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Age Incidence.
In considering this we must have in mind the fact that the inmates of the Institution are for the most part adults. It would appear to especially affect those between the ages of 15 and 25. In point of fact most cases occurred between the ages of 15 and 20-three occurred earlier, namely, one at 3 years of age, and two at 14, and no cases were seen in those over 25 years of age. No conclusions may be definitely drawn from these figures except perhaps that when the disease occurs among the female sex those between the ages of 15 and 25 are principally affected.
Duration of the Disease under Treatment.
The disease is as a rule very slow in resolving itself. This points to a dege- neration of the nerve trunks and the muscles. Regeneration takes a prolonged time. The establishment of the path is first effected. and then after an appreciable period its conductivity becomes restored. This process takes a prolonged time to be accomplished, and considering the lengthy period during which treatment must be undergone it is doubtful whether any method of treatment is to be regarded as specific. In this series of cases the average length of time devoted to treatment before the patient was pronounced cured was 98 days:-17 of the cases remained under treatment from 117 to 156 days, 6 cases for the following periods, namely, 11, 20, 31, 21, 21, 16 days, and the remainder from 50-100 days. We might infer that except in the mildest cases treatment is not effective, that cases run their course, and arrive at a natural resolution-that is, that regeneration of the damaged nerves and muscles takes place in its own appointed time, and that gradually thereafter conductivity becomes established leading to a righting of the sensory and motor functions,
The one case that succumbed was of a rather more advanced nature than the others. She developed more ædema of the feet and legs; the nervous apparatus of the circulatory and respiratory systems became more profoundly affected, leading to vaso motor paralysis and to consequent infiltration of the tissues, among which the lung became affected, and a sub-acute condition of pneumonia supervened. She was under treatment for 50 days.
Incidence with reference to Occupation.
The occupation of all these patients was returned as "destitute ", a vague term which comprises many conditions in life. Some of them were occupied in house- hold duties-not the majority of them; some were looked after by parents or guardians and did no work; a few enjoyed a considerable latitude in their mode of life. In this particular series of cases it could not be said that occupation in any way modified the incidence of the disease. The conditions that existed were eminently favourable for the development of Beri-beri, and it was a coincidence that the building was inhabited by these women at the time.
The Treatment.
There being no specific for Beri-beri, treatment was mainly directed towards keeping up the strength of the patient, and towards alleviating any special symp- toms which arose.
As soon as the diagnosis was made the patient was put upon a mixture con- taining strychnine, arsenic and iron. If the pulse was weak, digitalis or stro- phanthus was added, and sometimes ether and ammonia given as well. Together with this routine treatinent, massage was carried out in every case-either with the bare hand, or with a stimulating embrocation. This was found to be especially effective in removing the cedema and in maintaining the nourishment of the mus- cles. When symptoms of dyspepsia were present the usual hospital mixtures were administered, namely, soda and rhubarb, bismuth and pepsin, hydrochloric acid and nux vomica, and so on. For any pain over the heart or palpitation, a mustard poultice or a belladonna plaster was applied. Any diarrhea on the rare occasions it appeared was checked with chalk and bael,