Difficulties in diagnosing infantile scurvy before 1878.

Early nineteenth-century British paediatric authors usually wrote extensively about rickets while making no mention of infantile scurvy. The latter may indeed have been a rare disease among weanlings or, alternatively, one that escaped diagnosis. In the opinion of the paediatrician and historian, George Frederick Still, and of Morwenna and John Rendle-Short, some of the hazards formerly associated with teething were due to unrecognized scurvy. In an analysis of Joseph Hurlock's Practical treatise upon dentition or the breeding ofteeth in children, published in 1742, Still commented as follows: "No doubt, in Hurlock's day, as in our own, unfortunate infants have had their swollen gums lanced to relieve what was supposed to be swelling due to mere dentition, when the purple swelling over a tooth just coming was really due to the haemorrhage of infantile scurvy."' In their Life of William Cadogan, the Rendle-Shorts also intimated that scurvy was a contributory cause to teething problems in the eighteenth century.2 Nevertheless, the fact that late eighteenthand early nineteenth-century physicians did not include scurvy in their assessments of weanling disorders tends to negate the view that the malady could have been commonplace. Thomas Barlow, who in 1883 gave a persuasive account of infantile scurvy, thought it probable that the illness had recently increased in incidence, since it was "inconceivable that men of the authority of Jenner and West and Hillier should not have insisted upon it if this group of symptoms had often occurred within the common range of their experience."3 Five years earlier, in 1878, Walter B. Cheadle had described three instances of scurvy supervening on rickets in young children aged from sixteen months to three years.4 The conjunction of the two diseases intrigued him, for rickets was the commonest morbid condition found in patients admitted to the Hospital for Sick Children, Great Ormond Street, whereas cases of scurvy were extremely rare. Cheadle concluded that an almost entirely farinaceous diet known to be conducive to rickets would not produce scurvy unless potatoes were excluded, an unlikely event in