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19. STARR, P. et al, Arch. Int. Med. 34: 354, 1924.20. VAN DYKE, H. B., J. Biol. Chem. 54: 11, 1922.21. WEBSTER, B., Bull. Johns. Hfopk. IHosp. 45: 215,

1929.22. KOCHER, A., Verhandl. deutsch. Gesellsch. f. Chir.

39: 45, 1910; also, Arch. f. klin. Chir. 92: 442,1910.

23. CATTELL, R. B., Boston M. S. J. 192: 989, 1925.24. MARINE, D., J. Am. M. Ass. 59: 325, 1912.25. REINHOFF, W. F., Bull. Johns Hopk. Hosp. 37:

285, 1925.26. JANSEN, W. H., UND ROBERT, F., Deutsches Archiv.

f. klin. Med. 157: 224, 1927.

A NEW WHOLE WHEAT IRRADIATED BISCUIT, CONTAINING VITAMINSAND MINERAL ELEMENTS*

By FREDERICK F. TISDALL, M.D., T. G. H. DRAKE., M.B.,

PEARL SUMMERFELDT, M.B., AND ALAN BROWN, MI.B.,

Toronto

IN planning a diet it is necessary to have a.

knowledge not only of caloric requirementsand the relative amounts of fats, carbohydrates,and proteins needed but it is also necessary to

have a kniowledge of the importance of vitaminisand mineral elements in metabolism. Beforediscussing a food product in biscuit form whiclhwe have devised we will briefly consider theimportance of the vitamins and mineralelements. Deficiencies in these substances are

the faults most frequently encountered in our

modern diets.At the present time six separate and distinct

vitamins are recognized, and without doubtmore will be discovered in the future. Thechemical composition of all is as yet unknown.A lack of vitamin A results in deficient growthand the development of xerophthalmia. In ad-dition, this particular deficiency produces a

definite alteration in the morphology and func-tion of many of the mucous membranes.Vitamin B has been recently divided into twoseparate and distinct vitamins; B,, a lack of

which causes peripheral neuritis and poor

growth; and B2 which is necessary for the pre-

vention of pellagra and certain skin conditions.Vitamin B2 is also necessary for normal growth.Vitamin C prevents scurvy. The antirachitic, or

sunshine, vitamin D is necessary for the growthand repair of bone and other tissues. VitaminE is essential for reproduction, and possibly cer-

tain other body changes at the age of puberty.

* From the Research Laboratories of the Hospitalfor Sick Children and the Sub-Department of Pwediatrics,University of Toronto, under the direction of AlanBrown, M.B. Presented at the Academy of Medicine,Toronto, January 14, 1930.

In addition to producing such definite clinicalentities as rickets, tetany, scurvy, and the beforementioned conditions, an inadequate supply ofvitamins results in a lowered resistance toinfection.", 2, 3 4 -We realize that there are manyother food factors which influence the resistanceof the body cells against disease, such as proteinsand mineral elements, but it is evident that a

lack of vitamins over a long period may play animportant role in the development of many ofthe chronic infective conditions encountered inchildren and adults.In regard to degenerative changes it had long

been thought that an excess of proteins tends to

produce degeneration of the heart, kidneys, andother organs. This idea is now gradually beingabandoned, as carefully controlled observationshave furnished no, evidence in its favour. How-ever degenerative changes do occur in animalsfed diets deficient in vitamins, and these changesare sufficient to warrant the belief that anadequate supply of vitamins may be an impor-tant factor in the prevention of degenerativechanges in human beings. Recent clinical ob-servations lend weight to this belief. Fletcherand Graham5 have demonstrated the remarkableeffect of wheat germ with its high vitamin con-tent in the treatment of chronic arthritis.Boyd, Drain and Nelson" have shown the strik-ing results of the administration of a combina-tion of vitamins in the prevention of dentalcaries and other mouth conditions. Langstroth7in a very general paper has advanced someevidence that a lack of vitamins may be asso-eiated with arthritis, hypertension, and otherdegenerative diseases. The importance of focal

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infections, however, in the production of de-generative diseases is well known, but, as animatexperiments indicate that an inadequate supplyof vitamins may be an important factor in thedevelopment of these foci of infection, we mayconclude that many degenerative diseases mayhave their origin, either directly or indirectly,in an inadequate supply of vitamins.

It should be remembered that the requirementsfor vitamins and mineral elements vary greatly,larger amounts being necessary during child-hood, and during pregnancy and lactation.The importance of an adequate supply of the

mineral elements, calcium and phosphorus, isuniversally recognized, particularly for thegrowth and repair of bone and teeth. Phos-phorus is fairly widely distributed, being presentin large quantities in meat, eggs, whole grains,milk, and some vegetables. The supply ofcalcium, however, is more limited, our chiefsources being milk and leafy vegetables. Mc-Collum and Simmonds,8 Sherman anid Hawley,9and others have shown that the average diettends to be poor in calcium unless one to twopints of milk are included daily. Although it isobvious that growing children and pregnant or

lactating women require large amounts of cal-cium, it is not so widely recognized that theaverage adult diet is low in this element unlesscare is taken to supply it.

Iron is an essential element of the haemoglobinof the blood and of the chromatin substanceswithin the body cells. Egg yolk has the highestiron content of any food. It is also present inappreciable amounts in liver, lean beef, manyfruits and vegetables, and whole grain products.Unfortunately, white flour and finely milledcereals contain very little of this element, as thegreater part of the iron is in the discarded germand bran. AMilk contains very little iron.Sherman10 found that "the typical Americandietary does not contain any such surplus ofiron as would justify the practice of leaving thesupply of this element to chance." It is there-fore essential in planning a diet, particularlyduring inifancy and pregnancy, to see that anadequate supply of ironi is included.As recently as one or two years ago it was

thought that nine inorganic elements were allthat were necessary for life. It can n0ow be saidthat many others are required. Onie of the mostimportant of these is copper, minute amounts of

which are necessary for the formation of hemo-globin.

It is obvious that the correct method of plan-ning a diet is first to incorporate in it theessential articles of food, and then to add thenon-essenitial foods in order to cover the remain-ing caloric requirements. The chief essentialfoods are milk, meat, eggs, vegetables and fruit.In addition to fats and carbohydrates, thesefoods supply proteins, vitamins, mineral ele-ments, and roughage. With the knowledge thatthe average diet, such as white flour, finely milledcereals, sugars, etc., contains an excess of thenon-protective or vitamin- and mineral-lackingfoods, and realizing the necessity of an adequatesupply of these elements we have devised a foodproduct in biscuit form which contains thesenecessary substances in appreciable quantities.Where tfhe ordinary biscuit, zwiebach, rusk, toastor bread are all low in proteins, lacking invitamins, and deficient in caleium, iron, andother salts, this biscuit contains in appreciablequantities most of the food elements necessaryfor the growth and repair of body cells and themaintenance of resistance against disease. Thebiseuit has as its basis whole wheat flour, ir-

radiated wheat germ, milk, bone meal and iron.The whole wheat is in the form of a finelyground flour. The milk is added as a milkpowder.

In regard to wheat germ, which constitutes15 per cent of the biscuit, it is well to mentionhere the place it occupies in the structure of a

grain of wheat. Due to the present day desirefor only finely milled products the germ isordinarily discarded an-d not used for humanconsumption. The whole grain consists of threewell definlAd structures, the bran, the enido-sperm, and the germ. The bran wNhich consti-tutes about 13.5 per cent of the w%Nheat acts as

a protective layer for the rest of the grain.It is comparatively rich in proteins, phosphatesand vitamins. The endosperm which furnishesfood for the germ during growth anid makesup about 85 per cent of the grain is the portionwhich is utilized in the manufacture of wvhiteflour and finely milled cereals. It is very poorin mineral elemcnts and is devoid of vitamins.The germ eonstitutes only about 1.5 per centof the grain and is the living part of the seedwhich grows and develops into the new plant.The germ contains about 8 per cent fat and 30

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per cent protein. Its mineral content is aboutdouble that of the whole wheat flour and tentimes that of white flour. It contains in appre-

ciable quantities vitamins A, B1, and B2, and isthe most concentrated source known of the re-

productive vitamin E.Before the wheat germ is used in the biscuit

it is exposed to the rays from a mercury quartzlamp. As discovered by Steenbock,'1 these rays

activate the ergosterol normally present in thegerm and thus produce the antirachitic, or sun-

iron per 100 grams of biscuit as compared toabout double this amount in egg yolk, our mostconcentrated source of iron in food. The ironis largely obtained from the wheat germ andwhole wheat. Examination of the biscuit showsthe presence of copper in the concentration ofabout 1 mg. per 100 grams of biscuit.

In studying the vitamin D content of thebiscuit it was found that a considerable amountof the vitamin D present in the irradiated germ

before cooking was destroyed when the biscuit

FIG. 1. - Roentgenogram of ratfed on a rachitogenic diet +25 percent non-irradiated biscuit. Bloodphosphorus 1.1 mgm. per 100 c.c.,and bone ash 37.2 per cent.

FIG. 2.-Roentgenogram of rat fedon a rachitogenic diet +25 per centirradiated biscuit cooked at 4250 F.Blood phosphorus 2.4 mgm. per 100c.c. and bone ash 37.8 per cent.

FIG. 3.-Roentgenogram of rat fedon a rachitogenic diet +25 per centirradiated biscuit cooked at 3000 F.Blood phosphorus 3.0 mgm. per 100c.e. and bone ash 48.7 per cent.

shine, vitamin D. The whole wheat flour andgerm used in our product thus contains all theknown vitamins with the exception of the anti-scorbutic vitamin C found in fresh orange juice.The vitamin content is further increased by theuse of some butter and yeast. Butter suppliesvitamin A in large quantities and yeast is a

highly concentrated source of both vitamin B1and B2. The yeast is not used as a leaveningreagent but as a source of vitamins.The bone meal is obtained by cooking bones

in an autoclave at 2670 F. for five hours. Thisremoves all the fat. The bones are then groundand dried in an oven at 2200 F. for twelvehours. The final product is an odourless andtasteless white powder. We are using this pro-duct in preference to the chemical substancecalcium phosphate as there are traces of othermineral elements in the bone meal which may

be of importance in the mineral metabolism ofthe body. The bone meal constitutes about 3per cent of the biscuit. 2'his means that five tosix biscuits have the calcium content of one

pint of milk. The iron content is about 5 mgs.

TABLE I

THE ANTIRACHITIC EFFECT OF IRRADIATION OF FOODAND SUBSEQUENT COOKING AT DIFFERENT

TEMPERATURES

Mgm. P. per Percentage100 c.c. of of ash in,

blood bones

Rat on normal diet; age 8 weeks.. 6.3 57.0Rat on Steenbock 's rachitogenic

diet ....................... 1.0 32.5Rat on rachitogenic diet + 25 per

cent of non-irradiated biscuit* 1.1 39.0Rat on rachitogenic diet + 25 per

cent of irradiated biscuitcooked at 4250 F.* ........ 2.4 37.8

Rat on rachitogenic diet + 25 percent of irradiated biscuitcooked at 3000 F.*.3.0 48.7

Rat on rachitogenic diet + 25 percent of irradiated whole wheatand germ in proportions usedin the biscuit, uncooked* 3.0 46.5

Maximum antirachitic effect poss-ible with rats on rachitogenicdiet with the use of ordinarytherapeutic measures ....... 4.5 54.0

(about) (about)

* 76 per cent of the rachitogenic diet consists ofyellow corn. The material to be tested was substitutedfor an equivalent amount of corn.

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TISDALL AND CO-WORKERS: IRRADIATED BISCUIT

was baked at 4250 F. the temperature ordinarilyused in baking biscuits. It is quite possible thatif the amount of vitamin D produced by irradi-ation is markedly increased sufficient amountsfor practical purposes may escape destruction atthis temperature. After experimenting with dif-ferent temperatures it was found that very littleof the vitamin D was destroyed when the tem-

FIG. 4.-Pigeon fed on a diet deficient in vitaminsB1 and B2. After 4 weeks it developed polynieuiitis, orberiberi, and died.

perature of baking did not exceed 3000 F. Thisis shown by the results in Table I and Figs. 1,2 and 3. We estimate that the vitamin D contentof ten to twelve biscuits is equal to that of oneteaspoonful of standard cod liver oil.

Fig. 4 is that of a pigeon fed on a diet de-ficient in vitamin B1 and B2. After 4 wvTeeks itdeveloped polyneuritis, or beriberi, and died.Fig. 5 is that of another pigeon fed oni the samediet, but in addition' it received 15 per cent ofwheat germ cooked at 3000 F. for 20 minutes.After eight weelks on this diet it was apparentlyniormal. Fig. 6 is that of two rats, the smallerone being fed for 4 weeks on a diet deficient invitamin B1 and B2, and the larger rat was fedon the same diet, but in addition received15 per cent of the cooked wheat germ. Thisdemonstrates that the heat condition underwhich the biscuits are cooked does not entirelydestroy vitamin B1 and B2.

It is the custom in the manufacture ofbiscuits to add certain alkaline salts as leaven-ing agents. This produces an alkaline reactionwhich readily destroys vitamin B1 and B2during cooking. To overcome this we have pro-duced a biscuit with a reaction just on the acid

side of nieutrality through the addition of asmall amount of cream of tartar. Further ob-servations are underway to determine the exactconcentration of each vitamin in the biscuit.We would like to emphasize that no attempt

should be made to supply all the vitamin re-quirements with this biscuit. Cod liver oilshould still be administered to infants anldchildren, to supply vitamins A and D. The dietshould still be conistructed around the esselntialarticles of food, namely, milk, eggs, meat,

FIG. 5-Pigeon fed on a diet deficient in vitaminsB, and B2 with 15 per cent of wheat germ added. Thewleat germ was cooked at 300° F. for 20 minutes. Aftereiglht weeks on this diet the bird was apparently normaL

FIG. 6.-Two rats fed on a diet deficient in vitaminsB1 and B2. The larger rat received in addition 15 percent wheat germ cooked at 3000 F. for 20 minutes.

vegetables and fruit. But when the biscuit isused in place of the ordinary biscuit, rusk,zwviebach, toast or bread, in addition to simplysupplying calories, a food will be given whichwill assist in the repair and growth of bodycells and the maintenance of resistance againstdisease.With the realization that our work is only

partly completed unless this biscuit is manu-factured under the conditions outlined amidmade available to the public, we have arrangedwith the McCormick Manufacturing Companiyto produce this biscuit under our supervision.

.j

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THE CANADIAN MEDICAL ASSoCIATION JOURNAL

It will shortly be available under the tradename of McCormick's Sun Wheat Biscuit.*

SUMMARY

A biscuit has been devised containing wholewheat, wheat germ, milk, butter, yeast, bonemeal, iron and copper.The wheat germ contains a large amount of

vitamin E and appreciable, amounts of vitaminA, B1 and B2. In addition it has been exposedto the rays of a mercury quartz lamp whichactivates the ergosterol present and thus pro-duces the antirachitic vitamin D. Vitamin Ais present in large amounts in the butter, andyeast is a concentrated source of vitamins B1and B2.The biscuit is baked under conditions which

conserve the vitamin content.Bone meal is added to supply calcium and

phosphorus. Five to six biscuits contain thesame amount of calcium as one pint of milk,the most important food source of this element.

* The patents for the manufacture of this biscuitare held by the Research Laboratories, and all royaltiesaccruing will be devoted to medical research.

The iron content is approximately one-half theconcentration found in egg yolk, our highestsource of iron in food. A trace of copper isalso present.The biscuit should be regarded as belonging

to the essential or protective class of foods,and may be used to replace the ordinary biscuit,rusk, zwiebach, toast, or bread which are non-protective foods.

REFERENCES1. GREN, H. N., AND MELLANBY, E., Brit. M. J. 2:

691, Oct. 20, 1928.2. COWGILL, G. R., STUCKY, C. J., AND ROSE, W. B.,

Arch. Path. 7: 197, 1929.3. FINDLAY, G. M., J. Path. 4- Bact. 1: 26, 1923.4. ROBERTSON, E. C., Am. J. Hyg. 9: 75, 1929.5. FLETCHER, A. A., AND GRAHAM, D., Am. J. Med.

Sctence 179: 91, 1930.6. BoYD, J. D., DRAIN, C. L., AND NELSON, M. V., Am.

J. Dis. Child. 38: 721, 1929.7. LANGSTROTH, L., J. Am. M. Ass. 93: 1607, 1929.8. MCCOLLUM, E. V., AND SIMMONDS, N., The Newer

Knowledge of Nutrition, New York; MacmillanCompany. Third Edition, 1927.

9. SHERMAN, H. C., AND HAWLEY, E., J. Biol. Chem.53: 375, 1922.

10. SHERMAN, H. C., Chemistry of Food and Nutrition,New York, Macmillan Company, Third Edition,p. 342, 1928.

11. STEENBOCK, H., BLACK, A., J. Biol. Chzem. 61: 405,1924.

SURGICAL MEASURES IN THE TREATMENT OFPULMONARY TUBERCULOSIS*

BY C. D. PARFITT, M.D.,

Gravenhurst, Ont.

THEg treatment of pulmonary tuberculosis byartificial pneumothorax was barely estab-

lished on this continent when the surgeon enteredthe field to help make good its failures. To Dr.E. W. Archibald, as a pioneer in introducingthoracoplastic methods to America, and to Dr.John Alexander, for his illuminating survey ofa vast literature, thereby hastening their adop-tion, a great debt of gratitude is owing fromboth physicians and patients. I had the goodfortune to have Dr. Archibald accessible, al-though at long range, and I am grateful to himfor the successful results obtained in the earlierdays when patients were persuaded with somedifficulty to undergo what seemed an appalling

* Read at the forty-fourth annual meeting of theAssociation of American Physicians, at Atlantic City,May 7, 1929.

operation, uncertain in outcome. I am also in-debted to Dr. N. S. Shenstone for undertakingmore recently some very unpromising materialwith the hope of palliation, and for doing theseries of phrenicotomies.

Something may be gained by the analysis ofthis small amount of material in regard to theindications for the operations and to the factorsof resistance, and by a re-appraisal of the pointsupon which selection was based.During the twelve years since 1916, compres-

sion of the lung by artificial pneumothorax hasbeen attempted in 141 patients, that is in 22 percent of all tuberculous patients under treatment,or .in 28 per cent of the moderately- and far-advanced cases.

Satisfactory compression was impossible in, 63patients (45 per cent of the cases attempted),

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