IX. EFFECTS OF DEFICIENCY 675 



have been one of the factors responsible for some of the eye lesions, possibly 

 those invohing the cornea. 



(2) Burning Feet Syndrome. Probably the findings in humans most sug- 

 gestive of pantothenic acid deficiency are those related to the syndrome 

 known as "burning feet."-^^' -''^ This has no exact counterpart in the experi- 

 mental animal, and there is no justification for concluding that it is due 

 soley to a deficiency of pantothenic acid. This condition, seen in so many 

 of the men who were in prisoner-of-war camps in Japan and Burma, had a 

 characteristic syndrome, was associated with neurological and mental dis- 

 turbances, did not respond satisfactorily to therapy with thiamine chloride, 

 riboflavin, or nicotinic acid, and was reported by Gopalan^^* as responding 

 to calcium pantothenate. The other fractions of the vitamin B complex 

 improved the nutritional state of the individual although they were not 

 successful in completely correcting the feet symptoms or the mental dis- 

 turbance. Dried brewers' yeast was apparently the most successful therapy, 

 and this, of course, contains all fractions of the B complex. 



Glusman,-^^ who himself was a prisoner of the Japanese from the time of 

 the fall of Corregidor until the war was over, had an opportunity of observ- 

 ing prisoners of war in the Philippines and in Japan. He reports that evi- 

 dence of weight loss and malnutrition became apparent soon after the 

 American troops were taken prisoner in the Philippines, but that three or 

 four months elapsed before the first patients with burning feet began to 

 appear. The incidence then increased rapidly so that approximately 300 of 

 some 800 patients were complaining of this symptom. In other camps, such 

 as Cabanatuan, some 2000 more cases were observed. In these patients 

 evidences of pellagra were common, as well as corneal ulcerations, constric- 

 tion of the visual fields, central scotomata, scrotal dermatitis, glossitis, and 

 cheilosis. Diarrhea was almost universal. The burning feet syndrome oc- 

 curred in conjunction with evidences of these other deficiencies, but Glus- 

 man reports that "it could occur as a distinct symptom complex by itself." 

 As described by all authors, the onset was gradual, with numbness and 

 tingling in the toes, usually bilateral. The paresthesias then gave way to 

 burning pains in the toes and soles of the feet, and then the shooting pains 

 began. These radiated from the dorsa of the feet up the legs. There seemed 

 to be a relationship in these pains to the time of day, and they were much 

 more severe at night. In the most advanced cases, pains in the palms of the 

 hands also occurred. Relief occurred to a certain extent when the feet were 

 immersed in cold water. Preservation of the reflexes was the rule, and motor 



2« G. F. Harrison, Lancet I, 961 (1946). 

 2" E. K. Cruickshank, Lancet II, 369 (1946). 

 2" C. Gopalan, Indian Med. Gaz. 81, 22 (1946). 

 2^5 M. Glusman, Am. J. Med. 3, 211 (1947). 



