SPEC. IV. Raphania. Raphania. GEN. III. pain in the head, and anxiety about the præcordia. These symptoms are followed by spasmodic twitchings and afterwards rigid contractions of the limbs or joints, with excruciating pains, often accompanied with fever, coma or delirium, sense of suffocation, and a difficulty of articulating distinctly. It continues from eleven days to three or four weeks; and those who die generally sink under a diarrhoea or a paroxysm of convulsions. Close. Remedial treatment. The warm antispasmodics, as valerian, castor, and camphor, appear to have been employed with decisive success. An emetic, however, given at the onset of the symptoms, as recommended by Henman, would probably cut short the course of the disease, and mitigate its violence. This writer advises also blistering or bathing with Dippell's Animal Oil*. Camphorated vinegar, as employed by other practitioners, would probably be found a more useful embrocation†. Towards the close of the disease purple exanthems or vesications are said to be sometimes thrown out, which approximate it to mildew-mortification, and the erythematic pestis, both which, as we have already observed, have been traced to a similar cause. SPECIES V. SYNCLONUS BERIBERIA. Beribery. Barbiers. SPASMODIC RIGIDITY OF THE LOWER LIMBS IMPEDING GEN. III. BONTIUS seems first to have introduced the term BERI- generic name. • Abhandl. von der Kriebelkrankheit, GEN. III. SPEC. V. Synclonus us it is of oriental origin*: and Sauvages has hence copied it into his list of "nomina barbara, seu nec Græca, nec Latina." Mangetus affirms that the disease was Beriberia. known to Erasistratus, but certainly not under this name. Barbiers. Beribery. Eustathius, however, has Bépcept, but in the sense of How reconcha or ostreum", "conch or shell",-and tells us that garded by it is a term of Indian origin. He might have said, with Sauvages. more propriety, of oriental origin, for it is common both Said to have been known to the or Greeks, but ברבר (ברא or בר in its primary and duplicate form a not under this name, as they used the word in sense. Term cleartal origin: a different ly of orien and com mon to most oriental tongues. Probably French to the Hebrew, Chaldee, Syriac, and Arabic, in which last it is (berabir), and in all of them is nomadic term, importing tillage and its production which is grain, or pasturage, and its production which is sheep, or other cattle; and hence, probably the origin of brebis or sheep in the French tongue. The term is said to be applied to this disease in India from the patient's exhibiting, in walking, the weak and tottering step of a sheep that has been over-driven. This disease, though common to various parts of India, the etymon is chiefly met with on the Malabar coast and in Ceylon: of the and seems to be produced by sudden transitions of the at- brebis. mosphere from dry to damp, and from sultry calms to Disease chilling breezes, by which the nervous and absorbent chiefly systems are peculiarly debilitated and torpified. In this Malabar region it attacks both natives and strangers, but particularly the latter during the rainy season, which commences in November and terminates in March; through a great part of which, also, the land-winds blow from the neighbouring mountains every morning about sun-rise with great coolness; and hence those who sleep abroad, or without sufficient shelter, are equally exposed to the influence of a penetrating chill and damp. found on the coast and in Ceylon. Causes. Fresh troops, partly from their being new to the cli- Fresh troops principally mate, but chiefly from their want of a sufficient degree of affected. caution, very frequently suffer severely from this com- Exemplified. plaint so long as the rainy season continues. Thus we SPEC. V. Synclonus Predispo nents. GEN. II. learn from Mr. Christie that the 72nd regiment was severely attacked with it in the autumn of 1797, not many months after its arrival, and continued to suffer from it till the ensuing spring; and that the 80th regiment, which relieved the 72nd in March 1797, was equally attacked with it in the ensuing November. It is, however, in all such cases most frequently to be found amongst those who have previously weakened their constitutions by sedentary habits or a life of debauchery: and particularly where too free an indulgence in spirits has co-operated with sedentary habits, as among the tailors and shoemakers of a battalion; who, in order to give them time to work at their respective trades, are often excused from the duties of the field, and by their double earnings, are enabled to procure a larger quantity of spirits than other men. And we may hence in some degree account for Mr. Christie's remark that, during his stay at Ceylon, he never met with an instance of this complaint in a woman, an officer, or a boy under twenty. History and progress of the disease. The disease commences with a lassitude and painful numbness of the whole body, the pain sometimes resembling that of formication, The legs and thighs become stiff, the knees are spasmodically retracted, so that the legs are straightened with great difficulty and instantly relapse into the retracted state, whence the patient is apt to fall if he attempt to walk. In some cases, indeed, the motory and sensific power, instead of flowing through the muscles of loco-motion irregularly, does not flow at all, and the limbs become paralytic. And even where the spasmodic action exists, it often travels or extends to other parts of the body, and particularly to the chest and the larynx, so that speaking and respiration are conducted with great difficulty. At the same time the whole of the absorbent system exhibits equal proofs of torpitude, the legs first, and afterwards the entire surface of the body becomes bloated and edematous, and all the cavities, particularly those of the chest, are progressively loaded with fluid: and hence towards the close of the disease, where it terminates fatally, SPEC. V. the dyspnoea is extreme, and accompanied with an intolerable restlessness and anxiety, and constant vomiting; the Synclonus muscles are convulsed generally; while the pulse gradu- Beriberia. ally sinks, the countenance becomes livid, and the extre- Barbiers. mities cold. Beribery, severe and Such is the course of the disease as it shows itself at Sometimes peculiarly Ceylon, where it seems to rage more severely than on the Malabar coast, and where we are told by Mr. Christie, rapid. inspector-general of the hospitals at this station, whose account is confirmed by Mr. Colhoun*, that its progress is so rapid that the patient is often carried off in six, twelve, twenty-four, or thirty-six hours from its onset, though it ordinarily runs on for several weeks. communica tions from the Army Medical the pre Since the first edition of the present work, various im- Original portant communications have been made to the Army Medical Board upon the subject before us. These, by the kindness of my eminent friend the Director-General, I Board, have been enabled to examine, and they concur in sup- confirming porting the general character of the disorder as given ceding acabove; as they do also in affirming that neither women, count. officers, nor persons under twenty years of age become the subjects of beribery; evidently because such individuals are rarely called upon to expose themselves at night, or to sleep in the open air. sometimes cation of especially of From the complicated nature of the disease, however, Beribery and the variety of organs that are linked in the general suspected to chain of morbid action, suggestions have often occurred, be a modifiwhether beribery be not rather a modification of some some other other malady than an idiopathic affection; and especially disease, whether it be not a peculiar form of anasarca deflected from its common course by accidental circumstances. The last is more especially the opinion of Mr. Collier, a staff- Collier's surgeon of considerable talents and authority; and to the opinion. same opinion I find Dr. Dwyer inclining, physician to the Dwyer's. forces at Kandy in Ceylon. Yet, after having, in his Essay on the Diseases incident to Indian Seamen or Lascars on long Voyages; by W. Hunter, A.M. &c. Lord Valentia's Travels. Vol. 1. p. 318, anasarca. GEN. III. SPEC. V. Synclonus Farrell's. manuscript report, which is a very valuable document, called it incidentally by the name of acute anasarca, hè tells us that from the great diversity of its symptoms, many cases have been referred to apoplexy, carditis, aneurism, gastritis, which were purely examples of beribery. And he then proceeds as follows: "although allied in many of the symptoms to dropsical affections IT IS TO BE CONSIDERED DISTINCT BOTH IN SYMPTOMS AND TREAT MENT. And to the same effect, a very able inspector of hospitals in the same quarter, Dr. Farrell, who observes as follows: "I cannot help thinking still, notwithstanding the weight of his (Mr. Collier's) authority, that the affection commonly called beri-beri is a disease of exhaustion and debility, occurring chiefly in persons of intemperate habits, and labouring under other maladies." In effect it is not only a disease of exhaustion and debility, but of these properties peculiarly applied to the nervous system; the dropsical and apoplectic symptoms only taking place secondarily, and as a result of the general weakness. "The more prominent symptoms", observes Description Dr. Dwyer, in the manuscript report just alluded to, were numbness of the extremities, muscular power greatly impaired, walking attended with a considerable degree of unsteadiness, pain, tottering and weakness of the joints; such instability of gait as resembles a person walking on his heels; sometimes paralysis. In the latter stages of the disease, when the thorax becomes affected, increased uneasiness of the epigastrium and vomiting succeed; dyspnoea and all the symptoms of hydrothorax." by Dwyer. Spasmodic action at times very extensive. Strikingly illustrated. At times the spasmodic action spreads, even from the first to other organs than the limbs, and produces a very striking effect. A sergeant of the 45th regiment, of sober habits, who seems to have nearly recovered from two previous attacks at Kandy about a year before, and had left the hospital, was suddenly seized, April 1, 1822, with "an extreme difficulty of breathing, inability to walk or speak much. The muscles of the forehead, face and nose were in motion at the exertion made to speak or breathe. The corrugations of the latter gave a sharpness |
