IMMUNITY AND VITAMIN DEFICIENCY.

670 Inconclusive Experiment. bit of human experience in the matter goes Every to show that lack of vitamin D facilitates the development of tuberculosis and that administration of IMMUNITY AND VITAMIN DEFICIENCY. vitamin D, as cod-liver oil, or provision for the body, of the opportunity to form vitamin D itself, by A REVIEW OF THE EVIDENCE. exposure to ultra-violet light from the sun or an artificial source cures it after it has developed. There THE idea that the immunity of the body is, however, remarkably little experimental conby dietary deficiency is a very attractive one, and it firmation of this. A leading article in the Journal is remarkable how little experimental evidence there of the American Medical Association (Feb. 4th, 1928) is in support of it. In a paper read before the British quotes investigations by Agnes H. Grant and Association at Leeds last year and published in our co-workers,9 who have induced tuberculosis in the columns, W. Cramerdrew attention to the relation otherwise very resistant albino rat by feeding it on of national health to milk production and milk fat a rachitic diet. They do not appear to have been consumption. He referred to the best-known example troubled by inconsistency in their results, but S. S. of infection related to dietary deficiency, which is Zilva and H. Schutze," who carried out experifamiliar to every dietetic worker who has dealt ments of a similar type, found it very difficult to with rats-i.e., the occurrence of an acute or chronic arrive at any clear-cut conclusion. In their summary lung disease in rats, which is associated with a they state that they found some evidence for saying deficiency of the antixerophthalmic vitamin, vitamin that " a large excess of fat-soluble vitamins in the A. Lack of this vitamin seems to lead to a break- diet, as supplied by cod-liver oil, inhibits the formation down of the mucous membrane, by which, according in rats of these tuberculous tumours, but such evidence to S. B. Wolbach and P. R. Howe,a stratified keratin- was by no means conclusive." They also found that ising epithelium is substituted for the normal one. the inclusion of large amounts of cod-liver oil in the The epithelium may then become infected at many diets of rats, or ultra-violet irradiation of the rats, points in both old and young rats. I. G. Macy and produced a slight, but constant, leucocytosis. S. S. co-workers3 noted otitismedia, mastoid disease, and Zilva 11had also previously investigated the influence sublingual abscesses, besides the usual lung disease, of deficient nutrition, on the production of agglutinins, and H. C. Sherman and F. L. McLeod4 were extremely complement, and amboceptor. He used rats and struck with the liability to broncho-pneumonia, guinea-pigs and studied deficiencies of the elements, induced in rats by a deficiency of vitamin A ; they Ca, Fe, K, Cl, P, and Na, of certain amino-acids, and of argued from the rat to the human being. the antiscorbutic, antineuritic, and fat-soluble vitamins ; restriction of total calories was also studied. Effects of Dietetic Deficiency in Human Infants. It was found that a deficiency of phosphorus was the It remained for C. E. Bloch,5 of Copenhagen, to trace only one which had any effect in lowering the titre the same condition in human infants. In his studies of agglutinins and amboceptor. Experiment has not, on children suffering from xerophthalmia, as a result therefore, been able so far to throw much light on of a diet deficient in vitamin A, he noted the liability problem, and we must be chiefly guided by of such children to catarrhal infections of the mucous empirical knowledge. membranes, particularly of the respiratory organs, References. and to infections of the urinary tract, with Bacillus 1. THE LANCET, 1927, ii., 774. coli. So serious were these infections that the child 2. Jour. Exp. Med., 1925, xliii., 753. 3. Jour. Biol. Chem., 1927, lxxiii., 175. died if the diet were not changed. Olaf Blegvad6 4. Proc. Soc. Exp. Biol. and Med., 1924, xxii., 75. gives a set of these cases, in which, out of 60 fatal 5. Jour. of Hygiene, 1921, xix., 283, and Jour. of Dairy Science, January, 1924, vii. ones, where the cause of death was known, 46 were 6. Amer. Jour. of Ophthalmology, 1924, 3rd S., vii., 89. due to broncho-pneumonia. The dietary conditions 7. Report of the Medical Research Council, Special Report studied in Denmark were, of course, extreme. It is Series No. 77, 1923. to of infants hard believe that broncho-pneumonia 8. Münch. Med. Woch., 1928, lxxv., 79. 9. Amer. Rev. Tuberc., 1927, xvi., 628 and 642. can ordinarily be associated with a lack of vitamin A, 10. Jour. of 1927, xxvi., 204. but a mild degree of insufficiency might exist and 11. Biochem.Hygiene, Jour., 1919, xiii., 172. manifest itself in no other way than by a lowering of immunity. The Antirachitic Vitamin. PUBLIC HEALTH OF SOUTH AFRICA. When we turn to the antirachitic vitamin we are on less sure ground. The Report to the Medical THE annual report of the Department of Public Research Council on Rickets in Vienna7 of the Union of South Africa for the year Health records that respiratory infections, otorrhoea, and furunculosis were less common in a group of children ended June 30th, 1927,1 bears close resemblance to its predecessors. Nothing remarkably new is found receiving energetic antirachitic treatment than in a in its pages, but it is a faithful record of the activities but not which were receiving it, comparable group of a rather small Government department, which, even the antirachitic treatment consisted chiefly in the administration of cod-liver oil, which is rich in vitamin A if striking progress is absent, manifest steady improvement in many respects. The work of the department as well as in vitamin D, so that it is not possible to say which vitamin was responsible for the improved was again severely handicapped by the apparent and H. Kreitmair8 have lately unwillingness of the legislatwe assembly to put the condition. W.theEichholz effect of diets, rich and poor in Medical, Dental, and Pharmacy Bill on the statute investigated vitamin D (irradiated ergosterol), on adult rats and book. This is a long overdue measure, and the same In a series of rats a spontaneous epidemic holds true in the case of the Food, Drugs, and Dismice. of paratyphoid occurred among the animals without infectants Bill. The department also deplores its vitamin D, while those receiving it were spared, but lack of power to deal with matters like general hospitals, it was never found possible to repeat this observation. district nursing, school medical inspection and cognate It was found that mortality from inoculation with a affairs. This is due to the Provincial Administrations virulent strain of pneumococcus was decreased by having kept the control of these and many other administration of vitamin D and still further decreased matters too long in their own hands. Attention is when vitamin B, in yeast, was added as well. It is drawn to the facilities which the Union Government to owners of sick cows, in contrast to the suggested that even among adult human beings offers vitamin D may have a beneficial effect in raising enormous difficulties surrounding the provision of for those living in remote localities. This resistance in the winter when sunshine is scanty. medical aid does not refer to paupers, for whom the services of is not D vitamin effect of The upon immunity 1 Pretoria : Government Printing and Stationery Office. regarded as a specific one, but one which is common to any form of dietary deficiency. Pp. 70. 2s. 6d.

Special Articles.

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(1923)