It will be noted that "_ship-beriberi_" is included in this group of
diseases. Very little is known about this condition, except what is
contained in the investigation of Nocht (1903) and that of Holst and
Froelich. It is a very rare condition but of interest because it is
characterized by spongy, hemorrhagic gums and other signs encountered in
scurvy. The feature which differentiates it sharply from scurvy,
however, is an anæsthesia of the extremities. Ship-beriberi is generally
regarded as a combination of beriberi and scurvy. Where these two
disorders occur concomitantly, the beriberi manifests itself some months
before the scurvy, as the latter takes much longer to develop.
In considering the vitamines in connection with diseases of the nervous
system, mention may be made of "central neuritis" and the "peripheral
neuritis" which has been reported from the West Indies. This bears only
a partial resemblance to beriberi, as there is no edema, nor dyspnoea,
and its course is more chronic. Judging from the report of Edwards from
Jamaica, the cases more closely resemble pellagra, terminating after
many years. A degeneration of the cells of the spinal cord was found and
"in some isolated patches of the cerebellum and in the roots of the
optic and auditory nerves." The disease occurs among the poor classes
whose diet is inadequate chiefly in nitrogen.
Eijkman was the first to draw an analogy between beriberi and
_pellagra_, and thus to suggest that the latter might be a disease due
to an unidentified factor; he compared the pernicious effect of a diet
of polished rice with that of decorticated corn. Of recent years,
largely as the result of the investigations of Goldberger and his
co-workers, pellagra has come to be regarded as a dietetic disorder
primarily due to a lack of adequate protein, rather than to a lack of a
specific vitamine. Its relationship to scurvy cannot, therefore, at the
present time, be discussed from an etiologic viewpoint. Apart, however,
from the question of etiology, the two diseases have certain clinical
symptoms in common. Weston states that "distinguished physicians, who
were really astute observers, have mistaken pellagra for scurvy, eczema,
various kinds of intestinal troubles, syphilis, and many other
diseases." In the chapter on symptomatology, attention has been directed
to the fact that an eczema which yields to antiscorbutic treatment may
occur in scurvy; at times it presents the symmetrical arrangement so
typical of pellagra. In other cases a fleeting erythema may be observed,
another sign noted frequently in pellagrins. In some instances
congestion of the gums has been recorded. In describing a little girl of
three who had pellagra, Weston writes: "The gums are also red and
swollen, suggesting scurvy." This child had eaten large amounts of
turnips, so that there could have been no question of complicating
scurvy. Lombroso and some of the earlier authors drew attention to the
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