BERI-BERI AND EPIDEMIC DROPSY 



1. Arsenical Poisoning. — R. Ross, in 1900 and subsequent years, drew 

 attention to the similarity between beri-beri and the arsenical poisoning which 

 at that time was prevalent throughout Lancashire, being brought about 

 through the agency of arsenical beer. He further supported this by finding 

 arsenic in the hair in recent, but not in old, cases of the disease in Penang, and 

 woke up a controversy as to whether arsenic existed in normal hair or not. But 

 apart from the obvious reasons against this theory as an explanation for such 

 a widespread disease, Herzog has definitely shown that no arsenic could be 

 found in the hair of ten cases of different types of the disease. There is no 

 doubt that cases of chronic arsenical poisoning do occur in the tropics, as we 

 have seen, particularly in Europeans who have had to live for a long time on 

 tinned food, but these cases are not beri-beri. 



2. Oxalate Poisoning. — The oxalate theory is based upon the fact that 

 Maurer and Treutlein were able to produce a condition resembling beri-beri 

 in fowls by giving them oxalic acid in their food. The latter observer con- 

 sidered that the acid removed the calcium salts from the body of these animals, 

 and caused thereby a degeneration of the peripheral nerves and heart muscle, 

 and considered that this was proved by curing them by the administration 

 of calcium salts. Further, he showed that there was an excessive excretion 

 of calcium in the urine of beri-beri patients. But polyneuritis has been 

 produced in fowls by Eijkman by feeding them with cooked rice, and it is 

 possible that neither oxalic acid nor rice, but an infection, was the cause of 

 the disease, which may, of course, be quite different from true beri-beri. 



3. Carbon Dioxide Poisoning. — Ashmead believes that the disease is 

 caused by the excessive inhalation of carbon dioxide, but outbreaks occur 

 without any overcrowding, as we have seen ourselves. 



4. Food Poisoning- — (a) Ichthyotoxismus.- — Grimm considers the ingestion 

 of raw fish to be the cause of the disease, and Miura the consumption of 

 species of the Scombridae; but Wright has shown that in the gaol at Kwala 

 Lumpur, the disease infected forty-nine prisoners when no fish had been 

 given for eight months. 



(6) Sitotoxismus. — Rice poisoning at present is the favourite theoiy, and has 

 had many supporters. Thus Eijkman and Vorderman consider that it is 

 due to eating rice without husk, which is the natural protection. Gelpke 

 considers that it is due to stale or badly-kept rice. Yamagiwa considers it 

 due to rice improperly stored and preserved, as it occurs even when this rice 

 is well boiled. Braddon, who is often wrongly quoted, ascribes the disease 

 to the ingestion of a poison found in the rice, which is the result of the specific 

 product of some organism — epiphyte or parasite — but he does not believe 

 that the disease is due to the ingestion of the organism. Contrary to Eijkman 

 and Vorderman, Braddon looks upon the husk as the dangerous element, as 

 it is in this that the germ grows. 



But the disease has been observed, according to Scheube, who quotes 

 Fiebig and Voorthuis, in Brazil, the Moluccas and Liugga, where the people 

 live on sago, fish, and game, and where the attacked Europeans had never 

 eaten rice. 



Travers details an interesting observation on this point concerning an 

 epidemic of beri-beri in the Pudoh Gaol of Kwala Lumpur, in August, 1895, 

 when some of the cases were transferred to the Old Gaol, one and a half 

 miles distant, on October i, 1895, because the mortality in the Pudoh Gaol 

 was extremely high; and on October 25, 1895, sixty prisoners, showing no 

 signs of the disease, and apparently in good health, were similarly transferred. 

 From October i to December 14, 1895, all food supplied to the healthy 

 prisoners in the Old Gaol, as well as to the beri-beri patients transferred from 

 the Pudoh Gaol, was cooked in the Pudoh Gaol with the food for the other 

 prisoners who were suffering from the disease. 



This food was carried to the Old Gaol twice daily, and the diet was exactly 

 the same in both gaols, the rice being taken out of the same bag and cooked 

 in the same steamer. Further, it appears from Braddon's remarks that in 

 1895 a new scale of ordinary diets, with an increased amount of rice, was 

 allowed, fresh fish was replaced by salted, and beans were omitted, and 



