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I have, since my arrival in the Colony, taken special interest in this particular disease, and in ad- dition to the cases I have had under treatment at the Civil Hospital I have had the opportunity of seeing many cases of this disease in the wards of the Alice Memorial Hospital.
As far as I can ascertain in those which have come under my notice, the patient, when attacked, complains of: Numbness in the legs, accompanied by swelling (Edema) of the ankles, this is soon followed by progressive loss of power in the legs, "he soon gets tired" and as this advances he finds it difficult to walk, at times his limbs will give way completely under him so that he often falls down, there is also a feeling of numbness in the feet, and a tingling followed by numbness in the tips of his fingers.
On admission to the Hospital he presents the following symptoms:-
i. More or less swelling (Edema) of the ankles and feet. This seems to be the earliest symptom the Chinese complain of, although in some cases, it is altogether absent and is often very slight, in the severer forms of the disease this increases up the leg, and becomes general, in the one fatal case this was very marked, general dropsy supervening.
ii. A peculiar ataxic gait when told to walk there is an unsteadiness in his gait, the patient feels that he is losing control over the movements of his legs and during pro- gression he lifts the foot up to an unnecessary height throws it forward and outwards and brings down the heel with a thud. In an advanced case at times, when walking he will suddenly lose all control over the muscles of his legs and fall down “all of a heap," and he cannot get up without assistance.
iii. On gently compressing the muscle of the calf with the finger and thumb considerable pain is experienced so much so that the patient will call out, this hyperesthetic con- dition of the muscles is very well marked, and in severer cases not only are the muscles of the calves affected but also the muscles of the thighs, of the arms, the pectoral muscles, and indeed nearly all the muscles of the body become similarly affected.
iv. Loss of power (paræsis), with subsequent wasting in the muscles affected, those of the
legs, thighs and arms most generally undergoing this change.
v. There is an enfeeblement of the normal knee-jerk, and in well marked cases a complete
absence of the same.
vi. An irregular action of the heart, in none of the cases have I seen evidence of valvular implication. In the fatal case before mentioned there was a peculiar tumultuous heaving action of the heart, and for two or three days before death decided evidence of heart failure, showing that the muscle of the heart was probably affected by the same degenerative changes which evidently occur in the voluntary muscles.
The only disease with which this may be confounded is Locomotor ataxy,-in both the ataxic gait is present, indeed I had two cases in the Hospital, one of Beri-beri and another of Locomotor ataxia and from the gait you could not distinguish the two, in Locomotor ataxia however you do not get the hyperesthetic muscles, and you have a condition of the eyes, the so called "Årgyll Robertson phenomena, which you do not get in Beri-beri.
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There are evidently two forms of the disease, the wet (Beri-beria hydrops), and the dry (Beri- beria atrophia.)
In the wet variety the Edema is much more marked and becomes in fact general all over the body, all the symptoms are more marked and the disease runs a rapidly fatal course.
In the dry variety the Edema, although generally present at first, is very slight and soon disappears, and the disease is rarely fatal. (Fayrer's Tropical Diseases.)
I have recently, through the courtesy of The Honourable W. M. DEANE, The Captain Superin- tendent of the Police, been enabled to examine the majority of the men in the Water Police, the exceptions being those absent on leave, the total Force numbering from 120 to 130 men.
On October 12th I visited the Stations at Tsimtsatsui and Yaumati. Out of a total of one hundred and twelve (112) at these two stations, there were fourteen (14) men who had suffered from this disease. All these men showed signs of having had this disease, and on being questioned through the Interpreter, stated that they had suffered from "Dropsy" accompanied by weakness in the legs, and in my opinion it was evidently Beri-beri from which they had been suffering.
Inspector CRADOCK, who has been connected with the Force for many years and is at present in charge of the Tsimtsatsui Station, seemed quite familiar with the symptoms of this disease and he informed me that it had been a common complaint amongst these men for some years past but more men had suffered from it during the present year. He also stated that in many cases a fatal result had followed in a very short time.