IX. EFFECTS OF DEFICIENCY IN HUMAN BEINGS 



369 



these circumstances, then ascorbic acid without any additional factors will 

 induce rapid blood regeneration. In the average case without megaloblas- 

 tosis the jaundice clears, reticulocytes slowly fall to normal, and the erythro- 

 cytes and hemoglobin begin to increase 5 to 8 days after ascorbic acid is 

 begun and reach normal values in about 3 weeks (see Fig. 15). In patients 

 with megaloblastic marrows, administration of ascorbic acid may provoke a 

 reticulocyte response similar to that seen in pernicious anemia when liver 



I I I — I — r—i — I I I I I I I I I I I I I I I — r— n — r-r 



J/29 30 31 6/1 2 3 4 5 6 7 a 9 10 II la 13 14 IS 16 17 IS 19 20 21 22 23 24 23 26 27 28 29 30 

 DAYS 



Fig. 15. Hematologic response to ascorbic acid in a patient with severe scurvy. 

 Prior to administration of vitamin C, the anemia was becoming more severe and the 

 reticulocytes were rising, even though the patient was not losing blood externally or 

 developing new ecchymoses. The response to vitamin C alone was rapid. 



extract, folic acid, or vitamin B12 are given (see Fig. 16). In general, the 

 marrow })ecomes normoblastic and hyperactive; and if megaloblasts were 

 present, they disappear. 



No other substance has been found which will induce such a dramatic 

 therapeutic response in the anemia. Refined liver extract, folic acid and 

 iron have no effect on the anemia, although bizarre metamyelocytes dis- 

 appear from the marrow after folic or folinic acids are given. Vitamin B12 

 has not had an adequate trial, but it is unlikely that it would have any 

 effect since refined liver extract failed. 



The morphologic evidence and therapeutic trials suggest that several 

 mechanisms besides those of blood loss and chronic debilitating illness are 



