Sir Edward Mellanby: I cannot claim any special clinical knowledge of otology but, in the course of my experimental work, some observations on the labyrinthine capsule and its contents were made which may serve as an introduction to this discussion.There is at present no well-founded evidence that vitamin deficiency is an important factor in any of the clinical conditions found in Otology. This, however, cannot be regarded as a final judgment. We have as yet only scratched the surface of the subject of nutrition, and, in view of other facts, it would be strange if some important relations, at present unknown, between nutrition and morbid conditions of the ear, nose and throat did not come to light.Had we been meeting seventeen years ago, my opening remarks would have been rather different. At that time we had discovered that otitis media could be produced with some regularity in rats by omitting vitamin A from the diet and we then felt that otitis media in children might also be related in some way to vitamin-A deficiency. Now we know that this is not the case. It was just unfortunate that the rat was chosen for this experimental work, since it reacts to vitamin-A deficiency in a particular way by developing epithelial hyperplasia, especially in the Eustachian tube, and this is generally followed by infection in the middle ear and in other places. As far as my knowledge goes, however, rats are the only animals so far tested that react in this particular way, and further experienceI does not suggest that children are similarly affected, even if their diet is very deficient in vitamin A. On the contrary, you have all seen otitis media develop in children whose vitamin-A intake is very high.As regards the wider problem of vitamin deficiency, certain writers have said that if nicotinic acid or riboflavin or vitamin B1, &c. were cut out of the diet, defects in the hearing mechanism were produced, and if these substances were given to patients suffering from these conditions an improvement was forthcoming. But other investigators have been unable to confirm these results. Instead, however, of reviewing the literature I shall refer to some experimental work showing the effect of one nutritional factor on the labyrinth which although it may not have any clinical significance at the present time, will no doubt form the basis of future studies on man as well as on animals.The story started many years ago when I was working on rickets. Some of the experimental animals became very inco-ordinated in their movements, a condition which was clearly not a part of the rachitic syndrome itself but evidently had an aetiological basis not far removed from that of rickets.The differentiation of the original vitamin-A complex, first described by McCollum and Davis in 1913, into two constituents now known as vitamin A and vitamin D-occupied scientists for a period of many years, and it was not until 1929 that vitamin D (the antirachitic vitamin) was obtained in a pure form, and this was followed in 1931 by the preparation of pure vitami...