scurvy

Classification according to ICD-10
E54	Ascorbic Acid Deficiency Vitamin C Deficiency Scurvy
ICD-10 online (WHO version 2019)

The scurvy (obsolete even scurvy and mouth rot ) is occurring in humans, monkeys and guinea pigs vitamin deficiency disease that with continued lack of Vitamin C occurs in the diet in humans after two to four months and also as (vitamin) avitaminosis C was called. In infants , the disease is also known as Möller-Barlow disease or Möller-Barlow syndrome , after Thomas Barlow (1845–1945) and Julius Otto Ludwig Möller (1819–1887).

Symptoms and ailments

The following symptoms occur with this deficiency disease - sometimes only several months after the onset of the vitamin C deficiency:

Bleeding gums in scurvy

Bleeding in the tongue

• Bleeding gums and gum overgrowth (gingival hyperplasia) and later tooth loss
• Susceptibility to infectious diseases
• Exhaustion and fatigue
• poor healing of wounds
• Skin problems ( ecchymosis , hyperkeratosis ) and skin inflammation as well as skin bleeding ( petechiae ) and bleeding in the area of ​​the hair follicles (perifollicular haemorrhages)
• muscular dystrophy
• Bone pain due to bleeding under the periosteum (subperiostal), resulting in partial limping, relieving posture, restricted mobility
• Joint inflammation
• high fever
• severe diarrhea
• sudden dizziness

The efficiency and the manpower decrease considerably. Scurvy can lead to death from heart failure.

Most of the symptoms of scurvy can be traced back to the faulty biosynthesis of collagen . Vitamin C is an important cofactor in the modification of the amino acids proline and lysine to hydroxyproline and hydroxylysine ( hydroxylation ). If there is no hydroxylation, only damaged collagen molecules are formed that cannot fulfill their function as structural proteins .

The depression that occurs in severe scurvy, on the other hand, could be related to the disturbed formation of noradrenaline , secondary adrenaline and serotonin , since their synthesis is vitamin C-dependent.

In X-rays , significant withdrawals of the periosteum show by bleeding (subperiosteal haemorrhages), particularly at the metaphyses . In children and adolescents, the growth plates are widened and irregular, often with an additional white metaphyseal line (Frankl line) and a hypodense "rubble field" zone underneath, the so-called "scurvy line". Bone age is usually a year or two behind biological age.

Causes and Treatment

Structural formula of L -ascorbic acid

The cause of scurvy is a lack of vitamin C , for example caused by insufficient consumption of fresh fruit and vegetables or raw meat or raw fish. The treatment of the disease therefore consists in the intake or administration of vitamin C or the consumption of food containing appropriate vitamins.

Metabolic studies with ¹⁴ C -labelled vitamin C show that the daily turnover in humans is around 20 mg regardless of the vitamin C intake. The technical information of the Federal Institute for Drugs and Medical Devices (BfArM) indicates a daily total turnover of about 1 mg / kg body weight for vitamin C. According to the recommendation of the German Nutrition Society, the daily requirement of a healthy adult is 100 mg. To avoid scurvy, however, 10 mg a day can be sufficient.

Origin of name

The German disease name scurvy comes (like English scurvy ) via Middle Latin scorbutus from Russian skrobot ("scratching") and is related to "schrappen" ("to scrape").

The old German name Scharbock (documented as Schorbock since 1486 in the interior of Meissen, as Scharbock since 1534 in Cologne) is distorted under various references from the Latin name and not entirely cleared ( cf.Charbock ): According to an explanation, the word has its origin in the Dutch Scheurerbek ("wonderful mouth ", from bek "mouth"); in today's Dutch, scurvy is called Scheurbuik (“sore belly ” since the 16th century, perhaps under the influence of scheur-mond , the “mouth rot”). The forms scerbuk and schorbuk already existed in Low German in the 15th century . According to another explanation, it comes from the Germanic (Icelandic) Skyrbjūgr , from Skyr (" sour milk ", " Quark ") and Bjúgr , a tissue change , which describes a disease that mainly occurs when you are in times of need or on ship journeys had to feed on longer-lasting, but low-vitamin foods such as rusks.

history

Since the 2nd millennium BC In Egypt scurvy was known as a disease. Later the Greek physician Hippocrates and the Roman author Pliny wrote about it.

In the Middle Ages, for example, an author named Master Heinrich von Braunschweig wrote a (lost) dietetic-medical text on scurvy with bathing and eating rules as well as rules of conduct and remedies against it.

In the Age of Discovery (15th to 18th centuries), scurvy was a major killer of seafarers ; For example, the ship of Vasco da Gama lost about 100 men to scurvy on a voyage of 160 men. The reason for the occurrence of scurvy at sea was the inadequate diet , which mainly consisted of canned or dried food ( cured meat and ship's biscuits ). The crew of the French navigator Cartier was helped by coastal Indians on Newfoundland in 1535 with a brew of spruce needles.

In 1601 Ernst Hettenbach the Elder, Professor zu Wittenberg, wrote a treatise on scurvy in Latin, which later became the property of the Saxon State Library in Dresden .

In the 17th century, after the proposal of an English clergyman from the India Company had been rejected by the government in London, a Dutch branch was established at the Cape of Good Hope in 1652, the main purpose of which was to supply the Dutch fleet with fresh vegetables on trips to East Asia .

The Austrian military doctor Johann Georg Heinrich Kramer ( Kramer Rocks was named after him ) was in Hungary with a field army in 1720 when a severe scurvy epidemic broke out among the soldiers and had requested "anti-scurvy herbs", which, however, were not fresh (and therefore ineffective) . He had recognized green vegetables, oranges, lemons as juice, jam or lemonade as effective remedies against scurvy and later noted this in his diary.

In 1734 the theologian and physician Johann Friedrich Bachstrom demanded the use of fresh fruit and vegetables to cure scurvy.

The British ship's doctor James Lind showed in a study in 1754 that citrus fruits help against scurvy. However, Lind's findings were slow to gain acceptance in the British Navy for two reasons : First, vitamins were still unknown, and even Lind initially suspected that the healing properties of the acid in citrus fruits could be ascribed to. As a result, cheaper acids have been sought as scurvy remedies. Second, the citrus fruits were only viewed as a remedy and consequently lemon juice was only given by the ship's doctor. The fact that they have a preventive effect was initially unknown (for details see the section A therapy for scurvy in the article about James Lind). It was not until 1795 that the British Admiralty decreed that the crew of Royal Navy ships should be given a ration of lemon juice every day . From 1844 this measure was taken to heart in the British merchant navy. In the 19th century, lime juice was mostly used instead of lemon , although limes contain significantly less vitamin C than lemons and are therefore less effective as a prophylactic against scurvy. In 1844, with the enactment of the Merchant Seamen's Act , shipowners were legally obliged to always carry lemon or lime juice with them on all overseas voyages and to dispense them every day at the latest if salted instead of fresh provisions were to be served in the crew mess for more than 10 days . The nickname "Limey" for British sailors (or the British in general), which is still used in German today, derives from the daily ration of citrus juice, which is contrasted with the expression "Krauts" for the North German merchant traders who eat sauerkraut .

Georg Forster reports that malt mash was very effective in combating scurvy. James Cook's travelogues mention that the occurrence of scurvy can be prevented by eating fresh sea lion meat.

Scurvy also occurred on land, especially in the winter months and in besieged fortresses or among the first North American settlers, where fruit and vegetables were initially scarce. Maximilian zu Wied-Neuwied fell ill with scurvy on March 11, 1834 on the Missouri in Fort Clark. After eating the leaves and bulbs of the white flowering wild prairie onion Allium textile (old name Allium reticulatum ), he recovered.

When Robert Falcon Scott made his first expedition (1901–1904) to Antarctica , the prevailing theory was that scurvy was caused by ptomain poisoning , especially canned meat. Scott realized, however, that a diet of fresh Antarctic seal meat cured scurvy before serious illness or death occurred to his crew.

In 1907, those African prisoners of war in German South West Africa (today Namibia) who were interned on Shark Island were less fortunate . Two thirds of the more than 2,000 prisoners employed in the construction of the railway died, most of them from scurvy. A German missionary suspected the harsh climate by the sea to be the cause, which the Africans are not used to, and pleaded, initially unsuccessfully, for resettlement inland.

In 1907, the two Norwegian doctors Axel Holst and Theodor Frølich accidentally discovered that guinea pigs are susceptible to scurvy. Scurvy is rare in the animal kingdom (since most species synthesize their own vitamin C), and thus guinea pigs could for the first time serve as an "animal model" in the laboratory for research into scurvy. The researchers had exposed the guinea pigs to various diets consisting of grain (mainly rice) and flour. As a result, Holst and Frølich were able to detect scurvy in animals for the first time, which until then had only been observed in humans. They also showed that certain feed additives could cure the disease in the guinea pigs. In doing so, they provided an essential prerequisite for the discovery of vitamin C (ascorbic acid) as a causal factor in 1932 by the Hungarian biochemist Albert von Szent-Györgyi and the American researcher Charles Glen King .

After the molecular structure of ascorbic acid had been clarified by crystal structure analysis by Walter Norman Haworth (Nobel Prize in Chemistry for his studies on carbohydrates and vitamin C in 1937) and Tadeus Reichstein had developed the Reichstein synthesis , which could be carried out on a large scale , Roche began industrial vitamins in 1934. C synthesis.

In the 20th century, scurvy occurred en masse during the Japanese-Russian War , the First and Second World Wars, as well as in the German concentration camps and the Soviet gulag . In contrast, the National Socialists actively promoted the supply of the then just discovered vitamins, especially vitamin C, to the population . In the post-war period in Germany , scurvy was common among the children of displaced persons . Spruce needle brew was also often used here.

Scurvy is a common side effect of malnutrition (other such deficiency diseases are beriberi or pellagra ) and is therefore still widespread worldwide, especially in underdeveloped countries . Since fruit and vegetables are now available all year round, scurvy rarely occurs in industrialized countries.

The lesser celandine has its name because it in the spring was eaten to treat scurvy, as well as nettles . Both are high in vitamin C.

Herbal remedies for scurvy

The following table shows some herbal remedies for scurvy, as well as their historical and current importance.

Surname	image	description
Occidental tree of life ( Thuja occidentalis )		The occidental tree of life is considered the first traditional remedy for scurvy. The brew from its branches was successfully used on the expeditions of Jacques Cartier , but was quickly forgotten. Today, however, the consumption of the brew is problematic due to the neurotoxic thujone . Still, the tree is popular as a hedge plant.
Onion ( Allium cepa )		When it comes to scurvy, the use of onions is also historically based. Due to their increased vitamin C content and their long shelf life, they were often used on long sea voyages and consumed raw.
Sauerkraut ( Brassica oleracea var. Capitata f. Alba )		The in the fermentation of white cabbage required, low pH ensures that a portion of the contained vitamin C is retained. Sauerkraut was therefore a popular source of vitamin C, especially in Eastern and Northern Europe .
Potato ( Solanum tuberosum )		Although the nightshade plant came to Europe as early as 1555 , it was not used as a staple food in Germany until the beginning of the 18th century. The tuber is extremely rich in vitamins, also vitamin C . That is why at that time it was primarily the main source of food for the poor population, so that scurvy regularly occurred after severe potato harvests due to pest infestation.
Paprika ( Capsicum annuum )		According to legend, the chemist and later Nobel Prize winner Albert Szent-Gyorgyi was served paprika for dinner one day by his wife. Since he had no appetite, he examined the (botanically) berry and found out that this extremely rich in vitamin C is.
Acerola ( Malpighia glabra )		The juice of the fruit contains up to 4.5% vitamin C , the amount of the vitamin is higher in unripened fruit. Due to the high content of vitamin C , the dried acerola juice is nowadays used as a natural food additive in organic products (e.g. gummy bears ).

literature

• D. Léger: Scurvy: reemergence of nutritional deficiencies. In: Canadian Family Physician. Volume 54, October 2008, pp. 1403-1406, PMID 9059387 . Review PMID 18854467 .
• Sabine Streller, Klaus Roth: About sailors, guinea pigs and citrus fruits. The long fight against scurvy. In: Chemistry in Our Time. Volume 43, 2009, pp. 38-54. doi : 10.1002 / ciuz.200900481
• Otto Westphal , Theodor Wieland , Heinrich Huebschmann: life regulator. Of hormones, vitamins, ferments and other active ingredients. Societäts-Verlag, Frankfurt am Main 1941 (= Frankfurter Bücher. Research and Life. Volume 1), pp. 44–47 ( The horror of the old seafarers ).
• Ludwig Weissbecker: Vitamin C avitaminosis (Möller-Barlow disease, scurvy, scurvy, scurvy). In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition, ibid. 1961, pp. 1096-1098.

Web links

Commons : Scurvy  - collection of images, videos and audio files

Wiktionary: Scurvy  - explanations of meanings, word origins, synonyms, translations

Individual evidence

1. ↑ Barbara I. Tshisuaka: Scurvy. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 1338 f., Here: p. 1338.
2. ^ CP Duggan et al. a .: A 9-year old boy with bone pain, rash and gingival hypertrophy. Case record. In: The New England Journal of Medicine. Volume 357, number 4, 2007, p. 392 f.
3. ↑ Barbara L. Tshisuaka: Scurvy. In: Werner E. Gerabek (Hrsg.): Enzyklopädie Medizingeschichte. Berlin / New York 2005, p. 1338 f.
4. ↑ DGE : The reference values ​​for nutrient intake: Vitamin C. Valid for the DA-CH area , as of 2008.
5. ↑ Karl Huth, Erich Muskat, Angelika Winzen: Nutrition, Dietetics and Food Law. 2nd Edition. Heidelberg / Wiesbaden 1989, pp. 59 and 67.
6. ^ Friedrich Kluge , Alfred Götze : Etymological dictionary of the German language . 20th edition, ed. by Walther Mitzka . De Gruyter, Berlin / New York 1967; Reprint (“21st unchanged edition”) ibid 1975, ISBN 3-11-005709-3 , p. 712.
7. ^ Friedrich Kluge, Alfred Götze, p. 712.
8. ^ Walter Alfred Kozian: Scurvy and beriberi on German sailing ships as reflected in the decisions of the Maritime Administration. Part 1: Scurvy. In: German Shipping Archive. Volume 22, 1999, pp. 109-140.
9. ↑ Ralf Vollmuth : Notes on ship hygiene, nutrition, health care and health care in the military seafaring of the empire at the time of the mercenary system. In: Würzburg medical history reports. Volume 11, 1993, pp. 289-310, here: pp. 297 ff. ( Notes on nutrition at sea ).
10. ↑ Wolfgang Wegner: Heinrich von Braunschweig, master. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 563.
11. ↑ J. Tillmanns (Ed.): Journal for the investigation of food . tape 68 . Springer, Berlin 1934, p. 404 ( limited preview in Google Book Search).
12. ^ Otto Westphal , Theodor Wieland , Heinrich Huebschmann: life regulator. Of hormones, vitamins, ferments and other active ingredients. Societäts-Verlag, Frankfurt am Main 1941 (= Frankfurter Bücher. Research and Life. Volume 1), p. 45.
13. ^ Otto Westphal, Theodor Wieland, Heinrich Huebschmann: life regulator. Of hormones, vitamins, ferments and other active ingredients. 1941, p. 45 f.
14. ↑ JF Bachstrom: Observationes circa scorbutum: ejusque indolem, causas, signa, et curam, institutæ, eorum præprimis in usum, qui Groenlandiam & Indiam Orientis petunt. Conrad Wishoff, Leiden 1734.
15. ↑ James Lind: A Treatise on the Scurvy. London 1753.
16. ^ Christopher Lloyd : The Introduction of Lemon Juice as a Cure for Scurvy. In: Bulletin of the History of Medicine. Volume 35, No. 2, 1961, pp. 123-132.
17. ^ Otto Westphal, Theodor Wieland, Heinrich Huebschmann: life regulator. Of hormones, vitamins, ferments and other active ingredients. 1941, p. 45.
18. ^ Allium reticulatum in the Germplasm Resources Information Network (GRIN), USDA , ARS , National Genetic Resources Program. National Germplasm Resources Laboratory, Beltsville, Maryland.
19. ↑ "I understand did scurvy is now Believed to be ptomaine poisoning" Scott, Robert F. " The Voyage of the Discovery ", Smith, Elder & Co, London 1905, p 550th
20. ↑ "[no] party wintering in the Antarctic Regions will have great difficulty in providing themselves with fresh food; and, as we have proved, where such conditions exist there need be no fear of the dreaded word 'scurvy'. "Robert F. Scott: The Voyage of the Discovery. Smith, Elder & Co, London 1905, p. 556.
21. ↑ Casper W. Erichsen: Genocide in German South West Africa: The Colonial War (1904-1908) in Namibia and its consequences. Ed .: Jürgen Zimmerer, Joachim Zeller. Ch. Links Verlag, Berlin 2016, ISBN 978-3-86153-898-1 , Forced Labor in the Concentration Camp on Shark Island, p. 80-85 ( google.co.uk ).
22. ↑ They actually studied the "ship beriberi " in the ship crews of the Norwegian fishing fleet.
23. ^ KR Norum, HJ Grav: Axel Holst and Theodor Frolich - pioneers in the combat of scurvy. In: Tidsskr Nor Laegeforen. Vol. 122, No. 17, June 2002, PMID 12555613 , pp. 1686-1687. (Norwegian).
24. ^ M. Stacey: Haworth Memorial Lecture. The consequences of some projects initiated by Sir Norman Haworth . In: Chemical Society Reviews . tape 2 , 1973, p. 145-161 , doi : 10.1039 / CS9730200145 .
25. ^ The Nobel Prize in Chemistry 1937. In: Nobelprize.org. Retrieved November 12, 2013 . 
26. ^ ^{A b} Markus Grill: National Socialism: Vitamin boost for the people's body. January 19, 2012, accessed November 12, 2013 . 
27. ^ Otto Westphal, Theodor Wieland, Heinrich Huebschmann: life regulator. Of hormones, vitamins, ferments and other active ingredients. 1941, p. 46 f.
28. ↑ ^{a b c d e f} K. Roth: Chemical delicacies. Wiley-VCH, Weinheim 2010, p. 114.

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