REVIEW TKOPICAL MEDICINE, ETC. 15 



ascending spinal paralysis, locomotor ataxy, ataxic paraplegia, spastic paraplegia, myelitis Beri-beri— 

 affecting the lumbar region, epidemic dropsy, pernicious anfemia, heart-disease, Bright's continual 



disease, ankylostomiasis, trichinosis, pellagra, ergotism and lathyrism. It is curious that in 

 this long list scurvy is not included, for the resemblance of certain cases of scurvy to certain 

 types of beri-beri is well known. 



Thus, Barnardo,' in a paper on scurvy affecting troops in Somaliland, draws attention to 

 toxjEmic cases characterised by a neuritis sometimes peripheral, sometimes cardiac, and 

 suggests that both scurvy and beri-beri may be due to toxin production in the alimentary 

 tract, as suggested for the latter by Hamilton Wright, an hypothesis first put forward by 

 Chevers. Hoist and Frolich^ term ship beri-beri " the younger brother of scurvy," but point 

 out that it is possibly a different disease from tropical beri-beri. However that may be, 

 beri-beri has been mistaken for scurvy more than once, and their resemblance has to be kept 

 in mind, especially when one is dealing with advanced, untreated scurvy. This fact was 

 forcibly brought to my notice by an epidemic of the latter which occurred in the 

 Civil Prison, Khartoum, during the winter of 1906. Several of the patients developed 

 symptoms strongly recalling dropsical beri-beri. Hyperaesthesia, oedema, peculiar gait, 

 cardiac dilatation and other classical signs were present, though most of them presented, in 

 addition, spongy and bleeding gums. Epidemic dropsy was the other disease which had to 

 be differentiated, and it was only when energetic treatment, principally of a dietetic nature, 

 was established that the question of diagnosis was settled. 



The disease is known to occur in the French Sudan, while Bagshawe^ suggests on very 

 strong evidence that the condition " Bihimbo," in Uganda, is really beri-beri. Hodges* 

 comments on this and records his opinion that the disease is, in all probability, beri-beri. 

 Captain Ensor states that he has seen two typical cases in the Sudan, and I have met with a 

 case of peripheral neuritis not unlike beri-beri. As, therefore, the disease may come more 

 into prominence in the future, a few notes on recent work upon it may prove useful. As 

 regards its etiology, facts favouring the mouldy rice theory are quoted by Gimlette^ in a 

 paper on a localised outbreak in the Malay Peninsula, while, under " Current Topics," the 

 Indian Medical Gazette'' deals with the same question and cites, as does Gimlette, the 

 suggestive work of Hose and Lucy of Penang. The theory that beri-beri is due to an 

 intoxication by a poison conveyed in " uncured " rice originated with Braddon, who has 

 recently published a large work' on the subject and brought forward such evidence that, to 

 quote a review, "one is inclined to come to the conclusion that rice does play a part in the 

 production of the disease, or, at least, that further experiments should be carried out to 

 prove or disprove its action as a cause." Fletcher* supports Braddon's view as a result of 

 his experience and experiments in connection with an outbreak at Kuala Lumpur Lunatic 

 Asylum. He concludes that : — 



Uncured rice is, either directly or indirectly, a cause of beri-beri, the actual cause being either (1) a poison 

 contained in the rice ; (2) deficiency of proteid matter, the disease being due to nitrogen starvation ; or (3) uncured 

 rice does not form a sufficiently nutritive diet and renders the patient's system specially liable to invasion by a 

 .specific organism which is the cause of beri-beri. 



This leads us to speak of the organismal theories and to quote Herzog," whose 

 investigations are recorded in a very complete and interesting paper. His experiments 

 led him to believe that none of the claims brought forward for the discovery of a specific 

 micro-organism for the disease can be looked upon as substantiated. This includes 



• Bamardo, J. P. (July, 1904) "Scurvy in Somaliland: Notes on the Condition of Blood Serum." Indian, 

 Medical Gazette, p. 241, Vol. XXXIX. 



' Hoist, A., and Frolich, T. (October, 1907), "Experimental Studies Relating to Ship Beri-beri and Scurvy." 

 ■Journal of Hygiene, Vol. VII., No. 5. 



' Bagshawe, A. Q. (January 15th, 1907), " ' Bihimbo ' Disease r The Nature of the Disease termed ' Bihimbo ' 

 met with in the Chaka District of the Uganda Protectorate." Journal of Tropical Medicine and Hygiene, 

 p. 18, Vol. X. 



•* Hodges, A. D. P. (October 31st, 1906), "Report to P. M. O. Uganda and East Africa on Sleeping Sickness." 



^ Gimlette, J. D. (September 1st, 1906), " Beri-beri, Mouldy Rice : The Occurrence of Beri-beri in the Sokor 

 District." 



" "Beri-beri and Diet." (May, 1906). Indian Medical Gazette, p. 183, Vol. XLI. 



' "The Cause and Prevention of Beri-beri." London, Rebman, Ltd., 1907. 



' Fletcher, W. (June 29th, 1907), " Rice and Beri-beri." Lancet, p. 1776, Vol. I. 



'' Herzog, M. (September, 1906), " Studies in Beri-beri." Philippine Journal of Science, p. 709, Vol. I. 



