X. EFFECTS OF DEFICIENCY 561 



These and other facts have led some observers to speculate that the 

 stomach may have a special relationship to the etiology of pellagra.^- 

 Sydenstricker and associates'^ treated six cases of pellagra with gastric 

 juice from normal individuals and obtained very favorable results. These 

 investigators proposed that there was an "intrinsic factor" produced in the 

 stomach of normal individuals but absent in pellagrins which was essential 

 in curing pellagra, as well as an "extrinsic factor" present in food which 

 was also required. Diaz-Rubio and Lorente'* treated thirty-six cases of 

 pellagra with gastric juice from normal individuals and failed to obtain 

 very dramatic results (nine of the thirty-six died). They did note an im- 

 provement in diarrhea in a few patients and a striking improvement in the 

 neurological symptoms of many patients. The medical literature has been 

 singularly free of any reference to an "intrinsic factor" in pellagra since the 

 discovery that nicotinic acid was the pellagra-preventive vitamin. 



6. Heart 



Nicotinic acid deficiency is not known to selectively damage the heart, 

 such as occurs frequently in beriberi. Pathological studies have showai no 

 gross and only minor microscopic lesions. There is no reason to believe 

 that the biochemical defects present in this deficiency affect the heart any 

 more or less than any other organ. Yet, several independent studies of 

 human pellagra have shown a very high incidence of abnormal electrocardio- 

 grams. These defects were mainly of the myocardial type rather than 

 conduction defects. Inverted Ti and/or Tn, Pardee-type S-T intervals, 

 notched or low-voltage ventricular complexes, and other defects were noted. 

 Most of these abnormalities disappeared promptly following therapy with 

 nicotinic acid.'^"'^ 



7. Brain 



Man is apparently unique among mammals in that no other species 

 develops such a striking and profound mental disturbance in nicotinic acid 

 deficiency as occurs frequently in man. Deficient animals customarily de- 

 velop apathy and other mild disturbances which might be referable to the 

 central nervous system. Pathological lesions have been observed in the 

 spinal cord of nicotinic acid-deficient dogs (p. 566). The hind limb paralysis 

 and acute collapse syndrome sometimes seen in dogs on Goldberger-type 



82 V. P. Sydenslrickor and .J. W. Thomas, Southern Med. J. 30, 14 (1937). 



"' V. P. Sydenstricker, E. S. Armstrong, C. J. Derrick, and P. S. Kemp, .4m. J. 



Med. Sci. 192, 1 (1036). 

 *^ M. Diaz-Ruhio and L. Lorcnte, Rev. clin. espan. 15, 72 (1944); Author's summary 



in Rev. asoc. vied, argentina 59, 1178 (1945). 

 95 H. Feil, Am. Heart J. 11, 173 (1936). 

 86 F. Mainzer and M. Krause, Brit. Heart J. 2, 85 (1940). 

 9' M. Rachmilewitz and K. Braun, Am. Heart J. 27, 203 (1944). 



