Two epidemics of beriberi occurring on board ship, which appear to prove very conclusively that this disease is propa gated through the drinking-water. In both cases the men were healthy as long as they still had a supply of European water. although staying for some time at places where the disease is endemic. But, the water having run short, they had, in the one case, to lay in fresh water at Batavia and, in the other, at Mauri tius, in both of which places the disease occurs endemically. About four weeks after commencing to drink this water the disease broke out among the crew. It would thus, also, appear that the in cubation period of beriberi is about one month. Roll (Norsk Mag. f. Laege videnskaben, Nov., '95; May, '96).
European or mulatto contracted beriberi, there were 45 cases among the aborigi nals. Length of residence in the jail and want of occupation, together with over crowding, defective ventilation, inade quate provisions for cleanliness, and the removal of filth were the chief deter mining causes. The affection generally commenced toward the third month of incarceration. Compulsory exercise was invariably followed by an amelioration of symptoms, but if the patient remained Case of beriberi on top of Fujiyama, Japan, in the month of December, as cribed to insufficient alimentation and constipation. Miura (Sei-I-Kwai Med. Jour., June, '96).
At the Dakar prison in Senegal, west ern Africa, the total number of prisoners under observation in 1S95 was 647, of whom 52 were Europeans, the remainder being natives. The two classes lived under identical conditions; whereas no in prison a relapse ending fatally was sooner or later certain to supervene. Of twelve prisoners suffering from beriberi for whom pardon was asked in order that their lives might be saved, five were dead before the official intimation reached Dakar three months later. The seven survivors were at once set at lib erty, and eventually all of them recov ered. Unhygienic conditions an impor tant factor, but the chief cause of the disease is the lack of suitable employ ment. Lasnet (Archives de Med. Navale et Coloniale, Feb., '97).
Marked predominance of the number of outbreaks that occur in the wet and cold months of the year, when, presum ably, the native sailors will remain huddled up in their stuffy forecastle. Out of the 157 cases recorded, 96 oc curred between October 1st and Febru ary 28th; the remaining 01 occurred between March 1st and September 30th. It has been shown that in a certain group of vessels, all drawing their food supply presumably from the same source, in only one-half of their number did beriberi occur; and, further, that one epidemic undoubtedly renders a ship liable to future outbreaks.
The history of the outbreaks at the Richmond Asylum tends to prove that beriberi is a "place" disease and not a "food" disease. It is highly improbable that the same food-supply was used in this asylum during the epidemics of 1894, 1890, and 1897. With all these facts before us, we are justified in adhering to the belief that an outbreak of beriberi depends on "place" infection plus favor able predisposing conditions. D. C. Rees (Brit. Med. Jour., Sept. 18, '97).
Forty-five deaths from this disease among 506 men of the Australian pearl ing fleet, in voyages lasting altogether 53 months. They sustain the view (1) that beriberi is confined to a very great ex tent to rice-eating races, and with proper care will not develop in less than sixteen months; (2) that the substitution of a mixed diet of wheat-flour, beans, pota toes, etc., to the exclusion of rice, miti gates, even if it does not prevent, the disease. Lime-juice is not very useful, bnt beer is very beneficial. T. H. Haynes (Jour. of Tropical Med.. Mar. 15, 1900).
Epidemic of beriberi in a foundling house. There had been one or two cases in a blind-asylum near by, the inmates of which came in contact with the chil dren in the foundling-house. Sixty-nine cases occurred, and only 27 healthy chil dren were left in the house. Two of the patients with beriberi died, the remain der were improving. The children at tacked were all between 4 and 7 years of age. Their hygienic surroundings were good, and the diet was excellent. All those attacked slept on the ground floor. F. Clarke (Brit. Med. Jour., May 12, 1900).
Other factors in the etiology of the disease are fatigue, exhausting diseases, exposure to marked alternations of tem perature, all conditions tending to sap the vital energies and reduce the nutri tion of the nerve-centres, and to prepare the system for the attacks of the infec tious principle.
Pathology.—Pekelharing and Winkler have obtained from the blood of beri beri patients a micrococcus which, inocu lated in animals, produced polyneuritis. Ogata and Lacerda ascribe the disease to a bacillus resembling that of anthrax. Musso and Morelli have isolated four micro-organisms: a staphylococcus pyog enes albus; a micrococcus in chains; a small micrococcus; and, last, a small organism which, inoculated in dogs and guinea-pigs, produced a universal degen erative neuritis.