Interest in scurvy has been stimulated in the last few years as the result of a new and broader conception of nutrition. It has come to be realized that in addition to the substances heretofore recognized as of essential importance in the dietary—the proteins, fats, carbohydrates and the salts—there is still another group, termed “vitamines,” “accessory food factors” or “food hormones,” which must be included in order to render the diet complete and adequate. It has become increasingly evident that the attention of physiologists and of clinicians has been focussed too sharply and too narrowly on the caloric value of foodstuffs. At the same time we have begun to appreciate the existence of a group of nutritional disorders which depend largely on a deficiency of these illusive vitamines or food factors, and which evidently are of vital importance to the welfare of the individual and of mankind. Scurvy is one of this newly-constituted group, and due to this association has acquired a fresh and broader significance. It is in this light that the intensive research work must be interpreted, which has been applied within the past few years, both in this country and abroad, to problems relating to this disorder. It is clear that the subject is in its infancy, and is destined to participate in a consideration of many of the nutritional and infectious diseases of the adult and the child.

The World War has tended also to demand a renewed consideration of scurvy. This disorder has played a rÔle in all wars—in the campaigns of the CÆsars, the pilgrim ages of the Crusaders, and the numerous wars of the last century. In the recent war it existed among the various armies, particularly those in the East, to an extent greater than at first was realized. In Mesopotamia it is stated to have been one of the decisive factors in forcing the surrender of the British at Kut. Its incidence, however, was not limited to the military forces. Reports from England and the continental countries clearly indicate that scurvy prevailed among the civilian population during the past few years to a degree unknown in peace times. This was especially true of infants and children.

For the past seven years I have been engaged in an investigation of scurvy both in the laboratory and in the clinic, and have treated various aspects of the subject in a large number of articles published in various medical journals. In the course of these studies there has been ample opportunity for a comprehensive review of the widely-scattered literature. No treatise on scurvy has been published in English since the classical work of Lind in 1772. The time, therefore, seemed opportune to gather into one volume the recent advances in this field and to offer to the clinician, to the hygienist, and to the biological chemist a presentation of the existing status of this important nutritional disease.

It is with pleasure that I acknowledge my obligation to Dr. Lester J. Unger, who has assisted in carrying out much of the work described in this volume. Thanks are due also to Dr. Charles Gottlieb for the radiographs which are here reproduced, and to Dr. Gertrude McCann for seeing the work through the press. To my associates in the clinic who shared in the observations, and to friends who read various chapters in the course of their preparation, I wish to express my appreciation.

Alfred F. Hess.

New York,
August, 1920.