By Robert S.; Thimann, Kenneth V.; Marrian, G. F. Harris
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Larger doses, however, might have produced some improvement. DIETARY NEUROPATHIES 41 The classical picture and pathological changes of this syndrome bore no relation to Wernicke’s encephalopathy and the maximum incidence occurred a t a time when few fresh cases of beriberi were appearing. The deficiency states associated with the condition were as follows: (a) amblyopia, probably from retrobulbar neuropathy46 % (b) “painful feet”-38% (c) stomatitis and scrota1 dermatitis-18 %. 2. Relation to Lathyrism As this syndrome did not occur in any of the other prisoner-of-war camps in the Far East, it is possible that it was not due to dietary deficiency but to an ingested toxic factor.
I n a great majority of cases, there is no other sign to suggest pyramidal tract lesions, since the abdominal and cremasteric reflexes are active and the plantar responses are flexor. Protracted pain and loss of sleep may be contributing factors. In Changi Prisoner-of-War Camp, however, cases of spastic paraplegia, the result of motor neuron myelinoclasis, occurred when the incidence of the painful feet syndrome was a t its height and the DIETARY NEUROPATHIES 25 onset of spasticity in some of these patients was preceded by painful feet.
In the cases observed in tropical climates, there is no evidence of vascular spasm or trophic changes, but when sufferers are transferred to cold climates, or if prolonged immersion in cold water occurs, the feet may become pale and cyanosed when dependent. In these cases the posterior tibia1 and dorsalis pedis pulses often disappear and gangrene of toes and loss of a limb can result (Page, 1946). Variations in skin temperature and color are regarded by some writers as indicative of an abnormal capillary circulation.