NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
52
.and previous researches as a test of Beriberi producing power of a rice when
it forms the staple of a diet in man.
3. The addition of rice polishings to a diet of white rice is an effective
preventive of the development of polyneuritis in fowls. Rice polishings
comprise from 8 to 10 per cent. by weight of the original grain.
4. The substances contained in polishings which are effective in prevent
-ing polyneuritis are soluble in 0 . 3 per cent. HCL. and are not precipitated
from the solution on the addition of 95 per cent. alcohol, in quantity sufficient
to make the resulting mixture of proof spirit strength. These substances
comprise 16 per cent. or less by weight of rice polishings or 1 . 6 per cent. or
less by weight of the original unpolished rice grain.
5. The fats, which are contained in comparative abundance in rice
polishings, have been proved of no importance in preventing polyneuritis.
1. Phosphorus compounds equal to 85 per cent. of the total phosphorus
content have been proved to be unimportant in preventing polyneuritis.
Breaudat1 h a s e x t r a c t e d f r o m r i c e b r a n a n u c l e o a l b u m i n o r v e g e t a b l e
casein, a gluten, which is present in the rice to the amount of 12 to 13 per cent.
and which he found protected pigeons fed on white polished rice from poly-
neuritis.
In my previous Report2 t h e e f f e c t o f t h e a d d i t i o n o f m e a t t o a n d i t s
absence from the dietary in cases of Epidemic Dropsy was recorded. Hindu
widows, for religious reasons, do not consume meat at all and the mortality
from Epidemic Dropsy was shown to be very high amongst them, whilst male
Hindus (Bengalis) pertake of a considerable amount of meat and the mor
-tality was low. It is interesting to note that McCay 3 h a s s h o w n f r o m h i s
investigations on Bengal Jail diet that the reduction of the quantity of rice
and the addition of fish or meat to the dietary improves nitrogen metabolism
as the following table from his Report shows:—
Ordinary diet.
Per cent. of protein
absorbed.
Grammes nitrogen per
man daily.
26 ozs. rice, 7 ozs. gram dal .
.
.
.
.
49.20
7.35
13 ozs. rice, 7 ozs. gram dal .
3 ozs. fish
.
.
{2½ ozs. goat flesh.
78.68
11.30
1Bull. Soc. Path. Exot., Tome 111, No. 1, Seance, Jan. 12, 1910.
2
First Report on Epidemic Dropsy in Calcutta by Major E. D. W. Greig, M.D., D.Sc., I.M.S., Scientific Memoir
No. 45.
3Scientific Memoirs of the Govt. of India, No. 37, p. 84.
53
The following is a fairly full summary of a recently published Mono
-graph by Dr. H. Schaumann1 on the etiology of Beriberi including " Ship
Beriberi." The monograph contains a very complete, up to date bibliography
on the subject.
Schaumann has exhaustively examined possible factors as causal agents
in Beriberi and particularly " Ship Beriberi." The following are extracts
from his important monograph:
—
1.
Toxines and Oxalic acid as possible pathogenic factors .—He investi
-gated this problem by (1) Animal experiments, (2) Mycological studies of pro
-visions from Beriberi ships, (3) By chemical researches undertaken for the
purpose, which included, (a) the examination of the provisions from a Beriberi
ship, (b) the urine from cases of ship beriberi, (c) the contents of the crop,
the stomach, and the intestine of pigeons which died of polyneuritis for oxalic
acid. He concludes, " The results of the above described experiments and in
-vestigations permit the conclusion that they afford no grounds for supporting
the view of there being one or more specific poisons for the production of
Beriberi or 'Ship Beriberi.' This especially applies to oxalic acid, the quan
-tities of which in the urines examined was only very small, and indeed were
far below the normal limits (0.029 in 24 hours), whilst this acid could not be
found in the intestines of fowls who had died of experimental neuritis."
2. Poverty of enzymes in the food material as a possible pathogenic fac
-.tor .—This question he studied by (a) Animal experiments, (b) Chemical in
-vestigations. He concluded that poverty of autolytic enzymes in the food
material as a pathogenic factor of Beriberi cannot be considered.
3. Poverty in protein material (albumin) as a possible pathogenic
factor.—From his observations and that of others which he quotes, he is of
opinion that his experiments prove that the addition of albumin to a diet
which can produce neuritis in rabbits and pigeons, does not protect these
animals from the disease.
4. Poverty in mineral constituents in the diet as a possible pathogenic
factor .—He added various mineral constituents in different quantities to
polished rice on which 5 pigeons were being fed. The minerals were, Potass.
Carbonate, 30 gram., Sodium Chloride, 3 gram., Anhydrous Sodium Sulphate,
2 gram., Calcium Carbonate, 3 gram., Magnes. Carb. 4 gram., Dyalised oxide
of Iron, 3 gram. In this combination all the constituents in vegetable ash are
found, with the exception of phosphates and silicates. Silicates were not
added, because it is known that pigeons pick up these themselves (sand, etc.).
All the pigeons developed neuritis and died. Schaumann concludes that,
1 A r c h i v . S c h i f f s u . T r o p e n h y g i e n e , B d . X I V , B e i h e f t , D e c . 8 , 1 9 1 0 .
54
" A protective action of the mineral constituents added to the food was ex-
cluded."
5. Phosphorus and its relation to Beriberi.—Schaumann deals very com-
pletely with this question.
A. The combinations of Phosphorus in diet.
The phosphorus content of food varies greatly from 0 . 2 per cent. in,
polished rice and egg albumin to 19 per cent. in cow milk and egg yolk.
He discusses the following phosphorus combinations : —
1. Phosphatide (Lecithane)—
(a) Lecithin.
(b) Kephalin.
(c) Jecorin.
(d) Kuorin.
Falk1 gives the amount of phosphatides in
Non-medullated fibres.
Medullated fibres.
Per cent.
Per cent.
Total extract
.
.
.
11.51 Total extract .
.
.
.
46.59
Percentages of total extract—
Percentage of total extract —
Kephalin.
.
.
23.7
Kephalin
.
12.4
Lecithin.
. . .
9.8
Lecithin
.
.
.
2.9
This would correspond to phosphatides in the original nerve substan-
ces :—
In non-medullated fibres 3.85 per cent. In medullated fibres 7 . 13 per
cent.
2. Nucleoproteids (Nucleic Acid) .
(a) Nucleoproteid.
(b) Nucleic acid.
Nucleic acid; constant and characteristic constituents of all nucleic acids
are organically combined phosphoric acid and Purin as well as Pyrimidin
bases. The molecule of phosphorus in nucleic acid is probably not as ortho-
phosphoric acid, H 3PO4, but as anhydride.
Schaumann thinks it is probable that the phosphoric acid is present in
nucleic acid as Metaphosphoric acid, so it is theoretically possible to increase
1 Biochem. Zeitschr. 1908, Bd. XIII, p. 153.
55
the number of these combinations to an extraordinary extent, since according
to the investigations of Tanmann 1 the metaphosphates as concerns their rich-
ness in Isomeres and Polymeres, are unique.
3. Paranucleoproteids (Nucleo-albumin).
Kasein.
4 . P h y t i n .
— A s
w i l l b e s e e n f r o m t h e w o r k o f F r a s e r
a n d S t a n t o n
r e f e r r e d
to in this Report the relation of phytin to the causation of Beriberi has been
excluded. This substance was discussed in my first Report
.
2
5 . P r o t a g o n .
6 . N u c l e o n .
7 . I n o r g a n i c p h o s p h a t e s .
8 . P h o s p h o r u s c o m b i n a t i o n s o f u n k n o w n c o m p o s i t i o n .
The following table from Schaumann's Monograph shows the distribution
of phosphorus in the dry substance of various food materials:
—
The results give the amounts of phosphorus in 100 parts of dry substance
of food material.
Substance.
Dry
substance.
TOTAL PHOSPHORUS
P. as
phospha-
tide.
P. as
soluble
phosphate.
P. as
soluble
ester.
P. as
Nuclein
and P.
alumin.
Estimated
direct. Calculated
1. Horse flesh
.
.
26.0
0.74
0.73
0 . 150
0.440
0.04
0.10
2. Cow milk
.
.
.
12.6
0.84
0.80
0.050
0.250
0.05
0.45
3. Egg Alb.
.
. .
12.6
0.12
0.11
0.000
0.020
0.02
0.07
4. Bread .
.
.
70.1
0.14
0.13
0.010
0.050
0.00
0.07
: 5. Rice
.
.
.
87.8
0.11
0.11
0.005
0.0050
0 . 0 0
0.10
6. Gluten .
.
.
.
98.8
1.47
1.29
0.020
0.250
0.35
0.67
7. Yellow turnips
.
.
13.6
0.40
0.38
0.030
0.200
0.11
0.04
8. Sweet turnips . .
14.6
0.19
0.19
0.040
0.080
0.05
0.02
9. Green cabbage
. .
12.3
0.48
0.070
0.220
0.09
0.10
10. White cabbage
. .
8.3
0.31
0.060
0.140
0.017
0.04
1 Jour. F. prakt. Chemie. neue folge, 1892, Bd. XVII, pp. 417 and 120.
2 First Report on Epidemic Dropsy in Calcutta by Major E. D. W. Greig, M.D., D.Sc., I.M.S., Scientific Memoir
No. 45.
56
Schaumann gives the following table which shows the distribution of
P2O5 in the organs of the human body :—
Substance (organs, etc.).
TOTAL P2O5 IN THE MATERIAL.
In original substance.
In the ash.
Per cent.
Per cent.
1. Human body .
.
.
.
.
4.35
38.90
2. Bones .
.
. .
.
.
26.76
40.09
3. Teeth
.
.
.
. .
.
31.61
4. Cartilage
.
.
.
.
.
0.41
9.05
5. Muscle .
.
.
.
.
.
0.40
42.00
6. Brain .
.
.
.
.
.
1.11
49.00
7. Liver .
.
.
.
.
.
4.65
46.46
8. Spleen .
.
.
.
.
.
3.02
38.64
9. Lungs .
.
.
.
.
.
0.20
44.60
10. Heart .
. .
.
.
.
2.75
11. Kidneys
.
.
. .
.
3.22
12. Bile .
.
.
.
.
.
0.84
13. Blood (corpuscles) .
.
.
.
0.11
14. Blood (serum)
.
. .
.
0.007
15. Blood (serum and corpuscles) .
.
0.078
10.23
16. Lymph .
.
.
.
.
.
1.09
17. Milk (human)
.
. .
.
0.049
20.74
18. Fæces .
.
.
.
.
.
0.710
26.90
19. Urine .
.
.
. .
.
0.230
11.21
Schaumann states that the phosphorus requirements of adult men of
average weight on mixed dietary and moderate physical exercise amounts to
1.96 to 2.18 gram. phosphorus or 4.5 to 5 gram. P 2O5 per day.
He also discusses the metabolism of all the phosphorus combinations men-
tioned above, Phosphatide, Nucleic Acid, etc.
57
Schaumann considers it probable that the absence of the different phos-
phorus combinations in the organism will be expressed specifically in various
ways, that it will produce different kinds of morbid phenomena, e.g., Scurvy,
Beriberi, Ship Beriberi, etc. He admits, however2 t h a t t h e s u b j e c t i s a v e r y
complex one.
As a result of his experimental studies in animals he comes to the follow-
ing conclusions:
—
1. The food material, which after a long period of feeding in certain
animals can produce neuritis, is characterised by either a poverty in phos-
phorus or certain organic phosphorus combinations. The poverty in the latter
may be either naturally present or brought about by artificial means.
2. The addition of albumin, inorganic salts (including phosphate and
Calcium biphosphoricum) as well as the artificially produced organic phos-
phoric acid combinations (Albumin-phosphate Calcium glycerophosphoric
acid) to a diet which produces polyneuritis does not prevent its occurrence.
3. The addition of certain substances which contain much organically
combined phosphorus (yeast, rice bran, white gluten, Testikulin, Mung dal,
pulses) to a diet, by long exclusive feeding on which, polyneuritis is produced,
exercises even in small quantities complete prophylactic and curative action.
4. Vegetarians (pigeons) and carnivora (dogs) respond to these protective
substances (Bull's testicles preparation, Testikulin) differently. Whilst Testi-
kulin protects the latter completely, in the former it does so only in a limited
number of cases. Yeast protects both completely.
5. The organic phosphorus combinations (phytin from rice bran, phytin
like bodies from Mung dal, Nucleic acid of yeast, and probably also certain
phosphatides), which have been obtained from these protective substances, and
whose action has been tested, exert only a limited prophylactic and a tem-
porary curative action. The inorganic phosphates alone afford no protection.
It is very probable that the above named protective substances (yeasts,
rice bran, white gluten, Testikulin, Mung dal, pulses) owe their peculiar
prophylactic and curative properties to a collective effect of a number of phos-
phorus containing substances found in them, amongst which the organic phos-
phorus combinations are essential. The inorganic phosphates in the food
serve to maintain the phosphorus metabolism of the body; they are not, how-
ever, in a position to support or replace the organic phosphorus combinations
in the food. It may be accepted on good grounds that the animal body does
not possess the power of forming by suitable transformations organic phos-
phorus combinations from inorganic phosphates; it is very probable that this
I
58
is the case, as has been proved in plants, and as is the case in other food stuffs
(albumins and carbohydrates).
7. Nitrogen and Phosphorus metabolism, as has been shown by former
experiment and confirmed by my own observations, stand in close relationship.
If the content in organic phosphorus combinations sinks below a certain
amount in the food, then nitrogen transformation is simultaneously depressed.
8. The polyneuritis, which occurs in animals, dependent on an alimentary
origin or produced intentionally, is a disease of metabolism, which in the latter
case is dependent on the poverty of the food in certain organic phosphorus
combinations, which require to be more closely defined.
Schaumann comes to the following final conclusions on the etiology of
Beriberi including " Ship Beriberi ":
—
1. Beriberi is a disease of metabolism, which is caused by insufficient in-
take of organic phosphorus combinations into the general circulation of the
body.
2. This deficiency is occasioned in a great number of cases, by too small a
content of organic phosphorus combinations in the food consumed.
3. In others but apparently in a very small minority of cases, this condi-
tion is brought about by an insufficient absorption of organic phosphorus com-
binations although their content in the food consumed is sufficient.
Apparently this insufficient phosphorus absorption may be brought about
by—
( a ) I n j u r y o f t h e i n t e s t i n a l t r a c t b y m i c r o - o r g a n i s m s o r t h e i r
metabolic products by which the preparation of organic phos-
phorus combinations for absorption is affected, or pathologically
by micro-organisms producing alterations of the intestinal
mucus membrane by which an adequate absorption becomes im-
possible.
( b ) T h e d e s t r u c t i o n o f t h e o r g a n i c p h o s p h o r u s c o m b i n a t i o n s i n t h e
chyme by organisms as well as by their enzymes.
( c ) A c o m b i n e d a c t i o n o f (
a ) a n d (
b ) .
It is noteworthy that Schaumann inclines to the opinion that deficiency
of certain organic phosphorus combinations brings about the following dis-
eases in addition to Beriberi and Ship Beriberi ":
—
1 . S c o r b u t u s .
2 . Ba r l o w' s d i s e a s e .
3 . R i c k e t s .
59
1
He considers that the explanation of the difference in the features of the
above diseases is dependent on the absence of different kinds of combinations
of organic phosphorus: each combination plays a specific part in the function.
of metabolism of the human body; and their absence is e xpressed by disease
processes, which are as specifically different from one another, as are the
organic phosphorus combinations, the absence of which produces them.
Heubner & Reeb 2 give as the result of their analysis the following dis-
tribution of Phosphorus in polished rice:—
In 100 grammes dry
substance.
Relationship to the
total P2O5.
Gram.
Percentage.
1. P205 as phosphatide
•
•
•
•
0.011
4.38
2. „ „ sol phosphates .
.
.
.
0.011
4.38
3. ,, „ ester.
•
•
•
0.000
0.000
Total P205 content.
0 . 251
100.00
Schaumann' s results are :—
For 100 grammes
rice.
Relationship to the
total
P20 5.
Gram.
Percentage.
1. P20 5 as phosphatide.
•
0.043
16.41
2. „ „ sol. phosphates .
.
.
.
0.062
23.66
3. „ „ „ ester
•
•
.
.
traces
0.00
4. „ „ Nuclein and Albumin .
. .
0.157
59.93
Total P205
0.262
100.00
1 Hœnicke E. Zur Theorie der Osteomalacie, Berlin, Klin, Woch. 1904, No. 44.
2 Archiv. s. Exper. Path. u. Pharmak, 1908, Suppl. Schmiedeberg Festschrifc S. 265 (quoted by Scbaumann).
I 2
60
Having discussed the literature of the most recent and important experi-
mental investigations on the etiology of Beriberi including " Ship Beriberi " I
now proceed to detail the results of my own experimental enquiry on the
etiology of Epidemic Dropsy in Calcutta.
The animal experiments referred to in my previous Report1 h a v e b e e n
continued and a large number of feeding experiments with pigeons and fowls
to test the nutritive value of the various kinds of food grains have been carried
out by me. As already pointed out these animals form very delicate in-
dicators of the food value of the different grains. When fed on polished
grains they lose weight progressively and develop neuritis. A symptom,
which was frequently noted in pigeons and fowls, which showed signs of
neuritis, was a recurving of the neck, the head being drawn over towards the
animal's back. Post mortem the peripheral nerves of pigeons and fowls dying
with symptoms above noted show well marked degeneration changes, and a
plate is given in my first Report 1 w h i c h d e p i c t s t h e s e c h a n g e s i n t h e n e r v e s o f
the animals.
I have carried out a large number of experiments with pigeons and fowls
fed on different kinds of polished grains with the result that progressive loss
of weight and neuritis with death invariably occurred. The symptoms
developed whether the rice was boiled or unboiled; indeed a more rapid course
was taken by the disease in the case of animals fed on boiled rice. The rice
was also placed in the autoclav for one hour before giving it to the pigeons,
in this way any organisms, moulds, bacteria, etc., and, probably, enzymes, pre-
sent in the rice would be destroyed; yet loss of weight and neuritis invariably
resulted when pigeons were fed on polished rice so heated.
An account of the experimental work is given below and Charts No. 6 to
9 and Photographs 10-14 illustrate certain experiments.
The details of the conditions under which the experiments were conducted
are given in my first Report.1
1. Experiments with polished grains.
Bengal (Khulna) rice polished (unboiled) .
This variety of Bengal rice was used because a sample was sent in to the
Medical College from Khulna district, where Epidemic Dropsy was prevailing
at the time, to be examined.
Six pigeons Were fed on 30 gram. of this rice daily. No other grain was
given.
1
First Report on Epidemic Dropsy in Calcutta by Major E. D. W. Greig, M.D., D.Sc., I.M.S., Scientific
Memoir No. 45.
61
The chemical analysis of these grains gave the, following results:—
Weight of 100
grains in
gram.
Moisture.
Ash.
Nitrogen.
Protein.
P2 O 5 .
Per cent.
Per cent.
2.43
10.2
0.82
1.45
9.06
.43
The following table shows the number of pigeons fed, the duration of the
experiment, the weight at the beginning and end of experiment, the percent-
age loss of weight, and the occurrence or non-occurrence of neuritis:
—
No. of pigeon.
Duration
of
experiment.
Weight at
beginning of
experiment.
Weight at
end of
experiment.
Gain or loss
of weight.
Result.
Days.
Gram.
Gram.
Per cent.
1
.
•
•
•
18
420
260
—38.1
Neuritis.
2
•
.. • •
26
320
200
—37.5
, ,
3
.
•
•
32
270
120
—55.5
, ,
4
51
300
130
—56.6
, ,
5
.
.
•
.
59
380
160
—59.9
, ,
6
.
.. . •
61
280
190
—37.1
, ,
Remarks.—It will be noted that the average percentage loss of weight in
these pigeons was 50.8 per cent. In all cases neuritis developed. The animals
were killed when the symptoms became well marked in order to obtain fresh
specimens of the nerves. Examination of the peripheral nerves showed well
marked degenerative changes.
Rangoon rice polished (unboiled).
Experiment 22.—Eight pigeons were fed on 30 grammes of this rice
daily.
No other grains were given.
The chemical analysis of these grains gave the following results:—
Weight of
100 grains in
grammes.
Moisture.
Ash.
Nitrogen.
Protein.
P2 O
5
.
Per cent.
Per cent.
Per cent.
Per cent.
Per cent.
2.06
10.2
0.82
1.45
9.06
0.43
62
The following table shows the number of pigeons fed, the duration of
the experiment, the weight at the beginning and end of experiment, the
percentage loss of weight, and the occurrence of neuritis:—
No. of pigeon.
Duration
of
experiment.
Weight at
beginning of
experiment.
Weight at
end of
experiment.
Gain or loss
of weight.
Result.
Days.
Gram.
Gram.
Per cent.
1
.
.
.
26
310
170
—45.5
Neuritis.
2
.
.
.
37
270
140
—48.1
, ,
3
. . .
33
280
190
—32.1
, ,
4
.
.
44
210
130
—38.1
, ,
5
.
.
.
25
230
130
—43.4
, ,
6
.
. .
53
250
120
—52
, ,
7
.
.
.
46
260
100
—61.5
, ,
8
. . .
59
270
120
—55.5
, ,
Remarks.—In this experiment the results were very similar to the last;
the average percentage loss of weight was 45.8 per cent. All the animals
developed neuritis which was verified by microscopic examination.
The above two experiments illustrate very clearly the effects of feeding-
pigeons on polished grain, one Bengal, the other Rangoon rice. They show
that constituents necessary to meet the physiological demands of the body,
particularly of the nervous system are wanting from these polished grains.
Rangoon rice polished (boiled).
Experiment 31. —Six pigeons were fed on 30 grammes of this rice daily,
but before administration it was boiled in the autoclav for 1 hour, then dried
in the sun.
The chemical analysis is the same as given under Experiment 22.
The following table shows the number of pigeons fed, the duration of
the experiment, the weight at the beginning and end of the experiment, the.
63
percentage loss of weight, and the occurrence or non-occurrence of neuritis :—
No. of pigeon.
Duration
of
experiment.
Weight at
beginning of
experiment.
Weight at
end of
experiment.
Gain or loss
of weight.
Result.
Days.
Gram.
Gram.
Per cent.
1
.
.
25
290
180
—37.9
Neuritis.
2
.
.
.
36
250
120
—52.0
, ,
3
. .
.
40
310
190
—38.7
, ,
4 .
.
50
240
130
—45.8
, ,
5
. .
.
51
350
190
—45.7
, ,
6
. .
.
50
290
200
—31.03
, ,
Remarks.—In this experiment the grains were placed first in the autoclav
by which treatment all moulds, bacteria, etc., would be destroyed, but never-
theless the symptoms produced were exactly the same as in pigeons fed on
unboiled rice. The average percentage loss of weight was 40.8 per cent.
Polished Rangoon, rice (boiled).
Experiment 51.—Six pigeons received 30 grammes of this rice daily; the
rice was treated as in Experiment 22.
The chemical analysis is the same as given under Experiment 22.
The following table shows the number of pigeons fed on boiled polished
Rangoon rice, the duration of the experiment, the weight at the beginning
and end of the experiment, the percentage loss of weight and the occurrence
or non-occurrence of neuritis :—
No. of pigeon.
Duration
of
experiment.
Weight at
beginning of
experiment.
Weight at
end of
experiment.
Gain or loss
of weight.
Result.
Days.
Gram.
Gram.
Per cent.
1.
•
•
•
105
320
170
—46.8
Neuritis.
2.
•
•
•
94
320
230
—56.2
, ,
3
.
.
.
36
310
200
—35.4
, ,
4
.
.
.
32
400
230
—42.5
, ,
5
•
•
•
105
350
260
—25.7
, ,
6
•
•
•
28
330
200
—39.3
, ,
Remarks.—This experiment corresponds in all respects to the previous
one and the results are similar.
Polished Rangoon rice (boiled).
Experiment 53.—Six pigeons received 30 grammes of this rice daily; the
rice was treated as in Experiments 22 and 51.