Has infantile scurvy, or Barlow’s disease, really disappeared? Or is it now diagnosed as ‘shaken baby syndrome’, without any evidence that the infant was ever shaken?1,2 If so, we may be missing the mark in infant care and subjecting parents to a grave injustice.3,4

Even Caffey,5 in his original observations of ‘child abuse’, observed subperiosteal haemorrhages and long-bone fractures typical of infantile scurvy in his six infants with subdural haematomas.

We do not like to believe that scurvy could possibly occur today in the modern world. Yet, 6% of a consecutive sample of people attending a Health Maintenance Organization (HMO) clinic in Arizona were found to have deficient plasma vitamin C concentrations in 1998 (<11.4 micromols/L), and 30% had depleted levels (<28.4 micromols/L).6

Blood levels of vitamin C and histamine are inversely related, because L-ascorbic acid is essential for the removal of histamine by conversion to hydantoin-5-acetic acid. Thus, severe vitamin C deficiency can cause a 10-fold increase in the blood histamine concentration.7 Any further production of histamine by vaccinations, infections, and other stresses can give rise to toxic histaminaemia, which could be fatal.

We will not be able to solve the present-day medicolegal dilemma regarding shaken babies, until hospital laboratories are set up to provide accurate, same-day plasma ascorbic acid and whole blood histamine analyses for all sick infants.7–9