EFFECT OF DEFICIENCY IN MAN 



mouth and throat, known as " trench mouth " among the troops 

 during the war of 1914-18. Large numbers of fusiform bacilli and 

 spirochetes invade the tonsils in this condition, and similar organisms 

 have been reported in patients suffering from pellagrous stomatitis 

 and glossitis, in the mouths of dogs with blacktongue, and in pellagrous 

 pigs and monkeys. King concluded that a pre-pellagrous condition, 

 due to nicotinic acid deficiency, was one of the predisposing factors in 

 Vincent's angina. 



V. P. Sydenstricker and R. M. Cleckley *° used nicotinic acid for 

 the treatment of psychiatric disorders unconnected with pellagra. 

 Twenty-nine patients with no sign of pellagra were treated, and the 

 psychic manifestations, which included maniac excitement, delusions, 

 hallucinations, disorientation and delirium tremens, disappeared 

 promptly, often dramatically. In other cases treated, the underlying 

 cause may have been a vitamin deficiency. 



F. J. Neuwahl,*^ following a similar line of reasoning, tried nico- 

 tinic acid in angina pectoris, where the mental symptoms are similar 

 to those in pellagrous psychosis. Administration of the drug by 

 mouth produced a decrease in the number and severity of attacks in 

 some cases, but in others the effect was transient. Better results 

 were obtained by drip infusion of a nicotinic acid solution. The 

 mechanism of this effect is still obscure but may be connected with 

 the vasodilator action of nicotinic acid (see page 274). 



The paroxysms in sixteen out of nineteen asthmatical subjects 

 were relieved when nicotinic acid was injected intravenously, and the 

 frequency and severity of the attacks were reduced in sixteen out of 

 thirty patients by oral doses taken between attacks. ^^ This effect is 

 also probably associated with the vasodilator action of nicotinic acid. 

 Again, over a hundred patients with idiopathic Meniere s3mdrome 

 showed improvement on treatment with nicotinic acid,*^ though 

 nicotinamide had no effect. In such cases nicotinic acid owes its 

 value to its vasodilator properties. 



Nicotinic acid has been stated ** to benefit intestinal irregularities 

 in patients, a claim 'that is consistent with the existence of excessive 

 gut movement in dogs maintained on a blacktongue-producing diet. 



Nicotinic acid has been used with success in so-called radiation 

 sickness, the vomiting produced by X-ray therapy.*^ 



Several cases of lupus erythematosus were reported *® to have 

 responded rapidly to oral or parenteral administration of nicotin- 

 amide. 



References to Section 8 



I. J. Goldberger, G. A. Wheeler and V. P. Sydenstricker, /. Amer. 

 Med. Assoc, 1918, 71, 1944- 

 247 



