SCURVY IN THE ANTARCTIC

892 SCURVY IN THE ANTARCTIC SIR,-Miss Salmon (Jan. 6, p. 42) draws attention to the statement in standard textbooks of physiology 1-5 that man, monkeys, and guineapigs are the only animals incapable of synthesising their own vitamin C. In my original letter1I described the condition of husky dogs after 100 days without fresh food, when they became listless and readily fatigued, with swollen hxmorrhagic gums, but recovered completely in 2 or 3 weeks on a diet of fresh seal meat. I should mention that husky dogs on comparable journeys of 100 days that were fed an occasional meal of fresh seal meat did not develop these signs. I did not state that this deficiency disease was necessarily scurvy, although the signs were similar to human scurvy. Similar signs can occur with " pellagra " in dogs, called " black tongue ", due to nicotinic-acid-amide deficiency. However, our husky dogs were fed dog pemmican which contained dehydrated meat, from which source of tryptophan, nicotinic-acid-amide could be synthesised. It thus seems that our husky dogs developed a deficiency disease which was most likely to be scurvy. A search through the veterinary literature gives some support to this. Lacroix et al. found low ascorbic-acid blood-levels in some dogs with non-parasitic dermatitis, and these as a rule responded to vitamin C. There are other reports 11 that rats and cattle on vitamin-A-deficient diets have low Garlick9 ascorbic-acid content in tissues and plasma. of in a female two attacks reported spitz, six years scurvy of age, that developed extensive cutaneous and subcutaneous haemorrhages, bleeding gums, anaemia, haemorrhagic diarrhoea, weakness, and anorexia. Therapeutic doses of vitamin C resulted in rapid recovery in two attacks 8 months apart. It may be that under some conditions of stress or poor nutrition dogs fail to synthesise vitamin C or it may be utilised more rapidly than it can be synthesised. Sumner-Smith 10 is of the opinion that some factor, as yet not isolated, from naturally occurring sources of vitamin C is responsible for prevention of a scurvy-like condition in dogs which does not respond to treatment with purified vitamin C.

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were

diminished; cranial

monocytes; normal serum transaminases and bilirubin; and a negative Wassermann reaction. Cerebrospinal fluid contained 106 mg. per 100 ml. protein and 249 white cells (65% mononuclear) per c.mm. X-rays of the spine were normal, and a myelogram did not demonstrate a block. A second spinal fluid drawn during her fourth week in hospital contained 44 mg. per 100 ml. protein and 7 mononuclear cells per c.mm. The clinical course was very slow improvement in sensorimotor function over several months, complicated by recurrent urinary-tract infections.

We received one serum drawn during the fourth week in hospital. This serum had an E.B.-virus indirect fluorescent antibody titre of 1/800, a high value which strongly suggests either recent infection or activation, but did not contain heterophile antibodies, as indicated by a negative ox-cell haemolysis test. The patient may have had a short-lived heterophile response early in the course of her illness. It is also possible that she had a serological pattern similar to 3 cases of Guillain-Barré syndrome with high E.B.-virus antibodies and negative heterophile reactions. 112z With regard to such extremely variable and sometimes absent heterophile responses in the presence of high E.B.-virus antibodies, it may be more appropriate to consider these neurological manifestations as E.B.-virusassociated diseases, rather than as complications" of infectious mononucleosis. Certainly E.B.-virus serology will allow us to identify more cases than was previously possible with only the Paul-Bunnell test. "

Albert Einstein College of Medicine, Bronx, New York 10461, U.S.A. Center for Disease Control,

Atlanta, Georgia

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20-year-old female first noticed difficulty voiding three before admission. Within 24 hours she had paraesthesiae and weakness in her legs, and was unable to urinate. On admission she required urethral catheterisation because of retention. There was a flaccid paraplegia with absent vibratory and position senses, decreased anal sphincter tone, and a sensory

days

1. Samson Wright’s Applied Physiology; p. 432. London, 1965. 2. Ganong, W. F. Review of Medical Physiology; p. 229. Los Altos, California, 1971. 3. Best, C. H., Taylor, N. B. Physiological Basis of Medical Practice; p. 935. Baltimore, 1961. 4. Hawk’s Pnysiological Chemistry; p. 693. New York, 1965. 5. Goodman, L. S., Gilman, A. Pharmacological Basis of Therapeutics; p. 1667. New York, 1970. 6. Butson, A. R. C. Lancet, 1972, ii, 1146. 7. Lacroix, J. V., Park, S. E., Adler, A. E., Jr. N.A. Vet. 1942, 23, 329. 8. Maynard, L. A., Loosli, J. K. Animal Nutrition; p. 307. New York, 1969. 9. Garlick, N. L. J. Am. vet. med. Ass. 1946, 109, 70. 10. Sumner-Smith, G. Personal communication, 1973. 11. Munter, M. D. Med. Klin. 1969, 64, 1752.

30333.

CHARLES GROSE. P. M. FEORINO.

IN CUTANEOUS BLOODVESSEL WALLS AND MESANGIUM IN HENOCH-SCHÖNLEIN SYNDROME

IgA-DEPOSITS

EPSTEIN-BARR VIRUS AND TRANSVERSE MYELITIS

A review 11 in 1969 contained 7 cases from the world literature and added 1 case. All were between 9 and 28 years. We wish to report an instance of transverse myelitis with a high Epstein-Barr (E.B.)-virus antibody titre.

Deep

spleen were not enlarged. Laboratory data included hxmatocrit 34%, white cells 10,000 per c.mm., with 73% neutrophils, 19% lymphocytes, and 8%

A. R. C. BUTSON.

SiR,-Acute transverse myelitis is one of the rarest neurological manifestations of infectious mononucleosis.

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Suite 804, 25 Charlton Avenue E., Hamilton 20, Ontario, Canada.

tendon reflexes in the upper extremities The nerves and fundi were normal.

level

.

SiR,—The diagnosis of Henoch-Schänlein syndrome (H.s.s.) is easy when the clinician faces the typical features. However, recognition of cases with only some of the characteristics may be difficult. The problems result from the lack of knowledge of the essential background of this disease. We wish to report a finding which may contribute to a better understanding of its pathogenesis. In 46 patients with various nephropathies, we compared the immunohistochemical characteristics of biopsy specimens from kidney and diseased and/or clinically uninvolved skin (dorsum of lower arm). The findings in 8 of these cases are the basis of this letter. 4 patients had H.S.S., while the others had only proteinuria and/or hsematuria. Brilliant mesangial fluorescence indicative of IgA deposition was seen in all cases. Far less conspicuous, or even absent, was the staining in this area for IgG, complement (C3.4)’ and fibrin. Sometimes scanty granular deposits of IgG and complement were observed along the glomerular basement membranes. In the clinically uninvolved skin of all 8 patients, granules, containing particularly IgA, but also IgG, IgM, and complement, were found in the walls of capillaries. Vessel-wall deposits were also found in the purpuric lesions of the 4 H.s.s. patients next to heavy perivascular fibrin deposits of the type seen in allergic vasculitis.13 Glomerulonephritis, accompanied by mesangial deposition of IgA, has already been described in H.s.s., and 12.

Lancet, 1972, ii, 1285. Faille-Kuyper, E. H. Lupus Erythematosus: an Immunohistochemical and Clinical Study of 485 Patients; p. 47. Utrecht, 1969.

13. Baart de la