676 PANTOTHENIC ACID 



power was preserved. No paralysis of the extremities occurred; there was 

 no evidence of foot drop. The gait is best described by quoting from Glus- 

 man's report: "The gait was pecuhar but this appeared to be due to pain 

 and hypersensitivity of the soles of the feet rather than to disturbance of 

 motor power or equilibrium. The patient walked as if the ground beneath 

 the soles of his feet were hot. He walked cautiously, gingerly, and on a some- 

 what widened base. Because of his reluctance to use his oversensitive toes 

 to grip the ground, the gait had a characteristic flat-footed quality. In 

 standing, patients frequently shifted their weight from one foot to the other 

 in a restless and repetitious fashion. It seemed as if they could not endure 

 the discomfort of resting their weight on one foot for more than a few mo- 

 ments at a time. The same restlessness was frequently noted while the pa- 

 tient was in bed. Often when the pain was severe patients would sit cross 

 legged in bed, holding the distal portions of their feet in their hands and rock 

 rhythmically backward and forward with the pain. This last attitude was 

 not only pitiful but it was so pathognomonic that any observer walking into 

 a ward could pick out those with burning feet at a glance." 



Attempts at therapy were, according to Glusman, disappointing. Nico- 

 tinic acid, as reported by other observers also, relieved the associated signs 

 of pellagra "but was without effect on the symptoms of burning feet." The 

 same was true of thiamine chloride. 



Glusman also mentions discussing the matter with Professor Kinosita, 

 and the report was the same as published in Page's article.^^^ Kinosita 

 claimed that the Japanese had been unfamiliar with the syndrome of burn- 

 ing feet before the war. However, they began to see patients with this con- 

 dition among the Japanese military personnel who had been cut off by 

 allied operations in the southern battle areas for variable periods of time 

 before rescue. Professor Kinosita autopsied a small number of these Japa- 

 nese soldiers. He observed that the spinal cords and peripheral nerves in 

 these patients were normal. He found changes in the small arteries "whose 

 walls were diffusely thickened, and he commented on the absence of new 

 vessels." 



A clue to the etiology of the syndrome is provided by Gopalan's report,^^^ 

 which was done in the Nutrition Research Laboratories in South India. 

 This author very kindly provided me with a microfilm copy of his report. 

 He points out that the "differences between 'burning feet' and the peripheral 

 neuritis associated with thiamine deficiency are so fundamental that it is 

 surprising that the two conditions have been confused." He found that the 

 incidence was greatest among the poorer classes and that the diet consumed 

 was mostly rice gruel and cheap vegetables, the rice being of the parboiled 

 type which contains enough thiamine to prevent beriberi. Again, the signs 



"6 J. A. Page, Brit. Med. J. II, 260 (1946). 



