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The term ‘global health’ did not exist in the time of Christiaan Eijkman (1858-1939), although his work could certainly be seen as representative for the field. In this article, we want to commemorate the life and work of Christian Eijkman, who was awarded the Nobel Prize in 1929 for his invaluable insights into the role of vitamin deficiency and nutrition. This year, the Eijkman Medal will once again be awarded, four years after the previous award. We will also reflect on why we value this tradition, which started with the first medallist in 1929, and share our thoughts on the future of the Fund.
Chickens and prisoners
In 1883, the young Eijkman moved to Java with his wife to serve the Dutch military as a medical officer, just after he received his medical degree cum laude from the University of Amsterdam. It was there that he was first confronted with beriberi, a nasty nutritional disorder from which many soldiers suffered, causing peripheral neuropathy, muscle pain and atrophy, cognitive dysfunction, heart failure, and even death. In those days, the germ theory of disease was popular, and Eijkman committed himself to finding what he believed was the microbial causative agent.
However, shortly after his arrival he got malaria, for which he was eventually sent home to recover. Back in the Netherlands, he continued studying beriberi. He travelled to Berlin where he met Robert Koch, who had discovered the tuberculosis bacterium three years earlier and had developed a method to grow bacteria and infect animals. Eijkman worked with Koch for a year and was included in the team of bacteriologist Pekelharing and neurologist Winkler, both of whom were commissioned to study beriberi.
In 1886, Eijkman returned to Batavia where he continued his research on neuritis. As he searched for a microorganism as the cause of neuritis and to demonstrate Koch’s postulates, he injected chickens with blood and urine of beriberi patients. However, the chickens developed polyneuritis independently of what they were injected with. The chickens from both the experimental group and the control group developed the disease, and even sterile chickens that had not been in contact with sick peers did so. But one day, strangely enough, the condition of the affected chickens improved and the disease disappeared. Eijkman found that a change in food – the new cook had changed their diet from left-over white rice to cheap brown rice – cured the chickens from their beriberi-like disease. Nine years later, Eijkman expanded his research to include humans, with the support of Adolph Vorderman, Inspector of Public Health of Java, by surveying inmates in 101 prisons for cases of beriberi. Their research showed that beriberi mortality was about 300-fold higher in prisons that served polished rice.
From vital amine to vitamin
The correlation between beriberi and nutrition was made. Thereafter, developments went fast. In 1898, Sir Frederick Hopkins postulated that some foods contained ‘accessory factors’ that were vital for the human body, and in 1901, Gerrit Grijns, an assistant and successor to Eijkman, correctly interpreted beriberi as a dietary deficiency of a ‘protective nutrient’ in the outer hull of rice grains that gets lost during polishing. Between 1910 and 1913, Edward Bright Vedder established that an extract of rice bran is a treatment for beriberi. In 1914 the Polish chemist Casimir Funk coined the name of ‘vitamin’ from ‘vital amine’, and in 1926, Jansen and Donath separated the crystalline vitamin B1 in the same laboratory in Batavia.
In 1929, both Eijkman and Hopkins were awarded the Nobel Prize for their discoveries. Christiaan Eijkman and his fellow researchers laid the foundation for vitamin supplementation, and nowadays beriberi is rarely observed, although accurate statistics on the incidence of the condition are no longer available. Beriberi has been reported among refugees who rely on emergency food aid, due to the lack of available micronutrient supplementation. In high-income countries, beriberi is limited to persons with high alcohol intake, people on fad diets, persons on long-term peritoneal dialysis without thiamine replacement, persons undergoing long-term starvation, or persons receiving intravenous fluids with high glucose concentration.
Global health research avant la lettre
In honour of Christiaan Eijkman as one of the founders of modern nutrition, the Eijkman Medal Fund was established on the occasion of his twenty-fifth anniversary as a professor at the University of Utrecht, on 1 October 1923. After the award of the first medal to Dr B Jansen for his research in the Dutch East Indies on the anti-beriberi vitamins in 1927, another 22 years passed before the next medal was awarded (1949). The list of people who were honoured is long. A total of 51 researchers received recognition for their work, predominantly in tropical medicine. Of these, some received the medal for their work as a Director of a Tropical Institute, and in a few cases, it went to social scientists for their research in medical anthropology or health systems. Sister Barten received the Medal in 1985 for her continued work and inspiration for public health in Indonesia, in particular for mother and child health. She is one of six women among the 51 laureates.
Gradually, the Eijkman Medal Fund has developed into a foundation that aims to promote research in global health, thereby defining global health as ‘the area of study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide’. This focus is very much in line with the work of Eijkman, who also addressed what we now would call a ‘poverty related disease’, as beriberi was very common among the poorer populations in Southeast Asia who ate mostly rice. Because of the new rice-producing machines that were introduced by the Europeans, beriberi was their sure fate. In that sense, Eijkman’s work can be seen as global health research avant la lettre. Four years after the previous Eijkman Medal ceremony, the Medal will be awarded again during this year’s NVTG symposium ‘From tropical medicine to global health’.
Over the past years, the Board of the Eijkman Medal Fund has discussed broadening its mission, for example by including research in the field of global health and research being conducted in developing economies. For this, the statutes of the Foundation need adaptation, something which will be done in close collaboration with the Royal Tropical Institute (KIT) and the NVTG, giving them a more prominent role in the Foundation to shape the proposed change. Promoting research in the field of tropical medicine and global health in the Netherlands remains relevant, also in view of the fact that the Dutch government identified health care as one of the top sectors on its research agenda. KIT and NVTG are willing to deploy capacity to support the Foundation in its mission and in efforts to raise funds to safeguard the future of the Eijkman Medal. Promotion of scientific research in the field of global health – including tropical medicine – is still relevant, now perhaps even more so than ever. One of the ways to do so is strengthening the links between the Eijkman Medal Fund and the activities of both organisations. The Board of the Eijkman Medal Fund is looking forward to this new impulse for the Eijkman Medal and all it stands for.
References
- Medicine in Stamps Christiaan Eijkman (1858-1930): The vicar of vitamins. Merritt C, MD* and Tan S Y, MD, JD, Singapore Med J 2011; 52(9): 652
- https://nl.wikipedia.org/wiki/Christiaan_Eijkman
- https://www.nobelprize.org/educational/medicine/vitamin_b1/eijkman.html
- http://www.discoveriesinmedicine.com/General-Information-and-Biographies/Eijkman-Christiaan.html
- http://jn.nutrition.org/content/125/2/155.extract#
- https://www.kit.nl/kit/nl/organisatie/stichting-eijkman/
