i66 MEDICINE 



operation within 16 hours of the onset of the attack. Only one of these 20 died, and 

 that from another disease. Of 115 who underwent operation between 16 and 24 hours 

 after the onset, 4 died = 3. 5 per cent. Of 145 who underwent operation on the second 

 day, 9 died = 6 per cent. Of 103 operations on the third day, the death rate was 7.7 per 

 cent. Of operations on the fourth day, the death rate was 18 per cent. 



Beri-beri. Few events in pathology, during late years, have been more notable, or 

 more happy, than the discovery of the cause of this endemic disease. Beri-beri, a form 

 of peripheral neuritis, with loss of muscular power, emaciation, and exhaustion, has been 

 one of the scourges of the tropics. In the Federated Malay States, the estimate has 

 been made of 45,000 deaths from beri-beri in the course of 30 years. In the Philippines, 

 it has been a long-standing evil. During the Russo-Japanese War, it accounted for a 

 very large part of the sickness among the Japanese. 1 



In 1909 Fraser and Stanton published their Etiology of Beri-beri. Working on the 

 lines suggested by C. Hose and Braddon, they traced the cause of the disease to the use of 

 " milled " rice, i.e. rice which has been "polished " by the removal of its husk and outer 

 layers. Fowls or pigeons, fed on polished rice alone, quickly showed signs of the dis- 

 ease: but, if the polishings of rice were added to their food, they quickly recovered. 

 Further observations, by De Haan, Chamberlain, Eijkmann, and others, showed that 

 the disease was not due simply to the absence of phosphates from the rice. It was due 

 to the loss of a substance which is present as a mere trace in the husks: indeed, there are 

 no more than 10 grains of it in a ton of rice. Funk, working at the Lister Institute, has 

 lately isolated this substance, and has given it the name of " vitamine." A pigeon, on 

 polished rice alone, will in three or four weeks show signs of the disease. If, a few hours 

 before death, a minute dose of vitamine be given to it, then it will quickly recover. 



The wonder does not end here. For this work on beri-beri throws light on scurvy, 

 epidemic dropsy, scurvy-rickets, etc. Indeed, Funk has isolated from limes a sub- 

 stance similar to vitamine, and present in about i in 100,000 parts of the fruit. 

 This " vitamine of the lime " has a favourable action alike on beri-beri and on scurvy. 

 The practical result of this brilliant series of studies is bound to be very great. We may 

 take for example, the Philippines. President Taft, speaking on May 4, 1911, of the 

 American occupation of these islands, said, " The change of their food from polished 

 to unpolished rice has practically stamped out the disease." Dr. Heiser (Journ. Amer. 

 Med. Ass., 1911, i, 1237) reports on a leper colony at Culion. The disease had been so 

 common in this colony, since its founding in 1906, that, in one year, one-third of the 

 deaths in the colony had been due to it. After the use of unpolished rice was made 

 compulsory, no deaths occurred from the disease: moreover, cases of the disease were 

 quickly cured by the addition of rice-polishings to their food. In May, 1910, the use of 

 polished rice was forbidden in all civil public institutions: with the result that only 2 

 cases of the disease have since occurred in these institutions, and in neither case had the 

 prohibition been strictly obeyed. 



Cancer. The Imperial Cancer Research Fund, in 1910, published its Third Annual 

 Report, giving facts as to the production of immunity, among mice, against mouse- 

 cancer. In its Fourth Annual Report, 1911, it upholds the theory of " the individuality 

 of cancer" as hardly open to doubt. On this theory, " each tumour is peculiarly and 

 genetically related to the individual in which it arises. . . . The relation of each 

 malignant new growth to the affected animal is an individual one, parallel to that 

 obtaining between the organs of the body and the organism as a whole." And again: 

 " The individuality of cancer, both as regards the organism attacked and the tumour, 

 would appear to have been placed at last beyond all further doubt. Such a relationship 

 has long been maintained in various forms on the basis of deductions drawn from 

 histological examination of the tissues at the site of the primary lesion, and from the 

 nature of dissemination, but this interpretation of the findings has been as vehemently 



1 A very important discussion on beri-beri, with papers by Dr. Schaumann, Prof. Axel 

 Hoist, and others, is published in the Transactions of the Society of Tropical Medicine and 

 Hygiene, v, 2, December 1911. 



