710 
excluded it as far as possible from these notes. When the day of complete 
knowledge of the nature of beriberi shall arrive, it must assuredly happen that 
many of the hitherto published records will disappear, from their failure to 
mention the circumstances which attend the real cause. 
The present writer, after having investigated a number of cases of 
beriberi both from a clinical and pathological standpoint, occurring in 
Manila between February, 1904, and August, 1905, was directed during 
the latter month to proceed to Japan for the purpose of studying the 
large amount of kakke material which had accumulated in the military 
hospitals of Hiroshima and Tokyo during the late Russo-Japanese war. 
A brief preliminary report concerning these studies has already been 
published in this journal.’ In the discussion which follows it is the 
intention to present to the practitioner who may be called upon to 
diagnosticate and to treat cases of beriberi, a systematic general outline 
of the affection, and at the same time there has been included an account 
of the investigations which have been carried on with the view of finding 
the specific micro-organism which causes this disease and of confirming 
or denying the recent claim of Okata and Kokubo concerning the dis- 
covery of the causative factor of the malady. A detailed summary of the 
first Japanese publication on the Okata-Kokubo kakke coccus was given in 
my preliminary report. These Japanese army surgeons have published a 
number of further contributions since this publication appeared and have 
reaffirmed their statements as to the specific nature of their coccus. How- 
ever, we can not confirm their claims, since we find that this organism 
certainly is not the etiological factor in beriberi. In fact, none of the 
bacteria and other micro-organisms from time to time proposed as being 
the cause of this mysterious disease can be considered to be specific. I 
have not, for obvious reasons, given a lengthy review of the literature 
of beriberi. The greater part of it to-day is merely of historical interest. 
DEFINITION. 
Beriberi—Polyneurilis endemica (Baelz), Neuritis multiplex endemica 
(Scheube)—may be defined as an acute, subacute, or chronic infectious 
disease, characterized clinically by disturbances of the circulation, of 
motion and of sensation, and associated anatomically with hypertrophy 
and degeneration of the heart, of the peripheral nerves, and of the 
voluntary muscles.‘ 
® Herzog: Beriberi in the Japanese Army During the Late War. Phil. Journ. 
Science, February (1906), 1, 169. 
*A complete discussion of the nomenclature is given in Scheube’s Die Krank- 
heiten der warmen Liinder’ (1903), Jena, and Die Beriberi-Krankheit (1894), 
Jena. These two publications of Scheube include a summary of the literature of 
beriberi up to 1903, comprising about 700 books, monographs, and other articles. 
