SCORBUTUS IN INFANTS- 
AMERICAN CASES. 
(ILLUSTRATED. ) 
BY WILLIAM P. f^RTHRUP, M. D., 
PATHOLOGIST TO THE N. Y. FOUNDLING 
HOSPITAL. 
Reprinted from the 
Archives of Pediatrics, 
January, 1892. 
New York : 
M. J. Rooney, Printer and Stationer, 
1329 Broadway. SCORBUTUS IN INFANTS; AMERICAN CASES* 
(Illustrated.) 
BY WILLIAM P. NORTHRUP, M.D., 
Pathologist to the New York Foundling Hospital. 
The object of this paper is to present some cases of 
infantile scurvy occurring in this country, and to intimate 
something regarding their frequency of occurrence. As 
to the essential nature of the disease there is no positive 
recent contribution to literature, nor has the writer any- 
thing new to offer. After the valuable papers on scurvy 
in children to be found in Keatings Cyclopedia, and in 
that most admirable book of Eustace Smith's, there 
remains nothing to say until some investigator shall 
announce the long hidden secret of the essential causa- 
tive factor which gives rise to the lesions which we, by 
common consent, denominate scurvy-be it in infants or 
adults. 
The first case reported in this paper is so typical in 
lesion, course and symptomatology ; in its aetiology so 
suggestive and in its treatment so successful; in short, so 
typical and instructive is the case, that it has seemed best 
to the writer to set it forth in detail, with the statement 
that it illustrates nearly every point mentioned in the two 
articles referred to above. As these volumes are prob- 
ably in the library of every member of this section, it is 
* Read before the American Pediatric Society, Washington, D. C., 
Sept. 24, 1891. 2 
Northrup: Scorbutus in Infants. 
useless to duplicate words. If it shall appear that scurvy- 
in children is not of frequent occurrence, there is yet a 
certain advantage in considering such cases, especially if 
they are liable to spring up in the path of the general 
practitioner at any turning.* 
CASE I.- Typical; scurvy occurring in rich surround- 
ings; recovery; patient aged sixteen months. In the 
midst of a pouring rain on a Sunday morning, a carriage 
drew up to the curb, the bell gave two quick jumps and 
in a few minutes a man was marching up and down the 
office floor. The cause of his nervousness was quickly 
announced. His second child, an infant, had rheumatism 
and had become no better during the fortnight's sojourn 
of himself and wife in a neighboring capital. The child in 
their absence had been in the care of an old nurse, so gifted 
in the art of nursing and, I may add, in self-conceit. On his 
return home the previous evening, the infant was not 
well. It was not very sick, so he thought, when he went 
away, and by this time he supposed it would have entirely 
recovered-instead, it was worse. He sent for the doctor 
and, in his anxiety, desired an immediate consultation. 
His family physician was among the ablest practitioners 
in New York ; he had not been called to the child within 
a week ; had not been informed by the nurse, if indeed 
he had not been misled by her. The history of many 
cases can be written backwards better than consecutively, 
and the present one is of this character. Suffice it to say, 
in preface, the diagnosis was rheumatism and the treat- 
* Scurvy, by Thos. Barlow. Cyclopaedia of the Diseases of Children, 
Keating, vol. ii., page 277. 
CONCLUSIONS-(CHARACTERISTICS.) 
"(l). Predominance of lower-limb affection; («) immobility; (^exces- 
sive tenderness ; (r) general swelling of lower limbs ; (</) skin sniny and 
tense but seldom pitting and not characterized by undue local heat; 
(^) on subsidence, revealing a deep thickening of the shafts ; (f) 
liability to fracture near epiphyses. 
"(2) Swelling of the gums, varying from definite sponginess down to 
a vanishing point of minute transient ecchymosis 
But to them must be added as : 
"(3). The most diagnostic of all, definite and rapid amelioration by 
antiscorbutic regimen." Northrup : Scorbutus in Infants. 
3 
ment had embraced salicylic acid and tincture of iron, 
without success. 
At the time of the consultation the father and mother of 
the little patient were present; both were within the thir- 
ties, healthy and vigorous, the father looking like a hardy 
yachtsman. The family history on both sides was good. 
The family were luxuriantly housed in the most hygienic 
surroundings of up-town New York. In short, the infant, 
whose history we are going to consider, who was suffer- 
ing from malnutrition, from " insufficient and poor food," 
to quote words so often used in connection with chil- 
dren's diseases, was the offspring of wedded representa- 
tives of two rich and powerful families in the fashionable 
and political world of the great metropolis. There was 
no lack of love and devotion on the part of parents or 
grandparents. The lack was in wisdom and judgment, 
the abundance, the ' nurse's self-esteem and ignorance ; 
these allowed the present case and history to continue on 
to full accomplishment. 
The child at this time was sixteen months old ; was 
the second born ; a female; thriving very well in 
the early months of. life ; at the fourth month the 
mother's milk failed to be of sufficient quantity and 
quickly, thereafter, ceased altogether. The first born is 
still living and robust ; the mother's milk had after a few 
months been insufficient for it, but the child continued to 
thrive. After the failure of the mother's milk, in our 
patient's case, one of the proprietary foods was given her. 
By some misunderstanding this food was diluted with 
water and milk, the proportion of the latter being too 
small. For a time the child thrived very well, appar- 
ently, though it was rather backward about walking and 
talking. Its digestion was good, its bowels reasonably 
satisfactory and it seemed satisfied with its food. It 
never gave any evidence of rickets ; teeth in usual 
quantity made their appearance at the usual time. 
Three weeks before the visit spoken of (this fact was 
subsequently elicited after questioning both parties) the 
nurse had noticed some change in the child's gums, 4 
Northrup: Scorbutus in Infants. 
After reflecting a week upon this she called the attention 
of the mother to the same. The change was not marked. 
While on a visit to another patient in the household, the 
doctor's attention was called to the child as he was 
hurrying out to his carriage. The baby was reported as 
not quite well and nothing was said concerning the gums. 
He hastily looked her over, learned of the misadventure 
with the proprietary food, added the requisite amount of 
milk to bring it up to the prescribed standard, ordered 
beef-broth, iron peptonate, and was gone. 
One week later than this, the patient developed trotible 
in the right lower limb, evidenced by worrying, sen- 
sitiveness on handling and tendency to keep the limb 
nearly straight. Anti-rheumatic remedies were prescribed. 
There seemed no reason why the case should not speedily 
come out of its condition of slight depression, now that 
the food was improved and treatment instituted. 
During the succeeding week very little is known con- 
cerning the child ; the parents were absent from home ; 
the family physician was not called ; the nurse drew no 
conclusions from the, now rapidly-changing gums, and 
as to the rheumatism, the progress was slow. It is not 
difficult for physicians to understand how this infant, 
once started on its career of malnutrition, could even in 
the house of luxury, under these circumstances, develop 
ripe symptoms. At this juncture the parents returned 
home to find the rheumatism worse, instead of cured, 
and a hasty muster of physicians was the result. 
The child cried on seeing a strange face, becoming 
alarmed also for the safety of its lame leg. In the wry 
face of crying, the little patient fairly unbuttoned from 
between its lips two rows of irregularly nodulated, 
purplish gums, from the summits of which the points 
of its teeth fairly protruded. In the upper spongy 
rozv was a depression with ulcerated walls and slough- 
ing shreds. The gums were dark and bled freely 
in the act of crying, from compression of the lips 
alone. There was nothing further abnormal about the 
face beyond a worried expression ; no ecchymoses ; no Northrup : Scorbritus in Infants. 
5 
petechiae; conjunctivae were normal ; no evidence of 
unhealthily condition of the mucous membrane of the 
nose. There was no history of nose-bleeding, no haema- 
turia, no haemorrages from the bowels. The child was 
now stripped of all clothing and laid on its back on the 
bed. It continued to whimper, throw its arms about 
freely, draw up its left leg ; as for its right, it could 
move it slowly, but only a little, and could not be induced 
to flex it. The right thigh was somewhat larger than the 
lefty to observation ; by measurement it showed a dif- 
ference of about two and a half inches, which, consider- 
ing the thin thighs of the small patient, augured a 
marked difference. The enlargement was fusiform, great- 
est just above the knee. Apart from the spongy gums and 
swollen thigh there were no external manifestations. 
The diagnosis of this case is scorbutus ; what confir- 
mation of this diagnosis can be offered ? The answer 
is, the success in treatment. 
The child was removed at once to the country, its 
proprietary mixture was stopped and in its place were 
given fresh cow's milk, expressed juice of beef, baked 
potatoes, also citrate of iron with excess of citric acid. 
The one thing which this scurvy case seemed to crave, 
for which it reached out, which it seized with ravenous 
avidity, was orange. The child could hardly be re- 
strained till it held the fruit in its grasp; and then 
proceeded to souse its lips and nos^ in the juice. Im- 
provement began at once ; in five days its gums were 
markedly better, in ten entirely normal. As for its 
thigh, at the end of ten days the improvement was 
marked both in sensitiveness and size, and a month later 
the child was standing on its feet. A slight thickening 
over the femur could be detected for a few days, at the 
end of which time, the patient seemed absolutely well. 
"Now," to quote the words of the latest report, "she 
would strike you as a child small for her age simply, 
nothing having ever been the matter with her." 
Several points may be learned by reading between 
the lines in this case. As Dr. Charles McBurney once 6 
Northrup: Scorbutics in Infants. 
very aptly said, speaking of the value of original in- 
vestigation: "There is also great value in /^-search." At 
least we may argue, that in cases of spongy gums and 
pains in the knees it is well to consider the diagnosis 
of scurvy. A certain amount of sinister interest attaches 
to the fact that this child was vaccinated a month be- 
fore the first symptoms appeared, and all medical men 
connected with the case were catechised as to the near 
or remote possibility of its causal relation to the lesion 
of the gums and thighs. It was, by the way, vaccinated 
on the leg. Needless to add, its course was perfectly 
typical for an effective inoculation and was followed by 
speedy healing. 
To entirely complete the disease-picture given us by 
the English authorities, nothing is required but the post- 
mortem findings, which the following cases furnish. 
CASE II.-Fatal scurvy in a child of eighteen months; 
Autopsy* 
This child was an inmate of the New York Foundling 
Hospital and was what is called a " nurse-baby," that is, 
she was nursed by a mother who, in addition to her 
own baby, nursed a second of about equal age. Her 
own child thrived; the second furnishes this example 
of malnutrition and the pathological specimen which is 
here shown. The nurse was said to be very fond of 
the child and " took on " when -it sickened and died. 
Since we are considering a case of scurvy develop- 
ing in a breast-fed {sic) child it is well to bear in 
mind the above facts and the added fact that nearly 
all babies nursing two at one woman require to be 
fed more or less. We are justified in forming our 
own conclusions as to which was fed more and which 
less ; we know which baby was hers and which was 
not, which thrived and which developed fatal scurvy ; 
we also have our notions of the tendencies of maternal 
instincts. However, the history must be recorded as 
* Reported in Proceedings of the N. Y. Pathological Society, 1889, 
pp 66-67. Northrup : Scorbzitus in Infants. 
7 
those in charge of the case furnish it, and it reads, 
" the child was wet-nursed the first sixteen months 
of its life." 
Briefly the history of the illness was as follows : 
This female child when sixteen months old was observed 
to be failing, and as the history reads, " on account of 
impaired nutrition was taken from the breast and was 
given vegetable acids." In the seventeenth month of 
life, which was one month before death, the right leg 
and knee became swollen and tender. Temperature 
was ioi ° F. After two days the symptoms seemed 
temporarily to disappear. Two weeks before death and 
six weeks since the weaning, the child appeared to be 
very sick, her gums were swollen, smoky-black and 
bled freely ; two days later her left eyelid became 
swollen, black, having the appearance of the classical 
"black eye." Temperature thus far continued about 
ioi° F. One week later there developed the physical 
and rational signs of pneumonia. At this time her 
other eyelid became ecchymotic and the other thigh 
markedly swollen. 
During the remaining days of life the small patient 
became excessively anaemic, having a metallic pallor, 
which gave a particularly wretched appearance with the 
contrasting ecchymoses about the eyes. Her passages 
were black and pasty ; no petechiae ; the child failed 
rapidly and died with pronounced symptoms of pneu- 
monia. 
Autopsy.-The main interest lies in the condition of 
the legs. As regards the organs, it is sufficient to say 
there were no haemorrhages ; extensive pleuro-pneumonia 
of left side. Left thigh symmetrically enlarged, larger 
than the right, though both were obviously above normal 
in size. Left femur was, at its upper extremity, normal, 
epiphysis and end of shaft. The lower half was invested 
about with a black grumous subperiosteal layer of 
blood having a thickness of two to three millimeters. 
The lower epiphysis was detached, the lower end of 
the shaft macerated, eroded and soft, lying loose in the 8 
NORTHRUP: Scorbutus in Infants. 
black disintegrating blood-clot. The femur of the com- 
panion leg was surrounded for its lower two-thirds by 
a thinner, black, subperiosteal blood-layer-(See illus- 
tration). 
The lower epiphysis was not detached though both 
it and the shaft were congested. No haemorrhage into 
any joints. The right and left tibiae were surrounded 
by a thin, dark haemorrhagic layer beneath the perios- 
teum and the proximal portions of both were con- 
gested. The fibulae, likewise the bones of the upper 
extremities, were normal. 
The accompanying illustration is drawn from a speci- 
men which consists of a lateral half of the lower limb 
of the side less affected. 
^Microscopical examination of the bone disclosed no 
syphilitic or rhachitic changes-, and no inflammatory 
changes in bone or periosteum. The softened, macer- 
ated bone gave no evidence of suppuration ; moderate 
congestion of the fellow femur and the upper extrem- 
ities of the tibse. 
CASE III.-Dr. Richard Van Santvoord has reported* 
the autopsy of a helpless idiot, six years of age, in whom 
extensive haemorrhage, with separation of* both upper 
epiphyses, had occurred under the periosteum of the 
upper halves of both humeri. This haemorrhage was 
apparently the immediate cause of death. The case was 
regarded by him at the time as probably traumatic. Re- 
ports that he had subsequently seen of extensive sub- 
periosteal haemorrhage, with epiphyseal separation, had 
been regarded by their recorders as scorbutic. He had 
become convinced that his own case belonged under 
that heading. Gums were not mentioned as being in- 
volved. 
CASE IV.-Dr. August Caille contributes for use in this 
paper, an autopsy record of a typical case of scurvy- 
autopsy by himself. He says :-" In addition to the 
external appearances there were subcutaneous effusions of 
*Ibid. Northrup : Scorbutus in Infants. 
9 
[Drawn from Specimen by H. McDonald, M.D.] 
Specimen from a case of Infantile Scurvy, showing subperitoneal hem- 
orrhage about femur and tibia of the side less affected. 10 
Northrup: Scorbutus in Infants. 
blood, haemorrhagic spots on divers mucous and serous 
membranes, swellings at the joints and subperiosteal 
effusions of blood at the epiphyses." 
The three last narrated cases furnish the only autopsies 
the writer has been able to collect. Bearing in mind the 
complete picture of disease furnished by the previous 
cases, let us consider the following ; 
CASE V.-Dr. Chas. H. Richardson of the North East- 
ern Dispensary-children's class-has furnished the fol- 
lowing most interesting and illustrative case. 
Anne K., aged twelve months, was brought to the dis- 
pensary by its mother with the history of "failing" for 
nearly two months. The child was healthy for some 
time after birth, when the mother was obliged to work, 
and of necessity the baby was "farmed out." She 
reported the food as having been condensed milk, 
adding the somewhat ambiguous item, "and what was 
going." 
The child had recently vomited blood, passed blood 
from the bowels and presented petechial spots of sub- 
cutaneous haemorrhage. The gums were slightly soft- 
ened and according to the mother's account the inside of 
the mouth had been black. Both legs were enlarged to 
considerably more than double their normal size. Epi- 
physeal ends showed marked enlargement. Limbs very 
tender, hard and pitted slightly on pressure." 
" Head sweats. Temp., ioo|°. Tendency to spinal 
curvature in dorsal region." 
To continue the verbatim quotation of the doctor's 
letter :-" I considered this a combination of scurvy and 
rickets and put the child on a live diet of fresh milk, 
orange and lemon juice." Three days from the first 
observations and prescription the purpuric spots had 
mostly disappeared, and no new ones had occurred. The 
child seemed slightly better; there was no vomiting, yet 
the condition of the limbs was unchanged and the tem- 
perature continued slightly elevated as before. 
The following paragraph gives the case an added inter- 
est and accuracy : " The swelling of the limb being due to NORTHRUP: Scorbutus in Infants. 
11 
subperiosteal haemorrhage, added to subcutaneous oedema, 
I wished to see the character of the effusion next the bone. 
I thereupon passed an aspirating needle down to the femur 
and drew off some of the effused fluid. It consisted appar- 
ently of pure blood, which microscopically showed the 
red globules, somewhat ragged and disintegrated, and the 
white ones somewhat increased in number." 
At this point the case escaped from observation and 
the history ends. 
Case VI.-Dr. Hermann Goldenberg, at his class in 
the Mt. Sinai Hospital Dispensary, observed the follow- 
ing case of scurvy : 
A boy, two years old, was brought in by his father, 
who stated that the patient had been well up to a few 
days previous, when he noticed red spots over all his 
body, swelling of the legs, bleeding from the mouth, 
bowels, nose ; also haematuria. The food of the child 
consisted exclusively of milk. 
The family history was good ; a number of older chil- 
dren were strong and healthy ; no malaria ; no syphilis. 
To quote Dr. Goldenberg literally:-"I found a haemor- 
rhagic eruption in nodes, spots and large patches, up to 
the size of a palm of a hand, on face, trunk and extrem- 
ities. The haemorrhagic character was clearly demon- 
strated by the fact that the redness remained on pressure, 
and the changes in color, within a few days. The gums 
had the characteristic color and form, as in scurvy. 
There were gangrenous spots in pharynx and on tonsils, 
swelling of the feet and legs and of the scrotum, through 
extravasations into subcutaneous tissue. Fcetor of the 
mouth ; urine which the father brought was bloody ; 
general malaise. No signs of rickets." Dr. Goldenberg 
presented this case before the Mt. Sinai Alumni Associa- 
tion as a characteristic case of scurvy. It was accepted 
as such. One member temporarily dissented, preferring 
to call it haemorrhagic urticaria. The patient was on the 
following day sent to Dr. Jacobi, who confirmed the 
diagnosis and pronounced the case scorbutus. Lemon 
juice, fresh vegetables, potassium chlorate, internally and 12 
Northrup: Scorbutus in Infants. 
as gargle, were ordered and within a few days the child 
was well. 
CASE VII.-The following case was narrated to the 
writer by the physician to the child, whose case was first 
narrated. The patient was a boy sixteen months old ; 
the fifth child of a father, of high rank in the army, 
having a physique which the doctor fittingly typified as 
by the word "bull" ; the mother was a delicate woman ; 
its four or five brothers and sisters were all delicate. The 
child was well housed and cared for, or to use the words 
of the narrator, "over-cared for"; was wetnursed for 
a few days only. Thereafter, it was fed on a proprie- 
tary food. Up to the sixteenth month of life it seemed to 
be well nourished and attain good development. At last, 
its gums became spongy, then *its right ankle became 
swollen, discolored, bluish, tender, fluctuating. This pa- 
tient was seen by an able consultant, an honored member 
of this society, and pronounced rickets-probably mean- 
ing acute rickets. 
On a treatment of lime, muriatic acid and tincture of 
iron the child slowly and gradually recovered. The symp- 
toms in this case were spongy gums and haemorrhages 
about one ankle. No mention is made of petechiae. 
CASE VIII.-Dr. Delafield furnishes the following in- 
teresting case. In the month of June, a child about 
three years old, suffering from obstinate diarrhoea, was 
brought to him for consultation. He prescribed an ex- 
clusive meat diet and advised the parents to take it at 
once into the country. They did as directed, and the 
child speedily recovered. So pleased were the parents 
with the prompt effect*of the diet in the pronounced im- 
provement of the patient that they believed they had 
learned a valuable secret for securing the continued 
health of the child. 
They, without hesitation, settled down to a rigid regime 
of exclusive meat food. This they followed conscien- 
tiously for two or three months. In the last of Septem- 
ber, the condition of the child induced them to return to 
town and again consult Dr. Delafield. This time the pa- Northrup: Scorbutus in Infants. 
13 
tient presented a characteristic case of scorbutus. To use 
the words of the narrator: "The diagnosis was perfectly 
clear ; had characteristic signs of scurvy." On a rational 
diet all symptoms quickly disappeared and the child 
became quite well. 
Case IX.-A letter from Dr. L. Emmett Holt gives 
the following: "Some points regarding a scorbutus case ; 
the first symptoms appeared in the latter part of April, the 
infant being at that time eleven months old, and having had 
all the symptoms of extreme marasmus for several months. 
From the latter part of February she had been upon an 
exclusive diet of a proprietary food. There was first no- 
ticed a swelling of left knee resembling in general ap- 
pearance that due to articular ostitis ; a week or more 
later the gums were spongy, purplish, and slight haemor- 
rhages occurred from time to time. The swelling about 
the knee increased steadily during the next six weeks 
until it was fully four inches in diameter ; the swelling 
extended up to the middle of the thigh ; there was ex- 
treme tenderness and later a slight purplish discoloration 
of the skin. Exploratory puncture gave blood only. The 
child died on June 23d. The above symptoms continued 
together with those of extreme anaemia and exhaustion ; 
there was a slight fever for the last two months ; at no 
time was there any ecchymoses beneath the skin. At the 
autopsy the swelling of the limb was' found to be due to 
subperiosteal haemorrhages, the bone being surrounded 
by a mass of old blood-clots ; the periosteum was ex- 
tensively stripped up ; there was complete separation of 
the lower epiphysis of the femur. 
Case X.--Dr. W. F. Lockwood, of Baltimore, furnishes 
the following: we quote the letter in full, verbatim. 
"Aug. 12th.-Mrs.W , whose family had been in the 
country during the warm weather, asked me to visit her 
child, thirteen months old. She stated that it had been 
ailing for some weeks with diarrhoea varying in severity, 
but never entirely relieved. Of late she had thought the 
child suffered pain in its lower limbs, that it screamed in 
an unusual way at night, especially when moved or 14 
Northrup: Scorbutics ill Infants. 
touched, and that there was increased fretfulness during 
the day. She referred also to some spots 'like old 
bruises' on its legs below the knees, more marked on the 
right. 
"It had been nursed until six months old, after which 
time it had taken almost exclusively a proprietary food. 
"Examination showed the child fairly well nourished, 
rather anaemic, complexion sallow. No evidence of rickets, 
no swelling along shaft, or enlargement at ends of bones. 
Ill defined ecchymotic spot on left leg, but plainer on the 
right. The right leg semi-flexed and everted. No ten- 
derness manifested on gentle manipulation of body or 
limbs. Gums showed dusky purplish fold at root of each 
tooth. They had bled occasionally for some weeks and 
the stool had pretty constantly been streaked with blood. 
Pulse and temperature were normal. 
The diagnosis was made of scorbutus and directions 
were given to change the diet to fresh milk undiluted, 
potato and orange or peach juice. A few days after my 
visit the mother reported the child improved in every 
way. The diarrhoea had stopped and there was no 
screaming or restlessness at night. A second visit 
was not required and the improvement, I have heard, has 
continued." 
Case XI.-Dr. G. H. Whitcomb, of Greenwich, N. Y., 
has, since the writing of this paper, published a most illus- 
trative case ^Archives of Pediatrics, Oct. 1891, p. 760, of 
Artificial Baby Food and Scorbutus.] The child was eleven 
months old ; after fifth month was fed exclusively on ar- 
tificial food, during which time it grew very fat, "seemed 
to thrive famously." "When a little over ten months old 
she became petulant, and evinced a disinclination to move 
or be handled. The legs were partially flexed and re- 
mained rigid. Any attempt to straighten them elicited 
screams. The gums were spongy and bled frequently; 
muscular pains were so severe as to deprive the child of 
rest." "The physician at that time in charge diagnosti- 
cated and treated rheumatism. . . . After ten days the 
family went to Rome, . . . where the diagnosis of rheu- Northrup: Scorbutus in Infants. 
15 
matism was approved and alkaline treatment pursued for 
two weeks, after which they came to Greenwich." 
In Dr. Whitcomb's graphic account occur such expres- 
sions as the following : " screamed when handled . . . 
limbs resembled Bologna sausages . . . gums were spongy, 
ecchymotic blebs discharging sero-sanguinolent fluid . . . 
seven teeth ... no evidence of rachitis?' Treatment com- 
prised fresh milk, rare-broiled beefsteak and sweet 
oranges. 
In three weeks the child was restored to complete 
health. The doctor believes the scorbutus to have been 
caused by the exclusive use of the prepared food and he 
concludes that "no cereal or chemically prepared food 
can nourish perfectly," and should be supplemented with 
fresh milk, meat and fruit juices. 
During the summer just past, the writer has had oppor- 
tunity in three great medical centres, personally, to com- 
pare notes on the subject of scorbutus in young chil- 
dren. 
Prof. Ranke, of Munich, said that with him it was "in 
the highest degree of rare occurrence." He could not at 
once recall a case. 
The assistant of Prof. Widerhofer in Vienna, Dr. Karl 
Foltanek, at that moment surrounded by a throng of 
wretched out-patients at the children's hospital, declared 
that in his experience, and it must be considered a colos- 
sal experience, "scorbut" in children was "ungeheuer 
selten." 
Dr. John Abercrombie, of Great Ormond street Chil- 
dren's Hospital, in London, believed it not frequent, 
though it did occur and was due to patent prepared baby 
foods. In a subsequent conversation with the house phy- 
sician, in answer to the question-to what is scorbutus 
among children commonly attributed in this hospital-he 
promptly gave the name of a proprietary food which is ad- 
vertised upon and within every omnibus in London, at every 
railway station in all England, and whose name glares 
at one from the back cover of every sixpenny novel. 
This point will be of interest to our worthy and honored 16 
Northrup: Scorbutus in Infants. 
president. Well do we remember his able plea before 
the Academy of Medicine in New York, that the tender 
life of the children of this country might be emancipated 
from the thrall of enterprising pap-peddlers. It is a sig- 
nificant fact that the country which furnishes most of 
the literature of scorbutus in children is the same which is 
posted from end to end with advertisements of proprie- 
tary foods. 
As to the frequency of scurvy in America, Dr. Roger 
S. Tracy, Register of Vital Statistics of New York Board 
of Health, has very kindly copied off for the writer all 
deaths reported under scurvy from 1870 to 1890. In this 
twenty years, there have been 100 deaths frqm scurvy, 
reported to the office, of which sixteen have been in pa- 
tients of five years or under. Of the sixteen fatal cases 
in children, twelve have been in infants (under two years 
of age). So it comes about, that of the class of cases 
which we are here and now considering, sixteen have 
been reported among the deaths of the last two decades 
in the City of New York. Some have doubtless gone 
astray in the records, because scurvy has been little con- 
sidered and less thought of among the derangements of 
childhood and infancy; many of them, no doubt, have 
found their way to the list of purpura and acute rickets, 
some to haemorrhagic exanthemata. 
Surgeon J. S. Billings, librarian of the Surgeon-Gene- 
ral's office, has kindly furnished seven references to cases 
of scurvy in children and infants. The first five cases are 
from England, the sixth from France and the seventh 
from America. This case on examination is not con- 
sidered scurvy by the writer. 
It would seem that England, and that means London 
in this case, is the source of most of the cases, and of the 
literature, of scurvy in children. To W. B. Cheadle and 
Thomas Barlow of Great Ormond street Hospital, is due 
the credit (the former) of "having first shown on clinical 
grounds the true affinities of this form of infantile cach- 
exia," and (the latter) the anatomical nature of the dis- 
eases determined by post-mortem examination. Scurvy NORTHRUP : Scorbzitzis in Infants. 
17 
is not in the index of Meigs & Pepper's Diseases of 
Children (Edition, 1883) ; nor does it appear in the last 
edition of J. Lewis Smith's book. 
The writer has held correspondence with twenty-five 
persons, members of this Pediatric section, and others, in 
New York and different large cities ; the purpose has been 
to unearth any cases of infantile scurvy unreported and to 
learn the opinion of the gentlemen as to its frequency of 
occurrence. The answers have been prompt, to the 
point, of great service to the writer, and he here desires to 
express his obligations. All of these correspondents 
have vast opportunities for seeing cases in dispensaries, 
hospitals and asylums, as well as private practice. The 
majority of the answers contain such words (and with 
relief and satisfaction we record it) as "rare in children." 
" I know of very few cases of scorbutus" ; have thus far 
not seen any case of scurvy in children." " Have never 
recognized a case . . . nor do I know of any recognized 
case." " Have never seen a case in children in this city 
nor at the Juvenile Asylum where I pass in review 1,000 
annually, and many are from the ' slums.'" " I think the 
cases extremely rare." " Cases of scurvy in children I 
have not seen." " During a service of two years, in 
which time 1,600 children have been seen, I have not met 
a single case of scurvy." 
The purpose of this paper has been so modest that it 
may fairly be assumed that that purpose has been at- 
tained. Cases have been collected-eleven of them-and 
with pains to make the number represent the approximate 
frequency of occurrence. We must now await the report 
of the investigator for the intimate essential cause of the 
various lesions of scurvy. It is not a question of opinion; 
it is a question of facts. The whole line of sturdy soldiery 
must await the arrival of the aid who brings a message 
from him who holds his council amid culture ovens and 
flasks, dry plates and oil immersions. 
So many apparent causative elements enter into the 
haemorrhagic diseases and blood-dyscrasia, from drugs to 
bad food, that it seems idle to recount them ; they rest 18 
NORTHRUP: Scorbutus in Infants. 
just where they did decades ago. The germ investiga- 
tions have not rendered a final answer, though they seem 
soon to explain some of the group. 
Finally, to dwell on such a topic as the present, to 
bring together rather more cases of scurvy than one ex- 
pects are to be found, to, in a certain way, apply for the 
admission of a new disease into American literature, is 
somewhat similar to the player's role of villain ; he may 
set forth upon the boards a most excellent villain, but 
after all, it is a gruesome business. OreKiues of Pediafriss. 
The Archives of Pediatrics, January, 1892, commences its 
ninth year, and a new era of progress and prosperity under the 
business management of Messrs. Fairchild & Company (1329 Broad- 
way, New York City), the publishers of the New York Journal of 
Gyncecology and Obstetrics. Those who have read the ARCHIVES 
during the past year cannot get along without it, and those who 
have not will soon find that they must do so in order to keep up 
with their professional brethren who do. 
Each number contains Original C ommunications from the best 
pediatrists in America and Great Britain, Clinical Memoranda and 
Clinical Lectures from all the great pediatric centres, and a com- 
plete resume, carefully prepared, of all the current pediatric litera- 
ture of the world, so that at the end of each year you have a 
cylopaedia of nearly 1,000 pages, on Diseases of Children, costing 
less than a penny a day, which being carefully indexed will be in- 
valuable to every active practitioner. The ARCHIVES has the most 
distinguished corps of collaborators-each one contributing at least 
one article during the year-connected with any medical journal. 
The highly interesting scientific papers, together with a stenographic 
report of the discussions thereon, read before the American Pediatric 
Society, are published exclusively in the ARCHIVES OF PEDIATRICS. 
It is admitted that children form the large majority of the gen- 
eral practitioner's patients ; yet it is a deplorable fact that the study 
of their diseases has been sadly neglected, even our leading medical 
colleges having given but little attention to this important branch 
of medicine. There is a remedy for this evil which can be furnished 
by the Archives of Pediatrics. To accomplish this object we 
solicit the hearty co-operation of the entire profession in placing 
this-the only journal of its kind published in English-in the very 
forefront of the advanced field of medical science.