884 ALFRED F. HESS 



prising quite different from what they expected, or what we should have 

 expected. They write: "The balance of the mineral metabolism, in- 

 cluding the total ash, the calcium, phosphorus and chlorin during the 

 florid stage of the disease must be regarded not only as not damaged, com- 

 pared to that of the healthy child, but indeed as somewhat increased." 

 "All the more striking, on the contrary, are the results found during the 

 stage of convalescence. Here the balances were all markedly negative, and 

 only after a lapse of weeks was the tendency manifested to a return to 

 normal conditions." The authors regard these results as indicating a 

 sort of washing out of "dead material" during convalescence of material 

 which had gathered during the florid stage of the disease. According 

 to their interpretation the disease is due not to a primary or secondary salt 

 deficiency, but to a disturbance in salt elimination, and in the first place 

 of a calcium excretion. This is shown by the fact that even in the "stage 

 of healing," when the total ash and the phosphorus balance once more had 

 become positive, the calcium balance nevertheless remained somewhat 

 negative. The metabolism of infantile scurvy, they believe, far from 

 showing a resemblance to rickets, manifests quite the contrary tendency. 

 The study of this case of infantile scurvy, and that of Baumann and How- 

 ard of a case of adult scurvy, comprises the total investigation of the 

 metabolism in human scurvy. 



In the course of a recent discussion on rickets before the Medical 

 Society of Vienna, Moll(&) stated briefly that in a case of infantile scurvy, 

 at the height of the disease, he found a positive calcium balance which 

 became poor and later negative on giving fruit juice; in other words, a 

 partial confirmation of the work which has just been cited. 



In 1913 Bahrdt and Edelstein reported the analyses of the organs 

 of an infant almost nine months old who died of scurvy. An examina- 

 tion of the tissues, especially of the bones, should be especially valuable 

 in checking up determinations of the metabolism during life. This in- 

 vestigation runs absolutely counter to that of Lust and Klocman. The 

 bones showed a decrease of ash, especially of calcium and of phosphorus, 

 and also a lack of calcium in the muscles, but normal amounts in the liver 

 and in the kidneys. These conditions resemble the deficiency of ash and 

 of lime commonly associated with rickets, and it seems quite possible that 

 this infant had rickets as well as scurvy, and that in this way the discrep- 

 ancy between the two reports is to be explained. The fact that the water 

 content of the bones was two to three times the normal also lends emphasis 

 to this interpretation. In any metabolism, study of infantile scurvy 

 great care will have to be exercised thai the disorder is not complicated 

 by rickets, and the issue thereby confused. It will be very difficult to 

 avoid this pitfall, for there is no test by which early rickets can be diag- 

 nosed. The danger of this complication may be realized when we bear in 

 mind that the majority of infants have rickets to some degree. An in- 





