18
REPORT ON THE RANGOON LUNATIC ASYLUM FOR THE YEAR 1894.
of the germ alone is often insufficient to give rise to any of the symptoms of
beriberi. Under hygienic conditions the disease may remain latent for long
periods, or the tendency to it become altogether eradicated. Given, however,
persons with debilitated constitutions, or lowered vitality, resulting from insani-
tary surroundings, especially overcrowding and bad ventilation, the potentiality of
the beriberi virus then makes itself manifest, and symptoms of the disease are
produced. And it is under circumstances such as these that the development
of beriberi takes place and epidemics of it are determined.
97. That beriberi, however, may occur and assume virulent characters with-
out reference to insanitary agencies, there can be no question. Sufficient proof
of this is afforded by the fact that the disease is subject to extreme fluctuations
of prevalence, although the sanitary conditions, within the sphere of its operation,
remain unchanged.
98. The sanitary state of the asylum was, in every respect, as satisfactory
during the year of report as in preceding years. Excepting' for occasional over-
crowding, during the day, of a slight and temporary nature, which has always
existed in the sheds used by the lunatics, the capacity of the asylum buildings
was more than sufficient for the maximum number of its inmates, while the venti-
lation of all buildings gave complete satisfaction.
99. The general health of the lunatics was excellent, and the mortality
among them, excluding that due to beriberi, was very small.
100. Clearly, therefore, the insanitary conditions to which outbreaks of beri
beri are often attributed did not exist in the asylum.
101. The asylum premises, formerly demarcated by a bamboo hedge, were
during the year surrounded by a brick wall 7 feet high, and much of the newly
enclosed land, used as a place of burial for excreta, which had until then lain
fallow, was brought under cultivation. Disturbances of the asylum soil to the ex-
tent equivalent to the demands made by these works, therefore, took place. Al-
though excavations of the soil are sometimes known to produce malarial diseases,
it is not established that such excavations have at any time exercised the least
influence in determining an outbreak of beriberi.
102. Looking at the etiological data furnished in the foregoing remarks,
the conclusion arrived at is that the outbreak of beriberi which prevailed in the
asylum during the year of report was the consequence of the prevalence in an
acute form of a widely distributed epidemic of beriberi affecting the population of
the district in which the asylum stands.
103. Treatment.—Aware of the importance attached to change of climate
as a remedial measure in the treatment of beriberi, 70 of the lunatics attacked
were transferred to other districts, 66 being sent to Moulmein and 4 to Toungoo.
But on this occasion the results obtained by the removal of the patients from the
locality wherein they acquired the disease were disappointing, and it cannot be
said that the lunatics sent to Moulmein derived any benefit from the adoption of
this measure. The four lunatics sent to Toungoo certainly improved during the
few weeks they were absent from Rangoon, but some of the cases detained and
treated in the asylum also underwent quite 'as much improvement in the same
space of time.
104. The firmly held belief that recovery from beriberi always ensued on
removal to a non-beriberic area was further shaken by the death from beriberi at
Pakôkku, in Upper Burma, of a Burmese woman sent there in November from the
Rangoon Hospital. The case attracted some attention. The patient was young
and active, and although she had general œdema from head to foot, the strongest
hopes of her ultimate recovery were entertained.
105. Treatment.—There is but little to be said on the drug treatment of
this disease. Active purgation with sulphate of magnesia, followed by the admin-
istration of iron, was the method of treatment that found most favour, but it is
questionable whether iron is of any service except in cases associated with
anæ ia. Two of the lunatics were bled from the arm for the relief of urgent
dyspnœa; one obtained marked benefit from the operation and lived, but the
other died,