The Vitamine Manual by Walter H. Eddy

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In general then, the adult needs to review his feeding habits and analyze
them in the light of our new knowledge. For this purpose the tables of
Chapter IV supply data useful so far as vitamines are concerned, but it
will be perhaps worth while to repeat here some of this data in more
generalized form.

_a. Sources of the "A" vitamine_

Its most abundant sources are milk, butter, egg yolk fat, and the green
leaves of plants usually classed as salads. Cabbage, lettuce, spinach and
carrots contain this substance in considerable quantity. The germ of
cereals is fairly rich in the factor, but the rest of the grain is
deficient and white flours are therefore poorer than whole meals in this
respect. Cooking temperatures have little effect on this vitamine and
hence little attention need be paid to cooking temperatures as far as this
vitamine is concerned.

_b. Sources of the "B" vitamine_

Its principal sources outside of yeast are the seeds of plants and the
eggs and milk of animals. Meat contains relatively little of this
substance but glandular organs such as the liver and pancreas are fairly
rich in it. In the seeds the distribution is general throughout the whole
body of the seed in the case of beans, peas, etc., but in the cereal
grains it is largely restricted to the embryo portion and hence a high
degree of milling tends to reduce the per cent of this factor in any
highly milled cereal. White flour and polished rice are notable examples
of deficiency of "B" vitamine due to this milling process. Fruits such as
oranges, tomatoes, and lemons are good sources and there is a fair amount
present in the apples and grapes and other common food fruits. Many
vegetables show it in fair abundance, notably potatoes, carrots, and
turnips, but the rule is not general for beets are extremely poor in this
factor. Nuts are also good sources. Eggs, milk and cheese contain it in
fair abundance. Cooking temperatures have little effect on this type if
the temperature does not climb above the boiling point and if the cooking
water is not "alkaline." In the latter case it becomes necessary to
determine the extent of destruction and either eat enough to insure
protection, or reform the method of cookery.

_c. Sources of the "C" vitamine_

Its richest sources are vegetables such as cabbage, swedes, turnips,
lettuce and watercress; fruits such as lemons, oranges, raspberries and
tomatoes. Certain of the vegetables such as potatoes have a substantial
value in this respect, but meat and most prepared milks are low in
antiscorbutic values. The susceptibility of this vitamine to drying, heat
and alkali, make it necessary to scrutinize your cooking methods very
carefully in order not to ruin a good source by a poor preparation of it
for the table.

CHAPTER VIII

AVITAMINOSES OR THE DISEASES THAT RESULT FROM VITAMINE DEFICIENCIES

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

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

I. BERI-BERI

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

II. SCURVY

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

III. RACHITIS (RICKETS)

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

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

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

IV. PELLAGRA

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

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

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

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

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

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

In elaborating on conclusion 5 Voegtlin states that:

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

V. OTHER AVITAMINOSES

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

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