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THE PATHOLOGIC CHANGES RESULTING FROM VITAMIN DEFICIENCY

S. B. WOLBACH, M.D.
[+] Author Affiliations

Owing to lack of space, this article has been abbreviated for publication in The Journal. The complete article appears in the author's reprints.

Read before the Section on Pathology and Physiology at the Eighty-Seventh Annual Session of the American Medical Association, Kansas City, Mo., May 14. 1936.


BOSTON


JAMA. 1937;108(1):7-13. doi:10.1001/jama.1937.02780010009002
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Descriptive accounts of the pathologic changes resulting from each vitamin deficiency would make a voluminous report, dry and nonstimulative. The subject will be presented with the attitude that each deficiency causes distinctive functional disturbances and is accompanied by distinctive morphologic changes which together may reasonably be regarded as primary effects. In consequence, it is assumed that some of the general disturbances in nutrition, blood formation and growth, common to several of the vitamin deficiencies, are in all probability secondary nonspecific effects. The primary morphologic effects, as far as known, when analyzed all prove to be manifestations of retardation or suppression of normal processes. In recovery from a vitamin deficiency following restoration of the vitamin to the diet, normal morphologic sequences are resumed and proceed for a brief period at a rate exceeding the normal, until repair is completed. Possibly physiologic activities of certain types may be suppressed without demonstrable tissue

REFERENCES

Wolbach, S. B., and Howe, P. R.:  Tissue Changes Following Deprivation of Fat-Soluble A Vitamin , J. Exper. Med. 42:753 ( (Dec.) ) 1925;.
Wolbach, S. B., and Howe, P. R.:  Vitamin A Deficiency in the Guinea-Pig , Arch. Path. & Lab. Med. 5: 239 ( (Feb.) ) 1928;.
Wilson, J. R., and Dubois, R. O.:  Keratomalacia in Infant with Postmortem Examination , Am. J. Dis. Child. 26:431 ( (Nov.) ) 1923;.
Blackfan, K. D., and Wolbach, S. B.:  Vitamin A Deficiency in Infants , J. Pediat. 3:679 ( (Nov.) ) 1933;.
Tilden, E. B., and Miller, E. G.:  The Response of the Monkey (Macacus Rhesus) to Withdrawal of Vitamin A from the Diet , J. Nutrition 3: 121 ( (Sept.) ) 1930;.
Wolfe, J. M., and Salter, H. P.:  Vitamin A Deficiency in the Albino Mouse , J. Nutrition 4: 185 ( (July) ) 1931;.
Hughes, J. S.; Aubel, C. F., and Lienhardt, H. E.: The Importance of Vitamin A and Vitamin C in the Ration of Swine, etc., Kansas State Agric. Coll. Techn. Bull. 23, 1928.
Steenbock, Harry; Nelson, E. M., and Hart, E. B.:  Fat-Soluble Vitamins: The Incidence of an Ophthalmic Reaction in Dogs Fed on a Fat-Soluble Deficient Diet , Am. J. Physiol. 58:14 ( (Nov.) ) 1921;.
Stimson, A. M., and Hedley, O. F.:  Observations on Vitamin A Deficiency in Dogs , Pub. Health Rep. 48:445 ( (April 28) ) 1933;.
Nelson, V. E., and Lamb, A. R.:  The Effect of Vitamin Deficiency on Various Species of Animals , Am. J. Physiol. 51:530 ( (April) ) 1920;.
Nelson, V. E.; Lamb, A. R., and Heller, V. G.:  The Effect of Vitamin Deficiency on Various Species of Animals , Am. J. Physiol. 59: 335 ( (Feb.) ) 1922;.
Jones, I. R.; Eckles, C. H., and Palmer, L. S.:  The Rôle of Vitamin A in the Nutrition of Calves , J. Dairy Sc. 9: 119, 1926;.
Guilbert, H. R., and Hart, G. H.:  Storage of Vitamin A in Cattle , J. Nutrition 8:25 ( (July) ) 1934;.
Beach, J. R:  Vitamin A Deficiency in Poultry , Science 58:542, 1923;.
Guerreró, L. E., and Concepcion, I.:  Xerophthalmia in Fowls Fed on Polished Rice and Its Clinical Importance , Philippine J. Sc. 17: 99 ( (July) ) 1920;.
Emmett, A. D., and Peacock, G. J.:  Does the Chick Require the Fat-Soluble Vitamins? J. Biol. Chem. 56: 679 ( (June) ) 1923;.
Wolbach, S. B., and Howe, P. R.:  Epithelial Repair in Recovery from Vitamin A Deficiency: An Experimental Study , J. Exper. Med. 57:511 ( (March) ) 1933;
Wolbach, S. B., and Howe, P. R.:  The Incisor Teeth of Albino Rats and Guinea-Pigs in Vitamin A Deficiency and Repair , Am. J. Path. 9:275 ( (May) ) 1933;.
Mellanby, May:  The Influence of Diet on the Structure of the Teeth , Physiol. Rev. 8:545 ( (Oct.) ) 1928;.
Boyle, P. E.:  Manifestations of Vitamin A Deficiency in a Human Tooth Germ , J. Dental Research 13:39 ( (Feb.) ) 1933;.
Hughes, Aubel and Lienhardt.6 Hughes, J. S.;  Lienhardt, H. F., and Aubel, C. E.: Nerve Degeneration Resulting from Avitaminosis A , J. Nutrition 2: 183 ( (Nov.) ) 1929;.
Zimmerman, H. M.:  Lesions of the Nervous System in Vitamin Deficiency: I. Rats on a Diet Low in Vitamin A , J. Exper. Med. 57: 215 ( (Feb.) ) 1933;.
Aberle, S. B. D.:  Neurological Disturbances in Rats Reared on Diets Deficient in Vitamin A , J. Nutrition 7:445 ( (April) ) 1934;.
Mellanby, Edward:  Xerophthalmia, Trigeminal Degeneration and Vitamin A Deficiency , J. Path. & Bact. 38:391 ( (May) ) 1934;
Nutrition and Disease: The Interaction of Clinical and Experimental Work , Edinburgh and London, Oliver and Boyd, 1934;.
Long, J. A., and Evans, H. McL.: The Oestrus Cycle in the Rat and Its Associated Phenomena , Memoirs of the University of California, vol. 6, 1922;.
Ascboff, L., and Koch, W.: Scorbut, Eine Pathologish-Anatomische Studie , Jena, Gustav Fischer, 1919;.
Hess, A. F.: Scurvy, Past and Present , Philadelphia, J. B. Lippincott Company, 1920;.
Wolbach, S. B., and Howe, P. R.:  Intercellular Substances in Experimental Scorbutus , Arch. Path. & Lab. Med. 1:1 ( (Jan.) ) 1926;.
Menkin, Valy; Wolbach, S. B., and Menkin, Miriam F.:  Formation of Intercellular Substance by the Administration of Ascorbic Acid (Vitamin C) in Experimental Scorbutus , Am. J. Path. 10:569 ( (Sept.) ) 1934;.
Wolbach, S. B.:  Controlled Formation of Collagen and Reticulum: A Study of the Source of Intercellular Substance in Recovery from Experimental Scorbutus , Am. J. Path. ( (suppl.) ) 9:689, 1933;.
Erdheim, J.:  Ueber das Barlow Herz , Wien. klin. Wchnschr. 31: 1293, 1918;.
Goettsch, M., and Pappenheimer, A. M.:  Nutritional Muscular Dystrophy in the Guinea-Pig and Rabbit , J. Exper. Med. 54: 145 ( (Aug.) ) 1931;.
Rogers, W. M.; Pappenheimer, A. M., and Goettsch, M.:  Nerve Endings in Nutritional Muscular Dystrophy in Guinea-Pigs , J. Exper. Med. 54: 167 ( (Aug.) ) 1931;.
Bessey, O.; Boyle, P., and Wolbach, S. B.: Unpublished research.
Park, E. A.; Guild, H. G.; Jackson, D., and Bond, M.:  The Recognition of Scurvy with Especial Reference to the Early X-Ray Changes , Arch. Dis. Childhood 10:265 ( (Aug.) ) 1935;.
Elliot, W. E.; Crichton, A., and Orr, J. B.  Rickets in Pigs , Brit. J. Exper. Path. 3: 10 ( (Feb.) ) 1922;.
Goldblatt, H., and Moritz, A. R.:  Experimental Rickets in Rabbits , J. Exper. Med. 42:499 ( (Oct.) ) 1925;.
Christeller, E.:  Die Formen der Ostitis Fibrosa der Saügetiere, etc. , Ergeb. d. allg. Path. u. path. Anat. 20: 1 (part (2) ) 1922;.
Nonidez, J. F.:  Studies on the Bones in Avian Rickets , Am. J. Path. 4: 463 ( (Sept.) ) 1928;.
Pommer, G.: Untersuchungen über Osteomalacie und Rachitis , Leipzig, 1885;.
Schmorl, G.:  Die pathologische Anatomie der rachitischen Knochenerkrankung mit besonderer Berücksichtigung ihrer Histologie und Pathogenese , Ergebn. d. inn. Med. u. Kinderh. 4:403, 1909;.
Erdheim, J.: Rachitis und epithel Körperchen , Vienna, 1914;.
Pappenheimer, A. M.:  Experimental Rickets in Rats , J. Exper. Med. 36:335 ( (Sept.) ) 1922;.
Hess, A. F.: Rickets, Including Osteomalacia and Tetany , Philadelphia, Lea & Febiger, 1930;.
Shohl, A. T., and Wolbach, S. B.:  Rickets in Rats: XV. The Effect of Low Calcium-High Phosphorus Diets at Various Levels and Ratios upon the Production of Rickets and Tetany , J. Nutrition 11: 275 ( (March) ) 1936;.
Browning, E.: The Vitamins , Monograph 1 of the Pickett-Thomson Research Laboratory, London, Bailliere, Tindall and Cox, 1931;.
Wolbach, S. B.: Unpublished research.
Ogata, T. S.:  Reserat über die Reiserkrankung des Geflügels , Verhandl. d. Japan path. Gesellsch. 10: 1, 1920;.
Bierry, H., and Kollmann, M.:  Le pancréas et le testicule au cours de la polynéurite aviare , Compt. rend. Acad. d. sc. 186:264 ( (Jan. 23) ) 1928;.
Birch, T. W.; György, P., and Harris, L. J.:  The Vitamin B2 Complex: Differentiation of the Antiblacktongue and the "P-P" Factors from Lactoflavin and Vitamin B6 (So-Called "Rat Pellagra" Factor) , Biochem. J. 29:2830 ( (Dec.) ) 1935;.
Zimmerman, H. M., and Burack, Ethel:  Studies on the Nervous System in Deficiency Diseases: II. Lesions Produced in the Dog by Diets Lacking the Water-Soluble, Heat-Stable Vitamin B2 (G) , J. Exper. Med. 59:21 ( (Jan.) ) 1934;.

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Wolbach, S. B., and Howe, P. R.:  Tissue Changes Following Deprivation of Fat-Soluble A Vitamin , J. Exper. Med. 42:753 ( (Dec.) ) 1925;.
Wolbach, S. B., and Howe, P. R.:  Vitamin A Deficiency in the Guinea-Pig , Arch. Path. & Lab. Med. 5: 239 ( (Feb.) ) 1928;.
Wilson, J. R., and Dubois, R. O.:  Keratomalacia in Infant with Postmortem Examination , Am. J. Dis. Child. 26:431 ( (Nov.) ) 1923;.
Blackfan, K. D., and Wolbach, S. B.:  Vitamin A Deficiency in Infants , J. Pediat. 3:679 ( (Nov.) ) 1933;.
Tilden, E. B., and Miller, E. G.:  The Response of the Monkey (Macacus Rhesus) to Withdrawal of Vitamin A from the Diet , J. Nutrition 3: 121 ( (Sept.) ) 1930;.
Wolfe, J. M., and Salter, H. P.:  Vitamin A Deficiency in the Albino Mouse , J. Nutrition 4: 185 ( (July) ) 1931;.
Hughes, J. S.; Aubel, C. F., and Lienhardt, H. E.: The Importance of Vitamin A and Vitamin C in the Ration of Swine, etc., Kansas State Agric. Coll. Techn. Bull. 23, 1928.
Steenbock, Harry; Nelson, E. M., and Hart, E. B.:  Fat-Soluble Vitamins: The Incidence of an Ophthalmic Reaction in Dogs Fed on a Fat-Soluble Deficient Diet , Am. J. Physiol. 58:14 ( (Nov.) ) 1921;.
Stimson, A. M., and Hedley, O. F.:  Observations on Vitamin A Deficiency in Dogs , Pub. Health Rep. 48:445 ( (April 28) ) 1933;.
Nelson, V. E., and Lamb, A. R.:  The Effect of Vitamin Deficiency on Various Species of Animals , Am. J. Physiol. 51:530 ( (April) ) 1920;.
Nelson, V. E.; Lamb, A. R., and Heller, V. G.:  The Effect of Vitamin Deficiency on Various Species of Animals , Am. J. Physiol. 59: 335 ( (Feb.) ) 1922;.
Jones, I. R.; Eckles, C. H., and Palmer, L. S.:  The Rôle of Vitamin A in the Nutrition of Calves , J. Dairy Sc. 9: 119, 1926;.
Guilbert, H. R., and Hart, G. H.:  Storage of Vitamin A in Cattle , J. Nutrition 8:25 ( (July) ) 1934;.
Beach, J. R:  Vitamin A Deficiency in Poultry , Science 58:542, 1923;.
Guerreró, L. E., and Concepcion, I.:  Xerophthalmia in Fowls Fed on Polished Rice and Its Clinical Importance , Philippine J. Sc. 17: 99 ( (July) ) 1920;.
Emmett, A. D., and Peacock, G. J.:  Does the Chick Require the Fat-Soluble Vitamins? J. Biol. Chem. 56: 679 ( (June) ) 1923;.
Wolbach, S. B., and Howe, P. R.:  Epithelial Repair in Recovery from Vitamin A Deficiency: An Experimental Study , J. Exper. Med. 57:511 ( (March) ) 1933;
Wolbach, S. B., and Howe, P. R.:  The Incisor Teeth of Albino Rats and Guinea-Pigs in Vitamin A Deficiency and Repair , Am. J. Path. 9:275 ( (May) ) 1933;.
Mellanby, May:  The Influence of Diet on the Structure of the Teeth , Physiol. Rev. 8:545 ( (Oct.) ) 1928;.
Boyle, P. E.:  Manifestations of Vitamin A Deficiency in a Human Tooth Germ , J. Dental Research 13:39 ( (Feb.) ) 1933;.
Hughes, Aubel and Lienhardt.6 Hughes, J. S.;  Lienhardt, H. F., and Aubel, C. E.: Nerve Degeneration Resulting from Avitaminosis A , J. Nutrition 2: 183 ( (Nov.) ) 1929;.
Zimmerman, H. M.:  Lesions of the Nervous System in Vitamin Deficiency: I. Rats on a Diet Low in Vitamin A , J. Exper. Med. 57: 215 ( (Feb.) ) 1933;.
Aberle, S. B. D.:  Neurological Disturbances in Rats Reared on Diets Deficient in Vitamin A , J. Nutrition 7:445 ( (April) ) 1934;.
Mellanby, Edward:  Xerophthalmia, Trigeminal Degeneration and Vitamin A Deficiency , J. Path. & Bact. 38:391 ( (May) ) 1934;
Nutrition and Disease: The Interaction of Clinical and Experimental Work , Edinburgh and London, Oliver and Boyd, 1934;.
Long, J. A., and Evans, H. McL.: The Oestrus Cycle in the Rat and Its Associated Phenomena , Memoirs of the University of California, vol. 6, 1922;.
Ascboff, L., and Koch, W.: Scorbut, Eine Pathologish-Anatomische Studie , Jena, Gustav Fischer, 1919;.
Hess, A. F.: Scurvy, Past and Present , Philadelphia, J. B. Lippincott Company, 1920;.
Wolbach, S. B., and Howe, P. R.:  Intercellular Substances in Experimental Scorbutus , Arch. Path. & Lab. Med. 1:1 ( (Jan.) ) 1926;.
Menkin, Valy; Wolbach, S. B., and Menkin, Miriam F.:  Formation of Intercellular Substance by the Administration of Ascorbic Acid (Vitamin C) in Experimental Scorbutus , Am. J. Path. 10:569 ( (Sept.) ) 1934;.
Wolbach, S. B.:  Controlled Formation of Collagen and Reticulum: A Study of the Source of Intercellular Substance in Recovery from Experimental Scorbutus , Am. J. Path. ( (suppl.) ) 9:689, 1933;.
Erdheim, J.:  Ueber das Barlow Herz , Wien. klin. Wchnschr. 31: 1293, 1918;.
Goettsch, M., and Pappenheimer, A. M.:  Nutritional Muscular Dystrophy in the Guinea-Pig and Rabbit , J. Exper. Med. 54: 145 ( (Aug.) ) 1931;.
Rogers, W. M.; Pappenheimer, A. M., and Goettsch, M.:  Nerve Endings in Nutritional Muscular Dystrophy in Guinea-Pigs , J. Exper. Med. 54: 167 ( (Aug.) ) 1931;.
Bessey, O.; Boyle, P., and Wolbach, S. B.: Unpublished research.
Park, E. A.; Guild, H. G.; Jackson, D., and Bond, M.:  The Recognition of Scurvy with Especial Reference to the Early X-Ray Changes , Arch. Dis. Childhood 10:265 ( (Aug.) ) 1935;.
Elliot, W. E.; Crichton, A., and Orr, J. B.  Rickets in Pigs , Brit. J. Exper. Path. 3: 10 ( (Feb.) ) 1922;.
Goldblatt, H., and Moritz, A. R.:  Experimental Rickets in Rabbits , J. Exper. Med. 42:499 ( (Oct.) ) 1925;.
Christeller, E.:  Die Formen der Ostitis Fibrosa der Saügetiere, etc. , Ergeb. d. allg. Path. u. path. Anat. 20: 1 (part (2) ) 1922;.
Nonidez, J. F.:  Studies on the Bones in Avian Rickets , Am. J. Path. 4: 463 ( (Sept.) ) 1928;.
Pommer, G.: Untersuchungen über Osteomalacie und Rachitis , Leipzig, 1885;.
Schmorl, G.:  Die pathologische Anatomie der rachitischen Knochenerkrankung mit besonderer Berücksichtigung ihrer Histologie und Pathogenese , Ergebn. d. inn. Med. u. Kinderh. 4:403, 1909;.
Erdheim, J.: Rachitis und epithel Körperchen , Vienna, 1914;.
Pappenheimer, A. M.:  Experimental Rickets in Rats , J. Exper. Med. 36:335 ( (Sept.) ) 1922;.
Hess, A. F.: Rickets, Including Osteomalacia and Tetany , Philadelphia, Lea & Febiger, 1930;.
Shohl, A. T., and Wolbach, S. B.:  Rickets in Rats: XV. The Effect of Low Calcium-High Phosphorus Diets at Various Levels and Ratios upon the Production of Rickets and Tetany , J. Nutrition 11: 275 ( (March) ) 1936;.
Browning, E.: The Vitamins , Monograph 1 of the Pickett-Thomson Research Laboratory, London, Bailliere, Tindall and Cox, 1931;.
Wolbach, S. B.: Unpublished research.
Ogata, T. S.:  Reserat über die Reiserkrankung des Geflügels , Verhandl. d. Japan path. Gesellsch. 10: 1, 1920;.
Bierry, H., and Kollmann, M.:  Le pancréas et le testicule au cours de la polynéurite aviare , Compt. rend. Acad. d. sc. 186:264 ( (Jan. 23) ) 1928;.
Birch, T. W.; György, P., and Harris, L. J.:  The Vitamin B2 Complex: Differentiation of the Antiblacktongue and the "P-P" Factors from Lactoflavin and Vitamin B6 (So-Called "Rat Pellagra" Factor) , Biochem. J. 29:2830 ( (Dec.) ) 1935;.
Zimmerman, H. M., and Burack, Ethel:  Studies on the Nervous System in Deficiency Diseases: II. Lesions Produced in the Dog by Diets Lacking the Water-Soluble, Heat-Stable Vitamin B2 (G) , J. Exper. Med. 59:21 ( (Jan.) ) 1934;.
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