That is what we have in mind when we say that the mother’s milk must be satisfactory not alone in quantity but in quality as well.
In order to make quite clear how damaging are the results of diets which are deficient or lacking in these protective substances, we shall take up, briefly, the deficiency diseases in turn.
Scurvy (scorbutus) is caused by a lack or deficiency of the substance called water-soluble C, the most unstable of all the protective substances, being easily impaired or destroyed by heating, drying or aging. This anti-scorbutic substance is present in fresh milk, potatoes, oranges, lemons, onions, and such fresh vegetables as lettuce, raw cabbage and celery and in apples, pears, peaches, bananas and cantaloupe. Tomatoes are rich in the anti-scorbutic substance and, moreover, this form is but slightly injured by heating or aging, for which reason canned tomatoes are frequently used both to prevent and to cure scurvy.
Scurvy is a disease which develops slowly. The patient loses weight, is anemic, pale, weak and short of breath. The gums become swollen, bleed easily and frequently ulcerate; the teeth loosen and often drop out. Necrotic areas in the bones may result. Hemorrhages into the mucous membranes and the skin are characteristic. Large black and blue spots develop in the skin, after trivial injury, or even spontaneously. The ankles become edematous and in severe cases a hard, board-like condition of the skin and subcutaneous tissues develops. There is sometimes severe headache and in the later stages there may be convulsions and delirium.
Although scurvy has been known to exist for centuries, well developed cases are not often seen among adults to-day, because experience has taught the importance of including some fresh food in the dietary, and present transportation facilities make this a fairly simple matter for most people. The disease was doubtless limited almost entirely to soldiers and pioneers until after the discovery of America. This event marked the beginning of long sailing voyages, with diets of dried and otherwise preserved foods, and scurvy began to take a heavy toll of life among the mariners. It became known as “the calamity of sailors” because of its frequency on shipboard. A notable instance in the history of the disease was the voyage of Jacques Cartier, in 1536, when he lost twenty-six of his party from scurvy, and only saved the remainder by the use of an infusion of pine needles. The efficacy of fresh fruits and vegetables in the prevention and cure of scurvy was discovered by common experience; when it became customary to administer lime- or lemon-juice to all sailors, scurvy practically disappeared from the service.
Although we seldom see actual cases of the disease among adults to-day, it is believed that there are large numbers of border-line cases among people who subsist largely on meats, canned and dried vegetables and canned fruits, the meat-bread-and-potato type of diet, for several months at a time, as during the winter season.
“Every individual requires a certain amount of anti-scorbutic substance in his dietary, or to put this statement in a broader way, every nation has need for a per capita quota of foodstuffs containing this necessary food factor, if scurvy is to be avoided.”[[11]]
Infantile scurvy is seen among babies who are fed solely on milk that has been heated, boiled, pasteurized or canned, since the anti-scorbutic substance in milk is practically destroyed by heating or aging. The disease is characterized by malnutrition, pain, typical changes in the structure of the bones and hemorrhage in various parts of the body, most frequently in the gums and beneath the periosteum. The disease develops slowly, the first symptoms appearing between the seventh and tenth months. Tenderness or pain in the legs is perhaps the most common symptom and may be detected first by the baby’s crying when its diaper is changed or its stockings are put on. And a baby that previously has been cheerful, playful and active will prefer to lie quietly and will cry whenever it is touched. He grows pale, listless and weak and fails to gain in weight or length. The large joints are likely to be swollen and tender; the swollen gums may bleed; the urine may be diminished in amount and contain blood and there also may be edema. But it is quite possible for a baby to be in serious need of an anti-scorbutic and still not present well defined symptoms of scurvy, or it may suffer from the latent or subacute type of the disease. In the latter case there may be stationary weight; fretfulness; a muddy complexion; rapid pulse and respirations; edema over the tibiæ with perhaps tenderness of the bones and tiny hemorrhagic areas over the body.
Scurvy may be both prevented and cured by giving orange juice, potato water, or tomato juice to a baby whose diet consists of milk that has been heated and is therefore lacking in water-soluble C. Many doctors believe that an anti-scorbutic should be started as early as the end of the first month, with babies fed on pasteurized milk, for the disease develops so slowly that severe damage may be done if the administration of this material is delayed until symptoms appear.
Scurvy, itself, does not often cause death among babies, but its occurrence is serious since it renders the infants very susceptible to infection, particularly nasal diphtheria and “grip.” Recovery from even severe attacks is amazingly rapid, sometimes being complete in a week or ten days as a sole result of giving orange juice.