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Study Guide: Scurvy: Etiology, Pathophysiology, and Historical Context

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Scurvy: Etiology, Pathophysiology, and Historical Context Study Guide

Etiology and Pathophysiology of Scurvy

Scurvy is a deficiency disease primarily caused by a lack of vitamin D in the diet, leading to metabolic bone disorders.

Answer: False

Explanation: Scurvy is defined as a deficiency disease resulting from a lack of vitamin C (ascorbic acid) in the diet, not vitamin D.

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Humans are susceptible to scurvy due to the absence of the L-gulonolactone oxidase (GULO) enzyme, which is essential for endogenous vitamin C synthesis.

Answer: True

Explanation: Humans, along with certain other species, lack the functional L-gulonolactone oxidase (GULO) enzyme in their liver, which is required for the final step in the internal biosynthesis of vitamin C.

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Ascorbic acid (Vitamin C) is essential for the biosynthesis of collagen, carnitine, and catecholamines, and it also facilitates the intestinal absorption of iron.

Answer: True

Explanation: Vitamin C is a vital antioxidant required for the production of collagen, carnitine, and catecholamines, and it plays a role in enhancing the absorption of iron from dietary sources.

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Ascorbic acid is indispensable for various biosynthetic pathways, functioning as a catalyst for hydroxylation and amidation reactions.

Answer: True

Explanation: Ascorbic acid is essential for numerous biosynthetic pathways, where it accelerates hydroxylation and amidation reactions, crucial chemical processes within the body.

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What constitutes the primary etiological factor for scurvy?

Answer: A lack of vitamin C in the diet

Explanation: Scurvy is defined as a deficiency disease resulting from an inadequate intake of vitamin C (ascorbic acid) in the diet.

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Which of the following represents a crucial physiological function of vitamin C in the human organism?

Answer: Helping the intestines absorb iron from foods

Explanation: Vitamin C is essential for several bodily functions, including aiding the intestines in absorbing iron from foods, in addition to its roles in producing collagen, carnitine, and catecholamines.

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Elucidate the specific role of ascorbic acid in the biochemical pathway of collagen synthesis.

Answer: It acts as a cofactor for enzymes that hydroxylate proline and lysine.

Explanation: In collagen synthesis, ascorbic acid functions as a cofactor for prolyl hydroxylase and lysyl hydroxylase, enzymes crucial for hydroxylating proline and lysine amino acids, which stabilizes collagen through cross-linking.

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Differentiate the susceptibility to scurvy between guinea pigs and pigeons, providing the underlying physiological reason.

Answer: Guinea pigs lack the L-gulonolactone oxidase (GULO) enzyme.

Explanation: Guinea pigs are susceptible to scurvy because, like humans, they lack the L-gulonolactone oxidase (GULO) enzyme necessary for internal vitamin C synthesis, whereas pigeons can synthesize ascorbic acid internally.

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Clinical Manifestations and Diagnosis

Initial symptoms of scurvy, including general weakness and fatigue, typically manifest within one week of inadequate vitamin C intake.

Answer: False

Explanation: Early symptoms of scurvy, such as general weakness and fatigue, typically appear after at least one month of insufficient vitamin C intake, not within a week.

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During the advanced stages of scurvy, patients may present with jaundice, generalized edema, and neuropathy, which can ultimately lead to mortality.

Answer: True

Explanation: Late-stage scurvy is characterized by critical symptoms such as jaundice, generalized edema, decreased urine output, nerve damage, fever, and convulsions, often culminating in death from infection or bleeding.

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The 'scorbutic rosaries' observed in individuals with scurvy manifest as bead-like swellings at the costochondral junctions.

Answer: True

Explanation: Scorbutic rosaries are characteristic bead-like swellings found at the junctions of the ribs and cartilage, indicative of bone and cartilage abnormalities caused by scurvy.

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Which of the following terms is NOT identified as an alternative nomenclature for scurvy within the provided source material?

Answer: Addison's disease

Explanation: The source lists Moeller's disease, Cheadle's disease, scorbutus, Barlow's disease, hypoascorbemia, vitamin C deficiency, hypovitaminosis C, and 'Spring fever' as alternative names for scurvy, but not Addison's disease.

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Following what duration of insufficient vitamin C intake do the initial symptoms of scurvy typically emerge?

Answer: After at least a month

Explanation: Symptoms of scurvy typically begin to appear after at least one month of consuming little to no vitamin C in the diet.

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Which of the following represents a critical clinical manifestation observed during the advanced stages of scurvy?

Answer: Jaundice (yellowing of the skin and eyes)

Explanation: In the late stages of scurvy, patients frequently experience jaundice, generalized edema, decreased urine output, nerve damage, fever, and convulsions, ultimately leading to death from infection or bleeding.

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In the context of scurvy, what anatomical manifestation is denoted by the term 'scorbutic rosaries'?

Answer: Bead-like swellings at the junctions of the ribs and cartilage

Explanation: Scorbutic rosaries are bead-like swellings found at the junctions of the ribs and cartilage, indicative of bone and cartilage abnormalities caused by scurvy.

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Epidemiology, Risk Factors, and Management

Scurvy is primarily managed within the medical specialty of Cardiology, focusing on cardiovascular nutritional impacts.

Answer: False

Explanation: Scurvy is generally addressed within the medical specialty of Endocrinology, which focuses on metabolic diseases and nutritional deficiencies, rather than Cardiology.

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The process of cooking typically enhances the vitamin C content in foods, thereby rendering cooked vegetables a superior dietary source.

Answer: False

Explanation: Cooking often significantly decreases the amount of vitamin C in foods, as ascorbic acid is sensitive to heat.

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The therapeutic approach for scurvy involves oral administration of vitamin C supplements, with clinical improvement frequently observed within a few days.

Answer: True

Explanation: Treatment for scurvy consists of oral vitamin C supplementation, which typically leads to improvement within days and complete recovery within weeks.

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Pasteurization of milk in the late 19th century contributed to the prevention of infantile scurvy by preserving its natural vitamin C content.

Answer: False

Explanation: Pasteurization, a heating process, destroys the natural vitamin C content of milk. This lack of vitamin C in pasteurized cow's milk was a cause of infantile scurvy in the late 19th century.

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Within which medical specialty is the management of scurvy typically situated?

Answer: Endocrinology

Explanation: Scurvy is generally addressed within the medical specialty of Endocrinology, which encompasses metabolic diseases and nutritional deficiencies.

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Which of the following demographic cohorts is NOT enumerated as a common risk factor for the development of scurvy in contemporary society?

Answer: Professional athletes with strict training diets

Explanation: Common risk factors for scurvy in modern times include neglected children, individuals with mental disorders, people with unusual eating habits, those with alcohol or substance use disorder, and older people who live alone. Professional athletes are not listed as a common risk group.

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What constitutes the principal therapeutic intervention for scurvy?

Answer: Taking vitamin C supplements by mouth

Explanation: The primary treatment for scurvy involves the oral administration of vitamin C supplements, which typically leads to rapid improvement.

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How does the culinary process generally influence the ascorbic acid content in foodstuffs?

Answer: It significantly decreases it.

Explanation: Cooking often significantly decreases the amount of vitamin C present in foods, as vitamin C is sensitive to heat.

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What was the underlying reason for pasteurized cow's milk contributing to infantile scurvy in the late 19th century?

Answer: The heating process destroyed its natural vitamin C content.

Explanation: Pasteurization, a heating process, destroys the natural vitamin C content of milk. This deficiency in pasteurized cow's milk was a cause of infantile scurvy in the late 19th century, particularly among urban upper-class children.

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What is the contemporary incidence of scurvy in the United States, and which specific demographic group exhibits a disproportionately high prevalence?

Answer: About one in 4,000 people, with two-thirds of cases in autistic individuals.

Explanation: In 2020, the incidence of scurvy in the US was approximately one in 4,000 people, with about two-thirds of all cases occurring in autistic individuals, often linked to highly restricted eating habits or ARFID.

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Historical Understanding and Early Interventions

Historically, scurvy posed a minor concern for long-distance maritime travel, seldom resulting in significant fatalities.

Answer: False

Explanation: Scurvy was a major limiting factor in long-distance sea travel during the Age of Sail, causing widespread deaths, with estimates suggesting at least two million sailors died from it between 1500 and 1800.

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Symptoms indicative of scurvy were first documented in ancient Greece by Hippocrates, but not in earlier historical records.

Answer: False

Explanation: Symptoms of scurvy were recorded as early as 1550 BC in Ancient Egypt, predating Hippocrates' descriptions from between 460 and 370 BC.

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The assertion by the Chinese monk Faxian that ginger prevented scurvy on ships was subsequently corroborated by historical records.

Answer: False

Explanation: The Chinese monk Faxian's claim in 406 CE that ginger prevented scurvy on ships has been noted as having 'failed verification' in historical records.

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Captain James Lancaster executed one of the earliest controlled experiments on scurvy in 1601, thereby demonstrating the efficacy of lemon juice.

Answer: True

Explanation: In 1601, Captain James Lancaster conducted a controlled experiment providing lemon juice to one of his ships' crews, which prevented scurvy, while non-treated crews contracted the disease.

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The introduction of potatoes from the Americas exacerbated scurvy prevalence in Europe, attributed to their low vitamin C content.

Answer: False

Explanation: The introduction of potatoes from the Americas gradually improved the situation regarding scurvy in Europe, as they provided a source of vitamin C, leading to scurvy being virtually unheard of in Scotland by 1800.

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The consumption of freshly obtained, cooked horse meat contributed to the mitigation of a scurvy epidemic within Napoleon's army during the Siege of Alexandria in 1801.

Answer: True

Explanation: During the Siege of Alexandria in 1801, Baron Dominique-Jean Larrey observed that consuming freshly obtained, cooked horse meat from young horses helped curb a scurvy epidemic among French soldiers.

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What was the historical impact of scurvy on long-distance maritime expeditions during the Age of Sail?

Answer: It was a major limiting factor, causing widespread deaths.

Explanation: Historically, scurvy was a major limiting factor in long-distance sea travel, causing the deaths of large numbers of people, with estimates suggesting at least two million sailors died from it between 1500 and 1800.

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At what point in ancient history were the earliest documented symptoms of scurvy recorded?

Answer: As early as 1550 BC in Ancient Egypt

Explanation: Symptoms of scurvy were recorded as early as 1550 BC in Ancient Egypt, with later descriptions by the Greek physician Hippocrates between 460 and 370 BC.

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Which European explorer acquired knowledge of scurvy treatment from the St. Lawrence Iroquoians, involving the decoction of aneda tree needles?

Answer: Jacques Cartier

Explanation: During his 1536 expedition, Jacques Cartier learned from the St. Lawrence Iroquoians to prepare a tea from aneda tree needles, which contained vitamin C and saved his men from scurvy.

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Identify the individual who conducted one of the pioneering controlled experiments on scurvy in 1601, utilizing lemon juice as an intervention.

Answer: Captain James Lancaster

Explanation: Captain James Lancaster conducted one of the first controlled experiments on scurvy in 1601, demonstrating the effectiveness of lemon juice in preventing the disease among his crew.

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What is the estimated mortality figure for sailors attributed to scurvy between the years 1500 and 1800?

Answer: At least two million

Explanation: Researchers have estimated that scurvy caused the deaths of at least two million sailors between 1500 and 1800, during the Age of Exploration.

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In the context of early Australian colonies, what condition was referred to as 'Spring fever' or 'Spring disease'?

Answer: Scurvy, caused by a lack of fresh produce during winter

Explanation: In the early Australian colonies, scurvy was known as 'Spring fever' or 'Spring disease,' an often-fatal condition caused by the lack of fresh fruit and vegetables during winter.

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Scientific Breakthroughs and Modern Understanding

James Lind formally established the therapeutic efficacy of citrus fruit for scurvy in 1747 through a controlled experiment, a landmark in clinical research.

Answer: True

Explanation: In 1747, James Lind, a naval surgeon, formally demonstrated through a controlled clinical experiment that supplementing the diet with citrus fruit could treat scurvy.

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The British Royal Navy promptly adopted Lind's findings on citrus as a universal therapeutic intervention for scurvy following his 1747 experiment.

Answer: False

Explanation: Lind's findings were not immediately adopted by the British Royal Navy due to several factors, including Lind's own belief in multiple causes for scurvy, his attempts to create a concentrated 'rob' that destroyed vitamin C, and the dismissal of anecdotal evidence by classically trained physicians.

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Captain James Cook successfully prevented scurvy on his voyages primarily by ensuring his crew consumed substantial quantities of lemons.

Answer: False

Explanation: James Cook avoided scurvy on his voyages primarily through a strict regime of shipboard cleanliness, enforced discipline, and frequent replenishment of fresh food and greenstuffs, rather than exclusive reliance on lemons.

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The British Admiralty mandated the daily provision of lemon juice to Royal Navy crews in 1795, subsequent to a successful expedition.

Answer: True

Explanation: Following Rear Admiral Gardner's successful expedition in 1795, the Admiralty mandated the daily issuance of lemon juice and sugar as a ration to all warships' crews by June of that year.

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Rose's lime juice achieved widespread use in the British Navy subsequent to the Merchant Shipping Act of 1867, which mandated a daily ration of 'lime or lemon juice'.

Answer: True

Explanation: Lauchlin Rose patented a method to preserve citrus juice without alcohol in 1867, leading to Rose's lime juice becoming nearly ubiquitous in the British Navy after the Merchant Shipping Act of 1867 mandated its daily issuance.

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West Indian limes were considered superior to lemons in scurvy prevention due to their purported higher vitamin C content and enhanced preservation techniques.

Answer: False

Explanation: West Indian limes had significantly lower vitamin C content than lemons, and their processing further reduced this content, rendering them largely ineffective against scurvy, contrary to the belief that their acidity made them superior.

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The 'ptomaine poisoning' theory of scurvy posited that it resulted from a viral infection, causing considerable diagnostic confusion.

Answer: False

Explanation: The 'ptomaine poisoning' theory suggested scurvy was caused by a waste product of bacteria, particularly in tainted tinned meat, not a viral infection.

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Robert Falcon Scott's initial Antarctic expedition successfully ameliorated scurvy among his crew through the provision of fresh seal meat.

Answer: True

Explanation: Robert Falcon Scott's 1902 Antarctic expedition observed complete recovery from scurvy within two weeks after consuming fresh seal meat, despite his confusion about the underlying causes.

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Axel Holst and Theodor Frølich established the animal model for scurvy utilizing pigeons, which exhibit high susceptibility to vitamin C deficiency.

Answer: False

Explanation: Axel Holst and Theodor Frølich discovered the animal model for scurvy using guinea pigs, not pigeons, as guinea pigs, like humans, lack the L-gulonolactone oxidase (GULO) enzyme.

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Vilhjalmur Stefansson's 1928 study indicated that an exclusively carnivorous diet invariably results in vitamin deficiencies.

Answer: False

Explanation: Vilhjalmur Stefansson's 1928 study at Bellevue Hospital demonstrated that an all-meat diet did not lead to vitamin deficiencies, as he and a companion remained in good health for a year on such a diet.

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Albert Szent-Györgyi isolated 'hexuronic acid' in 1927, a compound subsequently identified by Charles Glen King as the antiscorbutic agent and renamed ascorbic acid.

Answer: True

Explanation: Albert Szent-Györgyi isolated 'hexuronic acid' in 1927, and in 1932, Charles Glen King proved this compound was the antiscorbutic agent, leading to its renaming as ascorbic acid.

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Human dietary studies conducted during World War II and the 1960s revealed that a daily supplementation of 10 mg of vitamin C was adequate to reverse all overt symptoms of experimentally induced scurvy.

Answer: True

Explanation: Dietary studies on conscientious objectors during World War II and Iowa state prisoner volunteers in the 1960s demonstrated that 10 mg of daily vitamin C supplementation was sufficient to completely reverse all obvious symptoms of experimentally induced scurvy.

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Who formally demonstrated the therapeutic efficacy of citrus fruit for scurvy in a controlled experiment conducted in 1747?

Answer: James Lind

Explanation: In 1747, James Lind, a naval surgeon, formally demonstrated through one of the first controlled clinical experiments that scurvy could be treated by supplementing the diet with citrus fruit.

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Explain the reasons for the delayed adoption of Lind's findings regarding citrus by the British Royal Navy.

Answer: He believed scurvy had multiple causes and his 'rob' of lemon juice destroyed vitamin C.

Explanation: Lind's findings were not immediately adopted because he himself believed scurvy had multiple causes and his attempts to create a concentrated 'rob' of lemon juice inadvertently destroyed the vitamin C. Additionally, classically trained physicians often dismissed anecdotal evidence.

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Identify a pivotal factor contributing to Captain James Cook's successful prevention of scurvy during his maritime expeditions.

Answer: Strict shipboard cleanliness and frequent fresh food replenishment

Explanation: James Cook avoided scurvy on his voyages primarily through a strict regime of shipboard cleanliness, enforced discipline, and frequent replenishment of fresh food and greenstuffs, rather than exclusive reliance on lemons.

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In what year did the British Admiralty ultimately mandate the daily provision of lemon juice to Royal Navy crews?

Answer: 1795

Explanation: The British Admiralty mandated the daily issuance of lemon juice and sugar as a ration to all warships' crews by June 1795, following a successful expedition.

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Identify the individual who patented a non-alcoholic method for preserving citrus juice in 1867, which led to the development of Rose's lime juice.

Answer: Lauchlin Rose

Explanation: Lauchlin Rose patented a method to preserve citrus juice without alcohol in 1867, resulting in the creation of Rose's lime juice.

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Elucidate the reasons why West Indian limes demonstrated inefficacy against scurvy upon their substitution for lemons in the British Navy.

Answer: They had significantly lower vitamin C content, and processing further reduced it.

Explanation: West Indian limes had significantly lower vitamin C content than lemons, and the processing methods (exposure to light, air, and copper tubing) further reduced their vitamin C, rendering the lime juice largely ineffective against scurvy.

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Describe the 'ptomaine poisoning' theory of scurvy that gained traction in the late 19th and early 20th centuries.

Answer: Scurvy was caused by a waste product of bacteria, particularly in tainted tinned meat.

Explanation: The 'ptomaine poisoning' theory, influenced by germ theory, hypothesized that scurvy was caused by a waste product of bacteria, especially in tainted tinned meat, leading to confusion among medical professionals.

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Identify the researchers who discovered that guinea pigs developed classic scurvy when fed a diet of grains and flour, thereby establishing a crucial animal model for the disease.

Answer: Axel Holst and Theodor Frølich

Explanation: In 1907, Axel Holst and Theodor Frølich discovered that guinea pigs developed classic scurvy on a diet of grains and flour, establishing an animal model critical for identifying the 'antiscorbutic factor'.

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What significant finding did Arctic explorer Vilhjalmur Stefansson present in his 1928 study conducted at Bellevue Hospital?

Answer: That an all-meat diet did not lead to vitamin deficiencies.

Explanation: Vilhjalmur Stefansson's 1928 study at Bellevue Hospital demonstrated that an all-meat diet did not lead to vitamin deficiencies, as he and a companion remained in good health for a year on such a diet.

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Identify the scientist who isolated 'hexuronic acid' in 1927, a compound subsequently recognized as ascorbic acid.

Answer: Albert Szent-Györgyi

Explanation: In 1927, Albert Szent-Györgyi isolated a compound he named 'hexuronic acid,' which Charles Glen King later proved to be the antiscorbutic agent, renamed ascorbic acid.

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