motor car, and several yacht clubs which make convalescent officers members, honorary medically there are massage, appliances for exercises, electrical treatment of all sorts, saline and other baths, rest cures and the like." All this for half a crown a day. There is no difficulty and there need be no diffidence in applying for admission : on the back of the Army Lists (Home and Indian) will be found details as to the procedure neccssary to gain admission. The other institution for officers is the King Edward VIl's Hospital for officers at 9, Grosvenor Gardens, S.W. This hospital was founded in 1904 by Sister Agnes, and is intended for officers of the Army, Navy and Indian Army on the active list. Everything in the hospital is free except the doctor's fees. There is no honorary medical staff, and patients can be treated by any member of the surgical staff of a London hospital. Officers are asked to subscribe the small sum of five shillings or more, and we believe all will agree that such an institution deserves the support of every officer in India, and we commend it to the attention of our readers (see inside advertisement in the quarterly Army List (Indian). HEALTH AND EMPIRE.*
Thts is a very interesting volume, written by Dr. Freemantle, author of a well-known book A Doctor in on the S. African war entitled Khaki." It is dedicated to the "Statesman"
(ItiiTtinf
?opics.
Pioneer," Joseph Chamberlain.
record of 18 months travel to study of public health and to fit the author "should occasion for parliamentary service, arise," as we hope it will. The writer employed himself for six months on plague duty in the Punjab, and as a high official in Simla foretold, he learned more of Indian problems in those six months than any but a dozen members of the House of Commons." The book is written for the general reader, and we can only wish that it will be read by that somewhat vague personage. We may now give our leaders a brief sumChapter I deals with the mary of the volume. work in the village of in the and plague Punjab Tarn Taran, and gives an interesting account of the work of an inoculation officer, "English he must be for the natives do not trust a native, however well qualified." He also visited other places in company with " a Lt.-Colonel, i.m.s. whom I assisted to perform his ten thousandth cataract, on a man attracted by his fame from beyond the Himalayas." Dr. Freemantle next favourably comments upon the research organisation started b}' the late Lt.-Col. J. T. Leslie, r.M.S., and advocates a "general staff for disease" in the Empire, and It is
HOSPITALS AT HOME FOR OFFICERS.
We have been asked to call the attention of officers of the Indian Army to the advantages offered by two hospitals at home for sick and invalid officers of the Arm}7. There are the Convalescent Home at Osborne and King Edward VIl's Hospital for Officers at 9, Grosvenor Gardens, S.W. As regards Osborne it is well known that this, Queen Victoria's favourite palace, was given to the Nation by King Edward VII, and the gift was settled by an Act of Parliament in 1902, as a Convalescent Home for Officers of the Navy and Army. There is no need to describe the beautiful surroundings of this well-known palace, the accommodation available is for 43 officers, five of whom may be accompanied with their wives and is equally divided between the Navy and Army. Medical attendance is free, except in cases requiring special nursing or massage, &c. The entire cost amounts to 011I3" half a crown a day for each officer or his wife. The accommodation, writes Colonel H. H. Forman, a.M.S. (ii.a.mc., Journal, June 1911), is of the best, dining"
drawing-rooms, lofty airy bed-rooms, organ, pianos, &c. Outof-doors there are golf, tennis, croquet, bowls, a
rooms,
/
smoking-room, billiards,
a
problems
"
*
Health and Empire, a Traveller's study, Medical Officer of Health, London.
County
F. Freemantle, J. Onseley, Lt.
by
Dec., 1911.J
THE MEETTNG OP THE FAR EAST TROPICAL ASSOCIATION.
he sa}'s what is now wanted in India are " pracWe may pass over chapter II tical measures. and its comments on the remark of a learned Parsi lady?well known in official circles in Bengal?on the "gamble in life." "Half policies are the devil ;a vigorous rule is what native races require, and some remains of the gamble in life," says Dr. Freemantle. The history of the Pasteur Institute and of rabies is dealt with in the next chnpter. Chapter IV deals with the plague-flea and plague work since Haffkine's first researches. Beri-beriand the good work done for the Empire in the Laboratory of the Federated Malay St ites forms the subject of another chnpter, the work done by Shiga in Japan is duly appreciated, but we venture to think that there is much inaccuracy in some of the statements about Shiga's serum for dysenteiy. A. very interesting chnpter is given to the subject of town planning in Kuala Lumpur; where streets 120 feet broad are to be found, and the pressing subject of housing in Hongkong is discussed in detail. In Japan our author comments favourably on the prison management, but points out thatsimilar methods are in force in our Indian prisons. He also notes the terrible hold that tuberculosis has on the Japanese; as also in India where its prevalence is not yet sufficiently recognised by government and the public. The satisfactory attitude of the Japanese towards sanitation is noted, which shows the extent to which they have seiz id upon modern ideas. There is an interesting note 011 the Japanese Red Cross work in the late war. In contrast with progress in many parts of the world the account given of "health faking" in San Francisco is not creditable to the citizens of the great republic, though the system of federal l^'giene by the so-called Marine Hospital service is highly appreciated. We can strongly recommend this book. It is one that should be in every station library in India. "
"
"
"
"
FAR EASTERN ASSOCIATION OF TROPICAL
MEDICINE.
The
of the next
of this The is Dr. J. Mitford Atkinson, of and the Secretary Dr. F. Claik,
prospectus
Second Biennial Association is
president
Hongkong, Hongkong.
meeting
published.
The following is the programme of work to be done and the Secretary invites medical men to be present:? "The Second Biennial Congress of this Association will be held in Hongkong from Saturday,
January 20th,
to
Saturday, January 27th, 1912,
and you are cordially invited to attend and to take part in the work of the Congress. The Association is an international one formed to promote the science and art of Tropical Medicine in the Far East.
471
Saturdaj', January 20tl), will be devoted to reception of official delegates and visitors, leaving the whole of the following week for the the
scientific woik of the
Congress."
The papers offered will be classified, so as to give, as far as possible, a day to each of the following groups of
subjects : Protozoology?Helminthology. Cholera ?Plague?Leprosy?Tuberculosis. Tropical Fevers including Malaria?Beri-Beri? -
Dysentery.
Surgery? Obstetrics?Infantile Diseases. Climate?Hygiene?Sanitation. The following practitioners have already expressed
their intention to submit papers, and other members of the medical profession in the Far East who are willing to introduce subjects for discussion are requested to communicate at once with the Secretary. Papers may be read in either English, French or German, but authors are asked to send a brief abstract in English in all cases. J. Mitfoid Atkinson, m.b., d.p.ii., Hongkong :? Presidential Address : The progress of tropical medicine during the past twenty-five years. J. C. Dalmahoy Allen, m.d., Hongkong :?Blood pressure. Professor Cheng Hao, Canton Army Medical School, Official Delegate from the Government of ChinaSubject not yet announced. Major Weston P. Chamberlain, m.d., Chairman of the United States A1 my Board for the Study of Tropical Diseases as they exist in the Philippine Islands :? (1). Prevention of Beri-Beri among the Philippine (Native) Scouts by the use of undermilled rice ; and in conjunction with Captain Edward B. Vedder, m.d. :?
The substance in rice polishings which prevents and Beri-Beri. C. Noel Davis, m.b., d.p.h., Shanghai :?Beri-Beri. Blackwater Fever Lawrence G. Fink, m.b., Burma in Burma. George A. Finlayson, m.a., m b., M.R.c.r., Official Delegate from the Government of the Straits Settlements :? Malaria as a factor in the aetiology of biliary calculi. H. Fraser, m.d., d.p.h., Official Delegate from the Government of the Federated Malay States, Director of the Institute for Medical Research, Kuala Lumpur :? Beri-Beri. Paul C. Freer, m.d., pIi.d , Official Delegate from the Results of the Government of the Philippine Islands past two years' work in the study of tropical sunlight Dr. Furtli, Staff Surgeon, Official Delegate from the Government of Kiautschou :?Neuer Untersuchungen iiber Flecktyphus (latest researches into spotted Fever). G. Montagu Harston, m.d., Hongkong :? (1J. The care of children in the tropics. (2). The care of the eyesight in the tropics. Victor G. Heiser, m d., Official Delegate from the Beri-Beri. Government of the Philippine Islands C. Montague Heanley, m.b., d.p.h., Hongkong :?The laboratory diagnosis of Syphilis. Major S. P. James, m.b., d.p.ii., i.m.s., Official Delegate from the Government of India :?Subject not yet announced. Gregory P Jordan, m.b , Hongkong :?Carbon dioxide snow?its use in private practice in the tropics. K. Justi, m.d., Hongkong :?The Diagnosis of Malarial Fever in the absence of the parasites from the peripheral
(-2).
Polyneuritis gallinarmn
blood. O. MUller, m.d., Hongkong
of
Dysentery.
The
Surgical
Treatment
J. A. F. de Moraes Pallia, m.d., Official Delegate from the Government of Macau : ?Subject not yet announced. Sir Allan Perry, m.d., Ceylon :?Indian native coolie
immigration.
J. M. Swan, m.d., Canton :?Some rare conditions which have been met with in the treatment of vesical calculi in South China.
THE INDIAN MEDICAL GAZETTE.
472
Richard P. Strong, m.d., pli d., Official Delegate from the Government of the Philippine Ts'ands : (1) Immunization against Pneumonic Plague. (2) The Aetiology of Beri-Beri. H. Gordon Thompson, m.d., f.r.c.s., Pakhoi :?Surgical Work in South China Dr. Uthemann, Fleet Surgeon, Official Delegate from the Government of Kiautschou : (1). Stadtanlage und sanitare Einrichtungen in Tsingtau (Town planning and sanitary conveniences at Tsingtau); and will introduce a discussion on : (2). Die Notwendigkeitder Quarantanebestimmungen an den Klisten-platzen Ostasiens nacli Moglichkeit in IJbereinstimmung zu bringen (The necessity for uniform Quatantine Regulations for all tlie coast ports of China) Captain Edward B. Vedder, m.d , United States Army Medical Corps, Manila: An experimental study of the action of Ipecacuanha on Amoebic G. Duncan Whyte, mis , Swatow :-Tuberculosis in South China. J. P. A. Wilson, F.a.c.s., (Ed.), d.p.ii., Official Delegate from the Government of Johore Subject not yet announced. In the event of any member of the Association being unavoidably prevented from at tending the Congress his paper will be read by the Secretary, if duly forwarded for that purpose. The meetings of the Congress will be held in the City Hall commencing on Saturday, January 20th, at 11 a.m., with an Address of Welcome by His Excellency Sir Frederick .1. D. Lugard, G c.m.g , c b , d s o , Governor of the Colony. ?
?
ALASTRIM OR MILK-POX.
The most important article in The Transactions of the Society of Tropical Medicine and Hygiene (July 1911, Vol. IV, No. 8) is the paper by Dr. Emilio Ribas of Brazil on what is called
Alastrim, Amaas, or Milk-pox, a highly infective and specific eruptive fever which has been often
confused with small-pox and chicken-pox and is claimed by Dr. Ribas to be a separate entitj\ Our readers may remember that we previously commented upon a similar outbreak in Trinidad, which had been called half a century ago by Dr. Izett Anderson "Variolid Varicella." It is probable that Dr. Korte has described the same disease in S. Africa under the local name of " Amaas or Kaffir Milk-pox. It is, however, not to be forgotten that in the tropics chicken-pox is by no means a trifling children's disease but it attacks adults severely, and the eruption is so widespread that cases have not infrequently been mistaken for small-pox. Dr. Ribas describes the clinical symptoms as follows :? "
"The eruption usually appears on the third day of the illness, first as a rash, which in a few hours becomes papular and vesicular. If the hand is passed over the surface at this stage there is a feeling as if there was small shot in the skin. On the fourth day of the eruption and seventh of the disease the vesicles become "pearly" in appearance, and immediately afterwards they become frankly pustular, and especially on the face. A reddish aureola surrounds the vesicles, but in severe cases this aureola becomes more extensive. The vesicles then lose the pearly appearance and take on a more milky look, or, at times, that of white wax. On the fifth day of eruption and eighth of the disease the vesicles have become pustules. On the sixth day the pustules begin to dry up and form scabs ; some, however, flattening out, do not form scabs.
[Deo-.
1911-
These scabs are formed iti the following manner :?A small point, at first the colour of yellow wax and afterwards becoming darker, occupies the centre of each pustule. This point is the beginning of the change in texture of the vesicular wall There a small opening occurs, thus allowing the liquid contents to escape. This drying on the thin vesicular wall forms the scab. I am of opinion that there is no true umbilication as in small pox ; that is to say, in milk-pox this appearance is only present when the above-mentioned change has taken place, which gives a paeudo-umbilication. In small pox the true umbilication is due to the actual structure of the vesicles. When the resulting scab falls off, in the form of a small dark-coloured scale, the underlying surface is seen to be slightly elevated compared with the surrounding skin. The colour is dark red, but this disappears 011 pressure, and at the end of a certain time these maculae disappear altogether. Only in rare instances, and that where the disease has been of a confluent type, do the marks remain permanently. The eruption also appears on the mucous membrane of the mouth and other parts In cises of moderate intensity the duration of the disease may be put at fifteen days, but in severe confluent cases it may last twice this time. Confluence is most frequently observed on the face and lower limbs, rarely 011 the arms and trunk. Alastrim has the same incubation period as small-pox, and during the period of invasion there is a rise in temperature till the appearance of the rash. The temperaThe pulse rate is in ture may reach 40?C to 4l?C. proportion to the temperature.
Other symptoms are sore throat, swelling of cervical glands, and coryza; also headache and backche are common. The opinion of the meeting seems to be that the disease was a " modified" small-pox, and " none of the tropical experts present seemed to have realised how severe chicken-pox could be in adults and in the tropics. "
ANNALS OF TROPICAL MEDICINE.
The second number of the fifth volume of these valuable annals is dated 1st August 1911, and contains much of interest to medical men in the tropics. Prof. U. Gabbi of Rome has an interesting " article on the occurrence of certain tropical diseases in Southern Italy. As might be expected Mediterranean or Malta fever is well-known, and it is said that from 3 to 17 per cent, of the goats in Sicily and south Italy are infected. Another more distinctly tropical disease, KalaAzu* has been demonstrated in Italy by Pianese of Naples and Prof. Gabbi claims that he and his students have shown that youths aud even " adults are affected by Kala-Azir, though very seldom" while it is more common in children. It appears early in spring and is "greatly dif" fused among the poorer classes in the littoral towns of the south, moreover typical tropical oriental sores have been seen in the same places. Three days fever or Pappataci (sandfly) fever has also been recognised and it is regarded as a regular summer disease. "
*
on
Iii our next issue we shall give a summary of an article this subject by Sir Win. Leishraau.?Ed., I, M. G.
BERI-BERI, AND ALLIED DISEASES.
Dec., 1911.]
Tn another article Mr. R. Newsted (in a report of the 23rd expedition sent out by the Liverpool school) describes the Pappataci flies (Phlebotomus) in the Maltese Islands (a paper which we propose to abstract in another column). Dr. J. W. \V. Stephens has an interesting note He on the anti-malarial operations at Ismalia. in states that these operations have resulted the town from completely freeing anophelines and hence from malaria." Dr. Stephens gives reasons for believing that malaria had existed in Ismalia before the introduction of the enlarged freshwater canal in "
1877.
The work done on the advice of Sir Ronald Ross consisted of draining numerous marshes, large and subsidiary, oi'iing of pools, &c. Stephens points out three factors which largely contributed to achieving this success, viz., Ismalia is in the desert, (2) the intermittent irrigation scheme with a fall of 20 feet from the freshwater to the Maritime canal, and (3) the presence of fish in all the drains. The cost of the operations was very considerable, viz., an initial expenditure of ?2,000, another ?4,000 on draining swamps at the rate of ?4 an acre. The permanent expenses are ?312 in keeping the drains in good repair, and apparently ?720 per annum for disinfection, hunting larvae, &c. The total is given by Dr. Stephens as follow :?
(1)
1903
...
...
...
...
...
...
...
...
1907
...
...
1908
...
1904 1905 1906
...
?1,528 ?1,039 ? ? ? ?
696 678 625
672
also employed and it Quinine prophylaxis sums (variously estimated) from ?65(5 in was
cost
1902 to ?237 in 1908. Dr. Stephens thinks that the decrease in in considerable part due malaria in 1903 was "
to
quinine prophylaxis," though (he quaintly
result would have been arrived " taking a grain of quinine." Another valuable report is on human trypanosomiasis in Gambia by Dr. Todd and S. G. Wolbach. Dr. W. Yorke and R. W. Nauss 1 iave a valuable report on suppression of the urine in blackwater fever, and they consider that, under certain conditions, the mere passage of haemoglobin through the kidneys is sufficient to cause suppression owing to the occlusion of the lumen of the renal tubules by plugs of granular material derived from the haemoglobin. The article on organic phosphorus, beri-beri and diets is deserving of fuller extracting than we can here ffive it.
adds)
the
same
at without
TAON OR INFANTILE BERI-BERI.
Di?. F. C. Calduron of the University of the Philippines, has a useful article in the Bulletin of the Manila Medical Society (August 1911)
473
the treatment of what is locally called Taon, Taol. This disease is very prevalent in the PhilipIslands and destroj's many infant lives. pine " Children apparently healthy are seized suddenly by violent convulsions, a piercing ciy, an or intense asphyxia followed by death," such is l)r. Fernando Oalderon's brief description The disease has been considered to be infantile eclampsia, but its claim to be an infantile beri-beri was made out by Dr, Manuel Guerrero in 1904, basing his observations on 103 clinical cases, and since then many practitioners have agreed that the complaint is a clinical entity and is a form of toxrernia duo to beri-beri and transmitted to the child by a mother or wetnurse who has beri-beri, through the milk." Dr. McLaughlin and Dr. V. L. Andrews have also shown that of the infants who die in Manila no less than 74 per cent, ate breast-fed infants?so that what saves infants in other countries kills them in Manila. As a result of these facts an institution called La Oota de Lache was established and by the issue free of sterilised milk has saved already the lives of many infants. on
or
.
ORGANIC PHOSPHORUS BERI-BERI AND ALLIED DISEASES.
In Annals of Tropical Medicine (August 1011) Dr. G. G. E. Simpson and Mr. E. S. Edie have a very complete article on the relation of the organic phosphorus contents of various diets to disease of nutrition particularly beri-beri. The article is preliminary and consists largely of an abstract of Schaumann's important monograph which, as it is little knowa in India, we may here abstract. We need not refer to the account given of the well-known work of Braddon, Fraser and Stanton and of Hoist?but quote some of Schaumann's conclusions as given in the article referred to :? "Schaumaun further gives exhaustive tables of the composition of various food-fetuffs grains (fresh and prepared), peas, beans, potatoes, meat, etc., both in the fresh and dried states, showing their composition with reference to protein, carbohydrate and fat, and in particular their vaiious phosphorus-containing compounds? inorganic phytin-like compounds, nucleins and phosphatides?and discusses the present state of our knowltdge
of the metabolism of these bodies. " Schaumaun next proceeds to a critical review of the various theories of the etiolrgy and points out that neither place, climate, nor season appear to be of importance, and that no specific organism has been isolated though many bacteriologists, and even Koch himself, have made careful investigations ; Fletcher and Fraser also carefully excluded the question of infection since they showed that whether Beri-beri was present or absent among the inmates of a building or compound it could be banished by feeding with partly milled rice or called forth by feeding on wholly milled rice. " Braddon, with respect to Beri-beri, and Eijkman, with reference to Polyneuritis in birds, at first assumed that some toxic agent was present in the kernel of the grain
THE INDIAN MEDICAL GAZETTE.
474
which gave rise to Beri-beri and that the antidofe to this toxin was present in the pericarp, and that so no bad effect followed feeding with the whole grain ; but, if the pericarp were lvmoved, the toxin already present or elaborated during digestion was free to exercise its effects " Schauiuann then considers the theories which ascribe the development of Beri-beri t?> a faulty nutrition, and he calls attention to the theories of Nocht(l003); the latter ascribes both the multiform manifestations of Tropical Beri beri and the usually milder ship Beri-beri (which appears to be somewhat allied to scurvy), to dietetic errors ; and lays special stress on the fact th*t it is not a question of defect of the main components of food-stuffs?proteid carbohydrate and fat?but of some subtle defect of the less known constituents?enzyme?,
complements, compound proteids, etc. "Schauiuann himself, however, is inclined
to consider the substance or substances of importance to be organic compounds of phosphorus He resolved first of all to investigate the possibility of the neuritis being due (1) to the development of oxalic acid by fermentation or to acidosis from deficiency of alkaline salts in the grain ; (2) to the removal of ferments or other thermolabile substances by milling or ' denaturisation,' and (3) to investigation of the influence of phosphorus compounds, and inorganic. organic " He points out that the exact chemical nature of the phosphorus compounds in food-stuffs and the body is but imperfectly known, that the methods of separation are but approximate and uncertain in many cases, and that the isolated products are probably modified by the processes of extraction, and so differ in physiological effect from their precursors. "Subject to modifications necessitated by the light gained in the process, he resolved to try diets, as polished rice and denaturised foods, which were known to produce neuritis, etc., and see whether any favourable results are obtained by the administration of such diets, with the addition of : 1. Known organic and inorganic compounds of
phosphorus.
Small amounts of substances rich in phosphorus, rice meal, yeast, Katjang-idjo, wheat meal, testicular extract, or extracts from roe, etc 3 Phosphorus compounds isolated by him "from articles of food, e.g., yeast, Katjang-idjo, etc 2.
e.i7
,
The
following
conclusions
are
drawn
:
?
Food-stuffs which lead to the development of Polyneuritis in animals are characterised by a low content of phosphorus or of certain organic compounds of phosphorus. This may be either fundamental or be caused by artificial processes. II. Animals are not protected from the ill-effects caused by such diets by the addition thereto of proteid^, I.
inorganic salts, inorganic phosphates, or the synthetic organic compounds of phosphorus (calcium glycerophosphate, albumen-inetaphosphate). III.
The
addition of certain substances, rich in to such diets exercises b >th a protective and a curative effect Yeast, rice meal, wheat bran, peas, Katjang beans, and testicular extracts are the chief substances with this power. Carnivora and lierbivora, however, react rather differently to testicular extract, the former are completely protected, the latter only in a less degree IV. Artificially separat d organic phosphorus compounds of various kinds, prepared from these natural protective substances, exercise only a moderate and transient influence Such compounds include yeast nucleic acid, phytin-like compounds from Katjang, phytin from rice meal, and possibly certain phosphatides. V. Apparently the protective or curative effect of these substances is dependent not on any one of their organic compounds of phosphorus, but on the collective effect of a number of these. Animals do not apparently possess the power of forming the organic phosphorus
organic phosphorus,
[Dec.,
1911.
compounds necessary to their economy from inorganic phosphates by their own metabolism, but are dependent for their provision on the plant world, as they are for othn* classes of food-stuff (eg., protein and carbohydrate). VI. The metabolism of phosphorus and nitrogen stand in close relationship to one another. VIE. Spontaneous or experimental polyneuritis in animals appears to be a disease of metabolism, attributable to the lack of some specific organic phosphorus compounds whose identity is still uncertain. Schaumaun next discussed ship Beri-beri, a well-known disease in Indian waters and on
light-houses. " Preserved vegetables carried on one s-hip were very rich in organic phosphorus, and had been found to be extremely valuable in the treatment of the sailors stricken with Beri-beri. Preserved meat is also rich, particularly in lecithin phosphorus. Schaumaun considers that the cause of Beri-beri on ships lies in the lack of organic phosphorus compounds in the diet of the sailors. This is especially noticeable on the return voyage (especially in ships leading home from nitrate and guano ports where fresh meat and vegetables are not obtainable), in part owing to the sailors being partly driven to bread, rice, etc , through the mouldiness of the peas or their hardness from keeping (rendering them impossible to soften even the decay and smell of or when boiled in soda) the meat. To this is added in other cases the loss of organic phosphorus in the salt meat due to the action of the lye, and the similar loss in the leguminous foods owing to standing or to boiling with soda He calls attention again to the affinity between scurvy and ship Beri-beri (vide also his animal experiments), and suggests that scurvy may be found to be due to use of stale vegetables, and Beri-beri to use of rotten or stale flesh?the important factor in each being lack of organic compounds of phosphorus. As a curative agent, he says, all sailors know the value of fresh meat and vegetables. As a preventive agent, he suggests that it might be possible to carry dried yeast, l ice meal or testicular extract for use when the ordinary diet becomes inadequate, and especially lays stress on the probable value of requiring all ships engaged on voyages where fresh provender may be difficult to obtain, to carry a supply of Katjang beans in sealed (sterilised) cases In the future, he hopes a more active principle requiring but small bulk may be isolated. Sailing ship Beri-beri is a disease of metabolism dependent on lack of organic phosphorus in the diet. Schaumann and Werner tried the therapeutical < ffects of phosphorus-rich compounds 011 Tropical Beri-beri and obtained improvement by the use of yeast, nucleic acid, testicular extract, etc.. though the improvement was not so marked as in polyneuritis in animals, owing to the more advanced lesions in these cases requiring longer for regeneration. (Fat-free yeast and carefully prepared nuclein should alone be 1 sed ) Ivatjang beans, peas, and also the peptic extract of Katjang are also very valuable. On these grounds it appears clear that Tropical Beriberi resembles experimental Polyneuritis and ship Beri-beri in being due to lack of organic phosphorus in the diet, but it appears to be due to a chronic deficiency of long duration, with severe deep-seated lesions requiring a long time to cure. The experimental neuritis in a goat already described is analogous to Tropical Beriberi. The other experimental cases and ship Beri-beri. 011 the contrary, aie due to a sudden large deficiency of organic phosphorus, and the lesions, though severe, are not deep seated, and are rapidly recovered from. In the majority of cases, Beri bei i is due to a gross deficiency of the organic phosphorus, in the diet. In other cases the diffeiences may be individuals in the since some individuals patient, require much larger amounts than others, and others again may be unable to absorb and assimilate the compounds,
Dec, 1911.]
DISPOSAL OF REFUSE IN THE TROPICS.
in the diet. Schaumann quotes the of a German colonist, who, after being very ill with malaria on the Amazon, developed Beri-beri on the voyage home though on an ample diet ; in this case the intestinal absorption appeared faulty, as there was a great deficiency in urinary, and a very large increase in the frecal phosphorus. Occasionally, epidemics of Beri-beri appear to be due to a bacterial infection of the gastro-intestinal tract, either through the catarrh interfering with absorption or to the bacteria (or their products) absorbing or splitting the organic phosphates before they could be absorbed. Tropical Beri-beri is a disease of metabolism due to the amount of organic phosphoius compounds assimilated being below that essential for the human organism. This is in the majority of cases due to deficiency of
though present
case
organic phosphorus." Concluding Considerations. " A whole cycle of other diseases in all probability have a similar etiology to that of Beri-beri, more especially ship Beri-beri. Scurvy has already been conclusively shown to be of this nature by a whole series of observations, and to all appearance Infantile Scurvy, Rickets, and Osteomalacia are also included. Pellagra and the form of malnutrition described by Czerny and Kellner in artificially fed children may be further examples. The suspicion arises that all these diseases may be due to deficient assimilation of organic phosphorus, but it is difficult to understand how a similar cause can produce the different effects shown by the symptoms in these diseases. It has already been shown that the animal organism is not adapted to build up organic phosphorus compounds for itself, but depends for these on the plant kingdom, and it is probably equally unable to form compounds of one group from those of another {e.g., nucleo-proteids from phosphatides). Since different groups play different joles in the ceitain that deficiency of each economy of man, it is and in addition group will have its own special effect, this will be complicated by an associated influence on the general metabolism ; for example, inorganic comalkaline earths of the bone?, pounds would react on the on the proteins, etc. would react
nucleo-proteids
Individual differences would further intervene to comthe picture, more especially age differences, and infancy, childhood, puberty, pregnancy and old age would, in particular, have a far-reaching influence.
plicate
So by deficiency of single groups, or of combinations of groups of phosphorus compounds, various symptom complexes?different diseases?may be originated. Thus lack of nucleo-proteid in adults is probably connected with Beri-beri ; in children a similar deficiency might give a different disease : deficiency of phosphatides may give yet a third, "a combination of the two will give yet another picture
faecal matter, receptacles, buckets, &c., are exposed for periods to Hies, the handling of the nightsoil and emptying of it into carts is open to many objections; on this matter the writer quotas the following pointed remarks of Col.
Forman,
Major R. J. Blaciuiam, r.a.m.c., read a useful and practical paper on the disposal of refuse in the tropics at. the recent Belfast meeting of the Royal Sanitary Institute. He discussed four methods of sewage disposal, the dry system, the wet, incineration and septic tanks.
The defects of the dry-earth system as apnot in jails where labour is plenty and is controlled, but in cantonments and municipalities, are obvious and consist in the fact that
plied,
a M.S. :?
"
I believe that we can in great measures stamp out the enteric scourge in India, if we adopt the following suggestions (1) remove latrines well away from cookhouses ; (2) make them light and airy structures, easily moved if necessary ; (3) pave them with cement ; (4) abolish dryearth and substitute crude petroleum or carbolic ; (5) let the seats be movable and the pans so placed that slopping is impossible ; (6) eliminate flies; (7) ensure scrupulous cleanliness, not make-believe, but scientific; (8) provide early steiilization by boiling, if possible on the spot, and before transit ; (9) secure efficient means of transit in water-tight vehicles ; (10) arrange for frequent sterilization of all receptacles, and last but by no means least, see to (11) careful and scientific disposal at a distance."
Colonel YV. A. Mokris, a.m.s., strongly advocates the wet-system of conservancy :?" A wet-system of conservancy is directed towards the destruction or inhibition of the growth of bacilli at the It is especially moment they leave the human subject. directed against those bacilli of disease which are found in the liquid and solid excreta, and the inhibition of their action or destructions is effected by disinfectants, under which term are included deodorants, antiseptics, etc." This system may be carried out with either a coal-tar disinfectant, such as saponified cresol or a solution of perchloride of mercury. The cresol solution, which is now in use in all military cantonments, is made up by adding half an ounce of cresol to a gallon of water. One pint of this solution is placed in each receptacle. Colonel Morris strongly advocated in lieu of it a 1 in 2,000 solution of perchloride of mercury.
On the subject of incinerators, Major Blackham has some good remaiks. One tiling is certain, they are not as cheap to erect or to work as their inventors and advocates have made out. As for the Raitt incinerator, Major Blackham writes as follows : ?
"
The incinerator is set going by placing a quantity of litter and dry refuse on the framework, and setting fire to it. When combustion has proceeded for some time the total contents of the latrine pans are emptied over the smouldering material. I frankly confers that I do In my experience heavy rain not believe in this system. invariably puts these incinerators out, and the exposure of smouldering material to the strong gales of the winter and that storms of the summer must, and does, result in the addition of much objectionable matter to the dust which is blown in all directions."
experience of this incinerator in a is very similar. Major Blackham mentions but gives no details of the Umballa B incinerator, recently invented at Indian Army Head-quarters. We are glad to see lie quotes and approves of Major Cleiiiesha's pronouncement as to the combustibility of Indian street rubbish, this rubbish usually will not burn. Major Blackham is in favour of septic tanks and quotes largely from Major Clemesha's invaluable book on the subject. This paper is an excellent and practical one. Our
THE DISPOSAL OF REFUSE IN THE TROPICS.
475
own
Bengal jail
ire
THE INDIAN MEDICAL GAZETTE. REVISION OF THE B. P.
have received the second and third reports of the Committee embodying the results of their work from 1908 till May 1911 in connection with the revision of the British PharmaWis
copoeia.
No date is yet mentioned for the new edition, which need not be expected for some j'ears. The second report deals with the following drugs, extracts, Belladonna, and Glycyrrhiza, Hydrastis, Ipecacuanha, Nux Vomica, Opium, Sarsa, Taraxacum, with Ferri Carbonas, Ferri Sulphas, Filix Mas, Guaiacum, Mercury, Iodine, Hyoscyamus, Ipecacuanha root, resin of Jalap. The third report is of a similar character, and deals chiefly with descriptions, tests, and nomenclature, and strength. The changes recommended are also frequently mere alterations in strength to bring the preparations into approximate conformity with the
International Agreement.
Memoir No. 2 of the Indian Civil
Veterinary Department (Calcutta: Thacker, Spink & Co.) "
is modestly entitled but it Collected Notes contains several papers of interest, e.g., Mr. A. S. Leese, on the natural transmission of Surra. The two flies concerned are tabanus liseuiatopota and stomoxys. The latter is the most common biting fly on the Naini Tal and the Dehra Dun roads. Mr. S. H. Gaiger has an article on hemorrhagic septicemia, a disease only differentiated in India within the past 10 years. It rarely attacks horses, but it is very common among buffaloes. The same writer describes a worm lingulata tcvnoides?a parasite very common in pariah dogs in India. "
A. M. A. June 10) praises the better known under the name of urotropine in commencing-colds; 15-grain doses four times dail}'. The irritating action on the bladder must be remembered. A writer
use
of
(J.
hexamethylenamin
Sin Ronald Ross discusses the question why Yellow lever has not spread in the Old World as it has in the New. The Stegomyia fasciata is found widespread in Africa, India and China. He concluded that the number of S. fasciata is not sufficient, the number must not only be high, but high enough to maintain the disease and extremely high to cause a proper outbreak." "
Du. St. J. Choley asks
us
to the fact that in his article
to call attention
(I. M. G., September 1911,)). 336) he intended it to be understood that the chlorotone was to be given per rectum, and not hy podermically.
[Dec,
1911.
Accouding to Berlin Klinische Wochen, Bacelli used very successfully a subcutaneous injection of carbolic acid in tetanus cases. He uses a 2 or 3 per cent, watery solution of carbolic acid which he injects subcutaneously. He begins by very small doses, and as soon as tolerance is established by examination of the urine, he rapidly increases the dose till the patient takes one to one-and-a-half grammes in 24 hours. He says that tetanus patients tolerate carbolic acid in surprisingly large doses. Recent research in Texas has established the existence of Mediterranean (Malta) fever in that State.
Epidemics of cerebro-spinal fever and of acute poliomyelitis lias been reported from Devon and Cornwall. Both diseases have been prevalent in the United States for some years past andpoliomyelitis has recently been very much in evidence. In Ireland with 3 million
inhabitants there lunatics in with 57 million inhabitants there is accommodation for about 1,000 lunatics. No wonder we have said that local Governments in India get off very cheaply in the matter of asylums. On 1st January 1911 there were 133,157 certified lunatics in England and Wales out of a population of 45,210,665 at the recent average strength of 24,394 confinement in 1910; in Bengal
were
an
census.
We call the special attention of all I. M. S. Officers to the book now in the press on the Indian Medical Service, by Major 13. Setor/ and Major Gould, I M.S. It will be found extremely useful to all men in the Service.
Thts is a very interesting volume, written by Dr. Freemantle, author of a well-known book A Doctor in on the S. African war entitled Khaki." It is dedicated to the "Statesman"
(ItiiTtinf
?opics.
Pioneer," Joseph Chamberlain.
record of 18 months travel to study of public health and to fit the author "should occasion for parliamentary service, arise," as we hope it will. The writer employed himself for six months on plague duty in the Punjab, and as a high official in Simla foretold, he learned more of Indian problems in those six months than any but a dozen members of the House of Commons." The book is written for the general reader, and we can only wish that it will be read by that somewhat vague personage. We may now give our leaders a brief sumChapter I deals with the mary of the volume. work in the village of in the and plague Punjab Tarn Taran, and gives an interesting account of the work of an inoculation officer, "English he must be for the natives do not trust a native, however well qualified." He also visited other places in company with " a Lt.-Colonel, i.m.s. whom I assisted to perform his ten thousandth cataract, on a man attracted by his fame from beyond the Himalayas." Dr. Freemantle next favourably comments upon the research organisation started b}' the late Lt.-Col. J. T. Leslie, r.M.S., and advocates a "general staff for disease" in the Empire, and It is
HOSPITALS AT HOME FOR OFFICERS.
We have been asked to call the attention of officers of the Indian Army to the advantages offered by two hospitals at home for sick and invalid officers of the Arm}7. There are the Convalescent Home at Osborne and King Edward VIl's Hospital for Officers at 9, Grosvenor Gardens, S.W. As regards Osborne it is well known that this, Queen Victoria's favourite palace, was given to the Nation by King Edward VII, and the gift was settled by an Act of Parliament in 1902, as a Convalescent Home for Officers of the Navy and Army. There is no need to describe the beautiful surroundings of this well-known palace, the accommodation available is for 43 officers, five of whom may be accompanied with their wives and is equally divided between the Navy and Army. Medical attendance is free, except in cases requiring special nursing or massage, &c. The entire cost amounts to 011I3" half a crown a day for each officer or his wife. The accommodation, writes Colonel H. H. Forman, a.M.S. (ii.a.mc., Journal, June 1911), is of the best, dining"
drawing-rooms, lofty airy bed-rooms, organ, pianos, &c. Outof-doors there are golf, tennis, croquet, bowls, a
rooms,
/
smoking-room, billiards,
a
problems
"
*
Health and Empire, a Traveller's study, Medical Officer of Health, London.
County
F. Freemantle, J. Onseley, Lt.
by
Dec., 1911.J
THE MEETTNG OP THE FAR EAST TROPICAL ASSOCIATION.
he sa}'s what is now wanted in India are " pracWe may pass over chapter II tical measures. and its comments on the remark of a learned Parsi lady?well known in official circles in Bengal?on the "gamble in life." "Half policies are the devil ;a vigorous rule is what native races require, and some remains of the gamble in life," says Dr. Freemantle. The history of the Pasteur Institute and of rabies is dealt with in the next chnpter. Chapter IV deals with the plague-flea and plague work since Haffkine's first researches. Beri-beriand the good work done for the Empire in the Laboratory of the Federated Malay St ites forms the subject of another chnpter, the work done by Shiga in Japan is duly appreciated, but we venture to think that there is much inaccuracy in some of the statements about Shiga's serum for dysenteiy. A. very interesting chnpter is given to the subject of town planning in Kuala Lumpur; where streets 120 feet broad are to be found, and the pressing subject of housing in Hongkong is discussed in detail. In Japan our author comments favourably on the prison management, but points out thatsimilar methods are in force in our Indian prisons. He also notes the terrible hold that tuberculosis has on the Japanese; as also in India where its prevalence is not yet sufficiently recognised by government and the public. The satisfactory attitude of the Japanese towards sanitation is noted, which shows the extent to which they have seiz id upon modern ideas. There is an interesting note 011 the Japanese Red Cross work in the late war. In contrast with progress in many parts of the world the account given of "health faking" in San Francisco is not creditable to the citizens of the great republic, though the system of federal l^'giene by the so-called Marine Hospital service is highly appreciated. We can strongly recommend this book. It is one that should be in every station library in India. "
"
"
"
"
FAR EASTERN ASSOCIATION OF TROPICAL
MEDICINE.
The
of the next
of this The is Dr. J. Mitford Atkinson, of and the Secretary Dr. F. Claik,
prospectus
Second Biennial Association is
president
Hongkong, Hongkong.
meeting
published.
The following is the programme of work to be done and the Secretary invites medical men to be present:? "The Second Biennial Congress of this Association will be held in Hongkong from Saturday,
January 20th,
to
Saturday, January 27th, 1912,
and you are cordially invited to attend and to take part in the work of the Congress. The Association is an international one formed to promote the science and art of Tropical Medicine in the Far East.
471
Saturdaj', January 20tl), will be devoted to reception of official delegates and visitors, leaving the whole of the following week for the the
scientific woik of the
Congress."
The papers offered will be classified, so as to give, as far as possible, a day to each of the following groups of
subjects : Protozoology?Helminthology. Cholera ?Plague?Leprosy?Tuberculosis. Tropical Fevers including Malaria?Beri-Beri? -
Dysentery.
Surgery? Obstetrics?Infantile Diseases. Climate?Hygiene?Sanitation. The following practitioners have already expressed
their intention to submit papers, and other members of the medical profession in the Far East who are willing to introduce subjects for discussion are requested to communicate at once with the Secretary. Papers may be read in either English, French or German, but authors are asked to send a brief abstract in English in all cases. J. Mitfoid Atkinson, m.b., d.p.ii., Hongkong :? Presidential Address : The progress of tropical medicine during the past twenty-five years. J. C. Dalmahoy Allen, m.d., Hongkong :?Blood pressure. Professor Cheng Hao, Canton Army Medical School, Official Delegate from the Government of ChinaSubject not yet announced. Major Weston P. Chamberlain, m.d., Chairman of the United States A1 my Board for the Study of Tropical Diseases as they exist in the Philippine Islands :? (1). Prevention of Beri-Beri among the Philippine (Native) Scouts by the use of undermilled rice ; and in conjunction with Captain Edward B. Vedder, m.d. :?
The substance in rice polishings which prevents and Beri-Beri. C. Noel Davis, m.b., d.p.h., Shanghai :?Beri-Beri. Blackwater Fever Lawrence G. Fink, m.b., Burma in Burma. George A. Finlayson, m.a., m b., M.R.c.r., Official Delegate from the Government of the Straits Settlements :? Malaria as a factor in the aetiology of biliary calculi. H. Fraser, m.d., d.p.h., Official Delegate from the Government of the Federated Malay States, Director of the Institute for Medical Research, Kuala Lumpur :? Beri-Beri. Paul C. Freer, m.d., pIi.d , Official Delegate from the Results of the Government of the Philippine Islands past two years' work in the study of tropical sunlight Dr. Furtli, Staff Surgeon, Official Delegate from the Government of Kiautschou :?Neuer Untersuchungen iiber Flecktyphus (latest researches into spotted Fever). G. Montagu Harston, m.d., Hongkong :? (1J. The care of children in the tropics. (2). The care of the eyesight in the tropics. Victor G. Heiser, m d., Official Delegate from the Beri-Beri. Government of the Philippine Islands C. Montague Heanley, m.b., d.p.h., Hongkong :?The laboratory diagnosis of Syphilis. Major S. P. James, m.b., d.p.ii., i.m.s., Official Delegate from the Government of India :?Subject not yet announced. Gregory P Jordan, m.b , Hongkong :?Carbon dioxide snow?its use in private practice in the tropics. K. Justi, m.d., Hongkong :?The Diagnosis of Malarial Fever in the absence of the parasites from the peripheral
(-2).
Polyneuritis gallinarmn
blood. O. MUller, m.d., Hongkong
of
Dysentery.
The
Surgical
Treatment
J. A. F. de Moraes Pallia, m.d., Official Delegate from the Government of Macau : ?Subject not yet announced. Sir Allan Perry, m.d., Ceylon :?Indian native coolie
immigration.
J. M. Swan, m.d., Canton :?Some rare conditions which have been met with in the treatment of vesical calculi in South China.
THE INDIAN MEDICAL GAZETTE.
472
Richard P. Strong, m.d., pli d., Official Delegate from the Government of the Philippine Ts'ands : (1) Immunization against Pneumonic Plague. (2) The Aetiology of Beri-Beri. H. Gordon Thompson, m.d., f.r.c.s., Pakhoi :?Surgical Work in South China Dr. Uthemann, Fleet Surgeon, Official Delegate from the Government of Kiautschou : (1). Stadtanlage und sanitare Einrichtungen in Tsingtau (Town planning and sanitary conveniences at Tsingtau); and will introduce a discussion on : (2). Die Notwendigkeitder Quarantanebestimmungen an den Klisten-platzen Ostasiens nacli Moglichkeit in IJbereinstimmung zu bringen (The necessity for uniform Quatantine Regulations for all tlie coast ports of China) Captain Edward B. Vedder, m.d , United States Army Medical Corps, Manila: An experimental study of the action of Ipecacuanha on Amoebic G. Duncan Whyte, mis , Swatow :-Tuberculosis in South China. J. P. A. Wilson, F.a.c.s., (Ed.), d.p.ii., Official Delegate from the Government of Johore Subject not yet announced. In the event of any member of the Association being unavoidably prevented from at tending the Congress his paper will be read by the Secretary, if duly forwarded for that purpose. The meetings of the Congress will be held in the City Hall commencing on Saturday, January 20th, at 11 a.m., with an Address of Welcome by His Excellency Sir Frederick .1. D. Lugard, G c.m.g , c b , d s o , Governor of the Colony. ?
?
ALASTRIM OR MILK-POX.
The most important article in The Transactions of the Society of Tropical Medicine and Hygiene (July 1911, Vol. IV, No. 8) is the paper by Dr. Emilio Ribas of Brazil on what is called
Alastrim, Amaas, or Milk-pox, a highly infective and specific eruptive fever which has been often
confused with small-pox and chicken-pox and is claimed by Dr. Ribas to be a separate entitj\ Our readers may remember that we previously commented upon a similar outbreak in Trinidad, which had been called half a century ago by Dr. Izett Anderson "Variolid Varicella." It is probable that Dr. Korte has described the same disease in S. Africa under the local name of " Amaas or Kaffir Milk-pox. It is, however, not to be forgotten that in the tropics chicken-pox is by no means a trifling children's disease but it attacks adults severely, and the eruption is so widespread that cases have not infrequently been mistaken for small-pox. Dr. Ribas describes the clinical symptoms as follows :? "
"The eruption usually appears on the third day of the illness, first as a rash, which in a few hours becomes papular and vesicular. If the hand is passed over the surface at this stage there is a feeling as if there was small shot in the skin. On the fourth day of the eruption and seventh of the disease the vesicles become "pearly" in appearance, and immediately afterwards they become frankly pustular, and especially on the face. A reddish aureola surrounds the vesicles, but in severe cases this aureola becomes more extensive. The vesicles then lose the pearly appearance and take on a more milky look, or, at times, that of white wax. On the fifth day of eruption and eighth of the disease the vesicles have become pustules. On the sixth day the pustules begin to dry up and form scabs ; some, however, flattening out, do not form scabs.
[Deo-.
1911-
These scabs are formed iti the following manner :?A small point, at first the colour of yellow wax and afterwards becoming darker, occupies the centre of each pustule. This point is the beginning of the change in texture of the vesicular wall There a small opening occurs, thus allowing the liquid contents to escape. This drying on the thin vesicular wall forms the scab. I am of opinion that there is no true umbilication as in small pox ; that is to say, in milk-pox this appearance is only present when the above-mentioned change has taken place, which gives a paeudo-umbilication. In small pox the true umbilication is due to the actual structure of the vesicles. When the resulting scab falls off, in the form of a small dark-coloured scale, the underlying surface is seen to be slightly elevated compared with the surrounding skin. The colour is dark red, but this disappears 011 pressure, and at the end of a certain time these maculae disappear altogether. Only in rare instances, and that where the disease has been of a confluent type, do the marks remain permanently. The eruption also appears on the mucous membrane of the mouth and other parts In cises of moderate intensity the duration of the disease may be put at fifteen days, but in severe confluent cases it may last twice this time. Confluence is most frequently observed on the face and lower limbs, rarely 011 the arms and trunk. Alastrim has the same incubation period as small-pox, and during the period of invasion there is a rise in temperature till the appearance of the rash. The temperaThe pulse rate is in ture may reach 40?C to 4l?C. proportion to the temperature.
Other symptoms are sore throat, swelling of cervical glands, and coryza; also headache and backche are common. The opinion of the meeting seems to be that the disease was a " modified" small-pox, and " none of the tropical experts present seemed to have realised how severe chicken-pox could be in adults and in the tropics. "
ANNALS OF TROPICAL MEDICINE.
The second number of the fifth volume of these valuable annals is dated 1st August 1911, and contains much of interest to medical men in the tropics. Prof. U. Gabbi of Rome has an interesting " article on the occurrence of certain tropical diseases in Southern Italy. As might be expected Mediterranean or Malta fever is well-known, and it is said that from 3 to 17 per cent, of the goats in Sicily and south Italy are infected. Another more distinctly tropical disease, KalaAzu* has been demonstrated in Italy by Pianese of Naples and Prof. Gabbi claims that he and his students have shown that youths aud even " adults are affected by Kala-Azir, though very seldom" while it is more common in children. It appears early in spring and is "greatly dif" fused among the poorer classes in the littoral towns of the south, moreover typical tropical oriental sores have been seen in the same places. Three days fever or Pappataci (sandfly) fever has also been recognised and it is regarded as a regular summer disease. "
*
on
Iii our next issue we shall give a summary of an article this subject by Sir Win. Leishraau.?Ed., I, M. G.
BERI-BERI, AND ALLIED DISEASES.
Dec., 1911.]
Tn another article Mr. R. Newsted (in a report of the 23rd expedition sent out by the Liverpool school) describes the Pappataci flies (Phlebotomus) in the Maltese Islands (a paper which we propose to abstract in another column). Dr. J. W. \V. Stephens has an interesting note He on the anti-malarial operations at Ismalia. in states that these operations have resulted the town from completely freeing anophelines and hence from malaria." Dr. Stephens gives reasons for believing that malaria had existed in Ismalia before the introduction of the enlarged freshwater canal in "
1877.
The work done on the advice of Sir Ronald Ross consisted of draining numerous marshes, large and subsidiary, oi'iing of pools, &c. Stephens points out three factors which largely contributed to achieving this success, viz., Ismalia is in the desert, (2) the intermittent irrigation scheme with a fall of 20 feet from the freshwater to the Maritime canal, and (3) the presence of fish in all the drains. The cost of the operations was very considerable, viz., an initial expenditure of ?2,000, another ?4,000 on draining swamps at the rate of ?4 an acre. The permanent expenses are ?312 in keeping the drains in good repair, and apparently ?720 per annum for disinfection, hunting larvae, &c. The total is given by Dr. Stephens as follow :?
(1)
1903
...
...
...
...
...
...
...
...
1907
...
...
1908
...
1904 1905 1906
...
?1,528 ?1,039 ? ? ? ?
696 678 625
672
also employed and it Quinine prophylaxis sums (variously estimated) from ?65(5 in was
cost
1902 to ?237 in 1908. Dr. Stephens thinks that the decrease in in considerable part due malaria in 1903 was "
to
quinine prophylaxis," though (he quaintly
result would have been arrived " taking a grain of quinine." Another valuable report is on human trypanosomiasis in Gambia by Dr. Todd and S. G. Wolbach. Dr. W. Yorke and R. W. Nauss 1 iave a valuable report on suppression of the urine in blackwater fever, and they consider that, under certain conditions, the mere passage of haemoglobin through the kidneys is sufficient to cause suppression owing to the occlusion of the lumen of the renal tubules by plugs of granular material derived from the haemoglobin. The article on organic phosphorus, beri-beri and diets is deserving of fuller extracting than we can here ffive it.
adds)
the
same
at without
TAON OR INFANTILE BERI-BERI.
Di?. F. C. Calduron of the University of the Philippines, has a useful article in the Bulletin of the Manila Medical Society (August 1911)
473
the treatment of what is locally called Taon, Taol. This disease is very prevalent in the PhilipIslands and destroj's many infant lives. pine " Children apparently healthy are seized suddenly by violent convulsions, a piercing ciy, an or intense asphyxia followed by death," such is l)r. Fernando Oalderon's brief description The disease has been considered to be infantile eclampsia, but its claim to be an infantile beri-beri was made out by Dr, Manuel Guerrero in 1904, basing his observations on 103 clinical cases, and since then many practitioners have agreed that the complaint is a clinical entity and is a form of toxrernia duo to beri-beri and transmitted to the child by a mother or wetnurse who has beri-beri, through the milk." Dr. McLaughlin and Dr. V. L. Andrews have also shown that of the infants who die in Manila no less than 74 per cent, ate breast-fed infants?so that what saves infants in other countries kills them in Manila. As a result of these facts an institution called La Oota de Lache was established and by the issue free of sterilised milk has saved already the lives of many infants. on
or
.
ORGANIC PHOSPHORUS BERI-BERI AND ALLIED DISEASES.
In Annals of Tropical Medicine (August 1011) Dr. G. G. E. Simpson and Mr. E. S. Edie have a very complete article on the relation of the organic phosphorus contents of various diets to disease of nutrition particularly beri-beri. The article is preliminary and consists largely of an abstract of Schaumann's important monograph which, as it is little knowa in India, we may here abstract. We need not refer to the account given of the well-known work of Braddon, Fraser and Stanton and of Hoist?but quote some of Schaumann's conclusions as given in the article referred to :? "Schaumaun further gives exhaustive tables of the composition of various food-fetuffs grains (fresh and prepared), peas, beans, potatoes, meat, etc., both in the fresh and dried states, showing their composition with reference to protein, carbohydrate and fat, and in particular their vaiious phosphorus-containing compounds? inorganic phytin-like compounds, nucleins and phosphatides?and discusses the present state of our knowltdge
of the metabolism of these bodies. " Schaumaun next proceeds to a critical review of the various theories of the etiolrgy and points out that neither place, climate, nor season appear to be of importance, and that no specific organism has been isolated though many bacteriologists, and even Koch himself, have made careful investigations ; Fletcher and Fraser also carefully excluded the question of infection since they showed that whether Beri-beri was present or absent among the inmates of a building or compound it could be banished by feeding with partly milled rice or called forth by feeding on wholly milled rice. " Braddon, with respect to Beri-beri, and Eijkman, with reference to Polyneuritis in birds, at first assumed that some toxic agent was present in the kernel of the grain
THE INDIAN MEDICAL GAZETTE.
474
which gave rise to Beri-beri and that the antidofe to this toxin was present in the pericarp, and that so no bad effect followed feeding with the whole grain ; but, if the pericarp were lvmoved, the toxin already present or elaborated during digestion was free to exercise its effects " Schauiuann then considers the theories which ascribe the development of Beri-beri t?> a faulty nutrition, and he calls attention to the theories of Nocht(l003); the latter ascribes both the multiform manifestations of Tropical Beri beri and the usually milder ship Beri-beri (which appears to be somewhat allied to scurvy), to dietetic errors ; and lays special stress on the fact th*t it is not a question of defect of the main components of food-stuffs?proteid carbohydrate and fat?but of some subtle defect of the less known constituents?enzyme?,
complements, compound proteids, etc. "Schauiuann himself, however, is inclined
to consider the substance or substances of importance to be organic compounds of phosphorus He resolved first of all to investigate the possibility of the neuritis being due (1) to the development of oxalic acid by fermentation or to acidosis from deficiency of alkaline salts in the grain ; (2) to the removal of ferments or other thermolabile substances by milling or ' denaturisation,' and (3) to investigation of the influence of phosphorus compounds, and inorganic. organic " He points out that the exact chemical nature of the phosphorus compounds in food-stuffs and the body is but imperfectly known, that the methods of separation are but approximate and uncertain in many cases, and that the isolated products are probably modified by the processes of extraction, and so differ in physiological effect from their precursors. "Subject to modifications necessitated by the light gained in the process, he resolved to try diets, as polished rice and denaturised foods, which were known to produce neuritis, etc., and see whether any favourable results are obtained by the administration of such diets, with the addition of : 1. Known organic and inorganic compounds of
phosphorus.
Small amounts of substances rich in phosphorus, rice meal, yeast, Katjang-idjo, wheat meal, testicular extract, or extracts from roe, etc 3 Phosphorus compounds isolated by him "from articles of food, e.g., yeast, Katjang-idjo, etc 2.
e.i7
,
The
following
conclusions
are
drawn
:
?
Food-stuffs which lead to the development of Polyneuritis in animals are characterised by a low content of phosphorus or of certain organic compounds of phosphorus. This may be either fundamental or be caused by artificial processes. II. Animals are not protected from the ill-effects caused by such diets by the addition thereto of proteid^, I.
inorganic salts, inorganic phosphates, or the synthetic organic compounds of phosphorus (calcium glycerophosphate, albumen-inetaphosphate). III.
The
addition of certain substances, rich in to such diets exercises b >th a protective and a curative effect Yeast, rice meal, wheat bran, peas, Katjang beans, and testicular extracts are the chief substances with this power. Carnivora and lierbivora, however, react rather differently to testicular extract, the former are completely protected, the latter only in a less degree IV. Artificially separat d organic phosphorus compounds of various kinds, prepared from these natural protective substances, exercise only a moderate and transient influence Such compounds include yeast nucleic acid, phytin-like compounds from Katjang, phytin from rice meal, and possibly certain phosphatides. V. Apparently the protective or curative effect of these substances is dependent not on any one of their organic compounds of phosphorus, but on the collective effect of a number of these. Animals do not apparently possess the power of forming the organic phosphorus
organic phosphorus,
[Dec.,
1911.
compounds necessary to their economy from inorganic phosphates by their own metabolism, but are dependent for their provision on the plant world, as they are for othn* classes of food-stuff (eg., protein and carbohydrate). VI. The metabolism of phosphorus and nitrogen stand in close relationship to one another. VIE. Spontaneous or experimental polyneuritis in animals appears to be a disease of metabolism, attributable to the lack of some specific organic phosphorus compounds whose identity is still uncertain. Schaumaun next discussed ship Beri-beri, a well-known disease in Indian waters and on
light-houses. " Preserved vegetables carried on one s-hip were very rich in organic phosphorus, and had been found to be extremely valuable in the treatment of the sailors stricken with Beri-beri. Preserved meat is also rich, particularly in lecithin phosphorus. Schaumaun considers that the cause of Beri-beri on ships lies in the lack of organic phosphorus compounds in the diet of the sailors. This is especially noticeable on the return voyage (especially in ships leading home from nitrate and guano ports where fresh meat and vegetables are not obtainable), in part owing to the sailors being partly driven to bread, rice, etc , through the mouldiness of the peas or their hardness from keeping (rendering them impossible to soften even the decay and smell of or when boiled in soda) the meat. To this is added in other cases the loss of organic phosphorus in the salt meat due to the action of the lye, and the similar loss in the leguminous foods owing to standing or to boiling with soda He calls attention again to the affinity between scurvy and ship Beri-beri (vide also his animal experiments), and suggests that scurvy may be found to be due to use of stale vegetables, and Beri-beri to use of rotten or stale flesh?the important factor in each being lack of organic compounds of phosphorus. As a curative agent, he says, all sailors know the value of fresh meat and vegetables. As a preventive agent, he suggests that it might be possible to carry dried yeast, l ice meal or testicular extract for use when the ordinary diet becomes inadequate, and especially lays stress on the probable value of requiring all ships engaged on voyages where fresh provender may be difficult to obtain, to carry a supply of Katjang beans in sealed (sterilised) cases In the future, he hopes a more active principle requiring but small bulk may be isolated. Sailing ship Beri-beri is a disease of metabolism dependent on lack of organic phosphorus in the diet. Schaumann and Werner tried the therapeutical < ffects of phosphorus-rich compounds 011 Tropical Beri-beri and obtained improvement by the use of yeast, nucleic acid, testicular extract, etc.. though the improvement was not so marked as in polyneuritis in animals, owing to the more advanced lesions in these cases requiring longer for regeneration. (Fat-free yeast and carefully prepared nuclein should alone be 1 sed ) Ivatjang beans, peas, and also the peptic extract of Katjang are also very valuable. On these grounds it appears clear that Tropical Beriberi resembles experimental Polyneuritis and ship Beri-beri in being due to lack of organic phosphorus in the diet, but it appears to be due to a chronic deficiency of long duration, with severe deep-seated lesions requiring a long time to cure. The experimental neuritis in a goat already described is analogous to Tropical Beriberi. The other experimental cases and ship Beri-beri. 011 the contrary, aie due to a sudden large deficiency of organic phosphorus, and the lesions, though severe, are not deep seated, and are rapidly recovered from. In the majority of cases, Beri bei i is due to a gross deficiency of the organic phosphorus, in the diet. In other cases the diffeiences may be individuals in the since some individuals patient, require much larger amounts than others, and others again may be unable to absorb and assimilate the compounds,
Dec, 1911.]
DISPOSAL OF REFUSE IN THE TROPICS.
in the diet. Schaumann quotes the of a German colonist, who, after being very ill with malaria on the Amazon, developed Beri-beri on the voyage home though on an ample diet ; in this case the intestinal absorption appeared faulty, as there was a great deficiency in urinary, and a very large increase in the frecal phosphorus. Occasionally, epidemics of Beri-beri appear to be due to a bacterial infection of the gastro-intestinal tract, either through the catarrh interfering with absorption or to the bacteria (or their products) absorbing or splitting the organic phosphates before they could be absorbed. Tropical Beri-beri is a disease of metabolism due to the amount of organic phosphoius compounds assimilated being below that essential for the human organism. This is in the majority of cases due to deficiency of
though present
case
organic phosphorus." Concluding Considerations. " A whole cycle of other diseases in all probability have a similar etiology to that of Beri-beri, more especially ship Beri-beri. Scurvy has already been conclusively shown to be of this nature by a whole series of observations, and to all appearance Infantile Scurvy, Rickets, and Osteomalacia are also included. Pellagra and the form of malnutrition described by Czerny and Kellner in artificially fed children may be further examples. The suspicion arises that all these diseases may be due to deficient assimilation of organic phosphorus, but it is difficult to understand how a similar cause can produce the different effects shown by the symptoms in these diseases. It has already been shown that the animal organism is not adapted to build up organic phosphorus compounds for itself, but depends for these on the plant kingdom, and it is probably equally unable to form compounds of one group from those of another {e.g., nucleo-proteids from phosphatides). Since different groups play different joles in the ceitain that deficiency of each economy of man, it is and in addition group will have its own special effect, this will be complicated by an associated influence on the general metabolism ; for example, inorganic comalkaline earths of the bone?, pounds would react on the on the proteins, etc. would react
nucleo-proteids
Individual differences would further intervene to comthe picture, more especially age differences, and infancy, childhood, puberty, pregnancy and old age would, in particular, have a far-reaching influence.
plicate
So by deficiency of single groups, or of combinations of groups of phosphorus compounds, various symptom complexes?different diseases?may be originated. Thus lack of nucleo-proteid in adults is probably connected with Beri-beri ; in children a similar deficiency might give a different disease : deficiency of phosphatides may give yet a third, "a combination of the two will give yet another picture
faecal matter, receptacles, buckets, &c., are exposed for periods to Hies, the handling of the nightsoil and emptying of it into carts is open to many objections; on this matter the writer quotas the following pointed remarks of Col.
Forman,
Major R. J. Blaciuiam, r.a.m.c., read a useful and practical paper on the disposal of refuse in the tropics at. the recent Belfast meeting of the Royal Sanitary Institute. He discussed four methods of sewage disposal, the dry system, the wet, incineration and septic tanks.
The defects of the dry-earth system as apnot in jails where labour is plenty and is controlled, but in cantonments and municipalities, are obvious and consist in the fact that
plied,
a M.S. :?
"
I believe that we can in great measures stamp out the enteric scourge in India, if we adopt the following suggestions (1) remove latrines well away from cookhouses ; (2) make them light and airy structures, easily moved if necessary ; (3) pave them with cement ; (4) abolish dryearth and substitute crude petroleum or carbolic ; (5) let the seats be movable and the pans so placed that slopping is impossible ; (6) eliminate flies; (7) ensure scrupulous cleanliness, not make-believe, but scientific; (8) provide early steiilization by boiling, if possible on the spot, and before transit ; (9) secure efficient means of transit in water-tight vehicles ; (10) arrange for frequent sterilization of all receptacles, and last but by no means least, see to (11) careful and scientific disposal at a distance."
Colonel YV. A. Mokris, a.m.s., strongly advocates the wet-system of conservancy :?" A wet-system of conservancy is directed towards the destruction or inhibition of the growth of bacilli at the It is especially moment they leave the human subject. directed against those bacilli of disease which are found in the liquid and solid excreta, and the inhibition of their action or destructions is effected by disinfectants, under which term are included deodorants, antiseptics, etc." This system may be carried out with either a coal-tar disinfectant, such as saponified cresol or a solution of perchloride of mercury. The cresol solution, which is now in use in all military cantonments, is made up by adding half an ounce of cresol to a gallon of water. One pint of this solution is placed in each receptacle. Colonel Morris strongly advocated in lieu of it a 1 in 2,000 solution of perchloride of mercury.
On the subject of incinerators, Major Blackham has some good remaiks. One tiling is certain, they are not as cheap to erect or to work as their inventors and advocates have made out. As for the Raitt incinerator, Major Blackham writes as follows : ?
"
The incinerator is set going by placing a quantity of litter and dry refuse on the framework, and setting fire to it. When combustion has proceeded for some time the total contents of the latrine pans are emptied over the smouldering material. I frankly confers that I do In my experience heavy rain not believe in this system. invariably puts these incinerators out, and the exposure of smouldering material to the strong gales of the winter and that storms of the summer must, and does, result in the addition of much objectionable matter to the dust which is blown in all directions."
experience of this incinerator in a is very similar. Major Blackham mentions but gives no details of the Umballa B incinerator, recently invented at Indian Army Head-quarters. We are glad to see lie quotes and approves of Major Cleiiiesha's pronouncement as to the combustibility of Indian street rubbish, this rubbish usually will not burn. Major Blackham is in favour of septic tanks and quotes largely from Major Clemesha's invaluable book on the subject. This paper is an excellent and practical one. Our
THE DISPOSAL OF REFUSE IN THE TROPICS.
475
own
Bengal jail
ire
THE INDIAN MEDICAL GAZETTE. REVISION OF THE B. P.
have received the second and third reports of the Committee embodying the results of their work from 1908 till May 1911 in connection with the revision of the British PharmaWis
copoeia.
No date is yet mentioned for the new edition, which need not be expected for some j'ears. The second report deals with the following drugs, extracts, Belladonna, and Glycyrrhiza, Hydrastis, Ipecacuanha, Nux Vomica, Opium, Sarsa, Taraxacum, with Ferri Carbonas, Ferri Sulphas, Filix Mas, Guaiacum, Mercury, Iodine, Hyoscyamus, Ipecacuanha root, resin of Jalap. The third report is of a similar character, and deals chiefly with descriptions, tests, and nomenclature, and strength. The changes recommended are also frequently mere alterations in strength to bring the preparations into approximate conformity with the
International Agreement.
Memoir No. 2 of the Indian Civil
Veterinary Department (Calcutta: Thacker, Spink & Co.) "
is modestly entitled but it Collected Notes contains several papers of interest, e.g., Mr. A. S. Leese, on the natural transmission of Surra. The two flies concerned are tabanus liseuiatopota and stomoxys. The latter is the most common biting fly on the Naini Tal and the Dehra Dun roads. Mr. S. H. Gaiger has an article on hemorrhagic septicemia, a disease only differentiated in India within the past 10 years. It rarely attacks horses, but it is very common among buffaloes. The same writer describes a worm lingulata tcvnoides?a parasite very common in pariah dogs in India. "
A. M. A. June 10) praises the better known under the name of urotropine in commencing-colds; 15-grain doses four times dail}'. The irritating action on the bladder must be remembered. A writer
use
of
(J.
hexamethylenamin
Sin Ronald Ross discusses the question why Yellow lever has not spread in the Old World as it has in the New. The Stegomyia fasciata is found widespread in Africa, India and China. He concluded that the number of S. fasciata is not sufficient, the number must not only be high, but high enough to maintain the disease and extremely high to cause a proper outbreak." "
Du. St. J. Choley asks
us
to the fact that in his article
to call attention
(I. M. G., September 1911,)). 336) he intended it to be understood that the chlorotone was to be given per rectum, and not hy podermically.
[Dec,
1911.
Accouding to Berlin Klinische Wochen, Bacelli used very successfully a subcutaneous injection of carbolic acid in tetanus cases. He uses a 2 or 3 per cent, watery solution of carbolic acid which he injects subcutaneously. He begins by very small doses, and as soon as tolerance is established by examination of the urine, he rapidly increases the dose till the patient takes one to one-and-a-half grammes in 24 hours. He says that tetanus patients tolerate carbolic acid in surprisingly large doses. Recent research in Texas has established the existence of Mediterranean (Malta) fever in that State.
Epidemics of cerebro-spinal fever and of acute poliomyelitis lias been reported from Devon and Cornwall. Both diseases have been prevalent in the United States for some years past andpoliomyelitis has recently been very much in evidence. In Ireland with 3 million
inhabitants there lunatics in with 57 million inhabitants there is accommodation for about 1,000 lunatics. No wonder we have said that local Governments in India get off very cheaply in the matter of asylums. On 1st January 1911 there were 133,157 certified lunatics in England and Wales out of a population of 45,210,665 at the recent average strength of 24,394 confinement in 1910; in Bengal
were
an
census.
We call the special attention of all I. M. S. Officers to the book now in the press on the Indian Medical Service, by Major 13. Setor/ and Major Gould, I M.S. It will be found extremely useful to all men in the Service.
