DIAGNOSIS AND TREATMENT OF BERIBERI 891 



The pathological changes just mentioned have also been observed in 

 experimental polyneuritis , although the edema, so pronounced in certain 

 human cases, is only of moderate intensity and is usually absent in 

 animals. Vedder and Clark (1912) conclude from the study of the dis- 

 ease in pigeons that the heart may show no microscopic changes, or may 

 show slight edema and pigmentation, or an appearance of beginning 

 mucoid or parenchymatous degeneration. In marked cases every fiber of 

 the vagus usually shows degenerative changes, -but no marked changes 

 suggestive of degeneration were obse'rved in the cervical sympathetic 

 ganglia, or in the post- or preganglionic fibers. Myeline degeneration of 

 the sciatic nerve is a, constant finding. Degenerative changes were 

 observed in both dorsal and ventral roots, and in both axic cylinder and 

 medullary sheath in the fibers of all columns of the thoracic spinal cord, 

 also in certain large cells in both ventral and dorsal horns of the gray 

 substance of the lumbosacral cord (Nissl method). No abnormality in 

 mitochondria was noted in the cord. "The symptoms of the disease 

 are not chiefly referable to the degeneration of the peripheral nerves, since 

 the degeneration occurs before symptoms arise, and because advanced de- 

 generation may be present accompanied by no symptoms at all, and be- 

 cause degeneration of the nerves results after recovery has occurred." 

 Funk(&) (1912) has analyzed the brains of normal and polyneuritic 

 pigeons and found that the latter showed a decrease in total nitrogen and 

 phosphorus. Funk and Douglas (1914), and Williams and. Crowell 

 (1915) have observed degenerative changes in the glands with internal 

 secretion. McCarrison(a) (1919) comes to the conclusion that beriberi is 

 not merely a polyneuritis, but that it leads to functional and degenerative 

 changes in every organ and tissue of the body, as evidenced by great atro- 

 phy of the skeletal muscles, the reproductive organs, thymus and spleen; 

 the bones are thinned and the marrow is diminished. A mild degree of 

 anemia is present. The adrenals are hypertrophied in all cases where an 

 increased amount of fluid in the pericardial sac was noted, an observation 

 which leads McCarrison(fr) (1920) to attribute the edema in beriberi to an 

 excessive production of epinephrin. The vitamin deficiency finally ren- 

 ders the body very liable to infection. According to Midorikawa (1918), 

 the blood pressure is not increased in beriberi, although the hypertrophy 

 of the adrenals is very marked at autopsy. 



In the chapter on the metabolism of vitamins, it was stated that Funk, 

 Braddon and Cooper and others have claimed a relationship between 

 the antineuritic vitamin and carbohydrate metabolism. Thus it was 

 found by Funk(J) (1914) that an increased consumption of carbohydrate- 

 rich foods hastens the onset of polyneuritis. Funk and Schonborn 

 (1914) then showed that in polyneuritis gallinarum, the glycogen 

 almost completely disappears from the liver and there is present a marked 

 hyperglycemia, both of which conditions return toward the normal on 



