AN EXPLANATION OF THE CAUSE OF SCURVY AND THE ACTION OF THE DIFFERENT SO-CALLED ANTISCORBUTICS;

Archer Farr
1869 The Lancet  
424 the least losing all value as a hasmostatio barrier; or it may, if large, act as a direct irritant, and induce both inflammation and suppuration within the sac. The second condition demands that the blood should possess a given constitution ; and this, if originally defective I (so far as we at present know), either chemically or clini-' , cally, can be but very imperfectly corrected. This aplastic i quality of the blood, if we investigate the cause of death in many cases, will be found to
more » ... , will be found to have been, apparently, the sole impediment to cure. , The third requirement consists in a certain physical pecu-I liarity and arrangement, so far as relates to the state of the ' orifice of the sac and the condition of its inner walls. If the mouth of the sac be wide, as in the crateriform aneurism, ' , and the walls comparatively smooth, the formation of coagu-' , lum is much impeded; but if the neck be narrow, and the walls roughened by calcareous or atheromatous deposit, it constitutes a veritable straining chamber; and then, the other conditions being present, the plasmine divides, allowing fibrin to settle, molecule by molecule, with that singular mode of adhesion and formation of laminve-the most internal hyaline, the external still fibrillary-so well investigated and described by Robin in his " Lectures on the Normal and Morbid Fluids of the Body" (p. 161). THERE have been many speculations with regard to the cause of scurvy: one authority affirming that it is owing to the absence of vegetables in the food taken; another maintaining that a deficiency of the salts of potash is the cause; while a third gives it as his opinion that it results from bad ventilation, deficient water-supply, wet seats, &c.,-all of which fail to explain the real cause of the disease. That scurvy is not owing to a deficiency of the salts of potash in the food of the sailor, and that salt meat contains all the elements necessary for nutrition, have been proved beyond doubt; while that the belief that fresh succulent vegetables or lime-juice are indispensably necessary to the cure of the disorder is an error, is proved by the fact that beef-tea and milk will effect a cure in the absence of both. If salt meat contains all the elements required for nutrition, how does it produce scurvy ? Purely by its hard and indigestible nature as food, and its inability, from its resistance to peptic change, to supply for any length of time all the conditions necessary for proper digestion. Added to this is man's natural aversion to the continued use of one, and only one, kind of food for any length of time. Physiology teaches us that the gastric fluid is secreted only in the presence of food; but that it ceases to be secreted, although food be present in the stomach, as soon as the wants of the system are satisfied. Now, what takes place during digestion where the only food employed consists of salt meat-sometimes of the consistence of buckhorn-and dry biscuit? The food remains in the stomach probably five or six hours, while the wants of the system continue unsatisfied. All this time the stomach is being excited to secretion, while the gastric juice, from this exhausting secretory action, becomes deteriorated in quality, or in the end, perhaps, deficient in quantity; and the result is that the whole digestive process is brought to a standstill. Scurvy, therefore, is the result of mal-nutrition. But we know that if lime-juice or vegetables be added to the staple fare of salt meat and biscuit, scurvy may be pre-vented. And the prophylactic power of the lime-juice does not, as is generally supposed, depend upon its having any direct action upon the blood, but upon its immediate action on the contents of the stomach, by serving as the agent by which these hard ingesta become reduced and rendered fit for absorption-in fact, by taking the place of the gastric fluid. Now, what facts have we to strengthen this hypothesis ? In the first place, that the solvent power of the gastric fluid depends, for the most part, upon the acid it contains, it having been found to yield, on analysis, hydrochloric, acetic, lactic, malic, and phosphoric acids ; one being capable of taking the place of the other. Hence it is that the acid wines and vinegar become antiscorbutics. Secondly, that the solvent effect of the different acids upon the fibrin of meat is well known, and is taken advantage of in making analyses of the contents of the different viscera in medico-legal investigations. We learn by experience that saur-kraut, spruce-beer, oranges, lemons, and their juices, and all kinds of esculent fruits and vegetables, possess more or less so-called antiscorbutic properties ; also, that the acid wines, vinegar, brandy, molasses, pickles, and sauces tend greatly to prevent the occurrence of scurvyindeed, it would be difficult to name anything contained in the category of eatables and drinkables which does not possess, to a greater or less degree, some antiscorbutic value. Now, it must be patent to all who possess the smallest knowledge of chemistry, that if vinegar and brandy serve at all to prevent the disease, it cannot be owing to the salts of potash they contain; while it is equally certain that they must operate in a manner quite different from that in which potatoes and green vegetables effect a cure. The juice of the lime and lemon, acid wines, beer and vinegar, act by virtue of their solvent effect upon the food contained in the stomach; whereas alcohol can only act through the medium of the circulatory system. The secret of vegetables and fruits being so potent as antiscorbutics is this :-The alimentary canal may be very appropriately termed a double organ, inasmuch as the animal food is digested by the stomach, and the vegetables by the intestines. Hence man has two distinct appetites, one for each kind of food-the animal and vegetable. He may eat to repletion of the one kind, and then partake heartily of the other. Is it not fair to assume, then, that, in the case of the scorbutic patient whose stomach digestion has been most imperfect, the intestines, which for weeks have been almost wholly unemployed, should, upon the accession of vegetable food, play an active part in supplying the necessary nutritive material to the system ? Scurvy is to be prevented, then, in two ways: either by employing the stomach better, or by giving the intestines more to do. Food should be so constituted as to contain within it the materials from which may be drawn all the primary elements of the blood; and no one kind of food is so rich in these as flesh, the fibrinous portions being the most essential. It is true that wherever scurvy has happened, whether on land or sea, it has always been in the absence of vegetable food; but what other condition is there that strikes one ? P That the fibrinous and albuminous portions have always been deficient in the materia alimentaria supplied, or they have been presented in such a form as not to admit of their being, for any length of time, properly and effectually reduced ; the latter being the case where salt meat has been the cause, and the former where bread, tea, coffee, bacon, cheese, &c., have formed the diet under which an outbreak of scurvy has taken place. We have sufficient proof that the fibrinous and albuminous principles play a most important part in eradicating scurvy in the fact that vegetables will sooner effect a cure when combined with salt meat than when administered alone, and still quicker conduce to such result when taken in conjunction with fresh meat. And again, a healthy, growing youth, with craving appetite, whose stomach is equal to any emergency in the way of food, will outlive a much longer voyage on salt meat and biscuit than the man in middle life with fastidious stomach; although in the case of the youth the demands of the system for food are greater, in order to supply the wants of a growing frame. What stronger arguments can be adduced in favour of my theory? What greater proof can we have, in opposition to the prevailing opinion, that vegetables are chemically antiscorbutic-that they supply a something which meat does not possess, and which the body requires ? The four varieties of food necessary for the main-
doi:10.1016/s0140-6736(02)65582-5 fatcat:sudfsytdqvaaxcpuh5zi7juq3m