Infants as well as adults usually recover rapidly and completely from
scurvy, the result depending largely upon the early recognition of the
disease. We must always bear in mind, however, that from a histologic
standpoint the cure is not simultaneous with the magic disappearance of
the clinical symptoms, but that months probably elapse before the
tissues return to their normal state. It is difficult to give reliable
mortality statistics for infantile scurvy, for so many cases are of the
rudimentary form that percentages are necessarily misleading. Still
writes that in 5 out of 64 cases the disease proved fatal by diarrhoea
and exhaustion. The American Pediatric Society reports 29 deaths out of
397 cases, which gives a similar mortality percentage. When infantile
scurvy was not so generally recognized by physicians the mortality was
much higher, and we find that Barlow encountered 7 deaths in his first
series of 31 cases.
Even when the child recovers it may not regain its normal health if it
has continued for a prolonged period in a state of chronic scurvy. It
may remain pale and fail to gain in weight in spite of a liberal and
well-balanced diet. Cases of this kind are not infrequent. In this
connection it is worthy of note that 4 of the 41 cases of "coeliac
disease," an interesting intestinal condition described by Still, had
scurvy just before or during the onset of the disease. This observation
conforms to the experience that chronic bowel disorders often follow in
the wake of adult scurvy.
In adults the heart may be weakened by scurvy, and death may result from
cardiac failure. Cardiac disturbances occur also in infantile scurvy.
This involvement might be expected, in view of the tachycardia
(cardiorespiratory phenomenon) which is so frequent a symptom of
infantile scurvy. The heart may be rapid for months or even for years
after the disorder, and tachycardia may develop on the occasion of even
a mild infectious disease. For example, a fever of 101°, due to a common
coryza, may cause the heart-beat to rise to perhaps 180 a minute.
Children so affected succumb readily to infection, especially to
pneumonia, which may lead to sudden collapse followed by death.
An important factor in the prognosis of scurvy, as in that of other
disorders due to a lack of vitamines, is the marked susceptibility to
infection. Even latent or subacute scurvy causes a peculiar
susceptibility to diphtheria (especially the nasal type), to coryza,
bronchitis, and pneumonia. A perusal of the literature shows that this
susceptibility was noted by the older authors in relation to adults.
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