602 IX. CAROTENOIDS AND VITAMINS A 



fully treated with cod liver oil by Snell,'"^'' in 1876. A number of cases of 

 these conditions have been recorded in the literature, including the report 

 of de Gouvea^°^^ on a series of cases of plantation slaves in Rio di Janeiro 

 who were treated effectively with cod hver oil, and the classic studies of 

 Mori,'°^^ who described 1511 cases of xerophthalmia and 116 cases of kera- 

 tomalacia observed in Japan between 1899 and 1902. There are also the 

 reports of Bloch^"^°~^°^^ and of Blegvad^"^^ which, combined, furnish data on 

 211 cases of xerophthalmia and 453 cases of keratomalacia observed in Den- 

 mark during the years 1919 and 1920. Mori^"^^ observed the highest inci- 

 dence of the diseases in summer, when they were associated with the so- 

 called summer diarrhea. Although Mori considered a lack of fat to be the 

 cause of the disorder, it was recognized that cod liver oil played a unique 

 role in the cure of these conditions. 



Xerophthalmia and keratomalacia have been reported in insufficiently 

 breast-fed children, '"''•* •"''^* as well as in newborn babies. ^'''^^•"'" Bouman 

 and van Creveld'"" noted that keratomalacia occurred in an infant whose 

 mother, during pregnancy, had had a diet deficient in vitamin A, in the pro- 

 vitamins A and in fat, consisting mainly of bread and tea with unfortified 

 margarine. Although the mother exhibited no symptoms of \'itamin A de- 

 ficiency, the infant was born with keratomalacia, which resulted in com- 

 plete and permanent blindness. For a further description of the external 

 manifestations and the histopathology of this condition, the reader is re- 

 ferred to the review of Mason. '"-^ 



(c) Metaplasia of EpitheUa. The association of sjonptoms which can be 

 attributed to a metaplasia of the epithelia of the respiratory tract, with 

 keratomalacia, was early recognized. Thus, symptoms such as dryness of 

 oral, nasal, and pharyngeal membranes were observed in patients Avith 

 keratomalacia, together with hoarseness, husky voice, and a dry cough, 

 frequently associated with pneumonia. Keratinization of the mucosa of 



'0" S. Snell, Lancet, 1876, I, 8-9. 



io«8 H. de Gouvea, Albrecht von Graefe's Arch. Ophthalmol, 29, Part I, 167-200 (1883). 

 los^ M. Mori, Jahrh. Kinderheilk., 69, 175-195 (1904). 

 i»™ C. E. Bloch, J. Hxjg., 19, 283-304 (1921). 

 '"1 C. E. Bloch, Am. J. Diseases Children, 27, 139-148 (1924). 

 JO" c. E. Bloch, Am. J. Diseases Children, 28, 659-667 (1924). 

 >»" O. Blegvad, Am. J. Ophthalmol. [2], 7, 89-117 (1924). 

 1074 T. Thalberg, Arch. Augenheilk., 12, 315-332 (1883). 



'0" J. H. de Haas, J. H. Posthuma, and O. Meulemans, Indian J. Pediat., 8, 139-157 

 (1941). 



">'« J. P. Maxwell, /. Obstet. Gynecol. Brit. Empire, 39, 764-776 (1932). 



w" H. D. Bouman and S. van Creveld, Z. Vitaminforsch., 10, 192-197 (1940). 



