Studies in Deficiency Disease

251 Pages·1945·3.358 MB·English

by  Robert McCarrison

OXFORD MEDICAL PUBLICATIONS
STUDIES IN DEFICIENCY
DISEASE
BY
ROBERT McCARRISON
M.D., D.Sc., Hon. LL.D. (Belf.)
FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS, LONDON ; LAUREAT DE L'ACADÉMIE
DE MEDECINE, PARIS ; HONORARY SURGEON TO THE VICEROY OF INDIA ; LIEUTENANT-
COLONEL, INDIAN MEDICAL SERVICE
LONDON
HENRY FROWDE AND HODDER & STOUGHTON
THE LANCET BUILDING
1 & 2 BEDFORD STREET, STRAND, W.C.2
Reproduced by Photo-Lithography
1945
Lee Foundation for Nutritional Research
Milwaukee 3, Wisconsin
First printed in 1921
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PRINTED IN GREAT BRITAIN
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J. B.
AND
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PREFACE
THE aim of this book is to present the reader with a consecutive account
of the results of recent experimental researches into the nature of Deficiency
Diseases, and to point out the application of these results to their prevention.
The subject is one which, as I shall hope to show, concerns both the
administrator and the practitioner of medicine.
My own investigations, on which this book is mainly based, were
originally undertaken in 1914, at a time when I was engaged in a study of the
thyroid gland and its disorders. My object then was to ascertain the effects of
deficient food on this organ. These studies were interrupted at the outbreak
of war, and it was not until my return to India from active service, early in
1918, that I was able to resume them. The scope of the inquiry was then
extended to include an investigation of the effects of deficient and ill-
balanced foods on all other organs of the body. It was hoped that, in the
course of such an inquiry, facts might emerge which would not only explain
some of the manifestations of deficiency disease, but throw light also on
problems relating to the place of the endocrine glands in the human
economy. The methods of study adopted were experimental, gravimetric, and
histo-pathological ; the last being held to be of especial importance. For
however necessary a knowledge of the normal structure and function of the
organs of the body may be, it is not less necessary to possess a knowledge of
the structural and functional changes induced in them by so fundamental a
factor as faulty food. I have thus approached the study of Deficiency Disease
from an aspect differing somewhat from that of other students of this subject
whose object, as a rule, has been the induction in animals, by means of
specially-devised food mixtures, of such maladies as scurvy, beri-beri,
rickets, and pellagra. My own method, on the other hand, has been to observe
the more general symptomatic and pathological effects of faulty food on the
animal body as a whole, and thereby to ascertain what forms of human illness
might reasonably be attributed to it. In this way I have been brought to the
conclusion that much of the gastro-intestinal disorder so common at the
present day, and much of the endocrine disorder probably almost equally
common, though less readily recognizable, are attributable to deficient and
ill-balanced food.
The results reached in the course of my investigations have for the most
part been published, during the years 1919 and 1920, in the Indian Journal of
Medical Research, in a series of articles under the general title of " The
Pathogenesis of Deficiency Disease " ; but certain observations relating to
the adrenal glands and malnutritional oedemas have been communicated to
the Royal Society. Abstracts of some of these papers appeared from time to
time in the British Medical Journal, but the original papers are not readily
accessible except to those having the facilities afforded by a large medical
library. For this reason, and because there was considerable overlapping in
the subject-matter of the papers as they originally appeared, I have taken the
opportunity afforded by a period of leave to reconstruct them so that the
results might be presented in a consecutive and more accessible form. Other
and more cogent considerations, however, prompted me to undertake the task
: the desire to reconsider the whole of my work after a period of absence from
it, and the necessity of studying the recent literature of the subject (not
available for reference in India during the progress of the investigations
themselves) in order to collate my results with those of others, in the hope
that in this way a just estimate might be made of their utility in practical
medicine.
The book is divided into four parts. In the first the objects and scope of
my inquiry are set out and the experimental methods used are described ; in
this part is given also a brief summary,1 prepared from the literature, of the
present state of knowledge of vitamins. The second part deals with the
various factors which influence the onset of symptoms and with the
symptoms themselves. The third relates to the morbid anatomical effects of
faulty food and to special pathology. In the fourth an attempt has been made
to indicate some of the more obvious practical applications of the results
reached in the laboratory to the prevention and cure of disease.
Throughout the progress of my investigations, and during the
preparation of this volume, I have been assisted by my wife, who has been
untiring in her perusal of the literature, in search of matter relating to the
investigations them-selves and to their bearing on practical medicine. To the
Hon. Major-General W. R. Edwards, C.B., C.M.G., Director-General, Indian
Medical Service, I, am indebted both for the opportunity to carry out the
work and for the help and encouragement he has at all times afforded me. My
thanks are also due to the Council, Royal Society, for permission to
reproduce Fig. 74, and to the Governing Body, Indian Research Fund
Association, under whose auspices my investigations were conducted, for
their ready response to the demands I have made upon them and for
permission to use some eighty of the illustrations which originally appeared
in papers published in their official Journal. To Sir Dawson Williams I am
indebted for reading my manuscript and for much helpful criticism.
R. McCARRISON.
OXFORD,
15th March, 1921.
1 In this summary it has not been possible to take account of publications later than February 15,
1921.
CONTENTS
PART I
INTRODUCTION—VITAMINS—EXPERIMENTS
CHAPTER
I. INTRODUCTION
II. VITAMINS
III. DESCRIPTION OF EXPERIMENTS
PART II
FACTORS INFLUENCING THE ONSET OF DEFICIENCY
DISEASE—SYMPTOMATOLOGY
IV. FACTORS INFLUENCING THE ONSET OF MORBID STATES DUE TO
FOOD DEFICIENCYV. SYMPTOMS OF DEFICIENCY DISEASE IN
PIGEONS
VI. SYMPTOMS OF DEFICIENCY DISEASE IN MONKEYS
VII. SUMMARY OF SYMPTOMATOLOGY
PART III
PATHOGENESIS OF DEFICIENCY DISEASE
VIII. MORBID ANATOMY
IX. THE GASTRO-INTESTINAL TRACT
X. THE GASTRO-INTESTINAL TRACT (continued)
XI. OTHER DIGESTIVE ORGANS : SALIVARY GLANDS, LIVER, PANCREAS
XII. THE ENDOCRINE ORGANS
XIII. THE THYMUS AND SPLEEN
XIV. THE REPRODUCTIVE ORGANS
XV. THE THYROID AND PARATHYROID GLANDS
XVI. THE PITUITARY BODY
XVII. THE ADRENAL GLANDS
XVIII. THE ADRENAL GLANDS AND MALNUTRITIONAL OEDEMA
XIX. THE ADRENAL GLANDS AND MALNUTRITIONAL OEDEMA (continued)
XX. THE HEART AND BLOOD-VESSELS
XXI. THE KIDNEYS AND BLADDER
XXII. THE NERVOUS SYSTEM
XXIII. THE FUNCTION OF VITAMINS
PART IV
PRACTICAL APPLICATION
CHAPTER
XXIV. INTRODUCTION
ACUTE GASTRO-INTESTINAL DISORDERS
XXV. CHRONIC GASTRO-INTESTINAL DISORDERS
XXVI. PELLAGRA
XXVII. BERI-BERI
XXVIII. THE SELECTION OF FOOD
APPENDIX
INDEX
INDEX OF NAMES
LIST OF ILLUSTRATIONS
FIG.
1. LOSS OF BODY-WEIGHT IN PIGEONS RESULTING FROM A DIET OF
AUTO-CLAVED RICE, BUTTER, AND ONIONS
2. LOSS OF BODY-WEIGHT IN PIGEONS RESULTING FROM AN
EXCLUSIVE DIET OF AUTOCLAVED RICE
3. INFECTIVE POLYNEURITIS COLUMBARUM DUE TO INJECTION OF
BACILLUS SUIPESTIFER
4. INFECTIVE POLYNEURITIS GALLINARUM DUE TO INJECTION OF
BACILLUS SUIPESTIFER
5. FALL OF RESPIRATORY RATE IN POLYNEURITIS COLUMBARUM
6. FALL OF BODY TEMPERATURE IN POLYNEURITIS COLUMBARUM .
7. POLYNEURITIS COLUMBARUM OPISTHOTONOS
8. POLYNEURITIS COLUMBARUM : EMPROSTHOTONOS
9. MONKEY FED ON AUTOCLAVED FOOD AND FRESH ONION
10. DEGENERATED NERVE FIBRES FROM MONKEY FED ON
AUTOCLAVED FOOD AND FRESH ONION
11. ATROPHY OR HYPERTROPHY OF ORGANS RESULTING FROM (a)
INANITION, AND (b) AN EXCLUSIVE RICE DIETARY,
CONTRASTED
12. WEIGHTS OF ORGANS IN PIGEONS FED EXCLUSIVELY ON RICE
13. WEIGHTS OF ORGANS IN PIGEONS FED ON RICE, BUTTER, AND
ONIONS, CON-TRASTED WITH THOSE OF PIGEONS FED
EXCLUSIVELY ON RICE
14. WEIGHTS OF ADRENAL GLANDS, TESTICLES, THYROID GLAND, AND
PITUITARY BODY IN DEFICIENTLY-FED MONKEYS
15. WEIGHTS OF SUBMAXILLARY GLAND, PANCREAS, AND SPLEEN IN
DEFICIENTLY-FED MONKEYS
16. WEIGHTS OF HEART, KIDNEYS, AND LUNGS IN DEFICIENTLY-FED
MONKEYS
17. WEIGHTS OF BRAIN AND LIVER IN DEFICIENTLY-FED MONKEYS
18. SECTION OF UPPER INTESTINE FROM HEALTHY PIGEON, X 105
19. SECTION OF UPPER INTESTINE FROM A CASE OF POLYNEURITIS
COLUMBARUM, X 105
20. SECTION OF UPPER INTESTINE FROM A CASE OF POLYNEURITIS
COLUMBARUM, X 105
21. SECTION OF UPPER INTESTINE FROM A CASE OF POLYNEURITIS
COLUMBARUM, X 85.
22. SECTION OF LOWER INTESTINE FROM HEALTHY PIGEON, X 75
23. SECTION OF LOWER INTESTINE FROM A CASE OF POLYNEURITIS
COLUMBARUM, X 75
24. SECTION OF UPPER INTESTINE FROM A CASE OF POLYNEURITIS
COLUMBARUM, X 65
25. SECTION OF SWOLLEN AND DEGENERATED GANGLION OF
AUERBACH FROM UPPER INTESTINE OF A CASE OF
POLYNEURITIS COLUMBARUM, X 105
26. SECTION OF MUCOUS MEMBRANE OF DUODENUM FROM HEALTHY
GUINEA-PIG, X 105
27. SECTION OF MUCOUS MEMBRANE OF DUODENUM FROM A GUINEA-
PIG FED ON A SCORBUTIC DIET, X 105
28. GASTRO-INTESTINAL TRACT OF HEALTHY MONKEY
29. GASTRO-INTESTINAL TRACT OF MONKEY FED ON AUTOCLAVED
RICE
30. COLONS OF HEALTHY AND DEFICIENTLY-FED MONKEYS
31. SECTION OF THE MUCOUS MEMBRANE OF PYLORIC END OF
STOMACH FROM HEALTHY MONKEY, X 165
32. SECTION OF THE MUCOUS MEMBRANE OF PYLORIC END OF
STOMACH FROM MONKEY FED ON AUTOCLAVED RICE, X 165
33. SECTION OF DUODENUM FROM HEALTHY MONKEY, X 165
34. SECTION OF DUODENUM FROM MONKEY FED ON AUTOCLAVED
RICE, X 165
35. SECTION OF COLON FROM HEALTHY MONKEY, X 75
36. SECTION OF COLON FROM MONKEY FED ON AUTOCLAVED RICE, X 75
37. SECTION OF AN AUERBACH'S GANGLION FROM COLON OF
HEALTHY MONKEY, X 165
38. SECTION OF AN AUERBACH'S GANGLION FROM COLON OF MONKEY
FED ON AUTOCLAVED RICE, X 165
39. SECTION OF MUCOUS GLANDS FROM COLON OF HEALTHY MONKEY, X 165
40. SECTION OF MUCOUS GLANDS FROM COLON OF MONKEY FED ON
AUTO-CLAVED FOOD, BUTTER, AND ONION, X 225
41. GASTRO-INTESTINAL TRACT OF HEALTHY MONKEY
42. GASTRO-INTESTINAL TRACT OF MONKEY FED ON AUTOCLAVED
FOOD AND ONION
41a. GASTRO-INTESTINAL TRACT OF HEALTHY MONKEY
42a. GASTRO-INTESTINAL TRACT OF MONKEY WHICH WAS FED FOR
TWENTY-EIGHT DAYS ON AUTOCLAVED RICE AND THEREAFTER
ON AUTOCLAVED FOOD AND ONIONS
43. CANCER OF PYLORUS FROM MONKEY FED ON AUTOCLAVED FOOD,
BUTTER, AND ONION
44. SECTION OF CANCER OF PYLORUS FROM MONKEY FED ON
AUTOCLAVED FOOD, BUTTER, AND ONION, X 165
45. SECTION OF LIVER FROM GUINEA-PIG FED ON A SCORBUTIC DIET, X 165
46. SECTION OF PANCREAS FROM A CASE OF POLYNEURITIS
COLUMBARUM, X 165
47. SECTION OF PANCREAS FROM A CASE OF POLYNEURITIS `
COLUMBARUM, X 165
48. SECTION OF SPLEEN FROM HEALTHY PIGEON, X 165
49. SECTION OF SPLEEN FROM A CASE OF POLYNEURITIS
COLUMBARUM, X 165
50. TESTICLES AND ADRENAL GLANDS OF HEALTHY PIGEON IN SITU
51. TESTICLES AND ADRENAL GLANDS FROM A CASE OF POLYNEURITIS
COLUMBARUM IN SITU
52. SECTION OF TESTICLES FROM A CASE OF POLYNEURITIS
COLUMBARUM, X 95
53. SECTION OF TESTICLES FROM HEALTHY PIGEON, X 95
54. SECTION OF THYROID GLAND FROM A CASE OF POLYNEURITIS
COLUMBARUM WITH CONCURRENT INFECTION, X 165
55. SECTION OF THYROID GLAND FROM MONKEY FED ON AUTOCLAVED
RICE, X 265
56. SECTION OF THYROID GLAND FROM MONKEY FED ON AUTOCLAVED
RICE, BUTTER, AND ONIONS, X 265
57. SECTION OF THYROID GLAND FROM MONKEY FED ON AUTOCLAVED
RICE AND BUTTER, X 210
58. SECTION OF PARATHYROID GLAND FROM MONKEY FED ON
AUTOCLAVED RICE AND BUTTER, X 210
59. SECTION OF ACTIVELY-SECRETING THYROID GLAND FROM
HEALTHY MONKEY, X 265
60. SECTION OF THYROID GLAND FROM MONKEY FED ON AUTOCLAVED
FOOD AND ONION, X 265
61. SECTION OF ANTERIOR PART OF PITUITARY BODY FROM HEALTHY
PIGEON, X 165
62. SECTION OF ANTERIOR PART OF PITUITARY BODY FROM A CASE OF
POLYNEURITIS COLUMBARUM, X 165
63. KYMOGRAPHIC TRACING OF ARTERIAL BLOOD-PRESSURE IN SHEEP
FOLLOWING INJECTION OF EMULSIFIED ADRENAL GLANDS OF
PIGEONS FED ON AUTO-CLAVED RICE
64. KYMOGRAPHIC TRACING OF ARTERIAL BLOOD-PRESSURE IN SHEEP
FOLLOWING INJECTION OF EMULSIFIED ADRENAL GLANDS OF
PIGEONS FED ON AUTO-CLAVED RICE, BUTTER, AND ONIONS
65. SECTION OF ADRENAL GLAND FROM HEALTHY PIGEON, X 165
66. SECTION OF ADRENAL GLAND FROM PIGEON FED ON AUTOCLAVED
RICE, X 165
67. SECTION OF ADRENAL GLAND FROM PIGEON FED ON AUTOCLAVED
RICE, BUTTER, AND ONIONS, X 165
68. SECTION OF ADRENAL GLAND FROM PIGEON FED ON AUTOCLAVED
RICE AND BUTTER, X 165
69. CHART SHOWING CHANGES IN ADRENAL GLAND OF GUINEA-PIG
CONSEQUENT ON A SCORBUTIC DIET
70. SECTION OF ADRENAL GLAND FROM A GUINEA-PIG FED ON A
SCORBUTIC DIET, X 20
71. SECTION OF ADRENAL CORTEX FROM A HEALTHY GUINEA-PIG X 105
72. SECTION OF ADRENAL CORTEX FROM A GUINEA-PIG FED ON A
SCORBUTIC DIET, X 105
73. HYDROPERICARDIUM FROM A CASE OF POLYNEURITIS
COLUMBARUM
74. CHART SHOWING EPINEPHRINE-CONTENT OF ADRENAL GLANDS IN
DRY POLYNEURITIS COLUMBARUM, AND IN WET POLYNEURITIS
COLUMBARUM
75. SECTION OF KIDNEY FROM A CASE OF POLYNEURITIS
COLUMBARUM, X 165
76. SECTION OF MUCOUS MEMBRANE OF BLADDER FROM HEALTHY
GUINEA-PIG, X 165
77. SECTION OF MUCOUS MEMBRANE OF BLADDER FROM GUINEA-PIG
FED ON A SCORBUTIC DIET, X 165
78. SECTION OF MUCOUS MEMBRANE OF BLADDER FROM GUINEA-PIG
FED ON A SCORBUTIC DIET, X 165
79. SECTION OF MUCOUS MEMBRANE OF BLADDER FROM GUINEA-PIG
FED ON A SCORBUTIC DIET, X 165
80. SCIATIC NERVE FIBRES FROM A CASE OF POLYNEURITIS
COLUMBARUM
81. SECTION OF GANGLION ATTACHED TO ADRENAL GLAND FROM A
CASE OF POLYNEURITIS COLUMBARUM, X 250
82. SECTION OF AN AUERBACH'S GANGLION FROM THE INTESTINE OF
A CASE OF POLYNEURITIS COLUMBARUM, X IO5
The illustrations are from originals prepared by the Author