EFFECT OF DEFICIENCY IN MAN 



the nicotinic acid, in order to obtain a complete cure. Cures invari- 

 ably result following administration of yeast or liver. 



Such cases are not examples of true pellagra but of a multiple 

 vitamin B deficiency due to the absence of several members of the 

 vitamin B complex, and several of the cases described in the literature 

 as pellagra are more properly regarded as of this type. According to 

 V. P. Sydenstricker,^^ the paraesthesias, neuritic pains, diminished 

 tendon reflexes, oedema and tachycardia, often seen in so-called 

 pellagra, are relieved by aneurine, whilst the anorexia, flatulence and 

 constipation sometimes disappear at the same time. On the other 

 hand, the psychic manifestations only disappear on administration 

 of nicotinic acid, which also controls the nausea and diarrhoea. At 

 the same time, the typical red tongue, due to distended capillaries, 

 becomes blanched, and the stomatitis and other lesions heal rapidly. 

 Certain of the patients who respond in this way, however, retain some 

 of the lesions, or acquire others, probably as the result of riboflavine 

 deficiency, for example, seborrhoeic dermatitis of the face (" shark 

 skin ") and fissures of the lip. In some patients, the tongue acquires 

 a purplish-red colour and becomes pebbly in appearance. W. H. 

 Sebrell and R. E. Butler ^^ reported similar symptoms in subjects fed 

 a ribofla vine-deficient diet (see page 174), thus confirming the associa- 

 tion of riboflavine and nicotinic acid deficiencies in " pseudo-pellagrous 

 conditions ". 



Symptoms of multiple vitamin deficiency were observed in pellagra 

 in infants by T. Gillman and J. Gillman.^^ In addition to dermatitis 

 and stomatitis, presumably due to nicotinic acid deficiency, greying 

 of hair with alopecia, steatorrhoea and large fatty livers were noted ; 

 these symptoms are generally regarded as indicating a deficiency of 

 pantothenic acid, ^-aminobenzoic acid or inositol. 



A different type of " pseudo-pellagrous condition ", which benefits 

 by administration of nicotinic acid, is " alcoholic pellagra ".^^ This 

 is the result of an excessive consumption of spirits, and is due to the 

 fact that the metabolism of alcohol and glucose involves the same 

 coenzyme system, so that the two sources of energy are in competition 

 with one another for the available nicotinic acid which is essential for 

 their oxidation. At the same time, the loss of nicotinic acid is not 

 made good, a high proportion of the calorie intake being derived from 

 the spirit, which, being a distillate, does not contain any of the vitamin 

 B complex, although fermented liquors contain considerable amounts 

 (see page 235). F. Mainzer and M. Krause ^^ described a case in which 

 a chronic whisky addict, suffering from delirium tremens associated 

 with severe gastro-intestinal manifestations and acute stomatitis, 

 responded dramatically twelve hours after oral administration of 

 nicotinic acid. 



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