T. D. Spies

A Note on the Interrelationship of Deficiency Diseases and Resistance to Infection.

Summary and Conclusions 1. Our observations in 150 patients from a region of Alabama in which deficiency diseases are endemic show a relationship between these diseases and the resistance to, and presence of, infections with Staphylococcus aureus and Streptococcus hemolyticus. 2. The lesions at the corners of the mouth, characteristic of riboflavin deficiency, contained pure or nearly pure cultures of hemolytic strains of Staphylococcus aureus in 80% of the cases, and in the remaining 20%, Streptococcus hemolyticus predominated. Following the oral or intravenous administration of riboflavin or substances rich in it, the fissures healed rapidly and the organisms were no longer demonstrable. 3. When the bacterial flora of the conjunctival sacs were studied in cases of dietary deficiency disease and associated conjunctivitis, hemolytic strains of Staphylococcus aureus were found to predominate in 14 of the 30 cases. Smears and cultures demonstrated the presence of Corynebacterium xerosis in a pure state in all of the spots of Bitot which occurred in 5 cases. 4. In addition to masses of Vincents organisms, 64% of the ulcerations of the tongue, gums, or buccal mucosa yielded Streptococcus hemolyticus, and the remaining 36% contained hemolytic strains of Staphylococcus aureus. Following specific therapy with anti-pellagric substances, the bacterial flora of these ulcerations, including the Vincents organisms, promptly disappeared. 5. A low complement titre exists in acutely deficient patients, and in the subclinical and mild cases the titre is slightly subnormal or normal. Following clinical improvement the complement titre increases. 6. In the whole blood of acutely deficient patients there is a distinct depression in the bactericidal power for Staphylococcus aureus, whereas, only a slight diminution in staphylococcidal power was observed in the blood of subclinical and mild cases of vitamin deficiency.

Antibody Response of Persons with Pellagra, Beriberi and Riboflavin Deficiency.

Summary Response to antigenic stimulation with B. tularense in persons with pellagra, beriberi, and riboflavin-deficiency was less than in normal persons. In general, the resulting agglutinative titers were less in proportion to the severity of the deficiency, and persons with the greatest deficiency had less ability to maintain their titers. There was a quantitative relation between the higher titers and the amount of agglutinin-nitrogen.

A note on the relationship of pellagra to pernicious anemia.

Pellagra and pernicious anemia are now regarded as special types of deficiency diseases. They have in common such clinical manifestations as achylia gastrica, glossitis, peripheral neuritis, and central nervous system changes. Goldberger and his associates 1 , 2 believe that pellagra is caused solely by a diminished intake of some specific food substance (“vitamin G”). Rolph, 3 Turner, 4 and others have described cases developing secondary to lesions of the gastrointestinal tract. While it has likewise been suggested that in certain instances the lack of some substance in the diet may cause pernicious anemia, it usually follows the lack of the essential secretion (“intrinsic factor”) in the gastric juice which changes food into an anti-anemic substance. 5 A short time ago Spies and Payne 6 produced remissions in 2 patients with pernicious anemia, by giving an incubated mixture of beef muscle and achylic gastric juice from acute pellagrins. This observation indicated that the “intrinsic factor” was present in gastric secretions from pellagrins in an amount adequate to form the antianemic substance. They suggested in this study that the usual pellagrin apparently develops his disease as a result of inadequate food ingestion, whereas the usual pernicious anemia patient developed the anemia from the failure of his gastric juice to make an antianemic substance from food. Since pernicious anemia and pellagra are both related to diet and its subsequent assimilation by the body, there have been recent attempts to recognize more specifically those substances in food which are important in the pathogenesis of the 2 diseases. Strauss and Castle 7 , 8 have found that the substance in food (“extrinsic factor”) concerned with the development of pernicious anemia is associated with so-called “vitamin G” which other workers have considered as the “antipellagric vitamin”.

Whole Blood and Plasma Ascorbic Acid Concentrations in Patients with Pellagra and Associated Deficiency Diseases.

Summary and Conclusions Whole blood and plasma ascorbic acid determinations made on 70 patients in the nutrition clinic of the Hillman Hospital indicate that 55 of these persons had a whole blood concentration of ascorbic acid lower than in normal controls. In 8 of the 70 cases, the concentration was so low as to suggest that depletion may have been advanced. Most of these patients had clinical evidence of other deficiencies, such as pellagra, beriberi and riboflavin deficiency, but no significant correlation could be made between the blood ascorbic acid values and the symptoms of these deficiency states, nor indeed of scurvy itself. These observations seem pertinent in view of the fact that they were made in late June, at a period when leafy vegetables and berries had been available to the patients for some time, and probably indicate that ascorbic acid deficiency is still greater at other periods. These studies give strong support to the concept that natural-occurring deficiency diseases exist as complexities rather than as single entities.

Pellagra: an Experimental Study of the Skin. lesions.

It was reported in a previous publication 1 that the skin lesions of pellagrins improved while they were restricted to a so-called “pellagra-producing” diet. Since this diet consisted of such diverse foods as cornmeal, pork fat, artificially colored (synthetic) maple syrup, polished rice, cornstarch pudding, and sugar, it seemed advisable to observe the skin lesions of pellagrins limited to a diet less complex in food materials and even more deficient in vitamin G. Evidence is presented in this paper to show that the dermatitis of pellagra often improves while the patient is restricted to cornstarch and lactose. Ten cases with the characteristic dermatitis of pellagra were chosen for this experiment and extreme care was exercised to select patients without neurological involvement. Each patient remained in bed during the experiment and was given a diet of cornstarch and lactose amounting to 2,000 or 3,000 calories per day. Two of the 6 individuals in this series with stomatitis were unable to tolerate this diet so it was discontinued. The skin lesions of the 8 patients who remained on the diet of lactose and cornstarch showed definite improvement during the first 6 to 15 days of the experiment. The stomatitis of one individual improved and that of the 3 others became worse while they received the restricted diet. The 4 patients free of stomatitis at the beginning of the experiment did not develop it and none of the pellagrins used in this experiment showed any signs of central nervous system involvement. It has been noted by the writer 2 as well as by others that pellagra may involve the central nervous system, the gastro-intestinal tract, and the skin in the same patient, while in other patients it may affect one or 2 organ systems. In several instances 2 the writer has observed that the dermatitis and stomatitis healed while there was a steady progression of the central nervous system disease.