The diagnostics and treatment of tropical diseasesStitt, E. R. (Edward Rhodes)
Science
The diagnostics and treatment of tropical diseases
Stitt, E. R. (Edward Rhodes)
Tropical medicine
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.
_War Oedema._—In those areas of Europe where famine conditions
were approached during the great war a condition of weakness and
oedema was noted by many observers and to this symptom-complex
various designations were applied such as war dropsy, war oedema,
etc. The oedema was more marked than would be true in ordinary
cases of starvation so that such factors as consumption of large
amounts of water and salt in the thin soups so prominent in the
dietary, plus hard work, must have been additional causes.
The oedema was most common in the feet and legs, at times extending
to the thighs and trunk, and in about one-half the cases involving
the face. Marked muscular weakness and alimentary disturbances
were common. There was dyspnoea on slight exertion with a slow
pulse, but cardiac disturbances were not features of the disease.
The urine was pale, of low specific gravity and free of albumin.
There was reduction of red cells and a tendency to leukopenia.
These cases showed marked emaciation upon the disappearance of
the dropsy. As is well known the deficiency in fats was marked
in Central Europe so that it was to be expected that ocular
manifestations should be frequently noted, deficiency of fat
soluble A being the exciting cause of xerophthalmia. The cases
tended to recovery under proper diet and hospital care.
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