REPORT ON THE RANGOON LUNATIC ASYLUM FOR THE YEAR 1894.
17
beri without more or less œdema in the early stage of the disease are, it is
believed, practically unknown in Rangoon.
88. Many of the asylum patients had, apart from slight œdema, no other
physical sign of beriberi; others none but marked œdema and loss of knee-
jerk. But in serious cases symptoms of embarrassment of the respiratory and
circulatory organs predominated, and præcordial distress, extreme restlessless,
shortness of breath, and palpitation were prominently marked.
Disorders' of sensation did not admit of investigation, and muscular par-
alysis, a symptom generally of late development, was not observed.
89. Causes of the outbreak.—That beriberi is a disease sui generis, and is
not causally related to either anæmia or helminthiasis, have now become well-
established beliefs.
It will serve no useful purpose to set forth the various views held on the
nature of the materies morbi of beriberi; it is perhaps sufficient to state that
the most conflicting ideas prevail on the subject. What is of far closer concern
is a consideration of the conditions under which the disease is developed and
becomes epidemic. That beriberi is endemic in Rangoon there can be no
question.
90. It may be safely asserted that the wards of the Civil General Hos-
pital are never altogether free from cases of beriberi. In the tabular state-
ment of diseases submitted from that institution no column exists for beriberi,
and cases of the malady coming under treatment are returned amongst " All
other general diseases." Of the patients admitted with general dropsy and beri-
beri taken collectively, it would be no exaggeration to say that at least three-
fourths are suffering from beriberi; of those admitted during the past few months
the proportion is even greater.
91. During the last three years the aggregate number of patients treated
for general dropsy and beriberi in the Civil General Hospital was, in the suc-
cessive years, 52, 62 and 96 respectively. These figures show not only that
beriberi is a constant and common disease in Rangoon, but also that it obtained,
during the last of the three years, which is the year of report, greater prevalence
than usual; and if the monthly statements are examined separately, it will be
seen that this increased prevalence was entirely confined to the last three months
of the year; and, further, that the month in which the largest number of ad-
missions took place was the very month in which the epidemic in the asylum
was at its height.
92. Seeing that the patients admitted to the General Hospital are drawn
from all classes of the population and came from all directions, it would be
hard to find stronger evidence that, coincident with the outbreak of beriberi in
the asylum, there was a general epidemic prevalence of the disease in Rangoon.
93. Furthermore, it seems probable that this epidemic prevalence was not
confined to Rangoon, for not only were two lunatics suffering from beriberi sent
into the asylum in November from the Amherst district, one of whom died
shortly after his reception, but early in December an outbreak of the disease
occurred on board a British India steamer trading between Calcutta and Penang.
Of the 22 engine-room hands employed on board the vessel, 2 died and 11
others were found on inspection to be suffering from more or less œdema. The
Agent of the steamer removed the 20 survivors out of the ship and sent them, as
passengers, away to Bombay.
94. It would be interesting to learn whether, in other hospitals in the prov-
ince, any corresponding increase occurred in the number of admissions from
general dropsy simultaneously with the increase observed in Rangoon.
95. Beriberi is not unknown among the lunatics, but cases of the disease
have been very seldom seen. Although the asylum has existed for 23 years, no
outbreak of beriberi has, until the year of report, taken place within its walls.
The epidemic declared itself without warning shortly after the close of the south-
west monsoon, resembling in this respect outbreaks which have occurred else-
where.
96. Beriberi, as already stated, is a specific malady, and like other diseases
of its class, cannot exist in the absence of its particular virus. But the presence
5