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BORDERLINE STATES OF NUTRITIVE FAILURE

JAMES S. McLESTER, M.D.
[+] Author Affiliations

The DaCosta Foundation Oration, read before the Philadelphia County Medical Society, Philadelphia, March 15, 1939.


BIRMINGHAM, ALA.


JAMA. 1939;112(21):2110-2114. doi:10.1001/jama.1939.02800210004002
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Nutrition now occupies the center of the stage. Formerly she played only a minor, somewhat unattractive, role and her lines were few, but today she enjoys a leading part and has the spotlight. Still greater brilliance of performance is promised. This advancement began about a quarter of a century ago when man's imagination was fired and his zeal for scientific inquiry kindled by the discovery that certain hitherto unknown substances, later called vitamins, although required only in minute amounts, are absolutely essential to the orderly progress of an animal's life processes. Without these substances the young fail to grow and the older animal sickens. It is of this sickness, in its many forms, that I wish to speak.

Three facts concerning nutritive failure are becoming increasingly obvious: first, that it does not come solely from lack of vitamins but from deficiency of proteins and minerals as well; in certain of

REFERENCES

Mackie, T. T.; Miller, D. K., and Rhoads, C. P.:  Sprue: Roentgenologic Changes in the Small Intestine , Am. J. Trop. Med. 15:571-589 ( (Sept.) ) 1935;.
Miller, D. K., and Rhoads, C. P.:  The Experimental Production of Loss of Hematopoietic Elements of the Gastric Secretion and of the Liver in Swine with Achlorhydria and Anemia , J. Clin. Investigation 14: 153-172 ( (March) ) 1935;.
Whipple: Personal communication to the author.
Kellogg, Frederick, and Mettier, S. R.:  Effect of Alkaline Therapy for Peptic Ulcer on Utilization of Dietary Iron in the Regeneration of Hemoglobin , Arch. Int. Med. 58:278 ( (Aug.) ) 1936;.
Cowgill, G. R.:  The Physiology of Vitamin B1 , J. A. M. A. 110: 805-812 ( (March 12) ) 1938;.
Williams, R. R., and Spies, T. D.: Vitamin B1 and Its Use in Medicine , New York, Macmillan Company, 1938;.
Heymann, Walter:  Importance of the Liver for the Antirachitic Efficacy of Vitamin D , Proc. Soc. Exper. Biol. & Med. 36:812-814 ( (June) ) 1937;.
Sherman, H. C., and Ellis, L. N.:  Necessary Versus Optimal Intake of Vitamin G , J. Biol. Chem. 104:91 ( (Jan.) ) 1934;.
Batchelder, E. L.:  Nutritional Significance of Vitamin A Throughout the Life Cycle , Am. J. Physiol. 109:430 ( (Sept.) ) 1934;.
Knott, Elizabeth M.:  A Quantitative Study of the Utilization and Retention of Vitamin B by Young Children , J. Nutrition 12: 597 ( (Dec.) ) 1936;.
Minot, G. R.:. Nutritional Deficiency , Ann. Int. Med. 12:429 ( (Oct.) ) 1938;.
Brennan, T. J.:  The Early Diagnosis of Beriberi , Nutrition Abstr. & Rev. 2: 841 ( (April) ) 1933;.
Cowgill, G. R., and Gilman, Alfred:  Physiology of Vitamins: XXIII. The Effect of Lack of the Vitamin B Complex on the Secretion of Gastric Juice in Dogs with Gastric Pouches , Arch. Int. Med. 53:58 ( (Jan.) ) 1934;.
Shimazono, J., quoted by Cowgill, G. R.: The Vitamin B Requirements of Man Yale University Press, 1934;.
McLester, James S.:  The Nature of Pellagra: A Critique , Ann. Int. Med. 8:475 ( (Oct.) ) 1934;.
Minot, G. R.:  The Anemias of Nutritional Deficiency , J. A. M. A. 105: 1176 ( (Oct. 12) ) 1935;.
Youmans, J. B., and Corlette, M. B.:  Specific Dermatoses Due to Vitamin A Deficiency , Am. J. M. Sc. 195: 644 ( (May) ) 1938;.
Weiss, Soma, and Wilkins, R. W.:  The Nature of the Cardiovascular Disturbances in Nutritional Deficiency States (Beriberi) , Ann. Int. Med. 11:140 ( (July) ) 1937;
 Disturbances of the Cardiovascular System in Nutritional Deficiency , J. A. M. A. 109: 786 ( (Sept.) ) 1937;.
Strauss, M. B., and McDonald, W. J.:  Polyneuritis of Pregnancy: A Dietary Deficiency Disorder , J. A. M. A. 100: 1320 ( (April 29) ) 1933;.
Strauss, M. B.:  Nutritional Deficiency and Water Retention in the Toxemias of Pregnancy , J. Clin. Investigation 14:710 ( (Sept.) ) 1935;
 Observations on the Etiology of the Toxemias of Pregnancy , Am. J. M. Sc. 194: 772 ( (Dec.) ) 1937;.
Weech, A. A.; Wollstein, M., and Goettsch, E.:  Nutritional Edema in the Dog , J. Clin. Investigation 16: 719 ( (Sept.) ) 1937;.
Connor, C. L.:  The Etiology and Pathogenesis of Alcoholic Cirrhosis of the Liver , J. A. M. A. 112: 387 ( (Feb. 4) ) 1939;.
Bourne, M. C.:  Metabolic Factors in Cataract Production , Physiol. Rev. 17: 1 ( (Jan.) ) 1937;.
Rinehart, J. F.; Greenberg, L. D.; Baker, Frances; Mettier, S. R.; Brukman, F., and Choy, Frank:  Metabolism of Vitamin C in Rheumatoid Arthritis , Arch. Int. Med. 61:537 ( (April) ) 1938;.
Rinehart, J. F.; Greenberg, L. D.; Olney, Mary, and Choy, Frank:  Metabolism of Vitamin C in Rheumatic Fever , Arch. Int. Med. 61:552 ( (April) ) 1938;.
French, L. R., and Bloomfield, A. L.:  "Latent Deficiency" in Rats , J. Nutrition 14: 117 ( (Aug. 10) ) 1937;.
Richards, M. B.:  Role of Vitamin A in Nutrition , Brit. M. J. 1: 99 ( (Jan. 19) ) 1935;.

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Mackie, T. T.; Miller, D. K., and Rhoads, C. P.:  Sprue: Roentgenologic Changes in the Small Intestine , Am. J. Trop. Med. 15:571-589 ( (Sept.) ) 1935;.
Miller, D. K., and Rhoads, C. P.:  The Experimental Production of Loss of Hematopoietic Elements of the Gastric Secretion and of the Liver in Swine with Achlorhydria and Anemia , J. Clin. Investigation 14: 153-172 ( (March) ) 1935;.
Whipple: Personal communication to the author.
Kellogg, Frederick, and Mettier, S. R.:  Effect of Alkaline Therapy for Peptic Ulcer on Utilization of Dietary Iron in the Regeneration of Hemoglobin , Arch. Int. Med. 58:278 ( (Aug.) ) 1936;.
Cowgill, G. R.:  The Physiology of Vitamin B1 , J. A. M. A. 110: 805-812 ( (March 12) ) 1938;.
Williams, R. R., and Spies, T. D.: Vitamin B1 and Its Use in Medicine , New York, Macmillan Company, 1938;.
Heymann, Walter:  Importance of the Liver for the Antirachitic Efficacy of Vitamin D , Proc. Soc. Exper. Biol. & Med. 36:812-814 ( (June) ) 1937;.
Sherman, H. C., and Ellis, L. N.:  Necessary Versus Optimal Intake of Vitamin G , J. Biol. Chem. 104:91 ( (Jan.) ) 1934;.
Batchelder, E. L.:  Nutritional Significance of Vitamin A Throughout the Life Cycle , Am. J. Physiol. 109:430 ( (Sept.) ) 1934;.
Knott, Elizabeth M.:  A Quantitative Study of the Utilization and Retention of Vitamin B by Young Children , J. Nutrition 12: 597 ( (Dec.) ) 1936;.
Minot, G. R.:. Nutritional Deficiency , Ann. Int. Med. 12:429 ( (Oct.) ) 1938;.
Brennan, T. J.:  The Early Diagnosis of Beriberi , Nutrition Abstr. & Rev. 2: 841 ( (April) ) 1933;.
Cowgill, G. R., and Gilman, Alfred:  Physiology of Vitamins: XXIII. The Effect of Lack of the Vitamin B Complex on the Secretion of Gastric Juice in Dogs with Gastric Pouches , Arch. Int. Med. 53:58 ( (Jan.) ) 1934;.
Shimazono, J., quoted by Cowgill, G. R.: The Vitamin B Requirements of Man Yale University Press, 1934;.
McLester, James S.:  The Nature of Pellagra: A Critique , Ann. Int. Med. 8:475 ( (Oct.) ) 1934;.
Minot, G. R.:  The Anemias of Nutritional Deficiency , J. A. M. A. 105: 1176 ( (Oct. 12) ) 1935;.
Youmans, J. B., and Corlette, M. B.:  Specific Dermatoses Due to Vitamin A Deficiency , Am. J. M. Sc. 195: 644 ( (May) ) 1938;.
Weiss, Soma, and Wilkins, R. W.:  The Nature of the Cardiovascular Disturbances in Nutritional Deficiency States (Beriberi) , Ann. Int. Med. 11:140 ( (July) ) 1937;
 Disturbances of the Cardiovascular System in Nutritional Deficiency , J. A. M. A. 109: 786 ( (Sept.) ) 1937;.
Strauss, M. B., and McDonald, W. J.:  Polyneuritis of Pregnancy: A Dietary Deficiency Disorder , J. A. M. A. 100: 1320 ( (April 29) ) 1933;.
Strauss, M. B.:  Nutritional Deficiency and Water Retention in the Toxemias of Pregnancy , J. Clin. Investigation 14:710 ( (Sept.) ) 1935;
 Observations on the Etiology of the Toxemias of Pregnancy , Am. J. M. Sc. 194: 772 ( (Dec.) ) 1937;.
Weech, A. A.; Wollstein, M., and Goettsch, E.:  Nutritional Edema in the Dog , J. Clin. Investigation 16: 719 ( (Sept.) ) 1937;.
Connor, C. L.:  The Etiology and Pathogenesis of Alcoholic Cirrhosis of the Liver , J. A. M. A. 112: 387 ( (Feb. 4) ) 1939;.
Bourne, M. C.:  Metabolic Factors in Cataract Production , Physiol. Rev. 17: 1 ( (Jan.) ) 1937;.
Rinehart, J. F.; Greenberg, L. D.; Baker, Frances; Mettier, S. R.; Brukman, F., and Choy, Frank:  Metabolism of Vitamin C in Rheumatoid Arthritis , Arch. Int. Med. 61:537 ( (April) ) 1938;.
Rinehart, J. F.; Greenberg, L. D.; Olney, Mary, and Choy, Frank:  Metabolism of Vitamin C in Rheumatic Fever , Arch. Int. Med. 61:552 ( (April) ) 1938;.
French, L. R., and Bloomfield, A. L.:  "Latent Deficiency" in Rats , J. Nutrition 14: 117 ( (Aug. 10) ) 1937;.
Richards, M. B.:  Role of Vitamin A in Nutrition , Brit. M. J. 1: 99 ( (Jan. 19) ) 1935;.
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