea pigs that are fed an inadequate diet. To prevent scurvy in guinea pigs, they should be fed guinea pig food such as guinea pig pellets, which must be supplemented with fresh fruit and vegetables or vitamin C drops as the vitamin C in the pellets degrades very quickly (50% within six weeks of manufacture). It is not recommended that any supplement or medication be given to a guinea pig via a water bottle as it may impact their water consumption. <ref>[http://www.petplace.com/small-mammals/vitamin-c-deficiency-scurvy-in-guinea-pigs/page1.aspx Vitamin C Deficiency (Scurvy) in Guinea Pigs<!-- Bot generated title -->]</ref>
==Further reading==
#''[http://stephenrbown.net/scurvy1.htm SCURVY: How a Surgeon, a Mariner, and a Gentleman Discovered the Greatest Medical Mystery of the Age of Sail''] by Stephen R. Bown. Published by Thomas Dunne Books 2004.
== See also ==
* [[Scurvy-grass]]
==References==
{{Reflist}}<!-- -->
{{Nutritional pathology}}
[[Category:Malnutrition]]
[[Category:Animal diseases]]
[[bs:Skorbut]]
[[bg:Скорбут]]
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[[ja:壊血病]]
[[no:Skjørbuk]]
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[[pl:Szkorbut]]
[[pt:Escorbuto]]
[[ro:Scorbut]]
[[ru:Цинга]]
[[simple:Scurvy]]
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[[sr:Скорбут]]
[[fi:Keripukki]]
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