EFFECT OF DEFICIENCY IN MAN 



tendency to confabulation ; depression and mild delusional states 

 may also develop. Similar symptoms were observed by Williams et 

 al}^ in artificially induced aneurine deficiency, but the psychic mani- 

 festations in pellagra cannot be cured by administration of aneurine. 

 After several relapses the mild p^ychoses are replaced by marked 

 disorientation, hysterical and confusional episodes and sometimes by 

 maniacal states. Advanced cases fail to respond to nicotinic acid, 

 presumably because the cerebral neurones are actually destroyed, 

 whereas earlier cases respond dramatically to nicotinic acid or nicotin- 

 amide. 



These psychic disturbances are followed, after a variable interval 

 of time, by characteristic dermatitis, stomatitis (desquamation of the 

 tongue) and glossitis, with ulceration of the angles of the mouth, a 

 condition now known as cheilosis, and probably due to riboflavine 

 deficiency (see page 174). P. Manson-Bahr and O. N. Ransford^® 

 believe that the skin lesions of pellagra do not develop in temperate 

 climates, but that the condition then manifests itself as stomatitis 

 and chronic diarrhoea ; they describe a case of this type that was 

 rapidly cured by nicotinic acid. I. Katzenellenbogen,^^ in Palestine, 

 also described the successful treatment with nicotinic acid of cases of 

 stomato-glossitis, in which there were no signs of pellagra except 

 soreness of the tongue, of the angles of the mouth, and of the throat. 

 J. V. Landor,^^ on the other hand, described cases in the hospital at 

 Singapore similar to pellagra in certain respects but different in others. 

 Eczema of the scrotum andstomatitis were the most constant symptoms 

 noted, and the disease was not curable by nicotinic acid, although the 

 symptoms cleared up on the administration of yeast or " marmite " ; 

 this condition was, therefore, caused by a deficiency of other factors. 

 Aykroyd et alP described twenty-four cases of stomatitis occurring 

 among a rice-eating population in India. These were treated with 

 nicotinic acid and only nine showed rapid improvement, whilst seven 

 showed some improvement and eight none. The authors concluded 

 that the stomatitis in question was not true pellagra but arose from a 

 multiple vitamin deficiency. 



Pellagra assumed epidemic proportions in the war of 1939-45 

 among American prisoners of war in the Philippines after six months 

 on a diet made up largely of carbohydrates and deficient in animal 

 proteins, fresh fruit, vegetables and calories. ^^ The condition was 

 remedied by a crude yeast culture, and with less satisfactory results, 

 by pure vitamin preparations. As might be expected, the symptoms 

 were due to a multiple vitamin deficiency rather than to a deficiency 

 of any one vitamin. 



Nicotinic acid and nicotinamide generally have a beneficial effect 

 in pellagra and " pseudo-pellagrous conditions ", and are specific in 



243 



