1678 BERI-BERI AND EPIDEMIC DROPSY 



The epidemic of beri-beri now began: December, 190 1, 52 cases and 2 

 deaths; January, 1902, 169 and 12; February, 1,087 ^^^^ March, 576 

 and 15; April, 327 and 15; May, 310 and 19; June, 451 and 17; July, 233 

 and 33; August, 571 and 24; September, 522 and 31. 



On October 20 the diet was again changed, and this time proteids were 

 10 1 '7 1 grammes; fats, 19*37 grammes; carbohydrates, 39573 grammes; 

 salts, 29-13 grammes; including 119-07 grammes of potatoes and 255'i5 

 grammes of rice. Nitrogen was 209-8 grammes; carbon, 3,816-2 grammes; 

 hydrogen, 70-4 grammes; sulphur, 17-2 grammes; and salts, 185 grammes — 

 N: C:: i: 13-4. 



In October there were 579 cases and 34 deaths; November, 476 and 8; 

 December, 89 and 3; half January, 1903, 4 cases and no deaths. 



Along with the beri-beri there was an epidemic of scurvy, and Fales was of 

 the opinion that both diseases were led up to by a deficiency of vegetables, 

 the essential principle of which he believes to be potassium carbonate, of which 

 rice contains only o-oi grain per ounce, while potatoes contain 1-875 grains. 

 Hence, according to Fales, the disappearance of the disease when a suffi- 

 ciency of vegetables, especially potatoes, was given. But he says this 

 deficiency was only a predisposing cause, which enables the micro-organism, 

 whatever it is, which is the true cause of the disease, to flourish and produce 

 the symptoms. In other words, the people get run down by a bad diet, and 

 are ready for any disease, so that this does not clear up the aetiology. 



Recently Ingram has drawn attention to an outbreak in the 8ist Pioneers 

 and the 2nd Battalion of the King's Own Scottish Borderers, at Aden, in 

 which he could find no clear evidence that beri-beri was due to diet alone, 

 whether insufiicient proteids or excessive rice, or bad rice, but he considered 

 a diet rich in proteids good as a preventative. He could only find one thing 

 in common in the two regiments — viz., both brought the disease with 

 them — but was unable to find any source of infection, parasitic or 

 otherwise. 



[e) Deficient Phosphorus. — Schaumann and others have maintained that 

 deficient organically combined phosphorus in the uncured rice is the setio- 

 logical factor. 



(/) Deficient Cholesterin. — 'Chrisostem has treated cases with injections of 

 cerebrin with good results, and with 5 per cent, cholesterin in olive oil with 

 better results. 



6. An Intoxication from a Germ living Outside the Body. — Manson 

 brought forward the hypothesis that a germ may live in the soil, the house, 

 or the ship occupied by the human being, under certain conditions of tem- 

 perature and moisture, and may grow and produce some kind of toxin which, 

 being inhaled or swallowed, or otherwise introduced, causes the disease. More- 

 over, this germ may be carried by men from place to place. 



He supports this theory by pointing out — (i) that when patients are 

 removed from an endemic spot they at once begin to recover ; (2) he quotes 

 Hirota's observation that fifty-two infants nursed by beri-beric mothers 

 showed signs of the disease, and did not improve when treated medicinally, 

 but rapidly improved, if the disease had not advanced too far, when taken 

 from these mothers and placed on artificial food or given to a healthy wet- 

 nurse. Further, Herzog says that, according to Dr. Albert, similar cases 

 are not very infrequent in the Philippine Islands, but the removal of the 

 child from the mother is most difficult, as the people do not understand the 

 necessity. 



Manson rightly points out that these children must have been poisoned 

 with some chemical substance, and not infected with a germ. But, of course, 

 the germ causing the toxin might be in the mother's body. 



Again, Manson points out that the disease clings to ships, in which it 

 appears year after year when the tropics are reached. There is also evidence 

 that the cause, whatever it is, clings to rooms for a short time. 



7. An Intoxication or an Auto-Intoxication. — Duerck is convinced 

 from the study of the pathology that the cause of the disease is a toxaemia, 

 and points out that substances formed in the body by process of auto- 



