IX. EFFECTS OF DEFICIENCY 677 



of ribofla\in deficiency and other deficiencies were present in many of the 

 subjects. The description of the symptoms was much the same as Glusman's, 

 but probably the most significant finding was the result of treatment. 

 Gopalan found that 50 mg. of thiamine chloride daily, 300 mg. of nicotinic 

 acid, and 10 mg. of riboflavin resulted in the disappearance of the deficien- 

 cies such as glossitis, stomatitis, and some of the ocular symptoms but 

 had no effect on the burning feet. A striking improvement occurred follow- 

 ing the administration intramuscularly of 20 to 40 mg. of calcium panto- 

 thenate daily. The burning and hyperhidrosis disappeared first, and the 

 pins-and-needles sensation later. Up to 80 mg. of calcium pantothenate was 

 given in some cases and in fact was necessary in the more severe cases. No 

 untoward reactions occurred. Gopalan points out the resemblance to the 

 neurological lesions occurring in pantothenate-deficient swine. Spies has 

 reported that riboflavin or biotin injections increased the blood level of 

 pantothenic acid.^^^ This may account for the moderate improvement re- 

 ported by some other authors after treatment with the other fractions of 

 the B complex. The probability is that the other fractions of the B vitamin 

 complex also are involved to a certain extent in the syndrome. However, 

 it would seem that the burning feet syndrome was associated with a de- 

 ficiency of pantothenic acid and suggests that in humans a deficiency of 

 this vitamin will affect the small arteries and may involve the central ner- 

 vous system as it does in the experimental animal.^^^"^^^ Major Bruce Hunt, 

 of the Australian Army Medical Corps,^^^ who was taken prisoner by the 

 Japanese at Singapore, told me that personality changes and mental dis- 

 turbances were also present in many of the men suffering from the burning 

 feet syndrome. 



(3) There were no reports on pathological examination of fatty infiltra- 

 tion of the liver or atrophy of the adrenals in men dying as a result of star- 

 vation in the prison camps, but apparently complete pathological examina- 

 tions were not feasible. 



(4) Apparently some decrease in the secretion of the male sex hormone 

 occurred, as a common observation among the prisoners was the fact that 

 they had to shave much less frequently than normally, and loss of libido 

 was frequently reported. Whether or not this was due to atrophy or changes 

 in the tubular cells of the testes is not known, but undoubtedly it was the 

 result of malnutrition. 



c. Summary 



Obviously, at the present time one can only surmise, on the basis of ani- 

 mal experimentation, what the possible pathological changes in humans 



2" T. D. Spies, S. R. Stanbery, R. J. Williams, T. H. Jukes, and S. H. Babcock, 



J. A)n. Med. Assoc. 115, 523 (1940). 

 2^* B. Hunt, personal communication, Perth, Australia. 



