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February 10, 1945


JAMA. 1945;127(6):354. doi:10.1001/jama.1945.02860060052022

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To the Editor:—  I was greatly interested in the paper "A Subacute Generalized Neuromuscular Exhaustion Syndrome" by J. M. Nielson, in The Journal, Nov. 25, 1944, page 801. A possible etiologic explanation for this "syndrome" is that it represents acute beriberi (i. e., acute polyneuritis). It could be explained on the basis of exhaustion of vitamin B by the heightened metabolism of excessive physical exertion in the face of a relatively inadequate supply of that vitamin.As pointed out by G. R. Cowgill (The Vitamin B Requirement of Man, New Haven, Conn., Yale University Press, 1934) any proces's increasing the total metabolism will increase the requirement for vitamin B.I reported (case 7 in Vitamin B Deficiency in Private Practice, New England J. Med.231:174 [Aug. 3] 1944) a slightly similar though very much milder case of peripheral neuritis of the nerves of the arms and hands of a

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