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PUBLIC RECORD OFFICE

Reference :-

C.O.885

21 PUBLIC RECORD OFFICE, LONDON

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO|

Present position

The work which has been done.

25994

(No. 106.)

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No. 114.

FIJI.

THE GOVERNOR to THE SECRETARY OF STATE.

(Received 8 August, 1911.)

Government House, Suva, Fiji, 27th June, 1911. [ Published as No. 10 in Appendix VI. & [Cd. 6024], February, 1912.]

No. 115.

FEDERATED MALAY STATES.

MR. D. J. GALLOWAY to SIR JOHN ANDERSON.

DEAR SIR JOHN,

(Received 17 August, 1911.)

Morebattle, Kelso, 14 August, 1911. You were good enough, when in Edinburgh, to ask me to tabulate my views on the question of beri-beri.

I have done so, and made them as concise as possible. They are somewhat revolutionary, but each investigator seems to have fallen into the same rut as his predecessor, with the same lack of result.

Before any man begins the research he should review the literature which I have suggested the Principal Medical Officers should extract from their reports and/or should obtain from their subordinate officers.

As I am cut off from all my authorities and can give no references, this little pamphlet is not quite fit for publication, but feel quite sure that the course suggested is the only practical one if a definite result is to be attained.

I have, &c.,

Enclosure in No. 115.

DAVID J. GALLOWAY.

MEMORANDUM ON BERI-BERI.

The theories of the causation of beri-beri are numerous, and a concise summary of the better-known ones, with a short criticism of each, is given in Brooke's "Tropi- cal Medicine." Each theory as it arose has been hailed as a "discovery" and the most recent is that of Dr. Fraser. It had been known for some time that milled rice was in some way a favourable soil for the development of beri-beri, while rice prepared in the native manner was not so. Dr. Fraser has shown that this is due

to the removal of the subpericarpal layer, which contains some element inimical to the development of the disease. That element he assumes to be phosphorus, and on this assumption is based the proposition that beri-beri is caused by phosphorus starva- tion. This theory is reminiscent of a very similar one propounded many years ago the theory of " nitrogen starvation." It had been proved that if to a diet of white rice some nitrogenous food clement were added beri-beri did not occur; hence the nitrogen starvation " theory. The mode of action in each is alike. If to a diet

of polished rice the huskings be added, or the proteid (nitrogenous element) be added, the contents of the digestive tract are made a less favourable development of the micro-organism or of its toxin, and the level of nutrition, and, nidus" for the therefore, of resistance, of the patient is raised. Fraser's" discovery" is of immense economic value, but it has not advanced our knowledge of the disease itself. the work which has been done on the subject of beri-beri is in the realm of its morbid Most of anatomy, and a reference to Pekelharing's beautiful plates will show that we knew as much 25 years ago as we do now.

Much has also been done in the way of experimental feeding, and the reports of the Medical Departments of the Straits Settlements and Federated Malay States bristle with the results of these. Among others is the now famous Pudoh Gaol episode, which was long supposed to be an insoluble puzzle. It proved one thing only--that the peccant material was not in rice, but was a superaddition conveyed to

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it from some extraneous source. Perhaps the most valuable find, from a scientific point of view, is that no micro-organisms of any kind have been found in the nerves or other tissues affected by beri-beri degeneration.

Some crude isolated attempts to deal with the matter from the direction of patho- logical chemistry have elicited two facts of some importance that the saliva of beri- beri contains no sulphocyanic acid, and that the urine of beri-beri is much more toxic than the normal.

cause.

The cause of the profound changes in the nerves wrought by beri-beri must be Probable some non-organised toxic element, in other words, a toxin; and the close analogy which the neuritis of beri-beri to other forms of neuritis known to be due to toxic causes (alcohol, lead, diphtheria, &c.), supports this view.

Tsuzuki's work has proven that the primary agent in the production of the disease is a diplococcus, and from the whole history of experimental feeding it may be gathered that the toxin does not enter the body as a toxin, but is elaborated within the body. Further, the wide modifications in the production and course of the disease which can be made by altering the contents of the alimentary tract point to that tract as the site of the elaboration.

definition1

The research which is indicated is one which will link up these isolated facts, at present unconvincing, into a logical and consecutive whole. As defined in the litera- Present ture beri-beri is a neuritis characterised by all the symptoms which would of necessity follow an interference with the functions of peripheral nerves. accurate definition, but is in reality a description of certain symptoms which occur This is not an at a late stage of the disease; a description of certain effects of the disease but not of the disease itself.

definition.

The definition suggested is "beri-beri is an infection of the alimentary tract by Sugges ed a micro-organism, which, in a suitable nidus, is capable of producing a toxin having a selective action on the tissues of the nerve trunks causing a diminution or abolition of their function." Some particular nerves are invariably affected more early and more profoundly than others (nervi peronei et vagi).

The clinical manifestations bear out the suggested definition, the earliest being got in the mouth, gullet, and stomach. The sufferer complains of salivation and an Early uneasiness, expressed by the word "chin " (cold), in the epigastrium. Vomiting is "ymptoms. common, as is also diarrhoea. On inspection the inside of the mouth is seen to be sodden in appearance, and of an unhealthy lividity, most marked on the gums, and resembling in slight measure the "blue line " of lead poisoning. The epigastrium is tender on pressure, and gives a feeling of "boarding." In these persons the stomach itself may be palpated, and will he found to be enlarged, much thickened, and sensitive beyond normal.

In a few days a week at most-those nerves which, froin their situation, are capable of palpation (peronei, &c.) will be found to be tender on pressure and slightly enlarged, and if the hand he slowly carried over the skin, areas will be found which give a sensation of pungent heat to the touch. These areas, if further examined, will be found to be devoid of perspiration, of diminished sensibility, and, by surface thermometer, of a higher temperature than normal. stage of nerve invasion, neuralgias and cramps are common.

At this stage, the

It is now only a matter of a week or two until the symptoms described in the literature as the "early " symptoms become evident-the loss of reflexes, weakness of the legs, localised oedema, and the cardiac, gastric, and pulmonary symptoms due to implication of the vagus.

The terminal stage, with complete paralysis, general œdema, &c., requires no description.

The whole gamut of symptoms, from the time of exposure to the fully developed disease,

may

be run within five weeks. Some observers give less. No Chinaman ever swallows his saliva, but expectorates it broadcast, and, hear- Source and ing in mind the salivation which is so obvious in the early stages of beri-beri, this beri-beri be spoken of as a

mode of

affords a very abundant supply of infective material, and in this sense alone can infection.

place" disease.

Air may be the means of convection of the dried sputum (analogue tubercle), or that, and also the urine and fæces, may contaminate water (analogue typhoid), or the common house-fly may be the carrier.

But the most likely vehicles of infection are the rice bowl and chop sticks, all of which, used in the manner they are, come freely into contact with the saliva of the feeder. They are never disinfected, and are used indiscriminately, by many persons

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