Vitamin deficiencies during the Spanish Civil War in Madrid: a reminiscence

During the second winter of the war (1937-38) most of the patients showed a picture of classic pellagra, with a number of neurological disorders which in same cases appeared with no other manifestations of Pellagra. The clinical picture was dominated by the appearance of famine edema, with less manifestations of specific vitamin deficiencies, with neurological manifestations called similar to those "burning feet" syndrome and described by us as Paresthetic and Paresthetic-causalgic syndrome. The prominent features were: acroparesthesia, dysestesia dolorosa, sensation of cold, sensation of wetness, hyperpathia and causalgic pain. Treatment with nicotinic acid was very effective for the classical manifestations of Pellagra (dermatitis, diarrhea and dementia), but had no significant effect on the neurological manifestations. No effect of vitamin B1 was observed, but some improvement following the administration of autoclaved brewers yeast. It was concluded that the neurological manifestations often associated with the classical picture of Pellagra are not due to nicotinic acid deficiency, but to the deficiency of some component of the vitamin B complex which was neither vitamin B1, nor vitamin B2.