Scurvy in Rural Area
2
CASE REPORTS SCURVY IN RURAL AREA,:~ SHANKAR VtAo, M.B., B.S., Saltanabad (Nizar~ State) Case No. 1.--S. S., a male child 10 months' old, was first brought to the hospita! on 18-11-1944 for a boil on thc undcrpart of the scrotum. Tincture of iodine was .paintcd and boric powder was dusted with some relief. On 23-11-194~1. he was again brought. Two red patches were noticed on the abdomen and the prepuce was flmnd swollen. The history was that the two patches developed all of s sudden during the course os onc night, two days ago and the prepuce became swollen the next day. Since then therc was aggravation of all symptoms. On examination, the child, though well built was extremely restless. There wc~c two elliptical maculm on the abdomcn 2" long and l" wide. The prepuce was inflakicd. B6sides there were also five patches of petechia] h~emorrhages on the forehead, left cheek and the neck. The tonguc was raw. No teeth were .cut. There was no temperature. The h~cmorrhages whre attributed to moderate vitamin C deficiency. Dietetic histo:y showed that the child was fed on boiled rice only. Fish, vegetables or fruits were absent from the dict. He was given 'Cvimin' pills; 333 units were given in a day. After four days the haemorrhagic patches had lost the red colour, swelling of the prepnce was subsiding tongue was normal and the child was quiet. In a week's time the child was completely healthy and only pale-white marks were recognised at the site of the maeulm. Besides the pills the child received no other treatment. Ca.Qe No. 2.--B. V., a boy aged one year, was treated for nearly a month and a half for boils by an unqualified person. The disease was not recognised. The child was brought to the hospital on 21)-10-1944, as there was no relief of symp- toms. 2he attendants stated that the malady began with small red peteehi~e on the thighs about two months ago. These increased day by day till nearly the whole body was covered. It became even difficult to handle the child. The child was breast fed and was well-built before thc condition arose. Mother was quite healthy, as were other members of the family. On admission nearly the whole body surface of the child was found to be -overed with big irregular macular p_atches. The skin over the feet, thighs, underside of the scrotum and sides of the trunk had given way with the result that large ulcers were formed. The margins of these were thick and the bottom was covered with foul smelhng debris formed due to secondary infection. The surrounding tissue was loosc and blue. No teeth was eut. The tongue was red and swollen and any attempt to feed, sent the child sereamig. Temperature in the axilla was lOl~ Pulse 120 p.m.. Respirations 32. Urine could not be collected-for examination. IEood was not examined. Other systems were normal. A. diagnosis of scurvv was made and as there was no preparation of vitamin C avatlab.le ~ hand the at~:endants were advised to put the child on lime juice in the meanwhile. Patient's people did not mind the advice. The child lived for two days and died, developing ' blueness of the face and body ' before death. Case No. 3.--D. A., a girl aged 14, months, was first seen on the 9-11-44. She was ill for the last three months and her condition was serious since a month. She was breast fed. Just before the onset of the disease she was given a few feeds of ~rrom the Civil IIespital, Sultanabad (Nizam State). Submitted for publication, March 5, 1945.
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Transcript of Scurvy in Rural Area
CASE REPORTS
SCURVY IN RURAL AREA,:~
SHANKAR VtAo, M.B., B.S.,
Saltanabad (Nizar~ State)
Case No. 1.--S. S., a male child 10 months ' old, was first brought to the hospita! on 18-11-1944 for a boil on thc undcrpar t of the scrotum. Tincture of iodine was .paintcd and boric powder was dusted with some relief. On 23-11-194~1. he was again brought. Two red patches were noticed on the abdomen and the prepuce was flmnd swollen. The history was tha t the two patches developed all of s sudden during the course os onc night, two days ago and the prepuce became swollen the next day. Since then therc was aggravation of all symptoms.
On examination, the child, though well buil t was extremely restless. There wc~c two elliptical maculm on the abdomcn 2" long and l" wide. The prepuce was inflakicd. B6sides there were also five patches of petechia] h~emorrhages on the forehead, left cheek and the neck. The tonguc was raw. No teeth were .cut. There was no temperature .
The h~cmorrhages whre a t t r ibuted to moderate vi tamin C deficiency. D i e t e t i c histo:y showed tha t the child was fed on boiled rice only. Fish, vegetables or fruits were absent from the dict. He was given 'Cvimin' pills; 333 units were given in a day.
After four days the haemorrhagic patches had lost the red colour, swelling of the prepnce was subsiding tongue was normal and the child was quiet. In a week's time the child was completely heal thy and only pale-white m a r k s were recognised at the site of the maeulm. Besides the pills the child received no other t rea tment .
Ca.Qe No. 2.--B. V., a boy aged one year, was t reated for nearly a month and a half for boils by an unqualified person. The disease was not recognised. The child was brought to the hospital on 21)-10-1944, as there was no relief of symp- toms.
2he a t tendants stated that the malady began with small red peteehi~e on the thighs about two months ago. These increased day by day till nearly the whole body was covered. I t became even difficult to handle the child. The child was breast fed and was well-built before thc condition arose. Mother was quite healthy, as were other members of the family.
On admission nearly the whole body surface of the child was found to be -overed with big irregular macular p_atches. The skin over the feet, thighs, underside of the scrotum and sides of the t runk had given way with the result that large ulcers were formed. The margins of these were thick and the bot tom was covered with foul smelhng debris formed due to secondary infection. The surrounding tissue was loosc and blue. No teeth was eut. The tongue was red and swollen and any a t t empt to feed, sent the child sereamig. Temperature in the axilla was lOl~ Pulse 120 p.m.. Respirat ions 32. Urine could not be collected-for examination. IEood was not examined. Other systems were normal.
A. diagnosis of scurvv was made and as there was no preparat ion of vi tamin C avatlab.le ~ hand the at~:endants were advised to put the child on lime juice in the meanwhile. Pat ient ' s people did not mind the advice. The child lived for two days and died, developing ' blueness of the face and body ' before death.
Case No. 3.--D. A., a girl aged 14, months, was first seen on the 9-11-44. She was ill for the last three months and her condition was serious since a month. She was breast fed. Jus t before the onset of the disease she was given a few feeds of
~r rom the Civil IIespital , Sultanabad (Nizam State). Submitted for publication, March 5, 1945.
34 Indian Journal o] Pediatrics
boiled rice. As the disease progressed, it was soon stopped. Mother was healthy. An enquiry of dietetic history revealed absence o'f any fresh vegetablcs or fruits in the diet since the last summer.
The child was of fair and average build. Lower central incisor teeth were cut- Gums were red and swollen but were not fungas like or spongy. The condition of the body surface was just like that of case No. '2 There was no temperature. Lemon juice was advised but it could only be had from a market eight miles away. Ascorbic acid preparation, was ordered, but was not available.
Next day the child did not open her eyes and shunned any attempt to do so. By the evening an extcnsive h~emorrhage had taken place under the~conjunctiva of the right eyc. The whole conjenctiva was swollen, red and had protruded over the cornea, giving the eye an awcful appearance. Patient's pcoplc were frightened and did not attend the hospital thereafter.
A few days later, it was learnt from her relatives that she died in hcr village on the 15-11-44~-six days after she was first seen.
COMMENT
The cases are in te res t ing f rom t h e . f a c t t ha t typica l BARI, OW'S symp- toms were comple te ly absent . S y m p t o m s usual ly seen in a d u l t s w e r e a marked fea ture of all the three eases. These were the only eases of scurvy recorded dur ing the year 1944 in this hospi tal wi th an annual average of abou t 10,000 new pat ients .
The seasonal incidence in October and N o v e m b e r should be noted . I n the mofussil af ter the winter crops in March and April the season is d ry and no greens are grown till the monso6ns in J u l y . I t takes about a mon th or two for the vegetables to become edible. As such dur ing the period from April to Sep tember an o rd inary vi l lager consumes v e r y l i t t le or no fresh vegetables . Thus the food is ap t to be deficient in v i t a m i n s dur ing this per iod of the year . The adult~ m a y no t a lways show any manifes t symptoms of deficiency (as in the case of the mothers of ~he above pat ients) . The infants are more l ikely to be v ic t ims of the deficiency.
