The American Journal of Tropical Medicine and Hygiene - Volume s1-8, Issue 6, November 1928

Fermentative disturbances of the digestive tract with complaints of acidity and burning in the epigastrium, esophagus, and frequently the mouth, accompanied by loss of weight and strength, are by far the most common gastro-intestinal vagaries seen in Porto Rico.

Loss of weight is only moderate but loss of appetite is considerable, with constipation broken at intervals by short periods of loose bowels. Indefinite nervous symptoms, such as mental irritability and depression, restless nights, vague muscle pains, cramps in the legs, numbness of the extremities, and palpitation of the heart are constant by-products. The skin becomes dry and bronzed in patches, especially over malar prominences, forehead, neck, back, and extensor surfaces of the arms. The temperature is apt to be subnormal and the blood pressure low, with a light grade of secondary anemia.

• 1.  It seems reasonable to suspect the existence of beri-beri wherever pellagra and scurvy are found, because all three diseases develop on a basis of faulty nutrition and because beri-beri probably may be combined with either pellagra or scurvy.
• 2.  In the Far East a number of important factors are recognized which may predispose or contribute to the development of beriberi. Among them are chronic malaria, pregnancy, climatic heat and moisture, bad hygiene and various other debilitating conditions.
• 3.  In the United States there are various forms of disease which are debilitating and which may interfere seriously with nutrition as well. Polyneuritis, moreover, appears occasionally with these diseases. Among them may be mentioned chronic alcoholism, including Korsakoff's syndrome, diabetes, cancer, tuberculosis, syphilis, pregnancy, and the marasmus of infants.
• 4.  Some of the cases of polyneuritis developing with the above mentioned conditions might, perhaps, be properly regarded as true beri-beri and not merely as complications or sequelae of the other diseases. But, because polyneuritis is not a common disease in the United States, it is not likely that beri-beri is common here.
• 5.  Inasmuch as there are no known criteria which are satisfactory for the diagnosis of beri-beri the therapeutic test should be applied in doubtful cases. The usual course of polyneuritis is gradual, the convalescence requiring weeks or months. On the other hand, early cases of beri-beri respond quickly to treatment and this is particularly true of infants. Chronic cases of beriberi, in which extensive degeneration of nerves and muscles has taken place, cannot respond quickly to any form of treatment so that the therapeutic test would be of little value in these cases.
• 6.  Circulatory disorders with cardiac hypertrophy and dilatation in a case of polyneuritis suggest the diagnosis of beri-beri but may be due to other causes.
• 7.  Conditions due to faulty nutrition are particularly common in infants. Even breast-fed infants may suffer from them. The beri-beri of infants in the Far East is said to develop, as a rule, in breast-fed infants, and its occurrence is explained by deficiency in the diet of the nursing mother, even though she may not herself show definite symptoms of beri-beri. A polyneuritis appearing in a nursing infant in this country might, perhaps, be due to beri-beri.

The problem of cancer is of much scientific interest and of extreme medical importance. It seems undoubtedly worth while to follow up any clue to possible light. This paper discusses phenomena in certain Protozoa, but the discussion may well be introduced by reference to certain cytological phenomena in mammalian cancerous tissue and to Boveri's masterful interpretation of these phenomena in the light of his intimate and profound studies of related conditions in certain invertebrates.

von Hansemann has shown the association of enlarged cell size with the beginning of mammalian cancer. Trambusti (1897) and Bashford and Murray (1904, 1908) have shown that such enlarged cells arise by the fusion of adjacent cells and their nuclei uniting (a) directly (fig. 1) or (b) being drawn at time of mitosis into one spindle (fig. 2) or (c) by the division of chromosomes in a nucleus without division of the nucleus or of the cell body.

Placental tissues from a person infected with Plasmodium falciparum was fixed in Bouin's fluid, dehydrated, and embedded in paraffin. Sections 2µ in thickness were cut, and stained in Harris's hematoxylin. The parasites have been found invariably to be intracellular.

The diagnosis of yellow fever was easy in those great epidemics of the prefinlayan America, when thousands of cases presented themselves in the immigrants under the well-known severe and generally fatal symptoms as described in the textbooks. The medical profession did not realize at that time that a great number of other cases completely escaped their attention, because they were so mild that they did not need a doctor's assistance.

Today we know from numerous experiences that in many infectious diseases the mild or symptomless cases are the ones that are of special epidemiological importance in connection with the propagation of the infective germs and therefore are almost more dangerous than the well marked and easily controlled severe cases. So it happens in yellow fever, which as long as it is merely endemic occurs in such a mild form that it is difficult or often impossible to make the diagnosis with certainty.