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
Public-domain text, read in full here on John Shaqi.
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