The Vitamine Manual

by Walter Hollis Eddy

CHAPTER VIII

AVITAMINOSES OR THE DISEASES THAT RESULT FROM VITAMINE DEFICIENCIES

A survey of the vitamines would be incomplete without a discussion of the vitamine deficiency diseases in particular, though many of the facts already cited obviously bear on the treatment and prevention of such diseases.

The idea of "avitaminoses" or vitamine deficiency as the cause of a disease of a specific nature was set forth in detail by Funk in his book Die Vitamine. In his discussion of this view he suggests several types that would, he felt, on examination prove to be due to the absence of a vitamine in the diet. Of these predicted types beri-beri was the only one to be established in 1913. Scurvy has now been added to the fold and rickets or rachitis seems well on the way to acceptance though the specific vitamine absent in this case is not yet positively identified. Pellagra still resists the efforts of the vitamine hypothesis to bend it to that theory and its etiology is still obscure.

I. BERI-BERI

This disease while specifically confined to the oriental in the mind of the student can be justly considered of much wider distribution for the mild forms of malnutrition associated with a deficiency in the "B" vitamine are less acute manifestations of this disease. The disease is not likely to become marked in well nourished districts in its acute form, but in famine districts its incidence is always possible. It would be more than possible were it not for the fact that famine tends to eliminate the highly milled cereals and throw the people back on to the whole grain, peas and beans, which are rich in the preventive factor. But when for any reason diets become limited extra attention is demanded in regard to their selection and preparation. The main characteristics of this disease have already been fully covered in what precedes and need not be repeated here.

II. SCURVY

This disease, like beri-beri has already been fully discussed in what precedes. One of the striking discoveries of this subject has been the retreat from favor of the time-honored lime juice which is now found to be much less potent than oranges, lemons, or even canned tomato juice and which on preservation loses practically all its potency. In the modern hospital, cases of scurvy rarely appear outside of occasional infant cases and it might appear that the problem of scurvy prevention is peculiarly that of the sailor, the explorer and the army rationer. Nevertheless an insufficient supply of the "C" vitamine may retard growth and well being in the individual without manifesting itself in its more acute form of scurvy. In a recent review Hess states: "It is hardly an exaggeration to state that in the temperate zones the development or non-development of scurvy depends largely on the potato crop." "This is attributed in part to the fact that the potato is an excellent antiscorbutic, but to a greater extent because it is consumed during the winter in amounts that exceed the combined total of all other vegetables." To the public and to the food purveyor there is a definite problem in how to best supply the preventive and how best to concentrate and preserve the sources of this vitamine without injury to its potency. The following observation is therefore appended as bearing on this point. In the absence of fruits or other high potency sources it is possible to develop this factor in cereal grains by the simple expediency of sprouting. If seeds are soaked in water for twenty-four hours and then kept moist for from one to three days with the free access of air, sprouts will develop whose content of the antiscorbutic vitamine is comparable to that of many fresh vegetables, even though the dry seeds themselves have little of this factor. In other words the germination process is a synthesiser of the vitamine. This observation may be of value where fruits and vegetables are scarce or expensive. On account of cooking effects, it cannot be too often reiterated that raw fruits, vegetables and salads, are of more value than cooked forms of these same sources and that drying processes are extremely destructive where heat enters into the drying process. Vacuum drying seems to be much less destructive and it may be possible to develop the drying of vegetables to a point where retention of this vitamine factor is practical. At present all dried vegetables should be regarded with suspicion as a source of vitamine "C." Expressed juices may often be used where the whole vegetable is scarce or incompatible and this fact is one to be borne in mind by the worker in famine districts.

III. RACHITIS (RICKETS)

This disease is engaging the attention of many workers on both sides of the Atlantic at the present time. In England the principal contributor is Dr. Mellanby, who has accumulated evidence which he believes indicates that the preventive factor is the A vitamine. This view is not yet accepted as conclusive by the American workers. McCollum, Howland, Park, and others at Johns Hopkins University have experimented with various rickets-producing diets and while the principal deficiency in these diets seems to be Ca salts and the A vitamine they do not consider that the disease can as yet be traced to deficiency in any one factor. Hess has called attention to several new features and the significance of some older measures. He has shown on the one hand that cod-liver oil is almost a specific remedy for the disease but that this remedy is not replaceable by other rich sources of the A vitamine. He has also recently shown that hygienic measures may have an influence. Schmorl showed that the disease was seasonal, a high rate maintaining in the winter months and a lower rate in the summer months. Hess has recently reported beneficial results from use of the ultra-violet rays which he uses as a substitute for sunlight. The results seem to confirm Schmorl's view that the sunlight of the summer months is a preventive factor. He has also suggested that the specific effect of the cod-liver oil might be due to a new vitamine, Vitamine D? On the other hand Zilva and Miura in England have recently shown that crude cod-liver oil is something like two hundred and fifty times as rich in vitamine A as butter fat, which tends to support the British view that the A vitamine is the antirachitic factor.

Sherman and Pappenheimer have recently shown that the phosphates exert a marked preventive effect on rickets and suggest that the utilization of the calcium by the individual may be determined in part by this factor.

The views in brief are now in an extremely chaotic state and it is impossible at present to determine whether rickets is a true avitaminose or a consequence of deficiency in a series of factors. It is however certain that the disease in its subacute forms is extremely wide-spread among infants and that its prevention can be most easily secured by the addition of cod-liver oil to the diet. In this procedure warning is necessary that the cod-liver oil be as pure a product of oil as possible, since the market preparations are often almost devoid of the true oil and hence of the curative agent.

IV. PELLAGRA

This disease has been the subject of exhaustive inquiry and study on this side of the Atlantic and the findings of the various investigating boards have added much to the prevention and cure of the scourge, but have failed as yet to agree on any one etiological factor. The best recent review of the current findings is to be found in an article by Voegtlin published as Reprint 597 of the Public Health Reports of the United States Public Health Service. His conclusions may be quoted in full as representing the latest summary of evidence now extant:

1. The hypothesis that there is a causal relation between pellagra and a restricted vegetable diet has been substantiated by direct proof to this effect and has led to results of considerable practical and scientific value.

2. The metabolism in pellagra shows certain definite changes from the normal, which point to decreased gastric secretion and increased intestinal putrefaction.

3. In the treatment and prevention of pellagra, diet is the essential factor. The disease can be prevented by an appropriate change in diet without changing other sanitary conditions.

4. A diet of the composition used by pellagrins prior to their attack by the disease leads to malnutrition and certain pathological changes in animals, resembling those found in pellagra. A typical pellagrous dermatitis has not been observed in animals. Pellagrous symptoms have been produced in man by the continued consumption of a restricted vegetable diet.

5. The nature of the dietary effect has not been discovered, although certain observations point to a combined deficiency in some of the recognized dietary factors as the cause of the pellagrous syndrome.

In elaborating on conclusion 5 Voegtlin states that:

The conception that pellagra is due to a dietary deficiency is, therefore, not contradicted by the available evidence. This does not imply that the disease is necessarily due to a deficiency of diet in a specific substance such as the hypothetical pellagra vitamine of Funk (1913). It is much more likely that the pellagrous syndrome is caused by a combination of the deficiencies in some of the well recognized food factors.

V. OTHER AVITAMINOSES

The rôle of the vitamine in the nutrition and growth of organisms other than the man is becoming a matter of interest in various ways. The construction of culture media for various strains of bacteria and the conditions favorable or unfavorable to their growth, are features of study in which the new hypothesis has demanded attention. It has already been claimed that vitamines are essential to the growth of the meningococcus, the influenza bacillus, the typhoid bacillus, the gonococcus, the pneumococcus Type I, Streptococcus hemolyticus, the diptheria bacillus, the Bacillus pertussis and certain soil organisms. If these views are confirmed it becomes evident that the means for prevention of the development of these forms may lie in the control of the vitamine content of the materials on which these forms thrive and that in the study of these types it may be possible to speed up the incubation of strains and thus hasten diagnostic measures by introducing the necessary vitamines into the culture media. These observations merely suggest the possible widening of the scope of the vitamine study in the service of man and give added reason for our keeping pace with the strides made in this particular field.