Vitamin C as an Adjuvant in the Therapy of Pulmonary Tuberculosis

By Dr. Ernst Albrecht.

The works of Jusatz (1) revealed the fundamental role of vitamin C during antibody formation and in the course of infections. The successful therapeutic use of vitamin C preparations has been reported with various diseases, such as with scarlet fever, pertussis, diphtheria (with simultaneous use of bovine suprarenal body extracts) and in particular with lobar pneumonia. Inspired by the work of Hasselbach (2) and Pilz (3) on the occurrence of C-hypovitaminosis over the course of a chronic infectious illness (such as tuberculosis) and its resolution, I have undertaken at the request of my director a series of therapeutic trials with vitamin C on tuberculosis patients in our department. For this the company Hoffmann La Roche supplied to us the necessary quantities of vitamin C, in the form of its preparation Redoxon kindly given upon request, for which we herein express our most cordial thanks.

Because was clear to us that we were not, by correcting the Vitamin C deficit, pursuing a comprehensive therapy of tuberculosis as such, but rather only effecting an adjuvant treatment of these patients, we had to measure success not so much on the improvement of the total findings, nor even by characterizing the diseased lungs themselves, but rather by breaking down results into series of individual factors, and resolving these. Therefore, before beginning and after achieving saturation with vitamin C, in each case the weight and blood picture were checked, and the blood corpuscle sedimentation rate was determined. Of course the progress of temperature and the subjective condition (appetite etc.) were closely tracked.

The results thereof were as follows: the patients, after the 3rd or 4th injection of Redoxon (administered subcutaneously without irritation), unanimously reported experiencing increased good appetite and physical well-being. With a single exception, weight was gained throughout, occurring partially during the vitamin treatment, partially after treatment termination, i.e. after reaching saturation. In only one case did the weight come to a standstill; this was however judged a success because this female patient had lost weight before and after treatment. Before beginning treatment, weight gain was ascertained in only 3 of 10 cases.

Before beginning treatment, the blood corpuscle sedimentation rate (determined after Poindegger) was already nearly or completely normalized in most cases by bed rest or pneumatic treatment. But it continued to fall throughout, and an increase in the observation time was registered in only three of the 10 cases, which with unfavorably-situated disease prognoses is not surprising.

The differential blood picture showed a decline of the left shift and an appearance of monocytes in a much shorter time, so that, in 8 of 10 cases after the normalization of the blood picture, the influence becomes entirely clear; in the controls, the blood pictures were never changed in this manner in so short a time.

Those of our cases with fevers showed a temperature decrease upon vitamin C administration, one case in particular with almost experimental confirmation. Subfebrile temperatures, which had defied months-long treatment in hospital and welfare establishments, subsequently fell to normal after 400 mg Redoxon; due to entering menstruation on the 5^th day, medication was suspended, whereupon the next day the temperature rose, again reaching 37,6°. On the 9^th day the daily injection of 100 mg Redoxon was resumed and on the 12^th day freedom from fever was attained, which lasted up to the 16^th day. This female patient left the hospital on this day, received no more injections, and on the 18^th day (2 days injection-free) had returned to the previous temperature, at which it remained. It was remarkable that in this case saturation was not achieved: the daily elimination in the urine averaged 3½ to 4½ mg, achieving only 10 mg after 11 injections each of 100 mg ascorbic acid. In one case improvement of the temperatures could not be achieved.

Over the period of vitamin C determinations, 26 refillings of artificial pneumothoraces occurred; we had the opportunity to observe variations in urinary vitamin C status following each instance, and were thereby able to ascertain the following: in 24 cases was found a more or less clear removal of the vitamin content of the urine after refilling, in which fresh pneus with good compression showed this phenomenon more clearly than older ones, or such with less good compression. In the cases in which the disappearance of vitamin C after refilling was especially clear, temperature increases also resulted.

This observation, which to our knowledge has not been described elsewhere, suggests how, after the refilling of a pneus, an increased toxin status of the blood exists, with increased vitamin C consumption as a consequence. In one patient we witnessed a clear increase of the concentration of vitamin C in the urine after 2 pneumothorax refillings. The behavior here might be such that fewer toxins are flushed out with good compressions of the diseased lung section than with less good ones.

As an aside, we would like to mention that the subcutaneous administration of Redoxon has the advantage of more uniformly increasing the vitamin status, compared to the intravenous method, and is thriftier compared to parenteral administration. After attaining saturation, the maintenance of the C status is easily carried out via oral doses of a vitamin C preparation, which is an absolute prerequisite in the maintenance of the partial successes achieved.

Summary: with a sufficient supply of vitamin C, an a priori unfavorably situated illness prognosis can be improved more rapidly. This improvement expresses itself in increased appetite, improvement in subjective well-being, the behavior of weight curve, blood picture and temperature. The behavior of the vitamin C content of the urine after refilling of artificial pneumothoraces suggests a relationship between urinary vitamin C content and the toxin status of the blood; this could be demonstrated in pneus cases with good compression of the diseased lung sections. Hence an expansion of the application of vitamin C can be made with evident success, because it proves itself not only as an adjuvant in the treatment of the toxic appearances of milder cases, but also during pneumothorax therapy (especially at the beginning), being consumed by the organism in increased measure.

Bibliography

Jusatz, Klin.Wschr.1935, 40.
Hasselbach, Dtsch. Tbk.bl. 1936, 9.
Schweiz. med. Wschr. 1937, 37.
Pilz, Med. Klin. 1938, 7.

It is incumbent on us to thank most cordially docent Dr. Halden of the Medical-Chemical Institute of the University of Graz for the promotion of our efforts.

[Translator’s Notes: This was a stubborn translation with some confusing abbreviations. In particular the term “Pneus” seems to have been used as shorthand for Pneumothorax; in the spirit of the original, the former term is retained.]

From Medizinisches Klinik, 1938, Number 39, p. 972-