In this connection the clinical experiences of Drs. Hess and Fish are instructive. Early in 1914 an outbreak of infantile scurvy occurred in the Hebrew Orphan Asylum, New York. The infants afflicted had been fed for several months upon a diet of cow's milk which had previously been heated to 145 degrees (Fahrenheit) for 30 minutes. No orange juice was included in the diet, because two years earlier a Medical Milk Commission had declared that for purposes of infant feeding, heated milk was fully the equivalent of raw milk. Despite the conclusion of this Commission, Dr. Hess recommended the addition of orange juice to the diet. The scorbutic symptoms cleared up rapidly.

A diet even more frequently employed than the above to produce scurvy in animals consists of oats, bran and milk that has been heated under carefully regulated conditions. Both fat-soluble A and water-soluble B are present in such a mixture, yet the animal develops scurvy.* Even large additions of butter fat or yeast to the diet has no effect whatsoever, showing that the scurvy is not due to a deficiency in fat-soluble A and water-soluble B vitamines. But the addition of a little orange juice immediately brings about a cure.

By developing scurvy in guinea-pigs and then trying the effect of the addition of various foodstuffs, we can determine which foods are antiscorbutic. In this way it has been shown that not only the orange, but all fruit juices contain the water-soluble C to a greater or less extent. So do fresh vegetables - cabbage, lettuce, potatoes, carrots and fresh meat. Milk, as we have stated, is not very rich in this vitamine; nor are dried vegetables. The cereal grains show almost an entire absence of it; so does heated or dried milk. The importance of adding orange juice to an infant's food consisting of dried milk now becomes evident.

Even where two or more vitamines are present in one food, the facts of the case are not as a rule altered. For example, experiments have shown that a diet in which clover or alfalfa is present to the extent of 5 per cent will supply the necessary quantity of fat-soluble A and induce growth in rats. If these vegetables are present to the extent of 15 per cent they will cure beriberi. The vegetables contain fat-soluble A and water-soluble B, but in different proportions. Orange juice, so valuable as an antiscorbutic, also contains appreciable quantities of the antineuritic vitamine that cures beriberi. The addition of orange juice to a child's diet, and its inclusion by the adult, serves, therefore, more than one purpose.

* " I regard the work of Givens and Cohen from my laboratory as most convincing because they used diets containing vitamine A, B, roughage, and good protein, and still secured scurvy." (Professor Mendel.)

Dr. Seidell, of the U. S. Department of Hygiene, and Dr. Harden, of the Lister Institute, London, have shown how by the use of "Fuller's earth," a common laboratory chemical, and other substances closely related to it, the antineuritic vitamine in orange juice can be completely removed, leaving only the antiscorbutic.

Note how such an experiment can be carried out. Your orange juice in sufficient quantities cures scurvy and cures beriberi, which means that the orange contains both vitamines responsible for such cures. You now mix your orange juice with "Fuller's earth" and shake. You next withdraw the "Fuller's earth" and you find that it has acquired the property of curing beriberi, but not scurvy. Before mixing the orange juice with "Fuller's earth" the latter cured neither the one nor the other disease. "Fuller's earth," by being mixed with orange juice, must have absorbed the antineuritic vitamine. The solution that is left after the "Fuller's earth" has been removed has the power of curing scurvy, but not beriberi. Hence we conclude that the antiscorbutic vitamine has not been removed by the chemical.

By the means outlined, any confusing results that might be obtained from the presence of more than one vitamine in the food is eliminated. For ordinary purposes, however, foods containing more than one vitamine are no drawback. We may certainly feel thankful that most of our foods do contain more than one vitamine.

Scurvy At The Siege Of Kut

How specific in behavior these vitamines are may be illustrated in an account taken from the siege of Kut. For four months, from December, 1915 to April, 1916, British and Indian troops were besieged by the Turks. During this period the food of the Britishers consisted of white flour or biscuits, tinned meats and horse flesh. The Indians refused to eat fresh meat (horse flesh), but ate ata or barley flour instead. The Indians developed scurvy and the British beriberi. Why? The nature of the cereal diet (rich in water-soluble B) protected the Indian troops from beriberi, but not from scurvy. On the other hand, the fresh meat the British troops ate protected them from scurvy, for the meat contained water-soluble C, but there was nothing in their diet to supply the water-soluble B. The white flour and biscuits are practically free from water-soluble B.

Scurvy In Northern Russia

In the northern parts of Russia scurvy makes its appearance quite regularly every year; yet the Allied troops sent to support the Anti-Bolsheviks were quite free from it. This was due to the fact that the British Government allowed itself to be guided, in its choice of food for soldiers, by the British leaders in nutrition. Professors Bayliss and Starling and Hopkins and Harden and Miss Chick have all been able exponents of the vitamine hypothesis. On their advice the Allied soldiers in Russia were allowed liberal amounts of such foods as soured milk, fresh meat, fresh lemon juice, etc. The results amply confirmed the claim made that scurvy is a deficiency disease due to the absence of one of the necessary vitamines.

Stefanson's Experiences In The Arctic

Stefan-son's polar expedition, to which reference has already been made, has also presented striking evidence in favor of the vitamine hypothesis to explain scurvy. All foods rich in water-soluble C, all foods that cure scurvy in animals, proved excellent antiscorbutics when used on his arctic expedition. Stefanson's emphasis of fresh food also confirms the experiments of many investigators that desiccated or preserved or heated foods lose much of their potency.

The loss in antiscorbutic value of canned food was strikingly shown in some work by Miss Chick, of the Lister Institute, London. Heating cabbage or beans for one hour at a temperature close to that of boiling water decreased the anti-scorbutic value by 70 per cent; and canning involves such a heating operation. Heated milk also loses its antiscorbutic quality. Even storage alone seems to have a deteriorating effect.

It should, however, be added that different antiscorbutic foods do show different heat-resisting power. The antiscorbutic in orange juice seems to resist increases of temperature much better than any of the antiscorbutics in other foods.

Stefanson's conclusions are worth quoting: "The strongest antiscorbutic qualities reside in certain fresh foods and diminish or disappear with storage by any of the common methods of preservation - canning, pickling, drying, etc. Fresh tomatoes may be of value - I have never tried them* - but canned tomatoes are of little or no value; fresh potatoes are good, but desiccated potatoes have shown little or no adequacy in our expedition. . . . The juice just expressed from fresh lime is said to be excellent, and I have no reason to doubt it; but bottled lime juice has never yet prevented scurvy. . . . Cooking lessens or destroys the value of most or all foods. . . . Bodily cleanliness and ventilation are not by any facts known to me shown to have any bearing on the incidence or severity of scurvy. Here it is instructive to compare the filth and good health of Nansen and Johansen, as described in Farthest North, with the immaculate Scott expeditions with their numerous and serious scurvy cases."

The last sentence is instructive, but it needs amplification to prevent it from being misleading.

* As a matter of fact they are.

Filth may bring on disease, but that disease will not be scurvy. The diseases due to filth are usually of bacteriological origin; but scurvy is not a disease due to bacteria; scurvy is not due to an infection.

The Value Of Fruit And Vegetables

This and preceding chapters bring to light new values of fruits and vegetables. Aside from their agreeable taste and appetizing character, and aside altogether from their mineral content, which certainly should not be minimized, the fruits and vegetables supply very necessary constituents to the diet. The deleterious effect on the vitamine efficiency of canned and dried foods is unfortunate. Utilization to the maximum degree of our foods is imperative, and canning and drying help this considerably. The value of drying is still further enhanced by the way the weight and bulk of the material is lessened; in most cases the reduction may amount to from 50 to 90 per cent, a factor important enough in the matter of storage and transportation.

Canning and drying we must have, and canned and dried foods we must use. But until improved methods of preserving foods are invented, whereby the vitamine efficiency of such foods will not suffer diminution, we must supplement our diet with fresh fruit and fresh vegetables, and, in general, as many fresh foodstuffs as possible. In the meantime, the attempted preparation of stable vitamine products by Dr. Harden and others deserves much encouragement.

In this connection it may be mentioned that Miss Chick, of the Lister Institute, has found that though dry beans contain little or no water-soluble C, these same beans, when allowed to sprout, do.* This discovery was used to advantage in the later stages of the Great War.

* This was first observed by Dr. Furst in 1912.