Intended for healthcare professionals

Practice Lesson of the Week

Unrecognised scurvy

BMJ 2009; 339 doi: (Published 17 September 2009) Cite this as: BMJ 2009;339:b3580

unrecognised scurvy

In this article BMJ 16 1 2010 p.150 CTP Choh et al
do not refer to the important human experiment on the
effects of vitamin C deprivation on conscientious
objectors in Sheffield in 1942. {1} This study
demonstrated the earliest signs of scurvy and
showed that young men could remain healthy on as little
as 10 mg ascorbic a day for at least a year.

Of the 20 young male volunteers 3 were put on a
diet cntaining 70 mg ascorbic acid a day, 7 on one
containing 10 mg a day and 10 on a diet providing no
food containing vitamin C.
All ten iof those in the last group developed clinical
scurvy after four to seven months. None of those in the
other other two groups developed any signs of scurvy
or any illness which could be attributed to scurvy.

Choh et al mention the occurrence of follicular
hyperkeratosis as an early sign of scurvy. In our 10
deprived subjects thousands of very small {1-2 mg },
haemorrhages around the bases of the hair follicles
were the first most obvious clinical sign. {see photos}.
{1} This sign and a careful dietary history should make it
possible to diagnose scurvy before serious
haemorrhages as described occur.

The authors state that adults require 40 mg of vitamin
C daily. We found that 7 young men remained healthy

for at least a year on only 10 mg daily but we
suggested a figure of 30 mg daily to provide a margin
of safety.

John Pemberton
Emeritus Professor of Social and
Preventive Medicine
Queen's University Belfast

1 Medical Research Council. Special Report Series
No 280 1953
Vitamin C Requirement of Human Adults

Competing interests:
None declared

Competing interests: No competing interests

20 January 2010
John Pemberton
home s321