The diagnostics and treatment of tropical diseases

by E. R. Stitt

In general, the groups were fed for the greater part of the time occupied by the experiments as follows: Group (1) “White rice and extract of rice polishings and special diet.” Group (2) “White rice and special diet.” Group (3) “Red rice and special diet.” Group (4) “White rice and special diet.”

Of 6 men on the Group 1 diet, 2 developed beriberi. The symptoms however, were not marked, being chiefly loss of weight, tachycardia, slight oedema of legs and tenderness of muscles of calves. Four of the 6 men of Group 2 developed beriberi and 6 out of 11, in Group 4, showed symptoms of beriberi. In Group 3, only 2 in 6 developed symptoms and these consisted in case No. 13 only in tenderness of epigastrium, paraesthesia, cardiac disturbance and marked diminution of knee jerk. In case No. 18 there was noted only slight cardiac disturbance and epigastric pulsation. In none of the cases was the complete picture of beriberi obtained except in those in which the white polished rice formed the staple article of diet, but in one case, fed on red rice, the diagnosis of beriberi was almost definite.

The results of their experiments with the addition of rice polishings to the diet would indicate that whatever may be the results obtained with extracts from this material in preventing polyneuritis of fowls or in curing it after it has developed it is not as efficient in man as the cheaper and more readily obtainable mongo or katjangidjo bean or yeast.

Evidently symptoms of beriberi may also sometimes occur in individuals fed on red rice as a staple article of diet when the diet is very monotonous, comprising few articles and continued for long periods of time. From the experiments it is evident that beriberi may be produced by the prolonged consumption of white rice as a staple diet. Of 17 individuals fed on such diet 8 developed beriberi, all with distinct loss of knee jerk, as well as with other marked symptoms of the disease. Symptoms appeared within 61 to 75 days after the commencement of the diet.

Vedder thinks that the red rice used in these experiments may not have been sufficiently undermilled, as it was found most difficult to obtain such a beriberi-preventing rice for the Philippine scouts. As regards the lack of success with extract of rice polishings the same author considers that a sufficient amount of alcohol for the extraction of the vitamines was not used in the above experiments, as he found it necessary to use 30 litres of alcohol to 5 kilos of rice polishings. Strong and Crowell used only 14 litres of 95% alcohol to 5 kilos of polishings.

Braddon’s views.—Prior to the investigations of Fraser and Stanton the importance of the rice factor in the etiology of beriberi was insisted upon by Braddon who thought that a poison was elaborated by some organism which poison was contained in the beriberi-producing rice. This development was thought to occur in rice stored in damp places, but Vedder has shown that storing undermilled rice in a damp place for a year does not cause it to lose its anti-beriberi-producing properties.

Endocrine Gland Disturbances and Beriberi.—We owe in particular to the researches of McCarrison our appreciation of the important rôle of the endocrine glands in deficiency diseases. With dietaries deficient in vitamines he noted in birds and other animals hypertrophy of the adrenals, atrophy of the thyroid, thymus, testicles and ovary. The pituitary was unaffected. Vitamine deficiency seems to impair the activity of the thyroid and to thus favor the action of products of intestinal bacteria. It is now accepted as important this secondary factor of bacterial infection in all types of food deficiency pathology. Dietaries rich in fats and proteins with sufficiency of vitamines bring about thyroid hyperplasia. In a diet too rich in carbohydrates and deficient in vitamines marked endocrine disturbances are noted.

The adrenals show hypertrophy on a vitamine-deficient diet and this hypertrophy is associated with increase of the adrenalin content of the glands. Oedema seems to be associated with adrenal hypertrophy. McCarrison believes the oedema to be associated with increased intracapillary pressure from the effect of adrenalin but others dispute the explanation. The adrenalin content of the enlarged adrenals varies; it is in excess with a diet rich in carbohydrates and deficient in proteins and vitamines, but is below normal when the diet is scurvy-producing. Butter, probably from its fat soluble A content, seems to protect against oedema.

Polyneuritis gallinarum.—The work of Eijkman in showing that polyneuritis could be produced in fowls by feeding them on polished rice and prevented when a diet of rice polishings was added to the neuritis-producing rice opened the way for a vast amount of experimental work. As regards the nature of the neuritis-preventing substance in the rice polishings it was soon found that it had no relation to the phosphorus content. Funk has isolated a substance he calls vitamine, a pyramidine base precipitated by phosphotungstic acid, which is present in rice polishings and seems to possess extraordinary curative properties in polyneuritis gallinarum. Heart muscle, egg yolk and yeast are rich in this anti-neuritis substance, which is also present in lentils and barley.