454 A M E R I C A N J O U R N A L OF D I G E S T I V E D I S E A S E S VOLUM~ 8 NUigBF, a 12

significance with respect to the mechanism of hydro- chloric acid secretion.

SUMMARY During the rapid secretion of hydrochloric acid by

the gastric mucosa, appreciable differences in the chloride concentration in the arterial and gastric venous blood were observed only occasionally; these differences were mainly in the cell chloride.

R E F E R E N C E S 1. Hanke, M. E., Johannesen, R, E. and Hanke, Maude M.: Alkalinity

of Gastric Venous Blood Dur ing Gastric Secretion. Proc. Soc. Exper. Biol, and Med., 28:698-700, March, 1931.

2. Bulger, H. A., Allen, Duff r Harr ison, L. B.: Studies of the Chemical Mechanism of Hydrochloric Acid Secretion. II. Obser- vations on the Blood Pass ing Through the Stomach of Dogs. J . Clin. Invest., 5:561-571, June, 1928,

3. Peters, J . P. and Van Slyke, D. D. : Quanti tat ive Clinical Chemistry. Baltimore, Williams & Wilkins Company, Vol. 2, p. 835, 1932.

4. Mann, F. D. and Mann, F, C.: An Experimental Study of Some Chemical Inhibitors of Gastric Acidity. Am. J. Dig. Dis., 6:322- 325, July, 1939.

5. Bandes, J. , Hollander, F. and Glickstein, J . : Effect of Fluid Ab- sorption on Dilution Indicator Technique of Gastric Analysis. Am. J. Physiol., 131:470-482, Dec, 1940.

6. Dodds, E. C. and Smith, K. Shirley: Variat ions in the Blood Chlorides in Relation to Meals. Pa r t 1. J. Physiol., 58:157-162, Dec. 28, 1923.

7. Lira, R. K. S. and Ni, T. G.: Changes in the Blood Constituents Accompanying Gastric Secretion. I. Chlorides. Am. J. Physiol., 75:475-486, Jan. , 1926.

The Value of Meat as an Antiscorbutic

By

VICTOR E. LEVINE, M.D. OMAHA, NEBRASKA

INTRODUCTION

D R. VILHJALMUR STEFANSSON in a communi- cation to SCIENCE, entitled "The Dilemma in

Vitamins," calls attention to a difference of opinion between the field observer and the experimental nu- tritionist on the subject of scurvy with reference to meat as a preventive or curative. Upholding the stand of the explorer, Dr. Stefansson asserts that the records of travelers, field anthropologists and frontiersmen, such as the managers of trading posts in the employ of the Hudson's Bay Company through- out the north of Canada, abound in case histories, which offer indisputable proof of the fact that ex- clusive meat e a t e r s never develop the symptoms characteristic of scurvy. It must be noted, however, that in countries and climates where fruits and vege- tables are available, animal food does not enter into the problem of the prevention of scurvy.

Stefansson's views harmonize with his own ex- periences in curing and in preventing scurvy among his own Arctic companions by the consumption of fresh meat (2, 3). In his very interesting volume, THE F R I E N D L Y ARCTIC, he recounts how in 1917 he induced in his companions, Lorne Knight and Harold Noice, rapid recovery from scurvy by the con- sumption of fresh meat.

Stefansson makes the illuminating, significant and judicious suggestion that Arctic and Antarctic ex- plorers should not provide themselves with anti- scorbutics in the form of fruits and vegetables. These may prove a burden on the trail because of excessive weight; they may be lost through accident; they may in time undergo rapid diminution in antiscorbutic potency. Fresh meat secured by "living off the land" has all advantages and no disadvantages (4, 5).

However, it must be admitted that living off the land with reference to the prevention of scurvy is no longer an important problem for explorers, since they now can supply themselves amply with synthetic Vitamin C or ascorbic acid without any addition to the weight of supplies and without much danger of deterioration.

* F r o m the Department of Biological C h e m i s t r y and Nutri t ion, Creighton University, School of Medicine, Omaha, Neb. Submitted March 29, 1941.

The experimental nutritionist is responsible for the belief that meat is inefficacious as an antiscorbutic. This viewpoint had its origin in the results obtained in the biologic assay of its antiscorbutic value, utili- zing the guinea pig as the test animal. The findings of the nutritionist indicate that muscle meat has a negligible quantity of Vitamin C, and that it possesses therefore dubious value as a food to be utilized in the prevention and cure of scurvy. The internal organs, on the other hand, especially liver, are comparatively rich in Vitamin C and do possess efficiency as anti- scorbutics (6). Moreover, muscle meat of all soft animal tissues the poorest in Vitamin C content, may undergo considerable loss or even complete loss in antiscorbutic potency as a result of oxidation, aided by aging, by cooking, by the natural process of drying or by the mechanical process of dehydrating.

Dr. Stefansson is not in accord with the findings of the experimental nutritionists. He cites the case of such meat eaters as the northern Athapascans who punctiliously cook their food to an extent to which nutritionists imply would practically destroy Vitamin C potency. These northern Athapascans as well as the northern Canadian Eskimos feed to dogs or throw away most of the internal organs rich in Vitamin C. Yet, according to Stefansson, neither these Eskimos nor these Athapascans ever develop symptoms of scurvy.

In attempting to solve the apparent dilemma be- tween the animal experimenters and the observers of diets among primitive peoples, Stefansson offers four pertinent suggestions :

(1) "The experimenters reach unsound conclusions with regard to human needs when they analogize for Vitamin C from guinea pigs to human beings."

(2) "Those who measure the Vitamin C content of animal tissues through the current methods have probably overestimated from two to ten times the amount necessary to prevent scurvy symptoms in man - - o r perhaps they have underestimated the superi- ority of the human over the guinea pig mechanism for extracting and utilizing Vitamin C."

(3) "The experimenters have overestimated the destructive effect of ordinary cooking upon the Vita-

JOUR. D. D. D~CEMBER, 1941

L E V I N E - - T H E VALUE OF MEAT AS AN ANTISCORBUTIC 455

rain C efficiency of animal t issues--in all probability the Vitamin C is greatly weakened or destroyed only in the outermost layer of a piece of meat. Most carnivorous people boil or roast their meat in large pieces and cook to where the outside only is well done while the inside of either boiled or roast is about like the inside of our roasts. In such cooking the Vitamin C efficiency may remain nearly or quite undiminished through 90 per cent of the diameter of each chunk."

(4) "Or possibly t h e r e is some component of animal tissue other than Vitamin C which is able to prevent scurvy."

In discussing these suggestions we shall endeavor to remove the dilemma.

VITAMIN P AND ITS POSSIBLE RELATION TO SCURVY

With reference to the suggestion relating to the probability of the presence of a component of animal tissue other than Vitamin C which is capable of pre- venting scurvy, it may be stated that Szent-Gyiirgi and his coworkers reported in extracts of Hungarian red pepper (paprika) and in lemon, grapefruit or orange, or in the peelings from these citrus fruits, a substance other than ascorbic acid which decreases capillary fragili ty and capillary permeability (7, 8). This substance, St. Ruzny~k and Szent-Gy5rgi (9) claimed to be a flavonone in chemical nature, and Bruckner and Szent-Gyhrgi (10) identified it as a mixture of hesperidin (a glucoside of 4-methoxyeri- odyctyol) and eriodyctyol glucoside (a glucoside of 5 :7 :3 :4 : tetrahydroxyflavanone). Clinically this vita- min, named Vitamin P (permeability factor), re- turned fragile and permeable capillaries to their normal state. Vitamin P deficiency may be part of the picture of clinical scurvy.

Szent-Gyhrgi and his workers were able to control the number of hemorrhages in the course of certain clinical conditions, in three cases of vascular purpura, in four cases of thrombocytopenic purpura, in seven cases of infectious disease, and in two cases of dia- betes me]litus. Experiments with scorbutic guinea pigs indicated a prolongation of life for 28.5 to 44 days as a result of the administration of Vitamin P and a decreased number of hemorrhages. Zilva (11) and also Moll (12) working with guinea pigs were unable to confirm these results. McHenry and Perry (13) maintain that a deficiency of Vitamin P is not a factor in producing hemorrhages in scorbutic guinea pigs and that a deficiency of ascorbic acid is alone re- sponsible for scurvy in these animals.

Results of other investigators on the other hand point to another factor implicated with Vitamin C. Jacobson (14) reported a lower concentration of ascorbic acid in the adrenals of guinea pigs receiving daily 20 milligrams of crystalline ascorbic acid than in the same organs receiving an equal amount of Vitamin C from cabbage. Fox and Levy (15) kept four guinea pigs for two months on a basal diet plus five milliliters of orange juice equivalent to 2.5 to 3.0 milligrams of ascorbic acid and found a retention of 0.5 gram of ascorbic acid per gram of adrenal tissue. Five animals fed for three months a basal diet plus lucerne leaves equivalent to 3.2 milligrams of ascorbic acid per day showed an average storage of only 0.32 milligram per gram of adrenal tissue. The differ- ence may be in the fact that orange juice is rich in

Vitamin P. Hawley, Daggs and Stephens (16) also observed better retention of ascorbic acid in the tissue of guinea pigs when the vitamin was ingested in the natural form as cabbage, alfalfa and orange juice than when administered in the form of crystalline Vitamin C.

Very recently Todhunter, Robbins, Ivey and Brewer (17) made a comparison of the utilization by guinea pigs of equivalent amounts of ascorbic acid in lemon juice and in the crystalline form. They reported that comparable amounts of ascorbic acid in aqueous so- lution and as lemon juice made similar gains in weight but those receiving lemon juice had fewer hemor- rhages when scored for scurvy. The blood plasma levels were the same in each group and there was no appreciable difference in the ascorbic acid content of the adrenals of each. Their data indicate the possi- bility that lemon juice contains an additional factor which is concerned in the prevention of the hemor- rhages characteristic of scurvy. Zacho (18) studied the influence of Vitamin P on the capillary resistance of guinea pigs. Citrin (Vitamin P) showed distinct powers of increasing capillary resistance, but the simultaneous presence of both citrin and ascorbic acid was necessary for the maintenance of normal capillary resistance. Citrin also prevented intestinal hemor- rhage in scorbutic guinea pigs. According to this investigator the hemorrhagic diathesis in scorbutic guinea pigs was largely due to lack of cit~in and that the other scorbutic symptoms developed because of lack of ascorbic acid.

Recently Scarborough (19) worked on human sub- jects alone and confirmed the findings of Szent-Gyhrgi. Scarborough was able to increase the capillary re- sistance by the use of Vitamin P preparations. The preparations showed potency by oral administration and by rectal or intramuscular injection. The increase in capillary resistance was induced in every case even when ascorbic acid by mouth or by injection failed to produce this result. Elmby and Warburg (20) have found that ascorbic acid alone failed to cure the hemorrhagic condition of human scurvy. It is inter- esting to note that Jessild (21) reported Vitamin P to be specific in the treatment of Schhnlein-Henoch purpura.

In view of these newer findings, it may be argued that the increased capillary fragili ty and the marked tendency to bleeding in scurvy may not be due to lack of Vitamin C, but to lack of Vitamin P. Both of these compounds seem to be closely associated in foods, so that the absence of Vitamin C may also parallel the absence of Vitamin P, and may lead not only to the development of scurvy, but to the hemorrhagic dia- thesis as well. At present very little is known about Vitamin P and its distribution in animal and plant tissue. Tke various B vitamins are also closely asso- ciated in foods, although in different proportions. Egg white, however, contains riboflavin, but no Vitamin B r Oranges and lemons are rich in both Vitamin C and Vitamin P, yet grapefruit with an abundance of Vitamin C is markedly poor in Vitamin P.

INACTIVATION OF VITAMIN C BY HEAT

With regards to the second" suggestion referring to the relation of temperature to the destruction of Vita- min C, Stefansson asserts correctly that the Vitamin C is diminished in content or completely destroyed

4 5 6 A M E R I C A N J O U R N A L OF D I G E S T I V E D I S E A S E S VOL~M~ S ~ U bl BER 12

only in the outermost layer of a piece of meat not thoroughly heated. He states that most carnivorous people boil or roast their meat in large pieces and cook them sufficiently long to get only the outside well done, and in consequence of this procedure the Vita- min C content may remain nearly or quite undi- minished through 90 per cent of each chunk.

Some Eskimos prepare their meat in the white man's way. But the great majority still boil large pieces of meat in a pot of water obtained by melting snow or ice in the winter time. When fuel is short even this type of parboiling is dispensed with. Never- thelessEskimos lose large amounts of Vitamin C even in their crude and incomplete way of cooking. Hoygaard and Rasmussen (22), using the chemical method in- volving the reduction of 1,6-dichlorophenolindophenol, found that raw seal meat contained 2 milligrams of Vitamin C per 100 grams, while cooked seal meat may lose at least 50 per cent of this vitamin content, partly by oxidation and partly by solution in the water used for cooking.

VITAMIN C POTENCY WITH R E F E R E N C E TO FREEZING

With reference to climatic conditions in the Arctic it may also be well to keep in mind the effect of freezing on the Vitamin C content of foods. The re- lation of freezing to Vitamin C or ascorbic acid con- tent has been studied by Tressler, Mack and King (23) and by Nelson and Moltern (24). Freezing brings about a certain amount of cellular disorgani- zation with the liberation of enzymes that may oxidize ascorbic acid. Considerable losses may occur during storage and thawing because of the action of these enzymes. The slower the thawing process the greater the loss in Vitamin C potency. Losses as high as 80 to 90 per cent may thus take place within a few hours in beans, in peas, or in spinach.

The present-day Alaskan Eskimo keeps his meat supply in an ice dug-out, in the cache, or on the roof of the igloo or in the igloo itself. The small-sized igloo has two compartments, an outer compartment or vestibule, usually long, unheated, and which serves as a storeroom for all sorts of odds and ends, such as furs, pups, reins for the dog team, pokes of blubber, and meat. The outer compartment opens into the inner room which is the kitchen, living room and sleeping room combined. Reindeer, seal, walrus, birds and fish freeze as hard as rock. The animal food may be brought into the living compartment to thaw out. Many days and even weeks may pass before the meat is consumed. In the defrosting process, loss of Vita- min C may result from the action of released cellular enzymes, from the action of bacterial enzymes, or by the oxidation induced by hemoglobin set free from hemolyzed red cells. Such losses may be avoided by eating the meat raw in the frozen state or by cooking without preliminary defrosting. Heat destroys the enzymes capable of inducing oxidation.

BLOOD AS AN ANTISCORBUTIC Stefansson (25) emphasizes the fact that the flesh

food of carnivorous people, such as that of Eskimos remote from the influence of white people, are rich in blood, since the natives do not kill their food animals through a process of stunning followed by exsangui- nation accomplished by cutting the throat. In the past Eskimos harpooned their food animals, while at

present they shoot them. In either case the blood re- mains with the tissues at least so far as birds, seals, reindeer and caribou are concerned. The walrus, how- ever, is too heavy and too bulky to be conveniently brought back to the village. It is as a rule cut up on the ice shortly after it is killed so that the chunks of blubber and meat can be easily loaded into the umiak.* The abdomen and thorax are opened, and the large blood vessels accidently cut, thus affording escape of blood from the thoracic and abdominal organs. Whales are similarly treated.

Stefansson lays claim to the fact that blood may serve as a good source of the antiscorbutic factor. There are a few estimations of the Vitamin C content of the blood of animals used for food. Fuji ta and Ebihara (26, 27) found the reduced ascorbic acid content of the blood of the rabbit to be 0.3 milligrams per 100 grams, and the reduced plus the unreduced ascorbic acid 2.30 milligrams per 100 grams. Hoygaard and Rasmussen (22) reported 3 milligrams of Vita- rain C in 100 grams of the blood of the Greenland fiord seal. Stefansson is correct in his views on the antiscorbutic value of blood if it is consumed by itself. Since the Vitamin C content of blood is practically of the same low order as muscle meat, it would be neces- sary to ingest daily a considerable quantity, about one and a half liters of blood to secure about 50 milli- grams. This blood, however, has to be fresh, since the Vitamin C content may rapidly diminish on standing. A number of investigators - - Fujita, Ebihara and Numata (28), Gabbe (29), Kellie and Zilva (30), van Eekelen (31), Emmerie and van Eekelen (32), Berend and Fisher (33), Klodt (34), and Greenberg and Rinehart (35)--have reported the destruction of ascorbic acid by hemoglobin released from the red cells as a result of hemolysis. Frozen meat may begin to lose its Vitamin C when in the process of thawing, hemolysis sets in. The low content of Vitamin C in the blood does not materially help the Eskimo in in- creasing his daily Vitamin C intake.

Concerning the third suggestion relative to the daily human requirement for Vitamin C and the rela- tive efficiency of the guinea pig and the human being for extracting and utilizing Vitamin C, Stefansson states that those who measure the Vitamin C content of animal tissues by the current methods have proba- bly overestimated from two to ten times the amount needed to prevent symptoms of scurvy in man, or perhaps have underestimated the superiority of the human over the guinea pig mechanism for extracting and utilizing Vitamin C.

There is no evidence that there exists a biologic superiority of the human being over the guinea pig with relation to the utilization of Vitamin C. It is more likely that the healthy guinea pig used in the biologic assay is far better qualified to absorb and assimilate this vitamin than the average human being of today. The Vitamin C requirements of the human being are influenced by his age, by his state of health, by the presence of major and minor infections, by the adequacy of his diet with respect to factors other than Vitamin C, and by the energy expenditures of the body. Hamel (36) demonstrated increased utilization or increased disappearance of ascorbic acid as a result

* A n umiak is an open boat used by the Eskimo. I t consis ts of a f r [ m e w o r k of wood covered over the wal rus skin.

JouB. n.D. LEVINE--THE VALUE OF MEAT AS AN ANTISCORBUTIC 457 DECEMBER, 1941

of manual labor or violent exercise. Concerning the fact that men engaged in hard manual labor develop scurvy more easily than men on the same diet but less actively engaged, the British Medical Research Council (37) states as follows: "In the expedition of the ALERT and the DISCOVERY to seek the North Pole in 1875, the men wintered on the ships within the Arctic Circle. There was no definite scurvy diagnosed during this period although the diet was defective from the point of view of antiseorbutie substances, notably by the substitution of lime juice for lemon juice. In the spring of 1876 the sledging parties set out, and with the performance of hard manual labor scurvy at once made its appearance, the first ease oc- curring within ten days of departure. At first the officers escaped, but as the men fell sick and the labor of dragging the sledges devolved more and more upon the officers, they also fell victims to the disease. In due course scurvy also broke out among the crews left behind upon the ships during the spring and summer of 1876, but its onset was distinctly later."

The old sailing captains recognized the fact that the loafing sailors suffered the least from scurvy, while the most energetic and industrious seamen were the first to become incapacitated. The rigors of the Arctic winters and the strenuous exercise of travelling for many hours at a stretch with dogs and sledge over frozen tundra or ice-covered ocean no doubt call for a greater Vitamin C in take . Despite this fact, Heygaard (38) maintains that 15 milligrams of Vita- min C per day sufficed to protect him from scurvy in the Arctic while on sledging journeys of long duration.

THE GUINEA PIG AS A TEST ANIMAL FOR VITAMIN C POTENCY

The fourth suggestion conveys the idea that the ex- perimenters in nutrition reach unsound conclusions with regard to human needs when they analogize for Vitamin C from guinea pigs to human beings. With reference to the guinea pig, all present knowledge leads unequivocably to the inference that conclusions relative to antiscorbutic potency of foods secure'd by experimentation with this species apply to the human being with, however, one very conspicuous exception. The guinea pig is ideal for assaying foods with high concentrations of Vitamin C. but is a total failure for testing foods with very low concentrations of this dietary factor.

For foods with a high vitamin content, such as citrous fruits or red peppers, one to two cubic centi- meters or one gram or even less per day may suffice to cure or prevent the classical symptoms of scurvy. For foods with low vitamin content, such as milk or meat, quantities to be fed daily in order to prevent or cure scurvy may be so large as to overreach the ana- tomical and the physiological capacity of the small test animal, the weight of which at the beginning of the bio-assay may range from 250 to 300 grams.

To impress one with the difficulties involved in the use of the guinea pig in the assay of foods with low concentrations of Vi tamin C, we shall cite Barnes and Hume (39) :

"Guinea pigs are however not well suited for work upon the antiscorbutie value of milk. In order to maintain health and to prevent scurvy, these animals need a comparatively large amount of antiseorbutic material in their diet. In case,

therefore, of foodstuffs like milk with a low con- tent of anti-scurvy vitamin, it is necessary for large quantities to be consumed. I t is against the habit and nature of these animals to take much liquid and we have never come across an animal which would take voluntarily the large daily ration (100 cc. and upward) of raw milk neces- sary to afford protection from scurvy. Hand feed- ing of these large quantities is indescribably tedious and in many cases they cannot be toler- ated without digestive disturbances."

In order to determine the amount of milk required to prevent er cure scurvy, the guinea pig must be forced to ingest daily a quantity of milk equal to at least one-third or one-fourth to more than one-half of its body weight. Chick, Hume and Skelton (40) used young guinea pigs who could be more readily induced to take large quantities of milk. They found that a daily consumption of less than 50 cc. of fresh milk brought about scurvy, and that a daily ration of 50 to 100 cc. offered lesser or greater protection from scurvy, depending upon the amount consumed. A daily consumption of 100 to 150 ec. produced freedom from scurvy and satisfactory growth. This amount is practically the equivalent of a complete milk diet.

Dutcher, Pierson and Biester (41) in their studies of the antiscorbutic properties of raw beef fed one group of guinea pigs a diet of oats, water, and an amount of milk sufficient to improve the diet but insufficient to prevent scurvy. These animals developed the disease and died. When 5 grams of raw lean beef were fed daily or water extracts of raw beef repre- senting 5, 10, 15, or 20 grams of raw beef, no differ- ence could be noted in the time of the onset of scurvy or in the length of life of the experimental animals. The initial weight of the experimental animals fed the scorbutic diet together with the beef or water ex- tracts therefrom ranged from 153 to 365 grams.

Dutcher, Pierson and Biester do not mention the difficulties encountered in feeding guinea pigs an unaccustomed food. Grace Medes (42) realizing these difficulties investigated the antiscorbutic properties of beef by employing younger animals with correspond- ingly lower weights so that they could be trained more successfully to eat beef. She secured fresh beef daily from the market and kept it on ice until feeding time. She succeeded in feeding the young guinea pigs daily amounts of 20 to 30 grams of beef. The inclusion of the beef in the scurvy-producing diet served to delay the onset of scurvy for seven days only.

Neither Dutcher and his associates nor Grace Medes furnish us with decisive evidence on the efficiency of Vitamin C as an antiscorbutie for human beings. They were limited by the shortcomings of the biologic method and consequently could not feed sufficient beef to solve the problem satisfactorily. Moreover, Dutcher and his associates rendered some of their findings all the more questionable by the use of water extracts without determining the completeness or incomplete- ness of the extraction of the vitamin from fresh raw beef. Furthermore, it must be remembered that Modes and Dutcher and his associates used beef se- cured in the open market. Such meat may not be freshly killed beef.

The experiments of Gatti, Menendez and Knallinsky (43, 44) indicate that such beef is sufficiently rich in

458 AMERICAN JOURNAL OF DIGESTIVE DISEASES VOL~'~E S NUMBEn 12

Vitamin C to protect guinea pigs from scurvy. They have successfully used the guinea pig as a test animal to demonstrate the efficiency of freshly killed meat as an antiscorbutic and the inability of old meat or dried meat to protect from this disease. During the War of the Chaco during 1932-35, the Paraguayan soldiers developed scurvy. The scurvy-producing ration con- tained dried and preserved meat (corned beef). When this meat was fed to guinea pigs, they developed the typical symptoms of active scurvy. When, however, fresh meat secured within half an hour of slaughter- ing was substituted for the dried and preserved meat, the guinea pigs did not develop scurvy.

Fresh meat may contain a sufficient concentration of Vitamin C so that it may be fed in quantities within the physical capacity of the gastro-intestinal tract of the guinea pig. The Vitamin C content of meat is generally given to be about 2 milligrams per 100 grams. It is quite likely fresh meat may contain two or three times as much. The least daily intake of Vitamin C which begins to show curative properties is one-half milligram. On the basis of 2 milligrams per 100 grams, 25 grams of meat in the diet would prevent scurvy and on the basis of 4 milligrams per 100 grams of fresh meat that is recently killed meat, 12.5 milligrams. That amount of meat can be easily tolerated by a guinea pig. The less Vitamin C the meat contains, the greater the quantity of this meat that must be fed in order to reach a level of Vitamin C intake sufficient to prevent or remove the symptoms of scurvy.

THE DESIRABILITY OF USING A LARGER ANIMAL THAN THE GUINEA PIG IN THE

BIOLOGICAL ASSAY OF VITAMIN C To estimate biologically the antiscorbutic value of

meat in relation to the human being, it would be de- sirable to employ a larger experimental animal, like the monkey or the human being. Barnes and Hume finally employed monkeys to determine more definitely the antiscorbutic value of fresh milk. Lind (45) was the first investigator to ascribe antiscorbutie proper- ties to meat. In 1771 he made the interesting obser- vation that a soup prepared from the flesh of the green turtle was curative of scurvy in the human being. William Stark (46) who was born in 1741 and died in 1770 was a medical student in Glasgow, Edin- burgh. At about the time Cook was sailing around the earth, Stark was engaged in performing dietary experiments upon himself. He gave himself scurvy upon a diet of honey and flour, but not upon one rich in meat. Curran (47) in 1847 described an epidemic of scurvy in Dublin and cited more than 80 individuals who suffered from the disease all of whom had re- ceived one pint of milk daily at least six months prior to the development of symptoms of scurvy. Their diet however, was deficient in fresh meat and in vege- tables. Potatoes were scarce because of an existing potato famine. Barlow (48) in 1894 advocated the use of meat juice and meat gravy as an antiscorbutic food for infants emphasizing the superiority of un- cooked meat over cooked meat.

THE RELATIVE IMPORTANCE OF MEAT AS AN ANTISCORBUTIC IN THE DIET

OF THE PAST Stiebling (49) in 1936 reported her studies of

typical American dietaries of today. She found that

the citrus fruits and tomatoes, representing less than five per cent of the expenditure for food, furnished over 37 per cent of the total Vitamin C intake, green and yellow vegetables nearly 13 per cent, all other fruits and vegetables about 20 per cent, potatoes and sweet potatoes about 23 per cent, milk and its pro- ducts 5 to 6 per cent, meat and fish, fats and eggs only a negligible amount, if any. According to Stiebling's estimate 90 per cent of our Vitamin C intake is de- rived from fruits and vegetables, and about 5 to 6 per cent of the remainder from milk and milk products, while the flesh foods constitute but a very inconse- quential and negligible percentage of the total. The flesh foods without doubt could be made to furnish a larger proportion of Vitamin C in the diet if we ate them, as some Eskimos still do, in greater quantities, with a lesser period of storage, with less cooking, and with greater utilization of the visceral organs.

The flesh foods at one time did supply a much greater part of the Vitamin C intake of the population in both England and in America. At the time of Henry VIII , Craik and Macfarlane (50) described the diet of the English people in the following words: "The delicate ladies of the court as well as the hungry citizens and robust squires commenced and concluded the day with boiled steaks or mighty sirloins and flagons of brown ale." Hardly any fruits and vege- tables were eaten at that time. Fruits were very ex- pensive and were consumed with great rari ty even by the wealthy. When Catherine of Aragon came to England it was necessary for the household of Henry VII I to send abroad to get the vegetables for a salad.

Market gardening came into England from Flanders only about the beginning of the seventeenth century. Towards the end of that century vegetables like peas, beans, cabbages, and a few others were grown only for animal food in order to increase the supply of meat. Only potatoes were cultivated for human con- sumption. When vegetables began to be used as human food they were cooked for a very long time. Radishes and occasionally "sailer" were eaten raw. Milk was used but sparingly and then only by those who possessed cows. Cheese and butter were made from the milk and the unused whole milk, buttermilk and whey were thrown to the pigs. The diet in the thirteen colonies and in the United States in the earlier days was not much different (51).

Our English and colonial forefathers obtained their Vitamin C from meat, which was consumed shortly after slaughtering, from potatoes, and from the beer and ale, which in their time was made with sprouting barley, a rich source of Vitamin C. Beers of today are also made with the aid of germinating grain, but the applications of heat in the manufacturing process removes practically all of the antiscorbutic substance.

OTHER EXAMPLES OF MEAT AS AN ANTISCORBUTIC

Scurvy has played a very significant part in Arctic and Antarctic explorations. It was scurvy that proved to be the cause of the failure of many of these expe- ditions. Dr. Elisha Kent Kane in his book, "Arctic Explorations," made the following entry in his diary on Tuesday, May 30, 1853: "For the past three weeks we have been living on ptarmigan rabbits, two rein- deer and seals. They are fast curing our scurvy." An

Joum D. D. DECEMBER, 1941

L E V I N E - - T H E VALUE OF

outbreak of scurvy occurred in the British polar expe- dition of 1875-76. The British Arctic Survey Com- mittee appointed to investigate the cause reported in 1877 that scurvy was due to the absence of lime juice from the sledge dietaries and that meat in large quantities was capable of preventing this disease. Nansen and Johansen wintered safely in Franz-Josefs- land on a diet of meat. Vilhjalmur Stefansson was able to live in the Arctic for many years without de- veloping the classical signs and symptoms of scurvy, and he was able to cure scurvy in his companions in Arctic exploration solely by the use of meat. To quote from Stefansson :

"The sick men were now put up on the follow- ing diet. In the morning meat enough for a small meal was boiled and eaten slightly underdone. There was enough broth left over to furnish something to drink for the rest of the day, and any food eaten beyond the breakfast had to be eaten raw . . . . . The raw meat was eaten by preference slightly frozen at a hardness analogous to that of ice cream." It is evident from Stefansson's dietary prescription

that his men sick with scurvy received ample quanti- tie~ of Vitamin C to insure complete recovery. The broth, containing some unoxidized Vitamin C dis- solved out from the meat, added to the daily intake of the antiscorbutic factor. In contrast to the curative diet of Stefansson with the rations received by Indian troops in the World War of 1914-18, Colonel Hehir (52) in his official report of scurvy among the Indian troops wrote as follows:

"The only vegetable now allowed was two ounces of potatoes (per day) and the only fresh meat 28 ounces a week (four ounces a day). It is very doubtful whetl~er this authorized ration, if not supplemented by other vegetables and more meat, is sufficient to prevent scurvy." Stefansson and Andersen, who at one time together

spent three years in the Arctic, undertook in 1928 to live exclusively on animal food which consisted largely of muscle meat and which included liver, sweetbreads and fat. This diet they followed for twelve months not in the Arctic, but under the climatic conditions existing in New York City. Lieb (53) who followed the condition of these two men reported in 1929 at the end of the experimental period that they were in good health. On this exclusive meat diet they did not de- velop scurvy.

The whalers wintering in Hudson Bay frequently suffered from scurvy. It was common knowledge among the captains of the whaling vessels that fresh meat could prevent and cure scurvy. It was indeed their practice to secure meat from the Eskimos whenever possible. When the season is poor in game, Eskimos themselves may develop scurvy. The disease may be especially prevalent along the Danish coast of Green- land, among the Eskimos who subsist largely on breadstuffs. Jackson, who lived for some time among the Samoyeds, who inhabit the Arctic coast of Siberia between the Ob and Yenisei rivers, found no scurvy among them. These people consume reindeer meat even though they eat no vegetables or fresh fruit during the winter (54).

The incidents of Amundsen's, Scott's and Shakle- ton's adventures in the Antarctic demonstrate beyond doubt the value of fresh meat as an antiscorbutic

MEAT AS AN ANTISCORBUTIC 459

(55, 56). It was only when the food supply of these explorers was supplemented with the fresh food avail- able in the region traversed that scurvy was pre- vented. Fresh food in the Antarctic means seal meat, dog meat and penguin. In the autumn of 1911 the Norwegian expedition, led by Amundsen and the English expedition under Scott started for the South Pole. Amundsen and his companions started October 20 from the edge of the Rose Ice Barrier and arrived at the Pole December 14. The five men and the dogs they did not kill for food arrived at their start ing point in excellent health. Their rations on the march to and from the South Pole was composed of pemican made with vegetables and oatmeal, chocolate, and oat- meal biscuits. But they also used as food frozen seal meat and fresh dog meat. None of Amundsen's party suffered from scurvy.

With reference to Scott and to Shackleton, we shall quote from Stefansson:

"Scott in 1900 sought the most orthodox scien- tific counsel when outfitting his first expedition. He followed advice by carrying lime juice and by picking up quantities of fruits and other vege- tables as he passed New Zealand on his way to the Antarctic. He saw to it that the diet was "whole- some," that the men took exercise, that they bathed and had plenty of fresh air. Yet scurvy broke out and the subsequently famous Shackle- ton was crippled by it on a journey. They were pulling their own sleds at the time, so they must have had enough exercise. There was plenty of light with the sun beating on them, and there was plenty of fresh air. To believers in catchwords and slogans of their day, to believers in the virtues of lime juice, the onset of scurvy was battling."

Shackleton, himself, developed scurvy. His illness interfered with the success of the first Scott expe- dition. Shackleton may have smarted under the charge that his weakness had been Scott's main handicap. The passion to clear his name drove Shackleton to the organization of an expedition.

To quote again from Stefansson: "The organization and the first Shackleton

expedition went with a hurrah. They were as careless as Scott had been careful, they did not have Scott's type of backing, scientific or finan- cial. They arrived helter-skelter on the shores of the Antarctic continent, pitched camp, and dis- covered that they did not have nearly enough food for the winter, nor had they used such pains- taking care as Scott to provide themselves with frui t and other antiscorbutics in New Zealand. Compared with Scott's their routine was slipshod as to cleanliness, exercise, and several of the ordi- nary hygienic prescriptions.

"What signifies is that Scott's men with un- limited quantities of jams and marmalades, vege- tables and fruits, grains, curries and potted meats, had been little inclined to add seals and penguins to their dietary. With Shackleton it was neither wisdom nor the acceptance of good ad- vice but dire necessity which drove to such use of penguins and seal that Dr. Alister Forbes Mac- kay, physician from Edinburgh, who was a member of that Shackleton expedition and later physician of my ship, the Karluk, told me he esti-

460 AMERICAN JOURNAL OF DIGESTIVE DISEASES VOLUM~ 8 NUMBER 12

mated half the food during their s tay in the Ant- arct ic was fresh meat.

"In spite of the lack of care (indeed, as we now see it, because of that lack), Shackleton has bet ter average health than Scott. There was never a sign of scurvy; every man retained his full s trength, and they accomplished that spring what most authori t ies still consider the greates t phys- ical achievement ever made in the southern polar regions. With men dragging the sledges a con- siderable par t of the way, they got to lati tude 88 ~ 23' 5", practically within sight of the Pole.

"Scott began his second venture as he had begun the first, by asking the medical profession of Br i ta in for protection from scurvy and by re- ceiving from them once more the good old advice about lime juice, f ru i ts and the rest. In winter quarters he again placed reliance on that advice and in constant medical supervision, on a planned and carefully varied diet, on numerous scientific tests to determine the condition of the men on exercise, fresh air, sani tat ion in all its s tandard forms. The men lived on the foods of the United kingdom, supplemented by the f ru i t and garden produce of New Zealand. Because they had so much which they were used to, they ate lit t le of what they had never learned to like, the penguins and seals.

"Once more they s tar ted their sledge travels a f te r a winter of sanitation. The results had previously been disappointing, now they were tragic. While scurvy did not prevent them from reaching the South Pole, it began to sap their s t rength on the re turn and progressed so rapidly that the growing weakness prevented them if only by ten miles, from being able to get back to the final provision depot.

"Those who have ignored the scurvy have some- times claimed tha t i f Scott had reached the depot he would have been able to reach eventually the base camp 150 miles away. This becomes more than doubtful when you realize that the progres- sive decrease of vigor, both mental and bodily, was not going to be helped by even the largest meals, if those meals were food lacking in anti- scorbutic values."

Scott and his companions lost their lives on their re turn journey from the South Pole only eleven miles from food and fuel. They slowed thei r pace, for two of their five men were seriously indisposed from scurvy. One of these two men died from it. The other voluntari ly walked away from the tent to die in the blizzard to save the other three who were delayed by his condition. Scott and his two companions died in the i r tent while a blizzard raged outside, a f te r one of the greates t marches in history, 1600 miles on foot over a desert of ice and snow. The story of the last few weeks of their lives is indeed one of the noblest stories of mankind and the most tragic, a gr im story of scurvy tha t could have been prevented had Scott and his men supplemented thei r own diet with the abundant antiscorbutic foods of the Antarct ic.

THE PRACTICAL IMPORTANCE OF MEAT AS AN ANTISCORBUTIC IN TIMES OF WAR

During the siege of Kut-el-Amara in 1916 Hehir (57, 58) reported 1050 cases of scurvy. All but one

of these cases appeared in the Hindu troops. The almost complete absence of this disease among the Bri t ish troops was occasioned by thei r use of fresh meat toward the end of the siege. I t was about tha t t ime tha t the bullocks, horses and mules were killed because of diminishing food supplies. The Brit ish, however, with their rat ion of white flour, biscuits and fresh meat did develop beriberi. The Hindu soldiers, whose rations consisted of barley and preparat ions of whole wheat grain remained free from beriberi, but developed scurvy instead. Religious scruples kept the Hindus from eat ing the fresh meat, which contained the antiscorbutic factor.

In the war of the Chaco fought between Bolivia and Pa raguay during the years 1932-35 extensive out- breaks of scurvy occurred in the Bolivian a rmy as well as in the Paraguayan army (45, 46). The war resul t ing from disputes over boundaries was at t imes fought in a tropical region of extensive jungle lacking in the ordinary edible f ru i ts and vegetables. In these periods the rat ion of the soldier was deficient in anti- scorbutic foods, the zone of conflict being of such a nature that the prescribed rat ion could not be supple- mented with foods containing Vitamin C.

At the end of 1933 and at the beginning of 1934 the Paraguayan army won victories over the Bolivian a rmy and penetrated more deeply into the Chaco region, thus removing itself f a r the r from the base of supplies for fresh food. As a result the f r e sh meat of the sheep had to be supplemented in the rat ion by sun-dried meat, by large cuts of old meat and by came enlatada (corned beef). The other components of the rat ion were unchanged. Several months af te r the forced revision of the diet of the soldier the first case of scurvy appeared in the Paraguayan army in spite of the fact that the quant i ty of yerba mate in the rat ion was doubled. The cases of scurvy that developed numbered in the thousands. The soldiers suffering from scurvy were evacuated to the rear and a diet of fruits , vegetables and fresh meat soon brought about complete recovery.

Towards the end of 1934 the Paraguayan army came into possession of new extensive t e r r i to ry in the Chaco region. In these Bolivian areas were si tuated extensive fields wherein grazed large herds of cattle. These herds supplied an abundance of fresh meat. With the introduction of fresh meat to the scorbutic rat ions of the soldier, no new cases of scurvy made the i r appearance. The only change in the diet tha t was responsible for the prevention of scurvy was the subst i tut ion of the freshly killed meat for the dried meat, for cuts of old meat, and for the corned beef.

CAPACITY FACTOR VERSUS I N T E N S I T Y FACTOR

In sa t i s fy ing the daily Vitamin C requirement, we must consider two factors, the in tens i ty factor and the capacity factor.

I N T E N S I T Y FACTOR }( CAPACITY FACTOR DAILY R E Q U I R E M E N T

The intensi ty factor represents the concentration or mi l l ig rams of Vitamin C per unit weight. The capacity factor represents the weight of the food in- gested. To fulfill the requirement with a food of a high intensi ty factor, the capacity ' factor would neces- sar i ly be small; with a food of low intensi ty factor,

Joum D. D. DECeMbER, 1941

L E V I N E - - T H E V A L U E OF

the capacity factor or the amount consumed, would be necessarily high.

The biological method indicates that meat with reference to Vitamin C content has a low intensity factor. It is a food comparatively poor in Vitamin C. This information, however, is indefinite and therefore of little practical value. The chief uncertainty lies in the unavoidable nature of what we may term the biologic end point. King (59) points out that complete protection from scurvy or a definite degree of partial protection is a problem difficult to judge. Lack of an exact figure for the Vitamin C concentration of meat leaves us in almost total darkness as to the capacity factor with reference to daily needs.

The isolation of Vitamin C as a chemical entity by Waugh and King (60, 61) and somewhat later by Svirbely and Szent-GySrgi (62), and its synthesis by Reichstein, Griissner and Oppenauer (63) and others, and numerous studies of its properties, have led to chemical methods for its quantitative estimation. These chemical methods give us among other ad- vantages the ability to determine with reasonable accuracy the Vitamin C content of foods low in this dietary factor. Bessey and King (64) employing a chemical procedure found that animal tissues highest in Vitamin C content are the adrenal glands with about 140 to 230 mgs. per 100 grams followed by brain, liver, testes, ovaries and other glandular pro- ducts with about 10 to 40 milligrams per 100 grams. Active muscular tissue, such as heart muscle, contains about 5 to 15 milligrams per 100 grams. Lean muscle stands at the foot of the list with 4 milligrams per 100 grams. The writer has found the Vitamin C content of fresh reindeer meat to vary from 3 to 3.5 milli- grams per 100 grams, and fresh seal meat from 2 to 3 milligrams per 100 grams. Hoygaard and Rasmussen (22) recently reported the Vitamin C content of seal meat to be 2 milligrams per 100 grams, and blood of the fiord seal 3 milligrams per 100 cubic centimeters.

As an illustration of the importance of the capacity factor in case of foods low in Vitamin C, we shall cite the findings of Fox and Stone (60), who determined by biologic assay as well as by a chemical method the ascorbic acid or Vitamin C content of Kaffir beer, a drink consumed by South African natives. Experi- ments with guinea pigs showed that daily adminis- tration of as high a quantity as 7.5 cc. of filtered beer gave no protection against scurvy. The autopsy re- vealed the typical hemorrhages, beading of the ribs at the costo-chondral junction, fragil i ty of bones and teeth, and chemical analyses indicated diminished Vitamin C content of liver and of adrenal glands.

GERMINATION AS A MEANS OF PROVIDING VITAMIN C

The guinea pig bio-assay demonstrated the fact that Kaffir beer had very little Vitamin C, but yielded no information as to its practical value as an antiscor- butic for human beings. Nevertheless Kaffir beer is as valuable an antiscorbutic to the natives of South Africa as the potato is to people of Europe and America. During the World War of 1914-18 the Kaffirs constituted the South African native labor corps working in France. While in that country they developed scurvy because the French supplied these natives with a beverage similar to the one to which

M E A T AS A N A N T I S C O R B U T I C 461

they were accustomed with the notable exception that the process of germination had been omitted in its preparation (61). It is a well accepted fact that grains and other seeds, such as beans and peas, are devoid of Vitamin C. When allowed to germinate, however, they develop great antiscorbutic potency (62-65).

The older literature often mentions beer and ale as beverages of great antiscorbutic value. James Lind stated that beer and fermented liquors of any sort constituted the best remedy for scurvy. Captain Cook in his famous voyage around the world, accomplished without the loss of a single sailor from scurvy, sup- plied his men with an infusion of barley called sweet- wort, prepared fresh and served liberally. The anti- scorbutic value of the beers and ales used in the days of Lind and Cook may be attributed to their prepa- ration from freshly germinated grain as well as to its consumption only a short period after brewing. Beer produced in the modern way contains only minute quantities of Vitamin C, about 0.06 milligrams to 0.15 milligrams to the ounce.

Fox and Stone also analyzed Kaffir beer chemically for its Vitamin C content. Using the method involving the reduction of the dye, 1,6 dichlorophenolindophenol, they estimated the Vitamin C content of the beer to be 0.8 milligram per 100 cubic centimeters. Kaffir beer is evidently not rich in Vitamin C. If it is to be a suc- cessful and practical antiscorbutic it must be con- sumed in very large quantities. A gallon a day is well within the capacity of a native living in the kraal and even larger quantities are consumed. Through custom or poverty or both, the diet of the South African native is largely mealie or Kaffir corn porridge. This is washed down with copious draughts of native beer. The practical value of this beer as an antiscorbutic depends solely on the large amounts usually consumed and not on the actual concentration of this vitamin, which is of a very low order. The intensity factor being small, the capacity factor must therefore be large. Two liters of beer, a little less than two quarts, furnish about 15 milligrams of Vitamin C, four liters of beer, a little less than a gallon, about 30 milligrams of Vitamin C, and six liters about 45 milligrams.

THE VITAMIN C CONTENT OF ARCTIC FOODS

The data on the Vitamin C content of Arctic foods is as yet very meager. Hoygaard and Rasmussen (22) have published analytical data for the Vitamin C con- tent of the muscle meat and of several internal organs of the seal. According to their findings, the muscle meat of the fiord seal off the coast of Greenland con- rains 2 milligrams of Vitamin C per 100 grams, al- though Levine (67) has found the muscle meat of the seal caught" along the Barrow Coast to vary in Vita- rain C content from 2.5 to 3 milligrams per 100 grams, and 3 milligrams for the muscle meat of the reindeer. We have no analytical figures on the Vitamin C con- tent of the various organs of the reindeer and of the muscle and visceral organs of the caribou, the polar bear, the walrus, t h e large Arctic whale, the small white whale or beluga, the narwhal, the oogrook,* the salmon, the trout, the sculpin and the tom cod. The data available, however, confirms Stefansson's con- tention that meat alone can well serve as an anti- scorbutic with these two provisos: that the meat be

~The oogrook is a bearded seal, la rger in size than the ordinary seal.

462 AMERICAN JOURNAL OF DIGESTIVE DISEASES VO~.U,~E S NUMBER 12

fresh and that at least a sufficient quant i ty be con- sumed to sa t i s fy the biologic demands for the pre- vention of the onset of the classical symptoms or for the i r removal.

What the minimum requirement in the human being for the prevention or removal of the classical signs and symptoms of scurvy is we do not know. It is, no doubt, much less than the requirements for the main- tainence of a fa i r s tate of health and very much less than the demands for optimal health. On the basis of 2 to 3 mil l igrams of Vitamin C per 100 grams of lean seal meat, about 500 to 750 grams or about one and a half to two and a half pounds of raw meat or twice the amount of boiled meat would have to be eaten during the day to supply 15 mil l igrams of Vitamin C, the lowest daily requirement yet promulgated by any nutr i t ionist . On the basis of 50 mil l igrams as the daily need, about 1667 to 2500 grams, that is about three and three-fourths to five pounds of raw lean seal meat would have to be ingested. That amount would by no means tax the daily capacity of an Eskimo or a meat-eat ing northern Indian.

I t is remarkable indeed tha t as early as 1918 when scientific knowledge c o n c e r n i n g the antiscorbutic factor was yet very meager, Stefansson's published ideas concerning the proper.ties of this vi tamin with reference to its s tabi l i ty and his published ideas con- cerning prevention and cure of the disease induced by its absence in the diet still conform today with the accumulated laboratory-tested facts regarding scurvy and Vitamin C. Stefansson's promulgation of the doctrine of l iving off the land begins a new epoch of successful Arctic exploration. I t also emphasizes the important yet oft forgotten or neglected lesson in the field of dietetics and nutr i t ion that the field observer can make contributions of equal importance with those of the laboratory invest igator .

SUMMARY

M e a t exclusive of such visceral organ as the liver has been regarded as a food playing no role or at least a very insignificant role as an antiscorbutic. The inn- bil i ty of muscle meat to prevent and to cure scurvy is an idea which has taken root because of the experi- ments of the ear l ier investigators. These workers did not appreciate the importance of freshly killed meat in contradist inct ion to fresh market meat. Fu r the r - more, they used the guinea pig as a test animal. This animal has a l imited gastro- intest inal capacity. I t can, therefore, be fed only a small quant i ty of a food biologically assayed for Vitamin C content. I f this small quanti ty possessed sufficient Vitamin C to cure or prevent scurvy, the food was said to possess anti- scorbutic potency. If, however, this small quanti ty did not contain sufficient Vitamin C to cure or prevent scurvy, the food was regarded as one devoid of anti- scorbutic p o t e n c y . More recent experiments with freshly killed meat indicate ~hat quanti t ies fed within the physical capacity of the guinea pig possessed de- cided antiscorbutic value.

The chemical method for Vitamin C does not have the disadvantages of the guinea pig bio-assay method. Chemical analysis of fresh meat proves that it does contain Vitamin C. Due to the low concentration of Vitamin C in meat, a l iberal quant i ty must be ingested

to make up the daily requirement. Cooking will de- s troy a portion of the Vitamin C and cause another portion to dissolve out in the cooking water. The cooked meat, together with the cooking water, may contain approximately 50 per cent of the original Vita- min C. The shorter the period of heating, the less the destruction of the vitamin.

Under present-day conditions meat cannot be con- sidered a source of antiscorbutic vitamin. Too much time elapses between consumption on the one hand and slaughtering, r e f r ige ra t ing and marke t ing on the other. Time is an important factor in the slow oxi- dation and consequent destruction of the biologic potency of Vitamin C. The prepara t ion of meat for the table dur ing which process more or less heat is employed induces a considerable l o s s o f potency through oxidation of some or all of the remaining vitamin. Even under such unfavorable conditions, meat as the sole article of diet may yet protect from scurvy. Stefansson and Andersen lived for a whole year on meats supplied from the New York City markets without manifes t ing any of the clinical s':gns of scurvy.

In times of emergency a var ie ty of substances have been pressed into service in the cure and in the pre- vention of scurvy. During the Alaska gold rush an American physician, Dr. Sidebotham, found himself with a number of patients suffering from scurvy and with none of the s tandard antiscorbutics available, such as f ru i ts and vegetables. He decided to t ry pine needles (51). These he extracted with water. He ad- ministered the decoction to his patients. They re- covered. Later studies indicate that a decoction of pine needles may contain as much Vitamin C as orange juice. Jacques Car t ier years earlier, in 1535, upon the advice of Indians, used a decoction of the sassafras bark and leaves to cure his men suffering severely from scurvy. Recent investigations of the Russian government interested in the sett lement of northern Siberia indicate that the leaves and tvcigs of both pines and spruces may be utilized as antiscorbu- tics. As a mat te r of fact Lind almost two hundred years ago gave in his classical t rea t i se on scurvy de- tailed d i r e c t i o n s for prepar ing antiscorbutic de- coctions from fir tops, leaves and bark.

Seamen of old prevented scurvy by the use of beers and ales made with germinated gra ins as well as by the use of germinated seed foods, such as barley, peas, beans and lentils. Cook, who successfully circum- navigated the world, as well as other navigators used among other things scurvy grass, which they sought wherever and whenever they set foot on land. Even the ordinary lawn var ie ty of freshly cut or freshly gathered grass may be employed to advantage. Weight for weight grass has more Vitamin C than orange juice.

In times of emergency meat has been utilized and can still be utilized as the sole source of ant iscorbutic substance in the diet. Brave and courageous men have cured and prevented scurvy in the Arct ic and in the Antarct ic by the liberal use of fresh seal meat, walrus meat and caribou meat. Brave and courageous men in the polar regions have lost the i r lives, victims of scurvy, by fai l ing to supplement thei r own food supply with the animal antiscorbutics very abundant in these

J(ul~. D. D. DECEMBER, 1941

areas . A r m i e s of soldiers have suffered f r o m scurvy and have in severa l ins tances cured or p reven ted th i s n u t r i t i o n a l scourge by the use of meat , the only avai l - able an t i s co rbu t i c under the c i rcumstances . I t is im- p o r t a n t to bea r in mind t ha t when mea t was effectively used as the sole an t i scorbut ic , i t was f r e sh ly ki l led and consumed in l ibera l quant i t i es .

L E V I N E - - T H E V A L U E OF M E A T AS A N A N T I S C O R B U T I C 4(~

We mus t r e m e m b e r the nu t r i t i ona l Iessons of the past . Emergenc i e s may ye t a r i se in the fu ture .

In the preparat ion of this article the wri ter ac- knowledges with appreciation the criticisms and sug- gestions of Dr. Vilhjahnur Stefansson and Dr. Mary Swartz Rose, who reviewed the manuscript shortly before her death.

R E F E R E N C E S 1. Stefansson, V . : The Dilemma in Vitamins. Science, 89:484, 1939. 2. Stefansson, V . : Observations on Three Cases of Scurvy. J . A.

M. A., 71:715, 1918. 3. Stefansson, V. : Original Observations on Scurvy and M:~ Opinion

of the Medical Profession. Mad. Review of Reviews, 24:257, 1918. 4. Stefansson, V . : The Food of Ancient and Modern Stone Age

Man. J. Am. Dietetic Ass 'n , 13:102, 1937. 5. Stefansson, V . : Adventures in Diet. Harper's Magazine, Nov.,

1935 and Dec., 1936. 6. Aron, H., Hirsch-Kaufmann, H. and Schiidrich, E . : Lebertherapie

ben Skorbut. Jahrberiehte ]f~r Kinderheilku~de, 1:123, 1921. 7. Armentano, L., Bents~th, A., Bares. T., Rusznyak and Szent-

Gyorgi, A. : Uber den Einfluss yon Substanzen der Flacon Gruppe auf die Permeabil i tat der Kapil laren: Vi tamin P. Deutsche mcdizinische Wochenschri#, 62:1325, 193S.

8. Bentsath, A., St. Ruszfiyak and Szent-GySrgi, A. : Vi tamin Nature of Flavones. Nature, London, 138:798, 1936.

9. St. Ruszfiyak and Szent-GySrgi, A. : Vi tamin P . : Fl2vonols as Vitamins, Nature, London, 138:27. 1936.

10. Bruckner, V. and Szent-GySrgi, A. : Chemical Na ture of Citrin. Nature, London, 138:1057, 1936.

11. Zilva. S. : Vi tamin P. Biochemical J., 3I :915, 1488, 1937. Nature, London, 140:588, 1937.

12. Moll, T . : Zur F rage des Vi tamin P. Klinische Wochenschri#, 16:1653, 1937.

13. McHenry, E. W. and Perry, H. M.: Observations on the Relation of Vi tamih P to Scurvy. Proceedings of the 7th annual meet ing of the American Inst i tute of Nutri t ion. J. Nutrit., 12:19, 1940.

14. Jacobsen, E . : On the Storage of Aseorbie Acid in the Organs of Guinea Pigs Given Crystalline Ascorbic Acid with a Vi tamin C Free Diet. Skandinavisches Archly. fiir Physiologie, 72:259, 1935

15. Fox, F. W. and Levy, S. F . : Exper iments Confirming the Anti- scorbutic Activity of Dehydroascorbic Acid and a Study of I ts Storage and that of Ascorbie Acid by the Guinea at Different Levels of Intake. Biochemical J., 30:211, 1935.

16. Hawley, E. E., Daggs, R. G. and Stephens, D. J . : The Effect of the Administrat ion of Acid and Alkaline Salts Upon the Ascorbie Acid Content of Guinea Pig Tissues. J. Nutrit., 1:14, 1937.

17. Todhunter, E. N., Robbins, R. C., Ivey, G. and Brewer, W . : A Comparison of the Utilization by Guinea Pigs of Equivalent Amounts of Ascorbic Acid (Vitaanin C) in Lemon Juice and in the Crystalline Form. J. Nutrit., 19:113, 1940.

18. Zacho, C. E . : Influence of Ascorbic Acid and of Citrin on Capil- lary Resistance of Guinea Pigs. Acts Pathologiea et Mierobi- ologica Scandinaviea, 16:144, 1939.

19. Scarborough, H. : Vi tamin P. Biochemical J., 33:1400, 1939. 20. Elmby. A. and Warburg , E . : The Inadequacy of Synthetic

Ascorbic Acid as an Antiscorbutie Agent. Lancet, 2:1363, 1937. 21. Jessild, T . : Therapeutic Effect of Vi tamin P in SchSnlein-Hen-

noch Purpura . Lancet, 1:445, 1938. 22. I-Ioygaard, A. and Rasmussen, H. W . : Vi tamin C Sources in

Eskimo Food. Nature, London, 143:943. 1939. 23. Tressler, D. K., Mack, G. L. and King, C. G.: Factors Influencing

Vi tamin C Content of Vegetables. Am. J. of Public Health, 26:905. 1936.

24. Nelson, E. M. and Moltern, H. H . : The Vi tamin C Content of Frozen Grape Juice. J. of Industrial and Engineering Chemistry, 25:216, 1933.

25. Stefansson, V. : Meat Diet. Blood as an Antiscorbutic Factor. Science, 84:227, 1936.

26. Fuji ta , A. and Ebihara, T . : Uber die Vertei lung des Vi tamins C in tierischen und pflanzlicben Geweben. Biochemische Zeitschrift, 290:20, 1937.

27. Fuji ta , A. and Ebihara, T . : Kolorimetrische Bes t immung yon Vitamin C mittels Phospho*18-Wolframsaure II Mitteilung. Bioehemische ZeitschriIt, 290:192, 1937.

28. Fuji ta , A., Ebihara, T. and Numata , I . : Uber die Oxydation der Ascorbinsaure durch H~moglobin. Biochemische Zeitschri#, 16: 483, 1937.

29. Gabbe, E. : ?3bar Adsorption you Aseorbinsilure im Blute. Klinische Woehensehrift, 301:243, 1939.

30. Kellie, A. E. and Zilva, S. S. : Catalytic Oxidation of Ascorbic Acid. Biochemical J., 29:1028, 1935.

31. Van Eekelen, M.: The Amount of Ascorbic Acid in Blood and Urine. The Daily Requirements for Ascorbic Acid. Biochemical J. , 30:2291, 193~.

32. Emmerie, A. and Van Eekelen, M.: Determination of Ascorbic Acid in the Blood. Biochemical J.. 31:2125, 1987.

33. Berend, M. and Fisher, M.: Uber die Resorption des Vi tamins C. Modifizierung der Methode Tillmans ffir die Bes t immung der Ascorbinsiiure in farblosen Korperflussigkeiten. Bioehemisehe Zeitsehrift, 291:221, i937.

34. Klodt, W. : Einfiuss der Aseorbinsiiure auf die Sauerstoffdissozi- ation des Blutes und den chemischen verlauf der vitalen Oxy- dationsprozesse. Klinische Wochenschrift, 15:1636, 1936.

35. Greenberg, L. D. and Rinehart , J . F . : The Stability of Aseorbic Acid in Blood. J. Lab. and Clinical Med., 25:1288, 1939-40.

36. Hamel, P. : Ueber die Vi tamin C-Bilanz des Menschen. Klinische Wochenschrift, 16:1105, 1937.

37, V i t a m i n s : A Survey of Present Knowledge. Medical Research Council. His Majesty 's Office, London, 1932, p. 268: also quoted by Rose, Maxy Swartz. The Foundations of Nutri t ion. The Macmillan Co., 3rd edition, p. 310, 1938.

38. ]-Ioygaard, A . : Some Invest igat ions Into the Physiology and Nosology of Eskimos f rom Angmagssa l ik in Greenland: A Prel iminary Statement. Norweg. Svalbard og lshavos-und Sokel- ser Skr i f ten can Svalbard og lshavet., Nr. 74, 1937.

39. Barnes, R. E. and Hume, E. M.: Relas Antiscorbutic Value of Fresh, Dried and Heated Cow's Milk. Biochemical J., 13:306, 1919.

40. Chick, H., Hume, E. H. and Skelton, R. F . : A Comparison Be- tween the Antiscorbutic Propert ies of Fresh, Heated ahd Dried Condensed Milk. Biochemical J., 12:131, 1918.

41, Dutcher, R. A., Pierson, E. M. and Blaster, E . : Vi tamin Studies. The Antiscorbutie Properties of Raw Beef. J. of Biological Chemistry, 42:301, 1920.

42. Medes, Grace: The Antiscorbutic Vi tamin in Fresh Beef. J . of Lab. and Clin. Med., 1:861, 1925-26.

43. Gatti, C., Menendez, P. ~nd Knallinsky, A. : Influencias de la carne y de la yerba mate sobre un brote de escorbuto humane y sobre el escorbuto experimental. Archivio di farmacologia speri- mentali e scienze affini, 62:37, 1936.

44. Gatti, C., Menendez, P. and Knallinsky, A. : E1 escorbuto y la carne. Revista de la Sanidad Militar de Paraguay, 4:2, 1935.

45. Lind, J . : An Essay on Diseases Incidental to Europeans in Hot Climates. 2nd edition, p. 206, 1771

46. Drummond, J . C. and Wilbraham, A. : William S t a r k : Eighteenth Century Exper iment in Nutri t ion. Lancet, 2:459, 1935.

47. Curran, J . O. : Observations on Scurvy as it Has Lately Appeared Throughout Ireland and in Several Par t s of Great Bri tain. The Dublin Quartely J. of Med. Sci., 7:83, 1847.

48. Barlow, T . : Infant i le Scurvy in Relation to Reickets. Lancet, 2:1075, 1894.

49. Stiebling, H. K, : Bureau of Labor Statistics, Depar tment of Labor, Report Serial No. R, 409, 1936.

50. CraNk and MacFar lane : The Pictorial History of England. Vol. 2:881, 1849.

51. Borsook, H. : Vitamins. The Viking Press, 1940. 52. Hehir, P. C.: Citation from Hess, A. F . : Scurvy, Pas t and

Present. J . B. Lippincott Co., p. 19, 1920. 53. Lieb, C. W . : The Effects on Human Beings of a Twelve Month's

Exclusive Meat Diet. J . A. M. A., 93:20, 1929. 54. Hess, A. F . : Scurvy, Past and Present. J . B. Lippincott Co.,

pp. 147-148, 1920. 55. Amundsen, R . : The South Pole. New York, 1913. 56. Scott, R. F . : Scott 's Last Expedition. The Personal Journals ,

New York, 1913. 57. Hehir, P . : Scurvy. Indian J. of Med. Research Spec., Indian

Scientific Congress, No. 79-82, 1919. 58. Wilicox, W. H . : Trea tment and Management of Diseases Due to

a Deficiency of Diet, Scurvy and Beriberi. British Med. J., 1:73, 1920.

59, King, C. G. : Vi tamin C. Aseorhic Acid. Physiological Revic~,s, 16:238, 1936.

60. Waugh, W. A. and King, C. S.: The Chemical Nature of Vi tamin C. Science, 75:357, 1932.

61. Waugh, W. A. and King, C. S. : The Isolation and Identification of Vi tamin C. J. Biol. Chem., 97:325. 1932.

62. Svirbeiy, J . L. and Szent-GySrgi, A. : Hexuronie Acid as the Anti- scorbutic Factor. Nature, London, 129:576, 1932. Biochemical J., 26:865, 1932.

63. Reichstein, T., Griissner, A. and Oppenauer, P . : Synthesis of d-and 1-Ascorbic Acid. Helvetia Chemica Acta, 16:1019, 1988.

64. Bessey, O. A. and King, C. G.: Distribution of Vi tamin C in Plant and Animal Tissue, and Its Determination. J. Biol. Chem., 103:687, 1933.

65. Fox, F. W. and Stone, W . : Antiscorbutie Value of Kai~r Beer. South African J. Mad. ScL, 3:7, 1938.

66. Dyke, H. W . : Outbreak of Scurvy in the South African Nat ive Labour Corps. Lancet, 2:513, 1918.

67. Levine, V. E. : Unpublished communication.