HYPOVITAMINOSIS A (aVITAMINOSIS a) 603 



the renal pelvis was recorded by Leber. '"'^^ Wilson and DuBois'''^^ called 

 attention to the widespread keratinizing metaplasia of the epithelia of the 

 I'cspiratory tract and of various ducts in the case of a five-months-old in- 

 fant who had succumbed to keratomalacia. IVIore recent reports of meta- 

 plasia in cases of vitamin A deficiency include those of Thatcher and 

 Sure,'"™ (one case), Blackfan and AVolbach'"*^ (tweh^e cases) and Sweet and 

 K'ang'"^^ (seventeen cases). The keratinization of epithelia on the inter- 

 nal surfaces of the body is a relatively late manifestation of a\dtaminosis 

 A. In addition to the epithelia of the respiratory tract, those of the gastro- 

 intestinal tract, and of the genitourinary tract, are involved. 



(d) Cutaneous Lesions. The skin and its appendages are the first to ex- 

 hibit the effect of avitaminosis A by an unthrifty appearance. The first 

 definite association of the skin condition with keratomalacia was that of 

 Pillat,^"^^ who studied it in six patients. Their hair was described as dull, 

 dry, coarse, or brittle, while the skin over the entire body (except the face) 

 was generally desiccated, finely wrinkled, covered with fine scales, and 

 earthy broA\Ti to slate gray in color. The presence of a folUcular type of 

 skin lesion in soldiers with ocular difficulties was recorded by Frazier and 

 Hu;^°^^ they referred to this t3T)e of lesion as "follicular hyperkeratosis." 

 Cutaneous lesions of this nature were observed in the case of 180 patients 

 with xerophthalmia and twenty-seven without this condition. Follicular 

 h3TDerkeratosis has also been found in association with night blindness. '°*^ 

 Confirmation that avitaminosis A is the cause of follicular hyperkeratosis 

 was presented by NichoUs, ^"^^ who studied laborers and convicts in Ceylon, 

 and by Loewenthal,^**^^'"*^ who observed prisoners in Uganda, East Africa. 

 It was given the name "phrynoderma" by Nicholls, but is more commonly 

 known as follicular hyperkeratosis. A number of investigators ^"^^"^"^^ 

 confirmed the fact that a\dtaminosis A causes cutaneous lesions which re- 



i»7« T. Leber, Albrecht von Graefe's Arch. Ophthalmol, 29, Part III, 225-290 (1883). 

 10" J. R. Wilson and R. O. DuBois, Am. J. Diseases Children, 26, 431-446 (1923). 



1080 H. S. Thatcher and B. Sure, Arch. Pathol, IS, 756-765 (1932). 



1081 A. Pillat, Arch. Ovhthalmol. (Chicago), 2, 256-287, 399-415 (1929). 



1082 F. Reiss, Chinese Med. J., 60, 945-948 (1936). 



1083 L. Nicholls, Indian Med. Gaz., 68, 681-687 (1933). 



•084 L. J. A. Loewenthal, E. African Med. J., 10, 58-59 (1933). 



1085 L. J. A. Loewenthal, Arch. Dermatol and Syphilol, 28, 700-708 (1933). 



1086 W. E. Giblin, Med. J. Australia, 1936, 1, 202-203. 



1087 M. V. Radhakrishna Rao, Indian J. Med. Research, 24, 727-736; 25, 39-44 (1937). 



1088 p. Fasal, Arch. Dermatol and Syphilol, 50, 160-166 (1944). 



1089 L. F. Steffens, H. L. Bari, and C. Sheard, Am. J. Ophthalmol, 23, 1325-1340 

 (1940). 



1090 J. B. Youmans and M. B. Corlette, Am. J. Med. Set., 195, 644-650 (1938). 



1091 B. M. Nicol, Brit. J. Nutrition, 3, 25-43 (1949). 



