[33] The beading may have the usual, rounded, smooth, knobby character. There may be, however, what one might term “angular beading,” the junction taking on a step-like form, as if the abutting ends of the cartilage and the bone were of unequal size and not well fitted to each other. The cartilage overtops the bone, so that on palpating the joint there is a precipitous fall as we run the finger outward from the surface of the cartilage, or a sudden elevation on palpating the rib from without inward toward the sternum.
[34] There seems to be some misconception as to the pathogenesis of the subperiosteal hemorrhage in scurvy. In most reports this lesion is described as if it resulted from a hemorrhage burrowing its way beneath the periosteum and raising it from the subjacent bone. In point of fact, such an event is impossible, as will be fully realized when one experiences the great difficulty in separating periosteum from normal bone. Scurvy involves a periosteum which is not normal; it is insecurely attached to the shaft of the bone, so that it is readily stripped off by hemorrhage.
[35] Hogs fed on 1.5 kg. of rye bread and 0.5 kg. of meat heated to 100° or 110° C. for a half hour showed the hemorrhages, loosening of the teeth and affections of the gums characteristic of scurvy, as well as the paralysis and neuritis typical of polyneuritis.
[36] A guinea-pig requires about 80 to 100 c.c. of fresh milk per diem to protect it from manifest scurvy, if this constitutes its sole antiscorbutic quota. There is, however, a great difference in the amount of milk which individual animals consume, so that if we furnish it ad libitum our results will be irregular, one animal developing scurvy and another remaining well, according to individual appetite. Frequently guinea-pigs take very little milk at first, learning gradually to drink more and more, so that it comes to pass that only after some weeks, if at all, they take sufficient to afford protection. Under these circumstances, if any addition is made to the dietary after the experiment has progressed, the lack of development or cure of the scurvy may mistakenly be attributed to this newly introduced factor, whereas, in point of fact, it is due to an increased consumption of milk.
[37] These changes are not found in every specimen, so that in order to be able to exclude scurvy definitely, it is necessary to examine a considerable number of ribs; several may be normal, only one or two showing the characteristic microscopic changes.
[38] A maximum count of 35 was formulated, representing the highest degree of clinical scurvy. This includes three grades of beading of the ribs, four of tenderness of each knee and wrist joint, and four of swelling of each of these joints. It is apparent from the clinical curve ([Fig. 10]) that an animal may have developed a marked degree of scurvy (20 points), and gained rather than have lost in weight.
[39] It is of interest that John Hall, the son-in-law of Shakespeare, and a prominent physician of Warwickshire, was one of the first to urge the use of antiscorbutics. In a quaint work entitled, “Select Observations on English Bodies, or Cures both Empericall and Historical” (1657 London), he describes how he cured scurvy by means of brewing a beer or ale from “Scorbutick hearbs, viz.: scurvy grass, water-cresses and brook lime.” This book, which ran through at least two editions, has not achieved the popularity of the works of the father-in-law.
[40] Preserved mulberries which had been sugared and cooked for one-quarter to one-half an hour were found by Holst and Froelich (1912) to possess good antiscorbutic power three months later.
[41] Dr. Guy’s evidence, Report of the Lords Commissioners of the Admiralty on the Outbreak of Scurvy in the Recent Arctic Expedition—1877 (cited from Chick and Hume).
[42] The swede is a root vegetable of the natural order Cruciferæ. It is grown to a large extent in England, but is practically unknown in the United States.