BERGERAC- -B E R I - B E R I Qg irgQ 1T3LCj chief town of arrondissement, department it have not hitherto been successful. It is “ not obviously of Dordogne, France, 19 miles S.S.W. of Perigueux, at the communicable from person to person ” (Manson), but may intersection of the railways from Libourne to Buisson, and be carried from place to place. It clings to particular Angouleme to Marmands. Extensive trade is maintained localities, buildings, and ships, in which it has a great jj ^ gram, and chestnnts, considerable (Quantities of tendency to occur; for instance, it is apt to break out the last being sent to England. There are fine nurseries, again and again on certain vessels trading to the East. It and an important salmon fishery at the Salvette reservoir. haunts low-lyjng districts along the coast, and the banks of Population (1881), 10,022; (1896), 10,697; comm. rivers. Moisture and high temperature are required to develop its activity, which is further favoured by bad 13,594; (1900), 15,982. ventilation, overcrowding, and underfeeding. . Some Berhampore, the name of two towns in British writers have suggested that it is allied to malaria, but India, in Bengal and Madras. (1) The headquarters of it has not the same geographical distribution, and the Murshidabad district, in Bengal, is situated on the left bank symptoms are entirely different. The absence of fever of the river Bhagirathi, 5 miles below Murshidabad city. seems to exclude the theory of a micro-parasite. Another Population, about 25,500. Berhampore was fixed upon hypothesis is that it is caused by unwholesome diet. The after the battle of Plassey as the site of the chief military experience of the Japanese navy points strongly in this station for Bengal; and a huge square of brick barracks direction. Beri-beri was constantly prevalent among the was erected in 1767, at a cost of £300,000. Here was sailors until 1884, when the dietary was changed. A committed the first overt act of the mutiny, on 25th striking and progressive diminution at once set in, and February 1857. No troops are now stationed here, continued until the disease wholly disappeared. Major and the barracks have been utilized for a jail, a lunatic Konald Boss has suggested that beri-beri is really arsenical asylum, and other civil buildings. The old cemetery con- poisoning. Many facts about it support the idea that it is tains many interesting tombs, including those of Warren some form of chronic poisoning, but at present there is Hastings’ first wife, the Irish adventurer George Thomas, nothing pointing to arsenic. One would rather expect it and the hero of Mrs Sherwood’s tale, Little Henry and to be some fungoid growth affecting grain, such as rice or his Bearer. A college, founded by Government in 1853, maize, or some other food-stuff commonly used in the was made over in 1888 to a local committee, being mainly localities where beri-beri is prevalent, and among sailors. supported by the munificence of the late Kani Svarnamayi. The conditions under which their food is kept on board (2) The headquarters of Ganjam district, in Madras, is certain ships might explain the tendency of the disease to situated in 19° IS7 N. lat. and 84 48 E. long., about haunt particular vessels. 9 miles from the sea-coast. It is a station on the East The most susceptible age is from 15 to 40. Children Coast railway, which connects Calcutta with Madras. under 15 and persons over 50 or 60 are rarely attacked. Population, about 25,500. Berhampore has a military can- Men are more liable than women. Bace has no influence. tonment, containing a wing of a native regiment^ sometimes Previous attacks powerfully predispose. distinguished as Baupur. There is some weaving of silk The symptoms are mainly those of peripheral neuritis cloth, and export trade in sugar. There are two churches with special implication of the phrenic and pneumo-gastric and four printing-presses. The college, originally founded nerves. There is usually a premonitory stage, in which by Government, is now maintained by the Baja of Kallikota. the patient is languid, easily tired, depressed, and comBeri-beri.—Beri-beri is described as a specific form plains of numbness, stiffness, and cramps in the legs; the of multiple peripheral neuritis, endemic in certain latitudes, ankles are cedematous and the face is puffy. After this, and liable to epidemic diffusion. (For peripheral neuritis, pronounced symptoms set in rapidly, the patient suddenly see Pathology, Neuropathologyi) According to Dr Man- loses power in the legs and is hardly able to walk or stand ; son, it is a disease of the greatest antiquity, and known this paresis is accompanied by partial anaesthesia, and by to the Chinese from an extremely remote period. At one burning or tingling sensations in the feet, legs, and arms; time its importance as a tropical disease was generally the finger-tips are numb, the calf muscles tender. These recognized, but it gradually dropped out of sight and was symptoms increase; the oedema becomes general, the forgotten, until an epidemic in Brazil in 1863, and the paralysis more marked; breathlessness and palpitation opening up of Japan, where it prevails extensively under come on in paroxysms; the urine is greatly diminished. another name, brought it again into notice. The recog- There is no fever, unless it is of an incidental character, nition of its character as essentially a form of peripheral and no brain symptoms arise. The patient may remain neuritis is quite recent, and due to the researches of in this condition for several days or weeks, when the Scheube and Baly in Japan, and of Pekelharing and Wink- symptoms begin to subside. On the disappearance of the ler in the Dutch Indies. The geographical distribution of oedema the muscles of the leg are found to be atrophied. beri-beri is between 45° N. and 35° S. It occurs in Japan, Becovery is very slow, but appears to be certain when once Korea, and on the Chinese coast south of Shanghai; in begun. When death occurs it is usually from syncope Manila, Tongking, Cochin China, Burma, Singapore, through over-distension of the heart. The mortality varies Malacca, Java, and the neighbouring islands; also in greatly, from 2 to 50 per cent, of the cases. The disease is Ceylon, Mauritius, Madagascar, and the east coast of said to be extremely fatal among the Malays. After Africa. In the Western hemisphere it is found in Cuba, death there is found to be serous infiltration into all the Panama, Venezuela, and South America. This distribution tissues, and often haemorrhages into the muscles and is curious and unintelligible as it stands. Probably further nerves, but the most important lesion is degeneration of investigation will show that the disease is much more widely the peripheral nerves. The cerebro-spinal centres are not distributed. It has been carried in ships to Australia and affected, and the degeneration of the nerve-fibres is more to England. Dr Manson has “ known it originate in the marked the farther they are from the point of origin. The port of London in the crews of ships which had been in implication of the phrenic and pneumo-gastric nerves, and harbour for several months,” and he suggests^ that when of the cardiac plexus, accounts for the breathlessness, palperipheral neuritis occurs in epidemic form it is probably pitation, and heart failure ; that of the vaso-motor system for the oedema and diminution of urine, and that of the beri-beric. The cause is believed by many authorities to be an in- spinal nerves for the loss of power, the impairment and fective agent of a parasitic nature, but attempts to identify perversion of sensation. According as these nerves are 222
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