B VITAMIN DEFICIENCY STATES 411 



vcstigations of mental disease from the nutritional and metabolic stand- 

 points, and to remove the laissez faire policy now applying to the natural 

 sciences in the study of the mental processes. 



A variety of nervous symptoms also occur in pellagra, but it is uncer- 

 tain to what extent these arc due to an accompanying thiamine defi- 

 ciency. 93 - 94 While there are apparently no marked cardiovascular changes 

 in pellagra, a macrocytic hyperchromic anemia is frequent. 05 Atypical 

 forms of pellagra are frequently encountered as a result of compound 

 deficiencies. In addition, most workers feel that subclinical pellagra is 

 common in the United States, and to some considerable degree even in 

 the North. Finally, recent years have brought forth an increasing number 

 of reports of cases of nervous and mental disease that have responded 

 markedly to niacin therapy. To a lesser extent there have been obtained 

 similar remissions of other of the characteristic symptoms of pellagra 

 that occasionally appear singly in individuals not exhibiting the general 

 pattern of the avitaminosis. 



Post-mortem examination of pellagrins shows little to indicate the 

 cause of the disease other than the skin lesions. There is seldom any 

 change in the stomach, but the colon is thickened, red and typically 

 stippled with cystic lesions. Nervous lesions are common, but generally 

 believed to be due to deficiencies of other factors. The heart appears quite 

 normal, but the liver, while normal in size, is yellowish gray and mottled, 

 and characterized by fatty degeneration and fibrosis. From the overall 

 standpoint, it is apparent that the marked differences between the symp- 

 tomatology of niacin deficiency and that of thiamine and riboflavin defi- 

 ciency do not in any way reflect obvious relationships of these vitamins 

 to their coenzyme functions. Indeed, the mental symptoms associated 

 with pellagra might far more logically result from beriberi, since 

 thiamine occupies a special place in nerve function (p. 384) ; and since 

 niacin and riboflavin function metabolically in an intricate fashion, it is 

 strange indeed that there is not a greater similarity between the symptoms 

 of their deficiencies. 



Until recent years, the mortality from pellagra varied, but was gener- 

 ally above 66 per cent of the cases. Recently, however, due to improved 

 dietotherapy and hospital methods, and the specific use of niacin, this 

 has dropped to below 5 per cent. Niacin, in doses of from 50 to 1,000 mg 

 daily when administered orally (or intravenously in acute cases) , gener- 

 ally achieves a rapid remission of the symptoms of niacin deficiency, the 

 redness of the tongue disappearing in a day and the lingual ulcers in 

 several days, nausea and vomiting ceasing immediately, the mental 

 symptoms vanishing within a week, and the dermatitis regardless of its 

 severity eventually disappearing completely. 



