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THE GUT AND NUTRITIONAL DEFICIENCY
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people, Never have so many given so much radiological evidence of diminished gut motility that to so many." There is a constant, unobtrusive flow of responded to liver extract or yeast. These cases seem kindness going on all over the country, from gifts of tea to have differed from the sprue syndrome, since, although steatorrhoea occurred if fat was given, the stools conto those who outrun their 2 oz. a week (and many of the aged and lonely seem almost to live on tea) and fruit and tained undigested starch and muscle-fibres whereas in vegetables from gardens, even sharing meals, to the sprue there is no failure of digestion of these. Brown and Trowell draw attention to the similarity of their findings bestowal of waste and scraps for feeding the animals. with the deficiency-bowel pattern of Golden,lo but GolIt always has been a real problem to cater for oneself den’s hypothesis of alone, but in war-time it is eased by this kindly help. damage to the intramural nervous system of the intestine " was based on one biopsy speeiTHE GUT AND NUTRITIONAL DEFICIENCY men from a 61-year-old man without any controls. The PHYSIOLOGISTS tell us that 50% by weight of the changes in the radiological appearance of the gut may be secondary to the interference with absorption, the faeces is composed of dead bacteria. The normal gut is therefore a flourishing botanical garden. Its inhabitants bulky intestinal contents causing diminution in have sometimes been tolerated and sometimes discourmotility.ll It is clear that vitamin deficiencies can proaged ; that they were beneficial to the cow was admitted, duce changes in the gut either directly by interfering with the nervous mechanism (for which there is as yet no but they were at best regarded as harmless parasites in man. Recent work has indicated that we rely for part evidence) or indirectly by causing a failure of absorption of foodstuffs and consequent distension. Conversely, of our daily supply of vitamins on the synthetic activity of our intestinal flora. changes in the gut that are not nutritional in-origin can cause vitamin deficiencies, and these can also be caused Mackieand others have repeatedly stressed that diarrhcea or resection - of the gut can cause vitamin by changes in the intestinal flora. Which comes first and which second is usually difficult to determine ; but the deficiencies. But it has usually been assumed that the of the nutritional deficiency deficiency arises from failure of absorption due to in- recognition and treatment immediate are the most objectives.’or a has important testinal hurry diminished absorbing surface. It now been proved that disease can arise from failure of GRANTS FOR PSYCHIATRY AND NEUROLOGY bacteria to .grow and synthesise vitamins, this failure THE Nuffield Provincial Hospitals Trust has promised resection caused unsuitable by diarrhoea, being of the gut, £15,000 to the University of Leeds to establish a wholemedia or ingestion of sulphonamides. Such deficiencies include those of vitamin Bi2 and of folic acid.3 Further, time chair in psychiatry and a psychiatric unit. Facilities for undergraduate and postgraduate instruction, it is known that certain nutritional deficiencies, such as of for research, and for treatment will be provided. It is niacin4 cause achlorhydria which is corrected when the proposed that the unit should seek to promote contact nutrient is supplied ; and achlorhydria itself tends to between general medicine and psychiatry and to increase since destrucor nutritional deficiencies, produce coordinate the various mental health services of the area. tion of certain vitamins, such as B1, readily occurs in an The Trust has also made a grant of E3000 a year for alkaline medium 5 five years to help the University of Liverpool to set the There is another and more obscure relation between a department of neurology. An anonymous donor up and his and vitamin deficiencies. Sydenstricker gut 7 has to cover the promised already capital expenditure, colleagues,6 Bandier and in particular Petri and and the services of the new department will be available associateshave postulated an intrinsic factor produced voluntary and to municipal hospitals throughout the by the stomach which acts in preventing pellagra. Petri to district. believes that the stomach is necessary for the synthesis of coenzymes I and II from niacin, of flavoprotein enzymes RAW MATERIALS OF CANCER RESEARCH from riboflavin, and of cocarboxylase from vitamin Bl ; think that in medical science the season of SoME the latter is in agreement with the suggestion of Laurent synthesis and interpretation is long overdue. Now and Sinclair S that diminished phosphorylation of vitathat the British Empire Cancer Campaign has reached min B1 with failure of cocarboxylase formation may 9 maturity1 we may hope to see more attempts towards account for " gastrogenous " polyneuritis. Verzir a synthesis of the raw materials presented yearly in the believed that the failure to absorb fatty acids and glucose form of further proof or elaboration of knowledge already in the sprue syndrome was due to failure of phosphorylaCancer research makes one think of some gained. in tion the intestinal mucosa. intricate jigsaw puzzle whose pieces always retain the Since vitamin deficiencies produce disorders of the gut, same shape but sometimes have one picture, sometimes and disorders of the gut produce vitamin deficiencies, another superimposed on them. Whatever the picture it is often difficult to decide which is the cart and which happens to be, no-one can put the whole together and the horse. For instance, Sydenstricker suggested that few attempt this even in one corner. We continue to niacin deficiency produced atrophy of the gastric mucosa, assume that some of the pieces are missing, and no and that a normal gastric mucosa was necessary for the doubt they are. It ought, nevertheless, to be possible conversion of niacin to niacinamide-a hypothesis, to make quite a number fit. however, which does not explain why his pellagrins were Meanwhile we must be thankful that the present administration of normal gastric juice. rapidly cured by contains new data and aids to research. Waterreport That gastric and intestinal dysfunctions can arise from in the biochemical research soluble made cestrogens, vitamin deficiencies has been proved, and in this primary laboratories of the Middlesex Hospital, provide us with issue Brown and Trowell describe cases of kwashiorkor in another weapon for attack upon some of the problems. Africa which were accompanied by a dermatitis that J. C. Mottram records that he has produced epitheDr. to oedema and anorexia probably niacin, responded lial tumours in mice with a single painting of benzpyrene caused by deficiency of vitamin B1, and diarrhoea with and subsequent painting for 20 weeks with croton oil, 1. Mackie, T. T., Eddie, W., Mills, M. A. Ann. intern. Med. 1940, 14, which is itself not carcinogenic. Dr. F. Bielchowsky 28. 2. Najjar, V. A., Holt, L. E. jun., J. Amer. med. Ass. 1943, 123, 683. has succeeded in obtaining benign and malignant 3. Daft, F. S., Sebrell, W. H. Publ. Hlth Rep., Wash., 1943, 58, 1542 ; tumours of the thyroid gland in rats by the combined M. 329. G. Proc. Clin. Higgins, Mayo 1944, 19, 4. Sydenstricker, V. P. Arch. intern. Med. 1941, 67, 746. action of acetyl aminoiluorene and allyl-thiourea, both 5. L. P. H. M. 1045. the British
"
-
-
.
.
’
.
Laurent,
E., Sinclair,
Lancet, 1938, i,
6. Sydenstricker, V. P., Armstrong, E. S., Derrick, C. J., Kemp, P. S. Amer. J. med. Sci. 1936, 192, 1. 7. Bandier, E. Acta med. scand. 1939, 101, 496. 8. Petri, S. Nørgaard, F., Bandier, E. Ibid, 1940, 104, 245. 9. Verzar, F. Absorption from the Intestine, London, 1936.
10. Golden, R. Radiology, 1941, 36, 262 ; 37, 284. 11. Kantor, J. L. Amer. J. Roentgenol. 1939, 41, 758 ; Stannus, H. S. Trans. R. Soc. trop. Med. Hyg. 1942, 36, 123. 12. Twenty-first Annual Report of the British Empire Cancer Campaign, 11, Grosvenor Crescent, London, SW1, 1944.
.
people, Never have so many given so much radiological evidence of diminished gut motility that to so many." There is a constant, unobtrusive flow of responded to liver extract or yeast. These cases seem kindness going on all over the country, from gifts of tea to have differed from the sprue syndrome, since, although steatorrhoea occurred if fat was given, the stools conto those who outrun their 2 oz. a week (and many of the aged and lonely seem almost to live on tea) and fruit and tained undigested starch and muscle-fibres whereas in vegetables from gardens, even sharing meals, to the sprue there is no failure of digestion of these. Brown and Trowell draw attention to the similarity of their findings bestowal of waste and scraps for feeding the animals. with the deficiency-bowel pattern of Golden,lo but GolIt always has been a real problem to cater for oneself den’s hypothesis of alone, but in war-time it is eased by this kindly help. damage to the intramural nervous system of the intestine " was based on one biopsy speeiTHE GUT AND NUTRITIONAL DEFICIENCY men from a 61-year-old man without any controls. The PHYSIOLOGISTS tell us that 50% by weight of the changes in the radiological appearance of the gut may be secondary to the interference with absorption, the faeces is composed of dead bacteria. The normal gut is therefore a flourishing botanical garden. Its inhabitants bulky intestinal contents causing diminution in have sometimes been tolerated and sometimes discourmotility.ll It is clear that vitamin deficiencies can proaged ; that they were beneficial to the cow was admitted, duce changes in the gut either directly by interfering with the nervous mechanism (for which there is as yet no but they were at best regarded as harmless parasites in man. Recent work has indicated that we rely for part evidence) or indirectly by causing a failure of absorption of foodstuffs and consequent distension. Conversely, of our daily supply of vitamins on the synthetic activity of our intestinal flora. changes in the gut that are not nutritional in-origin can cause vitamin deficiencies, and these can also be caused Mackieand others have repeatedly stressed that diarrhcea or resection - of the gut can cause vitamin by changes in the intestinal flora. Which comes first and which second is usually difficult to determine ; but the deficiencies. But it has usually been assumed that the of the nutritional deficiency deficiency arises from failure of absorption due to in- recognition and treatment immediate are the most objectives.’or a has important testinal hurry diminished absorbing surface. It now been proved that disease can arise from failure of GRANTS FOR PSYCHIATRY AND NEUROLOGY bacteria to .grow and synthesise vitamins, this failure THE Nuffield Provincial Hospitals Trust has promised resection caused unsuitable by diarrhoea, being of the gut, £15,000 to the University of Leeds to establish a wholemedia or ingestion of sulphonamides. Such deficiencies include those of vitamin Bi2 and of folic acid.3 Further, time chair in psychiatry and a psychiatric unit. Facilities for undergraduate and postgraduate instruction, it is known that certain nutritional deficiencies, such as of for research, and for treatment will be provided. It is niacin4 cause achlorhydria which is corrected when the proposed that the unit should seek to promote contact nutrient is supplied ; and achlorhydria itself tends to between general medicine and psychiatry and to increase since destrucor nutritional deficiencies, produce coordinate the various mental health services of the area. tion of certain vitamins, such as B1, readily occurs in an The Trust has also made a grant of E3000 a year for alkaline medium 5 five years to help the University of Liverpool to set the There is another and more obscure relation between a department of neurology. An anonymous donor up and his and vitamin deficiencies. Sydenstricker gut 7 has to cover the promised already capital expenditure, colleagues,6 Bandier and in particular Petri and and the services of the new department will be available associateshave postulated an intrinsic factor produced voluntary and to municipal hospitals throughout the by the stomach which acts in preventing pellagra. Petri to district. believes that the stomach is necessary for the synthesis of coenzymes I and II from niacin, of flavoprotein enzymes RAW MATERIALS OF CANCER RESEARCH from riboflavin, and of cocarboxylase from vitamin Bl ; think that in medical science the season of SoME the latter is in agreement with the suggestion of Laurent synthesis and interpretation is long overdue. Now and Sinclair S that diminished phosphorylation of vitathat the British Empire Cancer Campaign has reached min B1 with failure of cocarboxylase formation may 9 maturity1 we may hope to see more attempts towards account for " gastrogenous " polyneuritis. Verzir a synthesis of the raw materials presented yearly in the believed that the failure to absorb fatty acids and glucose form of further proof or elaboration of knowledge already in the sprue syndrome was due to failure of phosphorylaCancer research makes one think of some gained. in tion the intestinal mucosa. intricate jigsaw puzzle whose pieces always retain the Since vitamin deficiencies produce disorders of the gut, same shape but sometimes have one picture, sometimes and disorders of the gut produce vitamin deficiencies, another superimposed on them. Whatever the picture it is often difficult to decide which is the cart and which happens to be, no-one can put the whole together and the horse. For instance, Sydenstricker suggested that few attempt this even in one corner. We continue to niacin deficiency produced atrophy of the gastric mucosa, assume that some of the pieces are missing, and no and that a normal gastric mucosa was necessary for the doubt they are. It ought, nevertheless, to be possible conversion of niacin to niacinamide-a hypothesis, to make quite a number fit. however, which does not explain why his pellagrins were Meanwhile we must be thankful that the present administration of normal gastric juice. rapidly cured by contains new data and aids to research. Waterreport That gastric and intestinal dysfunctions can arise from in the biochemical research soluble made cestrogens, vitamin deficiencies has been proved, and in this primary laboratories of the Middlesex Hospital, provide us with issue Brown and Trowell describe cases of kwashiorkor in another weapon for attack upon some of the problems. Africa which were accompanied by a dermatitis that J. C. Mottram records that he has produced epitheDr. to oedema and anorexia probably niacin, responded lial tumours in mice with a single painting of benzpyrene caused by deficiency of vitamin B1, and diarrhoea with and subsequent painting for 20 weeks with croton oil, 1. Mackie, T. T., Eddie, W., Mills, M. A. Ann. intern. Med. 1940, 14, which is itself not carcinogenic. Dr. F. Bielchowsky 28. 2. Najjar, V. A., Holt, L. E. jun., J. Amer. med. Ass. 1943, 123, 683. has succeeded in obtaining benign and malignant 3. Daft, F. S., Sebrell, W. H. Publ. Hlth Rep., Wash., 1943, 58, 1542 ; tumours of the thyroid gland in rats by the combined M. 329. G. Proc. Clin. Higgins, Mayo 1944, 19, 4. Sydenstricker, V. P. Arch. intern. Med. 1941, 67, 746. action of acetyl aminoiluorene and allyl-thiourea, both 5. L. P. H. M. 1045. the British
"
-
-
.
.
’
.
Laurent,
E., Sinclair,
Lancet, 1938, i,
6. Sydenstricker, V. P., Armstrong, E. S., Derrick, C. J., Kemp, P. S. Amer. J. med. Sci. 1936, 192, 1. 7. Bandier, E. Acta med. scand. 1939, 101, 496. 8. Petri, S. Nørgaard, F., Bandier, E. Ibid, 1940, 104, 245. 9. Verzar, F. Absorption from the Intestine, London, 1936.
10. Golden, R. Radiology, 1941, 36, 262 ; 37, 284. 11. Kantor, J. L. Amer. J. Roentgenol. 1939, 41, 758 ; Stannus, H. S. Trans. R. Soc. trop. Med. Hyg. 1942, 36, 123. 12. Twenty-first Annual Report of the British Empire Cancer Campaign, 11, Grosvenor Crescent, London, SW1, 1944.
.