One of the earliest, as well as one of the most constant symptoms of
scurvy, is a _lack of appetite_. It is a typical sign of latent scurvy,
although occasionally we have met with cases where the appetite remained
unimpaired until the hemorrhagic stage was reached. In adults there is
sometimes bulimia and a marked capriciousness of the appetite. Anorexia
is a true scorbutic symptom, disappearing with remarkable rapidity when
antiscorbutic food is given, and not capable of alleviation by tincture
of gentian or other vegetable bitters. Whether it depends upon a lack of
secretions in the gastro-intestinal tract is not known, as there has
been no thorough study of this aspect of the disorder. The hydrochloric
acid generally is deficient in cases of scurvy. Recently McCarrison has
laid emphasis on the importance of the impairment of the digestion and
assimilative function in scurvy. This subject gains added interest in
view of the recent reports of Uhlmann as well as of Voegtlin, showing
that water-soluble vitamine acts as a stimulant for the various
secretions of the gastro-intestinal tract.
As a result of McCollum's statement that scurvy is due mainly to
_constipation_, marked attention has been directed recently to the
action of the bowels in this disorder. This question has been discussed
in the chapter on etiology, and, therefore, will be referred to in this
place merely from the clinical viewpoint. In our experience the activity
of the bowel varies greatly in cases of latent or subacute scurvy. In a
great many instances it has been normal; more often there has been
slight constipation, and exceptionally there has been irregular
diarrhoea. In other words, no causative relationship or parallelism
could be observed between the emptying of the intestinal tract and the
development of scurvy. This in general has been the experience of
others. In the report of the American Pediatric Society the bowels are
stated as having been regular in 74 cases, irregular in 15, constipated
in 126, and diarrhoeal in 65. It may be added that we were unable to
cure scurvy by means of liquid petrolatum or phenolphthalein, either in
infants or in guinea-pigs, and likewise unable to protect guinea-pigs
from scurvy by means of various laxatives. On the other hand, opium
given in the form of the camphorated tincture did not lead to an
intensification of the symptoms, although, in one case, the bowels did
not move for over three days.
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