One cannot survey the various diseases of the bones—scurvy, rickets, osteoporosis, osteogenesis imperfecta, osteomalacia, etc.,—without realizing that this group is at present in a state of great confusion and will have to be rearranged and winnowed. The differentiation between some of these diseases is not in every instance clear morphologically—forinstance, early cases of scurvy and osteoporosis—so that it is difficult to consider them satisfactorily from the standpoint of pathogenesis. Clinical differentiation is still more difficult and uncertain. It seems probable that new entities will be established, as has happened in the past. It is not so long since rickets included almost all the bone diseases of infants. Gradually congenital syphilis, scurvy, and achondroplasia were segregated as distinct diseases. Probably a similar separation of other pathologic conditions, now so entangled as to be indistinguishable, will be evolved.
Among the diseases which have been attributed to a vitamine deficiency are “war or hunger edema,” sprue, the “mehlnaerschaden” of infants, and the “exudative diathesis” described by Czerny and Keller. Future investigation will disclose whether any of these disorders belong in the group with scurvy. Thehunger edema, noted in the late war and in previous wars, seems to be a complex condition, quite dissociated from scurvy, as many of the sufferers consumed comparatively large quantities of potatoes or other vegetables. The “mehlnaerschaden” resembles scurvy and the other vitamine disorders in its tendency to produce hydremia and susceptibility to infection. It also develops in spite of a liberal supply of antiscorbutic foodstuff in the dietary. As its name implies, it comes about on a diet containing large quantities of carbohydrate, of the cereal paps so commonly fed to infants. It is conceivable that an unbalanced diet of this kind may not provide a sufficiency of all the vitamines.
It does not seem probable thatexudative diathesis, a term which implies a predisposition to develop exudations or denudations of the skin and mucous membranes, is theresult of a lack of vitamine. This condition does, however, predispose to scurvy. The association was very evident in the group of cases reported by Hess and Fish in 1914. It is not without significance that the blood-vessels in exudative diathesis also show a decided weakness, an increased permeability, as judged by the “capillary resistance test.” In both scurvy and in exudative diathesis eczema and petechial hemorrhages are encountered.
There may benutritional diseases due to an excess of foodrather than to a deficiency. A superfluity may be harmful by hindering the proper utilization of the food, or may possibly lead to the formation of deleterious products. Disturbances of this kind do occur. For example, it is by no means uncommon for an infant which has been overfed with milk to show the typical signs of rickets. Young guinea-pigs which are fed liberal amounts of cow’s milk develop a disease characterized by fragility of the bones. The experience of Lubarsch, who produced osteogenesis imperfecta in rabbits by means of a diet consisting mainly of liver, or adrenal gland, is of interest, especially as this condition did not come about when they were fed muscle tissue.
From what has been stated, it must be evident that this subject not only is in a state of flux but that it is in a state of great confusion. This applies not only to the relationship of vitamines to these disorders, but to their identification and demarcation pathologically as well as clinically. During the past few years we have begun to regard these diseases from a new viewpoint, which no doubt will be helpful, but it is probable that they will not be sharply defined and their relationships determined until it is possible to bring about each disease definitelyand regularly in an experimental animal. Until this time we should proceed slowly, and not bring about “confusion worse confounded” by yielding to the vogue, and grouping together heterogeneous and little-understood clinical conditions under the caption of deficiency diseases. There is a growing danger of attributing every unexplained nutritional disorder to the new, overworked, but ill-defined vitamines—of their sharing with the secretions of the endocrine glands the fate of becoming the dumping-ground for every unidentified disorder.
Extract from “Treatise on Scurvy,” by James Lind, London, 1772.
(a)Recipe for preparing a stable orange or lemon juice.Let the squeezed juice of these fruits be well cleared from the pulp and purified by standing for some time; then poured off from the gross sediment; or, to have it still purer, it may be filtrated. Let it then be put into any clean open vessel of china or stone-ware, which should be wider at the top than bottom, so that there may be the largest surface above to favor the evaporation. For this purpose a china basin or punch-bowl is proper, and generally made in the form required; all earthen glazed vessels are unfit, as their glazing will be dissolved by the acid. Into this pour the purified juice, and put it into a pan of water, upon a clear fire. Let the water come almost to a boil, and continue nearly in that state (with the basin containing the juice in the middle of it) until the juice is found to be of the consistence of a thick syrup when cold. The slower the evaporation of the juice the better; and it will require at least twelve or fourteen hours continuance in the bath heat before it is reduced to a proper consistence.
It is then, when cold, to be corked up in a bottle for use. Two dozen good oranges, weighing five pounds four ounces, will yield one pound nine ounces and a half of pure juice; and when evaporated, there will remain about five ounces of rob, or extract; which in bulk will be equal to less than three ounces of water. So that thus the acid, and the virtues of twelve dozen lemons or oranges, may be put into a quart bottle, and preserved for several years.
I have now some extract of lemons which was made four years ago.
Those who intend this extract for making punch may infuse some of the fresh peel of the oranges or lemons into the spirit before it is used.
But for this purpose I find it is sufficient to add a very small quantity of the outer peel to the extract a little before it is taken off the fire, and there will be all that is requisite to make it entirely equal to the freshest fruit.
(b)How to preserve berries and other fruits for long periods.And it may be proper to acquaint them that most berries, and several fruits, when gathered two-thirds ripe on a dry day, while the sun shines, if put into earthen pots, or rather in dry bottles, well corked, and sealed up, so that no air or moisture can enter, will keep a long time, and at the end of a year, be as fresh as when new pulled.
(c)Method of preparing an antiscorbutic decoction from fir-tops, leaves, bark, etc.When the Swedes carried on a war against the Muscovites, almost all the soldiers of their army were destroyed by the scurvy, having putrid gums, rigid tendons, etc. But a stop was put to the progress of this disease by the advice of Erbenius, the King’s physician, with a simple decoction of fir-tops, by which the most deplorable cases were perfectly recovered, and the rest of the soldiers prevented from falling into it.
I am inclined to believe by the description given by Cartier of the ameda tree, with a decoction of the bark and leaves of which his men were so speedily recovered, that it was the large swampy American spruce tree.
A simple decoction of the tops, cones, leaves or even green bark and wood of these trees is an excellent antiscorbutic medicine; but it will, I am apt to think, become much more so when fermented, as in making spruce beer. By carrying a few bags of spruce or its extract to sea, this wholesome drink may be prepared at any time. But where it cannot be had the common fir-tops used for fuel in the ship should be first boiled in water, and the decoction afterwards fermented with molasses in the common method of making spruce beer; to which a small quantity of wormwood and horse-radish root (which it is easy to preserve fresh at sea) may be added. The juice of the cocoanut tree was experienced to be of very great benefit to several persons afflicted with the scurvy.
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A
Acid, effect on keeping qualities of antiscorbutics,66,161
Acidosis,244theory,24
Adrenals,102in guinea-pig scurvy,122
Adult, scurvy in, history of,1
Age incidence,51
Aging, effect on antiscorbutics of,67
Agglutinins, effect of scurvy on,68
Alimentary tract, gross pathology,89microscopic pathology,100
Alkalization, effect on milk of,50on orange juice of,66,154
Amboceptor, effect of scurvy on,68
Anasarca,86,196
Animals, scurvy in,114
Anorexia,206
Antiscorbutics, and antiscorbutic foods,143,149,157history of use of,9,143
Antitoxin, effect of scurvy on,68
Appendicitis, confused diagnosis,183
Appetite,206
Apple, antiscorbutic value of,158
Armies, scurvy in,3,15
Army, use of canned tomatoes in ration of U. S.,231
B
Bacteria, fecal, in scurvy,28as etiological factor in scurvy,134in tissues,133
Bacterial theory of scurvy,30
Banana, antiscorbutic value of,158
Beading of ribs,197in guinea-pig,129,137pathology of,94
Beans, germinated,167,231
Beef juice,236
Beer, antiscorbutic value of,20,169
Beriberi, differential diagnosis,221relation to scurvy,249
Berries, antiscorbutic value of,156
Blindness,182
Blood cells, changes in,209–211
Blood cells, chemistry of,244,245coagulability of,211
Blood vessels, changes in,68,98,209in guinea-pigs,133
Blood, vitamine content of,76
Bones, gross pathology,93microscopic pathology,105
Brain, pathology,93
Breast fed, scurvy in,35
C
Cabbage, antiscorbutic value of,159dehydrated,165effect of heat on,159
Calcium, deposits of,98,102,103metabolism,241–247