Gastric, intestinal, pancreatic, and biliary insufficiency are, according to McCarrison, important consequences of a diet too rich in starch and too poor in vitamins and other essential constituents of the diet. A state of acidosis results from the absence of so-called antineuritic vitamin, which state is due to imperfect metabolism of carbohydrates and to acid fermentation of starches in the intestinal tract. Chemically it is evidenced by progressive slowing and deepening of the respirations. He suggests that some of the obscure metabolic disorders of childhood be examined from this point of view as well as from that of starvation of the glands of internal secretion.

Great atrophy of muscular tissue results from a deficiency of accessory food factors. McCarrison holds that this is due, in part, to disturbance of carbohydrate metabolism in consequence of disordered endocrine function, and in part to the action of the adrenals in supplying blood to the vegetative organs of the body at the expense of the muscles. The central nervous system atrophies little; paralytic symptoms when they occur are due mainly to impaired functional activity of the nerve cells, much more rarely to their degeneration.

Pigeons on a diet of autoclaved milled rice (deficient in both A and B) showed congestive and atrophic changes in all coats of the bowel, lesions of its neuromuscular mechanism, impairment of digestive assimilative processes and failure of its protective resources against infection. Great susceptibility to various septicaemic and tuberculosis infections were also shown. McCarrison40 suggests that certain gastro-intestinal disorders in the human subject (e. fe. mucous disease, celiac disease and chronic intestinal stasis) may owe their origin to subminimal supply of accessory food factors protracted over long periods of time.

Since both inanition and a diet too rich in starch and too poor in vitamin lead to depression of biliary, pancreatic, and gastro-intestinal functions, it follows that if these functions are exposed in addition to toxic or bacterial infection their depression will be manifestly greater. The many toxic influences to which human beings are subject under conditions of food deficiency must play an important part in further depressing these organs and tissues on which normal metabolism are dependent. That abnormal putrefaction in the intestine actually exists in beriberi is shown by the increased indican content of the urine. The toxic products of the intestinal bacteria or parasites may thus assume a role of high importance in the genesis of morbid states which were no doubt initiated by the dietetic defect. Vitamin deficiency renders the body very liable to be overrun by a rank growth of bacteria.41

40 McCarrison, Brit. Med. J. 1919, II, 36.

Monkeys fed on a diet of autoclaved milled rice, with or without the addition of butter-fat, died within two or three weeks, death being more rapid in the group given butter-fat than among those fed on rice alone. There was no evidence of polyneuritis.42 the symptoms noted being progressive anaemia, gastro-intestinal disorders, and progressive asthenia. The stomach and abdominal walls were greatly thinned and the whole gastro-intestinal tract showed congestive, necrotic, and inflammatory changes, with degenerative changes in the neuromuscular mechanism, leading to dilation of the stomach and ballooning of areas of the intestine.43

This also points to the conclusion that dietaries which are deficient in vitamins and protein, and at the same time excessively rich in starch or fat, or both, are potent sources of disease, and especially of gastro-intestinal disease. An excess of fat, in association with a deficiency of B vitamin and protein and superabundance of starch, is peculiarly harmful.44 Under such conditions the invasion of the blood and tissues by bacteria is greatly favored.

Observations very similar to those of McCarrison were made by Bmmett and Allen45 on rats which had been deprived of B. The various tissues ex-amined histologically were: Thymus, thyroid, pancreas, testes, ovaries, adrenals, liver, spleen, ilium, colon, kidneys, heart, lungs, brain, optics, lower cord, and sciatic nerves. The most noticeable changes were found in the almost complete atrophy of the thymus; hypertrophy of the adrenals; passive congestion; fatty infiltration; and at times fatty degeneration in the liver46 and some atrophy of muscle fibers of the heart. In addition there was more or less passive congestion in the pancreas, spleen, ilium, colon, kidneys, and lungs.

Vezar and Bogel,47 in studying the effect of various accessory food materials, found that the alcoholic extract of vitamin B from bran gave a marked vasoconstriction, which was, however, not obtained with an aqueous extract of the same material, and which was therefore probably due to something other than vitamin B. Similarly, extract of A from butter gave a vasodilation, but the same effect was obtained from aqueous extract of butter, which renders it improbable that vitamin A was the potent factor.

41 See also, Drummond, Bioch. J. 13, 66, 1919.

42 But compare Gibson, see p. 207.

43 See also Hewlett and de Korte, Brit. Med. J. 1907, 11, 201.

44 See also Bmmett and Allen, J. Biol. Chem. 38, 325, 1919.

45 Emmett and Allen, J. Biol. Chem. 41, liii, 1920.

46 See also Funk and Douglas, J. Physiol. 47, 476, 1913-14.

47 Vesar and Bogel, Bioch. Zeits. 108, 1920.