Constitutional Affections
The present chapter will be devoted to a group of symptom-complexes commonly classified as “constitutional diseases and diseases of metabolism.” One group of “diseases of metabolism” is called “deficiency diseases.” These shall be considered in the last part of this chapter. The reader should understand that metabolic perversions, deficiencies and constitutional disturbances exist in all so-called “disease.”
DIABETES INSIPIDUS
Definition: A chronic symptom-complex characterized by persistent passage of large quantities of normal urine of low specific gravity, and seen chiefly in young nervous males.
Symptoms: Diabetes insipidus develops gradually. Ten to twenty litres of pale urine is passed daily. The total amount of solids passed is often normal. There is thirst with dryness of the mouth and skin. The appetite and general condition are usually apparently normal, although often feebleness and emaciation are present:
Etiology: Nervous “derangement” is back of the excess urination. Fear and overworked emotions, excitement and any other cause of nervous impairment are causes. Babies at the breasts are prone to diabetes insipidus. Excitement and perhaps excessive fluid intake are to blame.
Prognosis: Full recovery in a reasonable time may be expected in all cases if cared for hygienically.
Care of the Patient: Put the patient to bed and withhold all food. Keep the feet warm using artificial heat if necessary. Give water only when demanded by thirst and see that an excess of water is not taken. When the symptoms have ceased, proper diet and emotional poise will maintain health.
DIABETES MELLITUS
Definition: This is the name given to a group of symptoms that center around an impairment of carbohydrate metabolism. Commonly we are told that it is a disease of the pancreas, but it is now realized that it is a disturbance of the metabolic processes involving the entire organism and not strictly localized in any one organ. It is, in other words, a manifestation of a systemic derangement and, however important the pathology in the pancreas may be, this is secondary to the systemic derangement which has resulted in the “disease” of the pancreas.
Symptoms: The urine is frequently voided, is pale and of high specific gravity unless there is inflammation of the kidneys, in which case specific gravity is not usually so high. The urine contains varying amounts of sugar and certain acids that are absent from the urine of healthy subjects.
There is great thirst and a ravenous appetite with, commonly, loss of weight. Headache, depression and constipation are common. The breath is sweet, though unlike that of the healthy person. The mouth and skin are dry, even parched, the tongue is red and glazed, and when the “disease” is advanced the teeth usually decay and become loosened. There is a tendency to pyorrhea and bleeding of the gums. Loss of sex power is common, while Bright’s “disease” may develop as a “complication.” Impairment or loss of vision may occur. Boils and eczema are also frequent. The pathology progresses more rapidly in young patients than in older ones, and it is thought by some Hygienists that children rarely if ever make a complete recovery.
A high medical authority says that “in the present state of our knowledge” “it is not’ always possible to make a good clinical distinction between an occasional glycosuria and the serious illness, diabetes .
Complications: Boils and carbuncles, balanitis or itching of the vulva, less often eczema or gangrene; lobar or bronchopneumonia, pulmonary tuberculosis or gangrene; arteriosclerosis, peripheral neuritis often with ataxic gait, or paraplegia, occasionally herpes zoster, perforating ulcer of the foot, often loss of sex power (conception rare, usually abortion), cataract, optic nerve atrophy, retinitis, sudden blindness, neuritis, and diabetic coma are among the common complications.
Hirshfeld’s “Disease”: This is a form of diabetes which is supposed to run its course in about three months and end in death. Three months afford ample time to stop the killing habits. Only fools think they can get well while practicing habits that build pathology.
Etiology: The islands of Langerhans may be described as little organs within the pancreas. These structures produce an internal secretion commonly known as insulin, which is essential to the oxidation of sugar. When they fail to secrete sufficient insulin an excess of sugar accumulates in the blood and is eliminated by the kidneys in the urine. Hence sugar in the urine (glycosuria) is the principal symptom of what the layman calls sugar diabetes. But it is a subordinate symptom and is valuable chiefly as a criterion of the progress of the condition.
There is no destruction in the pancreas when the “disease” first begins and the destructive changes take place slow1y against the weakened resistance of the body. Enervation (fatigue) of the islands of Langerhans is the probable beginning of diabetes. It is toxemia that produces the pathology (the destruction) in the pancreas. Toxemia produces first a mild, chronic pancreatitis which may persist for a long time before marked damage to the pancreas occurs.
It is true that there are many cases, of diabetes in children and youth and it is quite possible that there is marked larval endocrine deficiency in all such children. There may even be a lesser degree of larval endocrine deficiency that establishes the tendency to diabetes in adults. The time of life at which carbohydrate tolerance breaks down may be considered an index to the larval endocrine imbalance in the individual. But we must not overlook the fact that of two individuals with the same degree of larval endocrine deficiency, the one that subjects his body to the most enervating influence and consumes the greatest amount of carbohydrates will break down his carbohydrate tolerance first.
In those cases developing after the thirty-fifth or fortieth year we think the larval deficiency may be considered negligible and think that the cause is a decidedly over-crowded general nutrition in which carbohydrate consumption has been excessive throughout life. The islands of Langerhans have merely been overworked through the years.
Worry, anxiety, grief, shock—fright, accidents, surgical shock — will so impair the function of the pancreas that sugar shows up in the urine immediately. In many cases of diabetes, emotional stress is the chief cause, but it is never the sole cause. Every so-called ”disease” is a complex effect of a number of correlated antecedents.
Diet and drink, sex and sleep, work and play, and many other factors enter the cause of every so-called “disease.” Any form of over-stimulation — mental, emotional, sensory, physical, chemical, thermal, electrical — may give rise, first to functional, and finally, to organic, “disease.” Diabetes is a functional disturbance at its beginning.
Diabetes is more markedly on the increase in those countries in which sugar consumption has mounted to such high figures during the past fifty years — France, Germany, Britain and the United States. Every fat person is a potential diabetic. The over-feeding which is responsible for the fat overworks the pancreas and as overwork of any organ results in impairment of the function of the organ, pancreatic failure results. If its causes are not corrected, functional impairment gradually passes into organic ”disease. ”
Carbohydrate excess places a strong stress On the pancreas and when this gland is overworked, by too great an intake of starches and sugars, there will be first, irritation and inflammation, then enlargement, followed by degeneration (de-secretion); after which the body loses control of sugar metabolism and of the excess acidity caused by too much starch and sugar.
But it should not be thought that overeating of carbohydrates alone impairs the pancreas. Anything that produces enervation —tobacco, tea, coffee, chocolate, cocoa, alcohol, soda fountain slops, sexual excesses, loss of sleep, overwork, general overeating, emotionalism, etc. — impairs organic function in general, including pancreatic function.
Sedentary habits added to overeating increase the tendency to diabetes, as they do to all other so-called “degenerative diseases of later life.”
Prognosis: Recovery depends upon the amount of functioning tissue left in the pancreas. Fortunately, the pancreas, like all other organs of the body, possesses a great excess of functioning power over that needed for the ordinary activities of life, so that even after part of the Islands of Langerhans have been destroyed, the remainder will be able to function sufficiently to meet the regular needs of life provided the impairing causes are removed and they are given opportunity to return to a state of health.
When organs are not destroyed beyond repair, rest, poise, self-control, and a restricted, proper diet will restore normal functioning. In diabetes, rest and proper food, with diet restricted to the patient’s digestive capacity, and full cooperation will result in dependable health in a few years. Failure is for all those who are not willing to carry out instructions.
Care of the Patient: All enervating influences and habits must be corrected or removed. Sufficient rest for restoration of nerve energy is imperative. A fast, not merely to give the pancreas a rest, but of sufficient duration to free the body of its load of toxins, must be followed by a diet that is designed to produce all possible regeneration in the pancreatic gland. Feeding: that is designed merely to cause the disappearance of sugar from the urine may speedily kill the patient. Until pancreatic function is restored, sugar is not tolerated very well. Sugars must be introduced into the diet in small quantities and increased cautiously. After health is restored the patient must be taught to live within his compensating capacity.
OBESITY
Definition: This is an excessive deposit of fat in portions, or in all parts of the body.
Etiology: Popular and professional opinion has it that some cases of obesity are hereditary, while other cases are supposed to be due to glandular troubles. In truth, obesity is due to overeating and under activity — that is, eating more food than is used up in work. This type of eating is almost universal while only a small percentage of those who so eat become obese. Certain internal factors, of which glandular imbalance may be one, incline some to obesity. Sexual deficiency seems to incline the deficient individual to obesity. It occurs most frequently in middle-aged women and in children.
The over-consumption of fats, starches and sugars tends to put on fat. Drinking malt liquors tends to produce fatty degeneration. Few fat people will acknowledge that they overeat: the fat just jumps on them in the dark. In fact, many of them do eat less than their thin friends and relatives.
Fat increases in all its normal locations and the heart and liver are often large and fatty. Dilatation or rupture of the fat-infiltrated heart may cause death. Fat lowers resistance to all pathogenic influences, reduces vigor, detracts from beauty, lowers working efficiency, and shortens life.
Care of the Patient: Care is dietetic and gymnastic. Few fat people ever reduce, for the indulgence and indifference that have resulted in the accumulation of the unrendered lard also prevent them from carrying out instructions long enough to recover full health.
RHEUMATIC ARTHRITIS
Definition: Arthritis is inflammation of a joint and may result from a number of causes. In this place we are confined to a consideration of gouty or rheumatic arthritis — arthritis in those of the gouty diathesis. Several forms are recognized. We shall discuss them in alphabetical order.
ARTHRITIS DEFORMANS (Osteo-arthritis)
Definition: This condition, also called rheumatoid arthritis, is a chronic, supposedly incurable, condition. It may be chronic throughout or may be punctuated with frequent acute crises, and may lead to more or less permanent deformity of the joints.
Symptoms: When osteo-arthritis first appears as an acute crisis it is likely to be confined to the smaller joints, especially those of the hand, neck or jaw, the inflammation rarely shifts to other joints, the temperature seldom exceeds 102 F., the pulse-rate is increased out of proportion to the fever and there is a marked tendency to structural changes in the joints, and muscular atrophy.
When it appears first in the chronic form, inflammation develops in one or two joints and then, it develops in joint after joint, tending to become general. For a time the chief symptoms are pain, swelling and impaired mobility of the joints, but eventually, signs of structural changes develop. These comprise rigidity, deformity and crepitation (grating) on movement. Muscular atrophy always develops and often contractures and partial dislocations add to the deformity. In advanced cases the joints may be fixed in a flexed position, though the terminal rows of phalanges. In the hands may be extended. Acute exacerbations are very common. Anemia, profuse sweating about the hands and feet, irregular pigmentation and rapid pulse are sometimes observed.
In old people arthritis may develop in only one joint (mon-articular form), usually in either the hip or shoulder, presenting persistent pain, impaired mobility, and muscular atrophy.
Arthritis deformans of the spine (spondylitis deformans) may exist alone or other joints may be involved. Its chief symptoms are pain in the back and limbs, especially the legs, limited motion, and ultimately extreme stiffness or fixation of the spine (“poker spine”), exaggerated reflexes, gradual muscular wasting, and, in some cases, spinal curvature of some form.
Small nodules that develop at the sides of the terminal phalanges of the fingers are called Heberden’s nodes. They are rarely painful but are sometimes the sole expression of arthritis deformans.
Prognosis: Medical works say, “a complete cure is exceptional.” Our experience refutes this. Complete recovery is the rule when cause is removed before deformity is great.
CHRONIC ARTICULAR RHEUMATISM
Definition: A standard medical work says: “The many cases of polyarthritis with a tendency to chronicity and to permanent structural changes in or about the joints, which are usually referred to as chronic articular rheumatism, had better be regarded as examples of rheumatoid arthritis.” “There is no proof, * * * that rheumatism ever passes into a distinctly chronic condition or ever becomes a chronic affection.”
So-called chronic articular rheumatism (rheumatic arthritis) is said to be “one of the most common, intractable, and disabling of diseases and one of the most resistant to all forms of treatment.” Various classifications of rheumatic arthritis, all of them more or less arbitrary, are made by various authorities.”
Hypertrophic Arthritis is the term applied to enlargement of the bones, cartilaginous structures, and periarticular tissues. There is swelling, redness, pain, and later, deformity of the joints. Ankylosis, which is at first fibrous and later bony, is common. There is a great degree of perversion of nutrition due to deficient nerve supply, and there seems to be an abnormal retention of calcium.
Atrophic Arthritis presents a picture that is in many respects opposite to the above. There seems to be calcium deficiency in these cases. In hypertrophic arthritis calcareous deposits are the rule, while in atrophic arthritis the X-ray shows a honeycombed condition of the articular surfaces, indicating decalcification.
Degenerative Arthritis: which may be confined to one joint, but is frequently polyarticular, is common in women especially at the menopause. Manifesting frequently with grating (crepitation) of one or both knees, accompanied by increasing stiffness and pain, it successively involves other joints, including the wrists, elbows, ankles, hips, shoulders, fingers, hands, feet, and spine. There are recurrent acute exacerbations (crises), muscular atrophy, decreasing mobility, suffering, mental and physical depression, anxiety, contraction of the flexor muscles and tendons with consequent drawing up and tension fixation of the parts, and eventually, in most cases, the wheel chair and such permanent and hopeless invalidism and deformity as to require constant attendance.
Prognosis: Possibility of complete recovery depends upon how early in the course of the pathology proper care is instituted.
GOUT
Definition: This is a form of arthritis characterized in its typical form by deposits of sodium biurate in the joints and other structures, and by recurrent arthritic crises.
Symptoms: Two varieties are described, which may be acute or chronic.
Acute Gout is usually preceded by certain prodromal symptoms — restlessness, insomnia, moroseness, irritability, dyspepsia, and changes in the urine. This is followed by the sudden appearance in the early morning hours of pain and swelling in the ball of the great toe. The inflamed joint is so tender that the slightest pressure causes agony. It is of a reddish-purple color, the overlying veins are full and distinct and its surface is glazed. The pulse is quickened and temperature rises to 101 to 102 F. Toward daylight the pain subsides and the patient falls asleep. He is comparatively comfortable during the night, but there are severe exacerbations for several successive nights. At first the crises may be a year apart, but as they multiply, the interval grows less, until finally the sufferer is seldom free from pain.
Retrocedent Gout is the term applied to a condition in which the arthritic crisis suddenly subsides and grave gastric, cardiac, or cerebral symptoms follow. It is probably due to suppression.
Chronic Gout: One by one, the joints become stiff, irregularly enlarged and deformed. Chalk-stones (tophi) form and are sometimes discharged through the skin by ulceration. Similar deposits are often found along the tendons and in the helix of the ear, or on the underside of the eyelid.
Non-articular Gout (uric acid diathesis, latent gout, goutiness, lithemia) is a term applied to a group of symptoms in which no gout is present. It resembles a case of severe, chronic indigestion.
Complications and Sequelae: Chronic interstitial nephritis, arteriosclerosis, hypertrophy of the heart, angina pectoris, apoplexy, chronic bronchitis, chronic eczema, urticaria and psoriasis, are the chief complications.
Etiology: We will consider the cause of these various forms of arthritis together, for they are all related and grow out of the same causes. Fundamentally, toxemia is at the base of all these conditions. Uric acid is suspected of playing a leading role in all these affections, but its office in their production is not well understood. We agree with Dr. Weger, when he says, uric acid, instead of being the sole cause of rheumatism, is only one of the many acids an excess of which leads to trouble and internal dissention. No one knows just how many subtle chemical toxins are involved in the arthritic process. There may be hundreds or even thousands. Many years will elapse before we are able to isolate the compounds which the amino acids alone are capable of forming with one another and with other byproducts of both the protein and carbohydrate families. We may safely assume that no single, harmful chemical poison is alone and independently responsible for rheumatism. Neither shall we be able for many years, if ever, to isolate and designate any one particular toxic substance that causes cancer or Bright’s disease or hardening of the arteries.”
Excesses of all kinds build the toxic state back of these symptom-complexes. Carbohydrates, especially the sugars, seem to give most offense in causing rheumatism.
Prognosis: Acute cases respond very readily and recurrences occur only in those who return to their old habits of living and eating, Chronic gout responds more slowly.
Care of the Patient: Fortunately, it is not necessary to know which, if any, single toxin causes arthritis, or any other “disease,” in order to eliminate it. Nor, do we need such knowledge in order to eliminate the causes of enervation.
Fasting, rest and a corrected mode of living soon eliminate toxemia and restore normal nerve energy. A change from acid-forming to base or alkali-forming foods is followed by the most wholesome reactions. Metabolism is most rapidly altered by fasting, and the body is thus more readily reconciled to accept a gradual chemical change in the fluids and secretions. Fasting relieves pain more effectively than drugs and with less risk of general harm.”
Arthritics do not handle sugars and starches well, due to metabolic disturbance. However, best results are obtained, not by a mere reduction of carbohydrates, but by a general reduction of the diet, for the carbohydrates are not alone to blame. The toxemia present is the result of long abuse with a redundancy of foods of all kinds and in wrong combinations.
AVITAMINOSES
Avitaminoses is a term often used to describe what are otherwise called “deficiency diseases.” Due to preoccupation with and overemphasis on vitamins, there is a strong tendency to limit the term “deficiency” to conditions that are supposed to grow out of vitamin deficiency.
We are so afflicted with science madness that we are hardly able to discern between tomfoolery and science. We were swept from the calorie insanity into the vitamin insanity. It is inconceivable, in the light of the well established law of the minimum that any diet that is inadequate in any of its essential constituents can give rise to a deficiency of any one food essential. We must cease looking’ for unitary causes and recognize the complexity of cause in all conditions.
Besides the “definite diseases” which are diagnosed by “characteristic signs” and by changes in the organs and structures of the body, there is a vastly greater number of less clearly distinguished ailments, functional weaknesses, or health impairments, which are suspected of deficiency bases. Some forms of goitre, anemia, etc., are blamed on deficiency, while there is definite deficiency in tuberculosis. The obvious fact is that there is deficiency in all so-called “disease.” In our present considerations we shall confine ourselves to the “definite deficiency diseases,” taking them up in alphabetical order
BERIBERI (Kakke)
Definition: Beriberi, or multiple neuritis or endemic multiple neuritis, occurring endemically in tropical and subtropical countries, is characterized by disturbances of circulation, motion, and sensation, and great loss of weight. The “disease” is prevalent in Japan, China, India, the Philippine Islands, and parts of South America.
Symptoms: Four general forms are described — namely:
(1) Acute pernicious form, of rapid onset with grave circulatory disturbances and death in a few days from heart failure and edema of the lungs.
(2) The wet form in which there is marked edema and often edema into the serous sacs:
(3) The dry form characterized by pronounced muscular atrophy and little edema;
(4) Rudimentary cases, in which leg weakness, palpitation and paresthesia are the only symptoms.
The usual symptoms are paresis, especially in the lower extremities, paresthesia, hyperesthesia, pains, tenderness of the nerve-trunks, loss of deep reflexes, muscular atrophy, palpitation, venous congestion, weakness of the pulse, difficult breathing, and, in many cases, more or less edema of the feet and legs.
Etiology: Beri-Beri in human beings and polyneuritis in other animals are not solely associated with an exclusive rice diet, but may accrue when various other nutrients are given in conjunction, and when they are given in association with nutrients that have a curative effect on polyneuritis.
“Acidosis” plays a notable part in the development of the condition and anything that adds to the “acidosis” hastens the “disease.”
Cases of beri-beri have been reported in which whole and not polished rice was eaten. It is assumed that in such cases, the rice had been kept too long in storage.
The addition of carbohydrates to the diet of victims of polyneuritis has a very deleterious effect. This is assumed to be due to the weakened state of digestion arising out of a vitamin-free diet. Much carbohydrate in the diet gives rise to acid fermentation and the production of organic acids which, being absorbed by a debilitated organism unable to effect their speedy and complete combustion, produce well-marked acidosis. Sugar and denatured starch added to the diet increase the rapidity of the “disease,” sugar more so than starch. The reduction of carbon dioxide in the respiratory output in such cases is taken as evidence that the combustion of organic acids is crippled in this “disease.”
Fats, which contain an excess of acids, tend to increase the “diseaseThe “disease” is attributed to different causes by different investigators. Lack of vitamin B, potassium and phosphorus deficiency, spoiled rice, lack of protein, poison in rice analogous to that in cotton seed, bacterial toxins, and oxalic-acid intoxication originating in the intestine, are among the supposed causes. The “disease” has been observed among persons living on a mixed diet.
When beri-beri occurs in persons taking a mixed diet, it will be found: (a) that some of the important nutrients have been subjected to a preserving process involving exposure to excessive or unduly prolonged beat; or (b) that the cereals in the diet have been subjected to too extensive a hulling process in the mill; or (c) —that other important constituents of the food have, in preparing for the table, been boiled and that their vitamin content has passed into the cooking water and been thrown away.
The “disease” is seen chiefly in young adults and is predisposed to by bad hygiene, overcrowding, exposure to cold, hard work and other factors that produce an added need for food.
Prognosis: In the early stages recovery is rapid. In advanced stages recovery is slow or absent.
MEHLNAHRSCHADEN (Meal-Diet-Hurt)
Definition: This is a malnutritional condition that develops on a diet that “has consisted mainly of gruel, mush, or porridge of some kind, to which sugar and fat are often added to promote energy.”
Symptoms: This condition, noted in infants-in-arms, presents “a nervous hyperirritability which may lead to tetanoid spasms. Again at an early stage , little patients suffer from moderate flatulance. By degrees, the nutritive condition grows worse, unless ultimately a markedly atrophic state arises. In the last stages there may be edema. To complete the picture, it is necessary to add that acute gastro-intestinal disorder is a frequent complication. There is also a notable increase in the susceptibility to every kind of infection.” The muscles are hard and hypertonic (contracted).
Etiology: The diet of these infants, even assuming that they are fed on whole grains, is deficient in the organic salts, particularly in sodium and calcium, and “is poorly supplied with organically combined sulphur and with bases generally.” It contains an over-abundance of the “inorganic” acid-formers and of potassium. The proteins are inadequate, being especially poor in lysin and cystin. Vitamins A, B and C are deficient. Fermentation is inevitable on this diet, not alone because of the absence of A and B, which absence is supposed to impair the functions of the digestive glands, but also, and largely, because of the absence of starch-splitting enzymes in the infant s digestive juices and because the starches are consumed soaked or boiled. These deficiencies are all the more marked where the foods are of the refined or denatured kinds.
Prognosis: Good in average cases.
MILCHNAHRSCIIADEN (Milk-diet-Harm)
Definition: This is a malnutritional state seen in infants fed upon pasteurized or diluted milk.
Symptoms: The first symptom of the disorder is that sleep is greatly disturbed; the infant is overtired, and manifests its discomfort by fits of crying. The skin becomes pale and turgid, and is morbidly sensitive to injury. The tonicity of the tissues and the blood-pressure decline; the stools contain large quantities of fatty soaps; and there is marked flatulance. For a time there is an arrest of weight, and then the weight actually falls until extreme atrophy has been established. Marked intolerance of fat is displayed, especially when cream is added to the milk in the hope of improving the nutritive condition. Nervous symptoms have not been noted, but the disease may sometimes be complicated with infantile scurvy.”
Etiology:, Milchnahrschaden, is a result, of the hand-feeding of infants, especially on cow s milk. Ordinarily, in this form of artificial feeding, the milk is greatly diluted and is also pasteurized or at least scalded.
The dilution of the milk in the diet of these infants lowers the mineral content with respect to all of its minerals. Iron, sodium, calcium, and the bases generally are rendered inadequate. This induces an “acidosis.” The dilution of the milk also lowers its vitamin content. All of this in addition to the evils wrought by scalding or pasteurization.
Prognosis: Rapid recovery may be expected in most cases.
MALNUTRITIONAL OEDEMA
Definition: Malnutritional oedema is a passive oedema, an extravasation of blood serum into the tissues, due to an insufficiency in the arterial walls, with a consequent swelling, of these tissues, seen in malnutritional states.
The condition is an old one and has many names, as “famine dropsy,” “ship beriberi,” “prison dropsy,” etc.
Symptoms: The condition may range all the way from small local edemas to general edema resulting in death. In advanced states the transuded serum accumulates in the various body cavities —- cardiac, pleural, peritoneal and joint cavities. This, condition develops quite frequently in deficiency “diseases” and may become so severe as to overshadow all other symptoms. In severe cases of beriberi and scurvy the passive edema may pass into cardiac edema, due to the failing of the overtaxed heart.
Etiology: The authorities are as much confused about the cause of malnutritional oedema as of other “deficiency diseases.” “Morgulis says of the hypothesis that the condition is due to vitamin A deficiency: “The experiments of Kohman showing that the edema is the product of a complexity of circumstances involving general malnutrition together with a very low protein intake dispense with this hypothesis.”
Berg says in writing of the malnutritional oedema of the first World War: “Opinions are diametrically opposed concerning the nature of the pathogenic diet. There is hardly an assertion in respect of this, which is not disputed by some rival authority. It is obvious that the personal bias of the various writers has played a considerable part in dictating their respective assertions. What one describes as an abundance is referred to by another as a quite inadequate quantity. Most observers are agreed in stating that the caloric contents of the pathogenic diet is too low; but according to Schittenhelm and Schlecht, this has not always been the cause. We are often told that the supply of protein has been too small, the daily amount ranging in these instances from to 41 to 74 grammes. According to Liebers, however, the protein content of the diet was sufficient; in peace time the amount of protein in the hospital diet has been 77.33 grammes; in 1916, it fell to 50.53 grammes; in 1917, it was 60.26 grammes; and in 1918, it was 71.05 grammes.
“Many authorities incline to regard an excess of carbohydrates in the diet as injurious, but Jansen reports a cure by a liberal supply of carbohydrates. Others consider that the fats in the food were deficient. According to Burger, it is not always possible to demonstrate that the supply of inorganic salts was inadequate.
“German writers in general are agreed in insisting that there seemed to be no lack of complettins in the diet; whereas the British authorities refer to the lack of accessory food factors; and according to Burger, the complettin content was primarily low, and the deficiency was often exaggerated by faulty methods of preparation. Kohman and Nixon stress the disproportion between the richness of food in water and its lack of solid constituents. Kohman, working alone and also in collaboration with Denton, saw dropsy arise in cases in which carrots were being consumed in conjunction with an abundance of fat or starch, but in which a cure resulted on the administration of casein and calcium salts. The report of H. de Waele and Burger contain typical instances of diets leading to malnutritional edema. According to de Waele, in a French almshouse, the diet consisted of soup and bread, or soup and potatoes, with beans and fat twice a week. In Burger’s cases the pathogenic diet was composed of bread, vegetables, and a small quantity of potatoes, with a little lard, and small amounts of pickled or salted meat.”
Prognosis: Recovery is often rapid following improved dietary.
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OSTEOMALACIA and OSTEOPOROSIS
Definition: Osteomalacia is a progressive softening of the skeleton with resulting deformity. Adults and pregnant women are most liable to the condition. It is characterized by rarification of the osteoid tissue, which may be reduced to the thinness of paper near the epiphyses and by a more or less complete disappearance of the spongy tissue. (Osteoporosis is a decreasing density due to the development of a porous condition of the bones) Osteomalacia is attended with “rheumatic pains.”
Etiology: Berg says that “during the latter years of the war, osteomalacia and other forms of osteopathy, were frequent, and in the large towns sometimes assumed epidemic proportions.” Osteomalacia, osteofragilitis (fragility of the bones, also called osteopsathyrosis) and osteoporosis developed in whole communities, and especially in Vienna, during the first World War. Softening of the bones with innumerable spontaneous, fractures followed upon the lack of fruits and vegetables.
Berg and others consider the condition to be due to a lack of complettin A. Some consider it to be due to a lack of calcium and phosphorus. Amenorrhea in adult women and a failure of menstruation to begin in girls at puberty are often seen associated with the condition. Tetany and other spasmodic troubles are sometimes present.
Prognosis: Complete recovery is possible only in the early stages and before deformity has developed.
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PELLAGRA
Definition: Pellagra – is defined as “an endemic chronic disease characterized by digestive disturbances, erythematous roughness of the skin, especially of the exposed surfaces and symptoms referable to widespread degenerative changes in the brain and spinal cord.”
Symptoms: Pellagra begins with stomatitis (inflammation of the mouth), pains in the abdomen, vomiting and diarrhea. The skin eruptions appear in spring and disappear in winter. Headache, irritability, hallucinations and profound mental depression comprise the usual nervous symptoms. In severe cases the mental disturbances assume the forms of melancholia, dementia or mania, and in rare cases, paresis (slight paralysis) and ataxia of the spastic type.
Etiology: Pellagra is due to a lack of meat, to spoiled corn, to germs, vitamin deficiency, etc., etc., depending on who is doing the experimenting. Some of the worst cases reported in this country were in people whose diet contained no maize (Indian corn) at all. All is confusion.
Prognosis: “Pellagra,” says Weger, “is a more obstinate condition and requires a very rigid dietetic and general disciplinary regimen. The most difficult problem in advanced cases is the psychic depression, and much tact is needed in bringing about a better mental state. It usually requires from three months to a year to overcome the depraved condition of the mucous membranes of the entire digestive tract.”
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RICKETS
Definition: Rickets is a “deficiency disease” in which there is softening of the bones with a predominant loss of calcium salts. The deformities are usually permanent. There is often enlargement of the liver, spleen and the glands of the mesentery.
Symptoms: The “disease” develops most commonly between the sixth month and the third year of life. The head is relatively large, the fontanelles do not close at the normal age, parts of the occipital and parietal bones may be thin and yielding, the chest may be flattened and the sternum thrust forward (pigeon-breast); bony enlargement, or beads, often form at the junction of the osseous and cartilagenous portions of the ribs, curvature of the spine is frequent, bow-legs or knock-knees is quite common, while the pelvic outlet may be much narrowed, a serious thing in females who are later to be mothers.
The teeth erupt late, are irregular, small and defective, there are gastro-intestinal disturbances, pallor, emaciation, flabby muscles, excessive feeling, restlessness at night, a disinclination to and excessive sweating especially, about the head.
The bone-ash in a case of rickets contains an abnormal preponderance of magnesium salts. These, changes occur more particularly in the bones of the extremities. There is a marked increase of cartilage at the end of the bones, the bones are irregular, sometimes much deformed and bent.
Complications: Green-stick fractures, broncho-pneumonia, convulsions, involuntary passage of urine, tetany, and laryngismus stridulus are the chief complications that sometimes occur.
Etiology: Rickets, of which I have described an extreme case, results from poor nutrition of the mother, faulty diet in the child, lack of sun light, fresh air and poor general hygiene. The experts disagree as to its cause. Osborn and Mendel think it is due to a lack of vitamin A. Rohmann thinks it is due to lack of calcium in the diet or to a failure to absorb calcium from the intestine. McCollum, Simmonds, Parsons, and Dalyell, think it is caused by a lack of vitamin B or vitamin C, and a lack of calcium salts and phosphorus. Mackay thinks a lack of vitamin A has nothing to do with causing the disease. The United States Public Health Service considers that it is due solely to a lack of sunshine. Mann thinks it due to several factors chief of which is lack of fat.
Dr. Hess reported a number of cases of children who had rickets even though the diet included an abundance of fat-soluble A. He also reported perfectly normal children whose diet included little or no vitamin A.
Morgulis says: “The American students of this problem, both Hess and McCollum with his co-workers, find no evidence for the hypothesis of the relation between rickets and vitamin A starvation.” McCollum “considers the disease to be caused by a complex dietary deficiency, which involves the calcium and protein factors.”
But why go on; they can’t agree on anything, unless it is that cod-liver oil will prevent and cure the trouble. The question comes up: Why do children fed on this oil develop rickets, and, why does cod-liver oil so often fail to result in a cure? Fortunately whole milk, fruit juices, sun shine and good general hygiene will both prevent and remedy the condition.
Prognosis: Weger says “rickets presents no difficult problem and can be overcome in a relatively short time by diet plus hygiene, sunshine and favorable environment. We have had no personal experience with the more recent additions to the pharmocopeia of irradiated foods, drugs, and oils which have come into high medical favor. These diseases (he includes in this also sprue and scurvy) respond readily to proper diet without artificial concentration – of vitamin D or other active substance.”
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SCURVY (Scorbutus)
Definition: Scurvy is defined as a “constitutional disease.”
It is frequently associated with beriberi and also with sprue. The ” disease” is one of the oldest known to man in north latitudes; – the people of northern Europe, in particular have been sufferers from it. Berg says: “In summer the Eskimos, who live almost exclusively on flesh and fat, often suffer a mild form of the hemorrhagic diathesis, being affected with bleeding from the gums, nosebleed, hemorrhages from the other mucous membranes, and severe extravasations of blood in the subcutaneous tissues upon comparatively slight provocation, while in winter, under the combined influence of famine and unsuitable diet, typical scurvy is apt to arise, sometimes carrying off entire tribes.” In western Asia, northern Japan, and on the old time sailing vessels this “disease” was quite common.
Symptoms: Scurvy is characterized by marked weakness, a spongy condition of the gums, anemia, hemorrhages from the mucous membranes and into the skin, gums, muscles, joints, and internal organs. There is great lassitude, constipation, fetor of the breath, a craving for acid fruits, loosening of the teeth, brawny induration of the muscles in various parts of the body, due to blood exudated into the muscles, and in the worst stages, spontaneous fracture of the bones.
Infantile Scurvy (Barlow’s “disease”) is seen in children fed on condensed milk, pasteurized milk and proprietary foods — drug-store foods. It is characterized by pallor, tenderness or pain in the legs or back on handling, slight swelling, especially about the shaft of the long cylindric bones, pseudoparalysis (immobility of the legs), hemorrhages into the tissues, subperiosteal hemorrhages, especially of the long bones, and blood in the urine. The gums are not affected if the teeth have not erupted.
Etiology: The cause of scurvy is still in dispute. Furst excluded acidosis and infection as possible causes. McCollum and Pitz advanced the theory that the “disease” is due indirectly to a microbe. Prolonged retention of feces, in the bowel, with putrefaction and toxemia resulting therefrom, they think causes the “disease.” Harden and Zilva denied this. Hess and Unger showed that keeping the bowels cleaned out does not prevent the “disease.” Rohmann thought protein insufficiency causes the affection. Howe refers its etiology to vitamin C deficiency, others to a lack of vitamin A or vitamin B. Drummond declares it is due to a lack of “water-soluble G.” Florence thinks both scurvy and infantile scurvy are due to a lack of sulphur. Whatever it is in food that protects against scurvy is destroyed by prolonged boiling and by drying.
Prognosis: Scurvy presents “no difficult problem,” says Weger, “and can be overcome in a relatively short time .by diet plus hygiene, sun light and favorable environment.”
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SPRUE (Psilosis)
Definition: This deficiency is seen largely in the tropics, and chiefly among European residents.
Symptoms: Sprue begins with slight digestive disorders, which resemble the common digestive disorders, which come and go. Isolated patches of inflammation on the tongue appear from time to time, but completely disappear. Time passes and the digestive disorders grow more frequent and the inflammation of the tongue becomes more severe and lasting. The inflammatory patches on the tongue finally merge (coalesce), the skin of the tongue disappears and small suppurating vesicles or extremely sensitive circumscribed minute ulcers are seen on the tongue. The muscles of the tongue atrophy, the tongue becomes small, deeply furrowed, thin and covered with an overgrowth of connective tissue.
The gums and lining of the mouth may become inflamed, sometimes salivation, sometimes a dryness of the mouth ensues. The sense of taste is impaired and the saliva becomes acid. Inflammation of the throat and other portions of the upper alimentary tract make swallowing painful and difficult. There is flatulency, eructations, “heart burn,” and in rare cases, vomiting.
Numerous other symptoms and changes occur, such as diarrhea, increased appetite at first, with later, decreased appetite, intense thirst, atrophy of the liver, distended abdomen, emaciation, flaccid and wrinkled skin and, finally, death.
Etiology: Berg says: “The pathological anatomy of this disease does not furnish any etiological explanation, for the pathological changes are no more than the results of the abnormal fermentations in the intestine.” There is nothing new or strange about this. We have long known that “dead men tell no tales.” Causes are never discovered at the necropsy. The medical profession has the bad habit of going to the dead-house (the morgue) to discover cause. We should not follow in their footsteps.
Prognosis: Weger says sprue presents “no difficult problem and can be overcome in a relatively short time by diet plus hygiene, sunlight, and favorable environment.”
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XEROPHTHALMIA (Keratomalacia)
Definition: This is a dry, thickened condition of the conjunctiva, which is seen in certain dietary deficiencies. It occurs quite often in Denmark and is regarded as the chief cause of blindness in Danish children. The condition usually passes rapidly into keratomalacia, a softening of the cornea. It may even culminate in blindness. In experimental animals in which these conditions have been induced, hemorrhagic and even purulent discharges from the eyes are seen. Softening of the cornea may be followed by the subsequent destruction of the eyeball.
Etiology: Here again the “authorities” are at odds over cause. Some declare these conditions to be due to a lack of vitamin A. Others declare that calcium deficiency is the cause and that recovery is more rapid if the calcium in the diet is increased along with the vitamin A. Bloch reported several cases in the eyes of babies artificially fed on separated milk. Beginning with dryness (xerosis) of the conjunctiva, the condition progressed to severe affections, with involvement of the cornea and, – in several babies, resulted in complete blindness. He fed a diet of whole milk and cod liver oil and the eyes returned to normal.
McCollum was led by his investigations to the conclusion that the animal organism has stored up in its fat and glandular organs a sufficient reserve of “fat-soluble A,” the absence of which is said to cause xerophthalmia and keratomalacia, to supply its immediate needs, when this vitamin is lacking in the diet.
Night-blindness, seen among Eskimos and Chinese and Japanese coolies, is also attributed to deficiency of vitamin A. A diet of carrots, lettuce and other raw green vegetables is said to restore normal night-vision.
Prognosis: These conditions rapidly disappear under proper general care and correct feeding.
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FAMINE OPHTHALMIA
Definition: Purulent inflammation of the eyes and blindness are frequent aftermaths of famine. Even long after a famine has passed, children suffer with purulent inflammation of the eyes.
Care of the Patient: In dealing with these “deficiency diseases” we have departed somewhat from our regular order in this book in that we have not discussed “care of the patient” under each separate deficiency. This seemed advisable from the very nature of the affections.
The “authorities” cannot agree on the causes of the various nutritional “diseases.” If the experimenters and research workers are hopelessly confused about the causes of these deficiency “diseases” they are no less so when they come to their treatment. What Funk and Segawa find will cure beriberi, for instance, Williams and Schaumann find does nothing of the kind. The marasmus which Segawa regards as a secondary symptom in beriberi, Berg regards as the first and most fundamental, with pareses and paralyses superadded as further characteristics.
What one investigator can accomplish with vitamins, another cannot, but requires the aid of salts, another does with protein, another with carbohydrates and still another with fats. One investigator discovers that beriberi develops in men fed on polished rice and is cured by adding the polishings to the diet. Another reports cases of beri-beri in individuals living on whole rice.
Fortunately for us, malnutritional “diseases” are remedied by rest in bed, fasting, followed by proper diet and good general hygiene. Lamps, irradiated food, cod-liver oil, yeast, etc., etc., are not to be considered.
Dr. Tilden says “the symptom-complex of faulty nutrition embraces all diseases because all diseases are of a nutritional character.” It is impossible to separate poisoning (toxemia) and malnutrition. They always co-exist. Malnutrition must always lower function and produce toxemia and it must always decrease resistance to poisons, and poisoning must always impair and pervert nutrition. Every so-called “disease” is a combination of these factors and many of the symptoms described in “deficiency diseases” are toxic symptoms. Toxemia and malnutrition are Siamese twins
Berg says of these so-called “deficiency diseases”: “There is all the more reason for the use of such a collective designation, inasmuch as it is somewhat exceptional to find one of these morbid processes in a pure form.” There are common factors in all of them. From what we know of the inter-relationships of the food elements we could not logically expect a deficiency in one food element without a co-existent and consequent deficiency in other elements. The “deficiency diseases” are all related not alone one to another, but to other pathologies. .
There seems to be no doubt about the relationship of sprue, pellagra and those milder forms of mucous membrane depravity that do not break down the resistance of tissues in so profound a manner. The differential diagnosis of sprue and pellagra is not easy and cases are seen where one day the patient presents a typica1 picture of sprue and a day or so later the case is more like pernicious anemia or pellagra.
Berg tells us: “Zambrazycki regards malnutritional oedema, scurvy and beriberi a nutritive disorders which have a kindred etiology. He says that the same symptoms are common to all three diseases, the difference being the extent to which this or that symptom predominates. In beriberi the pareses (paralysis) are most conspicuous; in scurvy, the symptoms of the hemorrhagic diathesis give the specific character to the disease; and the most notable feature of malnutritional oedema is, of course, the anasarca (general dropsy) .”
It is our view that the conclusions arrived at by Goldberger in his researches in pellagra are faulty. We hold that a constitutional impairment, enervation and toxemia and their effects, exist in sprue and pellagra prior to the appearance of nutritional imbalance. The toxic state it seems to us, is the larger factor in these cases, and the mineral and vitamin deficiencies are secondary to this.
Latent deficiency “disease” is prevalent among the so-called intelligent and among the well-to-do, for malnutrition is developed by the typical American meals of denatured, badly prepared and wrongly combined foods. Normal blood and healthy tissues cannot be built on a diet of white bread, denatured cereals, white sugar, pasteurized milk, muscle meats, mashed potatoes, canned fruits and vegetables, cakes, cookies, pies, candies, spices, condiments, coffee, tea, cocoa, chocolate, ice cream, soda fountain slops and drugs. The addition of a small quantity of “protective foods” to such a diet will not render it adequate.
Food deficiencies are not noticeable at the beginning. They develop slowly at first and then with increasing speed. Berg says: “Aaron, and also Erich Muller and other specialists in the diseases of children, observed that in children that were supposed to be thriving, to supplement the diet by fresh vegetables, extract of green vegetables, extract of carrots, or extract of bran, could always bring about a further increment of growth. These observations show how defective the nutrition of our children must be in contemporary life, even under what appears to be favorable conditions.”
Plant-feeders will always consume green vegetables if they can procure them and in the green parts of plants, vitamins and minerals are present in their active state and in favorable quantities. So-called gramnivorous animals become ill, breed badly, and rear fewer young, if they cannot get green leaf food in addition to grains. Even carnivores revert to plant feeding at certain seasons of the year and are rejuvenated thereby.
But it would be a mistake to suppose that food deficiencies arise wholly from faulty or inadequate diet. Any weakening of the nervous system through whatever cause (shock, overwork, extreme exposure, over-stimulation, emotional strain) lowers physiological efficiency — lowers digestive and assimilative power. Thousands of overfed individuals are suffering from dietary deficiency because of their inability to digest and appropriate the food they eat. Anything and everything which makes a special claim upon the activities of the body predisposes to “disease,” unless the diet is of a character to adequately meet the demands. Even vigorous growth, if not met with the needed food elements, will result in deficiency. Work, exposure and other factors which make special demands upon the body, worry, anxiety, nervous strain, etc., by crippling nutrition, may result in deficiency. Indigestion is a common cause of deficiency.
Natural elements needed for the nourishment and repair of, the body are not present in drug-store preparations and patent-foods, vitamin extracts, vitamin concentrates, mineral concentrates, cod-liver oils, etc. I defy any doctor who goes to the laboratory to find iron, iodine, vitamins, pepsin, and all such drugs that appeal to the profession, to get the results I obtain with fruits and vegetables.
By attempting to extract vitamins from their natural media and to administer them medicinally, instead of insisting upon the consumption of whole foods, the medical profession lends both passive and active support to the food spoilers, food-fakers and manufacturing chemists, to the greater profit of both and loss, both in health and pocket, to the unfortunate consumer.
A thing torn from its natural environment — a vitamin divorced from its related nutrients — is no longer the same thing. A vitamin in a bottle, dissociated from its symbiotic partners is quite different from a vitamin in oranges.
Patients and parents annually waste millions of dollars in filling prescriptions for vitamins “when none are needed, for these are altogether adequate in natural — unprocessed, unrefined, uncooked — foods. Indeed, prescribing expensive vitamins even where there seems to be a real need for them, without at the same time teaching the patient how to get along without the patent-foods, by improving his diet, is to fail in your duty to the patient.
Vedder says that “crude vitamins” used as remedies for polyneuritis, are from 20 to 30 times less effective than the foods from which they were derived. The same thing is true of all deficiency “diseases.” After the present enthusiasm for the new saviour has died down, it will be clear to all that man must still subsist on whole foods and not extracts or tinctures or fusions or other drug-like derivatives. It is quite natural, of course, that medical men should look for means to employ parts of foods as drugs.