Diagnosis and Treatment of Beriberi 



CARL VOEGTLIN ' 



WASHINGTON 



Introduction. Beriberi is an acute or chronic, endemic or epidemic 

 disease most prevalent among the rice-eating population of Japan, Dutch 

 Indies, the Malay States, the Philippines and certain parts of China and 

 India. It has also been observed in Central and South America, Africa 

 and North America. In 1890 Putnam and Birch reported a number of 

 cases among New England fisherman. The first American epidemic was 

 reported by Bondurant (1895-96) from the State Insane Asylum at. Tusca- 

 loosa, Alabama. The disease was also recognized in 1895 at the Arkansas 

 State Insane Hospital and in 1907 at the Texas Lunatic Asylum. In 

 1912 Little reported an epidemic of beriberi among the inhabitants in 

 Labrador and Newfoundland who, during the winter season, had lived 

 largely on white bread. 



Beriberi is now generally considered as a disease due to the continued 

 consumption of food deficient in antineuritic vitamin (water-soluble B), 

 and therefore belongs to the group of deficiency diseases. The dietary 

 theory of the origin of the disease is supported by numerous epidemiolog- 

 ical observations which clearly show that the disease is apt to occur when 

 the diet is restricted to highly milled (white) rice, corn or patent flour, 

 whereas it does not appear if less highly milled cereal foods form the bulk 

 of the diet. In this connection, it may suffice here to refer to the important 

 experiments on the production and prevention of beriberi in man carried 

 out by Fraser and Stanton(a) (6) (1909), and Strong and Crowell (1912). 

 Eraser and Stanton found that under well-controlled sanitary conditions 

 20 cases of beriberi occurred among 220 prisoners fed largely on "white" 

 rice, whereas no cases appeared among 273 prisoners on "parboiled" rice. 

 The cessation of the outbreak in the former group followed the substitu- 

 tion of parboiled rice for white rice. Further evidence of the dietary 

 origin of the disease was furnished by the important discovery of Eijkman 

 (1897), who observed in chickens fed exclusively on white rice a disease 

 which he considered to be similar to beriberi. This observation has been 

 confirmed over and over again by numerous investigators, who also showed 

 that pigeons develop the same disease, which on account of its striking 

 nervous manifestations was called polyneuritis gcdlinarum. Deficiency 



889 



