The prevention of infantile scurvy, especially in its rudimentary form, is of great practical importance, because of its frequent occurrence. There is no question but that breast milk and raw cow’s milk furnish sufficient antiscorbutic vitamine, but there is a difference of opinion as to whether pasteurized milk, or milk that has been brought just to the boiling-point, or even sterilized milk, is adequate in this respect. Much of this divergence of opinion is due to the fact that the various clinicians have not considered or stated the quantity of milk which they have found sufficient to protect, and also because milk itself differs in its antiscorbutic value according to its freshness and probably also according to the fodder of the cows.[52] Without entering once more into a discussion of this question, it may be stated that unless the cow’s milk is raw, the infant should receive additional antiscorbutic foodstuff. Moreover, this supplement to the dietary should be made as soon as possible, so as not to allow the vitamine deficiency and inadequate diet to exist for even a short period. In our experience there is no contra-indication to the giving of orange juice or of strained canned tomato, the two antiscorbutics with which we have had a large experience, to babies one month of age or even younger. The common practice, however, is to wait until the infant is five or six months of age, which certainly must allow a rudimentary scorbutic condition to develop. At the age of a month one teaspoonful of orange juice may be given; it should be diluted with water and sugar added if it is tart. This may be administered notwithstanding the fact that a baby has a tendency to looseness of the bowels, as orange juice, as recently pointed out by Gerstenberger, has practically no laxative action. Occasionally babies regurgitate orange juice, but the reaction usually ceases after a day or two. If it does not, a small amount of an alkali—for example, limewater or sodium bicarbonate—may be added just previous to feeding; in this state the juice will be better tolerated.[53] The amount of orange juice should be increased so that when the baby is three months of age it receives one tablespoonful.
A few years ago Hess and Fish recommended the use of an infusion of orange peel in infant feeding. The peel was finely grated, soaked overnight in water (1 ounce of the peel to 2 ounces of water), and a small amount of sugar added to this liquid. Animal experiments showed that this preparation possessed decided antiscorbutic value. This decoction may well be used for the sake of economy, and even when the orange juice is employed the infusion of the peel may be added.
An antiscorbutic which vies with orange or with lemon juice in adaptability for infant feeding is canned tomatoes, as recently suggested by Hess and Unger. Tomatoes are not in good repute among food experts in view of the small amount of calories which they contain—only about 100 to the pound—and are regarded with suspicion amounting almost to superstition by mothers and nurses as a food for children. In spite of this fact, it may be stated without hesitation that they are fully as well borne by infants a few weeks or months of age as orange or lemon juice. In considering antiscorbutics, it has been shown that notwithstanding the canning process and subsequent aging, they preserve their potency. The dose is two tablespoonfuls for babies over three months of age. The tomatoes are merely strained through a colander and warmed (not cooked). To illustrate their innocuous character, it may be added that as much as 6 and 8 ounces a day of this juice have been given to a baby under one year of age without producing untoward symptoms. This antiscorbutic should have wide applicability, especially in the United States.[54]
Another antiscorbutic which can be used in a routine way to prevent infantile scurvy is swede juice, prepared by grating the raw vegetable and squeezing the pulp in muslin. Chick and Rhodes report that this juice has been adopted for use in some of the English infant-welfare centres. It should be given in about the same dosage as the tomatoes, and seems applicable where the swede can be readily obtained.
For babies over six months of age, reliance may be placed on the ordinary household vegetables—potatoes, spinach, carrots, squash, etc. Attention should be paid to the amount which is taken, as one or two teaspoonfuls of a vegetable which is poor in antiscorbutic power, such as carrots or beets, will be insufficient to protect against scurvy. Especially is this true if the vegetables are old and stale and are cooked for a long period;[55] some years ago two infants under our care developed scurvy in spite of a small daily ration of vegetables.
Potato in the amounts usually consumed is a valuable antiscorbutic. It is not an exaggeration to state that it is the main antiscorbutic bulwark of man. In giving baked potato to children it is commonly advised to use the floury part just beneath the peel; this should be put through a sieve and mixed thoroughly with boiled milk so as to constitute a cream; for younger babies it can be prepared with water to form a diluent similar to the barley water so commonly employed to dilute cow’s milk (1 tablespoonful of potato to a pint of milk, cooked for 15 minutes). Little reliance should be placed on beef juice in the usual dosage and none on eggs.
Cure.—There is almost nothing in the realm of therapy which is so striking as a scorbutic patient’s prompt reaction to antiscorbutic treatment. It is all the more marvelous as the cure is effected by means of foodstuffs with which we are accustomed to associate no specific virtue. A magic result is seen frequently within 24 or 48 hours. A baby which has had a poor appetite, has been irritable and exquisitely tender, suddenly regains its appetite, is no longer fretful, and can be handled without occasioning crying. Within a week, if the case is mild, all definite symptoms of scurvy may have disappeared, and soon thereafter the infant is thriving and apparently cured. A table is here reproduced (Table 6) from the report of the American Pediatric Society showing the duration of treatment before marked improvement was noticed:
| Days | Cases | Weeks | Cases | Months | Cases |
|---|---|---|---|---|---|
| 1 | 19 | 1 | 47 | 1 | 6 |
| 2 | 58 | 2 | 27 | 2 | 4 |
| 3 | 46 | 3 | 8 | 3 | 4 |
| 4 | 26 | 4 | 1 | ||
| 5 | 19 | 5 | 1 | ||
| 6 | 1 | 6 | 1 | ||
| 7 | 2 | ||||
| 8 | 2 | ||||
| 9 | 1 | ||||
| 10 | 7 | ||||
| 12 | 2 |
In most instances a gain of weight accompanies improvement. In not a few instances, however, there is a temporary loss or cessation of weight, due in part to an increased excretion of urine. Occasionally there is observed a short exacerbation of the symptoms following the giving of an antiscorbutic—a swelling of the thigh or hemorrhage of the gums. A similar phenomenon has been noted in relation to the treatment of polyneuritis in birds and of beriberi in man.