is good, provided the exciting cause can be removed. The only cases which form an exception to the rule are those whose constitutions are much impaired by excesses or other diseases; those who have so far indulged in alcohol, or are so completely soaked with arsenic or lead as to be unable to throw off the poison; and those in whom the disease begins with great suddenness, advances rapidly, and involves the phrenic and pneumogastric nerves. These cases die either of respiratory paralysis or of some complication. When a case has reached the stationary period, the prognosis is generally favorable, and if the encouraging signs of recovery already mentioned begin to appear, a cure may be promised. The possibility of the complication of myelitis must not, however, be overlooked, and if it occurs the prognosis becomes at at once unfavorable."

Treatment. In the early stages of multiple neuritis, salicin, salicylic acid, sodium salicylate, salol, or oil of gaultheria, may be given combined with bromides; morphia or other anodynes may also be necessary. Either hot or cold applications, or both alternately, may be found of great advantage. Syphilitic cases should be treated with mercury and iodides; malarial cases with quinine and arsenic; lead cases with potassium iodide or ammonium chloride, etc. Alcohol should be strictly prohibited. In the chronic stage strychnia and other tonics may be employed, with warm baths and douches, massage, passive, duplicated, active, systematized active movements, and electricity. The galvanic current is to be preferred for regenerating the diseased nerves; but faradism may also be used, especially after some improvement has occurred.

Semmola" reports a case of rheumatic neuritis or myositis, in which the use of pilocarpine was followed by an almost immediate cure, by its diaphoretic effect. The patient was a woman who had exposed herself, while overheated, to the draught from an open window. Violent pain and stiffness came on in the arm and shoulder. Passive movement was not impaired. Salicylic acid, electricity, massage and quinine had failed to give relief. Semmola gave two injections daily of centigram of muriate of pilocarpine. After the second injection great improvement occurred and in four days the patient was cured. This remedy might prove of value in some cases of multiple neuritis.

BERI-BERI.

33

Starr supplies some highly interesting details concerning beriberi, but the most exhaustive contribution on the subject is by Dr. Karl Weintraub,30 Sanitary Chief of the Netherland East Indian Army. Like the lectures of Starr on the general subject of multiple neuritis, this series of papers leaves little to be learned from other sources, and to it we have resorted for much of the material of the present paper. During 1887, the French Government sent out Prof. Pekelharing to their East Indian possessions, to investigate the nature and character of the disease under consideration. Cornelissen and Sugenaya have also contributed a Van den Driessche scientific report from the Dutch Indies. addressed a communication on beri-beri to the King of the Belgians, on which M. Barella presented a report, reviewing the entire subject, to the Belgian Royal Academy of Medicine. K. Takaki, Surgeon-General of the Japanese Navy, and Prof. Baelz, of the Imperial Japanese University of Tokio, the latter one of the corresponding editors of the ANNUAL, have added facts and advanced views of great interest. From another of the corresponding editors of the ANNUAL, Mr. Henry Strachan, of Kingston, Jamaica, we have received a valuable original article on Malarial Multiple Peripheral Neuritis, a summary of which will be given later.

35

36

34

From Seguin, of New York, the year has afforded some excellent notes on three cases of beri-beri, and some analogous indigenous cases of multiple neuritis; from Vineberg, some clinical observations of an endemic of beri-beri among the Chinese coolies at the Sandwich Islands; from Marie" an account of the paralysis of the Isthmus of Panama, a form of beri-beri; from Roosevelt, two papers on cases observed in New York; from Shattuck, Stevens," Pomroy," reports of interesting cases; from Slater and Oliver, notes of an outbreak of beri-beri on the Chinese transport ship, "Too Nan," stationed at Newcastleupon-Tyne.

39

38

42

In the U. S. Marine Hospital Report for 1881 (referred to by Starr) is an interesting account by Dr. Hebersmith of the development of beri-beri in a Brazilian naval vessel, and in connection with the Report is given a map which we reproduce. It demonstrates the localities in which beri-beri is endemic.

The derivation of the word beri-beri, according to Weintraub, is doubtful, and is given in several ways. Bontius knew the affection by this name in the 17th century. It is variously claimed to relate to the gait, i.e., the Arabic word biri signifying "sheep," because of the way the animal walks, or from biribi, of the Malay-Japanese dialect, meaning "stiff gait." The disease has different names in the various parts of the Indian Archipelago. Van den Driessche, quoted by M. Barella, says the words demi, "half," and ri, "rice," indicate the fruit of the rice before it has attained maturity and that in writing the word "demi-riz," the medical service of the Netherland-Indies wrote the word “beri,” and thence came the double word "beri-beri." According to Herklots, the word comes from the Hindostanee, bharbari, signifying "œdema" or "swelling." Carter says it is a corruption of two Arabian words, buhr, signifying "oppression" or "asthma," and bahri, rignifying "marine;" thus we have "buhr-bahri." Marshall says bhayree signifies in Ceylon "weakness," and the redoubling of bhayree (beri-beri) expresses a degree of extreme feebleness. By the Japanese the disease is called kakke, from two Chinese words,-kiaku, "legs," and ke, "disease." It has been known among the Chinese by this name for centuries.

Attention is called by the Lancet for August, 1887, to the fact that writers seem to have overlooked the very interesting observations of de Lacerda, of Rio Janeiro, who, in 1885, published a pamphlet, in Portuguese, entitled, Hip Epidemic, or Marajo Epizootia; its Analogies with Beri-Beri, in which he gives an account of the fatal disease affecting horses and swine in the Island of Marajo. This affection appeared to be due to a polymorpheous microphyte belonging to the ascomycetes, which abounded in the water of Lake Arary on the Island. This microphyte was found to produce the disease in a number of animals,— rabbits, pigs, birds, monkeys, etc., inoculated with it. The symptoms and the lesions found in the spinal cord after death, corresponded very closely, in de Lacerda's opinion, with those of beri-beri, and he came to the conclusion that the Marajo epizootic was identical with that disease. If so, his researches throw considerable light on its etiology, and are certainly well worth the study of those interested in the subject.

Dr. H. H. McCandliss, Corresponding Editor of the ANNUAL,