7
of Rangoon, Waddell 1 in 1826 states, " In all the worst cases the feet became
œ d e m a t o u s : a n d h o w e v e r a p p a r e n t l y m i l d t h e o t h e r s y m p t o m s m i g h t h a v e b e e n
this affection was an almost certain prognostic of approaching anasarca, hydro-
thorax and death." He, also, mentions, " To those affections (Scorbutic)
were associated, in many instances, diarrhœa and œdematous swellings of the
feet."
Norman Chevers 2 in his chapter on beri-beri fever, in which he describes
the last severe outbreak of Epidemic Dropsy in Calcutta, 1877-78-79, states, " Mark-
ed evidences of scorbutus are so often noticeable as prominent symptoms in cases of
beri-beri that at least one of our best Indian observers has considered that beri-beri
is essentially a form of scurvy." Morehead 3 considered, " That beri-beri, more
particularly in its acute form, occurs usually in persons favourably circumstanced
for the development of a scorbutic taint, and subsequently exposed to cold, dry or
moist winds, or to lying on the ground wet with rain or clew." Chevers 4 ex
presses his own opinion on this point as follows, " I think that, when we state the
fact that, wherever beri-beri prevails it specially selects the scurvied, we are free
from the error of supposing that acute beri-beri is an expression of scorbutic cach-
exia, although scorbutus should be looked for in all cases of beri-beri, and be treated
when present, as a grave complication." It will be seen from the above that the
occurrence of scurvy in relation to previous outbreaks of Epidemic Dropsy in
India had been observed and commented on. It is interesting in this relation to
note that Chevers 5 l a y s d o w n t h e f o l l o w i n g : " O n e o f t h e m o s t v a l i d m a x i m s
which an old Indian physician can offer to a young one is : Never treat a case of
any severe disease in India, whether the patient be European or Native—landsman
or sailor—without taking at least a glance at the question—is scorbutus possibly
a factor in the causation of this malady."
It is possible that Epidemic Dropsy is one phase or expression of a general
condition long ago recognised by Chevers and called by him Morbus Bengalensis, 6
although he himself did not associate the two conditions Chevers gives the
following account of this disease : " it appears to be an arrest of nutrition result-
ing from chronic starvation. I have never seen this condition in a European or
East Indian, or in a native gentlemen who lived generously but wealthy orthodox
Hindus of the old school, whose diet is very poor and deficient in nitrogenous
1Waddell G. (M. D.) (Assistant Surgeon, Bengal Establishment) on the Diseases of Rangoon. Trans.
Medical and Physical Society, Calcutta, Vol. III, page 240, 1827.
2Chevers Norman, C.I.E., M.D. (Deputy Surgeon-General, H. M.'s Indian Army, Late Principal and
Professor of Medicine in the Medical College, Calcutta). A Commentary on the Diseases of India, 1886.
3 Morehead. C., M.D., Late Principal and Professor of Medicine, Grant Medical College, Bombay. Re-
searches on Diseases of India, Churchill, 1860.
4Chevers, Norman, C.I. E., M.D., Deputy Surgeon-General, H. M.'s Indian Army, late Principal and
Professor of Medicine in the Medical College, Calcutta.
5
I b i d ,
page 347.
6 Ibid.