VIII. REQUIREMENTS 261 



is advised when the mother cannot be trusted to give oral medication regu- 

 larly, or when rapid healing of rickets is indicated, as in thoracic rickets, 

 or in rickets complicated by pneumonia or whooping cough, when the per- 

 sistence of the ricketic state is itself a menace to the life of the child. It is 

 especially useful in tetany. For the single massive dose therapy 600,000 

 units may be given orally or by intramuscular injection. Post-mortem 

 studies have failed to reveal any detectable harm from such therapy. 



Although the primary indication for the use of vitamin D is the preven- 

 tion and treatment of rickets and infantile tetany, there is some evidence 

 that the use of this vitamin may also help in the normal development of the 

 teeth. 



In recent years vitamin D has been used extensively, usually in massive 

 doses, in the treatment of diseases having no obvious relationship to rickets, 

 tetany, or dental caries. Favorable results have been reported in intestinal, 

 bone, and h'mph-node tuberculosis,'- in arthritis,''' in acne vulgaris,''' in 

 hay fever,'° in asthma and urticaria,'^ in psoriasis,'^ in the prevention of 

 anterior poliomyelitis;'^ in the ti-eatment of toxemia of pregnancy,'^ and in 

 the amelioration of the bleeding tendency in obstructive jaundice.-" More 

 recently, Pascher has summarized the evidence in favor of vitamin D in 

 the treatment of lupus vulgaris.-' Sobel and his coworkers have studied the 

 role of vitamin D in experimental lead poisoning.^- It should be emphasized 

 that some of these therapeutic reports have by no means been substantiated, 

 and that most of the instances of vitamin D poisoning have arisen in the 

 course of such treatment. 



Table XIII simimarizes the forms in which vitamin D may be given, 

 and the daily doses required for prevention and treatment of rickets. 



12 B. L. Wyatt, R. A. Hicks, and H. E. Thompson, Ann. Internal Med. 10, 534 (1936). 



13 B. L. Wyatt, R. A. Hicks, and H. E. Thompson, Ann. Internal Med. 10, (1936); 

 I. Dreyer and C. I Reed, Arch. Phys. Therapy 16, 537 (1935); E. G. Vritak and 

 R. S. Lang, ./. A?n. Med. A.ssoc. 106, 1162 (1936). 



" C. A. Simpson, F. A. Ellis, and H. Kirby-Smith, Arch. Dermatol, and Syphilol. 



41, 835 (1940); M. B. Sulzberger, Year Book of Dermatology and Syphilology, 



p. 14. Year Book Publishers, Chicago, 1949; F. C. Combes, Med. Times, Chicago 



77, 473 (1949). 

 •5 B. Z. Rappaport and C. I. Reed, J. Am. Med. Assoc. 101, 105 (1933). 

 16 B. Z. Rappaport, C. I. Reed, M. L. Hathaway, and H. C. Struck, J. Allergy 5, 



541 (19.34). 

 1' L. Olivetti and E. Ratto, Giorn ital. dermatol. e sifilol. 90, 187 (1949); H. Schmitz, 



Praxis 36, 307 (1947); J. Krafka, Jr., J. Lab. Clin. Med. 21, 1147 (1936); E. T. 



Cechir and L. Zon, Pnbl. Health Repts. {U. S.) 52, 1580 (1937). 



18 J. A. Toomey, Am. J. Diseases Children 53, 1202 (1937). 



19 G. W. Theobold, Lancet I, 1397 (1937). 

 2" L. B. Johnston, J. Med. 18, 235 (1937). 



21 F. Pascher, M. G. Silverberg, I. E. Marks, and J. Markol, J. Invest. Dermatol. 13, 

 89 (1949). 



22 A. E. Sobel, H. Yuska, D. D. Peters, and B. Kramer, /. Biol. Chem. 132, 239 (1940). 



