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
5. Barley, a known preventive of beriberi, should be used in all
soups.
6. If corn meal is the staple of diet it should be yellow meal or
water-ground meal, i.e., made from the whole grain.
7. White potatoes and fresh meat, known preventives of beriberi,
should be served at least once a week, and preferably once daily.
8. The too exclusive use of canned food must be carefully avoided.
McCarrison has noted the value of onions even in a diet in which
protein and vitamine constituents are sufficient. The onions seem
to inhibit the growth of putrefactive bacteria.
=Treatment.=—The most important treatment is that of the
substitution of a diet containing the essential vitamines for the
beriberi-producing one. In carrying this out regard must be had
for the customs and tastes of the race concerned. Thus fresh beef
may be excellent for some people but objectionable to others.
Eggs, particularly the yolk, are very valuable as is also true of
unsterilized milk. Extract of rice polishings has given splendid
results in infantile beriberi but does not seem to have been as
efficacious in the disease in adults. Yeast has great curative value.
An extract of yeast known as _marmite_ has achieved reputation
when given in doses of 20 grains daily. Seidell has recently used
an autolyzed brewers’ bottom yeast. By treating this material with
Lloyds’ reagent he has extracted the vitamines so that instead of
having to give 200 cc., a dose of 10 grams of the concentrated
product suffices.
Malt extract is very rich in vitamines and liver seems to have a
higher content than beef muscle. Fat soluble A vitamine is abundant
in glandular organs but scarcely present in the beef of our
markets—this is probably true of water soluble B. Heart muscle is
about on a par with liver. Germinating wheat and beans seem to have
special value in treatment as well as prophylaxis.
In the treatment of a case care must be had not to allow a patient
with any cardiac involvement to sit up in bed as this may cause
sudden death. Braddon considers atropine hypodermically as of value
in cardiac types of cases.
Amyl nitrite inhalations or injections of 1% solution of
nitroglycerine are indicated when there is evidence of extreme
cardiac dilatation. Venesection is also to be kept in mind. Cardiac
tonics are of less value than rest, diet and venesection.
In the feeding of such patients only small amounts should be given
at a time to avoid epigastric distress. Again carbohydrates should
be restricted as there is evidence that excess of carbohydrates as
well as vitamine deficiency may be concerned in the disease. The
bowels should be kept open with salines. Mineral oil tends to keep
down intestinal putrefaction which is a factor of importance.
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