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diff --git a/40505-h/40505-h.htm b/40505-h/40505-h.htm index b27f653..70e94ee 100644 --- a/40505-h/40505-h.htm +++ b/40505-h/40505-h.htm @@ -2,7 +2,7 @@ "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd"> <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <head> - <meta http-equiv="Content-Type" content="text/html;charset=iso-8859-1" /> + <meta http-equiv="Content-Type" content="text/html;charset=UTF-8" /> <meta http-equiv="Content-Style-Type" content="text/css" /> <title> The Project Gutenberg eBook of Scurvy Past and Present, by Alfred F. Hess, M.D. @@ -183,45 +183,7 @@ ins {text-decoration:none; border-bottom: 1px dashed red;} </style> </head> <body> - - -<pre> - -The Project Gutenberg EBook of Scurvy Past and Present, by Alfred Fabian Hess - -This eBook is for the use of anyone anywhere at no cost and with -almost no restrictions whatsoever. You may copy it, give it away or -re-use it under the terms of the Project Gutenberg License included -with this eBook or online at www.gutenberg.org - - -Title: Scurvy Past and Present - -Author: Alfred Fabian Hess - -Release Date: August 14, 2012 [EBook #40505] - -Language: English - -Character set encoding: ISO-8859-1 - -*** START OF THIS PROJECT GUTENBERG EBOOK SCURVY PAST AND PRESENT *** - - - - -Produced by Bryan Ness, Thiers Halliwell and the Online -Distributed Proofreading Team at http://www.pgdp.net (This -file was produced from images generously made available -by The Internet Archive/American Libraries.) - - - - - - -</pre> - +<div>*** START OF THE PROJECT GUTENBERG EBOOK 40505 ***</div> <p class="transnote">Transcriber’s notes:<br /> <br /> @@ -236,7 +198,7 @@ The book contains numerous spelling inconsistencies. No change has been made to those representing archaic spellings (e.g. <i>somethimes</i>, <i>urin</i>, <i>feavers</i>, <i>joynts</i>) and those occurring in quotations. Spelling variants occurring with similar frequency have been left in their -original form (e.g. Röntgen/Roentgen, rachitic/rhachitic, +original form (e.g. Röntgen/Roentgen, rachitic/rhachitic, albumen/albumin – the correct spellings is used for egg albumen but both are used randomly for serum/urine albumin). Most other spelling inconsistencies have been changed to the more-frequent or more-accurate @@ -244,12 +206,12 @@ form (e.g. twofold→two-fold, guinea pig→guinea-pig, oedema→edema, neuroedema→neuredema, gm.→g., Luborsch→Lubarsch, Bauman→Baumann, McCluggage→McClugage, Eijkmann→Eijkman). Although the -spelling of 'fæces' and its adjective 'fecal' is not consistent, the two +spelling of 'fæces' and its adjective 'fecal' is not consistent, the two spellings are used consistently throughout the book and therefore have not been altered. Similarly 'hemorrhage' and 'hemoglobin' are consistently spelt thus, while other words pertaining to blood -consistently use the æ ligature, e.g. 'hæmatemesis', 'hæmatoma', -'hæmaturia', 'leukæmia', 'hyperæmia'.<br /> +consistently use the æ ligature, e.g. 'hæmatemesis', 'hæmatoma', +'hæmaturia', 'leukæmia', 'hyperæmia'.<br /> <br /> Wrong or missing French accents and typos have been corrected where necessary. German expressions in the bibliography contain various @@ -258,9 +220,9 @@ unfamiliarity with the language and what was perhaps legitimate at the time of writing (e.g. Moeller-Barlow'sche Krankheit, Moeller-Barlow'scher Krankheit, Moeller-Barlowscher Krankheit and Barlow'schen Krankheit; Muench. med. Woch., Muenchn. med. Woch. and -Muenschner med. Woch.; Beiträge z., Beitraege zur, Beitrag zur). The +Muenschner med. Woch.; Beiträge z., Beitraege zur, Beitrag zur). The term <i>Gernest-mark</i> on p. 108 should probably be <i>geruestmark</i> (or -perhaps gerüstmark) as used elsewhere in the book (pp. 96, 107, 108 and +perhaps gerüstmark) as used elsewhere in the book (pp. 96, 107, 108 and 128).<br /> <br /> The book also contains numerous hyphenation inconsistencies. Some of @@ -356,8 +318,8 @@ participate in a consideration of many of the nutritional and infectious diseases of the adult and the child.</p> <p>The World War has tended also to demand a renewed -consideration of scurvy. This disorder has played a rôle -in all wars—in the campaigns of the Cæsars, the pilgrim +consideration of scurvy. This disorder has played a rôle +in all wars—in the campaigns of the Cæsars, the pilgrim ages of the Crusaders, and the numerous wars of the last century. In the recent war it existed among the various<span class="pagenum" title="iv"><a name="Page_iv" id="Page_iv"></a></span> armies, particularly those in the East, to an extent greater @@ -613,7 +575,7 @@ to crystallize the conception of scurvy, which had been stretched out of all proportions to include an ever-increasing<span class="pagenum" title="4"><a name="Page_4" id="Page_4"></a></span> conglomeration of clinical conditions. Scurvy had become the Alpha and Omega of professional routine, -the catchword of the day, the asylum ignorantiæ of the +the catchword of the day, the asylum ignorantiæ of the practical man. Into this chaos, as Hirsch expresses it, “the first beams of light fell when Lind’s classical work appeared.”</p> @@ -623,7 +585,7 @@ of epidemics of scurvy which occurred from this time to the present day. They may be found in tabular form in the excellent survey of scurvy by Hirsch. The literature of this long period may likewise be found in a work of -encyclopædic character, that of Krebel, which gives the +encyclopædic character, that of Krebel, which gives the titles, with a summary of the various articles on this subject, appearing to the year 1859. If we look over the chronological table compiled by Hirsch, we note a remarkable @@ -675,7 +637,7 @@ from practice in civil life.”</p> Franco-Prussian War in the winter of 1870–71 suffered severely from scurvy. The accounts of their pitiable condition have been portrayed for us by numerous French -writers (Delpech, Hayem, Lasèque and Legroux). The +writers (Delpech, Hayem, Lasèque and Legroux). The people lived mainly on rice and bread, with an occasional addition of potatoes or horse meat. The winter was exceptionally severe, which was supposed to have intensified @@ -771,7 +733,7 @@ this disease more than four out of five of the original number of its crews. In striking contrast to this picture, and to that furnished by the voyages of earlier navigators, is that of Captain Cook, who in 1772 undertook a voyage<span class="pagenum" title="9"><a name="Page_9" id="Page_9"></a></span> -lasting over three years, sailing from 52° north to 71° +lasting over three years, sailing from 52° north to 71° south, with a loss of but one of his crew from disease, and that not from scurvy. This remarkable feat, more than any other, centered attention on the feasibility of @@ -805,7 +767,7 @@ warfare. Sir R. Hawkins stated in the latter part of the sixteenth century that he could give an account of 10,000 mariners who had been<span class="pagenum" title="10"><a name="Page_10" id="Page_10"></a></span> destroyed by scurvy during the twenty years that he had been at sea.</p> -<p>As is well known, scurvy has played an important rôle in Arctic and +<p>As is well known, scurvy has played an important rôle in Arctic and Antarctic explorations, and has been the cause of the failure of many of these expeditions. It is now realized that the development of scurvy is quite preventable, that if a sufficient quantity of meat (especially raw @@ -816,7 +778,7 @@ causes of the outbreak of scurvy in the recent Arctic expedition” (1877), and who reported that it may result from an absence of fresh meat. That this conclusion was sound has been proved by the experiences of Nansen and of Johansen, who wintered safely in Franz-Josefsland on a -diet of meat and bacon. More recently Stefánsson has carried out +diet of meat and bacon. More recently Stefánsson has carried out successful Arctic explorations, depending entirely on fresh meat as antiscorbutic foodstuff and making no provision whatsoever for vegetable food.</p> @@ -920,7 +882,7 @@ rickets. Netter was one of the first in France to recognize the true nature of the disorder, and published several papers in 1898 describing typical cases. Infantile scurvy was, however, almost unknown in that country until what -is termed “lait maternisé” and “lait fixé” came into +is termed “lait maternisé” and “lait fixé” came into vogue. This is apparent from a table prepared by Lecornu, which gives a list of all cases in the French literature between 1894 and 1904, and of the diets on @@ -1035,7 +997,7 @@ cooked. This would point rather to a deficiency of the fat-soluble vitamine, as these substances could have little effect in curing scurvy. The cases reported by Wassermann,<span class="pagenum" title="17"><a name="Page_17" id="Page_17"></a></span> where neuritic pains in the legs played a considerable -rôle, evidently are also not simple scurvy, but +rôle, evidently are also not simple scurvy, but may well be the result of more than one food deficiency or a complicating ostitis. In the same way some reports show clearly that “hunger edema” complicated scurvy.</p> @@ -1056,7 +1018,7 @@ Roumania he was surprised to find scurvy the most prevalent disease in the army, and that since the spring of 1917 it was widely disseminated among the German troops. Lobmeyer writes of scurvy among the Turkish troops, -and Disqué reports 500 cases among prisoners captured +and Disqué reports 500 cases among prisoners captured in Turkestan.</p> <p>Along the Western front very few cases are described. @@ -1073,7 +1035,7 @@ vegetables in the ration.</p> <p><span class="pagenum" title="18"><a name="Page_18" id="Page_18"></a></span></p> <p>From all these accounts it is evident that scurvy played -an important rôle in the general nutrition of the troops +an important rôle in the general nutrition of the troops on the Eastern front. Probably it was of the latent variety, which is exceedingly difficult to diagnose, but which increases the susceptibility to infection, and intensifies @@ -1344,7 +1306,7 @@ There is sound basis for believing that the hypothetical poison is not introduced preformed in the food. In the first place, infantile scurvy frequently develops in babies who receive milk of the very best grade indeed, in contradistinction -to rickets, this is not preëminently a disease +to rickets, this is not preëminently a disease of the poor. Furthermore, there is no relation between the concentration of the food mixture and its liability to induce scurvy. For example, if among a large number @@ -1385,7 +1347,7 @@ of harmful bacteria in the intestine, which are normally restrained by the acid reaction of the chyme. McCollum and Pitz, on the basis of a study of experimental scurvy, suggested that as the result of a break in the metabolism -it might be due to the retention of fæces and consequent +it might be due to the retention of fæces and consequent absorption of toxins. Still more recently Gerstenberger suggested that as the result of the break in the metabolism of carbohydrates, a defunctioning substance, possibly @@ -1399,7 +1361,7 @@ This is true solely of <i>the relation of constipation to scurvy</i>, and we shall confine ourselves therefore to a consideration of this aspect of the question.</p> -<p>There can be no question whether retention of fæces of +<p>There can be no question whether retention of fæces of itself can bring about scurvy; this is excluded by the marked instances of constipation frequently encountered among thriving babies. The majority of bottle-fed babies @@ -1426,8 +1388,8 @@ potent antiscorbutics is potato, which has no definite laxative property. It may be added, as noted elsewhere, that scurvy developed in infants in spite of their receiving cod liver oil or olive oil for long periods. It is evident, therefore, -that the retention of fæces is not the essential factor -in the etiology of scurvy. Its secondary rôle, especially +that the retention of fæces is not the essential factor +in the etiology of scurvy. Its secondary rôle, especially after scurvy has developed, will be considered later in this chapter.</p> <p><span class="pagenum" title="29"><a name="Page_29" id="Page_29"></a></span></p> @@ -1487,7 +1449,7 @@ in Russia to-day, and recently has been advanced by European army surgeons. This question illustrates in an interesting manner how the trend of the day influences medical thought—it has been suggested lately by -Much and Baumbach that the scurvy microörganism may +Much and Baumbach that the scurvy microörganism may be carried by means of lice. But clinical experience points absolutely against the infectious nature of scurvy. Indeed, the only episode which lends any support to this @@ -1521,7 +1483,7 @@ Moody, and of Moore, who conclude tentatively that scurvy may be a bacterial infection. Jackson and Moody cultivated a diplococcus from the tissues of scorbutic animals after death, reproduced hemorrhages by inoculating -cultures of these microörganisms into the circulation, +cultures of these microörganisms into the circulation, and recovered the bacteria from the tissues some weeks later. Their results are open to the criticism that bacteria were found only after death, and that all blood @@ -1581,7 +1543,7 @@ seemed unaltered; that high degrees of heat had generally the same effect; that under certain conditions these foods withstood prolonged heating, demonstrating that the antiscorbutic factor was not a ferment; that acids and alkalies -played no essential rôle in the etiology; that fats, proteins +played no essential rôle in the etiology; that fats, proteins and carbohydrates were not significant factors; that as little as 1.0 g. of cabbage suffices to afford protection to a guinea-pig. In other words, by a process of exclusion @@ -1620,7 +1582,7 @@ etiologic factors, but they are of a secondary character. Bacterial invasion has been referred to in this connection, and it is possible that toxins are absorbed from the intestine after nutrition has been disturbed. Diarrhœa and -digestive disturbances may play a rôle. Whether the +digestive disturbances may play a rôle. Whether the total intake of food or the correlation of its constituents—protein, carbohydrate, fat and salts—affects the action of the vitamine, is one which has not been well studied @@ -1804,7 +1766,7 @@ if a baby receives but eight ounces daily of raw milk—one-half the requisite amount—it may well develop scurvy, notwithstanding the fact that the milk has not been heated. In addition to the quantity, there are other factors which -play a greater or less rôle in the relation of raw milk to the +play a greater or less rôle in the relation of raw milk to the etiology of scurvy. It is no doubt of consequence whether the fodder of the cows was rich or very poor in the antiscorbutic factor, and, accordingly, whether the baby received @@ -1814,7 +1776,7 @@ milk must be borne in mind, for we have found that even raw milk loses some of its potency on becoming stale.<a name="FNanchor_10_10" id="FNanchor_10_10"></a><a href="#Footnote_10_10" class="fnanchor">10</a></p> <p>One of the mooted questions relative to the etiology of -scurvy is the rôle of heated milk, and more particularly +scurvy is the rôle of heated milk, and more particularly of <i>pasteurized milk</i>. In view of the vogue which pasteurization has acquired in the large municipalities, especially in the United States, this aspect has assumed @@ -1828,28 +1790,28 @@ deprecate its virtues in any regard.</p> of pasteurization milk loses an important measure of antiscorbutic vitamine. The term pasteurization, when employed in this connection, is not meant to be synonymous -merely with the heating of milk to 140° to 165° F., but +merely with the heating of milk to 140° to 165° F., but embraces the entire commercial process—the heating, handling, subsequent cooling, aging and all other factors involved. There can be no doubt that milk which has undergone this elaborate treatment has suffered in its antiscorbutic property. In 1914 Hess and Fish reported mild cases of scurvy occurring among infants who had received -milk heated to a temperature of 165° F. for thirty minutes. +milk heated to a temperature of 165° F. for thirty minutes. This degree of heat is claimed by many physicians and hygienists, including the National Commission on Milk Standards, not to destroy its chemical constituents. Nevertheless typical cases of scurvy supervened after this diet had been followed for a period of six to nine months. Subsequent experience, published by Hess in 1917, with -milk heated to only 145° F., served to confirm the previous +milk heated to only 145° F., served to confirm the previous observations. That these cases were true scurvy was proved by the fact that a cure resulted when raw milk was substituted. A similar experience in Berlin reported by Neumann and others was convincing, but was not heeded in this country. In 1901 one of the largest dairies in that city established a pasteurizing plant where all -milk was raised to a temperature of about 60° C. After +milk was raised to a temperature of about 60° C. After an interval of some months infantile scurvy began to be reported from various sources throughout the city. Neumann depicts the situation as follows: “Whereas, Heubner, @@ -1898,26 +1860,26 @@ refer to the experience of Switzerland and of France. In 1907 Bernheim-Karrer reported nine cases of scurvy which occurred on “homogenized” milk. This milk is forced between rapidly-rotating surfaces at a temperature -of 55° to 65° C. at a pressure of 150 atmospheres. This +of 55° to 65° C. at a pressure of 150 atmospheres. This process had been introduced the year previous by a large dairy which was well known for its excellent grade of milk. Before this innovation, milk usually had been boiled for a long while before being fed to infants. In France a similar epidemic of scurvy followed the introduction of -the use of homogenized milk (lait fixé). Lecornu gives an +the use of homogenized milk (lait fixé). Lecornu gives an interesting account of this episode, remarking on the large number of cases of scurvy occurring on this milk compared with sterilized milk, which was employed so much more extensively. These experiences furnish excellent examples of <i>the harmful effect of industrial methods on milk</i>, especially on its antiscorbutic vitamine. Lecornu also -emphasized the scorbutic influence of “lait maternisé,” +emphasized the scorbutic influence of “lait maternisé,” which is similar to the German Gaertner milk, and is subjected to dilution, centrifugation, and sterilization.<a name="FNanchor_11_11" id="FNanchor_11_11"></a><a href="#Footnote_11_11" class="fnanchor">11</a> He states that before this preparation was introduced scurvy was practically unknown in France. Lecornu attributes -the deleterious effect of the “lait maternisé” and the -“lait fixé” to bacterial contamination, as does Bernheim-Karrer.<span class="pagenum" title="44"><a name="Page_44" id="Page_44"></a></span> +the deleterious effect of the “lait maternisé” and the +“lait fixé” to bacterial contamination, as does Bernheim-Karrer.<span class="pagenum" title="44"><a name="Page_44" id="Page_44"></a></span> We believe, rather, that its loss of potency is due to the mechanical processes to which it has been subjected.</p> @@ -1986,7 +1948,7 @@ milk following pasteurization, has not been definitely shown.</p> <p>Up to the present time <i>dried milk</i> has played an -insignificant rôle in the etiology of infantile scurvy. One +insignificant rôle in the etiology of infantile scurvy. One of the factors which has hindered the general acceptance of dried milk by physicians and laymen has been the fear that its use might lead to the development of Barlow’s @@ -2002,7 +1964,7 @@ not lead to scurvy, but may contain sufficient antiscorbutic vitamine to cure this disorder</i>. Recently a scorbutic baby was fed with milk which had been dried by the so-called Just-Hatmaker process—whereby it is subjected -on a drum for a few seconds to about 230° F.—with the +on a drum for a few seconds to about 230° F.—with the result that the hemorrhages of the gums began to be absorbed in about three days, and all symptoms to disappear shortly thereafter. This infant received dried @@ -2229,7 +2191,7 @@ would fall earlier than the current figures indicate. The earliest instance of this disorder which we have seen occurred in a baby four and a half months of age.</p> -<p>Age does not seem to play a definite rôle in regard +<p>Age does not seem to play a definite rôle in regard to the incidence among adults. Scurvy frequently has been encountered among old men, and is of common occurrence among the most vigorous of the nation, the young @@ -2283,7 +2245,7 @@ referred to elsewhere, the disease is endemic during the dry, hot season. Formerly it broke out on the men-of-war and vessels of the mercantile marine while they were in southern waters. As regards infantile scurvy, it has -always seemed to us that season played a slight rôle; that +always seemed to us that season played a slight rôle; that cases which occurred in the summer tended to be less severe and to be characterized by periods of intermission rarely observed in the winter time.</p> @@ -2328,7 +2290,7 @@ Slavs, especially the White Russians, were more susceptible.<a name="FNanchor_18 Of course a lack of susceptibility of this nature can be merely relative. Such a racial distinction may seem far-fetched, but if we admit that disposition and -habits of life can play a rôle, it is quite possible for races +habits of life can play a rôle, it is quite possible for races to vary in their predisposition to this disorder. Moreover, we shall see that individuals differ markedly in this respect. Lind and others repeatedly emphasize the fact that<span class="pagenum" title="57"><a name="Page_57" id="Page_57"></a></span> @@ -2383,7 +2345,7 @@ serves to emphasize the inherent difficulties of the subject. v. Starck’s report of an instance where twins were fed on similar milk mixtures and one developed scurvy, whereas the other thrived satisfactorily, is a striking -illustration of the rôle of idiosyncrasy. This case, as +illustration of the rôle of idiosyncrasy. This case, as well as many others, fails to be absolutely convincing in view of the fact that the daily intake of milk is not recorded.</p> @@ -2603,16 +2565,16 @@ best be obtained by considering the subject in connection with some definite foodstuffs. The most exhaustive study from a quantitative standpoint is that of Delf. She showed that when cabbage is subjected for an hour -to a temperature of 80° to 100° C., 90 per cent. of its +to a temperature of 80° to 100° C., 90 per cent. of its antiscorbutic vitamine is lost, and that 80 per cent. is -lost when a temperature of 90° to 100° is maintained for -twenty minutes, or a temperature of 60° for a period of +lost when a temperature of 90° to 100° is maintained for +twenty minutes, or a temperature of 60° for a period of sixty minutes. This experiment shows that the destructive influence of heat is enhanced to a comparatively slight degree by a rise of temperature, only about threefold -when it is raised from 60° C. to the boiling point. +when it is raised from 60° C. to the boiling point. This result points to a temperature coefficient of about -1.5 to 10° C. of temperature. It is suggested by Delf +1.5 to 10° C. of temperature. It is suggested by Delf that this low coefficient of destruction is opposed to the enzyme or protein-like theory of the nature of the vitamine, and suggests a simpler constitution. On the other<span class="pagenum" title="66"><a name="Page_66" id="Page_66"></a></span> @@ -2627,7 +2589,7 @@ intensity of heat is not as destructive as prolonged heating. This agrees with the clinical experience that milk which has been boiled for a few minutes does not induce scurvy as readily as pasteurized milk which has been heated for -45 minutes to 140° or 165° F. (Hess and Fish).</p> +45 minutes to 140° or 165° F. (Hess and Fish).</p> <p>As demonstrated by tests with orange and with lemon juice, the antiscorbutic vitamine is greatly protected from @@ -2794,9 +2756,9 @@ between the amount of vitamine required by fowls and their carbohydrate intake. Funk in 1913 made a similar observation in regard to beriberi, and in the following year, with von Schoenborn, showed that a vitamine-free -diet led to hyperglycæmia, with diminished amount of +diet led to hyperglycæmia, with diminished amount of hepatic glycogen, and that the addition of water-soluble -vitamine diminished the hyperglycæmia and increased the +vitamine diminished the hyperglycæmia and increased the liver glycogen. The work of Burge and his co-workers on the catalase content of tissue led to a similar conclusion. Their results may be summarized by the statement that @@ -2823,7 +2785,7 @@ angle. As is well known, certain bacteria require serum, blood, milk, etc., in order to grow satisfactorily on artificial culture media. It has been established recently, primarily by the work of Lloyd, that<span class="pagenum" title="72"><a name="Page_72" id="Page_72"></a></span> -this peculiarity in the cultivation of microörganisms is +this peculiarity in the cultivation of microörganisms is due largely to their requirement of vitamine. She found a relationship of the inverse order between the amount of amino acid present in the culture medium and the amount @@ -2940,7 +2902,7 @@ is the case is demonstrated for the antiscorbutic vitamine by the fact that muscle tissue contains sufficient antiscorbutic to protect individuals subsisting largely on a diet of which raw meat constitutes the sole antiscorbutic -agent (Stefánsson). It is very probable that some organs +agent (Stefánsson). It is very probable that some organs contain more of the vitamines than others; this has been proved for the “antineuritic” factor, and seems to hold good for the antiscorbutic—the liver being particularly @@ -3156,8 +3118,8 @@ in the protocols.</p> <tr><td style="padding-top: .5em; padding-bottom: .5em" align="center" colspan="5"><span class="smcap">Adults</span></td></tr> <tr><td class="blc">Many</td><td class="bm plr03m">Lind</td><td class="bm tac">1772</td><td class="bm plr03m">Brief summaries</td><td class="br"></td></tr> <tr><td class="blc">51</td><td class="bm plr03m">von Himmelstein</td><td class="bm tac">1843</td><td class="bm plr03m">Brief summaries</td><td class="br"></td></tr> -<tr><td class="blc"> 8</td><td class="bm plr03m">Hayem</td><td class="bm tac">1871</td><td class="bm plr03m">Résumé</td><td class="br plr03m">Brief résumé.</td></tr> -<tr><td class="blc"> 7</td><td class="bm plr03m">Lasèque & Legroux</td><td class="bm tac">1871</td><td class="bm plr03m">Fairly detailed</td><td class="br"></td></tr> +<tr><td class="blc"> 8</td><td class="bm plr03m">Hayem</td><td class="bm tac">1871</td><td class="bm plr03m">Résumé</td><td class="br plr03m">Brief résumé.</td></tr> +<tr><td class="blc"> 7</td><td class="bm plr03m">Lasèque & Legroux</td><td class="bm tac">1871</td><td class="bm plr03m">Fairly detailed</td><td class="br"></td></tr> <tr><td class="blc"> 7</td><td class="bm plr03m">Charpentier</td><td class="bm tac">1871</td><td class="bm plr03m">Brief summaries</td><td class="br"></td></tr> <tr><td class="blc">13</td><td class="bm plr03m">Sato & Nambu</td><td class="bm tac">1908</td><td class="bm plr03m">Fairly detailed</td><td class="br plr03m">Fairly detailed.</td></tr> <tr><td class="blc"> 2</td><td class="bm plr03m">Urizio</td><td class="bm tac">1917</td><td class="bm plr03m">Brief summaries</td><td class="br plr03m">Brief summaries.</td></tr> @@ -3182,11 +3144,11 @@ in the protocols.</p> <tr><td class="blc"> 1</td><td class="bm plr03m">Looser</td><td class="bm tac">1905</td><td class="bm plr03m">Summary</td><td class="br"></td></tr> <tr><td class="blc"> 1</td><td class="bm plr03m">Hoffmann</td><td class="bm tac">1905</td><td class="bm plr03m">Summary</td><td class="br plr03m">Bones only.</td></tr> <tr><td class="blc"> 1</td><td class="bm plr03m">Stoeltzner</td><td class="bm tac">1906</td><td class="bm plr03m">Bone only</td><td class="br plr03m">Bone only.</td></tr> -<tr><td class="blc">22</td><td class="bm plr03m">Fraenkel</td><td class="bm tac">1908</td><td class="bm plr03m">Résumé</td><td class="br plr03m">Bones only.</td></tr> -<tr><td class="blc"> 1</td><td class="bm plr03m">Nobécourt et al</td><td class="bm tac">1913</td><td class="bm plr03m">Brief report</td><td class="br plr03m">Bone only.</td></tr> +<tr><td class="blc">22</td><td class="bm plr03m">Fraenkel</td><td class="bm tac">1908</td><td class="bm plr03m">Résumé</td><td class="br plr03m">Bones only.</td></tr> +<tr><td class="blc"> 1</td><td class="bm plr03m">Nobécourt et al</td><td class="bm tac">1913</td><td class="bm plr03m">Brief report</td><td class="br plr03m">Bone only.</td></tr> <tr><td class="blc"> 3</td><td class="bm plr03m">Ingier</td><td class="bm tac">1913</td><td class="bm plr03m">Brief report</td><td class="br plr03m">Bones, very complete.</td></tr> <tr><td class="blc"> 1</td><td class="bm plr03m">Bahrdt & Edelstein</td><td class="bm tac">1913</td><td class="bm plr03m">Complete</td><td class="br plr03m">Bones, brief report.</td></tr> -<tr><td class="blc">31</td><td class="bm plr03m">Erdheim</td><td class="bm tac">1918</td><td class="bm plr03m">Brief summaries</td><td class="br plr03m">Brief résumé.</td></tr> +<tr><td class="blc">31</td><td class="bm plr03m">Erdheim</td><td class="bm tac">1918</td><td class="bm plr03m">Brief summaries</td><td class="br plr03m">Brief résumé.</td></tr> <tr><td class="bblc"> 1</td><td class="bb plr03m">Epstein</td><td class="bb tac">1918</td><td class="bb plr03m">Very detailed</td><td class="bbr"></td></tr> </table> @@ -3210,7 +3172,7 @@ and will no doubt soon be followed by others of similar character.</p> <p><b>Gross Pathology.—General Appearance.</b>—The skin usually -is pale, livid, and dotted with numerous petechiæ. These +is pale, livid, and dotted with numerous petechiæ. These vary in size from the tiniest pin-points, barely recognizable to the naked eye, to ecchymoses of moderately large size. The most frequent site is the lower extremities. @@ -3246,16 +3208,16 @@ lesions of this condition.</p> that it is not surprising to find it was regarded by the older writers as the pathognomonic sign of scurvy. The bleeding may take place into almost any organ, and -vary from small petechiæ to very extensive extravasations. +vary from small petechiæ to very extensive extravasations. The hair follicles and sweat glands are particularly susceptible, -as Lasèque and Legroux noticed in cases occurring +as Lasèque and Legroux noticed in cases occurring in the French prisons. Aschoff and Koch, during the recent war, noted the same peculiarity of involvement, calling attention also to the fact that previous skin diseases such as keratosis or seborrhea seemed to predispose to this localization.</p> -<p>Trauma plays a very important rôle in determining<span class="pagenum" title="85"><a name="Page_85" id="Page_85"></a></span> +<p>Trauma plays a very important rôle in determining<span class="pagenum" title="85"><a name="Page_85" id="Page_85"></a></span> the location of the deeper as well as of the superficial hemorrhages. In adults, especially in soldiers, in whom the greater number of cases have been recorded, the lower @@ -3295,7 +3257,7 @@ hemorrhage. The central nervous system is often spared, notwithstanding extensive bleeding elsewhere, the meninges being somewhat more frequently involved. Hemorrhage of the lungs is also less common than might -be expected, and it is probably true as Lasèque and Legroux +be expected, and it is probably true as Lasèque and Legroux suggested, that previous pulmonary disease, particularly tuberculosis, is an important predisposing factor.</p> @@ -3320,7 +3282,7 @@ frequently it is produced by venous thrombosis.</p> <p>Any or all of the serous cavities may be involved in this hydrops, the order of frequency being pericardium, -pleuræ, peritoneum, and joint surfaces, especially the +pleuræ, peritoneum, and joint surfaces, especially the knee. The fluid is clear and straw-colored, or, in the event of secondary infection, becomes cloudy and fibrino-purulent. Later the exudate may become organized so that the @@ -3373,7 +3335,7 @@ Aschoff and Koch, that in two cases of uncomplicated scurvy there were fatty degeneration and dilatation of the heart. Fatty degeneration of the muscle is frequent, brown atrophy exceptional. Sato and Nambu also found -hyperæmia and atrophy with increase of connective tissue +hyperæmia and atrophy with increase of connective tissue between the muscle fibres.</p> <p>The pericardial cavity contains almost invariably an @@ -3397,7 +3359,7 @@ frequent complications and causes of death. Active tuberculosis is a not uncommon secondary manifestation.</p> <p><span class="pagenum" title="89"><a name="Page_89" id="Page_89"></a></span></p> <p>Subserous hemorrhages are almost the rule; if infection -supervenes, the pleuræ become thickened and covered +supervenes, the pleuræ become thickened and covered with an exudate of pus and fibrin.</p> <p><b>Alimentary Tract.</b>—The lesions of the gums so well @@ -3414,9 +3376,9 @@ teeth. In advanced cases the gums are enormously swollen, fungous, ulcerated and covered with a foul, greenish, necrotic mass, which may extend widely over the buccal mucous membrane. The teeth become loosened and fall -out. Secondary infection undoubtedly plays the chief rôle +out. Secondary infection undoubtedly plays the chief rôle in producing this condition, for the most severe forms are -found only where caries and pyorrhœa preëxisted. This +found only where caries and pyorrhœa preëxisted. This seat of infection may serve as the source of dissemination throughout the body, giving rise to many of the lesions found at postmortem, especially in the lower part of @@ -3458,7 +3420,7 @@ of scurvy in some epidemics, may add to this ulceration and lead to even complete sloughing of the inner lining of the intestine. Hemorrhages are found in the mucous, serous or muscular layers. Here, as elsewhere, the -hemorrhages vary in size from petechiæ to large infiltrations +hemorrhages vary in size from petechiæ to large infiltrations of blood. A very striking picture is sometimes presented<span class="pagenum" title="91"><a name="Page_91" id="Page_91"></a></span> by the pale, edematous intestinal wall dotted or streaked with vivid red.</p> @@ -3504,7 +3466,7 @@ conditions and not a part of the true scurvy.</p> <p>Small hemorrhages may be found in the uterus, bladder or urethra. They are especially common in the bladder, both in man and in the guinea-pig, and in some -instances may be the cause of the hæmaturia noted during +instances may be the cause of the hæmaturia noted during life.</p> <p><b>Lymph-nodes.</b>—General enlargement of the lymph-nodes @@ -3634,7 +3596,7 @@ cases diagnosed as congenital dislocation of the hip.</p> <p>On sectioning the bones longitudinally the cortex is noted to be exceedingly thin, a mere shell and very brittle. -The trabeculæ are so thin and reduced in number that the +The trabeculæ are so thin and reduced in number that the bone has become a very fragile structure. The marrow is no longer deep red at the ends of the long bones, but yellowish, frequently presenting a patchy appearance. @@ -3694,7 +3656,7 @@ is very marked. Changes in the muscle fibres themselves have not been encountered by all observers. Hayem describes widespread fatty degeneration and a deposit of pigment within the fibres, Leven a loss of sarcolemma, -while Lasèque and Legroux found fatty changes +while Lasèque and Legroux found fatty changes which were equally marked in muscles showing no hemorrhage. On the other hand, Aschoff and Koch, in their careful studies, did not find noteworthy fatty change of the @@ -3725,7 +3687,7 @@ valuable information.</p> <p>Hayem found fatty infiltration of the walls of the small veins and capillaries, and believed this to play an important -rôle in the etiology of these bleedings. Lasèque and<span class="pagenum" title="99"><a name="Page_99" id="Page_99"></a></span> +rôle in the etiology of these bleedings. Lasèque and<span class="pagenum" title="99"><a name="Page_99" id="Page_99"></a></span> Legroux also found occasional fatty changes. Other authors have failed to demonstrate similar lesions, or have considered them due to postmortem change. Koch @@ -3784,7 +3746,7 @@ stages, erosion of the mucosa occurs, and the upper layers of submucosa become involved. Polynuclear cells appear in great numbers, abscesses and ulcers are formed, which with proper staining can be shown to harbor the various -types of mouth bacteria, cocci, spirillæ, etc. The pigmentation +types of mouth bacteria, cocci, spirillæ, etc. The pigmentation becomes intense, and a marked increase of the newly-formed connective tissue takes place.</p> @@ -3840,7 +3802,7 @@ that one of their severe, acute cases showed “a recent cellular cirrhosis.” An exceptional lesion is reported by Reinert—a “leucocytic” infiltration of the liver and spleen occurring in a three-year-old child, and resembling -that seen in pseudoleukæmia. Finally, it should be remembered +that seen in pseudoleukæmia. Finally, it should be remembered in this connection that Hart and Lessing found calcium deposits not only in the muscles and adrenal glands of their monkeys, but also in the liver.</p> @@ -3876,7 +3838,7 @@ changes in the cellular elements of cortex and medulla” consisting of vacuolation and disintegration of the cells with disappearance or loss of staining reactions of their nuclei. Rondoni, some years previously, had -called attention to this increase in size and hyperæmia of +called attention to this increase in size and hyperæmia of the adrenals in guinea-pigs fed exclusively cereal diets. He, as well as McCarrison, noted an increase, though much less marked, as the result of starvation. LaMer @@ -3972,7 +3934,7 @@ phrenic nerves and one vagus and its cardiac branch.” Another animal is referred to as having shown “very marked and well-developed degeneration of the nerves of the lower extremities.” It is open to question whether -starvation played a rôle in the causation of these lesions. +starvation played a rôle in the causation of these lesions. Schoedel and Nauwerk, and Aschoff and Koch examined these nerves but failed to find any lesions; the latter directed their attention especially to the vagus of twenty-two @@ -4011,7 +3973,7 @@ to it. The bone is hollowed out and irregularly concave, whereas the cartilage presents a convex appearance. At the site of the junction is the <i>Truemmerfeld area</i>, where the normal tissue is splintered and fragmented. Everything -in a state of disorder—trabeculæ of bone of various +in a state of disorder—trabeculæ of bone of various shapes and sizes lie scattered about, the cells irregularly arranged and much distorted, signs of recent hemorrhage, unrecognizable detritus. The picture is that of weakened @@ -4034,7 +3996,7 @@ judge from sections of early scurvy in guinea-pigs, this disturbance of the columnar formation of the proliferating cartilage is one of the early signs of scurvy, and is associated with an unevenness and irregularity in shape and -size of the bone trabeculæ. In young individuals, where +size of the bone trabeculæ. In young individuals, where cartilage activity is great, these changes are most marked and the entire zone of active cells may be somewhat widened.</p> @@ -4052,12 +4014,12 @@ This extends for about 5 to 10 mm. toward the lymphoid marrow, where it ends more or less abruptly. It is composed of a loosely-constructed fibrillar tissue on a gelatinous-appearing groundwork, of sparsely scattered cells, -and bony trabeculæ which are markedly thin and weak. +and bony trabeculæ which are markedly thin and weak. Here and there are hemorrhages and blood pigment, especially adjacent to the “Truemmerfeld.” Another feature which strikes one at first glance is that the entire marrow area is incompletely filled by the thin and greatly-depleted -trabeculæ of the spongiosa. The question has been raised +trabeculæ of the spongiosa. The question has been raised whether this rarification is to be considered entirely of scorbutic origin. It is due evidently to a lack of function of the osteoblasts, which are diminished in number, and @@ -4404,12 +4366,12 @@ salts. To this end the group of workers at the Lister Institute (Chick and co-workers, Harden and Zilva) place their animals on a basal diet of one part of crushed oats and two of wheaten bran, and a daily ration of 50 to 60 c.c. -of milk autoclaved for one hour at 120° C. This milk +of milk autoclaved for one hour at 120° C. This milk still retains a small amount of antiscorbutic vitamine. Cohen and Mendel have employed, apparently with good result, a “soy bean cracker,” containing soy bean flour which has been heated for 30 minutes at 15 pounds’ pressure -(120° C.), 3 per cent. of sodium chloride, the same +(120° C.), 3 per cent. of sodium chloride, the same percentage of calcium lactate and of dried brewers’ yeast, and raw milk sufficient to supply 5 per cent. of butter-fat.</p> @@ -4432,13 +4394,13 @@ accept the deductions of these authors. The conclusions of McCollum and Pitz are so striking and have led to such wide discussion, that they require consideration, in spite of the fact that the error in the dietary is now recognized. -These authors found that the cæcum of their animals was -greatly distended with putrefying fæces. As the cæcum is +These authors found that the cæcum of their animals was +greatly distended with putrefying fæces. As the cæcum is extraordinarily large and delicate in this species, they drew the deduction that the development of scurvy in the guinea-pig was due principally to the retention of -fæces. “An impacted cæcum, the seat of putrefaction, -may cause injury to the cæcal wall, sufficient to permit the +fæces. “An impacted cæcum, the seat of putrefaction, +may cause injury to the cæcal wall, sufficient to permit the invasion of the tissues by bacteria, or the animals may perhaps be injured primarily by the absorption of toxic products of bacterial origin.” Accessory dietary factors @@ -4462,36 +4424,36 @@ to make appropriate observations in normal and in scorbutic animals. It was soon reported by various workers, Rappleye, Cohen and Mendel, Hess and Unger, and others, that there was no definite relationship between -the occurrence of scurvy and impaction of the cæcum. In +the occurrence of scurvy and impaction of the cæcum. In <a href="#Fig_8">Fig. 8</a> we see portrayed the stool output of a guinea-pig during the period in which it was developing scurvy, and during a subsequent period when it was being cured by means of orange juice. It is clear that there was no significant variation in the output during these divergent periods. A similar conclusion was arrived at by those -who examined the cæcums of animals postmortem. Cohen +who examined the cæcums of animals postmortem. Cohen and Mendel write: “Summarizing our experience with nearly one hundred scorbutic animals, we conclude that -actual impaction of the fæces in the cæcum occurred in +actual impaction of the fæces in the cæcum occurred in about one-quarter of the cases, and visible damage to wall, <i>i.e.</i>, congestion or hemorrhage, or impaction, or both, was found in perhaps half of the cases. It should be noted that this statement covers all the diets we have tried.” We concur in this conclusion. Not infrequently we found<span class="pagenum" title="120"><a name="Page_120" id="Page_120"></a></span> -the cæcums of markedly scorbutic pigs to contain semi-fluid -fæces, the consistency of its contents depending on +the cæcums of markedly scorbutic pigs to contain semi-fluid +fæces, the consistency of its contents depending on the character of the diet, quite apart from its adequacy and lack of the antiscorbutic factor. For example, a diet rich in milk, containing 100 c.c. or more, led to the formation -of rather solid fæces; if oats were added to the -milk diet the fæces in the cæcum were found to be still more +of rather solid fæces; if oats were added to the +milk diet the fæces in the cæcum were found to be still more solid, and this portion of the gut more often impacted. This condition could be detected by palpation even during life. Just as we encountered scorbutic animals on an oat, -hay and water diet, who had semi-fluid fæces in the cæcums, +hay and water diet, who had semi-fluid fæces in the cæcums, so we met with others which were on a milk diet, and -showed no signs of scurvy, although their cæcums were -impacted with fæces of a putty-like consistence. Guinea-pigs<span class="pagenum" title="121"><a name="Page_121" id="Page_121"></a></span> +showed no signs of scurvy, although their cæcums were +impacted with fæces of a putty-like consistence. Guinea-pigs<span class="pagenum" title="121"><a name="Page_121" id="Page_121"></a></span> do not seem to be able to tolerate a diet containing a large quantity of the fat of cow’s milk. Such a diet leads to impaction of the large intestine resulting in death, but @@ -4499,7 +4461,7 @@ does not induce scurvy. Jackson and Moore produced a condition of this kind by feeding pigs with cream containing 26 to 28 per cent. fat. “In every case,” they write, “the large intestine was distended with light mustard-colored -semi-solid fæces.” This pathological condition is +semi-solid fæces.” This pathological condition is not understood, but is quite distinct from scurvy, and remarkable in view of the fact that the milk of the guinea-pig contains as high as 25 per cent. of fat. It is an interesting @@ -4532,7 +4494,7 @@ Mendel, in order to test the adequacy of their diet as to roughage, supplemented it with additions of considerable filter paper and sawdust, “without averting the appearance of scurvy.” It is evident, therefore, that constipation -does not play an essential rôle in the pathogenesis +does not play an essential rôle in the pathogenesis of scurvy in the guinea-pig, and that antiscorbutics are by no means synonymous or interchangeable with laxatives.<span class="pagenum" title="122"><a name="Page_122" id="Page_122"></a></span> These results accord with observations on infantile @@ -4589,7 +4551,7 @@ by a delicate band of periosteum. The shafts of the bones are brittle, rarefied, and easily broken.</p> <p>On opening <i>the chest</i>, slight hemorrhages may be noted -in the pericardium and in the visceral and costal pleuræ. +in the pericardium and in the visceral and costal pleuræ. The heart is frequently enlarged, and the pericardial sac contains an excess of serum; the right ventricle, however, is not found disproportionately hypertrophied. Pneumonia @@ -4642,11 +4604,11 @@ been discussed.</p> <p>Lower down in the bowel there are occasionally areas of congestion and ulceration, but no section seems particularly predisposed to these lesions. The contents of the<span class="pagenum" title="125"><a name="Page_125" id="Page_125"></a></span> -bowel, especially of the cæcum, as mentioned above, depend +bowel, especially of the cæcum, as mentioned above, depend more on the character of the food than on the existence of scurvy. If the diet has consisted of milk and oats, -the cæcum will be found full and perhaps impacted, -whereas if hay and oats have been fed, the cæcum will be +the cæcum will be found full and perhaps impacted, +whereas if hay and oats have been fed, the cæcum will be less full and its contents semisolid.</p> <p>In view of the fact that many of the animals have taken @@ -4778,14 +4740,14 @@ blood-vessels is considerably reduced and fresh hemorrhage or blood pigment is frequently seen. The osseous tissue itself shows marked changes, corresponding to the rarification and brittleness noted on gross examination. -The osseous trabeculæ are fewer in number and those +The osseous trabeculæ are fewer in number and those which remain are slender and irregular, and frequently appear as isolated islets. The cortical substance also becomes very thin. There are marked alterations in the intermediate cartilages, especially of the ribs.<a name="FNanchor_37_37" id="FNanchor_37_37"></a><a href="#Footnote_37_37" class="fnanchor">37</a> Instead<span class="pagenum" title="129"><a name="Page_129" id="Page_129"></a></span> of the cells being arranged in orderly rows, they are irregularly placed, and frequently greatly reduced in size -and number. The bone trabeculæ on which they abut are +and number. The bone trabeculæ on which they abut are not well formed or of equal length, and do not present an even and transverse plane, but are misshapen, small, so that the line of junction with the cartilage is zigzag. In @@ -4840,18 +4802,18 @@ have developed.</p> <p>2. Diagram of rib-junction to illustrate “Incipient Scurvy.” This rib-junction is very nearly normal, but shows what may be regarded as the first recognizable signs of the onset of the disease; these are: (<i>a</i>) An appearance of general abnormality (when compared with the normal). (<i>b</i>) Unevenness of the junction and slight disorganization of the rows of cartilage cells. (<i>c</i>) Shortening of the length of the rows of cartilage cells. -(<i>d</i>) Shortening, and decrease in number of the trabeculæ. (<i>e</i>) Increased amount of blood in the marrow cavity.</p> +(<i>d</i>) Shortening, and decrease in number of the trabeculæ. (<i>e</i>) Increased amount of blood in the marrow cavity.</p> <p>3. Diagram of rib-junction to illustrate “Definite Scurvy.” Histological signs vary considerably in these cases (according to the severity of the disease), and may approach in appearance those characteristic of the “Acute” condition. The rows of cartilage cells may be almost normal, -but are more often noticeably shortened and usually somewhat disorganized or arranged in circular groups. The trabeculæ are usually about half +but are more often noticeably shortened and usually somewhat disorganized or arranged in circular groups. The trabeculæ are usually about half the normal length and have a truncated appearance. The junction as a whole may present an uneven, slightly disorganized appearance and there is sometimes a certain amount of macroscopic deformity.</p> <p>4. Diagram of rib-junction to illustrate “Acute Scurvy.” In these cases the junction and rows of cartilage cells are often completely disorganized, causing a marked macroscopic deformity of the bone. The bone of the shaft is frequently fractured. The marrow is no longer in contact with the edge of the junction and the space is filled with a mass of connective tissue; this is very characteristic in cases of fracture. A -condition in which the trabeculæ have almost disappeared and the rows are much shortened is also found in “Acute Scurvy,” in those ribs in +condition in which the trabeculæ have almost disappeared and the rows are much shortened is also found in “Acute Scurvy,” in those ribs in which no fracture of the shaft has occurred; usually, however, there is little or no ossification across the junction. There is frequently hemorrhage into the marrow cavity.</p> @@ -4860,7 +4822,7 @@ into the marrow cavity.</p> <p>5. May be described as “Chronic Definite Scurvy.” The rows are much shortened but not disorganized and an ossified band extends across the junction.</p> -<p>6. May be described as “Acute Chronic Scurvy.” The junction is deformed, and the rows are very disorganized; the trabeculæ have +<p>6. May be described as “Acute Chronic Scurvy.” The junction is deformed, and the rows are very disorganized; the trabeculæ have disappeared and an ossified band extends across the junction. There is no connective tissue to be seen and no existing, or recent, fracture. </p></div> @@ -4907,7 +4869,7 @@ one of the first tissues of the body to be affected by scurvy. The authors quite rightly raise the question whether the teeth of young children may not likewise be injured by a deficiency of antiscorbutic vitamine, whether this may -not play a rôle in the dental caries so prevalent among +not play a rôle in the dental caries so prevalent among civilized communities. It is evident, they state, that such transient conditions of infantile scurvy as have been described by Hess as “subacute” or “latent” scurvy, may @@ -4929,7 +4891,7 @@ of the mucous membrane of the glands of the stomach and of the intestine. Hart and Lessing, in their protocols of necropsies on monkeys, describe an interesting lesion associated with the degenerated muscle fibres—a collection -of granules staining deep blue with hæmatoxylin and +of granules staining deep blue with hæmatoxylin and dissolving on the addition of acid. These granules, interpreted as being composed of calcium, were found in the muscles of the limbs, of the tongue, and in the heart. It is @@ -5207,13 +5169,13 @@ noted, however, that although the pigs developed scurvy they did not lose weight, as is usually the case. After they had developed definite scurvy they were given in addition the equivalent of 80 c.c. of a dried milk prepared by being -heated to about 116° C. for a few seconds. The addition +heated to about 116° C. for a few seconds. The addition of this milk to the diet cured the scurvy, showing that it had largely retained its antiscorbutic vitamine. </div> <p>Exophthalmos may be mentioned again in this connection -as a very rare sign of guinea-pig scurvy. Hæmaturia<span class="pagenum" title="141"><a name="Page_141" id="Page_141"></a></span> +as a very rare sign of guinea-pig scurvy. Hæmaturia<span class="pagenum" title="141"><a name="Page_141" id="Page_141"></a></span> also occurs at times; it is not known how frequently it is present, whether it is an early manifestation in the guinea-pig as in the infant, or whether the source of the @@ -5394,7 +5356,7 @@ evident in relation to the great epidemic of scurvy in 1847. Holst and Froelich inform us that “all scurvy epidemics in Norway in the nineteenth and beginning of this century followed failure of the potato crop.” Nor -is this danger past. In an article entitled “The Rôle of +is this danger past. In an article entitled “The Rôle of Antiscorbutics in Our Dietary,” the author recently reported that the partial failure of the potato crop in the eastern part of the United States led to the development @@ -5417,7 +5379,7 @@ a British Arctic Survey Committee was appointed to make an investigation. In 1877 it reported that “although the scurvy was due to the absence of lime juice from the sledge dietaries, meat in large amounts is able -to prevent the disease.” Stefánsson also emphasized the +to prevent the disease.” Stefánsson also emphasized the value of meat in preventing scurvy in the Polar regions. In his expeditions he has found that raw meat, if taken in sufficient quantity, is able to afford complete protection. @@ -5601,7 +5563,7 @@ it is pasteurized, a larger quantity is required, depending upon various conditions connected with the heating process and upon the age of the milk, circumstances fully discussed in relation to etiology. Thus it becomes -evident that pasteurized milk assumes a two-fold rôle, acting +evident that pasteurized milk assumes a two-fold rôle, acting as an antiscorbutic if little of its vitamine content has been destroyed and if a large quantity is consumed, or leading to the development of scurvy when one or @@ -5654,10 +5616,10 @@ of clinical signs.</p> <p>Both of these juices withstand heat remarkably well. Orange juice can be boiled for 10 minutes without noting any diminution of its antiscorbutic value, and lemon juice -heated to 110° C. without appreciably losing its efficacy. +heated to 110° C. without appreciably losing its efficacy. However, orange juice undergoes some change as the result of being heated in an autoclave for 45 minutes at a -temperature of 110° under 10 to 15 pounds pressure. +temperature of 110° under 10 to 15 pounds pressure. Although 6 c.c. of this heated preparation were able to prevent the development of scurvy, the guinea-pigs did not gain nearly as well as those which received 3 c.c. of @@ -5755,9 +5717,9 @@ was tested by Holst and Froelich (1912) and found comparable to oranges and to lemons. The juice was also<span class="pagenum" title="158"><a name="Page_158" id="Page_158"></a></span> highly resistant to heat, so that 10 c.c. of freshly-pressed juice were of protective value, even after it had been subjected -to 100 or 110° C. for one hour. Guinea-pigs which +to 100 or 110° C. for one hour. Guinea-pigs which were thus treated showed no microscopic signs of scurvy -in any of the ribs, in the tibiæ or the femora.</p> +in any of the ribs, in the tibiæ or the femora.</p> <p class="tabhead"><a id="TABLE_3"></a>TABLE 3</p> <table summary="Table showing the relative distribution of the antiscorbutic factor in the commoner foodstuffs"> @@ -5858,7 +5820,7 @@ will be found on microscopic examination.</p> <p><b>Effect of Heating.</b>—Vegetables are of decidedly less antiscorbutic value when cooked than raw; cabbage, for instance, on being boiled is weakened about one-half. -Heating to 110° C. for an hour destroys almost all of its +Heating to 110° C. for an hour destroys almost all of its antiscorbutic factor. Delf’s tests did not show so great a loss. She came to the conclusion, of theoretical and practical value, that slow cooking at a low temperature @@ -5893,7 +5855,7 @@ not only age, but the <i>degree of ripeness</i> must be considered in appraising the food value of vegetables. Feeding experiments showed that tomatoes which were fully ripe were more potent than those which were slightly -green. Probably many other factors play a rôle in determining +green. Probably many other factors play a rôle in determining the richness of vegetables in vitamine. It may not be immaterial whether they are allowed to ripen on the vine or shrub, or mature subsequently. The nature @@ -5929,7 +5891,7 @@ Such is not the case, however, as demonstrated both by laboratory tests and clinical experience. Considering its importance, there have been surprisingly few feeding experiments carried out with potato. Holst and Froelich -(1912) found that 17 g. of potatoes, steamed at 100° C. +(1912) found that 17 g. of potatoes, steamed at 100° C. for 30 minutes, afforded but slight protection, and that it required 20 g. to fully protect a guinea-pig. Givens and Cohen failed to ward off scurvy by means of cooked potatoes<span class="pagenum" title="162"><a name="Page_162" id="Page_162"></a></span> @@ -5942,7 +5904,7 @@ diets, concluded that 14 ounces daily would protect them from scurvy (if the ration included one ounce of other fresh vegetable and 4 ounces of meat), is probably close to the mark.<a name="FNanchor_41_41" id="FNanchor_41_41"></a><a href="#Footnote_41_41" class="fnanchor">41</a> With the experience that potatoes play -such a significant rôle in the prevention of scurvy, how +such a significant rôle in the prevention of scurvy, how are we to interpret the fact that they are only mildly antiscorbutic? Potatoes are consumed in very large amounts; in the Temperate Zone probably twice as many pounds @@ -5967,7 +5929,7 @@ seemed to show that it is of value in this field. The authors believe that the potency of vegetables is closely associated with certain botanical species, and that in this way the marked virtue of the swede can be explained, as -it belongs to the natural order of Cruciferæ, which includes +it belongs to the natural order of Cruciferæ, which includes also the cabbage, the scurvy grass and the cresses. If, however, this is a rule of nature, it is difficult to explain the marked difference between the lime and the @@ -6002,7 +5964,7 @@ them for the fresh food.</p> <div class="figcenter" style="width: 400px;"> <img src="images/fig_012.png" width="400" height="331" alt="Dehydrated vegetables as a cause of scurvy " /> <a id="Fig_12"></a><span class="smcap">Fig. 12.</span>—Hay, oats, water <i>ad libitum</i>, and 7 g. of dehydrated -carrots dried at a room temperature of about 130° F. +carrots dried at a room temperature of about 130° F. about 1 month previously. All animals developed scurvy. The marked gain in weight when an equivalent amount of fresh carrots was substituted for the dehydrated vegetable @@ -6088,7 +6050,7 @@ when a lot was used which had been prepared a year previously. This is indeed remarkable, considering that the food undergoes a two-fold heating in the course of canning, during one of which (“processing”) the temperature -is raised to fully 230° F. Tomatoes have another advantage +is raised to fully 230° F. Tomatoes have another advantage over most other vegetables in that they are richly endowed with the water-soluble vitamine, as shown by our tests on pigeons suffering from polyneuritis, and by the @@ -6331,7 +6293,7 @@ degree of temperature, is less deleterious than longer cooking at a low degree. In other words, that less damage is brought about by boiling or by steaming vegetables than by stewing them. Here age and freshness again -play a rôle; in fact, a double rôle, as the older and tougher +play a rôle; in fact, a double rôle, as the older and tougher vegetables contain not only less antiscorbutic, but require more prolonged cooking.</p> @@ -6509,7 +6471,7 @@ signs of scurvy is <i>hemorrhage</i>. Indeed, in many of the systematic treatises of medicine it is classified as a hemorrhagic disease. Besides the bleeding into the gums, skin and bones, hemorrhage into the stomach may -take place, giving rise to hæmatemesis, or there may be +take place, giving rise to hæmatemesis, or there may be hemorrhage into the eye, under the conjunctiva or into the anterior chamber, leading to the destruction of the eyeball. A very unusual form is meningeal bleeding, @@ -6609,7 +6571,7 @@ infections.</p> <p>O’Shea reports the exceptional case of a man who was operated upon for acute appendicitis. A large hemorrhage -in the wall of the cæcum was found, as well as some +in the wall of the cæcum was found, as well as some other hemorrhages in the peritoneal cavity. This report is interesting, not so much from a diagnostic standpoint as because “contrary to what might have been expected, @@ -6655,7 +6617,7 @@ examination may be no longer visible, and may have consisted merely of a rim of crimson edging the borders of the upper gum, perhaps behind an upper incisor, as Still pointed out. On closer examination it may be observed -that the papillæ of the tip of the tongue are markedly congested, +that the papillæ of the tip of the tongue are markedly congested, and that a petechial spot is to be seen on its frenum, on the palpebral conjunctiva, or here and there on the surface of the body, more especially where there are erosions, @@ -6798,7 +6760,7 @@ of infantile scurvy is that reported by Vincent:</p> <p>The infant lay in its bed extremely apathetic and barely conscious. Its face was ashy gray in color, the respirations were extremely frequent, the pulse-rate was -144 per minute, and the temperature 103.2°. When +144 per minute, and the temperature 103.2°. When touched it moaned feebly, and made no attempt at movement. The mouth was kept open, the lower jaw hanging away from the face. There was a complete absence of @@ -6831,7 +6793,7 @@ epiphyses; the tenderness also was greater than at any other part.</p> <p>Bleeding from the gums and nose had occurred; no -history of hæmaturia could be obtained. The motions +history of hæmaturia could be obtained. The motions were semisolid, green, and offensive. During the last twenty-four hours the infant had refused food.</p> @@ -6839,7 +6801,7 @@ twenty-four hours the infant had refused food.</p> subcutaneous injections of salt solution and the necrosing surfaces of the gums were scraped and swabbed with boracic solution. By the third day the pulse was 100, the -temperature 99.8°, the odor from the mouth scarcely +temperature 99.8°, the odor from the mouth scarcely noticeable, and the general condition distinctly improved. It continued to improve and to gain in weight and when seen at the end of the sixth week of treatment it was @@ -6893,7 +6855,7 @@ in the months that the baby was under observation.</p> <p>The localization of the hemorrhage in the gums is due largely to trauma, occasioned by the sharp contact of the jaws or of the nursing-bottle. Local infection plays -almost no rôle in infants, although in the adult where +almost no rôle in infants, although in the adult where there is caries of the teeth it frequently incites hemorrhage. Dental caries and gingival infection may lead to local hemorrhage, even where the nutritional conditions @@ -6979,10 +6941,10 @@ exist to bring about a rupture of the small vessels. The idiosyncrasy of the individual has to be considered as well as the fact that infants have a tendency to develop minute skin hemorrhages, especially such as have an exudative -diathesis. In the course of scurvy, petechiæ may be found +diathesis. In the course of scurvy, petechiæ may be found not only in the skin, but in the mucosa of the mouth, especially overlying the hard palate, and also in the palpebral -conjunctiva, identical with the minute petechiæ so significant +conjunctiva, identical with the minute petechiæ so significant of general sepsis. In addition to these minute hemorrhages larger ones are not infrequently found in various parts of the body, especially in the neighborhood of the @@ -7014,15 +6976,15 @@ mistaken for subperiosteal hemorrhages.</p> <p>Less frequently there are <i>hemorrhages into the internal organs</i>. These, however, play a comparatively insignificant -rôle in the symptomatology of this disease. At +rôle in the symptomatology of this disease. At postmortem examination we find numerous hemorrhages of the pleura, pericardium and peritoneum, which rarely produce symptoms during life. Still records a case with marked abdominal pain and swelling, which he believed to have been due to hemorrhage into the wall of the intestine. As previously mentioned, O’Shea met with a case -of hemorrhage into the cæcum which was mistakenly operated -upon for appendicitis. Hæmothorax and hæemopericardium +of hemorrhage into the cæcum which was mistakenly operated +upon for appendicitis. Hæmothorax and hæemopericardium occur, especially associated with local inflammatory processes of tuberculous nature. The clinical aspect of hemorrhage of the gastro-intestinal and the genito-urinary @@ -7095,13 +7057,13 @@ subperiosteal hemorrhage or separation of the epiphyses of the long bones, but a mild and peculiar form which is seen early in the disease. It involves most regularly the upper eyelids, and the legs—especially the skin covering -the lower part of the tibiæ. In the latter site it differs +the lower part of the tibiæ. In the latter site it differs from edema as usually encountered, in that it does not pit on pressure; it is firm, tense, causing some glossiness of the overlying skin, which is rendered difficult to wrinkle or to pinch between the fingers. Not infrequently the skin is slightly reddened, a sign of interest, in view of a similar, -although much more intense, hyperæmia seen in pellegra.</p> +although much more intense, hyperæmia seen in pellegra.</p> <p>In addition to this very mild edema there may be marked swelling, resulting in what might be called, following @@ -7195,7 +7157,7 @@ of scurvy.</p> months after cure of scurvy. </div> -<p>We have referred to use of röntgenograms in connection +<p>We have referred to use of röntgenograms in connection with separation of the epiphyses, subperiosteal hemorrhage, cardiac enlargement and beading of the ribs. In addition to its application in these connections, the @@ -7250,7 +7212,7 @@ note regarding the heart and lungs.”</p> out by the author that there is frequently enlargement of the heart, and more especially of the right heart. This can be elicited at the bedside and has been substantiated -in numerous cases by means of the Röntgen-ray, which +in numerous cases by means of the Röntgen-ray, which demonstrates not only enlargement of the heart, but also a marked broadening at its base, at the site of the large vessels (Fig. 21). These phenomena resemble closely the @@ -7283,7 +7245,7 @@ The heart-beat not infrequently is found to be 200 per minute, and to be characterized by marked lability—increasing to an astonishing degree as the result of slight exertion or excitement. A mild febrile disturbance causing -a rise of temperature to little more than 100° F. will +a rise of temperature to little more than 100° F. will send the pulse-rate up 30 beats. It must not be thought that this refers to severe cases; the babies we have in mind are similar to the one cited as an instance of subacute @@ -7348,7 +7310,7 @@ the pain and tenderness in infants are due in part to a sensitiveness of the nerve trunks as well as of the periosteum. Careful studies in adult scurvy should furnish an answer to this question. No methodical examination for -areas of anæsthesia or paræsthesia, signs which occur so +areas of anæsthesia or paræsthesia, signs which occur so frequently in connection with beriberi, has been carried out in scurvy. In certain epidemics, however, pains in the limbs have been prominent symptoms.</p> @@ -7367,7 +7329,7 @@ of the spinal cord. Herpes has been described in connection with both adult and infantile scurvy. In one of the early cases in the American literature Fruitnight reported a case with herpes in a girl five years of age. In considering -the rôle of the nervous system, mention should +the rôle of the nervous system, mention should be made of cases where sweating constituted an important symptom. Finkelstein lays particular stress on this symptom in infantile scurvy. We have not met with it @@ -7404,7 +7366,7 @@ this disorder.</p> <p>The urinary system is frequently involved in the course of scurvy. Among 38 cases Still reports that 89 per cent. gave evidence of urinary changes and that 60 per cent. -showed hæmaturia. Finkelstein found urinary signs in +showed hæmaturia. Finkelstein found urinary signs in at least a third of his cases. Our figures, the result of a study of subacute and mildly acute cases, correspond more nearly with those of Finkelstein.</p> @@ -7417,7 +7379,7 @@ the onset, as does hemorrhage into or about the joints, or hemorrhage behind the eyeball. It is well to bear these possibilities in mind, but they must be regarded as very exceptional early signs of this disorder. We have encountered -frank hæmaturia but once in the early stage of +frank hæmaturia but once in the early stage of infantile scurvy. The blood emanates generally from the kidneys, although the submucous hemorrhages of the bladder as well as in the urethra, described both in man @@ -7644,7 +7606,7 @@ scurvy of various grades of severity, of different stages of development, or complicated by intercurrent disease.</p> -<p>Nobécourt, Tixier, and Maillet have questioned +<p>Nobécourt, Tixier, and Maillet have questioned whether there is always complete recovery from this anemia, which is severe from the standpoint of hemoglobin and iron. The older authors reported instances where @@ -7656,7 +7618,7 @@ the rule.</p> <p>In view of the fact that scurvy frequently is classed as a hemorrhagic disease, and that hemorrhages play such -an important rôle in its symptomatology, a consideration +an important rôle in its symptomatology, a consideration of the factors concerned in the <i>coagulability of the blood</i> is of interest. In an investigation (Hess and Fish) it was found that the oxalated plasma (of blood taken directly @@ -7803,8 +7765,8 @@ orange-peel juice. Lower curve represents the normal. </div> <p><b>Fever.</b>—Fever frequently accompanies scurvy. It is -generally of a low grade, ranging between 100° and -101°, as may be seen in <a href="#Fig_15">Fig. 15</a>. There is a difference +generally of a low grade, ranging between 100° and +101°, as may be seen in <a href="#Fig_15">Fig. 15</a>. There is a difference of opinion as to whether the rise of temperature should be considered as truly scorbutic in nature, as “scorbutic fever,” or regarded merely as a condition @@ -7814,7 +7776,7 @@ character is the sharp subsidence on giving antiscorbutic food. On the other hand, this may quite as well be interpreted as due to a secondary reaction, checking<span class="pagenum" title="217"><a name="Page_217" id="Page_217"></a></span> the absorption of toxins or bacteria. High temperatures—for -example, fever of 103° or over—are attributable to a +example, fever of 103° or over—are attributable to a complicating infection and should lead to careful examination for the source of the trouble; pyelitis should particularly be borne in mind. In a recent case fever of @@ -7886,7 +7848,7 @@ cabbage in addition.</p> <tr><td class="bl tac plr03m">1. J. H.</td><td class="bm tar vat plr03m wsnw">  6½</td><td class="bm tac"> 9  6</td><td class="bm plhi">Humerus, tibia, face.</td><td class="bm tar plr03m">Apr. 19</td><td class="bm plhi" rowspan="2">Breast milk (1 week); pasteurized milk previously.</td><td class="br plhi" rowspan="2">Grippe since end of February; nephritis; v. Pirquet negative.</td></tr> <tr><td class="bl tac"></td><td class="bm tac"></td><td class="bm tac plr03m">10  4</td><td class="bm plhi">Upper eyelid</td><td class="bm tar plr03m">May 9</td></tr> <tr style="height: 0.4em"><td class="bl"></td><td class="bm"></td><td class="bm"></td><td class="bm"></td><td class="bm"></td><td class="bm "></td><td class="br"></td></tr> -<tr><td class="bl tac plr03m">2. L. S.</td><td class="bm tac"> 5</td><td class="bm tac plr03m">12 14</td><td class="bm plhi">External ear, parietal bones, vertebral column, abdominal wall</td><td class="bm tar plr03m">May 4</td><td class="bm plhi">Pasteurized milk formula; orange juice 1 oz. daily since April 22.</td><td class="br plhi">Twitchings and convulsions; signs of intoxication; red blood cells in urine fever to 101° F.; v. Pirquet negative.</td></tr> +<tr><td class="bl tac plr03m">2. L. S.</td><td class="bm tac"> 5</td><td class="bm tac plr03m">12 14</td><td class="bm plhi">External ear, parietal bones, vertebral column, abdominal wall</td><td class="bm tar plr03m">May 4</td><td class="bm plhi">Pasteurized milk formula; orange juice 1 oz. daily since April 22.</td><td class="br plhi">Twitchings and convulsions; signs of intoxication; red blood cells in urine fever to 101° F.; v. Pirquet negative.</td></tr> <tr style="height: 0.4em"><td class="bl"></td><td class="bm"></td><td class="bm"></td><td class="bm"></td><td class="bm"></td><td class="bm"></td><td class="br"></td></tr> <tr><td class="bl tac plr03m">3. A. R.</td><td class="bm tac">10</td><td class="bm tac plr03m">12  8</td><td class="bm plhi">Femur</td><td class="bm tar plr03m">Apr. 19</td><td class="bm plhi" rowspan="2">Pasteurized milk formula; vegetables for a month; orange juice longer; getting orange juice and vegetables.</td><td class="br plhi" rowspan="2">Grippe end of January; again in April; fever until April 17; v. Pirquet positive; gums negative.</td></tr> <tr><td class="bl tac"></td><td class="bm tac"></td><td class="bm tac"></td><td class="bm plhi">Femur again swollen and tender.</td><td class="bm tar plr03m">June 4</td></tr> @@ -7980,8 +7942,8 @@ to ship-beriberi, regarded by Nocht as a hybrid of these diseases. The diagnosis is rendered more difficult, as at times scurvy is associated with signs of neuritis. We shall have to depend on the involvement of the gums and -the hemorrhages in scurvy, and on the hyperæsthesia, -paræsthesia, and anæsthesia in beriberi; marked edema +the hemorrhages in scurvy, and on the hyperæsthesia, +paræsthesia, and anæsthesia in beriberi; marked edema points to the latter disease.</p> <p>We have thus far had in mind frank and outspoken @@ -8036,15 +7998,15 @@ of the urinary tract, renal tumor, orbital tumor, appendicitis, peritonitis, pleurisy and pneumonia. Holt writes as follows: “I have known two cases to be operated upon by eminent surgeons, once with a diagnosis of -sarcoma and once of ostitis of both tibiæ. Not until the +sarcoma and once of ostitis of both tibiæ. Not until the subperiosteal hemorrhages and epiphyseal separations were discovered was the nature of the trouble suspected.” Recently we saw a case of fracture of the distal end of the femur diagnosed as infantile scurvy; the baby had caught its thigh between the bars of the crib and snapped the bone in trying to extricate itself. Finkelstein adds acute -endocarditis, hemorrhagic septicæmia with multiple bone -swellings, and leukæmia as having been confused +endocarditis, hemorrhagic septicæmia with multiple bone +swellings, and leukæmia as having been confused with scurvy.</p> <p>In an interesting account of scurvy in the Russian @@ -8087,7 +8049,7 @@ PROGNOSIS</h2> <p>The outcome of scurvy, as we encounter it in peace time in the Temperate Zone, is generally favorable, so that -it plays but an insignificant rôle in our mortality statistics. +it plays but an insignificant rôle in our mortality statistics. This results from the fact that we are abundantly provided with a specific remedy, so that if the diagnosis is made early and treatment is prompt and thorough, @@ -8165,7 +8127,7 @@ phenomenon) which is so frequent a symptom of infantile scurvy. The heart may be rapid for months or even for years after the disorder, and tachycardia may develop on the occasion of even a mild infectious disease. -For example, a fever of 101°, due to a common +For example, a fever of 101°, due to a common coryza, may cause the heart-beat to rise to perhaps 180 a minute. Children so affected succumb readily to infection, especially to pneumonia, which may lead to sudden @@ -8771,7 +8733,7 @@ phenols, were observed, provided the factor of partial starvation was ruled out. This is believed to indicate that no increased bacterial action occurs in the intestine of scorbutic guinea-pigs despite the difficulty of evacuation -of the fæces.” These results are in harmony with +of the fæces.” These results are in harmony with the bacteriological study of Torrey and Hess, who found that there was no increase in the proteolytic flora of the intestine in infants or in guinea-pigs suffering @@ -8799,7 +8761,7 @@ observed in the present series.” It should be remembered, however, that the diets of the guinea-pigs and the monkeys were quite different, the former consisting mainly of oats, and the latter of condensed milk. It is<span class="pagenum" title="247"><a name="Page_247" id="Page_247"></a></span> -quite possible that the basic diet may play a rôle in the +quite possible that the basic diet may play a rôle in the metabolism of this disease, although, as stated elsewhere, its effect cannot be noted clinically. Special attention should be paid to this factor in metabolic studies, in view @@ -8927,7 +8889,7 @@ of Nocht (1903) and that of Holst and Froelich. It is a very rare condition but of interest because it is characterized by spongy, hemorrhagic gums and other signs encountered in scurvy. The feature which differentiates -it sharply from scurvy, however, is an anæsthesia of the +it sharply from scurvy, however, is an anæsthesia of the extremities. Ship-beriberi is generally regarded as a<span class="pagenum" title="251"><a name="Page_251" id="Page_251"></a></span> combination of beriberi and scurvy. Where these two disorders occur concomitantly, the beriberi manifests itself @@ -9274,7 +9236,7 @@ Jena, 1913, Gustav Fischer, 58.</p> VIII, 289.</p> <p><span class="smcap">Ausset, E.</span>: (2) Un cas de maladie de Barlow chez un enfant nourri exclusivement -avec du babeurre frais, Bull. Méd., 1910, XXIV, 675.</p> +avec du babeurre frais, Bull. Méd., 1910, XXIV, 675.</p> <p><span class="smcap">Bachstrom</span>: Observationes circa Scorbutum, 1734.</p> @@ -9309,7 +9271,7 @@ Arch. Int. Med., 1912, IX, 665.</p> <p><span class="smcap">Baumann, L.</span>, and <span class="smcap">Howard, C. P.</span>: (2) Mineral Metabolism of Experimental Scurvy of the Guinea-pig, Am. Jour. Med. Sci., 1917, CLIII, 650.</p> -<p><span class="smcap">Benoit, A.</span>: Une <ins title="Transcriber’s Note: originally Epidemie">Épidémie</ins> de Scorbut, Paris Méd., 1919, IX, 469.</p> +<p><span class="smcap">Benoit, A.</span>: Une <ins title="Transcriber’s Note: originally Epidemie">Épidémie</ins> de Scorbut, Paris Méd., 1919, IX, 469.</p> <p><span class="pagenum" title="262"><a name="Page_262" id="Page_262"></a></span></p> <p><span class="smcap">Bernheim-Karrer</span>: Saeuglingskorbut bei Ernaehrung mit Homogenisierter @@ -9325,7 +9287,7 @@ London, J. Murray.</p> <p><span class="smcap">Bohn</span>: Acute Rachitis, Jahrb. f. Kinderheilk., 1868, II, 201.</p> -<p><span class="smcap">Boldyreff, W. N.</span>: Quelques Considerations sur les Causes étiologiques du +<p><span class="smcap">Boldyreff, W. N.</span>: Quelques Considerations sur les Causes étiologiques du Scorbut, Comp. rend. soc. de biol., 1917, LXXX, 911.</p> <p><span class="smcap">Bolle, C.</span>: Zur Therapie der Barlowschen Krankheit, Ztschr. f. diaetet. u. @@ -9351,15 +9313,15 @@ Control of Oxidation in the Body, Am. Jour. Phys., 1918, XLVI, 117.</p> <p><span class="smcap">Busk, G.</span>: Report of Committee on Scurvy, etc., London, 1877.</p> -<p><span class="smcap">Caillé, A.</span>: Minority Report, Amer. Ped. Soc. Collective Investigation +<p><span class="smcap">Caillé, A.</span>: Minority Report, Amer. Ped. Soc. Collective Investigation (see <a href="#American_Pediatric_Society">above</a>).</p> -<p><span class="smcap">Carel</span>: Un Cas de Scorbut imputable au Lait <ins title="Transcriber’s Note: originally Sterilisé">Stérilisé</ins>, Bull. de la Soc. de -Pédiat. de Paris, 1910, XII, 79.</p> +<p><span class="smcap">Carel</span>: Un Cas de Scorbut imputable au Lait <ins title="Transcriber’s Note: originally Sterilisé">Stérilisé</ins>, Bull. de la Soc. de +Pédiat. de Paris, 1910, XII, 79.</p> <p><span class="smcap">Cassel</span>: Ein Fall von Skorbut, Arch. f. Kinderheilk., 1893, XV, 350.</p> -<p><span class="smcap"><a id="Charpentier_P"></a>Charpentier, P.</span>: Étude sur le Scorbut, Paris, 1871, A. Delahaye.</p> +<p><span class="smcap"><a id="Charpentier_P"></a>Charpentier, P.</span>: Étude sur le Scorbut, Paris, 1871, A. Delahaye.</p> <p><span class="smcap">Cheadle, W. B.</span>: Infantile Scurvy, Allbutt’s System of Med., 1901, V, 64.</p> @@ -9387,10 +9349,10 @@ Experimental Scurvy of Guinea-pigs, Proc. Soc. Exp. Biol. and Med., <p><span class="smcap">Cohen, B.</span>, and <span class="smcap">Mendel, L. B.</span>: (2) Experimental Scurvy of the Guinea-pig in Relation to the Diet, Jour. Biol. Chem., 1918, XXXV, 427.</p> -<p><span class="smcap">Comby, J.</span>: (1) Twelve New Cases of Infantile Scurvy, Arch. de Méd. des +<p><span class="smcap">Comby, J.</span>: (1) Twelve New Cases of Infantile Scurvy, Arch. de Méd. des Enfants, 1917, XX, 337.</p> -<p><span class="smcap">Comby, J.</span>: (2) Infantile Scurvy, Presse Médicale, 1918, XXVI, 480.</p> +<p><span class="smcap">Comby, J.</span>: (2) Infantile Scurvy, Presse Médicale, 1918, XXVI, 480.</p> <p><span class="smcap">Concetti, L.</span>: Sopra due casi di morbo di Barlow, Rev. di clin. pediat., Firenze, 1909, VII, 225.</p> @@ -9404,7 +9366,7 @@ Firenze, 1909, VII, 225.</p> <p><span class="smcap">Coutts, F. J. H.</span>: Upon an Inquiry as to Dried Milks, etc. Report to the Local Govt. Board, 1918, New Series No. 116, 31.</p> -<p><span class="smcap">Couvy</span>: Une <ins title="Transcriber’s Note: originally Épidémic">Épidémie</ins> de Beriberi et de Scorbut, Annales d’<ins title="Transcriber’s Note: originally Hygiéne">Hygiène</ins> de Méd. +<p><span class="smcap">Couvy</span>: Une <ins title="Transcriber’s Note: originally Épidémic">Épidémie</ins> de Beriberi et de Scorbut, Annales d’<ins title="Transcriber’s Note: originally Hygiéne">Hygiène</ins> de Méd. Coloniales, 1911, XIV, 97.</p> <p><span class="smcap">Crandall, F. M.</span>: Scurvy in an Infant of Six Weeks, Arch. of Pediat., 1899, @@ -9430,10 +9392,10 @@ XII, 448.</p> <p><span class="smcap">Delf, E. M.</span>, and <span class="smcap">Tozer, F. M.</span>: The Antiscorbutic and Growth-Promoting Properties of Raw and Heated Cabbage, Biochem. Jour., 1918, XII, 416.</p> -<p><span class="smcap">Delpech, M. A.</span>: Le Scorbut pendant le Siège de Paris, Annales d’Hyg., +<p><span class="smcap">Delpech, M. A.</span>: Le Scorbut pendant le Siège de Paris, Annales d’Hyg., 1871, XXXV, 2nd S.</p> -<p><span class="smcap">Disqué, L.</span>: Enstehung and Verlauf des Skorbuts im Jahre, 1916, Med. +<p><span class="smcap">Disqué, L.</span>: Enstehung and Verlauf des Skorbuts im Jahre, 1916, Med. Klinik, 1918, XIV, 10.</p> <p><span class="smcap">Duke, W. W.</span>: Pathogenesis of Purpura Hemorrhagica, Arch. Int. Med., 1912, @@ -9482,7 +9444,7 @@ Verhandl. deutschen Naturforsch. u. Aerzte, Abt. f. Innere Med., and Amylase of fresh and dehydrated vegetables, Jour. Biol. Chem., 1919, XXXVIII, 229.</p> -<p><span class="smcap">Feigenbaum, D.</span>: Ein Beitrag zur Kenntnis der Rückenmarkblutungen beim +<p><span class="smcap">Feigenbaum, D.</span>: Ein Beitrag zur Kenntnis der Rückenmarkblutungen beim Skorbut, Wien. klin. Woch., 1917, XXX, 1455.</p> <p><span class="smcap">Fife, C. A.</span>: Pathology of Infantile Scurvy, N. Y. Med Jour., 1910, XCI, 1322.</p> @@ -9607,12 +9569,12 @@ XXXVIII, 305.</p> <p><span class="smcap">Harvey, G.</span>: A New Discourse of the Smallpox and Malignant Fevers with an Exact Discovery of the Scurvy, London, 1685.</p> -<p><span class="smcap">Harvier, P.</span>: Épidémie de Scorbut, Paris Méd., 1917, VII, 394.</p> +<p><span class="smcap">Harvier, P.</span>: Épidémie de Scorbut, Paris Méd., 1917, VII, 394.</p> <p><span class="smcap">Hawkins, Sir R.</span>: Voyage to the South Sea, A. D. 1593, in Purchas’s “Pilgrim,” Vol. IV.</p> -<p><span class="smcap">Hayem, M. G.</span>: Note sur l’Anatomie Pathologique du Scorbut, Gazette Méd. +<p><span class="smcap">Hayem, M. G.</span>: Note sur l’Anatomie Pathologique du Scorbut, Gazette Méd. de Paris, 1871, XXVI, 126.</p> <p><span class="smcap">Hess, A. F.</span>: (1) Infantile Scurvy: II. A New Aspect of the Symptomatology, @@ -9631,7 +9593,7 @@ Syndrome (a New Sign), Jour. Am. Med. Assn., 1917, LXVIII, <p><span class="smcap">Hess, A. F.</span>: (5) Infantile Scurvy: V. A Study of Its Pathogenesis, Am. Jour. Dis. Child., 1917, XIV, 337.</p> -<p><span class="smcap">Hess, A. F.</span>: (6) The Rôle of Antiscorbutics in Our Dietary, Jour. Am. +<p><span class="smcap">Hess, A. F.</span>: (6) The Rôle of Antiscorbutics in Our Dietary, Jour. Am. Med. Assn., 1918, LXXI, 941.</p> <p><span class="smcap">Hess, A. F.</span>: (7) Focal Degeneration of the Lumbar Cord in a Case of Infantile @@ -9774,13 +9736,13 @@ Woch., 1916, XXIX, 912.</p> by Diet Deficient in Antiscorbutic Vitamine, Proc. Soc. Exper. Biol. and Med., 1920.</p> -<p><span class="smcap">Lasèque, Ch.</span>, and <span class="smcap">Legroux, A.</span>: L’Épidémie de Scorbut dans les Prisons de -la <ins title="Transcriber’s Note: originally Sèine">Seine</ins> et a l’Hôpital de la Pitié, Arch. <ins title="Transcriber’s Note: originally Gèn">Gén</ins>., 1871, II, 5, 680.</p> +<p><span class="smcap">Lasèque, Ch.</span>, and <span class="smcap">Legroux, A.</span>: L’Épidémie de Scorbut dans les Prisons de +la <ins title="Transcriber’s Note: originally Sèine">Seine</ins> et a l’Hôpital de la Pitié, Arch. <ins title="Transcriber’s Note: originally Gèn">Gén</ins>., 1871, II, 5, 680.</p> -<p><span class="smcap">Lecornu, P.</span>: Les Laits Industriels, Thèse de Paris, 1904.</p> +<p><span class="smcap">Lecornu, P.</span>: Les Laits Industriels, Thèse de Paris, 1904.</p> -<p><span class="smcap">Leven, M.</span>: Une Épidémie de Scorbut observée a l’Hôpital Militaire d’Ivry -pendant le Siège de Paris, 1871.</p> +<p><span class="smcap">Leven, M.</span>: Une Épidémie de Scorbut observée a l’Hôpital Militaire d’Ivry +pendant le Siège de Paris, 1871.</p> <p><span class="smcap">Lewis, A. B.</span>, and <span class="smcap">Karr, W. G.</span>: Changes in the Urea Content of the Blood and Tissues of Guinea-pigs Maintained on an Exclusive Oat Diet, J. @@ -9895,7 +9857,7 @@ Centralbl. f. allg. Path. u. path. Anat., 1897, VIII, 687.</p> <p><span class="smcap">Nansen</span> and <span class="smcap">Johansen</span>: Cited by Holst and Froelich (see above).</p> -<p><span class="smcap">Netter</span>: Le Scorbut Infantile, La Semaine <ins title="Transcriber’s Note: originally Medicale">Médicale</ins>, 1899, No. 8.</p> +<p><span class="smcap">Netter</span>: Le Scorbut Infantile, La Semaine <ins title="Transcriber’s Note: originally Medicale">Médicale</ins>, 1899, No. 8.</p> <p><span class="smcap">Neumann, H.</span>: Bemerken ueber Barlow’sche Krankheit, Deutsch. med. Woch., 1902, XXVIII, 628.</p> @@ -9903,11 +9865,11 @@ Woch., 1902, XXVIII, 628.</p> <p><span class="pagenum" title="271"><a name="Page_271" id="Page_271"></a></span></p> <p><span class="smcap">Nichols</span>: Infantile Scurvy, Brit. Med. Jour., 1896, I, 25.</p> -<p><span class="smcap">Von Niedner</span>: Hæmorrhagische Exantheme, Med. Klinik, 1918, XIV, 333.</p> +<p><span class="smcap">Von Niedner</span>: Hæmorrhagische Exantheme, Med. Klinik, 1918, XIV, 333.</p> -<p><span class="smcap">Nobécourt, P.</span>, <span class="smcap">Tixier, L.</span>, and <span class="smcap">Maillet</span>: Hematologie et Altérations -osteo-médullaires dans la Maladie de Barlow, Compt. Rend. de l’Assoc. -de <ins title="Transcriber’s Note: originally Pèdiatrie">Pédiatrie</ins>, 1913–15, 123.</p> +<p><span class="smcap">Nobécourt, P.</span>, <span class="smcap">Tixier, L.</span>, and <span class="smcap">Maillet</span>: Hematologie et Altérations +osteo-médullaires dans la Maladie de Barlow, Compt. Rend. de l’Assoc. +de <ins title="Transcriber’s Note: originally Pèdiatrie">Pédiatrie</ins>, 1913–15, 123.</p> <p><span class="smcap">Nocht, B.</span>: Festschrift zum 60 Geburtstage v. R. Koch, 1903, 203.</p> @@ -9944,7 +9906,7 @@ XXXIII, 471.</p> <p><span class="smcap">Plantenga, B. P.</span>: Rohe Milch als Saeuglingsnahrung, Arch. f. Kinderheilk., 1912, VIII, 155.</p> -<p><span class="smcap">Poupart</span>: <ins title="Transcriber’s Note: originally Etranges">Étranges</ins> Effets du scorbut arrivés à Paris en 1699, Hist. de +<p><span class="smcap">Poupart</span>: <ins title="Transcriber’s Note: originally Etranges">Étranges</ins> Effets du scorbut arrivés à Paris en 1699, Hist. de l’Acad. Royale des Sci., 1699.</p> <p><span class="smcap">Ralfe, C. H.</span>: Inquiry into the General Pathology of Scurvy, Lancet, London, @@ -9988,7 +9950,7 @@ gesammten Phosphorstoffwechsels, Beihefte z. Arch. f. Schiffs-u. Tropenhygiene, <p><span class="smcap">Schmorl, G.</span>: (1) Ueber Stoerung des Knochenwachstums bei Barlow’scher Krankheit, Centralbl. f. allg. Path. u. path. Anat., 1899.</p> -<p><span class="smcap">Schmorl, G.</span>: (2) Zur Path. Anatomie der Barlowschen Krankheit Beiträge +<p><span class="smcap">Schmorl, G.</span>: (2) Zur Path. Anatomie der Barlowschen Krankheit Beiträge z. path. Anat., 1901, XXX.</p> <p><span class="smcap">Schmorl, G.</span>: (3) Ueber die Pathogenese der bei Moeller-Barlowscher Krankheit @@ -9998,10 +9960,10 @@ LXVI, 50.</p> <p><span class="smcap">Schoedel, J.</span>, and <span class="smcap">Nauwerk, C.</span>: Untersuchungen ueber die Moeller-Barlow’sche, Krankheit, Jena, 1900.</p> -<p><span class="smcap">Schreiber, G.</span>: Scorbute et Dysenterie, Paris Médical, 1918, VII, 508.</p> +<p><span class="smcap">Schreiber, G.</span>: Scorbute et Dysenterie, Paris Médical, 1918, VII, 508.</p> -<p><span class="smcap">Schreiber, G.</span>, and <span class="smcap">François, M.</span>: Scorbut Infantile chez un enfant de quatre -ans nourri au lait homogénéisé, Arch. de Méd. des Enfants, 1914, XVII, +<p><span class="smcap">Schreiber, G.</span>, and <span class="smcap">François, M.</span>: Scorbut Infantile chez un enfant de quatre +ans nourri au lait homogénéisé, Arch. de Méd. des Enfants, 1914, XVII, 610.</p> <p><span class="smcap">Seidell, A.</span>: Vitamines and Nutritional Diseases, U. S. Public Health Reports, @@ -10039,7 +10001,7 @@ Industry, Ann. Rep. 1895–96, 172.</p> <p><span class="smcap">Steenbock, H.</span>, <span class="smcap">Boutwell, P. W.</span>, and <span class="smcap">Kent, H. E.</span>: Fat-Soluble Vitamine, J. Biol. Chem., 1918, XXXV, 517.</p> -<p><span class="smcap">Stefánsson, V.</span>: Observations on Three Cases of Scurvy, Jour. Am. Med. +<p><span class="smcap">Stefánsson, V.</span>: Observations on Three Cases of Scurvy, Jour. Am. Med. Assn., 1918, LXXI, 1715.</p> <p><span class="smcap">Steiner</span>: Kompendium der Kinderkrankheiten, Leipzig, 1878, F. C. W. Vogel.</p> @@ -10064,11 +10026,11 @@ XXXIII, 497.</p> <p><span class="smcap">Sugiura, K.</span>, and <span class="smcap">Benedict, S. R.</span>: The Nutritive Value of the Banana, Jour. Biol. Chem., 1918, XXXVI, 171.</p> -<p><span class="smcap">Sutherland, G. A.</span>: On Hæmatoma of the Dura Mater Associated with +<p><span class="smcap">Sutherland, G. A.</span>: On Hæmatoma of the Dura Mater Associated with Scurvy in Children, Brain, 1894, XVII, 27.</p> <p><span class="smcap">Talbot, F. B.</span>, <span class="smcap">Dodd, W. J.</span>, and <span class="smcap">Peterson, H. O.</span>: Experimental Scorbutus -and the Röntgen Ray Diagnosis of Scorbutus, Boston Med. and Surg. +and the Röntgen Ray Diagnosis of Scorbutus, Boston Med. and Surg. Jour., 1913, CLXIX, 232.</p> <p><span class="smcap">Tobler, W.</span>: Der Skorbut in Kindesalter, Zeitschr. f. Kinderheilk., 1918, @@ -10100,7 +10062,7 @@ klin. Wochenschr., 1917, XXX, 1449.</p> Emorragico-scorbutiche tra le Truppe Combattenti, Il Policlinico, Sez. Pratica, 1917, XXIV, 873.</p> -<p><span class="smcap">Variot, G.</span>: Du Lait <ins title="Transcriber’s Note: originally Sterilisé">Stérilisé</ins>, Compt. rend. de l’Acad. d. Sci., 1905, +<p><span class="smcap">Variot, G.</span>: Du Lait <ins title="Transcriber’s Note: originally Sterilisé">Stérilisé</ins>, Compt. rend. de l’Acad. d. Sci., 1905, CXXV, 1002.</p> <p><span class="smcap">Vedder, E. B.</span>: Beriberi, New York, 1913, Wm. Wood & Co.</p> @@ -10863,7 +10825,7 @@ mastitis. If such proves to be the case, it would have an important bearing on the question of scurvy and pseudo-scorbutic conditions in nursing infants.</p></div> <div class="footnote"> -<p><a name="Footnote_11_11" id="Footnote_11_11"></a><a href="#FNanchor_11_11"><span class="label">11</span></a> In the case of the “lait maternisé,” which is a milk of high fat content, +<p><a name="Footnote_11_11" id="Footnote_11_11"></a><a href="#FNanchor_11_11"><span class="label">11</span></a> In the case of the “lait maternisé,” which is a milk of high fat content, the dilution of the preparation also must have been a factor. Ounce for ounce, cream is poorer in antiscorbutic vitamine than an equal quantity of milk. It is also possible that the mere dilution of milk—quite apart from @@ -10933,7 +10895,7 @@ I have called the second stage it is hardly to be cured without their (fruits and vegetables) assistance.” (Lind.)</p></div> <div class="footnote"> -<p><a name="Footnote_20_20" id="Footnote_20_20"></a><a href="#FNanchor_20_20"><span class="label">20</span></a> Caillé has described a case of scurvy in an infant suffering from Mongolian +<p><a name="Footnote_20_20" id="Footnote_20_20"></a><a href="#FNanchor_20_20"><span class="label">20</span></a> Caillé has described a case of scurvy in an infant suffering from Mongolian idiocy, and we have also seen a similar case.</p></div> <div class="footnote"> @@ -11027,8 +10989,8 @@ a periosteum which is not normal; it is insecurely attached to the shaft of the bone, so that it is readily stripped off by hemorrhage.</p></div> <div class="footnote"> -<p><a name="Footnote_35_35" id="Footnote_35_35"></a><a href="#FNanchor_35_35"><span class="label">35</span></a> Hogs fed on 1.5 kg. of rye bread and 0.5 kg. of meat heated to 100° -or 110° C. for a half hour showed the hemorrhages, loosening of the teeth +<p><a name="Footnote_35_35" id="Footnote_35_35"></a><a href="#FNanchor_35_35"><span class="label">35</span></a> Hogs fed on 1.5 kg. of rye bread and 0.5 kg. of meat heated to 100° +or 110° C. for a half hour showed the hemorrhages, loosening of the teeth and affections of the gums characteristic of scurvy, as well as the paralysis and neuritis typical of polyneuritis.</p></div> @@ -11082,7 +11044,7 @@ on the Outbreak of Scurvy in the Recent Arctic Expedition—1877 (cited from Chick and Hume).</p></div> <div class="footnote"> -<p><a name="Footnote_42_42" id="Footnote_42_42"></a><a href="#FNanchor_42_42"><span class="label">42</span></a> The swede is a root vegetable of the natural order Cruciferæ. It is +<p><a name="Footnote_42_42" id="Footnote_42_42"></a><a href="#FNanchor_42_42"><span class="label">42</span></a> The swede is a root vegetable of the natural order Cruciferæ. It is grown to a large extent in England, but is practically unknown in the United States.</p></div> @@ -11096,15 +11058,15 @@ Scurvy. James Lind, London, 1772, p. 143.)</p></div> <div class="footnote"> <p><a name="Footnote_44_44" id="Footnote_44_44"></a><a href="#FNanchor_44_44"><span class="label">44</span></a> The cabbage was subjected to a preliminary drying for 8 days at -37° C. It was then put in an air-tight desiccator which contained a dish of +37° C. It was then put in an air-tight desiccator which contained a dish of phosphorus pentoxid. (The pentoxid was replaced for several weeks until it ceased to liquefy.) It was then placed in cylinders which had been rendered air free by means of a suction pump and which contained phosphorus pentoxid. -This was kept at 37° C. and examined after 10, 18 and 26 months. +This was kept at 37° C. and examined after 10, 18 and 26 months. A similar result was not obtained when calcium chlorid was employed, the -temperature held at 37° C. and the cabbage was kept in an air-tight cylinder +temperature held at 37° C. and the cabbage was kept in an air-tight cylinder rather than in a vacuum. However, under these conditions if the cabbage -was placed in the ice-box at a temperature of 4°, 10° or 12° C. the antiscorbutic +was placed in the ice-box at a temperature of 4°, 10° or 12° C. the antiscorbutic property was conserved after boiling.</p></div> <div class="footnote"> @@ -11134,7 +11096,7 @@ insecurely attached to the shaft of the bone, and is readily stripped off by hemorrhage.</p></div> <div class="footnote"> -<p><a name="Footnote_48_48" id="Footnote_48_48"></a><a href="#FNanchor_48_48"><span class="label">48</span></a> Senator regarded the marrow in scurvy as being aplastic. Nobécourt, +<p><a name="Footnote_48_48" id="Footnote_48_48"></a><a href="#FNanchor_48_48"><span class="label">48</span></a> Senator regarded the marrow in scurvy as being aplastic. Nobécourt, Tixier and Maillet report postmortem examinations where the marrow showed an increased number of myelocytes and nucleated red cells of various kinds. They consider the typical blood change an intense myeloid reaction @@ -11152,7 +11114,7 @@ to entirely obstruct the return flow of the blood. </p> <p> The test is considered to be “positive” when the forearm shows many -petechial spots. In normal infants petechiæ were almost always absent, or +petechial spots. In normal infants petechiæ were almost always absent, or there were few to be seen. This is not a specific test for scurvy, but demonstrates a weakness of the vessel walls, whatsoever may be the cause. It is found to be positive in the majority of cases of scurvy.</p></div> @@ -11236,386 +11198,9 @@ a necropsy report of Hart and Lessing on one of five monkeys fed on a scorbutic diet. This animal died of disseminated tuberculosis, and the bones showed “the classic picture of severe rickets.” This occurrence cannot be explained, although illness and lack of exercise no doubt played a -rôle. Until similar cases are reported, the incident must be regarded merely +rôle. Until similar cases are reported, the incident must be regarded merely as interesting and suggestive.</p></div></div> - - - - - - - -<pre> - - - - - -End of Project Gutenberg's Scurvy Past and Present, by Alfred Fabian Hess - -*** END OF THIS PROJECT GUTENBERG EBOOK SCURVY PAST AND PRESENT *** - -***** This file should be named 40505-h.htm or 40505-h.zip ***** -This and all associated files of various formats will be found in: - http://www.gutenberg.org/4/0/5/0/40505/ - -Produced by Bryan Ness, Thiers Halliwell and the Online -Distributed Proofreading Team at http://www.pgdp.net (This -file was produced from images generously made available -by The Internet Archive/American Libraries.) - - -Updated editions will replace the previous one--the old editions -will be renamed. - -Creating the works from public domain print editions means that no -one owns a United States copyright in these works, so the Foundation -(and you!) can copy and distribute it in the United States without -permission and without paying copyright royalties. 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