SCIENCE 



NEW YORK, NOVEMBER 18, 1892. 



CONTRIBUTION TO THE ETIOLOGY OF BERI-BERI.' 



BY ALBERT S. ASHMEAD, M.D., NEW YORK. 



Through the courtesy of Captain J. R. Durke, of the bark " H. 

 B. Cann,'" whose crew were prostrated by beri beri in the tropics, 

 two of them dying of the disease, and of Messrs. Edward Hincken 

 & Son, the consignees of the carg«, I have been enabled to extract 

 the following data from the ship's log-book, to which I add some 

 informations otherwise imparted. The bark (registered 1,299 

 tons) sailed April 27 from Ilo ilo, Philippine Islands, with a cargo 

 of raw sugar, 70,284 sacks. Let me say that this is a considerable 

 freight, for a sack amounts to 66 pounds, which gives a total 

 amount of over 2,300 tons ! The sugar was mostly No. 3, the 

 lowest grade, and the most liable to fermentation.'' Fermenta- 

 tion in such a mass of sugar must have set free an enormous 

 quantity of gases. Her crew consisted of fifteen men. On May 

 32 bad sveather set in; there were 18 inches of water in the well 

 in 12 hours, a condition which necessitated pumping every two 

 hours. On June 5, heavy squalls, the bark ships large quantities 

 of water; this weather continues until the 20th. Even when the 

 squally weather has ceased, the pumps are worked every two 

 hours. On July 15 a terri6c storm strikes them, and continues 

 until July 20. The decks for 24 hours were continually filled- 

 with water. A strong south-west current (60 miles an hour), 

 lasting many days, set in. 1 observe here that it is generally sup- 

 posed that there is a connection between the south-west winds 

 and beri-beri. But the current called south-west is the current 

 naturally due to the emptying of the waters of the Indian Ocean 

 into the South Atlantic, around the Cape of Good Hope. It flows, 

 therefore, toward the south-west and not from the south-west. 

 In fact, throughout the voyage the bark never met the south- 

 western trades. The following data show that the bark had less 

 to deal with trade-winds than vessels usually do. When she left 

 Ilo-ilo April 27, the north-east monsoons were becoming very 

 weak; they carried the ship to the Basilan channel. The captain 

 tried to get through Macassar Strait, but the wind was too weak ; 

 so he changed his course, and came down, with variable winds, 

 Molucca passage. He was 45 days getting free of the East Indies 

 into the Indian Ocean, through Lonibock, an extraordinarily long 

 passage. He had south-east trades, strong and squally, to Port 

 Natal. He had 10 days' hard weather around the Cape of Good 

 Hope, three days of which there was a heavy gale. From the 

 Cape of Good Hope he had variable winds and calms until he 

 struck the south-east trades in the South Atlantic (Aug. 7), which 

 carried the ship past the equatorial line, 3' north latitude. Then 

 he had calms and doldrums to Sept. 11, at which date, latitude 

 9° 39' north, longitude 44" 21' west, he found south-east winds 

 prevailing instead of the usual north east trades, which he should 

 have met here. These carried him to the North Atlantic and to 

 port. Considering these facts, and the comparatively violent 

 outbreak of beri-beri on the vessel, we must conclude that the 

 etiological impoi-tance of the south-west trades in beri-beri has 

 been very much exaggerated, if it is not altogether imaginary. 

 Of course they have clearly an influence, inasmuch as they bring 

 wet and heavy weather, which wet and heavy weather would be, 

 I think, as innocent as the winds themselves if the really toxic 

 action of carbonic emanations was absent. 



Bodily exhaustion has always been considered as an etiological 

 factor in beri-beri. Here is added, what, as 1 just said, is in my 

 opinion, a much more important factor, the influence of carbonic 



1 Communicated to the Sel-I-Kwai, or Sockty for the Advancement of 

 Medical Science in Japan. 



2 The fact that the cargo in question came from lio-ilo to the United States 

 shows it to he of the lowest grade. The Philippines send us but their meanest 

 wares, strange as that may be, and for some unknown reason always from 

 Ilo-ilo. Nos. 1 and 2 go to Germany and England, always from Manilla. 



gases. One month after they left Ilo-ilo, the water got into the 

 hold, and the sugar began to ferment. Strong and stifling fumes 

 permeated the vessel, whicli continued until she got into still 

 water at Norfolk, Va. On Sept. 3 (this happened — the observa- 

 tion is not without its bearing — in latitude 2° 40' north, longitude 

 41° 2i' west, near St. Helena, 139 days from the Philippines, the 

 lUth day of the fermentation, on the very edge of the range of 

 the ti-ades) Russell, a seaman, was laid up with swollen limbs; he 

 died Sept. 33. The pumping, mean%vhile. continued every two 

 hours. On Sept. 16 (latitude 13° 27' north, longitude 52° 14' 

 west) the carpenter was laid up with swollen feet. Sept. 25 An- 

 drew, Sept. 26 Peterson, Sept. 27 Kemp, seamen, were afflicted 

 likewise. The carpenter died Oct. 9. At this date all were more 

 or less ill, except four. The work at the pumps was being con- 

 tinued with fewer hands. A signal of distress was hoisted Oct. 

 10. There got then 5 inches of water into the well every two 

 hours. Oct. 11 (I67th day of the voyage) the tug Rescue came 

 to the relief, took the bark in tow to Hampton Roads, where six 

 men sick of beri-beri were left in the hospital. A new crew was 

 enlisted, and the vessel, having been well pumped out, was towed 

 to New York harlior. It has been said somewhere that there had 

 been a famine on board and a scarcity of water. This, says the 

 captain, has not been the case. They had plenty of water, as ap- 

 pears by the following notation in the log-book: May 20, Filled up 

 starboard water-tank on deck. Aug. 30, Put about 150 gallons of 

 water into the starboard tank. Sept. 16, Saved about 300 gallons 

 of water. Sept. 19, Five feet of fresh water in the tank. And 

 the water was good throughout. Vegetables were the only thing 

 wanting, and rice and ship's bread (hard tack) were plentiful. 

 They had Australian beef, of which they had broached seven 

 casks (a cask is 300 pounds), and one cask of pork (300 pounds). 

 I extract a,gain from the log-book the following insertions to show 

 how far a cask of beef goes: April 27, broached a cask of beef;. 

 May 17, beef; May 39, pork; June 8, beef; July 5, beef; Aug. 

 17, beef ; Sept. 14, beef ; Oct. 3, beef. It is just a little inferior 

 to American beef. Besides the salt meat, the men had twice a 

 week fresh beef packed in tins, also lime-juice every day, and 

 fresh wheat bread baked every day. The ration table was that 

 required by the English Marine Service. 



The crew consisted exclusively of Europeans, the captain him- 

 self IS a Nova Scotian, and the bark flies the English flag. The 

 disease undoubtedly was beri-beri, so I hear from Surgeon J. C. 

 Perry of the United States Marine Hospital Service, Norfolk, Va. 

 Being English, the patients were placed in charge of Quarantine 

 Medical Officer Dr. W. A. Thom, Jr. All of them have now re- 

 covered. One of them, the first mate, reached New York by rail 

 and met the ship at her arrival. There had been eleven men sick; 

 four had resisted, the captain, aged 40; a Londoner, aged 25; the 

 steward, a German, aged 60; and the second mate, an Englishman, 

 aged 35. 



I extract from the log-book: Oct. 9, Andrew and Peterson both 

 still laid up. which makes it very hard for the rest of us. It takes 

 all hands to take in top gallant sail, or in fact do almost any- 

 thing, as we are getting weak from this sickness that has over- 

 taken us. More water than usual coming to the pumps. Mill 

 going almost all the time. Monday, Oct. 10, There are now three 

 men laid up, and we have to-day finished the last of our pro- 

 visions. The remaining of us are more or less affected by this 

 sickness. It is as much as we can do to pump ship with all hands. 

 Hoisted the signal P.H. to a steamer; apparently he took no notice 

 of us. Five inches of water in the well every two hours. Observe 

 that the victuals gave out only the day befoi'e they touched port. 

 I myself visited the ship and inspected the sleeping apart- 

 ments of the men. The forecastle is on deck ; it has twelve bunks 

 in a room 15 feet long, 10 wide, 7 high; doors and a scuttle ^^ive 

 free ventilation. The bunks were tight-boarded pens and. of 

 course, would hold gases. 



