Symptoms
The onset of scurvy graduates with anaemia. It is, however, usually abrupt with severe pain in a leg or arm. The chief feature of the disease is that the limbs become painful and tender from the haemmorrhages under tight periosteum. The child becomes irritable and very comprehensive when approached, from fear of pain on handling. He lies quite still since the slightest movements in bed causes pain. The limbs adopt the characeteristic ‘frog position’ with the things abducted and the knees slightly flexed. Purple swellings and bleeding of the gums may occur if teething is in progress, because the lack of vitamin C makes the capillaies fragile and their rupture is common.

Causes
Scurvy is caused by lack of vitamin C or ascorbic acid. Inadequate intake of fresh fruits and vegetables can lead to this condition. The disease is likely to attack the rich as well as the poor, becuse it arises in the system not from an insufficient diet quantitatively, but from a diet lacking in organic mineral salts so essential to health and vitality.
The disease is more common in artifically fed infants. Cow’s milk contains less than half the vitamin C found in breast milk. This is reduced further if the milk is boiled or processed. Scurvy may also occur in older children who are mentally retarded and cannot chew, and are consequently fed on sloppy foods.

Treatment
The most important factor in the prevention and treatment of scurvy in children is proper feeding. All children after their bith should be breast-fed for atleast six months, as this is the best natural way to provide all the essential nutrients during this period. If for any reasons, it is not possible to breast-feed the child, he should be fed on either on cow’s milk or commercially available milk formulas. As far as possible, the baby should not be given artifically prepared, patent or tinned milk foods.
Supplementary feeding is necessary, after the initial six months of life for the maintenance of expected growth rate and health of the baby. The method of supplementing the baby’s food at this stage may be followed as outlined in the Introductory Chapter.
The child with scurvy should be given liberal quantities of vitamin C-rich foods. This vitamin is found in fresh fruits and vegetables, but is llargely destroyed in cooking especially if baking soda is used. The amount of this vitamin required is between 10 and 29 mg. daily. The normal diet, however, contains much less amount than this. It can, therefore, if necessary, be taken as a tablet of ascorbic acid.
One of the best remedies for scurvy is the use of Indian gooseberry (amla), which is the richest known source of vitamin C. The powder of dry amla , mixed with equal quantity of sugar, should be given in half a teaspoon doses thrice daily, with milk. If fresh amla is available, it should be cooked like vegetable and eaten.
As rich sources of vitamin C , lemon (bara nimbu) and lime (nmboo) are regarded as foods or exceptional therapeutic value in scurvy. The juice of either or both these fruits should be consumed by the patient diluted in warm water and mixed with honey.
Another effective remedy for scurvy is the use of amchur, a popular article of diet in Indian house, consisting of green mangoes, skinned,stonned, cut into pieces and dried in the sun. Fifteen grams of it is believed to be equivalent to 30 grams of good lime on account of its citric content.
Besides a well-balanced diet, the child-patient should be given liberal quantities of vitamin C -rich foods like orange, bittergourd, tomatoes and leafy vegetables such as spinach and cabbage. The child should also be allowed as much fresh air and sunshine as possible. A cold towel rubbed twice daily and a gentle massage twice or thrice a week will also be beneficial in the treatment of scurvy.

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