NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
30
into the diet of these patients. In both batches the progress of the disease
was the same. The œdema generally disappeared rapidly, and the nervous
symptoms cleared up. The cardiac symptoms are very tenacious, and often
persist after the patient has left Hospital. This was also noted in the recent
Calcutta outbreak by me. Relapses were: 25.75 per cent. among the treated,.
and 31.25 per cent. among the controls. One death among the treated, and
two among the controls.
The authors reach the following conclusions:—
(1) The bran of paddy even if given in large doses does not produce
digestive disturbance.
(2) Employed as a prophylactic, especially among the men of the Rifles,
in doses of 40 gram. daily, it had a distinct protective influence.
On the contrary when given in this dose to men already affected
its action appeared to be nil, but larger doses were not adminis-
tered.
(3) From the curative point of view when given in doses of 40 gram.
and over, the bran employed as the only means of treatment
without in any way changing the ordinary native dietary has
given the same results as the numerous therapeutic measures
mentioned until it was associated with a European diet.
This interesting paper demonstrates the value of rice bran as prophy-
lactic in polyneuritis, and also in the cure of Beriberi when the native dietary
is simultaneously improved and approaches the European standard. Rice
bran has the advantages over other therapeutic measures in being infinitely
simpler, less costly, and always available.
An interesting note by Theze,1 on the relation of rice to Beriberi, has been
published recently. He states that the Penitentiary at Poulo Condore
(Cochin China) for a long time has been a focus of Beriberi: in 1906 this
disease caused 116 out of the total 130 deaths and this mortality did not
exceed the average in this establishment.
In the epidemic of 1906 the substitution of incompletely decorticated
rice (red rice) for white rice mechanically decorticated has produced remark-
able results when disinfection of the locality and intestinal disinfection did
no good. This measure commenced towards the middle of August completely
arrested the epidemic; and the patients already affected, who were submitted
to the new régime, rapidly improved; after the 22nd August there was not a
single case.
1 Ann. d'hyg. et de med., col. 1910, p. 16, referred to in Archiv. Schiffs u. Trop. Hyg., Bd. XIV, Heft. 21, p. 678,
1910.
31
The analysis of the ration distributed to the prisoners at Poulo Condore
leads the author to believe that the symptoms are due to an insufficient quan-
tity of phosphorus in the diet. Contagion does not appear to play any part
at all.
In a note, appended to the report of M. Theze, the Editor of the Annales
d'hygiene de medicine coloniales gives an interesting account of the results
obtained in the prison at Saigon by excluding polished rice; the orders were
given by M. Grall in November 1903.
The following table gives the results :—
Saigon Prison.
Year.
Average number of prisoners.
Deaths from Beriberi.
1899.
.
.
. . .
615
8 0
1900
.
.
.
.
.
. .
628
7 8
1901
.
.
. . . . .
507
93
1902
.
.
.
. .
464
85
1903
.
.
. . . . .
584
76
1904
.
.
. . . . .
746
3
1905
.
. . . . . .
779
6
1906
. . . . . . .
860
15
1907
. . . . . . .
762
5
The following table shows the results of substituting partially husked
(red rice) for white rice in 1906 at the Penitentiary at Poulo Condore :—
Year.
Average number of prisoners.
Deaths from Beriberi.
Percentage.
1901
. . . . .
295
27.45
1902
.
.
. . . . .
375
13.60
1903
.
.
.
. .. . .
489
57.46
1904
.
.
.
.
. . .
534
7.67
1906 From 1st January to 15th August
.
363
31.99
1906 From 15th August to 31st December
249
0
1907
. . . . . . .
703
0
1908 From 1st January to 1st September .
909
0
The above table illustrates in a very striking manner the effect on the
mortality from Beriberi of altering the diet from polished to unpolished rice.
32
Gilmore Ellis,1 Medical Superintendent, and Medical Officer, Beriberi
Hospital, Singapore, brings forward evidence from his own investigations,
which have been carried on since 1901, showing the causal connection between
polished rice and Beriberi.
It is interesting to note that, in his report on the Medical Department of
the Straits Settlements for 1909, Dr. Ellis2 states that no case of Beriberi
originated in the Singapore Jail; this is the third year in succession in which
this immunity has occurred. In the same report it is stated that parboiled
rice is now used in various Government institutions of the Malacca Pro-
vince. One fatal case of Beriberi occurred at a police depôt; the victim, a
sub-inspector, had been warned against Siam rice, but refused to alter his
diet.
It will be observed from my tables that the quantity of dal taken by the
Bengalis in Calcutta is small; in the great majority of cases under 1 Chittak
a day is consumed. This is an important point, because I have shown in my
previous report 3 that dal, especially the Mung dal, Phaseolus radiatus, has
valuable prophylactic and curative properties when administered in suitable
doses; it supplies the essential constituents which are deficient in a polished
rice diet. In the chapter of this report dealing with the results of the ex-
perimental investigations the prophylactic and curative properties of the
Indian Mung dal in relation to the neuritis of birds are clearly demonstrated.
In regard to the consumption of ata a very interesting fact is brought
out, namely, that practically all cases of Epidemic Dropsy amongst Bengalis
in Calcutta partook of fine or sifted ata, and this, as was shown in my first
report,4 is remarkably poor in certain essential constituents necessary to meet
the physiological requirements of the body. Consequently, a diet composed
of polished rice and sifted ata is very deficient in respect of these constitu-
ents.
It will be noted that Hindu widows partake of very little fish and no
meat at all. Thus of 84 widows suffering from Epidemic Dropsy, only 13
took fish, and none consumed meat.
By reference to the tables giving the mortality it will be observed that
the death rate from Epidemic Dropsy amongst the Hindu females in Calcutta.
is very high.
Considerable importance has been attached to mustard oil in connection
with the etiology of Epidemic Dropsy, and consequently enquiries were made
1 Brit. Med. Journal, Oct. 2, 1909.
2 Lancet, Feb. 4, 1911.
3F i r s t R e p o r t o n E p i d e mi c Dr o p s y i n Ca l c u t t a b y Ma j o r E . D. W. Gr e i g , M. D. , D. S c . , I . M. S . , S c i e n t i f i c
Memoir No. 45.
4 Ibid.
33
regarding it. It was thought that the causation of Epidemic Dropsy was
dependent on certain impurities, mineral oils ("Batch and Bloomless oils"),
in the mustard oil, and this hypothesis received a considerable amount of
popular attention in Calcutta. The results of the experimental study of this,
question are recorded in the chapter dealing with experimental investiga-
tions in this report. Neither the epidemiological nor the experimental
studies, made in connection with the present enquiry, support the above
hypothesis, and there is no scientific evidence in favour of it.
1n
34
CHAPTER II.
Note on an Outbreak of Epidemic Dropsy in Basti Jail, United
Provinces.
As some interesting facts regarding the relationship of rice diet to
Epidemic Dropsy were brought out in the course of this enquiry, a record of
it may be appropriately inserted at this point.
In December 1907 I was directed to proceed to Basti Jail to enquire into
an outbreak of a disease resembling Beriberi. I was only able to devote a
short time to the enquiry as I was officiating as Director of the Central
Research Institute at the time. From the evidence I was able to collect I
expressed the opinion, tentatively, that defects in dietary were playing an
important part in the causation of the disease.
The general features of the condition very closely resembled those of
Epidemic Dropsy in Calcutta. In this jail rice was consumed, and it is of
interest to note that this was the only jail in the United Provinces in which
rice was generally consumed by all the prisoners, and it is the only jail in the
United Provinces which has recorded an outbreak of this disease.
The Honourable Lieutenant-Colonel C. Mactaggart, I.M.S., Inspector-
General of Prisons, United Provinces, in answer to a recent query by me
kindly supplied me with further notes regarding the epidemic at Basti Jail.
He writes under date 23rd February 1910, " So far as I am aware no cases
of Beriberi or Epidemic Dropsy have occurred in our jails except those you
investigated at Basti. I was on the Factory Commission when the epidemic
in Basti Jail occurred, and you yourself know far more about the epidemic
than I do. Rice is never given in our jails as an article of diet except to a
few toothless old prisoners and infirms. The only exception to this rule was
the Basti Jail, where for some years rice was given as a forenoon meal, because
some Superintendent of that jail considered it was more in harmony with the
diet of the free population of the district, and the prisoners did better on it
than wheat. I stopped the issue of rice in the Basti Jail in October 1907
owing to the occurrence of some cases of cholera, and it must have been about
the same time that the cases of Beriberi occurred although the disease was not
recognised till November. Whether the disease was due to the rice diet or not
I cannot say, but it is peculiar that the disease should have occurred in the
only jail where rice was issued generally as an article of diet. The epidemic
in Basti came to an end in January 1908 I believe. Rice diet has not been
reverted to in the jail and so far as I know there have been no cases of Beri-
beri in the jail since January 1908.
35
"Mustard oil is issued to all prisoners in our jails daily and the oil
issued is made in the jail. I do not think it is at all likely that adulteration
with petroleum could occur. I believe there were some cases of Epidemic
Dropsy in Gorakhpur city and a few in Cawnpore city some time ago, but
otherwise I have never heard of the disease in these Provinces. Cases may
occasionally occur but they are certainly rare."
The study of this outbreak at Basti Jail presents several interesting
features. In the first place it will be noted that the disease occurred in the
only jail in the United Provinces in which rice is consumed generally, and
this in itself is a significant fact in the light of our recent knowledge of this
disease. Nextly, with the cessation of the rice and the replacement of it by
wheat the epidemic stopped and no fresh cases occurred. Further, the mus-
tard oil consumed could not have been adulterated with petroleum, as will be
seen from the letter of the Inspector General. Hence in this case the etiolo-
gical connection between adulterated oil and Epidemic Dropsy could be
excluded. Evacuation was not carried out. Had it taken place the
cessation of the outbreak might have been attributed erroneously to this
measure.
As my report on the epidemic at Basti Jail to the Sanitary Commissioner
with the Government of India has not been published before, I include it in
the present one, because, it has important relationships to the Calcutta
epidemic.
A Report on an Epidemic resembling Beriberi at Basti Jail, United Provinces, by
Captain E. D. W. Greig, M.D., I.M.S.
Forwarded to the Sanitary Commissioner with the Government of India
on 14th January 1908.
I have the honour to state that in accordance with your telegram No. 53,
dated the 22nd December 1907, I proceeded to Lucknow on December 26th,
and arrived there next day and had an interview with Lieutenant-Colonel
S. H. Henderson, I.M.S., Officiating Inspector General of Prisons, United
Provinces, who gave me particulars of a disease resembling Beriberi in the
Basti Jail. I reached Basti next day and remained there till 31st December.
This report contains the result of the enquiry which I conducted with the
Superintendent, Basti Jail, Dr. N. S. Harvey, who facilitated my work there
in every way.
2. The first official intimation of the occurrence of cases of a disease
resembling Beriberi in Basti Jail was made by Dr. Harvey, who reported on
2nd December 1907 that, " I took over the jail from Dr. MacLeod on the 19th
November 1907, he handed over to me two convicts in the Jail Hospital who
36
were suffering from œdema of the legs, lassitude and cardiac irritability, but
nothing abnormal was discovered in any of their organs; their urine, although
repeatedly examined, was found normal, they had no rise of temperature; in
addition to these two cases there were 14 to 10 convicts who were suffering
from slight œdema of the feet; as this did not inconvenience them to any great
extent they were not admitted into Hospital." "These have steadily increased,
so that to-day I have 48 male and 2 female prisoners and 1 warder suffer-
ing from the above symptoms." "I am of opinion that the disease is Beri-
beri in mild form, although the insidious nature of the disease showed itself
in two convicts, who had very slight œdema of the feet and no other symp-
toms; suddenly they complained of dyspnœa and violent palpitation, they
gasped and struggled for breath and died in 6 hours, one on the 29th Novem-
ber, and the other on the 30th November; they developed, what is styled an
acute Pernicious Cardiac attack of Beriberi." On December 7th, 1907, Lieute-
nant-Colonel S. H. Henderson, I.M.S., Officiating Inspector General, United
Provinces, paid a special visit to Basti Jail and reported, "The Jail popula-
tion is at present 329, of whom there are 50 men and 2 women in Hospital suf-
fering from symptoms of this disease. The symptoms are, briefly, œdema of
the feet and legs, and sometimes of the body and face, pain and oppression
over the heart, anæmia and a generally debilitated condition." "Three cases
have already died in which practically the only symptom was severe precordial
oppression, dyspnœa and cardiac pain coming on suddenly in men who other-
wise had shown no sign of the disease."
3. On enquiry it was found that some of the cases admitted into the
Jail Hospital, had been suffering from œdematous swelling of the feet—the
most constant sign of the disease—for a considerable period, in one case, for
at least 90 days before admission to Hospital on 8th December 1907. Hence
we see that the disease was existent in the jail early in September last. 1
Many of the cases present very few signs and might easily have escaped detec-
tion, or slight significance might have been attached to them. However, the
occurrence of two fatal cases at the end of November forcibly directed atten-
tion to the malady, and in December all cases showing any signs of the disease
were admitted to Hospital. Thus, during the month of December 1907 a
high admission rate for this disease occurred.
4. In considering the general facts connected with this outbreak of dis-
ease in Basti Jail, it is important, in the first place, to bear in mind that the
disease is not confined to the jail; cases are also occurring in the district
round the jail. As regards the jail itself, which has a population of between
1
This is important in regard to the question of the connection between rice dietary and this disease. The rice
was not stopped until October, vide paragraph 8 of this report, and the epidemic died down in December and January.
37
320 and 350, cases have been admitted into hospital from practically every
part of it. Cases have been received from the female ward; here the female
prisoners are completely shut off from all communication with the male pri-
soners. Also, cases have occurred in the families of the jailors, who never
mix with the prisoners. A feature of interest is that the disease was first
detected amongst the prisoners employed as cooks, and the incidence of the
disease was high amongst them. 38.5 per cent. of the prisoners employed as
cooks contracted the disease.
5. The etiology of Beriberi and its allies has not yet been scientifically
determined.1 Hence in investigating a disease of this class the most profitable
course to adopt is to proceed to analyse systematically, on scientific lines, the
bearing of each conceivable factor in the production of the disease. In this
particular epidemic, the factor common to all effected individuals, is the
food supply, and this factor is, also, common to the population of this district,
in which the disease is prevailing. The food supply of the jail, therefore,
requires, in the first place, to be carefully studied in its possible causal rela-
tion to the disease.
6. By the following observation it could be ascertained whether or not
the food supply (grain) of the district, which is partly used in Basti Jail,
can produce the train of symptoms associated with this disease. The pri-
soners in Basti Jail might be equally divided into two groups A and B for
the purpose of this observation. A roll of prisoners in A and B groups re-
spectively would be made out. The food of the prisoners in A group would be
exactly the same as they are getting at present whilst all the grain for B
group would be got from a district free from the disease, preferably, the same
kind of grain as is being used in the jail of the selected district. The quanti-
ties and kind of grain would be exactly the same for A and B, the only differ-
ence being the source. Should, therefore, the disease continue, it would be
possible to determine whether or not the grain of Basti district is producing
the train of symptoms at present met with amongst the prisoners in the jail. 2
7. On my arrival at the Basti Jail the great majority of the cases of the
disease resembling Beriberi were already convalescent; so I had not an oppor-
tunity of observing the clinical phenomena of the acute phase of the malady.
In Table No. 11 an analysis of the signs and symptoms of all cases of this
disease at present in hospital is given; the most constant objective feature of
these cases is œdematous swelling of the feet and lower limbs. The knee
1
This was written in January 1908. Since that date our scientific knowledge of the etiology of these diseases
has been materially advanced.
2 The Superintendent informed me that no fresh cases occur after January 1910. Observations were not under-
taken therefore to test the etiological relationship of the different kinds of food grains to the disease. However in this
case the cessation of the epidemic was probably due to the stopping of the rice diet.
38
jerks were absent in a number of cases, but they showed no signs of paralysis
or paresis.1 In one of the more severe cases there was distinct tenderness on
pressure over the nerves. In a certain percentage of cases cardiac signs and,
symptoms were present. Examination of the urine by Dr. Harvey had shown
it to be normal. Apart from the nervous and circulatory, the systems of the
body presented no noteworthy alteration.
8. The daily diet of the prisoners at present is : Wheat (1st Class 12
Chittaks; 2nd Class 10 Chittaks); Gram (1st Class 2 Chittaks; 2nd Class 2
Chittaks) ; Dal (1 Chittak); Vegetables (3 Chittaks). Mustard oil 2 seers oil
per 100 diets. Up to 2nd October the prisoners were receiving Rice (1st Class
7 Chittaks; 2nd Class 6 Chittaks) in addition to a smaller quantity of Wheat
(1st Class 7 Chittaks; 2nd Class 6 Chittaks) and Gram (1 Chittak for both
classes). On this date owing to cholera the rice was stopped and the amount
of wheat and gram increased as before. 2
9. In this district I am informed by Dr. Harvey that although actual
famine conditions do not exist there is a scarcity at present. 3
1 In this respect they closely resemble the cases of Epidemic Dropsy in Calcutta.
2 This is a very important point, because shortly after the rice was stopped and the wheat increased the acute phase
of the epidemic ceased. The part played by diet in the production of this disease has been more clearly demonstrated
by recent research.
3 T h i s i s a n i n t e r e s t i n g p o i n t , b e c a u s e i n t h i s o u t b r e a k t h e c o n d i t i o n s o f s c a r c i t y w o u l d o p e r a t e b y b r i n g i n g a b o u t
a " One-sidedness " in dietary of the population outside the jail, amongst whom cases of the disease were occurring, in
the same way as I have shown the high price of food operated in the Calcutta epidemic.
TABLE I.
Showing population of Basti Jail in December 1907, the number of cases, and the number
of deaths from Epidemic Dropsy which occurred there.
Population of Jail.
Total number of cases of Epidemic
Dropsy.
Total number of deaths from
Epidemic Dropsy.
329
81
4
TABLE II.
Showing an analysis of the signs of Epidemic Dropsy as observed in 63 prisoners at Basti Jail.
ŒDEMA OF
FEET.
CARDIAC SIGNS.
NERVOUS SYSTEM.
Total
number of
cases
investigated
Present
in
Absent
in
PRECORDIAL,
PAIN.
HEART.
KNEE JERKS.
SENSATION
FEET.
Present
in
Absent
in
Action.
Heart sounds.
Normal. Diminished. Absent. Present
in
Absent
in
Normal
in
Rapid
in
Weak
in
Alteration of,
Murmurs in
63
63
0
55
8
45
4
6
8
22
6
35
51
12
39
CHAPTER III.
Epidemic Dropsy and Ship Beriberi.
In my first report1 I r e f e r r e d t o t h e s i m i l a r i t y o f t h e f e a t u r e s o f E p i d e m i c
Dropsy and Ship Beriberi as described by Axel Holst and the Norwegian
Ship Beriberi Committee. Since my last report I have obtained further in
-formation on this important question.
Fleet Surgeon R. C. Munday, R.N., P.M.O., of the ships in the Persian
Gulf, writes under date 28th November 1910 to me 2 t h a t , " L a s t y e a r w e h a d
a number of cases of Beriberi amongst the natives in the crews of these ships
and there was a high mortality. I advised the Admiral to allow none but
cured (parboiled) rice on board any ship. Since then although the number of
lascars have enormously increased no Beriberi has occurred. On the other hand
although there has been no Beriberi amongst the natives, we have had a run
-ning dropping fire of cases of peripheral neuritis closely resembling Beriberi
occurring solely amongst Europeans and having no mortality. There was in
nearly every case some slight œdema of the legs. The heart was either not
affected at all or only very slightly. None of these men had eaten rice in any
but very small quantities and that was cured rice. Suspecting that this was
a form of scurvy due to the poverty of the food obtainable in the Persian
Gulf Ports, I advised the Admiral to issue a special ration of fruit which
was to be obtained from Bombay or Karachi. Once a week chickens were to
be issued in lieu of beef and mutton to be supplied as live stock from Bombay
or Karachi. As soon as this improved dietary came into force the cases of
peripheral neuritis diminished and have now ceased. This may be due to the
cessation of the hot weather." He adds also, " I am anxious to acquire all
the knowledge I can about Beriberi, its diagnosis, and preventive treatment
as it has become an important factor in the campaign we are carrying on
against the Afghan gun-runners in the Persian Gulf."
In this interesting note of Fleet Surgeon Munday it will be seen that
cases with slight œdema of the feet as the most prominent symptom occurred
amongst the Europeans of the squadron resembling the milder cases of
Epidemic Dropsy in Calcutta. As soon as the European dietary was ren
-dered less " One-sided " and monotonous by the supply of fresh fruit and
chickens, the latter being obtained as live stock, and fresh meat could thus be
partaken of, the outbreak ceased. The association between the diet and the
disease was demonstrated in this case. The beneficial effect of fresh flesh in
I First Report on Epidemic Dropsy in Calcutta by Major E. D. W. Greig, M.D., D.Sc., I.M.S., Scientific Memoir
No. 45.
2Also in paper read before United Services Society. Brit. Med. Jour., Mar. 4, 1911.