BEVrEV — TROPICAL MEDICINE, ETC. 47 



For drain pipes a solution of i tto'is sulphate 1 lb. to the goilon \n recommended, while Disinfection 

 water pipes are disinfected by .♦JUini; v.hem with a 2 per cen', . -^elation of carbolic acid for — continued 

 24 hours and then flushing them out \' i -lure water. 



Dropsy (Epidemic) . Our knowleu, th^, sease does no to have increased. 



Eogers' describes it as met with in India. The rash ■ to be ran vhile it would 



seem that the presence of the jerks and the absence of anaes^ ''ish it from 

 beri-beri. I have never heard of its being founu in t' Sudan. 



Since the above was written, an important paper by '^QJp ( He was 



appointed to investigate the causation of beii-beri in Indian jtii. 'there was 



no true beri-beri in Eastern Bengal and Assam — the uljease present oic dropsy. 



He believes this latter to be a specific infectious or bacterial disei s conveyed 



from person to person by bed-bugs. His reasons for looking upon •' rial disease 



are : (1) Its epidemic character ; (2) the initial fever; (3) the rash o. ) the local 



or house infectiousness ; (5) the sudden disappearance of the disease wn.. ted houses 



are vacated. The bed-bug theory is supported by (1) the well-known manner in ivliich the 

 disease ailects households ; (2) its close association with the sleeping places of affected 

 persons ; (3) the presence of bug-infested bamboo stools (morahs) in an infected district ; 

 (4) the benefits resulting from evacuation of infected jails and houses. He recommends 

 the latter method combined with bug prevention and bug destruction as likely to prevent 

 and eradicate the disease. 



Pearse,^ the Health Officer of Calcutta, is inclined to believe that beri-beri and 

 epidemic dropsy are one and the same disease due to a specific organism, but Delany, in 

 the paper just quoted, enters very fully into this question and tabulates the particulars in 

 which the diseases resemble and differ from each other. 



The diseases resemble one another in the following manner : — 



{(t) Both occur mostly in epidemics. 



(6) The knee jerks are altered in each. 



(c) Dropsy of various degrees occur in both. 



{d) There is considerable cardiac disturbance in each, dilatation and heart murmurs being present, or 

 palpitation and dyspnoea only. 



(f) In each disease the pericardium, pleura and peritoneum may contain fluid. 



(/) In each disease there is frequently oedema of the lungs. 



{g) Cutaneous sensation is disturbed in both diseases. 



(A) Hyperaesthesia occurs in both. 



(i) In each disease motion is frequently disturbed or interfered with. 



{}) And in each disease death occurs with distressing dyspnoea and orthopncea. 



But the diseases differ as follows : — 



(a) Knee jerks in beri-beri are at first and for a brief period (rarely over 48 hours) increased and painful, 

 and then lost in probably more than 95 per cent, of cases. 



In epidemic dropsy knee jerks are diminished or lost in no more than 3 per cent, of cases. 



(b) Anaesthesia is a marked feature of beri-beri and will be found in practically every case either in small 

 patches or over extensive areas. In epidemic dropsy cutaneous sensation is lessened over the dropsical areas and 

 not in patches otherwise than over dropsical areas ; but in this disease, though cutaneous sensation is diminished, 

 it is not lost, and probably is only so diminished from mechanical interferences with nerve termini by the 

 effused fluid. 



(c) In bei'i-beri true paralyses occur, with toe drop, wrist drop, paraplegia or paralysis of all four limbs. In 

 epidemic dropsy various forms of paresis are simulated by mechaniciil obstruction around, joined by the effused 

 fluids ; the very weight of a swollen limb may cause a difficulty in using it. An ataxic gait is simulated owing 

 to the swollen legs, and this may be more apparent when the external genital organs are swollen. 



But in beri-beri a characteristic symptom is the presence of varying degrees of paralysis in cases that have 

 no dropsy whatever (dry beri-beri), and this occurs, according to Hunter and Koch of Hong Kong, in quite 

 50 per cent, of the cases, these cases having besides the characteristic patchy anaesthesia. 



(d) The hypei-testhesia differs in the two diseases, being present in the dropsical skin and subcutaneous 

 tissue when gently pinched in epidemic dropsy ; but in beri-beri, the muscles are painful on moderate deep 

 pressure in cedematous and non-oedematous parts alike. 



(c) Some few cases of epidemic dropsy are found to undergo a general emaciation and so simulate the 

 atrophic stage of beri-beri in which the muscles atrophy to such a degree that the patients look like living 



' Rogers, Leonard, " Fever in the Tropics." London, 1908. 



'' Delany, T. H. (May, 1908), " Epidemic Dropsy or Beri-beri in Eastern Bengal." Indian Medical Gazette. 



» Pearse, P. (March 2nd, 1908), " On the Identity of Beri-beri and Epidemic Dropsy." Journal of Tropical 

 Medicine and Hiji/iene. 



