notes from india

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entertained the Americans on the evening of July 26th atthe garden restaurant in the Exhibition Park. Speeches weredelivered by Professor Waldeyer, by Dr. Moll, and by someof the American visitors.

The Etiology of Beri-beri.In a paper on beri-beri read at a recent meeting of the

Berlin Medical Society, Dr. Moszkowski said that the hypo-thesis that beri-beri was due to an infection was no longertenable, the prevalent opinion being that the disease wascaused by a defect in the patient’s food, especially an in-sufficient supply of phosphoric acid in organic compounds.He had found that peeled rice had a toxic action and thatthe pellicle of the grains of rice contained the antitoxin.He accordingly tried to produce beri-beri in himself byeating peeled rice in great quantities. Soon after the

beginning of the experiment he suffered from constipation,headache, loss of appetite, and heartburn. Giddiness,paresthesia, nervous pains, abnormal softness of the pulse, asoporous state, slight cedema, and finally effusion into thesheaths of the tendons followed. The heart showed dilata-tion of both sides, a cardiac murmur at the apex, and anincrease of the second sound over the pulmonary artery.The dilatation increased, and finally symptoms attributableto the vagus nerve were produced. The sensible symptomswere also characteristic for beri-beri, including formication,Lasegue’s symptom, increase of the reflexes. The motornerves were less damaged. The aspect of the disease mightbe compared with sensible neuritis. When rice bran wasadded to the food all the symptoms promptly disappeared.An investigation of the metabolism proved that thealbuminous substances had undergone extensive destructionwhich could be caused only by toxic influence. When pigeonswere fed on eggs and peeled rice they also contracted beri-beri. Professor Caspari, of the Zuntz Laboratory, who hadmade the experiments on metabolism, said that the destruc-tion of the albuminous substances could not be produced byunder-feeding, but only by the action of a toxin. He men-tioned that dogs might fast for six weeks without showingsuch symptoms, but that they became ill within three weeksafter they had been fed on peeled rice. Beri-beri was inclose connexion with scurvv. Different kinds of meal when

deprived of bran produced polyneuritis. Epidemics of beri-beri have been observed in Labrador as a result of the useof bread made with flour from which the bran had beenremoved.August 16th. _______________

NOTES FROM INDIA.

(FROM OUR OWN CORRESPONDENTS.)

The Health Officer of the New Capital.A DISPATCH has recently been received from the Secretary

of State sanctioning the conditions of the appointment ofthe health officer of the Delhi Municipality. He will be anofficer of the Indian Medical Service employed in the sani-tary department, and the tenure of the appointment will befor five years. It is understood that the post will be anaddition to the cadre of the Indian Medical Service.

Sanitation in the Punjab.The Punjab Sanitary Conference will be held at Simla

from August 24th to 30th, under the presidency of theFinancial Commissioner, the Hon. M. W. Fenton. Allfive Commissioners of divisions and a number of electedDeputy Commissioners will be among those attending. An

interesting report on sanitation in the Punjab for 1912 showsthat the death-rate for 1912 was only 26’63, in spite of asevere small-pox epidemic, against 42’7 for the previousquinquennium. In the Punjab there are only three towns,of the size of Cork or Dublin, where the death-rates were28-54, 38 - 33, and 26 - 23 respectively. The conclusion fromthe comparisons to rates in Europe is that the Punjabin a favourable year is healthier than several Europeancountries, though it has still much way to make up to reachthe level of the more advanced states. It is the seasonal

epidemic which disturbs the death-rate. There is a growingdesire in India for sanitation.

The St. John Ambulance Brigade.The Viceroy and Lady Hardinge were recently "at home

"

at Viceregal Lodge to the Simla Nursing and Ambulance

Divisions of the St. John Ambulance Brigade. During theafternoon His Excellency presented the Gwalior ambulancechallenge shield for Regular Troops to a deputation fromthe 14th Hussars, and the Dewas ambulance challengeshield to a deputation from the Kashmir Imperial ServiceInfantry. In presenting the shields to the winners His

Excellency expressed his deep interest in ambulance work inIndia and congratulated the deputations on the efficiencyindicated by their success in the All-India competitions.The excellent services of the Simla nursing division in Delhiduring the outrage are still fresh in the public memory.

Sanitation in Bengal.The Government resolution on sanitation in Bengal for

1912 shows that the death-rate had incieased chiefly fromfever and cholera, and the Governor in Council reasonablyasks how far, if a all, this increase is due to unusual varia-tion in rainfall, which is not discussed in the SanitaryCommissioner’s report. The birth-rate shows an increasewhich would have been greater, it is considered, if the priceof foodstuffs had not been so high. The birth-rate is35-3 per 1000, with a death-rate of 29-77, which, for thePresidency, is considered favourable in comparison to otherprovinces. There was a very heavy infantile death-rate, andin this respect Calcutta has been surpassed by the districts ofJalpaiguri and Dinajpore, where the rates. were as high as28’69 and 26’26 respectively. Plague was chiefly confinedto the area of Calcutta and its suburbs. Cholera was pre-valent in every district except Darjeeling. There was alsoan increase in the small-pox mortality compared withthat of 1911. In spite of the extra distribution of

quinine by sub-assistant surgeons and other antimalariameasures, there was an increase in the malaria returns.It is stated in the report that clearance of jungle andtanks and the destruction of mosquitoes have not provedsuccessful, and a more extended use of quinine is putforward, on present knowledge, as the only method bywhich it is possible to reduce the rate of mortalityand the risk of infection. I regret to see so sweepinga statement with no inquiry into the causes of failure. Itwould point to some mal-administration in the method ofquinine distribution, jungle cutting, tank treatment, andother methods of mosquito destruction. Such methods, ifcorrectly applied and supervised, should have resulted in alowered death-rate, and there seems a necessity for an

inquiry into the methods of carrying out these antimalariameasures. The matter is of far too much importance to bethrown aside by so sweeping a statement when the chancesof mal-administration are so great.July 31st.

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AUSTRALIA.

(FROM OUR OWN CORRESPONDENT.)

King’s Birthday Honours.THE members of the medical profession throughout

Australia are much gratified at the inclusion of Sir A.MacCormick, M.D., of Sydney, in the list of new knights inhonour of the King’s birthday. Sir A. MacCormick, who isa graduate of the University of Edinburgh, came to Sydney asan assistant to Professor Anderson Stuart. He devoted hisattention to surgery, and after a few years at the Universityof Sydney decided to begin practice. He soon acquired areputation as a singularly gifted operator, and took a leadingposition, not only in his own city, but among Australiansurgeons generally. For many years he has been surgeonto the Sydney Hospital and lecturer on surgery in the

University. Sir A. MacCormick has never evinced any desireto take part in public questions, and has not contributedlargely to literature, but his work is recognised inside theprofession as exceptionally good, and satisfaction is ex-

pressed that his distinction is conferred purely as a tribute ’

to professional merit.

Small-pox in Sydney.For some weeks past cases of an eruption which has been

diagnosed as chicken-pox have been occurring in Sydney. Anumber of such cases having occurred in a large clothingfactory the proprietors asked the public health officials toinquire into the matter. One patient was in consequencesent to the Coast Hospital for observation, and as a result