Another point of distinction is that once the ship arrives in port and a diet of fresh meat and vegetables is substituted for the one of sterilized canned meats and desiccated and preserved vegetables, the patient recovers rapidly so that in one or two weeks there is no sign of the disease remaining. Beriberics improve at once when put on a curative diet but the damage done the peripheral nerves makes complete recovery a matter of weeks or months. Nocht is of the opinion that ship beriberi is closely related to scurvy as he found sore gums and haemorrhages into muscles in some of his cases. He also notes that even in true scurvy there may be cases of dropsy without the spongy gums and haemorrhages. Dropsy plus sore gums is not infrequently noted in the beriberi-like affection of the men of the French fishing fleet off the Newfoundland banks.
Schaumann believes that ship beriberi is due to an acute deficiency in phosphorus, a chronic deficiency causing beriberi. It is probable that this disease is caused by a deficiency in certain vitamines, these being destroyed in the sterilization of canned meats or by drying vegetables.
Scurvy.—It will be remembered that in scurvy, which is the classic food deficiency disease, we have spongy, swollen gums, loose teeth, oedema about ankles and, in particular, haemorrhages into skin at site of hair follicles and tumor-like haemorrhages into subcutaneous and muscular tissues. Haemorrhages into the mucous membranes are not uncommon. The heart shows marked palpitation and weakness.
The scurvy vitamine is much less stable than the beriberi one. It is contained in fresh foods only, drying destroying it.
In connection with the question of multiplicity of vitamines monkeys fed on rice will develop beriberi while if fed on a bread deficiency diet they develop scurvy.
In Mesopotamia the Indian troops suffered greatly from scurvy but not from beriberi while the British troops had many cases of beriberi. From July to December there were 11,445 cases of scurvy among the Indian forces and 104 cases of beriberi among the British. During this period the British ate white biscuits, tinned meats and horse flesh. This latter protected them from scurvy but the Indian troops would not eat the fresh meat but ate barley flour instead. The antiscorbutic vitamines are sometimes designated as water soluble C vitamines.
Rand Scurvy.—In investigating the endemic scurvy on the Rand, in South Africa, Darling noted hypertrophy and dilatation of right heart. Such cases often showed vagal degeneration. Pathologically, these cases were closely related to beriberi, but clinically, they showed spongy gums, and haemorrhages elsewhere. The knee-jerks were always exaggerated.
Infantile Scurvy.—As differing from infantile beriberi, we have in infantile scurvy, which is attributed to the use of sterilized milk instead of fresh milk, a tendency to separation of the epiphyses from the shafts of the bones and extreme sensitiveness to any movement particularly of the legs. A markedly anaemic and asthenic condition is also characteristic. The chief lesion is a subperiosteal blood extravasation.
Milk contains several vitamines some of which, as the growth vitamine, are, destroyed in boiling; others, however, are not destroyed until subjected to a temperature of about 120°C.