EPIDEMIC DROPSY 



1691 



Calcutta to Shillong, Dacca, and South Sylhet, and to Mauritius, 

 by means of labourers passing through that town. Mauritius 

 became infected in 1878, and was clear of the disease in 1879. 



No further accounts of the complaint appeared until 1901, when 

 it was again recognized in Calcutta and Madras. In 1902 it occurred 

 in the Barisal Gaol in Bengal, and in 1907 it occurred in Assam and 

 the two Bengals. It is probable that during the intervening years 

 it has really been present in some part of India, but has been called 

 ' beri-beri.' Greig has come to the conclusion that it is a 

 deficiency disease. 



Climatology. — The disease is met with in India and Mauritius, 

 and generally in the cold season. Recently cases of this condition 

 have been reported by Leporini from Cirenaica. 



etiology. — The causation of the disease is unknown, but there 

 are various theories — e.g., (i) that it is beri-beri; (2) that it is a 

 post-dysenteric anaemia or hydrsemia; (3) that it is due to nitrogen 

 starvation; (4) that it is due to eating Burma rice, the action of 

 which is explained in various ways; (5) that it is dal poisoning; 

 (6) that it is a special bacterial disease conveyed from person to 

 person by the bed-bug. 



This latter is Delany's theory, and is supported by the fact that 

 the disease is epidemic, and spreads apparently by the agency of 

 human beings, but not from man to man; that it begins with an 

 initial fever, and has a rash, and that there is a local house infection; 

 and, finally, by its sudden disappearance and reappearance. Other 

 theories are that it is a ptomaine poisoning, or a bacillus in fish, or 

 a rust or fungus on rice. 



Pathology. — ^No remarks can be made on this part of the subject. 



Morbid Anatomy. — There is subcutaneous oedema and fluid in 

 the peritoneal and pleural cavities. The mouth and pharynx are 

 oedematous, and the oesophagus may be ulcerated. The stomach 

 is very congested, and may show hsemorrhagic patches, and the 

 jejunum is congested, as are the mesenteric glands and the liver. 

 The pancreas is normal. The aryepiglottidean folds and the lungs 

 are oedematous and congested. The kidney is congested, and may 

 show cloudy swelling, but the bladder is normal. The spleen is 

 shrunken; the pericardium may be normal, but the heart is dilated. 



Symptomatology. — Generally there are no distinct prodromata; 

 occasionally the onset of the disease is preceded by diarrhoea. 



Epidemic dropsy begins with an attack of fever without any initial 

 rigor, the temperature rising to 99° to 104° F., and continuing of low 

 type with remissions and, later, intermissions for a variable period of 

 time, sometimes as long as a month. Associated with the fever, 

 and, indeed, the most constant and characteristic symptom, is the 

 dropsy, which, beginning in the feet and legs, may spread up the 

 thighs to the abdomen, and even to the hands, arms, and face. 



There is distinct anaemia after the disease has lasted a little time. 

 Rogers records a count of 3,090,000 erythrocytes per cubic 

 centimetre, and a haemoglobin count of 54 to 65 per cent. The 



