METABOLISM IN SCUKVY 885 



vestigation of the chemistry of adult scurvy has an advantage from this 

 point of view. 



Chemical examination of the blood has yielded such valuable informa- 

 tion regarding metabolic diseases that it might be expected to shed light 

 on the disturbances of scurvy. The only investigation from this stand- 

 point is that of Hess and Killian, who have reported estimations of the 

 urea, creatinin, sugar, CO 2 combining power, diastase, cholesterol, chlorin 

 and calcium. 1 The urea content was normal, varying between 12 and 14 

 ing. per 100 c.c. of blood; this is the average of twenty-one tests on ten 

 cases of infantile scurvy. (In severe cases of beriberi Yano and iSTemoti 

 have recently reported that the blood contains an increase of urea, and 

 that its excretion is frequently disturbed.) The creatinin was estimated in 

 two cases and was found to be 2.0 mg. and 1.7 mg. per cent respectively 

 also normal figures. The blood sugar varied from 0.12 to 0.14 per cent, 

 and was examined in almost all the cases in which urea was estimated; 

 these figures are at the upper level of normality (no attention was paid 

 to the interval elapsing between the feeding and the withdrawal of the 

 blood). The diastatic activity was likewise normal. The CO 2 combining 

 power showed figures under 40 to 45, according to the Van Slyke method, 

 and indicated therefore a mild degree of acidosis. In six cases the 

 dilorids were estimated, the figures being remarkably constant at about 

 0.42 or 0.43. Cholesterol was a little below normal in the four cases 

 examined. Contradictory results were obtained in regard to calcium. 

 Earlier tests showed a definite deficiency of this salt, but those carried out 

 more recently have generally yielded normal results. Further studies of 

 the blood calcium are highly desirable to ascertain whether it varies in 

 amount in the circulation and especially in different stages of the disease. 

 This aspect is worthy of particular attention in view of the positive 

 calcium balance noted by Lust and Klocman during the active stage of 

 scurvy, and the negative balance during the period of convalescence. 



It is evident from the limited data concerning the blood chemistry of 

 scurvy that it is a field which has been inadequately explored and will 

 repay more intensive study. Investigations of this kind have recently 

 been made possible by the introduction of accurate methods requiring only 

 small quantities of blood. 



Studies of the metabolism of animals suffering from scurvy are almost 

 as few as those on man. The work of Morgan and Beger, which is fre- 

 quently quoted in this connection, is not applicable, as it concerns rabbits, 

 which do not develop scurvy. They found that rabbits fed solely on 

 oats and water suffered in their nutrition (loss of appetite, emaciation, 

 paralysis of hind legs), and could be cured by the addition of sodium 

 bicarbonate to the dietary. In 1916 Lewis and Karr published a paper 



1 Almost all of these cases were receiving liberal daily amounts of cod liver oil, 

 which should exclude the possibility of complicating rickets. 



