1672 



BERI-BERI AND EPIDEMIC DROPSY 



Later, Tulpius, a Dutch physician, also described the symptoms of 

 the disease as seen in a person who had returned to Holland from 

 the Indies. From that time the literature on beri-beri has grown 

 until it has reached enormous proportions, but unfortunately there 

 is no doubt that until recently several diseases, especially ankylo- 

 stomiasis and epidemic dropsy, were confounded with it. Rogers 

 in 1808, and later Davy, described the disease as ' beri-beria,' while 

 the latter says that it is almost peculiar to Ceylon. There is little 

 doubt that the condition described by Davy was in reality ankylo- 

 stomiasis. 



In 1847 Carter gave a description of the disease, indicating asthma 

 as the principal feature, probably because of the cardiac dyspnoea. 

 In 1873 Fayrer laid great stress on oedema as the important clinical 

 feature. In 1877 Wernich defined the disease kakke in Japan, 

 while van Meedervoort showed that it was the same disease as 

 beri-beri. In 1886 Kynsey published an account of the anaemia or 

 beri-beri of Ceylon, by which he really meant ankylostomiasis; 

 hence the idea that beri-beri was due to Ancylostoma duodenale, 

 and hence the large number of cases of so-called beri-beri in Ceylon 

 years agcp. 



The scientific and clinical study of the disease has been largely 

 due to the work of Oudenhoven, Da Sylva Lima, Overbeck de 

 Rieyer, Baelz, Scheube, Pekelharing and Winckler, Hamilton Wright, 

 Jataki, Braddon, Fraser and Stanton. The workers on the aetiology 

 of the disease are so numerous that this part of the history is best 

 treated in the section on the causation. 



Beri-beri is in certain regions a most serious disease. Thus 

 Braddon says that in the Straits Settlements and Malaya, where 

 the population is only 1,250,000, no less than 150,000 cases of the 

 disease, with 30,000 deaths, have occurred in Government hospitals 

 and infirmaries in the last twenty years; but he says that only 

 one-third of the deaths of Chinese took place in those hospitals, and 

 therefore the total deaths in that period would be about 100,000. 

 It is also a great element in inefficiency, for it is reckoned that 

 33 per cent, of the sailors of the Japanese Navy prior to 1884 were 

 continuously disabled by it. In 1904-05 it is said that 24 per 

 cent, of the entire sick and wounded in the Japanese armies — 

 i.e., about 85,000 men — were also disabled by it. It is obvious, 

 therefore, that the disease is of great medical and economic interest, 

 for its incidence particularly falls upon the labourer, the sailor, the 

 soldier, and the prisoners in the gaols, and hence hampers both the 

 employer of labour and the Government. Braddon estimates the 

 cost of the disease to the Government of Malaya as £10,000 per 

 annum in direct hospital charges only. 



Much work has been done by Eijkman, Vordeman, Fraser, Stanton, 

 Funk, and many other observers, with the result that the consensu? 

 of opinion at the present time is that beri-beri is ^.deficiency disease 

 — i.e., is caused by the deficiency of some essential substance in 

 the dietary (t;/^^^ Chapter IV., p. 109). 



