From a clinical standpoint scurvy may be said to occur in infants during
the second half year of their lives. There is general agreement on this
point; it is borne out by the investigation of the American Pediatric
Society and by the statistics of various individuals. On the basis of a
large experience, Still states that nearly eighty per cent. of the cases
appear between the ages of six and ten months, and that in no case did
the disorder occur before the age of five months. It is of importance
from both the etiologic and the therapeutic standpoint to distinguish
clearly between the age when infantile scurvy is commonly diagnosed, and
the earlier stage when it appears as a general nutritional disorder. We
must remember that scurvy generally takes from six to nine months to
become manifest, this developmental period varying mainly in proportion
to the degree of the dietary deficiency. It is evident, therefore, that
there must be a prolonged period of nutritional failure which precedes
the diagnosis. This stage consists of two early phases, the first months
where the faulty diet causes no apparent change and seems to have no
deleterious effect on the infant, and the second, of latent and subacute
scurvy. The "latent" condition is one merely of unsatisfactory nutrition
and retarded growth, which it is not possible to interpret; "subacute
scurvy," which develops subsequently, is distinguished by characteristic
signs and symptoms. We shall not review their symptomatology, as it is
given in the chapter devoted to this topic. The subject is brought
forward in this connection to emphasize the fact that the scorbutic
condition occurs far earlier than is generally realized, and
furthermore, that if the earlier and more subtle symptoms of scurvy were
comprehended, the age incidence would fall earlier than the current
figures indicate. The earliest instance of this disorder which we have
seen occurred in a baby four and a half months of age.
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