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    Discussion points 4-6

    4.  Evidence that the auditory system is susceptible to impairment by loss of aerobic
    enzyme function.  One famous example is when the co-enzyme thiamine
    (vitamin B1) is lacking [37-49].  See figures 7, 8, and 9.

    Note: Beriberi was once believed to be caused by a bacterial infection: “The
    cause of beriberi appears to be a bacillus which gains entrance to the
    alimentary canal in contaminated food and drink.” [50, p289]

    5.  Evidence that the auditory system is part of the subcortical pattern of damage
    found in children affected by kernicterus [51, 52].  See figure 10 below.

    Note: Ranck and Windle (1959) in their paper on asphyxiation of newborn
    monkeys commented: “The human neuropathologic entity most closely
    resembling the effects of asphyxia neonatorum in the monkey is kernicterus.
    There are similarities in the distribution and type of nerve cell changes in both
    conditions.  Major differences between the findings in the monkey and those
    in human infants with kernicterus are absence in the former of the usual
    history of erythroblastosis fetalis, lack of clinical jaundice, lack of pigment in
    the lesions, . . .” [4, p153]

    6.  Evidence that bilirubin staining of the basal ganglia and other subcortical areas
    is secondary to impairment of the blood-brain barrier [53-57].

    Note: Bilirubin is not toxic.  Bilirubin staining of subcortical nuclei results from
    impairment of the blood-brain barrier by anoxic-ischemic injury or by a
    substance that disrupts aerobic metabolism.
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