In cerebrospinal meningitis the value of intramuscular
injections of ascorbic acid is proved beyond shadow of doubt.
While it is not for a moment suggested that treatment with
vitamin C should replace sulphapyridine or sulphathiazole
therapy, the vitamin is a most useful adjuvant: injection
of 1500 mg. during the first three days of illness causes a
dramatic drop both in the percentage of deaths and in the
incidence of complications and sequelae.
Owing to gastro - intestinal upset, oral administration
of ascorbic acid is often impracticable in cases of cerebro-
- spinal meningitis; and, even in cases which can tolerate
drugs given by mouth, it is doubtful whether any real benefit
is conferred by oral administration of moderate doses of the
vitamin.
In severe faucial or nasopharyngeal diphtheria treatment
with adequate amounts of the vitamin significantly reduces
the mortality rate. An adequate dose for a severe case of
diphtheria is, - 500 mg. intravenously, with ( or immediately
after) the antitoxin, followed. by 600 mg. orally during the
next three days.
Since the dosage just mentioned gives satisfactory
results in toxic diphtheria, the use of -the parenteral route
after the first day of treatment appears to be unnecessary
and - in view of the relative costs of tablets and sterile
ampoules - undesirable.
In mild diphtheria, streptococcal tonsillitis, and
scarlet fever oral administration of the vitamin does not
produce very marked results: such effects as are occasioned
by ascorbic acid therapy are certainly in the direction of
shortening the period of illness and the duration of faucial
inflammation, but the benefits are so trivial that it is
doubtful whether the giving of synthetic ascorbic acid in
these diseases is a justifiable expense. It seems probable
that, under the conditions of normal times, all that is
necessary is the provision of sufficient fruit drinks during
the acute stage and of ample fresh fruit and green vegetables
during convalescence.
In cases of influenza a study of the urinary excretion
of ascorbic acid proves that 400 mg. of the vitamin ( or
Falke's suggested dosage of 100 mg. for each day of pyrexia ) is insufficient to remedy the state of hypovitaminosis C.
Since treatment with even this inadequate dosage has been
found, in a comparison of only fifty -four treated and fifty-four untreated cases, to cause a diminution in the incidence
of complications and relapses sufficiently marked to approach
the level of statistical significance, it is suggested that
- until some subsequent investigator definitely proves or
disproves the value of ascorbic acid in influenza - cases of
that disease should be given about 200 mg. of the vitamin
daily for the first three days of illness.
In brief, then, parenteral administration of vitamin
C should form part of the treatment of cerebrospinal meningitis, the drug should be given orally and intravenously in
severe diphtheria, and it is probably desirable to give the
vitamin orally to cases of influenza; but in mild diphtheria,
scarlet fever and tonsillitis the provision of synthetic
ascorbic acid appears to be an unjustifiable expense.
