In the latter part of the '50s a married woman of about 40 was brought to an Eastern diagnostic clinic by her husband.

Her story was brief and somewhat baffling. A number of months previously she had begun to lose some of her hair. She became extremely depressed, self-conscious, and irritable.

Soon she began to believe that her friends were deliberately attempting to embarrass her by calling attention to her hair. She stopped seeing friends, refused to go out, and no longer attended social functions.

By the time she was taken to the clinic, she had paranoid ideas, with delusions of being persecuted.

"I've done everything I can," the husband told the doctors at the clinic. "At first, I tried to cheer her up, to convince her that things weren't nearly as bad as she thought they were. But she seemed to become even more despondent. She wouldn't eat. You can see her now. She's just a shadow of the lovely woman she was less than a year ago."

He hesitated and his eyes filled with moisture.

"She's had medical attention," he said. "You have the his­tories they've sent. They simply can't find out what it is. It's mental. I know that. She's even had electroshock treatment. But it hasn't helped."

He stopped speaking and looked at the doctors. One of them smiled thoughtfully.

"I'm not certain that we can help," the doctor said.

"But you'll try?"

"Of course!" both of them assured the worried husband in the same instant.

Examination showed that the wife was obviously mentally ill. She was tense, slow in movement, thought and apprehen­sive. Some of her answers to questions were irrational. Some were incomplete.

She was dehydrated and fluids were given to her intra­venously. She was given drugs to calm her apprehensions and ease her tension.

A very careful, searching physical examination was begun.

Her thinning hair was obvious. There was a waxiness to her skin. Her tongue was smooth. There were indications of changes in her nervous system.

After several days of testing, it was discovered that she was lacking in vitamin B-12. Usually this pronounced deficiency would be associated with pernicious anemia, but in this case it was not.

"Perhaps," one of the doctors suggested, "the anemia might come later. Maybe the mental aberrations are preceding the anemia."

Injections of B-12 were given to her. In a very short time a change began to take place. Within a week she was free of her depression and apprehension. She was eating better, sleep­ing better.

Within two months she was home, doing her housework, mentally normal, enjoying her friends again, and evidently well on the road to a good recovery.

Her case is an excellent example of the importance of vitamins in treating some illnesses, and it also is one of the first cases that demonstrated the importance of one particular vitamin in relation to the treatment of a mental condition.

Within the last four months, the following conversation was overheard in a "food store" that specialized in vitamin and mineral supplements along with "health foods."

A middle-aged woman clerk, wearing a white uniform not unlike that of an attendant in a doctor's office, was talking to an elderly woman who was rather poorly but neatly dressed. She listened intently as the clerk spoke.

"What you need for that terribly tired feeling is iodine," the clerk said. "We have it specially prepared."

"But I thought maybe some vitamins—"

"Oh, you'll need those, too. We have a multivitamin that has all the vitamins you need as well as all the trace minerals. Then if you'll take this iodine I'm certain you'll feel much better."

"Are the vitamins really good?"

"They're our high potency vitamins. They have A, most of the Bs, C, D, and E. There's also all the trace minerals plus brewers yeast. You know, as we get older, we simply must supplement our vitamin and mineral intake. You know about our foods, of course—"

"Foods?"

"I mean the foods you buy in most stores—and the ones we have here. Our bread, for instance. We don't use the refined flour from which all the nutrition has been extracted in processing. We use whole wheat. And all of our other foods are fully nutritional. Even so, it's advisable to take supple­mentary minerals. It's the land."

The elderly lady looked at her with puzzled eyes.

"Our land has been farmed so much the soils are depleted," the clerk said. "It stands to reason that foods raised on it lack essentials, so all of us take trace minerals along with vitamins to make up for what the soil fails to give the foods we raise."

The clerk nodded wisely at her customer.

"And when they say a white flour is enriched—well . . . I just suggest that you try our multivitamins and some of our natural health food. I'm certain that you'll like it. And, of course, the iodine ..."

The clerk made her sale. The cost to the elderly woman was $6.25 for the multivitamins and $1.25 for the iodine. She also bought some health food.

A few days later the person who had overheard the con­versation was talking with a doctor and questioned him about the iodine sale to the elderly woman.

"Do you know how much iodine?" the doctor asked sharply.

"I'm not certain. But I had the impression that it was in fairly heavy doses."

"That old woman can be seriously harmed with overdoses of iodine. It could even be fatal."

"Do you think she needed the multivitamins?"

"Not unless she has a real deficiency, and in that case she should probably have therapeutic doses prescribed by her doctor. If she's following an ordinary, well-balanced diet, she's probably getting plenty of vitamins."

These two cases tell a part of the vitamin-mineral story in America today.

Another factor tells more of it. Doctors' prescriptions for vitamins totaled $29 million in 1958, according to estimates. For the same year, the American Medical Association esti­mated and observed that commercial drug firms had sold 10 million Americans $500 million worth of vitamins and minerals for which the buyers had no need, and for whom— in some cases—the vitamin-minerals may have done consid­erable harm. (A Consumer Report observation in 1960 placed the total vitamin-mineral sale at $400 million a year.)

Most of the furor about vitamins actually began back in 1936 when vitamin B-l was successfully synthesized. The existence of vitamins had been known for many years. Their importance to the body also was known. But until this time, the usual method of prescribing for a deficiency in a vitamin was through a food known to contain the desired vitamin.

With B-l synthesized, additional vitamins followed. Doctors now could prescribe to meet exact vitamin needs.

Soon vitamins were on the open market for anyone to buy. The word became almost magic. Books appeared about vita­mins and certain minerals the body needs. Various dietary experts in the area began to accumulate large audiences and followers. Vitamins became big business.

Before examining the strange tug-of-war that has been going on recently in relation to the public's concept of vita­mins, it may be wise to define vitamins.

Actually the name is a misnomer, as is pointed out by Dr. Paul Kuhne: "It originated because the first vitamin to be discovered belonged to the chemical substance group of 'amines.' It was a vital amine. Most vitamins are, however, not amines, but this was not known at the time."

A medical definition of vitamin is clear and simple: "A general name for a number of unrelated organic substances that occur in many foods in small amounts and that are neces­sary for the normal metabolic functioning of the body. They may be water-soluble, or fat-soluble."

Deprived of vitamins, the body cannot manufacture them. Without them illness or death can result.

(It should also be noted that certain minerals are also as essentially required by the human body.)

Before taking a closer look at the individual vitamins, it might be emphasized that with the exception of Vitamin C, which we need in a rather substantial amount each day, the quantities we need of all other vitamins actually are very small, averaging in the neighborhood of 1 to 3 milligrams, up to possibly 10 or so for a couple. (The Vitamin C daily allow­ance for an adult is estimated at 70 to 150 milligrams.)

Probably innumerable tables have been printed, summariz­ing information about the different vitamins—usually giving their principal sources, properties, physiologic effects, defi­ciency symptoms, and daily allowances or requirements. There is general agreement and little variation among the tables.

Vitamin A is necessary for healthy mucous membranes, skin, hair, and various parts of the eye. Poor night vision may result from a deficiency of vitamin A, as well as coarse and shaggy hair, and unhealthy mucous membranes of nose, mouth, windpipe, and urinary tract. Sources of vitamin A include fish liver oils, liver, eggs, milk, butter, green leafy or yellow vegetables.

Vitamin B complex. Once there was thought to be only one vitamin B. Now we know that there are at least ten. Three are considered to be most important.

B-l, Thiamin is important to carbohydrate metabolism, growth, and nerve function. A deficiency can result in beri­beri, peripheral neuritis, and cardiac disease. It is found in substantial amounts in whole grains, milk, eggs, meat, liver, nuts, potatoes, some fruits, and most vegetables.

B-2, Riboflavin, which promotes general health and growth. A deficiency causes cracks in the corners of the mouth, and other mouth, lip, skin, and eye troubles. It is found in milk, cheese, liver, organ meats, beef muscle, and egg white.

Niacin (nicotinic acid) is essential for tissue respiration, metabolism, growth, gastrointestinal function, and normal skin. A niacin deficiency can bring mouth, skin and intestinal trouble which may be part of a disease called pellagra.

Vitamin C (ascorbic acid) is necessary for the development of teeth, bones, blood vessels, and other tissues. It increases resistance to infection, cold, and other harmful things. A defi­ciency can result in loose teeth, bleeding around the gums, and hemorrhages which mark the condition called scurvy. Vitamin C is found abundantly in citrus fruits, tomatoes, potatoes, cabbage, and green pepper.

Vitamin D prevents rickets in children. It is essential to the correct metabolism of bones and calcium. It is found in fish liver oils, eggs, milk, butter, sunlight and irradiation. A defi­ciency of Vitamin D results in soft, bent bones, poor teeth, weakness of muscle and ligaments—the symptoms of rickets. Vitamin D is the one vitamin that sometimes may not be acquired from a well-balanced diet, especially with children.

Vitamin E probably has been one of the most contro­versial vitamins. It is necessary to reproduction in animals and thus has been frequently termed the "fertility" vitamin. It is recommended by some for heart conditions, but not by most experts. In 1959, researchers established the need for vitamin E in the physiological processes of the body. The FDA, which previously had taken court actions to prevent vitamin E products from being offered for the treatment of heart disease, sterility, and muscular dystrophy, in an an­nouncement which removed vitamin E from the "not-yet-proved" classification, observed that: "Since the daily diet provides more than adequate amounts of vitamin E . . . supplementing with the vitamin is not necessary."

This, to a degree, indicates the vitamin tug-of-war for public attention that has been going on for some time.

On the one hand, there are the vitamin manufacturers, the copywriters, the "food faddists" and the sales forces, trying to persuade the public that vitamin supplements are highly desir­able. On the other hand are qualified, scientific researchers and various acknowledged medical authorities, pointing out that in most cases where an "adequate" diet is followed, addi­tional vitamins probably are not needed. (Vitamin D seems to be excepted by everyone, but even here it is warned that too much vitamin D can eventually result in serious prob­lems.)

From the "sales" side come various "sales points" for buy­ing and using supplemental vitamins. There is the familiar warning that "our soils are depleted" and that as a result the foods raised in them are substantially low in vitamin and mineral content.

In answer to this are reports from U. S. Government and other experimental stations that have carried on research on identical crops grown in depleted soil and fertilized fields. The crop yields varied greatly. The difference in nutritive value of similar crops grown under various conditions was insignificant.

A vitamin salesman says to a prospective client, "Processed foods aren't nutritious. Pasteurized milk loses most of its vitamin C in the process. Most vitamin Bs are lost in the milling of white flour."

To which a public health worker points out that the pas­teurization of milk to bring it to us free of disease-causing germs is well worth the sacrifice of some vitamin C which can easily be obtained from other sources.

A dietician employed by a milling company explains: "We enrich the white flour with vitamins that may be lost." Labora­tory tests will confirm the statement.

"Well, you need to take all the vitamins to make sure you get them—a nutritional insurance," says a consumer. "Even if you do get a balanced diet, there's no harm in being sure!"

A doctor reminds the consumer that an excess of vitamin D can do harm, as can too much vitamin A.

"Subclinical deficiency" is usually intimated to be a condi­tion in which it is impossible to obtain any evidence of vita­min deficiency, but when one may be suspected because of "that tired feeling" or various aches and pains.

Consumer Reports (on vitamins in September and October, 1960) observes: "No person can go through even a small part of his life without experiencing some of these symptoms. Furthermore, there is no basis for assuming that such symp­toms are due to vitamin deficiency, or for expecting vitamin pills to cure them."

In the vitamin tug-of-war it can easily be understood why a public can become a little confused.

On the one hand there are many instances where doctors have resorted to vitamins to remedy serious illnesses. Vitamins are used to combat pellagra, scurvy, beriberi, rickets, perni­cious anemia, and is being used more and more in other areas. Vitamin K is used in conjunction with one treatment of cancer, to offset undesirable reactions to powerful drugs. As we have already seen, B-12 may be valuable in certain mental cases.

Certainly no one can deny the importance and usefulness of vitamin therapy in specified instances, and certainly a great many children and adults—elderly especially—have had vita­mins prescribed for them.

Why then shouldn't we all load up on vitamins "to make sure"? Don't the vitamin manufacturers and salespeople make sense?

A classic reply probably is to be found in a chapter in Drill's Pharmacology in Medicine by Dr. Edgar S. Gordon, Professor of Medicine at the University of Wisconsin: "The amounts of the various vitamins needed by normal animals or humans are exceedingly small and never exceed a few micrograms to a few milligrams per day. All available evidence indicates that excessive quantities supplied through the diet or administered artificially are lost, chiefly through renal excretion, without entering actively into any metabolic reac­tion. Capacity for storage of excess vitamins is variable, and in some instances is relatively large so that depletion, under conditions of inadequate dietary supply, may ensue rather slowly. Because of the staggering magnitude of self-prescribed vitamin therapy of an enthusiastically health-minded but in­adequately informed public, it is fortunate that vitamins are sufficiently nontoxic that serious consequences usually do not occur."

Dr. Gordon goes on to observe that even physicians find difficulty in accepting the proposition that "large quantities of these nutrients in excess of the daily requirement for metabolic processes, in addition to those amounts required to replete or maintain full storage capacity, must inevitably be ineffective and wasted."

Advice from authoritative sources such as the Council on Foods and Nutrition of the A.M.A., the Food and Drug Administration, the World Health Organization, and the National Research Council suggest adequate diets for most of the vitamins we need, and a trip to the doctor if we don't feel well.

To obtain information about what a normal, well-balanced diet should have, it is only necessary to consult any standard textbooks on nutrition or dietetics, public health pamphlets and publications dealing with diets, many of the better-known magazines, and many, many books written about the subject.

The U.S. Department of Agriculture publication entitled Food for Fitness, A Daily Food Guide (leaflet No. 424) discusses in detail one method that is also outlined by Con­sumer Reports.

Acknowledging that ill persons should have diets planned by their physicians, the balanced menus for normal children and adults may be based on the daily selections from four basic groups of food plus any foods that suit the taste of the family.

The groups are as follows:

Milk Group. Including what is used in cooking: for chil­dren, 3 to 4 cups; for teen-agers, 4 or more cups; for adults, 2 or more cups. Cheese and ice cream can replace part of the milk. For weight control, skim milk may be substituted for whole milk.

Meat Group. Two or more servings of such foods as beef, veal, pork, lamb; poultry, fish, liver, or eggs.

Vegetable-Fruit Group. Four or more servings, including at least one citrus or other fruit, or tomato juice (rich in vitamin C) every day, and one dark-green or deep-yellow vegetable (important for vitamin A) at least every other day.

Bread-Cereal Group. Several servings of foods made with whole, enriched, or restored grains products.

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