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The butterfly sign and tongue pigmentation
482
CORRESPONDENCE.
THE
BUTTERFLY
SIGN
AND
TONGUE
PIGMENTATION.
To the Editor, TRANSACTIONSof the Royal Society of Tropical Medicine and Hygiene. SIR,
I was interested in MCGREGOR'S article on the significance of the butterfly sign and of tongue pigmentation in these TRANSACTIONS.* I was under the impression that the butterfly sign was considered, in the old days, a sign of intestinal tuberculosis. This is the first time that I have heard of its being traced to schistosome infection (SINDERSON) and to urinary infection. Schistosome infestation is unknown in South India and yet the butterfly sign is common enough. As for tongue pigmentation it is difficult to appreciate how the tongue and especially how the palate (for the palate is also pigmented in many of these cases) is accessible to solar radiation. We felt that the tongue pigmentation was due to the hookworm toxin, as McGREGOR did in the first instance, and also to the Leishman-Donovan body of kala-azar. MCGREGOR'Sanalysis of stools in persons with pigmented tongues seems to dispose of the hookworm theory. His analysis is, however, admittedly incomplete. One criticism of his remarks regarding urinary infection might be that it would be more appropriate to find out the percentage incidence of tongue pigmentation in known urinary infection, rather than to look for evidence of urine infection in persons with tongue pigmentation. It strikes me that tongue pigmentation in the tropics, as elsewhere, may be due to the toxic depression of the adrenal cortex from any cause. The adrenal cortex presides over sodium and presumably over Vitamin C metabolism. I recently came across the suggestion (by MCCANCE I think) that pigmentation in Addison's disease was probably due to deficiency of Vitamin C, as experimentally sodium deficiency never produced pigmentation, but did produce practically all the other symptoms of Addison's disease. Is pigmentation, then, a measure of sub-clinical deficiency of Vitamin C ? It should not be difficult to check this hypothesis by the new method of finding out how much of a large test dose of the vitamin is recovered from the urine. I remain, Sir, etc., _~Iadras /VIedicaI Service, S . K . SUNDARAM.
Government General Hospital. Madras. *McGREGOR, L . J . (1936). The significance of the butterfly sign and of tongue pigmentation. Trans. R. Soc. trop. Med. ~.~ Hyg., xxx (2), 229.
CORRESPONDENCE.
THE
BUTTERFLY
SIGN
AND
TONGUE
PIGMENTATION.
To the Editor, TRANSACTIONSof the Royal Society of Tropical Medicine and Hygiene. SIR,
I was interested in MCGREGOR'S article on the significance of the butterfly sign and of tongue pigmentation in these TRANSACTIONS.* I was under the impression that the butterfly sign was considered, in the old days, a sign of intestinal tuberculosis. This is the first time that I have heard of its being traced to schistosome infection (SINDERSON) and to urinary infection. Schistosome infestation is unknown in South India and yet the butterfly sign is common enough. As for tongue pigmentation it is difficult to appreciate how the tongue and especially how the palate (for the palate is also pigmented in many of these cases) is accessible to solar radiation. We felt that the tongue pigmentation was due to the hookworm toxin, as McGREGOR did in the first instance, and also to the Leishman-Donovan body of kala-azar. MCGREGOR'Sanalysis of stools in persons with pigmented tongues seems to dispose of the hookworm theory. His analysis is, however, admittedly incomplete. One criticism of his remarks regarding urinary infection might be that it would be more appropriate to find out the percentage incidence of tongue pigmentation in known urinary infection, rather than to look for evidence of urine infection in persons with tongue pigmentation. It strikes me that tongue pigmentation in the tropics, as elsewhere, may be due to the toxic depression of the adrenal cortex from any cause. The adrenal cortex presides over sodium and presumably over Vitamin C metabolism. I recently came across the suggestion (by MCCANCE I think) that pigmentation in Addison's disease was probably due to deficiency of Vitamin C, as experimentally sodium deficiency never produced pigmentation, but did produce practically all the other symptoms of Addison's disease. Is pigmentation, then, a measure of sub-clinical deficiency of Vitamin C ? It should not be difficult to check this hypothesis by the new method of finding out how much of a large test dose of the vitamin is recovered from the urine. I remain, Sir, etc., _~Iadras /VIedicaI Service, S . K . SUNDARAM.
Government General Hospital. Madras. *McGREGOR, L . J . (1936). The significance of the butterfly sign and of tongue pigmentation. Trans. R. Soc. trop. Med. ~.~ Hyg., xxx (2), 229.