I. F., girl, was seen when 3 months old, weighing somewhat over 8
pounds. She was given Schloss milk, 4 ounces, and then 5 ounces
every three hours, and did well, weighing 11¼ pounds two months
later. As she failed to gain for some weeks, although getting 6
ounces of food, it was thought that this might be due to the fact
that she was getting pasteurized milk and had never received an
antiscorbutic. Autolyzed yeast had been tried as a prophylactic
antiscorbutic, but failed to bring about a gain. When, however,
orange juice was substituted for the yeast, a prompt growth-reaction
resulted, a gain of 1¼ pounds in four weeks. Accompanying this
lack of gain in weight there were many of the other symptoms
enumerated above; irritability, pallor, slight tenderness of the
lower ends of the femora, albumin and a few red and white cells in
the urine. The pulse- or heart-beat was frequently over 150, and the
respiration 60 (Fig. 15). The diagnosis of subacute scurvy was
substantiated by the prompt subsidence of all symptoms when orange
juice was administered.
[Illustration: FIG. 15.--Chart of I. F., aged 7 months, showing a prompt
effect on pulse, respiration and temperature of substitution of orange
juice (30 c.c.) for autolyzed yeast (30 c.c.) and a further response
when the former was replaced by potato (15 g.).]
Infantile scurvy may be dormant for a long time. The diagnosis of
_latent scurvy_ is based mainly on the reaction to specific therapy, on
the marked improvement when orange juice, tomato, potato or other
antiscorbutic food is given. The symptoms themselves are suggestive, and
do not enable an absolute diagnosis to be made. In our experience with
many cases of this kind the usual course has been as follows: The infant
has been generally from 6 to 9 months of age, and fed for a considerable
period on pasteurized milk, which may or may not have been prepared with
cereal decoction. Nor has it been material whether gruels also had been
given. When about 6 months of age the baby ceased to thrive, to gain
satisfactorily, to look healthy, and to feed as it should. The most
careful investigation or physical examination has failed to solve the
difficulty. On the other hand, the history of a diet of heated milk,
especially if the quantity was not large, considered in conjunction with
the pallor and poor appetite, the increased knee-jerks, and perhaps a
rapid pulse and respiration (the cardiorespiratory syndrome), has
awakened suspicion. Orange juice or canned tomato, prescribed in such
cases with a view to diagnosis as well as to treatment, frequently
brings about a magic result. The following case, the weight chart of
which is reproduced (Fig. 14), is fairly typical of this abnormal
nutritional state:
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