The recognition of scurvy with especial reference to the early x-ray changes.

Twelve years ago, under the auspices of the United States Children's Bureau, Dr. Martha Eliot undertook the prevention of rickets in a district of New Haven, Connecticut, numbering 12,000 inhabitants. At once it became necessary to have more accurate knowledge than was available concerning the criteria for the diagnosis of early rickets in the x-ray films. Accordingly comparative x-ray and histological studies of the bones of all children dying from any cause in the paediatric service of the New Haven Hospital were begun, and have been continued at the Harriet Lane Home, Johns Hopkins Hospital, Baltimore. Altogether examinations have been made of the bones of 532 children between the ages of two months and two years. In the course of the work scurvy was discovered in a number of patients in whom the disease had not been suspected during life, and in this way it was learned that scurvy was escaping diagnosis. Moreovea, as the resu't of the comparisons of the x-ray films of individual bones with their histological counterparts certain early x-ray manifestations of scurvy were observed, which had either entirely escaped attention previously or else had never received adequate notice in the literature. The case records of scurvy in the Harriet Lane files were then examined in the hope of obtaining further information. Altogether, the clinical and x-ray records in 125 cases of scurvy have been studied, and the present paper is the result. Its main emphasis is on the early x-ray signs of scurvy and their histological interpretation, but it also contains scattered observations of clinical interest and importance.