• TABLE OF CONTENTS
HIDE
 Title Page
 Front Matter
 Preface
 A bit of history
 Chemical composition
 Caloric values
 Mineral content
 Vitamins
 Acidosis
 Scurvy
 Infantile scurvy
 Infant feeding
 Citrus fruits in dentistry
 Citrus fruits in other disorde...
 Some erroneous beliefs regarding...
 Grapefruit
 Tangerines
 Appendix














Group Title: New series bulletin - Florida Department of Argiculture ; no. 101
Title: The therapy of Florida citrus fruits
CITATION THUMBNAILS PAGE IMAGE ZOOMABLE
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Permanent Link: http://ufdc.ufl.edu/UF00002881/00001
 Material Information
Title: The therapy of Florida citrus fruits together with a compilation of the latest findings of leading authorities on diet and nutrition
Series Title: <Bulletin> New series
Physical Description: 62 p. : ; 23 cm.
Language: English
Creator: Aurin, Emil C
Florida -- Dept. of Agriculture
Publisher: Florida Department of Agriculture
Place of Publication: Tallahasse Fla
Publication Date: <1939>
 Subjects
Subject: Citrus fruits -- Florida   ( lcsh )
Genre: government publication (state, provincial, terriorial, dependent)   ( marcgt )
non-fiction   ( marcgt )
 Notes
Statement of Responsibility: by Emil C. Aurin.
General Note: Cover title.
General Note: "May 1939."
General Note: "Reprint"
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Bibliographic ID: UF00002881
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: aleph - 001962963
oclc - 28605083
notis - AKD9640
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Other version: Alternate version (PALMM)
PALMM Version

Table of Contents
    Title Page
        Page 1
        Page 2
    Front Matter
        Page 3
        Page 4
    Preface
        Page 5
        Page 6
        Page 7
        Page 8
    A bit of history
        Page 9
        Page 10
    Chemical composition
        Page 11
    Caloric values
        Page 12
        Page 13
    Mineral content
        Page 14
        Page 15
    Vitamins
        Page 16
        Page 17
        Page 18
    Acidosis
        Page 19
        Page 20
        Page 21
        Page 22
        Page 23
        Page 24
        Page 25
        Page 26
        Page 27
        Page 28
    Scurvy
        Page 29
        Page 30
        Page 31
        Page 32
        Page 33
    Infantile scurvy
        Page 34
        Page 35
        Page 36
    Infant feeding
        Page 37
        Page 38
        Page 39
    Citrus fruits in dentistry
        Page 40
        Page 41
        Page 42
        Page 43
        Page 44
    Citrus fruits in other disorders
        Page 45
        Page 46
        Page 47
        Page 48
        Page 49
        Page 50
        Page 51
        Page 52
    Some erroneous beliefs regarding citrus
        Page 53
        Page 54
        Page 55
    Grapefruit
        Page 56
        Page 57
    Tangerines
        Page 58
        Page 59
    Appendix
        Page 60
        Page 61
        Page 62
Full Text


NEW SERIES NO. 101


THE

THERAPY
OF

FLORIDA CITRUS

FRUITS

together with a compilation of the latest findings
of leading authorities on Diet and Nutrition



Preparecd E.cclutsietly for
THE MEDICAL and DENTAL PROFESSIONS
By EMIL C. AURIN, M.D.



(Reprint)
Published by
FLORIDA DEPARTMENT OF AGRICULTURE I9
I-JON. NATHAN MAYO, Commrnissioner
TALLAHASSEE, FLORIDA
MA'Y, 1939.


-A 2111 111fnkjn-m- rfe3











To the person who has not studied nutrition,

an orange is a bright-colored, fragrant globe in-

side of which are neatly packed sections yielding a

delicious pulp. It is just something good to eat.

So are cake and pie and chocolate creams. But to

one who has learned to think in terms of nutritive

value, the orange is a food shop. First, there is

water Then thcre is sugar, amounting to one-

tenth of the edible portion; a mere "sample" of

protein; scarcely a trace of fat; a, galaxy of min-

eral elements, including calcium, phosphorus,

sulphur, iron, sodium, potassium, etc.; and lastly

vitamins A., B,. C. and G.




From THE FOUNDATION OF NUTRITION (1933)
by Mary Swartz Rose, Ph.D.
Professor of Nutrition
TEACHERS COLLEGE, COLUMBIA UNIVERSITY






PREFACE

TWO or three years ago a prominent Chicago interneist
sat on my front porch enjoying a tall, cool glass of
fresh orange juice.
"Doctor," he said "if some pharmaceutical chemist should
discover a preparation just half as effective in half as many dis-
orders as orange juice is, every physician in the country would
be flooded with literature concerning it."
He was absolutely right, and what he said with reference to
orange juice would apply with equal force to grapefruit juice.
Here is a product containing vitamins A, B, and G, and second
to none as a source of vitamin C, a food factor essential to health
from infancy to old age; a product containing bountiful supplies
of all the mineral elements necessary to prevent, or cure, acidosis,
one of the most common complications in both acute and chronic
disorders, and having these mineral elements so combined with
citric acid as to prevent all risk of their disturbing digestion; a
product with 75 percent of the food (caloric) value of milk and
in such form as to be in part almost predigested; a product hav-
ing both a mild laxative and a diuretic effect; a product having
all these therapeutic properties in a menstruum that is not only
palatable but actually delicious; a product absolutely free from
objectionable side effects and cheap enough to be within the
reach of all.
This last item-low cost-is particularly true of Florida fruit
on account both of its high juice content and cheaper freight
rates due to Florida's proximity to most of the major markets
of the country.
In fact, except in some emergency where extremely large dos-
age may be necessary for a time, Florida citrus need cost the
patient practically nothing extra as oranges, grapefruit and
tangerines may be used in so many ways to replace some other
item in the menu less valuable in the specific condition.





It can be used in salads, desserts or cocktails; for breakfast,
luncheon or dinner; in place of "soft" drinks; and in place of
other fruits in school and other lunches. Tangerines are particu-
larly valuable for this.
If the author of the old saying about an apple a day keeping
the doctor away had been familiar with citrus he would no
doubt have said "an orange a day keeps the doctar away," for
while containing about the same number of calories as an apple
an orange contains two and a half times as much protein, al-
most eight times as much calcium, almost twice as much phos-
phorus, twice as much vitamin A, almost twice as much vitamin
B, and about nine times as much vitamin C. Only in iron does
the apple beat the orange and then the difference is but 25
percent.
Considering all these therapeutic properties of citrus fruits
the author has no apology to offer for this attempt to bring
them to the attention of the profession.
In using the term profession (or physician) herein the term
is intended to cover all those who practice the healing art-
physicians, osteopaths. chiropractors, dentists and dietitians.
So far as the author knows this is the first time that an at-
tempt has been made to compile the published information re-
garding the therapy of citrus fruits, and to present it in a con-
cise and accurate form.
To obtain this information it has been necessary to search
through scores of books and hundreds of medical journals, for
the science of diet and nutrition is progressing so rapidly that
the accepted theory of today may be rejected tomorrow, and
the average text book is in many respects out of date almost
before it is printed.
Yet it is absolutely necessary for the profession to keep in-
formed along these lines, as the laity is not only greatly inter-
ested in every thing pertaining to diet and health, but avidly
reads everything that is printed.
Unfortunately much that they read is prepared by writers
more concerned in producing interesting-and salable-copy
than in scientific accuracy.




Having been prepared for professional men only, no space
has been wasted in definitions or on facts with which every
professional man is familiar. On the other hand certain dis-
eases and conditions, such as scurvy or vitamin C deficiencies,
and acidosis have been treated in considerable detail since re-
cent investigations have thrown new light on these subjects.
The author desires to extend due credit to the various authors
whose works have been quoted. Every effort has been made to
give this credit in the text rather than in an appended bibliog-
raphy, as, in the author's opinion, the average reader, while
wanting to know who is being quoted, seldom takes time to
check back to a bibliography to find out.
In conclusion the author wishes to express the hope that this
booklet may be of some slight assistance to his fellow practition-
ers in acquiring an understanding of the therapeutic merits of
Florida oranges, grapefruit and tangerines in the prevention
and cure of disease.

EMIL C. AURIN, M.D.


Nov. 20, 1937.






A BIT OF HISTORY

rI HE VALUE of citrus fruits in medicine has been recog-
nized for centuries; but, of course, until a comparatively
short time ago, their use was entirely empirical. This
has been the history of many valuable remedies. Quinine was
used in the treatment of malaria long before the discovery
of the plasmodium; mercury in syphilis long before the spiro-
cheta was found; cod liver oil before the essential vitamin D
was even suspected.
It was not until the comparatively recent advances in bio-
chemistry, and the more recent discovery of the vitamins and
the part they play in nutrition, that it was proved that the em-
pirical use of citrus fruits had, in fact, a sound scientific basis.
The most important discovery along this line was that scurvy
is nothing more or less than a deficiency of vitamin C.
For centuries scurvy was one of the most common causes of
death. It was especially rampant in the armies, navies and
prisons, but affected entire nations when through crop failures
the people were compelled to subsist on a diet containing few
fresh fruits and vegetables.
Authorities claim that it was one of the principal causes of
death among the Crusaders; while the toll it took among sea-
men in the days of the "wind-jammers" is almost unbelievable.
HARRISON tells of a Spanish galleon found at sea, its entire crew
dead from scurvy; and when Vasco da Gama sailed around the
Cape of Good Hope in 1498, one hundred of his men died from
scurvy out of a total crew of a hundred and sixty; while in
1593 Admiral Sir Richard Hawkins said that 10,000 seamen
had died from scurvy within his own personal experience.
But it was not until over a century later that we find citrus
fruits recommended for this condition. In 1720, KRAMER, an
Austrian physician, wrote that "Three or four ounces of orange
or lime juice will cure this dread disease without o'her help."





THE THERAPY OF FLORIDA CITRUS FRUITS


Thirty-seven years later (1757) LIND tells how in 1747 he
experimented on twelve patients suffering from scurvy on the
ship Salisbury. He divided them into six different groups of
two each, each group receiving a different treatment. Here is
what he wrote concerning those that received citrus. "Two others
had two oranges and one lemon given them every day. These
they ate with greediness at different times, upon an empty
stomach. They continued but six days under the course, having
consumed the quantity that could be spared... The consequence
was that the most sudden and visible good effects were per-
ceived from the use of the oranges and lemons; one of those
who had taken them being at the end of six days fit for duty.
. The other was the best recovered of any in his condition
and being now deemed pretty well, was appointed to nurse the
rest of the sick."
Something like fifty years later scurvy was practically ban-
ished in the British Navy by issuing lemon (in those times fre-
quently spoken of as lime) juice as a part of the ration, and in
1867 laws were passed compelling the merchant marine to like-
wise carry a supply of lime or lemon juice as a protection against
scurvy. Even to this day British sailing vessels are often spoken
of as "Lime Juicers" and their crews as "Limies."
Despite this recognition of the virtue of citrus fruits as a
prophylactic against and a cure for scurvy there was no marked
advance in our knowledge along this line until late in the 19th
Century, when, according to LUSK (Elements of Science and
Nutrition) the work of EIJKMAN & ROHMAN was the begin-
ning of a scientific knowledge of the so-called "deficiency dis-
eases."
In 1906 HOPKINS wrote, "No animal can live on a mixture of
pure protein, fat and carbohydrate, and even when the necessary
inorganic material is carefully supplied the animal still cannot
flourish." He called the missing elements "accessory factors."
HOFMEISTER, about the same time, termed them "accessory





THE THERAPY OF FLORIDA CITRUS FRUITS


foodstuffs," and FUNK finally selected the term by which they
are now known-vitamins.
In 1912 and 1913 two Norwegian investigators, HOLST and
FROLICH, announced the result of a long series of experiments
on the distribution of the anti-scorbutic properties of citrus
fruits, and their findings were confirmed during the next five
years by HESS and UNGER, COHEN and MENDEL, CHICK and
HUME.
In 1918 HESS and UNGER found that the anti-scorbutic sub-
stance in orange juice could be extracted with alcohol and would
cure scurvy when injected directly into the blood stream. This
proved that in addition to sufficient calories, protein, mineral
salts and vitamins A and B, an adequate diet must contain an
anti-scorbutic substance; and in 1920 DRUMMOND proposed
that this anti-scorbutic substance be called vitamin C.
But it was not until 1932 that KING and WAUGH isolated the
vitamin C crystals, and the following year that a group of Swiss,
and a group of British scientists, almost simultaneously, suc-
ceeded in producing the vitamin artificially.
Thus several centuries after the anti-scorbutic properties of
citrus fruits were first noted, science has at last placed the seal
of its approval on their use.

CHEMICAL COMPOSITION
"All nutrition work, to be worthy of our present knowl-
edge and opportunity, must stand four-square upon equal
recognition of calories, protein, mineral elements and vita-
mins."
SHERMAN in The Relation of Nutrition to Health.
Some years of experience as a member of a state board of
medical examiners has convinced the author that the average
practicing physician finds it hard to keep up with the latest ad-
vances in chemistry. This is, of course, particularly true of
the older men, for chemistry, and especially the chemistry of
nutrition, has made such vast strides during the past decade





THE THERAPY OF FLORIDA CITRUS FRUITS


or two that only those with plenty of leisure and a special inclin-
ation can possibly hope to keep up to the minute on this subject.
Nutritional chemistry, including the chemistry of the vita-
mins, is really an ultra-modern science. As elsewhere stated,
vitamin C is of particular interest in the consideration of citrus
fruits, having been isolated only in 1932 and not synthetically
produced until a year later.
The story of citric acid, likewise of major importance in the
study of citrus fruits, is very similar. Some of the most impor-
tant discoveries relative to the part it plays in the metabolism
were published by SHERMAN, VICKERY and PUCHER only three
years ago-1936.
Aside from all this, the chemical composition of a substance
as complex as citrus fruit is, after all, a none-too-satisfactory
method of judging its merits either as a food or as a medicinal
substance.
And yet a reasonable knowledge of their composition is neces-
sary to a proper understanding of the part they play in metab-
olism, to say nothing of the necessity of being able to explain
to an inquisitive patient such matters as why a fruit definitely
acid when consumed, should increase the alkaline reserve and
not decrease it.
In view of all the foregoing, only the essential factors in the
chemistry of citrus will be considered, and they as briefly aw
possible.
Finally, it must be remembered that in this, as in the case oj
most "new" sciences, authorities seldom agree when it comes tc
matters of detail. The following data has been largely taken
from SHERMAN'S Chemistry of Food and Nutrition (5th edi-
tion, 1937) as being the latest information available.

CALORIC VALUES

We seldom think of citrus fruits in terms of direct nutritive
values. These fruits usually find their place on the menu, not
on account of their food (fuel) value, but on account of their





THE THERAPY OF FLORIDA CITRUS FRUITS


delicious taste, their vitamin C content, or their mineral ele-
ments, yet the orange and the tangerine both have high food
values.
For example it requires but 194 grams or 6.8 ounces of the
edible portion of an orange to equal 100 calories.
Of this 6.2 percent is derived from protein, 3.5 percent from
fat, and 90.3 percent from carbohydrates; the latter, according
to KELLOGG, in the form of "invert sugar, similar in composition
to honey and predigested and so ready for immediate absorption
and utilization.
It is difficult to realize just how high this fuel value really is
until it is compared to something like milk-usually regarded
as one of the nourishing foods-and find that it takes 145
grams or 5.1 ounces of milk to produce an equal number of
calories. Orange juice has, therefore, approximately 75 percent
of the food value of whole milk, or put in other terms a glass of
orange juice contains as many calories as :/j. glass of milk.
Tomato juice, which is quite frequently substituted for orange
juice in the belief that their nutritive value are about the same,
actually contains less than half the amount of nourishment, it
requiring 438 grams or 15.5 ounces to provide 100 calories.
Thus one glass of orange juice equals, in actual food value, 2/1,
glasses of tomato juice.
The fuel value of a pound of orange juice equals 233 calories
while that of grapefruit is about one third less. For this reason
grapefruit is to be preferred when ever it is deemed desirable
to increase the intake of vitamin C, or to increase the "alkaline
reserve," and yet keep the total number of calories down, as, for
example, in obesity.
It is certainly important to keep this "fuel" value of citrus
fruits in mind especially in cases where the patient's capacity
to take nourishment is limited, or where it is desirable to in-
crease the total intake of calories in a pleasant, agreeable man-
ner. Few patients will refuse citrus juice between meals even
when almost any other form of nourishment would be rejected.





THE THERAPY OF FLORIDA CITRUS FRUITS


But, after all, important as their fuel value may at times be,
the outstanding merit of citrus fruits is not dependent on the
number of calories they will produce, but on their mineral and
vitamin content.

MINERAL CONTENT

The citrus fruits contain many valuable mineral elements.
.fhe principal ones in orange juice and the amounts of each in
percentages is as follows:
Calcium .024, Magnesium .011, Potassium .181, Sodium .012,
Phosphorus .018, Chlorine .005, Sulphur .010, Iron .0004. There
is also a small amount of Copper-about .25 milligram to each
100 calories. Small as this amount is it has been proved that an
infinitesimal amount of this mineral in some way, not as yet
understood, increases the efficacy of iron in the treatment of
anemia.
The percentages of these mineral elements in grapefruit differ
somewhat from those in the orange. SHERMAN gives them as
follows:
Calcium .021, Magnesium .009, Potassium .161, Sodium .004,
Phosphorus .028, Chlorine .005, Sulphur .010, Iron .00027.
It will be seen by comparing the two that the orange is higher
in the percentage of calcium, magnesium, potassium and sodium,
while the grapefruit is higher in phosphorus. Except in the
case of sodium and iron, the difference is not great, ranging
from 8 to 121/2 percent. In the matter of iron there seems to be
some difference of opinion as KELLOGG states that grapefruit
contains "fifty percent more of the precious blood-building iron."
However, considering the fact that iron composes only ap-
proximately one twenty-fifth thousandth part of the body-
roughly one-tenth ounce-and the daily requirement is esti-
mated by SHERMAN as 8 milligrams, while the amount present
in a pint of orange juice is about 2.5 miligrams, it is obvious
that whichever figure may be right, the citrus fruits are a most
valuable source of this important mineral element.





THE THERAPY OF FLORIDA CITRUS FRUITS


For reasons given under the heading TANGERINES no exact
figures regarding the mineral elements thereof are available,
but the amounts will approximate very closely those given for
oranges.
Of course these mineral elements do not exist in citrus fruits
in the form of free alkalies but are found combined with citric
acid. When absorbed the citric acid radicles are oxidized and
the mineral elements released to aid in neutralizing the acids of
the system and in helping to maintain the proper alkaline re-
serve.
Since much of our diet is composed of foods, which, when
oxidized, yield phosphorus, sulphuric and hydrochloric acids, a
considerable amount of mineral elements is needed to neutralize
them. In addition a large amount of lactic acid is constantly
produced by the system as a result of muscular activity. This,
too, must be neutralized, for should the amount of mineral
elements ingested be insufficient to neutralize these acids, the
alkaline reserve is called upon to supply the necessary balance.
But the alkaline reserve is like any other reserve-it can be
tapped occasionally without undue damage. But when it is
tapped too persistently exhaustion will ultimately follow and
acidosis result.
In other words, the acid-base ratio governing the hydrogenion
concentration within normal limits must be maintained.
Fortunately, citric acid--H,(C;H:,O,)-is probably the most
readily utilized of any of the organic acids. Almost unbeliev-
able amounts of this acid may be ingested without increasing
the acidity of the system.
SHERMAN, MENDEL, SMITH and TOOTHILL found that when
40 grams (11/. ounces) of citric acid was taken at one time, less
than 5 percent thereof appeared in the urine, the system having
utilized the balance.
However the bulk of the citric acid in orange and grapefruit
juice is in the form of the potassium salt and not in the form
of free acid. Once this salt is broken up the potassium combines





THE THERAPY OF FLORIDA CITRUS FRUITS


with the carbonic acid forming potassium bicarbonate-the real
alkaline reserve.
SHERMAN calls attention, to the fact that citric acid is also of
importance "in conserving the fixed acids of the body when
there is an excess of basic elements to be eliminated."

VITAMINS

But important as are the caloric values and the mineral ele-
ments in Florida citrus fruits their most valuable food factors is
their vitamin content. Oranges, grapefruit and tangerines all
contain approximately like amounts of vitamins A, B, C, and G.
The amount of A is not great but since this vitamin tends "-o
increase resistance to infections even a moderate amount is of
value.
Both vitamins B and G are present in much greater amounts
and are both components of the complex originally known as
vitamin B, but which has now been found to contain at least six
separate components.
Vitamin B, or BI, seems to be essential to the growth of chil-
dren and a shortage thereof to cause constipation, anorexia and
other intestinal upsets. Some authorities recommend that vita-
min B be administered in all cases of polyneuritis, not only beri-
beri but also alcoholic and the type found in pregnancy. It is
also believed that it may have some affect on the carbohydrate
metabolism.
HALL and MYERS found deficiency of this vitamin in about
50 percent of their cases of arthritis. Vitamin B therapy has
also proven of benefit in many cases of anemia.

VITAMIN G

Vitamin G is one of the components of the complex originally
designated as vitamin B, and was thought by GOLDBERGER to be
the antipellagra vitamin. Today many writers designate it as





THE THERAPY OF FLORIDA CITRUS FRUITS


vitamin B2 but it has been found that it contains of at least two
factors-flavin and B;.
Due to the uncertainty still existing in regard to this vitamin
it would be a waste of time to go into a discussion of the various
theories regarding it.

VITAMIN C

This is probably the most important single element in citrus
fruits as well as the one that first introduced vitamins to the
medical profession.
Isolated by KING and WAUGH in 1932, and synthesized by
AULT the following year, it was first called ascorbic acid for its
anti-scorbutic properties had long been known. Later it was
found to be identical with hexuronic acid which had been known
for several years, but it is now generally known as Cevitamin
acid.
It is a water soluble vitamin with the formula C0H,O, and is
found in quite a number of fruits and vegetables as well as milk,
but the amounts present vary greatly in all except the citrus
fruits-oranges, grapefruit and tangerines. For this reason it
is not only necessary to know something of the amount originally
present in a specific food substance, but also the conditions
under which it was kept and the processes to which it was sub-
mitted in preparing it for the table.
For these reasons all authorities on nutrition agree that there
is no better source of vitamin C than citrus fruits.
Not being stored to any extent in the system it is necessary
to have the daily diet contain a supply sufficient to take care
of the body's needs.
This amount-just sufficient to prevent scurvy-is known as
the protective dose.
GOTHIN found this to be about 0.7 c.c. of orange juice per
kilogram in men and about 1 c.c. in women. This would mean
from 11/2 to 2 ounces per day.





THE THERAPY OF FLORIDA CITRUS FRUITS


ROSE says: "The regular inclusion of not less than four table-
spoonfuls of orange juice in the daily diet is a protective
measure of great value even when other fruits and vegetables
are included."
HARRIS after voicing the opinion that many of us do not eat
enough fresh fruits and salads to furnish the needed vitamin
C, says: "The moral to be drawn is that risks would be obviated
by the consumption of an orange every day."
The amounts here indicated are amounts believed to be suffi-
cient to protect a well person against scurvy, while the amounts
necessary to cure after symptoms of scurvy have manifested
themselves are much larger-usually estimated at about ten
times the "protective" dose, or from 1/! to 1 pint of orange or
grapefruit juice per day.
But vitamin C is of value in disease other than scurvy such
as infections, arthritis, rheumatic fever, pneumonia, tubercu-
losis, etc. These will be considered elsewhere.
Aside from these disorders, vitamin C is, in the opinion of
many authorities, valuable in increasing resistance to disease in
general and in building up a sense of well being.
SHERMAN puts it this way: "It is gradually becoming clear
that vitamin C not only protects against scurvy but has an im-
portant function in the maintenance of a high level of positive
health." Elsewhere he says: "It would seem to be well for us
to keep ourselves well 'saturated' with vitamin C."
MCCOLLUM and SIMMONDS in their Newer Knowledge of
Nutrition" state that a liberal intake of vitamin C helps in "the
preservation of the characteristics of youth."
As far back as 1923, FINLAY found that the resisting power
(positive or buoyant health) is increased by a diet containing a
liberal amount of vitamin C.
SHERMAN also writes "There are a number of observations on
record which indicate that vitamin C helps to protect the body
from such changes as are characteristics of the ageing pro-
cess."




THE THERAPY OF FLORIDA CITRUS FRUITS


With all these medicinal properties present in citrus fruits
there is ample justification in KELLOGG'S statement that "Citrus
has saved more human lives than has any other fruit, perhaps
more than all other fruits together."

ACIDOSIS

Of late there has been considerable criticism of the use of the
word acidosis to designate a lowered alkalinity of the blood
plasma. Without wishing to enter into this controversy, the
word acidosis will be used here with full knowledge that it is
probably a misnomer, and that the word hypoalkalinity more
nearly describes the condition.
Irrespective of what designation may be used, the fact remains
that in many 'diseases an increased acidity or a decreased alkalin-
ity of the blood plasma is an important symptom.
Dr. Kellogg of Battle Creek, Mich., in an address delivered
before the Florida State Horticultural Society, made the state-
ment that "Every year not less than 500,000 persons in this
country die of chronic disorders in which chronic acidosis may
be an active or predisposing factor."
Whether or not Dr. Kellogg's figures are correct may be open
to discussion, but the author's experience of over forty years in
general practice convinces him that it is none too high, and that,
if the deaths due to the acidosis predisposing to or complicating
acute diseases were added, the figures would be much higher.

TYPES OF ACIDOSIS
There are two distinct types of acidosis; one due to the incom-
plete oxidation of fats-the acidosis of diabetes-and one re-
sulting from excessive and continued ingestion of foods which,
when burned in the body, leave an excess of acid substances.
It is only the latter type which we will consider in this chapter,
for while some of the citrus fruits-grapefruit in particular-
have been recommended in the treatment of diabetes and may
be of some merit, the author feels that the acidosis accompany-





THE THERAPY OF FLORIDA CITRUS FRUITS


ing this disease is of too grave a nature to justify any great
dependence being placed on the anti-acid properties of citrus
fruits in its treatment. In the type due to faulty diet,.however,
the vast preponderance of evidence indicates that the citrus
fruits are of exceptional value in even the sevzrest cases.
This latter type of acidosis, which might well be termed
dietetic acidosis, is not only responsible for a great deal of ill
health per se, but is found as a complication in many different
diseases. That it tends to lower the resistance to disease, especi-
ally to infections, is a generally accepted fact. This seems
particularly true of colds, influenza, and other respiratory af-
fections.
CAUSES OF ACIDOSIS
The average American diet is composed largely of foods
which are either acid producing or neutral. Among the acid-
producing foods commonly found in the average American
diet are the lean meats; beef, pork, mutton, veal, and lamb;
eggs, chicken, fish, bread-white, whole-wheat, rye and graham;
corn, rice, oatmeal and all other cereals. The foods classed as
neutral are those that produce only carbonic acid which is easily
eliminated by the lungs., and as they add nothing to the .alkaline
reserve, they have no particular effect on the acid-alkaline
ratio of the body. Among these are butter, cream, sugar, starch,
glucose, lard and. the fatty portions cf beef, pork, mutton, fish,
game and fowl.
Considering the important part played by these two classes
of foods in the average diet, it becomes obvious why so many
Americans suffer from acidosis and evident that special pains
should be taken to supplement these foods by others containing
sufficient amounts of alkaline elements to offset this tendency
to acid preponderance.
GUTMAN, in the chapter on Acid-base Balance in his work
Practical Therapeutic, says: :
"The acid-base ratio is the important factor which gov-
erns the maintenance of hydrogen-ion concentration with-





THE THERAPY OF FLORIDA CITRUS FRUITS


in normal limits; a change in such acid-base balance may be
dangerous to cell life. Under ordinary conditions there is
generated a greater quantity of acid products than basic,
but this acid excess under normal conditions is adequately
taken care of; first by the buffers of the blood, by combin-
ing the acid radicles with the base of bicarbonates, the pro-
duced carbon dioxide passing out of the system through the
lungs; second, by the kidneys which also sustain blood alka-
linity, by freeing the acid radicles from their alkaline bases,
excreting the acid ions in strong acid urine and returning
the remaining bases to the blood stream; third, the acid
radicles are also linked up with ammonia to form neutral
salts; here again a saving of some alkali occurs, for other-
wise such alkali would serve for the neutralization of acid
radicles and be lost to the organism upon elimination of the
combined product."
KELLOGG estimates that a sprinter, when running, produces a
dram of lactic acid per second, or nearly half a pint of this strong
acid per minute, in addition to the great volume of carbonic acid
gas which is eliminated through the lungs.
Considering the large amount of acids produced by the body,
especially during forced breathing or strenuous exercise, it is
really remarkable that the alkalinity of the blood plasma re-
mains so constant.
SHERMAN gives the normal range as being from pH 7.33 to
pH 7.51, and states that a drop below pH 7 or a rise to above
7.8 is incompatible with life.
It is therefore evident that it is absolutely essential to health
that a proper acid-base ratio, or as it has been called, the
"alkaline reserve" be maintained.
MCCOLLUM and SIMMONDS word it thus:
"A certain alkaline reserve in the blood is essential to
maintain its capacity. to carry carbon dioxide to the lungs
for elimination. .Acidosis exists when this reserve falls be-
low normal.",.




22 THE THERAPY OF FLORIDA CITRUS FRUITS

As has been shown in the chapter on CHEMISTRY, Florida cit-
rus fruits not only contain large amounts of the mineral ele-
ments, such as potassium, sodium, calcium and magnesium, nec-
essary to combat this ever-present tendency towards acidosis,
but provide them in such a form as to make them readily avail-
able to the system, without disturbance of the digestive function,
in a most pleasing medium, and combined with other valuable
properties in addition.

SYMPTOMS
The symptoms of acidosis are so great in number that they
are often overlooked for this reason. As a complication in both
acute and chronic disorders it is so common that it is all-too-fre-
quently ignored.
In the chapter of Acid-base Balance in Practical Therapeutics,
GUTMAN says:
"Acidosis .. occurs in pernicious vomiting of adults, as
in pregnancy, and in cylic vomiting of children; in these
disorders considerable alkaline fluid, the alkaline bile and
pancreatic secretion, is lost. In the resulting emaciation,
there is incomplete combustion of the utilized body fats,
causing the production of acid products, constituting an
added etiological factor of the acidosis.
"Acidosis in a mild grade also accompanies infections. In
pneumonia, for example, a decrease in hydrogen-ion con-
centration may occur, also in rheumatism, typhoid fever,
and general tuberculosis; in Asiatic cholera, with its mark-
ed loss of fluid from the body, there is also marked acidosis
present. In anesthesia, acidosis may occur also, though in
mild form; in starvation, as the result of ketone body for-
mation from breaking down of the organism's own ele-
ments, especially fats; in pregnancy, as the result of
inanition or other causes; in various chronic diseases, as
pernicious anemia, cancer, liver cirrhosis, acidosis of a mod-
erate degree may also occur for similar reasons. In all these,





THE THERAPY OF FLORIDA CITRUS FRUITS


the symptoms may be expressed in nausea, vomiting, head-
ache, lassitude, and general indisposition."
SUTHERLAND (Diet and Dietetics) in the chapter on Acidosis
or Acid Intoxication, writes:
"The symptoms of poisoning may be mild or severe, and
probably many mild attacks are recovered from without
the condition being recognized. These milder attacks are
frequently put down to biliousness or constipation, or acute
gastric catarrh. In severe cases the leading symptoms are
sudden and uncontrollable vomiting, persisting for some
hours or days, and accompanied by constant neausea, retch-
ing, and great prostration. One form of acidosis in child-
hood is of unknown origin, and is variously described as
periodic vomiting, cyclic vomiting, or recurrent vomiting.
Another occurs after the administration of an anesthetic."
Writing in the Medical Record (Mar. 3, 1937) on Acidosis
and Alkalosis; Their Significance and Treatment, GUTMAN says:
"Diagnostic symptoms in severe degree of acidosis are ex-
treme weakness, headache, drowsiness, marked hypernea
and acetone breath which may be detected very early. As
acidosis progresses, marked hyperpnea results, with accen-
tuation of other symptoms until deep coma supervenes,
and subsequent death."
McCOLLUM and SIMMONDS (The Newer Knowledge of Nu-
trition) quote HODGSON as reporting that many cases of rickets
developed an acidosis, while PRITCHARD says: "I cannot think
that we are entitled to describe any case as rickets unless the con-
tributory causes have definitely led to such a degree of chronic
acidosis or mineral depletion that evidence of it are found in
soft bones, muscular debility and nervous irratibility."
In addition to the symptoms mentioned above, other authors
cite insomnia, loss of appetite, muscular aching, acid mouth with
resulting injury to the enamel of the teeth, acid sweat in which
the acidity may be so great as to rapidly injure silk fabrics or to
discolor jewelry worn next to the skin. Some now go so far as to





THE THERAPY OF FLORIDA CITRUS FRUITS


believe that the disease of the blood vessels which is responsible
for high blood pressure, kidney disease, gangrene, and apoplexy
is also the result of prolonged injury due to eating excessive
amounts of acid-forming foods.
SHEFFIELD (Diseases of Children) states:
"Acidosis is most common in children from two to five
years old. It is manifested clinically by sudden attacks of
vomiting, anuria, prostration, sopor, and hyperpnea. The
respirations may reach up to sixty per minute, yet be free
from dyspnea and cyanosis (the patient's lips are usually
deep red in color). The vomiting recurs periodically,
cyclically, at short or long intervals, is incessant and un-
controllable, often blood and bile stained, and occasionally
so intense as to produce alarming hemorrhage from the
stomach. The vomitus in the beginning has a 'sweetish'
odor. The attacks may last from a few hours to several
days, and abruptly end in perfect recovery of the patient or,
exceptionally, lead to a fatal issue, particularly if not prop-
erly handled. The temperature is moderate, except when
acidosis is complicated by pyelitis which is not rarely the
case especially in girls; the pulse at first somewhat retarded,
and the blood shows marked leucocytosis. Often the lips
are bright red. With these symptoms in view there ought
to be no difficulty to arrive at a correct diagnosis. It may,
however, be mistaken for appendicitis, recurrent uremia
from chronic nephritis and tubercular meningitis, all of
which diseases of course have pathognomonic symptoms of
their own."
KELLOGG says that "acidosis leads to rheumatism, Bright's
disease, premature old age, arteriosclerosis, high blood pressure,
skin maladies and various degenerative disorders."
He also calls attention to the fact that its presence is shown by
excessive acidity of the urine, and states that the urine is not
infrequently fifty or even a hundred times as acid as it should be.
One other pronounced symptom of acidosis is chronic fatigue,




THE THERAPY OF FLORIDA CITRUS FRUITS


the fatigue of the tired business man. This is largely due to an
acid-poisoning of the nervous system. The inability to concen-
trate, the inability to apply one's self to the job at hand, is more
often due to the excessive consumption of acid-producing foods,
than to overwork. Fatigue products are notoriously acid and
cannot be neutralized without drawing on the basic elements of
the body unless a sufficient quantity of alkalizing foods is taken.
For this reason, if for no other, the tired business man would be
wise to drink a glass of orange juice or grapefruit juice whenever
he feels tired instead of, as is so often the case, trying to increase
his "pep" by means of drinks containing stimulants.
The foregoing should be sufficient to show the possibility of
acidosis being present as a part of the pathology in almost any
disease, acute or chronic, mild or severe, in infants, children, and
adults, even to senescence. And if not actually present in a case
it is always in the offing as a possible complication, and like most
complications it is usually more easily prevented than cured.
Frequent examinations of the urine to detect any marked in-
crease of acidity is certainly advisable in every case no matter
what the diagnosis may be.
TREATMENT
In theory, the treatment of acidosis can be stated in a very
few words. Reduce the percentage of acid-producing foods in
the diet; neutralize the excessive acidity already existing by
the use of alkalies; see that the patient takes sufficient base-
forming foods to keep up the alkaline reserve.
Unfortunately the use of free alkalies is not without its dis-
advantages as their administration has a distinct tendency to
interfere with gastric digestion.
KELLOGG states, "The common practice of dosing with soda to
combat acidosis is objectionable. Soda upsets gastric digestion
and imposes an unnecessary burden on the kidneys."
That Kellogg is right, a moment's consideration will convince
any one with a knowledge of the physiology of digestion. The
gastric juice is normally acid and must be kept acid to perform





THE THERAPY OF FLORIDA CITRUS FRUITS


its proper function. Whenever soda or other free alkali is ad-
ministered, part or all of this acid is neutralized and digestion
interfered with to just that degree, while the absorption of the
partially digested food products throws an added burden on the
eliminatory organs and especially the kidneys.
All this does not mean that alkalies should never be given. At
times they may be absolutely necessary until the excessive acid
in the system has been neutralized and the pH of the blood plas-
ma brought to somewhat near normal. But once this has been
accomplished, resort should be had to agents that will maintain
the pH at the proper level without interfering with digestion.
Of this class of agents none exceeds in real merit Florida citrus
-oranges, grapefruit and tangerines. Few agents even ap-
proach them in effectiveness; none excel them.
While differing somewhat in the proportion of mineral ele-
ments, as shown elsewhere, all three contain sufficient quantities
to make them of major importance in the treatment of acidosis.
So it should be understood that whenever oranges or orange juice
are mentioned, what is said applies with equal force to grape-
fruit and tangerines; the choice depending either on the presence
of some other condition, other than acidosis, that might effect
the choice, such as the desire for more or less sugar, or simply on
the patient's preference for one or the other. Where there is no
special reason for selecting a specific one, the choice may be
safely left to the patient's taste.
While it is extremely rare to find a patient tiring of any of
these fruit juices, yet should such be the case, one of the others
may be given with full confidence of obtaining equally benefi-
cial results; or they may be given in alternation or mixed in any
proportion to please the taste.
The principal reason why citrus fruits are superior to all
others in the treatment of acidosis lies in the fact that citric
acid is so readily and so completely o:idized in the system.
SHERMAN, MENDEL, SMITH and TOOTHILL state, "It has been
found that when human beings take by mouth as much as forty





THE THERAPY OF FLORIDA CITRUS FRUITS


grams of citric acid (more than it seems likely that they would
ingest per day in their food) less than 5 percent of the acid ap-
pears in the urine."
Elsewhere these same authorities on nutrition state, "Many
fruits and fruit juices contain considerable amounts of organic
acids, of which citric is perhaps the most familiar. Most of these
are di- or tri-basic acids and exist in fruits partly as potassium
salts and partly as free acids. As eaten, these fruits have an
acid reaction; whether they are potentially acid or potentially
basic in metabolism depends upon the extent the organic acid
radicles are oxidized in the body with the formation of potas-
sium bicarbonate. Thus oranges tend to diminish the
acidity of the urine."
This fact is well known to every one practicing in the citrus
producing areas. It is particularly evident among those em-
ployees in the citrus industry whose work requires the tasting
of fruit to determine its probable maturity. (The maturity test
that all fruit must pass before it can be shipped is, of course, a
chemical one and, incidentally, in Florida is considerably higher
than that required by the Federal Government.) These men not
only swallow an exceedingly large amount of fruit juice in the
course of a day, some of it from unripe fruit with a correspond-
ingly large amount of acid, and invariably their urine is highly
alkaline.
KELLOGG says, "Near the head of the list of alkalizing foods
are found citrus fruits and fruit juices, the most convenient and
agreeable means of alkalizing the blood. Each pint of orange
juice contains 13 grams of potassium, one of the most powerful
and readily soluble alkalies."
Grapefruit juice contains only a little more than half this
amount of potassium but has other properties that frequently
make it the better of the two.
Continuing his discussion on the merits of citrus fruits in
acidosis KELLOGG says, "The potassium of orange juice is com-
bined with citric acid and so does not act as an alkali in the





THE THERAPY OF FLORIDA CITRUS FRUITS


stomach, neutralizing the gastric juice and arresting digestion
as do soda and other alkalies. After the orange juice is absorbed
in the blood, the acid is oxidized and used as food the same as
starch or sugar, thus setting the alkali free to help alkalinize the
blood and tissue fluids. In this way orange juice combats aci-
dosis, one of the most common predisposing causes of both acute
and chronic disease. An excess of acid in the blood and tissue
fluids lowers resistance to colds, which cost the people of the
United States many millions of dollars annually.
Referring once more to the advantages of using citrus fruits
in preference to alkalies in the treatment of acidosis the follow-
ing quotation from SHERMAN, M1ENDEL, SMITH and TOOTHILL
is of interest.
"This interference with digestion by the ingestion of free
alkalies is one of the reasons why it is much preferable to
use citrus fruits as a source of the alkaline elements."

DOSAGE
The amount of orange or grapefruit juice necessary in a given
case depends, of course, on its severity. KELLOGG states, A pint
or two of orange juice daily will often cause complete disappear-
ance of the excess acidity in four or five days and with the
acidity will also disappear a host of disagreeable symptoms such
as headache, loss of appetite, soreness of the muscles, neuralgic
pains, nervousness, depression and a host of other miseries."
Since the administration of citrus juice is entirely free from
objectionable side effects, there is no possible danger from over-
dosage. Give plenty. It is pleasant, cheap, and harmless. Pos-
sibly a good rule-o'-thumb method is to give enough to render
the urine neutral or slightly alkaline in reaction; then gradually
reduce the amount to whatever point that may be necessary to
keep the urine normally acid or a shade below this point.
It cannot be emphasized too strongly that there is no possible
danger from over-dosage; that there is no disturbance of diges-
tion; no untoward side effects; and that, due to the exceptionally




THE THERAPY OF FLORIDA CITRUS FRUITS


large amount of juice contained in Florida fruit, it is cheap
enough to be within the reach of all.

SCURVY

It is interesting to realize that scurvy has been recognized
for what it actually is. for almost two centuries. Naturally it
was not termed vitamin C deficiency, for the word vitamin was
not coined until the present century. Yet scurvy was known
to be due to the lack of "something" in the diet. It was likewise
known that this "anti-scorbutic something" was found in certain
vegetables and fruits. particularly in citrus fruits.
This is probably the only case in the history of medicine in
which a hundred-year-old theory regarding etiology of a dis-
ease, and an equally old empirical treatment for the same dis-
ease, have both been proved to be founded on a sound scientific
basis.
This very fact, however, has tended to cause a certain amount
of confusion as to the proper definition of the term scurvy, some
writers classing all vitamin C deficiencies, no matter how slight,
as scurvy, while others restrict the meaning of the word to cases
sufficiently severe to show at least part of the classical symp-
toms-spongy, bleeding gums, loosened teeth, extreme weakness,
submucous and subcutaneous hemorrhages, etc.
When KELLOGG says that "Millions of Americans suffer from
scurvy," he is certainly referring to vitamin C deficiencies of all
degree and not to cases of frank scurvy alone; while when
HARRIS states that "Scurvy is still met with in so many isolated
regions of the globe," he is not referring to minor deficiencies
of this vitamin, but to cases severe enough to produce at least
some of the classical symptoms.
Even at that, it is difficult to say just where HARRIS draws
the line between frank scurvy and mere vitamin C deficiencies,
for he states that outbreaks of scurvy occurred in all belliger-
ent countries during the World War, including Great Britain





THE THERAPY OF FLORIDA CITRUS FRUITS


and the United States and that "There were many thousands
of cases among the troops on every one of the fronts."
One of the worst outbreaks among the troops occurred at Kut
el Amara, in Mesopotamia, in 1915 and 1916, where there were
over a thousand severe cases in the beleaguered garrison, mostly
among the East Indian troops. It must be remembered, how-
ever, that these troops had been on a very restricted ration for
months and were ultimately starved into surrender. The British
troops with them suffered much less.
SYMPTOMS
It must again be emphasized that the term "scurvy" as used
herein covers not only the symptom complex seen in cases of
frank scurvy, but also the less serious symptoms due to lesser
degrees of vitamin C deficiencies.
STEFANSON, the Arctic explorer, who was himself a victim of
scurvy, states that "The first observable symptoms of scurvy
include laziness, gloom and irritability, showing itself in tend-
ency to condemnatory and uncalled-for argumentativeness."
PLIMMER says, "Before definite symptoms of scurvy appear
there is a period of ill-health, characterized by certain symptoms
which may also be looked for in those who habitually take too
little vitamin C though they get enough to prevent acute scurvy.
These symptoms are shallow, muddy complexion, loss of energy,
mistaken for rheumatism."
LIND, an acknowledged authority on scurvy, writing espe-
cially of the disease on shipboard says, "An uncommon degree of
sloth and laziness which constantly accompany this evil is often
mistaken for the wilful effect of the patient's disposition. This
may prove fatal to many, some of whom, when obliged to climb
up in the shrouds have been seen to expire and fall."
Scurvy develops gradually. Adults lose weight, are anemic,
pale, weak and short of breath. Gums become swollen, bleed
freely, and frequently ulcerate. The teeth loosen and may drop
out. In the skin, large blue-black spots develop after trivial in-
jury or even spontaneously. Hemorrhage into mucous mem-





THE THERAPY OF FLORIDA CITRUS FRUITS


brane and skin are characteristic. Necrotic areas in the jaw-
bone may develop. The ankles become edematous and in severe
cases there develops a hard, board-like condition of the skin
and subcutaneous tissues. Nervous symptoms of various types
are seen. In the latter stages headache, convulsions and delir-
ium appear.
MCCRAE. in the 1935 edition of OSLER. adds to the foregoing,
swelling of the pina of the ear possibly extending to the scalp;
foul breath; tongue swollen but not usually coated; skin dry and
brought; effusions between periostium and bones of legs forming
nodes that may break down leaving foul-looking ulcers; epistaxis
and hematuria; palpitation with feeble and irregular pulse, en-
largement of heart; and secondary anemia.
PATHOLOGY
The one outstanding pathological condition found in all cases
of vitimin C deficiency, no matter how mild or how severe is
capillary fragility.
HARRIS (Vitamins in Theory and Practice) says that "the
characteristic thing about scurvy is the tendency for bleeding 'o
occur very easily in different parts of the body."
These hemorrhages are almost always due to this fragility or
weakening of the smaller blood vessels, and may appear almost
any where. At times they are due to very slight injuries and
again apparently spontaneous. Some are subcutaneous (ec-
chymosis or petechia) ; some submucous epistaxiss, gingival or
intestinal bleeding) ; some subeperiosteal (usually in the bones
of the legs, and in children at the epiphysis) ; some retinal: peri-
cardial, conjunctival; etc.
MCCOLLUM and SIMMONDS state that fragility of the capil-
laries and of the bones were the most noticeable conditions
observed at autopsy.
A capilliary fragility test, to determine the degree of fragility
present, has recently been developed by a group of Swedish in-
vestigators and applied by GOTHLIN of the University of Upsala
in the study of vitimin C requirements.





32 THE THERAPY OF FLORIDA CITRUS FRUITS

This test is very simple as its sole purpose is to determine the
ability of the small blood vessels to withstand intra-vascular
pressure. A compression banA is applied just above the elbow
and pressure slowly applied. If the capillaries are weak, show-
ing that there is a vitimin C deficiency, slight hemorrhages will
appear in the skin at the bend of the elbow with very little
increase in pressure. In very severe cases of scurvy these sub-
cutaneous hemorrhages sometimes make their appearance with
practically no increase in pressure.
GOTHLIN and others have found this test to be a valuable-
diagnostic measure especially where the symptoms are not very
pronounced and there is a possibility of a mistake in diagnosis.
As the test is practically painless it is of particular value in
examining children.
Writing in the Scandinavian Archives for Physiology, GOTH-
LIN cites an occasion where he applied this test to fifty girls
ranging from 11 to 14 years. Ten showed marked capillary
fragility. Describing the result of treatment with orange juice
in the worst of these, a girl of twelve, he says, "I shall never
forget how this little girl with dull, tired, resigned expression
on her face through five weeks of intense treatment with
orange juice awakened, so to speak; how her movements became
livlier and her eyes grew bright, and how her looks showed
what pleasure she got out of life."
WEISS and WILKINS writing on "Disturbance of the Cardio-
vascular System in Nutritional Deficiency" in the J. A. M. A.,
Sept. 4, 1937, state that "The tendency to vascular fragility in
vitamin C deficiency may well lead to recognized hemorrhages
and tissue damage."
DILLDORF found that capillary fragility could be shown in
from 35 to 66 percent of children from economically poorer
homes admitted to Grassland Hospital, and states that most of
them responded to increased vitamin C dosage; while SHERMAN
found that "liberality of intake of vitamin C protects against
capillary fragility."





THE THERAPY OF FLORIDA CITRUS FRUITS


ROSE writing on "Resistance to Infection," states that "In the
case of vitamin C the extent of its effects on the organism is
particularly striking. Having to do in some way with factors
which hold cells together in specialized tissues and organs, its
withdrawal means widespread disintegration. As has already
been shown, the walls of the blood vessels, the marrow and cal-
cified portion of the bones, the connective tissue where ever
found, even the nerves, are involved in the general collapse.
Teeth are loosened from their sockets, their roots absorbed; the
walls of the lungs cave in, owing to dissolution of connective
tissue; the capillary walls give way and blood stagnates in mi-
nute pools making slight hemorrhagic spots called petechia.
The bones lose their calcium because the connective tissue is
unable to hold it and symptoms similar to rickets are observed."

TREATMENT

Since scurvy is a deficiency disease caused solely by a lack of
the proper amount of vitamin C in the diet, the treatment neces-
sarily consists of supplying this lacking factor.
And all the leading authorities on diet and nutrition agree that
the best possible sources of vitamin C are the citrus fruit juices.
This fact has been recognized for two hundred years, and only
since the vitamin has been isolated and synthetically produced,
has there been any advance in treatment.
Today, in extremely severe cases, or in those complicated by
obstinate vomiting, it is possible-and at times necessary-to
administer the vitamin in the form of the pure cevitamic acid.
This permits the administration of a much larger number of
units in a much smaller bulk.
As soon as the emergency is past, however, the use of citrus
fruit juices is by far the preferable treatment, for in these juices
the vitamin C is reinforced by vitamins A, B and G, of which
there is also apt to be a deficiency. They also contain goodly
quantities of easily disgusted fuel and energy values, and last, but
not least, large amounts of mineral elements essential to combat





THE THERAPY OF FLORIDA CITRUS FRUITS


the acidosis almost invariably complicating every severe case of
scurvy.
The most common mistake made in the treatment of scurvy
is in giving insufficient doses.
As SHERMAN says, "Objectively demonstrable facts are stead-
ily coming to the support of the feeling that the amount of
vitamin C required to prevent scurvy (hitherto recognized as
classical or manifest scurvy) is only a fraction of the amount
which induces the best results: or, in other words, that vitamin
C is one of those factors which differ from the energy value and
the total protein content of the diet in showing a wider zone of
increasing liberality of intake between the merely adequate and
the truly optimal."
HANKE believes that the teeth and gums can be greatly im-
proved by the intake of about ten times the minimum protective
dose-the juice of half a lemon in half a pint of orange juice.
Whenever sufficient amounts of vitamin C are administered
it is remarkable how quickly the case will respond. If the diag-
nosis is correct and the amount administered ample, improve-
ment will manifest itself in from 48 to 72 hours, and ten days to
two weeks are usually sufficient for a cure.
But it must be remembered that vitamin C is water-soluble
vitamin and not stored by the tissues, so that after a cure has
been effected, citrus fruits should be made part of the daily diet
in quantities sufficient to protect against recurrence.
Oranges, grapefruit and tangerines may be used as the source
of the necessary vitamin C either separately, in combination or
in alteration. A favorite method when it is necessary to admin-
ister large quantities for a long time is to give grapefruit or its
juice for breakfast, orange juice for between meal drinks and
tangerines in salads and as a table fruit.

INFANTILE SCURVY

Scurvy is no respector of age. It attacks the infant in the
cradle and the grand sire in the wheel chair with absolute im-




THE THERAPY OF FLORIDA CITRUS FRUITS


partiality; and in young and old the same causitive factor is at
work-lack of vitamin C.
So there would be no excuse for considering Infantile Scurvy
separately but for the fact that the structure of the bones, espe-
cially about the epiphyseal junctions, is different in infants than
in later years.
SIR THOMAS BARLOW gave so graphic a description of this
disease a number of years ago that it is still quite frequently
spoken of as Barlow's Disease. Nor can his description be im-
proved on today:
"So long as it is left alone the child is tolerable quiet; the
lower limbs are drawn up and still; but when its diapers are
changed, or it is placed in its bath, or otherwise moved,
there is continuous crying, and it soon becomes evident that
the pain is connected with the lower limbs. At this period
the arms may be handled with inpunity, but any attempt
to move the legs or thighs gives rise to screams. Next, some
obscure swelling may be detected, first on one lower limb
and then on the other, though it is not absolutely symmet-
rical. The swelling is ill-defined, but is suggestive of thick-
ening around the shafts of the bones, beginning above the
epiphyseal junctions. Gradually the bulk of the limbs be-
comes visibly increased, and the position assumed becomes
somewhat different from what it was at the outset. Instead
of being flexed they lie everted and immobile in a state of
pseudo-paralysis. About this time, if not before, great
weakness of the back becomes apparent. A little swelling
of one or both scapulas may appear, and one or both arms
show similar changes, though rarely as marked as in the
legs. The joints are free. In severe cases another symptom
may now be found, namely, crepitus in the region adjacent
to the junction of the shafts with the epiphyses. The upper
and the lower extremities of the femur and the upper end of
the tibia are the common sites of such fractures, but the
upper end of the humerus may also be affected. A very





THE THERAPY OF FLORIDA CITRUS FRUITS


startling appearance may now be observed over the front
of the chest; the sternum, costal cartilages, and a portion
of the adjacent ribs seem to have been forcibly jammed
back toward the spinal column. Occasionally thickenings
of varying extent may be observed on the surface of the
skull, or even on some of the bones of the face. A remark-
able eye symptom may appear; proptosis of one eyeball.
with puffiness and very slight staining of the upper lid.
In a day or two the other eye presents the same appearance.
Little ecchymoses may appear on the conjunctiva. Coinci-
dent with these symptoms, and proportional to the amount
of limb involved, a very profound anaemia develops. The
complexion becomes sallow or earthly colored, and small
ecchymoses, or more rarely petechiae, appear on various
parts of the body. Emaciation is not a marked feature-in
fact, during the early stages of the disease the child may ap-
pear to be unusually plump and well nourished. Asthenia is,
however, well marked. The temperature is erratic; it is
often raised for a day or two and the teeth may even fall
out."
Reading this description, it is not surprising that HARRIS
wrote:
"At the beginning of this century scurvy ceased to be
the 'sailors' calamity' but was fast becoming a 'babies'
calamity'."
Infantile scurvy usually makes its appearance between the
sixth and twelfth months, rarely after two years, and as FRO-
LICH pointed out, in 1912, is actually more apt to occur in care-
fully reared children fed almost exclusively on sterilized milk
and cereals or other prepared foods.
HESS and FISH described outbreakes of scurvy in an infants'
asylum in New York where the children had been fed on pas-
teurized milk and cereal gruel. The patients were restless,
irritable and retarded in growth.
There is little doubt that the development of scurvy in bottle-





THE THERAPY OF FLORIDA CITRUS FRUITS


fed infants is usually due to the destruction of the vitamin C in
the milk by heat. As has been elsewhere pointed out vitamin C
is easily destroyed by heat, especially in the presence of oxygen.
ROSE says that it is never wise to depend on milk for the nec-
essary vitamin C, even when the milk used is fresh, "but to use
some outstanding source-known to digest we1, such as orange
juice," for even fresh milk varies largely in its vitamin C con-
tent, that from cows fed on green pasture being from three to
five times as rich in this vitamin as that from cows on dry feed.
Infantile scurvy is also possible in breast-fed babies if the
mother's intake of vitamin C is not sufficient for both her and
the baby.
WIDENBAUER and KUHNER state that vitamin C requirements
of nursing mothers are higher than normal; BAUMAN and KAP-
POLT finding that the nursing mother requires not less than
50 mg. of cevitamic acid per day.
Besides, NEUWEILLER points out, the vitamin C requirements
of the suckling are relatively high, 6 mg, of ascorbic acid per
kilogram per day.
For these reasons ROSE suggests that all breast-fed babies be
given a teaspoonful of orange juice between feedings beginning
at the second week.
TREATMENT

The treatment of infantile scurvy differs in no way from that
in the adult-vitamin C in amounts large enough to obtain re-
sults. Fortunately, even infants like orange juice and most of
them will like tangerine juice even more, so there is no difficulty
in getting them to take it. As stated under the treatment of
scurvy, give plenty, and when the case is cured keep giving pro-
tective doses large enough to prevent any recurrence.

INFANT FEEDING

The value of orange juice in infant feeding-breast or bottle
-is so universally recognized that it would almost seem an in-





THE THERAPY OF FLORIDA CITRUS FRUITS


suit to the profession to spend time or space in discussing it.
Yet HARRIS (Vitamins in Theory and Practice) says,
"Lately I have been surprised to discover what a large
proportion of babies-in this country fail to get their daily
dose of orange juice, and show that they are 'unsaturated'
with vitamin C when we examine them."
Besides, there are some points in connection with this subject,
such as the amount necessary for optimal results, that have been
brought up so recently that a brief mention thereof may be well
worth while.
One thing frequently overlooked is that breast-fed babies are
just as apt to need orange juice as are those fed on the bottle.
NEUWEILER states that "the vitamin C requirements of the
suckling are relatively high, 6 mg. of ascorbic acid per kilogram
per day."
ROSE, under "Foods for the Breast-fed Baby" writes,
"The next addition should reinforce the mother's milk with
regard to vitamin C since this in liberal amounts may be favor-
able to the development of the teeth For this purpose a
teaspoon of strained orange juice is most suitable and may
be introduced at the beginning of the second month between
two breast feedings."
HANKE calls attention to the fact that orange juice contains
something that acts as a growth stimulus to children, while
HESS has shown that a deficiency in vitamin C causes an arrest
of growth in infants and small children.
ROSE likewise makes the statement that observations have
shown that vitamin C is of importance for the growth of infants.
Several authors call attention to the importance of vitamin C
in the development of the teeth, HARRIS stating that shortage of
vitamin C is almost certainly a factor making for badly formed
teeth and hence decay.
MCCOLLUM and BECKER state that infants, even though
showing no sign of rickets, should have a regular supply of vita-





THE THERAPY OF FLORIDA CITRUS FRUITS


min C as the dentine-forming cells in the teeth are extremely
sensitive to vitamin C deficiencies.
HESS points out that frequently children who are not showing
any definite symptom of scurvy are lacking in stamina and more
or less retarded in growth, and are relieved by increased feed-
ing of orange juice.
DENNETT, noted New York pediatritian, says that vitamin C
seems to promote freedom from digestive disturbances in babies,
while HESS says that one of the striking symptoms of scurvy
in infants is susceptibility to infections.
In collaboration with FISH, HESS made a study of a group of
children in an orphan asylum where a large number were suffer-
ing from scurvy due to the use of sterilized milk and found that
they quickly recovered when given orange juice.
DANIELS found that raising the orange juice from 15 c.c. to 45
c.c. resulted in gain in weight where the diet appeared adequate
in vitamin C and the only other factor in the diet materially in-
creased appeared to be vitamin B.
Speaking of the variable supply of vitamin C in fresh milk,
ROSE (Food Needs of Young Children) says, "For vitamin C it
is not well to depend on the variable supply even in fresh milk
but to use some outstanding source known to digest well such as
orange juice Two to four tablespoonfuls per day are
ample as a rule."
HESS says, "In view of our present belief that liberality of
intake of vitamin C is highly beneficial it is probably best to
recommend that all infants be given some such antiscorbutic
food as orange juice. If this is done the possible variation in
vitamin C content among different forms of milk need not be a
matter of practical concern.
Stating his opinion as to how much should be given HANKE
says, "It seems reasonable to assume that if half an ounce of
orange juice will protect an infant from scurvy, a tentative
dietary standard may be set at approximately three times this
amount. This amount will afford probably good protection





THE THERAPY OF FLORIDA CITRUS FRUITS


against latent as well as acute scurvy during the period in which
the total intake is below 2000 calories."
ROSE suggests the following amounts of orange juice daily as
sufficient to provide the requisite amount of vitamin C in arti-
ficially fed well babies.
Note that these amounts are for well babies; if there is any
trace of vitamin C deficiency they should have much larger
quantities.
Beginning at 2 weeks 1. 3 tablespoonful
During 2nd month -
During 3rd month - 1 "
During 4, 5 and 6th months 1' "
During 7th mcnth - 2
During 8th month .- 21/,
During 9, 10 and 11th months 3 "
From then on -4 "

CITRUS FRUITS IN. DENTISTRY

Dentists will find Florida citrus fruits of as much value as do
physicians. These fruits contain not only the mineral elements
necessary for the proper development of the teeth, but, what is
of even greater importance, large amounts of vitamin C, recog-
nized by all authorities as one of the factors essential to the
maintenance of healthy teeth and gums.
That scurvy is nothing more or less than deficiency or total
lack of vitamin C is generally recognized, and some of the most
pronounced symptoms of scurvy are dental rather than medical
in nature. The spongy, bleeding gums and loosened teeth are
among the most characteristic symptoms of the disease, and fre-
quently come to the attention of the dentist before a doctor is
consulted.
Then, too, a deficiency of vitamin C seems to affect the odon-
toblastra more than almost any other structure. According to
McCOLLUM and BECKER (Food Nutrition. a~l Health) :




THE THERAPY OF FLORIDA CITRUS FRUITS


"It is evident that the most sensitive structures in the
body to deficiency of vitamin C are the dentine-forming
cells (odontoblasts). On these depend the nourishment of
the dentine. The capillary blood vessels come next in im-
portance for health on an abundance of vitamin C, a de-
ficiency of which may account for impaired metabolism
of the pulp of the teeth and their attaching tissues in the
jaw. Dentine, like bone, is not static but is taken down
and renewed throughout life. Impairment of the nutritive
processes dependent on the soft tissues of the tooth, within
or without, may well make it susceptible to decay."
MILTON T. HANKE (Diet and Dental Health), says that

"The average American diet is adequate in calories, but
appears to be deficient in certain substances that are requi-
site to dental health. This dietary deficiency may be the
ultimate cause of much of the gingivitis, pyorrhea and
dental caries with which we are afflicted. The addition of
a pint of orange juice and the juice of one lemon to the diet
that is nearly adequate in all other respects supplies some-
thing that leads to a disappearance of most of the gingivitis
and an arrest of about fifty percent of the dental caries."
In the chapter on "Diet and Preventive Dentistry," in their
work already referred to, MCCOLLUM and BECKER state that
"Injury to the odontoblasts or dentine-forming cells
which line the pulp cavity of the tooth, and consequent
deprivation of the dentine of its normal nutrition; damage
to the peridental membrane which covers the tooth below
the enamel line; and damage to the gum tissues, result from
the deficiency of vitamins, especially vitamin C.
This opinion was probably first advanced by HOGER, but had
likewise been mentioned by HANKE.
Other authorities agree with these findings, almost without
exception.
HARRIS (Vitamins in Theory andl Practice) says that





THE THERAPY OF FLORIDA CITRUS FRUITS


"Shortage of vitamin C is almost certainly another factor
making for badly formed teeth, and hence decay."
MARY SWARTZ ROSE (Foundationis of Nutrition), after set-
ting forth that there are many factors in nutrition that may
affect the teeth-calcium, phosphorus, vitamins A, B, C, and D
-(all of which, except vitamin D, being present in Florida cit-
rus fruits, Author.)-says, that in guinea pigs,
"It was found that when the diet was low in vitamin C
the odontoblasts lose their orderly arrangement. They
shrink away from the dentine, which in turn begins to de-
generate, either becoming liquified or changing to bone.
There is also damage to the pulp, sometimes resulting in
large hollows filled with fluid.
"To what extent these laboratory findings are applicable
in human caries is still uncertain; however Dr. Hanke of
the Department of Pathology of Chicago University, work-
ing in connection with the Chicago Dental Research Club,
questioned very carefully 114 patients ranging from 6 to
60 years, with regard to their dietary habits. Seventeen
were found free from dental disorders, and these seemed to
be eating diets with ample vitamins. The remainder had
caries or pyorrhea, sore gums, bone absorption, or dead pulp,
and practically all of their diets seemed deficient in vitamin
C. When the vitamin C intake was markedly increased by
a half pint daily orange juice containing the juice of half a
lemon, together with 1/4 to 1/, head of lettuce or its equiv-
alent in raw cabbage, there was prompt arrest of caries
and improvement in gum tissue."
KELLOGG (Dietetic Value of Florida's Tropical Fruits) quotes
from a report made by MRS. MELLANBY, a well known British
physiologist, who, after 16 years of research on the causes of
decay in teeth, during which time 30,000 teeth were examined in
situ and 200 microscopically, and including dietary studies on
over 400 children for a period of two years, comes to the con-




THE THERAPY OF FLORIDA CITRUS FRUITS


clusion that the cause of decay was largely due to a deficiency of
vitamin C.
HARRIS (Vitamins in Theory and Practice) writes as follows:
"With DR. WILFRED FISH of the Royal Dental Hospital
I have investigated the effects of a shortage of vitamin C on
the teeth. There is little doubt that it gives rise to serious
faults in tooth structure (such as poor dental enamel and
cement) and therefore is a potential cause of decay."
Elsewhere HARRIS says:
"In the absence of vitamin C certain cells are no longer
able to perform their functions properly, and this is why
the teeth lose their normal structure and become
diseased."
MCCOLLUM and BECKER emphasize the importance of sup-
plying all babies with vitamin C without waiting for deficiency
symptoms to manifest themselves.
"Since the dentine-forming cells in the teeth are exceed-
ingly sensitive to deficiencies of vitamin C, it is of great im-
portance that vitamin C be provided regularly, since the
tooth development may be interferred with in infants who
never show any sign of scurvy."
Once more quoting from HANKE'S (Diet and Dental Health):
"Diets rich in vitamin C are conducive to an arrest of
dental caries in man and the arrest of caries may be due to
an increased vitality of the denture. Dental disorders of
all kinds occurred in patients who were apparently receiv-
ing an adequate amount of vitamin D, but whose diets were
deficient in vitamin C."
HANKE also believes that the amount of citrus fruit juices is
usually too small. He says:
"We have investigated the effect of one type of food,
namely citrus fruit juices, because most American diets ap-
pear to be deficient in foods that contain vitamin C. A
notion has apparently gained credance in some circles that
if a large amount of a given food is very good, a small





THE THERAPY OF FLORIDA CITRUS FRUITS


amount may be of some good. This is correct, broadly
speaking, but not necessarily correct when some given dis-
ease is considered. It is a well known fact that a man does
not develop symptoms of frank scurvy if he receives the
equivalent of three ounces of orange juice per day. It has
been assumed therefore, that the amount of vitamin C con-
tained in three ounces of orange juice is ample to prevent all
manifestations of scurvy in man. The administration of 3,
6, or even 8 ounces a day is just waste of time and material
in many cases of severe gingivitis or pyorrhea because the
dose is too small."
Considering the practical unanimity of opinion regarding the
importance of vitamin C in dental health, it is not at all strange
to find KELLOGG saying, "Florida Citrus Fruits May Save Amer-
icans from becoming a Toothless Race"; and adding, that in
his opinion, the old saying about an apple a day keeping the
doctor away, should be changed to read that "An orange a day,
keeps the dentist away."
McCOLLUM and BECKER give it as their opinion that
"The problem of preventing dental caries will not be
solved until all children are protected against rickets in in-
fancy and childhood, and until the diet of the nation is made
to provide a more nearly optimal content of mineral ele-
ments, especially calcium and phosphorus, and the people
of all ages regularly receive a diet containing appropriate
amounts of vitamins A, C, and D.
All too frequently dentists are accused of doing slip-shod work
because fillings and inlays come loose and drop out. In probably
more than 99 percent of these cases the fault lies not with the
dentist's workmanship but is due to the fact that the patient is
suffering from a vitamin C deficiency. Without such deficiency
it is unlikely that a cavity would have formed; and merely clean-
ing the cavity and filling same may give temporary relief but
unless the underlying trouble is rectified, the condition is al-
most certain to return.





THE THERAPY OF FLORIDA CITRUS FRUITS


The surest way to prevent such recurrence is to prescribe for
these patients Florida citrus fruits and their juices in liberal
amounts.
HANKE believes that the teeth and gums can be greatly im-
proved by intake of about ten times the minimum protective
dose-half the juice of a lemon in half a pint of orange juice.
At the first glance this looks like a large amount even as a cura-
tive dose-two and a half quarts a day-but as HANKE says
"there is no evidence to show that large amounts of vitamin C
does any harm, and much to show that liberal amounts are good
health insurance.

CITRUS FRUITS IN OTHER DISORDERS

Recent investigations have definitely proved that vitamin C
deficiency is an important factor in a number of diseases other
than scurvy per se; and many of these disorders also have a
marked tendency towards acidosis. It is therefore obvious that
the free use of citrus fruit juices must necessarily be of con-
siderable value in the treatment thereof.

ANEMIA

KELLOGG believes anemia to be one of the most common mani-
festations of latent scurvy. He also considers it more common
than generally supposed; citing a test made during the Chicago
Worlds Fair (1893) where an examination of the blood of 6,000
persons showed an average hemoglobin percentage of only 80.
Also a study during the First Race Betterment Conference at
Battle Creek in 1914 where 5,000 children were examined and
almost all found to be anemic. He heartily recommends citrus
fruits, believing that vitamin C helps the system to utilize the
iron ingested and says, "If every anemic person in the United
States could be induced to drink three glasses of orange juice or
an equivalent amount of grapefruit juice per day ... the demand
for calves liver would soon fall off."





THE THERAPY OF FLORIDA CITRUS FRUITS


GLANZMANN (Int. Med. Digest) states that iron deficiency
anemia responds more rapidly to iron administration when vita-
min C is administered with the iron.
WIDENBAUER and KUHNER found that oral administration of
ascorbic acid was able to raise lowered erthrocyte, thrombocyte,
and reticulocyte counts and lowered hemoglobin percentages.
DUNLAP and SCARBOROUGH found that the administration
of vitamin C in scorbutic patients produced a rapid cure of the
symptoms and the anemia.
RADFORD in the American Review of Tuberculosis says that
the daily administration of vitamin C and orange juice promoted
higher red cell count and higher hemoglobin values.

ARTERIOSCLEROSIS
KING and MENTEN believe that under stress of combatting a
toxin the body may or may not develop arteriosclerosis accord-
ing to the liberality with which vitamin C is supplied.

ARTHRITIS
In an article "Vitamins B and C" in Therapeutic Notes, (Oct.
'37) the statement is made that arthritis may be favorably in-
fluenced by vitamin C.
FLETCHER and GRAHAM of the University of Toronto report
that 40 patients suffering from arthritis showed marked im-
provement when large doses of vitamin B were given.
(As shown under Chemistry, citrus fruits have enough vita-
min B to be of some value as a source thereof.)

ARSPHENAMINE REACTION
CORMIA writing in the Journal of the Canadian Medical Asso-
ciation says that vitamin C deficiency predisposes to and intensi-
fies existing arsphenamine reactions; and recommends that pa-
tients with arsphenamine dermatitis or receiving arsenic therapy
be given large doses of vitamin C.





THE THERAPY OF FLORIDA CITRUS FRUITS


DIPHTHERIA

HEGLER thinks that adrenal cortex and vitamin C are indi-
cated in severe cases of diphtheria. In a study of 188 cases the
results were much better when they were added to the regular
serum treatment.

EYE LESIONS

Cataract. JOSEPHSON in "Science" reported that the adminis-
tration of from 0.015 to 0.30 g. of vitamin C to patients with
cataracts caused marked improvement, and in less than a week
of treatment mature cataracts became sufficiently transparent to
allow examination of the eye grounds, and even permit some vis-
ion. Cataracts caused by dinitrophenol poisoning responded
very rapidly to treatment with vitamin C and other toxic effects
were also ameliorated.
Hemorrhage. VILLARD and others report recurring hemor-
rhage of the eye occurring about every 20 days being treated
with vitamin C and clearing up very rapidly.

FEVERS

OSBORNE (Principals of Therapeutics) states that "The waste
of tissue during remittent or continuous fever is shown by the
loss of fat, which breaks down and causes acidosis. The patient
should have either lemonade or orangeade, or he may chew and
swallow orange pulp. These fruit juices stimulate the flow of
saliva and are valuable foods for fever patients." (In these cases
it is mineral elements that are of value rather than vitamin C.
Tangerines are the equal to oranges in every way, as is grape-
fruit but for the fact that it has only about 50 percent the caloric
value.)
FRACTURES

MCCOLLUM and SIMMONDS report that one of the most no-
ticeable conditions found at postmortems in scurvy patients was





THE THERAPY OF FLORIDA CITRUS FRUITS


fragility of the bones. SHERMAN likewise mentions fragility of
the bones as a symptom of vitamin C deficiency; and HANKE
states that vitamin C is indispensable to repair of fractured
bones.
A recent editorial in the British Medical Journal states that
vitamin C deficiency is a very important factor in delayed union
and healing of fractured bones.

HEART LESIONS
The fact that vitamin C deficiencies play a part in certain
cardiac disturbances has been well established. As far back as
1918 ERDHEIN performed postmortems on 31 children that had
died of scurvy in Vienna, and found that cardiac hypertrophy
and dilations were regularly manifest.
WEISS and WILKINS in an article on "Disturbance of the Car-
dio-Vascular System in Nutritional Deficiency" (J. A. M. A.
Sept. '37) state that HIFT and BRULL observed acute recurrent
hemorrhagic pericarditis among scorbutic patients in a con-
centration camp in Siberia. They also state that studies made to
determine the relation of vitamin C deficiency to rheumatic
heart disease show that the cevitamic acid of the blood is low.

HEMORRHAGE
Hemorrhage due to capillary fragility is one of the most no-
ticeable of the symptoms of vitamin C deficiency. This has been
discussed at some length under scurvy, but there is also consider-
able evidence indicating that the amount of vitamin C has a
direct influence on the clotting time. MCCOLLUM and SIM-
MONDS report that in scurvy patients autopsy revealed hemor-
rhage as one of the most noticeable conditions. HUME found
that the administration of 50 to 100 mg. ascorbic acid per day
reduced the clotting time in two haemophiliacs. LORENZ shows
the importance of vitamin C in promoting the coagulability of
the blood and states that the administration of vitamin C lowered
the bleeding time to normal in purpura hemorrhagica. In fact





THE THERAPY OF FLORIDA CITRUS FRUITS


he considers vitamin C a specific therapeutic agent in this dis-
ease.

INFECTIONS
Citrus fruit juices, either full strength or diluted with water
to made "ades" (lemonade, orangeade, limeade) have probably
been used in the treatment of all diseases, infectious or otherwise
having an elevated temperature ever since the dawn of history.
That they are of great value aside from quenching thirst, is, how-
ever, a comparatively recent discovery. First it was found that
they furnished a pleasant and agreeable method of increasing
the intake of fluids when ever there were signs of dehydration;
then the value of their mineral content as an aid in combatting
acidosis and now numerous investigators have found that on the
one hand, practically all infections show a tendency to vitamin C
deficiency, and on the other, that vitamin C deficiency tends to
lessen the resistance to infection. As far back as 1923 FINDLAY
found that low vitamin C intake lessened resistance to infectious
diseases. HESS likewise called attention to the fact that in in-
fants one of the important symptoms of scurvy was susceptibility
to infection.
ROSE, writing under the caption "Resistance to Infections,"
after setting forth the striking effects of vitamin C deficiencies
on the system (quoted under scurvy) says:
"It would be strange if under such circumstances bac-
teria of many sorts did not find ready access to organs and
tissues and aid in their deterioration."
In an article on "Vitamins B and C" in "Therapeutic Notes"
for October, 1937, the statement is made that "Acute infections
increase the need for vitamin C."
WEISS and WILKINS reporting on the relation of vitamin C
deficiency to rheumatic feve, etc., say:
"These studies indicate that in rheumatic fever as in other
chronic infections-due to inadequate intake and or to
decreased utilization of vitamin C the cevitamic acid of the





THE THERAPY OF FLORIDA CITRUS FRUITS


blood is low and the body is partially depleted of its nor-
mal storage."
In the article "Vitamins B and C" mentioned above the author
states, "As time passes it seems to be increasingly clear that
vitamin C plays an important part in man's resistance to infec-
tions and toxins."
In an abstract from the Biochemical Journal ABBASY is quoted
as saying that a specific diuretic effect has been noted follow-
ing the administration of vitamin C, and that this fact is addi-
tional evidence of the advisability of giving large doses of vita-
min C in acute infective diseases. ABBASY also states that it
has been shown that fever and infection greatly increase the
body's need for vitamin C. In view of the foregoing plus the
fact practically all infectious diseases have a tendency toward
acidosis, it is obvious that citrus fruit juices are of value in
every case. Grapefruit is particular agreeable as the tartness
seems to allay thirst more than almost any other drink. The
caloric value is also of value in keeping up the strength of
the patients.
MALNUTRITION

MELLANBY states that a deficiency of vitamin C in the diet
may result in a type of malnutrition relating to serious illness.

PNEUMONIA

GANDER and NEIDERBERGER demonstrated that a marked vita-
min C deficiency exists in pneumonia patients and suggests
that intensive vitamin C therapy should supplement other
therapy in every case.
BULLOWA (The Management of Pneumonia) under the head-
ing "General Treatment" says, "An attempt should be made to
meet the caloric, vitamin, fluid and salt needs of the patient.
Studies have shown that the cevitamic acid reserve is depleted
in pneumonia."
Citrus fruit will furnish not only the vitamin C requirements.





THE THERAPY OF FLORIDA CITRUS FRUITS


but also aid in meeting the caloric, the fluid and the salt re-
quirements as well.

PSORIASIS

VOLPE reports that psoriasis responded in a striking manner
to the administration of cevitamic acid (vitamin C).
RHEUMATISM AND RHEUMATIC FEVER
In an article in the October ('37) number of Therapeutic
Notes, the author states that rheumatic fever may be influenced
favorably by the administration of vitamin C. RINEHART be-
lieves that latent scurvy may be a contributing cause of rheu-
matic fever and that vitamin C has definite therapeutic and
prophylactic value in this disease.
ABBASY and associates studied 195 cases of rheumatic fever
and demonstrated: conclusively that juvenile rheumatism is
associated with vitamin C deficiency, and that these children
require more vitamin C than other children on similar diet.
PLIMMER says, "So-called rheumatism in infants and young
children has often been proved to be due to insufficient vitamin
C and is really scurvy."
WEISS and WILKINS after calling attention to the fact that the
relation of vitamin C deficiency to rheumatic fever and rheu-
matic heart disease has been extensively investigated in recent
years, state:
"It seems advisable to feed rheumatic patients with
a balanced diet rich in vitamins including vitamin C."

TUBERCULOSIS

An editorial in the Journal of the American Medical Associa-
tion in 1936 called attention to the fact that there is an increased
demand for vitamin C in tuberculosis.
HASSELBACH, writing in the Deutsche Med. Wochenschrift,
says that extensive studies have shown that vitamin C deficiency
is demonstrated in pulmonary tuberculosis, and that this de-
ficiency exists in all febrile and destructive forms of the disease.





THE THERAPY OF FLORIDA CITRUS FRUITS


RADFORD (American Review of Tuberculosis) finds that a
study of blood changes fJllowing contiuous daily administra-
tion of vitamin C and orange juice to tubercular patients reveals
that this therapy promotes higher red cell counts and hemo-
globin values and some general improvement in the patients'
tuberculosis.
WOUND HEALING

PLIMMER writes that "During the war slow healing of wounds
was found to be associated with a shortage of vitamin C." HOWE,
WOLBACH and CHURCH demonstrated that experimental bone
wounds healed better with an ample supply of vitamin C. LAN-
MAN and INGALLS (Annuals of Surgery '37) initiated clinical
and experimental studies to determine the role of vitamin C de-
ficiency in delayed and abnormal wound healing. Their con-
clusion was that vitamin C deficiencies are probably of more im-
portance in the healing of surgical wounds in humans than has
been heretofore suspected and that when there is any doubt as
to the adequacy of the patient's vitamin C reserve it would seem
logical to administer this vitamin.

HEALTH PLUS

In addition to meeting pathological conditions of a great
many sorts, citrus fruits, if taken regularly and in adequate
amounts, are apparently able to bring about a feeling of well
being, retard the degenerative processes of old age, and in gen-
eral bring about a condition that can best be described as
health plus.
MCCOLLUM and SIMMOND in "The Newer Knowledge of
Nutrition" state that "A liberal intake of vitamin C apparently
helps in 'the preservation of the characteristics of youth'." FIN-
LAY puts it "that the resisting power (positive or buoyant
health) of the body is increased by a diet containing a liberal
amount of vitamin C."





THE THERAPY OF FLORIDA CITRUS FRUITS


SHERMAN words it thus: "There are now a number of obser-
vations which indicate that vitamin C helps to protect the body
from, or defer the intensification of, such changes as are char-
acteristics of the ageing process." Elsewhere he says: "It is grad-
ually becoming clear that vitamin C not only protects from
scurvy but has important functions in the maintenance of a
high level of positive health, and that much weight should be
given to vitamin C values in the daily choice and use of food."
KING and MENTEN are therefore not far off when they suggest
that "It would seem to be well for us to keep ourselves well 'sat-
urated' with vitamin C."

SOME ERRONEOUS BELIEFS REGARDING
CITRUS

Considering the multitude of books and articles on the subject
of dietetics that have made their way into print during the past
few years, many by writers with little or no knowledge of nu-
trition, it is not surprising that some erroneous beliefs have
come to be accepted as proven facts. This is, of course, true of
many foods but we are here interested in citrus.
True, these erroneous beliefs are held by the laity and not by
the profession, but the profession is frequently called upon to
refute them, and it is for this reason that they are discussed
here.
1. That, being acid, citrus fruits should: be avoided by those
suffering from so-calla:l acid disorders--acidosis, rheumantism,
arthritis, etc. Of course there is nothing to this. As explained
under ACIDOSIS, citrus fruits do not increase the acids of the
system but actually decrease the acidity on account of the mineral
elements (particularly potassium) they contain. And it has been
definitely proved that almost all cases of rheumatism and ar-
thritis show a marked deficiency of vitamin C.
2. That citrus fruits should not be taken at the same meal
with starches. This belief is probably based on the fact that
certain organic acids such as acetic and oxalic (found in rhu-





THE THERAPY OF FLORIDA CITRUS FRUITS


barb or pie plant) do interfere with the salivary digestion of
starches. But this is not true of citric acid which in no way
interferes with digestion at any stage. Citrus fruits may be
taken before, during or after any meal, irrespective of what
it may contain, without fear of injurious or unpleasant result.
3. That tangerines tend to cause gastro-intestinal upsets in
children. This notion is due to the fact that if allowed free
access to tangerines most children will grossly over-eat, as they
are so delicious. In addition, tangerines are so easily pared
that they are usually eaten out of hand instead of taking the
juice. This means that the children eat a large amount of pulp,
which might possibly cause some trouble, just as an abnormal
amount of any other fruit might cause trouble.
4. That citrus fruit juices and milk should not be taken at
the same meal as the fruit juice curdles the milk. This is true
so far as the curdling is concerned, but all wrong so far as it
seems to imply that such curdling is harmful. Not only is the
hydrochloric acid of the gastric juice much stronger than the
citric acid, but curdling is always the first step in the digestion
of milk.
5. That citrus fruits should never be eaten in cases of gastric
hyperacidity. Fruit acids never cause irritation of the stomach.
In case of pre-existing irritation it may be well to discontinue
the use of fruits temporarily, but as soon as the irritation is re-
lieved citrus fruits may again be taken with perfect assurance
that they will not prove injurious.
6. That Florida oranges contain less vitamin C than California
oranges. The following editorial under the caption "The Vita-
min C Content of Orange Juice," appearing in the Journal of
the American Medical Association (Jan. 30, 1937), gives the
answer from an authorative and unbiased source.
"In newspapers and magazines, on cards and bill-boards,
the public is being told by the California Fruit Growers Ex-
change that Sunkist naval oranges are '22 percent richer in
vitamin C.' What evidence exists for this statement and





THE THERAPY OF FLORIDA CITRUS FRUITS


what significance should be attached to it? Last September
among other papars presented at the meeting of the Amer-
ican Chemical Society at Pittsburgh, was a report by A. J.
Lorenz of the California Fruit Growers Exchange. His
paper bore the imposing title 'Statistical Review of 1,100
Sugar-Ratio Determinations Corelated with Vitamin C
Values Representing 14,000 Oranges under Varying Con-
ditions.' The juice of California oranges was reported to
contain an average of 0.60 mg. cevitamic acid per cubic
centimeter, whereas the juice of Florida oranges contained
0.53 mg. when tested by the same chemical method. The
difference is only 13 percent so perhaps the California or-
ganization did not use its own values as basis for the claims
of superior vitamin C content. A recent report from the
laboratories of the Bureau of Home Econmics of the U. S.
Department of Agriculture contains data of interest. The
Washington investigators determined the cevitamic acid
content of the juice of fresh valencia and navel oranges
grown in California and of valencia and pineapple oranges
grown in Florida. The cevitamic acid in milligrams per
cubic centimeter of orange juice for each of these four va-
rieties was found to be respectively 0.40, 0.58, 0.45, and
0.51. There appears to be no justification therefore in this
unbiased report to a claim that the oranges grown in Cali-
fornia provide 22 percent more vitamin C than do Florida
oranges, because the variety of oranges, as well as the local-
ity in which it was grown, must be considered. It is the
opinion of the government investigators that the volume of
juice per orange is also a factor worthy of consideration.
The California navel orange yields less juice than do other
varieties of oranges of equal size. Of greater importance is
the application of the laboratory observations to problems
of nutrition. When the vitamin C content is translated into
International units (one Interational unit is equivalent to
0.05 mg. cevitamic acid) the point is brought out that fresh
orange juice contains approximately 1,000 units per cubic





THE THERAPY OF FLORIDA CITRUS FRUITS


centimeter. This volume is roughly 31', fluid ounces or
somewhat less than one-half cup of ordinary household
measure. The relatively slight difference in vitamin C con-
tent amounts to about a tablespoonful more or less of juice
added or subtracted from this volume. It is generally recog-
nized that the minimum amount of vitamin C required to
prevent scurvy in man is about 300 International units. A
desirable intake for an adult would be more than the esti-
mated minimum requirements, of course, and different
authorities have suggested values of from 500 to 1,000
units. It is apparent that all four varieties of the orange are
excellent sources of vitamin C. To direct attention to slight
differences in vitamin C content with the view of capitaliz-
ing them is both misleading and contrary to the interests of
the public. Such unfortunate publicity tends to defeat the
efforts of the nutritionists and physicians to educate the
public about the importance of the various fruits and other
foods that go to make up our diet. It does not reflect credit
on the large California Fruit Growers Exchange."

GRAPEFRUIT

Although in general the therapeutic properties of all citrus
fruits are similar there is enough difference in the chemical conm-
position of oranges and grapefruit to make it well worth taking
into consideration.
This difference is both in the caloric value and in the amount
of mineral elements, the vitamin content being about the same.
In the matter of mineral elements the orange contains some-
what higher percentages of all the more important ones except
phosphorus where the reverse is true. Yet for some reason a
great many physicians apparently prefer grapefruit in the treat-
ment of acidosis.
Just why this should be so is hard to say but, as mentioned
under "('hemical Composition," the bio-chemistry of citrus
fruits is still in its swadling clothes and further investigation




THE THERAPY OF FLORIDA CITRUS FRUITS


may develop a reason why grapefruit, with its lower percentage
of mineral elements, is apparently superior in combatting
acidosis. Possibly the lesser amount of carbohydrates in grape-
fruit plays a part.
A great many physicians likewise prefer grapefruit to oranges
in the treatment of colds, influenza and similar respiratory in-
fections.
During the influenza epidemic in 1918 hundreds of reports
were published regarding the value of grapefruit both in treat-
ing and in aborting this disease. Almost every one of these re-
ports emphasized the necessity of using the grapefruit juice
freely-the juice of from four to six and even eight grapefruit
was the usual recommendation. And most of the reports stated
that where it was thus freely used 24 to 48 hours was all that
was required to bring about the cure .
Considering these reports in the light of the more recent dis-
coveries as to the part played by vitamin C both in increasing
resistance to infections, and its value in the treatment of other
respiratory infections, such as pneumonia, plus the fact that
almost every case of cold and influenza shows evidence of aci-
dosis, it is fair to assume that the free use of grapefruit in these
conditions has a sound scientific basis.
Some physicians consider grapefruit the better in gastric dis-
turbances such as anorexia, train-sickness, and the neausea fol-
lowing excessive smoking. It is also a wonderful pick-up for
the morning after. KELLOGG also considers it superior to oranges
for anemia.
Some investigators are considering the possibility that vitamin
C plays some part in carbohydrate metabolism, and a few have
gone so far as to claim direct therapeutic merit for grapefruit
juice in diabetes, but the evidence so far produced is certainly
insufficient to support any such claims.
However in every case of diabetes, acidosis is a constant threat,
and to ward off this danger the free consumption of grapefruit
juice certainly appears logical.





THE THERAPY OF FLORIDA CITRUS FRUITS


A similar condition exists in obesity, especially if the patient
is on a diet to reduce. Every reducing diet is based on the prin-
ciple of ingesting less food than the system burns up-in other
words a partial starvation.
And whenever the system is compelled to draw on its reserve
for its daily needs, as it must in such case, acidosis is a certain
consequence.
So whenever there is a need for either vitamin C or for the
mineral elements, and yet it seems desirable to restrict the num-
ber of calories ingested, grapefruit should be prescribed in
place of oranges.
But don't expect half of a grapefruit for breakfast to supply
the system with all the vitamin C it needs; use grapefruit juice
and use plenty. Don't eat it-drink it.

TANGERINES

Tangerines are so seldom mentioned in connection with the
therapeutic value of citrus fruits that one might get the im-
pression that they are of little or no value.
This is far from being the case, however, as tangerines have all
the vitamin, mineral and caloric values of oranges.
The reasons why they are so seldom mentioned are many, but
none reflect on the merits of the fruit from either a therapeutic
or a dietetic standpoint.
To begin with tangerines are produced on a commercial scale
only in Florida, and the season is short-about five months.
Then, too, until recently tangerines have been so high in price
that they were always classed as a luxury fruit and beyond the
reach of the average person.
Both of these factors are serious handicaps to investigators
along nutritional lines, as most of the investigations are made in
charitable institutions and extend over a considerable period of
time.




THE THERAPY OF FLORIDA CITRUS FRUITS


However during the past few years production has increased
so that now tangerines can be purchased about as cheaply as
oranges.
Another reason why tangerines have not been more freely used
is the difficulty of extracting the juice. The peel is so brittle and
the pulp segments so loosely connected, that about the only way
to extract the juice is to peel, divide the segments, crush and
strain. This extra work is no item in the home where only a few
glasses would be required, but it is an important item in a large
institution. Of course very few people bother to extract the
juice of the tangerine, yet if a measured quantity is to be given
there is no other way to determine it.
But this very difficulty in extracting the juice makes the tan-
gerine the ideal fruit for eating out of hand. Tangerines are
frequently spoken of as kid glove oranges for this very reason, as
they can be peeled and eaten while wearing gloves and without
even soiling the gloves.
For this reason they are also the ideal fruit for lunches, espe-
cially for school lunches, for most children of school age need
some addition to their regular diet that will furnish an adequate
supply of vitamin C.
There is yet another reason why tangerines are not consumed
more freely. The idea has become more or less current that tan-
gerines tend to cause gastro-intestinal disturbances in children.
The only basis for any such belief is that tangerines are so delic-
ious that children will almost always overeat if not closely
watched. Tangerines in reasonable amounts will no more cause
up-sets than oranges, apples, or any other fruit, or for that mat-
ter, any other food.
Tangerines are all that the botanical name-citrus nobilis deli-
coisa-implies-a noble, delicious fruit, full of vitamins, min-
eral salts and calories.





THE THERAPY OF FLORIDA CITRUS FRUITS


APPENDIX

THE FOURTH DOWN

To the Editor of The Telegraph: (Macon, Ga.)
The chief concern of all industrial surgeons is not only to re-
store the victim of an accidental injury to his former position
but to prevent the occurrence of the accident to some fellow
workman. It is astonishing how many men were injured by
the absence of a button from a shirt sleeve before a general
order was issued forbidding men from running machines unless
their shirt sleeves were made without buttons.
The number of accidents is directly dependent upon the speed
of the machine. This applies especially to automobiles. Do you
remember what a commotion was caused by the first person
killed by an automobile? With a little encouragement the people
would have strung up the offender. Now we kill thirty thous-
and a year and no one pays any attention to it.
With the hope of reducing the number of fatalities among the
drivers themselves, we have been doing some research work, be-
cause we have been driving for 25 years and hope to continue.
Because of the strain on the optic nerve, sometimes an irresis-
tible desire for momentary unconsciousness seizes us, and if we
are driving at the lawful rate of speed, 55 miles per hour, and
an accident occurs, our friends will be invited to attend the
funeral next day.
How best to combat this desire for sleep while driving and
especially alone, is the question of the hour.
We have tried all the hard drinks and all the soft drinks, food
drinks, fool drinks, coffee, caffeine drinks, and medicinal stimu-
lants, and we found that stimulants are not indicated. It is
true that they arouse you temporarily, like the whip arouses
the horse, but the whip does not add any energy or endurance
to the horse; neither do stimulants add any benefit to the driver.
Both are followed by a reaction which means following a temp-
orary increase in motion there is a reduction of motion to a




THE THERAPY OF FLORIDA CITRUS FRUITS


slower pace than at the beginning and in addition, sometimes, a
physical injury which may be serious.
Of all the foods we tried in our test the lowly peanut, freshly
parched, gave the best results. After 20 years, we found by
accident, not by design, that a glass of fresh orange or grape-
fruit juice was the answer to our problem. We are publishing
the result of our work for the benefit of all the boys and especi-
ally for those over 76 years old. Life begins at 75.
To remove any doubt as to the value of our discovery, we call
your attention to the chemical analysis of orange juice and brain
and nerve tissue. The orange juice contains the six principal
elements found in brain and nerve tissue and in almost the
same proportions. The addition of a pinch of table salt will in-
crease the chloride contents of the juice to that of the tissue,
but that is not necessary.
Composition of brain and nerve tissues: Potassium 0.3 per-
cent; sodium 0.02 percent; chloride 0.1 percent; magnesium
0.02 percent; iron 0.006 percent; calcium 0.01 percent.
Composition of orange juice: Potassium 0.2 percent; sodium
0.012 percent; chloride 0.005 percent; magnesium 0.011 percent;
iron 0.004 percent; calcium 0.024 percent.
Chemical elements do not mean anything unless they are so
combined that they can be readily appropriated or assimilated.
So far as we can recall at this time orange juice is more easily
digested than any other food. Not only this, but in a meat-
eating country like ours, a great many people suffer from acid-
osis, or too much acid, the best remedy for which is orange
juice. Nor is this all, there are no after effects. No cirrhosis,
or hardening of the liver like you have after using alcoholic stim-
ulants; no cancer of the stomach like you have following the use
of coffee; no apoplexy or rupture of a blood vessel in the brain
like you have following the use of soft drinks containing caf-
feine.
Now permit us to make a suggestion to the filling-station boys,
our friends in time of trouble. Adopt a sign bearing the picture





62 THE THERAPY OF FLORIDA CITRUS FRUITS

of two oranges. Display the sign only when you have the fruit,
and we will Le seeing you; if we do not see the sign, we will
not stop. Yes, it is worth a dime.
Warm Springs.
NEAL KITCHENS,




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