In the foregoing there has been frequent reference to the close
relationship between scurvy and the incidence of the infectious
diseases--to the fact that a scorbutic condition increases the
susceptibility to infection. This is indeed one of the most
characteristic, as well as one of the most important phenomena
associated with scurvy and other disorders resulting from vitamine
deficiency. Mention has been made of the special susceptibility to the
diphtheria bacillus, and to the organisms leading to coryza and the
respiratory diseases, but no doubt this applies also to invasion by
other bacteria. We wish, however, to confine ourselves to the
nutritional disorders, first in their relationship one to the other, and
second, as a group of deficiency diseases, due to a lack of vitamines of
various kinds. As is well known, in addition to scurvy, this group
generally includes beriberi, a disease attributed to a lack of the
water-soluble vitamine, and xerophthalmia, an eye condition which
recently has been brought about in rats by placing them on a diet free
from fat-soluble vitamine. These, however, form only the nucleus of the
disorders which commonly are included in this category. Schaumann, the
first to formulate this classification, illustrated his conception of
the interrelationship by depicting the various members as spokes of a
wheel surrounding a central hub. He included scurvy, rickets,
osteomalacia, typical beriberi, ship-beriberi, pellagra and
mehlnaerschaden. Funk made a similar classification of disorders which
he termed the "avitaminosen." There is a tendency to enlarge rather than
to decrease the membership of this class, and recently war or hunger
edema, infantile atrophy and diarrhoea, sprue, coeliac disease,
leprosy and others have been proposed as suitable candidates. At the
present time it is impossible to determine which and how many of this
motley company should be associated with scurvy. Some, possibly, are the
result of a lack of vitamine, but for the present it will be well to
bear in mind that three vitamines only have stood the test of
experiment, and only these three therefore can be definitely connected
in a causal relationship with pathologic conditions. In addition to this
consideration of the interrelationship of the "deficiency diseases," the
kinship of allied disorders--more particularly of rickets--must be
discussed.
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