The World War has tended also to demand a renewed consideration of scurvy. This disorder has played a rôle in all wars--in the campaigns of the Cæsars, the pilgrim ages of the Crusaders, and the numerous wars of the last century. In the recent war it existed among the various armies, particularly those in the East, to an extent greater than at first was realized. In Mesopotamia it is stated to have been one of the decisive factors in forcing the surrender of the British at Kut. Its incidence, however, was not limited to the military forces. Reports from England and the continental countries clearly indicate that scurvy prevailed among the civilian population during the past few years to a degree unknown in peace times. This was especially true of infants and children. For the past seven years I have been engaged in an investigation of scurvy both in the laboratory and in the clinic, and have treated various aspects of the subject in a large number of articles published in various medical journals. In the course of these studies there has been ample opportunity for a comprehensive review of the widely-scattered literature. No treatise on scurvy has been published in English since the classical work of Lind in 1772. The time, therefore, seemed opportune to gather into one volume the recent advances in this field and to offer to the clinician, to the hygienist, and to the biological chemist a presentation of the existing status of this important nutritional disease. It is with pleasure that I acknowledge my obligation to Dr. Lester J. Unger, who has assisted in carrying out much of the work described in this volume. Thanks are due also to Dr. Charles Gottlieb for the radiographs which are here reproduced, and to Dr. Gertrude McCann for seeing the work through the press. To my associates in the clinic who shared in the observations, and to friends who read various chapters in the course of their preparation, I wish to express my appreciation. ALFRED F. HESS. New York, August, 1920. CONTENTS PAGE PREFACE iii-iv CHAPTER I HISTORY OF SCURVY 1 (_a_) OUTBREAKS ON LAND; (_b_) OUTBREAKS AT SEA; (_c_) INFANTILE SCURVY; (_d_) SCURVY IN THE WORLD WAR CHAPTER II PATHOGENESIS AND ETIOLOGY 23 PATHOGENESIS: THEORIES; POTASSIUM DEFICIENCY; ACIDOSIS; TOXIC; BACTERIAL; VITAMINE (ACCESSORY FACTOR) ETIOLOGY: BREAST-FED INFANTS 35 ARTIFICIALLY FED INFANTS: PASTEURIZED MILK; BOILED AND STERILIZED MILK; DRIED MILK; CONDENSED MILK; PROPRIETARY FOODS (EFFECT OF ALKALIZATION) 40