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Mccarrison, Sir Robert, M.D. Studies in Deficiency Disease

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Mccarrison, Sir Robert, M.D. Studies in Deficiency Disease 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 A note about the Soil and Health Library online version: This book was made in an era when typographers had the same level of skill as did Victorian-era house-builders who routinely used beautiful mouldings and rococo design elements. Great care was taken to follow the original formatting as much as possible, including page breaks. Still, an exact reproduction could not be made within any reasonble time frame. Similarly, considerable attention was given to delivering an accurate reproduction, without typographical errors. Of course, achieving that goal has, to a degree, failed. Our apologies in advance. Finally, the photographs reproduced here were taken from the inexpensively produced Lee Foundation edition. Whenever fine zinc cuts are reproduced by photo-lithography on uncoated paper there will be considerable loss of quality. If any patron of our library possesses a copy of the original book and is willing to lend it or to supply scans of the many interesting photographs in this book, they will be updated in the e-book online version. Your cooperation in this matter is sincerely requested. PRINTED IN GREAT BRITAIN BY HAZELL, WATSON AND VINEY LTD., LONDON AND AYLESBURY J. B. AND W. R. E. Vobis quid per vos 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.
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