Clinical and Blood Pictures in Adult Scurvy

G. H. Jennings, A. J. Glazebrook
1938 BMJ (Clinical Research Edition)  
Cases of scurvy such as were described by clinicians in past generations are becoming very rare, and at the same time more and more accurate laboratory methods for diagnosing the malady in a latent or pre-clinical stage are being evolved. So accurately quantitative are some of these tests that there might seem to be little place for the clinician in the diagnosis of scurvy, and a consequent danger that he may miss the condition even in its more flagrant forms. For this reason, and because of
more » ... , and because of the rather unusual and deceptive blood picture in one of our cases, we have ventured to present them in this paper. Case I This patient, a man aged 52, had led an active and energetic life, and apart from a period of war service spent in India and Mesopotamia-had worked continuously on the railways since the age of 18. He came of healthy stock, with no familial tendencies, was married, but had no children. Twenty years ago he had had malaria, and about seven years ago a severe attack of bronchitis; otherwise he had enjoyed good health. For several years, however, he had noticed a tendency to excessive breathlessness on exertion, but could not date the onset of this symptom. In August, 1937, he noticed a sudden pain in the right shoulder, which he ascribed to rheumatism. The shoulder was not swollen or discoloured; the paiR persisted for about four weeks, and then passed completely away. In November he found on rising one morning that the right knee was swollen. The swelling was followed by pain, which gradually increased in severity over a period of fourteen days and then as gradually passed off. The pain kept him awake at night, but was not increased by movement and did not prevent him from getting about. In December he was admitted to the surgical department at the Postgraduate Medical School for treatment of the condition in the right knee. The knee was found to be grossly swollen, with effusion into the joint and much periarticular bruising and redness. Flexion was possible to a right angle only. It was thought that the condition might be of infective origin, although the Wassermann test, the gonococcal complement-fixation test, and culture of aspirated fluid yielded no positive information. While he was in hospital it was noted that he had anaemia with a colour index below unity and a red count of 3,200,000. Radiographs of the joint showed no recognizable abnormality. With symptomatic measures the swelling and pain in the knee cleared up in three weeks, and he was discharged to the out-patient department for treatment of his anaemia. The anaemia, however, progressed, and by January the red count had fallen to 2,240,000, with a colour index of 1.27. Accordingly he was admitted to the medical department on January 15, 1938, with a provisional diagnosis of pernicious anaemia. CONDITION ON ADMISSION The patient was a well-built, cheerful man, with pallor of the mucous membranes and a sallow muddy tinge to the skin; he was not in any pain or distress, and was not dyspnoeic at rest. Temperature, pulse, and respiration rate were normal. The mucosa of the tongue was smooth at the edges but not atrophic. The jaws were edentulous and the gums healthy, with no tendency to sponginess or bleeding. The heart was normal apart from a slight apical systolic murmur. The blood pressure was 155/80. The lungs showed slight emphysematous changes, and the liver was soft and a trifle enlarged; there were no other findings in chest or abdomen. The central nervous system was normal. The right knee was stiff, full flexion not being possible; and there was infiltration and staining of periarticular tissues as a result of former blood extravasation. Multiple small raised petechiae into the hair follicles were present on the extensor aspects of both legs. The patient stated that these had been noticed for some time, but he did not remember when they first occurred as they had never troubled him. INVESTIGATIONS Blood Count (15/1 /38).-Red cells, 1,900,000 per; haemoglobin, 40 per cent.; colour index, 1.05. White cells, 3,000 per; reticulocytes, 3.2 per cent.
doi:10.1136/bmj.2.4058.784 fatcat:5cahn3iub5b4fjoikrdbb4ga3e