Dr. Barlow's Treatment

The cases of infantile scurvy that Sir Thomas Barlow describes are those of children who had never been breast-fed, but had received proprietary infant foods, condensed milk and perhaps a little fresh milk. Dr. Barlow's treatment consisted in giving each such child plenty of fresh milk - a full pint for a child six months old - sieved potato (in the place of the proprietary food), and a tablespoonful of orange juice. Striking recoveries were made in two to three days.

The treatment just outlined cannot be improved upon to-day. Sir Thomas Barlow's account of the disease, as well as his treatment of it, is a most complete clinical picture. What we do know today that Barlow did not know in the eighties, is that the foods that benefit the sufferer are rich in vitamine C.

Sir Thomas Barlow's opinion that the disease is intimately related to the type of food eaten has not gone unchallenged, despite the amazing results which he obtained with his treatment of the disease. Russian physicians in particular were - and some still are - of the opinion that scurvy is the result of an infection. We have heard a similar story regarding rickets. It is so easy to regard each distinct disease as being due to a specific bacterium; and physicians, being mortal, and being impressed by the wonderful advances made by the science of bacteriology, are sometimes apt to lose all sense of perspective, and ascribe to bacteria the sum total of human suffering. But the fact remains that neither in rickets nor in scurvy has any microorganism in any way related to these diseases been isolated. Where infection has arisen it could be ascribed to secondary causes just as easily; to the generally lowered resistance of the body, for example.

Recently (March, 1920) Drs. Givens and Hoffmann, of the Western Pennsylvania Hospital, Pittsburgh, have presented the most convincing evidence yet advanced against the bacteriological hypothesis. Blood from scorbutic animals, regardless of the diet producing the disease, has been found to be sterile. "The enlarged front joints of guinea-pigs developing scurvy on oats alone were sterile; this was likewise true in the majority of cases of guinea-pigs developing scurvy on other special diets. Occasionally staphylococci were isolated, but these could not be made to produce scurvy when introduced into healthy guinea-pigs."

Equally unsatisfactory and vague is the hypothesis that the disease originates from some toxic materials in the food. What these toxic materials are no one has the remotest idea.

The contention by Dr. McCollum that the curative value of antiscorbutic foods is merely due to their laxative properties, and that such foods are indeed interchangeable with such laxatives as liquid petrolatum and phenolphthalein, has been disproved, and I understand that Dr. McCollum himself no longer believes it. In his book on The Newer Knowledge of Nutrition, which was published in 1918, Professor McCollum says (page 97): "McCollum and Pitz found in the guinea-pigs which had died of scurvy, that the cecum, which is a very large and very delicate pouch through which the food must pass in going from the small to the large intestine, was always packed with putrefying feces. They decided that the mechanical difficulty which the animals have in the removal of feces of an unfavorable character from this part of the digestive tract was in some way related with the development of the disease.

"That this assumption was correct, was shown by the fact that the administration of liquid petrolatum, a 'mineral' product to which no food value can possibly be attributed, served to relieve a certain number of animals after they were near death from the disease, while confined strictly to the diet of oats and milk which caused them to develop scurvy. The explanation which they offered was that liquid petrolatum served to improve the physical properties of the contents of the packed cecum, and thus enable the animals to rid themselves of this mass which was undergoing putrefactive decomposition."

As has already been stated, Dr. McCollum himself no longer shares these views. The criticism of his experiments centers around the quantity of milk he used. Milk itself contains water-soluble 0, but not in very large quantity. If enough milk is given, or still better, if the milk is not heated under certain specified conditions whereby the water-soluble C is destroyed, the milk itself will act as a cure.

An Experiment to Show that Scurvy is a Disease Due to Lack of Water-Soluble C Vitamine. The postulate of vitamine deficiency fits the case of scurvy very well. Consider an experiment of this kind. You feed guinea-pigs* with a mixture of soy bean flour, whole milk, dried yeast, paper pulp and mineral salts. The guinea-pigs develop scurvy. You next add a little orange juice to the diet and scurvy rapidly disappears. The amount of orange juice added could have made no material difference in the calorific value of the food; nor could it have supplied any necessary amino-acid constituents. The flour and milk and yeast are rich in protein, fat and carbohydrate. The yeast supplies the water-soluble B or antineuritic factor; the milk, the fat-soluble A or antirachitic factor. Both of the two vitamines with which we have familiarized ourselves are present in the food supplied to the guinea-pigs. Evidently there is some other factor necessary which only the addition of the orange juice to the diet supplies. This other factor, present in orange juice and in other fruits and vegetables, is the water-soluble C vitamine, or the antiscorbutic vitamine.

*We owe to Axel Hoist the discovery that the guinea-pig can develop scurvy.

But you may say this still does not sound very convincing. Milk is the sole food of infants, yet according to your account milk contains no antiscorbutic. As a matter of fact, it does contain a little, but not enough; and where the quantity of milk is cut down to give place to other foods - as in the diet of the guinea-pigs just cited - the deficiency of water-soluble C becomes apparent. And indeed even where milk is the sole source of food, the tendency among physicians nowadays is to recommend the addition of orange juice two or three months after birth.