1^0 



SCIENCE. 



[Vol. XXII. No. 552 



The meteorological station which is nearest these re- 

 sorts is called Nuniacizu; it is at sea-level, about twenty 

 miles west of the Hakone Mountains, on Sucfura Bay, 

 Pacific side of Japan. The notations for August are: 



Bar. Range. Temp. Range. Vap. Hum. Rainfall. Rainy da j'S 



757.6 12.7 25. S 7.2 20.5 S3, 187.2 23. 



The average humidity at Tokio, sea-level, for the three 

 Kakke months, June, July and August, as given in the 

 meteorological summary, is 81.6. This figure is inferior 

 to that shown by mountain resorts.-- 



It will be seen that recovery from beri-beri takes place 

 in these noted places, in spite of their excess of humidity 

 and rainfall, which makes it evident that the humidity 

 aaid rainfall of the Kaklve months, June, July and August, 

 at sea-level, in the bei'i-beri centres, cannot be a direct 

 cause of the outbreak. 



Another cause must be looked for. The history of the 

 following case shows that a high altitude is absolutely 

 necessary for a real cure of Kakke. 



A patient of mine, M. H., 23 years old, a ship builder 

 and a powerful man, by no means ancemic, a native of 

 Kochi (a city of 50,000 inhabitants, not a beri-beri centre, 

 on the sea-level, island of Shikoku), contracted beri-beri 

 iu Tokio, June, 1885. He was a patient at that time of 

 Dr. Ikeda, the emperor's physician. He was ordered to 

 the mountain, but his father insisted on his returning 

 home. He recovered and came back to Tokio in October. 

 In June, 1886, the disease reappears; this attack is 

 stronger than the last; for ten days he is unable to walk 

 at all. He has this time the attendance of Dr. Sasaki. 

 That eminent physician tells him that he must stay in the 

 inountains near Tokio, and not return home, if he wants 

 to be cured for good and all; should he go back, thinks 

 the doctor, the cure would only be temporary. The 

 patient disregards this advice, and goes again to Kochi, 

 and recovers in September, as before. He arrives again 

 in Tokio in November, spends there the winter and the 

 following spring. In May, 1887, there comes upon him 

 a third attack, not a strong one this time. As usual, he 

 retreats to his native place, and recovers in August. He 

 betakes himself to Yokohama, and in November sails for 

 San Francisco, where he sj)ends the -winter. May, 1888, 

 finds him again in Tokio, and this year he escapes beri- 

 beri. Pie stays all summer in Tokio, and all winter, and 

 in June, 1889, he has a fourth attack of beri-beri. This 

 time again he flies to Kochi, and recovers only in Octo- 

 ber. After recovery he reappears in Tokio in November, 

 and spends there the winter and the spring. In May, 

 1890, he goes back to his native jslace before the beri- 

 beri season begins, and escapes. He spends the follow- 

 ing winter in Kobe. In 1891 he returns to Kochi, and 

 spends the summer. He again is spared. (It must be 

 observed here that in Kochi, his native place, there is but 

 little charcoal used as compared with Tokio, and that the 

 city, situated at the head of a seven-miles bay, is not sur- 

 rounded by hills or fells, which might coop up the dele- 

 terious products of combustion: it was really from this 

 carbonic poisoning that he was escaping during his so- 

 journ at Kochi). The winter he spends in Tokio. In 

 April, 1892, he goes to Osaka, having heard of the im- 

 proved climatic conditions for beri-beri j)atients of that 

 place, for the purpose of getting out of the range of the 

 disease, but does not succeed. He is visited by it there 

 and recovers in September, having been only one month 

 sick this time. He sj)ends the winter in Tokio, and in 

 May comes to the United States. 



He has neglected the only remedy which can have any 

 real and lasting effect on his case; that is, in his own 



2For most of these facts, I am indebted to Trans, of the Asiatic Soc. of 

 Japan. 



country, the mountain air. He is not cured, though his 

 diet has been irreproachable, at least for years. 



Dr. Toyama, who has charge of the beri-beri hosjoital 

 at Usigomi, Tokio, has in his hospital, in the beri-beri 

 season, from 100 to 200 patients. This establishment is 

 situated on the highest ground of Tokio. A vegetable diet 

 is imposed upon the patients; they get no milk, no meat, 

 no fat fish. If they decline to remain in the hospital or 

 do not improve, he orders them to the Hakone Mountains, 

 about eighty miles southwest of Tokio, or to the hot 

 springs Mountain of Ikao at Nikko, eighty miles north of 

 the capital. 



An albuminous diet is not considered by this eminent 

 physician as of signal importance for the cure of beri- 

 beri: it is the altitude, even the moderate one of his own 

 establishment, that does it. If one high place has no 

 effect, he sends his patients to a still higher one. Does 

 this suggest, in any human mind, the idea of rice and 

 ancemia as the causes of a disease which disappears, al- 

 most at once, when the air is pure, rich in oxygen, com- 

 paratively free from carbonic emanations ? If the cure 

 takes place (and even in the Kakke season) where the 

 degree of humidity is the same as, or greater than, in the 

 beri-beri centres; and where the vegetable diet is com- 

 pulsory, neither humidity nor ancemia resulting from a 

 non-albuminous diet can be chief etiological factors of 

 beri-beri, or, to exjsress my opinion with complete frank- 

 ness, can be factors at all. 



One can hardly supp)Ose that any merit in the cure of 

 beri-beri patients can be attributed to the springs them- 

 selves around which the stricken herd gather. For why 

 do not the same mild chalybeate and sulphur compounds 

 (see Dr. Geert's analyses) operate in the same manner at 

 sea-level. Hot bathing is also out of the question, it be- 

 ing in Japan a universal, almost passionate, habit. Con- 

 sider also this fact: There are in Japan some excellent 

 arsenic springs. It is well known that arsenic is the prin- 

 cipal remedy for chloro-anoemia. Tet beri-beri patients find 

 no benefit in them. There is, at any rate, no rush there, 

 as would certainly be the case if beri-beri was an 

 ancemia. 



I have obtained, recently, sonje facts about the beri- 

 beri situation in the island of Java, and I think I will 

 append a few to this sketch : The Batavia beri-beri hos- 

 j)itals are situated at Buitenzorg, the old capital of Java. 

 They are built on very high grounds; it takes a two 

 hours ascending drive from the seaport to reach them. 

 The patients are brought thither from the sea-level. The 

 doctors in charge of these patients feed them rice and 

 curry and eggs in different forms. The patients them- 

 selves, strange to say, take exception to a meat diet. The 

 chief source of success, the doctors avow, is the climate. 



In the whole of Java, the beri-beri outbreaks are at sea- 

 level. 



One thing is made evident by these facts: the beri-beri 

 specialists, not only of Japan, but of Java, the cradle of 

 the disease, have been taught by the most persuasive of 

 all masters, long experience, that the cure of beri-beri 

 has little or nothing to do with the diet, as they feed 

 their patients even with vegetables. They seem to know 

 by instinct that the disease must disappear as the red 

 corpuscles are recreated by the ozone of the mountain 

 air. It is not, as I view the matter, the condition of the 

 red corpuscles, in itself, that causes the disease, nor does 

 their rehabilitation in itself constitute the cure. But, as 

 these red corj)uscles reacquire the faculty of carrying 

 oxygen, the carbonic toxine is eliminated, and with it the 

 very root and soul of the disease. Dr. Takaki's rice and 

 ancemia theory to the contrary notwithstanding. It is 

 the elimination of the paralj'zing element, carried by the 

 blood, which, when thus recreated, the red corpuscles are 



