The History of Tropical Neurology: Nutritional Disorders

The authors state in the preface that tropical neurological disorders are not diseases of particular latitudes, but of particular deprivations. These diseases occur in the tropics because war, famine, poverty and oppression occur in the tropics. They point out that neurological diseases common in the tropics today were once common everywhere. However, this opening view does not serve as a platform for an incisive political history of nutritional disorders. This slim book is not overtly political , nor does it even take an historical approach. Rather, the prefatory remark seems intended to justify the book's unfortunate eclecticism. The text reads more like a series of brief biographical sketches of physician-scientists, interspersed with asides from the authors. These asides vary from their opinions on whether Eijkman ought to have won the 1929 Nobel Prize to possible etiologies for poorly understood conditions to flickering insights into the intellectual history of these diseases. This melange is collected around six neurolog-ical disorders related to improper nutrition: beriberi, burning feet, endemic cre-tinism, tropical ataxic neuropathy, neuro-lathyrism, and pellagra. Readers searching for coherent narratives or explanatory frameworks will remain frustrated. Paragraphs leap between centuries and continents. The story the authors are most interested in telling is the elucidation of the etiologies of these diseases by the Western world in the late 19th and early 20th centuries. However, detours into contemporary Japanese medicine are not uncommon, nor are glimpses of ancient China, India, and Greece, World War Two POW camps, and a host of other times and places. Sustaining the jetlagged reader is the substantial science. The excellent bibliographies attest to the enormous amounts of research the authors conducted on the scientific histories of these diseases. While some familiarity with these diseases is a prerequisite, the authors provide thorough summaries of research findings. Their chapters function best as comprehensive review articles. They also highlight where questions remain, indicating further areas where more research is needed. Unfortunately, the well-researched scientific history is presented in a disorganized fashion, obscuring the development of the scientific ideas. When turning from description to explanation, the historical analysis is largely empty; occasional sentences merely suggest the fertile possibilities of a history of tropical neurology. The authors assert, in various chapters (albeit somewhat inconsistently), that the dominance of the Koch-Pasteur germ theory substantially delayed the discovery of the vitamin theory. While plausible, much more could, and should, be said about the particulars of this …