Abstract
The literature relating to experimental animals indicates decreased resistance to tuberculous infection in animals on vitamin C deficient diets.1-5 Conversely, animals with chronic disease are more easily precipitated into acute scurvy. 4 Clinical reports 1 , 6 , 7 , 8 have appeared to the effect that scurvy renders a patient increasingly susceptible to tuberculosis, while the addition of vitamin C to the diet improves the prognosis in these cases. With the development of knowledge concerning subclinical vitamin deficiencies 9 , 10 and of a method of judging the state of ascorbic acid nutrition in the human, 10 the study of this substance in its relation to tuberculosis was indicated.
Schroeder 11 has reported an increased requirement of vitamin C in tuberculosis. Three cases were studied: 2 for a period of 5 days during which they were fed 300 mg. of ascorbic acid daily. The report of Bullowa, et al., 12 shows in one tuberculous patient a reduced excretion of vitamin C but with prolonged dosage of ascorbic acid a high peak was reached which fell rapidly on discontinuing the treatment.
The present study includes 44 cases with minimal, moderately advanced and far advanced tuberculosis; with every stage of activity under each type as shown by X-ray, symptomatology, and sedimentation rates.
A consideration of the daily excretion of vitamin C of patients with no complications, on the sanatorium diet, permits a rough classification into 4 groups: those excreting from 0 to 5 mg. of ascorbic acid daily; those from 5 to 8 mg.; those from 8 to 14 mg., and a fourth group comprising those excreting over 14 mg. daily. The method developed by Tillmans, et al., 13 and Harris and Ray 14 for the estimation of vitamin C excretion in urine by titration against phenolindophenol was used throughout. Twenty-four-hour samples were collected, using glacial acetic acid as a preservative. In the group from 0 to 5 mg. daily excretion, there are 6 cases, 5 of which have active tuberculosis and one with questionable activity. This group consists of moderately and far advanced cases. The second group, 5 to 8 mg. daily excretion, has 14 cases, 5 of which are inactive and 9, or 70%, active. The group from 8 to 14 mg. comprises 21 cases with 7 active and 14, or 66%, inactive. The group 14 mg. or above contains 13 cases, one of which is active and 12, or 93%, inactive. This shows a rough parallelism between activity in uncomplicated tuberculosis and the daily excretion of ascorbic acid on a controlled diet. The factor of complications of the disease must be emphasized as it is realized that such conditions as acute sinusitis, etc., might render the determination valueless as an indication of the activity of the tuberculous process.
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