said was true, claiming the attention of com- 
petent persons to judge in the matter. 
In July 1916, appeared MIGUEL COU- 
TO’S masterly work “Lessons on Clinical 
Medicine” in two lessons of which the author 
analyses and criticizes the current doctrines. 
In the same year THEOPHILO DE AL- 
MEIDA published his thesis on Beriberi. 
This contains all the modern theories in 
vogue, and discusses the develcpment of 
beriberi in several provinces of Brazil. It de- 
serves to be better known as the ideas de- 
fended deserve to triumph. 
In his historic memoirs, presented in 
1917 to the Faculty of Medicine, AFRANIO 
PEIXOTO discusses, in clear and elegant Jan- 
guage all the different questions of patho- 
geny in the Amazonas province, and shows 
himself a partisan of the alimentation 
theory. In 1917, CLEMENTINO FRAGA pu- 
blished a synthetic study on “Beriberi or 
beriberi syndrome.” 
In this work, FRAGA analyses the epi- 
demics of beriberi in Bahia, from 1866 to 
1916. The beriberi epidemics in St. John’s 
Asylum, the Pentenciary, the Palm Barracks, 
the Hospital of St. Elizabeth are all careful- 
ly studied. For FRAGA, beriberi is endemic 
in Bahia, and in the places where there are 
many cases, it has become from time to time 
epidemic; for this reason he believes in the 
infectious etiology of the disease. For him 
beriberi is an illness and not a syndrome. 
In 1918 ARLINDO DE ASSIS’ thesis 
appeared in Bahia; it was written under the 
direction of CLEMENTINO FRAGA, and is 
quite a remarkable work, both because of 
the doctrine and the experiments and because 
it is probable {that after having seen those 
experiments Professor FRAGA should have 
modified his opinions. 
As I said before, there are very few me- 
dical men in Brazil who have studied this 
disease. On the other hand, since EIJKMAN’S 
discovery, a great many English, Japanese 
and Americans authours have published much 
valuable work on this subject. 
We must remember that in the East het 
101 —— 
idea of beriberi being caused by insufficient 
nourishment is not a new one. Even before 
there were any experiments mady, the prac- 
titioners had noticed this. In 1867 VAN 
LEENT said: “The principal cause of beri- 
beri is an uniform and insufficient diet of 
bad quality.” The organism being deprived 
of the indespensable elements for the for- 
mation of the blood, nutrition is impove- 
rished by degrees. WERNICH in 1878 de- 
clares: “Kaki is a constitutional chronic di- 
sease of blood formation and of the vascular 
system.” 
“The rice, exclusively used as food, is 
chiefly responsible for the disease, not becau- 
se it is of bad quality, (as one supposes) but 
because it is very satisfying so that the 
power of assimilating other food is reduced; 
and however good it may be, it is not su- 
fficient for alisnentation and blood forma- 
tion.” 
TAKAKI obtained’ brilliant results in the 
Japanese Navy. He was not however able 
to cope with the opposition with which he 
met, nor to introduce his proposed reforms 
in the Army. 
Everyone knows how great was the 
mortality amongst the Japanese army from be- 
riberi during the Russo-Japanese war (80.000) 
and how small the proportion amongst the 
marines. Round Port Arthur, there was not a 
single death amongst the marines of the Naval 
Brigade, whilst the soldiers were decimated, 
though both endured the same conditions of 
climate and temperature while feeding diffe- 
rently. TAKAKPS theory was true, but he 
erred in thinking that the defficiency was in 
nitrogen. For this reason his theories were 
not generally accepted by his countrymen. 
BRADDEN (1907) for many years sus- 
tained thetheory thatthe cause of the disease 
was not the rice as an article of diet, but that 
there was an alteration in it by germs or 
spores; these spores either existed in the 
husk and were mixed with the rice during 
the process of cleaning, or they developed 
after the shelling. 
In 1908—1909 FRAZER and STANTON 
