The Vitamine Manual by Walter H. Eddy

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Emmett has recently opposed this view and suggests that while the
antineuritic factor and the growth factor are found in the same sources
and have much in common it does not follow that they are identical and
that his experiments tend to show that there are marked differences which
suggest that the "B" type is not a single entity but a group. Mitchell has
summarized very well the controversial phases of this question with an
impartial review of the facts. One of strongest of the opposition
arguments lies in the failure of milk to cure beri-beri except when
administered in large quantities. This objection has been partly allayed
by data bearing on the relation of the milk content to the food of the
cow. Hess, Dutcher, Hart and Steenbock and others have adduced sufficient
evidence to show that the vitamine content of the milk of a cow is largely
determined by the cow's food and as a consequence the milk may be very
poor in vitamine. It is obvious then that the failure of the milk to cure
beri-beri in a given case might be due to this cause and not to lack of
identity of the curative with the growth factor. Osborne and Mendel have
also shown that milk in general must not be classed among the rich sources
of the vitamine, even when the cow's food is rich in vitamine. The
principal facts in the controversy have been presented and at present the
evidence for regarding the vitamines identical seems to be preponderant.

Recently Auguste Lumiere in Paris has put forth the view that polyneuritis
is not merely a vitamine deficiency disease but a nutriment deficiency
disease. He reports that he fed birds on a starvation diet, but with
plenty of vitamine "B". These birds developed polyneuritis and were cured
by adding to the diet plenty of polished rice. The view he wishes us to
take is that all factors must be present and that the absence of the
nutriment is as important as the absence of the vitamine.

In the field of nutrition the absence of the "B" type is particularly
marked by the behavior of the deprived animal. Rats transferred from a
vitamine-free diet to one containing the "B" only, make a much more rapid
recovery toward normal (even in the absence of the "A") than do animals
transferred from the vitamine-free diet to one containing the "A" and not
the "B". This initial jump from addition of the "B" will not continue long
in the absence of the "A", as a general rule. Hess believes that in some
of his infants he was able to show markedly successful growth on the diet
deficient in the "A" but rich in the "B". It is not certain however that
his diets were sufficiently devoid of the "A" factor to be declared "A"
vitamine-free and we know little of the amount of the "A" necessary to
normal infant growth. All results however show that both "A" and "B" are
necessary to growth production and though the term growth vitamine was
applied to the "A" originally the distinction is one that should be
rejected, for both "A" and "B" and possibly "C" are all entitled to this
name.

The manner in which the "B" vitamine acts is still obscure. Voegtlin some
time ago tried to demonstrate that it was identical with secretin and
stimulated pancreatic flow. Recent work at the Johns Hopkins University by
Cowgill and by Aurep and Drummond in England has failed to confirm this.
One of its most marked immediate effects is increase in appetite. Karr in
Mendel's laboratory has shown that dogs which refused their basal diet
would resume eating it if they were allowed to ingest separately a little
dried yeast. Karr studied the metabolism of these dogs as regards nitrogen
partition but the results give little data that is explicatory of the
behavior of the vitamine. In 1915 the author was able to bring about
marked immediate improvement and the ultimate recovery of a number of
infants who were of the marasmic type by merely increasing the "B"
vitamine content of their food. In these cases the vitamine was carried by
Lloyd's reagent and administered mixed with cereal, or the crude extract
was combined with the milk. The pancreas of the sheep was the source used.
In these cases the growth curve changed abruptly from a decline to a sharp
rise and this increase in weight continued and was accompanied by all the
other signs of improved nutrition including increase in appetite. The
change in the growth curve from decline to rise was accomplished without
increasing or changing the basal diet but as the appetite increased the
food had naturally to be increased to keep pace. In these cases the effect
of the vitamine was to enable the child to utilize its normal food and to
increase its appetite for it. This action certainly suggests stimulation
of digestive glands. It also showed that even though the diet may contain
the vitamine as was the case in the milk fed to these children the
addition of the vitamine in concentrated form often gives an upward push
that the food mixture fails to accomplish. Daniels and Byfield have
recently confirmed the effect of increased "B" in infant growth. Cramer
has suggested in a paper published recently in _The American Journal of
Physiology_ that the fatty tissue about the suprarenals may be a
depository of vitamine and that in the absence of vitamine this tissue
loses its supply and that this is the explanation of lessened activity of
that gland in certain metabolic disturbances. This idea tends to support
the idea that vitamines are gland stimulants or hormones and the word food
hormone has been suggested to describe them on that account. A few years
ago Calkins and Eddy tried to determine the effect of the vitamine on the
single cell by use of the paramecium but the results of the experiments
failed to show a vitamine requirement on the part of these animals.
McDougall has recently suggested that the vitamines produce their effect
on yeast cells by increasing hydration. Unfortunately nearly all stimuli
which produce growth are accompanied by hydration effects and it is
difficult to feel that this is a specific vitamine effect although without
denying the possibility. Dutcher has tried to show that vitamines have a
relation to oxidation effects. He observed that the issues of polyneuritic
birds showed a marked reduction in catalase and that this catalase was
restorable by curing the birds with vitamine. The main difficulty lies in
the conflexity of factors that function between cause and effect.

[Illustration: FIG. 8. THE EFFECT OF VITAMINE B ON A MARASMIC INFANT

_1_. On the twentieth day the patient developed a cough. _2_. On
the twenty-first day the cereal was reduced from three times a day to
twice a day. The patient cried during the night. _3_. On the twenty-
second day the stools showed free starch. _4_. On the twenty-third
day an anal abscess was opened. The stools continued to show free starch
until the twenty-fifth day. _5_. On the twenty-fifth day the stools
showed soluble starch but no free starch. _6_. On the twenty-seventh
day the appetite was good and there was no starch. _7_. From the
twenty-eighth to the forty-third day no starch was observed in the stools.
_8_. On the thirty-first day the patient developed a cough. _9_.
From the forty-ninth day to the time of discharge three tablespoonsful of
orange juice were given daily. _10_. On the seventy-third day the
patient developed a bronchitis and mustard paste was applied every four
hours up to the eighty-fourth day.

_V1_ = From the twenty-first day to the forty-third day the patient
received each day 2 grams of Lloyd powder, activated with pancreatic
vitamin. The powder was administered by mixing 1 gram. with each cereal
feeding. The result was 20 ounces gain in twenty-two days, a normal
growth.

_V2_ = After a period of ten days without vitamin, during which the
patient settled down to a level growth curve, the treatment described
under V1 was resumed. This was continued from the fifty-third to the
seventy-sixth day. The result was the resumption of growth but at a slower
rate; 8 ounces were gained in twenty-three days. During the latter part of
the period the patient developed a bronchitis. At the end of this period
the patient was placed on a whole milk formula. From that time to the time
of discharge the patient grew normally.--From the _American Journal of
Diseases of Children,_ 1917, xiv, 189.]

[Illustration: Effects of Vitamines on Growth FIG. 9]

These views are at best speculations. The literature is singularly lacking
in detailed metabolic analyses of excreta of animals during vitamine
stimulation and we know nothing of the possibilities of overdosage, for in
all the work done it has been generally assumed that the presence of an
amount greater than that necessary to produce normal growth is not
material.

The exact manner of the vitamine's action then remains to be determined
and it is obvious that this solution will come much more rapidly if we can
first identify the substance chemically.

VI. THE PHYSIOLOGICAL PROPERTIES OF THE "C" VITAMINE

The steps that led to the acceptance of scurvy as a vitamine deficiency
disease have already been discussed and show how the vitamine acts in such
a disease. Practically all the work done with this vitamine to date has
been concerned either with dosage or with reaction to heat, drying, etc.
The only paper that we have seen that suggests another function than
antiscorbutic power for this vitamine is the one by McCollum and Parsons
in which they suggest that even in animals where scurvy does not exist,
the presence of this factor may be necessary to normal metabolism. The
following table gives some of the data compiled by the British workers as
to the antiscorbutic power of various sources:

_Table compiled from, page 44, British Medical Research Committee
Report_

________________________________________________________________________
| |
| | MINIMUM DAILY
FOODSTUFF | VALUE AGAINST | RATION NECESSARY
| SCURVY | TO PREVENT SCURVY
| | IN GUINEA PIGS
_______________________________|_______________|________________________
| |
_Cereals:_ | |
Whole grains . . . . . . . . | 0 |
Germ . . . . . . . . . . . . | 0 |
Bran . . . . . . . . . . . . | 0 |
Endosperm . . . . . . . . . | 0 |
_Pulses:_ | |
Whole dry . . . . . . . . . | 0 |
Germinated (lentils) . . . . | ++ | 5.0 grams
_Vegetables:_ | |
Cabbage (raw). . . . . . . . | ++++ | 1.0 gram
Cabbage (cooked one-half | |
hour at 100 C) . . . . . . | ++ | 5.0 grams
Runner beans (green pods). . | +++ | 5.0 grams
Carrot (juice) . . . . . . . | + | 20.0 cc.
Beet root (juice). . . . . . | + | More than 20 cc.
Swede (juice) . . . . . . . | +++ | 2.5 cc.
Potatoes (cooked one-half | |
hour at 100 C . . . . . . | + | 20.0 grams
Onions . . . . . . . . . . . | + |
Desiccated vegetables . . . | 0 to + | 60.0 grams expressed
| | as equivalent in
| | fresh cabbage
_Fruits:_ | |
Lemon juice (fresh) . . . . | ++++ | 1.5 cc.
Lemon juice (preserved) . . | ++ | 5.0 cc.
Orange juice (fresh) . . . . | ++++ | 1.5 cc.
Lime juice (fresh) . . . . . | ++ | 10.0 cc.
Lime juice (preserved) . . . | 0 to + |
Grapes . . . . . . . . . . . | Less than + | More than 20.0 grams
Apples . . . . . . . . . . . | Less than + |
Apples dried . . . . . . . . | Less than + |
Tamarind dried . . . . . . . | Less than + |
Mango . . . . . . . . . . . | Less than + |
Kokum . . . . . . . . . . . | Less than + |
_Meat:_ | |
Raw, juice . . . . . . . . . | Less than + | More than 20 cc.
Tinned . . . . . . . . . . . | 0 |
_______________________________|_______________|_______________________

A glance at this table shows the richest sources (see also table on page
59.) To these must be added canned tomato juice which Hess has shown
practically equal to orange juice in efficiency and uses with infants in
the same quantity. This discovery is of great value in instances where the
cost of orange juice is often prohibitive.

La Mer and Campbell have presented some evidence to show that the
antiscorbutic vitamine has a direct effect upon the adrenal glands. In
their scurvy cases they find definite evidence of the enlargement or
hypertrophy of this organ. Whether it affects other organs or not it
remains to be shown.

CHAPTER VII

HOW TO UTILIZE THE VITAMINE IN DIETS

In the preceding chapters it has been the aim to present the findings of
the principal workers in the field. In attempting to summarize the work of
so widely scattered a group as are now engaged in vitamine research it is
impossible to cover completely the many investigations and it is
inevitable that some work will have been overlooked, but the foregoing
covers at least the principal data on the subject. What is the bearing of
all this information on human behavior and what lessons can the layman
draw from it that is of direct application to him? Let us first consider
this question from the dietary viewpoint.

I. INFANT NUTRITION

The limited character of the infant's diet has made the consideration of
vitamine content in his diet much more important than in the case of the
adult with the latter's wide variety of choice. It is evident from the
previous data that a growing infant must not only be provided with a
sufficient supply of calories, nutrients and salts, but must also have a
liberal supply of the three vitamines. Milk has in general been classed as
adequate in all these features, but the vitamine researches have forced us
to reconsider our views in regard to this staple.

The first point to be borne in mind is that the vitamine content of either
cow or human milk is dependent primarily upon the food eaten by the
producer of the milk. In other words milk is merely a mobilization of the
vitamines eaten and if the diet is to yield vitamine-rich milk it must
itself be rich in these factors. Many a cow produces milk low in vitamine
content and the same is true of nursing mothers. There are many "old
wives" prejudices in regard to what food a lactating mother may eat and
unfortunately many of these prejudices are extremely injurious and false.
One of them is the prejudice against green vegetables. Experience has
shown that under ordinary conditions such vegetables are well tolerated by
the mother and from their content of vitamine it is evident that they are
suppliers of these factors. In the case of the cow the fact that cereals
are poor in some of the vitamines and green grasses rich therein, teaches
a lesson that bears directly upon winter feeding of cattle if the milk
supply is to be used for infants. We need a series of diets and cattle
foods for just this purpose of insuring the proper vitamine content in
milk. The preceding tables will enable one to develop such diets fairly
satisfactorily, but more data is urgently needed.

The second point in regard to milk lies in the effect of pasteurization.
This measure is now well nigh universal and in America at least has played
a tremendous part in the reduction of infant mortality, especially during
the summer months. At present, however, we know that this treatment while
removing dangerous germs may also eliminate the antiscorbutic factor. The
sensible attitude then is to recognize this fact and if a clean whole milk
is not available retain the pasteurization and meet the vitamine
deficiency by other agents. Such agents are orange juice and tomato juice
and experience has already shown that these juices can be well tolerated
by infants much earlier than used to be thought possible.

While the pasteurization does not appreciably affect the content of "A" or
"B" vitamines, the variability in content of these vitamines in milk
indicates that it may at times be necessary to supplement them in the
diet. In this connection it must be borne in mind that cereals vary widely
in content and cannot be, as they often are now, considered equivalent in
growth stimulation power. This is a subject that needs special attention
on the part of vitamine experts and dietitians and finally by the food
manufacturers. A good vitamine-rich cereal combination would form an
excellent adjuvant to infant dietaries after they reach the age of
tolerance to such a diet. But even before that time the expressed juice of
various vegetables as well as fruits is found to be well tolerated when
mixed with the milk or given separately, and carrot and spinach juice are
now being used in this connection with good results. These juices like
orange juice contain the B type in abundance and there is no doubt that in
their stimulation to the appetite they play an important part in making
the desirable daily gain.

Fortunately for the layman he has in the scales a good indicator of the
normal progress of his child and so long as growth is normal he can fairly
assume that the diet is adequate but if the scales say otherwise it is
time for him to seek advice and then he is wise who insures that his
medical adviser knows the newer aspects of nutrition. The parent can do
this only by proper selection, but with a little knowledge he can soon
satisfy himself as to whether his pediatrist is the right sort and it is
one of the purposes of this text to bring home to the layman his
responsibility in this matter.

There has grown up in this country a great regard for prepared milk
substitutes in infant feeding and a wide usage of condensed milks,
reinforced milks, diluted milk formulae, etc. All such preparations must
be examined anew in the light of the vitamine discoveries and unless the
given preparation can show a clean bill of health in vitamine content, it
should be either discarded or properly supplemented.

As children grow up, it is fortunate that in their wider choice of
dietaries the danger of vitamine deficiency decreases. But even in
childhood it is unsafe to rely too much on chance. In this country there
are well deserving movements on foot to attract the parents of the
community to the necessity of attention to simple standards of growth
progress, and clinics for this purpose are appearing in increasing numbers
with each year. Such movements are to be most heartily approved. It is
also possible in these measures to not only build better children, but to
make the children themselves intelligent in their rejection of unsuitable
combinations and in that way not only conserve their own health, but
provide an educated body of citizens to pass on the knowledge to future
generations. In a school in New York City I recently had occasion to
discuss the school lunch room and its offerings with the children of the
school in the light of vitamine discoveries. The keenness and intelligence
shown by the children in the discussion that followed has convinced me
that in this matter of vitamines the children themselves can be relied
upon to assist materially in the matter of better food combinations and
intelligent selection.

Finally it must be noted that one of the most common of infant
deficiencies is the failure of the bones to lay down lime. The effect of
this failure is commonly described as rickets. The British workers
consider that this deficiency is a lack of vitamine "A." Their views have
been set forth at greatest length by Mellanby, the principal worker in
this subject. While this view is still debatable and in this country it is
not yet accepted, one fact has come out in the controversy and that is the
remarkable value of cod-liver oil as a preventive of rickets. It may be
that the power of the oil is due to its "A" vitamine content in which it
is known to be rich, or it may be due to a new vitamine, but the fact that
the oil is a preventive in this respect gives the pediatrist another agent
to insure normal growth. The various views on the causes of rickets are
set forth more in detail in Chapter VIII.

II. ADULT DIETS

A study of the dietary habits of various sections of the United States
shows that there is a very general tendency on the part of the majority of
the people to confine their foods to a meat, potato, and cereal diet. The
use of salads is looked upon by many sections as a foreign affectation and
too little attention is paid to the value of eggs, milk and cheese. Enough
has been said already to show that these latter articles have much more
than an esthetic value and one of the missions of the nutrition expert
must be to show the people why dairy products and salads must become
features in the every-day meals of the every-day people. And even if the
salads are still unappreciated, it is necessary that cooked green
vegetables occupy more of a position in the menu than is too often the
case.

There has recently appeared a crusade for the eating of yeast cakes. The
claim made for their use rests on a perfectly firm basis, they are rich in
the "B" vitamine, the proteins of the yeast cake are of good quality and
the cake contains no ingredients poisonous to man. Many people are
reporting beneficial effects from their use. Is there any lesson to be
drawn from this experiment? I feel that the very fact that benefits have
resulted from this yeast feeding is excellent evidence of lack of the
vitamine in the diets of the people affected and a clear argument that the
dietary habits of many people need adjustment to a higher vitamine
content. Whether it is necessary to use yeast cakes or any other
concentrate of vitamine, depends entirely upon whether the ordinary diet
is lacking in these factors and my first advice in the matter would be to
make if possible a selection of the vitamine containing foods and see if
normal conditions did not result before utilizing foods whose taste is not
pleasing or which are taken as medicine. For it is an old experience that
medicines will be taken only so long as the patient is sick and perhaps it
is just as well so. In other words I believe it is possible with
intelligent selection based on such tables as are given in Chapter IV for
people to secure from the butcher and the grocer all their requirements of
these vitamines as a part of their regular palatable diet. To those who
have neglected this selection and find remedy in concentrates, that fact
should lead them to reconstruct their diet rather than persist in
dependence on the medicine to correct faulty diet. In other words the same
arguments apply to the use of medicinal concentrates of vitamines as
applies to the use of laxatives. At times these substances are very
valuable as cures, but it is better by far to so regulate the dietary
habits as to avoid the necessity for their use.

Another phase of this matter that promises to develop in the near future
as a result of the vitamine hypothesis is a reform in food manufacture.
There has been a strong tendency during the past two decades to "purify"
food products. The genesis of this tendency is to be found in a highly
laudable ambition to force the manufacturer to eliminate impurities and
adulterations and provide clean, wholesome, sanitary food. Unfortunately
in attempting to meet this demand on the part of the public, the food
manufacturer has sometimes neglected to seek advice from the nutrition
expert and the latter has failed to appreciate the need of advice. The net
result has been to discover that Nature is often a better chemist than man
and has a much better knowledge of what man needs in his diet than the
chemist. The chemist employed by the manufacturer has, as a result, gone
to such a limit in his development of purification methods as to often
eliminate the essential nutrients and the result has been foods that will
stand analysis for pure nutrients, but which will not stand Nature's
analysis for dietary efficiency. As a secondary result of this tendency we
have acquired habits that in many cases must either be broken or must have
grafted on to them other habits which shall remedy the defective ones.
Take the milling of wheat as an example. Nature put into the wheat grain
most of the elements needed by man and in the early days he was content to
grind up the whole grain and find it palatable. The craze for purity as
expressed by color has gradually replaced this whole meal wheat with a
beautiful white product that is largely pure starch with a few of the
proteins retained. And the principal protein retained lacks one of the
greatest essentials for growth while the vitamines have all been
practically eliminated with the grain germ. Intelligence tells us then
that if, having formed the habit, we will persist in our appetite for
white flour we must see to it that the protein deficiency of the latter
and its lack of vitamines is compensated for by supplementing the diet
with the food-stuffs in which these are rich. We may in other words retain
our bad habits in taste if we will graft on to them the attention to the
eliminated factors and their substitution in other form.

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