334 Vitamines and Deficiency Diseases [June-September 



much work on this disease, continues to regard sprue as due to in- 

 fection, but the data f rom his own paper indicate that it is dietary in 

 origin. He saw, in many sprue cases, tetany with anemia, often 

 accompanied by unconsciousness and fever up to 103° F. Continued 

 fever indicates the last and fatal stages, results (very likely) of 

 secondary infection. For treatment he recommends strawberries, 

 ripe raw gooseberries and the juice of blackberries. Bahr (93) 

 found that the disease is more common in women (analogy to Pel- 

 lagra). His post mortem findings were: great waste of internal 

 Organs and inflamed intestines. Leede (94) also recommended straw- 

 berries as a eure; but he made an interesting Observation from our 

 point of view, namely, that preserved strawberries are not equal in 

 curative power to fresh fruit. He suggested that the beneficial prin- 

 ciple is destroyed by heat. Mühlens (95) believes that sprue is 

 sometimes complicated by dysentery, when, besides ingestion of 

 strawberries, the administration of emetine is indicated. He is in- 

 clined to accept the deficiency theory. Werner (96) observed 

 scurvy Symptoms (petechise) in a case of sprue. 



VII. RICKETS 



Our knowledge of rickets has not increased sufficiently, in this 

 connection, to advance us beyond the stage of the very promising 

 hypothesis that the disease is due to deficiency of vitamines. Ad- 

 vance has been slow because there have been many cases where the 

 differential diagnosis of rickets and bone porosity was impossible. 

 Bone porosity {Fragilitas ossium) is not improved by treatment 

 with calcium salts, phosphorus or cod-liver oil, according to 

 Ostheimer (97), but by good food. Ostheimer considers this dis- 

 ease a result of faulty metabolism during pregnancy (congenital 

 fault of metabolism) and that it has nothing to do with rickets or 

 osteomalacia. On the other band we have to differentiate, clinically, 

 between cases that improve on dietary additions of calcium and 

 phosphorus only, and those that do not improve after the further 

 addition of vitamine to the diet. The latter types of cases must not 

 be regarded as rickets. 



As we have seen in the preceding chapters, special attention must 

 be given to the fact that, in experiments with so called calcium- and 



