162 THE VITAMINS 



symptoms developing under conditions of partial deprivation or in 

 the earlier stages of complete deprivation of the vitamin are probably 

 of greater significance than those of typical scurvy. 



Hess and Unger (1920a), from cHnical observations and post- 

 mortem examinations and from the literature on scurvy and rickets, 

 concluded that beading of the ribs, the so-called rachitic rosary, is not 

 the result of rickets alone, but is one of the typical signs of scurvy and 

 has also been noted in connection with beriberi and pellagra in children. 

 The belief that this phenomenon is attributable solely to rickets is 

 thought to be responsible for the misinterpretation of many cases of 

 latent scurvy. On the other hand there is the possibility, as noted before, 

 of attributing certain phenomena to lack of vitamin C when in 

 reality a deficiency in another factor or factors is responsible. Tozer 

 (1921a) compared histologically the condition of the bone marrow of 

 guinea pigs suffering, respectively, from lack of vitamin C, of vitamin 

 A, and of both of these factors and concluded that unless the scurvy 

 animal is protected from the effects of an insufficiency of vitamin A 

 the results will be complicated and difficult of diagnosis. It was the 

 recognition of the multiple deficiencies of a diet of cereal grains and 

 water alone that led to the use of autoclaved milk in basal diets for 

 the vitamin C studies. 



Zilva and Wells (1919) compared microscopic sections of teeth 

 from normal guinea pigs which had received subnormal amounts of 

 antiscorbutics in their food and came to the conclusion that the tooth 

 is one of the first if not the first part of the system to be aflfected by 

 a deficiency of antiscorbutic material and that changes of a profound 

 nature may occur in the teeth even when the ordinary scorbutic symp- 

 toms are still so slight as to be almost unrecognizable. They described 

 the effect upon the teeth as a fibroid degeneration of the pulp, the fine 

 cellular connective tissue of the normal tooth being replaced by a fibrous 

 structure devoid of distinct cells. Similar radical changes were also 

 noted in monkeys on a scorbutic diet. In discussing the application of 

 these results to human nutrition, they suggested the possibility that 

 dietary deficiency is an important factor in the great prevalence of 

 tooth decay in civilized communities. They pointed out that cases of 

 scurvy so mild as to escape detection may occur more often than is 

 usually suspected and may reasonably be expected to influence dentition. 



Howe (1920) also found that scorbutic diets have a very marked 

 effect upon the teeth. He noted in guinea pigs in a state of chronic 

 scurvy a marked decalcification and loosening of the teeth, with exten- 

 sive absorption of the alveolar processes similar to pyorrhea. The 



