713 
than any other in the vicinity. The conclusion certainly appears justified that 
the number of victims in the capital and the surrounding provinces reached 
several thousand.” 
Koniger attributes the great mortality which he noticed in this 
epidemic of beriberi to the distress existing among the natives and to 
their very poor state of nutrition. Almost all of the cases were seen 
among the poorer classes, the author observing only two among Kuro- 
peans, who, however, were also living under very unfavorable conditions. 
Among the Chinese the number was small as compared with that among 
the natives. 
ETIOLOGY. 
It is astonishing and at the same time embarrassing that the etiology 
of beriberi, a disease so widespread and one which has been the subject of 
such extensive investigations, is still but little understood, not merely as 
to its specific cause but also as to other concomitant factors favoring 
its appearance and spread. Manson,® in a recent article on this subject, 
expresses his views as follows: 
“It is a somewhat humiliating fact that although beriberi is a disease of first- 
class importance in the Tropics, although it exhibits peculiarities in its epidem- 
iology so striking that they seem to suggest that surely the cause can not be 
hard to find, and that although not a few investigators, medical and lay, have 
diligently set themselves to find this cause, they are about as ignorant of its 
true nature and of the medium in which it is applied and of the other etiologic 
circumstances as was Bontius when he wrote about beriberi over two hundred and 
fifty years ago. Quite recently there may have been some advances, but even these 
recent advances are more in the direction of showing what beriberi is not, rather 
than in the direction of showing what it is.” 
Scheube, to whom, as well as to Baelz, we owe so much of our knowledge con- 
cerning beriberi, believes that beriberi is art infectious disease and not a disturb- 
ance of the functions of nutrition caused by rice, fish, or insufficient nutrition. He 
points out that frequently strong, well-nourished young people suffer from 
beriberi, that the disease occurs independently of nutrition and other conditions of 
environment in certain well-defined districts, and that it is particularly prevalent 
at the seashore and along the banks of large rivers. He believes that the disease 
is not contagious, but that it may be and is earried along the lines of traflie by 
railroads and by vessels. He calls attention to the fact of the frequency of beriberi 
in places where human beings are crowded together, such as in prisons, schools, 
and factories. He also states that observations have been made in Japan showing 
clearly that the importation of a few cases of beriberi into a heretofore non- 
infected district has been followed by larger outbreaks of the disease, a fact 
which also has been reported by Robert Koch with reference to the introduction 
of the disease into New Guinea by some laborers coming from a distance. Scheube 
believes that beriberi is due to a micro-organism, either of a vegetable or of an 
animal nature, forming a toxin which acts upon the nervous system. He empha- 
sizes the fact that beriberi shows a predilection for certain races, being very 
common among the Japanese, Chinese, and Malays and rare among the Europeans 
8 Manson: The Phophylaxis and Treatment of Beriberi. Brit. Med. Journ. 
(1902), 2, 830. 
