Deficiency disease in P.O.W., Royal Naval Hospital, Sydney (1945-46)

this film was made to demonstrate some of the clinical features seen in released prisoners of war and internees from Hong Kong and Singapore during their captivity from 1941 to 1945 the prisoners had existed on a dart consisting mainly of rice usually polished and frequently deteriorated from Storage in constant addition were dried fish beans peanut oil and cranum leaves nearly all suffered some deficiency symptoms which occurred in a similar order usually beginning within 3 months of imprisonment swelling of the ankles appeared first followed by dimness of vision an axic gate paresthesia of the limbs and in a few cases nerve deafness this patient demonstrates well the defective vision due to Central scheta which was the usual finding he can be seen to move the newspaper in a rotatory manner in order to dodge the skomer and use the periphery of his retina both his discs showed partial optic atrophy and he also had macular degeneration which was not uncommonly associated with optic atrophy the charts are typical of those in most cases and show bilateral small Central scotter scotter were usually relative but occasionally absolute their situation was always Central or parentral and the peripheral Fields remain full visual accurity in most cases was reduced to 6 60ths or less in each eye this man had again great difficulty in reading and his funai showed bilateral partial optic atrophy although the onset of visual symptoms in most patients was gradual some became almost blind in a shorter time as 48 hours this shows the size of type the last patient was endeavoring to read this man shows again very defective sight note the long distance away he holds the newspaper the optimum focal distance varied from case to case his funai showed normal vessels with bilateral palor of the temple side of the discs and macular degeneration in this man optic atrophy was only one sign amongst many in addition he developed severe nerve deafness paresthesia of the limbs and foot drop he can be seen here attempting to read a newspaper but requiring support to prevent his falling because of rism when he stops using his eyes to orientate himself in his surroundings he falls unless supported this shows corneal scarring due to sever old Coral ulceration in the left eye a normal right eye scarring of this degree was rare but deficiency ulcers were common the Gate of the axic patients was very typical they showed an exaggerated stamping and wide BAS gate in some cases suggestive of Hysteria this SEO shows well the exaggerated stamping an ax here he can be seen to be unsteady when he turns or bends down he now shows Axia and weakness of the legs and complete anesthesia of the stocking type this man developed numbness and electric feet in 1942 this was followed by Axia and bilateral foot drop his condition remained stationary throughout the remainder of his imprisonment and on release he shows slight optic atrophy anesthesia and loss of deep reflexes in the legs weakness of dsy flexes of the feet and as is seen here a steppage and wide Base gate this man developed complete bilateral nerve deafness in 1943 hence the need for the death and dumb language he also has bilateral stocking anesthesia at fin prick bilateral foot drop and as can be seen here a high steppage gate with a tax here these views show two of the most axic patients walking together for Mutual support one shows the steppage and axic gate with foot drop and the other a sastic scissor gate so exaggerated as to suggest Hysteria this patient shows only slight axio when walking but becomes unsteady when he attempts to run he has optic atrophy and rism with only very little diminution of sensation to vibration and joint position and no loss to pin prick he received nicotinic acid and thomine for 2 years in Camp without any improvements note his lateral staggering as he approaches the camera this and the following views show three patients being tested for rism loss of propri receptive sensation was a common finding case two case three we come now to a case which differed in many ways from the remainder the onset was in the usual way with defective Vision numbness of the legs deafness and Axia later he developed difficulty in swallowing a horse voice and precipitate micturation with nocturnal enuresis his gate as shown in these views is a scissor leg one with exaggerated High stepping o to foot drop he has great difficulty imbalancing as he has loss of all forms of sensation up to the nipple line and also the right side of his face he has optic atrophy and nerve deafness the whole condition suggests amyotrophic lateral sclerosis with sensory changes this shows his tricked movements to oppose index finger and thumb because of wasting of the intrinsic muscles of the hands this shows the wasting of the palms and here the backs of the hands he has General increase in deep reflexes and muscle tone the right knee Jer the left knee Jer this shows a flexed foot drop and a foot drop note the difficulty in forc dors Def flexion in the last case compared with the normal an absent kneejerk which was the common finding this is an improvised foot drop spring produced in captivity by one of the patients this shows the anesthesia to pin prick in one patient on his legs but the normal sensation on his arms remedial exercises were given not so much to increase muscle power as to restore confidence and re-educate patients in balance and movement despite the loss of proceptive sensation as can be seen in these views several of the patients have difficulty performing trunk turning without falling over in addition to exercises a high calorie value Dart augmented with large doses of thine nicotin acid riboflavine and malite was given many patients had had vitamin therapy whilst in imprisonment this had produced Improvement during the early stages of the disease but once fully established no change had resulted the results of treatment since their release have been on the whole disappointing there has been subjective Improvement and some of the grossly axic cases have learned to walk better but neurological signs have remained unchanged