In this connection attention should be drawn to a peculiar and puzzling clinical phenomenon, which we have noted several times. Even if the antiscorbutic treatment is carried out incompletely and only for a short period, recrudescences may not take place. We have seen cases where orange juice was given for merely ten days or two weeks—that is, only until all scorbutic signs had disappeared,—and yet the scurvy did not return, the infants thrived for months thereafter, but were merely somewhat pale and undernourished. In the case of two babies which we have in mind, the diet remained absolutely unchanged, with the exception of the short period of antiscorbutic treatment, but this seemed sufficient to bring about a diminished susceptibility.
CHAPTER IX
TREATMENT
“Seek the cure of scurvy neither in the armamentarium of the physician nor in the apothecary shops. The druggist will be of as little aid to you as the art of the surgeon. On the other hand, employ fresh vegetables, the juice of fresh antiscorbutic plants, oranges and lemons or the juice of those fruits preserved with sugar; in this way without other means you will be able to overcome this terrible disease.” This reads like the advice of some modern therapeutist; it is, however, the conclusion of a physician (Kramer) who wrote on scurvy almost two hundred years ago, and shows that the treatment of scurvy has undergone no fundamental change in the intervening years. Our resources, however, have been amplified by an increased knowledge of the relative value of antiscorbutic foodstuffs and by the introduction of some new ones.
Prevention.—In the Temperate Zone, under ordinary conditions, the adult population consumes sufficient antiscorbutic foodstuff to protect it from scurvy. Under exceptional circumstances, however—for example, when the potato crop fails, or, in the case of individuals, when the diet has been unduly restricted, scurvy will be encountered. This disorder is still an important problem, however, in relation to the health of adults in the Tropics, in military expeditions and in Polar explorations. From what has been stated in the preceding chapter, it is evident that, at the present time, no reliance can be placed on dehydrated vegetables as a protective agent. The recent suggestion of using germinated dried pulses and seeds, under circumstances where fresh food is not available, is practical and probably will be resorted to in the future. To this end the pulses (beans, peas, lentils) are soaked in water for 24 hours, and then kept moist with access of air for about 48 hours at room temperature. During this period they sprout and develop small radicles. They are cooked in the usual way and have been found to possess an antiscorbutic value comparable to that of most vegetables. An individual should receive about four ounces a day of these sprouted seeds. In the treatment of some Serbian soldiers suffering from scurvy, Wiltshire found that this amount of germinated beans brought about a cure. There are, however, two drawbacks to their general use. The prolonged cooking necessary for their preparation reduces their antiscorbutic potency, and they have been found indigestible when consumed in sufficient quantity.
Under similar conditions canned tomatoes can be employed; they have the disadvantage of greater bulk, but are a more potent antiscorbutic, require no preparation whatsoever, and are readily digested. They form part of the present ration of the United States Army, in which they can be given “in lieu of an equal quantity of potatoes not exceeding twenty per cent. of the total issue.”[50] The necessity of including an antiscorbutic in the army ration has been recognized only in recent years; during our Civil War and for thirty years thereafter there was no such provision. It was stated at that time that a general scorbutic taint pervaded the troops—a mere euphemism for the widespread existence of subacute or latent scurvy. Even to-day the ration of the French and of the Italian armies makes no definite provision in this regard and the Russians provide merely for a variable quantity of vegetables.
Recently it has been shown that lemon and orange juices (Givens and McClugage) can be dried and still preserve their antiscorbutic value. It is quite possible that concentrated preparations of this kind will be serviceable for army use and in regions where fresh fruit or vegetables cannot be obtained.[51]
Lind makes numerous ingenious suggestions for preparing antiscorbutic remedies (Lind, pp. 7, 8 and 9) which have a practical as well as historic interest. (Appendix 1.) One of these includes a formula for the preparation of orange and lemon juice which may be preserved for years; another gives a method for the preservation of berries and other fruits which are to be picked when partly ripe and put up in earthen pots; still another gives the recipe for preparing a simple decoction of fir tops, which was found by the Swedes efficacious in preventing the development of scurvy among their soldiers. It is interesting that a similar practice was resorted to in Vienna during the recent war and recommended as a prophylactic for scurvy in children (Tobler).