X. EFFECTS OF DEFICIENCY 553 



deficiency, as well as a vitamin deficiency, was involved in the etiology of 

 pellagra. He singled out cystine and tryptophan as the probable culprits 

 and with W. F. Tanner conducted therapeutic trials in three patients. ^^ 

 The results were cautiously evaluated as a marked improvement in the 

 dermal lesions of two patients given cystine and a steady gain in weight 

 with some improvement in diarrhea when both cystine and tryptophan 

 were administered to the third patient. Apparently, tests with tryptophan 

 alone were conducted but they were never reported. The author of this 

 review is in possession of a copy of a progress report to Goldberger from 

 Tanner, dated August 5, 1921, which has never been publicly reported. In 

 it, Tanner relates the course of one pellagrous patient who was given "one- 

 half dram" of tryptophan before each meal. There was no improvement in 

 the diarrhea at the time of the report, but prompt and marked improvement 

 in the patient's extensive dermatitis was noted. After describing the progress 

 of the skin lesions. Tanner stated: 'T might add that the improvement in 

 this patient's skin condition has surpassed anything I have ever seen in a 

 case of pellagra in an equal period of time." There is no record of the final 

 result. 



The second instance of the production of pellagra in man by dietary 

 means was recently described by Goldsmith et al}^ These experiments are 

 of special interest, since the importance of tryptophan was realized and 

 both the tryptophan and nicotinic acid intakes were controlled. These 

 workers also provided supplementary vitamins such as riboflavin and folic 

 acid. It has long been a debatable issue as to the extent to which the 

 pellagra syndrome, as commonly seen clinically, may be modified by con- 

 comitant deficiencies of other vitamins. It is, therefore, of interest that 

 essentially typical pellagrous lesions appeared in spite of added vitamins 

 (not including nicotinic acid). These workers were also able to cure pellagra 

 with tryptophan, a clear demonstration of the ability of this amino acid 

 to cure pellagra in man.^^'' Other interesting aspects of these investigations 

 are discussed in later sections. 



Dogs also develop a very characteristic reaction to nicotinic acid defi- 

 ciency, the so-called blacktongue. The severe oral lesions, drooling of 

 saliva, the very foul and characteristic oral odor, diarrhea, often bloody, 

 the emaciated appearance, and the complete lack of appetite for food and 

 water form a typical picture. This syndrome is described in detail in Sec- 

 tion XI. 



18 J. Goldberger and W. F. Tanner, Public Health Repts. (U. S.) 37, 462 (1922). 



19 G. A. Goldsmith, H. P. Sarett, U. D. Register, and J. Gibbens, J. Clin. Invest. 31, 

 533 (1952). 



IS'' W. B. Bean, M. Franklin, and K. Daum, .J. Lab. Clin. Med. 38, 167 (1951), also 

 reported that tryptophan produced rai)id improvement in the tongue of two 

 patients with pellagrous glossitis. 



